폐흡충증의 외과적 치료

안욱수 대한흉부심장혈관외과학회 1979 Journal of Chest Surgery (J Chest Surg) Vol.12 No.4

1] During the period of Jan. 1959, to Aug. 1979, 47 patients of paragonimiasis have been treated in the department of Chest Surgery. 2] The total number of patients who has been admitted and treated in the department of Chest Medicine are 262 and annual distribution of number of patients has been decreased. However, since 1964, the number of patients has been stationary. On the other hand, the total number of patients who has been admitted and treated surgically in the department of Chest Surgery are 47 and the annual distribution of number of patients has not been decreased. 3] The peak age incidence lies in fourth decade [34%], and over halves of patients is in third to fifth decade. Male to female is 8.4 to 1. 4] The symptoms, which are mainly cough, chest pain, dyspnea and blood tinged sputum, developed mostly in two to five years after infestation by Paragonmius westermani. 5] Sputum tests for eggs of Paragonimus westermani were positive in 16 out of 43 patients [37%]. The 93% of patients were positive in skin test for Paragonimus westermani. The patients with negative skin test were 7%, but sputum or stool examination for Paragonimus westermani`s eggs were positive in these negative group of skin test. 6] Chest roentgenogram revealed pleural effusion [41 cases], hydropneumothorax [1 case], atelectasis [1 case] and mediastinal mass [1 case]. 7] All patients were preoperatively treated with Bithionol. The mode of surgery were decortication only [31 cases], pleuropneumonectomy [3 cases], decortication & lobectomy [2 cases], decortication & closure of bronchial fistula [1 case], thoracentesis [1 case] and postural drainage [1 case]. 8] Paragonimiasis is primarily medical disease and well treated by the administration of Bithionol. But the delayed diagnosis and missed diagnosis, especially as pulmonary tuberculosis, make the disease aggravated and chronic. Subsequently, surgical treatment is infrequently required. Chronic empyema due to Paragonimus westermani is much benign than tuberculous empyema thoracis.

부식성 식도협착부위에 발생한 식도암 - 14례 보고 -

안욱수 대한흉부심장혈관외과학회 1990 Journal of Chest Surgery (J Chest Surg) Vol.23 No.1

Between Dec. 1958 and Oct. 1989, we had been experienced 14 cases of the esophageal corrosion carcinoma among 562 cases of corrosive esophageal stricture, which incidence was revealed 5.6 % of total esophageal carcinoma cases and 2.5 9o of total benign esophageal stricture cases. The age distribution was from 15 to 64 years, and the mean age was 45.6 years. Ten of the patients were women. The caustic agents were lye in 12 patients and hydrochloric acid in 2 patients. The latent time from injury to the development of carcinoma was from 12 years to 45 years, and the mean latent time was 29 years. In majority of cases, the developing site of carcinoma was just or just above the benign stricture portion of the esophagus. Corrective surgery were made in seven cases; three cases were made esophagectomy and esophagogastrostomy, and the other four cases were made esophagectomy and colon interposition. Palliative surgery including feeding gastrostomy were made in seven cases. All cases had a longstanding history of difficult oral swallowing especially at the site of stricture. We think chronic food irritations of stricture portion of the esophagus induced the development of corrosion carcinoma. In conclusion, we had to suspect possibility of carcinoma in patient with long standing history of benign esophageal stricture. So we recommended preoperative esophagoscopic biopsy in such cases.

개심술시 자가 수혈체계[Cell Saver]의 이용 효과

안욱수 대한흉부심장혈관외과학회 1992 Journal of Chest Surgery (J Chest Surg) Vol.25 No.11

Autologous blood transfusion is a common method of reducing the need for homologous blood transfusion during cardiac operations. Between June 1991 and May 1992, 12 cases [Group I] were experienced autologous blood transfusion using Cell Saver undergoing double valve replacement or redo-valve replacement. Control group [N=12, Group II] was selected to above similar operation during same period. The Cell Saver system [Haemonetics Corp.] was employed for autologous blood transfusion. The blood shed in the operative field before and after cardiopulmonary bypass and remained cardiotomy reservior was aspirated by means of a locally heparinized collecting system. After centrifused salvaged blood, the resulting red cell concentrate reinfused subsequently. The patient receiving autologous blood transfusion required significantly less homologous blood transfusion than their control group. [Group I; 3519 $\pm$ 869, Group II; 4622 $\pm$ 856, Respectively; P=0.005] There were no clinical infections in the autotransfusion group. And there was no apparent intergroup difference of the clinical findings, hematologio datas and coagulation parameters. We conclude the autotransfusion using Cell Saver is effective for reducing of the hom-ologlous blood transfusion in cardiac surgery.

