개심술후 폐의 Physiologic dead space 와 Shunt 의 변화상 추적

이길노 대한흉부심장혈관외과학회 1985 Journal of Chest Surgery (J Chest Surg) Vol.18 No.4

It has been recognized that the proper matching of ventilation and perfusion within the lung is essential for the efficient exchange of gases following open heart surgery. Physiologic shunt reflects the amount of blood going to lung units with inadequate ventilation and these are also areas of the lung with adequate ventilation but inadequate blood flow. This can be quantified by measuring physiological dead space. From January to August 1985, The physiologic dead space and shunt during postoperative course had been taken in 30 patients of open heart surgery in Soonchunhyang University Hospital. Twenty cases had congenital heart disease and acquired valvular heart disease were noticed in 10 cases. The physiological dead space and shunt during postoperative periods were calculated and we made 5 items of conclusion: 1. There is high probability of ventilation-perfusion mismatch in the acquired heart disease group compared to the congenital group. 2. Duration of the CPB can exert significant influences in the physiological dead space but less in the shunt fraction. 3. There is positive relationship between Qs/Qt and Vd/Vt in the group B [CPB>90 min.] but less reliable in correlation. 4. Perfusion impairment is more significant in the diminished pulmonic blood flow group compared to the increased pulmonic blood flow [Qp/Qs>2.0] group. 5. There is no significant ventilation-perfusion mismatch within the lung during all postoperative courses.

모녀 및 형제에서 발생된 선천성 심장 질환

강창희,안욱수,이길노 순천향대학교 1987 논문집 Vol.10 No.2

The true incidence of congenital heart disease is difficult to determine accurately, but it had been estimated that approximately 0.8% of live births. The congenital heart disease appears to result from and interaction between multifactorial genetic and environmental systems too complex to allow a single specification of etiology. Four congenital heart diseases in two families underwent cardiac operation at Thoracic and Cardiovascular Surgery of Soonchunhyang University Hospital. In the one family, a 52-year-old mother had secundum type of atrial septal defect(2.5㎝ in diameter) and the daughter(33-year-old) had perimembranous type of ventricular septal defect(0.8㎝ in diameter). In the other family, they are in sibling relationship. A 15-year-old boy had perimembranous type of ventricular septal defect(0.7㎝ in diameter) and his brother(13-year-old) also had ventricular septal defect which was mixed type(supracristal+perimembranous) and 1.2㎝ in its diameter.

흉선절제에 의한 근무력증 치료 2례 보고

이길노 대한흉부심장혈관외과학회 1980 Journal of Chest Surgery (J Chest Surg) Vol.13 No.4

Myasthenia gravis is a neuromuscular disorder manifested by fatigability and weakness of voluntary muscles. The basic defect in the myasthenia is reduction of available acetylcholine receptors at neuromuscuiar junctions by an autoimmune attack. Removal of the thymus gland now play an Important role in the management of this disease. We have two experiences of thymectomy for myasthenic patients. The 31-year-old housewife(J.H) was admitted to the Taegu Presbyterian Medical Center because of bilateral ptosis, mastication and swallowing difficulties. The presence of thymoma was strongly suggested by roentgenographic studies. A 99.8 gm thymoma was removed completely by total thymectomy. On the 2nd postoperative day respiratory failure developed. Tracheostomy was performed and ventilatory assist was given for 3 days. The patient was completely recovered with antichollestrase drug only. C.N. was 17-year-old girl who has the symptoms of bilateral ptosis and diplopia for 3 years. Tensilon test was positive and antichollnestrase was given for several months, but the patient showed no improvement. After thymectomy she was free from myasthenic symptoms with out anticholinestrase drug.

기관지 섬유경에 의한 폐암 진단[임상적 관찰]

