결장 간막의 유착에 동반된 횡행 결장 염전증 1예

김원곤,이기석,김원곤,이기석 대한대장항문학회 1996 Annals of Coloproctolgy Vol.12 No.3

Biomedicus pump를 이용한 개심술후 심실보조

김원곤,이창하,김기봉,안혁,노준량,Kim, Won-Gon,Lee, Chang-Ha,Kim, Ki-Bong,Ahn, Hyuk,Rho, Ryang-Joon 대한흉부심장혈관외과학회 1996 Journal of Chest Surgery Vol.29 No.11

The reported incidence of postcardiotomy cardiogenic shock not responding to conventional therapy is still 0.1 to 0.8%. For this group of patients, more aggressive form of circulatory support must be employed. Centrifugal pumps are a ventricular assist device most commonly used on this purpose, due to low cost and easy availability. Currently, however, clinical experience of centrifugal pumps as a ventricular assist device is rarely reported in Korea. From January 1992 to January 1996, 2986 patients underwent cardiac operations on cardiopulmonary bypass at Seoul National University Hospital. Refractory postcardiotomy cardiac failure requring ventricular support with a Biomedicus centrifugal pump developed in ten of these patients. There were eight men and two women, ranged in age from nine years to 77 years with a mean of 50$\pm$20 years. The primary surgical procedures consisted of isolated coronary revascularization in four patients, combined coronary revascularization and aortic valve replacement in two, aortic dissection repair in two, pulmonary embolectomy in one, and heart transplantation in one. Of the ten patients, five had left ventricular assistance, one had right ventricular assistance, and four had biventricular assistance. Duration of ventricular assistance ranged from 24 to 175 hours, with a mean of 76$\pm$51 hours. Seven patients were weaned from ventricular assistance, and four of them discharged. The causes of death for nonsurvivors were progressive cardiac failure in two patients and multiorgan failure, intractable ventricular fibrillation, irreversible brain injury, and mechanical problem, respectively, in the other four. Survival was not predicted by time on cardiopulmonary bypass, aortic cross-clamp time, or duration of ventricular support. Major complications included bleeding(7), renal failure(6), infection(3) and neurologic complication(2). These results indicate that a centrifugal pump can provide reasonably satisfactory short-term circulatory support.

종격동 지방종 및 지방육종: 3례 보고

김원곤,김주현,Kim, Won-Gon,Kim, Ju-Hyeon 대한흉부심장혈관외과학회 1983 Journal of Chest Surgery (J Chest Surg) Vol.16 No.3

The lipomatous of the mediastinum are fairly uncommon tumors. Since 1971, two patients with proven mediastinal lipoma and one primary liposarcoma of the mediastinum have been treated at the Seoul National University Hospital. This report reviews our experience with the review of literature. Case 1.: A 3 year old body revealed a huge round homogenous mass density in the posterior mediastinum in routine chest X-ray. The tumor mass, lipoma, was successfully removed and postoperative course was uneventful. Cases 2.: An asymptomatic 24 year old male was operated on with the preoperative diagnosis of mediastinal lipoma. His preoperative chest X-ray and CT films showed a huge anterior to middle mediastinal tumor, right, with fat density. There is no postoperative problem after successful removal of the tumor mass. Case 3. : A 24 year old female was hospitalized with the complaints of cough and chest pain. A mediastinal mass was removed, which proved to be a liposarcoma on pathologic examination. About one year later, she was found to have recurrent liposarcoma in the right chest area at the OPD follow-up. She was lost to follow-up since then.

인공심장판막의 재치환수술: 7례 보

김원곤 대한흉부심장혈관외과학회 1984 Journal of Chest Surgery (J Chest Surg) Vol.17 No.1

Prosthetic valve replacement has resulted in marked improvement in the functional status of many patients with valvular heart disease. But valve failure from various causes has necessitated re-replacement of prosthetic valve in some of these patients. This selective group of patients has many inherent problems. This report presents our experience with seven patients who received re-replacement of prosthetic valve in the Seoul National University Hospital from 1981, to 1983. The patients included one woman and six men in the range of 9 and 49 years old. As the first valve operations, there were five MVR using tissue valves, one DVR [Bjork-Shiley and Ionescu-Shiley valve] and one case of modified Bentall operation with composite graft [Ionescu-Shiley valve]. Reoperations on prosthetic valve failure were performed 17 to 54 months after the first operation [mean 34 months]. Amon8 seven patients, there were two cases of prosthetic valve endocarditis and five cases of primary tissue failure. Gross calcification of the xenograft was found in two children with Ionescu-Shiley valve. All except one had relatively successful operative results. The unsuccessful one died intraoperatively from low output syndrome.

