S-상 심실중격의 임상적 고찰

이동민,장경식,양종태,장대용,김종오,서영욱,고영엽,홍순표 조선대학교 부설 의학연구소 2002 The Medical Journal of Chosun University Vol.27 No.1

Background: The sigmoid septum described an anatomical variation in the contour of the left ventricular outlet. It is related to degenerative change with aging. We observed clinical significance of sigmoid septum in Korean. Methods: Echocardiographic examination was performed in 434 patients. Sigmoid septum is defined as discrete bulging of the proximal interventricular septum with that thickness is greater than 1.3cm or the thickness is grater 1.5 times than adjacent mid interventricular septum in apical 3 chamber view. Result: The incidence of patient with sigmoid septum(septum patient) is 24.8% (male 8.4%, female 16.3%) . The incidence increases with age and is more common in women. The patients with sigmoid septum were compared with targeted groups, there was no significant difference in blood pressure between them, but in height and weight, the former were lower. (p<001, p<03). In the patients with sigmoid septum, weight and the surface area of a body have an opposite correlation with increase of age (p<03, r=-0.34) (p<04, r=-0.31) , but no decrease of height was found according to age increase (p=0.47, r=-0.11) The main reason patients with sigmoid septum ask echocardiolography and its clinical symptoms were abnormal results of previous electrocardiography and/or usual chest pain. Compared with control group, interventricular septal thickness is larger in septum patients (p<001). The thickness of interventricular septum located in subaortic left ventricular outflow tract is 1.6±0.3cm. There is another web like structure that continued from interventricualr septum to anterior free wall of left ventricle and the width is 1.6±0.4cm. A sign of insignificant obstruction due to left ventricular outflow was observed from three sigmoid septum patients. Conculusion: Septum patient is largely found in older age group and the body weight and body surface area are lower than control group. The body weight and body surface area are opposite correlation with age. So sigmoid septum is considered as structural change by weight reduction with aging. It is assumed that septum patients are related with asymptomatic ischemia because they have more abnormal ECG finding such as T wave inversion on precordial leads or standard leads, nonspecific ST-T change, LBBB etc. Sigmoid septum is not only proximal interventricular septal bludging but also another web like structure continuing to anterior wall of left ventricle.

자연발증 고혈압쥐에서 Atenolol이 대동맥 미세구조변화에 미치는 영향

김용태,이승일,장경식 朝鮮大學校 附設 醫學硏究所 1992 The Medical Journal of Chosun University Vol.17 No.1

Hypertension has been known as a major risk factor for atherosclerosis, left ventricular hypertrophy, sudden death and other cardiovascular diseases. Hypertension-induced vascular changes are thought to be adaptive to the increased stress. Adaptation in the media includes incresed synthesis of the major connective tissue components, elastin and collagen, hypertrophy and hyperplasia of smooth muscle cells (SMC), which are due to wall thickening and increase in arterial cell mass. The present electronmicroscopic study was performed in normal Wistar-Kyoto rats(WKR), nontreated spontaneously hypertensive rats(SHR) and atenolol-treated SHR (2.5 ㎎/Kg/day) to define and compare the morphologic changes of aorta induced by hypertension as well as the restoration on its wall in normal WKR, SHR & atenolol treated SHR. Pretreatment with atenolol for 22 weeks thickness of media of the SHR aorta caused by hypertension was decreased and space between prominent elastic laminae was narrowed as compared to the control SHR. Irregularly arranged collagenous fibers among the abundant SMC in control SHR aorta are regularly distributed as shown in control WKR or atenolo-pretreated SHR. Cross bands of collagen fibrils are partly apparrent in atenolol-treated SHR. While were not clear and some fragemented in the media of the control SHR aorta. Ultrastructural study also revealed that nucleus with double membrane was well-developed, heterochromatin along with normally distributed, enchromatin and that various-sized vacuoles disappeared follow ing improvement of hypertension by chronic pretreatment with atenolol. According to the from these experimental results, it is thought that atenolol a beta-adrenergic antagonist may improve vascular changes inducde by hypertension. Euchromatin are normally distributed and various-sized vacuoles disappeared following reversal of hypertension. From these experimental results, it is thought that atenolol, one of the beta-adrenergic blockades may improve vascular changes induced by hypertension.

