두경부 편평세포암종에서 미세혈관밀도, p53 단백발현, 경부림프절 전이의 상관성

이철범,임상철,조재식,백준,이재홍 대한이비인후과학회 1999 대한이비인후과학회지 두경부외과학 Vol.42 No.9

체외순환 개심술이 혈액응고 요소에 미치는 영향에 관한 임상적 연구

이철범,박영관,Lee, Chul-Bum,Park, Young-Kwan 대한흉부심장혈관외과학회 1980 Journal of Chest Surgery (J Chest Surg) Vol.13 No.4

Even now, the hemorrhagic syndrome after cardiac surgery with the aid or a pump oxygenator constitutes a significant problem. The purpose of this study is to postulate the possible causes of the bleeding after open hear surgery [OHS]. Fifteen consecutive OHS patients with various heart diseases were selected and platelet count, plasma fibrinogen, serum calcium level were observed pre-, intra- and post- operatively until 21 th postoperative day [POD]. The platelet count was significantly decreased with initiation of extracorporeal circulation [ECC] and continued to decrease slowly until cessation of ECC. Within 10 minutes after ECC the platelet count stared to increase. But it was significantly less than preoperative count until 5th POD. The peak count was found on 14th POD and the platelet count was gradually decreased. Plasma fibrinogen also decreased significantly during operation, but it recovered up to preoperative amount within 5 hours after termination of ECC. Thereafter it rapidly increased until 3rd POD when it reached its peak. From 3rd POD it showed slow downward slope until 21st POD, but it remained in significantly higher level than preoperative amount. Serum calcium levels showed minimum fluctuations during the whole course of study. Conclusively, the decrease in platelet count and fibrinogen amount may play a considerable role for the postoperative hemorrhage. But numerous other effects of ECC must be accounted for.

폐의 염증성 가종양

이철범,염명걸 한양대학교 의과대학 2001 한양의대 학술지 Vol.21 No.2

Inflammatory pseudotumors(IPT) of the lung are uncommon. These masses resemble carcinoma of the lung or sometimes mediastinal tumor radiographically and are discovered only at time of the histologic review of the resected specimen. A 14 year old girl presented with high fever and iron deficiency anemia had a radiological left upper mediastinal and left upper lung lesion, that was interpreted as an mediastinal tumor. At operation an inflammatory pseudotumor was found in the left upper lobe of the lung, that was projecting across the mediastinum. Left upper lobectomy was carried out. Histological examination confirmed the diagnosis of an IPT. The patient had an uneventful postoperative course and has been free of recurrence for 42 months since her operation.

