춘천 지역에서 발생한 쯔쯔가무시병의 임상적 특징

이호권 ( Ho Gwon Lee ),민슬기 ( Seul Ki Min ),공승진 ( Seung Jin Kong ),이수정 ( Su Jung Lee ),송헌호 ( Hun Ho Song ),윤종우 ( Jong Woo Yoon ),이명구 ( Myung Goo Lee ),신동훈 ( Dong Hoon Shin ),강성하 ( Sung Ha Kang ),이정열 ( Jeo 대한내과학회 2005 대한내과학회지 Vol.69 No.2

목적 : 쯔쯔가무시병 환자의 일부는 중증감염으로 중환자실 집중치료를 필요로 하며 이 중 사망하는 환자들도 있다. 본 연구는 춘천 및 인근 지역에서 발생한 쯔쯔가무시병 환자의 임상적인 특징과 이 중 중증환자들의 특징을 분석하여 지역사회의 쯔쯔가무시병의 진단과 치료 및 교육에 도움이 되고자 하였다. 방법 : 1997년 4월부터 2002년 12월까지 한림대학교 부속 춘천성심병원에서 쯔쯔가무시 병으로 진단되었던 81예의 환자들의 의무기록 열람을 통한 후향적 분석을 시행하였다. 81예 환자들의 내원시 임상소견을 분석하였고, 이 중 본 병원에서 치료 받았던 79예의 환자들의 치료결과를 분석하였으며, 내원시 일반병실로 입원한 환자와 중환자실로 입원하였던 환자의 임상소견을 비교하여 중증환자들의 특징을 비교하였다. 결과 : 73예의 환자가 가을에 발생하였으며, 70예에서 발열이 있었고, 가피가 발견된 경우는 58예(71.6%)였다. Doxycycline 치료 후 45예의 환자가 48시간내 열이 없어졌으나 13예에서는 5일이상 열이 지속되었다. 79예 중에서 중환자실로 입원한 경우가 25예 였으며 이 중 8예에서 기계환기 치료를 받았고, 3예가 다발성 장기부전으로 사망하였다. 중환자실에 입원한 중증환자들은 백혈구수가 많았고, BUN과 크레아티닌이 높았고, 알부민 수치가 낮았다. 결론 : 쯔쯔가무시병은 중증질환으로 이환될 수 있으며 특히 고령이거나 만성질환을 가지고 있는 환자에게서는 치명적인 결과를 초래할 수 있으므로 감염발생의 위험이 있는 지역사회에서 유행 시기에 발열 등의 증상이 있을 때 조기 진단이 필수적이며 이를 위한 교육이 필요하다. 그리고 중증환자에서 백혈구수, 혈청 알부민, BUN, 크레아틴 등에서 차이를 나타내어 쯔쯔가무시 병의 예후를 예측하는 요소로 사료된다. Background : Tsutsugamushi disease is an acute febrile disease in Korea. Some patients with tsutsugamushi disease have severe illness, which needs care in intensive care unit, and may die due to the disease. We analyzed the cases with tsutsugamushi disease who lived in Chuncheon and neighboring communities to find out clinical manifestations, laboratory findings especially in severe cases. Methods : We reviewed the clinical records of the 81 cases who were diagnosed as tsutsugamushi in Chuncheon Sacred Heart Hospital from April, 1997 to December, 2002. We analyzed the clinical and laboratory findings of the 81 cases, and the treatment results of 79 cases who recieved the treatment in this hospital. We also compared the characteristics of the patients between admission to general ward and intensive care unit (ICU). Results : Seventy three cases developed the disease in autumn. Seventy cases had fever. 58 cases had eschar in their bodies. With the doxycycline treatment, forty five cases subsided the fever within 48 hours, but in 13 cases, fever continued after 5 days of treatment. Twenty five cases were admitted to ICU, 8 cases among them were treated with ventilator, 3 cases died due to the multi-organ failure. When we compared the clinical characteristics of the patients admitted to ICU with those to general wards, leukocyte count, the level of BUN and creatinine were higher, the albumin level was lower in ICU patients than those of general ward patients. Conclusion : Tsutsugamushi disease can progress to severe disease, and be fatal to the patients. So it is necessary to diagnose early and treat carefully. We suggest that leukocyte count, BUN, creatinine, or albumin can be used to predict the prognosis.(Korean J Med 69:190-196, 2005)

관상동맥 스텐트 재협착 병변에 대한 99mTc-HMPAO 국소 전달요법을 이용한 새로운 방사선 치료법

김원 ( Weon Kim ),정명호 ( Myung Ho Jeong ),김성희 ( Sung Hee Kim ),박우석 ( Uh Seok Park ),박옥영 ( Ok Young Park ),김주한 ( Ju Han Kim ),범희승 ( Hee Seung Bom ),정환정 ( Hwan Jung Jeong ),안영근 ( Young Keun Ahn ),조정관 ( Jeo 대한내과학회 2003 대한내과학회지 Vol.64 No.5

