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급성 심근 경색 후 사망을 예측할 수 있는 폐정맥 혈류의 도플러 심초음파 지표
노치완,주승재,최병주,서수홍,신채희,김현영,김찬욱,김성만,차태준,이재우 한국심초음파학회 2001 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.9 No.2
Background:Restrictive left ventricular (LV) filling patterns after acute myocardial infarction (AMI) predict poor prognosis. Doppler indexes of LV inflow, especially peak velocity ratio of early versus late diastolic flow (E/A) and deceleration time, can predict heart failure or death. Doppler indexes of pulmonary venous flow are also used to diagnose restrictive LV filling, but their prognostic values after AMI are not known. Methods:Doppler echocardiographic examination were performed in patients with AMI (n=122) between 7 to 10 days after attack, and followed for 30 months. Death group included 9 deaths (7.4%) during follow-up. 18 age-matched patients (control group) were selected from 70 patients without death, heart failure or readmission. Doppler echocardiographic indexes of peak systolic velocity (SV), peak diastolic velocity (DV), and peak reverse flow velocity associated with atrial contraction (AR) of pulmonary venous flow were measured by transthoracic echocardiography. Results:Death group had lower SV (46.1±6.3 vs 57.0±14.7 cm/sec;p=0.059) and SV/DV ratio (1.26±0.50 vs 1.58± 0.37 ; p=0.076). Death group had significantly more patients with SV/DV ratio less than 1.3 (67% vs 17%;p=0.026). AR was significantly different between death and control groups (29.7±7.8 vs 24.7±6.8 cm/sec;p=0.023). Death group had significantly more patients with ARgreater than 25 (78% vs 33% p=0.046). Conclusion : SV/DV ratio and AR of pulmonary venous flow predicted death after AMI. 연구배경: 급성 심근 경색 후 좌심실 이완 기능이 제한성 장애인 경우 예후가 불량하며, 좌심실 유입 혈류의 도플러 심초음파 지표 중 E/A 비와 초기 유입 혈류의 감속 시간등이 사망이나 심부전 등을 예측하는데 사용된다. 폐정맥 혈류의 도플러 심초음파 지표도 제한성 장애를 진단하는데 도움을 주나, 급성 심근 경색 후 사망을 예측할수 있는 지표인지는 아직 알려져 있지 않다. 방 법: 급성 심근 경색 후 7~10일 사이에 경흉부 심초음파를 시행 받은 122명의 환자 중 9명(7.4%)이 30개월 이내에 사망하였다. 이 9명을 사망군으로 하였다. 30개월 동안 사망, 심부전, 재입원 등의 사건이 없었던 70명의 환자 중 사망군의 연령이 보정된 18명의 대조군을 선정하여, 폐정맥 혈류의 도플러 심초음파 지표인 수축기 최대 혈류 속도(peak systolic velocity:SV), 이완기 최대 혈류 속도(peak diastolic velocity:DV),좌심방 수축에 의한 역류 혈류의 최대 속도(peak reverse flow velocity associated with atrial contraction:AR) 등을 측정하였다. 결 과: SV가 사망군에서 작은 경향이 있었다(46.1±6.3 vs57.0±14.7 cm/sec;p=0.059). SV/DV 비는 사망군에서 작았으며(1.26±0.50 vs 1.58±0.37;p=0.076),SV/DV 비가 1.3 미만인 경우가 사망군에서 67%로, 대조군의 17%에 비해서 유의하게 많았다(p=0.026). AR은 사망군에서 유의하게 높았으며(29.7±7.8 vs 24.7±6.8cm/sec;p=0.023), 그 값이 25 cm/sec 이상인 경우가 사망군에서 78%, 대조군에서 33%로 사망군에서 유의하게 많았다(p=0.046). 결 론: 폐정맥 혈류의 SV/DV 비, AR 등이 급성 심근 경색후 사망을 예측할 수 있는 지표로 생각되었다.
