• 방사선산업학회지
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• 제12권4호
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• pp.325-332
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• 2018

Carotid angiography covering the aortic arch includes contrast-enhanced magnetic resonance angiography (CEA), which is applied to a large region and usually employs contrast media. However, the use of contrast media can be dangerous in infants, pregnant women, and patients with chronic renal failure (CRF). Follow-up patients informed of a lesion may also want to avoid constant exposure to contrast media. We aimed to apply time-of-flight (TOF) angiography to a large region and compare its usefulness with that of CEA. Ten patients (mean age, 58 years; range, 45~75 years) who visited our hospital for magnetic resonance angiography (MRA) participated in this study. A 3.0 Tesla Achieva magnetic resonance imaging (MRI) system (Philips, Netherland) and the SENSE NeuroVascular 16-channel coil were employed for both methods. Both methods were applied simultaneously to the same patient. Three TOF stacks were connected to cover the aortic arch through the circle of Willis, and CEA was applied in the same manner. For the quantitative assessment, the acquired images were used to set the regions of interest (ROIs) in the common carotid artery (CCA) bifurcation, internal carotid artery, external carotid artery, middle cerebral artery, and vertebral artery, and to obtain the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR) for the soft tissues. Three radiologists and one radiological resident performed the qualitative assessment on a 5-point scale - 1 point, "very bad"; 2 points, "bad"; 3 points, "average"; 4 points, "good"; and 5 points, "very good" - with regard to 4 items: (1) sharpness, (2) distortion, (3) vein contamination, and (4) expression of peripheral vessels. For the quantitative assessment, we estimated the mean SNR and CNR in each of the 5 ROIs. In general, the mean SNR was higher in TOF angiography (166.1, 205.2, 154.39, 172.23, and 161.95) than in CEA(92.05, 95.43, 84.76, 73.69, and 88.3). Both methods had a similar mean CNR: 67.62, 106.71, 55.9, 73.74, and 63.46 for TOF angiography, and 67.82, 71.19, 60.52, 49.45, and 64.07 for CEA. In all ROIs, the mean SNR was statistically significant (p<0.05), whereas the mean CNR was insignificant (p>0.05). The mean values of TOF angiography and CEA for each item in the qualitative assessment were 4.2 and 4.28, respectively for item 1; 2.93 and 4.55, respectively, for item 2; 4.6 and 3.13, respectively, for item 3; and 2.88 and 4.65, respectively, for item 4. Therefore, TOF angiography had a higher mean for item 3, and CEA had a higher mean for items 2 and 4; there was no significant difference between the two methods for item 1. The results for item 1 were statistically insignificant (p>0.05), whereas the results for items 2~4 were statistically significant (p<0.05). Both methods have advantages and disadvantages and they complement each other. However, CEA is usually applied to a large region covering the aortic arch. Time-of-flight angiography may be useful for people such as infants, pregnant women, CRF patients, and followup patients for whom the use of contrast media can be dangerous or unnecessary, depending on the circumstance.

• Journal of Chest Surgery
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• 제15권3호
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• pp.331-337
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• 1982

Complete TGA is a common congenital cardiovacular anomaly, and without palliative or corrective surgery, the infant born with TGA rarely survives the first year of life. Hemodynamically, recirculated blood flow in the systemic and pulmonary circuit has a key role in systemic arterial oxygen saturation and the status of the pulmonary vascular bed. Recently a d-TGA with VSD and PS, in a 12 year old male patient had been tried for inversion of the ventricular flow with Rastelli operation. An intracardiac tunnel was constructed between the VSD and the aortic orifice to connect the ventricle to the aorta. The right ventricle was connected with the pulmonary circulation by anastomosis of an valved conduit between the right ventricle and the distal end of the pulmonary artery. During the postop, period, the irreversible renal failure, accompanied by metabolic acidosis and pulmonary edema, occured under relative stabilized cardiac performance state. The autopsy was done, which revealed diffuse infarcted area in both kidney and preserved intra & extracardiac graft constructed.

