Amiodarone 투여와 동반된 갑상선 기능 이상

강무일(Moo Il Kang),이만영(Man Young Lee),한제호(Je Ho Han),손현식(Hyun Sik Son),윤건호(Kun Ho Yoon),홍관수(Kwan Soo Hong),차봉연(Bong Yun Cha),이광우(Kwang Woo Lee),손호영(Ho Young Son),강성구(Seung Ku Kang) 대한내과학회 1994 대한내과학회지 Vol.47 No.1

N/A Objectives: Amiodarone, a benzofuranic derivative containing 37. 2% iodine, is widely used for the long- term treatment of cardiac arrhythmias. It affects the peripheral metabolism of the thyroid hormones, and may induce hyperthyroidism and hypothyroidism. We performed this study to evaluate the effects of amiodarone on thyroid function. Methods: To evaluate the effects of amiodarone, antiarrhythmic drug, on thyroid function, we performed cross-sectional study in 30 patients (18 men and 12 women; mean age 61, 2 yr). All had a variety of cardiac diseases (ventricular tachycardia, supraventricular tachycardia, angina pectoris, cardiomyopathy) and taking long term amiodarone therapy (maintenance dose 200 mg; mean duration of treatment 18. 9 months). Thyroid status was assessed by clinical examination and thyroid function test (T3, T4, rT3, TSH, TRH test). Thyroid antimicrosomal antibody was measured using indirect agglutination method. All the tests were perfonned at the time of study only. Results: 1) Among 30 amiodarone treated patients, 3 were hyperthyroid and 1 was hypothyroid. So the incidence of amiodarone induced thyroid dysfunction was 13.3%(4/ 30). Including subclinical thyroid dysfunction, overall rate of thyroid dysfunction was 36.6%(11/30). 2) Antimicrosomal antibody was positive in 21,7% Sf patients (5/23). 3) Goiter was observed in 30%(9/30) of amiodarone treated patients and 63.6%(7/11) of patients with amiodarone induced thyroid dysfunction. 4) After TRH test in eleven euthyroid patients, 54,5% (6/11) showed abnormal response. 5) Between normal and abnormal responders in TRH test, there was no aignifieant difference in age and duration of amiodarone treatment (p>0,05). 6) In patients with thyroid dysfunction, duration of amiodarone treatment was significantly longer than euthyroid patients (p<0.02), but there was no significant difference in age between two groups (p>0.05), Conclusion: There results suggest that the incidence of thyroid dysfunction in amiadarone treated patients is high and further prospective study will be needed for more detailed information

주폐경기 여성의 골다공증 유병률과 연관인자

강무일(Moo Il Kang) 대한내과학회 2002 대한내과학회지 Vol.62 No.1

N/A

B 형 만성활동성간염 환자에서 합성 Interferon Alpha 2b ( INTRON A(R) ) 의 효능 및 안정성 - 제 1 보 -

이창돈(Chang Don Lee),강무일(Moo Il Kang),유혜신(Hye Sin Yu),권혁호(Hyuk Ho Kwon),김재유(Jae Yoo Kim),정진우(Jin Woo Jeong),김부성(Boo Sung Kim) 대한내과학회 1987 대한내과학회지 Vol.32 No.6

N/A To evaluate the efficacy and safety of recombinant interferon alpha-2b (INTRONA®), in eleven patients with chronic active hepatitis (CAH) type B, a course of 28-day Intron A® was given daily subcataneous injection at a dose of 1 milion unit (MU) on the first day, 3 MU on the second, 5 MU on the 3rd to 7th, 3 MU on the 8th to 28th each. In 10 patients with HBeAg positive CAH type B, DNA polymerase and transaminoferase activities were assessed and compared before, during and after INTRON A administration. The peripheral blood white blood cell (WBC), granulocyte and platelet counts were checked. The results were as follows: 1) during administration of INTRON A, DNA polymerase activities were decreased significantly within first week and sustained in spite of persistent HBe antigenemia in all patients (p<0.05). Serum alanine aminotransferase (ALT) and aspartate aminotransferase were decreased significantly from 2 and 3 weeks after therapy respectively (p<0.01). 2) After discontinuation of INTRON A, improved transaminase level lasted for 4 weeks but rebound phenomena of DNA polymerase activities were observed 7 cases (70%) within 2 weeks, 3) during follow up period, transient increase of serum ALT activities were observed 9 cases within 12 weeks. One case of seroconversion (Anti-HBe) and one case of transient loss of HBeAg were observed at 16 week during mean follow up period of 30.3 weeks (range 16-58 weeks). But transient increment of serum ALT activities were observed 9 cases (90%) within 16 weeks. 4) In all 11 patients, peripheral white blood cell, granulocyte, platelet counts were decreased significantly within first week but not decreased further during INTRON A administration and recovered within 2 weeks after discontinuation of INTRON A. 5) Myalgia and fever were noted in 10 cases (91%) and headache and high fever (>38'C) were noted in 5 cases (45%) within 4 days. Mild anorexia (36%), hair loss (27%), diarrhea (9%), nausea (9%) were noted after 2 weeks. It suggested that subcutaneous injection of 3 MU INTRON A was safe and effective in decrement of DNA polymerase and transaminase activities in patients with CAH type B transiently. Long term therapy will be nessessary for the eradication of HBe Antigenemia and clinical improvement.

