Prevalence, Pathophysiology, Screening and Management of Osteoporosis in Gastric Cancer Patients

임중섭,이종인 대한위암학회 2011 Journal of gastric cancer Vol.11 No.1

Osteoporosis in gastric cancer patients is often overlooked or even neglected despite its high prevalence in these patients. Considering that old age, malnutrition, chronic disease, chemotherapy, decreased body mass index and gastrectomy are independent risk factors for osteoporosis, it is reasonable that the prevalence of osteoporosis in gastric cancer patients would be high. Many surviving patients suffer from back pain and pathological fractures, which are related to osteoporosis. Fractures have obvious associated morbidities, negative impact on quality of life, and impose both direct and indirect costs. In the era of a >55.6% 5-year survival rate of gastric cancer and increased longevity in gastric cancer patients, it is very important to eliminate common sequelae such as osteoporosis. Fortunately, the diagnosis of osteoporosis is well established and many therapeutic agents have been shown to be effective and safe not only in postmenopausal females but also in elderly males. Recently, effective treatments of gastric cancer patients with osteoporosis using bisphosphonates, which are commonly used in postmenopausal woman, were reported.

Pediatric dual-energy X-ray absorptiometry: interpretation and clinical and research application

임중섭 대한소아청소년과학회 2010 Clinical and Experimental Pediatrics (CEP) Vol.53 No.3

Peak bone mass is established predominately during childhood and adolescence. It is an important determinant of future resistance to osteoporosis and fractures to gain bone mass during growth. The issue of low bone density in children and adolescents has recently attracted much attention and the use of pediatric dual-energy X-ray absorptiometry (DXA) is increasing. The process of interpretation of pediatric DXA results is different from that of adults because normal bone mineral density (BMD) of children varies by age, body size, pubertal stage, skeletal maturation, sex, and ethnicity. Thus, an appropriate normal BMD Z-score reference value with Z-score should be used to detect and manage low BMD. Z-scores below -2.0 are generally considered a low BMD to pediatrician even though diagnoses of osteoporosis in children and adolescents are usually only made in the presence of at least one fragility fracture. This article will review the basic knowledge and practical guidelines on pediatric DXA based on the International Society for Clinical Densitometry (ISCD) Pediatric Official Positions. Also discussed are the characteristics of normal Korean children and adolescents with respect to BMD development. The objective of this review is to help pediatricians to understand when DXA will be useful and how to interpret pediatric DXA reports in the clinical practice for management of children with the potential to develop osteoporosis in adulthood.

정상 소아ㆍ청소년에서 사춘기 발달단계에 따른 혈중 렙틴 농도와 신체조성의 변화 및 상호 연관성

임중섭,신충호,양세원 대한소아내분비학회 2003 Annals of Pediatirc Endocrinology & Metabolism Vol.8 No.2

소아청소년기 골다공증의 원인과 진단 및 치료

임중섭 대한의사협회 2018 대한의사협회지 Vol.61 No.10

Osteoporosis was once thought to be a disease of the elderly. Now, there is universal agreement that osteoporosis has a pediatric origin. If individuals fail to achieve optimal peak bone mass and strength in childhood and adolescence, the development of osteoporosis later in life becomes more likely. Furthermore, increased knowledge and improved care for children with genetic disease and chronic illnesses has led to many children living long enough to develop osteoporosis and fractures even in childhood or adolescence. Thus, early interventions including nutrition, exercise, and pharmacological treatment are paramount. The objective of this review is to help clinicians diagnose and manage children at a high risk of osteoporosis. This article also reviews the latest advances in the treatment of pediatric osteoporosis including Korean experiences.

The current state of dyslipidemia in Korean children and adolescents and its management in clinical practice

임중섭 대한소아내분비학회 2013 Annals of Pediatirc Endocrinology & Metabolism Vol.18 No.1

Cardiovascular disease (CVD) is a leading cause of death worldwide including Korea. The risk factors of CVD are known as positive family history of early CVD, obesity, hypertension,diabetes, and dyslipidemia. Among those, dyslipidemia is one of modifiable risk factors. Dyslipidemia starts in childhood and progress to adulthood. Furthermore, dyslipidemia cause atherosclerosis and is closely related to other CVD risks. On the rationale that early identification and control of pediatric dyslipidemia will reduce the risk and severity of CVD in adulthood, the National Heart, Lung, and Blood Institute guidelines expanded to universal screening for lipid levels. However, there was no guideline for lipid screening and management in Korean children and adolescents yet. This review deals with the rationale of early identification and control of pediatric dyslipidemia along with the current Korean status of pediatric dyslipidemia. This review also deals with how to screen, diagnosis, and treatment of pediatric dyslipidemia.

