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자가폐동맥판막을 이용한 대동맥근부치환술의 단기 추적관찰 성적
신은석(Eun Sug Shin),홍석근(Suk Keun Hong),황흥곤(Hweung Kon Hwang) 대한내과학회 2001 대한내과학회지 Vol.60 No.4
Background: Ross procedure is the pulmonary valve autograft in the aortic valve disease, and its use trends to increase after introduced by Ross in 1967, firstly. The most import ant point is that it is a permanent valve replacement. It is to be ideal method to the young patient because the graft is a viable tissue to be able to grow, and hemodynamically, most similar to the normal aortic valve, and doesn`t need to do anticoagulation therapy due to not having the thromboembolism, but not popular because it has a lot of technical problem and doesn`t have the long-term follow-up Methods: The patient s were 8 admitted between October 1997 and October 1998, the age from 15 t o 39 ; 6 males and 2 females. The causes of disease were 4 patients of rheumatic disease, 1 of a infective endocarditis with the aortic annular abscess, 1 of recurred severe aortic insufficiency 2 years after replacement. Two patients used the homograft and 6 patients switched a diseased aortic valve with the pulmonary autograft. Results: There were no death and the preoperative dyspnea nearly disappeared (NYHA FC III- IV - > I-II). The diastolic diameter of left ventricle decreased significantly when we compared to the previous echocardiography 1 month after the operation, and we observed the mild aortic valve insufficiency in 3 patients, severe in 4, mild pulmonary valve insufficiency in 4, severe in 1, and mild pulmonary valve stenosis in 4. Conclusion : The operative death rate of Ross procedure in the aortic valve disease was not higher than the artificial valve replacement. Therefore, if we find the appropriate indication of operation, we can expect better results and think that we should have the long- term follow-up furthermore.(Korean J Med 60:368- 372, 2001)
Q 파 심근경색과 비 - Q 파 심근경색의 임상경과 및 관동맥조영술 소견의 비교
정기영(Ki Young Chung),홍석근(Suk Keun Hong),이명룡(Myung Yong Lee),조주희(Joo Hee Zo),김준수(June Soo Kim),김치정(Chee Jeong Kim),조명찬(Myeong Chan Cho),박영배(Young Bae Park),이명묵(Myoung Mook Lee),최윤식(Yun Shik Choi),서정돈(Ju 대한내과학회 1991 대한내과학회지 Vol.40 No.1
Despite of having smaller infarct size and better left ventricular function, patients with non-Q wave myocardial infarction has been reported to have an high late cardiac event rate, and long term prognosis is ultimately comparable to that of patients with Q wave myocardial infarction. This is because there is more viable tissue in the perfusion zone of infarct-related artery rendering myocardium more prone to reinfarction. To compare the prognosis and clinical characteristics of Q wave myocardial infarction with those of non-Q wave myocardial infarction, 390 patients with acute myocardial infarction were reviewed and analyzed retrospectively. Patients were classified according to electrographic results into Q wave infarction (n=336) and non-Q wave infarction (n=54). Predischarge coronary angiography, gated blood pool scan, end treadmill exercise test were performed. There was no significant difference in sex, age, angina history, previous myocardial infarction, location of infarction, and severity of coronary disease; Q wave myocardial infarction did have higher peak CK (1733.9±1432.6 vs. 511.1±588.8 IU; P<0.01) and CK-MB fraction level (334.2±371.5 vs. 78.7±128.5; P<0.01). Predischarge treadmill exercise test showed no significant difference in the exercise duration, ST segment change, and chest pain. In gated blood pool scan, ejection fraction of left ventricle did not show significant difference, but proportion of normal left ventricular wall motion was significantly higher in non-Q wave infarction. (21/257 vs. 19/42; P<0.01). The extent of coronary artery disease and degree of coronary artery stenosis was not different between two groups, but high degree obstruction (>90%) of infarct related artery was more frequent in Q wave myocardial infarction (134/187 vs. 19/35; P<0.05). During follow-up, in-hospital mortality was significantly higher in Q wave myocardial infarction (13% vs. 2%, p<0.01). But postdischarge mortality and the rate of reinfarction did not different between two groups. Further prospective studies should be performed to clarify the clinical behaviors and long-term prognosis in patients with non-Q wave myocardial infarction.
