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최락경(Rak Kyeong Choi),이무용(Moo Yong Rhee),전원호(Won Ho Jeon),김인수(In Su Kim),김석연(Seog Yeon Kim),전용덕(Yong Deog Jeon),이홍순(Hong Soon Lee),유수웅(Soo Woong Yoo),이학중(Hak Choong Lee) 대한내과학회 1995 대한내과학회지 Vol.49 No.5
Objectives: The exercise test is commonly used in conjunction with baseline clinical information to estimate the likelihood that a patient has significant coronary diseases. The purpose of this study was to determine if patterns of ST depression or elevation during exercise testing provide reliable information about the location of an underlying coronary lesion. Methods: We reviewed 49patients out of 137patients who performed treadmill test and coronary angiography at National Medical Center from January, 1984 through August, 1993. All the patients underwent modified Bruce protocol treadmill exercise test and coronary angiography. Exercise ST changes were classified as depression or elevation by lead groups involved(V1-V3, V4-6, I AVL, II III AVF), Coronary angiography was done in several oblique projections and results were reviewed by at least two senior angiographers. Results: 1) There were significant stenosis in coronary angiography in 22cases(70.9%) among positive 31cases, 0cases(0%) among borderline positive 4cases, 5cases(10.2%) among negative 49cases. 11cases(47.8%) among nondiagnostic 23cases, and 3cases(25%) among pseudonormalization 12cases in exercise treadmill tests. 2) The sensitivity of treadmill exercise electrocardiography was 61.2%, and specificity was 81.8%. The sensitivity of each coronary artery diseases was 6l.7% in Left anterior descending artery disease, 66.6% in Right coronary artery disease, 38.5% in Left circumflex artery disease, 100% in 2-vessel disease, and 100% in 3-vessel disease. 3) ST depression was not useful in predicting the site of coronary artery narrowing. In contrast, ST elevation was correlated with coronary artery disease. 4) ST depression was most often seen in leads V4-V6 and leads II III AVF without correlation between the diseased coronary artery and the leads in which ST depression occurred. Conclusion: The exercise treadmill induced depression of the ST segment is an significant sign for predicting the presence of coronary artery disease and for the decision to perform coronary angiography. But, site of ST depression during exercise is not a good predictor of anatomic site of coronary artery disease. The other noninvasive test and coronary angiography may be necessary to nondiagnostic group which revealed insufficient exercise load or target heart rate during exercise test because the presence of coronary artery disease can't be ruled out.
정영리 ( Young-lee Jung ),최락경 ( Rak-kyeong Choi ),엄문용 ( Moon-yong Eom ),조현아 ( Hyun-a Cho ),최웅 ( Woong Choi ),김동진 ( Dong-jin Kim ),함의근 ( Ui-geun Ham ) 대한내과학회 2016 대한내과학회지 Vol.91 No.2
Leiomyomatosis refers to benign smooth muscle cell tumors that often arise from unusual growth patterns and include benign metastasizing leiomyoma, disseminated peritoneal leiomyomatosis, and intravenous leiomyomatosis. Intravenous leiomyomatosis is the extension of a vascular tumor into the venous channels, whereas disseminated peritoneal leiomyomatosis is characterized by multiple leiomyomas growing along the submesothelial tissues of the abdominopelvic peritoneum. It is extremely rare for intravenous leiomyomatosis and disseminated peritoneal leiomyomatosis to occur simultaneously. A 42-year-old female presented with disseminated peritoneal leiomyomatosis and intravenous leiomyomatosis extended through the inferior vena cava into the right side of the heart. The patient underwent one-stage surgery under simultaneous sternotomy and laparotomy, and radical excision of the tumor was achieved using cardiopulmonary bypass. Here we describe a case in which complete removal of a leiomyomatosis with an unusual growth pattern was successfully performed using one-stage surgery. (Korean J Med 2016;91:185-190)
장덕현 ( Duck Hyun Jang ),최락경 ( Rak Kyeong Choi ),함의근 ( Eo Kewn Ham ),심원흠 ( Won Heum Sim ),채명준 ( Myung Joon Chae ),이수연 ( Soo Youn Lee ),현주용 ( Joo Yong Hyun ) 대한내과학회 2013 대한내과학회지 Vol.84 No.1
Acute pulmonary embolism is considered a cardiovascular emergency and is one of the most important causes of morbidity and mortality in hospitalized patients. Tumor embolism is a rare and unique complication of malignancies, and detached thrombi or tumors may cause massive pulmonary embolism in patients with malignancies. The identification of the type of pulmonary embolism is critical because treatment and prognosis vary considerably. We report an unusual presentation of a tumor embolism that was misdiagnosed as a pulmonary thromboembolism in a young woman. The patient was initially treated with the anti-coagulants warfarin and aspirin, but her symptoms were aggravated after two months and she required emergency surgery. Histology revealed a pulmonary embolism due to metastatic chondrosarcoma. Following surgery, her condition deteriorated, and she did not survive. This case highlights the need to investigate the cause of pulmonary embolism should the patient not respond to anti-coagulatant therapy. (Korean J Med 2013;84:96-100)
