食道成形術에 對한 臨床的 考察

姜信學,鄭相鳳,李章博,崔鳳洛,李鐵 계명대학교 醫科大學 外科學敎室同門會 1990 남경 박영관 교수 정년퇴임기념 논문집 Vol.S No.-

This study consists of a clinical study of 48 cases of esophageal obstruction from . either benign caustic burn or malignant lesion treated by surgery, mainly subcutaneous or substernal colon replacement. Theses were all treated at the department of surgery, Presbyterian Hospital, Taegu, Korea from January 1965 to December 1969. The age and sex distribution of these cases and the patient’s motives of having swallowed caustic materials in cases of caustic esophageal stricture have all been analysed, and discovered that most of their age range was between 21-30 years of age, and the sex ratio was 2 : 1 being the female predominant. There were 4 cases of cancer of the esophagus which were treated by either resection or colon by-pass. Interestingly enough 25 cases out of the total had been previously treated by conservative means, such as either direct esophageal bouginage or retrograde dilation through a permanent gastrostomy for months or even years unti1 they cause to definitive reconstruction surgery. The organs chosen for the replacement were mostly right and left colon and the routes were intra .thoracic, subcutaneous, and substernal. ln 25 cases from the total, the anothers used their substernal tunneller in creating the substernal space safely and bringing up the organs chosen to be anatomosed to the proximal esophagus into the neck satisfactori1y. The authors feel that the usage of the tunneller has ‘ helped them a great deal in lowering the Post-operative complications, such as pneumothorax suppurative mediastinitis, and instantaneous vascular injuries of the bowel used for replacement. The cases of fistula resulted from the leakage at the site of anastomosis which were mostly from not properly functioning end to side anastomosis, and not healed up by conservative measures were re-operated and treated by end to end anastomosis rather than just closing the fistula in the usual fashion. From the experience the auahors emphsize that it would be advisable to perform an end to end esophago-colostomy rather than end to side anastomosis in case of reconstructing. the esophagus for caustic stricture. This benefits also not only the. surgeon, but also the patients in case the distal portion of the ulcerative, scarry, esophagus which is not function needs to be removed. The authors are rather strongly convinced that the partial resection of one-third of the clavicle and portion of the sternum together with paying attention to the length of thf colon used for esophageal replacement, must be just right 50 as not to stretch the organ and injure the colon vessels, has greatly reduced the incidence of postoperative regurgitation.

