복수의 감별진단에 있어서 복수내 Cholesterol 측정의 의의

성연아(Yeon Ah Sung),박성숙(Sung Sook Park),김순옥(Soon Ok Kim),박혜선(Hye Sun Park),문일환(Il Hwan Moon),박이갑(Lee Gap Park) 대한내과학회 1988 대한내과학회지 Vol.34 No.3

N/A In order to investigate the diagnostic value of ascitic fluid lipids analysis in differentiation between malignant from cirrhotic ascites, ascitic fluid concentration of cholesterol, triglycerides and phospholipids were compared with ascitic fluid total protein in 61 patients with ascites (38 with cirrhosis and 23 with malignant neoplasm). The results were as follows: 1) The median and mean values of each parameter were significantly higher in malignant ascites compared to cirrhotic ascites(p<0.01). 2) The discrimination values were 50 mg/dl for cholesterol, 43 mg/dl for triglycerides, 49 mg/dl for phospholipids, 2.5 g/dl for protein, 0.3 for ascitic fluid to serum ratio of cholesterol and 0.4 for ascitic fluid to serum ratio of protein, respectively. 3) Applying the discrimination value, diagnostic efficiency was 96.7% for cholesterol, 72.1% for triglycerides, 90.2% for phspholipids, 90.2% for total protein, 98.4% for ascitic fluid to serum ratio of cholesterol and 93.4% for ascitic fluid to serum ratio of protein, respectively. 4) There was a significant positive correlation between cholesterol and phospholipids (r=0.41, p<0.01), cholesterol and protein (r=0.80, p<0.01) phospholipids and protein (r=0.71, p<0.01), respectively. 5) There was no significant difference in serum concentration of cholesterol between patients with cirrhosis and malignant neoplasm in contrast to total protein. We concluded that ascitic fluid cholesterol determination and ascitic fluid to serum ratio of cholesterol were the two parameters which best differentiate cirrhotic from malignant ascites.

남자에서 테스토스테론과 대사증후군

성연아 ( Yeon Ah Sung ) 대한내과학회 2007 대한내과학회지 Vol.73 No.6

There is an evidence to suggest that testosterone is an important regulator of insulin sensitivity in men via effects on body fat distribution and insulin action in muscle. Observational studies have shown that metabolic syndrome is strongly associated with low testosterone levels in men and hypogonadism is likely a fundamental component of metabolic syndrome. Low testosterone could be not only an early marker of metabolic syndrome but also involved in the pathogenesis of disease processes from the prospective studies. Although obesity, insulin resistance and hypogonadism are certainly thought to be linked, the exact causal relationships among them remain unclear. Large population based prospective observational and intervention studies are needed to elucidate the exact causal relationship among testosterone and the components of metabolic syndrome. (Korean J Med 73:553-555, 2007)

양성 단일 갑상선결절의 L - Thyroxine 억제요법

성연아(Yeon Ah Sung),경난호(Nan Ho Kyung) 대한내과학회 1991 대한내과학회지 Vol.41 No.6

N/A Clinically apparent thyroid nodule is a very common disease in adults and patients with benign solitary thyroid nodules on aspiration biopsy often treated nonsurgically. We investigated the efficacy of thyroxine sup pressive therapy and the hormonal characteristics during thyroxine therapy to findout whether such measurements could be used to determine the effectiveness of this therapy in patients with benign solitary thyroid nodule proved by aspiration biopsy. Fifty-two patients were randomized to receive the L-thyroxine treatment (group I, n=28) or a placebo (group II, n=24). High resolution ultrasonography was used to measure the size of the nodules before and after treatment. The dose of thyroxine was adjusted until the TRH test was negative. Patients were followed at 3- month intervals. The results were as follows: 1) Twelve (42.9%) out of 28 Group I patients after adequate TSH suppression and 6 (25.0%) out of 24 Group II patients after 3 months had a reduction of nodule size, and before-to after nodule volume ratios were not significantly different between the Group I and Group II patients. 2) In 15-month follow-up periods, the nodule volume decrement was larger in Group I than Group II, but there was no statistical significance. 3) In the responders among Group I patients, the before-to-after therapy ratio of thyroglobulin was significantly higher than in the nonresponder. 4) In the responders among the Group I patients, the before-to-after therapy ratio of the nodule volume was not related to the pretreatment nodule size or thyroid hormone and thyroglobulin levels. Thus we concluded that an adequate suppressive dose of L-thyroxin did not alter the natural course of the benign solitrry thyroid nodules, and serum thyroglobulin measurements may prove a useful indicator of the efficacy of thyroxine therapy.

