• Pediatric Infection and Vaccine
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• 제26권1호
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• pp.60-65
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• 2019

항인지질항체는 자가면역 질환에서 발생할 수 있고, 때로는 마이코플라즈마와 같은 감염 후에도 발생할 수 있다. 그러나 마이코플라즈마 폐렴 후 항인지질항체의 발현과 혈전의 발생은 매우 드물게 보고되어왔다. 본 8세 환아는 마이코플라즈마 폐렴 입원 치료 중 손가락의 변색 및 감각 저하가 발생하였고 혈액검사 결과 항인지질항체 양성으로 확인되었다. 이로 인해 상완동맥 혈전증이 발생하여 혈전제거술을 시행하여 제거하였다. 양성이었던 항인지질항체는 5개월 내 다시 정상화되었다. 마이코플라즈마 폐렴의 합병증은 피부 병변을 포함하여 체내 많은 장기에 다양한 증상을 보이지만, 그 중 항인지질항체의 발현으로 인한 혈전의 발생은 치명적이므로, 마이코플라즈마 폐렴의 치료에 있어 고려해야 할 합병증의 사례를 보고한다.

• 한국정보통신학회논문지
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• 제24권11호
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• pp.1411-1416
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• 2020

본 논문에서는 색조 도플러 초음파 영상에서 K-Means 알고리즘을 적용하여 혈류 영역을 추출하는 방법을 제안한다. 제안된 방법에서는 ROI 영역을 추출하고, 추출된 ROI 영역에서 최대 명암도를 임계치로 설정한 이진화 기법을 적용하여 ROI 영역을 이진화한다. 이진화된 ROI 영역에서 4 방향 윤곽선 추적 기법을 적용하여 상완 동맥의 혈류 영역이 존재하는 사다리꼴 형태의 영역을 추출한다. 추출된 사다리꼴 형태의 영역에서 상완동맥의 혈류영역을 정확히 추출하기 위하여 K-Means 기반 양자화 기법을 적용한다. 실험에서 제안 된 방법은 현장 전문가의 검증을 거쳐 30건 중 28건 (93.3%)에서 혈류 영역을 성공적으로 추출하였다. 그리고 제안된 K-Means 기반 혈류 영역 추출 방법을 30개의 색조 도플러 초음파 영상에 적용하여 전문의가 제공한 상완동맥 혈류 영역과 제안된 방법을 비교 분석한 결과, 정확도가 평균적으로 94.27%로 나타났다.

• Journal of Chest Surgery
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• 제53권6호
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• pp.408-410
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• 2020

Iatrogenic vascular injuries may occur during venipuncture, arterial cannulation, or catheterization procedures. Brachial arteriovenous fistula (AVF) resulting from antecubital vascular access is rare and develops slowly. We report the case of an 18-year-old man who had developed iatrogenic brachial AVF. He had a history of several venipunctures in the left arm at the age of 10 months. Doppler ultrasonography and computed tomographic angiography were used to establish a diagnosis of brachial AVF, and surgical correction of the AVF was performed. As our case indicates, delayed surgery can be considered as a treatment option and may be associated with a decreased risk of vascular complications in the management of iatrogenic brachial AVF in infants.

• Archives of Reconstructive Microsurgery
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• 제6권1호
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• pp.73-79
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• 1997

Complete denervation after severe brachial plexus injury make significant muscle atrophy with loss of proper function. It is much helpful to reconstruct the essential function of the elbow flexion movement in patient with total loss of elbow flexion motion after brachial plexus lesion which was not recovered with nerve surgery or long term conservative treatment from onset. In whole arm type brachial plexus injury, if there were no response to neurotization or neglected from injury, the volume of the denervated muscle is significantely reduced month by month. About 18 months most of the muscle fibers change to fibrous tissues and markedly atrophied irreversibly, further waiting is no more meaningful from that period. Authors performed 14 cases of functioning gracilis muscle transfer from 1981 to 1995 with microneurovascular technique, neuromusculocutaneous free flaps were performed for reconstruction of lost elbow flexion function. Average follow-up period was 5 years and 6 months. We used couple of intercostal nerves as a recipient nerve which were anastomosed to muscular nerve from obturator nerve in all cases. Recipient vessels were three deep brachial artery and eleven brachial artery which were anastomosed to medial femoral circumflex artery with end to end or end to side fashion. Average resting length of the transplanted gracilis were 24 cm. We can get average 54 degree flexion range of elbow with fair muscle power from flail elbow. There were one case of muscle necrosis with lately developed thrombosis of microvascular anastomosed site which comes from insufficient recipient arterial condition, 3 cases of partial marginal necrosis of distal skin of the transplanted part which were not significant problem with spontaneously solved with time goes by gracilis muscle has constant neurovascular pattern with relatively easy harvesting donor with minimal donor morbidity. Especially it has similar length and shape with biceps brachii muscle of upper arm and longer nerve pedicle which can neurorrhaphy with intercostal nerve without nerve graft if sufficient mobilization of the nerves from both sides of gracilis and intercostal region. Authors can propose gracilis muscle transplantation with intercostal nerves neurotization is helpful method with minimal donor morbidity for neglected brachial plexus palsy patients.

