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조완재 대한흉부심장혈관외과학회 1989 Journal of Chest Surgery (J Chest Surg) Vol.22 No.4
During aortic valve surgery, cardioplegic solution is delivered through direct cannulation of both coronary ostia. Since this approach may cause an intimal injury leading to acute dissection or late ostial stenosis, this study was undertaken to evaluate myocardial protective effect of retrograde perfusion of cardioplegia [RCSP <% RRAP] in 18 clinical cases, which were compared with antegrade perfusion of cardioplegia in 27 clinical cases. This study were investigated 1] cease and return of electromechanical activity after cardioplegia infusion 2] the myocardial temperature during operation 3] the aortic cross clamping time and total bypass time 4] frequency of DC shock for defibrillation 5] need for inotropic drugs after operation 6] electrocardiographic evidence of myocardial infarction or ventricular arrhythmia after operation 7] the enzymes activity during preoperative and postoperative period as an evaluation of myocardial ischemic injury and 8] operative mortality rate The combination of retrograde cardioplegia and topical cooling with ice slush yielded promptly hypothermia of myocardium and shorter aortic cross-clamping time compared with antegrade cardioplegia [P < 0.05]. The temperature of the interventricular septum was maintained below 20oC by continuous perfusion or intermittent perfusion of cold blood cardioplegia and other results were no statistically significant difference between the two methods [P >0.05]. This technique provides clear operative field and avoids some serious complications which are caused by coronary ostial cannulation. These results suggested that the retrograde perfusion of cardioplegia is a simple, safe, and effective means of myocardial protection during open heart surgery.
오봉석,조완재,이동준,O, Bong-Seok,Jo, Wan-Jae,Lee, Dong-Jun 대한흉부심장혈관외과학회 1989 Journal of Chest Surgery (J Chest Surg) Vol.22 No.5
This study concerns the late results observed at follow-up[average: 32.5 months] of 23 patients, in whom Patent Ductus Arteriosus with pulmonary hypertension among 55 patients. They were operated from May 1984 to July 1987 in Chonnam University Medical School. There was predominance of woman [2.5:1]. No operative death occurred. All of patients subside preoperative symptoms, but 1 patient diagnosed recannalization of duct at follow-up. Systolic murmur was found over the pulmonary area in 5 patients [22 %], but it may be not related to systolic pulmonary arterial pressure[SPAP]. Also, SPAP were normalized in 74 % of patients and had mild hypertension in 26 % of patients. Although the patients had Patent Ductus Arteriosus with pulmonary hypertension, successful surgical correction was carried out safely in all instance but one, by ligation and facilitated by hypotensive anesthesia.
다발성 늑골골절 및 Flail Chest 환자에서 Judet's strut를 이용한 수술적 고정술 105례
박병순,조완재,오정우,Park, Byeong-Sun,Jo, Wan-Jae,O, Jeong-U 대한흉부심장혈관외과학회 1997 Journal of Chest Surgery (J Chest Surg) Vol.30 No.8
저자들은 1989년 8월부터 1995년 8월까지 흉부외상으로 인한 다발성 늑골골절 및 유동흉이 발생한 105례의 환자에게 Judet's strut를 이용한 늑골고정술로 치험하였다. 전체 환자중 86명이 남성, 19명이 여성이었으며 연령분포는 17세부터 77세로 평균연령은 $48\pm12였다.$ 흉부외상의 원인은 교통사고가 85명(81%)으로 가장 많았다. 평균 늑골골절의 수는 5.5개였으며 환자는 유동흉환자가 72명(64%), 이탈이 심한 다발성 늑골골절이 18명(17.1%), 외상성 흉벽기형이 10명(9.5%), 기타 5명(4.7%) 등이었다. 수술 후 1명이 사망하여 사망율 0.96%를 보였고 총 13명의 환자에서 합병증이 발생하여 12.3%의 발생율을 보였다. 수술후 인공호흡기 치료기간은 평균 $90.5\pm22.6시간,$ 동맥혈 검사상 PO2는 수술전 평균 $62.8\pm9.mmHg에서$ 수술후 평균 $113.0\pm26.3mmHg로$ 개선되었다. 수술 결과 인공호흡기 치료기간 및 입원기간의 단축, 흉부손상에 의한 합병증의 감소등 기존의 치료 방법에 비해 우수함을 알 수 있었다. 또한 본 술식은 누구나 시행할 수 있으며, 향후 흉부손상에 의한 다발성 늑골골절 및 유동흉 환자에서 폐좌상의 정도가 전체 용적의 30% 미만의 경우 치료 \ulcorner일차적으로 고려되어질 수 있는 치료법으로 여겨진다. There were 105 patients with multiple rib fracture or flail chest who had underwent surgical rib fixation using judet's strut from Aug. 1989 to Aug. 1995. They were 86 men and 19 women, and the age distribution was from 17 to 77(mean $48\pm12).$ The most common cause of accident was a traffic accident(81%), The mean number of rib fracture was 5.5 and the distribution of patient were flail chest(72, 64.7%), severe displaced rib Fracture(18, 17.1%), traumatic chest wall deformity(10, 95%) and others(5, 4.7%). The operative mortality was 1 patient(0.96%) and the incidence of postoperative complication were 13 patients(12.3%). The duration of perioperative artificial ventilator therapy was $90.5\pm22.6$ hours. Our method allowed shorter duration of an artificial ventiatin and decreased a functional sequelae. We find this technique to be better than previously published methods, since it provides better stabilization and immobilization of he ribs and thus obviates the need for artificial ventilation and prevents post-traumatic chest deformity.