성인 활로씨 사징증의 외과적 교정

안욱수 대한흉부심장혈관외과학회 1991 Journal of Chest Surgery (J Chest Surg) Vol.24 No.1

This report describes our 10-year experience with intracardiac repair in 42 patients older than 16 year with tetralogy of Fallot. The mean age was 22.0$\pm$5.18 years[range 16~41]. The preoperative clinical manifestations were cyanosis & clubbing[93%], frequent URI [55%], anoxic spell[40%], pulmonary tuberculosis[21%], tuberculous empyema[7%], chronic renal failure[7%], congestive heart failure[7%] and subacute bacterial endocarditis [2%], etc. The previous shunt procedure for palliation had been performed in 7 patients. The type of VSD were typical perimembranous type[67%], total canal defect[28%] and combined type[5%]. The right ventricular outflow tract obstruction were combined type[69%], infundibular type[21%] and valvular type[10%]. Transannular patch was used in 50% of patients. Associated cardiovascular anomalies were ASD[33%], PFO[31%], Rt. aortic arch[10%], Lt. SVC[10%], single Rt. pulmonary artery, single Lt. coronary artery, ASI, proximal stenosis of Rt. pulmonary artery and anomalous systemic venous return, etc. Hospital mortality was 7.1%[3 cases]in overall. The causes of hospital deaths were revealed low cardiac output & acute renal failure[2 cases], postoperative bleeding[1 case]. There were 2 late deaths 3 & 68 months after surgery. Residual intracardiac shunt was detected in 2 patients. one patient was successfully reoperated and another patient had Qp /Qs ratio less than 1.5.

소아 흉부질환에 대한 임상적 고찰 [비심장혈관계 질환]

안욱수 대한흉부심장혈관외과학회 1981 Journal of Chest Surgery (J Chest Surg) Vol.14 No.3

The results of reconstruction of the lower esophagus with jejunum in a total of 24 cases of primary carcinoma of the lower third esophagus and gastroesophageal carcinoma were presented, and clinical values of substitution for the esophagus with jejunum were also discussed. They were operated in the department of thoracic and cardiovascular surgery, Hanyang University Hospital during the period of 9 years from 1972 to 1981. Surgical managements to lower esophageal reconstruction with jejunum were carded out with not the same procedure in all cases studied, but with three different procedure mentioned below/ In 13 cases of lower third esophagectomy with or without partial `8astrectomy of a total of 24 cases, interposition of jejunum between the esophagus and the stomach were performed after the fashion to esophagojejunostomy with mobilized jejunal loops and 8astro-JeJunostomy with side to side anastomosis. In 7 cases of lower third esophagectomy and total gastrectomy, the continuity of the esophagus were performed the fashion to esophagojejunostomy with mobilized jejunum. In 4 cases of unresectable gastro-esophageal carcinoma, bypass operation of the lower esophagus and the stomach were performed after the fashion to esophagojejunostomy with side to and anastomosis. After the bypass operation, it was observed that oral feeding to the patients was excellent. Following these consecutive series of 20 cases of radical operation for lower esophageal carcinomas and 4 cases of bypass operation for unresectable gastroesophageal carcinomas, no complication such as postoperative leakage and stenosis from anastomotic site or Infection In operating area and operative death were observed.

재수술을 요한 식도재건술 환자의 원인분석과 임상적 고찰

안욱수 대한흉부심장혈관외과학회 1992 Journal of Chest Surgery (J Chest Surg) Vol.25 No.2

Reconstructive surgery for corrosive esophageal stricture was performed in 392 patients at National Medical Center from 1959 to 1990 Between Jan. 1971 and Dec. 1990, 23 cases were experienced stenotic anastoma of neck after reconstructive surgery for corrosive esophageal stricture. The major procedure of esophageal reconstruction was colon interposition without resection of the strictured esophagus except jejunal interposition in 1 case. There were 12 males % 11 females, and mean age was forty years. The caustic materials were 16[70%] alkali and 7[30%] acid. Half of the cases had hypopharyngeal injury. After reconstructed surgery, dysphagia was developed immediate in 65%, from 2 months to 5 months in 31%, and from years in 4%[1 case]. The complications were anastomatic leakage in 13 cases, anastomatic stenosis in 8 cases, graft gangrene in 1 case, and cancer development in 1 case. The therapeutic procedures were end-to-end anstomolis & partial resection of stenotic anastoma in 18 cases, bourgination in 2 cases, and coin interposition with graft removal in 3 cases. The therapeutic results were excellent in 16 cases, mild discomfort in 3 cases, poor in 3 cases, and death in 1 cases.

