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좌심방이 혈전을 동반한 승모판 협착증 환자에서 풍선판막성형술 : 경구항응고 요법과 경식도 초음파의 역할
정상식(Sang Sig Cheong),박승정(Seung Jung Park),송재관(Jae Kwan Song),홍명기(Myeong Ki Hong),강덕현(Duk Hyun Kang),김재중(Jae Joong Kim),박성욱(Seong Wook Park),이종구(Jong Koo Lee) 대한내과학회 1996 대한내과학회지 Vol.50 No.6
N/A Objectives: The presence of left atrial thrombi is believed to be a contraindication to balloon dilatation in mitral stenosis. The purpose of this study is to determine whether balloon valvuloplasty is possible in mitral stenosis patients with left atrial thrombi after oral anticoagulation therapy and to evaluate the evolution of left atrial thrombi with oral anticoagulation by transesophageal echocardiography. Methods: Prospective oral anticoagulation with warfarin has been started in tight mitral stenosis with left atrial thrombi. Regular follow up has been performed by transesophageal echocardiography to determine whether the left atrial appendage thrombi are resolved. Percutaneous balloon valvuloplasty has been performed after resolution of left atrial appendage thrombi with oral anticoagulation. Results: Fourteen patients were included in this study period. Nine patients(64%) had been performed balloon valvuloplasty after average 8month oral anticoagulation. Mitral valve replacement had been performed in 3(21%) patients due to renal embolism, menorrhagia and no change of left atrial appendage thrombi. There are two cases in decreasing thrombi size with oral anticoagulation, Conculsion: Left atrial appendage thrombi in mitral stenosis could be resolved in a high proportion after oral anticoagulation treatment, which has been followed by transesophageal echocardiography. Percutaneous mitral halloon valvuloplasty could be safe and effective treatment modality despite of the presence of left atrial appendge thrombi after oral anticoagulation therapy.
한국인에서 D-Dimer의 위양성과 관련된 인자와 검사의 정확도 향상을 위한 Cut-Off Value
홍만용 ( Man Yong Hong ),이창근 ( Chang Kun Lee ),유상용 ( Sang Yong Yoo ),신대희 ( Dae Hee Shin ),정상식 ( Sang Sig Cheong ),권장훈 ( Jang Hoon Kwon ),장우성 ( Woo Sung Jang ),유승진 ( Seung Jin Yoo ),오광훈 ( Kwang Hoon Oh ) 대한내과학회 2013 대한내과학회지 Vol.84 No.3
목적: 폐동맥 색전증과 심부 정맥 혈전증 이외에 D-dimer 검사의 양성 결과를 나타내는 여러 질환들이 보고되고 있으나, 현재까지 한국인에서 위양성을 유발하는 인자에 대해서는 명백하게 알려진 바가 없다. 따라서 한국인에서 위양성을 초래하는 인자들을 확인하고, 정확도를 향상시키기 위한 새로운 cut-off value를 제시하고자 한다. 방법: 2009년 1월부터 12월까지 본원에 방문한 환자 중 다양한 이유로 D-dimer 검사를 시행 받은 2,047명의 환자를 대상으로 분석하였고, 위양성을 유발하는 인자들을 확인하기 위해 오즈비와 95% 신뢰구간을 로지스틱 회귀분석을 이용하여 분석하였다. 새로운 cut-off value는 ROC curve를 이용하여 구하였다. 결과: 연령의 증가, 외상, 수술의 기왕력, 급성 감염, 결핵, 뇌혈관 질환, 악성종양, 만성 신부전, 급성 관동맥 증후군, 심부전, 호흡기 질환 등이 D-dimer 검사의 위양성을 유발하는 인자로 확인되었다. 또한 민감도와 특이도를 향상시키기 위해 ROC curve를 이용하여 구한 새로운 cut-off value는 0.68mg/L였다(65세 이하에서는 0.58 mg/L, 65세 이상에서는 0.77mg/L). 결론: 여러 인자들이 D-dimer 위양성과 관련이 있었으며, 임상에서 D-dimer 검사를 시행하고 임상에 적용할 때에는 이러한 인자들이 결과치에 영향을 줄 수 있음을 충분히 고려하여야겠다. Background/Aims: The D-dimer value is a simple blood test used to evaluate venous thromboembolism (VTE). However, due to its low specificity, another test is needed for a definite diagnosis, such as a radiographic test. We evaluate the factors associated with a false positive D-dimer test and propose a new cut-off value for detecting VTE more effectively in Koreans. Methods: This was a retrospective, observational study. From January 2009 to December 2009, 2,047 patients (988 men, 63 ± 15 years) had the D-dimer value checked to evaluate VTE. The main outcome of interest was a positive D-dimer test. Odds ratio and 95% confidence intervals were determined using logistic regression analysis. The new D-dimer cut-off was evaluated using receiver operating characteristics (ROC) curves. Results: The result was positive in 1,093 patients (53%), for a false positive percentage for VTE of 95% and a false negative percentage for VTE of 1%. Significant false positive predictors for a positive D-dimer were increasing age, trauma, postoperative, acute infection, tuberculosis, stroke, malignancy, chronic renal failure, acute coronary syndrome, heart failure, and lung disease. The discriminative value of the D-dimer test was assessed using ROC curve analysis. A D-dimer value of 0.68 mg/L on admission was the best cut-off value for predicting the development of VTE with a sensitivity of 95% and specificity of 57%. Conclusions: Many factors affect the D-dimer value and we must consider these factors before using the D-dimer value to evaluate VTE. A D-dimer value of 0.68 mg/L appears to be a good cut-off value for evaluating VTE more effectively in Koreans. (Korean J Med 2013;84:372-378)
