• Journal of Digestive Cancer Research
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• v.5 no.2
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• pp.120-124
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• 2017

A-49-year-old male patient with no specific medical history was admitted to the clinic because of persistent epigastric pain radiating to back for 4 months. He had multiple parenchymal tumors in body and tail of pancreas, para-spinal muscle, and mediastinum on abdomen CT image. Cytologic examination of the pancreas which was done by endoscopic ultrasound guided fine needle aspiration (EUS-FNA) showed adenocarcinoma, whereas histological examination of the para-spinal mass showed undifferentiated sarcoma. Histologic examination of the pancreatic mass was made through endoscopic ultrasound guided fine needle biopsy (EUS-FNB) for accurate diagnosis, and the histologic examination of both the pancreas and posterior mediastinal mass showed the same undifferentiated sarcoma. Therefore, we reviewed the cytopathic tissue obtained from the pancreas for the first time, and it was confirmed to be similar to histologic findings in the mediastinal mass.

• Journal of Chest Surgery
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• v.56 no.6
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• pp.387-393
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• 2023

Background: The aim of this study was to evaluate the clinical efficacy of a modified surgical procedure for the treatment of varicose veins. Methods: This retrospective analysis was conducted on lower extremities with symptomatic great saphenous vein (GSV) incompetence that underwent stripping from the groin to the knee, with preservation of the superficial epigastric vein (SEV), between January 2015 and April 2022. Follow-up assessments were performed using Doppler ultrasound, Venous Clinical Severity Score (VCSS), and the Aberdeen Varicose Vein Questionnaire (AVVQ) at 6 and 12 months after surgery. Results: The study included 179 limbs from 120 patients (47 men and 73 women). The mean patient age was 56.5 years (range, 20-78 years), and the distribution of preoperative Clinical-Etiology-Anatomy-Pathophysiology clinical classes was 8% C0-C1, 88% C2, and 4% C3-C6. The preoperative diameter of the saphenofemoral confluence averaged 6.9 mm (range, 2.7-15.8 mm). After a mean postoperative follow-up period of 24 months, evidence of neovascularization around the stump of the saphenofemoral junction (SFJ) was observed in 2 limbs (1.1%). Additionally, varicose vein recurrence was found in 1 limb (0.6%) and was associated with an incompetent thigh perforator. At postoperative follow-up, both VCSS and AVVQ scores were significantly lower than the preoperative scores. Conclusion: Modified surgical treatment of GSV incompetence, involving preservation of the SEV and stripping of a short segment up to the knee, demonstrated favorable clinical results in terms of postoperative complication rate, neovascularization rate around the SFJ stump, varicose vein recurrence rate, and improvement in lower extremity symptoms.

• Korean Journal of Acupuncture
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• v.20 no.4
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• pp.65-75
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• 2003

