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만성 심방세동에 대한 전기적 심율동전환 전 경식도 심초음파검사의 유용성
강천수(Chun Soo Kang),심원보(Won Bo Shim),임장근(Jang Gun Im),장용우(Young Wo Jang),양주동(Ju Dong Yang),김태균(Tae Gyun Kim),심지향(Ji Hyang Shim),이성주(Sung Ju Lee) 대한내과학회 1995 대한내과학회지 Vol.48 No.1
N/A Objectives: Cardioversion is performed in patients with atrial fibrillation to improve cardiac function, relieve symptoms, and decrease the risk of thrombus formation. Because atrial thrombi are poorly detected by conventional noninvasive techniques, such as transthoracic echocardiography and successful cardioversion is associated with 5 to 7% incidence of embolism in case of no anticoagulant therapy, several weeks of anticoagulation before cardioversion is required. But anticoagulation carries its own risks and the patient must be rehospitalized for cardioversion after several weeks. We evaluated the efficacy of transesophageal echocardiography, a accurate method of detecting atrial thrombi, to exclude the presence of atrial thrombi in patients with chronic atrial fibrillation, thereby allowing early safe cardioversion. Methods: A total 154 consecutive patients after being excluded the cases of paroxysmal atrial fibrillation, sick sinus syndrome, digitalis toxicity, heart failure or angina class 4, myocardial infarction within 6 months, unstable angina, hyperthyroidism, severe systemic disease, long-term anticoagulation, or contraindication of TEE, underwent transthoracic and transesophageal echocardiography followed by cardioversion in 44 patients who agreed cardioversion among patients without thrombi. Before cardioversion, left atrial (LA) dimensions, LA area, left ventricular ejection fraction (LVEF) were measured. Short-term anticoagulation with heparin was used in 44 patients before cardioversion, and then heparin was continued for 24 hours after cardioversion success according to α-PTT. Oral anticoagulation with warfarin was used in selected cases of the failed cardioversion according to PT. Results: LA thrombi were identified in 32 patients (21%) on TEE, and LA thrombi of 25 patients were visualized only on TEE. Cardioversion was deferred with warfarin in these patients. 34 patients (77%) of the 44 patients without thrombi underwent successful cardioversion to sinus rhythm. Clinical and echocardiographic data showed the significant differences between cardioversion-success group and cardioversion-failure group in the duration of atrial fibrillation, LA area, and LVEF (all, p<0.01). None of these patients of both groups had an embolic event, but there're mild precordial hotnesses subsided spontaneously in 10 patients. Conclusion: In patients with chronic atrial fibrillation who are not receiving long-term anticoagulation, atrial thrombi are detected by TEE in a some portion (21%). Although large-scale trials are required to determine whether early cardioversion guided by TEE is safter than conventional therapy, our study suggest that early cardioversion can be performed safely without the prolonged oral anticoagulation before the procedure if TEE excludes the presence of thrombi.
國史古語彙 借字原義考 : 國號·地名·始祖·官名·祭政·歌樂名 등
梁柱東 명지대학교 1968 明大論文集 Vol.1 No.-
상대국사에 관한 여러 차자[사독]어휘--- 예컨대 '조선ㆍ아사달ㆍ낙랑' 또는 '단군ㆍ헉거세ㆍ거서간ㆍ을지'내지 '소도ㆍ화랑ㆍ화백ㆍ회소곡'등 고지명ㆍ인명ㆍ관명ㆍ제정ㆍ가락명 등등의 우리말로서의 근본적 어의는 민족문화 내지 사상의 원류를 징할만한 만중한 자료인 만큼 정확 또 신중항 고어학적ㆍ사학적 고증과 구명을 요함이 물론이다. 도서 '조선고가연구'(1942)의 주기의 일반이 특히 그 방면의 차자해의에 바쳐졌음은 그 때문이었다. 이러한 문제들의 정당한 해의가 일견 '묵은 일'인 듯하면서도 기실 민족문화 내지 민족사상의 매우 중요ㆍ결긴한, 언제나 새로운 논제임에 비추어, 문득 다시 학적 필흥을 일으켜 다음 몇측을 구설상서 중에서 골라 정리하고 간간 신견을 더하여 국학계에 부친다.