급성 심근경색 환자에서 심전도상 ST 분절 상호 하강(reciprocal depression)의 임상적 의의 : 심근경색 후 경과시간에 따른 분석

장혁재 ( Hyuk Jae Chang ),박인휘 ( In Whee Park ),김정은 ( Jung Eun Kim ),이종우 ( Jong Woo Lee ),최소연 ( So Yeon Choi ),황교승 ( Gyo Seung Hwang ),윤명호 ( Myeong Ho Yoon ),신준한 ( Joon Han Shin ),탁승제 ( Seung Jea Tahk ),최 대한내과학회 2003 대한내과학회지 Vol.64 No.1

배경 : 급성 심근경색 환자에서 관찰되는 초기 심전도상의 ST 분절 상호 하강의 임상적 의의를 알아보고 특히 심근경색 발생 후 심전도 기록까지 걸린 시간에 따라 ST 분절 상호 하강의 의의가 차이를 보이는지 알아보고자 하였다. 방법 : 1999년 1월에서 2001년 5월 사이 진단받고 심전도상 ST 분절의 상승이 있었으며, 관동맥 조영술을 받은 급성 심근경색 환자 198명을 대상으로 하였다. 이들을 심근경색 부위에 따라 구분하였으며 심전도상 ST 분절 Background : To investigate the clinical significance of reciprocal ST segment depression on the presenting electrocardiogram (ECG) in patients with acute myocardial infarction (MI), in particular, this study focuses whether there is any difference accord

심장외막지방과 대사 증후군 및 심혈관 질환 위험인자와의 연관성

백승희 ( Seung Hee Baik ),안성균 ( Sung Gyun Ahn ),최정현 ( Jung Hyun Choi ),고보람 ( Bo Ram Koh ),유준환 ( Jun Hwan Yoo ),강수진 ( Soo Jin Kang ),최병주 ( Byoung Joo Choi ),최소연 ( So Yeon Choi ),윤명호 ( Myeong Ho Yoon ),탁승제 대한내과학회 2007 대한내과학회지 Vol.72 No.3

목적: 저자 등은 1) 심장외막지방과 대사 증후군과의 연관성과 2) 심혈관 질환의 위험인자와의 상관관계를 알아보고 3) 심장외막지방과 인슐린 저항성 정도를 알아보고자 본 연구를 수행하였다. 방법: 흉통을 주소로 내원하여 처음 관동맥조영술을 시행 받은 289명을 대상으로 경흉부 심초음파을 이용한 심장외막지방의 두께 및 인체 계측, 혈청 총 콜레스테롤, 중성지방, 고밀도지단백 콜레스테롤, 저밀도지단백 콜레스테롤, 공복 시 혈당, 공복 시 인슐린, CRP, 섬유소(fibrinogen), 요산 등을 측정하였다. 결과: 1) 대사 증후군의 환자군(185명, 64%)에서 심장외막지방의 두께가 의미있게 두꺼웠다(평균 4.3±2.5 mm vs. 평균 3.6±2.8 mm, p=0.005). 2) 심장외막지방 두께의 중앙값인 3.4 mm을 기준으로 환자를 두 군으로 분류하여 심혈관 질환의 위험인자들을 비교해 보았을 때 두꺼운 군에서 대사 증후군 동반 빈도가 높고, 대사 증후군의 구성요소의 유병률이 높았으며. 나이, 허리둘레, 총 콜레스테롤, log CRP 등이 통계학적으로 의미 있게 높았고 고밀도지단백 콜레스테롤은 통계학적으로 의미있게 낮았다. 3) 대사 증후군의 여부에 따라 심장외막 지방의 ROC curve를 분석하여 심장외막지방의 두께 3.2 mm가에서 민감도 58%, 특이도 58%를 보여 가장 신뢰성 있는 cut-off 수치였다. 로지스틱 회귀 분석을 이용하여 심장외막지방의 두께가 0.1 mm 증가할 때마다 대사 증후군의 유병률이 1.78배 증가함을 알 수 있었다. 4) 나이, 허리둘레, 고밀도지단백 콜레스테롤, log CRP가 통계학적으로 의미있는 상관관계가 있었고. 이들 중 나이, log CRP는 다중 회귀 분석을 통하여 심장외막지방의 두께와 독립적으로 상관관계가 있었다. 5) 비 당뇨 환자군에서 인슐린 및 HOMA-IR score도 심장외막지방의 두께와 연관이 있었다. 결론: 경흉부 심초음파로 측정한 심장외막지방의 두께는 대사 증후군 및 심혈관 질환의 위험인자와 연관성을 보였고, 인슐린 저항성과도 관련성을 보여 앞으로 내장 지방의 새로운 지표로서 대사 증후군 및 심혈관 질환을 예측하는 새롭고 부가적인 유용한 지표가 될 수 있으리라 생각된다. Background: Increased adiposity is widely accepted as the main expression of obesity and an important risk factor for the development of cardiovascular and metabolic syndrome. The significance of epicardial adipose tissue (EAT), frequently observed during a transthoracic echocardiographic examination, is not well recognized. The purpose of this study was to investigate the relationship of EAT to metabolic syndrome and cardiovascular risk factors. Methods: We collected clinical, biochemical, and anthropometric information from 289 consecutive and prospective patients (147 men; 59±11 years) who visited our hospital for a complaint of chest pain. EAT thickness was measured by transthoracic echocardiography on the free wall of the right ventricle in the parasternal long axis and short axis views at the base level during end-diastole. Results: EAT thickness was significantly increased in 185 (64%) patients with metabolic syndrome as compared with patients without metabolic syndrome (4.3±2.5 mm vs. 3.6±2.8 mm, p=0.005). By a simple linear regression analysis, EAT was correlated to age (r=0.484, p<0.001), waist circumference (r=0.177, p=0.01), the level of HDL cholesterol (r=-0.182, p=0.001) and log CRP (r=0.268, p=0.012). Multivariate analysis showed that age and log CRP were the independent variables that correlated to EAT thickness. Conclusions: These results suggest that echocardiographic EAT should be considered as a new useful imaging indicator of visceral adipose tissue related to metabolic syndrome and cardiovascular disease. (Korean J Med 72:290-297, 2007)

