호흡기 ; 다발성 관상동맥누공의 코일 색전술 도중 발생한 좌주간부 관상동맥 박리

이형탁 ( Hyung Tak Lee ),임영효 ( Young Hyo Lim ),이강원 ( Kang Won Lee ),신진호 ( Jin Ho Shin ),임헌길 ( Heon Kil Lim ),김정현 ( Jeong Hyun Kim ),김경수 ( Kyung Soo Kim ) 대한내과학회 2010 대한내과학회지 Vol.79 No.4

관상동맥누공은 희귀한 질환으로 대부분은 증상이 없지만 드물게 관상동맥 `steal`에 의한 증상을 보이게 된다. 관상동맥누공의 치료로는 수술적 치료와 심도자를 이용한 선택적인 색전술이 있는데 심도자를 이용한 색전술도 수술과 동일한 수준의 효과가 있음이 보고되고 있다. 한편, 의인성 좌주간부 관상동맥 박리는 드물고도 매우 치명적인 합병증이다. 이번 증례에서 우리는 심도자를 이용한 관상동맥누공의 코일 색전술 도중 좌주간부 관상동맥 박리를 경험하고 치료한 드문 경험을 하였기에 이를 보고한다. A congenital coronary fistula is a rare defect. Many congenital fistulas drain into the pulmonary artery and may be an incidental finding; however, some fistulas can cause a coronary `steal` phenomenon resulting in angina. The transcatheter closure of coronary fistulas is an accepted, effective, and safe alternative to surgery in adults. In comparison, left main coronary artery (LMCA) dissection is rare and can lead to life-threatening complications during percutaneous coronary intervention. The optimal treatment patients with LMCA dissection during catheter-based procedures is uncertain. Some studies suggest that bail-out LMCA stenting provides good acute and long-term results. Here, we present a case of LMCA dissection during the transcatheter coil closure of multiple congenital coronary fistulas with subsequent successful stent implantation in the LMCA. (Korean J Med 79:422-427, 2010)

제2형 당뇨병 환자에서의 당뇨병성 망막증과 대혈관 합병증과의 관계

홍상모 ( Sang Mo Hong ),박정환 ( Jung hwan Park ),임영효 ( Young Hyo Lim ),박용수 ( Yong Soo Park ),김동선 ( Dong Sun Kim ),최웅환 ( Woong Hwan Choi ),안유헌 ( You Hern Ahn ) 대한내과학회 2011 대한내과학회지 Vol.81 No.3

Background/Aims: Type 2 diabetes with microvascular complications is often accompanied by macrovascular complications. However, the relationship between the two complications is unclear. In this study, we determined the relationship between diabetic retinopathy and morphological changes of the carotid artery. Methods: We analyzed the presence of plaque and mean carotid intima-media thickness (CIMT) in patients with type 2 diabetes (n = 133) using high-resolution ultrasound. The presence and severity of retinopathy were graded according to fundus photographs. Results: The mean CIMT of the diabetic retinopathy (DR) group (0.111 ± 0.048 cm) was significantly greater than that of the nondiabetic retinopathy (No DR) group (0.074 ± 0.039 cm, p = 0.007). An abnormal mean CIMT (> 0.08 cm) was more frequently observed in the DR group (76%) than that in the No DR group (23.1%; odds ratio, 10.609; 95% confidence interval, 3.072-36.639; adjusted by age, body mass index, hypertension, and diabetes duration). Although the mean CIMT in patients with plaque was significantly greater than that of patients without plaque, no significant difference was observed between the DR (36%, 17 patients) and NoDR (18.5%, 20 patients) groups in the presence of plaque. Conclusions: Diabetic retinopathy was associated with an increased CIMT but not with atherosclerotic plaques. However, the increases in IMT were associated with the presence of plaques, which predispose patients to cardiovascular disease. These results imply that the microvascular complications of diabetes have indirect relationships with the cardiovascular complications of diabetes. (Korean J Med 2011;81:351-358)

IR-UWB 레이더 센서 기반 수면 효율 측정 알고리즘

최정우(Jeong Woo Choi),이유나(Yu Na Lee),조석현(Seok Hyun Cho),임영효(Young-Hyo Lim),조성호(Sung Ho Cho) 한국통신학회 2017 韓國通信學會論文誌 Vol.42 No.1

