영구형 심박조율기 시술에 대한 임상경험

조정관(Jeong Gwan Cho),정명호(Myung Ho Jeong),박종춘(Jong Chun Park),양승진(Seung Jin Yang),박찬형(Chan Hyung Park),길광채(Gwang Chae Gill),조길우(Keal Woo Cho),강정채(Jung Chaee Kang) 대한내과학회 1989 대한내과학회지 Vol.37 No.1

N/A Pacemaker implantation for symptomatic bradycardia is becoming popular recently in this country. Though its clinical benefit has been documented clearly there are still a lot of clinical problems arising from surgical problems, implanting techniques and pacemaker inherited problems. This study was designed to evaluate the indications, clinical manifestations and complications of 62 implantation procedures in 55 patients who had undergone the implantation procedure in Chonnam University Hospital by reviewing the pertinent clinical records. From 1983 to 1988, 62 implantation procedures in 55 patients (19 men and 36 women) were carried out. Annual numbers of implantation had been increasing, with 5 cases in the beginning year up to 20 cases in 1987, the numbers increased. The most common age was the fifties and patients older than fifty years comprised 74.5% of the total. The main symptoms which brought the 52 patients who underwent the first implantation to the hospital were syncope in 26, dyspnea in 14, dizziness in 9, shock in 2, and nonspecific in l. Electrocardiographic manifestations of the patients were atrioventricular block in 32 (58.2%, 28 complete AV blocks, 3 type II 2nd AV blocks, and one trifascicular block) and sick sinus syndrome in 23 patients (41.8%, 10 sinus arrests, 9 sinus bradycardias, 3 tachy-bradycardias, and one second degree SA block). Associated diseases were hypertension in 20, coronary artery disease in 7, cerebral infarction in 4, surgical correction of VSD in 2, dilated cardiomyopathy in 2, diabetes mellitus in 2, thyrotoxicosis in l, and liver cirrhosis in 1 patient. But, abaut one fourth of the patients had no associated disease. The systems implanted were all ventricular demand pacing system, among which 41 (70%) were multi-programmable. Pacing leads were introduced via the cephalic vein in most of the cases and via the external jugular vein in some cases. At implantation the pacing threshold was 0.67±0.25 volts (M±SD), electrode impedance 1258±266 ohm (M±SD), and intracardiac R wave amplitude 10.3±9.7 mvolts (M±SD). The causes of revision due to complications were 2 chronic exit blocks, 2 erosions of the generator or lead, one preerosion followed by infection after a revision, one generator pocket abscess shortly after an implantation, one power depletion, and 3 occasions of twiddler's syndrome in a patient. Other complications which were controllable without revision of the system were one indifferent electrode skeletal muscle pacing treated by reprograming the output, chronic increase of threshold in another 2, pacemaker syndrome in one treated by reprograming, and a hematoma in the generator pocket resolved by needle aspiration. We learned from this review that although pacemaker implantation has been helpful in the majority of the patients treated, same annoying and potentially life threatening complications warranted, and efforts to prevent or detect them early are necessary mention.

GPS/Leveling에 의한 표고결정 연구

조정관(Cho Jung Gwan),곽성남(Kwak Seong Nam),고광준(Ko Gwang Jun),송인호(Song In Ho) 한국지적정보학회 2005 한국지적정보학회지 Vol.7 No.2

본 연구는 지역적인 지오이드고를 구하여 소구점의 표고와 부합여부를 확인하는데 목적이 있으며, 방법은 삼각점표고 성과가 아닌 정밀한 1등 수준점과 2등 수준점을 이용하여 직접 GPS관측, WGS84좌표계의 타원체고를 구하고 정표고와 차이점을 평균하여 여러 가지 유형으로 소구점의 표고를 비교ㆍ분석하였다. 연구결과 소구점의 표고 수준점은 양호하게 나타났으나, 지적삼각점 표고는 삼각점에서 연직각관측에 의한 간접수준측량 방식을 사용했으므로 정밀도는 높지만 그 값의 차이만큼 균일하게 벗어남을 알 수 있었고, 소구점의 표고를 비교ㆍ분석한 결과 표고의 차이가 크게 영향을 미치지 않으므로 GPS 관측의 표고산정 값을 이용하여 현실적인 표고 값을 구하는 것이 효과적인 것으로 나타났다. This study aims at ascertaining the coincidence with geoidal height and height of observed point. and the way of confirmation was to compare and make an analysis the elevation of observed point with many types after averaging the orthometric and the difference. The way, we've sought for ellipsoid height of WGS84 coordinate system, was not the result of triangulation point elevation but the survey of GPS with the closer first order bench mark and second order bench mark. Studies showed that the elevation bench mark of observed point was nice, The cadastral triangulation point which was surveyed in indirect leveling by the measurement of vertical angle at the triangulation point was precision, however, we could realize it had error uniformly. The result of comparing and analysis with the elevation of observed point showed that calculating the realistic elevation with the elevation result of GPS observation, because of the difference of the height did not affect very much.

