• Tuberculosis and Respiratory Diseases
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• 제66권4호
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• pp.319-323
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• 2009

객혈의 원인혈관은 대부분 기관지동맥이다. 하지만 다른 전신혈관 및 폐동맥에 의한 객혈도 항상 염두에 둬야하고, 만약 기관지동맥색전술 후 객혈이 지속되거나 기관지동맥에서 출혈의 원인을 찾지 못하면 다른 전신혈관에 대한 검사를 시행하여야 한다. 전신혈관-폐혈관의 문합이나 폐동맥 가성동맥류는 매우 드문 폐혈관질환으로 여러원인에 의해서 발생할 수 있으며, 이로 인한 객혈이 발생할 경우 생명을 위협할 수 있기 때문에 정확하고 빠른 진단과 치료가 필요하다. 저자는 77세 남자로 우하횡경막동맥-폐동맥 문합 및 문합부위 가성동맥류로 인한 지속적인 객혈로 내원하여, 색전술로 성공적으로 치료된 환자를 경험하여 이를 보고한다.

• 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 Chest Surgery
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• 제47권1호
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• pp.6-12
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• 2014

Background: Although a residual intimal tear may contribute to the dilatation of the descending aorta following surgical repair of acute type I aortic dissection (AD), its causal relationship has not been elucidated by clinical data due to the limited resolution of imaging modalities. Methods: This study enrolled 41 patients (age, $55.2{\pm}11.9$ years) who were evaluated with dual-source computed tomography (CT) imaging of the whole aorta in the setting of the surgical repair of acute type I AD. Logistic regression models were used to determine the predictors of a composite of the aortic aneurysm formation (diameter >55 mm) and rapid aortic expansion (>5 mm/yr). Results: On initial CT, a distal re-entry tear was identified in 9 patients. Two patients failed to achieve proximal tear exclusion by the surgery. Serial follow-up CT evaluations (median, 24.6 months; range, 6.0 to 67.2 months) revealed that 14 patients showed rapid expansion of the descending aorta or aortic aneurysm formation. A multivariate analysis revealed that the residual intimal tear (odds ratio [OR], 4.31; 95% confidence interval [CI], 1.02 to 19.31) and the patent false lumen in the early postoperative setting (OR, 4.64; 95% CI, 0.99 to 43.61) were predictive of the composite endpoint. Conclusion: The presence of a residual intimal tear following surgery for acute type I AD adversely influenced the expansion of the descending aorta.

• Journal of Korean Neurosurgical Society
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• 제30권sup2호
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• pp.281-288
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• 2001

Objectives : The purpose of this study is to evaluate the usefulness of SSEP monitoring during intracranial aneurysm surgery and compare the characteristics of wave change in relation to neurologic changes between ACA aneurysms and MCA aneurysms. Methods : During recent three years(between January 1997 and November 1999), intraoperative SSEP monitoring had been done in 63 operations for intracranial aneurysms. We had monitored the median nerve SSEP during surgery for aneurysms of MCA and the posterior tibial nerve SSEP for aneurysms of ACoA or ACA. A more than 50% reduction of any cortical SEP response was considered to be a significant SEP change, compared to its baseline value before the start of surgery. Changes in the SEPs were categorized as follows : Type IA, no significant amplitude changes without temporary clipping ; Type IB, no significant amplitude changes with temporary clipping ; Type II, significant changes with temporary clipping and complete return to control amplitude ; Type III, significant changes with temporary clipping and incomplete return to control amplitude ; Type IV, significant changes with temporary clipping and more decreased amplitude changes. Results : Among the 63 intraoperative monitoring, there were 37 cases of ACA aneurysms(An), and 26 of MCA An. The temporary proximal arterial occlusion during surgery were performed in 31(83.8%)cases of ACA An, 22(84.6%) of MCA An. Seven of the 31 ACA An(22.6%) and ten of the 22 MCA An(45.5%) had significant changes. The type were as follows : 4 patients with type II and 3 with type III in the ACA An ; 3 patients with type II and 3 with type III and 4 with type IV in the MCA An. In both group type II changes had no new postoperative neurological deficit. All 6 patients with type III had new neurological deficits ; However, One case in the ACA An and two cases in the MCA An. had transient neurologic deficit and improved markedly over the next two months. All 4 type IV changes in the MCA An. had permanant neurologic deficits. Two out of 30 cases(6.7%) in the ACA An. and one out of 16 cases(6.3%) in the MCA An. without significant amplitude change had new neurologic deficit postoperatively. Conclusion : Based on this study, Intraoperative SSEP monitoring during aneurysm surgery would provide useful information for detecting cerebral ischemia. SSEP response during surgery for MCA An. is more sensitive than ACA An. Otherwise, there were no meaningful difference in rate of false negativity.

• Journal of Chest Surgery
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• 제49권6호
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• pp.468-471
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• 2016

An 81-year-old male patient presented with complaint of a pulsating neck mass. The patient had a previous history of cervical lymphadenopathy by non-tuberculous mycobacterium infection. Rapid growth of the mass on admission and contrast enhanced computed tomography of the neck resulted in a diagnosis of non-tuberculous mycobacterium induced pseudoaneurysm. The patient underwent emergency open repair of the pseudoaneurysm. Pseudoaneurysm of the common carotid artery is regularly reported, but here we report a rare case of non-tuberculous mycobacterium induced pseudoaneurysm of the common carotid artery.

