식도정맥류에대한 수술요법

박영관,송국현 계명대학교 醫科大學 外科學敎室同門會 1990 남경 박영관 교수 정년퇴임기념 논문집 Vol.S No.-

We studies 83 cases of esophageal varices with portal hypertension treated by Sugiura procedure (esophageal transection with paraesophagogastric devascularization) in one or two stages, or by Kobayashi procedure (transabdominal esophageal transection) and Yamamoto procedure (TEPG, terminal esophagoproximal gastrectomy), depending on the patient’s condition, at the Department of Surgery, Keimyung University School of Medicine, from January 1979 to February 1985. The results of the operative procedures can be summarized as follows: 1) The ages of the patient ranged from 11 years to 62 years. Among 83 patients. 52 were male and 21 were female and the ratio of male and female was about 2.5: 1, the age incidence were most prevalent in the 4th and 5th decades. 2) The procedures were prophyactic measure in 13 cases(15. 7%), elective surgery in 59(71.1%), and emergency in 11(13.2%) 3) Twenty-six patients were in Child’s classification group A (31.3%). forty.one in group B (49.4%) and sixteen in group C (19.3%). 4) The Sugiura procedure was performed at 73 cases as one stage-two procedures in 39 cases. two stages-one procedure in 25 (6 thoracic procedure only and 19 abdominal procedure only), and two stages-two procedures in 9. The Kobayashi procedure was performed at 6 cases and the Yamamoto procedure at 4 cases. 5) The portal pressures measured intra operatively ranged from approximately 130 to 450mm. saline in 60 cases. Among them. 57 cases were above 2OOmm. saline and 3 cases (5.0%)were normal portal pressure. The intraoperative liver wedge biopsy was performed at 62 cases. The results were cirrhosis of liver in 55 cases, chronic inflammation in 3, portal fibrosis 1 and normal3. 6) postoperative complications occurred in. 43 cases. The significant complications were hepatic failure in 6 cases, esophageal leakage accompanied with rebleeding in 2, rebleeding only in 3, esophageal leakage only in 3, esophageal stenosis in 3. Alkaline reflux esophagitis was occurred in 1 case of Yamamoto procedure. No postoperative encephalopathy was noted. 7) The overall mortality within one month after surgery was 13 cases. among them. 1(7.7%) in 13 prophylactic cases. 6(10.2%) in 59 elective cases and 6 (54.5%) in 11 emergency cases. And the operative mortality according to the Child’s classification. 1 (3.8%) in 26 group A. 8(19.5%) in 41 group B and 4 (25.0%) in 16 group C. 8) The postoperative esophagography was performed at 39 cases and revealed disappearance of esophageal varices in 17 cases. marked improvement in 19(50.0%) and stationary in(5. 3%). 9) 60 cases were followed up from 3 months to 6 years period. Among them. 7 cases were expired due to rebleeding in 3 cases. hepatic failure in 3 cases and metastatic hepatoma in 1 cases. The remaining 53 cases were relatively well without rebleeding.

식도 정맥류 108예에 대한 직달수술의 임상적 고찰

박영관,홍성권,임태진 계명대학교 醫科大學 外科學敎室同門會 1990 남경 박영관 교수 정년퇴임기념 논문집 Vol.S No.-

Different types of non-shunt operations were perfomed on 108 esophageal varix cases from January 1979 to August 1987> The procedures included 87 cases of Sugiura method (50 cases of one stage two procedures, 28 cases of two stage one procedure, and 9 ‘cases of two stage two procedures), 11 cases of transabdominal esophageal transection, 6 cases of TEPG (Terminal Esophago Proximal Gastrectomy) and 4 cases of Hassab operation. The results were as follows. 1) Of the 108 patients 80 were male and 28 were female with ratio 2.8:1 and 82.5:1 were 30’s to 50’s. 2) Among the 108 patients prophylactic surgery was performed in 15 cases, elective 82 cases and emergency surgery were 11 cases. 3) 34 cases belonged to Child’s criteria A, B were 54 cases and C were 20 cases (18. 5%). 4) Of the total 81 intraoperative wedge biopsy of the Iiver revealed 72 cases of cirrhosis, 3cases chronic inflammation, 2 cases of fibrosis and 4 cases were normal finding. 5) Postoperative complications included pleural effusion, wound infection (12 cases), rebleeding (7 cases), esophageal leakage, esophageal stenosis (5 cases) and etc. 6) The overall mortality within one month after surgery were 15 cases, Among them, prophylactic 1 out of 15 cases, elective 8 out of 82 cases and emergency 6 out of 11 cases. 7) 60 cases of follow up esophagogram, Varices were disappeared in 25 cases, much improved in 31cases and no interval changes in 4 cases.