이길노 대한흉부심장혈관외과학회 1981 Journal of Chest Surgery (J Chest Surg) Vol.14 No.3

摘出作業心臟에서 心筋麻痺液의 投與回數와 心筋保護效果 : In the Isolating Working Rabbit Heart

조영철,이길노 순천향대학교 1990 논문집 Vol.13 No.3

For evaluation of the myocardial protection afforded by infusion frequency of the cardioplegic solution during global ischemia, the isolated rabbit hearts were studied in the working heart model. Thirty hearts were underwent a 15 minute period of retrograde nonworking perfusion with Krebs-Henseleit buffer solution(37℃) and were switched over to the working mode for 15 minutes. After baseline measurement of peak aortic pressure, heart rate, aortic flow, and coronary flow, all hearts were subjected to 60 minutes of ischemic arrest at 10℃ induced with St. Thomas Hospital cardioplegic solution: Group Ⅰ had single does cardioplegia, group Ⅱ double dose, group Ⅲ multi-dose infusion. Hearts were then revived with a 15 minute period of nonworking reperfusion at normothmia, followed by 30 minutes of working perfusion. Repeat measurement of hemodynamic function were obtained and expressed as percent of the preischemic baseline value. The oxygen content of the arterial perfusate and coronary effluent was meaasured by the designed time. Leakage of creatine kinase was determined from the coronary effrluent during 15 minutes of postischemic reperfusion period, Finally, wet hearts were weighed and placed in 120℉ dry oven for 36 hours for measurement of dry weight. There was no significant difference in the peak aortic pressure but heart rate of the group Ⅲ (100.44±1.08%, p<0.01) exceeded the baseline value. In the group Ⅲ, the percent recovery of the aortic flow(94.71±1.88%, p<0.0005), cardiac output (95.18±1.99%, p<0.005), stroke volume(94.75±1.58%, p<0.05), and stroke work(94.03±1.75%, p<0.005) were significantly better than the group Ⅰ or Ⅱ. Myocardial oxygen consumption was increased in the group Ⅱ (0.71±0.03㎖/min, p<0.0005) and the group Ⅲ (0.75±0.01/, p<0.0005) during reperfusion period. The water content and tissue water were significantly diminished in the group Ⅲ(82.78±0.28%, p<0.0005, 4.82±0.10gm/dry gm, p<0.005) and group Ⅱ (83.68±0.30%, p<0.01, 5.14±0.11gm/dry gm, p<0.0005) compaired with the group Ⅰ. Leakage of creatine kinase in the group Ⅲ (26.59±1.29I U/15min, p<0.0005) and group Ⅱ (30.58±0,84 IU/15min, p<0.05) was significantly redeced than the group Ⅰ (32.99±0.85 IU/15min). During ischemic arrest, the heart protected by double dose and multidose cardioplegia demonstrated superior preservation of myocardium compaired to the heart by single dose cardioplegia.

心停止시 Histidine과 L.Glutanmate 의 心筋保護效果에 관한 硏究

南忠熙,李吉魯 순천향대학교 1988 논문집 Vol.11 No.1

The effects of histindine and L-glutamate on myocardial preservation during global ischemia were studied in the isloated working rabbit heart model. Twenty isolated hearts undertook the retrograde nonworking perfusion with Krebs-Henseleit buffer solution (37℃) for 15 minutes and followed by 15 minutes of working mode. After measurement of the cardiodynamics as baseline(peak aortic pressure, heart rate, aortic flow, and coronary flow), all heart were arrested with cold cardioplegic solution(double dose of St. Thomas Hospital solution, myocardial temperature :10℃) for 60 minutes. After nonworking reperfusion for 15 minutes, the caridodynamics were measured again at 20 minute of working period and expressed as percents of baseline values. The leakage of creatine kinase(IU/15min. dry gm of heart) was measured from the coronary effluent for 15 minutes of nonworking reperfusion. Wet and dry weights of the hearts were obtained after experments for tissue water(gm water/dry gm of heart) and water content(%). The control group(n=10) had double dose of cardioplegic solution, but the experimental group(n=10) had histidine(13 mmol/L) and L-glutamate(13 mmol/L) as additives into the cardioplegic solution. The experimental group revealed no significant difference at peak aortic pressure, heart rate, and coronary flow compared with the control group. The percent recoveries of aortic flow(control;79.41±1.24%, experimental;88.4±3.07%, p〈0.02), cardac output(control:81.9±1.17%, experimental;89.1±2.06%, p〈0.01), and stroke volume(control;86.1±1.57%, experimental ; 94.4±3,38%, p〈0.05) were significantly better in the experimental group. The tissue water and water content of the myocardium were significantly diminished in the experimental group(5.0±0.21 gm water/dry gm. p〈0.05, 83.1±0.57%, p〈0.05) compared with the control group(5.6±0.12 gm water/dry gm, 84.7±0.29%). The leakage of creatine kinase was also significantly lower in the experimental group(22.4±2.16 IU/15 min. dry gm, p〈0.001) than the control group(33.5±0.82 IU/15min. dry gm). Consequently, this study reveals that histidine and L-glutamate as cardioplegic additives improve myocardial protection during global ischemia in the isolated working rabbit heart.

심내막상 결손증 - 2례 보고

노증기,이길노 순천향대학교 1985 논문집 Vol.8 No.4

Two patients at our institution underwent repair of endocardial cushion defect in April and August, 1985. The first case was 12 years old girl with complete ecdocardial cushion defect(Rastelli type A) and combined anomaly of cortriatriatum(Loeffler type D). Through a right atriotomy, the anomalous septum of left atrium was resected and the mitral cleft was approximated with interrupted sutures. The atrial septal defect was closed with Dacron patch but ventricular septal defect was closed with direct interrupted sutures. The second case was 12 years old girl with incompletely displayed form(VMT type) of endocardial cushion defect. Through the right atriotomy and interatrial septotomy, the mitral cleft was approximated with interrupted sures and ventricular septal defect was closed with direct sutures. Postoperative transient A-V block was noted in the second case but returned to regular sinus rhythm after 2 days.

