증례보고 : 심장수술 후 발생한 총비골신경 마비

정태은 ( Tae Eun Jung ),문희림 ( Hi Lim Moon ),지대림 ( Dae Lim Jee ) 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.45 No.3

4-스포크 형상의 스켈리튼 스틸 휠 디스크의 성형 해석

정태은(Tae-Eun Chung),인정제(Jeong-Je Yin),이동재(Dong-Jae Lee),고형규(Hyung-Gyu Ko),고정민(Jung-Min Ko) 한국자동차공학회 2004 한국자동차공학회 춘 추계 학술대회 논문집 Vol.- No.-

4-spoke typed skeleton steel wheel disk using high strength steel is developed. The skeleton steel wheel has many merits such as light weight, fuel economy and product price. But effective structure, profit forming process and other factors must be considered. Finite element simulation is done to examine the draw processes. The desirable model for drawing process is proposed from the detailed simulation.

고등교육기관에서의 학제적 교육 현황 분석

김대현(Dae-Hyun KIM),김은주(Eun-Ju KIM),정태은(Tae-Eun JUNG),김혜나(Hye-Na KIM) 한국수산해양교육학회 2011 水産海洋敎育硏究 Vol.23 No.4

영아기 심실중격결손 봉합술의 임상적 고찰

정태은,이장훈,이동협,이정철,한승세,김세연,지대림 영남대학교 의과대학 2002 Yeungnam University Journal of Medicine Vol.19 No.2

Background: Simple ventricular septal defect(VSD) is the most common congenital heart disease. Although closure of VSD is currently associated with a relatively low risk, experience with younger and smaller infants has been variably less satisfactory. We assessed the results of surgical closure of VSD in infant. Materials and Methods: Between 1996 and 2000, 45 non-restrictive VSD patients underwent patch repair and retrospective analysis was done. Patients were divided into two groups based on weight: group I infants weighed 5kg or less(n=16), and group II infants weighed more than 5kg(n=29). Both groups had similar variation in sex, VSD location, aortic cross clamp time and total bypass time. But combined diseases (ASD, PDA, MR) were more in group I. We closed VSD with patch and used simple continuous suture method in all patients. Results: There were no operative mortality, no reoperation for hemodynamically significant residual shunt and no surgically induced complete heart block. As a complication, pneumonia(group I: 2 cases, group II: 2 cases), transient seizure(group II: 2), wound infection(group I:, group II:1), urinary tract infection(group I: 1) and chylopericardium(group I: 1) developed, and there was no significant difference between two groups(p>0.05). Conclusion: Early primary closure with simple continuous suture method was applicable in all patients with non-restrictive VSD without any serious complications.

소아 개심술에서 Histidine-Tryptophan-Ketoglutarate 용액과 냉혈심정지액의 심근보호 효과

정태은,이동협,한승세 영남대학교 의과대학 2006 Yeungnam University Journal of Medicine Vol.23 No.1

심실중격결손이나 심방중격결손과 같이 대동맥 차단시간이 길지 않은 질환에 있어서는 HTK용액의 심근보호효과가 냉혈심정지액과 비슷한 효과를 가짐을 알 수 있었다. 따라서 한번 투여로 2~3시간의 수술이 가능한 장점을 가진 HTK용액을 소아에서도 유용하게 사용할 수 있을 것으로 생각되며 향후 복잡심기형과 같은 긴 대동맥차단이 요구되는 소아환자의 안정성에 대해서는 더 많은 연구가 필요할 것으로 생각된다. Background: There is limited data on comparisons between the effect of histidine-tryptophan-ketoglutarate (HTK) solution and cold blood cardioplegic (CBC) solution in pediatric cardiac surgery. The purpose of this study was to compare the myocardial protective effect of HTK solution and CBC solution in patients undergoing pediatric cardiac surgery. Materials and Methods: We selected 49 patients with ventricular septal defect and atrial septal defect. HTK solution was used in 21 patients and CBC solution was used in 28 patents. HTK solution was given as a single dose, whereas CBC solution was used in the usual multi-dose method. The incidence of EKG change and concentration of Troponin T and CK-MB were compared for the evaluation of myocardial damage. Results: There were no significant differences in the incidence of ST, T segment change by EKG and serial cardiac enzyme levels between two groups. Conclusion: These results suggested that the myocardial protective effect of HTK solution was similar to CBC solution in simple pediatric cardiac surgery.