경피적 관상동맥성형술후 응급 관상동맥 우회로 조성술 경험

안욱수 대한흉부심장혈관외과학회 1988 Journal of Chest Surgery (J Chest Surg) Vol.21 No.2

Since the introduction of percutaneous; transluminal coronary angioplasty[PTCA] by Grunt-zig in 1977, this is widely used in some patients with coronary artery disease and is an effective alternative to surgery for many patients. Indications for emergency coronary artery bypass graft[CABG] after PTCA are prolonged chest pain, worsening of coronary artery obstruction, "current of injury" by electrocardiogram, cardiogenic shock, and in a lesser incidence, ventricular fibrillation, coronary artery dissection[without obstruction], heart block, and intractable cardiac arrest. Recently, we have experienced one case of emergency CABG following unsuccessful PTCA. The patient was 54 year-old male and admitted with complaint of angina pectoris. The routine electrocardiogram revealed within normal limit. The treadmill test revealed severe chest pain after 2 min. exercise. Coronary cineangiogram revealed 95% segmental stenosis of the proximal right coronary artery. Our cardiologist was planned PTCA. During PTCA, severe chest pain and ischemic pattern on electrocardiogram were developed. But they were not relieved even by morphine and nitroglycerin till 90 min. So we performed emergency single coronary artery bypass graft from aorta to proximal right coronary artery with great saphenous vein. The patient had an excellent postoperative recovery and was free from anginal attack. He has shown striking improvement in general status[NYHA functional class 1] during 6 months after operation.operation.

Western Blot에 의한 肝吸蟲抗原의 分析

이옥란,안욱수 순천향대학교 1989 논문집 Vol.12 No.1

The antigenicities of Clonorchis sinensis antigens(worm extract crude antigen: CA) were analyzed by Western blot. Clonorchis sinensis antgens were fractionated by SDS-polyacrylamide gel electrophoresis(SDS-PAGE), and the fractionated antigens were subsequently transfered to nitrocellulose paper. The blots on nitrocellulose strips were then reacted with anti-Clonorchis sinensis rabbit sera by ELISA(Enzyme-linked immuno-electrotransfer bolt:EITB). The results were as follows: 1. Clonorchis sinensis antigens by SDS-PAGE were fractionated with 35 polypeptide bands on 10% gel in range of molecular weights 10,000-92.500 daltons. Major polypeptide bands mainly consisted of low molecular weight, less than 31,000 dalton. 2. By EITB, the fractionated antigens transfered onto nitrocellulose paper from SDS-PAGE gel made 9 major antibody-binding bands wth anti-Clonorchis sinensis rabbits sera. In generally, the antibody-binding bands on nitrocellulose strips were diffuse and does not resolve in clear-cut bands. The molecular weights of 9 bands were at 70,000-72,000(a), 45,000(b), 40,000-41,000(B), 36,000-38,000(c), 33,000-34,000(d), 30,000-31,000(e), 27,000-29,000(f), 16,000-18,000(g) and 10,000-13,000(h) daltons. Of these the most dominant band is seen at band c of 36,000-38,000 dalton. By period of infection, the antibody-binding bands showed at the 3rd week after infection in all infected rabbits, but showed occasionally at the 1st or 2nd week in heavily infected rabbits individuals. The antibody-binding bands g εh were not found at 3rd week in all rabbits, mostly were found at 5th-7th week except showed rarely at 4rd week in heavily infected rabbits individuals. By intensity of infection(worm burden), antibody-binding strength were a little difference, but particularly were not difference in chronic period(in plateu of antibody titer). Antibody-binding g ε h bands were not found in lightly infected rabbits individuals. By rabbits individuals, antibody-binding strength were a difference in some degree. And formation of some antibody-binding bands were a difference in some rabbits. Antibody-binding bands a-d were found in all rabbits, but f-h bands were not found one or some of these bands according to rabbits individuals. summarizing the above results, Clonorchis sinensis antigens were analyzed with several antigenic components by Western blot analysis, and some these antigens showed a difference of antibody-binding bands according to infection-period, -intensity and -rabbits individuals.

