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- 저자 : 고진신 ( Jin Sin Koh ) (검색결과 4 건)
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증례 : 순환기 ; 심부전 환자에서 발생한 반복적인 자발성 저혈당과 의식저하 1예
김계환 ( Kye Hwan Kim ),김완철 ( Wan Chul Kim ),이은주 ( Eun Ju Lee ),고진신 ( Jin Sin Koh ),박정랑 ( Jeong Rang Park ),함종렬 ( Jong Ryeal Hahm ),황진용 ( Jin Yong Hwang ) 대한내과학회 2014 대한내과학회지 Vol.87 No.2
저자들은 반복적인 저혈당에 의한 의식저하를 주소로 내원한 심부전 환자로 수술적 치료 이후 1년간 저혈당 및 심부전 악화 없이 외래 경과관찰 중인 환자 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Hypoglycemia in adults without diabetes can be caused by drugs, critical illness, hormone deficiency, and hyperinsulinism. Spontaneous hypoglycemia in congestive heart failure has been reported rarely in adults. We report a case of spontaneous hypoglycemia in congestive heart failure in a 73-year-old woman with mitral stenosis and atrial fibrillation who had been receiving treatment for 6 years. She had two episodes of low serum glucose with unconsciousness, but there was no evidence of diabetes. Heart failure with concomitant hepatic dysfunction was presumed to have caused the hypoglycemia. She underwent mitral valve replacement after being diagnosed with severe mitral stenosis. There was no episode of hypoglycemia during follow-up. (Korean J Med 2014;87:205-208)
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민지현 ( Ji Hyun Min ),안종화 ( Jong Hwa Ahn ),이정미 ( Jeong Mi Lee ),박정랑 ( Jeong Rang Park ),고진신 ( Jin Sin Koh ),황진용 ( Jin Yong Hwang ),곽충환 ( Choong Hwan Kwak ) 대한내과학회 2013 대한내과학회지 Vol.84 No.2
MELAS 증후군은 비교적 드문 질환으로 비후성 심근증, WPW 증후군, 심장전도장애 등의 심장 관련 증상이 발생할 수 있다. 동기능 이상과 동반된 MELAS 증후군은 거의 알려 진바 없어, 실신을 동반한 동정지로 영구형 심박동기 시술을 시행한 MELAS 증후군 환자 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. A 35-year-old male patient with heart and renal failure and pneumonia was transferred to our department due to recurrent cardiac standstill with syncope. He had been diagnosed as and treated for MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes) syndrome for the past 3 years. Electrocardiography (ECG) showed the Wolff-Parkinson-White pattern, and an echocardiogram showed hypertrophic cardiomyopathy. He developed syncopal attacks intermittently, and ECG monitoring showed intermittent bradycardia. His Holter monitoring showed several episodes of 5-16 seconds of sinus arrest. We conducted an electrophysiological study to evaluate the arrhythmia. During atrial and ventricular extra-stimuli, cardiac standstill developed several times, and the duration of pauses varied from 2.5 to 5.5 seconds. Abrupt asystolic events also developed accompanying syncopal attacks that were not related to the extra-stimuli. We decided to implant a permanent pacemaker. The patient`s syncopal episodes disappeared after implantation of a DDD type pacemaker. (Korean J Med 2013;84:265-268)
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관상동맥 중재술을 받은 환자에서 실로스타졸 사용 후 동맥경직도의 변화
조상영 ( Sang Young Cho ),김계환 ( Kye Hwan Kim ),안종화 ( Jong Hwa Ahn ),강영란 ( Young Ran Kang ),고진신 ( Jin Sin Koh ),황석재 ( Seok Jae Hwang ),박용휘 ( Yongwhi Park ),정영훈 ( Young Hoon Jeong ),곽충환 ( Choong Hwan Kwak 대한내과학회 2015 대한내과학회지 Vol.89 No.3
Background/Aims: Increased arterial stiffness is a well-known risk factor for cardiovascular disease. Cilostazol, a phosphodiesterase type 3 inhibitor, is a unique antiplatelet agent with vasodilatory and vasoprotective effects. Therefore, we hypothesized that cilostazol may affect arterial stiffness. Methods: We enrolled 161 patients (112 males; mean age, 63 years) who had undergone percutaneous coronary intervention (PCI) for ischemic heart disease. The brachial-ankle pulse wave velocity (baPWV), radial augmentation index (rAI), rAI adjusted for a heart rate of 75 beats/min (rAI75), central systolic blood pressure (cSBP), and central pulse pressure (cPP), were measured at baseline and at the 30-day follow-up. Parameter changes were compared between the cilostazol group (n = 51) and the control group (n = 110). Results: In the cilostazol group, the values for