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증예(症例) : 승모판 협착증 환자에서 신생 혈관을 동반한 좌심방 혈전
이선화 ( Sun Hwa Lee ),이경석 ( Kyoung Suk Rhee ),이상록 ( Sang Rok Lee ),채제건 ( Jei Keon Chae ),김원호 ( Won Ho Kim ),고재기 ( Jae Ki Ko ) 전북대학교 의과학연구소 2010 全北醫大論文集 Vol.34 No.2
좌심방 혈전 형성은 승모판 협착증과 심방세동이 있는 환자에서 흔한 합병증이다. 심장내 종괴와 동반된 신생혈관 형성은 일반적으로 혈전보다는 종양과 관련되어 발생한다고 알려져 있다. 저자들은 중증도 승모판 협착증과 심방세동이 있던 64세 여자 환자에서 거대한 좌심방내 종괴가 발견되었고 최초 혈전으로 진단하였다가 관상동맥 조영술에서 풍부한 신생혈관이 발견되어 진단에 혼동이 초래되었으나 조직학적으로 혈전으로 증례를 보고하는 바이다. Left atrial (LA) thrombosis is a common complication in patients with mitral stenosis (MS) and atrial fibrillation. Neovascularization is a phenomenon generally related to cardiac tumor rather than thrombosis. We describe here a 64-year-old woman with moderate MS and a huge LA thrombus whose initial diagnosis was confused due to prominent feeding vessels demonstrated by coronary angiography.
유경보 ( Kyung Bo Yoo ),이선화 ( Sun Hwa Lee ),이경석 ( Kyoung Suk Rhee ),이강휴 ( Kang Hyu Lee ),이상록 ( Sang Rok Lee ),채제건 ( Jei Keon Chae ),김원호 ( Won Ho Kim ),고재기 ( Jae Ki Ko ) 전북대학교 의과학연구소 2010 全北醫大論文集 Vol.34 No.2
배경 및 목적: 최근 약물과 관련되어 발생한 서맥성 부정맥의 예후에 대한 재평가가 이루어지고 있다. 본 연구는 약제 유발성 서맥으로 최초 진단받은 환자들의 임상 경과를 분석하여 그 예후를 평가하고자 하였다. 방법: 전북대학교 병원 심장내과에 2000년 1월 이후 약물 유발성 서맥으로 진단 받고 입원치료를 받았던 환자들을 대상으로 하여 의무기록 분석 및 전화상담을 통한 후향적 조사를 하였다 결과: 전체 환자 중 경과 관찰 기간 동안 영구적 심박동기 삽입술을 시행 받은 환자는 28명(26.9%)으로, 동기능 부전 증후군 군과 고도방실차단 군에서 각각 15명(/68, 22.1%)과 13명(/36, 36.1%)이었다 결론: 고전적으로 양호한 임상경과를 취하는 것으로 알려져 왔던 이차성 서맥성 부정맥 환자 상당수에서 유발인자가 없이도 서맥이 점차 진행하여 결국 영구형 인공심박동기 이식시술을 받게 된다. Background and Objectives: Recently, the prognosis of drug-induced bradyarrhythmias has been reported not as benign as previous considerations. We performed the investigations about the patients who had been diagnosed as drug-related bradyarrhythmias presenting it at first. Subjects and Methods: Medical records of those who had been admitted to Chonbuk National University Hospital due to drug-related bradyarrhythmias since January 2000 were investigated retrospectively and clinical follow-up was performed using phone call. Results: One hundred and four patients were enrolled. Mean age was 68±10(34-85) years. Underlying diseases that need relating drugs were hypertension (50, 48.1%), ischemic heart disease, atrial fibrillation, cardiomyopathy, etc. Most common single causative agent was β-blockers (53.0%) and the others were nondihydropyridine calcium channel blockers (18.9%), digoxin (10.6%), antiarrhythmics (9.1%) and herb-medications (3.8%). 68 patients showed sinus node dysfunction (SND, 65.4%) and 36 showed AVB (34.6%). Mean heart rate on admission was 37.0±7.1 beats/minute. Permanent pacemaker implantations were performed in 28 patients (26.9%). Fifteen among them were with SND (15/68, 22.1%), 13 were with AVB (13/36, 36.1%). Conclusion: Unlikely to the general considerations, it would be better to say that drug-related bradyarrhythmias are not drug-induced bradyrrhythmias itself, but unmasked underlying bradyarrythmias in substantial portion of the patients. Very close and cautious clinical monitoring should be performed, especially in patients with AVB.
증예(症例) : 심장을 침범하고 염색체 이상을 동반한 원발성 과호산구 증후군 1예
권혁진 ( Hyeok Jin Kwon ),이호경 ( Ho Kyung Lee ),송은기 ( Eun Ki Song ),이승룡 ( Seung Ryong Lee ),김원호 ( Won Ho Kim ),채제건 ( Jei Keon Chae ),고재기 ( Jae Ki Ko ) 전북대학교 의과학연구소 2002 全北醫大論文集 Vol.26 No.2
The idiopathic hypereosinophilic syndrome(HES) is defined by the sustained eosinophilia without the apparent etiologies and with any organ involvement. Congestive heart failure resulting from cardiac involvement is a major cause of morbidity and mortality. A 21-year-old female patient had visited with hoarseness and exertional dyspnea. Fine crackles and holosystolic cardiac murmur were heard. Mild cardiomegaly in chest x-ray and hepato- and splenomegaly in computed tomography were observed. Severe mitral and tricuspid regurgitation accompanied with pulmonary hypertension was observed in echocardiographic examination. Limitation of mobility of the posterior mitral leaflet and tricuspid valve and thickening of endocardium may be caused by the eosinophilic infiltration. Cardiac involvement was confirmed by endomyocardial biopsy. The bone marrow biopsy was reported as a chromosomal abnormality of karyotype(46,XX,del(5)(p15)), which is exclusively seen in idiopathic HES. Therefore, we report a case of HES with chromosomal abnormality and cardiac involvement.
채제건 대한핵의학회 1999 핵의학 분자영상 Vol.33 No.2
Percutaneous Transluminal Coronary Angioplasty (PTCA) remains limited by restenosis that occurs in 30 to 50% of patients with coronary artery disease. During the last decade, numerous agents have been used to prevent restenosis. Despite positive results in animal models, no pharmacological therapy has been found to significantly decrease the risk of restenosis in humans. These discrepancies between animal models and clinical situation were probably related to an incomplete understanding of the mechanism of restenosis. Neointimal thickening occurs in response to experimental arterial injury with a balloon catheter. Neointimal formation involves different steps: smooth muscle cell activation, proliferation and migration, and the production of extracellular matrix. The factors that control neointimal hyperplasia include growth factors, humoral factors and mechanical factors. Arterial remodeling also plays a major role in the restenosis process. Studies performed in animal and human subjects have established the potentials for "constrictive remodeling" to reduce the post-angioplasty vessel area, thereby indirectly narrowing the vessel lumen and thus contributing to restenosis. The reduction of restenosis rate in patients with intracoronary stent implantation has been attributed to the preventive effect of stent itself for this negative remodeling. In addition to these mechanisms for restenosis, intraluminal or intra-plaque thrombus formation, reendothelialization and apoptosis theories have been introduced and confirmed at least in part.