증례 : 순환기 ; 대동맥 박리에 의한 비정형적 ST분절 상승 심근경색 1예

박병원 ( Byoung Won Park ),서대철 ( Dae Chul Seo ),문인기 ( In Ki Moon ),정진욱 ( Jin Wook Chung ),방덕원 ( Duk Won Bang ),현민수 ( Min Su Hyon ),장원호 ( Won Ho Chang ) 대한내과학회 2013 대한내과학회지 Vol.85 No.5

가슴 통증을 호소한 환자가 심전도에서 ST분절 상승과 비정형적인 관상동맥 폐쇄를 보여 ST분절 상승 심근경색으로 관상동맥 재개통술 시행하였고 이후 퇴원하였으나 가슴 통증이 악화되어 재입원하여 대동맥 박리에 의한 심근경색이 진단되었으며 수술적으로 대동맥 박리를 치료한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. ST-elevation myocardial infarction (STEMI) caused by an acute aortic dissection is relatively rare. A diagnosis of dissection can be missed and the situation can become complicated. We report a patient who presented with acute aortic dissection responsible for STEMI related to a dissecting flap into the right coronary artery. This case emphasizes the need for careful assessment of the aorta in cases of atypical coronary occlusion in patients with STEMI without evidence of atherosclerosis in non-culprit coronary segments. The patient was discharged 7 days after primary percutaneous intervention for STEMI. However, she revisited the emergency department for recurrent chest pain and aortic dissection and was diagnosed and managed successfully with surgery.. (Korean J Med 2013;85:516-520)

우울증 치료를 위한 목회상담적 접근

박병원 ( Byoung Won Park ) 한국성경적상담학회 2004 성경과 상담 Vol.4 No.-

지금까지 우울증의 원인을 분석하고 예방하고 대처하기 위한 대표적인 접근들에는 정신역 동적 입장, 학습이론적 입장, 인지이론적 입장과 같은 심리학적 이론과 생물학적 입장의 신경생리학 이론이 있다. 그러나 이런 우울증에 대한 이해와 치료책에 대한 노력은 일반 정신 의학적, 심리학적 차원에 국한되어서는 안된다. 크리스천도 우울증을 경험할 수 있다. 그런의미에서 기독교관점에서의 우울증에 대한 이해와 그에 맞는 적절한 치료책의 모색, 혹은이미 일반적인 우울증 치료에 대한 성경적 관점에서의 평가가 요구되는 것은 당연하다. 따라서 본 논문의 목적은 우울증 치료를 위한 목회상담적 접근 방법에 대해 모색함으로, 우울증 치료에 대한 기독교적 관점을 제시하는데 있다. 이를 위해 첫째, 우울증에 대한 일반적 치료 방법을 살펴보고 그 방법의 장점과 제한점을 함께 분석해 보면서, 우울증 상담은 단순히 심리적 치료로 해결되는 것이 아니라 하나님의 새롭게 하시는 능력을 힘입어서 이루어져야만함을 보여주려 한다. 제이 아담스(Jay E. Adams)의 말대로 상담은 성령의 사역이다. 크리스천에게 있어서 상담이란 성령의 중생케하시는 사역과 성화시키시는 사역의 조화속에서 이루어져야 하는 것이다. 성령은 믿는 자의 성화를 포함한 참된 퍼스낼리티의 변화를 가져오게 하는 근원이다. 성령은 은혜와 말씀을 통하여 변화시키신다. 둘째, 우울증 치료를 위한 목회상담적인 치유는 어떻게 이루어져야 하는가를 연구하는데 그 목적이 있다. There have been so far two theories which analyze the cause of depression, and prevent and cope with the disease. One is psychological theory which takes a mind-dynamic, learning-theoretical, and cognitive-theoretical standpoint. The other one is neurophysiological theory which takes a biological standpoint. Each theory has presented their own therapies for depression and has made exerted for to heal the disease. But we must not confine the understanding to and the effort to heal depression within a general mental-medical and a psychological dimension. No matter who is a christian, he cannot be excluded from the cold, viz christians can experience the cold. So that the believers often have more suffering than they are supposed to have. Thus it is necessary to be required that we should evaluate, in view of christianity, understanding to depression, groping the proper cure for it, and that we should evaluate the previous cure for depression in view of the Bible. Therefore the purpose of the thesis is, by groping the pastoral counselling approach, to present the christian viewpoint of the cure for depression. For this, first, while examining general methods to cure of depression, and analyzing the advantage and the confines of the methods, I am going to show that not depression can be simply cured with psychological therapy, but that must only be cured by God`s power which makes it new. Counselling is the work of the Holy Spirit as Jay E. Adams says. Counselling for christians must be taken in the harmony of the Holy Spirit`s works that make sinners born again, and them sanctified. The Holy Spirit is the source that brings about the true change in personality, including sanctification, of believers. He makes believers change through the grace and the Word. The second purpose of the thesis is to research how the pastoral counselling cure for depression should be taken.

