정보홍수, 스스로 판단선택 어려움 가중 정보통신분야 소비자 보호대책 시급하다

신동구,Sin, Dong-Gu 한국정보통신집흥협회 1995 정보화사회 Vol.94 No.-

국가과학기술종합정보서비스(NTIS)-과학기술정보유통기반

권이남,이병희,신동구,최희석,Gwon, Lee-Nam,Lee, Byeong-Hui,Sin, Dong-Gu,Choe, Hui-Seok 한국과학기술정보연구원 2008 지식정보인프라 Vol.30 No.-

운동부하심전도검사에서 있어서 ST / HR Slope 의 진단적 의의

이태일(Tae Il Lee),권준영(Jun Young Kwen),최교원(Kyo Won Choi),김영진(Young Jin Kim),신동구(Dong Gu Sin),김영조(Young Jin Kim),심봉섭(Bong Sup Shim),이현우(Hyun Woo Lee) 대한내과학회 1995 대한내과학회지 Vol.48 No.3

closely related to changes in myocardial oxygen demand during higher exercise workloads, the ST/HR slope should more accurately reflect the balance of myocardial oxygen supply demand than does simple mearsurement of the amount, of exercise induced ST segment depression, For improvement the accuracy of exercise stress electrocardiogram for the identification of coronary artery disease, exercise stress test and coronary angiograpty were performed. Methods: Exercise stress test and coronary angiography were performed in 213 patients who visit Yeuneg-nam Universit.y Hospital due to chest pain. Results: 112 patints had normal coronary artery and 101 patients had coronary artery stenoses. Among 101 patients 64 patients had 1 vessel disease, 33 patients had 2 vessel disease, 4 patients had 3 vessel disease. The sensitivity of ST segment. change criteria was 60.4%, specificity 68.8%,. At cutpoint 1.1, 2.4, 3.0 and 6.0 μV/beat/min the sensitivity of ST/HR slope were 60.4%, 48.5%, 42.6%, and 20.8%, the specificity were 60.7%, 88.4%, 96.4%, 100%, and overall test accuracy were 60.7%, 69.5%, 70.9 % and 62.4%, respectively. The mean ST/HR slope was significant higher in coronary artery disease group than normal coronary artery group(0.9±l.l vs 3.2±4.0μV/beat/min, p< 0.05). Conclusion: In conclusion, ST/HR slope did not improve the diagnostic accuracy of the exercise test to identify the presence of coronary arytery disease but was useful for the identification of severity of coronary artery disease.

급성 호산구성 심근염으로 나타난 과호산구 증후군

박용호 ( Park Yong Ho ),홍그루 ( Hong Geu Lu ),김민경 ( Kim Min Gyeong ),정항재 ( Jeong Hang Jae ),신동구 ( Sin Dong Gu ),김영조 ( Kim Yeong Jo ),심봉섭 ( Sim Bong Seob ) 대한내과학회 2004 대한내과학회지 Vol.66 No.3

The hypereosinophilic syndrome (HES) is a leukoproliferative disorder, marked by sustained blood eosinophilia of greater than 1,500/㎣, for longer than 6 months and predilection to damage specific oragans. Any organ system may be affected in HES, but the most severe clinicopathophysio-logical involvements are of the heart and nervous system. We report a case of a 48-year-old man with acute eosinophilic myocarditis combined with hypereosinophilic syndrome who was successfully treated with steroids.

급성심근경색증 환자에서 응급으로 시행한 Tc - 99m Sestamibi 심근관류 SPECT와 심전도의 비교

원규장(Kyu Chang Won),이형우(Hyoung Woo Lee),심봉섭(Bong Sup Shim),이현우(Hyun Woo Lee),조인호(Ihn Ho Cho),박종선(Jong Sun Park),도준영(Jun Young Do),신동구(Dong Gu Sin),윤경우(Kyung Woo Yoon),김영조(Young Jo Kim) 대한핵의학회 1996 핵의학 분자영상 Vol.30 No.1

