경동맥의 내막 중막 두께의 분리 측정은 필요한가?

김기식 ( Kee Sik Kim ) 대한내과학회 2008 대한내과학회지 Vol.75 No.2

Early detection of risk factors related with atherosclerosis, is necessary to decrease the morbidity and mortality of cardiovasular disease(CVD). Carotid intima-media thickness (IMT) is regarded as a surrogate markers of cardiovascular risk, believed to detect high risk better than traditional risk factors alone have been proposed. There were numerous studies which were evaluated the correlation with carotid IMT and cardiovascular events. In addition, measure of carotid IMT is safe, noninvasive, and relatively inexpensive method to detect early changes of atherosclerosis. Recently, the method which could measure carotid intima and media thickness seperatly, was developed. In this issue, Won et al, reported that in hypertensive patients, media thickness was greater than that of normotensive patients. however, intima thickness was not different in between two groups. They concluded medial hypertrophy contribute to increase IMT in hypertensive patients. However, there are technical limitation related with the characteristics of ultrasound., individual measurement of intima and media is very promising method to evaluate the disease progression earlier than the other methods. Thus this method can be applied to identify and track the progression of atherosclerotic disease. (Korean J Med 75:176-178, 2008)

새로이 대두되는 고혈압 위험 표식인자

김기식 ( Kee Sik Kim ) 대한내과학회 2009 대한내과학회지 Vol.76 No.4

Recently, the management of hypertension has focused on the prevention of target organ damage to organs such as the heart, kidney, brain, and blood vessels. To detect subclinical organ damage, several novel surrogate markers were established after amassing considerable evidence. Left ventricular hypertrophy, diastolic dysfunction measured by echocardiography, carotid intima-media thickness, ankle-brachial index, pulse wave velocity, central blood pressure, estimated glomerular filtration rate, and micro-albuminuria have been proposed as new parameters to detect subclinical organ damage in patients with hypertension. The European guidelines for the management of arterial hypertension, published in 2007, suggested that risk stratification based on using new surrogate markers was important for classifying the stage of hypertension and choosing appropriate anti-hypertensive drugs. Therefore, these surrogate markers should be checked in the early phase of hypertension and their clinical importance considered in daily practice. (Korean J Med 76:402-408, 2009)

도시지역의 관상동맥질환 발생률 조사

천병렬,김권배,김기식,김영조,김윤년,김창윤,박의현,신동구,심봉섭,이종주,이충원,장성국,전재은,Chun, Byung-Yeol,Kim, Kwon-Bae,Kim, Kee-Sik,Kim, Young-Jo,Kim, Yoon-Nyun,Kim, Chang-Yoon,Park, Wee-Hyun,Shin, Dong-Gu,Shim, Bong-Sub,Lee, Jong-Joo,L 대한예방의학회 1998 Journal of Preventive Medicine and Public Health Vol.31 No.3

To estimate the incidence rate of coronary heart disease in Korea, of all residents in Taegu city aged 25 or above, those who had an acute MI or a fatal coronary event between 1 July 1996 and 30 June 1997 were registered. Seven hundreds and eight patients were registered during the study period(685 were identified at hospital and 23 were autopsy cases). Age-standardized annual incidence rate of men in city area was 93 per 100,000(95% CI; 61-142) and 35% CI; 16-67) in women(100 in men and 20 in women aged 35-64). The incidence was rapidly increased after age 40 in men, however, in women after age 60. Twenty-eight-days case fatality rate was 45% in men and 47% in women. However, in the age group of 45-59 case fatality rate in women was two times higher than that in men. In conclusion, crude annual incidence rate of CHD in city area was 73 per 100,000 in men and 33 in women. The age-standardized annual incidence of CHD in men(93 per 100,000) was 2 times higher than that in women (33 per 100,000) in Korea.

Arbutamine부하 심초음파도의 안정성과 유용성

신이철(Yi Chul Synn),김기식(Kee Sik Kim),배장호(Jang Ho Bae),한성욱(Seong Wook Han),박소영(So Young Park),남창욱(Chang Wook Nam),김기영(Ki Young Kim),김윤년(Yoon Nyun Kim),김권배(Kwon Bae Kim),김여희(You Hee Kim) 대한내과학회 2000 대한내과학회지 Vol.58 No.1

