폐면균증(肺麵菌症)의 외과적(外科的) 치료(治療) -일례(一例) 보고(報告)-

김학제,이남수,송요준,김형묵,Kim, Hark Jei,Lee, Nam Soo,Song, Yo Jun,Kim, Hyong Mook 대한흉부심장혈관외과학회 1976 Journal of Chest Surgery (J Chest Surg) Vol.9 No.2

A 33 year old male patient was admitted with 20 years history of recurrent hemoptysis. On clinical examination, mild left chest discomfortness and foul odored sputum with occasional rusty hemoptysis were principal complaints noted. Chest X-ray film revealed moderately advanced active tuberculosis lesion on both upper lung fields, and hen-egg sized mass surrounded with linear crescent of air shadow in a cavity on his left upper lung field. On left thoracotomy, dense pleural adhesions on left apicoposterior segmental surface with multiple lymphnode enlargements were noted, and the soft encapsulated mass of $5{\times}5{\times}8cm$ was localized in the apicoposterior segment of the left upper lobe. Apicoposterior segment with anterior segment of the left upper lobe was resected. Cavity was opened to find a rusty grayish colored, fragile mass, which was confirmed as "fungus ball" of aspergillosis by histological section slide with Gomori staining. The authors report one case of pulmonary aspergilloma superinfected with previous long standing pulmonary tbc.

후복막강 내시경을 이용한 요추 교감신경절 절제술 - 2례 보고 -

이송암,김광택,백만종,이인성,김형묵,김학제,이건,Lee, Song-Am,Kim, Kwang-Taik,Baek, Man-Jong,Lee, In-Sung,Kim, Hyoung-Mook,Kim, Hark-Jei,Lee, Gun 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.2

고대 안암병원 흉부외과에서는 각각 1개월과 20개월전에 수족장부 다한증으로 흉강경하 흉추 교감신경절 절제술을 시행받았으나 족장부 다한증이 지속되는 환자 2명에 대해 후복막강 내시경을 이용한 요추 교감신경절 절제술을 시행하였다. 첫 번째 환자의 경우 우측에서 트로카 삽입중 기복이 발생하여 개복적 방법으로 전환해야 했으며, 우측 요추 교감신경절의 불완전한 절제로 발한이 지속되어 재수술을 시행하였다. 술후 각각 70일과 30일이 경과한 시점에서 추적관찰하였으며 만족도 결과를 매우만족, 만족, 보통, 불만족으로 평가하였다. 첫 번째 환자는 '매우만족', 두 번째 환자는 항문주위 대상성 다한증이 있었으나 대체로 '만족'을 나타내었다. 족장부 다한증에 대한 후복막강 내시경하 요추 교감신경절 절제술은 통증이 적고 반흔이 작으며, 회복기간과 입원기간을 줄일 수 있어 족장부 다한증의 유용한 치료방법의 하나이다. We have experienced 2 patients who underwent retroperitoneal endoscopic lumbar sympathectomy(RELS) for bilateral plantar hyperhidrosis. They had underwent thoracic sympathectomy by thoracoscopy 20 months and 1 month ago, respectively. The first patient had to be converted to the open procedure due to pneumoperitonium and she was reoperated due to continous sweating by the incomplete sympathectomy on right side. At follow-up after 70 and 30 days postoperatively, RELS results were graded as excellent, good, fair, or poor. The first patient was very satisfied as "Excellent" and the second was slightly less satisfied as "Good" with compensatory hyperhidrosis at perianal area. This RELS is a feasible procedure to plantar hyperhydrosis patients with less pain, minimal scar, short period of convalescence, and short hospital stay.short hospital stay.

안면 다한증의 하부성상 교감신경절 절제술

김일현,김광택,이인성,김형묵,김학제,이건,Kim, IL-Hyeon,Kim, Kwang-Taik,Lee, In-Sung,Kim, Hyoung-Mook,Kim, Hark-Jei,Lee, Gun 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.3

