• Journal of radiological science and technology
• /
• v.31 no.3
• /
• pp.267-276
• /
• 2008

The 25 healthy male volunteers aged from 20 to 50years old have been employed in this study. 2D-PC MRA was performed to measure the velocity of the blood flow in the internal carotid artery and internal jugular veins using 3.0T MRI Whole body (signa VH/i GE). ECTRICKS-CEMRA was performed to evaluate the pattern of blood circulation from internal carotid artery to internal jugular vein. Using 2D-PC MRA, the cross-section of the 4th and 5th cervical discs was scanned with 24cm FOV. Then the speed of blood flow was measured for internal carotid artery and internal jugular vein when the subject wears a necktie tightly and no tie. The average of maximum velocity of internal carotid arteries without a necktie was 72.13cm/sec in the right side and 74.96cm/sec in the left side(average 73.54cm/sec in both sides) while the average of maximum velocity of internal jugular veins without a necktie was -34.45cm/sec in the right side and -24.99cm/sec in the left side (-29.72cm/sec in both sides). However, when wearing a necktie tightly, the average of maximum velocity of internal carotid arteries was 61.35cm/sec in the right side and 65.19cm/sec in the left side(average 63.27cm/sec in both sides) while the average of maximum velocity of internal jugular veins was -22.14cm/sec in the right side and -17.93cm/sec in the left side(-20.03cm/sec in both sides). With the necktie tightly knotted, the average blood flow speed of both internal carotid arteries slightly decreased to 86% (63.27/73.54cm/sec) compared to no tie case in which both internal jugularveins significantly went down to 67% (-20.03/-29.72 cm/sec). Thus it is suggested that wearing a necktie affects the circulation of internal jugular veins(33% decrease in blood flow speed) more significantly than that of internal carotid artery(14% decrease in blood flow speed). Without a necktie, ECTRICKS-CEMRA showed natural blood circulation patterns of internal carotid arteries and internal jugular veins without any disturbances or compressions. However, when wearing a necktie tightly, ECTRICKS-CEMRA showed severe compression onto both internal jugular veins in all 25 volunteers. In conclusion, the result of the study showed that the tightly worn necktie instantly presses more internal jugular veins than internal carotid arteries, thereby significantly reducing the blood flow speed and leading to the temporary occlusion. Thus, the defecation or washing the face under the tightly tied necktie situations can cause the unexpected and temporary compression or occlusion of the internal jugular veins, subsequently leading to the occurrences of the stroke due to the secondary intracranial venous hypertension.

• Childhood Kidney Diseases
• /
• v.9 no.1
• /
• pp.15-20
• /
• 2005

Purpose : Nutcracker syndrome must be considered when hematuria or proteinuria occurs in a healthy child. The purpose of this study is to investigate the prevalence of nutcracker syndrome among children with asymptomatic hematuria or proteinuria, and to obtain the ratios of the peak velocity of the left renal vein between the aortomesenteric portion and the hilar portion in children with asymptomatic hematuna or protelnuria in which nutcracker syndrome was excluded and to observe whether the ratios are affected by sex, age or urinalysis findings. Methods : Using Doppler ultrasonography, we measured the flow velocity and obtained the peak velocity ratios of the left renal vein at the aortornesenteric portion and at the hilar Portion of the left kidney in children with asymptomatic hematuria or proteinuria who visited the Division of Pediatric Nephrology, Severance Hospital from May 2001 to March 2004. Results : Of 304 children with asymptomatic hematuna or proteinuria, 107 children(35.2%) were diagnosed with nutcracker syndrome. For 197 children with asymptomatic hematuria or proteinuria excluding nutcracker syndrome, the mean ratio of the peak velocity was 2.54 $\pm$0.73, which was not affected by sex, age or urinalysis findings. Conclusion : Nutcracker syndrome was the major cause of asymptomatic hematuria or proteinurla In children, comprising 35% of all cases. Doppler ultrasonography was helpful in the screening of nutcracker syndrome and prevention of its complications. For children with asymptomatic hematuria or proteinuria excluding nutcracker syndrome, the peak velocity ratio of the left renal vein did not differ from that of normal children and was not affected by sex, age or urinalysis findings. (J Korean Soc Pediatr Nephrol 2005;9:15-20)

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.17 no.5
• /
• pp.203-212
• /
• 2016

This study examined the prevention of deep vein thrombosis and skin response after the application of boots or calf intermittent pneumatic compression (IPC) devices in immobile patients with intracranial surgery. The subjects of this study included 60 patients in a surgical intensive care unit after receiving intracranial surgery from May to November in 2015. The blood flow velocity was measured daily to assess the deep vein thrombosis for 7 days, and the skin response of the legs was observed regularly. As a result, the boots IPC group showed an increased blood flow velocity over time compared to the calf IPC group. A significant statistical difference was observed in both the boots IPC group and calf IPC group over time (Right side; F=64.41, p<.001, Left side; F=58.21, p<.001). The dorsum circumference over time and the correlations between two groups (Right side; F=9.13, p <.001, left side; F=9.29, p<.001) also showed a significant difference. In addition, the boots IPC group showed no skin complications. In conclusion, the boots type IPC is a more effective method for preventing deep vein thrombosis for immobile patients with intracranial surgery.

