• Journal of Korean Neurosurgical Society
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• 제56권1호
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• pp.48-50
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• 2014

A 70-year-old woman presented with headaches and recurrent stroke symptoms. During five years, the patient has been treated for cerebral infarction associated with severe atherosclerotic stenosis of the internal carotid artery. Three-year follow-up magnetic resonance angiography showed a tiny de novo aneurysm arising from the distal part of atherosclerotic internal carotid artery. And 5-year follow-up three-dimensional CT angiogram demonstrated a definite aneurysm enlargement as large as requiring treatment. During dissection of aneurysm, the oculomotor nerve was found to be penetrated with the growing de novo aneurysm. The authors report a case of a de novo aneurysm, which resulted from atherosclerotic stenosis of the internal carotid artery at the supraclinoid portion, that was found to be penetrating the oculomotor nerve with no ocular palsy.

• Journal of Korean Neurosurgical Society
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• 제56권4호
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• pp.303-309
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• 2014

Objective : The purpose of this study was to retrospectively review cases of intracerebral hemorrhage (ICH) medically treated at our institution to determine if the CT angiography (CTA) 'spot sign' predicts in-hospital mortality and clinical outcome at 3 months in patients with spontaneous ICH. Methods : We conducted a retrospective review of all consecutive patients who were admitted to the department of neurosurgery. Clinical data of patients with ICH were collected by 2 neurosurgeons blinded to the radiological data and at the 90-day follow-up. Results : Multivariate logistic regression analysis identified predictors of poor outcome; we found that hematoma location, spot sign, and intraventricular hemorrhage were independent predictors of poor outcome. In-hospital mortality was 57.4% (35 of 61) in the CTA spot-sign positive group versus 7.9% (10 of 126) in the CTA spot-sign negative group. In multivariate logistic analysis, we found that presence of spot sign and presence of volume expansion were independent predictors for the in-hospital mortality of ICH. Conclusion : The spot sign is a strong independent predictor of hematoma expansion, mortality, and poor clinical outcome in primary ICH. In this study, we emphasized the importance of hematoma expansion as a therapeutic target in both clinical practice and research.

• 대한두경부종양학회지
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• 제17권1호
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• pp.13-18
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• 2001

Objectives: We studied what is the role of elective carotid artery resection in the management of advanced cervical metastatic cancer. Materials and Methods: 5 patients with elective carotid artery resection in advanced metastatic cervical cancer were reviewed retrospectively. The patients underwent complete neuroradiologic evaluation, including CT/MRI. angiography, duplex doppler, balloon occlusion test with EEG, and brain SPECT for determination of compatible collateral circulation after carotid artery resection. Results: Perioperative complication were appeared in 2 patients those were middle cerebral arterial infarction and mediastinal bleeding. Postoperative mortality rate was 20%. 4 patients recurred within 1 year. Conclusion: Preoperative collateral study rarely provide whether resection carotid artery or not. Elective carotid artery resection cannot provide locoregional control of tumor and don't promote survival.

• Journal of Chest Surgery
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• 제34권8호
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• pp.644-647
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• 2001

Lemierre 증후군은 원발성 구인두 감염증으로 인하여 내경정맥의 패혈성 혈전정맥염과 원격전이성 감염증이 발생하는 드물고도 진행이 빠른 임상적 상태로 특징지워진다. 심한 흉부 외상으로 기관 절개하에서 기계호흡 치료 중이던 40세 남자 환자가 우측 경부의 현저한 종창과 폐렴증상이 나타나면서 전신적인 패혈증상이 동반되었다. 경부 전산화 단층촬영과 자기공명 혈관조영술에서 우측 내경정맥이 큰 중심 괴사성 혈전에 의해 완전히 폐쇄되어 있었으며, 주위로의 염증파급이 매우 심한 혈전정맥염의 소견을 보였다. Clindamycin과 haparin의 투여에도 불구하고 염증소견은 더욱 악화되었다. 즉각적인 내경정맥 혈전제거술 및 절제술을 시행하였으며, 이후 환자의 전신적인 패혈증상과 폐렴 그리고 국소적인 염증소견이 소실되었다.

