St.Jude 기계판막을 이용한 인공심장판막 치환의 외과적 고찰

진웅,나석주,조규도,김치경,조건현,왕영필,이선희,곽문섭,김세화,이홍균,Jin, Ung,Rha, Suk-Joo,Cho, Kyu-Do,Kim, Chi-Kyung,Jo, Keon-Hyon,Wang, Young-Pil,Lee, Sun-Hee,Kwak, Moon-Sub,Kim, Se-Wha,Lee, Hong-Kyun 대한흉부심장혈관외과학회 1994 Journal of Chest Surgery (J Chest Surg) Vol.27 No.4

Total 400 St.Jude Medical Bileaflet Valves were implanted in 336 pts from January 1983 to June 1993; 64 were aortic, 205 were mitral, 64 were double valve and 3 were tricuspid position. The follow up period extended from 6 months to 10 years[mean 24.3 months]. Male to female ratio was 1:1.7. There were total 27 deaths[cardiac related 20, cardiac non-related 7]. Overall mortality was 2.9%/pt-yr. There were 10 early deaths[3.0%] and 10 late cardiac related deaths [3.0%]. Prosthetic valve related complications occurred in 19 patients[5.7%] and among them, seven died; four died of thromboembolic events, two died of anticoagulants therapy related hemorrhagic complications and one died of bacterial endocarditis. NYHA class improved significantly especially in aortic valve replacement and double valve replacement. In AVR cases, the mean NYHA was 2.8 preoperatively and 1.3 postoperatively. And in DVR cases, 3.3 preoperatively and 2.2 postoperatively. The decision to employ a particular prosthesis was made according to the anticipated or known complications of the valve. The St.Jude Medical Valve retains all the hazards of other mechanical valves, most notably, thromboembolism. But the hemodynamic performance of St.Jude Medical Valve compared most favorably with other substitute valves in many reports. 0ur experience didn`t show any differences compared other authors in terms of valve related complication. So we concluded St. Jude Medical Valve can be primarily considered in the selection of artificial valve except in the patients when the usage of anticoagulant therapy is contraindicated.

기관지협착환자에서 기관지내 팽창성 급속 스텐트 삽입후 재발한 기관지협착 치험 2례

김우찬,진웅,나석주,조건현,이선희,곽문섭,김세화,Kim, Woo-Chan,Jin, Ung,Rha, Suk-Joo,Jo, Keon-Hyon,Lee, Sun-Hee,Kwack, Moon-Sub,Kim, Se-Wha 대한흉부심장혈관외과학회 1995 Journal of Chest Surgery (J Chest Surg) Vol.28 No.5

Since the insertion of self expandable metalic stent[SEMS has became popular method for hollow organ stenosis, many attempts for further apply the stent to airway stenosis as an simple procedure has been made, but intrabronchial migration of stent or occurrence of inflammatory granuloma around stent develop occasionally and sometimes it worsen bronchial stenosis further more. This report describes 2 case of surgically treated bronchial restenosis in whom intrabronchial stent were applied for release of bronchial stenosis. Our surgical option was pneumonectomy and bronchoplasty with sleeve right middle and upper lobectomy respectively. During the operation we found the SEMSs were tightly impacted in restenotic bronchial lumen with overgrowth of granulation tissues. The bronchial obstructions occupied more than 90% of lumens in both cases, and needed much complicated procedure to be relieved. Therefore, even though the insertion of SEMS remains as a prcedure determined by the physician`s preference, it has to be considered prudently that the use of SEMS can cause severe restenosis and the surgeon has more difficulties in performing segmental resection of restenotic bronchus in patient with SEMS previously inserted. Throughout these experiences we can conclude that the insertion of SEMS must be performed only in very selected cases of bronchial stenosis.

