심도 저체온 순환 정지를 이용한 급성 폐 색전증이 동반된 신세포암의 수술적 치료 -1 예 보고-

이동협 ( Dong Hyup Lee ),박동춘 ( Dong Chun Park ) 영남대학교 기초/임상의학연구소 2007 Yeungnam University Journal of Medicine Vol.24 No.2S

Renal cell carcinoma occasionally invades the inferior vena cava and rarely extends to the right atrium and occurred massive pulmonary embolism. A healthy 54-year-old man presented to the emergency room with anterior chest pain, dyspnea and hypotension from which he had been suffering for several hours. We diagnosed him as left renal cell carcinoma with acute both pulmonary arteries embolism. The patient underwent a complex surgical procedure in which left radical nephrectomy, inferior vena cava thrombectomy and both pulmonary arteries thromboembolectomy under deep hypothermic circulatory arrest. Total circulatory arrest time was 44 minutes. We should use many inotropic agents for weaning of cardiopulmonary bypass. The patient had many postoperative complications including of acute renal failure, respiratory distress and sepsis. He died from septic shock and multi organ failure at 36th postoperative day.

심실중격 결손증의 해부학적 분류 및 임상적 고찰

강면식,이철주,정태은,이동협 영남대학교 의과대학 1986 Yeungnam University Journal of Medicine Vol.3 No.1

영남대학교 의과대학 흉부외과학교실에서는 1984년부터 1986년까지 총 99명의 심실중격 결손증 환자들을 수술 치험하였던 바 다음과 같은 결론을 얻었다. 1. 남여비는 1.2:1로 남자가 약간 많았다. 2. 연령분포는 다양하였으며 전체의 ⅔가 3세에서 12세 사이였다. 3. 체중분포는 10㎏미만이 13예이고 21㎏이상이 44예였다. 4. 입원시 주소는 잦은 상기로 감염증이 78예로 제일 많은 빈도를 보였다. 5. 심도자 검사장 폐·체동맥압비가 0.75이상인 경우가 6명, 폐·체 혈관 저항비가 0.5이상인 경우는 0명,폐·체 혈류량비가 3이상인 경우가 13명을 대부분이 중등도의 병변을 보였다. 6. 동반된 심기형은 개방성 난원공, 폐동맥 협착증, 개방성 동맥관 등의 순이었다. 7. 심실중격 결손의 부위는 막변연 유입부 결손이 45예로 제일 많았으며 근육형은 1예로 없었다. 8. 술후 합병증은 완전 혹은 불완전 우각 차단증이 52예로 가장 많았다. 9. 술후 사망은 2예였으며 2%의 발생율을 보였다. Ventricular septal defect is most common congenital cardiac anomaly in Korea and worldwide. And its clinincal spectrum is well known. The anatomic classification had been undertaken by several authors, but recently Dr. Soto and Anderson's classification is widely used instead of Dr. Kirklin's it. From April, 1984 to December 1986, 99 cases of ventricular septal defects had been taken surgical repair under direct vision using conventional cardiopulmonary bypass technique at Yeungnam university hospital. The clinical spectrum was similar to other hospital, and the postoperative mortality was 2%, The most common associated anomaly was patent foramen ovale, and the most common postoperative complication was incomplete or complete right bundle branch block. The rank of defects was as followings : 45 perimembranous inlet type, 21 doubly commited subarterial type, 17, perimembranous trabecular type, and 16 perimembranous outlet type. There was no muscular and mixed type.

심방세동의 최신 외과적 치료

이동협,정태은 영남대학교 의과대학 2005 Yeungnam University Journal of Medicine Vol.22 No.1

Atrial fibrillation (AF) is the most common cardiac rhythm disturbance, which carries significant cardiovascular morbidity and mortality. The medical treatment for AF is cumbersome and unsatisfactory, which has highlighted the need to develop alternative treatments for AF. The recent discovery that AF is often initiated by atrial ectopic beats has resulted in treatments designed to target the ectopic sources, particularly those within the pulmonary veins. Building an the pioneering work of Cox et al., a recent reported series demonstrated the feasibility of treating patients undergoing cardiac surgery for other structural heart diseases with limited, left-atrial ablation lesion sets using alternative energy sources. As less complex modifications of the Maze procedure have been developed, a number of energy sources have been introduced to create of electrically isolating lesions within the atria. These sources have been used both endocardially in arrest heart procedures as well as epicardially in a beating heart setting. This review summarizes the recent advances in surgery for AF that will aid in the development of an effective, minimally invasive surgical procedure to cure patients with AF.