이창원(Chang Won Lee),장덕환(Duk Whan Jang),백인석(In Seok Baek),김장원(Jang Won Kim),배순철(Soon Chul Bae),김철우(Cheol Woo Kim),권재구(Jae Koo Kweon),최락경(Rak Kyeong Choi),이무용(Moo Yong Rhee),이홍순(Hong Soon Lee),유수웅(Soo Wo 대한내과학회 1997 대한내과학회지 Vol.52 No.4
Objectives: Signal-averaged electrocardiography (SAECG) has been found to be a useful noninvasive technique for identifying patients at risk for life-threatening ventricular tachycardia. Delayed and fragmented activation of abnormal myocardial tissues causes the occurrence of high frequency low amplitude (HFLA) electocardiographic signals or late potentials. Generally, there are two methods in analyzing signal-averaged electrocardiography. Late potentials in the time domain analysis do not provide sufficient diagnostic power with regard to life-threatening Ventricular tachycardia. Buckingham et al. (1989) reported a time-domain sensitivity of 62%, a specificity of 75%. Spectral turbulence analysis (STA) of the signal-averaged ECG is the most recent frequency domain technique to improve the time domain sensitivity and specificity. So, We designed the study to compare the efficacy of Time Domain Analysis and Spectral Turbulence Analysis among five groups (Normal control, QRS widening, Postmyocardial infarction, Frequent VPC's with group beats, Nonsustained ventricular tachycardia). Methods: 88 patients were selected from the patients who had been admitted between January 1994 and October l994, at National Medical Center. Patients were divided into five groups, which were respectively, Group A: Normal control group (n=33), Group B: QRS widening group (n=14), Group C: Postmyocardial infarction group (n=10), Group D: Frequent VPC's with group beats (n=22), Group E: Nonsustained VT group (n=9). We compared Spectral Turbulence Analysis and Time Domain Analysis of Signal-Averaged Electrocardiogram by 24 hours-Holter monitoring. Results: 1) In normal control group(Group A), 9.1%(3 patients) were positive by Time Domain Analysis, but, all were negative by Spectral Turbulence An- alysis. 2) In QRS widening group (Group B), 71.4%(10 patients) were positive by Time Domain Analysis, but, all were negative by Spectral Turbulence Analysis. 3) In postmyocardial infarction group (Group C), 309o were positive by Time Domain Analysis, and 10% were positive by Spectral Turbulence Analysis. 4) In frequent VPC's group (Group D), 22.7% (5 patients) were positive by Time Domain Analysis, and, 4.5%(1 patient) was positive by Spectral Tur-bulence Analysis. 5) In Nonsustained VT group (Group E), 33.3% (3 patients) were positive by Time Domain Analysis, and 11.1% (1 patient) was positive by Spectral Turbulence Analysis. Conclusions: In Time Domain Analysis, abnormal results were presented at Group R (QRS widening group) by 71.4%, which was markedly higher than other groups. But, in Spectral Turbulence Analysis, abnormal results were not presented at Group A and Group B. In Group A and Group B, Spectral Turbulence Analysis shows less false positive results than Time Domain Analysis.
김인수(In Soo Kim),문석준(Seok Jun Moon),박현진(Hyun Jin Park),김동조(Dong Jo Kim),손행종(Haeng Jong Sohn),이무용(Moo Yong Rhee),박건욱(Keon Uk Park),최락경(Rak Kyeong Choi),유병희(Byung Hee Yu),문성수(Seong Soo Moon) 대한내과학회 1996 대한내과학회지 Vol.50 No.4
Objectives: The construction and maintenance of vascular access are essential in patients with end stage renal disease(ESRD) on chronic hemodialysis. So, the complications of vascular access are significant causes of morbidity and inadequacy of hemodialysis. The current study was undertaken to provide an estimate of the magnitude of the problem of access-related morbidity and to explore the relationship of sex, age, and underlying cause of renal failure as risk factors for vascular complications. Methods: We observed vascular access-related hospitalization, access complications, and sex, age, and underlying cause of renal failure as risk factors on 167 ESRD patients who have received maintenance hemodialysis between January 1983 and June 1993 at the National Medical Center. A univariate survival analysis of time to vascular access-related hospitalization was carried out for each of the risk factors under study, that is, sex, age, and underlying cause of renal failure. Kaplan-Meier survival curves were generated for categorized levels of each variable and compared using the log rank test. Results: 1) The vascular access-related hospitalization occupied 16.5% of all hospital stays and the mean length of hospital stays was 12.4 days. 2) The thrombosis occurred in 82.8% of all access complications. The formation of new vascular access was performed in 69.0% of vascular access-related morbidity. 3) The cumulative 1 year, 2 year, 3 year, 5 year, and 10 year survival rates of vascular access were 89.2%, 83.8%, 75.5%, 67.2%, and 53.2%, respectively, The cumulative survival rate of vascular access in women was lower significantly than in men. It was also lower significantly in diabetics than in other diseases including glomerulonephritis. But, age was not statistically correlated with vascular access survival. Conclusion: The complications of vascular access cause increase in hospitalization among ESRD patients, and women and diabetics apperar to be at particularly high risk. Additional studies on the risk factors for vascular access morbidity are needed to manage vascular access more carefully in ESRD patients on chronic hemodialysis.