증례 : 순환기 ; 전벽 심근 경색의 일차 관상동맥 시술 중 연속된 하벽 심근 경색

박병원 ( Byoung Won Park ),서대철 ( Dae Chul Seo ),함남석 ( Nam Seok Ham ),박정완 ( Jung Wan Park ),정진욱 ( Jin Wook Chung ),방덕원 ( Duk Won Bang ),현민수 ( Min Su Hyon ) 대한내과학회 2014 대한내과학회지 Vol.87 No.3

ST-elevation myocardial infarction (STEMI) involving multivessel coronary arteries is extremely rare. Consecutive STEMI in a nonculprit vessel during primary percutaneous coronary intervention (PCI) of the culprit vessel has not been reported. A 53-year-old male presented to the emergency department with anterior wall STEMI. Just after successful primary PCI of the left anterior descending artery, inferior wall STEMI developed. PCI of the right coronary arteries was performed successfully. Five days later, the patient was discharged without symptoms of heart failure. This case underlines the high thrombogenicity along the coronary arteries in patients with STEMI. (Korean J Med 2014;87:334-337)

관상동맥 질환 환자에서 경동맥 초음파의 유용성

방덕원 ( Duk Won Bang ),심윤숙 ( Yun Suk Shim ),박병원 ( Byoung Won Park ),현민수 ( Min Su Hyon ),김성구 ( Sung Koo Kim ),권영주 ( Young Joo Kwon ) 대한내과학회 2007 대한내과학회지 Vol.73 No.1

목적: 경동맥 초음파로 측정한 내중막 두께 및 경화반의 유무와 관상동맥 질환 여부와의 관련성에 관한 보고가 있었으나, 이들과 관상동맥 질환의 중증도와의 관련성에 관한 연구는 적었다. 저자들은 이들 지표들과 관상동맥 질환의 중증도의 관련성을 검토하여 관상동맥질환 환자에서 경동맥 초음파의 유용성을 평가하였다. 방법: 2005년 11월부터 2006년 11월까지 관상동맥조영검사와 경동맥 초음파를 시행한 환자를 대상으로 하였고, 관상동맥 질환의 중증도는 50% 이상의 협착이 있는 관상동맥의 수에 따라 1군, 2군, 3군으로, 그리고 정상인 경우를 대조군(0군)으로 분류하여, 경동맥 초음파상 좌우 총경동맥 내중막 두께의 평균치, 최대치 및 동맥 경화반 유무를 비교하였다. 결과: 총 환자수는 90명이었고, 3군으로 갈수록 남자가 많았다(p=0.001). 총경동맥 내중막 두께의 평균치는 3군으로 갈수록 유의한 증가를 보였다(0군, 0.67±0.11 mm; 1군, 0.66±0.13 mm; 2군, 0.68±0.08 mm; 3군, 0.78±0.10 mm, p=0.001). 내중막 두께의 최대치도 유사한 결과를 나타내었다(0군, 0.88±0.16 mm; 1군, 0.85±0.20 mm; 2군, 0.89±0.13 mm; 3군, 1.06±0.17 mm, p=0.000). 경화반의 빈도도 3군으로 갈수록 유의한 증가를 보였다(p=0.004). 결론: 경동맥 내중막 두께 및 경화반의 유무 등 경동맥 초음파 지표들과 관상동맥 질환의 중증도의 관련성을 평가한 결과 관상동맥 질환이 심할수록 경동맥 내중막 두께가 증가하고, 동맥 경화반의 빈도도 증가되었다. 경동맥 초음파는 관상동맥 질환을 가진 환자에서 관상동맥 질환의 중증도를 평가하는데 유용하게 사용될 것으로 사료된다. Background: Carotid intima-media thickness (IMT) or the presence of carotid plaque has been reported to be related to coronary artery disease (CAD). We evaluated the relationship of the parameters of carotid ultrasonography (US) with the severity of the CAD. Methods: From November, 2005 to November, 2006, the patients who underwent both coronary angiography and carotid US were enrolled in our study. The severity of CAD was defined by the number of diseased major coronary arteries with a percent diameter stenosis over 50. Four groups including Group 0, which has normal coronary arteries, were compared. The average and maximal IMT and the presence of plaque were used as the parameters of carotid US. Results: The total number of patients was 90. Men had a greater severity of CAD (p=0.001). The average carotid IMTs were increased with the severity of CAD (Group 0, 0.67±0.11 mm; Group 1, 0.66±0.13 mm; Group 2, 0.68±0.08 mm; Group 3, 0.78±0.10 mm; p=0.001). The maximal carotid IMTs were also increased (Group 0, 0.88±0.16 mm; Group 1, 0.85±0.20 mm; Group 2, 0.89±0.13 mm; Group 3, 1.06±0.17 mm; p=0.000). Carotid plaques were also more frequently present with the increased severity of CAD (p=0.004). Conclusions: Increased carotid IMT and the presence of carotid plaque were related to the severity of CAD. Carotid ultrasonography is useful for evaluating the severity of CAD.(Korean J Med 73:11-17, 2007)

