症例(증례) : 고립성 편측 외전신경 마비로 나타난 원발성 알도스테론증

박지현 ( Ji Hyun Park ),노정미 ( Jung Mee Rho ),이가영 ( Ka Yeoung Yi ),오선영 ( Sun Young Oh ),송민주 ( Min Ju Song ),진홍용 ( Heung Yong Jin ),김소영 ( So Young Kim ),강선미 ( Seon Mee Kang ),박태선 ( Tae Sun Park ),백홍선 ( Hon 전북대학교 의과학연구소 2007 全北醫大論文集 Vol.31 No.2

외전신경마비는 급성 복시의 흔한 원인중 하나로써 뇌종양이나 혈관병증, 또는 당뇨병과 같은 전신질환의 한 증상으로도 나타난다. 당뇨병과 같은 전신 질환에서 외전신경마비는 미세혈관장애와 관련된 현상으로 알려져 있으며 60세 이전의 환자에서는 발생이 드물다. 원발성 알도스테론증은 전체 고혈압의 약 10%를 차지하는 이차성 고혈압의 원인 중 가장 흔한 내분비 질환이다. 과혈압과 저칼륨혈증을 특징으로 하며 대부분 수술로 치료가 가능한 질환이다. 임상 증상은 무증상인 경우가 가장 많고 일부에서 높은 혈압이나 저칼륨혈증과 관련된 증상들이 나타날 수 있다. 저자들은 극히 드물게 보고된 외전신경 마비를 동반한 부신의 알도스테론 분비 선종에 의한 원발성 알도스테론증 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Sixth cranial nerve innervates the lateral rectus muscle and its palsy is a common cause of acute diplopia. Isolated sixth nerve palsy may be associated with different pathologic conditions such as brain tumors and vasculopathy, or a symptom of generalized disease such as diabetes. Hypertension had been also frequently reported as being vascular or ischemic etiology of acquired sixth nerve palsy. However, the recent population based-study showed that systemic hypertension dose not seem to be a significant association. Secondary hypertension, there is a known cause, is in about 10% of all hypertension cases. Primary aldosteronism could be the most common identifiable and specifically treatable form of secondary hypertension. The clinical features of primary aldosteronism are not specific. Some patients are completely asymptomatic or have minimal symptoms. There is rare literature about the primary aldosteronism related with sixth nerve palsy. We here report a case of a 41 year old male with secondary hypertension by aldosterone-producing adrenal adenoma presenting with isolated unilateral sixth nerve palsy.

Rhupus Syndrome 환자에서 발생한 Lupus Enteritis

박지현 ( Ji Hyun Park ),류완희 ( Wan Hee Yoo ),박태선 ( Tae Sun Park ),백홍선 ( Hong Sun Baek ) 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.2

Rheumatoid arthritis(RA) and systemic lupus erythematosus(SLE) are common rheumatologic diseases, and considered to be separate diseases with defined criteria for diagnosis. Occasionally, patients with overlapping features of RA and SLE, termed rhupus syndrome, have been encountered. Appreciation of these patients with rhupus is important since their therapy and outcome differ from those having RA or SLE alone. Rhupus syndrome is a systemic disease which can involve gastrointestinal tract as SLE alone. Lupus enteritis, most feared gastrointestinal complication of SLE, can develop in rhupus syndrome, Recently, we experienced a 54-year-old female patient with lupus enteritis during treatment of rhupus syndrome and present the case here with brief review of literatures.

간으로 전이된 뇌막 혈관주위세포종 환자에서 발생한 저혈당 1 예

박성일(Sung Il Park),김남수(Nam Su Kim),류완희(Wan Hee Yoo),박태선(Tae Sun Park),백홍선(Hong Sun Back) 대한내과학회 2000 대한내과학회지 Vol.59 No.3

Tumour-induced hypoglycemia is usually caused by insulinoma or non-islet-cell neoplasm, such as hemangiopericytoma, fibrosarcoma, mesotheliomas. Most of the neoplasms in non-islet-cell tumour-induced hypoglycemia are mesenchymal type, and have a common features, including large-sized, slow-growing and metastatic involvement of the liver. The mechanisms of hypoglycemia in metastatic liver disease are not clearly defined, and liver failure secondary to hepatic metastasis or insulin or insulin-like mediated process are considered. Glucagon stimulation test has been used to distinguish between insulin-mediated or insulin-like-mediated hypoglycemia and hypoglycemia induced by liver failure. We experinced a case of hypoglycemia in a patient of hemangiopericytoma with liver metastasis in which glucagon stimulation test was used for proper evaluation. We compare this case with previously reported cases, and present here with brief review of literatures.(Korean J Med 59:319-324, 2000)