허혈성 심질환의 치료에서 관동맥우회술의 임상적 고찰

정태은 영남대학교 의과대학 1996 Yeungnam University Journal of Medicine Vol.13 No.2

허혈성 심질환의 치료로서 시행되는 관동맥 우회술은 최근 국내에서도 보편적으로 시행되고 있는데 1992년부터 1996까지의 영남대학교 의과대학 흉부외과학교실에서 시행한 63례의 관동맥 우회술을 대상으로 수술성적 및 술전 위험인자들이 술 후 합병증에 미치는 영향을 조사하여 다음과 같은 결론을 얻었다. 환자의 성별 및 연령을 보면 총63례의 환자 중 남자가 44례, 여자가 19례였으며 연령분포는 36세에서 71세까지 평균 58.3±8.6세 였으며 50대와 60대에서 대부분을 차지하였다 원위문합수는 환자당 평균 3.5개의 원위부 문합을 하였으며 수술사망은 6례였으며 술후 합병증으로 부정맥이 7례, 창상감염이 5례, 술후 출혈이 4례, 술중 및 술후 심근경색이 4례, 뇌졸증이 4례, 그리고 위장관 및 신장 합병증이 5례에서 발생하였다. 술후 합병증 발생의 요소를 분석 해 본 결과 술전 관동맥 질환 발생의 위험인자 중 흡연환자에서 합병증의 발생빈도가 유의하게 증가하였으며(p<0.05) 술전 위험인자로 정맥으로 Nitroglycerin의 투여가 필요했던 경우와 대동맥 차단시간이 2시간 이상인 경우에 경우 합병증의 발생빈도가 유의하게 증가하였으며(p<0.05) 특히 65세 이상의 고령환자의 경우 수술사망율이 유의하게 증가하였다(p<0.05). 이상의 결과로 흡연, 65세 이상의 고령, 술전 정맥으로 Nitrogloycerin의 투여가 필요했던 경우 그리고 이식혈관의 수가 많아 대동맥 차단시간이 긴 경우 술중 및 술후 관리에 더욱 섬세한 주의가 필요함을 알 수 있었다. From August 1992 to July 1996, 63 consecutive patients underwent coronary artery bypass surgery. The mean age of these patient was 57 years(range form 30 to 71years). There were 44 men and 19 women. Preoperative 12 patients had stable angina pectoris and 23 patients were unstable angina pectoris. 8 patients had previous myocardial infarctation history and emergency or urgent myocardial revascularization were performed in 9 cases. In the risk factors of coronary atherosclerosis, 25 patients(40%) were hypercholesterolemia, 38 patients(60%) have smoking history and 19 patients(30%) have hypertension history. In the patterns of disease, 9 patients were single vessel disease, 18 patients were two vessele disease and 33 patients were three vessel disease. We performed total 284 distal anastomosis(mean 3.5 anastomosis per patient) and performed one case of ascending aorta graft interposition, two cases of mitral valve replacement, one case of aortic valve replacement, one case of ventricular septal defect repair and one case of atrial septal defect repair and the mean aortic cross clamp time was 115.3 minutes. The common complications were arrhythmia(7cases), wound infection(5cases), perioperative myocardial infarction(4cases), reoperation for bleeding control(4cases) and stroke(4cases). There were six hospital deaths due to low cardiac output syndrome, ventricular arrhythmia and respiratory failure. In the evaluation of operative risk factors, preoperative intravenous nitroglycerin requirement and prolonged aortic cross clamp time(>2hours) were found to be predective factor of morbidity and old age(>65years) was found to be predective factor of mortality.

혈관외로 유출된 Mitomycin-C에 의한 조직괴사 예방을 위한 Dimethyl Sulfoxide와 Sodium Thiosulfate의 효과

정태은,김기형,최병철,우상현,설정현 영남대학교 의과대학 1996 Yeungnam University Journal of Medicine Vol.13 No.2

