Annuloaortic ectasia의 외과적 치험

이섭,안욱수,김병열,이정호,유회성,Lee, S.,Ahn, W.S.,Kim, B.Y.,Lee, J.H.,Yu, H.S. 대한흉부심장혈관외과학회 1991 Journal of Chest Surgery (J Chest Surg) Vol.24 No.1

Between November, 1981 and July, 1989, 4 patients, 3 male and 1 female patients ranging in age from 36 to 45 years, were operated on for aortic insufficiency associated with uncomplicated annuloaortic ectasia. All patients were in New York Heart Association class III. Two patients had clinical stigmata of the Marfan syndrome. The surgical treatment consisted of. supracoronary replacement of ascending aorta with vascular graft and replacement of the aortic valve in our first case. and composite graft replacement of the ascending aorta and aortic valve with reimplantation of the coronary arteries in subsequent 3 cases. Our first patient developed aneurysm of proximal aorta and pseudoaneurysm of distal aortic anastomosis 5 years postoperatively. One patient among the three patients with Ben-tall operation, died of ventricular fibrillation and myocardial failure during immediate postoperative period. Remaining 2 patients were in NYHA class I with follow-up of 16 months and 20 months respectively.

대동맥 축착증 1례 보고

허용,안욱수,류병하,김병열,장운하,이정호,유회성,Hur, Y.,Ahn, W.S.,Yoo, B.H.,Kim, B.Y.,Chang, U.H.,Lee, J.H.,Yu, H.S. 대한흉부심장혈관외과학회 1982 Journal of Chest Surgery (J Chest Surg) Vol.15 No.3

Coarctation of the aorta is a congenital constriction of the aorta of varying degree usually located slightly distal to the origin of the left subclavian artery. This congenital malformation is found at 5-9% of the congenital heart disease in Europe & North America, but in our country, it is reported as one of rare malformations. We present a case of coarctation of the aorta, which had double diaphragms as discrete form. This is 9 year-old boy, who has suffered from hypertensive symptoms since 6 years before. Coarctation of the aorta was confirmed by aortography, and there was no combined anomalies, and it was postductal type, and coarctations were consisted of two diaphragmatic webs at the both ends with a central aneurysmized. After resection of the coarctated segment completely, Woven Dacron graft was inserted with 18mm in diameter & 2.5cm in length successfully.

폐결핵에대한 외과적 치험[제 4보]

이섭,안욱수,허용,김병열,이정호,유희성,Lee, S.,Ahn, W.S.,Hur, Y.,Kim, B.Y.,Lee, J.H.,Yu, H.S. 대한흉부심장혈관외과학회 1992 Journal of Chest Surgery (J Chest Surg) Vol.25 No.1

We have analyzed 1559 operated cases during the 32 year period, from October, 1958 to December, 1990. Annual incidence of the surgical treatment decreased from 101[1960] to 25[1990]. The ratio between male and female was 2.1: 1 and the age of peak incidence was in the 3rd and 4th decades. Recently, patients below the age of 20 years were decreased, but above 50 years were much increased. The patients were consisted of far-advanced case in 71.8% and moderately-advanced case in 22.0% in 1990, as compared with 44% and 54% correspondingly in 1960. Preoperative sputum positivity decreased from 91%[1958~1963] to 38%[1982~1990]. Preoperative antituberculous chemotherapy for more than 3 years increased from 16% [1958~1963] to 56.5% [1982~1990]. From the view of surgical indication, totally destroyed lung and destroyed lobe or segment has been main indication. Recently empyema with parenchymal lesion was increased, and so more extensive surgical resection such as pleuropneumonectomy was performed more frequently. The trends in the mode of surgical treatment revealed that thoracoplasty has virtually disappeared and operations required for residuals of pleural disease have increased. Postoperative mortality increased from 1.6-2.0% to 3.6% recently as well as morbidity. On the basis of our study, far-advanced and drug-resistant patients increased in number recently, whose pulmonary function was poor. So postoperative mortality and morbidity was increased despite improved anesthetic and surgical techniques. Proper surgical intervention should be considered before the appearance of resistance for all chemotherapeutic drugs.

