Dipyridamole 부하 심근 SPECT에서 Dipyridamole의 작용과 부작용

고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(June Key Chung),이동수(Dong Soo Lee),최창운(Chang Woon Choi),배상균(Sang Kyun Bae),양형인(Hyung In Yang),여정석(Jeong Suk Yeo) 대한핵의학회 1993 핵의학 분자영상 Vol.27 No.2

N/A Dipyridamole is an agent that may be used to noninvasively evaluate coronary artery disease. The effect of dipyridamole infusion its generally related to its induced peripheral vasodilatory effect. In normal person, heart rate is generally increased slightly while blood pressure decrease, but the achieved double product and related myocardial oxygen consumption have no significant change. The purpose of this study is to examine the effect and side effect of dipyridamole, and to compare different response to dipyridamole among the patients. We evaluated 847 patients who underwent dipyridamole stress myocardial SPECT. 93.6% of them had induced hypotension 0.9% showed no change of blood pressure, 5.5% had increased blood pressure 8.3% had no change of pulse rate more than 10% of basal pulse rate. Among diabetes, 16.9% was not change of pulse rate, 6.7% in non-diabetes. There was no significant correlation between age and rate pressure product rest(RPPr), in patients without perfusion defects on SPECT(y=7.1x+48.4r=0.13 p>0.01). As increasing age, RPPs/RPPr was declined(y=-11.6x+68.9 r=0.17 p〈0.01), similar results were obtained in patients with perfusion defect. The size of perfusion defect on myocardial SPECT have no correlation between RPPr and RPPs/RPPr. The side effects of dipyridamole included chest pain and chest tightness, headache, abdominal pain, dizzness, nausea, and dyspnea. As increasing age, dipyridamole-induced cardiac work at rest was increased, cardiac response to dipyridamole was decreased.

Al³^(+) 존재가 ^(99m)Tc-MDP의 표지효율과 생체내 분포에 미치는 영향

장영수,정재민,김영주,곽철은,이동수,정준기,이명철,고창순 大韓核醫學會 1996 핵의학 분자영상 Vol.30 No.3

Graves 병 환자에서 항갑상선제 투여에 의한 TSH 수용체 항체의 변동에 관한 연구 : 치료 용량 및 기간에 따른 차이 및 임상상과의 관계 its relation to dose and duration of treatment~and clinical features

이문호,조보연,문대혁,고창순,민헌기,서교일 대한내과학회 1986 대한내과학회지 Vol.30 No.3

We undertook a prospective study of 59 patients with Graves' disease in order to clarify the influence of antithyroid drug on the immunological indices and to determine the association of the changes of TSH receptor antibodies activities with drug dosage, duration of treatment and clinical features according to mode of antitbyroid drugs treatment. Patients were divided into two groups. High dose group included 28 patients and conventional dose group 31 patients. We measured TBII activities, antimicrosomal antibodies, and the size of goiter every 3 months, comparing them with clinical features and laboratory findings. TBII activities declined from R months until 9 months following drug treatment. Therafter no significant change of TBII activities were observed. Antimicrosomal antibodies showed the same pattern of change. There was no statistically significant difference of declining rate of TBII activities, antimicrosomal antibodies, and reduction of size of thyroid between two treatment groups. TBII activities fell into normal range in 15 patients among those 44 patients who had been followed for more than 9 months (8 high dose group, 7 conventional dose group). In those 15 patients, TBII activities and frequency of exophthalmos were less than those whose TBII activity did not normalized. We conclude that TSH receptor antibodies activities and antithyroid autoantibodies are diminished by antithyroid drug treatment in patients with Graves disease and there is no relationship between dose of drug and declining of TBII activities. We suggest that changing levels of TBII activities might be secondary phenomenon which can be achieved by control of thyroid function by antithyroid drug rather than direct immunosuppressive effect of antithyroid drug per se.

무증상 갑상선기능저하증 환자에서 Thyroxine 치료에 따른 혈청 지질 및 아포지단백의 변화

조보연,신찬수,김원배,고창순,김성연,박혜영,박건상,이홍규,박형규,김숙경 대한내분비학회 1996 Endocrinology and metabolism Vol.11 No.1

