심근조영초음파 검사를 이용한 측부혈류의 관동맥조영 검사 등급에 따른 심근관류의 평가

권준(Jun Kwan),홍의수(Eui Soo Hong),김대혁(Dae Hyeok Kim),전민재(Min Jae Jeon),서정기(Jeong Kee Seo),박금수(Keurm Soo Park),이우형(Woo Hyung Lee) 대한내과학회 2000 대한내과학회지 Vol.58 No.2

N/A Background : A collateral flow can be assessed and graded by coronary angiography, however, the technique does not provide any information about perfusion. Myocardial contrast echocardiography (MCE) can assess collateral perfusion and has superior spatial resolution in defining its distribution. Objective : To investigate the difference of transmural perfusion according to the angiographical collateral grade in normal myocardium, we performed MCE of collateral artery in 16 patients (m : f = 11 : 5, age: 57±13yrs.) with angina and compared the results with the angiographical grades. Methods : In six patients with preexisting collaterals on baseline angiography, we performed MCE after intracoronary injection of sonicated Hexabrix. For 10 patients without preexisting collaterals on baseline angiography, we performed angiography, MCE for recruited collateral arteries during balloon inflation of stenotic coronary arteries (2 times for 120sec.). For 12 patients who underwent PTCA, we performed pressure wire simultaneously with angiography and MCE for recruited collateral arteries during balloon inflation. Fractional collateral flow(FCF) was defined by the ratio of coronary wedge pressure to proximal pressure(Pw/Pa). Angiographical collaterals were graded according to 'Rentrop' criteria(grade 0-3). Transmural thickness (TMT) and enhanced myocardial thickness (EMT) of an enhanced segment on MCE were measured at diastolic phase. The depth of collateral perfusion was estimated by collateral perfusion index (CPI) that was the ratio of EMT to TMT. Results : There were significant differences of CPI with respect to angiographical grades according to one way ANOVA test (p<0.05). One of five patients who had no recruited collaterals showed partial enhancement confined to the epicardium with CPI of 0.24. There was significant correlation between the angiographical grade and the CPI with Spearman's Rho value of 0.93(p<0.0001). The angiographical grades were significantly correlated with FCF with the Spearman's Rho value of 0.87(p=0.0002). There was also significant correlation between FCF and CPI with Pearson's r=0.81(p=0.0016). Conclusion : The higher the angiographical collateral grade is, the higher the collateral pressure and the deeper the fractional transmural perfusion from epicardium into endocardium gets. (Korean J Med 58:170-179, 2000)

혈관내 초음파 검사로 관찰한 보상성 혈관 재구성 ( Adaptive Arterial Remodeling ) 과 불충분 혈관 재구성 ( Inadequate Arterial Remodeling ) 의 비교

서정기(Jeong Kee Seo),박금수(Keum Soo Park),홍의수(Eui Soo Hong),김대혁(Dae Hyeok Kim),이효정(Hyo Jung Lee),조성욱(Seong Wook Cho),권준(Jun Kwan),이우형(Woo Hyung Lee) 대한내과학회 1999 대한내과학회지 Vol.56 No.6

