• Clinical Pain
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• v.16 no.1
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• pp.20-25
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• 2017

Objective: To find that the patients who conducted home self-exercise in conjunction with intra-articular corticosteroid injection will have better improvement in subacromial subdeltoid (SASD) bursitis symptoms than those who received only an injection. Method: A prospective, nonrandomized, comparison study was conducted in outpatient rehabilitation clinic in a tertiary university hospital. Patients diagnosed with SASD bursitis with physical examination and ultrasound evaluation were included and received ultrasound guided injection (UGI). Patients were divided into two groups according to the compliance of self-exercise: UGI-exercise group and UGI only group. Visual analog scale (VAS) was checked before, at 3 weeks, 3 months, and 6 months after the UGI. A patient's global impression of change (PGIC) survey was made at 3 months after the UGI. Results: A total of 82 patients with SASD bursitis were included. At 3 weeks after the injection, the mean VAS for the UGI-exercise group was 2.6 ± 1.7 and for UGI only group was 1.9 ± 1.3 (p=0.030). At 3 months after the injection, the mean VAS for the UGI-exercise group was 4.0 ± 1.3 and for UGI only group was 5.4 ± 1.4 (p<0.001). Conclusion: We concluded that home-based self-exercise of the shoulder provides an additional benefit for pain alleviation possibly with prolonging the effect of injection in SASD bursitis.

• Clinical Pain
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• v.18 no.2
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• pp.76-81
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• 2019

Objective: To examine (1) the degree of reduction of passive range of motion (PROM) on the affected side compared to that on the unaffected side and (2) the degree of increase in PROM following intra-articular corticosteroid injection (IACI) in patients with frozen shoulder. Method: The medical records of 120 patients with frozen shoulder were retrospectively reviewed. PROM of the unaffected and affected shoulder (flexion, extension, abduction, internal rotation, external rotation) was compared, and changes in PROM of the affected shoulder after a single IACI (triamcinolone 20 mg) were evaluated after 12 weeks. Results: At the time of diagnosis, PROM of the affected shoulder was most limited in external rotation, followed by internal rotation, abduction, extension, and flexion, compared to that of the unaffected shoulder. Compared to before IACI, PROM of external rotation demonstrated the greatest increase compared to all the other movements after IACI. Conclusion: Limitation in PROM of the frozen shoulder at the time of diagnosis was greatest for external rotation. Moreover, external rotation experienced the greatest improvement after IACI. Our findings should help to further clarify the clinical characteristics of frozen shoulder, aid in its diagnosis, and allow the prediction of the effects of IACI.

• Clinical and Experimental Pediatrics
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• v.49 no.7
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• pp.726-731
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• 2006

Purpose : We reported previously that intramuscular ketamine with adjunctive midazolam is more effective than ketamine alone in pediatric procedural sedation, but with limited satisfactory sedation by suboptimal ketamine dose. The optimal dose of intramuscular ketamine in children has never been studied in Korea. In this study, we investigated the effectiveness and adverse events of ketamine 4mg/kg with adjunctive midazolam in pediatric laceration repair. Methods : From Jan. 2005 to July 2005, we enrolled 60 children, aged 3 months-7 years, who needed laceration repair under sedation. After verbal consent from parents, patients were randomly assigned to KMA group(IM ketamine 4 mg/kg＋atropine 0.01 mg/kg＋intramuscular midazolam 0.05 mg/kg) or KA group(without midazolam). We compared both groups with the induction time, recovery time, total sedation time, efficacy of sedation, adverse effects, and the satisfaction score of treating physicians. Results : Potentially confounding variables, age, weight, injury site and anxiety score, were similar between groups. The induction time, recovery time and total sedation time were not different statistically. In KMA group, 90.9 percent of patients showed satisfactory sedation compared to 66.7 percent of KA group(P=0.02) and the occurrence rate of significant adverse effect was 0.0 percent and 37.0 percent respectively. Conclusion : We found adjunctive midazolam with ketamine doses of 4 mg/kg IM produced more effective, satisfactory sedation and less adverse effect than without midazolam in pediatric laceration repair. The emergence phenomenon(agitation during recovery) only occurred in 9 KA group patients. In spite of adverse effect, all patients recovered, were discharged and there were no reported delayed events.