당뇨병 신증 환자에서 초음파로 관찰된 경동맥 두께와 Angiotensin Converting Enzyme 유전자와 Apolipoprotein E 유전자 다형성에 대한 연구

강성귀(Sung Kyew Kang),박성광(Sung Kwang Park),김원(Won Kim),김달식(Dal Sik Kim),박태선(Tae Sun Park),백홍선(Hong Sun Baek) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.3

N/A Backgroud: We evaluated the distribution of the polymorphisms of apolipoprotein E and angiotensin converting enzyme gene in patients with diabetic nephropathy and also evaluated possible association between the apolipoprotein E carriers and angioten-sin converting enzyme genotypes and intima-media thickness of the common carotid artery. Methods: Study participants were 92 patients with diabetic nephropathy(50 men and 42 women). Hb(A1C), albuminuria, and lipid status were assessed by standard laboratory techniques ; the apolipopro-tein E carriers were assessed by modified amplifi- cation refractory mutation system and the angioten-sin converting enzyme genotypes were assessed by polymerase chain reaction. The intima-media thick- ness was measured by high-resolution ultrasonog-raphy. Results : The apolipoprotein E frequencies of patients were E2 8%, E3 76%, and E4 16%. The intima-media thickness varied by apo E groups. E2 group has less common carotid intima-media thickness than E3 and E4 groups(p<0.05). The angiotensin converting enzyme genotypes were distributed as follows ; 35% II, 49% ID, 16% DD. The intima-media thickness value did not differ among patients with various angiotensin converting enzyme genotypes. Multiple logistic regression analysis showed that age and apolipoprotein E genotypes were determinants for the intima-media thickness. Conclusion: Our results suggested that apolipo- protein E polymorphism is associated with carotid artery intima-media thickness in diabetic nephro-pathy. But, we could not find an association between carotid artery intima-media thickness and angioten-sin converting enzyme gene polymorphism in dia- betic nephropathy.

Marked Weight Loss in a Type 2 Diabetic Patient Treated with Acarbose

류완희 ( Wan Hee Yoo ),박태선 ( Tae Sun Park ),백홍선 ( Hong Sun Baek ) 대한내과학회 1999 대한내과학회 추계학술대회 Vol.57 No.-

Remission of Rheumatoid Arthritis with Taxol in a Patient with Breast Carcinoma

류완희 ( Wan Hee Yoo ),박태선 ( Tae Sun Park ),백홍선 ( Hong Sun Baek ) 대한내과학회 1999 대한내과학회 추계학술대회 Vol.57 No.-

Graves 병 치료중 발생한 루마티스 관절염 1 예

류완희(Wan Hee Yoo),박태선(Tae Sun Park),백홍선(Hong Sun Back),박지현(Ji Hyun Park) 대한내과학회 2000 대한내과학회지 Vol.59 No.3

The relationship between thyroid disease and rheumatic disorders has been the subject of considerable debate. Autoimmune thyroid disease (ATD), such as Graves' disease, Hashimoto's thyroiditis are occasionally associated with systemic lupus erythematosus, Sj gren syndrome, and rheumatoid arthritis (RA). Although the exact mechanism of this association is not well documented, genetic factor, immunologic defect, hormonal factor, drugs for treatment might contribute for it. There is a question of whether common factors are involved in the etiology of RA and thyroid disease, and controversy over whether an association between RA and ATD exists. The possibility of coexistent thyroid disease in patients with RA should be carefully considered throughout the course of follow-up. Recently, we experienced a 39-year-old male patient with RA during treatment of Graves' disease, and present the case here with brief review of literatures.(Korean J Med 59:325-330, 2000)

제2형 당뇨병 환자에서 혈청 라미닌 농도와 경동맥 플라크 진행의 관계

최은경 ( Eun Kyoung Choi ),박명한 ( Ming Han Pao ),박지현 ( Ji Hyun Park ),백홍선 ( Hong Sun Baek ),박태선 ( Tae Sun Park ) 대한내과학회 2006 대한내과학회지 Vol.71 No.4

Background: Laminin, the main non-collagenous constituent of vascular basement membranes, can be changed by alteration of metabolism and distribution in diabetic microangiopathy. The serum laminin levels are known to reflect these histological changes. The aim of present study was to investigate whether the serum laminin levels are related to carotid atherosclerosis and diabetic complications, and to assess what clinical variables influence on the serum laminin levels in type 2 diabetes. Methods: The subjects were 103 type 2 diabetic patients (51 in the no complication group and 52 in the complication group) and 39 controls. We evaluated the intima-media thickness (IMT) and plaques in both carotid arteries by duplex scan. and the serum laminin levels were measured. Results: The serum laminin levels were higher in the group with complications complication group compared to the no complication group (p<0.01), and in the no complication group compared to the control group (p<0.01). There were no differences in the carotid parameter values between the complication group and the no complication group. The correlations between the serum laminin levels and the measured IMT values were not significant. However, there were significant correlations between the serum laminin levels and the plaque counts and scores (r=0.24, p<0.05). The presence of diabetic complications, the waist hip ratio, plaque score and apo B affected the elevation of the serum laminin levels (p<0.05). Conclusions: The serum laminin levels were related to the presence of diabetic complications. Such levels may be a risk factor for plaque progression rather than the initiation of plaque formation or IMT thickening in the carotid atherosclerosis of type 2 diabetic patients.(Korean J Med 71:396-404, 2006)