• Journal of Chest Surgery
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• 제17권4호
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• pp.636-643
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• 1984

For the purpose of avoiding postoperative massive pulmonary insufficiency after transannular outflow tract reconstruction in patients with tetralogy of Fallot, we have used monocusp bearing outflow patch since June 1983. Right heart catheterization and pulmonary arteriography were performed in 7 patients among the total 11 patients corrected with monocusp bearing outflow patch during postoperative 14th day to 22nd day. Particular attention was paid to the evaluation of the pulmonary valve competence, and the results were; 1.One patient died of acute renal failure secondary to low cardiac output and the operative mortality was 9.1%. 2.The average PRV/FA ratio was 0.491 and the average systolic pressure gradient between right ventricle and pulmonary artery was 17.7mmHg. The average Qp/Qs was 1.13. 3.Inspite of using monocusp bearing outflow patch, the hemodynamic and pulmonary arteriographic results were unsatisfactory in respect to pulmonary valve competence.

• Journal of Trauma and Injury
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• 제30권4호
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• pp.206-211
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• 2017

Aortic dissection caused by blunt trauma is a rare injury that can be complicated by malperfusion syndrome resulting from obstruction of branch vessels of the aorta. Here, we present a case of traumatic type B aortic dissection with right renal and small bowel ischemia, successfully managed by endovascular fenestration.

• 대한수의학회지
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• 제31권4호
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• pp.389-395
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• 1991

가토 적출 신동맥에 있어서 purinergic 신경 분포를 perivascular nerve stimulation을 통해서 확인하였다. 1. 가토 적출 신동맥은 perivascular nerve stimulation에 의해 수축성 반응을 나타내었다. 2. Perivascular nerve stimulation에 의한 수축현상은 자극의 크기와 자극의 빈도에 의존적이었으며, 내피세포의 유무에는 영향을 받지 않았다. 3. Perivascular nerve stimulation에 의한 수축현상은 prazosin$(1{\mu}M)$에 의해 강하게 억제되어졌으며, tetrodotoxin$(1{\mu}M)$ 또는 ${\alpha},{\beta}-methylene$ATP$(10{\mu}M)$에 의한 $P_{2x}-purinoceptor $ desensitization에 의해 완전히 수축현상이 사라졌다. 이와같은 결과는 가토 신동맥에는 purinergic신경이 분포되어 있으며, perivascular nerve stimulation에 의해 purinergic 신경전달물질이 norepinephrine과 함께 유리되어지는 것을 시사하고 있다.

• 한국임상수의학회지
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• 제29권5호
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• pp.372-376
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• 2012

급성신손상은 높은 이환율과 치사율을 나타내는 심각한 질환이며, 허혈-재관류에 의한 신손상은 급성신손상의 중요한 원인이 된다. 본 연구는 미니돼지에서 급성신손상을 진단하는데 임상적으로 유용한 바이오마커를 찾아내기 위해 실시되었다. 세 마리의 미니돼지에서 60분간 신동맥을 결찰하여 양측성 신허혈을 유도하였다. 각 미니돼지에서 결찰 전, 결찰 후 0, 1, 3, 5일에 혈액 및 뇨 검체를 채취하였다. 혈청 및 뇨 검체에서 BUN, creatinine, 나트륨 및 요산을 측정한 후 나트륨 및 요산의 분획배설율($FE_{Na}$, $FE_{UA}$)을 산출하였다. 또한 IL-6, IL-18, L-FABA 및 GST를 Western immunoblotting을 실시하여 측정하였다. 결과에서 세 마리 미니돼지 모두 혈청 BUN과 creatinine 농도는 결찰 후 1일째에 유의적으로 증가하였다. 그러나 $FE_{Na}$와 $FE_{UA}$는 현저한 개체차를 보였다. 수술 전과 후를 비교했을 때 허혈 이후의 뇨 검체에서는 IL-6, IL-18, L-FABP 및 GST의 농도가 유의적으로 증가하였다. 결론적으로, $FE_{Na}$와 $FE_{UA}$에 대해서는 추가적인 연구가 필요하다고 생각되며, 혈청 BUN, creatinine과 뇨 IL-6, IL-18, L-FABP 및 GST는 돼지의 허혈-재관류 모델에서 다른 바이오마커와 함께 급성신손상을 진단하는 민감한 바이오마커가 될 수 있을 것이라 생각된다.

