• 한국방사선학회논문지
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• 제17권5호
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• pp.701-707
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• 2023

PET/CT에서 ¹⁸F-FDG의 주사용량은 SUV(Standard Uptake Value)에 직접적인 영향을 끼쳐 판독결과에 영향을 미칠 수 있다. 따라서 정확한 ¹⁸F-FDG의 dose 값을 주사하는 것이 중요하다. 본 연구에서는 ¹⁸F-FDG 주사 시 플러싱 횟수에 따른 주사기와 혈관삽입기구의 잔류방사능간의 상관관계분석을 실시하였다. 실험장비는 CRC-25R 검량계, 3WAY line과 needle, 3 cc 주사기 및 50 cc 생리식염수를 사용하였고 결과값을 SP SS 21 Statics로 통계 분석하였다. 그 결과, 주사기와 혈관삽입기구의 총 잔류 방사능은 2회 플러싱 시 5.84 % 로 가장 높았고 5회 플러싱 시 1.49 % 로 가장 낮게 잔류하였다. 상관관계분석결과, 플러싱 횟수는 주사기의 잔류방사능과 -0.436, 혈관삽입기구와 - 0.300으로 음(-)의 상관관계를 보였다. 플러싱횟수에 따른 주사기, 혈관확보기구의 잔류 방사능 평균값을 일원배치 분산분석(One way - ANOVA)를 실시한 결과, 주사기의 잔류방사능은 4회부터 유의미한 감소를 보였고, 혈관확보기구의 잔류방사능은 5회부터 유의미한 감소를 보였다. 그러나 혈관확보기구의 평균 잔류방사능이 총 잔류방사능의 0.8 %라는 점을 고려할 때, 4회의 플러싱횟수가 가장 합리적으로 보인다.

• 종양간호연구
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• 제11권1호
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• pp.1-8
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• 2011

Purpose: The purpose of this study was to identify the types of venous access devices (VAD) for cancer patients and investigate the factors related to the insertions of central venous catheter (CVC) in cancer patients. Methods: The subjects were 379 cancer patients. A retrospective review of all patients who were discharged from a cancer unit from November 1st to 21st in 2008 was done using a structured questionnaire. Results: A total of 82 CVC (21.6%) was inserted among 379 patients for administering anticancer therapy. There were statistically significant differences in age, length of stay (LOS), cumulative LOS, medical department, history of CVC insertion, cancer category, and albumin level between patients using peripheral intravenous (IV) catheters and CVC. In addition, factors influencing the use of CVC were LOS (odds ratio [OR]=0.286, confidence interval [CI]=1.043-1.124), history of CVC insertion (OR=3.920, CI=0.128-0.637), albumin level (OR=1.010, CI=1.879-8.179), cumulative LOS (OR=1.010, CI=1.001-1.018), and hematological diseases (OR=4.863, CI=2.162-10.925). Conclusion: We found that central venous catheterization for anticancer therapy was minimal even though CVC was safe and effective device for IV access. It is necessary to develop a strategy to use VADs efficiently and timely for cancer patients.

• Journal of Chest Surgery
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• 제47권1호
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• pp.26-31
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• 2014

Background: When managing patients who require repeated venous access, gaining a viable intravenous route has been problematic. To improve the situation, various studies on techniques for venous access have been conducted. The aim of this study is to evaluate the clinical results of complications following totally implanted central venous access port (TICVAP) insertion. Methods: A retrospective analysis was conducted on 163 patients, from December 2008 to March 2013. The occurrence of complications was studied in three separate periods of catheter use: the intraoperative period, postoperative period, and period during the treatment. Results: A total of 165 cases of TICVAP insertions involving 156 patients were included in the final analysis. There were 35 complications (21%) overall. Among these, 31 cases of complications (19%) occurred during the treatment period and the other 4 cases were intraoperative and postoperative complications (2%). There were no statistically significant differences in age and gender of the patients between the two groups to be risk factors (p=0.147, p=0.08). Past history of chemotherapy, initial laboratory findings, and the locations of TICVAP insertion also showed no statistical significance as risk factors (p>0.05). Conclusion: Because the majority of complications occurred after port placement and during treatment, meticulous care and management and appropriate education are necessary when using TICVAPs.

