• 제목/요약/키워드: epigastric fullness

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당뇨병 합병증 발생 이전의 위장관 증상 (Gastrointestinal Symptoms in Diabetes Occur Long before Diabetic Complications)

  • 정환석;이은정;이미연;박정호;박동일;전우규;손정일
    • The Korean Journal of Medicine
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    • 제99권4호
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    • pp.210-218
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    • 2024
  • 목적: 자율신경계 합병증과 같은 당뇨 합병증을 갖고 있는 환자들에게 있어 위장관계 증상은 매우 흔한 편이다. 그러나 당뇨 합병증이 발병하기 전에 위장관계 증상의 유병률이 어떤지는 명확히 알려져 있지 않다. 방법: Rome III 기준에 의거해 내분비내과를 찾은 환자들에게 기능성 위장장애에 관한 증상 설문조사를 실시하였다. 조사 영역은 기능성 소화 불량과 과민성 대장증후군, 기능성 변비에 관련된 질문들로 구성하였다. 결과: 당뇨 전단계, 당뇨병성 신경병증을 가지고 있지 않은 당뇨병 환자들, 당뇨병성 신경병증을 가진 당뇨병 환자군에 있어서 기능성 위장장애의 유병률은 각각 기능성 소화 불량의 경우 16.52%, 27.27% 그리고 23.53%, 과민성 대장증후군의 경우 8.70%, 11.68% 그리고 16.81%, 기능성 변비의 경우 8.85%, 11.85% 그리고 15.25%로 확인되었다. 하위 분류분석에서 식후 포만감과 조기 만복감과 같은 증상을 보이는 식후고통증후군의 유병률이 명치통증증후군보다 좀 더 높게 확인되었다. 기능성 변비에 관련된 하위 분류 분석에 있어 항문직장 폐쇄감이 있거나 배변을 돕기 위한 부가 처치가 필요한 경우와 같은 골반 출구 폐쇄 증상의 유병률이 서행성 변비 증상의 경우보다 더 높게 확인되었다. 결론: 기능성 위장장애의 유병률은 전반적으로 당뇨병이 더 심해짐에 따라 더욱 증가한다. 하지만 당뇨병과 연관된 위장관계 증상은 그 합병증이 발생하기 오래전부터 발생하게 된다. 따라서 이를 미리 확인하여 적절한 치료와 조치를 취할 필요가 있겠다.

구충증(鉤蟲症)에 관(關)한 연구(硏究) 제1편(第1篇) 구충(鉤蟲)의 감염(感染) 및 구충성빈혈(鉤蟲性貧血)에 관(關)한 고찰(考奈) (Studies on Ancylostomiasis I. An Experimental Study on Hookworm Infection and Anemia)

