지난 2년간의 학회지 "신경정신의학" 심사 평가보고

김찬형,김세주,김도관,김성곤,박원명,송동호,박용천,이영문,오강섭,정영철,이상열,김주한,이동영,이헌정,함병주,김율리,김문두,김정진,이강욱,천근아,김재진,홍진표,홍승철 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.6

Differences in Insulin Sensitivity and Secretory Capacity Based on OGTT in Subjects with Impaired Glucose Regulation

( Sang Youl Rhee ),( Mi Kwang Kwon ),( Byong Jo Park ),( Suk Chon ),( In Kyung Jeong ),( Seung Joon Oh ),( Kyu Jeung Ahn ),( Ho Yeon Chung ),( Sung Woon Kim ),( Jin Woo Kim ),( Young Seol Kim ),( Jeon 대한내과학회 2007 The Korean Journal of Internal Medicine Vol.22 No.4

Background: This study examined whether defects in insulin secretion contribute to the development and progression of type 2 diabetes mellitus (T2DM). Methods: Plasma insulin and glucose were measured after a glucose tolerance test to calculate the insulinogenic index (IGI) and the HOMA-IR Homeostasis model assessment of insulin resistance in subjects with normal glucose tolerance (NGT), prediabetes (preDM, n=49), and T2DM patients with disease duration <1 year (n=84), 1~5 years (n=45), or >5 years (n=37). Plasma proinsulin and adiponectin levels were also measured as a parameter of insulin secretion and resistance. Results: The mean HOMA-IR increased and the adiponectin levels decreased relative to the deterioration of glucose tolerance in NGT and preDM subjects. However, differences in the HOMA-IR were not related to disease duration in T2DM subjects. The mean IGI was similar in NGT and preDM subjects, but there were significant deteriorations in IGI relative to the duration of diabetes. Conclusions: Defects in both insulin sensitivity and insulin secretion contribute to T2DM, but decreased insulin secretion may be more important in the development and progression of T2DM.

S-656 Empyema necessitatis caused by Streptococcus agalactiae: a case report and revie w of literatures

( Dong Youn Kim ),( Sang Youl Rhee ),( Ki Ho Park ),( Yu Jin Kim ),( Suk Chon ),( Seungjoon Oh ),( Jeong-taek Woo ),( Sung Woon Kim ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1

Empyema necessitatis is a rare complication of empyema that is defined by the extension of an empyema from pleural cavities to the surrounding structures. It is usually occurred after thoracic surgery, or caused by tuberculosis (TB) or actinomycosis. Streptococcus agalactiae hasn’t been reported as the causative agent of empyema necessitatis. We report the case of empyema necessitatis caused by Streptococcus agalactiae. A 72-year-old female presented to hospital with complaints of right shoulder pain and swelling of right upper chest of 2 weeks duration. While the patient had a history of diabetes and peripheral arterial occlusive disease, she had not history of tuberculosis and thoracic surgery. Computed tomography (CT) confirmed a consolidation on peripheral portion of right upper lobe apex with extension through anterior chest wall with abscess formation. Percutaneous tube thoracostomy of right upper chest wall mass was performed. Culture of the abscess was positive for Streptococcus agalactiae, which was highly penicillin-susceptible. After the drainage and the administration of penicillin, chest wall mass was reduced in size and upper chest wall pain improved. After 4weeks, chest CT revealed marked improvement of abscess. We searched articles about empyema necessitatis caused by bacteria in the English literature up to 2015, using Pubmed and Medline. After excluding TB, actinomycosis, fungus causes, and non-infectious causes, we identified 18 cases of empyema necessitatis. 13 (72%) patients were male, and the median age was 28 years (range, 4 week-72 years). The most frequently isolated organisms were Staphylococcus aureus (61% [11/18]), with 63% (7/11) being methicillin-resistant. Although TB and actinomycosis have been reported to be most common causes of empyema necessitatis, but here we found that pyogenic bacteria were not uncommon etiology of these infections. Therefore, when the clinicians encounter the patients with suspected empyema necessitatis, pyogenic bacteria as well as TB and actinomycosis should be considered in differential diagnosis. Empyema necessitatis caused by drug-resistant organisms such as methicillin-resistant S. aureus challenge the clinicians who treated these diseases.

