관상동맥 질환 환자에서 관상동맥내 Acetycholine 유발검사의 임상적 의의에 관한 연구

강흥선(Heung Sun Kang),조정휘(Chung Whee Choue),김권삼(Kwon Sam Kim),김명식(Myung Shick Kim),송정상(Jeung Sang Song),배종화(Jong Hoa Bae) 대한내과학회 1992 대한내과학회지 Vol.43 No.2

N/A Backgroand: Coronary vasoconstriction plays an improtant role in the pathogenesis of coronary artery disease. It has been known that acetylcholine (Ach) dilate normal vessels by releasing an endothelium- derived relaxing factor (EDRF), but when the endothelium is removed or dysfunctional, the vasodilator response is replaced by vasoconstriction resulting from the direct effects of this agent on vascular smooth mulscle. Methods: To evaluate the effects of intracoronary injection of Ach, 42 patients (27 males, 15 females; age range, 32~70 years) who had a history of chest pain were studied by using biplane cineangiography. Twentytwo patients had angiographically normal coronary arteries (Group I) and 20 patients had significant coronary artery disease (Group II). Results: Coronary artery vasoconstriction was induced in 11 patients (50%) of Group I, and in 14 patients (70%) of Group II by intracoronary injection of Ach. The site of vasoconstiction induced by Ach was more frequent in right coronary artery (23 patients out of 25 patients) than in left coronary artery. The levels of plasma total cholesterol in the patients with coronary vasoconstriction (GroupIB: 191.8±23.9 mg/dl, GroupIIB: 208.6±34.2mg/dl) were higher than those who without coronary vasoconstriction (154.5±35.9 mg/ dl)(p?0.01). Conclusion: These results suggest that vasoconstriction of coronary artery are induced easily by intracoronary injection of Ach and more frequent observed in right coronary artery, Intracoronary injection of Ach may be helpful in the evaluation of the patients with atypical chest pain and in the early detection of the patients with coronary artery atherosclerosis

승모판 협착증 환자에 있어서 좌심방내 Spontaneous Echo Contrast 에 관한 연구 - 경흉부 및 정식도 심초음파도의 비교관찰 -

신선영(Sun Young Sin),윤창상(Chang Sang Yoon),강흥선(Heung Sun Kang),조정휘(Chung Whee Choue),김권삼(Kwon Sam Kim),김명식(Myung Shick Kim),송정상(Jung Sang Song),배종화(Jong Hoa Bae) 대한내과학회 1994 대한내과학회지 Vol.46 No.2

N/A Objectives: Left atrial thrombus (LAT) has been known as a major cause of systemic arteria1 embolization in patients with mitral stenosis. This study was undertaken to compare the diagnostic efficacy of transthoracic echocardiography (TTE) with that of transesophageal echocardiography (TTE) in the detection of LAT, Additionally, we assessed the prevalence and clinical significance of left atrial SEC and the factors related to its presence in patients with mitral stenosis. Methods; The study group comprised 33consecutive patients who had mitral stenosis (MS) or mitral stenoinsufficiency, 26patients of them had atrial fibrillation (AF), 7patients had sinus rhythm. Among them, 14cases had systemic embolization. All patients were studied with transthoracic and transesophageal echocardiography. We measured left atrial dimension (LAD), mitral valve area (MVA), ejection fraction (EF), severity of mitral regurgitation, and examined the presence and location of LAT and SEC by TTE and TEE. Cardiac rhythm, history of systemic cmbolization were collected by review of the patients hospital records. Results: 1) TTE revealed left atrial SEC in only 1patient. In contrast, left atrial SEC clould be detected in 25patients by TEE. In 8patients, LAT were diagnosed by TTE, whereas detected 14cases of LAT by TEE. The difference between two methods was statistically significant (p<0 05). 2) The patients with LAT had significantly highter prevalence of SEC and AF, lower EF, lower frequency of severe mitral regurgitation than in patients without LAT (p<0 05). But, MVA and LAD were not significantly different between two groups. 3) Patients with SEC had significaotly higher frequency of AF and history of systemic embolization, more severe stenosis of MVA, lower frequency of severe mitral regurgitation than in patients without SEC (p<0, 05). But LAD and EF were not significantly different between two groups. 4) LAT or systemic embolization, or both were found in 20 of 25patients (80%) with SEC. Whereas, only 1 of 8patients (13%) without SEC had a history of arterial embolization (p<0,01), and no patient without SEC was found to have thrombus within the left atrium, Conclusion: This results suggested that TEE was more sensitive to detect left atrial SEC and LAT than TTE, and left atrial SEC was strong predictor for thrombus formation and systemic embolization in patients with mitral stenosis.

