증례 : 역 다코주보 심근증으로 발현된 갈색세포종

윤현주 ( Hyun Ju Yoon ),권택근 ( Taek Geun Kwon ),김기영 ( Ki Young Kim ),현대우 ( Dae Woo Hyun ),배장호 ( Jang Ho Bae ) 대한내과학회 2007 대한내과학회지 Vol.73 No.1S

고혈압 환자의 경동맥 내중막 두께의 증가는 중막 두께의 증가에 기인한다

원희관 ( Hee Kwan Won ),김원식 ( Wuon Shik Kim ),김기영 ( Ki Young Kim ),현대우 ( Dae Woo Hyun ),권택근 ( Taek Geun Kwon ),배장호 ( Jang Ho Bae ) 대한내과학회 2008 대한내과학회지 Vol.75 No.2

목적: 죽상경화증의 전신적인 위험인자에 대한 혈관의 서로 구분 되는 다양한 반응이 제시되어왔다. 저자들은 각각의 동맥벽층을 측정할 수 있는 새로운 방법을 사용하여 경동맥벽에 미치는 고혈압의 영향을 측정하고자 하였다. 방법: 이 연구는 고해상도의 초음파로 경동맥 초음파를 시행하여 좌측 경동맥 내중막, 내막, 중막을 분리하여 측정할 수 있었던 163명의 환자들을 대상으로 하였다. 각각의 경동맥벽의 두께는 Canny edge-detection algorithm을 사용한 새로운 방법으로 측정되었다. 결과: 고혈압 환자군(79명, 평균 연령 61.8세)은 정상 혈압군(84명, 평균 연령 59.6세)에 비해 더 높은 당뇨병의 유병률을 보였으며(31.6% vs 11.9%, p=0.004), 정상 혈압군에 비해 고밀도 지단백 콜레스테롤이 더 낮았다(41.8±11.0 mg/dL vs 45.7±10.0 mg/dL, p=0.019). 두 군에서 경동맥 내막의 두께는 유의한 차이를 보이지 않았으나(0.34±0.04 mm vs 0.34±0.04 mm, p=0.196), 고혈압 환자군은 정상 혈압군에 비해 경동맥 내중막 두께가 높은 것으로 나타났으며(0.81±0.21 mm vs 0.74±0.18 mm, p=0.003), 경동맥 중막 두께에 있어서도 더 높은 값을 나타내었다(0.46±0.12 mm vs 0.42±0.09 mm, p=0.007). 다변수적 분석을 통해 나타난 경동맥 내중막 두께의 독립적 인자로는 경동맥 중막 두께(β=0.915, p<0.001), 고혈압(β=-0.076, p=0.008), 나이(β=0.074, p=0.010), 그리고 성별(β=-0.079, p=0.005)가 있었으며, 경동맥 내중막 두께와 경동맥 중막 두께 사이의 Pearson 상관관계는 경동맥 내중막 두께와 경동맥 내막 두께 사이의 것보다 더 높게 나타났다(r=0.932, p<0.001 vs r=0.445, p<0.001). 또한 고혈압 환자에서 경동맥 내중막 두께와 경동맥 내막 두께 사이의 상관관계가 낮았던 것에 비해(r=0.344, p=0.002 vs r=0.583, p<0.001) 고혈압 환자에서 경동맥 내중막 두께와 경동맥 중막 두께사이의 상관관계는 더 높은 것으로 나타났다(r=0.940, p<0.001 vs r=0.910, p<0.001). 결론: 고혈압 환자에 있어서 경동맥 내중막 두께의 증가는 경동맥 중막 두께의 증가에 의해서이며, 이 결과는 고혈압 환자에 있어서 중막층의 비후와 일치한다. 향후 고혈압환자와 관련된 연구에 있어 경동맥 중막층에 대한 연구에 더 초점이 맞춰져야 할 것이다. Backgrounds/Aims: It has been suggested that there is a differential response of the vasculature to systemic risk factors for atherosclerosis. We sought to evaluate the impact of hypertension on the carotid arterial wall using new methods that can measure each arterial wall layer. Methods: The study subjects consisted of 163 patients who underwent carotid arterial scanning using high-resolution ultrasound that could measure the left carotid intima-media, intima, and media separately. The individual carotid arterial wall thickness was measured off-line by a new method using the Canny edge-detection algorithm. Results: Hypertensive patients (n=79, mean age 61.8 years) had a higher prevalence of diabetes (31.6% vs 11.9%, p=0.004) and a lower level of HDL-cholesterol than did normotensive patients (41.8±11.0 mg/dL vs 45.7±10.0 mg/dL, p=0.019). Hypertensive patients had higher carotid intima-media thickness (CIMT, 0.81±0.21 mm vs 0.74±0.18 mm, p=0.003) and carotid medial thickness (CMT, 0.46±0.12 mm vs 0.42±0.09 mm, p=0.007) than did normotensive patients, whereas carotid intimal thickness (CIT) was not significantly different (0.34±0.04 mm vs 0.34±0.04 mm, p=0.196). Multivariate analysis revealed that the independent factors of CIMT were CMT (β=0.915, p<0.001), hypertension (β=0.076, p=0.008), age (β=0.074, p=0.010), and sex (β=-0.079, p=0.005). Pearson correlation coefficient between CIMT and CMT was higher (r=0.932, p<0.001 vs r=0.445, p<0.001) than that between CIMT and CIT. The correlation between CIMT and CMT was higher (r=0.940, p<0.001 vs r=0.910, p<0.001) in hypertensive patients than in normotensive patients, whereas that between CIMT and CIT was lower (r=0.344, p=0.002 vs r=0.583, p<0.001) in hypertensive patients. Conclusions: The increased CIMT is caused by increased CMT in hypertensive patients, and this finding is compatible with the medial hypertrophy seen in hypertension. The carotid medial layer should be the focus of attention in future studies looking at hypertensive patients. (Korean J Med 75:179-185, 2008)

