흉부손상 401례에 대한 임상적 관찰

안병희,이호완,이동준,Ahn, Byoung-Hee,Lee, Ho-Wan,Lee, Dong-Joon 대한흉부심장혈관외과학회 1981 Journal of Chest Surgery (J Chest Surg) Vol.14 No.4

A clinical evaluation was performed on 402 cases of chest trauma those were admitted and treated at the department of chest surgery, Chonnam National University Hospital, during the past 13 years and 7 months from Jan. 1968 to July 1980. 1. The ratio of male to female was 5.5:1 in 1968 and 3.4:1 in 1980 with progressive increase of female patient and age from 20 to 59 years is 81.0%. 2. The most common cause of chest trauma was stab wound in penetrating trauma and traffic accidents in nonpenetrating trauma. 3. The most common injury from chest trauma was hemothorax in penetrating trauma and rib fracture in nonpenetrating trauma. 4. Hemothorax was observed in 76 cases [18.9%] of total cases and rib fracture was observed in 163 cases [40.5%] of total cases. 5. Rib fracture was prevalent from 4th to 8th rib, and 1st and 2nd rib fractures were associated with major thoracic injuries and with other organ injuries. 6. Open thoracotomy was performed in 72 cases [17.9%] and others were treated with conservative nonoperative treatment. 7. Overall mortality was 4.5% [19 cases], and common causes of the death were shock and respiratory insufficiency.

단관상동맥에 발생한 관상동정맥루 -치험1례-

안병희,이동준,Ahn, Byoung-Hee,Lee, Dong-Jun 대한흉부심장혈관외과학회 1982 Journal of Chest Surgery (J Chest Surg) Vol.15 No.3

Single coronary artery is rare congenital anomaly with incidence about 0.04%. Above half of single coronary artery is symptomless, and about 41% of cases are associated with another congenital cardiac anomalies . Single coronary artery is sometimes important for cardiac operation to avoid fatal result from cutting of coronary artery during the right ventriculotomy. Among the associated anomaly of the single coronary artery, coronary arteriovenous fistula is very rare. We experienced congenital single coronary artery with coronary arteriovenous fistula drained into the right ventricle, and so we report this case with literatures.

누두흉의 임상적 고찰

안병희,허선,Ahn, Byoung-Hee,Hur, Sun 대한흉부심장혈관외과학회 1990 Journal of Chest Surgery (J Chest Surg) Vol.23 No.2

This study is a review of the early postoperative results in fifteen patients who diagnosed funnel chest and underwent the corrective surgical procedure by the sternal turnover[STO] or the sternocostal elevation[SCE] between January 1988 and February 1990. Thirteen among fifteen patients were male. Early eight patients were corrected by the STO and late seven patients by the SCE. Cosmetic result was excellent in one, fair in five, poor in two patients who received the STO and excellent in all patients corrected by the SCE. This unfavorable postoperative result in the STO group was due to the protrusion of inverted xiphisternal joint, the depression along the rejoined costal cartilages and forward tilting of the distal sternum. The lower vertebral indices measured on the lateral chest film were improved postoperatively from 0.42\ulcorner0.08 to 0.30\ulcorner0.05 in the STO group and from 0.31\ulcorner0.05 to 0.24\ulcorner0.03 in the SCE group. There was significant improvement in lower vertebral index in both groups, but it was difficult to compare the postoperative improvement between groups due to the different preoperative status. In the SCE group, the funnel index and the degree of depression measured on the computed tomography were significantly improved from 5.29\ulcorner1.72 and 3.11\ulcorner0.71 to 2.77\ulcorner0.46 and 1.63\ulcorner0.19[P<0.05], but there was no significant change in the degree of flatness postoperatively. This results suggest that sternocostal elevation is more cosmetic procedure than sternal turnover in children and in young adolescents whose funnel index measured on the computed tomography is low.

승모판 협착증에서 치료 방법에 따른 임상 및 심초음파 소견의 변화

조인종(In Jong Cho),김원(Woen Kim),김계훈(Kye Hun Kim),강경태(Kyung Tae Kang),안영근(Young Keun Ahn),정명호(Myung Ho Jeong),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),강정채(Jung Chaee Kang),안병희(Byoung Hee Ahn),김상형(Sang Hyu 대한내과학회 2001 대한내과학회지 Vol.60 No.6

