• Journal of Gastric Cancer
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• v.20 no.1
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• pp.1-18
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• 2020

Splenic hilar lymph node dissection has been the standard treatment for advanced proximal gastric cancer. Splenectomy is typically performed as part of this procedure. However, splenectomy has some disadvantages, such as increased risk of postoperative complications, especially pancreatic fistula. Moreover, patients who underwent splenectomy are vulnerable to potentially fatal infection caused by encapsulated bacteria. Furthermore, several studies have shown an association of splenectomy with cancer development and increased risk of thromboembolic events. Therefore, splenectomy should be avoided if it does not confer a distinct oncological advantage. Most studies that compared patients who underwent splenectomy and those who did not failed to demonstrate the efficacy of splenectomy. Based on the results of a randomized controlled trial conducted in Japan, prophylactic dissection with splenectomy is no longer recommended in patients with gastric cancer with no invasion of the greater curvature. However, patients with greater curvature invasion or those with remnant gastric cancer still need to undergo splenectomy to facilitate splenic hilar node dissection. Spleen-preserving splenic hilar node dissection is a new procedure that may help delink splenic hilar node dissection and splenectomy. In this review, we examine the evidence pertaining to the efficacy and disadvantages of splenectomy. We discuss the possibility of spleen-preserving surgery for prophylactic splenic hilar node dissection to overcome the disadvantages of splenectomy.

• Advances in pediatric surgery
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• v.1 no.1
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• pp.73-78
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• 1995

Torsion of the wandering spleen is a rare condition especially in children. Unfortunately, splenectomy was the advocated treatment of choice for wandering spleen in many children up to 1985 in spite of the well-known possibility of overwhelming postsplenectomy sepsis. Because of the conclusive evidence of the vital function of the spleen in infection, indication of splenectomy have been revised and more attention has been paid to preserving the spleen where possible. We are presented a girl with splenic torsion, seen as a migratory abdominal mass and intermittent vague abdominal pain. Splenopexy by fixation of the spleen to the diaphragm and posterolateral peritoneum and the use of Avitene in the splenic bed was successfully performed. Complete fixation of the spleen was confirmed by ultrasound a year after this procedure was carried out. The clinical presentation, etiology, diagnostic procedures and management are discussed also.

• Journal of Gastric Cancer
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• v.20 no.1
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• pp.19-28
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• 2020

Gastrectomy with lymph node dissection remains the gold standard for curative treatment of gastric cancer. Dissection of splenic hilar lymph nodes has been included as a part of D2 lymph node dissection for proximal gastric cancer. Previously, pancreatico-splenectomy has been performed for dissecting splenic hilar lymph nodes, followed by pancreas-preserving splenectomy and spleen-preserving lymphadenectomy. However, the necessity of routine splenectomy or splenic hilar lymph node dissection has been under debate due to the increased morbidity caused by splenectomy and the poor prognostic feature of splenic hilar lymph node metastasis. In contrast, the relatively high incidence of splenic hilar lymph node metastasis, survival advantage, and therapeutic value of splenic hilar lymph node dissection in some patient subgroups, as well as the effective use of novel technologies, still supports the necessity and applicability of splenic hilar lymph node dissection. In this review, we aimed to evaluate the need for splenic hilar lymph node dissection and suggest the subgroup of patients with favorable outcomes.

• Journal of Trauma and Injury
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• v.31 no.2
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• pp.87-90
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• 2018

Non-operative management has been preferred in blunt spleen injury. Moreover children are more susceptible to post-splenectomy infection, spleen should be preserved if possible. However, splenectomy is inevitable to patients with severe splenic injury. Therefore splenic autotransplantation could be the last chance for preserving splenic function in these patients although efficacy has not proven. Here we reported four cases of children who were underwent splenic autotransplantation successfully after blunt trauma.

