허혈성 심질환에서 나타나는 황상화지수, 사이토카인 및 염증지표의 변화

전상훈,안지훈,방덕원,온영근,현민수,김성구,권영주 순천향대학교 의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.3

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젊은 성인에서 흡연에 의한 상완동맥 내피기능의 부전에 관한 연구

이상철,권영주,방덕원,이선해,이보영,김지욱,김영훈,온영근,현민수,김성구 순천향의학연구소 2002 Journal of Soonchunhyang Medical Science Vol.8 No.1

Background and Objectives : Cigarette smoking is a major factor and the most modifiable risk factor for atherosclerosis. Endothelial dysfunction is an early event in atherosclerosis, before the structural change of the systemic arteries. We hypothesized that endothelial dysfunction might be present in the systemic arteries of young adult smokers and that this might be dose-dependent phenomenon. Therefore, we try to certify that smoking is associated with endothelial dysfunction in healthy young adults without other risk factor of atherosclerosis. Subjects and Methods : we studied noninvasively 29 subjects aged 3 to 4 decades without other risk factor of atherosclerosis, they were composed of the two groups, current smokers(n=15) and nonsmokers(n=14). Smoking history varied from 3 to 20 pack years. Using high-resolution ultrasound, vessel diameter and mean flow rate were measured at rest, during reactive hyperemia(with flow-mediated endothelium-dependent dilation), and after sublingual nitroglycerin(NG-induced endothelium-independent vasodilation). Result : Flow mediated endothelium dependent dilation was observed in the control subjects (9.4±3.44%) but was impaired in the smokers(5.8±2.51%)(p=0.004). NG-induced endothelium independent dilation is no difference in all subjects. Conclusion : Cigarette smoking is associated with endothelial dysfunction in healthy young adults.

허혈성 심질환에서 나타나는 항산화지수, 사이토카인 및 염증지표의 변화

전상훔,안지훈,방덕원,온영근,현민수,김성구,권영주 순천향대학교 교수학습개발센터 2004 Journal of Soonchunhyang Medical Science Vol.10 No.3

Purpose : As diet habits change and the elderly popuation increases conronary artery disease(CAD) has also increased. Recent ongoing studies on varous inflammatory indexes in acute coronary syndrome(ACS) are underway. Several study results have shown that total antioxidant status(TAS) was remarkably lower in unstable angina than in chronic stable angina and levels of interleukin-(IL-6), C-reactive protein(CRP), monocyte chemoattractant protein-1(MCP-1), P-selectin were reported to be elevated in unstable angina and acute myocardial infarction(AMI). In our study, we studied and compared the level changes of cytokines and inflammatory indexes that play important roles inside the blood vessel. Methods : Study subjects were patients who were admitted and underwent coronary angiography at the cardiology department in Soonchunhyang university hospital. Subjects were divided into 4 groups, a control group, a stable angina and unstable angina group and an acute myocardial infarction group. The clinical findings, TAS, inflammatory cytokines(P-selectin, MCP-1, IL-6), anti-inflammatory cytokines(IL-10), Homocysteine and CRP levels in each group were measured and compared. Results : The total number of study participants was 86 patients, with 26 patients in the control group, 21 patients with stable angina, 15 patients with unstable angina, and 24 patients with AMI. There were significant differences in the TAS among the 4 grouops. 1.7±0.51 mmol/L, 1.6±0.60 mmol/L, 1.4±0.20 mmol/L, 1.4±0.29 mmol/L respectively. IL-6 levels also showed a significant difference between groups, averaging 0.8±2.47 pg/ml, 2.7±3.77 pg/ml, 6.8±10.63 pg/ml, 10.9±17.43 pg/ml respectively. Homocysteine levels averaged 8.0±2.47 pg/ml, 6.8±10.63 pg/ml, 10.9±17.43 pg/ml restectively. Homocysteine levels averaged 8.0±1.0 μmol/L in the control group, 14.3±5.14 μmol/L in patients with stable angina, 16.0±4.66 μmol/L in patients with unstable angina, and 17.3±10.08 μmol/L in AMI patients. Conclusion : Compared to the control group, the TAS levels were significantly lower in patients with unstable angina and AMI. there was no difference between the control group and those with stable angina. IL-6 and homocysteine levels were also higher in patients with unstable angina and AMI. Therefore we concluded that measurements of TAS, IL-6 and homocysteine are useful in measuring the inflammatory index of coronary artery diseases and may be important factors in predicting the states and prognosis of cardiovascular disorders.

