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The High Proportion of Painless Thyroiditis as a Cause of Thyrotoxicosis in Korea
모상일,류아정,김여주,김상진 대한갑상선학회 2015 International Journal of Thyroidology Vol.8 No.1
Background and Objectives: The most common cause of thyrotoxicosis is Graves’ disease (GD), while painless thyroiditis (PT) comes in second. In Korea, the treatment of choice for GD is antithyroid drugs (ATDs). Since most cases of PT spontaneously improve, an accurate diagnosis is very important for the proper management of patients presenting with thyrotoxicosis. Materials and Methods: Ninety-nine thyrotoxic patients were routinely checked with 99m Technetium (99mTc) thyroid scan except in pregnant or lactating women. We assessed the patients’ clinical characteristics, serum levels of free T4 (FT4), thyroid stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TGAb), thyrotropin-binding inhibitory immunoglobulin (TBII), and findings of 99mTc thyroid scan. Results: Among the 99 thyrotoxic patients, 69 were diagnosed with GD and 30 had PT. All of the patients with GD, diagnosed by scan, improved clinically and the thyroid hormone returned to normal with ATDs. All patients with PT improved spontaneously without ATDs. TPOAb and TGAb were positive in 13 (43.3%) and 20 (66.7%) patients with PT, respectively. TPOAb and TGAb were positive in 45 (65.2%) and 44 (63.8%) patients with GD, respectively. TBII was positive in only 73.5% of GD, and was entirely negative in the PT group. Mean FT4 level in GD was higher than in PT, but some patients with PT showed the highest level of FT4. Conclusion: PT accounted for a very high proportion of thyrotoxicosis in this study. All parameters investigated such as age, sex, goiter size or nature, level of FT4, TPOAb or TGAb, and TBII were unable to differentiate GD from PT. Considering the increased proportion of PT in the current study, we recommend routine thyroid scan in all thyrotoxic patients except in pregnant or lactating women.
일차성 Sjogren씨 증후군에서 발생한 림프구성 간질성 폐렴 증례보고와 국내문헌고찰
모상일 ( Sang Il Mo ),이혁규 ( Hyeok Gyu Lee ),조아라 ( A Ra Cho ),정혜경 ( Hye Kyoung Chung ),이호성 ( Ho Sung Lee ),최재성 ( Jae Sung Choi ),서기현 ( Ki Hyun Seo ),나성수 ( Seong Su Nah ),김용훈 ( Yong Hoon Kim ),나주옥 ( Ju Ock 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.69 No.5
Lymphoid interstitial pneumonia (LIP) is a rare benign lymphoproliferative interstitial lung disease. LIP has been associated with autoimmune disorders, HIV, viral infections, and so on. Once underlying systemic diseases have been excluded, a diagnosis of idiopathic LIP can be made. Although 6 cases of pathologically confirmed LIP have occurred in Korea, thus far none has been associated with primary Sjogren`s syndrome. A 44-year-old man was admitted to hospital due to a dry cough and dypsnea on exertion that had been ongoing for 2 months. A chest radiography showed multiple and variable-sized cystic lesions, on both lungs and both interstitial infiltration and consolidation in both lower lung fields. Tests for autoantibody showed positive results of anti-nuclear antibody and anti-Ro/La antibody. The patient underwent a video assisted thoracoscopic surgery biopsy and pathologically confirmed LIP. We report the first known case of LIP-associated with primary Sjogren`s syndrome in Korea.
김기원,모상일,나성수 대한내과학회 2011 대한내과학회 추계학술발표논문집 Vol.2011 No.1
서론: Q fever는 Coxiella burnetii 감염에 의해 발생하는 인수공통전염이다. 감염시 두통, 오한, 발열, 전신무력감, 근육통 등의 기유사증상부터 폐렴, 간염, 뇌수막염, 심막염, 심근염까지 다양한 임상 증상을 나타낸다. Q fever의 임상경과에서 흔히 자가항체가 발견되며 가면역질환의 진단 기준을 만족하기도 한다. 이에 저자들은 SLE로 오인되었던 불명열 환자에서 간접면역형광항체법으로 진단된 Q fever 1예를 경험하였기에 보고하는 바이다. 증례: 38세 남자가 7일 동안의 발열을 주소로 내원하였다. 내원 전 동물에 접촉하거나 멸균되지 않은 우를 섭취한 병력은 없었고 두통, 오한, 근육통, 양측 슬관절통 등의 증상을 호소하였다. 내원 당시 혈압 120/70 mmHg, 체온 39.5℃, 맥박 72/분이었고 신체 검진에서 급성 병색을 띄었으며 흉통이나 복통, 안면 홍반, 구강내 궤양, 일광 과민 등은 관찰되지 않았으나 몸통에 발진이있었다. 혈액 검사에서 혈색소 16.7 g/dL, 백혈구 6,690/mm3, 혈소판 153,000/μl이었고 혈청화학검사에서 AST 95 IU, ALT 121 IU이었다. 적구 침강속도는 29 mm/hr 이고 CRP는 150.9 mg/L이었다. 혈액세균배양검사와 리케치아증, 쓰쓰가무시병, 렙토스피라증, 브루셀라, HIV에 대한검사 및 CMV와 EBV에 대한 항체는 음성이었다. 경험적 항생제로 ceftriaxone을 투여하였으나 반응이 없고 혈액세균배양검사 음성으로 발원인이 분명하지 않아 자가항체를 검사하였다. 항핵항체 양성(1:320, cytoplasmic pattern), 항Ro/항La 양성, 항카디오리핀 IgM/IgG 항체양성, 항β2GPI 항체 양성, 루프스항응고인자 양성, 항DNA 항체 음성, 항Sm 항체 음성이었다. Embolism CT, both leg Doppler USG, brainMRI&MRA에서 혈전증은 관찰되지 않았다. 간접면역형광항체법을 이용한 antiphase II 항체 IgM과 IgG의 역가가 각각 1:1024, 1:1024로 증가어 급성Q fever로 진단하였고 독시사이클린 2주 경구투여 후 발열 등의 증상 및 혈액 검사 소견이 호전되었다. 2개월 후 측정한 IgM, IgG 가는 각각 1:16미만, 1:512로 감소되었고 증상의 재발없이 외래에서 추적 관찰 중이다. 결론: Q fever 환자에서 자가항체가 발견되는 경가 흔하다. 자가항체가 양성인 경우라도 발열이 지속되면서 혈액 세균배양검사에서 음성인 경우 감별진단으로 Q fever를 고려하여야 한다.
