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D형 인격 척도의 표준화 예비연구 : 내적일치도 및 구성타당도
이문수,박영민,임홍의,송우혁,안정천,김성환,이분희,한창수,김용구,조숙행,고영훈,Lee, Moon-Soo,Park, Young-Min,Lim, Hong-Euy,Song, Woo-Hyuk,Ahn, Jung-Chun,Kim, Seong-Hwan,Lee, Bun-Hee,Han, Chang-Su,Kim, Yong-Ku,Joe, Sook-Haeng,Ko, Young- 한국정신신체의학회 2007 정신신체의학 Vol.15 No.2
연구목적 : D형 인격은 국내에서는 아직 생소하며, 심혈관 질환을 비롯한 다양한 질환과의 관련성, 그리고 그 질환에 대한 예측인자로서의 가능성 등에 대해 아직까지 연구된 바가 거의 없다. 그러나, 기존 외국의 연구 결과들은 D형 인격이 심혈관 질환의 발병이나 경과에 중요한 예측인자가 될 수 있음을 보여 주었으며, 현재에도 관련 연구결과가 지속적으로 보고되고 있어 국내에서도 관련 연구가 요구되는 상황이다. 이에 본 저자들은 예비연구를 통해 D형 인격의 검사 도구인 DS14를 번안하고 이에 대한 신뢰도와 타당도를 검증함으로써, D형 인격 평가 척도의 표준화된 기준을 제시하고자 본 연구를 진행하였다. 방법 : 1차 조사에서는 총 17문항으로 구성된 DS14의 예비 척도를 국문으로 번역하여, 서울 및 경기도 안산지역에서 무작위 표집한 심혈관 질환이 없는 정상인 372명에게 작성하도록 하였다. 예비척도에서 척도화가 가능한 문항을 추출하여 14문항의 DS14를 완성하고, 그 신뢰도를 알아보았다. 또한 2차조사에서는 1차조사의 대상 중 40세 이상을 대조군으로 심혈관 질환 환자들과 DS14에 의한 D형 인격의 분포를 비교하였다. 결과 : 1차 조사에서 예비 척도의 분석결과 '사회적 억제' 하위척도의 10문항 중 7개의 문항이 결정되어 14문항의 DS14척도가 완성되었다. 부정적 정서와 사회적 억제 각 하위척도의 내적일치도를 나타내는 신뢰도계수는 각각 0.817, 0.797이었다. 2차조사에서는 관상동맥질환 군에서 일반인구군에 비해 D형 인격의 빈도가 유의하게 높음을 확인할 수 있었다. 결론 : 한국어판 DS14척도는 신뢰도와 타당도를 고려할 때 부정적 정서와 사회적 억제의 양상을 보이는 D형 인격의 평가에 유용한 척도로 생각된다. 또한 본 연구에서는 한국어판 DS14척도를 사용하여, 관상동맥질환의 예측인자로서 D형 인격의 가능성을 확인하였다. Objectives : The distressed personality (type-D) pattern, consisting of negative affectivity and social inhibition, has been shown by Denollet et al. For measuring the Type D characteristics, Denollet has devised the 14 item Type D scale (DS14). In the present study, this instrument was translated into Korean. The reliability and validity of the Korean DS14 was pilot tested. Methods : Preliminary version of the total 17-item DS14 scale was translated into Korean. 372 controls that did not have any coronary heart diseases (CHD) were randomly sampled in Seoul and Gyeonggi province. Preliminary Korean version was applied to controls and 14 items were finally selected to maximize reliability of the scale. We compared the distribution of type-D personality among the normal controls, hypertensive patients, and the CHD patients. Results : 7 of 10 items in social inhibition were selected and final 14-item version was made. The internal consistency of negative affectivity (0.817) and social inhibition (0.797) were high. In addition, the prevalence of type-D personality in the CHD patients group was significantly higher than normal controls. Conclusion : These findings suggest that Korean version of DS14 is a valid tool for measuring the type D characteristics. Type-D characteristics can be suggested to predict adverse prognosis in patients with CHD.
