• Journal of Chest Surgery
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• 제35권10호
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• pp.730-735
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• 2002

횡격막은 횡격막 신경과 동측의 하 흉벽 늑간신경의 지배를 받는다. 상완신경총의 적출 손상을 가진 환자에서 신경총의 일부 신경의 신경이식술에 횡경막 신경의 신경 이식편이 종종 이용된다. 이와 같이 횡격막 신경이 신경이식편으로 사용된 환자에서 횡격막 신경의 탈신경으로 인하여 발생하는 횡격막의 위치 및 운동의 변화를 연구하였다. 대상 및 방법 : 어께의 둔상으로 상완신경총의 적출 손상 때문에 동측의 횡격막 신경으로 근피부신경에 신경이식술을 시행한 13예를 대상으로 하였다. 흉강경 수술방법으로 흉강 내 횡격막 신경을 박리하고 횡격막 바로 위에서 횡격막 신경을 절단하여 경부 절개창을 통해서 외부로 끌어낸 다음 피하 터널을 통해서 동측의 근피부신경에 이식하였다. 엑스선 투시검사와 흉부 엑스선 촬영으로 수술 전후의 횡격막 위치 및 운동 상태를 조사하였다. 결과 : 흉강경을 이용하여 횡격막 신경을 박리 절단하는데 기술적 어려움이나 경미한 합병증도 없었다. 횡격막 신경의 절단 직후에는 횡격막이 평균 1.7 늑간 정도 올라가 있었으나, 엑스선 투시검사에서 흡기시 횡격막의 역행성 운동은 보이지 않았다. 1.5개월 이후의 엑스선 검사에서 횡격막의 위치는 수술 전에 비해 유의한 차이 없을 정도(평균 0.9 늑간 차이; p＝NS로 복원되었다. 횡격막 신경의 절단으로 횡격막의 운동 범위는 탈신경 전에 비해 유의한 차이가 없었다. 결론 : 횡격막 신경의 차단으로 인한 탈신경 후 횡격막의 운동기능은 남아 있었으며 횡격막의 위치는 시간이 경과함에 따라 어느 정도 회복되는 현상을 보였다. 그러나 폐활량이 계속 감소된 소견은 횡격막의 흡기력이 완전히 회복되지 않았음을 추정할 수 있다.

• Korean Journal of Acupuncture
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• 제22권1호
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• pp.67-74
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• 2005

Objectives : This study was carried to identify the component of the Pericardium Meridian Muscle in human. Methods : The regional muscle group was divided into outer, middle, and inner layer. The inner part of body surface were opened widely to demonstrate muscles, nerve, blood vessels and to expose the inner structure of the Pericardium Meridian Muscle in the order of layers. Results We obtained the results as follows; He Perfcardium Meridian Muscle composed of the muscles, nerves and blood vessels. In human anatomy, it is present the difference between terms (that is, nerves or blood vessels which control the muscle of the Pericardium Meridian Muscle and those which pass near by the Pericardium Meridian Muscle). The inner composition of the Pericardium Meridian Muscle in human is as follows ; 1) Muscle P-1 : pectoralis major and minor muscles, intercostalis muscle(m.) P-2 : space between biceps brachialis m. heads. P-3 : tendon of biceps brachialis and brachialis m. P-4 : space between flexor carpi radialis m. and palmaris longus m. tendon(tend.), flexor digitorum superficialis m., flexor digitorum profundus m. P-5 : space between flexor carpi radialis m. tend. and palmaris longus m. tend., flexor digitorum superficialis m., flexor digitorum profundus m. tend. P-6 : space between flexor carpi radialis m. tend. and palmaris longus m. tend., flexor digitorum profundus m. tend., pronator quadratus m. H-7 : palmar carpal ligament, flexor retinaculum, radiad of flexor digitorum superficialis m. tend., ulnad of flexor pollicis longus tend. radiad of flexor digitorum profundus m. tend. H-8 : palmar carpal ligament, space between flexor digitorum superficialis m. tends., adductor follicis n., palmar interosseous m. H-9 : radiad of extensor tend. insertion. 2) Blood vessel P-1 : lateral cutaneous branch of 4th. intercostal artery, pectoral br. of Ihoracoacrornial art., 4th. intercostal artery(art) P-3 : intermediate basilic vein(v.), brachial art. P4 : intermediate antebrachial v., anterior interosseous art. P-5 : intermediate antebrarhial v., anterior interosseous art. P-6 : intermediate antebrachial v., anterior interosseous art. P-7 : intermediate antebrachial v., palmar carpal br. of radial art., anterior interosseous art. P-8 : superficial palmar arterial arch, palmar metacarpal art. P-9 : dorsal br. of palmar digital art. 3) Nerve P-1 : lateral cutaneous branch of 4th. intercostal nerve, medial pectoral nerve, 4th. intercostal nerve(n.) P-2 : lateral antebrachial cutaneous n. P-3 : medial antebrachial cutaneous n., median n. musrulocutaneous n. P-4 : medial antebrachial cutaneous n., anterior interosseous n. median n. P-5 : median n., anterior interosseous n. P-6 : median n., anterior interosseous n. P-7 : palmar br. of median n., median n., anterior interosseous n. P-8 : palmar br. of median n., palmar digital br. of median n., br. of median n., deep br. of ulnar n. P-9 : dorsal br. of palmar digital branch of median n. Conclusions : This study shows some differences from already established study on meridian Muscle.

