혈액투석중인 만성신부전증 환자에서 심전도상 RR 간격의 변화

장경식(Kyoung Sig Chang),이승일(Seung Il Lee),문철웅(Chul Oong Moon) 대한내과학회 1992 대한내과학회지 Vol.43 No.4

N/A Background: Heart rate variability is a noninvasive index of the neural activity of the heart. Peripheral neuropathy, especially autonomic dysfunction, may be present in patients with chronic renal failure treated with hemodialysis. Heart rate variatios (RR interval) response to deep breathing and the Valsalva maneuver enable accurate, reproducible, and noninvasive evaluation of autonomic dysfunction. Method: To evaluate autonomic neuropathy in CRF patients, 41patients (postural hypotension: 7) who had been treated with hemodialysis were compared with 39normal subjects. Result: The findings were as follows. RR variations (Mean, Max, Min, SD, CV, Max/Min) during deep breathing were significantly lower in the CRF patients than in the normal control group (p<0,01, p<0.01, p< 0.05, p<0,05, p<0.05, respectively), RR variations (Vmax, Vmax-Vmin, Vmax/Vmin) during Valsalva maneuver were significantly lower in the CRF patients than in the normal control group (p < 0.01, p<0.01, p<0.05, respectivley). RR variations and Valsalva ratio were more significantly lower in the CRF patients with and without postural hypotension compared to normal control group (p<0.01, p<0.05, respectively). But there was no significant correlation between any measures of heart rate variations and postural hypotention of CRF patients. RR variations and Valsalva ratio (SD, CV, Max/Min, Vmax/Vmin) decreased progressively with advancing age in the normal control group (p<0.01, p<0.05, respectively), but a lack of correlation in CRF patients treated with hemodialysis. Conclusion: From the above findings, it is concluded that measurement of RR variation during deep breathing and Valsglva maneuver allows assessment of the integrity of autonomic dysfunction in chronic renal failure treated with hemodialysis.

정상인에서 도플러 초음파술을 이용하여 측정한 니트로글리세린 투여후 두개내 혈류속도의 변화

박일(Il Park),장경식(Kyoung Sig Chang),안기완(Gi Wan An),최연수(Yeon Soo Choi),국기용(Ki Yong Kook),홍순표(Soon Pyo Hong) 대한내과학회 1995 대한내과학회지 Vol.48 No.4

N/A Objectives: With advances in transcranial ultrasound technology, transcranial color-code Doppler ultrasonography provides the anatomical location of basal transcranial vessel and their blood flow. To study of changes of cerebral blood flow, we measured continuously the blood flow velocity of middle cerebral artery by transcranial Doppler(2.5MHz) before and after sublingual administration of 0.6mg. nitroglycerin in twenty healthy young persons. Methods: Pulse rate and systolic and diastolic blood pressure and velocity of percussion(P), tidal (T) and dicrotic(Dc) wave, and diastole(Ds), velocity time integral(VTI), mean velocity(V), pulsatility index(PI) were measured. Results: Heart rate was increased, and systolic blood pressure was decreased significantly two minutes after administration of nitroglycerin. Diameter of outer margin of color Doppler spectrum was increased, and P, T, Ds, VTI and V were decreased significantly after two minutes. PI was increased significantly after two minutes, but returned to baseline level soon. Conclusion: We concluded that dilatation and decreased blood flow velocity of middle cerebral artery were resulted by nitroglycerin.

탐측자 심첨부 회전법에 의한 좌심방이 관찰에 대한 연구

정재용(Jae Yong Chung),장경식(Kyoung Sig Chang),류보열(Bo Yeol Ryu),모성환(Sung Whan Mo),김태종(Tae Jong Kim),문철호(Chel Ho Moon),진영기(Young Kei Chin),박유환(Yoo Whan Park),이승일(Seung Il Lee),홍순표(Soon Pyo Hong) 대한내과학회 1997 대한내과학회지 Vol.52 No.6

