변형술식에 의한 완전방실중격결손의 교정

김웅한,김수철,이택연,한미영,정철현,박영관,김종환 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery Vol.32 No.7

Background: Recent advances in understanding the anatomy of the complete atrioventricular septal defect(including right-dominant unbalanced atrioventricular septal defect) have led to alternative methods of repairing these defects. Material and Method: From May 1997 to July 1998, 8 consecutive infants(age range, 2 to 28 months, mean body weight 6.0$\pm$2.2 kg) received a single-stage intracardiac repair of the complete atrioventricular septal defect with modified surgical methods. Depending on the specific anatomic structure, the procedure was simplified in 3 patients by a direct closure of the ventricular element of the defect(Group I). Two patients judged unsuitable for direct closure due to a potential left ventricular outflow tract obstruction had received a standard two-patch repair(Group II). The remaining 3 patients with right-dominant unbalanced complete atrioventricular septal defect underwent biventricular repair; to enlarge the orifice of the left atrioventricular valve, the ventricular septal patch was placed slightly more to the right of the ventricular crest, a left sided bridging leaflet was augmented with an autologous pericardial patch, and the leaflet was repaired with a double- orifice(Group III . Result: In all 8 patients, the postoperative echocardiography demonstrated good hemodynamics. Seven patients were weaned from the ventilators after a mean 3$\pm$1 days, and 1 patient was weaned after 24 days due to a reoperation and emphysematous lung problem. A reoperation was performed in 1 patient for progressive left atrioventricular valve regurgitation due to leaflet tearing. There were no early and late mortalities. At the time of the latest review, judging from the echocardiographic criteria, left atrioventricular valve stenosis was mild in 1 patient(mean pressure gradient 6.5 mmHg, 13.5%), left atrioventricular valve regurgitation was absent or grade I in 7 patients(87.5%). The right atrioventricular valve regurgitation was absent or grade I in all 8 patients(100%). Conclusion: Infants with complete atrioventricular septal defect were treated with either a simplified approach with direct closure of the ventricular element of the defect or a modified surgical technique for a right-dominant unbalanced atrioventricular septal defect, depending on the anatomic structure. The results were no operative mortalities and low morbidity.

완전방실중격결손수술의 단순화

김웅한,김수철,오삼세,정도현,정홍주,김욱성,이창하,정철현,나찬영 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery Vol.31 No.9

Recent advances in understanding the anatomy of complete atrioventricular septal defect have led to alternative methods of repairing these defects. Here we report two cases of complete atrioventricular septal defect repair by direct closure of the ventricular element of the defect. Follow-up for average of 3 months suggests that, when direct closure can be performed, the results can be comparable with those of the standard technique. Our initial success with this approach is encouraging; however, longer follow-up and more experiences are required to establish whether it will be broadly applicable.

Synchrotron Microangiography of the Rat Heart Using the Langendorff Model

김웅한,최수연,곽재근,김동진,오세진,김동정,장우성,이재항,최은석,김영준 대한심장학회 2008 Korean Circulation Journal Vol.38 No.9

