• Title/Summary/Keyword: Phrenic nerve

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A Successful Direct Phrenic Nerve Reconstruction in the Course of Malignant Thymoma Resection (악성 흉선종 절제술 중의 성공적인 횡격막 신경 직접 재건술)

  • Lee, Seong-Kwang;Kim, Yeon-Soo;Park, Kyung-Taek;Jang, Woo-Ik;Ryoo, Ji-Yoon;Kim, Chang-Young;Cho, Seong-Joon;Choe, Hyun-Min
    • Journal of Chest Surgery
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    • v.42 no.3
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    • pp.401-403
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    • 2009
  • We performed nerve resection and reconstruction of the phrenic nerve in a 63-year-old female patient who underwent complete resection of a malignant thymoma. The left phrenic nerve was completely encased by the tumor for 2 cm. Thus, a 3 cm long piece of phrenic nerve with 5 mm margins of safety on each end was resected and it was directly anastomosed in an end-to-end fashion. At 11 months after reconstruction, fluoroscopy demonstrated adequate and symmetric motion of both hemidiaphragms, which indicated the restoration of phrenic nerve function. The pulmonary function test results were comparable to those obtained preoperatively at 30 months. There has been no evidence of recurrence at the recent follow up visits.

The Effect of Phrenic Nerve Paralysis After Pediatric Cardiac Surgery on Postoperative Respiratory Care (소아 심혈관 수술 후 발생한 횡격신경마비가 술후 호흡관리에 미치는 영향)

  • 윤태진;이정렬
    • Journal of Chest Surgery
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    • v.29 no.10
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    • pp.1118-1122
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    • 1996
  • From January 1990 through December 1995, 43 patients underwent diaphragmatic plication for the management of phrenic nerve palsy .complicating various pediatric cardiovascular surgery. Their mean age at plication was 11.1 months and sex ratio was 31 males to 12 females. In order of decreasing incidence, the primary cardiovascular procedures included modified Blalock-Taussig shunt (7), total correction for the Tetralogy of Falloff (7), arterial switch operation (6), unifocalization for the pulmonary atresia with VSD (3), modified Fontan operation (3), VSD patch closure (3) and others. The involved sides of diaphragm were right in 17, left in 2) and bilateral in 3. Extensive pericardial resection with electocauterization of resected margin was thought to be the most common cause of phrenic nerve palsy (20). The interval between primary operation and plication ranged from the day of operation to 98 days (median 11 days). The methods of plication were central pleating technique(plication with phrenic nerve branch preservation) in 41, and other technique In 2. 10 patients died after plication (7: early, 3; late), and the causes of death were thought to be unrelated to plication itself. Among the 36 early survivors, extubation or cessation of positive pressure ventilation could be accomplished between 1 and 24 days postoperatively(mean : 4.5). Cumulative follow-up was 92 patient years without major complications. Postoperative follow-up fluoroscopy was performed in 6 patients, and the location and movement of plicated diaphragms were satisfactory in 5 patients. We concluded that diaphragmatic plication with preservation of phrenic n rve branch could lead to cessation of positive pressure ventilation and complete recovery of diaphragmatic function in the long term, unless the phrenic nerve was irreversibly damaged.

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Studies on the Phrenic Nerve Fibers in the dog II. On the Myelinated Fibers of the Intradiaphragmatic Branches (개의 횡격막신경섬유(橫隔膜神經纖維)에 관(關)한 연구(硏究) 제(第)II보(報) 횡격막신경(橫隔膜神經)의 횡격막내분기(橫隔膜內分技)의 유수섬유(有髓纖維)에 관(關)하여)

