• Korean Journal of Radiology
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• 제22권11호
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• pp.1834-1840
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• 2021

Objective: To analyze the computational fluid dynamics (CFD) of femoral artery pseudoaneurysm (FAP), identify a suitable location and timing for percutaneous thrombin injection (PTI) based on this analysis, and report our clinical experience with the procedure. Materials and Methods: CFD can be used to analyze the hemodynamics of the human body. An analysis using CFD recommended that the suitable location of the needle tip for PTI is at the center of the aneurysm sac and the optimal timing for starting PTI is during the early inflow phase of blood into the sac. Since 2011, seven patients (three male and four female; median age, 60 years [range, 43-75 years]) with FAP were treated with PTI based on the devised suitable location and time. Prior to the procedure, color Doppler ultrasonography was performed to determine the location and timing of the thrombin injection. Results: The technical success rate of the PTI was 100%. The amount of thrombin used for the procedure ranged from 200 IU to 1000 IU (median, 500 IU). None of the patients experienced any symptoms or signs of embolic complications during the procedure. Follow-up CT images did not reveal any embolism in the lower extremities and showed complete thrombosis of the pseudoaneurysm. Conclusion: Based on our study of CFD, PTI administered centrally in the FAP during early inflow, as seen on color Doppler, can be an effective technique.

• Journal of Korean Neurosurgical Society
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• 제58권4호
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• pp.316-320
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• 2015

Objective : The main concern during transfemoral carotid artery stenting (CAS) is preventing cerebral embolus dislodgement. We compared clinical outcomes and intraprocedural embolization rates of CAS using a distal filter protection device or proximal balloon occlusion device. Methods : From January 2011 to March 2015, a series of 58 patients with symptomatic or asymptomatic internal carotid artery stenosis ${\geq}70%$ were treated with CAS with embolic protection device in single center. All patients underwent post-CAS diffusion-weighted magnetic resonance imaging (DW-MRI) to detect new ischemic lesions. We compared clinical outcomes and postprocedural embolization rates. Results : CAS was performed in all 61 patients. Distal filter protection success rate was 96.6% (28/29), whose mean age was 70.9 years, and mean stenosis was 81%. Their preprocedural infarction rate was 39% (11/28). Subsequent DW-MRI revealed 96 new ischemic lesions in 71% (20/28) patients. In contrast, the proximal balloon occlusion device success rate was 93.8% (30/32), whose mean age was 68.8 years and mean stenosis was 86%. Preprocedure infarction rate was 47% (14/30). DW-MRI revealed 45 new ischemic lesions in 57% (17/30) patients. Compared with distal filter protection device, proximal balloon occlusion device resulted in fewer ischemic lesions per patient (p=0.028). In each group, type of stent during CAS had no significant effect on number of periprocedural embolisms. Only 2 neurologic events occurred in the successfully treated patients (one from each group). Conclusion : Transfemoral CAS with proximal balloon occlusion device achieves good results. Compared with distal filter protection, proximal balloon occlusion might be more effective in reducing cerebral embolism during CAS.

• 대한기계학회논문집B
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• 제26권1호
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• pp.39-44
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• 2002

The arterial stenosis related to the intimal thickening of the arterial wall is the main cause of many diseases in human cardiovascular system. Hemodynamic behavior of the blood flow is influenced by the presence of the arterial stenosis. In this study, effects of the pulsatile flow, caused by the periodic motion of the heart, on the blood flow and its interaction with the arterial stenosis are analyzed by the FEM-based computational fluid dynamics. As a result, it was found that the characteristics of the pulsatile flow in the artery with stenosis are quite different from those of the steady flow. And, the pulsatile flow condition affects the wall shear stress, which is one of the most important physiological parameters in the hemodynamics.

• Journal of Chest Surgery
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• 제30권12호
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• pp.1205-1213
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• 1997

가톨릭대학교 의과대학 부속 성바오로 병원에서 1996년 1월부터 7월까지 개심술시 경식도심초음파를 이용하여 수술 중 관찰한 61명의 증례를 분석하여 다음과 같은 결과를 얻었다. 61명의 환자 중 질병 분류는 심장 판막 질환 25명, 관상동맥 질환 22명, 선천성 심질환 13명, 심장 판막 질환과 관상동맥 질환이 병발한 경우가 1명 이었다. 1. 경식도심초음파를 이용하여 선천성 심질환 1예(심실중격결손증 재수술)와 대동맥 판막 치환술을 시행한 환자 1예에서 일차 심정지에 의한 수술 후 잔존 단락과 판막 주위 누출이 확인되어 재심정지를 유도하여 수술을 완료하였다 2. 공기색전증의 발생을 전 예에서 방지할 수 있었다. 3. 경식도심초음파로 측정한 심박출량과 온도희석법으로 측정한 심박출량은 통계학적으로 의미있는 상관관계를 보여 경식도 초음파를 이용한 심박출량 감시가 의미 있음을 시사하였다(Linear regression analysis, p<0.001). 4. 관상동맥우회로술을 시행한 23명의 환자에서 수술 중 경식도 초음파도상 이상 벽운동을 보이는 분절의 도부타민 투여 전후와 관상동맥우회로술 후의 반응을 비교 관찰하였다. 저 용량 도부타민 검사는 통계적으 \ulcorner유의하였다(민감도 76%, 특이도 94.7%, 양성 예측율 95%, 음성 예측율 75%).

