Saccular Coronary Artery Aneurysm and Fistula with Organized Thrombi

정은행,김병진,방기배,Min Suk So,성기철,Jung-Tae Kim,Joon-Hyuk Kong,Tae Ho Kim 대한심장학회 2013 Korean Circulation Journal Vol.43 No.2

Saccular coronary artery aneurysm, associated with coronary artery fistula, is a very rare condition. A 48-year-old woman was referred to our hospital for the evaluation of an abnormal shadow on the left cardiac border from a chest X-ray film during regular medical health examination. A huge saccular aneurysm with organized thrombi in the proximal left anterior descending artery (LAD) and coronary artery fistulae from LAD and conus branch of the right coronary artery to pulmonary artery was diagnosed by transthoracic echocardiography,multi-detector computer tomography (MDCT), and coronary angiography. The patient received surgical treatment, including thrombecto-my of aneurysm, ligation of the inlet and outlet of aneurysmal sac, coronary artery bypass graft (left internal mammary artery-to-distal LAD), and ligation of fistulae. The postoperative course was uneventful, and postoperative echocardiography and MDCT revealed patent bypass graft; however, a small fistula from proximal LAD across aneurysmal sac to pulmonary artery was observed.

원관 주위의 대류 열전달에 대한 원둘레 방향의 열전도의 영향

이승홍,이억수,정은행 釜山大學校生産技術硏究所 1997 生産技術硏究所論文集 Vol.53 No.-

원관축의 수직방향으로 유체가 유동하는 경우에, 가열되는 수평 원관 주위에서 원둘레 (θ)방향으로 비대칭적으로 균일하지 않게 온도가 분포하기 때문에 원둘레 방향으로의 전도 열전달이 존재하고 비균일 대류 열전달 현상이 생긴다. 본 연구에서는 공기와 물을 작동유체로 하고 직교 유동내에 있는 수평 원관의 열전달 실험에서 국소 대류 열전달에 대한 원둘레 방향 열전도의 영향에 대하여 연구하였다. 에너지 방정식에서 유도된 무차원 수가 반경방향에 대한 원둘레 방향의 열전도의 영향을 나타내는 무차원 수로 사용되었다. 4가지 모델을 직접 전기저항 가열방식으로 가열하고, 원관 표면의 온도를 직접 측정하여 2차원 온도분포의 경계조건으로 사용하여 원관의 단면 내부에서 2차원 온도분포 T(r,θ) 를 보여준다. With uniform heat generation in a horizontal cylindrical heater placed in a cross flow boundary condition, heat flow that is conducted along the wall of the heater creates a non-isothermal surface temperature and heat flux distribution. In the present investigation, the effects of circumferential wall heat conduction on convection heat transfer is investigated for the case of forced convection around horizontal cylinder in cross flow of air and water. Non-dimensional conjugation parameter which can be deduced from the governing energy differential equation should be used to express the effect of circumferential wall conduction heat transfer. Two-dimensional temperature solutions T(r,θ) distribution is presented. The influence of circumferential wall heat conduction is demonstrated on graph of local Nusselt number.

수평 원관의 비등 열전달에서 강제대류의 영향

이승홍,이억수,정은행 대한설비공학회 1998 설비공학 논문집 Vol.10 No.5

This paper presents the results of experiments involving external forced convection on boiling heat transfer from electrically heated horizontal tube to water in cross flow. In these experiments, all of the following primary variables were varied: heat flux, cross flow velocity, pressure and degree of subcooling. Local surface temperatures were measured at nine peripheral positions. Surface temperature distributions are classified into four groups as a function of heat flux. The characteristics of the boiling curve at different velocity, degree of subcooling and pressure are examined.

원관 주위의 대류 열전달에 대한 복합 열전달

이승홍,이억수,정은행 대한설비공학회 1998 설비공학 논문집 Vol.10 No.5

The convection heat transfer on horizontal circular tube is studied as a conjugated heat transfer problem. With uniform heat generation in a cylindrical heater placed in a cross flow boundary condition, heat flow that is conducted along the wall of the heater creates a non-isothermal surface temperature and non-uniform heat flux distribution. In the present investigation, the effects of circumferential wall heat conduction on convection heat transfer are investigated for the case of forced convection around horizontal circular tube in cross flow of air and water. Non-dimensional conjugation parameter $ K^*$ which can be deduced from the governing energy differential equation should be used to express the effect of circumferential wall heat conduction. Two-dimensional temperature distribution$ T({\gamma,\theta})$ is presented. The influence of circumferential wall heat conduction is demonstrated on graph of local Nusselt number.

