비만증 -내과적 이해 및 치료-

오연상,Oh, Yeon-Sahng 한국정신신체의학회 1995 정신신체의학 Vol.3 No.2

Obesity is a major nutritional problem in the developed countries. The prevalence of obesity may range from 10 to 50 per rent or mort of adult population and it may be increasing tendency. Many efforts have been made to understand the pathogenesis of obesity, but except a few metabolic obesities in the most of obese patients, the mechanisms are not understood. The treatment modalities of obesity, ranging from dietary and pubilc health intervention through the pharmacological and surgical therapy, have been developed and tested. In the obese patients mortalities and mobilities are significantly increased than non obese subjects due to hypertension, diabetics, and other problems. There are four possible mechanisms by which energy balance might be altered to enhance metabolic efficiency. futile metabolic pathway, alteration of protein rum over, alteration in sodium-potassium ATPase and alteration in uncoupled oxidation in brown adipose tissue are considered as possible mechanisms. Low calory and very low calory diets are recommended as a dietary program. Several pharmacological agent such as benzphetamine, fenfluramine, mazindol and fluoxetin are currently popular drugs for the treatment of obesity.

원저 : 복부비만이 있는 성인에서 혈장 아디포넥틴과 대사증후군의 구성요소와의 연관성

이승은 ( Seung Eun Lee ),문정현 ( Jung Hyun Moon ),안지현 ( Ji Hyun Ahn ),오연상 ( Yeon Sahng Oh ),신순현 ( Soon Hyun Shinn ) 대한비만학회 2007 The Korean journal of obesity Vol.16 No.4

연구배경: 대사증후군은 인슐린저항성과 고인슐린혈증을 공통분모로 비만, 고혈압, 내당능장애, 이상지혈증 등을 동반하는 질환군으로 죽상경화증 및 심혈관질환의 위험요인이 되기 때문에 최근 주목받고 있다. 대사증후군의 주요병태생리인 인슐린저항성의 가장 중요한 원인으로 복부비만이 강조되고 있으며, 비만인에서 지방과 혈장의 아디포넥틴이 감소하는 것으로 알려지고 있다. 이에 본 연구에서는 복부비만이 있는 성인에서 혈장 아디포넥틴과 대사증후군의 다른 구성요소와의 연관성을 알아보고자 하였다. 방법: 2006년 5월부터 8월까지 중앙대학교병원 건강검진센터에 내원한 20세 이상의 성인 가운데 복부둘레가 대한비만학회(2005년)의 한국인 기준에 따라 남자는 90 cm, 여자는 85 cm 이상에 해당하는 110명을 대상으로 혈압, 혈청지질, 공복혈당, 인슐린, 아디포넥틴 농도 등을 측정하였다. 결과: 총 110명 중 남자는 65명(59.1%), 여자는 45명(40.9%)이었고, 연령은 23세에서 71세에 걸쳐 분포하였으며, 평균 연령은 48.02 ± 11.41세였다. IDF의 진단기준으로 대사증후군을 만족하는 대상자는 70명(63.6%), 그렇지 않은 대상자는 40명(36.4%)이었다. 공복 혈장 인슐린 농도와 HOMA-IR 값은 수축기 및 이완기혈압, 공복혈당이 증가할수록 유의하게 증가하는 양의 상관관계를 나타내었다. 공복 혈장 아디포넥틴 농도는 고밀도지단백 콜레스테롤 농도가 증가할수록 유의하게 증가하는 양의 상관관계를 나타냈으며 이때 고밀도지단백 콜레스테롤 농도가 독립변수인 것으로 나타났다. 결론: 대한비만학회의 복부비만 기준과 IDF의 대사증후군 진단기준을 사용하였을 때 대사증후군의 구성요소 가운데 저고밀도지단백 콜레스테롤혈증만 혈장 아디포넥틴 농도에 영향을 주는 독립변수인 것으로 나타났으며, 향후 복부비만의 개선 노력에 따른 혈장 아디포넥틴 농도의 변화와 대사증후군 구성요소와의 연관성에 대해 전향적 연구가 필요할 것으로 사료된다. Background: The metabolic syndrome is a constellation of interrelated risk factors of atherosclerosis and cardio-vascular disease. Abdominal obesity is emphasized as the most important cause of insulin resistance, which is the major pathogenesis of the metabolic syndrome. It is reported that adiponectin concentration in fat and plasma is decreased in obese individuals. In this study, we evaluated the association between plasma adiponectin and the components of metabolic syndrome in adults with abdominal obesity. Method: This study included 110 Korean adults with abdominal obesity (waist circumference ≥ 90 cm in men and ≥ 85 cm in women according to the criteria of Korean Society for the Study of Obesity, 2005), who visited to Center for Health Promotion in Chung-Ang University Medical Center. Their blood pressure, lipid profiles, fasting plasma glucose, insulin, and adiponectin concentration were measured. Results: A total 110 adults (aged 23-71 years, 65 men and 45 women) were included. Using the IDF criteria, number of individuals with metabolic syndrome was 70 (63.5%). Fasting plasma insulin concentration and HOMA-IR had positive correlation with systolic and diastolic blood pressure, and fasting plasma glucose concentration. In multivariate linear regression analysis, fasting plasma adiponectin concentration was mainly influenced by serum HDL cholesterol concentration. Conclusion: It is noted that low level of HDL cholesterol concentration was the only independent factor of fasting plasma adiponectin concentration. Further prospective studies regarding the association between the change in plasma adiponectin and the components of the metabolic syndrome after relieving abdominal obesity seem to be warranted.

