Usefulness of a Biliary Manipulation Catheter in Percutaneous Transhepatic Biliary Drainage

박오환,원제환,이제희,선주성,곽규성,배재익 대한영상의학회 2011 대한영상의학회지 Vol.64 No.4

Purpose: To evaluate usefulness of a manipulation catheter in percutaneous transhepatic biliary drainage (PTBD). Materials and Methods: A biliary manipulation catheter was used for the aspiration of retained bile and lesion crossing during an initial PTBD in 91 consecutive patients over a 6 month period. This catheter allowed for a 0.035 inch guide wire made of 5F short steel braided polyurethane. The terminal 1 cm segment was tapered and 45。angulated. Two side holes were made in the terminal segment to facilitate the aspiration of bile. The safety of this procedure was evaluated based on whether the catheters caused complications during insertion and manipulation, and whether cholangitis was aggravated after the procedure. Effectiveness of the procedure was evaluated based on the ability to aspirate retained bile and to cross the lesion. Results: Both the insertion of a 0.035 inch hydrophilic guide wire and aspiration of sufficient retained bile were successful with the catheter. Crossing the common bile duct (CBD) lesion had a 98.1% success rate during the initial PTBD. Crossing the hilar obstruction lesion was had a 94.7% success rate to the CBD and 92.1% to the contralateral lobe. Cholangitis improved in 97% of cases, and aggravated transiently in only 3% of cases after PTBD. Conclusion: A biliary manipulation catheter should be considered as a useful tool for a safe and effective PTBD, attributed to the facilitation of bile aspiration and lesion crossing.

Percutaneous Transhepatic Biliary Biopsy with a Newly Designed Stent Biopsy Kit

Park, Auh Whan 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.4

목적: 담도 폐색환자에 있어 새로이 고안된 스텐트 조직생검기구를 이용한 조직생검의 효과를 평가하기 위함. 재료 및 방법: 2002년 7월부터 2003년 1월까지 폐색성 황달을 보이는 총 15명의 환자(남자 10명, 여자5명: 평균나이, 65세)를 대상으로 경피경간담즙배액술 도중 혹은 후에 담도내 스텐트 조직생검을 실시하였다. 조직을 얻은 위치는 간내외담도(12명), 간외담도장문합부(1명), 파터팽대부(2명)였으며 최종진단은 수술 혹은 내시경적 조직생검으로 확진 하였다. 결과 : 14명(93%)에서 악성진단을 받았고 1명에서 양성진단이 나왔다. 조직생검과 관련된 임상적으로 특이할만한 합병증은 없었고 전체적인 민감도, 특이도, 정확도 각각 85.7%, 100%, 86.7% 였다. 결론 : 새로이 고안된 경피경간 스텐트 조직생검기구를 이용한 조직생검은 비교적 높은 민감도를 보였으며 안전하고도 쉽게 시행이 가능하며 특히 총담관 파터팽대부 병변의 생검시 용이한 잇점이 있다고 하겠다.

Intraperitoneal Metastases with Spontaneous Rupture secondary to Ruptured Hepatocellular Carcinoma : A Case Report

Park, Auh Whan,Juhn, Jae Ryang 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.4

간세포암 파열로 인한 복강내 전이는 드문 합병증중의 하나로 저자들은 간세포암 파열후 복강내전이 및 복강내전이암의 자발성파열로 인한 복강내 출혈을 1례 경험하였던 바 방사선학적 소견 및 역할 그리고 임상적 치료에 대해 문헌고찰과 함께 보고하는 바이다.

Angiographic Diagnosis and Therapeutic Embolization of Massive Spontaneous Retroperitoneal Hemorrhage originated from Adrenal Gland : A Case Report

Park, Auh Whan 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.4

성인에서 부신 출혈은 드문 질환이다. 저자는 부신의 자발성 출혈로 인한 후복막강 대량 출혈환자에서 미세코일을 이용한 색전술 치료를 경험하여 혈관촬영을 통한 진단 및 동맥색전술의 치료 가치에 대해 문헌 고찰과 함께 보고하는 바이다.

