흉부 둔상 후 발생한 관상동맥 박리에 의한 ST 분절 상승 심근경색 1예

한정연 ( Jung Yeon Han ),최동현 ( Dong Hyun Choi ),정중화 ( Joong Wha Chung ),고영엽 ( Young Youp Koh ),장경식 ( Kyung Sik Chang ),홍순표 ( Soon Pyo Hong ) 대한내과학회 2013 대한내과학회지 Vol.84 No.6

Coronary artery injury after thoracic injury is very rare, but can result in serious acute myocardial infarction (MI). It can be easily mistaken for chest wall pain or cardiac contusion if relying solely on a history and physical examination. We herein report a rare case of a 60-year-old female patient who presented with inferior wall ST-segment elevation MI due to right coronary artery dissection following blunt chest trauma after a traffic accident. Successful primary percutaneous coronary intervention was performed without complications. (Korean J Med 2013;84:847-850)

급성 심근경색증으로 발현된 대동맥 박리증 1예

박근호(Keun-Ho Park),기영재(Young-Jae Ki),김성수(Sung Soo Kim),김현국(Hyun Kuk Kim),최동현(Dong-Hyun Choi),정중화(Joong-Wha Chung),고영엽(Young-Youp Koh),장경식(Kyong-Sig Chang) 조선대학교 의학연구원 2020 The Medical Journal of Chosun University Vol.45 No.2

Emergency diseases that can lead to sudden cardiac death with acute severe chest pain include acute myocardial infarction and aortic dissection. These two diseases show high mortality rates, but they have very different initial treatments, therefore, early diagnosis and start of treatment are very important. However, rarely, acute myocardial infarction could be complicated by aortic dissection. We report a case of a 68-year-old woman with anterior chest pain who was finally diagnosed with aortic dissection on chest computed tomography after inevitable percutaneous coronary intervention under the diagnosis of acute myocardial infarction.

저항성 고혈압

정중화 朝鮮大學校 附設 醫學硏究所 2009 The Medical Journal of Chosun University Vol.33 No.S

Resistant hypertension is a common problem in clinical practice. About one-third of hypertensive patients is not controlled properly and some portion of this group is may assigned to resistant hypertension. Hypertension is one of the most prevalent and powerful contributors to cardiovascular diseases. The poor outcomes associated with poor blood pressure control may be exacerbated by inadequate usage of antihypertensive drugs. Understanding of underlying pathophysiology will introduce you to a hemodynamic-based approach. This review will show you that resistant hypertension is not an impregnable disease. If you find the inside of this issue, you can control resistant hypertension accordingly.

특발성 확장심근병증과 비대심근병증에서 심실재분극의 차이

정중화 朝鮮大學校 附設 醫學硏究所 2007 The Medical Journal of Chosun University Vol.32 No.2

Background and Objectives: Experimental studies have suggested that variability between the ECG leads in measurement of QT intervals and QT dispersion reflects spatial and temporal inhomogeneity of left ventricular recovery times, Previous clinical studies of QT dispersion have shown that it is increased in patients with hypertrophic cardiomyopathy (HCM), the long QT syndrome, myocardial infarction and idiopathic dilated cardiomyopathy (IDCM). We investigated difference of ventricular repolarization between IDCM and HCM through difference of the QT dispersion and QT variables. Methods: From january 2005 until September 2006, 25 patients with IDCM and 23 patients with HCM were prospectively enrolled in this study at the Chosun University Hospital. Inclusion criteria were left ventricular ejection fraction <50%, left ventricular diastolic dimension >=55mm in the IDCM and left ventricular wall thickness <=13 mm in the HCM. Results: The intraventricular septal thickness (IVST:17.17±2.87, p<0.001) increased in the HCM more than IDCM. End-diastolic left ventricular dimension diastolic (LVDd: 63.00±7.70, p<0.001) was increased in the IDCM. The EF (31.92±10.65, p<O.OOl) and FS (15.64±5.77, p<0.001) were decreased in the IDCM. The QTd, QTc did not differ significantly between IDCM and HCM. But QTcd differ significantly between IDCM and HCM. In the analysis of limb lead and frontal lead, QTc-F (QTc in the Frontal lead) correlate with LVDd in patients with IDCM and all QT variables in the frontal leads correlate with IVST in patients with HCM. In the IDCM, QTd-L, QTcd-L was prolonged more than QTd-F, QTcd-F. In contrast, QT variables of frontal leads were prolonged more than that of limb leads, Conclusion: Our study shows that QTd increased in the IDCM and HCM. But the results of QT interval analysis did not differ among the IDCM and HCM except QTcd, QTcd-L. All QT variables correlate with LV wall thickness in patients with HCM. Therefore the inhomogeneity of ventricular refractoriness in the HCM was influenced by the LV wall thickness. The inhomogeneity of ventricular refractoriness in the IDCM was influenced by LVDd in the analysis of QTc-F.

