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- 저자 : 신길자 ( Gil Ja Shin ) (검색결과 56 건)
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신길자 ( Gil Ja Shin ) 대한내과학회 2010 대한내과학회지 Vol.78 No.2
Hypertension is one of the most common preventable disease for premature death in worldwide. In Korea, the prevalence rate of hypertension is 24.9% in adult. The pathophysiology of the hypertension is complicated including genetics, aging, sympathetic nerv
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한국인 본태성 고혈압환자의 계절변화에 따르는 혈압변동에 대한 연구
신길자(Gil Ja Shin),조홍근(Hon Keun Cho) 대한내과학회 1997 대한내과학회지 Vol.53 No.6
N/A Objectives: The mortality rate due to stroke and myocardial infarction by the complication of the hypertension were the major causes of death among the Korean followed by the cancer. There are many factors to affect the blood pressure variability such as physical activity, sleeping, activation of the autonomic nervous system, climate, cold exposure and seasonal variation. The blood pressure was increased by cold exposure. In general, blood pressure was increased in winter and the cardiovascualr mortality is also increased at winter. In Korea, we have distinct seasonal variation of the climate, we have no clinical data on the seasonal variation of the blood pressure. Methods: To investigate the seasonal variation of blood pressure of Korean essential hypertensives and make effort to reduce the cardiovascualr mortality, we studied 63 hypertensive men and women hypertensives. Results: 1) The mean age was 60±10 years with 19men and 44 women. The mean systolic blood pressure was 146±22mmHg, mean diastolic blood pressure was 91 ±11mmHg. 2) The mean systolic and diastolic blood pressure during the 12 months was 137±18mmHg, 86±10mmHg in men respectively. In women, the mean systolic blood pressure was 137±16mmHg and the mean diastolic blood pressure was 86±8mmHg. 3) The biochemical findings including hemoglobin, hematocrit and creatinine levels were significantly lower in women(P<0.05). 4) The systolic and diastolic blood pressure were significantly increased during the winter as January and February, 5) There was also significant increase of systolic blood pressure at the transitional zone to the sum- mer to autumn(P=0.0004). Conclusion: There was significant increase in systolic and diastolic blood pressure in winter in Korean hypertensives. This phenomenon was also observed the transitional zone to summer to autumn. So, during these period, more strict blood pressure control by frequent measurement and increase the room temperature may be recommended to reduce the cardiovascular mortality during winter.
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고혈압환자에서 도플러 심초음파를 이용한 좌우심실 이완기능에 관한 연구
강덕희(Duk Hee Kang),신길자(Gil Ja Shin) 대한내과학회 1993 대한내과학회지 Vol.45 No.3
N/A Background: It is well known that the diastolic dysfunction of the left ventricle plays an important role in pathophysiology of heart failure in the various cardiac diseases. And many hypertensive patients manifest diastolic dysfunction of the left ventricle in its early stage. But, there are very few studies of right ventricular diastolic dysfunction reported, and effects of systemic hypertension on right ventricular function are not well understood. Thus, left ventricular diastolic dysfunction and its effects to right ventricular function need to be evaluated in hypertensive patients. Method: For the evaluation of the left and right ventricuiar diastolic function in the hypertensive patients, 20 normotensive control subjects and 30 untreated essential hypertensive patients were studied by pulsed doppler echocardiography at the left and right ventricular inflow, and then E/A velocity ratio [E/A (v)], acceleration time (AT), deceleration time (DT), and diastolic filling period (DFP) were measured after confirming normal ejection fraction by M-mode echocardiography. Results: 1) In the 20 normal control group, ejection fraction was 63.7±11.8% and in the 30 hypertensive patient group, it was 60.3±10.8%. There was no significant differences between the normal control and the hypertensive patient group. 2) In the normal control group, E/A (v) of left ventricle was 1. 48±0.32, E/A (v) of LV was 0.88±1.07, mean E/A (v) of RV was 0.91±0.73. E/A (v) of LV & RV was significantly decreased (p<0.01), compared with those of normal control group. 3) DT of left ventricle was significantly prolonged in hypertensive group (p<0.05), but there was no significant difference in DT of right ventricle. 4) AT and DFP were signficantly prolonged in right ventricle, compared with left ventricle, but there was no significant correlation between normal control group and hypertensive patient group. 5) Among the factors influencing the RV E/A ratio, LV E/A ratio was only significantly correlated (r=0. 538, p<0.05). Age of subject, left ventricular ejection fraction and severity of hypertension have no significant correlation with right and left ventricular E/A ratio. Conclusion: The E/A ratio and deceleration time measured from pulsed doppler echocardiogram seem to be useful parameters for evaluation of left and right ventricular diastolic function in hypertensive patients with normal systolic function. And, right ventricular diastolic dysfunction is closely related with left ventricular diastolic function.