中國 侵權責任法의 環境汚梁責任規定에 관한 檢討

李哲範 동국대학교 비교법문화연구원 2010 比較法硏究 Vol.10 No.2

개흉 환자에서 흉막 유착을 위한 탈크의 임상적 이용 : 탈크 흉막유착술

최종범,이삼윤,이철범 圓光大學校 大學院 1996 論文集 Vol.16 No.-

탈크(talc)는 늑막을 자극하여 섬유화와 늑막유착을 일으키는 효과적인 약제이기는 한나, 사용후 여러 부작용과 합병증이 발생하는 단점을 가지고 있다. 저자들은 개흉후 철저한 흉막 유착이 필요한 27례의 환자에서 국산의 탈크를 흉막유착제로 사용하고 합병증의 정도와 그 유용성을 알고자 하였다. 탈크는 속발성 자연기흉 환자 18례, 원발성 자연기흉 환자 2례, 외상성 기흉 4례, 폐 악성종양 1례, 농흉 2례에서 사용되었다. 주로 지속적인 공기누출과 심한 폐기종을 가진 고령의 기흉 환자를 대상으로 하였다. 주병변인 폐기포는 봉합기로 정상적인 폐실질과 차단하고 말단ㄴ부위의 절제없이 3-0 Vicryl호 연속 봉합하였으며, 주 병변외의 작은 ㅍㅖ기포나 공기누출 부위는 4-0 나 5-0 pROLENE으로 연속 봉합하였다. 벽측늑막(PARIETAL PLEURA)에는 기계적 찰과상을 만들고 탈크 분말은 폐측늑막에 고루 발랐다. 탈크를 사용한 환자에서 그에 의한 사망이나 감염은 없었다. 11례 (40.7%)에서 술후 일시적인 발열이 있었으며, 4례 (14.8%)에서 술후 일시적인 효소치의 상승을 보였다. 21례 (77.8%)에서 수술 2일 이내에 공기 누출이 소실되었고, 술후 평균 27개월의 추적으로 기흉의 재발은 없었다. 탈크의 사용으로 개흉절개의 둥통이 부가되지는 않았다. 결론적으로, 지속적인 공기 누출을 동반하는 다발성 폐기포 병변이나 폐괘성 폐질환을 가진 환자에서 개흉시 선택적으로 탈크를 흉막에 도포하므로써 합병증이 적고 효과적인 흉막유착을 얻을 수 있을 것으로 사료된다. Talc is avery effective pleural irritant, producing fibrosis and adhesion, but it has been associated with numerous side effects and complications. Twenty-seven patients underwent talc poudrage between March 1991 and August 1995. The patients ranged in age from 18 to 77 years. Of the 27 patients who underwent the treatment, 18 had secondary spontaneous pneumothoraces, 2 had primary spontaneous pneumothoraces, 4 had traumatic pneumothoraces, 2 had empyema with bronchopleural fistula and 1 had lung cancer. All patients had continuous air leakage with bullous exclusion technique using a Proximate RL stapler ("Ethicone) for the treatment of pneumothoraces. There were no talc- related deaths or infections. Complications included mild fever in 40.7 % (11/27), temporary elevation of hepatic enzyme in 14.8 % (4/27), and delayed moderate pain requiring analgesics in 11.1 % (3/27). There was no recurrence of air leakage or pneumothorax during the follow-up period of mean 27 months. This study suggests that proper selection of patients and talc poudrage will result in effective treatment with low morbidity.

늑골의 고립성 호산구성 육아종

이철범,박충기,박용욱 한양대학교 의과대학 2001 한양의대 학술지 Vol.21 No.2

We report a case of solitary Langerhans cell histiocytosis, formerly usually referred to as eosinophilic granuloma of rib. A 52 year old woman presented with six month history of left sided chest pain. A left oblique view of chest x-ray and chest computed tomography revealed a 4 by 1 cm osteolytic lesion in the posterior portion of the left 10th rib. An excisional biopsy was taken from the left 10th rib. The specimen typically showed eosinophilic leukocytes and numerous Langerhans cell histiocytes. Immunohistochemically, they exhibited reactivity for S100-protein. Eosinophilic granuloma of the bone shows a characteristic age distribution with an incidence of 90% in children. However this case is unusual because of the age of the patient.

대동맥판폐쇄부전을 합병한 심실중격결손의 치험례

이철범 대한흉부심장혈관외과학회 1980 Journal of Chest Surgery (J Chest Surg) Vol.13 No.4

This is one case report of surgically treated ventricular septal defect [VSD] with aortic insufficiency [AI] at department of thoracic and cardiovascular surgery, Hanyang university hospital. He had had progressive dyspnea on exertion and palpitation for 3 years prior to admission to our hospital. On examination, the blood pressure was 120/0 mmHg and the pulse rate 88 times/min. Bobbing motion of the head, Water hammer pulse, Corringan`s pulse, Quincke`s pulse and to and fro murmur were present. The heart murmur was consistent with .VSD and AI. Cardiomegaly was seen in chest X-ray. EKG, echocardiogram, aortogram and right heart catheterization was performed. On Sep. 9, 1980, open heart surgery was performed under the impression of VSD with AI. Infracrystal type VSD measuring 2 x 1.5 cm in diameter was closed with Teflon patch graft through the transverse ventriculotomy. AI was due to prolapsed, elongated right coronary and noncoronary cusp, especially noncoronary cusp. The prolapsed, elongated aortic leaflets were plicated by placing three 8-figure sutures between the free edge and the base of the leaflet [Frater`s method] through a transverse aortotomy. Postoperatively, he made an uneventful recovery, his blood pressure was 120/70 mmHg and showed no signs AI or residual shunt at discharge.

