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좌각 차단 및 하향성 전기축을 보이는 특발성 심실 빈맥의 전극도자 절제술: 우측 전흉부 유도상 R파의 형태적 차이의 의의
이만영 ( Man Young Lee ),신우승 ( Woo Seung Shin ),진승원 ( Seung Won Jin ),오용석 ( Yong Seok Oh ),허민 ( Min Huh ),정성훈 ( Sung Hoon Jung ),장시진 ( See Jin Jang ),임민경 ( Min Kyung Lim ),김연성 ( Yeon Seong Kim ),노태호 ( Ta 대한내과학회 2005 대한내과학회지 Vol.68 No.4
관상동맥 질환으로 입원한 한국인 환자의 임상양상과 예후인자
조진만 ( Jin-Man Cho ),김종진 ( Chong-Jin Kim ),신우승 ( Woo Seung Shin ),조은주 ( Eun-Ju Cho ),박철수 ( Chul-Soo Park ),김범준 ( Pum Joon Kim ),이종민 ( Jong-Min Lee ),임상현 ( Sang-Hyun Ihm ),임효영 ( Hyou-Young Rhim ),장기육 ( 대한내과학회 2007 대한내과학회지 Vol.73 No.2
Background: Coronary artery disease (CAD) has recently become one of the major causes of mortality and morbidity in Korea. However, not much epidemiologic and demographic data has yet been reported. The purpose of this study was to investigate the clinical features as well as the prognostic factors of patients with CAD. Methods: We prospectively enrolled 1,665 consecutive patients with CAD who had been admitted to the Catholic University Hospitals from December 1999 to April 2003. Results: Acute myocardial infarction (AMI) was the most common cause of admission (n=715, 42.9%). Dyslipidemia, hypertension and smoking were the most common risk factors. More than 70% of the patients who underwent percutaneous coronary intervention (PCI) received stent implantation. A total of 965 (612 males) patients were followed at least for 6 months (the mean follow-up duration was 23.8±12.2 months). The incidence rates of major adverse cardiac events (MACE: cardiac death, acute myocardial infarction, target vessel revascularization) and cardiac death were 15.1% (n=146) and 2.2% (n=21), respectively. There was no difference in overall survival between the patients treated with medical therapy and those treated with PCI. By Cox regression analysis, the independent prognostic factors for MACE were PCI (95% CI: 1.75-4.85; p<0.01) and multivessel disease (95% CI: 1.03-2.04; p<0.05), and the independent prognostic factors for cardiac death were medical therapy (95% CI: 1.08-14.41; p<0.05) and old age (95% CI: 1.13-16.13; p<0.05). Conclusions: There was no difference in overall survival between the patients treated with medical therapy and those treated with PCI. However, PCI was superior to medical therapy for preventing death of the patients with acute coronary syndrome.(Korean J Med 73:142-150, 2007)
흉통으로 응급실로 내원한 환자에서 조기에 관상동맥 질환을 진단 할 수 있는 새로운 허혈 표지자로서의 Ischemia Modified Albumin의 유용성
장은철 ( Eun Chul Jang ),전희경 ( Hui Kyung Jeon ),김성훈 ( Seong Hun Kim ),신동일 ( Dong Il Shin ),정혜빈 ( Hae Bin Jeong ),신정아 ( Jeong Ah Shin ),신우승 ( Woo Sung Shin ),장기육 ( Ki Yuk Jang ),김영식 ( Young Sik Kim ),이혜경 대한내과학회 2006 대한내과학회지 Vol.71 No.6