관상동맥 풍선성형술 후 발생한 관상동맥 박리의 초기 조영술적 고찰

고영엽,강지인,장재혁,강민정,정중화,장경식,홍순표 朝鮮大學校 附設 醫學硏究所 2007 The Medical Journal of Chosun University Vol.32 No.1

Background and Objectives: Percutaneous coronary intervention (PCI) is widely utilized in the treatment of symptomatic coronary artery disease (CAD). Althouth it has numerous benefits, intimal tear or dissection, serious and potentially life-threatening complications of plain old balloon angioplasty (POBA) can occur. The aim of this study was to assess the implications of coronary dissections after ballon angioplasty. Methods: 78 consecutive patients (age, 62 +/- 11 years; 46 men, 32 women) identified to two groups as having with or without dissection (dissection (D) group or non-dissection (ND) grouP) underwent balloon angioplsty for CAD were studied. All patients with dissection could be managed by successful stent implantation to rescue the artery. The morbidity of ischemic complication and mortality were evaluated for 30days after PCI. Results: Coronary dissection developed 44 lesions (38%) in 31 patients out of 117 lesions in 78 patients after POBA and a good final angiographic result was obtained in all patients with dissection, Significant correlates of a development of dissection were the lesion morphology of ACC/AHA type B and C (P<0.05). There were no significant correlations of clinical pictures, whether POBA in single vessel disease or in multivessel disease, diameter stenosis before POBA, and balloon/coronary artery diameter ratio. Morphologic feature of dissection was type A in 15 (34%), type B in 13(30%), type C in 12 (27%), and type D in 4 (9%). After PCI, there was no ischemic complication or death related coronary dissection during follow-up period for 30days. Conclusions: Coronary dissection after angioplasty occurred in 44 lesions (38%) out of 117 lesions of 78 consecutive patients underwent POBA. Coronary dissection after POBA significantly correlated with the severity of lesion morphology. Coronary stenting is effective in the management of acute coronary dissections after angioplasty.

갑상선결절의 임상 및 초음차소견의 진단적 가치

박거운,박철진,박일구,신지혜,정중화,배학연,김상용 朝鮮大學校 附設 醫學硏究所 2007 The Medical Journal of Chosun University Vol.32 No.2

