발작성 상심실성 빈맥환자에 있어서 각종 항부정맥제에 대한 전기생리학적 검사

김성순(Sung Soon Kim),박승정(Seung Jung Park),장양수(Yang Soo Jnag),탁승제(Seung Jea Tahk),심원흠(Won Heum Shim),조승연(Seung Yun Cho),김현승(Hyun Seung Kim) 대한내과학회 1991 대한내과학회지 Vol.40 No.3

Electrophysiologyc studies (EPS) and serial drug testing were performed in 100 consecutive patients with paroxysmal supraventricular tachycardia (PSVT) but without ventricular preexcitation. All patients had a history of electrocardiographically-documented PSVT. Two patients with concealed bypass tract (CBT) had Ebstein's amomally, and 1 patient with atrial reentrant SVT had mitral stenosis. The remaining patients had structurally normal hearts. Ninety-eight patients had inducible sustained PSVT during the control study. Two had only nonsustained PSVT. EPS revealed AV reentrance utilizing concealed bypass tract (CBT) in 63 patients (Group I), A V nodal reentrance in 36 (Group II), and atrial reentrance in 1. The location of the accessory pathway in Group I was left free wall in 45 (72%.), posteroseptal in 12 (19%), right free wall in 4 (6%), and anteroseptal in 2(3%) patients. Eight patients had associated anterograde dual AV nodal pathways. Five of them utilized slow AV nodal pathway for anterograde conduction during AV reentrant SVT. Single and double atrial extrastimulation demonstrated discontinuous AV nodal conduction curve in 28 patients (77%) in Group II, and the remaining 8 had a continuous AV nodal conduction curve. Serial daily SVT induction was attempted after intravenous ad- ministration of procainamide 20 mg/kg, verapamil 0.15 mg/kg, digoxin 0.75 mg, and proplanolol 0.15 mg/kg. In Group I, procainamide showed drug response in 40/49 (82%), flecainide in 24/32 (75%), verapamil in 36/41 (89%), digoxin in 5/20 (25%), and digoxin + propranolol in 9/18 (50%). In Group II, procainamide showed drug response in 21/24 (88%), flecainide in 10/11 (91%), verapamil in 20/28 (95%), digoxin in 12/20 (60%), and digoxin + propranol l in 11/15 (73%) patients. In conclusion, AV reentrant SVT utilizing CBT is the most common mechanism (63%) of PSVT in symptomatic Korean patients. Serial EPS with multiple drugs is very useful to define effective dugs in patients with symptomatic PSVT. Our data on serial drug testing might help us select the drug for those who want to be treated without invasive EPS.

발작성 상심실성 빈맥 환자에 대한 항부정맥 약물작용 기전과 약물반응 예측에 관한 연구

김병옥(Byung Ok Kim),김성순(Sung Soo Kim),황성오(Sung Oh Whang),장양수(Yang Soo Jang),심원흠(Won Heum Shim),조승연(Seung Yun Cho),김현승(Hyun Seung Kim),박승정(Seung Jung Park) 대한내과학회 1990 대한내과학회지 Vol.39 No.6

