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관동맥 연축환자의 약물투여기간 및 질병의 활성도에 대한 장기 추적 관찰
김철홍(Cheol Hong Kim),유규형(Kyu Hyung Ryu),한성우(Seong Woo Han),박규용(Kyu Yong Park),한윤창(Yun Chang Han),홍경순(Kyung Soon Hong),두영철(Young Cheoul Doo),한규록(Kyu Rok Han),오동진(Dong Jin Oh),임종윤(Chong Yun Rim),고영박(Youn 대한내과학회 1998 대한내과학회지 Vol.54 No.1
N/A Objectives: Clinical course of vasospastic angina is variable : spontaneous remission, persistent angina and progression of disease or death. Several studies from western institutes have been performed on the clinical characteristics and long-term prognosis of patient with coronary vasospasm. In these reports, 53-82% of patients had spontaneous remission. These results may be assumed differ from that of Korean patients with vasospastic angina, but no detailed studies have been reported in Korea. Currently, in patients with vasospastic angina, treatment with calcium antagonists and/or nitrates are effective in reducing the frequency of anginal attacks. And, clinical course and outcome of vasospastic angina may be different from previous western reports thereafter. The purpose of this study is to describe the disease activities and the factors influencing the clinical course of vasospastic angina in relation to medication-period; age, sex, risk factors, extents of coronary vasospasm, initial ischemic events and significance of fixed lesion. Also we tried to determine if clinical or angiographic variables might be useful in predicting the possibility of spontaneous remission for an each patient. Methods: Eighty-seven patients with vasospastic angina(M/F;58/29, mean age;53±9 years) were included and all documented coronary vasospasm on the coronary angiogram, spontaneous spasm in 35, positive ergonovine or acetylchoine provocation in 52. Coronary artery spasm was defined as more than 75% reduction in coronary luminal diameter and ST segment changes on electrocardiogram, or typical anginal symptoms together and then narrowed coronary arteries were recovered after intracoronary nitroglycerin. The patients were treated with calcium antagonists(nifedipine, diltiazem, amlodipine and felodipine) and nitrates single or both and were divided into 3 groups according to angina activity: group I, which anginal attacks less than one time monthly, group II, which anginal symptoms occurred in 24- 48 hours after withdrawal of medication, group III, which symptoms recurred frequently with the incidence of over one time weekly, After discharge, each patient returned to a medical out-patient department at every 1-2 months. Results: Age, gender, other coronary risk factors, disease activity of vasospastic angina, initial clinical presentation at admission, coronary angiographic findings, fixed lesion and alcohol-induced anginal attacks were not statistically different among the 3 groups. But admission frequency of group II and III, which had a high anginal activities, were more than that of group I significantly. Conclusion: In the present study, it is concluded that medical treatment in patients with vasospastic angina in Korea may be taken long duration during follow-up period if the patient of group II and III considered to persistent angina group. To assess the prevalence of spontaneous remission, we consider that systematic attempts to taper medication may be done for patient of group I(angina free-on treatment) after absence of anginal attacks for at least one year medication-period.
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박성우,박정식,신형식,지제근,장연복,이일준,장웅기,고영박,황도윤 대한내과학회 1988 대한내과학회지 Vol.34 No.2
The is a case report of the metastatic adenocarcinoma in the pituitary gland, of which the primary site is not identified. The predilection of metastatic carcinoma for the posterior hypophysis may be due to the fact that the neural protion has a blood supply directly from the systemic circulation, while the anterior lobe does not. The clinical manifestations are polyuria, polydipsia, indicating insufficiency in the posterior lobe of the pituitary, but the function of the anterior pituitary gland is preserved. The clinical diagnosis has been made by C.T. scan of brain, but it is difficult to differentiate from the pituitary tumor. the diagnosis was confirmed by surgical biopsy of the pituitary gland and it revealed the metastatic adenocarcinoma from unknown site.
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이춘일,김정완,길현교,장연복,박정식,박성우,김병태,최문기,고영박,선덕재 대한내과학회 1990 대한내과학회지 Vol.38 No.3
Heat stroke is a medical emergency and the most important environmental heat illness. It is a disease of high fever, dry warm skin without sweating, and mental disturbances. It commonly involves several organs including the liver, kidney, heart, brain, and the coagulation system. Recently, we experienced 10 cases of heat stroke. The clinical findings of those were as follows: 1) At the time of admission, body temperature in all patients were higher than 39.4℃, and especially in 4 cases, higher than 41.4℃ : pulse rates in all patients were more than 140/min: and systolic blood pressure were less than 100 ㎜Hg except in one case. 2) The clinical manifestations were CNS symptoms including 6 cases of coma, variable skin lesions, G-I hemorrhage, muscle swelling with tenderness and oliguria. 3) On blood chemistry, there were markedly decreased levels of protein, albumin and calcium: markedly inceased level of SGOT, SGPT, CPK, LDH, BUN, and creatinine: one case of hypokalemia and two cases of hyperkalemia: and 4 cases of hyperbilirubinemia greater than 2㎎/㎗. 4) Two cases of myoglobinuria, 3 cases of proteinuria nd 1 cases of hematuria were observed. 5) Complications, such as uremia, ventricular tachycardia, D.I.C., pulmonary edema, pleural effusion, jaundice and acute pancreatitis were observed. 6) Four cases out of 10 were died. The causes of death were pulmonary edema, cerebral edema, D.I.C., hepatic failure and cardiac failure.
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