N/A Background : Although rheumatic mitral stenosis is still a prevalent and clinically significant valvular heart disease in Korea, the natural history of rheumatic mitral stenosis has not been clearly determined yet. The present study aimed to evaluate the clinical and echocardiographic changes in patients with rheumatic mitral stenosis according to different therapeutic modalities. Methods : A total of 91 patients (66 women; mean age, 50.9±12 years) with dominant rheumatic mitral stenosis and mitral valve area of less than 1.5 cm2 who were followed for more than 3 years (mean: 5.1 years) were included in this study. The subjects were divided into 3 groups according to the therapeutic modalities for mitral stenosis (A: medical therapy (n=31), B: percutaneous mitral valvuloplasty (n=30), C: mitral valve replacement (n=30)). Clinical and echocardiographic follow-up was performed before and immediately after therapeutic intervention such as percutaneous mitral valvuloplasty (PMV) and mitral valve replacement (MVR) and every year thereafter. Clinical symptoms and echocardiographic findings were compared between 3 groups. Results : The patients of group B consisted of less females and more younger (p=NS). Clinical symptom of dyspnea was more severe in group B and C initially (A: 1.8±0.8, B: 2.5±0.8, C: 2.9±0.7; A vs. B, A vs. C, p<0.05) but more improved in group B and C (A: 1.6±0.5, B: 1.3±1.0, C: 1.6±0.5; A vs B, A vs. C, p<0.05) during the follow-up. The prevalence of atrial fibrillation did not change significantly during follow-up. Mitral valve area decreased significantly in A group from 1.1±0.4 to 0.9±0.3 cm2 (p<0.05), but, no significant change was observed in group B and C. No significant changes were observed in the left ventricular end-diastolic, end-systolic dimensions, and ejection fraction during the follow-up period. No clinically significant aggravations of associated valvular

당뇨병 환자에서 고위험 관상동맥 중재술시 혈소판 당단백 IIb / IIIa 수용체 차단제 ( Abciximab : ReoPro ) 의 장기 임상 효과

심두선(Doo Sun Sim),정명호(Myung Ho Jeong),김원(Weon Kim),류제영(Jay Young Rhew),염주협(Ju Hyup Yum),김주한(Ju Han Kim),안영근(Young Keun Ahn),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),안병희(Byoung Hee Ahn),김상형(Sang Hyung Ki 대한내과학회 2002 대한내과학회지 Vol.62 No.2

N/A Background: High-risk percutaneous coronary interventions (PCI) are associated with high complication rate, low procedural success rate and high restenosis rate, especially in diabetics. We sought to observe whether diabetes affects long-term clinical outcomes after Abciximab (ReoPro) therapy in Korean patients undergoing high-risk PCI. Methods: One hundred nineteen patients with 152 lesion sites were administered ReoPro out of 2,231 patients who underwent PCI at Chonnam National University Hospital from Mar 1999 to Feb 2001. They were divided into two groups, 30 in diabetic group (Group I, 57.7±8.2 years, 22 male) and 89 in non-diabetic group (Group II, 59.6±10.8 years, 68 male). Early and long-term clinical outcomes after PCI were analyzed. Results: In clinical diagnosis the number of acute myocardial infarction was 25 in Group I (83.3%) and 76 in Group II (85.4%). As for risk factors and target lesion artery, ACC/AHA types, there were no differences between the two groups. The number of patients with total occlusion was 21 (55.3%) and 62 (53.9%) and thrombus-containing lesion 28 (93.3%) and 88 (98.9%) in Group I and II respectively. Procedure was successful in 27 (90.0%) in Group I and 80 (89.9%) in Group II and there were no differences in bleeding complications. No major adverse cardiac events (MACE), including myocardial infarction, repeat revascularization or cardiac death were observed in Group I, but there were 8 cases of MACE in Group II during hospitalization. Clinical follow-up was performed in 116 patients (97.5%) during 18.5±6.7 (5∼28) months. The number of overall MACEs were 10 (3.3%) in Group I and 14 (15.7%) in Group II (p=0.038). Conclusion: ReoPro used in high-risk PCI in diabetics was effective in early clinical outcome, but long-term clinical benefits were not warranted.(Korean J Med 62:171-181, 2002)

부분형 심내막상 결손증의 외과적 치험

안병희 全南大醫大 1986 전남의대학술지 Vol.23 No.3

항혈소판제와 병합요법에 따른 Probucol의 관상동맥 스텐트 시술환자에서 임상적 효과

김남호,정명호,김관,김용록,이승욱,김건형,조장현,박종철,앙영근,나국주,조정관,안병희,박종춘,강정채 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.7

한국인 심장판막 질환자의 수술 전 관상동맥 조영술에서 관상동맥 병변 예측인자

이민구,박종춘,홍영준,임지현,박형욱,김한균,김주한,김원,안영근,정명호,조정관,안병희,김상형,강정채 대한내과학회 2004 대한내과학회지 Vol.66 No.6

