심부정맥혈전을 동반한 폐색전의 임상분석

권굉보,서보양,손대호 대한혈관외과학회 1996 Vascular Specialist International Vol.12 No.1

Most current articles on venous thromboembolism begin with the statement that pulmonary embolism(PE) is a common problem and remains a significant cause of mortality in the western countries in spite of recent development in diagnostic and therapeutic mordality. In korea clinically apparent PE was reported infrequently probably due to rare incidence and small mumber of autopsy. Authors evaluated clinical symptoms,diagnostic modality and therapeutic results of clinical PE which was associated with Deep Vein Thrombosis(DVT) in 6 cases at Department of Surgery, Yeungnam University Hospital. For diagnosis of PE, chest x-ray, EKG, lung perfusion scan and pulmonary angiography were performed and reviewed literatures. Mean age was 41.5 years old with range of 21∼64. Male to female ratio was 3: 3 and mean hospital stay was 29 days. EKG and chest abnormality were found in 3 cases respectively. According to classification of lung perfusion scan in PE,moderate probability in 5 cases and intermediate probability in I case were noted. Treatment modalities were heparin and coumadin in all cases, Inferior Vena Cava(IVC) plication in 1 case of recurrent PE, and IVC ligation in 1 case of septic PE. All patients were recovered without any complication. In conclusion,although incidence of PE associated with DVT is uncertain and rare in korea, major concern and meticulous inspection are required to detect PE and to decrease mortality.

Vasopressin의 지속적 경정맥 주입시 Nifedipine이 관상동맥과 문맥혈류에 미치는 영향

서보양,심민철,박동일,김홍진,권굉보 대한응급의학회 1991 대한응급의학회지 Vol.2 No.1

Vasopressin(Pitressin), when used to control gastrointestinal bleeding, has been shown to significantly reduce coronary flow. Our purpose was to determine of Nifedipine could be used to counteract Vasopressin's coronary effect. Six mongrel dogs, weighing approximately 25kg, underwent laparotomy and left thoracotomy under pentobarbital anesthesia. Electromagnetic flowmeter probes were used to measure blood flow in the circumflex coronary artery(CCF), the superior mesenteric artery(SMAF) and portal vein(PVFP). Portal venous pressure(PP), femoral arterial and Swan-Ganz catheters were inserted. After baseline control parameters were recorded, Pitressin was administered at a continuous rate of 0.04U/kg/min. When all parameters stabilized, Nifedipine was infused at 0.3㎍/kg/min. Under Pitressin infusion PVP, PP, SMAF, CCF and cardiac output decreased by an average of 43.4, 73.1, 56.8, 54.8 and 59.1% respectively. When Nifedipine was added to Pitressin unfusion, CCF and cardiac output increased significantly, averaging 105 and 83.5% of control, respectively ; SMAF also increased moderately to an average of 76% of control value. However, both PVF and PP remained lower than control by average of 59.7 and 78.1% respectively. These data indicate that with Pitressin and Nifedipine infusion PVP and PP were reduced significantly while CCF and cardiac output were preserved.

합리적인 진료시스템, '개방병원' 활성화 바란다

권굉보,Gwon, Goeng-Bo 한국과학기술단체총연합회 2006 과학과 기술 Vol.39 No.1

출혈성 쇼크의 인공소생에 있어 고장식염용액이 혈액산소운반 및 조직에서의 산소소비에 미치는 영향

김재황,정연웅,박동일,심민철,권굉보 대한응급의학회 1990 대한응급의학회지 Vol.1 No.1

Recently it has been reported and confirmed that hypertonic salt sloution is more effective than sostonic salt soultion in resuscitation from hemorrhagic shock. However the direct correlation of improved hemodynamics with oxygen consumption and restored cellular function has not been clearly evaluated. Authors conducted an experiment of evaluate the changes of cellular function after hypertonic resuscitation by means of observing the tissue oxygen consumption, blood PH and oxygen delivery. 15 dogs were divided into 3 groups with 5 dogs each, and bled to shock(MAP : mean arterial presssure : 70mmHg). Normal saline(Group Ⅰ: 300mOsm), 3% Nacl(Group Ⅱ : 1000mOsm) and 3% Nacl 5% Dextan 40(Group Ⅲ : 1100mOsm) solution were used for resuscitation in each group. Changes of hemodynamics and blood gas were observed. Hemodynamic improvement was dramatic in hypertonic groups as shown on our previous report(1). Arterial oxygen delivery was increased in all groups after resuscitation and no significant differences between groups were noted. Mixed venous oxygen delivery increased in all groups at immediate resuscitation, but it increased significantly in hypertonic group by 90 minutes. Tissue oxygen consumption decreased in hypertonic group more than isotonic group immediately after resuscitation (GⅠ126.8㎖ O₂/㎖, GⅡ 76.5㎖ O₂/㎖, GⅢ 75.4㎖ O₂/㎖). But after 90 minutes, it decreased to 43.4㎖ O₂/min in GⅠ, and increased upto 99.3㎖ O₂/min, 84.8㎖ O₂/min in GⅡ GⅢ, each. In conclusion, tissue O₂consuption and PH were not improved immediately after hypertonic resuscitation in spite of dramatic improvement of hemodynamics, but they gradually improved to normal range. The serum PH change was correlated with the tissue O₂consumption. In isotonic Group, the sustained increased in MAP could not improve the tissue O₂consumption and PH effectively.

