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The Impact of Mitral Annular Calcification on Left Ventricular Function in Nonagenarians
서기우,김은영,김정은,조은정,권재은,오민석,홍준화,서재승,이왕수,이광제,김상욱,김태호,김치정,조대윤,류왕성 대한심장학회 2010 Korean Circulation Journal Vol.40 No.6
Background and Objectives: Mitral annular calcification (MAC) is known to be associated with degenerative processes of the cardiac fibrous skeleton and cardiovascular disease mortality. However, MAC has not been evaluated in an extreme age group (patients ≥90 years of age). In this study, the clinical significance of MAC associated with aging was examined in this age group and compared with MAC associated with aging in a younger (20to 50 years of age) group of patients. Subjects and Methods: We assessed echocardiographic parameters in 43 nonagenarians and 51 young patients. In the nonagenarian group, patient’s age was 92±2 years and 27% were male;in the young control group, patient’s age was 36±9 years and 51% were male. Comprehensive M-mode and Doppler echocardiography, including tissue Doppler imaging, were performed. The frequency and severity of MAC was assessed from the leading anterior to the trailing posterior edge at its largest width for least 3 cardiac cycles. Results:Echocardiography showed that the left ventricular (LV) end-diastolic dimension was larger in the young controls (p=0.007); however, the ejection fraction (EF) was lower in the nonagenarian group (p=0.001). The frequency of MAC was greater in nonagenarians {42/43 (97%)} than in controls {9/51 (17%), p<0.0001}. The maximal width of MAC was larger in nonagenarians (0.52±0.17 mm and 0.05±0.13 mm, p<0.0001). MAC was correlated with LV mass index (g/m2) (r=0.280, p=0.014) and EF (%) (r=-0.340, p=0.001). More importantly, early mitral inflow velocity/early diastolic mitral annulus velocity (E/E’) was strongly correlated with MAC in non-agenarians (r=0.683, p<0.0001). Conclusion: MAC may be associated with extreme age and increased LV filling pressure in nonagenarians. Further study is necessary to assess the cardiovascular mortality and structural changes related to mitral annulus calcification associated with aging.
증례 : 감염 ; 국내 암환자에서 발생한 Trichosporon pullulans 진균혈증 1예
서기우 ( Ki Woo Seo ),정진원 ( Jin Won Chung ),조선영 ( Sun Young Cho ),박금보래 ( Bo Rae G. Park ),이미경 ( Mi Kyung Lee ) 대한내과학회 2009 대한내과학회지 Vol.77 No.4
Trichosporon pullulans는 드물게 발생되어 그 문헌보고는 적지만 최근에 인체감염을 일으키는 중요한 병원균으로 여겨지고 있다. 최근 혈액암, 백혈구 감소, 골수이식 및 장기이식 등의 면역저하 환자가 증가되면서 치명적인 전신감염의 보고가 증가되고 있다. 저자들은 호중구감소증이 없는 환자에서의 T. pullulans 진균혈증을 경험하였기에 국내 최초로 보고하는 바이다. 70세 여자 환자는 전이성 대장암으로 진단 후 항암제 치료 없이 빗장밑 정맥으로 영양공급 등의 보존적 치료만 받았다. 입원 16일째 발열이 발생하여 시행한 3쌍의 혈액배양 검사와 빗장밑 정맥카테터 끝 배양검사에서 모두 T. pullulans이 분리되었다. 환자는 정맥카테터 제거와 amphotericin B deoxycholate 치료를 시행받았으나 지속적인 진균혈증으로 사망하였다. Trichosporon pullulans has recently been recognized as a human pathogen. Given its rarity, however, few reports describe infection attributable to this fungal pathogen. In immunocompromised hosts, T. pullulans infection is associated with significant mortality. For the first time in Korea, we report a case of T. pullulans infection in a non-neutropenic patient. A 70-year-old woman was diagnosed with metastatic colon cancer. She did not undergo chemotherapy and received only supportive care and intravenous nutrition via the subclavian vein. Sixteen days after admission, a fever developed. Three sets of blood culture and a catheter tip culture were carried out and T. pullulans grew in all cultures. Although she was treated with amphotericin B deoxycholate and catheter removal, she died on hospital day 40 due to persistent fungemia. (Korean J Med 77:527-530, 2009)
증례 : 순환기 ; 전신적인 발진성, 결절성 황색종을 동반한 제3형 고지단백혈증 1예
김은영 ( Eun Young Kim ),서기우 ( Ki Woo Seo ),김정은 ( Jung Eun Kim ),조은정 ( Eun Jeong Cho ),이왕수 ( Wang Soo Lee ),김치정 ( Chee Jeong Kim ),이갑석 ( Kap Sok Li ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5
저자들은 55세 여자 환자에서 전신적으로 발생한 발진성, 결절성 황색종을 동반한 제3형 고지단백혈증을 경험하였기에 보고하는 바이다. A 55-year-old female presented with extensive yellowish eruptive plaques over both elbows and the buttocks that she had first noticed 2 years earlier. Yellowish orange discoloration of her palmar creases was noted. Her serum cholesterol and triglyceride were markedly elevated. Lipoprotein electrophoresis showed a broad β band. On apolipoprotein E genotyping, the arginine at position 158 had been replaced by cysteine in both alleles (E2/E2). Under a diagnosis of type III hyperlipoproteinemia, combined atorvastatin and fenofibrate therapy for 2 months normalized the serum cholesterol and triglyceride levels. (Korean J Med 77:620-624, 2009)
