급성 심근경색증의 정맥 혈전용해요법에 대한 임상적 관찰

채장성(Jang Seong Chae),전승석(Seung Sok Chun),김종상(Jong Sang Kim),김재형(Jae Hyung Kim),홍순조(Soon Jo Hong),최규보(Kyu Bo Choi),김학중(Hak Joong Kim) 대한내과학회 1987 대한내과학회지 Vol.34 No.1

N/A Progress in reducing mortality and morbidity has been slow in spite of increased understanding of the pathophysiology af myocardial infarction. By the use of coronary care units together with improved therapy for life threatening arrhythmias, cardiac pump failure has emerged as the principal cause of in-hospital death. The objectives of thrombolytic therapy are to lyse coronary thrombi during the early phase of transmural myocardial infarction to salvage jeopardized myocardium, preserves ventricular function and may enhance survival by lysing thrombotic coronary artery occlusion which is commonest cause of transmural myocardial infarction. To evaluate the usefulness of thrombolytic agents (Urokinase : UK) for acute myocardial infarction, we analized 51 patiens who admitted within 6 hours after symptoms developed and treated with UK (0.3 million u bolus and daily 0.3 million u continuous IV infusion for 3-4 days) in case who did not have any evidence of contraindication of thrombolytic therapy and compared with 57 patients who were treated by conventional method. The results were as follows: 1) The annual cases of acute myocardial infarction showed increasing tendency and peak frequency of onset was from 6 a.m. to noon throughout the day. 2) The ratio of male to female for acute myocardial infarction was 3:1 and the average age was 59. 3) The common preceding disease were hypertension (31 cases), angina pectoris (21 cases) and diabetes mellitus (12 cases). The cholesterol level over 201 mg/dl was 40% of patients. 4) Anterior wall infarctions were observed in 59 cases, inferior wa11 infarctions in 46 ca and subendocardial infarctions were 3 cases. In anterior myocardial infarction, 20% and 29.4% expired with thrombolytic and conventional therapy respectively. In inferior myocardial infarction, 31.8% expired with conventional therapy but there was none with thrombolytic therapy, 5) Arrhythmias were observed in 83.6% of all cases and ventricular arrhythmia (60.2%) was the msot common. Conduction disturbances were observed in 24.1% and more frequent in inferior than anterior myocardial infarction. 6) Five of 51 patients (9.8%) were expired with thrombolytic therapy and 17 of 57 patients (29.8%) with conventional therapy were expired (P<0.01), and overall mortality was 20.4% 7) The mortality for killip classification III k IV was 38.5% and 66.7% with thrombolytic and conventional therapy respectively (P<0.1). The mortality who had Norris coronary prognostic index over 10 were 25% and 69.2% with thrombolytic and conventional therapy respectively (P <0.05). 8) Only one case of tarry stool was observed as a complication of thrombolytic therapy, In conclusion, intravenous thrombolytic therapy in early phase of acute myocardial infarction improved survival.

혈관내 초음파 영상에 의한 형태 및 조직병리 소견 평가

채장성(Jang Seong Chae),최규보(Kyu Bo Choi),(Robert J . Siegel) 대한내과학회 1992 대한내과학회지 Vol.43 No.1

N/A Background: To evaluate geometric accuracy of intravascular ultrasound and histopathologic validation of ultrasound and angioscopy we studied postmortem human arterial segments and phantoms in vitro. Method: We used 7 to 9 French fiberoptic angioscopes and 30 MHz intravascular ultrasound imaging catheter. We assessed the area and wall thickness on 9 phantom vessels and 12 arteries with different imaging media and 30 angle of incidence. To evaluate histopathologic validation of ultrasound and angioscopy, the images of 12 normal and 55 abnormal (stable atheroma, disrupted atheroma and thrombi) vessels were compared with histology. Results: Geometric accuracy: The measured area were smaller in blood (7.2-7.6%) and gel (10,8-13.6%) than that of saline. A 30 angle of incidence resulted in 14.2%-16.3% increase in lumen area and 10,6% increase in wall thickness. Ultrasonic wall thickness of human vessels correlated closely with the actual measured thickness (r=0,93). Histopatholgic validation: the sensitivity specifictiy and accuracy of both method were greater than 96% in normal vessel and 90% in stable atheroma. For normal vessel predictive value was better for angioscopy than for ultrasound. For stable atheroma the predictive value were 77%. for angioscopy and 78% for ultrasound due to classification of disrupted atheroma to stable atheroma. For thrombus detection sensitivity was 62% for ultra- sound due to false negative interpretation of lamina clots and atheroma in vessel. Conclusion: With ultrasound measurement, lumen area and wall thickness were accurate when the catheter placement was coaxial. For histopathologic validation, angioscopy and ultrasound images had significant agreement with the results obtained from histology.

