• Tuberculosis and Respiratory Diseases
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• 제56권4호
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• pp.420-425
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• 2004

관상동맥-폐동맥 누공은 비교적 드문 질환으로 선천적 원인이 대부분이나 최근 흉부 시술이나 방사선 치료의 증가로 점차 후천적 원인이 많아지는 추세이다. 증상이 비특이적이어서 진단이 늦어질 수 있어 주의를 요한다. 저자들이 경험한 환자는 기존의 폐질환 증상 때문에 심장 혈관 질환의 진행을 예측하기 어려웠다. 약간의 논쟁이 있으나 원인에 계 없이 크기가 작은 누공에서는 추적관찰이, 중등도 이상의 크기이거나 확장 가능성이 있는 경우에는 누공을 막거나 원인혈관을 제거하는 방법이 장되고 있다. 예후는 대체로 양호한 편이다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제30권6호
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• pp.572-576
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• 2008

Gorham-Stout 증후군은 조직학적으로 양성의 혈관 증식을 보이면서 광범위한 골 용해 현상을 나타내는 희귀한 병으로 알려져 있다. 병인론은 아직 명확히 밝혀져 있지 않으며 주로 남성과 젊은 성인에게서 호발하는 것으로 알려져 있다. 진단에는 컴퓨터 단층촬영, 자기공명영상, 핵의학검사, 혈관조영검사 등의 영상검사가 도움이 되며, 조직학적검사 역시 몇몇 특이 소견을 통해 진단에 도움을 줄 수 있다. 발생하는 부위에 따라서 그 예후는 매우 다르며, 특히 척추나 흉곽에 발생할 경우는 생명을 위협할 수 있다. 저자등은 우측 하악골의 병적 골절을 주소로 내원한 환자에서 임상검사, 방사선학적 검사, 조직병리학적 검사를 통해 Gorham-Stout 증후군으로 진단한 환자를 비골유리피판을 이용한 하악골 재건술을 통해 치료하였고 4년 동안 관찰 기간 중 재발 없이 양호한 치유 경과를 보였기에 문헌고찰과 함께 보고하는 바이다.

• Bulletin of the Korean Chemical Society
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• 제20권12호
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• pp.1399-1408
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• 1999

Geometrical structures for the dimerization of (NO)₂ from (NO + NO) have been calculated using ab initio Har-tree-Fock (SCF), second-order Møller-Plesset perturbation (MP2), and coupled cluster with the single, double, and triple substitution [CCSD(T)] methods with a triple zeta plus polarization (TZP) basis set including diffuse Rydberg basis functions. The structure of (NO)₂ can be described by two interactions (N…N, N…O). One is the ONNO structure with an (N…N) interaction. In this structure, acyclic cis-ONNO with $C_{2v}$-symmetry, acyclic trans-ONNO with $C_{2h}$, and cyclic ONNO with trapezoidal structure ($C_{2v}$) are optimized at the MP2 level. The other structure is the ONON structure with an (N…O) interaction. In the structure, acyclic cis-ONON with Cs$^{-symmetry}$ and cyclic ONON of the rectangular ($C_{2h}$), square $(D_{2h})$, rhombic $(D_{2h})$, and parallelogramic $(D_{2h})$ geometries are also optimized. It is found that acyclic cis-ONNO (¹A₁) is the most stable structure and cyclic ONNO (³A₁) is the least stable. Acyclic trans-ONNO (³A₁) with an (N…N) interaction, acyclic trans-ONON and bicyclic ONON $(C_{2v})$ with (N…O) interaction, and acyclic cis- and trans-NOON with an (O…O) interaction can not be optimized at the MP2 level. Particularly, acyclic trans-ONNO with $C_{2h}$-symmetry can not be optimized at the CCSD(T) level. Meanwhile, acyclic NNOO (¹A₁, $C_s)$ and trianglic NNOO (¹A₁,$C_{2v})$ formed by the (O…N) interaction between O₂ and N₂ are optimized at the MP2 level. The binding energies and the relative energy gaps among the isomers are found to be relatively small./sec. Spiral CT scans during the arterial phase were obtained 35 seconds after the injection of contrast medium. CT findings of 78 lesions less than 4cm in diameter were correlated with angiographic findings. Results : The attenuation of lesions was high(n = 69), iso(n = 5), and low(n = 4) compared with liver parenchyma during the arterial phase of spiral CT. In lesions with high-, iso-, and low-attenuation during the arterial phase of spiral CT, hypervascularity on angiograms was found in 63 of 69(91.3%), three of five(60%), and three of four lesions(75%), respectively. Six lesions with high-attenuation on the arterial phase of spiral CT were not seen on angiography. Two iso-attenuated and one low-attenuated lesion were hypovascular on angiograms. Conclusion : The results of this study suggest that with some exceptions there was good correlation between the arterial phase of spiral CT and angiography.

