이형성 협심증의 임상상

강정아(Jeong A Kang),이유선(Yeu Seon Lee),정승현(Seung Hyeon Jeong),이정우(Jeong Woo Lee),김보영(Bo Yeong Kim),임대승(Dea Seung Im),이민수(Min Soo Lee),김정희(Jeong Hee Kim),정준용(Jun Young Jeong),최시완(Si Wan Choi),정진옥(Jin Ok J 대한내과학회 2002 대한내과학회지 Vol.63 No.2

목적: 우리나라는 이형성 협심증의 발생 빈도가 높음에도 불구하고 임상상과 예후에 대한 연구가 부족한 실정이다. 이에 본 조사는 이형성 협심증으로 진단을 받은 환자를 대상으로 그 빈도와 임상상 그리고 예후에 대해 연구 조사하였다. 방법: 1995년 1월부터 2000년 7월까지 흉통을 주소로 충남대학교병원 순환기 내과에 입원하여 관상동맥 조영술를 시행한 결과 관상동맥의 내경의 협착이 50% 미만이며 에르고노빈(ergonovine)8, 9) 유발 검사로 이형성 협심증으로 진단된 178명을 대상으로 하였다. 결과: 1) 관상동맥질환자 중 이형성 협심증 환자의 빈도는 13.2%로 높았다 2) 이형성 협심증의 위험인자는 흡연이 가장 많았다. 3) 이형성 협심증의 임상상은 대부분 불안정형 협심증의 양상이었고, 13.2%의 환자는 급성심근경색의 임상상을 보였다. 4) 흉통의 발생 시간대는 대부분 새벽이었고, 흉통의 지속시간 평균 11분으로 일반 협심증보다 길었다. 5) 흉통이 없을 때 검사한 심전도는 대부분에서 정상이었고, 운동부하 심전도검사는 76%에서 음성소견을 보였다. 6) 이형성 협심증의 진단에 에르고노빈 유발 관상동맥 조영술은 안전하고 유용한 검사이다. 7) 이형성 협심증의 치료에 칼슘길항제와 나이트레이트제제는 효과적인 약물이다. 8) 이형성 협심증의 예후는 비교적 양호하나 임의로 약물이 중단된 상태에서 심장사 할 수 있다. 따라서 이형성 협심증 환자는 흉통 발생에 대비한 나이트레이트의 준비가 필요하다. 결론: 본 조사에서는 관상동맥질환자의 13.2%가 이형성 협심증 환자였고, 이들은 약물 치료에 대한 효과와 예후가 비교적 양호하였다. 그러나 2.8%의 환자에서 심정지나 심장사가 발생하여 흉통 발생시에 적절한 나이트레이트제제의 사용이 필요하겠다. Background: Coronary artery spasm plays an important role in the pathogenesis of variant angina. However the precise mechanism (s) and the clinical characteristics of variant angina remain to be elucidated. We investigated the clinical characteristics and diagnostic features of variant angina. Methods: The clinical characteristics and coronary angiographic findings were analyzed in 178 patients with angiographically documented coronary artery spasm, which developed spontaneously or was provoked by the admistration of intravenous ergonovine maleate. All patients were followed for at least 1 year or more or until their death. Results: One hundred and eleven patients complained of chest pain which developed especially at night and in the early morning. One hundred and thirty three patients (74.7%) were smokers. The electrocardiographic findings at the time of admission showed no changes in 147 cases (82.6%), testes showed ST segment elevation in 22 cases (12.4%), ST segment depression in 2 cases (1.1%), T wave inversion in 7cases (3.9%). The treadmill test was performed in 135 cases, ST segment elevation was noted in 6 patients (4.4%) and ST segment depression in 18 patients (13.3%). All of the other results were within normal range. The ergonovine provovative tests for coronary spasms were safe and effective. The right coronary artery was the most prevalent site of coronary artery spasm. Drug treatment was applied initially to all patients, but only 115 patients (64.5%) received the follow-up. Of these three died from cardiac arrest. The rate of cardiac death was low (1.7%) in patient, which made it difficult to know the risk factors for the cardiac deaths. Two (1.1%) had cardiac arrest. They didn't take any medication. Patients with variant angina usually responded well to nitrates and calcium antagonists. Thus nitrates and calcium antagonists are useful in preventing attacks and abolished attacks of variant angina. Conclusion: In this study, 13.2% of coronary artery disease was variant angina. The effectiveness of drug therapy and the prognosis of the patients was quite good in the group. But when chest pain happens, the adequate use of nitrate agents is needed because of cardia arrest or cardiac death in 2.8% of the patients. (Korean J Med 63:195-202, 2002)