최근 흉강경 수술수기 및 기구의 발달로 본태성 안면 다한증 치료에 대한 흉강경을 이용한 교감신경절 절제술은 안전하고 효과가 우수한 치료방법으로 적용이 늘고있다. 고려대학교 안암병원 흉부외과에서는 1996년 7월부터 1997년 4월까지 본태성 안면 다한증을 호소한 43명의 환자를 대상으로 비디오 흉강경을 이용한 하부성상 교감신경절 절제술을 시행한 후 효과를 조사하였다. 대상이된 환자들의 성별은 남자가 33명 여자가 10명이었으며, 평균 연령은 37세였고, 다한증 부위는 순수 안면 다한증 23례, 수부 및 족부동반 안면 다한증 20례였다. 수술부위는 하부성상 교감신경절 절제술 12례, 하부성상 교감신경절 및 제 2번 흉부 교감신경절 절제술 28례였으며, 하부성상 교감신경절 및 제 2번, 3번 흉부 교감신경절 절제술이 3례였다. 수술후 합병증으로는 흉부 통증 8례, 안검하수 4례, 기흉 1례있었다. 보상성 다한증은 36례(83.7%)에서 발생하였으며, 부위별로는 체간 19례, 대퇴부 3례, 족부 2례, 체간 및 대퇴부 10례, 체간 및 족부가 2례발생하였다. 수술결과는 퇴원후 3개월 이상 경과후 추적관찰 결과 다한증 증상에 있어 32례(74.4%)에서 매우 호전을 보였고 11례에서 수술전보다 호전을 보였으며, 만족도에서도 "만족한다"가 33례(76.7%), "대체로 만족한다"가 8례(18.6%)였으며 "불만족"도 2례(4.6%)에서 조사되었다. 본태성 안면 다한증에서 비디오 흉강경을 이용한 하부성상 교감신경절 절제술은 증상 호전에서 만족할만한 결과를 보였으나, 보상성 다한증은 수술후 만족도를 저하시키는 주된 부작용으로, 이에 대한 개선 연구가 필요하다. With recent advancements in the instrumentation and technique of VATS, it has become the method of choice to cure facial hyperhidrosis. From July 1996 to April 1997, we performed 43 thoracic lower stellate ganglionectomy with VATS for facial hyperhidrosis. There were 33 men and 10 women whose ages ranged from 17 to 63 years(mean age, 37 years). Of those patients, 23 complained only of facial hyperhidrosis, and 20 complained of facial hyperhidrosis along with excessive sweating of the palm or foot. Thoracoscopic sympathetic ganglionectomy procedures included lower stellate ganglionectomy in 12 patients; lower stellate ganglionectomy and T2-sympathetic ganglionectomy in 28 patients; and lower stellate, T2 and T3 sympathetic ganglionectomy in 3 patients. Common complications were compensatory hyperhidrosis(36 patients) and causalgia(8 patients). At the end of the follow-up period(minimum, 3 months) ninety-five percent of the patients reported satisfactory results. Thoracic lower stellate ganglionectomy with VATS is an efficient, safe and minimally invasive surgical procedure for facial hyperhidrosis.

단기간의 심근허혈이 심근보호에 미치는 영향 -적출 쥐 심장의 연구-

전영진,이인성,김연수,최영호,김광택,김형묵,김학제,이건,Cheon, Young-Jin,Lee, In-Sung,Kim, Yeon-Soo,Choi, Young-Ho,Kim, Kwang-Taik,Kim, Hyoung-Mook,Kim, Hark-Jei,Lee, Gun 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.2