  • Ko, Kwang Doo;Yoon, Suk Bong;Lee, Joon Sup
    • Korean Journal of Veterinary Research
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    • v.9 no.1
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    • pp.1-9
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    • 1969
  • The experimental studies were performed to observe the characteristics of the myelinated nerve fibers of the tradiaphragmatic branches of phrenic nerves in dog In the work to be reported five mixed breed Korean dog were used, they were one year old and he body eights were about 12 Kgm. in average with healthy conditions. The specimens (nerve) were taken at the point of 1.5 cm posterior part from the left and right phrenic nerves entrance to the diaphragm, and the dorso-lateral and dorso-medial branches of phrenic nerves vere also, taken at the point of 0.5 cm distal part from their branching portion. The specimens were fixed for 24 hrs. in Flemming's solution, and embedded in paraffin. The paraffin section. were cut at 6 microns and stained with Walter's modification of Weigert-pal method for the myelinated fibers. Microphotographs were taken and enlarged into 750 times of the actual size, and the diameter of the photographic images of the myelinated fibers were measured by the scale on the transparent Percepex Plate. The following conclusions were made: 1. The percentage of distribution of the several intradiaphragmatic branches of phrenic nerves were as follows. Ventral branches were 34.97%, lateral branches were 37.90%, dorsal branches were 27.13%, and the dorsal branches were branched again into dorso-lateral branches(54.22%) and dorso-medial branches (45. 78%). 2. The mean value and S.D. of the total numbers of the myelinated nerve fibers at the left ventral branches were $490.80{\pm}12$, and at the right ventral branches were $486.6{\pm}13$. Total average cross sectional area on the left ventral branches were 38,000. $6{\pm}136{\mu}^2$, and the right ventral branches were $37,150.2{\pm}1.782{\mu}^2$. 3. The mean value and S.D. of the total numbers of the myelinated nerve fibers at the left lateral branches were $533.8{\pm}8$, and at the right lateral branches were $525.6{\pm}7$. Total average cross sectional area of the left lateral branches were $41,582{\pm}1,170{\mu}^2$, and the right lateral branches were $40,454.8{\pm}812{\mu}^2$. 4. The mean value and S.D. of the total numbers of the myelinated nerve fibers at the left dorsal branches were $378.2{\pm}14$, and at the right dorsal branches were $380.2{\pm}8$. Total average cross sectional area of the left dorsal branches were $27,771{\pm}1,256{\mu}^2$, and the right dorsal branches were $27,507.2{\pm}645{\mu}^2$. 5. The mean value and S.D. of the total numbers of the myelinated fibers at the left dorso-lateral branches were $205.4{\pm}15$, and at the right dorso-lateral branches were $210.6{\pm}17$. Total average cross sectional area of the left dorso lateral branches were $15,354. 8{\pm}1,519{\mu}^2$, and the right dorsal branches were $15,887{\pm}1,297{\mu}^2$. 6. The mean value and S.D. of the total numbers of the myelinated nerve fibers at the left dorso-medial branches were $175{\pm}14$, and at the right dorso-medial branches were $176.2{\pm}17$. Total average cross sectional area of the left dorso-medial branches were $13,037.4{\pm}944{\mu}^2$, and at the right dorso-medial branches were, $13,103{\pm}1,373{\mu}^2$. 7. The highest frequent distribution of the intradiaphragmatic branches of phrenic nerves were found in the $10-12{\mu}^2$ groups, and they were almost 30% of the total groups. 8. The largest fibers diameter were in the $14-16{\mu}^2$ groups, and these were shown the lowest frequent distribution. 9. The largest cross sectional area of the intradiaphragmatic branches of phrenic nerves were found in the $10-12{\mu}^2$ groups. 10. All of the intradiaphragmatic branches of phrenic nerves were unimodal which has a peak in the $10-12{\mu}^2$ groups.

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Ultrasound-guided Pulsed Radiofrequency Lesioning of the Phrenic Nerve in a Patient with Intractable Hiccup

  • Kang, Keum-Nae;Park, In-Kyung;Suh, Jeong-Hun;Leem, Jeong-Gill;Shin, Jin-Woo
    • The Korean Journal of Pain
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    • v.23 no.3
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    • pp.198-201
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    • 2010
  • Persistent and intractable hiccups (with respective durations of more than 48 hours and 1 month) can result in depression, fatigue, impaired sleep, dehydration, weight loss, malnutrition, and aspiration syndromes. The conventional treatments for hiccups are either non-pharmacological, pharmacological or a nerve block treatment. Pulsed radiofrequency lesioning (PRFL) has been proposed for the modulation of the excited nervous system pathway of pain as a safe and nondestructive treatment method. As placement of the electrode in close proximity to the targeted nerve is very important for the success of PRFL, ultrasound appears to be well suited for this technique. A 74-year-old man suffering from intractable hiccups that had developed after a coronary artery bypass graft and had continued for 7 years was referred to our pain clinic. He had not been treated with conventional methods or medications. We performed PRFL of the phrenic nerve guided by ultrasound and the hiccups disappeared.

Effect of Knee Joint Stimulation on the Activity of Phrenic Nerve and Inspiratory Nuron in the Cat (슬관절 자극이 횡격신경 및 흡식중추신경에 미치는 영향)

