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염욱,성상현,박성혁,Youm, Wook,Sung, Sang-Hyun,Park, Sung-Hyuk 대한흉부심장혈관외과학회 1993 Journal of Chest Surgery (J Chest Surg) Vol.26 No.5
Primary lung cancer has increased markedly in its incidence and prevalence rate recently in Korea. In frequency, it occupies the second rank cancer preceded by stomach cancer in korean male. From February 1986 to December 1992, we have operated on 55 cases of primary lung cancer in Korea Veterans Hospital and followed them. The results are as follows; 1. The peak incidence of age of primary lung cancer was 6th decade and 5th decade and those were 87.3% of study group, mainly in male. 2. Symptoms were cough [63.6%], dyspnea [41.8%], chest pain and discomfort [38.2%], blood tinged sputum and hemoptysis [21.8%]. Symptoms were frequently encountered before hospitalization and asymptomatic cases were 9.1% of study group. 3. Methods of diagnostic confirmation were bronchoscopic biopsy [52.7%], percutaneous needle aspiration[PCNA][21.8%], sputum cytolgy [12.7%], open biopsy [12.7%]. 4. Histopathologically, squamous cell carcinoma [76.4%] was the most frequent cancer and adenocarcinoma [10.9%], giant cell cancer [7.3%], and the others in order. 5. Methods of operation were pneumonectomy [32.7%], bilobectomy [18.2%], lobectomy [27.3%], lobectomy and segmenectomy [1.8%], exploration [20%], and overall resectability was 80%. 6. Operative mortality was 5.5% [3 cases] and there were 5 cases of complication. 7. Postoperative long-term follow up reveals that the cumulative survival rates in 6 months, 12 months, 26 months, 34 months, 43 months, 64 months were 89.5%, 71.7%, 66.7%, 57.2%, 50.8%, 42.3% respecively.
염욱,이영균,Youm, Wook,Lee, Yung-Kyoon 대한흉부심장혈관외과학회 1983 Journal of Chest Surgery (J Chest Surg) Vol.16 No.1
Fifty-Seven Cases of tricuspid valve replacement were done from April 1976 to January 1983. Fourteen congenital and 43 acquired cases were found. In 13 cases tricuspid valve alone was replaced with 2 operative deaths and one late deaths. In 35 cases TVR and MVR were done with 6 operative deaths and 6 late deaths. In 9 cases TVR, MVR, and AVR were done with one operative deaths. Over all operative mortality was 15.8% and late mortality 12.3% among the 48 survivors. Over all Survival rate was 71.9% during follow-up period ranging from 8 months to 6 years and 9 months. In every case TVR was done with bioprosthetic xenograft valves.
염욱,조대윤,노준량,Youm, Wook,Cho, Dae-Yun,Rho, Joon-Ryang 대한흉부심장혈관외과학회 1982 Journal of Chest Surgery (J Chest Surg) Vol.15 No.4
Pulmonary artery aneurysm usually carries an ominous prognosis due to the associated pulmonary hypertension. In July 1981, a patient with a huge aneurysm of main pulmonary artery secondary to pulmonary hypertension and bacterial endocarditis due to a patent ductus arteriosus was treated by resection of the aneurysm and Dacron patch graft replacement and closure of the patent ductus arteriosus. The immediate postoperative result was excellent. We now report the surgical treatment, clinical course, and one and half years follow up of the patient.
염욱,성상현,Youm, Wook,Sung, Sang-Hyun 대한흉부심장혈관외과학회 1988 Journal of Chest Surgery (J Chest Surg) Vol.21 No.1
168 cases of open heart surgery had been performed in Korea Veterans Hospital from Aug. 1984 to Nov. 1987. There were 150 cases of congenital heart disease and 18 cases of acquired heart disease. In congenital heart cases, 123 cases [82%] were acyanotic and 27 cases [18%] were cyanotic. Common congenital defects were VSD, TOF, ASD, PS in order of frequency. There were 11 cases of operative mortality; 5 cases [4%] in acyanotic group, 6 cases [22\ulcorner6] in cyanotic group. There was no mortality in valvular heart disease group. Overall mortality rate was 6.5%.