경부임파절 종대를 동반한 침윤성 섬유성 ( 리들 ) 갑상선염 1 예

정현경(Hyun Kyung Chung),김광석(Kwang Seok Kim),김재택(Jae Taek Kim),김미경(Mi Kyung Kim),오연상(Yeon Sahng Oh),신순현(Soon Hyun Shinn) 대한내과학회 1996 대한내과학회지 Vol.50 No.3

Riedel's thyroiditis described by Bernhard Riedel in 1883, is rare chronic inflammatory diseases of unknown etiology and may be one manifestation of multifocal fibrosclerosis. The disorder presents with a history of painless anterior neck enlargement, which may gradually progress to produce symptoms of pressure, We reported a case of Riedel's thyroiditis in 61 years old man, He presented with painless swelling of the anterior neck with mild dysphagia. Physical examination revealed a stony hard, huge goiter and palpable cervical lymph nodes with mild tenderness. Surgical biopsy was done in thyroid mass and enlarged cervical lymph nodes. The histologic findings were diffuse dense fibrosis and inflammatory change replaced with normal thyroid tissue and severe necrosis with infarction of the lymph nodes. He was discharged while being treated with thyroxine and oral prednisolone. The thyroid mass and cervical lymphadenopathy were nearly resolved at three months of treatment. We think it may be the first report of the Riedel's thyroiditis that combined with cervical lymphadenopathy in Korea.

증례 / Prader-Willi 증후군 1예

김재택(Jae Tack Kim),공병호(Byeong Ho Kong),최성남(Sung Nam Choi),배현철(Hyun Chul Bae),김광석(Kwang Seok Kim),정현경(Hyun Kyung Chung),오연상(Yeon Sahng Oh),신순현(Soon Hyun Shinn) 대한내과학회 1999 대한내과학회지 Vol.56 No.5

Chronic cough is defined as a cough that lasts for more than three weeks. In most patients, chronic cough is caused by four conditions: postnasal drip, asthma, chronic bronchitis, gastroesophageal reflux. Psychogenic chronic cough is not a frequent disorder. Furthermore, chronic vocal tic disorder is a very rare cause of chronic dry cough. A 22- year-old male suffered from chronic dry cough for last two years. His character showed obsessive- compulsive disorder. He has been shrugging both shoulders inadvertently since his childhood. Consequently, he was diagnosed as having chronic motor tic disorder. But after contracting respiratory tract infection, his motor tic disappeared and chronic dry cough was developed concomitantly. He had no history of smoking, chronic rhinitis, sinusitis, asthma, and gastroesophageal reflux. Physical examinations were normal. Chest X-ray, paranasal sinus view, metacholine bronchial provocation test, and esophago-gastroscopy were normal. Chronic cough was never relieved despite empirical treatment. Psychiatric consultation suggested chronic vocal tic disorder. The frequency of cough was diminished two days after administeration of valium and haloperidol and thereafter his complaint disappeared in one month. Here we report a very rare case of chronic motor tic disorder which was transformed into chronic vocal tic disorder presenting as a chronic cough. As far as we know, this is the first case of its kind in Korea.