췌장소도세포에서 인지질분해산물에 의한 Guanine Nucleotide 결합단백질 활성의 조절

성연아(Yeon Ah Sung),경난호(Nan Ho Kyung) 대한내과학회 1995 대한내과학회지 Vol.49 No.1

N/A Objectives: Physiologic secretagogues of insulin, such as glucose, work via the generation of soluble mediators. One group of such mediators consists of phospholipid hydrolytic products generated by phospholipases A2 and D endogenous to pancreatic islets. Experimental data also suggest that some of these lipid second messengers may regulate the function of certain G-protein in different cell types, such as brain cells and neutrophils. Based on the available in- formation on the potential regulator properties of G-protein function by these lipids and their purported role in insulin secretion, we undertook the present investigation to determine whether the functional properties of G-proteins, are regulated by these lipids in normal pancreatic islets. Methods: After isolation and subcellular fractionation of normal rat pancreatic islets, we measured the effects of phospholilpid hydrolytic products (arachidonic acid, lysophospholipids, phosphatidic acid) on GTP binding, GTPase activity, and GDP/GTP exchange activity in each subcellular fractions Results: 1) Arachidonic acid and lysophospholipids(lysophosphatidylcholine or lysophosphatidylinositol) inhibited GTPase activity in all of the subcellular fractions of normal rat pancreatic islets, but phosphatidic acid inhibited GTPase activity in plasma membrane and cytosol. 2) Arachidonic acid, lysophosphatidylcholine and phosphatidic acid increased the GTP binding and GDP/GTP exchange activity in normal rat pancreatic islets. Conclusion: Insulinotropic lipids regulate the activity of G-protein in a manner that would pro- mote the maintenance of G-proteins in their active (GTP bound) configuration.

한국인 당뇨병의 진단을 위한 당화혈색소 측정의 유용성

성연아 ( Yeon Ah Sung ) 대한내과학회 2011 대한내과학회지 Vol.80 No.3

Glycated hemoglobin (HbA1c, A1C) is a widely used marker of chronic glycemia, reflecting average blood glucose levels over a 2- to 3-month period of time. Recently role of A1C in diagnosing diabetes has been extensively reviewed and International Expert Committee and American diabetes Association recommended the use of the A1C test to diagnose diabetes, with a threshold of ≥ 6.5%. The diagnostic A1C cut point of 6.5% is associated with an inflection point for retinopathy prevalence, as are the diagnostic thresholds for plasma glucose levels. But A1C levels vary with different races. Meta-analyses for previous studies regarding A1C cut off value for plasma glucose in Koreans and determination of A1C cut point based on the development of diabetic microvascular complications in community based cohorts should be performed to establish diagnostic A1C cut point in Korean population. (Korean J Med 2011;80:288-290)

인슐린 비의존성 당뇨환자에서 도플러 심초음파를 이용한 좌우 심실 이완기 기능평가

김성배(Sung Bae Kim),변정란(Jeong Ran Byun),강성인(Sung In Kang),강덕희(Duck Hee Kang),성연아(Yeon Ah Sung),신길자(Gil Ja Shin),이우형(Woo Hyung Lee),경난호(Nan Ho Kyung) 대한내과학회 1991 대한내과학회지 Vol.40 No.3

N/A Doppler echocardiagrams of the mitral and tricuspid valve were recorded along with electrocardiograms from 32 non-insulin dependent diabetes and 17 normal subjects (1) to determine whether a relation existed between the microangiopahtic complications and the patterns of diastolic filling. (2) to evaluate the diastolic LV&RV filling characteristics in non-insulin dependent diabetic patients, and correlation between LFKRV filling parameters. The diabetics were divided into 3 groups according to the number of microangiopathic complications i.e., peripheral neuropathy, nephropathy, retinopathy. (Group I:10 cases without complications Group II:12 cases with 1, 2 complications Group III:10 cases with 3 complications) The results were as follows. 1) No significant difference was found among groups for PFVE 8r, AT in Lt&Rt ventricular filling pattern. 2) PFVA in control (Lt:53.64±16.88, Rt:30.23±7.54) and Group L(Lt:57.4±15.02, Rt:38.44±8.58) were significantly decreased (Lt:p<0.005, p<0.025, Rt:p<0. 005, p<0.05) compared to Group III (Lt:71.8±15.24, Rt: 44.6±89) 3) E/A ratio in contro (Lt:1.30±0.33+Rt:1.59±0.28) and Group I(Lt:1.09±0.28, Rt:1.27±0.35) were significantly increased (Lt:p<0.005,p<0.05, Rt:p<0,05, p<0.05) compared to Group III(Lt:1.11±0.28), 4) DT was prolonged in groups with more microgagniopathic complication, but it showed no significant differences among groups(p>0.05). 5) There was a significant correlation in PFVE, E/A ratio, deceleration time between the left and right ventricular inflow pattern, (r=0.56, 0.60, 0.47 respectively) Data indicated that indexes of RV diastolic dysfunction were closely related to corresponding LV diastolic filling parameters (PFVE, E/A ratio, DT), and a correlation existed between diabetic microangiopathic complications and diastolic filling pattern.