짧은 기간의 허혈은 뒤에 오는 장시간의 허혈 및 재관류시에 심근의 손상방지에 효과가 있는 것으로 보고되고 있으나 그 기전에 대해서는 논란이 많다. 본 연구에서는 심근에 단기간의 허혈조건을 부여한 후 심근보호액을 이용하여 심정지를 유도하였고 다시 재관류하였을 때 심근 기능의 회복에 미치는 영향을 연구하기 위해 적출 쥐 심장모델을 이용하여 2 시간의 저장기를 이용하여 재관류시의 기능을 비교하였다. 10 마리의 실험군에서는 심근보호액을 이용한 심정지전에 1 분간의 전체 허혈기를 가지고 5 분간의 재관류를 3 번 반복하는 방법으로 허혈조건부여를 하였으며 대조군에서는 위와 같은 조건부여 없이 2 시간의 심근보호액을 이용한 심정지 및 저장기를 가졌다. 2 시간의 저장기를 $0^{\circ}C$의 심근보호액에서 가진 후 재관류를 하여 두 군간의 회복시의 기능을 비교하였다. 재관류 20 분후의 회복기 기능의 비교에서 허혈 조건부여를 한 실험군에서 대조군에 비하여 좌심실 발생압 및 좌 심실압 순간 변화율에서 우수한 회복율을 보였다. 심정지전의 수치를 100으로 본 경우의 재관류시의 좌심실 발생압의 회복율에서 허혈 조건부여를 준 실험군에서는 93.20$\pm$15.7%의 회복율을 보인 반면 대조군에서는 67.3$\pm$15.6%의 회복율을 보여 차이가 있었다. 좌심실압 순간 변화율의 회복율에서 대조군은 54.7$\pm$18.2%의 회복율을 보인 반면 실험군에서는 78.1$\pm$15.1% 의 회복율을 보였다. 심박동수 및 관동맥 관류량에서는 양 군에서 통계적으로 유의한 차이를 발견하지 못하였으며 같은 압력으로 관류한 심근보호액의 관류량에서도 유의한 차이를 보이지 않았다. 이상의 결과 허혈 조건부여는 적출 쥐 심장에서 심근보호액을 이용한 심정지 및 2 시간의 저장 후 재관류시의 심근 기능 회복에 재관류시 심근기능 회복에 도움이 된다고 생각되며 이는 심근보호액의 관류량 및 관류저항과는 다른 기전에 의한 것으로 생각된다. Ischemic preconditioning is known to have protective effect on myocardial function at prolonged ischemic insult but the mechanism of the effect is not clearly known. The effect of the preconditioning on the global ischemia using cardioplegic solution is not well known. To evaluate the effect of global myocardial preconditioning on the functional recovery after cardioplegic arrest and two hours of hypothermic storage, we used the isolated rat heart and two hours cardioplegic arrest time at $0^{\circ}C$. In the experimental group(n=10), after baseline functional data was obtained, ischemic preconditioning was induced with 1 min of global normothermic ischemia for three times before the arrest period. In the control group(n=10), hearts underwent no ischemic precondi- tioning. After 2 hrs of cardioplegic arrest and storage in the $0^{\circ}C$ cardioplegic solution reperfusion was done and hemodynamic data were collected at post-reperfusion 20 min. Heart with ischemic preconditioning showed improved functional recovery at post reperfusion 20 min in peak developed pressure and dP/dT. In percent change of the peak pressure, preconditioning group showed 93.20$\pm$15.7% recovery rate compared to baseline data, and control group showed 67.3$\pm$15.6% recovery rate. In percent change of the dP/dT, control group showed 54.7$\pm$18.2% recovery rate and preconditioning group showed 78.1$\pm$15.1% recovery rate. Percent changes in heart rate and coronary flow showed no significant difference between two groups and there was no significant differences in amount of cardioplegic delivery between groups. Our data suggest ischemic preconditioning may have protective effect on recovery state after cardioplegic arrest and 2 hr ischemic storage of isolated rat heart and its mechanism is not related to the amount of the cardioplegic delivery amount.

한국형 이동식 심폐소생기 개발 보고 I. 실험견을 이용한 개흉식과 폐쇄식 심폐소생술 비교

김형묵,이인성,백만종,선경,김광택,김연수,김맹호,이혜원,이규백,김학제,Kim, Hyoung-Mook,Lee, In-Sung,Baek, Man-Jong,Sun, Kyung,Kim, Kwang-Taik,Kim, Yeon-Soo,Kim, Maeng-Ho,Lee, Hye-Won,Lee, Kyu-Back,Kim, Hark-Jei 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.9