• Journal of Chest Surgery
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• 제37권1호
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• pp.84-87
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• 2004

상완신경총에 생기는 신경원성 종양은 드문 질환이다. 최근에 저자는 상완신경총에 발생한 한 예의 신경초종을 치험하였다. 환자는 34세 남자로 좌측 쇄골상부에 서서히 자라는 종괴를 주소로 내원하였다. 자기공명영상에서 좌측 쇄골하동맥의 후상방부에 고립성 종괴를 발견하였다. 수술 시 상완신경총 직하부에 피막으로 잘 감싸진 종괴를 발견하였으며, 신경 섬유를 가능한한 다치지 않게 하기 위해 피막을 열고 종양을 적출하였다. 수술 후 신경학적인 결함은 없었다.

• Korean Journal of Acupuncture
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• 제39권4호
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• pp.172-183
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• 2022

Objectives : An error was found in the recent standard by the World Health Organization (WHO) on the locations of the Upper arm Route of Lung Meridian (URLM) and its acupoints LU3 and LU4. This possible incorrect information is being taught throughout Korean medicine colleges nationwide, which follow WHO standards. Therefore, an investigation is required to sort out this discrepancy based on the evidence in historical documents. Methods : The location of WHO's URLM and LU3 and LU4 were compared with corresponding information in the classical literature. The anatomical structure mentioned in these classical documents was examined. Finally, an assessment was conducted on whether this structure is reflected in the WHO standards. Results : Classical literature prior to the early 20th century records the locations of the Lung Meridian and LU3 and LU4 of the upper arm to be in the artery on the medial aspect. This artery corresponds to the brachial artery. The location established by the WHO is on the anterolateral side of the upper arm, where no large arteries exist that can be found by haptic search or angiographically. The anterolateral side of the upper arm belongs to the Yang aspect, which does not coincide with the Yin aspect of Lung Meridian. Conclusions : The WHO's URLM and LU3-4 standards do not agree with the classical literature. The correct route must coincide with the brachial artery passing through the medial side of the humerus. The actual location of LU3-4 is on the medial aspect of the arm, just medial to the border of the biceps brachii muscle, on the brachial artery, 3-4 B-cun inferior to the anterior axillary fold.

• Archives of Plastic Surgery
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• 제44권1호
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• pp.12-18
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• 2017

Background Nonliving chickens are commonly used as a microvascular anastomosis training model. However, previous studies have investigated only a few types of vessel, and no study has compared the characteristics of the various vessels. The present study evaluated the anatomic characteristics of various chicken vessels as a training model. Methods Eight vessels-the brachial artery, basilic vein, radial artery, ulnar artery, ischiatic artery and vein, cranial tibial artery, and common dorsal metatarsal artery-were evaluated in 26 fresh chickens and 30 chicken feet for external diameter (ED) and thicknesses of the tunica adventitia and media. The dissection time from skin incision to application of vessel clamps was also measured. Results The EDs of the vessels varied. The ischiatic vein had the largest ED of $2.69{\pm}0.33mm$, followed by the basilic vein ($1.88{\pm}0.36mm$), ischiatic artery ($1.68{\pm}0.24mm$), common dorsal metatarsal artery ($1.23{\pm}0.23mm$), cranial tibial artery ($1.18{\pm}0.19mm$), brachial artery ($1.08{\pm}0.15mm$), ulnar artery ($0.82{\pm}0.13mm$), and radial artery ($0.56{\pm}0.12mm$), and the order of size was consistent across all subjects. Thicknesses of the tunica adventitia and media were also diverse, ranging from $74.09{\pm}19.91{\mu}m$ to $158.66{\pm}40.25{\mu}m$ (adventitia) and from $31.2{\pm}7.13{\mu}m$ to $154.15{\pm}46.48{\mu}m$ (media), respectively. Mean dissection time was <3 minutes for all vessels. Conclusions Our results suggest that nonliving chickens can provide various vessels with different anatomic characteristics, which can allow trainees the choice of an appropriate microvascular anastomosis training model depending on their purpose and skillfulness.