GIS - Engine의 설계 및 이를 이용한 위치검색시스템(TeleGIS)의 구현

조정관(Jung-gwan Cho),김부영(Bu-young Kim),옥준희(Joon-hee Ok),옥철영(Chul-young Ok) 한국정보과학회 1998 한국정보과학회 학술발표논문집 Vol.25 No.1B

본 논문에서는 지리정보의 관리, DB와의 연동, 그리고 Data Query를 처리하기 위한 GIS-Engine을 설계하고, 이 Engine을 이용하여 전화번호를 검색, 관리하는 TeleGIS를 구현한다. GIS-Engine은 Spatial Data를 관리하기 위해 Tiled Map 기법을 적용하였으며, Attribute Data는 ODBC를 사용하여 구현 가능하게 하였다. 또한 GIS-Engine과 Application과 실용적인 접근을 위하여 GIS-Engine을 DLL(Dynamic Linked Library)로 제공함으로써, Application 제작을 위한 편리한 환경을 제공한다. TeleGIS의 GIS-Engine의 기능을 이용하여 Vector 타입 지도의 Display와 전화번호를 이용하여 지도내의 특정 위치를 검색하는 기능을 구현한다.

심낭삼출환자의 심낭천자후 심전도에서 QRS 파 전위의 변화

조정관(Jeong Gwan Cho),박종수(Jong Soo Park),이명곤(Myung Kon Lee),안영근(Young Keun Ahn),박주형(Joo Hyung Park),정명호(Myung Ho Jeong),박종춘(Jong Chun Park),강정채(Jung Chaee Kang) 대한내과학회 1994 대한내과학회지 Vol.46 No.3

N/A Background: The ECG QRS voltage is determined mostly by ventricular mass and also by ventricular cavity size, distance from the chest wall to the electrical center of the heart, and electrical characteristics of the tissue between the skin and the heart. Low QRS voltage is observed in patients with significant pericardial effusion. However, the relationship between the QRS voltage and pericardial fluid amount has rarely been studied. The present study was performed to evaluate the possibility that pericardial fluid amount can be predicted by using the summed QRS voltage and to determine the factors influencing QRS voltage change after pericardial drainage. Methods: Twenty-nine patients with nontraumatic pericardial effusion of moderate amount or more were included in the study. Pericardial fluid amount was determined by measuring the actively drained pericardial effusion. The QRS voltage was measured from the peak of R wave to the nadir of q or s wave, whichever was deeper. Left ventricular volume, total ventricular volume, left ventricular mass, and distance from the chest wall to the center of the left ventricle (LV) were calculated from 2-D echo guided M-mode echocardiography of the ventricle. Results: Pericardial fluid amount was estimated by total QRS voltage of 12-lead ECG recorded before pericardiocentesis with the regression equation of Y=-50X+5950(r=-0.55, p<0.05). The change of QRS voltage after pericardial drainage was related with the left ventricular mass change (r=0.65, p<0.01) but not with the amount of drained pericardial fluid and the changes of the left ventricular volume and distance from the chest wall to the center of the LV. Conclusions: The surface ECG total QRS voltage can be used to estimate pericardial fluid amount. The most important determinant of the QRS voltage change after pericardia1 drainage is LV mass change, however, other factors remain to be determined.

