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Surgical Treatment of Varicose Vein - TIPP(Transilluminated Powered Phlebectomy) - (정맥류 환자의 수술적 치료 -광투시 전도형 정맥적출요법-)

  • 이교준;김해균;정은규;강두영
    • Journal of Chest Surgery
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    • v.35 no.2
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    • pp.144-148
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    • 2002
  • The present study was done to determine the efficacy and safety of varicose vein removal using a minimally invasive, powered vein-extracting device with cutaneous transillumination and tumescent anesthesia techniques and then compared this to a retrospective group of conventional phlebectomy operations. There were 133 limbs in 104 patients(72 women, 32 men) treated with the use of the vein extractor aided by transcutaneous illumination. The hydrodissection was performed with Trivex™ Irrigated illuminator(Smith & Nephe $w^{ R}$) system using normal saline after the 2~3mm sized skin incision. Varicose clusters were extracted by the use of TriveTM esector(Smith & Nephe $w^{ R}$) system under transillumination. After the varisoce vein extraction, the operation area was compressed with surgical pad for bleeding control. The complication rate was 3.84% The mean number of incisions was 3.24 and mean operative time per limb was 65.9 minutes. The mean hospitalization was 1.86 days. The varicose vein extraction using transilluminated powered phlebectomy(TIPP) is a safe, efficacious and cosmetically satisfactory method. The procedure decreases the operating time and the number of incisions required to remove varicose clusters. Further evaluation and long term follow up will be necessary to determine the recurrence rate and long termcomplications.to determine the recurrence rate and long termcomplications.

Patient Radiation Dose Values During Interventional Cardiology Examinations in University Hospital, Korea (심장혈관 조영술과 심장혈관 인터벤션의 환자 선량 평가)

  • Kim, Jung-Su;Lee, Joun-Hyuk;Jung, Hae-Kyoung;Kim, Jung-Min;Cho, Byung Ryul
    • Journal of radiological science and technology
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    • v.39 no.1
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    • pp.27-33
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    • 2016
  • The use of cardiac angiography (CA) and the interventional procedures is rapidly increasing due to the increase in modern adult diseases. Cardiovascular intervention (CI) is an examination method where radiation is applied to the same area for a long period, and thus may cause skin injury. In this study, we investigate the diagnostic reference level (DRL) of the cardiovascular intervention (CI) carried out by medical institutions and use it as a tool to reduce patient exposure dose. In this study, the DRL was set by acquiring information about the cumulative fluoroscopy time, cumulative fluoroscopy dose-area product (DAP), radiography DAP, cumulative DAP, air kerma, number of video clips, and the total number of images from the cardiac angiography and interventional procedures performed on 147 patients. The DAPs corresponding to the DRL of cardiac angiography(CA) and that of the interventional procedures were shown to be $44.4Gy{\cdot}cm2$ and $298.6Gy{\cdot}cm2$, respectively; the corresponding DRLs of fluoroscopy time were shown to be 191.5s and 1935.3s, respectively. A DRL is not a strict upper bound for radiation exposure. However, the process of setting, enacting, and reviewing the DRLs for the dose by medical institutions will contribute to a reduction in the unnecessary exposure dose of patients.

Esophageal Dysmotility in a Young Adult Dog (식도운동성 저하에 대한 진단 및 치료)

  • Kim, Jae-Hoon;Park, Hyung-Jin;Song, Kun-Ho;Choi, Ho-Jung;Seo, Kyoung-Won
    • Journal of Veterinary Clinics
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    • v.30 no.3
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    • pp.193-195
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    • 2013
  • An 18-month-old intact male Cocker Spaniel dog weighing 7.7 kg was referred with a 2-week history of severe regurgitation. Based on the screening examination and fluoroscopy, this patient was diagnosed as having esophageal dysmotility. Treatment with mosapride and feeding small amounts of canned food frequently in an elevated position resulted in a successful outcome. The severe regurgitation improved, and the esophageal transit time improved from 18 sec to 8 sec. This is the first case report describing the diagnosis and clinical management of esophageal dysmotility in a young dog in Korea.

