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      • KCI등재후보

        감염성 심내막염의 임상적 고찰

        현민수(Min Su Hyon),강덕현(Duk Hyun Kang),고광곤(Kwang Kon Koh),손대원(Dae Won Sohn),오병희(Byung Hee Oh),이명묵(Myoung Mook Lee),박영배(Young Bae Park),최윤식(Yun Sik Choi),서정돈(Jung Don Seo),이영우(Young Woo Lee) 대한내과학회 1989 대한내과학회지 Vol.37 No.5

        N/A We reviewed the patients who were diagnosed as infective endocarditis from January 1984 to September 1988, The total number of patients was one hundred and sixteen. Seventy-six were male and forty were female. The mean age was 37.5 years. Rheumatic heart disease was the most common predisposing heart disease with fifty-five cases l47.4%), followed by congenitai heart disease with eighteen cases (15.5%), prosthetic valve endocarditis with sixteen (18.8%) and cardiac pacemaker with one case. Culture was positive in sixty-eight cases (58.6%). Alpha hemolytic streptococci were the most commonly isolated micrroorganisms (51.5%), followed by S. aureus (16.2%). Fungus was also isolated (1case). Vegetations were found in seventy-nine cases an echocardiographic examination (68.1%). These were found more frequently on the aortic valve (48.1%) than on the mitral valve (32.9%). Fifty-nine cases (50.8%) developed congestive heart failure and twenty-seven cases (23.3%) had embolic complications. Out of 116 patients, 27 died and the overall mortality was 23.3%. Main causes of death were congestive heart failure and embolic complications. Surgical traeatment was performed in thirty-nine patients (33.6%). Operation was indicated more frequently in patients with prosthetic valve endocarditis ar in patients with vegetation.

      • KCI등재SCOPUS
      • KCI등재후보

        관동맥 조영술 중에 관찰된 관동맥 기형의 빈도에 관한 연구

        김주성(Ju Sung Kim),김명수(Myung Su Kim),정호석(Ho Seuk Jeung),류은상(Eun Sang Ryoo),현민수(Min Su Hyun),김성구(Sung Gu Kim),권영주(Young Joo Kwon) 대한내과학회 2001 대한내과학회지 Vol.60 No.5

        N/A Background : Coronary anomalies are found incidentally, in which anatomy is altered but physiology is normal; that is, coronary blood flow is normal. However, certain anomalies are associated with myocardial ischemia or infarction, heart failure, and sudden death. Methods : From February 1988 to February 2000, 3534 cases have been catheterized, among them we experienced 28 cases of coronary anomalies. The incidence of coronary anonalies and clinical characteristic were evaluated. Results : The incidence of coronary anomalies was 0.79% and in 28 cases of coronary anomalies, 5 cases of anomalous origin from the aorta (0.14%), 2 cases of coronary artery aneurysm (0.16%) and 21 cases of coronary arteriovenous fistula (CAVF,0.59%) were found. In 5 cases of anomalous origin from the aorta, 4 cases showed that right coronary artery originated from left coronary sinus of Valsalva, 1 case showed that left circumflex coronary artery originated from right coronary sinus of Valsalva. All of coronary artery aneurysm were found in right coronary artery. In 21 cases of CAVF, 28 sites of fistula were found and 14 sites originated from right coronary artery (50%), 6 sites from left circumflex coronary altery (21.5%), 6 sites from left anterior-descending coronary artery, 2 sites from left main coronary artery (7%). 13 sites of CAVF drained into pulmonary artery (46%), 10 sites into right atrium (36%), 5 sites into right ventricle (18%). In 7 cases which had double CAVF, 4 cases were originated from bilateral coronary artery, 3 cases were originated from single coronary artery. In 10 cases CAVF without other cardiac lesion, 4 cases confirmed ischemic heart disease. Conclusion: In our study, CAVF is most common coronary anomaly and without other cardiac disease CAVF may develope ischemic cardiac disease. (Korean J Med 60:448-455, 2001)

      • 허혈성 심질환에 있어서 아데노신 급속 정맥투여후 관동맥압의 변화에 관한 연구

        봉종대,오종용,배성한,신원용,김철현,이광희,최태명,현민수,김성구,권영주 순천향의학연구소 1998 Journal of Soonchunhyang Medical Science Vol.4 No.2

