• 대한핵의학회지
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• 제11권1호
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• pp.59-70
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• 1977

Eight patients with polycythemia vera were diagnosed from 1965 through 1977 among the patients of Seoul National University Hospital. In our series there were 4 men and 4 women with average age of 54 years at the time of diagnosis. Symptoms of facial plethora, headache, pruritus and dizziness were the most frequent manifestations of disease in order of frequency. At inital examination 8 of 8 patients had facial plethora, 6 of 8 patients splenomegaly and 4 if 8 patients hepatomegaly. The laboratory data revealed mean Red cell volume of 55+10ml/kg which was elevated in all cases. Leukocytosis was observed in 5 of 8 patients and thrombocytosis 2 of 8 patients. Leukocyte alkaline phosphatase was increased in all cases. Bone marrow aspiration disclosed typical panmyelosis in 5 of 8 patients. In one patient there was diffuse myelofibrosis on bone marrow biopsy. The combined diseases included 2 patient with hypertension and 1 patient with thrombosis of aorta and left renal artery. The patients were treated with phlebotomy alone in 2 patients, chemotherapy with busulfan in 1 patient and $^{32}P$ in 5 patients with favorable results. During the mean 29.9 months follow up period, there were development of iron deficiency in 3 patients, hyperuricemia in 2 patients and thrombosis in 1 patient. The occurrence of acute leukemia of myelofibrosis was not observed in the course of disease.

• 한국임상수의학회지
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• 제39권4호
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• pp.177-184
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• 2022

Caval syndrome is a severe complication of canine heartworm disease in which affected dogs present with various clinical signs that are often life-threatening. In cases of severe infection, adulticidal treatment has numerous complications as a result of a marked immune response against dead worms. Therefore, several surgical and non-surgical methods, including interventional extraction, have been applied in veterinary medicine. Despite the usefulness and efficiency of conventional retrieval devices, a few associated limitations must be addressed to reduce their risks and increase their applicability. Herein, we introduced a case of treating three dogs with caval syndrome by applying a newly developed heartworm basket device. The dogs were diagnosed with heartworm disease by heartworm antigen testing and direct smear. Imaging findings revealed remarkable remodeling of the right heart and pulmonary vessels and the presence of heartworms in the right heart. Additionally, heartworms were confirmed in the distal part of the abdominal aorta and femoral arteries in one dog, indicating aberrant systemic migration of the worms. Under general anesthesia, the heartworm basket device was introduced into the right heart via femoral venotomy and arteriotomy in one dog and jugular venotomy in the other two dogs. Although the number of cases in this study was small, the basket device was successful in gradual and cautious extraction of the heartworms in all three dogs. They exhibited good prognosis of clinical symptoms as indicated by imaging analyses.

• 대한방사선기술학회지:방사선기술과학
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• 제29권4호
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• pp.249-255
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• 2006

목 적: 양전자방출단층검사(Fluorine-18 2-Deoxy-D-Glucose positron emission tomography : $^{18}F-FDG$ PET)는 가시적 영상분석과 반정량적 섭취계수 분석 방법을 사용하여 폐의 염증성 질환과 폐암을 구별 및 진단하는 데 유용하다. 일반적으로 표준화섭취계수(Standardized Uptake Value : SUV)가 폐 질환의 진단에 사용되지만, 이는 폐 조직에 있어서 반정량적, 정량적 분석을 통한 동적인 정보를 포함하지 않는다. 그러므로, 본 연구는 $^{18}F-FDG$ PET 검사에서 폐 질환의 동적 섭취 분석이 보다 정확한 대상질환의 진단을 유용하게 할 수 있을 것이라는 가정하에 시간-방사능 곡선(Time-Activity Curve: TAC), 표준화섭취계수-동적곡선(Standardized Uptake Value-Dynamic Curve : SUV-DC), 패트락 분석법(Patlak analysis : Glucose Metabolic Rate(MRGlu))을 토대로 얻은 분석방법을 이용하여 진단적 유용성을 평가하였다. 대상 및 방법: 폐 질환을 가진 17명의 환자를 대상을 하여, 각각 60분간 Dynamic $^{18}F-FDG$ PET검사를 시행하였다. 획득한 정보를 통하여 폐질환의 형태를 따라 관심영역(Region of Interest: ROI)를 그린 후, 반정량적 분석인 TAC, SUV-DC와 정량적 분석인 Patlak analysis를 각각의 군에 따라 분석하여 비교 분석하였다. 결 과: Dynamic $^{18}F-FDG$ PET을 통한 분석결과, TAC 형태는 초기 혈류상에서 폐의 염증성 질환과 폐암의 구분이 어려웠으나, 시간이 지날수록 폐암의 곡선이 염증성 질환의 경우보다 확연히 증가하였다. SUV-DC의 경우는 TAC 형태와 거의 유사한 형태를 가졌다. Patlak analysis 분석결과, 대동맥 영역에서는 폐의 염증성 질환이 폐암보다 높은 혈액 방사능을 보였으나 시간이 지남에 따라 염증성 질환의 혈액 방사능이 극히 낮아졌다. 반면, 병변 조직에서는 폐암이 가장 높은 섭취를 보였으며 폐의 염증성 질환은 중간 정도에 머물렀다. 결 론: TAC와 SUV-DC 분석에서 폐암과 폐의 염증성 질환은 각각 고유한 그래프 형태를 띠었으며 Patlak analysis에서 역시 주목할 만한 차이를 보였다. 따라서 이러한 분석법을 토대로 좀더 깊이 있는 연구가 진행된다면 비침습적으로 폐의 질환을 구별하는 데 보다 적절하고 유용한 진단적 정보를 얻을 수 있을 것이다.

