상부 기관에 발생한 사구 종양 1예

이승민 ( Seung Min Lee ),이정현 ( Jung Hyun Lee ),황재준 ( Jae Jun Hwang ),이송암 ( Song Am Lee ),이정근 ( Jeong Geun Lee ),김완섭 ( Wan Seop Kim ),한혜승 ( Hye Seung Han ),이태훈 ( Tae Hoon Lee ),유광하 ( Gwang Ha Yoo ),이계영 ( 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.63 No.2

기관 내 사구 종양은 매우 드문 종양이며 일반적인 사구 종양의 증상을 보이지 않다가 크기가 커진 이후에 호흡 곤란이나 객혈, 기침 등의 비특이적인 증상을 보이기 때문에 진단 및 치료가 지연될 수 있다. 따라서 비특이적인 호흡기 증상을 지속적으로 호소하는 환자의 경우 흉부 전산화단층촬영 및 기관지 내시경 등의 적극적인 검사가 필요할 것으로 사료된다. 본 저자들은 호흡 곤란을 주소로 내원한 58세 남자 환자에서 상부 기관 후벽에 발생한 사구 종양 1예를 경험하였기에 이에 대한 문헌 고찰과 함께 보고하는 바이다. A glomus tumor is composed of modified smooth muscle cells that are similar to those of the glomus body. Its occurrence in the trachea is quite rare. To our knowledge, only 20 cases of glomus tumor of the trachea have been reported worldwide and there has been only 1 case in Korea. We report one case of a 58-year-old man with dyspnea who had a glomus tumor in the upper trachea with a review of literatures. The chest CT scan and bronchoscopy demonstrated a 2.5 cm sized lobulated tumor at the posterior wall of the upper trachea. It had an elongated shape with a broad base and with a highly vascularity. A simple resection of 3 levels of the trachearing was with a tumor and end-to-end anastomosis performed. Microscopic and immunohistochemical staining of the tumor revealed the characteristics of a glomus tumor. (Tuberc Respir Dis 2007; 63: 183-187)

원발성 자연 기휴에 대한 2mm 비디오 흉강경 검사

이송암,김광택,박성민,정봉규,선경,김형묵,이인성,Lee, Song-Am,Kim, Kwang-Taik,Park, Sung-Min,Chung, Bong-Kyu,Sun, Kyung,Kim, Hyoung-Mook,Lee, IIn-Sung 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.4

Background: The purpose of this study was to evalute the diagnostic value of 2mm video thoracoscopy for primary spontaneous penumothorax. Material and Method: During the period of March to June 1999, we prospectively analyzed 33 consecutive patients suffering from primary spontaneous pneumothorax. 2mm video-assisted thoracoscopy was compared with the operative finding. We observed recurrence during the mean follow-up of 3months. Result: Blebs were present in 24 patient(73%: 24/33). These were treated by 10mm video-assised thoracoscopic stapling. Nine pateints with no bleb were treated with pleural drainage. There were no significant differences in the bleb finding. No recurrence occurred during the follow-up period. Conclusion: A 2mm video thoracoscopic examination for primary spontaneous pnumothorax is a useful alternative in deciding the operative indication.

후복막강 내시경을 이용한 요추 교감신경절 절제술 - 2례 보고 -

이송암,김광택,백만종,이인성,김형묵,김학제,이건,Lee, Song-Am,Kim, Kwang-Taik,Baek, Man-Jong,Lee, In-Sung,Kim, Hyoung-Mook,Kim, Hark-Jei,Lee, Gun 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.2

