• The Korean Journal of Pain
• /
• v.31 no.2
• /
• pp.125-131
• /
• 2018

Background: The thoracic transforaminal epidural block (TTFEB) is usually performed to treat herpes zoster or postherpetic neuralgia (PHN). Especially, multiple segmental involvements and approximate contrast medium spread range, according to volume, help to choose the proper drug volume in the transforaminal epidural block. This study investigated the contrast medium spread patterns of 1-ml to 3-ml TTFEBs. Methods: A total of 26 patients with herpes zoster or PHN were enrolled in this study. All participants received 1 ml, 2 ml, or 3 ml of contrast medium. Results were divided into Groups A, B and C based on the volume (1, 2, or 3 ml), with n = 26 for each group. After the injection of contrast medium, the spread levels were estimated in both the lateral and anteroposterior (AP) images using fluoroscopy. Results: The cephalad spread of contrast medium in the lateral image as expressed by the median (interquartile range) was 2.00 levels (1.00-2.00) for Group A, 2.50 (2.00-3.00) for Group B, and 3.00 (2.00-4.00) for Group C. The caudal spread level of contrast medium was 1.00 (1.00-2.00) for Group A, 2.00 (2.00-3.00) for Group B, and 2.00 (2.00-3.00) for Group C. There was ventral and dorsal spread of the 3-ml contrast medium injection in 88% (23/26) of cases in the lateral image. Conclusions: Injection of 3 ml of contrast medium through the foramina spread 6 levels in a cephalocaudal direction. Spread patterns revealed a cephalad preference. TTFEB resulted in dorsal and ventral spread in a high percentage of cases. This procedure may be useful for transferring drugs to the dorsal and ventral roots.

• Journal of Korean Neurosurgical Society
• /
• v.39 no.5
• /
• pp.366-369
• /
• 2006

Objective : There are various surgical approaches to far-lateral lesions in the L5-S1 intervertebral space. Of these is the validity of a paramedian tangential approach is being investigated in this study. Methods : A retrospective study was conducted on 25 patients who had been diagnosed as having a far-lateral L5-S1 disc herniations, osteophyte, costal process hypertrophy, and had undergone a paramedian tangential approach from November 1999 through December 2003. The degree of symptoms and improvement were compared via the visual analog pain scale, before and after surgery. Results : This study included 4 males and 21 females with a mean age of $62{\pm}11.8$ years old. The average follow-up period after surgery was $8.2{\pm}2.7$ months. The visual analog pain scale taken before surgery was $6.7{\pm}1.1$ points, while the post-surgical scale was $2.4{\pm}0.9$ points showing a significant degrease [p < 005]. There were no complications that developed during surgery. Conclusion : A paramedian tangential approach is less invasive in the soft tissue than that of the median approach. This approach may effectively reduce nerve root compression and expand intervertebral foramens, and is devoid of the risk of spinal instability after surgery. The authors suppose that a paramedian tangential approach is quite an effective technique to relive compression in the far-lateral L5-S1 intervertebral space.

• Journal of Korean Neurosurgical Society
• /
• v.58 no.6
• /
• pp.499-503
• /
• 2015

Objective : The transradial catheterization (TRC) is becoming widespread, primarily for neurointerventions. Therefore, the evaluation of radial artery puncture in clinical practice and a better understanding of the anatomy are important to improve the safety of neuroendovascular surgery. Methods : Ten formalin-fixed adult Korean cadavers were dissected to expose radial artery (RA), brachial artery (BrA) and subclvian artery (ScA), bilaterally. Vessel lengths and diameters were meaured using a caliper and distance between the specific point of vessels and the anatomical landmarks including the radial styloid process, the medial epicondyle of the humerus, the sternoclavicular joint, and the vertebral artery orifice were also measured. Results : The average length between the radial (RAPS) and the BrA puncture sites (BrAPS) and between the vertebral artery orifice (VAO) and the BrA bifurcation (BrAB) did not differ between sides (p>0.05). The average length between the radial styloid process (RSP) and the RAPS was $13.41{\pm}2.19mm$, and the RSP was $26.85{\pm}2.47mm$ from the median nerve (MN). The mean length between the medial epicondyle (ME) and the BrAPS as $44.23{\pm}5.47mm$, whereas the distance between the ME and the MN was $42.23{\pm}4.77mm$. The average VAO-ScA angle was $70.94{\pm}6.12^{\circ}$, and the length between the ScA junction (SCJ) and the VAO was $60.30{\pm}8.48mm$. Conclusion : This study provides basic anatomical information about the radial artery and the brachial route and can help improving new techniques, selection of size and shape of catheters for TRC. This can help neurointerventionists who adopt a transradial neuroendovascular approach and offers comprehensive and safe care to their patients.

