• The Korean Journal of Pain
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• 제7권2호
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• pp.162-169
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• 1994

Blockade of cervicothoracic sympathetic ganglion (stellate ganglion controls pain on face, head, neck, shoulder, upper limbs, and upper chest, including their viscera and sympathetically maintained pain. This procedure also increases blood flow to the above areas and relieves hyperreactivity of sympathetic nervous system. Clinically, repeated stellate ganglion blocks with local anesthetic agent may become difficult with complications such as accidental intravascular or subdural injection, recurrent laryngeal nerve or bracheal plexus paralysis, pneumothorax and edema on injection site. Therefore, at times long-term cervicothoracic ganglion block with neurolytics is necessitated but its applications are prohibited by the critical structures surrounding ganglion. There are also few reports of neurolytic stellate ganglion block. This study was performed to observe the complications, gross changes of surrounding structures, and microscopic findings of ganglion cells after neurolytic block and to certify the possibility of clinical use of neruolytic stellate ganglion block. The unilateral superior cervical sympathetic ganglion of rabbit was blocked with absolute ethyl alcohol 0.4 ml at the level of cricoid cartilage. Normal ganglion was used as a control and 5 animals were sacrificed at each intervals of 7, 15 and 50 days after block. The results were as follows; 1) All experimental animals showed no specific changes of behavior, motor function. No necrotic tissues were present in the block area during the observation period. There were some gross scar tissues along the fascia of muscles surrounding the needle injection site, but gross atrophy of muscles or injured major vessels were not found. 2) Microscopically, structures of normal ganglion of rabbit were very similar to those of humans. Seven days after absolute ethyl achohol injection there were marked edema of ganglion cells and nuclei with irregular nuclear membrane. Some of the ganglion cells lost their nuclei and showed degenerative changes. Fifteen days after block, cell edema were decreased and loss of the Nissl's body was prominant. The ganglion cell structures looked close to normal but the cytoplasm and nucleus were generally contracted 50 days after block. These results suggest absolute ethyl alcohol injection on cervical sympathetic ganglion with above method mainly blocks pre- and post-synaptic fibers and the long-term neurolytic blockade of this ganglion may be possible in rabbits.

• The Korean Journal of Pain
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• 제28권3호
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• pp.210-216
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• 2015

Background: Infusion methods during regional analgesia using perineural catheters may influence the quality of postoperative analgesia. This study was conducted to compare the effects of combined or bolus-only infusion of 0.2% ropivacaine on the postoperative analgesia in interscalene brachial plexus block (ISBPB) with perineural catheterization. Methods: Patients scheduled for arthroscopic rotator cuff repair were divided into two groups, one that would receive a combined infusion (group C, n = 32), and one that would receive intermittent infusion (group I, n = 32). A perineural catheter was inserted into the interscalene brachial plexus (ISBP) using ultrasound (US) and nerve stimulation, and 10 ml of 0.2% ropivacaine was administered. After the operation, group C received a continuous infusion of 4 ml/h, and a 4 ml bolus with a lockout interval of 60 min. Group I received only a 4 ml bolus, and the lockout interval was 30 min. Postoperative pain by the numeric rating scale (NRS) and the forearm muscle tone by the manual muscle test (MMT) were checked and evaluated at the following timepoints: preoperative, and postoperative 1, 4, 12, 24, 36, and 48 h. Supplemental opioid requirements, total consumed dose of local anesthetic, and adverse effects were compared between the two groups. Results: Sixty-four patients completed the study and the postoperative values such as operation time, time to discharge, and operation site were comparable. There were no differences in NRS scores and supplemental opioid requirements between the two groups. The MMT scores of group I at 4 and 12 h after surgery were significantly higher than those of group C (P < 0.05). The total consumed dose of local anesthetic was significantly lower in group I than in group C (P < 0.05). The adverse effects were not different between the groups. Conclusions: The bolus-only administration of 0.2% ropivacaine provided a similar analgesic effect with a lower total volume of local anesthetic and decreased motor weakness compared to combined infusion. Therefore, bolus-only administration is an effective postoperative analgesic method in ISBPB with perineural catheterization after rotator cuff repair.

