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World Wide Web 을 이용한 순환기내과 교육시스템의 개발
조명찬(Myeong Chan Cho),남기병(Gi Byoung Nam),이진형(Jin Hyung Lee),이상훈(Sang Hoon Lee),김동운(Dong Woon Kim) 대한내과학회 1998 대한내과학회지 Vol.55 No.6
N/A Objectives: Few disciplince in medicine encompasses such wide diagnostic and treatment modalities as cardiology. A traditional text and education system is limited in its efficacy to convey such variety. In order to address this problem, a comprehensive computer-aided education system that compiles and links the current knowledge of cardiovascular diseases is proposed. An availability of such system through CD-ROM and world wide web will contribute undoubtedly to the promotion and betterment of current understandings of cardiology all over the world. Methods and Results: 1) The information about the cardiovascular diseases has been complied and organized. Mu1timedia medical information includes text, audio features that allow the users to study actual sounds, and visual aids(slides, real-time demonstration, and schematic illustrations). 2) Cardiology education system can be approached according to Disease module or Laboratory test module. One can readily look up the disease of interest and see the results of different tests, Or one can choose the laboratory test or physical examination and study the differences among the diseases. Self test module is also available to help user's self assessment of his/her understanding of cardiovascular diseases. 3) This cardiology education pnm is conveniently stored in CD-ROM and can also be accessible through the world wide web(http://med.chungbuk,ac,kr/-mccho/ web-cardiology/alogo.html). Conclusion: A multimedia approach for the study of cardiovascular diseases has been developed and is now avaliable in CD-ROM The same information can be obtained from our home page through the world wide web.
홍윤기 ( Yoon Ki Hong ),남기병 ( Gi Byoung Nam ),최기준 ( Kee Joon Choi ),박경민 ( Kyoung Min Park ),김정욱 ( Jong Wook Kim ),김형용 ( Hyung Yong Kim ),김유호 ( You Ho Kim ) 대한내과학회 2008 대한내과학회지 Vol.74 No.1
목적: 본 연구는 우리나라에서 제세동기를 삽입한 환자들의 임상적 특징을 알아보고자 하였다. 방법: 서울아산병원에서 1996년부터 2005년 까지 제세동기를 삽입한 135명의 환자들을 대상으로 후향적으로 분석하였다. 결과: 제세동기를 삽입하게 된 환자들의 3가지 주요 기저 질환은 심근 경색 후 심실성 빈맥, 브루가다 증후군, 비후성 심근증이었고, 이 중 브루가다 증후군이 상대적으로 많은 것은 서구와 다른 특징이다. 제세동기 삽입 후 적절한 전기 충격이 43명(31.9%)에서 발생하였으며, 부적절한 전기 충격도 39명(28.9%)에서 발생하였다. 결론: 제세동기는 급성 심장사의 고위험군 환자에서 치명적인 심실성 부정맥으로 인한 사망을 감소시키는데 중요한 역할을 할 것으로 생각된다. 하지만 상당수의 환자에서 부적절한 전기충격이나 제세동기의 감지오류 등의 문제가 발생하였고, 이는 적절한 항부정맥제의 사용이나 제세동기 감지 설정의 최적화 등을 통하여 최소화할 필요성이 있음을 시사한다. Background/Aims: The purpose of this study was to analyze the clinical features of the patients who underwent implantable cardioverter- defibrillator (ICD) treatment. Methods: The clinical features and the test data of the intracardiac electrograms for the patients who underwent ICD implantation between 1996 and 2005 at Asan Medical Center were retrospectively analyzed. Results: One hundred thirty five patients (109 males and 26 females, a mean age of 54±13 years) were included in this study. The underlying cardiovascular diseases were post-myocardial infarction (MI) ventricular tachycardia (VT), Brugada syndrome, hypertrophic cardiomyopathy (CM) and dilated CM. During a mean of 2.9±2.0 years of follow-up, appropriate shocks were delivered in 43 (31.9%) and inappropriate shocks were delivered in 39 (28.9%) patients. Anti-tachycardia pacing therapy was effective in 17 patients. Inappropriate shocks were caused by atrial fibrillation with rapid ventricular responses, T wave oversensing or electromagnetic interference. Major complications of ICD therapy during follow-up included ICD infection, lead problems, electromagnetic interference and generator malfunction. Conclusions: The three major cardiovascular diseases in patients with ICD implantation were post-MI VT, Brugada syndrome and hypertrophic CM. Inappropriate shocks were delivered to a significant proportion of the patients, which emphasize the need for an aggressive rate control strategy in patients with atrial fibrillation. Most complications of ICD therapy were caused by device malfunction. (Korean J Med 74:68-74, 2008)
고혈압 임부에서 24 시간 활동 중 혈압 측정의 임상적 유용성
전현정(Hyeon Jeong Jeon),고병성(Byeong Seong Ko),곽남주(Nam Ju Kawk),김도형(Do Hyeong Kim),배장환(Jang Hwan Bae),김동운(Dong Woon Kim),남기병(Gi Byoung Nam),조명찬(Myeong Chan Cho),정은환(Eun Hawn Jeong) 대한내과학회 1998 대한내과학회지 Vol.55 No.1
