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그레이브스 병에서 항갑상성제 투여중 발생한 갑상성기능저하증의 치료
송기호(Ki Ho Song),김병수(Byung Su Kim),장상아(Sang A Jang),안유배(Yu Bae Ahn),한제호(Je Ho Han),유순집(Soon Jip Yoo),이종민(Jong Min Lee),손현식(Hyun Sik Son),윤건호(Kun Ho Yoon),감무일(Moo Il Kang),차봉연(Bong Yun Cha),이광우(Kwang Wo 대한내과학회 1996 대한내과학회지 Vol.51 No.3
N/A Objectives : Antithyroid drug is highly effective and safe in the treatment of Graves` disease. However, some patients may be rendered hypothyroid by large dosage of andithyroid drug : at this point reduction of dosage is common but often difficult to quantitate. Alternatively, combination therapy of antithyroid drug with L-thyroxine is often used, but there are few reports on its long-term effectiveness. Methods : 43 patients with Graves` disease who developed hypothyroidism during methimazole treatment were studied. They received combination therapy of 100mg methimazole with 50 ㎍(group 1, n=16) or 100 ㎍(group 2, n=27) L-thyroxine per day. Hypothyroidism was defined as elevation of seruum thyroid-stimulating hormone (TSH) concentrations above normal ranges. Results : 1) Hypothyroidism occurred within 5.8±3.7(mean ± SD) months after methimazole treatment and mean doses of methimazole were 22,1±8.4mg per day. 2) Serum total thyroxine concentrations increased significantly from 3.7±2,4㎍/dl in the hypothyroid stage to 9.4+3.0 ㎍/dl after 2 months of combination therapy(p<0.0001). 3) Serum TSH concentrations decreased significantly from 34.1+30.6μU/ml in the hypothyroid stage to 3.4+5.2 μU/ml after 2 months of combination therapy(p<0.0001). 4) After 6 months of combination therapy, 74.2Yo of patients became euthyroid. 5) There was no significant difference in the frequency of euthyroid patients after combination therapy betwen group 1 and group 2. Conclusion: These results suggest that long- term combination therapy of antithyroid drug with L-thyroxine in small fixed doses could be effective and convenient to maintain euthyroidism in patients with Graves' disease who developed hypothyroidism during antithyroid drug treatment.
증례 : 내분비 ; PET-CT에서 우연히 발견된 비기능성 뇌하수체 거대선종 1예
송윤미 ( Youn Mi Song ),임동준 ( Dong Jun Lim ),문성대 ( Sung Dae Moon ),한제호 ( Je Ho Han ),한치화 ( Chi Wha Han ),김성훈 ( Sung Hoon Kim ) 대한내과학회 2009 대한내과학회지 Vol.76 No.3
FDG-PET은 많은 종류의 암에서 질병의 범위를 판정하거나, 치료효과 판정 및 재발병소 진단에 유용한 영상기법이다. FDG-PET을 시행하여 뇌하수체 부위에 우연히 섭취가 증가된 소견이 있을 경우 추가적인 영상 검사와 내분비 기능 검사를 시행하여 기능성 또는 비기능성 종양 여부를 결정하고 적절한 치료를 시행해야 한다. 저자들은 우연히 FDG-PET에서 발견되어 확진 검사 후 비기능성 뇌하수체 선종으로 진단한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Whole-body positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose (18F-FDG) is a tomographic imaging technique that uses a radiolabeled analog of glucose, 18F-FDG, to image relative glucose uptake rates in various tissues. Since the glucose uptake is increased in many malignancies, 18F-FDG PET is a sensitive method for detecting, staging, and monitoring the effects of therapy on many malignancies. However, it is uncommon to discover an asymptomatic non-functioning pituitary tumor unexpectedly as a hypermetabolic lesion in PET studies. Here, we report a pituitary tumor that was detected incidentally by FDG-PET and ultimately turned out to be a non-functioning pituitary macroadenoma. (Korean J Med 76:374-379, 2009)
강무일(Moo Il Kang),이만영(Man Young Lee),한제호(Je Ho Han),손현식(Hyun Sik Son),윤건호(Kun Ho Yoon),홍관수(Kwan Soo Hong),차봉연(Bong Yun Cha),이광우(Kwang Woo Lee),손호영(Ho Young Son),강성구(Seung Ku Kang) 대한내과학회 1994 대한내과학회지 Vol.47 No.1