We did Tc-99m sestamibi myocardial perfusion SPECT in 36 patients with acute myocardial infarction when they arrived at the emergency room. And we compared myocardial perfusion images with ECG findings. Then we obtained the follows. The myocardial infarction by the obstruction of left coronary descending artery and right coronary artery showed a good concordance in the diagnosis and infarction site between myocardial perfusion images and ECG findings. The 7 patients with myocardial infarction by a left circumflex coronary artery showed a perfusion defect in the lateral wall in myocardial perfusion SPECT images. But 4 patients of them showed ST segment elevation, 2 patients showed ST depression and 1 patient showed normal ECG findings. The diagnostic sensitivity of Tc-99m sestamibi myocardial perfusion SPECT was 100% by a qualified analysis. The perfusion defect site in the myocardial perfusion SPECT were con-responded with the infarct related coronary artery in 31 patients which was diagnosed by coronary angiograpy. The size of perfusion defect in the polar map was 31±18%(M±SD), in the myocardial infarction with left anterior descending coronary arery obstruction, 31±13% (M±SD) in the myocardial infarction with right coronary artery obstruction and 25±5.9%(M±SD) in the myocardial infarction on with left circumflex coronary artery obstruction. We concluded that emergency myocardial perfusion SPECT images are useful in the diagnose of myocardial infarction and it's very useful when we are difficult to diagnose with ECG like as lateral wall infarction or left bundle branch block.

본태성 고혈압에 대한 Imidapril의 강압효과 및 마른기침 발현율에 대한 고찰

신동구,박종선,전대진,배준호,김영조,심봉섭,홍그루 영남대학교 의과대학 1999 Journal of Yeungnam Medical Science Vol.16 No.1

1993년 일본의 Tanabe제약에서 개발된 염산 Imidapril(Tanatril )은 새로운 작용지속형 ACE inhibitor이며 강압효과와 안정성이 뛰어나고, 마른기침 등의 부작용이 다른 ACE inhibitor 보다는 적은 것으로 보고되고 있다. 1997년 10월 6일부터 1998년 12월까지 영남대학교 의과대학 부속병원 순환기 내과에 내원하여 고혈압이 처음 잔단되었거나 진단받은 후에도 강압제치료를 받지 않았던 환자 중 경증(1기)에서 중증(3기) 본태성 고혈압(JNC V 분류의거)을 보인 30명 중 최종분석이 가능한 21명(부작용으로 투약을 중단한 1명 포함)을 대상으로 하였다. 임상시험 종료 시 측정한 확장기 혈압은 88.7±9㎜Hg로 평균 하강량은 13.8mmHg이었다. 혈압강하효과 판정에서 16명이 혈압 하강군으로 분류되어 혈압강하효과는 76.2%(16/21)였다. Imidapril 단독 투여로 치료 종료시 정상 혈압(140/90㎜Hg 미만)을 보인 경우는 10명(47.6%)이었다. 임상시험 중 나타나는 부작용으로는 마른기침, 두통, 현기증, 오심, 상복부 불쾌감, 졸리움 등이 있었으며 총 7명에서 (33.3%) 부작용이 관찰되었고, 심한 위장관계 불편감을 호소한 한 예를 제외하고는 모두 일상 생활에 불편을 주지는 않는 상태였으며, 시간이 경과할수록 그 정도가 점차로 약해졌다. ACE inhibitor의 가장 흔한 부작용 중의 하나인 마른기침은 모두 2명(9.5%)에서 관찰되었다. 새로운 ACE inhibitor인 Imidapril은 다른 ACE inhibitor와 비슷한 강압효과와 안정성을 보이며 특별히 심각한 부작용을 보이지 않고, 그 중에서도 특히 마른기침 발현 빈도는 9.5%로 다른 제제에 비해 현저히 낮았으며, 그 정도가 미미하여 감량없이 계속투여가 가능했다. Imidapril(Tanatril ), a newly developed ACE inhibitor, has been used to treat hypertension and congestive heart failure. This study was designed to assess the antihypertensive effect and safety of Imidapril(Tanatril ) in patients with essential hypertension. 5-10mg of imidapril(Tanatril ) was administered once a day in 30 patients with essential hypertension and followed up for 8 weeks. We tested the drug's effectiveness, safety, and the incidence of imidapril induced dry coughs. After 8 weeks of treatment with imidapril, 76.2%(16/21) of patients showed lowered blood pressure and 47.6% showed normal blood pressure. The overall incidence of adverse effects was 33.3%(7/21), and among these adverse effects, dry cough was shown in only 9.5%. Thus, we concluded that imidapril(Tanatril ) is as safe and effective as other ACE inhibitors, especially with imidapril showing very little incidence of dry cough compared to other ACE inhibitors.

