• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.20 no.3
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• pp.194-197
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• 2017

Alimentary tract duplication cysts are rare congenital anomalies, most commonly located in the ileum, but may present anywhere from mouth to anus.Clinically, they may be asymptomatic, incidentally diagnosed or may present with obstruction, volvulus, intussusception or gastrointestinal bleed. Here we report a case of a one year old male child presenting in gasping state and shock. Despite the initial strong suspicion of Meckel's diverticulum and tubercular abdomen, the final diagnosis remained elusive till exploratory laparotomy was performed which revealed a duplication cyst of ileum with perforation into the umbilicus. Duplication cyst should always be kept as a differential diagnosis so that early intervention can help in better management.

• Archives of Plastic Surgery
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• v.38 no.3
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• pp.326-328
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• 2011

Purpose: The anatomical anomaly of the rectus abdominis muscle and it's fascia is very rare. No case of the absence of the linea alba below the umbilicus has yet been reported. During breast reconstruction with pedicled TRAM flap, we experienced one case of absence of linea alba. Methods: The patient was a 38-years old female who underwent immediate breast reconstruction with pedicled TRAM flap after Right modified radical mastectomy in June 2010. While the TRAM flap was being elevated, bilateral twitching of the rectus abdominis muscle occurred when electrocautery was applied, and we found the absence of the linea alba below the umbilicus. Results: When the rectus abdominis muscle was exposed, the linea alba below the umbilicus was not observed, and the bilateral rectus abdominis muscle was indistinguishably fused in a gross observation. In addition, bilateral twitching of rectus abdominis muscle was simultaneously observed as one muscle unit when electrocautery was applied. As with both rectus abdominis muscles was bluntly dissected with scissors, the scanty fatty tissues were observed between the both rectus muscles, and the bilateral rectus abdominis muscle was easily separated. The flap was transposed into the corresponding defect to make breast mound. Midline fascia was fixed to the posterior rectus sheath to reconstruct smilar anatomic linea alba. Abdominal defect was reinforced by suturing between remaining anterior rectus sheath. Conclusion: As the unexpected anatomical anomaly may affect the operation outcome, surgeons should be careful when they unexpectedly encounter the anatomical anomaly during an operation. Here, we report a rare case of absence of the linea alba seen at the time of pedicled TRAM flap elevation for breast reconstruction.

• Radiation Oncology Journal
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• v.12 no.2
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• pp.233-241
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• 1994

Purpose : This study was performed to verify dose distribution with the tissue compensator which is used for uniform dose distribution in total body irradiation(TBI). Materials and methods : The compensators were made of lead(0.8mm thickness) and aluminum(1mm or 5mm thickness) plates. The humanoid phantom of adult size was made of paraffin as a real treatment position for bilateral total body technique. The humanoid phantom was set at 360cm of source-axis distance(SAD) and irradiated with geographical field size(FS) $144{\times}144cm^2(40{\times}40cm^2$ at SAD 100cm) which covered the entire phantom. Irradiation was done with 10MV X-ray(CLINAC 1800, Varian Co., USA) of linear accelerator set at Department of Therapeutic Radiology, Chonnam University Hospital. The midline absorbed dose was checked at the various regions such as head, mouth, mid-neck, sternal notch, mid-mediastinum, xiphoid, umbilicus, pelvis, knee and ankle with or without compensator, respectively. We used exposure/exposure rate meter(model 192, Capintec Inc., USA) with ionization chamber(PR 05) for dosimetry, For the dosimetry of thorax region TLD rods of $1x1x6mm^3$ in volume(LiF, Harshaw Co., Netherland) was used at the commercially available humanoid phantom. Results : The absorbed dose of each point without tissue compensator revealed significant difference(from $-11.8\%\;to\;21.1\%$) compared with the umbilicus dose which is a dose prescription point in TBI. The absorbed dose without compensator at sternal notch including shoulder was $11.8\%$ less than the dose of umbilicus. With lead compensator the absorbed doses ranged from $+1.3\%\;to\;-5.3\%$ except mid-neck which revealed over-compensation($-7.9\%$). In case of aluminum compensator the absorbed doses were measured with less difference(from $-2.6{\%}\;to\;5.3\%$) compared with umbilicus dose. Conclusion : Both of lead and aluminum compensators applied to the skull or lower leg revealed a good compensation effect. It was recognized that boost irradiation or choosing reference point of dose prescription at sternal notch according to the lateral thickness of patient in TBI should be considered.

