PPG 2차 미분을 이용한 정상인과 당뇨병 환자의 말초혈관 탄성도 비교

김성우(Sung-Woo Kim),이주형(Ju-Hyung Lee),강은석(Eun-Seok Kang),김수찬(Soo-Chan Kim),김덕원(Deok-Won Kim) 대한전기학회 2007 대한전기학회 학술대회 논문집 Vol.2007 No.4

Recently, the prevalence rate of diabetes in Korea has been increasing rapidly due to high growth of economy and changes in dietary lifestyle. Vascular complication is one of diabetic complications which have frequently occurred by obesity, hyperglycemia and impaired glucose metabolism. Photoplethysmogram(PPG) measured from finger and toe is very useful for evaluation of vascular aging and sclerosis level since the PPG signal represents characteristics of peripheral vascular. Several researchers have reported that second derivative of the finger PPG waveform was useful to evaluate vascular compliance and developed various analysis methods for vascular compliance. However, peripheral vascular compliance study for diabetic patient was never evaluated by using second derivative of PPG. Therefore, we aimed to objectively compare and to assess normal and diabetic group vascular compliance using the second derivative of PPG waveform in this study. The evaluated factors of second derivative of PPG are 'a', 'b', 'c', 'd ', 'e' and b/a represents vascular compliance. Study found out that when vascular compliance is decreased, b/a is increased, the absolute value of b/a is decreased. The average vascular compliance of 50 diabetic patients with neuropathy is statistically lower than the normal group(p<0.05). We suggest an objective evaluation of peripheral vascular compliance for diabetic patients and prevention of vascular complication.

Incidence of Vascular Complications Arising from Anterior Spinal Surgery in the Thoraco-Lumbar Spine

Zdenek Klezl,Girish Nanjunda Swamy,Thomas Vyskocil,Jan Kryl,Jan Stulik 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.1

Study Design: Modern biomaterials and instrumentation have popularised surgery of the thoraco-lumbar spine through an anterior route. The advantage of anterior surgery is that it allows for a direct decompression of the compromised spinal canal. However, the potential for devastating long-term sequelae as a result of complications is high. Purpose: The aim of this study was to give a general overview and identify the incidence of vascular complications. Overview of Literature: There is limited literature describing the overall incidence and complications of anterior spinal surgery. Methods: A retrospective review of a prospective database of 1,262 consecutive patients with anterior surgery over a twelve-year period. Results: In our study, 1.58% (n=20) of patients suffered complications. Injury to a major vessel was encountered in 14 (1.11%) cases, of which nine involved an injury to the common iliac vein. In six cases, the original procedure was abandoned due to a life-threatening vascular injury (n=3) and unfavourable anatomy (n=3). Conclusions: The incidence of vascular and other complications in our study was relatively low. Nevertheless, the potential for devastating long-term sequelae as a result of complications remains high. A thorough knowledge and awareness of normal and abnormal anatomy should be gained before attempting such a procedure, and a vascular surgical assistance especially should be readily accessible. We believe use of access surgeons is mandatory in cases with difficult or aberrant anatomy.

