장기이식의 발전

서보양 영남대학교 의과대학 1990 Yeungnam University Journal of Medicine Vol.7 No.2

말초 동맥질환의 최신경향

서보양 대한순환기학회 1999 Korean Circulation Journal Vol.29 No.4

만성 하지 허혈성 질환의 임상분석

서보양,권우형,오준협,권굉보 대한혈관외과학회 1999 Vascular Specialist International Vol.15 No.2

Purpose & Method: To evaluate clinical pattern and operative outcome of the ischemic lower extremity, 142 patients who were admitted to Yeungnam University Hospital between January 1996 to December 1998 were analyzed. Results: The patients were 125 males and 17 females ranging from 21 to 88 years of age. The mean age was 59, with the highest incidence among people in their 60s, followed by those in their 70s and then in their 50s. The causes of arterial occlusive disease were artherosclerotic obliterans (ASO) in 87 cases (61.2%), thromboangitis obliterans (TAO) in 44 cases (30.9%), thromboembolism in 10 cases and superficial femoral aneurysm in 1 case. Associated diseases in ASO were hypertension in 37 cases (42.5%), diabetes mellitus in 17 cases (30.9%), cardiac disease in 24 cases (27.5%) and cerebrovascular disease in 7 cases (8.0%). History of smoking was noted in 77.4% of the cases. The major arterial occlusive site of ASO were femoral artery in 36 cases (41.3%), aortoiliac artery in 26 cases (29.8%), iliofemoral artery in 9 cases (10.3%), popliteal artery in 5 cases (5.7%), tibial artery in 6 cases (6.8%) and multi-level occlusion in 5 cases (5,7%). The major arterial occlusive site of TAO were tibial artery in 35 cases (79.5%), pedal artery in 8 cases (18.1%) and popliteal artery in 1 case. According to the Fontaine classification of clinical symptoms, the distribution was as follows: Grade 0 0 case, Grade I 48 cases (33.8%), Grade II 46 cases (32.3%) and Grade III 48 cases (33.8%). The operative procedures of arterial occlusive disease were bypass graft operation in 72 cases, thromboembolectomy in 12 cases, endarterectomy in 2 cases and percutaneous transluminal angioplasty (PTA) was performed in 9 cases. Arterial bypass operation with autogenous or artificial prosthesis were done in 72 cases, which included aortobifemoral or aortobipopliteal bypass in 12 cases, iliofemoral bypass in 5 cases, femoropopliteal bypass in 26 cases, femorotibial bypass in 5 cases, popliteotibial bypass in 8 cases. axillobifemoral bypass in 4 cases and femorofemoral bypass in 12 cases. In over 90% of the operative cases, the early outcome was good with 3+ to 2+ rating according to Rutherford criteria. Mortality for 114 cases was 2.6% (3 cases), including 2 resulting from associated cardiac condition and 1 resulting from ARDS. Conclusion: Strategies for successful revascularization and long term patency may be made by consideration of the extent of diseases, associated diseases, clinical symptoms and status of distal perfusion.

심부 정맥 혈전의 진단에 있어 비침습성 검사의 타당성

서보양,노진우,권굉보 대한혈관외과학회 1991 Vascular Specialist International Vol.7 No.1

Unreliability of clinical diagnosis of deep vein thrombosis(DVT) led to wide use of venography for confirmation of diagnosis. However venography is invasive, expensive, and time consumming. Also it may cause a few untoward side reactions, such as superficial phlebitis, drug sensitivities, and etc. Therefore recently several noninvasive diagnostic modalities have been introduced in clinical practice. The purpose of this study is to validate such noninvasive tests by comparison of their results with the one of venography. Three noninvasive diagnostic tests-Doppler ultrasound, impedance plethysmography(IPG), and duplex ultrasonography and venography were performed for 40 patinets in whom DVT was suspected clinically. We compared the results of venogram with findings of noninvasive tests. The results are as follows. Doppler ultrasound was done in the 18 patients. The sensitivity was 77.8% and positive predictability was 100%. IPG was done in the 17 patients. The sensitivity, specificity, and positive predictability were 91.7%, 50,0%, and 84.6%. Duplex scan was done to the 18 patients. The sensitivity, specificity, and positive predictability were 91.7%, 83.3%, and 91.7%. Compared with IPG, duplex scan showed much higher specificity and positive predictability but same sensitivity. Therefore, if IPG and duplex scan are done together, the sensitivity and specificity were much higher than each modality alone. We concluded that the use of IPG and duplex ultrasonography together in same time will increase diagnostic reliability and replace venography in the diagnosis of deep vein thrombosis.

