• Title/Summary/Keyword: Stenosis

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초기 상후두암종에서 레이저를 이용한 내시경하 상후두부분절제술의 적용 (Clinical Application of Endoscopic Laser Assisted Supraglottic Partial Laryngectomy in Early Supraglottic Cancer)

  • 최종욱;권기환;오준환;한승훈;이승훈;최건
    • 대한두경부종양학회지
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    • 제14권2호
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    • pp.164-168
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    • 1998
  • 레이저를 이용한 내시경하 상후두부분절제술은 술전에 정확한 병기판정으로 초기 국소병변의 선택을 신중하게 하고 경부 림프절전이의 치료를 효율적으로 시행하는 경우 기존의 수술법과 유사한 생존율을 얻을 수 있었다. 환자의 상태에 따라서 충분한 수술시야를 확보하는데 어려움이 있으며, 병변의 위치에 따라서 술중 절제연의 확인이 힘들다는 제한점을 고려해야 하며, 술 후 발생할 수 있는 출혈, 부종, 오연 등의 합병증에 대비하기 위하여 술 전 기관절개술이 유용할 것으로 생각된다.

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협착 동맥혈관의 혈류유동 모델링 (Modeling of Hemodynamics in Stenosed Artery)

  • 김성종;박영란;김상진;강형섭;김진상;오성훈;강성준;김기범
    • 한국산학기술학회논문지
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    • 제13권5호
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    • pp.2285-2290
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    • 2012
  • 동맥경화는 혈관 안에서 콜레스테롤의 침착 때문에 혈관이 좁아지거나, 딱딱해 지거나, 두꺼워 지게 되는데, 이런 현상이 심해지게 되면 동맥은 단단해져서 혈액이 원활히 통과하지 못하게 되고 심하면 사망 까지 이르게 되는 것이다. 본 연구에서는 복대동맥에서의 동맥경화가 진행되는 것을 탄성 혈관 일 때와 강성 혈관 일 때 각각 협착률이 혈관 직경의 20과 45%로 설정하고 속도와 압력 변화를 살펴보기 위하여 유한 요소 해석을 이용하여 모델링을 하였다. 혈관이 탄성 혈관일 때 속도와 압력 값은 협착률이 혈관 직경의 20%일 때 보다 45%일 때 더 높게 나타났으며, 강성 혈관에서 속도와 압력 값은 협착률이 혈관 직경의 20%일 때보다 45%에서 더 높았다. 협착률이 혈관 직경의 20과 45%인 탄성 혈관에서 재순환영역이 나타났다. 본 연구결과 혈관 협착에 따른 혈류역학적 특징을 이해하는데 도움이 될 것으로 판단된다.

양측성 상대정맥 기형을 동반한 기관성 기관지 1예 (A Case of Tracheal Bronchus Associated with Bilateral Superior Vena Cava Anomaly)

  • 정재희;박무석;김희만;박정탁;정재호;최병욱;김영삼;장준;김성규;김세규
    • Tuberculosis and Respiratory Diseases
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    • 제53권3호
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    • pp.337-343
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    • 2002
  • 저자들은 어렸을 때부터 간헐적인 호흡곤란이 있어 기관지 천식으로 치료를 받아온 과거력이 있는 20세 남자에서 군입대 신체검사를 위해 시행한 흉부전산화단층촬영과 굴곡성 기관지내시경 검사상 우연히 발견된 양측성 상대정맥 기형을 동반한 기관성 기관지 1예를 경혐하였기에 문헌 고찰과 함께 보고하는 바이다.

Ebstein 기형의 외과적 치험 (Surgical Treatment of Ebstein Anomaly)

