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남창욱 ( Chang Wook Nam ) 대한내과학회 2011 대한내과학회지 Vol.81 No.6
To get the best clinical outcome after revascularization, understanding of patient and lesion should proceed. Although coronary angiography has been regarded as the gold standard for assessing coronary artery disease for several decades, it has several well-known limitations. Fractional flow reserve (FFR), measured with a coronary pressure wire, is an accurate and lesion-specific index for determining the functional significance (myocardial ischemia) of a particular stenosis. The selection of target vessels, the decision and method for revascularization, and the determination of prognosis in patients with CAD can be helped by FFR in daily practice. In this manuscript, we will review the role of pressure wire and discuss the limitation of it in evaluating CAD. (Korean J Med 2011;81:708-715)
심인성쇼크로 관상동맥 중재술 중 대동맥 내 풍선펌프 사용 시 임상 경과
이재필 ( Jae Pil Lee ),남창욱 ( Chang Wook Nam ),박정호 ( Jung Ho Park ),배종엽 ( Jong Yop Bae ),김인철 ( In Cheol Kim ),조윤경 ( Yun Kyeong Cho ),박형섭 ( Hyoung Sub Park ),윤혁준 ( Hyuck Jun Yoon ),김형섭 ( Hyungseop Kim ),허승 대한내과학회 2015 대한내과학회지 Vol.89 No.2
Background/Aims: The mortality of hospitalized patients undergoing treatment with an intra-aortic balloon pump (IABP) due to cardiogenic shock is well known as quite high. The aim of this study was to evaluate the outcome of percutaneous coronary intervention (PCI) with an IABP in patients with acute coronary syndrome (ACS) and cardiogenic shock and identify the predictors of in-hospital mortality. Methods: 134 patients who underwent PCI with IABP due to ACS complicated by cardiogenic shock were consecutively enrolled. Outcomes were obtained and analyzed during hospitalization and after 1 year. Results: The incidence of all-cause mortality was 35.8% (in-hospital mortality, 34.3%, 1-year mortality, 1.5%). The nonsurvival group exhibited higher peak levels of creatine kinase MB, lower ejection fractions, and higher incidences of ST elevation myocardial infarction, ventricular arrhythmia, and use of an assistive device than did the survival group. Aging (hazard ratio 2.839, 95% confidence interval 1.408-5.723, p = 0.004), the use of a temporary pacemaker (2.035, 1.114-3.720, 0.021), the use of a mechanical ventilator (4.376, 1.852-10.341, 0.001), and the performance of cardiopulmonary resuscitation (CPR) (2.219, 1.017-4.839, 0.045) were independent predictors for in-hospital mortality. However, out-of-hospital mortality among in-hospital survivors was not affected by predictors of in-hospital mortality. Conclusions: The incidence of in-hospital mortality was high, as expected in patients undergoing PCI with IABP due to ACS with cardiogenic shock. Aging, CPR, and additional procedures such as pacemaker use and mechanical ventilation were predictors of in-hospital mortality. However, the patients who were successfully discharged after the complex procedure showed acceptable 1-year outcomes. (Korean J Med 2015,89:186-191)
진통 소염제를 사용한 환자에서 발견된 대동맥 식도 누공의 1예
조현옥 ( Hyun Ok Cho ),김권배 ( Kwon Bae Kim ),남창욱 ( Chang Wook Nam ),김형섭 ( Hyung Seop Kim ),한성욱 ( Seong Wook Han ),허승호 ( Seung Ho Hur ),김윤년 ( Yoon Nyun Kim ) 대한내과학회 2008 대한내과학회지 Vol.75 No.4