• Journal of Korean Academy of Nursing
• /
• v.39 no.2
• /
• pp.288-297
• /
• 2009

Purpose: This study was done to evaluate the mean venous velocity (MVV) response with knee and thigh length compression stockings (CS) versus intermittent pneumatic compression (IPC) devices in immobile patients with brain injuries. Methods: We carried out a randomized controlled study. We analyzed both legs of a randomly chosen sample of 43 patients assigned to one of 4 groups (86 legs). The patients were sequentially hospitalized in the intensive care unit (ICU) in "S hospital" from November 2005 to December 2006. The base line and augmented venous velocity was measured at the level of the common femoral vein. We applied leg compression 42 times over 7 days (for 2 hours at a time at 2 hour intervals). Results: There was a statistical difference among the 4 groups. The difference for the "IPC" group was more significant than the "CS" group. Conclusion: These results indicate that the application of IPC can be considered as an effective method to prevent deep vein thrombosis for immobile patients with brain injury.

• Progress in Medical Physics
• /
• v.23 no.3
• /
• pp.177-187
• /
• 2012

Magnetic resonance angiography (MRA) techniques are widely used in diagnosis of vascular disorders such as hemadostenosis and aneurism. Especially, phase contrast (PC) MRA technique, which is a typical non contrast-enhanced MRA technique, provides not only the anatomy of blood vessels but also flow velocity. In this study, we developed the 2- and 3-dimensional PC MRA pulse sequences for a low magnetic field MRI system. Vessel images were acquired using 2D and 3D PC MRA and the velocities of the blood flow were measured in the superior sagittal sinus, straight sinus and the confluence of the two. The 2D PC MRA provided the good quality of vascular images for large vessels but the poor quality for small ones. Although 3D PC MRA gave more improved visualization of small vessels than 2D PC MRA, the image quality was not enough to be used for diagnosis of the small vessels due to the low SNR and field homogeneity of the low field MRI system. The measured blood velocities were $25.46{\pm}0.73cm/sec$, $24.02{\pm}0.34cm/sec$ and $26.15{\pm}1.50cm/sec$ in the superior sagittal sinus, straight sinus and the confluence of the two, respectively, which showed good agreement with the previous experimental values. Thus, the developed PC MRA technique for low field MRI system is expected to provide the useful velocity information to diagnose the large brain vessels.

• Journal of Chest Surgery
• /
• v.35 no.10
• /
• pp.712-723
• /
• 2002

Substantial alterations in cerebral blood flow(CBF) are known to occur during cardiopulmonary bypass(CPB). Many investigators have speculated that these changes may be responsible for both minor and major cerebral damages after CPB. More recently, these changes in CBF have been observed to be intimately related to the arterial carbon dioxide tension(Pa$CO_2$) maintained during CPB. The present study was prospectively designed to investigate the clinical effects of normocapnic and hypercapnic CPB on the cerebral oxygen metabolism in cardiac surgery Material and Method: Thirty-six adult patients scheduled for elective cardiac surgery were randomized to either normocapnic group (Pa$CO_2$35~40 mmHg, n＝18) or hypercapnic group(Pa$CO_2$, 45~55 mmHg, n＝18) with moderately hypothermic nonpulsatile CPB(nasopharyngeal temperature of 29~3$0^{\circ}C$). In each patient, middle cerebral artery blood flow velocity( $V_{MCA}$), cerebral arteriovenous oxygen content difference (C(a-v) $O_2$), cerebral oxygen extraction(COE), cerebral metabolic rate for oxygen(CMR $O_2$), cerebral oxygen transport( $T_{E}$ $O_2$), $T_{E}$ $O_2$/CMR $O_2$ ratio, cerebral desaturation(internal jugular bulb blood oxygen saturation $\leq$ 50%), and arterial and jugular bulb blood gas were evaluated throughout the operation. Postoperative neuropsychologic complications were assessed in all patients. All variables were compared between the two groups. Result: VMCA(169.13 $\pm$ 8.32 vs 153.11 $\pm$8.98%), TE $O_2$(1,911.17$\pm$250.14 vs 1,757.40$\pm$249.56), $T_{E}$ $O_2$,/CMR $O_2$ ratio(287.38$\pm$28.051 vs 246.77$\pm$25.84), $O_2$ tension in internal jugular bulb (41.66$\pm$9.19 vs 31.50$\pm$6.09 mmHg), and $O_2$saturation in internal jugular bulb(68.97$\pm$10.96 vs 58.12$\pm$12.11%) during CPB were significantly lower in normocapnic group(p＝0.03), whereas hypercapnic group had lower C(a-v) $O_2$(3.9$\pm$0.3 vs 4.9$\pm$0.3 mL/dL), COE(0.3$\pm$0.03 vs 0.4$\pm$0.03), CMR $O_2$(5.8 $\pm$0.5 vs 6.8$\pm$0.6), and arterial blood pH(7.36$\pm$0.09 vs 7.46$\pm$0.07, p＝0.04) during CPB. Hypercapnic group had lower incidence of cerebral desaturation than normocapnic group(3 vs 9 patients, p=0.03). Duration of the neuropsychologic complication(delirium) were shorter in hypercapnic group than in normocapnic group(36 vs 60 hrs, p＝0.009). Conclusion: These findings suggest that hypercapnic CPB may have salutary effects on the cerebral oxygen metabolism and postoperative neurologic outcomes in cardiac surgery.surgery.

