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영구적 심방세동 환자에서 동시 발병한 급성 ST 분절 상승 심근경색과 다발성 말초 및 전신동맥 색전증
고영엽(Young Youp Koh) 조선대학교 의학연구원 2023 The Medical Journal of Chosun University Vol.48 No.1
Acute myocardial infarction(AMI) is myocardial necrosis resulting from acute obstruction of a coronary artery, which is a significant cause of morbidity and mortality among adults worldwide. Coronary artery plaque rupture, erosion, thrombosis, and dissection account for nearly all obstruction of a coronary artery. However, coronary artery embolism is also one of the rare but important causes of AMI. It is imperative that practicing clinicians be aware of coronary embolism as a cause of AMI, particularly in high-risk populations such as those with atrial fibrillation. Atrial fibrillation(AF) is one of the most common dysrhythmias, in general, the most concerning complication of AF is thromboembolic events including cardioembolic stroke and systemic embolism. For many patients with AF, anticoagulation therapy is the cornerstone of management to prevent thromboembolic events. Here, we report a very rare case of not only acute ST segment elevation myocardial infarction(STEMI) due to coronary artery embolism but also several systemic embolic events(SEE) including acute unilateral renal infarction and the sudden occlusion of the superior mesenteric artery and right popliteal artery caused by multiple peripheral or systemic arterial embolism simultaneously developed in a 77-year-old man with permanent atrial fibrillation after discontinuing anticoagulation arbitrarily.
박근호(Keun-Ho Park),기영재(Young-Jae Ki),김성수(Sung Soo Kim),김현국(Hyun Kuk Kim),최동현(Dong-Hyun Choi),정중화(Joong-Wha Chung),고영엽(Young-Youp Koh),장경식(Kyong-Sig Chang) 조선대학교 의학연구원 2020 The Medical Journal of Chosun University Vol.45 No.2
Emergency diseases that can lead to sudden cardiac death with acute severe chest pain include acute myocardial infarction and aortic dissection. These two diseases show high mortality rates, but they have very different initial treatments, therefore, early diagnosis and start of treatment are very important. However, rarely, acute myocardial infarction could be complicated by aortic dissection. We report a case of a 68-year-old woman with anterior chest pain who was finally diagnosed with aortic dissection on chest computed tomography after inevitable percutaneous coronary intervention under the diagnosis of acute myocardial infarction.
흉부 둔상 후 발생한 관상동맥 박리에 의한 ST 분절 상승 심근경색 1예
한정연 ( Jung Yeon Han ),최동현 ( Dong Hyun Choi ),정중화 ( Joong Wha Chung ),고영엽 ( Young Youp Koh ),장경식 ( Kyung Sik Chang ),홍순표 ( Soon Pyo Hong ) 대한내과학회 2013 대한내과학회지 Vol.84 No.6
Coronary artery injury after thoracic injury is very rare, but can result in serious acute myocardial infarction (MI). It can be easily mistaken for chest wall pain or cardiac contusion if relying solely on a history and physical examination. We herein report a rare case of a 60-year-old female patient who presented with inferior wall ST-segment elevation MI due to right coronary artery dissection following blunt chest trauma after a traffic accident. Successful primary percutaneous coronary intervention was performed without complications. (Korean J Med 2013;84:847-850)
Urea Kinetic Modeling 을 이용한 지속적 혈액투석 환자의 영양 상태 평가
최규복(Gyu Bog Choi),변정란(Jung Lan Byun),박정은(Jeong Eun Park),이은영(Eun Young Lee),이지수(Ji Soo Lee),편욱범(Wook Bum Pyun),고영엽(Young Youp Koh),윤견일(Kyun Ill Yoon) 대한내과학회 1994 대한내과학회지 Vol.46 No.2
N/A Objectives: Nutritional factors play a role in the morbidity and mortality of patients in maintenance hemodialysis as well as in their quality of life and ultimate rehabilitative potential. It was reported that if the deviation of urea distribution volume calculated by Urea Kinetic Modeling(UKM) (Vol-Dev) from Anthropometric volume exceeded the acceptable range, clinical application of the NPCR (normalized protein catabolic rate) as nutritional index might be inappropriate. And it was also reported that if the KT/Vurea without consideration of residual renal function (D-KT/V) was above 1.5 or below 0.8, the NPCR might be inaccurate. So we selected patients whose Vol-Dev was within the acceptable range and grouped according to the D-KT/V. Then we analyzed the relationship between the NPCR and other nutritional parameters. Methods: We selected 17patients undergoing maintenance hemodialysis with adequate Vol-Dev level and grouped as group 1 if D-KT/V was between 0.8 and 1. 