고농도 Dipyridamole 심초음파를 이용한 관상동맥 질환의 진단

심완주(Wan Joo Shim),서홍석(Hong Seog Seo),안태훈(Tae Hoon Ahn),김영훈(Young Hoon Kim),오동주(Dong Joo Oh),박정의(Jeong Euy Park),노영무(Young Moo Ro) 대한내과학회 1992 대한내과학회지 Vol.43 No.5

N/A Background: Dipyridamole infusion induces myocardial ischemia in the presence of coronary artery stenosis. Regional wall motion abnormality detected by 2-dimensionai echocardiography (2DE) is a reliable sign of mycoardial ischemia. Method: Dipyridamole of 0.56mg/kg was infused over the 4 minutes and followed by 4 minutes of no infusion and then 0.28mg/kg of dipyridamole infusion during 2 minutes in 31 patients. At the baseline, full 2DE was recorded and continuous 2DE was performed during the dipyridamole infusion and 10 minutes thereafter. Blood pressure was measured every 1 minute and ECG was checked at baseline, 4 minutes 10 minutes and at the end of the study. Coronary angiography wa done in all cases within 2 minths of dipyridamole echocardiography. Result: As a criteria of myocardial ischemia, 4 parameters such as emergence of chest pain, ischemic ST change in ECG, reduction of ejection fraction and development of new abnormal regional wall motion was analysed. The sensitvity for each parameter was 52,9%, 72.2%, 77.8% and 83.3% respectively. The specificity was 100% for abnormal regional wall motion, 91.7% for reduction of ejection fraction, 76,9% for ischemic ST change and 53.8% for chest pain. No serious side effect was observed during the procedure. Comclusion: Thus we conclude high dose dipyridamole echocardiography is a safe and useful method to detect coronary artery disease especially who is unable to exercise

급성 심근경색후 좌심실 기능과 용적의 변화

심완주(Wan Joo Shim),안태훈(Tae Hoon Ahn),김영훈(Young Hoon Kim),노영무(Young Moo Ro) 대한내과학회 1991 대한내과학회지 Vol.41 No.6

N/A To assess changes of left ventricular size and function after acute myocardial infarction, 15 patients with acute myocardial infarction were studied by 2-D echocardiogram. The left ventricular volume and extent of regional wall motion abnormality were calculated using measurements from the 2-D echocardiogram at entry and at 7 days and 2 months after acute myocardial infarction. The left ventricular volume increased from 124+40ml at entry to 143+24ml at 2 months after acute myocardial infarction in 5 patients (33.3%). The location of the infarction was the anterior wall in all of these 5 patients, who had a greater infarct area than those who had normal left ventricular volume at 2 months (p=0.07). The timing of the left ventricular dilatation after acute myocardial infarction was different in each of these 5 patients. The rest of the 10 patients (66.7%) exhibited either no change of a decrease in left ventricular volume. The wall motion score decreased from 6.2+2.9 at entry to 5.2+2.8 at 2 months (p<0.05) with no con-comitent improvement of gloval left ventricular function. No relation was demonstrated between the ejection fraction at entry and the left ventricular dilation at 2 months, Thus, left ventricular dilation after acute myocardial infarction occurs mainly in anterior wall infarction and is related to the extent of the infarct area at entry. Initial left ventricular function (ejection fraction) does not predict left ventricular dilatation 2 months after acute myocardial infarction.

우 Valsalva동에서 기시한 좌주관상동맥 기형과 합병된 동맥관개존증 1예

주형준 ( Hyung Joon Joo ),홍순준 ( Soon Jun Hong ),김진석 ( Jin Seok Kim ),박희남 ( Hui Nam Pak ),심완주 ( Wan Joo Shim ),신승용 ( Seung Yong Shin ),임도선 ( Do Sun Lim ) 대한내과학회 2008 대한내과학회지 Vol.74 No.2

