• Journal of Yeungnam Medical Science
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• 제41권1호
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• pp.56-57
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• 2024

• Journal of Chest Surgery
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• 제41권6호
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• pp.807-810
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• 2008

안면부 다한증으로 클립을 이용한 흉부교감신경 차단술을 시행받고 이 중 심한 보상성 다한증을 4명의 환자를 대상으로 2005년 10월부터 2006년 8월까지 클립 제거와 늑간 신경을 이용한 흉부교감신경재건수술을 시행하였다. 재건 수술은 4명 모두 흉강경하에 가능하였으며 3번째 늑간 신경을 박리하여 신경집을 제거하고 클립으로 손상된 교감신경의 근위부와 원위부의 신경집을 제거한 후 늑간신경을 밀착시켜 fibrin sealant를 도포하여 연결하였다. 재건 수술 후 만족도는 외래 추적 관찰 또는 전화 설문으로 평가하였다. 1명의 환자는 먼저 흉부교감신경을 차단한 클립을 제거하였으나 28개월 동안 증상의 호전이 없어 다시 흉부교감신경 재건술을 시행하였다. 다른 3명의 환자는 클립 제거와 재건술을 동시에 시행하였다. 2명의 환자는 수술 후 보상성 다한증의 호전이 나타나지 않았으나 나머지 2명의 환자는 보상성 다한증의 호전이 관찰되었다. 신경집을 제거한 늑간 신경을 신경집을 제거한 흉부 교감신경 손상부위의 원위부와 근위부에 밀착시키는 재건술은 흉부 교감신경 수술 후 발생하는 보상성 다한증을 호전시키는 유용한 치료 방법이 될 수 있을 것으로 생각된다. 그러나, 더 많은 증례와 장기간의 추적 관찰이 필요할 것이다.

• Archives of Plastic Surgery
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• 제47권5호
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• pp.435-443
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• 2020

Background The innervated radial artery superficial palmar branch (iRASP) flap was designed to provide consistent innervation by the palmar cutaneous branch of the median nerve (PCMN) to a glabrous skin flap. The iRASP flap is used to achieve coverage of diverse volar defects of digits. However, unexpected anatomical variations can affect flap survival and outcomes. Methods Cases in which patients received iRASP flaps since April 1, 2014 were retrospectively investigated by reviewing the operation notes and intraoperative photographs. The injury type, flap dimensions, arterial and neural anatomy, secondary procedures, and complications were evaluated. Results Twenty-eight cases were reviewed, and no flap failures were observed. The observed anatomical variations were the absence of a direct skin perforator, large-diameter radial artery superficial palmar branch (RASP), and the PCMN not being a single branch. Debulking procedures were performed in 16 cases (57.1%) due to flap bulkiness. Conclusions In some cases, an excessively large RASP artery was observed, even when there was no direct skin perforator from the RASP or variation in the PCMN. These findings should facilitate application of the iRASP flap, as well as any surgical procedures that involve potential damage to the PCMN in the inter-thenar crease region. Additional clinical cases will provide further clarification regarding potential anatomical variations.

• Journal of Acupuncture Research
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• 제35권1호
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• pp.4-10
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• 2018

The aim of this report was to show the effects of acupotomy in patients with carpal tunnel syndrome. Four patients were treated with acupotomy twice. Visual analogue scale (VAS), Tinel's sign, Phalen's test, Boston carpal tunnel syndrome questionnaire (BCTQ), muscular strength test, and a cross-sectional area of median nerve was measured using ultrasound before and after treatment. In all 4 cases, the VAS score, BCTQ score and cross-sectional area of median nerve, all decreased and muscular strength test score increased. Tinel's sign and the Phalen's test changed from a positive to a negative in most cases. This report shows that acupotomy is an effective treatment for carpal tunnel syndrome. Further larger are needed to fully evaluate the beneficial effects of this treatment.

