고주파 전극도자 절제술의 임상적 경험

김윤년(Yoon Nyun Kim),배장호(Jang Ho Bae),신경목(Kyeung Mok Shin),한성욱(Sung Wook Han),허승호(Seung Ho Huh),김기식(Kee Sik Kim),김권배(Kweon Bae Kim) 대한내과학회 1997 대한내과학회지 Vol.52 No.1

N/A Objectives : Among the current therapeutic options for paroxysmal supraventricular tachycardias, only surgery and ablative techniques are curative. However, surgery is associated with substantial cost, morbidity, and rarely death. Recently, catheter ablation techniques have been developed to treat paroxysmal supraventricular tachycardias. These techniques are effective and low-risk curative treatment for supraventricular tachycardias. This article shall describe our clinical experiences in radiofrequency catheter ablation for supraventricular tachycardias and review the literature. Methods: The study population consisted of 154 patients with supraventricular tachycardias from January 1993 to August 1995. Eighty one patients were men and seventy three patients were women, and their mean age was 41.29±15.41 years. Radio-frequency currents(mean) were applied through a catheter electrode positioned against the mitral or tricuspid annulus or a branch of the coronary sinus or atrioventricular node. Results: Among 154 patients, the mechanisms for paroxysmal supraventricular tachycardias were found to be atrioventricular reentrant tachycardia involving a concealed accessory pathway in 51(33.1%), Wolff-Parkinson-White syndrome in 57(37%), and atrioventricular nodal reentrant tachycardia in 46 (29.9%). Successful outcomes were achieved in 46 of 46 patients(100%) with atrioventricular nodal reentrant tachycardia, 7 of 8 patients(87.5%) with double accessory pathways, 69 of 72 patients(95.8%) with left-sided accessory pathway, and 19 of 28 patients (67.9%) with right-sided accessory pathway. Total 141 of 154 patients(91.6%) with supraventricular had a successful outcome with radio- frequency current application(mean). Conclusions: Radiofrequency catheter ablation techniques are highly effective in ablating accessory pathways or modifying atrioventricular node, with low morbidity and no mortality.

승모판 대치이식수술에 사용한 조직판막의 초음파심음향도 소견

김권배 ( Kwon Bae Kim ),김교성 ( Kyo Sung Kim ),김윤년 ( Yoon Nyun Kim ),허정욱 ( Jung Wook Hur ),김두환 ( Doo Hwan Kim ),권영주 ( Yong Joo Kwon ) 대한내과학회 1984 대한내과학회지 Vol.27 No.1

도시지역의 관상동맥질환 발생률 조사

천병렬,김권배,김기식,김영조,김윤년,김창윤,박의현,신동구,심봉섭,이종주,이충원,장성국,전재은,Chun, Byung-Yeol,Kim, Kwon-Bae,Kim, Kee-Sik,Kim, Young-Jo,Kim, Yoon-Nyun,Kim, Chang-Yoon,Park, Wee-Hyun,Shin, Dong-Gu,Shim, Bong-Sub,Lee, Jong-Joo,L 대한예방의학회 1998 Journal of Preventive Medicine and Public Health Vol.31 No.3

To estimate the incidence rate of coronary heart disease in Korea, of all residents in Taegu city aged 25 or above, those who had an acute MI or a fatal coronary event between 1 July 1996 and 30 June 1997 were registered. Seven hundreds and eight patients were registered during the study period(685 were identified at hospital and 23 were autopsy cases). Age-standardized annual incidence rate of men in city area was 93 per 100,000(95% CI; 61-142) and 35% CI; 16-67) in women(100 in men and 20 in women aged 35-64). The incidence was rapidly increased after age 40 in men, however, in women after age 60. Twenty-eight-days case fatality rate was 45% in men and 47% in women. However, in the age group of 45-59 case fatality rate in women was two times higher than that in men. In conclusion, crude annual incidence rate of CHD in city area was 73 per 100,000 in men and 33 in women. The age-standardized annual incidence of CHD in men(93 per 100,000) was 2 times higher than that in women (33 per 100,000) in Korea.