만성동맥폐색증 환자에 대한 PGI₂ 유도체 Beraprost sodium(TRK-100)의 임상효과

서보양,권굉보,권태원,김석구 대한외과학회 1997 대한외과학회 학술대회 초록집 Vol.1997 No.11

만성동맥폐색증 환자에 대한 PGI₂유도체 Beraprost Sodium (TRK-100)의 임상효과

서보양,김석구,권굉보,권태원 대한혈관외과학회 1997 Vascular Specialist International Vol.13 No.2

The main object of treatment in chronic occlusive arterial disease is to increase blood flow for ischemic limb. In case of severe symptoms and signs such as rest pain, ischemic ulcer and gangrene with poor angiographic distal run-off, conservative medical treatment is recommended. Beraprost sodium(TRK-100) is the oral preparation of a prostaglandin I₂,that has known to increase blood flow, prevent secondary thrombi formation, suppress platelet aggregation,increase oxygen perfusion pressure, increase deformability of erythrocyte, and protect endothelial cell from ischemia and inflammation. From September 1995 to January 1997, 23 patients among 42 patients with severe ischemic ulcer and poor angiographic distal run-off underwent Beraprost oral treatment in the Department of Surgery, Ulsan-chungang and Yeungnam University Hospital: Buerger's disease(TAO) in 14 and arteriosclerosis obliterans(ASO) in 9 cases. Daily dose was 120 μg(6 tablets #3) and medicated for consecutive 6 weeks. To detect the changes of symptoms, signs & ischemic ulcer size and occurrence of side reactions, inquiries, photography and laboratory tests were checked at prior to medication and 2, 4 & 6 weeks after medication. The results wete as follows. There were 21 men and 2 women, ranging in age from 23 to 77 years old with mean of 44 years old and in body weight from 43 to 75kg with mean of 61kg. Forteen cases(60.9%) were improved but 2 cases(6.2%) were aggravated on rest pain and coldness. Improval rate on ischemic ulcer & granulation size was 70%(16 cases) and 82.6%(19 cases) respectively. There noted infection in 7 cases(30.4%). Overall improval rates were 70.0%(16 cases), general safety rates were 95.7%(22 cases), and usefulness of the drug was shown in 16 cases(70.0%). One case(3.2%) of indigestion was reported as side reaction. There noted no significant hematologic, urinary or biochemical abnormalities. In conclusion, Beraprost treatment for severe ischemic limb had a beneficial effect on relieving pain and ulcer healing and proved safety in its use.

동맥 재협차그이 외과적 처지

서보양 대한혈관외과학회 1999 Vascular Specialist International Vol.15 No.2

The number of procedures performed annually for occlusive vascular disease continues to increase. Currently, approximately 500,000 patients undergo reconstructive vascular surgery each year; half of these procedures are coronary bypass procedures and the remainder include various operations on the peripheral vascular tree. These peripheral interventions encompass a wide assortment of procedures including autogenous and prosthetic bypass grafts, endarterectomies, and a variety of new endovascular procedures. Most established vascular procedures, as well as the new technologies and applications, have proven both technically feasible and safe. The value of any surgical procedure must be measured not only by the success by which it can be initially performed but also in terms of the durability of the results. Although in-hospital success rates are excellent, the long-term durability of most of these procedures has been disappointing. Furthermore, the common culprit accounting for much of the poor long-term success rate of these procedures is intimal hyperplasia. Clearly this process is a significant cause of morbidity in patients undergoing procedures on the vascular system, and investgations into methods to prevent or reverse this process are of great importance. Author evaluates incidence, cause and treatment procedures to correct restenosis and analyzes the results of these procedures in the fields of restenosis after peripheral bypass, carotid endarterectomy and endovascular surgery.

