후두 결핵의 컴퓨터 단층 촬영 소견 : 후두암 소견과의 비교

김만득 대한영상의학회 1996 대한영상의학회지 Vol.34 No.5

목 적:후두 결핵을 진단하는데 있어서 CT의 유용성을 알아보고, 후두암과는 다른 특징적인 소견이 있는지에 대하여 알아보고자 하였다. 대상 및 방법 : 12명의 조직 병리학적으로 확인된 후두 결핵 환자와 15명의 후두암 환자의 CT 소견을 후향적으로 분석하였다. 또한 임상적 증상, 후두 내시경 소견 및 단순 흉부 사진상 폐결핵의 유무를 조사하였다. 경과:후두 결핵의 경우, 양측 대칭성 또는 비대칭성 병변을 보인경우가 9예(75%), 단측성 병변은 3예(25%)를 나타낸 반면, 후두암의 경우 단측성 병변이 12예(80%)를 나타내었으며, 이는 통계학적으로 유의한 차이를 나타내었다(p = 0.004). 후두개염(epiglottis)의 자유연이 두꺼워지는 특징적인 소견이 6예(50%)에서 판찰되었으며, 또한 광범위한 후두점막의 병변을 나타내고 있음에도 불구하고 preepiglottis와 paralaryngeal space의 지방층에 침윤 소견은 보이지 않았다. 반면에 후두암의 경우 12예(80%)에서 점막하 심침윤이 관찰되었다. 결 론:CT는 후두 결핵을 진단하는데 있어서 매우 유용하였으며, 그 소견으로는 앙측성 병변이라는 것, 후두개염(epiglot­t tis)의 자유연이 두꺼워지는 것, 그리고 넓은 후두 점막의 병변에도 불구하고, preepiglottis와 paralaryngeal fat spaces는 침윤을 나타내지 않는 것으로 특징 지워질 수 있었다. Purpose: To determine the value of CT(Computerized Tomography) in the diagnosis of laryngeal tuberculosis and to assess to what extent its characteristic findings different from those of aryngeal carcinoma. Materials and Methods: CT scans of twelve patients with laryngeal tuberculosis were reviewed and compared with those of fifteen patients with laryngeal cancer, retrospectively. Clinical symptoms, laryngoscopic examinations and the presence of pulmonary tuberculosis on chest radiographs were also reviewed. Results: In laryngeal tuberculosis, bilateral symmetric or asymmetric involvement was noted in nine(75%) patients, while unilateral involvement was seen inthree(25%). This was significantly different from laryngeal cancer in which unilateral involvement was noted in twelve patients(80%). Diffuse thickening of the free margin of the epiglottis was a characteristic and frquent finding in tuberculosis(n = 6, 50%). No deep submucosal infiltration of preepiglottic and paralaryngeal fat spacesis seen in tuberculosis in spite of large areas of involvement of laryngeal mucosa, while twelve patients(80%)with laryngeal cancer showed thickened deep infiltration which resulted in a submucosal mass. Conclusion: CT wasuseful in the diagnosis of laryngeal tuberculosis and its CT findings wee characterized by bilateral involvement, thickening of the free margin of the epiglottis and good preservation of preepiglottic and paralaryngeal fatspaces in spite of large areas of involvement.

UFE : Website Running Since 2006 Oct.

김만득 대한인터벤션영상기술학회 2009 대한인터벤션영상기술학회지 Vol.12 No.1

Uterine Artery Embolization for Leiomyomas and Adenomyosis: A Pictorial Essay Based on Our Experience from 1300 Cases

김만득 대한영상의학회 2019 Korean Journal of Radiology Vol.20 No.10

Since its introduction in 1995, uterine artery embolization (UAE) has become an established option for the treatment of leiomyomas. Identification of a leiomyoma using arteriography improves the ability to perform effective UAE. UAE is not contraindicated in a pedunculated subserosal leiomyoma. UAE in a cervical leiomyoma remains a challenging procedure. A leiomyoma with high signal intensity on T2-weighted imaging responds well to UAE, but a malignancy with similar radiological features should not be misdiagnosed as a leiomyoma. Administration of gonadotropin-releasing hormone agonists before UAE is useful in selected patients and is not a contraindication for the procedure. The risk of subsequent re-intervention 5 years after UAE is approximately 10%, which represents an acceptable profile. UAE for adenomyosis is challenging; initial embolization using small particles can achieve better success than that by using larger particles. An intravenous injection of dexamethasone prior to UAE, followed by a patient-controlled analgesia pump and intra-arterial administration of lidocaine after the procedure, are useful techniques to control pain. Dexmedetomidine is an excellent supplemental sedative, showing a fentanyl-sparing effect without causing respiratory depression. UAE for symptomatic leiomyoma is safe and can be an alternative to surgery in most patients with a low risk of re-intervention.

