• Journal of Chest Surgery
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• 제43권6호
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• pp.635-641
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• 2010

배경: 대복재 정맥의 역류로 인한 대퇴정맥 접합부 부전에 대한 치료로써 정맥내 시술인 고주파 열폐쇄술은 고전적 복재정맥 스트리핑과 비교해 부작용이 적고 우수한 방법이다. 기존의 대복재정맥에 대한 고주파 열폐쇄술의 단점은 시술 시간이 길다는 점이었으나 이를 보완한 2세대 고주파 열폐쇄술($VNUS^{\circledR}Colosure$ fast)은 분절 소작법을 채택하여 시술시간이 짧아지고 치료 방법 또한 더 간편해졌다. 이에 본 연구는 하지정맥류에 대한 2세대 고주파 열폐쇄술($VNUS^{\circledR}Colosure$ fast)을 이용한 치료 결과 및 합병증을 기존의 고주파 열폐쇄술($VNUS^{\circledR}Colosure$ plus)과 비교하고자 한다. 대상 및 방법: 2006년 6월부터 2009년 8월까지 대퇴 정맥 접합부의 역류가 있는 경우만을 골라 정맥내 고주파 열폐쇄술을 받은 환자를 대상으로 하였다. 기존의 고주파 열폐쇄술($VNUS^{\circledR}Colosure$ plus)를 시행 받은 총 4 명 (59족)의 환자(이후 1세대군)와 2세대 고주파 열폐쇄술($VNUS^{\circledR}Colosure$ fast) 시행 받은 67명 (76족)의 환자(이후 2세대군)를 대상으로 후향적으로 두 집단 사이의 환자의 성비, 평균 시술시간, 치료된 정맥직경, 동반한 치료방법, 시술 후 합병증을 비교하였다. 결과: 모든 환자는 하지정맥류로 인한 증상이 있었고 CEAP class 2 이상으로 초음파상 대퇴정맥접합부의 역류가 있었다. 치료된 대복재 정맥의 평균직경은 1세대군과 2세대군 사이에 양 군간의 통계학적 차이는 없었다($5.59{\pm}0.6mm$ vs.$5.65{\pm}0.6mm$, p=0.68). 평균 치료 시간은 2세대군이 유의하게 낮았다($17.0{\pm}6.5min$ vs. $62.7{\pm}9.8min$, p<0.001). 양 군에서 유의할 만한 합병증은 발생하지 않았다. 결론: 하지정맥류에 대한 치료로서 정맥내 시술인 고주파 열폐쇄술은 안전하며 효과적인 시술이며 2세대 열폐쇄술($VNUS^{\circledR}Colosure$ fast)은 시술시간의 단축과 조작의 용이함으로 의사 및 환자의 만족도가 높은 치료라 할 수 있겠고 향후 더 많은 수의 환자를 대상으로 장기적인 연구가 필요하다고 생각된다.

• Korean Journal of Radiology
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• 제25권9호
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• pp.773-787
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• 2024

Local ablation for hepatocellular carcinoma (HCC), a non-surgical option that directly targets and destroys tumor cells, has advanced significantly since the 1990s. Therapies with different energy sources, such as radiofrequency ablation, microwave ablation, and cryoablation, employ different mechanisms to induce tumor necrosis. The precision, safety, and effectiveness of these therapies have increased with advances in guiding technologies and device improvements. Consequently, local ablation has become the first-line treatment for early-stage HCC. The lack of organized evidence and expert opinions regarding patient selection, pre-procedure preparation, procedural methods, swift post-treatment evaluation, and follow-up has resulted in clinicians following varied practices. Therefore, an expert consensus-based practical recommendation for local ablation was developed by a group of experts in radiology and hepatology from the Research Committee of the Korean Liver Cancer Association in collaboration with the Korean Society of Image-guided Tumor Ablation to provide useful information and guidance for performing local ablation and for the pre- and post-treatment management of patients.

• Tuberculosis and Respiratory Diseases
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• 제72권2호
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• pp.228-231
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• 2012

Bronchobiliary fistula (BBF), defined as an abnormal communication between the biliary duct and bronchial trees, is a very rare condition. Bilioptysis is a pathognomonic finding for BBF. We studied a 58-year-old man, who had a BBF complicated by liver biloma that occurred after radiofrequency ablation. The diagnosis was confirmed by the presence of bile-stained sputum and an Endoscopic Retrograde Cholangio-Pancreatography. BBF was treated successfully by endoscopic sphincterotomy and biliary drainage with insertion of a double pig-tail plastic stent into the biloma. We suggest that the optimal choice of treatment modality for BBF depends on the natural course of the underlying disease, and the status of the biliary stricture.

