단독 좌전하행관동맥 질환의 치료에서 약물치료 , 풍선확장술 , 스텐트삽입술간의 비교관찰

조승연(Seung Yun Cho),장양수(Yang Soo Jang),이동일(Dong Il Lee),편욱범(Wook Bum Pyun),최동훈(Dong Hoon Choi),심원흠(Won Heum Shim) 대한내과학회 1999 대한내과학회지 Vol.57 No.5

N/A With recent advances in transarterial interventional technique, there is a tendency to treat single LAD lesion with balloon angioplasty or stent insertion rather than with medical therapy alone. Therefore, it is important to evaluate the long-term clinical outcomes of such interventional therapy. Methods : Subjects are comprised of patients who underwent coronary angiogram from 1993 to 1996 and diagnosed as having single LAD lesion without decrease of left ventricular fuction. The incidence of major ischemic complications, revascularization and reduction of angina pectoris after different therapeutic strategies in these patients are evaluated. Result : 1) There was total of 190 patients. Patients receiving medical therapy, balloon angioplasty and stent insertion were 70, 75, and 45 respectively. There was no significant difference in mean age, sex ratio, and risk factors of coronary artery occlusive disease between each groups. 2) The medical therapy group(30%) had a significantly lower incidence of proximal stenosis lesion compared to the balloon angioplasty group (45%) and stent insertion group(52%) according to the location of the lesion(p<0.05). The lesion characteristics according to the AHA/ACC criteria showed that the proportion of type A lesion was significantly higher in the balloon angioplasty group(33.3%) compared to the medical therapy group(8.6%) and stent insertion group(13.3%), whereas the proportion of type C lesion was significantly higher in the medical therapy group(41.4%) compared to the balloon angioplasty group(14.3%) and stent insertion group(22.2%). 3) The incidence of ischemic complication were low with 9 out of total 190 patients during follow up consisting of 2 cases of cardiogenic death(1.1%) and 7 cases of acute myocardial infarction(3.7%). 4) During the follow-up period revascularization was performed in 10% of medical therapy group, 27% of balloon angioplasty group and 22% of stent insertion group. There was higher rate of revascularization in patients who received interventional therapy. 5) During the mean follow-up period of 38 months, event-free survival rate was 85% in the patient group receiving medical therapy, 71% in the patient group undergoing balloon angioplasty and 74% in the patient group undergoing stent insertion. There was lower incidence of major events in medical therapy patients, but the difference of the rate among each group was not significant. In considering the patients with proximal LAD stenotic lesion, event-free survival rate was 73% in medical therapy group, 75% in balloon angioplasty group and 81% in stent insertion group, but the difference between each groups did not show any significant difference. 6) Follow-up of each study groups at 6 months, 1 year and 3 years showed that the proportion of chest pain-free patients in balloon angioplasty and stent insertion group were higher than those in medical therapy group despite the lack of statistical significance(p>0.05). Conclusion : For patients with single LAD stenotic lesion interventional therapies such as balloon angioplasty and stent insertion might be more effective without statistical signigicance in reducing chest pain compared to medical therapy. There was no significant difference in the incidence of ischemic complication and rate of revascularization among different study groups. Further studies will be needed to clarify the beneficial effects of interventional coronary artery therapy such as improvement of chest pain, increased exercise capacity, and improved quality of life along with other parameters. (Korean. J. Med 57:896-905, 1999)

심근경색증 환자에서 간헐파도플러 심초음파검사에 의한 심실확장기능에 관한 연구

조승연(Seung Yun Cho),박승정(Seung Jung Park),백경권(Kyung Kwon Paik),정익모(Ik Mo Chung),박성삼(Sung Sam Park),심원흠(Won Heum Shim),김성순(Sung Sun Kim),이웅구(Woong Ku Lee) 대한내과학회 1988 대한내과학회지 Vol.35 No.4

