심장 점액종의 임상적 고찰

황의석(Eui Seock Hwang),김용석(Yong Seok Kim),최진오(Jin Oh Choi),채인호(In Ho Chae),손대원(Dae Won Sohn),김철호(Cheol Ho Kim),오병희(Byung Heui Oh),이명묵(Myoung Mook Lee),박영배(Young Bae Park),최윤식(Yun Shik Choi),이영우(Young Wo 대한내과학회 2002 대한내과학회지 Vol.62 No.1

N/A Background: Cardiac myxoma is uncommon, even though accounts for 50% of primary cardiac tumor, histologically benign disease but may be lethal because of its strategic position. It has diverse clinical manifestations mimicking various diseases, which can be described under the three headings: constitutional, obstructive and embolic and the diagnosis can be easily missed unless clinician has high index of suspicion. A correct diagnosis is made before operation with the development of echocardiography. We reviewed our clinical experience in diagnosis and management of 21 cases of myxomas from 1985 to 2000. Methods: There were 4 males (19%) and 17 females (81%). Their ages ranged from 17 to 66 years (mean 42.2 years). All the patient`s medical records on their clinical features, laboratory findings, chest X-rays, electrocardiograms, echocardiographic findings, operative findings and post operative follow-up were reviewed. Results: Seventeen cases (81%) of the myxomas originated in left atrium and four (19%) in right atrium. Most common symptom was that of intracardiac obstruction such as dyspnea or dyspnea on exertion (62%). Fatigue which accounted for most of the constitutional symptom found in 38% of the 21 patients while embolism accounted for 38%. In all patients, echocardiography was used for diagnosis and the diagnostic accuracy of echocardiography was 100%. All patient s received surgical treatment and immediate postoperative complications occurred in seven patients (33%). Among them, serious complications were found in two cases and one expired due to congestive heart failure. Follow-up duration ranged from 2 months to 15 year s. There was no recurrence or other problem in all patient s during the follow-up period. Conclusion: Although clinical suspicion is difficult due to the nonspecific presentation of myxoma, the diagnosis can be made easily with echocardiographic examination in all cases and surgical excision of myxoma may be curative with good long-term result.(Korean J Med 62:49-57, 2002)

고혈압의 임상적 고찰

이영우 ( Young Woo Lee ),이명묵 ( Myoung Mook Lee ),오병희 ( Byung Heui Oh ),서봉관 ( Bong Kwan Seo ),김치정 ( Chee Jeong Kim ),김성국 ( Seong Gook Kim ),유왕성 ( Wang Seoung Ryu ) 대한내과학회 1985 대한내과학회지 Vol.29 No.5

증례 : 양면성심에코도로 진단된 좌심실점액종 1 예 보고

이영우 ( Young Woo Lee ),서정돈 ( Jung Don Seo ),최윤식 ( Yun Sik Choi ),박정식 ( Jeong Sik Park ),오병희 ( Byung Heui Oh ),노준량 ( Joon Ryang Rho ) 대한내과학회 1981 대한내과학회지 Vol.24 No.7

성인연령에서의 수정대혈관전위증에 관한 임상적 고찰

이영우,김성국,이명묵,전은석,서정돈,오병희 대한내과학회 1986 대한내과학회지 Vol.30 No.5

A clinical observation was made on 17 patients with corrected transposition of the great arteries who visited Seoul National University Hospital during the period of Feb1979-May, 1985. 1) Sex distribution was 13 male and 4 female patients. 2) Age distribution was from 15 to 39 years old and mean age was 26 years old. 3) Symptoms were exertional dyspnea in 15 cases, cyanosis in 3 cases, palpitation, syncope, growth retardation and chest deformity. 4) On physical examination, cardiac murmurs were heard in all cases, and cyanosis and clubbings were noticed in 3 cases. 5) Situs inversus was noticed in 2 cases, dextrocardia in 4 cases and right sided aortic arch in one case by simple chest PA. 6) Electrocardiographic findings were biventricular hypertrophy in 3 cases, left ventricular hypertrophy in 5 cases and right ventricular hypertrophy in 3 cases. 1° AV block was noticed in 5 cases, complete AV block in 1 case and incomplete left bundle branch block in 1 case. Intraventricular conduction defect was observed in 2 cases, atrial fibrillation in 1 case and paroxysmal supraventricular tachycardia in 1 case. There was no septal Q wave in lead I, aVL and left precordial lead in 16 cases, but in one case the septal Q wave was observed in above leads. 7) C-TGA was diagnosed by echocardiography in 15 cases. 8) The diagnosis of C-TGA and it's associated anomalies were confirmed by cardiac catheterization and angiography in all cases, There were 2 cases of IDD type and 15 cases of SLL type C- TGA's. 9) The associated anomalies were tricuspid regurgitation in 8 cases, pulmonary stenosis in 8 cases, ventricular septal defect in 7 cases, atrial septal defect in 6 cases, mitral regurgitation in 2 cases, patent ductus arteriosus in 1 case and right-sided aortic arch in 1 case. There was one case who had no associated anomaly. 10) Operation was done in 4 cases, In the first case, the modified Fontan's operation was done. Ligation of PDA was done in the second case. The patch closure of VSD, primary closure of ASD and pulmonary valvotomy were done in the third case and additional replacement of tricuspid valve was done in the last case. The permanent pacemaker was inserted in one case who has complete AV block.