Cortisone 이 腹膜貪喰細胞의 貪喰機能에 미치는 影響에 關한 電子顯微鏡的 硏究

朴永寬 계명대학교 醫科大學 外科學敎室同門會 1990 남경 박영관 교수 정년퇴임기념 논문집 Vol.S No.-

It is well known that the phagocytic action of the cells of the reticuloendothelial system plays an important role in the immunological reaction and as a barrier against foreign bodies. It is also known that when the reticuloendot-helial system is blockaded by cortisone, adherence of the foreign bodies to the cell membrane of phagocytes, an initial step of phagocytic mechanism, and absorption of foreign body into the cytoplasm of phagocytes are considerably disturbed. An investigation was undertaken to study the phagocytic activity of the omental milk spots by light and electron microscopy. Sixteen albino rats, maintained on a stock diet, weighing 200.0gm. average, were divided into 3 experimental groups. Group 1. Control group. No intraperitoneal injection of india ink given. a. Two rats, untreated. b . 2 rats: A dose of 25mg of cortisone acetate was given intramuscularly for 6consecutive days. Group 2. 6 rats: A single dose of 6.0ml of 2% india ink in normal saline was given once a day, intraperitoneally, for 3 consecutive days. Group 3. 6 rats: A dose of 25 mg of cortisone acetate was given intramuscularly, once a day, for 6 consecutive days. Starting on the 4th day, a 6.0ml of 2% india ink in normal saline, once a day, was administered intraperitoneally, for 3 days. Each of the experimental rats were sacrificed 24 hours after the last treatment of india ink preparation from the groups 2 and 3. The control group was sacrificed simillarly. Then the greater omentum was extirpated and inspected for india ink pigmentation of the milk spots, followed by both light and electron microscopic examinations. The results were as follows: 1. Light microscopic observations: In the experimental group of rats treated with 25 mg doses of cortisone acetate with a resulant reticuloendothelial system blockade followed by an intraperitoneal india ink injection (group 3), the degree of carbon particle phagocytic activity of omental milk spots was greatly diminished over the group of rats treated with india ink only (group 2). 2. Electron microscopic observations: The number of phagosomes in the cytoplasms of the phagocytes of the milk spots of the greater omentum was increased substantially in the group of rats treated with india ink only (group 2). In this group, a large quantity of carbon particles were found to be contained in the phagosomes. Although there was an increased number of phagosomes bearing carbon particles in the group of rats treated with 25mg doses cortisone acetate followed by india ink injection (group 3), the number of phagosomes in this group was less than in the group of rats treated with india ink alone (group 2). A considerable quantity of carbon particles were also found outside the cytoplasms of phagocytes for group '3. It can be concluded, therefore: The phagocytic activity of omental milk spots was greatly decimated but not completely inhibited when the reticuloendothelial system was b!ockaded by Large quantity of cortisone administration.

한국과 일본의 대장·직장암의 비교연구

박영관,박성대,체종민,정재홍,畦倉薰,高橋孝,柳澤昭夫,加藤洋 계명대학교 醫科大學 外科學敎室同門會 1990 남경 박영관 교수 정년퇴임기념 논문집 Vol.S No.-

In both sides, Korea and Japan, for the past few decades, they have an increasing tendency of the incidence of colo-rectal cancer in general population. Among several environmental factors which promote cancer development, the changing food and dietary are considered to. be the most important factors. We have realized there may be some differences on clinical and pathologic features of colorectal cancer between two countries. So we decided to disclose and discuss the difference on those aspects between Keimyung University School of Medicine, Taegu, Korea and Cancer institute Hospital, Tokyo, Japan. Each side of research group reviewed the clinical charts of the patients which show the findings at admission, at operation and during a follow-up period, and pathologists on each side reviewed the histological sides of cancer according to the same criteria. After a considerable of research, we had two incorporated meetings to discuss on the results of research. We reached the following concl usion 1) In Taegu, younger patients, right sided colon cancer, mucinous adenocarcinoma and cancer of low grade cell differentiation are predominant. 2) In Tokyo, older patients, the left sided colon cancer, concomitant polyps, well and moderately differentiated adenocarcinoma, and Dukes' A are high.