급성 하벽심근경색증에 동반된 ST 절의 상호 하강 ( V₁ - V₃ ) 에 대한 연구

류혜영(Hyae Young Lew),윤용선(Yong Sun Yun),강흥선(Heung Sun Kang),조정휘(Chung Whee Choue),김권삼(Kwon Sam Kim),김명식(Myung Shick Kim),송정상(Jung Sang Song),배종화(Jong Wha Bae) 대한내과학회 1997 대한내과학회지 Vol.53 No.3

N/A Background: Reciprocal ST-segment depression in precordial leads is a common finding in acute inferior myocardial infarction. The responsible mechanism and the significance of this finding, however, are still controversial. Methods: From January 1991 to December 1994, 38 patients with acute inferior myocardial infarction were treated at the Department of Internal Medicine in Kyung Hee University Hospital. Clinical characteristics, serial electrocardiograms, and angiographic findings of coronary artery and left ventriculography, echocardiography were reviewed. Reciprocal ST-segment depression was defined as ST-segment depression≥1.0mm in two or more adjacent precordial leads(V₁-V₃) in patients with acute inferior myocardial infarction showing ST-segment elevation in II, III, aVF. Coronary angiography and echocardiography were performed within 24 hours from admission. In this study, angiographic distribution score was used to define the perfusion territory causing inferior ischemia. Results : 1) The summation of ST-segment elevation in II, III, aVF leads was significantly more higher in group H than group A (P<0.05). 2) However, the angiographic distribution score, peak CK levels, in-hospital complications and ejection fraction showed no difference between two groups (P>0.05). 3) There were no evidence of anterior wall motion abnormality in two groups. Conclusions: Our results suggest that the S'I'- segment depression on the precordial leads in acute myocardial infarction can be explained mainly by benign reciprocal electrical change.

우리나라 뇌졸중의 최근 10 년간 변화 양상에 대한 연구

송일한(Il Han Song),오동환(Dong Hwan Oh),강흥선(Heung Sun Kang),조정휘(Chung Whee Choue),김권삼(Kuen Sam Kim),김명식(Myung Shick Kim),송정상(Jung Sang Song),배종화(Jong Hwa Bae) 대한내과학회 1992 대한내과학회지 Vol.43 No.5

N/A Background: Stroke is well known one of the major causes of death in adults. In the incidence of type of stroke, the cerebral infarction occured more frequently than the cerebral hemorrhage in the Western, but the incidence varies with the individual clinical studies in Korea. We expect that there is changing pattern in the incidence of type of stroke during the recent 10 years in Korea. Methods: To investigate the changing pattern of stroke during the recent 10 years, 1304 patients with stroke who underwent the computerized tomographic scanning were evaluated for the type of stroke, the sex and age distribution, the underlying diseases and the location. Group I included 450 pateints with stroke who admitted from January 1978 to October 1981, at department of internal medicine, Kyung Hee University Hospital. Group II included S54 patients with stroke who admitted from January 1989 to December 1989. Results: Cerebral hemorrhage was the most frequent type of stroke in group I, but cerebral infarction in group II. Male was more prevalent than female in cerebral hemorrhage and cerebal infarction in both groups. The subarachnoid hemorrhage more frequently occurred in female than in male. It was a tendency to increase the frequency in females in group II including all types of stroke. Cerebral hemorrhage occurred most frequently in sixth decade in both groups, but cerebral infarction occurred most frequently in sixth decade in group I and seventh decade in group II. In both groups, hypertension was the most frequent associated disease. The proportion of diabetes mellitus and heart diseases increased in group II than group I. The level of serum total cholesterol in patients with cerebral infarction was higher than those with cerebral hemorrhage in group II. In cerebral infarction, the most frequent lesion site was lobal area. In cerebral hemorrhage, basal ganglia was the most frequent lesion site, the second was thalamus and then subcortical area. Conclusions: These results suggest that the cerebral infarction is the most frequent type in the stroke in Korea recently due to increased population with old age, increased incidence of diabetes mellitus and heart diseases, the adequate control of hypertension and changes of life style and diets.

