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배성권 ( Sung Kwon Bae ),송정수 ( Jung Soo Song ),박원 ( Won Park ),오윤주 ( Yoon Ju Oh ),김성수 ( Sung Soo Kim ) 대한류마티스학회 2000 대한류마티스학회지 Vol.7 No.2
Rheumatoid arthritis is thought to be a collagen disease induced by autoimmune mechanism of unknown etiology. Idiopathic myelofibrosis is a myeloproliferative disorder in which the large majority of patients is characterized by anemia, leucoerythroblastosis, splenomegaly, and bone marrow fibrosis with a predominance of megakaryocyte. In some patients autoimmune bone marrow damage has been claimed to he involved in the pathogenesis. A 76-year-old female patient was diagnosed to have rheumatoid arthritis 30 years ago and medicated intermittently. Three months ago, she started to take hydroxychloroquine 300mg/day, prednisolone 7.5mg/day and non-steroidal antiinflammatory drug. One month ago, white blood cell (WBC) count was 5,000/μL with the neutrophil count was 3000/μL, the hemoglobin (Hb) was 4.3g/dL, the platelet count was 95,000/μL and the reticulocyte count was 0.1%. The bone marrow biopsy had revealed hopercellular marrow with increased all hematopoietic element. At this time, the WBC count was 1,600/μL and the neutrophil count was 760/μL, the Hb was 2.7g/dL, the platelet count was 11,000/μL and the reticulocyte count was 0.2%. The bone marrow aspiration resulted in dry tap and the biopsy revealed fibrosis with marked degree of reticulin fibrosis and small numbers of hematopoietic cells.
박영주,김미림,남문석,김영완,김성기,홍성빈,오윤주,김용성 대한내과학회 2001 대한내과학회지 Vol.61 No.2
Graves' disease is commonly associated with a variety of muscle abnormalities from muscle weakness, paralysis to exophthalmopathy. There are several reports of Graves disease associated with polymyositis and myasthenia gravis. It is generally uncommon that muscle enzyme is increased in patients with hyperthyroidsm without polymyositis. We report thyrotoxic myopathy presented as myalgia without muscle weakness but with increased muscle enzyme, which was improved by anti-thyroid drug. A 33 year-old man developed severe proximal myalgia and headache. The creatinine kinase level was elevated. But there was no specific finding in electromyography. Muscle biopsy showed increased number of mitochondria and decreased glycogen content. There was no inflammatory cell infiltration. Diagnosis of hyperthyroidism due to Graves' disease was made, followed by the treatment with prothiouracil 300 mg per day. Five day after the treatment, myalgia improved, and serum CPK was decreased. He never complain myalgia after thyroid function was normalized.(Korean J Med 61:173-177, 2001)
노인당뇨병에서 인슐린저항성과 프로인슐린 및 프로인슐린/총인슐린 비의 변화
박영주,김용성,김미림,남문석,홍성빈,김영완,김성기,오윤주,김여주 대한당뇨병학회 2001 Diabetes and Metabolism Journal Vol.25 No.2
Backgound: It is well known that the concentration of serum proinsulin and the ratio of proinsulin/total insulin (P/I) are elevated in type 2 diabetes. Proinsulin is produced by the ribosome in pancreatic beta cells, undergoes maturation in Golgi body and exists in the form of secretory granules. Immature granules possess disproportionately large amount of proinsulin. When there is increased demand of insulin caused by diabetes, higher level of proinsulin is secreted from immature granules of dysfunctioning beta .cells. Thus, the elevated concentration of proinsulin and the increased ratio of P/I are considered to be the markers of pancreatic dysfunction and predictors for the future. development of diabetes. The elderly-onset type 2 diabetes is also thought to develop due to both dysfunction of insulin secretion by impaired beta cell with aging and increased insulin resistance in peripheral tissue due to less muscle mass and more fat. However, it is still controversial as to' which mechanism is predominant in the development of type 2 diabetes. Methods: We measured the levels of fasting blood glucose, serum proinsulin and specific human insulin by using radioimmunoassay kit, and calculated the P/I ratio and insulin sensitivity index in normal adults (40≤age$lt;60, n=67), normal elderlies (age≥60, n=35) and also in the newly-diagnosed elderly type 2 diabetes (age≥ 60, n=24). Results: The concentration of serum proinsulin and the ratio of P/I in normal adults over age 40 were 7.70±6.08 pmol/L and 0.13±0.10, respectively. The concentration of proinsulin in the normal adult, normal elderly and elderly diabetes group were 6.50±3.71, 11.17±8.30 and 16.75±11.68 pmol/L. The differences among three groups were statistically significant(p= 0.0001). The P/I ratios for each of the three groups were 0.11 ±0.05, 0.17±0.12 and 0.16±0.08 (p=0.0004). P/I ratios in the elderly control and elderly diabetes were higher than that of the normal adult group. Insulin sensitivity index (ISI, 10,000/(basal glucose x basal insulin)) of elderly diabetes (1.19±0.89) was lower when compared with the indices of other groups (40≤ age $lt;60 adult control; 2.53±1.34 and elderly age≥60 control; 2.27±1.11, p=0.0001). Conclusion: Although the age-related reduction of pancreatic insulin secretory function attributes to the pathogenesis of old-age onset type 2 diabetes, it appears that the decreased insulin sensitivity may serve as more important factor in the development of the disease.
