40세 이하 관상동맥 질환자에서 장기적 임상 관찰

이승욱,정명호,박종철,박형욱,조상희,김원,김계훈,이상현,강경태,조장현,김남호,김건형,안영근,조정관,박종춘,강정채 全南大醫大 2001 전남의대학술지 Vol.37 No.2

교합면 열구 법랑질의 미세구조 및 산부식 형태

조태식,이상호,윤정훈,김수관 大韓小兒齒科學會 2005 大韓小兒齒科學會誌 Vol.32 No.2

치면열구전색제의 접착력에 영향을 줄 수 있는 교합면 열구 법랑질의 미세구조 및 산부식 형태, 그리고 산부식 형태에 영향을 줄 수 있는 prismless enamel의 존재 여부 및 법랑질의 화학적 조성을 규명하고자 소구치를 대상으로 협설면과 근원심으로 각각 절단하여 열구내의 법랑질 표면과 산부식 형태를 주사전자현미경으로 관찰하고 EDX를 사용하여 법랑질의 화학적 조성을 분석한 결과 다음과 같은 결과를 얻었다. 1. 열구내 법랑질은 대부분이 prismless enamel이 존재하였다. 2. 미성숙 영구치와 성숙된 영구치 간의 열구내 법랑질 표면 구조 및 산부식 형태는 차이가 없었다. 3. 열구 법랑질은 부위 에 관계없이 60초 산부식 이 15초, 30초, 45초에 비해 산부식 효과가 가장 켰으며 15초, 30초, 45초의 산부식 시간에서는 적절한 유지력을 얻을 수 있는 산부식 상이 관찰되지 않았다. 4. 열구 법랑질의 표면을 기계적으로 제거한 경우는 30초의 산부식 시간에서도 60초 산부식 시간에 못지않은 전형적 인 산부식 상이 관찰되었다. 5. 산부식 형태는 주로 rod 주위가 소실된 제 2형의 산부식 상이 관찰되었다. 6. 열구 내 법랑질의 부위별 화학적 조성의 차이는 없었으나 미성숙 영구치와 성숙된 영구치 사이의 칼슘/인 비는 유의한 차이를 보였다. 이상의 연구결과를 종합하면 교합면 열구내 법랑질은 대부분 산에 저항성이 큰 prismless enamel로 덮여 있어 기존에 제안된 15-30초의 산부식 시간으로는 적절한 유지력을 얻을 수 있는 산부식 상을 형성할 수 없다는 사실을 알 수 있다. 따라서 기존의 제안된 산부식 시간에 대한 재고가 필요하며 이와 함께 적절한 산부식 상을 얻기 위한 방안으로 산부식 전bur를 사용하여 열구내 법랑질 표면을 제거해 주는 보조적인 술식에 대한 검토가 필요하리 라 사료된다. The purpose of this study was to compare the effectiveness of mechanical and acid treatment on enamel surfaces for the retention of pit and fissure sealants and evaluate the presence of a prismless layer. The etch pattern produced on enamel from immature and mature premolar teeth extracted with varying period of acid etching using 37% phosphoric acid was examined using a scanning electron microscope(SEM). The composition of each groups was evaluated using an energy dispersive x-ray(EDX) spectroscopy. The result of present study can be summarized as follows: 1. Prismless layer was commonly observed on the fissure enamel in young and mature premolar. 2. There were no differences in micro-structure and etching pattern on fissure enamel between the young and the mature premolar. 3. The most effective etching pattern for retention of pit and fissure sealant was observed in 60 seconds of etching time and no apparent difference of etching pattern was found among 15, 30, and 45 seconds of etching time which showed non-retentive etching patterns. 4. The etching pattern obtained by grinding enamel surface with bur followed by 60 seconds of etching was similar to that of 60 seconds of etching without any pretreatment of fissure surface. 5. Type 2 etching pattern was commonly found on fissure enamel in both young and mature premolar. 6. The calcium content and P/Ca ratio in fissure enamel between the young and the mature premolar were significantly different(PK0.05). But content of calcium, phosphate and P/Ca ratio on various regions of fissure enamel in both young and mature premolar did not showed any difference. Based on these results, prismless layer may negatively influence the retention of pit and fissure sealants. 'Therefore, the mechanical removal of the prismless layer by grinding prior to etching or by prolonged etching time of enamel within the fissure system should result in an improved bonding of a pit and fissure sealant.