• Clinical and Experimental Pediatrics
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• 제51권12호
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• pp.1359-1362
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• 2008

혈우병 환자에서 가장 효과적인 치료 방침은 응고 인자의 보충으로, 그를 위해 안전하고 오래 사용할 수 있는 정맥 확보가 필요하다. 그러나 중심 정맥으로의 port는 전신 마취와 일정한 입원이 필요하고, 혈우병 환자에서 시행할 경우 보험 삭감의 문제도 있다. 본 저자는 두 명의 중증 혈우병 항체 환자에게 말초 삽입 중심 정맥관을 삽입하였다. 환자들은 잦은 출혈 소견 때문에 응고 인자를 투여 받았으며, 그로 인하여 혈관 확보에 어려움이 있었다. 환자 나이는 7세와 11세였다. 제 8 응고 인자 활성도는 모두 1% 이하였으며, 제 8 응고 인자 항체 수치는 각각 160과 26.3 BU/mL였다. 말초 삽입 중심 정맥관은 초음파 인도 하에, 외래에서, 국소 마취로 쉽게 삽입되었다. 말초 삽입 중심 정맥관 삽입은 잦은 출혈을 보이는 혈우병 환자에게 사용해 볼 수 있는 방법이다.

• 핵의학기술
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• 제18권1호
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• pp.94-97
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• 2014

PET/CT 영상에서 표준섭취계수(Standardized uptake value, SUV)는 간단한 반정량적인 방법으로 정상 조직과 종양 조직의 섭취 비를 측정하여 임상에서 육안적인 평가와 함께 유용하게 사용되고 있지만 많은 변수들로 인해 SUV에 영향을 주게 된다. 그 중 혈관 삽입기구나, 주사 부위의 잔여 방사능과 그 위치에 따라서 영향을 평가해 보고자 한다. GE Discovery 600 (GE Healthcare, MI, USA)과 NEMA IEC Body Phantom을 사용하였다. $^{18}F-FDG$ 5.7 kBq/mL를 물과 함께 phantom에 채웠고, 22 mm 직경의 구에 7.4, 14.8, 22.2, 29.6, 37, 55.5 MBq로 변화하여 SFOV에 포함, 불포함 그리고 끝단에 걸쳐진 조건으로 시뮬레이션 하였다. 획득된 영상에 관심영역을 설정하여 SUV에 미치는 영향을 비교 평가하였다. SFOV 포함 여부에 따라 구분한 3 그룹에서 방사능량에 상관없이 SFOV에 포함되지 않은 것이 가장 높은 SUV를 나타내었으며, 끝단에 걸친 것, 포함된 순으로 SUV의 변화가 있었다. 이중 구의 방사능량이 7.4 MBq의 경우 SFOV에 포함과 끝단에 걸친 위치의 경우 평균 SUV는 0.780, 0.840로 나왔으며 SFOV 밖에 위치 할 경우 0.896이 나왔다. 22.2 MBq과 55.5 MBq의 SUV는 동일한 순서대로 0.600, 0.700, 0.728, 0.372, 0.460, 0.508로 나왔으며, 구의 잔여방사능량에 따라 최소 10.4% 최대 62.8% 차이를 보였다. 본 연구를 통해 혈관삽입기구에 잔여 방사능이 많이 남아 있을수록 SUV를 과소평가하였다. 또한 SFOV에 포함여부에 따라서도 SUV의 변화가 있었으며, 포함되지 않았을 때 가장 적은 차이를 알 수 있었다. 추후에 혈관 삽입 기구 내 잔여 방사능과 환자의 혈관외 누출에 따른 방사능을 측정 할 수 있다면 임상에 더욱 도움이 되리라 사료된다.

• 대한치과마취과학회지
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• 제12권1호
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• pp.45-50
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• 2012

