폐문부박리가 폐혈류 역학에 미치는 영향

곽문섭,이홍균,Kwack, Moon Sub,Lee, Hong Kyun 대한흉부심장혈관외과학회 1976 Journal of Chest Surgery (J Chest Surg) Vol.9 No.1

Author has performed experimental study on hemodynamic changes of lung following radical hilar stripping and contralateral pulmonary artery ligation. In view of hemodynamic changes in group 1 (right pulmonary artery ligation only) and group 2(left hilar stripping+right pulmonary artery ligation). group 2 showed remarkable decrease rate in oxygen uptake (P<0.001) and total pulmonary blood flow(P<0.001), and the more increase rate in mean pulmonary artery pressure(P<0.02) and total pulmonary vascular resistance (P<0.001). Meanwhile, the decrease percent of left lung vascular resistance was lower than group 1(P<0.001). The hemodynamic changes in group 1 returned to control range two weeks later. In the group 2, two dogs were expired as a result of atelectasis and pulmonary hypertension. Among allying 8 dogs, five months after operation, follow up studies performed in two dogs, which showed normal pulmonary hemodynamics similar to preoperative data. The altered blood gas values and decreased oxygen uptake are more remarkable in denervated lung, which may due to pulmonary hypertension and partly retained more secretion in bronchial trees than usual. Important factors of raising pulmonary vascular resistance and pulmonary artery pressure are considered as the increased blood flow to remaining left lung and dysfunction of pulmonary vascular bed to accept the increased blood flow after denervation. Loss of nerve innervation had a influence, to some extent, to the decrease of oxygen uptake and the increase of pulmonary vascular resistance and pulmonary artery pressure. There can be little question that denervation does impair the pulmonary hemodynamics, however, intact pulmonary nerve innervation is not absolutely essential for survival of the animal.

두개의 전극도자를 사용하게 된 Permanent Transvenous Pacemaker Implantation: 1례 보고

곽문섭,이홍균,Kwack, Moon-Sub,Lee, Hong-Kyun 대한흉부심장혈관외과학회 1981 Journal of Chest Surgery (J Chest Surg) Vol.14 No.2

Since cardiac pacemaker was first totally implanted by Chardack, Gage and Greatbatch [1966], the electrical circuity of the cardiac pacemaker has been improved, modified, and refined. The problem of transvenous electrodes, however, is still remained; this may be due to electrode displacement, exit and/or entrance block, lead fracture and insulation defects. In permanent cardiac pacing, Irreversible loss of function of the transvenous electrode catheter eventually requires insertion of new lead. Authors now report one case that disclosed easy displacement of electrode tip in early phase of implantation and then two years and five months later, malfunctioning electrode could not be withdrawn from the cardiovascular system because it has become firmly enclosed by fibrous tissue along its course from the vein tract to the right ventricle. Under such circumstances, the electrode catheter tip was left in tricuspid annulus after being sutured at its entrance and burying the loop of lead in generator pocket. New other one electrode was then reimplantation through left external jugular vein.

만성 신부전으로 인한 무뇨증 환자에서의 판막치환술 - 1례 보고 -

김시훈,곽문섭,이선희,박재길,진웅,Kim, Si-Hoon,Kwack, Moon-Sub,Lee, Sun-Hee,Park, Jae-Kil,Jin, Ung 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery (J Chest Surg) Vol.32 No.6

오늘날 말기 신부전 환자에서의 심장수술은 보편화 되는 추세이며, 만성 신부전 환자들의 수가 늘어남에 따라 이들 환자에 대한 적절한 치료법 개발이 필요하게 되었다. 이 환자들에게는 관상동맥질환 뿐만 아니라 판막질환도 드물지 않다. 이들에게 시행되는 복막투석은 체외순환에 다소의 지장은 있을수 있지만 수술 전후에 적절한 대책을 준비한다면 더 이상 심장수술의 걸림돌이 되지 않는다. 저자는 심한 승모판막 폐쇄부전과 만성신부전을 동반한 33세의 무뇨증 여자환자에서 기계판막치환술을 시행하였다. 환자는 수술전에 복막투석을 주기적으로 함으로써 수분 및 전해질 균형을 적절히 유지시켰고, 수술후에도 혈액 생화학적 검사결과를 수시로 예의검토하면서 복막투석을 계속시행함으로써 무사히 회복될 수 있었다. It is now generalized to perform cardiac surgery in the patients with end-stage renal disease. The growing number of patients with chronic renal failure wake us up to the need to prepare for proper management. There are not only the prevalence of coronary artery disease, but also a great amount of valve dysfunction exist in this group. Peritoneal dialysis may be one of the obstacles for cardiopulmonary bypass but it is not a great hindrance in cardiac surgery with careful preparation and well organized perioperative care. The author has performed mitral valve replacement in a 33-year-old anuric female patient with chronic renal failure and severe mitral insufficiency. Preoperatively, the patient was kept in adequate fluid and electrolyte balance using peritoneal dialysis. Peritoneal dialysis continued and regulated according to the laboratory data in this patient during and after the surgery. She recovered well showing an uneventful course and was discharged on postoperative 1 th day.

