The Usefulness of the Glycosylated Hemoglobin Level for the Diagnosis of Gestational Diabetes Mellitus in the Korean Population

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.

증례 : 좌측 신장 무형성과 척추기형을 동반한 선천적 배측 췌장 발육 부전증 1예

류아정 ( Ah Jeong Ryu ),이재준 ( Jae Jun Lee ),문현진 ( Hyeon Jin Moon ),전석재 ( Seok Jae Jeon ),박순현 ( Soon Hyeon Park ),이재민 ( Jae Min Lee ),박강서 ( Kang Seo Park ) 대한내과학회 2012 대한내과학회지 Vol.83 No.2

7년 전부터 당뇨병으로 인슐린 치료 중이던 24세 남자 환자가 내원일 오전에 발생한 복부 불편감을 주소로 내원하였고, 복통에 대한 검사 중 복부 전산화 단층촬영 결과 배측췌장 발육 부전증과 좌측 신장 및 12번 흉추의 좌측 추궁근 결손이 발견되었다. 자기공명 담췌관조영술에서 주 췌관은 정상적이었으며 산토리니관(Santorini-duct) 및 체부와 미부의 췌관은 관찰되지 않았다. 저자는 복부 전산화 단층촬영과 자기공명 담췌관조영술을 통해 선천적 배측 췌장 발육 부전증과 동반된 신장 및 척추의 기형을 진단하였고, 이에 다발성 선천성 기형과 당뇨병이 동반된 배측 췌장 발육 부전증 1예를 보고하는 바이다. Agenesis of the dorsal pancreas is a rare congenital anomaly that arises from the failure of the dorsal pancreatic bud of endodermal cells to form the body and tail of the pancreas and can manifest as diabetes. A 24-year-old man, who had been treated with insulin for 7 years, presented with epigastric pain, vomiting, and watery diarrhea. Abdominal computed tomography showed only the head of the pancreas without visualization of the pancreatic body and tail. Left renal agenesis and absence of the left vertebral pedicle in T12 were also observed. The duct of Santorini and the duct in the body and tail were not visible in magnetic resonance cholangiopancreatography. The associated anomalies reported here are very rare globally. We report a case of complete agenesis of the dorsal pancreas with multiple congenital abnormalities and diabetes mellitus.

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.

Long-Term Survival after T-cell Lymphoblastic Lymphoma Treated with One Cycle of Hyper-CVAD Regimen

유일환,조인성,류아정,김민규,전재웅,김주석,이재준,최지욱,강동욱 대한암학회 2015 Cancer Research and Treatment Vol.47 No.1

T-lymphoblastic lymphoma (T-LBL) is a rare form of aggressive non-Hodgkin’slymphoma. The standard approach for management of T-LBL involves intensivemultiagent chemotherapy regimens for induction and consolidation phases withcentral nervous system prophylaxis and a maintenance phase lasting 12-18 months. We report on a case of long-term survival after one cycle of hyperfractionatedcyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD) andhigh-dose methotrexate. A 30-year-old woman diagnosed with T-LBL with a largemediastinal mass underwent one cycle of hyper-CVAD. Four days after the start oftreatment, the mediastinal mass was markedly reduced. Treatment continued withone cycle of consolidation chemotherapy, comprising high-dose methotrexate andhigh-dose cytarabine. The patient then refused all further chemotherapeutictreatment. Seven years have passed without relapse.

조기 위암 환자의 겸자 조직 검체와 내시경 절제술 검체의 병리학적 진단의 차이

김주석,김새희,김민규,류아정,유일환,이재준,전재웅,최지욱,김안나 고신대학교(의대) 고신대학교 의과대학 학술지 2014 고신대학교 의과대학 학술지 Vol.29 No.2

Objective: Endoscopic resection(ER) is effective therapy on EGC and which is treated according to the histological diagnosis of forcep biopsy. But sometimes the histological diagnosis of forcep biopsy and post-ER does not match with each other and it might lead to wrong treatment. The aim of this study is to find the frequency of histologic differences between forcep biopsy and post-ER, and to confirm the characteristics of lesions which make errors. Methods: We selected the confirmed cancer cases of 141 patients of 1359 gastric tumor lesions which were treated under the ER in Eulji university hospital from May 2005 to March 2013. They were sorted by the age and sex of patient, location of lesion, present of ulcer and depression to identify the discordance between forcep biopsy and ER. The discordant group was compared with non-cancer-diagnosed controlled group, retrospectively. Results: 70 cases(5.5%) of 1283 cases of “cancer negative” in forceps biopsy were found to be diagnosed cancer on final diagnosis of cancer by post-ER result. In this discordant group showed characteristics of bigger size that are with more frequently in tumor size 15mm(17.9% vs. 31.4%, p=0.03), have depressed lesion(14.3% vs. 41.4%, p<0.01) and have ulceration(2.4% vs.18.6%, p<0.01) than that of 84 control group not diagnosed cancer. Conclusions: In cases of tumor with size 15mm, presented with depressed lesion and ulceration, we should consider combined cancer, even the result of forcep biopsy was negative. Therefore, more careful and accurate resection should be taken with characters listed above.