Ebstein씨 심기형에 동반된 Wolff-Parkinson-White 증후군 및 방실결절 회귀성 빈맥에 대한 수술치험 1례 보고

장병철 대한흉부심장혈관외과학회 1990 Journal of Chest Surgery (J Chest Surg) Vol.23 No.1

A 17 year old female patient with Ebstein`s anomaly received surgical treatment for WPW syndrome and AV nodal reentrant supraventricular tachycardia[SVT] Electrophysiologic study revealed that an anomalous pathway was located in the right posterolateral portion and antegrade dual AV nodal pathway responsible for AV nodal reentrant tachycardia. The patient was underwent surgery on February 18, 1987. Intraoperative mapping was used to define the location of accessory pathway. The accessory pathway was cryoablated through the epicardium. Simultaneously discrete cryoablation around the perinodal area was performed to prevent AV nodal reentrant SVT. The atrialized right ventricle of Ebstein`s anomaly was plicated with 11 pledget mattress sutures under the cardiopulmonary bypass. Two and half years after surgery, the patient has no evidence of WPW syndrome or supraventricular tachycardia.

개심수술후 심장부정맥에 대한 임상적 연구: 원인,빈도 및 치료

장병철 대한흉부심장혈관외과학회 1991 Journal of Chest Surgery (J Chest Surg) Vol.24 No.9

We prospectively studied postoperative cardiac arrhythmia after open heart surgery to analyze the types and incidence of cardiac arrhythmia and to predict preoperative risk factors. And also we evaluated the effectiveness of atrial and ventricular epicardial electrodes which were placed during operation Between March 1990 and August 1990, We had operated on in 211 patients and we studied 201 consecutive patients excluding 10 patients. The study group included 99 males and 102 female patients, ages 1 month to 75 years[Mean$\pm$SD=28.0$\pm$21.7 years]. Postoperatively, all patients were regularly seen by the cardiac surgeon and cardiologist, They had continuous electrocardiographic monitoring for the first 3 days, initially in the intensive care unit and were checked routine electrocardiography on the postoperative 7 days, The postoperative cardiac arrhythmia were analyzed and possible associations of this arrhythmia with various pre, intra, and postoperative factors were studied by univariate and multivariate discriminant analysis, The overall incidence of postoperative cardiac arrhythmia except relative sinus bradycardia was 36.8%;[74/201], The incidence of postoperative cardiac arrhythmia in acyanotic congenital heart disease: 19.4%, cyanotic congenital heart disease: 20.8%, cardiac arrhythmia surgery: 33.3%, acquired valvular heart disease: 60.9% and coronary artery occlusive disease: 38.9%. Both univariate and multivariate studies indicated the pre operative symptom duration[p = 0013], the duration of medication[p=0.003], presence of preoperative arrhythmia[p<0.001] and pre-operative left atrial dimension in echocardiography to be the factor promoting postoperative cardiac arrhythmia. Multivariate discriminant analysis showed that the presence of preoperative cardiac arrhythmia, bypass time and the duration of preoperative symptom duration conveyed considerable risk factor on post-operative arrhythmia. The atrial wire electrodes were used diagnostically in 36 and were used therapeutically in 89 among 201 patients. Atrial pacing were used to treat relative sinus bradycardia, accelerated junctional tachycardia or premature atrial or ventricular contractions in 51 patients. Atrioventricular sequential pacing were used in 16 patients and ventricular pacing were used in 20 patients. Hemodynamics were evaluated in 2 patients of relative sinus bradycardia before and after atrial pacing. The atrial pacing increased the amount of cardiac output to 15% more. Because of their great utility in the diagnosis and treatment of arrhythmias, we conclude that routine placement of atrial and ventricular electrodes at the time of operation is indicated regardless of the nature of the open-heart procedure.

Historical Perspectives of the Korean Society for Thoracic and Cardiovascular Surgery: Pill Whoon Hong (1921–2004), A Pioneer in Cardiothoracic Surgery in Korea

장병철,박국양,Cho Bum Koo 대한흉부외과학회 2023 Journal of Chest Surgery (J Chest Surg) Vol.56 No.1

Ubiquitous-Severance Hospital Project: Implementation and Results

장병철,김남현,김영아,Jee Hea Kim,정혜정,Eun Hae Kang,Hee Suk Kang,Hyung Il Lee,김용욱,유선국,선우일남 대한의료정보학회 2010 Healthcare Informatics Research Vol.16 No.1

Objectives: The purpose of this study was to review an implementation of u-Severance information system with focus on electronic hospital records (EHR) and to suggest future improvements. Methods: Clinical Data Repository (CDR) of u-Severance involved implementing electronic medical records (EMR) as the basis of EHR and the management of individual health records. EHR were implemented with service enhancements extending to the clinical decision support system (CDSS)and expanding the knowledge base for research with a repository for clinical data and medical care information. Results:The EMR system of Yonsei University Health Systems (YUHS) consists of HP integrity superdome servers using MS SQL as a database management system and MS Windows as its operating system. Conclusions: YUHS is a high-performing medical institution with regards to efficient management and customer satisfaction; however, after 5 years of implementation of u-Severance system, several limitations with regards to expandability and security have been identified.

