일측 폐이식 실험견에서 이식폐의 기능 평가연구

박창권 대한흉부심장혈관외과학회 1995 Journal of Chest Surgery (J Chest Surg) Vol.28 No.12

We experienced 7 cases of left single lung transplantation in 14 mongrel dogs and analyzed graft lung function by hemodynamics, blood gas analysis, chest X-ray, biopsy and perfusion lung scan. We performed right pulmonary artery cuff[PA cuff for analysis of graft lung function in 3 cases. The donor lungs were flushed with modified Euro-Collins solution[n=3 or low potassium dextran glucose solution[n=4 and preserved for 4 to 5 hours[n=4 or 24 hours[n=3 at 10o C and implanted to the dogs with similar weight . Assessment of left graft lung was done by occluding the right pulmonary artery for 10 minutes using PA cuff. Assessment for graft lung function was done immediately after an operation and after 3 days, 7days and 3 weeks postoperatively. Four dogs survived for 3days, 7days[2 cases and 3 weeks respectively. Other three dogs expired within 3 hours of reperfusion. Immediate perfusion scans of left lung in four survived dogs after reperfusion were 42.1%, 36% , 11% and 5.9% respectively, and another dog with 4.8% perfusion to left lung was dead due to left atrial thrombi after 3 hours reperfusion. In one case among three acute rejections follow-up perfusion scan was done on 3rd and 11th postoperative day and the result decreased from 36% perfusion immediate postoperatively to 21% and 15% respectively. Three expired dogs postoperatively couldn`t tolerate occlusion of right pulmonary artery with above 40 mmHg of mean pulmonary artery pressure. On the other hand, three survival dogs postoperatively tolerated occlusion of right pulmonay artery with less than 30 mmHg of mean pulmonary artery pressure. and one dog couldn`t tolerate same procedure immediate postopertively but in 2 hours reperfusion later tolerated with 29 mmHg of mean pulmonary artery pressure.In conclusion we couldn`t compare the effect of two flushing solutions but low potassium dextran glucose solution showed relatively safe preservation effect in cases with preservation of more than 20 hours. Also canine left single lung transplantation model with PA cuff indicated useful method for the assessment of graft lung function with effect of lung preservation.

효과적·탄력적인 경계 및 작전태세 강구가 중요

박창권 북한연구소 2010 北韓 Vol.- No.458

흉선종의 술후 예후판정요인의 분석

박창권 대한흉부심장혈관외과학회 1994 Journal of Chest Surgery (J Chest Surg) Vol.27 No.9

In this study, the authors analyzed the prognostic value of four clinical variables[age and sex of patients, association with myasthenia gravis and clinical stage] and histological type in 30 consecutive patients with thymoma, histologically classified as cortical[10],medullary[5] and mixed[15]type according to Marino and Muller-Hermelink classification. There were significant differences between the histological types in the frequency of the different tumor stages and myasthenia gravis and prognosis.Most of the cortical thymomas were at stage III and all of the medullary and most of the mixed tumors at stage I or II.Myasthenia gravis occurred more commonly in patients with cortical[30%] and mixed thymoma[60%] than in patients with medullary thymoma[10%]. Follow-up was conducted in 30 patients,with follow-up range from 3 months to 120 months[mean,47.3months]. 5 year actuarial survival was 100% for medullary thymoma, 73% for mixed thymoma, and 47% for cortical thymoma.The overall survival curve shows that 87.6% of the patients are alive at 2 years and 72.8% at 5 years. And 7 patients was dead during follow-up periods.By Kaplan-Meier technique, we found that the patients who had myasthenia gravis had better prognosis[P<0.05]. Medullary thymoma is a comparatively rare, benign tumor, and usually not associated with myasthenia gravis. Cortical thymoma must be regarded as malignant. Mixed thymoma is intermediate in its behavior between medullary and cortical thymoma. But these tumors should be considered potentially malignant despite of presence as stage I of II disease. Also, the patients with stageI,II had good prognosis and the patients with total resection had good prognosis[P<0.05].

폐이식 실험견에서 LPDG용액을 이용한 20시간 이상 폐보존효과 관찰

박창권,권건영,유영선,Park, Chang-Gwon,Gwon, Geon-Yeong,Yu, Yeong-Seon 대한흉부심장혈관외과학회 1997 Journal of Chest Surgery (J Chest Surg) Vol.30 No.10

