40 세 이상 성인병 검진에서의 심방세동의 빈도와 위험인자에 관한 연구

정준훈(Joon Hoon Jeong) 대한내과학회 2001 대한내과학회지 Vol.61 No.5

N/A Background: Atrial fibrillation (AF) is a common arrhythmia that is a potent independent risk factor for stroke. The incidence of AF increases with age and most affected people have underlying cardiac disease. This study aimed to describe the incidence of and risk factors for AF in Korean. Methods : In this study, 14,540 adults (M/ F =6,573/ 7,967)≥40 years old were received screening test for general health between April 2000 and December 2000. Participants answered questionnaires and underwent examinations that included blood pressure, electrocardiogram (ECG), total cholesterol and fasting glucose. Data analysis was done by database statistics (dBSTAT) for windows program. Results: The incidence of AF is 0.7% (106/ 14,540) in people older than 40 years and 2.1% (60/ 2,876) in those older than 65 years . Approximately 56.6% (60/ 106) of individuals with AF are older than 65 years . The incidence of AF is higher at all age group in men than in women. Also, the incidence of AF is most highest in people older than 80 years. Male sex, old age (≥65 years), hypertension, diabetes mellitus (DM), left ventricular hypertrophy (LVH), stroke, and cardiac disease were associated with an increased risk of AF . Hypercholesterolemia, cigarette smoking, alcohol drinking, and hyperthyroidism were not associated wit h an increased risk of AF. The most potent risk factor of AF is electrocardiographic left ventricular hypertrophy (ECG- LVH) in this study. Conclusion: The incidence of AF is 0.7% in those older than 40 year s and 2.1% in those older than 65 years. The incidence of AF is 3- fold in men (1.2%) than in women (0.4%). Reversible risk factors of AF are hypertension, DM, LVH, stroke, and cardiac disease in this study. So, control of blood pressure and glucose may be import ant in preventing the development of AF. (Korean J Med 61:489- 495, 2001)

40세 이상 성인의 건강검진에서의 각차단의 빈도와 위험인자에 관한 연구

정준훈 ( Joon Hoon Jeong ) 대한내과학회 2003 대한내과학회지 Vol.64 No.4

목적 : 일반 인구에서의 각차단의 빈도는 다소 낮은 것으로 알려져 있고, 장기간의 예후에 대한 역할은 아직 확실히 알려져 있지 않다. 각차단에 대한 빈도나 위험인자에 대한 연구들마다 상이한 결과들을 보고하고 있지만, 연령과 매우 관련이 있는 것으로 알려져 있다. 본 연구는 한국인에서의 각차단의 빈도와 위험인자와의 관계를 알아보고자 시행하였다. 방법 : 본 연구는 2000년 4월부터 2000년 12월까지 40세 이상의 성인에서 건강검진을 시행 받은 14, Background : In the general population, the incidence of bundle branch block (BBB) is relatively low, and its effects on long-term prognosis have not been established. Previous studies of incidence and correlation to clinical factors have produced conflic

울혈성 심부전 환자의 치료 경과중 혈청 마그네슘의 동태에 관한 고찰

임종훈(Jong Hoon Lim),전국진(Kook Jin Chun),정준훈(Joon Hoon Jeong),김병진(Byung Jin Kim),오현명(Hyun Myung Oah),박용현(Yong Hyun Park),박융인(Yong Hyun Park),홍택종(Taek Jong Hong),신영우(Yung Woo Shin) 대한내과학회 1997 대한내과학회지 Vol.53 No.6

N/A Objectives: There are many interesting reports suggesting that magnesium(Mg) deficiency is deleterious in patients with congestive heart failure (CHF). It is paradoxical that the most important cause of Mg deficiency in these persons is maybe use of therapeutics including diuretics. Authors investigated the trend of serum and 24 hour urine Mg with other relating electrolytes in Mg homeostasis prospectively, in the management of CHF. And we assessd the effects of medications and many variables in .CHF on serum Mg, and the usefulness of serum Mg representing the body content. Methods: Fifty three patients who were diagnosed as CHF by clinical finding and echocardiogaphy were prescribed conventional doses of diuretics as furosemide 40mg and spironolactone 50mg daily, with or without angiotensin converting enzyme(ACE) inhibitor and digitalis. And then, serial serum and 24 hour urine Mg, sodium, potassium and calcium were obtained at admission, 2nd day, 5th day, and discharge. Results: The patients group with chronic CHF, which was defined as long-term use of diuretics over 6 months, showed higher prevalence of low level of serum Mg concentration than the group with acute one(11 of 28, 39% vs. 2 of 25. 8%, P< 0.01). Of those two groups, the latter showed upward trend of serum Mg from admission to discharge, but the former showed no change. In 24 hour urine Mg excretion, the amount of the patients with CHF was larger than that of control group. In the chronic CHF group, the effect of digitalis on decreasing serum Mg was evident. Serum Mg of acute CHF group correlated with serum BUN(r=0.5609). Whereas, that of chronic group with ejection fraction(r= ?0.4742) and plasma renin activity(r= ? 0.3791), with serum potassium(r=0.4673) and creatinine(0.5846). Serum Mg may be useful indicator of Mg homeostasis, especially in chronic CHF patients. Conclusion: Because patients with chronic CHF were prone to deficiency of Mg in the management, maintaining the adequate serum Mg through long- term replacement seems very important in decreasing the morbidity and mortality of these persons.

