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혈액 투석 환자에서 투석중 정맥압과 요소재순환율 측정에 의한 동정맥루 협착의 조기진단
김영옥(Young Ok Kim),전희경(Hui Kyung Jeon),박용근(Yong Kun Park),윤선애(Sun Ae Yoon),송하헌(Ha Hun Song),김남일(Nam Il Kim),김용수(Yong Soo Kim),김석영(Suk Young Kim),최의진(Euy Jin Choi),장윤식(Yoon Sik Chang),방병기(Byung Kee Bang 대한내과학회 1998 대한내과학회지 Vol.54 No.6
N/A Objectives: The most cammon cause of vascular access loss is thrombosis, usually caused by venous stasis associated with venous stenotic lesions. Therefore early detection of venous stenosis is very important. We studied the correlation of venous dialysis pressure and urea recirculation ratio to venous stenosis in chronic hemodialysis patients. Methods: Venous dialysis pressure and urea recirculation ratio were measured at extracoporeal blood flow of 200 ml/min thruugh 16 gauge needles within initial 30 minutes in 80 chronic hemodialysis patients. Venography was performed in patients with elevated venous dialysis pressure (>100 mmHg) or urea recirculation ratio (>15%), and if significant stenosis was found, venous dialysis pressure and urea recirculation ratio were reevaluated after percutaneous transluminal angioplasty (PTA). Results: Of the total 80 patients, 30 patients had elevated venous dialysis pressure or urea recirculation ratio. In patients with elevated urea recirculation ratio, venous dialysis pressure was high (102±21 mmHg vs 71±20 mmHg, P<0.001) and the past history of subclavian catheterization ipsilateral to fistula site was also high (39.1% vs 15.8%, P=0.02). There were no differences between two groups in terms of age, sex, diabetes mellitus, duration of hemodialysis, fistula site, and interneedle length. Of the total 27 patients undergone venography, 14 patients (51.9%) had venous stenosis. PTA was performed in 11 significant stenotic lesions in 5 patients and initial success rate of 91% was obtained, After PTA, urea recirculation ratios significantly decreased (16.7±5.9% vs 5.0±3.6%, P=0.01) and venous dialysis pressures slightly decreased without statistical significance (117.4±23.0 vs 99.0±8.9 mmHg, P=0.058). Conclusion: Venous dialysis and urea recirculation ratio seem to be active indicator of venous stenosis and outcome of subsequent percutaneous transluminal angioplasty in hamodialysis patients.
증례 : 인공 심장박동 조율기를 삽입한 환자에서 대동맥 판막부위에 발생한 감염성 심내막염 1예
백정선 ( Jung Sun Pack ),전희경 ( Hui Kyung Jeon ),곽재욱 ( Jae Wook Kawk ),장은철 ( Eun Chul Jang ),윤나리 ( Na Ri Youn ),신정아 ( Jung Ah Shin ),장기육 ( Ki Yuk Chang ) 대한내과학회 2007 대한내과학회지 Vol.73 No.3
본 환자는 심장에 구조적 이상이나 판막 질환 없이 동기능부전 증후군으로 10년 전 인공 심장박동 조율기를 삽입하고 내원 6개월 전 전지의 수명이 다하여 인공심장박동 조율기를 교체하였다. 인공 심장박동 조율기 교체 후 국소감염이 발생하였고, 이후 우심장과 삼첨판에 심내막염이 발생하지 않고 혈행성 전파를 통해 대동맥 판막에 심내막염이 발생하였다. 환자는 국소적 염증소견으로 발병하였으나 초기에 적절히 인공 심장박동 조율기 전체를 제거하지 못해 대동맥 판막의 우종 및 전신적 심내막염으로 악화하여 수술을 시행했음에도 불구하고 사망하였다. 따라서 인공 심장박동 조율기 삽입 후 발생한 국소적 염증도 항생제 치료와 함께 조기에 인공심장박동 조율기 및 유도선 모두를 완전히 제거해야한다는 사실을 다시 한번 확인 시켜준 증례로 문헌고찰과 함께 보고하는 바이다. Infective endocarditis related to pacemaker implantation is a rare complication. However, it is a potentially lethal complication with a mortality rate of 30 to 35%. Infective endocarditis associated with pacemaker implantation usually involves the right heart and tricuspid valve. Conservative treatment without complete removal of the entire pacing system is prone to fail (i.e. result in infection relapse or development of sepsis). Therefore, the total extraction of the entire pacemaker system should be considered as standard therapy for most patients with pacemaker-related endocarditis and for many patients with local infectious symptoms at the site of pacemaker implantation to achieve complete recovery. We report a case of a 42-year-old man with documented pacemaker related left-sided endocarditis that was associated with multiple embolic events. Also, we review the literature regarding pacemaker-related endocarditis and local wound infection, in particular with respect to the modalities of treatment.(Korean J Med 73:324-329, 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)
혈액투석 환자에서 동정맥루의 과도한 혈류에 의한 고박출성 심부전
방병기(Byung Kee Bang),김영옥(Young Ok Kim),윤선애(Sun Ae Yoon),천경아(Kyung Ah Chun),김남일(Nam Il Kim),김현재(Hyeon Jae Kim),전희경(Hui Kyung Jeon) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.1
Although excessive arteriovenous fistula blood flow may be a factor in the development of high-output cardiac failure, this diagnosis is easily over-looked. Surgical reduction of fistula blood flow can improve the condition. We here report a case of high-output cardiac failure due to excessive arterio-venous fistula blood flow in a hemodialysis patient. A 51-year-old man who had been treated with hemodialysis since 5 years ago was admitted for increasing cardiac failure. Echocardiographic evaluation of cardiac output and duplex measurement of the fistula confirmed the diagnosis of high-output cardiac failure due to excessive arteriovenous fistula blood flow. After surgical closure of the fistula, the signs and symptoms of cardiac failure subsequently subsided and both systolic and diastolic dimension of left ventricle much decreased.
