• Title/Summary/Keyword: noninvasive approach

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Endoscopic Intervention for Anastomotic Leakage After Gastrectomy

  • Ji Yoon Kim;Hyunsoo Chung
    • Journal of Gastric Cancer
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    • v.24 no.1
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    • pp.108-121
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    • 2024
  • Anastomotic leaks and fistulas are significant complications of gastric surgery that potentially lead to increased postoperative morbidity and mortality. Surgical intervention is reserved for cases with severe symptoms or hemodynamic instability; however, surgery carries a higher risk of complications. With advancements in endoscopic treatment options, endoscopic approaches have emerged as the primary choice for managing these complications. Endoscopic clipping is a traditional method comprising 2 main categories: through-the-scope clips and over-the-scope clips. Through-the-scope clips are user friendly and adaptable to various clinical scenarios, whereas over-the-scope clips can close larger defects. Another promising approach is endoscopic stent insertion, which has shown a high success rate for leak closure, although vigilant monitoring is required to monitor stent migration. Infection control is essential in post-surgical leakage cases, and endoscopic internal drainage provides a relatively safe and noninvasive means to manage fluids, contributing to infection control and wound healing promotion. Endoscopic suturing offers full-thickness wound closure, but requires additional training and endoscopic versatility. As a promising tool, endoscopic vacuum therapy potentially surpasses stent therapy by draining inflammatory materials and closing defects. Furthermore, the use of tissue sealants, such as fibrin glue and cyanoacrylate, has been reported to be effective in selected situations. The choice of endoscopic device should be tailored to individual cases and specific patient conditions, with careful consideration of the nature of the defect. Further extensive studies involving larger patient populations are required to provide more robust evidence on the efficacy of endoscopic approach in managing post-gastric anastomotic leaks.

A noninvasive esthetic treatment of isolated microdontia using new high-translucent cubic-phase zirconia (5Y-PSZ) laminate veneers: A case report (고투명도 입방정상 지르코니아(5Y-PSZ) 라미네이트를 이용한 왜소치의 비침습적 심미 수복 증례)

  • Ahn, Min-Zin;Ahn, Do-Gwan;Pyo, Se-Wook;Kim, Hee-Kyung
    • The Journal of Korean Academy of Prosthodontics
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    • v.57 no.3
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    • pp.263-270
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    • 2019
  • Current trends in restorative dentistry focus on improving the esthetics and keeping the sound dental tissues as long as possible. The aims of this case report were to describe the successful outcome of cubic-phase zirconia laminate veneers for a patient with isolated microdontia by using a digital workflow, and to describe their clinical implications. A 15-year-old female who had isolated microdontia in combination with spacing visited Ajou University Dental Hospital for esthetic treatment. In this case, 6 maxillary anterior teeth were restored with cubic-phase zirconia laminate veneers without tooth structure removal by using a digital impression, computer-aided design (CAD) software, and computer-aided manufacturing (CAM) procedures. At 6-month follow-up, no distinct mechanical and biological complications were detected and the prostheses exhibited satisfactory esthetics and functions. Due to its favorable tissue responses and enhanced translucency, cubic-phase zirconia can be a suitable strategy for a noninvasive esthetic approach.

Intracranial Magnetic Resonance Angiography-Its Role in the Approach to Ischemic Stroke (허혈성 뇌혈관질환에서 자기공명혈관조영술의 가치에 대한 임상연구)

  • Lim, Dong-Jun;Cho, Tae-Hyoung;Chung, Yong-Gu;Kim, Baek-Hyun;Kim, Keun-Hoe;Kim, Se-Hoon;Kwon, Taek-Hyun;Chung, Heung-Seob;Park, Jung-Yul;Park, Youn-Kwan;Lee, Hoon-Kap;Lee, Ki-Chan;Suh, Jung-Keun
    • Journal of Korean Neurosurgical Society
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    • v.29 no.8
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    • pp.1063-1068
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    • 2000
  • Objectives : To determine the contribution of cranial magnetic resonance angiography(MRA) for the evaluation of patients with ischemic cerebrovascular accident. Methods : Magnetic resonance image(MRI) and MRA studies performed on 34 patients with ischemic stroke were retrospectively reviewed with the clinical records. Results : There were 9 transient ischemic attacks and 25 completed strokes in our series. Twenty-three of 34 MRA examinations(68%) were positive for stenosis or occlusion. The distribution of stenotic or occlusive vascular lesions were correlated with the location of infarction in 22 of the 23 positive cases(96%). MRA provided additional information not obtained from the MRI in 19 cases(56%). Conclusions : Vascular lesions demonstrated on intracranial MRA show a high correlation with infarct distribution. MRA provided information adjunctive to conventional MRI in a majority of cases. We conclude that MRA is an important noninvasive component of the complete evaluation of ischemic stroke.