This study was carried to identify the component of Spleen Meridian Muscle in human, dividing into outer, middle, and inner part. Lower extremity and trunk were opened widely to demonstrate muscles, nerve, blood vessels and the others, displaying the inner structure of Spleen Meridian Muscle. We obtained the results as follows; 1. Spleen Meridian Muscle is composed of the muscle, nerve and blood vessels. 2. In human anatomy, it is present the difference between a term of nerve or blood vessels which control the muscle of Meridian Muscle and those which pass near by Meridian Muscle. 3. The inner composition of meridian muscle in human arm is as follows ; 1) Muscle; ext. hallucis longus tend., flex. hallucis longus tend.(Sp-1), abd. hallucis tend., flex. hallucis brevis tend., flex. hallucis longus tend.(Sp-2, 3), ant. tibial m. tend., abd. hallucis, flex. hallucis longus tend.(Sp-4), flex. retinaculum, ant. tibiotalar lig.(Sp-5), flex. digitorum longus m., tibialis post. m.(Sp-6), soleus m., flex. digitorum longus m., tibialis post. m.(Sp-7, 8), gastrocnemius m., soleus m.(Sp-9), vastus medialis m.(Sp-10), sartorius m., vastus medialis m., add. longus m.(Sp-11), inguinal lig., iliopsoas m.(Sp-12), ext. abdominal oblique m. aponeurosis, int. abd. ob. m., transversus abd. m.(Sp-13, 14, 15, 16), ant. serratus m., intercostalis m.(Sp-17), pectoralis major m., pectoralis minor m., intercostalis m.(Sp-18, 19, 20), ant. serratus m., intercostalis m.(Sp-21) 2) Nerve; deep peroneal n. br.(Sp-1), med. plantar br. of post. tibial n.(Sp-2, 3, 4), saphenous n., deep peroneal n. br.(Sp-5), sural cutan. n., tibial. n.(Sp-6, 7, 8), tibial. n.(Sp-9), saphenous br. of femoral n.(Sp-10, 11), femoral n.(Sp-12), subcostal n. cut. br., iliohypogastric n., genitofemoral. n.(Sp-13), 11th. intercostal n. and its cut. br.(Sp-14), 10th. intercostal n. and its cut. br.(Sp-15), long thoracic n. br., 8th. intercostal n. and its cut. br.(Sp-16), long thoracic n. br., 5th. intercostal n. and its cut. br.(Sp-17), long thoracic n. br., 4th. intercostal n. and its cut. br.(Sp-18), long thoracic n. br., 3th. intercostal n. and its cut. br.(Sp-19), long thoracic n. br., 2th. intercostal n. and its cut. br.(Sp-20), long thoracic n. br., 6th. intercostal n. and its cut. br.(Sp-21) 3) Blood vessels; digital a. br. of dorsalis pedis a., post. tibial a. br.(Sp-1), med. plantar br. of post. tibial a.(Sp-2, 3, 4), saphenous vein, Ant. Med. malleolar a.(Sp-5), small saphenous v. br., post. tibial a.(Sp-6, 7), small saphenous v. br., post. tibial a., peroneal a.(Sp-8), post. tibial a.(Sp-9), long saphenose v. br., saphenous br. of femoral a.(Sp-10), deep femoral a. br.(Sp-11), femoral a.(Sp-12), supf. thoracoepigastric v., musculophrenic a.(Sp-16), thoracoepigastric v., lat. thoracic a. and v., 5th epigastric v., deep circumflex iliac a.(Sp-13, 14), supf. epigastric v., subcostal a., lumbar a.(Sp-15), intercostal a. v.(Sp-17), lat. thoracic a. and v., 4th intercostal a. v.(Sp-18), lat. thoracic a. and v., 3th intercostal a. v., axillary v. br.(Sp-19), lat. thoracic a. and v., 2th intercostal a. v., axillary v. br.(Sp-20), thoracoepigastric v., subscapular a. br., 6th intercostal a. v.(Sp-21)

• Archives of Plastic Surgery
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• v.37 no.5
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• pp.547-554
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• 2010

Purpose: The purpose of this study is to delineate the optimal time of venous revascularization for preventing the flap necrosis due to venous occlusion, and to clarify the usefulness of tissue oxygen pressure ($TcpO_2$) in the determination of the point of time for venous revascularization. Methods: Thirty-six, $3{\times}3\;cm$ sized epigastric island flap was elevated in left abdomen of male Sprague-Dawley rat weighing 250 gram. Flaps were randomly assigned to six groups of six flaps according to the duration of venous occlusion with microvascular clamp; 10 minutes in the group I as the control, 60 minutes in the group II, 2 hours in the group III, 3 hours in the group IV, 4 hours in the group V, and 6 hours in the group VI, respectively. Just before removal of clamp after flap was reposed in situ, the ratio of $TcpO_2$ (tissue oxygen pressure) of the island flap to that of right abdomen was calculated in each group, and tissue specimen was harvested from the distal area of the flap for histological evaluation of vascular change. Five days later, survival area of the flap was estimated, and evaluated the correlation between the tissue oxygen pressure and the rate of flap survival. Results: The $TcpO_2$ and the survival rate of flap were decreased proportionally with the duration of venous occlusion. The ratio of the $TcpO_2$ of the flap is decreased abruptly to below sixty percentile compared to the $TcpO_2$ of normal tissue, and the survived area of the flap is decreased to nine-tenth of the designed size after three hours of total venous occlusion. Histologically, the number of congested vessels was increased according to venous occluded time, and proportionally increased after 3-hours of occlusion significantly. Conclusion: There is a close correlation between the $TcpO_2$ and the survival rate of flaps according to the duration of venous occlusion. Therefore, the $TcpO_2$ represents the hemodynamic changes within the flap, and thought to be an alternative effective tool in the flap monitoring for venous revascularization.