• Journal of Oral Medicine and Pain
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• v.30 no.1
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• pp.131-140
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• 2005

The purpose of this study was to examine the ablation rate of Er: YAG laser irradiation on dentin and enamel and to observe the microscopic structures of cavities formed after ablation of enamel and dentin in using a bur and cavities formed after ablation using laser. Er:YAG laser irradiated at 200 mJ, 250mJ, 300mJ at the frequency of 20Hz, 15Hz. The following results were obtained : 1. The ablation rate of dentin groups at power of 3 W-6 W was about $1.103{\sim}2.639mm^3/sec$ and there were no significant differences between power of 4.5 W$\sim$6 W. 2. The ablation rate of enamel groups at power of 3 W-6 W was about $0.413{\sim}0.969mm^3/sec$ and there were no significant differences between power of 4 W$\sim$6 W. 3. With SEM examination of the cavity surface treated with the conventional high speed bur revealed relatively flat appearance almost covered with a debris like smear layer. 4. With SEM examination of the lased surface of dentin groups revealed no smear layer and no debris and openings of dentinal tubules were clearly opened. But the lased surfaces of the groups over 3 W were irregular and particles were loosely attached on it. 5. With SEM examination of the lased surface of enamel groups revealed severely destructed surface at the 6 W group and melting drop materials at the 3 W group. But the lased surface of 4 W group revealed clearly ablated surface. Therefore when cutting teeth using Er:YAG laser, the lasing power which can make effective ablation rate and minimize the thermal effect could be 3W at dentin and 4W at enamel. But, further studies and additional data collection will be necessary for appropriate lasing condition of Er:YAG laser.

• The Journal of Korean Physical Therapy
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• v.10 no.1
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• pp.1-6
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• 1998

The purpose of this study was to determine the of effective concentration of procaine iontophoresis for durarion of cutaneous local anesthesia. Forty-five healthy students with an age range of 19 to 34 years$(21\pm2.7)$, were participated in this study. The subjects were randomly assigned into 5 groups. Bach 9 subjects received iontophoresis on the flexor surface of dominant forearm with soft cotton pad $(3.5\times3.5cm)$ soaked in 2ml of $2\%$ (pH 5.28), $4\%$ (pH 5.12), $8\%$ (pH 4,98), $16\%$ (pH 4.72), $32\%$ (pH 4.52) procaine hydrochloride solution at 4mA for 10 minutes (total current 40mA min) using anodal direct current. The study was performed in a randomized, double-blind design, After procaine iontophoresis, the duration of anesthesia were evaluated at five minute intervals on five random locations in the iontophoretically area using a 21-gauge sterile hypodermic needle pressed with 1mm invagination unitl sharp pin-pricking pain sensation returned. The data were analyzed with one-way ANOVA to determine significant differences between groups. Duncan post hoc was performed at level .01. The relationship between anesthetic duration and procaine concentration was assessed with Pearson Product-Moment Correlation Coefficients. ANOVA tests showed significant differences in the anesthetic duration between the concentration of procaine solution (p<.001). Procaine iontophoresis with $4\%$ concentration produced cutaneous Socal anesthesia of significantly longer duration(15.56 min) than iontophoresis with $2\%,\;8\%,\;16\%$, and $32\%$ of procaine GCl(p<.01). Whereas the anesthetic duration had no correlation with concentration of procaine solution (r=-0.41, NS). These results support the $4\%$ procaine solution was an effective concentration of iontophoresis for induced cutaneous local anesthesia.

• Journal of Oral Medicine and Pain
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• v.24 no.4
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• pp.397-410
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• 1999