소의 대동맥 내피세포에서 산화저밀도 지단백에 의한 아포프토시스에 백일해 독소 및 콜레라 독소가 미치는 영향

손호영(Ho Young Son),강성구(Sung Ku Kang),강무일(Moo Il Kang),차봉연(Bong Youn Cha),이광우(Kwang Woo Lee),장상아(Sang Ah Chang),최윤희(Yoon Hee Choi),문성대(Sung Dae Moon),안유배(Yoo Bae Ahn),손현식(Hyun Sik Son),윤건호(Kun Ho Yoon) 대한내과학회 1999 대한내과학회지 Vol.56 No.5

N/A Objectives : Oxidized LDL is thought to play a key role in atherogenesis. Among their wide variety of biological properties, oxidized LDL injures the endothelium as an early event of atherogenesis. However, the mechanisms by which oxidized LDL injures endothelial cells are not definitely known. In order to evaluate the involvement of GTP-binding protein on the mechanism of apoptosis, we studied the effects of pertussis and cholera toxin on oxidized LDL-induced apoptosis in bovine aortic endothelial cells(BAECs). Methods : Oxidized LDL elicited apoptosis in cultured BAECs as shown by characteristic morphological and biochemical changes. Chromatin condensation and nucleus fragmentation were visualized by using fluorescence microscopy of intact cells staining by acridine orange/ ethidium bromide. DNA fragmentation was quantified by an ELISA with specific antibody for bromodeoxyuridine- labelled DNA fragments and confirmed with DNA ladder formation. Results : Studies using a combination of bacterial toxins which change the function of GTP-binding protein suggest that oxidized LDL-induced apoptosis was regulated by GTP-binding protein. Oxidized LDL-induced apoptosis was not changed by pretreatment of BAECs with pertussis toxin. In contrast, pretreatment with cholera toxin completely prevented the oxidized LDL- induced apoptosis. Conclusion : These results show that oxidized LDL induces apoptosis of BAECs and suggest that cholera toxin-sensitive G-proteins are involved in signal transduction of oxidized LDL-induced apoptosis of BAEC.

만성신부전증 환자에서 혈액투석, 복막투석 및 신장이식이 혈중 Apolipoprotein(a) 농도에 미치는 영향

윤건호 ( Kun Ho Yoon ),유순집 ( Soon Jip Yoo ),강무일 ( Moo Il Kang ),차봉연 ( Bong Yun Cha ),윤영석 ( Young Suk Yoon ),이광우 ( Kwang Woo Lee ),손호영 ( Ho Young Son ),강성구 ( Sung Koo Kang ),방병기 ( Byung Kee Bang ) 한국지질동맥경화학회(구 한국지질학회) 1996 韓國脂質學會誌 Vol.6 No.1

증례 : 내분비-대사 ; 무균성 뇌수막염으로 오인된 뇌하수체졸증 1예

윤유선 ( Yu Seon Yun ),김은숙 ( Eun Sook Kim ),신정아 ( Jung Ah Shin ),강무일 ( Moo Il Kang ),윤건호 ( Kun Ho Yoon ),차봉연 ( Bong Yun Cha ),손호영 ( Ho Young Son ) 대한내과학회 2011 대한내과학회지 Vol.80 No.1

