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      • KCI등재후보

        승모판협착증에서 운동능력을 결정하는 혈역학적인 인자 ; Exercise Doppler Echocardiography 를 이용한 연구

        송재관(Jae Kwan Song),강덕현(Duk Hyun Kang),이철환(Cheol Hwan Lee),이상곤(Sang Gon Lee),정상식(Sang Sig Cheong),홍명기(Myeong Ki Hong),김재중(Jae Joong Kim),박성욱(Seong Wook Park),박승정(Seung Jung Park),이종구(Jong Koo Lee) 대한내과학회 1996 대한내과학회지 Vol.51 No.5

        N/A Objectives: Objective assessment of degree of functional impairment in patients with valvular heart disease is crucial in the clinical decision-making. The present study was designed to examine the use of formal exercise testing in the evaluation of mitral stenosis (MS) ancl to determine hemodynamic factors associated with exercise tolerance in patients with MS. Methods: In 37 patients with MS (26 females, age of 51±10yrs), Doppler measurement of transmitral gradient (MG) and pressure gradient between right ventricle and atrium using turbulent jets of tricuspid regurgitation (PGTR) was performed before and immediately after maximum symptom-limited treadmill exercise (EX) according to Bruce protocol. Results: Mean mitral valve area (MVA) was 0.97±0.33㎠ (0.5-1.9) and number of patients with severe MS (MVA<1.0㎠) were 25/37. TR was present in 35/37 at rest and immediately after EX, PGTR could be measured in 86% (32/37). Mean EX time was 422±188 sec (112-760) and MG increased from 11±5 to 27±10mmHg (p<0.001) and PGTR form 31±13 to 61±30mmHg (p<0.001). Using a linear regression, factors associated with prolonged EX time were male gender, increased mobility of leaflet, low MG, small pre- and post-EX TR jets, low pre-and post-EX PGI'R, and appropriate increase of heart rate during EX; among them, low post-EX PGTR (p=0.000) and heart rate increase with EX (p=0.005) were the significant independent factors. In patients with tight MS with average MVA of 0.8±0.15㎠, the range of PGTR increase with EX was from 10 to 100mmHg. Patients with post-EX PGTR more than 60mmHg had larger jets of TR at rest, and higher basal MG and pre-EX PGTR compared to the others. Conclusion: Exercise Doppler echocardiography is technically simple and an important addition to the noninvasive evaluation of patients with MS. Increase of PGTR with EX rather than MVA at rest per se is the important determining factors for EX capacity in patients with MS, and it can be predicted by severity of TR at rest and pre-EX PGTR.

      • KCI등재후보

        관동맥연축에서 서방형 칼슘길항제인 Diltiazem 과 Verapamil 의 치료효과 : Ergonovine Echocardiography 를 이용한 무작위 비교 연구

        송재관(Jae Kwan Song),박성욱(Seong Wook Park),제수정(Soo Jung Je),김재중(Jae Joong Kim),두영철(Young Cheoul Doo),김원호(Won Ho Kim),진재용(Jae Yong Chin),김형호(Hyeong Ho Kim),정상식(Sang Sig Cheong),박승정(Seung Jung Park),이종구(Jo 대한내과학회 1994 대한내과학회지 Vol.46 No.3

