• Radiation Oncology Journal
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• 제24권4호
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• pp.317-321
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• 2006

67세 남자환자가 하지의 악성섬유조직구종으로 진단받고 광범위 절제술 후 방사선치료를 받는 동안 연쇄구균독소충격증후군이 발생하여 그 예를 소개하고자 한다. 환자는 수술 후 증감하는 부종이 있어 약 1개월간 비스테로이드소염제를 복용하였다. 환자는 C형 간염보균자였으며, 당뇨, 고혈압의 과거력이 있었다. 환자는 수술 후 방사선치료를 계획하여, 주 5회 조사하여 32.4 Gy를 치료받았다. 이틀간의 주말 치료중단이후 갑자기 방사선치료 받은 우측 대퇴부에 홍반성 염증이 발생하였고, 열, 오한, 소변감소증이 동반되었다. 환자는 즉시 감염내과에 의뢰되었고, 독소충격증후군이 의심되어 즉시 입원하였다. 입원당시 환자는 저혈압, 소변감소증, 변비, 비정상적인 신기능 및 간기능 소견을 보였다. 환자의 혈액 배양 결과 스트렙토콕쿠스 피오게네스균(Streptococcus pyogenes)이 검출되었다. 환자는 연쇄구균독소충격증후군으로 진단받고 적절한 항생제치료와 수액공급을 받았다. 연쇄구균독소충격증후군은 생명을 위협하는 종양학적 응급상황으로 즉각적인 처치가 필요하다. 본 예의 환자는 C형 간염보균, 수술 후 증감되는 부종, 지속적인 비스테로이드소염제 복용과 방사선치료가 연쇄구균독소충격증후군을 일으킨 인자들로 생각되어진다.

• 대한통합의학회지
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• 제8권1호
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• pp.47-56
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• 2020

Purpose : The purpose of this study was to determine the effects of upper extremity volume, pain, and range of motion after participation in thera-band exercises according to the hand grip type in patients with breast cancer with upper extremity edema. We also aimed to determine the most efficient type of grip. Methods : The subjects were 10 female patients diagnosed with stage 2 breast cancer who had stage 2 lymphedema. Randomly, 5 patients each were allocated to the experimental and control groups. For six weeks, the patients in both the experimental and control groups exercised daily. In both groups, manual lymph drainage was applied for 1 hour. Afterward, patients in the experimental group placed their hands in the thera-band ring and exercised with their fingers outstretched. Patients in the control group exercised while holding the thera-band ring with a finger. Both the experimental group and the control group underwent measurements of the circumference of the upper extremity, pain, and range of motion of the shoulder joint at weeks 1, 2, 4, and 6 before and after exercise. Results : The upper arm circumference decreased by more in the experimental group in all weeks than before than that in the control group, and there was a statistically significant difference at 6 weeks. Compared with the difference between pre-exercise and 6 weeks post-exercise, the change in pain significantly decreased in the experimental group and showed a statistically significant difference. The shoulder range of motion increased in extension, external rotation, and internal rotation compared with that in the control group, and there was a statistically significant difference. Although the operating range increased in flexion and abduction, there were no statistically significant differences. Conclusion : In this study, we found that thera-band exercises with an open-hand grip are more efficient than thera-band exercises with a closed-hand grip in edema reduction, pain, and range of motion. In addition, it was found that it was more effective to continue the thera-band exercises with open-hand grip extended for at least 6 weeks rather than for a short time.

• 대한핵의학회:학술대회논문집
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• 대한핵의학회 1996년도 제35차 춘계학술대회 초록집
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• pp.198-198
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• 1996

• Archives of Plastic Surgery
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• 제48권2호
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• pp.239-240
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• 2021

• Archives of Plastic Surgery
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• 제45권2호
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• pp.152-157
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• 2018

Background Intraoperative indocyanine green (ICG) lymphography can effectively detect functioning lymph vessels in edematous limbs. However, it is sometimes difficult to clearly identify their course in later-stage edematous limbs. For this reason, many surgeons rely on experience when they decide where to make the skin incision to locate the lymphatic vessels. The purpose of this study was to elucidate lymphatic vessel flow patterns in healthy upper extremities in a Korean population and to use these findings as a reference for lymphedema treatment. Methods ICG fluorescence lymphography was performed by injecting 1 mL of ICG into the second web space of the hand. After 4 hours, fluorescence images of lymphatic vessels were obtained with a near-infrared camera, and the lymphatic vessels were marked. Three landmarks were designated: the radial styloid process, the mid-portion of the cubital fossa, and the lower border of the deltopectoral groove. A straight line connecting the points was drawn, and the distance between the connected lines and the marked lymphatic vessels was measured at 8 points. Results There were 30 healthy upper extremities (15 right and 15 left). The average course of the main lymph vessels passed $26.0{\pm}11.6mm$ dorsal to the styloid process, $5.7{\pm}40.7mm$ medial to the mid-cubital fossa, and $31.3{\pm}26.1mm$ medial to the three-quarters point of the upper landmark line. Conclusions The main functioning lymphatic vessel follows the course of the cephalic vein at the forearm level, crosses the mid-cubital point, and travels medially toward the mid-axilla.

• Radiation Oncology Journal
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• 제6권1호
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• pp.81-84
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• 1988

유방절제술 후 임파육종은 유방암 환자에서 유방절제술 후 상지에 생기는 흔치 않은 악성 암이다. 유방절제술 후 임파육종에 평균 발병 연령은 63.9세이고 유방절제 후 발병할 때까지의 기간은 평균 10년 3개월이다. 유방절제술 후 임파육종은 혈관과 임파관에서부터 발생하는 것으로 알려져 있고 조직학적 소견은 진피의 부종과 악성세포로 둘러싸인 확장된 임파선이 특징이다. 견관절 분리술이나 전사분부 절제술 등의 광범위한 절제가 가장 효과적인 치료법으로 알려져 있고 방사선 치료를 포함한 다른 치료방법은 큰 도움이 않되는 것으로 보고되고 있다. 저자들은 유방절제술 후 만성 림프부종을 동반한 임파육종이 외부 방사선 조사에 의하여 종괴의 감소를 보여 이에 보고하는 바이다.

