• Journal of Chest Surgery
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• 제42권4호
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• pp.487-491
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• 2009

배경: 인조혈관 동정맥루 폐쇄의 구조요법으로는 수술적 방법과 중재적 혈관내 치료법을 사용할 수 있다. 인조혈관 동정맥루를 재개통 시키는데 이 두가지 방법의 효율성을 후향적으로 분석하였다. 대상 및 방법: 2006년 1월부터 2007년 12월까지 수술적 혈전제거술 및 재건술(그룹 A)또는 경피적 혈전제거술 및 혈관성형술(그룹 B)을 시행받은 41명의 환자를 대상으로 환자의 임상적 특성, 협착부의 위치, 시술 후 일차 개통률을 비교하였다. 결과: 총 41명의 환자 중, 21명의 환자는 수술적 혈전제거술 및 재건술을 받았으며, 20명의 환자는 경피적 혈전제거술 및 혈관성형 술을 받았다. 두 군간에 환자의 임상적 특성은 차이가 없었다. 두 군 모두에서 정맥 문합부 협착이 인조혈관 동정맥루 폐쇄의 가장 흔한 원인이었다. 시술 후 일차 개통률은 6개월 누적 개통률이 그룹 A 90.5%, 그룹 B 55%였으며, 1년 누적 개통률은 그룹 A 38.1%, 그룹 B 20.0%로 그룹 A가 통계적으로 의미 있게 높은 개통률을 보였다(p=0.034). 결론: 본 연구에서는 조기에 적절한 수술적 재건술을 시행함으로써 인조혈관 동정맥루의 구제가 가능하였고 비교적 우수한 개통률을 얻을 수 있었다. 인조혈관 동정맥루의 폐쇄가 발생하였을 경우 일차적인 치료방법으로서 수술적 재건술은 효과적인 방법이라고 생각된다.

• Investigative Magnetic Resonance Imaging
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• 제18권4호
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• pp.290-302
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• 2014

목적: 자화율 강조 자기공명영상 (Susceptibility-weighted imaging)은 혈액분해산물, 석회화, 철 침착물을 발견하는데 있어 높은 민감도를 보이는 3D spoiled gradient-echo pulse sequence 이다. 본 임상화보는 자화율 강조 자기공명영상의 주된 임상적 적용에 대해 설명하고 논의하는 데에 그 목적이 있다. 대상과 방법: 자화율 강조 자기공명영상은 자기강도영상 (magnitude image)과 위상영상 (phase image)을 이용한 고해상도, 3D fully velocity-compensated gradient-echo sequence 에 기초를 두고 있다. 정맥 구조물의 가시성을 향상시키기 위해, 자기강도영상은 여과된 위상 데이터 (phase data) 로부터 발생된 위상 마스크 (phase mask)를 이용해 증폭되고, 이것은 최소강도투사 (Minimal intensive projection) 알고리즘을 이용한 3D dataset 후처리 과정을 거치게 된다. 3T 자기공명기기에서 SWI를 포함하는 자기공명영상 검사를 시행한 총 200명의 환자를 대상으로 연구하였다. 결과: 자화율 강조 자기공명영상은 다양한 뇌 질환의 발견에 매우 유용하였다. 200명의 환자 중 80명은 선천성 정맥 기형, 22명은 해면상 혈관종, 12명은 다양한 질환에서의 석회화, 21명은 혈관자화 징후 (susceptibility vessel sign) 또는 미세출혈을 동반하는 뇌혈관 질환, 52명은 뇌종양, 2명은 미만성 축삭 손상, 3명은 동정맥 기형, 5명은 뇌경막 동정맥루, 1명은 모야모야병, 그리고 2명은 파킨슨병이 관찰되었다. 결론: 자화율 강조 자기공명영상은 미세 저혈량 혈관성 병변, 석회화 그리고 미세출혈과 다양한 뇌병변의 진단에 유용하다.

