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      • KCI등재

        전내장 역위증 환자에서 우연히 발생한 원발성 식도분석 1예

        조용찬,전원정,김형일,김성균,김현수,최성규,유종선 대한소화기내시경학회 2010 Clinical Endoscopy Vol.41 No.1

        Situs inversus totalis (SIT) is very rare autosomal recessive condition, and patients with SIT have complete mirror image reversal of the thoracic and abdominal viscera. There have been no case reports of esophageal bezoar in a patient with situs inversus totalis. Bezoars are retained concretions of indigestible foreign material, including food material, vegetable material and hair, and they are usually founded in the stomach, small intestine and rectum. Esophageal bezoars are very rare, but they are known to occur in patients with anatomical defects or esophageal motility disorders. The treatment of esophageal bezoar is usually based on endoscopic fragmentation and extraction, dissolution with papain, cellulose, pancreatic enzyme and/or Coca cola. We report here on a case of an endoscopically treated primary esophageal bezoar in a patient with situs inversus totalis, and the patient experienced no complications from the treatment. 전내장 역위증은 내부 장기의 해부학적 구조가 정상과 거울상으로 보이는 매우 드문 유전적 질환이다. 식도 분석은 매우 드물며 식도운동 장애나 게실, 식도열공, 위수술 등 해부학적 이상이 동반된 경우에 발생하거나 위로부터 역류하여 이차적으로 발생한다. 최근에는 내시경 제거술로 겸자, 올가미를 이용하거나 효소 및 콜라를 이용한 용해 요법 등의 비수술적인 치료방법이 주로 사용되고 있다. 저자들은 87세 내장 역위증 환자에서 우연히 발생한 식도 분석에 코카콜라를 소량 주입하였고 다음날 식도에 overtube를 유치한 후 내시경 기구를 사용하여 합병증 없이 성공적으로 제거하였다. 저자들은 비특이성 식도 운동 장애를 가진 전내장 역위증 환자에서 우연히 원발성으로 발생한 식도 분석을 내시경 제거술로 치료하여 보고한다.

      • KCI등재

        요골동맥을 이용한 관상동맥 조영술시 고용량 Nicorandil의 요골동맥 확장 및 임상적 효과

        조용찬,김원,김종태,정안덕,조상철,강원유,황선호,김완 대한심장학회 2008 Korean Circulation Journal Vol.38 No.4

        Background and Objectives: A spasm of the radial artery is one of the most common complications of coronary angiography (CAG) via the transradial approach (TR), and this spasm sometimes disturbs the procedure. Nicorandil has recently shown dose-dependent dilatation of the blood vessels and ischemic preconditioning. This study was designed to evaluate the clinical effects and radial artery vasodilation of high dose nicorandil solution during CAG via the radial artery. Subjects and Methods: This study was a prospective, randomized study to compare the effects of 12 mg of nicorandil (the Nicorandil group) and 10 mL of a cocktail solution (nitroglycerine 200 μg mixed with verapamil 100 μg) (the Cocktail group) in 146 patients. Vasospasms, which were expressed as the stenosis of the radial artery were examined at 2 parts of the radial artery. Results: There were no significant difference of gender, age and risk factors for the 2 groups of patients. The reductions in the systolic and diastolic blood pressure (BP) 1 minute after drug administration were 33.6±11.4/10.4±7.7 mmHg in the Nicorandil group and 12.8±9.8/3.8±5.3 mmHg in the Cocktail group (p<0.001). Both vasodilating agents showed significant radial artery vasodilation after administration of the drugs (p<0.005 for all). The minimal luminal diameter (MLD) after drug administration was more dilated in the Nicorandil group than that in the Cocktail group (0.63±0.25 mm vs. 0.48±0.19 mm, respectively, p=0.013). Conclusion: Nicorandil solution was more effective for inducing vasodilation of the radial artery, but it was not clinical superior to the cocktail solution. Background and Objectives: A spasm of the radial artery is one of the most common complications of coronary angiography (CAG) via the transradial approach (TR), and this spasm sometimes disturbs the procedure. Nicorandil has recently shown dose-dependent dilatation of the blood vessels and ischemic preconditioning. This study was designed to evaluate the clinical effects and radial artery vasodilation of high dose nicorandil solution during CAG via the radial artery. Subjects and Methods: This study was a prospective, randomized study to compare the effects of 12 mg of nicorandil (the Nicorandil group) and 10 mL of a cocktail solution (nitroglycerine 200 μg mixed with verapamil 100 μg) (the Cocktail group) in 146 patients. Vasospasms, which were expressed as the stenosis of the radial artery were examined at 2 parts of the radial artery. Results: There were no significant difference of gender, age and risk factors for the 2 groups of patients. The reductions in the systolic and diastolic blood pressure (BP) 1 minute after drug administration were 33.6±11.4/10.4±7.7 mmHg in the Nicorandil group and 12.8±9.8/3.8±5.3 mmHg in the Cocktail group (p<0.001). Both vasodilating agents showed significant radial artery vasodilation after administration of the drugs (p<0.005 for all). The minimal luminal diameter (MLD) after drug administration was more dilated in the Nicorandil group than that in the Cocktail group (0.63±0.25 mm vs. 0.48±0.19 mm, respectively, p=0.013). Conclusion: Nicorandil solution was more effective for inducing vasodilation of the radial artery, but it was not clinical superior to the cocktail solution.