심장 이식 후에 발생한 침윤성 폐 Aspergillosis 2 예
윤재형(Jae Hyung Yoon),이수금(Su Geum Lee),고경환(Kyung Whan Ko),홍석근(Suk Keun Hong),현민수(Min Su Hyon),김명아(Myung A . Kim),박성훈(Seong Hoon Park),박국양(Guk Yang Park),김희정(Hee Jung Kim),오미혜(Mee Hye Oh) 대한내과학회 1997 대한내과학회지 Vol.53 No.2
Case 1: A 39-year-old man underwent orthotopic heart transplantation on November 1994 for dilated cardiomyopathy. His postoperative course was unevenful and medications included daily cyclosporin A, Immuran and prednisone. On December 13.1994, he developed cough and sore throat. Chest radiographs revealed multiple patch growing lesions. Sputum fungus culture revealed Aspergillus Fumigatus. The patient was treated with daily infusion of amphotericin B. He remains well without evidence of relapse of Aspergillus, Case 2: This 39-year-old man had undergone orthotopic heart transplantation on November 16 1994 for dilated cardiomyopathy. In December 7.1994. he developed recurrent syncope. Chest radiographs revealed fungus ball like lesion on right lung field. On open lung biopsy and wedge resection of the mass was performed. Aspergillosis and CMV infection was demonstrated in the biopsy specimen. The patient was treated with conventional amphotericin B therapy for over 7weeks and Ganciclovir for over 2weeks. At the end of therapy chest X-ray showed only small residual scar in the area of previous mass.
김우규(Woo Gyu Kim),김정경(Jeong Kyung Kim),전성희(Seong Hee Jeon),임달수(Dal Soo Lim),홍석근(Suk Keun Hong),황흥곤(Hweung Kon Hwang),김미영(Mi Young Kim) 대한내과학회 2000 대한내과학회지 Vol.58 No.4
Fungal prosthetic valve endocarditis is a rare, poo-prognostic disease. The risk factors for fungal valve endocardits are open heart surgery, hyperalimentation, antibiotic therapy, IV drug abuse, concomitant bacterial endocarditis and immunosuppression. We report a case of aspergillus endocarditis in the aortic valve, which extended to ascending aorta after Redo-aortic valve replacement surgery. A 22-year-old male patient underwent Redo-aortic valve replacement surgery with 23mm-sized Sorin valve(bi-leaflet tilting disc valve) due to prosthetic valve failure. He was readmitted because of development of cough, anorexia, fatigue and fever after operation. The results of repeated blood culture were negative, and the symptoms continued in spite of 2 week treatment with broad spectrum antibiotics. Echocardiography and spiral computed tomographic angiography revealed multiple, huge masses in the aortic valve extending to ascending aorta. Emergent surgery was performed. Infected valve and surrounding areas were widely excised and aortic homograft was inserted. Resected aorta and prosthetic valve showed multiple mass-forming vegetations, measuring up to 4㎝×3㎝×3㎝. Microscopically, they revealed fungal organisms, showing sharp-angle branching and septate hyphae. Aspergillus flavus was isolated in culture of resected tissue. The patient suddenly died of ventricular fibrillation 3 weeks after surgery in spite of treatement with intravenous amphotericin B.(Korean J Med 58:466-471, 2000)
주폐동맥협착과 우관상동맥폐색으로 발현한 타카야수동맥염 1 예 -
전성희(Seong Hee Jeon),김연중(Yeoun Jung Kim),김우규(Woo Gyu Kim),류재춘(Jae Choon Ryu),홍석근(Suk Keun Hong),황홍곤(Hweung Kon Hwang),현민수(Min Su Hyon) 대한내과학회 1998 대한내과학회지 Vol.55 No.5
Takayasu's arteritis is generally recognized as a chronic, idiopathic, inflammatory disease, which affects the aorta and the proximal portions of its major branches. We experienced a patient with Takayasu's arteritis who was presented with main pulmonary artery stenosis and right coronary ostial occlusion without involvement of aorta nor its major branches, She was managed with pulmonary arterioplasty and coronary artery bypass graft. This case emphasize that the disease cannot affect the aorta.