• Journal of Korean Neurosurgical Society
• /
• v.50 no.4
• /
• pp.304-310
• /
• 2011

Objective : Intrathecal methotrexate (MTX) therapy combined with whole brain radiotherapy (WBRT) is one of the major treatment modalities for leukemia and lymphoma involving the central nervous system (CNS). The purpose of this study was to retrospectively determine the incidences of leukoencephalopathy and disseminated necrotizing leukoencephalopathy (DNL) following intrathecal MTX therapy for CNS lymphoma or leukemia and to assess the potential risk factors. Methods : Between January 2000 and August 2009, 143 patients with CNS lymphoma or leukemia received intrathecal MTX therapy alone or in combination with WBRT at a single institution. Patients were followed up clinically and radiologically at regular two- or three-month intervals. Medical records were reviewed to obtain information regarding the patients' demographics, medical histories, radiologic characteristics, treatments, and clinical courses. Results : On follow-up MR images, leukoencephalopathy was found in 95 of 143 patients (66.4%). The median time to develop leukoencephalopathy was 6.6 months. Among those with leukoencephalopathy, four patients showed seven extensive white-matter changes with strongly enhancing lesions demonstrating DNL. Histological confirmation was done in six lesions of three patients and radiological diagnosis alone in one patient. Four lesions spontaneously disappeared on MR images without any treatment, with a mean duration of 14 months before disappearance of DNL. Conclusion : Leukoencephalopathy is a common phenomenon that occurs following intrathecal MTX therapy; however, DNL occurs at a very low incidence. For newly developed enhancing lesions, consideration for the occurrence of DNL should be taken to avoid unnecessary invasive procedures or therapies.

• Molecular & Cellular Toxicology
• /
• v.2 no.4
• /
• pp.266-272
• /
• 2006

Carpal tunnel syndrome (CTS) is one of the most common disorders by under pressure of the median nerve at the wrist in these days. However, pathological mechanism of CTS is unknown. We carried out this study to identify the changes of gene expression and to evaluate possible mechanism in CTS. 120 CTS patients and 30 control patients were included in this study. Patients with a history of diabetes, hypertension, thyroid diseases, and arthritis were excluded. CTS patients were divided to three experimental groups-Mild, Moderate, and Severe group-according to elecrodiagnosis. Radioactive cDNA microarrays (Nylon membrane including 1,152 genes) were used to examine the difference of gene expression profile in CTS. We identified up-regulated genes by more than 2.0 value of z-ratio, and down-regulated genes by less than-2.0 value of z-ratio. 20 genes such as the ITGAL, ITGAM, PECAM1, VIL2, TGFBR2, RAB7, RNF5 and NFKB1 were up-regulated, and 28 genes such as PRG5, CASP8, CDH1, IGFBP5, CBX3, HREV107, PIN, and WINT2 were down-regulated. These genes were related with TGF beta signaling pathway, NF-Kb signaling pathway, antiapoptotic pathway and T cell receptor signaling pathway. However, there were no differences in gene expression profiles according to severities of symptoms. We suggest that CTS could be related with proinflammatory mechanism and antiapoptotic mechanism.

• The Journal of the Korean bone and joint tumor society
• /
• v.5 no.4
• /
• pp.201-207
• /
• 1999

Malignant tumors of the hand are very rare. Between 1989 and 1998, 17 patients with malignant tumors of the hand were evaluated for clinical features, prevalence, treatment and results. The mean age was 45 years and median duration of follow-up was 38 months. A painless mass was the most common symptom and the most common lesion was the digit. Fifteen cases of soft tissue and 2 cases of bone tumor were diagnosed. On pathology, soft tissue tumors were comprised of 8 cases of malignant melanoma, 2 cases of angiosarcoma and 1 case each of malignant fibrous histiocytoma, malignant peripheral nerve sheath tumor, extraskeletal chondrosarcoma, and squamous cell carcinoma. Bone tumors were metastatic tumors and each originated from the rectal cancer or lung cancer. Lymph node involvements were noted in 4 cases of malignant melanoma and 1 case of squamous cell carcinoma. Six cases of metacarpo-phalangeal joint disarticulation and 4 cases of phalanx amputation were performed. Wide excision, ray amputation and below-elbow amputation were also performed. Three cases expired due to metastasis and progression of the original lesion. Among the surviving 14 cases, a malignant melanoma had metastasis on the axillary lymph node and 13 cases showed no local recurrence or metastasis during the follow-up.

