기관지 성형술 5례 보고

김응중,김용진,Kim, Eung-Jung,Kim, Yong-Jin 대한흉부심장혈관외과학회 1985 Journal of Chest Surgery (J Chest Surg) Vol.18 No.3

Bronchoplastic techniques represent the ideal surgical therapy for benign endobronchial tumors as well as tumors of low-grade malignant potential, such as bronchial adenomas, and for repair of traumatic airway injuries and benign strictures. This approach is also applicable to a select group of patients with carcinoma of the lung, with long-term survival being comparable to that achieved by standard pneumonectomy. Five bronchoplastic procedures were performed at Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital during 7 months periods from Dec. 1984 to Jun. 1985. Of the 5 patients, 3 patients were male and 2 patients were female and ages ranged from 8 years to 55 years old. The final diagnoses of 5 patients were as followed; traumatic bronchostenosis, endobronchial tuberculoma, carcinoid tumor, tuberculous bronchostenosis and traumatic bronchial fracture. Operative procedures of 5 patients were as followed; resection and end-to-end anastomosis of right main bronchus, left lower lobectomy and wedge resection of bronchus, left upper sleeve lobectomy, right middle and lower sleeve lobectomy and resection and end-to-end anastomosis of left main bronchus. And 2 lungs and 3 lobes could be preserved by these bronchoplastic procedures. There was no post-operative complication or mortality and all patients are being followed up without specific problem.

대한 흉부외과학회지에 발표된 논문의 분석 고찰 - 개인용 콤퓨터를 이용한 논문자료의 저장과 조회의 실례 -

김응중,이정렬,나명훈,Kim, Eung-Jung,Lee, Jeong-Ryeol,Na, Myeong-Hun 대한흉부심장혈관외과학회 1990 Journal of Chest Surgery (J Chest Surg) Vol.23 No.3

Authors designed a computer-based article data management system using a 16 bit IBM personal computer and dBASE IV program and applied it to the management of article data of the Korean Journal of Thoracic and Cardiovascular Surgery. In this system, authors developed a coding system for systemic classification of form and subject of articles and this coding system made the storage and inquiry of data easy and convenient. Using the coding system in this article management system, total 1476 sheets of articles in the Korean Journal of Thoracic and Cardiovascular Surgery were analyzed and briefly described according to their forms and subjects. If this article data management system including the coding system is applied to other Journals related to the department of thoracic and cardiovascular surgery, we can utilize them easily and conveniently for the save of time and effort in the data inquiry or article preparation.

양성 식도질환의 외과적 요법

김응중,김용진,Kim, Eung-Jung,Kim, Yong-Jin 대한흉부심장혈관외과학회 1984 Journal of Chest Surgery (J Chest Surg) Vol.17 No.4

A clinical analysis was performed on 49 cases of the benign esophageal diseases experienced at Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital during 7 year period from 1977 to 1983. Of 49 cases Of the benign esophageal diseases, there were 19 patients of esophageal stricture, 11 of achalasia, 6 of perforation, 3 of bronchoesophageal fistula, 3 of esophageal perforation, 3 of esophageal leiomyoma and one of esophageal foreign body. Twenty three patients were male and 26 were female. Ages ranged from 4 years to 74 years with the average age of 34.7 years. Of 19 patients of esophageal strictures, 7 patients were male and 12 were female and ages ranged from 6 years to 74 years with the average being 33.8 years. Causes of esophageal strictures were corrosive of esophageal strictures were dysphagia, vomiting, general weakness, weight loss and pain that order and developed on several different parts of esophagus. Operations were performed in 18 cases, of whom 7 patients were performed by esophagocologastrostomy, 4 gastrostomy, 4 esophagogastrostomy, 1 esophageal resection and esophagoesophagostomy, 1 esophagotomy and dilatation and 1 scar revision. Five patients had one or two complications; 2 anastomotic leakage, 1 wound infection, 1 localized empyema, 1 bilateral pneumothorax and 1 respiratory failure. One patient expired due to respiratory failure arising from aspiration pneumonia. The average age of achalasia patients was 33.1 years and symptom durations were from 2 months to 10 years with the average of 3.3 years. Main symptoms were dysphagia, vomiting, weight loss, pain and cough in that order. Modified Hellers myotomy was performed in 11 patients with one complication of restenosis. One patient was operated on by using longitudinal incision and transverse sutures with good result. Of 6 patient of esophageal diverticulum, 2 patients were traction diverticulum on the midesophagus, 2 were pulsion diverticulum on the midesophagus and 2 were pulsion diverticulum on the lower esophagus. Diverticulectomy was performed on 2 cases of traction diverticulum and esophagocardiomyotomy with or without diverticulectomy was erformed on 4 cases of pulsion diverticulum with good results. Of 5 patients of congenital bronchoesophageal fistula, the chief complaints were productive cough in 4 patients and hematemesis without respiratory symptoms in one patient. Two patients were operated on by using fistulectomy only and 3 by fistulectomy with pulmonary lobectomy. Of 3 patients of esophageal perforation, causes were foreign body ingestion, esophageal stricture after ECG and corrosive esophagitis. Two patient were operated on by using drainage and gastrostomy with symptomatic improvement but one patient died due to septic shock after thoracotomy. Three patients of esophageal leiomyoma were all male and 2 patients were operated on by using enucleation and one by distal esophagectomy with esophagogastrostomy. In one patient of esophageal foreign body, it was removed by esophagotomy through the right thoracotomy.

