내막파열을 동반하지 않은 대동맥 박리 ( 대동맥 벽내출혈 ) 에 대한 임상적 고찰

황경국(Kyung Kuk Hwang),박대균(Dae Gyun Park),연태진(Tae Jin Yeun),조영석(Young Seok Cho),손대원(Dae Won Sohn),김효수(Hyo Soo Kim),김철호(Cheol Ho Kim),오병희(Byung Hee Oh),이명묵(Myoung Mook Lee),박영배(Young Bae Park),최윤식(Yun Sh 대한내과학회 1998 대한내과학회지 Vol.54 No.1

N/A Objectives: This study was performed to verify the incidence and prognosis of aortic dissection without intimal tear (aortic intramural hemorrhage, IMH) who took only medical treatment in special referrence to Stanford type A. Methods: We analysed the patients of IMH confirmed by TEE, CT, MRI, angiography or CT-angiography in Seoul National University Hospital between 1987 and l9%, retrospectively. Results: The diagnosis of IMH was estabilished in 20 of 143 patients(14%). Nine patients were Stanford type A, 11 patients were type B. The longitudinal extent varied between 8 and 30cm, and IMH size varied between 10 and 3mm. Surgery was performed in two of type A patients because of persistent chest pain and one of type B patients because of progressive aortic dilatation despite of medical treatment. Follow-up imaging studies (mean follow-up period of 20.0±22.0 months) were done in 10/17 patients who were treated medicaliy. Complete resolution of IMH was observed in seven cases, four of them were Stanford type A, and the mean size of IMH was 12mm(10-17mm). Partial resolution was observed in one case, Stanford type A, with the IMH size of 15mm. There was no significant change in the size of IMH in two cases. Initial mean size of IMH was 25mm. In no case, aortic rupture or death was observed during the follow up period. Conclusion: In the management of the patient with MH, same surgical indications as classic aortic dissection have been advocated based on similar prognosis. However our study showed better prognosis in IMH patients treated medically compared to the previous publications. Therefore, even in cases of proximal IMH. medical treatment should be seriously considered.

출생 후 제대혈관 폐쇄에서의 세포고사

황경국(Kyung Kuk Hwang),김효수(Hyo Soo Kim),서정욱(Jung Uk Seo),채인호(In Ho Chae),손대원(Dae Won Sohn),오병희(Byung Hee Oh),이명묵(Myoung Mook Lee),박영배(Young Bae Park),최윤식(Yun Shik Choi),서정돈(Jung Don Seo),이영우(Young Woo L 대한내과학회 1998 대한내과학회지 Vol.55 No.6

N/A Background: The mechanism of the closure of umbilical vessels is known to be multifactorial. In order to verify that apoptosis is one of the possible closure mechanisms, we studied to identify apoptosis in umbilical vessels and evaluate its mechanism by studying apoptosis-related gene and the relationship between the pattern of apoptosis and gestational age (GA). Methods: Twelve umbilical cords of GA of 37-42 weeks were obtained immediatly (less than 10 min. for minimal ongoing external influences) after birth. The presence of apoptotic cells was demonstrated by electron microscopy (EM) and terminal deoxynucleotidyl transferasemediated dUTP nick end labeling (TUNEL). Immnohistochemical staining and Western blotting were used for the analysis of the proteins of apoptosis-related gene. Results: Apoptosis of the smooth muscle cells of media and intima of umbilical vessels was identified at EM, regardless of GA from 37 to 42 weeks. The proportion of TUNEL(+) cells was 80% in intima, 40% in media, 80% in connective tissue of umbilical cord. The expressions of bax-a, bcl-Xs/L were strong in intima, in media and connective tissue, but those of bcl-2 were detected in only in connective tissue, regardless of GA in immunohistochemistry. The ratios of expressions of bax- a to bc1-2, bcl-Xs to bcl-XL, did not change with increasing GA from 37 to 42 weeks in Western blot- ting. Conclusion: Apoptosis was identified in umbilical vessels. The closure of umbilical vessels can be explained by apoptosis where the ratios of bax-a/bcl-2, bcl-Xs/ bcl-XL play an important role. The fact that there were no differences in the extent of apoptosis and the expressions of bax-a/bcl-2, bcl-Xs/bcl-XL according to GA, suggests that apoptosis of umbilical vessels is more dependent on the external stimuli during delivery than GA.