비침습적 지표들을 이용한 관상동맥 중증도 평가

윤세희 ( Se Hee Yoon ),배장호 ( Jang Ho Bae ),김기영 ( Ki Young Kim ),현대우 ( Dae Woo Hyun ),김완호 ( Wan Ho Kim ),구훈섭 ( Hoon Sup Koo ) 대한내과학회 2005 대한내과학회지 Vol.69 No.5

목적 : 관상동맥 경화증이 있는 환자군에서 관상동맥 경화의 정도와 비침습적 동맥 경화 지표와의 사이에 상관관계가 있는지 알아보고, 이들 지표들간의 상관관계가 있는지 알아보고자 이 연구를 시행하였다. 방법 : 관상동맥 조영술상 병변이 확인되고 비침습적 동맥경화 지표(경동맥 내중막 두께, 동맥 경직도, 내피세포 기능)를 동시에 시행한 연속적인 275명의 환자(평균 연령; 60세, 남자; 140명)를 대상으로 하였다. 관상동맥 경화의 정도는 50% 이상의 협착이 있는 주요 관상동맥 수에 따라 0, 1, 2, 3으로 분류하여 동맥 경화지표에 따른 상관관계를 비교하였다. 관상동맥의 협착이 10% 이상 50% 미만인 경우를 0으로 하였다. 경동맥 내중막 두께는 고해상도 초음파와 MATH software를 이용하여 반자동으로 측정하였고, 내피세포 기능은 상완 동맥 혈류의존 확장능(FMD, %)을 구하여 측정하였고, 동맥 경직도는 맥파속도를 대동맥, 하지 동맥, 상지 동맥에서 각각 측정하여 분석했다. 결과 : 경동맥 내중막 두께는 0군(n=125), 1군(n=75), 2군(n=38), 3군(n=21)에서 각각 0.85±0.16㎜, 0.88±0.15㎜, 0.91±0.19㎜, 0.98±0.18㎜로 관상동맥 경화의 정도에 따라 유의하게(r=0.211, p=0.001) 증가되는 경향을 보였다. 동맥 경직도와 내피세포 기능은 관상동맥 경화 정도에 따른 유의한 변화가 관찰되지 않았다. 경동맥 내중막 두께는 이들 지표들 중 대동맥의 경직도와만 서로 유의한 상관관계를 보였고(r=0.179, p=0.004), 대동맥 경직도는 하지와 상지의 동맥 경직도와 유의한 상관관계를 보였으나 다른 지표들과는 상관관계가 없었다. 내피 세포 기능과 상관관계는 이들 지표들 중에는 관찰되지 않았다. 결론 : 관상동맥 경화가 있는 환자군에서 관상동맥 경화의 정도와 상관이 있는 비침습적 지표로는 경동맥 내중막 두께였으나 독립적 인자는 아니었고, 이들 환자군에서 경동맥 내중막 두께는 대동맥 경직도와 유의한 상관관계가 관찰되었다. Background : We performed this study to evaluate the association between the extent of coronary atherosclerosis and the noninvasive atherosclerosis surrogates such as carotid intima-media thickness (IMT), endothelial function, and arterial stiffness in patients with coronary atherosclerosis. Methods : The study population was consisted of 275 consecutive patients (mean age; 60 yrs, 140 males), who had coronary atherosclerosis by coronary angiography. The extent of coronary atherosclerosis was classified to 0 (n=125), 1 (n=75), 2 (n=38), 3 (n=21) according to the vessel number narrowed by more than 50%. Carotid IMT was semi-automatically measured using MATH software and high-resolution ultrasound. Endothelial function was measured by flow-mediated brachial artery dilation (FMD, %). Arterial stiffness was measured by obtaining pulse wave velocity in the aorta, upper and lower extremities. Results : Carotid IMT was significantly (r=0.211, p=0.001) increased according to the extent of coronary atherosclerosis (0.85±0.16㎜, 0.88±0.15㎜, 0.91±0.19㎜, 0.98±0.18㎜, respectively). However, there was no significant association between the other surrogates and the extent of coronary atherosclerosis. Carotid IMT also showed the significant association with the aortic stiffness (r=0.179, p=0.004). There was not any more significant association among the other surrogates in this study. Conclusions : The extent of coronary atherosclerosis is associated with carotid IMT but not independently, only out of several noninvasive atherosclerosis surrogates in patients with coronary atherosclerosis. And carotid IMT is also associated with the aortic stiffness in this study population. (Korean J Med 69:493-502, 2005)