Arbutamine부하 심초음파도의 안정성과 유용성

신이철(Yi Chul Synn),김기식(Kee Sik Kim),배장호(Jang Ho Bae),한성욱(Seong Wook Han),박소영(So Young Park),남창욱(Chang Wook Nam),김기영(Ki Young Kim),김윤년(Yoon Nyun Kim),김권배(Kwon Bae Kim),김여희(You Hee Kim) 대한내과학회 2000 대한내과학회지 Vol.58 No.1

N/A Background : Exercise and pharmacologic stress echocardiography are widely used for detecting coronary artery disease. Arbutamine is a new synthetic mild α1-receptor and - receptor agonist developed specifically for stress echocardiography. Arbutamine is superior to dobutamine owing to its enforced chronotropic action than that of dobutamine. We intended to know safety and efficacy of arbutamine stress echocardiography in inducing myocardial ischemia and detecting coronary artery disease. Methods : We underwent arbutamine stress echocardiography on 52 patients, dobutamine stress echocardiography in 35 patients. Alteration of blood pressure, heart rate, regional wall motion on echocardiography were evaluated. Sensitivity and specificity were determined by coronary angiography for 61 patients(Arbutamine: 31, Dobutamine : 30) Results : 1) Hemodynamic alterations respect to stress agents Baseline Maximal Baseline Maximal Interval for Blood pressure Blood pressure Heartrate Heart rate maximal heartrate Arbutamine 122/70mmHg 138/72mmHg 69BPM 137BPM 8.2 min* Dobutamine 126/73mmHg 136/77mmHg 74BPM 102BPM 11.4 min* (* p < 0.05) 2) Comparison of Arbutamine and Dobutamine in sensitivity Sensitivity(Specificity) Side effects Atropine Arbutamine 80.1% (90%) 33(63.5%) 8(15.4%) Dobutamine 78.2% (71.4%) 21(60%) 7(20%) 3) Side effects of stress agents Hypotension Palpitation, tremor Arrhythmia Chest pain Arbutamine 15(28.8%)* 4(7.7%)* 21(40.4%) 8(9.2%) Dobutamine 3(8.6%)* 9(25.7%)* 12(34.3%) 5(5.7%) (* p < 0.05) 4) Premature ventricular contraction was most common arrhythmia in both group. There was no fatal or significant complication, and most complications were subsided after discontinuation of stress agents. Conclusion : Arbutamine is an effective and safe pharmacologic stress agent in detecting myocardial ischemia and superior to dobutamine in increasing heart rate. Sensitivity and specificity of arbutamine were higher than that of dobutamine.(Korean J Med 58:39-47, 2000)

응급실 급성 충수염 환자의 임상경로 개발

박철용,김윤년,최현석,신아미,Park, Cheol-Yong,Kim, Yoon-Nyun,Choi, Hyun-Seok,Shin, A-Mi 한국데이터정보과학회 2010 한국데이터정보과학회지 Vol.21 No.3