두강내 출혈 및 출혈성 경향을 동반한 선천성 담관 낭종 : 1예 보고와 문헌보고 Report of a case and review of literature

박영복,이명우,김홍진,권굉보 영남대학교 의과대학 1985 Yeungnam University Journal of Medicine Vol.2 No.1

저자들은 3개월 된 남아에서 생긴 선천성 담관낭종으로 인해 vitamin K 흡수 장애로 출혈성 경향이 생기면서 두강내 혈종을 동반한 1예를 치험하였기에 문헌고찰과 함께 보고하는 바이다. vitamin K를 주사하여 출혈성 경향을 교정하고 두강내혈종을 제거한 뒤 담관낭종 절제 및 담관공장 문합술을 시행하였으며, 술후 경과는 양호 했다. Congenital dilatation of the common bile duct is relatively rare anomaly. Its pathogenesis has not been completely understood. Complications of the choledochal cyst are mainly suppuratneous and traumatic rupture. We experienced one case of choledochal cyst associated with hemorrhagic tendency and a cerebral hematoma, which is extremely rare complication. The 3 months old male patient reported here was treated with complete excision of cyst and Roux-en- Y choledochojejunostomy after correction of bleeding tendency and removal of cerebral hematoma. Postoperative course was relatively uneventful. 11 days after operation, the patient was discharged with full improvement.

출혈성 쇼크시 전신혈역학 변동이 간혈류 및 간세포 기능에 미치는 영향

이상일,이상춘,박동일,이석강,김홍진,서보양,심민철,권굉보 대한응급의학회 1990 대한응급의학회지 Vol.1 No.1

It has been well known that the liver plays a central role in body energy metabolism. Reduced circulating blood volum and arterial hypotension in hemorrhagic shock may cause changes in hepatic blood flow, consequent derangement of hepatocyte functions, and alteration of hepatic energy metalbolism. An accurate assessment of hepatic funciton and hepatic energy during hemorrhagic shock may enable the estimation of the degree of shock. In order to investigage the changes in energy matablism and hepatocyte function during hemorrhagic shock the author conducted the following experiment. Hemorrhagic shocks were induced in 15 adult mongrel dogs by modified Wigger's method. Each dog bled to shock from 120mmHg to 60mmHg and maintained this level for 3 hours. Hemodynamic changes, arterial ketone body ratio, tissue oxygen consumption and liver function were monitored. The results were as follows ; 1) Cardiac output was decreased significantly throughout shock period. 2) Lactate level was increased significantly during shock. 3) SGOT, SGPT, LDH, and ALP were slightly increased during shock, but not statistically significant. 4) Arterial ketone body ratio was markedly decreased immediately after shock and remained low throughout the shock period. 5) Hepatic arterial blood flow was decreased significantly during shock, but portal vein and total hepatic blood flow were slightly decreased after one hour of shock and relatively wel maintained through the third hour of shock. 6) Systemic oxygen consumption was decreased significantly after shock but hepatic oxygen consumption was slightly decreased until late in shock. In conclusion, total hepatic blood flow and hepatic oxygen consumption were relatively well maintained until late in hemorrhagic shock in spite of severe reduction of cardiac output and total oxygen cnosumption, which suggested that the liver displayed more efficient oxygen utilization capacity than other organs. KBR was not correlated with hepatic blood flow and hepatic oxygen consumption.