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Simulation and Experimental Studies of Real-Time Motion Compensation Using an Articulated Robotic Manipulator System

  • Lee, Minsik;Cho, Min-Seok;Lee, Hoyeon;Chung, Hyekyun;Cho, Byungchul
    • Progress in Medical Physics
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    • v.28 no.4
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    • pp.171-180
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    • 2017
  • The purpose of this study is to install a system that compensated for the respiration motion using an articulated robotic manipulator couch which enables a wide range of motions that a Stewart platform cannot provide and to evaluate the performance of various prediction algorithms including proposed algorithm. For that purpose, we built a miniature couch tracking system comprising an articulated robotic manipulator, 3D optical tracking system, a phantom that mimicked respiratory motion, and control software. We performed simulations and experiments using respiratory data of 12 patients to investigate the feasibility of the system and various prediction algorithms, namely linear extrapolation (LE) and double exponential smoothing (ES2) with averaging methods. We confirmed that prediction algorithms worked well during simulation and experiment, with the ES2-averaging algorithm showing the best results. The simulation study showed 43% average and 49% maximum improvement ratios with the ES2-averaging algorithm, and the experimental study with the $QUASAR^{TM}$ phantom showed 51% average and 56% maximum improvement ratios with this algorithm. Our results suggest that the articulated robotic manipulator couch system with the ES2-averaging prediction algorithm can be widely used in the field of radiation therapy, providing a highly efficient and utilizable technology that can enhance the therapeutic effect and improve safety through a noninvasive approach.

A case of spinal muscular atrophy typeⅡ (제 2 형 척수근위축증(SMA type II; Spinal muscular atrophy typeⅡ) 환아 1례에 대한 증례보고)

  • Jo Hyeong-Jun;Lee Jin-Yong;Kim Deok-Gon
    • The Journal of Pediatrics of Korean Medicine
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    • v.14 no.1
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    • pp.197-204
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    • 2000
  • Neuromuscular disorders are common causes of weakness and hypotonia in the infantile period and in childhood. Accurate diagnosis of specific neuromuscular disorders depends first on identification of which aspect of the peripheral neuromuscular system is affected-the motor neuron in the spinal cord, the nerve root or peripheral nerve, the neuromuscular junction, or the muscle-and then on the determination of the etiology and specific clinical entity. Spinal muscular atrophy(SMA) is the most common autosomal-recessive genetic disorder lethal to infants. The three major childhood-onset forms of SMA are now usually called type I, type II and typeⅢ. Progression of the disease is due to loss of anterior horn cells, thought to be caused by apoptosis. Diagnosis is based on the course of the illness, as well as certain changes seen on nerve and muscle biopsy and electrodiagnostic studies. More recently, our understanding of the genetics of this disorder has provided a noninvasive approach to diagnosis. We report on a 3-year-old male patient with spinal muscular atrophy type II. He had progressive muscular weakness since 18 months of age. The upper arms were slightly, and the thighs moderately atrophic. There was muscle weakness of both the upper and lower limbs, being more proximal in distribution. Electromyogram revealed a neurogenic pattern.

