흉부손상에 병발한 급성호흡부전증 -2예 보고-

왕영필,이홍균,Wang, Young Pil,Lee, Hong Kyun 대한흉부심장혈관외과학회 1976 Journal of Chest Surgery (J Chest Surg) Vol.9 No.2

Acute respiratory failure has become an increasingly frequent cause of death following shock or trauma. Interstitial or diffuse alveolar edema, as chief pathophysiologic change of acute respiratory insufficiency, can be the result of sepsis, fat embolism, cardiac failure, lung congestion, and oxygen toxicity. These pulmonary problems are extremely difficult to treat without early recognition of their development and aggressive management. If the treatment is delayed, the progressive respiratory failure is almost uniformly fatal. Authors have experienced two cases of acute respiratory insufficiency following the blunt chest trauma, which were healed uneventfully. Literatures were briefly reviewed.

양성 폐종양의 수술적 치료

박건,조덕곤,박재길,조건현,왕영필,곽문섭,김세화,이홍균,Park, Kuhn,Cho, Deog-Gon,Park, Jae-Kill,Jo, Geon-Hyon,Wang, Young-Pil,Kwack, Moon-Sub,Kim, Se-Wha,Lee, Hong-Kyun 대한흉부심장혈관외과학회 1992 Journal of Chest Surgery (J Chest Surg) Vol.25 No.3

Benign lung tumors have been considered as relatively rare disease, which comprise approximately 8 to 15% of all solitary pulmonary lesions that are detected radiographically. We clinically analized 30 cases of benign lung tumors underwent the operation from Jan. 1970 to Aug.1991 in the department of thoracic and cardiovascular surgery, Catholic University Medical College. We adopted the classification presented by the World Health Organization[WHO], modified from Liebow, and added benign mesothelioma. There were 11 males & 19 females ranging in age from 2 years to 68 years old % the mean age was 38 years old. Of all 30 benign lung tumors, hamartomas [14 cases, 49%] were the most common & followed by hemangiomas [9 cases, 30%], 3 cases of benign mesotheliomas % a case of teratoma, papilloma, arteriovenous malformation and inflammatory pseudotumor. 14 cases of tumors were asymptomatic & were incidentally detected by plane chest x-ray In other cases, chief complaints at admission were coughing, chest discomfort, dyspnea, hemoptysis, and fever. Diagnosis were made by pathological examination; exploratory thoracotomy in 23 patients[76.7%], bronchoscopy in 4 patients and percutaneous needle aspiration biopsy in 3 patients. Precisely, preoperative diagnosis for confirmation of benign lung tumor was made only in 7 cases[23.6%]. Tumors were located on Rt.side[24 cases], especially Rt. middle lobe, and Lt.side[6 cases]. Operation methods were as follows: 21 cases [70%] of lobectomy, 2 cases of segmentectomy, 2 cases of wedge resection, 1 case of pneumonectomy, 1 case of bronchotomy, 2 cases of wedge resection, 1 case of pneumonectomy, 1 case of bronchotomy removal of the endobronchial hamartoma which located at the rt. main stem bronchus and 3 cases of complete resection in benign mesotheliomas. There were no operative death. The post operative complications were developed in 3 cases; post pneumonectomy empyema, wound infection and atelectasis. In conclusion, benign lung tumors must be histologically diagnosed to confirm of benignity and to provide limited resection for preservation of the lung tissue, whenever possible.

중증 폐기종 환자에서의 폐용적 감축술, 7례

진웅,이선희,김시훈,왕영필,조규도,박재길,곽문섭,김세화,Jin, Ung,Lee, Sun-Hee,Kim, Si-Hoon,Wang, Young-Pil,Cho, Kyu-Do,Park, Jae-Kil,Kwak, Moon-Sub,Kim, Se-Wha 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery (J Chest Surg) Vol.32 No.6

