• 대한임상검사과학회지
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• 제51권4호
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• pp.453-461
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• 2019

수술 중 발생하는 신경계 손상 여부를 감별하는 검사인 수술 중 신경계 모니터링(intraoperative neurophysiological monitoring, INM) 검사는 다양한 수술에서 안정적으로 수술이 잘 진행되고 있음을 확신하며 수술을 진행할 수 있도록 도움을 주는 매우 중요한 검사다. 수술실이라는 특수한 환경에서 검사의 최적화를 위하여 침 전극을 사용하여 검사를 진행하며, 수술실검사에 대하여 정확한 자극부위와 측정부위에 대한 교재나 안내책자가 없는 것이 실정이다. 그래서 이번 논문에서 운동유발전위검사, 체성감각유발전위검사, 청각유발전위검사, 시각유발전위검사에서 올바른 자극부위와 측정부위에 대하여 자세하게 설명을 하였다. 그리고 자유진행 및 유발근전도검사(free-running and triggered EMG)는 근육에서 발생하는 근전도의 관찰로 대부분의 뇌신경(cranial nerve)과 척수신경근(spinal nerve root)의 기능상태 파악을 한다. 검사의 이해를 돕기 위해 각각의 해당 근육에 전극을 삽입하는 사진을 첨부하였고, 척수신경근에 따른 해당근육도 표로 제시하였다. 검사 후 전극제거를 할 때에도 환자와 검사자 모두 안전한 방법을 제시하여 보다 완벽한 검사가 되었으면 한다.

• Archives of Plastic Surgery
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• 제37권1호
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• pp.95-98
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• 2010

Purpose: One of the most common cause of upper extremity lymphedema is breast cancer surgery. We experienced the nerve entrapment syndrome which was associated with postmastectomy lymphedema. To the best of our knowledge, this is the first case report of lymphedema induced nerve entrapment syndrome on upper extremity in Korea. Methods: A 54-year-old woman presented with a tingling sensation on her right hand, which had been present for 1 year. On her history, she had a postmastectomy lymphedema on her right upper extremity for 20 years. Initial electromyography (EMG) showed that the ampulitude of the median, ulnar, and dorsal ulnar cutaneous nerve were decreased, and conduction block was also seen in median nerve across the wrist. In needle EMG, incomplete interference patterns were observed in the muscles innervated by median and ulnar nerves. In conclusion, electrophysiologic study and clinical findings suggested right median and ulnar neuropathy below the elbow. Therefore, we performed surgical procedures, which were release of carpal tunnel, Guyon's canal, and cubital tunnel. Results: The postoperative course was uneventful until the first two years. The tingling sensation and claw hand deformity were improved, however, the motor function decreased progressively. In 7 years after the operation, patient could not flex her wrist and thumb sufficiently. EMG which was performed recently showed that ulnar motor response was of low ampulitude. Moreover, median, ulnar, dorsal ulnar cutaneous, lateral antecubital cutaneous and median antebrachial cutaneous sensory response were unobtainable. Abnormal spontaneous activities were observed in upper arm muscles. In conclusion, multiple neuropathies were eventually developed at above elbow level. Conclusion: On treating nerve entrapments associated with lymphedema, medical professionals should be fully aware of the possibility of unpredictable results after the surgery, because of the pathophysiologic traits of chronic lymphedema.

• Journal of Acupuncture Research
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• 제15권2호
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• pp.369-382
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• 1998

The purpose of this study was finding the pain inhibitory effect of acupuncture at $LI_4$. The pain at dentes incisivi was evoked by noxious electric stimulation and EMG changes based on the interval were measured. To do this, the opioid antagonist was administered intraperitoneally. Following are some of results. 1. The pain inhibitory effect of acupuncture at $LI_4$ was 94.35%, 84.56%, 57.62%, 54.40%, at 10, 20, 30 and 40 minutes respectively. All the data were calculated based on 100% at 0 minute. The effect was very significant at 40 minutes. 2. The continuous effect of acupuncture at $LI_4$ after taking out the needle was 58.58%, 57.62%, 66.22%, 73.18%, 83.70%, 92.68%, at 50, 50, 70, 80, 90 and 100 minutes respectively. The overall continuous effect was shown its maximum 20 minutes after taking out the needle and reached to the initial value at 60 minutes. 3. The pain inhibitory effect following the naloxone administration and acupuncture application at $LI_4$ was 95.96%, 96.04%, 94.86%, 94.92% at 10, 20, 30 and 40 minutes respectively. All values showed similar tendency to the initial data. 4. The continuous effect of acupuncture at $LI_4$ after taking out the needle which was preceded by the naloxone administration was 94.48%, 96.02%, 96.02%, 98.00%, 98.46%, 97.18% at 50, 60, 70, 80, 90 and 100 minutes respectively. This trend was not a significant fluctuation. It was concluded that effect of acupuncture at $LI_4$ was shown in conjunction with secretion of analgesic substance. Therefore it is implied that the acupuncture application will play a major role in treating many diseases with more revelation of scientific acupuncture mechanism. Further studies of acupuncture manipulation are needed in the future based on our study.

