Carney' Complex 소견을 보이는 가족성 심방 점액종 - 치험 1례-

김명천,이재영,박주철,유세영,조규석 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery Vol.31 No.8

Myxomas are the most common form of intracardiac tumors and are found primarily in the left atrium. In rare cases, Carney and associates have described a syndrome called "the complex of myxoma" consisting of cardiac myxoma, which characteristically is familial, in assocation with two or more of the follow conditions: myxomatous masses (cardiac myxoma, cutaneous myxosma, and mammary myxoid fibroademoma), spotty pigmented lesions of the skin, and endocrine disorders. We report a case of familial atrial myxoma with Carney's complex in a 19-year old woman who has spotty pigmentations on her face, and left atrial myxomas, and myxoma on the right nipple. Her mother and sister share the left atrial myxoma. The myxomas originated in the septum of the left atrium and the anterior leaflet of the mitral valve were successfully excised. In conclusion, family members of affected patients should be screened periodically with echocardiography in an attempt to identify asymptomatic cardiac myxomas. Complete excision and postoperative follow up are necessary to rule out the muticentricity and high rate of recurrent lesions.

기관 폐쇄 병변에서 시행된 기관 절제 및 재건술에 대한 결과

김명천,박주철,조규석,유세영,김범식 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery Vol.31 No.8

Background: There are various tracheal diseseas which cause the obstruction of the trachea: postintubation tracheal stenosis, tracheal cancer, thyroid cancer, endotracheal tuberculosis, et al. Recently surgical resection and reconstruction of the trachea has been adopted as the safe method for tracheal lesions. Materials and methods: We report our experience and results of resection and reconstruction for various obstructive tracheal lesions in 38cases from 1985 to 1996. Length of resection of the trachea was up to 6 cm. Twenty lesions were approached by cervical collar incision, 12 lesions by cervicosternal incision and 4cases needed transthoracic approach. Surgical procedures consisted of resection and tracheotracheal anastomosis in 32 cases, resection and laryngotracheal anastomosis in 6cases and in addition laryngeal release was necessary to release anastomotic tension in 3cases. Results: The complications were 4 minor wound infections, 2 mild suture line granulomas, 1 vocal cord palsy, 2 pneumonias and 1 systemic candidiasis. Two patients who had poor consciousness and pnemonia and one who developed systemic candidiasis were expired after operation. Conclusion: We suggests resection and reconstruction of trachea is optimal procedure for up to 6cm long tracheal lesions. However, for the patients with poor consciousness or poor general conditions would be the conservative treatment preferred to the tracheal reconstruction because of high serious complications and mortalities.

기타소식들 / 지방회소식 : 뉴스 , 캠페인 , 현안문제 , 기도제목

김명천 기독교대한성결교회 활천사 2001 활천 Vol.571 No.-

외상성 좌측주기관지 절단환자의 지연수술 치험

김명천,이재영,조규식,박주철,유세영 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery Vol.31 No.2

Recently, The non-penetrating injury of bronchus has been increased, especially by traffic accident. Early diagnosis and primary repair of bronchial injury not only restore normal lung function but also avoid the difficulties and complications associated with delayed diagnosis and repair. This report describes about a case of total collapse and consolidation of left lung with the complete transection of nearly bifurcated portion of left main bronchus , lasted for 2weeks after traffic accident. This was diagnosed by fiberbronchoscopy and 3-D chest computed tomography(CT). She underwent the sleeve resection and end to end anastomosis, and postoperative PEEP for 2 days, suctioning twice by fiberbronchoscopy, continue postural drainge and physiotherapy were applied. She had almost full expansion of the left lung at discharge.