5, as group 2 if D-KT/V was below 0.8 or over l.5, We measured the mean level of albumin, calcium, phosphorus and hematocrit and calculated midarm muscle area (MAMA), midarm fat area (MAFA) as anthropometric measurements. Results: 1) Nutritional Index: There were no differences in serum albumin, calcium, phosphorus and hematocrit between two groups. The mean MAMA of group 1 (37.4cm2) was not different from that of group 2(27.9cm2), but mean MAFA of group 1(19.2cm2) was significantly higher than that of group 2(14.3cm2). The NPCR of group 1 (1.00) was not different from that of group 2(1.12). 2) UKM Parameter: The mean level of D-KT/V as single dialysis dose in group 1 (1.23) was significantly lower than that of group 2(1.69) and the mean level of TW-KT/V as weekly dialysis dose in Group 1 (3.17) was significantly lower than that of Group 2(4.05). The mean level of TWR-KT/V as weekly dialysis dose with consideration of residual renal function in Group 1(3.24) was significantly lower than that of Group 2(4.07) also. 3) Correlation between NFCR and dialysis dose: There was no correlation between D-KT/V and NPCR in both Group. In group 1, there was positive correlation between NPCR and TW-KT/V or TWR-KT/V. But in group 2, there was no correlation between NPCR and TW-KT/V or TWR-KT/U. 4) Correlation between NPCR and Nutritional Index: There was no correlation between NPCR and serum nutritional index (albumin, calcium, phosphorus, hematocrit). There was also no correlation between NPCR and anthropometric parameter (MAMA, MAFA). Conclusions: It is not likely that the NPCR reflects the protein catabolic rate accurately in case of D-KT/V exceeded adequate level (0.8≤, ≤1.5). Although the protein catabolic rate might be increased due to the effect of dialysis itself, there was no significant change in the nutritional status of patients. Even though the D-KT/V was within the adequate level, it is difficult to evaluate the patients nutritional status with NPCR only.
활동성 전신성 홍반성 낭창환자에서의 Plasmapheresis를 이용한 치험 1례
고영엽,최규복,윤견일 梨花女子大學校 醫科大學 醫科學硏究所 1990 EMJ (Ewha medical journal) Vol.13 No.4
A patient with severe active systemic lupus erythematosus, who had not responded to conventional therapy, was treated with plasmapheresis and subsequent pulse cyclophosphamide. There was the reduction of anti-ds DNA level was deteced after plasmapheresis in conjunction with the immunosuppressive therapy could be and effective modality of management in patients with rapidly deteriorating SLE who are responding inadequately to the conventional therapy.
관상동맥 풍선성형술 후 발생한 관상동맥 박리의 초기 조영술적 고찰
고영엽,강지인,장재혁,강민정,정중화,장경식,홍순표 朝鮮大學校 附設 醫學硏究所 2007 The Medical Journal of Chosun University Vol.32 No.1
Background and Objectives: Percutaneous coronary intervention (PCI) is widely utilized in the treatment of symptomatic coronary artery disease (CAD). Althouth it has numerous benefits, intimal tear or dissection, serious and potentially life-threatening complications of plain old balloon angioplasty (POBA) can occur. The aim of this study was to assess the implications of coronary dissections after ballon angioplasty. Methods: 78 consecutive patients (age, 62 +/- 11 years; 46 men, 32 women) identified to two groups as having with or without dissection (dissection (D) group or non-dissection (ND) grouP) underwent balloon angioplsty for CAD were studied. All patients with dissection could be managed by successful stent implantation to rescue the artery. The morbidity of ischemic complication and mortality were evaluated for 30days after PCI. Results: Coronary dissection developed 44 lesions (38%) in 31 patients out of 117 lesions in 78 patients after POBA and a good final angiographic result was obtained in all patients with dissection, Significant correlates of a development of dissection were the lesion morphology of ACC/AHA type B and C (P<0.05). There were no significant correlations of clinical pictures, whether POBA in single vessel disease or in multivessel disease, diameter stenosis before POBA, and balloon/coronary artery diameter ratio. Morphologic feature of dissection was type A in 15 (34%), type B in 13(30%), type C in 12 (27%), and type D in 4 (9%). After PCI, there was no ischemic complication or death related coronary dissection during follow-up period for 30days. Conclusions: Coronary dissection after angioplasty occurred in 44 lesions (38%) out of 117 lesions of 78 consecutive patients underwent POBA. Coronary dissection after POBA significantly correlated with the severity of lesion morphology. Coronary stenting is effective in the management of acute coronary dissections after angioplasty.