• The Journal of Internal Korean Medicine
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• v.42 no.6
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• pp.1245-1254
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• 2021

Objectives: This study investigated the clinical characteristics and symptoms of patients with reflux esophagitis (RE) visiting a Korean medicine hospital. Methods: We retrospectively reviewed the medical records of patients with an RE diagnosis who visited a Korean medicine hospital from June 15, 2020, to April 15, 2021. We analyzed the clinical characteristics and the results of a symptoms questionnaire. Results: Our sample included 1,151 patients (711 females). The median age was 58 years; the most common age bracket was 60-69 years. A total of 837 patients (72.7%) presented with symptoms lasting more than one year, and 1,035 (89.9%) had been prescribed medications for more than three months before visiting a Korean medicine hospital. Belching (77.6%) and acid regurgitation (70.9%) were the most frequent symptoms, followed by epigastric pain (61.6%) and throat globus (58.5%). Throat globus was the most bothersome symptom, and 72.4% of the patients experienced the symptom on more than five days in the preceding two weeks. Patients with a longer symptom duration were older (p<0.01) and more likely to be overweight (p=0.03). Patients experiencing symptoms for more than five years were more likely to report throat globus (p=0.02), hoarseness (p<0.01), and coughing (p<0.01). Conclusions: Most RE patients visiting a Korean medicine hospital were females in their sixties with chronic and refractory RE. Atypical symptoms (belching, epigastric pain, and throat globus) were common. Throat globus was highly prevalent in severe cases, suggesting that it warrants attention when treating RE patients.

• The Journal of Internal Korean Medicine
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• v.42 no.6
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• pp.1211-1222
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• 2021

Objectives: The purpose of this study was to investigate the opinions of experts on abdominal examinations in Korean Medicine included in the curriculum of the College of Korean Medicine. Methods: Among Korean doctors, 14 experts on abdominal examinations were interviewed; the experts included 9 professors of Korean internal medicine, 1 expert in diagnostics of Korean Medicine, 1 primary care Korean medicine doctor, and 3 executives of a (former) Korean association of the abdomen. The interview consisted of questions regarding recognition of the clinical importance of abdominal examinations, how to perform abdominal examinations, the most frequent abdominal examination findings encountered in clinical practice, and the definition of some of the abdominal examination findings. Results: Most interviewees recognized abdominal examinations as important and used them in clinical practice. Opinions on additions and corrections were collected regarding observation items, posture, method, and order during abdominal examinations. Abdominal examination findings that were common clinically were abdominal fullness (腹滿), epigastric stuffness (心下痞鞕), abdominal tenderness, epigastric fullness (心下滿), and rib distention (胸脇苦滿). The answers to the question related to the definitions of abdominal examination findings included consent and supplementary opinions regarding definitions of deficiency-excess, cold-heat, abdominal tenderness, tension of abdominal muscles, succession sounds, and borborygmus; these were mainly selected based on abdominal symptoms that are highly quantifiable. Conclusions: In the future, based on the results of this study, additional research related to the drafting of a standard abdominal examination in Korean medicine should be conducted to provide an opportunity to increase the reliability of Korean medicine diagnosis.

• Archives of Plastic Surgery
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• v.50 no.4
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• pp.354-360
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• 2023

Background The Island transverse rectus abdominis musculocutaneous (TRAM) flap is well vascularized with very reliable blood flow, because all perforators of the zone I are included when it is harvested. The number of perforators, topographic mapping, and their relationship with reconstructed outcomes were investigated. Methods Fifty patients with Island TRAM breast reconstruction from September 2021 to August 2022 were investigated. The zone I was divided into a total of eight sections. Under the loupe magnification, all perforators larger than 0.5 mm in zone I were counted with fine dissection, and photographs were taken in background of vessel loops. Complications like flap necrosis, seroma, and hematoma were also investigated. Result There are 12 ideal perforators on average in zone I such as one perforator in section I, II, IV, V, VI, VIII, and three perforators in section III and VII. However, two perforators (M6 and L6) below arcuate line were sacrificed in the time of flap harvest to prevent hernia. Island TRAM included 10 perforators on average (5 perforators in each side) above arcuate line to be transferred to the recipient site. Only minor complications were identified. Conclusion The Island TRAM flap includes 10 perforators to get the vigorous blood flow. The periumbilical to upper medial perforators become more dominant in the perfusion of the flap after deep inferior epigastric artery division. Well preserved perforators will guarantee the satisfactory breast reconstruction with the least complication.

• Anatomy and Cell Biology
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• v.55 no.4
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• pp.467-474
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• 2022

At birth, the umbilical cord contains various types of thin vessels that are near and outside the umbilicus and separate from the umbilical arteries and vein. These vessels are regarded as the remnant "vitelline vessels" and are often called "umbilical vessels", although this terminology could lead to confusion with the true umbilical arteries and vein. No study has yet comprehensively examined these vessels using histological sections. Our examination of these vessels in 25 midterm fetuses (gestational age: 10-16 weeks) led to five major findings: (i) all specimens had umbilical branches of the inferior epigastric artery; (ii) 5 specimens had vitelline vein remnants; (iii) 4 specimens had a thin artery originating from the left hepatic artery that ran along the umbilical vein; (iv) 2 specimens had a so-called "para-umbilical vein" that was along the umbilical vein and reached the umbilicus; and (v) all specimens had lymphatic vessels originating from the umbilicus that ran caudally along the umbilical artery. The pelvic vein tributaries were well developed along the intra-abdominal umbilical artery, but did not reach the umbilicus. The lymphatic vessel was distinguished from the veins by an intraluminar cluster of lymphocytes attaching to the endothelium. The arterial branch in the umbilical cord did not accompany veins and lymphatic vessels, in contrast to the mother artery in the rectus abdominis. All these thin vessels seemed to be obliterated when the fibrous umbilical ring grew during late-term. The para-umbilical collateral vein in adults might develop outside the fibrous umbilical ring after birth.