염욱,이영균,Youm, Wook,Lee, Yung-Kyoon 대한흉부심장혈관외과학회 1982 Journal of Chest Surgery (J Chest Surg) Vol.15 No.1
Cardiac Myxoma is a most frequent benign tumor in primary cardiac tumors. About 75% occur in the left atrium & 20% in the right atrium, ventricular Myxoma is a very rare one among the cardiac myxoma. They may cause severe and progressive disease resembling valvular heart disease. With the advent of various diagnostic modalities, especially real time bidimensional echocardiography enabled us more accurate diagnosis of cardiac myxoma noninvasively and preoperatively. From April 1977 to Sept. 1981, 16 cases of cardiac myxomas were operated in Seoul National University Hospital using cardiopulmonary bypass. There were 13 cases of left atrial myxomas and each of a case was right atrial and right ventricular and left ventricular one. In all cases tumors were resected successfully & were discharged in healthy state. Follow up results of each patient was excellent.
혼합형 동종이인자형 키메라쥐에서 특정공여군의 동종 폐이식펀에대한 관용
염욱,Youm, Wook 대한흉부심장혈관외과학회 1996 Journal of Chest Surgery (J Chest Surg) Vol.29 No.7
폐이식후의 수용자들의 낮은 생존율은 주로 거부반응 또는 면역억제제 사용에 따른 합병증과 관련이 있다. 따라서 이식편에대한 수용자의 관용을 유도해낼 수 있는 더욱 좋은 방법이 절실히 요구된다. 저자 는 동종의 골수간세포가 주입되어진 혼합동종이 인자형 키메라 쥐에서 특정 동종 공여군의 공여 폐이식 편에대한 관용의 초래여부를 연구하였다. Fisher(F344)와 Wistar Forth(WF)종주의 쥐에서 치사량의 (1100c0y) 방사선조사후 T-임파구를 제거한 동일종주와 동종이인자형 골수의 혼합물로 재구성하였다 (F)44+WFIWF, AC1+F3441F3f4).28일후 말초혈액에서 임파구형의 검사로 혼합형 키메리즘이 확 인된 쥐에서 특정 공여군 또는 제3군의 동종 공여폐로 좌측의 동소 폐이식을시행하였다. 이식후 어떠 한 면역억제제도 투여하지 않았다. 이식편의 거부는 흉부 X선검사로 관찰하였고 조직학적으로 확인하 였다. 혼합형 키메라쥐들은 특정 공여군의 폐들을 받아들였으나 종주들 끼리의 특정효과에의한 것은 아 니었고, 이들에서 150일이상 거부반응을 관찰할 수 없었다. 이식편에대한 관용은 키메리즘의 백분율과 는 관계없이 일어났으며 제3군의 공여폐에대해서 \ulcorner정상대조군에서와 마찬가지로 10일내에 이식편에 대한거부반응이 완료되었다. 이 결과들은흔합형 키메라에서 정상적인 면역기전을 유지하면서도,특정 공여군의 폐이식후 안정적이고_1. 지속적 인, 이식 편에대한 관용이 일어난다는 것을 보여준다. Poor long term patient survival (60% at 2 years) in lung allograft recipients are mainly due to rejection and complications associated with the use of nonspecific immunosuppressants. Better means to achieve waft acceptance is desperately needed. 1 have investigated whether mixed allogeneic chimerism in the form of bone marrow stem cell engraftment would induce donor-specific tolerance for lung allografts. Fisher (F344) and Wistar Forth (WF)rats were lethally irradiated (1100c0y) and reconstituted with a mixture of T-cell depleted syngeneic and allogeneic bone marrow (F344+WFIWF, ACI +F344- F344). After Mixed chimerism was documented by peripheral blood Ipnphocyte typing at 28 days, orthotopic left single lung transplantation was performed, using donor-s ecific or third party allografts. No immunosuppressants were administered. Graft rejection was monitored by chest rentgenography, and con- firmed by histology Mixed chimeric rats accepted lung allografts permanently, and it was not strain specific effect. Tolerance was all or none phenomenon which had nothing to do with the percentage of chimerlsm. Mixed chimeras rejected third party allografts in less than 10 days, a time course similar to that of unmanipulated controls. No acute or chronic rejection was observed in donor specific grafts more than 150 days posttransplant. These data suggest that mixed chimerism in the form of bone marrow stem cell engraftment results in stable, systemic donor-specific transplantation tolerance for lung allografts.
