http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
오늘 본 자료
심폐바이패스 없이 시행하는 관상동맥 우회술시 고위험군 환자에서 대동맥내 풍선 펌프의 유용성
조석기,장우익,임청,이철,이재익,김용락,함병문,김기봉,Cho, Suk-Ki,Jang, Woo-Ik,Lim, Cheong,Lee, Cheul,Lee, Jae-Ik,Kim, Yong-Lak,Ham, Byung-Moon,Kim, Ki-Bong 대한흉부심장혈관외과학회 2001 Journal of Chest Surgery (J Chest Surg) Vol.34 No.12
배경 : 심폐바이패스를 하지 않고 심장박동 상태에서 시행하는 관상동맥 우회술(Off-pump Coranary Artery Bypns, OPCAB)은 심장 뒤쪽에 위치한 혈관 문합을 위해서 심첨부를 앞쪽으로 들어 올리는 등 심장의 위치를 변화시켰을 때, 심박출량 감소, 체동맥 혈압 감소, 국소적인 심근 허혈을 심화시켜 심장 기능이 떨어지게 되며 이런 변화는 고위험군 환자에서 심장 뒤쪽에 위치한 혈관문합을 어렵게 한다. 본 연구에서는 고위험군 환자에서 심폐바이패스 없이 시행하는 관상동맥 우회술시 수술 전 대동맥내 풍선펌프 사용의 안전성과 효율성을 밝히고자 하였다. 대상 및 방법 : 1998년 1월부터 2001년 4월까지 서울대학교 의과대학 흉부외과학 교실에서 시행한 OPCAB 300례 중 심장 뒤쪽 혈관의 문합이 필요하였던 189례를 대상으로 하였다. 189명 중 수술 전, 중 대동맥내 풍선펌프 삽입을 시행 받았던 환자 74례(I군, 64례는 수술 전 삽입, 10례는 수술 중 삽입)와 시행 받지 않았던 환자 115 례(II군) 의 임상 결과를 비교하였다. 술 전 대동맥내 풍선펌프 삽입의 적응증으로 심한 좌주 관상동맥 질환( 75% 폐색)이 39례, 지속적인 정맥 내 니트로글리세린과 헤파린의 주입같은 내과적 치료에 반응하지 않는 협심증이 40례, 심박출률이 35% 미만인 좌심실 기능부전이 14례, 최근 4주이내에 급성 심근경색이 있었던 심근 경색후 협심증이7례, 불안정형 협심증이 56례 등이 있었다. 결과 : 평균 원위부 문합수는 I 군이 3.5 0.9, II 군이 3.4 0.9 로 두 군 간에 차이는 없었다. I군에서는 수술 사망은 1명, II 군에서는 2명 있었다. 두 환자군 사이에서 인공호흡기 사용기간, 입원기간 등에 통계적인 차이는 없었으나 중환자실 체류기간은 I 군에서 통계적으로 유의하게 길었다. 두 환자군 사이에서 술 후 부정맥, 수술 중, 후 심근경색, 술 후 급성 신부전 등의 합병증의 발생에는 차이가 없었다. 술 후 대동맥내 풍선펌프를 사용한 시간은 평균 6.7$\pm$9.5 이었으며 대동맥내 풍선펌프와 연관된 합병증은 1명에서 발생하였다. 결론 : 저위험군 환자의 수술 성적과 비교를 통하여 술 전 대동맥내 풍선펌프를 삽입한 고위험군 환자에서 수술결과에 유의한 차이가 없음을 증명하였고 고위험군 환자에서 대동맥내 풍선펌프의 사용은 심장 뒤쪽 혈관 문합을 포함한 OPCAB을 가능케 함을 밝혔다. Background : This study aimed to evaluate the usefulness of preoperative placement of intraaortic balloon pump(IABP) in reducing operative risk and facilitating posterior vessel OPCAB in high risk patients with left main disease( 75% stenosis), intractable resting angina, postinfarction angina, or left ventricular dysfunction(ejection fraction 35%). Material and Method : One hundred eighty- nine consecutive patients who underwent multi-vessel OPCAB including posterior vessel revascularization were studied. The patients were divided into group I(n=74) that received preoperative or intraoperative IABP and group II(n=115) that did not receive IABP. In group I, there were 39 patients with left main disease, 40 patients with intractable resting angina, 14 patients with left ventricular dysfunction and 7 patients with postinfarction angina. Ten patients received intraoperative IABP support due to hemodynamic instability during OPCAB. Result : There was one operative mortality in group I and two mortalities in group II. The average number of distal anastomoses was not different between group I and group II(3.5$\pm$0.9 vs 3.4$\pm$0.9, p=ns). There were no significant differences in the number of posterior vessel anastomosis per patient between the two groups. There were no differences in ventilator support time, length of hospital stay, and morbidity between the two groups. There was one case of IABP-related complication in group I. Conclusion : IABP facilitates posterior vessel OPCAB in high risk patients, with comparable surgical results to low risk patients
권상옥(Sang Ok Kwon),이광훈(Kwang Hoon Lee),장우익(Woo Ik Jang),조한선(Han Seon Cho),차신웅(Sin Woong Cha),민병철(Byoung Chul Min),진춘조(Choon Jo Jin) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.4
Pregnancy is rarely encountered in women with cirrhosis since cirrhosis is less common in women and usually developes after the childbearing years. Additionally, cirrhosis in young women is often accompanied by severe menstrual irregularities and infertility with disturbance of estrogen metabo- lism. The managernent of the liver disease in pregnant patients is the sarne as that of normal people. Studies have shown that while pregnancy may result in a normal healthy infant, the risk of variceal hemorrhage is high, especially in the second and third trimesters. Cirrhosis seems to have an adverse effect on fetal outcome with a high incidence of stillbirths and prematurity in pregnant women. We report our experience of three episodes of pregnancy in two cases of liver cirrhosis and ascites with brief review of literatures.
