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      • HMG-CoA 환원효소 억제제에 의한 ICAM-1 유전자의 발현조절

        김현진,정효균,홍우정,김군순,조영석,김도희,채수흥,구본정,송민호,노흥규,김영건 충남대학교 의과대학 지역사회의학연구소 2001 충남의대잡지 Vol.28 No.1

        Background : ICAM-1 act as one of major adhesion molecules in the atherosclerotic lesion. ICAM-1 expression is mainly regulated at the level of transcription and depend on IFN-γ signal transduction pathway in which the STAT1 transcrption factor is a critical intermediate. IFN-γreceptor not only initiates tyrosine 701 phosphorylation of STAT1 by Jak1 and Jak2, but also phosphorylates serine 727 through the activation of Raf-1/MAP kinases. HMG-CoA reductase inhibitors have anti-atherosclertic effects, beyond normalization of hypercholesterolemia, by directly acting on endothelial cells, macrophages and vascular smooth muscle cells. HMG-CoA reductase inhibitors suppress the synthesis of isoprenoid intermediates such as geranylgeranyl-pyrophosphate or farnesylpyrophosphate. These effects results inhibitors suppress the synthesis of isoprenoid intermediates such as geranylgeranyl-pyrophosphate or farnesylpyrophosphate. These effects results inhibition posttranslational farnesylation and geranyl-geranylation processing of small GTP-binding preoteins and inhibition of normal signaling activities. Method : We made several 5'-deletion constructs of rat ICAM-1 promoter and analyzed the promoter activities by measuring the luciferase activity after transfection into ECV304 cells and smooth muscle cells. We checked the level of total and phosphorylated STAT1 protein by immunoblot analysis using specific antibodies. Results : Lovastatin inhibits IFN-γ-induced ICAM-1 gene expression in the ECV304cell. The cells pretreated with PD98059, MEKK inhibitor showed significantly low ICAM-1 RNA induction with IFN-γ stimulatio. IFN-γ induced phosphorylation of tyrosine 701 was not significantly changed by the pretreatment of lovastatin. But lovastatin suppresses IFN-γ-induced phosphorylation of ERK1/ERK2 which are responsible for the seine 727 phosphorylation in STAT1. Conclusion : We showed that HMG-CoA reductase inhibitors, lovastatin, suppresses IFN-γ mediated ICAM-1 gene expression through the inhibition of transcription. HMG-CoA reductase inhibitor suppresses IFN-γ-induced phosphorylation of serine 727 in STAT1 through the modulation of MAP kinases.

      • 부신 결핵에 의한 Addison씨병 1예

        송치운,구본정,안봉수,전준식,안미애,이진홍,송민호,김영건,노흥규 충남대학교 의과대학 지역사회의학연구소 1995 충남의대잡지 Vol.22 No.2

        Addison's disease is a rare primary adrenal insufficient disorder resulting from chronic deficiency of adrenal cortical hormones. Clinical manefestations are generalized weakenss, weight loss, hyperpigmentation (especially sun exposed area and mucous membrane), hypotension, hyponatremia, hyperkalemia, gastrointestinal symptoms (involving anorexia, nausea, vomiting, abdominal pain). A 34-year-old woman has experienced slowly progressive generalized weakenss and skin pigmentation, anorexia, nausea, vomiting with ascites and diffuse abdominal pain. On the time of admission, her main clinical manifestations were anorexia, nausea, vomiting, fatigue, generalized weakness, amenorrhea, hair loss, diffuse abdominal pain revealed as Addison's disease due to bilateral adrenal tuberculosis. Her adrenal insufficient symptoms were recovered with the replacement of adrenocortical hormones and antituberculous medications. After treatment, Her skin pigmentation was decreased and menstruation was reappeared. Here we experienced one cases of Addison's disease with tuberculous peritonitis.

      • 천추 갈색종양(Brown tumor)으로 발현된 부갑상선 기능항진증 1예

        홍우정,구본정,이재민,한상우,이효진,나소영,노흥규,김영건,송민호 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

        부갑상선 기능항진증에 의한 골병변으로 갈색종양이 있다. 갈색종양은 주로 장골을 침범하고 척추골에서의 발생은 매우 드물다. 국내의 보고에서 갈색종양의 장골 침범은 있었으나, 척추골에서의 발생은 보고된바 없다 .저자들은 부갑상선 기능항진증으로 인하여 척추골의 천추에 발생된 갈색종양 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. The bony involvement in primary hyperparathyroidism present as browm tumor or osteitis fibrosa cystica and lead to pathologic fracture. Brown tumor commonly involve long bone such as femur, tibia, fibula, humerus, and radius. Brown tumor of axial skeleton is a rare entity. Previously reported case that involve axial skeleton still not present. We report a 47-year-old male patient that he has a hyperparathyroidism presenting as brown tumor involving sacrum.