• Journal of Chest Surgery
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• 제29권2호
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• pp.171-176
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• 1996

1983년 3월부터 1994년 6월까지 22명의 환자에게 관상동맥 우회로 조성수술과 병행한 개심수술을 시행하였다. 대상환자들의 연령은 42세에서 72세 사이로 평균 60.4$\pm$8.2세였다. 이중 17명의 환자가 남자였고, 여자환자는 5명이 었다. 좌심실 박출계수는 25%에서 65% 사이로 평균 46.9 $\pm$ 14.2%였다. 22명의 대상환자중 9명이 심근경색증의 합병증으로 발생한 기계적인 장애를 동반하고 있었으며, 이중 5명은 좌심실류, 3명은 심실중격 결손 그리고 1명은 유두근 파열에 의한승모판 폐쇄부전증이 롱반되었다. 나머지 대상환자중 9명은 류마티스성 판막질환(대동맥판막 질환 7명, 승모판막 질환 2명)을 동반하였고, 2명은 좌심방혈전, 1명은 심방중격 결손 그리고 1명은 상행대동맥류를 동반하였다. 관상동맥 이식 편수는 1개에서 4개 사이로 평균 2.1$\pm$1.0개였다 수술후 합병증은 3명에서 발생하였으며, 이중 2명은 수술전후 심근경색증, 1명은 하지의 창상감염이었다. 수술사망은 1명에서 발생하였으며, 사망원인은 수술전후 심근경색증에 의한 저심박출량에 기인하였다. 추적조사 기간은 3개월에서 136개월 사이로 평균 41.1$\pm$ 40.2개월이었으며, 이기간 동안 1명\ulcorner 사망하였다. 사망원인은 뇌출혈이었다. 장기생존한 20명의 New York Heart Association functional class는 모두 I과 II였다. 비록 대상환자의 수가 적다고는 하지만 저자들의 수술결과는 양호한 것으로, 따라서 저자들은 관상동맥 우회로 조성수술을 병행한 개심수술이 수술위험도가 높지 않으면서 만기 사망율도 줄일 수 있을 것으로 생각한다.

• Journal of Chest Surgery
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• 제30권3호
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• pp.263-269
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• 1997