N/A Inflow characteristics of left and right ventricular filling were assessed in 33 patients with myocardial infarction and 20 normal subjects by pulsed doppler echocardiography. The presence of left and right ventricular diastolic functional change in accordance to the infarct location, serial change of left and right ventricular diastolic function in patients with acute myocardial infarction, and correlation between left ventricular end-diastolic pressure and pulsed doppler echocardiographic incices of left ventricular diastolic function were assessed. Patients with myocardial infarction were subdivided into two groups, the anterior infarct group(20 patients) and the inferior infarct group(13 patients), according to the site of the involved myocardium. Serial doppler echocardiograms were perfarmed three times, within 3 days after onset(lst phase), after about 12 days (2nd phase), and after 4 weeks (3rd phase). 1) Concerning the left ventricular diastolic function, A/E in the anterior infarct group(1.04±0.18) and inferior infarct group(1.07±0.23) was greater than in that of the control group(0.64+0.10)(p<0.05) The corrected isovolumic relaxation time in the anterior infarct group(2.34±0.60 √ms and inferior infarct group(2. 43±0.70 √ms) was longer than in that of the control (1.83±0.31 ms) (p<0.05). The 0.33 area fraction and E area fraction in the anterior infarct group(45±7%, 55±5%, respectively) and inferior infarct group(43+9 53±8%, respectively) were less than in those of the control group(59±9%, 67±5%, respectively) (p< 0.05, p<0.05, respectively) and A area fraction in the anterior infarct group (43±6%) and inferior infarct group(47±8%) was greater than that in the control group(36±7%) (p<0.05). 2) In the right ventricular side, A/E in anterior infarct group(0.86±0.23) and inferior infarct group(1.01±0.16) was greater than in that of contol group(0.62±0.10) (p<0.05), peak A velocity in inferior infarct group(0.44±0.09 m/s) was higher than in those of anterior infarct group(0.36±0.10 m/s) and control group(0,28±0.05 m/s) (p<0.05), 0.33 area fraction and E area fraction in anterior infarct group(43±7%, 52±10%, respectively) and inferior infarct group(42±9%, 50±10%, repectively) were lesser than in those of control group(56±9%, 63±7%) (p<0.05, p<0.05, respectively), and A area fraction in anterior infarct group(48±10%) and inferior infarct group(49±9%) was greater than in that of control group(36±7%) (p<0.05). 3) Serial left ventricular pulsed doppler echocardiogram in 12 patients with acute myocardial infarction showed follwoing results. A/E in phaae 2(0,86±0,17) and phase 3(0.83±0.21) was lesser than in that of phase 1(1.07±0.22) (p<0,05), 0,33 area fraction and E area fraction in phase 2(53±10%, 59±8%, respectively) and phase 3(55±9%, 59±7%, respectively) were greater than in those of phase 1(43±8%, 49±9 respectively) (p<0,05, p<0,05, respectively), A area fraction in phase 2(39±8%) and phase 3(39±8%) was lesser than in phase 1(49±11%) (p<0,05), and these variables were not changed between phase 2 and phase 3. 4) Serial right ventricular pulsed doppler echocardiogram in 12 patients with acute myocardial infarction showed following results, A in phase 2 (0.35±0.10 m/s) and phase 3(0,31+0,06 m/s) was lower than in that of phase 1(0,46±0.09 m/s) (p<0.05), A/E in phase 2(0.92±0.26) and phase 3(0,78±0.18) was lesser than in that of phase 1(1.10±0.16) (p<0.05, p<0.01, respectively), 0,33 area fraction and E area fraction in phase 2(53±10%, 47±9%, respectively) and phase 3(53±8%, 42±9%, respectively) were greater than in those of phase 1(41±10%, 49±8%, respectively) (p<0.05, p<0.05, respectively), and A area fraction in phase 2(47±9%) and phase 3(42±9%) was lesser than in that of phase 1(50±7%) (p<0.05), 5) Left ventricular end diastolic pressure had a signi1icant high correlation with A/E (r=0,76, p=0.01), with 0.08 area fraction (r=0,71, p=0,02), and with E area fraction

승모판 협착증 환자에서 운동부하 심장풀스캔을 이용한 좌심실기능의 평가

박창윤(Chang Yun Park),이도연(Do Yun Lee),심원흠(Won Heum Shim),김한수(Han Soo Kim),박승정(Seung Jung Park),조승연(Seung Yun Cho),김성순(Sung Soon Kim),이웅구(Woong Ku Lee),김명진(Myeong Jin Kim),최규옥(Kyu Ok Choe) 대한핵의학회 1992 핵의학 분자영상 Vol.26 No.1

N/A We performed exercise radionuclide ventriculography to evaluate left ventricular (LV) function in 35 patients with pure mitral stenosis (MS). There were 6 males and 29 females ranging from 21 to 63 years of age (mean 37±10 years). We also studied 8 healthy men as control group (mean age 27±5 years. Each patients was evaluated at rest and during maximal exercise on an isokinetic bicycle ergometer. Peak filling rate (PFR), peak ejection rate (PER), ejection fracion (EF), end-diastolic volume(EDV), end-systolic volume (ESV), stroke volume (SV), and cardiac output (CO) were determined by the radionuclide technique. The results were summarized as follows: 1) LV systolic dysfunction and reduced PFR were noted in patients with MS. 2) EDV as well as SV decreased with exercise in patients with MS. 3) No significant increase in EF during exercise compared to rest value was observed because it was caused by reduced EDV and SV during exercise in patients with MS. 4) CO increased with exercise was significantly lower than normal in patients with MS. 5) Patients with MS were divided into two groups according to whether EF increased more than 5% druing exercise compared to resting state or decreased. Significant difference were found between these two groups. Patients with a fall in EF with exercise were older, had larger left atrial size, and had lesser decreased in ESV during exercise.

