• 대한영상의학회지
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• 제81권6호
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• pp.1348-1363
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• 2020

2018년에 새롭게 개정된 장기 손상척도는 이전 미국외상수술협회의 응급수술분류체계와 유사한 형식을 가지며, 고형장기 손상의 등급을 지정하는 기준을 영상(imaging), 수술(operative), 병리(pathologic) 세 가지 세트로 나누어 분류하였다. 2018년 개정에서 가장 중요한 변화는 거짓동맥류와 동정맥 누공을 포함한 혈관 손상의 다중검출CT (multidetector CT; 이하 MDCT) 소견을 정의하여 장기 손상척도에 통합한 것이다. 이전 장기 손상척도와 동일하게 세 가지 기준 중에 가장 높은 등급이 최종 등급이 된다. 또한 한 장기 내에 여러 개의 1등급 또는 2등급 소견이 있으면, 다발성 손상에 대해 3등급의 부여가 가능하다. 본 임상화보에서는 2018년 개정된 미국외상수술협회 장기 손상척도의 MDCT 소견을 소개하고자 한다.

• Journal of Trauma and Injury
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• 제36권4호
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• pp.435-440
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• 2023

Mesenteric injury occurs rarely in cases associated with blunt abdominal trauma. Despite its low incidence, mesenteric injury can lead to fatal outcomes such as hypovolemic shock due to hemoperitoneum or sepsis due to intestinal ischemia, or perforation-related peritonitis. For mesenteric injuries, especially those involving massive bleeding, intestinal ischemia, and perforation, the standard treatment is surgery. However, in the case of operative management, it should be borne in mind that there is a possibility of complications and mortality during and after surgery. The usefulness of transcatheter arterial embolization (TAE) is well known in solid organs but is controversial for mesenteric injury. We present a 75-year-old man with mesenteric injury due to blunt abdominal trauma. Initial abdominal computed tomography showed no hemoperitoneum, but a mesenteric contusion and pseudoaneurysm with a diameter of 17 mm were observed near the origin of the superior mesenteric artery. Since there were no findings requiring emergency surgery such as free air or intestinal ischemia, it was decided to perform nonoperative management with TAE using microcoils in hybrid emergency room system. TAE was performed successfully, and there were no complications such as bleeding, bowel ischemia, or delayed bowel perforation. He was discharged on the 23rd day after admission with percutaneous catheter drainage for drainage of mesenteric hematoma. The authors believe that treatment with TAE for highly selected elderly patients with mesenteric injuries has the positive aspect of minimally invasive management, considering the burden of general anesthesia and the various avoidable intraoperative and postoperative complications.

• Archives of Reconstructive Microsurgery
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• 제24권2호
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• pp.75-78
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• 2015

High-pressure (HP) injection injury to the upper extremity often causes a very serious clinical problem, leading to poor outcomes, including amputation, so that a true surgical emergency is required. The outcomes can be improved with emergent wide surgical debridement. However the diagnosis of these injuries is often delayed due to underestimated evaluation at first appearance and lack of common knowledge of the seriousness of this injury. The type and pressure of the infecting material is an important factor in prognosis and organic solvents infected pressure injury can cause poor outcome and increased amputation rate. In this case, we report on reconstruction of HP oil-based paint injection injuries of the finger using T-shaped pedicles and multiple venous anastomoses. In this concept, arterial flow can be maintained by the reverse flow of distal anastomosis when there is difficulty with the proximal anastomosis. And venous flow can be preserved by deep and superficial vein anastomosis. This concept has various advantages including preserving patency of the pedicle in chronic vasculopathy or trauma cases and maintaining the arterial flow by the reverse flow of distal anastomosis and can improve the free flap survival by a two vascular anastomosis system.

• 대한정형도수물리치료학회지
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• 제1권1호
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• pp.9-14
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• 1995

인체에서 발생하는 체열을 과학적으로 이용하여 질병을 진단하고 치료과정을 관찰하고 예후를 추측할 수 있는 Thermography는 현대의학의 임상 여러분야에서 응용할 수 있는 유용한 진단장비에 속한다 하겠다. 인체의 피부온도는 좌우 대칭적으로 온도분포를 나타내며 여러가지 생리학적인 원인에 의하여 온도는 변화할 수 있으며, 그러한 온도변화는 여러 질병과의 연관성을 갖게 된다. Thermography는 유방암세포의 증식에 따른 유방체표면의 초기온도 상승을 screening 함으로서 조기에 유방암을 발견할 수 있으며, 척추의 신경근 자극에 따른 체열분포를 파악함으로서 신경근의 이상유무 및 척추질환을 진단할 수 있으며, 말초 혈액순환 장애 등으로 인한 질환에 있어서도 뚜렷한 체표면 온도분포를 나타내 줌으로서 혈액순환의 장애분포를 시각적으로 관찰할 수 있는 이점을 지니고 있다. 또한 정형 물리치료 분야에 속하는 근-골격계 질환에 있어서의 근육통, 압통점, 염좌, 염증질환 등을 구별할 수 있고 나아가 치료 전후에 적외선 체열검사를 실시해 봄으로서 치료전이나 치료결과에 대한 객관적인 평가를 할 수 있다는데 큰 의의가 있다고 하겠다.

