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관동맥질환의 진단에 있어서 Exercise Treadmill Score 의 의의
서정평(Jeong Pyeong Seo),조인종(In Jong Cho),류문희(Mun Hee Rheu),박종수(Jong Soo Park),이명곤(Myung Kon Lee),정명호(Myung Ho Jeong),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),강정채(Jung Chaee Kang) 대한내과학회 1997 대한내과학회지 Vol.52 No.3
N/A Objectives: The treadmill exercise eletrocardiography(ECG) is the most commonly used non- invasive method in the evaluation of patients with chest pain. But the accuracy of treadmill exercise ECG in detecting the coronary artery disease(CAD) is still controversial. To improve the accuracy of the treadmill exercise test, exercise treadmill score(ETS) based on exercise duration, degree of ST deviation, and treadmill anginal index during treadmill exercise ECG has been used. Methods: The authors calculated ETS by simple equation(total exercise duration-5×maximal ST- segment deviation during or after exercise-4×treadmill angina index) and analyzed coronary angiograms of 173 patients(mean age '55.5±8.7, male: female=2.7: 1) who underwent treadmill exercise ECG and coronary angiography in Chonnam University Hospital from January, 1990 through March, 1993. Results. 1) The studied subjects were subdivided into 3groups according to ETS. Group A(high risk, ETS≤11) were composed of 15cases(mean age 60.2±7.4, male: female = 1.2: 1), group B(moderate risk, 5>ETS≥11) 71cases(mean age 60.2±7.4, male: female=3.3:1), group C(low risk, ETS>5) 87cases(mean age 54.8±9.2, male-female =2.5:1). Clinical diagnoses of the studiedsubjects were 63stable angina, 61unstable angina, 3acute myocardial infarction, and 46 old myocardial infarction. On coronary angiographic findings, 61patients had single vessel disesase, 23patients had two vessel disease and 13patients had three vessel disease. 2) The sensitivity of the treadmill exercise ECG in diagnosing coronary artery disease was 88% and the specificity was 46%. 3) One hundred percent of group A patients had CAD and 54% of them had multivessel disease, 75% of group B had CAD and 27% of them had multivessel disease, and 33% of group C had CAD and 10% of them had multivessel disease. 4) There were no significant differences in the siite of stenotic lesion and degree of stenosis according to ETS in the patients with single vessel disease. 5) There were no significant differences in left ventricular ejection fraction and left ventricular end-diastolic pressure among three groups. Conclusion: Exercise treadmill score is useful in predicting the presence and severity of CAD and that low ETS less than -11 may be an indicator of multivessel coronary disease.
방실결절회귀성 빈맥의 유발에 관여하는 심전기생리학적 인자에 관한 연구
조정관(Jeong Gwan Cho),신순철(Soon Chul Shin),류제영(Jay Young Rhew),배열(Youl Bae),김준우(Jun Woo Kim),김성희(Sung Hee Kim),김주한(Ju Han Kim),서정평(Jeong Pyeong Seo),박종철(Jong Chul Park),차광수(Gwang Su Cha),박주형,정명호(Myung Ho 대한내과학회 1997 대한내과학회지 Vol.52 No.6
N/A Objectives: Although a subtle balance between conduction time of the antgrade slow pathway and refractory period of the retrograde fast pathway is known to play the most critical role in the induction of AV nodal reentrant tachycardia(AVNRT), other electrophysiologic factors such as concealed conduction in to the fast pathway have been suggested to be responsible. The present study was performed to determine the electrophysiologic factors responsible for the induction of AVNRT. Methods: Total 34 subjects undergoing electrophysiologic study(EPS) including 9 normal subjects(SAVNP), 7 subjects with dual AV nodal pathways(DAVNP) but no inducible AVNBT, and 18 inducible AVNRT patients were included in this study. EPS was performed using the conventional technique. To evaluate the presence of concealed conduction into the fast AV nodal pathway(FP) and its effects on the effective refractory period(ERP) of the FP (FP-ERP) to a subsequent impulse, single(A2) and double atrial extrastimuli(A2A3) were given. FP-ERP of conducted A2 [FP-ERP-A2(+)] was measured with a second atrial extrastimulus(A3) following a first atrial extrastimulus(A2), which was delivered at a coupling interval 20-30ms longer than FP-ERP. ERPs of non-conducted A2 [FP-ERP-A(-)] was measured with A3 following A2 at