배경: 고려대학교 흉부외과학교실에서는 심폐소생술에서 인공심 사용이 기존의 표준 심폐소생술에 비해 나은 결과를 보인다는 점에 착안하여 한국형 이동식 심폐소생기를 개발하고자 하였다. 1997년 1월부터 8월까지 한국형 이동식 심폐소생기 개발의 전단계로 심폐정지 모델 결정 및 표준 폐쇄식/ 개흉식 심폐소생술의 비교와 관찰지표 설정을 위한 준비실험을 실시하였다. 대상 및 방법: 실험은 한국산 잡견 9마리(28-35kg)를 대상으로 폐쇄식 심폐소생술군 4마리와 개흉식 심폐소생술군 5마리로 나누어, 4분 간의 심정지 및 15분간의 일차 심폐소생술(basic life support; BLS)과 30분간의 이차 심폐소생술(advanced life support; ALS)을 실시하였다. 심장압박은 폐쇄식군의 경우 흉부에 압박을 가하였고 개흉식군에서는 직접 심장을 맛사지하였다. 소생술기간에 양군 모두 동일한 조건의 폐환기 상태를 유지하였으며, 자발성 순환회복은 이차심폐소생술 기간 초기부터 재세동과 에피네프린 및 탄산수소 나트륨을 투여하여 유도하였다. 결과: 심폐소생술 기간안에 평균 체동맥압은 BLS 동안 폐쇄식군이 33$\pm$11 mmHg인데 비해 개흉식군은 45$\pm$15 mmHg로 높게 유지되었으며, ALS 동안에도 폐쇄식군 44$\pm$15 mmHg에 비해 개흉식군이 83$\pm$36 mmHg로 높게 유지 되었으나 통계상의 유의성은 없었다. 한편 평균 폐동맥압은 BLS 동안 폐쇄식군에서 32$\pm$10 mmHg로 평균 체동 맥압과 비슷한 정도로 증가하였으나 개흉식군은 22$\pm$4 mmHg로 평균 체동맥압의 약 50%정도까지만 증가하였고, ALS 동안에도 폐쇄식군은 32$\pm$15 mmHg로 개흉식군의 24$\pm$10 mmHg보다 높게 유지되었으나 통계처리상 유의성 은 없었다. 자발성 순환회복(restoration of spontaneous circulation; ROSC) 및 심폐소생 성공 여부에서 폐 쇄식군은 4마리 모두 사망하였으나 개흉식군은 5마리중 4마리가 생존하였고 생존기간은 384$\pm$705시간이였다 (p<.05). 결론: 본 연구 결과 개흉식 심폐소생술은 폐쇄식 소생술에 비해 비록 통계학상의 차이는 없었으나 소생술 기간 동안 비교해서 안정된 혈역학 상태를 유지하여서 자발성 순환회복 및 장단기 생존율을 향상시킬 수 있었다고 판단된다. Background: Effective cardiopulmonary resuscitation (CPR) should provide acceptable hemodynamics for the vital organs during cardiac arrest and early restoration of spontaneous circulation that guarantees long-term, neurologically intact survival. CPR using heart-lung bypass has been suggested as an option for that use. This study was designed to determine the effectiveness of standard CPR techniques, closed-vs. open-chest CPR, which could be used in the future study verifying the role of heart-lung bypass CPR. Material and Method: By using adult mongrel dogs, closed-chest CPR (CCCPR, n=4) and open-chest CPR (OCCPR, n=5) were compared with respects to hemodynamics, restoration of spontaneous circulation(ROSC), and survival. Ventricular fibrillation-cardiac arrest (VF-CA) was induced by electrical shock in all animals. After 4 minutes of cardiac arrest, basic life support (BLS) was applied for 15 minutes and followed by advanced life support (ALS). ALS was maintained until achi ving ROSC but not longer than 30 minutes regardless of the recovery. Resuscitation procedures in either group were standardized by adopting the protocol of American Heart Association. Result: Prearrest baseline hemodynamic data was not different between two groups. During resuscitation, substantially higher systolic pressure was maintained in OCCPR group than in CCCPR group (45$\pm$15 vs. 33$\pm$11 mmHg during BLS, 83$\pm$36 vs. 44$\pm$15 mmHg during ALS; p=NS). Mean pulmonary arterial pressure went up to the level of mean systemic arterial pressures in CCCPR group and to half of that in OCCPR group, and had kept higher in CCCPR group throughout CPR (32$\pm$10 vs. 22$\pm$4 mmHg during BLS and 32$\pm$15 vs. 24$\pm$10 mmHg during ALS; p=NS). ROSC was obtained in 4 of 5 dogs receiving open-chest CPR and 2 of 4 closed-chest CPR. Prolonged survival was noted in all dogs in OCCPR group (6 to 1440 hours) but not in CCPR group (p<.05). Conclusion: These findings indicate that open-chest CPR can be more effective t maintain hemodynamics during cardiac arrest and to obtain restoration of spontaneous circulation and survival. Further experiment will be designed to compare heart-lung bypass CPR with open-chest CPR.

인공승모판막 혈전의 용해 치료 - 3례 보고 -

백만종,김형묵,이인성,선경,김광택,김학제,Baek, Man-Jong,Kim, Hyoung-Mook,Lee, In-Sung,Sun, Kyung,Kim, Kwang-Taik,Kim, Hark-Jei 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery (J Chest Surg) Vol.32 No.1