핍혈상태 신장의 신동맥 혈류량에 대한 Prostandin(PGE₁-CD)의 효과

박영관,홍성권,조원현 啓明大學校 醫科大學 外科學敎室同門會 1990 남경 박영관 교수 정년퇴임기념 논문집 Vol.S No.-

Prostaglandins which are derived from unsaturated 2O-carbon fatty acids (most of them are arachidonic acid) have a variety of actions to vascular or nonvascular smooth muscle of 'Various organs and anti-platelet aggregating actions in experiment of acute arterial obstruction. They also are capable of influencing and preserving many physiologic functions in the kidney by participating in the regulation of renal blood flow, glomerular .filtration, and the. urinary excretion of electrolytes and water. To make sure the effect of prostaglandin to the blood flow of ischemic kidney, we checked renal arterial blood flow before and after clamping the renal artery for 45, 60 and 90 minutes in Korean house rabbits. Prostandin (PGEI-CD) was injected through ear vein of rabbit from 5 minutes before declamp and blood flow of renal artery was checked at immediate after declamp and 5, 15, 30 and 60minutes after declamp by Flowmeter. In the 45 minutes clamping group, renal blood flow at 60 minutes after declamp was 102.9% in control group and 130.0% in the group using PGEI-CD. In the 60 minutes clamping group, the flow was 92.9% in control and 124.7% in PGEI-CD group. In the 90 minutes clamping group, only 30.3% of original renal blood flow was returned in control group but 76.3% in PGEI-CD group. The mean survival times up to 7 days after experiments were 7, 7 and 3.8 days in 45, 60. 90minutes clamping groups using PGEI-CD compare with 6.8, 5.6 and 2.2 days in control groups.

食道靜脈瘤에 대한 Sugiura Procedure

朴永寬,朴盛大,朴承國 계명대학교 醫科大學 外科學敎室同門會 1990 남경 박영관 교수 정년퇴임기념 논문집 Vol.S No.-

In our past experiences with regard to the surgical treatment of portal hypertension, the portasystemic shunt procedures have had disappointing sequelae such as rebleeding, encephalopathy and high mortality rate as many other authors claimed. Since 1979, for the treatment of portal hypertension we performed the Sugiura procedure consisting of thoracic operation (transthoracic esophageal transection and devascularization) and abdominal operation (transabdominal esophago-gastric devascularization, splenectomy and pyloroplasty) in one or two stages, depending on the patient’s conditions. The results of the Sugiura procedure were as follows: 1) The procedure was performed in 12 patients prophylactically, electively, or in emergency sltuation. 2) The age distribution was from 14 years to 57 years. 3) Postoperatively, no varices bleeding recurred and encephalopathy has been notably absent. 4) Disappearance or improvement of the varices was noted in all the patients subjected to barium swallow examination postoperatively. 5) The operative mortality within one month of operation was nil in regardless to urgency of operation and the Child classification. 6) Although the actual late mortality rate of our patients are too early to evaluate, we predict the Sugiura procedure will have much better survival rate than the portasystemic shunt procedures. 7) Mild postoperative complications, such as atelectasis or transient ascites, were treated conservatively. No suture insufficiency or stenosis of the esophagus was noted. The present study demonstrated that the Sugiura procedure has proved to be safe and effective in both stopping and preventing bleeding of varices .without compromising hepatic functions, and the immediate and long-term results are much superior to the portasystemic shunt procedures.