당뇨병성 미세혈관 합병증 및 신경병증 환자에서 혈청 Lipoprotein ( a ) 의 농도

이경인(Kyoung In Lee),정준훈(Joon Hoon Jeong),최영근(Young Keun Choi),김영민(Young Min Kim),강양호(Yang Ho Kang),손석만(Seok Man Son),김윤성(Yun Seong Kim),김사웅(Sa Woong Kim),유석동(Seok Dong Yoo),김인주(In Joo Kim),김용기(Yong Ki 대한내과학회 1998 대한내과학회지 Vol.54 No.2

N/A Background: Several epidemiological studies have shown that high plasma concentration of lipoprotein(a) [Lp(a)] is associated with an increased risk for atherosclerotic cardiovascular disease and works as an independent risk factor for atherosclerosis. But, the significance of Lp(a) in diabetic microangiopathy & neuropathy is unclear essentially due to a paucity of relevant studies. This study was designed to evaluate whether Lp(a) concentration may be increased in patients with diabetic microangiopathy & neuropathy. Methods : We studied 96 patients who visited the department of internal medicine in Pusan National University Hospital from May 1995 to May 1996. The patients were grouped according to the presence of diabetic complications(microangiopathy and neuropathy, microangiopathy included retinopathy and nephropathy) and therapeutic modalities(diet, insulin, insulin with oral hypoglycemic agent, and oral hypoglycemic agent). Results: 1) Concentration of Lp(a) was significantly higher(p<0.05) in patients with diabetic retinopathy(nonproliferative, 38.6±33.6 mg/dl, proliferative, 39.5±32.1 mg/dl) than that of patients without retinopathy(23.3±25.3 mg/dl). The duration of diabetes was significantly longer(p<0.05) in patients with diabetic retinopathy(nonproliferative, 12.0 years, proliferative, 13.2 years) than that of patients without retinopathy(5.9 years). 2) Concentration of Lp(a) was significantly higher(p<0.05) in patients with diabetic nephropathy(36.5±39.3 mg/dl) than that of patients without nephropathy(23.3±17.8 mg/dl) and the duration of diabetes was also longer in patients with diabetic nephropathy(10.7±7.2 years vs 6.3±5.8 years, p<0.005). 3) Concentration of Lp(a) was significantly higher and the duration of diabetes was longer in patients with diabetic neuropathy than that of patients without neuropathy(35.9±31.7 mg/dl vs 23.2±25.1 mg/dl, p<0.05 and 10.8 years vs 6.2 years, p<0.005). 4) Concentration of Lp(a) was significantly higher in patients with three complications(53.6 mg/dl, p<0.005) and duration of diabetes was significantly longer in patients with two or three complications(11.3 years, 13.6 years, respectively, p<0.0001). than those in patients without complications. 5) When the patients were subgrouped according to the treatment modalities, there were no significant difference in Lp(a) concentration, however the duration of diabetes was longer in patient group treated with combination of insulin and oral hypoglycemics than that of the other groups(p<0.05). 6) In multivariate logistic regression analysis, concentration of Lp(a) ≥ 50 mg/dl was significantly correlated with diabetic retinopathy & nephropathy, but was not significantly correlated with diabetic neuropathy. Duration of diabetes(≥7 years) and total cholesterol(≥20 mg/dl) were signi5cantly correlated with diabetic retinopathy, nephropathy and neuropathy. Conclusions: Lp(a) concentration is increased in patients with diabetic microangiopathy and neuropathy compared with patients without these complications. So, Lp(a) may works as risk factor for diabetic microangiopathy and neuropathy, and further study to evaluate the role of Lp(a) as a risk factor of such complications would be necessary in large number of patients.

