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.

방실결절 이중전도로의 빈도 및 방실결절 회귀성 빈맥의 유발 여부에 따른 전기생리학적 특성의 차이

길광채(Gwang Chae Gill),서정평(Jeong Pyeong Soe),박주형(Joo Hyung Park),정명호(Myung Ho Jeong),조정관(Jung Gwan Cho),박종춘(Jong Chun Park),강정채(Jung Chaee Kang) 대한내과학회 1997 대한내과학회지 Vol.52 No.4

N/A Objectives: Refractory period and conduction time of the slow and fast pathways in the atrioven-tricular node are known to be the most important determinant of the inducibility of atrioventricular nodal reentrant tachycardia (AUNRT) but their relationship has not been determined in Korean. Methods: Two hundred and ten patients under-gone electrophysioiogic study. One hundred twenty two patients with dual AV nodal pathways were divided into two groups (group I, 77 patients with no inducible AVNRT; group II, 45 patients with inducible AVNRT). Results: Antegrade dual AV nodal pathways were documented in 77 patients (47%) out of 165 patients on whom AVNRT was not induced, Antegrade ERP of slow pathway in paced rhythm (600 msec) was shorter in group II than in group I (331±14 msec vs 269±47 msec, p<0.05). Ventriculoatrial block cycle length (VABCL) and retrograde ERP of the AV conduction system were significantly shorter in group 2 than in group 1 (p<0.001). Maximum slow pathway conduction times in sinus rhythm and paced rhythm (600msec) in group 2 were significantly longer than in group 1 (sinus rhythm: 332±68msec vs. 379±88msec, p<0.005; paced rhythm: 332±69msec vs. 392±85msec, p<0.005). The ERP gaps of two AV nodal pathways of group 2 in sinus rhythm and in paced rhythm were also significantly longer than those of group 1 (sinus rhythm 41±3msec vs. 78±50msec, p<0.001; paced rhythm 36±32 msec vs. 72±19msec, p<0.005). The incidence of intact ventriculoatrial conduction was significantly higher in group 2 than in group 1 (p<0.05). Antegrade slow pathway conduction time (A2H2 interval) at the time of AVNRT induction with single atrial premature depolarization (APD) with a coupling interval over 10 msec less than that of an APD producing AH jump were not correlated with VABCL (r=0.193, p<0.05). Conclusion: Dual AV nodal pathways were observed in 47% of patients with no-inducible AVNRT group. The inducibility of AVNRT appears to be closely ralated to the some conduction characteristics of the dual pathways and the refractoriness, i.e. maximum slow pathway conduction time, the ERP gap of two pathways, retrograde fast pathway ERP, VABCL.

갑상선기능항진증 환자에서 Propranolol 이 수축기시간간격 및 혈역학적동태에 미치는 영향

박옥규 ( Ock Kyu Park ),강정채 ( Jeong Chae Kang ) 대한내과학회 1979 대한내과학회지 Vol.22 No.8

당뇨병 환자에서의 Nitroblue Terazolium 검사

이태희 ( Tai Hee Lee ),정민영 ( Min Young Chung ),강정채 ( Jeong Chae Kang ) 대한내과학회 1978 대한내과학회지 Vol.21 No.8

Tc - 99m MIBI 와 Tl - 201 심근 SPECT에서 역재분포의 임상적 의의

김지열(Ji Yeul Kim),범희승(Hee Seung Bom),송호천(Ho Cheon Song),박주형(Joo Hyung Park),정명호(Myung Ho Jeong),조정관(Jeong Gwan Cho),박종춘(Jong Choon Park),강정채(Jung Chaee Kang),길광채(Kwang Chae Gill) 대한핵의학회 1996 핵의학 분자영상 Vol.30 No.1

N/A Reverse redistribution(RRD) refers to a perfusion defect that develops or becomes more evident on rest imaging compared with the stress imaging. This phenomenon was not uncommonly noted on myocardial perfusion single photon emission computed tomography(SPECT). However, the clinical significance and pathophysiological mechanism of RRD were unclear. The aim of this study was to evaluate the incidence and clinical significance of RRD on either dipyridamole T1-201 or Tc-99m MIBI myocardial perfusion SPECT. RRD was defined as≥10% decrease in relative T1-201 and Tc-99m MIBI uptakes on rest images compared to the stress images or as an appearance of new perfusion defects on rest images. It was observed in both T1-201 (44/463, 9.5%) and Tc-99m MIBI (124/999, 12.4%) myocardial SPECTs similarly, with an overall incidence of 11.5%(168/1462). Many apparently unrelated disease groups showed the finding: post-revascularization(53.9%), coronary artery disease(24.6%), myocardial infarction(l2.3%), and those with normal coronary arteries(9.2%). Clinical and angiographic characteristics of 65 consecutive patients who underwent coronary arteriography in 168 patients who had RRD on myocardial perfusion SPECT were reviewed. Tc-99m MIBI was used in 44 patients, and TI-201 was used in 21 patients. Of the 81 myocardial segments analyzed which showed RRD, 32 segments(39.5%) were in septum, 24(29.5%) in inferior wall, 12(14.8%) in anterior wall, 7(8.7%) in apex and 6(7.4%) in lateral wall. There was no clear association between RRD and coronary arterial stenosis or presence of collateral circulations. Ventriculographical wall motion was evaluated in 27 regions with RRD; it was normal in 12 regions, hypokinetic in 12 regions and dyskinetic in 3 regions. In 14 of 21 patients who showed RRD on T1-201 myocardial SPECT, T1-201 reinjection was performed immediately after the 3-4 hour redistribution studies. Ten of 14(71.4%) showed enhanced T1-201 activity(≥10% increased) after reinjection. We conclude that RPD is not related to mode of stre