이달의 X-선 : 흉막에 발생한 국소성 섬유성 종양 1예

김용환 ( Yong Hwan Kim ),나석주 ( Suk Joo Rha ),곽문섭 ( Moon Sub Kwack ) 대한결핵 및 호흡기학회 2000 Tuberculosis and Respiratory Diseases Vol.48 No.3

자발성 종격동기종의 자연경과와 그 의의

유은영,이원재,나석주 대한응급의학회 1997 대한응급의학회지 Vol.8 No.4

Study objective: We evaluate the clinical characteristics and natural history of patients presenting with spontaneous pneumomediastinum(SPNM). Design: A retrospective case series was conducted to identify patients diagnosed with SPNM. ICD-7(J98.2) discharge codes were used for Jan. 1993 to Aug. 1996 at four institutions, and emergency department(ED) records and admission charts were reviewed. Clinical features. interventions, complications, setting, etiology, symptoms, and length of hospital stay were recorded. Participants: All ED patients more than 12 years old with a diagnosis of SPNM. Results: Thirteen cases were identified. Age range was 14 to 58 years(mean 24 years). Presenting symptoms were chest pain in eight(62%), dyspnea in six(46%), both symptoms in three(23%), no complaints in three (23%), Seven(54%) patients complained only of throat discomfort. Seven(54%) had subcutaneous emphysema, and two(15.3%) had a small pneumothorax. Two(15.3%) were smokers. Three(23%) had normal esophagograms and another three had normal chest CT findings. Two cases(15.3%) were associated with inhalational drug use and three cases were due to exercise. Nine cases(69%) had a history of "Valsalva-type" maneuver. Two patients(15%) had a history of antituberculous treatment and one(7.7%) had suffered from bronchial asthma. Mean hospital days were 7.3 days(range 3 to 14), none of all needed any intervention. Specifically, no patient developed a subsequent pneumothorax or airway compromise. Seven cases(54%) were received prophylactic antibiotics. Conclusion: Most simple SPNM cases are benign disease and most of them(78%) had shown typical chest pain, dyspnea and subcutaneous emphysema. Inhalational drug use is not a main cause of SPNM yet, but increase in use of bronchoinhalers is a suspicous cause of SPNM.

햄스터에서 유발된 amiodarone에 의한 폐섬유화 모델에서 vitamin E와 N-acetylcysteine의 효과

오주석,최경호,김세경,왕영필,나석주 대한응급의학회 2003 대한응급의학회지 Vol.14 No.1

Purpose: Amiodarone (AD) is a potent and effective antidysrhythmic drug, but some literature reports that it' s long-term use is associated with the development of potentially life-threatening amiodarone-induced pulmonary toxicity (AIPT). Until now, oxygen free radical theory has been the most probable hypothesis for the development of AIPT. We investigated the protective effect of two potent antioxidants, N-acetylcysteine(NAC) and vitamin E, against AIPT. Methods: Twenty-six (26) Hamsters were divided into a sham-operation group(n=2) and the following 4 groups: AD-induced effects without antioxidants (group 1, n=6), with NAC (group 2, n=6), with vitamin E (group 3, n=6), and with both NAC and vitamin E (group 4, n=6). Vitamin E (100 mg/kg) was injected intramuscularly into the hind leg once a day. At day 21, amiodarone (1.83 umol) was administered by transoral intratracheal instillation. NAC (300 mg/kg) was injected intraperitoneally just after amiodarone instillation. At day 28, amiodarone and NAC were administered again. Twenty-one (21) days after instillation of the second dose of amiodarone, the hamsters were sacrificed, and the lung fibrosis index and the hydroxyproline content were assessed. Results: In the NAC-treated group (group 2), there was no significant decrease in either the lung fibrosis index, as determined by microscopic evaluation, or the lung hydroxyproline content (p>0.05). But there were significant decreases in the fibrosis index and the lung hydroxyproline content in the vitamin E-treated groups (group 3 and 4)(p<0.05). Conclusion: Although vitamin E and NAC are both potent antioxidants, we found that AD-induced lung fibrosis was significantly decreased by only vitamin E and that there was no synergistic effect between vitamin E and NAC. It is possible that AIPT is developed by some other mechanisms rather than oxygen free radical injury. Vitamin E may have some other path for decreasing lung fibrosis. Further studies are warranted.

비관통성 흉부손상에 의한 우심방 파열 1 례

김용환,곽문섭,나석주 대한외상학회 2000 大韓外傷學會誌 Vol.13 No.2

Cardiac rupture is uncommon and survival is rare. Patients typically present with either cardiac tamponade or massive hemothorax. Prompt diagnosis and emergent surgery is always mandatory despite apparent stable vital signs. Thus, patients with possible cardiac rupture can be saved by prompt surgery. A thoracotomy and cardiorrhaphy are definitive treatments for rupture or laceration of the cardiac chamber. We report a successful repair of a lacerated right atrium without a cardiopulmonary bypass by using an emergent thoracotomy.