• Journal of Chest Surgery
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• v.7 no.2
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• pp.163-168
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• 1974

Five cases of traumatic diaphragmatic hernia were repaired in the Department of Thoracic Surgery, Seoul National University Hospital, during the period from 1967 to 1974. The first case, a 14-year aid girl, was diagnosed as diaphragmatic hernia during laparotomy because of jejunal perforation 3 days after traffic accident. Herniated stomach, transverse colon, spleen and left lobe of the liver were repositioned and the diaphragmatic rupture on left posterolateral portion was repaired with two layers of nonabsorbable sutures by transthoracic approach. The second case, a 26-year old man,was diagnosed immediately after traffic accident at a local clinic and transferred to this hospital 24 hours later. Herniated stomach, transverse colon and jejunum were repositioned amd diaphragmatic rupture,about 9 cm in length,from the posterolat.edge to the base of pericardium was sutured in two layers. The third case, a 26-year old man who had stab wound on the left lower lateral chest two years ago,was admitted with sudden abdominal pain and vomiting. Upper gastrointestinal series with barium meal revealed diaphragmatic hernia. The herniated stomach and transverse colon through the defect,about 3.5cm in diameter, at anterolateral portion on the left side,were repositioned and repaired with two layers of nonabsorbable sutures. The forth case, a 26-year old man, sustained blunt trauma to the chest by a roller and was transferred to the emergency room complaining of dyspnea 40 minutes after the accident. The diaphragmatic rupture extended from left midaxillary line to contralateral anterior axillary line,about 20cm long, at anterior portion of diaphragm, which was repaired with two layers, of nonabsorbable sutures. The fifth case, a 4-year old girl, had two separate diaphragmatic ruptures on both sides, which were caused by traffic accident. Immediate upper gastrointestinal series after injury showed herniated stomach, colon and spleen into left Chest cavity. Another small rupture with anterior edge of right lobe of the liver in chest cavity was noted. These were repaired with non-absorbable sutures via thoracotomy.

• Physical Therapy Korea
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• v.20 no.3
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• pp.81-88
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• 2013

Active straight-leg raise (ASLR) is a physical evaluation procedure to test lumbar spine stability. Several previous studies have reported various methods to control the activation of abdominal muscles during ASLR. We investigated the effects of three different hip positions in frontal plane on abdominal muscles to increase or decrease the difficulty level of lumbar spine stability exercise during ASLR in pain free subjects. Eleven young and healthy subjects voluntarily participated in this study (6 men, 5 women; mean age=$24.0{\pm}1.2$ years, height=$160.0{\pm}7.3cm$, weight=$55.0{\pm}10.6kg$, body mass index=$21.5{\pm}2.3kg/m^2$). The subjects had three trials on each ASLR with hip $10^{\circ}$ adduction, neutral hip, and hip $30^{\circ}$ abduction. Separate repeated-measures analysis of variance (ANOVA) and the post hoc Bonferroni tests (with ${\alpha}$=.05/3=.017) were performed for each muscle among the three different hip positions in frontal plane (ASLR with hip $10^{\circ}$ adduction, neutral hip, and hip $30^{\circ}$ abduction). The ipsilateral external oblique (EO), contralateral EO, ipsilateral internal oblique/transverse abdominis (IO/TrA), and contralateral IO/TrA were significantly greater in ASLR with hip $30^{\circ}$ abduction compared with ASLR with hip $10^{\circ}$ adduction. Also, the ipsilateral EO, contralateral EO, and ipsilateral IO/TrA were significantly greater in ASLR with hip $30^{\circ}$ abduction compared with ASLR with neutral hip. These results suggest that ASLR with hip $30^{\circ}$ abduction and neutral would be useful method to strengthen the EO and IO/TrA. And, ASLR with hip $10^{\circ}$ adduction would be effective in early stages of lumbar stabilization program due to low activation of EO and IO/TrA during maintaining of ASLR position with low load.

• Physical Therapy Rehabilitation Science
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• v.9 no.3
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• pp.184-190
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• 2020

Objective: Patients with low back pain can possibly have impaired core muscle function, which is the common cause of low back pain. Spinal stabilization exercises are recommended for prevention and reinforcement. This study aimed to compare the effects of different types of feedback on abdominal and lumbar multifidus (LM) muscle recruitment during spinal stabilization exercises. Design: Cross-sectional study. Methods: Fifty-seven healthy subjects (sex=male 21/female 36, age=21.28±1.60 years) were divided into three different groups: the control group (n=19), the auditory feedback (AF) group (n=19), and the visual and auditory feedback (VAF) group (n=19). The control group received no feedback, whereas the AF group only received AF during exercises and the VAF group received the AF and visual feedback through the real-time ultrasound images. The main outcome measure was the assessment of the thickness of the abdominal muscles and LM measured by a dual ultrasound. Results: When VAF was applied, the thickness of the transverse abdominis significantly increased rather than when feedback was not applied or with AF only (p<0.05). The VAF group showed significant differences in both the control group and the AF group in the post-hoc test (p<0.05), and there was no significant difference between the control group and the AF group. Conclusions: With spinal stabilization exercises, VAF should be applied in standing posture for healthy adults to further promote the production of effective contractions.

