• 제목/요약/키워드: Coronary Risk Factors

검색결과 252건 처리시간 0.031초

가와사끼병에서 발병 6주째에 시행하는 추적검사의 임상적 유용성에 관한 고찰 (Clinical significance of follow-up laboratory tests, performed at 6 weeks after the onset of Kawasaki disease)

  • 오일지;문경희;홍명은;김연순;이창우;윤향석
    • Clinical and Experimental Pediatrics
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    • 제49권6호
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    • pp.672-676
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    • 2006
  • 목 적 : 가와사끼병에서 급성기 항염치료 후 회복기에 항혈전 요법으로 저용량 아스피린을 사용한다. 대개 6-8주간 투여하고 종료 시기에 혈소판 치를 포함한 각종 혈액검사와 관상동맥 이상 유무를 알기 위한 심초음파 검사를 시행하기도 한다. 발병 6주째에 시행하는 각종 추적검사가 임상적으로 얼마나 유용한지 알아보고자 본 조사를 시행하였다. 방 법 : 1997년 1월부터 2004년 12월까지 만 8년간 원광대학교병원 소아과에 입원하여 가와사끼병으로 치료받았던 282명의 환자를 대상으로 후향적으로 조사하였다. 입원 당시와 6주째에 백혈구수와 혈소판수, ASO, ESR, CRP, AST, ALT, 소변검사, 심초음파 검사를 시행하였다. 6주째에 혈소판이 증가했던 군과 대조군을 각종 검사 척도로 비교하였고, 나이와 성별, 재치료 여부, 발열-입원 기간, 치료-해열 기간, 관상동맥 이상 등이 6주째의 혈소판 증가에 영향을 미치는지 비교 분석하였다. 통계적 비교는 paired t-test와 Fisher's exact test, logistic 회귀분석으로 하였다. 결 과 : 입원 시에 증가를 보였던 ESR과 CRP는 6주째 시행한 검사상 각각 35명(12.4%), 12명(4.3%)을 제외하고 정상화되었고, 무균성 농뇨는 전례에서 모두 정상화되었다. 혈소판 증가는 36명(12.8%), 백혈구 이상 15명(5.3%), 관상동맥 이상 6명(2.1%), AST 상승 22명(7.8%), ALT 상승 3명(1.1%), AST/ALT 동시 상승은 3명(1.1%)에서 관찰되었다. 관상동맥 이상은 발병 초기에 이상을 보였던 경우에서만 관찰되었다. 6주째의 혈소판 증가군에서 대조군에 비해 성별과 재치료, 입원 시의 백혈구 이상, 농뇨, AST/ALT의 동시상승, 관상동맥 이상 빈도의 비교에서 모두 유의한 차이가 없었다. 6주째의 혈소판 증가에 영향을 주는 인자로는 어린 나이와 발병초기의 혈소판 증가증이었다. 발열-입원 기간과 치료-해열 기간, 입원 시의 ESR, CRP, AST, ALT치는 영향을 주지 않았다. 입원 시와 6주째의 혈소판 증가는 관상동맥 이상에 영향을 주지 않았다. 결 론 : 가와사끼병에서 6주째에 시행하는 각종 추적검사에서 소변 검사는 생략해도 될 것으로 보이며, 심초음파 검사는 발병 초기에 이상이 있었던 군에서만 선택적으로 시행해도 될 가능성을 시사했지만 이에 대한 연구가 더 필요하다고 판단된다. 혈소판 수는 계속적인 항혈전 치료와 관련이 있으므로 6주째의 검사가 필요하나, 백혈구수와 AST, ALT, ESR, CRP 검사의 임상적 의의는 크지 않다고 판단된다.

