• Archives of Reconstructive Microsurgery
• /
• v.19 no.1
• /
• pp.56-60
• /
• 2010

Purpose: Breast reconstruction with abdominal flap has many advantages. However, it might cause abdominal complications such as bulging or hernia. SIEA (Superficial inferior epigastric artery) flap is the most advanced form of abdominal flap which has no adverse effect on abdominal fascia. We report 2 cases of breast reconstruction with SIEA flap with reference review. Methods: From Jun 2006 to Jan 2009, 110 patients underwent breast reconstruction with free abdominal flap. We tried to find the SIEA in every cases and adopted SIEP flap if the diameter was larger than 1mm and it had visible pulsation. 2 patients underwent breast reconstruction with SIEA flap. After design of abdominal flap SIEA was investigated with portable Doppler. SIEA was usually found 4-5 cm lateral to the midline. Flap was elevated with SIEA and SIEV to their maximal length at hiatus. Results: There were no complications, such as infection, hematoma, and necrosis of flap. In both cases, flaps survived completely with excellent vascularity and breast reconstruction was successful. In one case, there was skin necrosis of mastectomy flap, and it was healed by conservative management. Conclusion: With the SIEA flap, donor site morbidity can be minimized along with reduction of operation time. If there is reliable SIEA, SIEA flap would be the preferred skills. However, the limitation of the SIEA flap is difficulty in identifying the SIEA. The reason for less availability of the flap in Korea might include high prevalence of the Caesarian section scar and relatively higher level of the lower margin of the flap.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.3 no.1
• /
• pp.89-92
• /
• 2000

Acute gastric volvulus is uncommon but surgically emergent. Normally, the stomach is held in position by four ligaments: gastrophrenic, gastrohepatic, gastrosplenic, and gastrocolic. In addition, relative fixation of the pylorus and esophagus provides further anchorage. A normal diaphragm also helps to prevent abnormal displacement of abdominal viscera and development of gastric volvulus. Volvulus may be organoaxial, mesenteroaxial, or a combination of both. Organoaxial volvulus is the rotation of the stomach around an axis extending from the hiatus of the diaphragm to the pylorus. Mesenteroaxial volvulus is the rotation of the stomach around an axis transecting the lesser and greater curvatures of the stomach. The symptoms of gastric volvulus depend on its type, the extent and degree of rotation and obstruction, and associated defects. Classic clinical features of acute gastric volvulus, as by Borchardt in 1904, include unproductive retching, acute, localized epigastric distention, and the inability to pass a NG tube. The presence and severity of these features depend on the degree of gastric obstruction of both the gastroesophageal junction and pyloric outlet. It may be suspected on plain abdominal radiographs and usually confirmed by upper gastrointestinal series. Acute volvulus requires immediate surgical repair, fixation to avoid recurrence, and correction of any underlying anatomic abnormality. Any associate defect should be repaired and the stomach must be fixed. The authors report a case of an 3-year-old girl who had a mesenterioaxial gastric volvulus.

• Atmosphere
• /
• v.20 no.3
• /
• pp.261-271
• /
• 2010

Carbon isotopic compositions of the YC-2 stalagmite in Yongcheon Cave were analyzed to delineate paleoclimatic variations near Korean peninsula for the past historical period. The YC-2 stalagmite is about 68 mm long and annual growth laminae are distinctively identified. Because the number of growth laminae is at least 242, the stalagmite can be estimated to be at least 241 years old. At about 15 mm from the bottom, one thick brown growth lamina is observed, and this lamina was likely to have been formed when the stalagmite ceased to grow, making the hiatus. High resolution, carbon isotope data indicate past fluctuations of East Asia monsoonal intensity (intimately related to the amount of precipitation). Based on the carbon isotope trend, the stalagmite can be divided into three stages (Stages I, II and III). The highest carbon isotopic compositions of Stage I (${\delta}^{13}C$=-3.3~0.4‰, PDB) indicate that the stalagmite grew during the Little Ice Age when cold and dry climate prevailed with less vegetation. Stage II is characterized by a transitional period from cold and dry to warm and wet climate with a increasing trend of carbon isotopic compositions (${\delta}^{13}C$=-9.6~-0.6‰) and this period indicates the weakening of the Little Ice Age climate. This decreasing trend also suggests that Little Ice Age was terminated near middle 1870's around Korean peninsula. Relatively low carbon isotopic compositions during Stage III (${\delta}^{13}C$=-11.0~-8.0‰) indicates that the climate was changed to warm and wet conditions which are similar to the present.