• 대한관절경학회지
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• 제5권2호
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• pp.120-123
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• 2001

목적 : 수근관 증후군의 치료로서 내시경적 수근관 절개술을 시행할 때 저자들은 유연한 투명 도관을 활용하여 정중신경 및 주변 구조물을 직접 눈으로 확인하며 횡수근인대를 절개하는 방법을 고안하여 시행함으로써 합병증을 줄일 수 있을 것으로 사료되어 그 술기의 안전성을 평가해 보고자하였다. 대상 및 방법 : 1997년 3월부터 2000년 3월까지 본원 정형외과에서 수근관 증후군으로 진단되어 유연한 투명도관을 이용한 내시경적 수근관 절개술을 시행 받은 12명(20례)의 환자를 대상으로 하였으며 수술방법은 two portal 술식을 사용하여 유연한 투명 도관을 삽입하여 정중신경 및 주변 구조물을 직접 눈으로 확인하면서 횡수근인대를 절개하였다. 결과 : 술전에 보였던 임상증상은 14례$(70\%)$에서 소실되었으며 6례$(30\%)$에서 부분적인 개선을 보였다. 절개 부위나 수근 관절부위의 압통을 호소하는 예는 없었으며 신경 손상 등의 심각한 합병증은 없었다. 결론 : 수근관의 내시경적 절개술시 저자들은 유연한 투명도관을 사용하여 정중신경을 직접 눈으로 보면서 횡수근인대를 절개하는 방법으로 $360^{\circ}$의 좋은 시야를 확보할 수 있어 신경 손상 등의 합병증을 피할 수 있었으며 유연한 도관을 사용하므로 수술중 항상 수근관절의 과신전 상태를 유지하지 않아도 되며 또한 수액의 정맥 주사용 line 이나 병원에서 흔히 사용하는 도관을 이용함으로서 기존의 비싼 수술장비를 구입하지 않아도 된다는 장점이 있다.

• Applied Microscopy
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• 제30권3호
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• pp.265-272
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• 2000

낙지 Octopus minor의 상완 신경절을 광학현미경과 전자현미경을 통해 관찰한 결과 다음과 같은 결론을 얻었다. 낙지의 상완신경절은 각각의 흡반 밑에서 둥근 형태로 관찰되었는데 그들의 크기는 흡반의 크기에 비례하였다. 둥근 형태의 상완신경절은 피질부와 수질부 두 부분으로 구분되었던 바, 피질부에서는 신경세포의 집단이, 수질부에는 신경망이 위치해 있었다. 신경세포의 집단에서는 3종류(소, 중, 대형)의 신경세포들이 관찰되었는데 소신경세포는 직경이 $0.9{\mu}m$정도인 둥근 형태의 작은 세포인데 비해 중신경세포는 직경 $1.6\times1.3{\mu}m$정도인 타원형세포였다. 대신경세포는 직경이 $2.8{\mu}m$정도 크기의 난원형의 큰 세포로 확인되었고 이들 3종류의 세포들은 모두 전자밀도가 낮아서 밝게 관찰되었으며 세포소기관의 발달은 미진하였다. 또한 중신경세포인 경우에는 $0.6\times0.4{\mu}m$정도 크기의 전자밀도가 중등도인 방추형 신경교세포에 의해 둘러싸여 있었다. 수질부의 신경망에서는 다양한 크기의 수상돌기와 축색돌기들이 복잡한 그물형태를 하고 있었다. 이들은 돌기내에서 4종류의 화학연접소포 (chemical synaptic vesicle)들을 소지하고 있었는데, 전자밀도가 매우 높고 직경이 100 nm 정도인 electron-dense synaptic vesicle과 전자밀도가 중등도이며 직경이 90nm 정도인 median electron-dense synaptic vesicle 그리고 중앙에 전자밀도가 높은 둥근 핵을 포함하는 직경 90nm정도의 electron-dense cored synaptic vesicle등이 관찰되었다. 그러나 전자밀도가 투명한 연접소포(electron-lucent synaptic vesicle)는 직경이 50nm정도로 가장 작은 형태를 하고 있었다.

• 한국전문물리치료학회지
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• 제3권2호
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• pp.77-83
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• 1996

The purpose of this study was to determine the effect of transcutaneous electrical nerve stimulation(TENS) on sympathetic tone in healthy subjects. Stimulation in the conventional and burst modes was applied to the skin of the forearm overlying the median nerve. TENS was applied for 20 minutes at an intensity sufficient to produce a perceptible though not uncomfortable sensation and no muscle contracion of the forearm musculature. The change in sympathetic tone was measured with skin temperature. Skin temperature was measured at the index finger and on the volar surface of the forearm in the stimulated limb. The conventional and burst modes did not change the skin temperature at any of the two measurement sites. We conclude that TENS, as applied in this study, does not influence sympathetic tone. Further research is needed to assess the sympathetic effects of TENS on patient groups, long term treatment and other modalities.

