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出血性 Shock에서 Steroid가 血液 pH, 血淸 Acid Phophastase 및 肝細胞의 微細形態學的 構造에 미치는 影響에 關하여
長秀一,洪善憙 慶北大學校 醫科大學 1974 慶北醫大誌 Vol.15 No.2
外見上 健康한 雜種成犬 14마리를 steroid投與群(7마리)과 非投與群(7마리)으로 나누어 血壓 40mmHg內外 의 出血性 shock를 惹起시킨 다음 每 時間마다 4時間에 걸쳐 4回, 血液 pH 및 血淸 acid phosphatase活 性度를 測定하고 出血性 shock 4時間 後의 肝細胞의 微細形態學的構造의 變化를 觀察한 成績은 다음과 같다. 1. 血液 pH는 兩群에서 다 같이 減少하는 傾向이었으나 steroid投與群에서는 輕微하였다. 2. 血淸 acid phosphatase活成度는 steroid非投與群에서는 時間의 經過와 더불어 增加하였는데 比해서 steroid投與群에서는 shock持續 4時間後 以外는 有意한 增加를 볼 수 없었다. 3. 電子顯微鏡的으로 肝細胞에 있어서는 steroid非投與群에서 lysosome은 主로 primary 및 secondary lysosome의 顯著한 增加, rER에는 水胞化, 空胞化, ribosome의 脫落, 斷裂等을 特徵으로 하는 變性性 變 化를, 그리고 mitochondria는 腫脹 및 cristae의 減少를 나타내는 變性性變化를 觀察할 수 있었다. 그리 고 出血性 shock時 steroid를 投與한 群에서는 上記한 變化들이 steroid非投與群에 比해서 顯著히 輕微 하였다. 4. 以上의 硏究成績으로 보아 出血性 shock時 steroid投與는 生化學的으로는 acid phosphatase活性度의 抑制, 電子顯微鏡的으로는 肝細胞 lysosome의 減少等을 招來하는 것으로 보아 steroid投與가 어느 程度 의 組織灌流를 好轉시킬 수 있을것으로 期待되며 따라서 shock治療에 相當한 도움이 될것이라 믿어진다. A convenient quantitative monitor of the extent of cellular damage is the amount of intracellular lysosomal enzyme released through the single-unit lysosomal membrane during a stress period. A lysosomal membrane-stabilizing action of glucocorticoids in shock eliminates the deleterious effect of the lysosomal hydrolase per se, that is, splanchnic vasoconstriction, capillary leakage, and sensitizing the heart to toxic factors, as well as their participation in the elaboration of a myocardial depressant factor. Attention has been directed previously to the ultrastructural changes produced by hypoxia, but a few investigators have described alterations in various organs at some phase of shock produced by different methods. In the present study, the effect of corticosteroids on hepatocellular ultrastructure in shock was observed with serial measurement of the blood pH and serum concentration of the lysosomal enzyme acid phosphtase in untreated and steroid treated dogs subjected to hemorrhagic shock and the following results were obtained. The elevation in serum acid phosphatase was considerably less in steroid treated dogs as compared to untreated animals showing progressive increase in enzyme values. In steroid treated dogs, the blood pH levels showed less tendency to be reduced as compared to untreated ones. The ultrastructure of hepatocyte after hemorrhgic shock in untreated group revealed degenerative changes characterized by primarily an apparent increase in the number of primary and secondary lysosomes with vesiculation, vacuolation, fragmentation and ribosomal shedding of rER. And also observed that degenerative changes showing swelling of mitochondria with the decrease of cristae. In steroid treated group, mostly ultrastructural alterations of intracellular organelles were not severe as compared to untreated one. These findings suggested that steroids are efficacious in the treatment of shock by improving tissue perfusion related to the decrease of hepatocellular lysosomes electron microscopically as well as the inhibition of acid phosphatase biochemically.
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張秀一 慶北大學校 醫科大學 1981 慶北醫大誌 Vol.22 No.2
1974年 5月부터 1980年 4月까지 滿 6年間 一次吻合術이 어려운 긴 間隔의 先天性食道閉鎖症 및 氣管食道瘻로 New York Babies Hospital 에 入院手術한 男兒 3例 女兒 2例를 對象으로 臨床的 觀察을 하였다. 上下食道端間의 間隔은 2.5㎝ 以上이었고 兩端內腔을 通하는 絹縫合絲를 利用하여 縫合絲瘻孔形成을 試圖하였다. 全例에서 術後初期觀察成績은 滿足할만 하였고 嚥下에 아무런 支障이 없었고 全例에서의 食道機能은 良好하였다. 그러나 長期遠隔 觀察結果 全例에서 胃食道逆流症(gastroesophageal reflux)이 있었으며 內科的治療에 好轉되지 않아 Nissen fundoplication後 臨床的 혹은 食道造影像 好轉을 가져왔다. 本法을 利用하므로써 從來에 一次的 根治術이 不可能한 例에서 向後 多段階的 手術이 必要한 食道置換術을 避할 수 있으리라 믿어진다. A clinical observation was made on five infants with long gap esophageal atresia who were admitted to NewYork Babies Hospital from May, 1974 through June, 1980. In each case, a fistula was created between the upper and lower esophageal segment by means of a central silk suture. The results in these children were initially gratifying. All of the cases swallowed without problem and had functioning esophagus. However, longterm follow-up of these children demonstrated a significant gastroesophageal reflux. Following Nissen fundoplication as treatment of the gastroesophageal reflux, all cases were clinically and radiographically improved. Author believes that adoption of this technique in selected cases will reduce the need of esophageal replacement in the future.
