폐동맥 색전증 환자의 임상적 소견의 관찰 : 심전도 및 심초음파를 중심으로

심규혁,김성구 순천향의학연구소 2000 Journal of Soonchunhyang Medical Science Vol.6 No.2

Purpose: The purpose of this investigation is to determine the characteristics of the history, laboratory findings, perfusion lung scans, and angiographys in patients with pulmonary embolism and to analyze the value of the electrocardiogram for the diagnosis of pulomary embolism Background: Pulmonary embolism is a major cause of morbidity and death in hospital, but, it remains a common condition that is both severe and difficult to diagnose. While the "gold standard" for diagnosis of pulmonary embolism remains selective pulmonary angiography and its sensitivity and specificty are very high, it is not frequently used, and its diagnosis in the clinical practice is far below the actual incidence. We suppose that the gap between frequency of diagnosis and actual incidence is mainly due to missed suspicion and lack of early diagnostic tool in screening for pulmonary embolism. Methods: Retrospective review of 55 inpatients with pulmonary embolism from January, 1995 to December, 1999 was performed. For diagnosis of Pulmonary embolism, clinical suspicion, aBGA, ECG, echocardiogram, perfusion lung scan, and angiography were performed and reviewed literatures. Results: Median age was 52.2 years old with range of 20-86. Dyspnea was the most common symptom, 39 do 55(70.9%), followed by chest pain, 38 of 55(69.1%). Hypoxemia(PaO2<60mmHg) was observed in 11 of 26(42.3%), and perfusion defect in 49 of 52(94.2%). Angiography was performed in only 8, and abnormality has shown in 7(87.5%). The most frequent changes of ECG signs was S wave in leadⅠ, aVL(50.9%), Q wave in lead Ⅲ, aVF(49.1%). There was a strong correllation between S1Q3 and right ventricular diastolic dimension (p<0.02) by echocardiography, Conclusions: Lung perfusion scan and pulmonary angiogram are the gold standard for diagnosis of pulmonary embolism. But, they are invasive, expensive, and difficult for and emergency situation. Hence, inspite of the low sensitivity and specificity for diagnosis, electrocardiogram and echocardiogram which is easy to perform rapidly should be done for the early diagnosis and treatment of pulmonary embolism.

허혈성 심질환에서 염증지표에 관한 연구

번정득,권영주,박상호,한대희,이상철,강진환,김명구,심규혁,최병조,온영근,현민수,김성구 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.2

Background : Atherosclerosis is the chief underlying cause of ischemic heart disease and there is increasing evidence that inflammation is an important determinant of the development of atherosclerosis. We assessed the levels of inflammatory markers in patients with ischemic heart disease and normal group who has normal coronary angiograms. Materials and Methods : Coronary angiography was performed in 142 patients. 107 patients of ischemic heart disease(stable angina pectoris 58, unstable angina pectoris 30, Acute myocardial infarction 19) and 38 normal control subjects. We assessed the level of inflammatory markers, such as CRP, ESR, fibrinogen and leukocyte. Results : CRP, ESR and fibrinogen values of the patients with stable angina pectoris and unstable angina pectoris were higher than that of normal control group, but there were no statistical significance. Leukocyte value of the patients with unstable angina pectoris(9003.3±701.5/mm^(3)) was significantly higher than that of the patients with stable angina pectoris(6685.5±245.8/mm^(3)) and normal control subjects(6394.3±235.1/mm^(3)). CRP, ESR and fibrinogen values of the patients with acute myocardial infarction were also higher than that of normal control subjects. CRP was 3.88±2.05 mg/dL in acute mocardial infarction group, and 0.29±0.15 mg/dL in normal control subject group(p<0.05). Fibrinogen was 541.6±45.1 mg/dL in acute myocardial infarction group, 321.4±25.6 mg/dL in normal control subject group(p<0.05). Leukocyte was 10942.1±737.6/mm^(3) in acute myocardial infarction group, 6394.3±235.1/mm^(3) in normal control subject group(p<0.05). Conclusions : This study demonstrate that CRP, fibrinogen and leukocyte values of acute myocardial infarction group were significantly higher than that of control group and stable, unstable argina pectoris group. Leucokyte values were significantly elevated in unstable angina group, but CRP values were not in unstable angina group.

