관동맥 연축환자의 약물투여기간 및 질병의 활성도에 대한 장기 추적 관찰

김철홍(Cheol Hong Kim),유규형(Kyu Hyung Ryu),한성우(Seong Woo Han),박규용(Kyu Yong Park),한윤창(Yun Chang Han),홍경순(Kyung Soon Hong),두영철(Young Cheoul Doo),한규록(Kyu Rok Han),오동진(Dong Jin Oh),임종윤(Chong Yun Rim),고영박(Youn 대한내과학회 1998 대한내과학회지 Vol.54 No.1

N/A Objectives: Clinical course of vasospastic angina is variable : spontaneous remission, persistent angina and progression of disease or death. Several studies from western institutes have been performed on the clinical characteristics and long-term prognosis of patient with coronary vasospasm. In these reports, 53-82% of patients had spontaneous remission. These results may be assumed differ from that of Korean patients with vasospastic angina, but no detailed studies have been reported in Korea. Currently, in patients with vasospastic angina, treatment with calcium antagonists and/or nitrates are effective in reducing the frequency of anginal attacks. And, clinical course and outcome of vasospastic angina may be different from previous western reports thereafter. The purpose of this study is to describe the disease activities and the factors influencing the clinical course of vasospastic angina in relation to medication-period; age, sex, risk factors, extents of coronary vasospasm, initial ischemic events and significance of fixed lesion. Also we tried to determine if clinical or angiographic variables might be useful in predicting the possibility of spontaneous remission for an each patient. Methods: Eighty-seven patients with vasospastic angina(M/F;58/29, mean age;53±9 years) were included and all documented coronary vasospasm on the coronary angiogram, spontaneous spasm in 35, positive ergonovine or acetylchoine provocation in 52. Coronary artery spasm was defined as more than 75% reduction in coronary luminal diameter and ST segment changes on electrocardiogram, or typical anginal symptoms together and then narrowed coronary arteries were recovered after intracoronary nitroglycerin. The patients were treated with calcium antagonists(nifedipine, diltiazem, amlodipine and felodipine) and nitrates single or both and were divided into 3 groups according to angina activity: group I, which anginal attacks less than one time monthly, group II, which anginal symptoms occurred in 24- 48 hours after withdrawal of medication, group III, which symptoms recurred frequently with the incidence of over one time weekly, After discharge, each patient returned to a medical out-patient department at every 1-2 months. Results: Age, gender, other coronary risk factors, disease activity of vasospastic angina, initial clinical presentation at admission, coronary angiographic findings, fixed lesion and alcohol-induced anginal attacks were not statistically different among the 3 groups. But admission frequency of group II and III, which had a high anginal activities, were more than that of group I significantly. Conclusion: In the present study, it is concluded that medical treatment in patients with vasospastic angina in Korea may be taken long duration during follow-up period if the patient of group II and III considered to persistent angina group. To assess the prevalence of spontaneous remission, we consider that systematic attempts to taper medication may be done for patient of group I(angina free-on treatment) after absence of anginal attacks for at least one year medication-period.

춘천지역 중년과 노인의 고혈압 인지율, 치료율, 조절률 및 인지율 관련 요인: 한림노년연구(HAS)

정진영,최용준,장숙랑,홍경순,최영호,최문기,김동현,Jeong, Jin-Young,Choi, Yong-Jun,Jang, Soong-Nang,Hong, Kyung-Soon,Choi, Young-Ho,Choi, Moon-Ki,Kim, Dong-Hyun 대한예방의학회 2007 예방의학회지 Vol.40 No.4