Background and Objectives: The ability to study microvessels of a beating heart in real time at the level of the capillary is essential for research. However, there are no proven methods currently available to achieve this. The conventional absorption-contrast agents have limitations for studying capillaries. Microangiography with using synchrotron phase-contrast X-ray technology and no contrast agent has recently been reported on. We tried to verify this previous report, and we wanted to visualize the microvessels of a rat heart using air as a contrast agent. Materials and Methods: We made the Langendorff apparatus in a hutch of the Pohang Accelerator Laboratory. The images were obtained with a white beam and a monochromatic beam. The visual images were magnified using 3× and 20× optical microscope lenses, and the images were captured with a charge-coupled device camera. Results: We could not duplicate the previously reported findings in which microvessels were visualized without the use of contrast agent. But with using air as a contrast agent, the microvasculature of rat hearts was clearly identified at a spatial resolution of 1.2 μm. Air being absorbed inside a capillary was also observed. Vessels under 10 μm diameter were unable to be visualized with using iodine as a contrast agent. Conclusion: Phase contrast imaging already allows spatial resolution of 1 μm, which is enough to inspect capillaries. We were able to obtain images of cardiac capillaries with using air as a contrast agent. Yet air has the fatal limitations in that it causes embolism and ischemia. A more suitable contrast agent or imaging method needs to be developed in order to study the microvessels of a beating heart. Background and Objectives: The ability to study microvessels of a beating heart in real time at the level of the capillary is essential for research. However, there are no proven methods currently available to achieve this. The conventional absorption-contrast agents have limitations for studying capillaries. Microangiography with using synchrotron phase-contrast X-ray technology and no contrast agent has recently been reported on. We tried to verify this previous report, and we wanted to visualize the microvessels of a rat heart using air as a contrast agent. Materials and Methods: We made the Langendorff apparatus in a hutch of the Pohang Accelerator Laboratory. The images were obtained with a white beam and a monochromatic beam. The visual images were magnified using 3× and 20× optical microscope lenses, and the images were captured with a charge-coupled device camera. Results: We could not duplicate the previously reported findings in which microvessels were visualized without the use of contrast agent. But with using air as a contrast agent, the microvasculature of rat hearts was clearly identified at a spatial resolution of 1.2 μm. Air being absorbed inside a capillary was also observed. Vessels under 10 μm diameter were unable to be visualized with using iodine as a contrast agent. Conclusion: Phase contrast imaging already allows spatial resolution of 1 μm, which is enough to inspect capillaries. We were able to obtain images of cardiac capillaries with using air as a contrast agent. Yet air has the fatal limitations in that it causes embolism and ischemia. A more suitable contrast agent or imaging method needs to be developed in order to study the microvessels of a beating heart.

심장외폰탄수술의 조기성적

김웅한,정도현,김수철,전홍주,이창하,김욱성,오삼세,정철현,나찬영 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery Vol.31 No.7

부천세종병원에서는 '96년 8월부터 '97년 8월까지 22명의 환자에게 심장외폰탄 (extracardiac Fontan) 수술을 시행하였다. 남자 14명, 여자 8명이었으며, 진단별로는 단심실증 16명(우심실형 12명, 좌심실형 4명), 삼첨판폐쇄증 4명, 좌측이소성(left isomerism), 대혈관전위증, 심실중격결손증이 있으면서 폐동맥협착증이 있는 환자 1명, 그리고 Criss-Cross 심장이면서 비대칭심실이 있는 1명이었다. 연령은 22개월부터 26세까지 분포하였고 폐동맥압은 평균 11.7$\pm$3.1 mmHg이었다. 선행수술로 양방향성대정맥폐동맥단락술(bidirectional cavopulmonary shunt)을 시행한 환자가 15명으로 평균 15.6$\pm$3.4개월의 기간을 두고 수술을 시행하였고, 고전적 글렌 수술 후 14년만에 Fontan 수술을 시행한 환자가 1명 있었다. 전대정맥폐동맥단락술(total cavopulmonary shunt, Kawashima operation)후 폐동-정맥루(pulmonary arteriovenous fistula) 발생으로 평균 37.5$\pm$20개월만에 수술을 받은 환자가 4명 있었고, 2명의 환자는 선행수술 없이 심장외폰탄수술을 시행하였다.