심방중격 결손중에서 경흉부 및 경식도 심초음파도의 비교

김양수(Yang Soo Kim),김성훈(Sung Hoon Kim),강흥선(Heung Sun Kang),조정휘(Chung Whee Choue),김권삼(Kwon Sam Kim),김명식(Myung Shick Kim),송정상(Jung Sang Song),배종화(Jong Hoa Bae) 대한내과학회 1994 대한내과학회지 Vol.46 No.3

N/A Objectives: Transthoracic two-dimensional echocardiography and conventional Doppler color flow mapping studies have been to used in patients with congenital cardiac defect. However, the transthoracic approach is of limited value in patients with poor acoustic window, Recently transesophageal echocardiography provides high quality images of structure because of close proximity. The purpose of this study is the usefulness of transesophageal echocardiography compared with transthoracic echocardiogrphy in the diagnosis and assessment of the shunt volume in patients with atrial septal defect. Method: 13 patients with atrial septal defect documented at cardiac catheterization or surgery were evaluated. The study group consisted of 7 men and 6 women aged 15 to 59 years. Two-dimensional transthoracic echocardiogrphy with Doppler color flow mapping assessed the morphology and shunt of atrial septum. The size of atrial septal defect and the shunt volume across the defect were estimated by using the tranesophageal echocardiography. Results: 1) Transthoracic echocardiography identified 9 of 13 patients with and atrial septal defect (69%), whereas transesophageal echocardiography identified 13 of 13 patients and the diagnostic sensitivity was 100%. 2) Transesophageal echocardiography identified the site and size of defect correctly compared with operative findings (r=0.73, p<0.05). 3) The shunt flow volume by transesophageal echocardiography was compared with pulmonary to systemic blood flow ratios (Qp/Qs) by cardiac catheterization. The net shunt flow volume by transesophageal echocardiography and shunt flow ratio cardiac catheterization correlatie well (r=0.88, p<0.001). Conclusion: Transesophageal echocardiography was better and more usuful than transthoracic echocardiography in the diagnosis and in the assessment of shunt volume in the patients of atrial septal defect. However further studies with large number of patients and using the biplane or multiplane TEE will be required to determine the exact status of this the technique in assessment of shunt.

말기 신부전증 환자에서 부하 심근 SPECT 의 임상적 의의

김희진(Hee Jin Kim),이태원(Tae Won Lee),김덕윤(Deog Yoon Kim),강흥선(Heung Sun Kang),홍성표(Seong Pyo Hong),임천규(Chun Cyoo Lim),김명재(Myung Jae Kim) 대한내과학회 1999 대한내과학회지 Vol.57 No.6