Prevalence of Chronic Complications in Korean Patients with Type 2 Diabetes Mellitus Based on the Korean National Diabetes Program

Rhee, Sang Youl,Chon, Suk,Kwon, Mi Kwang,Park, Ie Byung,Ahn, Kyu Jeung,Kim, In Ju,Kim, Sung-Hoon,Lee, Hyoung Woo,Koh, Kyung Soo,Kim, Doo Man,Baik, Sei Hyun,Lee, Kwan Woo,Nam, Moon Suk,Park, Yong Soo,W Korean Diabetes Association 2011 Diabetes and Metabolism Journal Vol.35 No.5

<P><B>Background</B></P><P>The Korean National Diabetes Program (KNDP) cohort study is performing an ongoing large-scale prospective multicenter investigation to discover the pathogenesis of type 2 diabetes in Korean patients. This study was performed to examine the prevalence of chronic complications in patients with type 2 diabetes among those registered in the KNDP cohort within the past 4 years.</P><P><B>Methods</B></P><P>This study was performed between June 2006 and September 2009 at 13 university hospitals and included 4,265 KNDP cohort participants. Among the participants, the crude prevalence of microvascular and macrovascular diseases of those checked for diabetes-related complications was determined, and the adjusted standard prevalence and standardization of the general population prevalence ratio (SPR) was estimated based on the 2005 Korean National Health and Nutrition Examination Survey (KNHANES) population demographics.</P><P><B>Results</B></P><P>Among the KNDP registrants, 43.2% had hypertension, 34.8% had dyslipidemia, 10.8% had macrovascular disease, and 16.7% had microvascular disease. The SPR of the KNDP registrants was significantly higher than that of the KNHANES subjects after adjusting for demographics in the KNHANES 2005 population. However, with the exception of cardiovascular disease in females, the standardized prevalence for the most complicated items in the survey was significantly higher than that in the KNHANES subjects.</P><P><B>Conclusion</B></P><P>The prevalence of macrovascular disease and peripheral vascular disease were significantly higher in Korean patients with type 2 diabetes than in the normal population. However, no significant difference was noted in the prevalence of cardiovascular disease in females.</P>

The Changes in Early Phase Insulin Secretion in Newly Diagnosed, Drug Naive Korean Prediabetes Subjects

Rhee, Sang Youl,Kim, Joo Young,Chon, Suk,Hwang, You Cheol,Jeong, In Kyung,Oh, Seungjoon,Ahn, Kyu Jeung,Chung, Ho Yeon,Woo, Jeong-taek,Kim, Sung Woon,Kim, Jin-Woo,Kim, Young Seol Korean Diabetes Association 2010 Korean diabetes journal Vol.34 No.3

<P><B>Background</B></P><P>There have been no systematic observations regarding changes in early phase insulin secretion among Korean prediabetes and early stage type 2 diabetes mellitus (T2DM) patients.</P><P><B>Methods</B></P><P>We conducted 75-g oral glucose tolerance tests (OGTT) in 873 subjects with suspected abnormal glucose tolerance. All subjects were diagnosed as having normal glucose tolerance (NGT), prediabetes (preDM), or T2DM according to the OGTT results and the insulin secretory and insulin resistance indices of each subject were calculated. Additionally, we analyzed the changes in early phase insulin secretion according to changes in fasting (Glc<SUB>0</SUB>), post-prandial (Glc<SUB>120</SUB>) glucose and HbA1c (A1c) levels.</P><P><B>Results</B></P><P>As compared to subjects with NGT, the insulin secretory indices of the preDM and T2DM subjects progressively declined, and the insulin resistance indices were progressively aggravated. Early phase insulin secretion decreased rapidly according to the increments of Glc<SUB>0</SUB>, Glc<SUB>120</SUB> and A1c, and these changes were most prominent in the NGT stage. Compared to the control group, the early phase insulin secretion levels of the preDM or T2DM subjects were less than 50% when Glc<SUB>0</SUB> was over 100 mg/dL, Glc<SUB>120</SUB> was over 145 mg/dL, and A1c was over 5.8%.</P><P><B>Conclusion</B></P><P>This study suggests that progressive beta cell dysfunction in Koreans may be initiated and rapidly aggravated during the period generally designated as 'normal.'</P>

Unilateral Diaphragmatic Paralysis after Thyroid Surgery

변종규,이상열,김유진,엄유진,김슬기,손정일,진상욱,전숙,김우식,김주영,이병욱,우정택,김영설,Byun, Jong Kyu,Rhee, Sang Youl,Kim, Yu Jin,Um, Yu Jin,Kim, Seul Ki,Son, Jung Il,Chin, Sang Ouk,Chon, Suk,Kim, Woo-Shik,Kim, Joo Young,Lee, Byoung Woo The Korean Society for Head and Neck Oncology 2014 대한두경부 종양학회지 Vol.30 No.2

