• Clinical Endoscopy
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• v.56 no.2
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• pp.239-244
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• 2023

Tuberculosis is an adverse event in patients with Crohn's disease receiving anti-tumor necrosis factor (TNF) therapy. However, tuberculosis presenting as a bronchoesophageal fistula (BEF) is rare. We report a case of tuberculosis and BEF in a patient with Crohn's disease who received anti-TNF therapy. A 33-year-old Korean woman developed fever and cough 2 months after initiation of anti-TNF therapy. And the symptoms persisted for 1 months, so she visited the emergency room. Chest computed tomography was performed upon visiting the emergency room, which showed BEF with aspiration pneumonia. Esophagogastroduodenoscopy with biopsy and endobronchial ultrasound with transbronchial needle aspiration confirmed that the cause of BEF was tuberculosis. Anti-tuberculosis medications were administered, and esophageal stent insertion through endoscopy was performed to manage the BEF. However, the patient's condition did not improve; therefore, fistulectomy with primary closure was performed. After fistulectomy, the anastomosis site healing was delayed due to severe inflammation, a second esophageal stent and gastrostomy tube were inserted. Nine months after the diagnosis, the fistula disappeared without recurrence, and the esophageal stent and gastrostomy tube were removed.

• The Journal of Pediatrics of Korean Medicine
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• v.32 no.3
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• pp.72-89
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• 2018

Objectives The objective of this study is to investigate the application of Sifeng point (EX-UE 10) in children and to make suggestions for domestic research and clinical application by reviewing relevant randomized controlled trials. Methods Eight electronic databases including English, Chinese, Korean databases were comprehensively searched for randomized controlled trials evaluating the effects of Sifeng point in children up to May 2, 2018. We extracted the year of publication, country, target diseases or symptoms, location of Sifeng, acupuncture method; such as acupuncture tool and depth of insertion, and frequency, number, and duration of the treatment. Results Fifty studies were included for analysis. All the included studies were conducted in China, and studies were published from 1962 to 2017. The most frequent target symptom was anorexia (46%). In addition, Sifeng point was used for digestive diseases or symptoms such as diarrhea, constipation, and mesenteric lymphadenitis, as well as respiratory diseases or symptoms such as cough, cold, acute bronchiolitis, recurrent respiratory tract infections, bronchopneumonia, and asthmatic bronchitis. Also, allergic diseases such as chronic urticaria, and other variety of symptoms such as malnutrition, fever, and iron-deficiency anemia were treated with the Sifeng point. The location of Sifeng points was inconsistent, and the most common location of the Sifeng point was the midpoint of transverse creases of the proximal interphalangeal joints of the index, middle, ring and little fingers (84.2%). The most commonly used acupuncture tool was three-edged needle (40.9%). All included studies have the method of squeezing out blood or mucus from the Sifeng points. The treatment was mostly conducted once per week (35.4%), mostly repeated for 4 times (32.6%). The most common treatment duration was 4 weeks (18.6%). Conclusions We could identify acupuncture method and various indications for the Sifeng points treatment. Based on this study, there is a need for the clinical application and related researches on the Sifeng points in children in Korea. In addition, the treatment location of Sifeng point should be standardized.

• Journal of Veterinary Clinics
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• v.28 no.6
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• pp.555-561
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• 2011

Laparoscopic surgery is a well-established alternative to open surgery across disciplines. However, in veterinary medicine, laparoscopic surgery in dogs was rarely reported because of small abdominal size for multiple ports insertion. The concept of single-incision laparoscopic surgery (SILS) is to perform the entire laparoscopic operation through a single incision rather than conventional multiple small skin incisions. Indirect evidence of potential benefits of SILS, decreases operative morbidity related to reduction in port size, already exists. Therefore, this study was performed to evaluate the safety and feasibility of the modified form of SILS using flexible endoscope in Cholecystectomy before clinical adoption. A 2 cm single periumbilical incision was performed, and flexible endoscope was introduced into the abdominal cavity. A laparoscopic grasper was inserted into the abdominal cavity for the traction of gall bladder. Cystic duct and artery were ligated by 5 mm Hem-o-lok$^{(R)}$. Then, gall bladder was dissected and resected from the liver with 5 mm Autonomy Laparo-Angle Maryland dissector and endoscopic needle knife. Resected gall bladder was wrapped by using specimen pouch and was retrieved through abdominal incision from the cavity. All three gall bladders were successfully removed. Hematological changes were not observed during examination periods. No leakage sign was identified at necropsy. The flexible endoscope, as distinct from conventional rigid laparoscope, allows the visualization from various angles and the wide range of motion, result in less crowding.