• 대한한의학회지
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• 제26권1호
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• pp.11-17
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• 2005

This study was carried out to identify the components of the human heart meridian muscle, the regional muscle group being divided into outer, middle, and inner layers. The inner parts of the body surface were opened widely to demonstrate muscles, nerves, blood vessels and to expose the inner structure of the heart meridian muscle in the order of layers. We obtained the following results; $\cdot$ The heart meridian muscle is composed of muscles, nerves and blood vessels. $\cdot$ In human anatomy, the difference between terms is present (that is, between nerves or blood vessels which control the meridian muscle and those which pass near by). $\cdot$ The inner composition of the heart meridian muscle in the human arm is as follows: 1) Muscle H-l: latissimus dorsi muscle tendon, teres major muscle, coracobrachialis muscle H-2: biceps brachialis muscle, triceps brachialis muscle, brachialis muscle H-3: pronator teres muscle and brachialis muscle H-4: palmar carpal ligament and flexor ulnaris tendon H-5: palmar carpal ligament & flexor retinaculum, tissue between flexor carpi ulnaris tendon and flexor digitorum superficialis tendon, flexor digitorum profundus tendon H-6: palmar carpal ligament & flexor retinaculum, flexor carpi ulnaris tendon H-7: palmar carpal ligament & flexor retinaculum, tissue between flexor carpi ulnaris tendon and flexor digitorum superficial is tendon, flexor digitorum profundus tendon H-8: palmar aponeurosis, 4th lumbrical muscle, dorsal & palmar interrosseous muscle H-9: dorsal fascia, radiad of extensor digiti minimi tendon & extensor digitorum tendon 2) Blood vessel H-1: axillary artery, posterior circumflex humeral artery H-2: basilic vein, brachial artery H-3: basilic vein, inferior ulnar collateral artery, brachial artery H-4: ulnar artery H-5: ulnar artery H-6: ulnar artery H-7: ulnar artery H-8: palmar digital artery H-9: dorsal digital vein, the dorsal branch of palmar digital artery 3) Nerve H-1: medial antebrachial cutaneous nerve, median n., ulnar n., radial n., musculocutaneous n., axillary nerve H-2: median nerve, ulnar n., medial antebrachial cutaneous n., the branch of muscular cutaneous nerve H-3: median nerve, medial antebrachial cutaneous nerve H-4: medial antebrachial cutaneous nerve, ulnar nerve H-5: ulnar nerve H-6: ulnar nerve H-7: ulnar nerve H-8: superficial branch of ulnar nerve H-9: dorsal digital branch of ulnar nerve.

• Archives of Plastic Surgery
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• 제39권3호
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• pp.227-231
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• 2012

Background : The ankle brachial pressure index (ABI) is a simple, useful method for diagnosing peripheral artery disease (PAD). Although the ABI is an objective diagnostic method, it has limited reliability in certain scenarios. The aim of the present study was to determine the accuracy and reliability of the toe brachial index (TBI) as a diagnostic tool for detecting stenosis in PAD, associated with normal or low ABI values. Methods : ABI and TBI values were measured in 15 patients with diabetic gangrene who were suspected of having lower extremity arterial insufficiency. The ABI and TBI values were measured using a device that allowed the simultaneous measurement of systolic blood pressure in the upper and lower extremities. In addition, the ABI and TBI values were compared pre- and post-angiography. Results : Patients with an ABI of 0.9-1.3 showed almost no difference between the 2 measurements. The patients with TBI >0.6 had no arterial insufficiency. The patients with TBI <0.6 required vascular intervention with ballooning. After the angiography, the gangrenous wounds decreased in size more rapidly than they did prior to the intervention. Conclusions : Our findings suggest that TBI is the method of choice for evaluating lower limb perfusion disorders. This result requires further studies of TBI in a larger number of patients. Future long-term studies should therefore evaluate the utility of TBI as a means of screening for PAD and the present findings should be regarded as preliminary outcomes.

• Journal of Chest Surgery
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• 제3권1호
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• pp.31-38
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• 1970

This is a report of three cases of successful embolectomy in peripheral arteries. First case was the patient who received a mitral commissurotomy 8 months ago. In that time, there was no evidence of left atrial thrombosis. He showed an embolism in the middle portion of left brachial artery without complaining of any ischemic pain. Embolectomy was performed 15 days after disappearance of radial pulse and resulted in no return of radial pulse postoperatively. Second case was a case of an embolism in lower portion of right brachial artery. She complained severe ischemic pain and cyanosis in the right forearm and fingers. She was also in the beginning state of cardiac failure, which was suspected from her hypertension associated with cardiomegaly and arrythmia Embolectomy was performed 17 hours after onset of acute pain. Immediate full pulsation of radial artery was obtained after embolectomy and the acute ischemic symptoms subsided gradually. Third case was an embolism in superior mesenteric artery which occured 24 hours after pneumonectomy for right bronchogenic carcinoma and the patient suddenly complained diffuse abdominal colicky pain. 7 hours after attack of abdominal pain. embolectomy with extensive reset ion of the small intestine was performed with uneventful recovery and without complication, such as short bowel syndrome, postoperatively. Histopathologically, the embolus was consisted of a tissue of anaplastic cell carcinoma, which was identical to the tumor of the resected right lung. Histological findings of other emboli of first and second case were old thrombus.