정량적 폐관류스캔에 의한 악성폐종양 환자에서의 수술전 평가에 관한 고찰

김원곤,서경필 대한흉부심장혈관외과학회 1984 Journal of Chest Surgery (J Chest Surg) Vol.17 No.1

The purpose of present study is to investigate the significance of preoperative evaluation with perfusion lung scintigraphy in patients with lung cancer. Lung scans with the use of macroaggregated human serum albumin labeled with technetlum-99m were carried out in 35 patients with lung cancer before thoracotomy at Seoul National University Hospital during the period from November 1981 to September 1983. The relationship between size of the perfusion defect as seen by perfusion lung scan and size of the mass lesion as seen radiologically was correlated with the presence of regional adenopathy and resectability. Among patients with a larger perfusion defect than mass lesion on chest X-ray film.86% were found to have regional lymph node involvement with 29% resectability, whereas among patients in whom a larger defect was not present only 14% had such extension of the disease with 93% resectability. The relative pulmonary arterial perfusion of affected lung was calculated from the counts of radioactivity recorded from affected lung on both anterior and posterior scans expressed as a percentage of the total counts in the scan. The mean relative pulmonary arterial perfusion of the inoperable group [34\ulcorner%] is significantly different from both that of the pneumonectomy group [39\ulcorner%] and that of the lobectomy group [48\ulcorner%].(p<0.01)

소아에서의 저체온 심폐바이패스후 재가온 종료온도와 후하강

김원곤,이해원,임청,Kim, Won-Gon,Lee, Hae-Won,Lim, Cheong 대한흉부심장혈관외과학회 1997 Journal of Chest Surgery Vol.30 No.2

Separating the patient from hypothermic cardiopulmonary bypass(CPB) before achieving adequate rewarming often results in afterdrop, which can predispose to electrolyte disturbances, arrhythmia, hemodynamic alterations, and shivering-induced increase of oxygen consumption. In an attempt to find an adequate end point temperature of rewarming after hypothermic CPB, 50 pediatric cardiac surgical patients were r ndomly assigned for end point temperature of rewarming of 35.5$^{\circ}C$ (Group 1) or 37t (Group 2), rectal temperature. Thereafter the rectal temperature was measured half, one, four, eight, and 16 hour after arrival to the intensive care unit(ICU), with heart rate and blood pressure. Additionally the rectal temperature was compared with esophageal temperature during CPB, and axillary temperature luring stay in the ICU. Nonpulsatile perfusion with a roller pump was used in all patients and a membrane or bubble oxygenator was used for oxygenation. Both groups were comparable with respect to age, sex, body surface area, total bypass time, and rewarming time. There was no afterdrop in both groups, and there were no statistical differences in the rectal temperatures between two groups. There were also no statistical dilyerences with respect to the heart rate and blood pressure between two groups. At the end of rewarming the esophageal temperature was higher than the rectal temperature. The axil ary temperature measured in ICU was always lower than the rectal temperature. No shivering was noted in all patients. In conclusion, with restoration of rectal temperature above 35.5$^{\circ}C$ at the end of CPB in pediatric patients, we did not observe an afterdrop.

Bacillus sp. N-25가 생산하는 Xylanase의 특성

김원곤,이찬용,이계호 한국산업미생물학회 1992 한국미생물·생명공학회지 Vol.20 No.5

섬유소 자원의 효율적 이용을 위하여 강력한 xylan 분해효소 생산 세균을 분리 및 선발하였으며, 형태학적, 배양학적 생리학적 특성을 확인한 결과 Bacillus sp.N25 로 동정하였다. 이 균주에 의해서 생산된 효소를 ammonium sulfate precipitation, DEAE-sephadex A-50, Sephadex G-100 column으로 부분 정제하여 얻은 효소의 열안정성은 50℃에서 30분간 처리시 80%의 역가가 잔존했으며, pH 안정은 pH 6∼B 범위에서 30℃에서 10시간 방치 후에도 안정했으며, cellulose 분해능력은 없었으며, Hg^2+, Ag^2+, Mn^2+에 의해 저해되었다. 그리고 최종분해산물은 주로 xylose이므로 exo-type xylanase로 추정된다. To increase the efficency of utilizing cellulosic biomass, a potent xylanase producing bacteria was isolated and identified as Bacillus sp. N-25. Extracellular xylanase from Bacillus sp. N-25 was partially purified by ammonium sulfate precipitation, DEAE-Sephadex A-25 and Sephadex G-100 column chromatographies. The xylanase was single fraction on chromatography and was true xylanase without cellulase activity. The enzyme was stable at pH 6∼8 and 80% activity was remained at 50℃ for 30 min, but was inhibited by Hg^2+, Ag^2+ and Mn^2+. From the fact that the major end product was xylose, we suggested that the enzyme is an exo-xylanase which may be a prime candidate for industrial use.

