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      • 좌심방 점액종 치험 1예

        장일중,허준,최규복,신길자,이우형,박이갑,이두연 梨花女子大學校 醫科大學 醫科學硏究所 1985 EMJ (Ewha medical journal) Vol.8 No.3

        Myxoma of the left atrium is known to mimic the clinical and hemodynamic features of mitral valvular disease. The tumor was diagnosed by using the Echophonocardiography, CAT-scanning, and hemodynamic studies including left heart catheterization and angiography. The diagnosis was confirmed at operation. An electrocardiographic timing signal permitted correlation of heart sounds and pressure waves with movement of the tumor between the left atrium and the left ventricle. In early systole, the tumor suddenly moved from left ventricle to the left atrium, and a notch in the rising left ventricular pressure, a prominant c-wave, and loud, late element of the first heart sound were noted. In early diastole, the tumor moved rapidly through the mitral valve, causing an abrupt diminution in the left atrial volume, thus-causing rapid y-descent despite severe obstruction of the mitral valve. An early diastolic sound, thought to be an opening snap, appeared to be related to the checking of the tumor in the left ventricle.("Tumor plop"). The unusual left atrial pressure pulse permits accurate preoperative diagnosis in left atrial myxoma. In this respect we evaluated the accuracy of the preoperative noninvasive studies for the diagnosis of intra-cardiac myxoma.

      • KCI등재후보

        비후성 심근증에 동반된 급성 세균성 심내막염 1 예

        조영주,이우형,신길자,장일중,이은령,박이갑 대한내과학회 1986 대한내과학회지 Vol.30 No.3

        Bacterial endocarditis in patient with hypertrophic cardiomyopathy is infrequently reported. though it may not be uncommon. Thirtynine patients with bacterial endocarditis in bypertrophic cardiomyopathy have been reported in the world. However, there was no such a case reported in Korea. We experinced a case of bacterial endocarditis in hypertrophic cardiomyopathy. This 16 year old male man visited hospital because of exertional dyspnea and high fever for three days. Echocardiography revealed asymmetrical septal hypertrophy, systolic motion of anterior mitral leaflet and sheggy appearance of mitral valvesuggestive of vegetation. In blood culture, staphylococcus aureus was isolated. We reported the case with review of literatures.

      • KCI등재후보

        울형성 심부전증에서 심혈관계 보상기전의 지표로서 저나트륨혈증의 의의에 관한 연구

        김경환,김미경,이우형,홍사석,신길자,장일중 대한내과학회 1986 대한내과학회지 Vol.31 No.3

        In patient with congestive heart failure, it is well known that the sympatho-adrenal system and the renin angiotensin system are activated to compensate for the reduction of cardiac output and the redistribution of blood flow. Although Lilly, et al. (1984) and Francis, et al. (1985) have insisted that the induction of these circulatory compensation mechanism by pastura1 changes is closely related to the concentration of plama sodium in congestive heart failure, it is still controversial. Thus, in an effort to clarify this hypothesis, present study was designed to determine the relationship between the existing sodium concentration in plasma and the changes of the plasma catecholamine concentration and renin activity during postural alterations in patients with congestive heart fai1ure and normal subjects. Ten patients with congestive heart failure who had been admitted to the Ewha Womans University Hospital from May, 1985 to July, 1985 and five normal volunteers were chosen. Patients with more than one year history of congestive heart failure belonging to class 3 or 4 as the criteria set by the New York Heart Association have been selected for this study. Among these ten patients, 5(3 males and 2 females) had low plasma sodium concentration(below 135mEq/l) and 5(3 males and 2 females) had normal plasma sodium concentration(above 135mEq/l). The observed results are as follows: 1) In the normal subjects, the observed plasma renin activity was 1,2±0.4ng/ml/hr and the concentrations of norepinephrine and epinephrine were 177.5±27 and 150.0±8pg/ml, respectively, at supine position. However, these values were increased by about 2 times by changing to upright position. 2) In patients with hyponatremic congestive heart failure, the values of plasma renin activity and catecholamine levels were significantly higher than those patients having normonatremia. 3) The increase in the plasma renin activity and catecholamin levels induced by upright position were minimal in patients with congestive heart failure having normonatremia. 4) However, in patients with hyponatremic congestive heart failure, the plasma renin activity and the levels of plasma catecholamines were not altered, or rather decreased, by the same postural changes. Based on the results, the levels of plasma sodium concentration in patients with congestive heart failure could provide an index for the induction of circulatory compensation mechaniams and may have important significance in determining the severity and prognosis of the disease. Particularly in the congestive heart failure patients with hyponatremia, as the circulatory compensation mechanism appear to be operating at maximum already, they would not be able to utilize the reflex compensation mechanism inducible with the changes of body position.

      • KCI등재후보

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