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Three-step PCR and RFLP Genotyping of the Swine Ryanodine Receptor Gene Using Aged Single Hair Follicles Delivered by General Mail

  • Kim, Y.;Woo, S.C.;Song, G.C.;Park, H.Y.;Im, B.S.;Kim, G.W.
    • Asian-Australasian Journal of Animal Sciences
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    • v.15 no.9
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    • pp.1237-1243
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    • 2002
  • We have developed a reliable and noninvasive method for swine genotyping of single locus nuclear gene with aged single hair follicles delivered by general mail. The method is based on booster and nested PCR amplification with step-wise increase of primers and dNTPs concentrations followed by restriction endonuclease digestion. To establish this method, the ryanodine receptor (RYR 1) locus which is an economically important trait in swine industry was employed for genotyping experiment. The 3-step PCR amplication method is much less dependent on the quantity and quality of template DNA and produces enough amplification product for the detection on the ethidium bromide-stained gel such as RFLP analysis. A total of 120 pigs were subjected to the RYR 1 genotyping analysis using three-step PCR method which amplified enough quantity of PCR products from the aged single hair follicles for RFLP analysis and genotyping results were identical to the results of the corresponding ethanol-fixed skeletal muscle tissue. This approach will be a great help for porcine breeders and investigators in genotyping of swine. They can receive genotyping results later by simply plucking single hairs of their pigs at farm and sending them in general mail to the diagnostic laboratory which eliminates the inconveniences to collect ear tissue or blood cells from pigs, or the investigator's need for travel to farms in order to collect fresh hair samples.

The Value of Preoperative Multidetector Computed Tomography for Deep Inferior Epigastric Artery Perforator Free Flap (심하복벽동맥 천공지 유리피판에서 술전 MDCT의 유용성)

  • Heo, Chan Yeong;Hong, Ki Yong;Yoon, Chang Jin;Eun, Seok Chan;Baek, Rong Min;Minn, Kyung Won
    • Archives of Plastic Surgery
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    • v.36 no.2
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    • pp.140-146
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    • 2009
  • Purpose: Autologous breast reconstruction with abdominal tissue is one of the best options after mastectomy. In a free transverse rectus abdominis myocutaneous(TRAM) or deep inferior epigastric artery perforator(DIEP) flap, a preoperative evaluation of the precise location of perforating vessels and vascular run - off systems is required. The objective of this report is to demonstrate the usefulness of multidetector computed tomography(MDCT) in the preoperative planning of patients undergoing breast reconstruction with abdominal flap. Methods: From June 2006 to January 2008, 28 patients underwent MDCT evaluation before breast reconstruction. All subjects were females with an age range of 30 to 55 years. The CT scan was performed using a 64 - slice MDCT scanner(Brilliance 64; Philips Medical Systems, Best, Netherlands). Results: One perforator or two major perforators were marked on image in good relation with a hand - held Doppler examination and intraoperative findings. All vascular run - off systems were cleared before operation. Conclusion: Preoperative evaluation of perforator arteries with MDCT angiography is beneficial in patients undergoing breast reconstruction. This technique provides a noninvasive approach of the vascular anatomy of the entire anterior abdominal wall.

Detecting Malignant Urothelial Cells by Morphometric Analysis of $ThinPrep^{(R)}$ Liquid-based Urine Cytology Specimens (형태 계측학적 분석과 $ThinPrep^{(R)}$ 액상 소변세포검사를 이용한 악성 요로상피 세포 검출)

  • Shin, Bong-Kyung;Lee, Young-Suk;Jeong, Hoi-Seon;Lee, Sang-Ho;Kim, Hyun-Chul;Kim, A-Ree;Kim, In-Sun;Kim, Han-Kyeom
    • The Korean Journal of Cytopathology
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    • v.19 no.2
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    • pp.136-143
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    • 2008
  • Urothelial carcinoma accounts for 90% of all the cases of bladder cancer. Although many cases can be easily managed by local excision, urothelial carcinoma rather frequently recurs, tends to progress to muscle invasion, and requires regular follow-ups. Urine cytology is a main approach for the follow-up of bladder tumors. It is noninvasive, but it has low sensitivity of around 50% with using the conventional cytospin preparation. Liquid-based cytology (LBC) has been developed as a replacement for the conventional technique. We compared the cytomorphometric parameters of $ThinPrep^{(R)}$ and cytospin preparation urine cytology to see whether there are definite differences between the two methods and which technique allows malignant cells to be more effectively discriminated from benign cells. The nuclear-to-cytoplasmic ratio value, as measured by digital image analysis, was efficient for differentiating malignant and benign urothelial cells, and this was irrespective of the preparation method and the tumor grade. Neither the $ThinPrep^{(R)}$ nor the conventional preparation cytology was definitely superior for distinguishing malignant cells from benign cells by cytomorphometric analysis of the adequately preserved cells. However, the $ThinPrep^{(R)}$ preparation showed significant advantages when considering the better preservation and cellularity with a clear background.