제2형 당뇨병 환자의 혈청 호모시스테인 농도와 만성합병증과의 관계

최승진,김재택,오연상,신순현 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.26 No.2

연구배경:최근에 고호모시스테인혈증은 당뇨병 환자에서 대혈관합병증과 미세혈관합병증에 관여하는 위험인자로 알려져 있으나 미세혈관 합병증과의 관계는 아직 완전히 정립되지 않을 상태로 본 연구에서는 경동맥 내중막 두께를 측정하여 혈청 호모시스테인 농도를 비롯한 죽상동맥경화증의 위험요소들과 대혈관 합병증과의 관계를 알아보고 혈청 호모시스테인 동도와 미세혈관합병증과의 관계를 알아보고자 하였다. 방법:2000년 1월에서 2000년 6월까지 중앙대학교 의과대학 부속병원에 입원했던 제2형 당뇨병 환자 58명을 대상으로 동맥경화증 위험인자와 고해상도 B­mode 초음파를 이용하여 경동맥 내중막 두께를 측정하였고 대혈관 합병증과 미세혈관합병증의 유무를 조사하여 상관관계를 분석하였다. 결과:1)제2형 당뇨병 환자에서 평균 혈청 호모시스테인 농도는 9.9±3.2μmol/L였고 연령 및 성별과 상관관계가 없었으나 혈청 크레아티닌(p=0.02)과 크레아티닌제거력(p=0.02)과는 상관관계가 있었다. 2)제2형 당뇨병 환자에서 경동맥 내중막 두께의 최대치, 최소치, 평균치는 각각 우측(4.00±1.20, 0.50±0.04, 1.04±0.62㎜)좌측(3.54±1.00, 0.31±0.02, 0.03±0.55㎜)평균(3.77±1.10, 0.44±0.03, 1.03±0.54㎜)이었고 혈청 호모시스테인 농도(p=0.03)와 유의한 상관관계가 있었고 혈청 저밀도지단백 콜레스테롤 농도(p=0.03)만이 독립적인 상관관계가 있었다. 3)대혈관합병증이 있는 환자에서 혈청 호모시스테인 농도(p=0.01), 평균 경동맥 내중막 두께(p<0.01)가 유의하게 증가되었다. 4)혈정 호모시스테인 농도와 미세혈관합병증과는 망막병증(p=0.07), 신병증(p=0.06), 신경병증(p=0.55)으로 상관관계가 없었으나 경동맥 내중막 두께와 당뇨병성신증과는 유의한 상관관계가 있었다(p=0.03). 결론:제2형 당뇨병 환자에서 혈청 호모시스테인 농도는 대혈관합병증의 위험인자로서 다른 인자와 복합적으로 대혈관합병증의 발생이나 진행에 관련될 것으로 사료되며 미세혈관합병증과는 상관관계가 없었다. 경동맥 내중막 두께는 대혈관합병증에서 증가디어 있었고 미세혈관합병증 중에서는 당뇨병성 신증과 관련되어 있었으며 이에 대한 기전이나 임상적 의의에 대한 더 많은 연구가 필요하다 하겠다. Background : Chronic complications in type 2 diabetic patients have microvascular and macrovascular components. Previous studies have shown that incidence of macrovascular complications correlates with the serum homocysteine levels, but the relatinship is unclear. In addition, the connection between the microvascular complications and the serum homocysteine levels is still obscure and controversial. In this study, the relationship between the serum homocysteine levels and microvascular and macrovascular complications were evaluated in type 2 diabetic patients. Methods : In 58 type 2 diabetic patients, the serum homocysteine levels, folic acid levels, Vit B12 levels, PAI-1 levels, the standard risk factors for macrovascular complications, the fasting serum glucose levels, the HbA_1c levels, and the fasting insulin and C-peptide concentrations, the renal function tests, and the carotid intima-media thickness were measured and the relationship between them and the serum homocysteine level was analyzed according to the presence and absence of macrovascular and microvascular complications. Results : 1) In type 2 diabetic patients, the mean serum homocysteine level was 9.9±3.2?mol/L. The serum homocysteine level showed no relationship with the clinical and biochemical variables including the risk factors for atherosclerosis except the serum creatinine level showed no relationship with the clinical and biochemical variables including the risk factors for atherosclerosis except the serum creatinine and creaaatinine clearance. 2) The maximum, minimum, and mean of the intima-media thickness of right carotid artery were 4.00±1.20, 0.50±0.04, 1.04±0.62mm, of left carotid artery were 3.54±1.00, 0.31±0.02, 1.03±0.55 mm, and means were 3.77±1.10, 0.44±0.03, 1,03±0.54mm, and correlated with the serum homocysteine level(p=0/03), but only the serum LDL cholesterol level independently correlated with the intima-media thicknes(p=0.04). 3) The serum homocysteine level(p=0.01) and intima-media thickness(p<0.01) was significantly higher in type 2 diabetic patients with macrovascular complications than without it. 4) The serum homocysteine level did not correlate with the incidence microvascular complications, but the intima-media thickness did correlate with diabetic nephropathy(p=0.03). Conclusions : The serum homocysteine level did not correlated with the incidence of diabetic microvascular complications. However, there was a small correlation with the risk factors of macrovascular complications.The intima-media thickness correlated with the incidency of macrovascular complications, and the relationship with diabetic nephropathy requires further study (J Kor Diabetes Asso 26: 112~125, 2002).

New Perspectives on Diabetic Vascular Complications: The Loss of Endogenous Protective Factors Induced by Hyperglycemia

정인경,George L. King 대한당뇨병학회 2011 Diabetes and Metabolism Journal Vol.35 No.1

Diabetic vascular complications are among the leading causes of morbidity and mortality in diabetic patients. In the past, many studies have focused on the mechanisms of hyperglycemia-induced chronic vascular complications via the formation of toxic metabolites such as oxidative stress, advanced glycosylated end products, persistent activation of protein kinase C, and increased sorbitol concentrations. However, vascular complications result from imbalances caused by increases in systemic toxic metabolites,such as those that occur under conditions of hyperglycemia and dyslipidemia, and by reductions in endogenous protective factors such as insulin, vascular endothelial growth factor, and platelet derived growth factor. This review outlines some of the evidence supporting the importance of enhancing endogenous regenerative factors.

