한국인 정상 성인에서 성장호르몬의 분비능

정윤석(Yoon Sok Chung),김현만(Hyeon Man Kim),이은직(Eun Jig Lee),정재희(Jae Hee Chung),이경미(Kyung Mi Lee),박석원(Seog Won Park),조홍근(Hong Keun Cho),이현철(Hyun Chul Lee),허갑범(Kap Bum Huh),박유경(Yoo Kyoung Park),김희선(Hee Son 대한내과학회 1994 대한내과학회지 Vol.47 No.3

N/A Objectives: Growth hormone secretory capacity of adults decrease with aging, Growth hormone secretory capacity and prevalence of growth hormone deficiency in Korean adults were studied. Methods: History, physical examination, and routine blood tests were performed to roule out ill patients among ordinary subjects. Anthropometry, nutritional history, serum insulin-like growth factor-1 (IGF-1) levels, L-dopa stimulation tests, and urinary growth hormone levels were measured in 309 Korean adults, ages 20-87 years. Results: The mean serum IGF-1 levels were 258,2+6. 8 ng/ml. The mean serum IGF-1 levels of adult males were significantly higher than those of the females. The serum IGF-1 levels decreased with aging. The prevalence of growth hormone deficiency defined by serum IGF-1 levels (< 150 ng/ml) were 0.0% in the 3rd decade, 5.5% in the 4th decade, 12.2% in the 5th decade, 10.0% in the 6th decade, 32.1% in the 7th decade, 48.1% in the 8th decade, respectively. The serum IGF-1 levels were positively correlated with total energy expenditure, but negatively correlated with body fat mass. The peak serum growth hormone levels after L-dopa stimulation and urinary growth hormone levels of the younger subjects were significantly higher than those of the older subjects, There were goad correlations among serum IGF-1 levels, peak growth hormone levels after L-dopa stimulation, and urinary growth hormone levels. Conclusion: Growth hormone secretory capacity decreased significantly with aging, and growth hormone deficiency was found in about 1/3 of subjects aged over 60 years.

한국인 임신성 당뇨병의 임상적 특성

안광진(Kwang Jin Ahn),정윤석(Yoon Sok Chung),이현철(Hyun Chul Lee),허갑범(Kap Bum Huh),김유리(Yoo Lee Kim),안명옥(Myong Ock Ahn),김문종(Moon Jong Kim),차경섭(Kyung Sub Cha),정춘희(Choon Hee Chung),곽인평(In Pyung Kwak) 대한내과학회 1992 대한내과학회지 Vol.43 No.6

N/A Background: Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of variable severity with onset or first recognition during the present pregnancy irrespective of whether or not insulin is used for treatment or the condition persist after delivery. Little has been known of the clinical characteristics of GDM in Korean wiomen. This study was done to investigate the clinical features of GDM of Korean women. Methods: Screening test was performed on pregnant women between 24th and the 28th week of gestational age or when showing glycosuria. Venous plasma glucose was measured 1 hour after 50 gm oral glucose load, A value of 130 mg/dl or above was indicated for 100 gm 3-hour oral glucose tolerance test after standard preparation. According to O`Sullivan and Mahan`s criteria, 45 women were diagnosed as having GDM. Results: Maternal age and parity of GDM patients (31.7±4.5, 0,66±0,65) was significantly higher than those in controls (28.6±3.4, 0.21±0,07). Pregnant body weight of GDM patients (109.3±16.0%) was significantly higher than that of controls (92.6±27.04). The incidence of macrosomic infant (≥ 4kg) was 26,8% in GDM patients and 6. 5% in controls. Among 35 GDM patients 7 showed impaired glucose tolerance and 6 showed overt diabetes mellitus 6 weeks after delivery. The fasting blood sugar at diagnosis of GDM were higher in those patients whose glucose intolerance persist than in the patients whose glucose intolerance recovered to normal 6 weeks after delivery (126.8±70. 0 vs 79.9+±7,7). Conclusion: Screening test for GDM is needed to all pregnant women and to investigate clinical course of GDM, further follow up study is needed.