1987년 4월부터 1996년 5월까지 복잡 선천성 심기형을 가진 13명의 환자에서 Norwood술식을적용 하였다. 진단별 분포로는 좌심형성부전증후군이 7례이었고, 상행대동맥과 대동맥궁의 형성부전이 있으 면서 심실중격결손증 및 대동맥하 협착증을 동반한 승모판 협착증, 심실중격결손증, 대동맥축착 및 대 동맥하 헙착증을 동반한 승모판 폐쇄증, 심실중격결손증 및 대동맥하 협착증을 동반한 대동맥궁 단절, 대혈관전위를 동반한 삼첨판 폐쇄증이 각각 1례씩 있었으며 이중입구부 좌심실이 2례 있었다 수술 당 시 나이는 3일에서 8.7개월 (평균 60.5 $\pm$ 71.6일, 중앙값 i9일)이었다. 수술 사망율( <30일)은 46% (6명) 이었으며 만기 사망율은 15% (2명)였다. 모든 수술사망은 술후 24시간 이내에 발생하였으며 체외순환으 로부터 이탈에 실패한 경우가 5례, 술후 갑작스런 혈역학적 불안정으로 사망한 경우가 1례 있었고, 만기 사망은모두 흡인성 폐렴에 의한 것이었다. 5명의 장기 생존자에 대한추후술식으로는2명의 환자에서 Norwood술식 후 각각 12, 17개월에 변형 Fontan수술을 하였으며 1명에서 4.5개월 후에 완전 대정맥폐동맥 단락술을 시행하였고 수술 사망은 없었다. 나머지 2명의 환자에서는 Fontan 술식전의 중간단계 로 양방향성 상대정맥-폐동맥 단락술을 각각 3, 5.5개휠 후에 시행하였으며 수술사망이 1례 있었다. 수 술 사망 및 만기 사망을 포함한 모든 환자에서 1년 생존율은 30.8%였다. 결론적으로 본원에서 경험한 Norwood 술식의 사망율이 다른 주요 심장기 형의 사망율과 비교하여 높지만 이에 대한 경험이 축적되면서 더 좋은 성적을 기대할 수 있을 것으로 생각된다.

• 대한한의학회지
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• 제31권5호
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• pp.124-135
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• 2010

Background and Objective: Atherosclerosis is a diffuse, systemic disease that affects the coronary, cerebral, and peripheral arterial trees. Clopidogrel is widely used antiplatelet agent and its efficacy has been proven in cardiac and extracardiac vascular diseases, but it has several side effects. Therefore we investigated whether Sopunghwalhyeoltang, which is widely used for treating the blood stasis syndrome in traditional medicine, could decrease the side effect of antiplatelets and have a synergic effect. Methods & Materials: Male $ApoE^{(-/-)}$ mice were randomly divided into three different experimental groups, non-treated group (Control group), clopidogrel-treated group (CP group) and clopidogrel with Sopunghwalhyeol-tang treated group (CPS group). The control group was fed with only an atherogenic diet, the CP group an atherogenic diet plus clopidogrel 25mg/kg and the CPS group an atherogenic diet plus clopidogrel 25mg/kg with Sopunghwalhyeol-tang 100 mg/kg. We investigated plasma lipids with liver function test, and performed a histological investigation of liver and abdominal aorta. Results: 1. Photomicrographs of liver and abdominal aorta tissue showed lower histological injury and lipid accumulation in the CP and CPS groups than those in the Control group. 2. In the CPS group, plasma triglyceride level was significantly lower than in the Control and CP groups. 3. In the CPS group, the plasma aspartate aminotransferase (AST) level was significantly lower than in the CP group. Conclusions: The above results shows that a combined treatment of Sopunghwalhyeol-tang and clopidogrel have a synergic effect through inhibiting vessel injury and decrease the side effects of clopidogrel alone.

• Journal of Chest Surgery
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• 제12권3호
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• pp.281-288
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• 1979

