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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)
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)
비인강악성종양에서 유도화학요법과 방사선요법을 병행치료한 결과
서장수(Jang Su Suh),김용대(Yong Dae Kim),전재윤(Jae Yun Chun),김준홍(Jun Hong Kim),이정화(Jung Hwa Lee),신세원(Sei Won Shin) 대한두경부종양학회 1994 대한두경부 종양학회지 Vol.10 No.2
The malignant tumor of nasopharynx occurs in china and other oriental contries as high incidence and its prognosis is relatively poor because of frequent intracranial extension and early metastasis. Traditional therapeutic modality of nasopharyngeal cancer was definite radiotherapy, but recently some cancer institute had tried combined modality with induction chemotherapy and reported it may be valuable. We report the clinical evaluation and therapeutic result about 28 nasopharyngeal cancer patients which were treated with 2 courses of induction chemotherapy(Cisplatin+5-FU) and radiotherapy. The results were as follows: 1) The 3 years and 5 years survival rate were 76% and 47% in total patients. 2) The 3 years and 5 years survival rate were 92% and 63% in T1, T2, T3 group, and 25% and 0% in T4 group. 3) The 3 year and 5 year survival rate were 100% and 60% in neck node negative group, and 60% and 40% in neck node positive group. 4) The 3 year and 5 years survival rate were 100% and 50% in stage I II group, and 71% and 44% in stage III, IV group.
이현국 ( Hyeon Gook Lee ),전국진 ( Kook Jin Chun ),이동완 ( Dong Wan Lee ),이혜정 ( Hye Jeong Lee ),김준홍 ( June Hong Kim ),홍택종 ( Taek Jong Hong ),신영우 ( Yung Woo Shin ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-
저자들은 식사시작과 함께 심계항진을 주소로 내원한 63세 여자 환자에서 국내에서 아직 보고된 바 없는 연하 유발성 심방세동을 진단하였고, 약물치료로 호전되었기에 문헌고찰과 함께 보고하는 바이다. Deglutition tachyarrhythmias are rare. We report a case of atrial fibrillation triggered by swallowing. A 63 year old female presented to our hospital with a 20 day history of paroxysmal palpitations lasting approximately 5 to 10 seconds in duration and precipitated by ingestion of solids but not liquids. Cardiovascular examination, chest radiography, Echocardiography, upper GI endoscopy and thyroid function tests were normal and 24 hour ambulatory monitoring showed sinus rhythm except for numerous episodes of atrial fibrillation with rates of 150 to 200 beats/minute during meals. Most episodes spontaneously reverted to sinus rhythm within few minutes. The patient`s exercise tolerance was good with the achievement of 96% of the age predicted maximum heart rate. Her symptoms were controlled by verapamil. She is currently symptom-free with regular doses of verapamil under clinical follow-up. (Korean J Med 69:S818-S823, 2005)