인슐린비의존형 당뇨병 환자에서 인슐린 분비능력이 당질 및 지질대사에 미치는 영향

허갑범(Kap Bum Huh),이현철(Hyun Chul Lee),정윤석(Yoon Sok Chung),박석원(Seog Won Park),박유경(Yoo Kyoung Park),박은주(Eun Ju Park),이종호(Jong Ho Lee) 대한내과학회 1994 대한내과학회지 Vol.47 No.3

N/A Background: Many studies have shown that obesity is closely related to non-insulin-dependent diabeties mellitus (NIDDM). This study was conducted to manifest the capacity of insulin secretion in Korean. Method: Fasting blood glucose and insulin level were measured in nondiabetic subjects and NIDDM patients. Overweight-obese subjects were divided into 3 groups; normal glucose tolerant, impaired glucose tolerant and NIDDM. Blood gIucose, insulin concentration, serum lipid and lipoprotein profiles were measured for all subjects. Result: In overweight-obese patients, fasting glucose level increased progressively from 70 to 150 mg/dl while plasma insulin concentration showed a 2 5 time in- crease. Shortly after when fasting glucose exceeded 150 mg/dl plsma insulin concentration precipitated and when the glucose level reached 260 mg/dl, they secreted an amount of insulin that is similar to that in healthy nondiabetic individual. The relationship between the response area of plasma insulin and fasting blood glucose was similar. The percent ideal body weight was not significantly different within each group, but waist to hip ratio of the NIDDM groups was higher than control. Overweight-obese NIDDM subjects with fasting glucose more than 150 mg/dl, showed a decreased insulin response area and similar glucose response area compared with the normal weight NIDDM patients. The progression from normal to glucose intolerance and NIDDM was associated with increase in free fatty acid area, Serum triglyceride level was high in overweightobese NIDDM patients, lipid profiles was apparently better in the normal glucose tolerant subjects. Conclusion: The result showed that overweight-obese Korean NIDDM patients were hyperinsulinemic. Insulin resistance represented the initial disturbance in NIDDM and the chronic hyperglycemic state eventually led impaired insulin secretion. NIDDM patients with normal weight had a lower insulin secretion compared with overweight-obese, and poor goucose control increased serum lipid profiles of the patients. From the result we can suggest that well controlled diabetes can minimize the impairment of p-cell function and may both augment insulin secretion and improve lipid metabolism.

Human bocavirus에 의한 세기관지염이 재발성 천명의 발생에 미치는 영향

조형민 ( Hyoung Min Cho ),나세린 ( Se Rin Na ),임봉칠 ( Bong Chil Im ),유주희 ( Ju Hee You ),유은정 ( Eun Jung You ),김은영 ( Eun Young Kim ),김경심 ( Kyoung Sim Kim ),김용욱 ( Young Wook Kim ),서진종 ( Jin Jong Seo ),정윤석 ( Yoo 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2010 소아알레르기 및 호흡기학회지 Vol.20 No.4

목적: 호흡기 감염의 중요 바이러스 중에 하나인 보카바이러스에 의한 세기관지염의 경험이 그 이후의 반복적인 천명과 아토피(atopy)의 발생에 어떠한 영향을 미치는 지를 알아보고자 연구를 진행하였다. 또 세기관지염의 증상의 중증정도 및 여러 위험인자와 천명의 재발과의 관계를 알아보고자 하였다. 방법: 2005년 1월부터 2007년 12월까지 광주 기독병원 소아청소년과에 호흡기질환으로 입원하였던 2430명의 환자에서 호흡기바이러스 검사를 시행하여 보카바이러스가 RT PCR검사에서 양성을 보였던 112명의 환자들을 대상으로 하였다. 이 중 61명에서 2008년 4월부터 2008년 6월 사이에 전화설문과 우편설문을 실시하였으며 또 이 기간 내에 병원에 내원하게 하여 알레르기 검사를 실시하였다. 이 환자들의 입원 당시의 병력지를 조사 하였고, 세기관지염 당시의 증상의 중등도를 호흡곤란지수에 의해 평가하여 경증, 중등도, 중증의 세집단으로 환자들을 분류하였다. 또한 세기관지염 감염 후에 천명의 재발 유무를 설문에 의해 조사하여 천명없음, 1-2회의 간헐적 천명 재발, 3회 이상의 빈번한 천명 재발을 경험한 군으로 환자들을 재분류해 보았다. 결 과: 천명의 재발은 26.2%에서 있었으며 증상의 중증 정도가 심할수록 천명 재발이 의미 있게 증가하였다. 알레르기 검사 양성률도 증상의 중증도가 심한 군에서 높았으나 통계학적으로 의미는 없었으며 환자의 알레르기 질환 동반력 및 가족력, 육아시설 이용 유무, 나이 많은 형제의 유무도 천명의 재발에 영향을 주지 않는 것으로 나왔다. 결론: 보카바이러스 감염은 천명을 동반하는 세기관지염을 일으킬 수 있는 원인이 되며, 영아기에 보카바이러스에 의한 세기관지염을 경험한 것이 그 이후의 천명의 재발 및 알레르기 감작에 영향을 줄 수 있음을 확인하였다. 또한 천명의 재발에 있어 세기관지염 당시의 중등도가 중요함을 알았다. 그러나 본 연구에서 알레르기 검사를 많은 수에서 실시하지 못하여 제한점을 가지며 알레르기 질환의 동반력 및 가족력, 육아시설 이용 유무, 형제의 유무와 천명의 재발에 대해서도 좀 더 연구가 필요할 것으로 사료된다. Purpose: Excluding RSV, the relationship between bronchiolitis caused by viruses and the development of wheezing and atopy in childhood has not been well studied. We studied this relationship in children who had bronchiolitis caused by human bocavirus before 2 years of age. Methods: We retrospectively investigated 2,430 throat swab obstained between January 2005 and December 2007 from pediatric in-patients with acute respiratory tract disease at the Kwangju Christian Hospital. Human bocavirus was detected in 112 patients. A total of 61 patients less than 2 years of age were finally enrolled in this study. Patients were followed up between April and June of 2008. We measured the frequency of wheezing and atopic status using (allergy skin-prick tests, CAP tests and MAST tests). Results: Of the 61 patients, 16 (26.2%) had recurrent wheezing. Of these 16 patients, 8 (13.1%) had Infrequent wheezing (1-2 wheezing episodes) and 8 (13.1%) had frequent wheezing (3 and over wheezing episodes). Of the total 61 patients, 18 (29.5%) completed allergy tests. Of the 18 patients, 10 (55.6%) were sensitized to at least 1 allergen. Recurrent wheezing was significantly associated with the severity of bronchiolitis (mild vs. moderate vs. severe; 9.1% vs. 22.2% vs. 66.7%). Conclusion: Human bocavirus-induced bronchiolitis in childhood are an independent risk factor for development of wheezing in childhood and may be associated with an increased risk of allergic sensitization. The most important risk factor for recurrent wheezing is the severity of lower respiratory tract illnesses. [Pediatr Allergy Respir Dis(Korea) 2010;20:247-255]

