급성 심근 경색에서 시행한 관상 동맥 우회술의 조기 결과

지현근,이원용,김응중,두영철,한규록,오동진,임종윤 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.8

보존된 사람 동종 복재정맥 이식편혈관 내피세포의 생활성에 관한 연구

지현근,김용진 대한흉부외과학회 2003 Journal of Chest Surgery Vol.36 No.4

배경: 관상동맥 우회술이나 말초 혈관 우회술 시 가장 많이 쓰이는 대체 혈관은 자가 복재정맥이나, 이러한 정맥을 사용할 수 없는 경우 동종 복재정맥이 이용되어 왔다. 1900년대 초부터 시작된 동종 정맥의 이식은 아직도 그 이용에 대하여 논란이 있으며 보존 방법에 따른 혈관 내피세포나 평활근의 생활성 평가에 있어도 큰 편차가 있다. 특히 혈관 내피세포의 항응고 기능이나 nitric oxide에 대한 연구가 이루어지면서 동종 정맥 이식에 있어도 이들의 생활성 및 항원성 여부에 관심이 모아지고 있다. 대상 및 방법: 본 연구는 사람의 복재정맥을 보존하였을 때 보존 방법 및 기간에 따른 혈관 내피세포의 생활성의 평가를 목적으로 하였다. 신선 복재정맥을 대조군으로 하였으며, 실험군 복재정맥은 RPMI (Roswell park memorial institute) 1640에 10% 우태혈청이 포함된 4oC 조직 배양액에 넣어 각각 1일(24시간), 3일, 5일, 7일, 14일간 냉장 보존(cold storage)하였다. 기간별 냉장 보존이 끝나면 반으로 나누어 이 상태의 정맥을 I군(I-1, I-3, I-5, I-7, I-14)으로 정하고 냉장 상태에서 실험하였으며, 나머지는 10% 우태혈청과 10% DMSO가 포함된 RPMI 1640 용액에 넣고 -196oC의 액화 질소 탱크에서 2주간 냉동 보존 후(cryopreservation), 37oC에서 급속 해동하여 냉장 보존된 기간에 따라 II군(II-1, II-3, II-5, II-7, II-14)으로 정하여 실험하였다. 각 군의 생활성을 알아보기 위하여 전자현미경을 이용한 내피세포의 관찰, 트롬보모듈린(thrombomodulin) 면역조직화학검사를 이용한 혈관 내피세포의 항응고 기능, 효소 소화에 의한 정맥에서의 혈관 내피세포 분리 후 트리판 블루(trypan blue)를 이용한 세포 생존율 검사 등을 시행하였다. 결과: 전자현미경을 통한 세포의 형태학적 검사에서 Groups I-7, I-14, II-5, II-7, 그리고 II-14정맥군들이 Gundry score의 의미 있는 증가(p<0.05)를 보이는 형태학적 변화가 나타났다. 트롬보모듈린을 이용한 면역조직화학검사와 트리판 블루를 이용한 세포 생존율 검사에서는 냉장군은 7일째 생활성 저하를 나타냈으나 냉동 보존군에서는 보존 기간에 상관없이 모두 생활성이 저하된 것으로 관찰되었다. 결론: 사람의 복재정맥을 우태혈청이 포함된 4oC의 RPMI 1640에 냉장 보존하였을 경우 냉장 7일째부터 형태학적, 기능적 생활성 저하를 관찰할 수 있었으나, -196oC에 냉동 보존한 경우에는 냉장 5일 후 냉동 보존한 정맥에서도 형태학적인 생활성 저하를 관찰할 수 있었으며 혈관 내피의 항응고 기능을 나타내는 트롬보모듈린 면역조직화학검사에서는 냉동 보존한 대부분 정맥에서 기능적 생활성이 저하된 것으로 관찰되었다. 그러나 이러한 생활성 및 항응고 기능의 저하가 일시적인 현상인지의 여부와 이러한 기능 저하가 이식 혈관의 장기 개통률에 미치는 영향에 대하여 지속적 연구가 필요하다.

