Effects of adriamycin and candesartan on the collagen and elastin of the aorta in rats

엄재선,정우백,윤정숙,오용석,윤호중 대한고혈압학회 2014 Clinical Hypertension Vol.20 No.-

Introduction: It has been reported that the chemotherapeutic agent, adriamycin, not only has an effect on the myocardium but also on the arteries. The aim of this study is to elucidate effects of adriamycin and an angiotensin receptor blocker, candesartan, on collagen and elastin of the aorta in rats. Methods: Twenty four male 8-week-old Wistar-Kyoto rats were divided into four groups: control (C) group, adriamycin-treated (AD) group, candesartan-treated (CA) group, and adriamycin- and candesartan-treated (AD + CA) group. Adriamycin of 2.5 mg/kg/wk was administered intraperitoneally one time per week for 6 weeks, and candesartan of 10 mg/kg/day was administered orally everyday for 6 weeks. After 6 weeks, the rats were sacrificed and the aortas were harvested. Hematoxylin-eosin staining, Verhoff’s elastic, and Goldner’s trichrome staining were performed for histopathologic analyses. Tunica media thickness, collagen, and elastic area fractions were measured quantitatively with a computerized digital image analyzer. Results: Tunica media thickness in the CA and AD + CA groups was significantly lesser than that in the C and AD groups, respectively. The AD and AD + CA groups had a tendency of lower elastin area fraction than the C and CA groups, respectively. Collagen area fraction in the AD + CA group was significantly lower than that in the AD group. There were no significant differences of collagen/elastin ratio between groups. Conclusions: These findings suggest that adriamycin has a tendency of decreasing the quantity of elastin fibers and candesartan cannot mitigate the effects of adriamycin on elastin fibers.

Long-Term Prognosis of Patients with an Implantable Cardioverter-Defibrillator in Korea

엄재선,정보영,김태훈,김인철,박영아,신동금,임영민,유희태,양필성,박희남,강석민,이문형 연세대학교의과대학 2017 Yonsei medical journal Vol.58 No.3

Purpose: The objective of this study was to elucidate the long-term prognosis of patients with implantable cardioverter-defibrillators(ICDs) in Korea. Materials and Methods: We enrolled 405 patients (age, 57.7±16.7 years; 311 men) who had undergone ICD implantation. The patients were divided into three groups: heart failure (HF) and ICD for primary (group 1, n=118) and secondary prevention (group 2, n=93) and non-HF (group 3, n=194). We compared appropriate and inappropriate ICD therapy delivery among the groups and between high- (heart rate ≥200 /min) and low-rate (<200 /min) ICD therapy zones. Results: During the follow-up period (58.9±49.8 months), the annual appropriate ICD therapy rate was higher in group 2 (10.4%) than in groups 1 and 3 (6.1% and 5.9%, respectively, p<0.001). There were no significant differences in annual inappropriate ICD therapy rate among the three groups. In group 1, the annual appropriate ICD therapy rate was significantly lower in patients with a high-rate versus a low-rate therapy zone (4.5% and 9.6%, respectively, p=0.026). In group 3, the annual inappropriate ICD therapyrate was significantly lower in patients with a high-rate versus a low-rate therapy zone (3.1% and 4.0%, respectively, p=0.048). Conclusion: Appropriate ICD therapy rates are not low in Korean patients with ICD, relative to prior large-scale studies in Westerncountries. Appropriate and inappropriate ICD therapy could be reduced by a high-rate therapy zone in patients with HF and ICD for primary prevention, as well as non-HF patients, respectively.

Comparison of Clinical and Imaging Characteristics and Outcomes between Provoked and Unprovoked Acute Pulmonary Embolism in Koreans

엄재선,정해억,Chan-Joon Kim,김태훈,윤호중,백상홍,정욱성,승기배 대한의학회 2012 Journal of Korean medical science Vol.27 No.11

This study was performed to compare clinical and imaging parameters and prognosis of unprovoked pulmonary embolism (PE), provoked PE with reversible risk factors (provokedrRF),and provoked PE with irreversible risk factors (provoked-iRF) in Koreans. Three hundred consecutive patients (mean age, 63.6 ± 15.0 yr; 42.8% male) diagnosed with acute PE were included. The patients were classified into 3 groups; unprovoked PE,provoked-rRF, and provoked-iRF; 43.7%, 14.7%, and 41.7%, respectively. We followed up the patients for 25.4 ± 33.7 months. Composite endpoint was all-cause mortality and recurrent PE. The provoked-iRF group had significantly higher all-cause mortality,mortality from PE and recurrent PE than the unprovoked and provoked-rRF groups (P < 0.001, P < 0.001, and P = 0.034, respectively). Prognostic factors of composite endpoint in the unprovoked group were high creatinine ( > 1.2 mg/dL; P < 0.001; hazard ratio [HR], 4.735; 95% confidence interval [CI], 1.845-12.152), C-reactive protein (CRP;> 5 mg/L; P = 0.002; HR, 5.308; 95% CI, 1.824-15.447) and computed tomography (CT)obstruction index (P = 0.034; HR, 1.090; 95% CI, 1.006-1.181). In conclusion, provokediRF has a poorer prognosis than unprovoked PE and provoked-rRF. Renal insufficiency,high CRP, and CT obstruction index are poor prognostic factors in unprovoked PE.