고대 안암병원 흉부외과에서는 각각 1개월과 20개월전에 수족장부 다한증으로 흉강경하 흉추 교감신경절 절제술을 시행받았으나 족장부 다한증이 지속되는 환자 2명에 대해 후복막강 내시경을 이용한 요추 교감신경절 절제술을 시행하였다. 첫 번째 환자의 경우 우측에서 트로카 삽입중 기복이 발생하여 개복적 방법으로 전환해야 했으며, 우측 요추 교감신경절의 불완전한 절제로 발한이 지속되어 재수술을 시행하였다. 술후 각각 70일과 30일이 경과한 시점에서 추적관찰하였으며 만족도 결과를 매우만족, 만족, 보통, 불만족으로 평가하였다. 첫 번째 환자는 '매우만족', 두 번째 환자는 항문주위 대상성 다한증이 있었으나 대체로 '만족'을 나타내었다. 족장부 다한증에 대한 후복막강 내시경하 요추 교감신경절 절제술은 통증이 적고 반흔이 작으며, 회복기간과 입원기간을 줄일 수 있어 족장부 다한증의 유용한 치료방법의 하나이다. We have experienced 2 patients who underwent retroperitoneal endoscopic lumbar sympathectomy(RELS) for bilateral plantar hyperhidrosis. They had underwent thoracic sympathectomy by thoracoscopy 20 months and 1 month ago, respectively. The first patient had to be converted to the open procedure due to pneumoperitonium and she was reoperated due to continous sweating by the incomplete sympathectomy on right side. At follow-up after 70 and 30 days postoperatively, RELS results were graded as excellent, good, fair, or poor. The first patient was very satisfied as "Excellent" and the second was slightly less satisfied as "Good" with compensatory hyperhidrosis at perianal area. This RELS is a feasible procedure to plantar hyperhydrosis patients with less pain, minimal scar, short period of convalescence, and short hospital stay.short hospital stay.

국소화 다한증에 대해 보툴리늄 독소를 이용한 치료 -5례보고-

이송암,김광택,박성민,정봉규,선경,김형묵,이인성,Lee, Song-Am,Kim, Kwang-Taik,Park, Sung-Min,Chung, Bong-Kyu,Sun, Kyung,Kim, Hyoung-Mook,Lee, IIn-Sung 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.3

Thoracic sympathicotomy has been used safely and successfully to treat essential hyperhidrosis. However, it has been difficult to treat compansatory hyperhidrosis after thoracic sympathicotomy and focal hyperhidrosis. The sweat glands were innervated by post-ganglionic sympathetic fibers with acetylcholic serving as the transmitter. Botulinum A toxin has been reported to block neuro-transmission at the cholinergic autonomic nerve terminals. Prospecting its effect for the sweat gland, we treated 5 patients with focal hyperhidrosis with botulinum A toxin. Three patients received bilateral thoracic sympathectomy (1 case) and sympathicotomy(2 case) via VAT. The hyperhidrosis area was marked with betadine and was subdivided into squares of 2$\times$2 cm(4$\textrm{cm}^2$) each. Botulinum A toxin was injected intracutaneously in a dosage of 2.5U/0.1ml(100U/4ml) /4$\textrm{cm}^2$. A total dose of 100U of Botulinum A toxin was injected into the affected sites. Subjective assessment of sweat production by the patients using a visual analogue scale showed a 20~70% improvement. During the follow-up period, no toxic effects were observed.

경막외마취하에 비디오 흉강경수술 - 고위험군에서

이송암,김광택,김일현,박성민,백만종,선경,김형묵,이인성,Lee, Song-Am,Kim, Kwang-Taik,Kim, Il-Hyeon,Park, Sung-Min,Baek, Man-Jong,Sun, Kyung,Kim, Hyoung-Mook,Lee, In-Sung 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery (J Chest Surg) Vol.32 No.8