The Usefulness of Video Fluoroscopic Swallowing Study in Post-Stroke Dysphagia Patients (뇌졸중 후 연하장애 환자에서 비디오 투시 연하 조영검사의 유용성)

  • Eun, Sung-Jong;Kim, Sung-Gil;Hong, Jea-Ran
    • Journal of the Korean Society of Radiology
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    • v.4 no.3
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    • pp.19-25
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    • 2010
  • Dysphagia is common and serious problems in post-stroke patients. The post-stroke dysphagia with aspiration is associated with dehydration, malnutrition, pneumonia, sepsis and death. Up to date, gag reflex and choking history used to decide the aspiration in clinical. The purpose of this study was to evaluate the aspiration and to choice the proper meal formation using by video fluoroscpic swallowing study(VFSS) with post-stroke dysphagia patients. 58 post-stroke patients and ten normal person participated to perform the VFSS with liquid type, puding, yoplait, rice mixed with barium(Ba). Two rehabilitation medicine doctors and a radiological technologist analysed the phase(oral, pharyngeal, esophageal phase)with video film, and checked the pharyngeal transition time(PTT). 38 patients showed abnormality in pharyngeal phase, 13 patients in oral and pharyngeal phase, 3 patients in oral phase, and 2 patients in pharyngeal and esophageal phase. 43 patients(65.2%) occured the aspiration, but 23 of 43 patients improved by the chin tuck position. Aspiration occured 34 patients in liquid type, 2patients in rice gruel and nothing in boiled rice. After VFSS, 13 of 23 patients change the intaking pathway from nasogastric tube(NGT) to oral, On the contrary with 3 of 42 patients from oral to NGT. Consequently VFSS is clearly effective to evaluate the aspiration with post-stroke dysphagia patients.

Shielding Effect of Radiation Protector for Interventional Procedure (중재적 방사선 분야 방호용구 차폐효과)

  • Ko, Shin-Kwan;Kang, Byung-Sam;Lim, Chung-Hwang
    • Journal of radiological science and technology
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    • v.30 no.3
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    • pp.213-219
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    • 2007
  • The purpose of this study is to evaluate shielding effect of radiation protector for interventional radiologists in procedures by measuring inside and outside of radiation protector. In this study, we measured the radiation dose of 4 interventional radiologists during TACE and PTBD procedure for 4 month(2005.05-2005.09). Absorbed dose were measured by TLD placed underneath and over radiation protector such as Goggle, Thyroid protector, Apron and placed on the 4th finger of Hand. In addition, we measured background radiation dose in the control room using TLD. During TACE procedure, using 0.07 mmPb Goggle decreased average 53.8% of radiation dose rate in continuous fluoroscopic mode and decreased average 77.6% of radiation dose rate in pulse fluoroscopic mode. Using 0.5 mmPb Thyroid protector decreased average 88.9% of radiation dose rate in continuous fluoroscopic mode and decreased average 92.8% in pulse fluoroscopic mode. During PTBD procedure, using 0.07 mmPb Goggle decreased radiation dose rate average 62.7%, 87.9% by 0.5 mmPb Thyroid protector, 90.5% by 0.5 mmPb Apron. The average fluoroscopic time of PTBD was 6.14 min. shorter than TACE procedure, but radiation exposure dose rate of PTBD was 3 times higher in total body dose, and 40 times higher in hand dose rate than TACE. Interventional radiologists must wear thicker protector recommended over 0.5 mmPb. Also, they must use lead Goggle during interventional procedure. Abdomen dose decreased average 38.4% by drawing a lead curtain under the patient's table, therefore, they must draw a lead curtain to shield scattering ray. Radiation exposure dose decreased average 59.0% by using pulse fluoroscopic mode. So radiologists would better use pulse fluoroscopic mode than continuous fluoroscopic mode to decrease exposure dose.

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Transilluminated Powered Phlebectomy for Varicose Vein (하지정맥류의 투시조명하 전동형 정맥류 수술법)

  • 신화균;원용순;송철민
    • Journal of Chest Surgery
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    • v.34 no.8
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    • pp.611-614
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    • 2001
  • To determine the efficacy and safety of endoscopic resection and ablation of superficial varicosities using a powered vein resector, irrigated illuminator. Material and Method: 83 consecutive patients were involved in the study. 103 limbs in 83 patients were treated using a minimal invasive, powered, vein resecting devide with cutaneous transillumination and tumescent anesthesia technique. There were 51 women and 32 men. All patients were operated under general anesthesia or regional anesthesia. Operative time and patient satisfaction scores were recorded along with the number of incisions made. Result: 83 patients(51/61.4% female, 32/38.6% male, aged 25-78 years) had varicose vein. Average age at the time of operation was 45 years(range, 25 to 78 years). There were 63 unilateral procedures and 20 bilateral operations. Operative time ranged from 24 to 46 minutes (average 35.3 minutes) in the unilateral procedure. The number of incisions per limb averaged 2.7(range, 2 to 5). Postoperative complications occurred in 7(8.4%) patients. Patients were asked to describe their pain on an analog scale ranging form 1 to 10 with r representing no pain and 10 worst imaginable pain. Immediately postoperative pain score was 2.4 Postoperative pain score at 72 hours had a mean score of 2.0. Postoperative pain score at 1 months were 1. Conclusion: Varicose vein removal using Transilluminated Powered Phlebectomy(TIPP) is a safe and efficient procedure. The procedure saves time, is easy to perform, and gives direct visualization and a distinct endpoint of the removal of veins. It is also less tedious to perform and gives good cosmetic results with significant pain relief.