급성 심근경색증에서 재혈관 개통술 후 심근 수축력의 향상을 예측하는 도구로써 심혈관 자기공명 영상의 유용성

김준홍 ( June Hong Kim ),박용현 ( Yong Hyun Park ),정준훈 ( Joon Hoon Jeong ),고우석 ( Woo Suk Ko ),배우형 ( Woo Hyung Bae ),이현국 ( Hyeon Gook Lee ),김준 ( Jun Kim ),전국진 ( Kook Jin Chun ),홍택종 ( Taek Jong Hong ),신영우 ( Y 대한내과학회 2005 대한내과학회지 Vol.69 No.4

목적 : 심혈관 자기공명영상의 발달은 생존심근의 진단에 많은 도움을 준다고 보고되고 있다. 저자들은 이러한 사실을 직접 규명하고자 본 연구를 시해하였다. 방법 : 급성 심근경색증으로 혈관 재개통술을 시행받은 19명의 환자에서 심혈관 자기공명영상을 얻었다. 자기공명영상은 좌심실을 32분절로 나누어 각각의 심근벽 운동과 후기조영 증강 정도를 결정하였으며 6개월 뒤 추적 관상동맥 조영술과 자기공명영상을 다시 얻어 비교 분석하였다. 결과 : 총 628개의 분절 중 177개의 분절에서 심근벽 운동의 이상을 보였으며 이 분절을 대상으로 분석을 시행하였다. 기저 심근벽 운동의 이상 중 심근벽 운동 이상을 보이는 분절(68분절)에서 심근벽 저운동을 보이는 군(109분절)에서 심근벽 운동의 호전을 보인 심근의 비율은 무운동을 보인 군과 비교하였을 때 의미있는 차이가 없었다(50% 대 41.3%, p=0.26). 자기공명영상의 후기 조영 증강영상에 따른 비교에서는 경색의 심근벽 이환 정도(transmural extent of infarction, TEI)에 따라 각각 TEI grade 0 군에서 60.5%, TEI grade I군에서 58.9%, TEI grade III군에서 51.2%, TEI grade IV군에서 29.4%, TEI grade V에서 8%였으며 이를 경색 정도가 심근벽의 50%를 이환하는 값으로 이분하였을 때 (TEI 50%) TEI가 50% 이하인 군(118분절)은 전체 분절 중 67분절(56.8%)에서 심근 운동의 회복을 보였으며 이는 TEI가 50%를 초과하는 그룹(59분절)의 12분절(20.3%)비하여 의미있는 차이를 보였다(p<0.001). 결론 : 심근경색에서 기저 심근벽 운동의 상태는 심근벽 호전을 예측하는데 도움이 되지 못하였다. 그러나 자기 공명 영상의 후기 조영 증강의 심근벽 이환 정도는 심근 수축력 향상을 예측하는데 유용하였으며 이는 임상에서 치료의 방향을 결정하는데 도움이 될 것으로 사료된다. Background : Cardiovascular MR has recently been reported that it can determine the viable myocardium. We investigated this study to determine the usefulness of cardiovascular MR in prediction of wall motion recovery after revascularization in acute myocardial infarction Methods : Both cardiovascular MR with contrast enhancement and coronary angiogram were performed in 19 patients with acute myocardial infarction who treated with precutaneous intervention or thrombolytic therapy. Six months follow-up angiogram and MR study were also preformed. Thirty two matched segments model of the left ventricle were used to analysis the wall motion change and the grade of transmural extent of hyperenhancement (TEI). Results : Among 628 segments, 177 segments showed wall motion abnormality. In group of segments showing hypokinesia (68 segments), the proportion of segments showing wall motion improvement was not different from that of the akinetic segments group (109 segments) (50% vs 41.3%, p=0.26). The proportion of segments showing wall motion improvement were 60.5% in group of TEI grade 0, 58.9% in TEI grade I, 51.2% in TEI grade III, 29.4% in TEI grade IV, 8% in TEI grade V. If the groups were divided into two according to cut-off value of TEI 50%, In the group of TEI less than 50%, 67 out of 118 segments (56.8%) showed wall motion improvement in contrast with 12 out of 59 segments (20.3%) in the group of TEI above 50% (p<0.001). The status of baseline wall motion abnormality (hypokinesia or akinesia) did not effect on wall motion improvement after revascularization. Conclusions : The baseline wall motion abnormality (hypokinesia or akinesia) did not predict the wall motion improvement. But, TEI grade was significant factor to predict the wall motion improvement.(Korean J Med 69:364-370, 2005)

