면역조직화학염색법을 이용한 정상 및 하지정맥류 환자의 대복재정맥벽에서의 Matrix Metalloproteinase 및 Tissue Inhibitor of Metalloproteinase의 발현도 분석

허승,권상휘,박태인,나목찬 대한혈관외과학회 2004 Vascular Specialist International Vol.20 No.1

The best vein to be accessed based on descriptive study of dorsal metacarpal vein

Muna A,Salameh,Amjad T,Shatarat,Darwish H,Badran,Mhmoud A,Abu-Abeeleh,Islam M,Massad,Amjad M,Bani-Hani 대한해부학회 2019 Anatomy & Cell Biology Vol.52 No.4

It is well known that the most common sites for venous access are the superficial veins of the upper limb, particularly dorsal metacarpal veins and median cubital vein. Although dorsal metacarpal veins are the first choice for venous cannulation, there is scarce information about their anatomic variation. Hence, detailed anatomical information about these veins will improve the anatomic knowledge of the health care providers. Subsequently, this study was designed to study the dorsal metacarpal veins and to determine the most prominent dorsal metacarpal vein. A cross sectional study of 402 subjects (804 hands), was prepared to study the superficial veins on the dorsum of the hand among Jordanian students and staff of one of the major governmental medical colleges in Jordan, by using infrared illumination system. The obtained data was analyzed according to sex, sidedness, and handedness. Six locations of the most prominent dorsal metacarpal veins were identified. There was a significant relation between both females and males and the most prominent dorsal metacarpal vein (P=0.01). For the first time this study identified the most common location of the most prominent dorsal metacarpal vein in the fourth intermetacarpal space.

The best vein to be accessed based on descriptive study of dorsal metacarpal vein

Muna A. Salameh,Amjad T. Shatarat,Darwish H. Badran,Mhmoud A. Abu-Abeeleh,Islam M. Massad,Amjad M. Bani-Hani 대한해부학회 2019 Anatomy & Cell Biology Vol.52 No.4

It is well known that the most common sites for venous access are the superficial veins of the upper limb, particularly dorsal metacarpal veins and median cubital vein. Although dorsal metacarpal veins are the first choice for venous cannulation, there is scarce information about their anatomic variation. Hence, detailed anatomical information about these veins will improve the anatomic knowledge of the health care providers. Subsequently, this study was designed to study the dorsal metacarpal veins and to determine the most prominent dorsal metacarpal vein. A cross sectional study of 402 subjects (804 hands), was prepared to study the superficial veins on the dorsum of the hand among Jordanian students and staff of one of the major governmental medical colleges in Jordan, by using infrared illumination system. The obtained data was analyzed according to sex, sidedness, and handedness. Six locations of the most prominent dorsal metacarpal veins were identified. There was a significant relation between both females and males and the most prominent dorsal metacarpal vein (P=0.01). For the first time this study identified the most common location of the most prominent dorsal metacarpal vein in the fourth intermetacarpal space.

하지정맥류의 원인 및 증상

고현민,안형준 대한의사협회 2022 대한의사협회지 Vol.65 No.4

Background: Varicose veins are a common disease that cause edema, heaviness, pigmentation, and skin ulcers, ultimately affecting the quality of life. Various treatments have recently been developed; therefore, clinicians need to understand the anatomy, pathophysiology, risk factors, and symptoms of varicose veins to provide optimal treatment. Current Concepts: Lower extremity veins are composed of deep, superficial, perforating, and communicating vein systems, and the main axial superficial veins are composed of the great and small saphenous veins. Venous circulation primarily relies on muscle pumps in the foot and calf. Pressure on the sole and contraction of calf muscles compress the veins, sending blood upward or to the deep vein system. Varicose veins are caused by valvular abnormalities, muscle pump failure, etc., and associated risk factors include age, pregnancy, obesity, and family history. The main symptoms include heaviness, fatigue, and edema. Discussion and Conclusion: Varicose veins have complex anatomical structures and are developed by various factors. Therefore, appropriate treatments should be selected considering patients’ symptoms, anatomical structure, and economic aspects.

