• Clinical and Experimental Pediatrics
• /
• 제50권10호
• /
• pp.938-947
• /
• 2007

Many dialysis modalities such as peritoneal dialysis (PD), hemodialysis (HD) and continuous hemofiltration or hemodialysis (CRRT) are available for the management of pediatric patients with acute renal failure (ARF). PD is a relatively simple, inexpensive modality and can be used in hemodynamically unstable patients. But, it may not be the optimal therapy for patients with severe volume overload or life threatening hyperkalemia. HD is the preferred modality for the treatment of severe volume overload, severe hyperkalemia, but it needs vascular access. Improvements in the HD equipment have allowed HD to be performend in small children. Recents technological improvements in CRRT therapies have enabled pediatric patients who are less stable to be treated. CRRT is becoming the preferred method of acute therapy in pediatric intensive care units. A sound knowledge of the underlying principles of dialysis and awareness of recent technological advancements in differnet dialysis modalities will hopefully result in improved management of children with ARF.

• 대한디지털의료영상학회논문지
• /
• 제15권1호
• /
• pp.27-31
• /
• 2013

Perfusion MR imaging is how to use exogenous and endogenous contrast agent. Exogenous perfusion MRI methods which are dynamic susceptibility contrast using $T2^*$ effect and dynamic contrast-enhanced using T1 weighted image after injection contrast media. An endogenous perfusion MRI method which is arterial spin labeling using arterial blood flow in body. In order to exam perfusion MRI in human, technical access are very important according to disease conditions. For instance, dynamic susceptibility contrast is used in patients with acute stroke because of short exam time, while dynamic susceptibility contrast or dynamic contrast enhancement provides the various perfusion information for patients with tumor, vascular stenosis. Arterial spin labeling is useful for children, women who are expected to be pregnant. In this regard, perfusion MR imaging is required to understanding, and the author would like to share information with clinical users

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제41권4호
• /
• pp.203-207
• /
• 2015

Osteomyelitis is classified into three groups according to its origin: osteomyelitis that originates from the blood supply, osteomyelitis related to bone disease or vascular disease, and osteomyelitis related to a local infection of dental or non-dental origin. The present case involved osteomyelitis related to a local infection of dental origin and was located in the rear area of the lingula of the mandible. We decided to use sagittal split ramus osteotomy to access the osteomyelitis area. Under general anesthesia, we successfully performed surgical sequestrectomy and curettage via sagittal split ramus osteotomy.

• 대한영상의학회지
• /
• 제84권1호
• /
• pp.197-211
• /
• 2023

목적 기능장애 혈액투석 접근로에서 나이티놀 비피복형 스텐트 설치 후 접근로 유형과 스텐트의 위치에 따른 개통성을 평가하고자 한다. 대상과 방법 2017년 1월과 2019년 12월 사이에 159명의 환자(평균 연령, 64.1 ± 13.2세)가 혈액투석 접근로 기능장애를 치료를 위해 나이티놀 스텐트를 설치하였다. 스텐트의 위치는 다음과 같다; 18개 팔머리 정맥, 51개 노쪽피부정맥궁, 40개 위팔 정맥, 10개 문합부위 인접 정맥, 7개 동정맥 문합부 및 33개 인조혈관-정맥 문합부. 12개월 개통률은 카플란-마이어 방법과 콕스 회귀 모델로 평가하였다. 결과 총 159개의 스텐트가 103개의 자가동정맥루와 56개의 인조혈관접근로에 성공적으로 설치되었다. 인조혈관접근로는 자가동정맥루에 비해 12개월 일차 및 이차 개통률이 더 낮았다(일차 개통률; 25.0%대 44.7%; p = 0.005, 이차 개통률; 76.8%대 92.2%; p = 0.014). 스텐트 설치 후 노쪽피부정맥궁 및 인조혈관-정맥 문합부에서 다른 부위에 비해 12개월 일차 개통성이 불량하였다. 결론 나이티놀 비피복형 스텐트 설치 후 자가동정맥루는 인조혈관접근로와 비교하여 더 좋은 12개월 일차 및 이차 개통률을 보인다. 노쪽피부정맥궁 및 인조혈관-정맥 문합부의 스텐트는 다른 위치의 스텐트에 비해 더 낮은 12개월 일차 개통률을 보인다.

