후방 대정맥-우심방 우회술에 의한 하대정맥 미만성 폐쇄의 치험 2

김웅한,안혁,Kim, Woong-Han,Ahn, Hyuk 대한흉부심장혈관외과학회 1993 Journal of Chest Surgery (J Chest Surg) Vol.26 No.12

Two patients with chronic Budd-Chiari syndrome resulting from segmental obstruction of the inferior vena cava underwent operation. There were 1 man and 1 woman. The obstructed segment was directly visualized by a transthoracic, transdiaphragmatic, retroperitoneal approach. In these two cases, severe segmental obstruction of the inferior vena cava was observed just above the right hepatic vein. These patients underwent successful retrohepatic cavoatrial bypass with a polytetrafloroethylene [PTFE] graft [ 16mm plain and 16mm ringed graft ]. There were no operative mortality and postoperative complication. These patients have been followed up for 6months and 36months without evidence of re-obstruction. When there is a severe stricture of the IVC with hepatic veins draining freely into the obstructed segment of the IVC, a dorsal cavoatrial bypass with a PTFE graft, preferably ringed, is the method of choice.

'-고 있'의 의미고(意味考)

김웅기(金雄起) 동악어문학회 1989 동악어문학 Vol.24 No.-

헤이트스피치의 피해자인 재일코리안의 반응과 대응

김웅기(Kim Woong Ki)(金雄基) 한일민족문제학회 2017 한일민족문제연구 Vol.32 No.-

本稿は多様な在日コリアンのうち、総連系朝鮮籍者の嫌韓現象によるヘイトスピーチに対する認識に関する聞き取り調査(2014年6-8月実施)の内容を論じたものである。在日コリアン社会の構成は移住時期や国籍、政治的性向などによって細分化されており、かつては多数だった総連系朝鮮籍者は今や少数になっている。しかし、民族教育や同胞コミュニティのつながりが依然として強固であることから、可視的な集団として存在している。他の属性を持つ在日コリアンに比べ、彼らの認識にはいかなる特徴があるのかについて調査を行った。 本調査が特記するに値する特徴は以下の通りである。 第一に、差別に対する認識をはじめとする内面における葛藤を言語化する能力に長けている点である。これはその他の属性を持つ在日コリアンとの違いと言えるものであり、幼い頃から同胞コミュニティが身近に存在することで、自尊感情を毀損されて来なかったことなどが影響を及ぼしているものと思われる。 第二に、差別に抗う意思が強固である一方、権利や公的制度に対する信頼感が低い点である。在特会による京都朝鮮第一初級学校襲撃に対し、告訴を行う過程における逡巡など、これまでの弾圧の歴史によって、制度の活用や日本社会への発信などにおいて消極的にならざるを得なかった点が作用している。実際に反差別に関する発信活動を行ったある朝鮮学校教員は日本人側による執拗な嫌がらせに遭っている。 第三に、民族教育の支援者であり、感謝の対象である北朝鮮よりも、韓国の方が自らのアイデンティティを主張する上で日本社会においては有利という認識が存在している。経済的格差などに加え、金正日による日本人拉致を認める発言以降、日本社会において「朝鮮人」としてのアイデンティティを表に出すことに恐れを感じ、「韓国人」と称する方が安全という認識が存在している。政治的信念が確固たるものとなっている一部を除けば、総連系朝鮮籍者と言えども、日本社会における差別に対する差別に対する不安や苦悩の中に暮していることがわかる。 This paper discusses how pro-Chongryon Chosen-seki Zainichi Koreans perceive hate speech/crime against them escalated by anti-Korean sentiment spread by recent South Korean-Japanese international relations. Comparing to the rest of categories of Zainichi Koreans, they are relatively visible and active in that the ties of their communities and ethnic schools are still firm. The author implemented a research survey from June to August of 2014, and the research method taken was in-depth interview, and the author interviewed 55 Zainichi Koreans. Among them, seven people are pro-Chongryon Chosen-sekis. Discussions in this paper are based on the contents of the interviews to them. The findings are as follows. First, pro-Chongryon Zainichis are good at languageizing their mental conflicts occurred by discrimination. Their ethnic communities gives positive influence on their self-esteem resisting discrimination. Second, the rate of their trust in rights and public institutions is low while the intention to resist discriminiation is strong. It is because of long history of Japan’s discriminatory perception against Koreans. Third, Third, they posess perceptions that claiming South Korean identities are more advantageous than North Korean ones as far as they live in Japan. This type of perception has been possessed even by pro-Chongryons since 2002 when Kim, Jungil admitted North Korea committed abductions of Japanese people.

