급성 ST분절 상승 심근경색 환자에서 성공적인 일차적 관상동맥 중재술 직후 발생한 급성 스텐트 혈전증

고영엽,김현욱,기영재,김성수,김현국,최동현,박근호,정중화,장경식 조선대학교 의학연구원 2017 The Medical Journal of Chosun University Vol.42 No.1

Stent thrombosis (ST) is the sudden occlusion of a stented coronary artery because of thrombus formation. ST is a rare, but can result in life-threatening complications. Early stent thrombosis occurs frequently after primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Here, we report a case of a 59-year-old man with acute stent thrombosis immediately after primary PCI with drug-eluting stent for acute STEMI.

Influence of Ketamine on Catecholamine Secretion in the Perfused Rat Adrenal Medulla

고영엽,정용훈,임동윤 대한약리학회 2008 The Korean Journal of Physiology & Pharmacology Vol.12 No.3

The aim of the present study was to examine the effects of ketamine, a dissociative anesthetics, on secretion of catecholamines (CA) secretion evoked by cholinergic stimulation from the perfused model of the isolated rat adrenal gland, and to establish its mechanism of action, and to compare ketamine effect with that of thiopental sodium, which is one of intravenous barbiturate anesthetics. Ketamine (30∼300μM), perfused into an adrenal vein for 60 min, dose- and time-dependently inhibited the CA secretory responses evoked by ACh (5.32 mM), high K+ (a direct membranedepolarizer, 56 mM), DMPP (a selective neuronal nicotinic NN receptor agonist, 100μM) and McN-A-343 (a selective muscarinic M1 receptor agonist, 100μM). Also, in the presence of ketamine (100μM), the CA secretory responses evoked by veratridine (a voltage-dependent Na+ channel activator, 100μM), Bay-K-8644 (an L-type dihydropyridine Ca²+ channel activator, 10μM), and cyclopiazonic acid (a cytoplasmic Ca²+-ATPase inhibitor, 10μM) were significantly reduced, respectively. Interestingly, thiopental sodium (100μM) also caused the inhibitory effects on the CA secretory responses evoked by ACh, high K+ , DMPP, McN-A-343, veratridine, Bay-K-8644, and cyclopiazonic acid. Collectively, these experimental results demonstrate that ketamine inhibits the CA secretion evoked by stimulation of cholinergic (both nicotinic and muscarinic) receptors and the membrane depolarization from the isolated perfused rat adrenal gland. It seems likely that the inhibitory effect of ketamine is mediated by blocking the influx of both Ca²+ and Na+ through voltage-dependent Ca²+ and Na+ channels into the rat adrenal medullary chromaffin cells as well as by inhibiting Ca²+ release from the cytoplasmic calcium store, which are relevant to the blockade of cholinergic receptors. It is also thought that, on the basis of concentrations, ketamine causes similar inhibitory effect with thiopental in the CA secretion from the perfused rat adrenal medulla. The aim of the present study was to examine the effects of ketamine, a dissociative anesthetics, on secretion of catecholamines (CA) secretion evoked by cholinergic stimulation from the perfused model of the isolated rat adrenal gland, and to establish its mechanism of action, and to compare ketamine effect with that of thiopental sodium, which is one of intravenous barbiturate anesthetics. Ketamine (30∼300μM), perfused into an adrenal vein for 60 min, dose- and time-dependently inhibited the CA secretory responses evoked by ACh (5.32 mM), high K+ (a direct membranedepolarizer, 56 mM), DMPP (a selective neuronal nicotinic NN receptor agonist, 100μM) and McN-A-343 (a selective muscarinic M1 receptor agonist, 100μM). Also, in the presence of ketamine (100μM), the CA secretory responses evoked by veratridine (a voltage-dependent Na+ channel activator, 100μM), Bay-K-8644 (an L-type dihydropyridine Ca²+ channel activator, 10μM), and cyclopiazonic acid (a cytoplasmic Ca²+-ATPase inhibitor, 10μM) were significantly reduced, respectively. Interestingly, thiopental sodium (100μM) also caused the inhibitory effects on the CA secretory responses evoked by ACh, high K+ , DMPP, McN-A-343, veratridine, Bay-K-8644, and cyclopiazonic acid. Collectively, these experimental results demonstrate that ketamine inhibits the CA secretion evoked by stimulation of cholinergic (both nicotinic and muscarinic) receptors and the membrane depolarization from the isolated perfused rat adrenal gland. It seems likely that the inhibitory effect of ketamine is mediated by blocking the influx of both Ca²+ and Na+ through voltage-dependent Ca²+ and Na+ channels into the rat adrenal medullary chromaffin cells as well as by inhibiting Ca²+ release from the cytoplasmic calcium store, which are relevant to the blockade of cholinergic receptors. It is also thought that, on the basis of concentrations, ketamine causes similar inhibitory effect with thiopental in the CA secretion from the perfused rat adrenal medulla.