토끼 단일 심방근 세포에서 Na-Ca 교환전류의 특성에 관한 연구
염욱,호원경,서경필,Youm, Wook,Ho, Won-Kyung,Suh, Kyung-Phill 대한흉부심장혈관외과학회 1989 Journal of Chest Surgery (J Chest Surg) Vol.22 No.4
In single atrial cells isolated from the rabbit the properties of inward current of Na-Ca exchange were investigated using the whole cell voltage clamp technique. The current was recorded during repolarization following brief 2 ms depolarizing pulse to +40 mV from a holding potential of * 70 mV. Followings are the results obtained: 1. When stimulated every 30 seconds, the inward currents were activated and reached peak values 6-12 ms after the beginning of depolarizing pulse. The mean current amplitude was 342 pA/cell. 2. The current decayed spontaneously from the peak activation and the time course of the relaxation showed two different phases fast and slow phase. The time constants were 10-18 ms and 60-140 ms, respectively. 3. The recovery of inward current was tested by paired pulse of various intervals. The peak current recovered exponentially with time constant of 140 ms and 1 p M isoprenaline accelerated the recovery process. 4. Relaxation time course was also affected by pulse interval and time constant of the fast phase was reduced almost linearly according to the decrease of pulse interval between 30 sec and 1 sec. 5. The peak activation was increased in magnitude by long prepulse stimulation, 5 p M Bay K, 1 p M isoprenaline or internal and external application of c-AMP. 6. The relaxation time constant of the fast phase was prolonged by 5 p M Bay K or c-AMP, and shortened by isoprenaline. However the time course of the slow relaxation phase was not so much changed. From the above results, it could be concluded that increase of the calcium current by Bay K or c-AMP results in the potentiation and prolongation of intracellular calcium transient, and the facilitation of Ca uptake by SR might be a mechanism of shortening the time constant of current relaxation by short interval stimulation or isoprenaline.
심실중격결손을 동반한 완전대혈관전위증 [S.D.D]에서의 Mustard 씨 수술[치험 1예]
염욱,임승평,김종환,Youm, Wook,Lim, Seung-Pyung,Kim, Chong-Whan 대한흉부심장혈관외과학회 1981 Journal of Chest Surgery (J Chest Surg) Vol.14 No.2
Mustard succeeded in the physiological correction of the circulation for transposition of the great arteries by redistribution of the pulmonary and systemic venous blood flow using pericardial baffle in the atrium. This procedure has become one of the most confirmative corrective operations for transposition. A six years old girl was performed mustard operation for complete transposition of the great arteries combined with hemodynamically insignificant ventricular septal defect in December 1979. The postoperative patient`s condition has been satisfactory and she is now enjoying a productive life.
박성혁,염욱,Park, Sung-Hyuk,Youm, Wook 대한흉부심장혈관외과학회 1997 Journal of Chest Surgery (J Chest Surg) Vol.30 No.2
복부대동맥과 그 이하 주요분지들의 동맥폐쇄에 의한 하지 만성허혈은 동맥경화증이 주원인이며 이 질환의 임상적 중요성은 혈관이 진행적으로 폐쇄됨에 따라 혈류장애가 발생하여 간헐적 파행, 휴식시 동통이 일어나며 더 진행되면 조직의 괴사가 발생,결국괴사된 조직의 절단을 초래하게된다. 본한국보 훈병원 흉부외과에서는 1992년 12월부터 1995년 12월까지 폐쇄성 하지동맥 경화증으로 입원한 20명의 환자를 대상으로 동맥간 우회술을 시 행하였다. 임상증상은 괴사및 괴저 9례(45B4), 파행 7례(35%), 안정 시 동통 4례(20%)순이었다. 사용한 혈관은 복부대동맥및 총대퇴동맥의 경우 Y-형및 I-형 인조혈관을 사 용하였고 대퇴동맥이하의 혈관에서는 주로 자가 대복재정 맥을 사용하였다. 술후 합병증은 4례로 20% 를 보였고 이식된 혈관내 혈전증 2례, 창상감염 2례 였다. 술후 혈관개존율은 복부대동맥과 양측 대퇴동 맥간 우회술의 경우 100%였고 대퇴동맥 이하에서는 6개월이 92.6%, 1년 84.2%, 2년 75.4%, 3년 69.4% 였다. From Dec. 1992 to Dec. 1995, 20 patients with atherosclerotic occlusive disease in the lower extremities underwent arter al bypass surgery. The age of the patients ranged between 46 and 77 years(mean .60.8 years) and the most prevalent incidence was in the 7th decades. The mean follow up period was 18.8 months ranging from 4 to 36 months. Associated diseases were diabetus mellitus(25%), hypertension (35%), cerebrovascular accident(25%), and acute myocardial infarction(5%). Disabling intermittent claudifcation(35%), resting pain(20%) or ischemic gangrene(or ulceration)(45%) were operative indications. Aorto-bifemoral bypass in 4 cases, aorto-single femoral bypass in 2 cases, Aorto-bifemoral bypass and femoropopliteal bypass in 3 cases, aorto-single femoral bypass and femoropopliteal bypass in 1 case, femoropopliteal bypass in 4 cases, femorotibial bypass in 1 case, popliteotibial bypass 4 cases and femorofemoral bypass in 1 case were the surgical approches. Early thrombosis(2 cases) and wound infection(2 case) were main complication. Postoperative complication rate was 20% . Postoperative patency rates re 92.6% at 6 months, 84.2% at 1 year, 75.4% at 2 years and 69.4% at 3 years.