• Journal of Acupuncture Research
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• 제15권2호
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• pp.287-300
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• 1998

The purpose of this study was finding the pain inhibitory effect of acupuncture at ST-36. The pain at dentes incisor was evoked by noxious electric stimulation and EMG changes based on time interval were measured. To do this, the opioid antagonist was administered intraperitoneally. Followings are some of the results. 1. The pain inhibitory effect of acupuncture at ST-36 was 93.82%, 87.00%, 75.30%, 69.76% at 10 20, 30 and 40 minutes respectively. All the data were calculated based on 100% at 0 minute. The effect was very significant at 40 minutes. 2. The continuous effect of acupuncture at ST-36 after taking out the needle was 77.46%, 79.66%, 87.60%, 91.50%, 95.14%, 99.48% at 50, 60, 70, 80, 90 and 100 minutes respectively. The overall continuous effect was shown its maximum 20 minutes after taking out the needle and reached to the initial value at 60 minutes. 3. The pain inhibitory effect following the naloxone administration and acupuncture application ST-36 was 93.44%, 94.58%, 90.80%, 88.04% at 10, 20, 30 and 40 minutes respectively. All values showed similar tendency to the initial data. 4. The continuous effect of acupuncture at ST-36 after taking out the needle which was preceded by the naloxone administration was 91.26%, 91.90%, 92.06%, 93.66%, 94.12%, 93.50% at 50, 60, 70, 80, 90 and 100 minutes respectively. This trend was not a significant fluctuation. It Was concluded that effect of acupuncture at ST-36 was shown in conjunction with secretion of analgesic substance. Therefore it is implied that the acupuncture application will play a major role in treating many diseases with more revelation of scientific acupuncture mechanism. Further studies of acupuncture manipulation are needed in the future based on our study.

• The Journal of Korean Physical Therapy
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• 제6권1호
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• pp.17-22
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• 1994

The purpose of this study were to identify the correlation of shoulder pain to Cervical Pathology and effectiveness of Cervical treatment on the neck and shoulder. Sixty patients complaining of shoulder pain only without neck pain were evaluated by physical examination. Cervical X- rays and electrodiagnostic Study. The results were as follows: 1) Forty nine Cases were abnormal in plain Cervical spine X-ray with straightening of Cervical lordotic curve in 41 cases, Cervical spondybsis 16 cases and disc space narrowing in 4 cases. 2) Cervical radiculopathies were diagnosed 52 cases which showed abnormal spontaneous activities in needle. EMG : 26 cases in paraspinal muscles and 26 cases in both paraspinal and upper extremity muscles. 3) The results of treatment were excellent in 6 cases, good in 6 cases and fair in 32 cases. 4) Treatment side were effective with shoulder and conical in 36 cases.

• Annals of Clinical Neurophysiology
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• 제4권1호
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• pp.7-11
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• 2002

Among drug-induced myopathy, steroids are probably the most common cause. The risk of steroid myopathy(SM) increases with the dose and duration of use. It is typically a proximal myopathy, preferentially affecting the hip girdle muscles. Motor and sensory nerve conduction studies are normal. The needle EMG is usually within the normal range or may be minimally abnormal. Occasionally, low-amplitude, short-duration MUAPs may be seen in the proximal muscles. Of note, abnormal spontaneous activity is not seen. This point is often very useful in differentiating polymyositis(PM) from SM. It is common for patients with PM to be treated with steroids, respond well, and then have the steroids tapered. If muscle weakness then returns, it may be very difficult to differentiate recurrent PM from SM on clinical grounds. The presence of abundant abnormal spontaneous activity strongly suggests PM rather than SM.

• Annals of Clinical Neurophysiology
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• 제5권1호
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• pp.11-15
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• 2003

Backgrounds: Kennedy disease is a X-linked recessive disease characterized by bulbar symptoms, proximal muscle weakness, and gynecomastia. Methods: We analyzed clinical symptoms and performed electrodiagnostic studies on 6 patients. Results: We found following features: 1) proximal muscle weakness 2) bulbar symptoms, as dysarthria, facial and tongue atrophy 3) hyporeflexia or areflexia 4) fasciculations, predominantly on face, and proximal upper extremities 5) decreased sensory nerve action potentials(SNAPs) 6) chronic neurogenic changes in needle EMG. Conclusions: Kennedy disease is characterized by degenerative process of anterior horn cell and dorsal root ganglion without upper motor neuron dysfunction. Increased triple nucleotide CAG repeats(>38) in androgen receptor gene of Xp21 will confirm early stage of this disease.