• Asian Pacific Journal of Cancer Prevention
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• 제17권9호
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• pp.4349-4352
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• 2016

Purpose: To evaluate whether combined transarterial chemoembolization (TACE) with radiofrequency ablation (RFA) or percutaneous ethanol injection (PEI) for hepatocellular carcinoma (HCC) have superior efficacy to transarterial chemoembolization (TACE) alone a retrospective review was conducted. Methods: During January 2009 to March 2013, 108 patients with hepatocellular carcinoma underwent TACE or combined therapies (TACE+RFA or TACE+PEI). The long-term survival rates were evaluated in those patients by various statistical analyses. Results: The cumulative survival rates in the combined TACE+RFA/PEI group were significantly superior to those in the TACE alone group. When the comparison among the groups was restricted to patients with two or three tumors fulfilling the Milan criteria, significantly greater prolongation of survival was observed in the combined TACE+ RFA/PEI group than in the RFA/PEI alone group. Conclusions: In terms of the effect on the survival period, combined TACE+ RFA/PEI therapy was more effective than TACE monotherapy, and also more effective than PEI or RFA monotherapy in cases with multiple tumors.

• 전기학회논문지
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• 제60권7호
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• pp.1417-1426
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• 2011

Radiofrequency ablation through cardiac catheterization is one of minimally invasive intervention procedures used in drug resistant arrhythmia treatment. To facilitate more accurate and precise catheter navigation, systems for robotic cardiac catheter navigation have been developed and commercialized. The authors have been developing a novel robotic catheter navigation system. The system is a network-based master-slave configuration 3-DOF (Degree-Of-Freedom) robotic manipulator for operation with conventional cardiac ablation catheter. The catheter manipulation motion is composed of the translation (forward/backward) and the roll movements of the catheter and knob rotation for the catheter tip articulation. The master manipulator comprises an operator handle compartment for the knob and the roll movement input, and a base platform for the translation movement input. The slave manipulator implements a robotic catheter platform in which conventional cardiac catheter is mounted and the 3-DOF motions of the catheter are controlled. The system software that runs on a realtime OS based PC, implements the master-slave motion synchronization control in the robot system. The master-slave motion synchronization performance tested with step, sinusoidal and arbitrarily varying motion commands showed satisfactory results with acceptable level of steady state error. The developed system will be further improved through evaluation of safety and performance in in vitro and in vivo tests.

• Journal of Chest Surgery
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• 제44권1호
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• pp.18-24
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• 2011

Background: We evaluated the efficacy of Cox-maze IV procedure using bipolar irrigated radiofrequency ablation and cryothermy in chronic atrial fibrillation associated with valvular heart disease. Material and Methods: From November 2005 to June 2009, ninety four patients have undergone valvular heart surgery with Cox-maze IV procedure. Preoperative duration of atrial fibrillation was $7.6{\pm}6.5$ years and follow-up duration was $22.7{\pm}12.3$ months. Results: There were two (2.1%) postoperative deaths not related to maze procedure. Two cerebrovascular accidents, five low cardiac output syndromes and two permanent pacemaker implantations have occurred after surgery. Preoperative ejection fraction on echocardiography was $55.3{\pm}8.1%$ and ejection fraction of postoperative six month was $54.7{\pm}6.5%$. Left atrial size of preoperative and postoperative were $61.5{\pm}11.6\;mm$ and $53.1{\pm}8.4\;mm$ at each. Freedom from atrial fibrillation rate at postoperative six-month was 80.7% and the cases of recurrence of atrial fibrillation after six months were three (3.3%). Risk factors for failure or recurrence of maze procedure were old age (p=.010) and preoperative moderate or severe tricuspid regurgitation (p=.033). Conclusion: The Cox-maze IV procedure using RFBP2 and cryothermy is quite safe and freedom from atrial fibrillation at postoperative 6 month was 82.5%. Risk factors for failure or recurrence of atrial fibrillation after Cox-maze IV were old age and preoperative over moderate tricuspid regurgitation.

• 대한영상의학회지
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• 제81권3호
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• pp.530-548
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• 2020

갑상선 영상의학 진료란 갑상선 질환 환자를 영상의학적 방법을 활용하여 질병 진단과 중재적 치료를 하는 의료 행위로 정의될 수 있으며 주요 진료 대상은 갑상선 결절 질환 환자들이다. 갑상선 결절의 진단은 일차적으로 초음파 영상진단과 생검에 의해서 이루어지고 결절의 치료는 비수술적 중재적 치료와 갑상선절제술이다. 갑상선 낭종 혹은 낭성우세 양성 결절에서는 에탄올절제술이 일차적 치료법이고 고주파절제술은 고형 혹은 고형우세 양성 결절과 갑상선 재발암 치료에 적용되고 있다. 갑상선 영상의학 진료는 갑상선 결절 질환 환자의 진단 및 비수술적 치료의 대부분을 담당하는 중요한 임상적 역할을 가지고 있으며, 적절한 환자 진료를 위해서는 표준적 진료 지침에 근거하여 진료가 수행되어야 한다. 환자에게 최적의 갑상선 영상의학 진료를 제공하기 위해서는 영상의학과 외래에서 환자를 진료하는 것이 바람직하며 외래 중심의 갑상선 영상의학 진료를 확대하도록 함께 노력해야 할 시점이다.

