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증례 : 순환기 ; 심장 외 인공도관 폰탄 순환을 가진 환자의 인공 심박동기 삽입 증례
전경현 ( Kyeong Hyeon Chun ),엄재선 ( Jae Sun Uhm ),이상은 ( Sang Eun Lee ),서지원 ( Jiwon Seo ),양필성 ( Pil Sung Yang ),최정호 ( Jung Ho Choi ),김남균 ( Nam Kyun Kim ) 대한내과학회 2015 대한내과학회지 Vol.88 No.3
심장 외 인공도관 폰탄 술식을 시행한 선천성 심장병 환자에서 도관 천자를 통하여 정맥을 통한 인공 심박동기 삽입을 한 증례는 아직 보고된 바가 없다. 결론적으로 본 증례와 같이 심장 외 인공도관 폰탄 수술을 시행 받은 환자에서도 안전하고 효과적으로 정맥을 통해 인공 심박동기를 삽입하는 것이 가능하리라 생각된다. As the survival rate of patients with complex congenital heart disease has improved and the number of adult patients with congenital heart disease has risen, arrhythmias and heart failure have become important issues in these patients. Cardiac implantable electronic devices, including pacemakers, are also on the rise. Transvenous implantation or epicardial pacemaker implantation is challenging in patients with complex congenital heart disease. Here we report a case in which a dual-chamber pacing, dual-chamber sensing, dual response and rate-adaptive (DDDR) pacemaker was implanted transvenously into a patient with congenital heart disease. A 34-year-old male with extracardiac conduit Fontan circulation complained of dizziness; an electrocardiogram revealed junctional bradycardia. We performed transvenous implantation of a DDDR pacemaker via trans-conduit puncture. In conclusion, transvenous implantation of a pacemaker is feasible in patients with extracardiac conduit Fontan circulation. (Korean J Med 2015;88:299-302)
심방세동과 말기 콩팥병이 동반된 환자에서 와파린과 항혈소판 요법의 안전성과 효과 비교
한동희 ( Donghee Han ),엄재선 ( Jae-sun Uhm ),박정탁 ( Jung Tak Park ),김태훈 ( Tae-hoon Kim ),정보영 ( Boyoung Joung ),유태현 ( Tae-hyun Yoo ),박희남 ( Hui-nam Pak ),강신욱 ( Shin-wook Kang ),이문형 ( Moon-hyoung Lee ) 대한내과학회 2019 대한내과학회지 Vol.94 No.2
목적: 심방세동과 말기 콩팥병이 동반된 환자에서 항응고제의 치료는 아직 명확히 정립되지 않았다. 본 연구에서는 이러한 환자에서 와파린과 항혈전제의 효과 및 안정성을 비교해 보았다. 방법: 본 연구에서는 2004년 1월부터 2014년 7월까지 단일기관에서 심방세동과 말기 콩팥병을 진단받은 총 256명의 환자 중 와파린(n = 53)이나 항혈전제(n = 105)를 투여받는 CHA<sub>2</sub>DS<sub>2</sub>-VASc 점수 1점 이상의 158명(나이, 63.7 ± 12.2세; 남성, n = 103)이 본 연구에 포함되었다. 결과: 총 추적 조사 기간 동안(31.0 ± 29.4개월), 10건의 혈전색전 사건과 29건의 주요 출혈 사건이 발생하였다. 혈전색전 사건의 발생은 와파린군과 항혈전제군 사이에 유의한 차이를 보이지 않았다(1.9%와 8.6%, p = 0.166). 주요 출혈 사건의 발생은 항혈전제군보다 와파린군에서 유의하게 높은 발생률을 보였다(32.1%와 11.4%, p = 0.002). 와파린의 사용은 주요 출혈 사건 발생을 증가시키는 주요한 위험인자였으나(HR, 3.44; 95% CI, 1.60-7.36; p = 0.001) 혈전색전 사건의 발생의 감소와는 통계적으로 유의한 관계를 보이지 않았다(HR, 0.34; 95% CI, 0.04-2.70; p = 0.306). 결론: 심방세동과 말기 콩팥병을 동반한 환자에서 와파린의 사용은 항혈전제와 비교하였을 때 출혈 사건의 위험을 증가시킨다. 결론: 심방세동과 말기 콩팥병을 동반한 환자에서 와파린의 사용은 항혈전제와 비교하였을 때 출혈 사건의 위험을 증가시킨다. Background/Aims: The optimal strategy for anticoagulation treatment in patients with atrial fibrillation (AF) and end-stage renal disease (ESRD) has not been established. We evaluated the efficacy and bleeding risk of warfarin and antiplatelet agents in patients with AF and ESRD. Methods: We retrospectively reviewed the medical records of 256 patients with AF and ESRD and included 158 patients (age, 63.7 ± 12.2 years; male sex, n = 103) with a CHA<sub>2</sub>DS<sub>2</sub>-VASc score ≥ 1 who were taking warfarin (n = 53) or an antiplatelet agent (n = 105). Results: During the follow-up period (31.0 ± 29.4 months), 10 ischemic events and 29 major bleeding events occurred. The thromboembolic event rate did not significantly differ between the warfarin and