• 대한핵의학회:학술대회논문집
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• 1999.05a
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• pp.205-208
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• 1999

Percutaneous Transluminal Coronary Angioplasty (PTCA) remains limited by restenosis that occurs in 30 to 50% of patients with coronary artery disease. During the last decade, numerous agents have been used to prevent restenosis. Despite positive results in animal models, no pharmacological therapy has been found to significantly decrease the risk of restenosis in humans. These discrepancies between animal models and clinical situation were probably related to an incomplete understanding of the mechanism of restenosis. Neointimal thickening occurs in response to experimental arterial injury with a balloon catheter. Neointimal formation involves different steps: smooth muscle cell activation, proliferation and migration, and the production of extracellular matrix. The factors that control neointimal hyperplasia include growth factors, humoral factors and mechanical factors. Arterial remodeling also plays a major role in the restenosis process. Studies performed in animal and human subjects have established the potentials for "constrictive remodeling" to reduce the post-angioplasty vessel area, thereby indirectly narrowing the vessel lumen and thus contributing to restenosis. The reduction of restenosis rate in patients with intracoronary stent implantation has been attributed to the preventive effect of stent itself for this negative remodeling. In addition to these mochanisms for restenosis, intraluminal or intra-plaque thrombus formation, reendothelialization and apoptosis theories have been introduced and confirmed at least in part.

• Journal of Chest Surgery
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• v.34 no.9
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• pp.711-715
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• 2001

Background: Deep venous thrombosis(DVT) is a curable disease when it is appropriately treated in the early stages of onset. The long term follow up of chronic DVT shows poor prognosis with serious complications such as venous valvular insufficiency, venous claudication, venous ulcer and leg swelling. Thrombolytic therapy is a very active treatment that delivers thrombolytic agents via catheter to the target thrombi. The aim of this study is to evaluate the effect of catheter directed thrombolysis using urokinase to acute DVT. Material and Method: We studied 5 patients, who were diagnosed as acute DVT and had no contraindication for selective hemolysis using urokinase. Result: All the patients were successfully recanalized. Total infusion time of urokinase was 2.0$\pm$0.6 days, and the amount was 5.9$\pm$2.45 million IU. In 4 patients, who were diagnosed as May-Therner syndrome, we performed the balloon angioplasty and inserted the stent at the stenotic portion. There were minor complications such as hematuria, hematoma at puncture site, and all of them are self limited. Conclusion: Catheter induced thrombolysis is an effective treatment in acute DVT.

• Journal of Chest Surgery
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• v.28 no.2
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• pp.156-161
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• 1995

Although there are many kinds of method in treatment of tracheal stenosis, tracheal resection and primary anastomosis can be performed for management of various kinds of tracheal stenosis because it is considered the most anatomical ideal therapeutic modality. During a 10-year period we performed 18 tracheal resection on 18 patients with no operative mortality and some morbidity. 13 patients had tracheal stenosis caused by endotracheal intubation [eight patients or tracheostomy [five patients ; and five patients caused by a variety of neoplastic lesions [four primary and one secondary . The length of tracheal stenosis were various from 1.5cm to 5.5cm and site of tracheal stenosis were cervical[17patients and thoracic [one patient . Operative techniques were tracheal resection and primary anastomosis[18 patients and additional procedures were cricoid cartilage reconstruction with costal cartilage [one patient , primary repair of esophagus[one patient and suprahyoid laryngeal release technique[eight patients without any complications. We have eight complications; tracheal restenosis were developed in five patients[growth of grannulation tissue at anastomotic site in three patients, delayed restenosis in two patients , anastomotic disruption in one patient, hoarseness and pneumonia in each of two patients. We managed tracheal complications with T-tube insertion in two patients, permanent tracheostomy in three patients and insertion of Gianturco tracheal stent in one patient, but tracheal stent did not reveal good result because it caused persistent production of sputum. We concluded that it is necessary to access full length of normal trachea including suprahyoid laryngeal release technique to avoid anastomotic tension in tracheal surgery and develope new ideal techniques to manage postoperative tracheal complications, because we suppose tracheal complications are developed due to anastomotic tension.

