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Vasopressin의 지속적 경정맥 주입시 Nifedipine이 관상동맥과 문맥혈류에 미치는 영향
서보양,심민철,박동일,김홍진,권굉보 대한응급의학회 1991 대한응급의학회지 Vol.2 No.1
Vasopressin(Pitressin), when used to control gastrointestinal bleeding, has been shown to significantly reduce coronary flow. Our purpose was to determine of Nifedipine could be used to counteract Vasopressin's coronary effect. Six mongrel dogs, weighing approximately 25kg, underwent laparotomy and left thoracotomy under pentobarbital anesthesia. Electromagnetic flowmeter probes were used to measure blood flow in the circumflex coronary artery(CCF), the superior mesenteric artery(SMAF) and portal vein(PVFP). Portal venous pressure(PP), femoral arterial and Swan-Ganz catheters were inserted. After baseline control parameters were recorded, Pitressin was administered at a continuous rate of 0.04U/kg/min. When all parameters stabilized, Nifedipine was infused at 0.3㎍/kg/min. Under Pitressin infusion PVP, PP, SMAF, CCF and cardiac output decreased by an average of 43.4, 73.1, 56.8, 54.8 and 59.1% respectively. When Nifedipine was added to Pitressin unfusion, CCF and cardiac output increased significantly, averaging 105 and 83.5% of control, respectively ; SMAF also increased moderately to an average of 76% of control value. However, both PVF and PP remained lower than control by average of 59.7 and 78.1% respectively. These data indicate that with Pitressin and Nifedipine infusion PVP and PP were reduced significantly while CCF and cardiac output were preserved.
소화성궤양 환자에 있어서 Latarjet Nerve 영역의 전정부와 체부의 조직학적인 경계
김홍진(Hong Jin Kim),구자일(Ja Ill Koo),심민철(Min Chul Shim),권굉보(Koing Bo Kwun),이수정(Soo Jung Lee),서보양(Bo Yang Suh),최원희(Won Hee Choi),이태숙(Tae Sook Lee) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.1
In highly selective vagotomy, one of the main problem is to find out antrum-corpus boundary and which branch of Crows foot must be sectioned in order to obtain a complete vagotomy to reduce incidence of the recurrence. This report was done to investigate the interrelationship between Crow s foot branches of Latarjet nerve and histologic antrum-corpus boundary determined by intraoper- ative biopsies. Studies were done on 22 patients of peptic ulcer who underwent vagotomy and antrectomy at YUH between September, 1987 and June, 1989. The results were as follows 1) The proximal, middle and distal branches were found to be located at a mean distance of 7.6cm (7~9), 6.6cm (6~8cm) and 5.6cm (5~6.cm) from the pylorus respectively. 2) At the level of proximal branch, oxintic mucosa was found in 45.5% and tranzitional mucosa was found in 50%. At the level of middle Branch, oxintic mucosa was found in 22.3% and transitional mucosa was identified in 68.2% to 72.7%, but antral mucosa was not seen. At the level of distal branch, oxintic mucosa was not seen, transitional mucosa was seen in 54.5% and antral mucosa was found in 45.5%. 3) There was no correlation between the distance from the pylorus to each of the terminal branches and the type of mucosa found on the lesser curvature at the level of the nervous branches is given.
