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울혈성 심부전 환자의 치료 경과중 혈청 마그네슘의 동태에 관한 고찰
임종훈(Jong Hoon Lim),전국진(Kook Jin Chun),정준훈(Joon Hoon Jeong),김병진(Byung Jin Kim),오현명(Hyun Myung Oah),박용현(Yong Hyun Park),박융인(Yong Hyun Park),홍택종(Taek Jong Hong),신영우(Yung Woo Shin) 대한내과학회 1997 대한내과학회지 Vol.53 No.6
N/A Objectives: There are many interesting reports suggesting that magnesium(Mg) deficiency is deleterious in patients with congestive heart failure (CHF). It is paradoxical that the most important cause of Mg deficiency in these persons is maybe use of therapeutics including diuretics. Authors investigated the trend of serum and 24 hour urine Mg with other relating electrolytes in Mg homeostasis prospectively, in the management of CHF. And we assessd the effects of medications and many variables in .CHF on serum Mg, and the usefulness of serum Mg representing the body content. Methods: Fifty three patients who were diagnosed as CHF by clinical finding and echocardiogaphy were prescribed conventional doses of diuretics as furosemide 40mg and spironolactone 50mg daily, with or without angiotensin converting enzyme(ACE) inhibitor and digitalis. And then, serial serum and 24 hour urine Mg, sodium, potassium and calcium were obtained at admission, 2nd day, 5th day, and discharge. Results: The patients group with chronic CHF, which was defined as long-term use of diuretics over 6 months, showed higher prevalence of low level of serum Mg concentration than the group with acute one(11 of 28, 39% vs. 2 of 25. 8%, P< 0.01). Of those two groups, the latter showed upward trend of serum Mg from admission to discharge, but the former showed no change. In 24 hour urine Mg excretion, the amount of the patients with CHF was larger than that of control group. In the chronic CHF group, the effect of digitalis on decreasing serum Mg was evident. Serum Mg of acute CHF group correlated with serum BUN(r=0.5609). Whereas, that of chronic group with ejection fraction(r= ?0.4742) and plasma renin activity(r= ? 0.3791), with serum potassium(r=0.4673) and creatinine(0.5846). Serum Mg may be useful indicator of Mg homeostasis, especially in chronic CHF patients. Conclusion: Because patients with chronic CHF were prone to deficiency of Mg in the management, maintaining the adequate serum Mg through long- term replacement seems very important in decreasing the morbidity and mortality of these persons.
급성 심근경색증에서 재혈관 개통술 후 심근 수축력의 향상을 예측하는 도구로써 심혈관 자기공명 영상의 유용성
김준홍 ( June Hong Kim ),박용현 ( Yong Hyun Park ),정준훈 ( Joon Hoon Jeong ),고우석 ( Woo Suk Ko ),배우형 ( Woo Hyung Bae ),이현국 ( Hyeon Gook Lee ),김준 ( Jun Kim ),전국진 ( Kook Jin Chun ),홍택종 ( Taek Jong Hong ),신영우 ( Y 대한내과학회 2005 대한내과학회지 Vol.69 No.4
목적 : 심혈관 자기공명영상의 발달은 생존심근의 진단에 많은 도움을 준다고 보고되고 있다. 저자들은 이러한 사실을 직접 규명하고자 본 연구를 시해하였다. 방법 : 급성 심근경색증으로 혈관 재개통술을 시행받은 19명의 환자에서 심혈관 자기공명영상을 얻었다. 자기공명영상은 좌심실을 32분절로 나누어 각각의 심근벽 운동과 후기조영 증강 정도를 결정하였으며 6개월 뒤 추적 관상동맥 조영술과 자기공명영상을 다시 얻어 비교 분석하였다. 결과 : 총 628개의 분절 중 177개의 분절에서 심근벽 운동의 이상을 보였으며 이 분절을 대상으로 분석을 시행하였다. 기저 심근벽 운동의 이상 중 심근벽 운동 이상을 보이는 분절(68분절)에서 심근벽 저운동을 보이는 군(109분절)에서 심근벽 운동의 호전을 보인 심근의 비율은 무운동을 보인 군과 비교하였을 때 의미있는 차이가 없었다(50% 대 41.3%, p=0.26). 