Partial Pericardial Defect Incidentally Discovered During Coronary Bypass Surgery

손국희,손호성,최은정,선경 대한의학회 2010 Journal of Korean medical science Vol.25 No.1

A 71-yr-old male patient with three vessel coronary artery disease underwent a coronary artery bypass graft. The patient was found to have a large pericardial defect at the apex of the heart that measured approximately 18 cm in circumference. The edge of the pericardial defect impinged on the epicardial coronary arteries. The left phrenic nerve descended via the dorsal boundary of the pericardial defect. Following coronary artery bypass grafting, the pericardial defect was repaired with a polytetrafluorethylene patch. The patient had an uncomplicated postoperative course.

인공 건삭과 판막륜 성형술을 이용한 외상 후 삼첨판 부전증의 치료

손국희,손호성,정재호,정원재,선경,이성호 대한흉부외과학회 2008 Journal of Chest Surgery (J Chest Surg) Vol.41 No.4

A 52-year-old man was taken to the emergency room following a motor vehicle accident. An echocardiogram showed moderate to severe tricuspid regurgitation due to rupture of the anterior chordae. An operation to repair the traumatic tricuspid regurgitation was recommended; however, the patient refused because he was asymptomatic. Two years later, he developed mild generalized edema and dyspnea. The echocardiogram revealed progressive severe tricuspid regurgitation and annular dilatation. We treated the posttraumatic tricuspid regurgitation successfully using artificial chordae and ring annuloplasty.

의식 있는 상태에서 경막외 마취를 이용한 심박동하 관상동맥우회술: 초기 경험

손국희,조광리,김기봉 대한흉부외과학회 2006 Journal of Chest Surgery (J Chest Surg) Vol.39 No.8

배경: 경막외 마취를 이용하여 의식 있는 환자에서 관상동맥우회술을 시행하는 경우 기계 환기 및 전신 마취에 의한 합병증을 피할 수 있는 장점들이 기대된다. 대상 및 방법: 2005년 4월부터 2005년 9월까지 12명의 환자를 대상으로 상흉부 경막외 마취를 이용하여 의식이 있는 상태에서 심폐바이패스를 사용하지 않는 관상동맥우회술을 시행하였다. 1명은 여자였고 11명은 남자였으며 평균 연령은 66 6세였다. 정중 흉골 절개술을 시행한 후 동맥도관만을 이용하여 관상동맥우회술을 시행하였다. 결과: 평균 원위부 문합수는 1.8 0.9 (1∼3)이었으며, 수술사망 예는 없었다. 수술을 시행하는 동안 모두 8명의 환자에서 기흉이 발생하였으며, 수술 중 기흉(n=3), 복부내장의 팽창(n=1), 흉관 삽입 후 발생한 혈흉(n=1) 등의 원인으로 12명 중 5명의 환자에서는 기관 삽관 후 전신마취로 전환이 필요하였다. 모든 환자에서 수술 후 1.2 0.6일째에 관상동맥조영술을 시행하였으며, 모든 우회도관은 개통되어 있었다. 결론: 본원의 초기 경험을 통해 전신 마취를 하지 않고 의식이 있는 상태에서 심폐바이패스를 사용하지 않는 관상동맥우회술을 시행하는 것이 가능함을 확인할 수 있었다. 이러한 수술 방법의 적응증 및 제한점에 대해서는 향후 경험을 통한 추가적인 연구가 필요할 것으로 생각된다.

수장부 다한증에서의 제3번 늑골 위 교감 신경(R3) 차단술의 중기 결과

손국희,김광호,백완기,김정택,김현태,김영삼,윤용한 대한흉부외과학회 2004 Journal of Chest Surgery (J Chest Surg) Vol.37 No.6