증례 : 내분비 ; 갈색세포종, 신경절신경종이 동반된 갑상선유두암 1예

안지현 ( Ji Hyun Ahn ),이승은 ( Seung Eun Lee ),정윤재 ( Yun Jae Chung ),지경천 ( Kyong Choun Chi ),김미경 ( Mi Kyung Kim ),오연상 ( Yeon Sahng Oh ),김재택 ( Jae Taek Kim ) 대한내과학회 2009 대한내과학회지 Vol.76 No.1

갈색세포종은 대부분 산발적으로 발생하고 다른 종양들과 연관되어 있으나 한 종양 내에서 갈색세포종과 신경절신경종이 동반되는 경우는 극히 드물다. 또한 다발내분비종양 제2형에서는 갈색세포종이 갑상선수질암과 관련되어 있으나 갑상선유두암과는 관련성이 드물고 이들간의 관계는 명백히 알려져 있지 않다. 저자들은 갈색세포종과 신경절신경종, 갑상선유두암이 동시에 발생한 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Composite tumors containing pheochromocytoma and ganglioneuroma are very rare. We report a 70-year-old female with papillary thyroid carcinoma and a compound adrenal medullary tumor, composed of pheochromocytoma/ganglioneuroma. She had complained of epigastric discomfort 2 months earlier. Chest computed tomography and pancreatic magnetic resonance imaging revealed an intrathoracic goiter and pancreatic cystic tumor. She underwent an explorative laparotomy, and a left adrenalectomy was done because of an adrenal mass, not the pancreatic mass. The pathological diagnosis was a compound adrenal medullary tumor, composed of pheochromocytoma and ganglioneuroma. Although there was no evidence of thyroid cancer on fine needle aspiration cytology, a total thyroidectomy was done because of the neck discomfort. The pathological diagnosis was a papillary thyroid carcinoma, and she underwent radioactive iodine therapy. (Korean J Med 76:85-89, 2009)

임상침윤성 섬유성 ( 리들 ) 감상선염

오연상 대한내분비학회 1994 Endocrinology and metabolism Vol.9 No.4

갑상선 안구병증의 치료

오연상 대한내분비학회 2001 Endocrinology and metabolism Vol.16 No.1

폐경후 여성에서 인슐린비의존형 당뇨병과 골다공증과의 상관관계

정현경,오연상,김재택,김광석,신순현,배현철,최성남 대한당뇨병학회 1996 Diabetes and Metabolism Journal Vol.20 No.3