이윤민,송석환,김동진,조완재 대한수부외과학회 2020 대한수부외과학회지 Vol.25 No.1
Purpose: The purpose of this study was to compare the preoperative magnetic resonance imaging (MRI) findings and intraoperative arthroscopic findings in ulnar impaction syndrome, and to assess the necessity of the arthroscopic evaluation in ulnar shortening osteotomy. Methods: We retrospectively reviewed 46 patients of idiopathic ulnar impaction syndrome, treated by ulnar shortening osteotomy and arthroscopic evaluation, from February 2012 to June 2018. In preoperative MRI and intraoperative arthroscopy, lunate, triquetrum, triangular fibrocartilage complex (TFCC) and lunotriquetral ligament were evaluated. Results: The chance to see the findings of chondromalacia of the lunate and triquetral cartilage in arthroscopy (58% and 2%) was less than the findings of abnormal signal intensity of the lunate and triquetrum in MRI (65% and 22%). The incidence of TFCC lesion in arthroscopy (89%) was almost equal with that of abnormal signal intensity of TFCC in MRI findings (87%). But there were 24 cases (52%) where the prediction of triangular fibrocartilage lesions in MRI was incorrect. In 19 cases (41%), arthroscopic findings were not appropriate with the disease stage of Palmer’s original classification. Conclusion: Although some recent reports say that arthroscopic surgery is not necessary in the treatment of ulnar impaction syndrome, we could confirm the value of arthroscopic evaluation for the identification of ulnocarpal pathologies. We would like to recommend the arthroscopic evaluation of ulnocarpal joint at the same time of the ulnar shortening procedure. 목적: 본 연구는 척골충돌증후군에서 수술 전 MRI 소견과 수술 중 관절경 소견을 비교하고 척골 단축술과 동시에 시행하는 관절경 술식의 효용성을 알아보고자 수행되었다. 방법: 2012년 2월부터 2018년 6월까지 척골 단축술과 동시에 관절경 술식을 시행한 46명의 환자를 대상으로 하였다. 수술 전 자기공명영상검사와 수술 중 관절경에서 월상골, 삼각골, 삼각섬유연골복합체, 월상삼각골간 인대를 평가하였다. 결과: 월상골과 삼각골의 연골연화증은 관절경(60%, 2%)에서 자기공명영상검사(67%, 22%)보다 더 적게 관찰되었다. 24예(52%)에서 수술 전 자기공명영상검사와 수술 중 관절경에서 삼각섬유연골복합체 소견이 일치하지 않았다. 삼각섬유연골복합체의 병변은 관절경(89%)과 자기공명영상검사(87%)가 비슷하게 관찰되었다. 하지만, 19예(41%)에서 관절경 소견이 Palmer의 분류와 일치하지 않는 소견을 보였다. 결론: 최근 보고에서 척골 단축술과 동시에 시행하는 관절경 술식에 대한 논란이 있지만, 관절경 술식은 척수근관절의 병변에 대한 정확한 진단이 가능하여 척골 단축술과 동시에 시행하는 것이 진단과 치료에 보다 도움이 될 것으로 생각된다.