말단비대증 환자의 뇌하수체 종양조직에서 H - ras 유전자 변이의 가능성

임승길(S . K . Lim),권이현(Y . H . Kwon),정윤석(Y . S . Chung),안광진(K . J . Ahn),이은직(E . J . Lee),김경래(K . R . Kim),이현철(H . C . Lee),허갑범(K . B . Huh),김태승(T . S . Kim) 대한내과학회 1993 대한내과학회지 Vol.45 No.3

N/A Backround: Little is known about the mechanism of tumorigenesis in pituitary adenomas. An important finding in somatotroph adenomas is that a somatic mutation may convert a G protein, Gs(α) into a putative oncogene termed gsp via point mutations at two critcal sites. The ras protooncogenes are structurally related to the G-protein family and are involved in cell proliferation and differentiation. Although ras oncogene mutations have been indentified in a wide variety of human neoplasm, only one case was reported as containting single point mutation in a patient with invasive prolactinoma, In this report we used oligonucleotide-specific hybridization to screen ras mutations in 13 acromegalic tumors. Methods: Pituitary tissue samples were derived from a central portion of the paraffin embedded pituitary tumor to minimize the possibility of contamination with normal tissue. Genomic DNA was isolated and purified from tumor tissue and amplified by the standard PCR method. Amplified DNAs from each of the region of H-ras genes (12/13 and 61) were analyzed for potential ras mutations using oligonucleotide-specific hybridization as described previously. Results: Wild type radiolabelled oligoncleotides were hybridized to the amplified DNAs from the patients' tumor and to the positive specimens. They were, however, easily striped out at 68℃ by nonstringent washing procedures except control (wild type) specimens. All radiolabelled mutant oligonucleotides could be easily striped out of 13 specimens except a control mutant specimen by the same procedure. Conclusion: We could not find any H-ras mutation that might not be frequently found in acromegalic patients, and that gsp (Gsa mutation) or mutations in the PKA system-related proteins might be the main oncogene in acromegalic patients. However further efforts to find the other somatic mutations including K-ras and N-ras should be given to these patients for more precise understanding of pathogenesis and for planning of the better treatment.

중증 부갑상선 기능항진중에서 부갑상선 결절내 Calcitriol 직접 주입술 및 충격요법 병용치료의 장기간 연구결과

신석균(S. K. Shin),황재하(J. H. Hwang),송현용(H. Y. Song),노현진(H. J. Noh),최규헌(K. H. Choi),임승길(S. G. Lim),이호영(H. Y. Lee) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.1

N/A Severe hyperparathyroidism(i-PTH>1,000pg/ml, dia-meter of nodules>1.0cm, and hypercalcemia) in dialysis patients may be resistant to conventional calcitriol- pulse therapy. To assess the usefulness of direct calcitriol injections in restoring the responsiveness to calcitriol, we performed a prospective study in 23 dialysis patients(mean age 42.3 years, M: F 0.9: 1, CGN 14, hypertension 4, lupus nephritis 2 & others 3, mean duration of dialysis 9.5 years, HD: CAPD 9: 14) who had severe hyperparathyroidism resistant to calcitriol pulse therapy for more than 2 months and had no ectopic gland in Sestamibi parathyroid scan. We three repeatedly injected calcitriol of dose(μg) equal to 3-D nodule volume(cm(3)) under U.S.(Acuson Computa Sono, California, USA, 7MHz probe) for 1 week and concurrently began calcitriol-pulse therapy(0.75-1.0μg/day, t.i.w.) after 3rd injection. All patients were followed up by serum i-FI H(Allegro Intact FPH kits, Nichols Ins.), calcium, phosphate, and U.S. after 7 days, 1 month, 6 months, and 1 year of 3rd calcitriol injection. These combination therapy could significantly decrease i-PTH level and gland volume in patients with resistant secondary hyperparathyroidism on conventional calcitriol therapy and the response were main-tained for one year after start of these therapy. The complete response group was the patients with lower baseline i-FFH levels compared to those with partial and non-response(1001.7±150.2 vs. 1521.8±328.3, 1569.2 ±344.3pg/ml, p<0.05, respectively). The patients with baseline i-PTH of less than l,200pg/ml or gland volume of less than 1.5cm were well responded to the three consecutive direct calcitriol injection and pulse combination therapy(i-PTH; PPV 77.8%, NPV 92.8%, gland volume', PPV 87.5%, NPU 93.3%). No severe adverse effect was observed during this study. In conclusion, direct calcitriol injections into the parathyroid nodules and pulse combination therapy could be useful in secondary resistant hyperparathyroidism patients with conventional calcitriol therapy especially in those with i-PTH of less than 1,200pg/ml or gland volume of less than 1.5cm. However, sugical management may be indicated in patients with higher i-PTEI levels or larger gland volume than these.

