• Archives of Plastic Surgery
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• v.47 no.4
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• pp.324-332
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• 2020

Background The deep inferior epigastric artery perforator (DIEP) flap is the commonest flap used for breast reconstruction after mastectomy. It is performed as a unilateral (based on one [unipedicled] or two [bipedicled] vascular pedicles) or bilateral procedure following unilateral or bilateral mastectomies. No previous studies have comprehensively analyzed analgesia requirements and hospital stay of these three forms of surgical reconstruction. Methods A 7-year retrospective cohort study (2008-2015) of a single-surgeon's DIEP-patients was conducted. Patient-reported pain scores, patient-controlled morphine requirements and recovery times were compared using non-parametric statistics and multivariable regression. Results The study included 135 participants: unilateral unipedicled (n=84), unilateral bipedicled (n=24) and bilateral unipedicled (n=27). Univariate comparison of the three DIEP types showed a significant difference in 12-hour postoperative morphine requirements (P=0.020); bipedicled unilateral patients used significantly less morphine than unipedicled (unilateral) patients at 12 (P=0.005), 24 (P=0.020), and 48 (P=0.046) hours. Multivariable regression comparing these two groups revealed that both reconstruction type and smoking status were significant predictors for 12-hour postoperative morphine usage (P=0.038 and P=0.049, respectively), but only smoking, remained significant at 24 (P=0.010) and 48 (P=0.010) hours. Bilateral reconstruction patients' mean hospital stay was 2 days longer than either unilateral reconstruction (P<0.001). Conclusions Although all three forms of DIEP flap breast reconstruction had similar postoperative pain measures, a novel finding of our study was that bipedicled DIEP flap harvest might be associated with lower early postoperative morphine requirements. Bilateral and bipedicled procedures in appropriate patients might therefore be undertaken without significantly increased pain/morbidity compared to unilateral unipedicled reconstructions.

• The Journal of Internal Korean Medicine
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• v.26 no.3
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• pp.641-651
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• 2005

It is well known that functional dyspepsia is one of the most common diseases. Functional dyspepsia, as defined by Rome I and II criteria, is a known and important gastrointestinal disorder. Symptoms of functional dyspepsia are postprandial fullness, postprandial discomfort, epigastric bloating, epigastric lump sensation, early satiety, nausea, vomiting, regurgitation, eruction, hunger pain, postprandial epigastric pain, heartburn, soreness and anorexia. Treatment of these symptoms are recorded in the Donguibogam(東醫寶鑑). This study is a comparative study between initial medical examination and end of medical treatment with LJTG mentioned in the Donguibogam. After treatment with LJTG, patients showed improvement in all symptoms associated with functional dyspepsia, including general condition. The results of this study suggest that LJTG is an effective treatment for functional dyspepsia.

• Journal of Yeungnam Medical Science
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• v.4 no.1
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• pp.43-47
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• 1987

7 cases of Acute Gastric Anisakiasis have been reviewed at the Department of Internal Medicine. Yeungnam University Hospital from March, 1983 to December 1986. 1. Of 7 cases, the ratio of male and female was 3:4 and the age 30s occupied most (5 cases) the 50s' followed (2 cases). 2. Chief complains were in order of epigastric pain (6 cases), vomiting (3 cases), Nause (2 cases), Ulticaria (1 case) & epigastric fulling sensation (1 case). 3. In all 7 cases, the causative fish is Astroconcer myriaster. 4. The onset of symptoms was observed within 5 to 7 hours after eating the causative raw fish. 5. Gastrofiberscopic exam was undergo within 18 hours since onset of symptoms. 6. The gastrofiberscopic findings were gastric mucosal edema and redness in all 7 cases. One case also had mucosal erosion. The involved sites of the stomach were in frequency of order, the body (5 cases), the antrum (2 cases). 7. The symptoms of the patients relieved spontaneously without medical treatment after the extraction of the larva with biopsy forcep during gastrofiberscopy. 8. In Korea, many people take raw fish and there may be many patients of Anisakiasis so if much concern and careful observation are paid to whom, with severe cramping epigastric pain after taking of raw marine fish in about 10 hours, we could find out and confirm more patients suffering from Anisakiasis by immediate endoscopic gastrofiberscopy.

