급성 척수허혈 및 재관류손상에 대한 Na^+/H^+ 교환억제제(DMA)의 보호효과 : 가토 척수의 허혈 및 재관류손상 모형에 의한 실험적 연구 An Experimental Study in Spinal Cord Ischemia and Reperfusion Injury Model

고정관,박형주,이길노 순천향의학연구소;Soonchunhyang Medical Research Institute 2000 Journal of Soonchunhyang Medical Science Vol.6 No.1

Spinal cord injury after operations on the descending thoracic and thoracoabdominal aorta remains a persistant clinical problem. Previous attemps to decrease the risk of this devastating complication by lowering the rate of metabloism of the spinal cord have met with varying success. We hypothesized that the tolerance of the spinal cord to an ischemic insult could be improved by means of Na^+/H^+ exchange inhibitor(DMA). DMA prevent intracellular Na^+ influx and maintain intracellular acid pH during ischemia by blocking the Na^+/H^+ exchange system. Additionally, subsequent Ca^++ influx during reperfusion is prevented by blocking the Na^+/Ca^++ exchange as well. It is well established that not only the intracellular acidosis during ischemia prolongs cellular survival but almost all of the reperfusion injury is associated with intracellular Ca^++ overload. Twenty four New zealnad white rabbits underwent 30 minutes of isolated infrarenal aortic occlusion after heparin anticoagulation. Clamps were placed both below the left renal vein and above the aortic bifurcation. In 12 rabbit(Amiloride Group), a bolus of amiloride(3㎎/㎏) intravenous injection and a bolus of diluted amiloride(100uM) was infused the isolated aortic segment immediately after crossclamping and immediately before release of clamping. In another control group(12 rabbits), the aortic segment was flushed with normothermic saline in a fashion identical to that of the study group. The aortic clamps were removed after 30 minutes, the abdomen was closed, and the animals were allowed to recover from anesthesia. Spinal cord function was assessed 72 hours after operation by the Talov's scale. All animals were put to death at 72 hours after operation and spinal cords were harvested for MDA and histologic analysis. The spinal cord function of all Amiloride group animals were fully intact with Talov's scores of 3-5; control group animals were all paraplegic with Talov's score of 0-2(p<0.001, student t-test). MDA level in Amiloride group was 0.046±0.06 and control group was 0.065±0.01(p<0.0001, student t-test). Histologic examination of spinal cords from Amiloride gropup rabbits revealed a little evidence of cord injury, whereas spinal cords from control group had evidence of extensive cord injuty with central gray necrosis, axonal swelling, dissolution of Nissl substance, and astrocyte and macrophage infiltration. Systemic and regional infusion of the crossclamped infrarenal rabbit aorta with Na^+/H^+ exchange inhibitor(DMA) nearly complete prevented paraplegia in our model despite a 30-minute ischemic insult.

선천성 횡격막 탈장의 수술치험 : 치험2례 A report of 2 cases

고정관,이철세 최신의학사 1995 最新醫學 Vol.38 No.1

관상동정맥루에 동반된 관상동맥협착증의 수술치험 1례

고정관 대한흉부심장혈관외과학회 1989 Journal of Chest Surgery (J Chest Surg) Vol.22 No.4

Congenital coronary arterial fistulae are the most prevalent hemodynamically significant congenital coronary artery malformations. Definition of congenital coronary arterial fistula is a direct communication between a coronary artery and the lumen of one of the four cardiac chambers or coronary sinus or SVC, pulmonary artery or pulmonary vein close to the heart. It is often associated with additional congenital or acquired heart disease. A 49 year old male patient was admitted with the chief complaints of anginal pain and exertional dyspnea for 9 months. He was diagnosed as the right coronary arterial fistula combined with right coronary arteriosclerotic stenosis and old inferior myocardial infarction by cardiac evaluation. The right coronary arterial fistula was communicated between the just distal portion of acute marginal branch and coronary sinus. The operative procedure was as followings; after suture ligation of fistula opening in the coronary sinus under beating heart, coronary arterial bypass grafting with saphenous vein was performed at the just proximal portion of the posterior descending branch under cardiopulmonary bypass. The postoperative course was uneventful and he was discharged without anginal pain at the 8th postoperative day.

Annuloaortic Ectasia 에 대한 Bentall 씨 수술치험

고정관 대한흉부심장혈관외과학회 1988 Journal of Chest Surgery (J Chest Surg) Vol.21 No.5

A case of Annuloaortic Ectasia associated with Marfan syndrome and mitral regurgitation is treated surgically by Bentall`s method and mitral annuloplasty. The Annuloaortic Ectasia is frequently accompanied with Marfan syndrome, its definition is simply explained as the following; the marked dilatation of the sinuses of Valsalva and the aortic annulus as well as the huge aneurysm of the ascending aorta. As the operative finding, the intimal tearing was shown as circular and the both coronary ostia were changed the position into high up. The patient was taken a corrective operation replacing the ascending aorta and aortic valve with a composite graft[St. Jude medical valve 29mm, woven Dacron tubular graft 31mm]. The both coronary ostia were reimplanted on the graft with 4-0 prolene by continuous suture. Mitral annuloplasty was performed. After the operation, the patient developed both spontaneous pneumothorax, he improved state by the closed thoracostomy. He has been doing well, postoperatively.