  • 이종호;김병렬
    • Journal of Chest Surgery
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    • 제32권1호
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    • pp.5-9
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    • 1999
  • 배경: Ebstein 기형은 삼첨판, 우심실 및 우심방의 특징적인 변형을 보이는 희귀한 선천성 심질환이다. 이 질환의 외과적인 치료는 삼첨판성형술과 판막치환술로 두가지가 시행되고있으나 가장 좋은 술식에 대해서는 의견이 일치되고 있지는 않다. 대상 및 방법: 본원에서 1984년 1월부터 1996년 12월까지 Ebstein기형의 수술적 교정을 한 8례를 대상으로 하였으며 대상 환자의 연령 및 성별분포, 임상증상, 흉부 방사선학적 소견, 술전 검사소견, 수술소견, 수술방법, 수술 결과등을 비교검토하였다. 결과: 성비는 남자 5명, 여자 3명이었고, 연령분포는 최소 2세에서 최고 28세로 평균연령은 17.6세였다. 모든예에서 전형적인 삼첨판의 변형을 보였으며 동반된 심기형으로는 개방성 난원창, 심방중격 결손증, 폐동맥 협착증이 있었다. 수술적 방법으로는 삼첨판막 치환술과 삼첨판륜 성형술 및 주름 성형술을 각각 4례씩 실시하였다. 술후 합병증으로 Danielson 술식을 받은 2례에서 빈맥이 있었으며 삼첨판 치환술을 받은 2례에서 완전 방실차단이 생겨 인공심박동기를 설치하였다. 2례의 술후 사망례가 있었으며 생존한 6례에서는 술후 평균 64.83 개월간 추적 관찰결과 NYHA class I-II로 별문제 없이 지내고 있고 술전보다 양호한 심기능을 보였다. 술후 5례에서 심초음파를 실시하였고 삼첨판의 역류정도는 술전 중등도이상에서 술후 경증도로 개선되었다. 결론: Ebstein 기형의 수술적 방법의 선택은 각환자의 해부학적 특성에 따라 다르지만, 삼첨판의 기형과 변형이 작고 판막치환이 필요하지않다면 삼첨판륜성형과 주름성형술이 좋은 술식이라고 판단된다.

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도플러 초음파를 이용한 중풍환자(中風患者)의 뇌혈관(腦血管) 혈류측정(血流測定)에 관한 임상적(臨床的) 연구(硏究) (경동맥(頸動脈), 추골동맥(椎骨動脈) 및 기저동맥(基底動脈)을 중심으로) (Clinical study on the estimation of blood flow velocity using doppler ultrasound of the cerebral artery in stroke patients)

  • 장인수;선중기
    • 대한한의학회지
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    • 제17권1호
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    • pp.345-360
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    • 1996
  • Background and Purpose: To evaluate the blood flow velocity using doppler ultrasound of the carotid artery, vertebral artery, and basilar artery in stroke patients Material and Methods: To evaluate the blood flow, I measured the peak systolic velocity and mean velocity of the common carotid artery(CCA), internal carotid artery(ICA), external carotid artery (ECA). vertebral artery(VA), and basilar artery(BA) in 44 stroke patients and 15 healthy adults. To investigate the difference between ischemic stroke patients and normal healthy adults, I selected 44 ischemic stroke patients diagnosed by brain CT and brain MRI, and 15 healthy adults who did not have any symptoms of stroke, hypertension, heart disease, and diabetes melitus. Results: Peak velocity in normal adults was 50.6${\pm}$1.6cm/sec in the CCA, 67.2${\pm}$1.7cm/sec in the ICA, 62.5${\pm}$2.4cm/see in the ECA, 45.5${\pm}$1.9cm/sec VA. and 50.5${\pm}$3.5cm/sec in the BA. Mean velocity in normal adults was 26.9${\pm}$1.1cm/sec in the CCA, 43.7${\pm}$1.4cm/sec in the ICA, 26.7${\pm}$1.3cm/sec in the ECA. 31.6${\pm}$1.9cm/sec in the VA and 33.0${\pm}$2.6cm/sec in the BA. In this study, there was a significant increase in the velocity of ICA, ECA, and VA of ischemic stroke patients in comparison with normal healthy adults. And the blood flow velocity of this study in the CCA and ECA was different from other reported foreign values and the other known values in my country. Conclusion: There was a significant difference in the blood flow velocity between ischemic stroke patients and normal healthy adults. And the blood flow velocity of this study was different from other reported foreign values and the other known values in my country. Therefore, it needs more detailed studies about old aged Korean and ischemic stroke patients than previous studies.