흰쥐의 뇌,척수 및 신경절에서 내장기관과 관련된 신경원의 추적에 관한 미세형태학적연구 - Ⅱ. 감각신경세포체와 신경섬유의 표지부위

이창현,오인균,이동협,장극선,이무삼 대한해부학회 1996 Anatomy & Cell Biology Vol.29 No.6

승모판 협착증과 동반된 자유롭게 부유하는 좌심방 구형혈전 1례

이정철,김영조,김영진,한승세,이태일,이동협,홍은표,최교원,심봉섭,강승호,신동구,이현우 영남대학교 의과대학 1993 Yeungnam University Journal of Medicine Vol.10 No.1

저자들은 승모판 협착증과 동반된 자유롭고 부유하는 좌심방내의 구형혈전은 1례를 치험하였기에 그 희귀성에 비추어 문헌 고찰과 함께 보고하는바이다. A free-floating ball thrombus in the left atrium is a rare complication of the mitral valvular disease. A 53-year-old man was admitted for pain and paresthesia on both legs. On admission he had auscultatory sign of mitral stenosis and mitral regurgitation, and the roentgenogram of his chest revealed a slight pulmonary venous congestion, enlargement of the pulmonary conus and cardiomegaly. Laboratory findings including complete blood counts, coagulation studies and blood chemistry were normal. An echocardiographic examination revealed a mitral stenosis and a free-floating ball thrombus in the left atrium. We performed the emergent open heat surgery for removal of the ball thrombus and mitral replacement successfully with Duromedics 29 mm valve. The size of thrombus was 39 X 32 X 30 mm.

동맥관개존증의 임상적 고찰

이철주,정태은,이동협,강면식 영남대학교 의과대학 1986 Yeungnam University Journal of Medicine Vol.3 No.1

영남대학교 의과대학 흉부외과학교실에서는 1984년 4월부터 1986년 12월까지 2년 8개월동안 61명의 동맥관개존증환자를 수술치험하였다. 61명중 53명예에서 Doppler식 심초음파검사만으로 동맥관개존증을 진단하여 수술을 시행, 확인함으로써 Doppler식 심초음파검사만으로의 진단상 감수성(Sensitivity)이 100%이었고 수술은 단순 결찰법으로 전례에서 행하였던 바 좌우 혈단락의 합병증은 없었으며 수술후 원격조사 결과도 매우 양호하였다. 수술사망은 없었으며 3예에서 경한 수술후 합병증이 발생하였으나 쉽게 치료되었다. 이에 수술결과에 더불어 동맥관의 일반적인 변화 및 혈역학적 중요성에 대해 문헌과 함께 고찰하였다. A clinical analysis was performed on 61 cases of patent ductus arteriosus experienced at Yeungnam University Hospital during 3 years period from Aprial, 1984 to December, 1986. Of the 61 patient of PDA, 13 patient were male and 48 patient were female and qge ranged 2 months to 26 years old with the everage age of 9.4 years. The chief complaints on admission were frequent URI and dyspnea on exertion. Main diagnostic procedure were Doppler Echocardiogram(in 53 among 61). All of the operatins were performed the method of ligation of PDA. Three posterative complication were developed, but there was no operative mortality.

식도폐쇄를 동반하지 않은 선천성 기관식도루의 치험 1예 보고

이동협,이철주,민현식 영남대학교 의과대학 1985 Yeungnam University Journal of Medicine Vol.2 No.1

H type의 기관식도루 특히 성인에서 발견되는 경우는 아주 드물다. 최근 영남대학교 의과대학 흉부외과학교실에서는 식도폐쇄를 동반하지 않는 선천성 기관 식도루 1예를 수술치험하여 양호한 성적을 얻었기에 문현고찰과 함께 보고하는 바이다. The congenital tracheosophageal fistula without atresia of the esophagus is considered a rare variant, and the literature concerned to the tracheosophageal fistula without artesia is little in adult especially. The 22-year-old male was admitted to Yeungnam University Hospital with his chief complaints of weight loss (6kg/6months),abdominal discomfort,and intermitting coughing. The diagnosis was made by the endoscopy and esophagography.The results was 1.5cm in dia-meter, 0.5cm in length. The level was around second thoracic vertebra. The operation was performed transpleurally through the right third intercostal space and the fistula was secured with interrupted silk suture after division. The fibrotic adhesion was seen around the tracheosophageal fistula. The postoperative course was uneventful, and postoperative esophagogram revealed no extraluminal leakage. Herewith we report this unusual case of isolated tracheo-esophageal fistula with review of literature.

