• The Korean Journal of Pain
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• v.29 no.3
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• pp.179-184
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• 2016

Background: Recently, ultrasound has been commonly used. Ultrasound-guided interscalene brachial plexus block (IBPB) by posterior approach is more commonly used because anterior approach has been reported to have the risk of phrenic nerve injury. However, posterior approach also has the risk of causing nerve injury because there are risks of encountering dorsal scapular nerve (DSN) and long thoracic nerve (LTN). Therefore, the aim of this study was to evaluate the risk of encountering DSN and LTN during ultrasound-guided IBPB by posterior approach. Methods: A total of 70 patients who were scheduled for shoulder surgery were enrolled in this study. After deciding insertion site with ultrasound, awake ultrasound-guided IBPB with nerve stimulator by posterior approach was performed. Incidence of muscle twitches (rhomboids, levator scapulae, and serratus anterior muscles) and current intensity immediately before muscle twitches disappeared were recorded. Results: Of the total 70 cases, DSN was encountered in 44 cases (62.8%) and LTN was encountered in 15 cases (21.4%). Both nerves were encountered in 10 cases (14.3%). Neither was encountered in 21 cases (30.4%). The average current measured immediately before the disappearance of muscle twitches was 0.44 mA and 0.50 mA at DSN and LTN, respectively. Conclusions: Physicians should be cautious on the risk of injury related to the anatomical structures of nerves, including DSN and LTN, during ultrasound-guided IBPB by posterior approach. Nerve stimulator could be another option for a safer intervention. Moreover, if there is a motor response, it is recommended to select another way to secure better safety.

• Physical Therapy Korea
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• v.3 no.2
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• pp.29-35
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• 1996

The purpose of this study was to compare acupuncture-like transcutaneous electrical nerve stimulation(ALTENS) with conventional transcutaneous electrical nerve stimulation(C-TENS) for crossover effect in healthy subjects. Forty subjects recieved ALTENS(20 persons), C-TENS(20 persons) to one upper extremity. Each technic was applied to the motor point of the wrist extensor muscle group for twenty-minutes. With the subject placed in supine the technics were applied at 80 Hz, 2-10 mA(ALTENS) and 10 Hz, 4-12 mA(C-TENS). Results revealed: (1) a significant difference between the pretreatment and posttreatment in each group(p<.05) (2) no significant difference between ALTENS and C-TENS(p>.05). In conclusion, there was no difference between ALTENS and C-TENS for crossover effect.

• Archives of Plastic Surgery
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• v.48 no.2
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• pp.213-216
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• 2021

Many surgeons have demonstrated the validity of sternocleidomastoid muscle flaps for the reconstruction of head and neck tumors. We present a case in which we used an island sternocleidomastoid muscle flap to reconstruct a cheek depression after excision of a malignant parotid tumor. A 44-year-old woman presented with a right malignant parotid tumor. We performed total resection of the parotid gland and facial nerve with the sural nerve and reconstructed the facial nerve and cheek depression with an island sternocleidomastoid muscle flap. The sternal head of the right sternocleidomastoid muscle was cut at the cranial and caudal segments to elevate it as an island flap. We used the superior thyroid artery as the sole pedicle for the island muscle flap. At 1 year and 3 months after the operation, the mimic muscles had gradually recovered and progressed without complications such as Frey syndrome, cervical motor dysfunction, or concave deformation of the neck and cheeks.

• Investigative Magnetic Resonance Imaging
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• v.20 no.3
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• pp.175-180
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• 2016

Carbon monoxide (CO) intoxication is a leading cause of the variable neuropsychiatric impairment. Despite of widely known central nerve system complications after CO intoxication, peripheral neuropathy due to CO poisoning is rare and has been under-recognized. We report interesting case of a 29-year-old male who suffered from motor weakness and sensory abnormalities in his lower extremity following acute CO intoxication. The patient revealed direct and indirect signs of peripheral neuropathy of the left inferior gluteal and sciatic nerve on magnetic resonance imaging.

• The Journal of Korean Physical Therapy
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• v.14 no.4
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• pp.163-171
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• 2002

Neuromuscular junction consist of presynaptic membrane, synaptic cleft and postsynaptic membrane. In the neuromuscular junction, presynaptic membrane is the motor nerve terminal, have many synaptic vesicle. Postsynaptic membrane is the motor end plate of muscle fiber and the most striking structural features are the deep infolding of the sarcolemma. Between the nerve and muscle cells, there is a synaptic cleft of some 50-100nm. This review shows the ultrastructure and function of neuromuscular junction, summarizes the current knowledge.