• Journal of Oriental Neuropsychiatry
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• v.3 no.1
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• pp.3-24
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• 1992

This paper is aimed at finding out the clue to the medical solution to the pathological phenomena of the dehumanizing and demoralizing state of our society by centering around the Chiljeong that originates from Oriental Medicine, Sung Confucianism and Sa-sang Medicine(四象醫學). In these fields,the Chiljeong is based on the theory of Eum-yang and Viscera(陰陽.臟腑論) in Oriental Medicine, on the problems of good and evil in Sung Cunfucianism and on the theory of Sa-sang Visceral Localization(四象.臟局의 理論) in Sa-sang Medicine. The principles of geneation of Chiljeong : In case of Oriental Medicine, Sin(神) controls Chiljeong and of it is stored in five Viscera, it becomes Sin in the Heart, Hon(魂) in the Liver, Sa(思) in the Spleen, Bed-Woo(悲.憂) in the Lung, and Kyeong-Kong(驚.恐) in the Kidney. Then five Viscera react with outer stimuli or Sin, it gives off Chiljeong as Joy(from the Heart), Anger(from the Liver). Thought (from the Spleen), Anxiety and Sorrow(from the Lung) and Surprise and Fear(from the Kidney) In Sung Confucianism, Sim(心) comtrols Seong-jeong(性.情), and at the moment of that Sim gives off Jeong(情), it becomes good when the Li(理) gibes off itself and then Chi(氣) follows Li, or Chi gives off itself and is regulated optimally, out it becomes evil when Li cannot preside over Chi and then shaded by cloudy Chi. The pathology: If the Chiljeong exceeds one's capacity, the corresponding Vicsera will be damaged, and the Passions(喜.怒.哀.樂) that may harm to four types of constitution severly are the Joy and Pleasure(in Tae-eum-in 太陰人 and So-eum-in 少陰人) and Grief and Anger(in Tae-yang-in 太陽人 and So-yang-in 少陽人), so one should be alert on some passions by regrding his constitutional frailty. More over, because of the variations in Sa-sang Visceral Localyzatin there is various ability in human affairs, but as the clumsiness in human affairs may make him hurt by it, so one should be prevented from these passions and human affairs, that is flowing Joy and Participations(黨與) in Tae-yang-in, flowing Pleasure and Dwelings(居處) in So-yang-in, explosive Anger and Companies(交遇) in So-eum-in, explosive Grief and Affairs(事務) in Tae-eum-in. How to clutivate the human nature: The ulitmate purpose in Oriental Medicine is preserving Cheon-Jin(天眞), that is following the Tao(道) by making him be in harmony with the Chi(氣) of the Seasons and by living a simple life. In Sung Confucianism, the way preventing the lustful desire and preserving Cheon-li(天理) is to observate derectly the calm, original place of human nature with reverence, when Sim has nat given off itself yet, and when Sim has already given off, it also is to meditating on one's passion and thought that the principle of good should be researched on or the evil should be cut off according to it's being good or evil. Such like as these various aspects of research on the Chiljeong it will be helpful in understanding human nature by producing the various materials on it, moreover, by doing so, we can lead out appropriate solution on the confusions of judgement value and demoralization.

• Journal of Korean Medical classics
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• v.20 no.2
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• pp.175-193
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• 2007