헤이트스피치의 피해자인 재일코리안의 반응과 대응

김웅기(Kim Woong Ki)(金雄基) 한일민족문제학회 2017 한일민족문제연구 Vol.32 No.-

本稿は多様な在日コリアンのうち、総連系朝鮮籍者の嫌韓現象によるヘイトスピーチに対する認識に関する聞き取り調査(2014年6-8月実施)の内容を論じたものである。在日コリアン社会の構成は移住時期や国籍、政治的性向などによって細分化されており、かつては多数だった総連系朝鮮籍者は今や少数になっている。しかし、民族教育や同胞コミュニティのつながりが依然として強固であることから、可視的な集団として存在している。他の属性を持つ在日コリアンに比べ、彼らの認識にはいかなる特徴があるのかについて調査を行った。 本調査が特記するに値する特徴は以下の通りである。 第一に、差別に対する認識をはじめとする内面における葛藤を言語化する能力に長けている点である。これはその他の属性を持つ在日コリアンとの違いと言えるものであり、幼い頃から同胞コミュニティが身近に存在することで、自尊感情を毀損されて来なかったことなどが影響を及ぼしているものと思われる。 第二に、差別に抗う意思が強固である一方、権利や公的制度に対する信頼感が低い点である。在特会による京都朝鮮第一初級学校襲撃に対し、告訴を行う過程における逡巡など、これまでの弾圧の歴史によって、制度の活用や日本社会への発信などにおいて消極的にならざるを得なかった点が作用している。実際に反差別に関する発信活動を行ったある朝鮮学校教員は日本人側による執拗な嫌がらせに遭っている。 第三に、民族教育の支援者であり、感謝の対象である北朝鮮よりも、韓国の方が自らのアイデンティティを主張する上で日本社会においては有利という認識が存在している。経済的格差などに加え、金正日による日本人拉致を認める発言以降、日本社会において「朝鮮人」としてのアイデンティティを表に出すことに恐れを感じ、「韓国人」と称する方が安全という認識が存在している。政治的信念が確固たるものとなっている一部を除けば、総連系朝鮮籍者と言えども、日本社会における差別に対する差別に対する不安や苦悩の中に暮していることがわかる。 This paper discusses how pro-Chongryon Chosen-seki Zainichi Koreans perceive hate speech/crime against them escalated by anti-Korean sentiment spread by recent South Korean-Japanese international relations. Comparing to the rest of categories of Zainichi Koreans, they are relatively visible and active in that the ties of their communities and ethnic schools are still firm. The author implemented a research survey from June to August of 2014, and the research method taken was in-depth interview, and the author interviewed 55 Zainichi Koreans. Among them, seven people are pro-Chongryon Chosen-sekis. Discussions in this paper are based on the contents of the interviews to them. The findings are as follows. First, pro-Chongryon Zainichis are good at languageizing their mental conflicts occurred by discrimination. Their ethnic communities gives positive influence on their self-esteem resisting discrimination. Second, the rate of their trust in rights and public institutions is low while the intention to resist discriminiation is strong. It is because of long history of Japan’s discriminatory perception against Koreans. Third, Third, they posess perceptions that claiming South Korean identities are more advantageous than North Korean ones as far as they live in Japan. This type of perception has been possessed even by pro-Chongryons since 2002 when Kim, Jungil admitted North Korea committed abductions of Japanese people.

'-고 있'의 의미고(意味考)

김웅기(金雄起) 동악어문학회 1989 동악어문학 Vol.24 No.-

‘1965년체제’와 재일코리안

김웅기(金雄基) 한국일본문화학회 2016 日本文化學報 Vol.0 No.68

The purpose of this thesis is to discuss the reasons why Koreans in Japan have not been able to improve their social status in Japan. This thesis intends to analyze how their social status in South Korea, a divided nation overwhelming anti-communism, has imposed constraints on improving status in Japanese society. At the same time, a fact that pro-norths and pro-souths live altogether imposes political vulnerability on them. South Korean-Japanese diplomatic normalization brought Koreans in Japan logics of South Korean politics backed by anti-communism. Their loyalty toward the nation of South Korea has been endlessly doubted since both pro-Norths and pro-Souths are living altogether in Japan. From late 1970s to 1980s, many of youngsters were concocted by South Korea’s dictatorial authorities under the name of spy of North Korea. Even after South Korean society achieved democratization, diversity of political value existing in the community of Koreans in Japan has not been approved by their mother nation. This situation becomes constraints for them to assert the improvement of their social status in Japan. For the purpose of the enhancement of social status of Koreans in Japan, they should consider not only their own circumstance in Japan but also that in their mother nation.

관상동맥-폐동맥 이상기시증(Anomalous Origin of Coronary Artery from Pulmonary Artery)의 수술적 치료: 중기 성적과 좌심실 및 승모판 기능의 변화 양상에 대한 연구

김웅한,강창현,서홍주,김재현,이철,장윤희,황성욱,백만종,오삼세,나찬영,한재진,이영탁,김종환 대한흉부외과학회 2004 Journal of Chest Surgery Vol.37 No.1

심첨과 대정맥이 동측에 있는 수정대혈관전위의 해부학적 교정

김웅한,이택연,김수철,전홍주,한미영,김수진,이창하,정철현,이영탁 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery Vol.32 No.8