심장손상 3례에 대한 치험

이영,곽문섭,Lee, Young,Kwack, Moon Sub 대한흉부심장혈관외과학회 1976 Journal of Chest Surgery (J Chest Surg) Vol.9 No.1

Cardiac injury is a relatively uncommon entity, which calls for emergency surgical treatment. During the period from 1974 up to 1975, three cases of stab wound of the heart were treated in Department of Thoracic Surgery. Capital Armed Forces General Hospital among 70 chest injury cases. All of the cases had stab wounds on the heart by knife. Injured sites were found in two cases on the right ventricle, and one case on the right atrium and intrapericardial inferior vena cava. All patients were treated by thoracotomized and sutured with 000 silk for myocardial stab wounds. One of these died of cerebral hypoxia, who was resuscitated from cardiac arrest during operation. Pericardial tamponade signs were not definite except one case.

악성 종양에 대한 Bleomycin 사용 경험례: 식도 및 폐암의 2예

이양삼,곽문섭,김세화,Lee, Yang-Sam,Kwack, Moon-Sub,Kim, Se-Wha 대한흉부외과학회 1970 Journal of Chest Surgery (J Chest Surg) Vol.3 No.2

Bleomycin is known as a antibiotic agent for malignant tumors especially sguamous cell carcinoma. We have treated 2 cases of malignant tumors, each one esophageal and lung carcinoma with bleomycin, 630 mg and 510 mg respectively. In case of esophageal carcinoma. the subjective symptoms such as dysphagea and swallowing disturbance are temporally relieved, but the irregular filling defect is not significantly changed in esophagogram. In case of lung carcinoma, the atelectasis of right upper lobe on chest X-ray was slightly regressed in its size without effective improvement of subjective symptoms. However, following additional radioactive $^60{Co}$ irradiation therapy (5200r), marked regression of tumor density and aeration of right upper lobe was observed. But 2 weeks later of ceasatioil of irradiatio:J, atelectasis of right upper lobe was again developed. Fever, anorexia, headache and eruption were developed during the treatmeat with bleomycin in both cases but the sign or symptoms of hone marrow depression, renal or liver damage were not noted.

기관지 결석의 수술치험 3례

조덕곤,조규도,박건,곽문섭,김치홍,Cho, Deog-Gon,Cho, Kyu-Do,Park, Kuhn,Kwack, Moon-Sub,Kim, Chi-Hong 대한기관식도과학회 1999 大韓氣管食道科學會誌 Vol.5 No.1

Broncholithiasis is defined as a condition in which calcified material is present within the bronchial lumen. It is a rare but troublesome disease that can cause life-threatening complications such as massive fatal hemoptysis. Therefore, pulmonary resection is frequently required to remove the broncholiths and irreversibly damaged parenchyma. We experienced 3 cases of broncholithiasis. In one case, a 36 year old female patient suffered from coughing, massive hemoptysis with lithoptysis caused by intrinsic obstructive broncholiths in the right middle and lower lobe. In the 2nd case, a 41 year old male patient complained of long-standing blood tinged sputum and frequent pneumonic symptoms for 10 months because of extrinsic broncholithiasis where the calcified peribronchial lymph node eroded into the bronchial lumen of the right lower lobe. The remaining case involved a 30 year old female patient who complained of intermittent blood-tinged sputum induced by intrabronchial broncholith in the orifice of the right middle lobe bronchus. Two patients underwent bilobectomy(right middle and lower lobe) for removal of the broncholiths, damaged bronchi and parenchyma. The other patient was treated with right middle lobectomy and stone removal by bronchotomy of bronchus intermedius. In all patients, the post-operative course was uneventful.

H-type 기관식도루 1례

박건,김영두,권종범,원용순,곽문섭,Park, Kuhn,Kim, Young-Du,Keon, Jong-Bum,Won, Yong-Soon,Kwack, Moon-Sub 대한기관식도과학회 2000 大韓氣管食道科學會誌 Vol.6 No.1

Isolated(H-type) tracheoesophageal fistula without esophageal atresia occurs in approximately 4% of esophageal anomalies, and represents the least form of abnormal laryngotracheo-esophageal communication. Its symptoms such as coughing and choking The during the feeding, abdominal distension and recurrent pneumonitis usually start from birth. Diagnosis is made between 4 days to 4 years using the contrast esophagography and/or tracheoscopy. In case of diagnostic delay the postoperative mortality is not negligible and the most common cause of mortality is respitatory problems(infection, respiratory distress). So early diagnosis is essential in the newborn period with high index of suspicion. We report a case of H-type TEF in which operative repair was successful with references to recent literature.