Background: Thoracoscopic R3 (above the third rib)sympathicotomy has been performed as an effective method in treating palmar hyperhidrosis because it is effective in eliminating the symptoms of hyperhidrosis and has lower degree of compensatory hyperhidrosis than that of sympathectomy. Most of the results published were based on the short-term follow up. So we evaluated the intermediate term follow up results of the R3 sympathicotomy. Material and Method: From April 1999 to August 2001, ninety-four patients with palmar hyperhidrosis had been treated by R3 sympathicotomy at the Inha University Hospital. Follow-up study was completed for 76 patients (male 38, female 38) and average follow-up period were 25±9.1 (15~50) months. The sympathetic trunk passing above the upper border of third rib was divided by electric cautery. The patient's satisfaction after surgery was estimated using the analogue scale from score 0 to 100 (100 means perfect satisfaction). Result: The scale of patient's satisfaction immediately after operation was 92.36±9.93. After 15 months, the scale of satisfaction was decreased to average 71.80±20.24 and it is statiscally significant. The cause of dissatisfaction were compensatory hyperhidrosis and recurrence of symptom. The degree of sweating immediately after operation was mean 0 and after 15 months it increased to mean 1.5. The degree of the compensatory hyperhidrosis immediately after operation was mean 1 and it increased to mean 5 after 15 months. Conclusion: R3 sympathicotomy has excellent therapeutic results immediately after operation but therapeutic effectiveness is becoming to decrease 15 months after operation. The common causes of dissatisfaction are compensatory hyperhidrosis and recurrence of hyperhidrosis. 배경: 수부 다한증을 치료하기 위해 시행하는 제3번 늑골 위 교감신경 차단술의 경우 다한증 치료 효과는 교감신경 절제술과 유사하면서 보상성 다한증의 발생이 교감신경절제술보다 적다는 연구결과들이 많이 있으나 대부분 단기 결과이며 중기 추적 결과가 발표되어 있지 않아 제3번 늑골 위 교감신경 차단술의 중기 추적을 시행하였다. 대상 및 방법: 인하대학병원 흉부외과에서 99년 4월부터 2001년 8월까지 제3번 늑골 위 교감신경 차단술을 시행한 환자 94명 중 설문조사가 가능했던 76명(남자 38명, 여자 38명)을 대상으로 전화 설문을 시행하여 평균 25 9.1개월 간(15∼50개월)의 중기 결과를 추적하였다. 교감신경은 3번째 늑골 상방에서 절단하였다. 환자들의 만족도를 알기 위하여 linear analogue scale을 사용하였다(100: 가장 만족함). 결과: 수술 후 만족도에 관한 질문에서 100점 만점 기준일 때 수술 직후 만족도가 92.36 9.93인데 비해 수술 후 15개월에는 71.80 20.24로 만족도가 감소하였으며(p<0.001) 이러한 만족도 감소의 이유는 보상성 다한증과 증상 재발 때문이었다. 땀나는 정도도 수술 직후 중앙값 0에서 15개월 후 중앙값 1.5로 증가하였다. 보상성 다한증의 경우 수술 직후 중앙값 1에서 수술 15개월 후 5로 증가하였다. 결론: 이와 같은 결과로 제3번 늑골 위 교감 신경 차단술의 경우 수술 직후에는 훌륭한 치료 효과를 보이나 수술 15개월 후에는 치료효과가 점차 감소한다. 불만족의 가장 흔한 이유는 보상성 다한증과 다한증의 재발이다.

신생아 긴장성 심막 기종

손국희,윤용한,김영삼,백완기,김광호,성태정,전용훈,김정택 대한흉부외과학회 2004 Journal of Chest Surgery (J Chest Surg) Vol.37 No.5

Neonatal tension pneumopericardium is a serious disease that requires prompt diagnosis and treatment. If untreated, it may lead to cardiac tamponade and death. We report a case of neonatal tension pneumopericardium which was succesfully treated by open pericardial window operation with review of literatures. 신생아에서 발생한 긴장성 심막 기종은 매우 심각하며 즉각적인 치료를 하지 않으면 심장 압전증(cardiac tamponade)에 의해 사망하는 것으로 알려져 있다. 저자들은 기계 환기 중 발생한 긴장성 심막 기종을 조기에 진단하고 개방성 심낭막 개창술로 치료하였기에 문헌 고찰과 더불어 보고하는 바이다.

