코로나19 대유행이 소아 합병 충수돌기염 발병률에 미치는 영향 비교연구

제환준,정동길,송금종,문형준,이동욱,김도의,이현정,김현준 대한응급의학회 2022 대한응급의학회지 Vol.33 No.3

Objective: After the coronavirus disease 2019 (COVID-19) outbreak, there have been some changes in the way the medical system deals with suspected infectious diseases. These changes may also affect non-COVID-19 patients. Acute appendicitis is a common disease that requires emergent surgical intervention in pediatric patients, and delayed diagnosis and treatment may cause some complications. This study analyzed the impact of the COVID-19 pandemic on the incidence of complicated appendicitis in pediatric patients presenting to emergency departments in South Korea. Methods: The target group (post-COVID group) included patients aged under 15 years and diagnosed with acute appendicitis between February 23 and November 30, 2020. Patients diagnosed during the same period in 2019 were selected as the control group (pre-COVID group). The difference in the incidence of complicated appendicitis before and after the COVID-19 outbreak was investigated, and the association with various variables was analyzed using the odds ratios and 95% confidence intervals. Results: The study enrolled a total of 94 patients: 54 in the pre-COVID group and 40 in the post-COVID group. There was no statistically significant variation in the incidence of complicated appendicitis (31.5% vs 35.0%, P=0.723) between the groups. In-hospital time was longer in the post-COVID group (7 hours vs. 10.5 hours, P=0.014), but pre-hospital time showed no significant difference (16 hours vs. 22 hours, P=0.768). In the multivariable logistic regression analysis, prehospital time (odds ratio [OR], 1.08; P=0.004), erythrocyte sedimentation rate (OR, 33.24; P<0.001), and the presence of fever (OR, 21.11, P=0.002) showed a significant correlation. Conclusion: Post the COVID-19 pandemic outbreak, there was no difference in the incidence of pediatric complicated appendicitis in South Korea.

하지의 폐색성 혈관질환에서 표재대퇴동맥의 도플러 파형과 혈관조영소견의 비교

제환준,고영환,김경원,김현범,정진욱,박재형 대한초음파의학회 2000 ULTRASONOGRAPHY Vol.19 No.3

The Antitumor Effect and Hepatotoxicity of a Hexokinase II Inhibitor 3-Bromopyruvate: In Vivo Investigation of Intraarterial Administration in a Rabbit VX2 Hepatoma Model

제환준,정진욱,이민종,김효철,윤정환,정혜선,박재형,이기창,박희선 대한영상의학회 2009 Korean Journal of Radiology Vol.10 No.6

Objective: The purpose of this study was to compare the antitumor effect and hepatotoxicity of an intraarterial delivery of low-dose and high-dose 3-bromopyruvate (3-BrPA) and those of a conventional Lipiodol-doxorubicin emulsion in a rabbit VX2 hepatoma model. Materials and Methods: This experiment was approved by the animal care committee at our institution. VX2 carcinoma was implanted in the livers of 36 rabbits. Transcatheter intraarterial administration was performed using low dose 3- BrPA (25 mL in a 1 mM concentration, n = 10), high dose 3-BrPA (25 mL in a 5 mM concentration, n = 10) and Lipiodol-doxorubicin emulsion (1.6 mg doxorubicin/ 0.4 mL Lipiodol, n = 10), and six rabbits were treated with normal saline alone as a control group. One week later, the proportion of tumor necrosis was calculated based on histopathologic examination. The hepatotoxicity was evaluated by biochemical analysis. The differences between these groups were statistically assessed with using Mann-Whitney U tests and Kruskal-Wallis tests. Results: The tumor necrosis rate was significantly higher in the high dose group (93% ± 7.6 [mean ± SD]) than that in the control group (48% ± 21.7) (p = 0.0002), but the tumor necrosis rate was not significantly higher in the low dose group (62% ± 20.0) (p = 0.2780). However, the tumor necrosis rate of the high dose group was significantly lower than that of the Lipiodol-doxorubicin treatment group (99% ± 2.7) (p = 0.0015). The hepatotoxicity observed in the 3-BrPA groups was comparable to that of the Lipiodol-doxorubicin group. Conclusion: Even though intraarterial delivery of 3-BrPA shows a dose-related antitumor effect, single session treatment seems to have limited efficacy when compared with the conventional method.