혈소판 풍부혈장의 임상적 응용

하정완,김수관,조세인,이철우,정태영,김수흥,김영균 대한악안면성형재건외과학회 2001 Maxillofacial Plastic Reconstructive Surgery Vol.23 No.5

Platelet-rich plasma is an autologous source of platelet-derived growth factor and transforming growth factor beta that is obtained by sequestering and concentrating platelets by gradient density centrifugation. We have used platelet-rich plasma for bone graft, especially allobone graft, at implant surgery, sinus lift procedure, and cyst enucleation. This article is retrospective study from October 1999 to November 2000. All cases were good healing and clinical success.

허혈심근에서의 퓨린성 및 콜린성 작동제의 심근보호 작용

김재하,박상덕,주정민,국현,조정관,박옥규 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.7

Atrial Fibrillation in Patients with Permanent VVI Pacemakers: Risk Factors for Atrial Fibrillation

( Jeong Gwan Cho ),( Yang Ho Jeong ),( In Jong Cho ),( Young Geun Ahn ),( Kwang Soo Cha ),( Jeong Pyeong Seo ),( Joo Hyung Park ),( Myung Ho Jeong ),( Jong Chun Park ),( Jung Chaee Kang ) 대한내과학회 1997 The Korean Journal of Internal Medicine Vol.12 No.1

Diagnostic Value of Nitroglycerin-Induced Headache as a Negative Predictor of Coronary Atherosclerosis

Cho, Sook Hee,Jeong, Myung Ho,Sim, Doo Sun,Hong, Young Joon,Park, Hyung Wook,Kim, Ju Han,Ahn, Youngkeun,Cho, Jeong Gwan,Park, Jong Chun,Kang, Jung Chaee Chonnam National University Medical School 2011 CMJ Vol.47 No.1

<P>The purpose of the present study was to clarify the possible relationship between nitroglycerin (NTG)-induced headache and both vascular functional and organic atherosclerosis. The study included 96 patients with NTG-induced headache (group I: 54.7±9.5 years, 52 males) and 204 patients without headache (group II: 58.1±9.1 years, 127 males) who suffered from new-onset chest pain. Flow-mediated dilation and nitroglycerin-mediated dilation were significantly greater in group I than in group II (8.8±4.1% vs. 7.1±3.5%, p=0.001, and 23.1±7.3% vs. 17.1±11.8%, p<0.001, respectively). The carotid intima-media thickness was significantly smaller in group I than in group II (0.55±0.15 mm vs. 0.67±0.22 mm, p=0.001). Heart-carotid pulse wave velocity was significantly lower in group I than in group II (784.5±160.1 m/s vs. 979.1±215.6 m/s, p=0.003). In the multiple regression analysis, the absence of NTG-induced headache was a predictor of coronary artery disease (CAD) (odds ratio: 17.89, 95% confidence interval: 7.89-40.02, p<0.001). NTG-induced headache developed more frequently in patients with normal coronary arteries or minimal CAD than in patients with obstructive CAD. The presence of NTG-induced headache might be helpful and provide additional information in evaluating patients with chest pain syndrome.</P>

High Lipoprotein(a) Levels are Associated With Long-Term Adverse Outcomes in Acute Myocardial Infarction Patients in High Killip Classes

Cho, Jae Yeong,Jeong, Myung Ho,Ahn, Youngkeun,Hong, Young Joon,Park, Hyung Wook,Yoon, Nam Sik,Yoon, Hyun Ju,Kim, Kye Hun,Kim, Ju Han,Cho, Jeong Gwan,Park, Jong Chun,Kang, Jung Chaee The Korean Society of Cardiology 2010 Korean Circulation Journal Vol.40 No.10

