PURPOSE: TRAM flap surgery has settled down as a common method for breast reconstruction after mastectomy. We investigated how TRAM flap surgery influences on the patients' physical movement capability by observing their capability of sit-ups as well as exercises they usually enjoy. METHODS: A total of consecutive 375 patients were investigated who had breast reconstruction with unilateral pedicled TRAM flap surgery at Asan Medical Center from July 2001 to August 2005. The patients were asked to sit up right before the surgery and do it again 6 months later and 1 year later. 221 patients were followed up 6 month after the surgery. And 132 patients were followed up 1 year after the surgery. In addition, 155 patients who used to exercise before the surgery were also asked to show us the change in their physical movement capability one year after their surgery. RESULTS: 139 patients showed decrease in the counted number of sit-ups, 48 increase, and 34 showed no change between 6 months in the first group of 221 patients. Among the second group of 132 patients, 64 showed decrease, 39 increase, and 29 no change a year later. There was a statistical significant decrease in the number of sit-ups between pre-operation and six months later and between pre-operation and one year later. According to the research on the exercise that 155 patients participated, 3 of them showed improvement in athletic ability, 7 showed decrease, while the rest, 145 patients, showed no change at all. CONCLUSION: Considering no difference in usual exercise ability, some patients' increase in the number of sit-ups and the effect of anticancer treatment, we found that the loss of abdominal wall function on this research is not too serious to exclude TRAM flap surgery in the field of breast reconstruction
Abdominal Wall* ; Breast* ; Chungcheongnam-do ; Exercise ; Female ; Humans ; Mammaplasty* ; Mastectomy ; Prospective Studies* ; Sports

PURPOSE: The transverse rectus abdominis myocutaneous(TRAM) flap has become a reliable method for autogenous breast reconstruction. However, dissection of the tendinous intersections of rectus abdominis is technically difficult. The tendinous intersection has significant vascularity within its fascial layers raising in importance of technique in elevation. If tendinous intersections are damaged during the elevation of the rectus muscle, circulation to TRAM flap can be endangered. The purpose of this study is to evaluate the number of tendinous intersections and to predict anatomical position of the tendinous intersections. METHODS: We dissected 182 consecutive TRAM flaps and measured the distance between xiphoid process and each tendinous intersection and evaluated the statistic correlation among the distance, patient's height and position of umbilicus. RESULTS: In this study, in 30.7% of patients, two tendinous intersections were observed in one rectus abdominis muscle, in 67.7% three tendinous intersections, and in 1.6% four tendinous intersections, respectively. But there was no correlation between patient's height and the distance between xiphoid process and each tendinous intersection. CONCLUSION: It still remains difficult to predict the position of tendinous intersections just by topography before the dissection. Careful and meticulous dissection of the tendinous intersections is still required.
Female ; Humans ; Mammaplasty ; Rectus Abdominis* ; Umbilicus

PURPOSE: Although the autogenous tissue transfer has been the mainstay of the breast reconstruction, concern for the donor site morbidity can lead to the superseded method using tissue expander with implant or permanent expander-implant. However, the additional procedure of tissue expansion possibly cause discomfort and raise the cost. We tried to verify the efficacy of using the saline-filled breast implant by itself for the safe and convenient immediate breast reconstruction modality if the patients have small, round and non-ptotic breasts and the sufficient breast skin can be saved with mastectomy. METHODS: From July 2002 to July 2005, 29 breasts of 26 patients were restored only with the saline-filled breast implant immediately after the skin sparing or nipple-areolar skin sparing mastectomy in Asan Medical Center. A pocket with pectoralis major and serratus anterior muscle was created and the implant was covered with this muscle pocket. Simultaneous contralateral augmentation was performed in patients whose mastectomy specimen weighed less than 100g. RESULTS: Using only the saline-filled breast implant resulted in the successful reconstruction with few complications including partial necrosis of nipple areolar skin (five cases, 17.2%), capsular contracture (three cases, 10.3%), hematoma (one case, 3.4%), depigmentation of areolar skin (one case, 3.4%), hypertrophic scar (one case, 3.4%), which were all healed by conservative management. There were no significant complications such as implant exposure and subsequent removal. CONCLUSION: Immediate breast reconstruction only with the saline-filled breast implant can be a satisfactory alternative option for the patients whose breast is small, round and non-ptotic, especially when the nipple-areolar skin of the breast is preserved in the mastectomy.
Breast Implants* ; Breast* ; Chungcheongnam-do ; Cicatrix, Hypertrophic ; Contracture ; Female ; Gynecomastia ; Hematoma ; Humans ; Male ; Mammaplasty* ; Mastectomy ; Mastectomy, Subcutaneous ; Necrosis ; Nipples ; Skin ; Tissue Donors ; Tissue Expansion Devices ; Tissue Expansion*