N/A In this study, the effects of antiarrhythmic drugs on the reentrant pathway in paroxysmal supraventricular tachycardia (PSVT) were evaluated by observing the changes of conduction block cycle length. And this study was aimed to determine whether the drug responses could be predicted by characterizing the reentry path- way. Seventy-three patients with clinically documented PSVT without preexcitation were carried on electro-physiologic studies between November, 1986 and April 1990 in Severance Hospital, Yonsei University were reviewed. The study group included 35 males and 38 females with ages ranging from 16 to 67 years (mean±SD:40±15). The mean duration of symptom was 10.9±9.5 years. They had experienced paroxysmal tachycardia once per week to once in 6 months (mean frequency: 5 per year). All patients had structurally normal heart except the 2 Ebstein`s anomaly. The induction of tachycardia and the determination of mechanism of PSVT were performed by baseline electrophysiologic study in drug free status, The effects of drugs were assessed by the intravenous administration of procainamide 20 mg/kg, flecainide 2 mg/kg, verapamil 0.15 mg/kg, digoxin 0.75 mg, and digoxin 0,75 mg plus propranolol 0.15 mg/kg. The response to drug was defined as the not-induced SVT or the induction of nonsustained SVT after drug administration. 1) Fourty-nine patients had atrioventricular (AV) reentrant tachycardia using concealed bypass tract(CBT) and twenty-four patients had atrioventricular nodal reentrant tachycardia. In AV reetry using CBT, procainamide prevented induction of sustained tachycardia in 38 of 45 patients (84%), flecainide in 23 of 30 patients(77%), verapamil in 34 of 39 patients(87%), digoxin in 4 of 17 patients (23%), and digoxin plus propranolol in 7 of 14 patients(50%), In AV nodal reentry, procainamide prevented induction of sustained tachycardia in 19 of 22 patients (86%), flecainide in 9 of 10(90%), verapamil in 20 of 22 patients(91%), digoxin in 10 of 17 patients(59%), and digoxin plus propranolol in 9 of 13 patients(69%). 2) In AV reentry using CBT, procainamide and flecainide induced significant prolongation of the ventriculoatrial block cycle length (VABCL) in responder group. Also the atriventricular block cycle length (AVBCL) was prolonged significantly, but not increased above the tachycardia cycle length. Verapamil, digoxin and digoxin plus propranolol showed significant prolongation of AVBCL, but not of VABCL. 3) In AV nodal reentry, procainamide and flecainide induced significant prolongation of VABCL in responder group, and AVBCL was also prolonged but not increased above the tachycardia cycle length. Verapamil, digoxin and digoxin plus propranolol induced significant prolongation of both AVBCL and VABCL in responder group. 4) In patients with AV reentry, there was no significant difference of baseline VA block cycle length between responders and non-responders for procainamide and flecainide. But the patients having the 260 millisecond or more of block cycle length were all responded to procainamide except 1 case and all to flecainide. 5) The procainamide and flecainide had a strong concordant relationship in drug response for AV reentry(p<0. 001). With the avove results, it is noted that the procainamide and flecainide prevent induction of reentrant supraventricular tachycardia by selectively depressing the conduction over retrograde pathway of reentry circuits in responders with AV reentry using CBT and AV nodal reentry. Also it is noted that the verapamil, digoxin and digoxin plus propranolol prevented induction of SVT by depressing the conduction over antegrade pathway in responders with AV reentry using CBT, and over antegrade (AV nodal slow) and retrograde (AV nodal fast) pathways in responders with A V nodal reentry. And it can be suggested that the baseline block cycle length of accessory pathway has a limited value in predicting the drug responses in AV reentry using CBT. Also it is noted that in AV r

증례 : Haloperidol 투여로 탁효를 본 Gilles de la Tourette 증후군 1 예

이수익 ( Soo Ik Lee ),김성순 ( Sung Soon Kim ) 대한내과학회 1973 대한내과학회지 Vol.16 No.5

A thirteen-year-old boy has had one year history of multiple tic-like movements involving the face, neck, and upper extremities, involuntary spitting and vocalization, and compulsive repetition of certain movements, such as repeatedly touching hot stove wi

급성 중증 폐색전증의 임상양상과 예후에 미치는 인자

박윤수(Yoon Soo Park),하종원(Jong Won Ha),권기환(Ki Hwan Kwon),장양수(Yang Soo Jang),정남식(Nam Sik Chung),심원흠(Won Heum Shim),조승연(Seung Yun Cho),김성순(Sung Soon Kim) 대한내과학회 2000 대한내과학회지 Vol.58 No.3