표지방식을 이용한 흰 쥐 복강 내장을 지배하는 감각신경세포체와 신경섬유의 표지부위

이동협,이창현,이무삼 영남대학교 의과대학 1998 Yeungnam University Journal of Medicine Vol.15 No.1

복강내장을 지배하는 감각신경세포체 및 신경섬유의 표지부위를 관찰하기 위하여 복강내장을 부위별(위,십이지장,공장,맹장,오름결장,내림결장)로 나누어 2.5% WGA-HRP 30μι와 0.5% CTB 20μι를 장막과 근육층 사이의 4부위에 나누어 주입하였다. 그 후 48-96시간의 생존시간이 경과한 후 뇌줄기, 척수신경절과 미주신경절에서의 감각신경섬유와 신경세포체의 표지부위를 면역조직화학 염색법과 HRP 조직화학 기법으로 관찰한 결과는 다음과 같다. 1. WGA-HRP에 표지된 감각신경섬유는 위와 맹장에서만 관찰되었으며, CTB에 표지된 감각신경섬유는 복강내장의 모든 장기에서 관찰되었다. 2. 복강내장을 지배하는 감각신경섬유는 뇌줄기내 좌우 고립로핵의 교질부, 교질부의 등쪽 내측부, 교차연결부, 내측부, 넷째뇌실벽, 맨아래구역의 앞쪽경계 및 중심관의 등쪽 정중선인 교차연결부에 국소적으로 강하게 표지되었다. 3. 척수신경절에서 위(stomach)에 분포하는 감각신경세포체는 좌우 관계없이 T₂에서 L₁까지 여러 신경절에 표지되었으며 이 중 좌우 T8-9부위에 가장 많이 표지되었다. 4. 십이지장에서의 척수신경절에 표지된 감각신경세포체는 좌우 T6-L2부위에 표지되었으나 다른 장기에 비하여 표지된 감각신경세포체의 수는 적었다. 5. 공장에서의 척수신경절에 표지된 감각신경세포체는 좌우 T6-L2부위에 표지되었다. 가장 많이 표지된 부위는 좌측 T12부위였으며, 우측은 T13부위에 표지되었다. 6. 회장에서의 척수신경절에 표지된 감각신경세포체는 좌우 T6-L2부위였다. 가장 많이 표지된 부위는 좌측에서 T11부위였고, 우측에서 L2부위였다. 7. 맹장에서의 척수신경절에 표지된 감각신경세포체는 좌측은 T7-L2부위였으며 우측은 T6-L1부위였다. 가장 많이 표지된 부위는 좌측은 T11이었으며, 우측은 T11-12에 표지되었다. 8. 오름결장에서 척수신경절에 표지된 감각신경세포체는 좌측은 T7-L2부위에 표지되었고 우측은 T9-L4부위에 표지되어 좌우측 표지부위의 차이를 보였다. 가장 많이 표지된 부위는 좌측은 T9이었으며, 우측은 T11에 표지되었다. 9. 내림결장에서 척수신경절에 표지된 감각신경세포체는 좌측은 T9-L2부위에 표지되었고 우측은 T6-L2부위에 표지되었다. 가장 많이 표지된 부위는 좌측은 T13이었으며, 우측은 L1에 표지되었다. 10. 복강내장을 지배하는 좌우 미주신경절에 표지된 감각신경세포체는 위에서 가장 많이 표지되었으며 위를 제외한 나머지 장기에서는 표지된 감각신경세포체의 수는 위에 표지된 수보다 적었다. 이상의 결과로 흰쥐의 복강내장을 지배하는 감각신경섬유의 뇌줄기내 표지영역은 좌우 고립로핵의 교질부, 교질부의 등쪽내측부, 교차연결부, 내측부, 넷째뇌실벽, 맨아래구역의 앞쪽경계 및 중심관의 등쪽 정중선인 교차연결부였으며, 감각신경세포체의 표지영역은 미주신경절과 척수신경절 T2-L4 부위였음을 알 수 있었다. 위를 제외한 나머지 장기들에서는 T6-L4부위에 표지되었으나 소장에서 대장으로 갈수록 가장 많이 표지된 부위는 원위부 가슴신경절에서 근위부 허리신경절쪽으로 이동하는 경향을 보였다. The local arrangement of sensory nerve cell bodies and nerve fibers in the brain stem, spinal ganglia and nodose ganglia were observed following injection of cholera toxin B subunit(CTB) and wheat germ agglutinin-horseradish peroxidase(WGA-HRP) into the rat intestine. The tracers were injected in the stomach(anterior and posterior portion), duodenum, jejunum, ileum, cecum, ascending colon or descending colon. After survival times of 48-96 hours, the rats were perfused and their brain, spinal and nodose ganglia were frozen sectioned (40㎛). These sectioned were stained CTB immunohistochemical and HRP histochemical staining methods and observed by dark and light microscopy. The results were as follows: 1. WGA-HRP labeled afferent terminal fields in the brain stem were seen in the stomach and cecum, and CTB labeled afferent terminal fields in the brain stem were seen in all parts of the intestine. 2. Afferent terminal fields innervating the intestine were heavily labeled bilaterally gelalinous part of nucleus of tractus solitarius(gelNTS), dorsomedial part of gelNTS, commissural part of NTS(comNTS), medial part of NTS(medNTS), wall of the fourth ventricle, ventral border of area postrema and comNTS in midline dorsal to the central canal. 3. WGA-HRP labeled sensory neurons were observed bilaterally within the spinal ganglia, and labeled sensory neurons innervating the stomach were observed in spinal ganglia T₂- L₁and the most numerous in spinal ganglia T8-9. 4. Labeled sensory neurons innervating the duodenum were observed in spinal ganglia T6-L2 and labeled cell number were fewer than the other parts of the intestines. 5. Labeled sensory neurons innervating the jejunum were observed in spinal ganglia T6-L2 and the most numerous area in the spinal ganglia were T12 in left and T13 in right. 6. Labeled sensory neurons innervating the ileum were observed in spinal ganglia T6-L2 and the most numerous area in the spinal ganglia were T11 in left and L₁in right. 7. Labeled sensory neurons innervating the cecum were observed in spinal ganglia T7-L2 and the most numerous area in the spinal ganglia were T11 in left and T11-12 in right. 8. Labeled sensory neurons innervating the ascending colon were observed in spinal ganglia T7-L2 in left, and T9--L4 in right. The most numerous area in the spinal ganglia were T9 in left and T11 in right. 9. Labeled sensory neurons innervating the descending colon were observed in spinal ganglia T9-L2 in left, and T6-L2 in right. The most numerous area in the spinal ganglia were T13 in left and L₁in right. 10. WGA-HRP labeled sensory neurons were observed bilaterally within the nodose ganglia, and the most numerous labeled sensory neurons innervating the abdominal organs were observed in the stomach. 11. The number of labeled sensory neurons within the nodose ganglia innervating small and large intestines were fewer than that of labeled sensory neurons innervating stomach. These results indicated that area of sensory neurons innervated all parts of intestines were bilaterally gelatinous part of nucleus tractus solitarius(gelNTS), dorsomedial part of gelNTS, commissural part of NTS(comNTS), medial part of NTS, wall of the fourth ventricle, ventral border of area postrema and com NTS in midline dorsal to the central canal within brain stem, spinal ganglia T₂-L₄, and nodose ganglia. Labeled sensory neurons innervating the intestines except the stomach were observed in spinal ganglia T6-L4. The most labeled sensory neurons from the small intestine to large intestine came from middle thoracic spinal ganglia to upper lumbar spinal ganglia.