김홍진,강만수,권우형,서보양,권굉보 대한혈관외과학회 2000 Vascular Specialist International Vol.16 No.1
Purpose: Traditionally vascular reconstruction has been reserved for patients with limb threatening ischemia. So, the surgery for claudication has been discouraged by the fear of bypass graft failure, limb loss, and significant perioperative complication that may be worse than the natural history of the disease. However, in a minarity of patients with claudication, the symptoms progress and a severe disability can result, which limit normal daily activities. In these patients intervention may be regarded as worthwhile. Methods: To evaluate the benefit or risk of revascularization that performed in patients with disabling or incapacitating intermittent claudication, the clinical data of patients who underwent the revas-cularization for disabling claudication at Yeungnam University hospital were collected and analyzed retrospectively. Results: From January 1990 to June 1999, 98 patients with disabling claudication were performed the surgical or interventional management (13.7% of all lower limb arterial disease registration in our unit). The patients were 93 males and S females ranging from 35 to 76 years of age. The mean age was 59, with the highest mcidence among people in their 50s, followed by those in their 60s and then in their 70s. History of smoking was noted in S2.7% of the cases. The major arterial occlusive site were aortoiliac artery in 42 cases (42.9%), femoral artery in 23 cases (23.5%), iliofemoral artery in 13 cases (13.3%), popliteal artery in 4 cases (4.1%), tibial artery in 5 cases (5.1%) and multi-level occlusion in 11 cases (11.2%). The operative procedures for disabling claudication were bypass graft operation in 70 cases, thromboembolectomy in 5 cases, endarterectomy in 4 cases and percutaneous trawluminal angioplasty (PTA) in 19 cases. Arterial bypass operations were aortobifemoral or aortobioooliteal bvaass in 17 cases. iliofemoral bvoass in 8 cases. femorotnpliteal bypass in 16 cases. femorotibial bypass in 3 cases, popliteotibial bypass in 6 cases, axillobifemoral bypass in 7 cases and femorofemoral bypass in 13 cases. In 98.4% of the operative cases, the early outcome was good with 3+ to 2+ rating according ta Rutherford criteria and cumulative 12, 24, 60-month primary and secondary patency rates were 83,3%, 76.4%, 71.3% and 87.8%, 86.3%, 81.8%. The operative mortality rates were 0% and no limb loss was noted in this series. Conclusion: In summary, arterial reconstruction for disabling claudication is noted as safe and durable procedure in some selective patients. Therefore, surgical intervention are valid treatment option in selected patients with disabling claudication.
경식도 심초음파도를 이용한 말초 동맥 색전증의 원발 병소 조사
권굉보,서보양,도병수,김춘직,김영조,한승세 대한혈관외과학회 1993 Vascular Specialist International Vol.9 No.1
Arterial embolic disease is an increasing number of clinical problem. After initial evaluation for peripheral arterial emboli, and then routine electrocardiogram was performed for screening embolic sources. In cases which abnormal ECG or history of cardiac disease is noted, transthoracic echocardiography(TTE) is commonly performed to detect cardiac sources of re- mained emboli. TTE has limitation to visualize the left atrium, thrombus limited to the left atrial appendage, stagnant atrial flow and thoracic aorta. To overcome these disadvantages, transesophageal echocardiography(TEE) can perform in selected and equivocal cases of TTE. Authors evaluated 22 cases of peripheral ischemia caused by emboli which were proven by operation. Male to female ratio was 15: 7 and average age was 53 years old(age range: 38-71 years old) and diagnosed to peripheral arterial embolic disease by arteriography. TTE could detect cardic pathology in 16 cases(72.7%) and noncardiac pathology in 6 cases (27.3% ). TEE was done in 6 cases of equivocal findings by TTE and found out 4 cases of thrombi which were located at left atrium(2 cases) and left atrial appendage(2 cases). All 4 cases were received cardiac operation and simultaneous peripheral embolectomies were done also. In conclusion, the use of TEE in evaluating the heart and thoracic aorta as a source of distal emboli is recomendable in equivical cases by TTE.
간경화 환자에서 발생한 문맥혈전증 : 증례 보고 A Case report
김동환,김홍진,권굉보,서보양,권우형 대한혈관외과학회 1999 Vascular Specialist International Vol.15 No.2
Portal vein thrombosis is a rare condition occurring in association with a wide variety of precipitating factors. Among these, liver cirrhosis and neoplasm constitute the major etiology of portal vein thrombosis. In oriental countries, as compared with westem countries, liver cirrhosis has been reported to be extremely rare cause of portal vein thrombosis. The authors experienced a case of portal vein thrombosis in a 46-years-old man with liver cirrhosis who admitted to our hospital due to abdominal pain. AMominal CT, angiography and laparotomy showed involvement of portal vein with thrombus and there were no evidences of neoplastic disease, The screening tests for hypercoagulable states were normal. The patient was treated with portal vein thrombectomy and anticoagulation therapy. We report this case with brief review of literature.