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개심술 후 발생한 급성 종격동염과 흉골골수염 : 대망편을 이용한 치료
최강주 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.3
흉골절개술 후 발생한 종격동염은 치명적인 합병증으로 알려져 있다. 종격동에 대망편을 전위하는 방법은 이러한 심각한 합병증을 치료하는 몇 가지 방법 중 하나이다. 흉골절개로 승모판막치환술은 받은 57세 여자환자에게서 발생한 종격동염을 치료하기 위해 대망편 전위술을 시행하였다. 골수염을 가진 흉골을 전부 제거한 후 대망편을 전위시켰다. 수술 후 환자는 특별한 합병증 없이 퇴 원하였다. Post-sternotomy mediastinitis has been known as a lethal complication. Omental flap transposition is one of the few procedures to treat this severe complication. A 57-year-old female patient who underwent mitral valve replacement using median sternotomy was performed omental flap transposition to treat post-sternotomy mediastinitis. The greater omentum was used to fill the space after resection of the infected sternum. After uneventful operation, the patient was discharged with no complications.
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방사선 치료 후 변형 흉곽을 가진 환자에서 발생한 급성 심근경색의 치료
최강주 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.3
방사선은 흉곽과 심장의 모든 구조물에 영향을 줄 수 있다. 관상동맥협착증은 종격동 방사선치료로 유발 될 수 있는 심각한 만기 합병증이다. 10년전 유방암으로 근치적 유방절제술과 흉부방사선치료를 받은 51세 여자 환자에서 발생한 급성 심근경색증의 치료중 중재적 시술이 실패한 후 관상동맥우회술을 시행하였다. 좌측 흉벽 구조물의 심한 변형과 부족한 흉부조직량으로 좌측 내흉동 맥을 사용하지 못하고 우측 내흉동맥을 이용하였다. 우측 내흉동맥을 좌전하행지에 문합하였다. 심낭은 매우 두꺼워져 있었고, 좌전하행지내 내막도 봉합침이 통과하기에 어려울 정도로 두꺼워져 있었다. 환자는 수술 후 합병증 없이 퇴원하였다. Radiation can affect all of the structure in the chest wall and the heart . Coronary stenosis is a severe late complication after mediastinal radiation therapy. A 51-year-old female patient who was treated with left radical mastectomy and radiation therapy for breast cancer 10 years ago, underwent a coronary artery bypass surgery for acute myocardial infarction after percutaneous coronary intervention(PCI). Right internal thoracic artery(RITA) was used as a conduit because of deformed left anterior chest wall. RITA was anastomosed to left anterior descending artery(LAD) under off pump system. The pericardium was very thickened. Marked intimal fibrosis of LAD made penetration of suture needle difficult. After uneventful bypass surgery, the patient was recovered with no complications.
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인삼의 근 , 엽 및 경(莖)의 사포닌 추출과정중 지용성 용매류의 정제효과
주현규,최강주,김석창,고성용 한국농화학회 1987 Applied Biological Chemistry (Appl Biol Chem) Vol.30 No.4
This study was carried out to investigate effects of fat-soluble solvents on the purification against nan-saponin substances such as chlorophylls and other pigments and on the yields of saponins in separating saponins from ginseng root, leaf and stem. Ginseng root saponins were effectively purified by various fat-soluble solvents while ginseng leaf stem saponins were by chloroform. And alternative extractions of ethyl acetate, ethyl ether, chloroform and benzene there more effective for ginseng leaf stem saponins than that by any single solvent. Contents of crude saponin fractions and total ginsenosides in ginseng leaf were 18.5∼19.5% and 10.8∼1.4%, which were very high compared with 4.6∼5.1% and 2.0∼2.6% in ginseng root or 2.2∼2.5% and 0.63∼0.67% in ginseng stem. Therefore, ginseng leaf is good resources for total saponin or ginsenosides-Rg₁, -Re, -Rc, -Rd, -Rb₂ and -Rf.