N/A Objectives: Visualization of the left atrial appendage(LAA) by the transesophageal echocardiography(TEE) is excellent, but it is difficult to visualize the LAA by the modified parasternal short-axis view(MPSA) in transthoracic echocardiography(TTE). We studied to determine the usefulness of the apical horizontal view(AHV) abtained by the apical rotation method of the transducer for the detection of the LAA. Methods: We studied the MPSA and AHV in 602 patients, The LAA was observed during diastole of the LAA. We obtained an apical horizontal view by 45 degree clockwise rotation of the transducer from the apical 2 chamber view and compared with the visualization of the LAA in AHV and MPSA. Results: Among 602 patients, LAA could not be visualized in 88(14.6%) because of a poor echo-window. LAA was more clearly visualized in 222 patients by the AHV than the MPSA and 56 patients by the MPSA than the AHV. LAA was same degree visualization in patients by the AHV and MPSA. In male and female, more than 55 ages and less than 55 ages, visualization of inner margin of the LAA by the AHV was more clear than by the MPSA. Conclusion: The AHV was a useful, noninvasive and reproducible method for the visualization of the LAA.

간장질환 환자의 혈중 α₁ - Antitrypsin 과 Prealbumin 에 관한 연구

채종구(Jong Koo Chae),배학연(Hak Yeon Bae),김만우(Man Woo Kim),장경식(Kyoung Sig Chang),정춘해(Choon Hae Chung),조건국(Kun Kook Cho) 대한내과학회 1987 대한내과학회지 Vol.33 No.2

N/A The alpha-1-antitrypsin and prealbumin concentrations were measured in sera of 34 cases of liver cirrhosis, 20 cases of liver cirrhosis with hepatocellular carcinoma, 18 cases of primary hepatocellular carcinoma and 30 normal control cases in Chosun University Hospital from Jan. 1985 to July 1986. The results are follows: 1) The mean concentration of alpha-1-entitrypsin in blood of normal control group was 141±39.9mg%, in liver cirrhosis, liver cirrhosis with hepatocellular carcinoma and primary hepatocellular carcinoma concentrations were increases each 151.4±93.0, 185.8±71.8 (P<0.05) and 163.4±88.6 mg% in comparison with the mean value of normal control group. 2) The mean concentration of prealburnin in blood of normal control group was 174±65 mg9o, in liver cirrhosis, liver cirrhosis with hepatocellular carcinoma and primary hepatocellular carcinoma concentrations were significantly decreased each 101±49, 82±16 and 75±26 mg% fall P<0.01). 3) The mean concentrations of serum prealbumin in each group of liver diseases with low serum alpha-1-antitrypsin levels: liver cirrhosis (79.1±21.1), liver cirrhosis with hepatocellular carcinoma (41.0±12.0) and primary hepatacellular carcinoma (52.5±17.0 mg%) were significantly decreased (all P<0.01). Consequently, in chronic liver diseases, the serum alpha-1-antitrypsin levels were usually increases and prealbumin levels were significantly decreased in comparison with mean value of normal control group. In chronic liver diseases with low serum alpha-1-antitrypsin level, serum prealbumin concentrations were significantly decreased, This study show that patients with low serum alpha-1-antitrypsin level in chronic liver diseases have severe damage of parenchymal cells in liver.

관동맥 스텐트 시술 직후 관동맥 분지폐쇄의 예측인자

서영욱 ( Young Uk Seo ),고영엽 ( Young Youp Koh ),강민정 ( Min Jung Kang ),장경식 ( Kyoung Sig Chang ),홍순표 ( Soon Pyo Hong ) 대한내과학회 2004 대한내과학회지 Vol.67 No.2

당뇨병 환자에서 RR 간격의 변화에 관한 연구

김완중(Wan Jung Kim),김중남(Jung Nam Kim),김호중(Ho Jung Kim),문철웅(Chul Oong Moon),이승일(Soung Il Lee),장경식(Kyoung Sig Chang),홍순표(Soon Pyo Hong) 대한내과학회 1990 대한내과학회지 Vol.39 No.4