증례 : 순환기 ; 관상동맥조영술 후 발생한 동정맥루 1예

김영일 ( Youngil Kim ),강민구 ( Min Koo Kang ),문인태 ( Intae Moon ),이동훈 ( Donghoon Lee ),이지영 ( Ji Young Lee ),이형탁 ( Hyung Tak Lee ),임영효 ( Young-hyo Lim ) 대한내과학회 2016 대한내과학회지 Vol.90 No.3

67세 남자 환자에서 경요골동맥 접근을 통해 CAG를 시행하고 3개월 후 시술을 시행한 손목의 박동을 주소로 외래를 방문하였다. 국소적인 압박을 통한 치료와 1회의 동정맥루결찰술 이후에도 잡음이 지속되어 상지 동맥조영술을 통해 남아있는 동정맥루를 확인하였고 외과적 동정맥루결찰술을 재시행하여 호전되었던 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. A 67-year-old man underwent coronary angiography using a transradial approach. Three months after coronary angiography, the patient complained of a thrill detected in his right wrist. Localized compression was performed in the assumption of arteriovenous fistula formation. Since thrill was still detected after localized compression, surgical revision of an arteriovenous fistula was performed. Six days later, radial bruit was still reported. It was decided to perform upper extremity angiography. Upper extremity angiography revealed the remaining arteriovenous fistula from radial artery to cephalic vein, and surgical revision was performed again. This appears to be a very unusual complication related to the transradial approach for coronary angiography. (Korean J Med 2016;90:231-233)

증례 : 일과성 뇌허혈과 심근병증으로 발현한 갈색세포종 1예

김웅준 ( Woong Jun Kim ),김해수 ( Hae Su Kim ),김석환 ( Seok Hwan Kim ),신정훈 ( Jeong Hun Shin ),신진호 ( Jin Ho Shin ),김정현 ( Jeong Hyun Kim ),임영효 ( Young Hyo Lim ) 대한내과학회 2012 대한내과학회지 Vol.83 No.2

본 증례에서 환자는 내원 6개월 전 일과성 뇌허혈이 있었고, 흉통을 호소하며 내원하여 심전도 및 심근효소에서 급성관상동맥 증후군이 의심되어 관상동맥조영술을 시행하였으나 관상동맥에는 특이 소견이 없었고, 좌심실 조영술에서 Takotsubo 심근병증 양상으로 나타났다. 내원 6개월 전에 있었던 일과성 뇌허혈 및 Takotsubo 심근병증이 모두 갈색세포종에서 드물게 보일 수 있는 양상이었으며, 발작적인 고혈압, 두통, 심계항진 등의 동반 증상 등으로 갈색세포종을 의심하였고, 복부 전산화단층촬영 및 24시간 요 카테콜라민 검사에서 확인이 되어 수술적 치료로 호전이 된 증례이다. Patients with pheochromocytoma show a variety of clinical symptoms secondary to excessive catecholamine secretion. Major symptoms include hypertension, headache, hyperhidrosis, and palpitation. Stroke and myocardial infarction are known to occur in patients with pheochromocytoma, but the incidence is low. Here, we describe a 45-year-old female with a previous history of transient ischemic attack and a clinical presentation mimicking acute myocardial infarction with transient takotsubo-like myocardial dysfunction. A subsequent diagnostic examination revealed a left adrenal pheochromocytoma. The patient recovered with intensive medical treatment, including alpha- and beta-adrenergic blockade. Follow-up echocardiography revealed normalized cardiac function and wall motion. Thereafter, the patient underwent a laparoscopic left adrenalectomy without complications.

증례 : 순환기 ; 폐동맥 카테터에 의한 폐동맥 파열 및 기관지 혈전에 의한 무기폐

이민규 ( Min Kyu Lee ),이건화 ( Gun Hwa Lee ),김석환 ( Seok Hwan Kim ),박진규 ( Jin Kyu Park ),신정훈 ( Jeong Hun Shin ),임영효 ( Young Hyo Lim ),신진호 ( Jin Ho Shin ) 대한내과학회 2011 대한내과학회지 Vol.81 No.6