간장 ( 肝臟 ) 및 담도 ( 膽道 ) : 알콜성 간질환에 있어서 혈청 Procollagen Type III Peptide 및 Laminin의 측정
권상옥(Sang Ok Kwon),이광훈(Kwang Hoon Lee),장우익(Woo Ik Jang),이동기(Dong Ki Lee),김호근(Ho Guen Kim),김현수(Hyun Soo Kim),윤갑준(Kap Jun Yoon) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.1
N/A To evaluate if serum procollagen type III peptide (P-III-P) and laminin levels reflect the extent of liver fibrosis or inflammation, we have studied 67 patients with histologically proven alcoholic liver disease and 12 non-alcoholic control with normal liver function test. The result showed that P-III-P values were significantly elevated in the patients with alcoholic hepatitis (1.87 +- 2.01 U/ml), alcoholic chronic active hepatitis (1.16 +- 1.20) and alcoholic liver cirrhosis (1.26 +- 1.50) compared to fatty liver (90.76 +- 0.49), alcoholic hepatic fibrosis (0.68 +- 0.60) and healthy controls (0.67+- 0.34 U/ml) (p<0.05). When the cut-off value for P-III-P is set at 1.25 U/ml (mean of the fatty liver+2 SD), nearly all (94.1%) of the case with elevated values above the cut-off were alcoholic hepatitis, alcoholic chronic active hepatitis and liver cirrhosis. Furthermore, a close correlation (r= 0.60) was found between the serum P-III-P and laminin (p<0.001). Although P-III-P and laminin did not appear to be particularly useful for differentiating various types of alcoholic liver disease, their concentrations seemed to be related to a degree of hepatic inflammation. And it is evident from our finding that an unexpected increase in serum P-III-P and laminin values could indicate the presence of alcoholic hepatitis, alcoholic chronic active hepatitis and alcoholic liver cirrhosis.
급성 간부전과 용혈성 빈혈로 증상 발현을 보인 Wilson 씨병
권상옥(Sang Ok Kwon),이광훈(Kwang Hoon Lee),심영학(Young Hak Shim),박진현(Jin Hyun Park),장우익(Woo Ik Jang),전근제(Geun Jae Jeon),최승옥(Seoung Ok Choi) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.1
The first manifestations of Wilsons disease are usually neuropsychiatric disorders and less fre- quently, hepatic disorders (cirrhosis or chronic hepatitis) or transient hemolytic anemia. The purpose of this work is to describe a less well known mode of onset of the disease characterized by the association of intravascular hemolysis and acute liver failure. The diagnosis of Wilson's disease was based in the presence of the Kayser-Fleischer ring and decreased serum ceruloplasmin, and acute intravascular hemolysis was based in the sudden develop- ment of anemia, the high value for the reticulocyte count, the absence of demonstrable bleeding, unconjugated hyperbilirubinemia. Necropsy revealed active liver cirrhosis, micronodular type with marked cholestasis. The mechanism of this syndrome is unknown. A hypothetical explanation might result from hepatic cell necrosis due to accumulation of copper, the consequences being acute liver failure and destruction of erythrocytes by the large amounts of copper released from the necrotic hepatic cells to the plasma. In conclusion: 1) The syndrome of acute intravascular hemolysis and acute liver failure is very suggestive of Wilsons disease. 2) This association can be the first clinical manifestation of the disease. 3) The treatment is generally unsuccessful, and the outcome is usually fatal.
류지윤,김연수,장우익,김욱성 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.3
Objective : According to the changes in the environmental factors, traumatic diaphragmatic injury is increased, especially due to traffic accident. Many reports described the early diagnostic methods and treatment modality. Method : We analyzed the traumatic diaphragmatic injury patients from the opening of our hospital to December 2002. Results : There were 7 patients (Male: Female=4:3). Sites of injury were 4 in left diaphragm and 3 in the right. 5 patients showed diaphragmatic rupture and 2 patient did diaphragmatic eventration. Emergency operation was done in 4 patient. One patients died of postoperative complications (Acute renal failure with sepsis). Conclusion : We concluded that if there is suspicion of diaphragmatic injury after a trauma, careful study and examination is essential and interdepartmental collaboration is very important to accomplish the good results.
상지 동맥 폐쇄를 동반한 흉곽출구증후군 수술 치험 : a case report
류지윤,김연수,장우익,김욱성 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.2
Thoracic outlet syndrome refers to the compression of the subclavian vessels and brachial plexus at the superior aperture of the thorax. It was previously designated according to the presumable etiologies such as scalenus anticus, costoclavicular, hyperabduction, cervical rib, and first thoracic rib syndromes. We experienced a case of thoracic outlet syndrome(cervical rib) combined with arterial obstruction of upper extremity. A 47-year-old male patient had suffered from pain, tingling sensation, and coldness of right hand. Preoperative brachial and CT angiography showed extrinsic compression of proximal subclavian artery with luminal thrombosis. Thromboendarterectomy and division of pectoralis minor tendon were done(1st operation), Transaxillary resection of first rib, cervical rib and scalenus anticus, thoracoscopic thoracic sympathicotomy and thromboendarterctomy were done(2nd operation). Thromboembolectomy was done(3rd operation). After the final operation good arterial pulsation of upper extremity was shown and maintained.