응급의료센터로 내원한 급성심근경색증 환자

정윤석,김준식,유인술,조준필 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

Early reperfusion can prevent myocardial necrosis, and clinical trials with reperfusion therapy demonstrating a significant reduction in acute myocardial infarction(AMT) mortality have dramatically changed the treatment paradigm for AMI. All patients with symptoms and ECG findings suggestive of AMI should be considered for treatment with thrombolytic agents. However, only a minority of AMI patients actually receive a thrombolytic therapy. Many patients are often excluded from treatment because they do not meet the criteria for age, duration of the chest pain, and a qualifying ECG. And late arrival at the hospital is a frequently cited reason for not giving a thrombolytic agent. To confirm the reason for not receiving an early reperfusion therapy, we obtained the data for the clinical characteristics, the time intervals between the symptom onset and the start of a thrombolytic agent infusion, the method of reperfusion therapy, the reason for not giving a thrombolytic agent and overall outcomes by retrograde chart review. During the 12-month study period between July 1994 and June 1995, 113 patients were finally diagnosed to AMI, who presented to Emergency Center of Ajou University Hospital in total 30,819 patients. The results were followings: 1. The average age was 59±12 years old, the ratio of male to female was 3.2:1. The direct visited patients to our hospital were 31 and the transfered were 82. 2. The chief complaints were chest pain(86.7%), dyspnea, dyspnea, and mental change. The common preceding diseases were angina pectoris(10 cases), old myocardial infarction(9 cases), congestive heart failure(2 cases) and typical chest pain but not diagnosed(23 cases). The risk factors were smoking(81 cases), hypertension (46 cases) and DM (22 cases). 3. 75 patients had arrived within 12 hours from symptom onset and 38 patients after 12 hours. 45cases (54.7%) were performed the reperfusion therapy ; 31 patients were taken the thrombolytic therapy by tissue-type Plasminogen Activator. 4. The most common reason for not receiving a reperfusion therapy was the time delay and the main was the patient/bystander factor. 5. 75.2%(85 cases) of the patients discharged with or without complications, 7.1% (8 cases) died, 10.6% (12 cases) discharged moribundly, and 7.1% (8 cases) discharged against advise. In conclusion, the time delay was the first reason for not receiving a reperfusion therapy in AMI patients. And the education for the AMI symptom and BLS (Basic Life Support) to the people, good EMS(Emergency Medical Service) system, early definite diagnosis and aggresive therapy may decline the mortality rate.