심부전 모델에서 실험적 심근성형술의 단기 혈역학적 효과에 관한 연구
정윤섭,염욱,이창하,김욱성,이영탁,김원곤,Jeong, Yoon-Seop,Youm, Wook,Lee, Chang-Ha,Kim, Wook-Seong,Lee, Young-Tak,Kim, Won-Gon 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery (J Chest Surg) Vol.32 No.3
배경: 역동적 심근성형술에서 골격근 수축에 의한 단기 혈역학적 변화를 관찰하고 이에 미치는 인자를 분석하고자 하였다. 대상 및 방법: 이를 위해 20-30kg 사이의 한국산 잡견 10마리를 두 그룹으로 나눠 심장 상태를 정상과 심부전 상태로 구분하였고 골격근 상태도 활성도 및 수축력의 차이가 나도록 구분하였다. 그룹 A에서는 5마리의 정상 심장상태의 실험견에 심근성형술을 시행한 뒤 8주후 혈역학 검사를 실시하였고, 그룹 B에서는 5마리의 실험견에 8주동안 매주 1 mg/kg의 doxorubicin을 주입하여 만성 심부전 상태를 만들면서 동시에 좌측 광배근의 사전 조건화를 위한 근육훈련을 한후 심근성형술을 시행하고 바로 혈역학 검사를 실시하였다. 결과: 그룹 A의 정상 심장 상태에서 광배근 수축으로 평균 우심방 압력을 제외한 나머지 좌심실 혈역학 지수에는 유의한 변화가 없었다. 그룹 B에서는 광배근 수축으로 심박출량(cardiac output; CO)은 16.7$\pm$7.2%, 좌심실 압력발생 속도(positive pressure development rate of left ventricle; dp/dt)는 9.3$\pm$3.2%, 일회 심박출량(stroke volume; SV)은 16.8$\pm$8.6%, 좌심실 박출작업량(left ventricular stroke work; SW)은 23.1$\pm$9.7% 증가하였고, 좌심실 이완기말압(left ventricular end-diastole pressure; LVEDP)은 32.1$\pm$4.6%, 평균 폐동맥쐐기압(mean pulmonary capillary wedge pressure; mPCWP)은 17.7$\pm$9.1% 감소하였다(p<0.05). 그러나 그룹 A에서 imipramine을 7.5 mg/kg/hour의 속도로 34$\pm$2.6분 투여하여 CO이 17.5$\pm$2.7%, 좌심실 수축기압(left ventricular systolic pressure)이 15.8$\pm$2.5% 감소하고 LVEDP가 54.3$\pm$15.2% 증가한 일시적 급성 심부전 상태를 유도한 뒤(p<0.05), 이 상태에서 광배근을 자극하였더니 CO은 4.5$\pm$1.8%, dp/dt는 3.1$\pm$1.1%, SV는 5.7$\pm$3.6%, SW는 6.9$\pm$4.4% 증가하였고, LVEDP는 11.7$\pm$4.7% 감소하였다(p<0.05). 그룹 A의 급성 심부전 상태와 그룹 B의 만성 심부전 상태에서 모두 광배근 수축으로 변화한 CO, dp/dt, SV, SW, LVEDP 같은 좌심실 혈역학 지표들의 변화의 폭을 비교하면 그룹 B에서 그룹 A에서보다 더 컸다(p<0.05). 그룹 A에서 유도된 급성 심부전 상태와 그룹 B의 만성 심부전 상태가 CO, dp/dt, SV, SW, LVEDP 같은 좌심실 혈역학 지표들 면에서 통계학적으로 차이가 없고(p>0.05), 육안적으로 광배근을 관찰하였을 때 그룹 A에서는 광배근의 유착 및 염증소견이 모두에서 있었고 그중 2마리에서는 광배근의 수축을 목격할 수 없었던 반면, 그룹 B에서는 5마리 모두에서 광배근이 활발하게 수축하였다는 점을 함께 고려하면 그룹 B에서의 더 큰 증폭 효과가 광배근의 활성도 및 수축력의 차이로부터 기인한다고 평가할 수 있다. 결론: 이상에서 역동적 심근성형술의 수축기 혈역학적 변화는 심부전 상태에서만 긍정적인 개선 효과를 나타내며, 그 효과의 극대화를 위해서는 근육의 수축력을 유지하는 것이 매우 중요함을 알 수 있다. Background: To evaluate the short-term effect of dynamic cardiomyoplasty on circulatory function and detect the related factors that can affect it, experimental cardiomyoplasties were performed under the state of normal cardiac function and heart failure. Material and Method: A total of 10 mongrel dogs weighing 20 to 30kg were divided arbitrarily into two groups. Five dogs of group A underwent cardiomyoplasty with latissimus dorsi(LD) muscle mobilization followed by a 2-week vascular delay and 6-week muscle training. Then, hemodynamic studies were conducted. In group B, doxorubicin was given to 5 dogs in an IV dose of 1 mg/kg once a week for 8 weeks to induce chronic heart