For years, physicians and anatomists have been interested in the heart that has one functioning ventricle. Various terms have been suggested for this entity including single ventricle, common ventricle, double-inlet left ventricle, cor biatriatum triloculare, and primitive ventricle. In this report, the term "single ventricle" is utilized as suggested by Van Praagh, and is defined as that congenital cardiac anomaly in which a common or separate atrioventricular valves open into a ventricular chamber from which both great arterial trunks emerge. An outlet chamber, or infundibulum, may or may not be present and give rise to the origin of either of the great arteries. This definition excludes the entity of mitral and tricuspid atresia. An 11 year old cyanotic boy was admitted chief complaints of exertional dyspnea and frequent upper respiratory infection since 2 weeks after birth. He was diagnosed as inoperable cyanotic congenital heart disease, and remained without any corrective treatment up to his age of 11 year when he suffered from aggravation of symptoms and signs of congestive heart failure for 2 months before this admission. On 22nd of May 1979, he was admitted for total corrective operation under the impression of tricuspid atresia suggested by a pediatrician. Physical check revealed deep cyanosis with finger and toe clubbing, and grade V systolic ejection murmur with single second heart sound was audible at the left 3rd intercostal space. Development was moderate in height [135 cm] and weight[28Kg]. Routine lab findings were normal except increased hemoglobin [21.1gm%], hematocrit [64 %], and left axis deviation with left ventricular hypertrophy on EKG. Cardiac catheterization and angiography revealed 1-transposition of aorta, pulmonic valvular stenosis, double inlet of a single ventricle with d-loop, and normal atriovisceral relationship [Type III C solitus according to the classification of Van Praagh]. At operation, longitudinal incision at the outflow tract of right ventricle in between the right coronary artery and its branch [LAD from RCA] revealed high far anterior aortic valve which had fibrous continuity with mitral annulus, and pulmonic valve was stenotic up to 4 mm in diameter positioned posterolaterally to the aorta. Ventricular septum was totally defective, and one markedly hypertrophied moderator band originated from crista supraventricularis was connected down to the imaginary septum of the ventricular cavity as a pseudoseptum of the ventricle. Size of the defect was 3X3 cm2 in total. Patch closure of the defect with a Teflon felt of 3.5 x 4 cm2 was done with interrupted multiple sutures after cut off of the moderator band, which was resutured to the artificial septum after reconstruction of the ventricular septum. Pulmonic valvotomy was done from 4 mm to 11 mm in diameter thru another pulmonary arteriotomy incision, and right ventriculotomy wound was closed reconstructing the right ventricular outflow tract with pericardial autograft of 3 x 4 cm2. Atrial septal defect of 2 cm in diameter was closed with 3-0 Erdeck suture, and atrial wall was sutured also when rectal temperature reached from 24`C to 35.5`C. Complete A-V block was managed with temporary external pacemaker with a pacing rate of 110/min. thru myocardial wire, and arterial blood pressure of 80/50 mmHg was maintained with Isuprel or Dopamine dripping under the CVP of 25-cm saline. Consciousness was recovered one hour after the operation when his blood pressure reached 100 /70 mmHg, but vital signs were not stable, and bleeding from the pericardial drainage and complete anuria were persisted until his heart could not capture the pacemaker impulse, and patient died of low output syndrome 320 min after the operation.

• Journal of Chest Surgery
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• 제12권3호
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• pp.289-296
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• 1979

For years, physicians and anatomists have been interested in the heart that has one functioning ventricle. Various terms have been suggested for this entity including single ventricle, common ventricle, double-inlet left ventricle, cor biatriatum triloculare, and primitive ventricle. In this report, the term "single ventricle" is utilized as suggested by Van Praagh, and is defined as that congenital cardiac anomaly in which a common or separate atrioventricular valves open into a ventricular chamber from which both great arterial trunks emerge. An outlet chamber, or infundibulum, may or may not be present and give rise to the origin of either of the great arteries. This definition excludes the entity of mitral and tricuspid atresia. An 11 year old cyanotic boy was admitted chief complaints of exertional dyspnea and frequent upper respiratory infection since 2 weeks after birth. He was diagnosed as inoperable cyanotic congenital heart disease, and remained without any corrective treatment up to his age of 11 year when he suffered from aggravation of symptoms and signs of congestive heart failure for 2 months before this admission. On 22nd of May 1979, he was admitted for total corrective operation under the impression of tricuspid atresia suggested by a pediatrician. Physical check revealed deep cyanosis with finger and toe clubbing, and grade V systolic ejection murmur with single second heart sound was audible at the left 3rd intercostal space. Development was moderate in height [135 cm] and weight[28Kg]. Routine lab findings were normal except increased hemoglobin [21.1gm%], hematocrit [64 %], and left axis deviation with left ventricular hypertrophy on EKG. Cardiac catheterization and angiography revealed 1-transposition of aorta, pulmonic valvular stenosis, double inlet of a single ventricle with d-loop, and normal atriovisceral relationship [Type III C solitus according to the classification of Van Praagh]. At operation, longitudinal incision at the outflow tract of right ventricle in between the right coronary artery and its branch [LAD from RCA] revealed high far anterior aortic valve which had fibrous continuity with mitral annulus, and pulmonic valve was stenotic up to 4 mm in diameter positioned posterolaterally to the aorta. Ventricular septum was totally defective, and one markedly hypertrophied moderator band originated from crista supraventricularis was connected down to the imaginary septum of the ventricular cavity as a pseudoseptum of the ventricle. Size of the defect was 3X3 cm2 in total. Patch closure of the defect with a Teflon felt of 3.5 x 4 cm2 was done with interrupted multiple sutures after cut off of the moderator band, which was resutured to the artificial septum after reconstruction of the ventricular septum. Pulmonic valvotomy was done from 4 mm to 11 mm in diameter thru another pulmonary arteriotomy incision, and right ventriculotomy wound was closed reconstructing the right ventricular outflow tract with pericardial autograft of 3 x 4 cm2. Atrial septal defect of 2 cm in diameter was closed with 3-0 Erdeck suture, and atrial wall was sutured also when rectal temperature reached from 24`C to 35.5`C. Complete A-V block was managed with temporary external pacemaker with a pacing rate of 110/min. thru myocardial wire, and arterial blood pressure of 80/50 mmHg was maintained with Isuprel or Dopamine dripping under the CVP of 25-cm saline. Consciousness was recovered one hour after the operation when his blood pressure reached 100 /70 mmHg, but vital signs were not stable, and bleeding from the pericardial drainage and complete anuria were persisted until his heart could not capture the pacemaker impulse, and patient died of low output syndrome 320 min after the operation.