흉부식도 파열에 대한 외과적 치험 - 4례 보고 -

진웅,박재길,이선희,곽문섭,Jin, Ung,Park, Jae-Kil,Lee, Sun-Hee,Kwack, Moon-Sub 대한기관식도과학회 1999 大韓氣管食道科學會誌 Vol.5 No.1

Perforating injury of the thoracic esophagus leads to an almost Immediate exposure of the mediastinum to both oral secretions and refluxed gastric contents. And necrotizing inflammatory response developed inevitably. So, without proper managements, mediastinitis results in severe dehydration or septic conditions, and consequently the life of the patient can be threaten. We experienced recently 4 cases of esophageal perforation. Three cases were Boerhaave's syndromes and the other one was instrumental perforation in patient with corrosive esophageal stricture. Curative surgical procedures were done in 3 cases and the drainage procedure was only possible in the other one due to hepatic failure. And the patient with the drainage management was dead.

부식성 상부식도 협착증에서 하인두-장 문합에 의한 식도재건술

박재길,이선희,장윤희,진웅,곽문섭,김세화,천성원,Park, Jae-Kil,Lee, Sun-Hee,Chang, Yun-Hee,Jin, Ung,Kwack, Moon-Sub,Kim, Se-Wha,Chun, Sung-Won 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.9

대상 및 방법: 저자들은 1995년 8월부터 1997년 1월까지 상부 식도를 포함한 광범위한 부식성 협착증 환자 7례에서 하인두-결장문합에 의한 식도재건술을 시행하였다. 결과: 연령은 20세에서 63세까지 였으며 7례중 6례가 여성이었다. 부식제는 6례에서 강산이었고 1례는 알칼리 용액이었으며, 부식제 연하후 식도재건까지의 기간은 6개월에서 50년이었다. 식도재건 방법으로 4례에서는 하인두- 우결장-공장문합을 시행하였으며, 3례에서는 하인두-우결장-위문합을 시행하였다. 수술사망례는 없었고 7례중 1례에서 만 문합부 협착으로 수차례의 식도 확장술을 받았으며, 6례에서는 경구섭식에 문제가 없어 전례에서 관찰기간중에 4kg 내지 13kg의 체중증가 소견을 보였다. 결론: 결론적으로 상부식도 협착증에서의 하인두-결장 문합술은 유효하고 안전한 술식이라고 할 수 있다. Material and Method: Esophageal reconstruction by the hypopharyngointestinal anastomosis was done in 7 patients of corrosive upper esophageal stricture at St. Mary's Hospital from August 1995 to January 1997. Result: There were one male and six female patients ranging from 20 to 63 years of age. The causative agents were acid in 6 patients and alkali in 1 patient. The esophageal reconstruction was made by hypopharyngcolojejunostomy in 4 patients and hypopharyngocologastrostomy in 3 patients. There were no operative mortalities. One patient developed anastomotic stenosis but others were free from dysphagia. All gained 4 kg to 13 kg of body weight during the follow-up period. Conclusion: In this experience right colon and terminal ileum including ileocecal valve was revealed as a good substitute for the esophagus and the esophageal reconstruction by hypopharyngocologastro (jejuno)stomy seems to be a satisfactory method with acceptable morbidity and mortality in corrosive upper esophageal stricture patient.

영아에서 발생한 식도열공탈장 수술치험 -1례 보고-

진웅,이선희,김우찬,박재길,곽문섭,김세화,Jin, Ung,Lee, Sun-Hee,Kim, Woo-Chan,Park, Jae-Kil,Kwack, Moon-Sub,Kim, Se-Wha 대한흉부심장혈관외과학회 1994 Journal of Chest Surgery (J Chest Surg) Vol.27 No.1

The esophageal hiatal hernia is a rare disease in Korea especially in children and infant. We experienced a case of type III esophageal hiatal hernia in 9 months female. She had no specific past history and familial history except recurrent URI and postprandial habitual vomiting. The chest X-ray and Barium swallowing showed herniated stomach in Rt. thoracic cavity and posterior mediastinum. We performed modified Belsey Mark IV procedure with using the 3-0 and 4-0 Pledgeted Ticrons. In operative field, the stomach cardia portion was herniated into the Rt.thoracic cavity and posterior mediastinum with elevation of the esophagogastric junction above the diaphragm. But there was no evidence of short esophagus and combined anomaly. The postoperative courses were uneventful and good without specific complication for about 5 months to this point.