이차공형 심방중격결손증의 외과적 치료;연령에 따른 혈류학적 상관관계에 관한 고찰

이섭,최병철,안욱수,허용,김병열,이정호,유회성,Lee, S.,Choi, B.C.,Ahn, W.S.,Hur, Y.,Kim, B.Y.,Lee, J.H.,Yu, H.S. 대한흉부심장혈관외과학회 1992 Journal of Chest Surgery (J Chest Surg) Vol.25 No.11

Backgroud. To determine the influence of age at operation upon surgical outcome in patients with isolated secundum atrial septal defect, retrospective clinical analysis was done. Material and method. From June, 1976 to December, 1991, 146 patients, 63 male and 83 female patients ranging in age from 13 months to 56 years, were operated on for isolated secundum atrial septal defect. The patients were divided into 3 groups according to their age at operation: Group I [<20 years old], 91 patients[62.3%]; Group II [21 to 40 years old], 44 patients[30.1%]; GroupIII[>41 years old], 11 patients[7.6%]. Significant differences in clinical features, hemodynamic function, early and late results between age groups were speculated. Results. One hundred thirty-one patients[89.6%] were symptomatic at the time of operation, the most common symptoms being dyspnea on exertion, recurrent respiratory infection, palpitation and chest pain. Patients in NYHA class III or IV were 3.3% in group I, 25% in groupIII, and 54.5% in group Ill. Hemodynamic data was available for 138 patients [94.5%]. Significant pulmonary hypertension [MPA systolic pressure $^3$ 40mmHg] was noted in 22 patients [15.9%]. Patients with pulmonary vascular disease [Rp/Rs>1.25] were 2% in group I, 7.3% in group Il, and 9.1% in groupIII. But there were no significant differences between the age groups in the size of the shunt or the ratio of pulmonary to systemic flow. Atrial septal defects were closed with direct suture in 144 patients and patch repair was performed in 2 patients with high defect. Atrial arrhythmia [8.2%] was the most common postoperative complication. The mean [LSD] duration of follow-up in all patients was 16$\pm$22 months [range, 1~96 months]. Functional result was excellent regardless of the age groups. During follow-up period, late cardiovascular events were arrhythmia [7 cases], reoperation for recurrent ASD [2 cases], and premature late death due to bacterial endocarditis [1 case]. Incidence of preoperative and late atrial fibrillation was significantly higher in older age group. Conclusion. Age at operation is one of the most important predictor of early and late surgical outcome with its impact on the following factors : 1] hemodynamic alterations and ventricular dysfunction due to longstanding volume and pressure overload, 2] pulmonary vascular disease, and 3] atrial arrhythmia including atrial fibrillation as a result of atrial dilatation. Therefore, among patients with surgically repaired atrial septal defects, those operated on over the age of 20 require careful supervision on the long-term basis.

인공심장판막 실패에 대한 재치환술의 임상적 고찰

최병철,유환국,안욱수,허용,김병열,이정호,유회성,Choi, B.C.,Yoo, H.K.,Ahn, W.S.,Hur, Y.,Kim, B.Y.,Yoo, H.S. 대한심장혈관흉부외과학회 1991 Journal of Chest Surgery (J Chest Surg) Vol.24 No.7

To evaluate risks, complications and mortality of reoperations on heart valve prosthesis, we reviewed clinical records of 53 patients who underwent reoperation because of prosthetic valve failure[PVF], from Jan 1959 through Jun. 1991. They had undergone 48 mitral, 10 aortic valve rereplacement Primary tissue failure was the main cause of reoperation : it occurred in 51 valves at a mean postoperative interval of 58 months. Calcification and collagen disruption of prosthesis were main causes of primary tissue failure in macro and micropathology, In 3 failing mechanical prostheses, paravalvular leak was in 2 cases, another one case had the thrombi at the hinge portion. If conditions such as emergency operation with or without endocarditis, thromboembolism and advanced NYHA functional class are prevented, we think that reoperative valve replacement has similar morbidity and mortality to initial valve replacement surgery. But our sturdy represents higher mortality [22.6%] because of late surgical intervention failing the prevention of conditions leading to myocardial damage. In conclusion if the tearing, calcification, and a new murmur were detected the early reoperation should be considered to increase late survival.