승모판의 기계판막치환술 후 판막이나 좌심방 내 혈전증은 판막 기능장애나 혈전색전증을 일으킨다. 조기 진단과 적절한 치료는 중요하지만 임상에서 쉽지 않다. 혈전용해 치료는 혈전증으로 인한 재수술의 위험성을 줄일 수 있어 혈전증 치료에 적절한 한 방법이 될 수 있다. 본 보고는 저분자량 헤파린과 와파린으로 혈전용해 치료를 한 3명의 환자를 보고하고자 하였다. 한 명의 임산부를 포함한 2명의 환자는 판막 혈전증으로 인한 판막폐쇄와 개폐운동 장애가 있었고 다른 한 명은 내원 5일전 혈전색전증으로 뇌경색이 발생한 좌심방내 혈전증 환자였다. 환자들은 프락시파린 0.3cc (7,500 ICU AXa)을 하루에 2∼3번씩 피하로 투여하여 치료를 받았다. 퇴원 당시 판막과 좌심방 내 혈전은 완전히 혹은 거의 완전히 용해되었고 판막의 개폐운동은 정상이었다. 혈전용해 때부터 외래 추적 기간동안 특별한 부작용은 없었다. Thrombosis in valve or left atrium after mechanical mitral valve replacement causes prosthetic valve dysfunction or thromboembolism. Early and adequate therapy is very important but clinically not easy. Thrombolysis can avoid reoperation-related risks and act as an optimal therapy for prosthetic valve thrombosis. This report describes three patients who were treated by using low molecular weight heparin (LMWH) and wafarin. Two patients, including one pregnant woman, had prosthetic valve thrombosis and immobility of valve leaflets, and one patient with recent cerebral infarction due to thromboembolism had thrombus in left atrium. Fraxiparine 0.3 cc (7,500 ICU AXa) was administrated subcutaneously twice or triple daily. At discharge, thrombosis in valve and left atrium were completely or near totally lysed and valve leaflets were normally mobile. During the period of thrombolysis and follow up, there were no complications in all patients.

$PEO-SO_3$를 이용한 항석회화 조직첨포의 개발 (I) - 잡견을 이용한 대동맥과 폐동맥 이식 실험연구 -

김형묵,백만종,선경,김광택,이인성,김학제,이원규,박기동,Kim, Hyoung-Mook,Baek, Man-Jong,Sun, Kyung,Kim, Kwang-Taik,Lee, In-Sung,Kim, Hark-Jei,Lee, Won-Kyu,Park, Ki-Dong 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.10

연구배경: 인체에 이식된 동종 혹은 이종조직은 궁극적으로 석회화 변성이 일어난다. 저자들은 독자적인 항석회화 처리법을 이용해 석회화에 내구성을 가진 심혈관용 조직첨포를 개발하였다. 재료 및 방법:도축장에서 채취한 신선한 소의 심막을 Hank 용액에 담아 실험실로 이송하였다. 불필요한 부분을 절제해 낸 심낭조직을 0.65% glutaraldehyde 용액(4$^{\circ}C$)에 1주일 동안 저장한 다음 phophate-buffered saline 용액(pH 7.4)로 세척하였다. 이후 2.5% 술폰산화 폴리에틸렌옥사이드(PEO-SO3) 용액으로 실온에서 2일 동안 처리한 다음 4$^{\circ}C$ NaBH4용액으로 16시간 동안 환원시켰다. 실험은 글루타르알데하이드 용액으로만 처리한 심막첨포와 항석회화 처리된 심막첨포를 각각 대조군(GA군, n=4)과 실험군(PEO-SO3군, n=4)으로 나누어 혈관벽에 이식하여 석회화 변성 정도를 비교하였다. 실험모델은 성견의 폐동맥과 대동맥 벽의 일부를 절제한 후 심막첨포로 재건하는 방법을 이용하였고, 수술 후 평균 1개월 째에 이식된 첨포를 적출하여 조직병리 변화와 칼슘 및 인 함량을 측정하였다. 결과: 실험군이 대조군에 비해 조직 위축 변성, 칼슘(폐동맥; 1.55$\pm$0.29 vs. 6.72$\pm$0.70 mg/g, 대동맥; 7.10$\pm$1.05 vs. 13.81$\pm$2.33 mg/g) 및 인의 침착량 (폐동맥; 2.58$\pm$0.40 vs. 12.60$\pm$3.40 mg/g, 대동맥; 8.11$\pm$1.07 mg/g vs. 19.33$\pm$4.31 mg/g)이 현저하게 적었다 (P<0.01). 결론:이상의 결과에서 PEO-SO$_3$로 처리한 조직첨포는, 비록 단기관찰 결과이지만, 충분한 석회화 내성을 보이며 이 조직첨포의 장기적인 안정성과 적합성에 대해서는 계속적인 연구가 필요할 것이다. Background: Calcific degeneration is unavoidable in either homo- or heterografts implanted in the human body. We have developed a calcification-resistant cardiovascular tissue patch using a novel technique of anticalcification. Materials and methods: Fresh bovine pericardium was harvested at the slaughter house and transfered to the laboratory in Hank's solution. After trimming and fixing the pericardium, it was embedded in 4$^{\circ}C$ 0.65% glutaraldehyde for a week and then washed by phosphate-buffered saline(PBS) of pH 7.4. This prepared pericardium was then stored in 2.5% sulphonated polyethyleneoxide(PEO-SO3) solution for 2 days at room temperature and reversed by 4$^{\circ}C$ NaBH4 solution for 16 hours. To evaluate the calcification-resistance of surface modified bovine pericardium with PEO-SO3, either glutaraldehyde- treated(GA group, n=4) or PEO-SO3-treated pericardial patch(PEO-SO3 group, n=4) was implanted into adult mongrel dog to reconstruct the main pulmonary artery and the descending aorta using a partial clamp technique. After 1 month follow-up, the implanted patches were retrieved to evaluate the pathologic findings and the content of calcium and phosphorous. Results: The PEO-SO3 group showed substantially less retraction and significantly less calcium deposition than the GA group in both aortic(7.10$\pm$1.05 vs. 13.81$\pm$2.33 mg/g of dried tissue) and pulmonary positions(1.55$\pm$0.29 vs. 6.72$\pm$0.70 mg/g)(p<0.01). Phosphorous contents were also less in the PEO-SO3 group than the GA group significantly, 8.11$\pm$1.07 mg/g vs. 19.33$\pm$4.31 mg/g in the aortic and 2.58$\pm$0.40 vs. 12.60$\pm$3.40 mg/g in thepulmonary position(p<0.01). Conclusions: These findings suggest that PEO-SO3 modified bovine pericardium is highly calcification-resistant but further study is needed to evaluate the long-term biological safety and compatibility of the prosthesis.