Objectives : To estimate the awareness, treatment and control rate, as well as to identify the awareness-related factors for hypertension. Methods : The study participants were 482 adults (men 206, women 276), aged 45 or over, diagnosed with hypertension and living in Chuncheon. The awareness rate was defined as the proportion of persons among those with hypertension who had previously been diagnosed by a physician. The treatment rate was defined as the proportion of persons who had used anti-hypertensive medication, among those who were aware of their hypertension. The control rate was defined as the proportion of persons who kept blood pressure normal, among those who had been treated for their hypertension. Multivariable logistic regression analysis was carried out for the awareness-related factors using SAS VER 8.1. Results : The awareness, treatment, and control rate were 55,8% (53.4% for men; 57.6% for women), 89.6% (87,2% for men; 91.2% for women), and 34.4% (28.1 % for men; 38.6% for women), respectively. The awareness-related factors included a family history of hypertension (odds ratio[OR], 5.63; 95% confidence interval[95% CI]=1.53-20.72), smoking([Ex; OR 0.38, 95% CI= 0.15-0.96)], [Current; OR 0.28, 95% CI=0.10-0.80]), and alcohol intake ([Ex; OR 3.22, 95% CI 1.03-10.09],[Current; OR 3.36, 95% CI=1.30-8.71]) for men, and education(OR 2.23, 95% CI=1.10-4.53), body mass index(OR 2.72, 95% CI=1.13-6.53), and self-rated health(OR 2.38, 95% CI=1.07-5.30) for women. Conclusions : The awareness rate of hypertension among the middle aged and elderly in Chuncheon was 55.8%. The related factors of awareness were gender specific. Further studies are needed to elucidate the putative reasons for these gender differences.

카오스 이론을 이용한 한글 문자 특징 추출에 관한 연구

손영우(Young-Woo Son),홍경순(Kyung Soon Hong),남궁재찬(Jae-chan Namkung) 한국정보과학회 1999 한국정보과학회 학술발표논문집 Vol.26 No.2Ⅱ

미세한 차이를 고감도 식별하는 카오스 이론의 프랙탈 차원과 스트레인즈 어트랙터를 생성하는 수정된 에농 함수를 이용하여, 한글 2,350 자에 대한 시계열 데이터의 혼도도를 분석하기 위해, 각각의 문자 O' 트랙터를 구성한 후, 프랙탈 차원을 나타내는 Box-counting Dimension 및 Natural Measure, Information Bit, Information Dimension 등을 구하여 문자 특징을 추출하는 새로운 알고리즘을 제시하였다. 실험결과 한글 2,350 자에 대하여 99.23%의 분류율을 나타내어 제안된 방법의 유효성을 보였다.

지역거주 노인 심뇌혈관질환 발병위험 예측모형 개발에 관한 연구

정진영(Jin-Young Jeong),홍경순(Kyung-Soon Hong),장숙랑(Soong-Nang Jang),최영호(Young-Ho Choi),최문기(Moon-Gi Choi),이상곤(Sang-Kon Lee),김현아(Hyun-Ah Kim),박석원(Seok-Won Park),홍나래(Na-Rae Hong),김동현(Dong-Hyun Kim) 한국역학회 2007 Epidemiology and Health Vol.29 No.2

  Purpose: This study was performed to develop risk prediction model for cardiovascular disease using intima-media thickness (IMT) of carotid artery among the community dwelling elderly.   Methods: Follow-up survey was conducted in 2007 to measure the IMT of carotid artery, which is known as a preclinical marker of atherosclerotic change, among participants at the baseline survey of Hallym Aging Study (HAS) in 2004. They were categorized into two groups; increased IMT >= 0.9 ㎜ and normal IMT < 0.9 ㎜ To evaluate which factors are independently related with the increased IMT, multiple logistic regression analysis was done. Based on the regression coefficients of these factors weighed by the magnitude of the effect estimates, we calculated the risk scores for increased IMT for every participants. ROC curve was plotted for the each cutoff point of risk scores and its fitness was tested using Area Under the Curve (AUC). Finally, we calculated risk ratios for the increased IMT according to the level of risk based on the risk scores.   Results: Several factors were found as related factors for the increased IMT in the multiple logistic regression: age (β=0.15), cholesterol (β=0.01), insulin (β=0.13), and pulse pressure (β=0.90) for men, and age (β=0.08), family history of diabetes mellitus (β=0.94) and stroke (β=0.79), alcohol drinking (β=0.39), and high cholesterol (β=0.77) for women. We assigned the weighed value for each factors. The average risk scores were 14.48 (range 9.69-18.76) for men and 4.59 (range 2.41-7.48) for women. The Area Under the Curve (AUC) were 0.77 for men and 0.71 for women. We also observed the higher risk of increased IMT as the risk scores increased.   Conclusion: Based on the results, we expect to predict the level of the risk for the increased IMT, which is preclinical marker for atherosclerotic change, among the elderly.