• 대한물리치료과학회지
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• 제5권3호
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• pp.643-650
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• 1998

저자들은 1996년 3월부터 1997년 3월까지 계명대학교 동산의료원 물리치료실에서 치료를 받은환자 중 안면신경 마비 증세를 나타낸 39례에 대하여 임상적인 고찰을 시행하여 다음과 같은 결과를 얻었다. 1) 연령별로는 30대에서 10례(24.6%)로 가장 많았다. 2) 성별로는 남자 21례(53.8%), 여자 18례(46.2%)였다. 3) 발생부위는 우측 19례(48.7%), 좌측 18례(46.2%)였다. 4) 발생원인별로는 원인불명(Bell's palsy) 19례(48 7%), 염증, 종양 각 6례(15.4%), 외상성 5례(12.9%), 대사성 2례(5.1%), 선천성 1례(2.6%)였다. 5) 병변의 발생에서 최초 치료일까지의 기간은 10일 이내가 26례(66.7%), 11-20일은 8례 (20.5% )였다. 6) 치료기간은 평균 25.21이며, 치료기간과 회복율의 상관관계는 통계학적 유의성은 없었다. 7) 치료 후 치료결과는 상당히 좋은 것으로 나타났다.

• Archives of Plastic Surgery
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• 제47권2호
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• pp.135-139
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• 2020

Background This study aimed to determine the magnitude of volume reduction of the latissimus dorsi (LD) muscle after treatment using only postoperative radiotherapy (PORTx) in patients who underwent immediate breast reconstruction using an extended LD musculocutaneous (eLDMC) flap after partial mastectomy. Methods We retrospectively reviewed 28 patients who underwent partial mastectomy and an eLDMC flap, received only PORTx, and underwent chest computed tomography (CT) 7 to 10 days after surgery and 18±4 months after the end of radiotherapy, from March 2011 to June 2016. The motor nerve to the LD was resected in all patients. One plastic surgeon performed the procedures, and the follow-up period was at least 36 months (mean, 46.6 months). The author obtained LD measurements from axial CT views, and the measurements were verified by an experienced radiologist. The threshold for statistical significance was set at P<0.05. Results A statistically significant decrease in the LD volume was found after the end of PORTx (range, 61.19%-80.82%; mean, 69.04%) in comparison to the measurements obtained 7 to 10 days postoperatively (P<0.05). All cases were observed clinically for over 3 years. Conclusions The size of an eLDMC flap should be determined considering an average LD reduction of 69% after PORTx. Particular care should be taken in determining the size of an eLDMC flap if the LD is thick or if it occupies a large portion of the flap.

• Journal of Acupuncture Research
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• 제18권2호
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• pp.51-66
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• 2001

The purpose of this morphological studies was to investigate the central neural pathway projecting to the acupoints $B_{62}$ and $K_6$ using the neuroanatomical method following injection of transsynaptic neurotropic virus, pseudorabies virus(PRV-Ba and PRV-Ga) into the $B_{62}$ and $K_6$. After survival times of 96 hours following injection into the twenty rats with PRV-Ba(Bartha strain) and PRV-Ga(Bartha strain, ${\beta}$-galacidodase insertion). They were perfused, and their spinal cord and brain were frozen sectioned($30{\mu}m$). These sections were stained by X-gal histochemical and PRV immunohistochemical staining method, and observed with light microscope. The results were as follows : 1. In spinal cord, overlaped PRV-Ba and PRV-Ga labeled neurons projecting to the $B_{62}$ and $K_6$ were founded in thoracic, lumbar and sacral spinal segments. In thoracic spinal segments, Densely labeled areas were founded in lamina IV, V, VII(intermediolateral nucleus) and X areas. In lumbar segemnts, labeled areas were founded in lamina II, IV, V and X areas. In sacral spinal segments, labeled areas were founded in lamina IV, V and VI areas. 2. In brain, overlaped PRV-Ba and PRV-Ga labeled neurons projecting to the $B_{62}$ and $K_6$ were founded in the $A_1$ noradrenalin cells/$C_1$ adrenalin cells/caudoventrolateral reticular nucleus, rostroventrolateral reticular nuclens, nucleus tractus solitarius, area postrema, raphe obscurus nucleus, raphe paltidus nucleus, raphe magnus nucleus, lateral paragigantoceltular nucleus, lateral rcticular nucleus, gigantocellular nucleus, locus coeruleus, subcoeruleus nucleus, motor trigeminal nucleus, Kolliker-Fuse nucleus, $A_5$ cell group, central gray matter, oculomotor nerve, paraventricular hypothalamic nucleus, median eminence, amygdaloid nucleus, frontal cortex, forelimb area, hindlimb area, 1, 2 areas of parietal cortex and granular and agranular cortex. This results were suggest that overlaped PRV-Ba and PRV-Ga labeled areas projecting to the $B_{62}$ and $K_6$ may be related to the emotional relay pathway in the central autonomic center.

