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증례 : 순환기 ; 영구적 심장 박동 조율기 이식 후의 재발성 리드(lead) 파손(fracture)과 완전 이탈 1예
노승영 ( Seung Eung Roh ),박희남 ( Hui Nam Park ),김지박 ( Ji Bak Kim ),문재영 ( Jae Young Moon ),이광노 ( Kwnag No Lee ),김영훈 ( Young Hoon Kim ) 대한내과학회 2010 대한내과학회지 Vol.78 No.6
우리는 완전 방실 차단 환자에서 반복적으로 발생한 유도절단과 이탈을 확인하였으며, 그 이유로 환자가 버스 운전을 하면서 과도하게 팔을 움직인 것과 삽입시 접근 방법을 생각해 볼 수 있었다. 새로운 유도를 겨드랑이 정맥 접근법으로 삽입하고 직업을 교체함으로써 문제는 해결되었다. With the increased use of implantable cardiac devices, the incidence of hardware problems has also increased. Some of the hardware problems might be induced by patient factors. We experienced recurrent pacemaker lead fracture and dislocation after permanent pacemaker implantation. The patient was a bus driver who used his left arm vigorously when he turned the steering wheel. After a new lead was inserted via an axillary vein approach and the patient changed his occupation, no more lead problems have occurred. When a recurrent hardware problem with an implantable pacemaker or defibrillator occurs, patient factors related to anatomy or behavior must be considered. (Korean J Med 78:747-750, 2010)
나승운,박지영,최병걸,최세연,최재웅,류성기,이세진,김승환,노영균,Raghavender Goud Akkala,Hu Li,Jabar Ali,김지박,이선기,나진오,최철웅,임홍의,김진원,김응주,박창규,서홍석,오동주 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.1
Purpose: Angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) are associated with a decreasedincidence of new-onset diabetes mellitus (NODM). The aim of this study was to compare the protective effect of ACEIversus ARBs on NODM in an Asian population. Materials and Methods: We investigated a total of 2817 patients who did not have diabetes mellitus from January 2004 to September2009. To adjust for potential confounders, a propensity score matched (PSM) analysis was performed using a logistic regressionmodel. The primary end-point was the cumulative incidence of NODM, which was defined as having a fasting bloodglucose ≥126 mg/dL or HbA1c ≥6.5%. Multivariable cox-regression analysis was performed to determine the impact of ACEI versusARB on the incidence of NODM. Results: Mean follow-up duration was 1839±1019 days in all groups before baseline adjustment and 1864±1034 days in the PSMgroup. After PSM (C-statistics=0.731), a total 1024 patients (ACEI group, n=512 and ARB group, n=512) were enrolled for analysisand baseline characteristics were well balanced. After PSM, the cumulative incidence of NODM at 3 years was lower in the ACEIgroup than the ARB group (2.1% vs. 5.0%, p=0.012). In multivariate analysis, ACEI vs. ARB was an independent predictor of thelower incidence for NODM (odd ratio 0.37, confidence interval 0.17–0.79, p=0.010). Conclusion: In the present study, compared with ARB, chronic ACEI administration appeared to be associated with a lower incidenceof NODM in a series of Asian cardiovascular patients.