• 대한영상의학회지
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• 제81권6호
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• pp.1459-1465
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• 2020

항암치료를 위해 흉강 내 속목정맥의 천자를 통한 피하매몰 중심정맥 케모포트(implantable central venous chemoport) 도관의 설치 중 발생할 수 있는 의인성 속목정맥 천공은 매운 드문 합병증 중의 하나로 혈흉이나 출혈성 쇼크를 일으킬 수 있으며, 부적절한 항암제 주입으로 인한 늑막삼출이 발생할 수 있다. 따라서 항암제 주입 전 조기에 진단하여 응급 개흉술을 통해 천공된 속목정맥을 봉합하는 것이 치료 원칙이다. 저자들은 우측 속목정맥을 통한 피하매몰 중심정맥 케모포트의 설치 후 발생한 속목정맥 천공 환자에서 부적절한 항암제 주입으로 인해 발생한 늑막삼출과 혈흉을 개흉술을 시행하지 않고 경피적 배액술 후 코일과 N-butyl cyanoacrylate를 이용한 색전술을 통해 성공적으로 치료한 1예를 경험하였기에 이를 보고하고자 한다.

• Journal of Trauma and Injury
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• 제26권3호
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• pp.243-247
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• 2013

Introduction: Surgical treatment of subclavian artery (SA) injury is challenging because approaching the lesion directly and clamping the proximal artery is difficult. This can be overcome by using an endovascular technique. Case 1: A 37-year-old male was drawn into the concrete mixer truck. He had a right SA injury with multiple traumatic injuries: an open fracture of the right leg with posterior tibial artery (PTA) injury, a right hemothorax, and fractures of the clavicle, scapula, ribs, cervical spine and nasal bone. The injury severity score (ISS) was 27. Computed tomography (CT) showed a 30-mm-length thrombotic occlusion in the right SA, which was 15 mm distal to the vertebral artery (VA). A self-expandable stent($8mm{\times}40mm$ in size) was deployed through the right femoral artery while preserving VA flow, and the radial pulse was palpable after deployment. Other operations were performed sequentially. He had a viable right arm during a 13-month follow-up period. Case 2: A 25-year-old male was admitted to our hospital due to a motorcycle accident. The ISS was 34 because of a hemothorax and open fractures of the mandible and the left hand. Intraoperative angiography was done through a right femoral artery puncture. Contrast extravasation of the SA was detected just outside the left rib cage. After balloon catheter had been inflated just proximal to the bleeding site, direct surgical exploration was performed through infraclavicular skin incision. The transected SA was identified, and an interposition graft was performed using a saphenous vein graft. Other operations were performed sequentially. He had a viable left arm during a 15-month follow-up period. Conclusion: The challenge of repairing an SA injury can be overcome by using an endovascular approach.

• Journal of Trauma and Injury
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• 제26권3호
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• pp.248-251
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• 2013

Introduction: A post-traumatic mesenteric arteriovenous fistula (AVF) is extremely rare. Case Report: A previously healthy 26-year-old male was injured with an abdominal stab wound. Computed tomography (CT) showed liver injury, pancreas injury and a retropancreatic hematoma. We performed the hemostasis of the bleeding due to the liver injury, a distal pancreatectomy with splenectomy and evacuation of the retropancreatic hematoma. On the 5th postoperative day, an abdominal bruit and thrill was detected. CT and angiography showed an AVF between the superior mesenteric artery (SMA) and the inferior mesenteric vein with early enhancement of the portal vein (PV). The point of the AVF was about 4 cm from the SMA's orifice. After an emergent laparotomy and inframesocolic approach, the isolation of the SMA was performed by dissection and ligation of adjacent mesenteric tissues which was about 6 cm length from the nearby SMA orifice, preserving the major side branches of the SMA, because the exact point of the AVF could not be identified despite the shunt flow in the PV being audible during an intraoperative hand-held Doppler-shift measurement. After that, the shunt flow could not be detected by using an intraoperative hand-held Doppler-shift measuring device. CT two and a half months later showed no AVF. There were no major complications during a 19-month follow-up period. Conclusion: Early management of a post-traumatic mesenteric AVF is essential to avoid complications such as hemorrhage, congestive heart failure and portal hypertension.