N/A Background : Coronary artery disease(CAD) is a leading cause of death in patients with end-stage renal disease(ESRD). Current data concerning the role of dipyridamole SPECT myocardial imaging for the diagnosis of CAD in patients with ESRD vary according to authors. This study was performed to evaluate the usefulness of dipyridamole SPECT myocardial imaging and coronary angiography in diagnosing the CAD in patients with ESRD. Methods : Sixty-three patients with ESRD underwent dipyridamole SPECT myocardial imaging and sixteen with positive myocardial imaging had selective coronary angiography. Controls were 73 patients with normal renal function who had dipyridamole SPECT myocardial imaging and coronary angiography because of chest pain or discomfort. The perfusion defect in myocardial images were defined as reversible or irreversible. Significant coronary artery disease was defined as one or more vessel disease with at least 50% stenosis on coronary angiography. The correlation between regional imaging defects and coronary stenoses in the corresponding vascular distribution was determined by the rule of a Van Train. Results : Forty-nine of the patients had abnormal myocardial images (16 reversible, 6reversible + irreversible, 27 irreversible defects). Twenty six patients had a left anterior descending artery(LAD) defect, 13 a left circumflex artery(LCX) defect, 26 a right coronary artery(RCA) defect. There were no differences in age, sex, type and duration of dialysis, and associated atherogenic risk factors between patients with positive and negative myocardial imaging except for the durations of diabetes. Ten of the 16 patients, and thirty-nine of the 45 controls with positive myocardial imaging had a 50% or greater stenosis of one or more coronary arteries in coronary angiography. Therefore, the predictive value of positive SPECT in patients with ESRD was 63%, and that of controls was 87%. Of the 10 patients with stenotic lesions, 6 had double-, 3 single-, and 1 triple-vessel disease. Altogether, 7 diseased LCX , 6 RCA, and 5 LAD were found. In contrast, Of the 39 controls with angiographically significant stenotic lesions, 24 had single-, 9 double-, and 6 triple -vessel disease. Altogether, 27 diseased LAD, 17 LCX, and 16 RCA were found. There were no differences in age, sex, type and duration of dialysis, ST-T waves change, duration of ESRD, associated atherogenic risk factors, LV mass index and LVH between the patients with and without CAD except for the history of smoking. Three of 6 patients with false positive results of myocardial images had inferior perfusion defect and were on peritoneal dialysis. The pressure effects of peritoneal fluids on inferior perfusion defect were proven by a significant change of disappearance of inferior perfusion defect in myocardial images after complete drainge of the peritoneal fluids. And, the predictive value of positive SPECT differed between patients with and without false positive results of myocardial images (predictive value of positive SPECT 63% and 77%, respectively). Conclusion : Dipyridamole SPECT myocardial imaging appears to be an useful method for detection and exclusion of CAD in patients with ESRD and interpretation of dipyridamole SPECT myocardial imaging with inferior perfusion defect in patients with continuous ambulatory peritoneal dialysis needs more caution.(Korean J Med 57:1037-1047, 1999)

간장 ( 肝臟 ) 및 담도 ( 膽道 ) : 만성 B 형 활동성 간염에서 단기 Prednisolone과 ARA - AMP 병용 요법의 효과

장린(Rin Chang),김병호(Byung Ho Kim),장영운(Young Woon Chang),이정일(Joung Il Lee),김효종(Hyo Jong Kim),강흥선(Heung Sun Kang) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.4

N/A The purpose of treatment of chronic hepatitis R virus (HBV) infection is the complete elimination of HBV and reduce the risk of further hepatic damage and hepatocarcinogenesis. Immune stimulation provided by corticosteroid withdrawal may be associated with a temporary loss of hepatitis B virus markers in patients effected by chronie active hepatitis B (CAHB). It is possible that an association of antiviral drugs with corticosteroid play a therapeutic role in CAHR. Twenty-Six patients with biopsy-proven, HBeAg and HBV-DNA positive CAHB were treated with prednisolone (PDL) withdrawal [40 mg/day for 4 weeks without tapering, orally] followed in sequence by 2-week rest interval and ARA-AMP [500 mg/day for 4 weeks, intravenously]. The followig results were obtained; 1) The treetment with short-term PDL and ARA-AMP showed dramatic decline in the titer of HAV-DNA. 2) In 13 of 26 patients (50%), partial response, in 6 of 26 patients (23%), complete response were observed at the end of treatment. 3) Partial responders were unstable, and 11 of 13-partial responders (85%) showed reappearance of HBV-DRA during follow-up period. 4) In 4 of 6 complete reaponders (67%), reappearance of HBeAg was observed. Two became seronegative for HBeAg by additional 4wk injection of ARA-AMF but another two became nonresponder in spite of ARA-AMI. 5) Responders showed significantly higher ALT values than nonresponders at two weeks after PDL treatment. 6) After mean follow up of 14.8 months, over,all response rate was 23%. In conclusion, the combination of short-term prednisolone and ARA-AMP in the treatment of chranic hepatitis B was effective in suppressian of HBV-DNA during treatment and shortly after treatment period. But long-term suppressive effect in HBV-DNA and effect in seroconversion of HReAg might be unsaitlsfactory. The larger, randomized, controlled trials using a similar approach is needed.