대동맥 이첨판과 승모판 이탈증을 동반한 대동맥 판하부 협착 1예

김용화,장경식,양태영,임영국,안기완,홍순표 朝鮮大學校 附設 醫學硏究所 1993 The Medical Journal of Chosun University Vol.18 No.1

Discrete subaortic stenosis is a rare cardiac disorder especially in Orientals which occupies eight to ten percent of aortic stenosis, It occurs mainly before age of eighteen and accompanies with aortic valve abnormalities such as aortic stenosis, supravalvrlar stenosis, bicuspid valve and muscular hypertrophic subaortic stenosis, and other cardiac abnormalities such as ventricular septal defect, pulmonary stenosis and coarctation of aorta. There is no report of discrete subaortic stenosis accompanied with mitral valve prolapse. The major complications of discrete subaortic stenosis are aortic insufficiency, and subacute bacterial endocarditis. We report a case of asymptomatic nineteen-year-old male of discrete subaotic stenosis with bicuspid aortic valve and mitral valve prolapse, which is comfirmed by two-dimensional and Doppler echocardiography including transesophaigeal echocardiography.

신장허혈백서에서 투여 시기에 따른 캄슘길항제의 효과

이승일,문철웅,장경식 朝鮮大學校 附設 醫學硏究所 1992 The Medical Journal of Chosun University Vol.17 No.1

During ischemia, the cellular ATP concentrations quickly decline due in part to the absence of an adequate electrone acceptor and in part to the continued utilization of previously sythesized ATP by energy-dependent functions and the levels of ADP and AMP rise rapidly and these were further catabolised to hypoxanthine. Hypoxanthine and xanthine catabolized to uric acid by xanthine oxidase and in these metabolic step, free radicals were produced. The levels of intracellular calcium were increased due to the impared faction of membrane pump such as Na-K ATPase and Ca-ATPase because of decresed ATP levels in ischemia. Calcium promote cell injury including the plasma membrane, mitochondria, endoplasmic reticulum and the cytoskeleton but the precise roles of calcium in ischemic cell injury were unknown. In this experiment, effects of trifluoperazine(calmodulin antagonist) and allopurinol(xanthine oxidase inhibitor) on ischemic-reflowed rat kidney was investigated by the contents of malondialdehyde(MDA) as a indicator of lipide proxidation, the activities of antioxidant enzymes including superoxide dismutase(SOD), glutathione peroxidase and catalase, and the levels of glutathione. Allopurinol(50㎎/㎏ of body weight) was administrated by orally 12 hours before ischemia and trifluoperazine(2㎎/㎏ of body weight) was administrated 10 minutes before ischemia or 10 minutes after ischemia by intravenous injection. The contents of MDA was significantly increased by ischemia-reflow but significantly reduced by allopurinol pretreatment. The decrement of SOD and catalase activities were significantly reduced by allopurinol and trifluoperazine regardless of adminstration time compared with allopurinol pretreated group. The changes of glutathione peroxidase activity was significantly reduced by allopurinol and trifluoperazine. But the levels of glutathione was significantly decreased by allopurinol and trifluoperazine. These result suggested that xanthine oxidase and calcium paticipate in ischemic-reflow cell injury in rat kidney and calcium induced cell injury occure mainly during reflow period.

성인형 당뇨병 환자에서 피부생검을 이용한 표피하 모세혈관 기저막 두께의 변화에 관한 연구

김원학,오금탁,김만우,장경식,채종구,조건국 朝鮮大學校 附設 醫學硏究所 1987 The Medical Journal of Chosun University Vol.12 No.1

Thickening and proliferation of capillary basement membrane is a generalized phenomenon in diabetes mellitus and has been described in many organs including heart, kidney, pancreas, retina etc. While such changes are specific, it is difficult to obtain specimens from those organs. We took the specimens from the medial surface of the thing of 33 diabetics and 4 healthy persons as controls by means of punch biopsy. The measurement carried out by normogram and electron microscopic technique. HbA_(1c) values were also measured simultaneously. 1. The HbA_(1c) values are higher in diabetics than in control group (p<0.01). 2. The subepidermal capillary basement membrane thickness of the diabetics : 30% of the 5 th decade population, 53.9% of the 6 rh decade population and 83.3% of the 7th decade population showed more rhan 3,000 A. Whereas all the controls showed below 3,000 A. 3. The subepidermal capillary basement membrane thickness did nor increase significantly with the duration of the disease. 4. In cases of high subepidermal capillary basement membrane thickness, HbA_(1c) showed significant increase. (p<0.01).