목적 : 판막 수술을 시행하고자 하는 일부 환자에서 수술 전 관상동맥 조영술이 시행되고 있다. 관상동맥 조영술의 필요성은 대개 나이, 성 그리고 이전의 협심증 병력의 유무에 따라 결졍되고 있으며, 본 연구는 심장판막질환자에서 관상동맥 병변의 존재 가능성을 시사하는 표지자를 찾고 수술 전 관상동맥 조영술의 적응증을 확립하기 위해 시행되었다. 방법 : 1996년 1월부터 2003년 1월까지 수술 전 관상 동맥 조영술을 시행받은 심장판막 질환자 208명을 조사하였다. 연령은 55.5±12.8세(남자 99명, 여자 109명)이었고, 각각의 환자에게 있어서 연령, 성별, 이전의 협심증 과거력, 고혈압, 당뇨병, 흡연력, 이상 지혈증, 비만 및 가족력의 변수들을 분석하였다. 결과 : 관상동맥 협착 병변을 보인 환자는 55명, 의의있는 관상동맥 병변을 보이지 않은 환자는 153명이었으며, 의의 있는 관상동맥 질환의 유병률은 26.4%이었고, 협심증은 33.6%에서 관찰되었다. 남자는 55세 이상, 여자는 65세이상의 연령에서 의의 있게 관상동맥 병변의 빈도가 높았다(p<0.05). 관상동맥 병변의 존재에 대한 표지자로서 의의 있는 변수들은 이상 지혈증(p<0.01), 고혈압(p<0.05), 협심증 과거력(p<0.05), 당뇨병(p<0.01), 흡연력(p<0.01) 등이었다. 결론 : 협심증의 과거력이 있어가 관상동맥 병변의 위험인자로 확인된 4개의 위험인자(고혈압, 흡연력, 당뇨, 이상 지혈증) 중 한 가지라도 있는 경우, 나이가 남자는 55세 이상, 여자는 65세 이상인 경우에 관상동맥 병변의 유병률은 높다고 할 수 있으며, 판막 수술을 시행하는 환자에서 이러한 조건에 해당하는 경우에는 수술 전 관상 동맥 조영술을 시행하는 것이 좋을 것으로 사료된다. Background : The preoperative coronary angiography is required in some patients underwent valvular surgery. The purpose of this study was to evaluate predictive factors for coronary lesion and to determine the indication for preoperative coronary angiography in Korean patients with valvular heart disease (VHD). Methods : Two hundreds eight patients (55.5±12.8 years, 99 male) with VHD underwent preoperative coronary angiography between January 1996 and January 2003 were analyzed the variables of age, gender, previous or current angina, hypertension, diabetes mellitus, smoking, dyslipidemia, obesity and familial predisposition according to the presence of coronary lesion. Results : The prevalence of significant coronary artery disease in VHD patients was 26.4% (55/208). The probability of coronary lesion was higher in male above 55 years and in female above 65 years than in younger patients. The predictive factors of coronary lesion were previous or current angina (p<0.05), dyslipidemia (p<0.01) by multiple logistic regression analysis. Conclusion : Previous or current angina and at least one of the four risk factors (hypertension, smoking, dyslipidemia and diabetes) are predictors of coronary lesion, especially in elderly Korean patients with VHD (older than 55 years in male and 65 years in female).

급성 심근경색증으로 인한 좌심실 기능 부전 환자에서 스타틴 투여의 장기적 임상 효과

홍영준,정명호,임지현,박형욱,김한균,박옥영,김주한,김원,안영근,조정관,서순팔,안병희,박종춘,김상형,강정채 대한내과학회 2004 대한내과학회지 Vol.66 No.6