Retrospective Analysis on the Efficacy, Safety and Treatment Failure Group of Sitagliptin for Mean 10-Month Duration

김원준,박철영,정은행,서정윤,설지수,박세은,이은정,이원영,오기원,박성우,김선우 대한당뇨병학회 2011 Diabetes and Metabolism Journal Vol.35 No.3

Background: To investigate the clinical results of sitagliptin (SITA) and the characteristics of the treatment failure group or of low responders to SITA. Methods: A retrospective study of type 2 diabetic patients reviewed 99 cases, including 12 treatment failure cases, who stopped SITA because of worsening patients’ condition, and 87 cases, who continued treatment over five visits (total 9.9±10.1 months) after receiving the prescription of SITA from December 2008 to June 2009. Subjects were classified as five groups administered SITA as an initial combination with metformin (MET), add-on to metformin or sulfonylurea, and switching from sulfonylurea or thiazolidinedione. The changes in HbA1c level from the first to last visit (ΔHbA1c) in treatment maintenance group were subanalyzed. Results: The HbA1c level was significantly reduced in four groups, including initial coadministration of SITA with metformin (ΔHbA1c=-1.1%, P<0.001), add-on to MET (ΔHbA1c=-0.6%, P=0.017), add-on to sulfonylurea (ΔHbA1c=-0.5%, P<0.001), and switching from thiazolidinedione (ΔHbA1c=-0.3%, P=0.013). SITA was noninferior to sulfonlyurea (ΔHbA1c=-0.2%, P=0.63). There was no significant adverse effect. The treatment failure group had a longer diabeties duration (P=0.008), higher HbA1c (P=0.001) and fasting plasma glucose (P=0.003) compared to the maintenance group. Subanalysis on the tertiles of ΔHbA1c showed that low-response to SITA (tertile 1) was associated with a longer diabetes duration (P=0.009) and lower HbA1c (P<0.001). Conclusion: SITA was effective and safe for use in Korean type 2 diabetic patients. However, its clinical responses and long-term benefit–harm profile is yet to be established. Background: To investigate the clinical results of sitagliptin (SITA) and the characteristics of the treatment failure group or of low responders to SITA. Methods: A retrospective study of type 2 diabetic patients reviewed 99 cases, including 12 treatment failure cases, who stopped SITA because of worsening patients’ condition, and 87 cases, who continued treatment over five visits (total 9.9±10.1 months) after receiving the prescription of SITA from December 2008 to June 2009. Subjects were classified as five groups administered SITA as an initial combination with metformin (MET), add-on to metformin or sulfonylurea, and switching from sulfonylurea or thiazolidinedione. The changes in HbA1c level from the first to last visit (ΔHbA1c) in treatment maintenance group were subanalyzed. Results: The HbA1c level was significantly reduced in four groups, including initial coadministration of SITA with metformin (ΔHbA1c=-1.1%, P<0.001), add-on to MET (ΔHbA1c=-0.6%, P=0.017), add-on to sulfonylurea (ΔHbA1c=-0.5%, P<0.001), and switching from thiazolidinedione (ΔHbA1c=-0.3%, P=0.013). SITA was noninferior to sulfonlyurea (ΔHbA1c=-0.2%, P=0.63). There was no significant adverse effect. The treatment failure group had a longer diabeties duration (P=0.008), higher HbA1c (P=0.001) and fasting plasma glucose (P=0.003) compared to the maintenance group. Subanalysis on the tertiles of ΔHbA1c showed that low-response to SITA (tertile 1) was associated with a longer diabetes duration (P=0.009) and lower HbA1c (P<0.001). Conclusion: SITA was effective and safe for use in Korean type 2 diabetic patients. However, its clinical responses and long-term benefit–harm profile is yet to be established.

