• The Korean Journal of Pain
• /
• 제37권3호
• /
• pp.264-274
• /
• 2024

Background: Radiofrequency ablation is an effective treatment modality in the symptomatic treatment of knee osteoarthritis. Our aim was to compare the efficacy of radiofrequency ablation of the superomedial and inferomedial genicular nerves (2 branches) with the superolateral, superomedial, and inferomedial genicular nerves (3 branches) and to show whether the 2-branch procedure is inferior to the 3-branch procedure. Methods: This study is a prospective, randomized, single-blind clinical study. Eligible participants were randomized into 2 groups: group A, which applied the procedure to the superomedial and inferomedial genicular nerves, and group B, which applied it to the superomedial, superolateral and inferomedial genicular nerves. Pain was evaluated with the numerical rating scale, quality of life with the Short Form-36 (SF-36), and disability with the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index before, and at 1 and 3 months after the procedure. Results: A total of 41 patients were included. There were no differences between the groups except for the SF-36 physical health sub-score at baseline. A significant improvement was seen in the numeric rating scale (NRS) score, SF-36 sub-scores, WOMAC Index total, as well as pain and physical function scores in both groups, though no significant difference was detected between the groups during follow-up. Conclusions: Although we were unable to establish the noninferiority of conventional radiofrequency ablation (CRFA) applied to 2 branches to CRFA applied to 3 branches, in this trial, significant and similar improvement was observed in NRS, WOMAC total, pain, and physical function and SF-36 scores in both groups.

• Journal of Chest Surgery
• /
• 제42권2호
• /
• pp.214-219
• /
• 2009

배경: 일차성 다한증은 교감신경의 과도한 활성을 특징으로 하고 흉강경을 통한 흉부 교감신경차단 술은 효과적, 안정적으로 시행되고 있다. 수술로 인한 교감신경과 부교감 신경의 불균형은 심장, 폐, 그 외 다른 여러 흉부장기에 영향을 준다. 저자들은 수술 후 나타나는 심박수와 심전도 변화를 분석하였다. 대상 및 방법: 우리는 1996년 10월부터 2006년 10월까지 수술 받은 263 명의 환자 중에 130명의 환자를 분석하였고 주된 수술부위에 따라 1, 2, 3군(1군: T2, 2군: T3, 3군: T4)으로 나누었고 수술 전과 후의 심전도를 비교하였다. 결과: 수술후 사망과 큰 합병증이 있는 환자는 없었고 심박수는 $71.6{\pm}10.6$회/분에서 $66.8{\pm}10.2$회/분으로 수술 후 감소하였고 PR 간격은 $148.6{\pm}21.2$ msec에서 $152.8{\pm}20.5$ msec으로 QTc 간격은 $399.2{\pm}15.4$ msec에서 $404.0{\pm}15.1$ msec으로 증가하였다. 흉부교감신경 차단부위에 따라 제1군에서는 심박동수와 QTc 간격이, 제2군에서는 심박동수와 PR간격이, 그리고 제 3군에서는 단지 QTc 간격이 수술전후에 의미 있게 변화하였다. 결론: 수술후 심박수와 심전도에 변화가 있었고 T2, T3, T4의 차단에 의하여 안정시 심장의 전기적 활성에 영향이 있었다.