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김현수,차태준,노치완,구상호 대한의학회 2013 Journal of Korean medical science Vol.28 No.5
This study investigated the role of angiotensin II receptor blocker in atrial remodeling in rats with atrial fibrillation (AF) induced by a myocardial infarction (MI). MIs were induced by a ligation of the left anterior descending coronary artery. Two days after, the rats in the losartan group were given losartan (10 mg/kg/day for 10 weeks). Ten weeks later,echocardiography and AF induction studies were conducted. Ejection fraction was significantly lower in the MI rats. Fibrosis analysis revealed much increased left atrial fibrosis in the MI group than sham (2.22 ± 0.66% vs 0.25 ± 0.08%, P = 0.001) and suppression in the losartan group (0.90 ± 0.27%, P = 0.001) compared with the MI group. AF inducibility was higher in the MI group than sham (39.4 ± 43.0% vs 2.0 ± 6.3%,P = 0.005) and significantly lower in losartan group (12.0 ± 31.6%, P = 0.029) compared with the MI. The left atrial endothelial nitric oxide synthase (NOS) and sarco/endoplasmic reticulum Ca2+-ATPase levels were lower in the MI group and higher in the losartan group significantly. The atrial inducible NOS and sodium-calcium exchanger levels were higher in the MI and lower in the losartan group significantly. Losartan disrupts collagen fiber formation and prevents the alteration of the tissue eNOS and iNOS levels, which prevent subsequent AF induction.
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서수홍,최병주,노치완,신채희,장성훈,김양수,어완규,김효경 고신대학교(의대) 고신대학교 의과대학 학술지 2002 고신대학교 의과대학 학술지 Vol.17 No.1
The POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin change) is a rare multisystemic disroder of unknown pathogenesis. Although the etiology is still unclear, proinflammatory cytokines such as tumor necrosis factor-a, IL-6, and paraprotein specificity for neuroendocrine tissue have been suggested to play a causative role. We report a case of POEMS syndrome presented as progressive sensorimotor neuropathy, hepatosplenomegaly, diabetes mellitus, solitary bone plasmacytoma, hypertrichosis and hyperpigmentation. The patient was treated with local irradiation and prednisolone and showed obvious neurological and systemic improvement.
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서수홍,최병주,노치완,신채희,장성훈,김양수,어완규,김효경 고신대학교 의학부 2002 高神大學校 醫學部 論文集 Vol.17 No.1
The POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin change) is a rare multisystemic disorder of unknown pathogenesis. Although the etiology is still unclear, proinflammatory cytokines such as tumor necrosis factor-α, IL-6. and paraprotein specificity for neuroendocrine tissue have been suggested to play a causative role. We report a case of POEMS syndrome presented as progressive sensorimotor neuropathy, hapatosplenomegaly, diabetes mellitus, solitary bone plasmacytoma, hypertrichosis and hyperpigmentation. The patient was treated with local irradiation and prednisolone and showed obvious neurological and systemic improvement.
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권성일,김규종,이지영,김동완,노치완,박무인,박선자,구자영,백승언 고신대학교(의대) 고신대학교 의과대학 학술지 2000 고신대학교 의과대학 학술지 Vol.15 No.1
Mucocele of the appendix is an uncommon disorder which is rarely diagnosed prior to a laparotomy. With progress in diagnostic procedures, such as the use of colonoscopy, ultrasonography, and computed tomography, preoperative diagnosis of the appendiceal mucocele has become possible. There have been several reported cases of appendiceal mucocele in which various symptoms and signs were present. In this case, a 50-year old female patient visited our hospital because of constipation and rectal bleeding, and then she had an incidental finding of mucocele of the appendix during colonoscopic evaluation for constipation and rectal bleeding. We have experienced the case of preoperatively diagnosed appendiceal mucocele by a colonoscopy and abdominal CT and barium enema in which she was operated and the surgical specimen revealed appendiceal mucocele.
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