• Clinical and Experimental Pediatrics
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• 제52권1호
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• pp.124-128
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• 2009

폐동정맥루는 폐동맥과 폐정맥이 모세혈관 없이 바로 연결된 것으로서 우좌 단락을 형성하여 청색증, 호흡곤란과 곤봉지를 일으키는 질환이다. 또한 뇌혈전에 의하여 뇌출혈이나 뇌농양 등의 신경학적인 합병증을 일으킬 수 있다. 대부분의 경우 청소년기 후기까지 증상이 나타나지 않는 경우가 많다. 본 증례는 입주위의 청색증과 곤봉지 및 호흡곤란을 보인 6세된 남아였다. 흉부 엑스레이에서 우측하엽에 국소적인 결절의 음영이 발견되었고 흉부 단층 촬영을 통해 우측 하엽의 큰 폐동정맥루를 확진하였다. 우측 하엽의 폐절제술로 합병증 없이 성공적으로 치료하였다. 영유아시기에 폐동정맥루의 발생 빈도는 드물긴 하지만, 심혈관계 질환 없이 청색증과 호흡곤란을 보이는 드문 원인으로 폐동정맥루의 가능성을 염두에 두고 일찍 진단하고 치료함으로써 신경학적인 합병증의 발생을 예방하여야 한다.

• 한국임상수의학회지
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• 제30권4호
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• pp.273-277
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• 2013

This study was performed to compare clinical and diagnostic imaging features between asymptomatic and symptomatic extrahepatic portosystemic shunts in dogs. The data of thirty patients diagnosed with extrahepatic PSS by multi-detector CT were reviewed, and the dogs were divided into asymptomatic (9/30) and symptomatic (21/30) groups. Signalments, hematologic results, liver size, morphologic classifications and main portal vein to abdominal aortic ratio (PV/AO) at the porta hepatis level from CT images were evaluated in two groups. Shih-tzu (5/9) was the most frequent breed in asymptomatic group, and various breeds were presented in symptomatic group. Mean age of asymptomatic group ($9.2{\pm}3.2$ years) was significantly higher than that of symptomatic group ($4.5{\pm}3.2$ years). The most morphologic form of shunt vessel was the splenophrenic shunt (16/30). PV/AO of asymptomatic group ($1.1{\pm}0.19$) was significantly higher than the values of symptomatic group ($0.55{\pm}0.19$). Clinical signs, hematologic results and diagnostic imaging findings of asymptomatic PSS are too nonspecific to suspect PSS. Therefore, considering of patient's age and CT examination with application of PV/AO ratio could be useful for the diagnosis of asymptomatic PSS.

• Journal of Chest Surgery
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• 제39권1호
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• pp.68-71
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• 2006

종격동 섬유화로 인한 상대정맥증후군을 가진 41세의 남자 환자를 정맥 우회단락을 사용하여 상대정맥 재건술을 시행하였다. 환자는 수술 전 상당히 높은 중심 정맥압을 보였으며, 수술 시 측행혈관이 차단될 수밖에 없어, 수술에 따른 신경학적 합병증의 위험성이 높았다. 수술은 막힌 상대정맥과 무명정맥을 제거한 후에 자가 심낭을 튜브 모양으로 만들어 재건술을 시행하였으며, 수술 중에 정맥 우회 단락을 이용하여 두경부 및 상지의 정맥환류를 유지하였다. 우회단락의 사용은 상대정맥증후군의 수술 시 정맥압을 즉시 감소시키고, 수술시간에 따른 부담이 없었으며, 수술 후 합병증 발생을 예방하는데 효과적이었다.