만성적 발목 불안정성이 있는 태권도 선수의 고관절과 발목 부위 근력

임미영 ( M. Y. Leem ),박명수 ( M. S. Park ),임승길 ( S. K. Lim ) 한국운동생리학회(구-한국운동과학회) 2010 운동과학 Vol.19 No.4

고관절 및 발목의 근력과 안정성은 정상 보행과 신체활동에 있어서 중요한 요소이다. 본 연구의 목적은 만성적 발목 불안정성이 있는 태권도 선수를 대상으로 환측과 건측의 고관절 외전근과 내전근, 발목의 외번과 내번근, 저측굴곡근과 배측굴곡근의 근력 차이를 종합적으로 규명하는 데 있다. 연구대상은 한쪽 발목에 만성적 불안정성이 있는 태권도 선수 15명을 대상으로 하였다. 환측과 건측 간의 근력 측정은 트렌델렌버그 검사와 등속성 근력 검사를 이용하여 측정하였다. 트렌델렌버그 검사 결과, 환측 고관절 외전근 약화를 나타내는 양성 반응이 46.7%에서 나타났다. 그러나 등속성 검사를 이용한 고관절 외전력 및 내전력에는 유의한 차이가 없었다. 등속성 검사를 이용한 발목의 외번력은 180o/s에서 측정한 환측의 피크토크와 단위체중당 피크토크가 건측에 비해 유의하게 낮았다(p<.05). 발목의 저측굴곡력 및 배측굴곡력에는 유의한 차이가 없었다. 이상의 결과를 바탕으로 결론을 내리면, 만성적 발목 불안정성을 가지고 있는 태권도 선수의 재활운동을 구성하기 이전에 고관절 외전력 약화에 대한 사전 검사가 이루어져야 하며, 고관절 외전력 약화가 있을 경우, 외전력 강화를 위한 운동 프로그램이 재활 및 재손상 방지를 위해서 반영되어야 한다. 또한 만성적 발목 불안정성을 가지고 있는 태권도 선수들의 발목 외전력 강화를 위한 프로그램이 적극적으로 권장된다. Strength and stability of hip and ankle muscle are important factors for normal gait and physical activity. The aim of this study was to investigate the strength difference of hip and ankle muscle between involved and non-involved side in taekwondo athletes with chronic ankle instability. A total of 15 subjects with unilateral chronic ankle instability were recruited. As a result of Trendelenburg`s test, positive response that indicate weakness of hip abductor was 46.7% at involved side. However, there were no significance difference between involved and non-involved side in isokinetic strength of hip abductor and adductor. Isokinetic strengths(peak torque and peak torque % body weight) of ankle evertor at 180˚/s were significantly less on the involved side than the non-involved side(p<.05). No significant difference were noted in ankle plantar flexor and dorsiflexor strength. Taken together, we conclude that screen test for weakness discrimination of hip abductor should be performed before rehabilitation program was designed for taekwondo athletes with chronic ankle instability. In the case with weakness of the hip abductor, strengthen exercise of hip abductor should be involved in the rehabilitation for functional recovery and re-injury prevention. Also, strengthening of ankle evertor is recommended for taekwondo athletes with chronic ankle instability.

갑상선 질환에 있어서의 골밀도의 변화

전근재(G . J . Jeon),임승길(S . K . Lim),이현철(H . C . Lee),김경래(K . R . Kim),허갑범(K . B . Huh) 대한내과학회 1988 대한내과학회지 Vol.35 No.6

N/A We studied 59 patients who had received a diagnosis of graves' disease or myxedema by dual photon absorptiometry from August 1986 to July 1987 at the Department of Internal Medicine, Yonsei University Severance Hospital. The results were summarized as follows: 1) Patients with Graves' disease of a mean duration of 19.2 weeks demonstrated an average of 9.37 mg/dl Ca and 4.29 mg/dl P in their blood samples while the 24 hr urine specimen showed 194.26 mg/dl 24 hr of Ca and the P revealed 520.36 mg/24 hr, which is higher than those of myxedema. 2) The patients with Graves' disease revealed a prevalance of osteoporosis in the following, Ward's triangle 18,8%, femora) neck 20.8%, trochanter 25%, but the spine, while observed at 22.9% in hyperthyroidism, also was detected at 18.2% in myxedema. 3) In females with Graves' disease, the values of BMD were relatively lower than those of the control group but showed a greater at traction to osteoporosis than the males. 4) Most womon in their postmonopaunal poriod showed a strong tondency to develop osteoporosis in the femoral neek but they demonstrated a greater relationship to the spine. 5) Even after treatment, the BMD revealed a tendency to continue increasing, however, there was still a possibility for incomplete recovery. Excess thyroid hormones lead to negative bone mineral balance. The revealed bone loss was clinically significant in postmenopausal women despite its short dyratuib abd ut aooeared ti be at keast oartuakkt reversubke after treatment.