헤파린 부착 관상동맥 스텐트의 스텐트 재협착 예방에 대한 효과

강정채(Jung Chaee Kang),박창수(Chang Soo Park),정명호(Myung Ho Jeong),조장현(Jang Hyun Cho),김성희(Sung Hee Kim),안영근(Young Keun Ahn),박주형(Joo Hyung Park),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),정상우(Sang Woo Juhng),김준 대한내과학회 1999 대한내과학회지 Vol.57 No.1

N/A The coronary stent reduces acute coronary arterial occlusion and late restenosis during and after coronary intervention. However, stent thrombosis and restenosis are still major limitations in widespread use of coronary stent. Local drug delivery with use of heparin-coated stent will be a new approach reducing the incidence of stent thrombosis and restenosis. In order to evaluate the effects of heparin-coated stent on stent restenosis, heparin-coated stents were compared with control stents in a porcine coronary stent restenosis model. Methods : Stent overdilation injury (stent:artery= 1.3:1.0) was performed with bare Wiktor (Group I, n=10) and heparin-coated Wiktor (Group II, n=20) stents (HEPAMEDTM, Medtronics, U.S.A.) in porcine coronary arteries. Follow-up quantitative coronary angiography (QCA) was performed at 4 weeks after stenting and histopathologic assessments of stented porcine coronary arteries were compared in both groups. Results : 1) On QCA, percent diameter stenosis was significantly higher in Group I than in Group II (16.3±6.62% vs. 9.6±5.06%, p<0.05). 2) Injury score of stented porcine coronary artery was not different in both groups (1.26±0.23 vs. 1.20±0.22). 3) Pathologic area stenosis of stented artery was higher in Group I than in Group II (41.6±12.5% vs. 27.1±9.9%, p<0.005). 4) Neointimal area was higher in Group I than in Group II (4.58±1.41 mm2 vs. 2.57±1.07 mm2, p<0.05). 5) By immunohistochemistry, proliferating cell nuclear antigen (PCNA) index was higher in Group I compared with in Group II (11.2±6.75% vs. 6.3±4.14%, p<0.05). Conclusions : Heparin-coated stent is effective in the prevention of late coronary stent restenosis in a porcine coronary stent restenosis model, which may be related with the inhibition of neointimal cell proliferation.

방실결절회귀성 빈맥의 성공적인 전극도자 절제의 예측인자

강정채(Jung Chaee Kang),정명호(Myung Ho Jeong),조장현(Jang Hyun Cho),김성희(Sung Hee Kim),안영근(Young Keun Ahn),박주형(Joo Hyung Park),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),이상현(Sang Hyun Lee),김준우(Jun Woo Kim) 대한내과학회 1999 대한내과학회지 Vol.57 No.5

N/A Catheter ablation of the AV nodal slow pathway using radiofrequency (RF) energy has been established as the first-line curative therapeutic modality of recurrent symptomatic AV nodal reentrant tachycardia (AVNRT). In contrast to catheter ablation of the AV bypass tract, there was no useful marker to localize succesful site of the pathway. This study was performed to determine predictors of successful catheter ablation of the AV nodal slow pathway in patients with AVNRT. Methods : Forty patients (18 men, 22 women; 47.9±13.3 years) with AVNRT undergoing successful catheter ablation of the AV nodal slow pathway were included in this study, in which 217 attempts were tried to ablate the AV nodal slow pathway. Characteristics of local atrial electrogram, anatomical site at each attempt, junctional rhythm during RF delivery were analyzed (40 successful, 177 failed). Maximum difference and duration of atrial electrograms were measured and local atrial electrograms were classified into 5 types (A1, A2, B1, B2 and C type) according to the type and the degree of fragmentation. Finally, the occurrence of junctional rhythm during RF discharge and its onset time were compared between successful and failed attempts. Results : There was no significant difference in the maximum difference of amplitude and duration of atrial electrograms between successful and failed attempts. The success rate in each type of atrial electrogram was significantly different. And, the success rate in non-C type atrial electrograms (A1, A2, B1, and B2) was significantly higher than that in type C atrial electrograms (25.0% vs 10.3%, p<0.01). No significant difference was noted in success rates according to attempted sites. Junctional rhythms during radiofrequency application occured significantly more frequent in successful attempts than in failed attempts (87.5% vs 47.5%, p<0.001). The time to onset of junctional rhythm was not different between successful and failed attempts (5.2±4.9 sec vs 6.1±5.5 sec). Conclusion : Fragmented local atrial electrogram and junctional rhythm during RF energy delivery may be used to predict successful catheter ablation of AVNRT. It is recommended that RF energy should be applied to the site where fragmented atrial electrogram is recorded and terminated if junctional rhythm does not develop within 15 seconds after starting RF energy delivery. (Korean. J. Med 57:867-874, 1999)

