자연기흉치료에서 극소개흉의 안전성 및 효과

최수승 梨花女子大學校 醫科大學 醫科學硏究所 1996 EMJ (Ewha medical journal) Vol.19 No.1

목적: 자연기융의 수술적 치료에 있어서 보통 소절개개다. 몇가지 점에서 더 개선된 극소개흉수술(Lim-minithoracotom)의 안전성과 효과를 검토해보고자 하였다. 방법: 1994년 1월1일부터 1995년 12월 31일까지 2년간 이대동대문병원에 자연기흉으로 입원하여 극소개흉수술을 받은 환자 11명을 대상으로 의무기록검토와 검사소수술소견, 수술시간, 수술상처조사 등을 시행하였으며, 전화통화 또는 외래방문시 진찰 등으로 술후 상태를 추적 조사하였다. 결과: 연속적인 11명의 기흉환자로 수술적응은 재발한 기 4명, 계속된 공기누출 7명, 흉부 X선상 또는 단층촬영상 기포가 확인된 예가 2명이었다. 양측 수술을 동시에 시행한 1례를 합하여 11명에서 12극소개흉수술이 시술되었으며, 평균수술시간은 54±12분/개흉 이었다. 극소개흉수술중 일반개흉으로 전환된 예는 없었다. 술후출혈이나 감염은 없었다. 합병증으로 지연된 공기누출 한명이 있었는데, 좌측 상엽과 하엽에 다발성 기포가 있던 환자로서 술후 18병일째 퇴원하였다. 또 한례에서는 수술후 경과가 좋아 4병일째 흉관을 제거하던중 흉강내로 공기흡입이 일어나서 술후 9일째 퇴원하게 되었다. 나머지 모든 환자는 수술 후 5일 이내에 퇴원하였다. 11명 모두 100& 추적조사 되었으며 12±7.7개월간 추적조사결과 재발은 없었다. 결론: 극소개흉수술은 수술이 필요한 원발성 자연기흉환자에서 1차적으로 권할 수 있는 수술로 생각된다. Objectives : This study was performed to know the safety and efficacy of limited min-ithoracotomy, which is a new method of operative procedure modified from minithoracotomy. Method : Eleven consecutive patients who underwent a limited minithoracotomy for the treatment of primary spontaneous pneumothorax from Jan.1.1994 to Dec.31.1995 were reviewed with medical records, laboratory and x-ray findings, and followed by reaching patient by phone or interviewing at the outpatient department. Results : The indication of these consecutive 11 patients were recurrent pneumothrorax 4 cases, continuous air leaking 7 cases, and visible bullae on chest x-ray or chest CT 2 cases. There were 12 limited minithoracotomies in 11 patients including on bilateral limited minithoracotomy. Average operative time was 54 minutes. There was no conversion to extended thoracotomy from limited minithoracotomy. No postoperative bleeding or infection was oberved. One patient showed prolonged air leak after operation who had multiple bullae resected from his left upper and lower lung, and was discharged 18 days after operation with good condition. Another patient experienced air sucking during chest tube removal on 4th postoperative day and discharged on 9th day after operation. Other patients wre discharged within 5th postoperative day. Average hospital stay after operation was 5.4 days. All eleven patients were followed up for 12±7.7months. There was no recurrences of pneumothorax. Conclusion : These results suggest that limited minithoracotomy is choice of treatment when primary spontaneous pneumothorax patient requires surgery.

