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원인 불명의 실신 환자에서 Implantable Loop Recorder의 임상 경험
신대희,김준수,박정왜,임혜란,김준형,이선미,김기선,이창희,정동채,온영근,김덕경,이상훈,홍경표,박정의 대한심장학회 2008 Korean Circulation Journal Vol.38 No.4
Background and Objectives: Possible mechanisms of syncope often remain unknown despite the performance of extensive cardiological and neurological tests. An implantable loop recorder (ILR) has been introduced to monitor the heart rhythm continuously over a year. We evaluated the diagnostic value of the use of the ILR for unexplained syncope. Subjects and Methods: Between 2006 and 2007, an ILR was implanted in 9 patients (7 male, 2 female, mean age 55±17 years) where syncope remained unexplained after extensive diagnostic tests. We analyzed the recorded electrocardiogram signal in the memory of the ILR. Results: During a follow-up period of 8.8±7.3 months, arrhythmia was detected in five patients. Two patients had a sinus pause and received a permanent pacemaker, and one patient had sustained ventricular tachycardia and fibrillation and received an implantable cardioverter defibrillator. One patient had micturition syncope with sinus pause and is waiting for permanent pacemaker implantation, and one patient had symptomatic paroxysmal atrial fibrillation and was administered anticoagulation therapy. Inappropriate auto-activations such as a pseudopause or a decreasing signal were also noted. Conclusion: ILR monitoring seems to be a useful diagnostic tool to identify the arrhythmic cause in patients with unexplained syncope. Background and Objectives: Possible mechanisms of syncope often remain unknown despite the performance of extensive cardiological and neurological tests. An implantable loop recorder (ILR) has been introduced to monitor the heart rhythm continuously over a year. We evaluated the diagnostic value of the use of the ILR for unexplained syncope. Subjects and Methods: Between 2006 and 2007, an ILR was implanted in 9 patients (7 male, 2 female, mean age 55±17 years) where syncope remained unexplained after extensive diagnostic tests. We analyzed the recorded electrocardiogram signal in the memory of the ILR. Results: During a follow-up period of 8.8±7.3 months, arrhythmia was detected in five patients. Two patients had a sinus pause and received a permanent pacemaker, and one patient had sustained ventricular tachycardia and fibrillation and received an implantable cardioverter defibrillator. One patient had micturition syncope with sinus pause and is waiting for permanent pacemaker implantation, and one patient had symptomatic paroxysmal atrial fibrillation and was administered anticoagulation therapy. Inappropriate auto-activations such as a pseudopause or a decreasing signal were also noted. Conclusion: ILR monitoring seems to be a useful diagnostic tool to identify the arrhythmic cause in patients with unexplained syncope.
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수술 전 심장기능 평가에 있어 심근관류 SPECT의 유용성
신대희,조한표,최성일,이숙진,이 상,이재웅,김경수,김순길,김정현,임헌길,이방헌,이정균,최윤영 한양대학교 의과대학 2001 한양의대 학술지 Vol.21 No.2
Background/Aims: The preoperative cardiac evaluation is important to predict perioperative cardiac event in patients who planned for non-cardiac operation. However, the usefulness of cardiac SPECT and/or evaluation of patient with clinical criteria is not clear. Therefore we evaluate the prognostic value of cardiac SPECT in surgical patients. And also compare the result of clinical risk stratification using the ACC/AHA guidelines with those of cardiac SPECT. Methods: 75 patients(M:F=31:44, 62.8±9.2 years), who have chest pain, EKG abnormality or history of ischemic heart disease were enrolled to the study. According to the result of cardiac SPECT, they were divided to 3 groups: normal perfusion(n=51), reversible perfusion defect(n=31), irreversible perfusion defect(n=3). Also we divided 3 groups according to clinical predictors of the ACC/AHA guidelines: minor risk group(n=51), intermediate risk group(n=21), and major risk group(n=3). I compare predictive power of perioperative cardiac event between cardiac SPECT and clinical predictors of the ACC/AHA guidelines. Results: Cardiac event occurred in 9.2% of patient. Prevalence of cardiac event in reversible cardiac perfusion group(19.0%) and irreversible cardiac perfusion group(33.3%) was higher than normal group(3.8%)(p〈0.05). By clinical predictors according to the ACC/AHA guidelines, I could not predict the postoperative cardiac event. Conclusion: Cardiac SPECT is more useful than clinical predictors according to the ACC/AHA guidelines in preoperative cardiac evaluation in patients with chest pain, EKG abnormality or history of ischemic heart disease.
