관동맥질환의 내과적 치료

김권배 啓明大學校 醫科大學 1992 계명의대학술지 Vol.11 No.2

관동맥질환이란 심근에 산소와 영양을 공급하는 관동맥순환에 이상이 생겨 심근이 필요로 하는 혈류량과 관동맥에 의해 공급되는 혈류량 사이에 불균형이 생겨 심근허혈을 초래하는 질환이다. 심근허혈을 일으키는 원인은 Table 1과 같이 다양하며 이중에서 죽상동맥경화증(atherosclerosis)이 가장 흔한 원인이다. 관동맥 질환의 임상상은 다양하며 안정형 협심증, 불안정형 협심증, 심근경색증, 부정맥 및 심부전, 급사 등이 있다. 이들 중에서 협심증에 대한 내과적 치료에 대해 기술하고자 한다.

Indomethacin 또는 Tetracaine 存在下에서 Oxytocin 이 摘出子宮收縮에 미치는 影響

金權培,李晩基,金重暎 慶北大學校 醫科大學 1987 慶北醫大誌 Vol.28 No.3

자궁수축제의 노출시간에 따른 자궁수축의 변화를 검토하기 위하여 흰쥐의 적출자궁을 muscle chamber내에 현수시키고 indomethacin(IND) 또는 tetracaine(TCA) 존재하에서 oxytocin(OXT) 또는 prostaglandin F_2α(PGF)에 10분간 노출될 때 야기되는 수축의 변화를 physiograph상에 기록하면서 APPLEⅡ+에 데이터를 저장하였다가 수축기(Tc), 이완기(Tr), 최고수축(Fc) 및 최저수축(Fr)으로 구분하여 분석하고 이를 전기(노출개시후 50∼초∼150초)와 후기(노출개시후 350초∼450초)로 나누어 비교하였던바 다음과 같은 결과를 얻었다. OXT에 같하여 유기된 자궁수축의 Tc, Tr 및 Fc는 전기에 비하여 후기에 증가되었고 Fr은 감소되었으며 이와같은 현상은 IND 및 TCA 존재로서 영향을 받지 않았다. 그러나 OXT에 의하여 야기된 수축의 Tc 및 Tr는 IND존재로서 전기 및 후기에서 감소되었으며 Fr은 IND존재로서 전기와 후기에서 증가하였고 Fc는 영향을 받지 않았다. TCA존재로서 OXT에 의한 Tr은 전기 및 후기에서 증가되었으나 Tc는 후기에서만 증가되었고, Fr은 전기에서 증가되었으나 후기에서 감소되었고, Fc는 영향을 받지 않았다. PGF에 의하여 야기된 자궁수축의 Fc는 전기에 비하여 후기에 증가하였으나 Tc 및 Fr은 감소되었고 Tr은 영향을 받지 않았다. 이와같은 현상은 IND 및 TCA 존재하에서 변화하였는데 IND존재로서 Tc 및 Tr은 전기에 비하여 후기에 증가 되었고 Fr은 감소되었으며 Fc는 영향을 받지 않았고 TCA 존재로서 Tr은 전기에 비하여 후기에 증가되었고 Tc 및 Fr은 감소되었으며 Fc는 영향을 받지 않았다. PGF에 의하여 야기된 수축의 Tc 및 Tr는 IND존재로서 전기에는 감소되었으나 후기에서는 Tc만 증가되었으며 TCA존재로서 Tc는 전기에서 감소하였고 후기에서는 증가되어지고 Fr은 IND 및 TCA존재로서 전기 및 후기에서 모두 증가하였고 Fc는 전기에서만 증가하였고 후기에서는 영향을 받지 않았다. 이상의 결과로 미루어 IND 및 TCA 존재하에서 OXT 및 PGF에 의하여 야기되는 자궁수축은 전기 및 후기에 차이가 있는 것 같다. The contractile responses, that were elicited by 10-minute infusion of solution containing oxytocin(OXT) or prostaglandin F_2α(PGE) in the presence of indomethacin(IND) and tetracaine (TCA), and that were recorded on the Physiograph and stored into the APPLEⅡ+computer, were divided into 2 phases, early (EP, 50 second-150 second during infusion) and later (EP, 350 second-450 second during infusion), and their components in each phase(contraction period, Tc; relaxation period, Tr; peak tension, Fc; trough tension, Fr) were analyzed to evaluate the changes during the contractile responses. Tc, Tr and Fc were increased but Fr was decreased in LP compared with EP during exposure to OXT. These effects were not affected by the presence of IND and TCA. In the OXT-induced contraction: By the presence of IND, Fr of EP and LP was increased; Tc, Tr of EP and LP decreased; Fc not changed. By the presence of TCA, Tr and Fr of EP, Tc and Tr of LP were increased; Fr of LP decreased; Fc not changed. Fc were increased but Tc and Fr was decreased in LP compared to EP during exposure to PGF. These effects were affected by the presence of IND and TCA: Tc, Tr increased; Fr decreased; Fc not changed by IND. Tr increased; Tc, Fr decreased; Fc not changed by TCA. In the PGF-induced contraction: By the presence of IND, Fc and Fr of EP, Tc and Fr of LP were increased; Tc and Tr of EP decreased; Fc of LP not changed. By the presence of TCA, Tc, Fc and Fr of EP, and Tc, Tr and Fr of LP increased; Tr of EP decreased; Fc of LP not changed. These results indicate that there are differences between early and later phase of contraction response elicited by OXT and PGF in the presence of IND and TCA.

