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관동맥이 완전폐쇄된 환자에서 측부순환과 99mTc - MIBI 심근 SPECT 소견 비교
손경환(Kyung Hwan Son),김권삼(Kown Sam Kim),이무열(Moo Yel Lee),이원호(Won Ho Lee),김덕윤(Deog Yoon Kim),강흥선(Heung Sun Kang),조정휘(Chung Whee Choe),김명식(Myung Sik Kim),송정상(Jung Sang Song),배종화(Jong Hwa Bae) 대한내과학회 1997 대한내과학회지 Vol.53 No.1
N/A Objectives: The role of coronary collateral circulation in protecting myocardium after the occlusion of a supplying artery has long been debated. Recent date show that the coronary collateral circulation may partially prevent ischemia and preserve myocardial contractile function. The purpose of this study was to evaluate the relation between the grades of collateral circulation and perfusion scores of 99mTc-Heart SPECT in patients with totally coronary occlusion. Methods: We studied 44 patients with totally coronary occlusion who had been hospitalized at Kyung Hee University hospital between October, 1989 and May, 1994, Patients were classified into two groups; Group 1: patients with angina pectoris (n=21), Group 2: patients with myocardial infarction (n=23). Angiographic collateral circulation was graded from 0 to 3: 0=none, 1=filling of side branch only, 2=partial filling of the epicardial segment, 3=complete filling of epicardial segment. The perfusion score of dipyridamole stress 99mTc-MIBI Heart SPCET was analyzed with angiographic findings. Resting and stress echocardiography were analyzed to identify left ventricular wall motion abnormalities. Results: 1) When LAD was totally occluded, there were hishevcrgree of collateral circulations from RCA in group 1 and group 2. When RCA was totally occluded, there was higherdesree of collateral circulation from LAD in group 1 and group 2. 2) The degree of collateral development was higher in group 1 than in group 2 (2.5±0.7 vs. 1.8±1.0, p<0.05). 3) In 99mTc-MIBI Heart SPECT, there was no significant difference of perfusion score at stress but perfusion score was significantly higher in group I than in group 2 at rest. 4) In 99mTc-MIBI Heart SPCET, there was no difference of perfusion score between totally coronary occlusion territories in group 1 and more than 50% coronary artery stenotic territories in group 1 and group 2. 5) In stress echocardiography, ten of the 13 patients showed normal LV wall motion at rest, but 9 of these 10 patients showed LV wall motion abnormalities at stress in group l. In group 2, all 10 patients showed LV wall motion abnormalities at rest and 3 of these patients showed more aggravation of LV wall motion abnormalities. Conclusion: Collateral circulation in angina patients can prevent myocardial ischemia and preserve myocardial function at rest, but not at exercise. Collateral circulation in patients with myocardial infarction cannot preserve myocardial function at rest. and exercise. Dipyridamole stress 99mTc-MIBI Heart SPECT is one of the indirect quantification methods to evaluate collateral development and coronary flow reserve.
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항호중구 세포질항체와 연관이 있는 혈관염에서 동반된 다발성 단신경염(Mononeuritis Multiplex) 1 예-ANCA(+) Mononeuritis Multiplex-
김권삼,강흥선,임천규,김명식,류혜영,손경환,이무열,정경천,성동욱,구혜수 대한내과학회 1996 대한내과학회지 Vol.51 No.5
Mononeuritis multiplex is known to occur in many illness including certain types of systemic vasculitis, ANCA has been described in association with Wegener's granulomatosis, polyarteritis nodosa, and pauci-immune necrotizing crescentic glomerulonephritis, since it was first reported in 1982 by Davis et al in patients who had necrotizing glomerulonephritis with no immune deposits. ANCA may well be useful in distinguishing cases mediated by vasculitis from those produced by other processes, especially early in the course of a disease. We report a case of mononeuritis multiplex due to ANCA associated vasculitis. We diagnosed vasculitis neuropathy by sural nerve biopsy and angiography. The patient was treated with prednisolone and oral cyclophosphamide. Her subjective symptoms and objective signs were improved. Subsequent examination of ANCA was negative.
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