수모세포종 치료후 발생한 척추골절에서 파미드로네이트 치료 1례

임중섭,이윤정,이현재,이준아,김동호,박경덕 대한소아내분비학회 2007 Annals of Pediatirc Endocrinology & Metabolism Vol.12 No.1

A twenty-one year old man, who had been treated for medulloblastoma 6 years ago, complained progressive right knee joints pain and back pain. Multiple thoracic vertebral compression fracture was detected in radiography. The bone mineral density(BMD) was in osteoporotic range in duel energy X- ray absorpometry. Growth hormone deficiency and primary hypothyroidism were detected after endocrine function test. We treated him by cyclic intravenous pamidronate because he had complained severe back pain and difficulty to walk. After pamidronate therapy, the pain was decreased and the BMD was increased. No severe adverse effect was noted. This is the first case report of pamidronate therapy in patient who had osteoporotic vertebral compression fracture due to a sequela of childhood medulloblastoma. 소아기에 발생한 수모세포종에서 골다공증의 발생률은 매우 높으며, 이는 대개 성장호르몬 결핍증이 그 주요 원인이다. 수모세포종 치료 후 정기적으로 성장호르몬 결핍 여부와 골다공증의 발생여부를 추적 관찰하는 것은 매우 중요하다. 골절이 동반되어 심한 통증을 호소하고 운동능력이 제한된 환자에서 파미드로네이트의 치료는 통증을 조절하고 골밀도를 증가시키며 삶의 질을 증진시킨다. 저자들은 척추골절을 보인 수모세포종 환자에서 파미드로네이트를 사용한 환자 1례를 문헌 고찰과 함께 보고하는 바이다.

단순 비만아에서 인슐린이 지질대사 이상에 미치는 영향

임중섭,신충호,양세원,Lim, Jung Sub,Shin, Choong Ho,Yang, Sei Won 대한소아청소년과학회 2002 Clinical and Experimental Pediatrics (CEP) Vol.45 No.6

목 적 : 영양과잉과 활동량의 감소로 비만한 소아가 급속히 증가하고있다. 성인에서는 비만에 의하여 인슐린 저항성과 고인슐린혈증, 당 및 지질대사 이상, 고혈압, 심혈관질환 등이 발생하며, 남녀간에 차이가 있는 것으로 알려져 있다. 소아 청소년 시기에 비만이 인슐린 저항성 및 지질대사 이상에 미치는 영향을 알아보고자 본 연구를 시행하였다. 방 법 : 1999년부터 2001년까지 비만을 주소로 내원한 비만아 중 90 백분위수 이상인 35명의 비만아[나이 : $10.6{\pm}2.8$년; 남(n=20), 여(n=15)]에 대하여 체중과 키를 계측하였고, 공복시 혈중 콜레스테롤, 중성지방, 고밀도 콜레스테롤, 저밀도 콜레스테롤, 혈당과 혈중 인슐린 농도를 측정하였다. 인슐린 저항성 지표로 공복 인슐린/혈당비(FIGR), HOMA-IR[$(glucose(mmol/L){\times}insulin({\mu}U/mL)$/22.5]를 이용하였다. 결 과 : 1) 체질량지수(BMI) : 전체 비만아의 BMI는 $27.1{\pm}5.4kg/m^2$(범위 20.6-44.0)로, 5명이 90-95 백분위수이었고, 30명이 95 백분위수 이상의 고도 비만을 보였으며, 남녀간에 차이는 없었다. 남녀 모두에서 연령과 상관관계가 보였다. 2) 공복시 인슐린 농도 : 인슐린 농도는 $20.7{\pm}10.6{\mu}U/mL$(범위 4.8-53.0)로, 남녀간에 차이는 없었다. 고인슐린혈증은 여아에 비하여 남아에서 유의하게 빈도가 높았다(27% vs 75%). 연령과 상관관계가 없었다. 3) 혈중 지질대사 : 혈중 중성지방이 150 mg/dL 이상인 비만아는 13명(37%), 고밀도 콜레스테롤이 40mg/dL 이하인 군은 2명(5.7%)이었다. 4) HOMA-IR과 인슐린 농도와의 관계 : 인슐린 저항성의 지표인 HOMA-IR은 인슐린 농도와 인슐린/혈당비에 대해 각각 양의 상관관계를 보였다(인슐린 : r=0.960, P<0.01; 인슐린/혈당비 : r=0.842, P<0.01). 5) BMI와 HOMA-IR, 인슐린 농도, 지질대사와의 관계 : BMI는 인슐린 농도, HOMA-IR, FIGR과 유의한 양의 상관관계를 보였으며(인슐린 r=0.629; HOMA-IR r=0.622; FIGR r=0.583; P<0.01), 남자에서 여자에 비하여 더 강한 상관관계를 보였다. 남녀 모두에서 BMI는 총콜레스테롤, 중성지방, 고밀도 콜레스테롤 및 저밀도 콜레스테롤과 상관관계가 관찰되지 않았다. 6) 공복시 혈중 인슐린 농도와 혈중 지질농도 : 중성지방은 남자에서 인슐린 농도와 유의한 양의 상관관계가 있었으나(r=0.544, P=0.013), 여아에서는 상관관계가 없었으며, 고밀도 콜레스테롤도 남자에서만 인슐린 농도와 약한 상관관계가 있었다(남자 : r=-0.431, P=0.058). 결 론 : 소아와 청소년에서는 지질대사 이상을 반영하는데 있어 BMI보다 인슐린 농도가 더 연관성이 크므로, 공복시 인슐린 농도를 측정하는 것이 비만에 의한 대사 이상을 평가하는데 큰 도움이 될 것으로 사료되며, 여자에 비하여 남자에서는 심혈관질환 및 대사 이상을 강화시킬 수 있는 고인슐린혈증의 빈도가 높기 때문에 더욱 더 적극적인 치료가 요구될 것으로 사료된다. Purpose : Obesity is closely related to insulin resistance, compensatory hyperinsulinemia and dyslipidemia in adults. We identified the effect of obesity measured by BMI and insulin resistance on dyslipidemia in children and adolescents. Methods : The fasting serum insulin, glucose, total cholesterol, triglyceride, HDL- and LDL-cholesterol were measured and insulin resistance(HOMA-IR) was calculated in 35 children with simple obesity(age :$10.6{\pm}2.8$ years; male 20, female 15; BMI : $27.1{\pm}5.4kg/m^2$). Results : The hypertriglyceridemia(37%), hyperinsulinemia(54%) and HDL-hypocholesterolemia(5.7%) were observed. HOMA-IR was well expressed by fasting insulin. As BMI increased, there was a statistically significant increase in insulin resistance and insulin level in both sexes. BMI was not related with lipid profile in both sexes. Triglyceride was correlated with only insulin level and insulin resistance index in boys. In girls, there was no correlation between triglyceride, HDL-cholesterol and insulin(insulin resistance). Conclusion : These results suggest that hypertriglyceridemia was dependent on insulin resistance in pre-adult males. Monitoring of insulin resistance and those risk factors known to become a part of insulin resistance syndrome should become part of routine medical care for obese children.