특집- 비만 : 비만: 서론

송도경 ( Do Kyeong Song ),성연아 ( Yeon Ah Sung ) 대한내과학회 2013 대한내과학회지 Vol.84 No.5

Obesity is defined as abnormal or excessive fat accumulation that presents a risk to a number of chronic diseases, including diabetes, cardiovascular diseases and cancer. Therefore, obesity is associated with decreases in life expectancy. Also weight loss of 5-10% is associated with clinically significant health benefits. In Korea, a person with a body mass index of 25 kg/m2 or more is considered obese. In 2012, the U.S. Preventive Services Task Force (USPSTF) recommended screening all adults for obesity and USPSTF advised that clinicians offer or refer patients with obesity to intensive, multicomponent behavioral interventions. In Korea, management of obesity 2010 recommendation was published but there is no recommendation about screening for obesity. Because of the increasing prevalence of obesity, new recommendations on screening and efficient treatment for obesity and overweight are needed in Korea. (Korean J Med 2013;84:619-623)

당뇨병 Statement : 당뇨병 진단에서 헤모글로빈A1C의 이용

이혜진 ( Hye Jin Lee ),성연아 ( Yeon Ah Sung ) 대한당뇨병학회 2009 임상당뇨병 Vol.10 No.3

도시지역사회 성인에서 20세 이후의 체중변화와 당뇨병 발생간의 상관관계

홍영선(Young Sun Hong),성연아(Yeon Ah Sung),경난호(Nan Ho Kyung),최은영(Eun Young Choi) 대한내과학회 1999 대한내과학회지 Vol.56 No.4

N/A Objective : The role of obesity in the pathogenesis of NIDDM has long been recognized. However, the relation between weight change and risk for diabetes has been less well defined and earlier studies have shown inconsistent results. We conducted a cross-sectional study to evaluate the relationship between weight change after 20 years of age and the risk of NIDDM in the Korean urban population. Methods : From April 1997 to February 1998, we examined 642 subjects among a total of 776 persons aged over 30 years living in Mokdong apartment area selected using a random cluster sampling method for the survey of the prevalence of diabetes in urban area. After 75g oral glucose tolerance test, they were diagnosed with normal glucose tolerance or diabetes by WHO criteria. We excluded the subjects with impaired glucose tolerance. We obtained the data about weight change since 20 years of age and measured the current weight, height and waist-hip ratio. Results : 1) Among 642 subjects, 46 were diabetic and the prevalence of diabetes was significantly increased with the increase of BMI in both men and women but with the increase of waist-hip ratio only in women. 2) The weight gain between 25 and 30 years of age was significantly greater in the subjects aged 30-39 than the older age groups. 3) In both men and women, weight gain of greater than 10 kg after 30 years of age increased the risk of diabetes. In women, weight gain greater than 20 kg between 20 years of age and the time of maximal obesity also increased the risk of diabetes. However, the significant risk factors for diabetes were age in men, whereas age and waist-hip ratio in women by multiple logistic regression analysis. 4) In women, weight gain less than 10kg after 30 years of age decreased the risk of diabetes, independent of age, BMI and family history of diabetes. Conclusion : Moderate weight gain after 30 years of age in women reduced the risk of diabetes. Extreme weight gain after 30 years of age in both men and women is related with high prevalence of diabetes. And in women, weight gain associated with pregnancy and otherwise after 20 years of age increased the risk of diabetes. However, the significance was disappeared after adjustment for age, BMI and family history of diabetes. The prospective study about the relationship between weight changes and the risk of diabetes would be needed.

아급성 갑상선염의 임상적 고찰

김희진(Hee Jin Kim),성연아(Yeon Ah Sung),경난호(Nan Ho Kyung) 대한내과학회 1997 대한내과학회지 Vol.53 No.2

N/A Objectives: Subacute thyroiditis is a nonsuppurative inflammation of thyroid gland and is probably caused by a cytopathic virus. Typical clinical symptoms and features of subacute thyroiditis vary widely during the course of illness. It has a clinical course, evolving from hyperthyroidism through a temporary hypothyroidism to recovery. However, the final outcome of this disease remains unpredictive in some patients. Permanet hypothyroidism occurs infrequently. Methods : Thirty-three patients proven to have subacute thyroiditis at the Ewha Womans University Hospital from September 1993 to November 1995 were studied. We analyzed their clinical features, laboratory findings, and duration of recovery to cha- racterize the course of the disease. Results : 1) Total 33 patients were studied: 31 patients were female and 2 patients were male. Their mean age was 42.6±8.3 years old. The peak months were August through October in this study. 2) Initial mean ESR was 73.0±35.2mm/hr, mean T3 was 217.3±73.9ng/dl, mean T4 was 15.2±8.5μg/ dl, and TSH was 0.06±0.09μIU/ml. The positive rates of antithyroglobulin and anitmicrosomal antibodies were 31% and 6% respectively, and TSH receptor antibody was elevated in one patient. 3) In the thyroid scan, 91% showed both lobes nonvisualisation, and 9% showed one lobe nonvisualization. Radioactive iodine uptake(RAIU) at 24 hour was 2.4±3.3%. 4) With the predisolone therapy, 90% of patients completely recovered, 57% of these patients had no hypothyroid phase and remaining 33% of them had hypothyroid phase during course of the disease. Three of the patients had permanent hypothyroidim. 5) The average duration of recovery was 3.2±1.4 months and it has no correlation with initial thyroid hormone levels, antithyroid antibodies and duration of steroid administration. Conclusion : There was no historical, physical, laboratory findings that help us predict those patients likely to have an exacerbation of the disease.