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윤덕형,최현희,홍경순,김형수,한상진 대한내과학회 2011 대한내과학회 추계학술발표논문집 Vol.2011 No.1
Subject: The purpose of this study is the evaluation of prognostic factors in patients treated with extracorporeal membrane oxygenation (ECMO) for refractory cardiogenic shock and/or refractory ventricular tachyarrhythmia (VT) as a complication of acute myocardial infarction (AMI). Method: From January 2006 to December 2009, the patients admitted to Chuncheon Sacred Heart Hospital, Hallym University and treated with ECMO for refractory cardiogenic shock or refractory VT as a complication of AMI were enrolled. We retrospectively analyzed prognostic factors for weaning from ECMO. Result: A total of 17 patients (39.5%) of the 43 enrolled patients were successfully weaned from ECMO. DM is more prevalent in patients failed to be weaned ECMO. Among the laboratory data at admission, the patients failed to be weaned ECMO had higher level of BUN (25.0±12.0 vs. 17.2±4.9 mg/dL, p=0.007), Troponin-I (56.6±103.2 vs. 8.7 ±25.9 ng/dL, p=0.051), CK-MB (134.5±234.0 vs. 39.3±108.6 ng/mL, p=0.047), and myoglobin (3401.2±8199.3 vs. 354.4±591.0 ng/mL, p=0.013) and had lower level of pH (7.07±0.15 vs. 7.21±0.18, p=0.005), bicarbonate (9.6±2.7 vs. 14.3±4.6 mmol/L, p<0.001), and base-excess (-20.5±4.5 vs. -13.3±7.3 mmol/L, p=0.001) than the patients succeed to be weaned ECMO. The patients who received cardiopulmonary resuscitation (CPR) at the initiation of ECMO showed lower weaning rate than the patients who didn``t (29.0% vs. 66.7%, p=0.037). Conclusion: At the initiation of ECMO, elevated BUN and cardiac enzymes, and decreased pH, bicarbonate, and base excess were associated with weaning failure. After initiation of ECMO, elevated levels of peak creatinine and peak myoglobin were associated with weaning failure. Receiving CPR at the initiation of ECMO is poor prognostic factor of weaning from ECMO in patients with AMI.
김성은,박대균,최현희,윤덕형,한규록,오동진,홍경순,이준희 대한심장학회 2009 Korean Circulation Journal Vol.39 No.9
Background and Objectives: Right ventricular (RV) dysfunction is associated with a poor prognosis in patients with an acute pulmonary embolism (APE). We studied the role of electrocardiography and biomarkers for early detection and recovery of right ventricular dysfunction (RVD) in APE. Subjects and Methods: The medical records of 48 consecutive patients diagnosed with APE using CT-angiography, at the Kangdong Sacred Heart Hospital, between January 2004 and February 2008 were reviewed retrospectively. RVD was assessed by serial echocardiography (ECG). Patients with one of the following were considered to have RVD: 1) RV dilatation (enddiastolic diameter >30 mm in the parasternal long axis view), 2) RV free wall hypokinesia, and 3) paradoxical septal systolic motion. We compared the electrocardiographic findings and the biomarkers for the early detection of RVD. Results: The electrocardiographic findings showed T-wave inversion (TWI) in leads V1 to V3 with a sensitivity of 75% and a specificity of 95%, and a diagnostic accuracy of 80% for the detection of RVD, with positive and negative predictive values of 95.5% and 73.1%, respectively; these results were better than the biomarkers such as cardiac enzymes or B-type natriuretic peptide (BNP) for the early detection of RVD. TWIs persisted throughout the period of RVD, in contrast to a transient S1Q3T3 pattern detected during the acute phase only. Conclusion: TWIs in leads V1 to V3 had the greatest sensitivity and diagnostic accuracy for early detection of RVD, and normalization of the TWIs was associated with recovery of RVD in APE. Background and Objectives: Right ventricular (RV) dysfunction is associated with a poor prognosis in patients with an acute pulmonary embolism (APE). We studied the role of electrocardiography and biomarkers for early detection and recovery of right ventricular dysfunction (RVD) in APE. Subjects and