만선신부전 환자에서 관상동맥조영술 소견에 관한 연구

한대희,김성구,박상호,김성한,조원영,방덕원,조윤행,정의룡,은영근,권영구 순천향의학연구소 2003 Journal of Soonchunhyang Medical Science Vol.9 No.1

Background : Patients with chronic renal fialure have a substantially elevated risk of death from cardiovascular diseases than do the general population. the patients with chronic renal failure are at significantly increased freqeuncy of hypertension, hyperlipidemia, and diabetes mellitus which are known to the risk factors of the coronary artery diseases, and the prevalence of the coronary artery diseases in chronic renal failure patients is highly associated with the hemodynamic disorder and metabolic abnormalities. therefore we expected that the coronary angiographic findings in patients with chronic renal failure should be different from the general population (control groups) and investigated the risk factors contributing to coronary artery diseases. Method : we have retrospectively compared the coronary angiographic findings of 44 patients with chronic renal failure on hemodialysis with that of 88 patients in the general population and investigated the factors contributing to the development and acceleration of coronary artery diseases in patients with chronic renal failure Result : Hypertension and diabetes mellitus which is risk factors for coronary artery disease is significantly increased in patients with chronic renal failure, in coronary angiographic finding the severity of the lesion is worse. the incidence of PCI or CABG of patients with chronic renal failure is more than that of control group but statistically no difference between patients with chronic renal failure and control group. the sex, the duration of disease, the duration of dialysis, serum creatinine in patients with chronic renal failure have no correlation to the prevalence of coronary artery disease and severity of lesion. hyperglycemic patients with chronic renal failure have high incidence of coronary artery disease and are worse in the severity of lesion Conclusions : There is significantly increased the pevalence and severity of involving multiple coronary artery diseses in hyperglycemic patients with CRF.

미세혈관 협심증 환자의 임상상 및 지표에 관한 연구

박상호,온영근,김현정,이태훈,길효욱,김현건,박수진,송해정,한대희,방덕원,신원용,이내희,김성구,권영주 순천향의학연구소 2003 Journal of Soonchunhyang Medical Science Vol.9 No.1

Background : Microvascular angina or syndrom X is heterogenous and encompasses different pathogenetic entities. Several studies suggest that microvascular angina have good prognosis and occurs predominantly in postmenopausal women. Lipoprotein (a), total cholesterol, LDL-cholesterol, HDL-cholesterol, triglyceride, homocystein, CRP and fibrinogen are the independent risk factor of acute coronary syndrome and are the chief underlying cause of atherosclerosis. We investigated clinical characteristics and markers in patients with microvascular angina. Methods : We studies 23 patients diagnosed with microvascular angina and 16 control group with negative treadmill exercise test and no significant coronary angiogram. We investigated clinical characteristics in patients group and evaluated symptom during a follow-up period of 4.2± 2.5 month. Exercise time in treadmill exercise test was compared between patients and control group. We assessed the level of markers, such as lipoprotein (a), total cholesterol, LDL-cholesterol, HDL-cholesterol, triglyceride, homocystein, CRP and ESR in two groups. Results : There is no difference in age between two groups. Patients group had a tendency to increase in female, hypertension, DM, and smoking history, but there was no statistical significance difference. Exercise duration time was significantly decreased in patients with microvascular angina (p<0,05). Serum lipoprotein (a), total cholesterol, LDL-cholesterol, HDL-cholestrol, Triglyceride, ESR, Fibrinogen and Homocystein value were no significant difference between microvascular angina and control group. Only CRP was significantly high in patients with microvascular angina (p<0.05). Conclusion : There was no statistical significance difference in age, sex, hypertension, DM and smoking history between two groups but patients group had a tendency to increase the prevalence in hypertension, DM and smoking history, female. Also, Symptom improvement and disappearance in follow-up was presented in 11 patients of 19(57.9%). Exercise tolerance was worse in patients group than control group. CRP value was significantly higher in patients group than control group. There was no statistical significance difference in lipoprotein (a), total cholesterol, LDL-cholesterol, HDL-cholesterol, triglyceride, homocystein, ESR and Fibrinogen between two groups.