하지정맥류의 진단

오행진,김송이 대한의사협회 2022 대한의사협회지 Vol.65 No.4

Background: Varicose veins refer to tortuous engorged veins on the lower extremities. Although this is a common condition observed in clinical practice, objective diagnosis is important for optimal treatment. Current Concepts: Thorough physical examination is the first key step for diagnosis of varicose veins. Both legs should be examined between the inguinal region and the feet with the patient in an erect position. The presence and location of venous reflux should be confirmed using duplex ultrasonography (DUS), which serves as a simple, non-invasive modality to assess both the anatomy and physiology of leg veins. Reflux is defined as duration of retrograde flow greater than 0.5 seconds in superficial veins, 0.35 seconds in perforating veins, and 1.0 seconds in deep veins. Computed tomography venography can be used in selective cases as a complementary tool to obtain objective images of all varicose veins; however, this imaging modality cannot confirm venous reflux. Discussion and Conclusion: DUS is a key diagnostic tool for varicose veins. However, DUS results are operator dependent; therefore, this procedure should be performed by experienced technologists or clinicians, based on guidelines. The location and duration of reflux should be recorded.

The Cause of Abnormal Skin Findings after Ultrasound-Guided Injection of Cyanoacrylate Glue in an Animal Model

Lee Jeeyeon,Cho Sungsin,Joh Jin Hyun 대한외과초음파학회 2020 대한외과초음파학회지 Vol.7 No.2

Purpose: Cyanoacrylate closure has been recently introduced as a non-thermal method for the treatment of varicose veins. An abnormal skin finding can be an extremely worrisome complication after a cyanoacrylate closure. This study aimed at identifying if joint movement could be a possible cause for this reaction using a pig model. Methods: The pigs were administered general anesthesia and monitored by a veterinarian. After aseptic preparation, the cyanoacrylate glue was injected into the leg vein through a delivery catheter, or into the ear vein through a 22G needle. The pigs were divided into 2 groups according to the involvement of the joints, with the injected glue. Ten days after the glue was injected, the veins were harvested, and pathologic findings were analysed. Results: We obtained 6 vein specimens with the surrounding tissue. Both the groups, involving the joint, and not involving the joint included one leg vein and 2 ear veins. The pathologic finding in the group not involving the joint showed that inflammatory cells (mainly lymphocytes) infiltrated the vein wall. In the group involving the joints, the same inflammatory cells infiltrated both the vein wall and surrounding tissue. Conclusion: In this animal study, the injected glue triggered an inflammatory reaction. When the glue was injected across a joint, an inflammatory reaction developed in the vein wall as well as the surrounding tissue. It may be assumed that cyanoacrylate glue injected during closure of the vein can result in an abnormal skin finding if there is an active movement of the joint involved.

Morphometric evaluation of great vein of Galen and its clinical implications

Grace Suganya. S(Grace Suganya. S ),Ariharan. K(Ariharan. K ),Raveendranath Veeramani(Raveendranath Veeramani ),Dinesh Kumar. V(Dinesh Kumar. V ),Nagarajan Krishnan(Nagarajan Krishnan ) 대한해부학회 2023 Anatomy & Cell Biology Vol.56 No.1

The Galenic venous system plays a vital role in the drainage of blood from deeper parts of the brain. This venous system is contributed by many major veins. These veins are located closer to the pineal gland making the surgical approach in this region difficult. Any accidental injury or occlusion of the vein of Galen could lead to devasting results. Thus, studying the dimensions of the vein of Galen is more important. Hence, we aimed to evaluate the morphometry and trajectory to the vein of Galen. About 100 computed tomographic venography records were evaluated and the length, diameter of vein of Galen, angle between straight sinus and vein of Galen and distance from internal occipital protuberance and roof of fourth ventricle to vein of Galen were studied. The mean length and diameter of vein of Galen were 9.8±2.7 and 4.08±1.04 respectively. The mean angle between straight sinus and vein of Galen was 64.2°. The mean distance between external occipital protuberance and roof of fourth ventricle to vein of Galen were 52±6.9 and 33.3±4.5 respectively. No significant morphometric differences were observed between the age groups as well as between the sexs. The results obtained from this study may be helpful for the neurosurgeons in better understanding of the anatomy of the Galenic venous system and to adopt a safe surgical approach to improve the efficacy of the surgeries of the pineal gland and also in the region of vein of Galen.

Cardiac Resynchronization Therapy planning을 위한 MDCT 활용 Coronary venous classification의 유용성

남태현(Tae Hyun Nam),권순안(Soon Ahn Kwon),민관홍(Kwan Hong Min),전은주(Eun Ju Chun) 대한CT영상기술학회 2018 대한CT영상기술학회지 Vol.20 No.1