横隔膜下膿瘍에 對한 臨床的考察

朴永寬,崔昌祿,J.R.Sibley,李鐵 계명대학교 醫科大學 外科學敎室同門會 1990 남경 박영관 교수 정년퇴임기념 논문집 Vol.S No.-

A clinical study of 12 cases of subphrenic abscess, treated in Presbyterian HospitaI. Taegu, Korea, between 1960 and 1967, is presented. English speaking Medical literatures on the subject are briefly reviewed, and analysis of important clinical symptoms and signs together with means of surgical drainage is made. 1. In ten cases subphrenic abscess developed following surgery for various primary conditions. and in one case it occured after sustaining a blunt trauma to the abdomen. The predisposing cause in the remainderrof the cases was unknown. 2. The ratio between male and female was 2:1, average age 37.4 years, and the prevalent age range was 40. 3. Chief complaints of the cases studied were intermittent high fever, upper abdominal pain, nausea. and fullness in the upper abdomen. 4. In seven cases, the white cell count was above 10.000/ cu.mm, and in the remainder of the cases it was within normal range. 5. Important X-ray findings were pleural effusion, elevation of the diaphragmatic hemisphere, limitation or absence of the diaphragmatic movement on fluoroscopy, and subphrenit or intraabdominal free air with fluid level. 6. Results of microbiological study were as follows: Single infection………………….10 Mixed infection…………………2 7. Distribution of location: Right side involvemet seven, left side four and bilateral involvement one. 8. Various approaches used for surgical drainage a. Extraperitoneal route used in eight cases. b. Transperitoneal route used in four cases. The latter approach appears to be a direct one and shortest distance to reach and easier one to perform. and also it seems to be accompanied by less postoperative morbidity and higher success rate than the former.

생체 신이식 55예의 생존율에 관한 비교

박영관,조원현,박성대,김현철,박성배,김천일 계명대학교 醫科大學 外科學敎室同門會 1990 남경 박영관 교수 정년퇴임기념 논문집 Vol.S No.-

Various factors that affect the outcome of renal allografts have been studied and analyzed by many authors. In order to compare the results of renal transplantation, we followed up and analyzed the renal transplantation patients which have been performed in our hospital from 1982 through 1987. The overall l and 2 year patient survivals were 91.9% and graft survivals were 87.2%, 75.9%respectively. 100% of 1 year graft survival was observed in 4 cases of HLA identical related living donor and 84.2% for haploidentical group including 2 antigens sharing group in non-related living donor. Their 2 year graft survivals were 100% for full matched group and 78.9% for haploidentical group. In the case of transplantation between siblings, both 1 and 2 year graft survivals were 72.6% and showed no significant difference compare with the group between parent donor and child recipient. Among 55 total cases, 43 cases were done pretransplant transfusion including DST. Compare with66.7% 1 and 2 year graft survivals of non-transfused group, the survivals of transfused group was 89. 5% at 1 year and 75.9% at 2 year(p<0.05). Better graft survivals were observed in the group more than 11 units transfusion before transplantation. According to ischemic time which was defined as duration between the time of clamp of renal artery from donor and revascularization in recipient, 1 year and 2 year graft survival of less than 60minutes grωp(n = 35) were 93.2% and 77.0% but 64.4 % at 1 and 2 year in over 60 minutes group. First urine after finishing vascular anastomosis in recipient was noticed within 5 minutes in 40 cases and their 1 and 2 year graft survivals were 91.5% and 73.9% and these were comparable with the results of the. group that took more than 5 minutes (61.9% at 1 and 2 year). Graft survivals according to other factorsinc1uding donor and recipient age, sex and blood type were also analyzed but showed no significant differences.

만성 교약성 심낭염 (23례 수술 보고)

박영관 대한흉부심장혈관외과학회 1968 Journal of Chest Surgery (J Chest Surg) Vol.1 No.1

In the 10 years from 1958 through 1968, 23 patients have undergone 24 times of operation for constrictive pericarditis at this department. Follow-up data were available for periods varying several months to almost 10 years from examination at this department or follow-up letters. There were 21 males and 2 females in this series. Range of the age varied from 2 years to 53 years. Seven cases were below 15 years of age. There were two hospital death, one expired two weeks and another four weeks after the pericardiectomy. In both of them, myocardial damage by disease process seemed to be major contributing factors. Clinical and histological study showed tuberculous origin in 12 cases, non-specific chronic infiammatory changes in 8 cases and in 3 cases previous pyogenic pericardial infection by staphylococcus preceded to the constriction. In 11 cases bone tissue was noted microscopically in the pericardium: Sixteen patients[70 %]had pleural effusions, five cases had bilateral, 6 right, and 5 left. Calcification was seen along cardiac border in 9 cases. In 15 catheterized patients, 6 showed pressure gradients between vena cava and right atrium, ranging from 6 mmHg to 10 mmHg. One case was reoperated 3 months after the original operation resulting in marked improvement. In this reoperated case the original pericardiectomy seemed to be incomplete. In 21 cases. excluding 2 hospital death, symptoms and physical findings improved markedly in every patient

생명의 맥박을

박영관 신학지남사 1968 신학지남 Vol.35 No.2