하지정맥류의 임상양상 - 227 수술예의 분석 -

최수승 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery (J Chest Surg) Vol.32 No.11

Background: To know the clinical aspects of varicose vein and the effectiveness of operative treatment, the patients who had been operated during the five and a half years were reviewed. Material and Method: From September 1993 to February 1999, 227 patients with varicose vein were operated upon. These patients were reviewed with history taking, physical examination, laboratory tests, operation and follow up visits at an out patient department. Result: The ages of the patients were from 20 to 69 years, mean 40.2 years. varicose veins. Occupations of the patients include housewives, store or factory owners, cooks, waiter or waitresses in a restaurant, salary men(women), teachers, hair stylists, professional athletes, in sequence, most of them require standing all day long. The 126 women had experienced child birth, among them 116 patients delivered more than 2 babies. All patients had protruding leg veins as the symptom. Most of them(61%) had pain. Other additional symptoms were heaviness, heatness, tingling, cramp, fatigue, etc. 68.3% of the patients had the symptoms for more than 10 years. Anatomical location of varicose vein was in long saphenous vein in 157 patients, in small saphenous vein in 27, and in other regions(combined or perforating vein) in 43 patients. There was no operative mortality. There were 2 patients who underwent reoperation due to recurrence during this study period. In one patient, it recurred in the distal perforating vein in small saphenous vein. The other patient had recurrence at the saphenofemoral junction in groin. The patients are doing well after the reoperation, but a long term observation is needed. Conclusion: Clinical aspects of varicose vein were reviewed. For the patients with varicose vein who had saphenofemoral regurgitation, operative treatment seemed to bea safe and effective modality of treatment.

제1늑골의 피로골절

최수승,유정현 대한흉부외과학회 2009 Journal of Chest Surgery (J Chest Surg) Vol.42 No.5

Isolated stress fracture of the first rib is rare, and repeated muscular pulling and fatigue of bone is thought to be responsible for this fracture. The diagnosis can be made by taking a thorough history and performing chest roentgenography, computed tomography or magnetic resonance imaging. Conservative treatment generally cures this condition. We report here on a case of exercise-induced isolated stress fracture of the first rib in a non-athlete college student and we review the related articles. 제1늑골의 피로골절은 드물다. 반복되는 근육수축으로 인한 뼈의 피로가 골절의 원인이라고 생각된다. 자세한 병력 조사와 컴퓨터 단층 촬영 및 전자기 공명영상 등으로 진단할 수 있다. 진통제 등 보존적 요법으로 치료한다. 농구를 취미로 하는 18세 남자 대학생 환자에서 운동연습으로 인한 제1늑골의 피로골절을 경험하였기에 문헌 고찰과 함께 이에 보고한다.

횡격막탈장(橫隔膜脫臟) 및 횡격막이완증(橫隔膜弛緩症) -10례(例) 보고-

최수승,이정호,유영선,유회성,Choi, S.S.,Lee, J.H.,Yoo, Y.S.,Yu, H.S. 대한흉부심장혈관외과학회 1976 Journal of Chest Surgery (J Chest Surg) Vol.9 No.2

This case report included 4 cases of traumatic diaphragmatic hernias, 3 cases of non-traumatic diaphragmatic hernias, and 3 cases of eventration of the diaphragm. Among the traumatic hernias, one case was in immediate phase of traumatic diaphragmatic rupture by traffic accident, 2 cases were in intermediate phase with chronic respiratory or vague gastrointestinal symptoms after traffic accident, and the other was developed after an operation, decortication for a chronic empyema with severe pleural calcifications, damaging the diaphragm. Three cases of nontraumatic diaphragmatic hernia were presented, including 2 cases of probable Bochadlek's hernia (Parents refused operation) and a case of Morgagni's hernia with severe gastrointestinal symptoms. And three cases of eventration of the diaphragm with symptoms were also reported. Results of all treated cases were excellent.