삼일열 말라리아 환자의 임상적 특징

송헌호 ( Hun Ho Song ),오순옥 ( Soon Ok O ),김수호 ( Su Ho Kim ),문상호 ( Sang Ho Moon ),김진봉 ( Jin Bong Kim ),윤종우 ( Jong Woo Yoon ),구자룡 ( Ja Ryong Koo ),홍경순 ( Kyung Sun Hong ),이명구 ( Myung Goo Lee ),김동준 ( Dong Joo 대한내과학회 2002 대한내과학회지 Vol.63 No.5

N/A Background : Since Plasmodium vivax malaria reemerged in Korea in 1993, a number of patients with malaria have been reported. We analyzed the cases with malaria who lived in Chuncheon and neighboring communities to find out clinical manifestations, laboratory findings and the differences in clinical findings compared to previous studies. Methods : We reviewed the clinical records of the cases who were confirmed as malaria by peripheral blood smear in Chuncheon Sacred Heart Hospital from July, 1998 to Octorber, 2001. Results : Forty-four cases were included. All cases were Plasmodium vivax with high fever, but tertian fever developed only in 15 patients (35.7%). A number of cases showed various symptoms including headache, abdominal pain, nausea, vomiting. Of the all cases, 41 cases (93.2%) developed malaria between June and September. Thrombocytopenia was prominent finding which was noted in 75% of the cases at diagnosis, and recovered during or after treatment. Other laboratory abnormalities such as anemia, elevated transaminases, coagulopathies, and elevated LDH level were also noted. Five patients were performed CSF studies, one patient showed pleocytosis in CSF. Conclusion : We observed that only 15 patients (35.7%) had tertian fever, the others had variable fever patterns. Thrombocytopenia was the prominent findings. Therefore we suggest that malaria should be included in the differential diagnosis of febrile diseases which developed from June to September regardless of the fever patterns. (Korean J Med 63:546-551, 2002) Key Words : Malaria, Fever, Thrombocytopenia

비후성심근증의 임상적 관찰

전상중(Sang Joong Jeon),정진홍(Jin Hong Chung),홍경순(Kyung Soon Hong),전재은(Jae Eun Jun),박의현(Wee Hyun Park),박희명(Hi Myung Park),김윤년(Yoon Nyun Kim),김권배(Kwon Bae Kim),장성국(Sung Kug Chang),이종주(Jong Joo Lee) 대한내과학회 1987 대한내과학회지 Vol.33 No.4

N/A The clinical and laboratory features of hypertrophic cardiomyopathy were studied in 30 cases. They consisted of 21 males and 9 females, and the age ranged from 21 to 74 years with an average of 50. The cardinal presenting symptoms were dyspnea, chest pain and palpitation in the order of decreasing frequency. Physical examination revealed apical systolic murmur in 27 cjases (90%), with thrill in 10 (33%), and the routine chest films showed enlargment of cardiac silhouette in 15 cases (50%). Abnormal electrocardiographic findings are noted in 27 cases (90%). Among them repolarization abormalities and left ventricular hypertrophy were the most common, occurring in 71% and 66 % of the cases, respectively, follower1 by left atrial enlargment in 24% and the abnormal Q waves in 20% Among various echocardiographic abnormalities, the mean of septal thickness and its ratio to left ventricular posterior wall thickness were 19 mm and 2,1 respectively, and the mean of the degree of systolic anterior motion of mitral valves was 9 mm. The mean of preejection period and left ventricular ejection time as well as their ratio determined in 10 cases were within normal limits. Out of 20 eases treated with beta or calcium blockers. for a mean of 22 months, 14 (70) experienccd symptomatic improvement. □ (5%) deteriorated and in the remainder (25%) there were no noticeable changes.