Various Complications after a Vascular Procedure in Patients with Hemophilia

하연수,박영실 대한소아혈액종양학회 2019 Clinical Pediatric Hematology-Oncology Vol.26 No.1

Hemophilia, an inherited bleeding disorder, is caused by a deficiency of coagulation factor VIII or IX. Most of patients with hemophilia need vascular procedure, which can lead to complications. Even though these complications can also occur in normal people, hemophilia and coagulopathy are particular risk factors. We reviewed medical records of patients with hemophilia who underwent vascular procedures and investigated its complications. Vessel-related complications occurred in five patients. Three patients had pseudoaneurysms after radial arterial puncture. All patients underwent coagulation factor replacement or ultrasound-guided compression and showed improvement. Neuropathy developed in one patient due to a hematoma that occurred after blood sampling. The hematoma improved, but motor and sensory deficits remained and neuropathy was confirmed. One patient died of uncontrolled bleeding after angiography. Vascular procedures require more attention in patients with hemophilia. Caution and prevention of complications is essential, even before the patient is diagnosed with hemophilia.

혈관 수술 후 심장 합병증 발생을 예측하기 위한 선별 검사로서 심근 관류 단일 광자 단층촬영의 유용성에 대한 연구

이형채,황윤호,위진홍,전희재,이양행,조광현 대한흉부외과학회 2010 Journal of Chest Surgery (J Chest Surg) Vol.43 No.1

배경: 혈관질환 환자는 관상동맥질환 및 심장질환을 많이 동반함으로 인하여 혈관 수술 후 잠재되어 있는 심장질환이 악화 또는 유발될 수 있는 가능성이 있다. 이러한 심장질환을 확인하기 위한 검사 중 비교적 간단하고 비침습적인 SPECT 촬영에 대한 효용성은 아직 논란이 되고 있다. 본 연구에서는 수술 전 SPECT를 촬영하고, 그 결과에 따른 검사 및 처치들이 혈관 수술 후 심장 합병증 발생에 미치는 임상적인 효과를 평가하고자 한다. 대상 및 방법: 2004년 4월부터 2007년 9월까지 3년 6개월간 본 병원에서 혈관 수술 전 아데노신 부하 Tc-99m 테트로포스민 SPECT를 촬영한 63명의 환자를 대상으로 하였다. 결과: SPECT 촬영 유소견의 심장 합병증 발생 예측에 대한 민감도와 특이도는 각각 41.2%와 52.2%로 비교적 낮게 나왔다. 그러나 비정상적인 SPECT 촬영결과를 보인 환자에게 관상동맥 조영술을 시행하고 관상동맥 병변에 대한 비정상 소견이 있을 때 관상동맥 중재적 시술 및 관상동맥 우회로술 등의 적극적인 처치를 한 경우 심장 합병증의 발생률이 낮은 경향을 보였다. 결론: SPECT 촬영은 혈관수술 후 심장 합병증 발생위험을 예측하기 위한 선별검사로서 효용성이 떨어진다. Background: Patients with vascular diseases commonly have coronary artery disease and associated cardiac problems. Therefore, their underlying heart diseases may be induced or exacerbated after vascular surgery. The effectiveness of SPECT imaging, which is a relatively simple and non-invasive imaging modality, for assessing these underlying heart diseases is still controversial. This study was performed to evaluate the clinical effect of tests and treatment based on SPECT imaging prior to vascular surgery on the development of post-operation cardiac complications. Material and Method: Sixty three patients who were treated at Inje University Pusan Paik Hospital between April 2004 and September 2007 and who underwent adenosine infusion technetium-99m (Tc-99m) tetrofosmin SPECT imaging prior to vascular surgery were selected for this study and we retrospectively reviewed their records. Result: The sensitivity and specificity of detecting a perfusion defect on SPECT to predict the development of cardiac complications was relatively low at 41.2% and 52.2%, respectively. However when coronary angiographies were done on the patients with abnormal SPECT and this was followed by aggressive treatment such as coronary artery intervention and coronary artery bypass grafting based on the angiography results, there was a tendency for lower cardiac complication rates. Conclusion: SPECT imaging shows low effectiveness as a screening test for predicting cardiac complications after vascular surgery.