antiplatelet groups (1.9% and 8.6%, respectively; p = 0.166). However, the rate of major bleeding events was significantly higher in the warfarin group than it was in the antiplatelet group (32.1% and 11.4%, respectively; p = 0.002). Cox’s regression analysis indicated that warfarin was related to an increased risk of major bleeding events (hazard ratio [HR], 3.44; 95% confidence interval [CI], 1.60-7.36; p = 0.001). Conversely, warfarin was not related to a decreased risk of thromboembolic events (HR, 0.34; 95% CI, 0.04-2.70; p = 0.306). Conclusions: In patients with AF and ESRD, warfarin use was associated with an increased risk of bleeding events, compared with antiplatelet agents. (Korean J Med 2019;94:191-199)
박제욱 ( Je-wook Park ),엄재선 ( Jae-sun Uhm ),김동준 ( Dong-jun Kim ),박동혁 ( Dong Hyuk Park ),김규 ( Kyu Kim ),조현수 ( Hyun Soo Cho ),장혁재 ( Hyuk-jae Chang ) 대한내과학회 2016 대한내과학회지 Vol.90 No.6
폐고혈압은 흔하지 않으나 치명적인 질환으로 적합한 원인을 찾아 교정하는 것이 중요하다. 이에 저자들은 동기능부전 및 동정지로 인한 좌심실 질환으로 폐고혈압의 발생을 심도자술로 증명하였고, 동기능부전 및 동정지를 치료함으로써 폐고혈압의 호전을 보인 1예가 있어 보고하는 바이다. A 60-year-old man visited the hospital after experiencing dyspnea after exertion for 2 weeks. An electrocardiogram showed sinus arrest with junctional escape rhythm at 40 beats/min. Transthoracic echocardiography showed that the right ventricular systolic pressure (RVSP) was approximately 71 mmHg and that the left ventricular ejection fraction was preserved. The ratio of peak early diastolic transmitral inflow velocity to early diastolic peak mitral annular velocity (E/E’) was 29. Cardiac catheterization revealed a systolic pulmonary artery pressure (SPAP) of 63 mmHg, a mean pulmonary artery pressure of 27 mmHg, and a pulmonary capillary wedge pressure of 22 mmHg with a rhythm of 40 beats/min. The patient was diagnosed with pulmonary hypertension (group 2) due to sick sinus syndrome. SPAP decreased to 48 mmHg during atrial pacing at 60 beats/min. After permanent pacemaker insertion, RVSP decreased from 71 mmHg to 44 mmHg. In this case, passive group 2 pulmonary hypertension occurred due to sick sinus syndrome. (Korean J Med 2016;90:528-532)
전기 기계 심장 모델을 이용한 심장 재 동기화 요법의 환자별 시뮬레이션
박민철(Min-Cheol Park),정의철(EuiCheol Jung),임철현(Chul Hyun Lim),최다솜(Da Som Choi),심은보(Eun Bo Shim),엄재선(Jae Sun Uhm) 대한기계학회 2019 대한기계학회 춘추학술대회 Vol.2019 No.11
Cardiac resynchronization therapy (CRT) is one of the treatment techniques to prevent cardiac arrest due to abnormal QRS waveform. The purpose of this study is to examine the new technological direction of ventricular resynchronization therapy, to establish a virtual surgical environment through future simulations, and to predict the function and state of the heart according to the shape of the heart after ventricular resynchronization therapy using computer simulation. In order to predict this, we developed an integrated cardiac model that takes into account the cellto-organ unit and will study the electrical conduction and contraction dynamics of patient-specific ventricular model. As a result, the data derived from the electrical conduction model of the patient and the contraction model obtained from the contraction, diastolic blood pressure and ejection fraction were compared and analyzed through three results. We propose a simulation technique that can predict the ventricular condition of patients after the actual procedure.
