• Advances in pediatric surgery
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• 제10권1호
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• pp.52-55
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• 2004

A newborn male baby was transferred to our hospital with a left inguinal mass. The mass was huge measuring $10{\times}10cm$, engorged, and dark-blue colored as a result of internal hemorrhage. Unstable vital signs were combined with DIC and acute renal failure. Emergency operation was performed because of the suspicion of bowel perforation. The peritoneal cavity was full of ascitis and the distal jejunum had a 0.5 cm perforation. Segmental resection of the jejunum and incisional biopsy of the inguinal mass were performed. On pelvic and thigh MRI, the mass protruded into pelvic cavity and encircled large vessels and nerves of the thigh. Pathologic diagnosis was congenital infantile fibrosarcoma. Fifteen days after operation, primary tumor excision was undertaken. The second look operation, performed after 6 times VAC chemotherapy, revealed no remained malignant cell on microscopic section. The baby has been followed closely for the last eight months.

• Clinical Pain
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• 제18권1호
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• pp.36-39
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• 2019

Chronic postoperative inguinal pain (CPIP) is a major complication after inguinal herniorrhaphy. We report the treatment of CPIP using ultrasonography-combined with nerve stimulator for injection of the genitofemoral nerve (GFN). A 59-year-old man underwent laparoscopic herniorrhaphy and presented with numbness from the inguinal region to the scrotum after operation. In the pain clinic, ultrasonography-guided GFN block and pharmacological treatments had little effect. Six month after operation, patient was referred to the Department of Physical Medicine and Rehabilitation, and ultrasonography-combined with nerve stimulator for GFN injection underwent to enhance the accuracy of neural approach. The induction of scrotal contraction and paresthesia on the GFN distribution was monitored by nerve stimulator and local anesthetic was injected. After the block, pain relief lasted for 6 months without analgesic use. Ultrasonography-combined with nerve stimulator is an effective approach to treat CPIP as it enhances precise localization and injection of small peripheral nerve like GFN.

• Archives of Plastic Surgery
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• 제48권4호
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• pp.440-447
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• 2021

Background Brown adipose tissue (BAT) is a potential target for anti-obesity treatments. Previous studies have shown that BAT activation causes an acute metabolic boost and reduces adiposity. Furthermore, BAT and BAT-derived cell transplantation reportedly help treat obesity by regulating glucose and fatty acid metabolism. However, since BAT transplantation leads to whole-body weight loss, we speculated that earlier approaches cause a generalized and unnecessary fat tissue loss, including in breast and hip tissues. Methods We transplanted white adipose tissue-derived or BAT-derived preadipocytes prepared from C57BL/6 mice into one side of the inguinal fat pads of an obese mouse model (db/db mice) to examine whether it would cause fat loss at the peri-transplant site (n=5 each). The same volume of phosphate-buffered saline was injected as a control on the other side. Six weeks after transplantation, the inguinal fat pad was excised and weighed. We also measured the concentrations of glucose, triglycerides, fatty acids, and total cholesterol in the peripheral blood. Results BAT-derived preadipocytes showed abundant mitochondria and high levels of mitochondrial membrane uncoupling protein 1 expression, both in vivo and in vitro, with a remarkable reduction in weight of the inguinal fat pad after transplantation (0.17±0.12 g, P=0.043). Only free fatty acid levels tended to decrease in the BAT-transplanted group, but the difference was not significant (P=0.11). Conclusions Our results suggest that brown adipocytes drive fat degradation around the transplantation site. Thus, local transplantation of BAT-derived preadipocytes may be useful for treating obesity, as well as in cosmetic treatments.

• Advances in pediatric surgery
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• 제5권1호
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• pp.26-32
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• 1999

We analyzed our experience with orchidopexy for undescended testicle performed during recent 10 years in order to evaluate our results and to determine the most effective treatment of undecended testes. Between 1988 and 1997, we treated 420 undescended tested (314 palpable and 106 nonpalpable) in 356 boys. Medical records were reviewed with respect to age at presentation, the surgical approach, testicular location, testicular volume and the final outcome. The average patient age at presentation was 4.1 years with 40.2 % presenting before age 2 years. Of 106 nonpalpable testes, 23 testes were intra-abdominal, 32 were preperitoneal and 51 were absent. During the first 5 years, we performed orchidopexy through 31 inguinal and 13 midline transabdominal incisions for 44 paitents with nonpalpable testes. In the next 5 years, all 47 patients with nonpalpable were treated through inguinal incisions. For the nonpalpable testes, the inguinal approach with or without intraperitoneal extension was successful in defining the location of testes and blind-ending vessels in all patients. Laparoscopy did not help to avoid surgical exploration in all our patients with nonpalpable tests. Of 339 inguinal and midline tranabdominal orchidopexies without spermatic vessels ligations, 324 testes were placed in the scrotum, 4 in the upper scrotum and 3 in the inguinal area. Eight testes underwent atrophy. Of 13 Fowler-Stephens orchidopexies, 7 were placed in the scrotum and 6 became atrophied. Testicular growths were noticed in most patients who underwent orchidopexies and the colume of pexed testes became as large as the contralateral normal testes by the mean duration of 43.3 months postoperatively. In conclusion, orchidopexies were successful in most cases of cryptochidism in terms of testicular position and growth. However, there were more testicular atrophies in cases where spermatic vessels were ligated. In cases of nonpalpable undescended testes, the inguinal approach with or without intraperitoneal extesion would be recommended.