• Journal of Chest Surgery
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• v.14 no.1
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• pp.77-82
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• 1981

The esophageal perforation is the most rapidly fatal and most serious perforation of the gastrointestinal tract. The 53 year old male patient was admitted because of substernal and epigastric pain altar esophageal bougienage for the indigestion and the difficult swallowing before about 18 hours. On esophagogram, there was the extravasation of contrast media at the right side of the lower esophagus [retrocardiac segment]. The emergency thoractotomy, debridement and suture closure with drainage were performed. But after 7 days the esophageal leakage was complicated again with pus discharge, although primary repair was done. On the 13th hospital day, the temporary cervical esophageal fistulation with dual drainages was made under general anesthesia. On the 38th day after this procedure, the esophageal leakage was closed spontaneously. On the 63rd hospital day the cervical fistulation was repaired and ever since the esophageal passage was good without leakage or swallowing difficulty.

• Journal of Chest Surgery
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• v.50 no.6
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• pp.453-455
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• 2017

We report the case of a 67-year-old woman presenting with epigastric pain. Computed tomography identified diffuse phlegmonous esophagitis. Esophagogastroduodenoscopy revealed multiple perforations in the mucosal layer of the esophagus. A large amount of pus was drained internally through the gut. The patient was treated with antibiotics and early jejunostomy feeding. Although phlegmonous esophagitis is a potentially fatal disease, the patient was successfully treated medically with only a minor complication (esophageal stricture).

• Advances in pediatric surgery
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• v.1 no.2
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• pp.200-203
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• 1995

Splenic tuberculosis is an uncommonly considered diagnosis in clinical practice. This is a case report of splenic tuberculosis in a 13-year-old boy who was seronegative to HIV. He was just well until 7 days prior to this admission when he started to feel epigastric and left subchondral pain. Chest X-ray was not pathological. Abdominal ultrasonography showed slight splenomegaly with multiple hypoechoic nodules and abdominal CT disclosed multiple irregular hypodense lesions in the spleen. Radiological interpretation suggested the possibility of lymphoma or metastatic malignancy. Splenectomy was done and the histopathological findings showed extensive chronic granulomatous inflammation compatible with tuberculosis. Splenic tuberculosis must be included in the differential diagnosis of hypoechoic and hypodense lesions by means of sonography and computed tomography, respectively.

• Parasites, Hosts and Diseases
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• v.27 no.4
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• pp.249-252
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• 1989

Fibricola cratera is a strigeoid trematode indigenous to North America that, heretofore, was known only to infect wild mammals. Herein, it is reported that an experimental inoculation of a human volunteer produced a patellt infection that lasted 40 months. Symptoms of epigastric discomfort, loose stools and flatulence occurred over the first year of infection and ameliorated thereafter. Eggs per gram of stool were low (${\leq}2$) throughout the course of infection and were not detected by the standard technique of formalin-ether concentration. To monitor infection, the entire stool sample was examined each month after sieving through No. 10 (pore size 2 mm) and 100 (pore size $145{\;}{\mu\textrm{m}}$) sieves and collecting eggs on a No. 325 (pore size $45{\;}{\mu\textrm{m}}$) sieve. This is the first report of a North American strigeoid trematode capable of maturing in a human and is only the second species of strigeoid known to do so. The other species is F. seoulensis which has been implicated in 26 human infections in Korea.

• Parasites, Hosts and Diseases
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• v.39 no.2
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• pp.193-196
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• 2001

We report a case of gastric pseudoterranoviasis proven by gastrofiberscopy on Dec. 13, 1994. The 34-year-old male patient, residing in Chungju-shi, was admitted to Konkuk University Hospital complaining of prickling epigastric pain. The symptoms suddenly attacked him two days after eating raw marine fish at Chonan-shi. By the gastrofiberscopic examination, a long white-yellowish nematode was found from the fundus region of stomach. The worm was $34.50{\;}{\times}{\;}0.84{\;}{\;}mm$ in size. and was identified as a 3rd stage larva of Pseudoterranova decipiens judging from the position of the intestinal cecum. This is the 12th confirmed case of human pseudoterranoviasis in Korea.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.16 no.2
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• pp.127-130
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• 2013

Rapunzel syndrome refers to a very rare condition in which swallowed hair forms a gastric trichobezoar that has a long tail extending into the small bowel. We describe a case of Rapunzel syndrome in an 8-year-old girl who presented with abdominal mass, epigastric pain and vomiting. Abdominal computed tomography scan showed a markedly dilated stomach filled with coarse heterogeneous materials. Upper gastrointestinal endoscopy revealed a huge hairy ball with a tail extending through the pylorus. We performed a surgical laparotomy and successfully removed a huge trichobezoar with a long tail extending into the middle portion of jejunum. Psychiatric consultation with review showed her past history of trichotillomania and trichophagia 4 years ago. But her parents denied further psychiatric therapy and she was lost to the follow-up. Rapunzel syndrome should be included in the differential diagnosis in children with chronic abdominal pain and trichophagia.