• Archives of Plastic Surgery
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• 제35권6호
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• pp.663-668
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• 2008

Purpose: Pedicled transverse rectus abdominis myocutaneous(TRAM) flap has been a gold standard for breast reconstruction and one of surgical techniques preferred by many surgeons. The authors examined the course of deep epigastric artery focusing on distance from margins of rectus abdominis to pedicle and location of choke vessels to get minimal muscles during pedicled TRAM flap operation. Methods: Eleven rectus abdominis muscle from nine cadavers were used in this study. Rectus abdominis was separated from the cadavers, deep inferior and superior epigastric artery were isolated and then 8 anatomical landmarks in medial and lateral margins of rectus abdominis were designated. Distance to a pedicle meeting first horizontally was measured and vertical location from umbilicus to choke vessel was determined. In addition, 32 rectus abdominis images of 16 women(average age: 37.2 years old) from 64 channel abdomen dynamic computerized tomography were also examined with the same anatomical landmarks with those of cadavers. Results: Average distance from four landmarks on lateral margin of rectus abdominis to pedicle was 1.9 - 3.4cm and 1.8 - 3.8 cm on medial margin. Choke vessel was located between middle and inferior tendinous intersection in all cases and average distance between two tendinous intersection was 6.7 - 7.0 cm on medial margin and 6.2 cm on lateral margin. Location of inferior tendinous intersection was on umbilicus or superior of it in all cases and its average distance from umbilicus was 1.8 - 5.6 cm on medial margin and 2.7 - 6.2 cm on lateral margin. Conclusion: Distance from medial and lateral margins of rectus abdominis muscle to pedicle was the shortest in inferior tendinous intersection and that was averagely 1.8 cm on medial margin and 1.9 cm in average on lateral margin. All choke vessels were located between middle and inferior tendinous intersection.

• 한국응급구조학회지
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• 제20권1호
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• pp.7-15
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• 2016

Purpose: There are few studies on the quality of cardiopulmonary resuscitation (CPR) performed by a single rescuer using a bag-valve-mask device. The aim of this study is to compare CPR quality outcomes according to the rescuer's position or mask fixation grip method and to determine the optimal means of achieving therapeutic goals. Methods: The three CPR methods were defined as over-the-head, lateral-superior, and lateral-inferior, depending on the rescuer's position or mask fixation hand placement. CPR quality was estimated for 83 paramedic students who performed 5 minutes of CPR in a randomized sequence on a manikin using each of the three methods. Results: The over-the-head method showed no advantage for cardiac compression and ventilation quality, but minimized the rescuer's fatigue score. Conclusion: In contrast to previous studies or prevailing beliefs, the lateral-superior position is optimal for achieving therapeutic goals with moderate or minimal rescuer fatigue.

• 대한관절경학회지
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• 제9권1호
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• pp.56-59
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• 2005

후격막 통과 도달법을 이용한 관절 내시경 수술은 슬관절 후방부에 위치한 병변의 진단 및 치료에 유용하게 사용되고 있는 술기이다. 저자들은, 후내측 후격막 통과 도달법을 이용하여 환자의 다리를 4자 형태로 압력을 가해 외측 관절 간격을 넓힘으로써 후각부의 하인을 제외한 외측 반월상 연골의 전부분 특히, 전각부의 하연과 전각부 아래의 경골외과를 쉽게 관찰할 수 있었다. 또, 수술시 후방에서 시야확보가 가능하여 전내측 및 전외측 삽입구를 통해 혼잡(clouding)이 없이 기구를 자유롭게 사용할 수 있어 외측 구획의 수술 특히, 전방부의 수술에 유용하게 사용될 수 있을 것으로 생각된다.

• 감성과학
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• 제20권4호
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• pp.101-112
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• 2017

We investigated the neural representation of reward probability recognition and its neural connectivity with other regions of the brain. Using functional magnetic resonance imaging (fMRI), we used a simple guessing task with different probabilities of obtaining rewards across trials to assay local and global regions processing reward probability. The results of whole brain analysis demonstrated that lateral prefrontal cortex, inferior parietal lobe, and postcentral gyrus were activated during probability-based decision making. Specifically, the higher the expected value was, the more these regions were activated. Fronto-parietal connectivity, comprising inferior parietal regions and right lateral prefrontal cortex, conjointly engaged during high reward probability recognition compared to low reward condition, regardless of whether the reward information was extrinsically presented. Finally, the result of a regression analysis identified that cortico-subcortical connectivity was strengthened during the high reward anticipation for the subjects with higher cognitive impulsivity. Our findings demonstrate that interregional functional involvement is involved in valuation based on reward probability and that personality trait such as cognitive impulsivity plays a role in modulating the connectivity among different brain regions.