호르몬 치환요법으로 호전된 쉬한증후군에 의한 Pancytopenia 1 예
박영주,김용성,김미림,남문석,홍성빈,김성기,오윤주,김영완 대한내분비학회 2000 Endocrinology and metabolism Vol.15 No.4
Postpartum ischemic necrosis of the pituitary gland, known as Sheehan`s syndrome, is well-established clinical entity. In anterior pituitary insufficiency, there is very often a normochromic or hypochromic anemia but pancytopenia secondary to the hypopituitarism is less common. We report a case of pancytopenia due to complete aplasia of the bone marrow associated with Sheehan`s syndrome, in which hormone replacement therapy alone produced full hematological recovery (J Kor Soc Endocrinol 15:595-599, 2000).
면역 혈소판감소성 자반증이 동반된 후복막강 섬유증 1예
최승원,송정수,우제홍,박원,배성권,오윤주,허윤석 대한내과학회 1999 대한내과학회지 Vol.56 No.6
Retroperitoneal fibrosis is a slowly progressing syndrome that is a part of a systemic fibrosing disease. Most causes are idiopathic, whereas the remainder are associated with methysergide ingestion, malignancy, or aneurysm of abdominal aorta. The pathogenesis is unclear, but the evidences supporting systemic autoimmune process are present, i.e. the apprearance of autoimmune antibodies, especially antinuclear antibody, positive direct or indirect Coombs' test, and the association with immune thrombocytopenia. Effective treatment with corticosteroid is another suggestion of autoimmune nature of this disease. We experienced a case of retroperitoneal fibrosis with immune thrombocytopenic purpura and positive antinuclear antibody. A 44-years old man who was in splenectomy state due to immune thrombocytopenic purpura for 15 years visited us for obstructive uropathy caused by retroperitoneal fibrosis. He was treated with double J catheter insertion in both ureters, and oral medication of corticosteroid and tamoxifen. Renal failure and thrombocytopenia was improved after treatment and the retroperitoneal fibrotic mass size decreased.
아미노산 수액의 신속한 정맥내 주사 후 담낭 수축에 관한 연구
김미영,김영수,최원,장재남,김명식,김인한,신용운,권계숙,이돈행,오윤주,김형길,이재수,김범수,조현근 대한소화기학회 1999 대한소화기학회지 Vol.33 No.1
Background/Aims: Gallbladder (GB) sludges and/or gallstones frequently develop due to hypomotility of GB after long-term total parenteral nutrition, abdominal surgery, bone marrow transplantatation, AIDS infection, trauma. The purpose of this study is to promote GB contraction and emptying with the rapid intravenous infusion of aminoacids and then, to determine the most effective dosage and infusion rate. Methods: After infusion of aminoacids, the volume of GB was measured serially using ultrasonography before infusion and immediately (0 min), 15 min, 30 min, 45 min and 60 min after infusion. The subjects of this study were 28 healthy male volunteers aged from 23 to 26. For control group (n=4), 250 cc of normal saline was infused for 30 min. For group A (n=8), 250 cc of aminoacids solution was infused for 30 min (21.2 g, 0.7 g/min). For group B (n=8), 250 cc of aminoacids solution was infused for 10 min (21.2 g, 2.1 g/mn). For group C (n=8), 125 cc of aminoacids solution was infused for 5 min (10.6 g, 2.1 g/min). Results: The volume of GB was significantly decreased with the lapse of time in A, B, C groups and the most significant change occurred at 45 min after infusion (p=0.0001). These groups showed significant volume change com pared to control group (p=0.0029). At 15 min after infusion, significant GB contraction occurred in group B, C compared to control group (p=0.0030). Only B group showed significant GB contraction at 45 min after infusion (p=0.0041). Conclusions: It is concluded that the intermittent rapid intravenous minoacids infusion may be useful to prevent GB sludges in the high risk groups. (Kor J Gastroenterol 1999;33:90 - 96)