• Journal of Acupuncture Research
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• 제17권2호
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• pp.95-117
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• 2000

The purpose of this morphological studies was to investigate the relation between the meridian, acupoints and viscera using neuroanatomical tracers. The common locations of the spinal ganglia, sympathetic chain ganglia, spinal cord and brain projecting to the large intestine meridian were observed following injection of transganglionic tracer, WGA-HRP and transsynaptic neurotropic virus, pseudorabies virus(PRV), Bartha strain(Ba) and PRV-Ba-Gal (Galactosidase)) into the the large intestine(cecum, colon and rectum), ST37 and LI4. After survival times of 96 hours following injection into the thirty rats with WGA-HRP, PRV-Ba and PRV-Ba-Gal. They were perfused, and their spinal ganglia, sympathetic chain ganglia, spinal cord and brain were frozen sectioned($30{\mu}m$). These sections were stained by HRP and X-gal histochemical and PRV immunohistochemical staining method, and observed with a light microscope. The results were as follows : 1. WGA-HRP labeled neurons innervating the large intestine were observed bilaterally within the T13-L4 sympathetic chain ganglia, and T9-11 spinal ganglia. WGA-HRP labeled neurons innervating ST37 were observed within the L3-5 sympathetic chain ganglia, and L2-4 spinal ganglia. WGA-HRP labeled neurons innervating LI4 were observed in the middle cervical ganglion and stellate ganglion, and C5-8 spinal ganglia. 2. In spinal cord, PRV-Ba labeled neurons projecting to the large intestine, ST37 and LI4 were found in thoracic, lumbar and sacral spinal segments. Densely labeled areas of each spinal cord segment were founded in lamina N, V, VII(intermediolateral nucleus), Ⅸ, X and dorsal nucleus. 3. In medulla oblongata, PRV-Ba and PRV-Ba-Gal labeled neurons projecting to the large intestine, ST37 and LI4 were commonly found in the A1 noradrenalin cells/C1 adrenalin cells/caudoventrolateral reticular nucleus, dorsal motor nucleus of vagus nerve, nucleus tractus solitarius, raphe obscurus nucleus, raphe pallidus nucleus, raphe magnus nucleus and gigantocellular nucleus. 4. In pons, PRV-Ba and PRV-Ba-Gal labeled neurons were commonly found in locus coeruleus, Kolliker-Fuse nucieus and A5 cell group. 5. In midbrain, PRV-Ba and PRV-Ba-Gal labeled neurons were commonly found in central gray matter. 6. In diencephalon, PRV-Ba and PRV-Ba-Gal labeled neurons were commonly found in paraventricular hypothalamic nucleus. These results suggest that PRV-Ba and PRV-Ba-Gal labeled common areas projecting to the large intestine may be correlated to that of the large intestine meridian, ST37 and LI4. Especially, These morphological results provide that interrelationship of meridian-acupoints -viscera may be related to the central autonomic pathways.

