• Journal of Periodontal and Implant Science
• /
• 제32권3호
• /
• pp.655-664
• /
• 2002

The purpose of this study was to observe the degree of surface obliteration of dentinal tubule using Gluma(R) desensitizer and MS coat(R) with 15 specimens made out of 15 extracted lower incisors. They were divided into Root planning group(control), Gluma(R) desensitizer group(test I ) and MS coat(R) group(test II). Degree of Obliteration was examined under the scanning electron microscope(${\times}$2000). The following results were obtained: 1. In the root planning group(control), the complete open of dentinal tubule surface was accounted for 73.8%, the partial obliteration for 17.2% and the complete obliteration for 9.0%. 2. In the Gluma(R) desensitizer group (test I), the complete open of dentinal tubule surface was accounted for 23.6%, the partial obliteration for 42.8% and the complete obliteration for 33.6%. 3. In the MS coat(R) group (test II), the complete open of dentinal tubule surface was accounted for 19.2%, the partial obliteration for 45.6% and the complete obliteration for 35.2%. 4. The average number of open dentinal tubules in the control was significantly higher than in the test I and II (P<0.05), but there were no statistically significant differences between the test I and II. 5. The average number of the partially obliterated and the completely blocked dentinal tubules in the control was significantly lower than the test I and II(P<0.05), but there were no statistically significant differences between the test I and II. The results of this study suggest that Gluma(R) desensitizer and MS coat(R) is significantly effective on dentinal tubule obliteration, therefore they were effective on hypersensitivity caused by periodontal treatment

• 대한방사선협회지
• /
• 제28권1호
• /
• pp.97-103
• /
• 2002

To evaluate the efficacy and safety of balloon occluded retrogade transvenous obliteration (BRTO) to treat acute gastric variceal bleeding. Between October 2001 and April 2002, seven patients(M : F = 6 : 1 : mean age, 55yrs) with acute gastric variceal bl

• Journal of Chest Surgery
• /
• 제54권5호
• /
• pp.408-411
• /
• 2021

Tuberculosis (TB)-infected giant bullae are rare. A 55-year-old man was referred when an infected bulla did not respond to empirical treatment. Computed tomography showed a giant bulla in the right upper lobe with an air-fluid level and surrounding infiltrate. Sputum culture, acid-fast bacilli (AFB) stain, and polymerase chain reaction (PCR) for TB were negative. Percutaneous drainage of the bullous fluid was performed. AFB stain and PCR were positive in the drained fluid. The patient was given anti-TB drugs and later underwent obliteration of the pulmonary cavity using talc. To summarize, we report a patient with a TB-infected giant bulla that was treated successfully with anti-TB drugs and obliteration of the pulmonary cavity using talc.

• Journal of Korean Neurosurgical Society
• /
• 제43권6호
• /
• pp.265-269
• /
• 2008

Objective : Outcome of gamma knife radiosurgery (GKS) in the consecutive 100 cases with cerebral arteriovenous malformations (AVMs) was analyzed. Methods : Data from initial 100 patients treated with GKS in the authors' institute were reviewed retrospectively. Spetzler-Martin grade at diagnosis were I in 18 patients, II in 27, III in 36, IV in 11, and V in 8. Thirty-five patients had experienced previous bleeding, 27 patients presented with seizure, and 31 patients presented with headache. The mean volume of the lesion was $4.3\;cm^3\;(0.1-29.3\;cm^3)$. The median radiation dose delivered to the margin was 20.0Gy (13-32Gy). Mean follow-up period was 37.5 months (5-63 months). Results : Angiographic follow-up was performed in 48 patients at least 2 years after GKS. Sixteen patients were lost in follow up following 2 years from GKS. Twenty-eight of 48 patients (58%) showed complete obliteration and 20 patients (42%) showed partial obliteration. Seven patients presented with post-GKS hemorrhage. Adverse radiation effect (ARE) was observed at follow-up MRI in 25 of 76 patients, and it was symptomatic in 5 patients. Complete obliteration was confirmed in 24 of 31 (77%) patients with volume less than $4\;cm^3$, meanwhile only 4 of 17 (24%) patients with volume of $4\;cm^3$ or more showed complete obliteration. Complete obliteration rate was 67% with 20Gy or higher marginal dose, 63% with 15-20 Gy, and 17% with less than 15Gy. Conclusion : GKS can provide high rates of obliteration with acceptable risk of morbidity in a subgroup of small AVMs. However, overall outcome in whole spectrum of AVMs, in which large proportion of cases have unfavorable characteristics for radiosurgery, is much worse. More effective therapeutic strategy needs to be developed for large AVMs that are difficult to be managed with current available treatment modalities.

