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방사선 치료 후 변형 흉곽을 가진 환자에서 발생한 급성 심근경색의 치료
최강주 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.3
방사선은 흉곽과 심장의 모든 구조물에 영향을 줄 수 있다. 관상동맥협착증은 종격동 방사선치료로 유발 될 수 있는 심각한 만기 합병증이다. 10년전 유방암으로 근치적 유방절제술과 흉부방사선치료를 받은 51세 여자 환자에서 발생한 급성 심근경색증의 치료중 중재적 시술이 실패한 후 관상동맥우회술을 시행하였다. 좌측 흉벽 구조물의 심한 변형과 부족한 흉부조직량으로 좌측 내흉동 맥을 사용하지 못하고 우측 내흉동맥을 이용하였다. 우측 내흉동맥을 좌전하행지에 문합하였다. 심낭은 매우 두꺼워져 있었고, 좌전하행지내 내막도 봉합침이 통과하기에 어려울 정도로 두꺼워져 있었다. 환자는 수술 후 합병증 없이 퇴원하였다. Radiation can affect all of the structure in the chest wall and the heart . Coronary stenosis is a severe late complication after mediastinal radiation therapy. A 51-year-old female patient who was treated with left radical mastectomy and radiation therapy for breast cancer 10 years ago, underwent a coronary artery bypass surgery for acute myocardial infarction after percutaneous coronary intervention(PCI). Right internal thoracic artery(RITA) was used as a conduit because of deformed left anterior chest wall. RITA was anastomosed to left anterior descending artery(LAD) under off pump system. The pericardium was very thickened. Marked intimal fibrosis of LAD made penetration of suture needle difficult. After uneventful bypass surgery, the patient was recovered with no complications.
폐결핵 환자에 적용된 폐절제 요법에 관한 검토: Automatic stapling device를 이용한 절제례의 검토
최강주 대한흉부심장혈관외과학회 1991 Journal of Chest Surgery (J Chest Surg) Vol.24 No.8
In Pusan Paik Hospital, Inje University, we experienced 174 cases of pulmonary resections for pulmonary tuberculosis from Jun. 1979 to Feb. 1990. In all of them automatic stapling devices were used for division of lung parenchyme and /or bronchial closure. The results were as follows; l. In 174 cases[male 100, female 74], third and fourth decades were 116 cases [66.7%]. 2. Indications for lung resection in the radiographic findings were destroyed lung 47 cases[27.0%], destroyed lobe 42 cases[24.1%], cavitary lesions 42 cases[24.1%], tuberculoma 22 cases[12.7%], and bronchial lesions 21 cases[12.1%]. 3. The mean of staplers used in the operations was 1.6, and possible stapler-associated complications were only 2 cases of bronchopleural fistula after pneumonectomy. 4. Twenty-seven of 36 patients with bilateral lesions and 52 of unilateral ones on chest X-ray films were AFB positive on preoperative sputum smears. Twenty-three[85.2%] of bilateral lesions and 51[98.1%] of unilateral ones were AFB negative at 6 months after operations. 5. Main complications of resections were operative death 1[0.6%], empyema 4[2.3%], respiratory insufficiency 3[1.7%], pleural dead space 5[2.9%], and bronchial spreading of tuberculosis 2[1.1%]. Bronchopleural fistula were only 2 cases after pneumonectomy and none after lobectomy or segmentectomy. 6. One hundred and forty two patients[92.8%] of 153 with available follow-up data were in the state of good quality of life.
최강주,고성룡,김우정,김나미 한국농화학회 1993 Applied Biological Chemistry (Appl Biol Chem) Vol.36 No.1
Effects of temperature, time, solvent addition ratio and number of extraction on contents of effectual components and soluble materials of cinnamon extracts were studied. All of the chemical contents of proximate composition and cinnamic acid, cinnamic aldehyde and eugenol were significantly increased as the extraction temperature increased from 20℃ to 80℃, while little change measured at 100℃. During ten hours of extraction at 80℃ more than six hours extraction showed a little increase effects the contents of cinnamic aldehyde, eugenol and proximate components. The ratio of solvents added to dried cinnamon also showed improving effects of chemical properties as the ratio increased from 5 to 40 times. Two times of extractions for 1 hour was found to be effective to recover those components.
개심술 후 발생한 급성 종격동염과 흉골골수염 : 대망편을 이용한 치료
최강주 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.3
흉골절개술 후 발생한 종격동염은 치명적인 합병증으로 알려져 있다. 종격동에 대망편을 전위하는 방법은 이러한 심각한 합병증을 치료하는 몇 가지 방법 중 하나이다. 흉골절개로 승모판막치환술은 받은 57세 여자환자에게서 발생한 종격동염을 치료하기 위해 대망편 전위술을 시행하였다. 골수염을 가진 흉골을 전부 제거한 후 대망편을 전위시켰다. 수술 후 환자는 특별한 합병증 없이 퇴 원하였다. Post-sternotomy mediastinitis has been known as a lethal complication. Omental flap transposition is one of the few procedures to treat this severe complication. A 57-year-old female patient who underwent mitral valve replacement using median sternotomy was performed omental flap transposition to treat post-sternotomy mediastinitis. The greater omentum was used to fill the space after resection of the infected sternum. After uneventful operation, the patient was discharged with no complications.
무심폐기하 관상동맥우회수술에서 아스피린과 Clopidogrel의 수술 전 병합투여가 수술 후 출혈에 미치는 영향
최강주,성후식,계여곤 대한흉부외과학회 2008 Journal of Chest Surgery (J Chest Surg) Vol.41 No.5
Background: It is well known that preoperative administration of combined antiplatelet agents can have an impact on the postoperative bleeding, the requirement for transfusion and the need for reexploration during on-pump coronary artery bypass surgery. Yet its effects have not been well evaluated in the case of off-pump coronary artery bypass surgery. Material and Method: We performed a retrospective study of nineteen patients who underwent OPCAB from March 2003 to December 2004. All the patients had taken antiplatelet agents until 12 hours before operation. The patients were divided into two groups as an aspirin group and a combined (aspirin+clopidogrel) group. The perioperative platelet count, the hemoglobin level, the hematocrit, the prothrombin time and the aPTT were compared between both groups. The amount of postoperative bleeding, the transfusion requirement and the need for re-exploration to control bleeding were also compared between both groups. Result: There was no difference of operation time and the intraoperative ACT between the aspirin group and the combined group. The amount of blood loss through the chest tube for 24 hours was not different between the aspirin group (697±271 mL) and the combined group (944±432 mL). The number of patients who received blood transfusion was also not different between both groups. There was no patient who required reexploration for bleeding control in both groups. The perioperative hemoglobin level and hematocrit were also not different between both groups, but the postoperative hemoglobin level and hematocrit were decreased significantly in the group. Conclusion: The preoperative combined antiplatelet (aspirin+clopidogrel) therapy group was not different from the aspirin group for the amount of postoperative bleeding, the amount of blood transfusion and the need for reexploration during off-pump coronary artery bypass grafting. This subject needs further evaluation because of small population in our study.