독시라민 중독에서 발견되는 혈뇨와 그 임상적 의의

박상혁,김명천,홍훈표,임천규,고영관,최한성 대한신장학회 2005 Kidney Research and Clinical Practice Vol.24 No.4

Background:Doxylamine is the most commonly intoxicated drug in the emergency room. This drug is relatively safe but is known to induce rhabdomyolysis and acute renal failure in rare occasions. We found the presence of microscopic hematuria in doxylamine intoxicated patients. But no previous studies have documented this hematuria. Our objectives of this study were to determine the incidence of microscopic hematuria after doxylamine overdose and to find the prognostic factors that contribute to this complication. Methods:This study was conducted from 22 patients admitted to Kyung Hee Medical Center after doxylamine intoxication during the period from January 2001 to December 2003. Using the protocol made beforehand, the amount ingested, past history and laboratory results were recorded. Rhabdomyolysis was defined as serum myoglobin over 300 ng/mL or serum creatine phosphokinase (CK) over 1,000 IU/L. Data were analyzed using SPSS program with t- test, Fisher's exact test and discriminant analysis. Results:The microscopic hematuria was detected in 63.6% of patients. The amount ingested per body weight, presence of rhabdomyolysis and the time when the muscle enzymes reach highest level were related to the hematuria. Conclusion:The incidence of microscopic hematuria was higher when more than 30 mg per body weight of doxylamine was ingested than less this amount. Microscopic hematuria suggests the presence of kidney and urinary tract injury. Urine pH of hematuria is over 7.5. Our findings provide no support for the belief that the ferrihemate injures the kidney of doxylamine ingested patients. (Korean J Nephrol 2005;24(4):618-625) 목 적:독시라민은 수면효과를 지닌 항히스타민제이며 다량 복용하면 횡문근융해증과 급성신부전증까지 초래할 수 있는 것으로 알려져 있다. 독시라민 중독환자들 중에서 실험실검사를 하루 1-2회씩 추적관찰 중에 초기검사에서 정상이었던 소변검사에서 혈뇨가 발견되어, 진단 및 처치에서 혼선을 초래하는 경우가 많았다. 이에 독시라민 중독환자에게서 실제로 혈뇨가 발생하는지와 그 임상적 의의를 알아보고자 하였다. 방 법:2001년부터 2003년까지 독시라민 중독환자를 대상으로 하여 환자들의 의무기록을 후향적으로 조사하여 22명을 선정하였고, 2001년 동안 도뇨관을 삽입하였던 외과중환자실의 다른 환자 96명을 선정하여 혈뇨의 발생여부와 임상적 특징을 비교하였다. 결 과:독시라민 중독환자에게 혈뇨가 발생하였고 대조군과는 유의한 차이가 있었다. 혈뇨는 복용량과의 관계가 있으며, 근육효소수치가 최고점인 시기와 관련이 있었고, 횡문근융해증이 합병된 환자의 대부분에서 발견되었다. 결 론:혈뇨가 발생한 환자에게서 혈뇨가 사라질 때까지 특별한 합병증이 발생하지 않았다면 더 이상의 문제가 없을 수 있다는 예상을 할 수 있고, 또한 퇴원 시기 결정에 도움을 줄 수 있을 것으로 생각된다. 또한 독시라민의 중독에서 발생하는 혈뇨는 횡문근융해증과 유의한 연관이 있었다.

급성 허혈성 뇌졸중에 대한 동맥내 혈전 용해술 후 발생한 혈복증 1예

정성구,김명천,고영관 대한응급의학회 2001 대한응급의학회지 Vol.12 No.2

Although thrombolytic therapy is one of the most effective therapeutic option for acute ischemic stroke, hemorrhagic complication still remains major concern about its application. A patient with hemoperitoneum, who previously underwent thrombolytic therapy(intraarterial urokinase infusion, IAUK) for acute ischemic stroke was treated successfully with emergency transarterial embolization for rupture of hepatocellular carcinoma. We present a rare case of rupture of hepatocellular carcinoma after intraarterial urokinase infusion for acute ischemic stroke with brief review of the literature.