목적 : 스타틴은 지질 저하 효과와 더불어 관동맥 질환 환자의 장기 사망률을 줄인다. 그러나 관동맥 질환으로 인한 좌심실 기능 부전 환자에서 스타틴의 효과에 대한 연구는 거의 없는 실정이다. 급성 심근경색증으로 내원하여 좌심실 기능 부전을 동반한 환자군을 대상으로 스타틴 투여에 따른 장기 임상경과를 관찰하고자 하였다. 방법 : 2001년 1월부터 2002년 6월까지 전남대학교병원 심장센터에 급성 ST 분절 상승 심근경색증으로 내원한 환자 중 LVEF가 40% 미만이었던 환자 202예를 대상으로 스사틴 투여군을 Ⅰ군(60.8±10.3세, 남: 76, 여: 30)으로, 스타틴을 투여하지 않은 군을 Ⅱ군(60.9±10.4세, 남: 75, 여: 19)으로 분류하고 양군 사이에 임상적 및 관동맥 조영술 특성 및 양군에서 1년 MACE를 관찰하였다. 결과 : 환자군의 임상양상, 내원시 혈액검사 소견, 관동맥 조영술상 특징 그리고 PCI의 결과 등에 있어서 양군간에 유의한 차이는 없었고, LVEF는 Ⅰ군 30.8±10.0%, Ⅱ군 31.9±9.6%이었다. PCI 시행 6개월 이후에 시행한 혈액검사에서 total cholesterol (Ⅰ군: 159±31 ㎎/dL, Ⅱ군: 178±33 ㎎/dL)(p=0.022), triglyceride (Ⅰ군: 108±54 ㎎/dL, Ⅱ군: 134±90 ㎎/dL)(p=0.013), LDL-cholesterol (Ⅰ군: 98±36 ㎎/dL, Ⅱ군: 123±29 ㎎/dL)(p=0.002), CRP (Ⅰ군: 0.6±0.4 ㎎/dL, Ⅱ군: 1.8±1.2 ㎎/dL)(p=0.011), fibrinogen (Ⅰ군: 255±55 ㎎/dL, Ⅱ군: 288±70 ㎎/dL)(p=0.017), 백혈구(Ⅰ군: 7,055±1,395/㎣, Ⅱ군: 573±180/㎣)(p=0.040)등의 수치에 있어서 Ⅰ군에서 유의한 감소를 보였고, HDL-cholesterol(Ⅰ군: 52±14 ㎎/dL, Ⅱ군: 42±10 ㎎/dL)(p=0.038)은 Ⅰ군에서 유의한 상승을 보였으며 PCI 시행 6개월 이후에 시행한 심초음파도에서 LVEF는 I군 42.4±10.7%, II군 38.9±10.1%로서 I군에서 더 유의한 좌심실 기능의 개선을 보였다(p=0.042). 1년간 추적관찰 중 MACE에 있어서 사망률[Ⅰ군: 2예(1.9%), Ⅱ군: 28예(43.1%), p=0.033], 반복전인 PCI율[Ⅰ군: 18예(25.7%), Ⅱ군: 28예(43.1%), p=0.033]등이 Ⅰ군에서 유의하게 낮았고, 무사고 생존한 경우가 Ⅰ군에서 유의하게 높았다[Ⅰ군: 83예(79.8%), Ⅱ군: 53예(57.0%), p=0.001]. 다변량 분석을 통한 재협착과 관련된 독립적인 예후인자는 병변의 길이, 내원시 0.5 ㎎/dL 이상으로 증가된 CRP 수치, 관동맥 조영술상 B_2 이상의 복잡 병변, 당뇨병 등이었다(각각 p<0.001, p=0.008, 0.014, 0.017). 다변량 분석을 통한 1년 주요 심장 사고와 관련된 인자는 내원시 0.5 ㎎/dL 이상으로 증가된 CRP 수치와 75세 이상의 고령 등이었다(각각 p<0.001. 0.012). 결론 : 좌심실 기능 부전을 동반한 급성 심근경색증 환자에서 스타틴을 투여한 경우 좌심실 기능이 개선되었고 사망률이 낮았으며, 재협착율과 반복적인 PCI율이 의미 있게 감소하였고, 1년간 무사고 생존율이 높았다. Background : Statins reduce mortality of patients with coronary artery disease. However, many trials have excluded patients with ischemic heart failure. Stains may have other beneficial effects besides cholesterol lowering, such as anti-inflammatory properties and improvement of endothelial function. The aim of this study was to determine the effects of statin therapy in acute myocardial infarction (AMI) patients with left ventricular (LV) dysfunction. Methods : We studied 202 patients with AMI with LV dysfunction [ejection fraction (EF) below 40%] between January 2001 and June 2002. The patients were divided into two groups: Group Ⅰ (n=106, 6038±10.3 years, male 71.7%) who were treated with simvastatin and Group Ⅱ (n=96, 60.9±10.4 years, male 78.1%) who were not treated with simvastatin. Results : At six-month after percutaneous coronary intervention (PCI), VLEF was more improved in Group Ⅰ than in Group Ⅱ (30.8±10.0% to 42.4±10.7% vs 31.9% to 38.9%, p=0.042). The levels of total cholesterol, trighlyceride and low density lipoprotein-cholesterol were more decreased and the level of high density lipoprotein-cholesterol was more increased in Group Ⅰ than in Group Ⅱ. The level of C-reactive protein, fibrinogen, white blood cell and monocyte count were more decreased in Group Ⅰ than in Group Ⅱ. During one-year clinical follow-up, statin therapy was associated with a significant reduction in mortality (1.9% vs 7.5%, p=0.048), restenosis rate (24.7%vs 43.1%, p=0.033) and repeat PCI rate (25.7% vs 43.1%, p=0.033). The event-free survival rate was higher in Group Ⅰ than in Group Ⅱ (79.8% vs 57.0%, p=0.001). Conclusion : Statin therapy improves LV systolic function and decreases mortality, restenosis and repeat PCI the AMI with LV dysfunction.

한국인에서 관상동맥 질환에 대한 만성 감염 및 염증의 역할

김계훈,정명호,신종희,주신배,김원,이승욱,김건형,김남호,조장현,박종철,안영근,나국주,조정관,안병희,박종춘,강정채 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.9