Reversed Circadian Variation in Variant Angina

민희석,구본권,김민경,임학령,김효수 대한심장학회 2008 Korean Circulation Journal Vol.38 No.1

It is known that there is a marked variation in the frequency of variant angina attacks according to the circadian rhythm. The attack frequency is usually highest in the early morning and lowest in the afternoon. We describe here a middle-aged woman with variant angina whose chest pain occurred only during daytime. Because of her job, she sleeps from noon to 6 pm, and she experienced chest pain only during 2 to 3 pm. These findings suggest that the alterations to the sleep and wake cycle can affect the circadian variation of variant angina. (Korean Circ J 2008;38:66-68)

티벳, 인도에 있어서의 예수

민희석 한인문화연구원 1982 한인문화논총 Vol.1 No.-

증례 : Sildenafil 치료로 성공적으로 출산한 문맥성 폐동맥고혈압(Portopulmonary Hypertension) 1예

민희석 ( Hee Suk Min ),장혁재 ( Hyuk Jae Chang ),조영석 ( Yong Seok Cho ),연태진 ( Tae Jin Youn ),정우영 ( Woo Young Chung ),채인호 ( In Ho Chae ),최동주 ( Dong Ju Choi ) 대한내과학회 2007 대한내과학회지 Vol.73 No.2

저자들은 문맥성 폐동맥고혈압을 가진 임산부에서 Phosphodiesterase V 억제제인 sildenafil 치료로 성공적인 출산을 한 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. The mortality of pulmonary hypertension that complicates pregnancy is very high. The increased pulmonary vascular resistance combined with the normal physiological changes of pregnancy and delivery is difficult to manage. We describe here the case of a pregnant woman who presented with severe portopulmonary hypertension. A 30-yr-old woman presented with dyspnea at 8 weeks of pregnancy. The mean pulmonary artery pressures (PAP), as measured from a pulmonary artery catheter at 20 weeks gestation, were 71 mmHg. Sildenafil was used to reduce the PAP for 4 months. She responded to sildenafil therapy and successfully completed her pregnancy.(Korean J Med 73:200-205, 2007)

스타틴 투여 중단 후 기간에 따른 혈청 콜레스테롤의 변화에 대한 연구

김민경,김학령,민희석,김민석,윤연이,박경우,김상현,조주희,김명아,문현종,김효수,손대원,오병희,박영배,최윤식 대한심장학회 2008 Korean Circulation Journal Vol.38 No.1