• 한국임상수의학회지
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• 제34권3호
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• pp.189-192
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• 2017

Thirteen dogs were diagnosed as congenital extrahepatic single PSS by intraoperative mesenteric portovenography or computed tomographic examination, repair surgery was performed by using an ameroid constrictor. Hepatic size was measured from the right lateral view using liver length/T11 length ratio. This measurement was performed on follow-up check of PSS ligation patients. Hepatic size parameter of pre-operative PSS patients is $4.13{\pm}0.13$ (range, 3.11-4.83). After surgery, hepatic size parameter of post-operative PSS patients is $4.79{\pm}0.19$ (range, 3.78- 5.93). Although follow-up periods varied 2 and 26 weeks, all patients showed increased liver size compared to that on pre-operative radiographs (P < 0.01). The increase rate was 1.01-1.46 times than those of preoperative radiographs. But in 5 patients, post hepatic liver size was small compared to the others, which showed low increase rate of body weight, total protein, albumin, and glucose level. It was thought that small value of hepatic size parameter was due to delay of hepatic regeneration. In conclusion, radiographic hepatic size parameter of pre- and post-operative patients is considered an effective evaluation for restoring after PSS surgery.

• Tuberculosis and Respiratory Diseases
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• 제42권5호
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• pp.767-771
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• 1995

저자등은 객혈을 주소로 내원한 기관지동맥과 폐정맥의 동정맥기형 1예를 기관지동맥 조영술로 확진하고 치료하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Korean Neurosurgical Society
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• 제65권4호
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• pp.582-590
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• 2022

Objective : Hydrocephalus after intracerebral hemorrhage (ICH) is known to be related to poor prognosis and mortality. We analyzed predictors of permanent hydrocephalus in the patients with surgically treated supratentorial ICH. Methods : From 2004 to 2019, a total of 414 patients with surgically treated primary supratentorial ICH were included. We retrospectively analyzed age, sex, preexisting hypertension and diabetes, location and volume of ICH, presence and severity of intraventricular hemorrhage (IVH), and type of surgery. Results : Forty patients (9.7%) required shunt surgery. Concomitant IVH was higher in the 'shunt required' group (92.5%) than in the 'shunt not required' group (67.9%) (p=0.001). IVH severity was worse in the 'shunt required' group (13.5 vs. 7.5, p=0.008). Craniectomy (47.5%) was significantly high in the 'shunt required' group. According to multivariable analysis, the presence of an IVH was 8.1 times more frequent and craniectomy was 8.6 times more frequent in the 'shunt required' group. In the comparison between craniotomy and craniectomy group, the presence of an IVH was related with a 3.9 times higher (p=0.033) possibility and craniectomies rather than craniotomies with a 7-times higher possibility of shunt surgery (p<0.001). Within the craniectomy group, an increase in the craniectomy area by 1 cm² was correlated with a 3.2% increase in the possibility of shunt surgery (odds ratio, 1.032; 95% confidence interval, 1.005-1.061; p=0.022). Conclusion : Presence of IVH, the severity of IVH and decompressive craniectomy were related to the development of shunt dependent hydrocephalus in the patients with ICH. The increasing size of craniectomy was related with increasing rate of shunt requirement.

• Journal of Chest Surgery
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• 제54권6호
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• pp.500-508
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• 2021

Background: The major limitation of arteriovenous graft access is the high incidence of thrombotic occlusion. This study investigated the outcomes of our salvage strategy for thrombosed hemodialysis arteriovenous grafts (including surgical thrombectomy with balloon angioplasty) and evaluated the efficacy of intragraft curettage. Methods: Salvage operations were performed for 290 thrombotic occluded arteriovenous grafts with clinical stenotic lesions from 2010 to 2018. Of these, 117 grafts received surgical thrombectomy and balloon angioplasty from 2010 to 2012 (group A), and 173 grafts received surgical thrombectomy and balloon angioplasty, with an additional salvage procedure using a curette and a graft thrombectomy catheter, from 2013 to 2018 (group B). Outcomes were described in terms of post-intervention primary patency and secondary patency rates. Results: The post-intervention primary patency rates in groups A and B were 44.2% and 66.1% at 6 months and 23.0% and 38.3% at 12 months, respectively (p=0.003). The post-intervention secondary patency rates were 87.6% and 92.6% at 6 months and 79.7% and 85.0% at 12 months, respectively (p=0.623). Multivariate Cox regression analysis demonstrated that intragraft curettage was a positive predictor of post-intervention primary patency (hazard ratio, 0.700; 95% confidence interval, 0.519-0.943; p=0.019). Conclusion: Surgical thrombectomy and balloon angioplasty showed acceptable outcomes concerning post-intervention primary and secondary patency rates. Additionally, intragraft curettage may offer better patency to salvage thrombotic occluded arteriovenous grafts with intragraft stenosis.