신장 ; Paraquat 중독 환자에서 혈액관류의 유용성

최원석 ( Won Seok Choi ),정은행 ( Eun Haeng Jung ),박은혜 ( Eun Hye Park ),서정연 ( Jung Yeon Seo ),전경홍 ( Kyung Hong Jun ),강명수 ( Myung Soo Kang ),김향 ( Hyang Kim ) 대한내과학회 2011 대한내과학회지 Vol.80 No.3

목적: Paraquat는 급성신부전 및 간부전과 함께 간질성 폐렴 또는 진행성 폐 섬유화증을 일으켜 폐부전으로 사망하게 하는 맹독성 제초제이다. 본 연구의 목적은 paraquat 중독 환자에서 혈액관류의 치료 효과 및 유용성에 대하여 연구하고자 하였다. 방법: 2009년 1월부터 2010년 1월까지 paraquat 중독 환자는 총 58명으로 이 중 27명이 혈액관류 치료를 시행 받았다. 혈액관류 치료 받은 환자를 대상으로 동맥혈 가스 분석 등의 혈액검사와 소변 dithionite 검사, 혈중 paraquat 농도를 비교 분석하여 혈액관류의 시작 시간과 종결시점 및 혈액관류의 효과 등에 대하여 조사하였다. 결과: 혈액관류를 받은 27명 중 생존군은 13명, 사망군은 14명이었다. 사망군에서 생존군에 비하여 음독량이 많았으며, 음독량이 4모금(80 mL) 이상인 경우는 혈액관류 치료에도 불구하고 24시간 이내에 사망하는 것으로 나타났다. 생존군에서 혈액관류 후 혈중농도는 Proudfoot 생존곡선 하방으로 감소하였으나 사망군에서는 혈액관류 치료에도 불구하고 Proudfoot 생존곡선 하방으로 혈중농도가 감소하지 않았다. 결론: Paraquat 음독환자의 혈액관류치료는 가급적 빠른 시간 내에 시행하는 것이 좋으며, 혈액관류의 대상은 대사성 산혈증이 없으며, 급성신부전이 동반되어 있지 않는 환자군에서 시행되어야 할 것으로 사료된다. 향후 대단위의 연구가 필요할 것으로 사료된다. Background/Aims: Paraquat is a potentially lethal herbicide that induces acute renal failure, hepatic dysfunction, and progressive respiratory failure. This study examined the usefulness of hemoperfusion in paraquat poisoning. Methods: We reviewed the medical records of 27 patients who underwent hemoperfusion after paraquat poisoning at Eumseong Keumwang Hospital from January 2009 to January 2010. Results: All 27 paraquat-poisoning patients underwent hemoperfusion therapy within 6 hours of ingestion, and 13 patients survived. Patients who had ingested more than four mouthfuls died with 24 hours despite hemoperfusion. The mean arrival time at the emergency room and the plasma paraquat concentration in the survivors was 3.08 hours and 1.30 μg/mL, respectively; after hemoperfusion, the mean elapsed time was 8.92 hours and the plasma paraquat level was 0.14 μg/mL. The mean arrival time at the emergency room and plasma paraquat concentration in the non-survivors was 2.93 hours and 50.52 μg/mL, respectively; after hemoperfusion, the mean elapsed time was 9.36 hours, and the plasma paraquat level was 40.52 μg/mL. Conclusions: Urgent hemoperfusion therapy is essential for complete recovery from paraquat poisoning in patients who do not have metabolic acidosis or renal failure. However, hemoperfusion is not effective in those who ingested large amount of paraquat or have a urine dithionite of 4+, metabolic acidosis, or acute renal failure. (Korean J Med 2011;80:308-316)

3개월 이내에 갑자기 발생한 거대 간세포암종

이상혁,김병익,전창욱,방기배,정은행,서정연,박은혜,설지수 영남대학교 의과대학 2012 Yeungnam University Journal of Medicine Vol.29 No.1

Hepatocellular carcinoma(HCC) is the second leading cause of cancer-related deaths in South Korea. To decrease its mortality rate, its early detection is very important. Screening for HCC detection has been accepted as the management modality for patients with chronic liver disease. Reported herein is a case involving the marked rapid growth of HCC detected at an advanced stage in a screening test with a 3 months interval. A 49-year-old male patient with chronic hepatitis B was admitted to the hospital due to a liver mass detected on CT scan. The patient underwent a first CT scan 3 months earlier, and no tumor was detected. Follow-up CT scan was performed and showed a 9.1cm HCC with portal vein thrombosis. Percutaneous liver biopsy was performed, and the diagnosis of hepatocellular carcinoma was confirmed. In the pertinent guidelines, the recommended screening interval for HCC is 6-12 months, but the screening interval and additional diagnostic methods should be considered due to the variation in the HCC growth rate according to the patient’s clinical characteristics.