급성 늑간 동맥 출혈의 경동맥 색전 치료

배재익,박오환,이선주,고기영,윤현기,윤창진,신태범,김영환 대한영상의학회 2005 대한영상의학회지 Vol.53 No.3

Purpose: To report our experiences of transarterial embolization for acute intercostal artery bleeding. Materials and Methods: A retrospectively analysis of the causes, clinical manifestations, angiographic findings and transarterial embolization technique in 8 patients with acute intercostal artery bleeding, with a review of the anatomical basis. Results: The causes of intercostal artery bleeding were iatrogenic and traumatic in 88 and 12% of cases, respectively. Active bleeding from the collateral intercostal or posterior intercostal arteries was angiographically demonstrated in 75 and 25% of cases, respectively. Transarterial embolization successfully achieved hemostasis in all cases. However, two patient with hypovolemic shock expired due to a massive hemothorax, despite successful transarterial embolization. Conclusion: Intercostal access should be performed through the middle of the intercostal space to avoid injury to the collateral intercostal artery. Transarterial embolization is an effective method for the control of intercostal artery bleeding. 목적 : 급성 늑간동맥 출혈을 경동맥 색전 치료한 사례를 분석하였다. 대상과 방법: 혈관조영술상 늑간동맥출혈이 확인된 8예를 대상으로(남:여= 6:2, 29-77세, 평균 58세), 원인, 출혈부위, 혈관조영 소견, 치료 방법, 치료 결과 및 환자의 임상경과 등을 후향적으로 분석하였다. 결과: 늑간동맥 출혈의 원인은 모두 의인성(88%) 이나 외상성(12%) 이었다. 출혈부위는 늑골의 상연을 따라 주행하거나 늑간을 가로지르는 부행늑간동맥(collateral intercostal artery)인 경우가 75%였고, 후늑간동맥(posterior intercostal artery)인 경우가 25%였다. 전 예에서 경동맥 색전술로 성공적으로 지혈 하였지만, 많은 양의 혈흉이 있었던 2예에서는 색전치료에도 불구하고 사망하였다. 결론: 늑간동맥 손상을 줄이기 위해서는 부행늑간동맥이 있는 늑간의 상연 보다는 중간부위를 천자하는 것이 바람직하다. 경동맥색전술은 늑간동맥출혈의 치료에 매우 효과적인 방법이다.

수술 후 총간동맥에서 발생한 가성동맥류로부터 초래된 출혈의 스텐트를 이용한 치료 : Endovascular Treatment with a Coronary Stent-Graft

전제량,박오환 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.3

A 65-year-old man underwent surgical treatment for cholangiocarcinoma in the distal common biliary duct, but complicated with peripancreatic abscess which was managed by ultrasound guided aspiration and drainage. He was suffered by abrupt arterial bleeding around surgical drain on upper abdomen and an emergent celiac angiogram demonstrasted a pseudoaneurysm in the common hepatic artery. A Jostent coronary stent-graft mounted on a 2.7F, 3.5㎜ X 19㎜ balloon catheter was successfully placed across the aneurysm neck. Final angiogram revealed exclusion of pseudoaneurysm with preservation of the arterial lumen, patient became stable after procedure. Endovascular treatment using stent-graft with preserving arterial lumen may be a alternative to conventional transcatheter embolization.

Ultrasound-Guided Fine-Needle Aspiration Biopsy of Thyroid Nodules Smaller Than 5 mm in the Maximum Diameter: Assessment of Efficacy and Pathological Findings

