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홍그루,김웅,박종선,신동구,김영조,심봉섭 영남대학교 기초/임상의학연구소 2001 Yeungnam University Journal of Medicine Vol.18 No.2
P wave dispersion(PWD) is defined as the difference between the maximum and minimal P wave duration in any of the 12 leads of the surface ECG. The prolongation of atrial conduction time and the inhomogeneous propagation of sinus impulse are known electrophysiologic features in patients with paroxysmal atrial fibrillation(PAF). The purpose of this study was to determine the role of P wave dispersion for the prediction of PAF and to evaluate the effectiveness of prophylactic antiarrhythmic therapy. Materials and Methods: The study population included 20 patients with a history of idiopathic PAF and 20 age and sex matched healthy control subjects. We measured the maximum P wave duration(P maximum) and P wave dispersion from 12 lead ECG. Results: P maximum and P dispersion in idiopathic PAF were significantly higher than normal control group(97.2±12, 48.5±9 msec vs, 76.5±11, 21±8 msec, respectively p<0.001, <0.001). After 12-month follow up period P maximum and P dispersion were significantly reduced than those of initial state(77.2±13, 26.4±9 msec vs, 97.2±12, 48.5±9 msec, respectively p<0.001,<0.001). Conclusion: P dispersion and P maximum were significantly different between patients with idiopathic PAF and healthy control group. Those are easily accessible, non-invasive simple electrocadiographic markers that could be used for the prediction and prognostic factors of idiopathic PAF.
본태성 고혈압에 대한 Imidapril의 강압효과 및 마른기침 발현율에 대한 고찰
신동구,박종선,전대진,배준호,김영조,심봉섭,홍그루 영남대학교 의과대학 1999 Yeungnam University Journal of Medicine Vol.16 No.1
1993년 일본의 Tanabe제약에서 개발된 염산 Imidapril(Tanatril )은 새로운 작용지속형 ACE inhibitor이며 강압효과와 안정성이 뛰어나고, 마른기침 등의 부작용이 다른 ACE inhibitor 보다는 적은 것으로 보고되고 있다. 1997년 10월 6일부터 1998년 12월까지 영남대학교 의과대학 부속병원 순환기 내과에 내원하여 고혈압이 처음 잔단되었거나 진단받은 후에도 강압제치료를 받지 않았던 환자 중 경증(1기)에서 중증(3기) 본태성 고혈압(JNC V 분류의거)을 보인 30명 중 최종분석이 가능한 21명(부작용으로 투약을 중단한 1명 포함)을 대상으로 하였다. 임상시험 종료 시 측정한 확장기 혈압은 88.7±9㎜Hg로 평균 하강량은 13.8mmHg이었다. 혈압강하효과 판정에서 16명이 혈압 하강군으로 분류되어 혈압강하효과는 76.2%(16/21)였다. Imidapril 단독 투여로 치료 종료시 정상 혈압(140/90㎜Hg 미만)을 보인 경우는 10명(47.6%)이었다. 임상시험 중 나타나는 부작용으로는 마른기침, 두통, 현기증, 오심, 상복부 불쾌감, 졸리움 등이 있었으며 총 7명에서 (33.3%) 부작용이 관찰되었고, 심한 위장관계 불편감을 호소한 한 예를 제외하고는 모두 일상 생활에 불편을 주지는 않는 상태였으며, 시간이 경과할수록 그 정도가 점차로 약해졌다. ACE inhibitor의 가장 흔한 부작용 중의 하나인 마른기침은 모두 2명(9.5%)에서 관찰되었다. 새로운 ACE inhibitor인 Imidapril은 다른 ACE inhibitor와 비슷한 강압효과와 안정성을 보이며 특별히 심각한 부작용을 보이지 않고, 그 중에서도 특히 마른기침 발현 빈도는 9.5%로 다른 제제에 비해 현저히 낮았으며, 그 정도가 미미하여 감량없이 계속투여가 가능했다. Imidapril(Tanatril ), a newly developed ACE inhibitor, has been used to treat hypertension and congestive heart failure. This study was designed to assess the antihypertensive effect and safety of Imidapril(Tanatril ) in patients with essential hypertension. 5-10mg of imidapril(Tanatril ) was administered once a day in 30 patients with essential hypertension and followed up for 8 weeks. We tested the drug's effectiveness, safety, and the incidence of imidapril induced dry coughs. After 8 weeks of treatment with imidapril, 76.2%(16/21) of patients showed lowered blood pressure and 47.6% showed normal blood pressure. The overall incidence of adverse effects was 33.3%(7/21), and among these adverse effects, dry cough was shown in only 9.5%. Thus, we concluded that imidapril(Tanatril ) is as safe and effective as other ACE inhibitors, especially with imidapril showing very little incidence of dry cough compared to other ACE inhibitors.