• The Korean Journal of Pain
• /
• v.10 no.2
• /
• pp.214-219
• /
• 1997

Background: Epidural neural blockade with local anesthetics combined with steroids has been in clinical trials for patients with low back pain. But pain treatment of low back pain remains somewhat problematic. Many patients with low back pain have epidural fibrosis and adhesions proved with magnetic resonance imaging(MRI) examination. These findings might play an important role in the origin of back pain. Present study was aims to investigate the effect of epidural adhesiolysis in patients with low back pain. Methods: We investigated 76 patients suspected with epidural fibrosis and adhesion was suspected. Nerve pathology was demonstrated and epidural fibrosis suspected or proved with MRI examination. 17G needle specially designed by Racz was inserted at sacral hiatus and catheter was inserted untill its tip was located at lesion site under fluoroscopic guidance. Injection of contrast dye was achieved and prospected spread of agents. Injection of 0.25% bupivacaine, triamcinolone, and 10% hypertonic saline via catheter were carried out daily for 3 days. Evaluation included assessment of pain relief (Numerical Rating Scale; NRS) post-epidural adhesiolysis 3 days, 1 week, and 3 months. We also looked for complication of epidural adhesiolysis. Results: Statistical analysis(Friedman nonparametric repeated measures test and Dune's multiple comparison test) demonstrated NRS was significantly less during 3 months after epidural adhesiolysis(P<0.05). Especially, there is a extremely significance in post-epidural adhesiolysis 3 days (P<0.001). Only four patients reported any complications the most common symptom among three persistent headache but disappeared after a few months without residual sequelae. Conclusion: We conclude epidural adhesiolysis is a safe and effective method of pain therapy for low back pain with proven lumbo-sacral fibrosis and adhesion. A direct visualization by epiduroscopy may be more useful to the resulting functional changes after epidural adhesiolysis.

• Economic and Environmental Geology
• /
• v.37 no.2
• /
• pp.255-267
• /
• 2004

Deep-sea surface sediments acquired by multiple corer from 69 stations in the Clarion-Clipperton fracture zone of the northeast equatorial Pacific, were analyzed for shear strength properties to understand sedimentological process. The pelagic red clay from northern part of study area shows low average shear strength(4.4 kPa), while the siliceous sediment from middle area shows high(6.3 kPa). The calcareous sediment from southern area shows very low average shear strength(3.4 kPa), and transitional sediment between middle and southern area shows intermediate value(3.8 kPa) between siliceous and calcareous sediment. The depth profiles of average shear strength of pelagicred clay show gradual increment with depth due to decrease of water content with depth by general consolidation process. On the other, abrupt increment of average shear strength with depth in siliceous sediment is related to sedimentary hiatus. The very low shear strength in calcareous sediment is linked to very high sedimentation rate ofsouthern area compared with other study area.

• Journal of Veterinary Clinics
• /
• v.18 no.3
• /
• pp.269-272
• /
• 2001

Fourteen dogs referred to veterinary Medical Teaching Hospital, Seoul National University were diagnosed as esophageal foreign body (9 cases), megaesophagus (4 cases) and esophageal stricture (1 case). Patients showed a variety of clinical signs including regurgitation, vomiting, anorexia, hypersalivation, and retching. Survey radiographic examination included the entire esophagus, including the caudal pharynx and cranial abdomen. contrast radiographs were done to identify lesions or to characterize abnormal radiographic findings on survey films. In case static contrast studies were not sufficient were not sufficient to differentiate the diseases, dynamic fluoroscopic studies were performed. In thoracic megaesophagus, when gas filled, it provided several hallmark findings such as visualization of paired longus colli muscle and tracheal stripe sign. When gas-distended, the caudal thoracic esophagus was seen as a pair of thin, soft-tissue stripes that converged into a point overlying the diaphragm and cranial abdomen. All cases of megaesophagus could be solely identified by survey radiographs. In esophageal foreign body, 6 cases out of 9 patients had the history of having foreign body and others not. Most of esophageal foreign body could be diagnosed on survey radiographs and one case with radiolucent foreign body was confirmed by esophagram. It appeared as radiopaque material along the path of esophagus and the radiopacity was determined by its nature. Obstruction caused by foreign body eventually led to dilation of the esophageal lumen cranial to the site in 3 cases. In esophageal stricture, there was no remarkable findings on survey radiograph of the thorax. However, esophagography with barium sulfate showed the narrowing of the esophagus near hiatus. On fluoroscopy, swallowed barium was stagnated cranial to the site despite the esophageal peristalsis.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.2 no.2
• /
• pp.211-216
• /
• 1999

The esophageal hiatal hernia is a herniation of an abdominal organ, usually the stomach, through the esophageal hiatus into thoracic cavity. It is a rare disease, usually congenital and frequently associated with gastroesophageal reflux and other congenital malformations in children. It is classified according to their anatomic characteristics as type I (sliding hiatal hernia), type II (paraesophageal hiatal hernia), type III (combined hiatal hernia) and type IV (multiorgan hiatal hernia). We experienced a case of type III congenital esophageal hiatal hernia simulating chest mass on simple chest x-ray because of right intrathoracic stomach secondary to congenital esophageal hiatal hernia and organoaxial rotation in 10 months male. After the operation, he showed an improved general condition and was discharged at the 14th hospital day. We report the case with the brief review of the related literatures.

