전혈류 정지술을 이용한 하공정맥 폐색증의 교정수술

김진국,나명훈,안혁,Kim, Jhin-gook,Na, Myung-Hoon,An, Hyuk 대한흉부심장혈관외과학회 1987 Journal of Chest Surgery (J Chest Surg) Vol.20 No.4

MOVC is an uncommon disease which can be corrected by surgical method if early detected. A case of a 34-year-old male with MOVC is reported. Operation was done on cardiopulmonary bypass with circulatory arrest under moderate hypothermia. The incision was done both on the RA extending to level of suprahepatic IVC and on the IVC just proximal to the right renal vein. And then, thrombectomy and membranectomy under the direct visualization was done. Total circulatory arrest was used intermittently in order to get good visual field and for preventing blood loss. The Postop. course was good except one episode of hepatic encephalopathy which was persisted for 12 hours and then controlled by conservative measures.

선천성 삼첨판 협착증의 수술치험 1례

김진국,안혁,오병희,Kim, Jhin-gook,Ahn, Hyuk,Oh, Byung-Hee 대한흉부심장혈관외과학회 1988 Journal of Chest Surgery (J Chest Surg) Vol.21 No.4

A case of congenital tricuspid stenosis in 24 year old male patient is presented. The lesion was successfully corrected with prosthetic valve replacement and closure of atrial and ventricular septal defects. Especially, this is the first reported case of successful large prosthetic valve replacement to a small annulus in tricuspid valve.

대동맥 박리증의 수술요법 -27례의 수술환자를 대상으로 한 5 년간의 성적-

김진국,안혁,Kim, Jhin-Gook,Ahn, Hyuk 대한흉부심장혈관외과학회 1988 Journal of Chest Surgery (J Chest Surg) Vol.21 No.3

Current therapy of aortic dissections remains unstandardized because of the relative rarity of these catastrophic events and conflicting reported results of various therapeutic strategies. Hence, we reviewed our current results and planned to purify our method of interpretation of results and so, to standardize therapeutic managements. This study comprised unselected, consecutive 27 patients with aortic dissections who were operated at Seoul National University Hospital from Jan 1983 to March 1988. The results from analysis of their preoperative, operative and postoperative finding were as follows: 1] 7 patients had acute type A, 14 had chronic type A, 4 had acute type B, and 2 had chronic type B. 2] The causes of dissections were unclear, but 8 patients had Marfan`s syndromes, 2 had previous operative histories on cardiovascular systems and 2 had congenital heart diseases. 3] Multiple preoperative variables were found to correlate significantly with operative mortality and complications. The prevalences of such preoperative major complicating factors were significantly more frequent in acute than chronic [P < 0.05] and type A than type B [P < 0.01]. 4] Operations were performed according to the type of the dissections and whether it was acute or chronic. Usually dacron tube graft replacements were performed[25/26]. Intraluminal sutureless graft replacement was performed in 11 patients. Of the 14 patients with combined aortic regurgitation, concomitant aortic valve resuspension in 4, seperative aortic valve replacement in 1, and aortic valve replacement with coronary reimplantation were performed in 9 patients. 2 patients had concomitant arch vessel managements. 5] Over-all operative mortality rate was 33% and 54% for acute type A, 25% for acute type B, 29% for chronic type A, 0% for chronic type B respectively. The main causes of operative mortality were cardiovascular complications [mainly CPB-weaning failure] in acute cases and hemorrhagic complications in chronic cases.

봉합사와 대망을 이용한 도관형 장기재건

김진훈 ( Jin Hoon Kim ),김진국 ( Jhin Gook Kim ),서수원 ( Soo Won Suh ) 한국조직공학과 재생의학회 2006 조직공학과 재생의학 Vol.3 No.4

To reconstruct the tube type organs like trachea, vessel, stomach, esophagus, bladder and intestine, two considerations have to solve that the first is to endure the suture strength of surgical operation and the movement of organ, and the second is to guarantee the bioactivity of cell and tissue through angiogenesis. Because the previous materials have weak strength or low biocompatibility and difficult to be supplied blood vessels in terms of the wide range replacement, differently with skin, new material or operation method are required. In this study, we are trying to solve the above problems and the possibility of making artificial organ by cell culture and implantation using the polyglycolide woven mesh scaffold(WMS) and the omentum.