• Journal of Korean Neurosurgical Society
• /
• 제46권4호
• /
• pp.378-384
• /
• 2009

Objective : In order to establish the role of Gamma Knife radiosurgery (GKS) in large intracranial arteriovenous malformations (AVMs), we analyzed clinical characteristics, radiological features, and radiosurgical outcomes. Methods : Between March 1992 and March 2005, 28 of 33 patients with large AVMs (> $10\;cm^3$ in nidus-volume) who were treated with GKS underwent single session radiosurgery (RS), and the other 5 patients underwent staged volumetric RS. Retrospectively collected data were available in 23 cases. We analyzed treatment outcomes in each subdivided groups and according to the AVM sizes. We compared the estimated volume, defined as primarily estimated nidus volume using MR images, with real target volume after excluding draining veins and feeding arteries embedded into the nidus. Results : Regarding those patients who underwent single session RS, 44.4% (8/18) had complete obliteration; regarding staged volumetric RS, the obliteration rate was 40% (2/5). The complete obliteration rate was 60% (6/10) in the smaller nidus group ($10-15\;cm^3$ size), and 25% (2/8) in the larger nidus group (over $15\;cm^3$ size). One case of cerebral edema and two cases (8.7%) of hemorrhage were seen during the latent period. The mean real target volume for 18 single sessions of RS was $17.1\;cm^3$ ($10.1-38.4\;cm^3$), in contrast with the mean estimated volume of $20.9\;cm^3$ ($12.0-45.0\;cm^3$). Conclusion : The radiosurgical treatment outcomes of large AVMs are generally poor. However, we presume that the recent development in planning software and imaging devices aid more accurate measurement of the nidus volume, therefore improving the treatment outcome.

• 대한영상의학회지
• /
• 제81권1호
• /
• pp.231-236
• /
• 2020

십이지장 정맥류는 간경화증에 의한 문맥압 고혈압 환자에서 발생할 수 있으며, 치명적인 심한 상부 위장관 출혈을 일으킬 수 있으나 아직까지 명확한 치료 지침이 정립되어 있지는 않다. 일차적으로 내시경으로 치료를 시도하고 지혈 실패 시 목정맥경유간속문맥전신순환연결술, 풍선 혹은 혈관 마개를 이용한 역행성 경정맥 폐색술, 피부간경유 폐색술 등과 같은 중재적 치료를 고려할 수 있다. 저자들은 내시경적 치료에 실패한 십이지장 정맥류 출혈 환자에게 저하된 간 기능과 해부학적인 구조의 제한으로 인해 코일을 이용한 역행성 경정맥 폐색술을 시행하여 성공적으로 치료한 1예를 경험하였기에 이를 보고하고자 한다.