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신대희,조국현,이혁,문미경,강대길,윤용갑,박도심,정선관,이호섭,Shin, Dae-Hee,Cho, Guk-Hyun,Lee, Hyuck,Moon, Mi-Kyung,Kang, Dae-Gill,Yun, Young-Gab,Park, Do-Shim,Juhng, Seon-Kwan,Lee, Ho-Sub 대한한의학방제학회 2008 大韓韓醫學方劑學會誌 Vol.16 No.2
Recently, people are becoming fatter in most parts of the world. Obesity is regarded as an important risk factor to adversely affect the health of humans, associated with hypertension, hyperlipidemia, diabetes, and cardiovascular diseases. In the present study, therefore, we tested the short time efficiency and safety of Bangpoongtongsungsan as a drug to decrease body weight in subjects with obesity. A total 48 volunteers (24 man, 24 woman) with body mass index (BMI : weight in kg divided by square of height in meters) of $23㎏/m^2$ participated in clinical study for 12 weeks, from 2008, March 01 to 2008, Jun 30. The subjects was received a dietary supplement of 12 pieces hard capsules per day (4 pieces in one, 3 times in a day) during the clinical study. At the end of clinical study, body weight of subjects was significantly decreased from $72.21{\pm}11.44\;kg$ to $70.53{\pm}11.67\;kg$ (p<0.05). Waist circumferences of subjects were reduced $91.58{\pm}6.43\;cm$ to $85.25{\pm}7.70\;cm$ (p<0.05). Also, a BMI of subjects was significantly decreased $26.07{\pm}2.35\;kg/m^2$ to $25.63{\pm}2.63\;kg/m^2$ (p<0.05). Particularly, a decrease in body weight, waist circumferences, and BMI was more significant in woman than man. But, other biochemical levels including lipid and glucose in plasma had no changes at the end of clinical study. In conclusion, administration of Bangpoongtongsungsan in subjects with high body weight fat could inhibit obesity associated with a decrease in body weight, waist circumferences, and BMI.
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임대식,신대희,박대규,Im, D.S.,Shin, D.H.,Park, D.K. 대한화학회 1996 대한화학회지 Vol.40 No.4
Cyclopentadecanone(2)으로부터 2-cyclopentadecen-1-one(4)까지의 일반적인 합성경로는 여러가지가 있을 수 있다. 본 실험에서는 우선 $C_2$-위치의 선택적인 브롬화반응을 위하여 $AlCl_3$를 써서 엔올산 염화하여 위치선택성을 증가시켰으며, 브롬화 수소 이탈반응에서의 시약 $Li_2CO_3$-LiBr-DMF 조건을 적절히 조절함으로써 화합물(4)를 쉽게 얻을 수 있었다. 이 과정에서 생기는 트랜스형 및 시스형 화합물(4)를 E.Ether 용매속에서 $CH_3MgI-Cu_2Cl_2$ 복합체에 적하하여 반응시킬 경우, 모두 1,4-첨가반응되어 dl-Muscone(1)를 생성함을 결과로 얻었다. 본 실험에서 Cyclopentadecanone(2)으로부터 dl-Muscone(1)까지의 3단계 과정을 통해 순수한 dl-Muscone(1)을 총 85%의 높은 수율로 얻었으며, 별다른 화학적 분리단계를 거치지 않아, 합성단가를 기존의 어느 방법보다 현격히 낮출수 있었다. New routes have been developed for the practical syntheses of dl-Muscone(1) employing cyclopentadecanone(2) as the starting material. In this experiment, addition of bromine to cyclopentadecanone in dried E. Ether solution with a trace of $AlCl_3$ as the catalyst were produced 2-bromocyclopentadecanone(3). This process was enhanced formation of regioselective enolate anion at $C_2$ position. 2-Bromocyclopentadecanone was put into $Li_2CO_3$-LiBr-DMF solution at 140∼150$^{\circ}C$, were produced trans- and cis-2-cyclopentadecen-1-one(4) mixture. Other by-products were reduced by control of reaction temperature and time. Trans- and cis-2-cyclopentadecen-1-one(4) mixture was directly put into dried E. Ether solvent and induce to react dropwise with $CH_3MgBr-Cu_2Cl_2$ complex, all of them got into 1,4-addition, dl-Muscone (1) was formed as the result. Conculsion, through three steps procedure from cyclopentadecanone(2) to dl-Muscone(1), the pure dl-Muscone was obtained with the high proportion of 85%, and synthetic cost was able to be much lower than any other conventional methods as there were no chemical separating steps.
