BiodivYsio Phosphorylcholine - coated Coronary Stent 를 이용한 작은 관상동맥 확장시술

장양수(Yang Soo Jang) 대한내과학회 2002 대한내과학회지 Vol.63 No.3

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관동맥 협착 예방에 있어 혈소판 글라이코프로테인 2b / 3a 차단제 코팅 스텐트의 의의

장양수(Yang Soo Jang) 대한내과학회 2001 대한내과학회지 Vol.60 No.4

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형제 및 자매의 유전자형 자료에 기초한 전달불균형 검정법에 관한 연구

김진흠,장양수,Kim, Jin-Heum,Jang, Yang-Soo 한국통계학회 2008 응용통계연구 Vol.21 No.1

Family-based tests such as the transmission and disequilibrium tests(TDT) have proved to be powerful tools in the search for disease genes. Unlike case-control studies, the tests are not affected by population admixture, which can lead to spurious association of multiple highly linked makers with disease-susceptible genes. Those tests have largely required knowledge of parental marker genotypes. However, parental data are often not available for late-onset diseases. In this article we propose sib-TDTs that overcome this problem by use of marker data from unaffected sib(s) instead of parents. To do this end, we fist defined a Mantel-Haenszel-type statistic for each haplotype and then proposed two tests based on this statistic. Simulation studies suggest that the proposed tests are robust to population admixture and are monotone increasing as a relative risk increases irrespective of mode of inheritance. We also illustrated the proposed tests with data adopted from Yonsei Cardiovascular Genome Center. 전달불균형 검정법(transmission and disequilibrium test)과 같은 가계중심(family-based) 검정법들은 질병 관련 유전자를 찾는 데 매우 유용한 방법으로 알려져 있다. 사례-대조군 연구와 달리 가계중심 검정법들은 집단혼합(population admixture)으로 인한 영향을 받지 않기 때문에 질병 관련 유전자와 표지자(marker) 사이의 집단 혼합으로 인한 가짜 연관성(spurious association)에 노출될 위험이 없다. 가계중심 검정법들은 대체로 표지자에 대한 부모의 유전자형(genotype) 정보를 필요로 한다. 그러나 고령층에서 발병하는 질병의 경우에는 발단자(proband) 부모의 유전자형을 구할 수 없는 상황에 종종 마주치게 된다. 본 논문에서는 이런 어려움을 극복하기 위해 부모의 유전자형 대신 질병에 노출되지 않은 발단자 형제나 자매의 유전자형을 이용한 검정법을 제안하고자 한다. 이를 위해 먼저 가능한 모든 일배체형(haplotype)에 대해 Mantel-Haenszel 형태의 통계량을 정의하고 그것에 기초한두 가지 검정통계량을 제안하였다. 모의실험 결과, 제안한 검정법은 집단 혼합으로부터 로버스트하고 유전 양식(mode of inheritance)에 관계 없이 상대위험(relative risk)이 증가함에 따라 단조적으로 증가하는 검정력을 갖는 것으로 나타났다. 제안한 검정법을 연세대학교 심혈관계질환 유전체연구센터로부터 수집한 자료에 적용하고 그 결과를 고찰하였다.

흰쥐에서 Curcuminoid 및 이를 함유한 천연식물 혼합물이 심혈관계에 미치는 영향

안수현(Ahn Soo Hyun),이종호(Lee Jong Ho),박하림(Park Ha Rim),권승택(Kwon Seoung Taek),고유석(Koh You Seok),손영덕(Sohn Young Doug),장양수(Jang Yang Soo),정광회(Chung Kwang Hoe) 韓國營養學會 2003 Journal of Nutrition and Health Vol.36 No.2

증례 : 순환기 ; 약물 용출성 스텐트에서 발견된 신생내막 석회화 1예

양영준 ( Young June Yang ),심재민 ( Jae Min Shim ),김중선 ( Jung Sun Kim ),고영국 ( Young Guk Ko ),최동훈 ( Dong Hoon Choi ),장양수 ( Yang Soo Jang ),홍명기 ( Myeong Ki Hong ) 대한내과학회 2011 대한내과학회지 Vol.81 No.1

본 증례는 ST 분절 상승의 심근경색으로 약물 용출성 스텐트를 삽입한 환자에서 4년 후 발견된 스텐트 내강 안쪽을 둘러싼 원형의 두꺼운 석회침착소견에 대하여 신생내막과 관련된 새로운 죽상동맥경화증으로 추정하여 보고하는 바이다. Neointimal hyperplasia is the main mechanism of stent restenosis. Therefore, drug-eluting stents have replaced bare metal stents because there is less neointima and scar formation. Recently, some cases of stent restenosis after using a bare metal stent were found to involve calcification, not neointimal hyperplasia, and regarded as de novo atherosclerosis. We report unusual circular calcification inside a drug-eluting stent, which we called neointimal calcification. (Korean J Med 2011;81:98-101)

