A Case of a Senile Systemic Amyloidosis Patient Presenting With Angina Pectoris and Dilated Cardiomyopathy

강구현,류동열,송필상,송영빈,한주용,최승혁,권현철 대한심장학회 2011 Korean Circulation Journal Vol.41 No.4

A 77-year-old man visited our hospital complaining of aggravated exertional chest pain. He was diagnosed with syndrome X 7 years ago and underwent medical treatment in a regional hospital. Coronary angiography and echocardiography did not show any significant abnormalities. On the seventh in-hospital day, cardiogenic shock developed and echocardiography showed a dilated left ventricular (LV) cavity and severe LV systolic dysfunction. We thus inserted an intra-aortic balloon pump for hemodynamic support and were forced to maintain it because of weaning failure several times. Finally, heart transplantation was the decided necessary procedure. After successful heart transplantation, the biopsy specimen revealed a wild-type transthyretin deposition indicating senile systemic amyloidosis in the intramuscular coronary vessels and interstitium. Cardiac biopsy at the 4-year follow-up showed no recurrence of amyloid deposition

콘크리트의 염해저항성에 미치는 표면 마감재의 영향

강구현,오상균,안재철,박동천 대한건축학회지회연합회 2010 대한건축학회지회연합회 학술발표대회논문집 Vol.2010 No.1

보람증권

강구현,안정호,최정규 대한설비공학회 1995 대한설비공학회 강연회 및 기타간행물 Vol.- No.-

비외상성 두개내 출혈 환자에서 심근손상의 발생과 예후에 미치는 영향

강구현,황성호,이강현,조준휘,김성환,문중범,박해상,이서영,이성수,김헌주 대한응급의학회 2000 대한응급의학회지 Vol.11 No.4

Objective: The aim of this study was to investigate the clinical significance of myocardial injuries in patients with nontraumatic intracranial hemorrhage by identifying the occurrence of myocardial injury and defining its correlation with subsequent cardiovascular events. Subjects and methods: One hundred twenty-four patients with nontraumatic intracraninal hemorrhage presented to the emergency department within six hours from onset of symptoms were enrolled. Brain CT, serial electrocardiography, and echocardiography were done at the emergency center. Blood samples for troponin I and creatine kinase(CK)-MB were drawn immediately and eight hours after admission, Troponin I and CK-MB were measured using a chemiluminescent immunoassay, respectively. Results: Electrocardiographic and echocardiography abnormalities were found in 65 cases(52.4%) and 21 cases(17%), respectively. Serum troponin I and creative kinase-MB were increased in 35 cases (28.2%) and in 58 cases(46.8%), respectively. Abnormal findings of echocardiography and ECG, as well as elevated levels of serum troponin I and creative kinase-MB, were associated with an increased risk of cardiovascular event and survival. Logistic regression analysis revealed that an abnormal echcocardiographic finding and elevation of serum troponin I were factors associated with the occurrence an adverse cardiovascular event and that electrocardiographic abnormalities and initial mental status were factors associated with poor prognosis. Conclusion: This study reveals that actual myocardial injury develops in a significant proportion of patients with nontraumatic intracranial hemorrhage and that the development of the myocardial injury is associated with an adverse cardiovascular event that occurs during admission.

Diagnostic Patterns in the Evaluation of Patients Presenting with Syncope at the Emergency or Outpatient Department

강구현,김준수,오주헌,온영근,송형곤,조익준,김수진,배수진,신태건 연세대학교의과대학 2012 Yonsei medical journal Vol.53 No.3