고해상도 위성영상을 이용한 송전선로 경과지 설계 프로그램 개발 및 활용

이희선(Hee-Seon Lee),박병원(Byoung-Won Park) 대한전기학회 2005 대한전기학회 학술대회 논문집 Vol.2005 No.11

지리정보시스템을 이용한 송전선로 경과지 선정

민규호(MIN Kyu-Ho),박병원(PARK Byoung-Won),노재덕(ROH Jae-Deok),오철호(OH Chol-Ho) 대한공간정보학회 1997 대한공간정보학회지 Vol.5 No.1

송전선로 경관 영향 예측 기법 개발을 위한 기초 연구

정정섭 ( Jeong Seob Jeong ),조태동 ( Tae Dong Jo(Cho) ),박병원 ( Byoung Won Park ),이희선 ( Hee Sun Lee ),박성우 ( Sung Woo Park ) 한국녹지환경디자인학회 2008 학술발표회 Vol.2008 No.-

증례 : 순화기 ; 경요골 경피적 관상동맥 중재술 중 발생한 요골동맥 천공의 간편한 관리

김윤석 ( Yunsuek Kim ),정찬성 ( Chan Sung Jung ),김효식 ( Hyo Shik Kim ),이민호 ( Min Ho Lee ),박병원 ( Byoung Won Park ),방덕원 ( Duk Won Bang ),현민수 ( Min Su Hyon ) 대한내과학회 2016 대한내과학회지 Vol.90 No.2

Radial artery perforation is one of the major complications of transradial percutaneous coronary intervention (PCI). Previous reports have suggested that sealing the perforation with a smaller guiding catheter may be possible. In one such study, the perforated segment was sealed with a 0.014- or 0.021-inch guidewire, and PCI was successfully completed. In this study, we describe a radial artery perforation that occurred after diagnostic coronary angiography and during insertion of a 6 French (FR) guiding catheter. PCI and the perforation were successfully managed through the use of a 5 Fr guiding catheter and a 0.035-inch guidewire. (Korean J Med 2016;90:136-139)

증례 : 순환기 ; 심정지 이후에 장시간 시행된 흉부압박에 의해 발생한 우심실 파열 1예

이희정 ( Hee Jeong Lee ),권성순 ( Seong Soon Kwon ),강혜란 ( Hye Ran Kang ),방덕원 ( Duk Won Bang ),박병원 ( Byoung Won Park ),이민호 ( Min Ho Lee ),장원호 ( Won Ho Chang ) 대한내과학회 2015 대한내과학회지 Vol.88 No.4

원인이 명확하지 않은 46세 급성 심장정지 환자에서 2시간 이상의 흉부압박을 시행 후 자발 순환 회복되었으나 설명되지 않는 지속적 저혈압을 보여 반복적인 심초음파를 시행하였고, 심낭압전 및 혈심낭이 확인되어 진단적 개흉술로 우심실벽 파열을 진단한 환자를 경험하여 보고하는 바이다. A 46-year-old male arrived at the emergency department with acute dyspnea. On the way to the hospital, heart massage was performed in the ambulance due to asystole on electrocardiography. After 2 hr of resuscitation, sinus rhythm was restored. Extracorporeal life support and an intra-aortic balloon pump were applied due to cardiogenic shock, but the patient showed sustained hypotension. Echocardiography showed moderate pericardial effusion with physiological evidence of cardiac tamponade; emergency pericardiocentesis was performed, which produced bloody pericardial fluid. An explorative sternotomy revealed a massive hematoma in the mediastinum and right ventricular (RV) free wall rupture. After primary repair, echocardiography showed improved left ventricular systolic function and the patient was stable clinically. This case presents RV free wall rupture as an unusual complication of prolonged heart massage. Heart rupture should be considered in hemodynamically unstable patients after prolonged heart massage.

주민참여를 통한 환경영향평가 항목선정

김귀곤,성현찬,윤소원,박병원 한국환경영향평가학회 1995 환경영향평가 Vol.4 No.3

The objective of the study is to produce preferential impact assessment factors for Environmental Impact Assessment by considering regional features and public participation in the initial stages of EIA. In order to produce preferential impact assessment factor, the study was carried out through theoretical research and a survey of public awareness as way to reflect public participation based on theoretical research. The survey of public awareness was conducted in the form of an interview to review the impact which the construction of atomic power plants at Hyo-am village, Jang-an, Kyungsang Province and Bi-hak village, Suhsan,-myon, Ulsan-Kun will have on the surrounding environment : to reflect public participation on deciding preferential assessment: and to determine the extent of alternatives of the proposed project. As the result of the study, the followings were identified as preferential assessment factors in the displacing settlement and surrounding areas: cultivation·marine products, change of temperature of seawater due to flow of warm water, land use (negative), noise·vibration during construction, existing vegetations, erosion·sedimentation, influx of manpower for construction(negative), recreation·landscaping during construction and operation, change in flow of transportation during construction, the quality of seawater during construction and operation were produced as preferential assessment factors in both displacing area and neighboring areas. In the displacing settlement area, the educational environment(negative & positive) and positive aspects of the influx of manpower for construction were also identified as preferential assessment factors.