N/A Heart rate variability is a noninvasive index of the neural, especially parasympathetic, activity of the heart. Autonomic neuropathy is frequently observed in diabetic patients, and a 5-year survival rate of this kind of patient is low. To evaluate autonomic neuropathy in diabetic patients, 35 diabetic patients (proliferative retinopathy: 14, neurogenic bladder:8, postural hypotenion:6) measured for RR intervals and Valsalva ratios compared with 77 persons of the normal control group. RR variations (standard deviation: SD, coefficient of variation: CV, max-min, max/min) during deep respiration and Valsalva ratios (Vmax-Vmin, Vmax/Vmin) during Valsalva maneuver were significantly lower in the diabetic patients than in the normal control group (p<0.001, respectively). RR variations and Valsalva ratios decreased progressively with an increase of age in the control group and in diabetic patients (p<0.001, respectively). RR variations and Valsalva ratios were significantly lower in the diabetic patients with retinopathy, neurogenic bladder, and postural hypotension compared to diabetic patients without such conditions (P value <0.01, <0.05, <0.05, respectively). It is concluded that diabetic autonomic neuropathy can be indicated by the measurement of RR variations and Valsalva ratios.

자연발증 고혈압쥐에서 Atenolol이 대동맥 미세구조변화에 미치는 영향

김용태,이승일,장경식 朝鮮大學校 附設 醫學硏究所 1992 The Medical Journal of Chosun University Vol.17 No.1

Hypertension has been known as a major risk factor for atherosclerosis, left ventricular hypertrophy, sudden death and other cardiovascular diseases. Hypertension-induced vascular changes are thought to be adaptive to the increased stress. Adaptation in the media includes incresed synthesis of the major connective tissue components, elastin and collagen, hypertrophy and hyperplasia of smooth muscle cells (SMC), which are due to wall thickening and increase in arterial cell mass. The present electronmicroscopic study was performed in normal Wistar-Kyoto rats(WKR), nontreated spontaneously hypertensive rats(SHR) and atenolol-treated SHR (2.5 ㎎/Kg/day) to define and compare the morphologic changes of aorta induced by hypertension as well as the restoration on its wall in normal WKR, SHR & atenolol treated SHR. Pretreatment with atenolol for 22 weeks thickness of media of the SHR aorta caused by hypertension was decreased and space between prominent elastic laminae was narrowed as compared to the control SHR. Irregularly arranged collagenous fibers among the abundant SMC in control SHR aorta are regularly distributed as shown in control WKR or atenolo-pretreated SHR. Cross bands of collagen fibrils are partly apparrent in atenolol-treated SHR. While were not clear and some fragemented in the media of the control SHR aorta. Ultrastructural study also revealed that nucleus with double membrane was well-developed, heterochromatin along with normally distributed, enchromatin and that various-sized vacuoles disappeared follow ing improvement of hypertension by chronic pretreatment with atenolol. According to the from these experimental results, it is thought that atenolol a beta-adrenergic antagonist may improve vascular changes inducde by hypertension. Euchromatin are normally distributed and various-sized vacuoles disappeared following reversal of hypertension. From these experimental results, it is thought that atenolol, one of the beta-adrenergic blockades may improve vascular changes induced by hypertension.

S-상 심실중격의 임상적 고찰

이동민,장경식,양종태,장대용,김종오,서영욱,고영엽,홍순표 조선대학교 부설 의학연구소 2002 The Medical Journal of Chosun University Vol.27 No.1

Background: The sigmoid septum described an anatomical variation in the contour of the left ventricular outlet. It is related to degenerative change with aging. We observed clinical significance of sigmoid septum in Korean. Methods: Echocardiographic examination was performed in 434 patients. Sigmoid septum is defined as discrete bulging of the proximal interventricular septum with that thickness is greater than 1.3cm or the thickness is grater 1.5 times than adjacent mid interventricular septum in apical 3 chamber view. Result: The incidence of patient with sigmoid septum(septum patient) is 24.8% (male 8.4%, female 16.3%) . The incidence increases with age and is more common in women. The patients with sigmoid septum were compared with targeted groups, there was no significant difference in blood pressure between them, but in height and weight, the former were lower. (p<001, p<03). In the patients with sigmoid septum, weight and the surface area of a body have an opposite correlation with increase of age (p<03, r=-0.34) (p<04, r=-0.31) , but no decrease of height was found according to age increase (p=0.47, r=-0.11) The main reason patients with sigmoid septum ask echocardiolography and its clinical symptoms were abnormal results of previous electrocardiography and/or usual chest pain. Compared with control group, interventricular septal thickness is larger in septum patients (p<001). The thickness of interventricular septum located in subaortic left ventricular outflow tract is 1.6±0.3cm. There is another web like structure that continued from interventricualr septum to anterior free wall of left ventricle and the width is 1.6±0.4cm. A sign of insignificant obstruction due to left ventricular outflow was observed from three sigmoid septum patients. Conculusion: Septum patient is largely found in older age group and the body weight and body surface area are lower than control group. The body weight and body surface area are opposite correlation with age. So sigmoid septum is considered as structural change by weight reduction with aging. It is assumed that septum patients are related with asymptomatic ischemia because they have more abnormal ECG finding such as T wave inversion on precordial leads or standard leads, nonspecific ST-T change, LBBB etc. Sigmoid septum is not only proximal interventricular septal bludging but also another web like structure continuing to anterior wall of left ventricle.

