• Archives of Hand and Microsurgery
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• v.23 no.4
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• pp.281-289
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• 2018

Purpose: Preoperative surgical planning utilizing computed tomography angiography (CTA) has now become a routine in many practices. We analyzed the course of the deep inferior epigastric artery (DIEA) and its perforators (DIEP) that would either facilitate or hinder flap dissection based on CTA to aid surgical planning. Methods: The 115 consecutive patients who underwent abdominally based free flap breast reconstruction were enrolled in this prospective study. DIEA/P courses were categorized mainly according to their intramuscular courses and their incidences were investigated. Results: A total of 425 perforators were identified preoperatively on the CTA, with an average number of 3.7 distinctly visualized in the entire flap territory. Eighty-nine perforators (20.9%) had a favorable (less than 1 cm intramuscular course) pattern, namely long submuscular (34.8% of the patients), long subfascial (15.6%), and total circummuscular (13.9%). Overall 56.5% of the patients had at least one favorable DIEA/P. On the other hand, absence of DIEA and absence of adequate (>1 mm) DIEP was reported in 3 and 8 hemiabdomen. Conclusion: Preoperative CTA evaluation of DIEA/P can be used to identify favorable as well as unfavorable courses for dissection to aid surgical planning.

• Proceedings of the Korean Society for Emotion and Sensibility Conference
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• 2000.04a
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• pp.113-119
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• 2000

The Pansori is a Korean traditional vocal music that has a unique story and melody which converts deep emotion into art. It has both verbal and emotional components. which can be coordinated by large-scale neural network. The purpose of this study is to illustrate the cortical network activated by a Korean traditional opera, Pansori, with different emotional valence using functional MRI (fMRI).Nine right-handed volunteers participated. Their mean age was 25.3 and the mean modified Edinburgh score was +90.1. Activation tasks were designed for the subjects to passively listen to the two parts of Pansories with sad or hilarious emotional valence. White noise was introduced during the control periods. Imaging was conducted on a 1.5T Siemens Vision Vision scanner. Single-shot echoplanar fMRI scans (TR/TE 3840/40 ms, flip angle 90, FOV 220, 64 x 64 matrix, 6mm thickness) were acquired in 20 contiguous slices. Imaging data were motion-corrected, coregistered, normalized, and smoothed using SPM-96 software.Bilateral posterior temporal regions were activated in both of Pansori tasks, but different asymmetry between the tasks was found. The Pansori with sad emotion showed more activation in the light superior temporal regions as well as the right inferior frontal and the orbitofrontal areas than in the right superior temporal regions as well as the right inferior frontal and the orbitofrontal areas than in the left side. In the Pansori with hilarious emotion, there was a remarkable activation in the left hemisphere especially at the posterior temporal and the temporooccipital regions as well as in the left inferior and the prefrontal areas. After subtraction between two tasks, the sad Pansori showed more activation in the right temporoparietal and the orbitofrontal areas, in contrast, the one with hilarious emotion showed more activation in the left temporal and the prefrontal areas. These results suggested that different hemispheric asymmetry and cortical areas are subserved for the processing of different emotional valences carried by the Pansories.

• Journal of Yeungnam Medical Science
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• v.33 no.2
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• pp.166-169
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• 2016

Afferent loop obstruction following gastrectomy is a rare but fatal complication. Clinical features of afferent loop obstruction are mainly gastrointestinal symptoms. A 56-year-old female underwent radical total gastrectomy with Roux-en-Y esophagojejunostomy for treatment of advanced gastric cancer. After fourteen months postoperatively, she showed gradual development of edema of both legs. Computed tomography (CT) scan showed disease progression at the jejunojejunostomy site and consequent dilated afferent loop, which resulted in inferior vena cava (IVC) compression. A drainage catheter was placed percutaneously into the afferent loop through the intrahepatic duct and an IVC filter was placed at the suprarenal IVC, and self-expanding metal stents were inserted into bilateral common iliac veins. With these procedures, sympotms related with afferent loop obstruction and deep vein thrombosis were improved dramatically. The follow-up abdominal CT scan was taken 3 weeks later and revealed the completely decompressed afferent loop and improved IVC patency. Surgical treatment should be considered as the first choice for afferent loop obstruction; however, because it is more immediate and less invasive, non-surgical modalities, such as percutaneous catheter drainage or stent placement, can be effective alternatives for inoperable cases or risky patients who have severe medical comorbidities.