2018 대한부정맥학회 심방세동 환자의 통합적 관리 지침
박준범 ( Junbeom Park ),정보영 ( Boyoung Joung ),김준 ( Jun Kim ),김진배 ( Jin-bae Kim ),박형욱 ( Hyung Wook Park ),박예민 ( Yae Min Park ),엄재선 ( Jae-sun Uhm ),안진희 ( Jinhee Ahn ),이대인 ( Dae In Lee ),김준수 ( June Soo Kim 대한내과학회 2018 대한내과학회지 Vol.93 No.4
Atrial fibrillation (AF) is the most common form of sustained arrhythmia in elderly patients. However, AF is often detected during health screening, or accidentally during testing for other diseases; some patients lack clinical symptoms. Nevertheless, AF increases the incidence of ischemic stroke and other thrombotic events, and compromises cardiovascular prognosis in terms of heart failure, dementia, and hospitalization. Therefore, initial AF management should be performed at the point of primary care, not only in specialized medical centers. We wish to propose a five-step management protocol for AF. We review the evidence supporting integrated management by primary care physicians new to AF, and by specialized physicians who often diagnose and manage AF. Further, we also outline a structured goal-based follow-up protocol; this is an important part of integrated management. (Korean J Med 2018;93:336-343)
Uhm, Jae-Sun,Oh, Byoung-Sun,Lee, Seung-Hwan,Kim, Sang-Il,Kim, Yang-Ree,Park, Yeon-Joon,Kang, Moon-Won 대한감염학회 2005 감염과 화학요법 Vol.37 No.2
Non-O1, non-O139 Vibrio cholerae usually causes gastroenteritis and bacteremia. It can also cause skin and soft tissue infection but the incidence is very rare. Patients who have been reported to have skin and soft tissue infection caused by non-O1, non-O139 V. cholerae had liver cirrhosis or chronic hepatitis. We present here a case of skin and soft tissue infection caused by non-O1, non- O139 V. cholerae in a patient with liver cirrhosis in Korea. After treatment of cefotaxime, doxycycline and debridement, the wound was clinically improved. This case suggests that non-O1, non-O139 V. cholerae infection should also be considered in addition to V. vulnificus infection when skin and soft tissue infections occurs in patients with liver cirrhosis, especially if they have had seawater or seafood exposure. Non-Ol, non-O139 Vibrio choleras는 위장관염 또는 균혈증을 발생시키고, 매우 드물게 피부 및 연부조직 감염을 일으킨다. Non-Ol, non-0139 V. cholerae에 의한 피부 및 연부조직 감염 환자는 대부분 간경변증 또는 만성 간염을 가지고 있는 것으로 보고되고 있다. 저자들은 간견병증 환자에서 해산물을 섭취한 후 발생한 non-Ol, non-O139 V. cholerae에 의한 피부 및 연부조직 감염의 증례를 보고하는 바이다. 환자의 경우 cefotaxime, doxycycline 등 항생제 투여와 괴사조직 제거술 후 회복되었다. 따라서 간경변증 환자에서 해산물 또는 바닷물에 노출된 후 발생한 피부 및 연부조직 감염의 경우 V. vulnificus에 의한 감염뿐만 아니라 non-Ol, non-O139 V. cholerae에 의한 감염도 고려해야 한다.