• Journal of Chest Surgery
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• 제37권9호
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• pp.774-780
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• 2004

외상성 흉부대동맥 파열은 수술적 치료가 요구되는 치명적 손상이며 이외에 다른 부위에 복합손상이 동반되면 심폐 바이패스에 의한 위험도를 크게 증가시킬 수 있다. 여기서 저자들은 심한 동반손상을 먼저 치료한 후 대동맥수술을 하고 그 결과를 관찰하였다. 대상 및 방법: 1997년부터 2003년까지 외상성 흉부 대동맥질환으로 수술을 받은 24명의 환자를 대상으로 의무기록을 후향적으로 검토하여, 동반손상 여부, 수술방법, 수술 후 경과, 합병증 등을 분석하고 국내외 문헌들과 비교하였다. 수술은 초저온 심정지법하에서 심폐 바이패스를 이용한 개흉술로 하였는데 근위부 연결 후 곁가지를 통해 뇌관류를 시행하였고 요추 카테터를 통한 뇌척수액 배액으로 하반신 마비를 예방하였다. 결과： 대상환자 전원에서 83예의 동반손상이 발생하였는데, 흉부손상이 49예, 근골격계 손상 18예, 복부 손상 13예였고, 수상 후 12명의 환자에서 7.6$\pm$12.6일에 16예의 동반손상에 대한 수술이 행해졌다. 수상당시 18예에서만 대동맥 손상이 진단되었다. 중환자실에서 혈압을 약물투여로 조절하면서 안정시키고 수상 후 693 $\pm$ 1350일에 지연수술을 시행하였는데, 관찰기간 중 사망이나 대동맥 파열의 진행은 없었다. 수술 사망은 없었으며, 술 후 큰 합병증은 없었다. 결론： 외상성 흉부대동맥 파열에 있어서 다른 부위 손상이 동반되면 심한 동반손상을 먼저 치료한 후 수술하는 것이 수술 사망률이나 이병률 면에서 좋은 결과를 가져온다.

• Journal of Chest Surgery
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• 제35권10호
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• pp.755-759
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• 2002

64세 남자가 혈뇨를 주소로 입원하여 하대정맥으로 종양 혈전이 파급된 우측 신세포암으로 진단받았다. 우신 적출술 시행 후 역행성 뇌관류하면서 심도 저체온 순환정지 하에 하대정맥 혈전 제거술을 시행하였다. 종양 혈전은 우 신에서 기원하여 하대정맥으로 자라면서 좌 신정맥의 생식선정맥 유입구까지, 위로는 간정맥 유입부까지, 아래로는 신정맥 하방 3cm까지 파급되어 있었다. 심도 저체온 순환 정지 하에서 하대정맥 손상 없이 혈전을 완전히 제거하였고 술 후 경과는 순조로웠다. 술 후 인터페론 면역 치료를 받았고 특별한 문제없이 추적관찰 중이다.

• Journal of Korean Neurosurgical Society
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• 제63권2호
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• pp.188-201
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• 2020

Objective : The purpose of this study was to suggest that computed tomography angiography (CTA) is valuable as the only preliminary examination for mechanical thrombectomy (MT). MT after single examination of CTA including noncontrast computed tomography (NCCT) and maximum intensity projection (MIP) improves door-to-puncture time as well as results in favorable outcomes. Methods : A total of 157 patients who underwent MT at Dong Kang Medical Center from April 2015 to March 2019 were divided into two groups based on the examination performed prior to MT : CTA group who underwent CTA with NCCT and MIP, and NCCT+magnetic resonance image (MRi) group who underwent MRI including perfusion images after NCCT. In the two groups, time to CTA imaging or NCCT+MRi imaging after symptom onset, and time to arterial puncture and reperfusion were characterized as time-related outcomes. The evaluation of vascular recanalization after MT was defined as a modified thrombolysis in cerebral infarction (mTICI) scale. National Institutes of Health Stroke Scale (NIHSS) was assessed at the time of the visit to the emergency room and modified Rankin Scale (mRS) was assessed after 90 days. Results : Typically, there were 34 patients in the CTA group and 33 patients in the NCCT+MRi group. A significantly shorter delay for door-to-puncture time was observed (mean, 86±22.1 vs. 176±47.5 minutes; <0.01). Also, a significantly shorter door-to-imege time in the CTA group was observed (mean, 13±6.8 vs. 93±30.8 minutes; p<0.01). Moreover, a significantly shorter onset-to-puncture time was observed (mean, 195±128.0 vs. 314±157.6 minutes; p<0.01). Reperfusion result of mTICI ≥2b was 100% (34/34) in the CTA group and 94% (31/33) in the NCCT+MRi group, and mTICI 3 in 74% (25/34) in the CTA group and 73% (24/33) in the NCCT+MRi group. Favorable functional outcomes (mRS score ≤2 at 90 days) were 68% (23/34) in the CTA group and 60% (20/33) in the NCCT+MRi group. Conclusion : A single-phase CTA including NCCT and MIP images was performed as a single preliminary examination, which led to a reduction in the time of the procedure and resulted in good results of prognosis. Consequently, it is concluded that this method is of sufficient value as the only preliminary examination for decision making.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제20권3호
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• pp.122-128
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• 2009