인슐린 비의존형 당뇨병환자에서 혈청 Adenosine Deaminase 활성도에 관한 연구

박애자,오연상,박수정,신순현,배현철,최성남 대한당뇨병학회 1996 Diabetes and Metabolism Journal Vol.20 No.1

제2형 당뇨병 환자의 혈청 호모시스테인 농도와 만성합병증과의 관계

최승진,김재택,오연상,신순현 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.26 No.2

연구배경:최근에 고호모시스테인혈증은 당뇨병 환자에서 대혈관합병증과 미세혈관합병증에 관여하는 위험인자로 알려져 있으나 미세혈관 합병증과의 관계는 아직 완전히 정립되지 않을 상태로 본 연구에서는 경동맥 내중막 두께를 측정하여 혈청 호모시스테인 농도를 비롯한 죽상동맥경화증의 위험요소들과 대혈관 합병증과의 관계를 알아보고 혈청 호모시스테인 동도와 미세혈관합병증과의 관계를 알아보고자 하였다. 방법:2000년 1월에서 2000년 6월까지 중앙대학교 의과대학 부속병원에 입원했던 제2형 당뇨병 환자 58명을 대상으로 동맥경화증 위험인자와 고해상도 B­mode 초음파를 이용하여 경동맥 내중막 두께를 측정하였고 대혈관 합병증과 미세혈관합병증의 유무를 조사하여 상관관계를 분석하였다. 결과:1)제2형 당뇨병 환자에서 평균 혈청 호모시스테인 농도는 9.9±3.2μmol/L였고 연령 및 성별과 상관관계가 없었으나 혈청 크레아티닌(p=0.02)과 크레아티닌제거력(p=0.02)과는 상관관계가 있었다. 2)제2형 당뇨병 환자에서 경동맥 내중막 두께의 최대치, 최소치, 평균치는 각각 우측(4.00±1.20, 0.50±0.04, 1.04±0.62㎜)좌측(3.54±1.00, 0.31±0.02, 0.03±0.55㎜)평균(3.77±1.10, 0.44±0.03, 1.03±0.54㎜)이었고 혈청 호모시스테인 농도(p=0.03)와 유의한 상관관계가 있었고 혈청 저밀도지단백 콜레스테롤 농도(p=0.03)만이 독립적인 상관관계가 있었다. 3)대혈관합병증이 있는 환자에서 혈청 호모시스테인 농도(p=0.01), 평균 경동맥 내중막 두께(p<0.01)가 유의하게 증가되었다. 4)혈정 호모시스테인 농도와 미세혈관합병증과는 망막병증(p=0.07), 신병증(p=0.06), 신경병증(p=0.55)으로 상관관계가 없었으나 경동맥 내중막 두께와 당뇨병성신증과는 유의한 상관관계가 있었다(p=0.03). 결론:제2형 당뇨병 환자에서 혈청 호모시스테인 농도는 대혈관합병증의 위험인자로서 다른 인자와 복합적으로 대혈관합병증의 발생이나 진행에 관련될 것으로 사료되며 미세혈관합병증과는 상관관계가 없었다. 경동맥 내중막 두께는 대혈관합병증에서 증가디어 있었고 미세혈관합병증 중에서는 당뇨병성 신증과 관련되어 있었으며 이에 대한 기전이나 임상적 의의에 대한 더 많은 연구가 필요하다 하겠다. Background : Chronic complications in type 2 diabetic patients have microvascular and macrovascular components. Previous studies have shown that incidence of macrovascular complications correlates with the serum homocysteine levels, but the relatinship is unclear. In addition, the connection between the microvascular complications and the serum homocysteine levels is still obscure and controversial. In this study, the relationship between the serum homocysteine levels and microvascular and macrovascular complications were evaluated in type 2 diabetic patients. Methods : In 58 type 2 diabetic patients, the serum homocysteine levels, folic acid levels, Vit B12 levels, PAI-1 levels, the standard risk factors for macrovascular complications, the fasting serum glucose levels, the HbA_1c levels, and the fasting insulin and C-peptide concentrations, the renal function tests, and the carotid intima-media thickness were measured and the relationship between them and the serum homocysteine level was analyzed according to the presence and absence of macrovascular and microvascular complications. Results : 1) In type 2 diabetic patients, the mean serum homocysteine level was 9.9±3.2?mol/L. The serum homocysteine level showed no relationship with the clinical and biochemical variables including the risk factors for atherosclerosis except the serum creatinine level showed no relationship with the clinical and biochemical variables including the risk factors for atherosclerosis except the serum creatinine and creaaatinine clearance. 2) The maximum, minimum, and mean of the intima-media thickness of right carotid artery were 4.00±1.20, 0.50±0.04, 1.04±0.62mm, of left carotid artery were 3.54±1.00, 0.31±0.02, 1.03±0.55 mm, and means were 3.77±1.10, 0.44±0.03, 1,03±0.54mm, and correlated with the serum homocysteine level(p=0/03), but only the serum LDL cholesterol level independently correlated with the intima-media thicknes(p=0.04). 3) The serum homocysteine level(p=0.01) and intima-media thickness(p<0.01) was significantly higher in type 2 diabetic patients with macrovascular complications than without it. 4) The serum homocysteine level did not correlate with the incidence microvascular complications, but the intima-media thickness did correlate with diabetic nephropathy(p=0.03). Conclusions : The serum homocysteine level did not correlated with the incidence of diabetic microvascular complications. However, there was a small correlation with the risk factors of macrovascular complications.The intima-media thickness correlated with the incidency of macrovascular complications, and the relationship with diabetic nephropathy requires further study (J Kor Diabetes Asso 26: 112~125, 2002).