• Journal of Chest Surgery
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• v.38 no.10 s.255
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• pp.721-724
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• 2005

Aortocaval fistula is a rare complication of abdominal aortic aneurysm, involving less than $1\%$ of all abdominal aortic aneurysms. A 64-years old man with a long history of hypertension and abdominal aortic aneurysm had chest pain, dyspnea, epigastric discomfort and palpable abdominal pulsating mass. Physical examination revealed hypo­tension with a systolic blood pressure of 70 mmHg, a large pulsatile mass and a systolic abdominal bruit. Laboratory data revealed a hemoglobin values of 11.0 g/dL, blood urea nitrogen (BUN) value of 5 mg/dL, and creatine value of $2.5 mg\%$. Abdominal Angio CT showed a 10cm infrarenal abdominal aortic aneurysm with dilatation of the IVC and aortocaval fistula from the aortic aneurysm, which was confirmed at emergency surgery. When the aneurysm was opened and the thrombus was removed, a 1 cm communication was identified between the aorta and IVC. This was controlled with Foley catheters ballooning, and the fistula was closed by continuous suture placed outside the aneurysm. A bifurcated aorto-iliac graft was used to restore arterial continuity. The patient was discharged home after uncomplicated postoperative course.

• Archives of Plastic Surgery
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• v.47 no.5
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• pp.428-434
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• 2020

Background Three-dimensional (3D) model printing improves visualization of anatomical structures in space compared to two-dimensional (2D) data and creates an exact model of the surgical site that can be used for reference during surgery. There is limited evidence on the effects of using 3D models in microsurgical reconstruction on improving clinical outcomes. Methods A retrospective review of patients undergoing reconstructive breast microsurgery procedures from 2017 to 2019 who received computed tomography angiography (CTA) scans only or with 3D models for preoperative surgical planning were performed. Preoperative decision-making to undergo a deep inferior epigastric perforator (DIEP) versus muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flap, as well as whether the decision changed during flap harvest and postoperative complications were tracked based on the preoperative imaging used. In addition, we describe three example cases showing direct application of 3D mold as an accurate model to guide intraoperative dissection in complex microsurgical reconstruction. Results Fifty-eight abdominal-based breast free-flaps performed using conventional CTA were compared with a matched cohort of 58 breast free-flaps performed with 3D model print. There was no flap loss in either group. There was a significant reduction in flap harvest time with use of 3D model (CTA vs. 3D, 117.7±14.2 minutes vs. 109.8±11.6 minutes; P=0.001). In addition, there was no change in preoperative decision on type of flap harvested in all cases in 3D print group (0%), compared with 24.1% change in conventional CTA group. Conclusions Use of 3D print model improves accuracy of preoperative planning and reduces flap harvest time with similar postoperative complications in complex microsurgical reconstruction.