경식도 심초음파상의 흉부대동맥 죽상경화증의 관찰과 그 의의

이만영(Man Young Lee),정욱성(Wook Seong Chung),승기배(Kie Bae Seung),김종진(Jong Jin Kim),전승석(Seung Seok Chun),노태호(Tai Ho Rho),채장성(Jang Seong Chae),김재형(Jae Hyung Kim),홍순조(Soon Jo Hong),최규보(Kyu Bo Choi) 대한내과학회 1994 대한내과학회지 Vol.46 No.6

N/A Objectives: Atherosclerosis has been suggested to be a generalized disease process. Thus, the pressence of an atherosclerotic cardiovascular event can predict the occurrence of a subsequent event located elsewhere. From a preventive point of view, it would be desirable to have an indicator before the clinical appearance of disease. Ultrasonography has the necessary accuracy, precision, and repeatability to serve as measurement tools of quantitative imaging of large vessel atherosclerosis. Aorta can be examined with relative ease using transesophageal echocardiography. We performed this study to find the prevalence of atherosclerosis of thoracic aorta using transesophageal echocardiography and also to evaluate the association of known atherosclerotic risk factors with its development and clinical significance. Methods: We evaluated the descending thoracic aorta of 548 patients (male 248, female 300: mean age 52±15 yrs), those underwent clinically indicated transesophageal echocardiography. We classified the patients into 4 groups: normal group (270 pts), thin atherosclerotic group (159 pts), thick athrosclerotic group (109 pts) and thick protruded plaque group (17 pts) according to the morphology and thickness of atherosclerotic plaque. Results: 1) Transesophageal echocardiography is a valuable diagnostic tool to assess the severity of atherosclerosis in thoracic aorta and the atherosclerosis of variable degree was commonly encountered in 278 patients of total 548 study subjects. 2) Among the well known atherosclerotic risk factors, the age and the prescnece of hypertension were most strongly related to atherosclerotic process of thoracic aorta. 3) The relations between the atherosclerosis of descending thoracic aorta and the coronany artery disease and cerebral infaction were thought to be weak and need further study. Conclusion: Atherosclerotic lesion of thoracic aorta could be accurately assessed by transesophageal echocardiography. There were close associations between age and hypertension as atherosclerotic risk factors and the atherosclerotic progression of thoracic aorta. Although there are somewhat weak relationships between the degree of atherosclerosis of thoracic aorta and other cardiovascular disease. To elucidate the precise relationship needs further study.

증례 : 종격동에 발생한 원발성 정상피종 (精上皮腫)의 증례

김동집 ( Dong Jip Kim ),김철민 ( Chul Min Kim ),이경식 ( Kyung Shik Lee ),채장성 ( Jang Seong Chae ),홍지희 ( Jee Hee Hong ),최강련 ( Kang Ryun Choei ) 대한내과학회 1983 대한내과학회지 Vol.26 No.4

비인강암 환자에서 발생한 경동맥동 과민증후군

윤형규(Hyung Gue Yoon),강진형(Jin Hyung Kang),문한림(Han Lim Moon),채장성(Jang Seong Chae),김훈교(Hoon Kyo Kim),이경식(Kyung Shik Lee),김동집(Dong Jip Kim),이광수(Kwang Soo Lee),윤세철(Sei Chul Yoon),조승호(Seung Ho Cho),서병도(Byung 대한두경부종양학회 1993 대한두경부 종양학회지 Vol.9 No.1