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장수일 慶北大學校 醫科大學 1980 慶北醫大誌 Vol.21 No.1
1977년 6월부터 1980년 5월까지 경북대학교 의과대학 외과학교실에 입원하여 수술받은 췌장손상 17예에 대한 입상적 고찰을 하여 다음과 같은 결과를 얻었다. 1) 성별빈도는 남자 15예, 여자 2예였으며 연령별 빈도는 10대, 20대 및 30대에 14명으로 가장 많았다. 2) 비관통상이 15예, 관통상이 2예였다. 3) 복통 및 압통은 전예에서, 반발통은 12예에서, 복부강직은 8예에서, 복부팽만은 11예서, shock증상은 4예에서 볼 수 있었다. 4) 15예에서 백혈구수가 증가되어 있었으며, 11예에서 수술전 혈청 Amylase치를 측정하였다. 그 중 7예에서 정상치보다 증가되어 있었다. 15예서 복부천자를 실시하여 14예서 복강내 출혈을 증명할 수 있었다. 5) 17예중 8예에서 타장기의 손상을 병발하고 있었다. 6) 손상부위는 두부가 4예, 경부 4예, 체부 6예, 및 미단부 3예로 비슷하였다. 7) 손상정도는 class Ⅰ이 7예, class Ⅱ가 8예, calss Ⅲ이 2예 이었다. 8) 췌장주관 손상이 없다고 판정된 7예에서 단순배액술 및 단순봉합술을, 췌장주관의 손상이 있다고 육안으로 확인된 10예에서는 절제수술을 실시하였다. 9) 17예중 11예에서 수술후 합병증이 병발하였고 그중 췌루가 8예로 가장 많았다. 그중 5예는 1달이내에 자연 치유되었으나 나머지 3예중 2예는 패혈증 및 대량출혈로 사망하였으며 1예는 3개월후 원위부 췌장절제술로 치유되었다. 10) 17예중 2명이 사망하여 사망률은 12%였다. The mortality and morbidity after pancreatic trauma remain high. The mortality of pancreatic trauma is known as 20%. Approximately one third the patients with pancreatic trauma will have the complications of a pseudocyst, severe hemorrhage, intra-abdominal abscess, recurrent pancreatitis, or persistent fistula. So it is apparent that pancreatic injury is one of the major unsolved problems in trauma. In an effort to improve the results of management of patients with pancreatic injuries, author reviewed the records of seventeen patients who were treated for pancreatic injuries at the department of general surgery, Kyungpook national university school of medicine.
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장수일 최신의학사 1976 最新醫學 Vol.19 No.3
Torsion of an accesory spleen is a rare abdominal emergency. A case of torsion of an accessory spleen in a boy of 8 years is reported. The clinical picture presented was that of acute appendicitis. At operation a normal spleen was found in the usual anatomical position. The large accessory spleen was situated in the free margin of the greater omentum and had twisted clockwise through many circles. Other associated abnormalities were not noted.
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장수일 慶北大學校 醫科大學 1980 慶北醫大誌 Vol.21 No.1
A statistical study of liver abscess was made for 94 patients, who were treated at Department of Surgery of Kyungpook National University Hospital from March 1968 to December 1979. The results are as follows: Of 94 cases of liver abscess, 55(58.5%) were amebic and 39(41. 5%) were pyogenic. The ratio of males to females was 3.3 : 1, and the highest age incidence was in the fifth decade(33%). The location of liver abscess was right lobe in 74.5%, left lobe in 7.5%, and both lobes in 18%. The ratio of single abscess to multiple abscess was 4 : 1. The principal symptoms and signs were abdominal pain (86.2%), fever (68%). abdominal tenderness (62.7%), and enlargement of liver (58.5%). The past history of intestinal amebiasis was obtained in 25.5% of the 55 amebic cases. The antecedent causes of 39 pyogenic cases were cholecystitis in 4 cases, and appendicitis, hepatic abscess, blunt abdominal trauma in 2 cases, respectively. The abnormal findings in chest X-ray were presented in 68.9%. Elevation of right hemidiaphragm (36%) and pleural effusion (14.5%) were most frequent findings. Liver scans showed cold area in 90.9%, which was a decisive finding in making diagnosis. In case with pyogenic abscess, positive culture was 41% with similar incidence of Gram (+) and Gram (-) organisms. Closed drainage was done in 23.4% and open drainage in 76.6%. The mode of open drainage was the transperitoneal approach in 50.9%, transpleural in 23.4% and extraserous in 2.3%. The overall mortality was 7.4% ; in amebic 3.6% and in pyogenic 13%. The cause of death was septicemia and hepatic failure.
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