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Johnson Ryan M.,Young Michael,Guglielmi Gina N.,Farhat Hamad 대한뇌혈관외과학회 2021 Journal of Cerebrovascular and Endovascular Neuros Vol.23 No.2
Iatrogenic vessel perforation from endovascular intervention is a devastating complication that commonly is treated with vessel sacrifice. We present a unique case of an iatrogenic proximal basilar artery perforation after submaximal angioplasty in a 67-year-old male presenting with an acute basilar artery occlusion with underlying intracranial atherosclerotic disease. Telescoping flow-diverting stents were then deployed to reconstruct the vessel wall with resulting active hemorrhage resolution. Our case documents a successful deployment of flow-diverting stents with resolution of active hemorrhage after an iatrogenic basilar artery perforation.
스위스 Mont Terri 지하연구시설 단층 내 유체 주입시험 모델링: 국제공동연구 DECOVALEX-2019 Task B(Step 2)
박정욱(Jung-Wook Park),Yves Guglielmi,Bastian Graupner,Jonny Rutqvist,박의섭(Eui-Seob Park) 한국암반공학회 2019 터널과지하공간 Vol.29 No.3
본 연구에서는 TOUGH-FLAC 연동해석기법을 이용하여 Mont Terri 지하연구시설에서 수행된 단층 내 물 주입시험을 수치적으로 모델링하고, 단층의 재활성과 수리역학적 거동 특성을 살펴보았다. TOUGH2 해석에서는 단층을 Darcy의 법칙과 삼승법칙(Cubic law)을 따르는 연속체 요소로 모델링하였으며, FLAC3D 해석에서는 미끄러짐과 개폐가 허용되는 불연속 인터페이스 요소를 통해 모사하였다. 현장에서 획득한 단층의 균열개방압력(fracture opening pressure), 주입율, 모니터링 압력, 변위 곡선 등을 바탕으로, 단층의 탄성적 변형과 파괴에 의한 수직팽창 특성을 반영할 수 있는 수리간극모델과 수리역학 커플링 관계를 해석모델에 반영하였다. 한편, 현지응력 조건, 단층의 강도 및 변형 특성에 따른 파라미터 해석을 실시하여 각 입력변수가 해석 결과에 미치는 영향을 분석하였으며, 이를 통해 현장시험 결과를 가장 잘 재현할 수 있는 파라미터 조합을 선정하였다. 해석 결과, 균열개방압력에서 단층의 주입율과 모니터링 압력이 크게 증가하는 현상을 합리적으로 재현할 수 있었다. 하지만, 동일한 입력 변수 조건에서 단층의 전단변위와 파괴영역의 범위는 현장시험 결과에 비해 과대평가되는 결과를 보였다. 이는 해석모델에서는 고압의 주입조건에서 단층의 지속적인 전단파괴가 유도되는 반면, 현장에서는 수리간극의 변화가 전단 미끄러짐보다는 인장력에 의한 단층면의 개방(tensile opening)에 크게 의존하는 것으로 추정되기 때문이다. We simulated the fault reactivation experiment conducted at ‘Main Fault’ intersecting the low permeability clay formations of Mont Terri Underground Research Laboratory in Switzerland using TOUGH-FLAC simulator. The fluid flow along a fault was modelled with solid elements and governed by Darcy"s law with the cubic law in TOUGH2, whereas the mechanical behavior of a single fault was represented by creating interface elements between two separating rock blocks in FLAC3D. We formulate the hydro-mechanical coupling relation of hydraulic aperture to consider the elastic fracture opening and failure-induced dilation for reproducing the abrupt changes in injection flow rate and monitoring pressure at fracture opening pressure. A parametric study was conducted to examine the effects of in-situ stress condition and fault deformation and strength parameters and to find the optimal parameter set to reproduce the field observations. In the best matching simulation, the fracture opening pressure and variations of injection flow rate and monitoring pressure showed good agreement with field experiment results, which suggests the capability of the numerical model to reasonably capture the fracture opening and propagation process. The model overestimated the fault displacement in shear direction and the range of reactivated zone, which was attributed to the progressive shear failures along the fault at high injection pressure. In the field experiment results, however, fracture tensile opening seems the dominant mechanism affecting the hydraulic aperture increase.
유체 주입을 동반한 절리 암반의 수리-역학 특성 평가에 대한 고찰
김형목(Hyung-Mok Kim),Yves Guglielmi,Jonny Rutqvist,박의섭(Eui-Seob Park) 한국암반공학회 2019 터널과지하공간 Vol.29 No.1
최근의 이산화탄소 심지층 처분, 인공지열저류층 형성 및 발전, 원유회수증진 사업 등에는 고압의 유체를 주입하는 과정이 수반되고 이들 사업의 안전하고 성공적인 수행을 위해서는 대상 부지 절리 암반의 투수 특성 및 주입압에 의한 역학적 변형에 기인한 변화를 정확하게 평가하는 것이 중요하다. 본 고에서는 절리 암반 수리-역학 특성 파악을 위한 해석적 및 실험적 평가 방법에 대해 검토하였다. 먼저 유체 주입 전 절리 암반 초기 투과 특성 및 수리-역학 특성 평가에 고려해야 할 기술요소를 분석하고 현장 시추공실험을 통해 이들 수리-역학 특성을 직접 측정하기 위한 최근의 SIMFIP 실험장치의 특징 및 활용방안에 대해서도 검토하였다. Permeability and its change due to a fluid injection in jointed rock mass is an important factor to be well identified for a safe and successful implementation of Carbon Capture and Sequestration (CCS), Enhanced Geothermal System (EGS) and Enhanced Oil Recovery (EOR) projects which may accompany injection-induced hydromechanical deformation of the rock mass. In this technical report, we first reviewed important issues in evaluating initial permeability using borehole hydraulic tests and numierical approaches for understanding coupled hydromechanical properties of rock mass. Recent SIMFIP testing device to measure these hydromechanical properties directly through in-situ borehole experiments was also reviewed. The technical significance and usefulness of the device for further applications was discussed as well.
