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한국인에게서 당뇨병성 말초 신경병증을 선별하기 위한 문진표의 유용성
정윤석(Yoon Sok Chung),채봉남(Bong Nam Chae),홍은경(Eun Gyoung Hong),이성규(Seong Kyu Lee),노혜림(Hae Lim Noh),김윤정(Yoon Jung Kim),신영구(Young Goo Shin),이관우(Kawn Woo Lee),김현만(Hyeon Man Kim) 대한내과학회 1999 대한내과학회지 Vol.57 No.1
N/A Discrepancies exist in the currently available data on the prevalence of diabetic neuropathy. Variations in the prevalence of diabetic neuropathy have reflected the different criteria used to form its diagnosis. The majority of diagnostic criteria are less practical in many routine clinical settings where there is a need for a simple assessment using widely available techniques to rapidly screen large numbers of patients. We already reported that the questionnaire of Feldman's two-step assessment was less useful in Koreans, because of the different expression of neuropathic symptoms. We proposed a representative questionnaire which was based on patients' own complaints, and assessed its clinical availability. Methods : Ninety diabetic patients(45 cases with diabetic neuropathy, 45 cases without neuropathy) were included in this study. Diabetic neuropathy was diagnosed by neurologic examination and nerve conduction velocity. The questionnaire consisted of 7 questions on foot sensation (prickling, lancinating, burning, numb), which are frequent complaints of diabetic patients. All subjects were assessed with the questionnaire. Results : 1. The most sensitive symptom was tingling sensation (75.6%) and the least sensitive one was numbness(28.9%). 2. The most specific symptom was numbness(82.2%) and the least specific one was tingling sensation(33.3%). 3. If we would assume that three or more of symptoms were diagnostic, the sensitivity and specificity were 66.7% and 53.3%, respectively. Conclusion : Our new questionnaire can be used as a screening test or a follow-up tool for the diagnosis of diabetic peripheral neuropathy in Koreans.
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.
인슐린 비의존형 당뇨병 환자의 직계자식에서 당수송체 유전자의 다형성과 인슐린 분비능 및 말초조직의 포도당 이용율 등의 대사적 측면과의 상호연관성에 관한 연구
이현철(Hyun Chul Lee),이영식(Young Sik Lee),박석원(Seog Won Park),정윤석(Yoon Sok Chung),안광진(Kwang Jin Ahn),이은직(Eun Jig Lee),임승길(Sung Kil Lim),김경래(Kyung Rae Kim),허갑범(Kap Bum Huh),김태연(Tae Yeun Kim),임정수(Jung Soo Rh 대한내과학회 1993 대한내과학회지 Vol.45 No.1
N/A Background: First-degree relatives of non-insulin dependent diabetes mellitus are generally accepted to be high risk group for development of non-insulin dependent diabetes mellitus. So we are intended to identify the early metabolic defects in the young first-degree relatives of non-insulin dependent diabetes mellitus. Methods: Ten offsprings of non-insulin dependent diabetes mellitus and ten healthy men were included in this study. They were all third decade male subjects and matched well with age and body mass indices. Both groups were not different in anthropometric measurements (IBW, BMI, WHR), dilay calorie intake and total energy consumptions (total energy expenditure, physical activity). Results: 1) Oral glucose tolerance test showed normal responses of plasma glucose levels and C-peptide levels in both groups. 2) There were statistically significant differences (p<0.05) in plasma glucose, C-peptide and insulin levels at 60 minutes between two groups (Glucose 100±19 vs. 77±19mg/dl; C-peptide 5.47±1.7 vs. 3.32±1.88ng/ml; Insulin 90.3±41.3 vs. 38.6±29.4 μU/ml). 3) The result of euglycemic hyperinsulinemic clamp study showed that offsprings of non-insulin dependent diabetes mellitus had significantly diminished rates of insulin-mediated glucose disposal compared to the control group (5.61±1.01 vs. 8.87±0.92mg/kg B.W/min, p<0.01). 4) Simple linear regression analysis showed a good correlation between peripheral glucose utilization rates and the lean mass composition measured by body composition analyzer (Futrex-5000, Futrex Co., USA). As the lean mass percentage increases, peripheral glucose utilization rate also increases with positive 1inear relationship (r2=0.49, p<0.05). 5) By the method of restriction fragment length polymorphism, we found two polymorphic Kpn I sites of 6.5 kb and 5.8 kd as described previously without any new polymorphism for GLUT4 gene DNA in both groups. We also used other two restriction endonucleases, Bam HI and Eco RI, but did not discover polymorphism at GLUT4 gene locus. Conclusion: This study supports the genetic tendency of non-insulin dependent diabetes mellitus and showed that the early metabolic defect in the young offsprings is expressed as insulin resistance rather than pancreatic beta-cell dysfunction, The insulin resistance is in the negative linear relationship with the lean mass composition and seems to arise from the skeletal muscle tissue. For preventing the development of glucose intolerant status and overt diabetes, the avoidance of obesity and maintenance of muscle mass by means of careful diet control and continuous exercise program may be helpful.