Thermotherapy for Na+/I− symporter-expressing cancer using anti-Na+/I− symporter antibody-conjugated magnetite nanoparticles

지현근,반현승,이정희,이상훈,권오석,최준호 한국공업화학회 2018 Journal of Industrial and Engineering Chemistry Vol.63 No.-

Surgery, followed by remnant ablation with radioactive iodine (I-131), is used for treating differentiated thyroid carcinoma (DTC) as the sodium–iodine (Na-I) symporter (NIS) is highly expressed in the thyroid and DTC cells. Our aim was to investigate the feasibility of using anti-NIS antibody-conjugated magnetite nanoparticles (NIS-MNPs) as a diagnostic and therapeutic agent for DTC by studying NIS-MNP in an NIS over-expressing HeLa (HeLa-NIS) cell line and a subcutaneous HeLa-NIS tumor-bearing mouse model. Immunofluorescence was used to determine if NIS-MNP could bind to HeLa-NIS, and its therapeutic effect was investigated using HeLa-NIS cells after alternating magnetic field (AMF) irradiation. Magnetic resonance imaging (MRI) was performed to visualize the normal thyroid gland of nude mice after intravenous injection of NIS-MNP. NIS-MNPs were injected into the cancer nodules of the mouse model, which were irradiated under AMF for 1 h twice at 24-h intervals. Accumulation of NIS-MNP was examined using MRI and tumor volume was measured over seven days. Results showed that NIS-MNP bound effectively to the surface of HeLa-NIS cells, and AMF inhibited growth of NIS-MNP-treated HeLa-NIS cells. Normal thyroid glands of mice were enhanced by NIS-MNP treatment in T2-weighted MRI. Inhibition of tumor growth was observed after AMF irradiation in the NIS-MNP group. In conclusion, NIS-MNP is a feasible diagnostic and therapeutic tool for localizing and treating NIS-expressing tumors such as DTC when coupled with AMF irradiation.

급성 심근 경색후 관상 동맥 우회술의 조기 적용

지현근,이원용 대한흉부심장혈관외과학회 1997 Journal of Chest Surgery Vol.30 No.11

To assess the early results, risk factors and optimal timing for coronary artery bypass graft surgery(CABG) after an acute myocardial infarction(AMI), we reviewed our 19 patients who underwent CABG within 30 days after AMI, between June 1994 and October 1996. This study excluded 1 patient whose diagnosis was AMI with ventricular septal rupture. 14 of the patients were male and 5 were female. Their ages ranged from 41 to 77 years(mean age, 60.6$\pm$ 10.4 years), and the amount of time between AMI and CABG ranged from 8 hours to 24 days(mean time, 10.6$\pm$6.4 days). There were 11 anteroseptal infarctions and 8 inferior wall infarctions. 11 patients had trsnsmural infarctions and 8 had subendocardial infarctions. Indications of operations were p imary revascularization and postinfarction angina. Three patients required preoperative intra-aortic balloon pump(IABP) support, and 4 additional patients required IABP to be separated from cardiopulmonary bypass. An average of 3.6 $\pm$ 0.6 vessels per patient were bypassed. The early mortality rate for these 19 patients was 5.3% and late mortality rate was 5.5%, 1-year and 2-year actuarial survival rates were 89.5% Univariate analysis of mortality showed that an ejection fraction less than 30% and intraopretative IABP supports were associated with risk factors(p value=0.018 and 0.015 respectively). Age, sex, time to CABG, emergency operations, types and locations of infarctions were not significant. Although our studies have weak p.oints in that there was only a small number of patients and the lack of long-term results, we could conclude that early myocardial revascularization is relatively safe after AMI for those individuals with an ejection fraction greater than 30%.