관동맥이 완전폐쇄된 환자에서 측부순환과 99mTc - MIBI 심근 SPECT 소견 비교

손경환(Kyung Hwan Son),김권삼(Kown Sam Kim),이무열(Moo Yel Lee),이원호(Won Ho Lee),김덕윤(Deog Yoon Kim),강흥선(Heung Sun Kang),조정휘(Chung Whee Choe),김명식(Myung Sik Kim),송정상(Jung Sang Song),배종화(Jong Hwa Bae) 대한내과학회 1997 대한내과학회지 Vol.53 No.1

N/A Objectives: The role of coronary collateral circulation in protecting myocardium after the occlusion of a supplying artery has long been debated. Recent date show that the coronary collateral circulation may partially prevent ischemia and preserve myocardial contractile function. The purpose of this study was to evaluate the relation between the grades of collateral circulation and perfusion scores of 99mTc-Heart SPECT in patients with totally coronary occlusion. Methods: We studied 44 patients with totally coronary occlusion who had been hospitalized at Kyung Hee University hospital between October, 1989 and May, 1994, Patients were classified into two groups; Group 1: patients with angina pectoris (n=21), Group 2: patients with myocardial infarction (n=23). Angiographic collateral circulation was graded from 0 to 3: 0=none, 1=filling of side branch only, 2=partial filling of the epicardial segment, 3=complete filling of epicardial segment. The perfusion score of dipyridamole stress 99mTc-MIBI Heart SPCET was analyzed with angiographic findings. Resting and stress echocardiography were analyzed to identify left ventricular wall motion abnormalities. Results: 1) When LAD was totally occluded, there were hishevcrgree of collateral circulations from RCA in group 1 and group 2. When RCA was totally occluded, there was higherdesree of collateral circulation from LAD in group 1 and group 2. 2) The degree of collateral development was higher in group 1 than in group 2 (2.5±0.7 vs. 1.8±1.0, p<0.05). 3) In 99mTc-MIBI Heart SPECT, there was no significant difference of perfusion score at stress but perfusion score was significantly higher in group I than in group 2 at rest. 4) In 99mTc-MIBI Heart SPCET, there was no difference of perfusion score between totally coronary occlusion territories in group 1 and more than 50% coronary artery stenotic territories in group 1 and group 2. 5) In stress echocardiography, ten of the 13 patients showed normal LV wall motion at rest, but 9 of these 10 patients showed LV wall motion abnormalities at stress in group l. In group 2, all 10 patients showed LV wall motion abnormalities at rest and 3 of these patients showed more aggravation of LV wall motion abnormalities. Conclusion: Collateral circulation in angina patients can prevent myocardial ischemia and preserve myocardial function at rest, but not at exercise. Collateral circulation in patients with myocardial infarction cannot preserve myocardial function at rest. and exercise. Dipyridamole stress 99mTc-MIBI Heart SPECT is one of the indirect quantification methods to evaluate collateral development and coronary flow reserve.

간장 ( 肝臟 ) 및 담도 ( 膽道 ) : 간경변증 환자에서 골이영양증에 관한 연구

민영일(Young Il Min),장린(Rin Chang),김병호(Byung Ho Kim),장영운(Young Woon Chang),이정일(Jung Il Lee),김효종(Hyo Jong Kim),강흥선(Heung Sun Kang),황영희(Young Hee Whang) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.4

