生에 홀린 여자

선경식(宣炅植) 샘터사 1989 월간 샘터 Vol.20 No.1

선천성 낭포성 선종양기형 -1례 보고-

선경,백광제,이철세,채성수,김학제,김형묵,Sun, Kyung,Baek, Kwang-Je,Lee, Chol-Sei,Chae, Sung-Soo,Kim, Hark-Jei,Kim, Hyung-Mook 대한흉부심장혈관외과학회 1984 Journal of Chest Surgery (J Chest Surg) Vol.17 No.1

Congenital Cystic Adenomatiod Malformation (C.C.A.M.) is rare, but one of the most common congenital pulmonary anomalies that cause acute respiratory distress in the newborn infants. It is characterized and differentiated from the diffuse pulmonary cystic disease pathologically, i.e. adenomatoid appearance due to marked proliferation of the terminal respiratory components. An 2/12 year old male patient was suffered from respiratory distress and cyanosis on crying since birth, but no specific therapy was given. With progression of symptoms, he came to Korea University Hospital for further evaluation and then transfered to Dept. of Chest Surgery for operative correction under the impression of Congenital Obstructive Emphysema suggested by a pediatrician. On gestational and family history, there was nothing to be concerned such as congenital anomaly. Physical examinations showed; moderate nourishment and development (Wt. 5.5kg), cyanosis on crying, both intercostal and lower sternal retraction on inspiration, Lt. chest building with tympany, Rt. shifting of cardiac dullness, decreased breathing sound with expiratory wheezing on entire Lt. lung field, decreased breathing sound on Rt. upper lung filed, and tachycardia. The remainders were nonspecific. Laboratory findings were normal except WBC $14000/mm^3$ (lymphocyte 70%), Hgb 9.8m%, Hct 28%, negative Mantaux test, and sinus tachycardia and counter-clockwise rotation on EKG. Preoperative simple Chest PA revealed marked hyperlucent entire Lt. lung, herniation of Lt. upper lobe to Rt., collapsed Rt. upper lobe, tracheal deviation and mediastinal shifting to Rt., and no pleural reaction. At operation, after Lt. posterolateral thoracotomy, 4th rib was resected. Operative findings were severe emphysematous changes limited to both lingular segmentectomy was done. The resected specimen showed slight solidity, measuring $8{\times}4.5{\times}2cm$ in size, and small multiple cystic spaces filled with air. Microscopically, entire tissue structures were glandular in appearance, cyst were lined by ciliated columnar epithelium, and occasional cartilages were noted around the cystic spaces. Bronchial elements were dilated but normal pattern on histologically. The patient had a good postoperative courses clinically and radiologically, and discharged on POD 10th without event. The authors report a case of Cogenital Cystic Adenomatoid Malformation (C.C.A.M.)

위축성 심낭염 [Constrictive Pericarditis]을 동반한 양측성 섬유흉 [Fibrothorax] 치험 1

선경,김요한,백광제,이철세,김학제,김형묵,Sun, Kyung,Kim, Yo-Han,Baek, Kwang-Je,Lee, Chol-Sae,Kim, Hark-Jei,Kim, Hyoung-Mook 대한흉부심장혈관외과학회 1984 Journal of Chest Surgery (J Chest Surg) Vol.17 No.4

Fibrothorax is the end stage of chronic pathologic processes of pleura such as hemothorax, empyema, or tuberculous effusion. The pleural space become adherent and obliterated, and the lung parenchyma is covered by a thick, fibrous, unexpandable "peel", so the lung function is diminished markedly with impaired ventilation and oxygenation. Constrictive pericarditis is often accompanied fibrothorax, also cardiac and hemodynamic function is deteriorated. Surgical relief of these fibrous peels causes remarkable improvement in pulmonary function, cardiac and hemodynamic function, and subjective symptoms. We experienced a case of bilateral fibrothorax combined with constrictive pericarditis which occured 3 years after bilateral tuberculous effusion. Decortication and percardiectomy were done at the same time through bilateral submammary thoracotomy with sternal transection. Comparing postoperative Peripheral venous pressure, Circulation time, Pulmonary function test, Arterial blood gas analysis, Subjective symptoms with preoperative conditions showed noticeable improvement.provement.