In order to obtain the basic data concerning the optimal parameters in using Nd:YAG laser as a therapeutic modality to dentinal hypersensitivity, the author prepared 3 sections of sound dentin and 10 sections of sclerotic dentin with thickness of $0.5mm{\pm}0.1mm$ from human extracted teeth of anteriors and premolars, and applied the laser energy from a fiberoptic delivered, free running, pulsed Nd:YAG laser (wavelength 1064nm, pulse duration $120{\mu}sec$, fiber diameter $320{\mu}m$) to surfaces of sound and sclerotic dentin sections for 1 second with contact/unidirectional moving mode of the fiber under speed of 3mm~4mm/sec and parameters of 0.5W/10Hz, 1.0W/10Hz, 1.5W/10Hz, 2.0W/10Hz: $62J/cm^2$, $124J/cm^2$, $187J/cm^2$, $249J/cm^2$. The author comparatively evaluated the characteristics of ultrastructural changes on surfaces of sound and sclerotic dentin sections irradiated by the pulsed Nd:YAG laser using the scanning electron microscopy. A fairly ill-defined bordered surface of partially closed and melted dentinal tubules can be seen on the scanning electron microscopic feature of the sound dentin surface irradiated by the pulsed Nd:YAG laser with energy density of $62J/cm^2$. The physical modification of sound dentin surface extensively occurred depended on the increase of energy density from $62J/cm^2$ to $124J/cm^2$, $187J/cm^2$, $249J/cm^2$. While, a fairly well-defined bordered surface of partially closed and melted dentinal tubules with thickened peritubular dentin can be seen on the scanning electron microscopic feature of the sclerotic dentin surface irradiated by the pulsed Nd:YAG laser with energy density of $62J/cm^2$. The physical modification of sclerotic dentin surface of a fairly rough, shallow depression with many cracks, thickened peritubular dentin and structureless dentinal tubules extensively occurred depended on the increase of energy density from $62J/cm^2$ to $124J/cm^2$, $187J/cm^2$, $249J/cm^2$ compared to those of sound dentin surface irradiated by the pulsed Nd:YAG laser under the same parameters. Therefore, it is recommended that the pulsed Nd:YAG laser as a therapeutic modality to dentinal hypersensitivity should be applied with the less energy density than $62J/cm^2$ on the sound dentin surface, and its energy density on the partially sclerotic dentin surface should be lower than that on the sound dentin surface to preserve tooth from unnecessary excessive structural destruction.

• Pediatric Infection and Vaccine
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• v.8 no.2
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• pp.160-167
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• 2001

Purpose : To assess the immunogenicity, safety, and tolerability of hepatitis A vaccine ($VAQTA^{TM}$) in healthy children and adolescents. Methods : Eligible subjects aged 2 to 17 years received 25 U/0.5 mL of $VAQTA^{TM}$ intramuscularly at 0 and 24 week schedule. Bleeds were obtained prior to vaccination and 4 weeks after the second dose to ascertain serostatus. To detect antibody to HAV after vaccination with an inactivated HA vaccine, a modification of the $Abbott^{(R)}$ HAVAB kit was used. Sample with titers ${\geq}10$ mIU/mL were considered seroconverted. Adverse experiences were monitored. Results : 102 subjects(54 male, 48 female) were enrolled. The mean age was $6.8{\pm}3.5$ years. Two subjects were seropositive, two were lost of follow up. 88 subjects were available for a per protocol analysis and 90 for all subjects with serology after the second dose, and ten withdral. All subjects(95% CI, 94.8~100) seroconverted. Geometric mean titers was 7,991.1(95% CI, 6,481.1~9,852.7) with very little difference in per protocol analysis and all subjects analysis. Adverse experiences to $VAQTA^{TM}$ were generally mild and transient. Conclusion : The pediatric two-dose regimen of $VAQTA^{TM}$ was found to be highly immunogenic, generally well tolerated and resulted in 100% seroconversion. Regarding Korea is in transition from a high to low risk region resulting in a paradox increase of clinical disease and disease burden, routine vaccination should be considered in order to control hepatitis A effectively.

• The Korean Journal of Pain
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• v.5 no.2
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• pp.213-220
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• 1992

The sciatic nerves of anesthetized rabbits were exposed and stimulated by a nerve stimulator in order to observe the myoneural response. These rabbits were divided into three groups and respectively injected with morphine (Group 1), meperidine(Group 2) and pentazocine (Group 3). The sciatic nerves were stimulated periodically and gait changes were observed to see the myoneural activity after the injections. When the distal part of the sciatic nerves were stimulated by the nerve stimulator after the respective drug injections, the normal muscle twitch responses were observed in all the progressional stages of Group 1. However, in Group 2 and 3, the muscle twitch responses decreased gradually, finally disappearing after approximately 10 minutes in these two groups. Complete motor paralysis continued for about 60 minutes. The muscle reactions returned to normal approximately 90 minutes after injection. Specimens drug-injected tissues were severed 4 hours, 24 hours and 1 week after injection respectively. These tissue were investigated under light as well as electron microscopy. The tissue revealed rare to moderate vacuolizations scattered in the axons of the myelinated and unmyelinated nerves of some of the specimens; however, there were no significant pathologic lesions. These results provide evidence that neurophysiologically, meperidine and pentazocine have a local anesthetic-like effect such as motor paralysis, but morphine does not. In addition, the results indicated that neurohistologically, the three narcotics have no significant toxic effects on the nerve tissue.