배경: 비디오 기술의 발전과 내시경의 향상으로 비디오 흉강경수술은 기흉, 다한증 및 종격동 종양 같은 몇 몇 질환에서는 표준 수술로서 인정받고 있다. 이러한 비디오 흉강경수술은 전신마취하에 이중기도관에 의한 일측 폐환기가 필요하였다. 그러나 폐질환이 동반된 환자나 전신상태가 나쁜 고령의 환자와 같은 고위험군 의 경우는 일측 폐환기나 전신마취 자체에 대한 위험성이 높다. 대상 및 방법: 1997년 12월부터 1998년 7월 까지, 전신상태가 나빠서 전신마취가 위험한 8례의 환자를 대상으로(농흉 6례, 난치성 흉수 1례, 간질성 폐섬 유증 1례) 경막외마취하에 자가호흡을 유지한 상태에서 비디오 흉강경을 이용하여 흉강내 질환의 진단 및 치료를 시행하였다. 결과: 7례에서 성공적으로 비디오 흉강경수술이 시행되었다. 수술 도중 호흡기능이 저하 되어 전신마취로 전환한 경우가 1례 있었으나 개흉술로 전환한 경우는 없었다. 만성 농흉 환자 2례의 경우 에서, 1례는 재발하여 다시 비디오 흉강경 배농술을 시행하였으며 1례는 수술 후 7일째 흉곽성형술을 시행 하였다. 수술시간은 평균 31.8$\pm$15.2분이었으며 수술 후 호흡합병증이 발생한 경우는 없었다. 결론: 경막외마 취하에 비디오 흉강경을 통한 진단 및 치료는 고위험군에서 안전하게 시행될 수 있는 기법이라고 사료된다. Background: Video-assisted thoracoscopic surgery has become a standard therapy for several diseases such as pneumothorax, hyperhidrosis, mediastinal mass, and so on. These methods usually required single-lung ventilation with double-lumen endobronchial tube to collapse the lung under general anesthesia. However, risks of general anesthesia itself and single-lung ventilation must be considered in high-risk patients. Material and method: Between December 1997 and July 1998, eight high-risk patients (6: empyema, 1: intractable pleural effusion, 1: idiopathic pulmonary fibrosis) with underlying pulmonary disease and poor general condition were treated by video-assisted thoracoscopic surgerys under epidural anesthesia and spontaneous breathing. Result: Video-assisted thoracoscopic surgerys were successfully per formed in 7 patients. Conversion to general anesthesia was required in 1 patient because of decrease in spontaneous breathing. But, conversion to open decortication was not required. In two patients with chronic empyema, one patient required thoracoplasty as a second procedure and one patient required re-video-assisted thoracoscopic procedure due to a recurrence. The mean operative time was 31.8$\pm$15.2 minutes. No significant postoperative respiratory com plication was encountered. Conclusion: Video-assisted thoracoscopic surgerys can be per formed safely under epidural anesthesia for the treatment of empyema and diagnosis of pulmonary abnormalities in high-risk patients.

수부 다한증에서 흉부 3번 교감신경 차단 수술의 효과

김광택,김일현,이송암,백만종,선경,김형묵,이인성,Kim, Kwang-Taek,Kim, Il-Hyun,Lee, Song-Am,Baek, Man-Jong,Sun, Kyung,Kim, Hyoung-Mook,Lee, In-Seong 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery (J Chest Surg) Vol.32 No.8

배경: 본 임상연구는 수부 다한증 환자에서 흉부 3번 교감신경 차단 후 효과를 관찰하였다. 대상 및 방법: 1998년 6월에서 동년 12월까지 수부 다한증을 호소한 50명(여자: 24, 남자: 26)의 환자에서 흉부 3번 교감신 경 차단 수술을 시행하였다. 환자중 수부 다한증만을 호소한 경우가 37명이었으며, 액와부 다한증이 동반된 경우가 13명이었다. 환자의 평균연령은 20세였다. 수술방법은 전기 소작용 가위를 이용하여 양측의 흉부 교 감신경을 차단하였으며, 수부 다한증만을 호소한 경우는 3번 늑골(흉부 2번, 3번 교감신경절 사이)에서 차단 하였으며 액와부 다한증을 동반한 환자는 3번, 4번 늑골에서 교감신경을 차단하였다. 수술 후 다한증의 호전 정도 및 보상성 다한증의 정도와 만족도의 측정은 Linear analogue scale을 이용하여, 수부, 안면부, 체간, 족부 의 땀 분비정도는 무한증을 0로 과다 발한을 10으로 하였으며 만족도는 후회하는 경우 0로 매우 만족해하는 경우를 10으로하여 조사 후 측정하였다. 결과: 모든 환자에서 수술 후 수부 다한증은 호전되었다. 흉부 3번 교감신경 차단 후 수부의 땀 발생 정도의 평균 측정치는 $1.5\pm$0.8로 조사되었으며, 보상성 다한증은 39명 (78%)의 환자에서 발생하였고 평균측정치는 3.4$\pm$1.6이었다. 2명(4%)의 환자에서 미각성 다한증이 발생하였 으며, 수술 후 만족도는 8.5$\pm$1.2였다. 결론: 수부 다한증에서 흉부 3번 교감신경 차단술 시행 후 증상이 호 전되었으며, 안면부 교감신경 기능의 보존과 보상성 다한증의 정도 및 미각성 다한증의 발생빈도가 낮아, 수부 다한증의 일차적 치료로 흉부 3번 교감신경 차단 술의 적용이 합당하다고 생각된다. Background: This study was designed to evaluate the effectiveness of T3 sympathicotomy in treatment of palmar hyperhidrosis. Material and Method: During the period of June to December 1998, 50 patients (24 females and 26 males) suffering from palmar hyperhidrosis either in isolation (n=37) or in combination with axillary hyperhidrosis (n=13) were operated. The mean age of the patients was 20 years. The bilateral sympathetic trunks were severed on the 3rd rib (2nd and 3rd ganglia) for the isolated palmar hyperhidrosis and on the 3rd and 4th ribs for the combined type using electrocoagulation scissors. A linear analogue scale was used to assess the degree of sweating on the palms, face, trunk, and feet (ranged 0 to 10:0 = anhidrosis: 10 = excessive sweating) as well as the patient's satisfaction with the surgery (ranged 0 to 10:0 = regret; 10 = completely satisfied). Result: All of the patients were relieved from palmar hyperhidrosis. A mean palmar sweat production score after T3 sympathicotomy was $1.5\pm$0.8. Some degree of compensatory sweating had occurred in 39 patients (78%) with a mean score of 3.4$\pm$1.6. Gustatory sweating occurred in 2 patients (4%). The mean score of the patient's satisfaction after the surgery was 8.5$\pm$1.2. Conclusion: Palmar hyperhidrosis can be successfully relieved by the T3 sympathicotomy. When considering the advantages of T3 sympathicotomy with respects to a better preservation of facial sympathetic function, less occurrence of severe compensatory sweating, and lower incidence of gustatory sweating. We recommend T3 sympathicotomy as a treatment of choice for palmar hyperhidrosis.

