십이지장 점막하 종양으로 나타난 원발성 대동맥-십이지장루 1예

송도경,심기남,강혜원,권경주,송은미,최주영,김태헌,김성은,문일환,정성애,정혜경,유권 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.-

십이지장 점막하 종양으로 나타난 원발성 대동맥-십이지장루 1예

송도경,심기남,강혜원,권경주,송은미,최주영,김태헌,김성은,문일환,심기남,정성애,정혜경,유권 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1

배경: 대동맥-장관루는 드문 질환으로 원발성 대동맥-장관루는 부검에서 0.04-0.07%, 그리고 복부 대동맥류가 있는 경우 0.69-2.36%가 발견된다. 대동맥-장관루는 원발성 또는 이차적 원인에 의한 것으로 구분되는데 원발성 대동맥-장관루의 경우 동맥 경화증이 주요한 인자이다. 원발성 대동맥-장관루의 치사율은 매우 높은데, 발생빈도가 적고 대량 출혈 전에 진단하기가 어려우며 대량 출혈로 인한 응급 수술을 요하기 때문이다. 증상으로는 측부통 또는 복통, 토혈, 흑색변, 그리고 복부 이물감 등이 있다. 저자는 토혈을 주소로 내원한 환자에서 십이지장 점막하 종양으로 나타난 원발성 대동맥-장관루를 경험하였기에 보고하는 바이다. 증례: 83세 남자가 내원 5일 전부터 흑색변이 있었고 내원 당일 시작된 토혈을 주소로 내원하였다. 환자는 과거력에서 특이소견이 없었다. 혈압은 128/70 mmHg, 맥박 95/min, 호흡수 22/min, 체온 38℃이었다. 급성 병색이었고 결막은 다소 창백하였다. 복부 진찰에서는 압통, 반발통은 없었고 종괴나 장기의 비대는 촉지되지 않았으며 직장수지 검사에서 흑색변이 관찰되었다. 혈액검사에서 Hb 12.5 g/dL, Hct 37.4%, WBC 21,300/mm3, Platelet 158,000/mm3, Electrolyte 141/4.2/103/14 mEq/L, BUN / Cr 12/1.3 mg/dL, AST/ALT 23/18 IU/L, TB 0.7 mg/dl였다. 응급 상부위장관 내시경에서 십이지장 2구역에 약 3 cm 크기의 점막하 종양이 관찰되었으며 종양의 상부에 궤양이 있었으며 궤양 중앙부에 노출된 혈관에서 출혈이 지속되는 것을 볼 수 있었다. 복부 혈관조영 CT에서 신동맥 하방으로 복부 대동맥류가 관찰되었으며 대동맥류와 십이지장간 생긴 루를 통하여 조영제가 십이지장 강 안으로 새는 것이 보였다. 환자는 응급 수술을 준비하던 중 출혈성 쇼크로 심정지 되었고 심폐소생술을 30분 동안 시행하였으나 사망하였다.

Increased Epicardial Adipose Tissue Thickness in Type 2 Diabetes Mellitus and Obesity

송도경,홍영선,이혜진,오지영,성연아,김유경 대한당뇨병학회 2015 Diabetes and Metabolism Journal Vol.39 No.5

Background: Epicardial adipose tissue (EAT) is suggested to play an important role in the progression of metabolic syndrome. We aimed to establish a simple method to measure EAT and examine the differences in EAT thickness according to the presence of type 2 diabetes mellitus or obesity. Methods: A total of 94 patients (42.6% type 2 diabetes mellitus, 53.2% obese, mean age 61±13) who underwent multidetector computed tomography were enrolled. Thickness of EAT was measured on the parasternal short and horizontal long axis view. Epicardial fat area (EFA) was measured at the level of left main coronary artery (LMCA). Results: All EAT thicknesses were correlated with EFA at the LMCA level (r=0.235 to 0.613, all Ps<0.05), and EAT thickness in the left atrioventricular groove (LAVG) had the highest correlation coefficient (r=0.613). EFA, and EAT thicknesses in the LAVG and the left ventricular apex were higher in the group with type 2 diabetes mellitus than in the group without type 2 diabetes mellitus when adjusted only for body mass index. When adjusted only for type 2 diabetes mellitus, EFA, and EAT thicknesses in the LAVG and the right atrioventricular groove were higher in obese group than in nonobese group. Conclusion: In conclusion, EAT thickness can be easily measured and represent EFA. EAT thickness, especially in LAVG, was higher in groups with type 2 diabetes mellitus and obesity independently. These findings implicate that EAT thickness may be a useful indicator for type 2 diabetes mellitus and obesity.