증례 : 후복강 기관지원성 낭종 1예와 후복강 종양의 임상 경험
임남규 ( Nam Kyu Lim ),김연경 ( Yun Kyung Kim ),안상미 ( Sang Mi Ahn ),김대중 ( Dae Jung Kim ),정윤석 ( Yoon Sok Chung ),이관우 ( Kwan Woo Lee ),소의영 ( Euy Young Soh ) 대한내과학회 2006 대한내과학회지 Vol.71 No.1
후복강 종양은 비교적 드문 질환이며, 대부분 증상 발현이 없다가 전산화 단층 촬영 등을 통해 우연히 발견되는 경우가 많다. 저자들은 우연히 발견된 후복강 종괴를 주소로 내원하여 외과적 절제술 후 매우 희귀한 질환인 기관지원성 낭종을 병리조직학적으로 진단하였기에 최근 5년간 본원에서 진단받은 연부조직 후복강 종양들의 비교 및 문헌고찰과 함께 이를 보고 하는 바이다. Retroperitoneal tumors are rare. They are asymptomatic, and are often found incidentally on abdominal computed tomograms (CTs). The patient reported here visited our hospital complaining of right flank pain. On abdominal CTs, a left-side retroperitoneal mass and a right ureteral stone were found. The hormonal study was normal. After surgical excision, the tumor was confirmed to be a bronchogenic cyst histologically, a very rare cause of retroperitoneal tumor. Our medical center has seen 15 cases with a soft tissue mass in retroperitoneal space over the past 5 years. Benign tumors were incidentally, while malignant tumors were often diagnosed after the patient complained of a palpable mass. In many of these cases, the radiologic impressions and pathologic diagnosis were inconsistent.(Korean J Med 71:97-102, 2006)
이은직(Eun Jig Lee),이현철(Hyun Chul Lee),안광진(Kwang Jin Ahn),임세중(Se Joong Rim),정윤석(Yoon Sok Jung),이관우(Kwan Woo Lee),임승길(Sung Kil Lim),김경래(Kyung Rae Kim),허갑범(Kap Bum Huh),양우익(Woo Ik Yang),박찬일(Chan Il Park),최 대한내과학회 1991 대한내과학회지 Vol.41 No.6
N/A This retrospective study concerns 73 patients with nonfunctioning pituitary adenoma who were operated on during an 9-year period from 1981 to 1989. Among them, 7 men showed positive immunocytochemistry for FSH and negative for other pituitary hormones. Six of them had elevated serum FSH levels, and LH levels were normal. Testosterone levels were low in six patients tested. Their major symptoms were visual impairment, headache, and impotence, which had developed from two months to 2 years before sugery. Primary hypogonadism could be eliminated on clinical grounds (recent onset of hypogonadism, previous fertility, and posttreatment-improvement). Transsphenoidal adenomectomies were performed in all patients, and radiation-therapies were paralleled in 6 of them. Clinical recovery occurred in all patients. One patient who did not received radiation therapy showed regrowth of tumor mass after 18 months. In remaining 6 patients, we haven't found any evidence of tumor recurrence during follow-up period from 10 months to 6.3 years. We conclude that these 7 men had primary gonadotrope adenoma of the pituitary, and present them with a literature review.