Outcomes of emergency endovascular versus open repair for abdominal aortic aneurysm rupture

Suk Jung Choo,Yang-Bin Jeon,Sam-Sae Oh,신성호 대한외과학회 2021 Annals of Surgical Treatment and Research(ASRT) Vol.100 No.5

Purpose: Ruptured abdominal aortic aneurysm (rAAA) is one of the most common aortic emergencies in vascular surgery and is associated with high operative mortality and morbidity rates despite recent treatment advances. We evaluated operative mortality risks for the outcomes of emergency endovascular aneurysm repair (eEVAR) vs. open repair in rAAA. Methods: Twenty patients underwent eEVAR (n = 12) or open repair (n = 8) for rAAA between 2016 and 2020. We adopted the EVAR first strategy since 2018. Primary endpoints included in-hospital mortality and 1-year survival. The outcome variables were analyzed with Fisher exact, Mann-Whitney test, and linear by linear association. The Kaplan-Meier method was used to estimate survival. Results: There were 13 males (65.0%) and the median age of the study cohort was 78.0 years (range, 49–88 years). Inhospital mortality occurred in 7 patients (35.0%); 5 (50.0%) in the early period and 2 (20.0%) in the later period of this series. According to the procedure type, 4 (50.0%) and 3 (25.0%) in-hospital mortalities occurred in the open repair and eEVAR patients, respectively. In 6 patients (50.0%), eEVAR was performed on unfavorable anatomy. The 1-year survival of eEVAR vs. open repair group was 75% ± 12.5% and 50% ± 17.7%, respectively. On univariate analysis, preoperative highrisk indices, postoperative acute renal failure requiring dialysis, pulmonary complications, and prolonged mechanical ventilation were associated with higher operative mortality. Conclusion: The current data showed relatively superior outcomes with eEVAR vs. open repair for rAAA, even in some patients with unfavorable anatomy supporting the feasibility, efficacy, and safety of EVAR first strategy.

파랑점자돔, Pomacentrus caeruleus의 산란주기 및 산란량

정민민 ( Min Min Jung ),오봉세 ( Bong Sae Oh ),김삼연 ( Sam Yeon Kim ),이창훈 ( Chang Hoon Lee ),양문호 ( Moon Ho Yang ),한석중 ( Seok Jung Han ),노섬 ( Sum Rho ),김형신 ( Hyeung Sin Kim ) 한국어류학회 2010 韓國魚類學會誌 Vol.22 No.2

비심장질환에서의 심폐바이패스 적용

김원곤,오삼세,김기봉,안혁,김종환,Kim, Won-Gon,Oh, Sam-Sae,Kim, Ki-Bong,Ahn, Hyuk,Kim, Chong-Whan 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.9