• Annals of Rehabilitation Medicine
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• 제42권6호
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• pp.814-821
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• 2018

Objective To suggest rotation angles of fluoroscopy that can bypass the carotid sheath according to vertebral levels for cervical transforaminal epidural steroid injection (TFESI). Methods Patients who underwent cervical spine magnetic resonance imaging (MRI) from January 2009 to October 2017 were analyzed. In axial sections of cervical spine MRI, three angles to the vertical line (${\alpha}$, angle not to insult carotid sheath; ${\beta}$, angle for the conventional TFESI; ${\gamma}$, angle not to penetrate carotid artery) were measured. Results Alpha (${\alpha}$) angles tended to increase for upper cervical levels ($53.3^{\circ}$ in C6-7, $65.2^{\circ}$ in C5-6, $75.3^{\circ}$ in C4-5, $82.3^{\circ}$ in C3-4). Beta (${\beta}$) angles for conventional TFESI showed a constant value of $45^{\circ}$ to $47^{\circ}$ ($47.5^{\circ}$ in C6-7, $47.4^{\circ}$ in C5-6, $45.7^{\circ}$ in C4-5, $45.0^{\circ}$ in C3-4). Gamma (${\gamma}$) angles increased at higher cervical levels as did ${\alpha}$ angles ($25.2^{\circ}$ in C6-7, $33.6^{\circ}$ in C5-6, $43.0^{\circ}$ in C4-5, $56.2^{\circ}$ in C3-4). Conclusion The risk of causing injury by penetrating major vessels in the carotid sheath tends to increase at upper cervical levels. Therefore, prior to cervical TFESI, measuring the angle is necessary to avoid carotid vessels in the axial section of CT or MRI, thus contributing to a safer procedure.

• 대한영상의학회지
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• 제84권5호
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• pp.1185-1190
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• 2023

가성동맥류는 경피적 풍선성형술의 가장 심각한 합병증 중의 하나이다. 가성동맥류의 파열은 드물게 발생하지만, 발생할 경우 환자의 죽음을 초래할 수 있기 때문이 조기 발견과 적절한 치료가 매우 중요하다. 저자들은 3개월 전 실시한 경피적 풍선성형술의 합병증으로 발생된 증상을 동반한 좌측 슬와동맥 거대 가성동맥류를 가진 34세 말기신부전 남자 환자의 증례를 보고한다. 가성동맥류는 인터벤션 치료를 통하여 성공적으로 치료되었고, 환자는 추적기간 동안 다른 합병증 없이 잘 회복되었다.

• Journal of Chest Surgery
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• 제9권1호
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• pp.10-19
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• 1976

One hundred and seventy-four patients were treated in this Department since 1956. One hundred and fifteen patients of them were surgically treated. They were classified on the basis of the disease entity as follows; 48 case of thrombo-angiitis obliterance, 8 cases of Leriche syndrome, 12 cases of arterial embolism, 36 arterial aneurysm, 5 arterio-venous fistula, 15 arterial and venous injuries, 8 pulseless diseases, 2 coarctation of aortas, 15 varicose veins, 12 thrombophlebitis, 9 superior venacaval syndromes, 2 inferior vena caval obstructions and Raynaud's diseases. All the cases of the Burger's diseases were males, and half of them were in the fourth decades, 39 cases underwent undergone unilateral or bilateral sympathectomies. All the Leriche syndromes were males aged over fifty. Three cases out of six were suffering from diabetes mellitus. 2 cases underwent aorto-femoral bypass graft with Y-shaped dacrons. And two embolectomies were performed in 2 cases. Eight cases of arterial embolisms among 12 had mitral valvular diseases with auricular fibrillation The most common site of lodgement of emboli was femoral artery. Nine out of 14 underwent embolectomies with Fogarty catheters. There were 14 peripheral arterial aneurysms, 16 thoracic and/or abdominal aortic aneurysms, and 4 dissecting aneurysms. Most frequent cause of peripheral arterial aneurysms were external trauma. Thoracic and abdominal aortic aneurysms were non-traumatic. And four cases of the dissecting aneurysms had significant hypertension and aged over fifty. Among 5 cases of arteriovenous fistulas, 2 cases hand typical Branham's sign, and they were normalized after operation. Eight cases of pulseless disease were females and aged from three to twenty-five. Three out of them were treated surgically using dacron prosthetic grafts, but the results of the surgery were variable and not satisfactory. A case of coarctation of aorta was treated surgically with an excellent result. Fourteen out of 15 varicose veins underwent ligation of the saphenous vein system, exstirpation of the varicose veins, stripping or some combination of these methods. Two cases of superior vena caval syndromes were operated by bypass graft between the left innominate vein and the right auricle. Two cases of inferior vena caval obstructions were operated upon through right atrial route using extracorporial circulation. All the four cases of vena caval obstructions showed excellent results postoperatively. Two cases out of 12 thrombophlebitis underwent thrombectomies. One of two Raynaud's diseases was surgically treated with an excellent result.