Propranolol이 심근 sarcoplasmic reticulum 및 mitochondria 의 $Ca^{++}$ 조절작용에 미치는 효과에 관한 연구

최수승 대한흉부심장혈관외과학회 1986 Journal of Chest Surgery (J Chest Surg) Vol.19 No.2

Propranolol is one of clinically useful antiarrhythmic agents and electrophysiologically classified as group II. And the negative inotropic effect which is not related to adrenolytic effect has been demonstrated with high concentration of propranolol. On the other hand, it has been well known that the calcium plays a central role in excitation-contraction coupling process of myocardium and also in electrophysiological changes of cell membrane. Author studies the effect of propranolol on calcium uptake and release in sarcoplasmic reticulum and mitochondria prepared from porcine myocardium to investigate the mechanism of action of propranolol on myocardium. The results are summarized as follow: 1] The maximum Ca++-uptake of sarcoplasmic reticulum is inhibited by propranolol in a dose dependent manner. 2] The release of calcium from sarcoplasmic reticulum is not affected by propranolol but with higher than 1x10-3 M of propranolol, rate of calcium release from sarcoplasmic reticulum is decreased. 3] Propranolol inhibits the maximum uptake and uptake rate of calcium in mitochondria non-competitively. [Ki = 6.21 x 10-4 M] 4] The rate of Na+ induced calcium release from mitochondrion shows a function of [Na+]2 and is inhibited by propranolol with the concentration significantly lower than that affect the calcium uptake in sarcoplasmic reticulum and in mitochondria [Ki = 2.91 x 10-5 M]. These results suggest that propranolol affects the intracellular calcium homeostasis which may considered to be one of the mechanism of action of propranolol on myocardium.

개심술후 뇌기능장애에 대한 임상적 고찰

최수승 대한흉부심장혈관외과학회 1985 Journal of Chest Surgery (J Chest Surg) Vol.18 No.4

A retrospective clinical observation was made of 40 patients with postoperative cerebral dysfunction among 2634 patients who underwent open-heart operations in Severance Hospital. Yonsei University between 1962, the year the first successful open heart operation was done, and June 1985. Suspected causes of brain damage were reviewed. Brain CT findings were evaluated in 24 patients. There were 15 cerebral infarcts, 4 intracerebral bleedings, 3 ischemic brain damages, 1 infarction with intracerebral hemorrhage and 1 diffuse cortical atrophy from unknown cause. The most frequent site of cerebral infarction was the middle cerebral artery area with no predilection on the right of left.

흉선종양과 Myasthenia Gravis가 합병한 1례 보고

최수승 대한흉부심장혈관외과학회 1974 Journal of Chest Surgery (J Chest Surg) Vol.7 No.1

The incidence of myasthenia gravis in patients with thymomas has been reported from 10 to 50 percent, and the controversy ranges from 8-15 percent. This is the report of myasthenia grayis combined with benign thymoma and obtained relatively good result through surgical treatment at the department of thoracic surgery, National Medical center. The thymoma was mixed type and benign nature. Post operatively this patient was developed myasthenia crisis, and treated with mechanical respirator, and recurred the symptoms about 2months later, but well controlled with medical treatment.