폐동맥 카테터에 의한 폐출혈 및 완전 무기폐는 매우 드물게 발생하지만 치명적일 수 있는 합병증이다. 저자들은 폐동맥 고혈압 환자에서 폐동맥 카테터를 이용한 우심장 심도자술을 시행하던 중 발생한 폐동맥 파열과 이로 인한 폐출혈, 좌측 완전 무기폐를 경험하고 치료하였기에 문헌고찰과 함께 보고하는 바이다. The use of pulmonary artery catheters has increased considerably since the Swan-Ganz catheter was first introduced in 1970. It is extremely helpful in the management of critically ill patients and in pulmonary hypertension. However, its manipulation carries potential risks, including subclavian or carotid artery laceration, pneumothorax, thoracic duct laceration, phrenic nerve injury, air embolism, arrhythmias, infection, valvular damage, thrombosis, pulmonary infarction, and pulmonary artery rupture. Pulmonary artery rupture, albeit rare, remains a severe complication. Here, we present a patient who developed pulmonary artery rupture and total atelectasis of the left lung after placement of a pulmonary artery catheter. (Korean J Med 2011;81:769-774)

증례 : 심정지 후 발생한 일과성 중간 좌심실 풍선 확장 증후군의 1예

김정은 ( Jeong Eun Kim ),최경수 ( Kyung Soo Choi ),정해룡 ( Hae Ryong Jeong ),김석환 ( Seok Hwan Kim ),신정훈 ( Jeong Hun Shin ),신진호 ( Jin Ho Shin ),임영효 ( Young Hyo Lim ) 대한내과학회 2012 대한내과학회지 Vol.83 No.3

일과성 중간 좌심실 풍선 확장 증후군은 스트레스성 심근증의 한 변형으로 중간부 좌심실에 국한된 심근벽 운동장애와 확장을 보이는 질환이다. 임상양상이 급성 관상동맥 증후군과 유사하여 감별 진단이 필요하다는 점에서 중요하며, 정확한 병태생리의 확립을 위한 추가 연구가 요구된다. 본 저자들은 자가 지방 이식 수술 도중 발생한 심정지로 심폐 소생술 시행 후 내원하여 심전도와 심초음파에서 급성 심근경색이 의심되었으나 관상동맥 조영술 및 좌심실 조영술 시행 후 일과성 중간 좌심실 풍선 확장 증후군이 진단된 증례를 경험하여 이를 보고한다. Stress-induced cardiomyopathy is characterized by transient wall-motion abnormalities involving the left ventricular apex. Emotional or physical stress might play a key role in this reversible form of cardiomyopathy, but the etiology remains unclear. Clinical features of stress-induced cardiomyopathyare similar to those of acute coronary syndrome, but there is no significant stenosis in the coronary arteries. Recently, transient mid-ventricular ballooning syndrome, a variant form of stress-induced cardiomyopathy in which only the mid-ventricle is affected, has been reported. Here, we report a case of a 42-year-old female patient who developed transient mid-ventricular ballooning syndrome after cardiac arrest during autologous fat transplantation.

증례 : 순환기 ; 프로포폴 수면 마취 이후 발생한 스트레스 유발성 심근병증 1예

민승연 ( Seung Yeon Min ),이형탁 ( Hyung Tak Lee ),장기설 ( Ki Sul Chang ),이정훈 ( Junghoon Lee ),김경수 ( Kyung Soo Kim ),신진호 ( Jinho Shin ),임영효 ( Young Hyo Lim ) 대한내과학회 2015 대한내과학회지 Vol.89 No.2

Propofol is an intravenous hypnotic agent that is generally used for sedation in the intensive care unit and for induction of anesthesia during minimally invasive surgery, endoscopy, and plastic surgery in local clinics. Low blood pressure and transient apnea might occur under propofol sedation, whereas stress-induced cardiomyopathy is a very rare complication. We herein describe a case involving a 25-year-old woman without cardiovascular risk factors who developed stress-induced cardiomyopathy after propofol injection for anesthesia and was treated with conservative treatment. This case reminds us that clinicians should consider the possible occurrence of stress-induced cardiomyopathy after anesthesia using propofol, even in patients without cardiovascular risk factors. (Korean J Med 2015,89:206-209)