• Journal of Acupuncture Research
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• v.18 no.1
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• pp.76-87
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• 2001

Objective : Zusanli(ST36) and Hoku(Li4) are analgesic acupuncture points frequently used for acupuncture in Oriental medicine. The present study was conducted to see the antinociceptive effects produced by electroacupuncture combined two frequencies(Low, High) and two different acupuncture points(LI4, ST36) in the rat tail flick test. Method : In this study the Rats (Sprague-Dawley, 250-300g) were partially anesthetized with thiopental sodium(40mg/kg, i.p.). The basal reaction time for the tail-flick was 3${\pm}$0.5 sec. Low frequency(3Hz, 5V, biphasic) and high frequency(100Hz, 5V, biphasic) were applied to the inserted needle for the period of insertion(twenty minutes). Experimental groups are divied as follow; a) electroacupuncture stimulation groups at Hoku with or high frequency(L-EA, H-EA), b) electroacupuncture stimulation groups at Zusanli with low or high frequency(1-EA, h-EA), c) low frequency at Hoku and Zusanli(LIEA), d) low frequency at Hoku and high frequency at Zusanli(LhEA), e) high frequency at Hoku and low frequency at Zusanli(HIEA), f) high frequency at Hoku and Zusanli(HhEA) Results : The individual stimulation at either Hoku or Zusanli with low frequency has stronger and longer analgesic effect than high frequency stimulation. In addition, the combined stimulation at Hoku and Zusanli with low frequency has superior effect to individual stimulation with low frequency. LhEA and LIEA have superior effect to other stimulation groups among the combined groups. In order to determine the involvement of opioid system on the different antinociceptive effects, Naloxone, an opioid antagonist, was used in the combined groups. LIEA is the most sensitive when naloxone was administrated among study groups. HhEA is the least sensitive in the administration of naloxone. Conclusion : From results, this study confirmed that the opioid system is involved in analgesic effect of low frequency stimulation of acupuncture point, and we also can suggest the stronger analgesic effect of combining stimulation points is due to the theory of spatial summation in the nervous system.

• Journal of Acupuncture Research
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• v.20 no.3
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• pp.194-208
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• 2003

Objective : Recently, many studies have showed the evidences of the effect of acupuncture treatment through scientific methods. We performed electro-acupuncture on Taixi(K3) and observed the change of brain activity using fMRI. Methods : To see the effect of electro-acupuncture stimulation on Taixi(K3), the experiment was carried out on twelve healthy volunteers, using the gradient echo sequence with the 3.0T whole-body fMRI system(ISOL). After the needle insertion on K3, 2 Hz of electric stimulation was given for 30 seconds, repeated five times, with 30 seconds' intervals. Result & Conclusions : Unilateral electro-acupuncture stimulation on K3 increased the brain activity in Brodman Area 8, 6, 9, 13, 21, 22, 38, 40, 43, 2, 5, 10, 20, 24, 32, 34, 37, 39, 41, 42. and decreased the brain activity in Brodman Area 9, 13, 38, 22, 31, 3, 6, 10, 21, 25, 29, 30. Group Averaged Brain activity induced by Unilateral Electro-acupuncture Stimulation on K3 was increased in Brodman Area 10, 22, 42, 43, 44 and was decreased inn Brodman Area 6 and pyrogen test of Bee venom. Bilateral electro-acupuncture stimulation on k3 increased the brain activity in Brodman Area 22, 3, 19, 4, 13, 17, 21, 41, 42, 2, 5, 6, 7, 18, 23, 29, 30, 31, 40 and decreased the brain activity in Brodman Area 18, 6, 39, 4, 13, 2, 10, 19, 36, 40, 45, 46, 47. Group Averaged Brain activity induced by Bilateral Electro-acupuncture Stimulation on K3 was increased in Brodman Area 22, 13, 4, 3, 29, 38, 43 and was decreased in Brodman Area 18, 3, 19, 22, 39. Motor Stimulation activated Brodmann Area 6, 43, 18.