心筋의 深度低溫과 Nitroprusside가 心筋保護에 미치는 效果

李吉魯 순천향대학교 1988 논문집 Vol.11 No.1

To evaluate the protective effect of profound hypothermi a and nitroprusside on the rabbit myocardium after global ischemia, we studied 30 rabbits using isolated working heart model. Experimental time courses were; (1) nonworking retrograde perfusion(15min), (2) working perfusion(15min), obtained hemodynamic parameters for baseline value (3) hypothermic(10'C) ischemic arrest(60min) induced with St. Thomas Hospital cardioplegic solution, (4) nonworking reperfusion(15min), measured creatine kinase leadage, (5)working reperfusion(20min), re-checked hemodynamic values and expressed as percent recovery, (6) weighed the wet and dry heart. Experimental hearts were devided to 3 groups: (1) Group I-myocardial temprature 28'C (2) Group Ⅱ-10' C profound hypothermia, (3) GroupⅢ-28'C hypothermia, nitroprusside infusion with the cardioplegic agent(100 μ/L). There was no differences in the peak aortic pressure and heart rate between the groups, but these values showed excellent recovery rate. The Group Ⅱ had good percent recoveries in the aortic flow, coronary flow, and stroke volume, but in the Group Ⅲ, these were relatively lower than the control group. Differences of water content ant tissue water between groups were not so significant. Leakage of creatine kinase in the Group Ⅲ was a little higher than the other two with no statistical significance. Finally, we concluded that deep hypothermia(10'C) is far superior than moderate hypothermia(28'C) on the myocardial protection after global ischemia but not in the nitroprusside.

개심술중 저온 심장정지에 의한 심근효소치 변화 추적

안상구,이길노 순천향의학연구소 1996 Journal of Soonchunhyang Medical Science Vol.2 No.2

Early detection of myocardial injury is a subject of considerable interest and investigation in patients undergoing cardiac surgery for evaluating the postoperative response. The diagnosis of myocardial damage depends upon the interpretation of historical, electrocardiographic, and serum enzyme data. The serial measurement of postoperative serum enzymes has been proposed as an important method for identifying myocardial infarction following open heart surgery. In order to assess the correlation of the myocardial damage and the duration of cardiopulmonary bypass, measurement of creatine phosphokinase(CPK), lactic dehydrogenase(LDH), serum glutamic oxalacetic transaminase(SGOT), serum glutamic pyruvic transaminase(SGPT), MB band of CPK and LDH isoenzyme(LDH₁) were carried out on the immediate postoperation, first, second, third, fifth, seventh day in 25 patients following open heart surgery. The patients were divided into two groups according to the duration of aortic cross clamp time(ACT): Group Ⅰ(ACT<90 minutes,n=16) and Group Ⅱ(ACT>90 minutes,n=9). The results were as follows; 1) The leakage of CPK and SGPT in total patients increased to the highest level at POD 1(P<0.05) with gradual decrease and returned to the normal range on the 7th day after the operation. THE leakage of CPK in Group Ⅱ were greater than in Group Ⅰ at POD 1(P<0.05), and the value of SGPT between two groups were no signification. 2) the serum levels of LDH and SGOT in total patients reached to maximum on the second day after the operation(P<0.05) with slightly increase until 7th postoperative day in LDH. The levels of two enzymes in Group Ⅱ were higher than in Group Ⅰ at POD 2(P< 0.05). 3) LDH₁was reached to the maximum on the 2nd day after the operation(P<0.001), and returned to the normal range on the 7th postoperative day. The values of Group Ⅱ were higher than Group Ⅰ on the 2nd day after operation(P<0.05). 4) The value of CPK-MB in group Ⅱ was greater than Group Ⅰ on first postoperative day(P<0.0). It is concluded that the myocardial injury was closely related with the duration of cardiopulmonary bypass in open heart surgery.

관상동맥 우회로 조성술 1례 경험

안욱수,조영철,이길노 순천향대학교 1987 논문집 Vol.10 No.2

Coronary bypass surgery has been the most important advance since 1967 for the management of the moderately to severely patient with angina due to obstructive atherosclerotic coronary artery disease. Medical and surgical therapy are complementary : patients treated surgically should also receive appropriate medical therapy. Recently, we have experienced one case of coronary artery bypass graft for the patient with unstable angina. The patient was 56 year-old male and admitted with complaint of angina pectoris. EKG revealed diffuse myocardial ischemia on anterolateral segments. Coronary cineangiogram revealed 90% stenosis of the proximal left anterior descending coronary artery. We have performed single bypass graft from left anterior descending coronary artery to aorta with great saphenous vein. The patient had an excellent postoperative recovery and was free from anginal attack. He has shown striking improvement in general status(NYHA functional class I) during 1 year after operation.