연구배경. 폐이식 분야에서 이식받아야 할 공여폐의 부족은 많은 문제점으로 되어 있다. 따라서 이상적인 폐관류-보존액인 세포내액성 용액이나 세포외액성 용액의 개발을 위하여 안전하고 장기간의 폐보존이 가능 한 많은 동물실험 연구가 시행되어 지고 있다. 연구자들은 세포외액성 용액인 LPDG용액을 이용하여 20시간 이상 폐보존의 효과를 연구하기 위하여 대조군으로 세포내액성 용액인 modified Euro-Collins(MEQ용액을 사 용하였다. 방법. 실험은 평균 20 Kg 이상의 한국산 잡종견 34마리를 구하여 17마리씩 공여견과 수용 견으로 암수 구 분없이 나누어 LPDG-꽁액군이 9례 MEC용액군이 8례로써 좌측 일측폐이식술을 시행하였다. 공여폐의 보존은 1$0^{\circ}C$에서 20시간 이상 저장하였으며 각 폐관류-보존용액에 prostaglandinEl(PGEI)을 공여폐획득시에 례동맥을 통해 주입하였다. 이식폐기능의 평가는 이식폐의 재관류후에 30분, 1시간, 2시간후 그리고 술후 3일째와 7일 째 폐동맥 clef를 이용하여 혈역동학적 검사와 동맥혈액가스분석을 시행하였다. 또한 재관류 3시간후와 술후 3일, 7일째에 단순흉부 X-선 촬영, 전산화 흉부 단층촬영 및 99mTc폐관류 스캔\ulcorner 실시하였다. 전 례에서 부검 을 실시하여 병리조직학적 소견을 얻었으며 20시간 이상 폐보존후에 각 용액별 전자현미경적 폐포구조와 폐 동맥내피세포의 소견을 비교하여 보았다. 결과 이식폐의 동맥혈가스분석에서 동맥혈산소분압은 두 용액 모두에서 재관류직후 현저히 감소되었으나 재관류 2시간까지 서서히 회복이 되었으며 이는 LPDG군에서 더 증가되었으나 통계학적 의의는 없었다. 재 관류 1시간후 MEC군이 LPDG군보다 평균폐동맥압이 상승하였고(p<0.05) 재관류 1시간과 2시간에서 LPDG군 이 심박출량이 더 높았다똘<0.05). 그리고 케혈관저항도는 양군 모두 재관류 2시간까지는 감소되거나 큰 변 화가 없다가 3일과 7일까지 점차 상승되었다. 전산화 흉부단층촬영에서 LPDG군이 MEC군보다 폐음영이 재 관류직후와 술후 3일, 7일째에 비교적 나쁘게 나왔으며 폐관류 스캔에서는 재관류직후, 3일후 및 7일후에서 LPDG군이 상대적으로 높게 나왔으나 전반적으로 감소되었으며 통계적 유의성은 얼었다. 병리조직검사에서 양 군모두 82%에서 이식폐의 폐렴소견이 있었고 MEC에서 8례에서 염증소견과 그중 5례는 이식폐치 부전소 견을 보였으며 20시간 이상 폐보존후 \ulcorner자현미경검사에서 양군에서 경증의 폐동맥내피세포의 부종과 불규칙 한 돌출이 관찰되었다. 내피세포의 불규칙한 돌출은 MEC군에서 더 심하게 관찰되었다. 결론: 두 용액 모두에서 재관류직후 폐기능은 급격히 감소하였으나 2시간까지 LPDG용액은 MEC용액보다 비교적 나은 회복을 보였고 재관류 3일과 7일의 폐기능 평가에서 두 용액 모두에서 폐기능의 점차적 소실을 보였으며 이는 병리조직검사에서 보듯이 폐혐에 의한 외적인 요소라고 생각되며 따라서 LPDG용액은 허혈재관류손상 방지 및 급성폐렴 등 염증을 잘 관리한다면 20시간 이상 LPDG용액의 안전한 폐보존의 가능성 을 얻을 수 있었다. Background. Limited ischemic tolerance of the lung has remained one of the factors that limits the expansion of pulmonary transplantation as a treatment for end-stage pulmonary disease. Numerous studies on safe long term preservation for lung transplantation has been performed for the purpose of developing ideal preservation solution with extracellular type or intracellular type solutions. In this. study, we examined the efficacy of L DG solution in lung preservation longer than 20 hours by comparison with modified Euro-Collins solution. Iwethods. Thirty-(our adult mongrel dogs were divided into two groups. Donor lungs were flushed with LPDG solution(n=9) or modified Euro-Collins(MEC) solution(n=8) and stored for 24 hours at 1$0^{\circ}C$. All donor lungs were perfused through the pulmonary arteries with solutions containing prostaglandin El and verapamil. Left canine lung allotransplantations wereperformed. Assessment(hemodynamic indices and arterial blood gas analysis) of left implanted lung was made by occluding the right pulmonary artery for ten minutes using pulmonary artery Cuff. Assessment was repeated at the interval of 30 minutes, one hour, and two hours later after reperfusion and then chest X-ray, computed tomogram and lung perfusion scan were obtained. In survival dogs follow-up studies were done with assessment with chest X-ray, computed tomogram of the chest and lung perfusion scan on 7th day postoperatively. After preservation above 20 hours, pathological examinations for ultrastructural findings on right lung were performed in each group. Results. With respect to arterial oxygen tension, LPDG group was superior to MEC but there was no statistical significance for 2 hours after reperfusion. Mean pulmonary artery pressure was less increased(p < 0.05) and cardiac output higher(p <0.05) than MEC group until 2 hours after reperfusion. After 2 hours of reperfusion, both groups showed transplanted lung function deteriorated gradually. Perfusion scan of the transplanted lung in LPDG group showed better perfusion rate in immediate post-reperfusion, 3 days and 7 days later respectively but there was no statistical significance and corelation with PaO2 and computed tomoRravhic views. In scanning electron microscopy of pulmonary artery after preservation, LPDG group relatively shows less irregular protrusion of the inner surface of endothelial cell of poulmonary artery than MEC group. Conclusions, e concluded that LPDG solution can offer safe lung preservation above 20 hours with adequate immunosuppressive therapy and prevention of the infection.