• Archives of Plastic Surgery
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• v.36 no.2
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• pp.140-146
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• 2009

Purpose: Autologous breast reconstruction with abdominal tissue is one of the best options after mastectomy. In a free transverse rectus abdominis myocutaneous(TRAM) or deep inferior epigastric artery perforator(DIEP) flap, a preoperative evaluation of the precise location of perforating vessels and vascular run - off systems is required. The objective of this report is to demonstrate the usefulness of multidetector computed tomography(MDCT) in the preoperative planning of patients undergoing breast reconstruction with abdominal flap. Methods: From June 2006 to January 2008, 28 patients underwent MDCT evaluation before breast reconstruction. All subjects were females with an age range of 30 to 55 years. The CT scan was performed using a 64 - slice MDCT scanner(Brilliance 64; Philips Medical Systems, Best, Netherlands). Results: One perforator or two major perforators were marked on image in good relation with a hand - held Doppler examination and intraoperative findings. All vascular run - off systems were cleared before operation. Conclusion: Preoperative evaluation of perforator arteries with MDCT angiography is beneficial in patients undergoing breast reconstruction. This technique provides a noninvasive approach of the vascular anatomy of the entire anterior abdominal wall.

• Archives of Plastic Surgery
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• v.47 no.2
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• pp.146-152
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• 2020

Background Preoperative computed tomography angiography (CTA) of the abdominal wall vessels is used when planning free flap breast reconstruction (FFBR) because it provides a surgical road map which facilitates flap harvest. However, there are few reports on the effect of abnormal findings on the operative plan. Methods We conducted a retrospective study of all FFBRs performed at a tertiary referral center over a 6-year period (November 2011 to June 2017). One consultant radiologist reported on the findings. Details on patient demographics, CTA reports, and intraoperative details were collected. Results Two hundred patients received preoperative CTAs. Fourteen percent of patients (n=28) had abnormal findings. Of these findings, 18% were vascular anomalies; 36% tumorrelated and 46% were "miscellaneous." In four patients, findings subsequently prevented surgery; they comprised a mesenteric artery aneurysm, absent deep inferior epigastric (DIE) vessels, bilateral occluded DIE arteries, and significant bone metastases. Another patient had no suitable vessels for a free flap and the surgical plan converted to a pedicled transverse rectus abdominis musculocutaneous flap. The remaining incidental findings had no impact on the surgical plan or appropriateness of FFBR. More than one in 10 of those with abnormal findings went on to have further imaging before their operation. Conclusions CTA in FFBR can have a wider impact than facilitating surgical planning and reducing operative times. Incidental findings can influence the surgical plan, and in some instances, avoid doomed-to-fail and unsafe surgery. It is therefore important that these scans are reported by an experienced radiologist.

• PNF and Movement
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• v.18 no.3
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• pp.415-424
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• 2020

Purpose: This study aimed to compare changes in abdominal muscle thickness in different standing postures with a handheld load between subjects with and without chronic low back pain (CLBP). Methods: Twenty subjects with CLBP and 20 controls participated in this study. Ultrasound imaging was used to assess the changes in the thickness of the transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles. Muscle thickness in three different standing postures (standing at rest, standing with loads, standing with lifting loads) was compared with the muscle thickness at rest in the supine position and was expressed as a percentage of change in the thickness of the muscle. Results: While standing with loads, the change in IO muscle thickness in the CLBP patients increased more significantly than in the pain-free controls (p < 0.05). The standing with lifting loads posture showed a significant increase in the change in thickness of the TrA compared with the standing with loads posture (p < 0.05). In addition, the standing with lifting loads posture showed a significant decrease in the change in the thickness of the EO when compared with the standing with loads posture (p < 0.05). Conclusion: The automatic activity of the IO muscle in subjects with CLBP increased more than that of the pain-free controls in the standing with loads posture. These findings suggest that IO muscle function may be altered in those with CLBP while standing with loads. Additionally, TrA the activation level was found to be associated with increased postural demand caused by an elevated center of mass.