대동맥 식도 누공은 치명적인 상부 위장관 출혈을 일으키는 매우 드문 질환이다. 대동맥 식도 누공의 원인으로는 흉부 대동맥류와 관련된 대동맥 식도 누공이 가장 많은 것으로 알려져 있다. 저자들은 수일간의 항염증 소염제를 복용한 후 토혈을 주소로 내원한 83세 남자 환자에서 상부 위장관 내시경을 시행하여 식도에 출혈소견을 동반한 접촉 궤양과 박동성 종괴를 발견하였으며, 흉부 전산화 단층 촬영을 시행하여 흉부 대동맥류에 의한 대동맥 식도 누공을 진단하였고, 과거와는 달리 시술과 관련성 없이 약제에 의한 식도 궤양이 흉부 대동맥류와 동반되어 발생된 드문 예이므로 보고하는 바이다. 고혈압, 심혈관계의 질환 등의 흉부 대동맥류 발생의 고위험군에서 토혈이 발생하였을 시 빈도는 낮지만 사망률이 높은 대동맥 식도 누공을 반드시 감별 진단하여야 하겠다. Aortoesophageal fistula secondary to thoracic aortic aneurysm is an uncommon cause of gastrointestinal bleeding and is uniformly fatal without surgical intervention. We report a case of aortoesophageal fistula in an 83-year-old male who presented with massive hematemesis after 4 days of NSAID use. Endoscopy showed a kissing esophageal ulcer with a pulsating mass lesion in the mid esophagus. HRCT showed a fusiform aortic aneurysm in the descending aorta that was affecting the mid esophagus. (Korean J Med 75:471-474, 2008)
신이철(Yi Chul Synn),김기식(Kee Sik Kim),배장호(Jang Ho Bae),한성욱(Seong Wook Han),박소영(So Young Park),남창욱(Chang Wook Nam),김기영(Ki Young Kim),김윤년(Yoon Nyun Kim),김권배(Kwon Bae Kim),김여희(You Hee Kim) 대한내과학회 2000 대한내과학회지 Vol.58 No.1
N/A Background : Exercise and pharmacologic stress echocardiography are widely used for detecting coronary artery disease. Arbutamine is a new synthetic mild α1-receptor and - receptor agonist developed specifically for stress echocardiography. Arbutamine is superior to dobutamine owing to its enforced chronotropic action than that of dobutamine. We intended to know safety and efficacy of arbutamine stress echocardiography in inducing myocardial ischemia and detecting coronary artery disease. Methods : We underwent arbutamine stress echocardiography on 52 patients, dobutamine stress echocardiography in 35 patients. Alteration of blood pressure, heart rate, regional wall motion on echocardiography were evaluated. Sensitivity and specificity were determined by coronary angiography for 61 patients(Arbutamine: 31, Dobutamine : 30) Results : 1) Hemodynamic alterations respect to stress agents Baseline Maximal Baseline Maximal Interval for Blood pressure Blood pressure Heartrate Heart rate maximal heartrate Arbutamine 122/70mmHg 138/72mmHg 69BPM 137BPM 8.2 min* Dobutamine 126/73mmHg 136/77mmHg 74BPM 102BPM 11.4 min* (* p < 0.05) 2) Comparison of Arbutamine and Dobutamine in sensitivity Sensitivity(Specificity) Side effects Atropine Arbutamine 80.1% (90%) 33(63.5%) 8(15.4%) Dobutamine 78.2% (71.4%) 21(60%) 7(20%) 3) Side effects of stress agents Hypotension Palpitation, tremor Arrhythmia Chest pain Arbutamine 15(28.8%)* 4(7.7%)* 21(40.4%) 8(9.2%) Dobutamine 3(8.6%)* 9(25.7%)* 12(34.3%) 5(5.7%) (* p < 0.05) 4) Premature ventricular contraction was most common arrhythmia in both group. There was no fatal or significant complication, and most complications were subsided after discontinuation of stress agents. Conclusion : Arbutamine is an effective and safe pharmacologic stress agent in detecting myocardial ischemia and superior to dobutamine in increasing heart rate. Sensitivity and specificity of arbutamine were higher than that of dobutamine.(Korean J Med 58:39-47, 2000)
증례 : 혈관 내 초음파 후퇴 중 발생한 스텐트 변형을 성공적으로 시술한 1예