심한 좌심실 부전을 갖는 환자에서 시행한 Off-Pump CABG와 On-Pump CABG의 중단기 성적비교 (The Comparison Study of Early and Midterm Clinical Outcome of Off-Pump versus On-Pump Coronary Artery Bypass Grafting in Patients with Severe Left Ventricular Dysfunction (LVEF${\le}35{\%}$))

  • 윤영남;이교준;배미경;심영희;유경종
    • Journal of Chest Surgery
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    • 제39권3호
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    • pp.184-193
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    • 2006
  • 배경: 심장박동 상태에서 시행하는 관상동맥우회술(Off pump coronary artery bypass grafting, OPCAB) 은 심폐체외순환 하에서 시행하는 관상동맥우회술(On pump coronary artery bypass grafting, On pump CABG)에 비해 합병증이 다소 적은 것으로 보고되고 있다. 저자들은 좌심실 기능이 저하된 환자들에서 OPCAB과 On pump CABG의 단기 및 중기 성적을 평가하여 OPCAB의 유용성을 확인하였다. 대상 및 방법: 2001년 1월부터 2005년 2월까지 동반수술을 시행 받지 않고 관상동맥우회술만을 시행 받은 946명 중 좌심실 박출계수가 $35\%$ 이하인 100명을 대상으로 하였다(OPCAB군 : On pump CABG군 =68명: 32명). 평균 연령은 두 군이 OPCAB군과 On pump CABG군이 각각 62.9$\pm$9.0세와 63.8 $\pm$ 8.0로 두 군의 차이가 없었다. 두 군의 수술 전 위험요인을 분석하고, 수술 결과 및 추적결과를 평가 및 비교하였다. 결과: OPCAB군은 평균 2.75$\pm$0.72개, On pump CABG군은 2.78$\pm$0.55개의 도관을 획득하여, 각각 3.00$\pm$0.79개, 3.16$\pm$0.72개의 원위문합을 시행하였다. 수술 후 사망은 OPCAB군에서만 1명 ($1.5\%$) 발생하였으나 두 군간의 통계적 유의성은 없었다. 수술시간, 수술 후 1일째 CK-MB, 수술 후 기계 환기 시간, 중환자실 체류기간, 합병증 발생률이 통계적으로 유의하게 OPCAB군에서 더 낮았다. 평균 추적 기간은 26.6$\pm$12.8개월(4${\~}$54개월)이었으며, 추적 기간 중 좌심실 박출계수는 OPCAB군과 On pump CABG군이 각각 $27.1\pm4.5\%$$26.9\pm5.4\%$에서 $40.7\pm13.0\%$$33.3\pm13.7\%$로 통계적으로 유의하게 각각 증가하였다. 4년 생존율은 OPCAB군과 On pump CABG군이 각각 $92.2\%,\;88.3\%$, 심장관련 사망에 있어서 4년 freedom rate은 각각 $97.7\%,\;96.4\%$로 두 군간의 차이는 없었으며, 심장관련 합병증과 협심증 발생의 freedom rate도 두 군간의 차이는 없었다. 결론: 좌심실 기능이 저하된 환자들에서 심장박동 상태에서 시행하는 관상동맥우회술은 심장기능을 향상시키고 On pump CABG군에 비해 우수한 수술결과를 보였다. 특히 On pump CABG군에 비해 우수한 단기 성적을 보였으나 중기성적은 차이가 없었다. 따라서 좌심실 기능이 저하된 환자들에 있어서 심장박동 상태에서 시행하는 관상동맥우회술은 안전하고 효과적으로 사용될 수 있는 수술방법이라고 생각한다.

우리 나라 개원의 고혈압 관리의 질 평가 (Quality Assessment of Hypertension Management of Office-based Physicians in Korea)

  • 조홍준;이상일
    • 한국의료질향상학회지
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    • 제4권1호
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    • pp.36-49
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    • 1997
  • Background : Hypertension is one of the most important risk factors of the cerebrovascular accident and coronary artery disease which are the major causes of mortality in Korea. In Korea, the quality of care provided by office-based physicians has not been evaluated formally. The purpose of this study is to assess the quality of hypertension management of office-based physicians. Method : Self-administered questionnaires were mailed to the office-based physicians with the speciality of internal medicine, general surgery, family medicine, and general practitioners. Among 2,045 physicians, 981 doctors(48.0%) replied the questionnaires. Contents of questionnaires were based on the recommendation from the JNC-V report(the Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure), and included the criteria of diagnosis, treatment, follow-up interval, and other characteristics of physicians(age, sex, type of speciality, and location of practice). Results : Eighty four percent of the office-based physicians made diagnosis of hypertension with less than 3 times of blood pressure measurements. The performance rate of required examination for hypertensives was very low in most items. Rate of fundoscopic examination is the lowest one among them(5.9%). The performance rate of laboratory examination was also low in most items. Internists tended to order more frequent laboratory examinations than any other type of physicians. Only 11.4% of the physicians did appropriate treatments for the mild hypertension case. The antihypertensives selected by the physicians as a first line drug were in the order of beta blocker(26.4%), calcium channel blocker(23.4%), diuretics(23.1%), ACE inhibitors(14.3%). The visit interval for established hypertensives was very short. Proportion of physicians with follow-up interval longer than 4 weeks was only 4.3%. Conclusions : The overall quality of hypertension management of office-based physicians in Korea is very problematic in many aspects. So further investigations to find out the reasons of low quality arid quality of care should be initiated.