Synchrotron Microangiography of the Rat Heart Using the Langendorff Model

김웅한,최수연,곽재근,김동진,오세진,김동정,장우성,이재항,최은석,김영준 대한심장학회 2008 Korean Circulation Journal Vol.38 No.9

Background and Objectives: The ability to study microvessels of a beating heart in real time at the level of the capillary is essential for research. However, there are no proven methods currently available to achieve this. The conventional absorption-contrast agents have limitations for studying capillaries. Microangiography with using synchrotron phase-contrast X-ray technology and no contrast agent has recently been reported on. We tried to verify this previous report, and we wanted to visualize the microvessels of a rat heart using air as a contrast agent. Materials and Methods: We made the Langendorff apparatus in a hutch of the Pohang Accelerator Laboratory. The images were obtained with a white beam and a monochromatic beam. The visual images were magnified using 3× and 20× optical microscope lenses, and the images were captured with a charge-coupled device camera. Results: We could not duplicate the previously reported findings in which microvessels were visualized without the use of contrast agent. But with using air as a contrast agent, the microvasculature of rat hearts was clearly identified at a spatial resolution of 1.2 μm. Air being absorbed inside a capillary was also observed. Vessels under 10 μm diameter were unable to be visualized with using iodine as a contrast agent. Conclusion: Phase contrast imaging already allows spatial resolution of 1 μm, which is enough to inspect capillaries. We were able to obtain images of cardiac capillaries with using air as a contrast agent. Yet air has the fatal limitations in that it causes embolism and ischemia. A more suitable contrast agent or imaging method needs to be developed in order to study the microvessels of a beating heart. Background and Objectives: The ability to study microvessels of a beating heart in real time at the level of the capillary is essential for research. However, there are no proven methods currently available to achieve this. The conventional absorption-contrast agents have limitations for studying capillaries. Microangiography with using synchrotron phase-contrast X-ray technology and no contrast agent has recently been reported on. We tried to verify this previous report, and we wanted to visualize the microvessels of a rat heart using air as a contrast agent. Materials and Methods: We made the Langendorff apparatus in a hutch of the Pohang Accelerator Laboratory. The images were obtained with a white beam and a monochromatic beam. The visual images were magnified using 3× and 20× optical microscope lenses, and the images were captured with a charge-coupled device camera. Results: We could not duplicate the previously reported findings in which microvessels were visualized without the use of contrast agent. But with using air as a contrast agent, the microvasculature of rat hearts was clearly identified at a spatial resolution of 1.2 μm. Air being absorbed inside a capillary was also observed. Vessels under 10 μm diameter were unable to be visualized with using iodine as a contrast agent. Conclusion: Phase contrast imaging already allows spatial resolution of 1 μm, which is enough to inspect capillaries. We were able to obtain images of cardiac capillaries with using air as a contrast agent. Yet air has the fatal limitations in that it causes embolism and ischemia. A more suitable contrast agent or imaging method needs to be developed in order to study the microvessels of a beating heart.