• Parasites, Hosts and Diseases
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• v.22 no.1
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• pp.51-60
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• 1984

Two cases of natural human infection by Heterophyopsis continua (Heterophyidae) were identified by collection of adult worms in 1983 in Korea. And in order to know the source of infection a study on fish intermediate hosts was performed along the southwestern coastal areas. The cases were 21 and 50 year old males residing in southern coastal areas. They had the clinical complaints of non-specific gastrointestinal symptoms such as epigastric pain and one of them also complained the discharge of tapeworm segments. Praziquantel in single dose of 10~15mg/kg was given followed by purgation with magnesium salt and 2 and 46 specimens of H. continua were collected from the diarrheal stools. They said to have eaten raw ilesh of several kinds of brackish water fishes. The results of fish examination for metacercarial infection were as follows: I. Seventeen (663.0%) out of 27 perches (Lateolabrax japonicus) and 10 (29.4%) out of 34 gobies (Acantkogobius flavimanus) harboured the metacercariae but none of 42 mullets (Mugil cepkalus) were found to harbour them. 2. The average metacercarial density in perches was 55.1 and 18.7 per fish respectively. And the majority of the metacercariae were collected from the muscle of body portions in these fishes. 3. After the metaeercariae were experimentally fed to two rats and one young dog. two adult worms were recovered from the dog while none from the rats. These worms were also identified as H. continua. From the results it was concluded that the brackish water flshes which the human cases said to have eaten were the source of infection.

• Clinical and Experimental Pediatrics
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• v.46 no.6
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• pp.572-575
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• 2003

Purpose : This study was performed to analyze the endoscopic findings in Henoch-Schonlein purpura patients, and to compare the differences in endoscopic findings according to age and gastrointestinal symptoms. Methods : We examined children with Henoch-Schonlein purpura aged 3 to 15 years between September 1996 and October 2002. The total number studied was 65, consisting of 41 boys and 24 girls. Endoscopy was performed and the results were analysed. Results : Among 65 cases, 12 cases of duodenitis, nine cases of gastritis and duodenitis, six cases of duodenal erosion, five cases of gastritis, five cases of duodenal ulcer, two cases of gastric ulcer and one case of colonic erosion were noted. Endoscopic abnormality was found in 38 of 53 who had gastrointestinal symptoms, and in two of 12 who didn't have gastrointestinal symptoms. Conclusion : Most of the gastrointestinal symptoms in Henoch-Schonlein purpura patients were relieved without complication. But in some cases severe symptoms such as hematemesis, melena, and abdominal pain localized to epigastric area were developed when diagnosis was delayed. Prompt endoscopy will be helpful for diagnosis and therapy of Henoch-Schonlein purpura with gastrointestinal involvement.

• Tuberculosis and Respiratory Diseases
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• v.65 no.3
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• pp.212-215
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• 2008

Rectus sheath hematoma (RSH) is a rare condition that's caused by a sudden disruption of the deep epigastric vessels or direct damage to the rectus abdominis muscle. This condition is associated with old age, childbirth, abdominal surgery, severe cough, severe sneezing, anticoagulation therapy and/or coagulation disorders. RSH is characterized by abdominal pain and an abdominal mass, so that this is often misdiagnosed as a surgical condition such as appendicitis, intraabdominal abscess, torsion of the ovary and ruptured abdominal aortic aneurysm; this can lead to unnecessary surgery. Thus, we have to be cautious not to miss RSH when a patient with predisposing factors is suffered from abdominal pain and an abdominal mass. We report here on a case of rectus sheath hematoma that was induced by severe cough in a patient who was taking warfarin.

• Journal of Gastric Cancer
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• v.2 no.1
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• pp.26-28
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• 2002

Carcinomas of the stomach can spread to adjacent structure by local extension or metastasize to lymph nodes, peritoneum and distant organs. However, the incidence of metastatic bladder cancer originated at the stomach is very rare. A fifty-five year-old man admitted complaining of epigastric pain for 2 months. A large ulceroinfiltrative lesion was seen in the low body, which was confirmed poorly differentiated adenocarcinoma by histological examination. Abdominopelvic CT scan showed wall thickening at the greater curvature side of gastric body and urinary bladder. Urine cytology was negative. By transurethral resection of bladder, he was diagnosed as metastatic adenocarcinoma of the bladder. We report a case of stomach cancer with metastasis to urinry bladder.