Over the past several years, a number of centers have reported favorable results of anatomical repair for the congenitally corrected transpositions. However, there have been subsequent problems related mainly to the results of atrial switch procedures in patients who had small atriums because of venoatrial obstructions or supraventricular arrhythmias, especially in patients with apicocaval juxtaposition. Cavopulmonary shunt may be a useful addition to the double switch operation in certain circumstances as a means of avoiding potential atrial complications. Herein, we describe the successful anatomical repair of congenitally corrected transposition of the great artery with pulmonary atresia, ventricular septal defect, and cavo apical juxtaposition with this modification.

단심실에서 폐동맥 교약술의 유용성 및 수술전략

김웅한,이영탁,박표원,김수철,임청,나찬영,오삼세,백만종,류재욱,최인석,황성욱,조준용,공준혁,이석기,박영관,김종환 대한흉부외과학회 2002 Journal of Chest Surgery Vol.35 No.6

Usefulness and Surgical Strategies of Pulmonary Artery Banding in Functional Univentricular Heart 배경 : 폐동맥 교약술은 기능성 단심실 환아에서 폐혈류가 많은 경우 시행하는 고식적 수술 방법 중의 하나이나 이들 환아의 최종 목표인 폰탄수술에 있어서는 유병율과 사망률의 위험 요소로 알려져 있다. 대상 및 방법 : 1989년 9월부터 1999년 8월까지 본원에서 기능적 단심실로 폐동맥 교약술을 시행 받은 37명의 환아를 대상으로 최소한 24개월 이상 외래 추적한 상태에서의 기록을 후향적으로 조사하였다. 수술 전후로 대동맥 협착의 유무, 대동맥하 협착의 발생 유무 그리고 수술 방법에 따른 사망률의 위험 요소를 분석하였다. 결과 : 기능적 단심실의 혈류역학을 가진 37명의 영유아에서 폐동맥 교약술 전후로 대동맥 협착이 동반된 경우는 7례였다. 폐동맥 교약후 조기 사망은 6례 (16.2%), 만기 사망은 폰탄수술후 3례 (8.1%) 였다. 조기 사망을 포함한 3년 및 5년 생존율은 각각 80.7±6.6%, 72.2±8.2%였다. 폐동맥 교약후 생존한 31명의 환아중 27명이 폰탄수술의 대상(87.1%)이 되며 이중 22명이 폰탄수술을 시행하였고(71.0%) 이 중 3명이 사망하였으며, 나머지 5명은 양방향성대정맥폐동맥단락술이나 폰탄수술을 기다리고 있다(외래 추적, 평균 4년 6개월, 최소 2년). 폐동맥 교약후 8명의 환아에서 대동맥하 협착이 발생하였으며(8/29, 27.6%), 이중 대동맥 협착이 없었던 환아에서는 3명이 발생하였고(3/22, 13.6%) 대동맥 협착이 있었던 환아에서는 5명이 발생하였다(5/7, 71.4%). 대동맥하 협착이 발생한 환아에서 초기 2명은 원추중격절제를 시행하였는데 장기 생존은 없으며 그후 6명은 Damus-Kaye-Stansel 술식을 시행하였는데 사망은 없었다. 위험 요소 분석에서 페동맥 교약술시 대동맥 협착이 동반된 경우는 향후 대동맥하 협착 발생과 매우 밀접한 관계를 가졌다 (p<0.001). 양방향성상대정맥폐동맥단락술을 거치지 않고 폰탄수술을 한 경우가 만기 사망에 있어서는 유일한 위험 요소였다 (p=0.001). 결론 : 폐혈류가 많은 기능성 단심실 환아에서 1차 고식적 수술 방법으로 폐동맥 교약술은 매우 유용한 방법이며 대동맥 협착이 동반된 고위험군에서도 단기간의 폐동맥 교약술을 거쳐 엄격한 추적관찰을 통하여 대동맥하 협착이 발생할 경우에 Damus-Kaye-Stansel 술식을 추가하는 경우 좋은 결과를 얻었다. 이러한 수술 방침으로 궁극적으로 폰탄수술에 적합한 혈류역학과 해부학적 형태를 기대할 수 있다.