N/A Objectives : Adaptive arterial remodeling (AAR) is a process to maintain luminal patency despite atherosclerotic plaque accumulation, whereas some of the lesions undergo a negative remodeling (vessel shrinkage), namely inadequate arterial remodeling (IAR). Histopathologic and intravascular ultrasound (IVUS) studies have shown lumen compromise is delayed until the atherosclerotic lesion occupies more than an estimated 40% to 50% of the potential area within the internal elastic lamina and proposed contributors to lumen compromise are medial and adventitial damage, superficial calcification, apoptosis. However the precise mechanisms and factors leading to these two vascular remodeling patterns are still unclear. The aim of this study is to investigate the effect of plaque accumulation on compensatory dilatation in arterial remodeling and their relationship according to their remodeling patterns. Methods : Preinterventional intravascular ultrasound images of 56 focal, de novo native and nonosteal lesions on coronary angiography were obtained. Cross sectional area of external elastic membrane (LEEM), Minimal lumen (MLA) and plaque plus media (P&M; P&M=EEM- MLA) in the target lesions were measured. Cross sectional area of external elastic membrane (REEM) and lumen (RLA) in proximal reference segments were measured. The lesions were divided into two groups according to their remodeling patterns ; adequate arterial remodeling (LEEM/REEM>0.78) and inadequate arterial remodeling (LEEM/REEM≤0.78). Results : 1) Forty-three patients (34 men, 9 women; mean age 58±11 years) who had not undergone previous coronary intervention were studied. 2) Adaptive arterial remodeling was observed in 47 (84%) of 56 lesions and inadequate arterial remodeling in 9 (16%). 3) No significant difference of clinical diagnosis, risk factors including hypertension, diabetes mellitus, smoking and lipid profiles was found between AAR and IAR group. 4) P&M/RLA of AAR was significantly higher than that of IAR (1.21±0.41 vs 0.91±0.23; p<0.001), whereas reference area stenosis (r-AST%) of AAR was significantly lower than that of IAR (59.8±23.0 vs 80.1±9.5; p<0.001). 5) In AAR group, P&M/RLA showed more significant correlation with LEEM/REEM (r=0.66, p<0.001) than r-AST% (r=0.36, p<0.05). 6) In IAR group, P&M/RLA showed significant correlation with r-AST% (r=0.79, p<0.05) but no correlation with LEEM/REEM (r=0.07, p>0.05). Conclusion : In adaptive arterial remodeling, the amount of plaque accumulation seems to be an important determinant of compensatory arterial dilatation and contribute weakly to stenosis severity. On the contrary, in inadequate arterial remodeling, it seems to contribute greatly to stenosis severity.

게이트 TI-201 관류 SPECT와 Cedars 소프트웨어를 이용하여 측정한 좌심실 구혈률

현인영(In Young Hyun),김성은(Sung Eun Kim),서정기(Jeong Kee Seo),홍의수(Eui Soo Hong),권준(Jun Kwan),박금수(Keum Soo Park),이우형(Woo Hyung Lee) 대한핵의학회 2000 핵의학 분자영상 Vol.34 No.3

N/A Purpose: We compared estimates of ejection fraction (EF) determined by gated Tl-201 perfusion SPECT (g-TI-SPECT) with those by gated blood pool (GBP) scan. Materials and Methods: Eighteen subjects underwent g-TI-SPECT and GBP scan. After reconstruction of g-TI-SPECT, we measured EF with Cedars software. The comparison of the EF with g-TI-SPECT and GHP scan was assessed by correlation analysis and Bland Altman plot. Results: The estimates of EF were significantly different (p<0.05) with g-TI-SPECT (40%±14%) and GBP scan (43%±14%). There was an excellent correlation of EF between e-TI-SPECT and GBP scan (r=0.94, p<0.001). The mean difference of EF between GRP scan and g-TI- SPECT was +3.2%, Ninety-five percent limits of agreement were +9,8%. EF between g-TI-SPECT and GBP scan were in poor agreement. Conclusion: The estimates of EF by g-TI-SPECT was well correlated with those by GBP scan. However, EF of g-TI-SPECT doesn't agree with EF of GBP scan. EF of g-TI-SPECT cant be used interchangeably with EF of GBP scan. (Korean J Nucl Med 2000;34:222-7)