누드 랫드의 호모자웅간 번식 성공사례의 보고

김희진(Heui-Jin Kim),박종성(Jong-Seong Park),김진국(Jhin-Gook Kim),한진수(Jin-Soo Han) 한국실험동물학회 1998 Laboratory Animal Research Vol.14 No.1

세포-PLGA 쉬이트를 사용한 대망배양

김진훈 ( Jin Hoon Kim ),김진국 ( Jhin Gook Kim ),서수원 ( Soo Won Seo ) 한국조직공학·재생의학회 2008 조직공학과 재생의학 Vol.5 No.3

The cell and porous scaffold are main components of tissue engineering. The cell seeded-porous scaffold is cultured in vitro to make tissue-like structure and then transplanted into in vivo to reconstruct the injured tissue and organ. However, in vitro culture method can not supply sufficient blood vessels and nutrients and growth factors for tissue formation and also require long cell culture time. For these reasons, in vivo culture method using omentum has been studied, because the omentum can supply many blood vessels and various nutrient and oxygen. But once the porous scaffold transplanted into in vivo, the intrusion of other kinds of cells into scaffold pores and the excessive accumulation of extracellular matrix are inevitable. As a result merits of the use of omentum are not worth. To avoid these problems and use omentum effectively, stable cell layer composed with cells have to be made. In this experiment, we made stable cell layer using PLGA sheet and used Q dot for identification of in vivo cell distribution.

원발성 기관 악성 흑색종 1예

강우헌,안병훈,정만표,김호중,권오정,이종헌,김진국,한정호,이경수,Kang, Woo-Heon,Ahn, Byung-Hoon,Chung, Man-Pyo,Kim, Ho-Joong,Kwon, O-Jung,Rhee, Chong-H.,Kim, Jhin-Gook,Han, Jung-Ho,Lee, Kyung-Soo 대한결핵및호흡기학회 1998 Tuberculosis and Respiratory Diseases Vol.45 No.1

We report a rare case of primary tracheal malignent melanoma documented by careful clinical examination. Differentiation between primary and metastatic malignant melanoma is very difficult We conclude that this tracheal tumor is a primary malignant melanoma based on characteristic pathologic features and the exclusion of the possibility of spontaneous regression of the primary site by patient's history and physical examination.

폐결핵으로 오인된 폐분아균증

전병우 ( Byung Woo Jhun ),김다민 ( Da Min Kim ),박지현 ( Ji Hyeon Park ),유홍석 ( Hong Seok Yoo ),심훈보 ( Hun Bo Shim ),김진국 ( Jhin Gook Kim ),한정호 ( Joung Ho Han ),권오정 ( O Jung Kwon ) 대한결핵 및 호흡기학회 2012 Tuberculosis and Respiratory Diseases Vol.72 No.1

Blastomyces dermatitidis is a dimorphic fungus that causes the systemic pyogranulomatous disease known as blastomycosis. Blastomycosis most often involves the lungs, skin, and may involve nearly every organ in the body. It is difficult, however, to diagnose blastomycosis in the early stage of pulmonary disease because clinical manifestations are varied from subclinical infection to acute respiratory distress syndrome. Since blastomycosis is often accompanied by granulomatous inflammation in histopathologic findings, differentiation from other etiologic diseases is important. We report a case of a 45-year-old male with pulmonary blastomycosis who had been misdiagnosed with tuberculosis for 3 months.

수술중 측정한 관상동맥 우회도관 혈류량의 분석

박계현,채헌,윤양구,이재웅,김관민,전태국,김진국,심영목,박표원,Park, Kye-Hyun,Chae, Hurn,Yun, Yang-Ku,Lee, Jae-Woong,Kim, Kwhan-Mien,Jun, Tae-Gook,Kim, Jhin-Gook,Shim, Young-Mog,Park, Pyo-Won 대한흉부심장혈관외과학회 1997 Journal of Chest Surgery (J Chest Surg) Vol.30 No.8