이 논문에서는 응급실 급성 충수염 환자의 치료와 검사 항목에 대한 임상경로를 개발하였다. 임상경로 개발을 위해 먼저 Park과 Kim (2010)에 의해 제시된 처방 선택 방법을 이용하였으며, 그 다음에 이렇게 선택된 처방들을 연관성이 있는 처방끼리 묶어서 그림으로 표시하였다. 구체적으로 사용된 처방 선택 방법은 향상도에 근거하고 있으며 빈도가 높은 처방부터 출발하여 이것과의 향상도가 0.9에 못 미치는 음의 연관성 처방들을 순차적으로 제거하였다. 이렇게 선택된 처방들에 대해 연관성이 있는 처방들을 묶는 방법도 처방 선택 방법과 비슷하다. 구체적으로 선택된 처방 중 빈도가 높은 처방부터 출발하여 순차적으로 이것과의 향상도가 1.1을 넘는 처방들을 연관성 있는 처방으로 고려하여 해당 처방 오른쪽에 표시하였다. 따라서 임상경로 그림에는 제일 왼쪽에는 연관성이 낮은 처방들을 빈도순으로 위에서 아래로 배치하고, 제일 왼쪽에 있는 각 처방의 오른쪽에는 이것과 연관성이 높은 처방들을 왼쪽에서 오른쪽으로 역시 빈도순으로 배치하는 것을 원칙으로 하였다. In this study, we develop clinical pathways for test and medical treatment items of acute appendicitis patients in emergency room. In order to develop the clinical pathways, we first employ the order selection method by Park et al. (2010), and then display the selected orders in such a way that associated orders are tied together. More specifically the order selection method that we employ is based on lift and, starting from the orders with higher frequencies, sequentially removes the negatively associated orders with lift values less than 0.9. The way associated orders are selected and tied together is similar to that of the order selection method. More specifically, starting from the selected orders with higher frequencies, the orders with lift values greater than 1.1 are considered associated and displayed to the right of the corresponding order. Therefore, in the diagram of clinical pathways, the orders at the left hand side, in principle, are not associated with each other and upper orders have higher frequencies, and associated orders are located to the right of corresponding order at the left hand side and more left orders, in principle, have higher frequencies.

혈압조절에 있어서 Renin 활성도의 차이와 Ca, Na 섭취습관 그리고 호르몬 간의 관련성

윤진숙(Yoon Jin-Sook),박정아(Park Jung-A),김윤년(Kim Yoon-Nyun) 韓國營養學會 1997 Journal of Nutrition and Health Vol.30 No.2

Electrocardiographic characteristics of significant factors of detected atrial fibrillation using WEMS

Min Soo Kim(김민수),Yoon Nyun Kim(김윤년),Young Chang Cho(조영창) 한국산업정보학회 2015 한국산업정보학회논문지 Vol.20 No.6

The wireless electrocardiographic monitoring system(WDMS) is designed to be long term monitoring for the early detection of cardiac disorders. The current version of the WDMS can identify two types of cardiac rhythms in real-time, such as atrial fibrillation(AF) and normal sinus rhythm(NSR), which are very important to track cardiac-rhythm disorders. In this study, we proposed the analysis method to discriminate the characteristics statistically evaluated in both time and frequency domains between AF and NSR using various parameters in the heart rate variability(HRV). And we applied various ECG detection methods (e.g., difference operation method) and compared the results with those of the discrete wavelet transform(DWT) method. From the statistically results, we found that the parameters such as STD RR, STD HR, RMSSD, NN50, pNN50, RR Trian, and TNN(p<0.05) are significantly different between the AF and NSR patients in time domain. On the other hand, the frequency domain analysis results showed a significant difference in VLF power(ms²), LF power(ms²), HF power(ms²), VLF(%), LF(%), and HF(%). In particular, the parameters such as STD RR, RMSSD, NN50, pNN50, VLF power, LF power and HF power were considered as the most useful parameters in both AF and NSR patient groups. Our proposed method can be efficiently applied to early detection of abnormal conditions and prevent the such abnormals from becoming serious.

심근교 ( Myocardial bridge ) 의 임상적 의의

한성욱(Seong Wook Han),김윤년(Yoon Nyun Kim),허승호(Seung Ho Hur),현대우(Dae Woo Hyun),김기식(Kee Sik Kim),김권배(Kwon Bae Kim) 대한내과학회 1998 대한내과학회지 Vol.54 No.6

