박동류 및 비박동류에 의한 체외순환의 비교

선경,백광제,김요한,임창영,김광택,김학제,김형묵,Sun, Kyung,Baek, Kwang-Je,Kim, Yo-Han,Kim, Chang-Young,Kim, Kwang-Taek,Kim, Hark-Jei,Kim, Hyoung-Mook 대한흉부심장혈관외과학회 1985 Journal of Chest Surgery (J Chest Surg) Vol.18 No.2

[here are so many reports that pulsatile blood flow provides physiologic organ perfusions during cardiopulmonary bypass. So, we compared the recent 30 cases undergoing cardiac surgery by Cobe-Stckert pulsatile roller pump with another 30 cases by Polystan nonpulsatile roller pump. Pulsatile flow was applied during aortic-cross clamping period when synchronized to internal EKG simulator, and perfusion mode was changed to continuous nonpulsatile flow after declamping of aorta. Age, sex, weight, and disease entities were comparable and operative techniques were similar between two groups. 1. There were no differences in average ACC time, ECC time, and Operation time. 2. Postoperative artificial respiration time was 6hrs 30mins in nonpulsatile group and 4hrs 48mins in pulsatile group, and detubation time after ventilator weaning was 2hrs 44mins in nonpulsatile group and 1hrs 43mins in pulsatile group. 3. Average pulse pressure was 8mmHg in nonpulsatile group and 55mmHg in pulsatile group, and a mean arterial pressure was 66.0mmHg in nonpulsatile group and 60.7mmHg in pulsatile group. 4. Mean urine-output during ACC;ECC period was 9.717.3;9.913.2ml/kg/hr in nonpulsatile group and 14.215.0;15.817.5 in pulsatile group [p<0, 05], and thereafter progressive decrease of differences in urine output between two groups until POD 2, and lesser amounts of diuretics was needed in pulsatile group during same postoperative period. Serum BUN/Cr level showed no specific difference and urine concentration power was well preserved in both groups. 5. Plasma proteins and other Enzymes showed no differences between two groups, but serum GOT/GPT level was higher in nonpulsatile group till POD 2. 6. Serum Electrolytes showed no differences between two groups. 7. WBC, RBC, Platelet counts, Hgb and Hct were not different and Coagulogram was well preserved in both groups. 8. Plasma free Hgb level was 7.09mg% in pulsatile group compared with 3.48mg% in pulsatile group on POD 1 but was normalized on POD 2. Gross hemoglobinuria after ECC was noted in 6 cases [20%] of pulsatile group and 4 cases [13%] of nonpulsatile group. 9. In both groups, most patients were included in NYHA class III to IV [28 cases;93% in nonpulsatile group, 22 cases;73% in pulsatile group] preoperatively, and well improved to class I to 11[22 cases; 73% in nonpulsatile group, 30 cases; 100% in pulsatile group] postoperatively. There were 7 operative mortalities in nonpulsatile group only, which were 5 cases of TOF with hepatic failure, 1 case of multiple VSDs with low out-put syndrome, and 1 case of mitral valvular heart disease with cardiomyopathy. We concluded that the new, commercially available Cobe-Stckert pulsatile roller pump device was safe, simple, and reliable.

위축성 심낭염 [Constrictive Pericarditis]을 동반한 양측성 섬유흉 [Fibrothorax] 치험 1

선경,김요한,백광제,이철세,김학제,김형묵,Sun, Kyung,Kim, Yo-Han,Baek, Kwang-Je,Lee, Chol-Sae,Kim, Hark-Jei,Kim, Hyoung-Mook 대한흉부심장혈관외과학회 1984 Journal of Chest Surgery (J Chest Surg) Vol.17 No.4

Fibrothorax is the end stage of chronic pathologic processes of pleura such as hemothorax, empyema, or tuberculous effusion. The pleural space become adherent and obliterated, and the lung parenchyma is covered by a thick, fibrous, unexpandable "peel", so the lung function is diminished markedly with impaired ventilation and oxygenation. Constrictive pericarditis is often accompanied fibrothorax, also cardiac and hemodynamic function is deteriorated. Surgical relief of these fibrous peels causes remarkable improvement in pulmonary function, cardiac and hemodynamic function, and subjective symptoms. We experienced a case of bilateral fibrothorax combined with constrictive pericarditis which occured 3 years after bilateral tuberculous effusion. Decortication and percardiectomy were done at the same time through bilateral submammary thoracotomy with sternal transection. Comparing postoperative Peripheral venous pressure, Circulation time, Pulmonary function test, Arterial blood gas analysis, Subjective symptoms with preoperative conditions showed noticeable improvement.provement.