생쥐 작은창자 사이질세포에서 bradykinin의 효과 및 bradykinin 수용체 아형의 발현

고영엽,전제열,최석,임용,김준수,문현식,김명룡,조경원,조향훈,장인엽 대한체질인류학회 2004 대한체질인류학회지 Vol.17 No.4

소화관 염증 시 소화관 운동성 이상이 초래되며 여기에 내인성 매개물질들이 관여하는 것으로 알려져 있 다. Bradykinin은 그 중 하나의 매개물질로서 신경전달물질이 아닌 펩티드성 국소 호르몬으로 염증이나 조직손상 시 혈장으로부터 생성되어 직접 민무늬근에 작용하여 소화관 운동성에 영향을 주고 있다. 소화관 운동성을 조절 하는 창자사이질세포(interstitial cells of Cajal, ICC)는 소화관 운동의 향도잡이 역할과 더불어 창자신경계로부터 민무늬근으로 신호를 매개하는 기능을 담당하고 있다. 본 연구는 생쥐 작은창자에서 배양된 창자사이질세포와 작 은창자근육층 전층표본을 대상으로 전기생리학적 및 면역조직화학적 방법을 통하여 bradykinin의 작용 및 분포를 알아보았다. Bradykinin-2는 창자사이질세포에서 세포막의 저분극을 유발하였으며, 소화관운동에 있어서 향도잡이 전류의 긴장성을 활성화 시켰다. 이중면역형광염색 결과, c-kit과 bradykinin-2 수용체가 창자사이질세포에서 함께 발현되었다. 따라서 본 실험의 결과 bradykinin이 간접적으로 창자사이질세포를 통하여 소화관 운동성을 조절할 수 있음을 시사하며 이 작용은 bradykinin-2 수용체를 통하여 매개되는 것으로 여겨진다. Interstitial Cells of Cajal (ICC) are pacemaker cells that generates slow waves and drive spontaneous mechanical contractions of gastrointestinal smooth muscle. Slow waves are generated the periodic activation of spontaneous inward currents (pacemaker currents). We studied the modulation of pacemaker activities by bradykinin (10-8 M) in cultured ICC with the whole cell patch-clamp technique, and the localization of bradykinin-2 receptor-immunoreactivity using double labelling immunohistochemistry in the murine small intestine. Externally applied bradykinin produced membrane depolarization in current-clamping mode. At a -70 mV of holding potential bradykinin increased tonic inward pacemaker currents. Double labelling with bradykinin-2 receptor and and c-kit was shown that ICC expressed the bradykinin-2 receptor-immunoreactivity. These results suggest that bradykinin modulates electrical activities of ICC via bradykinin-2 receptor, which may regulate gastrointestinal motility.

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.

