심부전에서 세포치료의 전망

백상홍 ( Sang Hong Baek ) 한국조직공학과 재생의학회 2005 조직공학과 재생의학 Vol.2 No.3

Cardiac repair is a dream of medical science field. The biological limitations to human cardiac regenerative growth create new strategies for cardiac regeneration using cells, genes and protein. Recent experimental studies and early-phase clinical trials showed stem cells have the potential to enhance myocardial perfusion and contractile performance in patients with acute myocardial infarction, advanced coronary artery disease, and chronic heart failure. The overall clinical experience also suggests that stem cell therapy can be safely performed, if the right cell protocol is used in the right clinical setting. Some experimental data showed stable stem cell engraftment by fusion or transdifferentiation into cardiomyocyte or vascular cell lineages as likely explanations for these beneficial effects. Others have proposed that transient cell retention may be sufficient to promote functional effects, e.g., by release of paracrine mediators. We should proceed cautiously with carefully designed clinical trials and concern that patient safety must remain the key issue. The translantional basic research to elucidate the mechanism of stem cell therapy is necessary.

국내 10개 대학병원의 관동맥질환자의 고콜레스테롤혈증 치료 현황

성지동 ( Ji Dong Sung ),김상현 ( Sang Hyun Kim ),김영대 ( Young Dae Kim ),백상홍 ( Sang Hong Baek ),안영근 ( Young Keun Ahn ),임도선 ( Do Sun Lim ),조홍근 ( Hong Keun Cho ),채성철 ( Shung Chull Chae ),한기훈 ( Ki Hoon Han ),김효수 대한내과학회 2005 대한내과학회지 Vol.69 No.4

목적 : 기존 연구들은 고콜레스테롤혈증 치료 지침이 충실히 지켜지지 않는 소위 치료 간극(treatment gap)을 보여 주고 있다. 국내에서 어느 정도의 치료 간극이 존재하는가에 대해서는 체계적인 연구가 전혀 없는 실정으로 앞으로 대책 수립을 위해서는 이에 대한 현황 파악이 필요하다. 본 연구는 국내의 10개 대학병원들에서 관동맥질환자의 고콜레스테롤혈증 관리에 있어서 NCEP ATP III 치료 지침에 근거하였을 때 어느 정도의 치료 간극이 존재하는가를 조사하고자 하였다. 방법 : 국내 10개 수련 병원에서 순환기내과 진료를 받은 총 1,048명의 환자에 대하여 의무기록을 조사하였다. 대상 선정 기준은 관동맥조영술 또는 심장부하검사 소견상 관동맥질환자로 판명된 경우, 외래병록지 또는 퇴원요약지 등에 협심증, 심근경색 등의 진단 또는 관동맥 성형술 또는 관동맥우회로술을 받은 병력이 명기되어 있는 경우로 하였다. 각 병원마다 3인 이상의 의사에서 각 의사마다 30인 이상의 환자를 추출하는 것을 기준으로 하여 순차적으로 의무 기록을 검토하도록 하였다. 다른 특정한 연구를 위하여 모집된 명부에서 환자를 추출하는 것은 금지하였다. 사용된 모든 고지혈증치료제의 명칭과 용량을 최초와 가장 최근의 경우로 나누어 기록하였고, 혈중 지질 검사 결과는 약물 복용 이전과 가장 최근의 결과를 기록하였다. 결과 : 연구의 결과는 10~50% 법칙으로 요약될 수 있다. 10% : 약물치료를 시행치 않는 경우의 평균 LDL 콜레스테롤 감소, 20% : 치료 전에 이미 치료 목표에 도달해 있는 비율, 30% : 약물치료시 평균 LDL 콜레스테롤 감소, 40% : 지질저하제 약물치료를 받지 않고 있는 관동맥질환자 비율, 50% : 치료 후 치료 목표에 도달하는 비율 결론 : 관동맥질환자의 고콜레스테롤혈증 치료에 있어서의 치료 간극 현상은 국내의 3차 병원의 순환기내과 의사들의 진료에 있어서도 존재하는 것이 확인되었다. 앞으로 다른 진료 환경에서의 치료 간극에 대한 추가 연구와 함께 치료 목표 달성율을 높이기 위한 조치들이 필요할 것으로 보인다. Background : Previous studies showed treatment gap phenomenon in the treatment of hyperlipidemia, meaning failure to adhere to the recommendation in the treatment guideline. In Korea, systematic research on this issue has never been done. This investigation was to estimate the hypercholesterolemia treatment gap in coronary artery disease (CAD) patients in tertiary care centers according to NCEP ATP-III guideline. Methods : Ten Korean educational hospital participated in the survey, reviewing medical record of 1,048 patients. Patients were enrolled when they were documented as having coronary artery disease by coronary angiography or stress tests or medical history of myocardial infarction, percutaneous coronary intervention or bypass surgery. Thirty or more medical records per each of 3 or more cardiologists were reviewed in each hospital. Sampling was done sequentially based on outpatient or inpatient list. Pharmacological treatment for hyperlipidemia included the first and last records of prescription. Baseline and the most recent lipid profiles were collected. Results : Findings from the survey was summarized as 10 to 50% rule: 10%: mean LDL-cholesterol reduction without lipid-lowering drug, 20%: LDL-cholesterol level at the treatment goal before any treatment, 30%: mean LDL-cholesterol reduction with lipid-lowering drug treatment, 40%: proportion of CAD patients without lipid-lowering drug, 50%: treatment goal achievement after treatment. Conclusions : Significant treatment gap exists in Korean cardiology practice in tertiary care centers. Systematic approach to reduce this gap is warranted.(Korean J Med 69:371-378, 2005)