• 대한약리학회지
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• 제26권1호
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• pp.25-33
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• 1990

가토의 적출동맥평활근 절편에 대한 peptide YY(PYY)의 수축작용을 관찰하고, PYY의 수축기전상 동원되는 칼슘의 기원을 조사하여 다음과 같은 결과를 얻었다. 각 동맥의 나선형 절편은 PYY의 실험조내 첨가에 의하여 농도의존적인 수축반응을 보였다. 그중 대퇴동맥이 가장 강력하고 예민한 수축경향을 보였으며, 그 다음은 대뇌의 기저동맥, 총장골동맥, 상장간막동맥, 신동맥, 총경동맥의 순으로 예민하였다. PYY에 대한 반응성을 Norepinephrine(NE)에 대한 반응성과 비교해볼때, 총경동맥과 신동맥은 PYY보다 NE에 대해서 유의하게 $(p{\leqslant}0.05)$예민하였고, 기저동맥은 NE보다 PYY에 더 예민하였다$(p{\leqslant}0.05)$. 대퇴동맥 절편에서 칼슘통로봉쇄제인 verapamil과 세포내 저장칼슘유리를 억제하는 3,4,5-Trimethoxybenzoic acid 8-(diethylamino)octyl ester ${\ulcorner}TMB-8{\lrcorner}$는 각각 PYY에 의한 수축을 억제하였는데 $(p{\leqslant}0.05)$, verapamil과 TMB-8이 동시에 존재할 때는 PYY에 의한 수축은 거의 완전히 억제되었고, ethyleneglycol-bis-(beta-aminoethyl ether), N,N,N‘,N’-tetraacetic acid${\ulcorner}EGTA{\lrcorner}$0.5mM를 첨가한 칼슘배제용액 내에서도 PYY에 의한 수축은 거의 완전히 억압되었다. 이상의 결과를 종합하면, 혈중 PYY가 증가했을 때는 교감신경계흥분시보다 강한 뇌혈관의 수축이 일어날 수 있으며, 뇌동맥압은 교감신경계 흥분시보다 더 높을 수가 있으리라 추정된다. 또 PYY에 의한 혈관 평활근 수축에는 세포외액의 칼슘과 세포내저장칼슘의 이용이 공히 필수적이라고 생각된다.

• Advances in pediatric surgery
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• 제16권2호
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• pp.154-161
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• 2010

Pulmonary sequestration (PS) is a rare congenital malformation of the lower respiratory tract. The anomaly is characterized by absence of communication with the tracheobronchial tree and isolated blood supply from an anomalous systemic vessels. With the utilization of antenatal ultrasound, the diagnosis of asymptomatic neonatal PS has increased. Treatment options include observation, arterial embolization and surgical resection. The aim of the present study is to review the clinical course of PS and to share our experience with thoracoscopic resection. A total of 96 patients with PS were treated at Asan Children's Hospital between 1999 and 2010. The diagnosis of PS was established by CT in the cases managed by observation or embolization, and by tissue pathology in the surgical cases. Medical records and radiographic images were retrospectively reviewed. Thirty-nine patients were managed by embolization and 30 patients by surgery. The remaining 27 patients have been under observation without any procedures. Among 27 observation patients, 1 patient regressed completely and 10 patients were lost to follow up. Of the 39 embolizations patients, 2 had their lesion regress and sepsis was suspected after embolization. In 1 patient, the microcoil migrated to the iliac artery during the embolization procedure, and another patient developed renal abscess caused by renal artery embolization. Among 30 surgical cases, resection by thoracotomy was performed in 27 at the Department of Thoracic Surgery, and thoracoscopic resection in 3 at the Division of Pediatric Sugery. Only one wound complication ocurred. We conclud that surgical excision should be recommended for pulmonary sequestration, whether the sequestration is symptomatic or not because of the risk of infection, the low rate of natural regress, poor compliance, severe complications after embolization, and to exclude other pathology. In summary, thoracoscopic resection of the pulmonary sequestration is feasible, efficacious, safe and cosmetically superior even in neonatal period.