• Journal of Chest Surgery
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• 제28권1호
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• pp.60-65
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• 1995

Congenital diverticula of the cardiac ventricle have been reported as arising either from the left ventricle or, rarely from both ventricles. A diverticulum arising from the right ventricle alone is very rare. Furthermore the diverticulum associated with double chambered right ventricle was extremely rare. We experienced a 62 years old female of double chambered right ventricle combined with congenital right ventricular true diverticulum. She had complained intermittent chest pain and mild dyspnea on exertion during 8 months. The chest X-ray and chest CT showed protruded abnormal density at anterolateral side of right ventricular outflow tract. Preoperative angiography demonstrated a double chambered right ventricle and a right ventricular diverticulum. In operative finding, there was found a anomalous muscle band, dividing the right ventricle into an inflow and outflow portion, and a 5x6cm sized right ventricular diverticulum arised from conus region with a stenotic orifice of 1.5cm in diameter. The diverticulum was open toward the infundibulum, and its orifice was approximately 1cm in diameter. On treatment, the diverticulum orifice was closed directly and the abnormal muscle band was resected in order to widen the right ventricular outflow tract. The postoperative result was satisfactory and good without specific complications.

• Journal of Chest Surgery
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• 제40권9호
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• pp.641-644
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• 2007

50세 남자 환자가 갑작스런 복통으로 내원하였다. 다중 검출 복부 컴퓨터 단층촬영상 상장간막 동맥의 근위부 폐쇄가 관찰되었다. 입원 당일 응급으로 개복술을 실시하여 혈전제거술을 실시하였고 다음날 다시 혈전제거술과 일부 소장 절제를 하였다 저자들은 상장간막 동맥 폐쇄증을 치험하였기에 보고하는 바이다.

• Journal of Radiation Protection and Research
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• 제47권1호
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• pp.39-49
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• 2022

Background: For proper monitoring of the eye lens dose, an appropriate calibration factor of a dosimeter and information about the mean energies of X-rays are indispensable. The scattered X-ray energy spectra should be well characterized in medical practices where eye lenses of medical staffs might be high. Materials and Methods: Scattered X-ray energy spectra were experimentally derived for three different types of X-ray diagnostic and therapeutic equipment, i.e., the computed tomography (CT) scan, the angiography and the fluoroscopy. A commercially available CdZnTe (CZT) spectrometer with a lead collimator was employed for the measurement of scattered X-rays, which was performed in the usual manner. Results and Discussion: From the obtained energy spectra, the mean energies of the scattered X-rays lied between 40 and 60 keV. This also agreed with that obtained by the conventional half value layer method. Conclusion: The scattered X-rays to which medical workers may be exposed in the region around the eyes were characterized by means of spectrometry. The obtained mean energies of the scattered X-rays were found to match the flat region of the dosimeter response.

• Journal of Trauma and Injury
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• 제22권2호
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• pp.199-205
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• 2009

Purpose: This study compared the characteristics of and the prognosis for intraperitoneal and retroperitoneal/pelvic contrast extravasation, which had been confirmed by enhanced abdominal CT scan, after blunt trauma in patients who had undergone angiographic embolization. Methods: From January 2001 to March 2009, data were retrospectively collected regarding patients who had undergone contrast extravasation (CE) on CT scanning and arterial embolization after blunt trauma. The study patient group was divided into the intraperitoneal and the retroperitoneal/pelvic groups according to the area of contrast extravasation. We reviewed the initial demographic data, the location of injury, the solid organ injury, the embolized vessel, and the clinical outcome. Results: The mean age of the study subjects was $40.2{\pm}2.6$ years old, and there were 24 male patients. The intraperitoneal group included 10 patients, and retroperitoneal/pelvic group was comprised of 17 patients. The amount of transfusion from presentation to intervention and during the first 24 hours was greater in the retroperitoneal/pelvic group than in the intraperitoneal group. The intraperitoneal group showed a higher frequency and severity of liver injury than the retroperitoneal/pelvic group. Angiography revealed that the hepatic artery (n=4) was the most frequently embolized vessel in the intraperitoneal group, while the internal iliac artery (n=6), followed by the renal artery (n=4), internal pudendal artery (n=3), and the gluteal artery (n=2), were the most frequently injured vessels in the retroperitoneal/pelvic group. Conclusion: In patients with intra-abdominal contrast extravasation found on CT scanning and arterial embolization after blunt trauma, the need for transfusion was less in the intra-abdominal group than in the retroperitoneal/pelvic group. Liver injury was also more frequent and severe in the intraperitoneal group than in the retroperitoneal/pelvic group.

