• Archives of Reconstructive Microsurgery
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• v.10 no.1
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• pp.28-33
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• 2001

The numbers of breast cancer are increasing in Korea and the needs for breast reconstruction are also parallel with cancer frequency. The purpose of the study is to define the different state and condition between the delayed reconstruction and the immediate reconstruction of breasts and to suggest how to get more satisfactory outcome. The study included 22 patients who underwent delayed breast reconstruction using transverse rectus abdominis myocutaneous(TRAM) free flap from December, 1990 to January, 2001. Their ages ranged from 28 years to 58 years. We have used internal mammary artery and vein as a recipient vessel in 13 patients because of fibrosis and severe scarring in the axillary region and thoracodorsal artery and vein in 9 patients. When we used internal mammary artery with recipient vessel, we would use contralateral deep inferior epigastric artery with donor vessel. We obtained satisfactory result without any flap loss, and most patients satisfied with shape and volume of reconstructed breast. We found that delayed breast reconstruction have some differences compared with immediate breast reconstruction. First, we remove fibrotic and scar tissue as much as possible to achieve satisfactory shape of breast. Second, we plan preoperative design in standing position to obtain symmetrical recreation of inframammary fold. Third, we use internal mammary vessel in many cases with recipient vessel for microvascular anastomosis. Fourth, patients with delayed breast reconstruction feel more satisfaction than patients with immediate breast reconstruction do. Finally, economic burden is much higher in the delayed case than in the immediate case because of no coverage with insurance.

• The Journal of Internal Korean Medicine
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• v.26 no.4
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• pp.926-934
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• 2005

It is well known that NERD(Non-erosive gastroesophageal reflux disease) is a well known esophageal disease. Symptoms of NERD may be divided into two classes. Important symptoms are acid regurgitation and heartburn. Secondary symptoms are noncardiac chest pain, dysphagia, chronic coughing, hoarseness, sore throat, globus, halitosis, epigastric pain or discomfort and abdominal pain or discomfort related to bowel movement. The relationship between NERD and Tan-San(呑酸) is complex. But the most common symptoms of NERD are acid regurgitation and heartburn. These symptoms arc similar to Tan-San and can be treated with oriental medical herb and acupuncture. Ljintang-Gamibang(二陳湯加味方) mentioned in the Donguibogam(東醫寶鑑) is one of these oriental medical herbs. Therefore, this comparative study between first medical examination and end of medical treatment with Ljintang-Gamibang and acupuncture was made. The clinical progress of NERD was investigated. After treatment, all seven patients showed improvement in all symptoms associated with NERD, including general condition. The results of this study suggest that Ljintang-Gamibang and acupuncture are an effective treatment for NERD and progressive research to develop a practical treatment of NERD are needed.

• Journal of Oriental Neuropsychiatry
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• v.13 no.1
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• pp.127-132
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• 2002

This case show that emotional stress and wekness of gastrointestinal function occur a chronic hiccup and eructation(during 3 months), oriental medical therapy can cure completely this symptom. Seven emotional stress(anger, delight, sadness, thinking, worry, fear, horror) occur various pathologic changes. Hiccup is caused by CNS, psychologic, thoracic, abdominal factor etc. In oriental medicine, GI trouble regarded as a very importent factor that occur hiccup and eructation. Besides, emotional stress is a very important factor as well. This patient have an introvert personality ordinary times. One day, she had a miscarriage by hers husband's assault. After that time, she suffered from very serious GI trouble(dyspepsia, epigastric pain, anorexia). And then hiccup, eructation, weight loss(10kg/3months) is occured. This patient diagnosed only gastritis. This symptom did not stop during 3 months, regardless of western medical therapy(some western drugs medication, fluid supply etc). After oriental medical therapy(herb medicine;Yukunjatang, acupuncture;CV12, CV6, S36, CV17, H7, SP6, P6, moxibustion;VI2, CV6, S36, negative therapy;back area and traditional oriental medical psychotherapy;ventilation, support, desensitization and family interview) put in operation during 15 days, patient completely recover from hiccup, eructation and anxiety disorders.