Combined aerobic and resistance exercise is effective for achieving weight loss and reducing cardiovascular risk factors without deteriorating bone health in obese young adults

임중섭,장국찬,문경래,김은영 대한소아내분비학회 2013 Annals of Pediatirc Endocrinology & Metabolism Vol.18 No.1

Purpose: Weight loss reduces cardiovascular risk factors in the obese. However, weight reduction through diet negatively affects long-term bone health. The aim of study was to determine the ability of combined aerobic and resistance exercise (CE) to reduce weight and cardiovascular risk without diminishing bone health. Methods: Twenty-five young adults participated in an 8-week weight loss CE program. Subjects were allocated to an obese group or a control group by body mass index (BMI). Body weight, BMI, body composition, and bone mineral density (BMD) of the lumbar spine and total hip were measured before and after the CE trial. Serum levels of metabolic markers, including adipokines and bone markers, were also evaluated. Results: Weight loss was evident in the obese group after the 8 weeks CE trial. Fat mass was significantly reduced in both groups. Fasting insulin, homeostatic model assessment-insulin resistance (HOMA-IR), leptin and aminotransferases level were significantly reduced from baseline only in the obese group. High density lipoprotein cholesterol increased in both groups. Hip BMD increased in the obese group. In all study subjects, BMI changes were correlated with HOMA-IR, leptin, and HDL changes. BMI decreases were correlated with lumbar spine BMD increases, lumbar spine BMD increases were positively correlated with osteocalcin changes, and lumbar spine bone mineral content increases were correlated negatively with C-terminal telopeptide of type 1 collagen changes. Conclusion: These findings suggest that CE provides effective weight loss and improves cardiovascular risk factors without diminishing BMD. Furthermore, they indicate that lumbar spine BMD might be maintained by increasing bone formation and decreasing bone resorption.

소아청소년 고지혈증의 약물치료

임중섭 대한소아내분비학회 2004 Annals of Pediatirc Endocrinology & Metabolism Vol.9 No.1

신생아 신정맥 혈전증 2례

임중섭,백경훈,한효정,이준호,정해일,최용,고광욱,김인원,Lim Jung-Sub,Paek Kyong-Hoon,Han Hyo-Jung,Lee Jun-Ho,Cheong Hae-Il,Choi Yong,Ko Kwang-Wook,Kim In-One 대한소아신장학회 1997 Childhood kidney diseases Vol.1 No.2

Renal venous thrombosis (RVT) in neonatal period is a rare disease and usually complicated to clinical situations with reduced renal blood flow and hypercoagulability ; like acute blood loss, sepsis, shock, and birth asphyxia. RVT should be suspected in sick babies with hematuria, anemia, thrombocytopenia, enlarged kidney and acute renal failure. And the diagnosis can be confirmed by renal ultrasonography. We report two cases of neonatal renal venous thrombosis with review of literatures. One case, associated with E. coli sepsis, recovered completely, and the other, follwed respiratory distress in the neonate, revealed permanent renal functional impairment.