박동류 및 비박동류에 의한 체외순환의 비교

선경,백광제,김요한,임창영,김광택,김학제,김형묵,Sun, Kyung,Baek, Kwang-Je,Kim, Yo-Han,Kim, Chang-Young,Kim, Kwang-Taek,Kim, Hark-Jei,Kim, Hyoung-Mook 대한흉부심장혈관외과학회 1985 Journal of Chest Surgery (J Chest Surg) Vol.18 No.2

[here are so many reports that pulsatile blood flow provides physiologic organ perfusions during cardiopulmonary bypass. So, we compared the recent 30 cases undergoing cardiac surgery by Cobe-Stckert pulsatile roller pump with another 30 cases by Polystan nonpulsatile roller pump. Pulsatile flow was applied during aortic-cross clamping period when synchronized to internal EKG simulator, and perfusion mode was changed to continuous nonpulsatile flow after declamping of aorta. Age, sex, weight, and disease entities were comparable and operative techniques were similar between two groups. 1. There were no differences in average ACC time, ECC time, and Operation time. 2. Postoperative artificial respiration time was 6hrs 30mins in nonpulsatile group and 4hrs 48mins in pulsatile group, and detubation time after ventilator weaning was 2hrs 44mins in nonpulsatile group and 1hrs 43mins in pulsatile group. 3. Average pulse pressure was 8mmHg in nonpulsatile group and 55mmHg in pulsatile group, and a mean arterial pressure was 66.0mmHg in nonpulsatile group and 60.7mmHg in pulsatile group. 4. Mean urine-output during ACC;ECC period was 9.717.3;9.913.2ml/kg/hr in nonpulsatile group and 14.215.0;15.817.5 in pulsatile group [p<0, 05], and thereafter progressive decrease of differences in urine output between two groups until POD 2, and lesser amounts of diuretics was needed in pulsatile group during same postoperative period. Serum BUN/Cr level showed no specific difference and urine concentration power was well preserved in both groups. 5. Plasma proteins and other Enzymes showed no differences between two groups, but serum GOT/GPT level was higher in nonpulsatile group till POD 2. 6. Serum Electrolytes showed no differences between two groups. 7. WBC, RBC, Platelet counts, Hgb and Hct were not different and Coagulogram was well preserved in both groups. 8. Plasma free Hgb level was 7.09mg% in pulsatile group compared with 3.48mg% in pulsatile group on POD 1 but was normalized on POD 2. Gross hemoglobinuria after ECC was noted in 6 cases [20%] of pulsatile group and 4 cases [13%] of nonpulsatile group. 9. In both groups, most patients were included in NYHA class III to IV [28 cases;93% in nonpulsatile group, 22 cases;73% in pulsatile group] preoperatively, and well improved to class I to 11[22 cases; 73% in nonpulsatile group, 30 cases; 100% in pulsatile group] postoperatively. There were 7 operative mortalities in nonpulsatile group only, which were 5 cases of TOF with hepatic failure, 1 case of multiple VSDs with low out-put syndrome, and 1 case of mitral valvular heart disease with cardiomyopathy. We concluded that the new, commercially available Cobe-Stckert pulsatile roller pump device was safe, simple, and reliable.

