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갑상선 기능 항진증 환자에서 24시간 홀터 심전도 측정의 의의
송일한,김성운,양인명,김진우,김영설,김광원,최영길 대한내과학회 1992 대한내과학회지 Vol.42 No.1
임상소견과 검사실소견상 갑상선 기능항진증으로 진단된 환자에서 단순 심전도와 24시간 홀터 심전도 검사를 비교한 결과 첫째, 최대 심박수와 평균 심박수에서 두 검사상의 유의한 차이를 보였다. 둘째, 단순 심전도상에서 보이지 않는 심방조기 수축과 심실조기 수축은 24시간 홀터 심전도상에서 각각 21명(67.7%), 11명(35.5%)서 관찰되었고 심방세동도 4명의 환자에서 관찰되었으며 이중 3명은 단순 심전도 검사에서는 정상이었다. 셋째, 단순 심전도에서 보이지 않는 2.0㎜이상의 ST depression이 24시간 홀터 심전도 검사에서는 4명의 환자에서 관찰되었다. 넷째, 갑상선 호르몬의 혈중농도 특히 T₄와 최대, 평균 심박수와의 상관관계는 유의하였다. 결론적으로 갑상선 기능항진증 환자에서 심박수와 부정맥의 정확한 평가가 중요하며 이들에서 나타나는 대부분의 부정맥은 episodic하게 나타났으며 갑상선 질환 환자에 있어서 순환기 증상의 이상으로 심박수와 부정맥을 평가하는데 단순 심전도의 측정보다는 24시간 홀터 심전도 검사가 더 유용하리라 생각된다. Thirty-one hyperthyroid individuals, who otherwise had no evidence of cardio-vascular disease and was not treated with antithyroid agents and β-blockers, under-went 24-hour Holter ECG monitoring and simple ECG. They were also checked serum T₃, T₄ TSH level and RAIU. The mean age of the subjects was 42.8 years with a range of 14 to 65 years. In 24-hour Holter ECG monitoring and simple ECG, the maximal heart rate was each 132.56±25.4bpm and 87.56±10.9bpm. There was a significant difference(p<0.001). In 24-hour Holter ECG monitoring, not in simple ECG, We detected many ECG abnormalities such as atrial premature beats (21 patients, 67.7%) ventricular premature beats (11 patients. 35.5%), atrial fibrillation (3 patients, 9.8%) and ST depression (4 patients, 12.9%). There was a significant correlation between the maximal heart rate and the thyroxine values. As a result, comparing the simple ECG and 24-hour Holter monitoring, the latter seems to more useful method to evaluate the heart rate and arrhythmias in hyperthyroid patients.
송일한,김정택 단국대학교 2000 論文集 Vol.35 No.-
Hepatobiliary cystadenoma is a rate but distinct neoplasm with malignant potential, similar to that occuring in the pancreas or ovary. The differential diagnosis of hepatobiliary cystadenoma includes other cystic neoplasms, primary and metastatic, and nonneoplastic cysts including infective conditions. A preoperative distinction from hydatid disease, difficult on radiologic grounds alone, is particulary important. We report a 38-year-old woman admitted because of intermittent epigastric pain. Abdominal ultrasonography, CT and MRI revealed about 15×10㎝ sized multiloculated cystic lesion in medial segment of left lobe of the liver. Hydatid serologic analysis was normal. But serum level of CA 19-9 was raised above 2400U/mL. Under ultrasonographic guidence, we performed aspiration of the cystic fluid. In the examination of cystic fluid, malignant cell was abscent and cystic fluid level of CA 19-9 was also rasied above 2400U/mL. Under the impression of hepatobiliary cystadenoma, laparotomy was performed. A 15×10㎝ sized cystic mass was noted in the medial segment of left lobe of the liver, and then left lobectomy was done. On cut section, 1800mL of serous fluid was obtained from the multiloculated cystic mass. Microscopic findings revealed a cystadenoma lined by a single layer of columnar epithelium containing some intracellular mucin pools and hemorrhagic infact without evidence of cellular atypism or mitosis.
특집 - 당뇨병환자가 소홀히하기 쉬운 간 - 당뇨병환자의 지방간 -
송일한,Song, Il-Han 사단법인 한국당뇨협회 2008 당뇨 Vol.220 No.-
이번 특집에서는 최근에 관심이 높아지면서 그 발병률이 증가하고 있는 비알코올성 지방간 질환의 발병 원인과 기전을 알아보고, 당뇨병환자에서의 지방간질환의 임상증상, 진단 등에 대해 살펴보고, 현재 응용되고 있는 치료방향에 대해서 알아보고자 한다.
송일한,이무용,박석건,신정우,기명주 대한간학회 2000 Clinical and Molecular Hepatology(대한간학회지) Vol.6 No.2
Background/Aims: Hypoxemia is often associated with liver cirrhosis without cardiopulmonary diseases. Pulmonary vascular impairments including intrapulmonary shunt have been considered as a major mechanism of hypoxemia. The aim of this study was to determine the incidence and pathophysiologic basis of hypoxemia in cirrhotic patients without respiratory symptoms. Methods: In fourty three cirrhotic patients without heart and lung diseases, we performed the arterial blood gas analysis and calculated alveolar arterial oxygen gradient (A-aO2). According to the A-aO2, the patients were divided into hypoxemic and normoxemic groups. In each group, a Tc-99m-macroaggregated albumin (Tc-99m-MAA) scan, a contrast-enhanced echocardiography and a pulmonary function test were performed. Results: Twenty-eight of 43 patients (65%) showed hypoxemia. Hypoxemic patients showed significantly more increased shunt fraction of 3.1±1.4% than normoxemic one of 2.1±1.1% in the Tc-99m-MAA scan (p$lt;0.05). However, only two of hypoxemic patients had shunt fraction above physiologic shunt range. By contrast-enhanced echocardiography, an intrapulmonary shunt was confirmed in one patient. There was no significant correlation between the shunt fraction and the hepatic reserve based on the Child-Pugh classification in hypoxemic patients. In the results of pulmonary function test, only DLco decreased more significantly in hypoxemic group than in normoxemic group (58.4 ± 14.2 % vs 75.3 16.5% of predicted, p$lt;0.05). Conclusions: Hypoxemia is not infrequently observed in cirrhosis, but incidence of significant intrapulmonary shunt is low. Therefore, other mechanism such as diffusion defect may be suggested to play a role in the development of hypoxemia in cirrhotic patients without respiratory symptoms. (Korean J Hepatol 2000;6:197-204)