고린도후서 구성의 통일성

임영효 고신대학교 고신신학연구회 2000 고신신학 Vol.- No.2

Second Corinthians is an occasional letter, that is, it is a real letter which was addressed to specific people and occasioned by concrete issues. Above all, it is a very human document, opening a window into the inner life of the apostle. It can be called the most human book in the New Testament. L. Berkhof says, “2 Corinthians is one of the most personal and the least doctrinal of all the letters of Paul, except the one written to Philemon." So some scholars regard this epistle as the most difficult of all the epistles of the New Testament or Paul' s. Specially, among the major epistles of the New Testament this suffered a totally unmerited measure of neglect. G. R. Beasley-Murray notes several reasons for this neglect: 1) The historical allusions in the letter are obscure. 2) Paul's compressed theological ideas place a heavy exegetical demand upon interpreters. 3) The Greek is complex. Nevertheless, this letter is one of Paul’ s richest in terms of theological profundity and autobiographical revelation. In this most letter-like of all the letters of Paul, we can find the heights of the transcendental victory of grace in and through the everyday experience of the Christian believer in whatever circumstances. Moreover, this epistle describes more fully Paul' s conception of his ministry than any other epistle. According to the traditional common view about this Epistle, it has come down to us as a single epistle. Notwithstanding, since the Enlightenment, some modern critics have been maintained that the original 2 Corinthians was not as long as it now stands. Johann Salomo Semler first supposed in 1776 that 2 Corinthians was originally several letters, that is, chapters 1-9 were one or more letters; chapters 10-13 were another. Other writers have thought that this Epistle was originally four or six letters sent not in the same order as we now have in our Bibles. However, it should be recognized that in no ancient manuscript of this Epistle is there any trace of a division at any point in the letter, or any variation in the arrangement of the material; and in no early Christian writer is there any suggestion that the document is composed of parts of different letters, or that it was not all written at one time to meet one particular situation. Without upright understanding on this problem of unity, we cannot have a very high regard for the accuracy of what we have. Also it will become difficult to have a high view of inspiration and authority of the Bible. Accordingly, it is necessary to observe carefully the grounds on which the theories for dividing this epistle are based, and to consider whether or not it is possible to explain the letter as a unity. We can find that there are various hypotheses of the composition of 2 Corinthians. The major reason for their being occurred seems that 2 Corinthians has the historical allusions which appears obscure and the most autobiographical character of all the epistles of Paul. From the historical background of the composition, we can understand the cause of diversity in tone and content of this epistle, for this epistle was written not at all through the peaceful environment but among the suffering and comfort, anxiety and joy, contention and conviction, and eagerness and boldness which the apostle experienced during his ministry. In addition, the whole epistle reflects the various stations in Paul’s journey and his very emotion at each place are revealed. However, in spite of diversity in its tone and content, we can find there is a structural unity which gives coherence to the whole because Paul wrote this epistle with a clear purpose, that is, to prepare the Corinthians for his third visit. Also, we can see that it harmonizes with the pervading theme of this epistle, namely, the theme of strength through weakness. The whole argument for the genuineness of Paul’s apostolic authority is bound up in this theme. Thus, this two main skeletons of the epistle are well articulate from beginning to end. Specially, for the good example of the unity of 2 Corinthians, we can find that the same thoughts of the last five exhortations(13:11) hide in the whole epistle, that is, joy(1:24; 2:3; 6:10; 7:4,7,9,13; 8:2; 12:10,15; 13:9), perfect(1:14; 13:9), comfort(1:3-6; 2:7; 7:4,6,7,13), be of one mind(6:13; 7:2), live in peace(1:2; 8:13). There are many other evidences for the unity of the composition as well. However, like other scholars who are in favor of the hypotheses of discontinuity, if we look into this epistle as the product of human endeavor without accepting the work and inspiration of the epistle’s primary author, namely, the Holy Spirit, as a result of it we can only find continually the problematic parts. Therefore, it can be said that the partition theories against the unity of this epistle are the products of seeing and understanding the epistle only by the human reasonable eye. Thus, it seems that the proof offered against the unity is entirely too subjective in nature and week in general. If several letters could have been jumbled into one epistle, how can we have a high view of for the accuracy of what we have? In fact, the more we try to solve the problematic parts of the word of God with a human biased view and reasonable thinking, the more we become to confront the bigger problems in the Bible. But, if only we can see the word of God by the regenerated heart and the eye of faith with the illumination of the Holy Spirit, the primary author of the Bible,we will understand it upright and see clearly the beautiful unity of every Scripture as well(Isa. 34:16). Also, we can find the solution of the problematic parts which appear in it. Therefore, it is necessary to study the word of God within the category which does not destroy the unity so long as there is no problem in external evidence. Now to conclude concerning the unity 2 Corinthians, it must be said that in spite of the various leaps in Paul’s thought from

문화적 상황에서의 하나님 말씀의 해석과 적용

임영효 고신대학교 기독교사상연구소 2000 기독교 사상연구 Vol.- No.6