배경: 폐용적 감축술은 말기 폐기종환자의 치료에 폐장이식의 대치술 혹은 전단계 시술로 최근 이용되고 있는 술식이다. 또한 심한 폐기종환자에서 종양이 동반되는 경우, 종양절제술과 동반하여 사용될 수 있을 것으로 생각된다. 저자들은 폐종양 절제술을 동시 시행한 2례를 포함하여 7례의 폐용적 감축술후 평균 21개월간의 추적 관찰 결과를 보고한다. 대상 및 방법: 가톨릭대학교 흉부외과에서는 1996년 7월부터 1997년6월까지 수술당시 폐 종양이 의심되었던 환자 2례를 포함하여 만성폐기종환자 7명에서 폐용적 감축술을 시행하였다. 술후 검사는 3개월, 6개월, 1년, 2년에 각각 시행하였으며 현재까지 평균 21개월의 추적관찰을 시행하였다. 결과: 술후 사망은 술후 13개월에 뇌 전이를 동반한 평편상피암이 좌상엽에서 발견된 환자 1례에서 있었다. 나머지 6례의 환자는 평균 21개월의 추적관찰 중으로 현재까지 양호한 경과를 보이고 있다. 결론: 폐용적 감축술은 심한 폐기종환자의 치료에 유용하며 앞으로 적절한 적응증이 확인되고 장기성적이 보고되는 등의 계속적인 연구 결과가 필요한 것으로 생각된다. 또 폐 기능의 여유가 없는 폐기종환자의 초기 폐종양치료에 술후 폐 기능의 개선을 위하여 종양절제술과 동시에 폐용적 감축술을 시행할 수 있을 것으로 생각된다. Background: These days, lung volume reduction surgery (LVRS) is used as an alternative or a bridge operation to lung transplantation in treating patients with severe emphysema. The procedure can be used in patients with pulmonary nodules combined with severe emphysema. We report the results of 21 months follow up after lung volume reduction surgery in 7 cases including 2 cases of concurrent resection of pulmonary nodules. Material and Method: Seven patients with emphysema, including 2 cases of preoperatively suspected lung cancer were operated with LVRS technique between July 1996 and June 1997. Result: Postoperative mortality was observed in a case of squamous cell carcinoma in LUL with brain metastasis, detected at postoperative 13months. Average of 21months(19-25months) follow up was done for other cases without specific events. Conclusion: LVRS is a useful operation in the treatment of patients with severe emphysema, but further evaluation should be done about the long term results and precise criteria for patient selection. Simultaneous LVRS and tumor resection could be done in patients with emphysema with marginal reserve in the hope of maximizing postoperative lung functions.

의인성 하인두-식도천공에 대한 외과적 고찰

박재길,조규도,박건,왕영필,Park Jae Kil,Cho Kyu Do,Park Kuhn,Wang Young Pil 대한기관식도과학회 2004 大韓氣管食道科學會誌 Vol.10 No.2

Background : Esophageal perforation due to a traumatic endoscopy or intubation is exceedingly rare. If riot noticed immediately or treated promptly, however, the morbidity and mortality is significant. We performed a retrospective review of patients with iatrogenic hypopharyngo-esophageal perforation to assess the outcome of current management techniques. Material and Methods : We retrospectively analyzed all cases iatrogenic hypopharyngo-esophageal perforation diagnosed at our hospital from January, 1999, through April, 2004. The study group consisted of 11 patients (4 men) with a mean age of 47.6 years (range, 21-83 yr). We reviewed the 11 patients with perforated injuries of the hypopharynx or esophagus during the diagnostic or therapeutic procedures. Result: Perforations were due to diagnostic gastroscopy ($54.5\%$, 6/11), esophageal dilation ($27.3\%$, 3/11), endoscopic port insertion ($9.1\%$, l/11), and tracheal intrathoracic ($9.1\%$, 1/11). Seven patients had intrathoracic and 4 had cervical perforations. Treatment included incision and drainage (5), resection and reconstruction (4), drainage only (1), and observation (2). Nonfatal complications included transient pneumonia (1), and wound infection (1). They occurred in advanced mediastinal abscess ]patients. Mortality was $9.1\%$ (1/11) in old patient who managed medically in cervical esophageal perforation. Conclusions : Current mortality rates in iatrogenic esophageal perforation were improved compared to previous published rates of $19\%\;to\;66\%$ for all patients with this condition. We concluded that aggressive and definitive surgery for thoracic esophageal perforations improving the survival rate, whether diagnosed early or late.