단독 좌전하행관동맥 질환의 치료에서 약물치료 , 풍선확장술 , 스텐트삽입술간의 비교관찰

조승연(Seung Yun Cho),장양수(Yang Soo Jang),이동일(Dong Il Lee),편욱범(Wook Bum Pyun),최동훈(Dong Hoon Choi),심원흠(Won Heum Shim) 대한내과학회 1999 대한내과학회지 Vol.57 No.5

N/A With recent advances in transarterial interventional technique, there is a tendency to treat single LAD lesion with balloon angioplasty or stent insertion rather than with medical therapy alone. Therefore, it is important to evaluate the long-term clinical outcomes of such interventional therapy. Methods : Subjects are comprised of patients who underwent coronary angiogram from 1993 to 1996 and diagnosed as having single LAD lesion without decrease of left ventricular fuction. The incidence of major ischemic complications, revascularization and reduction of angina pectoris after different therapeutic strategies in these patients are evaluated. Result : 1) There was total of 190 patients. Patients receiving medical therapy, balloon angioplasty and stent insertion were 70, 75, and 45 respectively. There was no significant difference in mean age, sex ratio, and risk factors of coronary artery occlusive disease between each groups. 2) The medical therapy group(30%) had a significantly lower incidence of proximal stenosis lesion compared to the balloon angioplasty group (45%) and stent insertion group(52%) according to the location of the lesion(p<0.05). The lesion characteristics according to the AHA/ACC criteria showed that the proportion of type A lesion was significantly higher in the balloon angioplasty group(33.3%) compared to the medical therapy group(8.6%) and stent insertion group(13.3%), whereas the proportion of type C lesion was significantly higher in the medical therapy group(41.4%) compared to the balloon angioplasty group(14.3%) and stent insertion group(22.2%). 3) The incidence of ischemic complication were low with 9 out of total 190 patients during follow up consisting of 2 cases of cardiogenic death(1.1%) and 7 cases of acute myocardial infarction(3.7%). 4) During the follow-up period revascularization was performed in 10% of medical therapy group, 27% of balloon angioplasty group and 22% of stent insertion group. There was higher rate of revascularization in patients who received interventional therapy. 5) During the mean follow-up period of 38 months, event-free survival rate was 85% in the patient group receiving medical therapy, 71% in the patient group undergoing balloon angioplasty and 74% in the patient group undergoing stent insertion. There was lower incidence of major events in medical therapy patients, but the difference of the rate among each group was not significant. In considering the patients with proximal LAD stenotic lesion, event-free survival rate was 73% in medical therapy group, 75% in balloon angioplasty group and 81% in stent insertion group, but the difference between each groups did not show any significant difference. 6) Follow-up of each study groups at 6 months, 1 year and 3 years showed that the proportion of chest pain-free patients in balloon angioplasty and stent insertion group were higher than those in medical therapy group despite the lack of statistical significance(p>0.05). Conclusion : For patients with single LAD stenotic lesion interventional therapies such as balloon angioplasty and stent insertion might be more effective without statistical signigicance in reducing chest pain compared to medical therapy. There was no significant difference in the incidence of ischemic complication and rate of revascularization among different study groups. Further studies will be needed to clarify the beneficial effects of interventional coronary artery therapy such as improvement of chest pain, increased exercise capacity, and improved quality of life along with other parameters. (Korean. J. Med 57:896-905, 1999)

말기 신부전 환자에서 시행한 관상동맥 조영술 소견과 치료에 대한 고찰

김재헌(Jae Heon Kim),윤수영(Soo Young Yoon),노현정(Hyun Jeong Roh),박형천(Hyung Cheon Park),강남규(Nam Gyu Kang),최동훈(Dong Hoon Choi),강신욱(Shin Wook Kang),장양수(Yang Soo Jang),신원흠(Won Heum Shim),조승연(Seung Yun Cho),이호영(H 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.4