A theory of the school which attach great importance to moxibustion therapy was more developed from 'Ge Hong(葛洪)', 'Wang Tao(王燾)' up to "BianQueXinShu(扁鵲心書)" of 'Dou Cai(竇材)' in Song Dynasty. The first volume of "BianQueXinShu" was described about the principles of health preserving method, diagnosis, treatment related with meridian system, support Yang theory, moxibustion therapy over the 10 chapters and in the continued 3 chapters, explained the symptoms and related moxibustion therapies. The summary is as follows. The Yang energy is the essence of the human body and it is minutely explained in "Hwangdineijing(黃帝內經)". However, the younger scholars after 'Zhang Zhongjing(張仲景)' held different views with "Hwangdineijing" so they didn't control serious diseases. Supporting the Yang energy, it will be possible to human body in good health and long life and perennial youth and longevity. To do like this, the first important thing is a moxibustion, the second is a Taoist hermit medication(丹藥) and the third is well usage of Radix Aconiti Lateralis Preparata. According to the sequence of Yang energy deficiency, the stages of diseases are classified as Ordinary Gi(平氣), Latter deficient state(微虛), The more deficient state(甚虛), Exhausting state(將脫), Exhausted state(已脫) and in the consideration of each stage, it is used gradually with warm-natured berbs, warm-acrid herbs, warm-heated herbs and moxibustion therapy. If it comes to the stage of Exhausted state, the Yang energy is too weak to treat a disease. Therefore it is easy to harm human body with usage the treatment of the Purgationist school theory or the Cold and cool medical school theory, so it is needed a great attention to use these therapies. To summarized the keynote of 'Du Jae''s moxibustion therapy, the one is a minority of selection of points(1$^{\sim}$2 acupuncture points), the second is a majority of moxibustion units(50$^{\sim}$500 units), and the other is a focused selection of points on spleen and kidney(especially Gwanwon, CC4). And in this book, it was explained concretely about the size of moxibustion, according to the experiment with mentioned size, the burning time of moxibustion was almost 4 min 40 sec, so the big size moxibustion was one of the characteristic of moxibustion therapy revealed in this book. Also it was used 'Suseongsan(睡聖散)' - a kind of analgesic herb complexes - to reduce a pain during the usage of moxibustion therapy in this book. To develop the moxibustion theory, it is more investigated in the future that there wasn't significant relation between Gwanwon(CC4) and spleen and kidney meridian in theory, compared to many used Gwanwon(CC4) in the prescription, where as mentioned the importance of spleen and kidney in treatment, that considering the burning time(1 unit - 4 min 40 sec, 12 units an hour, maximum 288 units a day) there were no guidances about meals, sleeping, stool and urine, and that there was no concrete study about the toxicity of 'Suseongsan' as analgesic moxibustion therapy.

• Journal of Korean Medical classics
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• v.12 no.2
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• pp.176-183
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• 1999

Each life has its own properties that distinguish one another. With this property, Oriental medicine suggests original diagnosis and treament. Our process of aging shows typical outline of cycle, i. e. from one's birth to death. Understanding the life cycle of men gives us very good hint to predict one's state of health, possible diseases, characteristics of disease in each term of his/her life cycle. It's because body and mode of diseases change according to age. Aging starts when $\breve{U}$m Essence(陰精)-the essence one receive from parents-dries up or when Deficient Fire(虛火) soars. Parts that compose our body-bones, muscles, flesh, etc.-gradually weaken and worn out as they no longer get support from Yang-Ki(陽氣), In "Yellow Emperor's Classic", aging starts around one's forties when $\breve{U}$m Essence(陰精) is reduced to less than half. However, what is usually accepted is that women start aging from 49 and men 64, regarding significant geriatric disease. As it is mentioned, aging starts with exhaustion of $\breve{U}$m Essence(陰精) which results in soaring Deficient Fire. Main symptoms are weak mental state due to Sin(神) disorder, and weak physical state due to Spleen and Stomacn(脾胃) disorder. Main principle in treating and preventing diseases related to aging is preserving $\breve{U}$m Essence(陰精), as well as fortifying Ki and Blood(氣血). To do this, Lung(肺)-which collects $\breve{U}$m Essence(陰精), and Kidney(腎) stores-which stores $\breve{U}$m Essence(陰精).

• Advances in pediatric surgery
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• v.3 no.2
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• pp.152-159
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• 1997

Transhiatal gastric transposition was performed in two case of long gap esophageal atresia without tracheoesophageal fistula. The patients were a 12 months old female and an 18 months old male. Stamm type gastrostomies were performed at other hospitals in both cases. The stomach was mobilized preserving the right gastric artery, the right gastroepiploic artery and spleen. A portion of the proximal and the distal esophageal segment were excised by transcervical and transhiatal route, respectively. The mobilized stomach was pulled up to the neck through the esophageal hiatus and posterior mediastinum. The esophagogastrostomy, the only one anastomosis of this procedure, was performed in the neck. There was no clinical evidence of anastomotic leakage, stricture, regurgitation, difficulty of gastric emptying, hoarseness or respiratory problem. Transhiatal gastric transposition seems to be a safe and easy alternative surgical procedure for esophageal replacement in long gap esophageal atresia.