선천성 낭포성 선종양기형 -1례 보고-

선경,백광제,이철세,채성수,김학제,김형묵,Sun, Kyung,Baek, Kwang-Je,Lee, Chol-Sei,Chae, Sung-Soo,Kim, Hark-Jei,Kim, Hyung-Mook 대한흉부심장혈관외과학회 1984 Journal of Chest Surgery (J Chest Surg) Vol.17 No.1

Congenital Cystic Adenomatiod Malformation (C.C.A.M.) is rare, but one of the most common congenital pulmonary anomalies that cause acute respiratory distress in the newborn infants. It is characterized and differentiated from the diffuse pulmonary cystic disease pathologically, i.e. adenomatoid appearance due to marked proliferation of the terminal respiratory components. An 2/12 year old male patient was suffered from respiratory distress and cyanosis on crying since birth, but no specific therapy was given. With progression of symptoms, he came to Korea University Hospital for further evaluation and then transfered to Dept. of Chest Surgery for operative correction under the impression of Congenital Obstructive Emphysema suggested by a pediatrician. On gestational and family history, there was nothing to be concerned such as congenital anomaly. Physical examinations showed; moderate nourishment and development (Wt. 5.5kg), cyanosis on crying, both intercostal and lower sternal retraction on inspiration, Lt. chest building with tympany, Rt. shifting of cardiac dullness, decreased breathing sound with expiratory wheezing on entire Lt. lung field, decreased breathing sound on Rt. upper lung filed, and tachycardia. The remainders were nonspecific. Laboratory findings were normal except WBC $14000/mm^3$ (lymphocyte 70%), Hgb 9.8m%, Hct 28%, negative Mantaux test, and sinus tachycardia and counter-clockwise rotation on EKG. Preoperative simple Chest PA revealed marked hyperlucent entire Lt. lung, herniation of Lt. upper lobe to Rt., collapsed Rt. upper lobe, tracheal deviation and mediastinal shifting to Rt., and no pleural reaction. At operation, after Lt. posterolateral thoracotomy, 4th rib was resected. Operative findings were severe emphysematous changes limited to both lingular segmentectomy was done. The resected specimen showed slight solidity, measuring $8{\times}4.5{\times}2cm$ in size, and small multiple cystic spaces filled with air. Microscopically, entire tissue structures were glandular in appearance, cyst were lined by ciliated columnar epithelium, and occasional cartilages were noted around the cystic spaces. Bronchial elements were dilated but normal pattern on histologically. The patient had a good postoperative courses clinically and radiologically, and discharged on POD 10th without event. The authors report a case of Cogenital Cystic Adenomatoid Malformation (C.C.A.M.)

한국형 이동식 심폐소생기 개발 보고 II. 응급소생술을 위한 이동식 심폐소생기의 동물 실험 연구

김형묵,이인성,백만종,선경,김광택,이혜원,이규백,장준근,김종원,김학제,Kim, Hyoung-Mook,Lee, In-Sung,Baek, Man-Jong,Sun, Kyung,Kim, Kwang-Taik,Lee, Hye-Won,Lee, Kyu-Back,Chang, Jun-Kuen,Kim, Chong-Won,Kim, Hark-Jei 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.12