고지혈증이 있는 급성 심근경색환자에서 statin/ezetimibe 병합요법의 효과

이미연 ( Mi Yeoun Yi ),배장환 ( Jang Whan Bae ),황경국 ( Kyung Kuk Hwang ),김동운 ( Dong Woon Kim ),조명찬 ( Myeong Chan Cho ) 대한내과학회 2008 대한내과학회지 Vol.74 No.1

목적: 원발성 고콜레스테롤혈증 환자에서 상용량의 스타틴/에제티미브 병합요법은 고용량의 스타틴 단독요법에 비해 이상반응의 증가 없이 저밀도 지단백 콜레스테롤을 효과적으로 감소시켰다. 그러나 급성 심근경색 환자에 대한 스타틴/에제티미브 병합요법의 효과에 안전성에 대한 연구는 없는 상태이다. 방법: 본 연구는 급성 심근경색으로 본원에 내원한 82명의 환자를 대상으로 임상특성과 지질의 변화양상을 후향적으로 분석하였다. 대상 환자군은 흉통 발생 후 12시간 내에 응급 관상동맥 중재술을 성공적으로 시행 받았고, 이 중 저밀도 지단백 콜레스테롤이 100 mg/dL 이상인 고지혈증 환자이며, 입원 후 72시간 이내에 스타틴 단독요법 혹은 스타틴/에제티마이브 병합요법을 시행 받은 환자로 하였다. 그리고 두 군 간의 입원 당시 및 1개월, 6개월 후의 지질 수치, 안정성 등을 비교하였다. 결과: 초기의 총 콜레스테롤 및 저밀도 지단백 콜레스테롤은 병합요법군이 단독요법군에 비하여 유의하게 높았으나 치료 1개월 후의 총콜레스테롤은 병합요법군이 27.9±13.1%, 단독요법군이 17.0±15.0%였고(p=0.004), 저밀도 지단백 콜레스테롤은 병합요법군이 38.5±12.5%, 단독요법군이 25.1±18.9%로 병합요법군이 우수하였다(p=0.001). 안전성면에서는 CPK가 정상의 정상상한치의 3배 이상으로 상승한 경우가 병합요법군에서 1명, ALT가 정상상한치의 2배 이상으로 상승한 경우는 단독요법군에서 1예가 있었다. 결론: 응급 관동맥 중재술을 통하여 성공적으로 재관류가 이루어진 급성 심근경색환자의 경우 지질저하를 위한 병합요법이 단독 스타틴 요법에 비해 지질 저하 면에서 우수하며 안전한 치료법이라 판단된다. Background/Aims: A moderate dose of statin/ezetimbe combination therapy reduced the LDL-C (low density lipoprotein-cholesterol) in a fashion comparable to high dose statin without increasing the adverse events in patients with primary hypercholesterolemia. Yet there is no data on the effectiveness and safety of statin/ezetimbe combination therapy in patients suffering with acute myocardial infarction (AMI). Methods: We retrospectively compared the lipid profiles and clinical variables of 82 patients who were admitted to our institution with AMI. These patients were successfully treated with emergent coronary intervention within 12 hours after the chest pain onset and they were prescribed a single statin (statin group) or statin/ezetimibe combination therapy (dual inhibition group) for treating their hyperlipidemia within 72 hours after the admission. We compared the initial lipid profiles, the % reduction of total cholesterol (TC), the LDL-C at 1 and 6 months and the safety profiles between the two therapeutic groups. Results: Although the initial TC and LDL-C levels were significantly higher in the dual inhibition group than the statin group, one month later, the % reduction of the TC was 27.9±13.1% and 17.0±15.0% (p=0.004) and the % reduction of the LDL-C was 38.5±12.5% and 25.1±18.9% (p=0.001) in each group, respectively. One patient in the dual inhibition group showed CPK elevation more than 3 times the upper normal limit and ALT elevation more than 2 times of upper normal limit was observed in one patient in the statin group. Conclusions: Cholesterol dual inhibition therapy is superior to single statin therapy for the aspect of cholesterol reduction and safety in successfully reperfused AMI patients. (Korean J Med 74:59-67, 2008)