• Journal of Chest Surgery
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• 제41권6호
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• pp.807-810
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• 2008

안면부 다한증으로 클립을 이용한 흉부교감신경 차단술을 시행받고 이 중 심한 보상성 다한증을 4명의 환자를 대상으로 2005년 10월부터 2006년 8월까지 클립 제거와 늑간 신경을 이용한 흉부교감신경재건수술을 시행하였다. 재건 수술은 4명 모두 흉강경하에 가능하였으며 3번째 늑간 신경을 박리하여 신경집을 제거하고 클립으로 손상된 교감신경의 근위부와 원위부의 신경집을 제거한 후 늑간신경을 밀착시켜 fibrin sealant를 도포하여 연결하였다. 재건 수술 후 만족도는 외래 추적 관찰 또는 전화 설문으로 평가하였다. 1명의 환자는 먼저 흉부교감신경을 차단한 클립을 제거하였으나 28개월 동안 증상의 호전이 없어 다시 흉부교감신경 재건술을 시행하였다. 다른 3명의 환자는 클립 제거와 재건술을 동시에 시행하였다. 2명의 환자는 수술 후 보상성 다한증의 호전이 나타나지 않았으나 나머지 2명의 환자는 보상성 다한증의 호전이 관찰되었다. 신경집을 제거한 늑간 신경을 신경집을 제거한 흉부 교감신경 손상부위의 원위부와 근위부에 밀착시키는 재건술은 흉부 교감신경 수술 후 발생하는 보상성 다한증을 호전시키는 유용한 치료 방법이 될 수 있을 것으로 생각된다. 그러나, 더 많은 증례와 장기간의 추적 관찰이 필요할 것이다.

• Journal of Yeungnam Medical Science
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• 제37권2호
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• pp.133-135
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• 2020

Intercostal nerve injury is known to occur during thoracotomy; however, rectus abdominis muscle atrophy has rarely been reported. We describe a 52-year-old man who underwent primary closure of esophageal perforation and lung decortication via left thoracotomy. He was discharged 40 days postoperatively without any complications. He noticed an abdominal bulge 2 months later, and computed tomography revealed left rectus abdominis muscle atrophy. We report thoracotomy induced denervation causing rectus abdominis muscle atrophy.

