폐절제후 농흉에 합병한 견인성 중부식도게실의 치험례

권중혁 대한흉부심장혈관외과학회 1978 Journal of Chest Surgery (J Chest Surg) Vol.11 No.3

This is a case report of surgically treated esophageal traction diverticulum which was resulted from postpneumonectomy empyema. In March, 1976, left lower lobectomy and thoracoplasty were performed at a hospital to treat long standing lung abscess, after operation it developed into empyema. One year later [April, 1977], We did decortication and left upper lobectomy[ultimate pneumonectomy], which was followed by empyema again, 3 months later it developed esophagopleurocutaneous fistula. Esophagograms bowed an adult thumb tip sized traction diverticulum in the midportion of the esophagus. Finally in January, 1978, after 6 months of gastrostomy feeding, fistulectomy and diverticulectomy were performed The funnel shaped diverticulum was in midesophagus and retracted by surrounding inflammatory scar tissue. Now the postoperative course was uneventful.

족근골의 Ewing씨 육종

권중혁 대한영상의학회 1985 대한영상의학회지 Vol.21 No.3

The Ewing's sarcoma comprises approximately less than 10 percent of malignant bone tumors and 5 percent of all bone tumors, occurs in almost all bones of the body, and presents a widely divergent roentgenographic manifestations. The tarsal bones are involved only 2 percent in the Ewing's sarcoma. Two cases experienced by authors and ten cases published in literatures of Ewing's sarcoma of the tarsal bone were analized retrospectively. The result were as follows: 1. Of the tarsal bones, the calcaneus was 7 cases, the talus 4 cases, cuneiform 1 case. 2. Female was affected more commonly than male, the ratio being 4 to 1 in the tarsal bones. 3. About sixty percent of total caes in the tarsal bones had evidence of diffuse sclerotic pattern. All the cases of the talus had evidence of diffuse sclerotic pattern. 4. The diseases to be considered in differential diagnosis are as follows: avascular necrosis, tuberculous osteomyelitis, osteosarcoma, and pyogenic osteomyelitis. 5. The dif use sclerosis radiographically showed a close relation with dead bone resulting from avascular necrosis dut to tumor infiltration histologically. Periosteal reactive new bone and osteoid deposition on the dead bone were also correlated with diffuse sclerosis. 6. Because it is difficult to differentiate sclerotic lesions in the tarsal bones by radiographic methods alone, all such lesions should be subject to biopsy as early as possible.

Monosegmental Hepatobiliary Fibropolycystic Disease Mimicking a Mass: Report of Three Cases

권중혁,김미정,김영환,강구정,강유나,권선영 대한영상의학회 2014 Korean Journal of Radiology Vol.15 No.1

Hepatobiliary fibropolycystic diseases are a unique group of entities involving the liver and biliary tract, which are caused by abnormal embryologic development of the ductal plates at various stages. We experienced strange hepatobiliary fibropolycystic diseases with a complex mass composed of malformed ducts and biliary cysts, which did not belong to, and were different from, previously known malformations. They were unique in imaging and histologic features. We herein report three cases of monosegmental hepatobiliary fibropolycystic disease mimicking a mass.

춘계학술대회 : 포스터발표 ; 복강내 원격전이를 가진 간세포암에 대한 CT유도하의 고용량의 경피적 에탄올 주입술에 의한 치료

권중혁,김미정,황재석,안성훈,박경식,정우진,이영석,정강욱 대한간학회 2005 Clinical and Molecular Hepatology(대한간학회지) Vol.11 No.3(S)

Background/Aims: Hepatocellular carcinomas (HCCs) metastasize to regional or distant lymph nodes, adrenal glands, or intraperitoneally. Treatment modalities for HCCs are known to be useless for this situation. The purpose of this study was to evaluate the

대장 용종의 임상적 고찰

권중혁,이준우,김병익,전우규,정을순,이만호,이상종,김명숙 대한소화기학회 1994 대한소화기학회지 Vol.26 No.3

Neoplasms of the colon, either benign or malignant, are very commonly encountered in clini- cal practice and gradually increased. From September 1985 to February 1993, we studied 249 patients with colorectal polyp by colonofibroscopic examination. The study included the clinical manifestations, barium enema and colonoscopic findings as well as the histopathological abnomalities and CEA level. Age distribution was in wide range from first to ninth decades, the peak prevalence was in 6th decades among both groups and the male to female ratio was 1.62: 1. The cardinal symp- toms were epigastric discornfort(16.1% ), low abdominal discornfort(15.7% ), and anal bleeding (14.9% ). Colorectal polyps were found at the sigmoid colon(31.5%), rectum(20.5%), trans- verse colon(11.9%) and ascending colon(11.3%), respectively. The number of colorectal polyp was single(48.6%) and multiple(51.4%). The size of colorectal polyp was less than 0.5cm in diameter(72.3%), between 0.5 and 1.0cm(20.1%), more than 2cm(13.3%). Among 191 cases, according to Yamada classification, type II was found in 31.4% and type 1V in 26.2%, respectively. Histopathologic findings were identified as tubular adenorna(53.7%), inflammato- ry polyp(16.8%), adenocarcinoma(12.3%) and hyperplastic polyp(7.5%). In 31 cases of this series, positive findings of barium enema were at sigmoid colon(36.7%), rectum(23.3%), as- cending colon(23.3%) and descending colon(16.7%). However, no abnormalities of barium en- ema studies were identified in 32.3%. In 65 cases, CEA(carcinoembryonic antigen) level was below 5ng/ml(78.5%), within 5 10ng/ml(7.7%) but above 10ng/ml(13.8%). The rate of ma- lignancy was 33.3% in t.he first group and 77.8% in the last group. The most common type was tubular adenoma(63.1%) by the histopathological examination. Colorectal polyps were most commonly found at sigmoid colon. The most common size of colorectal polyp was less than 0.5cm in diameter.(Korean J Gastroenterol 1994; 26: 465 472)