  • Cho, Dong-Ill;Han, Hee-Chul;Nahm, Sook-Hyun
    • Tuberculosis and Respiratory Diseases
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    • v.40 no.6
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    • pp.683-693
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    • 1993
  • Background: During movement the major inputs to nervous system come from firstly the muscle and joint to maintain posture and motion and secondly the chemoreceptors and baroreceptors to adjust the cardiovascular and respiratory function. Their complex relationships are generally studied for many years but the direct relation between the joint and respiratory system is not studied thoroughly until now. So this experiment was performed to determine whether the natural movement of knee joint can cause the enhancement of respiratory function by observation of the changes of respiratory rate, phrenic nerve activity and inspiratory neuron activity during the stimulation of knee joint in cat anesthetized with $\alpha$-chloralose. Method: Twenty six male adult cats were used and the extracelluar recording using bipolar platinum electrode and carbon filament electrode was done to record the changes in the activities of phrenic nerve and inspiratory neuron movement of knee joint, injection of chemicals into the joint cavity and electrical stimulation of articular nerve were done. Results: The 60 Hz. could not but 120 Hz. flexion-extension movement of knee joint increased respiratory rate(R.R.), tidal neural activity(TNA) and minute neural activity(MNA). Intra-articular injection of lactate could not increase R.R. but significantly increase TNA and MNA which represented the enhanced respiratory function. Injection of potassium chloride showed similar effects with the case of lactate but the duration of effect was shorter. The electrical stimulation of medial articular nerve with IV strength which could activate only group I and II afferents showed increased TNA and MNA during stimulation but 20 V stimulation which could activate all the afferents increased all the respiratory parameters. The changes of inspiratory neuron activity by knee joint stimulation was similar to that of phrenic nerve. Conclusion: The respiratory center could be directly stimulated by the activation of group I and II articular afferents and it seemed that the magnitude of the respiratory center enhancement is proportional to the amount of sensory information from the knee joint. These facts might suggest that the respiratory function could be enhanced even by the normal movement of knee joint.

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Treatment of Lung Cancer-Related Intractable Hiccups Using Pulsed Radiofrequency: Clinical Experience

  • Cho, Suk Ju
    • Journal of Hospice and Palliative Care
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    • v.21 no.3
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    • pp.104-107
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    • 2018
  • While most benign hiccups can be controlled with empirical therapy, intractable hiccups lasting longer than one month tend to have significant adverse effects with obscure etiology. Treatment strategies for intractable hiccups have not been established. Only a few sporadic cases of bilateral phrenic nerve blockage have been reported. Here, we report a case of intractable hiccups that lasted five weeks in a 56-year-old male patient with a lung cancer above the right diaphragm. We hypothesized that his intractable hiccups were caused by irritation and mass effect caused by the lung cancer. We performed an ultrasound-guided right unilateral phrenic nerve pulsed radiofrequency treatment, and the patient's intractable hiccups were successfully managed without complication.

Cervical Epidural Block Can Relieve Persistent Hiccups -Case report- (경부 경막외 신경차단을 이용한 2주간 계속된 딸꾹질의 치료 경험 -증례보고-)

  • Lee, Kyung-Jin;Park, Won-Sun;Chun, Tae-Wan;Kim, Chan;Nam, Yong-Taek
    • The Korean Journal of Pain
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    • v.8 no.1
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    • pp.131-134
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    • 1995
  • Hiccup is characterized by a myoclonus in the diaphragm, resulting in a sudden inspiration associated with an audible closure of the glottis. The reflex arc in hiccups comprises three pars: an afferent, a central and an efferent part. The afferent portion of the neural pathway of hiccup formation is composed of the vagus nerve, the phrenic nerve, and the sympathetic chain arising from T6 to T12. The hiccup center is localised in the brain stem and the efferent limb comprises phrenic pathways. All stimuli affecting the above mentioned reflex arc may produce hiccups. The pathogenesis of persistent hiccups is not known. Hiccup can present a symptom of a subphrenic abscess or gastric distention, and metabolic alterations may also cause hiccups. Numerous treatment modalities have been tried but with questionable success. We describe a patient whose persistant hiccups was treated successfully by a cervical epidural block.

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Pre- and Postoperative Hemodynamic Studies in the Patients with Constrictive Pericarditis (수축성 심막염에 대한 심막절제술 전후의 수술방법에 따른 혈역학적 비교)

  • 조인택
    • Journal of Chest Surgery
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    • v.19 no.1
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    • pp.68-74
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    • 1986
  • 15 patients with constrictive pericarditis who underwent interphrenic pericardiectomy from January, 1981 to April, 1983 and 11 patients who underwent radical pericardiectomy from May, 1983 to September, 1984 were compared to the clinical improvement and the results of pre- and postoperative cardiac catheterization. In the group of partial pericardiectomy the pericardium was removed anteriorly from the left phrenic nerve to the right phrenic nerve and in the group of radical pericardiectomy the pericardium was removed from almost entire surface of the heart including diaphragmatic surface and posterior wall of the left ventricle. The following results were obtained. 1. Both group of the patients showed marked symptomatic improvement early after operation. 2. The central venous pressure was decreased significantly after operation in both group of the patients. 3. The right atrial mean pressure and pulmonary arterial mean pressure decreased significantly after operation in both group of the patients and there was no significant difference in the amplitude of decrease between the two groups. 4. The right ventricular end-diastolic pressure and left ventricular end-diastolic pressure were decreased postoperatively in both group of the patients and the patients of the radical pericardiectomy showed more decrease than the patients of interphrenic pericardiectomy, and in the group of radical pericardiectomy the right and left ventricular end-diastolic pressure were normalized postoperatively but in the group of partial pericardiectomy they showed abnormally high pressure persistently. 5. The ejection fraction showed normal level pre- and postoperatively in both group of the patients.