실험용 쥐를 이용하여 항암약제인 mitomycinc를 피하 주사하여 인위적으로 혈관외 유출을 시켜 조직 괴사를 유발하였다. 조직괴사를 예방하기 위하여 치료 시작시간에 따른 dimethyl sulfoxide의 국소도포와 sodium thiosulfate의 진피내 주사의 치료 효과를 비교하고 조직학적 검사를 실시하여 다음과 같은 결과를 얻었다. 1. mitomycin-C가 혈관외로 유출될 경우 dimethyl sulfoxide를 6시간 이내외 국소 도포하면 괴사를 예방할 수 있었고, 24시간 이내에 치료를 시작해도 괴사 면적에 유의한 감소를 가져 올 수 있었다(p<0.01). 2. Sodium thiosulfate진피내 주사를 할 경우에는 12시간 이내에는 괴사를 예방할 수 있었으나 24시간이 경과한 후에는 치료효과가 없었다 (p<0.01). 3. MMC에 의한 괴사는 비균성 옹고성 괴사였으며, 염증 반응이나 육아 조직은 나타나지 않았으며, 국소도포와 진피내 주사 방법에 따른 조직학적 변화를 제외한 차이는 없었다. 4. MMC의 혈관외 유출로 피부병변을 최소화 시킬 수 있는 방법은 DMSO와STS 의 즉시 병합치료가 좋은 효과를 얻을 수 있을 것으로 추측된다. Extravasation of toxic chemotherapeutic agents cause severe skin ulceration and necrosis which often need secondary surgical intervention. Still, there were not established antidote agent in case of extravasation with mitomycin-c. Dimethyl sulfoxide is known as an effective chemical scavenger of toxic hydroxyl free radical and sodium thiosulfate also was demonstrated significant protector from mitomycin-c induced ulceration by a few experimental studies. Author investigated necrotic area of mitomycin-c injected site and compare to the effectiveness of topical treatment with dimethyl sulfoxide and intradermal injection of sodium thiosulfate according to starting times, forty five mice were divided into 3 groups. Control group(n=5) had no treatment after subcutaneous injection of mitomycin-c. Experimental group I and II were 20 mice treated dimethyl sulfoxide and sodium thiosulfate, respectively. Depending on the starting time of treatment, group I and II were subdivided into 1, 2, 3 and 4 as immediate, 6 hours, 12 hours and 24 hours after mitomycin-c injection. Histologic studies of the necrotic area and survival area after treatment were performed using hematoxylin-eosin staining. The mean necrotic area of group I was significantly decreased depending on the starting time of treatment compared with control group(p<0.01). The results means there was no necrosis area which was treated with topical sodium thiosulfate within 6 hours, and it showed also significant decrease of necrosis area within 24 hours. There was also no necrosis area in group II-1 and significant decrease of necrosis area II-2 and III-3. But, effctiveness of intradermal injection of sodium thiosulfate was not found in group II-4 which was started after 24 hours. Hisotolgic findings showed a bland coagulative necrosis without inflammatory changes and no granulation tissue. The significant difference that cytoplasmic loss of subcutaneous fat and decrease number of hair follicles between two groups resulted from the methods of treatment by topical application and intradermal injection. In conclusion, immediate treatments with topical dimethyl sulfoxide or intradermal injection of sodium thiosulfate signifcantly prevents necrosis by extravasation of mitomycin-c.

개심술 111예의 대한 임상적고찰

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

영남대학교 의과대학 흉부외과학교실에서는 1986년 한해동안 111예의 개심술을 시행하였으며 그 결과는 다음과 같았다. 1. 전 111예중 선천성 심질환이 88예로 79.2%를 차지했고 후천성 심질환은 23예로 20.8%를 차지했다. 2. 환자의 연령은 선천성 심질환의 경우 생후 5개월에서 52세까지였고 후천성 심질환의 경우 14세부터 55세까지였다. 3. 남녀의 비는 선천성 및 후천성 심질환 모두 남자가 1.3배 많았다. 4. 선천성 심질환 88예중 심실중격결손증이 45예로 가장 많았으며 다음이 심방중격 결손증으로 16예였고 활로씨 4증후군이 14예였다. 5. 후천성 심질환은 심장판막질환이 대부분으로 23예를 차지했고 1예가 해리성대동맥류이었다. 6. 수술사망은 선청성 심질환에서 2예 후천성 심질환에서 1예로 총 사망율은 2.7%였다. During 1986, 111 cases of open heart surgery were performed at Yeungnam University Hospital consisting 88 cases of congenital heart disease and 23 cases of acquired heart disease. Among 88congenital heart disease, 72 were acyanotic group and 16 were cyanotic. Common cogenital heart diseases were ventricular septal defect(51%), atrial septal defect(18%)and Tetralogy of Fallot(16%). Among 23 acquired heart disease, 22 cases were valvular disease and one was dissecting aortic aneurysm. Three cases of the postoperative death were present resulting 2.7% of surgical mortality rate.

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.

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.