• Journal of Korean Neurosurgical Society
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• 제64권6호
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• pp.891-900
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• 2021

Objective : Vertebral artery dissecting aneurysm (VADA) is a very rare subtype of intracranial aneurysms; when ruptured, it is associated with significantly high rates of morbidity and mortality. Despite several discussions and debates, the optimal treatment for VADA has not yet been established. In the last 10 years, flow diverter devices (FDD) have emerged as a challenging and new treatment method, and various clinical and radiological results have been reported about their safety and effectiveness. The aim of our study was to evaluate the clinical and radiological results with the use of FDD in the treatment of unruptured VADA. Methods : We retrospectively evaluated the data of all patients with unruptured VADA treated with FDD between January 2018 and February 2021 at our hybrid operating room. Nine patients with unruptured VADA, deemed hemodynamically unstable, were treated with FDD. Among other parameters, the technical feasibility of the procedure, procedure-related complications, angiographic results, and clinical outcomes were evaluated. Results : Successful FDD deployment was achieved in all cases, and the immediate follow-up angiography showed intra-aneurysmal contrast stasis with parent artery preservation. A temporary episode of facial numbness and palsy was noted in one patient; however, the symptoms had completely disappeared when followed up at the outpatient clinic 2 weeks after the procedure. The 3-6 months follow-up angiography (n=9) demonstrated complete/near-complete obliteration of the aneurysm in seven patients, and partial obliteration and segmental occlusion in one patient each. In the patient who achieved only partial obliteration, there was a sac 13 mm in size, and there was no change in the 1-year follow-up angiography. In the patient with segmental occlusion, the cause could not be determined. The clinical outcome was modified Rankin Scale 0 in all patients. Conclusion : Our preliminary study using FDD to treat hemodynamically unstable unruptured VADA showed that FDD is safe and effective. Our study has limitations in that the number of cases is small, and it is not a prospective study. However, we believe that the study contributes to evidence regarding the safety and effectiveness of FDD in the treatment of unruptured VADA.

• Journal of Korean Neurosurgical Society
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• 제62권4호
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• pp.405-413
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• 2019

Objective : We evaluated efficacy of combining proximal balloon guiding catheter (antegrade flow arrest) and distal access catheter (aspiration at the site of occlusion) in thrombectomy for anterior circulation ischemic stroke. Methods : We retrospectively analyzed 116 patients who underwent mechanical thrombectomy with stent retriever. The patients were divided by the techniques adopted, the combined technique (proximal balloon guiding catheter and large bore distal access catheter) group (n=57, 49.1%) and the conventional (guiding catheter with stent retriever) technique group (n=59, 50.9%). We evaluated baseline characteristics (epidemiologic data, clinical and imaging characteristics) and procedure details (the number of retrieval attempts, procedure time), as well as angiographic (thrombolysis in cerebral infarction (TICI) score, distal thrombus migration) and clinical outcome (National Institutes of Health Stroke Scale at discharge, modified Rankin Scale [mRS] at 3 months) of them. Results : The number of retrieval attempts was lower (p=0.002) and the first-pass successful reperfusion rate was higher (56.1% vs. 28.8%; p=0.003) in the combined technique group. And the rate of final result of TICI score 3 was higher (68.4% vs. 28.8%; p<0.01) and distal thrombus migration rate was also lower (15.8% vs. 40.7%; p=0.021) in the combined technique group. Early strong neurologic improvement (improvement of National Institutes of Health Stroke Scale ${\geq}11$ or National Institutes of Health Stroke Scale ${\leq}1$ at discharge) rate (57.9% vs. 36.2%; p=0.02) and favorable clinical outcome (mRS at 3 months ${\leq}2$) rate (59.6% vs. 33.9%; p=0.005) were also better in the combined technique group. Conclusion : The combined technique needs lesser attempts, decreases distal migration, increases TICI 3 reperfusion and achieves better clinical outcomes.