건강한 청년남자 14 례에서 Dipyridamole 부하 99mTc-MIBI SPECT 극성지도의 분석

이현우,심봉섭,신동구,김영조,이형우,조인호 영남대학교 의과대학 1994 Journal of Yeungnam Medical Science Vol.11 No.1

저자들은 14명의 관상동맥질환이 의심되지 않는 건강한 젊은 남자를 대상으로 dipyridamole 부하 99mTc-MIBI 심근 SPECT를 시행하였다. 이를 이용하여 Cedars-Sinai방법으로 극성지도를 구하고 전체 심근을 9부분으로 나누어 각 부위의 상대적인 방사능 세기를 조사하고 분석하였다. 이와 함께 dipyridamole 부하 전후의 혈역동학적인 변화와 부작용을 알아보았다. 극성지도에서 부하기와 휴식기 모두 방사능 계수치가 가장 높은 부위는 Latero-anterior wall이었고, 가장 낮은 부위는 Infero-septal wall이었다. 부하기와 휴식기사이의 각 부위의 방사능세기는 서로간에 유의한 차이가 없었다. dipyridamole 투여후 심박수와 이완기 혈압 및 Double product는 유의한 변화를 보였다. dipyridamole에 의한 부작용은 14명중 12명에서 나타나 비교적 높은 비율을 보였으나 중한 부작용은 관찰되지 않았다. 이상의 결과로 99mTc-MIBI 심근 SPECT에서 구한 극성지도에서 관상동맥질환을 판정할 때는 부위별로 혈류 저하를 판정하는 기준이 달라야만 할 것으로 생각된다. We performed the same day dipyridamole stress/rest myocardial SPECT in 14 healthy young men, reconstructed the polar maps according to Cedars-Sinai method and quantitated the radioactivity of myocardial wall. We divided the whole myocardium to 9 sectors. The latero-anterior wall contains the highest count. The infero-septal wall contains the lowest count. There isn't any significant differences of radioactivity in each segment between stress and rest polar map. The hemodynamic parameters after dipyridamole injection in the subjects were significantly changed except systolic blood pressure : the heart rate was increased and diastolic blood pressure was decreased. Adverse effects were reported in 85.7%. We suggest that these data can be used to dectect perfusion defect in the coromary artery disease.

승모판협착증 환자에서 뇌경색발생의 예측인자

김형준,이종석,홍그루,박종선,신동구,김영조,심봉섭,김웅 영남대학교 의과대학 2000 Journal of Yeungnam Medical Science Vol.17 No.1