양방향성 상대정맥-폐동맥 단락술 후의 폐동맥 크기 변화에 관한 연구

지현근,이정렬 대한흉부심장혈관외과학회 1996 Journal of Chest Surgery Vol.29 No.5

The bidirectional cavopulmonary shunt may be useful as an intermediate procedure before Fontal oper- ation in high-risk patients, because it provides adequate relief of cyanosis and relief of ventricular volume overload. But there are no established theory about the effects of bidirectional cavopulmonary shunt on pulmonary arterial development. The purpose of this article is a study of changes of pulmonary artery size after bidirectional cavopulmonary shunt. Ca diac catheterization and angiography procedures were done on 19 patients who underwent bidirectional cavopulmonary shunt from February 1992 to July 1994, their results were reviewed. Preoperative cardiac catheterization and angiography procedures were performed at a mean interval of ).8 $\pm$4.8($\pm$SEM) months before surgery and following catheterization at a mean postoperative interval of 19.6 $\pm$4.8 months. Pulmonary arterial sixte measurement were standardized for body surface area(Pulmon- arty artery index), and for diameter of descending thoracic aorta(McGoon ratio). Patient's age, body stir- face area, pulmonary angioplasty, preoperative McGoon ratio and follow-up intervals were considered as variables. Before bidirectional cavopulmonary shunt, patient's mean age, body surface area, arterial 02 saturation, diameter of right pulmonary artery, diameter of left pulmonary artery, pulmonary artery Index, McGoon ratio were 13.7$\pm$15.6 months, 0.40$\pm$0.12m2, 71.4$\pm$12.4m2, 7.1$\pm$1.7mm, 6.2$\pm$1 , 191.8$\pm$82.7mm21m2, 1.73 $\pm$0.49, respectively. After bidirectional cavopulmonary shunt, the values were changed to 39.9 $\pm$ 16.2 months, 0.58$\pm$0.07 m2, 83.0$\pm$3.8m2, 9.0$\pm$ 1.5 mm, 7.7$\pm$2.0, 197.3$\pm$57.1 mm2/m2, 1.76$\pm$0.32, respect- ively With patients'development (age, body surf'ace area), diameters of pulmonary arteries were increased, but pulmonary artery indices and McGoon ratios were not changed. And there were no effects of age, body surf'ace area, amount of increased 02 saturation, pulmonary angiography and follow-up duration on the increment of pulmonary ar- tery size. But when the McGoon ratio was as low as 1.2, there were significant increase in postoperative pulmonary artery sizes. There was a significant correlation between preoperative pulmonary artery index (PAI) and McGoon ratio (MGR) ; PAI : MGRxl18.0-12.4 In conclusion, bidirectional cavopulmonary shunt provides adequate increment of arterial 02 saturation and does not increase the pulmonary artery size. Further investi ation is mandatory to evaluate the effect of pulsatile bidirectional cavopulmonary shunt on pulmonary artery growth.

선천성 복잡 심기형 환자의 외과적 교정술시 동종이식편의 적용에 관한 연구

지현근 대한흉부심장혈관외과학회 1995 Journal of Chest Surgery Vol.28 No.11

We have been used cryopreserved homograft valves for right ventricular outflow tract[RVOT reconstruction since November 1993. The homograft valves were harvested from the hearts of brain dead patients or hearts of transplant recipients. There were 12 male and 10 female patients. Their ages ranged from 5 months to 13 years[mean age,39.2 $\pm$ 37.4 months and the weight ranged from 5 to 48kg [mean weight, 13.7$\pm$ 9. l kg . The diagnoses included pulmonary atresia with ventricular septal defect [n=14 , tetralogy of Fallot[n=4 , truncus arteriosus[n=3 , and double outlet right ventricle with pulmonic stenosis[n=l .Monocuspid homograft patches were used for RVOT widening or REV[reparation l`etage ventriculaire operations in 4 patients. We also used homograft as valved conduits for RVOT reconstruction in 17 patients and left ventricular outflow tract reconstruction in anatomically corrected transposition in 1 patient. Among them size-reducing technique [converting a tricuspid valved conduit into a bicuspid valved conduit were applied to six patients for the correction of size mismatching. The mean follow-up period was 10.6 $\pm$ 5.4 months. There was one operative death[4.5% due to bleeding and one reoperation for removal of vegetation on the homograft leaflet. Postoperative echocardiography documented no significant homograft insufficiency and RVOT obstructions.In short-term, the homograft valves provide excellent hemodynamic characteristics, even though further studies are necessary to evaluate the long-term results.

