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손현석(Hyun Suck Son),윤현구(Hyun Koo Yoon),김성운(Sung Woon Kim),양인명(In Myung Yang),김진우(Jin Woo Kim),김영설(Young Seal Kim),김광원(Kwang Won Kim),최영길(Young Kil Choi) 대한내과학회 1991 대한내과학회지 Vol.40 No.5
N/A Diabetes mellitus can be divided into insulin-dependent (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) by NDDG criteria largely based on clinical features. Recently the development of a radioimmunoassay for human C-peptide and of ICSA assay have provided insight into the pathogenesis of diabetes mellitus. We observed the characteristics of 105 diabetics under 40 years of age and classified these patients by their clinical features, ICSA and 24 hour urine C-peptide. The results were as follows: 1) Diabetic ketoacidosis developed in R patients (3%). of these, patients belonged to the 1st decade (8 patients), which had the highest incidence of diabetic ketoacidosis. 2) Considering of family history and obesity, the cases with typical NIDDM, which had family history and were obese, were between 4% and 29%. The cases with typical IDDM, which had no family history and were not obese, were between 45%, and 60%. 3) Considering family history, obesity and insulin secretory capacity, the cases with typical NIDDM, which had family history and normal or increased insulin secretory capacity and were obese, were 15%. The cases with typical IDDM, which had not family history and decreased insulin secretory capacity and were not obese, were 14. 4) In ICSA assay, 12.5% of the patients were positive. All these patients had family history, various obesity and increased insulin secretory capacity. In conclusion, in Korean diabetics between 15 and 40 years of age, 15 percent of the patients were considered typical NIDDM and 14 percent were considered typical IDDM, The remaining patients could not be classified accurately and turther detailed study were needed.
증례 : 내분비-대사 ; 임신 3분기 중 발현된 요붕증
이수희 ( Su Hee Lee ),원현선 ( Hyun Sun Won ),류현미 ( Hyun Mee Ryu ),박소영 ( So Young Park ),김성훈 ( Sung Hoon Kim ),한기옥 ( Ki Ok Han ),윤현구 ( Hyun Koo Yoon ) 대한내과학회 2009 대한내과학회지 Vol.77 No.4
임신성 요붕증은 임신 후반부에 다뇨, 다음 및 갈증이 발생하는 드문 질환으로 태아 및 모체에게 신경학적 손상을 초래할 수 있으며, 임신 여성 100,000명 중 약 4명에서 발생한다. 특이 질환이 없는 경우 임신 후반부에 태반에서 유래되는 바조프레시나제의 활동증가로 혈중 바조프레신이 분해되어 임신성 요붕증을 일으킬 수 있다. 드물게 발생하는 질환이지만 이차적 손상의 위험을 감소시키기 위하여 빠른 진단과 치료가 필요하다. 저자들은 임신 3분기에 다뇨, 다음 등이 발생하여 요붕증으로 진단된 34세 산모에서 바조프레신의 아미노 말단부를 처리하여 바조프레시나제에 의해 분해되지 않는 데스모프레신의 비강흡입으로 요농축과 임상적 호전이 관찰되고 출산 후 치료없이 회복된 임신성 요붕증을 경험하여 문헌고찰과 함께 보고하는 바이다. Gestational diabetes insipidus, which occurs rarely during late pregnancy, may injure the mother and fetus neurologically. It takes place in about 4 of every 100,000 pregnancies. Increased placental-derived vasopressinase in late pregnancy markedly degrades vasopressin. The decreased vasopressin activity causes hypotonic polyuria, polydipsia, and dehydration. We report a woman with gestational diabetes insipidus who had no abnormal laboratory tests before developing symptoms. The diabetes insipidus was controlled well by administering nasal desmopressin (1-desamino-8-D-arginine vasopressin, DDAVP) followed by resolution of the signs and symptoms after delivery. Although gestational diabetes insipidus is rare, a prompt diagnosis and appropriate treatment to reduce the risks of maternal and fetal injury are important. (Korean J Med 77:512-516, 2009)
폐경 여성의 골밀도 변화를 중심으로 한 치료 방법의 비용효과적 비교
오한진 ( Han Jin Oh ),김의현 ( Ui Hyun Kim ),오장균 ( Jang Kyun Oh ),윤현구 ( Hyun Koo Yoon ),한인권 ( In Kwon Han ) 대한폐경학회 2001 대한폐경학회지 Vol.7 No.1
N/A Background : There were many strategies to treat postmenopausal women with osteoporosis. Because of bone mass measurement confirms the existence of osteoporosis and also predicts the risk of fracture, the effectiveness of the treatment should be measured by the amount of increased bone mass. Methods : 311 postmenopausal Korean women were evaluated who visited one of university hospital located in Seoul from Aug. 1997 to July 2000, with respect to markers of bone turnover and BMD at lumbar spine. Subjects were classified into 3 groups, peri-menopause, early-menopause, and late-menopause by menopausal states. To evaluate the cost-effectiveness of treatment, we compared changes of BMD after 1-year of treatment and total drug costs for 1-year among 3 groups. And also to evaluated the cost-effectiveness between groups classified by WHO criteria, we also compared changes of BMD and total drug costs after 1-year. Results : Our results showed those findings: 1. The const-effectiveness was similar among 3 groups classified by the menopausal state. 2. Among three groups classified by bone density, osteopenia group showed significantly favorable cost-effectiveness score than normal or osteoporotic group.