저자들은 극소진행형 비인강암(제 4기, N₄N₂(c)) 환자에서 종양으로 인한 경동맥동 과민증후군과 관련되어 실신이 발생하였으며 방사선치료후 호전된 환자 1예를 경험하였다. The syndrome of carotid sinus hypersensitivity is cardovascular symptom complex including lightheadedness, transient loss of consciousness, perspiration, pallor, weakness of lower extremities, transient hypotension, bradycardia and seizure, which occurs from firing of hyperactive carotid sinus reflex. Most cases are idiopathic, but maliganant tumors involving parapharyngeal space have been occasionally implicated. We present a case of carotid sinus hypersensitivity due to nasopharyngeal carcinoma invading the parapharyngeal space with bilateral cervical lymphnode metastases(stage IV, T₄N₂M(0)). The patient experienced several episodes of severe syncope proceeded by blurring of vision, dizziness and nausea, which were used to occur while he was working in erect position. The tumors were markedly regressed by external radiation therapy with successful resolution of syncope.

D.D.D. 형 인공심박동기 시술 환자에서 심방심실 연속자극간격 변화가 수축기와 이완기에 미치는 영향

이만영(Man Young Lee),승기배(Ki Bae Seung),전승석(Seung Sok Chun),채장성(Jang Seong Chae),김종상(Jong Sang Kim),김재형(Jae Hyung Kim),홍순조(Soon Jo Hong),최규보(Kyu Bo Choi) 대한내과학회 1992 대한내과학회지 Vol.43 No.2

N/A Background: Although the duration of the atrioventricular delay is known to affect ventricular diastolic filling time, the hemodynamic effects have been controversial. Several recent studies attempted to clarify the issue of optimal AV delay and have come to different conclusions. So we performed this study to evaluate the hemodynamic effects of varying A-V delays in A-V sequential pacing by echocardiography. Methods: 9 patients of this study had D,D.D. pace- makers because of complete atrioventricular block or sick sinus syndrome. The mean age of 5 male and 4 female patients was 49±22 years. Using the programming device, the pacing rate was set at 70/min, and at 5 different A-V delays (100, 125, 150, 175, 200, 250 ms), we measured the changes of various time intervals during systolic and diastolic phase by recording the M-mode echocardiogram of aortic and mitral valve, ECG, and phonocardiogram simultaneously. Results: In systolic phase, preejection periods were significantly shortened at A-V delay 200ms, 250 ms comparing to those of A-V delays below l75 ms. Left ventricular ejection times showed no statistically significant changes between various A-V delays. Systolic time intervals showed significant decrements at A-V delay 200 ms, 250 ms comparing to those of A-V delays below 175 ms. Changing the A-V delay from 100 ms to 250 ms, isovolumic contraction times were significantly pro- longed and isovolumic contraction time/preejection period ratios were significantly increased. And in diastolic phase, mitral valve opening times were significantly shortened at A-V delay 200 ms, 250 ms comparing to those of A-V delays below 175 ms. A spike-Mc intervals were significantly prolonged as changing the A-V delay from 100 ms to 250 ms. Conclusion: These data suggest that the change of A-V delay in D.D.D. pacemakers had variable effects on various time intervals of systolic and diastolic phase. Considering the close relationship between the systolic time interval and cardiac function, relatively long A-V delay such as 200 ms or 250 ms was thought to be more desirable in patients of this study. And measurement of systolic time interval by echocardiography could be used as an useful, noninvasive guideline for determining the optimal A-V delay in individual patient.

중위심실부위에 압력차를 갖는 이형 ASH 2 예

홍순조 ( Soon Jo Hong ),김학중 ( Hak Joong Kim ),김삼수 ( Sam Soo Kim ),김재형 ( Jae Hyung Kim ),채장성 ( Jang Seong Chae ),박황현 ( Whang Hyun Park ) 대한내과학회 1982 대한내과학회지 Vol.25 No.6

Q 파 심근경색증과 non - Q 파 심근경색증

이만영(Man Young Lee),승기배(Ki Bae Seung),김종진(Jong Jim Kim),노태호(Tae Ho Rho),채장성(Jang Seong Chae),김종상(Jong Sang Kim),홍순조(Soon Jo Hong),최규보(Kyu Bo Chol) 대한내과학회 1990 대한내과학회지 Vol.39 No.6