목적: 급성 흉통을 주소로 응급실에 내원한 환자에서 관상동맥 질환을 진단하는데 어려움이 있으며, 이것은 심전도와 심근효소의 민감도가 떨어지기 때문이다. 최근에 혈청내 ischemia modified albumin은 민감한 심근 허혈의 검사법으로 알려지고 있다. 본 연구의 목적은 급성 흉통 환자가 응급실로 내원하였을 때 관상동맥 질환이 의심되는 경우 IMA 측정의 진단적 의의를 알아보고자 하였다. 방법: 대상 환자는 급성 흉통 후 6시간 안에 응급실에 내원한 연속적인 환자 100명을 포함시켰다. 관상동맥 질환의 진단은 내원하여 검사한 연속적인 표준 12유도 심전도와 심근효소 및 침습적/비침습적 심혈관 검사에 의해 전향적으로 분석하였다. ROC커브를 통해 진단적 의의를 조사하였다. 결과: 대상 환자에서 관상동맥 질환은 69예(69%)였다. ROC커브상 IMA의 area under the curve는 0.901(confidence interval, 0.840-0.961)이며 통계적으로 유의하였다(p<0.05). IMA치가 99.5U/mL에서 관상동맥 질환의 민감도, 특이도, 음성 예측도는 각각 86%, 81%, 74%였다. 기존검사들과 IMA 검사를 조합시 관상동맥 질환의 민감도, 음성 예측도는 각각 94%, 85%였다. 결론: 급성 흉통으로 내원한 환자에서 IMA의 측정은 관상동맥 질환을 예측할 수 있는 유용한 허혈 표지자 검사였다. Background: A diagnosis of coronary artery disease (CAD) in the early phase of acute chest pain is often difficult in an emergency department (ED) due to the lower sensitive ECG anti delayed expression of the cardiac necrosis markers. Ischemia modified albumin (IMA) has recently been reported to be an early sensitive biochemical marker of ischemia. The aim of this study was to evaluate the diagnostic value of IMA in patients with suspected CAD and less sensitive ECG/delayed cardiac necrosis markers. Methods: 100 consecutive patients (mean age: 5413 years, male: 66%) presenting to the ED with suspected CAD and chest pain within 6 hours of chest pain were enrolled in this study. An ECG check and blood sampling for IMA and CK-MB, cardiac troponin-T (TnT) were done within 1 hour at the ED. The diagnosis of CAD was based upon the clinical findings, results of serial ECG/TnT and coronary angiography. The ideal cutoff value of IMA for CAD was calculated by the Receiver Operator Characteristic (ROC) curve analysis. Results: CAD including acute coronary syndrome was diagnosed in 69/100 (69%). The optimum diagnostic cutoff point for the IMA levels in these study populations was found by ROC analysis to be 99.5 U/mL. The ROC curve area for the IMA test was 0.901 (95% confidential interval, 0.840-0.961, p=0.001). The IMA levels >99.5 U/mL demonstrated a sensitivity of 86%, specificity of 81%, positive predictive value of 90% and negative predictive value of 74% for the diagnosis of CAD. The combination of IMA-ECG-CKMB/TnT increased the sensitivity for detecting ischemia to 94%, with a negative predictive value of 85%. IMA is a highly sensitive with a high negative predictive value, and might improve the utility of standard biomarkers for CAD. Conclusions: IMA might be a useful ischemic marker of coronary artery disease in patients presenting within 6 hours after the onset of chest pain. (Korean J Med 71:620-626, 2006)
김병수,신우승,장재순,김성래,김영옥,김상우,김양리,강문원,방병기 대한감염학회 1997 감염 Vol.29 No.2
저자들은 배양된 균주는 없었지만 감염성 설사에 동반된 성인형 용혈성 요독증후군 2예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Hemolytic uremic syndrome (HUS) is defined by the triad of renal failure, thrombocytopenia and hemolytic anemia. HUS is usually developed by infectious disease in children, but occasionally in adults. Infectious disease associated with HUS is characterized by fever and diarrhea-commonly related with Escherichia coli O157:H7. Verotoxin (Shiga-like toxin) produced by E. coli damage the endothelial cells, promote local thrombosis and finally step to HUS. Other causes of HUS include drugs, pregnancy, organ transplantation and malignant tumor. We report two adult patients cases of HUS associated with infectious diarrhea.