의료의 패러다임 변화와 4차 산업혁명의 대응

선경 한국간호과학회 2018 한국간호과학회 학술대회 Vol.2018 No.10

개심술에서 부적절한 심근 표면저온법이 수술후 우심기능과 심근세포 미세구조에 미치는 영향

선경,김형묵 고려대학교 의과대학 1990 고려대 의대 잡지 Vol.27 No.1

The present study was designed to evalute the possibility that the inadequate topical hypothermic protection of the anterior free wall of right ventricle(RV), which could be exposed to the temperature of ambient air and illuminating light source of the operating room during ischemic arrest, may lead to postoperative RV dysfunction with ultra-structural derangements. Twelve mongrel dogs were placed on cardiopulmonary bypass with a single caval cannula and the systemic temperature was lowered to 28℃. After cross-clamping the aorta with an initial perfusion of cold cardioplegics(type Ⅱ St. Thomas hospital solution: 0-5℃ in temperature, l0㎖/kg in amount, 200㎖/min in rate), the pericardial cavity was filled with iced slush saline solution(0-4℃) for topical hypothermic protection. In the controlled group(Group Ⅰ, n=6), the right ventricle was emersed completely in the pericardial cold saline bath; on the other hand, in the experimental group(Group Ⅱ, n = 6), the RV anterior free wall was exposed to ambient air(25-28℃) and an illuminating light source. During the 90 minutes period of myocardial ischemia, an additional half dose of cold cardioplgics was given at intervals of 30 minutes twice. The RV anterior free wall temperature was monitored every 5 minutes and other parameters were obtained at prebypass, postbypass 20, 40, and 60 minutes. Myocardial biopsy specimen for electromicrosopy were taken from the RV anterior free wall at the points of prebypass and postbypass 60 miniutes. In Group Ⅰ, RV temperature was sustained below 15℃(min.; 6.1℃, max,; 14.6℃, av.; 10.1±2.6%, increment rate; 1.2±0.5℃/min) throughout the ischemic period, and cardiac output and RV dP/dt were depressed at postbypass 20 and 40 minutes(p<0.05), but CK-MB isoenzyme elevations were not significant(p = NS), On an electromicro-scopic examination of subcellular structures, there were ' slight injury' according to Schaper's classification or 'score l' according to Flameng's mitochondria1 score. In Group Ⅱ, however, RV temperature could not be maintained below 16℃ (min.; 16.6℃, max.; 26.2℃, av.; 21.7±3.2℃, increment rate; 1.5±0.8℃/min), and cardiac output and RV dP/dt were depressed more significantly than Group Ⅰ at postbypass 20, 40, and 60 minutes(p<0.05), and CK-MB isoenzyme elevations were significant at postbypass 40 and 60 minutes(p<0.05). On an electromicroscopic examination of subcellular structures, there were ' moderate' to ' severe injury' or ' score 2' to ' 3'. In both groups, postbypass heart rate, CVP, mean RA pressure, and both ventricular systolic/diastolic/mean pressure were not differ from prebypass values(p>0.05), and correlation coefficient using linear regression between RV dP/dt, cardiac output, and CK -MB were not significant(r<0.8). There was no intraoperative death till postbypass 60 minutes. In conclusion, inadvertent topical hypothermia during ischemic arrest could not maintained the RV myocardial temperature in optimal protective ranges, and in consequence, there were more significant RV dysfunction in contractility, cardiac output, and myocardial ultrastructures in the early postbypass period.