심첨과 대정맥이 동측에 있는 수정대혈관전위의 해부학적 교정

김웅한,이택연,김수철,전홍주,한미영,김수진,이창하,정철현,이영탁 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery (J Chest Surg) Vol.32 No.8

최근 여러 병원에서 선천성 수정대혈관전위의 해부학적 교정이 보고되고 있다. 해부학적 교정을 받은 수 정대혈관전위 환아의 단기 및 장기추적에서 문제가 되는 것은 주로 심방전환수술에 따르는 대정맥과 심방 문합 부\ulcorner의 협착과 상심실성 부정맥이며 이는 심방이 작은 경우에 위험도가 증가되고 특히 심첨과 대정맥 이 동측에 있는 경우에는 문제가 된다. 이런 경우 이중전환수술시 일부 선택된 환아에서 대정맥폐동맥단락 술을 추가함으로써 수술의 위험성과 심방의 잠재성 합병증을 피할 수 있다고 여겨진다. 본원에서는 수정대 혈관전위, 심실중격결손, 폐동맥폐쇄가 있으면서 심첨과 대정맥이 동측에 있는 환아의 해부학적 교정시에 대 정맥폐동맥단락술을 추가하여 좋은 결과를 얻었기에 보고하는 바이다. Over the past several years, a number of centers have reported favorable results of anatomical repair for the congenitally corrected transpositions. However, there have been subsequent problems related mainly to the results of atrial switch procedures in patients who had small atriums because of venoatrial obstructions or supraventricular arrhythmias, especially in patients with apicocaval juxtaposition. Cavopulmonary shunt may be a useful addition to the double switch operation in certain circumstances as a means of avoiding potential atrial complications. Herein, we describe the successful anatomical repair of congenitally corrected transposition of the great artery with pulmonary atresia, ventricular septal defect, and cavo apical juxtaposition with this modification.

대동맥판역류증과 좌심실수축말기용적 확장이 있는 환자에서 좌심실최고수축기압/수축말기용적비와 판막치환후의 증상적 호전과의 관계

김웅한,안혁,Kim, Woong-Han,Ahn, Hyuk 대한흉부심장혈관외과학회 1996 Journal of Chest Surgery (J Chest Surg) Vol.29 No.8

이 연구는 대동맥판역류증이 있으면서 좌심실수축말기용적(left ventricular end-systolic volullle)이 커져있는 환자에서 수술전 좌심실 최고수축기압수축말기용적비(left ventricular peak systolic presslle/end-systolic volume ratio)를 판막치환후의 증상적 호전 판단의 자료로서의 적용 여부를 검토하기위한 것이 다 대상은 중정도 이상의 대돈맥판역류증이 있고다른 심혈관계의 이상이 없으면서 좌심실수축말기용적이 60mm2 넘는 21명(남 15, 여 6, 15까에서 60세가지 연령 분포)이었다. 이들을 대상으로 심도자시 통 상적으로 측정하는 여러 변수와 판막치환후 증상적 호전과의 관계에 대해서 분석하였다. 수술 6개월후 증세의 호전이 13명(62%)의 환자에서 있었고, 8명(38%)에서는 증세의 변화가 없었다. 복합변수분석을 통해서 좌심실최고수축기압$\boxUl$수축말기 용적 비는 통계적으로 유의하게 수술 a개월후의 기능적분류상태(p=0.005)와 수술전에 비해 수술 6개월후 기능적분류상태의 변화 정도(p=0.032)를 판단 하는 지표임을 나타냈었다. 판막치환 6개월후 비가 1.71 mmHg/ml/m2 이상되는 모든 환자는 기능상태 I 혹은 II를 유지한 반면 비가 1.71 mmHg ml/m2 미만인 환자에서는 40%가 기능적분류상태 III이 있다. 좌심실 수축말기 용적이 60 ml/m2 이상 커져 있는 대동맥 판역류증 환자에서 좌심실최고수축기 압1수축 말기용적비는 판막치환후의 증상적 호전을 예측하는 지표로 사용될 수 있다. This study was designed to assess the left ventricular peak systolic pressure/end-systolic volume (PSP/ESV) ratio in predicting symptomatic improvement with valve replacement in patients with aortic regurgitation and enlarged left von'lrlcular volume. We studied 21 patients (15 men and 6 women aged 15 to 60 years) with moderate or severe aortic regur- gitation, no other cardiovascular abnormalities and left ventricular end-systolic volume over 60 m11m2. In this group we assessed the preoperative variables which routinely were measured at cardiac catheterlzation to predict symptomatic improvement with valve replacement. Six months after operation, symptoms were alleviated in 13 patients(62%), and unchanged in 8()8%). By multivariate analysis, the PSP/ESV rati was a strong predictor for functional class 6 months after surgery(p=0.005) and also for change- in functional class prior to an operation to 6 months postoperatively(p=0.0)2). By 6 months after receiving valve replacement, all patients with a ratio over 1. 71 mmHglml/m'were in functional class I or II , in contrast, of those with a ratio < 1.71 mmHg/ml/m2, 40% were in functional class III. The PSP/ESV ratio may help to predict which patients with aortic regurgitation and enlarged left ven- tricular end-systolic volume will have symptomatic improvement with valve replacement.