토끼 대동맥 혈관내피세포에서 저산소증이 내피세포성 이완인자의 분비에 미치는 영향

최수승 대한흉부외과학회 2009 Journal of Chest Surgery (J Chest Surg) Vol.42 No.5

Background: To clarify the effect of hypoxia on vascular contractility, we tried to show whether hypoxia induced the release of endothelium-derived relaxing factor (EDRF) and the nature of the underlying mechanism for this release. Material and Method: Isometric contractions were observed in rabbit aorta, and the released EDRF from the rabbit aorta was bioassayed by using rabbit denuded carotid artery. The intracellular Ca2+ concentration ([Ca2+]i) in the cultured rabbit aortic endothelial cells was recorded by a microfluorimeter with using Fura-2/AM. Hypoxia was evoked to the blood vessels or endothelial cells by eliminating the O2 in the aerating gases in the external solution. Chemical hypoxia was evoked by applying deoxyglucose or CN−. Result: Hypoxia relaxed the precontracted rabbit thoracic aorta that had its endothelium, and the magnitude of the relaxation was gradually increased by repetitive bouts of hypoxia. In contrast, hypoxia-induced relaxation was not evoked in the aorta that was denuded of endothelium. In a bioassay experiment, hypoxia released endothelium-derived relaxing factor (EDRF) and the release was inhibited by L-NAME or the K+ channel blocker tetraethylammonium (TEA). In the cultured endothelial cells, hypoxia augmented the ATP-induced increase of the intracellular Ca2+ concentration ([Ca2+]i) and this increase was inhibited by TEA. Furthermore, chemical hypoxia also increased the Ca2+ influx. Conclusion: From these results, it can be concluded that hypoxia might induce the release of NO from rabbit aortic endothelial cells by increasing [Ca2+]i. 배경: 저산소증이 혈관평활근 수축성에 미치는 영향을 규명하기 위하여 저산소증이 혈관내피세포에서 내피세포성 이완인자의 분비에 미치는 영향과 그 기전을 규명하고자 하였다. 대상 및 방법: 토끼 대동맥에서 내피세포 의존성 이완과 관찰하고, 토끼 대동맥에서 내피세포성 이완인자 분비 정도를 내피세포를 제거한 경동맥의 수축에 미치는 영향으로 생물검증을 하였다. 마지막으로, 배양한 토끼 대동맥 혈관내피세포에서 세포내 Ca2+ 변화를 측정하였다. 저산소증은 세포외 용액에 공급되는 산소를 질소로 대체하여 제거한 후 이 용액을 혈관 혹은 세포에 공급하여 유발시거나, deoxyglucose 혹은 CN−를 투여하여 화학적인 저산소증을 유발시켰다. 결과: 노에피네프린으로 토끼 대동맥을 수축시킨 다음 저산소증에 노출시키면 대동맥이 이완을 하였으며 저산소증에 반복하여 노출시키면 저산소증에 의한 이완이 더 크게 증가하였다. 이러한 저산소증에 의한 이완은 혈관내피세포를 제거한 대동맥에서는 관찰되지 않았다. 토끼 대동맥에서 분비되는 내피세포성 이완인자 분비를 내피세포를 제거한 경동맥을 이용하여 생물검증한 결과 저산소증에 의하여 내피세포성 이완인자의 분비가 증가하였는데 반복된 노출에 의하여 더 크게 증가하였다. 그리고 저산소증에 의한 내피세포성 이완인자 분비는 NO 생성을 억제하는 경우와 K+ 통로 억제제인 tetraethyl ammonium (TEA)에 의하여 억제되었다. 배양한 혈관내피세포에서 ATP에 의하여 증가한 세포내 Ca2+은 저산소증에 의하여 유의하게 증가하였으며 TEA에 의하여 억제되었다. Deoxyglucose에 의하여 세포내 Ca2+이 증가하였으며 세포외 Ca2+을 제거하면 감소하였다. CN− 역시 혈관내피세포 Ca2+ 유입을 증가시켰다. 결론: 이러한 실험 결과로 미루어 토끼 대동맥에서 저산소증은 내피세포 의존성 이완을 유발하는데 이는 저산소증에 의한 세포내 Ca2+ 유입 증가에 의하여 NO 생성이 증가되어 일어난 것으로 추정할 수 있었다.