조현옥 ( Hyun Ok Cho ),조윤경 ( Yun Kyeong Cho ),윤혁준 ( Hyuck Jun Yoon ),김형섭 ( Hyung Seop Kim ),남창욱 ( Chang Wook Nam ),허승호 ( Seung Ho Hur ),김권배 ( Kwon Bae Kim ) 대한내과학회 2013 대한내과학회지 Vol.84 No.2
관상동맥 중재술을 하는 과정에서의 혈관 내 초음파의 역할이 중요해지면서 그 이용빈도 또한 높아졌고 따라서 이의 사용에 따른 합병증도 간간이 보고되고 있다. 저자들은 스텐트를 좌전하행지에 삽입한 이후 그 부착 정도를 파악하고자 혈관 내 초음파를 시행하였고 이를 혈관으로부터 제거하는 과정에서 발생한 스텐트의 변형을 새로운 혈관 내 초음파를 통하여 확인하고 여기에 또 하나의 스텐트를 추가 삽입함으로써 좋은 결과를 얻었기에 이를 보고하는 바이다. Entrapment of an intravascular ultrasound (IVUS) catheter during coronary intervention is rare, but can cause serious complications. Retrieval of an entrapped catheter can also lead to adverse results for implanted stents. We report a case in which the sheath tip at the guidewire exit port was entrapped and caused stent distortion during a post-stent IVUS procedure with automatic pullback. (Korean J Med 2013;84:274-278)
헤파린 부착 JO 스텐트와 미부착 JO 스텐트 삽입술 후의 장기 추적 성적 비교
남창욱,김권배,김기영,김성열,권택근,이영수,조봉기,손봉준,한성욱,김기식,김윤년 계명대학교 의과학연구소 2000 계명의대학술지 Vol.19 No.2
The risk of acute or subacute closure after angioplasty has been minimized by using stent deployment. However, restenosis rating 20% ∼30% after stenting is still most important limiting factor for stenting. We investigated a long-term effect of implantation of a heparin-coated JO stent compared with the use of un-coated JO steno. Thirty eight patients were assigned heparin-coated JO stent{21 patients, JO(H)} or uncoated JO stent(17 patients, JO). All clinical and angiographic parameters were retrogradely reviewed. They were followed up monthly and performed follow-up coronary angiography 7 months later. The clinical and angiographic parameters were statistically not different between two groups, except hypertension {JO:18%, JO(H):52%, p<0.05}. The reference diameter was 3.12±0.53mm in 10 and 2.85 ±0.43mm in JO(H) (p=0.071). The minimum luminal diameter after stenting was not significantly different{2.91±0.52mm in JO, 2.78±0.42mm in JO(H), p=0.381}. The restenosis rate of JO was 32% and JO(H), 35%(p=0.545). Over seven months follow up, it seems that a strategy of elective stenting with heparin-coated JO stent was not more effective than uncoated JO stent.
이상준,박진용,임태형,윤영호,권순대,남창욱,허규찬,박근용,구본식,김상표,장종억 啓明大學校 醫科大學 1997 계명의대학술지 Vol.16 No.3
저자들은 인슐린 비의존형 당뇨병 환자에서 통증성 구강내 미란 및 전신성 수포성 미란을 동반한 심상성 천포창 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Various skin conditions such as diabetic dermopathy, necrobiosis lipoidica diabeticorum, bullosis diabeticorum, granuloma annulare occur frequently in diabetes, although common lesions may be associated by chance. Pemphigus vulgaris(PV) is a blistering skin disease seen predominantly in elderly patients. This disorder is characterized by the loss of cohesion between epidermal cells with the resultant formation of intraepidermal blisters. These blisters rupture easily, leaving denuded areases that may crust and enlarge peripherally. In half or more of patients, lesions begin in the mouth: approximately 90% of patients have oromucosal involvement at some time during the course of their disease. But the relationship of this disorder with diabetes is not clear. We experienced a case of pemphigus vulgaris associated with NIDDM in 67 years old woman who was admitted due to painful oral ulcer and control of blood glucose, so we present this case with a review of literatures.