• Journal of Korean Neurosurgical Society
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• 제29권12호
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• pp.1592-1599
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• 2000

Objective : Multiple cerebral aneurysms reportedly account for 14-33% of all cerebral aneurysms. However, multiple separate aneurysms on single parent artery are uncommon. The majority of these are found on middle cerebral artery(MCA). Multiple aneurysms arising from anterior communicating artery(ACoA) are rare. We report 5 cases of multiple aneurysms developed separately on single artery and describe angiographic and operative findings of these lesions. Materials and Methods : Among 127 patients of cerebral aneurysms operated in our hospital, only 5 had multiple aneurysms on single parent artery. Results : Among 5 cases, 4 were diagnosed preoperatively and the only one was found intraoperatively. Two were found on MCA bifurcation, one on M2 and two on ACoA. All separate aneurysms developed on single parent artery were treated successfully with multiple clipping. Conclusion : Multiple cerebral aneurysms, developed separately on single parent artery, are uncommon. Furthermore, those arising from ACoA are very rare. Despite the advanced technology in radiological examinations, multiple cerebral aneurysms may not be detected on preoperative study only. Close proximity or smaller size of the lesion may be responsible for the preoperative false negative angiographic findings.

• 대한의용생체공학회:의공학회지
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• 제13권2호
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• pp.165-174
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• 1992

Compliance mismatch across an end-to-end anastomosis was measured In the In vitro experimental setup. A 35mm camera was used and Image process was done in Gould/ DeAnza Image processor. The results showed that compliances of Penrose tubing and synthetic PTFE grafts were In good agreement with the previously reported In vivo data. PTFE grafts exhibited a nonlinear behavior with compliance decreasing with Increasing transmural pressure, whereas the compliance of the Penrose tubing remained relatively constant within the range of the pressures in which data were obtained. The lumen cross sections at the anastomosis were affected by the suture and the mismatch In compliance between the Penrose tubing and vascular grafts. The varla~lons In the lumen dtameter at the anastomosis was more pronounced with increasing transmural pressures. From the present study, it was clearly demonstrated that the compliance of prosthetic grafts Is much lower than that of the arteries. In addition to the hemodynamlc consequences, compliance mismatch across the anastomosis has been known to lead to Increased anastomotlc and suture stresses with resultant suture line dehlscence and false aneurysm formation. Thus, there are good hemodynamic reasons to suppose that Introduction of a less compliant arterial graft Into the arterial circulation wlll be damaging and that grafts should be made to match the elastic behavior of their host arteries as closely possible.

• Journal of Chest Surgery
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• 제49권1호
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• pp.42-45
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• 2016

Thrombosis at the left ventricular outflow tract occurs without any detectable heart disease or predisposing factors only extremely rarely. A 48-year-old male visited Konkuk University Medical Center with loss of consciousness one month prior to presentation. Before he visited our hospital, he had been diagnosed with a cardiac tumor, which was located between the left atrium and posterior aortic root, and which was adjacent to both the aortic and mitral valves. Cardiac transplantation was recommended at the other hospital because of the high risk of cardiac dysfunction induced by both aortic and mitral valvular dysfunction after surgical resection. Based on preoperative transthoracic echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging, and intraoperative transesophageal echocardiography, we considered it to be a benign tumor. Complete resection was achieved and the pathology confirmed organizing thrombus. We report a case of organizing thrombus mimicking a cardiac tumor, which was located at the mitral-aortic intervalvular fibrosa of the left ventricular outflow tract without any heart disease.

• 대한정형외과학회지
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• 제55권5호
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• pp.431-435
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• 2020

주로 고에너지 손상이나 관통상에 의해서 발생하는 가성동맥류는 진단이 지연되면 심각한 결과를 초래할 수 있다. 저자들은 계단에서 넘어져 다친 후 처음에는 단순 타박 및 피부 열상으로 진단되었다가 증상이 악화되어 수상 2주일 후 시행한 자기공명영상 검사와 컴퓨터 단층촬영 혈관 조영술에서 경골 동맥의 경골비골동체의 가성동맥류로 뒤늦게 진단된 63세 남자를 치험하였다. 경한 둔상에 의하여 경골비골동체에 가성동맥류가 발생한 예는 아직까지 국내에 보고된 바 없어 이에 저자들은 문헌고찰과 함께 보고하고자 한다.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• 제25권4호
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• pp.434-439
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• 2023

Pseudoaneurysms are rare but devastating complications of penetrating head traumas. They require rapid surgical or endovascular intervention due to their high risk of rupture; however, complex presentations may limit treatment options. Our objective is to report a case of severe vasospasm, flow diversion, and in-stent stenosis complicating the treatment of a middle cerebral artery pseudoaneurysm following a gunshot wound. A 33-year-old woman presented with multiple calvarial and bullet fragments within the right frontotemporal lobes and a large right frontotemporal intraparenchymal hemorrhage with significant cerebral edema. She underwent an emergent right hemicraniectomy for decompression, removal of bullet fragments, and evacuation of hemorrhage. Once stable enough for diagnostic cerebral angiography, she was found to have an M1 pseudoaneurysm with severe vasospasm that precluded endovascular treatment until the vasospasm resolved. The pseudoaneurysm was treated with flow diversion and in-stent stenosis was found at 4-month follow-up angiography that resolved by 8 months post-embolization. We report the successful flow diversion of an middle cerebral artery (MCA) pseudoaneurysm complicated by severe vasospasm and later in-stent stenosis. The presence of asymptomatic stenosis is believed to be reversible intimal hyperplasia and a normal aspect of endothelial healing. We suggest careful observation and dual-antiplatelet therapy as a justified approach.