희귀 증례 자발성 전체(全體) 괴사성 간세포암

김영준 ( Young Jun Kim ),정준용 ( Jun Yong Jeong ),이경호 ( Kyong Ho Lee ),김세형 ( Se Hyung Kim ),한준구 ( Joon Koo Han ),최병인 ( Byung Ihn Choi ) 대한간암학회 2002 대한간암학회지 Vol.2 No.-

분리된 백서 췌도의 인슐린 분비에 미치는 Atrial Natriuretic Factor 의 영향

전기엽(Ki Youp Jeon),최영숙(Young Suck Choi),박명철(Myung Chul Park),정숙현(Suck Hyun Jeong),정준용(Jun Yong Jeong),송미숙(Mi Suck Song),김은영(Eun Young Kim),이영화(Young Wha Lee) 대한내과학회 1991 대한내과학회지 Vol.41 No.2

N/A The atrial natriuretic factors have their main function in the regulation of water and elecrolyte balance and blood pressure1-5). Recently ANF-like immunoreactivty has been shown to also occur in pancreatic islet cells10), and because several intrapancreatic peptides are known to have the capacity to regulate islet function', we therefore investigated the influences of synthetic rat ANF (3-28) on glucose-stimulated insulin secretion. After pancreatic islets isolation, they were perifused with solutions which contained 10 mmol glucose, ANF, carbachol and adrenoceptor blockades. Their secreted insulin values are shown in Tables 1 and 2, and their results are summarized as follows: 1) ANF significantly suppressed the glucose-induced increment of the first-and second-phase insulin secretion.(*p<0.05 ***p<0.0025) 2) ANF did not significantly suppress the chlinergic carbachol-induced increment of the first-phase insulin secretion. (p>0.05) 3) There was no demonstrable inhibitory effect of the ANF in the solution which contained combined a-and β-adrenoceptor blockade. In conclusion, we suggest that rat ANF inhibits glucose-stimulated insulin secretion in the rat by direct peculiar interferences and partial mediation of the adrenoceptors.

도축우(屠畜牛) 담낭(膽囊)에서 분리(分離)한 대장균(大腸菌)에 관한 연구(硏究)

심항섭 ( Hang Sup Shim ),우종태 ( Jong Tae Woo ),정준용 ( Jun Yong Jeong ),강순근 ( Sun Keun Kang ),고영생 ( Young Sang Ko ),박찬숙 ( Chan Suk Park ),조중현 ( Jung Hyun Cho ) 한국가축위생학회 1991 韓國家畜衛生學會誌 Vol.14 No.2

The present study was conducted to investigate the biochemical properties, pathogenicity, antimicrobial test, and serotype of E-coli isolated from slaughtered cattle during the period from March 1991 to May 1991. 1. A total of 12 E-coli isolates were isolated from 132 bile juice of slaughtered cattle. 2. All isolates were resistant to Erythromycin, Cephalothin, Neomycin and Lincomycin while the majority of them were susceptible to Trimethoprimsulfamethoxazol(67%), Chioramphenicol (58%), Gentamicin(58%), Ampicillin (17%), Kanamycin (9%) and Tetracycline(9%). 3. In the test of colicinogenecity and congo red binding capability, 4(33%) isolates produced colicin, all isolates were congo-red negative. 4. The serotypes of isolated E-coli were identified as 088: K-(2 strain), 015: K-(1 strain), 08: K87: K88ab(1 strain), 0139: K12(1 strain), 0147: K89(1 strain), others(6 strains) were autoagglutination.