• Korean Journal of Radiology
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• 제21권12호
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• pp.1383-1392
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• 2020

Objective: This study aimed to evaluate the efficacy and safety of ultrasound (US)-guided minimally invasive treatment in patients with parathyroid lesions. Materials and Methods: This study included 27 patients who had undergone US-guided radiofrequency ablation (RFA) or ethanol ablation (EA) for parathyroid lesions between January 2010 and 2018. RFA was performed in 19 patients with primary hyperparathyroidism (PHPT, n = 11) or secondary hyperparathyroidism (SHPT, n = 8), and EA was performed in eight patients with symptomatic nonfunctioning parathyroid cysts (SNPCs). Nodule size, volume, serum parathyroid hormone (PTH) and calcium levels were recorded before and after treatment. Complications were evaluated during and after treatment. Results: In patients with PHPT, significant reductions in size and volume were noted after RFA at 6- and 12-month follow-up (all, p < 0.05). Seven nodules nearly completely disappeared (residual volume < 0.1 mL); serum PTH and calcium levels were reduced to normal ranges (7/11, 63.6%). Four patients experienced partial reductions of serum PTH and calcium levels (4/11, 36.4%). In patients with SHPT, three experienced therapeutic response of serum PTH (3/8, 37.5%), while five showed persistent hyperparathyroidism (5/8, 62.5%) within 6 months after RFA. In patients with SNPCs, EA resulted in significant reductions in cyst size and volume (all, p < 0.05) at the last follow-up. A total of four complications (two transient hypocalcemia [RFA], one permanent [RFA], and one transient [EA] hoarseness) were observed. Conclusion: Minimally invasive treatments, such as RFA and EA, may serve as therapeutic alternatives for patients with PHPT or SNPCs; they may have limited usefulness in patients with SHPT.

• Korean Circulation Journal
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• 제52권5호
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• pp.368-378
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• 2022

Background and Objectives: Recurrence rates after radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) patients are not low especially in non-paroxysmal AF. The diameter of left atrium (LA) has been widely used to predict the recurrence after RFCA for decades. However, LA diameter represents structural remodeling of LA and does not reflect electrical remodeling. We aimed to determine the predictive value of electrical remodeling of LA which is represented by the amount of low voltage zone (LVZ). Methods: We performed a retrospective cohort analysis of AF patients who underwent de novo RFCA in a single-center. Results: A total of 3,120 AF patients with de novo RFCA were analyzed. Among these patients, 537 patients underwent an electroanatomic mapping with bipolar voltage measurement of LA. The diameter of LA and flow velocity of LA appendage (LAA) differed significantly according to quartile group of LVZ area and percentage: patients with high LVZ had large LA diameter and low LAA flow velocity (p<0.001). Freedom from late recurrence (LR) was significantly lower in patients with high LVZ area and percentage (p<0.001). The diameter and surface area of LA had area under curve (AUC) of 0.592 and 0.593, respectively (p=0.002 for both). The predictive value of LVZ area (AUC, 0.676) and percentage (AUC, 0.671) were both superior compared with LA diameter (p=0.011 and 0.027 for each comparison). Conclusions: In conclusion, LVZ can predict freedom from LR after RFCA in AF patients. Predictive value was higher in parameters reflecting electrical rather than structural remodeling of LA.

• Journal of Chest Surgery
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• 제53권5호
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• pp.270-276
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• 2020

Background: We investigated the impact of previous catheter ablation (CA) on the midterm outcomes of totally thoracoscopic ablation in patients with lone atrial fibrillation (AF). Methods: Between February 2012 and July 2018, 332 patients underwent totally thoracoscopic ablation for the treatment of AF (persistent AF; n=264, 80%). The patients were stratified into CA (n=47, 14%) and non-CA (nCA; n=285, 86%) groups according to their CA history. Results: All the baseline clinical characteristics and risk factors were similar between the groups except for age, percentage of male patients, prevalence of paroxysmal AF, prior percutaneous coronary intervention, and left atrial volume index (LAVI). No significant intergroup differences were observed in the incidence of early and late complications. At late follow-up, normal sinus rhythm was observed in 92% (43 of 47) of the patients in the CA group and 85% (242 of 285) of the patients in the nCA group (p=0.268). The rate of freedom from AF recurrence at 5 years was 55.3%±11.0% in the CA group, which was similar to that in the nCA group (55.7%±5.1%, p=0.690). In Cox regression analysis, preoperative brain natriuretic peptide levels and LAVI were associated with AF recurrence, but CA history was not significant. Conclusion: Totally thoracoscopic ablation was safe and effective in treating AF irrespective of CA history. A history of CA did not appear to affect the procedural complexity.