Influence of Nicorandil on Catecholamine Release in the Perfused Rat Adrenal Medulla

고영엽,이은석,노해정,우승창,정중화,서유승,임동윤 대한약리학회 2007 The Korean Journal of Physiology & Pharmacology Vol.11 No.3

The present study was attempted to investigate the effect of nicorandil, which is an ATP-sensitive potassium (KATP) channel opener, on secretion of catecholamines (CA) evoked by cholinergic stimulation and membrane depolarization from the isolated perfused rat adrenal glands. The perfusion of nicorandil (0.3~3.0 mM) into an adrenal vein for 90 min produced relatively dose-and time-dependent inhibition in CA secretion evoked by ACh (5.32 mM), high K+ (a direct membrane depolarizer, 56 mM), DMPP (a selective neuronal nicotinic receptor agonist, 100μM for 2 min), McN-A-343 (a selective muscarinic M1 receptor agonist, 100μM for 4 min), Bay-K-8644 (an activator of L-type dihydropyridine Ca2+ channels, 10μM for 4 min) and cyclopiazonic acid (an activator of cytoplasmic Ca2+-ATPase, 10μM for 4 min). In adrenal glands simultaneously preloaded with nicorandil (1.0 mM) and glibenclamide (a nonspecific KATP-channel blocker, 1.0 mM), the CA secretory responses evoked by ACh, high potassium, DMPP, McN-A-343, Bay-K-8644 and cyclopiazonic acid were recovered to the considerable extent of the control release in comparison with that of nicorandil-treatment only. Taken together, the present study demonstrates that nicorandil inhibits the adrenal CA secretion in response to stimulation of cholinergic (both nicotinic and muscarinic) receptors as well as by membrane depolarization from the isolated perfused rat adrenal glands. It seems that this inhibitory effect of nicorandil may be mediated by inhibiting both Ca2+ influx and the Ca2+ release from intracellular store through activation of KATP channels in the rat adrenomedullary chromaffin cells. These results suggest that nicorandil-sensitive KATP channels may play an inhibitory role in the regulation of the rat adrenomedullary CA secretion.

Familial Isolated Noncompaction of the Ventricular Myocardium in Asymptomatic Phase

고영엽,서용욱,우정주,장경식,홍순표 연세대학교의과대학 2004 Yonsei medical journal Vol.45 No.5

Isolated noncompaction of the ventricular myocardium (INVM) is a rare cardiomyopathy resulting from a failure of normal endomyocardial embryogenesis and it has been categorized as a form of unclassified cardiomyopathy. The disorder is characterized by an excessively prominent trabecular meshwork with deep intertrabecular recesses. Although the disorder is sporadic, familial incidence may occur. Clinical symptoms and prognosis of INVM may differ markedly, and range from an asymptomatic course to a severe cardiac disability. The diagnostic method of choice for IVNM is echocardiography, which reveals multiple prominent trabeculations with deep intertrabecular spaces communicating with the left ventricular cavity in the middle and apical segments of the left ventricle. The authors report a case of INVM in a family in which three adult members (a brother and two sisters) were found to be affected by this disorder. They were all asymptomatic. The diagnosis of the disorder was made first in the 36-year-old brother by transthoracic echocardiography (TTE) and multidetector CT (MD CT), during the process of preoperative evaluation for surgical treatment of low back intervertebral herniated disc. TTE and MD CT showed similar and peculiar findings of INVM. Echocardiographic screening in all first-degree relatives of this patient, in order to identify asymptomatic patients, demonstrated INVM in two elder sisters.

항고혈압 치료시 발생할수 있는 신기능장애

고영엽 朝鮮大學校 附設 醫學硏究所 2004 The Medical Journal of Chosun University Vol.29 No.1

좌관동맥 입구 단독협착환자에서 자가심낭을 이용한 수술적 관동맥 성형술후 발생한 Patch원위부 협착 치험 1례

고영엽,홍석근,황흥곤 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.11

Inous풍선을 이용한 경피적 승모판막성형술후 추적관찰

고영엽,현민수,김정경 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.11