좌심실 수축 기능 보전 심부전증의 치료

나수진 ( Soo Jin Na ),백상홍 ( Sang Hong Baek ) 대한내과학회 2015 대한내과학회지 Vol.88 No.2

More than 50% of patients who are diagnosed with heart failure have preserved ejection fraction (HFpEF), and they have an equally poor prognosis when compared to patients with heart failure with reduced ejection fraction (HFrEF). However, a comprehensive understanding and awareness of heart failure with preserved ejection fraction is still limited and there are currently no optimized treatments to improve morbidity and mortality in these patients. This review summarizes the differences in the epidemiology, pathophysiology, diagnosis, and prognosis between HFpEF and HFrEF. We also review current management strategies of HFpEF patients according to evidence-based treatment guidelines. (Korean J Med 2015;88:135-141)

원인 불명의 실신 환자의 진단에 있어서 Head - up tilt Test 의 유용성과 혈관미주신경성 실신 환자의 임상적 특징

윤호중(Ho Joong Youn),정욱성(Wook Sung Chung),백상홍(Sang Hong Baek),김철민(Chul Min Kim),박인수(In Soo Park),김재형(Jae Hyung Kim),최규보(Kyu Bo Choi),홍순조(Soon Jo Hong) 대한내과학회 1994 대한내과학회지 Vol.47 No.2

N/A Background: Syncope, defined as a transient loss of consciousness, is a frequently encountered symptom, but despite thorough clinical and invasive diagnostic investigation, the cause of syncope remains unexplained. In recent years, head-up tilt test has been of increasing interest as a diagnostic aids in patients with unexplained syncope. We studied to define the usefulness of various diagnostic test in the evaluation of patients with recurrent syncope, to assess the usefulness of head-up tilt test in the working of syncope of unknown origin and to evaluate the clinical characteristics of subgroups of patients with syncope induced by head-up tilt test. Methods: Between June, 1991 and November, 1992 at St. Mary`s hospital, 21 patients with history of syncope and 24 control subjects without history of syncope underwent 60° head-up tild test for 60 min. Results: 1) The definite cause for recurrent syncope were diagnosed in 10 of patients (47,6%) after clinical and invasive tests. 2) During head-up tilt test, vasovagal responses were provoked in 5 of 21 patients (23.8%) with recurrent syncope and 1 of 24 patients (4.2%) without syncope (p<0,05). 3) The head-up tilt test induced symptomatic bradycardia or hypotension in 3 of 10 patients (30%.) with negative electrophysiologic results. 4) During tilt induced vasovagal response, a) mean heart rate decreased to 42±24 beat/min from supine control of 70±12 beat/min (p<0. 05), b) mean systolic blood pressure decreased to 95±12 mmHg from supine control of 120±S mmHg (p<0,05), c) mean diastolic blood pressure decreased to 60±21mmHg from supine control of 72±13 mmHg (p<0.05), d) the time interval to onset of vasovagal response was 22±12 min. Conclusions: 1) In a large proportion of patients with recurrent syncope, the diagnosis remains unexplained despite a neurologic and cardiologic investigation including an electrophysiologic study. 2) Vasovagal responses are frequent cause in patients with recurrent unexplained syncope. 3) The head-up tilt test may be a simple, safe and highly yielding provocative test in the investigation of syncope of unknown origin.

propylthiouracil 유발성간염 2예

정규원(Kyu Won Chung),정환국(Whan Kook Chung),백상홍(Sang Hong Baek),박석영(Suk Young Park),임계순(Kae Soon Im),백남종(Nam Jong Paek),김영우(Young Woo Kim),손호영(Ho Young Son) 대한소화기학회 1986 대한소화기학회지 Vol.18 No.2

Propylthiouracil-induced hepatitis is an uncommon entity. Two cases of PTU-induced hepatitis have been observed. One case presents a histological picture resembling chronic active hepatitis; the other acute cholestatic hepatitis proven by rechallenge and histological finding but reveal normal lymphocyte transformation test: clinical course in two cases was uneventful with spontaneous remission. Despite its rarity, the disease should be suspected in the patient receiving PTU in whom clinical or labarotory evidence of hepatocellular injury is present.

