신이식환자에서 발생한 복부대동맥류에 의한 상장간막동맥증후군

김용귀(Yong Gui Kim),김지일(Ji Il Kim),박정일(Jung Il Park),문인성(In Sung Moon),박장상(Jang Sang Park),김승남(Seung Nam Kim),고용복(Yong Bok Koh) 대한외과학회 2000 Annals of Surgical Treatment and Research(ASRT) Vol.59 No.3

흰쥐에서 간의 허혈-재관류 손상에 대한 Tacrolimus와 Prostaglandin E1의 보호효과

김동구(Dong Goo Kim),김용귀(Yong Gui Kim),정은선(Eun Sun Chung) 대한외과학회 1999 Annals of Surgical Treatment and Research Vol.57 No.4

수지 괴사를 동반한 과호산구증후군 1예

김재철(Jae Cheol Kim),이상권(Sang Kuon Lee),김용귀(Yong Gui Kim),문인성(In Sung Moon),김승남(Seung Nam Kim),고용복(Yong Bok Koh) 대한외과학회 2000 Annals of Surgical Treatment and Research Vol.58 No.5

무산소화 및 재산소화가 제대정맥 내피세포의 일산화질소 , ICAM-1 및 VCAM 생성에 미치는 영향

김승남,이도상,원종만,박장상,김용귀,고용복 대한혈관외과학회 2000 Vascular Specialist International Vol.16 No.1

Purpose: The reperfusion flowing ischemia are associated with high systemic complication rates and severe local tissue injuries, which are primarily related to the reperfusion process. Anoxia or hypoxia and reoxygenation are principal components of ischemia and reperfusion (I/R) and in I/R injury model endothelial cell injury is known to be a initial event. The purpose of this study is to examine the changes of the levels of nitric oxide (NO), intercellular adhesion molecule-1 gCAM-1) and vascular cell adhesion molecule (VCAM) of the cultured endothelial cells following anoxia and reoxygenation. Methods: Experimental groups were divided into 4 groups: control group, without any treatment; anoxia group (A-G), treatment with anoxic air (93% N, 5% CO₂, 2% H₂) for 20 minutes; reoxygenation group (RO-G), treatment with 100% Oy for 90 minutes; superoxide dismutase (SOD) group, treatment with SOD just before reoxygenation. Endothelial cells were isolated from human utnbilical vein and cultured in M-199 medium. Using micmelectrode and ELISA we studied the time-course changes of the levels of NO, ICAM-1 and VCAM of 4 groups, Results: The concentration of NO in A-0 was lower than that of control group (P $lt;0.05). NO concentration of RO-G at 30 minutes reached the highest level of 4809.01±444.69 nM/1×10^5 cells/ml (P$lt;0.005) and after then decreased. The concentration of ICAM-1 in A-G was higher than that of control group (P $lt;0.005). ICAM-1 concentration of RO-6 at 15 minutes reached the highest level of 7.18±0.62 ng/1×10^5 cells/ml (P $lt;0.005) and then decreased to the 1owest level but after 75 minutes increased again. The concentration of VCAM in A-G was higher than control group (P$lt;0.005). VCAM eoncentration of RO-G at 15 minutes reached the highest level of 5.50±0.55 ng/1×10 cells/ml (P$lt;0.05) and then decreased to the lowest level at 45 minutes, but after 60 minutes the concentration increased again. SOD group showed a little change of NO, ICAM-1 and VCAM concentration comparing with both A-G and RO-G. Conclusion: This study showed that endothelial cell function of reoxygenation group decreased significantly compared with anoxia group. In anoxia and reogygenation group, the levels of two adhesion molecules of ICAM-1 and VCAM increased faster than those of NO and the change of the level of ICAM-1 was mare sensitive than that of VCAM. In reoxygenation group SOD treatment could inhibit the changes of the levels of NO, ICAM-1 and VCAM.

