ATS 인공 심장 판막의 단기 및 중기 임상성적

임창영,문승철,양진영,구원모,김대식,이건,이헌재,Lim, Chang-Young,Moon, Seung-Chul,Yang, Jin-Young,Koo, Won-Mo,Kim, Dae-Sig,Lee, Gun,Lee, Hyeon-Jae 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery (J Chest Surg) Vol.32 No.11

Background: ATS mechanical valve is a recently introduced pyrolytic carbon bileaflet prosthesis. This report is to evaluate the results of hemodynamic and anticoagulant therapy after ATS valve replacement. Material and Method: From May 1995 to October 1998, 53 patients received 65 ATS prosthesis; 38 Mitral(27-33 mm), 27 Aortic(19-25 mm). 2 CABGs and 5 Tricuspid annuloplasty were taken concomitantly. The follow up period was 769 patient-months(mean 16.2$\pm$10.0), varied from 1 month to 39 months with 92.5% follow up rate. All patients were evaluated with Doppler echocardiography, 7-14 days after operation. Result: NYHA functional class was improved significantly, from 2.6$\pm$0.8 preoperatively to 1.3$\pm$0.4 postoperatively. The average value of peak and mean transvalvular pressure gradients were 25.7$\pm$13.5 mmHg, 12.7$\pm$8.3 mmHg in aortic position. In the mitral position, the average values of peak and mean transvalvular pressure gradient and valve area were 5.9$\pm$2.5 mmHg, 3.1$\pm$0.8 mmHg and 2.9$\pm$0.5 $\textrm{cm}^2$, respectively. In the anticoagulant therapy, mean INR was 2.5$\pm$0.6 in mitral valve replacement and 1.9$\pm$0.5 in aortic valve replacement. There was no anticoagulant related complication. During that period, there were 3 hospital death(5.9%) and 1 late death(1.9%). Conclusion: The early clinical results of the ATS heart valve replacement is quite satisfactory, and low target INR reginmen is safe. And long term follow of hemodynamic characteristics is also necessary.

자가면역성 만성 간염

임창영(Chang Young Lim),김대현(Dae Hyun Kim),박상현(Sang Hyun Park),경쾌수(Kwae Soo Kyung),전영빈(Young Bin Jeon),유권(Kwon Yoo),이윤우(Yun Woo Lee) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.6

The autoimrnune chronic hepatitis is a rare cause of chronic liver disease in Korea. A case of autoimmune chronic hepatitis was diagnosed in a 24 year-old female. She was admitted to the hospital due to the pain and swelling of the right parotid gland. Her liver function test had been known to be abnormal also. The liver biopsy was performed for the further evaluation of abnormal liver function. It showed chronic active hepatitis without evidence of viral infection or injury by hepatotoxin. Laborotory test showed hypergammaglobulinemia and autoantibodies. We report this case as a autoimmune chronic hepatitis with literature review. (Korean J Gastroenterol 1995;739 - 743)

다한증환자의 흉부교감신경절단술시 양측 손바닥의 온도변화

이헌재,김대식,문승철,구원모,양진영,이건,임창영,박정현,Lee, Hyeon-Jae,Kim, Dae-Sik,Moon, Seung-Cheol,Koo, Won-Mo,Yang, Jin-Young,Lee, Gun,Lim, Chang-Young,Park, Chung-Hyun 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery (J Chest Surg) Vol.32 No.5