• Journal of Chest Surgery
• /
• v.40 no.2 s.271
• /
• pp.97-102
• /
• 2007

Background: Endovenous laser treatment has recently been introduced as a less invasive technique, with many good results reported, A 980-nm diode laser was used on the great saphenous vein (GSV) occlusions in patients with varicose veins, due to GSV reflux, and the therapeutic effects analyzed. Material and Method: Between September 2003 and February 2006, 238 patients (332 cases) with GSV reflux underwent endovenous laser treatment with a 980-nm diode laser. Operative procedures were simultaneous endovenous laser treatment and ambulatory phlebectomy. The preoperative clinical findings, postoperative complications and postoperative duplex US follow up results at 1 and 3 months were reviewed. Result: Postoperative complications were ecchymosis in almost cases, paresthesia 68 cases (20.5%) and skin burn in 3 cases (0.9%). Follow up duplex US revealed 26 and 10 cases at 1 and 3 months of GSV reflux or partial recanalization, with therapeutic success rates of 91.3 and 87.9%, respectively. Conclusion: The treatment of GSV occlusion with an endovenous laser is less invasive than traditional GSV stripping, but relatively high recanalization was experienced, possibly due to inadequate laser power, laser fiber pullback speed or an extremely dilated GSV. However, continuous attempts will be required to reduce the recanalization after the procedure, with accurate follow up using duplex US.

• Journal of Chest Surgery
• /
• v.38 no.2 s.247
• /
• pp.101-109
• /
• 2005

Background: In sudden cardiac arrest, the effective maintenance of coronary artery blood flow is of paramount importance for myocardial preservation as well as cardiac recovery and patient survival. The purpose of this study was to directly compare the effects of pulsatile and non-pulsatile circulation to coronary artery flow and myocardial preservation in cardiac arrest condition. Material and Method: A cardiopulmonary bypass circuit was constructed in a ventricular fibrillation model using fourteen Yorkshire swine weighing $25\~35$ kg each. The animals were randomly assigned to group I (n=7, non-pulsatile centrifugal pump) or group II (n=7, pulsatile T-PLS pump). Extra-corporeal circulation was maintained for two hours at a pump flow of 2 L/min. The left anterior descending coronary artery flow was measured with an ultrasonic coronary artery flow measurement system at baseline (before bypass) and at every 20 minutes after bypass. Serologic parameters were collected simultaneously at baseline, 1 hour, and 2 hours after bypass in the coronary sinus venous blood. The Mann-Whitney U test of STATISTICA 6.0 was used to determine intergroup significances using a p value of < 0.05. Result: The resistance index of the coronary artery was lower in group II and the difference was significant at 40 min, 80 min, 100 min and 120 min (p < 0.05). The mean velocity of the coronary artery was higher in group II throughout the study, and the difference was significant from 20 min after starting the pump (p < 0.05). The coronary artery blood flow was higher in group II throughout the study, and the difference was significant from 40 min to 120 min (p < 0.05) except at 80 min. Serologic parameters showed no differences between the groups at 1 hour and 2 hours after bypass in the coronary sinus blood. Conclusion: In cardiac arrest condition, pulsatile extracorporeal circulation provides more blood flow, higher flow velocity and less resistance to coronary artery than non-pulsatile circulation.