Backgrounds: Thyroid nodule have been relatively common disease and it's prevalence estimated about 4-7%. Recently, high resolution ultrasonography has made the detection of small thyroid nodule possible, Increases in the detection of thyroid nodule have created a clinical dilemma on how to properly manage such thyroid nodules. We investigated the prevalence, clinical and ultrasonographic characterristics, and optimal diagnostic approach toward detected benign and malignant thyroid nodules. Methods: A retrosepctive review was undertaken on the 372 patients who was done Ultrasonograpy guided fine needle aspiration biopsy in Chosun University Hospital, Gwang-Ju, Korea between July 2003 and Spring 2005. Devided into four group such as benign and malignant thyroid nodule on the basis of size 1.5Cm. The review consisted of thyroid function test, antithyroid antibodies, thyroid autoantibodies, thyroid ultrasonography, fine needle aspiration biopsy in each group. Results: The prevalence of thyroid nodule malignancy rate was 18.0%. The prevalence of thyroid incidentaloma malignanct rate was 17.5%. There were no significant differences in age, sex, thyroid function test and size between the benign, malignant incidentalomas and nodule. Ultrasonographic characteristics, include ultrasonography index point showed meaningful diagnostic value for the detection of malignancy in thyroid nodule, Conclusion: Thyroid cancers are fairly common finding. There are no clinical difference between benign and malignant thyroid nodule; however, ultrasonographic findings can be used to decision of optimal management strategies 배경: 최근갑상선 초음파의 빈번한 시행으로 갑상선 결절의 발견이 증가하고 있다. 이러한 갑상선 결절중 특히 갑상션우연종을 임상적으로 어떻게 접근하고 치료를해야하는지는 적지 않는 문제가 되고 있다. 본 연구에서는 갑상선 우연종 및 직경 1.5 cm 이상의 갑상션결절의 유병률, 임상적 특징, 초음파특정 및 초음파의 진단적 유용성에 대해 알아 보았다. 방법: 2003년 7윌부터 2005년 3월까지 조선 대학교병원 내과 및 일반외과및 건강검진 센터를 통해 갑상선 초음파, 경동맥 초음파 및 경부 CT등을 통해 우연히 발견된 갑상션결절을 가진 372명을 대상으로 후향적 연구를 시행하였다. 크기 1.5 cm 미만의 양성및 악성 갑상선 결절군과 크기 1.5 cm 이상의 양성 및 악성결절로 그룹을 나누고 각 군에서 나이, 성별, 갑상선 기능검사, 항갑상선 항체, 갑상선 초음파 및 미세침흡인세포검사등을 검토하였고, 모든 갑상선 결절에 Koike (6)가 제한한 초음파지표 점수(Ultrasonographie index point)를 부여하여 각 군을 비교하였다. 결과: 분석한 갑상선 결절 372예 중 악성결절의 유병율은 18.0% (67예)였다. 갑상선 우연 종의 유병율은 81.5% (303예)였다. 갑상선 우연 종에서의 악성률은 17.5% (53예)로 나왔다. 크기 1.5 cm 이상의 양성 및 악성 갑상선 결절과 양성 및 악성 갑상선 우연종에서 나이, 성별, 갑상선 기능검사, 항갑상선항체에는 의미있는 차이가 없었다. 또한 양성 및 악성우연종에서 의 갑상선 결절크기에도 의미있는 차이는 보이지 않았다. 갑상선 결절의 초음파 지표점수만이 양성 및 악성우연종과 양성 및 악성갑상선 결절의 감별에 의미있는 차이를 보였다. 갑상 선우연종과 크기 1.5 cm 이상의 갑상선 결절에 서 양성을 나타내는 초음파지표점수는 각각 3 점과 4점으로 다르게 나타났다. 양성 및 악성 갑상선우연종의 감별에서 초음파 지표점수의 민감도는 93.6%, 특이도는 52.8%, 양성예측율은 92.4%로 나왔고, 진단적 효율은 86.4% 였으며 크기 1.5 cm 이상의 양성 및 악성 갑상선 결정의 감별에서 초음파지수 민감도는 92.7%, 특이도가 42.9%, 양성 예측도 86%, 효율 82.6%를 보였다. 결론: 갑상선결절에서의 양성 및 악성의 유무는 임상적으로 판단하기 힘들지만 갑상선 결절에서의 초음파 소견 및 초음파 지표 점수를 도입하면 이에 대한 감별에 도움을 줄 수 있다. 따라서 갑상선 초음파검사시 초음파지표점수의 사용은 향후 갑상선 결절의 진단 방향을 제시하는 중요한 길잡이가 될 수 있으리라 사료된다.