<P><B>Background and Objectives</B></P><P>An elevated concentration of lipoprotein(a) {Lp(a)} is associated with an increased prevalence and increased severity of coronary artery disease. However, the relationship between Lp(a) levels and outcomes after acute myocardial infarction (AMI) is unclear.</P><P><B>Subjects and Methods</B></P><P>Between October 2005 and June 2007, we measured serum Lp(a) levels in 832 consecutive AMI patients (age, 62.8±12.4 years, 600 men) on admission. They were divided into tertiles according to their serum Lp(a) levels {Tertile 1 (n=276), Lp(a)<13.8 mg/dL; Tertile 2 (n=279), Lp(a)=13.8-30.6 mg/dL; Tertile 3 (n=277), Lp(a)>30.6 mg/dL}.</P><P><B>Results</B></P><P>There were no differences in baseline clinical characteristics among Tertiles 1, 2, and 3, except for proportions of Killip class III-IV patients (5.8% vs. 10.0% vs. 18.8%, respectively, p<0.001). There were significant differences in left ventricular ejection fractions (57.3±11.4% vs. 55.9±12.3% vs. 53.1±13.1%, p<0.001). Among the laboratory findings, there were significant differences in total cholesterol (173.3±37.2 vs. 183.5±38.9 vs. 185.3±43.8 mg/dL, p=0.001), low density lipoprotein-cholesterol (111.3±34.3 vs. 122.9±34.7 vs. 123.3±39.4 mg/dL, p<0.001), apolipoprotein B (92.8±25.4 vs. 100.8±26.0 vs. 101.9±28.8 mg/dL, p<0.001), and amino-terminal pro-brain natriuretic peptide levels (1805.2±4343.3 vs. 2607.9±5216.3 vs. 3981.5±7689.7 pg/mL, p<0.001). After adjusting for multiple variables in the high Killip class (III-IV) subgroup, the risk estimate for major adverse cardiovascular events (MACE) at 1-year follow-up was significantly higher in Tertile 3 than in Tertiles 1 or 2 (hazard ratio 6.723, 95% confidence interval 1.037-43.593, p=0.046).</P><P><B>Conclusion</B></P><P>In patients in high Killip classes, high serum levels of Lp(a) were significantly associated with long-term adverse outcomes after AMI.</P>

심실상성 빈맥의 기전 규명에 있어서 심전기생리학적 지표인 △VACT와 VACT Ratio 의 가치

조정관(Jeong Gwan Cho),박상진(Sang Jin Park),류제영(Jay Young Rhew),배열(Youl Bae),김성희(Sung Hee Kim),김준우(Jun Woo Kim),김주한(Ju Han Kim),길광채(Gwang Chae Gill),박주형(Joo Hyung Park),정명호(Myung Ho Jeong),박종춘(Jong Chun Pa 대한내과학회 1996 대한내과학회지 Vol.51 No.2