증례 : 반복적인 스텐트 혈전증이 합병된 본태성 혈소판 증다증 1예

이미진 ( Mi Jin Lee ),이창섭 ( Chang Seob Lee ),김경리 ( Kyung Lee Kim ),권오경 ( Oh Kyung Kwon ),최현희 ( Hyun Hee Choi ),윤덕형 ( Duck Hyoung Yoon ),홍경순 ( Kyung Soon Hong ) 대한내과학회 2012 대한내과학회지 Vol.83 No.1

본태성 혈소판 증다증은 골수 증식성 질환으로 혈소판 기능 부전에 의한 동, 정맥의 혈전증 및 출혈이 주요한 합병증이며 특히 혈전증에 의해 뇌경색, 심근경색, 협심증, 내장혈관 혈전증 등의 주요 혈관 합병증이 발생할 수 있다. 본태성 혈소판 증다증에서 관상동맥 질환은 드물게 발생하나 관상동맥 중재술 이후 스텐트 혈전증 발생의 위험인자로 작용할 가능성이 있으며 스텐트 혈전증으로 인한 급사, 심근경색 등 치명적인 합병증이 발생할 수 있어 스텐트 삽입 치료 후 주의가 필요하다. 저자들은 본태성 혈소판 증다증으로 anagrelide (1 mg/day) 를 복용 중이며, 불안정성 협심증으로 3년 전, 2년 전 각각약물 용출 스텐트를 삽입한 병력이 있는 43세 여자 환자에 very late 스텐트 혈전증으로 급성 심근경색증이 발생하여 약물 용출 스텐트로 관상동맥 중재술을 시행한 직후 심인성쇼크 및 심정지를 동반한 acute 스텐트 혈전증이 다시 발생되어 체외 심폐순환장치로 관류를 유지하고 응급 관상동맥 우회술로 치료하였던 증례를 경험하여 문헌고찰과 함께 보고하는 바이다. Coronary artery involvement leading to acute coronary syndrome is a rare complication of essential thrombocythemia. A 43-year-old woman with essential thrombocythemia complained of severe acute chest pain. She had undergone percutaneous coronary intervention (PCI) with a drug-eluting stent (DES), due to unstable angina, 3 and 2 years earlier. Emergency coronary angiography revealed total occlusion of the DES with thrombus. Twenty minutes after successful primary PCI with a DES, an acute stent thrombosis developed. She was subsequently treated with coronary artery bypass graft surgery.

정-정맥 체외막형산소화요법을 이용한 급성호흡부전의 치료

김형수 ( Hyoung Soo Kim ),한상진 ( Sang Jin Han ),홍경순 ( Kyung Soon Hong ),윤덕형 ( Duck Hyoung Yoon ),이창률 ( Chang Youl Lee ),이명구 ( Myung Goo Lee ),홍원기 ( Won Ki Hong ),이순희 ( Sun Hee Lee ),김건일 ( Kun Il Kim ),이희성 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.68 No.2

Background: Extracorporeal membrane oxygenation (ECMO) during severe acute respiratory failure helps to recover the pulmonary function. This study evaluated our experience with veno-venous ECMO in adult patients with acute respiratory failure. Methods: From January 2007 to July 2009, ECMO was used on 54 patients. Of these 54 patients, 7 were placed on veno-venous ECMO for acute respiratory failure. The indications of ECMO were based on the lung dysfunction measured as a PaO2/FiO2 ratio <100 mm Hg on FiO2 of 1.0, or an arterial blood gas pH <7.25 due to hypercapnia despite the optimal treatment. EBS(R), Bio-pump(R), and Centrifugal Rotaflow pump(R) were used and all cannulations were performed percutaneously via both femoral veins. When the lung function was improved, an attempt was made to wean on ECMO at moderate ventilator settings followed by decannulation. Results: Five of the 7 patients were male and the mean age was 46.3±18.3. The causes of acute respiratory failure were 3 cases of pneumonia, 2 near-drownings, 1 pulmonary hemorrhage due to acute hepatic failure and 1 mercury vapor poisoning. The mean support time of ECMO was 17.3±13.7 days. Of the 7 patients implanted with ECMO, 5 patients (71%) were weaned off ECMO and 3 patients (43%) survived to hospital discharge after a mean 89.6 hospital days. Conclusion: The early use of ECMO for acute respiratory failure in adults due to any cause is a good therapeutic option for those unresponsive to the optimal conventional treatments.