• Archives of Reconstructive Microsurgery
• /
• 제5권1호
• /
• pp.46-55
• /
• 1996

The purpose of this study is to investigate if there is a higher rate of free flap failure in cases of vein grafts compared to non-vein graft, and to analyze the clinical usefulness and necessity in elective free flap surgery. We have used 24 vein grafts in 208 free flaps from May, 1986 until August, 1995. Vein grafts were from 2cm to 50cm in length between the recipient and donor vessels. Reconstructed sites were 10 lower extremities, 8 head and neck, 4 hand, and 2 trunk. Vein grafts were used 14 for arterial, 6 venous, 4 in both arterial and venous anastomoses. We intentionally used long vein grafts longer than 5cm for improved blood flow in cases of peripheral vascular disease, radionecrotic wounds, lower leg trauma. Short vein grafts of about 3cm in length were used to overcome the shortage of vascular length in cases of unexpected vessel anomaly, short donor vessel, and difficult access to recipient vessels after radical neck dissection. All veins were carefully handled with ligation of very small branches and were transferred to the recipient site without irrigation. 8 flaps were failed out of a total of 208 free flaps, however there was no failure among the 24 cases that needed vein grafts between the donor and recipient vessels. Success rates between non-vein grafts free flaps and vein graft free flaps were 95.6%(8/184) and 100%(0/24). Even though the vein grafts increase the operation time and the number of anastomoses, they do not result in any increased failure rate of free flap surgery(4.4% versus 0%). In addition to the reducing tension between recipient and donor vessels, the surgeon can select better recipient vessels with excellent blood flow so that vein grfats in microsurgery can provide a high success rate of free flaps.

• Journal of Chest Surgery
• /
• 제29권8호
• /
• pp.883-888
• /
• 1996

Expanded polytetrafluoroethyene(expanded PTFE) 인조혈관을 이용한 동정 맥루조성술은 장기간의 혈액투석을 시행받는 환자들의 이차적인 동정 맥루조성술로서 많이 이용되고 있는 방법이다. 충남대학교병원 흉부외과에서는 1990년 8월부터 1995년 8월까지 35명의 환자에서 48례의 expanded PTFE인조혈관을 이용한 동정 맥루조성술을 시행하였고, 이중 32명의 환자 43례 에서 1개월에서 46개월 까지 추적관찰하였다. 저자들은 forearm에 36례의 수술을 시행하였고 upperarm에는 7례의 수술을 시행하였다. 수술실패가 3례, 조기 및 만기 합병증이 22례였었다(15례의 인조혈관 혈전, 기타 7례). 전체 동정맥루의 누적개존율은 12개월이 63%, 24개월 32%, 36개월 32%, 46개월이 21%였다. Fore- arm graft의 누적개존율은 12개월이 55%, 24개월이 30%, 36개월이 30%, 46개월이 20%이었으며 upperarm graft의 누적 개존율은 12개 월이 83%, 24개 월이 41%, 29개 월이 41 %였다. 위의 결과를 볼때, 이차적인 동정 맥루술로서의 expanded PTFE graft는 아직 자가정맥에 의한 동정맥루술보다 개존율이 낮고많은 합병증을 갖고 있지만, 개존율을 높이기 위해서는 더 좋은 梔行仄袖\ulcorner개발과 술후 관심 있는 관찰 및 기능을 유지하기 위한 관심이 필요하다고 생각된다.

• Journal of Korean Neurosurgical Society
• /
• 제53권4호
• /
• pp.213-217
• /
• 2013

Objective : Transradial angiography has become popular among many cardiologists as a diagnostic and therapeutic tool. However, transradial cerebral angiography is not utilized to the same extent. The purpose of this study is to present our experience regarding the usefulness of transradial cerebral angiography, especially in elderly patients. Methods : Between May 2011 and February 2012, a total of 126 cerebral angiographies were performed via a transradial approach in a single center. Of them, only 47 patients were over 60 years old. In our institution, we shifted the initial access from the right femoral artery to the right radial artery in all patients requiring cerebral angiography in 2011. We did not attempt radial access in 40 cases for variable reasons. Results : The procedural success rate was 92.2%. We have four failures of transradial angiography; two because of loop formations of the radial and brachial artery and two due to multiple puncture failures. All supra-aortic vessels were successfully catheterized. However, the selective catheterization rates of the left side distal vessels were lower, as success rates were 89.7% for the right internal carotid artery and 75% for the left internal carotid artery. Procedure-related vascular complications, such as puncture site hematoma, hand ischemia, pseudoaneurysm, arteriovenous fistula and arterial dissection were not observed in our series. However, intraprocedural thrombosis developed in one patient, which was resolved completely by intraarterial thrombolytic agents. Conclusion : With advancing patient's age, we believe that transradial cerebral angiography is a useful tool to decrease patient's discomfort and more effectively manage the vessel tortuosity.