증례 : 순환기 ; 임시형 심박조율기 삽입 후 발생한 조율 허용성 다형 심실빈맥 1예

박재영 ( Jae Young Park ),곽성동 ( Seong Dong Kwak ),임주견 ( Ju Kyeon Yim ),정재식 ( Jae Shik Jeong ),천재홍 ( Jae Hong Chun ),최성열 ( Sung Yeol Choi ),정준훈 ( Joon Hoon Jeong ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5S

저자들은 하벽의 급성 심근경색증 환자에서 VVI 방식의 임시형 심박조율기를 삽입한 후 심박조율기 오작동으로 인한 조율 허용성 다형 심실빈맥을 경험하였기에 문헌고찰과 함께 이를 보고하는 바이다. A 74-year-old man was admitted with sudden-onset chest pain. Electrocardiography showed ST segment elevation in leads II, III, and aVF; in addition, the levels of several cardiac enzymes were elevated. The patient received a VVI temporary pacemaker due to bradycardia (45 beats/min) and was subjected to primary percutaneous coronary intervention. After percutaneous coronary intervention for the RCA infarction, the patient was admitted to the coronary care unit. Six hours later, polymorphic ventricular tachycardia occurred following a short-long-short sequence. This is the first case of temporary pacemaker-permitted ventricular tachycardia in Korea. Here we present a case of pacemaker-permitted polymorphic ventricular tachycardia in a patient with inferior acute myocardial infarction. (Korean J Med 77:S1157-S1161, 2009)

증례 : 순환기 ; Felodipine에 의한 잇몸비후 1예

박종선 ( Jong Sun Park ),이창헌 ( Chang Hun Lee ),김나래 ( Na Rae Kim ),노동현 ( Dong Hyun No ),김도형 ( Do Hyeong Kim ),최성열 ( Sung Yeol Choi ),정준훈 ( Joon Hoon Jeong ) 대한내과학회 2009 대한내과학회지 Vol.76 No.1S

증례 : 순환기 ; 독사조신 복용 후 발생한 여성형유방증 1예

박인성 ( In Seong Park ),이남희 ( Nam Hee Yi ),박치환 ( Chi Hwan Park ),박승운 ( Seung Woon Park ),유진석 ( Jin Seok Yu ),정준훈 ( Joon Hoon Jeong ) 대한내과학회 2016 대한내과학회지 Vol.90 No.3

Doxazosin은 알파아드레날린길항제의 대표적인 약으로 전립선비대증에 아주 흔하게 사용되고 있다. 비슷하게 사용되는 finasteride, dutasteride와 같은 5-알파환원효소억제제는 여성형유방증, 유방통과 같은 부작용이 흔하게 보고되고 있으나 알파아드레날린길항제는 보고된 바가 국내에 아직 없다. 또한 알파아드레날린길항제는 약리 기전으로 보아 그러한 부작용을 의심하는 것이 쉽지 않다. 이에 doxazosin 사용 후 일측성의 여성형유방증과 유방통이 발생한 1예를 경험하였기에 국내 첫 번째 사례로 보고하는 바이다. Doxazosin is an adrenergic alpha-1 receptor antagonist used to treat lower urinary tract symptoms that are common in prostatic hyperplasia. To our knowledge, few cases of gynecomastia and mastodynia, as a complication of adrenergic alpha-1 receptor antagonist, have been reported to date; no cases have been reported in Korea. We describe a case involving a 78-year-old man treated for prostatic hyperplasia with 13 months of doxazosin. He complained about unilateral gynecomstia and mastodynia. Five months after the discontinuation of doxazosin, the gynecomastia was significantly improved. This is the first reported case of gynecomastia and mastodynia associated with doxazosin use in Korea. (Korean J Med 2016;90:239-242)

Angiotensin Converting Enzyme Inhibitor에 의해 유발된 약제 유발 루푸스 1예

김병석 ( Byung Seok Kim ),홍영미 ( Young Mi Hong ),박성민 ( Seong Min Park ),박일우 ( Il Woo Park ),이병희 ( Byung Hee Lee ),정준훈 ( Joon Hoon Jeong ),이충원 ( Choong Won Lee ) 대한류마티스학회 2011 대한류마티스학회지 Vol.18 No.4