N/A The aim of tbe studywas to investigate the incidence and pathophysiology of osteodystrophy in patiients with pastnecrotic cirrhosis of the liver. Bone changes were meaSured by scanning densitometry. Various hormones and biochemical items which reflect calcium and bone metabolism were also measured. Twenty-one Korean male patients with HRsAg positive postnecrotic cirrhosis and 20 male controls matehed in age ans sex were included in study groups. The results were as follows ; 1) The incidence of ostsopenia in patients with postnecrotic cirrhosis of the liver was 19%. 2) Mean values of 25-OH-D and 1.25- (OH)2D2 were 7.3 +- 4.7 ng/ml and 12.5 +- 10.8 pg/ml respectively in patients with postnecrotic cirrhosis of the liver. Theses values were significantly lower than those of normal controls (28.1 +- 18.0 ng/ml and 29.4 +- 6.5 pg/ml) 3) Levels of ionized calcium were 5.4 +- 0.5 mg/dl and 5.4 +- 0.4 mg/dl in patients with postnecrot corrhosis of the liver and controls respectively. 4) The levels of carboxy-terminal parathyroid hormone were normal in patients with postnecrotic cirrhoeis (412 +- 145 pg/ml,controls: 393 +- 46pg/ml). 5) in patients with osteopenic liver cirrhosis, in spite of extremely low values of 25-OH-D3(24 +- 4.1ng/ml) and 1.25- (OH)2-D3(2.0 +- 0.3 pg/ml), mean serum ionized calcium level (5.9 +- 0.4mg/dl) was higher than those of nonostepenic liver cirrhosis (5.3 +- 0.4 pg/dl)was higher than those of nonos teopenic liver cirrhosis (5.3 +- 0.4 mg/dl) and normal controls (5.4 +- 0.4mg/dl). Inconclusion, vitamin D levels were significantly low in patients with postnectrotic cirrhosis of the liver but ionized calcium levels were maintained in normal range and protean bone changes were observed by scanning densitornetry. A certain portion of the patients (19%) with postnecrotic cirrhosis of the liver showed moderate degree of osteopenia accompained by extremely low levels of serum vitamin D and inappropriately elevated ionized calcium levels in the blood. These relative hypercalcemic changes seem to be related to low levels of estradiol rather than overproduction of parathyroid hormone.

한국인에서 경동맥 경화와 관상 동맥 질환의 연관 관계에 관한 연구

이상억(Sang Eog Lee),김권삼(Kwon Sam Kim),김병준(Byoung Joon Kim),이효정(Hyo Jung Lee),안우석(U Seouk Ahn),강흥선(Heung Sun Kang),조정휘(Chung Whee Choue),김명식(Myung Shick Kim),송정상(Jung Sang Song),배종화(Jong Hwa Bae) 대한내과학회 1996 대한내과학회지 Vol.51 No.6

N/A Objectives: Along with the recent change in lifestyle in Korea, the incidence of coronary artery disease(CAD) and cerebrovascular disease due to atherosclerosis has increased. B-mode ultrasound of the extracranial carotid arteries offers a valid and repeatable noninvasive method for quantifying the extent of atherosclerosis. The extent of carotid artery atherosclerosis as measured by B-mode ultrasound has been shown to be strongly and independently correlated with the presence or absence of CAD. We investigated the relation between carotid atherosclerosis and the status of CAD in Korean population with a carotid B-mode ultrasound. Methods: One hundred twenty eight patients underwent. B-mode ultrasound of the carotid arteries with 10 MHZ linear array probe. The intima-media thickness(IMT) at two sites in far(posterior) wall of the both common carotid artery and bifurcation were quantified and evaluated for the incidence of softand hard plaques. Coronary angiography was performed by the percutaneous technique using Judkins catheter. The extent of CAD was counted as 0,1,2,3-vessel disease according to the number of major coronary vessels with an obstruction of 50% or greater. Results: The number of coronary artery involved was single-vessel disease in 41, two-vessel disease in 19, three-vessel disease in 25 and no corona atherosclerotic disease in 43. The incidence of plaques was no CAD group in 10(23%) at the bifurcation, whearas CAD group in 18(23%) at the common carotid artery and 68(80%) at the bifurcation. The incidence of plaques at the bifurcation increased progressively in each of 2- and 3-vessel disease group compare with the 1-vessel disease group(89%, 100% vs 64%). The sum of IMT at both common carotid artery and bifurcation was significantly different between no CAD and CAD group(3.17±0.08mm vs 4.26±1.37mm, p<0,05), and increased progressively in each of the groups with increasing numbers of stenosed vessels(2-vessel clisease:4.98±1.28mm, 3-vessel disease: 5.29±1.20mm Conclusion: The results suggest that increased IMT of carotid arteries is closely related to status and extent of CAD Also measurement of IMT may be useful screening method for assessment of CAD and systemic atherosclerosis.