김동욱,박오환,이은주,추혜정,김상효,이상협,엄재욱 대한영상의학회 2009 Korean Journal of Radiology Vol.10 No.5

Objective: The aim of this study was to determine the efficacy of the use of an ultrasound-guided fine-needle aspiration biopsy (US-FNAB) to diagnose thyroid nodules smaller than 5 mm in the maximum diameter and to evaluate pathological findings of small thyroid malignancies. Materials and Methods: From May 2007 to April 2008, we evaluated the findings of US-FNABs of small thyroid nodules less than 5 mm in the maximum diameter. The cytopathological findings were retrospectively reviewed and the diagnostic performance of the use of an US-FNAB was examined in all patients. Results: Of 201 small thyroid nodules in 180 patients, there were 162 adequate specimens (81%). Among 180 patients, 75 patients underwent thyroid surgery and 50 malignant and 33 benign nodules were identified based on a pathological examination. All small malignant thyroid nodules were identified as papillary thyroid microcarcinomas (PTMCs). There were 34 (55%) true positive, 0 (0%) false positive, 23 (37%) true negative and five (8%) false negative results for malignancy after performing a first US-FNAB in 62 surgically confirmed nodules. The sensitivity (87%), specificity (100%), positive predictive value (100%), negative predictive value (82%), accuracy (92%), false positive rate (0%) and false negative rate (8%) for an US-FNAB were determined. In 23 patients with a primary PTMC, capsular invasion (9%, 2 of 23), a perithyroidal lymph node metastasis (30%, 7 of 23), the rate of multifocality (9%, 2 of 23) and bilaterality (4%, 1 of 23) were also determined. Conclusion: An US-FNAB of thyroid nodules smaller than 5 mm in the maximum diameter is an effective diagnostic procedure. Objective: The aim of this study was to determine the efficacy of the use of an ultrasound-guided fine-needle aspiration biopsy (US-FNAB) to diagnose thyroid nodules smaller than 5 mm in the maximum diameter and to evaluate pathological findings of small thyroid malignancies. Materials and Methods: From May 2007 to April 2008, we evaluated the findings of US-FNABs of small thyroid nodules less than 5 mm in the maximum diameter. The cytopathological findings were retrospectively reviewed and the diagnostic performance of the use of an US-FNAB was examined in all patients. Results: Of 201 small thyroid nodules in 180 patients, there were 162 adequate specimens (81%). Among 180 patients, 75 patients underwent thyroid surgery and 50 malignant and 33 benign nodules were identified based on a pathological examination. All small malignant thyroid nodules were identified as papillary thyroid microcarcinomas (PTMCs). There were 34 (55%) true positive, 0 (0%) false positive, 23 (37%) true negative and five (8%) false negative results for malignancy after performing a first US-FNAB in 62 surgically confirmed nodules. The sensitivity (87%), specificity (100%), positive predictive value (100%), negative predictive value (82%), accuracy (92%), false positive rate (0%) and false negative rate (8%) for an US-FNAB were determined. In 23 patients with a primary PTMC, capsular invasion (9%, 2 of 23), a perithyroidal lymph node metastasis (30%, 7 of 23), the rate of multifocality (9%, 2 of 23) and bilaterality (4%, 1 of 23) were also determined. Conclusion: An US-FNAB of thyroid nodules smaller than 5 mm in the maximum diameter is an effective diagnostic procedure.