• Anatomy and Cell Biology
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• 제56권4호
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• pp.570-574
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• 2023

The intercostobrachial nerve (ICBN) originates from the second intercostal nerve's lateral cutaneous branch, while the median nerve (MN) typically arises from the brachial plexus's lateral and medial roots. The medial cutaneous nerve of the arm, a branch of the medial cord of the brachial plexus, often connects with the ICBN. Variations were observed during the dissection of a 50-year-old male cadaver, including MN having two lateral roots (LR), LR1 and LR2, joining at different levels. Three ICBNs innervated the arm in this case, with the absence of the medial cutaneous nerve of the arm compensated by branches from the medial cutaneous nerve of the forearm. Understanding these anatomical variations is crucial for surgical procedures like brachioplasty, breast augmentation, axillary lymph node dissection, and orthopedic surgery. Surgeons and medical professionals must be aware of these variations to enhance preoperative planning, minimize complications, and improve patient outcomes in these procedures.

• 대한한의학회지
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• 제32권3호
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• pp.1-9
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• 2011

Objectives: This study was carried out to observe the foot gworeum meridian muscle from a viewpoint of human anatomy on the assumption that the meridian muscle system is basically matched to the meridian vessel system as a part of the meridian system, and further to support the accurate application of acupuncture in clinical practice. Methods: Meridian points corresponding to the foot gworeum meridian muscle at the body surface were labeled with latex, being based on Korean standard acupuncture point locations. In order to expose components related to the foot gworeum meridian muscle, the cadaver was then dissected, being respectively divided into superficial, middle, and deep layers while entering more deeply. Results: Anatomical components related to the foot gworeum meridian muscle in human are composed of muscles, fascia, ligament, nerves, etc. The anatomical components of the foot gworeum meridian muscle in cadaver are as follows: 1. Muscle: Dorsal pedis fascia, crural fascia, flexor digitorum (digit.) longus muscle (m.), soleus m., sartorius m., adductor longus m., and external abdominal oblique m. aponeurosis at the superficial layer, dorsal interosseous m. tendon (tend.), extensor (ext.) hallucis brevis m. tend., ext. hallucis longus m. tend., tibialis anterior m. tend., flexor digit. longus m., and internal abdominal oblique m. at the middle layer, and finally posterior tibialis m., gracilis m. tend., semitendinosus m. tend., semimembranosus m. tend., gastrocnemius m., adductor magnus m. tend., vastus medialis m., adductor brevis m., and intercostal m. at the deep layer. 2. Nerve: Dorsal digital branch (br.) of the deep peroneal nerve (n.), dorsal br. of the proper plantar digital n., medial br. of the deep peroneal n., saphenous n., infrapatellar br. of the saphenous n., cutaneous (cut.) br. of the obturator n., femoral br. of the genitofemoral n., anterior (ant.) cut. br. of the femoral n., ant. cut. br. of the iliohypogastric n., lateral cut. br. of the intercostal n. (T11), and lateral cut. br. of the intercostal n. (T6) at the superficial layer, saphenous n., ant. division of the obturator n., post. division of the obturator n., obturator n., ant. cut. br. of the intercostal n. (T11), and ant. cut. br. of the intercostal n. (T6) at the middle layer, and finally tibialis n. and articular br. of tibial n. at the deep layer. Conclusion: The meridian muscle system seemed to be closely matched to the meridian vessel system as a part of the meridian system. This study shows comparative differences from established studies on anatomical components related to the foot gworeum meridian muscle, and also from the methodical aspect of the analytic process. In addition, the human foot gworeum meridian muscle is composed of the proper muscles, and also may include the relevant nerves, but it is as questionable as ever, and we can guess that there are somewhat conceptual differences between terms (that is, nerves which control muscles in the foot gworeum meridian muscle and those which pass nearby) in human anatomy.