FTO Gene Variants Are Associated with PCOS Susceptibility and Hyperandrogenemia in Young Korean Women

송도경,이혜진,오지영,홍영선,성연아 대한당뇨병학회 2014 Diabetes and Metabolism Journal Vol.38 No.4

Background: The fat mass and obesity-associated (FTO) gene is associated with obesity and type 2 diabetes mellitus. Obesity and insulin resistance are also common features of polycystic ovary syndrome (PCOS). Therefore, the FTO gene might be a candidate gene for PCOS susceptibility. The aim of the present study was to evaluate the effects of FTO gene variants on PCOS susceptibility and metabolic and reproductive hormonal parameters. Methods: We recruited 432 women with PCOS (24±5 years) and 927 healthy women with regular menstrual cycles (27±5 years) and performed a case-control association study. We genotyped the single nucleotide polymorphisms rs1421085, rs17817449, and rs8050136 in the FTO gene and collected metabolic and hormonal measurements. Results: Logistic regression revealed that the G/G genotype (rs1421085, 1.6%), the C/C genotype (rs17817449, 1.6%), and the A/A genotype (rs8050136, 1.6%) were strongly associated with an increased risk of PCOS (odds ratio, 2.551 to 2.559; all P<0.05). The strengths of these associations were attenuated after adjusting for age and BMI. The women with these genotypes were more obese and exhibited higher free androgen indices (P<0.05) and higher free testosterone levels (P=0.053 to 0.063) compared to the other genotypes. However the significant differences disappeared after adjusting for body mass index (BMI). When we analyzed the women with PCOS and the control groups separately, there were no significant differences in the metabolic and reproductive hormonal parameters according to the FTO gene variants. Conclusion: The rs1421085, rs17817449, and rs8050136 variants of the FTO gene were associated with PCOS susceptibility and hyperandrogenemia in young Korean women. These associations may be mediated through an effect of BMI.

캡슐내시경과 단일풍선 소장내시경으로 진단된 공장의 간질종양 1예

송도경,심기남,태정현,김경진,송명은,송하응,윤혜원,정가영,정정화 이화여자대학교 의과학연구소 2012 EMJ (Ewha medical journal) Vol.35 No.2

Gastrointestinal stromal tumors (GISTs) are common mesenchymal tumors that arise in the wall of the gastrointestinal tract. We report a case of obscure gastrointestinal bleeding due to a GIST of the jejunum successfully documented by videocapsule endoscopy (VCE) and single-balloon enteroscopy (SBE). A 36-year-old man with hematochezia was referred for further evaluation of no evidence of bleeding focus on esophagogastroduodenoscopy and colonoscopy. A VCE showed a suspicious ulcerative hyperemic mass that located in about 1 hour apart from duodenal second portion. SBE revealed a nonbleeding 4×2 cm mass with an ulcer at the proximal jejunum. The patient underwent laparoscopic resection without complication. Histological examination revealed a well circumscribed, dumbbell-shaped firm mass comprised of spindle cells. Immunohistochemical staining for CD 117 was diffusely positive, whereas staining for S-100, CD 34 and MIB-1 was all negative. It was confirmed to be a low-grade GIST at the proximal jejunum.

