• Journal of Chest Surgery
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• 제49권5호
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• pp.366-373
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• 2016

Background: The aim of the study was to test the hypothesis that in patients with chronic complex sternum dehiscence, the use of muscle flap repair minimizes the occurrence of paradoxical motion of the chest wall (CWPM) when compared to sternal rewiring, eventually leading to better respiratory function and clinical outcomes during follow-up. Methods: In a propensity score matching analysis, out of 94 patients who underwent sternal reconstruction, 20 patients were selected: 10 patients underwent sternal reconstruction with bilateral pectoralis muscle flaps (group 1) and 10 underwent sternal rewiring (group 2). Eligibility criteria included the presence of hemisternum diastases associated with multiple (${\geq}$3) bone fractures and radiologic evidence of synchronous chest wall motion (CWSM). We compared radiologically assessed (volumetric computed tomography) ventilatory mechanic indices such as single lung and global vital capacity (VC), diaphragm excursion, synchronous and paradoxical chest wall motion. Results: Follow-up was 100% complete (mean $85{\pm}24months$). CWPM was inversely correlated with single lung VC (Spearman R=-0.72, p=0.0003), global VC (R=-0.51, p=0.02) and diaphragm excursion (R=-0.80, p=0.0003), whereas it proved directly correlated with dyspnea grade (Spearman R=0.51, p=0.02) and pain (R=0.59, p=0.005). Mean CWPM and single lung VC were both better in group 1, whereas there was no difference in CWSM, diaphragm excursion and global VC. Conclusion: Our study suggests that in patients with complex chronic sternal dehiscence, pectoralis muscle flap reconstruction guarantees lower CWPM and greater single-lung VC when compared with sternal rewiring and it is associated with better clinical outcomes with less pain and dyspnea.

• 한국산학기술학회논문지
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• 제12권9호
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• pp.4075-4082
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• 2011

항공기 승무원은 최초 반응자로 비행기내 환자 발생 시 적절하고 신속하게 응급처치를 시행하여야 한다. 승무원의 기본응급처치 의식조사 결과, 출혈 관리, 소아 고열, 경련, 심근경색, 기도유지, 부분기도폐쇄 등에 대한 대처방법은 80.5%~97.8%로 올바르게 의식하고 있었지만 의식 없는 기도폐쇄, 호흡확인 방법, 영아자동제세동기 사용 등에 대한 대처방법은 3.2%~20.0%로 비교적 낮게 나타났다. 따라서, 본 연구결과를 바탕으로 기내에서 발생되는 환자 중 발생빈도가 높은 유형, 해결하기 어려운 유형, 생명을 위협할 수 있는 유형 등에 대한 응급처치 매뉴얼이 마련되어야 된다.

• 한국정보통신학회:학술대회논문집
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• 한국정보통신학회 2019년도 춘계학술대회
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• pp.525-527
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• 2019

심정지(Cardiac arrest)는 원인과 관계없이 심장의 박동이 정지되어 발생하는 일련의 상태를 말한다. 심정지 발생 시 환자의 생명을 구하기 위한 유일한방법 중 하나는 심폐소생술이며 이 술기를 통하여 순환을 유지 시킬 수 있고, 고품질의 심폐소생술은 환자의 생존률과 신경학적 예후에 영향을 미치기 때문에 매우 중요한 술기이다. 영아 심폐소생술의 경우 두 손가락으로 가슴을 압박하는 방법을 사용한다. 하지만 이 방법은 해부학적으로 손가락의 피로도가 가중되고 수직압박이 힘들어 미국심장협회에서 권장한 가슴압박깊이에 도달하기 힘들 수 있다. 이 연구는 영아 심폐소생술 중 가슴압박 시행 시 새로운 가슴압박법의 효과를 검증하고, 고품질의 심폐소생술을 위한 기초자료를 제공하고자 한다. 연구결과 가슴압박 방법에 따라 가슴의 평균압박깊이 및 평균압박 속도가 유의한 차이가 있었다(p<0.001) 또한 가슴압박의 편리성 및 통증정도에서 유의한 차이를 보였다. 본 연구의 결과를 종합해 볼 때 영아 심폐소생술 중 새로운 가슴압박법 시행 시 정확도가 높아지고, 가슴압박 깊이가 나아져 가슴압박의 질적 지표가 개선되었음을 알 수 있었다.