Background : Pulmonary embolism is a relatively common disease but may also be manifestated as a lethal disease. Most previous studies on pulmonary embolism included hemodynamically stable patients who were able to tolerate a confirmative diagnostic workup, including ventilation-perfusion lung scan or pulmonary angiography. However, in most cases of acute massive pulmonary embolism, patients are unstable to tolerate a confirmative diagnostic workup. Studies of only stable patients with pulmonary embolism may have a bias on evaluating the clinical course and prognosis of pulmonary embolism. Therefore, we designed a study to observe the clinical manifestations, diagnostic methods, treatment modality, and to investigate the prognostic factors of patients with acute pulmonary embolism who present with overt or impending right heart failure using the diagnostic criteria suggested by MAPPET study. Methods : Among 103 patients diagnosed as pulmonary embolism from 1990 to 1997, 63 patients(male/female : 21/42, mean age : 56 15) were enrolled as acute major pulmonary embolism by MAPPET's diagnostic criteria. Patients were included in the study if they showed clinical, echocardiographic and cardiac catheterization findings signifying acute right heart failure or pulmonary hypertension due to pulmonary embolism, together with: 1) a diagnostic pulmonary angiogram, or 2) a lung scan indicating high probability of pulmonary embolism, or 3) at least 3 of the followings: ① syncope; ② tachycardia (heart rate > 100 beats /min); ③ dyspnea or tachypnea (> 24 breaths/min or need for mechanical ventilation); ④ arterial hypoxemia (partial arterial pressure of oxygen < 70mmHg while breathing room air) in the absence of pulmonary infiltrates on chest x-ray; ⑤ ECG signs of right heart strain. Results : Among the 63 patients, 15 patients(23.8%) did not have an underlying disease. Eleven patients(17.5%) had malignancy, 8 patients had an operation in the recent 20 days, 6 patients had chronic pulmonary disease, 5 patients had a history of congestive heart failure and cerebrovascular accident respectively, 4 patients had a previous history of pulmonary embolism, 3 patients had vasculitis such as Behcets' disease and systemic lupus erythematosus and a history of venous thrombosis, respectively. The main clinical manifestation on the time of diagnosis was dypnea in 55 patients(87.3%), which was the most frequent, and chest pain in 18 patients(28.6%), syncope in 10 patients(15.9%), and tachycardia in 2 patients(3.2%). The diagnostic methods were echocardiography(43 patients, 68.3%), lung perfusion scan(39 patients, 61.9%), chest computed tomography(16 patients, 26.4%), pulmonary angiography(4 patients, 6.3%) and right heart catherization(2 patients, 3.2%). In order to examine deep vein thrombosis, lower extremity Duplex ultrusonography and venography were performed in 11 patients(17.5%) and 7 patients(11.1%) respectively. The overall in-hospital mortality was 38.1%(24 patients). The factors influencing in-hospital mortality were associated malignancy(p<0.01) and unstable vital sign(systolic blood pressure of less than 90mmHg)(p<0.05). Conclusion : Acute pulmonary embolism with overt or impending right heart failure is a significant lethal disease with a high in-hospital mortality. The predictors of mortality were associated malignancy and unstable vital sign.(Korean J Med 58:293-300, 2000)

HIV 감염자의 혈청내 CD4 Antigen과 Soluble CD8치

조영걸(Young-Keol Cho),이웅수(Woong-Soo Lee),정경순(Kyung-Soon Cheong),김성순(Sung-Soon Kim),신영오(Yung-Oh Shin) 大韓微生物學會 1991 大韓微生物學會誌 Vol.26 No.4

부유/부착기름 유회수장비 개발 연구

민천홍(Cheon-hong Min),성기영(Ki-young Sung),김성순(Seong-soon Kim),이정희(Jung-hee Lee),박창수(Chang-soo Park),최혁진(Hyuek-Jin Choi) 한국해양환경·에너지학회 2020 한국해양환경공학회 학술대회논문집 Vol.2020 No.7

고지방혈중에서 Bezafibrate ( Bezalip(R)) 의 효과에 대한 연구

이웅구(Woong Ku Lee),김병옥(Byung Ok Kim),조현명(Hyeon Myeong Cho),장양수(Yang Soo Jang),정남식(Nam Sik Chung),심원흠(Won Heum Shim),조승연(Seung Yun Cho),김성순(Sung Soon Kim),양주영(Joo Young Yang) 대한내과학회 1991 대한내과학회지 Vol.40 No.6