Methods: The medical records of 48 consecutive patients diagnosed with APE using CT-angiography, at the Kangdong Sacred Heart Hospital, between January 2004 and February 2008 were reviewed retrospectively. RVD was assessed by serial echocardiography (ECG). Patients with one of the following were considered to have RVD: 1) RV dilatation (enddiastolic diameter >30 mm in the parasternal long axis view), 2) RV free wall hypokinesia, and 3) paradoxical septal systolic motion. We compared the electrocardiographic findings and the biomarkers for the early detection of RVD. Results: The electrocardiographic findings showed T-wave inversion (TWI) in leads V1 to V3 with a sensitivity of 75% and a specificity of 95%, and a diagnostic accuracy of 80% for the detection of RVD, with positive and negative predictive values of 95.5% and 73.1%, respectively; these results were better than the biomarkers such as cardiac enzymes or B-type natriuretic peptide (BNP) for the early detection of RVD. TWIs persisted throughout the period of RVD, in contrast to a transient S1Q3T3 pattern detected during the acute phase only. Conclusion: TWIs in leads V1 to V3 had the greatest sensitivity and diagnostic accuracy for early detection of RVD, and normalization of the TWIs was associated with recovery of RVD in APE.
Tako-Tsubo Cardiomyopathy by Transient Dynamic Left Midventricular Obstruction
홍경욱,박대균,최현희,김성은,윤덕형,이준희,한규록,오동진 대한심장학회 2009 Korean Circulation Journal Vol.39 No.1
A 48-year-old woman visited the emergency department with shock due to a urinary tract infection. The patient, who had a history of hypertension and diabetes mellitus, presented with precordial ST-segment elevation and Q waves, along with an increase of cardiac enzymes. An echocardiography showed moderately reduced systolic function, severe apical left ventricular ballooning, and a dynamic left ventricular outflow tract obstruction with a pressure gradient of 109 mmHg. Coronary angiography demonstrated normal coronary arteries. At the 1-month echocardiographic follow-up, the apical ballooning and left ventricular systolic function had recovered completely. There was no residual left ventricular intra-cavity gradient at rest, but it was induced in low-dose dobutamine stress-echocardiography. We demonstrated that dynamic left midventricular obstruction in the setting of either increased catecholamine stress or hypovolemia could develop Tako-tsubo cardiomyopathy. A 48-year-old woman visited the emergency department with shock due to a urinary tract infection. The patient, who had a history of hypertension and diabetes mellitus, presented with precordial ST-segment elevation and Q waves, along with an increase of cardiac enzymes. An echocardiography showed moderately reduced systolic function, severe apical left ventricular ballooning, and a dynamic left ventricular outflow tract obstruction with a pressure gradient of 109 mmHg. Coronary angiography demonstrated normal coronary arteries. At the 1-month echocardiographic follow-up, the apical ballooning and left ventricular systolic function had recovered completely. There was no residual left ventricular intra-cavity gradient at rest, but it was induced in low-dose dobutamine stress-echocardiography. We demonstrated that dynamic left midventricular obstruction in the setting of either increased catecholamine stress or hypovolemia could develop Tako-tsubo cardiomyopathy.
Myopericarditis in a Korean Young Male With Systemic Lupus Erythematosus
박규태,홍경순,한상진,윤덕형,최현희,이민영,류명신,이찬우 대한심장학회 2011 Korean Circulation Journal Vol.41 No.6
Myocardial involvement with clinical symptoms is a rare manifestation of systemic lupus erythematosus (SLE), despite the relatively high prevalence of myocarditis at autopsies of SLE patients. In this review, we report the case of a 19-year-old male SLE patient who initially presented with myopericarditis and was successfully treated with high dose of glucocorticoids.