Purpose: Patterns of syncope evaluation vary widely among physicians and hospitals. The aim of this study was to assess current diagnostic patterns and medical costs in the evaluation of patients presenting with syncope at the emergency department (ED) or the outpatient department (OPD) of a referral hospital. Materials and Methods: This study included 171 consecutive patients with syncope, who visited the ED or OPD between January 2009 and July 2009. Results: The ED group had fewer episodes of syncope [2 (1-2) vs. 2 (1-5), p=0.014] and fewer prodromal symptoms (81.5% vs. 93.3%, p=0.018) than the OPD group. Diagnostic tests were more frequently performed in the ED group than in the OPD group (6.2±1.7 vs. 5.3±2.0; p=0.012). In addition, tests with low diagnostic yields were more frequently used in the ED group than in the OPD group. The total cost of syncope evaluation per patient was higher in the ED group than in the OPD group [823000 (440000-1408000) won vs. 420000 (186000-766000) won, p<0.001]. Conclusion: There were some differences in the clinical characteristics of patients and diagnostic patterns in the evaluation of syncope between the ED and the OPD groups. Therefore, a selective diagnostic approach according to the presentation site is needed to improve diagnostic yields and to reduce the time and costs of evaluation of syncope. Purpose: Patterns of syncope evaluation vary widely among physicians and hospitals. The aim of this study was to assess current diagnostic patterns and medical costs in the evaluation of patients presenting with syncope at the emergency department (ED) or the outpatient department (OPD) of a referral hospital. Materials and Methods: This study included 171 consecutive patients with syncope, who visited the ED or OPD between January 2009 and July 2009. Results: The ED group had fewer episodes of syncope [2 (1-2) vs. 2 (1-5), p=0.014] and fewer prodromal symptoms (81.5% vs. 93.3%, p=0.018) than the OPD group. Diagnostic tests were more frequently performed in the ED group than in the OPD group (6.2±1.7 vs. 5.3±2.0; p=0.012). In addition, tests with low diagnostic yields were more frequently used in the ED group than in the OPD group. The total cost of syncope evaluation per patient was higher in the ED group than in the OPD group [823000 (440000-1408000) won vs. 420000 (186000-766000) won, p<0.001]. Conclusion: There were some differences in the clinical characteristics of patients and diagnostic patterns in the evaluation of syncope between the ED and the OPD groups. Therefore, a selective diagnostic approach according to the presentation site is needed to improve diagnostic yields and to reduce the time and costs of evaluation of syncope.

Metaplastic Thymoma: Report of 4 Cases

강구현,한정호,윤나라,김영은,김태성,김관민 대한병리학회 2012 Journal of Pathology and Translational Medicine Vol.46 No.1

Metaplastic thymoma (MT), accepted in the World Health Organization 2004 scheme, is a circumscribed tumor of the thymus exhibiting biphasic morphology. We herein describe the clinicopathologic features of four MTs and the differential diagnoses of this unusual tumor. There were three women and one man with mean age of 49.5 years. The patients were found to have mediastinal masses, and underwent surgical excision. One exhibited symptoms of myasthenia gravis, and the serum titer for anti-acetylcholine receptor antibody was positive. Grossly, the tumors were encapsulated, and showed vaguely multinodular, solid, tan-white to yellow cut surfaces. Histologically, they comprised epithelial islands intertwining with bundles of delicate spindle cells. The patients remained well after surgical excision at 5-55 months. Because of the distinctive histological appearance and benign clinical course, MT should be distinguished from other more aggressive mediastinal neoplasms displaying biphasic feature.

Usefulness of an Implantable Loop Recorder in Patients with Syncope of an Unknown Cause

강구현,오주현,천우정,박용환,송봉건,김준수,온영근,박승정,허준 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.3

Purpose: The mechanisms underlying syncope remain unknown in about 20% of patients with recurrent syncope. The implantable loop recorder (ILR) has been shown to be a useful diagnostic tool in patients with unexplained syncope even after negative initial evaluations. Nevertheless, ILR has rarely been used in clinical practice. Materials and Methods: This study included 18 consecutive patients who had an ILR implanted at our center because of recurrent unexplained syncope after extensive diagnostic tests between February 2006 and June 2011. Results: Diagnosis was confirmed in 10 (55.6%) of the 18 enrolled patients (13 males, 61±15 years). The confirmed diagnoses included sick sinus syndrome (n=6, 60%), advanced atrioventricular block (n=2, 20%) and ventricular tachyarrhythmia (n=2, 20%). The mean follow-up durations of the total study subjects and the diagnosed patients were 11.3±10.6 months and 5.6±9.2 months, respectively. Of the 10 diagnosed patients, 8 (80%) were diagnosed within 6 months of loop recorder implantation. Conclusion: ILR may be a valuable and effective diagnostic tool for patients with unexplained syncope.

