두개강내 동맥 스텐트 삽입시 발생한 급성 스텐트내 혈전에 대한 Abciximab 동맥내 주입 치료의 유용성

권운정,이태홍,이병희,김동현,김학진,김석,김창원,추기석,문태용 대한영상의학회 2004 대한영상의학회지 Vol.51 No.1

Purpose: To determine the efficacy and safety of the intra-arterial administration of glycoprotein IIb/IIIa inhibitor for resolving acute in-stent thrombosis complicating stent-assisted angioplasty for intracranial atherosclerosis. Materials and Methods: We placed 60 therapeutic stents (24 internal carotid arteries, 20 vertebrobasilar arteries, and 16 middle cerebral arteries) for the treatment of symptomatic intracranial atherosclerosis. Among the 60 stenting procedures, acute in-stent thrombosis occurred after stent deployment in 11 cases (18.3%). As the method of dissolving the acute in-stent thrombosis, 2 mg abciximab were intra-arterially administered through a guiding catheter. Angiography was then performed after 10-20 minutes to identify any undissolved material resulting from the thrombosis. If the thrombosis was still observed on the angiography, an additional 2 mg of abciximab were administered, and this procedure was repeated until complete thrombolysis was obtained. Post-procedural non-enhanced brain CT was performed for the evaluation of possible hemorrhagic complications. Results: After each intra-arterial administration of 2 mg of abciximab, successive angiographies showed the process of resolution of the acute thrombosis. All 11 acute in-stent thromboses were completely dissolved within 40 to 80 minutes. The total dosage of infused abciximab was 8 mg in one case, 10 mg in eight cases, and 16 mg in two cases. Post-procedural non-enhanced brain CT revealed no hemorrhagic complications. Conclusion: The intra-arterial administration of abciximab can be a safe and effective therapeutic method for acute in-stent thrombosis complicating the stenting of stenotic intracranial arteries. 목적: 동맥경화증으로 인한 뇌동맥 협착 치료에 스텐트를 이용한 혈관성형술 중 발생한 급성 스텐트내 혈전의 용해를 위해 동맥으로 주입된 glycoprotein IIb/IIIa inhibitor (Abciximab)의 유용성과 안전성을 알아보고자 하였다. 대상과 방법: 두개강내 동맥 협착으로 스텐트를 이용한 혈관성형술을 시행 받았던 53명, 60예 병변 중 급성 스텐트내 혈전이 발생하였던 11예를 대상으로 하였다. 급성 혈전이 발생한 경우 혈전용해를 위해 유도도관을 통해 동맥 내로 2 mg abciximab을 주입하고 10-20분 후 혈전 용해 정도를 확인하기 위해 혈관촬영술을 시행하였다. 만약 혈전이 지속적으로 관찰되면 추가 적으로 2 mg abciximab을 주입하였다; 이러한 과정을 혈전이 완전히 용해될 때까지 반복하였 다. 시술 후 출혈성 합병증은 비조영 CT로 확인하였다. 결과: 동맥 내로 2 mg abciximab씩 주입하고 시행한 연속적인 혈관촬영술 결과, 급성 혈전은 서서히 용해되어 11예 모두에서 급성 스텐트내 혈전이 40-80분 사이에 완전히 용해되었다. 사용된 abciximab의 총 용량은 1예에서 8 mg, 8예에서 10 mg, 2예에서 16 mg이었다.시술 후 시행한 비조영 CT에서 출혈성 합병증은 관찰되지 않았다. 결론: 두개강내 동맥 협착에 대한 스텐트를 이용한 혈관성형술시 발생한 급성 스텐트내 혈전 용해를 위해 동맥으로 abciximab을 주입하는 것은 안전하며 효과적인 치료 방법이었다.

A Case Report: Cavitary Infarction Caused by Pulmonary Tumor Thrombotic Microangiopathy in a Patient with Pancreatic Intraductal Papillary Mucinous Neoplasm

배경국,권운정,최성훈,이종화,차희정 대한영상의학회 2015 Korean Journal of Radiology Vol.16 No.4

Pulmonary tumor embolism is commonly discovered at autopsy, but is rarely suspected ante-mortem. Microangiopathy is an uncommon and distinct form of simple tumor pulmonary embolism. Here, we present a 52-year-old male with tumor thrombotic microangiopathy and pulmonary infarction, which might have originated from intraductal papillary mucinous tumor of the pancreas. Multiple wedge-shaped consolidations were found initially and aggravated with cavitation. These CT features of pulmonary infarction were pathologically confirmed to result from pulmonary tumor thrombotic microangiopathy.

