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고분자 중합체 심근 스템트를 이용한 기계적 경심근 혈류재건술의 혈관생성 반응
최호,이철주,문광덕,김영진,강준규,홍준화,지경수,한만정,조상호,Choi, Ho,Lee, Cheol-Joo,Moon, Kwang-Deok,Kim, Young-Jin,Kang, Joon-Kyu,Hong, Jun-Wha,Jee, Kyung-Soo,Han, Man-Jung,Cho, Sang-Ho 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.6
Background: Transmyocardial laser revascularization(TMLR) for revascularizing ischemic myocardium in patients was originally based on the assumption that laser channels remain their patency much longer. But recent studies show that laser channels did not remain open and that TMLR could achieve treatment benefits without long-term channel patency. The angiongencesis is currently thought to be induced by non-specific inflammatory response to mechanical tissue injury. This study is to evaluate hypothesis that various transmyocaridal mechanical revascularization(TMMR) may induce the angiogenic responses similar to that seen with TMLR, and transmyocaridal polymer stent revascularization(TMSR), the polymer stent in the myocardial tissue is hydrolyzed in 2 weeks, may enhance the non-specific inflammatory reaction resulting angiogenesis. Furthermore, polymer myocaridal stent channels remain long-term patency. Material and Method: Eight domestic pigs underwent ligation of the proximal circumflex artery, and 2 weeks later they were randomized to undergo transmycardial acupunctural revascularization (TMPR, Group I) of the left lateral wall with 18-G needle(n=2), to undergo transmyocardial (TMDR, Group II) with industrial 2mm steel drill(n=2), to undergo transmyocardial polymer stent revascularization (TMSR, Group III) after drilling the infarcted myocardium(n=2), the stent is poly(lactic acid-co-glycolic acid), which is self-degradated in the myocardium, and to a control group the ischemic zone was unterated(n=2). All the pigs were sacrificed after 4 weeks TMMR. Sections from the ischemic zone were submitted for vascular endothelial growth factor (VEGF) ELISA and histology. Result: There were makedly increase in the VEGF immunoassay in the ischemic zone of the TMMR group compared to the ischemic zone of the control group(control: each 30.85 and 43.15pg/mg protein, TMPR: each 44.14 and 68.61 pg/mg protein, TMDR: each 65.92 and 78.65 pg/mg protein, TMSR: each 177.39 and 168.87 pg/mg protein). TMSR channels caused greatest VEGF expression than channels made by other group and the polymer stent channels remained vacuole after 4 weeks. Conclusion: Transmyocardial polymer stent revascularization promoted the most angiogenci response by the VEGF immunoassay, although our study did not show the statistical significancy. The channels remained but the flow patency was not verified. Transmyocardial polymer stent revascularization (TMSR) is desirable in future experimental trials and in view of the significant cost implications comparable to that of laser.
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최호,이철주,홍준화,강준규,최진욱,윤유상,Choi, Ho,Lee, Cheol-Joo,Hong, Joon-Wha,Kang, Joon-Kyu,Choi, Jin-Wook,Yoon, You-Sang 대한흉부심장혈관외과학회 2001 Journal of Chest Surgery (J Chest Surg) Vol.34 No.5
Superior sulcus or pancoase tumor refers to any primarty lung cancer locating in thoracic inlet and causing pain in the periscapular region or aim. These originate inperipheral, and involve th extrapulmonary structures more than parenchyma of the lung. We experienced l case of superior sulcus tumor radically resected via anterior transcervical approach, which provide more safe exposure of cervical structures of thoracic inlet than classis posterolateral thoracotomy. Therefore were report this case with review of literature.
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폐절제술후 발생한 합병증 및 사망률에 대한 후향적 고찰
문광덕,이철주,김영진,최호,김정태,강준규,홍준화,Moon, Kwang-Deok,Lee, Cheol-Joo,Kim, Young-Jin,Choi, Ho,Kim, Jung-Tae,Kang, Joon-Kyu,Hong, Joon-Hwa 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.4
Background: A retrospectiye study was done for understanding morbidity and mortality after major lung resection. Material and Method: From June 1994 to August 1998, 203 patients received major lung resections for various causes. There were 142 males and 62 females with a mean age of 47.5 years. Initial complains were cough in 47.8%, sputum in 33.0%, hemoptysis or blood-tinged sputum in 23.2%, dyspnea in 18.2%, chest pain in 15.3%, weight loss in 10.8%, fever and chill in 4.9%. There were no complaints in 5.9% of the total patients. The underlying diseases were lung tumor(102 cases/50.2%), bronchectasis(28 cases/13.8%), aspergillosis(24 cases/1.8%), tuberculosis(20 cases/9.9%) and others (29 cases/66.5%) and pneumonectomy(68 cases/33.5%). The postoperative complications were classified as : empyema, BPF, respiratory problem, persistent air leakage over 7 days, arrhythmia, ventilator applied over 24 hours, bleeding, wound infection and chylothorax. The postlobectomy complications were revealed as follow: empyema(3.7%), BPF(2.2%), respiratory problem(5.2%), persistent air leakage over 7days(8.9%), arrhythmia(2.2%), ventilator applied over 24 hours(2.2%), bleeding(1.5%), wound infection(2.9%), chylothorax(0.7%). The postpneumonectomy complications were revealed as follow : empyema(5.9%), BPF (5.9%), respiratory problem(17.6%), persistent air leakage over 7days(0%), arrhythmia(5.4%), ventialtor apply over 24 hours(7.4%), bleeding (7.4%), wound infection(2.9%) and chylothorax(1.5%). Reoperation was done in 8 cases (4.0%). There were 5.8% operative mortalities in pneumonectomy and 0.7% in lobectomy.
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폐암의 병기결정에 있어서 컴퓨터 단층촬영(CT)과 감마 카메라를 이용한 양전자방출 단층촬영(PET)의 민감도와 특이도의 비교연구
문광덕,이철주,김영진,최호,김정태,강준규,홍준화,박찬희,윤석남 아주대학교 의과학연구소 1999 아주의학 Vol.4 No.1
A retrospective study was undertaken to compare sensitivities and speciticities of computed tomography (CT) scan and radiolabeled glucose analog ^(18)F-fluoro-2-deoxy-D-glucose (FDG) camera based positron emission tomography (PET). Nine patients with lung cancer who underwent preoperative CT and ^(18)F-FDG coincidence PET scanning were evaluated retrospectively. Imaging studies were read prospecdvely and blinded to the surgical and pathologic data. The final diagnosis was established by histopathologic examination at thoracotomy. CT was accurate in 7 patients (77.8%), with understaging in 1 patient and overstaging in 1 patient. In detection of locally advanced disease (N2/N3), the sensitivity, specificity, positive predictive value and negative predictive value were 50%, 85.7%, 50% and 85.7%, respectively. On the other hand, ^(18)F-FDG-PET was accurate in 8 patients (88.9%), with overstaging in 1 patient and without any understaging. In detection of locally advanced disease (N2/N3), the sensitivity, specificity, positive predictive value and negative predictive value were 100%, 85.7%, 66.7% and 100%, respectively. ^(18)F-FDG-PET was significantly more accurate than CT in lymph node staging of lung cancer. The high negative predictive value of FDG-PET could reduce a need for invasive surgical staging (ISS).
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