중증 근무력증의 흉선절제술

박창권 대한흉부심장혈관외과학회 1992 Journal of Chest Surgery (J Chest Surg) Vol.25 No.8

Between 1979 and 1991 thymectomy was performed on 31 patients with myasthenia gravis at the department of thoracic and cardiovascular surgery, Keimyung University medical school. All patients were treated by transsternal thymectomy. During follow-up period that ranged from a month to 10.7 years[mean 2 years], the remission rate for the entire group was 16.1 percent and an additional 71.0 percent had improvement [87.1 percent benefited]. In those 8 patients with thymoma, the remission rate was 12.5 percent with 75.0 percent of the patients benefiting from operations The remainimg 23 patients fared better the operations: 17.4 percent had remission and a total of 91.4 percent benefited. There was no mortality, I concluded that most patients with myasthenia gravis will benefit from thymectomy, and that the improvement persists over an extended period of time in a high percentage of patients.

[통일의 길] 포커스 : 주한미군 고엽제 매립 파문...전화위복 계기 삼자

박창권 평화문제연구소 2011 통일한국 Vol.331 No.-

트럼프 정부의 2017 대북 선제공격 위협의 실효성 평가 : 미국의 과거 선제공격 사례 시사점을 중심으로

박창권 국가안보전략연구원 2019 국가안보와 전략 Vol.19 No.2

It was widely perceived that President Trump would choose preemptive attack option in 2017 to enforce North Korea give up its nuclear program. President Trump carried out maximum pressure strategy and at the same time escalated the overt threat of preemptive attack on North Korea. ‘War of Words’ between Trump and Kim practically enhanced such a possibility. General Brooks, the Commander of US Forces in Korea at the time, mentioned recently that the US actually considered military option on North Korea in 2017. Nevertheless, it was questionable that North Korea perceived US threat on preemptive attack as a real one. In fact, North Korea aggressively responded to the Trump’s threat without showing much fear on the coming military attack. Also, South Korea which could get affected severly by the US military action remained relatively calm under the tense situation. This paper is to evaluate the actual effect of President Trump’s preemptive attack threat to North Korea with major factors which the US considers most importantly in calculating military attack. In addition, it examined and draw implication from the previous cases of US military attack overseas toward 2017 North Korea situation. 트럼프 대통령은 2017년 북한의 핵 개발을 포기시키기 위해 선제공격을실제 이행할 가능성이 매우 높아 보였다. 트럼프 대통령은 북한에 대해 최대의 압박정책과 병행하여 가시적인 선제공격 위협을 고조시켰다. 트럼프대통령과 김정은 위원장 간의 ‘말의 전쟁’과 한반도 주변에 대한 군사력 증강, 코피작전에 대한 보도 등이 연이어졌다. 최근 브룩스 전임 주한미군사령관은 미국이 2017년 실제로 군사옵션을 고려하였다고 밝혔다. 그럼에도불구하고 이러한 미국의 선제공격 위협은 실제로 가능성이 높았는지, 그리고 북한이 이를 위협으로 인식하였는지는 불분명하다. 사실 북한은 미국의군사공격이 실제 이행될 수 있다는 두려움을 보이지 않았고 트럼프 대통령의 위협에 호전적으로 대응하였다. 미국의 대북 군사공격에 가장 심각한악영향을 받을 수 있는 한국 역시 비록 불안한 사회적 분위기는 있었으나경제 등 제반 분야에서 위기의식은 높게 나타나지 않았었다. 본 연구는 트럼프 대통령의 선제공격 위협이 실제적으로 효과가 있었던 위협이었는가를정성적으로 평가하고자 한다. 미국이 군사공격을 결정하고 이행할 때 고려하는 정치적, 군사적 요소들과 미국이 베트남전 이후 이행하였던 군사공격사례의 시사점들을 기반으로 평가하였다. 본 논문은 트럼프 대통령의 선제공격 위협이 비록 목소리는 높았으나 실제로 이행될 가능성은 높지 않았으며, 결과적으로 북한에 대한 위협으로도 크게 작용하지 않았다고 주장한다.

연구논문 : 전쟁발발 가능성 통제하면서 대북압박 가할 수 있는 군사적 선택방안

박창권,김명진 평화문제연구소 2006 통일한국 Vol.276 No.-

북한 탄도미사일 위협의 실상과 한국의 억제전략

박창권 북한연구소 2012 北韓 Vol.- No.488

11.10 대청해전 완승 의미와 시사점

박창권 북한연구소 2009 北韓 Vol.- No.456