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Mid-Term Results of Totally Thoracoscopic Ablation in Patients with Recurrent Atrial Fibrillation after Catheter Ablation

  • Lim, Suk Kyung;Kim, Joo Yeon;On, Young Keun;Jeong, Dong Seop
    • Journal of Chest Surgery
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    • 제53권5호
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    • pp.270-276
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    • 2020
  • Background: We investigated the impact of previous catheter ablation (CA) on the midterm outcomes of totally thoracoscopic ablation in patients with lone atrial fibrillation (AF). Methods: Between February 2012 and July 2018, 332 patients underwent totally thoracoscopic ablation for the treatment of AF (persistent AF; n=264, 80%). The patients were stratified into CA (n=47, 14%) and non-CA (nCA; n=285, 86%) groups according to their CA history. Results: All the baseline clinical characteristics and risk factors were similar between the groups except for age, percentage of male patients, prevalence of paroxysmal AF, prior percutaneous coronary intervention, and left atrial volume index (LAVI). No significant intergroup differences were observed in the incidence of early and late complications. At late follow-up, normal sinus rhythm was observed in 92% (43 of 47) of the patients in the CA group and 85% (242 of 285) of the patients in the nCA group (p=0.268). The rate of freedom from AF recurrence at 5 years was 55.3%±11.0% in the CA group, which was similar to that in the nCA group (55.7%±5.1%, p=0.690). In Cox regression analysis, preoperative brain natriuretic peptide levels and LAVI were associated with AF recurrence, but CA history was not significant. Conclusion: Totally thoracoscopic ablation was safe and effective in treating AF irrespective of CA history. A history of CA did not appear to affect the procedural complexity.

중년 성인남녀의 혈중 지질농도가 가속도맥파에 미치는 영향 (Elevated Levels of Serum Lipids Accelerate Biological Vascular Aging evaluated by the Second Derivative of Photoplethysmogram Waveform in the Middle-Age Adults)

  • 남동현;고형균;박영배
    • Journal of Acupuncture Research
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    • 제19권3호
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    • pp.126-137
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    • 2002
  • Objective : There is accumulating data that cardiovascular diseases, including hypertension, cerebro-vascular accident, coronary heart disease, relate to atherosclerotic changes. Increased serum levels of lipids could play a role in these circumstances. the SDPTG(the second derivative of photoplethysmogram waveform) is noninvasive methods for evaluating the pulse wave and is correlated with age and other risk factors for atherosclerosis. Methods : To study the effects of serum lipid levels on the SDPTG in the middle-age adults, data on serum lipid levels and the SDPTG were collected in 80 healthy middle age with varying serum lipid concentrations. Biological vascular age was assessed using the SDPTG. the SDPTG consists of an a, b, c, and d wave in systole and an e wave in diastole; an SDPTG aging index(Al) was calculated as (b-c-d-e)/a. Results : Serum triglyceride, total cholesterol, total lipid, phospholipid, HDL cholesterol levels were respectively and significantly correlated with SDPTG Al. Serum lipid levels and blood pressure are age-dependent and the SDPTG is blood pressure-dependent. Restricting analysis to age and blood pressure yield strong positive correlations between serum triglyceride, total lipid levels and SDPTG Al, but no correlations between serum total cholesterol, phospholipid levels and SDPTG Al. Conclusion : The results of this study suggest that preventive acupuncture programs or herbal medications for reducing serum lipid, especially triglyceride, levels in middle-age should include a evaluation of biological vascular aging with the second derivative of photoplethysmogram waveform.