UDP/IP 메시지 전송의 QoS 성능 향상을 위한IP Over USB

장병철,박현희,양승민 한국정보처리학회 2007 정보처리학회논문지. 컴퓨터 및 통신시스템 Vol.14 No.5

The Linux-based embedded systems such as mobile telephones, PDAs and MP3 players are widely in use. USB (Universal Serial Bus) is the interface for data communication between the computers and these peripheral devices. Some embedded systems like intelligent home networking and multimedia streaming require guaranteed QoS (Quality of Service), which is needed for real time transmission of UDP/IP messages through USB. Although USB Ethernet driver is supported by USB Gadget API in Linux, it is unable to provide the desirable QoS required by each type of small embedded systems due to the unpredictability of TCP/IP Stack in Linux. This paper proposes IP-Over-USB to improve QoS of UDP/IP message transmission in the embedded systems using USB in Linux system. 임베디드 리눅스 기반의 휴대폰, PDA, MP3 플레이어 등의 소형 내장시스템이 널리 사용되고 있다. 이러한 소형 내장시스템에서 컴퓨터 또는 주변장치와의 데이터 통신을 위한 인터페이스 중에는 USB(Universal Serial Bus)가 있다. 특히 지능형 홈 네트워킹 및 멀티미디어 스트리밍을 지원하는 소형 내장시스템에서는 USB를 통한 UDP/IP 메시지를 실시간으로 전송하기 위한 서비스품질(Quality of Service)의 보장을 요구한다. 리눅스에서는 USB Gadget API 기반의 USB 이더넷 드라이버를 지원하고 있지만 TCP/IP Stack에서의 비 예측성으로 인하여 내장시스템에서 요구하는 QoS를 제공하지 못하고 있다. 본 연구에서는 USB와 리눅스를 사용하는 내장시스템에서 UDP/IP 메시지 전송 시의 QoS 성능 향상을 위한 프레임워크인 IP-Over-USB를 제안한다.

인체에서 Pick 원리 및 열희석법에 의한 심박출량 측정의 비교 연구

장병철 대한흉부심장혈관외과학회 1981 Journal of Chest Surgery (J Chest Surg) Vol.14 No.3

Measurement of cardiac output by thermodilution method is easy to perform and can be repeated at very short intervals and offers a number of theoretical and practical advantages. The purpose of this paper is to reevaluate the accuracy and reproducibility of the thermodilution cardiac output by comparing the results with those obtained by the direct Fick technique. From January through April 1981 [4 months], 26 simultaneous cardiac output measurements were made using thermodilution and direct Fick methods in 12 patients in the intensive care unit of Severance Hospital following open heart surgery. The average age of the patients was $34.8{\pm}12.0$ [SD] years [range; 17-57 years]. For cardiac output determination by thermodilution technique [$CO_TD$], a Swan-Ganz Thermodilution Catheter, Model 93A-131-7F [Edwards Laboratories], a Cardiac Output Computer, Model 9520A, and Strip Chart Recorder, Model 9810 [Edwards Laboratories] were used. For the determination of cardiac output by direct Fick principle [$CO_Fick$], a Van Slyke Manometric Apparatus [Thomas] for the measurements of arteriovenous oxygen content difference and a Collin`s Respirometer with Kymograph for the measurement of oxygen consumption were used. The correlation between the simultaneously measured $CO_TD$ and $CO_Fick$ was found to be $CO_Fick$ = 0.95.$CO_TD$ + 0.1073, [r= 0.9777, P < 0.001 ]. For 26 double or triple determinations of $CO_TD$, the values ranged from 1.77 L/min to 6.66 L/min, with a reproducibility of 2.18%. The maximum difference of $CO_TD$ for $CO_Fick$ was between +11.99% and -12,99% [$Mean{\pm}SD$ = $6.07{\pm}3.97$%]. Measurement of cardiac output by thermodilution method provides a simple, rapid, reproducible and highly accurate method for multiple cardiac output measurements suitable for use at the bedside. Comparison of Cardiac Output Determination by Direct Fick and Thermodilution Method in Man.