• Journal of Chest Surgery
• /
• 제42권6호
• /
• pp.738-743
• /
• 2009

배경: 일차성 수부다한증 환자에서 교감신경절제술 전후의 교감신경 작용의 변화를 정확하게 비교 평가할 수 있는 표준화된 수단이나 변수가 없다. 저자들은 선택적인 흉부 교감신경 절제술 전후의 교감신경차단의 효과를 평가하는 방법으로서의 교감신경 피부반응 검사에 대한 효율성을 측정하였다. 대상 및 방법: 일차성 수부다한증으로 진단 받은 12명의 환자에서 교감신경 피부반응을 확인하였다. 교감신경 피부반응은 좌측 손목과 발목에 전기적 자극을 준 후 우측 손바닥이나 발바닥에서 측정하였고, 반대 편에 대해서도 같은 방법으로 실시하였다. 검사는 선택적 흉부 교감신경 절제술 이전, 절제술 시행 후 2주 그리고 1년 후에 시행하였다. 검사 자료는 발생 잠복기와 교감신경 피부반응의 크기에 대하여 보정하였다. 결과: 평균 연령은 $24.6{\pm}0.4$세(19~36세)이었으며, 남녀 성비는 1 : 0.7이었다. 손바닥(n=24)의 술전, 술후 2주, 1년의 교감신경 피부반응의 평균 잠복기와 진폭은 각각 $1.46{\pm}0.24$ msec와 $6,043{\pm}2,339{\mu}V$, $1.63{\pm}0.42$ msec와 $823{\pm}638{\mu}V$, $1.44{\pm}0.39$ msec와 $2,412{\pm}1,546{\mu}V$이었으며, 발바닥(n=24)은 각각 $1.83{\pm}0.42$ msec와 $2,816{\pm}1,694{\mu}V$, $2.16{\pm}0.39$ msec와 $1,445{\pm}1,281{\mu}V$, $1.95{\pm}0.25$ msec와 $1,622{\pm}865{\mu}V$이었다. 교감신경 피부반응검사상 손바닥에서의 진폭의 감소성 변화는 통계적으로 의미가 있었다(p=0.002). 결론: 수부다한증으로 흉부교감신경 절제술을 받은 환자의 수술 전후 시행한 흉부 교감신경 피부반응 검사에서 진폭은 교감신경의 기능과 연관이 있으며 특히 한 개체 내에서 교감신경의 기능변화를 추적 관찰하는 데에 유용할 것으로 사료된다.

• Journal of Korean Biological Nursing Science
• /
• 제2권2호
• /
• pp.67-80
• /
• 2000

The purpose of this study was to identify hindlimb muscle atrophy in stroke induced rat and determine the effect of endurance exercise on body weight, weight of hindlimb muscle during 7 days after stroke induction. Thirty four male Sprague-Dawley rats with 200-270g body weight were divided into four groups : control, control+exercise(Con+Ex), stroke, and exercise after stroke(St+Ex) group. The control group and Con+Ex group received sham operation and the stroke group and St+Ex group received right MCA occlusion operation by using silicon-coated probe. The Con+Ex and St+Ex groups ran on a treadmill for 20min/day at 10m/min and $10^{\circ}grade$. Daily body weight and diet intake were measured every morning for 7 days. Cerebral infarction of stroke and St+Ex groups were identified by staining with TCC for 30minutes. The data were analyzed by Kruskal-Wallis test and Mann-Whitney U test using the SPSSWIN 9.0 program. Body weight of the control group at the 7th day increased by 18.3% significantly from the first day of experiment, that of the stroke group at the 7th day decreased by 6.7% significantly compared to the day of receiving right MCA occlusion operation. Body weight of the Con+Ex group at the 7th day increased by 10.3% significantly form the first day of experiment, that of St+Ex group at the 7th day also increased by 13.4% significantly compared to the day of receiving right MCA occlusion operation. The total amount of diet in stroke group decreased significantly compared to that of St+Ex and that of control group. In stroke group the wet weight of both sides of soleus, plantaris, and gastrocnemius muscles decreased significantly compared to that of control group. The relative weight of affected(left) plantaris and gastrocnemius muscles decreased significantly compared to that of the control group. The difference between the weight of affected and unaffected soleus, plantaris, and gastrocnemius muscles were not significant in stroke group. The wet weight of right gastrocnemius muscles in Con+Ex group increased compared to that of control group. The relative weight of right gastrocnemius muscle increased significantly compared to that of the control group. The wet weight of St+Ex group increased significantly compared to that of the stroke group in both sides of soleus, plantaris, and gastrocnemius muscles. The relative weight of affected plantaris muscle increased significantly compared to that of the stroke group. The difference between the weight of affected and unaffected soleus, plantaris, and gastrocnemius muscles were not significant in St+Ex group. Body weight and wet weight of soleus, plantaris, and gastrocnemius muscles in the St+Ex group did not recover to the values of control group. Based on these results, it can be suggested that endurance exercise during acute stage of stroke can reduce muscle atrophy related to denervation, inactivity and undernutrition.