증례 잉어 담즙 생식 후 병발된 무뇨성 급성신부전과 급성간염 및 횡문근융해증

강구현 ( Gu Hyun Kang ),박건태 ( Geon Tae Park ),송준휘 ( Jun Whee Song ),이지은 ( Ji En Lee ),우재곤 ( Jae Gon Woo ),조성 ( Sung Cho ),김성록 ( Sung Rok Kim ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.3

Gall bladder of a common carp is taken in some areas of Asia as a traditional medicine for improvement of their general health problems like hypertension, poor visual acuity, and impotence. Many cases have been reported on acute hepatitis, acute renal failure, gastrointestinal problems and neurological symptoms following ingestion of raw carp bile juice. We experienced a case of anuric ARF, acute hepatitis, and rhabdomyolysis that developed after indigestion of raw carp bile juice, not yet seen in previous studies. In this case, anuric state of patient was resolved after 4 days with continuous renal replacement therapy. Thus we report this case with review of literature.

AMFC system에서의 비정질 실리콘 박막의 결정화 특성

강구현(Ku Hyun Kang),이승재(Seung Jae Lee),김선호(Sun He Kim),이수경(Sue Kyeong Lee),남승의(Seung Eui Nam),김형준(Hyoung June Kim) 한국진공학회(ASCT) 2005 Applied Science and Convergence Technology Vol.14 No.1

a-Si을 poly-Si으로 결정화하는 전형적인 방법으로는 고상결정화(solid Phase Crystallization, SPC)가 있다[1-3]. 고상결정화는 균일한 공정특성과 생산비가 저렴하다는 장점이 있으나, 고상결정화 공정에서 높은 공정온도와 긴 공정 시간은 유리 기판의 손상으로 인해 적용되기 어렵다. 본 논문에서는 고상결정화의 저온공정과 짧은 공정시간을 위해 교번자장결정화(Alternating Magnetic field Crystallization, AMFC) 시스템 내에서 결정화하는 동안 교변 자장(Alternating Magnetic Field)을 적용하는 새로운 방법을 소개한다. 고상결정화의 경우, 열처리 시간은 570℃에서 24시간이 소요되었으나, 교번자장결정화의 경우, 같은 온도에서 20분이 소요되었다. A typical method for obtaining poly-Si films is the solid phase crystallization(SPC) of amorphous Si. Advantages of SPC are uniformity, process quality and low cost of production. However, high process temperature and long process time prevent the employment of SPC process on thermally susceptible glass substrate. In this paper, we propose a new method that applies an alternating magnetic field during crystallization annealing in an alternating magnetic field crystallization(AMFC) system for lowering process temperature and shorter process time of SPC. When we crystallized, in the case of SPC, annealing time is 24 hours at 570℃. But in the case of AMFC, annealing time is only 20 minutes at the same temperature.

대장용종의 겸자생겸과 내시경적 절제 후의 병리 조직 소견의 비교

강구흠 ( Gu Hyum Kang ),허규찬 ( Kyu Chan Huh ),김선문 ( Sun Moon Kim ),이태희 ( Tae Hee Lee ),임의혁 ( Euyi Hyeong Im ),최용우 ( Young Woo Choi ),김범경 ( Beom Kyoung Kim ),강영우 ( Young Woo Kang ),강구현 ( Gu Hyun Kang ) 대한내과학회 2008 대한내과학회지 Vol.74 No.3