본 저자들은 뇌수막염 증상으로 오인되어 치료가 지연, 부신 위기 동반으로 악화된 후 진단된 뇌하수체 선종의 뇌하수체졸증 1예를 경험하여, 무균성 뇌수막염이 호전되지 않을 경우에는 드물지만 치명적인 경과를 보일 수 있는 뇌하수체졸증일 가능성을 상기하고자 이를 보고하는 바이다. Pituitary apoplexy is a clinical syndrome caused by an acute ischemic or hemorrhagic vascular accident. Although pituitary apoplexy is an emergency, it is often overlooked because it is rare and presents with various signs and symptoms, including those of neurologic and endocrine disorders. We describe a case of pituitary apoplexy misdiagnosed as aseptic meningitis accompanied by acute-onset headache and nausea, followed by fever. Subsequently, it was revealed as pituitary apoplexy by brain magnetic resonance imaging (MRI) performed when the clinical course worsened and ophthalmoplegia developed. We suggest that pituitary apoplexy be included in the differential diagnosis of patients presenting with headache or signs of meningeal irritation; when there is no clinical improvement, prompt steroid treatment should be started, while considering neurological decompression to prevent neurological sequelae. (Korean J Med 2011;80:102-107)

임상화보 : 거대 뇌하수체 낭종으로 나타난 프로락틴종

김미경 ( Mee Kyoung Kim ),신주영 ( Joo Young Shin ),임동준 ( Dong Jun Lim ),백기현 ( Ki Hyun Baek ),강무일 ( Moo Il Kang ),이광우 ( Kwang Woo Lee ) 대한내과학회 2006 대한내과학회지 Vol.71 No.6

여러 장기를 침범한 이차성 혈색소침착증 1예

김미경 ( Mee Kyoung Kim ),임동준 ( Dong Jun Lim ),백기현 ( Ki Hyun Baek ),송기호 ( Ki Ho Song ),강무일 ( Moo Il Kang ),이광우 ( Kwang Woo Lee ),이종욱 ( Jong Wook Lee ) 대한내과학회 2008 대한내과학회지 Vol.75 No.6

불가피하게 반복적인 수혈을 받는 환자에서 수혈과 관련하여 이차성 혈색소 침착증이 발생할 수 있는데, 본 저자들은 재생불량성 빈혈로 10년간 약 400pints의 수혈을 받은 환자에서 피부 색소 침착, 저성선자극호르몬에 의한 성선기능저하, 당뇨병, 간기능 장애, 확장성 심근병증에 의한 울혈성심부전 등 여러 가지 심각한 합병증을 동반한 이차성 혈색소 침착증 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. We report a case of transfusion-associated hemochromatosis in a 38-year-old female who had severe aplastic anemia. She had undergone conservative treatment consisting of multiple transfusions because she had no suitable HLA-matched bone marrow donor. She had received 400 units of red blood cells (RBCs) over 10 years. The transferrin saturation and serum ferritin were increased to 88.4% and 29,905 ng/mL, respectively. Abdominal computed tomography (CT) showed increased densities in the liver and myocardium, suggesting iron deposits in those organs. In general, transfusional iron overload results in primarily reticuloendothelial iron accumulation, which is considered to be less harmful than parenchymal iron accumulation. Nevertheless, our patient had many striking complications associated with hemochromatosis, such as skin pigmentation, hypogonadotropin hypogonadism, insulin-requiring diabetes mellitus, impaired liver function, and left ventricular dysfunction. (Korean J Med 75:709-713, 2008)

한국인 폐경기 여성에서의 요 칼슘 배설과 골대사의 관계

오기원(Ki Won Oh),윤은주(Eun Joo Yun),오은숙(Eun Sook Oh),김상우(Sang Woo Kim),이덕철(Duk Chul Lee),장영건(Young Kwon Chang),노성일(Sung Il Roh),도병록(Byung Rok Do),강무일(Moo Il Kang) 대한내과학회 2002 대한내과학회지 Vol.63 No.4