Positive Result in the Early Passive Phase of the Tilt-table Test: A Predictor of Neurocardiogenic Syncope in Young Men

엄재선,윤호중,정우백,최윤석,박철수,오용석,정욱성,박경일,김태석 대한내과학회 2012 The Korean Journal of Internal Medicine Vol.27 No.1

Background/Aims: This study elucidated the prognostic factors for neurocardiogenic syncope in males in their late teens and early twenties. Methods: Tilt-table testing (TTT) was performed on 665 males (age range, 17 to 27 years) following the Italian protocol. The subjects were tilted head-up at a 70° angle on a table for 30 minutes during the passive phase. If the passive phase was negative, the subjects were given sublingual nitroglycerin and tilted to the same angle for 20 minutes during the drugprovocation phase. The subjects with positive results were followed without medication. We analyzed factors related to the recurrence rate of syncope. Results: Of 305 subjects (45.8%) with positive results, 223 (age range, 18 to 26 years) were followed for 12 months. The frequency of previous syncopal episodes ≥ 4 (p = 0.001) and a positive result during the passive phase (p = 0.022) were significantly related to a high recurrence rate. A positive result during the early passive phase (≤ 12 minutes) was significantly related to a higher recurrence rate than was that during the late passive phase (> 12 minutes; p = 0.011). Conclusions: A positive result during the early passive phase of TTT and frequent previous syncopal episodes were prognostic factors for neurocardiogenic syncope in men in their late teens and early twenties. Background/Aims: This study elucidated the prognostic factors for neurocardiogenic syncope in males in their late teens and early twenties. Methods: Tilt-table testing (TTT) was performed on 665 males (age range, 17 to 27 years) following the Italian protocol. The subjects were tilted head-up at a 70° angle on a table for 30 minutes during the passive phase. If the passive phase was negative, the subjects were given sublingual nitroglycerin and tilted to the same angle for 20 minutes during the drugprovocation phase. The subjects with positive results were followed without medication. We analyzed factors related to the recurrence rate of syncope. Results: Of 305 subjects (45.8%) with positive results, 223 (age range, 18 to 26 years) were followed for 12 months. The frequency of previous syncopal episodes ≥ 4 (p = 0.001) and a positive result during the passive phase (p = 0.022) were significantly related to a high recurrence rate. A positive result during the early passive phase (≤ 12 minutes) was significantly related to a higher recurrence rate than was that during the late passive phase (> 12 minutes; p = 0.011). Conclusions: A positive result during the early passive phase of TTT and frequent previous syncopal episodes were prognostic factors for neurocardiogenic syncope in men in their late teens and early twenties.

Safety and Efficacy of Switching Anticoagulation to Aspirin Three Months after Successful Radiofrequency Catheter Ablation of Atrial Fibrillation

엄재선,박희남,원호윤,정보영,남기병,최기준,이문형,김유호 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.5

Purpose: Although current guidelines recommend continuing the same antithromboticstrategy regardless of rhythm control after radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF), anticoagulation has a risk of major bleeding. We evaluated the safety of switching warfarin to aspirin in patients with successful AF ablation. Materials and Methods: Among 721 patients who underwent RFCA of AF, 608 patients (age, 57.3±10.9 years; 77.0% male, 75.5% paroxysmal AF) who had no evidence of AF recurrence at 3 months post-RFCA were included. We comparedthe thromboembolic and hemorrhagic events in patients for whom warfarin was switched to aspirin (ASA group; n=296) and patients who were kept on warfarin therapy (W group; n=312). Results: There were no significant differences in CHA2DS2-VASc or HAS-BLED scores between the groups. In 30 patients in the ASA group and 37 patients in W group, AF recurred and warfarin was restarted or maintained during the 18.0±12.2 months of follow-up. There were no significant differencesin thromboembolic (0.3% vs. 1.0%, p=0.342) and major bleeding incidences(0.7% vs. 0.6%, p=0.958) between ASA and W groups during the follow-up period. In the 259 patients with a CHA2DS2-VASc score ≥2, there were no significant differences in thromboembolism (0.8% and 2.2%, p=0.380) or major bleeding incidences(0.8% and 1.4%, p=0.640) between ASA and W groups. Conclusion: Switching warfarin to aspirin 3 months after successful RFCA of AF could be as safe and efficacious as long-term anticoagulation even in patients with CHA2DS2-VASc score ≥2. However, strict rhythm monitoring cannot be overemphasized.