• Journal of Chest Surgery
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• 제43권1호
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• pp.53-57
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• 2010

배경: 이 연구는 늑골 수상 후 발생하는 늑간 신경병증에 대한 평가를 위하여 숫자통증등급, 통증 기간 및 체질량 지수에 따른 늑간 신경병증에 대한 심한 정도를 알고자 하였다. 대상 및 방법: 늑골 골절 수상 후 3개월 이상 동안 보존적인 치료에도 불구하고 심한 통증을 호소하는 환자 47명을 대상으로 근전도 검사를 시행하여 흉부의 늑간 및 척추 주위 근육에 대한 평가를 하였다. 결과: 47명 중에서 11명에 대하여 늑간 신경병증의 진단을 얻을 수 있었으며, 남자 8명과 여자 3명이었으며, 그 연령은 직업적으로 활동적인 연령대였다. 늑간 신경병증이 호발하는 부위는 7번부터 12번 부위 늑골 골절의 늑간이었다. 그 빈도는 단일 골절보다는 다발성 골절과 밀접한 상관 관계를 알 수 있었다. 그 증상으로는 흉통(90.9%), 감각이상(81.8%), 무감각(63.6%), 후부 흉통(27.2%), 그리고 근위축(18.2%) 순이었다. 근전도에 의한 숫자통증등급, 통증 기간 및 체질량 지수와 관계는 없었다. 결론: 늑골 골절수상 후 3개월 이상 지속적인 통증을 호소하는 환자에서 지속적인 늑간 신경통에 대한 진단을 위한 평가로 근전도가 도움이 될 수 있다.

• The Korean Journal of Pain
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• 제7권1호
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• pp.84-87
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• 1994

Retrospective analysis, of 1,734 patients treated for nerve block from October 1991 to March 1994. Largest percentage of patients were in the 50 year old range, with a distribution of 44.9% male and 55.1% female. Treatments were for ailments of: Low Back Pain 17.3%, Multiple Contusion 10.5%, and Cancer 10%. Most common nerve block was epidural block 38.6%, followed by stellate ganglion block 38.4%, intercostal block 5.4%, and suprascapular nerve block 5.2%. Nerve block under fluorscopic guide were as follows: facet joint block 34.1%, lumbar sympathetic ganglion block 13.6%, and celiac plexus block 12.9%.

• Journal of Chest Surgery
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• 제24권1호
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• pp.54-63
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• 1991

Post-thoracotomy pain is so severe that lead to postoperative complications, such as sputum retention, segmental or lobar atelectasis, pneumonia, hypoxia, respiratory failure due to the patient`s inability to cough, deep breathing and movement. Many authors have been trying to reduce the post-thoracotomy pain, but there is no method of complete satisfaction. In 1974, Nelson and associates introduced the intercostal nerve block using the cryoprobe. The application of cold directly to the nerves causes localized destruction of the axons while preserving the endoneurium and connective tissue, thereby introducing a temporary pain block and able to complete regeneration of intercostal nerves. One hundred and two patients, who undergoing axillary or posterolateral thoracotomy at the Department of Thoracic and Cardiovascular Surgery in Korea University Medical Center between April 1990 and August 1990, were evaluated the effects of cryoanalgesia for the post-thoracotomy pain reduction. The patients were divided into two groups: Group A, control, the patients without the cryoanalgesia[No.=50], Group B, trial, the patients with cryoanalgesia[No.=52]. Before the thorax closed, in the group A, local anesthetics, 2% lidocaine 3cc, were injected to the intercostal nerves[one level with the thoracotomy, one cranial and caudal intercostal level and level of drainage tube insertion]. In the group B, cryoprobe was directly applied for 1 minute at the same level. Postoperative analgesic effects were evaluated by the scoring system which made arbitrary by author: The pain score 0 to 4, The limitation of motion score 0 to 3, The analgesics consumption score 0 to 3, The total score, the sum of above score, 0 to 10. For the evaluation of immediate analgesic effects, the score were evaluated at the operative day, the first postoperative day, the second postoperative day, and the seventh postoperative day. The effects of incision type, and rib cut to the post-thoracotomy pain were also evaluated. The results were as follows; 1. The intercostal block with cryoanalgesia reduced the immediate postoperative pain significantly compare with control group. 2. The intercostal block with cryoanalgesia improved the motion of the operation side significantly compare with control group. 3. The intercostal block with cryoanalgesia reduced the analgesics requirements at the immediate postoperative periods significantly. 4. The intercostal block with cryoanalgesia lowered the total score significantly compare with control group. 5. The intercostal block with cryoanalgesia were more effective to the mid-axillary incision than to the posterolateral incision 6. The intercostal block with cryoanalgesia were more effective to the patients without rib cut than to the patients with rib cut. 7. No specific complication need to be treated were not occurred during follow-up.

