• 대한한방내과학회지
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• 제23권2호
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• pp.274-279
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• 2002

The sick sinus syndrome refers to a combination of symptoms (dizziness, confusion, fatigue, syncope, and congestive heart failure) caused by sinus node dysfunction and marked sinus bradycardia, sinoarterial block, or sinus arrest. 'Abdominal pulsation' means a disagreeable symptom that is defined as sensation of beating at the abdomen. We experienced a 84 year-old female patient who had dizziness, fatigue, abdominal pulsation and frequent voiding. These symptoms were related to previous episodes and presumed sick sinus syndrome by symptoms, ECGs and 24 hrs of holter monitoring. In the point of Differentiation of Syndrome (辨證), this patient was diagnosed as 'Water retention(水氣)' and was administered with Yeonggyechulgam-tang(岺桂朮甘湯). After the treatment, abdominal pulsation (frequency) and dizziness (VAS) were improved. Futhermore, the interval of voiding was longer and each volume of urination increased.

• Journal of Chest Surgery
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• 제55권5호
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• pp.364-377
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• 2022

An anatomical understanding of the atrial myocardium is crucial for surgeons and interventionists who treat atrial arrhythmias. We reviewed the anatomy of the inter-nodal and intra-atrial conduction systems. The anterior inter-nodal route (#1) arises from the sinus node and runs through the ventral wall of the atrial chambers. The major branch of route #1 approaches the atrioventricular node from the anterior aspect. Other branches of route #1 are Bachmann's bundle and a vestibular branch around the tricuspid valve. The middle inter-nodal route (#2) begins with a broad span of fibers at the sinus venarum and extends to the superior limbus of the oval fossa. The major branch of route #2 joins with the branch of route #1 at the anterior part of the atrioventricular node. The posterior inter-nodal route (#3) is at the terminal crest and gives rise to many branches at the pectinate muscles of the right atrium and then approaches the posterior atrioventricular node after joining with the vestibular branch of route #1. The branches of the left part of Bachmann's bundle and the branches of the second inter-nodal route form a thin myocardial network at the posterior wall of the left atrium. These anatomical structures could be categorized into major routes and side branches. There are 9 or more anatomical circles in the atrial chambers that could be structural sites for macro re-entry. The implications of normal and abnormal structures of the myocardium for the pathogenesis and treatment of atrial arrhythmias are discussed.

• Journal of Yeungnam Medical Science
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• 제2권1호
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• pp.259-264
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• 1985

신경아세포종은 소아기에 발생하는 악성종양중 뇌종양 다음으로 흔히 발생하는 것으로 원발 혹은 전이된 부위에 따라 다양한 임상증상이 나타날 수 있으나 실명을 주소로 한 경우는 드물다. 본 증례는 4세된 남아의 복부에서 기원하여 사골동으로 원위전이하여 갑작스런 실명을 주소로 한 신경아세포종으로 cytoxan, vincristine, DTIC, adriamycin 및 VM-26의 병합요법으로 치료하여 실명은 그대로 있으나 복부와 사골동의 종괴는 현저히 감소하였고 환아는 건강이 양호한 상태이다.

• 대한두경부종양학회지
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• 제11권2호
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• pp.145-152
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• 1995

A retrospective analysis was performed to ascertain the relationship between the treatment modalities and their treatment results. From July 1980 to June 1993, 115 patients with squamous cell carcinoma of the maxillary sinus were: treated at the Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University. There were 88 men and 27 women with median age of 57 years. According to AJCC TNM system of 1992. eight patients of T2, 54 patients of T3 and 53 patients of T4 were available, respectively. Cervical lymph node metastases at diagnosis was observed in 11 patients. 87 patients were treated with radiotherapy and 28 patients were treated with combination of surgery and radiotherapy. The overall 5 year survival rate was 32 %, patients that were treated with radiotherapy alone had a 5 year survival rate 24.3 % and patients who were treated with combination of surgery and radiation therapy had a 5 year survival rate of 52.8 % (p<0.05). Combination of surgery and radiotherapy resulted in a better treatment modality for squamous cell carcinoma of the maxillary sinus. Improved radiotherapy technique and development of multimodality treatment are needed to improve the local control and the survival rate in patients with advanced maxillary sinus carcinoma.