흉통환자에서 아최대 다단계 자전거 운동 부하 검사의 진단적 가치

박찬형(Chan Hyung Park),조정관(Jeong Gwan Cho),강정채(Jung Chaee Kang) 대한내과학회 1989 대한내과학회지 Vol.36 No.3

N/A Although exercise ECG has been accepted as the first choice of diagnostic procedures, documenting valuable indirect evidence of insufficient myocardial perfusion during exercise induced stress, its value in predicting the presence of coronary artery disease (CAD) in an individual patient has been questioned because of its low sensitivity and specificity. This limited value of the exercise test in predicting CAD is particularly real in the society with a low prevalence of CAD. The idea that the exercise test should be ordered and interpreted based on the results of pretest probability for CAD is gaining consensus. In order to study how accurately CAD can be predicted, we formulated the 5 predictor scoring system (5 PSS) which is modified from Goldman's scoring system and based on 5 parameters of the patients such as age, sex, nature of chest pain, serum cholesterol level and smoking habits. The scoring system was evaluated in 38 patents who had bicycle ergometer GXT and coronary arteriography at our Division of Cardiology. The following results were obtained: 1) In predicting CAD the sensitivity and specificity of the 5 PSS were 86% and 88% respectively and the positive and negative predictabilities were 90% and 83% each, while the sensitivity, specificity, positive predictability and negative predictability of bicycle GXT were 62%, 71%, 72% and 60% respectively. 2) By combining the results of the 5 PSS, the predictability of the bicycle ergometer GXT for CAD increased. The positive predictability of GXT for CAD increased from 72% to 100% when the 5 PSS scores were above 30 and the negative predictability of GXT for CAD increased from 60% to 91% when the scores were below 30. 3) Only 29% of the cases with positive bicycle ergometer GXT had CAD when the 5 PSS scores were below 30; while 78% of the cases with negative bicycle GXT had CAD when the scores were above 30. These results suggested that in predicting CAD, the pretest probability derived from clinical parameters using the 5 PSS can be very helpful in rational evaluations of the bicycle ergometer GXT.

긴 스텐트는 관상동맥 스텐트 재협착의 유일한 예측 인자

정명호(Myung Ho Jeong),조정관(Jeong Gwan Cho),강정채(Jung Chaee Kang),이승현(Seung Hyun Lee),홍영준(Young Joon Hong),박옥영(Ok Young Park),정우곤(Woo Kon Jung),이상록(Sang Rok Lee),김원(Woen Kim),김계훈(Kye Hun Kim),강경태(Kyung Tae 대한내과학회 2001 대한내과학회지 Vol.60 No.6

N/A Background : Coronary stenting is one of the most effective methods of percutaneous coronary interventions (PCI) in the treatment of intimal dissection and prevention of restenosis after balloon angioplasty. However, coronary stent restenosis still remains a major clinical limitation. Methods : Three hundreds seventy three patients who underwent coronary stent implantations and follow-up coronary aniograms at Chonnam National University Hospital between June 1996 and December 1999, were divided into two groups: 123 patients with restenosis (Group A: 98 male, 25 female, 58.5±9.4 year-old) and 240 patients without restenosis (Group B: 193 male, 47 female). Results : The prevalence of clinical diagnosis and risk factors for the atherosclerosis were not different between two groups. The indications for stenting and stent types, reference vessel diameter and minimal luminal diameter before stenting were not different. However, stent length was 23.4±7.57 mm in Group A and 20.8±6.58 mm in Group B, which were longer in Group A than in Group B (p=001). By multiple logistic regression analysis for the independent predictive factors for stent restenosis, the long stent more than 25mm in length was the only significant predictive factor after correction according to age, sex, risk factor, lipid profiles (OR=2.590, 95% C.I.=1.40-4.78). Conclusion : The long coronary stent more than 25 mm in length is a predictive factor of restenosis after coronary stenting.(Korean J Med 60:529-536, 2001)