N/A Objectives: In the third trimester hypertensive pregnancies, we would like to evaluate effects of white coat hypertension, severity of hypertension and diurnal variation of blood pressure on the fetal outcome by using 24-hour ambulatory blood pressure monitoring. Methods: Hypertensives(n=50) and normotensives (n=14) in the third trimester of the pregnancy underwent 24-hour ambulatory blood pressure monitoring. We excluded hypertensives(n=5) who became pre-eclampsia patients. Hypertensives(n=45) were classified as white coat hypertensives(n=14, mean ambulatory blood pressure <139/87mmHg) and sustained hyprtensives(n=31). Sustained hypertensives(n=31) were divided as moderate to severe hypertensives(n=5, systolic blood pressure ≥160 mmHg or diastolic blood pressure ≥100mmHg ) and mild hypertensives(n=26). Sustained hypertensives were also divided into two grwps which had diurnal variation of blood pressure or not. To exclude effects of hypertension severity, effects of diurnal variation wane evaluated in hypertensives with similar mean arterial blood pressure. Gestational age, body weight, body weight for gestational age were used as parametars of the fetal outcome. Results : 1) The prevalence of white coat hypertension was 28%(14/50). 2) There were no significant differences in the fetal outcome between normotensives(n=14) and white coat hypertensives(n=14). 3) Body weight of fetus and body weight for gestational age in moderate to severe hypertensives(n=5) were less than those of mild hypertensives(n=26), but gestational age was not significantly different between two groups. 4) Body weight of fetus and body weight for gestational age in sustained hypertensives without diurnal variation(n=10) were less than those with diurnal variation(n=8), but gestational age was not significantly different between two groups. 5) All hypertensives who became pre-eclampsia (n=5) were severe hypertensives and had no diurnal variation of blood pressure. Conclusion: White coat hypertension in the third trimester was quite often and did not affect on the fetal outcome. The more severe hypertension and/or absence of diurnal variation of blood sure caused poor fetal outcome. Patients who became pre-eclampsia were severe hypertensives and had no diurnal variation of blood pressure. Ambulatory blood pressure monitoring may have several roles in the antenatal management of hypertenison.
Thallium - 201 심근 단층영상의 정량적 분석
이명철(Myung Chul Lee),정준기(June Key Chung),안규리(Cu Rie Ahn),이동수(Dong Soo Lee),김상은(Sang Eun Kim),최창운(Chang Woon Choi),고창순,이영우,서정돈,박영배,최윤식,이명묵(Myoung Mook Lee),남기병(Gi Byoung Nam),최기준(Kee Joon Choi),손대원(Dae 대한핵의학회 1991 핵의학 분자영상 Vol.25 No.2
N/A The purpose of this study was to assess the ability of quantitative Tl-201 tomography to identify and localize coronary artery disease (CAD). The study population consisted of 4l. patients (31 males, 10 females; mean age 55 +- 7 yr) including 14 with prior myocardial infarction who underwent both exercise Tl-201 myocardium SPECT and coronary angiography for the evaluation of chest pain. From the short axis and vertical long axis tomograms, stress extent polar maps were generated by Cedars-Sinai Medical Center prograrn, and the 9 stress defect extent (SDE) was quantified for each coronary artery territory. For the purpose of this study, the coronary circulation was divided into 6 arterial segments, and the myocardial ischemic score (MIS) was calculated from the coronary angiogram. Sensitivity for the detection of CAD (>50% coronary stenosis by angiography) by stress eXtent polar map was 95% in single vessel disease, and 100% in double and triple vessel deseases. Overall sensitivity was 97%<. Sensitivity and specificity for the detection of individual diseased vessels werc, respectively, 87% and 90% for the left anterior descending artery (LAD), 36% and 93% for the left circumflex artery (LCX), and 71% and 70%, for the right coronary artery (RCA). Concordance for the detection of individual diseased vessels between the coronary angiography and stress polar map was fair for the LAD (kappa=0.70), and RCA (kappa=0.41) lesions, whereas it was poor for the LCK lesions (kappa =0.32) There were siginificant correlations between the MIS and SDE in LAD (rs=0. 56, p=0.0027), and RCA territory (rs=0.60, p=0.0094). No significant correlation was found in LCX territory. When total vascular territories were combined, there was a significant correlation between the MIS and SDE (rs=0.42, p=0,0116). In conclusion, the quantitative analysis of TI-201 tomograms appears to be accurate for determining the presence and location of CAD.