Is Stem Cell-Based Therapy Going on or Out for Cardiac Disease?

변기현,김성한 대한심장학회 2009 Korean Circulation Journal Vol.39 No.3

Acute myocardial infarction and subsequent heart failure are leading causes of death worldwide. Stem cell-based therapies have improved cardiac function in recent clinical trials, but cardiomyocyte regeneration has not been demonstrated in human hearts. Angiogenesis and restoration of cardiac perfusion have been successfully performed using bone marrow derived stem cells and other adult stem cells. Resident cardiac stem cells are known to differentiate into multiple heart cell types, including cardiomyocytes. Furthermore, induced pluripotent stem cells are a focus of research due to the great potential for customized stem cell therapy. Acute myocardial infarction and subsequent heart failure are leading causes of death worldwide. Stem cell-based therapies have improved cardiac function in recent clinical trials, but cardiomyocyte regeneration has not been demonstrated in human hearts. Angiogenesis and restoration of cardiac perfusion have been successfully performed using bone marrow derived stem cells and other adult stem cells. Resident cardiac stem cells are known to differentiate into multiple heart cell types, including cardiomyocytes. Furthermore, induced pluripotent stem cells are a focus of research due to the great potential for customized stem cell therapy.

관상동맥의 중재술 후 Aspirin, Ticlopidine과 Cilostazol의 다제 병합 경구용 항혈소판응집 약물치료

변기현,심재광,민상조,전수진,김종현 대한심장학회 2004 Korean Circulation Journal Vol.34 No.5

Background and Objectives :Along with intracoronary stenting, medications, such as Ca++ channel blocker, -nosis. However, restenosis still remains as a challenging dilemma, with a frequency of 20-50%. Aspirin and ticlopidine are known as a standard anti -platelet regimen following PCI, but cilostazol is a comparably efe -ctive drug, which has a diferent mechanism to that of ticlopidine. It is unknown if the triple combination of aspirin, ticlopidine and cilostazol could further reduce adverse events and restenosis.Subjects and Methods :between Jan. 2000 and Dec. 200 1, were retrospectively analyzed. The patients had taken either aspirin+ ticlopidine or aspirin+ticlopidine+cilostazol, and the clinical observation and follow -up angiography was com -pleted for 6 months. There were 111 (66 males) and 87 (male :57) in the aspirin+ticlopidine and aspirin+ ticlopidine+cilostazol groups, respectively. The rates of major adverse cardiovascular events (MACE) and restenosis were compared during the follow -up period. Results:The frequency of MACE was similar, without a significant increase in the side effects during the folow -up period. The restenosis and target lesion reva -scularization (TLR) rates were significantly decreased in the triple combination therapy group (37.2% vs. 21.9%, p=0.006, 29.8% vs. 14.1%, p=0.008).Conclusion :This study showed that this triple combination of that these efects were probably due to more potent platelet inhibition by the multi -directional mechanism in addition to coronary vasodilation efect. (Korean Circulation J 2004 ;34(5):443-450) 배경 및 목적: 관상동맥내 스텐트술과 더불어 칼슘 길항제, Nitrate와 항혈소판 약물등은 경피적 관동맥 중재술후의 임상적인 결과와 재협착을 감소시키는데 기여하여 널리 보급되어 왔다. 그러나 현재까지 만성 재협착이 20~50%의 발생 빈도로 남아있어 여전히 반복적 관동맥 재관혈술이 불가피하여 시술의 제한점으로 알려져 있다. Cilo-stazol은 aspirin이나 ticlopidine에 비해 항혈소판 작용이 강력하고 백혈구 감소증과 같이 심각한 부작용은 없어, 경피적 관동맥 중재술후 혈소판이 활성화되는 급성기로부터 혈관 신생내막의 과증식으로 인한 재협착이 주로 일어나는 시술 후 6개월 이상 지속적으로 사용할 수 있는 비교적 안전한 약물이다. Aspirin, ticlopidine과 cilostazol을 다제 병합 혈소판 치료를 하였을 때 만성 재협착율 감소 효과가 증가되는지에 대한 기존에 알려진 연구가 없어, 이에 저자 등은 관상동맥 풍선확장과 스텐트 삽입 후 심장관련 사고의 발생율과 혈관 조영검사 결과에 미치는 영향을 알아보고자 하였다. 방 법: Walace 기념 침례병원에서 2000년 1 월부터 2001년 12월까지 24개월간 관동맥 조영술 및 풍선확장과 스텐트삽입술을 시행받았던 198명(평균 연령:60 ± 9세, 남자:123명)의 환자를 aspirin+ticlopidine 치료군과 aspirin+ticlopidine+cilostazol 치료군으로 나누어 임상경과 기록과 추적 관동맥 조영술의 결과를 후향적으로 비교 분석하였다. 결 과: 심장관련 사고의 발생율은 두 치료군간에 통계적으로 유의한 차이는 없었다. 또한 주요장기의 대량출혈을 비 롯한 약제와 관련된 중대한 부작용은 두군에서 발생하 지 않았고, 천자부위의 소량 출혈의 발생빈도는 다제 병합치료군에서 낮은 경향을 보였다. 그리고 경피적 관 동맥 중재술후 6개월 뒤 시행한 관동맥 조영술의 결과에 서 관상동맥 치료부위의 50% 이상의 관재협착이 발생 할 확률과 이로 인한 반복적 재관혈술의 시술율이 통계 적으로 유의하게 다제 병합 치료군에서 낮은 결과를 보 였다. 그러나 관상동맥의 치료부위가 아닌 50~75%의 중간정도 협착 병변의 악화로 인한 재관혈술 비율은 두 군 간에 유의한 차이가 없었다. 결 론: 본 연구의 결과로는 다제 병합 항혈소판 치료는 현재 까지 표준적인 치료로알려진 aspirin+ticlopidine 치료 에 비해 만성 재협착 방지에서 더 우월한 결과를 보였 으며, 다제 병합치료와 관련된 부작용에서도 유의한 차 이가 없어 2제 병합치료에 대치할만한 항혈소판 치료로 보였다. 이러한 효과는 이론적으로 기전이 다른 약물의 다제 병합으로 혈소판 억제의 상승 효과와 부가적인 혈 관 확장작용으로 인한것으로 추측된다. 그러나 본 연구 는 대상 환자의 규모가 작고 전향적 연구가 아니어서 향후 전향적 무작위 비교 연구가 필요할 것이다.