목적 : 관상동맥 스텐트 재협착 병변의 치료 방법으로서 국소 방사선 조사 요법의 효과가 입증되고 있으나, 아직은 고가이고 시술 절차가 복잡하여 간편하고 경제적인 방법이 요구되고 있다. 돼지 관상동맥 모형에서 99mTc-HMPAO의 국소 방사선 전달 요법이 스텐트 내 신생내막 증식 억제와 스텐트 재협착의 예방에 효과적임을 입증한 후, 임상에서 환자들을 대상으로 99mTc-HMPAO 국소 방사선 전달 요법의 안정성과 효과를 알아보고자 하였다. 방법 : 동물 Background : Restenosis after percutaneous coronary intervention (PCI) still remains a matter to be solved. We examined the inhibitory effects of local delivery of 99mTc-HMPAO (hexamethy-lprophylene amine oxime), a radioisotope, on neointimal hyperplasia

급성 심근경색증 환자에서 예후 예측인자로서 좌심방 용적지수

이지선 ( Ji Sun Lee ),정명호 ( Myung Ho Jeong ),이정애 ( Jung Ae Rhee ),최진수 ( Jin Su Choi ),윤현주 ( Hyun Joo Yoon ),김계훈 ( Kye Hun Kim ),홍영준 ( Young Joon Hong ),김주한 ( Ju Han Kim ),안영근 ( Young Keun Ahn ),조정관 ( Jeo 대한내과학회 2014 대한내과학회지 Vol.86 No.1

목적:급성 심근경색증 환자에서 좌심실의 이완기능 장애 는 환자의 예후와 관련되어 있다고 알려져 있다. 심장 초음파로 측정된 대부분의 도플러 지표들은 환자의 혈역학적 변화에 영향을 받아 이완기능 장애 정도를 정확하게 표현하기 어려운 반면, 좌심방 용적지수는 좌심실 충만압을 나타내는 비교적 안정적 지표이다. 따라서 이 연구의 목적은 급성 심 근경색증 환자에게서 입원 당시 측정된 좌심방 용적지수에 따른 임상경과의 차이를 파악하고자 하였다. 방법:2008년1월부터 2010년 12월까지 급성 심근경색증으로 전남대학교병원에 입원한 환자 1,906명 중 심장초음파 검 사가 시행되고 관상동맥 중재술을 시술받고 1년 동안 임상 관찰이 되어 분석 가능한 772명(64.1 ± 12.8세, 남자 80%)을 대상으로 하였다. 좌심방 용적지수가 40 mL/m2 이상인 I군 260명(71.1 ± 10.8세, 남자 191명)과 좌심방 용적지수가 40 mL/m2 미만인 II군 512명(62.8 ± 12.7세, 남자 432명)으로 분류하여 양 군 사이의 임상적 특성과 1년간 사망을 포함한 주요 심장 사건을 분석하였다. 결과:급성 심근경색증 후 1년간 추적조사한 결과, 주요 심장사건은 총 120예(15.5%)에서 발생하였으며 이 중 사망 은 18예(2.3%)에서 관찰되었다. I군이 II군에 비하여 주요 심 장사건의 발생률이 높았고(20.3% vs. 13.7%, p = 0.037) 사망 률 또한 유의한 차이를 보였다(15.5% vs. 2.0%, p = 0.023). 다변량 분석 결과 증가된 좌심방 용적지수(HR, 3.002; CI, 1.051 to 8.569; p = 0.040)가 사망률과 관련된 독립적 예측인 자였다. 결론:좌심방 용적지수는 급성 심근경색증 환자의 예후에 대한 독립적 예측인자이었으며 좌심방 용적의 측정은 심근 경색증 후고위험 환자군 분류에 유용할 것으로 기대된다. Background/Aims:Diastolic dysfunction may develop in conjunction with or without systolic dysfunction in patients with acute myocardial infarction (AMI). The present study investigated the association between left arterial (LA) volume and major adverse cardiac events (MACE) in 772 patients with AMI. Methods:The patients were divided into groups according to LA volume index (LAVI) measured using echocardiography according to the American Society of Echocardiography guidelines:LAVI ≥ 40 mL/m2 (Group I:n = 260, 191 males; age, 71.1 ± 10.8 years) and LAVI < 40 mL/m2 (Group II:n = 512, 432 males; age, 62.8 ± 12.7 years). The mean observational period was 314.2 ± 134.6 days. Results:Group I patients were older than those in Group II. Hypertension (56.8% vs. 46.0%, respectively; p = 0.007) and advanced Killip class (42.6% vs. 21.0%, respectively; p < 0.001) were more frequent in Group I than in Group II. MACE was more prevalent in Group I than in Group II (20.3% vs. 13.7%, respectively; p = 0.037). MACE-free survival rates were higher in Group II than in Group I during clinical follow-up. The multivariate analysis revealed that high LAVI was an independent predictor of mortality (hazard ratio, 3.002; confidedce interval, 1.051-8.569; p = 0.040). Conclusions:LA volume is an independent predictor of adverse cardiac events in patients with AMI, and the LAVI is useful for AMI risk stratification. (Korean J Med 2014;86:33-41)

