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- 저자 : 김만득 ( Man Deuk Kim ) (검색결과 12 건)
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돼지에서의 장과 간 사이 Coda 및 Bakri 풍선의 삽입: A FeasibilityStudy
김만득 ( Man Deuk Kim ) 대한간암학회 2015 대한간암학회지 Vol.15 No.2
Background/Aims: To investigate the feasibility of Bakri balloon and Coda balloon placement as a spacer between the liver and bowels using a swine model. Methods: Six adult female swine weighing from 24.0 to 41.5 kg (mean, 31.5 kg) were included for the study. After peritoneal puncture using a 21-G micro-puncture needle under ultrasound and fluoroscopic guidance, a 0.035-inch guidewire (Terumo, Tokyo, Japan) was advanced through the micro-introducer sheath. With sequential dilation of the tract with dilators up to 18-Fr or 10 mm balloon, the Coda and Bakri balloon was advanced between the liver and bowels. 50 mL and 200 mL of contrast were inflated for Coda and Bakri balloon, respectively. Gross examinations focused on whether placement of the Coda or Bakri balloon was at the correct location. Results: Technical success was achieved for Coda balloon placement in six of the six (100%) swine, and for Bakri balloon placement in five of the six (83.3 %) swine. The median placement time for the Coda balloon was 10 minutes (range, 7-15 minutes), while the median placement time for the Bakri balloon was 25 minutes (range, 17-35 minutes), which was significantly longer (p<0.05). Gross observations at necropsy revealed that the Coda and Bakri balloon was well placed between the liver and bowel. Conclusions: Placement of Coda and Bakri balloons between the liver and bowels was feasible. These balloons have a potential role as spacers between the liver and bowel during radiation therapy for hepatocellular carcinoma patients. (J Liver Cancer 2015;15:106-111)
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폐렴간균 간농양의 임상 및 CT 소견: 비폐렴간균 간농양과의 비교1
우영근,김만득,김현,이강문,윤상욱,김희진,하두희,이은자,Woo, Young-Geun,Kim, Man-Deuk,Kim, Hyun,Lee, Kang-Mun,Yoon, Sang-Wook,Kim, Hee-Jin,Ha, Doo-Hoe,Lee, Eun-Ja 대한영상의학회 2003 대한영상의학회지 Vol.48 No.3
목적: 폐렴간균에 의한 간농양의 임상 및 CT 소견을 분석하고 다른 균주에 의한 간농양의 임상 및 CT 소견을 비교하여 감별점을 찾고자 하였다. 대상과 방법: CT 검사를 시행하고 세균학적으로 확진 된 21예의 화농성 간 농양 환자를 대상으로 클레브시엘라군과 비클레브시엘라군으로 나누어 후향적으로 분석하였다. 입원 당시 의무기록을 조사하여 당뇨 유무, 혈청 alkaline phosphatase(ALP), SGOT, SGPT등의 상승, 동반되어있는 복강 내 이상소견과의 연관성을 조사하였다. CT 상에서는 농양강의 단일성 (single) 혹은 다발성 (multiple), 다강 연속성/비연속성 여부 (multiple contiguous/ discontiguous), 공동의 생성모양에 따라 단방성 (uniloculated)혹은 다방성 (multiloculated), 농양강내 가스 형성, 주위 간 실질 및 테두리 조영증강 여부를 알아보았다. 통계분석은 Fisher ’s exact test를 사용하였다. 결과: 21예 중 11예에서 폐렴간균 (Klebsiella pneumoniae)이 동정 되었고 Pseudomonas (n=3) E. coli(n=2), Enterococus(n=2), Gram positive cocci (n=2), polymicrobial (n=1)순이었다. 당뇨병이 클레브시엘라군에 더 많았고 (n=7,p=0.024). 담도 질환이 동반되어 있던 경우는 비클레브시엘라군에서 총 5명이었으며 클레브시엘라군에서는 한명도 없었다 (p=0.012). 단일강(n=10,p=0.047), 다방성(n=8, p<0.01)은 클레브시엘라군에서 많이 발견되었고, 간주위 조영증강 (n=7)은 비클레브시엘라군에서 자주 관찰되었다(p<0.01). 결론: 폐렴 간균이 화농성 간농양의 주 감염균이고 이는 특히, 당뇨가 있는 환자에서 많이 발견되었으며 특징적인 CT 소견은 단일, 다방성 농양을 보이며 동반되는 담도 질환이 드물고 농양주위 간 실질 조영증강이 잘되지 않는다는 점이다. Purpose: To analyse the clinical features and CT findings of pyogenic liver abscess due to Klebsiella pneumoniae, and to compare the findings with those of cases in which abscesses were caused by other pathogens. Materials and Methods: Twenty-one cases of pyogenic liver abscess were assigned to either the Klebsiella or the non-Klebsiella group, and the patients' past medical history and intra-abdominal abnormalities such as calculus or malignancy were reviewed. Laboratory data such as alkaline phosphatase (ALP), SGOT and SGPT levels were analyzed, and on the basis of the CT findings, decisions were reached as to (a) whether abscesses were single or multiple, multiple