• 대한약침학회지
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• 제7권2호
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• pp.57-64
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• 2004

This study was carried to identify the component of Small Intestine Meridian Muscle in human, dividing the regional muscle group into outer, middle, and inner layer. the inner part of body surface were opened widely to demonstrate muscles, nerve, blood vessels and the others, displaying the inner structure of Small Intestine Meridian Muscle. We obtained the results as follows; 1. Small Intestine 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 ; Abd. digiti minimi muscle(SI-2, 3, 4), pisometacarpal lig.(SI-4), ext. retinaculum. ext. carpi ulnaris m. tendon.(SI-5, 6), ulnar collateral lig.(SI-5), ext. digiti minimi m. tendon(SI-6), ext. carpi ulnaris(SI-7), triceps brachii(SI-9), teres major(SI-9), deltoid(SI-10), infraspinatus(SI-10, 11), trapezius(Sl-12, 13, 14, 15), supraspinatus(SI-12, 13), lesser rhomboid(SI-14), erector spinae(SI-14, 15), levator scapular(SI-15), sternocleidomastoid(SI-16, 17), splenius capitis(SI-16), semispinalis capitis(SI-16), digasuicus(SI-17), zygomaticus major(Il-18), masseter(SI-18), auriculoris anterior(SI-19) 2) Nerve ; Dorsal branch of ulnar nerve(SI-1, 2, 3, 4, 5, 6), br. of mod. antebrachial cutaneous n.(SI-6, 7), br. of post. antebrachial cutaneous n.(SI-6,7), br. of radial n.(SI-7), ulnar n.(SI-8), br. of axillary n.(SI-9), radial n.(SI-9), subscapular n. br.(SI-9), cutaneous n. br. from C7, 8(SI-10, 14), suprascapular n.(SI-10, 11, 12, 13), intercostal n. br. from T2(SI-11), lat. supraclavicular n. br.(SI-12), intercostal n. br. from C8, T1(SI-12), accessory n. br.(SI-12, 13, 14, 15, 16, 17), intercostal n. br. from T1,2(SI-13), dorsal scapular n.(SI-14, 15), cutaneous n. br. from C6, C7(SI-15), transverse cervical n.(SI-16), lesser occipital n. & great auricular n. from cervical plexus(SI-16), cervical n. from C2,3(SI-16), fascial n. br.(SI-17), great auricular n. br.(SI-17), cervical n. br. from C2(SI-17), vagus n.(SI-17),hypoglossal n.(SI-17), glossopharyngeal n.(SI-17), sympathetic trunk(SI-17), zygomatic br. of fascial n.(SI-18), maxillary n. br.(SI-18), auriculotemporal n.(SI-19), temporal br. of fascial n.(SI-19) 3) Blood vessels ; Dorsal digital vein.(SI-1), dorsal br. of proper palmar digital artery(SI-1), br. of dorsal metacarpal a. & v.(SI-2, 3, 4), dorsal carpal br. of ulnar a.(SI-4, 5), post. interosseous a. br.(SI-6,7), post. ulnar recurrent a.(SI-8), circuirflex scapular a.(SI-9, 11) , post. circumflex humeral a. br.(SI-10), suprascapular a.(SI-10, 11, 12, 13), first intercostal a. br.(SI-12, 14), transverse cervical a. br.(SI-12,13,14,15), second intercostal a. br.(SI-13), dorsal scapular a. br.(SI-13, 14, 15), ext. jugular v.(SI-16, 17), occipital a. br.(SI-16), Ext. jugular v. br.(SI-17), post. auricular a.(SI-17), int. jugular v.(SI-17), int. carotid a.(SI-17), transverse fascial a. & v.(SI-18),maxillary a. br.(SI-18), superficial temporal a. & v.(SI-19).