• Journal of Chest Surgery
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• v.43 no.5
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• pp.546-549
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• 2010

A 70-year-old man was transferred to our center due to severe epigastric and back pain with the impression of a ruptured thoracic aortic aneurysm. Six months previously, he had undergone insertion of stent graft into the descending thoracic aorta at another hospital. The findings of the computed tomographic scan suggested a rapidly growing malignant mediastinal tumor rather than a ruptured aneurysm. Exploratory thoracotomy confirmed the diagnosis and the tumor was resected along with the portion of the aorta contained in it. This exemplary case should raise the concern against overzealous application of endovascular aortic repair.

• Journal of Chest Surgery
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• v.43 no.3
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• pp.292-295
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• 2010

The surgical treatments for aortic arch aneurysm are thought to be very invasive procedures, and high morbidity and mortality rates have been reported after aortic arch aneurysm operations. Many surgeons currently prefer the insertion of a stent-graft rather than an operation for treating an aortic arch aneurysm and if needed, with bypass of the subclavian or carotid arteries, which is called the 'hybrid method'. We managed one patient with an aortic arch aneurysm by using the hybrid method, and so we report on this case with a review of the relevant literature.

• Journal of Periodontal and Implant Science
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• v.26 no.1
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• pp.244-254
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• 1996

The periodontal probe is a commonly used instrument to assess periodontal conditions. And so, there has been many studies to develop the accuracy and reproducibility of the periodontal probe. The purpose of this study was to compare two different periodontal probes for measurement reliability and time required to use in subjects with moderate periodontitis. It was done after evaluating reproducibility of probing depth by stent guiding for a Manual probe and a Florida probe in subjects with healthy periodontal condition. The results were as follows 1. In experiment to evaluate the reproducibility of probing depth by stent guiding for a Manual probe and Florida probe in subjects with healthy periodontal condition, there was no major significant difference between intraprobe and interprobe relationships. 2. There were reduced probing measuremint error by using the Florida probe for posterior teeth and by using the Manual probe for anterior teeth of subjects with moderate periodontitis. 3. At proximal area, there was higher measurement error by using the Manual probe than the Florida probe. 4. The mean of pocket depth measurement using Manual probe was signifi cantly higher than that using Florida probe(p<0.05). With increasing pocket depth, interprobe difference increased and reproducibility reduced. 5. There was no significant difference in time required to use between Manual probe and Florida probe(p<0.05). 6. There was slight probing measurement difference between Manual probe and Florida probe at different site, but both probes have similar degrees of reproducibility and similar time required to probe.

• Journal of Korean Neurosurgical Society
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• v.60 no.2
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• pp.262-268
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• 2017

Objective : Stents are widely used in coil embolization of intracranial aneurysms, but on occasion, a microcatheter must traverse a stented segment of artery (so-called trans-cell technique) to select an aneurysm, or double stenting may necessary. In such situations, microguidewire passage and microcatheter delivery through a tortuous stented parent artery may pose a technical challenge. Described herein is a microguidewire looping technique to facilitate endovascular navigation in these circumstances. Methods : To apply this technique, the microguidewire tip is looped before entering the stented parent artery and then advanced distally past the stented segment, with the loop intact. Rounding of the tip prevents interference from stent struts during passage. A microcatheter is subsequently passed into the stented artery for positioning near the neck of aneurysm, with microguidewire assistance. The aneurysm is then selected, steering the microcatheter tip (via inner microguidewire) into the dome. Results : This technique proved successful during coil embolization of nine saccular intracranial aneurysms (internal carotid artery [ICA], 6; middle cerebral artery, 2; basilar tip, 1), performing eight trans-cell deliveries and one additional stenting. Selective endovascular embolization was enabled in all patients, resulting in excellent clinical and radiologic outcomes, with no morbidity or mortality directly attributable to microguidewire looping. Conclusion : Microguidewire looping is a reasonable alternative if passage through a stented artery is not feasible by traditional means, especially at paraclinoid ICA sites.

