A Case of Traumatic Tricuspid Regurgitation Caused by Multiple Papillary Muscle Rupture

진한영,장재식,서정숙,양태현,김대경,김동기,김웅,설상훈,김두일,김동수 한국심초음파학회 2011 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.19 No.1

Traumatic tricuspid regurgitation is a rare complication of blunt chest trauma. With the increase in the number of automobile accidents, traumatic tricuspid regurgitation has become an important problem after blunt chest trauma. It has been reported more frequently because of better diagnostic procedures and a better understanding of the pathology. The early diagnosis of traumatic tricuspid regurgitation is important because traumatic tricuspid injury could be effectively corrected with reparative techniques, early operation is considered to relieve symptoms and to prevent right ventricular dysfunction. Echocardiography can reveal the cause and severity of regurgitation. We experienced a case of tricuspid regurgitation after blunt chest trauma early diagnosis and valve repair were performed. This case reminds the physicians in the emergency department should be aware of this potential complication following non-penetrating chest trauma and echocardiography is useful and should play an early role.

융모성림프구를 보이는 비장변연부 림프종 1예

진한영,손창학,주영돈,박정하,이재익,조영완,이원식 인제대학교 2006 仁濟醫學 Vol.27 No.-

Splenic marginal zone lymphoma is very rare B-cell lymphoma, characterized by an indolent clinical course. Clinical features are moderate-to severe splenomegaly, absolute lymphocytosis, and bone marrow intrasinusoidal infiltration of lymphocyte. We report the case of a 37-year-old male with SMZL. He complained of LUQ pain, who had a massive splenomegaly and moderate lymphocytosis in peripheral blood. Immunophenotyping findings and morphologic findings were consistent with SMZL. He underwent splenectomy and received chemotherapy with cyclophosphamide for eight months. Now, one year later after surgery he has a nearly normal blood count with no treatment.

Randomized Comparison of the Platelet Inhibitory Efficacy between Low Dose Prasugrel and Standard Dose Clopidogrel in Patients Who Underwent Percutaneous Coronary Intervention

진한영,양태현,최규남,서정숙,장재식,김대경,김동수 대한심장학회 2014 Korean Circulation Journal Vol.44 No.2

Background and Objectives: High dose rosuvastatin loading before percutaneous coronary interventions (PCI) reduces the myocardial damage and the incidence of adverse cardiac events in patients with stable angina and acute coronary syndrome. However, no studies are present yet about rosuvastatin loading in patients with ST-segment elevation myocardial infarction (STEMI) in a primary PCI setting. Subjects and Methods: A total of 475 patients who underwent primary PCI for STEMI were studied. The study population was divided into two groups with 208 patients in the statin group=40 mg rosuvastatin loading before primary PCI and 267 patients in the control group= no statin pretreatment. At median 3 days after PCI a single-photon emission computed tomography (SPECT) was performed with technetium 99m tetrofosmin For this study were compared infarct size, corrected Thrombolysis in Myocardial Infarction (TIMI) frame count and the myocardial blush grade (MBG) between the both groups. Results: Baseline clinical and procedural characteristics were similar between the groups. Infarct size, as assessed by SPECT, was significantly smaller (19.0±15.9% vs. 22.9±16.5%, p=0.009) in the statin group than in the control group. Patients of the statin group showed a lower corrected TIMI frame count (28.2±19.3 vs. 32.6±21.4, p=0.020), and higher MBG (2.49±0.76 vs. 2.23±0.96, p=0.001) than the patients of the control group. The multivariate analysis revealed that rosuvastatin loading {odds ratio (OR) 0.61}, pain to balloon time (OR 2.05), anterior myocardial infarction (OR 3.89) and final the MBG (OR 2.93) were independent predictors of a large infarct size. Conclusion: A high dose rosuvastatin loading before the primary PCI reduced the infarct size by microvascular myocardial perfusion improvement.