• 대한한방내과학회지
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• 제37권5호
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• pp.733-740
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• 2016

Objective: To evaluate the effects of integrative treatment with conventional and Korean medicine on cerebral infarction due to presumed paradoxical embolism through a patent foramen ovale. Methods: We applied acupuncture, herbal medication, western medication, and physical therapy routinely every day and applied fluid therapy provided as needed. The NIHSS, K-MBI, MRS, MMT, and MMSE-K score were determined to assess any improvement in symptoms. Results: Scores appeared to be improved for the NIHSS (9 to 5), K-MBI (94 to 100), MRS (2 to 1), MMT (2+, 4 to 4, 4), MMSE-K (24 to 26). No side effects were observed during the treatment. Conclusions: This study demonstrates that integrative treatment with conventional and Korean medicine may be an effective option for treating cerebral infarction due to a presumed paradoxical embolism through a patent foramen ovale.

• Tuberculosis and Respiratory Diseases
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• 제69권2호
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• pp.124-128
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• 2010

Septic pulmonary embolism is the process in which an infected thrombus becomes detached from its site of origin and lodges in a pulmonary artery, and is usually associated with infective endocarditis, especially right-sided, or infection-associated with indwelling catheters, peripheral septic thrombophlebitis, and periodontal diseases, etc. Here, we report a case of septic pulmonary embolism associated with tricuspid valve infective endocarditis. A 23-year-old female was admitted to our hospital, due to fever, sore throat, and myalgia. In her past medical history, she had undergone a surgical operation for closure of a ventricular septal defect, but was informed that the operation resulted in an incomplete closure. The initial chest radiograph demonstrated multiple rounded, parenchymal nodules in various sizes; several nodules had central lucency suggesting cavitations. Echocardiography demonstrated a large vegetation attached to the septal tricuspid valve leaflet, extending from right ventricular inflow tract to outflow tract. Computed tomography of thorax revealed bilateral peripheral nodules and wedge-shaped consolidation at various sizes, mostly accompanied by cavitations.

• Tuberculosis and Respiratory Diseases
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• 제46권4호
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• pp.564-573
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• 1999

배 경: 폐색전증의 임상증상은 비특이적이어서 임상증상 만으로 진단이 어렵다. 폐색전증의 진단을 위하여 폐환기관류주사가 선별검사로 널리 사용되고 있으나 PIOPED(the prospective investigation of pulmonary embolism diagnosis) 연구의 결과처럼 저 중등도 확률 소견일 경우 폐색전증의 진단을 내리거나 배제하는데 도움이 되지 않으며 PIOPED 연구의 약 60%의 환자가 저 중등도 확률 소견을 보인다. 이러한 환자들은 확진을 위해 폐동맥조영술이 필요하지만 침습적이며 쉽게 시행할 수 없다는 단점이 있다. 최근 가공 영상을 줄이고 조영제 일시주사 기술로 혈관구조를 조영할 수 있게 한 spiral CT가 폐동맥조영술을 대신하여 폐색전증의 진단에 이용하는 전향적 연구가 이루어지고 있다. 이에 저자들은 폐색전증의 진단에서 spiral CT의 유용성을 알아보고자 폐색전증을 의심하여 spiral CT를 찍은 환자를 대상으로 후향적 조사를 시행하였다. 방 법: 1994년 10월부터 1997년 2월까지 삼성서울병원에 입원한 환자 중 폐색전증이 의심되어 spiral CT를 시행한 20명(남자 : 13명, 여자 : 7명, 평균연령 : 58세)을 대상으로 하였다. 폐색전증의 위험인자로 심부정맥혈전증과 고령이 가장 많았고 폐색전증이 의심된 임상증상으로 갑자기 발생하였거나 악화된 호흡곤란이 가장 많았다. 결 과: 20명의 환자 중 spiral CT로 폐색전증으로 진단된 환자는 16명이었고 3명은 각각 폐암, 폐기종 환자에서 발생한 폐농양을 동반한 폐렴, 울혈성 심부전에 의한 흉막삼출증으로 색전을 확인할 수 없었다. 나머지 1명은 spiral CT에서 정상 소견이었다. 폐환기관류주사에서 고확률로 판정된 12명의 환자중 1명에서 spiral CT로 폐기종 환자에서 발생한 폐농양을 동반한 폐렴인 위양성으로 진단할 수 있었다. 폐환기관류주사에서 저 중동도 확률을 보이는 4명 중 3명에서 spiral CT로 폐색전증을 진단할 수 있었다. 야간, 기계호흡 등의 이유로 폐환기관류주사를 시행치 못한 3명에서 spiral CT로 폐색전증을 진단 또는 배제할수 있었다. 폐색전증으로 진단된 16명 중에서 폐엽동맥 수준 이상의 색전은 11례 였으며 분절하동맥 수준 이하의 색전 경우는 5례였다. 결 론: 이상의 결과로 spiral CT는 폐분절동맥까지의 폐색전증의 진단에 유용하며, 특히 중심성 폐색전증의 확진과 배제에 있어서 중요한 진단방법이라고 생각된다. 향후 폐색전증의 진단에 spiral CT가 진단과정에 도입될 수 있는지에 대한 대규모의 전향적인 연구가 필요할 것으로 사료된다.