본 연구는 관상동맥 우회수술중 측정한 우회도관의 혈류량을 결정하는 인자들을 분석함으로써 일반적으로 적용되고 있는 수술 전략의 의의를 검토하고자 하였다. 50명의 환자를 대상으로 관상동맥 우회수술중 transit-time ultrasound flowmeter를 이용하여 총 146개의 우회 도관의 혈류량(graft blood flow; GBF)을 측정하였다. 수혜관상동맥의 내경, 해당 심근의 면적, 우회도관의 종 류, 수술전 심근 관류 스캔 소견 등의 변수와 GBF간의 상관관계를 분석하고 수술 3개월후 시행한 심근 관류 스캔 소견과의 상관관계 여부를 분석하여 다음과 같은 결과를 얻었다. 1. 연속 문합된 목재정맥 우회도관의 GBF(평균 61.5 ml/min)가 내홉동맥(평균 42.5 ml/min)이나 단순 복재정맥 우회도관의 GBF(평균 46.9 ml/min)보다 의미있게 높았다(p<0.01). 2. GBF와 myocardial value 및 수혜동맥의 내경 간에 유의할 만한 상관관계가 있었으며 심근 스캔상 관류결손 의 유무와는 상관관계가 없었다. 3. 수혜동맥 내경이 1.5 m 미만이거나 혹은 myocardial value가 2 미만인 경우에는 CBF가 유의하게 낮았다. 4. myocardial value가 같을 경우 수혜 관상동맥의 내경과 GBF간의 상관관계가 약하였던 반면 수혜동맥의 내경이 같을지라도 myocardial value가 클수록 GBF가 증가하였다. 5. GBF 측정치가 회귀분석을 통하여 구한 기대치보다 낮았던 경우와 기대치 이상이었던 경우를 비교하면 전 자에서 수술후에 해당 심근영역에서 관류결손이 발견되는 비율이 유의하게 높았다(32.2% vs 15.1%, p< 0.05). 이상의 결과는 관상동맥우회도관의 혈류량은 해당 심근 영역과 동맥계(run-of)의 크기에 의하여 주로 결정됨을 시사하는 것으로 내경 1∼1.5 m의 작은 관상동맥일지라도 지배하는 심근의 면적이 클 경우에는 우회 도관을 조성하여 줌으로써 심근 관류를 효과적으로 개선시킬 수 있고 완전 혈류재건(complete revascularization)의 목적을 달성할 수 있음을 확인시켜주는 것이라 할 수 있다. 특히 이런 경우 연속문합술을 이용함으로써 우회도관 근위의 혈류량을 증가시켜 장기 개통율의 향상을 기대할 수 있을 것이라 판단된다. This study aimed to determine factors that influence blood flow through coronary bypass grafts and to analyze relationship between the graft flow and postoperative outcome. Blood flow through 146 bypass grafts(GBF) was measured with transit-time ultrasound flowmeter during coronary artery bypass grafting operations in 50 patients. Single and multiple regression analyses were done for relationships between the GBF and four variables: internal diameter of recipient coronary artery, myocardial value of bypassed branch(es), type of graft, and finding of preoperative myocardial perfusion scan. The relationship between GBF and postoperative scan finding was also analyzed. 1. The mean GBF was significantly higher in sequential grafts than in single vein grafts or in internal thoracic artery grafts(61.5 vs. 46.9 and 42.5 ml/min). 2. Myocardial value and recipient artery diameter were found to be the factors determining GBF. There was no correlation between GHF and presence of perfusion defect in the preoperative scan. 3. Myocardial value was found to be more important than recipient artery diameter in determinintg GBF. 4. Reversible perfusion defects were more frequently found in the areas upplied by grafts with low GBP. But this fact had only mild statistical significance. These results suggest that blood flow through a bypass graft is more determined by the size of its supplyinf: myocardium than by the size of recipient artery. So, we can expect effective improvement in myocardial flow reserve after grafting of small(1~1.5mm) coronary arteries, if they supply substantial area of myocardium.

Computer System을 이용한 정상 관상동맥 조영 사진의 양적분석

윤양구,박계현,최용수,김관민,전태국,김진국,심영목,박표원,채헌,Yun, Yang-Koo,Park, Kay-Hyun,Choi, Young-Soo,Kim, Kwhan-mien,Jun, Tae-Gook,Kim, Jhin-gook,Shim, Young-Mog,Park, Pyo-Won,Chae, Hurn 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.5