고혈압과 심혈관질환의 치료에서 Angiotensin Receptor Antagonist의 역할

김권배 대한순환기학회 1999 Korean Circulation Journal Vol.29 No.3

심낭삼출을 동반한 점액수종에서 심막천자술을 시행한 1예

김권배,김민수,한성욱,배장호,신동우,김성종,박근용 대한내분비학회 1999 Endocrinology and metabolism Vol.14 No.1

Myxedema is the nonpitting edema caused by the accumulation of glycosaminoglycans in subcutaneous and other interstitial tissue that occurs in hypothyroid patients. It is most often present in long-standing or severe primary hypothyroidism. While pericardial effusion appears to be a frequent occurrence in patients with myxedema, the development of cardiac tamponade in hypothyroid patients is distinctly unusual because of the slow formation of the pericardial effusion and the ability of the pericardium to distend. Recently we experienced a case of myxedema with pericardial effusion. The patient was 39-year-old female who was admitted due to aggrevated dyspnea for 1 month. She was obese and myxedematous. Chest X-ray revealed marked cardiomegaly. Two-dimensional echocardiography imaged massive pericardial effusion, especially left ventricular posterior wall and right ventricular side. The thyroid function test showed an obvious hypothyroid state. The patient was intubated and given controlled ventilation because of labored breathing, hypoxemia, and hypercapnea. After one half liter of straw-colored fluid was removed by pericardiocentesis, and she was given thyroid hormone replacement therapy, progressive clinical improvement was noted over course of next few weeks. We report this case with reviews of the literatures (J Kor Soc Endocrinol 14:165 170, 1999).

대사증후군에서의 고혈압

김권배 메디메디아코리아(주) 2003 심장과 혈관 Vol.5 No.4

Long-Term Treatment with Enalapril Depresses Endothelin and Neuropeptide Y-induced Vasoactive Action in Spontaneously Hypertensive Rats

김권배,손의동,김중영,Kim, Kwon-Bae,Sohn, Uy-Dong,Kim, Choong-Young The Korean Society of Pharmacology 1992 대한약리학잡지 Vol.28 No.1