• Childhood Kidney Diseases
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• 제27권2호
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• pp.105-110
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• 2023

Purpose: To analyze electrocardiograms (ECGs) of patients with a salt-losing tubulopathy (SLT) and to determine the frequency and risk factors for long QT and arrhythmia. Methods: A total of 203 patients aged <19 years with SLT, specifically Bartter syndrome and Gitelman syndrome, who had a 12-lead ECG were included in this retrospective study. We analyzed the presence of an arrhythmia or prolonged corrected QT (QTc) on ECGs obtained for these patients. Demographic and laboratory data were compared between patients with abnormal and normal ECG findings. Results: Out of the 203 SLT patients, 38 (18.7%) underwent electrocardiography and 10 (40.0%) of 25 patients with inherited SLT had abnormal ECG findings, including prolonged QTc and arrhythmias. The abnormal ECG group had significantly lower serum potassium levels than the normal group (median [interquartile range]: 2.50 mmol/L [2.20-2.83] vs. 2.90 mmol/L [2.70-3.30], P=0.036), whereas other serum chemistry values did not show significant differences. The cutoff level for a significant difference in QTc interval was serum potassium level <2.50 mmol/L. One cardiac event occurred in a 13-year-old boy, who developed paroxysmal supraventricular tachycardia and underwent cardiac ablation. No sudden cardiac deaths occurred in this cohort. Conclusions: The incidence of ECG abnormalities in patients with inherited SLT was 40.0%, whereas the ECG screening rate was relatively low (18.7%). Therefore, we recommend ECG screening in patients with inherited SLT, especially in those with serum potassium level <2.50 mmol/L.

• Korean Journal of Radiology
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• 제24권6호
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• pp.512-521
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• 2023

Objective: There is increasing recognition that left atrial (LA) strain can be a prognostic marker of various cardiac diseases. However, its prognostic value in acute myocarditis remains unclear. Therefore, this study aimed to evaluate whether cardiovascular magnetic resonance (CMR)-derived parameters of LA strain can predict outcomes in patients with acute myocarditis. Materials and Methods: We retrospectively analyzed the data of 47 consecutive patients (44.2 ± 18.3 years; 29 males) with acute myocarditis who underwent CMR in 13.5 ± 9.7 days (range, 0-31 days) of symptom onset. Various parameters, including feature-tracked CMR-derived LA strain, were measured using CMR. The composite endpoints included cardiac death, heart transplantation, implantable cardioverter-defibrillator or pacemaker implantation, rehospitalization following a cardiac event, atrial fibrillation, or embolic stroke. The Cox regression analysis was performed to identify associations between the variables derived from CMR and the composite endpoints. Results: After a median follow-up of 37 months, 20 of the 47 (42.6%) patients experienced the composite events. In the multivariable Cox regression analysis, LA reservoir and conduit strains were independent predictors of the composite endpoints, with an adjusted hazard ratio per 1% increase of 0.90 (95% confidence interval [CI], 0.84-0.96; P = 0.002) and 0.91 (95% CI, 0.84-0.98; P = 0.013), respectively. Conclusion: LA reservoir and conduit strains derived from CMR are independent predictors of adverse clinical outcomes in patients with acute myocarditis.

• 대한핵의학회지
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• 제34권1호
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• pp.39-54
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• 2000

목적: 디피리다몰 부하 심근 관류 SPECT 를 관동맥질환 환자의 예후 예측에 이용하여 장기간 추적하였을 때 정상 심근 SPECT 소견의 비례위험도가 달라지는지를 조사하여 정상 SPECT로 언제까지 예후가 양호하다고 예측할 수 있는지 보았다. 대상 및 방법: 관동맥질환이 의심되어 심근 관류 SPECT를 시행한 환자 1,169명을 대상으로 심장원인 사망이나 심근 경색이 발생한 중한 사건과 관동맥우회로술이나 관동맥성형술을 시행한 경한 사건을 합한 전체 심장사건의 발생률과 예측성능을 분석하였다. 비례위험도의 시간의존성을 분석하는 통계적 방법을 개발하고 적용하여 추적기간에 따른 예측도 차이를 조사하였다. 결과: 다변량 Cox 비례위험도 모델에서 전체 심장 사건을 예측하는데 심근 관류 SPECT의 가역성관류 감소가 독립적인 예후 예측 성능을 보였으며 관동맥조영술 소견에 더하여 부가효용을 나타냈다. 심근 SPECT의 가역성관류감소는 중한 사건을 예측하는 독립적 예측성능을 보였으나 관동맥조영술에 더하여 부가효용을 나타내지는 않았다. SPECT 소견의 비례위험도는 추적기간이 경과하면서 증가하였다. 전체 심장사건을 예측하는 비례위험도가 심근 SPECT 정상군에서 추적기간 말기에 유의하게 달라졌으며(p<0.001) 정상심근 SPECT의 위험률의 변이점은 4.4년이었다. 결론: 심근 SPECT에 나타난 가역성 관류 감소는 전체심장 사건을 예측하는 독립적이고 부가적인 성능을 보였다. 심근 관류 SPECT에서 정상일 때 장기추적 중 4.4년 후에는 예후 예측 위험도가 유의하게 증가하였다.