• Journal of Chest Surgery
• /
• 제53권1호
• /
• pp.28-33
• /
• 2020

Background: When an arteriovenous fistula (AVF) is created using the basilic or deep cephalic vein, it is additionally necessary to transfer the vessels to a position where needling is easy; however, many patients develop wound-related postsurgical complications due to the long surgical wounds resulting from conventional superficialization of a deep AVF or basilic vein transposition. Thus, to address this problem, we performed videoscopic surgery with small surgical incisions. Methods: Data from 16 patients who underwent additional videoscopic radiocephalic superficialization, brachiocephalic superficialization, and brachiobasilic transposition after AVF formation at our institution in 2018 were retrospectively reviewed. Results: Needling was successful in all patients. No wound-related complications occurred. The mean vessel size and blood flow of the AVF just before the first needling were 0.73±0.16 mm and 1,516.25±791.26 mL/min, respectively. The mean vessel depth after surgery was 0.26±0.10 cm. Percutaneous angioplasty was additionally performed in 25% of the patients. Primary patency was observed in 100% of patients during the follow-up period (262.44±73.49 days). Conclusion: Videoscopic surgery for AVF dramatically reduced the incidence of postoperative complications without interrupting patency; moreover, such procedures may increase the use of native vessels for vascular access. In addition, dissection using a videoscope compared to blind dissection using only a skip incision dramatically increased the success rate of displacement by reducing damage to the dissected vessels.

• Journal of Korean Neurosurgical Society
• /
• 제65권5호
• /
• pp.688-696
• /
• 2022

Objective : Transvenous embolization (TVE) via an occluded inferior petrosal sinus (IPS) in a cavernous sinus dural arteriovenous fistula (CSDAVF) is challenging, often requiring navigation of a microcatheter through resistive obstacles between the occluded IPS and shunted pouch (SP), although the reopening technique was successfully performed. We report five cases of successful access to the cavernous sinus (CS) or SP using the rigid-tipped microguidewire such as chronic total occlusion (CTO) wire aiming to share our initial experience with this wire. Methods : In this retrospective study, four patients with CSDAVF underwent five procedures using the CTO wire puncture during transfemoral transvenous coil embolization. Puncture success, shunt occlusion, and complications including any hemorrhage and cranial nerve palsy were evaluated. Results : Despite successful access through the occluded IPS, further entry into the target area using neurointerventional devices was impossible due to a short-segment stricture before the CS (three cases) and a membranous barrier within the CS (two cases). However, puncturing these structures using the rigid-tipped microguidewire was successful in all cases. We could advance the microcatheter over the rigid-tipped microguidewire for the navigation to the SP and achieved complete occlusion of the SP without complications. Conclusion : The use of the rigid-tipped microguidewire in the TVE via the occluded IPS of the CSDAVF would be feasible and safe.

• 간호행정학회지
• /
• 제9권2호
• /
• pp.205-216
• /
• 2003

Purpose : This study wad aimed to estimate nursing cost for hemodialysis of secondary hospitals using Resource Based Relative Value Scale(RVRBS). Method : The first, calculated nursing workload for the hemodialysis of secondary hospitals. Second, measured each spent time according to 14 nursing behaviors. Third, computed Resource Based Relative Value(RBRV) scores and nursing expenses of hemodialysis nurse. Finally, estimated nursing cost for hemodialysis of secondary hospitals, Result & Conclusion : The mean RBRV scores for each nursing behaviors were from 218.9 to 383.9 point(mean=312.7). The high RBRV socres were 383.9(Complication during hemodialysis), 353.7(Access patient vascular), 345.7 (Patient Teaching). Nursing cost for hemodialysis was estimated 23,234(won).