급성 심근경색 환자에서 재관류 후 운동부하 심전도에서 T파의정상화 소견과 심근기능 회복과의 관계
김경진(Kyung Jin Kim),심완주(Wan Joo Shim),정성원(Seong Won Jung),박희남(Hui Nam Pak),이수진(Soo Jin Lee),송우혁(Woo Hyuk Song),김영훈(Young Hoon Kim),서홍석(Hong Seog Seo),오동주(Dong Joo Oh),노영무(Young Moo Ro) 대한내과학회 2001 대한내과학회지 Vol.60 No.1
Background : Several studies has been reported that T-wave normalization(TWN) in exercise ECG indicates the presence of viable myocardium. But the clinical implication of this phenomenon in patients with acute myocardial infarction who received proper revascularization therapy was not determined. The aim of this study was to investigate the relationship between TWN in exercise ECG and myocardial functional recovery after acute myocardial infarction. Methods : We studied 30 acute myocardial infarction patients with negative T waves in infarct related electrocardiographic leads and who received successful revascularization therapy. All patients performed exercise ECG, 10-14days after infarct onset using Naughton protocol. Patients were divided into 2 groups, according to presence (group I; n=14) or not (group II; n=16) of TWN in exercise ECG. Exercise parameters, coronary angiographic findings were compared between groups. Baseline and follow up (mean 11 months) regional and global left ventricular function was analyzed by echocardiography. Results : Exercise parameters was similar between groups. There were no difference in baseline ejection fraction and regional wall motion between group I and II (EF; 56±12% vs 52±11%, p=ns. WMS; 21±3 vs 23±4, p=ns) and it was improved at the tenth month by similar magnitude. (group I/group II, EF % change = 12±12% vs 7±6%, p=ns, WMS % change = 6±6% vs 7±5%, p=ns) The findings of no relation between TWN and functional recovery was observed also when the patients were analysed according to infarct location and presence of Q-waves. Conclusion : As the exercise induced TWN in patients with acute myocardial infarction was not related with better functional recovery of dysfunctional regional wall motion, TWN dose not appears to be a sign of myocardial viability.(Korean J Med 60:51-60, 2001)
안젬마 ( Jem Ma Ahn ),이재민 ( Jae Min Lee ),황영재 ( Young Jae Hwang ),서영호 ( Young Ho Seo ),김용현 ( Yong Hyun Kim ),안정천 ( Jeong Cheon Ahn ),송우혁 ( Woo Hyuk Song ) 대한내과학회 2013 대한내과학회지 Vol.84 No.1
We report a rare case of acquired multiple coronary-cameral fistulae. A 46-year-old man presented to the cardiology department clinic complaining of recently aggravated exertional chest pain. He had been treated 10 years ago for an acute ST segment elevation myocardial infarction (STEMI) with percutaneous coronary intervention (PCI). During revascularization, diffuse multiple fistulae from the left anterior descending (LAD) artery to the left ventricle (LV) had been observed. The current chest pain was evaluated by elective coronary angiography but no significant stenosis was observed. However, newly developed diffuse fistulae from the distal right coronary artery (RCA) to LV were found during angiography, as well as LAD-LV coronary fistulae. Multiple coronary- cameral fistulae were thought to be causing chest pain. A beta-blocker was prescribed and, after 3 months of follow-up, exertional chest pain had subsided without further complication. (Korean J Med 2013;84:91-95)
ST - 분절의 하강에 R - 파고의 변화를 추가한 운동부하 심전도 검사의 관상동맥 질환에 대한 진단적 가치
박성미(Seong Mi Park),노영무(Young Moo Ro),정성원(Seong Won Jeong),신정호(Jeong Ho Shin),김진석(Jin Seok Kim),이호준(Ho Joon Lee),송우혁(Woo Hyuk Song),박창규(Chang Kyu Park),김영훈(Young Hoon Kim),서홍석(Hong Seog Seo),심완주(Wan Jo 대한내과학회 2002 대한내과학회지 Vol.62 No.2
Background: Exercise electrocardiogram is the most widely used non-invasive test in those patients suspected of having coronary artery disease. However, sensitivity and specificity of this test are not satisfactory, especially when the exercise induced ST-segment depression is used as a single criterion of myocardial ischemia. Although many investigators have tried to improve diagnostic accuracy with R-wave amplitude change in addition to ST-segment depression, controversy exists whether this new criteria improve the test accuracy for coronary artery disease or not. The purpose of this study is to determine the test accuracy of R-wave amplitude change induced by exercise