• Journal of Korean Neurosurgical Society
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• v.59 no.5
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• pp.449-457
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• 2016

Objective : Subarachnoid hemorrhage (SAH) caused by rupture of an internal carotid artery (ICA) or vertebral artery (VA) dissecting aneuryesm is rare. Various treatment strategies have been used for ruptured intracranial dissections. The purpose of this study is to compare the clinical and angiographic characteristics and outcomes of endovascular treatment for ruptured dissecting aneurysms of the intracranial ICA and VA. Methods : The authors retrospectively reviewed a series of patients with SAH caused by ruptured intracranial ICA and VA dissecting aneurysms from March 2009 to April 2014. The relevant demographic and angiographic data were collected, categorized and analyzed with respect to the outcome. Results : Fifteen patients were identified (6 ICAs and 9 VAs). The percentage of patients showing unfavorable initial clinical condition and a history of hypertension was higher in the VA group. The initial aneurysm detection rate and the percentage of fusiform aneurysms were higher in the VA group. In the ICA group, all patients were treated with double stent-assisted coiling, and showed favorable outcomes. In the VA group, 2 patients were treated with double stent-assisted coiling and 7 with endovascular trapping. Two patients died and 1 patient developed severe disability. Conclusion : Clinically, grave initial clinical condition and hypertension were more frequent in the VA group. Angiographically, bleb-like aneurysms were more frequent in the ICA group and fusiform aneurysms were more frequent in the VA group. Endovascular treatment of these aneurysms is feasible and the result is acceptable in most instances.

• Journal of Chest Surgery
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• v.32 no.1
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• pp.75-79
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• 1999

Budd-Chiari syndrome is a state of hepatic failure caused by impairment of blood flow anywhere from the inferior vena cava to the right atrium. In this case, a 45 year old patient had undergone membranotomy and dilatation with autogenous pericardial graft due to obstruction of the inferior vena cava caused by a congenital membrane in 1987. Ten years after the operation, restenosis occurred. Although a noninvasive method with a Gianturco stent dilatation was performed, a satisfactory result was not obtained. A reoperation was performed. The stenotic segment of inferior vena cava was excised and after augmentation with a prepared pentagon shaped Gore-Tex artificial graft allowing passage of two fingers. The patient's postoperative course was uneventful without signs of rebleeding or any other complications and the patient was discharged at postoperative two weeks without the use of anticoagulants. An excellent result was obtainable after operation using a prepared Gore-Tex graft and such a result. Reoperational case of Budd-Chiari syndrome may require rapid and excellent the operative techenic by prevention of massive bleeding under use of extracorporeal circulation.

• Journal of Chest Surgery
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• v.44 no.2
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• pp.148-153
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• 2011

Background: The number of cases employing thoracic endovascular aortic repair (TEVAR) has been increasing due to lower morbidity and mortality compared to open repair technique. The aim of this study is to evaluate the outcome of TEVAR for thoracic aortic diseases. Materials and Methods: Sixteen patients underwent TEVAR from October 2003 to April 2010. Mean age at operation was 59 years (20~78 years), and 11 were male. Indications for TEVAR were large aortic diameter (>5.5 cm) upon presentation in 6 patients, increasing aortic diameter during the follow-up period in 4, traumatic aortic rupture in 3, persistent chest pain in 2, and ruptured aortic aneurysm in one. The mean diameter, length and the number of the stents were 33 mm (26~40 mm), 12 cm (9.5~16.0 cm), and 1.25 (1~2), respectively. Aortography employing Multi-detector computerized tomography (MDCT) technique was performed at one week, and patients were followed up in the out-patient department at one month, 6 months, and one year postoperatively. Results: Primary technical success showing complete exclusion of the aneurysm was achieved in 15 patients. One patient showed a small endo-leak (type 1). Four patients developed perioperative stroke: Three recovered without sequelae, and one showed mild right-side weakness. There was no operative mortality. Diameter of the thoracic aorta covered by stent graft changed within 10% range in 12 patients, decreased by more than 10% in 3, and increased by more than 10% in one during mean follow-up duration of 18 months (1~73 months). There was no recurrence-related death during this period. Conclusion: Intermediate-term outcome after TEVAR was encouraging. Indications for TEVAR could be extended for other thoracic aortic diseases.