경피적 관동맥 성형술의 임상적 경험 - 최초 성공율을 중심으로 -

이기운 ( Lee Gi Un ),안영근 ( An Yeong Geun ),박주형 ( Park Ju Hyeong ),조길우 ( Jo Gil U ),정명호 ( Jeong Myeong Ho ),조정관 ( Jo Jeong Gwan ),박종춘 ( Park Jong Chun ),강정채 ( Kang Jeong Chae ) 대한내과학회 1992 대한내과학회지 Vol.42 No.4

연구배경 : 경피적 관동맥 성형술은 1977년 Andreas Gruentzig에 의해 최초로 성공된 이후 유도철선과 풍선도자의 기구개선과 시술자의 경험의 축적 및 시술 깃ㄹ의 발달로 그 적응중이 초기의 고적전인 병변에서 보다 복잡하고 힘든 다혈관병변이나 완전폐쇄병변에 까지 늘어나고 있다. 이에 그 시술결과를 알아보기 위하여 전남대학교 병원에서의 시술경험을 검토하였다. 방법 : 본대학 병원 순환기내과에서 1987년 8월부터 1991년 4월초까지 78예의 관동맥질환자를 대상으로 103예의 협착 및 완전폐쇄병변에 대해 경피적 관동맥 성형술을 시행한 임상 경험을 분석하였다. 결과 : 1) 대상 환자는 안정형 협심증 11예, 불안전형 협십증 32예, 급성 심근경색증 31예, 진구성 심근경색증 4예등이었다. 2) 78명의 관동맥 질환자에서 103예의 병변에 대해 관동맥 성형술을 시행하여 77예(74.8%)에서 성공하였다. 3) 병변의 형태에 따른 성공률은 A형, B형, C형에서 각각 82.6%, 71.7%, 25.0%이었고 완전폐쇄된 경우에는 18예중 9예서 성공하였다. 4) 혈관별 성공률은 좌전하행지, 좌회선지, 우관동맥에서 각각 72.2%, 78.9%, 78.6%였다. 5) 관동맥 성형술에 실패한 26예중 16예는 기술적인 문제로 실패하였는데 유도철선이나 풍선도자의 병변부위 관통 실패가 12예로 가장 많았다. 6) 합병증은 12예(11.9%)에서 관찰되었고, 이중 내막 박리가 7예로 가장 많았고 사망이 2예있었다. 응급 관동맥 수술이 필요한 경우는 없었다. 결론 : 경피적 관동맥 성형술이 관동맥 우회로 이식술을 대신하여 다양한 관동맥 질환의 효과적인 치료방법의 하나가 될 수 있음을 알 수 있었으나 사망등의 합병증을 줄이기 위한 노력이 계속되어야 할 것으로 생각되었다. Background: Percutaneous transluminal coronary angioplasty (PTCA) has been applied to some patients with symptomatic coronary artery disease and become recently an alternative to coronary artery bypass graft in selected cases. So we reviewed the results of our cases of PTCA. Method: PTCA was performed for 103 coronary arterial lesions in 78 patients (66 male, 12 female: 56.4±9.1 years) at Chonnam University Hospital from Aug. 1987 to April 1991. The acute results were assessed. Subjects: Eleven patients had stable angina, 32 unstable angina, 31 acute myocardial infarction, and four old myocardial infarction. Fortyfour patients had single vessel disease, 21 two vessel disease, and 13 three vessel disease. Results: Primary angiographic success rate was 74.8% (77/103) in the total 103 attempted lesions: 82.6% (38/46) in type A, 71.7% (38/53) in type B, and 25.0% (1/4) in type C according to ACC/AHA classification of the attempted coronary arterial lesions. The angiographic diameter stenosis reduced from 70.7±17.2% to 19.2±13.8% after successful PTCA. Complications associated with PTCA were seven intimal dissections (1 occlusive, 6 non-occlusive), one coronary occlusion by thrombosis, one coronary artery rupture, one guide wire impaction and fracture, and two deaths. There was no case requiring emergency CABG. Conclusion: Percutaneous transluminal coronary angioplasty (PTCA) can be an effective treatment in variable coronary artery disease and become an alternative to coronary artery bypass graft.