• Journal of Veterinary Science
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• 제25권3호
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• pp.37.1-37.10
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• 2024

Importance: The portal vein to aorta (PV/Ao) ratio is used to assess the clinical significance of extrahepatic portosystemic shunt (EHPSS). Previous studies using computed tomography (CT) were conducted in dogs but not in cats. Objective: This study aimed to establish normal reference values for PV indices (PV/Ao ratio and PV diameter) in cats and determine the usefulness of these for predicting symptomatic EHPSS. Methods: This study included 95 dogs and 114 cats that underwent abdominal CT. The canine normal (CN) group included dogs without EHPSS. The cats were classified into feline normal (FN, 88/114), feline asymptomatic (FA, 16/114), and feline symptomatic (FS, 10/114) groups. The PV and Ao diameters were measured in axial cross-sections. Results: The group FN had a higher PV/Ao ratio than the group CN (p < 0.001). Within the feline groups, the PV indices were in the order FN > FA > FS (both p < 0.001). The mean PV diameter and PV/Ao ratio for group FN were 5.23±0.77 mm and 1.46±0.19, respectively. The cutoff values between groups FN and FS were 4.115 mm for PV diameter (sensitivity, 100%; specificity, 97.7%) and 1.170 for PV/Ao ratio (90%, 92.1%). The cutoff values between group FA and FS were 3.835 mm (90%, 93.8%) and 1.010 (70%, 100%), respectively. Conclusions and Relevance: The results demonstrated significant differences in PV indices between dogs and cats. In cats, the PV/Ao ratio demonstrated high diagnostic performance for symptomatic EHPSS. The PV diameter also performed well, in contrast to dogs.

• 대한영상의학회지
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• 제83권3호
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• pp.712-718
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• 2022

판사이 동정맥루(diploic arteriovenous fistula) 혹은 골내 동정맥루(intraosseous arteriovenous fistulas)는 동정맥 단락의 한 형태로 드물게 발생한다. 판사이 동정맥루에서 누공은 뇌막동맥(meningeal artery)과 골내 판사이 정맥(intraosseous diploic vein) 혹은 이끌정맥(emissary vein) 사이에 형성되고, 누공의 핵은 골내에만 위치한다. 현재, 경막 동정맥루에 대한 대표적 치료 방법은 혈관내 색전술로 대부분이 대퇴동맥/대퇴정맥을 통하여 접근한다. 하지만 혈관내 색전술 시 접근 가능한 통로가 없는 경우에는 대체할 수 있는 다른 접근법을 고려해야 한다. 우리는 이번 증례에서 두개골내 판사이정맥을 직접 천자하여 혈관내 색전술로 치료된 판사이 동정맥루 증례를 보고하고자 한다.

• 대한영상의학회지
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• 제83권4호
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• pp.808-829
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• 2022

간세포암종은 역동적 조영증강 컴퓨터단층촬영이나 자기공명영상에서의 동맥기 조영증강 및 문맥기 또는 지연기 씻김현상과 같은 전형적 영상 소견을 기반으로 비침습적으로 진단할 수 있다. 그러나 일부 간세포암종은 비전형적인 영상 소견을 나타내기 때문에 영상의학과 의사는 진단에 있어 어려움에 직면하게 된다. 더욱이 동맥 문맥 단락, 혼합 간세포-담관암, 간내 담관암, 혈관종과 같이 많은 간세포암 유사 병변들이 다수 존재하여 영상을 통한 감별 진단에 난항을 겪는다. 초기 영상 검사에서 간세포암종과 이러한 유사 종양을 구별하는 능력은 적절한 관리 및 치료 결정에 중요하다. 따라서 본 임상화보에서는 간세포암종의 비전형적 영상 소견과 간세포암종을 모방하는 악성 및 양성 병변들의 영상 소견을 제시하고 감별 진단을 좁히는 데 도움이 될 수 있는 중요한 단서들에 대해 알아보고자 한다.