흉부외과 진료통계( I )

선경,곽영태,김형묵,Sun, K.,Kwak, Y.T.,Kim, H.M. 대한흉부심장혈관외과학회 1992 Journal of Chest Surgery (J Chest Surg) Vol.25 No.12

This is the result of the annual statistic analysis of thoracic and cardiovascular surgical cases in 1991, Korea. 14,715 cases of surgery[thoracic 8,995/cardiovascular 5,720] were done by 53 institutes replied. The order of frequency of cell type in primary lung cancer was squamous [62.3%] / adeno [23.9%] / small [6.4%] / adenosquamous [3.0%], and in mediastinal tumor, neurogenic[27.l%] / thymoma [27.1%] / teratoma[26.4%] / congenital cystic[12.0%]. Surgery for tuberculosis was decreased to 15.8% of overall infectious disease from the recent 6 year`s average 35.7%. In general thoracic surgery, the single most frequent operation was closed thoracostomy[4,047 cases] for pleural pathology. The ratio of congenital to acquired heart disease was 2:1, and acyanotic to cyanotic was 3:1. The order of frequency of congenital acyanotic heart disease was VSD [45.6%] / ASD [25.6%] / PDA [20.4%] / PS [2.9%], and that of cyanotic heart disease was TOF [42.6%] / PA [12.9%] / TGA [9.9%] / DORV [8.8%]. In 1,364 cases of valvular surgery, single mitral pathology was the most frequent candidate[729 cases, 53.4%]. In 243 cases of coronary surgery, bypassing graft materials were great saphenous vein[41.6%], internal mammary [39.5%], and artificial vessel[18.9%]. There were no specific differences in aortic surgery, assisted device implantation, and antiarrhythmic surgery as compared to previous study. This nation-wide inquiry will be continued and reported annually by KTCS Society.

흉부외과 영역의 의료보험 진료수가 조정을 위한 제언

선경,김형묵,Sun, Kyung,Kim, Hyoung-Mook 대한흉부심장혈관외과학회 1992 Journal of Chest Surgery (J Chest Surg) Vol.25 No.4

We analysed 7,180 annual cases of surgical treatment performed by Department of Thoracic and Cardiovascular Surgery of 6 major institutes in Seoul Korea, All cases were applied to 101 of 140 coded items applicable to the field of Thoracic and Cardiovascular Surgery, in the book of "Standard Price List for Medical Service" which was notified by the Ministry of Health and Social Affairs, and of them, applied field specific items were 70 of 93 applicables. The most frequently applied items were those associated to ECC[extracorporeal circulation] 1,510 cases, and then item of closed thoracostomy 751 cases was next. Except the items associated to ECC, the coded item of the highest "Total cost[fee x total applied numbers]" was mitral valve replacement 182,356,570 won[534,770 won x 341 cases]. 140 items were arranged in "Total cost" order, and then categorized into 5 groups. Medical insurance fees of each group were modified by different grades without changes in sum of total fees. Fees of Group 1, the highest group in "Total cost" were pulled up, on the other hand, Group 4, the lowest group, were pulled down, Group 5, composed of overlapping items with other fields, were not changed. The result of adjustment by grouping showed 21.2% increment effect[535,749,105 won] in real income. And we found that new coded items for modern high technological procedures should be added to "Standard Price List for Medical Service “Standard Price List for Medical Service".

한국산 P.V.C.의 생물학적 안정도 및 적합성에 대한 실험적 고찰

선경,Sun, Kyung 대한흉부심장혈관외과학회 1984 Journal of Chest Surgery (J Chest Surg) Vol.17 No.1