협심증과 심근경색증 환자에서 운동전후 Signal Averaged EKG 소견

이기운 ( Lee Gi Un ),안영근 ( An Yeong Geun ),박주형 ( Park Ju Hyeong ),조길우 ( Jo Gil U ),조정관 ( Jo Jeong Gwan ),박종춘 ( Park Jong Chun ),강정채 ( Kang Jeong Chae ) 대한내과학회 1992 대한내과학회지 Vol.42 No.5

연구배경 : 허혈성 심자병 환자가 사망하는 것은 주로 심실성 부정맥에 의한 돌연사라고 알려져 있으며 드물게 운동과 연관되어 나타난다고 한다. SA-EKG는 일반 심전도로 기록할 수 없는 심장의 미소한 전기적 활성을 기록하기 우해 개발되었는데 지금까지 심장의 돌연사 위험을 평가하는 비관혈적 방법으로 이용되어 왔으나 운동이 여기에 미치는 영향에 대한 연구는 비교적 적다. 방법 : 협십증과 심근 경색증 환자에게 안정시 SA-EKG 소견을 관찰하고 이들 소견의 운동후의 변화를 평가하기 위하여 대조군 189명, 협심증군 82명, 심근경색증 49에서 운동부하 검사 전후에 SA-EKG를 기록하여 f-QRS, RMS, HFLA 변화를 비교분석하였다. 결과 : 1) 대조군에서 운동후 평방근평균전위(RMS)는 의의있게 증가했고 고주파 저전위의 기간 (HFLA)은 의의있게 감소했다(p<0.05). 2) 운동전 지연전위가 양성이었던 예가 운동후 음성으로 변화한 경우는 대조군 52.4%, 협심증군 37.5%, 심근경색증군 40.0%이었고, 비정상 SA-EKG가 운둥후 정상으로 변화한 경우는 대조군 48.3%, 협심증군 22.2%, 심근경색증군 45.5% 이었으며 각 군간에 유의한 차이는 없었다. 3) 운동전 지연전위가 음성이었던 예가 운동후 양성으로 변화한 경우는 대조군 2.4%, 협심증군 6.1%, 심근경색증군 2.6%이었고, 정상 SA-EKG가 운동후 비정상적으로 변화한 경우는 대조군 1.9%, 협심증군 4.7%, 심근경색군 2.6% 이었으며 각군간에 유의한 차이는 없었다. 결론 : 허혈성 심장병의 동반 유무에 상관없이 등장성 운동후에 국소심근에 존재하는 전도지연이 개선될 수 있음을 시사하였다. Background: Major cause of sudden death in patients with ischemic heart disease is ventricular arrhythmia and associated with exercise. Recently signal averaged EKG (SA-EKG) is developed to record microelectrical potential that can t be detected in surface EKG and have been used evaluating the risk of sudden death in patients with ischemic heart disease, but few studies are reported for the effect of exercise on this. Method : To investigate the findings of signal averaged EKG (SA-EKG) in normal subjects(n=189), angina pectoris paitents(n=82) and myocardial infarction patients(n=49) and the effect of isotonic exercise on them, we analysed SA-EKG s recorded before and after treadmill exercise test. Result : In group A root mean square voltage (RMS) was significantly increased (p< 0.05) while duration of high frequency low amplitude activity (HFLA) was significantly decreased (p<O. 05) after exercise and duration of filtered QRS (f-QRS) was insignificantly decreased. In group B and group C, f-QRS and HFLA were insignificantly decreased while RMS was increased insignificantly. In considerable proportion of the subjects, the positive late potential (LP) was converted to negative LP after exercise, i.e. 52.4% in group A, 37.5% in group B, and 40.0% in group C and also the abnormal SA-EKG converted to normal SA-EKG, i.e. 48.3% in group A, 22.2% in group B, and 45.5% in group C. On the contrary in smaller proportion of the subjects the negative LP was converted to positive LP after exercise, i.e. 2.4% in group A, 6.1% in group B, and 2.6% in group C, and the normal SA-EKG converted to abnormal SA-EKG, i.e. 1.9% in group A, 4.7% in group B, and 2.6% in group C. There was no significant differences among groups in the conversion rates of SA-EKG findings after exercise. Conclusion : Slow conduction demonstrated by SA-EKG could be improved after isotonic exercise whether it is associated with ischemic heart disease or not.

正常人에서 propranolol이 收縮期時間間隔 및 血力學的 動態에 미치는 影響

姜貞採,朴玉圭 全南大醫大 1980 전남의대학술지 Vol.17 No.1

Fosinopril(Monopril^(�))의 강압 효과에 관한 임상적 연구

강정채,조인종,류문회,서정평,길광채,박주형,정명호,조정관,박종춘 최신의학사 1995 最新醫學 Vol.38 No.2

한국인 급성 심근경색증 환자에서 Tenecteplase(TNK-tPA)와 Alteplase(rt-PA)의 효과 비교(무작위, 다기관, 관상동맥 조영술을 이용한 임상 시험)

정명호,김 원,강정채,한성욱,허승호,김권배,차광수,김무현,강흥선,배종화,채인호,오병희,홍명기,박성욱,박승정,최소연,탁승제,최동훈,장양수,조승연,유병수,윤정한,최경훈 대한순환기학회 2003 Korean Circulation Journal Vol.33 No.5