• Journal of Chest Surgery
• /
• 제51권5호
• /
• pp.363-366
• /
• 2018

One of the complications of permanent pacemaker implantation is unintended phrenic nerve stimulation. A 15-year-old boy with a permanent pacemaker presented with chest discomfort due to synchronous chest wall contraction with pacing beats. Even after reprogramming of the pacemaker, diaphragmatic stimulation persisted. Therefore, we performed thoracoscopic phrenic nerve insulation using a Gore-Tex patch to insulate the phrenic nerve from the wire. A minimally invasive approach using a thoracoscope is a feasible option for retractable phrenic nerve stimulation after pacemaker implantation.

• Journal of Chest Surgery
• /
• 제53권2호
• /
• pp.82-85
• /
• 2020

Insertion of an epicardial pacemaker is a useful treatment for pediatric patients with an abnormal heart rhythm. However, there are limitations and concerns when implanting epicardial pacemakers in infants and neonates due to their small body size. We report a patient who experienced rare complications after implantation of a permanent pacemaker.

• Journal of Cardiovascular Imaging
• /
• 제30권1호
• /
• pp.62-75
• /
• 2022

BACKGROUND: Due to its location very close to the bundle of His, mitral annulus calcification (MAC) might be associated with the development of atrioventricular (AV) conduction disturbances. This study assessed the association between MAC and AV conduction disturbances identified by cardiac implantable electronic device (CIED) use and electrocardiographic parameters. The association between MAC and traditional cardiovascular risk factors was also assessed. METHODS: This cross-sectional study analyzed 14,771 participants, predominantly men aged 60-75 years, from the population-based Danish Cardiovascular Screening trial. Traditional cardiovascular risk factors were obtained. Using cardiac non-contrast computed tomography imaging, MAC scores were measured using the Agatston method and divided into absent versus present and score categories. CIED implantation data were obtained from the Danish Pacemaker and Implantable Cardioverter Defibrillator Register. A 12-lead electrocardiogram was available for 2,107 participants. Associations between MAC scores and AV conduction disturbances were assessed using multivariate regression analyses. RESULTS: MAC was present in 22.4% of the study subjects. Participants with pacemakers for an AV conduction disturbance had significantly higher MAC scores (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.01-1.23) than participants without a CIED, whereas participants with a CIED for other reasons did not. Prolonged QRS-interval was significantly associated with the presence of MAC (OR, 1.45; 95% CI, 1.04-2.04), whereas prolonged PQ-interval was not. Female sex and most traditional cardiovascular risk factors were significantly associated with high MAC scores. CONCLUSIONS: MAC was associated with AV conduction disturbances, which could improve our understanding of the development of AV conduction disturbances.

• 한국인공지능학회지
• /
• 제11권2호
• /
• pp.39-44
• /
• 2023

The creativity of thesis is that the significance of cyber security challenges in blockchain. The variety of enterprises, including those in the medical market, are the targets of cyberattacks. Hospitals and clinics are only two examples of medical facilities that are easy targets for cybercriminals, along with IoT-based medical devices like pacemakers. Cyberattacks in the medical field not only put patients' lives in danger but also have the potential to expose private and sensitive information. Reviewing and looking at the present and historical flaws and vulnerabilities in the blockchain-based IoT and medical institutions' equipment is crucial as they are sensitive, relevant, and of a medical character. This study aims to investigate recent and current weaknesses in medical equipment, of blockchain-based IoT, and institutions. Medical security systems are becoming increasingly crucial in blockchain-based IoT medical devices and digital adoption more broadly. It is gaining importance as a standalone medical device. Currently the use of software in medical market is growing exponentially and many countries have already set guidelines for quality control. The achievements of the thesis are medical equipment of blockchain-based IoT no longer exist in a vacuum, thanks to technical improvements and the emergence of electronic health records (EHRs). Increased EHR use among providers, as well as the demand for integration and connection technologies to improve clinical workflow, patient care solutions, and overall hospital operations, will fuel significant growth in the blockchain-based IoT market for linked medical devices. The need for blockchain technology and IoT-based medical device to enhance their health IT infrastructure and design and development techniques will only get louder in the future. Blockchain technology will be essential in the future of cybersecurity, because blockchain technology can be significantly improved with the cybersecurity adoption of IoT devices, i.e., via remote monitoring, reducing waiting time for emergency rooms, track assets, etc. This paper sheds the light on the benefits of the blockchain-based IoT market.

• Clinical and Experimental Pediatrics
• /
• 제49권11호
• /
• pp.1194-1201
• /
• 2006

목 적 : 혼수 환자는 원인에 상관없이 혼수 상태가 오래 지속되었을 경우 회복불능의 상태로 될 수 있기 때문에 원인을 신속하게 발견하여 치료하는 것이 중요하다. 그 중 MRI 검사는 혼수 환자의 원인을 감별하는데 중요하나 자발호흡이 없는 환자에게 MRI 검사 시 여러 가지 제한점으로 인해 그 시행이 어려웠다. 저자들은 변형된 수동식 인공호흡기를 이용하여 일정 거리에서 환자에게 전달되는 환기량을 유지하면서 MRI 검사가 가능한지 알아보고 안정성을 확인하고자 본 연구를 실시하였다. 방 법 : 특별히 고안한 장치는 self-inflating bag type의 수동식 인공호흡기에 PVC 관을 연결하고 그 끝을 환자의 기도와 연결하여 만든 비교적 간단한 장치이다. 또한 안정성을 확인하기 위하여 기계식 인공호흡기를 이용하여 PVC 연결 관의 길이와 직경 및 일회호흡량(tidal volume)을 변화시켰을 경우 TVe, MVe, PIP를 측정하여 환기에 미치는 영향에 대해 알아보았다. 결 과 : 15 mm, 25 mm 직경의 2가지 종류의 PVC 연결 관을 이용하여 TVi를 변화시킴과 동시에 관의 길이를 1, 2, 3 m로 증가시킴에 따라 TVe, MVe, PIP 값을 측정하였으며, 그 결과 TVe, MVe 값은 대조군과 비교해 차이가 없었고 PIP 값은 TVi가 증가함에 따라, 관의 길이가 늘어남에 따라 의미 있는 증가를 보였다(P<0.05). 또한 관의 길이, TVi에 관계없이 PIP 값은 PVC 연결 관의 직경과 음의 상관관계를 보였다. 즉 관의 직경이 작을수록, 관의 길이가 길어질수록, 일회호흡량이 증가할수록, 환기량을 유지하기 위한 PIP값은 증가하였다. 5명의 환자들을 대상으로 이러한 방법을 이용하여 MRI 검사를 시행하였으며 성공적으로 검사를 실시하였다. 결 론 : 저자들이 고안한 수동식 인공호흡기를 이용한다면 자발호흡이 불안정하여 MRI 검사를 시행하지 못했던 많은 환자들에게 더 많은 검사의 기회가 주어질 것이며 환자의 질환을 진단하는데 많은 도움을 줄 것이다.