심근교 ( Myocardial bridge ) 의 임상적 의의

한성욱(Seong Wook Han),김윤년(Yoon Nyun Kim),허승호(Seung Ho Hur),현대우(Dae Woo Hyun),김기식(Kee Sik Kim),김권배(Kwon Bae Kim) 대한내과학회 1998 대한내과학회지 Vol.54 No.6

N/A Objective: A myocardial bridge is an anatomic arrangement in which an epicardial coronary artery becomes engulfed for a limited segment by myocardial fibers from birth. It is recognized angiographyically by systolic compression of coronary artery. A large discrepancy exist between pathological series, in which the incidence has varied from 15% to 85%, and angiographic seires, in which it is reported as being between 0.51% and 2.5%. A myocardial bridge has been associated with myocardial ischemia, infarction and sudden death, but its clinical significance is controversial, The aim of this study was to assess the clinical characteristics and significance of myocardial bridge based on our exerience. Method: We reviewed the consecutive 1554 cinean-giograms performed in the cardiac laboratory of the Keimyung University Hospital from Nov, 1992 to May 1996. Two groups were constituted according to percentage of systolic reduction of the arterial lumen assessed visually or by computerized digital caliper. We differentiated them between below 50% and above 50% in the systolic reduction. Comparison between variables in two groups were made. Results: 1) Myocardial bridges were present in 36 patients (2.3%). 2) Among these patients, 21 had angina (58.3%), 8 had myocardial infarction (22.2%), 6 had hypertension (16.7%) and 4 had hypertrophic cardiomyopthy, primary pulmonary hypertension, mitral regurgitation and aortic regurgitation, respectively. 3) The highest prevalance was found in the mid-left anterior descending (LAD) artery (80.5%), next in the distal LAD artery (11.1%). Two cases had myocardial bridges in two sites. 4) Isolated myocardial bridges which excludes those associated with concomitant cardiovascular diseases were present in 19 patients (1.22%). Initiol symptoms in patients with myocardial bridge are exercise induced angina in 10, atypical chest pain in 3, resting onset chest pain in 3 and palpitation in 1 at admission. Two patients had no specific symptoms except electrocardiographic abnormality. 5) Clinical diagnosis of patients with isolated myocardial bridges were anginal pectaris in 13, myocardial infarction in 2 and nonspecific in 4. Myocardial infarction was present in the group of above 50% of systolic reduction. Conclusion: A myocardial bridge may induce myocardial ischemia and myocardial infarction, but prognosis may be good if patients should avoid precipitating factors i,e. condition induce tachycardia or administered β-blocker etc.