자기공명영상의 후기 조영 증강영상에 따른 비교에서는 경색의 심근벽 이환 정도(transmural extent of infarction, TEI)에 따라 각각 TEI grade 0 군에서 60.5%, TEI grade I군에서 58.9%, TEI grade III군에서 51.2%, TEI grade IV군에서 29.4%, TEI grade V에서 8%였으며 이를 경색 정도가 심근벽의 50%를 이환하는 값으로 이분하였을 때 (TEI 50%) TEI가 50% 이하인 군(118분절)은 전체 분절 중 67분절(56.8%)에서 심근 운동의 회복을 보였으며 이는 TEI가 50%를 초과하는 그룹(59분절)의 12분절(20.3%)비하여 의미있는 차이를 보였다(p<0.001). 결론 : 심근경색에서 기저 심근벽 운동의 상태는 심근벽 호전을 예측하는데 도움이 되지 못하였다. 그러나 자기 공명 영상의 후기 조영 증강의 심근벽 이환 정도는 심근 수축력 향상을 예측하는데 유용하였으며 이는 임상에서 치료의 방향을 결정하는데 도움이 될 것으로 사료된다. Background : Cardiovascular MR has recently been reported that it can determine the viable myocardium. We investigated this study to determine the usefulness of cardiovascular MR in prediction of wall motion recovery after revascularization in acute myocardial infarction Methods : Both cardiovascular MR with contrast enhancement and coronary angiogram were performed in 19 patients with acute myocardial infarction who treated with precutaneous intervention or thrombolytic therapy. Six months follow-up angiogram and MR study were also preformed. Thirty two matched segments model of the left ventricle were used to analysis the wall motion change and the grade of transmural extent of hyperenhancement (TEI). Results : Among 628 segments, 177 segments showed wall motion abnormality. In group of segments showing hypokinesia (68 segments), the proportion of segments showing wall motion improvement was not different from that of the akinetic segments group (109 segments) (50% vs 41.3%, p=0.26). The proportion of segments showing wall motion improvement were 60.5% in group of TEI grade 0, 58.9% in TEI grade I, 51.2% in TEI grade III, 29.4% in TEI grade IV, 8% in TEI grade V. If the groups were divided into two according to cut-off value of TEI 50%, In the group of TEI less than 50%, 67 out of 118 segments (56.8%) showed wall motion improvement in contrast with 12 out of 59 segments (20.3%) in the group of TEI above 50% (p<0.001). The status of baseline wall motion abnormality (hypokinesia or akinesia) did not effect on wall motion improvement after revascularization. Conclusions : The baseline wall motion abnormality (hypokinesia or akinesia) did not predict the wall motion improvement. But, TEI grade was significant factor to predict the wall motion improvement.(Korean J Med 69:364-370, 2005)
신장 이식 환자와 말기 신부전 환자의 심박수 변이도 비교
김성민 ( Sung Min Kim ),최승호 ( Seung Ho Choi ),오준석 ( Joon Seok Oh ),홍택종 ( Taek Jong Hong ),신용훈 ( Yong Hun Sin ),배우형 ( Woo Hyung Bae ),김중경 ( Joong Kyung Kim ),이희룡 ( Hee Ryong Lee ),정필 ( Peel Jung ),류태현 ( T 대한내과학회 2012 대한내과학회지 Vol.83 No.5
Background/Aims: Heart rate variability (HRV) is a method for evaluation of autonomic nervous system activity by expressing the balance of sympathetic and parasympathetic tones. Some studies of HRV in patients with end-stage renal disease (ESRD) have been performed in Korea. However, few have examined kidney transplantation (KT) patients. Therefore, we investigated autonomic nervous system activity by means of HRV in patients with KT due to ESRD. Methods: We compared the pattern of cardiac sympathetic and parasympathetic activity by time- and frequency-domain analysis of HRV with 24-h Holter monitoring of 23 KT and 56 dialysis patients. Patients underwent KT between January, 2008 and June, 2011. Results: The mean ages of KT and dialysis patients were 54.2±12.3 and 53.7±12.6 years, respectively. The KT group showed increased time- and frequency-domain HRV (including HRV index), very low frequency (VLF), means and standard deviations of all normal R-R intervals for all 5-min segments of the entire recording (SDNNi), low frequency (LF), LF in normalized units (LF norm), and LF to high-frequency power ratio, compared with the dialysis group. Conclusions: Autonomic tone in patients with KT is higher than that in patients with ESRD on dialysis. (Korean J Med 2012;83:606-612)
