한국 정상 성인에서 생활습관과 Cholesterol 치와의 관계

강승원(Seung Wan Kang),이붕렬(Bong Ryeol Lee),박현식(Heon Sik Park),김신우(Shin Woo Kim),우언조(Eon Jo Woo),채성철(Shung Chull Chae),전재은(Jae Eun Jun),박의현(Wee Hyun Park) 대한내과학회 1992 대한내과학회지 Vol.43 No.3

N/A Background: Hypercholesterolemia has been attracting a great deal of attention epidemiologically and clinically because of its close association with coronary artery disease (CAD). In recent years, the incidence of CAD is increasing in Korean population, being attributed to increasing longevity, the changes in diet and environmental circumstances Methods; Serum total cholesterols were measured by the enzymatic method and their levels were analysed in relation to lifestyle obtained by interview in 1075males and 526females in Taegu, Korea. The study group includes docters, professors, nurses, assistants and technicians who were considered to be clinically healthy. Results: Total cholesterol levels of male end female adults were 182±30.9mg/dl and 175±29.4mg/dl, respectively. The total cholesterol levels of males were significantly higher than those of females (p<0.001). Serum cholesterol levels of male non-smokers (593cases, 184±29.5mg/dl) were significantly higher than those of male non-smokers (333cases, 180±31.3mg/dI) (p<0.05), especially in the age group of 30~39(p<0.01). There were no significant differences in the cholesterol levels in terms of drinking habits, exercise habits and dietary habits in male. Concluions; In conclusion, total cholesterol levels of our study subjects are largely influencd by age, sex, smoking habits and weakly influenced by exercise habits but not by drinking habits.

급성하벽심근경색 환자에서 흉부유도 ST 절하강의 임상적 의의

이성구(Sung Ku Lee),백효종(Hyo Jong Baek),서상문(Sang Moon Suh),천병도(Byung Do Chun),이중기(Choong Ki Lee),김신우(Shin Woo Kim),우언조(Eon Jo Woo),강승완(Seung Wan Kang),채성철(Shung Chull Chae),전재은(Jae Eun Jun),박의현(Wee Hyun P 대한내과학회 1992 대한내과학회지 Vol.43 No.4

N/A The prognostic significance of precordial ST segment depression during early stages of acute inferior myocardial infarction is controversial. To examine this problem, electrocardiographic findings on admission were compared with the clinical variables in 50 patients with a first transmural inferior infarction. Patients were classified according to the admission ECG obtained an average of 7.0hours after the onset of chest pain. Twenty-five patients (group I) had≥1.0mm ST depression in at least one of leads V1 to V6 and 25 (group II) did not. There were no significant differences between the two groups in peak creatinine kinase activity, prevalence of in-hospital complications (i, e., congestive heart failure, hypotension, arrhythmias requiring treatment and death), and maximal ST elevation in inferior lead. A weak correlation existed between the quantities (mV) of inferior ST segment elevation and precordial ST depression (r=0.43, p<0.05). Thus, precordial ST depression during acute inferior infarction is not a reliable marker of the extent of myocardial damage or an adverse hospital course. Precordial ST segment depression might represent a benign electrical phenomenon.

Adenosine 부하 99mTc-MIBI 심근 관류스캔도중 나타나는 ST 절 하강과 관상동맥 질환의 중증도와의 관계

이규보(Kyu Bo Lee),이재태(Jae Tae Lee),손상균,채성철,전재은,박의현,정병천(Byung Cheon Chung),최정일(Chung Il Choi),곽동석(Dong Suk Kwak),강승완(Seung Wan Kang),우언조(Eon Jo Woo),김정균(Jeong Gyun Kim),배선근(Sun Kun Bae),조정아(Jung Ah Cho) 대한핵의학회 1994 핵의학 분자영상 Vol.28 No.2

