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노임환(Im Hwan Roe),황흥곤(Heung Kon Hwang) 대한내과학회 1995 대한내과학회지 Vol.49 No.6
N/A Objectives : Recently, the nutcracker esophagus has been considered as a major motility defect causing the non-cardiac chest pain, and the pain has usually attributed to the exaggerated contractions of the distal esophageal body. We investigated the effects of the calcium channel blocker on the esophageal contractions and LES pressure. Methods: Thirty four patients with the nutcraker esophagus were administered Diltiazem (180- 270mg/D, N=20) or Nifedipine(30-40mg/day, N=14) for 3 months. Patients underwent manometric testing with the 4 lumens polyvinyl cathter of noninfusion system(SANDHILL TDS 4000) before and after treating with Diltiazem or Nifedipine. Results: Significant pain relief was observed in 28 of 34 cases; 15 of 20 Diltiazem treated cases and 13 of 14 Nifedipine treated ones. Side effects such as headache, dizziness, edema developed in about 30Yo of the Nifedipine treated group, whereas there was no side effects in the Diltiazem treated group. Treatment with Diltiazem or Nifedipine decreased mean distal amplitude by 28.9% and 18.4%, respectively, and mean duration by 27.1% and 16.5%, respectively, Nifedipine reduced LES pressure significantly(p<0.05), whereas Diltiazem reduced distal amplitude end duration much more than Nifedipine did. Conclusion: These studies suggest that calcium channel blockers are effective in treating patients with the nutcracker esophagus, even though the cause of the esophageal chest pain is not consistently related with the distal esophageal contractions of high amplitude, long duration and multiplicity. And also Diltiazem is considered to be better to the patients with the nutcraker esophagus due to the minimal side effects. Key Words: Nutcraker esophagus , Non cardiac chest pain , Ca ehannel blocker
이영주 ( Young Ju Lee ),조현철 ( Hyun Chul Jo ),하승형 ( Seung Hyung Ha ),장지원 ( Ji Wong Jang ),김종화 ( Jong Hwa Kim ),황흥곤 ( Heung Kon Hwang ) 대한내과학회 2007 대한내과학회지 Vol.73 No.6
중증도의 확장성심근증을 동반한 말단비대증 환자에서 Sandostatin LAR 치료 이후에 좌심실기능의 호전과 뇌하수체 종양의 크기의 감소를 관찰할 수 있었던 환자 1예를 경험하였기에 보고하는 바이다. Cardiovascular disease is the most frequent cause of death in patients with acromegaly. Recently, long-term treatment with a somatostatin analogue (Sandostatin LAR) has been shown to be effective in controlling growth hormone (GH) and insulin like growth factor-1 (IGF-1) hypersecretion in most patients with acromegaly. Along with the effectiveness in the hormone profile, Sandostatin LAR has been reported to be effective for tumor mass shrinkage and clinical symptom improvement. We have encountered a female acromeglic patient with severe dilated cardiomyopathy and the patient was treated with Sandostatin LAR After treatment for 12 months, as seen by follow up echocardiography, the overall cardiac function was significantly improved. We report the case with a review of the literature. (Korean J Med 73:643-646, 2007)
출혈성 신증후군 환자의 혈장 Atrial Natriuretic Polypeptide 농도 변화
박정의(Jeong Euy Park),차대룡(Dae Ryong Cha),김종웅(Jong Woong Kim),표희정(Heui Jung Pyo),이호왕(Ho Wang Lee),문정식(Jung Sik Moon),황흥곤(Heung Kon Hwang),김대중(Dai Joong Kim) 대한내과학회 1991 대한내과학회지 Vol.41 No.2
N/A Hemorrhagic fever with renal syndrome (HFRS) is characterized clinically by acute renal failure and pathologically by dense hemorrhage in the right atrium and medulla of the kidneys. To investigate whether there is any significant relationship between the changes of plasma atrial natriuretic polypeptide (ANP) and the clinical course, the plasma ANP was measured in 21 patients with HFRS. The plasma ANP was normal to low during the early oliguric phase (94.6±37.0 pg/ml), went up to a very high level (292.4±190.4 pg/ml) at the beginning of diuresis, then fell to a near normal level in a few days. The plasma renin activity (PRA) was very high during the early oliguric phase and fell rapidly in an opposite direction to the plasma ANP as the patients began diuresis. The rapid increase of plasma ANP and decrease of PRA seem to play an important role in the beginning of diuresis in HFRS.