플라티눔 코일을 이용한 폐동정맥 기형의 치료: 증례 보고

김만득,김정숙,임창영 대한영상의학회 2005 대한영상의학회지 Vol.52 No.2

Pulmonary arteriovenous malformation (PAVM) is an abnormal direct communication between the pulmonary arteries and veins without any capillary network. The patients may be completely asymptomatic or may they develop serious complications including hemoptysis and brain abscess. We present here a case of incidentally found PAVM in a 33-year-old male who underwent embolization using platinum coils. Coil embolization is a safe, highly effective procedure that should be considered more often for the treatment of PAVM. 폐동정맥 기형은 드문 질환으로 일반적으로 증상이 없으나 우좌 단락으로 인한 저산소증, 객혈, 뇌 농양 등의 치명적인 합병증이 유발 될 수 있다. 저자들은 최근 우연히 발견된 33세 남자의 폐동정맥 기형을 플라티눔 네스터 코일을 이용하여 경피적 색전술로 치료한 1예를 경험 하였기에 이를 문헌 고찰과 함께 보고하고자 한다. 플라티눔 코일 색전술은 매우 효과적이면서 안전하여 폐동정맥 기형 치료에 우선적으로 고려해야 한다.

국제 외환시장 동향

김만득 한국구매조달학회 2005 한국구매조달학회 학술발표대회 Vol.2005 No.-

발작기 뇌혈류 스캔에서의 간질 확산에 관한 연구 : 간질 병소 국소화의 오류

김만득,이종두,유영훈,김도중,김재근,문성욱,윤평호,이창훈,이병인 ( Man Deuk Kim,Jong Doo Lee,Young Hoon Ryu,Do Joong Kim,Jai Keun Kim,Sung Wook Moon,Pyeong Ho Yoon,Chang Hoon Lee,Byung In Lee ) 대한핵의학회 1996 핵의학 분자영상 Vol.30 No.4

돼지에서의 장과 간 사이 Coda 및 Bakri 풍선의 삽입: A FeasibilityStudy

김만득 ( Man Deuk Kim ) 대한간암학회 2015 대한간암학회지 Vol.15 No.2

Background/Aims: To investigate the feasibility of Bakri balloon and Coda balloon placement as a spacer between the liver and bowels using a swine model. Methods: Six adult female swine weighing from 24.0 to 41.5 kg (mean, 31.5 kg) were included for the study. After peritoneal puncture using a 21-G micro-puncture needle under ultrasound and fluoroscopic guidance, a 0.035-inch guidewire (Terumo, Tokyo, Japan) was advanced through the micro-introducer sheath. With sequential dilation of the tract with dilators up to 18-Fr or 10 mm balloon, the Coda and Bakri balloon was advanced between the liver and bowels. 50 mL and 200 mL of contrast were inflated for Coda and Bakri balloon, respectively. Gross examinations focused on whether placement of the Coda or Bakri balloon was at the correct location. Results: Technical success was achieved for Coda balloon placement in six of the six (100%) swine, and for Bakri balloon placement in five of the six (83.3 %) swine. The median placement time for the Coda balloon was 10 minutes (range, 7-15 minutes), while the median placement time for the Bakri balloon was 25 minutes (range, 17-35 minutes), which was significantly longer (p<0.05). Gross observations at necropsy revealed that the Coda and Bakri balloon was well placed between the liver and bowel. Conclusions: Placement of Coda and Bakri balloons between the liver and bowels was feasible. These balloons have a potential role as spacers between the liver and bowel during radiation therapy for hepatocellular carcinoma patients. (J Liver Cancer 2015;15:106-111)

Plug-Assisted Retrograde Transvenous Obliteration for the Treatment of Gastric Variceal Hemorrhage

장민영,김만득,김태환,신원선,신민우,김경민,원종윤,박성일,이도연 대한영상의학회 2016 Korean Journal of Radiology Vol.17 No.2