        Background: Adenosine interacts with A1 receptors present on the extracellular surface of cardiac cells, activating K+channels in a fashion. It produces coronary vasodilatation and AV nodal block. The half-time is one to six second and has ultra-short action. In ischemic heart disease, fractional flow reserve(FFR) can be achieved safely with intravenous adenosine infusions at a rate of 150㎍/kg/min which cause maximal coronary hyperemia. Purpose: We investigated the patients who have had ischemic heart disease(n=8). After adenosine intravenous administration(150㎍/kg/min), the effect cause maximal hyperemia of coronary artery. During peak maximal hyperemia, we reported clinical findings, coronary hemodynamics and electrocardiogram findings. Methods: After diagnostic coronary angiography and left ventriculography, catheter was advanced into the ostium of coronary artery. We investigated coronary hemodynamics such as systolic coronary artery pressure, diastolic coronary artery pressure, mean coronary artery pressure and heart rate. To assess the use of adenosine for determination of fractional flow reserve, hemodynamics and electrocardiogram were measured at basal state and during peak maximal hyperemia. Results: Symptoms developed 1.5-2 minute after adenosine intravenous administration and each symptom disappeared 2-2.5 minute after adenosine administration. Two patients represented asymptomatic appearance and six patients complained of flushing, chest pain, palpitation and headache. In eight patients with ischemic heart disease, 1.5 minute after venous administration of 150㎍/kg/min of adenosine, coronary artery pressure decreased and heart rate increased significantly. Conduction abnormalities after administration of 150㎍/kg/min of adenosine were transient 2nd degree AV block 2 cases(25%). Conclusions: Adenosine is a potent ultra short-acting vasodilator. Although coronary artery pressure decreased and heart rate increased and mild cardiovascular symptoms occurred after continuous infusion of 150㎍/kg/min of adenosine, it is useful as an agent for determination of fractional flow reserve.

      • 심근 경색증을 동반한 좌측 단일 관상동맥 1례

        김성구,온영근,현민수,권영주 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

        Anomalous origin of the right coronary artery is uncommon in patient undergoing coronary angiography. Especially single coronary artery is a rare congenital anomaly. Most coronary anomalies did not result in signs, symptoms, or complications, and usually were discovered as incidental finding at the time of coronary angiography. However, some anomalies may be associated with malignant courses such as myocardial infarction, syncope or sudden cardiac death. This report describes a 65-year-old man who had right coronary artery originating from left circumflex artery with unusual type of isolated single coronary artery and myocardial infarction.

      • 관상 동맥 질환에서 아포 E 지단백 유전자 다형성과 혈청 지질치와의 관계

        곽선영,김성구,정호석,이유경,이광희,김철현,최태명,현민수,권영주 순천향의학연구소;Soonchunhyang Medical Research Institute 2000 Journal of Soonchunhyang Medical Science Vol.6 No.1

        Background and aims: The Apolipoprotein E is a ligand of both the protein component LDL receptor as well as the apo E LDL-Receptor related protein (LRP). It modulates the receptor binding of lipoproteins, with the apolipoprotein E found on cell surfaces as its component, thus serving an important role in the lipid metabolism by carrying out the intracellular transport of cholesterol in lipoproteins. The gene for apolipoprotein E is the product of three common genotypes as well as many more rare alleles. The common genotypes are ε2, ε3, and ε4, and are expressed in the three phenotype isoforms of E2, E3, and E4. In the event that E4 is the main component, a rise in the cholesterol level, as the result of down-regulation of the LDL receptor, is observed. Therefore, those samples with E4 genotypes are known to be in much higher risk of coronary artery disease than those with ε3/ε3, while those with ε2 are in low risk (with the exception of hypertiglyceremai Ⅲ). The aim of this study is to analyze in patients with ischemic heart disease the role of aplipoprotein E alleles in order to seek its correlation with coronary artery disease, as well as to seek whether the polymorphism of apo E produces any differences in the severity of coronary artery disease according to plasma lipid levels. Methods: The subjects for study were 273 patients admitted to the Internal Cardiology Division of the Soonchunhyang University Hospital form December 1998 to February 1999. The subjects were divided into the two groups of which one was ischemic heart disease (IHD) experiment group totaling 105 (avg.60.1 years of age, male/female ratio = 69/36) and the control group totaling 168 (avg. 59.7 years of age, male/female = 73:95). The coronary angiogram was given to 127 subjects, and of this total, 94 have developed significant stenosis in the coronary artery. The stages of the analyzing of the apo E phenotype was first, the separation of DNA from the blood samples, subjecting it to the PCR from with 228 base pairs of expanded products were obtained. The band was determined by means of the reverse hybridization principle on the nitrocellulose strip. Results: From the 105 patients the distributions of apo E phenotypes were as follows: ε3/2(5.7%), ε4/2(1.9%), ε3/3(70%), ε4/3(20%), ε4/4(1.9%). The relative frequencies of each allele are as follow: ε2 (0.038), ε3 (0.833), ε4 (0.128). The results show as follows: ⅰ) The IHD experiment group to have a higher occurrence of ε4/3 phenotypes as well as ε4 alleles than the control group. ⅱ) Both the control group and IHD group showed the largest distribution of ε3/3 for phenotypes, and ε4 for alleles. ⅲ) The IHD group showed less ε2/3 phenotypes as well as significantly less allele frequency of ε3 in comparison to the control group. ⅳ) the IHD group showed a much lower level of HDL in comparison to the control group, while the LDL was significantly higher; samples including the apo ε2 showed a significantly higher level of HDL than those without. Among the control group, samples including apo ε2 showed a significantly higher level of TG (triglyceride) than samples without. No significant difference was found between the experiment apo ε4 sample and the control plasma lipid sample. ⅴ) No significant correlation was found between an apo E polynorphism and the number of involved arteries of a coronary angiogram. Conclusion: Between the experiment IHD group and control group were found differences in the frequency of alleles. The polymorphism of apo E alleles may contribute as a risk factor to the development of heart disease by involving itself in the metabolism and modulation of plasma lipids.