        N/A Background: Detection of left ventricular regional wall motion abnormality with two dimensional echocardiography during ergonovine injection (Ergonovine Echocardiography: Erg Echo) is a useful noninvasive diagnostic method of coronary vasospasm, and as it can be used repeatedly, comparison of the therapeutic efficacy of the prescribed drugs for the patients with variant angina may be possible with this method. The purpose of this study were to compare the antispasmotic action of short-term medication of two currently available sustained-releasing (SR) calcium antagonists (Diltiazem vs Verapamil) with Erg Echo, to investigate the factors determining the drug efficacy and to determine if the results of repeated tests of Erg Echo after shortterm medication correlate with the clinical response. Methods: Forty patients with angiographicallyproven coronary vasospam and positive Erg Echo without medication were randomly assigned into group I and II. Diltiazem SR 90mg b.i,d. was prescribed in the patients of group l and Verapamil SR 120 mg b.i.d. in group II. Isosorbide-5-mononitrate (ISMN, Elantan 20 mg b.i.d.) was commonly given in both groups. After medication of 4 days Erg Echo was repeated, and if follow up results were positive doubling of the dosage of prescribed calcium channel antagonists (i.e. Diltiazem SR 180 mg or Verapamil SR 240 mg b.i.d.) was done and the second follow up test of Erg Echo was performed after another 4 days. Clinical follow-up was done with the dosage of negative Erg Echo, and during 9 (±3) month follow-up period one patient of group I and two of group II were lost and final analysis was done with total 37 patients (19 in group I and 18 in group II). Results: Among 37 patients with variant angina, 32 were male and the mean age was 53 (±8). Sex ratio, mean age, body weight, clinical activity of variant angina assessed by the frquency of chest pain attack, number of spasm-documented coronary vessels, dosage of ergonovine for positive response in baseline Erg Echo and number of the patients with concomitant fixed coronary stenosis were not significantly different between both groups. After 4 day medication coronary vasospasm was not provoked with ergonovine injection in 13 patients of group I, and the positive rate of Erg Echo after medication was 32% (6/19) in group I, which was not significantly different from that (50%, 9/18) of group II (p=0.66). In 15 patients coronary vasospasm was provoked with ergonovine injection despite the medication, and ergonovine dose for positive response rose from 146±84 microgram (mcg) to 218±75 mcg with medication. Patients with 'mixed disease' (coronary vasospasm and concomitant fixed disease) showed higher positive result of Erg Echo after medication than the patients with pure spasm (p=0.001). During open label follow-up of 9±3 months, there was neither case of acute myocardial infarction nor that of sudden cardiac death. Recurrent chest pain with medication was observed in 6 patients of group I and 7 of group II (p=0.90), and recurrent chest pain during follow-up was more frequently observed in patients with positive Erg Echo after 4 day medication than those with negative test (p=0.01). In group II medication was modified to control the high activity of variant angina (chest pain attacks more than 5 per week) in 3 patients and verapamil SR was withdrawned in 4 patients due to side effects (2 cases of impotence, each case of constipation and peripheral edema), while there was no case of drug modification or withdrawl of diltiazem SR (p<0.05) in group I. Conclusion: Although there was no significant difference of short term medication on prevention of coronary vasospasm provoked by ergonovine injection, during long term follow-up of variant angina, diltizem SR with ISMN was superior to verapamil SR with ISMN in control of chest pain and absence of side effects. Erg Echo after short term medication was useful in comparison of drug efficacy, investication of the fact

      • KCI등재후보
      • SCIESCOPUSKCI등재

        The anti-photoaging and moisturizing effects of Bouea macrophylla extract in UVB-irradiated hairless mice

        Cheong, Yongin,Kim, Changhee,Kim, Mi-Bo,Hwang, Jae-Kwan Korean Society of Food Science and Technology 2018 Food Science and Biotechnology Vol.27 No.1

        Ultraviolet (UV) light, a main cause of photoaging, leads to collapse of skin structure, resulting in wrinkle formation and dehydration. The present study assessed the anti-photoaging and moisturizing effects of Bouea macrophylla extract (BRE). UVB-irradiated hairless mice were orally administered with BME (300 mg/kg/day) for 8 weeks. BME ameliorated wrinkle formation, skin thickening, and inelasticity. BME upregulated COL1A1, COL3A1, COL4A1, and COL7A1 mRNA levels through activation of the transforming growth factor-${\beta}$ ($TGF-{\beta}$)/Smad pathway, thereby recovering the content of collagen reduced by UVB. Further, BME suppressed UVB-induced matrix metalloproteinase (MMP)-3 and MMP-13 expression and inhibited MMP-2 and MMP-9 activity by mediating the mitogen-activated protein kinases (MAPKs)/activator protein-1 (AP-1). BME improved moisture content by stimulating the expression of cornified envelope proteins and filaggrin-processing enzymes. Overall, the results show that BME prevents photoaging and promotes moisturization in UVB-irradiated hairless mice, suggesting its potential as a nutraceutical candidate for anti-photoaging and moisturizing effects.