• Archives of Plastic Surgery
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• v.37 no.5
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• pp.699-701
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• 2010

Purpose: Mondor's disease is a rare benign condition which involves thrombophlebitis of the superficial veins of the breast and anterior chest wall after breast surgery, breast tissue biopsy, inflammatory reaction, breast cancer, trauma. The affected veins include the lateral thoracic, axillary veins, thoracoepigastric veins and superior epigastric veins. Methods: A 49-year-old woman presented to the outpatient department with complaints of the sudden appearance of a subcutaneous cord just under the skin at left lower lateral abdominal wall 1 month later of bilateral mastectomy due to both severe breast paraffinoma. The cord was initially red and tender and subsequently became a painless, tough, fibrous band that was accompanied by tension and skin retraction. Results: On ultrasonographic findings, palpable threadlike structures at both lateral superficial abdominal wall after bilateral mastectomy were noted. Superficial short elongated hypoechoic tubular structures were noted just under the skin at palpable lower lateral abdominal wall. It was compatible to Mondor's disease of thoracoepigastric vein. Conclusion: The increase in breast surgery will give rise to the increase in the frequency of Mondor's disease clinically. Mondor's disease can be diagnosed with clinical symptoms and image findings and the disease has proved to be benign and self-limited.

• Archives of Plastic Surgery
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• v.41 no.6
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• pp.693-701
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• 2014

Background A thin perforator flap is one of the best methods for covering defects. This study aimed to revisit and further test the rapidly advancing field of flap thinning techniques. Methods We performed two cadaveric studies to test the known flap thinning methods, and then applied these methods to a clinical series. In the first study, five cadavers were used to observe the anatomical relation of the perforator with the subdermal plexuses and the subcutaneous fat layer by injecting a colored latex solution. The second study was done on four cadavers independently from the first study. Last, a clinical series was performed on 15 patients. Results The areolar fat lobules of 10 anterolateral thigh perforator (ALT), seven deep inferior epigastric artery perforator (DIEAP), and six thoracodorsal artery perforator (TAP) flaps were dissected to reduce the flap thickness guided by the colored vascular pattern. On average, the ALT, DIEAP, and TAP flaps were reduced to $32.76%{\pm}9.76%$, $37.01%{\pm}9.21%$, and $35.42%{\pm}9.41%$, respectively. In the second study, the areolar fat lobules were directly dissected in six ALT, six TAP, and four MSAP flaps, and an average reduction in flap thickness of $53.41%{\pm}5.64%$, $52.30%{\pm}2.88%$, and $47.87%{\pm}6.41%$, respectively, was found. In the clinical series, 13 out of the 15 cases yielded satisfactory outcomes with an average thickness reduction of $37.91%{\pm}7.15%$. Conclusions These multiple studies showed that the deep fat layer could be safely removed to obtain a thin yet viable perforator flap. This evidence suggests that the macroscopic flap thinning technique can achieve thin flaps. Surgeons should consider this technique before embracing the latest technique of supermicrosurgery.

• Parasites, Hosts and Diseases
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• v.32 no.1
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• pp.53-56
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• 1994

A case of gastric anisaklasis due to the larva of Pseunotewqnova decipiens was confirmed by gastroendoscoplc examination In April 23, 1991. The patient, residing In Pusan, was a 42-year-old housewife, who complained of severe epigastric pawn and recalled that the symptom suddenly attacked her about 6 hours after eating raw Sebqstes inermis. In the gastroendoscopic examination performed about 9 hours after the onset of the symptom, a long whitish nematode larva penetrating the gastric mucosa in the greater curvature of mid-body was found and removed with a biopsy forcep. The nematode was $29.73{\times}0.94mm$ in size, had an intestinal cecum reaching over mfd-level of the ventnculus and was identified as the 4th stage larva of f decfpiens.

• Parasites, Hosts and Diseases
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• v.33 no.2
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• pp.125-130
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• 1995

A 38-year old man visited a private clinic complaining of epigastric discomfort for 2 months A huge hepatic cyst was found by sonography and computerized tomography. An exploratory Laparotomy was performed under the impression of hydatid disease. The cyst was successfully removed. A lot of living protoscolices of Echinocucur Sranulosus were found from the cystic fluid under light microscopy. During the operation, however. the cyst was accidentally ruptured and the cystic fluid spilled out. The patient was medicated with albendazole, and had been well without any signs of anaphylaxis or recurrence for 1 year follow-up period. He had been in Saudi Arabia for 3 years. This is the 16th case of hydatid disease reported in Korea and a case without immediate complication in spite of rupture of the cyst.