목적 : 모든 여성은 폐경 후에 여성호르몬이 결핍되나 폐경 후 골다공증의 발병은 이들 폐경 후 여성 중 일부에서만 발생한다. 따라서 폐경 후 골다공증이 발병하는 여성에서는 정상 골밀도를 유지하는 여성과 달리 여성호르몬 결핍 이외에도 폐경 후 더 큰 골소실을 유도하는 또 다른 요인이 있을 것으로 생각된다. 본 연구에서는 신장에서의 칼슘소실이 폐경 후 골흡수 증가와 이에 따른 골다공증 발생의 한 원인인지 알아보기 위하여 한국인 폐경 전후 여성을 대상으로 하여 24시간 요 칼슘 배설량과 골밀도 및 골교체 표지자의 변화와의 관계를 관찰하였다. 방법 : 224명의 초기 폐경 후 여성, 158명의 후기 폐경 후 여성 및 145명의 폐경 전 여성을 연구대상으로 하였다. 연구대상에서는 24시간 요 칼슘 배설량, 요 deoxypyridinoline 농도, 혈청 osteocalcin과 알칼리성 인산분해효소 농도 및 요추골과 대퇴골 경부의 골밀도를 측정하였다. 결과 : 224명의 초기 폐경 후 여성 군에서 74명(33.0%)의 고칼슘뇨증이 있었다. 초기 폐경 후 여성 군에서 폐경 전 여성 군과 비교하여 평균 요 칼슘/크레아티닌 비와 혈청 칼슘 농도는 유의하게 높았다. 초기 폐경 후 여성 군 중 고칼슘뇨 군에서는 정상칼슘뇨 군과 비교하여 혈청 알칼리성 인산분해효소 농도와 요 deoxypyridinoline 농도가 유의하게 높았으며, 대퇴골 경부 골밀도는 고칼슘뇨 군에서 유의하게 낮았다. 결론 : 초기 폐경 후 여성에서 고칼슘뇨증 여성의 빈도가 많았으며 요 칼슘 배설이 증가하였고, 특히 고칼슘뇨 군에서는 골교체 표지자가 상승되었고, 대퇴골 경부 골밀도가 감소되었다. 따라서 고칼슘뇨증이 폐경 후 골다공증의 부분적인 기전으로 추측되나 직접적인 인과관계에 대하여는 향후 더 많은 연구가 필요할 것으로 생각된다. Background : Although all postmenopausal women are estrogen deficient, women who have postmenopausal osteoporosis may have some defects, in addition to estrogen deficiency, that explain for their higher rates of bone resorption and greater bone loss, relative to those who do not. To test the hypothesis that one of the defects is an impairment in renal calcium conservation, we have investigated relationship between urinary calcium excretion and bone mineral metabolism of postmenopausal women in Korea. Methods : We have measured 24-hour urinary calcium level; serum osteocalcin level, serum alkaline phosphatase level; urine deoxypyridinoline level; and bone mineral density in 224 early postmenopausal, 158 late postmenopausal and 145 premenopausal women. Results : 33.0 percent (74/224) of early postmenopausal women in Korea had urinary calcium excretion exceeding 4 mg/kg per day. The early postmenopausal women had higher (p<0.05) values for mean urinary calcium to creatinine ratio of 0.241±0.008 mg/mg of creatinine vs. 0.209±0.010 mg/mg of creatinine and higher (p<0.001) mean serum calcium level of 9.15±0.02 mg/dL vs. 8.92±0.03 mg/dL than the premenopausal women. Hypercalciuric group of early postmenopausal women had higher (p<0.05) values for mean urine deoxypyridinoline level (8.6±0.4 nMol/mMol Vs. 7.7±0.2 nMol/mMol), higher (p<0.05) mean serum alkaline phosphatase level (73.4±2.3 U/L Vs. 67.7±1.4 U/L) and lower (p<0.05) mean bone mineral density of femur neck (0.785±0.012 g/cm2 Vs. 0.815±0.008 g/cm2) than the normocalciuric group. Conclusion : The early postmenopausal women had larger numbers of hypercalciuric women and higher values for urinary calcium excretion than the premenopausal women. Hypercalciuric group of early postmenopausal women had higher values for biochemical markers of bone turnover and lower bone mineral density of femur neck than the normocalciuric group. We suggest that hypercalciuria could be accounted for the partial cause of postmenopausal osteoporosis, but further studies are needed to elucidate the direct effect about that.(Korean J Med 63:402-410, 2002)

폐경 후 골다공증 환자에서 여성호르몬과 알렌드로네이트 ( Alendronate ) 병합치료가 단기간의 골대사에 미치는 효과

오기원(Ki Won Oh),윤은주(Eun Joo Yun),오은숙(Eun Sook Oh),김상우(Sang Woo Kim),이덕철(Duk Chul Lee),노성일(Sung Il Roh),이원영(Won Young Lee),백기현(Ki Hyun Baek),강무일(Moo Il Kang) 대한내과학회 2002 대한내과학회지 Vol.63 No.3