• Archives of Plastic Surgery
• /
• v.42 no.3
• /
• pp.327-333
• /
• 2015

Background An anatomical analysis of the transverse carpal ligament (TCL) and the surrounding structures might help in identifying effective measures to minimize complications. Here, we present a surgical technique based on an anatomical study that was successfully applied in clinical settings. Methods Using 13 hands from 8 formalin-fixed cadavers, we measured the TCL length and thickness, correlation between the distal wrist crease and the proximal end of the TCL, and distance between the distal end of the TCL and the palmar arch; the TCL cross sections and the thickest parts were also examined. Clinically, fasciotomy was performed on the relevant parts of 15 hands from 13 patients by making a minimally invasive incision on the distal wrist crease. Postoperatively, a two-point discrimination check was conducted in which the sensations of the first, second, and third fingertips and the palmar cutaneous branch injuries were monitored (average duration, 7 months). Results In the 13 cadaveric hands, the distal wrist crease and the proximal end of the TCL were placed in the same location. The average length of the TCL and the distance from the distal TCL to the superficial palmar arch were $35.30{\pm}2.59mm$ and $9.50{\pm}2.13mm$, respectively. The thickest part of the TCL was a region 25 mm distal to the distal wrist crease (average thickness, $4.00{\pm}0.57mm$). The 13 surgeries performed in the clinical settings yielded satisfactory results. Conclusions This peri-TCL anatomical study confirmed the safety of fasciotomy with a minimally invasive incision of the distal wrist crease. The clinical application of the technique indicated that the minimally invasive incision of the distal wrist crease was efficacious in the treatment of the carpal tunnel syndrome.

• The Journal of Korean Physical Therapy
• /
• v.14 no.4
• /
• pp.266-273
• /
• 2002

Carpal Tunnel Syndrome(CTS) is a common entrapment neuropathy of the median nerve at the wrist. An Electrophysiologic study has been widely used for the diagnosis of carpal tunnel syndrome. The subjects of this study were 48 cases (88 hands) with clinically suspected carpal tunnel syndrome who underwent electrodiagnostic examination from Jan 1, 2001 to Sep 30, 2001, The results were as follows: 1. Among 48 persons with a clinically suspected carpal tunnel syndrome, 40 patients were female 83.33$\%$ and the patients who are above 60 years old were 37.50$\%$. 2. Electrodiagnostic results were 22 cases (45.84$\%$) with bilateral carpal tunnel syndrome and 10 cases (20.83$\%$) with normal. 3. Physical findings consisted of tingling sensation in 48.86$\%$ of the involved hands, positive Phalen's Sign in 20.46$\%$ of them, thenar atrophy in 15.91$\%$ of them, and weakness in 14.77$\%$ of them. 4. Electrophysiologic studies showed a decreased sensory conduction velocity in 20 cases (22.73$\%$) of total hands, a prolonged latency in 3 cases (3.41$\%$) of them, abnormal sensory and motor fiber in 33 cases (37.50$\%$) of them, and normal in 27 cases (30.68$\%$) of them. Considering above results, we had better make a diagnosis precisely the patients with clinically suspected carpal tunnel syndrome through subjective symtoms, physical examinations, and electrophysiologic studies.

• Journal of Korean Medicine Rehabilitation
• /
• v.30 no.4
• /
• pp.119-132
• /
• 2020

Objective The purpose of this study was to investigate clinical studies between 2015 and 2020 on the traditional Chinese medicine treatment for carpal tunnel syndrome (CTS) using the China National Knowledge Infrastructure (CNKI) database. Methods We searched clinical studies on the Chinese medicine treatment published in traditional Chinese medical journals on CTS through the CNKI search. Fifteen published studies between 2015 and 2020 were chosen and examined for the year of publication, sample size, study design type, diagnosis and evaluation of diverse criteria, treatment period, purpose of the study, and classification based on the treatment technique. Results Out of 73 studies, 15 had practiced various Chinese medical treatments, such as acupuncture, moxibustion, manipulation, herbal medicine application therapy, and external herbal treatment. Conclusions Various studies have investigated the Chinese medicine treatment for CTS in China. To envelope the treatment of CTS in Korean medicine, steady and valuable therapies for high-level clinical research are required. In the future, this study could be helpful in the development of the treatment of CTS with Korean medicine.

• Proceedings of the Korean Institute of Information and Commucation Sciences Conference
• /
• 2016.05a
• /
• pp.531-532
• /
• 2016

Carpal tunnel syndrome, carpal tunnel becomes part of a narrower median nerve pain occurs pressed. How a stable wrist stretch for the prevention of carpal tunnel syndrome is required, it should life guides to fit the user is provided. In this research, users themselves recognize the risk of carpal tunnel syndrome, to be able to stretch, it implements the application. Application, based on the usage time set by the user, executes the alarm and lock. At this time, the user may utilize arduino and inertia sensor, it is possible to wrist stretch, to analyze usage patterns, it is possible to provide a medical information and life guides to suit the user. Data using Bluetooth 4.0 communication has been to meet the runaway. In order to evaluate the mounted system, targeting four subjects, the time and the touch frequency of usage of the 3-day smartphone measured, as a result of the questionnaire, it reduces the frequency of use of smartphones, a positive it was possible to prove the effect.