• Proceedings of the Korean Society of Applied Pharmacology
• /
• 1994.04a
• /
• pp.345-345
• /
• 1994

BBB opening 에 의란 수용성 약물 및 지용성 약물의 뇌혈관 투과 패턴을 알아보기 위해 모델약물로서 수용성 약물인 $^{99}$Tc-DTPA, 지용성 약물인 Pherlytoin을 선택하여 뇌혈관 투과성(PA)의 증가율을 검토하고자 하였다. 랫트의 좌측 외경동맥(left external carotid artery)에 혈류의 역방향으로 PE-50 catheter를 분지점에서 1-2mm 전까지 삽입하고, 1.6 molal L-(+)-arabinosg 고장액 (1580 mOsm)을 0. 12ml/sec의 일정한 속도로 30초간 infusion 한 후. $^{99}$Tc-DTPA 혹은 phenytoin 약물 용액을 대뢰정맥으로 주사하고, 대뢰동맥으로부터 약물 투여전 및 투여후 10, 30초, 1, 1.5, 2, 3. 4, 5. 7, 10분 간격으르 혈액을 채취하였으며. 마지막 채혈후 즉시 단두하여 뇌조직을 취하였다. 채취한 뇌를 좌, 우반구 및 각 부위별로 분리하고 감마 카운터와 HPLC를 이용하여 뇌증농도를 정량하였다. 또한 뇌 실질 조직내 약물량을 구하기 위해 뇌 혈관내에 존재하는 약물양을 보정하였는데, 이때 계산에 필요한 뇌증 혈액부피의 측정은 $^{99}$Tc-albumin을 이용하여 구하였다.

• Journal of Chest Surgery
• /
• v.35 no.6
• /
• pp.420-429
• /
• 2002

Moderate hypothermic cardiopulmonary bypass (CPB) has commonly been used in cardiac surgery. Several cardiac centers recently practice normothermic CPB in cardiac surgery, However, the clinical effect and safety of normothermic CPB on cerebral metabolism are not established and not fully understood. This study was prospectively designed to evaluate the clinical influence of normothermic CPB on brain metabolism and to compare it with that of moderate hypothermic CPB. Material and Method: Thirty-six adult patients scheduled for elective cardiac surgery were randomized to receive normothermic (nasopharyngeal temperature ＞34.5 $^{\circ}C$, n=18) or hypothermic (nasopharyngeal temperature 29~3$0^{\circ}C$, n=18) CPB with nonpulsatile pump. Middle cerebral artery blood flow velocity (VMCA), cerebral arteriovenous oxygen content difference (CAVO$_{2}$), cerebral oxygen extraction (COE), modified cerebral metabolic rate for oxygen (MCMRO$_{2}$), cerebral oxygen transport (TEO$_{2}$), cerebral venous desaturation (oxygen saturation in internal jugular bulb blood$\leq$50 %), and arterial and internal jugular bulb blood gas analysis were measured during six phases of the operation： Pre-CPB (control), CPB-10 min, Rewarm-1 (nasopharyngeal temperature 34 $^{\circ}C$ in the hypothermic group), Rewarm-2 (nasopharyngeal temperature 37 $^{\circ}C$ in the both groups), CPB-off and Post-CPB (skin closure after CPB-off). Postoperaitve neuropsychologic complications were observed in all patients. All variables were compared between the two groups. Result： VMCA at Rewarm-2 was higher in the hypothermic group (153.11$\pm$8.98%) than in the normothermic group (131.18$\pm$6.94%) (p＜0.05). CAVO$_{2}$ (3.47$\pm$0.21 vs 4.28$\pm$0.29 mL/dL, p＜0.05), COE (0.30$\pm$0.02 vs 0.39$\pm$0.02, p＜0.05) and MCMRO$_{2}$ (4.71 $\pm$0.42 vs 5.36$\pm$0.45, p<0.05) at CPB-10 min were lower in the hypothermic group than in the normothermic group. The hypothermic group had higher TEO$_{2}$ than the normothermic group at CPB-10 (1,527.60$\pm$25.84 vs 1,368.74$\pm$20.03, p＜0.05), Rewarm-2 (1,757.50$\pm$32.30 vs 1,478.60$\pm$27.41, p＜0.05) and Post-CPB (1,734.37$\pm$41.45 vs 1,597.68$\pm$27.50, p＜0.05). Internal jugular bulb oxygen tension (40.96$\pm$1.16 vs 34.79$\pm$2.18 mmHg, p＜0.05), saturation (72.63$\pm$2.68 vs 64.76$\pm$2.49 %, p＜0.05) and content (8.08$\pm$0.34 vs 6.78$\pm$0.43 mL/dL, p<0.05) at CPB-10 were higher in the hypothermic group than in the normothermic group. The hypothermic group had less incidence of postoperative neurologic complication (delirium) than the normothermic group (2 vs 4 patients, p＜0.05). Lasting periods of postoperative delirium were shorter in the hypothermic group than in the normothermic group (60 vs 160 hrs, p<0.01). Conclusion: These results indicate that normothermic CPB should not be routinely applied in all cardiac surgery, especially advanced age or the clinical situations that require prolonged operative time. Moderate hypothermic CPB may have beneficial influences relatively on brain metabolism and postoperative neuropsychologic outcomes when compared with normothermic CPB.