배경:이동식 인공심폐기는 심정지 기간 동안 안정한 혈역학 상태를 유지하여 생존율을 향상시킬 수 있기 때문에 강력하고 효과적인 심폐소생법의 하나로 그의 사용이 증가하고 있다. 본 연구진은 초기모델의 한국형 이동식 심폐소생기를 이용한 심폐소생술과 기존의 개흉식 심폐소생술을 비교하여 혈역학 유지와 소생 여부 및 신체장기들에 미치는 효과를 알아보고자 하였다. 대상 및 방법: 한국산 잡견 8마리(30∼51kg)를 대상으로 개흉식 심폐소생술군과 심폐소생기를 이용한 심폐소생술군으로 각각 4마리 씩 나누었다. 4분 간의 심실세동형 심정지 기간이 지난 후 15분 간의 기본 심폐소생술(basic life support; BLS)을 실시하고 30분 간의 고급 심폐소생술(advanced life support; ALS)을 실시하여 자발순환회복, 혈역학 상태, 혈구성분에 미치는 효과, 혈액 가스 검사, 생화학 검사 및 생존율 등을 알아보았다. 심장압박과 폐환기는 두 군 모두 동일한 조건으로 유지하였으며, 고급 심폐소생술 시작과 동시에 제세동을 하고 에피네프린 및 탄산수소나트륨을 투여하여 자발순환회복을 유도하였다. 측정한 관찰값은 심정지전 관찰값으로부터의 변화율(%)로 환산하여 평균±표준편차로 표시하였다. 결과: 고급 심폐소생술 초기에 평균 체동맥압은 심폐소생기군에서 개흉식 심폐소생술군 보다 높게 유지되었고 (90±19% vs. 71±32%, p<.05), 평균 폐동맥압은 심폐소생기군이 개흉식 심폐소생술군 보다 낮게 유지되었다 (105±24% vs. 146±6%, p<.05). 자발순환회복은 모든 실험견에서 나타났다. 자발순환회복 후 심폐소생기군에서 혈중 헤마토크리트치, 적혈구와 혈소판 수가 유의하게 감소하였고 혈중 유리헤모글로빈치는 유의하게 증가하였다(p<.05). 혈액가스검사와 lactate 및 CK-MB치는 두 군간에 차이가 없었다. 실험 후 조기사망은 심폐소생기군에서 2마리, 개흉식 심폐소생술군에서 3마리에서 있었다(생존기간 228±153 vs. 31±36 시간, p=ns). 나머지는 모두 장기 생존율을 보였다. 결론: 본 연구결과 이동식 심폐소생기를 이용한 심폐소생술은 심정지 기간 동안 안정한 혈역학 상태를 유지하여 자발순환회복 및 장단기 생존율을 향상시킬 수 있다. 추후 이동식 심폐소생기 개선과 임상적용을 위해 초기모델을 수정 보완하는 실험연구가 더 필요하리라 본다. Background: Portable cardiopulmonary bypass(CPB) technique has been used increasingly as a potent and effective option for emergency cardiopulmonary resuscitation(CPR) because it can maintain more stable hemodynamics and provide better survival than conventional CPR techniques. This study was designed to develop a prototype of Korean portable CPB system and, by applying it to CPR, to discriminate whether it would be superior to standard open-chest CPR. Material and Method: By using adult mongrel dogs, open-chest CPR(OCPR group, n=4) and portable-CPB CPR(CPB group, n=4) were compared with respects to restoration of spontaneous circulation(ROSC), hemodynamics, effects on blood cells, blood gas patterns, biochemical markers, and survivals. Ventricular fibrillation-cardiac arrest(VF-CA) of arrest(VF-CA) of 4 minutes followed by basic life support(BLS) of 15 minutes was applied in either group, which was standardized by the protocol of American Heart Association. Then, advanced life support(ALS) was applied to either group under the support of internal cardiac massage or CPB. ALS was maintained until ROSC was achieved but not longer than 30 minutes regardless of the presence of ROSC. All of the measured values were expressed as means±SD percent change from baseline. Result: During the early ALS, higher mean arterial pressure was maintained in CPB group than in OCPR group(90±19 vs. 71±32 %; p<.05) and lower mean pulmonary arterial pressure was also maintained in CPB group than in OCPR group(105±24 vs. 146±6%; p<.05). ROSC was achieved in all dogs. Post-ROSC levels of hematocrit, RBC, and platelet were decreased and plasma free hemoglobin was increased significantly in CPB group compared to OCPR group(p<.05). Changes in blood gas patterns, lactate, and CK-MB levels were not different between groups. Early mortality was seen in 3 dogs in OCPR group(survival time 31±36 hours) and 2 in CPB group(228±153 hours, p=ns). The remainders in both groups showed prolonged survival. Conclusion: These findings indicate that portable CPB can be effective to maintain stable hemodynamics during cardiac arrest, to achieve ROSC and to prolong survival. Further study is needed to refine the portable CPB system and to meet clinical challenges.