다한증의 흉강경을 이용한 교감신경절 절제술

이재영,김명천,조규석 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery Vol.31 No.3

Exessive sweating of the palms and soles, is a psychologically and occupationally distressing and sometimes disabling condition. Hyperhidrosis is one of the common abnormalities in autonomic nervous system. There were no specific treatment on hyperhidrosis, so invasive thoracic sympathectomy via axillary thoracotomy or cervical approach had been used. Video-assisted thoracic surgery(VATS) is now mostly performed for treating of the palmar and axillary hyperhidrosis. From March 1996 to March 1997, 15 patients with bilateral palmar hyperhidrosis had been treated by the bilateral thoracic sympathectomy(T2, T3, T4) with thoracoscopic resection. The patient were evaluated preoperative and postoperative Digital Infrared Thermographic Imaging (DITI) at Kyung-Hee University Hospital. There were no case of the thoracotomy conversion. There were 3 complications ; pulmonary edema in 1 case, Horner's syndrome in 1 case, and gustatory hyperhidrosis in 1 case. More than half of the patients also had compensatory sweating in the lower abdomen, the buttocks, the back and the thighs. In conclusion, most of the patients were satisfied with the postoperative results of the thoracoscopic sympathectomy, including no more palmar and axillary sweating, less pain, better cosmetic appearances, decreased sweating of the face and soles. In addition, intraoperative temperature monitoring of the hands could estimate the successful thoracoscopic sympathectomy and the preoperative and postoperative Digital infrared thermographic imaging(DITI) could especially be the technique for the objective manifestation of the successful results of the thoracoscopic sympathectomy.

흉선 유암종 - 1례 보고 -

이재영,김명천,유세영,조황래,강홍모,양문호 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery Vol.31 No.3

Thymic carcinoid tumor is a rare mediastinal tumor, which was firstly described by Rosai and Higa in 1972. A carcinoid tumor of the thymus has recently been regarded as a distinct tumor from thymoma, and is probably Kultschizky cell origin. The pathologic diagnosis of thymic carcinoid is made from findings from light microscopy, immunohistochemical studies and electron microscopy. About 50% of thymic carcinoids were seen with endocrinopathies. Recurrences and extrathoracic metastasis are characteristics of thymic carcinoids. Surgical removal of the intial and tumor recurred are considered to be the most effective treatment today. However, the role of the adjuvant radiotherapy and the chemotherapy is still uncertain. Herein we report a case of thymic carcinoid tumor, which was confirmed by operation and pathologic study.

자발성 점막하 식도 박리의 치료 - 1례 보고 -

이재영,김명천,김수철,박주철,최수철,이정일 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery Vol.31 No.3

A 55-year-old male was admitted to our hospital complaining of chest discomfort, dysphagia and severe pain on swallowing. Esophageal manometry showed that there was no relaxation of lower esophageal sphincter to swallowing. There was double barrelled esophagus or mucosal stripe appearance on esophagogram. Endoscopy revealed an appearance as if an esophago-tracheal fistula had been made at the level of the upper thoracic esophagus. Also, two slit-like mucosal tears was seen on the lower esophagus. There after, fasting and total parenteral nutrition for several weeks failed to bring about any changes in his symptoms. So, as treatment, primary closure of the upper opening of the false lummen was performed under general anesthesia. Soon after the surgical procedure, the patient's symptoms were improved except for mild dysphagia. He was discharged after oral intake had been juduciously commenced with fluids and soft diet subsequently. During follow-up in out-patient department, he had no specific symptoms including fever or dysphagia and massive dissection of the esophagus was improved on esophagogram. We report the experience of a case of spontaneous submucosal dissection of the esophagus which required conservative and surgical management

선형가속기의 대칭조사야에서 off axis지점 변화에 따른 선량측정

최지혜,김명천,윤성환,배승민,신승희,임문택 대한방사선사협회 2003 대한방사선사협회지 Vol.29 No.1