만성 심부전환자의 혈액에서 측정한 Tumor necrosis factor-α 및 Interleukin-6의 임상적 의의

김명구,김성구,박상호,한대희,강진환,변정득,심규혁,최병조,방덕원,온영근,현민수,권영주 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.2

Background and objectives: Many conditions are responsible for the pathophysiology and progressive mechanisms of congestive heart failure. More recently, it has also become evidence that another class of biologycally activated molecules generically reffered to as cytokine these are also over expressed in congestive heart failure. Therefore, the purpose of this study was to measure concentrations of tumor necrosis factor-α(TNF-α), interleukin-6(IL-6) in mild to severe symptoms of heart failure and compare their values with those found in normal control and analysed correlation relationship between cytokine level, clinical findings and hemodynamic indicies. Subjects and Methodology: Levels of TNF-α and IL-6 were measured on pulmonary artery during cardiac catheterization in heart failure patients(n=32) and normal subjects(n=8) as well as physical examination and echocardiogram. Cytokines assay were performed on plasma using commercially available ELISA(Enazyme-Linked Immunosorbent Assay) kits. Results: Although the levels of TNF-α and IL-6 tend to increase in congestive heart failure group, the cytokines level was not made significantly statistical difference between congestive heart failure group and controls. When analyzing the correlation between the levels of PCWP(pulmonary capillary wedge pressure) and cytokines(TNF-α, IL-6), respectively, there were statistically significant correlation coefficient 0.32,(p<0.05), 0.39(p<0.01). The cytokine IL-6 and pressure of pulmonary artery were significant correlation.(correlation coefficient 0.36, p<0.02) More significantly, there was correlated with TNF-α and IL-6.(correlation coefficient 0.57, p<0.001) Conclusions: There was tended toward high concentration of TNF-α & IL-6 in congestive heart failure and significant difference for PCWP between TNF-α & IL-6, thus may be correlated with development and progression in congestive heart failure.

천식환자에서의 객담내의 뮤신의 변화에 관한 연구

김도진,박진,이상철,윤여일,이주영,황의원,김용현,임현진,정재화,심규혁,어수택,김용훈,박춘식 대한천식 및 알레르기학회 ( 구 대한알레르기학회 ) 1999 춘계학술대회 초록집 Vol.1999 No.-

천식환자의 급성발작시 객담의 세포성상 분석과 치료에 따른 염증세포의 변화에 관한 연구

김도진,박진,이상철,윤여일,이주영,황의원,김용현,임현진,정재화,심규혁,어수택,김용훈,박춘식 대한천식 및 알레르기학회 ( 구 대한알레르기학회 ) 1999 춘계학술대회 초록집 Vol.1999 No.-

관상동맥 질환자에서 Nicorandil의 폐동맥 투여 후 혈역학적 변화에 관한 연구

최병조,김성구,한대희,박상호,방덕원,강진환,김명구,변정득,심규혁,온영근,현민수,권영주 대한순환기학회 2001 Korean Circulation Journal Vol.31 No.12

관상동맥질환 환자에서 스텐트 시술 후 재협착에 관한 연구

강진환,권영주,박상호,한대희,이상철,김명구,변정득,최병조,심규혁,온영근,현민수,김성구 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.2

Background and aims : In the coronary artery disease, a rate of restenosis was much decreased by placement of coronary stent than when percutaneous transluminal coronary angioplasty has been applied, but there are still important clinical problems of restenosis. There has been many progressive studies about various factors contributed to this restenosis. So, we studied a relation between restenosis after placement of coronary stent in the coronary artery disease and many clinical factors, characteristics of stenotic lesion and procedural factors, and also assessed the restenosis rate of various coronary stents. Methods : Total 58 lesions(46 cases of patients ; man 30, woman 16) were evaluated, which has been performed a follow-up coronary angiography after 6 months (mean 188 days) since coronary stent had been placed. Various stents were implanted and assessed a relation between restenosis and many factors. Results : Of 58 lesions were target stenotic studies, there were 22 of restenotic lesions(37.9%), and the restenosis rate wes statistically significant difference in the relation with diabetes mellitus(p<0.05), group of acute myocardial infarction(p<0.05) among clinical diagnosis of ischemic heart disease(stable angina, unstable angina and acute myocardial infarction) in clinical factors and with high dilation pressure of stent(p<0.05) in procedural factors. When the rate of restenosis was evaluated among implanted stents, it was lowest in the Multilink^(®) stent and highest in the Nir Royal^(®) stent(60%). Conclusion : In this study of restenosis and various factors after placement of stents in the coronary artety disease, factors such as diabetes mellitus, group of acute myocardial infarction and a dilation pressure of stent were significant related with restenosis and the restenosis rate of Multilink^(®) stent was lowest and the highest restenosis rate was of Nir Royal^(®) stent.