• 대한간호학회지
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• 제45권2호
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• pp.271-279
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• 2015

Purpose: This study was done to examine the relation of uncertainty, uncertainty appraisal, and self-management in patients undergoing hemodialysis, and to identify factors influencing self-management. Methods: A convenience sample of 92 patients receiving hemodialysis was selected. Data were collected using a structured questionnaire and medical records. The collected data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlations and multiple regression analysis with the SPSS/WIN 20.0 program. Results: The participants showed a moderate level of uncertainty with the highest score being for ambiguity among the four uncertainty subdomains. Scores for uncertainty danger or opportunity appraisals were under the mid points. The participants were found to perform a high level of self-management such as diet control, management of arteriovenous fistula, exercise, medication, physical management, measurements of body weight and blood pressure, and social activity. The self-management of participants undergoing hemodialysis showed a significant relationship with uncertainty and uncertainty appraisal. The significant factors influencing self-management were uncertainty, uncertainty opportunity appraisal, hemodialysis duration, and having a spouse. These variables explained 32.8% of the variance in self-management. Conclusion: The results suggest that intervention programs to reduce the level of uncertainty and to increase the level of uncertainty opportunity appraisal among patients would improve the self-management of hemodialysis patients.

• Journal of Korean Biological Nursing Science
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• 제15권3호
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• pp.122-132
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• 2013

Purpose: The purpose of this study was to evaluate the effect of periodic video education on knowledge about hemodialysis, patient role behavior and the physiologic index in patients with hemodialysis. Methods: One-group pretest-posttest design was applied. A total of 50 patients with hemodialysis at a university hospital hemodialysis unit in Daegu participated. Periodic video education about kidney function, diet, arteriovenous fistula management, medication, and exercise was administered to them for 12 weeks at intervals of 2 weeks. Before and after the education, the participants completed the self-administered questionnaires of knowledge about hemodialysis and patient role behavior and the measures of serum potassium and phosphorus concentration, weight gain between hemodialysis sessions, and adequacy of dialysis (Kt/V). Statistical analysis was performed using paired t-test. Results: Knowledge about hemodialysis and patient role behavior were significantly different between before and after education (p<.01). For the physiologic index, serum potassium concentration and weight gain between hemodialysis sessions were not significantly different but the serum phosphorus concentration and Kt/V were significantly different between before and after education (p<.05). Conclusion: The results suggest that the periodic video education for patients with hemodialysis contributed to the change and improvement in knowledge about hemodialysis, patient role behavior, and the physiologic index.

• 대한추나의학회지
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• 제5권1호
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• pp.213-222
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• 2004

Objectives : To investigate contributing degree of other factors except pelvic tilting to F.L.L.D by analizing with Gonstead technique on the correlation between femur head height discrepancy on the standing pelvic AP view and F.L.L.D caused by pelvic tilting. Method : We analysed standing pelvis AP X-ray of 70 patients who had visited at the department acupunture and moxibustion in Conmaul oriental medical hospital, during May, 1st, 2004 - July, 30th, 2004, with low back pain or lower extremity pain. We excluded the person with any past history of polio, genetic defect, malunited fracture, growth plate injury, infection and overgrowth attributable to hemangioma, or arteriovenous fistula. Results & Conclusion : The functional leg length discrepancy caused by pelvic tilting and femur head height difference had no statistical difference(p=0.132) but poorly correlated(Pearson ${\nu}=0.05$). In the 94.28% of subjects, the femur head height difference wasn't in accord with F.L.L.D. caused by pelvic tilting. In 47.14% of subjects were expected to have over $3^{mm}$ of leg length discrepancy after pelvic adjustment. The mean of measurement difference between two methods was $3.76{\pm}3.12^{mm}$ and the range was $0{\sim}11.4^{mm}$. Consequently, we must consider not only functional leg length discrepancy caused by pelvic tilting but also anatomical leg length discrepancy, misalignment of ankle, knee or hip joint etc.

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

• 한국산학기술학회논문지
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• 제19권6호
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• pp.275-279
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• 2018

뇌농양은 심각한 신경학적 후유증을 일으킬 수 있는 중추신경계 감염이다. 신경집중치료 발달에도 불구하고, 여전히 뇌농양은 특정 위험 환자에게 높은 사망률을 보이고 있다. 특히 세균성 뇌농양은 즉각 진단 및 적절한 항생제 치료가 필요한 응급 상황이다. 또한 드물게 뇌농양이 재발되는 경우도 있다. 본 연구에서는 두통으로 내원한 59세 남자환자를 대상으로 증례보고를 통해 동일 분야 연구에 활용하고자 자료분석을 하였다. 59세 남자가 두통을 주소로 내원하였고, 연속적으로 시행한 뇌자기공명영상과 뇌척수액 검사에서 우측 전두엽에 뇌농양을 확인하였고, 항생제 치료 및 수술적 치료 후 완치하였다. 퇴원 후 5개월 뒤 두통 및 경기 증상 있어 다시 촬영한 뇌자기공명영상에서 뇌농양의 재발이 확인되었다. 뇌농양 재발은 특정 조건, 즉, 농양 부위에 이물질이 남아 있거나 만성 부비동염, 동정맥루, 좌우션트 등이 있을 때 생길 수 있다.