This study was designed to evaluate the responses of cardiovascular system to endothelin (ET) and neuropeptide Y (NPY) in 12 week-old SHR treated with or without enalapril (ENP) for 6 weeks. The diastolic blood pressure and heart rate were lower in ENP-treated SHR than in control. The pressor response to intravenous, but not intracerebroventricular, ET or NPY was attenuated by ENP treatment. The chronotropic action induced by electrical stimulation was attenuated by ENP or ET. The negative chronotropic action of ET was blocked by yohimbine. The increase in aortic tension induced by electrical field stimulation (EFS) was depressed in ENP-treated group as compared with non-treated group, and enhanced by ET, but not NPY, in the non-treated group. The ET-induced increase in tension was enhanced by removal of endothelium in the control group but not in ENP-treated group. The plasma concentration of norepinephrine and ET-induced increase in concentration of norepinephrine and epinephrine in plasma were decreased in ENP-treated group. These results suggest that preventive effect of enalapril on the development of hypertension may result from depressing vasoactive action of endothelin and neuropeptide Y, and sympathetic neurotransmission at peripheral nervous system. 선천성 고혈압 흰쥐(SHR)에서 endothelin-1(ET)과 neuropeptide Y(NPY) 투여에 의한 심혈관계 반응에 미치는 enallapril 장기처치의 영향을 검토하였다. 생후 6주의 SHR에 enalapril(3 mg/kg/day)을 6주간 투여하였을 때 고혈압 발현이 현저히 억제되었다(이하 enalapril 처치군). Enalapril 처치군에서 ET 및 NPY에 의한 승압반응이 현저히 억제되었지만, ET 측뇌실투여에 의한 혈압상승 및 NPY측뇌실 투여로 야기되는 혈압하강효과에는 영향이 없었다. 뇌척수제거 흰쥐에서 전기적 자극으로 야기되는 빈맥효과는 enalapril처치나 ET투여로 억제되었는데, ET의 작은 ${\alpha}_2$-수용체 길항제인 yohimbine 전처치로 봉쇄되었다. SHR의 적출 대동맥에서 전기자극 빈도수에 따르는 수축반응이 ET 전처치로 항진되었으나 NPY 전처치로는 차이가 없었다. 전기자극 빈도수에 따른 수축반응은 enalapril투여한 군의 것이 투여하지 않은 군의 것에 비하여 약화되었다. ET투여에 의한 혈중 norepinephrine의 증가작용이 enalapril처치로 감소되었으며, 이러한 감소작용이 뇌척수제거 흰쥐에서 현저하였다. 위의 결과로 미루어 고혈압흰쥐에 enalapril을 장기처치함으로써 고혈압 발현을 효과적으로 억제할 수 있으며, 이는 ET 및 NPY에 의한 승압반응 및 교감신경말단의 신경전달과정의 억제가 관여될 수도 있을 것 같다.