• The Korean Journal of Physiology and Pharmacology
• /
• 제19권2호
• /
• pp.159-165
• /
• 2015

Input signals originating from baroreceptors and vestibular receptors are integrated in the rostral ventrolateral medulla (RVLM) to maintain blood pressure during postural movement. The contribution of baroreceptors and vestibular receptors in the maintenance of blood pressure following hypotension were quantitatively analyzed by measuring phosphorylated extracellular regulated protein kinase (pERK) expression and glutamate release in the RVLM. The expression of pERK and glutamate release in the RVLM were measured in conscious rats that had undergone bilateral labyrinthectomy (BL) and/or sinoaortic denervation (SAD) following hypotension induced by a sodium nitroprusside (SNP) infusion. The expression of pERK was significantly increased in the RVLM in the control group following SNP infusion, and expression peaked 10 min after SNP infusion. The number of pERK positive neurons increased following SNP infusion in BL, SAD, and BL+SAD groups, although the increase was smaller than seen in the control group. The SAD group showed a relatively higher reduction in pERK expression when compared with the BL group. The level of glutamate release was significantly increased in the RVLM in control, BL, SAD groups following SNP infusion, and this peaked 10 min after SNP infusion. The SAD group showed a relatively higher reduction in glutamate release when compared with the BL group. These results suggest that the baroreceptors are more powerful in pERK expression and glutamate release in the RVLM following hypotension than the vestibular receptors, but the vestibular receptors still have an important role in the RVLM.

• Journal of Korean Neurosurgical Society
• /
• 제30권8호
• /
• pp.992-997
• /
• 2001

Objectives : Essential hyperhidrosis is a common condition characterized by excessive body sweating. Excessive sweating beyond what is necessary to maintain normal body temperature need not be considered pathological unless it interferes with one's occupation and/or life-style. The existing non-operative therapeutic options seldom give sufficient relief or show a transient effect. In this regard, the thoracic sympathectomy may provide a definitive cure. In the past, surgical procedures were highly invasive and caused significant morbidity, but the minimally invasive thoracoscopic procedure provided detailed visualization of sympathetic ganglia and is associated with minimally postoperative morbidity. Nowadays, thoracoscopic transthoracic sympathectomy is accepted as the treatment of choice for essential hyperhidrosis. In palmar hyperhidrosis, however, the level of sympathetic chain to be blocked has been somewhat obscure. It is assumed that the incidence of compensatory hyperhidrosis may closely related to the extent of thoracic sympathectomy. Material & Methods : To compare the results of posterior midline approach with endoscopic sympathectomy, and the results of T2 with T2, 3 sympathectomy or sympathicotomy, we retrospectively studied 62 patients treated for palmar hyperhidrosis between September 1993 and May 2000. We reviewed medical records and recently interviewed the patients by telephone calls. Results : The treatment effect of T2 sympathectomy is no different from T2, 3 sympathectomy. But, the incidence of compensatory hyperhidrosis is less in the T2 sympathectomy group than the T2, 3 sympathectomy group. Conclusion : Thoracoscopic sympathectomy is considered a simple, safe, and effective method for treating palmar hyperhidrosis, with a shorter operation time, fewer hospital days, and a better cosmetic result, as compared with the open approaches. However, sympathicotomy seems to provide the advantages of a limited extent of denervation and the resultant decrease of compensatory hyperhidrosis compared to sympathectomy.