• Annals of Clinical Neurophysiology
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• 제9권1호
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• pp.11-15
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• 2007

Background: The term "overlap syndromes" designates a group of diseases in which polymyositis (PM) or dermatomyositis (DM) is associated with some other disorders of connective tissues. The aim of this study was to delineate the clinical features, laboratory findings, and outcome of treatment of "overlap syndromes" Methods: We analyzed the medical records of 16 patients (PM in 10, DM in 6) with well documented "overlap syndromes" between 1997 and 2004. The diagnosis was made when the criteria for two different disorders were fulfilled. Results: All patients were female. Age of onset ranged from 14 to 52 years (mean 29.8 years) with peak incidence in the third and fourth decades. Systemic lupus erythematosus (SLE) was associated in 10, systemic sclerosis in 7, and rheumatoid arthritis in 3 patients. Four of the patients had two different connective tissue diseases simultaneously. The characteristic clinical features were muscle weakness, arthralgia, Raynaud's phenomenon, and myalgia. In laboratory tests, creatine kinase (CK), lactic dehydrogenase (LDH), and transaminases were usually abnormal. Positive antinuclear antibody (ANA), rheumatoid factor (RF), and cryoglobulin were found in 100%, 69%, and 67% of the patients, respectively. Needle electromyography (EMG) showed abnormal findings compatible with myopathy in 15 patients. The pathology of muscle biopsy from 14 patients revealed findings compatible with inflammatory myopathy. Glucocorticoids were administered to 15 patients. The muscle strength improved in all the treated patients, which was well correlated with repeat CK level and EMG findings. Conclusions: The presence of autoantibodies such as ANA, RF, and cryoglobulin in patients with PM or DM highly suggests the possibility of an overlap syndromes. These syndromes reveal a strong female predominance. The myositis associated with them usually shows a good response to glucocorticoids treatment.

• Korean Journal of Acupuncture
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• 제29권1호
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• pp.83-92
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• 2012

Objectives : The purpose of this research was to develop the magnetic acupuncture system which used solenoid coil for magnetizing acupuncture needle. The system could generate the meridian electric potential (MEP) similar to the potential by manual acupuncture. Thus, we tried to confirm the therapeutic effect that is caused by the MEP generation. Methods : To confirm the MEP, we stimulated the magnetic acupuncture with at 2Hz, $92.7{\pm}2mT$, PEMFs (Pulsed Electro-Magnetic Fields) at ST37 and measured the evoked potential between ST36 and ST41. Also, we conducted a fatigue recovery test using isokinetic exercise in order to identify the therapeutic effect on musculoskeletal disorders. We chose LR9 as a stimulation point. To observe the state of fatigue, we measured the EMG and analyzed median frequency and peak torque for 20minutes. Results : We observed that MEP which incurred from magnetic acupuncture was higher than he reported MEP induced by manual acupuncture. Moreover, its modes were divided into two types by the direction of magnetic flux. When generating magnetic flux in the direction of acupoint, the positive peak voltage of the MEP was generated. In contrast, negative peak voltage of the MEP was generated whenever meganetic flux generated in the outward direction. As a result of fatigue recovery, the median frequency (MF) of the magnetic acupuncture group were recovered faster than that of the non-stimulation group. However, the peak torques of both groups were not restored until after 20 minutes. Conclusions : We confirmed that the magnetic acupuncture system can lead to the MEP similar to manual acupuncture. Moreover, the MEP had a therapeutic effect on the musculoskeletal disorders.

• 대한골관절종양학회지
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• 제3권2호
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• pp.80-88
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• 1997

저온 열처리 후 신경의 기능적 회복과정을 연구하기 위해 가토의좌골 신경을 $60^{\circ}C$로 30분간 처리한 후 2주, 4주, 8주, 12주, 16주 후에 근전도 검사 및 조직학적 검사를 실시하여 다음과 같은 결과를 얻었다. 1. 신경전도 검사에서 평균 진폭은 실험 2주째에는 5마리 중 1마리를 제외하고는 측정되지 않았으며, 4주째에는 대조군의 7.2%, 8주째에는 26.8%, 12주째에는 52.9%, 그리고 16주째에는 89.5%의 수준으로 회복되었다. 평균 잠복기는 정상 대조군에서 0.62msec였으며, 실험군에서는 4주째에 3.58msec, 8주째에 2.68msec, 12주째에 1.2msec로 시간이 경과함에 따라 회복되어, 16주째에는 0.622msec로 대조군과 차이가 없었다. 2. 침근전도 검사에서 실험 2, 4, 8주째까지는 많은 수의 세동전위 및 양성 예파가 관찰되었으나, 12주째부터는 그 수가 감소하여 16주째에는 세동전위는 관찰되지 않았고 양성 예파만 관찰되어 손상된 신경이 회복됨을 나타내었다. 3. 조직학적 검사에서 실험 2주 및 4주째에는 유수신경섬유에 상당한 공포성 변성이 있고 신경섬유의 수가 감소된 것을 관찰할 수 있었으나, 시간이 경과할수록 신경섬유의 수가 점차 회복 되었으며 16주째에는 대조군과 차이가 없었다. 이상의 성적으로 미루어 보아 저온열처리에 의해 손상된 신경은 처리후 시간이 경과하며 기능적으로나 형태적으로 회복되므로, 임상적으로 신경이 종양조직으로 둘러싸이거나 접촉된 사지에서도 사지보존술이 가능할 것으로 사료된다.