• Korean Journal of Acupuncture
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• v.34 no.1
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• pp.37-46
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• 2017

Objectives : The acupuncture about acupoint affects the production of NO, NOS, and NE.Local action of acupuncture is important for acupuncture treatment. To prove this, the revelation degree of NO, NOS, and NE was observed by stimulating the acupuncture at the connecting point of SP4, KI4, and LR5 in the depths of Superficial layer, Middle layer and Deep layer. Methods : Needles were inserted into rats, on each right and left sides of the connecting point, SP4, KI4 and LR5 acupoints which are the stream points of the foot meridian. After insertion, needles were retained for three minutes. After the retention, rat was sacrificed via cardiac puncture, and tissues of each SP4, KI4 and LR5 point near meridian vessel was extracted to examine the changes in the expression of NO, NOS and NE. Results : In terms of the effect in NO production, there was significant increase in the Superficial layer, Middle layer and Deep layer at KI4. In terms of the effect in NE production, there was significant decrease in the Superficial layer at SP4 and increase in the Superficial layer, Middle layer and Deep layer at LR5. In terms of the effect in nNOS production, there was significant increase in the Superficial layer, Middle layer and Deep layer at SP4 also in the Superficial layer at KI4. In terms of the effect in eNOS production, there was a significant increase in the Superficial layer, Middle layer and Deep layer at SP4, KI4 and LR5. In terms of the effect in iNOS production, there was significant increase in the Superficial layer, Middle layer and Deep layer at SP4, KI4 and LR5. Conclusions : The effect of acupuncture applied at the connecting point of six meridians of the foot on the activities of NO, NOS and NE could be observed, and it can be induced from the effect of needle stimulation on disrupted local and systemic nervous responses.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.2 no.1
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• pp.37-43
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• 1995

This study was conducted to compare the severity of cannulation pain in hemodialysis patients after topical application of EMLA cream and local injection of lidocaine and evaluated side effects and problems accompanied by the former. Twenty patients, who were on hemodialysis from September 1 to October 15, 1994 at the Kangnam St. Mary's Hospital, Catholic University Medical College, were divided into two groups of ten. To conduct a cross over study, two groups were placed on four repeated methods with lidocaine followed by four repeated methods with EMLA cream and vice versa, respectively, while the severity of cannulation pain was being measured according to a Visual Analogue Scale with each methods. The results are follows : 1) The scale of pain was recorded as $4.56{\pm}1.38$ and $2.05{\pm}1.36$ points for methods with lidocaine and EMLA cream, respectively, indicating the less severe pain with EMLA cream. 2) Local side effects such as itching(4 cases, 5.0%)and pallor (5 cases, 6.3%)were observed with methods with EMLA cream but disappeared before the completion of hemodialysis. 3) Problems associated with local lidocaine were pain at the injection of anesthetic (27cases, 16.9%)and fear for needle insertion(6 cases, 3.8%). The most frequent problems with EMLA cream application were an inconvenience in use (11 cases, 6.9%)and tedious long pretreatment time(11 cases, 6.9%), those associated with inconvenience in cream applying procedures. 4) Twelve out of twenty patients(60.0%) responded with yes to a continued use of EMLA cream in spite of problems with cream application and economical difficulties in purchasing. These results indicate that 5% EMLA cream used as a local anesthetic in hemodialysis significantly reduces cannulation pain and lacks side effects, thus serving as a suitable method for the alleviation of cannulation pain and inconvenience in hemodialysis and the relief of psychological stress of nurses.

• Journal of Korean Neurosurgical Society
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• v.64 no.6
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• pp.933-943
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• 2021

Objective : Percutaneous pedicle screw (PPS) fixation is a needle based procedure that requires fluoroscopic image guidance. Consequently, radiation exposure is inevitable for patients, surgeons, and operation room staff. We hypothesize that reducing the production of radiation emission will result in reduced radiation exposure for everyone in the operation room. Research was performed to evaluate reduction of radiation exposure by modifying imaging manner and mode of radiation source. Methods : A total of 170 patients (680 screws) who underwent fusion surgery with PPS fixation from September 2019 to March 2020 were analyzed in this study. Personal dosimeters (Polimaster Ltd.) were worn at the collar outside a lead apron to measure radiation exposure. Patients were assigned to four groups based on imaging manner of fluoroscopy and radiation modification (pulse mode with reduced dose) : continuous use without radiation modification (group 1, n=34), intermittent use without radiation modification (group 2, n=54), continuous use with radiation modification (group 3, n=26), and intermittent use with radiation modification (group 4, n=56). Post hoc Tukey Honest significant difference test was used for individual comparisons of radiation exposure/screw and fluoroscopic time/screw. Results : The average radiation exposure/screw was 71.45±45.75 µSv/screw for group 1, 18.77±11.51 µSv/screw for group 2, 19.58±7.00 µSv/screw for group 3, and 4.26±2.89 µSv/screw for group 4. By changing imaging manner from continuous multiple shot to intermittent single shot, 73.7% radiation reduction was achieved in the no radiation modification groups (groups 1, 2), and 78.2% radiation reduction was achieved in the radiation modification groups (groups 3, 4). Radiation source modification from continuous mode with standard dose to pulse mode with reduced dose resulted in 72.6% radiation reduction in continuous imaging groups (groups 1, 3) and 77.3% radiation reduction in intermittent imaging groups (groups 2, 4). The average radiation exposure/screw was reduced 94.1% by changing imaging manner and modifying radiation source from continuous imaging with standard fluoroscopy setting (group 1) to intermittent imaging with modified fluoroscopy setting (group 4). A total of 680 screws were reviewed postoperatively, and 99.3% (675) were evaluated as pedicle breach grade 0 (<2 mm). Conclusion : The average radiation exposure/screw for a spinal surgeon can be reduced 94.1% by changing imaging manner and modifying radiation source from real-time imaging with standard dose to intermittent imaging with modified dose. These modifications can be instantly applied to any procedure using fluoroscopic guidance and may reduce the overall radiation exposure of spine surgeons.