• 대한영상의학회지
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• 제81권4호
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• pp.1003-1007
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• 2020

대망의 서혜부 탈장에 의한 이차성 대망 염전은 급성 복통의 원인으로써 드물게 보고된 바 있다. 그러나 만성 복통의 원인으로써 이차성 대망 염전이 섬유성 벽을 가진 거대하고 단단한 종괴로 발견되는 것은 이전까지 보고되지 않았기에 이를 보고하고자 한다. 74세 남자 환자가 한 달간 지속된 만성적인 하복부 복통과 우하복부에 만져지는 종괴를 주소로 내원하였다. 시행한 서혜부 초음파상에서 양쪽 서혜부 탈장이 관찰되었다. 컴퓨터단층촬영상에서 오른쪽 서혜관으로 대망의 일부가 빠져나갔고 그 축을 중심으로 대망 염전이 있었다. 염전 줄기의 원위부 대망은 우하복부와 골반강에 걸쳐 단단한 섬유성 벽을 가진 약 30 cm 정도의 거대한 종괴를 형성하였다. 환자는 복강경하 장막 절제술 및 양쪽 탈장 수술을 시행 받은 뒤 퇴원하였다.

• Advances in pediatric surgery
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• 제16권2호
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• pp.101-107
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• 2010

Herniorrhaphy of Indirect inguinal hernia (IIH) is one of the most frequently performed surgical procedures in children. The overall incidence of inguinal hernias in childhood ranges from 0.8 to 4.4 %. The incidence is up to 10 times higher in boys than girls, especially much higher in premature infants. IIHs in children are basically an arrest of embryologic development rather than an acquired weakness, which explains the increased incidence in premature infants. In normal development, the processus vaginalis closes, obliterating the peritoneal opening of the internal ring between 36th and 40th week of gestation. This process is often incomplete, leaving a small patent processus in many newborns. However, closure continues postnatally, and the rate of patency is inversely proportional to age of the child. The presence of a patent processus vaginalis is a necessary but not sufficient variable in developing a congenital IIH. In other words, all congenital IIHs are preceded by a patent processus vaginalis, but not all patent processus vaginalis go on to become IIHs. The overall incidence of IIH in population is approximately 1 to 2 % and the incidence of a processus vaginalis is approximately 12 to 14%, clinically appreciable IIH should develop in approximately 8 to 12 % of patients with a patent processus vaginalis. Although the classic open inguinal hernia repair remains the gold standard for most pediatric surgeons, laparoscopic repair is being performed in many centers. Like open technique, laparoscopic technique is fundamentally a high ligation of the indirect hernia sac with or without internal ring ligation. The advantages of laparoscopic approach include the ease of examining the contralateral internal ring, the avoidance of access damage to vas and vessels during mobilization of cord, decreased operative time, and an ability to identify unsuspected direct or femoral hernias. Almost all groin hernias in children are IIHs and occur as a result of incomplete closure of processus vaginalis. The treatment is repair by high ligation of hernia sac, which can be done by an open or laparoscopic technique. The contralateral side can be explored by laparoscopy or left alone, open exploration is no longer indicated due to potential risk of infertility.