증례 : 감염성 심내막염 환자에서 관상동맥색전으로 유발된 급성심근경색에서 색전제거술을 시행한 1예
이영주 ( Young Ju Lee ),조현철 ( Hyun Chul Jo ),하승형 ( Seung Hyung Ha ),장지원 ( Ji Won Jang ),유철웅 ( Cheol Woong Yu ),백만종 ( Man Jong Baek ),황흥곤 ( Heung Kon Hwang ) 대한내과학회 2007 대한내과학회지 Vol.72 No.1
흉통과 발열을 주소로 내원한 27세 남자 환자에서 심전도와 심초음파를 통하여 세균성 심내막염에 병발된 급성 심근 경색을 진단하였고, 심부전과 색전증의 위험성이 높아 응급 승모판 치환술 시행시 수술 시야상 관찰된 관상동맥색전 부위에 색전제거술을 시행한 예를 경험하였기에 보고하는 바이다. An acute myocardial infarction caused by a septic coronary embolism is a known complication of infective endocarditis and usually carries a fatal prognosis. We experienced a case of a 27-year-old man with an acute myocardial infarction caused by a coronary embolism due to bacterial endocarditis. An echocardiogram demonstrated mitral valve regurgitation with highly mobile multiple vegetations. Because of the high risk of systemic embolization and congestive heart failure, the patient underwent emergency surgery. Mitral valve replacement and an embolectomy were performed successfully without any surgical complications. (Korean J Med 72:85-89, 2007)
한국형 출혈열 환자에서 병기에 따른 혈중 Atrial Natriuretic Polypeptide 농도의 변화
박정의(Jeong Euy Park),송치욱(Chi Wook Song),송관규(Gwan Gyu Song),표회정(Heui Jung Pyo),박승철(Seung Chull Park),이창홍(Chang Hong Lee),김대원(Dae Won Kim),이갑노(Kap Ro Lee),양영선(Yung Sun Yang),황흥곤(Heung Kon Hwang),문정식(Jung 대한내과학회 1987 대한내과학회지 Vol.33 No.6
N/A The plasma atrial naturiuretic polypeptide (ANP) was repeatedly measured in each clinical phases in 20 patients (20.8±7.2yr) with Korean Hemorrhagic Fever (KHF). The study purpose was to see whether there is any relationship between the clinical course of KHF and the changes of plasma level of ANP. In three patients the plasma ANP could be repeatedly measured from the early oliguric to diruetic phases. In these three patients the plasma level of renin activity and aldosterone were very high in the early oliguric phase. Then the plasma renin activity and aldosterone level decreased steeply in remarkable degree to near normal level while the patient is still in oliguric phase and stayed at this level during the diuretic phase. The plasma ANP level was low (30-80pg/ml) in the early oliguric phase. Then with the sudden remarkable decrease of plasma renin activity and aldosterone the plasma ANP increased rapidly to high level (230-280pg/ml), then was decreased to near normal level (90-190pg/ml) making a narrow peaked plasma ANP concentration curve, and then the level stayed at near normal level during the diuretic phase. Around the time when the plasma renin activity and aldosterone concentrations were decreased to their low level and the plasma ANP was increased to it's peak level the oliguric phase was changed to the diuretic phase. The changes of plasma cortisol level followed the pattern of changes of plasma renin and aldosterone. It is possible that the increase of plasma ANP level might have had some role in the initiation of diuretic phase in these patients. It is not certain whether these changes are the unique changes seen only in patients with KHF or the changes seen also in patients with acute renal failure of other causes.