위에서 발생한 사중암 1예

김영수,이진우,박기수,신용운,권계숙,정석,김준미,홍의수 대한소화기내시경학회 1996 Clinical Endoscopy Vol.16 No.2

According to Moertel's classification, synchronous multiple gastric cancer is eonsidered to be a sort of multiple primary cancer, The clinical signifieance of multiplicity in gastric cancer was its location relative to the resection line. Compared with patients with single gastric cancer, multiple gastric cancer were more frequently found among the older men, and they were more commonly found in early gastric cancer. The frequency of multifocality in gastric cancer is 2.2-9% in the world literature reports and is increasing recently, with advance in the diagnostic method of gastric cancer. However, synchronous multiple gastric cancer which has more than four foci is rare. In Korea, there has been only one case reported about quadruple gaatric cancer. Recently, we experienced a case of a 58-year-old male patient with synchronously developed-quadruple gastric cancer on the body of stomach, for whom radical total gastrectomy and esophagojejunostomy was done. All of them were moderately differentiated adenocarcinoma. The mapping about four lesions showed that Borrmanin type III AGC extending to the serosa was placed on the posterior wall of higher body; EGC IIc invading the submucosa, the anterior wall of mid body, EGC III confined to the mucosa, the lesser curvature side of mid to lower body; EGC III localizing to the mucosa, the posterior wall of lower body. So we reported this case with a review of literatures.

간경변증 환자에서 고암모니아혈증과 Helicobacter pylori의 연관성

김영수,최원,신현주,신용운,권계숙,이돈행,김범수,조현근,이재수,홍의수,박은재 대한소화기학회 1999 대한소화기학회지 Vol.34 No.3

Background/Aims: We examined the correlation between hyperammonemia and gastric Helicobacter pylori (H. pylori) infection in patients with liver cirrhosis. Methods: We studied 31 patients with liver cirrhosis and 34 normal controls. However, the cirrhotic group did not include patients who had a bleeding tendency or hepatic encephalopathy. We performed gastroscopy, obtained gastric juice (3-4 mL) and antral biopsy specimens, and examined the ammonia levels of blood and gastric juice in each group. Results: In the cirrhotic group, there was no difference in blood ammonia levels between the H. pylori- positive (HP+) and negative (HP-) groups. However, the ammonia levels of gastric juice in the HP+ group showed a tendency to be higher than those in the HP- group (p=0.0773). Child-Pugh scores in the HP+ group were significantly lower than those in the HPQ group (p= 0.0309). By multiple regression analysis, factors affecting the ammonia levels of blood were determined. They were age (coefficient 1.2462, p=0.0256) in the control group (r2=0.2821), and ammonia levels of gastric juice (coefficient 0.007417, p=0.0322) in the cirrhotic group (r2=0.3127). On the other hand, Child- Pugh scores (coefficient 12.508122, p=0.0883) indicated a slight correlation with the blood ammonia levels in the cirrhotic group. Conclusions: It seems that gastric H. pylori infection is associated with hyperammonia in patients with liver cirrhosis.

장결핵에 의한 장중첩증 1예

김영수,신용운,권계숙,김범수,정석,조현근,김선후,홍의수,이돈행 대한소화기내시경학회 1998 Clinical Endoscopy Vol.18 No.1

Although intussusception is primarily a disease of children, about 5 to 10 percent of cases occur in adults. The underlying causes of adult intussusception are tumor, postoperative complication, local bowel ischemia, abnormal motility and rarely intestinal tuberculosis. Recently, we experienced a 62-year-old man with intussusception underlying pulmonary tuberculosis. The postoperative pathologic finding was intestinal tuberculosis. For its rarity, we report this case with review of literatures.

국소적 벽운동 차이를 보이는 확장성심근증 환자에서 벽운동 차이에 따른 관동맥 혈류예비력의 비교

서정기,권준,김대혁,홍의수,이효정,조성욱,박금수,이우형 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.10

심근조명 심초음파를 이용한 심내막하 경색 진단을 위한 심전도 검사의 신뢰도 평가

서정기,박금수,권준,권미영,이돈,양성식,홍의수,이효정,김대혁,조성욱,이우형 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.8

심근 기능 측정에 사용된 게이트 심근 관류 SPECT 방법의 재현성 평가 : 201Tl과 99mTc-MIBI 게이트 SPECT의 비교 Comparison with Thallium-201 and Technetium-99m-MIBI