contiguous or discontiguous, uniloculated or multiloculated; and (b) the presence or absence of gas, hepatic parenchymal enhancement, peripheral rim enhancement, and extrahepatic abnormality. For statistical analysis, Fisher's exact test was used. Results: Among 21 abscesses, Klebsiella pneumoniae was the most common pathogen (n=11). The others were Pseudomonas (n=3), E.coli (n=2), Enterococcus (n=2), G. (+) cocci (n=2) and Polymicrobial (n=1). Diabetes mellitus was more common among patients in the Klebsiella group, among whom a multiloculated single cavity was a frequent finding. Five patients in the non-Klebsiella group experienced biliary tract obstruction, which was not demonstrated in the Klebsiella group. Hepatic parenchymal enhancement was more common in the non-Klebsiella group. Conclusion: In cases of pyogenic liver disease, especially where diabates mellitus is involved, Klebsiella pneumoniae is a major pathogen. Significant CT findings of Klebsiella liver abscess included a multiloculated single cavity, rare biliary tract obstruction, and little hepatic parenchymal enhancement.
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복부 대동맥류의 합병증에 기인한 대동맥-하대정맥루: 1예 보고
정봉각,김현,강시원,김만득,Jeong, Bong-Gak,Kim, Hyun,Kang, Si-Won,Kim, Man-Deuk 대한영상의학회 2002 대한영상의학회지 Vol.46 No.1
대동정맥루는 복부 대동맥류의 드문 합병증으로 임상적으로 진단이 어려울 수 있지만 특징적인 방사선학적 소견이 진단에 도움을 줄 수 있다. 즉, 대동맥류 환자에서 갑작스러운 울혈성 심부전의 발생과 함께 조영증강 복부 CT상 동맥기에 대동맥과 하대정맥이 동시에 조영증강되고 하대정맥 내경이 늘어나 있는 것이다. 저자들은 신동맥 하방에 발생한 복부 대동맥류가 대동정맥루를 일으킨 1예를 경험하였기에 문헌고찰과 함께 방사선학적 소견을 보고한다. Aortocaval fistula is a rare complication arising from an abdominal aortic aneurysm. A typical feature observed during the arterial phase of contrast-enhanced CT scanning in such patients is simultaneous enhancement of the dilated inferior vena cava and aorta. Awareness of the specific radiologic features of aortocaval fistula may facilitate diagnosis when the condition is unsuspected clinically. We report a case of aortocaval fistula secondary to abdominal aortic aneurysm, and review the previous literature.
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혈역학적으로 불안정한 골반골 골절에서의 동맥 색전술의 유용성
윤형구 ( Hyung Ku Yoon ),김만득 ( Man Deuk Kim ),한수홍 ( Soo Hong Han ),김병국 ( Byung Kuk Kim ),안태근 ( Tae Keun Ahn ) 대한고관절학회 2008 Hip and Pelvis Vol.20 No.2
목적: 혈관 손상에 의해 혈역학적으로 불안정한 골반골 골절에서 혈관 조영술 및 동맥 색전술의 유용성 및 적절한 시술 시기에 대하여 알아보고자 하였다. 대상 및 방법: 2002년 5월부터 2007년 2월까지 골반골 골절로 입원했던 환자 중 혈관 조영술 및 동맥 색전술을 시행하였던 환자 19례를 대상으로 혈압, 맥박, 혈색소 수치, 프로트롬빈 시간, 부분 트롬보플라스틴 시간, 혈소판 수치에 대하여 응급실 내원당시, 혈관 조영술 및 동맥 색전술을 시행 하기 직전, 시행 후의 세 시기로 나누어 후향적으로 비교 연구 하였고 이에 따른 통계적 분석은 repeated measures analysis of variance을 사용하였다. 결과: 혈압은 동맥 색전술을 시행한 후의 결과가 시행전과 비교하였을 때 유의하게 회복되는 것을 보였고, 혈색소 수치와 프로 트롬빈 시간은 응급실 도착시와 동맥색전술 시행전에는 통계학적으로 유의하게 결과가 악화되다가 , 동맥색전술 시행전과 시행 후, 통계학적으로 유의하게 회복되는 것을 보였다. 부분 트롬보플라스틴 시간, 혈소판 수치는 응급실 도착 시와 동맥 색전술을 시행하기 전까지 유의하게 악화되는 소견을 보였다. 결론: 혈압, 혈색소 수치, 프로트롬빈 시간, 부분 트롬보플라스틴 시간, 혈소판 수치의 변화가 빠르나 수액 및 수혈 요법에 반응하지 않는 혈역학적으로 불안정성 골반골 골절은 혈관 조영 및 동맥 색전술을 진단 및 치료 방법으로 고려해 볼 수 있다. Purpose: To assess the effectiveness and appropriate time for arterial embolization with angiography in patients who sustained a hemodynamically unstable pelvic bone fracture Materials and methods: Nineteen cases with hemodynamically unstable pelvic bone fractures that were managed with arterial embolization out of 287 pelvic bone fractures between May, 2002 and February, 2007 were reviewed retrospectively. The blood pressure, pulse rate, hemoglobin, prothrombin time, partial prothrombin time and platelet checked were evaluated immediately after arrival at the emergency room, before and after embolization. Repeated measures analysis of variance was used for the statistical evaluation. Results: The blood pressure showed a