The Relationships between Body Mass Index and Left Ventricular Diastolic Function in a Structurally Normal Heart with Normal Ejection Fraction

서정숙,진한영,장재식,양태현,김대경,김동수 한국심초음파학회 2017 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.25 No.1

Background: We conducted research to determine the effect of the weight on left ventricular (LV) diastolic function in Asians,who are at greater risk of cardiovascular events compared to individuals from Western countries with similar body mass indices(BMIs). Methods: We studied 543 participants with structurally normal hearts and normal ejection fractions. Participants were classifiedas normal-weight (BMI < 23.0 kg/m2), overweight (BMI 23.0–27.4 kg/m2), or obese (BMI ≥ 27.5 kg/m2). Peak E velocity,peak A velocity, and E’ velocity were measured and E/E’ was calculated. Results: Overweight participants had lower E than normal-weight participants (p = 0.001). E’ velocities in overweight andobese participants were less than those in normal weight participants (both p < 0.001). The E/E’ ratio in obese participants washigher compared to the value in normal-weight participants (p < 0.001) and overweight participants (p = 0.025). BMI was associatedwith E (R = -0.108), A (R = 0.123), E’ (R = -0.229), and E/E’ ratio (R = 0.138) (all p < 0.05). In multivariate analyses,BMI was independently associated with higher A, lower E’, and higher E/E’. The risk of diastolic dysfunction was significantlyhigher among overweight [adjusted odds ratio: 2.088; 95% confidence interval (CI): 1.348–3.235; p = 0.001] and obese participants(adjusted odds ratio: 5.910; 95% CI: 2.871–12.162; p < 0.001) compared to normal-weight participants. Conclusion: Obesity and overweight independently predicted diastolic dysfunction. An optimal body weight lower than theuniversal cut-off is reasonable for preventing LV heart failure in Asians.

Giant Coronary Artery Aneurysm occurring Very Late after Acute Myocardial Infarction

조예원,진한영 대한내과학회 2023 대한내과학회 추계학술대회 Vol.2023 No.2

S-182 : 암페타민으로 유발된 반전된 스트레스성 심근병증 및 심근병증에서 발생한 허혈성 뇌졸중 1예

박재현,진한영,구동완,심호찬,조선영,서정숙,김동수 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1

서론: 스트레스성 심근병증은 감정적 또는 신체적인 스트레스 상황에서 발생하며 임상양상이 급성 관상동맥 증후군과 유사하다. 하지만 관상동맥 조영술에서 관상동맥은 정상이고 좌심실 조영술에서 좌심실의 심첨부가 풍선화되는 비정상적인 소견을 보인다. 스트레스성 심근병증의 원인은 명확히 밝혀지지 않았지만 혈중 카테콜아민의 증가와 관련이 있는 것으로 알려져 있다. 스트레스성 심근병증은 비교적 양호한 경과를 보이나 심인성 쇼크, 심부전 및 심장내 혈전증을 동반하기도 한다. 저자들은 암페타민 노출과 관련하여 발생한 반전된 스트레스성 심근병증 및 심근병증에서 발생한 허혈성 뇌졸중 1예를 경험하였기에 보고하는 바이다. 증례: 30세의 여자환자가 1일 전 암페타민 정맥주사를 투여 받은 이후 호흡곤란이 지속되어 본원 내원하였다. 초기 심전도는 정상이었으나 단순 흉부 방사선 사진에서 폐부종, 혈청심근효소 수치의 상승소견이 보였다. 경흉부 심초음파 검사에서 좌심실 구혈률은 51%로 감소되어 있었으며 좌심실 기저부에 무운동 소견을 보였다. 급성 관상동맥 증후군을 감별하기 위해 관상동맥 조영술을 시행하였으나 정상이었고, 좌심실조영술에서 기저부에 무운동과 심첨부의 정상 벽운동으로 좌심실 수축기에 반전된 심첨부 풍선화 모양이 관찰되었다. 이러한 결과로 환자는 반전된 스트레스성 심근병증으로 진단되어 이뇨제, 안지오텐신 전환효소 억제제, 베타 차단제를 투약하고 증상호전되어 퇴원하였다. 퇴원 2일 후 갑자기 발생한 두통으로 본원 내원하였고 급성 허혈성 뇌졸중으로 진단되어 항혈소판제로 보존적 치료하였다. 퇴원 50일 후 추적 경흉부 심초음파 검사에서 좌심실 구혈률은 60%로 정상화되었고 좌심실 기저부의 무운동은 관찰되지 않고 정상 벽운동을 보였다. 결론: 암페타민은 교감신경을 자극하여 혈중 카테콜아민을 증가시키는 작용을 한다. 본 증례를 통해 암페타민이 스트레스성 심근병증을 유발하고 그에 동반되어 허혈성 뇌졸중이 발생하였음을 알 수 있었다. 스트레스성 심근병증의 경과는 비교적 양호하지만 동반된 심장내 혈전증에 의한 허혈성 뇌졸중은 환자에게 치명적인 예후를 보일 수 있다. 기존의 심근병증 치료에 항응고치료가 동반되어야 하며 이를 위해 추가적인 연구가 필요할 것으로 생각된다.

