만성 신부전증 환자에서의 동정맥루조성술

김응중,이영,박진석,Kim, Eung-Joong,Lee, Young,Park, Jin-Seok 대한흉부심장혈관외과학회 1994 Journal of Chest Surgery (J Chest Surg) Vol.27 No.8

Because the number of patients who require maintenance hemodialysis is increasing in number recently, angioaccess has become important to many vascular surgeons participating in the management of such patients.The authors created 269 arteriovenous fistulas[AVF] for angioaccess in 229 patients with chronic renal failure[CRF] at the Department of Thoracic and Cardiovascular Surgery in Chungnam National University Hospital during the period from August 1990 to March 1993. We analyzed the results of 260 operations for 220 patients except 9 patients who were lost during the follow up period. We performed snuffbox AVF in 171 cases, classic radiocephalic AVF in 46 cases, direct AVF at other site in 5 cases, forearm Gore-Tex AVF in 29 cases, and upper arm Gore-Tex AVF in 9 cases. We experienced 13 cases of operative failures, 11 cases of early complications, and 60 cases of late complications including obstructions during follow-up period. The 1 year, 2 year and 3 year patency rates of snuffbox AVF[Group 1], classic radiocephalic AVF[Group 2], and Gore-Tex AVF[Group 3] are like followings; 89, 84, 76% in group 1, 84, 75, 68% in group 2, and 79, 66, 55% in group 3. It showed a statistically significant difference between group 1, 2 and group 3.

승모판막질환의 재수술에 대한 임상적 고찰

김명인,김응중,이영,Kim, Myung-In,Kim, Eung-Joong,Lee, Young 대한흉부심장혈관외과학회 1992 Journal of Chest Surgery (J Chest Surg) Vol.25 No.1

Total 20 cases of reoperation for mitral vavular disease, which had been performed during the period from May 1983 till October 1991, were reviewed. This study contained 1 case of previous balloon valvuloplasty and 1 case of death with bleeding from right ventricle during sternal reenrty. The average time intervals between reoperation and previous operation was 19 years in closed mitral commissurotomy[n=4], 7 years and 2 months in mitral valve replacement[n=10], 1 year and 8 months in mitral valvuloplasty[n=4], 3 years and 10 months in open mitral commissurotomy [n=2]. The cause of reoperation in closed mitral commissurotomy was progression of the disease, and residual stenosis with progression was the cause in open mitral commissurotomy cases. Technical failure might be the cause in the cases of valvuloplasty. In prosthetic valve replacement group the causes of reoperation were primary failure. Also two cases of suggested valve thrombosis and one case of failure of tricuspid annuloplasty was noted in prosthetic valve replacement group. The used valves for reoperation were Ionescue-Shiley in 3 cases, Bjork-Shiley in 6 cases, St. Jude Medical in 2 cases and CarboMedics in 8 cases. The mortality rate was 20%[n=4] and the causes of death were low output syndrome in 1 case, multiple organ failure in 2 cases and bleeding in 1 case during sternal reentry. During follow up 1 case of sudden death was observed.

혈액종양 ; 항암화학치료시 사전동의서 취득에 관한 의사의 인식도와 행위 조사

김세원 ( Se Won Kim ),강봉균 ( Bong Kyun Kang ),박근민 ( Gun Min Park ),한석재 ( Suk Jae Hahn ),김응중 ( Eung Joong Kim ),김도연 ( Do Yeun Kim ) 대한내과학회 2010 대한내과학회지 Vol.78 No.5