이야기재연전략교수와직접교수가읽기장애아동의읽기 유창성과이해력에미치는효과비교

장병철 한국특수교육교과교육학회 2009 특수교육교과교육연구 Vol.2 No.2

본 연구는 이야기 재연 전략교수와 직접교수가 읽기장애아동의 읽기 유창성과 읽기 이해력에 미치는 효과의 차이를 비교하는데 그 목적이 있다. 이러한 목적을 달성하기 위해 선정한 연구문제는 다음과 같다. 첫째, 이야기 재연 전략교수와 직접교수가 읽기장애아동의 읽기 유창성에 미치는 효과는 어떠한 차이가 있는가? 둘째, 이야기 재연 전략교수와 직접교수가 읽기장애아동의 읽기 이해력에 미치는 효과는 어떠한 차이가 있는가? 본 연구의 결과는 다음과 같다. 첫째, 이야기 재연 전략교수는 직접교수보다 읽기장애아동의 읽기 유창성을 향상시키는데 적합한 교수전략이라고 할 수 있다. 둘째, 이야기 재연 전략교수는 직접교수보다 읽기장애아동의 읽기 이해력을 향상시키는데 적합한 교수전략이라고 볼 수 있다. 이상에서와 같이 이야기 재연 전략교수가 직접교수보다 읽기장애아동의 읽기 유창성과 읽기 이해력을 향상시키는데 더욱 효과적인 전략으로 나타났다. 따라서 읽기 전략의 부재, 기억의 결함, 낮은 정보 처리 등의 특징을 가지는 초등학교 읽기장애아동의 열약한 읽기 유창성과 읽기 이해력을 향상시키기 위해서는 이야기 재연 전략교수를 적용할 필요가 있다고 할 수 있다.

개심수술후 혈량 증가를 위한 10% Pentastarch와 5% Albumin 용액의 비교연구

장병철 대한흉부심장혈관외과학회 1994 Journal of Chest Surgery (J Chest Surg) Vol.27 No.3

Pentastarch is a hydroxyethyl starch similar to hetastarch, but lower average molecular weight and fewer hydroxyethyl groups which result in enhanced enzymatic hydrolysis and faster renal elimination.This report was performed to compare the clinical efficacy and safety of 10 % pentastarch[Pentaspan , group I] for plasma volume expansion after open heart surgery with that of 5% albumin[Plasmanate, group II]. There were no statistically significant differences between the group I [n=18] and group II [n:19] in the preoperative parameters [age, sex, body weight] and operative parameters[bypass time, aorta cross clamping time]. During the first 24 hours after arrival of the patient in the surgical intensive care unit, colloid solution [500--1000 ml] was infused to maintain left atrial pressure of more than 8 mmHg, or cardiac index of 2.0 L/min/M2 of more. In results, there were 3 complications of hypotension immediately after infusion of 5 % albumin solution and 2 among the 3 patients were excluded for the study. However there was no complication after infusion of 10 % pentastarch solution. Hemodynamic responses to infusion was similar for both groups, although in group I a greater increase in both left atrial pressure[mean 1.8 versus 0.7 mmHg, p< 0.05] and right atrial pressure [mean 2.2 versus 1.7 mmHg, p < 0.05] was observed during infusion of the first 500 ml. There were no significant differences in any of the measured respiratory parameters[PaO2, intrapulmonary shunt, and effective lung compliance]. Homodilution with colloid significantly reduced hemoglobin [mean 1.2 versus 0.8 gm/dl], and serum protein and albumin level[total protein;4.8$\pm$ 0.5 versus 5.2 $\pm$0.5 gm/dl, p < 0.05: albumin: 3.2 $\pm$0.4 versus 3.6 $\pm$0.6 gm/dl, p < 0.05] by 6:00 AM on 1 day postoperatively, however there were no significant differences on 7 day postoperatively. The mean serum colloid osmotic pressure and osmolarity was similar in both group.There were no abnormal findings of liver function and kidney function in all the patients. There were no significant between-group differences in bleeding time, platelets, prothrombin time, activated partial thromboplastin time and amount of chest tube output measured on 1st and 7th postoperative day. These findings demonstrated that 10% pentastarch is more effective and safe for plasma volume expension than 5 % albumin solution with no adverse effects on coagulation. Also 10 % pentastarch is less expensive than 5 % albumin and it would appeare to be a reasonable first choice for plasma volume expansion.

이동형 고육정보 서비서의 개발

장병철,장재영,차재혁 한국컴퓨터교육학회 2002 컴퓨터교육학회 논문지 Vol.5 No.1

심장판막질환의 수술과 수술 후 환자관리

장병철 메디메디아코리아(주) 2000 심장과 혈관 Vol.2 No.4