죽상동맥경화성 하지동맥 폐쇄환자에서 추적혈관조영술을 통한 장골동맥의 변화에 대한 고찰

김승남,박중현,문인성,박장상,김용귀,고용복 대한혈관외과학회 2000 Vascular Specialist International Vol.16 No.1

Purpose: In the initiation and progression of the atherosclerosis many factors are related each other. The individual variations also complicate the prediction of the atherosclerotic process. The purpose of this study was to investigate the morphologic changes by angiography in iliac arterial segments of the patients who had received bypass operation for the infrainguinal atherosclerotic occlusive disease of the lower extremities. Methods: Forty-five common iliac artery (CIAs) and forty-two external iliac arteries (EIAs) in twenty nine male patients who underwent angiography for graft failure of lower extremity bypass surgery was included in this retrospective study, and their clinical chart and angiographic findings of iliac arteries were reviewed. Acute arterial occlusive cases were excluded from this study. The mean interval from the previous bypass surgery was 38.9 months (from 6 to 96 months) and the patient ages ranged from 34 to 81 years (average age 59 years). It was considered as change, that is disease progression, when luminal narrowing of iliac artery was more than 25% compared to the previous angiography at bypass surgery. Results: Of 45, fifteen CIAs (33.3%) showed change. In 3 patients, the change was bilateral; in 4, ipsilateral to the failed graft limb; and in 5, contralateral. Considering EIAs, 13 of QZ (31.0%) were changed. In 1 patient, the change was bilateral; in 6, ipsilateral to the failed graft limb; and in 5, contralateral. Therefore the side of the changed iliac arteries had no statistical significance in relation to the side of limb at which graft failure occurred (P $lt; 0.05). There was no significant correlation between age or interval between bypass operation and repeat angiography and the progression of atherosclerosis of iliac arteries. Conclusion: The progression of atherosclerosis is not dominated in iliac arteries ipsilateral to the side in which bypass surgery was performed and graft failure occurred. Ire iliac artery, the short-terns progression of atherosclerosis observed by angiography may vary among individuals independently withage, interval between operation and repeat angiography, and the hemodynamic change of the infrainguinal arteries.

위험하지허혈환자에서 슬관절하부 하지절단술의 후향적 고찰

김승남,문인성,박장상,고용복,김용귀,선숙래 대한혈관외과학회 1999 Vascular Specialist International Vol.15 No.2

한국 정상인과 제2형 당뇨병 환자에서 췌도베타세포의 정량

김병기,이광우,이정민,문인성,김용귀,이교영,손호영,차봉연,강무일,윤건호,강성구,고승현,김성래,서선희,김동구,이명덕,강찬석 대한당뇨병학회 2000 Diabetes and Metabolism Journal Vol.24 No.5

Background: There have been several reports about insulin secretory impairment in non-obese type 2 diabetic patients and even in impaired glucose tolerant subjects in Korea. Insulin secretory impairment might be induced by insufficient beta-cell mass, functional defects of beta-cells or both. To clarify the cause of impaired insulin secretion in type 2 non-obese diabetic patients in Korea, betacell masses were quantified in normal and type 2 diabetic subjects. Method: Normal pancreases were procured by 6 heart-beating non-diabetic donors under informed consent from relatives and approval of the university ethical committee. To quantify the beta cell mass and insulin content in various part of the pancreas, first we divided it into 3 parts: head, body and tail, and then each three parts were weighed and subdivided again into 8 segments equally. For diabetic patients, tissue sections were obtained from 15 partial or total pancreatectomized type 2 diabetic patients of any causes. After being fixed, tissues were immunostained using the Streptavidin-biotin-peroxidase method with anti-insulin antibody. Beta cells were counted by point count method. Results: The mean value of total pancreas weight of normal subjects (n=b) was 77.1±14.6 g, that of mean relative volume of beta cells in the pancreas was 2.1±0.9%, ranging from 1.4% to 3.1%(head 2.3±0.6%, body 1.8±0.2%, tail 2.2±0.4%). Mean value of total beta cell mass which was calculated from relative volume of beta-cells and weight of each portions was 1.3±0.3 g, ranging from 1.2 g to 1.9 g (head 0.6±0.3 g, body 0.4±0.2 g, tail 0.4±0.2 g). Mean insulin content per pancreas was 63.6±46.6 ㎍, ranging from 27.8 to 137.2 ㎍/pancreas (head 25.1±19.1 ㎍, body 20.8±15.5 ㎍, tail 17.7±14.9 ㎍). In diabetic patients, relative volume of beta cells in tissues were variable from 0.4% to 2.8% and there was good correlation between beta-cell mass and body mass index of the diabetic patients. However we can't find the correlation among relative volume of beta-cell, (r²=0.55, p$lt;0.05) duration of diabetes and age. Remarkable heterogeneity for loss of beta-cells in the islets of diabetic patients was observed even in the same lobe of pancreas. There were no evidence of lymphocytic infiltration in the islets. Conclusion: Insufficient beta cell mass seems to be a main cause for insulin secretory impairment in non-obese type 2 diabetic patients in Korea.