• Journal of Chest Surgery
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• v.39 no.5 s.262
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• pp.394-398
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• 2006

Background: Goal of the initial treatment of primary spontaneous pneumothorax is re-expansion of the lung by evacuation of air from pleural space. Authors thought small caliber catheter could reach to this goal instead of conventional large bore chest tube. This retrospective study was undertaken to assess the effectiveness of 7-French (Fr) catheter for the initial treatment of primary spontaneous pneumothorax. Material and Method: Between May 2003 and April 2005, 111 patients with primary spontaneous pneumothorax were managed with tube drainage; 7 Fr catheter for 86 patients and 24-French chest tube for 25 patients. We analyzed catheter indwelling time, use of analgesics, re-expansion of the lung, and catheter related problems by medical records. Result: Mean catheter indwelling time was $2.4{\pm}1.1$ days in 7 Fr group and $2.3{\pm}1.3$ days in chest tube group (p>0.05). All patients with 24 Fr catheter needed analgesics injection but never in 7Fr group. Complete re-expansion of the lung based on plane chest radiograph was obtained in 77% of 7 Fr group. The problem related with 7 Fr catheter was kinking, which showed in 5.6%. Conclusion: Application of the 7 Fr catheter for initial management of primary spontaneous pneumothorax was as effective as 24 Fr catheter.

• Journal of Oral Medicine and Pain
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• v.25 no.4
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• pp.415-425
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• 2000

In order to obtain the basic data concerning the optimal lasing conditions in using Nd:YAG laser as an adjunctive modality of periodontal therapy of root planing without irreversible structural deterioration of cervical cementum, the author selected 36 human teeth having no cervical abrasion and caries (; 12 anteriors, 12 premolars. 12 molars) extracted due to periodontal diseases, and divided them into 4 groups as Group I, II, III and IV (; each group of 3 anteriors, 3 premolars, 3 molars), and prepared a cementum specimen with thickness of $1.0mm{\pm}0.2mm$ sectioned longitudinally at the middle of mesio-distal thickness (; Group I) or horizontally at 1mm-2mm below the cemento-enamel junction (; Group II, III, IV) from each tooth of each group by low speed diamond wheel saw, and treated them with 0.5 M ethylene diamine tetraacetic acid (; EDTA, pH=7.4) for 2 minutes for elimination of remnants during tooth-sectioning. And the author applied the laser energy from a fiberoptic delivered, free running, pulsed Nd:YAG laser (; wavelength 1064nm. pulse duration $120{\mu}sec$, fiber diameter $320{{\mu}m}$) to cementum surfaces in triplicates of one experiment under the following lasing conditions: 1. stationary mode of fiber in contact to cementum surfaces without air-spray (; Group I )/with air-spray (; Group II), 2. unidirectional moving mode of fiber in contact to cementum surfaces under speed of 3mm-4mm/sec without air-spray (; Group III)/with air-spray (; Group IV), 3. energy per pulse (mJ/pulse) [; energy density ($J/cm^{2}$)] in order of 1.0W/10Hz (100J/pulse); $124J/cm^{2}$, 0.5W/10Hz (50mJ/pulse); $62J/cm^{2}$, 0.4W/10Hz (40mJ/pulse); $50J/cm^{2}$, 0.3W/10Hz (30mJ/pulse); $37J/cm^{2}$, 4. exposure time of 1 second. And the author applied the platinum coating on surfaces of cementum specimens, and evaluated the characteristics of ultrastructural change on surfaces of cementum using the scanning electron microscopy. In general the ultrastructural loss of cervical cementum irradiated under the same lasing condition of laser energy density occurred least in specimens of Group IV. And especially, the ultrastructural loss of cervical cementum irradiated under the laser energy density of $37J/cm^{2}$ almost did not occur in specimens of Group IV. Therefore, it is considered that the pulsed Nd:YAG laser should be applied with the lasing conditions of unidirectional moving mode of fiber in contact to cementum surfaces under speed of 3mm-4mm/sec with air-spray and of laser energy density within $37J/cm^{2}$ as an adjunctive modality of periodontal therapy of root planing without irreversible structural deterioration of cervical cementum.