최근 10년간 원광의대병원에서 시행한 소아 심장혈관 수술의 임상적 고찰

윤향석,정수미,최두영,오광수,오연균,김종덕,양현웅,이삼윤,김형곤,최종범,최순호,노병석 圓光大學校 醫科學硏究所 1995 圓光醫科學 Vol.11 No.2

We reviewed 10 years experiences of the clinical aspects and early postoperative results in 544 pediatric patients(age less than 16 years old). Among them. 529 cases had the congenital heart diseases, and 15 had the acquired diseases. Open heart surgery was performed in 413 patients. 115 cases were treated with non-open heart surgery. 16 with interventional catheterization. Annual increase of the cardiac patients was not significant in recent 10 years, except slight increase in 1994. The mean age of the study patients had been evidently changed to younger year by year. Total mortality rate of the open heart surgery was 6.4%. The cyanotic congenital heart diseases were high in early postoperative mortality by 25.7%, whereas 4% in acyanotic group. The age group less than one month was most highest in surgical mortality(66.7%). There were no deaths in patients with patent ductus arteriosus(103 cases), atrial septal defect(83 cases) or pulmonary stenosis(17 cases). Among 220 patients with ventricular septal defects(VSD). 10(4.5%) were died early postoperatively. In cyanotic group, the patients with pulmonary atresia with ventricular septal defects(PAVSD), transposition of the great arteries(TGA), interrupted aortic arch(IAA), complex cardiac anomalies with isomerism seemed to be most susceptible to an early death.

메틸수은이 백서의 배양 심근세포에 미치는 영향

윤향석,박승택 대한순환기학회 1996 Korean Circulation Journal Vol.26 No.4

사향쥐(Suncus murinus) 上頸神經節의 微細構造

尹向錫 全南大醫大 1983 전남의대학술지 Vol.20 No.2

신경성장인자(神經成長因子)로서의 약류별(藥類別) 한약제(韓藥劑)가 척수(脊髓) 운동신경세포(運動神經細胞)의 손상(損傷)에 미치는 효능(效能) 및 기전(機轉)에 관(關)한 비교(比較) 연구(硏究)

박승택,윤향석,형근영,조정구,이강창,김원신,김형민,전병훈,윤용갑,Park Seung-Taeck,Yoon Hyang-Suk,Hyoung Keon-Young,Cho Chung-Gu,Lee Kang-Chang,Kim Won-Shin,Kim Hyung-Min,Jeon Byung-Hoon,Yun Young-Gap 대한한의학방제학회 1999 大韓韓醫學方劑學會誌 Vol.7 No.1

In order to eludidate the mechanism of oxidative stress in cultured spinal motor neurons damaged by oxygen free radicals, cytoxicity was assesed by MTT assay and NR assay after spinal motor neurons from mouse were cultured in media containing various concentrations of xanthine oxidase(XO) and hypoxanthine(HX) for 3 hours. In addition, neuroprotective effects of several herb extracts on oxidant-induced neurotoxicity were examined in these cultures, compared with nerve growth factors such as basic fibroblast growth factor(bFGF). XO/HX decreased cell viability in dose- and time dependent manners on cultured mouse spinal motor neurons, and MTT50 and NR50 values were measured at 20mU/ml XO and 0.1mM HX for 3 hours in these cultures. bFGF significantlt increased cell viability. In neuroprotective of herb extracts, Epimedium Koreanum Nakai(EK) and Alpinia oxphylla Mig(IJI) was very effective in the prevention of the neurotoxicity induced by XO/HX in cultured mouse spinal motor neurons. From the above results, it is suggested that XO/HX shows toxic effect in cultured mouse spinal motor neurons and selective herb extracts such as Epimedium Koreanum Nakai(EK) and Alpinia oxphylla Mig(IJI) were very effective in the increase of cell viability against the neurotoxicity induced by oxygen radicals in these cultures.