• 대한약리학회지
• /
• 제30권1호
• /
• pp.11-18
• /
• 1994

Opioid수용체는 adenylate cyclase의 활성을 억제하므로써 cyclic AMP의 양을 감소시킨다. 본 연구에서는 striatum에서 dopamine과 opioid 신경전달계의 상호관계를 알아보고자 haloperidol(750ug/kg)을 10일간 복강내 투여하여 dopaminergic pathway를 차단시킨후 mouse striatum에서 선택적 opioid ${\mu},\;{\gamma}\;{\kappa}$ 수용체 agonist들에 의해 축적되는 cAMP양을 측정하여 본 결과, haloperidol단독투여에 의해서 cAMP는 유의한 증가를 나타내었으며, haloperidol 장기투여된 mouse striatum 에서 morphine(20mg/kg), DAGO(5Oug/kg), DPDPE(50ug/kg), U5O,488H (500ug/kg)투여에 의해서 haloperidol에 의한 cAMP 증가는 억제되었으며, 정상 mouse에 투여된 morphine, DAGO, DPDPE, U5O,488H에 비해서는 DAGO, DPDPE 투여군에서 증가를 나타내었다. Haloperidol장기투여로 인한 morphine, DAGO, DPDPE, U5O,488H의 영향은 naloxone에 의해서 morphine과 U5O, 488H투여군에서 길항되었으며 정상 mouse에 투여된 morphine, DAGO, DPDPE, U5O,488H에 의한 cAMP의 감소는 naloxone에 의하여 모든 실험군에서 길항되었다. 이상의 결과로 보아 dopaminergic denervation시 mouse striatum에서 ${\mu},\;{\gamma},\;{\kappa}$효현제에 의하여 축적되는 cAMP양은 ${\kappa}$수용체 효현제인 U5O,488H에서 가장 현저한 감소를 보여 각 수용체의 활성화정도는 변화되며, 그중에서 ${\kappa}$수용체는 그 기능이 가장 보존되고 있음을 알 수 있었다.

• Clinical and Experimental Pediatrics
• /
• 제56권3호
• /
• pp.125-129
• /
• 2013

Purpose: The use of implantable cardioverter defibrillators (ICDs) to prevent sudden cardiac death is increasing in children and adolescents. This study investigated the use of ICDs in children with congenital heart disease. Methods: This retrospective study was conducted on the clinical characteristics and effectiveness of ICD implantation at the department of pediatrics of a single tertiary center between 2007 and 2011. Results: Fifteen patients underwent ICD implantation. Their mean age at the time of implantation was $14.5{\pm}5.4$ years (range, 2 to 22 years). The follow-up duration was $28.9{\pm}20.4$ months. The cause of ICD implantation was cardiac arrest in 7, sustained ventricular tachycardia in 6, and syncope in 2 patients. The underlying disorders were as follows: ionic channelopathy in 6 patients (long QT type 3 in 4, catecholaminergic polymorphic ventricular tachycardia [CPVT] in 1, and J wave syndrome in 1), cardiomyopathy in 5 patients, and postoperative congenital heart disease in 4 patients. ICD coils were implanted in the pericardial space in 2 children (ages 2 and 6 years). Five patients received appropriate ICD shock therapy, and 2 patients received inappropriate shocks due to supraventricular tachycardia. During follow-up, 2 patients required lead dysfunction-related revision. One patient with CPVT suffered from an ICD storm that was resolved using sympathetic denervation surgery. Conclusion: The overall ICD outcome was acceptable in most pediatric patients. Early diagnosis and timely ICD implantation are recommended for preventing sudden death in high-risk children and patients with congenital heart disease.