승모판협착증 환자에서의 경피적 풍선학장 판막성형술

박승정(Seung Jung Park),심원흠(Won Heum Shim),조승연(Seung Yun Cho),이웅구(Woong Ky Lee),김성순(Sung Soon Kim),탁승재(Seung Jea Tahk),백경권(Kyung Kwon Paik),정익모(Ik Mo Chung) 대한내과학회 1988 대한내과학회지 Vol.35 No.1

N/A Percutaneous mitral balloon valvuloplasty (PMV) using the double-balloon technique was performed in 28 symptomatic patients with mitral stenosis who were candidates for mitral valve commissurotomy. There were 21 women and 7 men with a mean age 38±10 years (range 23 to 57). PMV in 28 patients with moderate to severe mitral stenosis (including 3 with a fluoroscopic calcified valve) resulted in an increase mitral valve area (0.9±0.2 to 2.2±0,7cm, p<0.0001) by Gorlin`s formula, and a decrease in mean diastolic mitral pressure gradient (16.8±5.7 to 6.1±3.9mmHg, p<0.0001), and mean left atrial pressure (23.6±6.7 to 11.7±5.8mmHg, p<0. 0001). And also cardiac output increased (4.8±1.0 to 5. 8±1.5L/min, p<0.005) and mean pulmonary artery pressure decreased (32±12 to 24±9mmHg, p<0.05). Mitral regurgitation developed or increased in severity after PMV in 15 (53.6%) patients, grade 3mitral regurgitation in 2 and no mitral regurgitation in 12 patients. Oxymetric studies performed immediately after PMV demonstrated a small left-to-right shunt (pulmonary-to-systemic blood flow ratios>1.5) through the interatrial communication in 4 patients. Follow up echocardiography showed improvement in mitral valve area by 2-D and Doppler pressure half-time (0.9±0.2 to 1.8±0.5 and 0.8±0.2 to 1.7±0.4 cm, p<0.0001), increase of mitral EF slope (13±7 to 37±17mm/ sec, p<0.0001) and decrease peak E mitral velocity (209±32 to 142±32cm/sec, p<0.0001). Transient cerebral embolic phenomenon just after PMV was observed in 1 patient and cerebral embolic infarction with hemorrhage requiring surgery developed in 1 patient. PMV using the double-balloon technique is safe and effective procedure to relieve mitral valve obstruction and could be an alternative to surgical mitral commissurotomy in selected patients with mitral stenosis.

우측 관상동맥 폐쇄 환자에서 관상동맥내 Thallium - 201 주사를 이용한 측부 혈행의 의의

박창윤(Chang Yun Park),이도연(Do Yun Lee),이종두(Jong Doo Lee),심원흠(Won Heum Shim),김한수(Han Soo Kim),조승연(Seung Yun Cho),김성순(Sung Soon Kim),정남식(Nam Sik Chung),김용수(Young Soo Kim),하종원(Jong Won Ha),권혁문(Hyuk Moon Kwo 대한핵의학회 1993 핵의학 분자영상 Vol.27 No.2

N/A To compare the myocardial viability in patients suffering from total occlusion of the right coronary artery (RCA) with the angiographic collaterals, intracoronary injection of Thallium-201 (T1-201) was done to 14 coronary artery disease (CAD) patients (pts) with total occlusion of RCA and into four normal subjects for control. All 14 CAD pts had Grade 2 or 3 collateral circulations. There were 14 male and 4 females, and their ages ranged from 31 to 70 years. In nine pts, T1-201 was injected into left main coronary artery (LCA) (300∼350 μCi) to evaluate the myocardial viability of RCA territory through collateral circulations. The remaining five pts received T1-201 into RCA (200-250 μCi) because two had intraarterial bridging collaterals and three had previous successful PTCA. Planar & SPECT myocardial perfusion images were obtained 30 minutes, and four to five hours after T1-201 reinjection. Intravenous T1-201 reinjection (six pts) or Tc-99m-MIBI (two pts) were also performed in eight CAD pts. Intracoronary myocardial perfusion images were compared with intravenous T1-201(IV T1-201) images, EGG, and ventriculography. Intracoronary TI-201 images proved to be superior to that of IV T1-201 due to better myocardial to background uptake ratio and more effective in the detection of viable tissue. We also found that perfusion defects were smaller on intracoronary T1-201 images than those on the IV T1-201. All of the 14 CAD pts had either mostly viable myocardium (seven pts) or large area of T1-201 perfusion (seven pts) in RCA territory, however ventriculographic wall motion and ECG did not correlate well with intracoronary myocardial perfusion images. In conclusion, total RCA occlusion patients with well developed collateral circulation had large area of viable myocardial in the corresponding territory.