임실지역 당뇨병 환자들의 관리 실태

진흥용 ( Heung Young Jin ),위상양 ( Sang Yang Wi ),박지현 ( Ji Heun Park ),박태선 ( Tae Sun Park ),백홍선 ( Hong Sun Baek ) 전북대학교 의과학연구소 2005 全北醫大論文集 Vol.29 No.2

연구배경: 당뇨병의 관리에 있어서 만성합병증 예방 및 치료는 당뇨병 환자의 예후와 밀접한 관계가 있다. 그러나, 이는 연령, 지역 및 경제적 여건에 따라 많은 차이를 보일 수 있고 또한 시골지역 고령 환자들의 관리 소홀로 반영될 수 있다. 본 연구에서는 시골지역 당뇨병 환자들의 관리 실태 및 문제점을 알아보고자 하였다. 방법: 임실 지역 환자들 중 최근 6개월간 임실의료원에 내원한 107명의 당뇨병 환자들을 대상으로 혈당 및 혈압조절 정도를 조사하였다, 또한 신경병증 및 망막병증 등을 포함한 만성합병증에 대한 검사여부 및 유병률, 그 외 운동 및 식이 조절행태에 대해 알아보았다. 결과: 대상환자들의 평균연령 및 당뇨병 이환 기관은 각각 63.7±8.9, 6.8±3.7년이었고 공 복시 평균혈당은 128.8±41.7mg/dl, 식후2시간 평균혈당은 233.7±73.9mg/dl, 평균 당화혈색소는 7.3±0.7%로 조사되었다. 고혈압이 동반된 환자는 58.9%, 단백뇨 및 신경병증증상을 보인 환자는 각각 23.4%와 30.8%였다. 75.7%에 달하는 많은 환자들은 한번도 망막병증에 대한 안과적 검진을 받은 적이 없었다. 그 외 운동 및 식이조절을 시행하고 있는 환자들은 각각 43%와 34.6%로 낮게 조사되었다. 결론: 시골지역 당뇨병 환자들의 관리에 있어서 혈당 및 혈압 조절 외에 소홀하게 여겨지고 있는 만성병증의 교육, 예방 및 치료를 위해 좀 더 적극적인 정책적 변화가 필요하리라 사료된다. Background: In the management of diabetic patient, the prevention and the treatment of chronic complications are strongly related with prognosis. But management status of chronic complications is affected by age, living area and economic condition of patients, so it is possible that the patients living in rural district might be managed carelessly. Therefore, this study was performed to estimate the management status and problems in caring of diabetic patients in the country. Methods: We studied 107 diabetic patients who visited Im-Sil public Medical Center during the period from September 2004 to March 2005 in Im-Sil district. We investigated blood glucose level, blood pressure, the prevalence of the chronic complications and whether the evaluations of chronic complications including peripheral neuropathy and retinopathy were done. Results: The average age was 63.7±8.9yrs and average disease duration was 6.8±3.7yrs. The mean fasting and 2-hr blood glucose level were 128.8±41.7mg/dl and 233.7±73.9mg/dl, respectively. The mean HbAlc level was 7.3±0.7% and 44.7% of the patients had < 7.0% of HbAlc level. Hypertension, proteinuria, peripheral neuropathy and retinopathy were combined 58.9%, 23.4%, 30.8% and 1.9%, respectively. Exercise trial and diet control were performed only 43% and 34.6% of the patients, respectively. Conclusion: We suggest that positive medical systems for diabetic patients living in the country should be prepared for prevention and treatment of chronic complications.

당뇨병 유발 백서에서 알파-리포산의 피하신경과 미세혈관 보존효과

박명한 ( Ming Han Piao ),진흥용 ( Heung Yong Jin ),송선경 ( Sun Kyung Song ),강선미 ( Seun Mi Kang ),김소영 ( So Young Kim ),박지현 ( Ji Hyun Park ),백홍선 ( Hong Sun Baek ),박태선 ( Tae Sun Park ) 대한당뇨병학회 2007 Diabetes and Metabolism Journal Vol.31 No.6