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당뇨병성 신경병증 진단법의 유용성 ( 예비보고 ) - Feldman 등의 2 단계 진단법에 대하여 -
신영구(Young Goo Shin),오윤정(Yoon Jung Oh),고영윤(Young Yoon Ko),이성근(Seong Keun Lee),이성규(Seong Kyu Lee),정윤석(Yoon Sok Jung),이관우(Kawn Woo Lee),김현만(Hyeon Man Kim) 대한내과학회 1998 대한내과학회지 Vol.54 No.6
N/A Objectives: It is important to consider the symptoms of diabetic neuropathy in determining a diagnostic approach. To evaluate diabetic neuropathy, an appropriate questionnaire for Korean diabetic patients is required. In 1994, Feldman et al. proposed the two-step diagnostic approach which included a questionnaire. To adapt a diagnostic approach and questionnaire for Korean diabetics, we initially diagnosed diabetic neuropathy by using Feldman's method and by assessing the efficiency of their method for Korean diabetics as a preliminary study. Methods: We diagnosed diabetic neuropathy with Feldman's method in 99 NlDDM patients who visited Ajou university hospital from October 1, 1996 to April 30, 1997. The sensitivity and specificity of Feldman's diagnostic procedures were ebaluated. To include the highly specific symptoms in the diagnostic approach, we applied a different scaring system (from 5 to 1) to the questionnaire accroding to specificity and then evaluated the sensitivity and specificity with this new system. If the sensitivity and specificity were 60% or more, the new scoring system was regarded as clinically useful. Results: Using Feldman's method, the sensitivity of MNSIQ and MNSIC was 12.8% and the specificity was 88.3% and 98.3%, respectively. The sensitivity of MDNS and NCV was 100% and the specificity was 68.3% and 61.6%, respectively. The new scoring system consisted of 13 of 15 questions with sensitivity of 46.2% and specificity of 71.7%, omitting 2 questions due to possible relation to vascular symptoms. Among the 4 diagnostic procedures, the strongest correlation existed between MDNS and NCV. None of the procedures had a significant correlation with MNSIQ. MNSIC, which shares similar characteristics with MDNS, had significant correlation with MDNS and NCV, but its sensitivity was very low. Conclusion: MNSIQ and MNSIC were not useful as screening instruments in the dignostic approach to diabetic neuropathy using Feldman's method, Thus, a new questionnaire composed of symptoms common in Korean diabetic patients should be designed, and MNSIC could be omitted from the diagnostic approach.
인슐린의존형 당뇨병환자에서 임신중 병발한 당뇨병성 케톤산증 1예
이성근,신영구,이성규,정윤석,이관우,김현만,김행수 아주대학교 1997 아주의학 Vol.2 No.2
저자등은 인슐린의존형 당뇨병환자에서 임신중에 병발한 당뇨병성 케톤산증을 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. IDDM is an autoimmune disease resulted from beta cell destruction and insulin deficiency, and developed mostly in children and puberty. Ketoaddosis remains one of the most senous complications that can occur in the pregnant diabetic. A 26-year-old woman, gravida 1, para 0, was admitted at 32 weeks gestation because of fever lasted for 6 days. She had been treated with insulin pump during the pregnancy. Blood sugar was well controlled before admission, and the etiology of her ketoacidosis was urinary tract infection and no insulin-intake. DKA was treated with fluids and intravenous insulin. Urinary tract infection was treated with antibiotics, based on culture test. Healthy newbom was later delivered by cesarean section due to fetal distress. We experienced a case of DKA in pregnant woman and report it with a review on literature.
정춘희,신영구,김홍승,조미연,김일회,양석우,김장영 대한내분비학회 1998 Endocrinology and metabolism Vol.13 No.1
Cushing's syndrome that is caused by an adenoma of the corticotrape cells of the anterior pituitay or, rarely, by couticotrope hyperplasia is refered to as Cushing's disease. Cushings disease is usually characterized by chronic, moderate hypersecretion of ACTH and other POMC derived peptide. Most patients have ACTH-secreting anterior pituitary corticotrope microadenomas, but a small minority have a pituitary macroadenoma. We recently experenced two cases of Cushings disease due to pituitary macroadenoma. and report this cases with review of literatures. (J Kor Soc Endocrinol 13:83-93, 1998)
고장현,신영구,이미영,정춘희,남수민,성중경,정필문,노진규,신장열 대한당뇨병학회 2008 Diabetes and Metabolism Journal Vol.32 No.3
Background: Postmenopausal status is associated with a 60% increased risk for metabolic syndrome. It is thought to be associated with decreased estrogens and increased abdominal obesity in postmenopausal women with metabolic syndrome. The purpose of this study was to investigate the association between metabolic syndrome components and menopausal status.Methods: A total of 1,926 women were studied and divided into three groups according to their menstrual stage(premenopausal, perimenopausal or postmenopausal). The presence of metabolic syndrome was assessed using the National Cholesterol Education Program's(NCEP) Adult Treatment Panel Ⅲ criteria. Results: The prevalence of metabolic syndrome was 7.1% in premenopause, 9.8% in perimenopause, and 24.2% in postmenopause. The strong correlation was noted between the metabolic syndrome score and waist circumference in postmenopause(r = 0.56, P < 0.01) and perimenopause(r = 0.60, P < 0.01). Along the menopausal transition, the risk of metabolic syndrome increased with high triglyceride after the age-adjusted(odds ratio(OR) 1.517 [95% confidence interval(CI) 1.014~2.269] in perimenopausal women and OR 1.573 [95% CI 1.025~2.414] in postmenopausal women). In addition, the prevalence of metabolic syndrome increased in accordance with elevated alanine aminotransferase(ALT) and gamma-glutamyl transpeptidase(GGT) levels. Conclusion: Triglyceride and waist circumference were important metabolic syndrome components, though ALT and GGT may also be related for predicting metabolic syndrome during the transition to menopause. (KOREAN DIABETES J 32:243-251, 2008)
급성심근경색증을 동반한 다발성 내분비 선종증 IIa형 1예
정춘희,신영구,윤정한,김영욱,강성준,갈응호,이미덕 대한내분비학회 1999 Endocrinology and metabolism Vol.14 No.1
MEN IIa is the rare disorder consisted of thyroid medullary carcinoma, pheochromocytoma, and hyperparathyroidism. We experienced the case in which 42 year-old male patient with thyroid medullary carcinoma and pheochromocytoma complicated by acute myocardial infarction. During the process of conventional treatment of acute myocardial infarction, paroxysmal hypertension occurred for several times. We sought for the cause of paroxysmal hypertension, and found pheochromocytoma by the radiologic imaging study and the biochemical study and we found the 4X4 cm sized neck mass by palpation. After stabilizing his blood pressure by the use of phenoxybenzamine, we removed the pheochromocytoma in right adrenal gland and the medullary thyroid cancer, by right adrenalectomy and total thyroidectomy respectively. Thereafter, his subjective symptoms and objective signs were improved. We report the case with review of literatures (J Kor Soc Endocrinol 14:189~196, 1999).