무릎전치환술 환자에서 일회성 복재신경차단술이 수술 후 출혈량 감소에 미치는 영향

최윤숙,윤소희,조승연,송승은,김상림,Choi, Yun Suk,Yun, So Hui,Cho, Seung Yeon,Song, Seung Eun,Kim, Sang Rim 제주대학교 의과학연구소 2021 The Journal of Medicine and Life Science Vol.18 No.1

In elderly patients, the vital parameters tend to fluctuate based on the blood volume status, which may cause sudden hypovolemic shock if the postoperative bleeding continues. Particularly, those who undergo surgery for arthritis needs to pay extra attention because the bleeding may persist over the joints after the surgery. Therefore, appropriate pain control is required to reduce the postoperative blood loss. This retrospective chart review study was conducted to assess the postoperative pain control and reduction of blood loss with a single injection of saphenous nerve block (SNB) in elderly patients with osteoarthritis. We reviewed the electronic medical records of patients who underwent knee total arthroplasty with spinal anesthesia between January and May 2016. A total of 51 patients participated in this study. All patients were treated with intravenous patient-controlled analgesia for the postoperative pain control, and additional analgesic agents were administered at a visual analogue scale above a score of 6. In 25 patients, SNB was performed using ultrasound with the administration of 0.75% ropivacaine (15 mL) after the surgery. Patients who received additional analgesics were significantly low in the nerve block group (P=0.009). Additionally, the volume of blood loss from catheter drainage was significantly low at 2 and 3 days postoperatively (P=0.013 and P=0.041, respectively) in the nerve block group. In patients who underwent total knee arthroplasty with osteoarthritis, only a single injection of saphenous nerve block was sufficient for the postoperative pain control and reduced bleeding.

심근병에서 123I - MIBG 영상을 이용한 교감신경기능의 평가

이도연(Do Yun Lee),이종두(Jong Doo Lee),김선정(Sun Jung Kim),박창윤(Chang Yoon Park),조승연(Seung Yun Cho),함진경(Jin Kyung Ham),정남식(Nam Sik Chung),이성숙(Sung Sook Lee),김용수(Young Soo Kim) 대한핵의학회 1993 핵의학 분자영상 Vol.27 No.2

N/A 123I-Iodine-metaiodobenzylguanidine(MIBG) which is a norepinephrine analogue, can be used to evaluate the sympathetic innervation of the heart. In this study, cardiac imaging with 123I-MIBG was performed in patients with 9 dilated cardiomyopathy, 2 ischemic cardiomyopathy and 1 acute myocardial infarction to evaluate the sympathetic nervous function. 123II-MIBG imaging showed multifocal defects (8), diffuse defect (2), near non-visualization (2). The defects of MIBG scans were found to be larger and more severe on 4 hours image than 30 minutes. Heart to lung, heart to mediastinum ratios were decreased at 4 hours than those at 30 minutes. Measured LVEF values were not correlated with the severity of MIBG uptake. Tc-99m-MIBI imaging was also performed in all patients to find the relationship with 123I-MIBG scan. Tc-99m-MIBI scan showed multifocal defects in 9 patients, diffuse defects in 1 patient and no defect in 2 patients. The defects are similar in size, severity and extent, but more larger and severe on 123I-MIBG imaging. Therefore, cardiac 123I-MIBG imaging is a useful method to evaluate the sympathetic nervous function in cardiomyopathy.