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심초음파도와 영상화 심혈관 조영술을 이용한 심 박출계수간의 상관 관계에 대한 연구
오지영(Jee Young Oh),신길자(Gil Ja Shin),박시훈(Si Hoon Park),이우형(Woo Hyung Lee),조한래(Han Rae Cho) 대한내과학회 1997 대한내과학회지 Vol.52 No.5
N/A Objective: Left ventricular ejection fraction is an important clinical variable with respect to diagnosis, treatment and prognosis in various cardiovascular diseases. Measurement of left ventricular ejection fraction is performed by three commonly used methods, M-mode and two dimensional echocardiography, radionuclide angiography and contrast cineangiography. We compared echocardiographic and contrast cinean-giographic ejection fraction by correlation coefficiency to determine the accuracy of echocardiography determined ejection fraction at our institution and to assess the agreement of left ventricular ejection fraction between two methods. Methods: We measured left ventricular ejection fraction by M-mode, two-dimensional echocardiography and contrast cineangiography in 144 cases of normal and cardiovascular heart disease patients from September 1993 to April 1995 in the cardiology division of Ewha Womans University hospital. The echocar-diography and contraat cineangiography were performed within 7 days of each other. Results: M-mode echocardiographic ejection fraction correlated with contrast cineangiographic ejection fraction (r=0.7841). M-mode echocardiographic ejection fraction corrected with two-dimensional echocardiography in the presence of regional wall motion abnormality correlated with contrast cineangiographic ejection fraction (r=0.8149). By agreement analysis, the difference of mean of ejection fraction measured by M-mode echocardiography and contrast cineangiography was within 95% confidence limits. The mean was 4.08% and the standard deviation was 8.29%. The difference of mean of ejection fraction corrected by two-dimensional echocardiography and contrast cineangiography was within 95% confidence limits. The mean was -3.19% and the standard deviation was 7.74% Conclusion: The values of left ventricular ejection fraction by echocardiography showed good correlation with those of contrast cineangiographic ejection fraction, Therefore, echocardiography would be a useful tool as contrast cineangiography in evaluating the left ventricular function.
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90세 이상 초고령 환자에서 수술 전 심장 초음파 검사 분석
김유리 ( Yoo Ri Kim ),조인정 ( In Jeong Cho ),신길자 ( Gil Ja Shin ),편욱범 ( Wook Bum Pyun ) 대한내과학회 2009 대한내과학회지 Vol.77 No.2
Background/Aims: Adverse cardiac events pose a significant perioperative risk to patients undergoing noncardiac surgery, especially geriatric patients. This study presents resting echocardiography data for a population older than 90 years. Methods: We performed transthoracic echocardiography in 108 patients who were older than 90 years and scheduled to undergo noncardiac surgery between November 1, 2004, and September 22, 2008, and evaluated their cal histories and electrocardiograms. Results: The 108 patients included 73 (67.3%) women and 35 (32.7%) men with a mean age of 92.05±2.77 years (range 90-104). Their medical histories included hypertension in 38.9% and diabetes mellitus in 15.7%. The average left ventricular end diastolic dimension and ejection fraction were 49.0±6.3 mm and 62.9±11.1%, respectively. Six (5.6%) patients had clinically significant aortic regurgitation and seven (6.5%) had mitral regurgitation as pathologic changes of aging. Six patients had mild to moderate aortic stenosis, found incidentally, that did not affect the clinical decision regarding the scheduled operation. The diastolic parameters showed that most of the patients (87%) had grade I relaxation abnormalities. The average mitral inflow E/A, deceleration time, and E/E`s were 0.69±0.33, 266±82 msec, and 11.15±3.88, respectively. Conclusions: Echocardiography cannot predict all of the postoperative cardiovascular complications and risks, but it is useful for screening for significant left ventricular dysfunction, valvular abnormalities, and as a guide for managing extremely old patients in the perioperative period. (Korean J 77:193-199, 2009)
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비악성 상대정맥 증후군의 경피적 스텐트삽입술 중 발생한 급성 폐부종 1예