Comparison of Output and Radiation Quality of X-rays according to the Full-Wave Rectification Method and Dual-Voltage Rectification Method of an X-ray Generator (X선 고전압장치의 전파 및 배전압 정류방식에 따른 X선 출력 및 선질 비교)

  • Kim, Tae-Gon;Cheon, Min-Woo;Park, Yong-Pil
    • Journal of the Korean Institute of Electrical and Electronic Material Engineers
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    • v.23 no.7
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    • pp.534-538
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    • 2010
  • X-ray systems for medical treatment use noninvasive procedures. Being capable of locally inspecting the inside of the body, X-ray systems are routinely used for basic diagnosis. X-ray systems to be used for medical purposes were originally made with a gas filled tube inside an induction coil in the initial stages of development but with this approach it becomes difficult to take a satisfactory picture through thick body sections, non invasively. However continued development made it possible to take non-invasive pictures of breasts, blood vessels and other body parts through thick body sections. Recently, high-voltage X-ray generators of more compact size, increased generation efficiency, and sophisticated output control have become possible. All of these features are made possible by the use of a high-frequency output from an inverter and a fast switching semiconductor device. In this paper, we describe a new X-ray generator operating with a resonant inverter in order to reduce switching loss and high frequency noise. In addition, in order to identify the differences amongst types of rectification, we have compared output and the quality of X-ray pictures obtained with full-wave rectification and dual-voltage rectification methods.

Radionuclide Angiocardiographic Evaluation of Left-to-Right Cardiac Shunts: Analysis of Time-Activity Curves (핵의학적 심혈관 촬영술에 의한 좌우 심단락의 진단 : 시간-방사능 곡선의 분석)

  • Kim, Ok-Hwa;Bahk, Yong-Whee;Kim, Chi-Kyung
    • The Korean Journal of Nuclear Medicine
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    • v.21 no.2
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    • pp.155-165
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    • 1987
  • The noninvasive nature of the radionuclide angiocardiography provided a useful approach for the evaluation of left-to-right cardiac shunts (LRCS). While the qualitative information can be obtained by inspection of serial radionuclide angiocardiograms, the quantitative information of radionuclide angiocardiography can be obtained by the analysis-of time-activity curves using advanced computer system. The count ratios method and pulmonary-to-systemic flow ratio (QP/QS) by gamma variate fit method were used to evaluate the accuracy of detection and localization of LRCS. One hundred and ten time-activity curves were analyzed. There were 46 LRCS (atrial septal defects 11, ventricular septal defects 22, patent ductus arteriosus 13) and 64 normal subjects. By computer analysis of time-activity curves of the right atrium, ventricle and the lungs separately, the count ratios modified by adding the mean cardiac transit time were calculated in each anatomic site. In normal subjects the mean count ratios in the right atrium, ventricle and lungs were 0.24 on average. In atrial septal defects, the count ratios were high in the right atrium, ventricle and lungs, whereas in ventricular septal defects the count ratios were higher only in the right ventricle and lungs. Patent ductus arteriosus showed normal count ratios in the heart but high count ratios were obtained in the lungs. Thus, this count ratios method could be separated normal from those with intra cardiac or extracardiac shunts, and moreover, with this method the localization of the shunt level was possible in LRCS. Another method that could differentiate the intracardiac shunts from extracardiac shunts was measuring QP/QS in the left and right lungs. In patent ductus arteriosus, the left lung QP/QS was higher than those of the right lung, whereas in atrial septal defects and ventricular septal defects QP/QS ratios were equal in both lungs. From this study, it was found that by measuring QP/QS separately in the lungs, intracardiac shunt could be differenciated from extracardiac shunts.

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