약인성 파킨슨증후군 환자의 한방 치험 1례

김연진,양승보,김정화,이보윤,조승연,박성욱,박정미,고창남,Kim, Yeon-jin,Yang, Seung-bo,Kim, Jeong-hwa,Lee, Bo-yun,Cho, Seung-yeon,Park, Seong-uk,Park, Jung-mi,Ko, Chang-nam 대한한방내과학회 2016 大韓韓方內科學會誌 Vol.37 No.2

Objective: This clinical study reports on the effect of Korean medicine on a patient with drug-induced Parkinsonism.Method: We used herbal medicine (Yigan-san), acupuncture, moxibustion, pharmacopuncture, and bee venom acupuncture to treat a patient with drug-induced Parkinsonism during hospitalization for 11 days. We observed the changes of symptoms using the unified Parkinson’s disease rating scale (UPDRS), the abnormal involuntary movement scale (AIMS), and the Beck depression inventory (BDI).Results: After treatment, the patient’s symptoms showed improvement in tremor, gait disturbance, and general condition. The UPDRS, AIMS, and BDI scores were also improved after treatment.Conclusion: This clinical case study suggests that traditional Korean medicine treatment could be effective in the treatment of drug-induced Parkinsonism.

급성심근경색의 혈액저류주사 구혈율 , 최고 혈정 CK 활성도 및 심혈관 영화촬영술 소견

정상만(Sang Man Chung),조승연(Seung Yun Cho),이웅구(Woong Ku Lee),박승정(Seung Jung Park),심원흠(Won Heum Shim),김성순(Sung Soon Kim),최규옥(Kyu Ok Choi) 대한내과학회 1988 대한내과학회지 Vol.34 No.4

N/A It has been shown that prognosis after myocardial infarction is directly related to the extent of left ventricular necrosis and to the residual function of left ventricle In the current study, we have compared the results of radioisotope blood pool scan ejection fraction of the left ventricle (RIEF) with peak CK activity and cardiac angiographic findings after aucte myocardial infarction. We reviewed the record of 48 consecutive patients (43 men and 5 women) who had underwent RIEF and serial measurement of CK activity. Infarct location was characterized according to the established electrocardiographic criteria with 30 anterior and 18 inferior myocardial infarction patients. 1) There was no significant difference in age, sex, and interval from symptom onset to RIEF study between anterior and inferior myocardial infarction 2) RIEF was significantly decreased in the patients (0.39±0.12) compared with normal control group (0.67±0.03) (p<0.01), and was significantly more decreased in anterior (0.35±0.09) than in inferior myocardial infarction (0.51±0.12) (p<0.05). 3) Peak CK activity was elevated in anterior (2152.7±1088.5) than in inferior myocardial infarction (1414.2±910.4) without significant difference. Strong linear correlation was demonstrated between RIEF and peak CK activity in anterior myocardial infarction (r=-0, 4119, p<0.05). 4) The angiographic area decreasing rate was significantly reduced in the patients (0.31±0.12) compared with control group (0.62±0.04) and was more reduced in anterior (0.26±0.09) than in inferior myocardial infarcition (0.37±0.11) without significant difference Linear correlation was demonstrated between RIEF and angiographic area decreasing rate in control (r=0.4010, p<0.05) and in anterior myocardial infarction (r=0,3045, p<0.05). 5) There was no significant difference of RIEF between single (0,41±0.12) and multivessel disease (0.50±0,12). Above data suggested that RIEF was decreased in acute myocardial infarction and was more decreased in anterior than in inferior myocardial infarction. The correlations of RIEF with peak CK activity and angiographic area decreasing rate were significant in anterior mycardial infarction. In cinclusion, RIEF was an adequate clinical indicator in evaluation the left ventricular function in acute myocardial infarction.

경피적 경혈관 관동맥 풍선성형술 후 관동맥 재협착의 양상

박시훈(Si Hoon Park),조승연(Seung Yun Cho),김현승(Heun Seung Kim),윤정한(Jung Han Yoon),김병옥(Byung Ok Kim),정남식(Nam Sik Chung),심원흠(Won Heum Shim),이웅구(Woong Ku Lee) 대한내과학회 1992 대한내과학회지 Vol.43 No.3

N/A Background and Methods: In a total of 40 patients who had undergone successful percutaneous transIuminal coronary angioplasty (PTCA) and were con- firmed as having restenosis by later coronary angiography, we observed time interval of restenosis and angiographic change of merphoiogy and severity of restenosis. The results were as follows. Results: 1) Restenosis was most prevalent in 2nd and 3rd months following PTCA 2) Angiographic morphology and severity of the restenotic lesion were similiar to those of pre-PTCA Conclusion: Repeat PTCA is justified for treatment of patients with restenostic lesions even considering of higher restenosis rate after second PTCA and optimal timing of angiographic restudy is at least 4months after successful PTCA.