목적: 대장암의 발생기전으로 생각되는 adenoma-carcinoma sequence 가설이 직접 증명된 경우는 없지만, 정상점막에서 양성선종, 대장암으로 진행되는 것에 대해서는 여러 가지 간접 증거들이 보고되고 있어 대장용종의 조직학적 진단이 매우 중요하다. 겸자 생검은 용종 전체 부분을 조직검사를 하는 것이 아니므로 전체 용종 절제를 통한 조직검사와는 다를 수 있으나, 처음 내원하여 내시경검사 시 언제나 즉시 대장용종 절제가 가능한 것은 아니다. 이에 저자들은 겸자 생검과 내시경 절제 후의 병리 조직 검사 결과를 비교하여 겸자 생검의 조직학적 유용성을 알아보고자 한다. 방법: 2003년 3월부터 2005년 12월까지 건양대학교 소화기내과를 방문하여 시행한 대장 내시경검사 시 시행한 조직검사에서 양성 용종으로 진단받은 환자 중에서 2주 이내에 전체 병변 절제를 시행한 환자 중 조직소견의 비교가 가능한 221명의 환자(평균나이 59.0, 남자: 152, 여자: 69)를 대상으로 겸자 생검 조직검사와 용종절제술 후 조직 검사 결과를 비교하여 보았다. 결과: 겸자 생검 결과 관상선종은 217예(71.8%), 관상융모상선종 20예(6.6%), 융모상선종 2예(0.6%), 증식성용종 29예(9.6%), 염증성용종 29예(9.6%), 그리고 암성변화는 5예(1.65%)였다. 용종절제술 후 조직검사 결과 관상선종은 186예, 관상융모선종 22예, 그리고 암종성 변화는 12예(4.0%)였다. 겸자 생검과 용종절제술 후 조직 소견은 302예 중 215예(71.2%)에서 일치하였다. 겸자 생검 결과에서 악성변화를 보이는 암종성 용종과 융모상 용종으로 진단된 경우, 용종절제술 후 조직검사에서도 모두 같은 소견을 보였다. 용종절제술 후 조직학적 진단에 비해 내시경적 겸자 생검의 악성도가 과소 진단된 경우 임상적 중요성을 가지며, 전체 용종 중 악성변화가 12예 중 겸자 생검에서 악성변화를 확인할 수 없었으나 용종절제술 후 조직검사에서 악성변화를 보인 경우는 7예로 모두 관상선종이었다. 7예 중 4예는 심한 이형성을 동반하였으며, 이형성이 없는 나머지 3예는 크기가 1 cm 이상인 경우였다. 결론: 대장용종 중 특히 선종은 대장암의 전구 병변으로 인식되고 있어, 선종성 용종의 진단은 매우 중요하며 조직학적 진단 시 겸자 생검 만으로 충분치 않다고 생각한다. 대장용종이 겸자 생검에서 선종으로 판명되었을 경우에는 정확한 진단 및 치료 목적으로 용종절제술이 필요하며 특히 크기가 1 cm 이상, 심한 이형성이 동반한 경우에는 용종절제술이 필요할 것으로 생각한다. Background/Aims: Adenomatous polyps of the colon are believed to be precursor of colon cancer. Total polyp resection is indicated when they are identified. However, resection of the polyp is not always attainable at the initial colonoscopy. The aim of this study was to assess the validity of cold biopsy findings as representative of the whole polypectomy specimen, with regard to the histopathological features. Methods: We analyzed 221 patients with colon polyps that were biopsied at their initial colonoscopy and had their adenomas subsequently removed by polypectomy within 2 weeks from the initial procedure. We analyzed the histopathological discrepancies between the cold biopsy and the polypectomy specimens. Results: We analyzed 302 cases from 221 patients. There was 71.2% agreement between the forceps biopsy and the polypectomy. When colon polyps were diagnosed as carcinoma and villous adenomas, the diagnosis was the same in the polypectomy. Discrepancy between in forceps biopsy with polypectomy was found in the tubular adenomas obtained by forceps biopsy. Fifty tubular adenoma samples obtained by forceps biopsy had a deferent diagnosis than did the polypectomy. Fourteen of 50 tubular adenomas were underestimated by the forceps biopsy samples and seven of the 50 tubular adenomas were finally diagnosed as carcinoma from the polypectomy specimens. Seven villous adenomas were diagnosed as carcinoma and had severe dysplasia (n=4) or 1>=(n=1) size. Conclusions: Accurate tissue sampling of colorectal adenomas is crucial for their management. However, forceps biopsy does not accurately reflect the histology of colon polyps. Total resection of colon polyps is needed for an accurate diagnosis. (Korean J Med 74:258-263, 2008)