Development of Brugada syndrome Following photodynamic therapy in a patient with cholangiocarcinoma

( Duk Won Bang ),( Min Su Hyon ),( Young Duk Cho ),( Sung Koo Kim ),( Young Joo Kwon ) 대한내과학회 2012 The Korean Journal of Internal Medicine Vol.27 No.1

Brugada syndrome can be unmasked by several conditions including a febrile state, marked leukocytosis, and electrolyte disturbances. Herein, we describe a 62-year-old man with cholangiocarcinoma in the first reported case of Brugada syndrome onset following photodynamic therapy.

관상동맥 질환 환자에서 경동맥 초음파의 유용성

방덕원 ( Duk Won Bang ),심윤숙 ( Yun Suk Shim ),박병원 ( Byoung Won Park ),현민수 ( Min Su Hyon ),김성구 ( Sung Koo Kim ),권영주 ( Young Joo Kwon ) 대한내과학회 2007 대한내과학회지 Vol.73 No.1

목적: 경동맥 초음파로 측정한 내중막 두께 및 경화반의 유무와 관상동맥 질환 여부와의 관련성에 관한 보고가 있었으나, 이들과 관상동맥 질환의 중증도와의 관련성에 관한 연구는 적었다. 저자들은 이들 지표들과 관상동맥 질환의 중증도의 관련성을 검토하여 관상동맥질환 환자에서 경동맥 초음파의 유용성을 평가하였다. 방법: 2005년 11월부터 2006년 11월까지 관상동맥조영검사와 경동맥 초음파를 시행한 환자를 대상으로 하였고, 관상동맥 질환의 중증도는 50% 이상의 협착이 있는 관상동맥의 수에 따라 1군, 2군, 3군으로, 그리고 정상인 경우를 대조군(0군)으로 분류하여, 경동맥 초음파상 좌우 총경동맥 내중막 두께의 평균치, 최대치 및 동맥 경화반 유무를 비교하였다. 결과: 총 환자수는 90명이었고, 3군으로 갈수록 남자가 많았다(p=0.001). 총경동맥 내중막 두께의 평균치는 3군으로 갈수록 유의한 증가를 보였다(0군, 0.67±0.11 mm; 1군, 0.66±0.13 mm; 2군, 0.68±0.08 mm; 3군, 0.78±0.10 mm, p=0.001). 내중막 두께의 최대치도 유사한 결과를 나타내었다(0군, 0.88±0.16 mm; 1군, 0.85±0.20 mm; 2군, 0.89±0.13 mm; 3군, 1.06±0.17 mm, p=0.000). 경화반의 빈도도 3군으로 갈수록 유의한 증가를 보였다(p=0.004). 결론: 경동맥 내중막 두께 및 경화반의 유무 등 경동맥 초음파 지표들과 관상동맥 질환의 중증도의 관련성을 평가한 결과 관상동맥 질환이 심할수록 경동맥 내중막 두께가 증가하고, 동맥 경화반의 빈도도 증가되었다. 경동맥 초음파는 관상동맥 질환을 가진 환자에서 관상동맥 질환의 중증도를 평가하는데 유용하게 사용될 것으로 사료된다. Background: Carotid intima-media thickness (IMT) or the presence of carotid plaque has been reported to be related to coronary artery disease (CAD). We evaluated the relationship of the parameters of carotid ultrasonography (US) with the severity of the CAD. Methods: From November, 2005 to November, 2006, the patients who underwent both coronary angiography and carotid US were enrolled in our study. The severity of CAD was defined by the number of diseased major coronary arteries with a percent diameter stenosis over 50. Four groups including Group 0, which has normal coronary arteries, were compared. The average and maximal IMT and the presence of plaque were used as the parameters of carotid US. Results: The total number of patients was 90. Men had a greater severity of CAD (p=0.001). The average carotid IMTs were increased with the severity of CAD (Group 0, 0.67±0.11 mm; Group 1, 0.66±0.13 mm; Group 2, 0.68±0.08 mm; Group 3, 0.78±0.10 mm; p=0.001). The maximal carotid IMTs were also increased (Group 0, 0.88±0.16 mm; Group 1, 0.85±0.20 mm; Group 2, 0.89±0.13 mm; Group 3, 1.06±0.17 mm; p=0.000). Carotid plaques were also more frequently present with the increased severity of CAD (p=0.004). Conclusions: Increased carotid IMT and the presence of carotid plaque were related to the severity of CAD. Carotid ultrasonography is useful for evaluating the severity of CAD.(Korean J Med 73:11-17, 2007)