김성은,최원식,이우형,홍의수,현인영,서정기,김대혁,권준,박금수 대한핵의학회 2000 핵의학 분자영상 Vol.34 No.5

Purpose: We compared the reproducibility of 201Tl and 99mTc-sestamibi (MIBI) gated SPECT measurement of myocardial function using the Germano algorithm. Materials and Methods: Gated SPECT acquisition was repeated in the same position in 30 patients who received 201Tl and in 26 who received 99mTc-MIBI. The quantification of end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) on 201Tl and 99mTc-MIBI gated SPECT was processed independently using Cedars quantitative gated SPECT software. The reproducibility of the assessment of myocardial function on 201Tl gated SPECT was compared with that of 99mTc-MIBI gated SPECT. Results: Correlation between the two measurements for volumes and EF was excellent by the repeated gated SPECT studies of 201Tl (r=0.928 to 0.986; p<0.05) and 99mTc-MIBI (r=0.979 to 0.997; p<0.05). However, Bland Altman analysis revealed the 95% limits of agreement (2 SD) for volumes and EF were tighter by repeated 99mTc-MIBI gated SPECT (EDV: 14.1 ml, ESV: 9.4 ml and EF: 5.5%) than by repeated 201Tl gated SPECT (EDV: 24.1 ml, ESV: 18.6 ml and EF: 10.3%). The root mean square (RMS) values of the coefficient of variation (CV) for volumes and EFs were smaller by repeated 99mTc-MIBI gated SPECT (EDV: 2.1 ml, ESV: 2.7 ml and EF: 2.3%) than by repeated 201Tl gated SPECT (EDV: 3.2 ml, ESV: 3.5 ml and EF: 5.2%). Conclusion: 99mTc-MIBI provides more reproducible volumes and EF than 201Tl on repeated acquisition gated SPECT. 99mTc-MIBI gated SPECT is the preferable method for the clinical monitoring of myocardial function.

관동맥 환자에서의 PTCA 시행 후 Coronary Flow Reserve 와 Fractional flow Reserve 치의 비교

최문희,이우형,서정기,박금수,홍의수,권준,조성욱 대한내과학회 1999 대한내과학회지 Vol.56 No.1

Objectives : Severity of coronary artery stenosis has been defined in terms of geometric dimensions, pressure gradient-flow relations, resistance to flow and coronary flow reserve(CFR) after maximum arteriolar vasodilation. Myocardial fractional flow reserve(FFR) is a new index of the functional severity of coronary stenosis that is calculated from pressure measurements during coronary angiography. We compared the relationship between FFR and CFR after PTCA and the residual stenosis with FFR and CFR in the patients with acute myocardial infarction (AMI) and angina. Methods : The study population consisted of 25 patients with AMI and 18 patients with angina. All AMI patients had successful restoration of infarc-related artery by thrombolysis or direct PTCA. Doppler index was measured using 0.014 inch Doppler wire 15 minutes after successful restoration of infarc- related artery. Hyperemic index was measured after intracoronary injection of adenosine(16-18ug). Baseline and hyperemic distal coronary artery pressure was measured using 0.014 inch pressure wire with advancing the wire distal to the lesion and simultaneous proximal aortic pressure was measured using guiding catheter. Results : 1) Post-interventional FFR and CFR were 0.91±0.09 and 1.87±0.45 in AMI and 0.93±0.06 and 2.73±0.67 in angina. There was no significant correlation between FFR and CFR in AMI and angina(p=NS). CFR showed the weak correlation with hyperemic distal pressure(hPd) in AMI(p=0.04) and FFR with hDSVR in angina(p=0.04). FFR and CFR were not correlated with mean blood pressure and heart rate(p=NS). 2) FFR and hyperemic pressure gradient had the close correlation with residual stenosis after successful PTCA in AMI and angina(p$lt;0.001). Baseline pressure gradient also showed weak correlation with FFR(p$lt;0.05). 3) CFR was 1.87±0.45 in AMI and 2.73±0.67 in angina with significant difference between two groups (p$lt;0.001) and FFR was 0.91±0.09 in AMI and 0.93±0.06 in angina without difference(p=NS). hPa and hPd showed the significant difference between the two groups(p$lt;0.05). Conclusion : FFR seems to be a new index of the functional severity of coronary stenosis that is calculated from pressure measurements during coronary angiography.