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인공 심박조율기의 기능 이상에 의해 유발된 Torsade de Pointes
최종호,권오경,조수형,이재민,주진덕 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.1
Anesthesiologists are faced with a growing number of patients in need of cardiac pacing with symptoms of increasing complexity. Because intraoperative pacemaker malfunction can lead to sudden death, it is important for the anesthesiologists to possessthe information necessary to evaluate and treat such patients. On the other hand, torsade de pointes, a particular form of life-threatening polymorphic ventricular tachycardia, is known to be elicited in patients with cardiac pacemakers in the setting of abnormally long QT intervals, decreased heart rate and severe electrolyte disturbances, notably hypokalemia. We herein report a case of intraoperative torsade de pointes that was triggered by pacemaker malfunction-induced bradycardia in a patient with a VVI-type cardiac pacemaker, whose serum potassium and magnesium level were low preoperatively. (Korean J Anesthesiol 1999; 37: 164∼167)
간이식 환자의 비계획성 발관에 대한 재삽관의 임상적 고찰
최종호,김은성,이재민,배만석,주진덕 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.3
Background : Unplanned extubation is a common occurrence in mechanically ventilated patients even in spite of careful attention. It is important to decide on reintubation or the retention of the extubated state especially in the critically ill patients. We tried to formulate general guideline for evaluation and safe management in unplanned extubated liver transplant patients with high risk of multiple organ failure and high mortality rate. Methods : We reviewed all medical records of 5 unplanned extubated cases from 27 liver transplantation cases. We checked delayed extubation criteria which included United Network Organ Sharing (UNOS) class 1 or 2, preoperative Na (below 130 mEq) and albumin (below 3.0) level, transfusion amount in operating room, severity of postreperfusion syndrome (PRS) and need of vasopressor agents in the 5 unplanned extubated cases. We also checked direct intubation determining factors such as PaO2/FiO2 ratio, respiration rate and pattern, mental state and mode of ventilation. Finally, we reviewed additional factors influencing reintubation. Results : We found a rate of 18 percent of unplanned extubation (5 of 27 events), and 80 percent of reintubation incidence (4 of 5 events). Conclusions : It is rational to reintubate immediately in unplanned extubated cases which meet 3 or more delayed extubation criteria. The direct reintubation determining factors are PaO2/FiO2 ratio (below 300) and the presence of paradoxical respiration with a high respiration rate (over 28/minute). (Korean J Anesthesiol 1999; 37: 393∼397)
Screening for Prediabetes Using Machine Learning Models
Choi, Soo Beom,Kim, Won Jae,Yoo, Tae Keun,Park, Jee Soo,Chung, Jai Won,Lee, Yong-ho,Kang, Eun Seok,Kim, Deok Won Hindawi Publishing Corporation 2014 Computational and mathematical methods in medicine Vol.2014 No.-
<P>The global prevalence of diabetes is rapidly increasing. Studies support the necessity of screening and interventions for prediabetes, which could result in serious complications and diabetes. This study aimed at developing an intelligence-based screening model for prediabetes. Data from the Korean National Health and Nutrition Examination Survey (KNHANES) were used, excluding subjects with diabetes. The KNHANES 2010 data (<I>n</I> = 4685) were used for training and internal validation, while data from KNHANES 2011 (<I>n</I> = 4566) were used for external validation. We developed two models to screen for prediabetes using an artificial neural network (ANN) and support vector machine (SVM) and performed a systematic evaluation of the models using internal and external validation. We compared the performance of our models with that of a screening score model based on logistic regression analysis for prediabetes that had been developed previously. The SVM model showed the areas under the curve of 0.731 in the external datasets, which is higher than those of the ANN model (0.729) and the screening score model (0.712), respectively. The prescreening methods developed in this study performed better than the screening score model that had been developed previously and may be more effective method for prediabetes screening.</P>
WCDMA 휴대전화 전자파가 인공심장 박동기 및 이식형 제세동기에 미치는 영향
정재원(Jai Won Chung),최수범(Soo Beom Choi),박지수(Jee Soo Park),김덕원(Deok Won Kim) 대한전자공학회 2015 전자공학회논문지 Vol.52 No.1
제 2세대 (2G) 휴대전화인 GSM (global system for mobile communication) 휴대전화는 pacemaker 및 ICD (implantable cardioverter defibrillator)의 기능에 영향을 미칠 수 있다고 보고가 되어 왔다. 이에 본 연구에서는 제 3세대 (3G) 휴대전화인 WCDMA (wideband code division multiple access) 휴대전화에서 방출되는 전자파가 pacemaker 및 ICD에 미치는 영향에 대해 알아보았다. 총 5개의 pacemaker 및 3개의 ICD를 대상으로 ECG simulator를 이용한 in-vitro 실험으로 진행하였다. 실제 WCDMA 휴대전화 대신 WCDMA 모듈 (평균 출력 : 0.25 W, 주파수 대역 : 1950 MHz)을 사용했다. WCDMA 모듈 전자파가 pacemaker 및 ICD에 미치는 영향을 평가하기 위해, 각 이식형 의료기기들을 WCDMA 모듈에 최대한 근접 (3 mm 이내) 시킨 후 5분간 전자파에 노출 시켰다. 실험 결과 WCDMA 모듈 전자파가 5개의 pacemaker 및 3개의 ICD에 미친 어떠한 영향도 관찰 할 수 없었다. WCDMA 휴대전화는 GSM 휴대전화보다 더 높은 주파수 대역 (1800-2200 MHz)에서 더 낮은 출력(0.01-0.25 W)을 방출하기 때문에, WCDMA 휴대전화에서 발생하는 전자파는 pacemaker 및 ICD 기기들에게 영향을 미치지 않을 것으로 사료된다. Reports show that global system for mobile communication (GSM) mobile phones, or two-generation (2G) mobile phones, could affect functions of pacemakers and implantable cardioverter defibrillators (ICDs). In this study, we evaluated the effects of radio frequency electromagnetic fields (RF-EMFs) emitted by wideband code division multiple access (WCDMA) mobile phones, which were third-generation (3G) mobile phones, on pacemakers and ICDs. Five pacemakers and three ICDs were subjected to in-vitro test using a ECG simulator. We used a WCDMA module (average power : 0.25 W, frequency band : 1950 MHz) instead of a real WCDMA mobile phone. To assess the effects of the WCDMA module on pacemakers and ICDs, each implantable device was placed in close proximity (within 3 mm) to the WCDMA module for 5 min. As a result, no effects were observed on the five pacemakers and three ICDs for the RF-EMFs emitted by the WCDMA module. Because WCDMA mobile phones have the higher frequency band (1800-2200 MHz) and lower power output (0.01-0.25 W) than GSM moboile phone, the RF-EMFs emitted by WCDMA mobile phones do not affect patients with pacemaker or ICD.