Percutaneous Transportal Sclerotherapy with N-Butyl-2-Cyanoacrylate for Gastric Varices: Technique and Clinical Efficacy

곽효성,한영민 대한영상의학회 2008 Korean Journal of Radiology Vol.9 No.6

Objective: This study was deigned to evaluate the technique and clinical efficacy of the use of percutaneous transportal sclerotherapy with N-butyl-2-cyanoacrylate (NBCA) for patients with gastric varices. Materials and Methods: Seven patients were treated by transportal sclerotherapy with the use of NBCA. For transportal sclerotherapy, portal vein catheterization was performed with a 6-Fr sheath by the transhepatic approach. A 5-Fr catheter was introduced into the afferent gastric vein and a microcatheter was advanced through the 5-Fr catheter into the varices. NBCA was injected through the microcatheter in the varices by use of the continuous single-column injection technique. After the procedure, postcontrast computed tomography (CT) was performed on the next day and then every six months. Gastroendoscopy was performed at one week, three months, and then every six months after the procedure. Results: The technical success rate of the procedure was 88%. In six patients, gastric varices were successfully obliterated with 1-8 mL (mean, 5.4 mL) of a NBCA-Lipiodol mixture injected via a microcatheter. No complications related to the procedure were encountered. As seen on the follow-up endoscopy and CT imaging performed after six months, the presence of gastric varcies was not seen in any of the patients after treatment with the NBCA-Lipiodol mixture and the use of microcoils. Recurrence of gastric varices was not observed during the followup period. Worsening of esophageal varices occurred in four patients after transportal sclerotherapy. The serum albumin level increased, the ammonia level decreased and the prothrombin time increased at six months after the procedure (p < 0.05). Conclusion: Percutaneous transportal sclerotherapy with NBCA is useful to obliterate gastric varices if it is not possible to perform balloon-occluded retrograde transvenous obliteration. Objective: This study was deigned to evaluate the technique and clinical efficacy of the use of percutaneous transportal sclerotherapy with N-butyl-2-cyanoacrylate (NBCA) for patients with gastric varices. Materials and Methods: Seven patients were treated by transportal sclerotherapy with the use of NBCA. For transportal sclerotherapy, portal vein catheterization was performed with a 6-Fr sheath by the transhepatic approach. A 5-Fr catheter was introduced into the afferent gastric vein and a microcatheter was advanced through the 5-Fr catheter into the varices. NBCA was injected through the microcatheter in the varices by use of the continuous single-column injection technique. After the procedure, postcontrast computed tomography (CT) was performed on the next day and then every six months. Gastroendoscopy was performed at one week, three months, and then every six months after the procedure. Results: The technical success rate of the procedure was 88%. In six patients, gastric varices were successfully obliterated with 1-8 mL (mean, 5.4 mL) of a NBCA-Lipiodol mixture injected via a microcatheter. No complications related to the procedure were encountered. As seen on the follow-up endoscopy and CT imaging performed after six months, the presence of gastric varcies was not seen in any of the patients after treatment with the NBCA-Lipiodol mixture and the use of microcoils. Recurrence of gastric varices was not observed during the followup period. Worsening of esophageal varices occurred in four patients after transportal sclerotherapy. The serum albumin level increased, the ammonia level decreased and the prothrombin time increased at six months after the procedure (p < 0.05). Conclusion: Percutaneous transportal sclerotherapy with NBCA is useful to obliterate gastric varices if it is not possible to perform balloon-occluded retrograde transvenous obliteration.

중복 금속 스텐트 삽입에 의한 비장동맥류 치료: 증례 보고

곽효성,한영민,진공용 대한영상의학회 2004 대한영상의학회지 Vol.51 No.3

The traditional treatment of splenic artery aneurysm (SAA) is generally surgery and/or transcatheter arterial embolization, but recently, the treatment of SAA using a stent graft has been reported. However, the acute angle of the celiac axis, as well as the tortuous path of the splenic artery makes the use of stent graft difficult for treatment of aneurysms. We report here a case of SAA treated with the technique of double overlapping metallic stents. 비장동맥류 치료 방법은 수술과 경관동맥색전술이 있고, 최근 스텐트 이식편에 의한 치료 성공이 보고되기도 하였다. 그러나, 복강동맥강의 급격한 각과 비장동맥의 비틀림은 동맥류 치료시 스텐트 이식편의 사용을 제한하는 주요한 요인이 된다. 이에 저자들은 비장동맥류를 중복 금속 스텐트 시술에 의해 치료한 경험을 보고한다.