These biologic test procedures are designed to test the suitability of P.V.C. made in Korea intended for parenteral preparation, which were based on the U.S. Pharmacopeia XIX "Biologic Test-Plastic Container", Official from July 1, 1975. Healthy adult human blood and rabbits weighing 2\ulcorner.2Kg were used for test materials. Sample P.V.C. were sampled from the medical equipments made in Korea randomly and Control P.V.C. were sampled from the standardized Cobe and Polystan P.V.C. tubes. P.V.C. extract was prepared from a homogeneous P.V.C. samples by incubating 60 square centimeters of the sample per 20 millimeters of sterile pyrogen-free saline at 70\ulcorner for 72 hours or autoclaving at 120\ulcorner for 1 hour. The Implantation Test was designed to evaluate the reaction of living tissue to the plastic by the method of the implantation of the Sample itself into animal tissue. The Systemic Injection Test, the Intracutaneous Test, and the remainders were designed to determine the biological response of animals to plastics by the single-dose injection of specific extracts prepared from a Sample. The results are as follows; 1.Implantation Test - No significant difference for reactions was noted between the Sample treated animal and the Control after 72 hours of implantation. 2.Systemic Toxicity Injection Test - No sign of toxicity and/or death immediately after injection and at 4, 24, 48 hours respectfully after injection. 3.Intracutaneous Test - None of the animals treated with the Sample showed a significantly greater reaction than the observed in the animals treated with Blank. 4.Pyrogen Assay-Only one animal treated with the Sample showed the maximal rise of rectal temperature about 0.2\ulcorner after 3 hours of injection, but remainders showed no change. 5.Hemolytic Index - The positive Control tube of distilled water exhibited complete hemolysis while the negative Control tube and P.V.C. extract were negative demonstrating no hemolysis. 6.Cell Morphology of Erythrocytes and Leukocytes on Stored, Heparinized Human Blood -- There was no significant difference in the morphology of either the Control or Sample extract. 7.Clotting Mechanism of Human Blood in vitro - After allowing to the P.V.C. extract at room temperature for 5 Hours and at 10\ulcorner for 24 hours, there was no appreciable difference in Prothrombin Time under these conditions. 8.Clotting Mechanism of Rabbit in vivo - At the termination of 5 days after intraperitoneal injection of the P.V.C. extract, no significant changes in Clotting Time were observed. According to the above results, it could be concluded that the P.V.C. made in Korea was acceptable for parenteral preparation, especially treated with physiologic saline and/or human blood.man blood.

누두흉의 수술적 교정: 14례 보고

선경,채성수,이철세,백광제,김학제,김형묵,Sun, Kyung,Chae, Seong-Soo,Lee, Chul-Sae,Baek, Kwang-Jei,Kim, Hark-Jei,Kim, Hyong-Mook 대한흉부심장혈관외과학회 1983 Journal of Chest Surgery (J Chest Surg) Vol.16 No.1

Pectus Excavatum is a congenital anomaly of the anterior chest wall with a sharp concave curvature of the body of the sternum, from above downward and from side to side, especially just before the junction of gladiolo-xiphoid. We have experienced 14 cases of Pectus Excavatum with several operative procedures, i.e., Ravitch operation in 1 case, Wada operation [Sternal turn-over} in 3 cases, Wada operation and K-wire splint in 5 cases, Modified Wada operation [Rectus Abdominis muscle pedicle attached sternal turn-over] in 5 cases. Nearly all patients developed flail chest treated with internal fixation, and necrotic chondritis was developed postoperatively and treated with excision and curettage in one case with Wada operation. Follow-up Vertebral Index showed 48% preoperatively and 33% postoperatively, average decrement of 15%. We report 14 cases of Pectus Excavatum and their operative treatments.

식도중간부 식도게실: 1 수술 치험례

선경,최영호,채성수,김학제,김형묵,Sun, Kyung,Choi, Young-Ho,Chae, Sung-Soo,Kim, Hark-Jei,Kim, Hyong-Mook 대한흉부심장혈관외과학회 1982 Journal of Chest Surgery (J Chest Surg) Vol.15 No.4

A 45 year old male officer was admitted due to upper substernal pain for 1 month, which was aggravated by swallowing. On past and family history, there was no specific history except heavy drinking. Simple chest x-ray revealed no specific abnormal findings. Preoperative esophagofiberscopy and Barium study showed midesophageal diverticulum, pulsion type, at about 2 cm below the left main bronchus. The opening of the diverticulum was located at the left posterolateral aspect of esophagus. Midesophageal false diverticulum, measuring 2 x 2 x 1 .S cm in size, was noted at about 5 cm under the aortic arch protruding through a slit-like muscular defect. After inversion of diverticular sac, interrupted sutures with 3-0 silks were done on muscular defect site, and mediastinal pleura was reinforced on the lesion with interrupted sutures. On 4th postoperative day, esophagography revealed no diverticulum or stenosis. Also esophagofiberscopy showed smooth mucosal tag without disturbance of passage. On 14th postoperative day, the patient was discharged uneventfully, and follow-up for 3 months after discharge revealed nothing abnormal symptoms. The authors report one case of midesophageal, pulsion type, false diverticulum.