종격동 종괴를 의심케한 우대동맥궁 1례

김만우,백학연,정춘해,장경식,홍순표,조건국,김종진 朝鮮大學校 附設 醫學硏究所 1987 The Medical Journal of Chosun University Vol.12 No.1

Developmental anomalies of the aortic arch, commonly known as vascular rings, are relatively rare congenital vascular anomalies which can compress the trachea and esophagus. One routine chest film of a patient who was checked and hepatoma-diagnosed in Internal Medicine, Chosun University Hospital left the room for doubt of mediastinal mass. But no subjective symptoms for the mass was told by the patient. This is to report our experience of a patient having right side aortic arch with aberrant left subclavian artery, as proved by diagnosis, but none of congenital heart disease. This right side aortic arch with aberrant left subclavian artery is the most frequent type among right aortic arch, the anomaly of which is usually detected from the incidental suspicion for mediastinal mass at routine chest film; because no symptoms are accompanied therewith.

백서에서 신 허혈성 손상에 미치는 칼슘 길항제의 효과

문철웅,정종훈,박천국,이승일,배학연,장경식,김만우,정춘해,홍순표,이병래,김호중 朝鮮大學校 附設 醫學硏究所 1993 The Medical Journal of Chosun University Vol.18 No.1

Renal ischemia is one of the most common causes of acute renal failure. Four factors related to the pathogenesis of acute renal failure are vasoconstriction, decreased glomerular filtration rate, tubular back leak of filtrate, and intratubular obstruction. The cellular response to renal ischemic insults include decreased content of adenosine trihosphate, lipid peroxidation induced membrane degradation, alteration in cellular pH, and calcium or phospholipase induced mitochondrial dysfunction. Much attention has been given to the role of increased cellular calcium as a pathogenetic contributor to cell injury during ischemia. Author studied the protective effects of calcium antagonists on cellular injury during renal ischemia in rat. To investigate the protective role of these agents, author measured the amount of malondialdehyde(MDA) and the enzyme activities of free radical scarvengers-superoxide dismutase(SOD), catalase and glutathione peroxidase from non-pretreated group and calcium antagonists pretreated groups in control, ischemia and reflow subgroups. The results were summerized as follows: 1) The amount of MDA in non-pretreated group was higher in the reflow compared with the control(<p<0.01). But, in all pretreated groups, there was no statistically difference in the amount of MDA. 2) The SOD activity in non-pretreated group was lower in both the ischemia and the reflow compared with the control (P<0.05). But, in both verapamil and trifluoperazine-pretreated groups, there was no statistically difference in the SOD activity. 3) Both catalase and glutathione peroxidase activities in non-pretreated group were lower in both the ischemia and the reflow compared with the control (P<0.05). But in all pretreated groups, there was no statically difference in both catalase and glutathione peroxidase activities. These results suggest that free radical mediated ischemic injury by renal artery clamp in rat can be protected by intraperitoneal pretreatment with calcium antagonists. As trifluoperazine has a protective effect in renal ischemia, the calcium activated calmodulin dependent enzyme may play a role in renal ischemic injury.