Left Ventricular End-Systolic Volume Can Predict 1-Year Hierarchical Clinical Composite End Point in Patients with Cardiac Resynchronization Therapy

엄재선,오재원,조인정,박민수,김인수,진무년,배한준,유희태,김태훈,박희남,이문형,정보영,강석민 연세대학교의과대학 2019 Yonsei medical journal Vol.60 No.1

Purpose: This study aimed to elucidate which echocardiographic criteria at three time points, for cardiac resynchronization therapy(CRT) response, are accurate in discriminating the hierarchical clinical composite end point (HCCEP). Materials and Methods: We included 120 patients (age, 66.1±12.6 years; men, 54.2%) who underwent CRT implantation for heartfailure (HF). Echocardiography was performed before and at 3, 6, and 12 months after CRT implantation. The 1-year HCCEP includedall-cause mortality, hospitalization for HF, and New York Heart Association functional class for 12 months. CRT responsecriteria were decrease in left ventricular (LV) end-systolic volume (LVESV) >15%, decrease in LV end-diastolic volume >15%, absoluteincrease in LV ejection fraction (LVEF) ≥5%, relative increase in LVEF ≥15%, and decrease in mitral regurgitation ≥1 grade. Temporal changes in CRT response rates, accuracy of CRT response criteria at each time and cutoff value for the discriminationof improvement in HCCEP, and agreements with improvement in HCCEP were analyzed. Results: HCCEP improvement rates were 65.8% in total group. In nonischemic group, CRT response rates according to all echocardiographiccriteria significantly increased with time. In ischemic group, CRT response rate did not significantly change withtime. In total group, ΔLVESV at 6 months (ΔLVESV6) had the most significant accuracy for the discrimination of HCCEP (areaunder the curve=0.781). The optimal cutoff value of ΔLVESV6 was 13.5% (sensitivity=0.719, specificity=0.719). ΔLVESV6 had fairagreement with HCCEP (κ=0.391, p<0.001). Conclusion: ΔLVESV6 is the most useful echocardiographic CRT response criterion for the prediction of 1-year HCCEP.

Adriamycin Deteriorates Myocardial Fibrosis in Hypertensive Heart

엄재선,윤호중,김지훈,박철수,임상현,이종민,조은주,전희경,정해억,오용석,정욱성,승기배,김재형,최규보,홍순조 대한내과학회 2004 대한내과학회 추계학술대회 Vol.2004 No.1

Erratum to: Effects of adriamycin and candesartan on the collagen and elastin of the aorta in rats

엄재선,정우백,윤정숙,오영석,윤호중 대한고혈압학회 2015 Clinical Hypertension Vol.21 No.11

A Case of Skin and Soft Tissue InfectionCaused by Non-O1, Non-O139 Vibrio choleraein a Patient with Liver Cirrhosis

엄재선,오병선,이승환,김상일,김양리,박연준,강문원 대한감염학회 2005 Infection and Chemotherapy Vol.37 No.2

Non-O1, non-O139 Vibrio cholerae usually causes gastroenteritis and bacteremia. It can also cause skin and soft tissue infection but the incidence is very rare. Patients who have been reported to have skin and soft tissue infection caused by non-O1, non-O139 V. cholerae had liver cirrhosis or chronic hepatitis. We present here a case of skin and soft tissue infection caused by non-O1, non- O139 V. cholerae in a patient with liver cirrhosis in Korea. After treatment of cefotaxime, doxycycline and debridement, the wound was clinically improved. This case suggests that non-O1, non-O139 V. cholerae infection should also be considered in addition to V. vulnificus infection when skin and soft tissue infections occurs in patients with liver cirrhosis, especially if they have had seawater or seafood exposure. Non-O1, non-O139 Vibrio cholerae는 위장관염 또는 균혈증을 발생시키고, 매우 드물게 피부 및 연부조직 감염을 일으킨다. Non-O1, non-O139 V. cholerae에 의한 피부 및 연부조직 감염 환자는 대부분 간경변증 또는 만성 간염을 가지고 있는 것으로 보고되고 있다. 저자들은 간견병증 환자에서 해산물을 섭취한 후 발생한, non-O1, non-O139 V. cholerae에 의한 피부 및 연부조직 감염의 증례를 보고하는 바이다. 환자의 경우 cefotaxime, doxycycline 등 항생제 투여와 괴사조직 제거술 후 회복되었다. 따라서 간경변증 환자에서 해산물 또는 바닷물에 노출된 후 발생한 피부 및 연부조직 감염의 경우 V. vulnificus에 의한 감염뿐만 아니라 non-O1, non-O139 V. cholerae에 의한 감염도 고려해야 한다.

포스타 전시 발표 : 감염,알레르기 ; 간경변증 환자에서 발생한 non-O1, 139 Vibrio cholerae에 의한 피부 및 연부조직 감염

엄재선,오병선,김상일,김양리,박연준,강문원 대한내과학회 2004 대한내과학회 추계학술대회 Vol.2004 No.1