백은경 ( Eun Kyung Baek ),오지영 ( Ji Young Oh ),강민정 ( Min Jung Kang ),신길자 ( Gil Ja Shin ),이순남 ( Soon Nam Lee ),정익모 ( Ick Mo Chung ),편욱범 ( Wook Bum Pyun ) 대한내과학회 2008 대한내과학회지 Vol.74 No.2
상대정맥 증후군의 비악성 원인은 염증, 특발성 종격동 섬유화, 대동맥류, 방사선 치료에 의한 섬유화 등이 주를 이루었으나, 최근에는 카테터의 장기간 거치 혹은 인공 심박동기, 제세동기 등에 의한 의인성 상대정맥 증후군이 증가추세에 있다. 상대정맥 증후군의 치료는 일반적으로 방사선치료와 항암치료 등이 알려져 있으나, 비악성 원인에 의한 경우는 스텐트 삽입을 통한 치료가 최근 대두되고 있다. 본 증례에서는 안면 부종, 양측 상지 부종으로 내원한 환자에서 혈관 조영술을 통하여 상대정맥 증후군을 확인하였고, 자기공명영상과 전산화 단층 촬영에서는 원인이 될 만한 특이소견이 없어 비악성 상대정맥 증후군으로 진단하였다. 환자는 스텐트 삽입술을 통하여 성공적으로 상대정맥 증후군을 치료받았으나, 스텐트 삽입 직후 드문 합병증인 폐부종을 경험하였기에 이를 문헌고찰과 함께 보고하는 바이다. The superior vena cava (SVC) syndrome results from the disturbance of blood flow in superior vena cava caused by the obstruction. The most common etiology of this condition is the external compression by a malignant tumor. Other causes include thrombus from a pacemaker, defibrillator or central venous catheters. The conventional treatment is radiation and chemotherapy. Recently stenting has been used as a first-line therapeutic strategy for non-malignant cases with balloon and self-expanding stents. In our report, a 77 year-old woman had the SVC syndrome without identification of an underlying disease. A percutaneous endovascular intervention was performed. The stent was placed successfully but just after the procedure, the venous return immediately increased and acute pulmonary edema developed. The patient improved after intravenous diuretics and oxygen. Here we report our experience and review the medical literatures for the management of the non-malignant SVC syndrome, with percutaneous endovascular intervention and the rare complication of pulmonary edema. (Korean J Med 74:192-197, 2008)
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한설혜(Seol Hye Han),임양희(Yang Hee Lim),박현주(Hyun Joo Park),신길자(Gil Ja Shin) 대한내과학회 1996 대한내과학회지 Vol.51 No.1
N/A Objectives: Various factors have been implicated in the pathogenesis of left ventricular hypertrophy in patient with end stage renal disease. These include hypertension, anemia, coronary artery disease, parathyroid hormone. In present study, we used echocardiographically derived left venticular mass and relative wall thickness to assess the patterns of ventricular geometry, left ventricular load and contractile performance. And to evaluate the effect of age, duration of hypertension, anemia on left ventricular hypertrophy may help treatment of end stage renal failure. Methods: We measured systolic and diastolic function of left ventricle and left ventricular mass with M-mode, two dimensional, and Doppler echocardiography in 50 cases of end stage renal disease and 30 cases of healthy adults from July 1993 to March 19%. Results: 1) End stage renal diease group was 50 cases. Among the study patients, 12 cases(24%) had increased relative wall thickness with normal ventricular mass(concentric remodeling), 14 cases(28%) had increased relative wall thickness and ventricular mass(concentric hypertrophy), 24 cases(48%) had increased left ventricular mass with relative wall thickness(eccentrophic hypertrophy). There was no case of normal left ventricular mass and normal wall thickness. Among 30 cases of noraml control group, most of them showed normal left ventricular mass and normal wall thickness. 2) In concentric remodeling group, peripheral resistance was increased and left ventricular end diastolic dimension was decreased. Ejection fraction was preserved. 3) In group with concentric hypertrophy, high blood pressure was noted and end systolic wall stress was increased. Ejection fraction was decreased, So it reflects compensation of heart for hypertension. 4) In group with eccentric hypertrophy, the increase of left ventricular end diastolic dimension and post wall thickness was different from group with concentic hypertrophy. Left ventricular systolic function in eccentric hypertrophy was more decreased than concentric hypertrophy. So, concentric hypertrophy progresses to eccentric hypertrophy. 5) All the patients with end stage renal disease, diastolic dysfunction was noted. Conclusion: Appropriate treatment of hyper- tension and left ventricular hypertrophy according to each pattern may reduce performance and mortality of patients with end stage renal disease.
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