지속성 외래 복막투석 환자에서 고호모시스틴혈증

나명윤 全南大醫大 2001 전남의대학술지 Vol.37 No.2

Routine intraoperative Doppler sonography in the evaluation of complications after living-related donor liver transplantation

Choi, Jin-Young,Lee, Jae Young,Lee, Jeong Min,Kim, Se Hyung,Lee, Min Woo,Han, Joon Koo,Choi, Byung Ihn Wiley Subscription Services, Inc., A Wiley Company 2007 Journal of clinical ultrasound Vol.35 No.9

<B>Purpose</B><P>To determine whether quantitative and qualitative analysis of intraoperative Doppler sonography data are predictive of vascular complications after living-related donor liver transplantation.</P><B>Methods</B><P>Intraoperative sonograms of 81 transplanted livers (right lobe in 61 patients, left lobe in 20 patients) were analyzed for the presence of blood flow, resistance index, systolic acceleration time (SAT), peak systolic velocity, and morphologic characteristics of spectral waveform of the hepatic artery. Peak velocity and spectral waveforms of portal and hepatic veins were also analyzed. Intraoperative sonography results were compared with information obtained with multidetector-row CT (MDCT) angiography or conventional angiography. The time interval between operation and angiography ranged from 1 to 23 days (mean, 8.5 days).</P><B>Results</B><P>Hepatic artery stenosis (HAS) was identified in 20 patients via MDCT angiography, conventional angiography, or both. The Doppler parameters found helpful for predicting HAS were tardus-parvus pattern and delayed SAT. The sensitivity, specificity, and negative predictive value (NPV) were 60.0%, 73.7%, and 84.9%, respectively, for tardus-parvus pattern and 40.0%, 83.6%, and 80.9%, respectively, for delayed SAT. Peak velocities of the portal and hepatic veins were not reliable indicators of vascular complication. Loss of triphasity of the hepatic vein had a 98.4% NPV for venous obstruction.</P><B>Conclusions</B><P>Delayed SAT of the hepatic artery and loss of triphasity of the hepatic vein had a >80% for specificity for predicting vascular complications. Tardus-parvus pattern, delayed SAT of the hepatic artery, and loss of triphasity of the hepatic vein showed an acceptable NPV for identifying vascular complications. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2007</P>

[FCT 11] The utility of color doppler ultrasound to explore vascular complications following filler injection

( Ga Ram Ahn ),( Hyun Jung Kwon ),( Eun Jung Ko ),( Kapsok Li ),( Beom Joon Kim ),( Myeung Nam Kim ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

As the popularity of dermal fillers has grown rapidly in recent years, the number of complications has been also increased. Among them, vascular compromise following filler injection is a major, emergent complication causing an embolism or external compression that impedes blood flow. Since various dermal fillers are recognizable with ultrasound, presenting different patterns of echogenicity and posterior acoustic artefacts, ultrasonography is regarded as an ideal diagnostic instrument to evaluate filler complications. A 42-year-old female presented to with discoloration, pain on her right cheek occurred after hyaluronic acid (HA) filler injection on right nasolabial fold. A Doppler ultrasound examination showed a hypoechoic pseudocyst compressing the near vessel. Under guidance with ultrasound, hyaluronidase was immediately injected into the pseudocyst. Following additional treatment including sublingual nitroglycerin and low-dose aspirin administration, saline soaking, topical antibiotics, hyperbaric oxygen therapy, 833-nm LED irradiation, and occlusive dressing, the skin lesions were completely resolved without any scarring or defect. Herein, we report a case of vascular filler complication which emphasizes the usefulness of Doppler ultrasound for proper evaluation and management., r,

Anesthetic Considerations for Cardiac Tamponade after Internal Jugular Central Line Placement during Trauma Resuscitation: A Case Report

Kevin M. Chen,Jamal Hasoon,Anvinh Nguyen 대한혈관외과학회 2023 Vascular Specialist International Vol.39 No.2

Numerous complications are associated with central venous catheters. Among them, cardiac tamponade is a rare but well-documented catastrophic complication. A 22-year-old healthy male presented with Code 1 trauma resulting from gunshot wounds in the abdomen. Upon examination, he was found to have a large pericardial fluid collection, a large right supraclavicular hematoma, and significant amount of bilateral pleural effusions secondary to extraluminal placement of the right internal jugular central line during resuscitation. After repairing the internal jugular injury and draining the pericardial fluid, the patient was transferred from the intensive care unit to the regular hospital floor. However, 15 days later, imaging revealed re-accumulation of a large pericardial effusion, which was eventually treated with a pericardial window operation. This case report explores potential complications that could arise from central line placement and the anesthetic considerations in a patient with cardiac tamponade from extraluminal central line placement.