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The Correlation between Caudal Epidurogram and Low Back Pain

  • Jo, Dae-Hyun;Jang, Sul
    • The Korean Journal of Pain
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    • 제25권1호
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    • pp.22-27
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    • 2012
  • Background: The common causes of lower back pain with or without leg pain includes disk disease and spinal stenosis. A definitive diagnosis is usually made by means of magnetic resonance imaging (MRI), but treatment is often difficult because the MRI findings are not consistent with the symptoms of the patient in many cases. The objective of this study was to observe the correlation between the patterns of epidurography performed in patients having lower back pain with or without leg pain and the position or severity of the pain as subjectively described by the patients. Methods: The subjects of this study were 69 outpatients with lower back pain with or without leg pain who visited our clinic and complained of predominant pain on one side. We performed caudal epidural block using an image intensifier. A mixture of the therapeutic drug and the contrast agent (10 ml) was injected to observe the contrast flow pattern. The patients who complained of predominant pain on one side were divided into the left side group and the right side group. A judgment of inconsistency was made if the contrast agent flowed to the side of the pain, while a judgment of consistency was made if the contrast agent flowed to the opposite side of the pain. The degree of the drug distribution was evaluated by counting the number of cells to which the contrast agent's flowed for evaluating the correlation between the contrasted cell and the severity of pain (one group ${\leq}$ VAS 7, the other group ${\geq}$ VAS 8) the degree of the contrast agent's contrast was evaluated by dividing and counting an image into 15 cells (the left, right, and middle sections at each level of L4, L5, S1, S2, and S3). Results: Thirty out of the 69 patients who had laterality in pain, that is, those who complained of predominant pain on one side, showed that the laterality of the pain and the contrast agent flow was consistent, while 39 patients showed that the laterality was inconsistent (P: 0.137). The evaluation of the correlation between the pain and the contrast agent flow showed that the mean number of contrasted cells was $9.0{\pm}2.2$ for the 46 patients in the group with a VAS of 7 or lower and $6.5{\pm}2.0$ for the 23 patients in the group with a VAS of 8 or higher, indicating that the former group showed a significantly greater number of contrasted cells (P < 0.001). Conclusions: This study, conducted with patients having lower back pain with or without leg pain, showed that the contrast flow pattern of caudal epidurography had a significant correlation with the severity of the pain but not with the laterality of the pain.

흉통환자의 관상동맥중재술 시행 여부에 따른 건강행위 및 건강지표 비교 - 간호정보조사지와 전자의무기록 분석- (Comparison of Health Behaviors and Health Indices According to Percutaneous Coronary Intervention in Patients with Chest Pain -Analysis of Nursing Information Chart and Electronic Medical Record-)

  • 권미수;이숙정
    • 한국콘텐츠학회논문지
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    • 제19권12호
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    • pp.279-288
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    • 2019
  • 본 연구는 흉통이 발생되어 관상동맥조영술을 실시한 후 재입원한 대상자의 관상동맥중재술 시행 여부에 따른 건강행위와 건강지표의 차이를 종단적으로 비교하고자 수행되었고, 2010년 1월부터 2017년 12월까지 일개병원에서 247명의 흉통발생자의 간호정보조사지와 전자의무기록을 분석한 2차 자료 분석연구이다. 대상자는 관상동맥중재술 비시행자와 시행자로 구분하여 병원 1차 입원 시점과 재입원 시점에서 흡연, 음주, 수면장애등 건강행위와 혈압과 혈중 지질 수치등 건강지표를 측정하였다. 수집된 자료는 SPSS 24.0를 사용하여 분석하였고, 연구 결과, 초기 입원시에는 관상동맥중재술 시행자와 비시행자간 건강행위와 건강지표에는 유의한 차이가 없었으나, 재입원시에는 관상동맥중재술 시행자가 비시행자에 비해 흡연과 지질 수치에 있어서 유의하게 건강한 양상을 나타내었다. 관상동맥중재술 비시행자의 경우 관상동맥협착의 위험이 많은 환자임에도 불구하고 흡연률이 높았고, 전체 대상자중 60%가 퇴원후 6-12개월 사이에 흉통으로 재입원하여, 흉통환자에게 의학적 치료와 더불어 건강행위를 도모하는 지속적인 통합관리가 필요함을 알 수 있었다. 본 연구의 의의는 관상동맥중재술 실시 여부에 따른 건강행위와 건강지표를 종단적으로 비교하여 관상동맥질환자와 위험환자의 건강행위의 중요성을 확인한 것이다.