Background: Subclinical hypothyroidism(SCH) is a common biochemical abnormality which can be found in routine screening tests of thyroid function. We are increasingly faced with the question of whether its an indication for thyroxine replacement therapy. The effect of thyroxine replacement on lipid profile in SCH has aroused a great interest because of an association of overt hypothyroidism(OVH) with hyperlipidemia and increased risk of coronary artery disease. Method: We prospectively evaluated the changes in lipids and apoproteins before and after thyroxine replacement therapy in 23 patients with SCH and in 37 patients with OVH. We measured serum total cholesterol and triglyceride using autoanalyzer, high density lipoprotein(HDL) chole-sterol by dextran sulfate method, Apo A1 and Apo B by immunonephelometric assay. Results: Thyroxine replacement therapy significantly decreased total cholesterol, low density lipoprotein(LDL) cholesterol and apo B levels, but did not affect the level of triglyceride, HDL cholesterol or apo AI in patients with OVH. In SCH, thyroxine replacement therapy with the doses to normalize serum TSH concentrations also decreased significantly the level of cholesterol and LDL cholesterol albeit apo B levels did not change. Moreover, in most of patients with OVH (11 of 12) and in all of patients with SCH(5 of 5) who had had hyperchlesterolemia before treatment, thyroxine replament normalized their cholesterol and LDL cholesterol levels. Conclusion: In regard to the beneficial changes in blood lipid levels, patients with SCH should be treated, especially in cases who have other risk factors for the development of atherosclerosis. If thyroxine replacement only will reduce the incidence of coronary artery disease in SCH remains to be elucidated by long-term prospective studies(J Kor Soc Endocrinol 11:41-51, 1996).

악성종양에서 골수면역신티그라피를 이용한 골수전이의 평가 : 99mTc-MDP 뼈스캔과의 비교

고창순(Chang Soon Koh),김노경(Noe Kyeong Kim),김병국(Byoung Kook Kim),최창운(Chang Woon Choi),정준기(Jun Key Chung),방영주(Yung Jue Bang),이경한(Kyung Han Lee),정홍근(Hong Keun Chung),이명철(Myoung Chul Lee) 대한핵의학회 1994 핵의학 분자영상 Vol.28 No.1

N/A Although bone scan is a highly sensitive test for detecting bone metastasis, its findings are often limited in specificity and cannot be used for assessing the bone marrow. Bone marrow scintigraphy may provide useful information but previous experience with radiolabelled colloid has been disappointing. Recently, 99mTc labeled anti-granulocyte rnonoclonal antibody (anti-NCA-95 MAb) has been introdueed as a new bone marrow imaging agent. To evaluate the usefulness of 99mTc anti-NCA MAb bone marrow scans for detecting skeietal metastasis, bone marrow scans of 44 malignant tumor patients were evaluated and compared with bone scan fmdings. Bone scan showed abnormal lesions in 26(59%) cases, and 18 of these patients also had an abnormal bone marrow scan. Seven of the 8 patients who had normal bone marrow scan despite bone scan lesions were confirmed to be free from metastasis. There was one case with a marrow defect despite normal bone scan but the presence of metastasis was not determined due to loss of follow up. Bone scan demonstrated a total of 64 lesions while bone marrow scan showed 38 lesions. Fifty percent (32/64) of the bone scan lesions had matching marrow defects while the rernaining 50% did not. Most of these non matched lesions were suggested to be nonspecific 1esions such as rib fractures or degenerative change. Meanwhile bone marrow scan was able to detect 6 new lesions not detected by bone scan, but metastasis in each lesion was not confirmed. Bone marrow scan was also helpful in assessing equivocal bone scan lesions to be of metastatic nature in 10 patients by demonstrating a matched marrow defect. Thus 99mTc anti-NCA MAb bone marrow scan can help exclude metastasis in patients with nonspecific bone scan lesions and may be able to detect metastatic lesions not seen with bone scan. It appears useful as a complementary study to bone scan in evaluating malignant tumor patients.

S-상 심실중격의 임상적 고찰

이동민,장경식,양종태,장대용,김종오,서영욱,고영엽,홍순표 조선대학교 부설 의학연구소 2002 The Medical Journal of Chosun University Vol.27 No.1

Background: The sigmoid septum described an anatomical variation in the contour of the left ventricular outlet. It is related to degenerative change with aging. We observed clinical significance of sigmoid septum in Korean. Methods: Echocardiographic examination was performed in 434 patients. Sigmoid septum is defined as discrete bulging of the proximal interventricular septum with that thickness is greater than 1.3cm or the thickness is grater 1.5 times than adjacent mid interventricular septum in apical 3 chamber view. Result: The incidence of patient with sigmoid septum(septum patient) is 24.8% (male 8.4%, female 16.3%) . The incidence increases with age and is more common in women. The patients with sigmoid septum were compared with targeted groups, there was no significant difference in blood pressure between them, but in height and weight, the former were lower. (p<001, p<03). In the patients with sigmoid septum, weight and the surface area of a body have an opposite correlation with increase of age (p<03, r=-0.34) (p<04, r=-0.31) , but no decrease of height was found according to age increase (p=0.47, r=-0.11) The main reason patients with sigmoid septum ask echocardiolography and its clinical symptoms were abnormal results of previous electrocardiography and/or usual chest pain. Compared with control group, interventricular septal thickness is larger in septum patients (p<001). The thickness of interventricular septum located in subaortic left ventricular outflow tract is 1.6±0.3cm. There is another web like structure that continued from interventricualr septum to anterior free wall of left ventricle and the width is 1.6±0.4cm. A sign of insignificant obstruction due to left ventricular outflow was observed from three sigmoid septum patients. Conculusion: Septum patient is largely found in older age group and the body weight and body surface area are lower than control group. The body weight and body surface area are opposite correlation with age. So sigmoid septum is considered as structural change by weight reduction with aging. It is assumed that septum patients are related with asymptomatic ischemia because they have more abnormal ECG finding such as T wave inversion on precordial leads or standard leads, nonspecific ST-T change, LBBB etc. Sigmoid septum is not only proximal interventricular septal bludging but also another web like structure continuing to anterior wall of left ventricle.