Background and Objectives: Some patients stop statin therapy in spite of their doctors' advice. This study was designed to assess the pattern of lipoprotein profile changes and clinical characteristics of the patients who discontinued statin therapy. Subjects and Methods: 69 patients (male 42.0%) were enrolled. The clinical characteristics and laboratory data on the lipoprotein levels were obtained from the medical records. Results: The coexistence of diabetes mellitus (DM) was seen in 28% of the patients, hypertension was noted in 72% and coronary artery disease (CAD) was noted in 42%. The average lipoprotein levels during statin therapy were total cholesterol (TC)=163.8 mg/dL, triglycerides (TG)=174.3 mg/dL, high-density lipoprotein cholesterol (HDL-C)=34.8 mg/dL and low-density lipoprotein cholesterol (LDL-C)=94.2 mg/dL. LDL-C level increased by 44.9% at 2-3 months after ceasing statin therapy and by 54.6% at 4-6 months after ceasing statin therapy (p<0.01). The changes of the lipoprotein levels from baseline to 2-3 months and 4-6 months after discontinuation were +22.6% and +30.0% for the TC level, +20.8% and +24.0% for the TG level, and 0.06% and -0.65% for the HDL-C level respectively (p<0.01 for TC and TG, p=not significant (NS) for HDL-C). The achievement rate of target LDL-C level as suggested by the Adult Treatment Panel III (ATP III) of National Cholesterol Education Program (NCEP) was decreased 62.7% at 2-3 months and then it was decreased to 61.8% at 4-6 months after statin discontinuation. DM and CAD were more frequent in the patients who did not achieve the target LDL-C level even with life style modification. Conclusion: After statin discontinuation, TC and LDL-C were increased within 3 months. DM and CAD were highly prevalent in patients who didn't achieve their treatment goal. (Korean Circ J 2008;38:36-42) 배경 및 목적스타틴은 심혈관계 질환의 일차적, 이차적 예방 효과가 증명된 약물이며, 고지혈증의 약물 치료로 많이 처방되고 있다. 본 연구에서는 치료 현실에서 여러 가지 이유로 스타틴 치료가 중단되었을 때 환자의 혈중 지질 수치가 시간이 지남에 따라 변화하는 양상에 대해 조사하였다.방 법서울시립 보라매병원 순환기내과에서 추적 관찰 중인 환자들 중에서 스타틴 처방이 중단되었던 총 69명 (남자 42%)의 환자들의 혈중 지질 수치를 분석하였다. 의무기록을 검토하여 환자의 당뇨병, 고혈압, 심혈관질환 여부 및 체질량 지수 등을 조사하였다. 결 과 환자들의 임상 병력을 보면, 28%에서 당뇨병을 동반하고 있었고, 72%가 고혈압을, 42%가 관상동맥질환을 동반하고 있었다. 스타틴 치료가 되고 있던 시점에서의 혈중 총 콜레스테롤 치는 163.8 mg/dL, LDL-C은 94.2±33.5 mg/dL 이었으며, 중성지방은 174.3 mg/dL, 고밀도지단백 콜레스테롤 치는 34.8 mg/dL였다. 혈중 LDL-C 수치의 평균 증가율은 중단 시점에서 2 내지 3개월 사이에는 44.9±47.8%, 중단 시점에서 4 내지 6개월 사이에 54.6±63.0%로서, 스타틴 치료 중단 후 유의하게 증가하였다 (p<0.01). TC, TG, HDL-C의 평균 변화율은 스타틴 중단 후 2개월에서 3개월 후에 각각 22.6±23.1%, 20.8±70.7%, 0.06±16.5%였으며, 중단 후 4개월에서 6개월 후에는 각각 30.0±35.0%, 24.0±69.1%, -0.65±17.7%로 증가하여, 스타틴 치료 중단 후 총 콜레스테롤이 유의하게 증가하였다 (p<0.01). 낮은 혈중 고밀도지단백 콜레스테롤 (<40 mg/dL)을 보이는 경우는, 스타틴 치료 중단 2~3개월 후에는 전체의 67.4%였고, 치료 중단 4~6개월 후에는 75.5%로 증가하였다 (p=NS). 스타틴 치료 중의 LDL-C의 NCEP-APT III 치료 지침에 의거한 LDL-C의 치료 목표 달성률은 84.3%였다. 스타틴 중단 후 지속적으로 감소하였으며, 운동과 식이요법을 권고받은 상태에서 목표 달성이 이루어지지 않았던 환자들 중에 당뇨병과 심혈관질환의 비율이 높았다. 결 론 스타틴 치료가 중단되면 3개월 이내에 지질 수치의 악화가 발생하게 되고, 이는 주로 저밀도지단백 콜레스테롤, 총 콜레스테롤의 상승으로 나타난다. 또한 각 위험군별 저밀도지단백 콜레스테롤 치료 목표 달성률이 감소하였는데, 운동과 식이요법만으로 치료목표를 달성하지 못하는 환자 중에 당뇨병과 심혈관질환의 비율이 높았다. 향후 고지혈증의 치료에 있어서 스타틴 복약 유지에 의사들의 적극적인 개입이 필요하겠다.

Successful Pacemaker Revision Through Sustained Right Superior Vena Cava in a Patient With Situs Inversus Totalis

김학령,김민경,민희석,최봉령,최의근,곽재진,최윤식,오세일 대한심장학회 2008 Korean Circulation Journal Vol.38 No.2

In patients with situs inversus totalis, the superior vena cava is normally positioned on the left side and drains into a left-sided right atrium (RA). If right-side superior vena cava (RSVC) is also present, it should be thought of as a combined congenital anomaly. Here, we report a case of succesful pacemaker lead insertion through the RSVC in a patient with situs inversus totalis. The left-side superior vena cava (LSVC) had ben already used as a route for the first pacemaker lead insertion 15 years earlier. During the pacemaker lead revision, we found that the LSVC was obliterated, and used the RSVC as a route for a new pacemaker lead insertion.

Comparison of long-term outcomes between the sirolimus and the paclitaxel drug eluting stents in diabetic patients and/or non diabetic populations (초)

최동현,조영진,민희석,박경우,이해영,박진식,강현재,구본권,오병희,박영배,김효수 대한내과학회 2008 대한내과학회 추계학술대회 Vol.2008 No.-

Comparison of Long-term outcomes between the sirolimus and the paclitaxel drug eluting stents in diabetic patients and/or non diabetic populations (초)

최동현,조영진,민희석,박경우,이해영,박진식,강현재,구본권,오병희,박영배,김효수 대한내과학회 2008 대한내과학회지 Vol.75 No.1S

한국 성인에서 황열 예방접종 후 발생한 이상반응

윤효은 ( Yoon Hyo Eun ),황보주 ( Hwang Bo Ju ),석웅 ( Seng Woong ),민희석 ( Min Hee Suk ) 국군의무사령부 2010 대한군진의학학술지 Vol.41 No.1