N/A Objectives: Amiodarone, a benzofuranic derivative containing 37. 2% iodine, is widely used for the long- term treatment of cardiac arrhythmias. It affects the peripheral metabolism of the thyroid hormones, and may induce hyperthyroidism and hypothyroidism. We performed this study to evaluate the effects of amiodarone on thyroid function. Methods: To evaluate the effects of amiodarone, antiarrhythmic drug, on thyroid function, we performed cross-sectional study in 30 patients (18 men and 12 women; mean age 61, 2 yr). All had a variety of cardiac diseases (ventricular tachycardia, supraventricular tachycardia, angina pectoris, cardiomyopathy) and taking long term amiodarone therapy (maintenance dose 200 mg; mean duration of treatment 18. 9 months). Thyroid status was assessed by clinical examination and thyroid function test (T3, T4, rT3, TSH, TRH test). Thyroid antimicrosomal antibody was measured using indirect agglutination method. All the tests were perfonned at the time of study only. Results: 1) Among 30 amiodarone treated patients, 3 were hyperthyroid and 1 was hypothyroid. So the incidence of amiodarone induced thyroid dysfunction was 13.3%(4/ 30). Including subclinical thyroid dysfunction, overall rate of thyroid dysfunction was 36.6%(11/30). 2) Antimicrosomal antibody was positive in 21,7% Sf patients (5/23). 3) Goiter was observed in 30%(9/30) of amiodarone treated patients and 63.6%(7/11) of patients with amiodarone induced thyroid dysfunction. 4) After TRH test in eleven euthyroid patients, 54,5% (6/11) showed abnormal response. 5) Between normal and abnormal responders in TRH test, there was no aignifieant difference in age and duration of amiodarone treatment (p>0,05). 6) In patients with thyroid dysfunction, duration of amiodarone treatment was significantly longer than euthyroid patients (p<0.02), but there was no significant difference in age between two groups (p>0.05), Conclusion: There results suggest that the incidence of thyroid dysfunction in amiadarone treated patients is high and further prospective study will be needed for more detailed information
수술적 치료를 받은 갑상선질환의 임상적 고찰 - 1988 년부터 1992 년까지 갑상선 수술의 경향 -
김형근(Hyung Keun Kim),문성대(Sung Dae Moon),장상아(Sang Ah Chang),안유배(Yoo Bae Ahn),송기호(Ki Ho Song),한제호(Je Ho Han),유순집(Soon Jip Yoo),이종민(Jong Min Lee),손현식(Hyun Sik Son),윤건호(Kun Ho Yoon),강무일(Moo Il Kang),차봉연(Bo 대한내과학회 1998 대한내과학회지 Vol.55 No.6
N/A Objectives: The thyroid disease is the common form of endocrine diseases, which often requires surgical management. Recently, fine needle aspiration biopsy is widely used preoperatively. As a result, some studies show that numbers of thyroid operation have decreased significantly. We performed this study to analyze the clinical features of thyroid diseases and the trend of thyroid operation in Korea. Methods: We reviewed medical records of 1787 cases with thyroid diseases who were managed surgically in Catholic Medical Center, Korea from 1988 to 1992. Results: 1) The percentage of thyroid diseases in total cases undergoing operation in Department of General Surgery was 3%, which tended to decrease with time. 2) 72.9% of thyroid diseases was benign. Among them, the frequency of nodular hyperplasia and follicular adenoma were 67.5% and 18.4%, respectively. 3) The percentage of thyroid cancers in thyroid diseases was 27.1%, which tended to increase with time. The frequency of papillary adenocarcinoma was 78.6%, follicular adenocarcinoma 18.2% and medullary carcinoma 1.5%. 4) Thyroid cancers were most commonly found in the forty and sixty decades. Male: female ratio was 1:8.5. 5) 7.6% of thyroid cancers was accompanied by benign thyroid diseases which were mostly nodular hyperplasia and follicular adenoma. 6) The most common type of operation was lobectomy(82.5%) in benign thyroid diseases, and total thyroidectomy(47.1%) and lobectomy(41.1%) in thyroid cancers. 7) Fine needle aspiration biopsy was performed in 51.7% of thyroid nodules, the frequency of which tended to increase with time. The sensitivity, specificity, false negative rate and false positive rate of this test were 78.3%, 89.4%, 13.7% and 17.2%, respectively. Conclusion: With the use of fine needle aspiration biopsy, numbers of thyroid operation decreased and the percentage of thyroid cancers in thyroid operation increased.