Recurrent Mesalazine-Induced Myopericarditis in a Patient with Ulcerative Colitis

박은혜,김병진,허정권,정은행,이상혁,방기배,설지수,성주욱,김범수,강진호 한국심초음파학회 2012 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.20 No.3

Inflammatory bowel disease (IBD) is considered as a dysregulated immune mediated disease. Pericarditis in IBD is a very rare disease both as an extra-intestinal manifestation of IBD and an adverse reaction of therapeutic drug for IBD such as mesalazine or sulfasalazine. A 26-year-old IBD male patient who had been taking mesalazine regularly for about 1 month was referred to our hospital because of fever, chest discomfort, and abnormal electrocardiographic findings. The patients was diagnosed as acute myopericarditis, and recovered after cessation of mesalazine using steroid and aspirin. When mesalazine was re-medicated some days after discharge, he suffered from myopericarditis again. Subsequently, myopericarditis was resolved just after cessation of mesalazine again. These findings suggest that the development of myopericarditis is caused by mesalazine.

개원의를 위한 내시경 세척 및 소독 지침

오태훈,한상택,홍광일,정은행,이혁,윤중원,박광혁,이준우,김영준,장웅기,박창영 대한의사협회 2018 대한의사협회지 Vol.61 No.2

Gastrointestinal endoscopy plays an important diagnostic and therapeutic role in the field of gastrointestinal disease. As endoscopies have become more common due to the nationwide screening program for digestive cancer and an increasing interest in health among the general public, the risk of infection transmission between patients has emerged as a clinical challenge. Although endoscopes can become highly contaminated with secretions and blood during use, the thorough reprocessing of an endoscope before it is reused in subsequent patients can be difficult due to its complicated structure. Although the incidence of endoscopy-associated infections has been reported to be extremely low, compelling evidence suggests that the actual incidence is underestimated. It has been well established that endoscopes reprocessed appropriately, in accordance with standard guidelines, have no risk of infection transmission. Although revised guidelines for endoscope reprocessing were released in Korea in 2015, suboptimal infection prevention practices during endoscope reprocessing have been reported. Under these circumstances, the Korean Society of Digestive Endoscopy developed the ‘Guidelines of cleaning and disinfection in gastrointestinal endoscope for clinicians' based on the currently available evidence. These guidelines provide accurate and updated information on reprocessing techniques, and can help improve the quality of reprocessing and compliance by health care personnel. As a result, infection control during gastrointestinal endoscopies can be expected to be achieved in Korea.

위장관 , 입원환자에서 Polyethylene Glycol 용액을 이용한 대장내시경 전처치 시 Bisacodyl을 병행하여 복용했을 경우의 효과 비교: 전향적 무작위 비교연구

방기배 ( Ki Bae Bang ),정은행 ( Eun Haeng Jeong ),정우신 ( Woo Shin Jeong ),채현범 ( Hyun Beom Chae ),김남희 ( Nam Hee Kim ),이태훈 ( Tae Hoon Lee ),김지연 ( Ji Yeon Kim ),정윤숙 ( Yoon Suk Jung ),박정호 ( Jung Ho Park ),손정일 ( 대한소화기학회 2014 대한소화기학회지 Vol.64 No.5

Background/Aims: Inpatient status can cause inadequate bowel preparation. The majority of previous studies regarding bowel preparation have focused on comparing the effects of different purgative regimens in outpatients. However, data on bowel preparation for inpatients are lacking. The aim of this study was to investigate whether bisacodyl plus polyethylene glycol (PEG) can improve bowel preparation in hospitalized patients. Methods: A prospective, randomized and observer-blind study was performed. A total of 196 hospitalized patients undergoing colonoscopy were randomized to receive 4 L PEG (PEG only group) or 4 L PEG+bisacodyl 10 mg (bisacodyl added group). The adequacy of bowel preparation was scored using the Ottawa bowel preparation scale. Results: One hundred and eighty-three subjects completed the study, 96 in the bisacodyl added group and 87 in the PEG only group. There were no significant differences between the bisacodyl added group and the PEG only group with respect to the score of bowel cleansing (3.59±2.81 vs. 3.82±3.03, p=0.607), quality of bowel cleansing (adequate preparation 89.6% vs. 85.1%, p=0.380), and overall adverse events (66.7% vs. 52.9%, p=0.057). However, a larger proportion of patients in the PEG only group were able to ingest the entire solution as prescribed than in the bisacodyl added group (98.9% vs. 75.0%, p<0.001). Conclusions: In hospitalized patients, the quality of bowel preparation did not differ depending on whether bisacodyl is added or not. In addition, patient compliance based on consumption of cleansing agent was better in the PEG only group. (Korean J Gastroenterol 2014,64:268-277)