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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)
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)
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.
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 시행받은 14,540명 (남자 6,573명, 여자 7,967명)을 대상으로 혈압, 심전도, 총콜레스테롤, 공복혈당을 측정하였고, 과거병력과 음주, 흡연 유무를 설문지를 통해 조사하였다. 통계처리는 dBSTAT (Data Base Statistics) for Windows 프로그램을 사용하였다. 결과 : 40세 이상 성인의 완전우각차단의 빈도는 1.5%이었고, 65세 이상에서는 2.9%로 나타났다. 완전 우각차단 환자의 38%가 65세 이상이었다. 모든 연령 대에서 남자가 여자보다 빈도가 높았고, 특히 남녀 모두 70대 후반에서 빈도가 가장 높았다. 남성, 나이(≥ 65세), 고혈압, 당뇨병 등이 유의한 위험인자로 나타났다. 40세 이상 성인의 좌각차단과 이섬유속차단의 빈도는 0.1%, 0.08%이었고, 65세 이상에서는 0.3%, 0.2%로 나타났다. 좌각차단과 이섬유속차단 환자의 71.4%, 58.3%가 65세 이상이었다. 나이와 심근경색증이 좌각차단과 이서유속 차단의 유의한 위험인자로 나타났다. 본 연구에서 각차단의 가장 유력한 위험인자는 나이였다. 결론 : 본 연구에서 40세 이상에서 각차단의 빈도는 1.7%이었고, 65세 이상에서는 3.4%이었으며, 완전우각 차단이 전체 각차단 중 89.3%를 차지하였다. 완전우각차단에서는 남자가 여자보다 1.5배 많은 것으로 나타났다. 각차단의 가장 강력한 위험인자는 나이로 나타났다. 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 conflicting results. but, the incidence of BBB was strongly related to age. This study aimed to describe the incidence of and risk factors for BBB 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 complete right bundle branch block (CRBBB) was 1.5% in people older than 40 years and 2.9% in those older than 65 years. Approximately 38.0% of individuals with CRBBB were older than 65 years. The incidence of CRBBB is higher at all age group in men than in woman. Also, the incidence of CRBBB is most highest in aged 75~79 years. Male, advancing age (≥ 65 years), hypertension, and diabetes mellitus (DM) were associated with an increased risk of CRBBB. The incidence of complete left bundle branch block (LBBB) and bifascicular bundle branch block (BBBB) were 0.1%, 0.08% in people older than 40 years and 0.3% of individuals with LBBB and BBBB were older than 65 years, respectively. Advancing age (≥ 65 years) and myocardial infarction (MI) were associated with an increased risk of LBBB and BBBB. the most potent risk factor of BBB was advancing age in this study. Conclusion : the incidence of BBB was 1.7% in those older than 40 years and 3.4% in those older than 65 years. Approximately 89.3% of individuals with BBB were CRBBB. The incidence of CRBBB is 1.5-fold in men than in women. The most potent risk factor of BBB was advancing age. (Korea J Med 64:412-421, 2003)
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 han 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)
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$lt; 0.01). Of those two groups, the latter showed upward trend of serum Mg from admission to discharge, but the former showed no change. In 24 hour urine Mg excretion, the amount of the patients with CHF was larger than that of control group. In the chronic CHF group, the effect of digitalis on decreasing serum Mg was evident. Serum Mg of acute CHF group correlated with serum BUN(r=0.5609). Whereas, that of chronic group with ejection fraction(r= ?0.4742) and plasma renin activity(r= ? 0.3791), with serum potassium(r=0.4673) and creatinine(0.5846). Serum Mg may be useful indicator of Mg homeostasis, especially in chronic CHF patients. Conclusion: Because patients with chronic CHF were prone to deficiency of Mg in the management, maintaining the adequate serum Mg through long- term replacement seems very important in decreasing the morbidity and mortality of these persons.
The number of persons with HIV infection in Korea have increased steadily, total number of HIV infection in Korea were 478 on August, 1995. To investigate the clinicoimmunologic manifestation of AIDS in Korea, we reviewed complete blood counts (CBC), CD4 counts, serum β₂-microglobulin level, opportunistic infections and cause of death for 19 AIDS patients who had been admitted or visited at Pusan national university hospital during the period of January, 1990 to August, 1995. 1) The predominant mode of HIV transmission was heterosexual contact(18), other modes of transmission were homosexual contact(1). Clues of diagnosis of HIV infection were routine occupational health examination(14), and opportunistic infection symptoms such as fever, coughing(4). 2) Mean CD4 cell counts(/㎣) were 53±72 totally, 22±27 for 8 dead patients at mean 2 month before, 91±87 for 7 living patients. There were not significant difference(p$gt;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$gt;0.05). 4) At CBC examination, WBC(/㎣) was 5,932±2,899 totally, 5,452±3,436 for 10 dead patients, 6,500 ±2,221 for 9 living patients(p$gt;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$lt;0.05). Lymphocyte count(/mm) was 1,255±800 totally, 731±424 for dead patients, 1,838±716 for living patients(p$lt;0.05). ESR(mm/h) was 72±47 totally, 97±33 for dead patients, 47±47 for living patients(p$lt;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.