N/A Background: Electrophysiologic methods useful in determining the mechanism of paroxysmal supra- ventricular tachycardia (PSVT) accurately and easily have been continuously studied. Most studies were focused on the development of a method to differentiate AVNRT and AVRT using the septal atrioventricular bypass tract, since these two tachycardias are very difficult to differentiate even with electrophysiologic study (EPS). Several methods previously reported have some limitation in accuracy and/or applicability, Objectives: The purpose of this study is to develop a new electrophysiologic parameter by evaluating the usefulness of the difference (△VACT) and ratio(VACT ratio) of VA conduction time (VACT) during right ventricular pacing at the cycle length of supraventricular tachycardia (SVT) in determining the mechanism of SVT and localizing accessory pathways (AP) in AVBT. Methods: Total of 94 SVT patients undergoing EPS and radiofrequency (RF) catheter ablation for 35 AVNRT (17 male, 18 female; mean age 45.6±17.2 years) and 59 AVRT (36 male, 23 female; mean age 37.5 ±15.3 years) were included in this study, The electrophysiologic mechanism of SVT and the location of APs in A VRT were confirmed by RF catheter ablation in all the patients. AVNRT was typical form in 34 patients and atypical (slow-slow) form in one. Among 59 APs, 19 (32.2%) APs were right side (12: free wall, RFW group; 7: septum, SPT group), 40 (67.8%) APs were left side (37: free wall, LFW group; 3: septum, SPT group), EPS was performed using the standard technique. 6F multipolar electrode catheters were positioned at the high right atrium (HBA), atrioventricular junction (HIS), right ventricular apex (RVA) in all the patients, and coronary sinus if needed. SVT was induced in all the patients with programmed electrical stimulation. VA conduction time (VACT) was measured from the onset of QRS complex to the onset of atrial electrogram from the HRA during SVT (VACT-SVT) and during RVA pacing at the SVT cycle length (VACT-RVP). △VACT was calculated by subtracting VACT-SVT from VACT- RVP and VACT ratio by dividing VACT-RVP by VACT-SVT. AVNRT and AVRT were differentiated using the previously reported criteria and then RF catheter ablation was performed. RF was delivered at the target site through a 7F 4 mm-tipped deflectable ablation catheter using continuous unmodulated sine wave with 350 KHz or 500 KHz generated from RF generator (RFG-3B, Radionics, Burlington, Mass or HAT 200S, Osypka, Germany). Results: The preexcitation index (PI) could be measured with a single ventricular extrastimulus in 22 (62.9%) of 35 AVNRT patients and 49 (83.1%) of 59 AVRT patients. PI was 139±31 (range 90-200) in AVNRT, 30±11 (range 15-40) in RFW group, 29 20 (range 10-70) in SPT group, and 92±24 (range 55- 160) in LFW group, showing a significant difference between each groups, but considerable overlap (52.6% of 76) between each groups except between AVNRT and AVRT with right side AP, DVACT was 126±20 (range 76-168) ms in AVNRT, 179 (range 4-35) ms in RFW group, 29 ±25 (5-76) ms in SPT group, 79±16 (50-110) ms in LFW group, showing a significant difference between AVNBT and 3 groups of AVRT and between 3 groups of AVRT except between RFW group and SPT group (p<0.01). The frequency of the patients with overlap in AVACT was lower than that in PI(52.6% vs. 24.5%, p<0.05). △VACT with a cut-off value of 50 ms differentiated the sideness (right vs. left) of APs in 58 (98.3%) of 59 AVRT patients, VACT ratio was 3.671.22 (range 2.20-8.30) in AVNRT, 1.10,1 (range 1.03-1.29) in RFW group, 120.2 (range 1.03-1.29) in SPT group, and 1.5±0.1 (range 1.30-1,86) in LFW group, showing no overlap between AVNRT and AVRT. AVNRT and AVRT were completely differentiated with VACT ratio with a cut-off value of 2.0. Conclusion : It is concluded that the mechanism of SVT may be accurately differentiated into AVNRT or AVRT using VACT ratio with a cut-off value of 2.0 and the location of accessory pathwa

관동맥질환의 진단에 있어서 Exercise Treadmill Score 의 의의

서정평(Jeong Pyeong Seo),조인종(In Jong Cho),류문희(Mun Hee Rheu),박종수(Jong Soo Park),이명곤(Myung Kon Lee),정명호(Myung Ho Jeong),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),강정채(Jung Chaee Kang) 대한내과학회 1997 대한내과학회지 Vol.52 No.3