하지동맥의 죽상경화증폐색환자에서 혈중 지질농도와 흡연태도의 후향적 관찰

김기환,문인성,고용복,김용귀 대한혈관외과학회 1998 Vascular Specialist International Vol.14 No.1

Many investigations about the development and progression of atherosclerosis have reported that hypertension, diabetes mellitus, serum lipids levels and somking status are major risk factors to the atherogenesis of peripheral arteries in Western countries. But the intensities of these epidemiological factors on atherogenesis are not supposed to be equal in oriental population owing to the different pattern of food intake or genetic factors. The aim of this study was to determine how the level of serum lipids and smoking status among the risk factors would be related with the presence of the atherosclerotic occlusive disease of lower extremity. 89 male patients with this disease were included in this study and same numbers of male surgical patients without peripheral arterial occlusive symptoms was used as control group. The levels of serum lipids (total-cholesterol and trglyceride) and smoking status were investigated retrospectively. The results were as follows. 1) serum total-cholesterol levels were higher in disease group than that of the control group (163.3±4.63 S.E. vs. 153.3±6.10 S.E.), but there was no statistical significance(P $gt; 0.05). 2) serum triglyceride levels were significantly higher in disease group than that of control group (148.5±11.0 S.E vs. 109.9±7.59 S.E., P$lt;0.05 ANOVA). 3) the rate of smoking in disease group was 85.4% (76/89) which was significantly higher than that of the control group, 37.1% (33/89) (P $lt;0.05, Chi-square test). These findings suggested that in our disease population studied, smoking has more strong impact on the development of atherosclerosis of lower extremity than serum total-cholesterol level.

장골정맥 압박증후군 4 예 보고

문인성,박장상,김용귀,문석일,고용복 대한혈관외과학회 1998 Vascular Specialist International Vol.14 No.2

Iliac vein compression syndrome is a rare clinical condition in which left common iliac vein is anatomically compressed between right common iliac artery and the fifth lumbar vertebrae or pelvic brim. Patients usually have marked edema of the left leg. Although the actual incidence is unknown, this syndrome most affects women in the second to fourth decade of life. We report 4 cases of iliac compression syndrome treated by surgical intervention during the last fifteen-year period. Among them, two women have suffered from chronic intermittent swelling and pain of left leg, and two men had acute or subacute symptoms. The fibrous web in the entrance of left iliac vein into vena cava existed in one case. Including this one, two were treated by transposition of iliac artery or vein with thrombectomy. One was decompressed the arterial compression by mobilization or adhesiolysis of the surrounding vessles with thrombectomy. To the last one in which the distal common iliac vein was compressed by tortous dilated left internal iliac artery, transsection and ligation of the internal iliac artery was performed. All patients have experienced improved left leg condition after operation. except the last one in which suffered from thrombosis of left popliteal vein after the iliac decompression.

염증성 동맥류 12예의 임상적 고찰

문인성,박장상,고용복,김중연,김용귀 대한혈관외과학회 1997 Vascular Specialist International Vol.13 No.2

Department of Surgery, Catholic University Medical College, Seoul, Korea The optimal management of inflammatory aneurysm is still a matter of controversy, especially in surgical aspect. The disease is a infrequent entity and without surgical intervention, usually lead to uncontrolled sepsis or catastrophic hemorrhage. We report 12 cases of inflammatory aneurysms those admitted and were managed at Kangnam St. Marys hospital during 6 years from April, 1991 through April, 1997. The medical records and dermographical datas of these patients were reviewed. Of these 12 patients, ten were male and three were female in age range from 37 through 80 years with a mean of 60 years. The diagnosis was mainly based on operative findings with aids of radiological and microbiological evidences. The number of location of involved arterial segments were 4 of thoracic aorta, 1 of suprarenal abdominal aorta, and 7 of infrarenal abdominal aorta including 2 of common iliac arteries. The main symptoms of these patients were abdominal or chest pain in 11 according to the location of the involved arterial segments, back pain in 6, fever and chillness in 8. The incidence of suspicious infected microorganisms of the patients, not of the credible direct cause of aneurysm itself, were 3 of Salmonellosis in Widal test, 2 of tuberculosis in AFB or sputum culture, 2 of G(-) bacilli in blood culture, and 1 of syphilis in FFA-ABS . 8 patients were operated by substituting the diseased arterial segments with artificial graft and 4 patients were medically managed. Of the 8 patients operated, one died within 48 hours after operation by sepsis. 7 patients were discharged by ambulation. In the 4 medically treated patients, one expired in hospital and three were discharged hopelessly. 7 patients those discharged after operation has been managed in out-patient department.