복수에서의 Carcinoembryonic Antigen 과 Alpha - Fetoprotein 에 관한 연구
유석동(Seuck Dong Yoo),강영진(Young Jin Kang),홍택종(Taek Jong Hong),박희욱(Hee Ug Park),김성은(Seong Eun Kim),최장락(Jang Rack Choi),조군제(Goon Jae Cho),양웅석(Ung Suk Yang),허윤(Yoon Huh) 대한내과학회 1988 대한내과학회지 Vol.35 No.2
N/A In order to determine whether carcinoembryonic antigen (CEA) & alpha-fetoprotein (AFP) in ascitic fluid assist in the diagnosis of malignant disease in abdominal cavity and their peritoneal metastasis, the authors studied 39 cases of malignant ascites patients (of which 19 cases were proven to be peritoneal metastasis) and 38 cases of nonmalignant ascites patients and analyzed the CEA 8z AFP levels of those cases from February, 1987 to August, 1987 in Pusan National University Hospital. The results obtained were as follows: 1) The CEA level of the malignant ascites group was significantly higher than that of the nonmaligant ascites group in ascitic fluid (p<0.005), but not significant in serum (p>0.05). 2) The AFP level of the malignant ascites group was significantly higher than that of the nonmaligant ascites group in ascitic fluid and serum (p<0.01; ascitic fluid, p<0.005; serum). 3) The CEA level of the hepatoma group was significantly lower than that of the non-hepatic malignant group in ascitic fluid and serum (p<0.005), but the AFP level of the hepatoma group was significantly higher only in ascitic fluid (p<0.005). 4) The AFP level of the hepatoma group was significantly higher than that of the liver cirrhosis group in ascitic fluid and serum (p<0.005) but the CEA level of the hepatoma group was significantly higher only in ascitic fluid (p<0.005). 5) Ascitic fluid and serum CEA levels were higher than the upper limit (4.37 ng/ml; ascitic fluid, 5.35 ng/ml; serum) in 15 of 39 of the cases in the malignant ascites group (38.5%), of which 11 eases proven to be peritoneal metastasis (8 cases of stomach Ca, 2 cases of pancreatic Ca, 1 case of colon Ca). 6) The specificity of ascitic fluid CEA for malignant diseases in the abdominal cavity was 86.8%, the positive predictability was 82.1%, the sensitivity was 59.0%, and the negative predictability was 67.3%. The specificity of serum CEA was 94.7/o, the positive predictability was 88.2%, the sensitivity was 38,5% and the negative predictability was 60.0%. 7) Ascitic fluid and serum AFP levels were higher than the upper limit (35.40 ng/ml; ascitic fluid, 43.02 ng/ ml; serum) in 14 of 39 of the cases in the of the cases in the malignant ascites group (35.9%), all of which were primary hepatoma out only 2 cases proven to be peritoneal metastasis. It was concluded that the measurement of ascitic fluid CEA & AFP levels is useful in determining the existence, peritoneal metastasis and differential diagnosis of malignant diseases in the abdominal cavity.