      • KCI등재

        요골동맥을 이용한 관상동맥 조영술시 Tiger Catheter의 임상적 유용성

        조용찬,반재성,김종태,노명주,정안덕,조상철,강원유,황선호,김완,김원 대한심장학회 2009 Korean Circulation Journal Vol.39 No.1

        The most important complications of the transradial coronary approach during coronary artery angiography are occlusion of the radial artery and arterial spasm which are known to be influenced by catheter size, procedure time, and repeat procedures. The purpose of this study was to evaluate the usefulness of a Tiger catheter (TC) which was designed for the selection of right and left coronary artery ostia simultaneously, compared with the Judgkins catheter (JC) during transradial coronary angiography (CAG). Subjects and Methods: One hundred forty-four patients were randomized between groups who underwent CAG with a standard 5F JC or a TC. The procedure time and vasospasm of the radial artery, which were expressed as stenosis of the vessel diameter, were examined using a transradial approach. Four parts of the blood vessel diameter were measured at baseline, during injection of the vasodilator, and at the end of the procedure. Results: There were no significant differences in gender, age, weight, or other cardiovascular risk factors between the two groups of patients. CAG was successfully performed using a TC in 89% of the patients. A TC was associated with a significantly shorter total procedure time than the JC for diagnostic CAG (451±120.4 vs. 542.3±180.5 sec, p=0.001), respectively. There was no significant difference in stenosis between the two groups (36% vs. 41% in TC and JC, respectively, p= 0.358). There were no angiographic or clinical complications in each group. Conclusion: This study showed that the TC is associated with decreased total CAG procedure time compared with the JC. 배경 및 목적 시술 후 중요한 합병증으로 요골동맥의 폐쇄가 보고되고 있으며, 이는 카테터의 크기, 시술시간, 요골동맥의 반복시 술이 영향을 미치는 것으로 알려져 있다. TC는 좌우 관상 동맥을 하나의 카테터로 조영할 수 있게 도안되었다. 본 연 구는 진단적 관상동맥 조영술시 기존의 2개의 JC와 TC의 단 독 사용시 시술시간 및 요골동맥의 혈관확장과 연축의 유무 에 미치는 영향을 비교, 분석하고자 하였다. 방 법 요골동맥을 이용하여 관상동맥 조영술을 시행한 환자 144 명을 JC와 TC를 사용한 두 군으로 나누었다. 도관의 크기는 5 Fr로 일정하게 하였으며, 요골동맥의 연축여부는 요골동맥 의 근위부와 중간분절에서 총 4곳의 혈관 직경을 혈관확장 제 투여후와 검사 종료시 각각 측정하여 비교하였다. 시술시 간은 요골동맥을 통하여 Judgkins 카테터 또는 Tiger 카테 터 삽입 시점부터 관상동맥 조영술 후 도관 제거 바로 전까지 의 시간으로 정의하였다. 일차종결점은 시술시간으로 하였다. 결 과 양 군 간의 성별, 나이, 신장, 체중, 체질량지수, 관상동맥질 환의 위험인자의 차이는 없었다. Tiger 도자 사용시 약 89% 의 환자에서 좌우 관상동맥 조영술이 가능하였다. 각 군간 의 시술시간은 TC군이 451.0±120.4초, JC군이 542.3± 180.5초로서 TC군에서 JC군과 비교하여 유의하게 짧은 시 술시간을 보였다 (p=0.01). 또한 TC군이 시술종료 때까지 혈관확장 및 연축발생 비율도 양호한 경향을 보였지만, 유 Yong Chan Cho, et al.·15 의한 차이는 없었다. 결 론 TC를 사용한 요골동맥 관상동맥 조영술시 시술시간을 감 소시킬 수 있었으며, 양호한 성공률을 보였다.

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