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당뇨병 환자에서 Power Spectrum Analysis 를 이용한 자율신경계 이상의 검정
이두하(Du Ha Lee),황형기(Hyoung Ki Hwang),이형우(Hyoung Woo Lee),김영조(Young Jo Kim),심봉섭(Bong Sup Shim),이현우(Hyun Woo Lee),신동구(Dong Ku Shin),이상학(Sang Hak Lee),이준하(Jun Ha Lee) 대한내과학회 1991 대한내과학회지 Vol.41 No.5
N/A In order to assess the autonomic nervous system activity in normal subjects and in diabetic patients affected by different degrees of diabetic autonomic neuropathy, we applied autoregressive power spectral analysis to 35 diabetic patients and 15 normal controls. This analysis was then compared to conventional methods by CAN score tests. Each subject was placed on a bed and connected to electro-cardiographic electrodes. After 15-minute rest in a sitting position, the electrocardiogram (ECG) recorded 512 heartbeats in a supine position. Thereafter, the same measure was taken in a standing position. During the test, the subjects quietly breathed in synchronosity with a 15/min (0.25 Hz) metronome signal to obtain stationary respiratory activity without frequency change or phase drift. R-wave detection by fast peak detection algorithm and spectrum computation by Fast Fourier transform enabled the study of the power spectrum of heart rate fluctuations. The power of fluctuations at different frequencies was the result of sympathetic and vagal input into the sinoatrial node. The autoregressive power spectral density of RR interval variability contained 2 major components: a high frequency (0.25 Hz), which is a quantitative marker of cardiac vagal activity, and a low frequency (<0.15 Hz), which is a quantitative marker of sympathetic activity with vagal modulation. A marked reduction in HF spectral density was found in diabetic patients relative to the normal controls (p<0.001). When neural activity was provoked through standing, less decreased HF spectral density and less increased LF spectral density were noted in diabetic patients relative to the normal controls (p<0.01). When diabetic autonomic neuropathy was advanced, HF and LF spectral density changes were lost. This method is simple, repeatible, objective, and quantitative. It may facilitate the screening of diabetic patients for autonomic neuropathy and enable convenient quantitative fallow-up.
안재희,이두하,전효진,현명수,이현우,김정숙 영남대학교 의과대학 1989 Yeungnam University Journal of Medicine Vol.6 No.2
피부 농양절개술 후 계속되는 출혈을 주소로 입원한 진성다혈증 환자에서 혈액응고인자, Ⅰ,Ⅷ,Ⅸ, ?? 등의 감소와 혈소판의 기능 장애를 동반한 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. We report a case of polycythemia vera combined with coagulation disorder. The patient was 54 years old man who complained of continuous bleeding after incision of skin abscess 20 days ago. Laboratory tests were revealed prolonged aPTT and slightly prolonged PT. Coagulation factor, I, VIII, IX, ?? and fibrinogen decreased, however FDP did not increased. It appears that patient with polycythemia vera have chronic activation of coagulation system, probably initiated by activation of factor XII. Platelet aggregation test to ADP, collagen, epinephrine was also revealed poor response.
Captopril검사 양성반응을 보인 부신외 갈색세포종(Extraadrenal Pheochromocytoma)1예
박종선,이두하,이인범,오태희 영남대학교 의과대학 1997 Yeungnam University Journal of Medicine Vol.14 No.2
There have been some case reports of the coexistence of extraadrenal pheochromocytoma and renal artery stenosis. Some reporters proposed that their coexistence may be associated through a common pathophysiological mechanism mediated by catecholamine secretion. Also some noted that trasient renal artery stenosis due to a spasm was induced by the catecholamines released from pheochromacytoma. We report a case of left paraaortic extraadrenal pheochromacytoma that had a transient oral captopril test positive result. After 5 days a-antagonist reduced the vasospastic response of catecholamines. After surgical removal of the tumor, plasma catecholamines and urinary vanillylmandelic acid concentrations as well as the blood pressure level, were restored to normal.
혈액투석 유지요법 환자에서 투석 전후의 좌심실 Doppler 심초음파를 이용한 기능지표의 변화 : A Doppler Echocardiographic Study
김현서,강동오,김성록,김현수,이두하,박종선 영남대학교 의과대학 1999 Yeungnam University Journal of Medicine Vol.16 No.2
Background: Left ventricular diastolic filling is an important determinant for maintenance of cardiac output during hemodialysis. Few investigators have studied the influence of hemodialysis on diastolic function. To evaluate the change of left ventricular systolic and diastolic function, we performed M-mode and Doppler echocardiographic studies before and after hemodialysis. Methods: The study population consisted of 30 patients(15 patients were male, mean age 45±10 years) with CRF on maintenance hemodialysis. They have normal left ventricular systolic function(Fractional shortening>30%) and no evidence of valvular heart disease or regional wall motion abnormalities. The ejection fraction(EF) was measured using M-mode echocardiography and Doppler indices such as peak E velocity. peak A velocity, isovolumetric relaxaion time(IVRT), deceleration time(DT), and left ventricular ejection time(LVET) obtained from Doppler echocardiography. The index of myocardial performance (IMP) was calculated from each of the Doppler velocity indices. Results: The weight reduction after hemodialysis was 2.1±1.0kg(p<0.0001). After hemodialysis, there was some decrease in blood pressure(p<0.05), but no significant change in heart rate, EF and fractional shortening, mean VCF. peak A velocity, and DT And significant reduction in peak E velocity, E/A ratio(p<0.0001, p<0.001), and significant increase in IVRT and IMP(p<0.05, p<0.0001) were noted. Conclusion: In conclusion, preload reduction is the main mechanism that accounts for changes in Doppler diastolic indices after hemodialysis. And an increased IMP suggests that diastolic function may be aggravated after hemodialysis, and that implies impaired left ventricular filling and disturbed left ventricular compliance.