Kawasaki 병의 임상적 관찰과 치료방법에 따른 예후의 비교

박철우,윤향석,오광수 圓光大學校 醫科學硏究所 1989 圓光醫科學 Vol.5 No.1-2

The twenty one children with kawasaki disease who were diagnosed and treated through admission at Wonkwang University Hospital for recent 3 years were investigated for clinical patterns and laboratory correlations. We devided the patients into two-groups in the methods of medical drug usuage : Group A ; aspirin only, Group B ; aspirin plus intravenous gamma globulin. The results were as follows ; (1) The average duration of fever was 10 to 11 days. (2) The principal signs during admission were fever, changes of lips and oral mucosa (95%, respectively), changes of peripheral extremities, polymorphous exanthema (81 %, respectively), bilateral conjunctival congestion (67 %), cervical lymphadeno-pathy (62 %) in descending order. (3) The main laboratory findings were positive-CRP (89%), elevated ESR (81%), leukocytosis (72%), increased ALT and pyuria (71%, respectively), proteinuria (43 %) in descending order. The average period of peak elevation of platelets was 10 to 14 days beyond the onset of fever (4) We observed the coronary abnormalities at 6 patients (34 %) Saccular aneurysm of left main coronary artery was developed in one patient who was medicated with aspirin only. But, in five patients (28 %) of double treatment with aspirin and intravenous gamma globulin, we observed a diffuse dilatation of the largest single or both coronary arteries. Those abnormal findings became normalized in periods of 3 to 6 months after the onset of fever.

Takaysu 질환에서 신혈관성 고혈압의 수술적 치료

문형배,윤향석,양기영,채권묵,노병석,소병준 대한혈관외과학회 1997 Vascular Specialist International Vol.13 No.1

Renovascular hypertension secondary to renal artery vascular disease is the most common form of surgically correctable hypertension. The common causes of renovascular hypertension are atherosclerosis, fibromuscular dysplasia, and Takayasu arteritis. Takayasu arteritis is a chronic nonspecific arteritis of unkown cause that is relatively prevalant in young female subjects. It has been well known that the pathologic feature of the dis'ease consist predominantly of occulsive changes in the aorta and the origin of its major branches. The most important pathogenetic mechanism of hypertension seems to be through renal artery stenosis. We have experimented three hypertensive patients with Takayasu arteritis experienced. Basic diagnosis was established by angiograpbic study. This article presents surgical treatment methods of Takayasu arteritis with renovascular hypertension and brief review of literatures.

선천성 심질환에서 이면성 심에코도를 이용한 좌우 단락량의 비관혈적 측정

김태업,윤향석 圓光大學校 醫科學硏究所 1988 圓光醫科學 Vol.4 No.1-2

Two-dimentional echocardiogram was performed in 51 children with isolated ventricular septal defect(VSD) and patent ductus arteriosus(PDA) undergoing cardiac catheterization. The magnitude of the left to right shunt was expressed as the pulmonary to systemic flow ratio (Q_p/Q_s) and was compared to a ratio of the echocardiographic left atrial diameter(LAD) to the aortic root diameter(AoD). The Q_p /Q_s was also compared to LAD/m2. Twenty-seven normal infants and children served as controls. The results are as followes : 1. The LAD/m2 and LAD/AoD were significantly larger in normal infants under one year of age than in children above one year 2. In 27 children with isolated VSD, relatively good linear relationship was found between Q_p/Q_s and the LAD/AoD (Q_p/Q_s = 1.66·LAD/AoD-0.51, r = 0.62) 3. In 24 patients with PDA, there was no relationship shown as isolated VSD. Conclusion : The LAD/AoD measurement appears to be helpful in the noninvasive assessment of the left-to-right shunt in patients with isolated VSD, but not in PDA.