임산부에서 발생한 대동맥 박리(Aortic Dissection) 1례

이정철,김영조,이형민,신동구,한승세,심봉섭,이동협,홍은표 영남대학교 의과대학 1993 Yeungnam University Journal of Medicine Vol.10 No.1

본원에서는 출산 후 지속되는 호흡곤란, 전신부종을 주소로 내원한 환자에서 임신과 관계된 De Bakey유형Ⅱ의 대동맥해리를 진단하고 성공적으로 수술을 시행한 1례를 경험하였기에 보고하는 바이다. We have experienced a case of aortic dissecting aneurysm in pregnant woman. She felt initially severe chest pain which was radiated to the neck on the 3days before delivery. Thereafter dyspnea and generalized edema were developed for 1 month after delivery. She was diagnosed as aortic dissection, Debakey type Ⅱ. During cardiopulmonary bypass, the selective cerebral perfusion was done through the right and left commom carotid arteries. Aortic replacement with Hemashield vascular graft and reimplantation of innominate artery, resuspension of aortic valve, repair of intimal tear were performed. The postoperative course was uneventful.

기관지 유암종 2례

이관호,한승세,이동협,김성숙,이현우,이정철,최교원,정진홍,서정일 영남대학교 의과대학 1993 Yeungnam University Journal of Medicine Vol.10 No.2

전형 중심성 기관지 유암종과 비전형 기관지유암종을 기관지내시경하 생검 및 전산화 단층촬영하 생검으로 확진했으며 근치적 치료로 폐절제술을 시행한 치험 2례를 문헌 고찰과 아울러 보고하는 바이다. Bronchial carcinoid tumor was a low grade malignant and it was regarded as predictable clinical course and good survivality after surgical resection. But despite of its low grade malignant potentiality, bronchial carcinoid tumor was clearly capable of metastasizing and causing death. We present 2 cases of bronchial carcinoid tumors. One of them was typical carcinoid tumor in 44 year-old female and another was atypical carcinoid tumor in 53 year-old male patient. Currative therapeutic procedure was performed by lobectomy and wedge resection.