• The Korean Journal of Zoology
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• v.39 no.2
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• pp.223-230
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• 1996

Fine structure of the neuromuscular junction in the venomous organ of the spider, Agelena li'mbutq, was studied using high magnification electron microscope. The motor nerve endings at neuromuscular contact area composed of neurons and neuroslial cells were located between musculature and extracellular sheath of the venom gBand. At the synaptic contact between a motor axon and a muscle fiber in the musculature, spherical synaptic vesicles were prominent in the nerve terminal. The sarcoplasm beneath the neuromuscular synapse has a granular appearance and lacks mvofilaments. And the main axon gives off a branch between the muscle fibers. The synaptic regions of this organ are located close to the myofilaments unlike to other chelicerate classes. Moreover the postsvnaptic complex of vesicles and membrane invasinations present in other synaptic legions are absent from these legions in this venomous organ.

• Journal of Korean Medicine Rehabilitation
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• v.19 no.2
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• pp.27-49
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• 2009

Objectives : The purpose of this study was to investigate the effects of Yanghyuljanggeungunbo-tang(Yangxuezhuangjinjianbu-tang) and Cervi Cornu Parvum pharmaco-acupuncture in Spinal Cord Injury(SCI)-induced rats. Methods : The subjects were divided into 5 groups ; Normal, Control no treatment after SCI, Experimental I taken with Yanghyuljanggeungunbo-tang (Yangxuezhuangjinjianbu-tang) 500 mg/kg $0.5m{\ell}$ daily after inducing SCI. Experimental II taken with Cervi Cornu Parvum pharmaco-acupuncture at Taegye(KI3) and $Yangnungch{\acute{o}}n$(GB34) after inducing SCI and Experimental III taken with Yanghyuljanggeungunbo-tang(Yangxuezhuangjinjianbu-tang) 500 mg/kg $0.5m{\ell}$ and Cervi Cornu Parvum pharmaco-acupuncture at KI3 and GB34 to SCI-induced rats. After each operation, the present author observed the motor behavior recovery and nerve regeneration by analysis of the motor behavior tests, EMG, hematological(AST, ALT, WBC), histological and immunological changes. Rats were tested at modified Tarlov test at the 1st, 2nd, 3rd, 4th day, and Motor behavior test at 1st, 3rd, 7th, 14th, 21st day. Results : Results are as follows. 1. All the experimental groups were improved compared with control group in the motor behavior tests including Tarlov test, Basso-Beattle-Bresnahan locomotor rating scale, modified inclined plane test, open field test, grid walk test and narrow beam test. Especially Experimental III was improved significantly among other groups. 2. In EMG test, H wave appeared weak only in Experimental III. And M wave was increased significantly in Experimental III. 3. All the experimental groups were significantly decreased compared with control group in serum AST, serum ALT and serum WBC tests. 4. significantly decreased in Tumor Necrosis Factor-${\alpha}$ test compared with the first day of SCI. 5. Muscle contraction and denaturation of all the experimental groups were inhibited in histological observations of gastrocnemius muscle. Especially, those of experimental III was more effective. 6. NGF and BDNF of spinal cord gray matter in all the experimental groups were increased compared with control group. Especially, those of experimental III was more effective. Conclusions : As above, it can be suggested that Yanghyuljanggeungunbo-tang(Yangxuezhuangjinjianbu-tang) and Cervi Cornu Parvum pharmaco-acupuncture may improve motor behavior, EMG, hematological, histological and immunological findings in Spinal Cord Injury(SCI)-induced rats. Especially, effects will be somewhat better in combination of these two treatments.