갑상선 암 진단과 치료기술이 발전하면서 최근 그 수술 건 수가 급격하게 증가하고 있다. 하지만이와 관련된 합병증과 부작용을 면밀하게 평가해야 할 필요 역시 점차 늘어나고 있다. 갑상선 암 수술 후 발생할 수 있는 드문 합병증의 하나로 횡격막 신경마비(phrenic nerve paralysis)가 있다. 이러한 횡격막신경마비는 대부분 증상이 경미하고 쉽게 호전되어 임상적으로 크게 중요하게 다루어지지 않았다. 하지만, 갑상선 수술 후 갑작스런 호흡곤란이 발생한다면 횡격막 신경마비에 의한 횡격막 마비(diaphragmatic paralysis)와 관련되었을 가능성을 놓치지 말아야 한다. 저자들은 최근 갑상선암 수술 후 발생한 호흡곤란으로 2년 동안 심각한 호흡곤란을 호소하던 73세 여자환자에서 투시촬영(fluoroscopy) 상 편측으로 상승되고 운동성이 저하된 횡격막을 확인하여 일측성 횡격막신경마비(Unilateral phrenic nerve paralysis)를 확진 하였다. 갑상선수술 후 발생하는 일측 횡경막 신경마비는 임상에서 드물게 관찰되는 수술 합병증이기에 환자는 상당기간 이에 대한 감별이 제대로 이루어지지 않았다. 우리는 횡격막 마비의 조기 진단과 적극적인 치료를 통하여 심한 호흡곤란을 호소하는 환자의 증상 및 병의 경과를 호전 시킬 수 있었다.

Analysis of diabetes quality assessment findings and future directions for the appropriate manage-ment of diabetes in Korea

( Yu Jin Kim ),( Suk Chon ),( Seungjoon Oh ),( Jeong-taek Woo ),( Sung Woon Kim ),( Sang Youl Rhee ) 대한내과학회 2019 The Korean Journal of Internal Medicine Vol.34 No.1

Background/Aims: Due to recent increases in the disease burden of diabetes mellitus, the Health Insurance Review and Assessment Service (HIRA) of Korea implemented a quality assessment of the treatment of diabetes to improve patient care. The present study was conducted to identify any changes after the implementation of the diabetes quality assessment (DQA). Methods: The present study evaluated eight quality assessment indicators that were proposed by the HIRA in all patients with diabetes who visited a university hospital in Korea between 2009 and 2014. The indicators were statistically compared according to the characteristics of the subjects. Results: There were several significant differences in the indicators among the subjects according to their demographic characteristics. Female patients had a higher continuity of treatment (COT) than that of male patients, and the insulin-treated group had a higher COT than that of the non-treated group, as well as a higher rate of undergoing the diabetes complication tests (DCTs). Patients between 40 and 80 years of age had the highest COT, while patients under 40 years of age had the lowest COT but the highest rate of taking the DCTs. Patients receiving treatment from an endocrinologist exhibited higher numbers of DCTs performed but displayed lower proportions for the prescription indicators. Conclusions: The present analysis of the DQA findings revealed that endocrinologists combine prevention and management of diabetes complications with measures for glycemic control. Thus, the effective management of diabetes likely entails systematic joint treatment regimens that involve an endocrinologist.

압력센서가 내장된 보행 분석기를 통한 아치 형성 보행의 생역학적 변수의 특성

이배열 ( Bae Youl Lee ),유승돈 ( Seung Don Yoo ),이승아 ( Seung Ah Lee ),전진만 ( Jinmann Chon ),김동환 ( Dong Hwan Kim ),정용설 ( Yong Seol Jeong ),노성규 ( Seong Gyu Noh ),이미애 ( Mi Ae Lee ),이우진 ( Woo Jin Lee ),김은혜 ( Eun 대한스포츠의학회 2016 대한스포츠의학회지 Vol.34 No.1

The objective of study was to compare biomechanical parameters between normal and arch building gait in healthy subjects. A total of 40 feet from 20 healthy adults were evaluated in this study. The participants were asked to walk on a treadmill comfortably at 2 km/hr for 30 seconds. Then, they were asked to walk after making arch building through raising arches with their feet by pulling the big toe toward the heel. Gait parameters such as geometry, center of pressure, maximum force, and maximum pressure were measured in normal and the arch building gait using a gait analysis system equipped with pressure sensor. Arch building gait demonstrated significantly (p<0.01) decreased forefoot maximum force but significantly (p=0.024) increased heel maximum force compared to normal gait. Maximum pressures of the midfoot and heel were also significantly (both p<0.01) increased. However, the maximum pressures of the forefoot were not significantly (p>0.05) different between the two conditions. Geometry, phase, and time parameters were not significantly (p>0.05) different between the two conditions, either. Although forefoot and midfoot maximum force were significantly decreased in arch building gait compared to those in normal gait, the maximum pressure of forefoot was not significantly changed, indicating decreased area of forefoot contact during arch building gait. The arch building gait moves the center of presser to the hind foot and redistributes the contact area, thus changing the distribution of maximum pressure.