Oxygen Delivery in Shock

권굉보 대한외과학회 1987 대한외과학회 학술대회자료집 Vol.- No.-

Insulinoma 1례 보고

송선교,박성훈,권굉보 영남대학교 의과대학 1988 Yeungnam University Journal of Medicine Vol.5 No.1

저자들은 경련성 발작후 의식소실이 자주 발생하였으며 그로 인해 항경련제를 장기간 투여하였고 저혈당으로 인한 의식소실의 상태로 내원한 비만한 여자 성인 환자에게 Insulinoma를 경험하였기에 문헌고찰과 함께 보고하고자 한다. Insulinoma is the most frequent endocrine of the pancreas and the first of the endocrine-secreting tumor of the gut to be recognized by Nicholls in 1902. Recurrent episodes of hypoglycemia is the main cause of the symptoms and signs which were sweating, pallor, dizziness, habitual change, convulsion and coma. In 1935, Whipple and Frants were described so-called "Whipple's triad": the patient's symptoms occur with fasting or exercise ; at the time of symptoms, the serum glucose in 50mg/dl or less ; and the symptoms are relieved by the administration of glucose. While these criteria were timely, they proved to be rather nonspecific and may be found in other conditions that result in fasting hypoglycemia. We experienced a 44-year-old female patient who had repeated attacks of convulsion, unconsciousness and coma for 3 years. Although she has been treated with anticonvulsant, the symptoms and signs were not disappeared. At the time of administration, she was a full coma state due to hypoglycemia and was dramatically reversed by intravenous administration of the glucose solution. The preoperative test such as provocative test, abdominal CT and celiac angiography revealed insulinoma and after enucleation the pathologic diagnosis was the same. We like to report a adult female patient with insulinoma and the review of literatures briefly.

응급의학과에서의 인공호흡기 처치

이삼범,도호석,도병수,이창현,심민철,권굉보 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

Study Objectives : To investigate and resolve the problems related with ventilator management in ED(emergency department). At present the ventilator is essential equipment of ED on university hospital and emergency center in Korea. Design : Retrospective consecutive case series. Setting : University teaching hospital Type of participants : All patients admitted and recieved ventilator management in ED of yeungnam university hospital from Jan. 1994 to jul. 1995. Methods and interventions : Charts of all patients were reviewed to determine the frequency, the types and causes of respiratory failure, the death rate, the mean duration of admission, the complications, and CPR(cardiopulmonary resuscitation) related with ventilator management in ED. We also identified the problems related with ventilator management by ED physicians and nurses through the answers to seven questions that suggested by us about ventilator management in ED. Measurements and main result : There were 34,751 admissions through ED during the study period. Of these 160 patients managed with ventilator in ED. The frequency of ventilator management in ED is increased at 1995(0.73%) that compared with 1994(0.32%). Non-trauma(113 cases) and hypoxic respiratory failure(83 cases) patients are more common than trauma(37 cases) and ventilatory failure Total CPR rate related with ventilator management are 25.3%. The mean duration of admission are 12.56±20.28 days, and the death rates are 45.3%. The incidence of complications occurred during ventilator management in ED are 37 cases. About seven questions suggested by us to 30 ED staffs(ED physician, nurses and paramedics), most frequent answer is the difficulty of keeping ventilator in ED because other department rent ventilator from ED and lost a part of ventilator. Conclusion : As the use of ventilator in ED is increased the emergency physician should be well trained for the indications, complications, setting mode and general problems of machine occurred during ventilator management in ED patients.

원발성 정맥류시 판막 성형술의 효과

권굉보,서보양,도병수,권우형 대한혈관외과학회 1993 Vascular Specialist International Vol.9 No.1

Current radical stripping technique for treating primary varicose vein has some disadvantages, in which the vein is no longer available for coronary and peripheral graft surgery. The valvuloplasty is a new, safe and advanced vascular surgical technique, and can also preserve great saphenous vein for further vascular bypass grafts. Two hemodynamic tests of Duplex scan and photophlethysmography were performed pre-and postoperatively in 12 among 15 patients who underwent valvuloplasty. The results were as follows: The male and female ratio was 5 to 7 and average age was 38.5 years with a range of 21-52 years. The clinical symptoms of calf pain(n=6) and tortuous veins(n=12) were all improved after valvuloplasty, but in l case, the heaviness of leg, venous engorgement and swelling were not improved. The reflux on Duplex scan was not found postoperatively except 1 case. The venous refilling times with PPG were 9.41±0.69 second preoperatively and 18.83±0.90 second postoperatively. In conclusion, treatment of the primary varicose vein using valvuloplasty is a new, and effective method that can preserve the valvular competence.