도관삽입을 이용한 심낭천자술에 관한 연구

이영우,김영권,이명묵,조명찬,최윤식,오병희 대한내과학회 1986 대한내과학회지 Vol.30 No.2

We reviewed a series of 75 pericardiocenteses, using an atraumatic indwelling catheter, comprising all those performed in the lntensive Care Unit from Jan. 1981 to Dec. 1984 and assessed the method, benefits and risks of pericardiocentesis. Pericardial fluid was obtained in 92 of the patients. Underlying diseases were as follow: neoplastic disease (52.0%), tuberculosis (21.4%), pyopericardium (8.0%), hemopericardium (5.3%), congestive heart failure (4.0%), primary idiopathic pericarditis (4.0%), rheumatic disease, chronic renal failure, postpericardiotomy syndrome, in order. Specific etiologic diagnosis of neoplasm, tuberculosis and pyoperioardium were made in 31 patients (41.3%) by the examination of the pericardial fluid. Chemotherapeutic agents were instillated to pericardial cavity through indwelling pericardial catheter in 24 patients. On the basis of the operative results, the patients were separated into three groups for comparison: successful pericardiocentesis (88.0%)-successful and sufficient pericardiocentesis (64,0%), successful and insufficient pericardiocentesis (24.0%); failed pericardiocentesis (8.0%); complicated pericardiocentesis (4.0%). Complications consisted of one death after right ventricular punture, one right ventricular punture without adverse sequelae, and one induced hemopericardium. Pericardiocentesis using indwelling catheter permits continuous pericardial drainage, obviating repeated aspirations; provides a convenient route for intrapericardial instillation of chemotherapeutic agents; and enables one to await the relults of diagnostic studies without sujecting a patient to surgery.

성인 EISENMENGER 증후군의 임상적 고찰 : 비관혈적 진단방법의 유용성에 대한 평가를 중심으로 With Appraisal of Usefulness of Noninvasive Diagnostic Methods

박영배,이영우,김영권,류왕성,조명찬,서정돈,오병희 대한내과학회 1986 대한내과학회지 Vol.30 No.2

A retrospective clinical study was done on 44 adult patients with Eisenmenger syndrome who had visited Seoul National University Hospital from February, 1979 to June, 1985 The result were as follows: 1) The underlying defect was a ventricular septal defect in 20: an atrial septal defect in 6; a patent ductus artericsus in 13; and combined lesions in 5. 2) There were 21 males and 23 females. The average age was 27. 3 year with the peak incidence in the third decade(24 patients). 3) The common symptoms were effort intolerance in 97.7%, hemoptysis in 28.2%, congestive heart failure in 28.2%, chest pain in 25.6%, squatting in 23.1%, and syncope in 10.3%. Cyanosis was observed in 87.5% and clubbing in 63.2%. 4) Cardiac catheterization was performed in 35 cases. Pulmonary artery preussre was elevated near to aortic pressure. Total pulmonary resistance increased markedly with the mean value of 20.0±5.0 units. Generally, shunts were bidirectional. 5) Radionuclide angiocardiographies were performed in 17 and contrastechocardiographies in 18 of 26 catheterized cases. Finding of right-to-left or bidirectional shunt, compatible with Eisenmenger physiology, was present in 5cases on the radionuclide angiocardiographies. Detection of a shunt by contrast echocardiography was fairly correct in 18 cases. It was suggested that noninvasive diagnostic methods including radionuclide angiocardiography and contrast echocardiography were very useful to confirm the adult Eisenmenger syndrome with a ventricular septal defect or a patent ductus arterisus without further invasive cardiac catheterization.

운동으로 유발되는 발적성 심실성빈맥에 관한 연구

이영우,김준수,송재관,이명묵,류왕성,최윤식,오병희 대한내과학회 1986 대한내과학회지 Vol.30 No.2

Exercise induced paroxysmal ventricular tachycardia is a rare condition and there has been little information on the electrophysiological mechanism or pharmacologic response of this arrhythmia, In this study, we investigated the electphysiological and pharmacologic characteristics of exercise-induced paroxymal ventricular tachycardia. The results are as follows: 1) The mean age of patients was 31 years. Four were males and two were females. 2) Underlying heart diseases were dilated cardiomyopathy in 2 cases, Ebstein`s anomaly in 1case, atrial septal defect in 1 caee, and nothing in 2 cases. 3) Common subjective symptoms during ventricular tachycardia were palpitation, dyspnea and syncope. 5) Electrocardiograms during attack showed left bundle branch block in all cases. Right axis deviation was noted in 3 cases, suggesting the origin of ventricular tachycardias in the right ventricular outflow tract. 5) During treadmil exercise test, ventricular tachycardia occurred at stage I in one case, at stage II in one case, at stage g in two cases, and at post-exereise 1 minute in two cases. 6) Electrophysiological studies were done in 4 cases. Ventricular tachycardia was induced with incremental atrial pacing, ventricular extrastimuli and rapid ventricular pacing in one case, with rapid ventricular pacing during isoproterenol infusion(2㎍/minute) in one case, and not inducible in two CRSCB. 7) Reta-blocker was most effective to prevent the attack of exercise-induced VT. Also verapamil was seemed to be effective.