• Archives of Plastic Surgery
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• v.41 no.2
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• pp.171-173
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• 2014

Preoperative perforator marking for deep inferior epigastric artery perforator flaps is vital to the success of the procedure in breast reconstruction. Advances in imaging have facilitated accurate identification and preselection of potentially useful perforators. However, the reported imaging accuracy may be lost when preoperatively marking the patient, due to 'mapping errors', as this relies on the use of 2 reported vectors from a landmark such as the umbilicus. Observation errors have been encountered where inaccurate perforator vector measurements have been reported in relation to the umbilicus. Transcription errors have been noted where confusing and wordy reports have been typed or where incorrect units have been given (millimetres vs. centimetres). Interpretation errors have also occurred when using the report for preoperative marking. Furthermore, the marking process may be unnecessarily time-consuming. We describe a bespoke template, created using an individual computed tomography angiography image, that increases the efficiency and accuracy of preoperative marking. The template is created to scale, is individually tailored to the patient, and is particularly useful in cases where multiple potential suitable perforators exist.

• Archives of Plastic Surgery
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• v.42 no.2
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• pp.226-231
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• 2015

The aim of this study is to consider breast imagery in art as depicted through western painting. Twenty western art paintings were collated. Most of the sample paintings were created from the mid-nineteenth century to the late twentieth century and some are from the Renaissance period. Ten anthropometric items were used to measure 15 distances between two landmarks and 3 angles between three points. The distance from the nipple to the sternal notch and to the midclavicular point was the same and they were 0.46 of the distance from the sternal notch to the umbilicus. The shape of the projection of the breast was almost an isosceles triangle and the altitude of the triangle was at a proportion of 0.45 of the bottom length and 0.16 of the distance from the sternal notch to the umbilicus. The distance between the lateral ends of the breasts was 2.14 times the facial width and the distance between nipples was 1.36 times the facial width. Proportions from works of art are more ideal and attractive than clinically measured proportions. The desirable ratios measured from historical paintings might be useful in planning breast surgeries.

• Advances in pediatric surgery
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• v.4 no.1
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• pp.27-33
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• 1998

Of 72 patients with vitelline duct and vessel remnants, 45 (62.5 %) had symptomatic lesions. The mean age of the patients was 27.9 months. Males predominated (4.6 : 1). There were 22 cases of Meckel's diverticulum, 6 of Meckel's diverticulum attatched to the umbilicus with a fibrous band, 6 cases of patent vitelline duct, 5 cases of vitelline artery remnants as a fibrous band and 2 cases each of umbilical sinus and polyp, and vitelline cyst. Twenty-three patients (51 %) presented with intestinal obstruction, 6(13 %) with rectal bleeding, 4(9 %) with perforated Meckel's diverticulum, 5 with intestinal juice drainage through umbilicus, 5 with umbilical lesions, 1 with abdominal mass, and 1 with sepsis. Intestinal obstruction due to fibrous band developed during infancy(average age; 4.6 months). Seventeen asymptomatic Meckel's diverticulum, 8 obliterated vitelline artery remnants and 1 vitelline vein remnant as fibrous band, and 1 vitelline cyst were found incidentally at laparotomy. About 82 % of the complicated Meckel's diverticulum presented in infants and children less than 4 years of age.

• Archives of Plastic Surgery
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• v.35 no.6
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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.

• Journal of Korean Medical classics
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• v.21 no.2
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• pp.21-28
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• 2008