Background - Disease of the heart remains the leading cause of death in patients treated for endstage renal disease(ESRD). In contrast to person with normal renal function, coronary risk factors or indicators could not yet clearly be defined in renal insufficiency. The aim of this study is to elucidate whether conventional risk factors are valid predictors of coronary artery disease(CAD) in ESRD patients and to examine the therapeutic outcome of percutaneous transluminal coronary angioplasty(PTCA) and coronary artery bypass graft(CABG) in chronic dialysis patients. Methods: Between 1997 and 1999, 44 ESRD patients were perfomed by echocardiography and coronary angiography. Results: 31 patients showed positive results in coronary angiography. In patients with CAD, there were statistically significantly older(45.4 vs 60.6 yrs), had higher LP(a> level(18.0 vs 37.5 mg/dL), lower HDL cholesterol level(42.5 vs 33.6 mg/dL), higher BMI (20.7 vs 22.6), and lesser degree of ejection fraction on echocardiography(58.6Yo vs 42.8Yo). And there were more patients who had DM(30.8 vs 64.5Fo) and previous myocardial infarction(MI) histories(7.796 vs 38.7 96) in CAD group. Logistic regression analysis suggested that old age, high Lp(a), and previous MI history could be risk factors for coronary artery disease in ESRD patients. Among the 31 patients had CAD, 10 in HD and 3 in CAPD group experienced PTCA, and another 2 in HD and 4 in CAPD group experienced CABG. Treatment modality and mortality were not different between the two groups. Follow up angiography were performed in 4 HD patients, and 2 of them had restenosis of previously involved vessels. Conclusion: Old age, previous MI history and high Lp(a) are independent risk factors for the presence of CAD in ESRD patients.

발작성 상심실성 빈맥 환자에 대한 항부정맥 약물작용 기전과 약물반응 예측에 관한 연구

김병옥(Byung Ok Kim),김성순(Sung Soo Kim),황성오(Sung Oh Whang),장양수(Yang Soo Jang),심원흠(Won Heum Shim),조승연(Seung Yun Cho),김현승(Hyun Seung Kim),박승정(Seung Jung Park) 대한내과학회 1990 대한내과학회지 Vol.39 No.6

N/A In this study, the effects of antiarrhythmic drugs on the reentrant pathway in paroxysmal supraventricular tachycardia (PSVT) were evaluated by observing the changes of conduction block cycle length. And this study was aimed to determine whether the drug responses could be predicted by characterizing the reentry path- way. Seventy-three patients with clinically documented PSVT without preexcitation were carried on electro-physiologic studies between November, 1986 and April 1990 in Severance Hospital, Yonsei University were reviewed. The study group included 35 males and 38 females with ages ranging from 16 to 67 years (mean±SD:40±15). The mean duration of symptom was 10.9±9.5 years. They had experienced paroxysmal tachycardia once per week to once in 6 months (mean frequency: 5 per year). All patients had structurally normal heart except the 2 Ebstein`s anomaly. The induction of tachycardia and the determination of mechanism of PSVT were performed by baseline electrophysiologic study in drug free status, The effects of drugs were assessed by the intravenous administration of procainamide 20 mg/kg, flecainide 2 mg/kg, verapamil 0.15 mg/kg, digoxin 0.75 mg, and digoxin 0,75 mg plus propranolol 0.15 mg/kg. The response to drug was defined as the not-induced SVT or the induction of nonsustained SVT after drug administration. 1) Fourty-nine patients had atrioventricular (AV) reentrant tachycardia using concealed bypass tract(CBT) and twenty-four patients had atrioventricular nodal reentrant tachycardia. In AV reetry using CBT, procainamide prevented induction of sustained tachycardia in 38 of 45 patients (84%), flecainide in 23 of 30 patients(77%), verapamil in 34 of 39 patients(87%), digoxin in 4 of 17 patients (23%), and digoxin plus propranolol in 7 of 14 patients(50%), In AV nodal reentry, procainamide prevented induction of sustained tachycardia in 19 of 22 patients (86%), flecainide in 9 of 10(90%), verapamil in 20 of 22 patients(91%), digoxin in 10 of 17 patients(59%), and digoxin plus propranolol in 9 of 13 patients(69%). 2) In AV reentry using CBT, procainamide and flecainide induced significant prolongation of the ventriculoatrial block cycle length (VABCL) in responder group. Also the atriventricular block cycle length (AVBCL) was prolonged significantly, but not increased above the tachycardia cycle length. Verapamil, digoxin and digoxin plus propranolol showed significant prolongation of AVBCL, but not of VABCL. 3) In AV nodal reentry, procainamide and flecainide induced significant prolongation of VABCL in responder group, and AVBCL was also prolonged but not increased above the tachycardia cycle length. Verapamil, digoxin and digoxin plus propranolol induced significant prolongation of both AVBCL and VABCL in responder group. 4) In patients with AV reentry, there was no significant difference of baseline VA block cycle length between responders and non-responders for procainamide and flecainide. But the patients having the 260 millisecond or more of block cycle length were all responded to procainamide except 1 case and all to flecainide. 5) The procainamide and flecainide had a strong concordant relationship in drug response for AV reentry(p<0. 001). With the avove results, it is noted that the procainamide and flecainide prevent induction of reentrant supraventricular tachycardia by selectively depressing the conduction over retrograde pathway of reentry circuits in responders with AV reentry using CBT and AV nodal reentry. Also it is noted that the verapamil, digoxin and digoxin plus propranolol prevented induction of SVT by depressing the conduction over antegrade pathway in responders with AV reentry using CBT, and over antegrade (AV nodal slow) and retrograde (AV nodal fast) pathways in responders with A V nodal reentry. And it can be suggested that the baseline block cycle length of accessory pathway has a limited value in predicting the drug responses in AV reentry using CBT. Also it is noted that in AV r