요추추간판탈출증군과 단순요통군간의 Current Perception Threshold상의 차이에 관한 연구 (The study of difference between HIVD group and simple low back pain group by Current Perception Threshold test)

  • 김철홍;이병훈;권혜연;임춘우;서정철;윤현민;송춘호;장경전;안창범
    • Journal of Acupuncture Research
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    • 제18권6호
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    • pp.59-69
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    • 2001
  • Objective : The aim of this study is to assess the ability of the CPT test to dignosis radiculopathy in Korean with NeuvalTM CPT database. Method : Electrical stimulation(at 2000, 250, and 5Hz) using Neurometer was applied to the 19 patients who felt back and sciatic pain with herniated intervertevral disc(HIVD) of L-spine, dignosisd by lumbar CT or MRI, and the 33 patients who felt only back or hip or leg pain without HIVD, stenosis, spondylolisthesis which causing radiculopathy. The test sites were toe1, toe3 and toe5 related to L4, L5 and S1 nerve roots. Results : The mean values of the CPT of HIVD group was stiatically lower than LBP group at toe1-250Hz, toe3-2000Hz, 250Hz and toe5-250Hz, 5Hz. The grading CPT score of HIVD group was stastically higher than LBP group at the toe3(L5). The VAS of HIVD group was stastically higher than LBP group. Conclusion : These results suggest that the CPT test can be a valuable testing for diagnosing radiculopathy in Korean. In using CPT test further study is needed for the diagnosis and evaluation of sensory nerve dysfunction in the musculoskeletal disease.

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모야모야병 환자의 뼈목동맥관 직경과 임상표현과의 관계 (Relation of Bony Carotid Canal Diameter and Clinical Manifestations in Patients with Moyamoya Disease)

  • 안소현;송홍기;김철호;손종희;장민욱;최휘철
    • Annals of Clinical Neurophysiology
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    • 제18권1호
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    • pp.1-6
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    • 2016
  • Background: Moyamoya disease is characterized by a progressive stenosis or occlusion of the intracranial internal carotid artery and/or the proximal portion of the anterior cerebral artery and middle cerebral artery. Whether the onset time was childhood or adulthood, the bony carotid canal diameter might be different, but reflects the size of internal carotid artery passing through the bony carotid canal. In this study, we aimed to identify the relationship between bony carotid canal diameter and clinical manifestation. Methods: 146 consecutive patients diagnosed with moyamoya disease by brain imaging studies were included. We measured the diameter of a transverse portion of bony carotid canal on bone window of a brain computed tomography(CT) image. Patients were divided into two groups, ischemic or hemorrhagic stroke according to clinical manifestation. As a result, 115 patients were included. The Suzuki stage was used as criteria for disease progression. Results: Bony carotid canal diameter was $3.6{\pm}0.5$ (right) and $3.6{\pm}0.4$ (left) in the hemorrhagic stroke group, and $3.7{\pm}0.4$ (right) and $3.6{\pm}0.4$ (left) in the ischemic stroke group. The bony carotid canal diameter of the moyamoya vessels (3.6 mm) was smaller than the diameter of non-moyamoya vessels (3.8 mm), significantly (p = 0.042). However, there was no difference in the collateral patterns and clinical manifestation in a comparison of both groups. Conclusions: In our study, there was no significant difference of clinical manifestations and collateral patterns depend on the bony carotid canal diameter in patients with moyamoya disease. These findings suggest that the clinical presentations of moyamoya disease are not related to the onset time of the disease.

A Case of Significant Endobronchial Injury due to Recurrent Iron Pill Aspiration

  • Kwak, Joo-Hee;Koo, Gun Woo;Chung, Sung Jun;Park, Dong Won;Kwak, Hyun Jung;Moon, Ji-Yong;Kim, Sang-Heon;Sohn, Jang Won;Yoon, Ho Joo;Shin, Dong Ho;Park, Sung Soo;Pyo, Ju Yeon;Oh, Young-Ha;Kim, Tae-Hyung
    • Tuberculosis and Respiratory Diseases
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    • 제78권4호
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    • pp.440-444
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    • 2015
  • Gastric mucosal damage by iron pills is often reported. However, iron pill aspiration is uncommon. Oxidation of the impacted iron pill causes bronchial mucosal damage that progresses to chronic bronchial inflammation, necrosis, endobronchial stenosis and rarely, perforation. We reported a case of a 92-year-old woman with chronic productive cough and significant left-sided atelectasis. Bronchoscopy revealed substantial luminal narrowing with exudative inflammation of the left main bronchus. Bronchial washing cytology showed necroinflammatory exudate and a small amount of brown material. Mucosal biopsy showed diffuse brown pigments indicative of ferrous pigments, crystal deposition, and marked tissue degeneration. After vigorous coughing, she expectorated dark sediments and her symptoms and radiological abnormalities improved. There are a few such reports worldwide; however, this was the first case reported in Korea. Careful observation of aspiration-prone patients and early detection of iron pill aspiration may prevent iron pill-induced bronchial injury.