좌심실 이완기능의 평가에 있어서 도플러 조직영상으로 평가한 승모판륜 속도의 유용성
홍그루(Gue Ru Hong),전대진(Dae Jin Jun),배준호(Jun Ho Bae),이종석(Jong Suk Lee),김형준(Hyung Jun Kim),박종선(Jong Sun Park),신동구(Dong Gu Shin),김영조(Young Jo Kim),심봉섭(Bong Sup Shim) 대한내과학회 1999 대한내과학회지 Vol.57 No.6
N/A Background : Doppler echocardiography is widely used for the noninvasive evaluation of left ventricular diastolic function. However the mitral flow velocity pattern is affected by several physiologic factors. The mitral annular velocity profile by Doppler tissue imaging may provide more additional information about left ventricular diastolic function. Thus, this study designed to assess the relationship between cardiac catheterization, MUGA scan, mitral flow velocity, and mitral annular velocity data and to assess the clinical availavility of mitral annulus velocity in the evaluation of left ventricular diastolic function. Methods : The study population consisted of 20 patients with dilated cardiomyopathy( 64±7years), 20 patients with normal left ventricular function (61±7years). Left ventricular catheterization was performed with fluid-filled catheter and left ventricular end diastolic pressure, -dP/dtmax were measured. The mitral flow velocity was recorded at mitral valve tip and the mitral annulus velocity during diastole was measured by Doppler tissue imaging(DTI). Simultaneously EF(ejection fraction), PER(Peak filling rate), PFR(Peak filling rate) were measured by MUGA blood pool scan. Results : Mean peak E velocity, mean peak A velocity, E/A ratio, mean peak E' velocity, mean peak A' velocity, E'/A' ratio and -dP/dtmax significantly difference betweeen two group. -dP/dtmax by cardiac catheterization showed significant correlation with mean peak E' velocity (r=0.552, p=0.003), E'/A' ratio(r=0.507, p=0.003), DT of E'(r=-0.556, p=0.001), TVI of E'(r=0.689, p<0.001) and DT of E wave(r=-0.538, p=0.003). PFR by MUGA scan also showed significant correlation with -dP/dtmax(r=0.537, p=0.01). Conclusion : Among mitral annulus velocity index mean peak E' velocity, E'/A' ratio, DT of E',TVI of E' had significant correlation with -dP/dtmax. And DT by mitral flow velocity, PFR by MUGA scan also had significant correlation with -dP/dtmax. Mitral annulus velocity determined by DTI is relatively convenient, safe, and preload-independent variable in evaluating diastole function. Thus mitral annulus velocity by Doppler tissue imaging is may be useful diagnostic modality for evaluating left ventricular diastolic function.(Korean J Med 57:1021-1029, 1999)
박용호,홍그루,김민경,정항재,신동구,김영조,심봉섭 대한내과학회 2004 대한내과학회지 Vol.66 No.3
과호산구 증후군은 특별한 원인없이 호산구가 1,500/㎣ 이상의 호산구 증가증이 6개월 이상 지속되고 다양한 기관의 침범으로 인한 증상과 증후를 보이는 질환이다. 본 저자들은 흉부 불쾌감을 주소로 내원한 환자에서 과호산구 증후군의 합병증의 일종으로 다발성 뇌경색과 급성 호산구성 심근염으로 나타난 1예를 체험하여 문헌고찰과 함께 보고한다. The hypereosinophilic syndrome (HES) is a leukoproliferative disorder, marked by sustained blood eosinophilia of greater than 1,500/㎣, for longer than 6 months and predilection to damage specific oragans. Any organ system may be affected in HES, but the most severe clinicopathophysio-logical involvements are of the heart and nervous system. We report a case of a 48-year-old man with acute eosinophilic myocarditis combined with hypereosinophilic syndrome who was successfully treated with steroids.