• Journal of Chest Surgery
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• 제47권3호
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• pp.255-261
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• 2014

Background: To determine the predictors of clinical outcomes following surgical descending thoracic aortic (DTA) repair. Methods: We identified 103 patients (23 females; mean age, $64.1{\pm}12.3$ years) who underwent DTA replacement from 1999 to 2011 using either deep hypothermic circulatory arrest (44%) or partial cardiopulmonary bypass (CPB, 56%). Results: The early mortality rate was 4.9% (n=5). Early major complications occurred in 21 patients (20.3%), which included newly required hemodialysis (9.7%), low cardiac output syndrome (6.8%), pneumonia (7.8%), stroke (6.8%), and multi-organ failure (3.9%). None experienced paraplegia. During a median follow-up of 56.3 months (inter-quartile range, 23.1 to 85.1 months), there were 17 late deaths and one aortic reoperation. Overall survival at 5 and 10 years was $80.9%{\pm}4.3%$ and $71.7%{\pm}5.9%$, respectively. Reoperation-free survival at 5 and 10 years was $77.3%{\pm}4.8%$ and $70.2%{\pm}5.8%$. Multivariable analysis revealed that age (hazard ratio [HR], 1.10; 95% confidence interval [CI], 1.05 to 1.15; p<0.001) and left ventricle (LV) function (HR, 0.88; 95% CI, 0.82 to 0.96; p<0.003) were significant and independent predictors of long-term mortality. CPB strategy, however, was not significantly related to mortality (p=0.49). Conclusion: Surgical DTA repair was practicable in terms of acceptable perioperative mortality/morbidity as well as favorable long-term survival. Age and LV function were risk factors for long-term mortality, irrespective of the CPB strategy.

• 대한영상의학회지
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• 제81권2호
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• pp.324-336
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• 2020

심혈관계 석회화는 다양한 심혈관계 질환에서 나타나며 심혈관 사건 발생의 표지자의 역할을 한다. CT의 기술이 발전함에 따라 심전도동기 CT뿐만이 아닌 비 심전도동기 CT에서도 심혈관계 석회화를 평가하는 것이 가능해졌다. 이번 종설에서는 비 조영증강 비 심전도동기 흉부 CT에서 발견되는 심혈관계 석회화를 심혈관 사건 발생과 연관되었다고 알려진 3가지 석회화(관상동맥, 흉부 대동맥, 판막 석회화)에 대해 자세히 살펴보고 추가적으로 우연적으로 발견될 수 있는 심막 석회화에 대해서도 간단히 기술하였다. 우리나라에서 2019년 하반기부터 폐암 검진이 시작되면서 고령 흡연자의 비 조영증강 비 심전도동기 저선량 CT의 영상의 수가 늘어나고 있고 이에 우연히 발견되는 심혈관계 석회화도 늘어나고 있다. 그러므로 비 조영증강 비 심전도동기 흉부 CT에서 발견되는 심혈관계 석회화의 의미를 이해하고 적절히 보고하는 것이 영상의학과 의사에게 중요할 것이다.