증례 : 인공 대동맥 판막 기능 부전으로 나타난 과호산구 증후군 1예
최태혁 ( Tae Hyuck Choi ),이주용 ( Ju Yong Lee ),정상식 ( Sang Sig Cheong ),최윤석 ( Yoon Suck Choi ),홍현일 ( Hyun Il Hong ),박종빈 ( Chong Bin Park ),강길현 ( Gil Hyun Kang ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-
특발성 과호산구 증후군은 특별한 원인없이 호산구가 1500/㎣ 이상의 호산구 증가증이 6개월 이상 지속되고 다양한 기관의 침범으로 인한 증상과 증후를 보이는 질환이다. 저자들은 처음으로 인공 대동맥 판막을 침범하여 이의 기능 부전 유발한 특발성 과호산구 증후군 환자 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Idiopathic hypereosinophilic syndrome (HES) refers to a group of leukoproliferative disorders characterized by unexplained persistent eosinophilia associated with damage to several organ. Cardiac involvement is the major source of morbidity and mortality. There have been several case reports that showed various types of cardiac involvement including native or prosthetic valve dysfunction with this syndrome. However, there has been no report involved mechanical aortic valve. We, for the first time, report a case of a 58-year-old man with idiopathic hypereosinophilic syndrome manifested by prosthetic mechanical aortic valve dysfunction that was successfully treated by valvular replacement, steroid and hydroxyurea therapy.(Korean J Med 69:S974-S978, 2005)
승모판협착증에서 운동능력을 결정하는 혈역학적인 인자 ; Exercise Doppler Echocardiography 를 이용한 연구
송재관(Jae Kwan Song),강덕현(Duk Hyun Kang),이철환(Cheol Hwan Lee),이상곤(Sang Gon Lee),정상식(Sang Sig Cheong),홍명기(Myeong Ki Hong),김재중(Jae Joong Kim),박성욱(Seong Wook Park),박승정(Seung Jung Park),이종구(Jong Koo Lee) 대한내과학회 1996 대한내과학회지 Vol.51 No.5
N/A Objectives: Objective assessment of degree of functional impairment in patients with valvular heart disease is crucial in the clinical decision-making. The present study was designed to examine the use of formal exercise testing in the evaluation of mitral stenosis (MS) ancl to determine hemodynamic factors associated with exercise tolerance in patients with MS. Methods: In 37 patients with MS (26 females, age of 51±10yrs), Doppler measurement of transmitral gradient (MG) and pressure gradient between right ventricle and atrium using turbulent jets of tricuspid regurgitation (PGTR) was performed before and immediately after maximum symptom-limited treadmill exercise (EX) according to Bruce protocol. Results: Mean mitral valve area (MVA) was 0.97±0.33㎠ (0.5-1.9) and number of patients with severe MS (MVA<1.0㎠) were 25/37. TR was present in 35/37 at rest and immediately after EX, PGTR could be measured in 86% (32/37). Mean EX time was 422±188 sec (112-760) and MG increased from 11±5 to 27±10mmHg (p<0.001) and PGTR form 31±13 to 61±30mmHg (p<0.001). Using a linear regression, factors associated with prolonged EX time were male gender, increased mobility of leaflet, low MG, small pre- and post-EX TR jets, low pre-and post-EX PGI'R, and appropriate increase of heart rate during EX; among them, low post-EX PGTR (p=0.000) and heart rate increase with EX (p=0.005) were the significant independent factors. In patients with tight MS with average MVA of 0.8±0.15㎠, the range of PGTR increase with EX was from 10 to 100mmHg. Patients with post-EX PGTR more than 60mmHg had larger jets of TR at rest, and higher basal MG and pre-EX PGTR compared to the others. Conclusion: Exercise Doppler echocardiography is technically simple and an important addition to the noninvasive evaluation of patients with MS. Increase of PGTR with EX rather than MVA at rest per se is the important determining factors for EX capacity in patients with MS, and it can be predicted by severity of TR at rest and pre-EX PGTR.
