경정맥(經靜脈) 내적(內的) Pacemaker 이식후(移植後) 발생(發生)한 복잡한 감염합병증(感染合?症)의 1치험례(治驗例)

이두연,윤여준,조범구,홍승록,Lee, D.Y.,Yoon, Y.J.,Cho, B.K.,Hong, S.N. 대한흉부심장혈관외과학회 1976 Journal of Chest Surgery (J Chest Surg) Vol.9 No.2

Implantation of a permanent pacemaker is a widely accepted procedure for the patient with complete heart block.As a result of these device, the prognosis for patients with Adams-Stokes syndrome caused by complete A-V block and other cardiac arrhythmia have become much more optimistic. Permanent pacemaker implantation by means of a transvenous approach has made the operative risk much less and the procedure simpler. However, a number of complications have been reported in the literature regarding transvenous endocardial pacemaker implantation during the last a decade. The patient presented in this paper is a 26-year old girl who was implanted with a permanent pacemaker at 14 years of age because of a congenital A-V block. Following first exchange of pulse generator, the electrode (lead) was fractured, so that by the pulse generator, a change to the transvenous technique of implantation was made, After this, there were episodes of recurrent wound infection on three occasions, even though the site of pulse generator implantation was exchanged to the contralateral side of chest wall, massive doses of antibiotics were administered and sensitivity tests for coagulase positive staphylococcal infection were performed. Though there was no definite evidence of blood stream infection by blood culture, we decided not to use the transvenous technique and not to implant the pulse generator in the chest wall because the venous system and the entire anterior chest wall appeared to be diseased or contaminated by virulent pyogenic organisms. Finally this intractable systemic and local wound infection was successfully controlled by myocardial lead implantation via a subxiphoid approach and implantation of the pulse generator far down in the abdominal wall. The causes and routes of recurrent wound infection and possible blood born infection in this particular patient are still obscure. We strongly believe that myocardial pacemaker implantation is much safer than transvenous endocardial pacemaker implantation & myocardial pacemaker implantation is a definite method for controlling such an intractable wound infection. following transvenous pacemaker implantation.

폐(肺)에 발생한 Hamartoma 치험 2예

이두연,윤여준,조범구,홍승록,이옥순,최인준,Lee, D.Y.,Yoon, Y.J.,Cho, B.K.,Hong, S.N.,Rkee, O.S.,Choi, I.J. 대한흉부심장혈관외과학회 1976 Journal of Chest Surgery (J Chest Surg) Vol.9 No.1

Pulmonary hamartoma is often incidental, asymptomatic finding on routine chest roentgenogram. It has been considered a congenital malformation. Since the original description by Albrecht in 1908, it has been classified into two types, a small, fibrocartilaginous mass in adults, and a cystic lobar mass in infants. We experienced two cases of pulmonary hamartoma which proved to be the adult form of hamartoma. One was located in left upper lobe of a 58 year old male patient, the other was located in the perihilar region of the right middle lobe of a 38 year old male patient. The former case was treated by wedge resection: the latter by right middle lobectomy and the postoperative courses of both cases were very good and without complication.

폐 Aspergillosis - 9예 보고 -

조규석,이두연,조범구,홍승록,Cho, K.S.,Lee, D.Y.,Cho, B.K.,Hong, S.N. 대한흉부심장혈관외과학회 1976 Journal of Chest Surgery (J Chest Surg) Vol.9 No.1

Pulmonary aspergillosis is a rare disease, mostly commonly presenting as secondary invasion of pre-existing cavitary disease. In severance hospital, 9 patients have recognized as having this disorders in the 16 years from 1960 to April, 1976. The diagnosis of the aspergillosis has been made by examination of tissues removed at surgery in severance hospital, all the cases of aspergillosis except one (a Lt upper lobectomy due to bronchiectasis, performed 20 years ago) the case had been diagnosed as pulmonary tuberculosis and treated with anti-tuberculosis drugs for periods ranging from 2 to 14 years the most common presenting symptoms were hemoptysis, blood-tinged sputum and cough for a long time. All of the cases were confirmed by pathological examination to be aspergillosis superimposed on underlying tuberculosis and/or bronchiectasis three cases were suspected clinically by fungus cultures, seven cases were confirmed as aspergillosis, after surgery. One patient died following surgery because of bleeding and pulmonary insufficiency.

신경섬유종 (Neurofibroma) 환자에서 발생한 악성 Schwannoma -3예 보고-

김훈,이두연,조범구,흥승록,김성규,조남훈,Kim, H.,Lee, D.Y.,Cho, B.K.,Hong, S.N.,Kim, S.K.,Cho, N.H. 대한흉부심장혈관외과학회 1988 Journal of Chest Surgery (J Chest Surg) Vol.21 No.6

We experienced 1 year old female patient with partial anomalous pulmonary venous return of the right lung into the inferior vena cava with atrial septal defect. Total anomalous venous drainage from the right lung is an uncommon form of congenital defect, and it may or may not be associated with an atrial septal defect. One patient having this venous anomaly is presented with a detailed description of the surgical reconstruction used. The postoperative result has been satisfactory.

식도에 발생한 원발성 Small Cell Carcinoma - 보고 -

박찬일(C I Park),김충배(C B Kim),최일섭(I S Choi),홍인철(I C Hong),김주항(J H Kim),이두연(D Y Lee) 대한소화기학회 1986 대한소화기학회지 Vol.18 No.1

The primary small cell carcinoma of the esophagus is very rare malignant disease. McKeown described if first 2 cases at 1952 and about 70 cases were reported thereafter. This tumor is indistinguishable clinically from the squamous cell carcinoma but it is more aggressive than that. It is easily diagnosed with the light microscope and the pulmonary lesion should be ruled out. And it is confirmed by detection of neurosecretory granule under the electron microscope or cytoplasmic argyrophilia with the Grimelius stain. The choice of treatment is the chemotherapy but the surgery or radiationtherapy is indicated in bulky tumor. The prognosis is extremely poor and the most cases were not survived 1 year. We experienced a case of primary small cell carcinoma of the esophagus at Severance Hospital Yonsei University College of Medicine.

생리적 심박동기 이식 치험 : VDD : 2예 VDD Type, a Report of 2 Cases

이두연,김원파,김혜승,이우형 梨花女子大學校 醫科大學 醫科學硏究所 1985 EMJ (Ewha medical journal) Vol.8 No.1

The implantation of pacemaker will be necessary in not only complete heart block after cardiac operation, but also sick sinus syndrome and a variable con-duction disturbancs. We had had so many experiences of single chamger pacemaker(VOO, VVI etc) implantation in patients with complete heart block. But single chamber ventricul-ar pacemaker had some problems because only ventricular pacemaker could not use normal sinus rhythm. Recently, we have tried to use the ventricular pacing system to a dual chamger pacing system in the patient with heart block. So many papers pointed that the decrease in cardiac out put of 15 to 25% with VVI pacing as compared with the normal sinus rhythm. We have experienced one 10 years old boy who had a sin-gle atrium had developed complete heart block after patch repair of atrial septal defect, and another 49 years old male patient who was suffered from frequent syn-cope with bradycardia. The first boy was taken VDD dual chamber pacemaker implantation through left subclavian vein puncture method on 14 days after open heart surgery because he had normal regular P-wave. And the second male patient was taken DDD typed dual chamger pacemaker im-plantation through left subclavian vein puncture and the DDD typed pacemaker was transformed to VDD pacemaker, also because he had normal regular P wave,too. Their postoperative couse was in uneventful and were discharged without complication. Their conduction have been in good to now.