BACKGROUND: As the elderly population increases, elderly patients visiting emergency departments (ED) with acute abdominal pain will also likely increase. The underlying causative diseases in these older patients are different from younger patients, usually more serious. Thus, correct diagnosis is very important, but difficult. There needs to be a better understanding of the characteristics of the elderly patient with acute abdominal pain seen in the ED. METHODS: We retrospectively reviewed the medical records of 98 elderly patients (>or=65 years) and 109 adult controls (<65 years) visiting an ED at one general hospital looking at the final diagnoses, characteristics of abdominal pain, admissions, and surgeries. RESULTS: Hepatobiliary tract diseases and bowel obstruction were more common in the elderly patients. The elderly had more admissions and surgeries than younger patients. In addition, they were more likely to have a fatal disease such as myocardial infarction. CONCLUSION: There is a difference in the underlying diseases causing acute abdominal pain in the elderly patients versus younger patients. In terms of frequency of admission and surgery, the elderly present with more serious and fatal diseases. We must consider these features when seeing an elderly patient with acute abdominal pain in an ED.
Abdominal Pain ; Adult ; Aged ; Emergencies ; Hospitals, General ; Humans ; Medical Records ; Myocardial Infarction ; Retrospective Studies

OBJECTIVE: To determine risk factors of orthostatic hypotension in ischemic stroke patients. METHOD: In 98 ischemic stroke patients, blood pressure and heart rate were measured after resting in the supine position for 10 minutes and again after standing for one minute. Presence of orthostatic hypotension was correlated with age, gender, body mass index, laboratory findings, diabetes mellitus, anti-hypertensive use, side of involved hemisphere, smoking and K-MBI (Korean Modified Barthel Index). RESULTS: 30 out of 98 patients had orthostatic hypotension. Those patients with orthostatic hypotension were older in age and had a higher average blood pressure, heart rate and plasma creatinine. On the other hand, body mass index, K-MBI and serum sodium levels were lower in the orthostatic hypotension group. Multivariate analysis revealed that age, body mass index, anti-hypertensive use and smoking were independently associated with orthostatic hypotension. CONCLUSION: Old age, low BMI, anti-hypertensive use, smoking were risk factors of orthostatic hypotension in the ischemic stroke patients. Patients in the higher risk categories should receive regular monitoring of blood pressure in order to detect orthostatic hypotension and prevent its complications.
Blood Pressure ; Body Mass Index ; Creatinine ; Diabetes Mellitus ; Hand ; Heart Rate ; Humans ; Hypotension, Orthostatic* ; Multivariate Analysis ; Plasma ; Risk Factors* ; Smoke ; Smoking ; Sodium ; Stroke* ; Supine Position

PURPOSE: Skin-sparing mastectomy(SSM) with immediate breast reconstruction is becoming a proved option for early-stage breast cancer patients. Recently, skin-sparing mastectomy with preserving the nipple- areolar complex is becoming popular procedure. METHODS: During a 13-month period, from April 2004 to January 2005, 101 cases of immediate breast reconstructions with pedicled TRAM flap were performed after 40 cases of nipple-areolar sparing mastectomies, 57 cases of skin-sparing mastectomies and 4 cases of modified radical mastectomies. RESULTS: During the 11 months follow up period, necrosis of mastectomy skin flap occurred in 17.5% (n=10) after skin-sparing mastectomy and necrosis of mastectomy skin flap and nipple-areolar necrosis occurred in 30%(n=12) after nipple-areolar sparing mastectomy. These complications were healed after simple dressing without any surgical procedure. CONCLUSION: Nipple-areolar sparing mastectomy and immediate breast reconstruction with TRAM flap is good option for early breast cancer patients and some modifications are needed to reduce skin necrosis.
Bandages ; Breast Neoplasms ; Breast* ; Female ; Follow-Up Studies ; Humans ; Mammaplasty* ; Mastectomy* ; Mastectomy, Modified Radical ; Necrosis ; Skin

INTRODUCTIONThe aim of this study was to investigate the clinical efficacy and safety of laparoscopic appendectomy (LA) during pregnancy by comparing the operative and obstetric outcomes of patients who during pregnancy underwent LA performed by an expert gynaecologic laparoscopist (LA group) with those patients who underwent an open appendectomy (OA) by a general surgeon (OA group).

MATERIALS AND METHODSIn this retrospective study, we evaluated all patients consecutively who had undergone appendectomy for acute appendicitis during pregnancy from January 2000 to December 2010. Twenty-eight patients underwent OA and 15 were treated by LA. We reviewed the clinical charts and analysed the data for each patient's age, parity, body mass index, gestational age at appendectomy, type of appendectomy, operating time, haemoglobin change, hospital stay, histopathological results, postoperative analgesics, complications, and obstetric outcomes.

RESULTSThere were no significant differences between the OA and LA groups in terms of clinical characteristics, hospital stay, haemoglobin change, return of bowel activity, complication rates, gestational age at delivery, and birth weight. However, there were significantly shorter operating time and less usage of postoperative analgesics in LA group.