스트레스 유발성 심근증 환자들의 원내 사망과 좌심실 기능 회복의 예측인자

김소연 ( So Yeon Kim ),김장영 ( Jang Young Kim ),박용현 ( Yong Hyun Park ),홍경순 ( Kyung Soon Hong ),조경임 ( Kyoung Im Cho ),조현수 ( Hyun Su Jo ),홍그루 ( Gue Ru Hong ),손창우 ( Chang Woo Sohn ),손장원 ( Jang Won Sohn ),윤준철 대한내과학회 2011 대한내과학회지 Vol.81 No.1

Background/Aims: The reported frequency of stress-induced cardiomyopathy (SCMP, Takotsubo cardiomyopathy) is increasing; however, there are no data regarding predictors of in-hospital mortality and the recovery of left ventricular (LV) systolic function in patients with SCMP. Therefore, in this study, we sought to identify clinical predictors of in-hospital mortality and of the recovery of LV dysfunction in Korean patients with SCMP. Methods: From November 2004 to November 2010, 155 patients who fulfilled the clinical diagnostic criteria of the Mayo clinic for SCMP were enrolled retrospectively from eight medical centers in Korea. We checked in-hospital deaths and compared the LVejection fraction (LVEF) and wall-motion score index (WMSI) upon enrollment for each patient with that after 1 week using echocardiograms. A total of 55 continuous variables and 52 nominal variables were analyzed to find variables associated with in-hospital mortality and the recovery of LV dysfunction. All significant variables were entered into a logistic regression analysis. Results: The mean age of the patients was 64±15 years; 118 (76.1%) patients were female. The in-hospital mortality rate was 5.2% (n=8). An elevated initial platelet count was identified as a predictor of in-hospital mortality (odds ratio [95% CI]: 0.99 [0.99-1.00]). There were no predictors of the recovery of LVEF. Predictors of the recovery of WMSI were an absence of arrhythmic events (odds ratio [95% CI]: 22.89 [1.98-265.34]) and an elevated initial LV end-systolic diameter (odds ratio [95% CI]: 0.86 [0.74-1.00]). Conclusions: An initial absence of arrhythmic events and elevated LV end-diastolic pressure in patients with SCMP may be predictors of the timely recovery of LV dysfunction. (Korean J Med 2011;81:64-72)

증례 : 순환기 ; 건강한 성인에서 마라톤 경기 중 발생한 급성 심근경색증 2예

이병무 ( Byoung Moo Lee ),안평 ( Pyoung Ahn ),민현준 ( Hyun Joon Min ),박상현 ( Sang Hyun Park ),최현희 ( Hyun Hee Choi ),윤덕형 ( Duck Hyoung Yoon ),홍경순 ( Kyung Soon Hong ) 대한내과학회 2013 대한내과학회지 Vol.85 No.4

기존에 심혈관계 구조적인 이상을 가지고 있던 환자에서 격렬한 운동 중 급성 관상동맥 질환의 발생률이 높은 것으로 알려져 있다. 저자들이 경험한 두 증례는 특이 기왕력도 없었고 마라톤과 같은 격렬한 운동을 하면서 건강하다고 생각해 왔던 환자들이 단일 마라톤 경기 중 의식 저하 및 심정지가 발생한 경우였다. 두 환자 모두 현장에서 심폐소생술을 바로 시행하였고 첫 환자에서는 ST 분절의 상승을 동반한 급성 심근경색증, 두 번째 환자에서는 ST 분절의 상승을 동반하지 않은 급성 심근경색증으로 진단하고 응급으로 경피적 관동맥 중재술을 시행하여 치료하였다. 마라톤 경기 도중급성심근경색이 발생하였던 환자를 빠르고 정확한 심폐소생술 및 적절한 치료로 후유증 없이 회복시켰던 두 증례를 경험하여 문헌고찰과 함께 보고하고자 한다. It is generally accepted that vigorous exercise may trigger cardiovascular accidents if underlying cardiovascular disease is present. Coronary artery disease is the most frequent cause of sudden cardiac arrest, especially in older individuals (≥ 35 years of age). We describe two patients who presented with cardiac arrest followed by loss of consciousness. Both had been participating in a marathon race. After acute myocardial infarction was diagnosed by electrocardiography and laboratory findings, urgent percutaneous coronary intervention was performed on both patients. (Korean J Med 2013;85:411-415)