• 한국의학물리학회지:의학물리
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• 제11권1호
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• pp.39-47
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• 2000

신경 외과적 수술의 한분야인 정위적 방사선 수술은 두 개강 내의 병변의 위치 계산 후, 고선량의 방사선을 조사하여 병변을 치료하는 방법이기 때문에, 효과적인 수술을 위해서는 병변의 정확한 위치 정보가 무엇보다도 중요하다. 본 연구에서는 DSA(Digital Subtraction Angiography) 영상이 내재적으로 이미지 왜곡이라는 문제점을 가지고 있기 때문에, 이것의 보정을 통하여 더욱 정확한 target 위치를 계산하였다 이미지 왜곡을 보정하기 위하여 grid 팬텀을 제작하였고, localization 알고리즘의 정확도를 평가하기 위하여, target 팬텀을 제작하였다. Image Intensifier의 앞쪽에 grid 팬텀을 부착하고, target 팬텀을 Leksell Frame에 고정시킨 후, DSA 영상을 얻었다. 본 실험을 위하여 개발된 프로그램을 이용하여, Anterior and Posterior, Left and Right 영상에서 bilinear transform을 적용하여 왜곡을 보정한 후, target 위치를 계산하였다. 그리고, 이와 같은 방법을 통하여 계산된 target 위치 좌표와 target 팬텀의 절대 좌표의 비교를 통하여 localization 오차가 계산되었다. 이번 실험의 결과는 왜곡을 보정하지 않은 경우, localization 오차는 $\pm$0.41mm, 왜곡 보정을 한 경우는 $\pm$0.34mm이었다. 따라서 본 연구에서 개발된 알고리즘 정밀도가 인정되며, 환자의 치료에 적합한 것으로 사료된다.

• Journal of Korean Neurosurgical Society
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• 제30권12호
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• pp.1361-1368
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• 2001

Objective : "Paraclinoid" aneurysms include those aneurysms arising from the internal carotid artery between the site of emergence of the carotid artery from the roof of the cavernous sinus and the origin of the posterior communicating artery. The authors reviewed and analysed the results of surgical approaches to paraclinoid aneurysms treated with transcranial surgery and endovascular surgery. Methods : Between January 1998 and May 1999, 14 patients were treated surgically through ipsilateral and contralateral pterional approaches, and anterior interhemispheric approach, and endovascular surgery for paraclinoid aneurysms. All transcranial approaches were performed by same surgeon. The medical records, neuroimaging studies and videotapes which had been recorded operations were reviewed retrospectively. Results : Twelve patients presented with subarachnoid hemorrhage and ICH. Nine of fourteen patients had multiple aneurysms. Thirteen cases were small and one was a large aneurysm. Six patients were treated through ipsilateral approaches, six contralateral pterional approaches, one anterior interhemispheric approach and one primarily by GDC embolization. All aneurysms treated through contralateral approaches were multiple aneurysms. Neck clipping was performed in 9(69.2%) of the thirteen aneurysms, wrapping in four cases, among them three cases were followed by GDC embolization. The surgical outcomes were : Glasgow Outcome Scale(GOS) I 71.4%, GOS II 21.4% and GOS V 7.1%. Conclusion : The surgical approaches to paraclinoid aneurysms should be chosen after careful anatomical evaluation of aneurysm and its neighboring structures. 3D-CT angiography and/or the raw data of MR angiography were useful. This study supports the usefulness of the contralateral approach to paraclinoid aneurysm associated with multiple aneurysms, unruptured and small aneurysms whose dome projecting medially, superiorly and dorsally. The determination of contralateral approach to small and medially projecting paraclinoid aneurysm may be stressful to operator, thus we believe anterior interhemispheric approach is better alternated. Also we recommend the endovascular surgery after reinforcement of aneurym neck and dome in the case with difficulty in clipping.