제1형 당뇨병 쥐 모델에서 유전공학적 제조 K-세포 이식을 통한 당뇨병의 치료
심주연 ( Ju Yeon Sim ),김주희 ( Ju Hee Kim ),안유배 ( Yu Bae Ahn ),송기호 ( Ki Ho Song ),한제호 ( Je Ho Han ),차봉연 ( Bong Yun Cha ),이숙경 ( Sook Kyung Lee ),문성대 ( Sung Dae Moon ) 대한당뇨병학회 2009 Diabetes and Metabolism Journal Vol.33 No.6
연구배경: 인슐린 유전자 치료법의 이상적인 표적세포로 K-세포가 알려져 있다. 이전 연구에서 본 연구자들은 EBV-유래 에피솜 벡터를 이용하여 K-세포에서 포도당농도 의존적인 인슐린 분비가 이루어지는 것을 실험실 환경에서 확인한 바 있다. 본 연구에서는 스트렙토조토신(STZ)으로 유발된 제1형 당뇨병 쥐의 신장 피막에 유전공학적으로 제조된 K-세포를 이식하여 당뇨병이 치료되는지를 관찰해 보았다. 방법: 인슐린이 분비되도록 제조된 K-세포를 STZ으로 유도된 BALB/c Nude 마우스의 신장 피막에 이식한 후 혈당과 몸무게를 측정하였다. 마우스는 정상군과 STZ으로 유도된 당뇨병군 그리고 당뇨병군의 일부는 K-세포를 이식한 치료군 등으로 분류하여 실험을 하였다. 이식 4주 후 모든 마우스에서 6시간 동안 금식한 후 2 g/kg의 포도당을 복강내로 주사하여 당내성검사를 하였다. 당내성검사가 끝나자마자 모든 마우스의 신장과 췌장을 적출하여 인슐린, 글루카곤, C-peptide 등으로 면역조직화학염색 및 면역형광염색을 한 후 그 결과를 분석하였다. 결과: STZ을 복강에 주사한 마우스는 주사 3일 후 혈당이 300±50 mg/dL로 상승하였다. 정상군과 K-세포를 이식한 당뇨병군에서는 몸무게가 점차 증가하였으나, STZ만을 주사한 당뇨병군에서는 실험기간 동안 낮게 유지되었다. 그리고 정상군에서는 정상범위의 혈당분포를 유지하였으나, STZ만을 주사한 당뇨병군에서는 지속적으로 혈당이 높게 유지되었다. 그리고 K-세포를 이식한 당뇨병군에서는 STZ만을 주사한 군에서보다 혈당이 서서히 떨어졌으며 이식 2주 후부터는 급격히 감소하였다. 당부하검사 결과 정상군과 K-세포를 이식한 당뇨병군에서는 서로 유사한 내당력을 보였으나 STZ만을 주사한 군에서는 지속적으로 포도당 불내성을 보였다. 조직면역검사 결과 정상군의 췌장에서는 인슐린과 글루카곤, C-peptide 모두에 염색이 되었지만 STZ만을 주사한 마우스의 췌장에서는 췌도파괴로 인슐린은 물론 글루카곤, C-peptide 모두에 염색이 되지 않았다. 그러나, K-세포를 이식한 당뇨병군의 신장에서는 면역조직화학염색에서 인슐린과 C-peptide 모두에서 염색이 되었으며 면역형 광염색에서도 인슐린이 발현하는 것을 관찰할 수 있었다. 결론: 유전공학적으로 제조된 K-세포가 마우스 신장 피막에 착상되어 혈당농도 의존적으로 인슐린을 분비하여 당뇨병이 치료되는 것을 생체 내에서도 확인할 수 있었으며, EBV-유래 에피솜벡터를 이용한 유전공학적 조제 K-세포는 제1형 당뇨병의 치료를 위한 대체베타세포로 사용될 수 있을 것으로 생각된다. Background: K-cells function as targets for insulin gene therapy. In a previous study, we constructed EBV-based plasmids expressing rat preproinsulin controlled by glucose-dependent insulinotropic polypeptide promoters. In the present study, we attempted to correct hyperglycemia in vivo using genetically engineered K-cells in a mouse model of type 1 diabetes. Methods: K-cells expressing insulin were transplanted under the kidney capsules of STZ-induced diabetic mice. The blood glucose levels and body weights of the experimental animals were measured daily. After four weeks, the mice were injected intra-peritoneally with 2 g/kg glucose following a 6 hr fast. Blood glucose levels were measured immediately following glucose injections. All animals were sacrificed at the end of the glucose tolerance study, and pancreas and graft-bearing kidney tissue samples were stained with antibodies against insulin, glucagon, and C-peptide. Results: The body weights of K-cell-transplanted diabetic mice increased after transplantation, whereas those of untreated diabetic control mice continued to decline. The blood glucose levels of K-cell-transplanted diabetic mice decreased gradually during the two weeks following transplantation. After intra-peritoneal injection of glucose into K-cell-transplanted diabetic mice, blood glucose levels increased at 30 minutes, and were restored to the normal range between 60 and 90 minutes, while untreated control diabetic mice continued