• The Journal of Internal Korean Medicine
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• v.26 no.4
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• pp.889-896
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• 2005

Objective : Diarrhea is defined as an increased frequency of stools(more than three per day), increased liquidity(loose or watery) and decreased consistency or stools. This study was done to examine the efficacy of Gwakhyang-junggisan for two patients who had suffered from chronic diarrhea of unknown origin on examination. At the time of admission, patients complained of diarrhea 4 or 5 times per day accompanied with epigastric discomfort, quadri pain. As of the fourth day of Gwakhyang-junggisan administration, the frequency and liquidity of diarrhea decreased and accompanying symptoms also improved. Method : Gwakhyang-junggisan was used for these patients suffering from chronic diarrhea of origin unknown to western medicine. patients were diagnosed as daejang-sul as bihu disease. Result : Results were taken as two cases of effective treatment of chronic diarrhea with Gwakhyang-junggisan. Conclusion : Result of this study suggest that Gwakhyang-junggisan is all effective treatment for such symptoms of chronic diarrhea as epigastric discomfort, quadri pain.

• Journal of East-West Nursing Research
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• v.13 no.1
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• pp.5-12
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• 2007

Purpose: The purpose of this study was to identify the effects of hand acupuncture on relieving of abdominal pain. Method: Fifty-five middle school students who complained abdominal pain were selected as subjects. There were 35 students in the experimental group while 20 students were in the control group. Convenience assignment was used. The experimental group received hand acupuncture treatment which was to puncture corresponding points (epigastric pain A8, A12, A16, K9, F4, E42; lower abdominal pain A1, A4, A6, A8, J1, H2) on both the palm and the back of a hand with disposable acupuncture needles, and then to remove them after a 20-30min. recess during the subjects was in supine position on a bed. Result: Degree of subjective pain decreased statistically in the experimental as compared to the control group. No statistical significant differences were found in objective pain and comfort between experimental and control group. Conclusion: These findings indicate that hand acupuncture is an effective method for reducing abdominal pain. Therefore, hand acupuncture could be considered as an independent nursing intervention for abdominal pain reduction.

• The Korean Journal of Pain
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• v.26 no.4
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• pp.396-400
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• 2013

Conventional transcrural CPB via the "walking off" the vertebra technique may injure vital organs while attempting to proximally spread injectate around the celiac plexus. Therefore, we attempted the CT-simulated fluoroscopy-guided transdiscal approach to carry out transcrural CPB in a safer manner, spreading the injectate more completely and closely within the celiac plexus area. A 54-year-old male patient with pancreatic cancer suffered from severe epigastric pain. The conventional transcrural approach was simulated, but the needle pathway was impeded by the kidney on the right side and by the aorta on the left side. After simulating the transdiscal pathway through the T11-12 intervertebral disc, we predetermined the optimal insertion point (3.6 cm from the midline), insertion angle (18 degrees), and advancement plane, as well as the proper depth. With the transdiscal approach, we successfully performed transcrural CPB within a narrow angle, and the bilateral approach was not necessary as we were able to achieve the bilateral spread of the injectate with the single approach.

• 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.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.4 no.2
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• pp.224-227
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• 2001

Esophageal duplication cysts are quite uncommon benign lesions of the esophagus that have previously been described as occurring only in the thoracic cavity. We experienced a rare case of completely intra-abdominal esophageal duplication cyst in a 10-year-old boy who has suffered from epigastric abdominal pain. Surgical excision is recommended at the time of cyst discovery whether symptoms present or not.

• Journal of Chest Surgery
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• v.19 no.2
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• pp.341-346
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• 1986

Crytococcosis is a subacute or chronic, very rare in incidence and very often fatal infection caused by Cryptococcus Neoformans. The organism is of world-wide distribution, affecting both sexes and all ages. The most common portals of entry appear to be respiratory tract. Recently we experienced one case of isolated Cryptococcal Granuloma on the right lower lobe. The patient was 63 year old housewife, who complained only of epigastric pain. On baseline studies of chest X-ray, we incidentally found the abnormal finding of mass density on right lower lobe.

• Advances in pediatric surgery
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• v.10 no.1
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• pp.43-46
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• 2004

Two cases of trichobezoar with unusual presentation in female children are described. The first case is a 7-year-old female with a 3-day history of abdominal pain, obstipation, and emesis. She developed intestinal obstruction and showed double bezoars in the stomach and intestine respectively. She had been in a habit of biting or sucking hairs before sleeping from infancy until 5 years of age. The other patient is a 6-year-old girl referred for an epigastric mass, emotional disturbance and trichotillomania. In spite of the psychological treatment, 4 laparotomies were necessary due to repeated recurrences.