N/A Pharmacologic coronary vasodilation in conjunct.ion with myocardial perfusion scintigraphy has become an alternative to dynamic exercise test for the diagnosis and risk stratification of coronary arter y disease, especially in patients who are unable to perform adequate exercise. Dipyridamole and adenosine have been used for pharmacologic stress t,esting with myocardial perfusion imaging. Adenosine is a potent, coronary vasodilator with rapid onset of action, short half Iife, near maximal coronary vasodilation and less serious side effects. ST segment depression has been reported in about 7-15% of patients with coronary artery disease receiving dipyridamole in conjunction with myocar dial perfusion imaging. The exact cause and clinical significance are not known. In order to evaluate ihe relationship between adenosine-induced ST segment depression dur- ing Tc-MIBI myocardial perfusion scin(igraphy and the severity of coronary artery disease, we performed 99mTc-MIBI imaging after int#ravenous infusion of adenosine in 120 patients with susper,t.ed coronary artery disease. Of t.he 120 patients, 28 also performed coronary angiography. There were 24 patients with ST segment depression during 99mTc-5/IIBI scintigraphy and 96 patients without ST segment depression. Adenosine was infused intravenously at. a dose of 0.14mg/kg per minute for 6minutes and 99mTc-MIB1 was injected at 3 miinute. We then compared the hemodynamic changes, side effects, scintigraphic and angiographic findings. Heart, rate increased 90 +- 19 beats/minute in t.he group with ST depression compared with 80+16 beats/rninute in the group without ST depression(p<0.05). Baseline systolic blood pressure was significantly higher in the group with ST depression(152 +- 27 mmHg) than in the group without ST depression(140 +- 21mmHg, p<0.05). Double product, at baseline(10.90 +- 2.77 versus 9.55 +- 2.34beats/minutexmmHg) and during adenosine infusion(12.72 +- 3.89 versus 10.83+2.98 beats/minutexmrnHg) were significant,ly higher in t.he group with ST de pression(p<0.05). The incidenoe of anginal chest pain was also significantly higher in the group with ST depression(75 versus 29%, p<0.0001). The 99mTc-MIBI images were abnormal in 23(96%) patients wit.h ST segment depression and 66(69%) patients without ST segment depression(p<0.05). In patients with ST segment depression, there were more reversible per- fusion defects than in patients without ST segment depression(83 versus 55%, p<0.05). The number of abnormal segments were significantly higher in the group with ST depression(3.05 +- 2.01 versus 1.51 +- 1.45, p<0.005). In patients with ST segment depression, there were more segments of reversible perfusion defects than in patients without segment depression(2.15 +- 2. 11 versus 0.89 +- 1.24, p<0.05). There were no differences in the angiographic severity by ves sel(p, NS). We concluded that ST segment depression during 99mTc-MIBI myocardial perfusion scintigraphy with intravenous adenosine is related to the severity of coronary artery disease.

관상동맥 질환에서의 Adenosine 부하 99mTc - MIBI 심근 스캔의 진단적 가치 : 운동 부하 99mTc - MIBI 심근 스캔과의 비교

이규보(Kyu Bo Lee),이재태(Jae Tae Lee),박의현(Wee Hyun Park),정병천(Byung Cheon Chung),최정일(Chung Il Choi),전재은(Jae Eun Jun),채성철(Sung Chull Chae),강승완(Seung Wan Kang),우언조(Eon Jo Woo) 대한핵의학회 1992 핵의학 분자영상 Vol.26 No.1

N/A Pharmacologic coronary vasodilation in conjunction with myocardial scintigraphy has become an accepted alternative to dynamic exercise testing for the diagnosis of coronary artery disease. Although dipyridamole has traditionally been used for this purpose, it causes frequent side effect, which at times can be life-threatening. Moreover, dipyridamole dose not elicit maximal coronary vasodilation in a substantial number of patients receiving the usual i.v. dose. Adenosine is an endogenously produced compound that has significant effects as a coronary vasodilator and rapid onset action and extremely short half-life ((10 seconds). The diagnostic accuracy and safety profile of adenosine Tc-99m-MIBI myocardial scintigraphy were evaluated and comparison with exercise Tc-99m-MIBI was performed. Twenty-eight subjects underwent Tc-99m-MIBI imaging after adenosine infusion and exercise Tc-99m-MIBI imaging. Adenosine was infused intravenously at a dose of 0.14 mg/kg/body weight per minute for 6 min and MIBI was injected at 3 minute. Adenosine caused an incerease in heart rate (64±12 at baseline versus 74±16 beats/min at peak effect, p〈0.001), a mild decrease in systolic and diastolic blood pressure and a slightly increase in PR interval(p; NS). Side effects were reported in 92% of patients and were mostly mild in nature and promptly resolved within 1 or 2 minutes of termination of adenosine infusion. Facial flushing (53%), chest pain (36%), mild dyspnea (39%), headache (21%), throat discomfort (21%) were frequent symptoms. ST segment depression(〉1mm) and second degree AV block in electrocardiography occured in 11% of thepatients, respectively. The overall sensitivity and specificity for individual coronary stenoses in 16 patients underwent coronary angiography were 88% and 95%, respectively. The agreement ratio of segmental perfusion between adenosine and exercise images was 92% (Kappa index=0.82). In conclusion, Tc-99m-MIBI myocardial perfusion scintigraphy with intravenous adenosine is a feasible, safe and highly accurate noninvasive technique for the detection of coronary artery disease and results are at least comparable with those of exercise Tc-99m-MIBI scintigraphy.