Chemical pneumonitis after intravenous injection of isoparaffin: Characteristic clinico-radiologic findings

변성수,권운정,홍은석,김양호,서광원,안종준,나승원 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.-

Chemical pneumonitis after intravenous injection of isoparaffin: Characteristic clinico-radiologic findings

변성수,권운정,홍은석,김양호,서광원,안종준,나승원 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1

Context: Although several cases of intravenous (IV) injection of hydrocarbons with additives have been reported, no report to date has addressed IV isoparaffin intoxication. We describe the first case of chemical pneumonitis and subcutaneous necrosis after IV injection of isoparaffin (C12-C13, 99%) and we describe the chest computed tomography (CT) pattern of chemical pneumonitis after IV hydrocarbon injection. Case details: Following a suicide attempt by IV self-injection of 1 mL of solvent (isoparaffin, 99%) used in his workplace, a 23-year-old man presented with bilateral pleuritic chest pain. Chest CT showed multiple, peripheral, wedge-shaped, ill-defined ground glass opacities with consolidations in both lungs, and bilateral pleural effusion. The patient developed fever and cellulitis around the site of injection, later followed by subcutaneous necrosis. Treatment with antibiotics led to complete resolution of the symptoms and chest imaging findings. Discussion: Isoparaffin causes severe inflammation and necrosis in perivascular tissues. When injected IV, isoparaffin can cause chemical pneumonitis and acute lung injury, mimicking pulmonary infarction on chest CT because lung is the organ bearing the first capillary bed encountered. Concomitant subcutaneous necrosis may be associated with the extravasations. A favorable outcome with minimal residual pulmonary sequelae can be expected if the amount of injected isoparaffin is small.

F-52 기관지내시경초음파를 이용한 종격동 림프절 흡인조직검사에서 세침회전 방법의 유용성

나승원,권운정,지영준,차혜영,김진형,배수현,강병주,이태훈,서광원,제갈양진,안종준 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.0

목적: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) 림프절 조직검사에서 새로운 세침회전 방법과 기존의 방법(“Jab” method)으로 얻은 조직(core tissue)의 길이를 비교하고자 하였다. 방법: 2009년 10월부터 2014년 12월까지 흉부 CT에서 종격동 림프절 종대 소견이 관찰되어 EBUS-TBNA를 시행한 환자 중 Jab method로 조직획득이 되지 않거나 조직의 양이 적어서, 세침회전방법 (Rotation Aiding, “RA” method)으로 전환하여 시도한 43명으로부터 얻은 61개의 림프절 core tissue 길이를 후향적으로 분석하였다. 통계분석방법으로 윌콕슨의 대응표본 부호순위검정을 사용하여 동일한 환자에서 Jab method와 RA method로 획득한 core tissue의 길이를 비교하였다. 성적: 연구대상자의 중앙나이(범위)는 63세(16-86) 이었으며 남녀 성비는 23:20 이었다. 조직검사상 악성소견은 25개(41%)의 림프절에서 진단되었고, 36개(59%)는 양성 림프절 이었는데 이중 reactive(50.0%)가 가장 많았으며, tuberculosis(30.5%), sarcoidosis(19.5%) 빈도순이었다. RA method가 Jab method보다 통계학적으로 유의하게 긴 core tissue를 얻을 수 있었고(83.2±12.7 vs 60.1±10.1 mm; p=0.02), subgroup 분석결과 양성 림프절에서는 차이가 없었고(63.8±14.2 vs 49.6±12.1 mm; p=0.24), 악성 림프절에서 유의하게 차이가 있었다(111.0±22.7 vs 75.2±17.3 mm; p=0.03). 결론: RA method는 기존의 Jab method 보다 더 많은 림프절 core tissue를 얻을 수 있었으며, 양성 림프절보다 악성 림프절에서 유의하게 더 많이 획득할 수 있었다.

수필:사과,의료윤리의 문제점들,북도처가,호박인심,낙제생들,어머님의 목소리

서정범,백상창,권용태,강석조,운정쇠,문중섭 북한연구소 1975 北韓 Vol.- No.48

"놀이치료"에 관한 도서들 : 천자서평4(千字書評): 아동중심 놀이치료

( Rose Vanfleet ),권운정(역) 한국상담선교연구원 2014 상담과 선교 Vol.82 No.-

경경정맥 간내문맥 정맥단락술에 사용한 비피막형 스텐트와 Expanded Polytetrafluoroethylene 피막형 스텐트의 개통률과 임상결과의 비교