증례 : 내분비-대사 ; 우연히 발견된 부신피질 과립세포종 1예

김동현 ( Dong Hyun Kim ),성지연 ( Ji Youn Sung ),이상열 ( Sang Youl Rhee ),박소영 ( So Young Park ),손정일 ( Jung Il Son ),진상욱 ( Sang Ouk Chin ),전숙 ( Suk Chon ) 대한내과학회 2013 대한내과학회지 Vol.84 No.4

부신피질 과립세포종은 매우 드문 부신종양으로, 대개 비기능성이기 때문에 우연히 발견되는 경우가 많다. 최근 저자들은 고혈압 병력을 가진 54세 남성에서 좌측부신에 위치하는 양성 비기능성 부신피질 과립세포종을 경험하였다. 이에 이번 증례와 함께 최근 발표된 문헌들에 대한 고찰을 하였다. 그 희귀성에도 불구하고 부신피질 과립세포종은 부신종양의 진단 시 반드시 감별하여야 하는데 이는 양성과 악성의 분류기준의 차이 및 예후의 차이 등에 기인하며 이를 위하여 임상소견, 생화학적 검사 및 조직학적 특징에 대한 평가가 필요하다. Adrenal oncocytomas are very rare. Because most of them are benign and nonfunctioning, they are detected incidentally. Here, we report a case of nonfunctioning benign adrenocortical oncocytoma located in the left adrenal gland in a 54-year-old man who presented with no symptoms. The tumor was 4.5 × 3 × 3 cm in size and was predominantly composed of oncocytes, which exhibited abundant eosinophilic granular cytoplasm and were arranged with a nested or diffuse architecture without capsular or vascular invasion. Nuclear atypia and mitotic figures were not observed. A discussion of this case and a review of recent updates in the literature are presented. In patients with adrenocortical oncocytomas, treatment is similar to that for adrenocortical neoplasia. However, due to the risk of over-diagnosis of malignancy, and the better clinical outcomes associated with adrenocortical oncocytoma, more attention should be paid to the diagnosis of adrenocortical oncocytoma. (Korean J Med 2013;84:581-585)

Impaired fasting glucose levels in overweight or obese subjects for screening of type 2 diabetes in Korea

( Jin-hee Lee ),( Suk Chon ),( Seon-ah Cha ),( Sun-young Lim ),( Kook-rye Kim ),( Jae-seung Yun ),( Sang Youl Rhee ),( Kun-ho Yoon ),( Yu-bae Ahn ),( Jeong-taek Woo ),( Seung-hyun Ko ) 대한내과학회 2021 The Korean Journal of Internal Medicine Vol.36 No.2

Background/Aims: We examined the concordance rate among fasting plasma glucose (FPG), 2-hour post-challenge glucose (2hr PG), and hemoglobin A1c (HbA1c) in the diagnosis of diabetes in a population with a high-risk for type 2 diabetes mellitus (T2DM) in Korea. Methods: Among the participants from the Korean Diabetes Prevention Study, individuals with FPG ≥ 100 mg/dL, body mass index (BMI) ≥ 23.0 kg/m², and no previous history of T2DM were consecutively enrolled after a 75 g glucose tolerance test. We analyzed the differences in the clinical characteristics in subjects with stage 1 (FPG, 100 to 109 mg/dL) and stage 2 (FPG, 110 to 125 mg/dL) impaired fasting glucose (IFG). Results: Of 1,637 participants, 27.2% had T2DM and 59.3% had IFG and/or impaired glucose tolerance (IGT). The mean age was 55.0 ± 8.1 years and the mean BMI was 26.3 ± 2.7 kg/m². Based on FPG criteria, 515 (31.4%) and 352 (21.5%) subjects were classified as having stage 1 and stage 2 IFG, respectively. The 19.0% of stage 1 and 43.5% of stage 2 subjects showed 2hr PG levels in the diabetic range. Even for those in the normal FPG range, 63 (9.5%) participants showed a 2hr PG level of ≥ 200 mg/dL. Of 446 subjects with newly-diagnosed diabetes, 340 (76.2%) showed FPG levels < 126 mg/dL. Conclusions: The oral glucose tolerance test should be actively considered for Korean adults who are overweight or obese with the IFG range (FPG, 100 to 125 mg/ dL) to allow for early detection of diabetes and prompt intervention.