배경: 심장수술의 표준 보조수단으로 자리잡고 있는 심폐바이패스 기법은 비심장질환 치료에서도 유용하게 사용될 수 있다. 국내에서는 이에 관해 산발적인 보고들은 있으나 전체적인 분석연구는 아직 없다. 대상 및 방법: 저자들은 1969-1996년 사이 서울대병원에서 경험한 환자중 후향적 의무기록 추적이 가능한 20례의 환자를 분석하였다. 환자들은 막성 하대정맥 폐쇄 8예, 악성 흑색종 5예, 폐색전증 3예, 그리고 두개골내 거대 동맥류, 신장암, 폐이식, 지방육종 각각 1예였다. 이중 심폐바이패스에 의한 초저 체온 유도 및 순환정지가 필요했던 경우는 모두 6예로 하대정맥폐쇄가 4예, 두개골내 거대동맥류 1예, 하대정맥내 혈전을 동반한 신세포암 1예였다. 결과: 심폐바이패스 시간은 하대정맥폐쇄에서 평균 113분(42~165분), 신세포암 156분, 거대동 맥류 161분이였다. 최저 직장온도는 하대정맥폐쇄에서 평균 26$^{\circ}C$(25.4~27.1$^{\circ}C$), 신세포암과 거대동맥 류에서는 19$^{\circ}C$였다. 하대정맥폐쇄 환자들에서의 술후 경과는 양호하였고, 거대동맥류에서는 수술직후 혈종제거를 위한 재수술을 시도하였으며 술후 14일째 사망하였다. 신세포암 환자는 술후 합병증 없이 회복되었으나 6개월후 전신전이로 사망하였다. 폐질환에서 심폐바이패스를 이용한 경우는 모두 4례로, 3례는 폐색전증이었고 1례는 양측폐이식술을 시행한 사례였다. 폐색전증에서는 응급소생술을 시행하였 던 환자에서 일시적인 신경학적 이상소견을 보인 것 외에는 모두 별 문제 없이 회복되었다. 양측폐이식 수술 환자에서는 일측폐이식 후 저산소증과 혈역학적 불안정으로 심폐바이패스 보조가 필요하였다. 이 후 심폐바이패스 이탈은 순조로웠으나 지속적인 저심박출증과 전신패혈증으로 술후 19일 만에 사망하였 다. 하대정맥 폐쇄에서 순환정지 없이 심폐바이패스를 시행한 경우는 모두 4례로 모두 심폐바이패스와 관련된 합병증은 없었으며 술후 양호한 경과를 보였다. 심폐바이패스를 이용한 고열 구역 항암화학 관류 요법을 시행받은 환자 6예중 5예는 사지에 발생한 악성흑색종이였고 나머지 1예는 재발성 지방육종 환자 였다. 심폐바이패스 시간은 평균 153분(107~270분)이였고, 국소 관류부위의 부종이나 신경장애 등의 합병증은 관찰되지 않았다. 결론: 이들 환자들에서의 치료 경험을 토대로 할 때 비심장질환에서의 심폐 바이패스 적용은 비록 그 적응이 제한되어 있지만 적절히 활용되는 경우에는 그 잠재적 유용성은 크다. Background: Cardiopulmonary bypass(CPB), a standard adjunct for open heart surgery, can also play an important role in treating patients with noncardiac diseases. Material and Method: We report a collective analysis of noncardiac applications of cardiopulmonary bypass experienced at Seoul National University Hospital from 1969 to 1996. Out of a total of 20 patients, 8 were treated for membranous obstruction of inferior vena cava(MOVC), 5 for malignant melanoma, 3 for pulmonary embolism, 1 for double lung transplantation, 1 for intracranial giant aneurysm(GA), 1 for renal cell carcinoma(RC), and 1 for liposarcoma. CPB was used to induce profound hypothermia with circulatory arrest in 6 patients(MOVC 4, GA 1, RC 1). Result: CPB time was 113 mins on average for MOVC, 161 mins for GA, and 156 mins for RC, while the lowest rectal temperature was 26$^{\circ}C$ on average in MOVC, and 19$^{\circ}C$ in GA and RC. Postoperative recovery was good in all MOVC patients. The patient with GA, who underwent reoperation for the removal of hematoma, died 14 days postoperatively. The patient with RC recovered from the operation in a good condition but died from metastatic spread 6 months later. CPB was instituted for pulmonary embolectomy in 3 patients, in whom postoperative courses were uneventful, except in 1 patient who showed transient neurologic symptoms. CPB was used in a patient with double-lung transplantation for hemodynamic and ventilatory support. The patient was weaned successfully from CPB but died from low output and septicemia 19 days postoperatively. CPB without circulatory arrest was used to treat in 4 patients with MOVC. These patients showed good postoperative courses. CPB was used to administer high concentrations of chemotherapeutic agents to the extremities in 6 patients(malignant melanoma 5, recurrent liposarcoma 1). CPB time was 153 mins on average. No complications such as edema and neurologic disability were found. Conclusion: Although CPB has a limited indication in noncardiac diseases, if properly applied, it can be a very useful adjunct in a variety of surgical cases.