선천성 관상동맥기형은 관상동맥조형술을 시행한 환자에서 약 0.5%로 발견되는 드문 질환이다. 하지만 주변구조물 및 주행경로에 따라 무증상에서 급사 및 심근 허혈등 다양한 임상경과를 나타낼 수 있다. 저자들은 이전에 동맥관개 존증으로 수술한 환자로 흉통을 호소하여 시행한 관상동맥 조형술에서 좌주관상동맥이 대동맥의 우 Valsalva동에서 우 관상동맥과 함께 기시하여, 정상보다 훨씬 긴 주행을 보이는 특이한 경우를 발견하여 보고하는 바이다. The finding of a left main coronary artery arising from the right sinus of Valsalva is a rare congenital anomaly. The clinical course of patients with a congenital anomaly of the coronary artery may be compromised depending on its anatomic relationship with adjunctive structures. Some anomalous origins of the left main coronary arteries arising from right aortic sinus of Valsalva have been associated with angina pectoris and sudden death, especially if their pathways are between the pulmonary artery and the aorta. We report a rare case with a combined congenital anomalous origin of the left main coronary artery arising with the right coronary artery simultaneously from the right aortic sinus of Valsalva in a patient with a patent ductus arteriosus. The left main coronary artery was extremely long because its pathway went in front of the pulmonary artery. There was no evidence of artherosclerosis or dynamic stenosis on the angiogram. (Korean J Med 74:188-191, 2008)

급성 심근경색 환자에서 재관류 후 운동부하 심전도에서 T파의정상화 소견과 심근기능 회복과의 관계

김경진(Kyung Jin Kim),심완주(Wan Joo Shim),정성원(Seong Won Jung),박희남(Hui Nam Pak),이수진(Soo Jin Lee),송우혁(Woo Hyuk Song),김영훈(Young Hoon Kim),서홍석(Hong Seog Seo),오동주(Dong Joo Oh),노영무(Young Moo Ro) 대한내과학회 2001 대한내과학회지 Vol.60 No.1

N/A Background : Several studies has been reported that T-wave normalization(TWN) in exercise ECG indicates the presence of viable myocardium. But the clinical implication of this phenomenon in patients with acute myocardial infarction who received proper revascularization therapy was not determined. The aim of this study was to investigate the relationship between TWN in exercise ECG and myocardial functional recovery after acute myocardial infarction. Methods : We studied 30 acute myocardial infarction patients with negative T waves in infarct related electrocardiographic leads and who received successful revascularization therapy. All patients performed exercise ECG, 10-14days after infarct onset using Naughton protocol. Patients were divided into 2 groups, according to presence (group I; n=14) or not (group II; n=16) of TWN in exercise ECG. Exercise parameters, coronary angiographic findings were compared between groups. Baseline and follow up (mean 11 months) regional and global left ventricular function was analyzed by echocardiography. Results : Exercise parameters was similar between groups. There were no difference in baseline ejection fraction and regional wall motion between group I and II (EF; 56±12% vs 52±11%, p=ns. WMS; 21±3 vs 23±4, p=ns) and it was improved at the tenth month by similar magnitude. (group I/group II, EF % change = 12±12% vs 7±6%, p=ns, WMS % change = 6±6% vs 7±5%, p=ns) The findings of no relation between TWN and functional recovery was observed also when the patients were analysed according to infarct location and presence of Q-waves. Conclusion : As the exercise induced TWN in patients with acute myocardial infarction was not related with better functional recovery of dysfunctional regional wall motion, TWN dose not appears to be a sign of myocardial viability.(Korean J Med 60:51-60, 2001)

한국인의 혈중 Lipoprotein ( a ) 농도와 Apolipoprotein ( a ) 유전적 표현형 분포특성

서홍석(Hong Seog Seo),오동주(Dong Joo Oh),이상칠(Sang Chil Lee),임도선(Do Sun Lim),박창규(Chang Kyu Park),김영훈(Young Hoon Kim),심완주(Wan Joo Shim),노영무(Young Moo Ro),김순덕(Soon Duk Kim),유재명(Jae Myung Yu) 대한내과학회 1996 대한내과학회지 Vol.50 No.5