이한민 ( Han Min Lee ),모상일 ( Sang Il Mo ),조현욱 ( Hyun Wook Cho ),이수진 ( Su Jin Lee ),전백규 ( Baek Gyu Jun ),김기원 ( Ki Won Kim ),김재원 ( Jae Yun Kim ),김영일 ( Young Il Kim ),나성수 ( Seong Su Na ) 대한류마티스학회 2013 대한류마티스학회지 Vol.20 No.1
Q fever is a zoonosis caused by a Coxiella burnetii. Q fever is clinically variable, presenting as asymptomatic infection, pneumonia, hepatitis and endocarditis. Treatment of acute Q fever with doxycycline is usually successful. Autoantibodies, such as anti-mitochondrial antibodies, smooth muscle antibodies (SMA), anti-cardiolipin and lupus anticoagulant, often rise in acute Q fever infection. Some cases may occasionally meet the criteria for autoimmune disease like systemic lupus erythematosus. We report a first case of Q fever that may mimic systemic lupus erythematosus in Korea.
류아정,문혁진,나주옥,김여주,김상진,모상일,변정란 대한당뇨병학회 2015 Diabetes and Metabolism Journal Vol.39 No.6
Background: An oral glucose tolerance test (OGTT) is the current method used for screening and diagnosis of gestational diabetes mellitus (GDM). OGTT is a relatively complicated procedure and is expensive. Thus, new strategies that do not require fasting or more than a single blood draw may improve the diagnosis of GDM and increase the rate of GDM testing. We investigated the utility of monitoring glycosylated hemoglobin (HbA1c) levels for the diagnosis of GDM. Methods: The data from 992 pregnant women with estimated gestational ages ranging from 24 to 28 weeks were retrospectively reviewed. There were 367 women with plasma glucose levels ≥140 mg/dL 1 hour after a 50-g OGTT. GDM was diagnosed according to the Carpenter-Coustan criteria for a 3-hour 100 g OGTT. A HbA1c assessment was performed at the same time. Results: We enrolled 343 women in this study, and there were 109 women with GDM. The area under the curve the receiver operating characteristic curve for HbA1c detection of GDM was 0.852 (95% confidence interval, 0.808 to 0.897). A HbA1c cutoff value ≥5.35% had maximal points on the Youden index (0.581). The sensitivity was 87.2% and the specificity was 70.9% for diagnosing GDM. A threshold value ≥5.35% indicated that 163 patients had GDM and that 68 (41.7%) were false positive. The positive predictive value was 58.3% at this threshold value. Conclusion: Despite substantial progress in methodology, HbA1c values cannot replace OGTT for the diagnosis of GDM.
중국 여행 후 발생한 Salmonella 감염에 의한 대동맥염 1예
김현수,박세경,정혜경,조아라,이혁규,모상일,고규봉,강병일,이은정,전민혁,김태형,김동훈,추은주 순천향대학교 순천향의학연구소 2010 Journal of Soonchunhyang Medical Science Vol.16 No.2
Arteritis due to Salmonella infection is unusual complication of Salmonella infection. Aorta is more common involved than peripheral arteries and, in many cases, aortic aneurysm is produced. Contrast enhanced computed Tomography scan is used as the most preferred diagnostic method. Surgical resection with use of antibiotics more than 6 weeks is used as main treatment and medical treatment alone without surgical resection is associated with a high mortality rate. As the incidence of non-typhoidal Salmonellosis has increased, its clinical importance has grown greater. We report a case of aortitis due to Salmonella infection which was treated successfully by antibiotics alone, that occurred after Chinese travel.