      • 흉통의 양상에 따라 분류한 불안정형 협심증 환자의 임상적 소견의 비교

        김명수,김성구,정호석,온영근,신원용,김철현,최태명,현민수,권영주 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

        Background and aims : The clinical syndrome unstable angina pectoris that encompasses a variety of symptoms and clincal presentations of transient episode of myocardial ischemia, was devided to several subgroups. Also, it has variable pathophysiologic factors to cause myocardial ischemia. According to clincal presentation, coronary angiographic finding and prognostic factor, the result of unstable angina pectoris is variable. In fact, there were a few data reported on the prognosis of wide spectrum of patients with unstable angina. However, the precise risk of subgroups according to classitication has not been established because it was difficult to compare between studies. We classified unstable angina pectoris by clinical nature of chest pain, and performed to establish and compare the clinical presentations, coronary angiographic findings, treatement and prognosis of patients with unstable angina within subgroups of classification. Methods : Retrospenctive data for 164 unstable angina pectoris patients admitted to the Internal Cardiology Division of Soon Chun Hyang University Hospital from May 1996 to July 1999 was analyzed. The patients were classified into one of the following categories: Class I, new onset of severe angina; Class II, acceleration of previous chronic stable angina; Class III, angina at rest. Clinical presentations, echocardiographic findings, coronary angiographic findings, treatment and prognosis were compared. Results : From the total 164 patients, the subjects of classes were as follows : Class I, 46 cases (28.1%); Class II, 74 cases (45.1%); Class III, 44 cases (26.8%). In view of age distribution, the 7th decade had the highest incidence, and then, 6th, 8th decades were followed. There was no baseline differences among the 3 classes with respect to gender, number of risk factors. Significantly, class II showed more severe findings in abnormal Q wave 15 cases (20.8%), total occclusive lesion 10 cases (20.8%) and three vessel coronary disease 11 cases (22.9%) than other classes. The change of ST segment was significantly apparent (p<0.02) among class I 28 cases (60.8%), class III 26 cases (59.0%), comparing with class II 30 cases (40.5%). Class III had the higher incidence of one vessel coronary artery disease than class I and III. The heparin treatment was performed in 99 cases (60.1%). The incidence of nonfatal myocardial infarction was much more in class I and III, each 4 cases (8.7%, 9.8%) than in class II 1 cases (1.4%). In-Hospital death was occurred in class I and II, each 1 case. Conclusion : The patients with the acclerated angina from chronic stable angina had more severe coronary artery disease than other classes, but they had better in-hospital prognosis.

      • KCI등재후보

        흉부 방사선 치료후 완전방실차단증과 양측 관동맥구 협착증을 보인 1예

        고경환,김정경,이수금,윤재형,조성제,이상훈,홍석근,현민수,황흥곤,김명아,박성훈 대한내과학회 1997 대한내과학회지 Vol.53 No.3S

        We have experienced a case of radiation-induced coronary biostial stenosis presented with recurrent syncopal attack, which was confirmed by coronary angiography and pathologic findings. A 60 year-old woman was admitted with the symptoms of recurrent syncopal attack. She had a history of radiation therapy of the chest for lung neoplasm 15 years ago. Initial electrocardiogram showed transient high-degree A-V block followed by third-degree atrioventricular block which was associated with syncope. Echocardiography revealed mild aortic regurgitation without left ventricular dysfunction. The coronary angiogram revealed biostial stenosis of coronary arteries. Initial cardiac symptom subsided after temporary pacemaker implantation. She had a coronary bypass graft surgery on both coronary arteries using saphenous vein. Biopsy findings showed mild fibrosis with intimal thickening of coronary artery.

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