고지방혈중에서 Bezafibrate ( Bezalip(R)) 의 효과에 대한 연구

이웅구(Woong Ku Lee),김병옥(Byung Ok Kim),조현명(Hyeon Myeong Cho),장양수(Yang Soo Jang),정남식(Nam Sik Chung),심원흠(Won Heum Shim),조승연(Seung Yun Cho),김성순(Sung Soon Kim),양주영(Joo Young Yang) 대한내과학회 1991 대한내과학회지 Vol.40 No.6

N/A Among the risk factors associated with coronary artery disease, hyperlipidemia is one of the most important. Bezafibrate has been shown to effctively reduce elevated levels of low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) in hyperlipidemia. It has also been claimd to be particularly effective in increasing high-density lipoprotein (HDL) concentrations. In the present study, 22 hyperlipidemic patients were investigated before and after 8 weeks treatment with bezafibrate (300 mg to 400 mg daily) in an effort to clarify futher the effects and side effects of the drug. In the group of 9 patients with hypertriglyceridemia (TG level>230mg%), the serum triglycerides decreased by 63%(p<0.01) and the HDL cholesterol increased by 45%, (p<0.01) corresponding to a significant reduction of total cholesterol/HDL cholesterol ratio. In the group of 9 patients with hypercholesterolemia (cholesterol level > 240 mg%), the total cholesterol decreased by 20% (p<0.01), the LDL cholesterol decreased by 25% (p<0.01) and HDL cholestrol increased by 44% (p<0.01) corresponding to a significant reduction of LDL/HDL ratio. In the group of 4 patients with combined hyperlipidemia (TG level > 230 mg% and cholesterol level > 240 mg%), the total cholesterol decreased by 23% (p<0.01), the serum triglyceride decreased by 62% (p<0.01) and the HDL-cholesterol increased by 19% (p<0.05) corresponding to a significant reduction of total cholesterol/HDL cholesterol ratio. In the total of 22 patients, the total cholesterol decreased by 15% (p<0.05), the serum triglyceride decreased by 59% (p<0.01) and the HDL cholesterol increased by 39% (p <0. 01) corresponding to a significant reduction of total cholesterol/HDL cholesterol ratio. No subjective side effects were noted from the drug, except in one patient with mild gastrointestinal symptoms. In conclusion, it was noted that the bezafibrate was an effective and safe drug useful in the treatment of hyperlipidemia in Korean adult patients.

폐질환에서 201 Thallium 의 섭취양상

김현승(Hyun Seung Kim),권혁문(Hyuck Moon Kwon),장양수(Yang Soo Jang),임상욱(Sang Uk Lim),남문석(Moon Suk Nam) 대한내과학회 1991 대한내과학회지 Vol.41 No.3

N/A 201 Thallium chloride has been described by Cox, Salvatore, Tonami as a positive indicator for lung neoplasm 201 Thallium scintiscan was performed in 10 patients with lung cancer and in 21 patients with benign lung diseases. Early scan demonstrated abnormal accumulation in 9 of 10 lung cancer and in 8 of,.,1 benign conditions(P=0.0066) and revealed strong positive uptake in all of 4 adenocarcinoma. Eight of twenty one benign conditions (4 in 8 active or cavitary pulmonary tuberculosis, 1 in 5 inactive pulmonary tuberculosis and 3 in 8 pneumonia or lung abscess) showed abnormal accumulation of 201Tl. And the fading apperance of radioactivity on some delayed scans was noted in benign conditions compared with persistent high radioactivity in lung cancer. 201Thallium scintiscan is useful in the differentiation of a pulmonary lesion whether is benign or malignant.