N/A Objectives: The treadmill exercise eletrocardiography(ECG) is the most commonly used non- invasive method in the evaluation of patients with chest pain. But the accuracy of treadmill exercise ECG in detecting the coronary artery disease(CAD) is still controversial. To improve the accuracy of the treadmill exercise test, exercise treadmill score(ETS) based on exercise duration, degree of ST deviation, and treadmill anginal index during treadmill exercise ECG has been used. Methods: The authors calculated ETS by simple equation(total exercise duration-5×maximal ST- segment deviation during or after exercise-4×treadmill angina index) and analyzed coronary angiograms of 173 patients(mean age '55.5±8.7, male: female=2.7: 1) who underwent treadmill exercise ECG and coronary angiography in Chonnam University Hospital from January, 1990 through March, 1993. Results. 1) The studied subjects were subdivided into 3groups according to ETS. Group A(high risk, ETS≤11) were composed of 15cases(mean age 60.2±7.4, male: female = 1.2: 1), group B(moderate risk, 5>ETS≥11) 71cases(mean age 60.2±7.4, male: female=3.3:1), group C(low risk, ETS>5) 87cases(mean age 54.8±9.2, male-female =2.5:1). Clinical diagnoses of the studiedsubjects were 63stable angina, 61unstable angina, 3acute myocardial infarction, and 46 old myocardial infarction. On coronary angiographic findings, 61patients had single vessel disesase, 23patients had two vessel disease and 13patients had three vessel disease. 2) The sensitivity of the treadmill exercise ECG in diagnosing coronary artery disease was 88% and the specificity was 46%. 3) One hundred percent of group A patients had CAD and 54% of them had multivessel disease, 75% of group B had CAD and 27% of them had multivessel disease, and 33% of group C had CAD and 10% of them had multivessel disease. 4) There were no significant differences in the siite of stenotic lesion and degree of stenosis according to ETS in the patients with single vessel disease. 5) There were no significant differences in left ventricular ejection fraction and left ventricular end-diastolic pressure among three groups. Conclusion: Exercise treadmill score is useful in predicting the presence and severity of CAD and that low ETS less than -11 may be an indicator of multivessel coronary disease.

영구형 심박조율기 시술에 대한 임상경험

조정관(Jeong Gwan Cho),정명호(Myung Ho Jeong),박종춘(Jong Chun Park),양승진(Seung Jin Yang),박찬형(Chan Hyung Park),길광채(Gwang Chae Gill),조길우(Keal Woo Cho),강정채(Jung Chaee Kang) 대한내과학회 1989 대한내과학회지 Vol.37 No.1

N/A Pacemaker implantation for symptomatic bradycardia is becoming popular recently in this country. Though its clinical benefit has been documented clearly there are still a lot of clinical problems arising from surgical problems, implanting techniques and pacemaker inherited problems. This study was designed to evaluate the indications, clinical manifestations and complications of 62 implantation procedures in 55 patients who had undergone the implantation procedure in Chonnam University Hospital by reviewing the pertinent clinical records. From 1983 to 1988, 62 implantation procedures in 55 patients (19 men and 36 women) were carried out. Annual numbers of implantation had been increasing, with 5 cases in the beginning year up to 20 cases in 1987, the numbers increased. The most common age was the fifties and patients older than fifty years comprised 74.5% of the total. The main symptoms which brought the 52 patients who underwent the first implantation to the hospital were syncope in 26, dyspnea in 14, dizziness in 9, shock in 2, and nonspecific in l. Electrocardiographic manifestations of the patients were atrioventricular block in 32 (58.2%, 28 complete AV blocks, 3 type II 2nd AV blocks, and one trifascicular block) and sick sinus syndrome in 23 patients (41.8%, 10 sinus arrests, 9 sinus bradycardias, 3 tachy-bradycardias, and one second degree SA block). Associated diseases were hypertension in 20, coronary artery disease in 7, cerebral infarction in 4, surgical correction of VSD in 2, dilated cardiomyopathy in 2, diabetes mellitus in 2, thyrotoxicosis in l, and liver cirrhosis in 1 patient. But, abaut one fourth of the patients had no associated disease. The systems implanted were all ventricular demand pacing system, among which 41 (70%) were multi-programmable. Pacing leads were introduced via the cephalic vein in most of the cases and via the external jugular vein in some cases. At implantation the pacing threshold was 0.67±0.25 volts (M±SD), electrode impedance 1258±266 ohm (M±SD), and intracardiac R wave amplitude 10.3±9.7 mvolts (M±SD). The causes of revision due to complications were 2 chronic exit blocks, 2 erosions of the generator or lead, one preerosion followed by infection after a revision, one generator pocket abscess shortly after an implantation, one power depletion, and 3 occasions of twiddler's syndrome in a patient. Other complications which were controllable without revision of the system were one indifferent electrode skeletal muscle pacing treated by reprograming the output, chronic increase of threshold in another 2, pacemaker syndrome in one treated by reprograming, and a hematoma in the generator pocket resolved by needle aspiration. We learned from this review that although pacemaker implantation has been helpful in the majority of the patients treated, same annoying and potentially life threatening complications warranted, and efforts to prevent or detect them early are necessary mention.