N/A Objective: A myocardial bridge is an anatomic arrangement in which an epicardial coronary artery becomes engulfed for a limited segment by myocardial fibers from birth. It is recognized angiographyically by systolic compression of coronary artery. A large discrepancy exist between pathological series, in which the incidence has varied from 15% to 85%, and angiographic seires, in which it is reported as being between 0.51% and 2.5%. A myocardial bridge has been associated with myocardial ischemia, infarction and sudden death, but its clinical significance is controversial, The aim of this study was to assess the clinical characteristics and significance of myocardial bridge based on our exerience. Method: We reviewed the consecutive 1554 cinean-giograms performed in the cardiac laboratory of the Keimyung University Hospital from Nov, 1992 to May 1996. Two groups were constituted according to percentage of systolic reduction of the arterial lumen assessed visually or by computerized digital caliper. We differentiated them between below 50% and above 50% in the systolic reduction. Comparison between variables in two groups were made. Results: 1) Myocardial bridges were present in 36 patients (2.3%). 2) Among these patients, 21 had angina (58.3%), 8 had myocardial infarction (22.2%), 6 had hypertension (16.7%) and 4 had hypertrophic cardiomyopthy, primary pulmonary hypertension, mitral regurgitation and aortic regurgitation, respectively. 3) The highest prevalance was found in the mid-left anterior descending (LAD) artery (80.5%), next in the distal LAD artery (11.1%). Two cases had myocardial bridges in two sites. 4) Isolated myocardial bridges which excludes those associated with concomitant cardiovascular diseases were present in 19 patients (1.22%). Initiol symptoms in patients with myocardial bridge are exercise induced angina in 10, atypical chest pain in 3, resting onset chest pain in 3 and palpitation in 1 at admission. Two patients had no specific symptoms except electrocardiographic abnormality. 5) Clinical diagnosis of patients with isolated myocardial bridges were anginal pectaris in 13, myocardial infarction in 2 and nonspecific in 4. Myocardial infarction was present in the group of above 50% of systolic reduction. Conclusion: A myocardial bridge may induce myocardial ischemia and myocardial infarction, but prognosis may be good if patients should avoid precipitating factors i,e. condition induce tachycardia or administered β-blocker etc.

데이터 이산화와 러프 근사화 기술에 기반한 중요 임상검사항목의 추출방법: 담낭 및 담석증 질환의 감별진단에의 응용

손창식,김민수,서석태,조윤경,김윤년,Son, Chang-Sik,Kim, Min-Soo,Seo, Suk-Tae,Cho, Yun-Kyeong,Kim, Yoon-Nyun 대한의용생체공학회 2011 의공학회지 Vol.32 No.2

The selection of meaningful clinical tests and its reference values from a high-dimensional clinical data with imbalanced class distribution, one class is represented by a large number of examples while the other is represented by only a few, is an important issue for differential diagnosis between similar diseases, but difficult. For this purpose, this study introduces methods based on the concepts of both discernibility matrix and function in rough set theory (RST) with two discretization approaches, equal width and frequency discretization. Here these discretization approaches are used to define the reference values for clinical tests, and the discernibility matrix and function are used to extract a subset of significant clinical tests from the translated nominal attribute values. To show its applicability in the differential diagnosis problem, we have applied it to extract the significant clinical tests and its reference values between normal (N = 351) and abnormal group (N = 101) with either cholecystitis or cholelithiasis disease. In addition, we investigated not only the selected significant clinical tests and the variations of its reference values, but also the average predictive accuracies on four evaluation criteria, i.e., accuracy, sensitivity, specificity, and geometric mean, during l0-fold cross validation. From the experimental results, we confirmed that two discretization approaches based rough set approximation methods with relative frequency give better results than those with absolute frequency, in the evaluation criteria (i.e., average geometric mean). Thus it shows that the prediction model using relative frequency can be used effectively in classification and prediction problems of the clinical data with imbalanced class distribution.

데이터마이닝 기법을 이용한 심방세동 유형 예측모형 개발

엄흥섭 ( Heung Seop Eom ),김윤년 ( Yoon Nyun Kim ),윤경일 ( Kyung Il Youn ) 한국보건정보통계학회 (구 한국보건통계학회) 2008 보건정보통계학회지 Vol.33 No.1