참깨에서 추출한 Sesamin 섭취가 혈청 지질 농도에 미치는 영향

윤명호,신준한,김한수,탁승제,최병일 아주대학교 1997 아주의학 Vol.2 No.2

Objectives : High serum cholesterol is one of the major risk factors of coronary artery disease. We investigated the lipid-towering property and the side effects of sesamin, an unsaturated fatty add extracted from sesame oil, for the primary prevention of coronary artery disease. Methods : The 37 patients (20 mates and 17 females) with hyperlipidemia, ages ranging from 22 years to 70 years old (48±12), who did not have atherosderotic diseases except essential hypertension were given three capsules of sesamin once daily for 6 weeks. The lipid profile of the patients were examined before and after sesamin treatment, and the patients were grouped according to the presence or abscence of hypertension, smoking habit and obesity. Result : Compared with pretreatment, the total cholesterol level of sesamin treated group decreased significantly (254.2±29.6 versus 241.6 34.0 ㎎/dl, p< 0.05). The level of LDL-cholesterol (162.6±24.3 versus 156.6±32.8 ㎎/dl)HDL- cholesterol (47.5±10.0 versus 47.0±8.7 ㎎/dl) and triglyceride (196.5±95.4 versus 179.3±96.7 ㎎/dl) and the ratio of LDL/HDL- cholesterol (3.6±0.9 versus 3.4±0.9) were not significantly different. The effect of cholesterol lowering property of sesamin was predominant in hypertensive, non- smoking and obese group (P< 0.05 vs pretreatment). The laboratory tests including complete blood cell counts, serum transaminases, total protein, albumin, blood urea nitrogen, creatinine and blood glucose did not change significantly. Conclusion : The lipid lowering effect of sesamin was statistically significant on the total cholesterol particularly with obese, non-smoking and hypertensive patients. There was no significant side effect during sesamin administration. Therefore, three capsules of sesamin as a single daily dose were effective in lowering total cholesterol and safe to administer in patients with hyperlipidemia.

관상동맥내 스텐트 시술시 Aspirin과 Cilostazol 2개월 병합요법

윤명호,탁승제,염철훈,장혁재,최소연,유상용,안성균,고종훈,신준한,김한수,최병일 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.8

관동맥질환에서 관동맥 재형성과 관련되는 환자의 임상상 및 죽상반의 특성

염철훈,탁승제,윤명호,최소연,신준한,심한수,최병일,고종훈 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.8

대동정맥루가 병발한 비외상성 복부 대동맥류 1예

김명성,신준한,윤명호,김영준,김한수,탁승제,조윤경,최병일 대한내과학회 1997 대한내과학회지 Vol.53 No.3S

저자 등은 3년 전 매독을 앓고 치유된 매독환자에서 대동정맥루(Aotro-Caval fistula)를 동반한 복부 대동맥류(Abdominal aneurysm) 1예를 경험하였기에 이를 보고하는 바이다. Aorto-caval fistula(ACF) is a rare complication of abdominal aortic aneurysm(AAA). The incidence of ACF has been estimated about one per cent of all patients with AAA and four per cent in patients with ruptured aneurysm. Approximately 100 cases of ACF has been reported, since Syme reported the first case of ACF in 1831. ACF is divided into three types : the spontaneous(80%), the traumatic(15%), and the iatrogenic(5%). Even though most of the spontaneous fistulas are arteriosclerotic in origin, syphilis, connective tissue disease such as Marfan's disease and Ehlers-Danlos syndrome have been reported as causes of ACF. Surgery is the choice of treatment. Without surgical intervention, the condition is always fatal, even though operative mortality has ranged from 25 to 50%. Causes of death are high-output heart failure, venous hypertension and multi-organ circulatory failure. We report a case of 52 year old male patient with aorto-caval fistula, who had been treated for syphilis 3 years ago and had been complaining lower back pain for 3 months. Physical examination revealed 10×10㎝ sized pulsatile mass in periumbilical area. Blood pressures were 95/60㎜Hg on right arm, 130/50㎜Hg on left arm, l00/60㎜Hg on right leg, and not palpable on left leg. With the clinical suspicion of a aortic aneurysm, abdominal computed tomography was performed and showed 5cm sized aortic aneurysm just below renal arteries and extending to the aortic bifurcation. On abdominal aortography, contast media could be seen in inferior vena cava indicating aortocaval fistula. On operation, abdominal aneurysm was repaired by using Y-graft and 0.3㎝ sized fistula located above aortic bifurcation was closed by ligation. Patient recoverd without a significant complication after operation. Histopathology of the specimen showed medial necrosis associated with calcification, which appeared to be necrotizing vasculitis, often seen in syphilitic arteritis.

관동맥질환 환자에서 관동맥내 내막두께의 정도와 혈관저항과의 관계

최소연,탁승제,염철훈,윤명호,고종훈,신준한,김한수,최병일 대한순환기학회 2001 Korean Circulation Journal Vol.31 No.1