• Journal of the Korean Academy of Clinical Electrophysiology
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• v.1 no.1
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• pp.1-15
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• 2003

The purpose of this study was to determine the effect of neuromuscular electrical stimulation(NMES) on the alteration of spinal motor neuron excitability. In this article, I would like to experiment on a standard capacity of clinical electrophysiology, a difference in applying methods and a clinical efficiency of NMES by Nerve conduction velocity. We used normal eight subjects without neuromuscular disease and all subjects participated 3 session, which at least 1 week between session. Participants classified according to each group in Antagonist, Agonist, Antagonist-Agonist by the NMES. The test was measured continuously pre test, post-test, post 20 minute test by EMG including H reflex, F wave, motor nerve conduction velocity(MNCV). The following results were obtained; 1. H-reflex latencies and H/M intervals were significantly increased in agonist and antagonist-agonist group(p<.01). 2. H-reflex amplitudes and H/M ratios were significantly decreased in agonist and antagonist-agonist group(p<.01). In agonist group, H-reflex amplitudes and H/M ratios were more significantly decreased than antagonist group. 3. F-wave latencies were significantly increased in agonist and antagonist-agonist group(p<.01). F/M intervals were significantly increased in antagonist-agonist group(p<.01). F wave conduction velocities were significantly increased in agonist and antagonist-agonist group(p<.01) but F/M ratios were not significant. 4. MNCV were significantly decreased in agonist(p<.01). These results lead us to the conclusion that agonist and Antagonist-agonist was significantly decreased excitability of spinal motor neuron. Conversely, Antagonist does not decreased. Therefore, A further direction of this study will be to provide more evidence that NMES have an effect on excitability of spinal motor neurons in UMN syndrome.

• Archives of Plastic Surgery
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• v.36 no.1
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• pp.80-83
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• 2009

Purpose: Isolated hypoglossal nerve palsy is a rare manifestation of various underlying disease. This article presents a rare complication of general anesthesia associated with an surgical procedure on a case of zygomatic fracture. Methods: An 18-year-old female patient was referred to our department by painful swelling on her left zygomatic area after the traffic accident. Left zygomatic complex fracture was identified on the simple x-ray and facial bone CT scan, and the fracture was treated with open reduction and internal fixation under general anesthesia. On the first postoperative day, she complained of difficulty in swallowing solid food, dysarthria and deviated tongue to her right side. There was no abnormal findings on the neurological examination, brain MRI and routine chemistry. She was diagnosed with transient hypoglossal nerve palsy and dexamethasone with multi-vitamins was administrated intravenously for 5 days. Results: The symptoms were completely resolved by the ninth postoperative day and the patient was discharged without any other complications. Conclusion: The hypoglossal(cranial nerve XII)nerve supplies motor innervation to all of the ipsilateral extrinsic and intrinsic tongue muscles. The hypoglossal nerve damage may caused by the compression between the airway and the hyoid bone during the endotracheal intubation, and direct trauma due to excessive pressure or neck extension. We described a rare case of unintended injury to hypoglossal nerve and care must be taken not to cause the hypoglossal nerve damage especially in facial plastic surgery with excessive neck extension under general anesthesia.

• Journal of Korean Neurosurgical Society
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• v.64 no.6
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• pp.873-881
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• 2021

Objective : Peripheral nerve injuries occur mostly as a result of mechanical trauma. Due to the microvascular deterioration in peripheral nerve damage, it becomes challenging to remove free oxygen radicals. Gallic acid is a powerful antioxidant with anti-inflammatory effects and a free radical scavenger. The purpose of the study is to show that gallic acid contributes to the restorative effect in mechanical nerve damage, considering its antioxidant and anti-inflammatory effects. Methods : Thirty male Sprague Dawley albino mature rats were included in the study. Ten of them constituted the control group, 10 out of 20 rats for which sciatic nerve damage was caused, constituted the saline group, and 10 formed the gallic acid group. Post-treatment motor functions, histological, immunohistochemical, and biochemical parameters of the rats were evaluated. Results : Compared to the surgery+saline group, lower compound muscle action potential (CMAP) latency, higher CMAP amplitude, and higher inclined plane test values were found in the surgery+gallic acid group. Similarly, a higher nerve growth factor (NGF) percentage, a higher number of axons, and a lower percentage of fibrosis scores were observed in the surgery+gallic acid group. Finally, lower tissue malondialdehyde (MDA) and higher heat shock protein-70 (HSP-70) values were determined in the surgery+gallic acid group. Conclusion : Gallic acid positively affects peripheral nerve injury healing due to its anti-inflammatory and antioxidant effects. It has been thought that gallic acid can be used as a supportive treatment in peripheral nerve damage.