• The Korean Journal of Physiology
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• 제30권1호
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• pp.33-41
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• 1996

The present study was aimed to investigate the role of endothelium-derived nitric oxide (NO) in the control of renin release and to examine if NO is implicated in the development of two-kidney, one clip (2K1C) hypertension. Male Sprague-Dawley rats $(150{\sim}200\; g)$ were constricted at the left renal artery. They were then supplemented with $N^{G}-nitro-L-arginine\;methyl\;ester\;(L-NAME,\; 5mg/100\;mL)$ or with L-arginine hydrochloride (400 mg/100 mL) in the drinking water. The control group was supplied with normal tap water. The sham-clipped rats were operated as in 2K1C rats except for that no clip was made. The kidneys were taken to examine in vitro release of renin at days 7 and 14 following clipping the renal artery. Northern blot analysis was also done to assess the expression of renin gene in the kidney. In sham-clipped rats, L-NAME caused a sustained increase of the blood pressure, whereas L-arginine was without effect. Neither L-NAME nor L-arginine-supplementation significantly affected the development of hypertension in 2K1C rats. Plasma renin concentration (PRC) measured on day 28 did not significantly differ among the L-NAME, L-arginine and control groups either in 2K1C or in sham-clipped rats. Renin contents (RRC) in the clipped kidney were increased, while those in the contralateral kidney were decreased. The release of renin in vitro from cortical slices was also enhanced in the clipped kidney, whereas it was attenuated in the contralateral. Comparing the RRC and in vitro release, the latter was more rapidly decreased than the former in the contralateral kidney. The renin mRNA levels in the contralateral kidney were almost at their nadir at days 7 and 14 in 2K1C rats. It is suggested that NO does not affect the development of 2K1C hypertension in which the renin-angiotensin system has been activated. The data also confirm that RRC and renin gene expression are increased in the clipped kidney and suppressed in the contralateral kidney in 2K1C rats.

• Journal of Chest Surgery
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• 제34권4호
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• pp.338-344
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• 2001

배경: 말기 신부전 환자에서 심장병, 특히 관상 동맥 질환의 이환이 늘어나면서 관상동맥 우회수술의 대상 환자가 지속적으로 증가하고 있다. 이들 환자군은 수술후 유병률과 사망률이 매우 높고 고위험군으로 알려져 있다. 대상 및 방법: 1996년 3월부터 2000년 5우러까지 서울 중앙 병원 흉부외과에서 술전 말기 신부전증으로 진단 받은 후 관상 동맥 우회수술을 시행받은 환자 25명을 대상으로 의무 기록을 중심의 후향적 분석을 하였다. 술전 위험 인자 및 술전 신기능, 수술 결과, 술후 경과, 수술후 합병증, 사망률 및 생존률 등을 분석하였다. 결과: 술전 평균 크레아티닌 청소율은 12.7$\pm$5ml/mim였고 술전 평균 혈중 크레아티닌 치는 6.2$\pm$3mg/dl(1.7-14.4)였다. 술전 투석을 시행중인 환자는 11례(44%)였고 술전 투석을 시행하지 않았던 14례(56%)중 8례(8/14, 57.1%)는 수술전후로 새로이 투석이 필요하였다. 술전 혈액 투석 중이었던 9례중 2례에서 수술후 복막 투석으로 전환하였다. 수술 사망률은 2례(8%)로 흡인성 폐렴과 종격동염으로 1례, 그리고 수술후 출형과 종격도염으로 1례가 사망하였다. 수술후 합병증은 14명(56%)의 환자에서 발생하여 매우 높은 발생율을 보였다. 만기사항은 2례(8%)에서 발생하였으며 사망원인은 카테터에 의한 복막염이었다. 생존 환자의 4년 생존률은 82$\pm$13% 였다. 결론: 말기 신부전 환자에서의 관상동맥 우회수술을 비교적 만족스러운 범위의 수술 사망률(8%)을 보였으나 합병증 발생률이 매우 높고 합병증 발생 시 사망률이 매우 높아 수술주위 감염 예방과 세심한 환자 관리가 필요하다.