급성 심근 경색중 후 추적 관찰에 관한 연구

박영배,이영우,오동진,고창순,서정돈,서봉관,오병회 대한내과학회 1986 대한내과학회지 Vol.31 No.5

To assess the change in left ventricular function after hospital discharge, 57 patients with acute myocardial infarction were studied before discharge and 26 of them after discharge as well with either or both of treadmill test and radionuclide ventriculography(RNV). Follow-up study patients were 2g men with mean age of 53.1. Their infarct locations were anterior in 16 cases, inferior in 8 cases and anterior and inferior in 2 cases; 21 cases were in Killip class I, 3 cases in II, and 2 cases in III. Follow-up study was performed 2~19 months(mean 7.3 months) after acute myocardial infarction. The results were as follows: 1) Predischarge study showed that a relationship is present between regional wall motion abnormality, Killip class, peak serum CK and left ventricular ejection fraction(LVEF). 2) Predischarge and follow-up treadmill tests showed no significant change. 3) Follow-up RNV showed worsening of regional wall motion only in 1 case: Other cases showed either improvement or no change in regional wall motion. 4) Overall patients showed a significant increase in LVEF on follow-up. By location, only anterior infarction showed a significant increase in LVEF. 5) Killip class I patients showed a significant increase in LVEF on follow-up. 6) Most cases in this study were uncomplicated myocardial infarction and they showed improved LV function(suggested by RNV) on follow-up. Treadmill test also seems to be valuable for evaluationg improvement in exercise capacity on follow-up. So it is recomended that treadmill test or RNV be performed after discharge to evaluate change in LV function objectively.

관상동맥 풍선성형술 후 발생한 관상동맥 박리의 초기 조영술적 고찰

고영엽,강지인,장재혁,강민정,정중화,장경식,홍순표 朝鮮大學校 附設 醫學硏究所 2007 The Medical Journal of Chosun University Vol.32 No.1

Background and Objectives: Percutaneous coronary intervention (PCI) is widely utilized in the treatment of symptomatic coronary artery disease (CAD). Althouth it has numerous benefits, intimal tear or dissection, serious and potentially life-threatening complications of plain old balloon angioplasty (POBA) can occur. The aim of this study was to assess the implications of coronary dissections after ballon angioplasty. Methods: 78 consecutive patients (age, 62 +/- 11 years; 46 men, 32 women) identified to two groups as having with or without dissection (dissection (D) group or non-dissection (ND) grouP) underwent balloon angioplsty for CAD were studied. All patients with dissection could be managed by successful stent implantation to rescue the artery. The morbidity of ischemic complication and mortality were evaluated for 30days after PCI. Results: Coronary dissection developed 44 lesions (38%) in 31 patients out of 117 lesions in 78 patients after POBA and a good final angiographic result was obtained in all patients with dissection, Significant correlates of a development of dissection were the lesion morphology of ACC/AHA type B and C (P<0.05). There were no significant correlations of clinical pictures, whether POBA in single vessel disease or in multivessel disease, diameter stenosis before POBA, and balloon/coronary artery diameter ratio. Morphologic feature of dissection was type A in 15 (34%), type B in 13(30%), type C in 12 (27%), and type D in 4 (9%). After PCI, there was no ischemic complication or death related coronary dissection during follow-up period for 30days. Conclusions: Coronary dissection after angioplasty occurred in 44 lesions (38%) out of 117 lesions of 78 consecutive patients underwent POBA. Coronary dissection after POBA significantly correlated with the severity of lesion morphology. Coronary stenting is effective in the management of acute coronary dissections after angioplasty.

핵의학 서론

고창순 한국의학사 1985 診斷과治療 Vol.5 No.1

凡山 高昌舜 敎授 정년퇴임 기념논문 : PET의 임상이용 Clinical Application of Position Emission Tomography

고창순 서울대학교 의과대학 내과동문회 1997 含春內科 Vol.27 No.1