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.

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.

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.-

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.

당뇨병성 족부궤양이 당뇨병환자의 재원기간 및 입원비용에 미치는 영향

김재문 ( Jae Moon Kim ),진홍용 ( Heung Yong Jin ),강선미 ( Sun Mi Kang ),김소영 ( So Young Kim ),박지현 ( Ji Hyun Park ),박태선 ( Tae Sun Park ),백홍선 ( Hong Sun Baek ) 전북대학교 의과학연구소 2007 全北醫大論文集 Vol.31 No.2

연구배경: 우리나라에서 아직까지 당뇨성 족부궤양이 재원기간 및 재원 비용에 대해 미치는 영향에 대해 잘 알려져 있지 않다. 비록 당뇨성 족부궤양에 의한 재원기간 및 비용들을 정확히 측정하기는 힘들지만 이러한 시도가 향후 경제학적인 측면 및 사회적 짐이 될 수 있는 측면에서 볼 때 효과적인 의료비 절감을 할 수 있는 방안에 영향을 줄 수 있겠다. 방법: 본 자료는 2005년 1월부터 12월까지 전북대 병원 내분비 내과 및 당뇨성 족부궤양 및 당뇨를 주소로 입원한 환자에 기초하여 조사 및 비교하였다. 이중 49명의 당뇨병성 족부궤양 환자 와 나이 및 성별이 비슷한 족부 궤양이 없는 당뇨병 환자 49명을 재원비용, 협진건수, 수술여부, Lab(TG, HDL, LDL, Cr, HbA1c, Insulin, C-peptide)등을 비교하였다. 결과: 당뇨성 족부궤양이 없는 환자보다 당뇨성 족부궤양이 있는 환자는 있어서 평균 재원기간 및 입원비용이 더 높았다. (46.5 ± 36.2 vs 23.0 ± 21.4 일, P<0.05), (9,114,079 ± 7,341,282 vs 5,770,949 ± 5,387,066 원 P<0.05). 또한 당뇨병성 족부궤양 환자중 수술환자는 23명이었으며 이중 8염이 Major operation을 받았으며 15명이 Minor operation을 받았다. 결론: 위와 같은 결과를 보았을 때 당뇨병성 족부궤양의 예방은 향후 당뇨환자에게 있어서 경제적 짐으로부터 벗어날 수 있게 함을 알 수 있다. 따라서 당뇨병환자를 관리할 때, 당뇨병성 족부궤양에 대한 예방 및 교육, 치료에 좀 더 많은 관심을 가져야 하겠고 이는 요즘 증가하고 있는 사회적 측면에서의 의료비 절감효과에도 영향을 미칠 수 있으리라 사료된다. Background: Few data has been reported about the impact of diabetic foot ulcer on the length of hospitalization and costs in hospital care in Korea. Although it is difficult to estimate precisely, this trial is necessary for efficient medical policy in the respect of social budget and health economy. Methods: From Jan. 2005 to Dec. 2005, diabetic patients who have been admitted in Chonbuk National University Hospital were reviewed according to the presence of foot ulcer. After that, admission days, costs, and treatment modality were compared with diabetic patients without foot ulcer. Results: The mean value of admission days and the direct costs of diabetic patients with foot ulcer were higher than those of diabetic patients without foot ulcer (46.5 ± 36.2 vs 23.0 ± 21.4 days, P<0.05), (9,114,079 ± 7,341,282 vs 5,770,949 ± 5,387,066 won P<0.05). Among diabetic patients with foot ulcer, 23 patients had been operated including of amputation and local debridement in operating room. Conclusion: From this data, we suggest that the prevention of diabetic ulcer has a significant economic benefit in the Korea healthcare budget. Therefore, specific foot care of diabetic patients may be more beneficial in the management of diabetic patients and multidisciplinary team approach with specialized foot clinics, if possible, should be performed in the future.

당뇨병 환자에 있어서 경동맥 두께와 angiotensin converting enzyme 유전자와 apolipoprotein E 유전자 다형성

김원(Won Kim),염정필(Jung Pil Yeom),김달식(Dal Sik Kim),박태선(Tae Sun Park),백홍선(Hong Sun Baek),강성귀(Sung Kyew Kang),박성광(Sung Kwang Park) 대한내과학회 2000 대한내과학회지 Vol.58 No.6

N/A Backgroud : To study the distribution of the polymorphism of apo E and angiotensin converting enzyme genotypes in type 2 diabetic patients and to evaluate possible association between the apo E genotypes and angiotensin converting enzyme genotypes and intima-media thickness of the common carotid artery. Methods : Study participants were 206 type 2 diabetic patients (112 men and 94 women), aged 18-81 years. HbA1C, albuminuria, and lipid status were assessed by standard laboratory techniques ; the apo E genotypes were assessed by modified amplification refractory mutation system of polymerase chain reaction technique and the angiotensin converting enzyme genotypes were assessed by multiplex polymerase chain reaction technique. The intima-media thickness was measured by high-resolution ultrasonography. Results : The apo E allele frequencies of patients were E2 11%, E3 72%, and E4 17%. Mean HDL-cholesterol was lower in E4 carrier (n=35) than E2 (n=148) and E3 (n=35) carrier. E2 carriers has less common carotid intima-media thickness than E3 and E4 carriers (p<0.05). The angiotensin converting enzyme genotypes were distributed as follows ; II 38%, ID 47%, DD 15%. The intima-media thickness value did not differ among patients with various genotypes. Multiple logistic regression analysis showed that only apo E polymorphism was determinant for the intima-media thickness. Conclusion : Our results suggested that apo E polymorphism was associated with carotid artery

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

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.

증예(症例) : 골다공증성 다발골절에 의한 하지마비로 내원한 쿠싱증후군 1예

정수진 ( Su Jin Jeong ),김소영 ( So Young Kim ),진흥용 ( Heung Yong Jin ),백홍선 ( Hong Sun Baek ),박태선 ( Tae Sun Park ),박지현 ( Ji Hyung Park ) 전북대학교 의과학연구소 2006 全北醫大論文集 Vol.30 No.2

저자들은 골다공증성 병적골절에 의한 하지마비와 통증으로 발현한 기능성 부신 피질 선종의 쿠싱증후군을 진단하고 수술 및 약물 치료를 통해 호전된 예를 경험하였기에 문헌고찰과 함께 보고 하는 바이다. (중심 단어 : 하반신마비, 쿠싱증후군, 골더 공증, 대사성 골질환) Osteoporotic vertebral fractures rarely cause neurologic deficits. We describe a case of paraplegia due to osteoporotic multiple pathologic fractures in a woman with Cushing`s syndrome. Pathologic fractures were seen in multiple ribs, left pubic bone, thoracic and lumbar vertebral bodies. These findings, accompanied by muscle weakness and fatigability, easy bruisability, plethoric face, irregular menstruation, were retrospectively compatible with those of Cushing`s syndrome, but she had no weight gain because of her calorie restriction. After adrenalectomy, the pain in her groin and back ceased. At 24-month follow-up, her BMD increased by 32% at the lumbar spine and 1.7% at the femoral neck. This case demonstrates the need to be alert for the possibility of metabolic bone disease, including Cushing`s syndrome, when we encounter paraplegia with multiple pathologic fractures in the middle-aged patients without trauma history.