유경성 대망 이식편을 이용한 농흉 치험 3례

허용,문준호,안욱수,김병일,이정호,유희성,Hur, Y.,Moon, J.H.,Ahn, W.S.,Kim, B.Y.,Lee, J.H.,Yu, H.S. 대한흉부심장혈관외과학회 1992 Journal of Chest Surgery (J Chest Surg) Vol.25 No.8

The omental pedicle flap[OFF] has been used for management of complicated problems in various fields of cardiovascular surgery. Its unique properties of enhancing neovascularity, relieving lymphedema, providing fibroblasts to promote healing, providing soft tissue coverage, & functioning in the face of existing infection make it ideal in managing many of the more complicated problems facing the thoracic surgeon. We have used omental pedicle for colosing of the bronchial fistula R esophageal fistula with filling the adjoining cavity after pneumonectomy. The successful closure of the bronchial stump with OFF were obtained in 2 cases, but one case was failed who was suffered from the esophageal fistula. The primary operation in each cases were right pleuropneumonctomy for tuberculous empyema in 2 cases & left pneumonectomy for chronic empyema in 1 case, We believe that the OFF is effective for closing fistula due to postoperative empyema k plombage procedures for dead space of infected thoracic cavity.

폐암의 임상적 고찰 (III)

허용,유환국,안욱수,김병열,이정호,유회성,Hur, Y.,Yu, H.K.,Ahn, W.S.,Kim, B.Y.,Lee, J.H.,Yu, H.S. 대한흉부심장혈관외과학회 1990 Journal of Chest Surgery (J Chest Surg) Vol.23 No.1

A total of 129 patients with a confirmed diagnosis of primary lung cancer were treated at Dep. of Thoracic k Cardiovascular Surgery, National Medical Center, Seoul, Korea, between July, 1981 and Dec., 1988. Particular emphasis was given in this review to the 72 patients that underwent surgical resection of their primary lung lesion. Factors such as histology, type of resection, sex, age, staging, and degree of dissemination were considered possible influences on survival. The age group of fifty k sixty decade occupied 55.8 %, and the youngest being 24 years and oldest 78 years. The incidence ratio of male to female was 3,2:1. The subjective symptoms of the patients were coughing [72.6%], chest pain [48.2%] and hemoptysis [35.6%], which were due to primary local influence. The confirmed diagnostic procedures were bronchoscopic biopsy, sputum cytology needle aspiration biopsy, open lung biopsy, anterior mediastinotomy & lymph node biopsy. By pathologic classifications, the squamous cell carcinoma was the most prevalent, 67 cases [51.9 %], and the adenocarcinoma in 36 cases [27.9%], undifferentiated small cell carcinoma in 13 cases [10.1 %], undifferentiated large cell carcinoma in 9 cases [6.9%], bronchioloalveolar carcinoma was 4 cases [3.1%]. The lymph node dissection with pneumonectomy [42 cases], lobectomy [14 cases] and pneumonectomy [6 cases], lobectomy [9 cases] without lymph node dissection were performed. The post operative TNM Staging[AJC] in 72 cases were Stage I in 24 cases, Stage II in 27 cases, and Stage III in 21 cases. Overall resectable was possible in 72 cases [55.8 %], and the operation mortality was 5.6 % [4 cases].

낭종성 종격동종양의 임상적 고찰: 11례 보고

허용,이상목,이섭,유환국,안욱수,김병열,이정호,유회성,Hur, Y.,Lee, S.M.,Lee, S.,Yu, H.K.,Ahn, W.S.,Kim, B.Y.,Lee, J.H.,Yu, H.S 대한흉부심장혈관외과학회 1991 Journal of Chest Surgery (J Chest Surg) Vol.24 No.10

Congenital cysts of the mediastinum are rare, but interesting lesions. Such cysts are important because they may produce distressing symptoms and because some have a malignant potential. Mediastinal cysts of foregut origin represent an important diagnostic group. Classified according to their anomalous embryonic origins they include pericardial, bronchogenic, esophageal, enteric, and nonspecific cysts. A series of 11 consecutive surgically treated cases from the Dep. of Thoracic & Cardiovascular Surgery in National Medical Center from Oct. 1959 to Dec. 1990, all successfully resolved without mortality. The 8 bronchogenic, 1 enteric, & 2 non specific cysts are included in this series. And 2 of 11 were asymptomatic patients presented. The clinical & pathological behavior of the individual cysts comprise a wide variety of patterns. Proper utilization of the many diagnostic tests available can accurately characterize the cysts. The exact histologic diagnosis, however, is rarely made prior to operation.