Functional Improvement Following Revision Surgery in a Patient with the Dual Disability of a Complicated Residual Limb and Contralateral Hemiplegia: A Case Report

변기현,양동석,장백희 대한물리치료학회 2018 대한물리치료학회지 Vol.30 No.5

The number of reported cases with dual disability is increasing for the past few decades. Currently, dual disability of lower limb amputation and motor weakness after stroke became a strong issue in public concern. The functional levels of patients have shown in the wide range from independent community ambulation to non-ambulation. Thus, it indicates that favorable outcomes for dual disability may depend upon adopted rehabilitative strategies. We present the case of a man with left below-knee amputation and severe right-sided weakness following a huge putaminal hemorrhage. He had suffered from extreme pain and misfit of the prosthetic socket and the complicated residual limb for three years prior to the stroke. Forty days post-stroke, we performed a revision surgery to resolve the complications of bony overgrowth, verrucous hyperplasia, and neuroma and applied an ankle foot orthosis (AFO). Two years post-stroke, he was able to ambulate outside his home and negotiate stairs using a cane. This is the first case with the dual disability of lower limb amputation and contralateral hemiplegia to undergo revision surgery. The results suggest that an early revision surgery and use of an AFO are crucial for achieving a higher level of mobility in such cases.

심경병성 근이영양증에 동반된 심근병증의 단기 성장호르몬 치료효과 1례

변기현,김동수,나준식,오수환,김인재,홍범기,권혁문,남수연,강성웅,김현승 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.8

베체씨병에서 대동맥궁 분지혈관에 재발한 가성 동맥류의 이식혈관 스텐트 치료 1예

변기현,최승혁,최동훈,심원흠 대한순환기학회 2001 Korean Circulation Journal Vol.31 No.8

폐경후 Syndrome X 환자에서 에스트로젠 치료의 유용성

김동수,변기현,권혁문,윤영원,홍범기,김현승,송경순 대한순환기학회 1999 Korean Circulation Journal Vol.29 No.3

심낭에 발생한 원발성 혈관주위세포종 1예

박자영,변기현,정호경,조훈,김종현,심재광,방정현,오훈규,신미정 대한심장학회 2002 Korean Circulation Journal Vol.32 No.10

Which Neural Tract Plays a Major Role in Memory Impairment After Multiple Cerebral Infarcts? A Case Report

박대권,변기현,양동석 대한재활의학회 2018 Annals of Rehabilitation Medicine Vol.42 No.4

Injury to the thalamocortical tract (one in the Papez circuit) that leads to memory impairment following brain injury is very rare. In this study, we present a case of partial injury to the thalamocortical tract that causes memory impairment after concurrent thalamic and hippocampal infarct. A 20-year-old male complained of memory impairment 1 month after partial injury to the thalamocortical tract. Using a probabilistic diffusing tensor tractography, it was found that the right thalamocortical tract was thinner than the left thalamocortical tract. However, all other neural tracts including the fornix, cingulum, and mammillothalamic tract were intact on both hemispheres. Therefore, the memory impairment in this patient was considered as being due to thalamic infarct based on the observation that the fornix from hippocampal infarct was intact. This case suggests that the assessment of lesions in the neural tracts of the Papez circuit might be useful for understanding the mechanism of memory impairment following cerebral infarction.

Right Atrial Lipoma Presenting with Angina

이성원,조덕규,변기현,은영민,유송현,조윤형 한국심초음파학회 2008 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.16 No.4

We report a case of a cardiac lipoma arising from the free wall of right atrium, which was diagnosed as the presumed source of angina by compressing the right coronary artery in a 54-year-old woman. Surgical excision of the tumor was performed well. She continues to do well for six months without angina.

심한 심근교락을 보인 협심증환자에서 시행한 관동맥 스텐트 삽입술 1례

최승혁,심상준,변기현,최동훈,심원흠 대한순환기학회 2001 Korean Circulation Journal Vol.31 No.9