combined with the conventional ST-segment criterion for myocardial ischemia. Methods: We reviewed our records of patients who visited to Korea University Anam Hospital with chest pain from January, 1998 to July, 1999. We included 130 patients with chest pain who had a tredmill test followed by a coronary angiography within 2 months. Patients with change in ST-segment depression (ΔSTD)≥1.00 mm and ΔSTD≥1.00 mm with R wave amplitude decrease (-ΔR)≥1.00 mm in the same lead in any of 12 leads and ΔSTD≥1.00 mm with R wave amplitude increase (+ΔR)≥1.00 mm in the same lead in any of 12 leads were compared. According to the findings of coronary angiograms, patients were divided into 4 groups ; normal coronary artery group, mild coronary artery stenosis group (≥30% to <50%), moderate coronary artery stenosis group (≥50% to <70%), severe coronary artery stenosis group (≥70%). Results: Fifty three patients (40.7%) had normal coronary angiograms and 77 patients (59.3%) had coronary artery stenosis. There was no significant difference in gender and age. But, patients with coronary artery stenosis had more diabetes mellitus, hyperlipidemia, smoking, previous myocardial infarction history and angina during exercise testing than those without coronary artery stenosis. The sensitivity of exercise EKG is significantly decreased when combined withΔR (ΔSTD, 74.0%, ΔSTD with -ΔR, 45.5%, ΔSTD with +ΔR, 30.0%, p<0.01), but the The test accuracy is ΔSTD; 73.7%, ΔSTD with -ΔR; 61.5%, ΔSTD with +ΔR; 57.7%. Conclusion: When ST-segment depression is combined with R-wave amplitude change as a marker for myocardial ischemia, the specificity is increased, but the test accuracy of exercise EKG is not improved.(Korean J Med 62:165-170, 2002)
두개강내 병소와 동반되는 급성 고혈압의 치료 : 이상적인 항고혈압 치료제의 선택을 중심으로 Focus on Selecting Ideal Antibypertensive Agents
박정율,이자규,이일옥,공명훈,송우혁,정흥섭,이기찬,이훈갑 고려대학교 의과대학 1997 고려대 의대 잡지 Vol.34 No.2
Patients with acute hypertension associated with intracranial pathology often require prompt reduction of elevated blood pressure. But the principal goal here is to ameliorate systemic hypertension while maintaining adequate cerebral perfusion pressure to provide required cerebral blood flow and thereby preventing secondary ischemic brain damage. Although many new antihypertensive agents are now available, the ideal agent along with optimal guidelines for blood pressure reduction still remain controversial in acute hypertensive patients with different types of intracranial pathologies. Object of this study was to first review briefly the cerebrovascular pathophysiology of hypertension in conjunction with management of these patients. Pertinent literature is searched, indexed, and referenced from MEDLINE for this purpose. From this information, along with clinical experiences, authors tried to provide some of basic guidelines for managing these patients in various clinical situations, focusing mainly on selecting ideal antihypertensive agents available at present time. From the present standpoint it is generally agreed that 1- or 1-adrenergic receptor antagonists provide arterial pressure reduction with little or no adverse effect on intracranial pressure within regulatory range. Although many promising calcium-channel blocking agents are now available, their use are often limited by their action to cause cerebral vasodilation and thus increased intracranial pressure. Angiotensin converting enzyme inhibitors can be used for moderate hypertension but have potential to further increase intracranial pressure in patients who already have intracranial hypertension. It has long been known that barbiturates can be adjuvant method in case of resistant or malignant hypertension with intractablly increased intracranial pressure since it decreases both the blood pressure and cerebral blood flow with reduction of oxygen metabolism. The proper management of acute hypertension in the patients with intracranial pathology should be based on sufficient understanding of the pathophysiology of hypertension and cerebral perfusion pressure. Ideal agents would be individually based on their ability to promptly and reliably ameliorate the hypertension and at the same time maintain adequate cerebral blood flow and intracranial pressure.