failure, and simultaneous muscle training was given for preconditioning during this period. Then, cardiomyoplasties were performed and hemodynamic studies were conducted immediately after these cardiomyoplasties in group B. Result: In group A, under the state of normal cardiac function, only mean right atrial pressure significantly increased with the pacer-on(p<0.05) and the left ventricular hemodynamic parameters did not change significantly. However, with pacer-on in group B, cardiac output(CO), rate of left ventricular pressure development(dp/dt), stroke volume(SV), and left ventricular stroke work(SW) increased by 16.7${\pm}$7.2%, 9.3${\pm}$3.2%, 16.8${\pm}$8.6%, and 23.1${\pm}$9.7%, respectively, whereas left ventricular end-diastole pressure(LVEDP) and mean pulmonary capillary wedge pressure(mPCWP) decreased by 32.1${\pm}$4.6% and 17.7${\pm}$9.1%, respectively(p<0.05). In group A, imipramine was infused at the rate of 7.5mg/kg/hour for 34${\pm}$2.6 minutes to induce acute heart failure, which resulted in the reduction of cardiac output by 17.5${\pm}$2.7%, systolic left ventricular pressure by 15.8${\pm}$2.5% and the elevation of left ventricular end-diastole pressure by 54.3${\pm}$15.2%(p<0.05). With pacer-on under this state of acute heart failu e, CO, dp/dt, SV, and SW increased by 4.5${\pm}$1.8% and 3.1${\pm}$1.1%, 5.7${\pm}$3.6%, and 6.9${\pm}$4.4%, respectively, whereas LVEDP decreased by 11.7${\pm}$4.7%(p<0.05). Comparing CO, dp/dt, SV, SW and LVEDP that changed significantly with pacer-on, both under the state of acute and chronic heart failure, augmentation widths of these left ventricular hemodynamic parameters were significantly larger under the state of chronic heart failure(group B) than acute heart failure(group A)(p<0.05). On gross inspection, variable degrees of adhesion and inflammation were present in all 5 dogs of group A, including 2 dogs that showed no muscle contraction. No adhesion and inflammation were, however, present in all 5 dogs of group B, which showed vivid muscle contractions. Considering these differences in gross findings along with the following premise that the acute heart failure state was not statistically different from the chronic one in terms of left ventricular parameters(p>0.05), the larger augmentation effect seen in group B is presumed to be mainly attributed to the viability and contractility of the LD muscle. Conclusion: These results indicate that the positive circulatory augmentation effect of cardiomyoplasty is apparent only under the state of heart failure and the preservation of muscle contractility is important to maximize this effect.