쥐 상장간막 동맥과 그 분지에서 pH 변화가 혈관평활근 수축성에 미치는 영향

최수승 대한흉부외과학회 2010 Journal of Chest Surgery (J Chest Surg) Vol.43 No.4

Background: Extracellular and intracellular pH (pHo and pHi), which can be changed in various pathological conditions such as hypoxia, affects vascular contractility. To elucidate the mechanism to alter vascular contractility by pH, the effects of pH on reactivity to vasocontracting agents, intracellular Ca2+ influx, and Ca2+ sensitivity in vascular smooth muscle were examined. Material and Method: Isometric contractions in rat superior mesenteric arteries (SMA) were observed. Intracellular Ca2+ concentration ([Ca2+]i) was recorded by microfluorometer using Fura-2/acetoxylmethyl ester in muscle cells. pHo was increased from 7.4 to 7.8 or decreased to 6.9 or 6.4. pHi was decreased by applying NH4+ or propionic acid or modulated by changing pHo after increasing membrane permeability using β-escin. Result: Decreases in pHo from 7.4 to 6.9 or 6.4 shifted concentration-response curve by norepinephrine (NE) or serotonin (SE) to the right and significantly increased half maximal effective concentration (EC50) to NE or SE. Increase in pHo from 7.4 to 7.8 shifted concentration-response curve by norepinephrine (NE) or serotonin (SE) to the left and significantly reduced EC50 to NE or SE. NE increased [Ca2+]i in cultured smooth muscle cells from SMA and the increased [Ca2+]i was reduced by decreases in pHo. NE-induced contraction was inhibited by NH4+, whereas the resting tension was increased by NH4+ or propionic acid. When the cell membrane of SMA was permeabilized using β-escin, SMA was contracted by increasing extracellular Ca2+ concentration from 0 to 10μM and the magnitude of contraction was decreased by a decrease in pHo and vice versa. Conclusion: From these results, it can be concluded that a decrease in pHo might inhibit vascular contraction by reducing the reactivity of vascular smooth muscle to vasoactive agents, Ca2+ influx and the sensitivity of vascular smooth muscle to Ca2+. 배경: 산성화를 초래하는 Hypoxia 등 여러 가지 조건에서 변화하는 세포외 pH 변화는 궁극적으로 세포내 pH 변화를 유발하며 세포 내외 pH 변화는 혈관평활근 수축성 변화를 유발한다. 이러한 세포 내외 pH 변화에 의한 혈관 수축성 변화 기전을 규명하고자, pH 변화가 혈관수축인자들에 의한 혈관평활근 수축, 혈관평활근세포내 Ca2+ 농도, 그리고 혈관평활근의 Ca2+에 대한 민감도에 미치는 영향을 알아보고자 하였다. 대상 및 방법: 쥐에서 분리한 상장간막동맥과 그 분지에서 등장성 수축을 기록하였으며 배양한 상장간막동맥 세포에서 세포내 Ca2+ 변화를 측정하였다. 세포외 pH는 정상인 7.4에서 6.4, 6.9 혹은 7.8로 변화시켰으며, 세포내 pH 변화는 propionic acid나 NH4를 투여하거나β-escin으로 세포막의 투과성을 증가시켜 세포외 용액의 pH 변화로 유발시켰다. 결과: 세포외 pH를 7.4에서 6.9, 6.4로 감소시키면 노에피네프린과 세로토닌에 의한 용량-반응 곡선이 우측 이동하였으며 최대 수축력의 50% 수축력을 유발하는 농도(half maximal effective concentration)가 증가하였고, pH를 7.8로 증가시키면 그 반대 현상이 일어났다. 노에피네프린은 배양한 혈관평활근세포에서 세포내 Ca2+ 농도를 증가시켰으며, 이 세포내 Ca2+ 증가는 세포외 pH 감소에 의하여 억제되었으며 세포외 pH 증가에 의하여 증가하였다. 노에피네프린에 의한 수축은 세포내 pH를 감소시키는 NH4+에 의하여 억제된 반면, 안정 장력은 NH4+과 propionic acid에 의하여 증가하였다. β-escin으로 세포막의 투과도를 증가시킨 후 세포외 용액의 Ca2+ 농도를 증가시켜 수축을 유발시킨 후 세포외 용액의 pH를 변화시키면 pH 감소에 의하여 수축력이 감소하였으며 증가에 의하여 수축력이 증가하였다. 결론: 세포외 pH의 감소는 혈관평활근의 수축성을 감소시키는데 이는 세포외 pH 감소에 의한 혈관평활근의 혈관수축물질에 대한 반응성 감소, 혈관평활근 세포내 Ca2+ 유입 억제 그리고 Ca2+에 대한 혈관평활근의 민감성 감소에 의하여 일어난 것으로 추정할 수 있었다.

自然氣胸에 對한 臨床的 考察

崔秀承,徐景弼 서울의대 1975 서울의대잡지 Vol.16 No.4