  • 이문호;김동집;이장규;서병설;이순형
    • 대한핵의학회지
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    • 제1권1호
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    • pp.55-66
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    • 1967
  • In view of its prevalence in the Far East area, a more detailed knowledge on the hookworm infection is one of the very important medical problems. The present study was aimed to; determine the infectivity of the artificially hatched ancylostoma duodenale larvae in man after its oral administration, evaluate the clinical symptomatology of such infection, determine the date of first appearance of the ova in the stool, calculate the blood loss per worm per day, assess the relation-ships between the ova count, infectivity(worm load), blood loss and severity of anemia. An erythrokinetic study was also done to analyse the characteristics of hookworm anemia by means of $^{59}Fe\;and\;^{51}Cr$. Materials and Methods Ten healthy male volunteers(doctors, medical students and laboratory technicians) with the ages ranging from 21 to 40 years were selected as the experimental materials. They had no history of hookworm infection for preceding several years, and care was taken not to be exposed to reinfection. A baseline study including a through physical examinations and laboratory investigations such as complete blood counts, stool examination and estimation of the serum iron levels was done, and a vermifuge, bephenium hydroxynaphoate, was given 10 days prior to the main experiment. The ancylostoma duodenale filariform larvae were obtained in the following manner; The pure ancylostoma duodenale ova were obtained from the hookworm anemia patients and a modified filter paper method was adopted to harvest larger number of infective larvae, which were washed several times with saline. The actively moving mature larvae were put into the gelatine capsules, 150 in each, and were given to the volunteers in the fasting state with 300ml. of water. The volunteers were previously treated with intramuscular injection of 15mg. of chlorpromazine in order to prevent the eventual nausea and vomiting after the larvae intake. The clinical symptoms and signs mainly of the respiratory and gastrointestinal tracts, appearance of the ova and occult blood in the stool etc. were checked every day for the first 20 days and then twice weekly until the end of the experiment, which usually lasted for about 3 months. Roentgenological survey of the lungs was also done. The hematological changes such as the red blood cell, white blood cell and eosinophil cell counts, hemoglobin content and serum iron levels were studied. The appearance of the ova in the stool was examined by the formalin ether method and the ova were counted in triplicate on two successive days using the Stoll's dilution method. The ferrokinetic data were calculated by the modified Huff's method and the apparent half survival time of the red blood cells by the modified Gray's method. The isotopes were simultaneously tagged and injected intravenously, and then the stool and blood samples were collected as was described by Roche et al., namely, three separate 4-day stool samples with the blood sample drawing before each 4-day stool collection. The radio-activities of the stools ashfied and the blood were separately measured by the pulse-height analyser. The daily blood loss was calculated with the following formula; daily blood loss in $ml.=\frac{cpm/g\;stool{\times}weight\;in\;g\;of\;4-day\;stool}{cpm/ml\;blood{\times}4}$ The average of these three 4-day periods was given as the daily blood loss in each patient. The blood loss per day per worm was calculated by simply dividing the daily blood loss by the number of the hookworm recovered after the vermifuge given twice a week at the termination of the experiment. The iron loss in mg. through the gastrointestinal tract was estimated with the daily iron loss in $mg=\frac{g\;Hgb/100ml{\times}ml\;daily\;blood\;loss{\times}3.40}{100}$ 3.40=mg of iron per g Hgb following formula; Results 1. The respiratory symptoms such as cough and sputum were noted in almost all cases within a week after the infection, which lasted about 2 weeks. The roentgenological findings of the chest were essentially normal. A moderate degree of febril reaction appeared within 2 weeks with a duration of 3 or 4 days. 2. The gastrointestinal symptoms such as nausea, epigastric fullness, abdominal pain and loose bowel appeared in all cases immediately after the larvae intake. 3. The reduction of the red blood cell count was not remarkable, however, the hemoglobin content and especially the serum iron level showed the steady decreases until the end of the experiment. 4. The white blood cells and eosinophil cells, on the contrary, showed increases in parallel and reached peaks in 20 to 30 days after the infection. A small secondary rise was noted in 2 months. 5. The ova first appeared in the stool in 40. 1 days after the infection, ranging from 29 to 51 days, during which the occult blood reaction of the stool became also positive in almost cases. 6. The number of ova recovered per day was 164, 320 on the average, ranging from 89,500 to 253,800. The number of the worm evacuated by vermifuge was in rough correlation with the number of ova recovered. 7. The infectivity of ancylostoma duodenale was 14% on the average, ranging from 7.3 to 20.0%, which is relatively lower than those reported by other workers. 8. The mean fecal blood loss was 5.78ml. per day, with a range of from 2.6 to 11.7ml., and the mean blood loss per worm per day was 0.30ml., with a range of from 0.13 to 0.73ml., which is in rough coincidence with those reported by other authors. There appeared to exist, however, no correlation between the blood loss and the number of ova recovered. 9. The mean fecal iron loss was 2.02mg. per day, with a range of from 1.20 to 3.89mg., which is less than those appeared in the literature. 10. The mean plasma iron disappearance rate was 0.80hr., with a range of from 0.62 to 0.95hr., namely, a slight accerelation. 11. The hookworm anemia appeared to be iron deficiency in origin caused by continuous intestinal blood loss.

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