PACS 웍스테이션에서 영상 후처리의 효과 : Dynamic Range Suppression(DRS)처리 전후의 정상 흉부 영상 비교

제환준 대한영상의학회 1999 대한영상의학회지 Vol.40 No.1

Purpose : To investigate the impact of post-processing on a PACS workstation before and after use of thedynamic range suppression method for the normal chest radiographs. Materials and Methods : Forty normal chestradiographs of healthy adult volunteers aged 20 to 33 (average 27; M:F = 29:11) were acquired by FCR using adigital interface and then transferred to an in-house-developed PACS workstation. The image size of computed chestradiographs was 7.5MB with 1760 x 2140 matrix. An image enhancement processing named DRS, developed by theauthors, was applied to the acquired images and generated a total of 40 chest radiographs. These were presented tothree groups of observers, each consisting of one radiologist and one technician on the PACS workstation, whichhad two monitors of 1712 x 2100 resolution. So that external light would not affect the visibility of imagesduring observation, these were displayed in a light-controlled room. The J.J.Vucich method, suitably modified, wasused to evaluate the anatomical structures and physical parameters of processed and unprocessed radiographs. Usinga percentage scale, the observers evaluated both anatomical sections (seven anatomical items : cortical margins ofribs, left diaphragms, thoracic vertebrae, trachea, pulmonary vasculature, trabeculae of ribs and clavicle,diaphragm outline) and physical sections (four items : contrast, graininess, density, detail). The results for thethree groups, both before and after DRS processing, were then compared. Results : There was a statisticallysignificant difference between the three groups: in the anatomical section, 78.64 before DRS and 82.55 after ; andin the physical section, 75.48 and 79.78 (p<0.05). The average values of all items were 77.06 before DRS and 81.17after (p<0.05). Conclusion : Post-processing of computed chest radiographs on the PACS workstation improves boththe visibility of anatomical features and general image quality. Thus, in a PACS environment, it can be a usefultool for enhancing the diagnostic efficacy of radiography.

Follow-up CT Evaluation of the Mural Changes in Active Takayasu Arteritis

제환준,박재형,정진욱,김효철,이활,소영호,김상영 대한영상의학회 2007 Korean Journal of Radiology Vol.8 No.4

Objective: We wanted to evaluate the mural changes by CT on the follow-up examination of patients with active Takayasu arteritis. Materials and Methods: The study included 18 patients, (4 males and 14 females), with active Takayasu arteritis. A total of 44 CT examinations were done during the follow-up period (mean: 55.6 months). At the time of the last follow-up CT, the disease, on the basis of the erythrocyte sedimentation rate (ESR), was found to be inactive in five patients and the disease was active and persistent in 13 patients. The thickness and CT attenuation of the aortic wall on the precontrast, arterial and venous phases were measured on the initial and the follow-up CT examinations. The ratio of the mural attenuation over that of the back muscle on the initial CT was compared with the ratio found on the follow-up CT. Results: The initial CT findings included high density and calcifications of the aortic wall in the precontrast images and a thickened wall with enhancements in the arterial and the venous phases. A low-attenuation ring was demonstrated in the venous phase in 15 patients (83%). On the follow-up evaluation, the mean mural thickness decreased significantly from 4.1 mm to 2.4 mm. The mean mural attenuation ratio in the venous phase decreased significantly from 1.9 to 1.3 (p =0.001). The low attenuation ring was identified in seven patients (39%) who had only with active, persistent Takayasu arteritis. Conclusion: The mural changes demonstrated by the follow-up CT evaluations for the patients with active Takayasu arteritis included a decrease of the mural thickness and enhancement, disappearance of the low-attenuation ring on the venous phase, and an increase of the mural attenuation and calcification on the precontrast phase.

