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방덕원 ( Duk Won Bang ),심윤숙 ( Yun Suk Shim ),박병원 ( Byoung Won Park ),현민수 ( Min Su Hyon ),김성구 ( Sung Koo Kim ),권영주 ( Young Joo Kwon ) 대한내과학회 2007 대한내과학회지 Vol.73 No.1
목적: 경동맥 초음파로 측정한 내중막 두께 및 경화반의 유무와 관상동맥 질환 여부와의 관련성에 관한 보고가 있었으나, 이들과 관상동맥 질환의 중증도와의 관련성에 관한 연구는 적었다. 저자들은 이들 지표들과 관상동맥 질환의 중증도의 관련성을 검토하여 관상동맥질환 환자에서 경동맥 초음파의 유용성을 평가하였다. 방법: 2005년 11월부터 2006년 11월까지 관상동맥조영검사와 경동맥 초음파를 시행한 환자를 대상으로 하였고, 관상동맥 질환의 중증도는 50% 이상의 협착이 있는 관상동맥의 수에 따라 1군, 2군, 3군으로, 그리고 정상인 경우를 대조군(0군)으로 분류하여, 경동맥 초음파상 좌우 총경동맥 내중막 두께의 평균치, 최대치 및 동맥 경화반 유무를 비교하였다. 결과: 총 환자수는 90명이었고, 3군으로 갈수록 남자가 많았다(p=0.001). 총경동맥 내중막 두께의 평균치는 3군으로 갈수록 유의한 증가를 보였다(0군, 0.67±0.11 mm; 1군, 0.66±0.13 mm; 2군, 0.68±0.08 mm; 3군, 0.78±0.10 mm, p=0.001). 내중막 두께의 최대치도 유사한 결과를 나타내었다(0군, 0.88±0.16 mm; 1군, 0.85±0.20 mm; 2군, 0.89±0.13 mm; 3군, 1.06±0.17 mm, p=0.000). 경화반의 빈도도 3군으로 갈수록 유의한 증가를 보였다(p=0.004). 결론: 경동맥 내중막 두께 및 경화반의 유무 등 경동맥 초음파 지표들과 관상동맥 질환의 중증도의 관련성을 평가한 결과 관상동맥 질환이 심할수록 경동맥 내중막 두께가 증가하고, 동맥 경화반의 빈도도 증가되었다. 경동맥 초음파는 관상동맥 질환을 가진 환자에서 관상동맥 질환의 중증도를 평가하는데 유용하게 사용될 것으로 사료된다. Background: Carotid intima-media thickness (IMT) or the presence of carotid plaque has been reported to be related to coronary artery disease (CAD). We evaluated the relationship of the parameters of carotid ultrasonography (US) with the severity of the CAD. Methods: From November, 2005 to November, 2006, the patients who underwent both coronary angiography and carotid US were enrolled in our study. The severity of CAD was defined by the number of diseased major coronary arteries with a percent diameter stenosis over 50. Four groups including Group 0, which has normal coronary arteries, were compared. The average and maximal IMT and the presence of plaque were used as the parameters of carotid US. Results: The total number of patients was 90. Men had a greater severity of CAD (p=0.001). The average carotid IMTs were increased with the severity of CAD (Group 0, 0.67±0.11 mm; Group 1, 0.66±0.13 mm; Group 2, 0.68±0.08 mm; Group 3, 0.78±0.10 mm; p=0.001). The maximal carotid IMTs were also increased (Group 0, 0.88±0.16 mm; Group 1, 0.85±0.20 mm; Group 2, 0.89±0.13 mm; Group 3, 1.06±0.17 mm; p=0.000). Carotid plaques were also more frequently present with the increased severity of CAD (p=0.004). Conclusions: Increased carotid IMT and the presence of carotid plaque were related to the severity of CAD. Carotid ultrasonography is useful for evaluating the severity of CAD.(Korean J Med 73:11-17, 2007)
전벽 심근 경색의 일차 관상동맥 시술 중 연속된 하벽 심근 경색
박병원 ( Byoung Won Park ),서대철 ( Dae Chul Seo ),함남석 ( Nam Seok Ham ),박정완 ( Jung Wan Park ),정진욱 ( Jin Wook Chung ),방덕원 ( Duk Won Bang ),현민수 ( Min Su Hyon ) 대한내과학회 2014 대한내과학회지 Vol.87 No.3
ST-elevation myocardial infarction (STEMI) involving multivessel coronary arteries is extremely rare. Consecutive STEMI in a nonculprit vessel during primary percutaneous coronary intervention (PCI) of the culprit vessel has not been reported. A 53-year-old male presented to the emergency department with anterior wall STEMI. Just after successful primary PCI of the left anterior descending artery, inferior wall STEMI developed. PCI of the right coronary arteries was performed successfully. Five days later, the patient was discharged without symptoms of heart failure. This case underlines the high thrombogenicity along the coronary arteries in patients with STEMI. (Korean J Med 2014;87:334-337)
박병원 ( Byoung Won Park ),서대철 ( Dae Chul Seo ),문인기 ( In Ki Moon ),정진욱 ( Jin Wook Chung ),방덕원 ( Duk Won Bang ),현민수 ( Min Su Hyon ),장원호 ( Won Ho Chang ) 대한내과학회 2013 대한내과학회지 Vol.85 No.5
ST-elevation myocardial infarction (STEMI) caused by an acute aortic dissection is relatively rare. A diagnosis of dissection can be missed and the situation can become complicated. We report a patient who presented with acute aortic dissection responsible for STEMI related to a dissecting flap into the right coronary artery. This case emphasizes the need for careful assessment of the aorta in cases of atypical coronary occlusion in patients with STEMI without evidence of atherosclerosis in non-culprit coronary segments. The patient was discharged 7 days after primary percutaneous intervention for STEMI. However, she revisited the emergency department for recurrent chest pain and aortic dissection and was diagnosed and managed successfully with surgery.. (Korean J Med 2013;85:516-520)