After translating the contents of "Treatise on Bundon Disease in Chapter 8 of the Essence of the Synopsis of the Golden Chamber" and it was compared with the contents of "The Lecture of Synopsis of Prescriptions of the Golden Chamber" and speculated to review the characteristics of the comments of Ui(尤怡) and the following conclusions were made. As the causes of bundon(奔豚) disease, which means gas rushing like a running piggy from the lower abdomen to the throat, they could be categorized into the cases belongs to miscellaneous diseases (雜病) and into the cases of suffering from cold diseases(傷寒). If it was diagnosed as miscellaneous disease, terror and fear(驚恐) could be regarded as its cause and if it was diagnosed as cold disease, insufficiency of heart Gi(心氣) due to the excessive sweating and the invasion of exterior coldness could be regarded as its cause. As the pathogenesis of this disease, the pathogenic factors of liver and kidney could be found. Since the liver and Soyang meridian(少陽經) are subjected to the exterior and interior relation in case of the pathogenic factor of liver, alternate attacks of chills and fever(寒熱往來) could be characteristic for the disease. If this disease was caused by the pathogenic factor of kidney, there are two cases. One is the palpitation under the umbilicus(欲作奔豚: 臍下動悸) developed by the lack of heart Gi(心氣) and the other is gas rushing like a running piggy from the lower abdomen to the throat which could be developed by the exterior cold disease which invade into the interior and reach into the kidney when the heart Gi(心氣) was insufficient. In its treatment, bundon disease caused by the pathogenic factor of liver could be treated with Bundontang(奔豚湯), and the understanding of Ui(尤怡) on Pinellia ternata Breitenbach(半夏) having the effect of perspiration in the prescription is quite unique concept. In case of bundon disease caused by the pathogenic factor of kidney, treatment is focused to treat exterior coldness by applying moxibustion(灸) and Gyejigagyetang(桂技加桂湯), and in case of the palpitation under the umbilicus(欲作奔豚: 臍下動悸), its pathogenic factor of kidney is controlled with Cinnamomum louerii Nees(桂技), Polia cocos Walf and the spleen Gi(脾氣) is cared by using Glycyrrhiza uralensis Fischer et. De Candolle(甘草) and Zizyphus jujuba Mill(大棗). Especially, Ui(尤怡) emphasized Cinnamomum louerii Nees(桂技) as the medication to treat the pathogenic factor of kidney.

• YAKHAK HOEJI
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• v.51 no.6
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• pp.455-462
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• 2007

The participants were recruited 77 healthy adult persons aged between 20 and 50 who have BMI above $25kg/m^2$ in this study. All subjects were randomly assigned to the Gentro $F^{(R)}$ drinking group and non-drinking group. We were investigated about abdomen fat decreasing effect of Gentro $F^{(R)}$, distillate of pepper. Total fat area (TFA), subcutaeneous fat area (SFA) and visceral fat area (VFA) and subcutaneous fat area/visceral fat area ratio (SVR) has been assessed by obesity index (BMI, body fat percent, waist circumference), CT scan taken on the $L4{\sim}5$ position, umbilicus level and blood analysis evaluated during 3 month. The obesity indexes were a little decreased in two groups. However, the waist circumference (WC) was decreased about 5% in drinking group after 3 month and there was significant difference in the change 2 and 3 between two group. TFA and VFA were significantly decreased in the drinking group compare to the non-drinking group (p<0.05) and in umbilicus and $L4{\sim}5$ position, were $370.33{\pm}92.30,\;380.35{\pm}97.64\;and\;114.90{\pm}44.91,\;101.99{\pm}41.24$, respectively. These result means that Gentro $F^{(R)}$ is effective on abdomen fat decreasing. Total cholesterol were decreased without difference in both groups. Lipid factors (TG, HDL- and LDL-cholesterol) were decreased without significance. The mea surement of SVR taken on the $L4{\sim}5$ position were more significantly correlated with obesity index that BMI was 0.787, body fat percentage was 0.754 than on the umbilicus level. The TFA and VSA was correlated with ALP, ASP, Albumin, Insulin and the SVR was correlated with the indexes of liver function and lipid factor found in the blood. Therefore, it is conclude that Gentro $F^{(R)}$ drinking leads to a decrease in abdominal obesity by reducing waist circumference and visceral fat area.

• Journal of Veterinary Clinics
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• v.19 no.2
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• pp.239-242
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• 2002

A two-month-old female Thoroughbred foal was referred to the Equine Hospital, Jeju Stud Fm, Korea Racing Association. The foal was presented with opening of the abdominal ring by congenital predisposition. In physical examination, the foal revealed a mild heating, fluctuant swelling at umbilicus. The umbilical hernia was diagnosed, and then modified umbilical herniorraphy was performed and resulted in successful treatment. We conclude this method is of great value within the six-month-old foal with hernial ring size less than 10 cm.