• The Journal of Internal Korean Medicine
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• v.30 no.1
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• pp.173-180
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• 2009

Objectives : The aim of this study was to investigate the evaluation of gastrointestinal parasympathetic nerve activity by comparing between HRV and bowel sound parameters in patients with functional dyspepsia. Methods : 62 patients (male 22, female 40) were enrolled. HRV was measured in all patients. and TP (total power), LF (low frequency density: 0.04$\sim$0.15Hz), HF (high frequency density: 0.15$\sim$0.4Hz). and LF/HF ratio were analyzed. HF band is a reflection of parasympathetic activity. and the LF-to-HF ratio is considered a marker of sympathovagal balance. Bowel sounds were recorded at the day after, and postprandial %BS was used to indicate the gastric vagal activity after eating. HRV and bowel sound parameters were compared. and correlation between them was analyzed. Results : There was no difference in LF/HF ratio between patient group and healthy group of other report. According to values of %BS, each patient was classified into a normal (>6 %BS) or hypoactivity (<6 %BS) of gastric vagus nerve group. HF component of the hypoactivity group was not significantly higher than that of the normal group. There was no correlation between HRV and bowel sound parameters. Conclusions : Because no correlation was found between HRV and bowel sound parameters in patients with functional dyspepsia, we concluded that it is not proper to evaluate gastric vagus nerve activity by HRV measurement.

• The Journal of Internal Korean Medicine
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• v.30 no.1
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• pp.191-199
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• 2009

Objectives : The aim of this study was to evaluate the therapeutic effect of acupuncture and herbal medicine in patients who had hvpoactivity of the gastric vagus nerve and pyloric valve disturbance simultaneously with function dyspepsia by bowel sounds analysis. Methods : Bowel sounds of 10 patients (male 1, female 9) were recorded and their % of bowel sound (%BS) and ratio of dominant frequency (DF) were analyzed before and after treatment. Hypoactivity of the gastric vagus nerve was considered if % BS was <6%. and pyloric valve disturbance was accepted if DF ratio (e.g.. postprandial DF/fasting DF) was <1. Electroacupuncture at Zusanli (ST36, 3Hz, 30 minutes) and manual acupuncture at other meridian points were applied daily for 2 weeks. Herbal medicine, Pyengwi-san. was administered to all patients (100cc, 3 times/day). Results : DF ratio significantly increased from $0.93\pm0.06$ to $1.06\pm0.04$ after treatment for 2 weeks (p=0.005). 9 of 10 patients were improved to DF ratio>1. %BS also increased from $2.97\pm1.17%$ to $4.49\pm4.27%$. not significantly. 3 patients showed a remarkable elevation, and their %BS reached >6% of normal value. Conclusions : Combined effect of electroacupuncture at Zusanli (ST36), manual acupuncture. and Pyengwi-san was shown effective in the improvement of pyloric valve disturbance more than hypoactivity of gastric vagus nerve on patients with functional dyspepsia.

• Journal of Chest Surgery
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• v.20 no.4
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• pp.839-846
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• 1987

The records of 10 patients with traumatic diaphragmatic hernia seen from November 1977 through July 1987 were reviewed. All the patients had a transdiaphragmatic evisceration of abdominal contents into the thorax. We treated 7 male and 3 female patients ranging in age from 3 to 62 years. In 8 patients, diaphragmatic hernia followed blunt trauma and in 2 patients, stab wounds to the chest. The herniation occurred on the right side in 3 patients and on the left side in 7. All the patients sustained additional injuries: rib fractures [7 patients], additional limb, pelvic and vertebral fractures [6], closed head injury [2], lung laceration [1], liver laceration [1], renal contusion [1], ureteral rupture [1], and splenic rupture [1]. Organs herniated through the diaphragmatic rent included the omentum [6 patients], stomach [4], liver [4], colon [3], small intestine [1], and spleen [1]. For right-sided injuries, the liver was herniated in all 3 patients and the colon, in 1. in the initial or latent phase, dyspnea, diminished breath sounds, bowel sounds in the chest were noted in 4 patients, and in the obstructive phase, nausea, vomiting, and abdominal pain were found in all 3 patients. Two patients had a diagnostic chest radiograph with findings of bowel gas patterns, and an additional 8 had abnormal but nondiagnostic studies. Hemothorax, pleural effusion or abnormal diaphragmatic contour were common abnormal findings. Three patients were operated on during the initial or acute phase [immediately after injury], 4 patients were operated on during the latent or intermediate phase [3 to 210 days], and 3 patients were operated on during the obstructive phase [10 to 290 days]. Six patients underwent thoracotomy, 2 required thoracoabdominal incision, and 2 had combined thoracotomy and laparotomy. Primary suture was used to repair the diaphragmatic hernia in 9 cases. One patient required plastic repair by a Teflon felt. Empyema was the main complication in 2 patients. In 1 patient, the empyema was treated by closed thoracostomy and in 1, by decortication and open drainage. There were no deaths.