도플러 심초음파를 이용한 폐동맥압의 비관혈적 측정방법들에 대한 비교 연구

오재화,윤향석,정진원 대한순환기학회 1995 Korean Circulation Journal Vol.25 No.4

영아의 선천성심질환에 대한 개심술후의 집중치료에서 복막투석용 도관삽입의 의의

오재화,윤향석 圓光大學校 醫科學硏究所 1999 圓光醫科學 Vol.15 No.2

Background: We reviewed 5 years' experience with peritoneal drainage(PDr) in infants who underwent open heart surgery. The aim of this study was to investigate the effect of PDr on fluid balance and several parameters of intensive care. We hypothesized that PDr is safe and effective in infants with low-output cardiac failure after cardiac operations. Methods: Six(3.3%) of 60 consecutive infants who underwent open heart surgery required peritoneal dialysis(PD) during the PDr. Simple PDr was performed in remaining 54 infants. The silicone rubber PD catheter was inserted into the center of abdominal cavity just after the operation, and the subsequent PDr was maintained during the intensive care. Results: Early postoperative mortality in all in infants with congenital heart disease was 1.6%. Total amount of intake was 6.30±1.59 ㎖/㎏/hr, and total output was 6.95±2.32 ㎖/㎏/hr, urine output was 5.08±2.55 ㎖/㎏/hr, pleural fluid 0.78±0.52 ㎖/㎏/hr, peritoneal fluid 1.20±0.90 ㎖/㎏/hr. The ratio of the output to the intake(O/I) was 1.1. None of the complications required early termination of the drainage. Hemodynamics and pulmonary function were maintained steadily during the postoperative intensive care. Conclusions: The early institution of peritoneal drainage(PDr) in infants with congenital heart disease after cardiac operations not only removes fluid, thus easing fluid restriction, but may also improve cardiopulmonary function.

하정맥동형 심방중격결손의 외과적처지 -4례 보고-

최형호,김천석,윤향석,최종범,최순호 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.2

Inferior sinus venosus defect is a rare lesion in which there is a large interatrial communication adjacent to the atrial connection of the inferior caval vein. The defect is located posteriorly and inferiorly, outside the confines of the true atrial septum, and partial anomalous pulmonary venous connections are the rule. We underwent surgical repair in four patients with inferior sinus venosus defect and partial anomalous pulmonary venous return. There were three males and one female with an age range from four months to 25 years. A cross- sectional echocardiogram and cardiac catheterization had been performed preoperatively in all patients, but the correct diagnosis had been made in only one case. Surgical repair was indicated due to congestive heart failure, and one patient of 4-month-old needed urgent operation. The repair was accomplished by suturing a untreated autologous pericardial patch to the right of the pulmonary veins, so that the defect was closed and all the pulmonary venous blood was directed to the left atrium. The preoperative knowledge of the unusual anatomy allows the surgeon to repair the anomaly without difficulties. For the patients in whom interatrial communication and anomalous pulmonary venous return are suggested, surgeon has to pay careful attention to the anatomical landmarks to avoid incorrect placement of the patch. 하정맥동 결손(inferior sinus venosus defect)은 하대정맥과 우심방의 경계 부위에 발생하는 심방중격결손의 한 형태로 매우 드문 선천성 심장질환이며, 심방중격의 하부 뒤쪽에 위치하고 한 개 이상의 우 폐정맥의 환류 이상을 동반하고 있어 개심술시 정확한 교정을 요하므로 수술 전 또는 수술 중 정확한 해부학적 진단이 선행되어야 한다. 저자들은 부분 폐정맥 환류이상을 동반한 하정맥동형 심방중격결손 4예를 치험하였다. 1예는 25세 성인이었고 3예는 14개월 미만의 영아 및 소아였다. 4예 모두 심부전 때문에 수술했으며 이중 4개월의 영아는 긴급 수술이 필요했다. 진단을 위해 심초음파 및 도플러 검사와 심도자법을 시행하였다. 수술전 확진은 1예에서 가능했고 3예는 수술전 병변을 의심하고 수술시 확진되었다. 수술방법으로 이상 환류되는 폐정맥이 좌심방으로 환류 되도록 자가심막을 이용하여 심방중격결손을 폐쇄하였다. 4예 모두 수술 결과는 양호하였으며 초음파 검사의 추적에서 하대정맥과 폐정맥의 환류장애 소견은 없었다. 정확한 수술 교정을 위해 수술전 정확한 진단이 필수적이며, 수술전 폐정맥의 부분 환류이상과 심방중격 결손으로 진단된 환자에서는 수술중 하정맥동 결손의 여부를 확인하여 적절한 수술적 교정을 시행해야 할 것으로 사료된다.