coupling intervals 20 ms shorter than FP-ERP. Concealed conduction was considered to be present when A1A3 interval of A3 blocked at the FP with a longest A2A3 interval was longer than FP-ERP. Concealment index(CI)-1 and CI-2 were calculated by dividing FP-ERP-A2(-) by FP-ERP-A2(+) and FP-ERP, respectively. In addition, relationship between antegrade slow pathway conduction time(A2H2) and retrograde fast pathway conduction time(HA), retrograde AV conduction system block cycle length(VA-BCL), and retrograde AV conduction system EBP(VA-ERP) was evaluated by a regression analysis. Results: Concealed conduction was present in all the subjects. CI-1 was 0.63±0.04 and CI-2, 0.79±0.04 in SAVNP and 0.67±0.11, 0.68±0.07 respectively, in AVNRT patients in whom the antegrade slow pathway(SP) was ablated with catheter ablation, showing no significant difference in CI between 2 groups. At the time of induction of AVNRT with A2, A2H2. was significantly correlated with FP-ERP and FP-CT(r=OA43, p=0.04; r=0.507, p=0,02, respectively). By multivariate regression analysis, it was derived that A2H2 should be greater than 0.79 FP-ERP+1.57 FP-CT-0.44 HA-190(ms) (r=0.71, p< 0.05). Conclusion: Induction of typical AVNRT with A2 is determined by conduction time of the slow pathway, refractory period and conduction velocity of the fast pathway, and concealed conduction into the fast pathway.
천식 환자에서 올바른 정량식 분무흡입기 사용 교육에 대한 효과
김상국(Sang Guk Kim),장안수(An Soo Jang),김윤경(Yun Kyung Kim),이승(Soong Lee),서정평(Jeong Pyeong Seo),양승원(Seung Won Yang),최수인(Soo In Choi),박상후(Sang Hoo Park),이경록(Kyung Rok Lee),박재홍(Jae Hong Park) 대한천식알레르기학회 2000 천식 및 알레르기 Vol.20 No.5
N/A Background: Medications for asthma can be administered either by inhaled or systemic routes. The major advantages of delivering drugs directly into the lungs via inhalation are that higher concentrations can be delivered more effectively to the airways and that systemic side effects are avoided or minimized. Inhaled medications, or aerosols, are available in a variety of devices that differ in required technique and quantity of drugs delivered to the lung. Objective : The purpose of this study was to determine the effects of patient education on correct use of metered dose inhaler in patients with asthma. Methods : Twenty patients with asthma were instructed three times on proper inhaler usage by a physician at two-week intervals. Practical performance and theoretical knowledge were assessed (ten-item assessment). Scoring was done by one physician using a score of 1-3 for each item. Results : The practical performance and theoretical knowledge scores were higher in patients after being instructed three times compared with those who were instructed once (26.2±2.2 vs 18.1±3.6, p< O.01). The scores were higher in patients with higher education level compared with those with lower education level after three lessons (27.3±1.94 vs 24.3±1.80, p< 0.05). The most common errors included inadequate actuation time and breath holding, and insufficient activations. Conclusion : These findings suggest that patients with asthma be instructed in inhaler use and that their technique be checked regularly and repeatedly depending on education level. (J Asthma Allergy Clin 1mmunol 20: 695-701, 2000)
김상국(Sang Guk Kim),양승원(Seung Won Yang),박상후(Sang Hoo Park),이경록(Kyung Rok Lee),박재홍(Jae Hong Park),장안수(An Soo Jang),서정평(Jeong Pyeong Seo),이숭(Soong Lee),남해성(Hae Sung Nam),손명호(Myung Ho Sun),신명근(Myung Geun S 대한내과학회 2001 대한내과학회지 Vol.60 No.6
N/A Background : Significant ethnic and geographic differences exist in the prevalence of diabetes mellitus, which has increased dramatically in South Korea. But a few population-based studies were performed in South Korea. The purpose of this study was to determine the prevalence of diabetes mellitus, impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) by the World Health Organization (WHO) and the American Diabetic Association (ADA) diagnostic categories, and to investigate their associated risk factors. Methods : Between march 22, 1999 and July 14, 1999, a random sampling of 1445 residents over 40 year of age in five villages in the Namwon county of South Korea was carried out. Among these subjects, 665 (46.0%) participants completed 75 g OGTT. WHO and ADA diagnostic criteria were used for the diagnosis of diabetes mellitus, IGT and IFG. Detailed questionnaire were performed and anthropometric data were collected. Results : After age-adjustment for population projection for Korea (1999), the prevalence of diabetes and IGT were 13.7% and 13.8% with WHO criteria, while the prevalence of diabetes, IGT and IFG were 15.8%, 12.8% and 5.7% with ADA criteria. The age-adjusted prevalence of previously diagnosed diabetes was 5.8%. The level of agreement between WHO and ADA diagnostic criteria except IFG was high (κ=0.94; p<0.001). The ROC curve analysis determined FSG of 114.5 mg/dL (6.4 mmol/L) to yield optimal sensitivity and specificity corresponding to a PP2SG 200 mg/dL (11.1 mmol/L). The prevalence of diabetes and IGT with ADA diagnostic criteria rose with increasing age (p<0.05). The difference in the prevalence of diabetes, IGT and IFG by BMI was not significant. The prevalence of diabetes rose with increase in the waist-hip ratio. The prevalence of diabetes was increased in subjects with dyslipidemia (Odds ratio 2.29, 95% CI: 1.16-3.49).
박홍배,장안수,서정평,양승원,조남중,이 숭 대한소화기학회 1999 대한소화기학회지 Vol.33 No.6
Pancreatic fistula is a rare complication which occurs in acute and chronic pancreatitis, or after trau matic or surgical disruption of pancreatic duct. Fistula may drain spontaneously into adjacent hollow viscera, peritoneal and pleural cavities (internal fistula) or communicate with the body surface exter nally (external fistula). We recently experienced a case of pancreatico-gastric fistula after acute phase of chronic pancreatitis without pseudocyst. To our knowledge, this is the first case in Korea. The patient was a 75-year-old man with epigastric and left upper quadrant abdominal pain. Abdomina computerized tomography (CT) and ultrasonography showed enlarged, poorly marginated pancreas with irregular dilated pancreatic duct. Endoscopic examination showed small orifice with marginal whitish mucosa at posterior wall side of gastric antrum. Endoscopic retrograde cholangiopancreato graphy showed irregular dilated duct in tail of pancreas and collection of contrast medium in fundu of stomach. CT guided aspiration and biopsy of pancreas showed fibroadipose tissue infiltrated with chronic inflammatory cells.
김형주,김상국,이경록,이숭,서정평,최수인,장안수,양승원 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.6
Background/Aims: The importance of esophageal hiatal hernias in the pathogenesis of gastroesophageal reflux disease has been debated. It has been reported that a variety of factors are associated with hiatal hernias and esophagitis. The purpose of this study was to determine the correlation between hiatal hernia, reflux esophagitis and weight, alcohol, smoking, coffee and H. pylori infection. Methods: 660 consecutive patients who had undergone an esophagogastroduodenoscopy due to upper gastrointestinal symptoms were reviewed. A diagnosis of hital hernia was made when the distance between the diaphragmatic crus and the tubular esophagus exceeded 1.5 cm, and the presence of a hernia sac at the U turn of the scope. Results: Among the 660 cases, 71 cases (10.8%) of hiatal hernia and 30 cases (4.5%) of reflux esophagitis were noted. The male-to-female ratio was 1.6:1 and 4.3:1, respectively. The most common age group involved the fifth decade and sixth decade. Reflux esophagitis was found in 13 (18.3%) of 71 patnts with hiatal hernias. Hiatal hernias were found in 36 (17.9%) of 201 patients who were overweight (BMI>23) and in 43 (23%) of 187 patients who were smokers. Reflux esophagitis was found in 23 (11.9%) of 194 patients who were alcohol drinkers and in 21 (11.2%) of 187 patients who were smokers. H. pylori infection was present in 36 (50.7%) of 71 patients with hiatal hernias, and 17 (56.2%) of 30 patients with reflux esophagitis. Conclusions: The rate of the hiatal hernia was significantly higher in patients who were overweight and smokers. The rate of reflux esophagitis was significantly higher in patients who were alcohol drinkers and smokers. But in multivariate analysis, none were risk factors associated with hiatal hernias or reflux esophagitis.