증례 : 순환기 ; 제1형 신경섬유종증 환자에서 나타난 폐고혈압 1예
나수진 ( Soo Jin Na ),이혜연 ( Hye Yeon Lee ),김현선 ( Hyun Seon Kim ),성현진 ( Hyeon Jin Seong ),전부석 ( Bu Seok Jeon ),전희경 ( Hui Kyung Jeon ) 대한내과학회 2013 대한내과학회지 Vol.85 No.5
신경섬유종증과 관련된 폐고혈압은 심각한 기능적, 혈역 학적 장애를 초래할 수 있다. 따라서 신경섬유종증 환자에서 호흡곤란, 기절, 피로 등 폐고혈압의 증상이나 징후가 나타 난다면 임상의들은 가능한 조기에 심초음파 등의 검사를 하여 폐고혈압을 발견하고 치료를 시작할 수 있도록 해야 한다. 또한 신경섬유종증과 관련된 폐고혈압의 병태생리적 이해를 위해 체계적이고 규모 있는 연구가 필요하며 이를 바탕으로 생존율 향상에 도움이 되는 추가적인 치료법에 대한 논의가 이루어져야 할 것이다. Neurofibromatosis type I is a genetic disease caused by mutations in the neurofibromin 1 (NF1) gene. Although it is characterized by a number of distinct clinical features, including cafe au lait macules, freckling in the axillary or inguinal regions, neurofibromas, and Lisch nodules (iris harmartomas), it can affect all physiological systems in the body [1]. Neurofibromatosis-related pulmonary hypertension has also been reported, and some patients showed a poor prognosis despite having received proper medical treatment [2-4]. We herein describe a case of pulmonary hypertension in a patient with neurofibromatosis type I who had no identified risk factors of pulmonary hypertension. To our knowledge, this is the first such report in Korea. (Korean J Med 2013;85:521-525)
증례 : 순환기 ; 우관상동맥에서 기원하는 영양혈관을 갖는 거대 좌심방 점액종 1예
김혜강 ( Hye Kang Kim ),이동현 ( Dong Hyeon Lee ),권태근 ( Tae Geun Gweon ),송미애 ( Mi Ae Song ),백명기 ( Myong Ki Baeg ),김정호 ( Jeong Ho Kim ),전희경 ( Hui Kyung Jeon ) 대한내과학회 2010 대한내과학회지 Vol.78 No.1
심방 점액종은 심방 중격에서 발생하여 좌심방 혹은 우심 방으로 천천히 점진적으로 커지며, 대부분은 좌회선 관상동맥에서 혈관 공급이 이루어지나 우관상동맥에서의 혈관공급은 드문 일차성 양성 종양이다. 본 증례에서 저자들은 경·중등도의 호흡곤란을 주소로 내원한 여자 환자에서 관상동맥조영술을 통해 진단된 우관상동맥에서 기시한 거대 심장 종양의 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. A 55-year-old woman was referred to our hospital with a 6-month history of dyspnea (NYHA II-III). The physical examination revealed a grade 2/6 "tumor plop," i.e., a low-pitched sound heard during early or mid-diastole. The chest X-ray showed mild cardiomegaly with lung congestion in both lower lung fields. Two-dimensional echocardiogram showed a large myocardial mass, prolapsing into the left ventricle during diastole. Chest computed tomography showed a multi-lobulated mass (6.8×4.1 cm) attached to the interatrial septum during systole and prolapsing into the left ventricle during diastole. Coronary angiography demonstrated large tumor vessels arising from and surrounding the posterior lateral branch of the right coronary artery. The mass was excised and the patient recovered uneventfully. (Korean J Med 78:104-108, 2010)