      • 당뇨병의 급성 대사성 합병증에 대한 임상적 고찰(Ⅲ)

        김영건,구본정,박소영,김윤,원진호,송민호 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.1

        We observed clinical features in 26 patients with acute metabolic complications of diabetes mellitus, diabetic ketoacidosis 21 cases and hyperosmolar nonketotic coma 5 cases who were diagnosed and treated in chungnam National University Hospital from January 1993 to December 1993. The overall incidence of diabetic inpatients with acute metabolic complications were 2.6 percent. The mean age of the diabetic patients with acute metabolic complications was 48.0 year-old. The durations of the diabetic patients with acute metabolic complications were 5.9 years and only 4(15.1 percent) out of the 26 patients with acute metabolic complications were presented as a initial manifestations of diabetes mellitus. Gastrointestinal symptoms were the most common complaints in the patients with diabetic ketoacidosis and altered consciousness was in the patients hyperosmolar nonketotic coma. Dehydration was the most common physical findings in both groups of patients with diabetic ketoacidosis and hyperosmolar nonketotic coma. Omission of the insulin therapy and infections were the most mommon precitipation factors for the development of diabetic ketoacidosis and hyperosmolar nonketotic coma, respectively. The mortality rates of the patients with diabetic ketoacidosis and hyperosmolar nonketotic coma were 7.7 percent and 20 percent, respectively.

      • 폐경후 골다공증 환자에서 체질량지수에 따른 Alendronate의 효과

        조영석,나소영,이효진,홍우정,김군순,김도희,구본정,송민호,김영건,노흥규 충남대학교 의과대학 의학연구소 2002 충남의대잡지 Vol.29 No.2

        배경 : 폐경후 골다공증은 심각한 문제로 대두되고 있다. 현재 Alendronate는 폐경후 골다공증의 치료제로서 널리 쓰이고 있다. 저자는 Alendronate의 골밀도에 효과를 알아보고 골다공증의 위험인자에 따른 Alendronate의 반응 정도를 평가하기 위하여 본 연구를 수행하였다. 방법 : Alendronate를 평균 12개월간 복용한 35명의 폐경후 골다공증환자에서 체질량지수와 폐경후 기간에 따른 치료효과를 조사하였다. 결과 : 전체 대상군에서 Alendronate 10㎎을 12개월간 투여한후 골밀도의 평균 변화율은 요추와 대퇴골 경부에서 각각 7.83±7.39%와 2.99±9.22%이었다. 과체중군에서 평균변화율은 요추와 대퇴골 경부에서 각각 7.15±4.5%와 3.05±2.86%였다. 양군간에 통계적 유의성이 있는 차이는 없었다. 폐경후 7년이 경과되지 않은 군에서의 평균변화율은 요추와 대퇴골 경부에서 각각 6.9±5.3%와 5.71±0.08%였다. 양군간에 통계적인 유의성이 있는 차이는 없었다. 결론 : 마른체형이 골다공증의 발병에는 영향이 있으나, Alendronate 치료효과의 차이는 없는 것을 확인할 수 있었다. 더불어 폐경이 있고 7년이 초과된 군과 년이 경과되지 않은 군에서의 Alendronate 치료효과의 차이는 없는 것을 확인할수 있었다. 이는 골흡수가 상당히 진행된 상태에서도 Alendronate가 치료효과를 가지고 있음을 반영한다고 할 수 있겠다. Postmenopausal osteoporosis is a serious health problem. The aminophosphonate Alendronate is widely used for treatment of postmenopausal osteoporosis. We studied the effect of l0㎎ of alendronate given daily for mean 12 months on bone mineral density in 35 women(mean age 61yrs. mean BMI 23.24㎏/m^(2)) with osteoporosis. An over weight group is defined such that BMI was above 23㎏/m^(2). All the women received 1500㎎ calcium carbonate daily. The bone mineral density of L-spine and femoral neck was measured by dual-energy X-ray absorptiometry. Alendronate increased BMD at mean 12 months at the L-spine (7.15±4.5%) and femoral neck(3.05±2.86%) in normal women. Alendronate increased bone mineral density at 12 months at the L-spine(6.00±5.3%) and femoral neck(4.17±4.87%) in overweight women. There was no difference between two groups. In the less than 7 years group of postmenopausal duration. alendronate increased bone mineral density at 12 months at the L-spine(6.9±4.9%) and femoral neck(3.18±7.1%). In the more than 7 years group of postmenopausal duration, alendronate increased hone mineral density at 1% months at the L-spine(6.5±5.3%) and femoral neck(5.71±0.08%). There was no difference between two groups. In postmenopausal women with osteoporosis, therapy with alendronate produced significant increases in BMD of the L-spine and femoral neck in both group. There was no difference between normal and over-weight groups. and between less than 7 years group and more than 7 years group of postmenopausal duration.