Objective: To evaluate the feasibility, safety, and clinical outcomes of plug-assisted retrograde transvenous obliteration (PARTO) to treat gastric variceal hemorrhage in patients with portal hypertension. Materials and Methods: From May 2012 to June 2014, 19 patients (11 men and 8 women, median age; 61, with history of gastric variceal hemorrhage; 17, active bleeding; 2) who underwent PARTO using a vascular plug and a gelfoam pledget were retrospectively analyzed. Clinical and laboratory data were examined to evaluate primary (technical and clinical success, complications) and secondary (worsening of esophageal varix [EV], change in liver function) end points. Median follow-up duration was 11 months, from 6.5 to 18 months. The Wilcoxon signed-rank test was used to compare laboratory data before and after the procedure. Results: Technical success (complete occlusion of the efferent shunt and complete filling of gastric varix [GV] with a gelfoam slurry) was achieved in 18 of 19 (94.7%) patients. The embolic materials could not reach the GV in 1 patient who had endoscopic glue injection before our procedure. The clinical success rate (no recurrence of gastric variceal bleeding) was the same because the technically failed patient showed recurrent bleeding later. Acute complications included fever (n = 2), fever and hypotension (n = 2; one diagnosed adrenal insufficiency), and transient microscopic hematuria (n = 3). Ten patients underwent follow-up endoscopy; all exhibited GV improvement, except 2 without endoscopic change. Five patients exhibited aggravated EV, and 2 of them had a bleeding event. Laboratory findings were significantly improved after PARTO. Conclusion: PARTO is technically feasible, safe, and effective for gastric variceal hemorrhage in patients with portal hypertension.

Practical Application of a Coronal MR Image during a Uterine Fibroid Embolization (UFE)

정진영,김만득,이현석,이미화,김희진,조진호,차선희 대한영상의학회 2010 대한영상의학회지 Vol.62 No.5

Purpose: To assess the role of coronal MR images during uterine fibroid embolization (UFE). Materials and Methods: A prospective study of 100 consecutive patients who underwent a uterine fibroid embolization was performed. The average age at embolization was 40.2 years (range, 19-49 years). The size of the predominant fibroids ranged from 2.5 cm to 21.0 cm (mean, 7.5 cm). The embolic agents included non-spherical polyvinyl alcohol particles. The angiographic and spot images after embolization were compared with coronal MR images. The patterns were divided into three categories: Matching, Undetermined, and Mismatching. Results: Coronal MR images were correlated with angiographic or single shot images of the uterus after embolization in 94 cases, undeterminined in three cases, and mismatched in three cases. Post-embolization aortographies were not helpful in patients showing complete matching images. In three cases of mismatching, two had ovarian collateral supplies to predominant fibroids in the uterine fundus and the remaining patienthad an internal pudendal artery of collaterals to fibroid. Mismatching spot images combined with MRI allowed us to find other collateral vascularities. Conclusion: Coronal MR images provided comprehensive information for the appropriate UFE. When perfectly matched, we could make sure that a particular UFE is appropriate without concern for collaterals.

Degeneration of Leiomyoma in Patients Referred for Uterine Fibroid Embolization: Incidence, Imaging Features and Clinical Characteristics

한승철,김만득,정대철,이명수,이무숙,박성일,원종윤,이도연,이광훈 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.1

Purpose: Imaging features and clinical characteristics of degenerated leiomyoma in patients referred for uterine fibroid embolization (UFE) were analyzed to assess the incidence of degenerated leiomyoma. Materials and Methods: Patients referred for UFE between 2008 and 2009 were retrospectively analyzed (n=276). Patients ranged in age from 27 to 51 years (mean 38.0 years). All patients underwent screening MRI with contrast enhancement. Medical histories and clinical symptoms were evaluated. Results: Among the 276 patients who underwent MRI, 14 (5.1%) showed degenerated leiomyomas. Symptoms were abdominal pain (n=4, 26.7%), menorrhagia (n=5, 35.7%) and bulk-related symptoms (n=5, 35.7%) and no symptoms (n=5, 35.7%). Of the 14 patients with degenerated leiomyomas,5 (42.9%) had a history of pregnancy in the past two years. For T1-weighted imaging (T1WI), a high signal intensity (SI) of the leiomyoma was the most common finding (n=9, 64.3%) and a hyperintense rim (n=4, 28.6%) was the second most common. On T2-weighted imaging (T2WI), a low SI of the leiomyoma was found in six patients (42.9%), a high SI in four (28.6%) and a heterogeneous SI in four (28.6%) patients. Conservative management was performed in 11 (78.6%) patients, surgery in 3 (21.4%) and uterine artery embolization in one (7.1%) patient. Conclusion: The incidence of degeneration of leiomyoma in patients referred for UFE was 5.1%. Patients presented with variable clinical symptoms with or without a history of pregnancy. MR imaging showed a high SI on T1WI and various SIs on T2WI without contrast enhancement. An understanding of the degeneration of leiomyomata is essential when considering UFE.