• Archives of Plastic Surgery
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• 제46권4호
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• pp.344-349
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• 2019

Background Lymphaticovenous anastomosis is an important surgical treatment for lymphedema, with lymphaticovenous side-to-end anastomosis (LVSEA) and lymphaticovenous end-to-end anastomosis being the most frequently performed procedures. However, LVSEA can cause lymphatic flow obstruction because of regurgitation and tension in the anastomosis. In this study, we introduce a novel and simple procedure to overcome this problem. Methods Thirty-five female patients with lower extremity lymphedema who underwent lymphaticovenous anastomosis at our hospital were included in this study. Eighty-five LVSEA procedures were performed, of which 12 resulted in insufficient venous blood flow. For these 12 anastomoses, the proximal lymphatic vessel underwent clipping after the anastomotic procedure and the venous inflow was monitored. Subsequently, the proximal ligation after side-to-end anastomosis recovery (PLASTER) technique, which involves ligating the proximal side of the lymphatic vessel, was applied. A postoperative evaluation was performed using indocyanine green 6 months after surgery. Results Despite the clipping procedure, three of the 12 anastomoses still showed poor venous inflow. Therefore, it was not possible to apply the PLASTER technique in those cases. Among the nine remaining anastomoses in which the PLASTER technique was applied, three (33%) were patent. Conclusions Our findings show that achieving patent anastomosis is challenging when postoperative venous inflow is poor. We achieved good results by performing proximal ligation after LVSEA. Thus, the PLASTER technique is a particularly useful recovery technique when LVSEA does not result in good run-off.

• 한국염색가공학회지
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• 제33권2호
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• pp.87-95
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• 2021

In this study, the application of a medical compression sleeve of Moisture Responded Transformable(MRT) fibers to the treatment of lymphedema after surgery in breast cancer patients was investigated. MRT fibers were manufactured with PET and Nylon6 bi-component cross-section yarns, and compression sleeves of sleeves 1, 2, 3, and 4 were knitted in order of size, and then the physical properties and clinical tests were evaluated. As a result, the pressure of compression sleeve in wrinkle was the lowest in sleeve 1 with 3.81 kPa, and the highest in sleeve 4 with 5.22 kPa. Elastic recovery rate is that all parts except the top of the sleeve 1 exhibited 100%. The air permeability was good at 12.1 ~ 16.1 cm³/cm²/sec, and peeling was also comparatively excellent as grade 3. In addition, the weight of the compression sleeves 1, 2, and 3 decreased as 18.3 ~ 23.0 g/m² depend on size, while the compared sample was heavier with 17.39 ~ 32.61 g/m². In lymphoscintigraphy test, it was confirmed that the function of remaining lymph node was good in all patients. Although there were no differences between samples in skin irritation and tightness in wearing comfort, the manufactured sleeves showed better fit, lightness, fashion and breathability than the comparable sleeves.

• Archives of Plastic Surgery
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• 제48권4호
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• pp.395-403
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• 2021

Background Groin wounds occurring after vascular surgical site infection, oncologic resection, or occasionally orthopedic surgery and trauma may represent a surgical challenge. Reconstruction of these defects by the usual workhorse flaps may be contraindicated following previous surgery and in patients with lower limb lymphedema or extreme morbidity. Methods This study included 15 consecutive patients presenting with inguinal wounds after vascular or general surgery that required debridement and soft tissue coverage. All cases had absolute or relative contraindications to conventional reconstructive techniques, including a compromised deep femoral artery network, limb lymphedema, scarring of potential flap harvesting sites, or poor overall condition. Abdominal adipocutaneous excess enabled the performance of adipocutaneous advancement flaps in an abdominoplasty-like fashion. Immediate and long-term outcomes were analyzed. Results Soft tissue coverage was effective in all cases. Two patients required re-intervention due to flap-related complications (venous congestion and partial flap necrosis). All patients fully recovered over a mean±standard deviation follow-up of 2.4±1.5 years. Conclusions Abdominal flaps can be an effective and simple alternative technique for inguinal coverage with reproducible outcomes. In our experience, the main indications are a compromised deep femoral artery network and poor thigh tissue quality. Relative contraindications, such as previous open abdominal surgery, should be considered.

• Clinical Pain
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• 제20권2호
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• pp.99-104
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• 2021

Objective: To confirm the safety of Intra-articular (IA) injection on the ipsilateral adhesive capsulitis (AC) after breast cancer surgery. Methods: Between January 2017 and May 2020, we retrospectively studied 29 patients after breast cancer surgery who underwent IA injection in the glenohumeral joint for AC in aseptic procedure. Results: There were no side effects or complications such as lymphedema or cellulitis in the patients. There was a significant improvement in pain score and range of motion (ROM) at the 1st, 3rd, and 6th months visits compared to the baseline (p<0.05). The presence or absence of axillary lymph node dissection and radiation therapy had no significant difference in improvement of ROM. But, in rotator cuff syndrome (RCS) group, there was a significant difference in improvement of shoulder IR in patients without RCS. Conclusion: IA Injection on the ipsilateral AC after breast cancer surgery was safe and even effective to improve pain and shoulder ROM. Ipsilateral IA injection can be a good treatment for breast cancer surgery patients suffering from AC.