유주 외장성 종양소견을 보인 위 신경내분비 암종: 1예 보고$^1$

곽효성,이정민,이영환,김영곤,김종수,Gwak, Hyo-Seong,Lee, Jeong-Min,Lee, Yeong-Hwan,Kim, Yeong-Gon,Kim, Jong-Su 대한영상의학회 2002 대한영상의학회지 Vol.47 No.2

방사선 검사에서 유주 외장성 종양으로 나타난 미분화성 신경내분비성 암종 1예를 보고한다. 전산화단층촬영에서 복막강 우측에 위치한 약 14.5 $\times$10.0 $\times$8.0 cm 크기의 내부에 괴상부위를 가진 분엽성 고형 종양이 있었다. 종양은 넓은줄기(stalk)에 의해 위문부와 연결되어 있었다. 자기공명영상에서 종양은 복막강 좌측에 위치하며, T1 강조영상에서등신호강도,T2 강조영상에서 고신호강도를 보였으며, 강한 조영증강소견을 보였다. 이러한 방사선 검사에서 종양의 유주는 위와 연결된 부위를 확인함으로써 종양의 원발부위를 알 수 있다. We describe a case of poorly differentiated gastric neuroendocrine carcinoma presenting as a wandering exophytic mass. CT imaging revealed a 14.5x10.0x8.0 cm, lobulated, solid mass with a multifocal necrotic portion at the right of the peritoneal cavity. It was attached to the antrum of the stomach by a broad stalk, and shown by MR imaging to be well-defined, lobulated and solid, with a multifocal necrotic portion, and at the left of the peritoneal cavity. Isointensity was apparent at T1-weighted imaging, and slightly hyperintensity at T2-weighted imaging, and after gadolinium injection, enhancement was stronger than at precontrast imaging.

Carotid Wall Imaging with Routine Brain MRI to Facilitate Early Detection of Carotid Plaque and Intraplaque Hemorrhage

곽효성,양혜진,황승배,정경호 대한뇌졸중학회 2017 Journal of stroke Vol.19 No.1

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The Clinical Outcomes of Transcatheter Microcoil Embolization in Patients with Active Lower Gastrointestinal Bleeding in the Small Bowel

곽효성,한영민,이수택 대한영상의학회 2009 Korean Journal of Radiology Vol.10 No.4

Objective: To assess the clinical outcomes of the transcatheter microcoil embolization in patients with active lower gastrointestinal (LGI) bleeding in the small bowel, as well as to compare the mortality rates between the two groups based on the visualization or non-visualization of the bleeding focus determined by an angiography. Materials and Methods: We retrospectively evaluated all of the consecutive patients who underwent an angiography for treatment of acute LGI bleeding between January 2003 and October 2007. In total, the study included 36 patients who underwent a colonoscopy and were diagnosed to have an active bleeding in the LGI tracts. Based on the visualization or non-visualization of the bleeding focus, determined by an angiography, the patients were classified into two groups. The clinical outcomes included technical success, clinical success (no rebleeding within 30 days), delayed rebleeding (> 30 days), as well as the major and minor complication rates. Results: Of the 36 patients, 17 had angiography-proven bleeding that was distal to the marginal artery. The remaining 19 patients did not have a bleeding focus based on the angiography results. The technical and clinical success rates of performing transcatheter microcoil embolizations in patients with active bleeding were 100% and 88%, respectively (15 of 17). One patient died from continued LGI bleeding and one patient received surgery to treat the continued bleeding. There was no note made on the delayed bleeding or on the major or minor complications. Of the 19 patients without active bleeding, 16 (84%) did not have recurrent bleeding. One patient died due to continuous bleeding and multi-organ failure. Conclusion: The superselective microcoil embolization can help successfully treat patients with active LGI bleeding in the small bowel, identified by the results of an angiography. The mortality rate is not significantly different between the patients of the visualization and non-visualization groups on angiography. Objective: To assess the clinical outcomes of the transcatheter microcoil embolization in patients with active lower gastrointestinal (LGI) bleeding in the small bowel, as well as to compare the mortality rates between the two groups based on the visualization or non-visualization of the bleeding focus determined by an angiography. Materials and Methods: We retrospectively evaluated all of the consecutive patients who underwent an angiography for treatment of acute LGI bleeding between January 2003 and October 2007. In total, the study included 36 patients who underwent a colonoscopy and were diagnosed to have an active bleeding in the LGI tracts. Based on the visualization or non-visualization of the bleeding focus, determined by an angiography, the patients were classified into two groups. The clinical outcomes included technical success, clinical success (no rebleeding within 30 days), delayed rebleeding (> 30 days), as well as the major and minor complication rates. Results: Of the 36 patients, 17 had angiography-proven bleeding that was distal to the marginal artery. The remaining 19 patients did not have a bleeding focus based on the angiography results. The technical and clinical success rates of performing transcatheter microcoil embolizations in patients with active bleeding were 100% and 88%, respectively (15 of 17). One patient died from continued LGI bleeding and one patient received surgery to treat the continued bleeding. There was no note made on the delayed bleeding or on the major or minor complications. Of the 19 patients without active bleeding, 16 (84%) did not have recurrent bleeding. One patient died due to continuous bleeding and multi-organ failure. Conclusion: The superselective microcoil embolization can help successfully treat patients with active LGI bleeding in the small bowel, identified by the results of an angiography. The mortality rate is not significantly different between the patients of the visualization and non-visualization groups on angiography.