제 2 형 당뇨병 환자 및 당뇨병과 심혈관질환이 없는 성인을 대상으로 조사한 심혈관계질환의 위험인자와 혈청 high sensitivity C - reactive protein 사이의 관련성 비교

김형진(Hyeung Jin Kim),배상운(S. W. Pae),김대중(Dae Jung Kim),김수경(Soo Kyung Kim),김세화(Se Hwa Kim),이유미(Yu Mie Rhee),정상수(Sang Su Chung),안철우(Chul Woo Ahn),차봉수(Bong Soo Cha),송영득(Young Duk Song),임승길(Sung Kil Lim),김경 대한내과학회 2002 대한내과학회지 Vol.63 No.1

N/A Background: High sensitivity C-reactive protein (hsCRP) is more sensitive than standard CRP assay for evaluation of risk of coronary heart diseases and other atherosclerotic events. But, there were no data of association of serum hsCRP with risk factors of cardiovascular diseases and nonalcoholic fatty liver in Korean type 2 diabetic and nondiabetic subjects. Methods: A hundred type 2 diabetic subjects (51 men and 49 women) from Severance Hospital and 200 nondiabetic subjects participating medical checkup in Health Promotion Center (105 men and 95 women) were recruited and subjects with acute illnesses and chronic inflammatory diseases such as upper respiratory infection, rheumatoid arthritis, osteoarthritis, or viral hepatitis were excluded. A standardized interview was conducted by trained personnel; detailed information was collected on medical history, dietary habits and lifestyle characteristics, including smoking, alcohol and physical activity. Body mass index (BMI) was computed and biochemical study were undergone using fasting blood. All subjects were done abdominal ultrasonography for evaluation of fatty liver. Serum hsCRP concentration was measured by Nephelometer AnalyzerⅡ (Behring Co.) and a lower detection limit of test was 0.18 mg/L. Results: There was no difference in sex, BMI, presence of fatty liver, concentration of total cholesterol, triglyceride, high density lipoprotein-cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and uric acid between diabetic and nondiabetic subjects. Age, total colesterol/HDL-C ratio, fasting blood glucose and incidence of hypertension were higher in diabetic than nondiabetic subjects, but a rate of smoking was higher in nondiabetic than diabetic subjects. The mean concentration of serum hsCRP was remarkably increased in type 2 diabetic subjects than nondiabetic subjects (1.34±1.87 vs 0.71±0.80 mg/L, p<0.05). After adjustment of different variables between both groups, there was significantly difference of the concentration of serum hsCRP (p<0.05). In nondiabetic subjects, by univariate analysis, there was a positive correlation between hsCRP and age (r=0.26, p<0.05), BMI (r=0.34, p<0.05), systolic blood pressure (r=0.21, p<0.05), diastolic blood pressure (r=0.16, p<0.05), triglyceride (r=0.27, p<0.05), total cholesterol/HDL-C ratio (r=0.22, p<0.05), uric acid (r=0.15, p<0.05) and a negative correlation between serum hsCRP and HDL-C (r=-0.16, p<0.05). Interestingly, subjects with fatty liver had shown increased serum hsCRP concentration than subjects without fatty liver (0.99±0.96 vs 0.58±0.69 mg/L, p<0.05). But there were no correlation of serum hsCRP with the history of smoking, sex, physical activity, fasting plasma glucose and presence of hypertension. After multiple regression analysis, only BMI and age were associated with serum hsCRP. In diabetic subjects, there were significant correlation of serum hsCRP with HDL-C and fasting plasma glucose, but other risk factors of cardiovascular diseases and fatty liver were not. When we compared serum hsCRP according to numbers of risk factors of cardiovascular diseases in nondiabetic subjects, group without risk factors had 0.41±0.55 mg/L, group with one risk factor had 0.48±0.40 mg/L, group with two risk factors had 0.75±0.88 mg/L, group with three risk factors had 1.08±0.87 mg/L and group with four risk factors had 1.55±1.21 mg/L. There was significant difference of serum hsCRP according to numbers of risk factors of cardiovascular diseases (p<0.05). Conclusion: Serum hsCRP is correlated with risk factors of cardiovascular diseases and may be useful tool for prediction of accelerated, atherosclerotic process in nondiabetic subjects. Although there is association of serum hsCRP with few risk factors of cardiovascular diseases, serum hsCRP is elevated in diabetic subjects. Therefore it is necessary to evaluate usefulness of serum hsCRP using carefully selected diabetic subjects. In addition, our study had show

내과 질환으로 입원한 환자의 영양상태

김유리(Y . L . Kim),김현만(H . M . Kim),임승길(S . K . Lim),이현철(H . C . Lee),허갑범(K . B . Huh),최은정(E . J . Choi),문수재(S . J . Moon) 대한내과학회 1988 대한내과학회지 Vol.35 No.5

N/A Nutritional assessment was performed on admission of 106 consecutive medical patients by anthropometry, biochemical tests, and dietary survey. Factors included in anthropometric measurements were height, weight, triceps skin fold, and mid-arm muscle circumference. Biochemical tests included serum total protein, serum albumin, and a complete blood cell count. Dietary intakes of nutrients before the development of disease were investigated by the 24 hour reca11 method. Using these parameters for malnutrition, (anthropometry<90% of standard value, serum albumin<3.0 g %, total lymphocyte count<1200/mm, intake of total calorie and protein<80fo of RDA, 39.6% of the patients showed a moderate degree of malnutrition. Based upon the above result, it could be concluded that the prevalence of malnutrition in hospitalized medical patients is similar to that indicated in foreign reports. This suggests that nutritional education for the general population, assessment of the nutritional status of patients, and nutritional support are needed for the prevention and effective treatment of disease.