술폰산화 폴리에틸렌옥사이드로 표면개질한 생체동맥의 석회화 저항 효과

김형묵,백만종,선경,이승렬,이송암,김광택,이인성,이원규,박기동,김영하,Kim, Hyoung-Mook,Baek, Man-Jong,Sun, Kyung,Lee, Seung-Yeol,Lee, Song-Am,Kim, Kwang-Taik,Lee, In-Sung,Lee, Won-Kyu,Park, Ki-Dong,Kim, Young-Ha 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery (J Chest Surg) Vol.32 No.11

Background: Calcific degeneration is the major cause of clinical failure of glutaraldehyde (GA) crosslinked bioprosthetic tissues implanted in the body and necessitates the reoperation or causes death. Surface modification of biologic tissues using sulfonated polyethyleneoixde (PEO-SO3) has been suggested to significantly enhance blood compatibility, biostability and calcification-resistance by means of the synergistic effect of highly mobile and hydrophilic PEO chains and electrical repulsion of negatively charged sulfonate groups. This study was designed to evaluate the anticalcification effect of surface-modification of biologic arteries by direct coupling of PEO-SO3 after GA fixation and changes of calcification according to the implantation period through the quantitative investigation of the deposited calcium and phosphorous contents of the biologic arterial tissues in the canine circulatory implantation model. Material and Method: Total of 16 fresh canine carotid arteries were harvested from eight adult dogs and divided in to GA group(n =8) and PEO-SO3 group(n=8). Sulfonation of diamino-terminated PEO was performed using propane sultone. Canine carotid arteries were only crosslinked with 0.65% GA solution in GA group and modified by direct coupling 5% PEO-SO3 solution after GA crosslinkage for 2 days and stabilized by NaBH4 solution for 16 hours in PEO-SO3 group. In both groups the resected segment of bilateral carotid arteries were reconstructed. Reconstructed segments of the two groups were analysed the quantities of calcium and phosphorous contents after 3(n=4) and 6(n=4) weeks in vivo. Result: After implantation of 3 seeks, PEO-SO3 group showed significantly less depositions.