고지혈증의 치료

김권배 대한내과학회 1999 대한내과학회지 Vol.57 No.4

원발성 위장관 림프종의 임상적 고찰

송홍석,박승국,김권배 啓明大學校 醫科大學 1984 계명의대학술지 Vol.3 No.2

1972년 1월부터 1983년 12월사이에 본 병원에서 14예의 원발성 위장관 림프종을 경험하여 다음과 같은 결과를 얻었다. 1. 연령은 3세에서 68세까지로 평균 33.7세였으며, 남녀비는 13:1로 남자에서 월등히 많았다. 2. 초진시의 증상은 복부동통이 12예(85.7%)로 가장 많았으며. 복부종양 6예(42.9%), 발열 3예(21.4%), 체중감소 2예(14.3%), 설사 2예(14.3%) 그리고 전신쇄약감, 식욕감퇴, 변비 및 구토가 각기 1예(7.1%)였으며, 증상이 나타나서 진단되기까지의 병력기간은 3개월이하가 11예(78.6%)였고 3개월~1년사이가 3예(21.4%)였다. 3. 검사실소견을 보면 빈혈 35.7%, 백혈구증가 28.6%, 림프구감소 28.6%, 저단백혈증 14.3%, 고질소혈증 7.1% 그리고 alkaline phosphatase 증가가 7.1%였다. 4. 침범부위를 보면 맹장 8예(57.1%) 회장 6예(42.9%)로 회맹부위가 대부분을 차지하였으며, 상행결장이 4예(28.6%)였고 위, 공장, 충수돌기 및 직장이 각기 1예(7.1%)였다. 5. 조직학적분류를 보면 12예가 비호지킨림프종으로 histiocytic형 5예, mixed cellularity형 3예, well-differentiated lymphocytic형 2예, 그리고 poorly-differentiated lymphocytic형이 2예였으며, 2예는 호지킨병으로서 모두 lymphcyte depletion형이었다. 6. 병기별로는 stageⅠ이 4예(28.6%), stageⅡ 7예(50%), stageⅢ 1예(7.1%), 그리고 stageⅣ가 2예(14.3%)였다. 7. 치료는 5예에서 방사선요법 및 병합화학요법의 병용치료를 실시하였으며, 13예 가운데 6예(46.1%)에서 완전관해 그리고 4예(30.8%)에서 부분적관해를 보였다. A clinical study was carried out retrospectively on 14 patients with primary intestinal lymphoma who admitted to the Dong San Hospital, Keimyung University between Jan. 1972 and December 1983. The results of the this study was as follows. 1. Male to female ratio was 13:1 with male predominance and the age distribution was between 3 and 68 with mean age of 33.7 years. 2. Abdominal pain was the most frequent complaint(12 cases: 85.7%). Abdominal mass was observed in 6 cases (42.9%), fever in 3 cases(21.4%), weight loss in 2 cases (14.3%), diarrhea in 2 cases (14.3%) and general weakness, anorexia, constipation and nausea in 1 case (7.1%) respectively. 3. Laboratory findings revealed anemia in 35.7%, leukocytosis in 28.6%, lymphopenia in 28.6%, hypoproteinmia in 14.3%, azotemia in 7.1% and increased alkaline phosphatase in 7.1%. 4. Sites of involvement were as follows: Cecum in 8 cases(57.1%), ileum in 6 cases(42.9%), ascending colon in 4 cases(28.6%) and stomach, jejunum, appendix, rectum in 1 case(7.1%) in each respectively. 5. Histopathologic classifications were as follows: Non-Hodgkin's lymphoma was 12 cases(5 eases of histiocytic type, 3 of mixed cellularity, 2 of well-differentiated and 2 of poorly differentiated lymphocytic type) and Hodgkin's disease was 2 cases(all in lymphocytic depktion type). 6. By Ann Arbor staging. stage I in 4 cases (28.6%), stage Ⅱ in 7(50%). Stage Ⅲ 1(7.1%) and stage Ⅳ in 2(14.3%). 7. Treatment was performed as follows: Radiotherapy in 5 cases, chemotherapy in 7 cases, chemotherapy in 7 cases and combined modality therapy in 1 case. 8. Follow-up study of 13 cases revealed complete remission in 6 cases(46.1%) and partial remission in 4(30.8%).

교약성 심낭염의 임상적 고찰

서승연,한승범,오영철,곽동협,송홍석,김윤년,김권배 啓明大學校 醫科大學 1986 계명의대학술지 Vol.5 No.1

We experienced fourteen patients with constrictive pericarditis, who were admitted to the Dong San Hospital, Keimyung University and treated by pericardiectiomies during the seven year periods between Jan 1980 and May 1986. The results of our experience were as follows: They were 10 males and 4 females and male to female ratio was 2.5 : 1 and age distribution was between 11 and 66 with mean age 46.4 years. The intervals between initial symtoms for acute pericarditis and the pericarditis were about 123.3 days and intervals between initial treatmetn for acute pericarditis and operation were about 55.4 days. Pleural effusion was noted in 55.7%, enlarged cardiac shadow in 50% and pericardial calcification in 7% on the chest roentgenograms. Regular sinus rhythem was noted in 100%, low voltage in 64%, T wave change in 71% and ST segment changes in 7% on the electrocardigram. The results of pericardial biopsy were tuberculosis in 57%, nonspecific chronic inflammation in 28%, purulent infection in 7% and neoplastic cell infiltration in 14%.

승모판 대치이식수술에 사용한 조직판막의 초음파심음향도 소견

김권배 ( Kwon Bae Kim ),김교성 ( Kyo Sung Kim ),김윤년 ( Yoon Nyun Kim ),허정욱 ( Jung Wook Hur ),김두환 ( Doo Hwan Kim ),권영주 ( Yong Joo Kwon ) 대한내과학회 1984 대한내과학회지 Vol.27 No.1