증례 / 대동맥판막 폐쇄부전증을 동반한 골형성부전증 1예
전성희(Seong Hee Jeon),김우규(Woo Gyu Kim),김정경(Jeong Keung Kim),김재성(Jae Seong Kim),류재춘(Jae Choon Ryu),홍석근(Suk Keun Hong),현민수(Min Su Hyon),황흥곤(Hweung Kon Hwang) 대한내과학회 1999 대한내과학회지 Vol.56 No.2
Osteogenesis imperfecta is one of the groups of hereditary disorders of connective tissue which includes the Ehlers-Danlos syndrome, the Marfan syndrome, pseudoxanthoma elasticum, and Hurler syndrome. While cardiovascular involvement is associated with each of these disorders, it is least common in osteogenesis imperfecta and is overshadowed by the bony, ocular, otologic, cutaneous, and dental manifestations that are characteristic of the disorder. In evaluating patients with osteogenesis imperfecta, careful attention should be paid to cardiovascular findings and if valvular lesions are noted, patients should be instructed regarding the need for antibiotic prophylaxis for dental and surgical procedures. We report a case of osteogenesis imperfecta associated with aortic regurgitation.
정상 심근과 확장성 심근증 심근에서의 미토콘드리아 DNA 에 대한 분석
최현석(Hyun Seok Choi),김효수(Hyo Soo Kim),오병희(Byung Hee Oh),이명묵(Myoung Mook Lee),최성준(Seong Choon Choe),홍석근(Suk Keun Hong),손대원(Dae Won Sohn),박영배(Young Bae Park),최윤식(Yun Shik Choi),서정돈(Jung Don Seo),이영우(Youn 대한내과학회 1997 대한내과학회지 Vol.53 No.3
Objective: The aim of this study is to analyze the mitochondrial DNA in failing and normal hearts. Methods: Genomic DNA was extracted from 18 failing and 4 normal hearts. The DNA was digested with each 50 units of BamH I, Pvu II, Pst I, and hybridized using DNA fragments encoding CO II (cytochrome oxidase II) and CO IU. They were detected using 'Fluorescein Gene Images' system. Results: The light microscopic feature of failing myocardium was compatible with that of primary cardiomyopathy. In southern blot analysis, there was no significant difference in mitochondrial DNA amounts between normal and failing hearts. The amount of mitochondrial DNA in hearts, whether normal or failing, was greater than that in lymphocytes. There were no abnormal bands except 16.6kb-normal band using the enzyme BamH I, Pvu II from failing and normal hearts. After digesting with Pst I, 2.1kb band was found using probe CO II and 14.5kb band using probe CO III. Conclusion : The amount of mitochondrial DNA in hearts, whether normal or failing, was greater than that in lymphocytes, which suggests that the heart is an active organ in the energy metabolism. Abnormal band was not found in southern blot analysis of the mitochondrial DNA from failing and normal hearts. The more sensitive method such as PCR is required to detect the presence of sma11 amount of mutated DNA.
오세일(Se Il Oh),오병희(Byung Hee Oh),노준량(Joon Ryang Rho),김기봉(Ki Bong Kim),김재중(Jae Joong Kim),송명근(Meung Gun Song),진동규(Dong Gyu Jin),박국양(Kook Yang Park),홍석근(Suk Keun Hong),정윤섭(Yoon Seop Jeong),이상훈(Sang Hoon 대한내과학회 2001 대한내과학회지 Vol.60 No.3
Background : Heart transplantation is a definite treatment modality of the patients with end-stage heart failure. Heart transplantation has been performed in Korea since 1992, and currently it is an established procedure for the management of terminal heart failure. The purpose of this study is to clarify the Korean status of heart transplantation. Methods : Six major heart transplantation centers' 137 cases during the period November 1992 through May 1999 are analyzed to evaluate the general demographics, underlying heart diseases, postoperative management, complications, and survival. Results : The mean age of the patients is 37 years old, and the mean follow-up period is 25 months (1 day - 80 months, median 20 months). Most common underlying disease related to heart failure is cardiomyopathy (86%). Total 16% of patients underwent cellular rejection of ISHLT (International Society of Heart and Lung Transplantation) grade 3A or more within 1 year after transplantation. The most common type of clinical infection is bacterial (18%), and the most common organism is Herpes zoster virus (6.4%). Graft coronary artery disease examined by coronary angiography detected in 3.7% of recipients within 12 months after transplantation. One, 2, 3, and 5-year overall survival rates of recipients are 81% , 72%, 71%, and 62%, respectively. Conclusion : Distribution of underlying heart diseases and the frequency of graft coronary artery disease of Korean heart transplantation recipients were different from those of the western patients. Although the history of heart transplantation in Korea is relatively short, the early and long-term results are comparable with well-established centers.(Korean J Med 60:228-233, 2001)