관상동맥 우회로 조성술 1례 경험

안욱수,조영철,이길노 순천향대학교 1987 논문집 Vol.10 No.2

Coronary bypass surgery has been the most important advance since 1967 for the management of the moderately to severely patient with angina due to obstructive atherosclerotic coronary artery disease. Medical and surgical therapy are complementary : patients treated surgically should also receive appropriate medical therapy. Recently, we have experienced one case of coronary artery bypass graft for the patient with unstable angina. The patient was 56 year-old male and admitted with complaint of angina pectoris. EKG revealed diffuse myocardial ischemia on anterolateral segments. Coronary cineangiogram revealed 90% stenosis of the proximal left anterior descending coronary artery. We have performed single bypass graft from left anterior descending coronary artery to aorta with great saphenous vein. The patient had an excellent postoperative recovery and was free from anginal attack. He has shown striking improvement in general status(NYHA functional class I) during 1 year after operation.

肝吸蟲 感染家兎의 免疫診斷에 對한 硏究 1. 全蟲體 抽出物 粗抗原에 대한 ELISA

李玉蘭,安郁洙 순천향대학교 1987 논문집 Vol.10 No.2

Enzyme-linked immunosorbent a assay(ELIST) using crude antigen of Clonorchis sinensis was performed for infected rabbit sera with different worm burden, from preinfection to 32th or 50th week after infection. The crude antigen was used the supernatant of homogenated adult worms centrifuged for 1 hr. at 15,000rpm. All rabbits(18) were divided into 4 groups(G-Ⅰ, G-Ⅱ, G-Ⅲ, G-Ⅳ) by different worm burden. The mean of recovered worms(±SD) and the number of rabbits in each group were as follows : G-Ⅰ, 5.4(±2.5) and five : G-Ⅱ, 168.3(±27.4) and three : G-Ⅲ, 317.8(±53.2) and five : G-Ⅳ, 817(±155.6) and five rabbits. The conjugate used in ELISA was Alkaline phosphatase conjugated anti-rabbit IgG, and substrate was p-nitrophenyl phosphate. The results were summarized as follows : 1. The optical density(OD) values(antibody levels) as mean of each group increased significantly at the 4th week(P<0.01) in G-Ⅰ : 3rd week (P<0.02) in G-Ⅱ and 4rd week in G-Ⅲ & G-Ⅳ. The mean OD values of groups reached 1.0 or more at 5th week in G-Ⅰ& G-Ⅱ and 4rd week in G-Ⅲ & G-Ⅳ. The mean OD values of groups increased every weekly to 10th(G-Ⅱ)-12th(G-Ⅰ & G-Ⅲ)-14th(G-Ⅳ) week, and after that the mean OD values of groups maintained plateau though repeatedly rise and fall(but no significantly) of mean OD values. The mean OD values of each group during plateau period were 1.606-1.794 in G-Ⅰ : 1.719-1.916 in G-Ⅱ : 1.783-1.947 in G-Ⅲ : 1.829->2 in G-Ⅳ. 2. The proportional relationship of worm burden and antibody levels(OD values) were more sensitive until 6th week after infection. The mean OD values of G-Ⅰ were significantly lower than thats of lst week in G-Ⅱ(P<0.02), 3rd-5rd-6th week in G-Ⅲ(P<0.001-P<0.05-P<0.01) and lst-3rd-4rd-5th-6th in G-Ⅳ(P<0.02-P<0.01-P<0.05-p<0.05-P<0.01). The G-Ⅱ were lower than thats of 3rd week in G-Ⅲ & G-Ⅳ(P<0.02), and the G-Ⅲ was lower than that of 3rd week in G-Ⅳ(P<0.05). The mean OD values of all groups were not revealed significant difference(P>0.05) from 8th week to 14th week with each others. The mean OD values of G-Ⅰ sometimes were lower than thats of G-Ⅲ & G-Ⅳ from 16th week to 32th week, and the mean OD values of G-Ⅱ & G-Ⅲ & G-Ⅳ were not revealed significant difference except 3rd week. 3. The individual animals of all groups became OD values 1.0 and more at 3rd to 5th weeks(except one, at 8th). The antibody levels in several individuals were not closely related with worm burden. The OD values were not reached to OD values 1.0 over in all individuals of G-Ⅰ. The individuals in G-Ⅲ & G-Ⅳ were showed OD values 2.0 over(>2) for remaining weeks after 16th week approximately. Consequently, the detection of antibody of rabbit clonorchiasis in ELISA was very sensitive, but there were a difference of antibody levels according to individual animals.