양성 기관종양에서 치험한 광역학 치료의 근치적 효과

박재길,김재준,송정섭,왕영필,Park, Jae-Kil,Kim, Jae-Jun,Song, Jeong-Sup,Wang, Young-Pil 대한기관식도과학회 2009 大韓氣管食道科學會誌 Vol.15 No.1

The photodynamic therapy (PDT) is a new treatment modality of destroying malignant tumors and pre-malignant lesions based on the use of photodynamical damage to tumor cells under the photochemical reactions. But the clinical reports of photodynamic application on the benign tumor of the internal organs were extremely rare. So we decribed our experience of one case of benign tracheal tumor successfully treated by PDT.

St.Jude 기계판막을 이용한 인공심장판막 치환의 외과적 고찰

진웅,나석주,조규도,김치경,조건현,왕영필,이선희,곽문섭,김세화,이홍균,Jin, Ung,Rha, Suk-Joo,Cho, Kyu-Do,Kim, Chi-Kyung,Jo, Keon-Hyon,Wang, Young-Pil,Lee, Sun-Hee,Kwak, Moon-Sub,Kim, Se-Wha,Lee, Hong-Kyun 대한흉부심장혈관외과학회 1994 Journal of Chest Surgery (J Chest Surg) Vol.27 No.4

Total 400 St.Jude Medical Bileaflet Valves were implanted in 336 pts from January 1983 to June 1993; 64 were aortic, 205 were mitral, 64 were double valve and 3 were tricuspid position. The follow up period extended from 6 months to 10 years[mean 24.3 months]. Male to female ratio was 1:1.7. There were total 27 deaths[cardiac related 20, cardiac non-related 7]. Overall mortality was 2.9%/pt-yr. There were 10 early deaths[3.0%] and 10 late cardiac related deaths [3.0%]. Prosthetic valve related complications occurred in 19 patients[5.7%] and among them, seven died; four died of thromboembolic events, two died of anticoagulants therapy related hemorrhagic complications and one died of bacterial endocarditis. NYHA class improved significantly especially in aortic valve replacement and double valve replacement. In AVR cases, the mean NYHA was 2.8 preoperatively and 1.3 postoperatively. And in DVR cases, 3.3 preoperatively and 2.2 postoperatively. The decision to employ a particular prosthesis was made according to the anticipated or known complications of the valve. The St.Jude Medical Valve retains all the hazards of other mechanical valves, most notably, thromboembolism. But the hemodynamic performance of St.Jude Medical Valve compared most favorably with other substitute valves in many reports. 0ur experience didn`t show any differences compared other authors in terms of valve related complication. So we concluded St. Jude Medical Valve can be primarily considered in the selection of artificial valve except in the patients when the usage of anticoagulant therapy is contraindicated.

Tc-99m Pertechnetate / TI-201 감영 신티그라피에서 부갑상선 선종으로 오인된 흉선종 1 예

정용안(Yong An Chung),유이령(Ie Ryung Yoo),김성훈(Seong Jang Kim),정수교(Soo Kyo Chung),왕영필(Young Pil Wang),정지한(Ji Han Jung),이교영(Kyo Young Lee),김병기(Byung Kee Kim) 대한핵의학회 2001 핵의학 분자영상 Vol.35 No.4

A large superior mediastinal mass was found incidentally by ultrasonography in a 60-year-old man. There was an abnormal accumulation of Tl-201 in the lower pole of left thyroid gland, extending into left superior mediastinum on Tc-99m pertechnetate/Tl-201 subtraction scan. Laboratory findings relating thyroid and parathyroid were all within normal range. We considered the mass as a non-functioning parathyroid adenoma tentatively. However, subsequent surgery and pathologic examination revealed the mass to be a benign mixed thymoma. We report a case of patient with thymoma showing unusual Tc-99m pertechnetate/Tl-201 subtraction imaging and laboratory findings, and suggest to consider the possibility of other mediastinal tumors rather than parathyroid adenoma. (Korean J Nucl Med 2001;35:274-279)

전신 저온법에서 체온저하에 따르는 혈액학적 변동 및 Heparin 적정량에 관한 실험적 연구

왕영필,이홍균 최신의학사 1982 最新醫學 Vol.25 No.7

성인에서 폐결핵으로 오인된 선천성 기관지낭종

왕영필,박재길,박희철,김세화 최신의학사 1983 最新醫學 Vol.26 No.3

심막낭종 : 2예 보고 Report of 2 cases

김세화,왕영필 최신의학사 1983 最新醫學 Vol.26 No.3