The Fontan operation is a heart operation used to treat complex congenital heart defects like tricuspid atresia, hypoplastic left heart syndrome, pulmonary atresia and single ventricle. A single ventricle is dedicated to pumping oxygenated blood to the systemic circulation and the entire systemic venous return reaches the pulmonary arterial system without the direct influence of a pumping chamber. In the patient with Fontan operation, it is important to achieve adequate pulmonary blood flow and cardiac output in anesthetic management. In this case, a 10-year-old boy (19.6 kg, 114 cm) with cleft palate, cerebral palsy and severe mental retardation, who underwent a Fontan operation when he was 4 years old, was presented for deep sedation. Because he was suffering from eating disorder with cleft palate, the orthodontist and the plastic surgeon planned to insert intraoral orthodontic device before cleft palate repair. But it was impossible to open his mouth for alginate impression procedure. After careful pre-anesthesia evaluation we planned to administer deep sedation with propofol infusion. After Intravenous catheter insertion, we started propofol intravenous infusion with the formula of a loading dose of 1.0 mg/kg followed by an infusion rate of 6.0 mg/kg/hr with syringe pump. His blood pressure was remained around 80/40 mmHg after loss of consciousness, but he could not maintain his airway patent. So we lowered the infusion rate to 3.0 mg/kg/hr, immediately. The oxygen saturation was maintained above 95% with nasal oxygen supply, and blood pressure was maintained around 100-80/60-40 mmHg. After the sedation of 110 minutes with propofol (the infusion rate to 3.0-5.0 mg/kg/hr), he fully regained consciousness, and was discharged without complication after 1 hour observation. In case of post-Fontan patient, intravenous deep sedation with propofol was safe and effective method of behavioral management during dental treatment.

• Journal of Dental Anesthesia and Pain Medicine
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• 제19권6호
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• pp.353-360
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• 2019

Background: Controlled hypotension (CH) provides a better surgical environment and reduces operative time. However, there are some risks related to organ hypoperfusion. The EV1000/FloTrac system can provide continuous cardiac output monitoring without the insertion of pulmonary arterial catheter. The present study investigated the efficacy of this device in double jaw surgery under CH. Methods: We retrospectively reviewed the medical records of patients who underwent double jaw surgery between 2010 and 2015. Patients were administered conventional general anesthesia with desflurane; CH was performed with remifentanil infusion and monitored with an invasive radial arterial pressure monitor or the EV1000/FloTrac system. We allocated the patients into two groups, namely an A-line group and an EV1000 group, according to the monitoring methods used, and the study variables were compared. Results: Eighty-five patients were reviewed. The A-line group reported a higher number of failed CH (P = 0.005). A significant correlation was found between preoperative hemoglobin and intraoperative packed red blood cell transfusion (r = 0.525; P < 0.001). In the EV1000 group, the mean arterial pressure (MAP) was significantly lower 2 h after CH (P = 0.014), and the cardiac index significantly decreased 1 h after CH (P = 0.001) and 2 h after CH (P = 0.007). Moreover, venous oxygen saturation (ScVO₂) decreased significantly at both 1 h (P = 0.002) and 2 h after CH (P = 0.029); however, these values were within normal limits. Conclusion: The EV1000 group reported a lower failure rate of CH than the A-line group. However, EV1000/FloTrac monitoring did not present with any specific advantage over the conventional arterial line monitoring when CH was performed with the same protocol and same mean blood pressure. Preoperative anemia treatment will be helpful to decrease intraoperative transfusion. Furthermore, ScVO₂ monitoring did not present with sufficient benefits over the risk and cost.

• 대한의용생체공학회:의공학회지
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• 제38권6호
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• pp.277-284
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• 2017

This paper presents an implantable pH measurement electrode for wireless gastroesophageal reflux measurement. Usually, gastroesophageal reflux is diagnosed by a catheter-type wire connection between the esophagus and the diagnostic device which brings many side effects such as restriction of daily living, pain, and discomfort in the nasal cavity and pharynx of patients. In order to solve these issues, researchers have been studied a wireless measurement method and a micro-sized pH electrode for human body insertion is necessary. Commercial glass packaged pH meter is formed by a sensing and a reference electrodes in a KCl solution. However, if the glass meter is inserted into the human body, there are risks of leakage of the solution, breakage of the glass package, injury of the body elements. Therefore, the solution should be solidified on the micro-sized noble metal wire which has a characteristic of biocompatible. After solidified wire fabrication, the designed meter was tested for feasibility of measurement and the result was well agreed with pH values of commercial pH meter. Potentials in pH 1 to 12 solution was measured to obtain the sensitivity of the sensor with linearity. And we have designed a simulation of gastroesophageal reflux with symptom frequency, interval, and duration time in pH 2 solution. The proposed sensor has capable to get the same potential for 24 measurements in 3 days, and it has sensed same pH values of 2 for one hour with every 10 minutes. Furthermore, the sensor was survived for 48 hours with reasonable potentials in the acid solution.