신생아와 유아 심장 수술 시 심폐기회로 충진액의 최소화

김웅한,장형우,박천수,이정렬,김용진,곽재건,양성원,조재희,이경훈,백인혁 대한흉부외과학회 2009 Journal of Chest Surgery (J Chest Surg) Vol.42 No.4

Background: Cardiopulmonary bypass (CPB) involves use of an initial priming volume which can cause side effects such as hemodilution, transfusion, inflammatory reaction and edema. Hence, there have been efforts made to reduce the initial priming volume. We compared this traditional method to a CPB method that uses a minimized priming volume (MPV). Material and Method: For 97 patients who underwent congenital cardiac surgery between July 2007 to June 2008, we discussed each case and decided which method to use. We reviewed the medical records and cardiopulmonary bypass sheets of the patients. Result: We used a MPV method for 46 patients, and a traditional method for the other 51. There were no significant differences in preoperative and intraoperative characteristics between the two groups, such as body weight, age, cardiopulmonary bypass time, lowest body temperature, etc. However, the priming volume was much smaller in the MPV group than the traditional group (p<0.001). The volume of initially mixed packed RBC was also much smaller in the MPV group (p<0.001). There were no significant differences in postoperative mortality and neurologic complications. Conclusion: We could significantly reduce the initial priming volume and initially mixed pRBC volume with the revised CPB method. We suggest that this method be used more widely for congenital cardiac surgery. 배경: 심장 수술시 체외순환은 불가피하며 이때 발생하는 혈액 희석, 수혈, 염증반응, 부종 같은 부작용을 최소화하기 위해서 초기 충진액을 최소화하려는 많은 노력이 이루어졌다. 저자들은 최근 체외순환 장비 및 운영방식의 개선으로 몸무게 10 kg 미만의 신생아 및 유아를 대상으로 체외순환 충진액의 양을 140 mL까지 줄일 수 있었으며 기존의 방법과 비교해보고자 하였다. 대상 및 방법: 2007년 7월부터 2008년 6월까지 본원에서 선천성 심장 기형으로 수술받게 될 5 kg 미만의 환아(n=97)를 대상으로 충진액 최소화 기법과 기존의 방법을 병행하여 수술을 시행하였다. 충진액 최소화 기법은, 심폐기 도관을 짧게 하고, 저혈조의 위치를 조절하며, 진공 배액을 사용하는 등 각 요소마다 충진액의 양을 줄일 수 있는 방법 등을 적용하는 것이었다. 연구 기간이 끝나고 난 뒤 후향적으로 체외순환기록지와 의무기록을 확인하였다. 결과: 새로운 충진액 최소화 기법을 사용한 환아는 46명이었으며 기존의 방법을 이용한 환아는 51명이었다. 양 집단에서 환아의 나이, 몸무게, 심폐기 가동시간, 최저체온 등에 유의한 차이가 없었다(p>0.05). 그러나 충진액 최소화 기법을 사용한 환아와 기존의 방법을 사용한 환아에서 심폐기 초기 충진액의 총량은 각각 160.3±14.1 mL, 277.8+58.1 mL로 유의한 차이를 보였으며(p<0.001), 초기 농축적혈구 혼합량은 33.6±27.2 mL, 115.3±49.4 mL로 역시 유의한 차이를 보였다(p<0.001). 수술 전 혈액검사에서 적혈구용적률은 오히려 충진액 최소화 기법 적용 군에서 평균 29.9%, 기존의 방법 군에서 평균 35.4%로 기존의 방법 군에서 유의하게 높았다(p<0.001). 각 군에 있어서 시행한 수술을 RACHS 카테고리에 의거해 난이도별로 나누었을 때 충진액 최소화 기법 사용 군에서 시행한 수술이 기존의 방법 사용 군에서 시행한 수술에 비해 높은 난이도에 더 많이 분포하였다. 두 군 간에 수술 후 사망률이나 신경학적 합병증의 발생률에는 차이가 없었다. 결론: 체외순환 장비 및 운영방식의 개선으로 기존의 방법과 비교하여 획기적으로 초기 충진액 및 수혈을 줄일 수 있었고 체외순환으로 발생할 수 있는 여러 부작용을 최소화 하는데 도움이 될 것으로 생각되며 향후 이 같은 기법의 확대 보급이 필요할 것으로 생각된다.