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황윤호,최강주,조광현 인제대학교 1999 仁濟醫學 Vol.20 No.1
선천성 관상동정맥루는 관상동맥이 정상적으로 대동맥에서 기시하지만 심방, 심실 또는 폐동맥, 관상정맥동, 상공정맥으로 이어지는 길이 있는 비교적 드문 질환으로 임상적인 증세가 없는 경우가 많아 우연히 발견되어 수술하게 되는 것이 보통이다. 본원에서는 이러한 선천성관상동정맥루 3 예를 발견하고 심도자 검사와 심초음파 검사를 통하여 우관상동맥과 우심실 사이의 연결 부위를 확인하여 성공적으로 수술하게 되었기에 보고하는 바이다. We perfomed cardiac operations on 3 patients with congenital coronary arteriovenous fistulas. The diagnosis was confirmed by coronary artery angiography and echocardiography. There was an aneurysmal dilated right coronary artery normally originated from aorta and anomalous fistulous connection from right coronary artery to anterior or inferior wall of right ventricle. The artery was terminated with an aneurysmal dilation in the case 3. The fistula was closed in the right ventricle through the right atrial incision under cardiopulmonary bypass.
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조광현,황윤호,이양행,류지훈,최강주,곽기오,최석철,양영일,최영균,신치만 인제대학교 1999 仁濟醫學 Vol.20 No.1
97년 9월 이후 2예의 동소 심장이식수술을 시행하였는데 대상 환자들은 남녀 각 1명, 나이는 여자는 55세, 남자는 23세이고, 체표면적은 각각 1.54m2, 1.62m2였다. 대상환자들은 확장성 심근증과 제한성 심근증 환자로 NYHA IV 정도의 심한 심부전증 증상이 있었다. 수술 후 면역억제제로는 사이클로스포린, 아자티오프린, 스테로이드를 사용하였다. 첫 번째 환자에서는 수술 10일 후 심근조직검사에서 ISHLT 기준의 I 단계의 거부반응을 보였고, 이후의 조직검사에서는 거부반응이 없었으며 술후 2개월째에 대상포진, 8개월째에는 구강 칸디다증으로 입원 치료를 받았다. 두 번째 학자에서는 술후 2일째 사이클로스포린에 의한 신독증을 보였으나, 순조롭게 회복되어 퇴원하였다. Since September 1997, we have performed two cardiac transplantations in one dilated cardiomyopathy and one restrictive cardiomyopathy. The patients were a 55-year-old female and a 23-year-old male, and their body surface area(m2) were 1.51 and 1.62 respectively. Both patients were suffered from dyspnea as NYHA functional class IV. Postoperative immunosuppression was accomplished with cyclosporine, azathioprine and predinisolone. In case 1, there was an ISHLT grade IA rejection in endomyocardial biopsy at postoperative 9th day which disappeared at the tome of next biopsy 20 days later. The patients were treated for herpes zoster and oral candidiasis at postoperaive 2 months and 8 months, respectively. In case 2, nephrotoxicity related to cyclosporine developed 2 days after the surgery, but was soon resolved and the patient was discharged in good condition.
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술 전 항혈소판제 복합투여가 무심폐기하관상동맥우회술 후 출혈에 미치는 영향
이수경,김태진,송윤석,정선호,양경호,최강주,김용복 영남대학교 의과대학 2011 Yeungnam University Journal of Medicine Vol.28 No.2
Background:Antiplatelet agent administration is critical in managing coronary-artery disease, but there is a concern regarding operation-related bleeding and an increase in blood transfusion in such, especially when delivering combined antiplatelet agents. This study was conducted to evaluate the effect of the administration of antiplatelet agents on off-pump coronary-artery bypass surgery (OPCAB). Methods:From March 2003 to December 2009, 49 patients who had undergone OPCAB were collected retrospectively. The patients were divided into three groups according to the administration of antiplatelet agents before the OPCAB operation: 21 patients were given an aspirin agent (group 1), 19 patients were given combined agents (aspirin+clopidogrel) (group 2), and nine patients were not given any antiplatelet agent (group 3). The three groups’ perioperative hematologic and coagulation profiles, including their platelet counts, hemoglobin levels, hematocrit, prothrombin times, and aPTTs (activated partial thromboplastin times), and their postoperative bleeding, related complications, transfusion requirements, and operation times, were compared. Results:The operation time in group 2 was 4.3 hours, longer than those in the two other groups, and urgent operation was significantly most frequent in group 2 (63%). The amount of blood loss and the number of patients who received blood transfusion were not different in the three groups. The perioperative hemoglobin level, hematocrit, platelet count, prothrombin time, and aPTT were also not significantly different among the three groups. Conclusion:The continuous administration of antiplatelet agents to the patients in this study did not increase their postoperative bleeding or operation-related complications. Therefore, OPCAB may well be considered even if combined antiplatelet agents are being administered.
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