Park, Jong Seon,Hong, Gu Ru,Bae, Jun Ho,Cho, Ihn Ho,Shim, Bong Sup,Kim, Young Jo,Shin Dong Gu 영남대학교 의과대학 2005 Yeungnam University Journal of Medicine Vol.22 No.1
관상동맥파열은 중재시술시 간헐적으로 발생하는 합병증이지만 급성 심장눌림증으로 진행하여 치명적일 수 있다. 일반적으로 중재시술시 사용하는 유도철선에 의한 천공은 자연방누되는 경우가 많으나 본 예와 같이 풍선이나 죽상판 제거술 등으로 인한 천공은 매우 급격히 진행하여 생명이 위험할 수 있다. 과거에는 젤라틴이나 자가혈전을 이용하여 파열된 부위를 막거나 수술적 교정을 하였으나 시술이 매우 복잡하고 시술지연에 따른 문제가 많이 발생한다. 이식판 그물망은 동맥류의 치료를 위해 개발되어 유용하게 이용되어 지고 있다. 본 예와 같이 관동맥 성형술 중에 관동맥이 천공되어 위급한 경우에도 이식판 그물망은 유용한 치료법으로 이용될 수 있다. A coronary artery perforation is a rare but often fatal complication of angioplasty. We experienced a coronary artery perforation and cardiac tamponade during balloon angioplasty. A polytetrafluorethylene (PTFE)-covered stent was used to successfully dose the perforation.
협심증 환자에서 관동맥중재술에 따른 C-reactive Protein의 변화 및 임상경과
박종선,홍그루,이채훈,신동구,김영조,심봉섭 영남대학교 기초/임상의학연구소 2001 Yeungnam University Journal of Medicine Vol.18 No.2
There are many evidences that inflammation is an important determinant of the development of atherosclerosis and one of the systemic markers of inflammation, C-reactive protein(CRP) , is associated with extent of coronary artery disease and risk of coronary events. We assessed the time response of CRP response after coronary angioplasty and it's influence on the clinical restenosis in angina patients. Materials and Methods: Patients included 36 angina patients undergoing single vessel angioplasty. Levels of CRP were measured before and 12, 24, 48, and 72 hours after angioplasty. Clinical restenosis was assessed at 6 months after procedure. Results: Baseline CRP level was 0.30±0.01 mg/dL in stable and 0.46±0.28 mg/dL in unstable angina patients(p<0.05). After angioplasty, CRP level was increased with peak at 24 hour and persisted to 72 hours after angioplasty. At 24 hour after angioplasty, the magnitude of CRP change was 0.32±0.31 mg/dL in stable and 0.79±0.73 mg/dL in unstable angina patient(p<0.05). The change of CRP level was not associated with troponin-T after angioplasty. In unstable angina patients, clinical restenosis was developed in 8% of patients with low baseline CRP levels and in 50% of those with high baseline CRP levels more than 0.6 mg/dL(p<0.05). Conclusion: In unstable angina patients, inflammatory response is more increased than stable angina patients, and increased inflammatory response effects on the restenosis after coronary angioplasty.