statistically significant increase from before and after embolization. The hemoglobin and prothrombin time checked upon arrival were significantly lower than those checked before embolization. In addition, the hemoglobin and prothrombin time was significantly higher before embolization than after embolization. The partial thromboplastin time and platelet checked immediately upon arrival were significantly lower than those checked before embolization. Conclusion: Interventional angiography and embolization can be an effective treatment modality in patients with hemodynamically unstable pelvic bone fractures showing rapid changes in the hemoglobin level, prothrombin time, partial thromboplastin time and platelet count but little response to fluid and transfusion resuscitation,.
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새로운 경구용 항응고제 사용 중 발생한 하대정맥 필터의 혈전성 폐쇄
박동혁 ( Dong Hyuk Park ),김만득 ( Man-deuk Kim ),이상학 ( Sang-hak Lee ) 대한내과학회 2016 대한내과학회지 Vol.90 No.6
A 68-year-old woman presented with chest pain and dyspnea and was diagnosed with a massive pulmonary embolism. Bleeding colon cancer was detected incidentally during anticoagulation therapy. After stabilization, she underwent surgical resection of the cancer with insertion of an inferior vena cava filter and was treated with rivaroxaban as antithrombotic therapy thereafter. Unexpectedly, thrombotic obstruction of the filter was revealed on a computed tomography scan taken in preparation for removing the device. After switching to warfarin, the obstruction had resolved at the 4-week follow-up examination. We discuss what to consider when performing antithrombotic therapy in patients with an inferior vena cava filter. (Korean J Med 2016;90:524-527)
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객혈 환자에서 기관지경술이나 기관지동맥색전술 시행 전의 다중절편 전산화 단층촬영의 유용성
이신재 ( Shin Jae Lee ),노지영 ( Ji Young Rho ),유승민 ( Seung Min Yoo ),김만득 ( Man Deuk Kim ),이지현 ( Ji Hyun Lee ),김은경 ( Eun Kyung Kim ),조영아 ( Young Ah Cho ),이상민 ( Sang Min Lee ) 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.68 No.2
Background: Recently, many institutions have acquired multi-detector computed tomography (MDCT) systems. This made it easier and more convenient to use MDCT as a initial diagnostic modality for hemoptysis. The purpose of this study was to evaluate the usefulness of MDCT before bronchoscopy and/or bronchial arterial embolization (BAE) for hemoptysis. Methods: We studied a total of 125 patients with hemoptysis who underwent, between 2006 and 2008, MDCT in a routine protocol before bronchoscopy and/or BAE. One hundred two patients underwent bronchoscopy and 29 patients underwent BAE. We compared the usefulness of MDCT and bronchoscopy for detecting the bleeding site and identifying the cause. We also evaluated our ability, using MDCT, to detect instances where the bronchial artery caused hemoptysis. Results: The rate of detection of a bleeding site was 75.5% on MDCT and 50.9% on bronchoscopy. MDCT and bronchoscopy detected the bleeding site in agreement in 62.7% of patients. MDCT alone found the bleeding site in 27.5% of cases. MDCT identified the cause of hemoptysis in 77.5% and bronchoscopy in 11.8%. In 29 patients who underwent BAE, we detected a total of 37 hypertrophied bronchial arteries that were causing hemoptysis. Of 37 bronchial arteries, 23 (62.2%) were depicted on MDCT. Conclusion: MDCT is superior to bronchoscopy for detecting the bleeding site and identifying the cause of hemoptysis. MDCT can also predict the side of affected bronchial artery with depiction of hypertrophied bronchial artery and localizing the bleeding site. Doing MDCT before bronchoscopy and BAE can provide a guideline for the next step.
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