• Archives of Hand and Microsurgery
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• 제23권4호
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• pp.281-289
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• 2018

목적: 우리는 미세혈관 유방 재건술 수술 계획에 참고하기 위하여 컴퓨터 단층 촬영(computed tomography, CT)혈관 조영술을 이용하여 심하복벽혈관과 천공지의 주행을 세부 유형으로 나누어 보고 영상 및 임상 소견의 상관성과 각 유형의 빈도를 보고하고자 한다. 방법: 하복부 조직을 이용한 유방 재건을 받은 연속한 115명의 환자를 전향적으로 분석하였다. 심하복벽동맥과 천공지를 주로 근육 내 주행의 특징에 따라 박리하기 용이한 것과 박리에 곤란한 것으로 특징짓고 각각의 빈도를 조사하였다. 결과: 확인된 425개의 천공지 중 89개(20.9%)의 천공지는 박리에 용이한 주행을 하였으며 긴 근육 아래 주행(34.8%), 긴 근막 아래 주행(15.6%), 근육 주위 주행(13.9%)이 그에 속하였다. 반면 심하복벽동맥이 없거나 적절한 천공지가 조영되지 않는 경우가 3예와 8예에서 보고되었다. 총 65명(56.5%)의 환자가 적어도 한 개 이상의 박리가 용이한 천공지를 가지고 있었다. 결론: 수술 전 CT 혈관 조영술을 통하여 심하복벽동맥과 천공지의 주행을 분석하여 박리에 용이한 유형과 곤란한 유형을 미리 파악함으로써 수술 계획의 수립에 도움을 받을 수 있다.

• Journal of Chest Surgery
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• 제35권8호
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• pp.599-604
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• 2002

급성 혹은 만성 대동맥 해리증은 파열을 일으킬 수 있는데 이는 사망의 주요 원인이 된다. 상행대동맥의 해리성 동맥류(Stanford A형 대동맥 해리증)는 극히 드물게 상대정맥으로 파열되어 대동백-상대정맥루를 형성할 수 있는데 대동백-하대정맥루는 복부 대동맥류 환자에서 이따금씩 보고되어 왔다. 최근 상대정맥증후군의 증상을 가진 67세 남자환자에서 CT, MR angiography, 동맥촬영 등 방사선학적 검사결과 Stanford A형 대동맥 해리증 및 대동맥-상대정맥루가 진단되었다. 해리된 동맥류는 절제 후 인조혈관으로 치환되었고 대동맥-상대정맥루는 초저온 순환정지 상태에서 교정되었다. 이에 대해 상세하게 기술하는 바이다.

• 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 Korean Neurosurgical Society
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• 제48권2호
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• pp.139-144
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• 2010

Objective : We report our surgical experience in the treatment of 16 consecutive patients with benign craniovertebral junction (CVJ) tumor, observed from 2003 to 2008 at our department. Methods : We had treated 6 foramen magnum meningiomas, 6 cervicomedullary hemangioblastomas, 1 accessory nerve schwannoma, 1 hypoglossal nerve schwannoma, 1 C2 root schwannoma, and 1 cavernous hemangioma. Clinical results were evaluated by Karnofsky Performance Scale (KPS) and all patients underwent preoperative neuroradiological evaluation with computed tomography (CT) and magnetic resonance image (MRI). Angiography was performed in 15 patients and preoperative embolization was done in 2 patients. Results : Five far-lateral, 1 supracondylar and 10 midline suboccipital approaches were performed. Gross total removal was achieved in 15 cases (94%) and subtotal removal in 1 patient (6%). None of the patients required occipitocervical fusion. Radiological follow-up showed no recurrence in cases totally removed. Postoperative decrease of KPS scores was recorded in only 1 patient. The treatment of cervicomedullary solid hemangioblastoma presented particular issues : by preoperative embolization, we removed tumor totally without an excessive bleeding or brainstem injury. In one of foramen magnum meningioma, we carried out subtotal removal due to hard tumor consistency and encasement of neurovascular structures. Conclusion : The choice of surgical approaches and the extent of bone resection should be defined according to the location and size of individual tumors. Moreover, we emphasize that preoperative neuroradiological evaluations on presumptive tumor type could be helpful to the surgeon in tailoring the technique and providing the required exposure for different lesions, without unnecessary surgical steps.

• Archives of Plastic Surgery
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• 제36권2호
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• pp.140-146
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• 2009

Purpose: Autologous breast reconstruction with abdominal tissue is one of the best options after mastectomy. In a free transverse rectus abdominis myocutaneous(TRAM) or deep inferior epigastric artery perforator(DIEP) flap, a preoperative evaluation of the precise location of perforating vessels and vascular run - off systems is required. The objective of this report is to demonstrate the usefulness of multidetector computed tomography(MDCT) in the preoperative planning of patients undergoing breast reconstruction with abdominal flap. Methods: From June 2006 to January 2008, 28 patients underwent MDCT evaluation before breast reconstruction. All subjects were females with an age range of 30 to 55 years. The CT scan was performed using a 64 - slice MDCT scanner(Brilliance 64; Philips Medical Systems, Best, Netherlands). Results: One perforator or two major perforators were marked on image in good relation with a hand - held Doppler examination and intraoperative findings. All vascular run - off systems were cleared before operation. Conclusion: Preoperative evaluation of perforator arteries with MDCT angiography is beneficial in patients undergoing breast reconstruction. This technique provides a noninvasive approach of the vascular anatomy of the entire anterior abdominal wall.