• Archives of Plastic Surgery
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• v.41 no.6
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• pp.693-701
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• 2014

Background A thin perforator flap is one of the best methods for covering defects. This study aimed to revisit and further test the rapidly advancing field of flap thinning techniques. Methods We performed two cadaveric studies to test the known flap thinning methods, and then applied these methods to a clinical series. In the first study, five cadavers were used to observe the anatomical relation of the perforator with the subdermal plexuses and the subcutaneous fat layer by injecting a colored latex solution. The second study was done on four cadavers independently from the first study. Last, a clinical series was performed on 15 patients. Results The areolar fat lobules of 10 anterolateral thigh perforator (ALT), seven deep inferior epigastric artery perforator (DIEAP), and six thoracodorsal artery perforator (TAP) flaps were dissected to reduce the flap thickness guided by the colored vascular pattern. On average, the ALT, DIEAP, and TAP flaps were reduced to $32.76%{\pm}9.76%$, $37.01%{\pm}9.21%$, and $35.42%{\pm}9.41%$, respectively. In the second study, the areolar fat lobules were directly dissected in six ALT, six TAP, and four MSAP flaps, and an average reduction in flap thickness of $53.41%{\pm}5.64%$, $52.30%{\pm}2.88%$, and $47.87%{\pm}6.41%$, respectively, was found. In the clinical series, 13 out of the 15 cases yielded satisfactory outcomes with an average thickness reduction of $37.91%{\pm}7.15%$. Conclusions These multiple studies showed that the deep fat layer could be safely removed to obtain a thin yet viable perforator flap. This evidence suggests that the macroscopic flap thinning technique can achieve thin flaps. Surgeons should consider this technique before embracing the latest technique of supermicrosurgery.

• Archives of Plastic Surgery
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• v.44 no.2
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• pp.109-116
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• 2017

Background The effect of liposuction on the perforators of the lower abdominal wall has been investigated in several studies. There are controversial results in the literature that have primarily demonstrated the number and patency of the perforators. The aim of this study was to determine the effect of liposuction on the perfusion of perforator-based abdominal flaps using a combined laser-Doppler spectrophotometer (O2C, Oxygen to See, LEA Medizintechnik). Methods Nine female patients undergoing classical abdominoplasty were included in the study. Perforators and the perfusion zones of the deep inferior epigastric artery flap were marked on the patient's abdominal wall. Flap perfusion was quantitatively assessed by measuring blood flow, velocity, capillary oxygen saturation, and relative amount of hemoglobin for each zone preoperatively, after tumescent solution infiltration, following elevation of the flap on a single perforator, and after deep and superficial liposuction, respectively. Results The measurements taken after elevation of the flap were not significantly different than measurements taken after the liposuction procedures. Conclusions The liposuction procedure does not significantly alter the perfusion of perforator-based abdominal flaps in the early period. The abdominal tissue discarded in a classic abdominoplasty operation can be raised as a perforator flap and has been demonstrated to be a unique model for clinical research.

• Restorative Dentistry and Endodontics
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• v.17 no.1
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• pp.1-9
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• 1992

The intradental nerve activity was recorded from single pulp nerve unit dissected from the inferior alveolar nerve in canine teeth of anesthetized cats. The effects of various test solutions on intradental nerve activity evoked by 4M NaCl applied to the deep dentinal cavities were investigated. 1. Total 15 single pulp nerve units were recorded. Of these 9 were Mi - fibers and 6 were C -fibers. The mean conduction velocity and electrical threshold of $A{\delta}$ - fiber were $6.3{\pm}3.7m/sec$, $1.2{\pm}0.7V$ and those of C - fiber were $1.0{\pm}0.2m/sec$, $2.3{\pm}1.3V$, respectively. The response to cold stimuli of $A{\delta}$ - fiber began immediately and that of C - fiber began after a latency. 2. When applied to deep dentinal cavity, 4M NaCl induced irregular bursts of action potential in 4 $A{\delta}$ - fibers and 3 C - fibers, which continued until the solution was washed away. 3. In the $A{\delta}$ - fiber, histamine failed to induce any nerve acitivity and did not produce an increase in intradental nerve activity evoked by 4M NaCl. However following the application of 1M KCl, the response to 4M NaCl was eliminated. 4. In the C - fiber, histamine generated some nerve activity and produced a significant increase in intradental nerve activity evoked by 4M NaCl, but 5M $CaCl_2$ did not abolish this enhandced response.

• Korean Journal of Remote Sensing
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• v.38 no.1
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• pp.103-110
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• 2022