활로씨 4징증의 좌심실용적이 수술후 심장기능에 미치는 영향

김응중,노준량,Kim, Eung-Jung,No, Jun-Ryang 대한흉부심장혈관외과학회 1988 Journal of Chest Surgery (J Chest Surg) Vol.21 No.2

Tetralogy of Fallot is a cyanotic congenital heart disease characterized by large ventricular septal defect[VSD] and stenosis of right ventricular outflow tract[RVOT] and the degree of RVOT stenosis and the state of pulmonary arteries are the major determinant of prognosis of this anomaly after operation. The sum of blood flow through RVOT and collateral flow from systemic arteries determine the total pulmonary blood flow and it is drained to left atrium and left ventricle. Therefore the degree of development of left ventricle not only reflects pulmonary blood flow and the status of peripheral pulmonary arteries but also affects postoperative prognosis as a systemic ventricle. In this article, left ventricular volume and its influence on postoperative cardiac function in tetralogy of Fallot were studied in 34 patients operated on at Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital in 1985. Mean age of the patients was 5 1/12*3 9/12 years[range 9/12 - 14 8/12 years], mean body surface area[BSA] 0.65*0.20m2[range 0.38 - 1.22m2], mean body weight 15.6k6.48kg[range 7.0 - 36kg]and mean hematocrit 50.6*9.77%[range 32.0 - 73.5%]. Left ventricular end-diastolic volume[LVEDV] of them were from 11.2 to 113cc and there was a good linear correlation between BSA[m2, X]and LVEDV[cc, Y][Y= - 20.0+923x, r= 0.84, p < 0.005]. Mean LVEDV/m2 was [57.6 * 18.3 cc / m2[range 28.7 - 95.8 cc / m2] and there was a significant reduction of volume compared with normal value. As body surface increases, there was a increasing tendency in LVEDV/m2 but there was no statistical significance. Mean total amount of postoperatively infused dopamine in these 33 patients[except one who expired postoperatively] was 65.6*74.5mg / kg and it was 40.6*44.0mg / kg in routine RVOT widening group [Group I] and 205*49.3mg / kg in transannular RVOT widening group[Group II]. There was a statistically significant difference between two groups. In group I patients there was a good linear inverse correlation between dopamine total amount[mg / kg, Y] and LV volume[cc / m2, X] [Y = 150 - 1.89 X, r = - 0. 77, p < 0.005]. But there were no correlations between dopamine total amount and Hct, cardiopulmonary bypass time and aorta cross clamp time. In conclusion, the patient with small preoperative left ventricular volume required more amount of dopamine as an inotropic agent for the maintenance of a cardiac function in postoperative period. But this is a result of immediate postoperative period and does not reflect the long term effect of left ventricular volume in tetralogy of Fallot. There must be more study for the evaluation of its long term effect.

만성 신부전증 환자에서의 동정맥루조성술

김응중,이영,박진석,Kim, Eung-Joong,Lee, Young,Park, Jin-Seok 대한흉부심장혈관외과학회 1994 Journal of Chest Surgery (J Chest Surg) Vol.27 No.8