N/A To evaluate the clinical differences between Q wave myocardial infarction and non-Q wave myocardial infarction, the records of 336 patients with first myocardial infarction were reviewed. According to the presence or absence of Q waves on electrocardiogram, the patients were divided into two groups: a Q wave myocardial infarction group and a non-Q wave myocardial infarction group. The results were as follows: 1) According to standard electrocardiographic criteria, among 336 patients 271 patients (80.6%) had Q wave myocardial infarctions, and 65 patients (19.4%) had non-Q wave myocaridal infarctions. 2) The average age and male-to-female ratio were similar in the two groups. There were no significant differencres between the two groups in serum cholesterol levels and in incidences of a history of hypertension and diabetes mellitus. 3) Peak cardiac enzyme levels of CPK and LDH were significantly higher in the Q wave myocardial infarction group than in the non-Q-wave myocardial infarctions group. 4) When the complications of arrythmia, congestive heart failure and hospital mortality were compaired, incidences of AV block and congestive heart failure were significantly higher in the Q wave myocardial infarction group, but there was no difference in hospital mortality between the two groups. 5) Incidences of recurrent angina, congestive heart failure, reinfarction, death, and cause of death were not different statistically between the two groups, even though there was a tendency to have more recurrent angina and reinfarction in the non-Q wave myocardial infarction group and more congestive heart failure in the Q wave myocardial infarction group.

임파구 간이냉동 보존후 세포성 면역능의 회복

김동집 ( Dong Jip Kim ),최규보 ( Kyu Bo Choi ),김춘추 ( Choon Choo Kim ),정태준 ( Tae June Chung ),김호연 ( Ho Youn Kim ),박종원 ( Chong Won Park ),채장성 ( Jang Seong Chae ),박황현 ( Whang Hyun Park ) 대한내과학회 1983 대한내과학회지 Vol.26 No.1

개에서 인공 심조율로 조성된 상실성 빈맥의 혈역학적 변화

조은주(Eun Ju Cho),김재형(Jae Hyung Kim),노태호(Tai Ho Rho),진승원(Seung Won Jin),김희열(Hee Yeol Kim),이만영(Man Young Lee),김종진(Chong Jin Kim),채장성(Jang Seong Chae),홍순조(Soon Jo Hong),최규보(Kyu Bo Choi) 대한내과학회 2002 대한내과학회지 Vol.62 No.1

N/A Background: Tachyarrhythmias have various clinical features according to their tachycardia rates, systolic function of the left ventricle, the origin site and the mechanisms. Atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) might cause different hemodynamic changes due to their different mechanisms. Methods: To evaluate the hemodynamic differences of supraventricular tachycardias, atrial tachycardia (atrial pacing with AOO mode, 180/min, group I), AVRT (VA pacing interval 80 msec with DOO mode, 180/min, group II) and AVNRT (VA pacing interval 0 msec, 25 msec with DOO mode, 180/ min, group III) were simulated in eleven dogs. Hemodynamic parameters were systemic arterial pressure including systolic, mean and diastolic arterial pressure (SAP, MAP, DAP respectively), mean pulmonary arterial wedge pressure (MPAWP) and cardiac output (CO). Results: The MAP was highest in group I (87.0±20.4mmHg) and decreased with decreasing VA interval of no significance. The SAP was higher in group II (109.8±22.6mmHg) than in group III (95.3±27.1mmHg) (p <0.05). The level of MPAWP had no significant differences among three groups and showed no peculiar pattern with changes of VA interval. The CO was higher in group I (1.18 ±0.32 L/ min) than in other two groups with significant difference (p <0.01) and decreased with shortening of VA interval without significance. Conclusion: Above result s suggested that the AVRT and AVNRT have different effects on hemodynamic changes, those from different timing of atrial contraction, especially on SAP and CO. So hemodynamic compromise during tachycardia could be more severe in AVNRT than in AVRT inspite of their similar QRS morphology and tachycardia rate.(Korean J Med 62:35- 41, 2002)