rAI, cSBP, and cPP all improved after 30 days, while the control group displayed no significant interval changes in these parameters. The changes in rAI75 and baPWV did not differ significantly between the two groups. The changes in rAI, cSBP, and cPP were related to brachial systolic blood pressure, brachial diastolic blood pressure, heart rate, and the use of cilostazol and beta-blockers. In a multivariate analysis, the use of cilostazol was identified an independent factor associated with changes in rAI, cSBP, and cPP. Conclusions: The addition of cilostazol to conventional antiplatelet therapy in patients undergoing PCI may be associated with improvements in rAI, cSBP, and cPP, but not in rAI75 or baPWV. Therefore, the effects of cilostazol might be related to an increased heart rate. (Korean J Med 2015;89:295-304)
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관상동맥 컴퓨터 단층 촬영술과 운동부하 심전도 검사의 실제임상에서의 검사 정확도 비교
윤성은 ( Seong Eun Yun ),강영란 ( Young Ran Kang ),김계환 ( Kye Hwan Kim ),최영민 ( Young Min Choi ),최정우 ( Jung Woo Choi ),고진신 ( Jin Sin Koh ),박정랑 ( Jeong Rang Park ),박용휘 ( Yong Whi Park ),황석재 ( Seok Jae Hwang ) 대한내과학회 2014 대한내과학회지 Vol.87 No.2
목적: 운동부하 심전도 검사(XECG)와 관상동맥 컴퓨터단층 촬영술(CTCA)은 현재 임상에서 관상동맥 질환의 초기 진단법으로 널리 사용하고 있다. 본 연구는 CTCA와 XECG를 동시에 시행한 환자에서 각 검사의 결과에 따른 고식적 관상동맥 조영술(CCA) 및 재관류시술(RT)의 시행률을 관찰하였고 CCA가 진행된 환자에서 각 검사의 진단능을 비교 분석하여 선별 검사에서 각 검사의 역할과 제한점을 비교하고자 하였다. 방법: 2006년 1월부터 20010년 3월까지 경상대학교병원 외래에서 관상동맥 질환을 평가하기 위해 CTCA와 XECG 검사를 같이 시행한 환자 598명의 임상자료들을 후향적으로 분석하였다. 결과: 전체 589명 중 107명(19%)에서 보다 정확한 검사 및 RT를 위해 CCA가 진행되었으며 77명(12.8%) 환자에서 한 가지 이상의 혈관에서 의미 있는 협착(≥ 50%)이 발견되었고, 65명(11%)의 환자에서 RT이 시행되었다. CTCA에서 의미 있는 협착(≥ 50%)을 보인 120명에서는 RT/CCA가 58(48%)/75 (62%)명에서 시행되었지만, XECG에서 양성을 보인 115명 중 RT/CCA 23 (20%)/41 (35%)명에서 시행되었다(p <0.05). 정상 CTCA를 보인 302명 중에는 RT/CCA가 1 (0.8%)/6 (5%)명에서 진행된 반면, XECG 음성이었던 413명 중 RT/CCA가 27 (6.5%)/51 (12%)명에서 진행되었다(p < 0.05). XECG 에서 진단이 불가능한 환자가 CTCA보다 많았다(11.7% vs. 5%, p < 0.05). CCA로 진행되었던 107명에서 의미 있는 관상동맥협착(≥ 50%)의 CTCA와 XECG의 민감도 89.9%, 50.0%, 특이도 74.0%, 67.9%, 양성예측도 90.6%, 78.0% 및 음성예측도 71.4%, 37.3%로 CTCA의 진단율이 더 우수하였다. CCA와 CTCA진단의 일치율은 0.62로 통계적인 의미가 있었으나(p< 0.001), CCA와 XECG의 일치율은 0.145로 통계적으로 유의하지 않았다(p = 0.113). 결론: 비교적 적은 위험도를 가진 환자에서 관상동맥 질환의 선별 검사로 CTCA의 결과를 XECG보다 더 신뢰하여 임상경로를 결정하고 있었으며 실제 진단율이 CTCA가 XECG보다 우수하였다. Background/Aims: The exercise ECG test (XECG) and computed tomography coronary angiography (CTCA) have been used widely in initial evaluations of coronary artery disease (CAD) in real-world practice. In this study, we compared the diagnostic power of CTCA and XECG, based on conventional coronary angiography (CCA). Methods: We enrolled 589 consecutive patients retrospectively who had been examined with both XECG and CTCA for the evaluation of CAD in outpatient clinics. Significant stenosis was defined as more than 50% diameter stenosis. Triage to CCA and/or revascularization treatment (RT) by the results of XECG and CTCA and the diagnostic accuracy of both exams, based on CCA, were investigated. Results: In the 589 patients, 107 (19%) were triaged to CCA for further evaluation; in 77 (12.8%) significant stenosis was detected on CCA. Also, 65 (11%) patients underwent RT. In the CTCA results, 120 patients had significant stenosis. Of them, 58 (48%) and 75 (62%) patients were triaged to RT and CCA, respectively. Based on the XECG, 115 positive patients were triaged to RT and CCA (23 [20%]/41 [35%]). Among 107 patients with CCA, the sensitivity, specificity, positive predictive value, and negativ e predictive value for significant stenosis on CCA of CTCA were 89.9%, 74.0%, 90.6%, and 71.4%, respectively, and those of XECG were 50.0, 67.9, 78.0, and 37.3, respectively. The kappa value of CCA and CTCA was 0.62 (p < 0.001) and that of CCA and XECG was 0.145 (p = 0.113). Conclusions: In real-world practice, CCA was decided on more frequently, based on CTCA. CTCA showed better diagnostic accuracy than XECG. (Korean J Med 2014;87:165-172)
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