• Journal of Chest Surgery
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• 제31권1호
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• pp.59-65
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• 1998

심방세동은 심부정맥중 가장 흔한 질환이다. 이환율과 사망율에 있어서 심각한 문제를 일으킬 수 있으며 약물치료에 반응을 않하는 경우가 많다. 실험적 및 임상적 연구의 측면에서 볼 때, 거대회귀성 회로의 존재와 소회귀성 회로 혹은 심방의 자동성의 결핍을 근거로 심방세동에 대한 수술적 절제가 가능하다고 확신한다. maze III술식을 통해서 술후 동성 율동으로의 회복 빈도 증가, 장기적으로 볼 때 동방결절의 기능 향상, 인공심박동기의 사용 감소, 부정맥의 재발 감소, 심방의 전달 기능의 장기적 측면에서의 향상 등의 효과를 기대할 수 있다. 본원에서는 만성 심방세동을 가진 4명의 환자를 치험했다. 심방중격결손증 및 심방세동을 가진 환자에대해 Hioki술식을 시행했으며 술후 심전도상 정상 동방율동을 보였으나 술후 3년후에 접합부율동 및 서맥을 보였다. 승모판막질환 및 심방세동을 가진 나머지 3명의 환자에 대해서는 maze III술식을 시행했으며, 수술직후 2명의 환자에서는 규칙적인 동방율동을 보였으며, 1명의 환자에서는 심방세동을 보여서 amiodarone으로 조절하였다. 술후 3개월후 규칙적인 동방율동을 보이는 2명의 환자에 대해 심초음파를 실시한 결과 우심방의 수축은 양호하나 좌심방의 수축은 미미한 편이였다.

• The Korean Journal of Physiology
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• 제6권2호
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• pp.31-37
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• 1972

The right cervical vagus nerve was electrically stimulated for 30 sec, and 30 minutes recording cardiac rate responses and electrocardiogram. The main purposes of the present experiment are to determine effect of stimulation frequency on the maintenance of cardiac rate responses and to determine recovery time of sinus rhythm after asystole period followed by idioventricular rhythm during prolonged electrical stimulation of the vagus, and the optimal stimulation parameters for vagal stimulation were studied as well. The results obtained are summarized as follows: 1. The maximum negative chrontropic responses were obtained with the following ranges of electrical parameters. Intensity: 3V-7V, Frequency: 20/sec-60/sec, and pulse duration: 5 msec-20 msec. 2. Compared with the responses from sympathetic effectors, cardiac rate responses to electrical stimulation of vagus nerve were well maintained with all stimulation frequencies. 3. At all stimulation frequencies except 20/sec, sinus node started to take over primary pacemaker activity when cardiac rates were restored to about 38-40/min. 4. It was indicated that upper limit of idioventricular rhythm does not exceed 38-40/min. 5. With the stimulation parameter set of 20/sec-5 msec-3 V, sinus rhythm did not appear during 30 minutes of stimulation period. Therefore, this electrical parameter set appears to be optimal for elicitation of prolonged and maximum cardiac rate responses by vagal stimulation.

• The Korean Journal of Physiology
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• 제19권2호
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• pp.101-111
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• 1985

Transient inward current (TI) was studied by the two micro-electrode voltage clamp technique in the sinoatrial node of the rabbit. The author confirmed that in $10^{-6}$ M ouabain TI was found in the SA node and investigated the effects of ions, $(Na^+,\;K^+,\;Ca^{2+})$, $\beta-agonist$ (isoprenaline), local anesthetics (quinidine, lidocaine) and Ca-blockers ($Co^{2+}$, verapamil, diltiazem) on the TI recorded during depolarizing voltage clamp pulses to -40 and -20 mV. The results obtained were as follows ; 1) $10^{-6}M$ ouabain increased the frequency of sinus action potential and decreased the amplitude, especially overshoot of action potential. TI was induced by the depolarizing voltage clamp Pulses and the magnitude of the slow inward current (isi) decreased and the time course was slowed by the same depolarizing pulses. 2) 30% $Na^{+}$ and 24mM $K^+$ decreased by $10^{-6}M$ ouabain and 6 mM $Ca^{2+}$ and $10^{-7}M$ isoprenaline increased TI, $i_{si}$ and current oscillations. 3) Quinidine $(5\times10^{-7}M)$ reduced TI and $i_{si}$ but lidocaine $(10^6\;-10^5M)$ didn't reduced or increase TI. Current oscillations increased and isi decreased by lidocaine. 4) Ca-blockers decreased the amplitude and the frequency of sinus action potential. TI and $i_{si}$ decreased significantly but were not abolished completely at the concentrations used in this experiment. Verapamil and diltiazem had inhibitory action on TI in $2\times10^{-7}M$ concentration and showed very slow recovery after wasting out with normal Tyrode solution.