관상동맥 질환은 최근 발생빈도가 현저히 증가하고 있고 사회적 관심이 많은 대표적 질환이다. 이와 동반하여 관상동맥 우회로 이식수술의 시술도 90년대들어 급격한 증가를 보이고 있다. 관상동맥 질환에 대한 외과적 시술시 수술의 시행 유무와 범위를 결정하는데 술전에 관상동맥의 상태를 검사하고 평가함은 매우 중요한 일이다. 술전 관상동맥의 형태학적 검사 방법으로 관상동맥 조영술은 현재 매우 유용하고 광범위하게 사용되고 있다. 그러나, 관상동맥 조영사진을 분석함에 있어 객관적이고 양적인 자료를 얻는 측정 방법이 임상에 널리 이용되고 있지는 않다. 이에 저자 등은 computerized system(Arripro 35)을 이용하여 관상동맥 조영사진을 관상동맥의 분지, 우세성 및 직경등 형태학적으로 연구 분석하여 보고한다. 연구 대상은 본 삼성 서울 병원에서 1994년 9월부터 1996년 6월까지 22개월간 관상동맥 조영술을 시행하였던 환자 경우중 형태학적으로 정상구조를 보인 174례의 관상동맥 조영사진을 대상으로 Arripro 35 system을 이용한 양적 분석을 하여 다음과 같은 결과를 얻었다. 1) 좌주관상동맥의 직경은 4.45$\pm$0.79 mm이고, 분지는 2분지가 117례, 3분지가 50례, 4분지가 7례이다. 2) 좌전행지의 근위부 직경은 3.47$\pm$0.62 mm이고 중위부 직경은 2.79$\pm$0.52 mm이며 원위부 직경은 2.16$\pm$0.39 mm이다. 사행지는 평균 1.99$\pm$0.88개가 분지되었고 2개가 있는 경우가 가장 많았고 범위는 0에서 4개였다. 3) 좌선회지의 근위부 직경은 3.17$\pm$0.61 mm이며 원위부 직경은 2.19$\pm$0.55 mm이다. 둔각 변연지는 평균 2.16$\pm$1.10개가 분지되었고 2개가 있는 경우가 가장 많았으며 범위는 0에서 6개였다. 4) 우관상동맥의 근위부 직경은 3.51$\pm$0.69 mm이고 원위부 직경은 2.93$\pm$0.68mm이며, 후측분지의 직경은 2.30$\pm$0.48 mm이고 후하행지의 직경은 2.09$\pm$0.48 mm이다. 5) 우측 우세성이 163례(93.68%)이고 좌측 우세성은 11례(6.23%)로 우측 우세가 절대적으로 많았다. 우관상동맥에서 분지되는 예각 변연지는 직경이 1.5 mm 이상으로 유의할만한 크기로 분지되는 경우가 89례(51.15%)였다. 관상동맥 우회로술시 완전 재관류을 위해서는 우측 예각 변연지에 대한 관심이 필요할 것으로 사료된다. In the preoperative evaluation before coronary artery bypass surgery, review of the coronary arteriogram is the most important step. Expected "normal" lumen diameter at a given coronary anatomic location is a basis for quantative estimation of coronary disease severity that could be more useful than the traditional "percent stenosis". The distribution and number of major coronary artery branches are determinants of number of bypass grafts needed. We reviewed the coronary artery anatomy in 174 adult patients who revealed no coronary pathology in angiographic studies done from September 1994 to June 1996. Quantative analysis was done in all cases by a single person using a Computerized System (Arripro 35ⓡ). The results were follows; 1) The mean diametre of left main coronary artery was 4.45 mm(range 2.74~6.72). The pattern of branching was bifurcation in 67.24%, trifurcation in 28.74% and quadrifurcation in 4.02% of the patients. 2) The mean diametre of left anterior descending artery was 3.17 mm(range 2.10~5.85), 2.79 (range 1.55~5.59) and 2.17 mm(range 1.37~3.81) in the proximal, mid, and the distal portions, respectively. The number of diagonal branches of left anterior artery was from one to four(mode=2). 3) The mean diametre of proximal and distal left circumflex artery were 3.17mm(range 1.74~4.89) and 2.19 mm(range 1.21~4.46). The number of obtuse marginal branches of left circumflex artery is from one to six(mode 2). 4) The mean diametre of proximal and distal right coronary artery, the posterior descending artery and the largest posterolateral branch were mean 3.51 mm(range 2.07~5.67), 2.09 mm (range 1.42~3.60), 2.09 mm(range 1.02~3.60) and 2.30 mm(range 1.39~4.39). 5) The right coronary artery dominant was 163 cases(93.68%) of the total 174 cases. 6) The large significant acute marginal artery was visualized in more than half of the people. half of the people.