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단순형과 혼합형 고콜레스테롤혈증 환자의 체위 및 혈장지질 특성 (Characteristics of the Anthropometry and Plasma Lipid Profiles of Patients with Simple and Combined Hypercholesterolemia)

  • 허영란;황금희;임현숙
    • 대한지역사회영양학회지
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    • 제4권2호
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    • pp.186-193
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    • 1999
  • Recent epidemiologic and clinical students have shown that plasma cholesterol and triglyceride levels are independent risk factors for coronary heart disease. However, there is not much data on the characteristics of anthropometry and lipid profiles of hypercholesterolemia patients with hypertiglyceridemia. In this study, 112 hypercholesterolemic subjects$(T.C{\ge}240mg/dl)$ were divided into two groups by their plasma triglyceride levels. We compared the anthropometric measurements and lipid profiles of the subjects between the two groups : the simples hypercholesterolemic group(SHC, TG<200mg/dl) and the combined hypercholesterolemic group$(CHC, TG{\ge}250mg/dl)$. The distribution of the subjects into the SHC and CHC groups was 36.6% and 47.3%, respectively. The frequency of the CHC patients decreased with age. The subjects in this group had higher weight, BMI, HWR, cricumferences of mid arm, waist, hip and thigh, and skinfold thicknesses of biceps and triceps than those of the SHC subjects. The difference of plasma total cholesterol level was mainly due to the difference of VLDL-C levels. These differences resulted in the CHC subjects having higher atherogenic indexes and T-C/HDL-C ratios than those of the SHC subjects. Also, the former had higher Apo-B and insulin levels than those the latter. However, blood pressure, fasting blood glucose and HDL-C levels were not significantly different between the two groups. These results suggest that hypercholesterolemic patients with hypertriglyceridemia have riskier lipid profiles for CHD than those of patients with normal triglyceridemia. They also indicate that CHC is closely associated with glucose resistance syndrome(obesity, hyperglycemia, hyperinsulinemia and hypertriglyceridemia), and more prevalent in young people.

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대동맥류의 수술적 치료에 관한 임상적 연구 (Clinical Study of Surgical Treatment of Aortic Aneurysm)

  • 류지윤;전홍주;조광현
    • Journal of Chest Surgery
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    • 제30권3호
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    • pp.300-307
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    • 1997
  • 인제대학교 부속 부산백병 원 흉부외과학교실에서는 지난 87년 10월부터 96년 1월까지 총25례의 흉부 및 복부 대동맥류를 수술로 치험하였다. 환자의 연령은 최소 26세에서 최고 73세(평균연령 52. 5세)였으며 남자가 13명 여자가 12명이였다. 발생 부위에 따라흉부 대동맥류가 18례 복부 대동맥류가7례였다. 원인에 따른 분류에서 16례가 박리성이 였으며 9례가 비박리성 대동맥류였다. 동맥류의 위험 인자로는 고혈압이 가장 많았으며 기타 고지질증, Marfan증후군등이였다. 흉부 대동맥류는 침범 부위에 따라 동맥류 절제술과 인조혈관 대치술 및 관상동맥 이식술등을 증례에 따라적절히 시행하였다. 복부 대동맥류는 동맥류 절제후 침범 부위에 따라 일자 또는 역Y형 인조혈관 을 대 치시켰다. 총 5례의 술후 사망이 있어서 수술 사망률은 20%였으며 생존 환자는 특별한 합병증 없이 퇴원하였다.

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Mass Reduction and Functional Improvement of the Left Ventricle after Aortic Valve Replacement for Degenerative Aortic Stenosis

  • Shin, Su-Min;Park, Pyo-Won;Han, Woo-Sik;Sung, Ki-Ick;Kim, Wook-Sung;Lee, Young-Tak
    • Journal of Chest Surgery
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    • 제44권6호
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    • pp.399-405
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    • 2011
  • Background: Left ventricular (LV) hypertrophy caused by aortic valve stenosis (AS) leads to cardiovascular morbidity and mortality. We sought to determine whether aortic valve replacement (AVR) decreases LV mass and improves LV function. Materials and Methods: Retrospective review for 358 consecutive patients, who underwent aortic valve replacement for degenerative AS between January 1995 and December 2008, was performed. There were 230 men and 128 women, and their age at operation was $63.2{\pm}10$ years (30~85 years). Results: There was no in-hospital mortality, and mean follow-up duration after discharge was 48.9 months (2~167 months). Immediate postoperative echocardiography revealed that LV mass index and mean gradient across the aortic valve decreased significantly (p<0.001), and LV mass continued to decrease during the follow-up period (p<0.001). LV ejection fraction (EF) temporarily decreased postoperatively (p<0.001), but LV function recovered immediately and continued to improve with a significant difference between preoperative and postoperative EF (p<0.001). There were 15 late deaths during the follow-up period, and overall survival at 5 and 10 years were 94% and 90%, respectively. On multivariable analysis, age at operation (p=0.008), concomitant coronary bypass surgery (p<0.003), lower preoperative LVEF (<40%) (p=0.0018), and higher EUROScore (>7) (p=0.045) were risk factors for late death. Conclusion: After AVR for degenerative AS, reduction of left ventricular mass and improvement of left ventricular function continue late after operation.