Takayasu동맥염의 임상적고찰

채성철,강승완,우언조,전재은,박의현,김기식,김윤년,김권배 慶北大學校 醫科大學 1989 慶北醫大誌 Vol.30 No.4

경북대학교병원 및 계명대학교의과대학 부속병원에 입원하였던 28례의 Takayasu동맥염환자의 임상적관찰을 하여 다음과 같은 성적을 얻었다. 1) 대상환자 28례중 남자가 7례, 여자가 21례였고, 남자의 평균연령은 44세, 여자의 평균연령은 21세, 전체환자의 평균연령은 27세였다. 2) 내원당시의 28례의 증상으로는 운동성호흡곤란(11례), 현기증(7례), 두통(7례), 무맥(4례), 전신쇠약감(3례), 시력장애(3례), 이상감각(3례), 복통(3례), 심계항진(2례), 흉통(1례)등이 있었다. 초기증상을 알 수 있었던 16례에서의 초기증상은 전신쇠약감 또는 피로감(8례), 국소동통(4례), 관절통(3례), 야간발한(3례), 흉통(3례), 발열(2례), 체중감소(2례), 식욕부진(1례)등이었다. 이들에서의 잠복기(latent period)는 42일에서 10년이상까지 다양하였다. 동반된 질환으로는 결핵이 2례, 류마티양관절염, 당뇨병, Valsalve동의 동맥류, 위점막 병변 및 사구체신염이 각각 1례씩 있었다. 3) 내원당시의 주요 이학적소견으로는 무맥(25례), 고혈압(16례), 병변부위동맥의 잡음(bruit)(12례), 울혈성심부전(11례), 고혈압성망막증(10례), 하지의 파행(8례), 폐동맥고혈압(2례) 및 대동맥판폐쇄부전과 승모판폐쇄부전(2례) 등이었다. 4) 검사실소견으로는 빈혈(10례), 혈침속도증가(22례)가 있었고, 그외 비특이적으로 CRP양성(13례중 9례), RA factor양성(13례중 3례) 및 ANA, LE세포, VDRL양성(13례중 1례)등이 있었고, Man toux검사는 시행한 11례중 3례에서 양성반응을 보였다. 심전도소견으로는 재분극이상(12례), 좌심비대소견(7례), QT간격연장(4례), 좌심방이상소견(2례) 및 심방세동, 발작성심방빈맥과 흉부유도에서의 R파의 "poor progression"(각각 1례)등이었다. 5) 동맥조영술소견은 Lupi-Herrera등의 1형이 11례, 2형이 6례, 3형이 9례 및 4형이 2례였다. 6) 치료받은 19례가운데 내과적치료를 받은 17례중 11례에서 부신피질호르몬제를, 10례에서는 항응고제를 사용하였는데, 부신피질호르몬제를 투여받은 4례에서만 혈침속도의 감소가 있었다. 그리고 고혈압치료를 위하여 경피적신동맥확장술이 7례에서, 신절제술이 1례에서 시행되었다. 7) 15례에서 추적관찰이 가능하였고, 이가운데 4례는 사망하였으며, 생존하고 있는 11례의 평균 추적관찰기간은 7개월(1.5-24개월)이었다. 사망한 4례중 3례는 심부전으로, 1례는 농흉에 의한 패혈증으로 사망하였다. Clinical observation on 28 cases of Takayasu's arteritis from Departments of Internal Medicine of Kyungpook National University and Keimyung University revealed followings: 1) Age and sex distribution: Seven cases were male and twenty one cases were female. Mean ages of male and female cases were 44 and 21 years old, respectively (range 11-66 years old). 2) Chief complaints on first presentation were dyspnea on exertion (11 cases), dizziness (7 cases), headache (7 cases), absence of pulse (3 cases), abdominal pain (3 cases), palpitation (2 cases), and chest pain (1 case). Initial systemic symptoms of 16 cases which could be recalled were generalized weakness and fatigue (8 cases), localized pain (4 cases), arthralgia (3 cases), night wsweating (3 cases), chest pain (3 cases), fever (2 cases), weight loss (2 cases), and anorexia (1 case). Latent periods of these cases were ranged from forty-two days to over 10 years. Concomittant diseases were pulmonary tuberculosis (2 cases), rheumatoid arthritis (1 case), diabetes mellitus (1 case), aneurysm of sinus of Valsalva (1 case), gastric mucosal lesion (1 case), and glomerulonephritis (1 case). 3) Among the physical findings were absence of pulse (25 cases), hypertension (16 cases), bruits over affected arteries (12 cases), congestive heart failure (11 cases), hypertensive retinopathy (10 cases), claudication of lower extremities (8 cases), pulmonary hypertension (2 cases), and aortic and mitral regurgitations (2 cases). 4) There were no specific laboratory findings. Among nonspecific findings were anemia (10 cases), increased ESR (22 cases). C-reactive protein, RA factor were positive in nine and three cases, respectively, of 13 cases tested. Antinuclear antibody, LE cell and VDRLK were positive only in a case of 13 cases tested. Mantoux test was positive in three of 11 cases tested. Electrocardiogram revealed abnormal repolarization (12 cases), findings of left ventricular hypertrophy (7 cases), prolongation of QT interval (4 cases). 5) According to angiographic findings, 11, 6, 9 and 2 cases had type 1, type 2, type 3 and type 4 of Lupi-Herrera and associates, respectively. 6) In 19 cases who were treated, 17 cases were given medical treatment of corticosteroid (11 cases) and/or oral anticoagulant (10 cases). Four cases on corticosteroid showed decrease in ESR. Percutaneous angioplasty of renal artery was performed in seven cases with hypertension, and successful in 4 cases in which blood pressures were normalized. In another hypertensive case, nephrectomy normalized blood pressure. 7) Follow-up observations were possible in 15 cases, of which 4 cases died. Average follow-up duration was seven months (range 1.5-24 mopnths). Causes of death were congestive heart failure in three cases, and pyothorax related sepsis in a case.