Prosthetic Grafting and Arteriovenous Fistula for the Surgical Management of a Common Femoral Vein Injury Using a Staged Approach

손국희,이소영,강진모,최창휴,박국양,박철현 대한흉부외과학회 2017 Journal of Chest Surgery (J Chest Surg) Vol.50 No.2

A 27-year-old female patient was referred due to an edematous left lower extremity. Both saphenous veins had been ablated with an endovenous laser procedure used to treat varicose veins. Venography revealed that the left common femoral vein had been divided and that thrombosis was present at the site of division. No veins were available around the thighs. The patient was treated using a staged procedure. During the first stage, a ringed polytetrafluoroethylene graft was used to repair the common femoral vein, and an arteriovenous fistula was constructed from the femoral artery to the graft using a short segment of cephalic vein to increase graft patency. The edema was relieved postoperatively and the graft was patent. During the second stage, which was performed 6 months later, the fistula was occluded by coil embolization. The staged procedure described herein provides an alternative for venous reconstruction when autologous vein is unavailable.

Endovascular Rescue of a Narrowed Aorto-Aortic Bypass Graft in a Patient with Takayasu’s Arteritis

손국희,김지성,김정호,정욱진,안수좌,박철현 대한흉부외과학회 2014 Journal of Chest Surgery (J Chest Surg) Vol.47 No.6

We report a case of successful endovascular treatment of a pseudoaneurysm and the obstruction of an aorto-aortic bypass graft, which had been performed to treat Takayasu’s arteritis fifteen years prior, at the thoracic aorta. Along with the immediate relief of proximal hypertension that had caused severe heart failure, the successful exclusion of the pseudoaneurysm and the patency of the stem graft were maintained three years after the procedure.

공문서에 나타난 어휘,문장 오류 분석을 통해 공무원에게 요구되는 문법 지식 연구

손국희 신라대학교 교육과학연구소 2012 교육과학연구 Vol.18 No.-

A Korean Multi-Center Survey about Warfarin Management before Gastroenterological Endoscopy in Patients with a History of Mechanical Valve Replacement Surgery

손국희,최창휴,이재익,김건우,김지성,이소영,박국양,박철현 대한흉부외과학회 2016 Journal of Chest Surgery (J Chest Surg) Vol.49 No.5

Background: Guidelines for esophagogastroduodenoscopy (EGD) in the West allow the continued use of warfarin under therapeutic international normalized ratio (INR) level. In Korea, no guidelines have been issued regarding warfarin treatment before EGD. The authors surveyed Korean cardiac surgeons about how Korean cardiac surgeons handle warfarin therapy before EGD using a questionnaire. Participants were requested to make decisions regarding the continuation of warfarin therapy in two hypothetical cases. Methods: The questionnaire was administered to cardiac surgeons and consisted of eight questions, including two case scenarios. Results: Thirty- six cardiac surgeons at 28 hospitals participated in the survey, and 52.7% of the participants chose to stop warfarin before EGD in aortic valve replacement patients without risk factors for thromboembolism. When the patient’s INR level was 2, 31% of the participants indicated that they would choose to continue warfarin therapy. For EGD with biopsy, 72.2% of the participants chose warfarin withdrawal, and 25% of the participants chose heparin replacement. In mitral valve replacement patients, 47.2% of the participants chose to discontinue warfarin, and 22.2% of the participants chose heparin replacement. For EGD with biopsy in patients with a mitral valve replacement, 58.3% of the participants chose to stop warfarin, and 41.7% of the participants chose heparin replacement. Conclusion: This study demonstrated that attitudes regarding warfarin treatment for EGD are very different among Korean surgeons. Guidelines specific to the Korean population are required.

수술 후 중환자실 치료 중 발생한 Takotsubo 심근병증

손국희,김광택,선경,손호성,송재윤,이성호,정재승,김용현 대한중환자의학회 2009 Acute and Critical Care Vol.24 No.3

`Takotsubo cardiomyopathy` or `stress-induced cardiomyopathy` is a newly described clinical entity that`s characterized by transient left ventricular apical ballooning and left ventricular apical dyskinesis in the absence of any angiographic feature of significant coronary artery disease. The cause of takotsubo cardiomyopathy is unclear, but catecholamines probably play a role in the genesis of takotsubo cardiomyopathy. We report here on two cases of takotsubo cardiomyopathy that occurred during ICU care.