포스터발표 : 복강내 원격전이를 가진 간세포암에 대한 CT유도하의 고용량의 경피적 에탄올 주입술에 의한 치료

권중혁,김미정,황재석,안성훈,박경식,정우진,이영석,정강욱 대한간학회 2005 춘계 학술대회 Vol.11 No.-

심실중격결손을 합병한 Valsalva's 동 동맥류 파열의 치험예

권중혁 대한흉부심장혈관외과학회 1979 Journal of Chest Surgery (J Chest Surg) Vol.12 No.1

This is a case report of surgically treated rupture of Valsalva Sinus aneurysm combined with VSD. He has been relatively healthy until about one month before admission, when during bath, he felt abruptly palpitation, left chest pain and exertional dyspnea. These symptoms have progressed. On admission, thrill was palpable and continuous machinery murmur was audible on 2nd and 3rd intercostal space along the left sternal border. A rupture of Valsalva`s sinus aneurysm was confirmed by aortography and echocardiography but a small VSD was found by cardiotomy in open heart surgery. On 11th Sep. 1978, open heart surgery was performed. Valsalva`s sinus aneurysm came out from right coronary aortic sinus and ruptured into the right ventricle. It sized 1.2X1.5X1.5 cm. Ruptured opening was noted on apex of aneurysm [0.8X0.8cm], VSD [1. 0X0. 3cm in size] was just below the aortic annulus. The aneurysmal sac was removed on neck. After that, VSD and aneurysmal orifice were closed together with interrupted mattress sutures on same plane. The postoperative course was uneventful and discharged three weeks after open heart surgery.

위 공장 문합술 후 문합부 후방 탈장의 초음파 및 전산화 단층촬영 소견

권중혁,Gwon, Jung-Hyeok 대한영상의학회 2003 대한영상의학회지 Vol.49 No.3

Purpose: To review the radiologic findings of retroanastomotic hernia and to derive useful US and CT criteria to assist in the diagnosis of the condition in patients who have undergone gastrojejunostomy. Materials and Methods: During a recent eight-year period, we encountered 11 consecutive cases of retroanastomotic hernia. Of the patients involved, nine underwent ultrasound (US), eight underwent computed tomography (CT), and in three, small bowel follow-through imaging was performed. The US and CT scans were reviewed to determine abnormal findings; surgical proof was available in all cases. Results: The efferent loop was herniated through the defect created behind the anastomosis in eight cases, both the efferent and afferent loop in two cases, and the afferent loop in one case. Retroanastomotic hernia was prospectively diagnosed in ten of these eleven cases. Among the eight cases of efferent loop herniation, US and CT signs of retroanastomotic hernia included whirling of mesenteric vessels, jejunal loops and mesentery in the periumbilical abdomen (8/8); mural thickening of herniated bowel loops (6/8); dilatation of herniated bowel loops (4/8); (at US) decreased peristalsis of herniated bowel loops (3/7); and (at CT) decreased contrast enhancement of herniated bowel loops (1/5). In one case, US and CT signs of retroanastomotic hernia of the afferent loop included its dilatation and whirling of a short length behind the anastomosis. In two cases, US and CT signs of retroanastomotic hernia of both the afferent and efferent loop included findings of both afferent and efferent loop herniation. Conclusion: Retroanastomotic hernia is an important and underdiagnosed condition, and the US and CT findings we have described may permit its accurate diagnosis. 목적: 위 공장 문합술을 받은 환자에서 문합부 후방 탈장의 방사선학적 소견을 분석하고 이 질환을 진단하는데 있어서 초음파와 전산화 단층촬영 소견의 유용한 기준을 얻고자 하였다. 대상과 방법: 지난 8년간 문합부 후방 탈장으로 진단된 연속적으로 발생한 11명의 환자를 대상으로 했으며 이 들은 9예의 초음파 검사,8예의 CT검사, 그리고 3예의 소장조영술을 시행했다. 이상 소견을 결정하기 위해 초음파 및 CT검사 소견을 분석했다. 전 예를 수술로 확진을 했다. 결과: 8예에서 원심성 고리가 문합부 후방에 생긴 구멍을 통해서 탈장이 되었고, 2예에서 원심성 고리와 구심성 고리가 탈장이 되었고, 1예에서 구심성 고리가 탈장이 되었다.11예 중 10예에서 전향적으로 진단했다.8예에서 존재한 원심성 고리가 탈장된 문합부 후방 탈장의 초음파 및 CT 소견은 배꼽주위에서 상장간막 혈관들, 공장, 그리고 장간막의 회전 (8/8), 탈장된 장의 벽 비후 (6/8),탈장된 장의 팽창 (4/8),초음파 검사에서 탈장된 장의 연동운동의 감소 (3/7),그리고 CT에서 탈장된 장의 조영 증강의 감소 (1/5)였다. 1예에서 경험한 구심성 고리가 탈장된 문합부 후방 탈장의 초음파 및 CT 소견은 구심성 고리의 팽창과 문합부 후방에 짧은 길이의 구심성 고리의 회전을 보여 주었다.2예에서 경험한 구심성 고리와 원심성 고리가 탈장된 문합부 후방 탈장의 초음파 및 CT 소견은 구심성 고리 탈장과 원심성 고리 탈장의 소견을 모두 보여 주었다. 결론: 문합부 후방 탈장은 중요하나 진단이 어려운 질환이다.여기서 보고된 초음파 및 CT 소견은 문합부 후방 탈장의 정확한 진단에 도움을 주리라 생각한다.