객혈 원인에 따른 기관지동맥 색전술의 효과

곽효성,한영민,임영수,전수빈,이상용,정경호,김종수,손명희,최기철 의과학연구소 1998 全北醫大論文集 Vol.22 No.1

1. Purpose : To evaluate of the effectiveness of bronchial arterial embolization acdording to the causess of hemoptysis. 2. Materials and methods : This study included 39 patients who had undertaken arterial embolization for the control of hemyptysis. The patinets were classified 1. Purpose: To evaluate of the effectiveness of bronchial arterial embolization according to the causes of hemoptysis. 2. Materials and methods: This study included 39 patients who had undertaken arterial embolization for the control of hemoptysis. The patinets were classified into the three groups: pulmonary tuberculosis (n=22), idiopathic bronchiectasis (n=10), lung cancer (n=7). Gelfoam particle were used as embolized material for all patients. And only for two patients, embolization coil was interpolated. The period of follow-u[ was from 1 to 66 months after arterial embolization. Immediate results were assessed based on careful observation of patients for 1 month after arterial embolization: success, indicating complete cessation of hemoptysis for 1 month: and fail, indicating continued hemoptysis or recurrent hemoptysis within 1 month. Long-term results were evaluated in patients with immediate success who could be followed for at least 1 month. Patients were classified into the three categories: complete remission, indicating complete cessation of bleeding during the observation period : partial remission, indicating complete cessation of hemoptysis with recurrent bloody sputum during the observation period : and recurrence, indicating recurrent hemoptysis. 3. Results : immediate success rate was 76.9%(30/39), and as classified into the causes, idiopathic bronchiectasis 90.0% (9/10), pulmonary tuberculosis 81.8% (18/22), lung cancer 42.9%(3/7). Long-term results in the causes of idiopathic bronchiectasis showed a high remission rate (77.8%), a low recurrence rate (22.2%). In pulmonary tuberculosis, remission rate was 70.8%m recurrence rate was 29.4%. No recurrence was observed in the cases of success of the lung cancer. During and after embolization, the complications were mild chest pain 1 or fever, which relieved spontaneously within a few days. 4. Conclusion : The benign diseases such as pulmonary tuberculosis and idiopathic bronchiectasis showed a high immediate success rate and a high long-term remission rate. The lung cancer showed a low immediate success rate. But during observation period, lung cancer showed no recurrence. (Key Words : Lung, hemorrhage, therapeutic, blockade)

Carotidynia presenting with acute ischemic stroke after carotid sinus massage

곽효성,정경호,이찬혁,정슬기,류한욱 대한임상신경생리학회 2017 Annals of Clinical Neurophysiology Vol.19 No.1

Carotidynia is characterized by unilateral neck pain around the carotid artery. We describe a 50-year-old woman who presented with transient left-side weakness and right-side neck pain. She frequently massaged the uncomfortable neck area during the symptomatic course of the condition. Magnetic resonance imaging revealed multifocal cerebral infarctions and a carotid intramural thrombus ipsilateral to the carotidynia.Long-term carotidynia might result in the involvement of an intramural thrombus and intimal disruption, and ischemic stroke after carotidynia may be provoked by carotid sinus massage.

풍선확장술 후 발생한 종격동 누출이 동반된 식도 전층 천공의 보존치료: 증례 보고

곽효성,한영민,정경호 대한영상의학회 2005 대한영상의학회지 Vol.53 No.2

A 43-year-old man was admitted complaining of swallowing difficulties. The esophagography revealed severe stenosis at the esophagogastric anastomotic site. Esophagography after balloon dilatation showed a transmural perforation with mediastinal leakage. The patient was treated conservatively for one week at which time the esophagography showed no further leakage at the anastomotic site and the good passage of barium. A 2-year follow-up chest computed tomography (CT) showed good patency of the esophageal lumen and the marked resorption of barium in the mediastinum. 연하곤란으로 내원한 43세 남자의 식도조영술상 식도위연결술을 시행한 부위에 심한 협착이 보였다. 풍선확장술후 시행한 식도조영술에서 전층천공(벽경유뚫림)과 종격동 누출(세로관 누출)이 보였고, 일주일동안 보존치료를 한 후, 연결부위에 더 이상의 누출은 없었고, 바륨 통과도 잘 되었다. 2년의 흉부 전산화단층촬영(CT) 추적검사에서 식도내강은 잘 유지되며, 종격동내 바륨도 흡수되었다.

Development of 3-D Modeling for Abrasive Waterjet Drilling Process

곽효성(Kwak Hyo-Sung),Rodovan Kovacevic Korean Society for Precision Engineering 1999 한국정밀공학회지 Vol.16 No.7

On-Line Monitoring of Abrasive Water Jet Drilling of Refractory Ceramics Using Acoustic Emission Sensing Technique

곽효성(Kwak, Hyo-Sung),Rodovan Kovacevic Korean Society for Precision Engineering 1998 한국정밀공학회지 Vol.15 No.6