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김춘직(Chun Jik Kim),김상운(Sang Woon Kim),이수정(Soo Jung Lee),김홍진(Hong Jin Kim),심민철(Min Chul Shim),권굉보(Koing Bo Kwun),정문관(Moon Kwan Chung) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.1
N/A Since operative cholangiography was introduced by Mirizzi in 1932, surgeons have used it routinely during cholecystectomy to find silent CBD stones. However, recent developments in preoperative evaluation techniques have led to debates regarding the routine use of operative cholangiography. The purpose of this study is to evaluate the necessity of the routine use of operative cholangiography. Of the 839 patients who underwent cholecystectomy, 625 patients underwent preexp- loratory cholangiography during the period from June 1983 to December 1991, at the Depart- rnent of Surgery, Yeungnam University Hospital. Unsuspected common duct stones were found in 5 out of 149 patients(5.9%) by preexploratoty cholangiography when emergency cholecystectomy was performed. Of the 448 cholangiography in patients without any abnor- mality in the preoperative test and no operative indication for CBD exploratiOn, the incidence of gall stones was only 1.1%. Of the 82 patients with minor abnormality of LFT or ultrasonogram, 38 cases of elective cholecystectomy were carried out without any other test. The incidence of gall stones in these patients was 28%. The ERCP was attempted on 163 pa- tients with one or more of the following abnormalities: LFT, ultrasonogram and past history of jaundice, pancreatitis or cholangitis. In 117 of these patients, CBD stones were found, in 2 of the patients, stricture were found, and in the rernaining 44, no stones were found. The ERCP performed on 35 patients with normal findings of preopeative LFT or ultrasonogram showed no evidence of CBD stone. Of the 79 whose ERCP was judged normal preoperatively, no stones were found at operative cholangiography. Therefore the following points may be concluded: First, operative cholangiography should be performed when emergency cholecystectomy is indicated. Secondly, it should also be done when the confirmatory test, such as ERCP, PTC and CT was not performed or failed in pa- tients with one or more of the following abnormalities such as LFT, ultrasonogram and past history of jaundice, pancreatitis or cholangitis. Finally, it should also be carried out on patients with dilated duct, small stones in the gallbladder and enlarged cystic duct.(Korean J Gastroenterol 1994; 26: 167-174)
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경식도 심초음파도를 이용한 말초 동맥 색전증의 원발 병소 조사
권굉보,서보양,도병수,김춘직,김영조,한승세 대한혈관외과학회 1993 Vascular Specialist International Vol.9 No.1
Arterial embolic disease is an increasing number of clinical problem. After initial evaluation for peripheral arterial emboli, and then routine electrocardiogram was performed for screening embolic sources. In cases which abnormal ECG or history of cardiac disease is noted, transthoracic echocardiography(TTE) is commonly performed to detect cardiac sources of re- mained emboli. TTE has limitation to visualize the left atrium, thrombus limited to the left atrial appendage, stagnant atrial flow and thoracic aorta. To overcome these disadvantages, transesophageal echocardiography(TEE) can perform in selected and equivocal cases of TTE. Authors evaluated 22 cases of peripheral ischemia caused by emboli which were proven by operation. Male to female ratio was 15: 7 and average age was 53 years old(age range: 38-71 years old) and diagnosed to peripheral arterial embolic disease by arteriography. TTE could detect cardic pathology in 16 cases(72.7%) and noncardiac pathology in 6 cases (27.3% ). TEE was done in 6 cases of equivocal findings by TTE and found out 4 cases of thrombi which were located at left atrium(2 cases) and left atrial appendage(2 cases). All 4 cases were received cardiac operation and simultaneous peripheral embolectomies were done also. In conclusion, the use of TEE in evaluating the heart and thoracic aorta as a source of distal emboli is recomendable in equivical cases by TTE.
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장대퇴 정맥 폐쇄시 Palma 술식후 악화된 정맥성 고혈압
이원종,권굉보,서보양,김춘직 대한혈관외과학회 1994 Vascular Specialist International Vol.10 No.1
Chronic venous insufficiency(CVI) is a disease which developes leg edema and venous claudication. In 1960, Palma operation was introduced for relief of clinical symptoms of CVI and more popularized and modified by Dale and Hunsi. We analyzed the 8 cases of CVI patients who were treated with Palma operation with distal A-V fistula formation. The outcomes were analyzed as follows; Four cases of mild venous hypertension were improved, but another Four cases of high venous hypertension were aggravated in pain and leg edema during 2 to 3 months postoperative period, inspite of patent graft. In 4 cases of noneffective Palma operation contrast to effective cases, there were absent or diminished collateral vein in preoperative venographic findings and high venous pressures above l0cmH₂O were measured at closing times of A-V fistula. A-V fistulas were closed by operation in 2 cases and by interventional radiologic coil in 1 case. The leg edemas of these 3 cases were relieved slightly after A-V fistula closure. As results, we conclude that the cases of well developed collateral circulation in venography or of low venous pressure between 6∼10cmH₂O are good candidate for Palma operation, but high venous pressure above 10cmH₂O or poor collateral circulatin in venography are noted, prosthetic cross femoral bypass(CFB) graft using above Smm diameter are rather recommanded than saphenous vein. After Palma operation, if venous hypertension or clinical symptoms were aggravated, A-V fistula closure were required to reduce venous pressure.
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