관동맥연축에서 서방형 칼슘길항제인 Diltiazem 과 Verapamil 의 치료효과 : Ergonovine Echocardiography 를 이용한 무작위 비교 연구
송재관(Jae Kwan Song),박성욱(Seong Wook Park),제수정(Soo Jung Je),김재중(Jae Joong Kim),두영철(Young Cheoul Doo),김원호(Won Ho Kim),진재용(Jae Yong Chin),김형호(Hyeong Ho Kim),정상식(Sang Sig Cheong),박승정(Seung Jung Park),이종구(Jo 대한내과학회 1994 대한내과학회지 Vol.46 No.3
N/A Background: Detection of left ventricular regional wall motion abnormality with two dimensional echocardiography during ergonovine injection (Ergonovine Echocardiography: Erg Echo) is a useful noninvasive diagnostic method of coronary vasospasm, and as it can be used repeatedly, comparison of the therapeutic efficacy of the prescribed drugs for the patients with variant angina may be possible with this method. The purpose of this study were to compare the antispasmotic action of short-term medication of two currently available sustained-releasing (SR) calcium antagonists (Diltiazem vs Verapamil) with Erg Echo, to investigate the factors determining the drug efficacy and to determine if the results of repeated tests of Erg Echo after shortterm medication correlate with the clinical response. Methods: Forty patients with angiographicallyproven coronary vasospam and positive Erg Echo without medication were randomly assigned into group I and II. Diltiazem SR 90mg b.i,d. was prescribed in the patients of group l and Verapamil SR 120 mg b.i.d. in group II. Isosorbide-5-mononitrate (ISMN, Elantan 20 mg b.i.d.) was commonly given in both groups. After medication of 4 days Erg Echo was repeated, and if follow up results were positive doubling of the dosage of prescribed calcium channel antagonists (i.e. Diltiazem SR 180 mg or Verapamil SR 240 mg b.i.d.) was done and the second follow up test of Erg Echo was performed after another 4 days. Clinical follow-up was done with the dosage of negative Erg Echo, and during 9 (±3) month follow-up period one patient of group I and two of group II were lost and final analysis was done with total 37 patients (19 in group I and 18 in group II). Results: Among 37 patients with variant angina, 32 were male and the mean age was 53 (±8). Sex ratio, mean age, body weight, clinical activity of variant angina assessed by the frquency of chest pain attack, number of spasm-documented coronary vessels, dosage of ergonovine for positive response in baseline Erg Echo and number of the patients with concomitant fixed coronary stenosis were not significantly different between both groups. After 4 day medication coronary vasospasm was not provoked with ergonovine injection in 13 patients of group I, and the positive rate of Erg Echo after medication was 32% (6/19) in group I, which was not significantly different from that (50%, 9/18) of group II (p=0.66). In 15 patients coronary vasospasm was provoked with ergonovine injection despite the medication, and ergonovine dose for positive response rose from 146±84 microgram (mcg) to 218±75 mcg with medication. Patients with 'mixed disease' (coronary vasospasm and concomitant fixed disease) showed higher positive result of Erg Echo after medication than the patients with pure spasm (p=0.001). During open label follow-up of 9±3 months, there was neither case of acute myocardial infarction nor that of sudden cardiac death. Recurrent chest pain with medication was observed in 6 patients of group I and 7 of group II (p=0.90), and recurrent chest pain during follow-up was more frequently observed in patients with positive Erg Echo after 4 day medication than those with negative test (p=0.01). In group II medication was modified to control the high activity of variant angina (chest pain attacks more than 5 per week) in 3 patients and verapamil SR was withdrawned in 4 patients due to side effects (2 cases of impotence, each case of constipation and peripheral edema), while there was no case of drug modification or withdrawl of diltiazem SR (p<0.05) in group I. Conclusion: Although there was no significant difference of short term medication on prevention of coronary vasospasm provoked by ergonovine injection, during long term follow-up of variant angina, diltizem SR with ISMN was superior to verapamil SR with ISMN in control of chest pain and absence of side effects. Erg Echo after short term medication was useful in comparison of drug efficacy, investication of the fact