심각한 판막질환이 없는 심방세동 환자에서 RR 간격과 초기 확장기 승모판윤 속도와의 상관관계
최여원,김정은,조은정,김은영,서기우,이경헌,이광제,김상욱,김태호,고홍숙,김치정,류왕성 대한심장학회 2008 Korean Circulation Journal Vol.38 No.10
Background and Objectives: Irregular RR intervals in atrial fibrillation (AF) results in beat to beat changes in hemodynamical parameters. Early diastolic mitral annulus velocity (E’) is one of the parameters that represent diastolic function of the left ventricle (LV). In this study, we have investigated the effects of continuous changes of systolic functions in AF on the diastolic functions of the LV. Subjects and Methods: E’ (35-40 beats) was recorded in 31 AF patients that did not have significant valvular heart diseases. The relationships between preceding RR intervals (RR-1) or pre-preceding RR intervals (RR-2) and E’s were obtained using a logarithmic function. Results: Slopes between RR-1 and E’ varied from -1.62 to 1.04 in total coordinates. In the logistic regression analysis patients with negative slopes were found to have a larger left atrial size than patients with positive slopes (5.5±0.67 cm vs. 4.9±0.56 cm, p=0.02). Slopes were negatively related with mean RR intervals in the Pearson correlation analysis (r=-0.40, p=0.028). Slopes between RR-2 and E’ were also variable and were not associated with other parameters. Conclusion: Beat to beat changes in systolic functions derived from irregular RR intervals in AF had variable effects on diastolic functions among patients. The relationship between RR-1 and E’ was associated with LA sizes and mean RR intervals. Background and Objectives: Irregular RR intervals in atrial fibrillation (AF) results in beat to beat changes in hemodynamical parameters. Early diastolic mitral annulus velocity (E’) is one of the parameters that represent diastolic function of the left ventricle (LV). In this study, we have investigated the effects of continuous changes of systolic functions in AF on the diastolic functions of the LV. Subjects and Methods: E’ (35-40 beats) was recorded in 31 AF patients that did not have significant valvular heart diseases. The relationships between preceding RR intervals (RR-1) or pre-preceding RR intervals (RR-2) and E’s were obtained using a logarithmic function. Results: Slopes between RR-1 and E’ varied from -1.62 to 1.04 in total coordinates. In the logistic regression analysis patients with negative slopes were found to have a larger left atrial size than patients with positive slopes (5.5±0.67 cm vs. 4.9±0.56 cm, p=0.02). Slopes were negatively related with mean RR intervals in the Pearson correlation analysis (r=-0.40, p=0.028). Slopes between RR-2 and E’ were also variable and were not associated with other parameters. Conclusion: Beat to beat changes in systolic functions derived from irregular RR intervals in AF had variable effects on diastolic functions among patients. The relationship between RR-1 and E’ was associated with LA sizes and mean RR intervals.
강의 피로균열지연거동에 미치는 과대하중의 영향과 통계적 변동에 관한 연구
김선진(Seon-Jin Kim),남기우(Ki-Woo Nam),김종훈(Jong-Hoon Kim),이창용(Chang-Ryong Lee),박은희(Eun-Hee Park),서상하(Sang-Ha Seo) 한국해양공학회 1997 韓國海洋工學會誌 Vol.11 No.3
Constant ΔK fatigue crack growth rate experiments were performed by applying an intermediate single and multiple overload for structural steel, SM45C. The purpose of the present study is to investigate the influence of multiple overloads at various stress intensity factor ranges and the effect of statistical variability of crack retardation behavior. The normalized delayed load cycle, delayed crack length and the minimum crack growth rate are increased with increasing baseline stress intensity factor range when the overload ratio and the number of overload application were constant. The crack retardation under low baseline stress intensity factor range increases by increasing the number of overload application, but the minimum crack growth rate decreases by increasing the number of overload application. A strong linear correlation exists between the minimun crack growth rate and the number of overload applications. And, it was observed that the variability in the crack growth retardation behavior are presented, the probability distribution functions of delayed load cycle, delayed crack length and crack growth life are 2-parameter Weibull. The coefficient of variation of delayed load cycle and delayed crack length for the number of 10 overload applications data are 14.8 and 9.2%, respectively.