고칼슘혈증을 동반한 림프종 1례 : 증례보고

김현리,문규,김동민,정중화,이지현,김태원,이만재,정회상,정종훈,정춘해 朝鮮大學校 附設 醫學硏究所 1997 The Medical Journal of Chosun University Vol.22 No.1

A 34-year-old man was admitted with 3 month history of nausea, vomiting and general weakness. On admission, laboratory studies revealed Hb 8.8g/dL, Hct26.2%, WBC 9040/mm3, Platelet 243,000/mm3, serum calcium 18mg/dL, serum phosphate4. Img/dL and serum PTH 7.0pg/dL. Bone marrow study showed abnormal lymphoid cell as much as 23%. Simple X-ray showed osteolytic bone lesions on left mandibular area. The patients was treated with cyclophosphamide, adriamycin, vincnstin, prednisone as remission chemotherapy and achieved normal range of serum calcium and renal function with complete remission hematologically and received 2 times of chemotherapy thereafter. The patient was re-admitted with nausea, vomiting and general weakness, during follow-up. He was improved symptomatically and hypercalcemia was disappeared, but lymphoma was metastasis to lung. The patient with his family refused further therapy, and discharged. He died after discharge.

일측 신무형성증을 동반한 Kallmann 증후군 1례

곽재정,김현리,이기주,문규,이지현,김동민,정중화,이봉규,김창욱,박치영,배학연 朝鮮大學校 附設 醫學硏究所 1997 The Medical Journal of Chosun University Vol.22 No.1

Kallmann's syndrome is a rare condition, defined as an isolated GnRH deficiency with anosmia and may be associated with cleft lip, cleft palate, color blindness, craniofacial abnormalities, renal agenesis, sensory neural hearing loss, cryptorchidism. obesity and osteoporosis. The mode of inheritance in Kallmann's syndrome is still uncertain, it has been described as possible autosomal dominant, autosomal recessive. X-linked dominant, and an X-linked recessive trait. We experienced a case of the Kallmann's syndrome associated with anosmia, renal agenesis. cryptochidism. gynecomastia and severe osteoporosis.

당뇨병성 합병증에서 혈청 제4형 콜라겐의 임상적 의의

김동민,이기주,김현리,문규,이지현,정중화,이봉규,김희중,배학연 조선대학교 부설 의학연구소 1999 The Medical Journal of Chosun University Vol.24 No.2

Objective and Method; In diabetes mellitus, serum concentration of type IV collagen is important in the progression of diabetic microangiopathy. In this study, serum concentrations of type IV collagen were measured in 34 healthy controls and 87 noninsulin-dependent diabetes mellitus(NIDDM) and examined with the development of diabetic nephropathy and retinopathy. Result: The present study revealed that serum levels of type IV collagen(by sandwich enzyme immuno assay, EIA) were more associated with retinopathy than nephropathy. A one-step sandwich enzyme immunoassay was used to measure the type IV-collagen level. The mean serum levels of type IV collagen (146.06±48.96ng/ml) in diabetetic patients were significantly higher than in healthy controls (101.6±4.42ng/ml). (p<0.01) The mean serum levels of type IV collagen (221.5±67.46 ng/ml) in diabetic patients with proliferative diabetic retinopathy were significantly higher than in those with nonproliferative retinopathy (167.6±56.07ng/ml). (p<0.01) and much more than in those with no retinopathy (134.30±37.04). (p<0.01) The mean serum levels of type TV collagen in normoalbuminuria rose significantly as the degree of retinopathy progressed from no retinopathy to proliferative retinopathy stages(p<0.01). Furthermore, the severity of retinopathy and nephropathy were closely associated with the serum type IV collagen level and the serum type IV collagen levels were significantly correlated with microalbuminuria. Conclusion; The results of this study suggest that the serum type IV collagen was a useful and noninvasive marker for the development of diabetic microangiopathy, it could also be used to predict the development of diabetic complications and to assess therapeutics or the prognosis of diabetes. In diabetic cataract patients, the prognosis after cataract surgery was related with presence of diabetic retinopathy. Therefore high values of type IV collagen level in serum may be useful in predicting poor prognosis after cataract surgery in patients with diabetes mellitus. The usefulness of this model will be clarified by a larger scale study.