소모성 응고 장애가 병발된 대동맥류의 중재시술 및 연속된 수술로 성공적으로 치료한 증례

김지현 ( Jee Hyun Kim ),양범희 ( Bum-hee Yang ),이주희 ( Ju-hee Lee ),이상엽 ( Sang Yeub Lee ),배장환 ( Jang-whan Bae ),황경국 ( Kyung-kuk Hwang ),김상민 ( Sang Min Kim ) 대한내과학회 2016 대한내과학회지 Vol.90 No.6

Aortic aneurysm-induced chronic consumptive coagulopathy is a very rare complication but can be a source of critical complications and mortality. A 72-year-old man presented with a rapidly expanding descending thoracic aortic aneurysm with a penetrating ulcer and an infrarenal abdominal aortic aneurysm complicated by chronic coagulopathy. We were aware of the bleeding risk during surgical replacement based on the patient’s chronic coagulopathy status and successfully performed endovascular repair of the thoracic aortic aneurysm with a penetrating ulcer. Platelet transfusion, antiplatelet agents, and proteinase inhibitors improved the coagulopathy. A delayed type Ib endoleak developed, and the coagulopathy recurred 2 months later when the patient presented with purpura of both lower legs. We successfully managed the condition by elective surgical replacement of the entire aorta after improving the coagulopathy with platelet replacement and administration of proteinase inhibitors. (Korean J Med 2016;90:537-541)

비ST분절상승 급성관동맥 증후군 환자에서 N-terminal Pro B-type Natriuretic Peptide(NT-proBNP)를 이용한 관동맥 협착의 중증도 및 초기 위험도 평가

김기석,한혜숙,황경국,연태진,김동운,조명찬 대한순환기학회 2004 Korean Circulation Journal Vol.34 No.2

위장 출혈로 발현한 비장동맥의 가성동맥류 1 예

이대희,이동호,송인성,정현채,최규완,김정룡,한철주,윤용범,장유현,신건성,조창락,황경국,김태현,전재석 대한내과학회 1996 대한내과학회지 Vol.50 No.6

The most common complications of chronic pancreatitis are pancreatic calcification, diabetes mellitus, steatorrhea, pancreatic pseudocyst and upper gastrointestinal bleeding. Pesudoaneurysm whether with pseudocyst or nat may cause gasrointestinal bleeding and it is a serious complication. Erosion of visceral artery with pseudoaneurysm formation may bleed into pancreatic duct which is known as $quot;emosuccus Pancreaticus$quot;. On rare occasions, pseudoaneurysm may bleed into adjacent organs (stomach, duodenum, colon). A 56-year-old man was admitted to Seoul National University Hospital with repeaoted hematemesis. With repeated gastroscopy, we found submucosal tumor like lesion in the stomach. Computed tomography and celiac angiography showed splenic artery pseudoaneurysm, which at operation was found to have ruptured into the stomach. The pseudoaneurysm and spleen were removed and the patient has had no further bleeding. When gastrointestinal bleeding is associated with chronic pancreatitis and the usual sources of bleeding are not detected by endoscopy, the rupture of a pseudoaneurysm schould be considered as one of the causes.