서영우,원영철,황재철,강병성,권운정,신상훈,남미정,양지연,최성훈 대한영상의학회 2013 대한영상의학회지 Vol.69 No.2

Purpose: The purpose of this study is to compare shunt patency and clinical outcomes between bare stents and expanded polytetrafluoroethylene (ePTFE) covered stents in patients who had undergone transjugular intrahepatic portosystemic shunt (TIPS) creation. Materials and Methods: 43 consecutive patients with active gastroesophageal variceal bleeding who had undergone de novo TIPS creation were included in this study. For TIPS creation, bare stents were placed in twenty patients (Group 1) from January 2001 to December 2003, while ePTFE-covered stents were placed in twenty-three patients (Group 2) from January 2004 to December 2007. The primary and secondary patency rates of TIPS along with the clinical outcome were assessed, and a comparison was made between the two groups. Results: The technical success rate was 100%. Cumulative primary shunt patency rate in Group 1 was 78.5%, 55.8%, and 45.8% at 6, 12, and 24 months, respectively, and in Group 2, 91.1%, 86.0%, and 79.9%, respectively (p = 0.009). Cumulative secondary shunt patency rate in Group 1 was 86.3%, 70.7%, and 64.3%, respectively, and in Group 2, 91.1%, 91.1%, and 85.0%, respectively (p = 0.022). Conclusion: The use of ePTFE-covered stents particularly designed to spare the juxtacaval segment of the hepatic vein resulted in an improved patency of shunts compared to using bare stents. 목적: 위식도 정맥류 출혈 치료를 위한 transjugular intrahepatic portosystemic shunt (TIPS) 시술시, 간정맥-하대정맥 이행부 보존을 위해 사용된 expanded polytetrafluoroethylene (ePTFE) 피막형 스텐트와 비피막형 스텐트의 개통률을 비교하여 ePTFE 피막형 스텐트의 유용성을 알아보고자 한다. 대상과 방법: 위식도 정맥류 출혈을 치료하기 위해 de novo TIPS를 시행한 43명의 환자가 대상이며, 2001년 1월부터 2003년 12월까지 20명의 환자는 비피막형 스텐트를 사용하였고(Group 1), 2004년 1월부터 2007년 12월까지 23명의 환자는 스텐트 양측 끝에 2 cm의 비피막부가 있는 ePTFE 피막형 스텐트를 사용하였다(Group 2). 두 군 간의 일차 개통률, 이차 개통률 및 임상결과를 비교하였다. 결과: 평균 추적관찰 기간은 985일이었으며, 모든 환자에서 기술적 성공을 하였다. 30일 내 재출혈은 Group 1에서 3명, Group 2에서 2명이 있었으나 통계적 차이는 없었다. 일차 개통률은 Group 1에서 78.5%, 55.8%, 45.8%(6개월, 12개월, 24개월)였고, Group 2에서 91.1%, 86.0%, 79.9%로 통계적으로 유의한 차이가 있었으며(p = 0.009), 이차 개통률은 Group 1에서 83.6%, 70.7%, 64.3%였고, Group 2에서 91.1%, 91.1%, 85.0%로 통계적으로 유의한 차이가 있었다(p = 0.022). 결론: 간정맥-하대정맥 이행부를 보존하기 위하여 제작된 ePTFE 피막형 스텐트는 비피막형 스텐트와 비교하여 우수한 개통률을 보여주며, 위식도 정맥류 출혈의 치료를 위한 TIPS 시술에 효과적이며 유용하다.

Development of Coronary Vasospasm during Adenosine-Stress Myocardial Perfusion CT Imaging

남정구,최성훈,강병성,방민서,권운정 대한영상의학회 2015 Korean Journal of Radiology Vol.16 No.3

Adenosine is a short-acting coronary vasodilator, and it is widely used during pharmacological stress myocardial perfusion imaging. It has a well-established safety profile, and most of its side effects are known to be mild and transient. Until now, coronary vasospasm has been rarely reported as a side effect of adenosine during or after adenosine stress test. This study reports a case of coronary vasospasm which was documented on stress myocardial perfusion CT imaging during adenosine stress test.

Thoracic Splenosis: A Case Report and the Importance of Clinical History

김경은,최혜정,김영민,권운정,이원찬,서재희 대한의학회 2010 Journal of Korean medical science Vol.25 No.2

We present a case of thoracic splenosis in a 42-yr-old man with a medical history of abdominal surgery for a penetration injury with an iron bar of the left abdomen and back. He had been in good condition, but a chest radiograph taken during a regular checkup showed a multinodular left pleura-based mass. Computed tomography (CT) showed that the mass was well-enhanced and homogeneous, indicating a sclerosing hemangioma. Following its removal by video-assisted thoracoscopic surgery, the mass appeared similar to a hemangioma, with marked adhesion to the left side diaphragmatic pleura and lung parenchyma. Frozen section showed that the lesion was a solid mass consisted with abundant lymphoid cells, suggesting a low grade lymphoma. On permanent section, however, the mass was found to be composed of white pulp, red pulp, a thick capsule and trabeculae and was diagnosed as ectopic splenic tissue, or thoracic splenosis. Review of the patient’s history and chest CT at admission revealed that the patient had undergone a splenectomy for the penetration injury 20 yr previously.