Among the risk factors associated with coronary artery disease, hyperlipidemia is one of the most important. Bezafibrate has been shown to effctively reduce elevated levels of low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) in hyperlipidemia. It has also been claimd to be particularly effective in increasing high-density lipoprotein (HDL) concentrations. In the present study, 22 hyperlipidemic patients were investigated before and after 8 weeks treatment with bezafibrate (300 mg to 400 mg daily) in an effort to clarify futher the effects and side effects of the drug. In the group of 9 patients with hypertriglyceridemia (TG level>230mg%), the serum triglycerides decreased by 63%(p<0.01) and the HDL cholesterol increased by 45%, (p<0.01) corresponding to a significant reduction of total cholesterol/HDL cholesterol ratio. In the group of 9 patients with hypercholesterolemia (cholesterol level > 240 mg%), the total cholesterol decreased by 20% (p<0.01), the LDL cholesterol decreased by 25% (p<0.01) and HDL cholestrol increased by 44% (p<0.01) corresponding to a significant reduction of LDL/HDL ratio. In the group of 4 patients with combined hyperlipidemia (TG level > 230 mg% and cholesterol level > 240 mg%), the total cholesterol decreased by 23% (p<0.01), the serum triglyceride decreased by 62% (p<0.01) and the HDL-cholesterol increased by 19% (p<0.05) corresponding to a significant reduction of total cholesterol/HDL cholesterol ratio. In the total of 22 patients, the total cholesterol decreased by 15% (p<0.05), the serum triglyceride decreased by 59% (p<0.01) and the HDL cholesterol increased by 39% (p <0. 01) corresponding to a significant reduction of total cholesterol/HDL cholesterol ratio. No subjective side effects were noted from the drug, except in one patient with mild gastrointestinal symptoms. In conclusion, it was noted that the bezafibrate was an effective and safe drug useful in the treatment of hyperlipidemia in Korean adult patients.

젊은 연령에서 발생한 급성 심근경색증의 장기 추적 경과 관찰

정보영(Bo Young Chung),하종원(Jong Won Ha),장양수(Yang Soo Jang),최동훈(Dong Hoon Choi),안신기(Shin Ki Ahn),임세중(Se Joong Rim),정남식(Nam Sik Chung),심원흠(Won Heum Shim),조승연(Seung Yun Cho),김성순(Sung Soon Kim) 대한내과학회 2000 대한내과학회지 Vol.59 No.1

Background : The purpose of this study was to evaluate risk factors, angiographic characteristics and long-term prognosis of young adults with myocardial infarction(MI). Methods : Of the 2,680 patients with a history of MI, there were 148 patients 40 years old(Group 1). Risk factors, angiographic characteristics, cardiac events and long-term prognosis of group 1 were compared with those of randomly selected 149 patients between 41 years to 70 years old(Group 2) for a mean follow-up duration of 38 months(1∼147 months). Cardiac events include death, reinfarction, coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, congestive heart failure, stroke, and angina. Results : Smoker and male gender were more frequent in group 1(p<0.001). In group 2, hypertension and diabetes were more frequently observed(p<0.001). Angiographically normal coronary arteries, nonobstructive disease(<70% stenosis) and single-vessel disease were more frequent in group 1 than those in group 2 (p<0.001). There was no significant difference of overall survival at 7 years between the two groups(group 1; 95%, group 2; 89%, p>0.05). If hospital deaths were excluded, the 7-year survival was better in group 1(group 1; 99%, group 2; 92%, p<0.01). The cardiac event free survial at 7 years was not different between two groups(p>0.05). Although a better left ventricular(LV) systolic function (ejection fraction(EF) 40%) showed more favorable survival in group 2(EF40%: 94%, EF<40%: 80%, p<0.05), survival was not influenced by LV systolic function in group 1. Conclusion : Young patients with MI have a more favorable long-term survival after discharge compared with that of the older patients regardless of LV systolic function. Cardiac event free survival was, however, not different between two groups.(Korean J Med 59:30-39, 2000)