• Journal of Korean Neurosurgical Society
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• 제47권5호
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• pp.365-369
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• 2010

Objective : There has been inconsistency about definition of the temporal stem despite of several descriptions demonstrating its microanatomy using fiber dissection and/or diffusion tensor tractography. This study was designed to clarify three dimensional configurations of the temporal stem. Methods : The fronto-temporal regions of several formalin-fixed human cerebral hemispheres were dissected under an operating microscope using the fiber dissection technique. The consecutive coronal cuts of the dissected specimens were made to define the relationships of white matter tracts comprising the temporal stem and the subcortical gray matters (thalamus, caudate nucleus, amygdala) with inferior limiting (circular) sulcus of insula. Results : The inferior limiting sulcus of insula, limen insulae, medial sylvian groove, and caudate nucleus/amygdala were more appropriate anatomical structures than the roof/dorso-lateral wall of the temporal horn and lateral geniculate body which were used to describe previously for delineating the temporal stem. The particular space located inside the line connecting the inferior limiting sulcus of insula, limen insulae, medial sylvian groove/amygdala, and tail of caudate nucleus could be documented. This space included the extreme capsule, uncinate fasciculus, inferior occipito-frontal fasciculus, anterior commissure, ansa peduncularis, and inferior thalamic peduncle including optic radiations, whereas the stria terminalis, cingulum, fimbria, and inferior longitudinal fiber of the temporal lobe were not passing through this space. Also, this continued posteriorly along the caudate nucleus and limiting sulcus of the insula. Conclusion : The temporal stem is white matter fibers passing through a particular space of the temporal lobe located inside the line connecting the inferior limiting sulcus of insula, limen insulae, medial sylvian groove/amygdala, and tail of caudate nucleus. The three dimensional configurations of the temporal stem are expected to give the very useful anatomical and surgical insights in the temporal lobe.

• The Korean Journal of Pain
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• 제8권1호
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• pp.144-148
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• 1995

Inferior mesenteric plexus block(IMPB) sa useful nerve block for the relief of intractable lower abdominal and pelvic pain caused by a lower abdominal visceral or a pelvic malignancy. IMPB has been performed in the prone position. But there are many patients who can't lie in the prone position, because ascites is frequently noticed in cancer patients and they also frequently received abdominal operations. We performed IMPB in the lateral position on two patients with lower abdominal pain, Case 1: A 77 year old female who had a right ovarian cancer with metastatic cancer of descending colon and rectum, experienced complete pain relief. Case 2: A 72 year old female who had a far advance pancreatic cancer with intestinal obstruction due to carcinomatosis received right and left celiac plexus block and right and left IMPB. The patient was satisfied with the result of these pain blocks. Conclusion; IMAPB performed in the lateral position on two patients with lower abdominal pain and their results were excellent for pain relief.

• The Korean Journal of Physiology
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• 제4권1호
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• pp.59-67
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• 1970