• Journal of Korean Neurosurgical Society
• /
• 제48권3호
• /
• pp.240-243
• /
• 2010

Objective : Radiofrequency (RF) medial branch neurotomy is an effective management of lumbar facet syndrome. However, pain may recur after period of time. When pain recurs, it can be repeated, but the successful outcome and duration of relief from repeated procedures are not clearly known. The objective of this study was to determine the success rate and duration of pain relief from repeated radiofrequency medial branch neurotomy for lumbar facet syndrome. Methods : A retrospective review of medical records was done on 60 consecutive patients, from March of 2006 to February of 2009, who had an initial successful RF neurotomy but subsequently underwent repeated procedures due to recurrence of pain. All procedures were done in carefully selected patients after at least two responsive medial branch nerve blocks. C-arm fluoroscopic guide, impedance, sensory and motor threshold monitoring tools were used for the precise placement of electrodes. Responses of repeated procedures were compared with initial radiofrequency neurotomy for success rates and duration of pain relief. Results : There were 48 females and 12 males. Mean age was 52.4 years (range, 26-83). RF medial branch neurotomy was done on one side in 38 and both sides in 22 patients, each covering at least three segments. Average visual analog scale at last procedure was 6.8. Twelve patients had previous lumbar operations, including 4 patients with instrumentations. Fifty-five patients had two procedures and five patients had three procedures. Mean duration of successful pain relief (> 50% of previous pain for at least 3 months period) after initial radiofrequency neurotomy was 10.9 months (range, 3-28) in 51 (85%) patients. From repeated procedures, successful pain relief was seen in 50 (91%) patients with average duration of 10.2 months (range, 3-24). Five patients had third procedure, which was successful in 4 (80%) patients with mean duration of 9.8 months (range, 5-16). This was not statistically different from initial results. There were no permanent neurological complications from the procedures. Conclusion : Results of this study indicate that the frequency of success and durations of relief from repeated RF medial branch neurotomy for lumbar facet syndrome are similar to initial results that provided relatively prolonged period of pain relief without major side effects Each procedure seems to provide successful pain relief for about 10 months in more than 85% of carefully selected patients when properly done.

• 대한수의학회지
• /
• 제43권1호
• /
• pp.57-66
• /
• 2003

Single and 28-day repeated dose toxicity studies of botulimnn toxin type A were carried out in ICR mice and Sprague-Dawley rats, respectively. In the single dose toxicity study, botulinwn toxin was injected intraperitoneally to male and female mice at a single dose of 40, 59, 89 133 and 200 ng/10 ml saline/kg. All animals died from 59 ng/kg group. Some clinical signs, such as decrease in locomotor activity, dyspnea, prone position and ptosis, were observed in most of both sexes from 59 ng/kg group, but no signs were seen in all animals at 40 ng/kg group. The results showed that the median lethal dose of botulinum toxin might be in the range of 40-59 ng/kg in both sexes. In the repeated dose toxicity study, the test material was administered intradermally for 28 days at doses of 0 (vehicle-treated control), 1.25, 2.5, 5.0 and $10.0ng/head/50{\mu}{\ell}$ saline in male and female rats. No test material-related changes were noted in survivals, clinical signs, food and water consumptions and gross finding in any group. Botulinum toxin treatment significantly decreased the body weight gain rate in male of 5.0 ng/head group and over and in female of 10.0 ng/head group compared to vehicle-treated control. One or more relative organ weights (i.e., spleen, thymus, liver and kidney) were increased significantly from 5.0 ng/head group compared to vehicle-treated control in both sexes. Serum biochemistry revealed increases in aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatine phosphokinase, total protein and albumin in male, and increases in AST and ALT and decreases in $K^+$ and $Cl^-$ in female without dose-pendent manners. In the histopathological study, physical stimulation by needle caused slight inflammations of dennis. In addition, botulinum toxin treatment induced denervation of nerve cell and disuse of muscle, resulting in atrophy of skeletal muscle in both sexes from 2.5 ng/head group. When the antibodies to toxin were determined in all animals, a significant increase in serum antibodies was observed from 5.0 ng/head group. The results showed that the NOAEL of botulinum toxin might be 1.25 ng/head for 28-day repeated dose toxicity in rats.