승모판 협착증 환자에서 운동부하 심장풀스캔을 이용한 좌심실기능의 평가

박창윤(Chang Yun Park),이도연(Do Yun Lee),심원흠(Won Heum Shim),김한수(Han Soo Kim),박승정(Seung Jung Park),조승연(Seung Yun Cho),김성순(Sung Soon Kim),이웅구(Woong Ku Lee),김명진(Myeong Jin Kim),최규옥(Kyu Ok Choe) 대한핵의학회 1992 핵의학 분자영상 Vol.26 No.1

N/A We performed exercise radionuclide ventriculography to evaluate left ventricular (LV) function in 35 patients with pure mitral stenosis (MS). There were 6 males and 29 females ranging from 21 to 63 years of age (mean 37±10 years). We also studied 8 healthy men as control group (mean age 27±5 years. Each patients was evaluated at rest and during maximal exercise on an isokinetic bicycle ergometer. Peak filling rate (PFR), peak ejection rate (PER), ejection fracion (EF), end-diastolic volume(EDV), end-systolic volume (ESV), stroke volume (SV), and cardiac output (CO) were determined by the radionuclide technique. The results were summarized as follows: 1) LV systolic dysfunction and reduced PFR were noted in patients with MS. 2) EDV as well as SV decreased with exercise in patients with MS. 3) No significant increase in EF during exercise compared to rest value was observed because it was caused by reduced EDV and SV during exercise in patients with MS. 4) CO increased with exercise was significantly lower than normal in patients with MS. 5) Patients with MS were divided into two groups according to whether EF increased more than 5% druing exercise compared to resting state or decreased. Significant difference were found between these two groups. Patients with a fall in EF with exercise were older, had larger left atrial size, and had lesser decreased in ESV during exercise.

우측 관상동맥 폐쇄 환자에서 관상동맥내 Thallium - 201 주사를 이용한 측부 혈행의 의의

박창윤(Chang Yun Park),이도연(Do Yun Lee),이종두(Jong Doo Lee),심원흠(Won Heum Shim),김한수(Han Soo Kim),조승연(Seung Yun Cho),김성순(Sung Soon Kim),정남식(Nam Sik Chung),김용수(Young Soo Kim),하종원(Jong Won Ha),권혁문(Hyuk Moon Kwo 대한핵의학회 1993 핵의학 분자영상 Vol.27 No.2

N/A To compare the myocardial viability in patients suffering from total occlusion of the right coronary artery (RCA) with the angiographic collaterals, intracoronary injection of Thallium-201 (T1-201) was done to 14 coronary artery disease (CAD) patients (pts) with total occlusion of RCA and into four normal subjects for control. All 14 CAD pts had Grade 2 or 3 collateral circulations. There were 14 male and 4 females, and their ages ranged from 31 to 70 years. In nine pts, T1-201 was injected into left main coronary artery (LCA) (300∼350 μCi) to evaluate the myocardial viability of RCA territory through collateral circulations. The remaining five pts received T1-201 into RCA (200-250 μCi) because two had intraarterial bridging collaterals and three had previous successful PTCA. Planar & SPECT myocardial perfusion images were obtained 30 minutes, and four to five hours after T1-201 reinjection. Intravenous T1-201 reinjection (six pts) or Tc-99m-MIBI (two pts) were also performed in eight CAD pts. Intracoronary myocardial perfusion images were compared with intravenous T1-201(IV T1-201) images, EGG, and ventriculography. Intracoronary TI-201 images proved to be superior to that of IV T1-201 due to better myocardial to background uptake ratio and more effective in the detection of viable tissue. We also found that perfusion defects were smaller on intracoronary T1-201 images than those on the IV T1-201. All of the 14 CAD pts had either mostly viable myocardium (seven pts) or large area of T1-201 perfusion (seven pts) in RCA territory, however ventriculographic wall motion and ECG did not correlate well with intracoronary myocardial perfusion images. In conclusion, total RCA occlusion patients with well developed collateral circulation had large area of viable myocardial in the corresponding territory.