• Journal of Chest Surgery
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• v.28 no.11
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• pp.1032-1037
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• 1995

Between September 1988 and December 1993, 32 cases of benign esophageal stricture, of which 12 males and 20 females, were managed in Seoul National University Hospital hospital. Their age ranged from 2 to 61 years, and the mean age was 33.9 years. The ingestion of caustic agent was the most common cause, and the caustic material was acid in 16 patients [58% and alkali in 11patients [39% . Nearly all of the patients complained of dysphagia, and some of chest pain, epigastric pain, weight loss, vomiting, general malaise, and dyspnea. The most frequent site of stricture was found in the upper thoracic esophagus with 34% incidence followed by the lower thoracic esophagus[28% , whole esophagus[19% , and the mid esophagus[16% . The operations performed were 17[53% ECG[esophagocologastrostomy , 5[16% PCG[pharyngocologastrostomy , 5[16% EG[esophagogastrostomy , 2 EJG [esophagojejunogastrostormy by free jejunal graft , and 1 case each of EJ [esophagojejunostomy , esophageal end to end anastomosis, jejunostomy only, and gastrostomy only. In 23 patients [72% , diseased esophaguses were resected, using transhiatal total esophagectomy in 15 [47% and transthoracic partial esophagectomy in 8 [25% . Of those 23 patients, 3 patients [9.4% were diagnosed as esophageal carsinoma on microscopic examination. The postoperative most common complications were unilateral vocal cord palsy in 6 patients [19% , followed by cervical anastomosis leakage in 4 patients [12.5% , wound infection in 2 patients [6% , and pneumothorax in 2 patients [6% . Late death occurred 8 months after the operation in one patient, which was associated with infection due to anastomotic leakage. Our experience shows that the rate of mortality and the morbidity were low in patients receiving surgical management for esophageal stricture and that the cancer transformation rate was high. We recommend esophageal reconstruction surgery with esophagectomy [transhiatal or transthoracic for the esophageal stricture because it can avoid a chance of prevent cancer transformation.

• Archives of Plastic Surgery
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• v.45 no.5
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• pp.441-448
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• 2018

Background Previously, surveys have been used to investigate breast reconstruction statistics. Since 2015, breast reconstruction surgery after mastectomy has been covered by the National Health Insurance Service in Korea, and data from breast reconstruction patients are now available from the Health Insurance Review and Assessment Service (HIRA). We investigated statistics in breast reconstruction in Korea through statistics provided by the HIRA Big Data Hub. Methods We investigated the number of cases in mastectomy and breast reconstruction methods from April 1, 2015 to December 31, 2016. Data were furnished by the HIRA Big Data Hub and accessed remotely online. Results were tabulated using SAS Enterprise version 6.1. Results The 31,155 mastectomy cases included 7,088 breast reconstruction cases. Implant-based methods were used in 4,702 cases, and autologous methods in 2,386. The implant-based reconstructions included 1,896 direct-to-implant and 2,806 tissue-expander (2-stage) breast reconstructions. The 2-stage tissue-expander reconstructions included 1,624 expander insertions (first stage) and 1,182 expander-to-permanent-implant exchanges (second stage). Of the autologous breast reconstructions, 705 involved latissimus dorsi muscle flaps, 498 involved pedicled transverse rectus abdominis myocutaneous (TRAM) flaps, and 1,183 involved free-tissue transfer TRAM flaps, including deep inferior epigastric perforator free-tissue transfer flaps. There were 1,707 nipple-areolar complex reconstructions, including 1,565 nipple reconstructions and 142 areola reconstructions. The 1-year mean number of breast reconstructions was 4,050. Conclusions This was the first attempt to evaluate the total number of breast reconstruction procedures using accurate, comprehensive data, and our findings may prove valuable as a foundation for future statistical studies of breast reconstruction procedures in Korea.

• Parasites, Hosts and Diseases
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• v.22 no.1
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• pp.66-71
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• 1984

Two cases of human infection by adult Spirometra erinacei were proved by collection of worms in Korea. The patients were 24 and 21-year old males residing in a mountainous village in Kangwon-do. They had the clinical complaints of abdominal pain and epigastric discomfort, revealing the diphyllobothriid eggs, $53~59{\times}37-42{\mu}m$ in size, in their stools. They were treated with 500 mg atabrine and purgated with magnesium salts, and 3~4 hours later several chains of tapeworm segments were recovered from the diarrheal stools. The recovered worms revealed the morphological characteristics of spiral-form or coiled uteri, separated vaginal opening from the cirrus sac, incorporated seminal vesicle into the cirrus sac, distribution of testes at the junction between proglottides, asymmetrical eggs with one pointed eggs, etc. and were identified as Spirometra erinacei (Rudolphi, 1819). The cases had the history of eating raw flesh of the snakes and these are considered the source of infection.