N/A Lipoprotein(a)[Lp(a)] is a cholestryl ester-rich lipoprotein composed of two components' an LDL -like particle to which is attached a single large glycoprotein, apolipoprotein(a)[apo(a)]. Elevated concentrations of Lp(a) have been established as a geneticalqly controlled risk factor for atherosclerotic vascular disease. Variable alleles at the apo(a) gene locus determine, to a large extent, the Lp(a) concentration in the general population. To determine and compare the mean and distribution of Lp(a) concentration, apo(a) phenotypes and allele frequencies of Lp(a) in Korean people and other several esthnic groups, we investigated the Lp(a) plasma concentration, apo(a) phenotypes and other lipid profiles in 481 Korean People, who were consisted of 280 cases with non-atherosclerotic vascular disease and 201rases with atherosclerotic vascular disease. Mean concentrations of Lp(a) in Korean people were 27.3±28.6mg/dl in cases with non-atherosclerotic vascular disease an 29.9±31.2mg/dl in cases with atherocslerotic vascular disease. No differences was found in Lp(a) doncentration between the two groups. Lp(a) concentration of Korean people was simular to those of Indian, but far higher than those of Caucacian, Chinese or Japanese. Proportion of those below 5mg/dl of Lp(a) concentration was 26.6%, and those below 30mg/ dl was 68.0%. Frequency distribution patterns of Lp(a) concentrations in Korean population were similar to those of Chinese, Japanese and Malysian, but different from those of Caucacian, Indian of African. In apo(a) phenotype of Korean, the mode of single band was S3(44.3%), and the mode of double bank was S3S4(8.2%), which were similar to those of Chinese, Malysian and Indian. Order of allele frequencies of Lp(a) of Korean was Lps4, null(Lp0), Lps3, Lps2, and Lps1. Similar frequency was seen in those of Chinese, and other Asians execpt Japanese, but not in those of Caucacian and black people. Lp(a) concentration was not correlated with any other lipid profiles. Homology of study samples with Korean population was confirmed by Hardy-Weinberg equilibrium test. These results show that Korean people has higher concentration of Lp(a) in Asian, and has characteristics of apo(a) phenotype and Lp(a) allele frequences.

혈중 Lipoprotein ( a ) 의 농도가 인체내 혈전 생성 및 용해 인자에 미치는 영향에 관한 연구

서홍석(Hong Seog Seo),오동주(Dong Joo Oh),이은미(Eun Mi Lee),한승환(Sung Whan Han),박희남(Hui Nam Pak),임도선(Do Sun Lim),박창규(Chang Kyu Park),김영훈(Young Hoon Kim),심완주(Wan Joo Shim),노영무(Young Moo Ro),권정아(Jung Ah Kwon),이갑 대한내과학회 1996 대한내과학회지 Vol.51 No.1

N/A Objectives: Recently, lipoprotein (a) is known as an independent genetic risk factor for cardiovascular disease. Lipoprotein (a) contains a unique structure, apolipoprotein(a), that shares a partial homology with plasminogen without haboring enzymatic activity. Several in vitro studies reported that lipoprotein(a) competes with plgsminogen for their receptors showing inhibited thrombolysis and promoted thrombosis. We investigated whether evalvuated that lipoprotein(a) has same properties in vivo by determining the homeostatic relation between lipoprotein(a) concentration and several parameters of thrombosis and thrombolysis, and whether parameters of thrombosis and thrombolysis are different in atherosclerotic vascular diseases. Methods: Lipoprotein(a), fibrinogen, plasminogen, FDP-d, antithrombin-III, prothrombin time, activated partial thromboplastin time, tissue-type plasminogen activator, alpha-2 antiplasmin, plaminogen activator inhibitor-l, platelet counts, and other lipid profiles were measured and were compared each others by venous samles in 239 cases with atherosclerotic vascular disease which consisted of 146 cases of coronary heart disease, 39 cases of non-hemorrhagic cerebral infarction, and 10 cases of arteriosclerosis obliterans and in 185 cases without atherosclerotic vascular disease., Results: There was neither significant homeostatic relationship between lipoprotein(a) levels and paramets d thrombolysis, nor between lipids levels and parameters of thrombosis and thrombolysis. Serum lipoprotein(a) levels were higher in patients with myocardial infarction than in those with non- atherosclerotic vascular disease(30.0±28.2mg vs 23.8±21.4mg/dl). Among the thrombogenic and thrombolytic parameters, only tPA and FDP-d were significantly elevated in patients with atherosclerotic vascular disease. Conclusion: The findings that lipoprotien(a) was not correlated with thrombogenic and thrombolytic profiles in vivo suggests that lipoprotein(a) is not related to thrombogenicity in Korean people, al- though lipoprotein(a) is a independent genetic risk factor for carodiovascular disease.