좌심실 이중유출로를 동반한 교정형 대혈관전위증 -1예보고-

권중혁 대한흉부심장혈관외과학회 1979 Journal of Chest Surgery (J Chest Surg) Vol.12 No.2

This is one case report of the extremely rare congenital cardiac malformation, Double-outlet of left ventricle in corrected transposition of great arteries. 11-year-old boy complained acrocyanosis and exertional dyspnea, the parents noticed cyanosis since birth. Physical examination revealed acrocyanosis, clubbed fingers and toes, G-III pansystolic murmur on 2nd and 3rd ICS, LSB. Right heart catheterization revealed significant $O_2$ jump in ventricular level. Right and left ventriculography showed the both catheters arriving in the same ventricle i.e. anterior chamber, morphological left ventricle was in right and anterior position, simultaneous visualization of aorta and pulmonary artery and aorta locating anterior and right side of pulmonary artery. Echo cardiogram surely disclosed interventricular septum. Conclusively it was clarified that the patient has Double-outlet of left ventricle and corrected transposition of great arteries [S.L.D.]. Operation was performed to correct the anomalies under extracorporeal circulation with intermittent moderate hypothermia. Right-sided ventriculotomy disclosed the following findings. 1. Right-sided ventricle was morphological left ventricle. 2. Left-sided ventricle was morphological right ventricle. 3. Right side atrioventricular valve was bicuspid. 4. Left side atrioventricular valve was tricuspid. 5. Aortic valve was superior, anterior and right side of pulmonary valve. 6. Subpulmonary membranous stenosis. 7. Non-committed ventricular septal defect. We made a tunnel between VSD and aorta with Teflon patch so that arterial blood comes through VSD and the tunnel into aorta. After correction the patient needed assisted circulation for 135 min. to have adequate blood pressure. Postoperatively by any means, adequate blood pressure could not be maintained and expired in the evening of operation day.

개심술환자의 뇨중 $K^+$ 배설에 관한 임상적 연구

권중혁,지행옥,김근호,Kwon, Jung-Hyuk,Jee, Heng-Ok,Kim, Kun-Ho 대한흉부심장혈관외과학회 1982 Journal of Chest Surgery (J Chest Surg) Vol.15 No.1

A Clinical study was carried out to observe changes in concentration of serum and urinary potassium during and after open-heart surgery under extracorporeal circulation with Heart-Lung-Machine. The patients studied in the present work included eight cases of congenital heart anomalies and seven cases of acquired valvular diseases of the heart. Blood and urine samples were collected at intervals of 30 minutes during open-heart surgery and at intervals of 8 hours until 48 hours after the operation to determine concentration of serum and urinary potassium. 1.While the concentration of urinary potassium was not changed during the operation, the concentration of urinary potassium was rapidly increased after the operation. Eight hours after the operation, the concentration of urinary potassium was increased to the highest value of 86.97±43.96 mEq/L and was gradually decreased thereafter. The concentration of urinary potassium, however, still remained elevated even 48 hours after the operation, the concentration being greater than preoperative state by 19.90 mEq/L. 2.The concentration of urinary potassium after the operation was higher in the group who went through 90 minutes of extracorporeal circulation [$108.71{\pm}94.71mEq/L$] than in the group who went through 60 minutes of extracorporeal circulation [$86.58{\pm}50.87mEq/L$]. The Increased level of urinary potas-sium observed In the group who went through 90 minutes of extracorporeal circulation continued for longer period of time as compared with that in the group who went through 60 minutes of extracorporeal circulation. 3.The increased level of urinary potassium was observed in the both groups of patients with or without diuretics plus digitalis therapy. However, the increased level of urinary potassium appeared to con-tinue for longer period of time in the group of patients receiving diuretics plus digitalis therapy prior to the operation than in the group of patients receiving no diuretics plus digitalis therapy.