흉선종을 동반한 적혈구 무형성증 1례 보

선경,이철세,백광제,김요한,김학제,김형묵,Sun, Kyung,Lee, Chol-Sae,Baek, Kwang-Je,Kim, Yo-Han,Kim, Hark-Jei,Kim, Hyoung-Mook 대한흉부심장혈관외과학회 1984 Journal of Chest Surgery (J Chest Surg) Vol.17 No.4

Pure Red-Cell Aplasia [P.R.C.A.] is rare disease characterized by absence of erythroid precursors in the bone marrow, normocytic normochromic anemia with profound reticulocytopenia in the peripheral blood, and relatively or completely spared granulopoiesis and thrombopoiesis. The association rates of P.R.C.A. with Thymoma is approximately 50%, but only 5-10% of all patients with a Thymoma have a P.R.C.A.. P.R.C.A. is thought to be a variety of autoimmune disease, and humoral inhibitor, i.e. IgG, has been demonstrated experimentally. Its treatments such as thymectomy, immunosuppressants, steroid, androgenic hormone, and splenectomy have been tried but the result is not satisfactory and the prognosis is poor. We experienced a case of P.R.C.A. with Thymoma treated with thymectomy and postoperative steroid therapy, and which showed good postoperative recovery clinically and hematologically.

선천성 낭포성 선종양기형 -1례 보고-

선경,백광제,이철세,채성수,김학제,김형묵,Sun, Kyung,Baek, Kwang-Je,Lee, Chol-Sei,Chae, Sung-Soo,Kim, Hark-Jei,Kim, Hyung-Mook 대한흉부심장혈관외과학회 1984 Journal of Chest Surgery (J Chest Surg) Vol.17 No.1

Congenital Cystic Adenomatiod Malformation (C.C.A.M.) is rare, but one of the most common congenital pulmonary anomalies that cause acute respiratory distress in the newborn infants. It is characterized and differentiated from the diffuse pulmonary cystic disease pathologically, i.e. adenomatoid appearance due to marked proliferation of the terminal respiratory components. An 2/12 year old male patient was suffered from respiratory distress and cyanosis on crying since birth, but no specific therapy was given. With progression of symptoms, he came to Korea University Hospital for further evaluation and then transfered to Dept. of Chest Surgery for operative correction under the impression of Congenital Obstructive Emphysema suggested by a pediatrician. On gestational and family history, there was nothing to be concerned such as congenital anomaly. Physical examinations showed; moderate nourishment and development (Wt. 5.5kg), cyanosis on crying, both intercostal and lower sternal retraction on inspiration, Lt. chest building with tympany, Rt. shifting of cardiac dullness, decreased breathing sound with expiratory wheezing on entire Lt. lung field, decreased breathing sound on Rt. upper lung filed, and tachycardia. The remainders were nonspecific. Laboratory findings were normal except WBC $14000/mm^3$ (lymphocyte 70%), Hgb 9.8m%, Hct 28%, negative Mantaux test, and sinus tachycardia and counter-clockwise rotation on EKG. Preoperative simple Chest PA revealed marked hyperlucent entire Lt. lung, herniation of Lt. upper lobe to Rt., collapsed Rt. upper lobe, tracheal deviation and mediastinal shifting to Rt., and no pleural reaction. At operation, after Lt. posterolateral thoracotomy, 4th rib was resected. Operative findings were severe emphysematous changes limited to both lingular segmentectomy was done. The resected specimen showed slight solidity, measuring $8{\times}4.5{\times}2cm$ in size, and small multiple cystic spaces filled with air. Microscopically, entire tissue structures were glandular in appearance, cyst were lined by ciliated columnar epithelium, and occasional cartilages were noted around the cystic spaces. Bronchial elements were dilated but normal pattern on histologically. The patient had a good postoperative courses clinically and radiologically, and discharged on POD 10th without event. The authors report a case of Cogenital Cystic Adenomatoid Malformation (C.C.A.M.)