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Valve Leaflet Escape of Edwards Duromedics Mechanical Valve - A Case report - (Edwards Duromedics 기계판막엽 탈출 - 1례 보고 -)

  • 윤영남;유경종
    • Journal of Chest Surgery
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    • v.35 no.1
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    • pp.60-63
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    • 2002
  • Edwards Duromedics mechanical valve was introduced into clinical use in 1982 and is still being used today after several modifications. Valve-related complications after mechanical valve replacement are thiombo-embolism, endocarditis, valve malfunction, valve leaflet escape and fracture. Incidence of valve leaflet escape is very low. A 40 year-old male patient who had undergone mitral replacement with a 31mm Edwards Duromedics mechanical valve(model

Reference Levels for Radiation Dose in Angiography and Interventional Radiology : In the Cerebrum (혈관 조영 검사 및 중재적 방사선 시술시 방사선량에 대한 참고 기준치 : 대뇌 중심으로)

  • Han, Jae-Bok
    • The Journal of the Korea Contents Association
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    • v.11 no.3
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    • pp.302-308
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    • 2011
  • The aim of this study is to compare reference levels for radiation dose in angiography and interventional radiology. Proposed reference levels for various procedures and classification of diseases are provided by fluoroscopy time and kerma area product(KAP) rate normalizing the body habitus focusing the cerebrum. Subarachnoid hemorrhage(SAH) represents the highest KAP-rates and aneurysm represents the lowest KAP-rates. According to these types of procedures, internal carotid artery(ICA), common carotid artery(CCA), and vertebral artery(VA) show the highest KAP-rates and guglielmi detachable coil shows the lowest KAP-rates. Therefore, the present study can suggested reference levels for patient radiation dose and is expected to be further useful in the field of radiation dose education and management of angiography and interventional radiology.

Usefulness of Virtual Fluoroscopy in Emergency Interventional Radiology (응급 인터벤션 영상의학에서 가상 투시영상 검사의 유용성)

  • Yoshihiro Tanaka;Akitoshi Oosone;Asuka Tsuchiya
    • Journal of the Korean Society of Radiology
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    • v.81 no.4
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    • pp.852-862
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    • 2020
  • Interventional radiology (IR) embolization requires image guidance to steer catheters to the site of bleeding, where embolic agents such as Gelfoam or coils are administered to stem blood flow. In addition to treating iatrogenic trauma, embolization is suitable for injuries precluding surgery such as blush-bleeding of the liver or kidney and for locating and treating intimal blood vessel tears. However, during hospital off-hours (such as nights and holidays), experienced IR personnel are not always available. In such situations, there is a dire need to build a coordinated IR team to treat seriously injured patients rapidly and reliably. This article reviews the current principles and techniques used in IR such as virtual fluoroscopy and their usefulness, and makes a convincing case for emergency IR.

Closed Manual Reduction of Mandibular Condylar Fracture Assisted by C-arm Fluoroscopy (C-arm 형광투시를 이용한 하악관절돌기골절의 비관혈적 도수정복)

  • Choi, Eui Chul;Kang, Sang Gue;Jung, Sung Gyun
    • Archives of Craniofacial Surgery
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    • v.10 no.2
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    • pp.131-134
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    • 2009
  • Purpose: Mandible fractures are common in maxillofacial trauma and the incidence of condylar fracture is high. The management of mandibular condylar fracture continues to be controversial. Conservative treatment of it may lead to complications such as asymmetry, malocclusion, temporomandibular joint dysfunction. Moreover, open reduction can cause facial nerve injury, parotid gland injury, scarring and hematoma formation. We present a case of mandibular condylar fracture that was treated by manual reduction without incision under C-arm fluoroscopy. Methods: A 76-year-old female was admitted due to left side mandibular condylar fracture that required surgical intervention. Because of her age, history of diabetes mellitus, hypertension, she underwent closed manual reduction under general anesthesia. We adopted C-arm fluoroscopy as a method of identifying the fracture site and a evaluation of reduction state. C-arm fluoroscopy was set up like modified Towne's view. Results: The reduction was successful and didn't result in any complications that could occur in open reduction-facial nerve injury, infection, parotid gland injury, hematoma, avascular necrosis. The mandibular-maxillary fixations were removed after 4 weeks and patients were could open 3.5 cm after 6 weeks with physical therapy. Conclusion: We tried closed manual reduction of mandibular condylar fracture due to high risk of complication using C-arm fluoroscopy and did achieve anatomic reduction with avoiding open incision. This is simple, effective, reversible, time saving and fairly attemptable method in condylar fracture cases before open reduction.