• Radiation Oncology Journal
• /
• 제21권1호
• /
• pp.1-9
• /
• 2003

목적 : 계명대학교 의과대학 치료방사선과학교실의 의료진들이 개발하여 사용하고 있는 방사선수술 시스템인 Photon Knife를 이용하여 뇌동정맥기형을 치료하고 그 효과를 보고자 하였다. 대상 및 방법 : 1993년 12월부터 2000년 10월까지 뇌동정맥기형으로 계명대학교 동산의료원 치료방사선과를 방문하여 Photon Knife로 방사선수술을 받은 환자는 30명이었다. 성별분포는 남자 20명, 여자 10명이며 연령분포는 7세부터 63세로 평균 34세이었다. 뇌동정맥기형(AVM nidus)의 위치는 전두부, 두정부, 시상부 순이었고 변소의 장경은1.2 cm에서 5.5 cm으로 평균 2.9 cm이었으며 표적용적은 0.5 cc에서 20.6 cc로 평균 6.8 cc이었다. 대부분에서 회전 중심선량의 80% 등선량곡선(Isodose line)에 1,500~2,500 cGy (중앙값 2,000 cGy)를 조사하였다. 1개의 회전중심점을 사용한 환자는 25명이었고 2개의 회전중심점을 사용한 환자는 4명이었으며 1명은 4개의 회전중심점을 사용하였다. 추적검사는 방사선수술 후 6개월에서 1년 간격으로 전산화단층촬영이나 자기공명영상을 시행하여 병소(nidus)의 완전소실이 관찰되면 뇌혈관조영술이나 자기공명영상 혈관조영촬영술로 확인하였다. 추적관찰기간은 10개월에서 103개월로 중앙추적기간은 39개월이었다 결과 : 전체환자 중 영상학적으로 20개월 이상 추적 관찰된 환자는 20명이었으며 그 중 70% (14/20)에서 완전폐색을 관찰하였다. 병소의 장경에 따라 작은 뇌동정맥기형(<2 cm) 환자 4명은 모두 완전폐색이 되었고 중간크기 뇌동정맥기형(2~3 cm은 80%, (8/10)에서 완전폐색이 되었으며 2명은 부분폐색이 되었다. 큰 뇌동정맥기형(> cm)에서는 환자 6명 중 1명만 완전폐색을 보였고 5명에서는 부분폐색은 되었으나 3년재에도 남아 있는 환자 3명은 재 방사선수술을 하였고 이 중 20개월 이상 추적검사를 받은 1명은 재 방사선수술 후 완전폐색이 되었다. 방사선 수술전 신경발작(seizure)을 주소로 내원한 환자 10명은 방사선수술과 약물투여로 신경발작의 재발은 없었다. 뇌출혈이 있었던 11명 중 1명에서 방사선수술 후 19개월, 61개월에 다시 출혈하였으나 입원 치료 후 회복되었다. 방사선수술에 의한 심각한 부작용은 관찰되지 않았다. 결론 : 이상으로 볼 때 저자들에 의해 개발된 Photon knife를 이용한 방사선수술은 뇌동정맥기형에서 수술이 불가능한 위치에 있거나 수술을 거부하는 환자 중 병소의 장경이 3 cm 이하이거나 병소의 용적이 10 cm$^{3}$ 이하인 뇌동정맥기형의 치료에 안전하고 효과적인 방법으로 사료된다. 또한 10 cm$^{3}$ 이상의 용적이 큰 뇌동정맥기형에서는 순차적(staged) 방사선수술을 처음부터 고려할 필요가 있을 것으로 사료된다.

• Clinical and Experimental Pediatrics
• /
• 제56권11호
• /
• pp.500-504
• /
• 2013

Here we present the case of an 11-year-old female patient diagnosed with Caroli syndrome, who had refractory esophageal varices. The patient had a history of recurrent bleeding from esophageal varices, which was treated with endoscopic variceal ligation thrice over a period of 2 years. However, the bleeding was not controlled. When the patient finally visited the Emergency Department, the hemoglobin level was 4.4 g/dL. Transhepatic intrajugular portosystemic shunt was unsuccessful. Subsequently, the patient underwent percutaneous transhepatic variceal obliteration. Twenty hours after this procedure, the patient complained of aphasia, dizziness, headache, and general weakness. Six hours later, the patient became drowsy and unresponsive to painful stimuli. Lipiodol particles used to embolize the coronary and posterior gastric veins might have passed into the systemic arterial circulation, and they were found to be lodged in the brain, kidney, lung, and stomach. There was no abnormality of the portal vein on portal venography, and blood flow to the azygos vein through the paravertebral and hemiazygos systems was found to drain to the systemic circulation on coronary venography. Contrast echocardiography showed no pulmonary arteriovenous fistula. Symptoms improved with conservative management, and the esophageal varices were found to have improved on esophagogastroduodenoscopy.

• Journal of Korean Neurosurgical Society
• /
• 제52권6호
• /
• pp.534-540
• /
• 2012

