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상장간맥 동맥과 간문맥사이의 동정맥 단락:코일을 이용한 치험 1예
강성권 대한영상의학회 1996 대한영상의학회지 Vol.34 No.1
최근 저자들은 복부자상 후 발생한 동정맥단락을 코일을 이용하여 성공적으로 치료 하였기에 이를 보고한다. 환자는 8년전 복부자상의 기왕력이 잇는 환자로 복부자상을 받은 직후 응급으로 수술을 시행하여 위와 장간막을 봉합하였으며 그이후로 복부에서 들리는 진 동과 심계항진이 있었으나 치료하지 않고 지내다 심계항진이 심해지고 실신을 두차례 경험 하였다. 환자의 기왕력과 증상 및 복부 이학적검사상 동정맥단락을 의심하고 혈관조영검사 를 시행하였다. 상장간막 동맥의 선택적 조영검사상 동맥기에 상장간막 정맥과 간문맥이 조 영되었으며 두군데에서 동맥과 정맥사이의 단락이 발견되었고 코일을 이용하여 성공적으로 치료하였다. 환자는 코일을 이용한 색적술직후 심계항진은 없어졌으며 복부에서 들리던 진 동도 들리지 않았다. We recently encountered a case of posttraumatic SMAVF(Superior mesenteric arteriovenous fistula), which hastreated by coil embolization. He had history of stab wound and emergent operation. Operative diagnosis was gastricperforation and mesenteric laceration which was simply repaired. After history of abdominal stab woung andoperation, he developed palpitation and thrill in left upper abdomen. Recentrly he have experienced syncope twice.On superior mesenteric arteriogram, early visualiation of superior mesenteric vein and portal vein was noted. Weembolized the SMAVF by using coils. Since coil embolization, palpitation and thrill disappreared.
강성권 대한영상의학회 1996 대한영상의학회지 Vol.34 No.1
Purpose : To review the effectiveness and complication of percutaneous cholecystostomy(PCCS). Materials andMethods : We performed PCCS in 60 patient who presented with acute cholecystitis. The causes of acutecholecystitis were as follows : acalculous cholecystitis(n=8), calculous cholecystitis(n=23), GB hydrops(n=3), GBempyema(n=15), septic cholangitis(n=11). Of 60 patients, 36 patients had high risk factor for cholecystectomy :underlying malignancy(n=13), severe trauma(n=2), liver cirrhosis(n=3), diabetes mellitus(n=6), end stage renaldisease(n=3), cardiac disease(n=3) and others(n=6). Cholecystostomy was done under ultrasonographic andfluoroscopic guide. Results : The cholecystostomy was successfully in 59 patients, and failed in 1 patients. 15patients improved without other procedure. 16 patients underwent cholecystectomy after improvement of theirgeneral condition. Severe complications of PCCS are as follows : bile peritonitis(n=6), hemoperitoneum(n=1),subphrenic abscess(n=1). Mild complication, such as pain, occured in most patients. Emergency operation was donein one patient who developed bile peritonitis. Disccussion : Cholecystostomy is effective and safe, especially incases of inoperable patients who represent acute cholecystitis. Percutaneous cholecystostomy may substitiutesurgical cholecystostomy.
강성권 대한영상의학회 1997 대한영상의학회지 Vol.37 No.4
Purpose : To evaluate the diagnostic efficacy of gastric air filling during DSA-hepatic arteriography of the left lobe in overcoming the pitfalls caused by accessory left gastric artery and left hepatic artery from left gastric arteryMaterials and Methods : In a prospective study, standard hepatic arteriogram and hepatic arteriogram after ingestion of an effervescent agent were performed in 22 patients with anatomic variation of the celiac axis. The anatomic variations were accessoty left gastric artery in 15 patients and left hepatic artery from left gastric artery in seven.Results : Hepatic arteriogram after ingestion of an effervescent agent was excellent in differentiating nodular stomach staining from hepatic tumor staining in the left hepatic lobe in patients with accessory left gastric artery, and for evaluatio of the left hepatic lobe when this was obscured by stomach staining.Concluson : Hepatic arteriogram after ingestion of an effervescent agent is a simple and safe method for overcoming angiographic pitfalls due to anatomic variation.
호흡 정지하에 시행한 조영증강 자기공명 혈관촬영술의 임상 응용
강성권 대한영상의학회 1998 대한영상의학회지 Vol.38 No.5
Purpose : To compare breath-hold gadolinium enhanced MR angiography(MRA) with digital subtraction angiography.Materials and Methods : Ten patients underwent angiography and breath-hold gadolinium enhanced MRA;the latterperformed at 1.5T with 3D FSPGR after a bolus injection of gadopentetate dimeglumine(0.4mmol/kg) Results : Sevenof ten pathologic conditions(70%) evaluated by both techniques had a similar appearance. The conditions examinedwere as follows : the artery feeding renal cell carcinoma(n=2): renal artery stenosis(n=2); pulmonaryAVM(n=2);abdominal aortic aneurysm(n=1); atheromatous plaque in the lower abdominal aorta(n=1);an enlargedbronchial artery(n=1); and an aberrant renal artery(n=1). For evaluating an anatomic relationship, a reconstructed3D image obtained by MRA is more advantageous. Conclusion : Breath hold contrast enhanced MRA is a potentiallyuseful noninvasive screening method for detecting vascular abnormality of the aorta and its branches.