N/A Background : Exercise and pharmacologic stress echocardiography are widely used for detecting coronary artery disease. Arbutamine is a new synthetic mild α1-receptor and - receptor agonist developed specifically for stress echocardiography. Arbutamine is superior to dobutamine owing to its enforced chronotropic action than that of dobutamine. We intended to know safety and efficacy of arbutamine stress echocardiography in inducing myocardial ischemia and detecting coronary artery disease. Methods : We underwent arbutamine stress echocardiography on 52 patients, dobutamine stress echocardiography in 35 patients. Alteration of blood pressure, heart rate, regional wall motion on echocardiography were evaluated. Sensitivity and specificity were determined by coronary angiography for 61 patients(Arbutamine: 31, Dobutamine : 30) Results : 1) Hemodynamic alterations respect to stress agents Baseline Maximal Baseline Maximal Interval for Blood pressure Blood pressure Heartrate Heart rate maximal heartrate Arbutamine 122/70mmHg 138/72mmHg 69BPM 137BPM 8.2 min* Dobutamine 126/73mmHg 136/77mmHg 74BPM 102BPM 11.4 min* (* p < 0.05) 2) Comparison of Arbutamine and Dobutamine in sensitivity Sensitivity(Specificity) Side effects Atropine Arbutamine 80.1% (90%) 33(63.5%) 8(15.4%) Dobutamine 78.2% (71.4%) 21(60%) 7(20%) 3) Side effects of stress agents Hypotension Palpitation, tremor Arrhythmia Chest pain Arbutamine 15(28.8%)* 4(7.7%)* 21(40.4%) 8(9.2%) Dobutamine 3(8.6%)* 9(25.7%)* 12(34.3%) 5(5.7%) (* p < 0.05) 4) Premature ventricular contraction was most common arrhythmia in both group. There was no fatal or significant complication, and most complications were subsided after discontinuation of stress agents. Conclusion : Arbutamine is an effective and safe pharmacologic stress agent in detecting myocardial ischemia and superior to dobutamine in increasing heart rate. Sensitivity and specificity of arbutamine were higher than that of dobutamine.(Korean J Med 58:39-47, 2000)

고혈압환자의 영양교육 효과에 관한 연구

전상미,김기식,김성미,Jeon Sang-Mi,Kim Kee-Sik,Kim Sung-Mee 동아시아식생활학회 2005 동아시아식생활학회지 Vol.15 No.6

The purpose of this study was to measure the effects of counseling for hypertension patients. the subjects were 44 hypertension patients who visited the general, hospital, located in Daegu, to receive medical treatments. Among 44 hypertension patient, 22 patients received the nutrition counseling three times for 8 weeks and the rest of the patients didn't as a non-counseling group(control group). The lifestyle, food habit, nutrient intakes, anthropometric measurements, and body fat and blood pressure as a main index were analysed before and after the nutrition counseling. The result after the nutrition counseling are as follows: 1) Body mass index(BMI), systolic blood pressure(SBP) and diastolic blood pressure(DBP) were significantly decreased in women(p<0.05). 2) The food habit score and nutrition knowledge score were dramatically increased(p<0.001). 3) The calcium intake was significantly increased in women(p<0.01). And energy, carbohydrate and fat intakes were decreased both men and women but there were no significant differences. The calcium intake as an Index of nutrition quality(INQ) and nutrient adequacy ratio(NAR) were significantly increased 5) Fat and cholesterol intakes in a group whose blood pressure reduced were significantly decreased compared with a group that had the same or higher blood pressure. These results showed that a well-planned nutrition counseling program would reduce the risk of cardiovascular disease.

고주파 전극도자 절제술의 임상적 경험

김윤년(Yoon Nyun Kim),배장호(Jang Ho Bae),신경목(Kyeung Mok Shin),한성욱(Sung Wook Han),허승호(Seung Ho Huh),김기식(Kee Sik Kim),김권배(Kweon Bae Kim) 대한내과학회 1997 대한내과학회지 Vol.52 No.1

N/A Objectives : Among the current therapeutic options for paroxysmal supraventricular tachycardias, only surgery and ablative techniques are curative. However, surgery is associated with substantial cost, morbidity, and rarely death. Recently, catheter ablation techniques have been developed to treat paroxysmal supraventricular tachycardias. These techniques are effective and low-risk curative treatment for supraventricular tachycardias. This article shall describe our clinical experiences in radiofrequency catheter ablation for supraventricular tachycardias and review the literature. Methods: The study population consisted of 154 patients with supraventricular tachycardias from January 1993 to August 1995. Eighty one patients were men and seventy three patients were women, and their mean age was 41.29±15.41 years. Radio-frequency currents(mean) were applied through a catheter electrode positioned against the mitral or tricuspid annulus or a branch of the coronary sinus or atrioventricular node. Results: Among 154 patients, the mechanisms for paroxysmal supraventricular tachycardias were found to be atrioventricular reentrant tachycardia involving a concealed accessory pathway in 51(33.1%), Wolff-Parkinson-White syndrome in 57(37%), and atrioventricular nodal reentrant tachycardia in 46 (29.9%). Successful outcomes were achieved in 46 of 46 patients(100%) with atrioventricular nodal reentrant tachycardia, 7 of 8 patients(87.5%) with double accessory pathways, 69 of 72 patients(95.8%) with left-sided accessory pathway, and 19 of 28 patients (67.9%) with right-sided accessory pathway. Total 141 of 154 patients(91.6%) with supraventricular had a successful outcome with radio- frequency current application(mean). Conclusions: Radiofrequency catheter ablation techniques are highly effective in ablating accessory pathways or modifying atrioventricular node, with low morbidity and no mortality.