Objective : Brainstem arteriovenous malformation (AVM) is rare and radiosurgical management is complicated by the sensitivity of the adjacent neurological structures. Complete obliteration of the nidus is not always possible. We describe over 20 years of radiosurgical procedures for brainstem AVMs, focusing on clinical outcomes and radiosurgical techniques. Methods : Between 1992 and 2011, the authors performed gamma knife radiosurgery (GKRS) in 464 cerebral AVMs. Twenty-nine of the 464 patients (6.3%) reviewed had brainstem AVMs. This series included sixteen males and thirteen females with a mean age of 30.7 years (range : 5-71 years). The symptoms that led to diagnoses were as follows : an altered mentality (5 patients, 17.3%), motor weakness (10 patients, 34.5%), cranial nerve symptoms (3 patients, 10.3%), headache (6 patients, 20.7%), dizziness (3 patients, 10.3%), and seizures (2 patients, 6.9%). Two patients had undergone a previous nidus resection, and three patients had undergone a previous embolization. Twenty-four patients underwent only GKRS. With respect to the nidus type and blood flow, the ratio of compact type to diffuse type and high flow to low flow were 17 : 12 and 16 : 13, respectively. In this series, 24 patients (82.8%) had a prior hemorrhage. The mean target volume was 1.7 $cm^3$ (range 0.1-11.3 $cm^3$). The mean maximal and marginal radiation doses were 38.5 Gy (range 28.6-43.6 Gy) and 23.4 Gy (range 18-27 Gy), and the mean isodose profile was 61.3% (range 50-70%). Results : Twenty-four patients had brainstem AVMs and were followed for more than 3 years. Obliteration of the AVMs was eventually documented in 17 patients (70.8%) over a mean follow-up period of 77.5 months (range 36-216 months). With respect to nidus type and blood flow, the obliteration rate of compact types (75%) was higher than that of diffuse types (66.7%), and the obliteration rate of low flow AVMs (76.9%) was higher than that of high flow AVMs (63.6%) (p<0.05). Two patients (6.9%) with three hemorrhagic events suffered a hemorrhage during the follow-up period. The annual bleeding rate of AVM after GKRS was 1.95% per year. No adverse radiation effects or delayed cystic formations were found. Conclusion : GKRS has an important clinical role in treatment of brainstem AVMs, which carry excessive surgical risks. Angiographic features and radiosurgical techniques using a lower maximal dose with higher isodose profiles are important for lesion obliteration and the avoidance of complications.

• Journal of Periodontal and Implant Science
• /
• 제27권4호
• /
• pp.829-844
• /
• 1997

Dentin hypersensitivity must be one of the most frequent postoperative complaints in periodontal patients. Obliterating the open dentinal tubules or decreasing the diameter of their orifices would, therefore, be an objective of treatment for hypersensitive teeth. The purpose of this study was to evaluate the effect of a pulsed Nd:YAG laser irradiation on obliteration of dentinal tubules and to determine any difference according to irradiation methods. The 45 posterior teeth that had been extracted due to periodontal disease were initially treated with tetracycline HCI(100 mg/ml, 4 min.) to remove the smear layer after root planing. The root surfaces were then irradiated by a pulsed Nd:YAG laser(EL.EN.EN060, Italy) by different laser beam spot size and different exposure condition: ${\cdot}$ group 1: irradiated group by small spot(beam diameter=1mm, lW, 2 sec) ${\cdot}$ group 2: irradiated group by large spot(beam diameter=10mm, 1W, 200 sec) ${\cdot}$ group 3: irradiated group by gradual increase of watt (from 0.3W to 1.0W), beam diameter=4mm ${\cdot}$ group 4: irradiated group by fixed watt(1.0 W), beam diameter=4mm ${\cdot}$ control group: no irradiation but root planing and tetracycline HCI conditioning only. Additionally, the specimens were retreated with tetracycline HCI(100mg/ml, 4min.) to evaluate the stability of obliteration effect by Nd:YAG laser. Specimens were examined under the scanning electron microscope(JEOL, JSM-840A, Japan). Photomicrographs were taken at ${\times}4,000$ magnification and were analyzed statistically. The results were as follows: l. Scanning electron micrographs of root surface treated by tetracycline HCI alone(control group) showed widened, funnel-shaped dentinal tubules, while those of the root surface irradiated by various methods showed partially or completely obliterated dentinal tubules and various surface alterations, eg, flat, multiple pitted, melted and resolidified surface at the same energy density. 2. There was no significant difference in the obliteration effect of dentinal tubules between group 1 and group 2, and between group 3 and group 4(p>0.05). 3. The obliteration effect of dentinal tubules by a Nd:YAG laser irradiation was relatively stable to tetracycline HCI. The results demonstrate that a pulsed Nd:YAG laser irradiation within 1.0W, regardless of irradiation methods, can obliterate dentinal tubules effectively.