• The Korean Journal of Pain
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• 제20권2호
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• pp.116-122
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• 2007

Background: Lumbar zygapophysial joints are a common source of chronic lower back pain and radiofrequency thermocoagulation (RF) of the medial branches (MB) has been shown to be effective at providing substantial pain relief for chronic low back pain. Therefore, we carried out this study to determine the short term outcomes and prognostic factors of RF on the MB of patients with lumbar facet syndrome. Methods: We performed RF in fourteen patients who showed greater than 80% pain relief up to three times after a diagnostic MB block was conducted using 0.3 ml of 0.5% bupivacaine. Using 10 cm curved electrodes with 10-mm active tip, a 60 second, $80^{\circ}C$ lesion was made after electrical stimulation at 50 Hz for sensory and 2 Hz for motor nerve testing. The degree of pain relief was then assessed after 2 weeks, and again after 3 months using a visual analog scale (VAS) and a four point Likert scale. The outcome was regarded as 'success' if at least a 50% reduction in the VAS was observed. Possible prognostic factors between the two groups were also evaluated Results: The success rate was 71.4% (10/14) after three months of follow-up. However, there were transient complications, such as neuritis like syndrome, in 4 patients. In addition, short symptom duration and low minimal voltage (< 0.4 V) for sensory stimulation were shown to be the relevant prognostic factors for a successful outcome. Conclusions: RF may be an alternative to repeated MB block or intraarticular injection for palliation of lumbar facet syndrome. For better outcomes, early diagnosis and strict patient selection should be coupled with efforts to avoid anatomically incorrect RF.

• Applied Microscopy
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• 제29권1호
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• pp.105-124
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• 1999

마우스(ICR mouse)의 신경배형성에 따른 뇌 및 척수 신경상피의 조직학적 및 미세구조적 분화를 관찰하여 다음과 같은 결과를 얻었다. 배발생 8일 (embryonic day 8) 마우스배 (mouse embryo)에서 위중층원주상피의 신경판 및 신경고랑이 형성되었고, 배발생 9일에서는 두부의 전단부 및 말단부를 제외한 전 체장에서 신경관이 형성되었으며, 배발생 10일에서는 미아에서 이차신경배형성이 이루어졌다. 배발생 8일 마우스배의 미부 말단부에서는 신경상피와 중간엽과의 경계가 불분명한 원시선이 관찰되었고, 두부에서는 신경상피, 척삭 및 중간엽세포의 구분이 분명하였다. 배발생 9일과 10일 마우스배의 경우, 후뇌 부위에서는 표피 외배엽세포의 결합에 의하여, 척수 부위에서는 신경상피세포의 결합에 의하여 덮개판을 이루어졌고, 바닥판은 높이가 낮은 위중층원주상피세포로 이루어겼다. 배발생 10일 마우스배에서 척수의 운동신경이 처음 분화되었다. 배발생 9일과 10일 마우스배에서 신경상피세포들은 세포소기관의 분화 및 전자밀도의 차이에 따라 암세포, 중간형세포 및 명세포로 구분되었다. 배발생 9일에서는 모든 형의 세포가 관찰되었으나, 배발생 10일에서는 중간형 및 명세포들 만이 관찰되었다. 모든 신경상피세포에서 free ribosome 및 polysome들이 다같이 발달하였으나, 암세포에서는 RER과 lipid droplet들, 중간형세포와 명세포에서는 Golgi체들이 발달하였다. 중간형세포의 세포질돌기에서는 신경미세섬유, 명세포의 세포질들기에서는 신경미세섬유 뿐만 아니라 미세소관들도 다수 관찰되었다.

• Clinical and Experimental Pediatrics
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• 제50권9호
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• pp.891-895
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• 2007