심근교 ( Myocardial bridge ) 의 임상적 의의

한성욱(Seong Wook Han),김윤년(Yoon Nyun Kim),허승호(Seung Ho Hur),현대우(Dae Woo Hyun),김기식(Kee Sik Kim),김권배(Kwon Bae Kim) 대한내과학회 1998 대한내과학회지 Vol.54 No.6

N/A Objective: A myocardial bridge is an anatomic arrangement in which an epicardial coronary artery becomes engulfed for a limited segment by myocardial fibers from birth. It is recognized angiographyically by systolic compression of coronary artery. A large discrepancy exist between pathological series, in which the incidence has varied from 15% to 85%, and angiographic seires, in which it is reported as being between 0.51% and 2.5%. A myocardial bridge has been associated with myocardial ischemia, infarction and sudden death, but its clinical significance is controversial, The aim of this study was to assess the clinical characteristics and significance of myocardial bridge based on our exerience. Method: We reviewed the consecutive 1554 cinean-giograms performed in the cardiac laboratory of the Keimyung University Hospital from Nov, 1992 to May 1996. Two groups were constituted according to percentage of systolic reduction of the arterial lumen assessed visually or by computerized digital caliper. We differentiated them between below 50% and above 50% in the systolic reduction. Comparison between variables in two groups were made. Results: 1) Myocardial bridges were present in 36 patients (2.3%). 2) Among these patients, 21 had angina (58.3%), 8 had myocardial infarction (22.2%), 6 had hypertension (16.7%) and 4 had hypertrophic cardiomyopthy, primary pulmonary hypertension, mitral regurgitation and aortic regurgitation, respectively. 3) The highest prevalance was found in the mid-left anterior descending (LAD) artery (80.5%), next in the distal LAD artery (11.1%). Two cases had myocardial bridges in two sites. 4) Isolated myocardial bridges which excludes those associated with concomitant cardiovascular diseases were present in 19 patients (1.22%). Initiol symptoms in patients with myocardial bridge are exercise induced angina in 10, atypical chest pain in 3, resting onset chest pain in 3 and palpitation in 1 at admission. Two patients had no specific symptoms except electrocardiographic abnormality. 5) Clinical diagnosis of patients with isolated myocardial bridges were anginal pectaris in 13, myocardial infarction in 2 and nonspecific in 4. Myocardial infarction was present in the group of above 50% of systolic reduction. Conclusion: A myocardial bridge may induce myocardial ischemia and myocardial infarction, but prognosis may be good if patients should avoid precipitating factors i,e. condition induce tachycardia or administered β-blocker etc.

발살바동 동맥류 파열의 임상적 고찰

석준호 ( Jun Ho Seok ),박종선 ( Jong Seon Park ),김영조 ( Young Jo Kim ),김기식 ( Kee Sik Kim ),허승호 ( Seung Ho Hur ),채성철 ( Shung Chul Chae ),박헌식 ( Hun Shik Park ),차광수 ( Kwang Soo Cha ),김무현 ( Mooh Hyun Kim ),김영대 ( 대한내과학회 2002 대한내과학회지 Vol.63 No.5

N/A Background : Aneurysms of sinus Valsalva are rare anomalies thought to be primarily congenital in origin. To evaluate the clinical features and surgical results associated with ruptured aneurysm of sinus of Valsalva, we reviewed the clinical characteristics and follow up results of the patients. Methods : From January, 1991, through June 2001, 33 patients with ruptured aneurysm of sinus of Valsalva underwent surgical correction from the above five university hospitals. The patients included 24 men and 9 women, with a mean age of 32±13 years. We reviewed symptoms, physical examination findings, ECG findings, the coexistent cardiac anomalies, echocardiographic findings, surgical results in 33 patients.Results : Patterns of fistula tract were right coronary sinus-right ventricle in 24 patients (73%), noncoronary sinus- right atrium in 3 patients (9%), noncoronary sinus - right ventricle in 3 patients (9%), right coronary sinus - right atrium in 2 patients (6%) and right coronary sinus ?right ventricle and right atrium in 1 patient (3%). Combined cardiac anomalies were VSD (20 cases; 61%), ASD (1 case; 3%) and PDA (1 case; 3%). But, only 12 cases of VSD (60%) were diagnosed with preoperative transthoracic echocardiography. The aneurysmal sacs were excised in all patients and the defects were closed with a patch in 21 patients (64%) and without patch in 12 patients (36%). No recurrence was observed during follow-up periods (68±38 months) for all survivors and there was no late complications or symptoms. Conclusion : In sinus of Valsalva aneurysm patients, combined cardiac anomalies, especially VSD, are common. Careful preoperative echocardiography should be performed to detect combined anomalies. And, surgical results are excellent without recurrence.(Korean J Med 63:532-538, 2002) Key Words : Sinus of Valsalva, Aneurysm, Combined anomalies

은행잎 추출물이 협심증 환자의 내피 세포 기능에 미치는 장단기 효과

배장호,김기식,이인규,김여희,김민수,김기영,남창욱,김윤년,김권배,정시전 대한순환기학회 1999 Korean Circulation Journal Vol.29 No.9

임상 증상이 심하지 않은 심낭 삼출 환자의 장기 추적 결과

배장호,김기식,강미숙,남명희,김미정,김민수,김기영,님창욱,김윤년,김권배,정시전,김여희 대한순환기학회 1999 Korean Circulation Journal Vol.29 No.7