Objectives : Autism is a well-known psychiatric disorder that is presumed to have a neural basis. To investigate the underlying neurofunctional abnormalities of autism, the authors performed single photon emission computed tomography (SPECT) on children with autism. Methods : Fifty-five children with untreated autism (47 boys and 8 girls, mean age=$50.6{\pm}20.28$ months) were selected from among the patients visiting the child and adolescent psychiatric clinic of Seoul National University Hospital. Psychiatrists had diagnosed the participants according to the DSM-IV criteria for autistic disorder and the Childhood Autism Rating Scale (CARS) criteria for a diagnosis of autism. All participants were examined using 99mTC-HMPAO Brain SPECT. Using statistical parametric mapping (SPM) analysis, we compared the participants' SPECT images to standardized SPECT images of normal children, which had been retrospectively selected by the authors, on a voxel by voxel basis. Voxels with a p-value less than .001 were considered to be significantly different. Results : The autistic group showed significant hypoperfusion in the right medial frontal gyrus, right precentral gyrus, and left precuneus gyrus. In addition, they showed no significant hyperperfusion areas when compared to the control group. Conclusion : The findings of hypoperfusion in the medial-frontal lobe and precuneus are accord with hemodynamic abnormalities that have been already reported. Therefore, these findings are compatible with the recently suggested "theory of mind" hypothesis and the disturbances in attention shifting that have been observed in autistic children.

• 대한핵의학회지
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• 제29권1호
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• pp.110-117
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• 1995

Tc-99m Labeled hexamethylenepropyleneamineoxime ([$^{99m}Tc$]-HMPAO) is a famous amino-oxime compound and is widely used to construct SPECT images of cerebral blood flow. To investigate the relationship between chemical structure and radiolabeling in these kind of diamine-oxime compounds, we synthesized seven compounds by Schiff's base formation and successive reduction with sodium borohydride. They were (RR/SS )-4,8-diaza-3,6,6,9-tetramethylundecane-2,10-dione bisoxime (2), (RR/SS/meso)-4,8-diaza-3,9-dimethy-lundecane-2,10-dione bisoxime (4), (RR/SS/meso)-4,8-diaza-3,10-dimethyldodecane-2,11-dione bisoxime (5), (RR/SS/meso)-4,7-diaza-3,6,6,8-tetramethyldecane-2,9-dione bisoxime (8), (RR/SS/meso)-4,7-diaza-5,6-cyclohexyl-3,8-dimethyldecane-2,9-dione bisoxime (10), (RR/SS/meso)-3,4-bis(1-aza-2-methyl-3-oxime-1-butyl)-benzoic acid (12), and (RR/SS/ meso)-2,3-bis(1-aza-2-methyl-3-oxime-1-butyl) benzophenone (14). Chemical structures of all the synthesized compounds were identified by taking $^1H$ spectrum. Among them, 2 and 4 are propyleneamine oxime (PnAO), 6 is butyleneamine oxime (BnAO) and 8, 10, 12 and 14 are ethyleneamine oxime (EnAO). Each compound (0.5 mg) was incubated with stannous chloride (0.5 g - 8 g), carbonate-bicarbonate buffer (final concentration = 0.1 M, pH 7 - pH 10) and Tc-99m-pertechenate (1 ml). Tc-99m labeling of these compounds were checked by ITLC (acetone), ITLC (normal saline), reverse phase TLC (50 % acetonitrile) and ITLC (ethyl acetate). According to the results, EnAO's were not labeled by Tc-99m in any of above condition. About 11 % of maximum labeling efficiency was obtained with BnAO. However, 4 (PnAO) was labeled with Tc-99m to 85 % which is similar to the labeling efficiency of 2 (HMPAO). Hydrophilic impurity (9 % ) was the most significant problem with the labeling of 4, however, pertechnetate (3 % ) and colloid (3 %) were minor problem. In conclusion, we synthesized seven diamine blsoxlme compounds. Among them, four EnAO compounds were not labeled by Tc-99m. A BnAO was labeled poorly and two PnAO's were labeled well. These labeling can be explained by tertiary structure of their Tc-99m chelate.