• Journal of Korean Neurosurgical Society
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• 제30권3호
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• pp.384-388
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• 2001

A 51-year-old woman presented with sudden severe headache, vomiting, and right hemiparesis at first admission. Computed tomography(CT) scans revealed an hemorrhagic density at left basal ganglia. Preoperative cerebral angiography showed no vascular lesion. Under the diagnosis of hypertensive intracerebral hemorrhage(ICH), total extirpation of hematoma was done. The postoperative neurological condition improved gradually and discharged without any neurological sequelae. Two months later, she revisited with headache, vomiting and progressive right hemiparesis. CT scans at second admission showed an irregular rim enhanced mass with central low density with surrounding edema at the initial bleeding area. Repeated craniotomy was performed and the mass was partially removed. The histopathological diagnosis of the specimen was confirmed as glioblastoma. The authors report a glioblastoma, which occurred at initial ICH site and regarded as a brain abscess with literature review.

• Journal of Chest Surgery
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• 제55권5호
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• pp.413-416
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• 2022

A 32-year-old woman diagnosed with Turner syndrome presented to the hospital for an evaluation of cardiovascular complications. Preoperative computed tomography (CT) and echocardiography showed progression of aortic root and ascending aorta dilatation, as well as a bicuspid aortic valve. There was no evidence of aortic regurgitation. We planned valve-sparing aortic root replacement and ascending aorta replacement with a high risk of aortic rupture. Intraoperatively, we incidentally found a juxtacommissural origin of the right coronary artery (RCA). We performed aortic valve reimplantation using a graft designed with a key-shaped hole to wrap the juxtacommissural-origin RCA by modifying the Florida sleeve technique. Coronary blood flow was patent on postoperative CT angiography, and there was no evidence of aortic regurgitation on postoperative echocardiography. The patient was discharged from the hospital on postoperative day 7 without any complications.

• Archives of Plastic Surgery
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• 제39권4호
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• pp.354-359
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• 2012

Background During the planning of a thoracodorsal artery perforator (TDAP) free flap, preoperative multidetector-row computed tomographic (MDCT) angiography is valuable for predicting the locations of perforators. However, CT-based perforator mapping of the thoracodorsal artery is not easy because of its small diameter. Thus, we evaluated 1-mm-thick MDCT images in multiple planes to search for reliable perforators accurately. Methods Between July 2010 and October 2011, 19 consecutive patients (13 males, 6 females) who underwent MDCT prior to TDAP free flap operations were enrolled in this study. Patients ranged in age from 10 to 75 years (mean, 39.3 years). MDCT images were acquired at a thickness of 1 mm in the axial, coronal, and sagittal planes. Results The thoracodorsal artery perforators were detected in all 19 cases. The reliable perforators originating from the descending branch were found in 14 cases, of which 6 had transverse branches. The former were well identified in the coronal view, and the latter in the axial view. The location of the most reliable perforators on MDCT images corresponded well with the surgical findings. Conclusions Though MDCT has been widely used in performing the abdominal perforator free flap for detecting reliable perforating vessels, it is not popular in the TDAP free flap. The results of this study suggest that multiple planes of MDCT may increase the probability of detecting the most reliable perforators, along with decreasing the probability of missing available vessels.

• 한국산학기술학회논문지
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• 제20권3호
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• pp.417-422
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• 2019

혈역학적으로 불안정한 골반골 골절 환자의 사망율은 40-60%에 이를 정도로 매우 높다. 하지만 이러한 환자들을 어떻게 치료해야 하는지에 대해서는 아직 논란의 여지가 많다. 저자들은 혈역학적으로 불안정한 골반골 골절 환자에서 빠른 응급 혈관조영술을 통해 효과적으로 지혈을 시행한 증례를 보고하고자 한다. 78세 여자가 넘어져서 발생한 골반 통증을 주소로 응급실을 통해 내원하였다. 내원 후 시행한 단순골반촬영에서 골반골 골절이 관찰되었으며, 혈압은 60/40 mmHg였다. 혈역학적으로 불안정하여 전산화단층촬영을 시행하지 않고 곧바로 혈관조영술을 시행하였으며, 빠른 지혈을 위해 세부적인 출혈 혈관을 선택하지 않고 양측 내장골동맥에 대해 색전술을 시행하였다. 색전술 시행 후 혈압이 안정화되고 나서 전산화단층촬영을 시행하였으며, 이 검사에서 장천공을 의심할 수 있는 다수의 복강내 공기 음영이 관찰되었다. 응급 개복술을 시행하였으며, 수술 소견상 소장에 약 1 cm 크기의 천공이 관찰되어 봉합을 시행하였고, 골반 주변 후복막강에 혈종이 있었으나 더 이상 팽창하지 않고 출혈 소견이 보이지 않아 그대로 두고 수술을 종료하였다. 환자는 중환자실로 입원하여 집중치료 시행하였고, 수술 3일째 일반병실로 전실하였다. 저자들은 이 증례에서 출혈을 동반한 골반골 골절과 소장천공 대해 전산화 단층촬영을 생략하고 빠른 혈관 조영술을 시행하여 효과적으로 치료할 수 있었다.

• 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.