CONCLUSIONLA performed by an expert gynaecologist can be a safe and effective method for treating acute appendicitis during the first and second trimester of pregnancy.

Adult ; Appendectomy ; adverse effects ; methods ; standards ; Appendicitis ; surgery ; Female ; Humans ; Laparoscopy ; Pregnancy ; Pregnancy Complications ; Republic of Korea ; Retrospective Studies ; Treatment Outcome ; Young Adult

PURPOSE: Sargassum horneri (S. horneri) is a species of brown macroalgae that is common along the coast of Japan and Korea. The present study investigated the immuno-modulatory effects of different types of S. horneri extracts in RAW264.7 macrophages. METHODS: S. horneri was extracted by three different methods, hot water extraction, 50% ethanol extraction, and supercritical fluid extraction. Cell viability was then measured by MTT assay, while the production levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and nitric oxide (NO) were measured by enzyme-linked immunosorbent assay and Griess assay, respectively. The expression and activation levels of inducible NO synthase (iNOS), mitogen-activated protein kinase (MAPK) and nuclear factor κB (NF-κB) were examined by western blot analysis. RESULTS: The three different S. horneri extracts were nontoxic against RAW 264.7 cells up to 50 µg/mL, among which treatment with hot water extract (HWE) of S. horneri significantly enhanced the production of TNF-α, IL-6, and NO in a dose-dependent manner. Hot water extract of S. horneri also increased the expression level of iNOS, suggesting that up-regulation of iNOS expression by HWE of S. horneri was responsible for the induction of NO production. In addition, treatment of RAW 264.7 macrophages with HWE of S. horneri increased the phosphorylation levels of ERK, p38 and JNK. Furthermore, the activation and subsequent nuclear translocation of NF-κB was enhanced upon treatment with HWE of S. horneri, indicating that HWE of S. horneri activates macrophages to secrete TNF-α, IL-6 and NO and induces iNOS expression via activation of the NF-κB and MAPKs signaling pathways. CONCLUSION: Taken together, these findings suggest that HWE of S. horneri possesses potential as a functional food with immunomodulatory activity.
Blotting, Western ; Cell Survival ; Chromatography, Supercritical Fluid ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Ethanol ; Functional Food ; Interleukin-6 ; Japan ; Korea ; Macrophages* ; Necrosis ; Nitric Oxide ; Nitric Oxide Synthase ; Phosphorylation ; Protein Kinases ; RAW 264.7 Cells ; Sargassum* ; Seaweed ; Up-Regulation ; Water

OBJECTIVE: To determine the time period and factors inhibiting recovery of orthostatic hypotension during head up tilt with ischemic stroke patients. METHOD: Fourty two ischemic stroke patients with orthostatic hypotension were included. Blood pressure and heart rate were taken after resting in the supine position for 10 minutes and again after standing for one minute every week. Age, gender, body mass index, laboratory findings, diabetes mellitus, anti-hypertensive use, side of involved hemisphere and K-MBI were obtained. RESULTS: The numbers of orthostatic hypotension patients were significantly decreased at 3rd week. Non recovering group until 3rd week were older in age and had higher plasma creatinine level. On the other hand, body mass index and K-MBI were lower than the group without orthostatic hypotention. Multivariate analysis revealed that age, body mass index, anti-hypertensive medication were independently associated factors for resistant orthostatic hypotension during head up tilt. CONCLUSION: For 7 weeks, especially at 3rd week, the numbers of orthostatic hypotension patients significantly decreased. Age, BMI, and antihypertensive medication were inhibitiing factors for recovery of orthostatic hypotension.
Blood Pressure ; Body Mass Index ; Creatinine ; Diabetes Mellitus ; Hand ; Head ; Heart Rate ; Humans ; Hypotension, Orthostatic ; Multivariate Analysis ; Plasma ; Stroke ; Supine Position

Purpose: To evaluate the reliability and validity of the Cataract-related Visual Function Questionnaire (CVFQ). Methods: A prospective cross-sectional study of 141 cataract patients was conducted from March 2022 to June 2022. The questionnaire was created based on a literature review and advice from an expert panel. This study determined its construct validity, criterion validity, internal consistency, and test-retest reliability. Results: The CVFQ consists of 15 items distributed among five categories: overall visual quality, overall visual function, distance vision, near vision, and glare. In the exploratory factor analysis of validity, the first three principal components explained 77.8% of the variance. The p-values in the Spearman correlation test comparing the pre- and postoperative total CVFQ score and best-corrected visual acuity (BCVA) were 0.006 and 0.004, respectively. In the reliability analysis, Cronbach’s alpha was > 0.9 for internal consistency and the p-values of each subcategory were all significant in the analysis of test-retest reliability. Conclusions Our results indicate that the CVFQ is useful for measuring the visual quality and visual function of cataract patients in Korea.