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Sensory Inputs to Upper Cervical Spinal Neurons Projecting to Midbrain in Cats

  • Kim, Jong-Ho;Jeong, Han-Seong;Park, Jong-Seong;Kim, Jong-Keun;Park, Sah-Hoon
    • The Korean Journal of Physiology and Pharmacology
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    • v.2 no.1
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    • pp.9-19
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    • 1998
  • The present study was primarily carried out to characterize the properties of the spinomesencephalic tract (SMT) neurons that project from the upper cervical spinal segments to the midbrain. It was also investigated whether these neurons received convergent afferent inputs from other sources in addition to cervical inputs. Extracellular single unit recordings were made from neurons antidromically activated by stimulation of midbrain. Recording sites were located in lamina $I{\sim}VIII\;of\;C1{\sim}C3$ segments of spinal cord. Receptive field (RF) and response properties to mechanical stimulation were studied in 71 SMT neurons. Response profiles were classified into six groups: complex (Comp, n=9), wide dynamic range (WDR, n=16), low threshold (LT, n=5), high threshold (HT, n=6), deep/tap (Deep, n=10), and non- responsive (NR, n=25). Distributions of stimulation and recording sites were not significantly different between SMT groups classified upon their locations and/or response profiles. Mean conduction velocity of SMT neurons was $16.7{\pm}1.28\;m/sec$. Conduction velocities of SMTs recorded in superficial dorsal horn (SDH, n=15) were significantly slower than those of SMTs recorded in deep dorsal horn (DDH, n=18), lateral reticulated area (LRA, n=21), and intermediate zone and ventral horn (IZ/VH, n=15). Somatic RFs for SMTs in LRA and IZ/VH were significantly larger than those in SDH and DDH. Five SMT units (4 Comps and 1 HT) had inhibitory somatic RFs. About half (25/46) of SMT units have their RFs over trigeminal dermatome. Excitabilities of 5/12 cells and 9/13 cells were modulated by stimulation of ipsilateral phrenic nerve and vagus nerve, respectively. These results suggest that upper cervical SMT neurons are heterogenous in their function by showing a wide range of variety in location within the spinal gray matter, in response profile, and in convergent afferent input.

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Costoclavicular brachial plexus block reduces hemidiaphragmatic paralysis more than supraclavicular brachial plexus block: retrospective, propensity score matched cohort study

  • Oh, Chahyun;Noh, Chan;Eom, Hongsik;Lee, Sangmin;Park, Seyeon;Lee, Sunyeul;Shin, Yong Sup;Ko, Youngkwon;Chung, Woosuk;Hong, Boohwi
    • The Korean Journal of Pain
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    • v.33 no.2
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    • pp.144-152
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    • 2020
  • Background: Hemidiaphragmatic paralysis, a frequent complication of the brachial plexus block performed above the clavicle, is rarely associated with an infraclavicular approach. The costoclavicular brachial plexus block is emerging as a promising infraclavicular approach. However, it may increase the risk of hemidiaphragmatic paralysis because the proximity to the phrenic nerve is greater than in the classical infraclavicular approach. Methods: This retrospective analysis compared the incidence of hemidiaphragmatic paralysis in patients undergoing costoclavicular and supraclavicular brachial plexus blocks. Of 315 patients who underwent brachial plexus block performed by a single anesthesiologist, 118 underwent costoclavicular, and 197 underwent supraclavicular brachial plexus block. Propensity score matching selected 118 pairs of patients. The primary outcome was the incidence of hemidiaphragmatic paralysis, defined as a postoperative elevation of the hemidiaphragm > 20 mm. Factors affecting the incidence of hemidiaphragmatic paralysis were also evaluated. Results: Hemidiaphragmatic paralysis was observed in three patients (2.5%) who underwent costoclavicular and 47 (39.8%) who underwent supraclavicular brachial plexus blocks (P < 0.001; odds ratio, 0.04; 95% confidence interval, 0.01-0.13). Both the brachial plexus block approach and the injected volume of local anesthetic were significantly associated with hemidiaphragmatic paralysis. Conclusions: The incidence of hemidiaphragmatic paralysis is significantly lower with costoclavicular than with supraclavicular brachial plexus block.