급성 지주막하 출혈에 동반된 관상동맥 연축에 의한 심근경색증 1예

부귀범,박근호,양종태,이동민,장성종,김건영,장경식 조선대학교 2001 The Medical Journal of Chosun University Vol.26 No.1

In many cases, acute cerebrovascular disease is accompanied by abnormal electocardiograms. Also, though rather uncommon, acute myocardial infraction is also seen. The mechanism of its occurance is uncertain but it is thought to be related to coronary artery spasms, an abnormal autonomic nervous system, and a catecholamine increase. A female patient of 34 years of age came to the hospital because of sudden headache accompanied by substernal chest pain. A subarachnoid hemorrhage due to a cerebral aneurysm rupture had occured, and there was ST segment elevation in lead II, III, and aVF of the electrocardiogram. A cardiac enzyme test, an echocardiography, and a coronary angiography were performed, and she was diagnosed to have acute myocardial infarction due to coronary artery spasm. Clipping of the aneurysm was performed. With the use of nitrate and an angiotension converting enzyme inhibitor, the condition of the patient improved.

관상동맥 풍선성형술 후 발생한 관상동맥 박리의 초기 조영술적 고찰

고영엽,강지인,장재혁,강민정,정중화,장경식,홍순표 朝鮮大學校 附設 醫學硏究所 2007 The Medical Journal of Chosun University Vol.32 No.1

Background and Objectives: Percutaneous coronary intervention (PCI) is widely utilized in the treatment of symptomatic coronary artery disease (CAD). Althouth it has numerous benefits, intimal tear or dissection, serious and potentially life-threatening complications of plain old balloon angioplasty (POBA) can occur. The aim of this study was to assess the implications of coronary dissections after ballon angioplasty. Methods: 78 consecutive patients (age, 62 +/- 11 years; 46 men, 32 women) identified to two groups as having with or without dissection (dissection (D) group or non-dissection (ND) grouP) underwent balloon angioplsty for CAD were studied. All patients with dissection could be managed by successful stent implantation to rescue the artery. The morbidity of ischemic complication and mortality were evaluated for 30days after PCI. Results: Coronary dissection developed 44 lesions (38%) in 31 patients out of 117 lesions in 78 patients after POBA and a good final angiographic result was obtained in all patients with dissection, Significant correlates of a development of dissection were the lesion morphology of ACC/AHA type B and C (P<0.05). There were no significant correlations of clinical pictures, whether POBA in single vessel disease or in multivessel disease, diameter stenosis before POBA, and balloon/coronary artery diameter ratio. Morphologic feature of dissection was type A in 15 (34%), type B in 13(30%), type C in 12 (27%), and type D in 4 (9%). After PCI, there was no ischemic complication or death related coronary dissection during follow-up period for 30days. Conclusions: Coronary dissection after angioplasty occurred in 44 lesions (38%) out of 117 lesions of 78 consecutive patients underwent POBA. Coronary dissection after POBA significantly correlated with the severity of lesion morphology. Coronary stenting is effective in the management of acute coronary dissections after angioplasty.

자궁근종 환자에서 정맥과 우심방 혈전의 방사선학적 소견을 보인 정맥내 평활근종 1예

김제상,강미라,이상철,박표원,김병기,안긍환,장경식 대한내과학회 2004 대한내과학회지 Vol.66 No.5

저자는 과거 자궁근중으로 수술한 50세 여자 환자가 심부전 및 광범위한 혈전증의증으로 본원에 내원하여 수술후 정맥내 평활근종으로 밝혀진 증례를 경험하였기에 이를 문헌고찰과 함께 보고하는 바이다. A case of intravenous leiomyomatosis (IVL) invading the vena cava and extending to the right atrium, a rare benign smooth-muscle tumor, is described. Despite their histological benignity these lesions have a tendency to metastasize and are closely related to the condition called "benign metastasizing leiomyoma" and " intracaval mass and cardiac extension" a 50-year old woman was admitted to the hospital with dyspnea beginning 6 months ago and precious history of hysterectomy due to uterne myoma. Echocardiography revealed severe tricupid valve insufficiency and a mobile elongated mass which occupied the inferior vena cava and was extending into the right ventricular cavity. Pelvic ultrasonography and pelvic MRI identified suspicious metastasis to both ovaries and peritoneum. She underwent resection of the cardiac tumor, conomitant tricuspid annuloplasty with a closure of the foramen ovale and both salphyngo-oophorectomy with vaginal stump mass biopsy. All of them could be histologically identified as IVL.