대동맥 이첨판과 승모판 이탈증을 동반한 대동맥 판하부 협착 1예

김용화,장경식,양태영,임영국,안기완,홍순표 朝鮮大學校 附設 醫學硏究所 1993 The Medical Journal of Chosun University Vol.18 No.1

Discrete subaortic stenosis is a rare cardiac disorder especially in Orientals which occupies eight to ten percent of aortic stenosis, It occurs mainly before age of eighteen and accompanies with aortic valve abnormalities such as aortic stenosis, supravalvrlar stenosis, bicuspid valve and muscular hypertrophic subaortic stenosis, and other cardiac abnormalities such as ventricular septal defect, pulmonary stenosis and coarctation of aorta. There is no report of discrete subaortic stenosis accompanied with mitral valve prolapse. The major complications of discrete subaortic stenosis are aortic insufficiency, and subacute bacterial endocarditis. We report a case of asymptomatic nineteen-year-old male of discrete subaotic stenosis with bicuspid aortic valve and mitral valve prolapse, which is comfirmed by two-dimensional and Doppler echocardiography including transesophaigeal echocardiography.

신장허혈백서에서 투여 시기에 따른 캄슘길항제의 효과

이승일,문철웅,장경식 朝鮮大學校 附設 醫學硏究所 1992 The Medical Journal of Chosun University Vol.17 No.1

During ischemia, the cellular ATP concentrations quickly decline due in part to the absence of an adequate electrone acceptor and in part to the continued utilization of previously sythesized ATP by energy-dependent functions and the levels of ADP and AMP rise rapidly and these were further catabolised to hypoxanthine. Hypoxanthine and xanthine catabolized to uric acid by xanthine oxidase and in these metabolic step, free radicals were produced. The levels of intracellular calcium were increased due to the impared faction of membrane pump such as Na-K ATPase and Ca-ATPase because of decresed ATP levels in ischemia. Calcium promote cell injury including the plasma membrane, mitochondria, endoplasmic reticulum and the cytoskeleton but the precise roles of calcium in ischemic cell injury were unknown. In this experiment, effects of trifluoperazine(calmodulin antagonist) and allopurinol(xanthine oxidase inhibitor) on ischemic-reflowed rat kidney was investigated by the contents of malondialdehyde(MDA) as a indicator of lipide proxidation, the activities of antioxidant enzymes including superoxide dismutase(SOD), glutathione peroxidase and catalase, and the levels of glutathione. Allopurinol(50㎎/㎏ of body weight) was administrated by orally 12 hours before ischemia and trifluoperazine(2㎎/㎏ of body weight) was administrated 10 minutes before ischemia or 10 minutes after ischemia by intravenous injection. The contents of MDA was significantly increased by ischemia-reflow but significantly reduced by allopurinol pretreatment. The decrement of SOD and catalase activities were significantly reduced by allopurinol and trifluoperazine regardless of adminstration time compared with allopurinol pretreated group. The changes of glutathione peroxidase activity was significantly reduced by allopurinol and trifluoperazine. But the levels of glutathione was significantly decreased by allopurinol and trifluoperazine. These result suggested that xanthine oxidase and calcium paticipate in ischemic-reflow cell injury in rat kidney and calcium induced cell injury occure mainly during reflow period.