낮 병동을 활용한 인터벤션 시술 시행

배재익,박오환,조혜선,박은희,최갑숙,이선주,김용우,전제량 대한영상의학회 2007 대한영상의학회지 Vol.56 No.1

Purpose: We wanted to describe the practice and results of applying the day-hospital system in an interventional radiology clinic. Materials and Methods: From Oct. 2004 to Dec. 2005, the day-hospital system was applied to various interventional procedures with using a part of the recovery room of an angiography suite as a facility for hospital admission. The study included 91 cases in 73 patients. The source of the patient referral, the procedures, hospital courses and complications were analyzed and questionnaire surveys were conducted for the available 55 patients. Results: Among the patients, 70% (n=64) were referred from other departments, 5% (n=5) from other hospitals, 5% (n=4) were new patients and 20% (n=18) were re-admissions. The procedures included gastrointestinal, biliary, urinary, hemodialysis related- and implantable port related interventions. 96% (n=87) of the patients were successfully discharged in a day and admission to the general ward was only 4% (n=4). Minor complications occurred after discharges in 3% (n=3). The questionnaire survey revealed that 96% (n=53) of the patients were satisfied with the service and they were not anxious after discharge. Conclusion: Most of common interventional procedures were safely done under the day-hospital system with the patients being highly satisfied. The day-hospital system can be a good tool for establishing admitting privileges for an interventional radiology clinic. 목적: 낮 병동을 활용한 인터벤션 시술시행에 대한 초기 경험과 환자의 반응을 요약 및 조사하여 보고하고자 한다 대상과 방법: 2004년 10월부터 2005년 12월까지 전향적으로 72명의(남: 37, 여: 35, 평균연령 57세) 환자에 대한 91예의 인터벤션 시술을 낮 병동 입원상태로 시행하였다. 낮 병동 시설은 혈관조영실 회복실 내에 마련하였다. 이를 대상으로 환자 내원 경로, 시술의 종류, 시술 후 경과, 합병증 발생여부 및 낮병동에 대한 환자 만족도를 조사하였다. 환자 만족도 조사는 설문이 가능한 55명에 대하여 시행하였다. 결과: 전체 91예 중 70%(n=64)는 본원의 타 과에서 전과 된 경우였고, 5%(n=5)는 다른 병원에서 전원된 경우였으며, 5%(n=4)는 새로운 환자였다. 나머지 20%(n=18)는 낮 병동 재진의 경우였다. 시술로는 위장관계, 담관계, 요로계 및 혈액 투석 관련, 그리고 정맥포트관련 시술이 많았다. 합병증이 생기거나 시술에 실패한 4%(n=4)를 제외한 96%(n=87)에서 모두 성공적 시술 후 문제없이 당일 퇴원하였다. 당일 퇴원 후 생긴 합병증은 3%(n=3)에서 발생하였는데 모두 경미하였다. 96%(n=53)의 환자가 낮 병동을 통한 시술에 대하여 만족하였고, 퇴원후 불안하지 않았다고 응답하였다. 결론: 다양한 인터벤션 시술이 낮병동 체계로 충분히 가능하였고 낮 병동에 대한 환자 만족 정도도 매우 높았다. 낮 병동은 인터벤션 영상의학 클리닉의 입원기반시설 수립을 위한 좋은 방법이 될 수 있다.

Thyroid Radiofrequency Ablation: Updates on Innovative Devices and Techniques

박혜선,백정환,박오환,정새롬,최영준,이정현 대한영상의학회 2017 Korean Journal of Radiology Vol.18 No.4

Radiofrequency ablation (RFA) is a well-known, effective, and safe method for treating benign thyroid nodules and recurrent thyroid cancers. Thyroid-dedicated devices and basic techniques for thyroid RFA were introduced by the Korean Society of Thyroid Radiology (KSThR) in 2012. Thyroid RFA has now been adopted worldwide, with subsequent advances in devices and techniques. To optimize the treatment efficacy and patient safety, understanding the basic and advanced RFA techniques and selecting the optimal treatment strategy are critical. The goal of this review is to therefore provide updates and analysis of current devices and advanced techniques for RFA treatment of benign thyroid nodules and recurrent thyroid cancers.

코일 색전술로 치료한 소아 Dieulafoy 병변 1예

정지미,송민섭,지근하,배재익,박오환,Jung, Ji-Mi,Song, Min-Seob,Chi, Geun-Ha,Bae, Jae-Ik,Park, Ao-Whan 대한소아소화기영양학회 2007 Pediatric gastroenterology, hepatology & nutrition Vol.10 No.2

저자들은 내시경적 에피네프린 국소 주입법과 수술적 혈관 결찰술 후에도 출혈이 재발된 Dieulafoy 병을 가진 환아에서 동맥 코일 색전술로 지혈된 증례를 문헌 고찰과 함께 보고한다. A dieulafoy lesion, which is an unusual cause of gastrointestinal bleeding that can be fatal in children. Dieulafoy lesions are characterized by an abnormally large eroded submucosal artery that is commonly located in the lesser curvature of the proximal stomach. In most cases, permanent hemostasis is achieved by endoscopic epinephrine injection, however, some patients require other endoscopic treatment modalities, embolization or surgery. We report here a case of a Dieulafoy lesion in an 11-year-old boy who had recurrent bleeding from the lesion in the duodenal bulb after endoscopic epinephrine injection and surgical ligation, that was successfully treated using coil embolization.