      • 골반경을 이용한 자궁외 임신의 치료

        정해관,이민석,이현경,임문환,김용탁,이성우,임현술,황선보,오연희,배철성,심재철,김승현,도은형,윤혜원 東國大學校醫學硏究所 1995 東國醫學 Vol.3 No.-

        동국대학교 의료원 산부인과에서는 1991년 10월 1일부터 1994년 12월 31일까지 약 39개월동안 자궁외 임신으로 진단된 79명의 환자에게 골반경 수술을 시행하였다. 골반경수술은 수술후 입원기간의 단축, 개복으로 인한 불필요한 출혈의 방지 및 수술시간의 단축, 수술후 유착감소 및 반복수술의 용이성, 미용상의 효과가 좋았다. 특히 비파열성 자궁외 임신에서 골반경을 이용한 난관개구술과 MTX 국소투여법 같은 보존적 치료는 매우 효과적이었다. 그리고 난관파열이 되어 어느정도 복강내출혈이 있는 파열성 자궁외 임신에서도 골반경수술의 장점을 살리면서 시술을 할 수 있을 것으로 생각된다. Prevalence of extrauterine pregnancy has increased. With the availability of the rapid quantitative B human chorionic gonadotropin titers and more accurate sonograms, the diagnosis of probable extrauterine pregnancy is being made earlier and often before tubal rupture. Salpingectomy at the time of laparotomy has been the standard treatment for tubal pregnancy, even when the tube was not ruptured. Recently conservative surgery via salpingotomy/salpingostomy or fimbrial expression has been advocated. The pelviscopy is an essential tool in making the diagnosis and, given certain criteria, can be useful for management as well. Pelviscopic management of extrauterine pregnancy has been described extensively in last several years. These methods have been associated with low morbidity, early recovery, and short hospital stay. Although the role of medical therapy for extrauterine pregnancy is still uncertain, medical therapy of early, unruptured extrauterine pregnancy can be safe and cost effective and even result in improved fertility, compared with the standard surgical therapy. Conservative treatment of unruptured type tubal pregnancy, which have been diagnosed early, salpingotomy and salpingostomy and MTX local injection are highly effective. We have experienced 80 cases of pelviscopic surgery in 79 patients with extrauterine pregnancy. Among the procedures, salpingectomy was peformed most frequently(78.5%). Salpingotomy was also performed(12.5%), salpingectomy was performed(1.3%), pelviscopy guided MTX local injection was performed(1.3%), and fimbrial expression was performed(1.3%). Of 79 patients, complication occurred in 7 patients. In one patient with liner salpingotomy, additional pelviscopic salpingectomy was needed for bleeding control from previous salpingotomy sites. Hospital stay was averaged 3.8 days. Pelviscopic treatment of extrauterine pregnancy was simple and effective with fast recovery even in patients with pelvic adhesions due to prior operations, ruptured extrauterine pregnancies with moderate intraperitoneal free blood.

      • Time trend of malaria in relation to climate variability in Papua New Guinea

        Jae-Won Park,Hae-Kwan Cheong,Yasushi Honda,Mina Ha,Ho Kim,Joel Kolam,Kasis Inape,Ivo Mueller 환경독성보건학회 2016 환경독성보건학회지 Vol.31 No.-

        Objectives This study was conducted to describe the regional malaria incidence in relation to the geographic and climatic conditions and describe the effect of altitude on the expansion of malaria over the last decade in Papua New Guinea. Methods Malaria incidence was estimated in five provinces from 1996 to 2008 using national health surveillance data. Time trend of malaria incidence was compared with rainfall and minimum/maximum temperature. In the Eastern Highland Province, time trend of malaria incidence over the study period was stratified by altitude. Spatio-temporal pattern of malaria was analyzed. Results Nationwide, malaria incidence was stationary. Regionally, the incidence increased markedly in the highland region (292.0/100000/yr, p =0.021), and remained stationary in the other regions. Seasonality of the malaria incidence was related with rainfall. Decreasing incidence of malaria was associated with decreasing rainfall in the southern coastal region, whereas it was not evident in the northern coastal region. In the Eastern Highland Province, malaria incidence increased in areas below 1700 m, with the rate of increase being steeper at higher altitudes. Conclusions Increasing trend of malaria incidence was prominent in the highland region of Papua New Guinea, while long-term trend was dependent upon baseline level of rainfall in coastal regions.

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