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The Incidence and Predictors of Postoperative Atrial Fibrillation After Noncardiothoracic Surgery
손관협,신대희,변경민,한혜진,조수진,송영빈,김준형,온영근,김준수 대한심장학회 2009 Korean Circulation Journal Vol.39 No.3
Background and Objectives: The incidence of postoperative atrial fibrillation after noncardiothoracic surgery is known to be very rare; there have been few prior studies on this topic. We evaluated the incidence, predictors, and prognosis of atrial fibrillation after noncardiothoracic surgery. Subjects and Methods: Patients who underwent noncardiothoracic surgery at our medical center under general anesthesia were enrolled. We reviewed medical records retrospectively and evaluated whether the atrial fibrillation developed postoperatively or was pre-existing. Patients who had a previous history of atrial fibrillation or atrial fibrillation on the pre-operative electrocardiogram were excluded. Results: Between January 2005 and December 2006, 7,756 patients (mean age: 69 years, male: 46%) underwent noncardiothoracic surgery in Samsung Medical Center and 30 patients (0.39%) were diagnosed with newly-developed atrial fibrillation. Patients who developed atrial fibrillation were significantly older and had significantly lower body mass indexes. Newly-developed atrial fibrillation was detected in 0.53% of the male patients and 0.26% of the female patients. The incidence of postoperative atrial fibrillation after an emergency operation was more frequent than that of elective operations (p<0.001). According to the multivariate analysis, age and emergency operations were independent predictors for new onset atrial fibrillation after noncardiothoracic surgery. Postoperative atrial fibrillation developed after a median of 2 days after the noncardiothoracic surgery and was associated with a longer hospitalization and increased in-hospital mortality. Four (13.3%) patients died and the causes of death were non-cardiovascular events such as pneumonia or hemorrhage. Conclusion: Postoperative atrial fibrillation after noncardiothoracic surgery is a rare complication and is associated with older age and emergency operations. Patients who develop atrial fibrillation have longer hospitalizations and higher in-hospital mortality rates. Background and Objectives: The incidence of postoperative atrial fibrillation after noncardiothoracic surgery is known to be very rare; there have been few prior studies on this topic. We evaluated the incidence, predictors, and prognosis of atrial fibrillation after noncardiothoracic surgery. Subjects and Methods: Patients who underwent noncardiothoracic surgery at our medical center under general anesthesia were enrolled. We reviewed medical records retrospectively and evaluated whether the atrial fibrillation developed postoperatively or was pre-existing. Patients who had a previous history of atrial fibrillation or atrial fibrillation on the pre-operative electrocardiogram were excluded. Results: Between January 2005 and December 2006, 7,756 patients (mean age: 69 years, male: 46%) underwent noncardiothoracic surgery in Samsung Medical Center and 30 patients (0.39%) were diagnosed with newly-developed atrial fibrillation. Patients who developed atrial fibrillation were significantly older and had significantly lower body mass indexes. Newly-developed atrial fibrillation was detected in 0.53% of the male patients and 0.26% of the female patients. The incidence of postoperative atrial fibrillation after an emergency operation was more frequent than that of elective operations (p<0.001). According to the multivariate analysis, age and emergency operations were independent predictors for new onset atrial fibrillation after noncardiothoracic surgery. Postoperative atrial fibrillation developed after a median of 2 days after the noncardiothoracic surgery and was associated with a longer hospitalization and increased in-hospital mortality. Four (13.3%) patients died and the causes of death were non-cardiovascular events such as pneumonia or hemorrhage. Conclusion: Postoperative atrial fibrillation after noncardiothoracic surgery is a rare complication and is associated with older age and emergency operations. Patients who develop atrial fibrillation have longer hospitalizations and higher in-hospital mortality rates.
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Left Atrial Mass with Stalk: Thrombus or Myxoma?
장경희,신대희,이창근,장진근,정상식,유상용 한국심초음파학회 2010 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.18 No.4
A 63-year-old female was presented to emergency room with an abdominal pain. The patient had moderate mitral valve stenosis and atrial fibrillation. Abdominal computed tomography revealed right renal infarction. Transthoracic echocardiography showed a large mobile mass in the left atrium. Transesophageal two-and three-dimensional echocardiography showed a large mobile ovoid mass with a narrow stalk attached to the left atrial septum. It was thought to be a myxoma rather than thrombus. Anticoagulation with heparin was continued. When the operation was performed, there was no mass in the left atrium. It must be a thrombus and melt away.
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