약제 유발 루푸스에 대한 여러 증례들이 보고되어 왔으나 ACE inhibitor에 의한 약제 유발 루푸스에 대한 증례는 없었다. ACE inhibitor에 의한 루푸스의 정확한 병리 기전은 밝혀지지 않았으나 고혈압과 심장질환의 다양한 환자에서 쓰이고 있는바 임상증상 추이를 관찰하면서 발생에 대해 염두 해둘 필요가 있다. 저자들은 불안정성 협심증환자에서 ACE inhibitor 사용 도중 발생한 약제 유발 루푸스 1예를 경험하였기에 이를 보고하는 바이다. Drug-induced lupus erythematosus is defined as a lupus-like syndrome related to continuous drug exposure which resolves after discontinuation of the offending drug. Here we report a case of a 70-year-old man who developed drug-induced lupus erythematosus after receiving angiotensin converting enzyme inhibitor medication for unstable angina pectoris, for 5 years. He was hospitalized with arthralgia, edema, and newly developed pleural effusion. The serum analysis revealed an elevated level of antinuclear antibody and antihistone antibody. After discontinuation of angiotensin converting enzyme inhibitor and receiving a course of prednisolone treatment, his symptoms and pleural effusion improved. To the best of our knowledge, this is, the first case report of angiotensin converting enzyme inhibitor-induced systemic lupus erythematosus in Korea.

후천성 면역 결핍증 환자 ( AIDS ) 의 혈액면역학적 특성과 기회감염에 대한 임상적 고찰

남태수(Tae Su Nam),서경수(Keung Su Seo),이경인(Kyong In Lee),김윤성(Yun Seong Kim),홍진희(Jin Hee Hong),김광하(Gwang Ha Kim),정준훈(Joon Hoon Jeong),주형준(Hyung Jun Chu),박승근(Seung Keun Park),성낙현(Nak Hean Seoung),정주섭(Ju Sup 대한내과학회 1997 대한내과학회지 Vol.52 No.1

N/A The number of persons with HIV infection in Korea have increased steadily, total number of HIV infection in Korea were 478 on August, 1995. To investigate the clinicoimmunologic manifestation of AIDS in Korea, we reviewed complete blood counts (CBC), CD4 counts, serum β2-microglobulin level, opportunistic infections and cause of death for 19 AIDS patients who had been admitted or visited at Pusan national university hospital during the period of January, 1990 to August, 1995. 1) The predominant mode of HIV transmission was heterosexual contact(18), other modes of transmission were homosexual contact(1). Clues of diagnosis of HIV infection were routine occupational health examination(14), and opportunistic infection symptoms such as fever, coughing(4). 2) Mean CD4 cell counts(/mm3) were 53±72 totally, 22±27 for 8 dead patients at mean 2 month before, 91±87 for 7 living patients. There were not significant difference(p>0.05). 3) Serum β2-microglobulin(MG;ug/ml) was measured at 12 patients, mean serum β2-MG level was4.8±7.3 totally, 7.1±10.3 for 6 dead patients at mean 1.3 month before, 2.5±0.4 for 6 living patients. There were not significant(p>0.05). 4) At CBC examination, WBC(/mm3) was 5,932±2,899 totally, 5,452±3,436 for 10 dead patients, 6,500 ±2,221 for 9 living patients(p>0.05). Hb(g/dl) was 11,4±2.8 totally, 9.4±1.8 for dead patients, 13.6±1.8 for living patients(p<0.05). Lymphocyte count(/mm) was 1,255±800 totally, 731±424 for dead patients, 1,838716 for living patients(p<0.05). ESR(mm/h) was 72±47 totally, 97±33 for dead patients, 47±47 for living patients(p<0.05). 5) Opportunistic infections had developed at 14 patients, candidiasis 7, pneumocystis carinii pneumonia 5, tuberculosis 3, cytomegalovirus infection 2, herpes zoster 3, toxoplasmosis 1, cryptococcal infection 2, bacterial pneumonia 5, and herpes simplex l. Malignant lymphoma had developed in 1 patient. 6) Mean survival interval from diagnosis of HIV infection to death was 32.8±19.1 months, and the most common cause of death was pneumocystis carinii pneumonia, and other causes of death were meningitis, bacterial pneumonia and AIDS-wasting syndrome. Based on these results, We concluded that CD4 counts, serum β2-microglobulin level, Hb, total lymphocyte count and ESR in AIDS patients are specific laboratory markers of progression and prognosis of AIDS, the most common opportunistic infection was candidiasis, and the most common cause of death in AIDS patients was pneumocystis carinii pneumonia.