      • 양성 갑상선 결절에서의 무수 알코올 치료 효과

        김도희,나소영,이효진,홍우정,김군순,조영석,구본정,송민호,김영건,노흥규 충남대학교 의과대학 의학연구소 2002 충남의대잡지 Vol.29 No.1

        목적 : 양성 갑상선 결절 환자에서의 PEI의 치료효과 및 부작용을 알아보고자 하였다. 방법 : 양성 갑상선 결절 환자 88명을 대상으로 초음파 소견에 따라 낭종성 결절, 복합성 결절, 고형성 결절 등 세 그룹으로 분류후 전체 및 각각에 대한 PEI의 치료효과 및 부작용을 조사하였다. 결과 : 양성 갑상선 결절 환자 88명을 PEI로 치료후 결절의 크기가 50%이상 감소한 경우는 전체 환자중 77.2%이었고 각 결절별로 살펴보면 고형성 결절에서 52.6%, 복합성 결절에서 72.4%, 낭종성 결절은 92.5%이었다. 부작용은 동통, 결절내 출혈, 감염, 결절의 누출등이 있었으나 대부분 무증상이었다. 결론 : PEI는 양성 갑상선 결절 환자증 적응증을 잘 살펴 고려해 볼 수 있는 치료법이라 생각되며 특히 낭종성 결절 환자에서 주사기에 의한 흡인후에 재발한 경우 일차적인 치료로 PEI를 고려해 볼 수 있겠다. Ultrasonography(US)-guided percutaneous ethanol injection (PEI) has been performed for the treatment of autonomous functioning thyroid nodules, thyroid cysts, & cold thyroid nodules. The author studied the efficacy of PEI in the treatment of benign cold thyroid nodules both solid and cystic (complex & pure). Eighty-eight euthyroid outpatients (age:44.2±13.9years, 75 women and 13 men) with benign cold thyroid nodules or simple thyroid cysts (69 with a single nodule and 19 with a prominent nodule within multinodular goiter) were includied in this study. After PEI, each subtype of thyroid nodules was divided into three groups in according to volume reduction complete response (90% or more of volume reduction), partial response (50% or more of reducton but below 90%), and failure (below 50% or increase in size) group. Overall response rates of PEI for benign thyroid nodules were complete 45(51.1%), partial 23(26.1%), failure 20(22.7%). In 20 cold solid nodules, complete response was observed in 6(30.0%), partial response in 5(25.0%), and failure in 9(45.0%). In 28 complex cysts, complete response was observed in 8(28.6%), partial response in 12 (42.9%), and failure in 8(28.6%). In 40 pure cysts, complete response was observed in 31(77.5%), partial response in 6 (15.0%), and failure in 3 (7.5%). Side effects comprised pain 8 (9.2%), intranodular bleeding 13 (14.6%), extracapsular leakage 1(1.1%), infection 1 (1.1%), increased size l(1.1%), and none 64(72.7%). PEI may prove a safe & effective tool for the therapy of cold thyroid nodules in selected cases and may be the treatment of choice of recurrent thyroid cysts. However, further investigation involving a larger number of patients and a longer follow-up is needed.

      • 인슐린 비의존형 당뇨병에 합병된 관상동맥질환의 임상소견과 관상동맥 조영 소견에 대한 고찰

        구본정,안봉수,정진옥,성인환,전은석,송민호,노흥규,김영건 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.1

        Diabetes mellitus has a major impact on cardiac morbidity and mortality. We analyzed the clinical characteristics and coronary angiographic finding in patients with a coronary artery disease and with noninsulin dependent diabetes mellitus We retrospectively reviewed the clinical and coronary angiographic findings in 74 patients with noninsulin dependent diabetes millitus and in 328 non-diabetic patients who a coronary insufficiency. Significant coronary occlusions and multiple coronary artery diseases were more common in diabetics than in non-diabetics. The patients with noninsulin dependent diabetes mellitus has several limiting factors to perform the successful percutaneous coronary angioplasty, it could bo a possible factor of rapid deterioration of coronary insufficiency in patients with diabetes mellitus. Smoking, hypertension significantly increased the incidence of significant coronary occlusions whereas obesity and hypercholesterolemia did not any significant influence on incidence of the significant coronary occlusions. The longer duration of diabetes mellitus associated with higher incidence of significant coronary occlusions and multiple coronary diseases. Significant coronary occlusions and multiple coronary artery diseases were occurred more common in diabetics than in non-diabetics. However, the patients with noninsulin dependent diabetes mellitus has several limiting factors to perform the successful percutaneous coronary angiolasty. Hypertension and smoking significantly increased the incidence of significant coronary occlusions.

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