Since satellite images generally include clouds in the atmosphere, it is essential to detect or mask clouds before satellite image processing. Clouds were detected using physical characteristics of clouds in previous research. Cloud detection methods using deep learning techniques such as CNN or the modified U-Net in image segmentation field have been studied recently. Since image segmentation is the process of assigning a label to every pixel in an image, precise pixel-based dataset is required for cloud detection. Obtaining accurate training datasets is more important than a network configuration in image segmentation for cloud detection. Existing deep learning techniques used different training datasets. And test datasets were extracted from intra-dataset which were acquired by same sensor and procedure as training dataset. Different datasets make it difficult to determine which network shows a better overall performance. To verify the effectiveness of the cloud detection network such as Cloud-Net, two types of networks were trained using the cloud dataset from KOMPSAT-3 images provided by the AIHUB site and the L8-Cloud dataset from Landsat8 images which was publicly opened by a Cloud-Net author. Test data from intra-dataset of KOMPSAT-3 cloud dataset were used for validating the network. The simulation results show that the network trained with KOMPSAT-3 cloud dataset shows good performance on the network trained with L8-Cloud dataset. Because Landsat8 and KOMPSAT-3 satellite images have different GSDs, making it difficult to achieve good results from cross-sensor validation. The network could be superior for intra-dataset, but it could be inferior for cross-sensor data. It is necessary to study techniques that show good results in cross-senor validation dataset in the future.

• Journal of Trauma and Injury
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• v.37 no.3
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• pp.182-191
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• 2024

Purpose: Vascular injuries require immediate surgical treatment with standard vascular techniques. We aimed to identify pitfalls in vascular surgery for trauma team optimization and to suggest recommendations for trauma and vascular surgeons. Methods: We reviewed 28 victims and analyzed the patterns of injuries, methods of repair, and outcomes. Results: Ten patients had torso injuries, among whom three thoracic aorta injuries were repaired with thoracic endovascular aortic repair, one left hepatic artery pseudoaneurysm with embolization, and two inferior vena cava with venorrhaphy, three iliac arteries with patch angioplasty or embolization, and three common femoral arteries with bypass surgery or arterioplasty. Four patients had upper extremity injuries, among whom one brachial artery and vein was repaired with bypass surgery after temporary intravascular shunt perfusion, two radial arteries were repaired with anastomoses, and one ulnar artery was repaired with ligation. One radial artery under tension was occluded. Fourteen patients had lower extremity injuries, among whom one superficial femoral artery and vein was repaired with bypass and concomitant ligation of the deep femoral artery and vein, three superficial femoral arteries were repaired with bypass (two concomitant femoral veins with bypass or anastomosis), one deep femoral artery with embolization, two popliteal arteries with bypass or anastomosis, four infrapopliteal transected arteries, one arteriovenous fistula with ligation, and one pseudoaneurysm with bypass. However, one superficial femoral artery and all femoral veins were occluded. One leg replantation failed. Conclusions: There are potential complications of vascular access during resuscitative endovascular balloon occlusion of the aorta procedures. Vascular repair should be performed without tension or spasm. Preservation of the harvested vein in papaverine solution and blood while using a temporary intravascular shunt is a method of eliminating spasms.

• Archives of Plastic Surgery
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• v.46 no.6
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• pp.599-602
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• 2019

We report a case of autologous breast reconstruction in which a thoracodorsal vessel was used as a recipient vessel after a hypoplastic internal mammary vessel was found on preoperative computed tomography (CT) angiography. A 46-year-old woman with no underlying disease was scheduled to undergo skin-sparing mastectomy and breast reconstruction using a deep inferior epigastric artery perforator flap. Preoperative CT angiography showed segmental occlusion of the right subclavian artery with severe atherosclerosis and calcification near the origin of the internal mammary artery, with distal flow maintained by collateral branches. The thoracodorsal artery was selected to be the recipient vessel because CT showed that it was of adequate size and was not affected by atherosclerosis. The patient experienced no postoperative complications, and the flap survived with no vascular complications. The breasts were symmetrical at a 6-month follow-up. This case highlights that preoperative vascular imaging modalities may help surgeons avoid using diseased vessels as recipient vessels in free flap breast reconstructions.

• Archives of Plastic Surgery
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• v.44 no.3
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• pp.238-242
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• 2017

The most common anatomic variant seen in donor kidneys for renal transplantation is the presence of multiple renal arteries, which can cause an increased risk of complications. Accessory renal arteries should be anastomosed to the proper source arteries to improve renal perfusion via the appropriate vascular reconstruction techniques. In microsurgery, 2 kinds of vascular augmentation methods, known as 'supercharging' and 'turbocharging,' have been introduced to ensure vascular perfusion in the transferred flap. Supercharging uses a distant source of the vessels, while turbocharging uses vascular sources within the same flap territory. These technical concepts can also be applied in renal transplantation, and in this report, we describe 2 patients who underwent procedures using supercharging and turbocharging. In one case, the ipsilateral deep inferior epigastric artery was transposed to the accessory renal artery (supercharging), and in the other case, the accessory renal artery was anastomosed to the corresponding main renal artery with a vascular graft (turbocharging). The transplanted kidneys showed good perfusion and proper function. No cases of renal failure, hypertension, rejection, or urologic complications were observed. These microsurgical techniques can be safely utilized for renal transplantation with donor kidneys that have multiple arteries with a lower complication rate and better outcome.