In recent observations on vestibular eye movements in mammals, reported by several different workers, it was indicated that the pattern of reflex eye movement from semicircular canal nerve stimulation in rabbits was different from that observed in the other species such as cats and dogs. Observing the different anatomical features of the extraocular muscles of rabbits, Kim ascribed the different pattern of eye movement of rabbits to the functional difference of inferior and superior oblique muscles from those of other species. Present experiment was carried out to elucidate a physiological mechanism underlying in such particular pattern of reflex eye movement in rabbits. An individual canal nerve was selectively stimulated, under a dissecting microscope, by a fine electrode induced into an ampulla through a hole provided on the wall of corresponding osseous canal, and responses of the extraocular muscles were checked by recording the isotonic changes of muscle length. Following results were obtained. 1. Direct stimulation of the superior or inferior oblique muscles Produced upward or downward movement of the eye turning toward medial side respectively. 2. Stimulation of the unilateral canal nerve Produced a marked contraction of a main contracting ocular muscle and simultaneous relaxation of an antagonistic muscle in both eyes. Less potent contraction of an additional ocular muscle was observed and it appeared to augment the function of the main contracting muscle in the ipsilateral eye. 3. Stimulation of superior semicircular canal nerve caused a primary contraction of superior rectus, synergic contraction of superior oblique and relaxation of inferior rectus in ipsilateral eye. Contraction of inferior oblique and relaxation of superior oblique were observed in the contralateral eye. 4. Stimulation of lateral semicircular canal nerve produced a primary contraction of medial rectus, synergic contraction of superior oblique and relaxation of lateral rectus in the ipsilateral eye. Contraction of lateral rectus and relaxation of medial rectus were observed in the contralateral eye. 5. Stimulation of inferior semicircular canal nerve produced a primary contraction of superior oblique, synergic contraction of superior rectus and relaxation of inferior oblique in the ipsilateral eye. Contraction of. inferior rectus and relaxation of superior rectus were observed in the contralateral eye. 6. Upon stimulation of individual canal nerve, the pattern of eye movement in rabbits is different from those of cats, however, the responses of the extraocular muscles appear to be similar in two species. Therefore, it is concluded that the different Pattern of eye movement in both species are not due to the possible difference of vestibule-ocular reflex pathways but to the functional difference of superior and inferior oblique muslces.

• Archives of Plastic Surgery
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• 제34권2호
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• pp.229-236
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• 2007

Purpose: Breast reconstruction with deep inferior epigastric perforator(DIEP) free flap is known to be the most advanced method of utilizing autologous tissue. The DIEP free flap method saves most of the rectus abdominis muscle as well as anterior rectus sheath. Therefore, the morbidity of the donor site is minimized and the risk of hernia is markedly decreased. Methods: We chose the internal mammary artery and its venae comitantes as recipient vessels, and deep inferior epigastric vessels as donor vessels. The number and location of the perforators derived from medial or lateral branch of deep inferior epigastric artery(DIEA) in 23 DIEP flaps were identified. Ten patients underwent evaluation of their abdominal wall function preoperatively and 6 months postoperatively by using Lacote's muscle grading system. Results: Of the 23 patients, a patient with one perforator from lateral branch of DIEA experienced partial necrosis of flap. Total flap loss occurred in one patient. Mild abdominal bulging was reported in one patient 4 months postoperatively probably because of early vigorous rehabilitational therapy for her frozen shoulder. Postoperative abdominal wall function tests in 10 patients showed almost complete recovery of muscle function upto their preoperative level of upper and lower rectus abdominis and external oblique muscle function at 6 months postoperatively. All patients have been able to resume their daily activities. Conclusion: The breast reconstruction with DIEP free flap is reliable and valuable method which provide ample soft tissue from abdomen without compromising the integrity of abdominal wall. Selection of reliable perforators is important and including more than two perforators may decrease fat necrosis and partial necrosis of flap.

• Archives of Plastic Surgery
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• 제47권5호
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• pp.473-477
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• 2020

Superficial inferior epigastric artery (SIEA) flaps represent a useful option in autologous breast reconstruction. However, the short-fixed pedicle can limit flap inset options. We present a challenging flap inset successfully addressed by de-epithelialization, turnover, and counterintuitive rotation. A 47-year-old woman underwent left tertiary breast reconstruction with stacked free flaps using right deep inferior epigastric perforator and left SIEA vessels. Antegrade and retrograde anastomoses to the internal mammary (IM) vessels were preferred; additionally, the thoracodorsal vessels were unavailable due to previous latissimus dorsi breast reconstruction. Optimal shaping required repositioning of the lateral ends of the flaps superiorly, which would position the ipsilateral SIEA hemi-flap pedicle lateral to and out of reach of the IM vessels. This problem was overcome by turning the SIEA flap on its long axis, allowing the pedicle to sit medially with the lateral end of the flap positioned superiorly. The de-epithelialized SIEA flap dermis was in direct contact with the chest wall, enabling its fixation. This method of flap inset provides a valuable solution for medializing the SIEA pedicle while maintaining an aesthetically satisfactory orientation. This technique could be used in ipsilateral SIEA flap breast reconstructions that do not require a skin paddle, as with stacked flaps or following nipple-sparing mastectomy.

• 대한핵의학회:학술대회논문집
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• 대한핵의학회 2000년도 2nd Korea-China Congress of Nuclear Medicine and 39th Annual Spring Meeting if the Korea SOciety Nuclear Medicine
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• pp.80.1-80.1
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• 2000