Because the number of patients who require maintenance hemodialysis is increasing in number recently, angioaccess has become important to many vascular surgeons participating in the management of such patients.The authors created 269 arteriovenous fistulas[AVF] for angioaccess in 229 patients with chronic renal failure[CRF] at the Department of Thoracic and Cardiovascular Surgery in Chungnam National University Hospital during the period from August 1990 to March 1993. We analyzed the results of 260 operations for 220 patients except 9 patients who were lost during the follow up period. We performed snuffbox AVF in 171 cases, classic radiocephalic AVF in 46 cases, direct AVF at other site in 5 cases, forearm Gore-Tex AVF in 29 cases, and upper arm Gore-Tex AVF in 9 cases. We experienced 13 cases of operative failures, 11 cases of early complications, and 60 cases of late complications including obstructions during follow-up period. The 1 year, 2 year and 3 year patency rates of snuffbox AVF[Group 1], classic radiocephalic AVF[Group 2], and Gore-Tex AVF[Group 3] are like followings; 89, 84, 76% in group 1, 84, 75, 68% in group 2, and 79, 66, 55% in group 3. It showed a statistically significant difference between group 1, 2 and group 3.

발살바동 동맥류 파열의 외과적 치료

김응중,황석하,박진석,Kim, Eung-Jung,Hwang, Seok-Ha,Park, Jin-Seok 대한흉부심장혈관외과학회 1993 Journal of Chest Surgery (J Chest Surg) Vol.26 No.6

Over the past 8 years, from 1985 to 1992, 6 patients with ruptured aneurysm of the sinus of Valsalva underwent open heart surgery in the Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital. Five aneurysms originated from the right coronary sinus and ruptured into right ventricle and one from noncoronary sinus into RA. Ventricular septal defects were associated with 5 cases and one had no associated cardiac anomalies. The ruptured aneurysms were repaired through double incisions in 3 cases, through aortotomy in 2 cases and through right atriotomy in 1 case. There were no early and late complications and follow up results are excellent in all patients.

16세 미만에서의 심장판막치환술

김응중,서경필,이영균,Kim, Eung-Jung,Seo, Gyeong-Pil,Lee, Yeong-Gyun 대한흉부심장혈관외과학회 1986 Journal of Chest Surgery (J Chest Surg) Vol.19 No.1

During 12 years period from 1974 to 1985, 76 valve replacement procedures were performed at Seoul National University Hospital in 67 pediatric patients aging up to 15 years [mean 12.3 years] and it was 7.3% of total valve replacement procedures in same period. Sixty seven patients were composed of 44 males and 23 females. Of the 67 patients, 43 patients had acquired valve lesions and 24 patients congenital valve lesions. Sixty cases received single valve replacement, 7 cases double or triple valve replacement and 9 cases redo-valve replacement. Sixty seven patients received 84 valves [65 bioprosthetic valves and 19 prosthetic valves by] 76 operations, Sixty three of 65 bioprosthetic valves had been replaced before 1983 and 15 of 19 prosthetic valves in recent 2 years. Eleven patients [14.6%] died within one month post-operatively and 8 patients [10.5%] during the follow-up period with the overall mortality rate of 25.1%. There were early post-operative complication of 23 cases [30.3%] and late post-operative complication of 27 cases [35.3%] with the total complication rate of 65.8%. In 58 patients received bioprosthetic valves, there were 14 cases of restenosis of replaced valves. Of the 14 cases of bioprosthetic valve restenosis, 8 cases received redo-valve replacement procedures without mortality in 1 5/12-5 years after initial operation but 4 cases died without reoperation and 2 cases lost during follow-up. The overall mortality and complication rate were still high but they markedly decreased during recent 2 years. So, in spite of its containing many problems, valve replacement in children is becoming safe and useful procedure in whom valve reconstructive procedures are impossible.

Morgagni`s Hernia 2예

육은주(Eun Ju Yook),전준식(Joon Sik Jeon),김성걸(Seong Gul Kim),김진희(Jin Hee Kim),김남재(Nam Jae Kim),정현용(Hyun Yong Jeong),이헌영(Houn Young Lee),김영건(Young Kun Kim),김응중(Eung Jung Kim),이영(Young Lee) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.1

We report two cases of Morgagnis hernia comprising the protrusion of omentum alone. The treated patients were 65- and 64-year old women. They were referred to our hospital due to epigastric discomfort, or dypnea accompanied by an abnormal shadow in right cardiophrenic angle on chest roentgenogram. Surgery through an abdominal approach was preferred and the post- operative course was benign. (Korean J Gastroenterol 1996;28: 148 150)

이강우심실을 동반한 양대혈관 우심실 기시증의 수술 치험

김원곤,김응중,김종환,Kim, Won-Gon,Kim, Eung-Jung,Kim, Jong-Hwan 대한흉부심장혈관외과학회 1985 Journal of Chest Surgery (J Chest Surg) Vol.18 No.2

The division of the right ventricle into two chambers by aberrant muscle bands traversing the sinus portion, Double Chambered Right Ventricle[DCRV], is a relatively rare congenital cardiac malformation. Double Outlet Right Ventricle[DORV], basically recognized by the origin of both great arteries from the morphologic right ventricle, is also a rare anomaly; its frequency has been reported as approximately 0.09 case per 1,000 birth. DORV associated with DCRV, unusual combination, is even more rare; only a few known cases have been recorded previously in the literature. This report presents our surgical experience with this rare anomaly, DORV with DCRV.