증례 : 순환기 ; 대동맥 박리에 의한 비정형적 ST분절 상승 심근경색 1예

박병원 ( Byoung Won Park ),서대철 ( Dae Chul Seo ),문인기 ( In Ki Moon ),정진욱 ( Jin Wook Chung ),방덕원 ( Duk Won Bang ),현민수 ( Min Su Hyon ),장원호 ( Won Ho Chang ) 대한내과학회 2013 대한내과학회지 Vol.85 No.5

가슴 통증을 호소한 환자가 심전도에서 ST분절 상승과 비정형적인 관상동맥 폐쇄를 보여 ST분절 상승 심근경색으로 관상동맥 재개통술 시행하였고 이후 퇴원하였으나 가슴 통증이 악화되어 재입원하여 대동맥 박리에 의한 심근경색이 진단되었으며 수술적으로 대동맥 박리를 치료한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. ST-elevation myocardial infarction (STEMI) caused by an acute aortic dissection is relatively rare. A diagnosis of dissection can be missed and the situation can become complicated. We report a patient who presented with acute aortic dissection responsible for STEMI related to a dissecting flap into the right coronary artery. This case emphasizes the need for careful assessment of the aorta in cases of atypical coronary occlusion in patients with STEMI without evidence of atherosclerosis in non-culprit coronary segments. The patient was discharged 7 days after primary percutaneous intervention for STEMI. However, she revisited the emergency department for recurrent chest pain and aortic dissection and was diagnosed and managed successfully with surgery.. (Korean J Med 2013;85:516-520)

IMAGE OF INTEREST : Extreme septal hypertrophy in an adolescent with congenital familial hypertrophic cardiomyopathy

( Byoung Won Park ),( Min Ho Lee ),( Duk Won Bang ),( Min Su Hyon ) 대한내과학회 2015 The Korean Journal of Internal Medicine Vol.30 No.6

Multiple Markers of Contrast Induced Nephropathy after the Percutaneous Coronary Intervention

Byoung-won Park,Seong Soon Kwon,Min Ho Lee,Do Hoi Kim,Min Su Hyon,Duk Won Bang 순천향대학교 순천향의학연구소 2018 Journal of Soonchunhyang Medical Science Vol.24 No.1

Objective: Contrast-induced nephropathy (CIN) frequently occurs after percutaneous intervention. Objective of this study was to investigate the usefulness of serum cystatin C, neutrophil gelatinase-associated lipocalcin (NGAL), urinary kidney injury molecule-1 (KIM-1), and interleukin-18 (IL-18) as early predictors for CIN after percutaneous coronary intervention (PCI). Methods: In 53 patients who underwent PCI were enrolled. Serum creatinine and cystatin C level were measured immediately before, and 24 hours and 48 hours after catheterization. Serum NGAL, urinary KIM-1, and IL-18 were measured immediately before, and 4 hours, 24 hours, and 48 hours after catheterization. CIN was defined as a rise in creatinine 0.5 mg/dL or 25% above baseline. Results: CIN occurred in four patients (7.5%). Serum cystatin C levels were higher at 24 hours and 48 hours in CIN patients than in those without CIN (P<0.05). Serum NGAL levels were higher at 48 hours in CIN patients than in those without CIN. Urinary KIM-1 levels were higher at 48 hours in CIN patients than in those without CIN. There were no significant markers of CIN on multi-variate analysis. Conclusion: In this study, the occurrence of CIN after PCI was 7.5%. Although there were some time-course changes in serum cystatin C and urinary KIM-1 after PCI, there was no significant predictor for CIN after PCI.