목 적 : ADEM은 급성 중추 신경계의 탈수초성 질환으로 병태 생리학적 기전은 확실히 밝혀지지 않았으나 대부분 바이러스 감염 또는 예방 접종 후 수일에서 수주일 경과 한 후에 발병하며, 면역학적 기전이 관여 하는 것으로 알려져 있다. 임상 양상과 예후에 있어서도 다양하게 나타나며, 대부분은 단상성의 경과를 보이는 양성 질환으로 알려져 있다. 뇌 자기공명영상 병변은 전형적인 경우 주로 백질에서만 관찰되나 심부 회백질을 침범하는 경우도 드물지 않게 보고 되고 있다. 이에 다양한 임상 증상과 예후가 뇌 병변의 위치에 의한 것이라 생각되어, 후향적으로 자기공명영상 소견과 의무기록지를 통하여 조사하였다. 방 법 : 1995년 1월부터 2003년 8월까지 경희대학교 소아과에 ADEM으로 입원한 환자 21명을 의무 기록을 토대로 조사하였다. 자기공명영상 소견에 따라 1군은 백질에 국한된 다중 또는 단일 병변, 뇌실 주위 및 소뇌의 병변도 포함된 경우로 분류하였으며, 2군은 심부 회백질 또는 피질 병변으로 백질을 침범하는 경우로 분류하였다. 두 군간에 선행 증상이나, 발병 시 신경학적 증상, 뇌 척수액 소견, 신경학적 후유증을 비교분석 하였다. 결 과 : 두 군에 있어 선행 증상의 빈도를 보면 아무런 선행 증상 없이 발병한 경우가 38.1%로 가장 많았으며 상부 호흡기 감염 증상이 28.6%였고, 두 군간에 선행 증상에 대한 통계학적 차이는 없었다. 발병 당시 증상을 보면 경련이 76.2%, 두통과 구토 증상이 47.6%, 의식의 변화가 38.1%로 관찰되었으며 두 군간에 통계학적 차이가 없었다. 검사 결과 백혈구 증다증이 38.1%, 뇌척수액 소견상 세포 증다증이 76.2%에서 보였으며, 뇌척수액 내 단백질 증가가 28.6%에서 관찰되었으며 두 군간에 통계학적 차이는 없었다. 예후에 있어서도 15명인 71.4%가 정상화 되었으며 지속된 경련은 19%, 운동 장애는 19%에서 보였으며 두 군간에 통계학적 차이가 없었다. 결 론 : 이번 연구에서 병변의 차이에 따른 임상 양상과 예후에 있어 차이가 없는 것으로 관찰되나, 다양한 증상과 다양한 병변 및 예후를 보이고 있어 수많은 다른 면역학적 기전을 가진 이종성 질환이 아닌지 의심된다. 아직까지 ADEM의 진단 기준은 임상 증상과 자기공명영상 소견에 의존하여 다소 불분명하다. 이에 ADEM에 대한 연구가 더 필요할 것이라 생각되며, 아울러 초기 자기공명영상 검사와 추적 관찰에 있어 좀더 세심한 주의와 연구가 필요하겠다.

• 생명과학회지
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• 제29권7호
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• pp.800-808
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• 2019

샤르코-마리-투스병(Charcot-Marie-Tooth disease: CMT)은 희귀 말초신경병의 그룹으로, 진행성 근육 약화 및 위축, 감각 소실, 상지 및 하지의 무반사 증상을 나타낸다. CMT1A는 PMP22 유전자가 존재하는 17p12 지역의 직렬 중복으로 발병하는데, 유전자형-표현형의 상관성이 느슨하여 2차 유전적 요인의 존재를 암시한다. 최근 MIR149의 rs71428439 (n.83A>G)와 rs2292832 (n.86T>C) 변이가 후기 발병 및 가벼운 증상의 표현형과 연관성이 있는 것으로 보고되었다. 본 연구는 CMT1A 기계내 임상적 표현형의 이질성이 MIR149의 SNP과 연관성이 있는지를 규명하기 위해 수행하였으며, 조사 대상으로는 가계내 표현형의 차이가 심한 6 CMT1A 대 가계를 대상으로 하였다. 그 결과, MIR149의 rs71428439와 s2292832 유전자형은 가족내의 늦은 발병과 약한 중증도의 유전적 요인으로 작용할 수 있음을 제시하였다. 특히, AG+GG (n.83A>G)와 TC+CC 유전자형(n.86T>C)은 발병 시기가 늦고 경미한 증상을 보였다. 운동신경 전기전도도(MNCV)는 MIR149 유전형과 연관이 없는 것으로 보였는데, 이러한 결과는 이전 연구와 일치한다. 따라서 본 연구는 MIR149의 rs71428439와 rs2292832 변이는 CMT1A 가계내 표현형적 이질성의 원인 중 하나로 작용할 가능성을 제시한다. 본 연구는 가계 내 증상의 차이가 심한 6 대가족을 사용하여 연구를 수행한 것은 의미가 크다고 여겨지며, 이런 결과는 CMT1A 환자의 분자 진단과 치료에 도움을 줄 수 있을 것으로 기대된다.