• 한국방사선학회논문지
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• 제12권7호
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• pp.845-852
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• 2018

본 연구는 심장 혈관 조영술의 투시 영상과 씨네 영상을 획득하는 데 있어서 초당 프레임 횟수를 변화함에 따라 흡수선량과 획득 영상의 화질의 추이를 살펴보는 것을 목적으로 한다. 또, FOV 확대와 Live Zoom이라는 두 가지 확대 모드에 따른 변화도 고찰 대상으로 한다. 인체모형 팬텀을 심장 혈관 조영장치 위에서 초당 프레임 횟수를 7.5, 15, 30 f/s로 설정하고 두 가지 확대 모드에 대하여 각각 5회씩 촬영하였다. 선량의 척도로서는 흡수선량과 에어 커머가 사용되었고, 화질 평가의 척도로는 잡음의 세기로서의 표준 편차(SD), 신호 대 잡음비(SNR)와 대조도 대 잡음비(CNR) 등을 활용하였다. 초당 프레임 횟수가 30부터 15, 7.5 f/s로 감소되었을 때, DAP와 에어 커머는 동일한 비율로 감소하였으나, 화질의 척도인 SD, SNR과 CNR은 거의 변화가 없었다. 확대 모드에의 의존도에 관해서는, Live Zoom이 FOV 확대와 비교하였을 때, DAP, 에어 커머와 SD에 대해서는 통계적 의미 있는 차이를 보이지 않았으나, SNR과 CNR에 있어서는 통계적 유의미한 개선을 보였다. 이러한 실험 결과에 의하여, 초당 프레임 횟수는 화질의 열화 없이 되도록 낮게 설정하는 것이 가능하며, 확대 모드도 추가적인 선량 없이 실시간 확대가 가능한 Live Zoom 모드를 적극적으로 활용 가능하며 이는 화질의 여러 척도의 저하를 가져오지 않음을 알 수 있었다.

• Journal of Korean Neurosurgical Society
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• 제62권6호
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• pp.649-660
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• 2019

Objective : To analyze the angiographic features and clinical course, including treatment outcomes and the natural course, of fusiform middle cerebral artery aneurysms (FMCAAs) according to their location, size, and configuration. Methods : We reviewed the literature on adult cases of FMCAAs published from 1980 to 2018; from 25 papers, 112 FMCAA cases, for which the location, size, and configuration could be identified, were included in this study. Additionally, 33 FMCAA cases in our hospital were included, from which 16 were assigned to the observation group. Thus, a total of 145 adult FMCAA cases were included. We classified the FMCAAs according to their location (l-type 1, beginning from prebifurcation; l-type 2, beginning from bifurcation; l-type 3, beginning from postbifurcation), size (small, <10 mm; large, ${\geq}10mm$; giant, ${\geq}25mm$), and configuration (c-type 1, classic dissecting aneurysm; c-type 2, segmental ectasia; c-type 3, dolichoectatic dissecting aneurysm). Results : The c-type 3 was more commonly diagnosed with ischemic symptoms (31.8%) than hemorrhage (13.6%), while 40.9% were found accidentally. In contrast, c-type 2 was more commonly diagnosed with hemorrhagic symptoms (14.9%) than ischemic symptoms (10.6%), and 72.3% were accidentally discovered. According to location, ischemic symptoms and hemorrhage were the most frequent symptoms in l-type 1 (28.6%) and l-type 3 (34.6%), respectively. Most of l-type 2 FMCAAs were found incidentally (68.4%). Based on the size of FMCAAs, only 11.1% of small aneurysms were found to be hemorrhagic, while 18.9% and 26.0% of large and giant aneurysms were hemorrhagic, respectively. Although four aneurysms of the 16 FMCAAs in the observation group increased in size and one aneurysm decreased in size during the observation period, no rupture was seen in any case and there were no significant predictors of aneurysm enlargement. Of 104 FMCAAs treated, 14 cases (13.5%) were aggravated than before surgery and all the aggravated cases were l-type 1. Conclusion : While ischemic symptoms occurred more frequently in l-type 1 and c-type 3, hemorrhagic rather than ischemic symptoms occurred more frequently in l-type 3 and c-type 2. In case of l-type 1 FMCAAs, more caution is required in determining the treatment due to the relatively high complication rate.

• 한국방사선학회논문지
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• 제17권1호
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• pp.53-62
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• 2023