중증 객혈환자의 구명을 위한 새로운 외과적 접근 : 흉골 정중절개에 의한 폐엽의 기관지-혈관 격리술

박형주,이철세,고정관 순천향대학교 1994 논문집 Vol.17 No.4

Major hemoptysis is not only a clinical challenge but also the most critical situation when it is aspirated into the tracheobronchial tree especially in the chronic debilitated patients. Recently, bronchial artery embolization(BAE) is the most effective measure for the primary conservative management and salvages a lot of lives in the emergency situations. However, as the recurrence rate of hemoptysis after embolization is significant and there are very poor cases that cannot be controlled by every medical efforts, emergency surgical resection is the only way of lifesaving. In these high risk group of patients, standard lobectomy resulted in high mortality and morbidity. Since October, 1993, we introduced a new surgical approach of "Broncho-vascular Isolation Lobectomy" for the lifesaving of medically failed life-threatening hemoptysis. Now we report 3 cases treated by this approach and would like to suggest future implications in the treatment of major hemoptysis.

폐암 환자에서 종격동 임파절 크기와 암전이에 대한 상관관계 연구 : A prospective study of operative and pathologic finding

고정관,이길노 순천향의학연구소 1997 Journal of Soonchunhyang Medical Science Vol.3 No.1

Computed tomography is being increasingly used for evaluation of mediastinal lymph node in patients with non-small cell luntg cancer. A lack of CT and pathologic correlationled the author to compare the result of CT scans of mediastinal lymph nodes with the result of postoperative pathologic findings. The number of three group patients had been through surgical-pathologic determination of mediastinal node ststus. The first group was a control group containing 10 normal nodes in non cancer patient. The number of non metastatic mediastinal lymph node as second group was 15 and metastatic lymph node of third group was 14. In the study of mediastinal lymph nodes size, maximal long axis diameter and maximal short axis diameter were higher in group 3 than in group 2(P<0.05), and group 3 than in group 1(P>0.05). The sensitivity of preoperative CT scan was 71.4% and specificity was 53.3%, but surgical-pathologic correlation of mediastinal lymph nodes was not statistically significant(P>0.05). In conclusion, the malignant mediastinal adenopathy was depond on size of lymph node. CT staging of the mediastinum in patients with non-small cell lung cancer was clinically not useful.

복막후강으로 파열된 감염성 대토동맥루 -치험 1례 보고-

이만복,김희준,고정관,조영철,강창희,남충희,노중기,이길노 大韓胸部外科學會 1988 Journal of Chest Surgery (J Chest Surg) Vol.21 No.4

전흉부에 발생한 거대 연골육종

박영우,장원호,고정관,이철세,박형주,탁민성,이영만 대한흉부심장혈관외과학회 2001 Journal of Chest Surgery (J Chest Surg) Vol.34 No.12

거대 연골육종은 흉벽의 원발성 악성종양 중 임상에서 드물게 보는 형태이다. 60세 여자 환자가 전흉부에 발생한 거대 종양과 심막 침범 및 심장의 장측 심막에 위성 종양 등의 진행된 연골육종을 보였다. 수술은 종괴를 포함하여 양측 3개의 늑골, 양측 쇄골, 흉골자루와 흉막, 심막을 광범위 총괄절제하고, 2mm Gore-tex 포편과 광배근 자유 피부 근육판을 이용하여 흉벽을 재건하였다. Huge chondrosarcoma is a rare form of primary malignant tumor of the chest wall. We operated on a 60 year old female patient who had a huge anterior chest wall mass with local invasion into the pericardium and satellite tumors on the visceral pericardium of the heart. En-bloc resection of the huge tumor including both upper 3 ribs, both clavicles, manubrium of the sternum, pleura, and pericarium, was followed by complex chest wall reconstruction using a Gore-tex soft tissue patch and latissimus dorsi musculocutaneous free flap.

기흉을 합병한 폐림프관평활근종증 치험 1례

장인성,이준복,고정관,양성린,김용훈,이철세 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery (J Chest Surg) Vol.32 No.11

Lymphangioleiomyomatosis(LAM) is defined as an abnormal proliferation of smooth muscles in the lung tissue throughout lymphatics, vascular and bronchial structure. A 52-year-old postmenopausal woman was admitted to our hospital for recurrent pneumothorax. She was treated for medroxyprogesterone by LAM 1 month ago. We performed operation of pulmonary partial resection and pleurodesis. The patient is receiving continuous medroxyprogesterone and Leuplin administration, and currently, 6 months after the operation, is still showing good results.

윤상인두근 무이완증

김재영,박형주,장인성,고정관,이철세,박상흠,이문호 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.4

Idiopathic cricopharyngeal achalasia is a rare condition that produces oropharyngeal dysphagia. It is caused by spasm of the cricopharyngeus and inability to relax with swallowing. A prominent muscle bar at the upper esophageal sphincter is a typical finding of the esophagogram. Cricopharyngeal myotomy is the treatment of choice. We report a case of cricopharyngeal myotomy for 61-year-old female patient. 특발성 윤상인두근 무이완증은 드물게 발생하는 식도 연하장애이다. 이는 연하작용시 윤상인두근의 이완불능으로 인해 발생하며 식도조영검사상 돌출된 윤상인두근간의 특징적 소견을 보인다. 치료는 윤상인두근 절개술이 가장 효과적이다. 본 순천향대학교 천안병원 흉부외과에서는 상부식도괄약근 무이완증의 61세 여자 환자에게 국소마취 하에서 윤상인두근 절개술을 시행하여 문헌 고찰과 함께 보고하는 바이다.