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김성순,조승연,정남식,장양수,심원흠,하종원,박윤수,권기환 대한내과학회 2000 대한내과학회지 Vol.58 No.3
Background : Pulmonary embolism is a relatively common disease but may also be manifestated as a lethal disease. Most previous studies on pulmonary embolism included hemodynamically stable patients who were able to tolerate a confirmative diagnostic workup, including ventilation-perfusion lung scan or pulmonary angiography. However, in most cases of acute massive pulmonary embolism, patients are unstable to tolerate a confirmative diagnostic workup. Studies of only stable patients with pulmonary embolism may have a bias on evaluating the clinical course and prognosis of pulmonary embolism. Therefore, we designed a study to observe the clinical manifestations, diagnostic methods, treatment modality, and to investigate the prognostic factors of patients with acute pulmonary embolism who present with overt or impending right heart failure using the diagnostic criteria suggested by MAPPET study. Methods : Among 103 patients diagnosed as pulmonary embolism from 1990 to 1997, 63 patients(male/female : 21/42, mean age : 56 15) were enrolled as acute major pulmonary embolism by MAPPET's diagnostic criteria. Patients were included in the study if they showed clinical, echocardiographic and cardiac catheterization findings signifying acute right heart failure or pulmonary hypertension due to pulmonary embolism, together with: 1) a diagnostic pulmonary angiogram, or 2) a lung scan indicating high probability of pulmonary embolism, or 3) at least 3 of the followings: ① syncope; ② tachycardia (heart rate $gt; 100 beats /min); ③ dyspnea or tachypnea ($gt; 24 breaths/min or need for mechanical ventilation); ④ arterial hypoxemia (partial arterial pressure of oxygen $lt; 70mmHg while breathing room air) in the absence of pulmonary infiltrates on chest x-ray; ⑤ ECG signs of right heart strain. Results : Among the 63 patients, 15 patients(23.8%) did not have an underlying disease. Eleven patients(17.5%) had malignancy, 8 patients had an operation in the recent 20 days, 6 patients had chronic pulmonary disease, 5 patients had a history ngestive heart failure and cerebrovascular accident respectively, 4 patients had a previous history of pulmonary embolism, 3 patients had vasculitis such as Behcets' disease and systemic lupus erythematosus and a history of venous thrombosis, respectively. The main clinical manifestation on the time of diagnosis was dypnea in 55 patients(87.3%), which was the most frequent, and chest pain in 18 patients(28.6%), syncope in 10 patients(15.9%), and tachycardia in 2 patients(3.2%). The diagnostic methods were echocardiography(43 patients, 68.3%), lung perfusion scan(39 patients, 61.9%), chest computed tomography(16 patients, 26.4%), pulmonary angiography(4 patients, 6.3%) and right heart catherization(2 patients, 3.2%). In order to examine deep vein thrombosis, lower extremity Duplex ultrusonography and venography were performed in 11 patients(17.5%) and 7 patients(11.1%) respectively. The overall in-hospital mortality was 38.1%(24 patients). The factors influencing in-hospital mortality were associated malignancy(p$lt;0.01) and unstable vital sign(systolic blood pressure of less than 90mmHg)(p$lt;0.05). Conclusion : Acute pulmonary embolism with overt or impending right heart failure is a significant lethal disease with a high in-hospital mortality. The predictors of mortality were associated malignancy and unstable vital sign.(Korean J Med 58:293-300, 2000)
홍관표,이성동,김왕수,정종일,장하종,정혁,한세준 朝鮮大學校 附設 醫學硏究所 1991 The Medical Journal of Chosun University Vol.16 No.1
This study was undertaken for the clinical evaluation and statistical analysis on the 38 cases of placenta previa who were admitted and treated from March 1, 1988 to Feb. 28, 1991. The results were as follows : 1. The incidence of placenta previa was one per 53 deliveries or 1.90% 2. There were 57.9 % total placenta previa, 21.1 % partial placenta previa, 13.1 % low-lying placenta previa and 7.9% marginal placenta previa. 3. Placenta previa has occured more often in multipara (63.2%) than primigravida 4. More than one-third (38.8%) cases of placenta previa had delayed admission until labor occured for some time following vaginal spotting has first time been noticed. More instructive prenatal education should be emphasized 5. Lower segment transverse section rate was 63.2%, classical cesarean section rate was 15.8% and cesarean hysterectomy was 9.8%. The rest of them were treated by vaginal deliveries of 5 cases(13.2%) 6. The perinatal loss associated with placenta previa was considered still higher : the premature death was 15.8% and term death was 2.6%. The problem of prevention of prematurity still remains to be studied. 7. There was no maternal mortality in our study
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김성순,조승연,최동훈,정남식,장양수,심원흠,하종원,정보영,안신기,임세중 대한내과학회 2000 대한내과학회지 Vol.59 No.1
Background : The purpose of this study was to evaluate risk factors, angiographic characteristics and long-term prognosis of young adults with myocardial infarction(MI). Methods : Of the 2,680 patients with a history of MI, there were 148 patients 40 years old(Group 1). Risk factors, angiographic characteristics, cardiac events and long-term prognosis of group 1 were compared with those of randomly selected 149 patients between 41 years to 70 years old(Group 2) for a mean follow-up duration of 38 months(1∼147 months). Cardiac events include death, reinfarction, coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, congestive heart failure, stroke, and angina. Results : Smoker and male gender were more frequent in group 1(p$lt;0.001). In group 2, hypertension and diabetes were more frequently observed(p$lt;0.001). Angiographically normal coronary arteries, nonobstructive disease($lt;70% stenosis) and single-vessel disease were more frequent in group 1 than those in group 2 (p$lt;0.001). There ws no significant difference of overall survival at 7 years between the two groups(group 1; 95%, group 2; 89%, p$gt;0.05). If hospital deaths were excluded, the 7-year survival was better in group 1(group 1; 99%, group 2; 92%, p$lt;0.01). The cardiac event free survial at 7 years was not different between two groups(p$gt;0.05). Although a better left ventricular(LV) systolic function (ejection fraction(EF) 40%) showed more favorable survival in group 2(EF40%: 94%, EF$lt;40%: 80%, p$lt;0.05), survival was not influenced by LV systolic function in group 1. Conclusion : Young patients with MI have a more favorable long-term survival after discharge compared with that of the older patients regardless of LV systolic function. Cardiac event free survival was, however, not different between two groups.(Korean J Med 59:30-39, 2000)