Background: Thoracoscopic T2 sympathicotomy is an effective method for the treatment of palmar hyperhidrosis. Not only are the symptoms of hyperhidrosis abolished but also the temperature of the ipsilateral palm is elevated due to the sympatholytic vasodilation after the completion of the sympathicotomy on the first side. However little is known about the temperature changes in the contralateral palm. This study was performed to evaluate the changes in both palmar temperatures during the thoracoscopic T2 sympathicotomy for palmar hyperhidrosis. Material and Method: Thoracoscopic T2 sympathicotomy was performed in 15 patients with primary palmar hyperhidrosis. Surface temperatures of both palms were monitored continuously and were recorded simultaneously during the 7 different stages of the operation. Result: When T2 sympathicotomy was performed on the first(left) side, an ipsilateral increase with a contralateral decrease of temperature was observed. The difference in the temperature of both palms was greatest just before the sympathicotomy on the contralateral(right) side(Lt. 34.6$\pm$0.9$^{\circ}C$ vs. Rt. 31.6$\pm$1.3$^{\circ}C$, P<0.0001). After the sympathicotomy on the second(right) side, temperature of the right palm was elevated. The difference in the temperature of both palms was abolished at the end of the operation(Lt.34.7$\pm$0.9$^{\circ}C$ vs. Rt.34.4$\pm$1.$0^{\circ}C$, P=0.415). Conclusion: When T2 sympathicotomy was performed on the first side, an ipsilateral palmar temperature increased due to the sympatholytic vasodilation. However contralateral palmar temperature decreased due to a vasoconstriction. Although the mechanism of vasoconstriction is still unknown, it is postulated that there may be a cross- inhibitory effect by the post-ganglionic neurons innervating blood vessels of the palm. 배경: 흉강경을 이용한 T2 교감신경절단술은 수장부다한증의 효과적인 치료법이다. 교감신경을 절단하면 다한증 증상이 소실되는 것은 물론 피하혈관의 확장으로 동측 손바닥 온도가 올라간다. 그러나 반대측 손바닥의 온도 변화에 대해서는 밝혀진 바가 적다. 저자들은 수장부다한증 환자에서 교감신경절단술 과정에 나타나는 양측 손바닥 온도의 변화양상을 알아보고자 하였다. 대상 및 방법: 일차성 수장부다한증 환자 15명에서 T2 교감신경절단술을 시행하였다. 수술중 양측 손바닥에 피부온도감지패취를 부착하여 손바닥의 온도를 관찰기록하였다. 결과: 먼저 좌측 2번 흉부교감신경을 절단하자 동측 손바닥의 온도는 상승하고 반대측 손바닥의 온도는 감소하였다. 두 손바닥의 온도차는 우측 교감신경절단전에 가장 컸으며(좌측 34.6$\pm$0.9 $^{\circ}C$, 우측 31.6$\pm$1.3$^{\circ}C$, P < 0.0001) 반대쪽(우측) 교감신경을 절단하자 감소하였던 우측 손바닥의 온도가 상승하여 수술종료시 두 손바닥의 온도차가 없어졌다(좌측 34.7$\pm$1.0 $^{\circ}C$, 우측 34.4$\pm$1.0 $^{\circ}C$, P=0.415). 결론: 수장부 다한증에서 교감신경절단술을 시행할 때는 상지에 분포하는 교감신경이 정확히 차단되었는가를 확인하는 것이 중요하다. 이를 위해서 수술중 손바닥 피부온도를 측정하여 온도상승을 확인한다. 반대측 손바닥 온도가 감소하는 기전인 혈관수축에는 교차억제효과(Cross inhibitory effect)가 관계될 것으로 생각되며 향후 이에 대한 많은 연구가 이루어져야 할 것으로 생각된다.

성인에서 발견된 선천성 식도기관지루 5예

임창영 ( Chang Young Lim ),최수전 ( Soo Jeon Choi ),이봉춘 ( Bong Chun Lee ),김동순 ( Dong Soon Kim ),전우기 ( Woo Ki Jeon ),김정숙 ( Joung Sook Kim ),이신영 ( Shin Yeong Lee ),오상준 ( Sang Joon Oh ),곽영태 ( Young Tae Kwak ) 대한결핵 및 호흡기학회 1993 Tuberculosis and Respiratory Diseases Vol.40 No.1

보행성 24 시간 식도 pH 및 내압검사를 이용한 만성기침 환자에서의 위식도역류에 관한 연구

지영구(Young Koo Jee),김윤섭(Yoon Seob Kim),임창영(Chang Young Lim),이계영(Kye Young Lee),김건열(Kun Yeol Kim) 대한내과학회 1997 대한내과학회지 Vol.53 No.5

N/A ficant GER among whom seven were confirmed to have true reflux related cough (cough induced by GER; 30.8±6.4%). Although the remained two have not only GER but cough, cough episodes were not directly related with GER events (cough induced by GER; 0%). Six among seven patients with reflux related cough showed good therapeutic response to anti-reflux medications but the other two patients with reflux not related cough did not. Conclusion: It is suggested that combined ambulatory 24hour esophageal pH and motility monitoring can provide an objective and good measurement for the discrimination of true reflux related cough episodes.

화상디자인의 유사성 판단기준에 대한 연구

김소영(Kim So-Young),최민영(Choi Min-Young),임창영(Lim Chang-Young) 한국디자인학회 2003 디자인학연구 Vol.16 No.4

체크리스트를 활용한 화상디자인의 유사성에 판단기준에 대한 연구

김소영(So-Young Kim),최민영(Min-Young Choi),임창영(Chang-Young Lim) 한국HCI학회 2004 한국HCI학회 학술대회 Vol.2004 No.2

Angiotensin Converting Enzyme Inhibitor 가 Capsaicin 유발 기침반사에 미치는 영향

김동순(Dong Soon Kim),권성운(Seong Woon Kwon),김용복(Yong Bok Kim),임창영(Chang Young Lim),유원상(Won Sang Yoo),최석구(Suck Koo Choi) 대한내과학회 1993 대한내과학회지 Vol.45 No.5