혈액종양 ; 항암화학치료시 사전동의서 취득에 관한 의사의 인식도와 행위 조사

김세원 ( Se Won Kim ),강봉균 ( Bong Kyun Kang ),박근민 ( Gun Min Park ),한석재 ( Suk Jae Hahn ),김응중 ( Eung Joong Kim ),김도연 ( Do Yeun Kim ) 대한내과학회 2010 대한내과학회지 Vol.78 No.5

목적: 늘어나는 암환자와 더불어 항암화학치료를 받는 환자들도 지속적으로 증가하고 있다. 한편 인권의 신장으로 인하여 환자의 자기 결정권은 최근 의료 현장에서 중요성이 더 커지고 있다. 본 연구에서는 일개 대학 병원에서 항암화학치료를 담당하고 있는 의사들을 대상으로 항암화학치료 시행 전 설명 및 사전동의 취득에 대한 의료인의 인식도 설문 조사 및 최근 1년 동안 항암화학치료를 시행한 환자의 전자의무기록을 후향적으로 분석하여 항암화학치료 사전동의서를 획득하는 의료인의 행위를 평가하고자 하였다. 방법: 2009년 8월 1일부터 31일까지 항암화학치료를 지시하거나 수행한 적이 있는 의사들을 대상으로 설문을 시행하였다. 또한 2008년 8월 1일부터 2009년 8월 31일까지 항암화학치료가 시행된 환자의 전자의무기록(Electronic Medical Record)을 바탕으로 항암제 동의서를 받았는지와 항암제 동의서가 있었던 환자군을 대상으로 사전동의 취득 행동을 평가하였다. 결과: 총 설문 인원 48명 모두 항암화학치료를 시행하기전에 설명 및 사전동의 취득이 필요하다고 생각하고 있었다. 그러나 서면 사전동의서에 대해 알고 있는 대상은 27명 (56.3%)이었다. 동의서의 형식은 자세한 설명보다는 간결하게 해야 한다는 응답이 70.8%로 선호되었고, 설명 및 사전동의서 취득 시 소요시간은 응답자의 43.8%가 대체적으로 10~14분이 소요된다고 하였다. 전자의무기록에서 항암화학 치료 시 사전동의서 획득 유무를 조사한 결과, 항암치료를 받은 총 141명의 환자 중 22명(15.6%)에게만 서면 사전동의서를 획득하였다. 결론: 양질의 항암화학치료 수행을 위해서는 설명 및 사전동의서의 의미와 중요성에 대해 의사와 환자에게 적절한 인식이 요구되며 환자의 이해도를 높이기 위해 평이한 용어로 작성된 적절한 길이의 표준화된 동의서 양식의 사용이 필요하겠다. Background/Aims: Given that the use of chemotherapy has increased, together with the incidence of cancer, the importance of patient autonomy in decision-making is being emphasized. This study aimed to promote understanding of informed consent by analyzing doctors` perceptions of, and conduct during, the acquisition of written informed consent before chemotherapy. Methods: Forty-eight doctors directing or performing chemotherapy were surveyed in August 2009. In addition, the electronic medical records of patients who underwent chemotherapy between August 1, 2008, and August 31, 2009, were reviewed retrospectively. Results: All 48 respondents replied that acquiring informed consent was necessary before chemotherapy, but only 27 (56.3%) were aware of the format of the consent that had been obtained. Regarding the format of informed consent, 34 (70.8%) felt that it should be brief and 21 (43.8%) indicated that the time they spent in acquiring informed consent ranged from 10 to 14 minutes. Reviewing actual performance in acquiring informed consent, only 22 (15.6%) out of 141 patients who underwent chemotherapy had written informed consent documents in their electronic medical records. Conclusions: To properly acquire informed consent for chemotherapy, its meaning and importance must be understood by both physicians and patients. Moreover, patients need a standardized format of appropriate length for informed consent, with easily understood terms. (Korean J Med 78:610-615, 2010)