Lower Extremity CT Angiography 검사 시 환자의 심박동 수(HR)에 따라 하지 혈관의 조영증강 차이를 비교 분석하여 최적화된 영상 기법을 찾고 유용성을 평가하고자 한다. 2022년 1월부터 22년 8월까지 아주대 병원을 내원하여 Lower Extremity CT Angiography 검사를 진행한 외래환자 139명을 대상으로 하였으며, 심박동 수(HR)에 따라 A 그룹(HR ≤65), B 그룹(65<HR<80), C 그룹(80≤ HR)으로 나누었다. 추가로 지연시간을 설정하여 D 그룹(HR ≤65), E 그룹(65<HR<80), F 그룹(80≤ HR) 으로 나누어 조영제 도달시간과 조영증강 평균값을 비교 분석하였다. 결과적으로 심박동 수(HR)의 차이는 하지 혈관 조영증강 강도에 영향을 주었고, 그룹별 정량적 평가 결과 Heart Rate가 65회 이상인 B, C 그룹은 A 그룹에 비해 슬와 동맥의 HU 값이 우수하였다(p<0.001^***). 지연시간을 적용한 D 그룹은 A 그룹에 비하여 하지 동맥의 조영증강 효과가 개선이 되었음을 확인할 수 있었고(p<0.001^***), 다른 그룹과의 비교한 분석은 유의미하지 않았다. 심박동 수(HR) 활용한 Lower extremity CTA 검사 방법은 유의미 하였고, 특히 심박동 수(HR)가 65이하로 낮은 경우에는 환자에게 적절한 지연시간을 적용하여 검사하는 것이 도움이 된다

• 대한정형외과학회지
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• 제55권4호
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• pp.343-347
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• 2020

메이-터너 증후군(May-Thurner syndrome)은 장골 정맥 압박 증후군으로 알려져 있고 좌하지의 총 정맥 유출로가 압박되어 부종, 통증 또는 혈전(심부정맥 혈전증)을 유발할 수 있는 상태이다. 특히 우측 총 장골 동맥과의 교차 지점에서 좌측 총 장골 정맥이 압박되는 형태가 전형적이다. 저자들은 우측 인공 슬관절 전치환술을 시행한 75세 여자 환자에서 메이-터너 증후군이 합병된 증례를 치료하였고 이를 보고하고자 한다. 수술을 시행한 후 좌측 하지의 부종과 통증에 대해 혈관 조영술 및 컴퓨터 단층촬영을 이용해 메이-터너 증후군을 진단하였다. 혈전용해제와 혈전제거술를 사용하여 혈전을 제거한 후 혈관 성형술 및 정맥 내 스텐트를 삽입하였다. 한국에서 인공 슬관절 전치환술 후 메이-터너 증후군이 합병된 증례는 보고된 바가 없다. 이에 저자들은 문헌고찰과 함께 보고하고자 한다.

• Journal of Korean Neurosurgical Society
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• 제65권3호
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• pp.422-429
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• 2022

Objective : Extracranial supra-aortic dissections (ESADs) with severe stenosis, occlusion and/or pseudoaneurysm presents potential risk of stroke. Endovascular stenting to reconstruct non acute phase ESADs (NAP-ESADs) is an alternative to anticoagulant or antiplatelet therapy. However, its feasibility, safety and efficacy of stenting in NAP-ESADs is unclear. This study aims to investigate the long-term outcomes of the feasibility, safety and efficacy of stenting in NAP-ESADs. Methods : Seventy-four patients with 91 NAP-ESAD vessels with severe stenosis, occlusion and/or pseudoaneurysm presents potential risk of stroke who underwent stent remodeling were enrolled into this respective study from December 2008 to March 2020. Technical success rate, complications, clinical and angiographic results were harvested and analyzed. Results : Success rate of stent deployment was 99% (90/91) with no procedural mortality or morbidity. Transient ischemic attack occurred in three patients during operation (4.1%, 3/74). Asymptomatic embolisms of distal intracranial vessels were found in two patients (2.7%, 2/74). One hundred and forty-two stents deployed at 85 carotid (135 stents) and six vertebral (seven stents) vessels. Six stent types (Wingspan, 28/135, 20.7%; Solitaire, 10/135, 7.4%; Neuroform, 8/135, 5.9%; LVIS, 2/135, 1.5%; Precise, 75/135, 55.6%; Acculink, 12/135, 8.9%) were deployed at carotid arterial dissection while two types (Wingspan, 5/7, 71.4%; Solitaire 2/7, 28.6%) at vertebral arterial dissection. Digital subtracted angiography (56%, 51/91), computational tomography angiography (41.8%, 38/91) and high resolution magnetic resonance imaging (2.2%, 2/91) were adopted for follow up, with a mean time of 17.2±15.4 months (5-77). All patient modified Rankin Scale scores showed no increase at discharge or follow-up. Angiographically, dissections in 86 vessels in 69 patients (94.5%, 86/91) were completely reconstructed with only minor remnant dissections in four vessels in four patients (4.4%, 4/91). Severe re-stenosis in the stented segment required re-stenting in one patient (1.1%, 1/91). Conclusion : Stent remodeling technique provides feasible, safe and efficacious treatment of ESADs patients with severe stenosis, occlusion and/or pseudoaneurysm.