• 대한핵의학회지
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• 제28권1호
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• pp.17-21
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• 1994

경련을 주소로 내원하여 뇌혈류 SPECT와 MRI 또는 CT, 뇌파도가 시행되었던 115명을 대상으로 경련의 원인과 뇌혈류 SPECT의 유형을 비교하고자 하였다. 대상환자 115명중 28명이 기질적인 원인에 의한 경련이었으며 42명이 전신성 경련, 45명이 부분적 발작이었다. 전신성 경련환자의 뇌혈류 SPECT 유형은 22명이 정상이었고 8명이 미만성의 혈류감소, 4명이 전두엽, 5명이 측두엽, 3명이 전두엽과 측두엽에 걸친 혈류감소를 보였다. 부분적 발작환자 54명중 19명이 뇌파도와 일치하는 부위에 혈류감소를 보였다. 결론적으로 간질 발작간의 뇌혈류 SPECT는 기질적인 원인을 비교적 예민하게 찾을 수 있었고, 전신성 경련환자에서는 정상이거나 육안적으로 경미한 정도의 전두엽 또는 측두엽의 혈류감소를 보였다. 이러한 혈류 감소가 전신성 경련환자와 부분적 발작 환자에서 인지기능이나 항경련제 등과의 연관성에 대해서는 더욱 연구가 되어야 할 것이다.

• 대한핵의학회지
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• 제29권3호
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• pp.328-331
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• 1995

$^{99m}Tc$ labeled PnAO(propylene amine oxime) derivatives have been widely studied as brain perfusion agents. We synthesized and characterized a PnAO derivative, (RR/SS/ meso)-4,8-diaza-3,9-dimethylundecane-2, 10-dione bisoxime(PRODD). Proton-NMR spectroscopy and thin layer chromatography(silica gel) were performed for its characterization. PRODD was labeled with $^{99m}Tc$ using stannous chloride as reducing agent. The labeling efficiency was determined to be about 85%. Brain uptakes of $4.16{\pm}0.42$ %ID/g and $3.24{\pm}0.13$ %ID/g were found after 10min and 30min after intravenous injection. Brain-to-blood ratios were 1.17 and 0.75 at 10 and 30 minutes, which were lower than 1.3 and 1.9 of the ratios with commercial ${\pm}$-HMPAO. Autoradiographs of rat brain sections showed the gray matter to white matter ratios of $1.13{\pm}0.10$ at 30 min after intravenous injection, which was lower than $1.94{\pm}0.19$ of commercial $^{99m}Tc$-HMPAO. With the above findings, we concluded that the lipophilic $^{99m}Tc$-PRODD complex was able to cross the blood-brain barrier, however the complex showed lower uptake than $^{99m}Tc$-HMPAO in mouse or rat brains. We could suggest possibility that PRODD could be used as another $^{99m}Tc$ chelator.

• Investigative Magnetic Resonance Imaging
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• 제20권2호
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• pp.105-113
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• 2016