• Journal of Chest Surgery
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• 제40권3호
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• pp.228-231
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• 2007

흉부 외상은 단순 부정맥에서 심근 파열 등 심장에 다양한 합병증을 일으킬 수 있다. 그중 관상동맥 손상은 매우 드문 합병증이고 특히 좌측 관상 동맥의 동맥류는 우측에 비해서 발생빈도가 작은 것으로 되어있다. 흉부 둔상 후 관상 동맥 내벽의 동맥류 형성, 박리, 열상, 동정맥루 및 혈전 등이 매우 드물게 생길 수 있으며, 혈관이 막히고 심근 경색이 발생하면 환자에게 치명적인 손상을 일으킨다. 교통사고로 인한 흉부의 둔상 후 발생한 심근경색증을 진단받은 33세 남자에서 관상동맥 우회로술을 통해 좋은 결과를 얻었기에 보고하는 바이다.

• Journal of Trauma and Injury
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• 제21권2호
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• pp.128-135
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• 2008

Purpose: As the care of surgical patients becomes increasingly complex and catheter-based techniques are more frequently applied, the pattern of iatrogenic vascular injuries may be increasing. Major vascular injuries can jeopardize a patient's life or limb survival. The purpose of this study was to examine the current etiology and prognosis for iatrogenic vascular injuries. Methods: We reviewed medical records of 29 cases of iatrogenic vascular injury that were treated Seoul National University Bundang Hospital between October 2003 and October 2008. We studied clinical variables including demographics, cause of injury, clinical presentations, management and prognosis. Results: The mean age was 60.8 years (range: 25-86), and the male to female ratio was 1.9 : 1. The causes of injuries were operation related complication in 18 cases (62.1%), endovascular intervention and diagnostic angiography in 11 cases (37.9%). The types of vascular injury were partial severance in 14 cases, pseudoaneurysm in 8, arteriovenous fistula (AVF) in 3, thrombosis in 2, complete severance in 2. Especially, device related complication including percutaneous closing device were occurred in 9 and the others came from inadvertent physician's procedure. Primary repair were done in 12 cases, end-to-end anastomosis in 5, interposition graft in 4, ligation in 2, patch angioplasty in 1, peudoaneurysm excision and arteriorrhaphy in 1, hematoma evacuation in 1, and endovascular repair in 3. There were 2 cases of mortality, one of them due to hemorrhagic shock and the other due to septic shock. Conclusion: Proper selection of treatment modalities should be important to have better outcome according to the type of injury as well as anatomical location. Each physician should be familiar to new device as well as patient's topographical feature. Immediate referral to vascular specialist is also essential to reduce morbidity.

• The Korean journal of internal medicine
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• 제33권6호
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• pp.1160-1168
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• 2018

Background/Aims: The Republic of Korea is a country where the hemodialysis population is growing rapidly. It is believed that the numbers of treatments related to vascular access-related complications are also increasing. This study investigated the current status of treatment and medical expenses for vascular access in Korean patients on hemodialysis. Methods: This was a descriptive observational study. We inspected the insurance claims of patients with chronic kidney disease who underwent hemodialysis between January 2008 and December 2016. We calculated descriptive statistics of the frequencies and medical expenses of procedures for vascular access. Results: The national medical expenses for access-related treatment were 7.12 billion KRW (equivalent to 6.36 million USD) in 2008, and these expenses increased to 42.12 billion KRW (equivalent to 37.67 million USD) in 2016. The population of hemodialysis patients, the annual frequency of access-related procedures, and the total medical cost for access-related procedures increased by 1.6-, 2.6-, and 5.9-fold, respectively, over the past 9 years. The frequency and costs of access care increased as the number of patients on hemodialysis increased. The increase in vascular access-related costs has largely been driven by increased numbers of percutaneous angioplasty. Conclusions: The increasing proportion of medical costs for percutaneous angioplasty represents a challenge in the management of end-stage renal disease in Korea. It is essential to identify the clinical and physiological aspects as well as anatomical abnormalities before planning angioplasty. A timely surgical correction could be a viable option to control the rapid growth of access-related medical expenses.