A case of Inflammatory aortic aneurysm in patient with ankylosing spondylitis

이현석,진한영,김동수,김대경,양태현,서정숙,박영아 대한내과학회 2020 대한내과학회 추계학술대회 Vol.2020 No.1

Combined Use of Neutrophil to Lymphocyte Ratio and C-Reactive Protein Level to Predict Clinical Outcomes in Acute Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention

신호철,장재식,진한영,서정숙,양태현,김대경,김동수 대한심장학회 2017 Korean Circulation Journal Vol.47 No.3

Background and Objectives: Both neutrophil to lymphocyte ratio (NLR) and C-reactive protein (CRP) are biomarkers associated with poor prognosis of patients with acute myocardial infarction (AMI). However, the combined usefulness of NLR and CRP in predicting adverse outcomes has not been investigated. Subjects and Methods: We analyzed 381 consecutive AMI patients who underwent percutaneous coronary intervention (PCI) from January 2012 to January 2014. The endpoints were all-cause mortality, recurrent myocardial infarction (MI), stent thrombosis, repeat revascularization, stroke, and major adverse cardiac and cerebrovascular events (MACCE) at 2-year follow-up. Included patients were divided into 4 groups according to the optimal cut-off values for NLR and CRP on receiver operating characteristic analysis predicting mortality. Results: Patients with both high NLR (>6.30) and high CRP (>0.76) had significantly greater risk of all-cause death and MACCE at 24 months, with no significant increase in the risk of recurrent MI, stent thrombosis, or stroke compared with patients with either low NLR or low CRP, as well as those with low NLR and low CRP. Kaplan-Meier analysis revealed significantly lower survival in patients with high NLR-CRP. On Cox multivariate analysis, high NLR-CRP (hazard ratio 23.172, 95% confidence interval 6.575 to 81.671, p<0.001) was an independent predictor of all-cause death. Conclusion: Elevated levels of both NLR and CRP are associated with increased risk of long-term mortality in AMI patients who have undergone PCI.

Analysis of Treatment Pattern and Blood Pressure Change According to Risk Stratification in Hypertensive Subjects (초)

김동기,조영완,진한영,양태현,김동수,김영대,홍택종,허정호,이상곤,김태익,김병수 대한내과학회 2010 대한내과학회 추계학술대회 Vol.2010 No.-

간세포암의 고주파 열치료 후 천자침 경로를 통한 전이 1례

조영완,박석주,진한영,김준영,이재익,강명주,박정하,윤정희,박성재,지삼룡,이연재,이상혁,설상영 인제대학교 2006 仁濟醫學 Vol.27 No.-

Radiofrequency ablation(RFA), as a form of minimally invasive therapy for hepatocellular carcinoma, has become an important treatment modality. Because of limitation of surgery, RFA has become standard therapy for hepatocellular carcinoma in some situations. But there are some complications of RFA such as bleeding, infection, hematoma, adjacent organ thermal damage including intestinal perforation, needle track seeding, and so on. There are few reports in the literature that systematically evaluate the incidence of needle tract seeding and its associated risk factors. And only 2 cases of needle tract seeding of hepatocellular carcinoma after RFA were reported in Korea. We report a case of needle tract seeding of hepatocellular carcinoma after RFA.