목적: 늘어나는 암환자와 더불어 항암화학치료를 받는 환자들도 지속적으로 증가하고 있다. 한편 인권의 신장으로 인하여 환자의 자기 결정권은 최근 의료 현장에서 중요성이 더 커지고 있다. 본 연구에서는 일개 대학 병원에서 항암화학치료를 담당하고 있는 의사들을 대상으로 항암화학치료 시행 전 설명 및 사전동의 취득에 대한 의료인의 인식도 설문 조사 및 최근 1년 동안 항암화학치료를 시행한 환자의 전자의무기록을 후향적으로 분석하여 항암화학치료 사전동의서를 획득하는 의료인의 행위를 평가하고자 하였다. 방법: 2009년 8월 1일부터 31일까지 항암화학치료를 지시하거나 수행한 적이 있는 의사들을 대상으로 설문을 시행하였다. 또한 2008년 8월 1일부터 2009년 8월 31일까지 항암화학치료가 시행된 환자의 전자의무기록(Electronic Medical Record)을 바탕으로 항암제 동의서를 받았는지와 항암제 동의서가 있었던 환자군을 대상으로 사전동의 취득 행동을 평가하였다. 결과: 총 설문 인원 48명 모두 항암화학치료를 시행하기전에 설명 및 사전동의 취득이 필요하다고 생각하고 있었다. 그러나 서면 사전동의서에 대해 알고 있는 대상은 27명 (56.3%)이었다. 동의서의 형식은 자세한 설명보다는 간결하게 해야 한다는 응답이 70.8%로 선호되었고, 설명 및 사전동의서 취득 시 소요시간은 응답자의 43.8%가 대체적으로 10~14분이 소요된다고 하였다. 전자의무기록에서 항암화학 치료 시 사전동의서 획득 유무를 조사한 결과, 항암치료를 받은 총 141명의 환자 중 22명(15.6%)에게만 서면 사전동의서를 획득하였다. 결론: 양질의 항암화학치료 수행을 위해서는 설명 및 사전동의서의 의미와 중요성에 대해 의사와 환자에게 적절한 인식이 요구되며 환자의 이해도를 높이기 위해 평이한 용어로 작성된 적절한 길이의 표준화된 동의서 양식의 사용이 필요하겠다. Background/Aims: Given that the use of chemotherapy has increased, together with the incidence of cancer, the importance of patient autonomy in decision-making is being emphasized. This study aimed to promote understanding of informed consent by analyzing doctors` perceptions of, and conduct during, the acquisition of written informed consent before chemotherapy. Methods: Forty-eight doctors directing or performing chemotherapy were surveyed in August 2009. In addition, the electronic medical records of patients who underwent chemotherapy between August 1, 2008, and August 31, 2009, were reviewed retrospectively. Results: All 48 respondents replied that acquiring informed consent was necessary before chemotherapy, but only 27 (56.3%) were aware of the format of the consent that had been obtained. Regarding the format of informed consent, 34 (70.8%) felt that it should be brief and 21 (43.8%) indicated that the time they spent in acquiring informed consent ranged from 10 to 14 minutes. Reviewing actual performance in acquiring informed consent, only 22 (15.6%) out of 141 patients who underwent chemotherapy had written informed consent documents in their electronic medical records. Conclusions: To properly acquire informed consent for chemotherapy, its meaning and importance must be understood by both physicians and patients. Moreover, patients need a standardized format of appropriate length for informed consent, with easily understood terms. (Korean J Med 78:610-615, 2010)

외과적 치료가 필요했던 심도자 합병증에 대한 임상적 고찰

이영,박경신,박진석,임승평,김응중,Lee, Young,Park, Kyung-Sin,Park, Jin-Seog,Lim. Seung-Pyung,Kim, Eung-Joong 대한흉부심장혈관외과학회 1995 Journal of Chest Surgery (J Chest Surg) Vol.28 No.6

We have experienced ten cases of emergent operation for the complications of cardiac catheterization during the period from 1985 to September 1994.Catheterization was done for the evaluation of the cardiac or vascular problem in 8 cases and 2 cases of neurosurgical problem. The extracardiac injection of contrast material have occurred in 3 cases[primum ASD,Trilogy,VSD . Six cases were unable to remove the catheter from femoral artery or vein. The catheters were knotted, coiled, impacted or broken. An embolectomy was done 40 years old man who suffered from chronic left subclavian artery obstruction a day after angiography. Open heart surgery was performed in 5 cases of cardiac perforation,impacted catheter in left inferior pulmonary vein and broken catheter of VSD. Arteriotomy was done in 4 cases to remove the knotted and coiled catheter. There was no complication or mortality for the emergent operation.