급성 심근경색증으로 일차 관동맥 스텐트 삽입술 후 조기 퇴원의 안전성에 대한 연구

이은미(Eun Mi Lee),오동주(Dong Joo Oh),강영선(Young Sun Kang),안정천(Jeong Cheon Ahn),김영훈(Young Hoon Kim),서홍석(Hong Seog Seo),심완주(Wan Joo Shim),노영무(Young Moo Ro) 대한내과학회 2000 대한내과학회지 Vol.59 No.6

N/A Background : Primary coronary stenting results in reduced rates of reinfarction, recurrent ischemia, stroke and in-hospital mortality and may allow earlier hospital discharge compared with primary angioplasty for acute myocardial infarction(AMI). This study evaluated the hypothesis that primary coronary stenting, with subsequent discharge within 4 days after admission, is safe and cost-effective in low risk patients for AMI, prospectively. Methods : The study group consisted of low risk patients after susccessful primary stenting with conventional transfemoral intervention for AMI. Low risk status required be met all the following criteria : age≤75 years, no persistent arrhythmias, no recurrent ischemia and no symptomatic heart failure signs during admission after successful reperfusion. The total 41 patients were randomized into 2 groups{early discharge group(ED, hospital stay ≤4 days), N=25//conventional discharge group(CD, hospital stay ≥5 days), N=16}. Their demographic and angiographic characteristics, the rate of major adverse cardiac events, ejection fraction during 3 months, and total medical costs were analyzed. Results : The 25 patients(61%) were discharged on day 3 or 4. The peak level of CK-MB were not significantly lower in early discharge group than conventional discharge group(ED/CD;112.4±67.3/153.3±76.9 U/L, p=0.089). Comparing to conventional discharge group, in-hospital costs were significantly lower in patients of early dicharge group(ED/CD;7,109,118±1,068,861/8,766,336±1,688,707￦, p=0.001). Major adverse cardiac events were similar in both group(ED/CD;16/25%, p=0.329). Conclusion : Early identificaton of low risk patients after successful primary stenting by transfemoral intervention for AMI allowed safe omission of the intensive care phase and noninvasive testing, and early hospital discharge, resulting in substantial costs savings.(Korean J Med 59:626-633, 2000)

급성심근경색증에서 정맥내 투여 Urokinase 의 혈전용해 효과

노영무(Young Moo Ro),오동주(Dong Joo Oh),심완주(Wan Joo Shim),최석주(Suck Joo Choi),송관규(Gwan Gyu Song),박창규(Chang Kyu Park),유승관(Seung Kwan Ryu),서순규(Soon Kyu Suh) 대한내과학회 1988 대한내과학회지 Vol.34 No.2

N/A To evaluate the thrombolyutic efficacy and safety of Urokinase (UK), an intravenous (IV) bolus of 20,000 units/kg was administered in 15 patients with acute evolving transmural myocardial infarction 6.15(2.5~8.0) hours after the onset of symptoms. Recognition of myocardial reperfusion was based upon the reperfusion scores according to the following indirect clinical criteria; rapid relief of chest pain, rapid resolution of ST segment elevation (∑ST reduction by ? 70%within 90 minutes), ischemic arrhythmia or A-V block and CK wash-out phenomenone, Signs of reperfusion began to occur 30 to 90 minutes after the IV bolus of UK. Of the 15 patients, 8(53.3%) had one or more of the signs of reperfusion and 6 (40%) had reperfusion scores of ?4, which indicates definite reperfusion according to the indirect reperfusion scoring system we employed. Those who received UK within 6 hours after the onset of chest pain, reperfusion was achieved in 71.4% (5 of 7 patients). Transient gum bleeding was the only side effect, which was seen in 1 patient (6.7%). These findings suggest that IV bolus of 20,000 units/ kg UK within 6 hours after the onset of chest pain is an effective and safe method to achieve reperfusion in patients with acute transural myocardial infarction. Since there was no significant complication on 20,000 units/kg of UK, higher dose than 20,000 units/kg can be used to improve reperfusion in acute evolving myocardiaI infarction,

갑상선기능저하증에 있어서의 몇가지 혈청효소치의 임상적 의의

이상종 ( Sang Jong Lee ),이만호 ( Man Ho Lee ),심완주 ( Wan Joo Shim ),최성규 ( Sung Kyu Choi ),이오수 ( Oh Soo Lee ),이승세 ( Seung Sei Lee ),배철환 ( Chul Hwan Bai ) 대한내과학회 1985 대한내과학회지 Vol.28 No.1

T1(201) - 심근주사의 정량적 분석

서순규 ( Soon Kyu Suh ),이민재 ( Min Jae Lee ),박정의 ( Jeong Euy Park ),심완주 ( Wan Joo Shim ),노영무 ( Young Moo Roh ) 대한내과학회 1985 대한내과학회지 Vol.28 No.5