정상인 직장도찰 피검물에서의 혐기균의 분리빈도

백상홍,이상원,진동찬 全北大學校 學徒護國團 1981 全國大學生學術硏究發表論文集 Vol.6 No.-

This study was made to isolate anaerobic bacteria from the rectal swabs of normal healthy persons and determine the normal flora of the intestine. Rectal swab specimens were obtaianed from normal healthy adults in Seoul. As the processes of bacteriological study, anaerobic bacteria were cultured in thioglycollate semisolid broth and isolated on brain heart infusion blood supplement agar plates, and biological properties were examined including the hemolysis on blood agar plated, gas production in the fluid media. Biochemical test was performed by Minitek Anaerobic Set (BBL^*) in anaerobic Gas Pak Jar (BBL^*) The result is as followings: 1. Among the 110 rectal swab specimens, 187 strains of anaerobic bacteria were isolated. The isolates included 88 straing (47.1%) of Gram positive bacilli, 74 strains (39.5%) of Gram negative bacilli and 25 strains (13.3%) of Gram positive cocci. 2. After preservation at-80 C in thioglycollate broth, only 134 strains (71.1%) of isolates survived. Theses survivors included 76 strains of Gram positive bacilli (survival rate 86.4%), 38 strains of Gram negative bacilli (survival rate 51.4%), and 20 strains of Gram positive cocci (survival rate 80.8%). 3. From these strains, 50 strains were randomly selected by the ratio of morphologic groups of isolates for the sugar fermentation and other biochemical tests. Among these selectes and tested straing, the determined were : Eubacterium aeroficiens 27 strains(54.0%) Bacteroiaes melaninogenicus 7 strains (14.0%) Peptostreptococcus produtus 6 strains (12.0%) Eubacterium limosum 1 strains (2.0%) and the undetermined strains were : Gram negative bacilli 7 strains (14.0%) Gram positive bacilli 1 strain (2.0%) Gram negative cocci 1 strain (2.0%)

불현성 우회로를 이용한 상실성 빈맥의 수술적 치험 1 예

김치경,최재철,홍순조,이홍균,홍현상,백상홍,전승석,곽문섭 대한내과학회 1989 대한내과학회지 Vol.36 No.2

Intracardiac stimulation and recording techniques have led to the recognition that a bypass tract which is functionally silent during sinus rhythm and therefore clinically unsuspected, is frequently responsible for cases of supraventricular tachycardia. The atrioventricular (AV) bypass tracts, functioning as the retrograde limb of the re-entrant circuit, is the second most common mechanism of paroxysmal supraventricular tachycardia and has no evidence of pre-excitation in the surface electrocardiogram. Surgical interruption of the accessory pathway may also be considered for the recurrent incapacitating or life-threatening episode that is refractory to medical treatment and/or pacing. In this report we describe the electrophysiological finding, in which the distal coronary sinus activation (post left atrium) appeared early relative to the low septal and high right atrium, and suggested the presence of left sided AV bypass tract. At surgery, epicardial mapping confirmed the site of the concealed AV bypass tract on the post left atrial wall. The young patient, who presented a refractory reciprocating tachycardia, was treated with a surgical incision with a local cryoablation at the site of the AV bypass tract. After operation, we could not induce PSVT any more by pacing.

Pasteurella Multocida 에 의한 심내막염 1예

백상홍,신완식,윤기주,홍순조,강문원,정희영 대한감염학회 1989 감염 Vol.21 No.3

Although pasteurella multocida infection in men is a rare disease but recently an increasing numbers of infections in men have been reported. Still pasteurella multocida is a quite rare cause of infective endocarditis. Recently we experienced a case of pasteurella multocida endocarditis. A 40-year old man was admitted because of dyspnea and fever. In this case pasteurella was identified from the blood culture, and echocardiography showed the findings of mitral stenosis, thrombi in both atria and bacterial vegetations on the aortic and mitral valve areas. In spite aggressive antibiotics and intensive care the patient was expired on 19th hospital day.

CAPD환자에서 복막염을 포함한 합병증에 관한 임상경험

방병기,백상홍,박인석,장윤식,윤영석 대한의학협회 1961 대한의학협회지 Vol.4 No.1

고콜레스테롤혈증 환자에 대한 Pravastatin(Mevalotin^(�)의 임상 효과

박준철,백상홍,김종진,김종상,김재형,최규보,홍순조 최신의학사 1993 最新醫學 Vol.36 No.3