좌내유동맥-관상동맥 우회술 환자에서 동반된 좌측 쇄골하동맥 협착에 대한 중재적 치료

제환준,박재형,신청일,이병진,조영권,정진욱 대한영상의학회 2006 대한영상의학회지 Vol.55 No.2

Purpose: We wanted to evaluate the clinical usefulness of percutaneous transluminal angioplasty (PTA) and stenting of left subclavian artery (LSA) stenosis in the patients with a left internal mammary artery (LIMA)-coronary artery bypass graft. Materials and Methods: From September 1998 to November 2005, significant proximal LSA stenoses were treated with PTA and stenting in 22 patients (15 men and 7 women) who had a prior LIMA-coronary artery bypass graft or who were willing to undergo LIMA-coronary artery bypass grafting. The technical success rates, complications and restenosis during the follow-up period were retrospectively evaluated. Results: Six patients had a prior LIMA bypass graft and 16 patients were treated before their coronary artery bypass surgery. The etiology of the LSA stenosis was atherosclerosis in all patients. Four patients were treated with PTA only, and stents were placed in 18 patients. Technical success was achieved in all patients. An embolism in the proximal LIMA occurred after stenting in one patient, and the LIMA was recanalized with transcatheter thrombolysis. During a mean follow-up of 30 months, only one patient was found to have recurrent LSA stenosis 29 months after stenting and this patient was successfully managed with angioplasty. Conclusion: Endovascular therapy is useful and efficacious for the treatment of LSA stenosis in patients with a LIMA-coronary artery bypass graft. 목적: 좌내유동맥-관상동맥 우회술을 시행 받았거나 받을 예정인 환자에게서 동반된 좌측 쇄골하동맥 협착에 대해 경피경관 혈관성형술과 스텐트 삽입술을 이용한 중재적 치료의 임상적 유용성을 알아보고자 하였다. 대상과 방법: 1998년 9월부터 2005년 11월까지 좌측 쇄골하동맥 협착으로 경피경관 혈관성형술이나 스텐트 삽입술을 시행 받은 환자 중에 좌내유동맥-관상동맥 우회술을 시행 받았거나 받을 예정인 환자 총 22명(남: 여=15:7, 평균 69.3세)을 대상으로 하였다. 쇄골하동맥 협착에 대한 중재적 치료의 기술적 성공률, 합병증 및 재협착 여부를 후향적으로 조사하였다. 결과: 대상환자 중 좌내유동맥-관상동맥 우회술을 시행 받은 환자는 6명, 받을 예정인 환자는 16명이었다. 좌측 쇄골하동맥의 협착원인은 모두 동맥경화성 병변이었다. 혈관성형술은 4예, 스텐트 삽입술은 18예에서 시행되었고 모든 예에서 기술적 성공을 보였다. 스텐트 삽입술 후 1예에서 좌내유동맥의 색전증이 발생하였으나 동맥 내 혈전용해제의 투여로 재개통되었다. 평균 30개월의 추적 관찰 기간 중, 1예에서 스텐트 삽입 29개월 후에 재협착이 발생하였으며 경피경관 혈관성형술로 치료하였다. 나머지 예에서는 심각한 합병증이나 재협착의 증거가 없었다. 결론: 좌내유동맥-관상동맥 우회술 환자에서 동반된 좌측 쇄골하동맥 협착에 대해 경피경관 혈관성형술과 스텐트 삽입술을 이용한 중재적 치료는 유용하고 효과적인 치료방법이다.

Transcatheter Arterial Embolization of Nonvariceal Upper Gastrointestinal Bleeding with N-Butyl Cyanoacrylate