A Case of Suspected Danon Disease Presenting as a Hypertrophic Cardiomyopathy
박소연,오동진,박대균,최현희,윤덕형,김성은,이준희,한규록 한국심초음파학회 2009 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.17 No.1
Danon disease is characterized clinically by the triad of cardiomyopathy, myopathy and mental retardation. It was originally reported as a lysosomal glycogen storage disease with normal acid maltase by Danon. Danon disease results from mutations in lysosome associated membrane protein-2 (LAMP-2) gene. The LAMP-2 gene is located on Xq24-25. We report a case of suspected Danon disease in patient who had hypertrophic cardiomyopathy and mental retardation along with abnormal findings in electromyography. Danon disease is characterized clinically by the triad of cardiomyopathy, myopathy and mental retardation. It was originally reported as a lysosomal glycogen storage disease with normal acid maltase by Danon. Danon disease results from mutations in lysosome associated membrane protein-2 (LAMP-2) gene. The LAMP-2 gene is located on Xq24-25. We report a case of suspected Danon disease in patient who had hypertrophic cardiomyopathy and mental retardation along with abnormal findings in electromyography.
우좌 단락 없이 관상동맥 색전증과 폐동맥색전증이 동시에 발생한
이민영 ( Min Young Lee ),윤덕형 ( Duck Hyoung Yoon ),이찬우 ( Chan Woo Lee ),박규태 ( Kyu Tae Park ),유명신 ( Myeong Shin Ryu ),최현희 ( Hyun Hee Choi ),홍경순 ( Kyung Soon Hong ) 대한내과학회 2011 대한내과학회지 Vol.81 No.4
A 65-year-old woman was referred for management of chest pain and ST segment elevation on electrocardiography. Emergency coronary angiography revealed a well demarcated thrombus that near totally occluded the mid portion of the left anterior descending artery, with a Thrombolysis In Myocardial Infarction (TIMI) flow grade 1, and a fusiform aneurysm on the left main coronary artery. No significant stenosis was observed after aspiration of the thrombus; however, complete coronary reperfusion by urgent aspiration did not improve her dyspnea and tachypnea. Echocardiography revealed a D-shaped left ventricle; thus, we performed a chest computed tomography scan and diagnosed a pulmonary embolism. The patient`s coagulation studies were normal. She was prescribed chronic anticoagulation, and we carried out transthoracic echocardiography using second harmonic imaging with agitated saline. Second harmonic imaging with the Valsalva maneuver revealed no right-to-left shunt. We report here a case of concurrent coronary embolism and pulmonary embolism without right-to-left shunt. (Korean J Med 2011;81:496-501)
에 대한 혈청 IgG 역가로 위 - 십이지장질환을 감별진단할 수 있는가 ?
최지용(Ji Yong Choi),김학양(Hak Yang Kim),윤덕형(Duck Hyoung Yoon),노승혁(Seung Hyuk Rho),김수진(Soo Jin Kim),이자영(Ja Young Lee),백광호(Gwang Ho Baik),김억(Auk Kim),이진헌(Jin Heon Lee),김용범(Yong Bum Kim),김우중(Woo Joong Kim),유 대한소화기학회 2002 대한소화기학회지 Vol.39 No.3
Background/Aims: Among the diagnostic methods to detect Helicobacter pylori (H. pylori) infection, serological test is a noninvasive, safe, and inexpensive method in clinical practice. This study was performed to determine whether the titer of anti-H. pylori IgG antibody was correlated with endoscopic findings of gastroduodenal diseases, gastric ulcer stage, and age. Methods: Two hundred and eighteen patients who were H. pylori positive by serological method and received gastroduodenal endoscopy were enrolled. All patients had the titers of anti-H. pylori IgG antibody >300 U/mL. We compared the antibody titer according to gastroduodenal diseases, peptic ulcer stage, and age group. Results: There was no statistically significant difference between serum anti-H. pylori IgG antibody titer according to gastroduodenal diseases (chronic gastritis, 999.8±120 U/mL; gastric ulcer, 1043±155.6 U/mL; duodenal ulcer, 1018.5±121.9 U/mL; gastric cancer, 1351±266 U/mL; p=0.504). No significant difference in the anti-H. pylori IgG antibody titer was observed according to peptic ulcer stage (p=0.065) and age (p=0.791). Conclusions: The serum anti-H. pylori IgG antibody titer is not valuable in differentiating the gastroduodenal diseases. (Korean J Gastroenterol 2002;39:167-172)