24시간 활동성 혈압과 임상 혈압과의 비교 및 좌심실 비대와의 상관관계
박승훈 ( Seung Hoon Park ),방덕원 ( Duk Won Bang ),서존 ( John Seo ),홍성욱 ( Sung Wook Hong ),김도회 ( Do Hoi Kim ),윤여준 ( Yeo Joon Yoon ),안지훈 ( Ji Hoon Ahn ),현민수 ( Min Su Hyon ),김성구 ( Sung Koo Kim ),권영주 ( Young Jo 대한내과학회 2007 대한내과학회지 Vol.72 No.2
Background: This study compared the results of 24 hour ambulatory blood pressure monitoring with the clinical blood pressure measurements, and we investigated the relationship of the blood pressure measurement and left ventricular hypertrophy, as determined by routine 12 lead electrocardiography. Methods: We studied 204 healthy adults with no prior history of heart disease or antihypertensive medication. The clinic blood pressure was measured 3 times and the average was taken. We compared the clinic blood pressure with the daytime blood pressure of the 24 hour ambulatory blood pressure monitoring, and we compared the blood pressure with the sum of the voltage of the S wave on V1 and the R wave on V5. Results: The average of the daytime ambulatory blood pressure of all the patients was 135.33±13.73 mmHg for the systolic pressure and 86.55±10.14 mmHg for the diastolic pressure. The average of the clinic blood pressure measurement was 140.10±17.41 mmHg for the systolic pressure and 88.84±10.14 mmHg for the diastolic pressure. The clinic blood pressure averaged higher than the daytime ambulatory blood pressure by 5 mmHg on the systolic pressure and 2 mmHg on the diastolic pressure (p<0.001). The normal ambulatory blood pressure limits were estimated as those that best correlated with 140/90 mmHg at the clinic. The estimated value was 135/87 mmHg for the daytime ambulatory blood pressure (p<0.001). The incidence of white coat hypertension was 10.8%. The sum of the voltage on electrocardiography showed a positive linear relationship with all the blood pressure measurements. The daytime systolic blood pressure showed the strongest correlation with the 24 hour ambulatory blood pressure monitoring (r=0.283, p<0.001). Conclusions: We found a linear relation and we analyzed the differences between the clinical and 24 hour ambulatory blood pressure. A daytime ambulatory blood pressure value of 135/87 mmHg was a suitable upper normal limit for the corresponding cutoff value of the clinic blood pressure. Left ventricular hypertrophy showed the strongest relationship with the daytime systolic blood pressure among the results of the 24 hour ambulatory blood pressure monitoring. (Korean J Med 72:181-190, 2007)
항산화제 투여 후 총 항산화지수 및 사이토카인 변화와 스텐트 재협착에 미치는 영향
윤형근 ( Hyung Geun Yoon ),방덕원 ( Duk Won Bang ),박승훈 ( Seung Hoon Park ),안지훈 ( Ji Hoon Ahn ),서존 ( John Seo ),윤여준 ( Yeo Joon Yoon ),현민수 ( Min Su Hyon ),김성구 ( Sung Koo Kim ),권영주 ( Young Joo Kwon ) 대한내과학회 2006 대한내과학회지 Vol.71 No.2
Background: Oxidative stress might be a role in atherosclerosis and increased intake of antioxidant appear to be protective and modify neointimal formation. An antioxidant and probucol prevents endothelial dysfunction and low density lipoprotein oxidation and also inhibits the secretion of cytokine by macrophages. We aimed 1) to study the effects of antioxidant (Vitamin C, E and probucol) supplementation on serum level of antioxidant status (TAS), P-selectin, MCP-1, IL-6 and IL-10 and 2) to investigate the effects of antioxidant intake on in-stent restenosis. Methods: Total 90 patients were assigned to control or antioxidant group (probucol; 500 mg, vitamin C; 1,000 mg, vitamin E; 400 mg). We performed follow up coronary angiography in 35 patients of antioxidant group and 36 patients of control group after 6 months of coronary bare metal stent implantation. We counted the stenotic lesions more than 50% of implanted stent lumen as a restenosis by quantitative coronary angiography. The serum levels of total antioxidant status, P-selectin, MCP-1, IL-6 and IL-10 were measured. Results: The serum levels of total antioxidant status was not elevated in antioxidant group. Antioxidant supplementation did not change the serum levels of P-selectin, MCP-1, IL-6 and IL-10. The 6-month angiographic in-stent restenosis rate was 27% versus 30% (p=NS) with an associated late loss of 0.76±1.01 mm versus 0.91±1.00 mm (p=NS) for antioxidant group and control group. The serum levels of total antioxidant status did not correlate with the restenosis or late loss after stent implantation. Conclusions: Vitamin C, E and probucol did not elevate the serum level of antioxidant status and could not prevent in-stent restenosis after bare metal stent implantation.(Korean J Med 71:158-165, 2006)