제환준,정진욱,정아영,이활,박재형 대한영상의학회 2007 Korean Journal of Radiology Vol.8 No.1

Objective: To evaluate the clinical efficacy and safety of transcatheter arterial embolization (TAE) with N-Butyl Cyanoacrylate (NBCA) for nonvariceal upper gastrointestinal bleeding. Materials and Methods: Between March 1999 and December 2002, TAE for nonvariceal upper gastrointestinal bleeding was performed in 93 patients. The endoscopic approach had failed or was discarded as an approach for control of bleeding in all study patients. Among the 93 patients NBCA was used as the primary embolic material for TAE in 32 patients (28 men, four women; mean age, 59.1 years). The indications for choosing NBCA as the embolic material were: inability to advance the microcatheter to the bleeding site and effective wedging of the microcatheter into the bleeding artery. TAE was performed using 1:1 1:3 mixtures of NBCA and iodized oil. The angiographic and clinical success rate, recurrent bleeding rate, procedure related complications and clinical outcomes were evaluated. Results: The angiographic and clinical success rates were 100% and 91% (29/32), respectively. There were no serious ischemic complications. Recurrent bleeding occurred in three patients (9%) and they were managed with emergency surgery (n = 1) and with a successful second TAE (n = 2). Eighteen patients (56%) had a coagulopathy at the time of TAE and the clinical success rate in this group of patients was 83% (15/18). Conclusion: TAE with NBCA is a highly effective and safe treatment modality for nonvariceal upper gastrointestinal bleeding, especially when it is not possible to advance the microcatheter to the bleeding site and when the patient has a coagulopathy.

영상의학 검사와 인터벤션

제환준(Hwan Jun Je) 한국간담췌외과학회 2007 한국간담췌외과학회지 Vol.11 No.2

급성 출혈 환자에서 N-Butyl Cyanoacrylate를 이용한 경도관 동맥색전술의 유용성

제환준 ( Hwan Jun Jae ),김상윤 ( Sang Youn Kim ),이의중 ( Eui Jung Lee ),이활 ( Whal Lee ),서길준 ( Gil Joon Suh ) 대한외상학회 2005 大韓外傷學會誌 Vol.18 No.2

Background: N-Butyl Cyanoacrylate (NBCA) is a liquid embolic material that can be useful for transcatheter arterial embolization (TAE) of acute bleeding especially in patients with coagulopathy, because it does not depend on coagulation for its therapeutic effect. The aims of this study were to evaluate the clinical efficacy and safety of TAE with NBCA in acute bleeding patients. Methods: Between August 2003 and September 2004, TAE using NBCA for acute bleeding was performed in 23 patients (16 men, 7 women; mean age, 56.5years). The causes of bleeding were gastric ulcer (n=5), postoperative bleeding (n=4), post-biopsy bleeding (n=3), postpartum bleeding (n=3), duodenal ulcer (n=2), angiodysplasia (n=2), gastric lymphoma (n=1), iatrogenic injury (n=1), CMV gastritis (n=1), stab injury of the liver (n=1). TAE was performed using 1:3 mixtures of NBCA and iodized oil. The angiographic and clinical success rate, recurrent bleeding rate, procedure-related complication and clinical outcomes were evaluated. Results: The angiographic and clinical success rate was 100% and 91.3% (21/23), respectively. There was no serious ischemic complication. Recurrent bleeding occurred in 2 patients (8.7%) and they were managed with successful second TAE (n=1) and endoscopic treatment (n=1). Nine patients (39.1%) had coagulopathy at the time of TAE and clinical success rate in this group of patients was 88.9% (8/9). Conclusions: TAE with NBCA is highly effective and safe treatment modality for acute bleeding patients, especially when the patient has a coagulopathy.

Endovascular Treatment of a Saccular Aneurysm in the Celiomesenteric Trunk: A Case Report and Review of Literature

이신애,제환준,안상현,민상일,하종원,민승기 대한혈관외과학회 2018 Vascular Specialist International Vol.34 No.2

To present a world-first case of a successful endovascular treatment of a celiomesenteric trunk (CMT) aneurysm. A 45-year-old man had an asymptomatic saccular aneurysm in a rare anomaly of CMT. Endovascular multiple micro-coil embolization of the common hepatic artery, splenic artery and the aneurysm was done, followed by a stent-graft deployment in the superior mesenteric artery covering the orifice to the aneurysm. Postoperative course was uneventful. Only 21 cases have been previously reported in the literature, and all were treated by open surgeries. Endovascular therapy can be safely done in selected cases of a CMT aneurysm with sufficient collaterals to the liver and spleen.