급성 신우신염에서 Gentamicin 1일 1회 요법과 분할 요법의 효과 및 부작용 비교
김양리,성광용,송치원,신우승,조은주,최정현,강문원 대한감염학회 1997 감염 Vol.29 No.2
목적:급성 신우신염 환자를 대사응로 gentamicin 1일 1회 요법과 분할 요법의 효과 및 부작용을 비교하였다. 방법:분할 투여군은 Gentamicin 3-5mg/kg을 1일 3회에 나누어 분할 투여하거나, 1일 1회 투여하였다. 임상적 효과와 독성 여부를 판정하고, gentamicin의 혈중 최고 농도와 최저 농도를 측정하였으며, 소변의 β₂-microglobulin과 N-acetyl-β-D-glucosaminidase를 측정하여 신독성 예측의 지표로 삼을 수 있는지 알아 보았다. 결과: 1)1회 투여군 19명, 분할 투여군 15명에서 모두 호전되었고, 미생물학적으로 원인균이 검출된 경우는 1회 투여군에서 19명 중 15명, 분할 투여군에서 15명 중 12명으로 모두 E.coli였으며, 치료 후에 모두 소실되었고, 신독성이나 이독성은 한 예도 없었다. 2)Gentamicin 혈중 최고 농도는 1회 투여군에서 평균 평균 14.79±5.71㎍/mL, 분할 투여군에서 5.33±1.99㎍/mL, 최저 농도는 1회 투여군에서 평균 0.35±0.45㎍/mL, 분할 투여군에서 0.69±0.58㎍/mL였다.. 3)분할 요법에서 gentamicin 혈중 최고 농도가 7.0㎍/mL 이상인 경우는 15예 중 2예, 5.0±㎍/mL 미만인 경우는 15예 중 7예였다. 4)소변의 β₂-microglobulin 농도는 두 군을 통털어 치료 전 2.71±2.20-㎍/mL, 치료 후 0.37±0.90㎍/mL이었고, N-acetyl-β-D-glucosaminidase 농도는 치료 전 8.67±7.39U/L, 치료 후 17.74±7.86 U/L였다. 결론:급성 신우신염환자에서 gentamicin 1일 1회 요법은 분할 요법과 비교하여 임상적, 미생물학적 효과 및 부작용에서 차이가 없는 것으로 나타났다. 위중한 그람 음성 간균 감염에서는 gentamicin의 분할 요법으로 적절한 혈중 최고 농도를 얻기 어려우며, aminoglycoside 사용시 소변의 N-acetyl-β-D-glucosaminidase를 측정하는 것이 신독성 예측의 지표가 될 수 있을 것으로 추측된다. Background: Once daily dose of aminoglycoside has been used recently in the gram-negative infection for the purpose of improving efficacy. The clinical efficacy and side effects of once daily versus divided doses of gentamicin were compared in acute pyelonephritis. Method: Gentamicin (3-5mg/kg/day) was administered into 3 divided doses intravenously in 15 patients of the divided dose group, and the same dose was administered at a time in 19 patients of the once daily dose group. The duration of treatment was 6-14 days. Results:The clinical outcome of all patients was favorable, and nephrotoxicity or ototoxicity was not detected in any patients. E. coli were isolated from 12 patients in the divided dose group, and 15 patients in the once daily dose group. They were all eradicated after treatment. The mean peak serum concentrations of gentamicin were 5.33±1.99㎎/mL in the divided dose group, and 14.79±5.71㎍/mL in the once daily dose group. The trough concentrations were not different significantly between two groups(0.69±0.58㎍/mL in the divided dose group vs. 0.35±0.45㎍/mL in the once daily dose group). The number of patients with peak concentration over 5.0㎍/mL were 8 out of 15 in the divided dose group. Conclusion: The once daily dose of gentamicin was as effective as the divided dose, and the nephrotoxicity or ototoxicity was not observed in both groups.
알콜 중독과 관련된 횡문근 융해증에 의한 급성 신부전의 임상적 특성
김용수,김영옥,김석영,한충민,윤선애,방병기,홍순화,신우승,임국희,성용직 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.1
Alcohol can cause rhabdomyolysis by either direct toxicity or associated metabolic abnormality such as hypophosphatemia and hypokalemia. It can also predispose to or cause trauma, seizures, or comainduced ischemic pressure necrosis. In order to investigate the clinical features of acute renal failure caused by alcohol induced rhabdomyolysis, we reviewed the medical records of the 12 patients. All patients had been drinking much amounts of alcohol for several years. All patients showed elevation of muscle enzyme such as creatine phosphokinase, lactic dehydrogenase, aspartate transaminase and blood urea nitrogen and serum creatinine. Predisposing factors of rhabdomyolysis were ischemic compression due to unconsciousness and dehydration(2 cases), and hypophosphatemia and dehydration(1 case), seizure and dehydration(1 case), and only severe dehydration(3 cases). Initial symptoms were painful swelling at lesion site(5 cases), abdominal pain(2 cases), general ache(2 cases), leg pain without swelling(1 case), dyspnea(1case), and lethargy(1 case). Seven patients developed delirium tremens during recovery stage. Eight patients showed oliguric acute renal failure and 8 patients were treated with hemodialysis. Complications were disseminated intravascular coagulation(DIC)(3 cases), compartment syndrome(2 cases), capillary leak syndrome and DIC(1 case). One of 12 patients died of disseminated intravascular coagulation and other patients showed complete recovery of renal function.