점막하 종양으로 발현한 원발성 식도 점막 연관 림프조직 림프종 1예

정재규 ( Jae Gu Jung ),강현우 ( Hyoun Woo Kang ),한석재 ( Suk Jae Hahn ),최종순 ( Jong Sun Choi ),김응중 ( Eung Joong Kim ) 대한소화기학회 2013 대한소화기학회지 Vol.62 No.2

We report a case of primary mucosa-associated lymphoid tissue (MALT) lymphoma in the esophagus that manifested as a large submucosal tumor (SMT). Primary esophageal lymphoma is very rare, occurring in less than 1% of all patients with gastrointestinal lymphoma. Only a few cases of MALT lymphoma in the esophagus have been reported in the English literature. A 53-year-old man was referred to Dongguk University Ilsan Hospital (Goyang, Korea) in July 2012 for further evaluation and treatment of an esophageal SMT. Endoscopy showed a cylindrically elongated submucosal mass with normal overlying mucosa in the mid esophagus, 25-30 cm from the incisor teeth. He underwent surgery to confirm the diagnosis. Pathologic findings showed diffuse small atypical lymphoid cells which were stained with Bcl-2, CD20, but not with CD3, CD5, CD23, Bcl-6, or cyclin D1. These cells showed a positive monoclonal band for immunoglobulin heavy chain gene rearrangement. Based on the pathological, immunohistochemical, and molecular biological features, the esophageal mass was diagnosed as extranodal marginal zone B-cell lymphoma of the MALT type. (Korean J Gastroenterol 2013; 62:117-121)

성인에서의 심폐보조를 위한 체외막산소화장치의 적용

김응중,최재성 동국대학교 의학연구소 2009 東國醫學 Vol.15 No.2

Extracorporeal membrane oxygenation (ECMO) is for the temporary mechanical circulatory support that uses a modified heart-lung machine to provide circulatory assistance and oxygenation and carbon dioxide removal from blood for days to weeks to permit recovery from severe cardiac or respiratory failure. ECMO can be deployed in a veno-arterial or veno-venous configuration. Veno-arterial mode is used for the treatment of cardiogenic shock which could be seen post-cardiotomy and in severe cardiac failure due to myocarditis, cardiomyopathy, acute coronary syndrome. Veno-venous mode is used for the treatment of respiratory failure, most commonly due to adult respiratory distress syndrome (ARDS), pneumonia, and trauma. We experienced 3 cases of ECMO in patients with post-cardiotomy cardiac failure, cardiac failure due to myocarditis, and respiratory failure due to ARDS associated with pneumonia. Two patients died and one patient survived. 체외막산소화장치 (Extracorporeal membrane oxygenation, ECMO)는 통상적인 방법으로 치료되지 않는 호흡부전이나 순환부전 환자에게 폐나 심장의 기능이 돌아올 때까지 일시적으로 기계적인 보조를 하는 장치로 통상 사용하는 인공심폐기를 조금 변형하여 사용한다. ECMO의 적용은 상황에 따라 정동맥, 혹은 정정맥 순환으로 사용할 수 있다. 정동맥 순환은 주로 심인성 쇼크에 사용되며, 심인성쇼크의 원인은 심장절개 후나 수술과 관련 없이 심근염, 심근병증, 급성 관동맥증후근 등에 발생하는 순환부전이다. 정정맥 순환은 주로 성인성 호흡곤란증후군(adult respiratory distress syndrome, ARDS), 폐렴, 혹은 외상 후에 나타나는 호흡부전 환자에 적용된다. 저자들은 최근 심장절개 후 순환부전, 심근염으로 인한 순환부전, 그리고 폐렴으로 인한 ARDS환자 3례에서 ECMO를 적용하여 2례는 사망하였으나 1례는 생존한 경힘을 하였기에 문헌고찰과 더불어 이를 보고하는 바이다.

하행 결장을 이용한 식도 재건술에 관한 임상적 고찰

김응중 충남대학교 의과대학 지역사회의학연구소 1991 충남의대잡지 Vol.18 No.2

Isoperistaltic left colon interposition is rapidly becoming the reconstructive technique of choice in the correction of benign esophageal stricture and some cases of malignant esophageal stricture. The author performed five isoperistaltic left colon interposition at the Department of Thoracic and Cardiovascular Surgery in Chungnam National University Hospital during the period from June 1990 to August 1991. Two cases were benign esophageal strictures and three caes were malignant esophageal strictures. There was one anastomotic leakage at esophagocolostomy site and one case of hoarseness due to recurrent laryngeal nerve injury. All of these five patients are being followed up wihtout specific problems. Left colon has many advantages in esophageal reconstruction comparing with right or transverse colon and is becoming the reconstructive organ of choice in many cases of benign and malignat strictures.