• Journal of Gastric Cancer
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• v.19 no.2
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• pp.212-224
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• 2019

Purpose: Splenic hilar lymph node dissection (LND) during total gastrectomy is regarded as the standard treatment for proximal advanced gastric cancer (AGC). This study aimed to investigate whether splenic hilar LND or D2 LND is essential for proximal AGC of pT2- 4aN0M0 stage. Materials and Methods: Data of curative total gastrectomies (n=370) performed from 2000 to 2010 for proximal AGC of pT2-4aN0 stage were retrospectively reviewed. Clinicopathological characteristics and long-term outcomes were compared using propensity score matching between patients who underwent splenectomy (n=43) and those who did not (n=327) and between patients who underwent D2 LND (n=122) and those who underwent D1+ LND (n=248). Results: Tumors of larger size and a more advanced T stage and significantly lower overall and relapse-free survival (P<0.001) were observed in the splenectomy group than in the 2 spleen-preserving groups. Before propensity score matching, worse overall and relapse-free survival (P<0.001) was observed in the splenectomy group than in the non-splenectomy group. After matching, although the overall survival became similar (P=0.123), relapse-free survival was worse in the splenectomy group (P=0.021). Compared with D1+ LND, D2 LND had no positive impact on the overall (P=0.619) and relapse-free survival (P=0.112) after propensity score matching. Conclusions: Splenic hilar LND with or without splenectomy may not have an oncological benefit for patients with pathological AGC with no LN metastasis.

• Journal of Sasang Constitutional Medicine
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• v.23 no.3
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• pp.275-284
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• 2011

1. Objective: This literary review investigates Lee Jema's clinical experiences with Soyang-type patients and their influence on his conceptualization of the Soyang physiology and pathology. 2. Methods: 1) The case reports in "Soyang constitutional type: Spleen Cold-based Exterior-Cold disease" were compared before and after the Sinchuk revision to explore the temporal change in the Sasang medical concepts. 2) The texts in Donguisusebowon (Gabo edition) and Donguisusebowon (Sasangchobongwon) were analyzed to investigate the pathological concepts appearing before the completion of the Donguisusebowon (Gabo edition). 3) The texts in Donguisusebowon (Sinchuk edition) was analyzed to investigate the pathological concepts formed between the Gabo and Sinchuk editions of Donguisusebowon. 3. Results and Conclusions: 1) Gabo edition : The Gabo edition divided the External-origin Exterior disease into Cold-dominant (Heat-moderate) and Heat-dominant (Cold-moderate) patterns and differentiated the severity of Exterior-based Exterior disease and Interior-based Interior disease into mild, moderate, severe, and critical conditions. Cold-damage Delirium disease pattern was categorized as an Interior-based Interior disease, and the treatment protocol using Baekho-tang (Baihu-tang) was established. The stool condition and bowel movement reflecting the patient's defecation habits, the prime indicator of health in the Soyang constitutional type, were emphasized on their importance. 2) Sinchuk edition: The Delirium disease pattern was moved into the Exterior-cold disease, and the treatment protocol applying Jihwangbaekho-tang (Dihuangbaihu-tang) and Hyeongbangsabaek-san (Jingfangxiebai-san), with variational usage of Gypsum, was newly established. The Seong-Jeong and basal disease patterns were suggested as important factors in treating the patients. Also, it was proposed that the symptoms and signs reflecting the condition of the life-preserving energy be assessed to understand the patient's current condition. The importance of post-acute rehabilitation and aftercare as well as the most appropriate acute-stage treatment were emphasized.