저자들은 후향적 연구로, 1995년 1월부터 1999년 3월까지 영남대학교 의과대학 부속병원에 내원하여 경흉부 및 경식도 심초음파를 시행한 승모판 협착증 환자 중 1년 이상 경과 관찰된 127명의 환자를 대상으로 뇌경색의 예측인자를 알아봄으로써 향후 예방 및 치료에 도움을 주고자 본 연구를 시행하였다. 전체 127명의 대상군은 뇌경색이 발생한 군(GroupⅠ : n=26, 나이 : 55±13세)과 뇌경색이 발생하지않은 군(Group Ⅱ : n=101, 나이 : 48.5±13)으로 나누었으며, 두군간에 성별이나 심부전의 정도(NYHA functional class)에는 의미있는 차이가 없었다. 뇌경색군(GroupⅠ)에서 나이가 많았으며(55.0±13 vs 48.5±13 ; p<0.05), 좌심방 크기가 보다 컸으며(5.10±0.48 vs 4.81±0.70 ; p<0.05), 승모판구 면적이 보다 작았고(1.01±0.39 vs 1.21±0.45 ; p<0.05), 심방세동의 유병률이 보다 높았다(22명/26명 vs 57명/101명 ; p<0.05). 좌심방의 자발에코영상은 뇌경색군(22명/26명)에서 비뇌경색군(44명/101명)보다 더 많이 관찰되었다(p<0.001). 상기 의미있는 변수들을 Multivariate logistic regression 분석결과 통계학적으로 유의한 예측인자는 심방세동(R. R=7.69)과 항응고제 치료(R. R=0.23)이었다. 결론적으로, 승모판 협착증 환자에서 뇌경색 발생과 연관된 유의한 예측인자는 심방세동과 항응고제치료이었으며, 나이와 좌심방 크기, 승모판구 면적, 좌심방의 자발에코영상도 밀접한 관계가 있었다. 따라서 심방세동을 동반한 고연령의 중증 승모판 협착증 환자에서는 조기 항응고제 투여가 전신색전증 예방에 중요할것으로 사료된다. Background : Systemic embolism, especially, cerebral infarction is one of the most important complications in patients with mitral stenosis. The authors analyzed the some factors that could predict the development of cerebral infarction in cases of mitral stenosis and propose preventive therapeutic measures. Methods : Retrospective study of 127 patients with rheumatic mitral stenosis was performed by analyzing their medical records for transthoracic(TTE) or transesophageal echocardiography(TEE) over a 12 months period. The patients were divided into two groups according to the presence (Group Ⅰ ; n=26, age ; 55±13 years) or absence (Group Ⅱ ; n=101, age ; 48.5±13 years) of cerebral infarction. No significant difference was observed between the two groups with respect to sex and functional class. Results : Patients in group Ⅰ were older (55.0±13 vs 48.5±13 ; p<0.05), had more dilated left atrial size(5.10±0.48 vs 4.81±0.70 ; p<0.05) and smaller mitral surface area(1.01±0.39 vs 1.21±0.45 ; p<0.05). In Group Ⅰ, the incidence of atrial fibrillation(22 out of 26 vs 57 out of 101 ; p<0.05) and spontaneous left intra-atrial contrast phenomenon(22 out of 26 vs 44 out of 101 ; p<0.05) was more frequently observed. On multivariate analysis, atrial fibrillation and anticoagulant therapy were the independent predictive factors. Conclusion : Age, left atrial dilatation, the severity of mitral stenosis, the presence of spontaneous contrast, and especially the presence of atrial fibrillation are the main predictive factors of the development of cerebral infarction in mitral stenosis. Patients presenting one or several of these factors may benefit from prophylactic anticoagulant treatment.

임산부에서 발생한 대동맥 박리(Aortic Dissection) 1례

이정철,김영조,이형민,신동구,한승세,심봉섭,이동협,홍은표 영남대학교 의과대학 1993 Journal of Yeungnam Medical Science Vol.10 No.1

본원에서는 출산 후 지속되는 호흡곤란, 전신부종을 주소로 내원한 환자에서 임신과 관계된 De Bakey유형Ⅱ의 대동맥해리를 진단하고 성공적으로 수술을 시행한 1례를 경험하였기에 보고하는 바이다. We have experienced a case of aortic dissecting aneurysm in pregnant woman. She felt initially severe chest pain which was radiated to the neck on the 3days before delivery. Thereafter dyspnea and generalized edema were developed for 1 month after delivery. She was diagnosed as aortic dissection, Debakey type Ⅱ. During cardiopulmonary bypass, the selective cerebral perfusion was done through the right and left commom carotid arteries. Aortic replacement with Hemashield vascular graft and reimplantation of innominate artery, resuspension of aortic valve, repair of intimal tear were performed. The postoperative course was uneventful.

영남대학교 의과대학 부속병원에서의 이차성 고혈압의 유병율

이형우,이현우,윤경우,권준영,심봉섭,김영조,신동구,최교원 영남대학교 의과대학 1994 Journal of Yeungnam Medical Science Vol.11 No.1

이차성 고혈압은 일차성 고혈압에 비해 빈도가 매우 적지만 그 원인 인자를 교정했을때 정상 혈압으로 완치가 되거나 증상의 완화를 보일 수 있기 때문에 이차성 고혈압을 시사하는 소견들이 있을 때에는 원인을 조사하여 그에 맞는 적절한 치료를 하는 것이 매우 중요하다. We studied the incidence and results of treatment of secondary hypertension in Yeungnam University Hospital. Nineteen hundred fifty patients with hypertension were included from march 1990 to march 1994. We analysed the prevalence of secondary hypertension and results of treatment. The incidence of secondary hypertension in Yeungnam University Hospital was six percent. The most common underlying causes of secondary hypertension was renal parenchymal disease. Patients with three forms of potentially reversible secondary hypertension, namely, renovascular hypertension, endocrine disease, exogenous hormone, were assed to determine whether surgery or withdrawal of the exogenous hormane had led to an improvement in blood pressure control. The incidence of secondary hypertension in Yeungnam University Hospital was low(6%), but some of these are curable. Thus it is very inportant that evaluate the secondary hypertension.