담즙산류과 베타-시이클로덱스트린간의 복합체 형성

이승용(Seung Yong Lee),정연복(Youn Bok Chung),한건(Kun Han),최송암(Song Am Choi) 대한약학회 1994 약학회지 Vol.38 No.1

From phase solubility studies bile acids and bile salts were found to form stable inclusion complexes with beta-cyclodextrin in aqueous solution. Stability constant of bile acids were larger than that of bile salts. Phase solubility diagrams of most bile acids showed Higuchi''s AL type but lithocholic acid showed Bs type. Not only the solubility of bile acids but also that of beta-cyclodextrin increased, especially in cases of cholic acid and ursodeoxycholic acid. Solubility increase of bile acids from their beta-cyclodextrin inclusion complex followed the order : cholic acid>ursodeoxycholic acid>chenodeoxycholic acid>deoxycholic acid>lithocholic acid. It seems that solubility of inclusion complexes was directly related with the hydrophilicity of bile acids.

흉골 골절 환자에서 시행한 심장초음파검사의 유용성

김요한 ( Yo Han Kim ),이송암 ( Song Am Lee ),황은구 ( Eun Gu Hwang ),이진웅 ( Jin Woong Lee ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.2

Background: Sternal fracture may be associated with myocardial contusion even in patients without associated with significant injuries. The aims of this study are to determine the role of echocardiogram(ECHO) in treatment of sternal fracture and to suggest the indication of ECHO. Material and Method: We reviewed the records of 50 consecutive patients presenting with sternal fracture after blunt chest trauma. The relationships between ECHO, creatine kinase MB isoenzyme(CK-MB), electrocardiogram(EKG) were assessed in reference to myocardial contusion. Results: Twelve patients(24%) had one or more abnormal cardiac tests but only 4(8%) had clinically symptomatic myocardial contusion. Eight(22.9%) out of 35 ECHO studies revealed pericardial effusion which was not associated with the severity of all other associated injuries. The incidence of an abnormal ECHO finding in patients of isolated sternal fracture was similar to that of the patients who suffered multiple injuries. In 4 patients with pericardial effusion, this finding was not associated with any other abnormal tests and was regarded as of no clinical cardiac significance. On the other hand, a myocardial contusion was shown by ECHO study only while EKG and CK-MB tests remained normal in that patients. Conclusion: We suggest that the ECHO should be used as a diagnostic and triage tool in every patient with sternal fracture associated with other injuries. However patients with benign epicardial effusion can be discharged as soon as their clinical condition improves regardless of other associate injuries.

단순 흉부 둔상시 늑골촬영에서 미발견된 늑골골절의 진단: 초음파검사의 유용성

김요한 ( Yo Han Kim ),황은구 ( Eun Gu Hwang ),이송암 ( Song Am Lee ),이진웅 ( Jin Woong Lee ),이창희 ( Chang Hee Lee ),최영칠 ( Young Chil Choi ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.1

Background: Rib fractures are the most common injuries resulting from blunt chest trauma. The sensitivity of conventional radiogrphy in showing the rib fracture is limited especially in whom involving the cartilage part of the rib. We investigated the rib fractures, those overlooked on conventional radiography, with the use of ultrasonography in minor blunt chest trauma. Materials and Methods: From september 2002 to March 2004, 40 patients (21 women and 29 men, mean age 43.3±15.1,range 16~85 years), with minor blunt chest trauma showing no evidence of rib fractures on conventional radiography, were admitted for examination with ultrasonography. Logistic regression analysis was done to outlined the clinical predictors of these incidious rib fractures. Results: A total of 15 (35%) patients showed rib lesions, whereas 25 (65%) patients had no evidence of rib lesions. Fractures of rib associated with a periosteal hematoma was the most common finding in ten (66.7%) patients followed by the rib fracture of the rib alone in four (26.7%) patients and subperiosteal hematoma alone in one (6.6%) patient. A total of eight (53.3%) patients had bony rib fractures, whereas seven (46.7%) patients had chondral rib fractures. Age (p=0.280), gender (p=0.431), type of etiology (p=0.823), duration of pain (p=0.470) and site of trauma (p=0.923) did not appear as significant predictors for these rib fractures. However, involved part of the rib showed a significant correlation with either age (p=0.043) or duration of pain (p=0.036). Bony rib fractures significantly occurred in elderly patients, and the duration of pain in patients with bony rib fractures was significantly longer than that of the patients with chondral rib fractures. Conclusions: Ultrasonography is a useful imaging method in showing the rib fractures those overlooked on conventional radiography in minor blunt chest trauma, and no significant clinical feature exists as a predictor for these insidious fractures. However, bony rib fractures significantly occur in elderly patients and result in a longer duration or pain.