음주측정 스마트키

최강현 ( Kang-hyeon Choi ),유종원 ( Jong-won Yu ),유강현 ( Kang-hyeon Yu ),주동철 ( Dong-chul Joo ),박현주 ( Hyun Joo Park ),박대우 ( Dae Woo Park ) 한국정보처리학회 2019 한국정보처리학회 학술대회논문집 Vol.26 No.2

South Korea's per capita alcohol consumption ranking is 14th in the world, but it ranks first in the world for binge drinking. In society, dining and dining culture is developed, which leads to drinking. He often puts his hands on the wheel in a relaxed way after drinking. To prevent this situation from happening in advance, a Bluetooth module is installed in the aduino circuit to transmit the measured alcohol level to the smartphone and measure the blood alcohol level.

재원기간중 사망한 급성 심근경색증 환자의 임상적 특징

현대우,김기식,신이철,박소영,배장호,한창엽,김윤년,김권배 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.9

용접 근로자의 혈액 및 요중 망간 농도

현대우,안선희,김강윤,최호춘 大韓産業醫學會 1998 대한직업환경의학회지 Vol.10 No.4

Blood and urine samples were taken from 447 welders exposed to manganese containing welding fumes and 127 office workers not exposed to welding fumes as a control. The air samples were analyzed by flame atomic absorption spectrophotometer(Varian 30A, Australia), and blood and urine samples were analyzed by flameless atomic absorption spectrophotometer(Z-8100, Hitachi, Japan). Data were evaluated in accordance with type of industry, smoking habits, and work duration. The results obtained were as follows: 1. The limit of detection(LOD) levels of manganese in blood and urine were 0.11㎍/100㎖ and 0.14㎍/ι, respectively. Our results of manganese concentration were shown within ±2 standard deviation which was the upper and lower warning limit(UWL or LWL) on quality control chart. 2. The airborne concentrations of manganese in welding workplaces were 0.067㎎/㎥ showing differences by type of industry; 0.017㎎/㎥ in automobile assembly and manufacturing industries, 0.084㎎/㎥ in steel heavy industries and 0.180㎎/㎥ in shipyards. 3. The blood manganese concentrations showed differences by type of industry showing the highest values of 1.70㎍/100㎖ in shipyards, 1.24㎍/100㎖ in automobile assembly and manufacturing industries and 1.111㎍/100㎖ in steel heavy industries. Urinary manganese concentration corrected by urinary creatinine concentrations was 0.34㎍/g creatinine in automobile assembly and manufacturing industries, 0.43㎍/g creatinine in steel heavy industries and 0.48㎍/g creatinine in shipyards. There were no difference urinary manganese concentrations by type of industry. 4. The overall blood manganese concentration was 1.26㎍/100㎖, and urinary manganese concentration was 0.35㎍/g creatinine in welders. In contrast to these values, blood and urinary manganese concentrations were lower in control group showing 0.73㎍/100㎖,, and 0.28㎍/g creatinine, respectively. 5. Smoking habits did not seem to affect on blood and urinary manganese concentrations both in welders and office workers. 6. Blood manganese concentrations were significantly higher in welder who had worked longer than 10 years than in welder who had worked less than 10 years. 7. The blood manganese concentrations were significantly correlated to airborne manganese concentrations(r=0.318, n=64), work duration(r=0.425, n=538), and cumulative exposure indices(CEI) (r=0.354, n=64).

상심실성 빈맥환자에서 관상정맥동의 형태비교

현대우,김윤년,박소영,한성욱,허승호,김기식,김권배 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.4

관상동맥 성형술이 QT 간격분산에 미치는 영향

신이철,김윤년,현대우,허승호,박남의 대한순환기학회 2003 Korean Circulation Journal Vol.33 No.11

관상동맥 스텐트 내 재협착의 발생에 미치는 임상적 관동맥 조영술적 요인들

윤혁준,김기식,박형섭,이영수,현대우,한성욱,허승호,김윤년,김권배,박남희,원경숙 대한순환기학회 2003 Korean Circulation Journal Vol.33 No.12