• The Journal of Internal Korean Medicine
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• v.29 no.2
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• pp.401-412
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• 2008

Objectives : The aim of this study was to investigate the characteristics of Ryodoraku and association of Ryodoraku with gastric dysmotility in functional dyspepsia(FD). Methods : Subjects were 154 patients with FD and 18 patients with asthma. We calculated the average Ryodoraku score(RS, ${\mu}A$) and each variation from physiologic range of 12 Ryodoraku points, and investigated the incidence when left and right points were simultaneously below(bilateral deficiency) or above(bilateral excess) physiologic range. Postprandial regularity of normal slow waves, power ratio, and postprandial % of bowel sound were obtained by electrogastrography and enterotachography, and were used as gastric dysmotility index. Results : 1. Bilateral excess of H4, H5, F1, and F4 and bilateral deficiency of H4, H5, and H6 were characteristic in FD compared with asthma patients. 2. Incidence of gastric dysmotility in bilateral deficiency of H4, H5, and H6 was 100%, and was higher than in total FD patients(88.3%). 3. There was a positive correlation between the variation of H6 and % postprandial bowel sound. 4. Deficient tendency of H4, H5, and H6 was more evident when RS was above $40{\mu}A$ in FD. Conclusions : These findings suggest that gastric dysmotility in FD can be diagnosed when a pattern of H4, H5, H6 bilateral deficiency and F1, F4 bilateral excess is shown at the same time. We think this phenomenon is related to low activity of the vagus nerve rather than meridian pathway with result based on positive correlation between variation of H6 and postprandial % of bowel sound.

• The Journal of Internal Korean Medicine
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• v.29 no.3
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• pp.621-628
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• 2008

Objectives : The aim of this study was to investigate changes of gastric vagal nerve activity and pyloric valve function after execution of combination treatments of both electroacupuncture at Zusanli(ST36) and manual acupuncture at other acupoints in patient with functional dyspepsia. Methods : Bowel sounds of 49 patients (18 male, 31 female) were recorded and their % of bowel sound (%BS) and ratio of dominant frequency (DF) were analyzed. Postprandial %BS was used to indicate the gastric vagal activity after eating. Ratio of postprandial/fasting dominant frequency was used to present the degree of pyloric valve function. According to values of %BS and DF ratio, each patient was classified into normal or abnormal (<6 %BS, hypoactivity: <1 DF ratio, dysfunction) group. For 2 weeks, patients received a treatment consisting of both electroacupuncture stimulation at Zusanli (ST36) and acupuncture at other meridian points. Variation of parameters shifting normal to abnormal or abnormal to normal was observed, and total cure rate was calculated. Results : Total cure rate of %BS was 16%, and that of DF was 37%. Patients who improved to normal value from abnormal or aggravated to abnormal level showed both significant difference in both vagal nerve hypoactivity and pyloric valve dysfunction, respectively. Conclusions : Analysis of bowel sound might be useful to evaluate both gastric vagal nerve activity and pyloric valve function. Combination effects of Zusanli (ST36) electroacupuncture and manual acupuncture of other acupoints showed a bidirectional effect in which their activity and function were in general improved. sometimes from aggravated to abnormal level.