목적 : Cardiac resynchronization therapy (CRT)는 뉴욕심장협회 (New York Heart Association, NYHA)의 기준 class III 및 IV에 해당하는 환자에게 적용하는 최신 치료 기법이다. 최신 Multi-detector CT (MDCT)로 촬영한 영상은 3차원 재구성을 통해 관상정맥의 평가가 가능해짐에 따라 CRT 계획을 위한 적절한 CT 검사 프로토콜을 제시하고 심장정맥을 표현하는 새로운 분류법을 제시하고자 한다. 대상 및 방법 : 2014년 3월부터 2016년 12월까지 본원을 내원하여 256 MDCT에서 CRT 프로토콜로 심장 CT를 촬영한 189명을 대상으로 하였으며, CT CRT 프로토콜은 Late arterial phase와 venous phase를 촬영하고 조영제는 두번 나누어 주입하는 방법을 사용하였다. 영상의 평가는 정성적 평가와 정량적 평가를 이용하였으며, 정성적 평가는 관상정맥에 대해 “0-5 points scale 평가법”을 사용하였고 정량적 평가는 관상정맥의 유무와 존재하는 각 혈관의 직경을 측정하고 결과값을 토대로 “LPM method”라 명명한 새로운 관상정맥 분류 표기법에 따라 구분해 보았다. “LPM method”는 세 개의 관상정맥을 유무 및 우세한 혈관을 앞으로 배치하여 표현하는 분류법으로 left marginal vein 은 [L, 1], posterior vein of left ventricle은 [P, 2], middle cardiac vein은 [M, 3]로 표기한다. 결과 : 본 논문에서 제시한 CT CRT 프로토콜로 촬영한 모든 환자의 영상에서는 관상정맥의 관찰이 가능했고 (135 excellent, 46 good, 8 fair), 관상정맥의 평가를 토대로 새로운 관상정맥 분류 표기법에 따라 구분해본 결과 189명 중 142명 (75.1 %)의 환자는 기준으로 하는 세관상정맥 (L, P, M)을 모두 관찰 할 수 있는 LPM 그룹으로 나타났으며, 18명 (9.5 %)의 환자는 두 관상정맥 (P, M)을 관찰 할 수 있는 PM그룹으로 나타났고, 23명 (12.2 %)은 두 관상정맥 (L, M)을 관찰 할 수 있는 LM 그룹으로 나타났으며, 2명 (1 %)의 환자가 두 관상정맥 (L,P)을 관찰 할 수 있는 LP그룹으로 나타났다. 분류법으로 표현하지 못한 환자는 4명 (2 %)으로 나타났다. 우세한 혈관의 분류 기준을 포함한 결과로는 LPM-3_1_2 (M>L>P)가 29.8 %로 가장 높게 나타났으며, LPM-3_2_1이 25.7 %, LM-3_1이 11.5 % 그리고 LPM-3_1,2가 10.5 %로 그 뒤를 따랐다. 결론 : 본 논문에서 제시한 CT CRT 프로토콜로 촬영한 환자 모두에게서 관상정맥을 관찰 할 수 있었을 뿐만 아니라 정성적 평과 결과 평균 4.7점으로 나타났다. CRT 시술을 진행하기 전에 MDCT를 활용하고 “LPM method”를 적용하여 시술에 사용되는 관상정맥을 분류하면 시술에 사용되는 fluoroscopy의 사용시간, 조영제의 사용량 그리고 전체 시술시간을 줄일 수 있을 것으로 사료된다. Purpose : Cardiac Resynchronization Therapy (CRT) is being used heart failure patients, category III and IV of NewYork Heart Association (NYHA). Multi-detector CT (MDCT) has allowed visualization of the 3-dimensional coronary venous anatomy. We aimed to evaluate the venous anatomy with coronary CT angiography using appropriate protocol and suggest the new classification for the coronary venous anatomy and anatomic variants. Materials and Methods : 189 patients underwent 256-row MDCT (Brilliance iCT, Philips Healthcare, Cleveland, OH, USA) were retrospectively involved for this study. We used CT protocol for CRT which has two phases scan (late arterial and venous phases) and split contrast agent injection technique. A volume rendering image set and a curved multi-planar reconstruction image set by 3D reconstruction workstations were used for identifying and measuring coronary veins. Image quality is graded with the 0-5 points scale method by a radiologist. We categorized the venous anatomy according to the presence of main 3 veins (left marginal vein [L, 1], posterior vein of left ventricle [P, 2] and middle cardiac vein [M, 3]) for CRT and order of their dominance. Results : The venous anatomy can be evaluated from all patients using this protocol. (135 excellent, 46 good and 8 fair). Depending on “Coronary Venous Anatomy Classification”, 142 out of 189 (75.1 %) patients had all 3 main veins (termed as “LPM” group), 18 patients (9.5 %) had P and M veins (termed as “PM” group), 23 patients (12.2 %) were “LM” group, 2 patients (1 %) were “LP” group. Only 4 out of 189 (2 %) patients were included in group “etc.” which cannot represent with this classification. According to the second category of dominant vein order, LPM_3_1_2 (M>L>P) is highest frequency (29.8 %), followed by LPM_3_2_1 (25.7 %), LM_3_1 (11.5 %) and LPM_3_1,2 (10.5 %). Conclusions : MDCT using two phase protocol can visualize the venous anatomy and variants with good image quality. By using the coronary venous anatomical information depend upon MDCT, simply categorized “Coronary Venous Anatomy Classification” can be useful prior to CRT implantation, it may save the procedure time.