N/A Background: Angiotensin converting enzyme(ACE) inhibitors are widely used for the treatment of hypertension and heart failure without serious side effects, but in some patients, they induce intractable cough. The mee-hanism of this cough is not known, but ACE and kininase II are the same enzyme, the derangement in the metabolism of kinines and Substance-P by ACE inhibitors has been proposed as one possibility. So we performed a placebo-controlled, double-blind, randomized crossover study, to find out whether the enalrpril can change the sensitivity to capsaicin which released Substance-P from the nerve ending and its relation to the development of cough after the enalarpril. Method: The subjects were 21 patients (9 men and 12 wemen) with mild to moderate hypertension. Eleven patients developed cough with the Enalarpril (cougher), and 10 pateints didn't have cough (non-cougher) and served as a control group. Baseline PFT, serum IgE level, and blood eosinophil count were done. The patients received either enalarpril 10 mg per day or placebo for one week, and after the washout period of at least one week, another drug(placebo if the patient had enalapril previously and vice versa) was given for a week. Blood pressure, pulmonary function test, and capsaicin challenge test were performed at the end of each period. Capsaicin challenge test was done by inhalation of different concentration of capsaicin via DeVil-bis 646 nebulizer with dosimeter (SCM Co., U.S.A.) and the lowest concentration which induced 2 or more coughs (Th-w) and 5 or more coughs (Th-5) were deter- mined. Result: The age of the two groups were similar (55.5 vs 52 years), but females were predominant in cougher (8 female and 4 male) compared to non-cougher (4 female and 6 male). There was no Significant difference in serum IgE level, eosinophil counts, and pulmonary function between two groups. Cough developed immediately after the inhalation of capsaicin, and the dose-response relationship was fonud between the number of coughs and the concentration of capsaicin. In all patients, Th-2 was 19.7±16.1uM and Th-5 was 78.8±48.6uM. But there was no significant difference in both Th-2 and Th-5 between coughers (21,3 uM and 72.2 uM) and non-coughers (18.0 uM and 81.6 uM). also, no significant change in Th-2 and Th-5 was found during the therapy of enarlapril compared to the placebo period in both groups. Among 11 coughers, 2 patients developed more coughs with capsaicin inhalation after the enarlapril compared to placebo period (responder), and in non-cougher, 3 among 10 patients were responders. Blood pressure was significantly decreased after the Enarlapril, but no significant change in pulmonary function was noted. Conclusion: Our data suggest that Enarlapril does not increase the sensitivity to capsaicin and the cough after the Enarlapril seems to have different mechanism.

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.

위십이지장질환에서 Helicobacter Pylori 의 DNA Variation 에 관한 연구

노임환(Im Hwan Roe),김창인(Chang In Kim),하동렬(Dong Ryul Ha),진영주(Young Joo Jin),송일한(Il Han Song),임창영(Chang Young Lim),김정원(Jung Won Kim),김정택(Jung Taik Kim),이종화(Jong Hwa Kim),염정선(Jung Sun Yeom) 대한내과학회 1997 대한내과학회지 Vol.53 No.4

N/A Background: The evidence for H. pylori as a gastrointestnal pathogen is now very strong, if not overwhelming. Among the pathogenic factors of H. pylori, flagella and urease are considered to be major factors causing the gastrododenal disease. We observed the gene diversity of H. pylori using the PCR-amplified 1.4Kb fla A gene and 0.9Kb ure B gene and examined the relationship between the gene pattern and the gastroduodenal disease. Method: Fifty-one cases of isolated strains were cultured at the Helicobacter-selective blood agar plates. To compare the gene diversity among the isolates of gastroduodenal disease genotypes was analyzed by PCR-based RFLP. 1.4Kb fla A gene and 0.9Kb ure B genes from isolates were amplified by PCR and digested with Hae 3 restriction enzymes to observe the restriction fragment length polymophysm. Protein patterns were also compared to examine the antigenic variations. Total cell proteins, and octyl-glucose extracts from isolates were analyzed by SDS-PAGE gel electrophoresis. Results: 41 cases (80.4%) of H. pylori were isolated in the 51 cases of gastroduodenal diseases. We could classify theses isolates 3 types of PCR-RFLP in the fla A gene, 900+500bp, 500+500+400bp, 600+800bp, and 9 types in the ure B gene. PCR-RFLP in the fla A gene and ure B gene of the isolates was different from the standard strain of Australia and the genetic diversity was not related to the types of the gastroduodenal disease. We demonstrated variations in the protein pattern and antigenic profiles among the isolates by SDS-PAGE analysis. These data also did not show any relationship between protein pattern and types of gastroduodenal diseases. Conclusion: Tese studies showed many different gene diversity in the flagella and urease gene without any relationship with the types of gastoduodenal disease. And variable protein pattern were noted among the strains of H. pylori. Further studies to demonstrate the pathgenecity of H. pylori should be continued even if there was no relationship between the genomic diversity of the flagella or urease and the types of gastroduodenal disease.