• Journal of Yeungnam Medical Science
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• 제20권1호
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• pp.1-12
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• 2003

Ischemic stroke is among the principal causes of death and disability in the elderly. Although control of blood pressure, decreased cigarette smoking, and modified dietary habits are among important reasons for stroke decline, the use of antithrombotic therapy, rigorously prescribed. Several antiplatelet agents are approved to reduce the risk of recurrent stroke. Aspirin is the best-studied and most widely used antiplatelet agent for stroke prevention; it provides approximately 15% to 25% relatively risk reduction for secondary prevention of stroke or the major vascular death. Combining 2 antiplatelet agents with different mechanism of action was demonstrated to provide a substantial increase in efficacy in several studies. Anticoagulation should be considered first with potential cardiac sources of embolism. Heparin reduces development of erythrocyte-fibrin thrombi that form in regions of vascular stasis especially within the heart, in severely stenosed arteries sometimes engrafted on white thrombi, in acute arterial occlusion. Heparin should not be indiscriminately given to all acute brain ischemia patients, but may contribute to treatment of large artery occlusion and severe stenosis, cardiogenic embolism with a high acute recurrence risk, and dural sinus and cerebral venous thromobosis.

• Tuberculosis and Respiratory Diseases
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• 제72권4호
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• pp.352-359
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• 2012

Background: The purpose of this study was to evaluate whether measuring the ratio of descending aortic enhancement (DAE) to main pulmonary artery enhancement (MPAE) on pulmonary computed tomography angiography (PCTA) can predict poor outcome in patients with acute massive or submassive pulmonary embolism (PE). Methods: We retrospectively, reviewed computed tomgraphy findings and charts of 37 patients with acute PE and right ventricular dysfunction. We divided the enrolled patients into 3 groups; group Ia (n=8), comprised of patients with major adverse event (MAE); group Ib (n=5), consisted of those with PE-related MAE; and group II (n=29), those without MAE. We analyzed the right ventricular diameter (RVD)/left ventricular diameter (LVD) and DAE/MPAE on PCTA. Results: For observer 1, RVD/LVD in group Ia ($1.9{\pm}0.36$ vs. $1.44{\pm}0.38$, p=0.009) and group Ib ($1.87{\pm}0.37$ vs. $1.44{\pm}0.38$, p=0.044) were significantly higher than that of group II. For observer 2, RVD/LVD in group Ia ($1.71{\pm}0.18$ vs. $1.41{\pm}0.47$, p=0.027) was significantly greater than that of group II, but RVD/LVD of group Ib was not ($1.68{\pm}0.2$ vs. $1.41{\pm}0.47$, p=0.093). For both observers, there was a significant difference of DAE/MPAE between group Ib and group II ($0.32{\pm}0.15$ vs. $0.64{\pm}0.24$, p=0.005; $0.34{\pm}0.16$ vs. $0.64{\pm}0.22$, p=0.004), but no significant difference of DAE/MPAE between group Ia and group II ($0.51{\pm}0.3$ vs. $0.64{\pm}0.24$, p=0.268; $0.53{\pm}0.29$ vs. $0.64{\pm}0.22$, p=0.302). Intra-class correlation coefficient (ICC) for the measurement of DAE/MPAE (ICC=0.97) was higher than that of RVD/LVD (ICC=0.74). Conclusion: DAE/MPAE measured on PCTA may predict PE-related poor outcomes in patients with massive or submassive PE with an excellent inter-observer agreement.

• Clinical and Experimental Pediatrics
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• 제48권2호
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• pp.216-220
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• 2005

폐동정맥루는 폐동맥 고혈압의 유무에 따라 치료가 달라진다. 따라서 폐동정맥루 치료 전 반드시 폐동맥압을 측정하여야 한다. 이에 저자들은 폐동맥 고혈압이 없어 폐동맥 색전술로 치료한 1례와 폐동맥 고혈압이 동반되어 항응고제를 투여하면서 관찰 중인 1례를 보고하는 바이다.