Purpose: Susceptibility vessel sign (SVS) on gradient echo image, which is caused by MR signal loss due to arterial thrombosis, has been reported in acute middle cerebral artery (MCA) infarction. However, the reported sensitivity and diagnostic accuracy of SVS have been variable. Susceptibility-weighted imaging (SWI) is a newly developed MR sequence. Recent studies have found that SWI may be useful in the field of cerebrovascular diseases, especially for detecting the presence of prominent veins, microbleeds and the SVS. The purpose of this study was to evaluate the diagnostic values of SWI for the detection of hyperacute MCA occlusion. Materials and Methods: Sixty-nine patients (37 males, 32 females; 46-89 years old [mean, 69.1]) with acute stroke involving the MCA territory underwent MR imaging within 6 hours after the symptom onset. MR examination included T2, FLAIR (fluid-attenuated inversion recovery), DWI, SWI, PWI (perfusion-weighted imaging), contrast-enhanced MR angiography (MRA) and contrast-enhanced T1. Of these patients, 28 patients also underwent digital subtraction angiography (DSA) within 2 hours after MR examination. Presence or absence of SVS on SWI was assessed without knowledge of clinical, DSA and other MR imaging findings. Results: On MRA or DSA, 34 patients (49.3%) showed MCA occlusion. Of these patients, SVS was detected in 30 (88.2%) on SWI. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of SWI were 88.2%, 97.1%, 96.8%, 89.5% and 92.8%, respectively. Conclusion: SWI was sensitive, specific and accurate for the detection of hyperacute MCA occlusion.

• Journal of Chest Surgery
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• 제34권10호
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• pp.733-744
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• 2001

배경: 대동맥 축착증과 심실중격결손이 동반된 환아의 적절한 치료 방침에 대해서는 이견이 많다. 본 연구는 생후 6개월 이하의 환아에서 대동맥 축착증과 심실중격결손의 일타 완전교정 결과 및 수술방법에 따른 대동맥 축착증의 재발에 대해 알아보고자 하였다. 대상 및 방법: 1995년 1월부터 2000년 12월가지 본원에서 대동맥 축착증과 심실중격결손으로 일차 완전교정을 시행받은 생후 6개월 이하의 환아 33명을 대상으로 후향적으로 조사하였다. 환아의 평균 연령과 체중은 각각 54$\pm$37일(12일~171일)과 3.9$\pm$1.1kg(1.5~6kg)이었다. 대동맥 축착 고정은 연구 초기에는 저체온하 완전순환정지하에서 시행하였으며 최근에는 순환정지없이 무명동맥을 통한 국소 뇌관류 상태에서 시행하였다. 축착증 교정 방법은 초기에는 Extended cad-to-end anastomosis(EEEA;n=16)와 Extended side-to-side anastomosis(ESSA;n=2)를, 최근에는 Extended end-to-sidc anasto mosis(EESA;n=15)를 이용하였다 심실중격결손은 초기 16명에서는 Dacron을, 최근 17명에서는 자가 심낭편을 이용하여 폐쇄하였다. 대동맥궁 발육부전은 29명(88%)에서 있었으며 원위부 발육부전 18명, 완전형 5명, 그리고 복잡형은 6명이었다.

• Investigative Magnetic Resonance Imaging
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• 제26권1호
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• pp.10-19
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• 2022

Purpose: To evaluate whether the added value of contrast leakage information from dynamic susceptibility contrast magnetic resonance imaging (DSC MRI) is a better prognostic imaging biomarker than the cerebral blood volume (CBV) value in distinguishing true progression from pseudoprogression in glioblastoma patients. Materials and Methods: Forty-nine glioblastoma patients who had undergone MRI after concurrent chemoradiotherapy with temozolomide were enrolled in this retrospective study. Twenty features were extracted from the normalized relative CBV (nCBV) and extraction fraction (EF) map of the contrast-enhancing region in each patient. After univariable analysis, we used multivariable stepwise logistic regression analysis to identify significant predictors for differentiating between pseudoprogression and true progression. Receiver operating characteristic (ROC) analysis was employed to determine the best cutoff values for the nCBV and EF features. Finally, leave-one-out cross-validation was used to validate the best predictor in differentiating between true progression and pseudoprogression. Results: Multivariable stepwise logistic regression analysis showed that MGMT (O⁶-methylguanine-DNA methyltransferase) and EF max were independent differentiating variables (P = 0.004 and P = 0.02, respectively). ROC analysis yielded the best cutoff value of 95.75 for the EF max value for differentiating the two groups (sensitivity, 61%; specificity, 84.6%; AUC, 0.681 ± 0.08; 95% CI, 0.524-0.837; P = 0.03). In the leave-one-out cross-validation of the EF max value, the cross-validated values for predicting true progression and pseudoprogression accuracies were 69.4% and 71.4%, respectively. Conclusion: We demonstrated that contrast leakage information parameter from DSC MRI showed significance in differentiating true progression from pseudoprogression in glioblastoma patients.