• Archives of Plastic Surgery
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• 제39권5호
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• pp.452-456
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• 2012

Background Phosphatidylcholine (PPC) and deoxycholate (DCA) compound has been recently used for the purpose of partial lipolysis and is valued for its efficacy and lower invasiveness compared to liposuction and dermolipectomy used previously. In this article, the authors discuss the efficacy of the PPC dissolved in DCA via an experimental rat study model, along with suggesting a useful animal experimental model for the study of adipose tissue and lipolysis. Methods Bilateral inguinal fat pads of an experimental rat were elevated with the deep inferior epigastric vessel as the sole vascular pedicle. Normal saline was injected on one side as a control group and a PPC and DCA compound was injected on the other side. After 4 days, the rats were euthanized for microscopic tissue examination. The pathology was scored by a sem-iquantitative system in 4 categories: normal fat amount, fat necrosis, inflammatory activity, and stage of fibrosis. A Wilcoxon signed-rank test powered by SPSS packet program was used for statistical analysis and to determine significance. Results Microscopic examination was performed on the obtained samples, and the experimental data of all four categories showed significant histologic differences compared to the control group. All of the data also showed statistical significance by the Wilcoxon signed-rank test (P<0.01). Conclusions In the inguinal fat pad rat model, the control group and the experimental group had a differed significantly in the amount of normal fat tissue, inflammation, necrosis, and fibrosis. We recommend the rat inguinal fat pad model used in this study, as it is likely to be useful in related research.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제13권4호
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• pp.370-380
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• 1991

This article is intended to study histopathological and immunohistochemical response after autogenous full-thickenss skin graft in rat. 12 male Sprague-Dawley rats were used as the experimental animals. A $1Cm{\times}1Cm$ skin(0.7mm diameter) was taken on the right inguinal area of the rat. Another full-thickeness skin graft($1Cm{\times}1Cm$) was taken from the left inguinal area of the rat. And it was transplanted to the right inguinal area of the rat. The left side wound was closed directly. Light microscopic observation was made at the postoperative $1^{\circ}3^{\circ}8^{\circ}16$ day, after the hematoxylin - Eosin staining of the 4u-thick paraffin embedded specimens and the immunoshitochemical staining of the 10u-thick frozen specimens with mouse anti-rat monoclone antibodies and ABC staining kit. The results were as follows. 1. Electromicroscopic studies revealed interstitial tissue bleeding of transplanted autogenous skin. The response was severe in the 1 day group after operation, moederate in 3 day group, mild in 8 day group, and almost resovled in the 16 days group. 2. Electromicrospic studied also revealed a mild monocyte response in the 3 day and 8 day group. A histiocytic infiltrate was observed. There was a mild response in the 3 day group and moderate response in the 8 day group. 3. Immunohistochmically studies revealed a few pan T cells in the 1 day group, mild appearance of pen T cells and cytotoxic T cells in the 3 day group, a moderate infiltrate of pan T cells and helper T cells in the 8 day group, and total resolution of pan T cells in the 16 day group. 4. According to these finding, a strong inflammatory response was observed around transplanted autogenous skin in the 3 & 8 day groups. In the 16 day group this response had resolved histopathologically and immunohistologically.

• Journal of Chest Surgery
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• 제43권5호
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• pp.562-564
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• 2010

임파루는 대퇴부 절개를 이용한 혈관 수술시 흔히 발생하는 합병증이다. 임파선은 해부학적으로 혈관과 매우 가깝게 위치하기 때문에 혈관 노출 과정에서 드물지 않게 손상된다. 임파액을 적절하게 배액시키지 않으면 환자가 다른 합병증으로 이환되는 원인으로 작용할 수 있으며, 흔히 창상 감염을 야기한다. 이에 대한 다양한 치료법이 보고되었음에도 임파루는 치료하기 어렵고 결국에는 재원기간을 연장 시킨다. 서혜부 절개를 이용한 혈관 수술을 받은 72세 여자환자에게서 수술후 임파루가 발생하였으며 창상에 음압 요법을 시행하였다. 조기에 적절한 배액이 되었고, 창상 치유가 원활하여 창상 봉합이 가능하였기에 재원기간을 단축할 수 있었다.

• Archives of Plastic Surgery
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• 제36권4호
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• pp.406-410
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• 2009

Purpose: An anatomical study concerning the location of the perforators to the posteromedial thigh perforator flap was done for the purpose of clinical application, and reconstruction using this flap was undergone for 3 patients with ischial sores. Methods: The authors dissected 6 cadavers, measuring the distance between the perforator of the posteromedial thigh perforator flap and the extended line of the inguinal crease. The location of the perforator was studied using this data. In the 3 cases mentioned above, perforators were traced using Doppler ultrasonography and the sores were reconstructed with posteromedial thigh perforator flaps. Results: Anatomical study results revealed that posteromedial thigh perforators were found $77{\pm}18.9mm$ below the extended line of the inguinal crease. Application of the flap in the 3 patients was successful. Conclusion: The perforator to the posteromedial thigh perforator flap was found to be located in a relatively consistent position. Since this flap is also comparatively easy to elevate and mobilize, and shows low donor site morbidity, it is thought to be very useful in the treatment of ischial sores.