부분방실관의 교정수술 치험 1예

이철범 대한흉부심장혈관외과학회 1981 Journal of Chest Surgery (J Chest Surg) Vol.14 No.1

This is one case report of surgically treated partial atrioventricular canal. The 22 year-old male patient had no definitive history of frequent respiratory infection and cyanosis in his early childhood. Since his age of 7 years, dyspnea was manifested on exertion. First appearance of congestive heart failure was at his age of 16 years old. The physical examination revealed that the neck veins were distended and heaving of precordium. A thrill was palpable on the left 3rd-4th intercostal space extending from the sternal border toward the apex and Grade IV/VI systolic ejection murmur was audible on it. Neither cyanosis nor clubbing was noted. Liver was palpable about 5 finger breadths. Chest X-ray revealed increased pulmonary vascularity and severe cardiomegaly (C-T ratio = 74%). EKG revealed LAD, clockwise rotation, LVH and trifascicular block. Echocardiogram showed paradoxical ventricular septal movement, narrowed left ventricular outflow tract and abnormal diastolic movement of the anterior leaflet of mitral valve. Right heart catheterization resulted in large left to right shunt (Qp : Qs = 5.7: 1), ASD and moderate pulfllonary hypertension. Finally, left ventriculogram revealed typical goose neck appearance of left ventrlcalar outflow tract. On Oct. 10, 1980, open heart surgery was performed. Operative findings were: 1. Large primum defect ($6{\times}5$ Cm in diameter) 2. Cleft on the anterior leaflet of mitral valve. 3. The upper portion of ventricular septum was descent but no interventricular communication. 4. Downward attachment of the atrioventricular valves on the ventricular muscular septum. 5. Medium sized secumdum defect ($2{\times}1$ Cm in diameter). The cleft was repaired with 4 interrupted sutures. The primum defect was closed with Teflon patch and the secundum defect was closed with direct suture closure. Postoperatively atrial flutter-fibrillation in EKG and Grade U/VI apical systolic murmur were found. The postoperative course was uneventful and discharged on 29th postoperative day in good general conditions.

자연기흉을 합병한 흉선지방종의 치험례

이철범 대한흉부심장혈관외과학회 1981 Journal of Chest Surgery (J Chest Surg) Vol.14 No.2

Thymolipoma is extremely uncommon benign mediastinal tumor consisting of fatty and thymic tissue. Only 50 verified cases have been reported in the world literatures. This one case is the first reported example of surgically treated thymolipoma associated with spontaneous pneumothorax. A thirty-two year old male patient had been in good health until two days prior to admission, when he noted sudden dyspnea associated with an aching pain over the left precordium. The dyspnea and chest pain had become progressively worse. The physical examination revealed that left hemithorax was tympanic sound on percussion and absence of breathing sound on auscultation and point of maximal impulse was located on the 4th intercostal space at the left sternal border. Emergency closed thoracostomy was performed under the impression of tension type spontaneous pneumothorax of the left lung. After closed thoracostomy, point of maximal impulse was not changed inspire of full expansion of the left lung and chest X-ray was strongly suggested pericardial effusion or cardiomegaly which couldn`t account for by clinical course and hemodynamic evidence. EKG, echocardiogram, bronchofiberoscophy, bronchogram and diagnostic thoracentesis was performed. On Dec. 8, 1980, operation was performed under the impression of mediastinal tumor in the anterior mediastinum. At left posterolateral thoractomy, a large fatty mass, measuring 35 x 27 x 13 Cm in dimension and weighing 3350 gm, was resected and multiple bullae on the apicoposterior segment of the left upper lobe was resected and continuously sutured. The pathologic diagnosis of the fatty mass was thymolipoma. The postoperative course was uneventful and discharged in good general conditions.

흉부에서 발생한 악성 섬유성 조직구종

이철범,정태열,함시영,김혁,정원상,김영학,강정호,지행옥,박용욱,Lee, Chul-Burm,Chung, Tae-Yul,Halm, Shee-Young,Kim, Hyuk,Jung, Won-Sang,Kim, Young-Hak,Kang, Jung-Ho,Jee, Heng-Ok,Park, Yong-Wook 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.4

Malignant fibrous histiocytoma(MFH) is a deep-seated pleomorphic sarcoma, which occurs principally as a mass of the extremities, abdominal cavity, or retroperitoneum in adults. However, it only rarely occurs in the chest wall. An 85-year-old man had undeergone excision of a small mass on the right posterior chest wall under local anesthesia 14 months age. However, the lesion did not heal and the mass recurred. He was referred to our hospital after the mass had grown to a size of 10.5$\times$8$\times$4cm with a 3$\times$3cm skin defect. Intraoperative frozen biopsy revealed MFH. An en-bloc wide resection and thin-thickness skin graft from his thigh were performed. Although distant metastasis to the lund developed 14 months later and the patient died 2 months later, there was no local recurrence. Thin-thickness skin graft is a simple method for a wide range skin defect, especially in the old age. He recovered in good condition without any physical disabilities.