비디오 흉강경을 이용한 자연기흉의 수술요법

권오춘,안욱수 대구효성가톨릭 대학교 1997 연구논문집 Vol.54 No.2

Primary spontaneous pneumothorax has an annual incidence of 9 cases per 100,000 populations, especially high incidence in young adults. Thoracoscopic surgery is not new, but its applications to chest surgery have been more increasing with advanced video technology and instrumentation. We performed 15 cases of bullectomy using video-assisted thoracoscopy(VATS) for patients of pneumothorax. The mean age of patients was 25.1±7.6 years old, 105.5±40.1 minutes of mean operation times, and 3.2±1.9 days of postoperative tube indwelling time. Postoperative complications were persistent air leakage in one case, which was converted to open thoracotomy later, and recurrence of pneumothotax in one case. Video-assisted thoracoscopic bullectomy is effective alternative to thoracotomy for treatment of pneumothorax in terms of short hospital stay, less morbidity, low rate of recurrence, less pain, and good cosmetic results. But objective comparison with mini-thoracotomy will be needed in many aspects.

肝吸蟲 感染家兎의 免疫診斷에 對한 硏究 1. 全蟲體 抽出物 粗抗原에 대한 ELISA

李玉蘭,安郁洙 순천향대학교 1987 논문집 Vol.10 No.2

Enzyme-linked immunosorbent a assay(ELIST) using crude antigen of Clonorchis sinensis was performed for infected rabbit sera with different worm burden, from preinfection to 32th or 50th week after infection. The crude antigen was used the supernatant of homogenated adult worms centrifuged for 1 hr. at 15,000rpm. All rabbits(18) were divided into 4 groups(G-Ⅰ, G-Ⅱ, G-Ⅲ, G-Ⅳ) by different worm burden. The mean of recovered worms(±SD) and the number of rabbits in each group were as follows : G-Ⅰ, 5.4(±2.5) and five : G-Ⅱ, 168.3(±27.4) and three : G-Ⅲ, 317.8(±53.2) and five : G-Ⅳ, 817(±155.6) and five rabbits. The conjugate used in ELISA was Alkaline phosphatase conjugated anti-rabbit IgG, and substrate was p-nitrophenyl phosphate. The results were summarized as follows : 1. The optical density(OD) values(antibody levels) as mean of each group increased significantly at the 4th week(P<0.01) in G-Ⅰ : 3rd week (P<0.02) in G-Ⅱ and 4rd week in G-Ⅲ & G-Ⅳ. The mean OD values of groups reached 1.0 or more at 5th week in G-Ⅰ& G-Ⅱ and 4rd week in G-Ⅲ & G-Ⅳ. The mean OD values of groups increased every weekly to 10th(G-Ⅱ)-12th(G-Ⅰ & G-Ⅲ)-14th(G-Ⅳ) week, and after that the mean OD values of groups maintained plateau though repeatedly rise and fall(but no significantly) of mean OD values. The mean OD values of each group during plateau period were 1.606-1.794 in G-Ⅰ : 1.719-1.916 in G-Ⅱ : 1.783-1.947 in G-Ⅲ : 1.829->2 in G-Ⅳ. 2. The proportional relationship of worm burden and antibody levels(OD values) were more sensitive until 6th week after infection. The mean OD values of G-Ⅰ were significantly lower than thats of lst week in G-Ⅱ(P<0.02), 3rd-5rd-6th week in G-Ⅲ(P<0.001-P<0.05-P<0.01) and lst-3rd-4rd-5th-6th in G-Ⅳ(P<0.02-P<0.01-P<0.05-p<0.05-P<0.01). The G-Ⅱ were lower than thats of 3rd week in G-Ⅲ & G-Ⅳ(P<0.02), and the G-Ⅲ was lower than that of 3rd week in G-Ⅳ(P<0.05). The mean OD values of all groups were not revealed significant difference(P>0.05) from 8th week to 14th week with each others. The mean OD values of G-Ⅰ sometimes were lower than thats of G-Ⅲ & G-Ⅳ from 16th week to 32th week, and the mean OD values of G-Ⅱ & G-Ⅲ & G-Ⅳ were not revealed significant difference except 3rd week. 3. The individual animals of all groups became OD values 1.0 and more at 3rd to 5th weeks(except one, at 8th). The antibody levels in several individuals were not closely related with worm burden. The OD values were not reached to OD values 1.0 over in all individuals of G-Ⅰ. The individuals in G-Ⅲ & G-Ⅳ were showed OD values 2.0 over(>2) for remaining weeks after 16th week approximately. Consequently, the detection of antibody of rabbit clonorchiasis in ELISA was very sensitive, but there were a difference of antibody levels according to individual animals.