• Journal of The Korean Society of Integrative Medicine
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• v.8 no.3
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• pp.181-188
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• 2020

Purpose : The purpose of this study is to compare the effects on abdominal muscle thickness and breathing by applying trunk strength exercise and deep stabilization exercise along with breathing exercise, which is the main respiratory muscle during breathing, to present an efficient exercise method with diaphragm breathing. Methods : This study was performed on normal 6 females and 14 males subjects. They were divided into 2 groups which trunk strength exercise and deep stabilization exercise group. The trunk strength exercise group (TSE) attended prone press-up, crunch and pelvic tiling. The deep stabilization exercise group (DSE) attended abdominal drawing, horizontal side-support and bridging exercise. Breathing exercise was performed for each set break time for 1 minute. Results : First, in the comparison of the change in the thickness of the abdominal muscle between the trunk strength training group and the deep stabilization group before and after exercise, there was a statistically significant difference in the comparison of transverse abdominis (TrA), rectus femoris (RF), external oblique (EO), internal oblique (IO) (p<.05). However, there was no significant difference in any comparison between groups (p>.05). Second, in the comparison of changes in respiratory function between the trunk strength exercise group and the deep stabilization exercise group before and after exercise, there were statistically significant differences in the exerted forced vital capacity (FVC), forced expiratory volume at one second (FEV₁), peak expiratory flow (PEF) in the comparison before and after the experiment (p<.05). However, there was no significant difference in any comparison between groups (p>.05). Conclusion : As a result of this study, it can be said that both trunk strength exercises and deep stabilization exercises along with diaphragm breathing are exercises that strengthen deep and superficial muscles, and have a positive effect on breathing function as well as muscle strength. However, it is not known which exercise was more effective, and because it was combined with breathing exercise, the interference effect appeared.

• Journal of the Korea Convergence Society
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• v.10 no.7
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• pp.93-100
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• 2019

The purpose of this study is to measure abdominal muscle thickness when Pelvic Floor contraction (PFC) and Abdominal Drawing-In Maneuver (ADIM) were separately applied and combined exercise was applied and to compare the effects of the exercise. After the pre-investigation, the subjects were given a explanation of the purpose and the method of the research and then an experiment was conducted targeting a total of 30 subjects, who voluntarily agreed with this. Thicknesses of internal oblique (IO), transverse abdominis (TrA) and external oblique (EO) were measured during a break and then three types of exercise. All the measured values of the experiment were processed using Repeated measure ANOVA, and Bonferroni method was applied. As a result, the three types of exercise showed significant differences in thicknesses of IO, TrA and EO. In conclusion, the subjects had the thickest muscles and muscular activity increased during PFC+ADIM, compared to PFC and ADIM.

• Journal of The Korean Society of Integrative Medicine
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• v.11 no.4
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• pp.51-60
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• 2023

Purpose : The purpose of this study was to determine the effect of pelvic floor muscle exercise (PFME) on an unstable support surface on maximal inspiratory pressure (MIP), maximum expiratory pressure (MEP), and abdominal muscle thickness as a method for effective PFME. Methods : This study was performed on 22 subjects. They were matched and divided into two groups based on body mass index; the experimental group (EG) performed PFME on a foam roller (n= 11), the control group (CG) performed PFME on a stable support surface (n= 11). Kegel exercise was performed with 10 seconds of contraction, 10 seconds of relaxation, and 4 sets of 10 reps per set. Both of group executed the exercise 3 times a week for 2 weeks. MIP and MEP was measured using a spirometer. Abdominal muscle thickness was measured using ultrasound. The paired t-test was used to compare difference on each group and the comparison between groups was analyzed using the independent t-test. A significance level of α= .05 was used to verify statistical significance. Results : The EG showed a significant increase in the MEP (p<.05). The CG showed a significant increase in the MEP (p<.05). There was no significant difference in the two groups (p>.05). The EG showed a significant increase in the external oblique, internal oblique and transverse abdominis (p<.05). The CG showed a significant increase in the internal oblique (p<.05). There was no significant difference in the two groups (p>.05). Conclusion : Based on the results of this study, additional research should be conducted to correct the limitations of this study to confirm that PFME performed on a foam roller has a positive effect on respiratory muscle strength and abdominal muscle thickness.

• Journal of Korean Physical Therapy Science
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• v.15 no.4
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• pp.61-74
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• 2008

Background: Purpose of this study is mat exercises and sling exercises that based on proceeding studies for exercising protocol for spinal stabilization. Methods: We analyze many other bibliographies and result of studies. Results: The vertebrae stabilization practices are formed on intra-abdominal pressure and converted into isolation of our body and limbs gradually through co-contraction training of transverse abdominis, pelvic floor muscle and diaphragm. Also, for prevention of low back pain and relapse, it is diverted to reflex muscle contraction training as well as functional integration. What is better, it should carry out with Activity of Daily Living. Conclusion: We should feel the necessity of it, more effective recognition training of local muscle for chronic low back pain patients. Besides, it is suggested that we should import measurable equipment and go hands with discipline.