• 대한두경부종양학회지
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• 제8권1호
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• pp.44-49
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• 1992

Malignant schwannoma is a rare tumor arising from the schwann sheath of the nerve fibers. It spreads early to reginal node and metastasis to the lung. Radical surgery have performed for treatment of choice but combined modalities such as radiotherapy or adjuvant chemotherapy have been recommanded recently. The authors experienced two cases of malignant schwannoma originating from the ethmoid sinus and ventricular fold of larynx. and we report these cases briefly.

• The Korean Journal of Physiology
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• 제21권1호
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• pp.1-12
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• 1987

There is evidence that the effect of extracellular $Ca^{2+}$ on heart rate is temperature-dependent: at $38^{\circ}C$ excess $Ca^{2+}$ induces positive chronotropic response, whereas at $30^{\circ}C$ there is no significant chronotropic effect of $Ca^{2+}$. The cause of this temperature-dependency, however, remains still unclear. Therefore, this study was undertaken to investigate the chronotropic effect of external $Ca^{2+}$ at different temperature in the isolated rabbit atria and in the small strips of SA node cut perpendicularly to crista terminalis. In the isolated atria, the $Ca^{2+}$ effect was temperature-dependent: at $35^{\circ}C$ excess $Ca^{2+}$ evoked positive chronotropic response, while at $30^{\circ}C$ there was no significant changes in sinus rate. On the contrary, in the small SA strips external $Ca^{2+}$ induced negative chronotropic effect. At $35^{\circ}C$ changes in $Ca^{2+}$ concentration from 2 to 4, 6, and 10 mM decreased the sinus rate by $2.7{\pm}1.6%$, $11.2{\pm}3.7%$ and $23.2{\pm}8.1%$ respectively. Lowering the temperature to $30^{\circ}C$, the negative chronotropic effect of $Ca^{2+}$ became greater. With intracellular microelectrodes transmembrane potential was recorded in the small SA strips at $30^{\circ}C$, $35^{\circ}C$ and $38^{\circ}C$. As temperature increased from 30 to $38^{\circ}C$, sinus rate was accelerated by $13/min/^{\circ}C$, $APD_{50}$(action ptential duration from peak to 50% repolarization) decreased by $5\;msec/^{\circ}C$, and amplitude of action potential was slightly decreased. With an increase in $Ca^{2+}$ concentrations from 0.5 to 6 mM, overshoot increased and MDP decreased. These $Ca^{2+}$ effects on the overshoot and MDP of action potentials were not altered by temperature. But the $Ca^{2+}$ effects on the rates of diastolic depolarization, systolic depolarization and repolarization were modified by temperature. Discrpancy of the chronotropic effects of $Ca^{2+}$ between isolated atria and small SA strips was discussed.

• Molecules and Cells
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• 제43권4호
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• pp.408-418
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• 2020

The sinus node (SN) is located at the apex of the cardiac conduction system, and SN dysfunction (SND)-characterized by electrical remodeling-is generally attributed to idiopathic fibrosis or ischemic injuries in the SN. SND is associated with increased risk of cardiovascular disorders, including syncope, heart failure, and atrial arrhythmias, particularly atrial fibrillation. One of the histological SND hallmarks is degenerative atrial remodeling that is associated with conduction abnormalities and increased right atrial refractoriness. Although SND is frequently accompanied by increased fibrosis in the right atrium (RA), its molecular basis still remains elusive. Therefore, we investigated whether SND can induce significant molecular changes that account for the structural remodeling of RA. Towards this, we employed a rabbit model of experimental SND, and then compared the genome-wide RNA expression profiles in RA between SND-induced rabbits and sham-operated controls to identify the differentially expressed transcripts. The accompanying gene enrichment analysis revealed extensive pro-fibrotic changes within 7 days after the SN ablation, including activation of transforming growth factor-β (TGF-β) signaling and alterations in the levels of extracellular matrix components and their regulators. Importantly, our findings suggest that periostin, a matricellular factor that regulates the development of cardiac tissue, might play a key role in mediating TGF-β-signaling-induced aberrant atrial remodeling. In conclusion, the present study provides valuable information regarding the molecular signatures underlying SND-induced atrial remodeling, and indicates that periostin can be potentially used in the diagnosis of fibroproliferative cardiac dysfunctions.