• Journal of Chest Surgery
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• v.13 no.2
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• pp.154-157
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• 1980

A twenty three year old, Primigravida and 32 week pregnant woman who has been complained dyspnea, chest pain, nausea and vomiting was admitted to this chest surgical department on Feb. 19, 1979. Physical findings were those of acutely ill appearance, decreased thoracic excursion and absence of breath sounds in the left hemithorax. Roentgen examination of the chest revealed reticular cystic densities in the left, particularly in lower lung field with collapse of the left lung. Correction of the diaphragmatic hernia was carried out with reduction and repair of the hernia through transperitoneal approach. On exploration, the defect of the diaphragm was 12 x 12 cm in size and was located posterolateral area of left diaphragm. Hernia contents were stomach, spleen, omentum and splenic flexure of large bowel. The baby was normal full term spontaneous delivered at 36th POD. Diaphragmatic hernia complicated by pregnancy is a rarity and mortality is extremely high. Therefore, the literatures have reviewed and the case is reported.

• Journal of Chest Surgery
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• v.15 no.4
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• pp.432-439
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• 1982

Congenital posterolateral diaphragmatic hernia [Bochdalek hernia] is the result of a congenital diaphragmatic defect in the posterior costal part of the diaphragm in the region of the tenth and eleventh ribs. There is usually free communication between the thoracic and abdominal cavities. The defect is most commonly found on the left [90%], but may occurs on the right, where the liver often prevents detection. The male to female ratio is 2:1. Owing to the negative intrathoracic pressure, herniation of abdominal contents through the defects occurs, with resultant collapse of the lung. Shifting of mediastinum to the opposite side and compression of the opposite lung occurs. Most often these hernias are manifestated by acute respiratory distress in the newborn. A second, but less well recognized, group of patient with Bochdalek hernia survive beyond the neonatal period, usually present at a later time with "failure of thrive, intermittent vomiting, or progressive respiratory difficulty. " The diagnosis can often be made on clinical ground from the presence of respiratory distress, absence of breath sounds on the chest presence of bowel sounds over the chest . Roentgenogram of the chest confirm the diagnosis. Obstruction and strangulation have been reported but are rare. Treatment consists of early reliable identification of these congenital diaphragmatic hernia with high risk and surgical repairment. and postoperative pharmacological management with extracorporeal membranous oxygenation [=ECMO] support in the period of intensive care. On the surgical approach, for defects on left side, an abdominal incision is preferred, because of the high incidence of malrotation and obstructing duodenal bands. In the neonate, the operative mortality may be appreciable, but, later repair almost always is successful. During the period from 1972 to 1982, 4 cases of congenital Bochdalek hernia were experienced at the Kyung-Hee University Hospital.

• Advances in pediatric surgery
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• v.13 no.1
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• pp.81-86
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• 2007

A 3-year-old boy with purulent otitis media received a chest radiograph as the part of a routine work up. The patient was normal appearing, in no acute distress. The patient's lung and heart sounds were clear and normal. The patient's abdomen was soft, non-distended, and non-tender. An anterior cardiophrenic mass was incidentally identified on the lateral chest radiograph. A computed tomography scan demonstrated a diaphragmatic hernia with bowel loops in the retrosternal space. An exploratory operation revealed a diaphragmatic defect (4 cm in diameter) on the left side of the falciform ligament, through which transverse colon was protruded. There was no hernia sac, and the defect was closed with interrupted No. 2 silk sutures. The child was discharged on the 8th postoperative day without any complications. During 6 months of follow-up period, recurrence was not noticed.

• Journal of The Korean Society of Clinical Toxicology
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• v.5 no.1
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• pp.53-56
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• 2007

Nicotine poisoning arising from the use of nicotine patches is rare. However, because nicotine patches are classified as an OTC drug, the risk of misuse or abuse is increasing. Nicotine poisoning using nicotine patches shows an unusual clinical presentation compared to that from oral ingestion of multiple doses of nicotine. We present a case of misused nicotine patches that cause a nicotine poisoning. A thirty-nine year-old healthy man visited the ER with complaints of an intermittent cramping abdominal pain with nausea and vomiting. Upon physical examination, there were no specific findings except increased bowel sounds, and the patient's initial laboratory findings were also unremarkable except for an increased bilirubin level. CT revealed a mild degree of fatty liver. The patient's symptoms did not improve any further with conservative management. During his ED stay, we meticulously took his history again, and we discovered that he had used nicotine patches for three days, six days before admission, and had misused the nicotine patches as NSAID patches. The patient's diagnosis of nicotine poisoning was confirmed by a urine cotinine level ten times the normal value. After a 12-hour stay in the ED, his symptoms disappeared without any specific management.