양방향성 상대정맥-폐동맥 단락술의 임상적 연구

지현근 대한흉부심장혈관외과학회 1995 Journal of Chest Surgery Vol.28 No.8

We reviewed our experiences on 33 patients who underwent a bidirectional cavopulmonary shunt[BCPS from February 1992 to July 1994. There were 19 male an 14 female patients, and their weight ranged from 4.4 to 13.3 Kg[mean weight 8.4 $\pm$2.9 Kg . The age ranged from 2 to 55 months [mean age 16.7 $\pm$15.5 months . Their diagnosis included single ventricle group in 16, unbalanced ventricles in 8 whose associated anomalies were double outlet right ventricle, transposition of great arteries and total anomalous pulmonary venous return, tricuspid atresia in 7, hypoplastic left heart syndrome in 1 who underwent a Norwood procedure and double outlet right ventricle with pulmonic stenosis and tricuspid stenosis in 1 who underwent biventricular repair. Among them 10 patients had received other palliative operation before [Norwood procedure 1, pulmonary artery banding 3, modified Blalock-Taussig shunt 6 . The BCPS operations were performed under the cardiopulmonary bypass. 16 patients underwent unilateral BCPS and 17 patients who had bilateral SVC underwent bilateral BCPS. Three patients whose associated anomalies were interruption of IVC underwent total cavopulmonary shunt. There were 5 operative deaths [mortality rate 15.1 % and 2 late deaths. The risk factor for the operation was high mean pulmonary artery pressure [p value<0.05 . The survivors showed good postoperative course and their postoperative oxygen saturation was increased significantly compared to that of preoperative status[p value<0.05 .Conclusively, BCPS operation is effective and safe palliative procedure for the many cyanotic complex congenital anomalies with decreased pulmonary blood flow especialy for the patients who have the high risk factors for Fontan operations.

특집/심장 및 폐이식의 현재와 발전방향

지현근,송명근 대한의사협회 2008 대한의사협회지 Vol.51 No.8

Heart transplantation remains the definitive surgical solution for Stage D heart failure. There have been impressive developments in lung transplantation also. This review is focused on the recent advancements in the field of heart and lung transplantation and the current status of thoracic organ transplantation in Korea. Future directions of thoracic organ transplantation are discussed.

Joint Statement of the Korean Society for Thoracic and Cardiovascular Surgery and the Korean Society for Coronary Artery Surgery on Chapter 7.1 in the 2021 American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography a

지현근,김호진,황호영,강준규,홍순창,김준성,최진호,윤영남,오상기,김욱성,백만종,주석중,나찬영,최창휴,김경환,윤정섭,유경종 대한흉부외과학회 2022 Journal of Chest Surgery Vol.55 No.5

부분적 심낭막 결손을 동반한 기관지성 낭종 -1례 보고-

지현근,성숙환,김주현,Ji, Hyeon-Geun,Seong, Suk-Hwan,Kim, Ju-Hyeon 대한흉부심장혈관외과학회 1995 Journal of Chest Surgery Vol.28 No.9

A case of bronchogenic cyst associated with a partial pericardial defect is reported. Bronchogenic cysts are not so rare in incidence, but they are more rare when associated with a pericardial defect, the first case being reported by Rusby and Sellors in 1945. Recently, we experienced such a rare case of a bronchogenic cyst with a partial pericardial defect. The patient is a 39-year-old female and she was found to have a left anterior mediastinal mass during routine chest X-ray. During the operation, we detected partial pericardial defect after removal of the mediastinal mass. The pericardial defect was repaired with a Gore-Tex Membrane. The pathological examination of the mass showed a bronchogenic cyst. The patient had an uneventful hospital course.