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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.
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협측 공간 병변: CT와MR영상소견에 기초한 새로운 분류법
한문희,한문희,제환준,최혁재,김영준,김인원,장기현,Han, Mun-Hui,Han, Mun-Hui,Je, Hwan-Jun,Choe, Hyeok-Jae,Kim, Yeong-Jun,Kim, In-Won,Jang, Gi-Hyeon 대한영상의학회 2004 대한영상의학회지 Vol.50 No.2
목적: 협측 공간 병변의 CT와 MR 영상소견에 기초한 새로운 분류법을 소개하고, 협측 공간 병변의 감별진단에 지침을 제공하고자 한다. 대상과 방법: 조직병리학적 또는 임상적으로 진단된 62예의 협측 공간 병변을 대상으로 하였다. 모든 병변은 그 형태학적 모양과 주변 공간으로의 침범에 따라 다음과 같이 3가지 형으로 분류하였다. 협측 공간에 국한되어 있고 명확한 경계를 가진 경우를 1형, 협측 공간에 국한되어 있고 불명확한 경계를 가진 경우를 2형, 그리고 여러 공간을 동시에 침범한 경우를 3형으로 하였다. 결과: 다형성선종, carcinoma ex pleomorphic adenoma, B-cell 임파선암, 세엽세포암종, 횡문근육종, 사구종양, 사기질모세포종은 1형으로 분류되었고, 악성종양과 양성종양의 감별은 불가능하였다. 농양, 감염이 동반된 유피낭종, Kimura 병, 선낭종암은 2형으로 분류되었다. T-cell 임파선암, 신경섬유종, 혈관기형, 두경부 염증, 이물육아종은 3형으로 분류되었고, 각각은 다른 영상 소견을 보였다. 결론: CT와 MR 영상소견에 기초한 이 새로운 분류법은 협측 공간 병변의 감별진단에 지침이 될 수 있을 것으로 생각한다. Purpose: To present a new classification based on the CT and MR imaging findings of buccal space lesions, and to propose guidelines for their radiologic differentiation. Materials and Methods: Sixty-two histopathologically confirmed or clinically diagnosed buccal space lesions were classified on the basis of their morphologic appearance and extension to adjacent space as either (1) a mass with a distinct margin, confined to the buccal space; (2) a mass with surrounding infiltration, confined to the buccal space; or (3) a multi-space occupying mass. Results: Type 1 included pleomorphic adenoma, ex-pleomorphic adenoma, carcinoma, B-cell lymphoma, acinic cell carcinoma, rhabdomyosarcoma, glomus tumor and ameloblastoma, and differentiation between malignant and benign neoplasms was not possible. Type 2 included adenoid cystic carcinoma, abscess, complicated dermoid cyst, and Kimura disease. T-cell lymphoma, neurofibroma, vascular malformation, inflammation, and foreign body granuloma pertained to type 3, and each type-3 entity showed different imaging characteristics. Conclusion: This new classification based on CT and MR imaging characteristics may provide useful guidelines for predicting the differential diagnosis of buccal space lesions.
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외상성 골반 출혈환자에서 CT 혈관조영술 후 동맥 색전술을 시행하는 치료방침의 유용성: 단일 권역응급센터의 경험
이유진 ( Yu Jin Lee ),제환준 ( Hwan Jun Jae ),차원철 ( Won Chul Cha ),서준석 ( Jun Seok Seo ),김효철 ( Hyo Cheol Kim ),신청일 ( Cheong Il Shin ),신상도 ( Sang Do Shin ) 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.2
Purpose: This study was conducted to evaluate the effectiveness of the treatment strategy of transcatheter arterial embolization after pelvic CT angiography (CTA) in cases of traumatic pelvic hemorrhage. Methods: This is a retrospective analysis of pelvic hemorrhage patients who underwent transcatheter arterial embolization after pelvic CTA at our regional emergency center during a 31-month period. We reviewed the medical records and imagings of all these patients. Results: Transcatheter arterial embolization was performed in 17 patients (M:F=7:10, mean age=53.9) who underwent pelvic CTA for the evaluation of traumatic pelvic hemorrhage. Arterial bleeding was demonstrated on pelvic CTA in all patients, and the combined injury was also noted in 13 patients. The admission-to-CTA time was 84.53±66.92 minutes, and the CTA-to-embolization time was 147.65±99.97 minutes. Extravasation of contrast media or pseudoaneurysm was demonstrated on conventional angiography in all patients. Unilateral iliac artery embolization was performed in 8 patients, and bilateral iliac artery embolization was performed in 9 patients. Additional embolizations other than in the iliac arteries were performed in 7 patients. Initial hemostasis was achieved in 16 patients. One patient died of ongoing pelvic bleeding. Rebleeding occurred in only one patient and hemostasis was achieved with the second embolization. Another patient died of intracranial and facial bleeding in spite of pelvic hemostasis. The overall mortality was 11.8%, and there was no significant adverse effects in the other patients. Conclusion: Transcatheter arterial embolization after pelvic CTA is an effective treatment strategy in the management of traumatic pelvic hemorrhage patients. (J Korean Soc Traumatol 2009;22:184-92)
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