혈관륜의 수술체험6례 보

김원곤 대한흉부심장혈관외과학회 1984 Journal of Chest Surgery (J Chest Surg) Vol.17 No.2

Developmental anomalies of the aortic arch, commonly known as vascular rings, are relatively rare congenital vascular anomalies which can compress the trachea and esophagus. We have presented six patients with surgically treated vascular rings at Seoul National University Hospital during the period June 1970 through May 1984. Two patients had double aortic arches and four patients had right aortic arch with aberrant left subclavian artery and left ligamentum arteriosum. Four patients had symptoms relating vascular ring and two patients were detected incidentally during diagnostic evaluation of symptomatic intracardiac defects. Associated congenital malformations were seen in four patients. The operative approach was through left thoracotomy in three patients and median sternotomy in remaining three patients associated with congenital cardiac defects. There were no postoperative deaths with excellent result in preoperative symptomatic patients. To our knowledge, successful surgical repair of vascular ring has been reported only once in the Korean literature.

임신랫트 태자에서 Nitrofen에 의해 유발된 선천성 심혈관 기형에 관한 실험연구

김원곤 대한흉부심장혈관외과학회 1987 Journal of Chest Surgery (J Chest Surg) Vol.20 No.4

Nitrofen [2,4-dichlorophenyl-P-nitrophenyl ether] is a diphenyl ether herbicide used for pre and post-emergent control of broad leafed weeds. This chemical was known to induce a variety of congenital cardiovascular anomalies with diaphragmatic hernia and hydronephrosis in the rate fetuses. The present study was conducted to produce congenital cardiovascular anomalies in the rat fetuses by oral nitrofen administration at the indicated doses and days of gestation, and to find the characteristics of nitrofen-induced cardiovascular anomalies. All the observed fetuses were removed from the pregnant Sprague-Dawley rats sacrificed on the twenty-first day of gestation. They were preserved in 10 per cent formalin and dissection for examination were carried out under a dissecting microscope using forceps and scissors. Following results and conclusion were based on dissecting microscopic findings on 482 offsprings. 1. The eleventh day of gestation was the most sensitive day for nitrofen induction of congenital cardiovascular anomalies in the rat. This incidence was dose-related in rats exposed on the eleventh day of gestation. 2. Ventricular septal defect was the most common single anomaly that represented more than half of the total cardiovascular anomalies, followed by aortic arch anomalies and tetralogy of Fallot. 3. Cardiac anomalies derived from infundibular maldevelopment such as tetralogy of Fallot and pulmonary atresia with ventricular septal defect were only observed in the eleventh gestation day treated group. 4. Aortic arch anomalies were found in high frequency and the great majority were characteristically anomalous right subclavian artery with left aortic arch. Key words; nitrofen, congenital cardiovascular anomalies.

이강우심실을 동반한 양대혈관 우심실 기시증의 수술 치험

김원곤,김응중,김종환,Kim, Won-Gon,Kim, Eung-Jung,Kim, Jong-Hwan 대한흉부심장혈관외과학회 1985 Journal of Chest Surgery (J Chest Surg) Vol.18 No.2

The division of the right ventricle into two chambers by aberrant muscle bands traversing the sinus portion, Double Chambered Right Ventricle[DCRV], is a relatively rare congenital cardiac malformation. Double Outlet Right Ventricle[DORV], basically recognized by the origin of both great arteries from the morphologic right ventricle, is also a rare anomaly; its frequency has been reported as approximately 0.09 case per 1,000 birth. DORV associated with DCRV, unusual combination, is even more rare; only a few known cases have been recorded previously in the literature. This report presents our surgical experience with this rare anomaly, DORV with DCRV.