to experience hyperglycemia. Kidney capsules containing transplanted K-cells were removed, and sections were stained with anti-insulin antibodies. We detected insulin-positive cells in the kidney capsules of K-cell-transplanted diabetic mice, but not in untreated control mice. Conclusion: We detected glucose-dependent insulin secretion in genetically engineered K-cells in a mouse model of type 1 diabetes. Our results suggest that genetically modified insulin producing K-cells may act as surrogate β-cells to effectively treat type 1 diabetes. (Korean Diabetes J 33:466-474, 2009)
증례 : 내분비-대사 ; 제1형 신경섬유종증 가족에서 발견된 NF1 유전자 변이와 임상양상
정연정 ( Yeon Jeong Jeong ),서유림 ( Yoo Rim Seo ),최규은 ( Kyu Eun Choi ),한유민 ( Yu Min Han ),김은숙 ( Eun Sook Kim ),문성대 ( Sung Dae Moon ),한제호 ( Je Ho Han ) 대한내과학회 2016 대한내과학회지 Vol.90 No.5
With an incidence of 1 per 2,500-3,000 individuals, neurofibromatosis type 1 (NF1) is the most common autosomal dominant disorder in humans. NF1 is caused by germline mutations of the NF1 gene, but to date genotype-phenotype analyses have indicated no clear relationship between specific gene mutations and the clinical features of this disease, even among family members with the same mutation. The present study describes a case of two siblings with NF1 with the same genetic mutation but different clinical manifestations. The first patient was a female with iris Lisch nodules, an adrenal incidentaloma, Graves’ disease, and skin manifestations, while the second patient, the first patient’s younger brother, exhibited only skin neurofibromas and freckling. Further study is needed to reveal the molecular processes underlying gene expression and phenotypes. A better understanding of the genetics associated with NF1 will allow clinicians to detect complications earlier and provide better genetic counseling to NF1 families. (Korean J Med 2016;90:455-459)
복강경 생검으로 확진된 활동성 부신 결핵에 의한 Addison씨 병 1예
이자영 ( Ja Young Lee ),김지희 ( Jee Hee Kim ),임동준 ( Dong Joon Lim ),문성대 ( Sung Dae Moon ),한제호 ( Je Ho Han ) 대한내과학회 2008 대한내과학회지 Vol.75 No.6
본 증례는 과거력, 가족력에서 결핵의 증거가 없고 단순 흉부, 복부 방사선 검사에서도 결핵의 증거가 없었으나 복부 전산화 단층 촬영 결과 양쪽 부신 비대, 부신 및 림프절의 석회화와 항부신항체 검사 음성 등으로 부신 결핵에 의한 Addison씨 병이 의심되었으나, 결핵 이외의 원인에 의한 Addison씨 병을 감별하기 위해 복강경을 이용한 부신 조직생검을 통해 활동성 결핵에 의한 Addison씨 병을 확진하고, 부신 스테로이드제 및 항결핵제를 투여하여 증상이 호전된 예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Addison`s disease is a rare disorder that is characterized by primary adrenal hypofunction and the underlying causes are various according to geographic regions. In order to establish an appropriate therapeutic regimen to treat adrenal insufficiency associated with Addison`s disease, knowledge of the underlying adrenal abnormality is essential. We report a case of a 37-year-old man who showed biochemical evidence of adrenocortical insufficiency without signs of tuberculosis. Computed tomography showed bilateral adrenal enlargement and definitive diagnosis of adrenal tuberculosis was established by laparoscopic biopsy. (Korean J Med 75:704-708, 2008)