심실중격결손, 큰 대동맥폐동맥 부행혈로를 동반한 폐동맥폐쇄환자의 정중절개일차완정교정술 - 1 례 보고 -

김웅한,이영탁 대한흉부심장혈관외과학회 1997 Journal of Chest Surgery (J Chest Surg) Vol.30 No.5

폐동맥폐쇄, 심실중격결손증 그리고 큰 대동맥폐동맥 부행혈관이 합병된 선천성심장병은 매우 드물고 폐 혈류공급원에 있어서 매우 다양한 형태를 가지는 복합병변이다. 세종병원 흉부외과는 이러한 질환이 있는 9 개월된 남아 1례에서 정중절개를 톤해 자가조직만을 이용한 폐동맥형성을 포함한 조기 일차완전교정술을 시 행하여 좋은 결과를 얻었기에 보고하는 바이다. Pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals is a rare and complex lesion in which great morphologic variability exists regarding the sources of pulmonary blood flow. We report a case of this disease with no true central pulmonary arteries in a 9-month-old-boy successfully treated by one-stage complete unifocalization and repair from a midline stemotomy approach.

‘1965년체제’와 재일코리안

김웅기(金雄基) 한국일본문화학회 2016 日本文化學報 Vol.0 No.68

The purpose of this thesis is to discuss the reasons why Koreans in Japan have not been able to improve their social status in Japan. This thesis intends to analyze how their social status in South Korea, a divided nation overwhelming anti-communism, has imposed constraints on improving status in Japanese society. At the same time, a fact that pro-norths and pro-souths live altogether imposes political vulnerability on them. South Korean-Japanese diplomatic normalization brought Koreans in Japan logics of South Korean politics backed by anti-communism. Their loyalty toward the nation of South Korea has been endlessly doubted since both pro-Norths and pro-Souths are living altogether in Japan. From late 1970s to 1980s, many of youngsters were concocted by South Korea’s dictatorial authorities under the name of spy of North Korea. Even after South Korean society achieved democratization, diversity of political value existing in the community of Koreans in Japan has not been approved by their mother nation. This situation becomes constraints for them to assert the improvement of their social status in Japan. For the purpose of the enhancement of social status of Koreans in Japan, they should consider not only their own circumstance in Japan but also that in their mother nation.

변형술식에 의한 완전방실중격결손의 교정

김웅한,김수철,이택연,한미영,정철현,박영관,김종환 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery (J Chest Surg) Vol.32 No.7