• Journal of Yeungnam Medical Science
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• v.35 no.2
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• pp.199-204
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• 2018

Background: The authors have performed ultrasound-guided stellate ganglion block (SGB) in our clinic using a lateral paracarotid approach at the level of the 6th cervical vertebra (C6). Although SGB at C6 is a convenient and safe method, there are ongoing concerns about the weak effect of sympathetic blockade in the ipsilateral upper extremity. Therefore, ultrasound-guided SGB was attempted using a lateral paracarotid approach at the level of the 7th cervical vertebra (C7). This prospective study aimed to compare changes in skin temperature after SGB was performed at C6 and C7, and to introduce a lateral paracarotid approach for SGB. Methods: Thirty patients underwent SGB twice: once at C6 and once at C7. For every SGB, the skin temperature of the patient's hypothenar area was measured for 15 min at 1-min intervals. Skin temperatures before and after SGB and side effects were compared between C6 and C7 groups. Results: The temperature of the upper extremity increased after SGB was performed at C6 and C7. There were significant differences between mean pre-SGB and the largest increases in post-SGB temperatures ($0.50{\pm}0.38^{\circ}C$ and $1.41{\pm}0.68^{\circ}C$ at C6 and C7, respectively; p<0.05). Significantly increased post-SGB temperatures (difference > $1^{\circ}C$) were found in 5/30 (16.7%) and 24/30 (80%) cases for C6 and C7, respectively (p<0.05). There were no significant differences in side effects between SGB performed at C6 or C7 (p>0.05). Conclusion: The lateral paracarotid approach using out-of-plane needle insertion for ultrasound-guided SGB performed at C7 was feasible and more effective at elevating skin temperature in the upper extremity than SGB at C6.

• Journal of Dental Anesthesia and Pain Medicine
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• v.24 no.1
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• pp.37-45
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• 2024

Background: The delivery of profound local anesthetics helps children receive successful treatment by reducing fear, anxiety, and discomfort during dental procedures. Local anesthetic injections are the most anticipated stimuli in dental surgery. Children's perceptions of pain can be altered by applying cryotherapy to precool the oral mucosa or by diverting their minds through taste distractions before administering local anesthetic injections. This study aimed to evaluate the efficacy of cryoanesthesia and xylitol sweet-tasting solution at the injection site in 7-10-year-old children. Methods: A total of 42 participants, aged 7-10 years, who underwent dental treatment requiring local anesthesia, were enrolled in the study. The children were randomly divided into three groups. In group I, sterile water was held in the mouth for 2 minutes before anesthetic administration, similar to group II, and in group III, a xylitol sweet-tasting solution was used for 2 minutes before needle insertion. The analysis of pain perception was carried out based on the Visual Analog Scale (VAS) and the Sound, Eyes, and Motor (SEM) scale. For VAS analysis, a one-way analysis of variance (ANOVA) was performed for intergroup comparison, and a post hoc Tukey test was performed for subgroup analysis. For the categorical SEM scale, the Kruskal-Wallis test followed by the post hoc test was performed for intergroup comparison. Where a P value of <0.05 was considered statistically significant at 95% confidence intervals. Results: Cryoanesthesia significantly reduced pain scores on VAS (4.21 ± 1.42) when compared to those on VAS with xylitol sweet-tasting solution (5.50 ± 1.40) and that with sterile water (6.14 ± 2.47). Intergroup comparison of the VAS scores among the three groups was performed using one-way ANOVA, which demonstrated statistically significant differences (P value <0.026) on the VAS scale. Intergroup comparison of the SEM scale was performed using the Kruskal-Wallis test, followed by post hoc comparison, which exhibited statistically significant differences (P < 0.007) among the three groups for the SEM scale. Conclusion: Cryoanesthesia demonstrated higher efficacy in reducing injection pain than that exhibited by the xylitol sweet-tasting solution.