Endoscopic Ultrasound Through-the-Needle Biopsy for the Diagnosis of an Abdominal Bronchogenic Cyst
Jessica Cassiani,Stefano Francesco Crinò,Erminia Manfrin,Matteo Rivelli,Armando Gabbrielli,Alfredo Guglielmi,Corrado Pedrazzani 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.5
A 57-year-old woman with epigastric pain was diagnosed with a 6-cm abdominal cystic lesion of unclear origin on cross-sectionalimaging. Endoscopic ultrasound (EUS) demonstrated a unilocular cyst located between the pancreas, gastric wall, and left adrenalgland, with a regular wall filled with dense fluid with multiple hyperechoic floating spots. A 19-G needle was used to puncture thecyst, but no fluid could be aspirated. Therefore, EUS-guided through-the-needle biopsy (EUS-TTNB) was performed. Histologicalanalysis of the retrieved fragments revealed a fibrous wall lined by “respiratory-type” epithelium with ciliated columnar cells,consistent with the diagnosis of a bronchogenic cyst. Laparoscopic excision was performed, and the diagnosis was confirmed basedon the findings of the surgical specimen. Abdominal bronchogenic cysts are extremely uncommon, and a definitive diagnosis iscommonly obtained after the examination of surgical specimens due to the lack of pathognomonic findings on cross-sectionalimaging and poor cellularity on EUS-guided fine-needle aspiration cytology. EUS-TTNB is useful for establishing a preoperativehistological diagnosis, thus supporting the decision-making process.
Cristian Conti,Corrado Pedrazzani,Giulia Turri,Eduardo Fernandes,Enrico Lazzarini,Raffaele De Luca,Alessandro Valdegamberi,Andrea Ruzzenente,Alfredo Guglielmi 대한대장항문학회 2021 Annals of Coloproctolgy Vol.37 No.3
Purpose: Laparoscopic complete mesocolic excision (CME) right colectomy is a technically demanding procedure infre- quently employed in Western centers. This retrospective cohort study aims to analyze the safety of laparoscopic CME col- ectomy compared to standard colectomy for right-sided colon cancer in a Western series. Methods: Prospectively collected data from 60 patients who underwent laparoscopic CME right colectomy were com- pared to the ones of 55 patients who underwent laparoscopic standard right colectomy. Results: No differences in clinical characteristics were observed between the CME and standard right colectomy groups. No differences were demonstrated in terms of blood loss (P = 0.060), intraoperative complications (P = 1), conversion rate (P = 0.102), and operative time (P = 0.473). No deaths were observed in either group, while complication rate was 40.0% in the CME and 49.1% in the standard group (P = 0.353). Severe complications occurred in 10.0% vs. 9.1% (P = 0.842), redo surgery in 5.0% vs. 7.3% (P=0.708), and unplanned readmission in 5.0% vs. 5.5% (P=1) after CME and standard colec- tomy, respectively. A significant difference in favor of CME was observed in the total length of specimen (P < 0.001), prox- imal (P=0.018), and distal margins (P=0.037). The number of lymph nodes harvested was significantly higher in the CME group (27 vs. 22, P = 0.037). Conclusion: In Western series, where patients have less favorable clinical characteristics, laparoscopic CME allows to ob- tain better quality surgical specimens and comparable short-term outcomes compared to standard right colectomy.
Li Shean Toh,Pauline Siew Mei Lai,David Bin-Chia Wu,Brian G. Bell,Cuu Phuong Linh Dang,Bee Yean Low,Kok Thong Wong,Giuseppe Guglielmi,Claire Anderson 대한골다공증학회 2019 Osteoporosis and Sarcopenia Vol.5 No.3
Objectives: To compare and assess the performance of 6 osteoporosis risk assessment tools for screening osteoporosis in Malaysian postmenopausal women. Methods: Six osteoporosis risk assessments tools (the Simple Calculated Osteoporosis Risk Estimation [SCORE], the Osteoporosis Risk Assessment Instrument, the Age Bulk One or Never Estrogen, the body weight, the Malaysian Osteoporosis Screening Tool, and the Osteoporosis Self-Assessment Tool for Asians) were used to screen postmenopausal women who had not been previously diagnosed with osteoporosis/osteopenia. These women also underwent a dual-energy X-ray absorptiometry (DXA) scan to confirm the absence or presence of osteoporosis. Results: A total of 164/224 participants were recruited (response rate, 73.2%), of which only 150/164 (91.5%) completed their DXA scan. Sixteen participants (10.7%) were found to have osteoporosis, whilst 65/150 (43.3%) were found to have osteopenia. Using precision-recall curves, the recall of the tools ranged from 0.50 to 1.00, whilst precision ranged from 0.04 to 0.14. The area under the curve (AUC) ranged from 0.027 to 0.161. The SCORE had the best balance between recall (1.00), precision (0.04e0.12), and AUC (0.072e0.161). Conclusions: We found that the SCORE had the best balance between recall, precision, and AUC among the 6 screening tools that were compared among Malaysian postmenopausal women.