당뇨병성 족부병변에서 분리된 혐기성 세균

이경원,김수경,김현만,정윤석,유병수 대한당뇨병학회 1995 Diabetes and Metabolism Journal Vol.19 No.3

두개인두종의 임상적 고찰

허갑범,이현철,임승길,김경래,정윤석,정재희,유내춘 대한내분비학회 1991 Endocrinology and metabolism Vol.6 No.2

Craniopharyngioma is the most common tumor involving the hypothalamic-pituitary area in childhood. It represents about 9% of intracranial tumors in children and is known to show prevalence about 20% of human sella-crucian tumors. We carried out a review of 37 cases of cranipharyngioma in children and adults from 1980 to 1990. The following results were obtaind: 1) Age at diagnosis ranged from 2 to 59 year (mean age 24.7±17.1 years) with the greatest frequency in the first two decades of the life (48.6%). 2) The male to female ratio was 1:1. 3) The presenting symptom was visual disturbance in 30(81.1%), headache in 21(59.4%), polyuria and scanty pubic hair in 12(37.8%) each, growth retardation in 13(35.1%) and sexual dysfunction in eight (8.1%). 4) Plain skull X ray showed calcification in or above the sella turcica in 15 (40.5%), enlarged or eroded sella turcica in 5(13.5%) and normal findings in only 2(5.4%). 5) The main site of the tumor was suprasellar (67.5%), but 2 occurred in intrasellar. 6) Basal abnormal horone was gonadotropin (33.3%), prolactin (29.6%), cortisol (15.7%) and thyroid hormone (12.5%). 7) In combined pituitary function test, the most common abnormal response was shown in GH (84.6%) and the least was in LH and prolactin. In conclusion, craniopharyngioma is vertually nonfunctioning and clinical symptoms are mainly seems to be caused by mass effect of the tumor, but the cause of hormonal abnormalities need to be investigated. (J Kor Soc Endocrinol 6:163~169, 1991)

체중과다 인슐린비의존형 당뇨병 환자에서 체중감소가 당질 및 지질 대사에 미치는 영향

윤지영,박은주,이종호,이현철,정윤석,박유경,허갑범 대한당뇨병학회 1994 Diabetes and Metabolism Journal Vol.18 No.1

폐경후 여성에서 Ipriflavone의 투여 효과

김희선,이종호,홍기영,이현철,임승길,이은직,김경래,정윤석,원영준,박유경,허갑범 대한내분비학회 1993 Endocrinology and metabolism Vol.8 No.3

Inriflavone, synthetic isoflavone, reduces bone resorption by inhibiting osteoclastic activiy. Compared to estrogen replacement therapy, ipriflavone had no risk of breast or endometrial cancer. We studed 24 cases of postmenopausal women. Nineteen patients on postmenopausal women were treated with 600 mg/day of ipriflavone (Teobone) by oral administration in 3 daily doses (treatment group), and five patients with placebo (control group). We studed nutritoinal status, biochemical bone marker, night time 12-hour urine pyridinoline/creatinine(PYD/Cr), and serum osteocalcin level. Our results were as followed. 1. Mean age of treated group and control group were 62±6 years, and 58±2 years old, respectively. Total calcium and animal calcium intake were 654±270 vs 599±254 mg/day and 276±199 vs 244±289mg/day, respectively. 2. Degree of bone pains was divided into no pain (0 pint), mild (1 point), moderate(2 points), and severe group (3 points). Treatment group improved pain score from 2.05±0.62 to 1.26±0.45 but control group had no interval change. 3. Serum level of calcium and inorganic phosphorus had no interval change before and after treatment, but serum level of alkaline phosphatase was significantly increased from 55±17 IU/L to 61±19 IU/L in control group. However ther was no change in treatment group. 4. Night time collected 12-hour urine PYD/Cr ratio was significantly decreased from 53±33 nM/mM to 42±32 nM/mM in reatment group, but there was no significant change in control group. Serum osteocalcin level was not significantly changed in treatment group. In conclusion, ipriflavone had effect on reliving bon pain and inhibiting bone resorption in patients with postmenopaual osteoporosis (J Kor Sco Endocrinol 8: 259~264, 1993)

임신과 동반된 말단비대증 1예

김현만,이관우,채봉남,김윤정,이성규,홍은경,황경주,정윤석,서유진,조현경 대한내분비학회 1999 Endocrinology and metabolism Vol.14 No.1

Pregnancy in acromegaly is very rare. Amenorrhea and infertility are common manifestations in acromegaly. The pregnancy may be influenced by acromegaly in many ways and pregnancy itself may influence the course of a pituitary tumor. We report of a case of pregnancy in a woman who was diagnosed with acromegaly during the course of pregnancy. Her pregnancy was uneventful and she delivered a healthy baby at 38 weeks by cesarean section. No treatment was undertaken during the pregnancy and transsphenoidal surgery was performed after the delivery (J Kor Soc Endocrinol 14:148~152, 1999).