Prednisolone이 淋巴組織에 미치는 影響에 關한 病理組織學的 硏究

姜信學,洪錫宰 慶北大學校 醫科大學 1973 慶北醫大雜誌 Vol.14 No.2

Prednisolone이 淋巴組織에 미치는 影響에 關한 病理組織學的 硏究

姜信學,洪錫宰 慶北大學校 醫科大學 1973 慶北醫大誌 Vol.14 No.2

著者는 成熟家兎를 實驗動物로 하여 prednisolone을 小量 乃室 大量 投與하고, 충수의 淋巴組織, 腸間膜 淋巴節, 脾小體 및 胸膜에 惹起되는 變化를 機能的 組織構造에 따라 分析的으로 檢索하여 다음과 같은 結果를 얻었다. 1) 腸關連 淋巴組織 特히 충수의 淋巴組織에서 Waksman等이 主張한 機能的 組織構造로서의 dome, corona, follicle, thymus-dependent area(TDA)등을 確認할 수 있었다. 2) Prednisolone을 投與한 家兎의 충수 淋巴組織에 있어서는 dome에서 大淋巴球와 淋巴母細胞 및 小淋巴球의 顯著한 減少와 大食細胞의 著明한 增加를, corona에서는 小淋巴球의 甚한 消失과 大食細胞의 顯著한 增加를, 그리고 follicle에서는 大淋巴球의 淋巴母細胞 및 小淋巴球의 甚한 消失과 大食細胞의 顯著한 增加를 볼 수 있었으나, TDA에서는 小淋巴球 및 淋巴母細胞가 極히 輕한 程度로 減少하였을 뿐으로서 거의 正常한 狀態가 維持되었다. 3) 腸間膜林波節에 있어서는 淋巴球小節의 重心部에서 大淋巴球와 淋巴母細胞의 甚한 消失과 細綱細胞의 著明한 增加를 볼 수 있었으며, TDA에서는 小淋巴球으 輕한 減少가 있을 뿐 뚜렷한 變化를 認定할 수 없었으며, 髓質에서는 大淋巴球가 顯著하게 增加하고 細胞分裂像도 處處에서 認定되었다. 4) 脾小體에 있어서는 種中心에서 大淋巴球와 淋巴母細胞의 顯著한 減少와 細綱細胞의 增加를 볼 수 있었고, 小體周邊帶에서는 小淋巴球의 輕度減少가 認定되었다. 5) 胸膜에 있어서는 小葉皮質에서 淋巴球의 甚한 消失과 細綱細胞의 顯著한 增加를 볼 수 있었으나 髓質에서는 淋巴球가 거의 減少되지 않고 正常한 狀態가 維持되었다. 6) Prednisolone을 投與한 家兎의 여러 淋巴組織에서 惹起된 上記한 바와 같은 變化들은 prednisolone의 投與量이 增加함에 따라 더욱 顯著하였다. 7) 以上의 實驗成績으로 보아 corticosteroid를 家兎에 投與할 때에는 垂에 있어서 B淋巴球의 産生處인 dome과 增殖處인 follicle이 主로 甚하게 侵害되고 T淋巴球가 存在하는 TDA는 別로 損傷을 받지 않으며, 腸間膜淋巴節과 脾小體에 있어서는 種中心의 細胞들이 主로 侵害되고, 赤是 TDA에 該當하는 組織은 損傷을 적게 받으며, 胸腺에서는 皮質의 淋巴球가 主로 甚하게 侵害되고 髓質의 淋巴球는 別로 損傷을 받지 않는 것으로 推定된다. This study was undertaken to investigate the changes of functional histologic structures in the lymphoi tissues of the adult rabbit treated with prednisolone. Fifteen healthy rabbits, weighing 2 to 2.5kg were divided into 4groups: Group 1. Control group three rabbits: Untreated. Group 2. Four rabbits: A dose of 5mg of prednisolone was given intramuscularly for 3 consecutive days. Group 3. Four rabbits: A dose of 10mg of prednisolone was given intramuscularly for 3 consecutive days. Group 4. Four rabbits: A dose of 20mg of prednisolone was given intramuscularly for 3 consecutive days. Each of the experimental rabbits were sacrificed 24 hours after the last treatment of prednisolone from the group 2, 3 and 4. Then the appendix, mesenteric lymph node, spleen and thymus were extirpated and examined hstologically. The results were as follows: 1) The author also was able to recognize the distinction of the functional histologic structures in the lymphoid tissue of the appendix, a dome with attached corona, a follicle and a thymusdependent area (TDA) as Waksman et al had already emphasized. 2) In the appendix of the rabbits treated with prednisolone, marked loss of large and small lymphocytes as well as marked increase of the phagocytes were noted. In the thyms-dependent area, there was a very mild decrease of the lymphocytes and the normal tissue pattern was relatively well preserved. 3) In the mesenteric lymph node, marked loss of the large lymphcytes and blasts and a remarkable increase of the reticulum cells in the germinal center were observed. It was also noted that there was only a very unnoticeable decrease of the lymphocytes in the thymus-dependent area. in the medullary portion there was a marked increase of the large lymphocytes and some mitotic figures were also seen. 4) In the splenic corpuscle marked loss of the large lymphocytes and blasts and some increase of the reticulum cells in the germinal center were noted. In the peripheral portion of the foilicle there was only a mild decrease of the small lymphocytes. 5) In the thymus severe loss of the cortical lymphocytes and remarkalbe increase of the reticular cells were observed. In the medulla of the lobule however, there was no decrease of the lymphocytes, maintaining an almost normal cellular pattern. 6) The above mentioned changes occurred in the lymphoid tissues of the rabbits treated with predniolone were quite parallel with the dosage given.

1979년도 춘계 학술대회 : 48. 이하선 질환의 외과적고찰

강신학,조희웅,강중신 () 대한외과학회 1979 대한외과학회 학술대회자료집 Vol.- No.-

食道成形術에 對한 臨床的 考察

姜信學(S.H. Kang),鄭相鳳(S.B. Chung),李章博(J.B. Lee),崔鳳洛(B.R. Choi),朴永?(Y.K. Park),李鐵(C. Lee) 대한외과학회 1971 Annals of Surgical Treatment and Research Vol.13 No.3

1978년도 춘계 학술대회 : 35. 선천성 비후성 유문협착증 - 23예 보고 -

곽재영,강신학,깅중신 () 대한외과학회 1978 대한외과학회 학술대회자료집 Vol.- No.-

제 23 차 학술대회 : 88. 문맥압 감압에 있어서 비정맥과 하공정맥의 단측문합술에 관한 새로운 수술방법

정기용,강신학,박영관,이철 대한외과학회 1971 대한외과학회 학술대회자료집 Vol.- No.-

제30차 학술대회 : 113. 쇄골하정맥을 이용한 중심정맥관 삽입술에 대한 임상적 고찰

정홍진,강신학,강중신 () 대한외과학회 1978 대한외과학회 학술대회자료집 Vol.- No.-

제30차 학술대회 : 23. 장충첩증 194예에 대한 임상적 고찰

김정균,강신학,강중신 () 대한외과학회 1978 대한외과학회 학술대회자료집 Vol.- No.-

門脈壓 減壓에 있어서 脾靜脈과 下空靜脈의 端側吻合術에 關한 새로운 手術方法

鄭紀溶,姜信學,朴永寬,李鐵 계명대학교 醫科大學 外科學敎室同門會 1990 남경 박영관 교수 정년퇴임기념 논문집 Vol.S No.-

This article deals with a report of a case with cirrhosis of the liver accompanying portal hypertension and ruptured esophageal varices in which a new operative technic for portal decompression was successfully app1ied. The operative technic was described and other decompression procedures previously described were chlonogically reviewed and discussed in some aspects of the procedures already published.