건강보험데이타베이스를 이용한 골다공증성 고관절 골절 식별 및 타당도
박찬미 ( Chan Mi Park ),장선미 ( Sun Mee Jang ),장수현 ( Su Hyun Jang ),하용찬 ( Yong Chan Ha ),이영균 ( Young Kyun Lee ),윤현구 ( Hyun Koo Yoon ),신찬수 ( Chan Soo Shin ),김덕윤 ( Deog Yoon Kim ),이성수 ( Seong Su Lee ),최형진 ( 대한고관절학회 2010 Hip and Pelvis Vol.22 No.4
Purpose: The aim of this study was to develop and validate identification criteria for the cases of osteoporotic hip fracture using the National Health Insurance Database, and we calculated the incidence rate of osteoporotic hip fracture in the Korean population using these criteria. Materials and Methods: The criteria to identify osteoporotic hip fracture using a diagnosis code, a procedure code, the type and number of medical service usages and the patients` ages were developed via discussions among experts. These criteria were validated by using a hip fracture cohort in which all the genuine osteoporotic hip fracture patients in the Jeju area were identified by reviewing the registered medical records and radiographs. By applying the identification criteria to the National Health Insurance Database that was accumulated until June 2009, we calculated the incidence rate of osteoporotic hip fracture in patients between 50 and 100 years of age in 2008. Results: The identification criteria had a sensitivity of 93.1% and a positive predictive value of 77.4%. A total of 20,432 osteoporotic hip fracture cases were identified in 2008, and the incidence rate was 15.7 cases per 10,000 persons. The osteoporotic hip fracture incidence rate for females was 20.7 (per 10,000persons), and this was 2.1 times higher than that for the males (9.8case per 10,000persons), and the rates were increased with age. Conclusion: The incidence of osteoporotic hip fracture that occurred on a nationwide scale can be more precisely estimated by using the National Health Insurance Database with its comprehensive information on the overall details of treatment as well as the diagnosis codes, and so the incidence of osteoporotic hip fracture can be reliably calculated for each year. The results from this research could be used as evidence in a hip fracture management plan for establishing Korean Health policy.
폐경후 여성에서 경피적 에스트라디올 겔과 경구영 프로게스테론 주기적 병합요법의 임상적 유효성에 관한 연구
정호연 ( Ho Yeon Chung ),최규홍 ( Kyu Hong Choi ),이창욱 ( Chang Uk Lee ),김해성 ( Hae Sung Kim ),임창훈 ( Chang Hoon Yim ),한기옥 ( Ki Ok Han ),장학철 ( Hak Chul Jang ),윤현구 ( Hyun Koo Yoon ),한인권 ( In Kwon Han ) 대한폐경학회 2001 대한폐경학회지 Vol.7 No.1
N/A Objectives: The purpose of our study was to evaluate the effects of transdermal 17β -estradiol gel combined with oral progestogen in terms of serum lipid, bone markers and bone mineral density in Korean postmenopausal women Subjects and methods: Nine healthy postmenopausal women were asked to volunteer for pharmacokinetic analysis of estradiol gel. Subjects received daily application of 1.5 ㎎ of estrogen gel in the morning. Peripheral venous samples were drawn at 0, 0.5, 1, 2, 4, 8, 24, 48, 72 hours after the daily gel application and serum E2 levels were analyzed. 41 postmenopausal women with intact uterus and no menstruation for more than 12 months were treated with 1.5 ㎎ of estradiol gel (day 1-25) sequentially combined with 2.5㎎ of medroxyprogesterone acetate (day 16-25) orally for 1 year. Results: Although one volunteer showed increment of serum E2 one hour after application of estrogen gel, pharmacokinetic study showed increase of serum E2 after 24 hours in the most volunteers. The mean serum E2 level at 72 hour after application was 59.6±58.8 pg/㎖. The acceptability of the combined treatment was 73.2%. Only 1 (3.3%) woman complained skin irritation during treatment. The combined estradiol gel and oral progestogen therapy significantly decreased serum cholesterol levels by 7.8%, LDL by 8.5%. Markers of bone turnover significantly decreased 3 months after treatment. The increase of the annual percent change in bone density was 4.8% at the lumbar spine and 4.4% at the femoral neck. Conclusion: The combined estradiol gel with oral progestogen therapy is acceptable and effective treatment in postmenopausal women.