• Annals of Clinical Neurophysiology
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• 제8권2호
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• pp.125-134
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• 2006

Among the various physiological factors that affect nerve conduction velocity (NCV), temperature is the most important. Because the influence of temperature is the most important source of error. It is known from animal experiments that conduction is eventually completely blocked at low temperatures, the myelinated A fibers being the first affected and the thin fibers of group C the last. Many studies showed that the NCV decreases linearly with lowering temperature within the physiological range. The distal motor latency increased by $0.2msec/^{\circ}C$ drop in temperature between $25^{\circ}C$and $35^{\circ}C$ in the median, ulnar and peroneal nerves. The temperature affect the neuromuscular transmission; The miniature endplate potential (MEPP) and endplate potential (EPP) are increase with increasing temperature. In myasthenia gravis, the reduction in the decremental response is observed following cooling. The lowering temperature make increase the amplitude of sensory compound action potential; make enlarge the surface area of compound muscle action potential with very little increase in amplitude; make diminish the fibrillation potential and increase the myotonia in needle electromyography (EMG). Because of these findings mentioned above, the skin temperature should be routinely monitored and controlled during nerve conduction tests and needle EMG and should be taken into account when interpreting the findings.

• Archives of Plastic Surgery
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• 제38권4호
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• pp.498-500
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• 2011

Purpose: Neurilemoma is benign tumor of the nerve sheath which arises from Schwann cells. It is usually formed along the path of a peripheral nerve but is rarely separate from normal nerve fascicles. We experienced a patient with an isolated neurilemoma localized in the palmaris longus tendon with no connection to the major nerve trunk, which was in an unusual location and has never been reported. We report our case with the review of the literature. Methods: A 23-year-old female visited our clinic with mild pain on the mass at the flexor area of the right wrist which had been present for about one year. The physical examination revealed a $1{\times}1cm$ sized subcutaneous mass at the flexor area of the right wrist. Sonography and computed tomography showed an ovoid, superficial solid mass on the palmaris longus tendon. Upon surgical excision, a $1{\times}0.5cm$ sized mass attached to the palmaris longus tendon was found. The tumor had no connection with the median nerve and was detached easily from the palmaris longus tendon. Results: Histological examination demonstrated the mass to be a neurilemoma, which consists of spindle shaped cells with oval elongated nuclei arranged fascicles. No sensory dysfunction or evidence of recurrence was found during the 12 months of postoperative follow-up. Conclusion: We experienced a rare case of neurilemoma attached to the palmaris longus tendon with no connection to the major nerve trunk. We wish to emphasize its unusual location through our case and hope to expand our spectrum in exploring the upper extremity mass.

• Clinical Pain
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• 제18권2호
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• pp.59-64
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• 2019

Objective: This study evaluated the feasibility of ultrasound-guided lumbar nerve root block (LNRB) and S1 nerve root block by identifying spread patterns via fluoroscopy in cadavers. Method: A total of 48 ultrasound-guided injections were performed in 4 fresh cadavers from L1 to S1 roots. The target point of LNRB was the midpoint between the lower border of the transverse process and the facet joint at each level. The target point of S1 nerve root block was the S1 foramen, which can be visualized between the median sacral crest and the posterior superior iliac spine, below the L5-S1 facet joint. The injection was performed via an in-plane approach under real-time axial view ultrasound guidance. Fluoroscopic validation was performed after the injection of 2 cc of contrast agent. Results: The needle placements were correct in all injections. Fluoroscopy confirmed an intra-foraminal contrast spreading pattern following 41 of the 48 injections (85.4%). The other 7 injections (14.6%) yielded typical neurograms, but also resulted in extra-foraminal patterns that occurred evenly in each nerve root, including S1. Conclusion: Ultrasound-guided injection may be an option for the delivery of injectate into the S1 nerve root, as well as lumbar nerve root area.