혈액 투석 환자에서 중심정맥 협착에 대한 스텐트 삽입술 : Wallstent Placement

임대승,노상필,이유선,정승현,김보영,이정우,강정아,김정희,이민수,정준용,최시완,정진옥,성인환,이강욱,신영태 충남대학교 의과대학 의학연구소 2002 충남의대잡지 Vol.29 No.1

Stenosis of central vein is a common complication arising after percutaneous subclavian vein catheter insertion performed for temporary vascular access in chronic renal failure patients undergoing hemodialysis. There are several treatment methods for the condition like percutaneous angioplasty(PTA), stent insertion, and surgery, but recent trend is toward PTA and stents. Among the patients diagnosed with chronic renal failure from March 1993 to May 2002 and undergoing hemodialysis through AV fistula, the 14 Patients in whom central vein stenosis arose were selected for the study. A total of 28 percutaneous interventions(5 PTA and 23 stent placement) were performed, and restenosis rate and the time taken till the restenosis in de novo lesions and instant lesions were compared. All 28 cases were operated successfully. The 14 cases that received both anigioplasty and stent placement initially. (de novo lesion : 14 cases), Among the 10 cases with de novo lesion that followed up more than 1 year, 3 cases are currently undergoing hemodialysis without restenosis, and the remaining 7 cases have recurred stenosis with the mean time to restenosis of 10.9 months. In the 7 cases in whom stenosis recurred, 11 interventions were done(instent lesion: 11 cases). 4 of these were using only ballon angioplasty with 100% restenosis rate and the mean time of 3 months until restenosis. The remaining 7 cases were using both balloon angioplasty and stent placement, also with 100% restenosis rate but with the mean time of 12 months until restenosis, which was later than the group receiving only balloon angioplasty. In treating the patients with central vein stenosis, stent placement seems to be more advantageous over PTA in terms of restenosis rate and the mean duration of patency. In the case of instent lesion, inserting the stent for the second time after stenosis recurred lengthened the duration of patency compared to performing balloon angioplasty alone.

고혈압 환자에서 도플러 심초음파를 이용한 좌심실내 혈류 전파 속도 측정

최시완,김준경,정준용,류정곤,정진옥,강승식,성인환,전은석,김영건 충남대학교 의과대학 지역사회의학연구소 1996 충남의대잡지 Vol.23 No.1

Background : Early detection and prevention of cardiac dysfunction is an important goal in the management of hypertensive patients. Doppler echocardiography was used to evaluate the pattern of left ventricular diastolic filling, however, filling indices from mitral sampling are not always nfluenced by factors related to left ventricular relaxation properties. Present study was performed to evaluate the relevance of propagation velocity to patients with hypertension by using pulsed Doppler echocardiography. Method : By using pulsed Doppler echocardiography, the velocity of left ventricular flow propagation velocity was measured from the distance and time difference of flow wave alcng the long axis propagation of left ventricular inflow during early filling in hypertensive patients (n=30 ), and M-mode echocardiographic data were obtained to evaluate mitral annulus long axis movement. Results : The values of E/A ratio, deceleration time, and left ventricular mass index were 0.82 + 0.18, 211 ± 55 msec,152 ±23 gr/m^2 respectively, and those of mitral ann ulus relaxation rate and left ventricular flow propagation velocity were 6.0 ±1.1 cm/sec and 62 ±17 cm/sec respectively. Flow propagation velocity was correlated to Doppler profiles such as E/A ratio ,r=0.47), deceleration time (r= -0.63) and mitral annulus relaxation rate (r=0.87) and also to left ventricular mass index (r= -0.69). Conclusion : left ventricular propagation velocity measurement by using pulsed Doppler echocardiography could be an important noninvasive tool in studying left ventricular diastolic function in patients with hypertension.