Different prognostic factors according to left ventricular systolic function in patients with acute myocardial infarction

Im, Moon-Sun,Kim, Hack-Lyoung,Kim, Sang-Hyun,Lim, Woo-Hyun,Seo, Jae-Bin,Chung, Woo-Young,Zo, Joo-Hee,Kim, Myung-A,Park, Kyung-Woo,Koo, Bon-Kwon,Kim, Hyo-Soo,Chae, In-Ho,Cho, Dong-Ju,Ahn, Youngkeun,Jeo Elsevier 2016 INTERNATIONAL JOURNAL OF CARDIOLOGY Vol.221 No.-

<P>Background: Initial left ventricular (LV) systolic function is a main determinant of clinical outcomes in patients with acutemyocardial infarction (AMI). This study was performed to investigate whether AMI patients have different prognostic factors according to their baseline LV systolic function. Methods: A total of 12,988 patients with AMI from a nationwide database were analyzed. Major adverse cardiovascular events (MACEs) within 12 months of AMI, including death, nonfatal myocardial infarction (MI), and revascularization, were assessed. Results: Patients were stratified into two groups according to LV ejection fraction (LVEF): those with LVEF < 40% and those with LVEF >= 40%. Patients with LVEF < 40% (n = 1962, 15.1%) were older and had more unfavorable cardiovascular risk factors than those with LVEF >= 40% (n= 11,026, 84.9%). The rate of MACE was higher in patients with LVEF < 40% than in those with LVEF >= 40% (26.8% vs 11.4%, p < 0.001). Independent predictors of 12-month MACEs in patients with LVEF >= 40% were history of MI, high Killip stage, three-vessel disease, and lower renal function, which are already known as risk factors. However, diabetes mellitus (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.17-2.40; p = 0.008), and the use of rennin-angiotensin system (RAS) blockers (HR, 0.63; 95% CI, 0.41-0.95; p = 0.029) were independent factors for 12-month MACE in patients with LVEF < 40%. Conclusions: Prognostic factors determining 12-month MACE after AMI are different according to LVEF. Management following AMI should be tailored according to their LV systolic function. (C) 2016 Elsevier Ireland Ltd. All rights reserved.</P>

Transradial versus transfemoral intervention in ST-segment elevation myocardial infarction patients in Korean population

( Hu Li ),( Seung-woon Rha ),( Byoung Geol Choi ),( Min Suk Shim ),( Se Yeon Choi ),( Cheol Ung Choi ),( Eung Ju Kim ),( Dong Joo Oh ),( Byung Ryul Cho ),( Moo Hyun Kim ),( Doo-il Kim ),( Myung-ho Jeo 대한내과학회 2018 The Korean Journal of Internal Medicine Vol.33 No.4

Background/Aims: Transradial intervention (TRI) is becoming the preferred method over transfemoral intervention (TFI) because TRI is associated with lower incidence of major bleeding and vascular complications. However, there has been limited published data regarding the clinical outcomes of TRI versus TFI in Korean patients with ST-elevation myocardial infarction (STEMI). Methods: A total of 689 consecutive STEMI patients who underwent primary percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) from January to December of 2009 at nine university hospitals were enrolled in this study. Mid-term angiographic and 12-month cumulative clinical outcomes of the TRI group (n = 220, 31.9%) were compared to those of the TFI group (n = 469, 28.1%). Results: After propensity score matching, in-hospital complications and the 12-month major clinical outcomes during follow-up in the two groups were similar to each other. However, the incidence rates of repeat revascularization (6.4% vs. 0.5%, p = 0.003), target vessel revascularization (6.4% vs. 0.5%, p = 0.003), and major adverse cardiac events (MACE; 11.6% vs. 4.6%, p = 0.018) in the TFI group were higher than those in the TRI group during the 12-month of follow-up. Conclusions: In our study, TRI in STEMI patients undergoing primary PCI with DESs was associated with lower incidence of access site hematoma, 12-month repeat revascularization, and MACE compared to TFI. Therefore, TRI might play an important role in reducing bleeding complications while improving major clinical outcomes in STEMI patients undergoing primary PCI with DESs.

S-267 Impact of Ezetimibe/Simvastatin on neointimal response to Biolimus-eluting stent Implantation

( Han Chul Lim ),( Young Joon Hong ),( Sang Wook Kim ),( Young Mi Cho ),( Ji Won Kim ),( Jung A Choi ),( Han Byul Kim ),( Min Chul Kim ),( Doo Sun Sim ),( Ju Han Kim ),( Youngkeun Ahn ),( Myung Ho Jeo 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1

Impact of Ezetimibe/Simvastatin on neointimal response to Biolimus-eluting stent Implantation