운동부하 검사상 무증상 심근 허혈 환자의 관동맥 병변 소견

조인종(In Jong Cho),서정평(Jung Pyung Suh),류문희(Moon Hee Rheu),이명곤(Myung Kon Lee),박종수(Jong Soo Park),박주형(Joo Hyung Park),정명호(Myung Ho Jeong),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),강정채(Jung Chaee Kang) 대한내과학회 1994 대한내과학회지 Vol.47 No.5

N/A Objectives: Silent myocardial ischemia is defined as the presence of transient ischemic alterations in absence of angina or its equivalents. In recent reports, silent ischemia comprises about 60-80% of total ischemic events in patients with symptomatic angina and its prognosis is similar to typical painful angina, So, we studied to compare the difference of coronary angiographic features between painful angina and silent angina in patients with positive treadmill exercise test. Method: We studied retrospectively coronary angiographic features of 34 patients; 20 patients with painful treadmill exercise test were grouped in A and 14 patients without pain were grouped in B. Both groups were positive in Thallium corynary perfusion scan. Results: 1) There were no significant differences in sex, age, smoking and hypertension between group A and B but diabetes were more prevalent in group A than in B(p< 0,05) 2) Total exercise duration, ST segment deviation and rate pressure product were not different between two groups in treadmill exercise test. Although treadmill score was significantly low in group A (p<0.05), there was no singificant difference between two groups in case of subtracting treadmill angina index from treadmill score. 3) In dipyridamole Tl scan, defect volume ratio was not different in two groups although defect index was significantly greater in group A(p<0.05). 4) In coronary angiographic findings, there were no sigificant differences in number of stenosed vessels, left ventricular ejection fraction and left ventricular end diastolic pressure, but right coronary artery lesion is more common in group A than group B(p<0,05). 5) The most common clinical diagnosis of studied subject was unstable angina, But there were no statistically difference between two groups. Conclusion: This results suggest that patient with silent myocardial ischemia has similar coronary artery disease to those with painful myocardial ischemia, Early detection and treatment of silent ischemia is essential in the management of ischemic teart disease.

관상동맥 중재술을 시행 받은 40세 이하의 ST 분절 상승과

박종춘 ( Jong Chun Park ),조정관 ( Jeong Gwan Cho ),김주한 ( Ju Han Kim ),홍영준 ( Young Joon Hong ),안영근 ( Youngkeun Ahn ),강정채 ( Jung Chaee Kang ),김남윤 ( Nam Yoon Kim ),박인혜 ( In Hyae Park ),정명호 ( Myung Ho Jeong ) 대한내과학회 2012 대한내과학회지 Vol.82 No.2

Background/Aims: The prevalence of coronary artery disease has increased in young adults. We evaluated the differences in clinical characteristics and clinical outcomes in young patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). Methods: A total of 164 patients with acute myocardial infarction who underwent percutaneous coronary intervention were divided into two groups: the STEMI group (120 patients; mean age, 35.7±3.8 years; 118 males) and the NSTEMII group (44 patients; mean age, 35.7±4.3 years; 43 males). We analyzed clinical and angiographic characteristics and major adverse cardiac events (MACE), including death from any cause, non-fatal myocardial infarction, target lesion revascularization, and coronary artery bypass graft surgery, during a 1-year clinical follow-up of the two groups. Results: During hospitalization, Killip class II acute myocardial infarction (5.8% vs. 15.9%, p=0.041) was observed more frequently in the NSTEMI group. The levels of troponin-I (66.9±103.6 vs. 26.6±38.5 ng/mL, p=0.014) and N-terminal pro-brain natriuretic peptide (733.0±1,018.1 vs. 476.2±374.5 pg/mL, p=0.012) were significantly higher in the STEMI group. One-year MACE did not differ between the two groups. By multiple logistic regression analysis, bare metal stents (odds ratio, 3.360; 95% confidence interval, 1.105-10.217; p=0.033) and high lipoprotein (a) levels (odds ratio, 1.047; 95% confidence interval, 1.020-1.075; p=0.001) were independent predictors of 1-year MACE. Conclusions: Young patients with STEMI and NSTEMI have similar clinical outcomes. Bare metal stents and high serum lipoprotein (a) levels are independent predictors of MACE during 1-year clinical follow-ups in young patients with acute myocardial infarction. (Korean J Med 2012;82:175-184)