Color Doppler Ultrasound of Lower Extremity Varicose Veins: A Simple Grading of Sapheno-Femoral Junction Reflux

허식,홍석주,김신기,박상우,홍선화,김연수 대한초음파의학회 2011 ULTRASONOGRAPHY Vol.30 No.4

Purpose: To establish a simple grading method for the severity of an incompetent sapheno-femoral junction (SFJ) using color Doppler ultrasound in patients with lower extremity varicose veins. Materials and Methods: 346 legs of 241 consecutive patients with varicose veins were examined (M:F = 96:145, 11-74 years, mean 50 years). The severity of SFJ and sapheno-popliteal (SPJ) incompetence was graded from I to IV according to the patient’s position (standing versus supine or prone) and whether the Valsalva’s maneuver had been induced. The extent of varicose veins was graded as I to III by the US findings in the SFJ incompetence group. The grading of SFJ incompetence was compared to the extent of varicose vein. Results: SFJ, SPJ, both SFJ and SPJ, and perforator incompetence was observed in 198 (57.2%), 81 (23.4%), 21 (6.1%) and 54 (15.6%), respectively. Among the SFJ incompetence group, severity grade I - IV were observed in 14 (7.1%), 75 (37.9%), 73(36.9%), and 36 (18.2%), respectively, and the extent grade I - III were noted in 47(23.7%), 95 (48.0%), and 56 (28.3%), respectively. The SFJ incompetence grade and varicose extent grade showed a positive correlation (p < 0.0001). Conclusion: Simple sonographic grading of the severity of SFJ incompetence is possible. The extent of varicose veins in the SFJ incompetence group can be determined using this new grading system.

A Study on the Implementation of Ultrasonic Guidance Algorithm for Improving Safety of Ultrasonic Varicose Vein Treatment

Seong-Cheol Kim(김성철),Ju-Young Kim(김주영),Si-Cheol Noh(노시철),Heung-Ho Choi(최흥호) 한국방사선학회 2018 한국방사선학회 논문지 Vol.12 No.3

In this study, we performed to design an image guiding algorithm to improve the efficiency and safety of treatment of varicose vein by focused ultrasound. The algorithm was suggested by different guiding images according to the location of varicose veins. In the case of deep-seated varicose veins, the target area was marked on the surface of the blood vessel in the obtained cross-sectional blood vessel ultrasound image. In the case of the superficial varicose vein, A guiding system based on image segmentation algorithm of the vascular region was suggested and designed two different algorithms according to varicose veins progression degree. as a results, the algorithm based on ultrasound image show a small error with 830 ㎛ at maximum. However, the algorithm based on charge coupled device image has a maximum error of 8.3 mm in some data. Therefore, it is expected that additional study is needed for superficial varicose vein image guiding algorithm, and it is expected that the accuracy of blood vessel tracking should be evaluated by constructing simple system. 본 연구에서는 집속초음파에 의한 하지정맥류 치료에서 치료의 효율과 안전성을 높이기 위한 영상유도 알고리즘을 제안하고자 하였다. 하지정맥류가 발생한 위치에 따라 영상 유도 기법을 달리하여 알고리즘을 수립하였다. 심부성 하지정맥류의 경우는 획득된 초음파영상에서 혈관의 가로 단면 영상을 추출하고 혈관 중심부의 목표영역을 표시하도록 하였으며, 표재성 하지정맥류의 경우에는 인체의 표재정맥에서 획득한 CCD 카메라 영상에서 혈관 영역을 분리한 영상을 기반으로 한 영상 유도 시스템을 제작하고 하지정맥류 진행 정도에 따라 각기 다른 알고리즘을 설계 하였다. 실험결과 초음파 영상 기반의 알고리즘은 전체적으로 최대 830㎛ 정도의 낮은 오차를 보였으나 CCD 영상 기반의 알고리즘은 일부 데이터에서 최대 8.3mm 정도의 오차를 보였다. 이에 표재성 하지정맥류 영상 유도 알고리즘에 대해서는 추가적인 연구가 필요할 것으로 예상되며 이후 간단한 시스템을 구성함으로써 혈관 추적의 정확도를 평가할 필요성이 있을 것으로 예상된다.