Comparisons of Food Consumption and Food Sources of Nutrients in the Diets of Postmenopausal Women with Normocholesterolemia and Hypercholesterolemia in Seoul, Korea

  • Kim, Sangyeon;Kyungah Jung;Yukyung Chang
    • Nutritional Sciences
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    • 제7권3호
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    • pp.174-182
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    • 2004
  • Women have a greater incidence of coronary heart disease (CHD) after menopause. This relates to hormone imbalance-induced changes in known CHD risk factors, especially hyperlipidemia. The purpose of this study was to explore d1e differences in food consumption and food sources of nutrients in the Korean diet between postmenopausal women aged 50-74 years with normocholesterolemia(NC) and those with hypercholesterolemia(HC). Each subject was either classified as part of the NC group (n=39, serum total cholesterol con. <200 mg/$dl$) or the HC group (n=31, serum total cholesterol con. $\geq$240 mg/dl) based on the Guideline for Korean Hyperlipidemia.l Diet was assessed through a validated semi-quantitative food frequency questionnaire. Consumption of foods such as biscuits and/or crackers, squid and eggs was significantly (p<0.05) higher in the HC group than in the NC group. On the other hand, consumption of potatoes/starches and carrots was significantly (p<0.05) lower in the HC group than in the NC group. There was no significant difference between the two groups in terms of the consumption of legumes and legume products containing phytoestrogen and we could not find a relationship between legumes and legume products and serum cholesterol levels. Consumption of green tea tended to be lower in the HC group than in the NC group. Major sources of cholesterol, cholesterol-saturated index and vitamin A in the diets of the HC group consisted of foods high in cholesterol. Our results confirm that postmenopausal women with hypercholesterolemia in Korea tend to consume cholesterol-rich foods and dishes.

창원시 건강증진 시범학교 일부 아동의 식습관 , 체격지수 , 혈액성상에 관한 연구 (A Study of the Relation between Food Habits , Anthropometric and Clinical Data in a Health Promoting Elementary School in Changwon)

  • 이갑연;주정;이부옥
    • 대한영양사협회학술지
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    • 제7권4호
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    • pp.331-348
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    • 2001
  • The purpose of this study was to obtain basic data for nutrition education of the children in a health promoting elementry school. The data was collected by a questionaire of food habits, and anthropometric measurement and biochemical test in comparison with obesity index. The study subjects were boys and girls aged 10 to 12 years who participated in the “99 Children Nutrition Camp”. The average obesity index was 1.7$\pm$21.6% in boys and -11.4$\pm$12.6% in girls. After school, major leisure items were significnatly different by gender but both boys and girls played mainly computer game. In concern for body image and eating habits, girls had more concern and girls had attempted weight control more than boys. 80.2% of subjects had prejudice for special food, especially, all subjects in the severely underweight group had prejudice. But this tendency was significantly decreased with the increasing obesity index. The lowest preferency was for vegetables(64.4%). The tendency of prejudice of subjects was higher whose mother are thirties than those of subjects whose mother are in fourties. The serum GOT and GPT values were significantly higher in overweight and obese group than the other groups. The only serum T-chol was significantly higher in boys than in girls. The number of risk factors related to coronary heart disease(CHD) based on coresponding criteria of TG, T-chol, HDL-chol, and LDL-chol was not increased significantly with the degree of obesity index. The results indicated the need of nutritional management for the children. At a point of view, to educate children early who are able to change food habits and life-styles means to help heathy growth and to deliver up heathy adults. Active nutrition education for both children and mothers will be recommended with joint participation of nutritionists in community public health center and elementary school.

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