• 대한의용생체공학회:의공학회지
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• 제16권4호
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• pp.415-424
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• 1995

Combined models, specified by two or more modeling formalisms, can represent a wide variety of complex systems. This paper describes a methodology for the development of combined models in two model types of discrete event and continuous process. The methodology is based on transformation of continuous state space into discrete one to homomorphically represent dynamics of continuous processes in discrete events. This paper proposes a formal structure which can combine model of the DES and the CS within a framework. The structure employs the DEVS formalism for the DES models and differential or polynomial equations for the CS models. To employ the proposed structure to specify a DEVS/CS combined model, a modeler needs to take the following steps. First, a modeler should identify events in the CS and transform the states of the CS into the DES. Second, a modular employs the formalism to specify the system as the DES. Finally, a moduler developes sub-models for the CS and continguos states of the DES and establishs one-to-one correspondence between the sub-models and such states. The proposed formal structre has been applied to develop a DEVS/CS combined model for the human cardiovascular system. For this, the cardiac cycle is partitioned into a set of phases based on events identified through observation. For each phase, a CS model has been developed and associated with the phase. To validate the DEVS/CS combined model developed, then simulate the model in the DEVSIM + + environment, which is a model simulation results with the results obtained from the CS model simulation using SPICE. The comparison shows that the DEVS/CS combined model adequately represents dynamics of the human heart system at each phase of cardiac cycle.

• 한국정보통신학회:학술대회논문집
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• 한국해양정보통신학회 2006년도 춘계종합학술대회
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• pp.421-425
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• 2006

헬스케어와 무선 기술의 접목은 새로운 생체신호 모니터링 방법과 환자의 이동성 및 편의성을 제공하며 더 나은 방법으로 환자를 돌볼 수 있으며 이러한 장점으로 인해 최근 무선기술을 이용한 ECG 모니터링 및 계측 시스템이 개발되고 있다. 본 논문에서는 중요한 생체신호 중 가장 중요한 신호의 하나인 ECG 신호를 무선센서네트워크를 이용하여 무선으로 받은 후, 이를 서버컴퓨터에서 의사, 간호사 또는 환자의 보호자에게 진단의 기초자료로 제공할 수 있게 빈맥, 서맥, 동정지와 같은 비정상적인 ECG신호를 판단하는 ECG 모니터링 시스템을 구현하였다. 신체에서 계측된 ECG신호는 무선으로 서버와 RS-232로 연결된 베이스스테이션으로 전송되고 서버는 비정상적인 ECG 신호를 검사하여 저장 및 모니터링을 위해 PC/PDA로 데이터를 전송하며, 이러한 시스템을 활용하여 의료비 절감 및 더 편리한 의료서비스를 받을 수 있을 것으로 예상된다.

• Clinical and Experimental Pediatrics
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• 제54권2호
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• pp.86-89
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• 2011

Traumatic ventricular septal defect (VSD) resulting from blunt chest injury is a very rare event. The mechanisms of traumatic VSD have been of little concern to dateuntil now, but two dominant theories have been described. In one, the rupture occurs due to acute compression of the heart; in the other, it is due to myocardial infarction of the septum. The clinical symptoms and timing of presentation are variable, so appropriate diagnosis can be difficult or delayed. Closure of traumatic VSD has been based on a combination of heart failure symptoms, hemodynamics, and defect size. Here, we present a case of a 4-year-old boy who presented with a traumatic VSD following a car accident. He showed normal cardiac structure at the time of injury, but after 8 days, his repeated echocardiography revealed a VSD. He was successfully treated by surgical closure of the VSD, and has been doing well up to the present. This report suggests that the clinician should pay great close attention to the patients injured by blunt chest trauma, keeping in mind the possibility of cardiac injury.

• 대한의용생체공학회:의공학회지
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• 제23권6호
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• pp.477-484
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• 2002

A pacemaker autosense algorithm with dual thresholds. one for noise or tachyarrhythmia detection (noise threshold, NT) and the other for intrinsic beat detection (sensing threshold. ST), was developed to improve the sensing performance in single pass VDD electrograms. unipolar electrograms, or atrial fibrillation detection. When a deflection in an electrogram exceeds the NT (defined as 50% of 57), the autosense algorithm with dual thresholds checks if the deflection also exceeds the ST. If it does, the autosense algorithm calculates the signal to noise ratio (SNR) of the deflection to the highest deflection detected by NT but lower than ST during the last cardiac cycle. If the SNR 2, the autosense algorithm declares an intrinsic beat detection and calculates the next ST based on the three most recent intrinsic peaks. If the SNR $\geq$2, the autosense algorithm checks the number of deflections detected by NT during the last cardiac cycle in order to determine if it is a noise detection or tachyarrhythmia detection. Usually the autosense algorithm tries to set the 57 at 37.5% of the average of the three intrinsic beats, although it changes the percentage according to event classifications. The autosense algorithm was tested through computer simulation of atrial electrograms from 5 patients obtained during EP study, to simulate a worst sensing situation. The result showed that the ST levels for autosense algorithm tracked the electrogram amplitudes properly, providing more noise immunity whenever necessary. Also, the autosense algorithm with dual thresholds achieved sensing performance as good as the conventional fixed sensitivity method that was optimized retrospectively.