Primary Cilia as a Signaling Platform for Control of Energy Metabolism

송도경,최종한,김민선 대한당뇨병학회 2018 Diabetes and Metabolism Journal Vol.42 No.2

Obesity has become a common healthcare problem worldwide. Cilia are tiny hair-like organelles on the cell surface that are generated and anchored by the basal body. Non-motile primary cilia have been considered to be evolutionary rudiments until a few decades, but they are now considered as important signaling organelles because many receptors, channels, and signaling molecules are highly expressed in primary cilia. A potential role of primary cilia in metabolic regulation and body weight maintenance has been suspected based on rare genetic disorders termed as ciliopathy, such as Bardet-Biedl syndrome and Alström syndrome, which manifest as obesity. Recent studies have demonstrated involvement of cilia-related cellular signaling pathways in transducing metabolic information in hypothalamic neurons and in determining cellular fate during adipose tissue development. In this review, we summarize the current knowledge about cilia and cilia-associated signaling pathways in the regulation of body metabolism.

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)

Emerging role of the brain in the homeostatic regulation of energy and glucose metabolism

노은,송도경,김민선 생화학분자생물학회 2016 Experimental and molecular medicine Vol.48 No.-

Accumulated evidence from genetic animal models suggests that the brain, particularly the hypothalamus, has a key role in the homeostatic regulation of energy and glucose metabolism. The brain integrates multiple metabolic inputs from the periphery through nutrients, gut-derived satiety signals and adiposity-related hormones. The brain modulates various aspects of metabolism, such as food intake, energy expenditure, insulin secretion, hepatic glucose production and glucose/fatty acid metabolism in adipose tissue and skeletal muscle. Highly coordinated interactions between the brain and peripheral metabolic organs are critical for the maintenance of energy and glucose homeostasis. Defective crosstalk between the brain and peripheral organs contributes to the development of obesity and type 2 diabetes. Here we comprehensively review the above topics, discussing the main findings related to the role of the brain in the homeostatic regulation of energy and glucose metabolism.

Triglycerides to High-Density Lipoprotein Cholesterol Ratio Can Predict Impaired Glucose Tolerance in Young Women with Polycystic Ovary Syndrome

오지영,송도경,이혜진,성연아 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.6

Purpose: The triglycerides to high-density lipoprotein cholesterol (TG/HDL-C) ratio could be related to insulin resistance (IR). We previously reported that Korean women with polycystic ovary syndrome (PCOS) had a high prevalence of impaired glucose tolerance (IGT). We aimed to determine the cutoff value of the TG/HDL-C ratio for predicting IR and to examine whether the TG/HDL-C ratio is useful for identifying individuals at risk of IGT in young Korean women with PCOS. Materials and Methods: We recruited 450 women with PCOS (24±5 yrs) and performed a 75-g oral glucose tolerance test (OGTT). IR was assessed by a homeostasis model assessment index over that of the 95th percentile of regular-cycling women who served as the controls (n=450, 24±4 yrs). Results: The cutoff value of the TG/HDL-C ratio for predicting IR was 2.5 in women with PCOS. Among the women with PCOS who had normal fasting glucose (NFG), the prevalence of IGT was significantly higher in the women with PCOS who had a high TG/HDL-C ratio compared with those with a low TG/HDL-C ratio (15.6% vs. 5.6%, p<0.05). Conclusion: The cutoff value of the TG/HDL-C ratio for predicting IR was 2.5 in young Korean women with PCOS, and women with NFG and a high TG/HDL-C ratio had a higher prevalence of IGT. Therefore, Korean women with PCOS with a TG/HDL-C ratio >2.5 are recommended to be administered an OGTT to detect IGT even if they have NFG.

식도암과 위암이 동시에 발생한 원발성 중복암 1예

윤혜원,심기남,나선경,송도경,정정화,정가영 이화여자대학교 의과학연구소 2012 EMJ (Ewha medical journal) Vol.35 No.2

Double primary cancers are two independently developed cancers in an individual. There have been some reports on double primary cancer since Billroth reported it for the first time in 1879. Double primary cancer of the stomach and esophagus has been revealed a very low incidence worldwide. The incidence of an esophageal cancer with another primary cancer is reported to be 9.5∼27%, but double primary cancers in the esophagus and stomach have been rarely reported to our knowledge. In this study, we present here a case of double primary esophageal and stomach cancer in a 66-year-old man because of progressive dysphagia.