목적 : 폐경 후 발생하는 골다공증의 치료제로 현재 사용할 수 있는 약물들은 대부분이 골흡수 억제제로서 직접적으로 골형성을 촉진하지는 않는다. 따라서 현저히 저하된 골밀도를 가진 폐경 후 골다공증 환자에서 기존의 골흡수 억제제를 병용투여하여 골량의 회복을 극대화 시키려는 시도들이 있었으며, 일부 연구에서는 병합치료가 한 가지 골흡수 억제제 단독투여에 비하여 그 효과가 높은 것으로 보고되고 있다. 그러나 아직까지 충분한 연구가 이루어지지 않아 그 효과에 대하여 많은 논란의 여지가 있다. 본 연구에서는 폐경 후 골다공증 환자를 대상으로 하여 여성호르몬과 알렌드로네이트 1년간 병합치료의 효과를 관찰하였다. 방법 : 골대사에 영향을 미치는 약물 복용자와 질환자를 제외한 30명의 폐경 후 골다공증 환자를 연구 대상으로 하였으며, 대조군으로는 여성호르몬 대체요법만을 시행한 20명의 폐경 후 여성을 비교하였다. 연구대상은 1년간 여성호르몬과 알렌드로네이트(10 mg/day)를 병용투여 하였고, 양 군 모두에서 Elemental 칼슘 600 mg/day을 투여하였다. 치료 전과 치료 1년 후 DEXA를 이용하여 요추골 골밀도를 측정하였고, 골교체 표지자는 요 deoxypyridinoline, 혈청 osteocalcin 및 혈청 알칼리성인산분해효소 농도를 측정하였다. 결과 : 골교체 표지자의 변화율의 비교에서는 혈청 알칼리성인산분해효소 농도의 평균 변화율에서 병합치료 군이 유의하게 많은 농도 감소가 있었으나, 혈중 osteocalcin 농도와 요 deoxypyridinoline 농도의 평균 변화율은 양 군 사이에 유의한 차이가 없었다. 요추골 골밀도의 변화율의 비교에서 여성호르몬과 알렌드로네이트 병합치료 군에서는 10.3±0.9%의 평균 요추골 골밀도가 증가된 반면에 여성호르몬 단독치료 군에서는 4.5±1.0%만 증가되어 단독치료와 비교하여 병합치료 군에서 유의하게 많은 요추골의 골밀도 호전이 있었다. 결론 : 결론적으로 여성호르몬과 알렌드로네이트 병합치료에서 여성호르몬 단독치료와 비교하여 단기간에 더 많은 요추골 골밀도의 호전과 일부 골교체 표지자의 감소가 관찰되었으나 이에 대한 장기간의 효과와 안정성에 대한 추가적인 연구가 이루어져야 할 것으로 생각된다. Background : The hormone replacement therapy (HRT) and bisphosphonate alendronate are efficacious in the prevention and treatment of postmenopausal osteoporosis. Acting by different mechanisms, these two agents decrease bone resorption and thereby increase or preserve bone mineral density. The combined effects of these medications have not been rigorously studied. This clinical trial examined the combined effects of HRT and oral alendronate on bone mineral density (BMD) and biochemical markers of bone turnover in 50 postmenopausal women with low bone mass. Methods : This was a 1-year study in which 50 postmenopausal women received daily treatment with 0.625 mg conjugated equine estrogens (with medroxyprogesterone acetate 2.5 mg to 5 mg, daily or cyclically) alone or in combination with 10 mg alendronate. All of the women received a supplement of 600 mg elemental calcium daily. Changes in BMD at the lumbar spine and biochemical markers of bone turnover were assessed. Results : At 1-year, significant increases from baseline in lumbar spine BMD were observed in both treatment groups [combined HRT and alendronate, 10.3%(p<0.001); HRT alone, 4.5% (p<0.05)]; Compared with HRT alone, combined HRT and alendronate significantly produced greater increases in BMD of the lumbar spine (p<0.001). Both treatment groups significantly decreased biochemical markers of bone turnover, especially mean serum osteocalcin level and mean serum alkaline phosphatase level. The combined HRT and alendronate significantly produced greater decreases in mean serum alkaline phosphatase level than HRT alone (p<0.05). Conclusion : Combined use of HRT and alendronate significantly produced greater increases in lumbar spine BMD and greater decreases in biochemical markers of bone turnover than that of HRT alone. Thus, the therapy of combined HRT and alendronate produced favorable effects on bone mineral metabolism in postmenopausal women with osteoporosis.(Korean J Med 63:299-305, 2002)