복부 자상 환자에 대한 임상적 고찰

한재웅 ( Jae Woong Han ),김병천 ( Byung Chun Kim ),정재필 ( Jae Pil Jung ),조지웅 ( Ji Woong Cho ),정봉화 ( Bong Hwa Chung ),정경석 ( Kyung Suk Chung ),강구현 ( Koo Hyun Kang ) 대한외상학회 2006 大韓外傷學會誌 Vol.19 No.2

Purpose: This study was done to evaluate the incidence, type of injury, medical consequences, mortality, and prognostic factors associated with stab wounds in patients who visited Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea. Methods: A retrospective analysis of the clinical data of 40 patients with abdominal stab wounds who visited Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea from January 1, 2000 to December 31, 2004. Results: 1) The most prevalent age group was patients in their the twenties to fourties (77.5% of all patients), and average age of the patients was 39.3 years. The male-to-female ratio was 2.07:1. 2) The external site of stab wounds was most commonly the periumbilcal area of the abdomen (14 cases, 33.3%). 3) The most commonly injured organs were the liver and the stomach (10 cases each, 16.9%). 4) Operations were performed on all 40 patients, with 9 (22.5%) negative operation findings. 5) Death occurred in 5 cases (12.5%). 6) The trauma indices of the death group were TRISS 51.9%, RTS 3.6 points, and APACHE II 23.0 points. 7) The average transfusion amount of the death group was 13.8 pints Conclusion: These data suggest that the transfusion amount and the trauma index of abdominal stab injuries may be statistically significant factors for predicting mortality. (J Korean Soc Traumatol 2006;19:143-149)

부분 간이식을 시행한 실험견의 이식전후의 혈역동적 변화

조원현,강구정,김형태 啓明大學校 醫科大學 1998 계명의대학술지 Vol.17 No.3

간이식시 나타나는 혈역동적 변화가 piggyback술식을 이용한 부분 간이식시에는 어떤 영상을 보이는지 알아보기 위해 성숙잡견을 이용해서 실험한 결과는 첫째, 평균동맥압, 심박출량, 폐동맥압은 무간기도안에 저하되었다가 재관류후 서서히 회복되는 양상을 보였고, 심박동수나 하대정맥압은 큰 변화를 나타내지 않았다. 전간이식시 흔히 볼수 있는 재관류증후군은 나타나지 않았다. 둘째, 동맥혈 가스분석 결과 동맥혈산소분압 및 탄산가스 분압은 무간기에 관계없이 변화를 보이지 않았으나 칼륨, 칼슘치는 무간가동안에 저하되었다가 재관류후 회복되는 양상을 보였고 심각한 산성화를 동반했다. 그리고 프로트롬빈 시간은 수술증 특별한 변화를 보이지 않았으나 활성 부분 트롬보플라스틴 시간은 무간기이후 연장되었으며 회복속도가 늦었다. 저자들은 이 실험을 통해 하대정맥을 결찰하지 않는 piggyback 술식을 시행하더라도 일시적인 혈역동적 변화를 감수해야 하나 일반적인 처치로 잘 극복할 수 있었고, 간기능과 혈액응고상의 변화를 확인하기 위해서는 여러 가지 혈액웅고인자들에 대한 실험이 필요하리라고 생각되었다. In order to compare the hemodynamic changes that occurred during the conventional whole liver transplantation, we performed piggyback type segmental liver transplantation in 6 adult dogs and monitored hemodynamic changes during the whole operative procedures. During the anhepatic period, only left hepatic vein was clamped but the influx of the inferior vena caval flow was completely preserved. The mean arterial pressure, cardiac output and pulmonary flow were decreased moderately but restored slowly after declamping of the portal vein. But we couldn't observe post-reperfusion syndrome in this procedure. Arterial blood gas analysis showed decreased level of potassium and ionized calcium during the anhepatic period with severe acidosis but slowly corrected after declamping of portal vein. The prolonged aPTT was continued during the operation but should consider the usage of the heparin during the vascular clamp. Therefore, we believe that piggyback procedure seems to minimize the hemodynamic changes during the segmental liver trandplantation. To detect other factors that disturb the coagulation mechanism, coagulation factor study will be necessary.