증례 : 동반 심기형이 없는 수정 대혈관 전위 성인 환자에서 나타난 완전 방실 차단 1예
한동철 ( Dong Cheul Han ),김준 ( Jun Kim ),문지윤 ( Ji Yoon Moon ),반지은 ( Ji Eun Ban ),이형두 ( Hyoung Doo Lee ),홍택종 ( Taek Jong Hong ),신영우 ( Yung Woo Shin ) 대한내과학회 2007 대한내과학회지 Vol.72 No.3
Isolated CCTGA 환자는 전체 CCTGA 환자의 약 1% 가량으로 매우 드문 것으로 알려져 있는데, 이들은 방실 차단, 전신 순환 방실 판막 역류 등 다른 기능적 이상이 나타날 때까지 무증상으로 지내는 경우가 많다. 저자들은 14년 동안 무증상으로 지내던 isolated CCTGA 환자가 호흡 곤란과 어지러움증으로 내원해 완전 방실 차단 보여 영구 심박동기를 이식해 치료한 1예를 경험하였기에 보고하는 바이다. Patients with isolated congenitally corrected transposition of the great arteries (CCTGA) comprise 1% of all CCTGA patients. They are usually asymptomatic until functional abnormalities such as atrioventricular block or systemic atrioventricular valve regurgitation become complicated. We report here a case of a 33 year-old man with isolated CCTGA and complete AV block that underwent implantation of a permanent pacemaker using endocardial leads. During a 12 month follow-up period, no symptoms developed and lead-related parameters have been stable. (Korean J Med 72:311-314, 2007)
증례 : 순환기 ; 좌심방 점액종 수술 후 발생한 동기능 부전 및 심방 빈맥 1예
안성규 ( Sung Gyu An ),김준 ( Jun Kim ),이상권 ( Sang Kwon Lee ),박태익 ( Tae Ik Park ),이태근 ( Tae Kun Lee ),홍택종 ( Taek Jong Hong ),신영우 ( Young Woo Shin ) 대한내과학회 2009 대한내과학회지 Vol.76 No.1
점액종의 외과적 절제 후 발생하는 동기능 부전 증후군은 드문 합병증으로 보고된다. 저자들은 좌심방 점액종을 수술한 63세 여자 환자에서 어지럼증을 동반한 동기능 부전 및 심방 빈맥이 발생하여 영구형 인공심장박동기를 시술하였으며, 항부정맥제로 조절되지 않는 심방빈맥을 전극도자 절제술로 치료한 증례를 경험하였기에 문헌고찰과 더불어 보고하는 바이다. Atrial myxoma is the most common primary cardiac tumor, and surgical removal is the treatment of choice. Atrial flutter-fibrillation is common after the surgical excision of such tumors, whereas sinus node dysfunction is a rare complication. We detected postoperative sinus node dysfunction and atrial tachycardia after the excision of a left atrial myxoma in a 63-year-old woman. The patient underwent the implantation of a permanent pacemaker two weeks after the operation. The patient underwent successful catheter ablation of macroreentrant right atrial tachycardia 16 months after the operation with no recurrence of atrial tachycardia over the next four months. (Korean J Med 76:100-104, 2009)
김태경 ( Tae Kyung Kim ),이한철 ( Han Cheol Lee ),김준 ( Jun Kim ),김준홍 ( June Hong Kim ),전국진 ( Kook Jin Chun ),홍택종 ( Taek Jong Hong ),신영우 ( Yung Woo Shin ) 대한내과학회 2008 대한내과학회지 Vol.75 No.5
심전도의 전흉부 유도에서 전벽과 하벽의 ST 분절 상승을 보였던 급성 심근 경색 환자에 있어 일차적 관상동맥 중재술을 통해 좌전하행지와 우관상동맥의 동시 폐쇄가 증명된 2예를 보고한다. The simultaneous presentation of acute myocardial infarction (AMI) in the right and left coronary arteriesis rare. Diabetes mellitus (DM), thrombus due to multivessel spasm, AMI with hypercoagulation,and hypoperfusion of other coronary arteries after an AMI may cause the simultaneous occurrence of right and left coronary artery infarctions. If emergency coronary revascularization (percutaneous coronary intervention, thrombolysis, and coronary artery bypass surgery) is not performed immediately, the mortality rate is very high due to the development of cardiogenic shock and ventricular arrhythmia. Here, we report a number of cases involving the simultaneous development of AMIin two coronary arteries and discuss the importance of rapid revascularization. (Korean J Med 75:586-591, 2008)