Objective: Yellow fever, a mosquito-borne viral hemorrhagic fever, is one of the most lethal diseases. Recently Korea raise nation's states to a higher level by hosting G20 SEOUL SUMMIT 2010. And Korea sends troops overseas such as Peace keeping operation(PKO) to contribute to world peace. Therefore, we carried out this study to provide Overseas dispatch soldiers information about Yellow Fever Vaccine(YFV). Method: This study was conducted at the OO clinic between June 7 to June 24, 2010, for the evaluation of adverse events of YFV. Eighty-three healthy adults were vaccinated YFV(17-DD) and were prospectively monitored for adverse events through questionnaire to July 23, 2010, after YFV vaccination. Results: Adverse events were observed in 41(49.4%) of 83 adults who were vaccinated YFV. Sixty-four of the adults(77.1%) were males. The mean age was 38.2±8.2 years. The common adverse events were myalgia in 28(33.7%), Chilling sense in 25(30.1%), Headache in 21(25.3%). There were no differences of adverse events according to gender or age. Most adverse events were developed between 4~9days after YFV injection. Conclusion: This study showed that adverse events by YFV have a higher incidence and delayed onset time than Influenza Vaccine. Studies are ongoing to clarify the cause and risk factors for rare adverse events.

급성 A형 간염 환자에서 발생한 간질성 신염과 IgA 신병증의 병발에 의한 급성 신부전 : 1예 보고

한승석 ( Seung Seok Han ),김민경 ( Min Kyung Kim ),최병용 ( Byoung Yong Choi ),민희석 ( Hee Suk Min ),김학령 ( Hack Lyoung Kim ),정용진 ( Chun Soo Lim ),임춘수 ( Chun Soo Lim ),이현주 ( Hyun Ju Lee ),문경철 ( Kyung Chul Moon ) 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.6

갑상선 전이암으로 오인된 흉선의 방사성요오드 섭취

이은경,김경원,박소연,박영주,김영태,정준기,조화영,구윤희,민희석,박성회,박도준,조보연 대한내분비학회 2007 Endocrinology and metabolism Vol.22 No.6

Radioactive iodine (RAI) therapy is used for the removal of remnant thyroid tissue or metastatic thyroid cancer cells in differentiated thyroid cancer. The main mechanism of the therapy is destruction of cells by radioactive iodine that penetrates the cells though the action of the sodium-iodide symporter (NIS). We experienced a case of a 26-year-old woman with mediastinal uptake as detected on a radioiodine scan, who was previously diagnosed with papillary thyroid cancer. For diagnostic tests including chest computed tomography (CT) and a radioiodine scan, the stimulated thyroglobulin level did not show a definite cause of the mediastinal uptake. During regular follow-up, the thymus became triangular with clear margins. The patient had neither specific symptoms nor physical findings related to the presence of a thymic mass. A subsequent CT scan showed an irregular margin of the thymus, suggestive of thymic metastasis. The patient underwent a mediastinectomy. The removed specimen was composed of normal thymic tissue. Moreover, we demonstrated the presence of human NIS by immunohistochemical analysis. After thymectomy, the mediastinal uptake was markedly decreased as compared to the previous scan. This case suggests that a clinician should be suspicious for the functional uptake of thymus when metastasis is unlikely in a clinical situation. (J Kor Endocr Soc 22:460~464, 2007) 갑상선 분화암 치료에 있어서 잔여 갑상선조직의 제거 및 갑상선 전이암을 치료하는데 사용되는 방사성요오드 치료는 NIS(sodium-iodide symporter) 통로를 통해 방사성요오드가 세포 내로 들어가 세포를 파괴하는 것이 치료 기전이다. 본 증례는 26세 갑상선 유두암 환자로 동위원소 치료 중 종격동의 요오드 섭취가 있어 흉부 전산화 단층촬영과 갑상선글로불린으로 전이 여부를 확인하였으나 이상소견이 없었다. 경과 관찰 중 흉부 전산화 단층촬영에서 깨끗한 변연을 지닌 무증상 흉선 종괴가 발견되었으나 증상이 없어 관찰하였다. 그러나 이후 갑상선호르몬 중단 시 갑상선글로불린이 증가하고, 흉부 전산화 단층촬영에서 흉선의 변연이 불규칙해져서 전이암을 배제하기 위해 환자는 종격동 절제술을 시행받았다. 제거된 조직의 병리 소견은 정상 흉선으로 갑상선조직은 관찰되지 않았으며, human NIS에 양성이었다. 흉선을 제거한 후 시행한 방사성요오드 스캔에서 이전과 비교하였을 때 종격동 섭취가 감소함을 관찰할 수 있었다. 본 증례와 같이 갑상선암 환자에서 갑상선전절제술 후 종격동에 방사성 요오드가 섭취될 경우 모양과 크기가 변화하더라도 생리적인 흉선에 의한 섭취일 수 있음을 문헌고찰과 함께 보고하는 바이다.