Background: Recent advances in understanding the anatomy of the complete atrioventricular septal defect(including right-dominant unbalanced atrioventricular septal defect) have led to alternative methods of repairing these defects. Material and Method: From May 1997 to July 1998, 8 consecutive infants(age range, 2 to 28 months, mean body weight 6.0$\pm$2.2 kg) received a single-stage intracardiac repair of the complete atrioventricular septal defect with modified surgical methods. Depending on the specific anatomic structure, the procedure was simplified in 3 patients by a direct closure of the ventricular element of the defect(Group I). Two patients judged unsuitable for direct closure due to a potential left ventricular outflow tract obstruction had received a standard two-patch repair(Group II). The remaining 3 patients with right-dominant unbalanced complete atrioventricular septal defect underwent biventricular repair; to enlarge the orifice of the left atrioventricular valve, the ventricular septal patch was placed slightly more to the right of the ventricular crest, a left sided bridging leaflet was augmented with an autologous pericardial patch, and the leaflet was repaired with a double- orifice(Group III . Result: In all 8 patients, the postoperative echocardiography demonstrated good hemodynamics. Seven patients were weaned from the ventilators after a mean 3$\pm$1 days, and 1 patient was weaned after 24 days due to a reoperation and emphysematous lung problem. A reoperation was performed in 1 patient for progressive left atrioventricular valve regurgitation due to leaflet tearing. There were no early and late mortalities. At the time of the latest review, judging from the echocardiographic criteria, left atrioventricular valve stenosis was mild in 1 patient(mean pressure gradient 6.5 mmHg, 13.5%), left atrioventricular valve regurgitation was absent or grade I in 7 patients(87.5%). The right atrioventricular valve regurgitation was absent or grade I in all 8 patients(100%). Conclusion: Infants with complete atrioventricular septal defect were treated with either a simplified approach with direct closure of the ventricular element of the defect or a modified surgical technique for a right-dominant unbalanced atrioventricular septal defect, depending on the anatomic structure. The results were no operative mortalities and low morbidity. 배경: 최근에 완전방실중격결손의 해부학적 구조에 대한 이해가 증가됨에 따라서 본원에서는 수술방법에 있 어서 여러 가지 변형을 시도하게 되었다. 대상 및 방법: 1997년 5월부터 1998년 7월까지 8명의 완전방실중 격결손 환자를 수술하였다. 남녀 각각 3명, 5명이었으며 나이는 2개월에서 28개월까지 분포하였고 평균 몸무 게는 6.0$\pm$2.2 Kg이었다. 심장의 해부학적 구조에 따라서 3명의 환아에서는 심실중격결손을 일차적으로 봉합 하여 수술을 단순화하였다(Group I). 좌심실유출로 협착의 가능성이 있는 2명의 경우에는 통상적인 방법대로 2개의 포편을 이용하였다(Group II). 그리고 불균형 완전방실중격결손의 경우에는 심실중격결손을 막는 포편 을 우심실에 치우쳐서 막고 심방중격을 새로 만들거나 좌측 방실판막의 부족한 판막부위를 자가 심낭막으로 메꾸어 주거나 좌측 방실판막이 parachute valve 인 경우에는 2개의 판막입구를 만들어 주었다(Group III). 결과: 모든 환자가 수술후 만족스러운 혈류역학을 보였으며 7명에서는 평균 3$\pm$1 일만에 인공호흡기 이탈이 가능하였으며 1명의 환자는 심장의 문제없이 폐질환으로 24일만에 인공호흡기를 이탈하였다. 수술후 합병증 으로 III군에서 판막성형을 시행한 좌측 판막이 찢어지면서 판막역류가 점진적으로 심해진 1명에서 2주만에 재수술을 하였다. 조기 및 만기사망은 없었으며 수술후 심장초음파검사에서 약간의 좌측 방실판막협착이 III 군에서 1명 있었으며(평균압력차 6.5 mmHg), 좌측 방실판막역류가 7명(87.5 %)의 환아에서 Grade I 이하였으 며, 우측 방실판막역류는 모든 환아에서 Grade I 이하였다. 결론: 완전방실중격결손의 수술시 해부학적인 구 조에 따라서 선택적으로 일부 환아에서는 심실중격결손을 일차적으로 봉합함으로써 수술을 단순화할 수 있 으며 우심실이 발달된 불균형 완전방실중격결손에서도 변형수술방법을 통하여 양심실성 교정을 하여 좋은 결과를 얻을 수 있었다.