심정지 이후에 장시간 시행된 흉부압박에 의해 발생한 우심실 파열
이희정 ( Hee Jeong Lee ),권성순 ( Seong Soon Kwon ),강혜란 ( Hye Ran Kang ),방덕원 ( Duk Won Bang ),박병원 ( Byoung Won Park ),이민호 ( Min Ho Lee ),장원호 ( Won Ho Chang ) 대한내과학회 2015 대한내과학회지 Vol.88 No.4
A 46-year-old male arrived at the emergency department with acute dyspnea. On the way to the hospital, heart massage was performed in the ambulance due to asystole on electrocardiography. After 2 hr of resuscitation, sinus rhythm was restored. Extracorporeal life support and an intra-aortic balloon pump were applied due to cardiogenic shock, but the patient showed sustained hypotension. Echocardiography showed moderate pericardial effusion with physiological evidence of cardiac tamponade; emergency pericardiocentesis was performed, which produced bloody pericardial fluid. An explorative sternotomy revealed a massive hematoma in the mediastinum and right ventricular (RV) free wall rupture. After primary repair, echocardiography showed improved left ventricular systolic function and the patient was stable clinically. This case presents RV free wall rupture as an unusual complication of prolonged heart massage. Heart rupture should be considered in hemodynamically unstable patients after prolonged heart massage.
혈전용해 치료를 시행한 광범위 및 아광범위 폐색전증 환자의 단기 사망률
조윤주 ( Yun Ju Cho ),구소미 ( So My Koo ),방덕원 ( Duk Won Bang ),김기업 ( Ki Up Kim ),어수택 ( Soo Taek Uh ),김양기 ( Yang Ki Kim ) 대한내과학회 2013 대한내과학회지 Vol.84 No.1
Background/Aims: The mortality rate following massive and submassive pulmonary embolism (PE) remains high despite thrombolytic therapy. Although thrombolytic therapy is considered a life-saving intervention in massive PE, it is only selectively indicated in patients without hypotension who are at high risk of developing hypotension. Little is known about its clinical outcome in Korea. Methods: We retrospectively reviewed the records of patients given thrombolytics for massive and submassive PE objectively confirmed with chest computed tomography at Soon Chun Hyang University Hospital, Seoul, Korea, from 1 January 2004 to 1 August 2011. The primary outcome of this study was 30-day mortality. Secondary outcomes were the incidence of major bleeding at 30 days, mortality at 90 days, and recurrent venous thromboembolism (VTE) at 90 days. Results: Thrombolytic therapy was performed in 21 patients: nine with massive and 12 with submassive PE. The overall 30-day mortality rate was 24% (5/21). The mortality rate in patients with massive PE was higher than that in patients with submassive PE (44% vs. 8%, respectively; p = 0.010). Mortality rates at 90 and 30 days were identical. The estimated causes of death were right ventricular failure in four patients and fatal bleeding in one patient. The median time to death from thrombolysis was 1 day (0-13 days). Major bleeding episodes occurred in three patients (14%), including fatal bleeding in one patient. There was no recurrent VTE at 90 days. Conclusions: Patients who underwent thrombolytic therapy for massive PE showed a higher 30-day mortality compared with patients with submassive PE. (Korean J Med 2013;84:62-70)
순화기 경요골 경피적 관상동맥 중재술 중 발생한 요골동맥 천공의 간편한 관리
김윤석 ( Yunsuek Kim ),정찬성 ( Chan Sung Jung ),김효식 ( Hyo Shik Kim ),이민호 ( Min Ho Lee ),박병원 ( Byoung Won Park ),방덕원 ( Duk Won Bang ),현민수 ( Min Su Hyon ) 대한내과학회 2016 대한내과학회지 Vol.90 No.2
Radial artery perforation is one of the major complications of transradial percutaneous coronary intervention (PCI). Previous reports have suggested that sealing the perforation with a smaller guiding catheter may be possible. In one such study, the perforated segment was sealed with a 0.014- or 0.021-inch guidewire, and PCI was successfully completed. In this study, we describe a radial artery perforation that occurred after diagnostic coronary angiography and during insertion of a 6 French (FR) guiding catheter. PCI and the perforation were successfully managed through the use of a 5 Fr guiding catheter and a 0.035-inch guidewire. (Korean J Med 2016;90:136-139)