• Atmosphere
• /
• v.28 no.4
• /
• pp.415-425
• /
• 2018

The roles of atmospheric heating formation and distribution on the global circulation are of utmost importance, and those are directly related to not only spatial but also temporal characteristics of monsoon system. In this study, before we clarify the characteristics of apparent heat source <$Q_1$> and moisture sink <$Q_2$>, comparisons of three reanalysis datasets (NCEP2, ERA-Interim, and JRA-55) in its global or regional patterns are performed to clearly evaluate differences among datasets. Considering inter-hemispheric difference of global monsoon regions, seasonal means of June-July-August and December-January-February, which is summer (winter) and winter (summer) in the Northern (Southern) Hemisphere are employed respectively. Here we show the characteristics of eight different regional monsoon regions and find contributions of <$Q_2$> to <$Q_1$> for the regional monsoon regions. Each term in apparent heat source and moisture sink is shown to come from the ERA-Interim dataset, since the ERA-Interim could be representative of three datasets. The NCEP2 data has a different characteristic in the ratio of <$Q_2$> and <$Q_1$> because it overestimates <$Q_1$> compared to the other two different datasets. The Australia monsoon has been performing better over time, while some regional monsoons (South America, North America, and North Africa) have been showing increasing data inconsistency. In addition, the three reanalysis datasets are getting different marching with time, in particular since the early 2000s over South America, North America, and North Africa monsoon regions. The recent inconsistency among the three datasets that may be associated with the global warming hiatus remains unexplored.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.36 no.2
• /
• pp.253-261
• /
• 2009

The purpose of this study was to present new data on the timing and sequence of permanent teeth emergence and to compare these findings with the results of earlier studies. The dental examinations had been performed to E-elementary school students, who visited the Yonsei University Dental Hospital between 1998 and 2005; 1,307 boys and 1,312 girls with the age ranging from 6 to 12 years old. The followings were concluded. 1. Eruption time of the maxillary permanent teeth is as follows. It was 6.81 years in male and 6.73 years in female for the central incisor, 7.78 years in male and 7.65 years in female for the lateral incisor, 10.48 years in male and 9.92 years in female for the canine, 9.76 years in male and 9.63 years in female for the first premolar, 10.66 years in male and 10.49 years in female for the second premolar, 6.39 years in male and 6.26 years in female for the first permanent molar, and 12.13 years in male and 12.03 years in female for the second permanent molar. 2. Eruption time of the mandibular permanent teeth is as follows. The central incisor could not be determined in this study, but it is assumed to erupt before the age of 6.08. In the mandible, eruption time was 6.78 years in male and 6.65 years in female for the lateral incisor, 9.76 years in male and 9.05 years in female for the canine, 9.82 years in male and 9.59 years in female for the first premolar, 10.67 years in male and 10.52 years in female for the second premolar, 6.22 years in male and 6.12 years in female for the first permanent molar, and 11.58 years in male and 11.14 years in female for the second permanent molar. 3. The eruption sequence is as follows. In the maxilla, the first permanent molar erupted first, followed by the central incisor, the lateral incisor, the first premolar, the canine, the second premolar, and the second permanent molar. In the mandible, the central incisor erupted first, followed by the first permanent molar, the lateral incisor, the canine, the first premolar, the second premolar, and the second permanent molar. 4. Tooth eruption occurred earlier in female compared to male by average of 0.19 year in the maxilla and 0.29 year in the mandible. 5. In both male and female, the hiatus (interval of rest) occurred between the emergence of lateral incisor and first premolar in the maxilla while it was observed between the lateral incisor and canine in the mandible. Male had a hiatus of 1.98 years in the maxilla and 2.90 years in the mandible, while the female's were 1.98 years and 2.40 years, respectively.

• Advances in pediatric surgery
• /
• v.17 no.2
• /
• pp.170-178
• /
• 2011

Hiatal hernia is a very rare disease in the pediatric population. However information from our esophageal atresia postoperative follow-up program has hypotheses; "Hiatal hernia may more frequently occur in postoperative esophageal atresia patients (EA group) than in the general pediatric population (GP group)" and "The tension on the esophagus after esophageal anastomosis may be an important etiologic factor of hiatal hernia in EA group". To prove the first hypotheses, we compared the incidence of hiatal hernia in the GP group with the incidence in the EA group. The Incidence in the GP group was obtained from national statistic data from Statistics Korea and Health Insurance Review and Assessment Service of Korea. The incidence in the EA group was obtained from the medical record and the imaging studies of our esophageal atresia postoperative follow-up program. To prove the second hypothesis, the presumptive risk factors for the development of hiatal hernia in EA group, such as the type of esophageal atresia, degree of esophageal gap, the stage operation and the redo-operation with resection and re-anastomosis of esophagus were analyzed statistically. The total number of patients in the EA group was ninety-nine and there were 5 hiatus hernias. The incidence of EA group (5 %) is significantly higher than incidence of GP group (0.024 %). (p=0.0001) The statistical analysis of the presumptive risk factors for hiatal hernia development in EA group failed to show any evidence of correlation between postoperative esophageal tension and the hiatal hernia. This study shows that the postoperative patients with esophageal atresia have high occurrence of hiatal hernia and should be followed up carefully to detect hiatal hernia.