Preoperative Extracorporeal Membrane Oxygenation for Severe Ischemic Mitral Regurgitation − 2 case reports −

Tae Sik Kim,Chan-Young Na,Jong Hyun Baek,Jae-Hyun Kim,Sam-Sae Oh 대한흉부외과학회 2011 Journal of Chest Surgery (J Chest Surg) Vol.44 No.3

Indication for extracorporeal membrane oxygenation (ECMO) has been extended as the experience of ECMO in various clinical settings accumulates and the outcome after ECMO installation improves. We report two cases of successful mitral valve surgery for severe ischemic mitral regurgitation in patients on ECMO support for cardiogenic shock which developed upon coronary angiography.

자연혼합배양에 의한 초기 먹이생물의 종 조성 변화

정민민,오봉세,구학동,이창훈,양문호,문태석,김삼연,김형신,Jung, Min-Min,Oh, Bong-Sae,Ku, Hag-Dong,Lee, Chang-Hoon,Yang, Moon-Ho,Moon, Tae-Seok,Kim, Sam-Yeon,Kim, Hyeung-Sin 한국해양학회 2010 바다 Vol.15 No.1

본 연구에서는 자연혼합배양(nature mixed culture)이라는 기법을 이용하여 해수관상어를 사육하는데 성공하였고 자연혼합배양수조에서 해수관상어의 자어는 정상적으로 성장하고 생존 가능하였다. 자연혼합배양수조에 출현한 플랑크톤성 미소생물은 모두 34종이었으며 그 중에는 Detonula pumila, Nitzschia sp., Fragilaria oceanica, Chaetoceros curvisetus, Stephanodiscus sp., Chaetoceros decipiens, Chaetoceros sp., Thalassiosira rotula, Eucampia zodiacus, Diploneis splendica, Nitzschia longissima, Surirella cuneata, Asterionella glacialis, Nitzschia spp., Chaetoceros debile, Thalassionema nitzschioides, Nitzschia, closterium, Skletonema costatum과 Licmophora sp와 같은 규조류가 19종, Euglena sp, Gonyaulax sp., Pyramimonas sp., Protoperidinium sp., Eutreptia, sp., Parapedinella sp., unidentified micro-flagellate, Gyrodinium sp., Scrippsiella trochoidea, Gymnodinium sanguineum, Chrysochromulina sp., Gymnodinium sp., Prorocentrum triestinum과 Micromonas sp.와 같은 편모조류가 14종 그리고 1종의 섬모충으로서 Mesodinium rubrum가 관찰되었다. 한편, 미소생물 종 중에서 편모조류의 한종인 Chrysochromulina sp.는 사육기간 동안 우점하였는데 이와 같은 결과는 배양 개시 후 10일째부터 지속적이고 안정적으로 유지 가능하였다. We were successfully reared young marine ornamental larva fish in a unique process of microalgae blooming culture tank. The marine fish larva was grown and survived in this method. Generally, we called this method as natural mixed culture. Observed planktonic microalgae were 34 species with 19 diatoms (Detonula pumila, Nitzschia sp., Fragilaria oceanica, Chaetoceros curvisetus, Stephanodiscus sp., Chaetoceros decipies, Chaetoceros sp., Thalassiosira rotula, Eucampia zodiacus, Diploneis splendica, Nitzschia longissima, Surirella cuneata, Asterionella glacialis, Nitzschia spp., Chaetoceros debile, Thalassionema nitzschioides, Nitzschia closterium, Skeletonema costatum and Licmophora sp.), 14 flagellates (Euglena, sp., Gonyaulax sp., Pyramimonas sp., Protoperidinium sp., Eutreptia sp., Parapedinella sp., unidentified micrc-flagellate, Gyrodinium sp., Scrippsiell trochoidea, Gymnodinium sanguineum, Chrysochromulina sp., Gymnodinium sp., Prorocentrum triestinum and Micromonas sp.) and 1 ciliate (Mesodinium rubrum) in this culture tank. Dominant microalgae were Chrysochromulina sp. during the larval rearing periods. Blooming condition maintained continuously and stably from 10 to 60 days in this microcosm.