만성폐쇄성 동맥질환의 치료예 Opalmon의 효과

서보양 대한혈관외과학회 1996 Vascular Specialist International Vol.12 No.2

Cycloheximade 投與가 膵藏外分泌細胞의 分泌機構에 미치는 影響에 關한 超微形態學的 硏究

서보양,손윤경,김용진,김중길,곽정식,손태중 慶北大學校 醫科大學 1983 慶北醫大誌 Vol.24 No.2

저자들은 분비 항진시에 있어서 cycloheximide 투여가 췌장외분비 세포의 분비기구에 어떠한 영향을 미치는가를 알아보기 위하여 Splague-Dawley종 흰쥐에 pilocarpine 단독투여, pilocarpine과 cycloheximide의 병합투여 그리고 cycloheximide 단독투여를 하여 얻은 형태학적 및 생화학적 성적을 요약하면 다음과 같다. 광학현미경적으로는 pilocarpine 단독투여군에 있어서는 pilocarpine 주사 후 1시간째부터 분비과립이 감소하기 시작하여 4시간째에 최고에 달하고 그 후 다시 증가하며 pilocarpine 투여 후 cycloheximide를 투여한 군에서는 cycloheximide 투여 직후부터 분비과립의 재축적은 일어나지 않았다. 그리고 cycloheximide 단독투여군에서는 분비과립에는 별 변동이 없었다. 전자현미경적으로는 pilocarpine 단독투여군에서 분비과립의 감소와 평행하여 Golgi장치 부근에 condensing vacuole의 증가 RER의 수포화 및 배열의 불규칙, lysosome의 증가 등이 일어나고, 분비과립의 재축적과 더불어 condensing vacuole의 감소, RER배열의 공포화 및 층상화가 일어났다. Pilocarpine투여로 분비를 항진시킨 후 cycloheximide를 투여하면 분비과립의 재축적은 거의 볼 수 없고, 이와 동시에 Golgi장치 부근의 condensing vacuole의 감소, 세포선단부에 있어서 다수의 apical vesicle의 출현, RER배열의 불규칙 membrane-bound ribosome의 감소 및 lysosome의 증가 등이 일어났다. Cycloheximide 단독 투여시에는 RER의 공포화 및 단절. ribosome의 탈락, free ribosome의 증가, Golgi장치에 있어서 공포성분의 증가, lysosome의 증가 및 mitochondria의 종창등이 경하게 일어났다. 혈중의 amylase치는 pilocarpine 단독 투여군에서는 세포내의 분비과립의 숫적증감과 반비례하였으며, pilocarpine 투여후 cycloheximide를 투여한 군에서는 감소를, cycloheximide 단독투여군에서는 pilocarpine과 cycloheximide 병합투여시와 같이 감소를 나타내었다. 이상의 연구성적으로 보아 분비물의 배출항진에 수반되는 주된 형태학적 변화는 분비과립의 감소이고, 분비과립 형성의 촉진에 동반되는 형태학적 변화는 Golgi체에 있어서의 condensing vacuole의 증가, Golgi lamellae의 condensing vacuole로의 이행의 증가등이고 cycloheximide로서 분비물의 합성을 억제한 경우에는 정상인 condensing vacuole 대신에 부전형 (abortive form)의 분비과립이라 생각되는 apical vesicle의 형성을 볼 수 있는데, 이것은 분비물 합성이 억제되어도 분비과립 생산의 노력이 계속되어 있는 현상이라 생각된다. The author had administered pilocarpine, cycloheximide, and combined both drugs to 40 Splague-Dawley rats in order to investigate the influence of cycloheximide on secretory organelles of pancreatic exocrine cells in the state of enhanced secretory activity. The results obtained by means of morphological and biochemical study were summarized as follows. Light microscopically, in pilocarpine group, secretory granules began to decrease as 1 hour after administration and were most prominent at 4 hours later, and then the granules were restored. In combined pilocarpine-cycloheximide group, restoration ofsecretory granules did not accured after cycloheximide administration. In cycloheximide group, there was no change in secretory granules. Electron microscopically, in pilocarpine group, parallel to decrease of secretory granules, increase of condensing vacuoles near Golgi apparatus, vesiculation and irregularity in arrangement of lysosome appeared. When cycloheximide was administered after enhancing secretory activity by pilocarpine administration, restoration of secretory granules failed to occur. But decrease of condensing vacuoles near Golgi apparatus, appearance of apical vesicles in apical areas, irregularity in arrangement of RER, decrease of membrane-bound ribosomes, and increase of lysosomes occurred. In cycloheximide group observed were; vesiculation and fragmentation of RER, shedding of ribosomes, increase of free ribosomes, vacuolar component of Golgi apparatus, lysosomes, and swelling of mitochondria. Level of serum amylase were inversely proportional to the number of secretory granules in pilocarpine group. The levels were decreased in cycloheximide group along and combined pilocarpine, cycloheximide group. From the above results, it is considered that main morphologic change associated with enhanced excretion of pancreatic exocrine grands is decreased secretory granules, and that changes associated with acceleration of formation of secretory granules are increased condensing vacuoles in Golgi apparatus and increased transforming of Golgi lamellae to condensing vacuoles. When the secretory protein synthesis is suppressed by cycloheximide administration, apical vesicles regarded as abortive form of secretory granules are formed instead of condensing vacuoles. This phenomenon is thought to be an expression of effort to produce granules even in the state of suppressed secretory protein synthesis.

식도·위저부정맥유출혈시의 식도하단위상부절제술 - 10례 보고 -

서보양,황일우 대한소화기학회 1978 대한소화기학회 추계학술대회 Vol.1978 No.-

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