만성 신부전증 환자에서 동정맥루형성술의 조기 성적

김응중,황석하,임승평,이영 충남대학교 의과대학 지역사회의학연구소 1991 충남의대잡지 Vol.18 No.2

The surgically created arteriovenous fistula has become the method of choice in achieving vascular access for maintenance hemodialysis. The authors performed 70 arteriovenous fistulas for angioaccess in 65 patients with CRF at the Department of Thoracic and Cardiovascular Surgery in Chungnam National University Hospital during the period form August 1990 to November 1991. There were 4 cases of early obstructions due to inadequate vein in 2 cases, inadequate artery in 1 case and technical failure in 1 case. In 3 cases except 1 case who was transferred to other hospital, re-AVF were tried with successful outcomes. There were 2 cases of minor complications (wound infection and arm swelling due to venous hypertension) which were managed conservatively with successful outcomes. During the mean follow up of 8 months in 59 patients whore are not expired or lost during follow up, 3 cases of late thrombosis were occured with fistula patency rate of 94.9%. The authors consider the 'anatomical snuffbox' arteriovenous fistula as a primary choice and consider another method if it is not possible.

대동맥판막에 발생한 유두상 섬유탄력종 1례

김응중,최재성,이명묵,김어진 동국대학교 의학연구소 2009 東國醫學 Vol.16 No.1

유두상 섬유탄력종은 주로 심장판막에 발생하는 원발성 종양으로 심장종양 중 두 번째로 많은 양성종양이나 전체적으로 그 빈도는 매우 드물다. 78세 여자 환자가 흉부 불편감을 주소로 내원해서 대동맥판막에 위치한 유두상 섬유탄력종이 발견되어 개심술 하에 대동맥판막의 손상 없이 종양을 제거하였기에 문헌고찰과 더불어 이를 보고하는 바이다. Cardiac papillary fibroelastoma is the rare primary cardiac tumor, though it is the second most common benign cardiac tumor. It usually involves the cardiac valve. Papillary fibroelastoma of the aortic valve was found in a 78-year-old woman with chest discomfort and it was excised without valvular injury under cardiopulmonary bypass. Thus we report the present case with relevant review of the literatures.

Clinical Analysis about Total Correction of TOF

Kim, Eung-Joong 충남대학교 의과대학 지역사회의학연구소 1992 충남의대잡지 Vol.19 No.1

충남대학교 병원 흉부외과에서 1983년부터 1991년까지 9년동안 완전 교정술을 시행한 총 96명의 활로씨 4징증 환자에 대하여 임상분석을 시행하여 다음과 같은 관찰결과를 얻었다. 환자는 동기간에 시행한 총 개심술의 12.1%를 차지하고 있었으며 그것은 또한 동기간에 시행한 선천성 심질환에 대한 개심술의 18.8%를 차지하고 있었다. 환자의 남녀비는 55:41을 이루고 있었으며 평균 나이는 10.1±8.0세로 7개월에서 42세까지 분포되어 있었다. 총 96례의 환자중 15례의 환자가 사망하여 15.6%의 수술사망률을 기록하고 있었으며 수술사망률에 기여하는 가장 중요한 인자로는 어린 나이와 저체중이 차지하고 있었다. 수술중 대동맥 차단시간도 수술후 사망률에 영향을 끼치는 경향은 보였으나 통계학적 의미는 존재하지 않았다. 기타 다른 요소들은 수술후 사망률에 영향을 미치지 않았다. 수술후 25명(26.0%)의 환자에서 총 35례의 합병증이 발생하였다. 가장 많은 합병증은 수술후의 우심실부전(10례)이었으며 그외에도 잔존하는 심실중격결손(8례), 부정맥(4례), 인공호흡기 제거 실패(3례), 출혈(2례), 그리고 그밖에 8례의 사소한 합병증이 발생하였다. 살아남은 환자들은 모두 합병증에서 회복되었으며 현재 외래에서 특별한 문제없이 추적관찰중이다.