심부정맥 혈전증

손창용,강구정,조원현,김유사 大韓脈管外科學會 1995 大韓脈管外科學會誌 Vol.11 No.1

심부정맥 혈전증

손창용,김유사,조원현,강구정 대한혈관외과학회 1995 Vascular Specialist International Vol.11 No.1

The deep vein thrombosis(DVT), which can cause chronic venous insufficiency or pulmonary embolism, is a serious medical problem and frequently occurs after prolonged surgery, trauma or underlying malignancy. The recognition and incidence of the DVT have gradually increased recently in our hospital probably because of improved diagnostic methods and changes in the life style. A total of 137 patients with DVT was found during the period between July of 1983 and June of 1993 and these patients were retrospectively analyzed. The diagnosis was based on clinical manifestations, noninvasive studies including ultrasonography, and venography. The male to female ratio was 1.63: l(85 males and 52 females) and the median ages of each sex group were 47 & 50.5 years old, respectively. Left lower extremity was more frequently involved than the right(62 vs 35). At the time of diagnosis of DVT, 19.0% of subjects had known malignancy, 22.6% had cardiovascular disease, 16.1% had history of recent operation or trauma and 11.7% had previous history of venous thrombosis. Pulmonary embolism was clinically suspected in only six patients(4.4%). The results at the time of the most recent follow up examination were defined as goad(no swelling and no functional disorder) in 33 patients(44%), fair(mild swelling, no functional disorder, partial improvement after medication) in 23 patients(30.7%) and poor(severe swelling, functional disorder, no response to medication) in l9 patients(25.3%).

Streptozotocin으로 유발된 당뇨쥐에서 췌도의 문정맥내 동계 이식

박근용,여준기,이인규,강구정,조원현 啓明大學校 醫科大學 1994 계명의대학술지 Vol.13 No.2

저자들은 췌도이식 여구의 첫단계로 collagenase 소화법 및 Ficoll density gradient법을 이용하여 분리한 흰쥐 췌도를 10마리의, streptozotocin으로 당뇨병이 유발되는 동계쥐의 문정맥에 이식하였다. 1) 성공적으로 이식된 예는 3례였으며 이식을 위해 사용된 분리췌도수는 250±310개였고 이식이 성공한 경우는 모두 이식후 1일째 혈당치가 정상으로 회복되었다.(121±15.5mg/dl). 2) 성공저긍로 이식된 예에서 이식췌도의 생존은 각 3일,8일,14일이었다. 이상의 결과를 종합하면 collagenase 소화법 및 Ficoll density gradient법을 이용하여 분리한 췌도를 사영한 문정맥내 췌도이식은 이식의 성공률을 높이기 위한 마취상의 미숙점을 보완한다면 기술적으로 어려움없이 가능하다고 사료된다. We evaluated this functional ability of fresh isolated islet of rats by the methods of collagenase digestion/Ficoll density gradient and we performed istransplantation of rat islet into portal vein as a first step procedure to islet cell transplantation. The results obtained were as follows. 1) Three out of 10 transplanted rats receiving 250±310 isolated islets normalized their nonfasting morning blood glucose(121±15.mg/이) and insulin levels(32.1±5.4uU/ml). 2) Normoglycemia has been maintained for 3 days, 8 days and 14 days in each 3 successfully transplanted rats. This study suggests that the islet isotransplantation into protal vein by the methods of collagenase digestion of Ficoll denisty gradient is feasible and appopriate method in treating the diabetes and can be used in the human also for the treatment of diabetes and could be used in the human diabetes.

심초음파로 결정된 응급 심낭천자술의 천자부위

김성환,황성오,이강현,조준휘,강구현,문중범,이승환,윤정한,최경훈,김영식 대한응급의학회 2000 대한응급의학회지 Vol.11 No.3

Background: The aim of this study was to determine whether the conventional subcostal approach is suitable for emergency pericardiocentesis in patients with cardiac tamponade or impending cardiac tamponade. Methods: This study was a prospective, observational study conducted at the emergency department of a tertiary hospital, Patients who had symptomatic pericardial effusion and who needed emergency pericardiocentesis in the emergency department were included in this study. We measured the epicardium-to-pericardium distance at the subcostal, parasternal, and apical area with two-dimensional echocardiography to determine the appropriate puncture site for pericardiocentesis. An epicardium-to-pericardium distance of more than 1.0 cm was considered as the primary safety factor in determining the Puncture site for pericardiocentesis. The skin-to-pericardium distance was considered as secondary safety factor. Results: Ninety-five consecutive patients(55 males and 40 females; total mean age: 53 year old) with cardiac tamponade or impending cardiac tamponade were enrolled in this study. The puncture site for pericardiocentesis, as determined by echocardiography, was the subcostal area in 43 patients(45%), the apical area in 40 patients(42%), the left parasternal area In 11 patients(12%), and the right parastemal area in one patient(1%). Pericardiocentesis failed in 2 patients(2%) with the subcostal approach and in one patient(1%) with the apical approach. The average epicardium-to-pericardium distance was 31 ±21 mm in patients with the subcostal approach and 21±8 mm in patients with other approaches. There were no differences in the amount of pericardial fluid and in the intraperical pressure among patient groups according to puncture site. There were two procedure related complications: a puncture of the right ventricle with the subcostal approach and a ventricular tachycardia with the apical approach.