• Title/Summary/Keyword: Phrenic nerves

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A case of Idiopathic Bilateral Brachial Neuritis Involving the Bilateral Phrenic Nerves (양측 횡격막신경을 침범한 원인불명의 양측 상완신경염 1예)

  • Kwak, Jae-Hyuk;Lee, Dong-Kuck;Kwon, Oh-Dae
    • Annals of Clinical Neurophysiology
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    • v.7 no.1
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    • pp.28-30
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    • 2005
  • Bilateral brachial neuritis is clinically uncommon and accidentally involvement of bilateral phrenic nerves is rarely reported. We experienced a 26 year old man who developed subacute onset of asymmetric bilateral shoulder and arm weakness. The weakness slowly aggravated and finally suffered from dyspnea due to bilateral phrenic nerve palsy. Cervical spine MRI and CSF study showed no abnormality. Viral markers and other serological test showed no specific finding. Electromyographic study showed bilateral brachial axonal polyneuropathy with cervical and upper thoracic polyradiculopathy. And bilateral phrenic nerve conduction study showed no resopnse. He showed no improvement for 10 months after treatment and managed with continuous artificial ventilation. We report a case of idiopathic bilateral brachial neuritis accidentally involving bilateral phrenic nerves.

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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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Change of Diaphragmatic Level and Movement Following Division of Phrenic Nerve (횡격막 신경 차단 후 횡격막 위치 및 운동의 변화)

  • 최종범;김상수;양현웅;이삼윤;최순호
    • Journal of Chest Surgery
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    • v.35 no.10
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    • pp.730-735
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    • 2002
  • Diaphragm is innervated by phrenic nerve and lower intercostal nerves. For patients with avulsion injury of brachial plexus, an in situ graft of phrenic nerve is frequently used to neurotize a branch of the brachial plexus. We studied short-term and mid-term changes of diaphragmatic level and movement in patients with dissection of phrenic nerve for neurotization. Material and Method : Thirteen patients with division of either-side phrenic nerve for neurotization of musculocutaneous nerve were included in this study. With endoscopic surgical procedure, the intrathoracic phrenic nerve was entirely dissected and divided just above the diaphragm. The dissected phrenic nerve was taken out through thoracic inlet and neck wound and then anastomosed to the musculocutaneous nerve through a subcutaneous tunnel. With chest films and fluoroscopy, levels and movements of diaphragm were measured before and after operation. Result : There was no specific technical difficulty or even minor postoperative complications following endoscopic division of phrenic nerve. After division of phrenic nerve, diaphragm was soon elevated about 1.7 intercostal spaces compared with the preoperative level, but it did not show paradoxical motion in fluoroscopy. More than 1.5 months later, diaphragm returned downward close to the preoperative level (average level difference was 0.9 intercostal spaces; p=NS). Movement of diaphragm was not significantly decreased compared with the preoperative one. Conclusion : After division of phrenic nerve, the affected diaphragm did not show a significant decrease in movement, and the elevated diaphragm returned downward with time. However, the decreased lung volumes in the last spirometry suggest the decreased inspiratory force following partial paralysis of diaphragm.

Left Side Otalgia Caused by Acute Myocardial Infarction (급성 심근경색에 의해 발생한 좌측 이통 1예)

  • Chung, Juyong;Park, Ji-Su;Choi, Jin Woong
    • Korean Journal of Otorhinolaryngology-Head and Neck Surgery
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    • v.60 no.6
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    • pp.322-325
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    • 2017
  • Otalgia consists of primary otalgia associated with disorders of the ear itself and referred otalgia due to disorders of organs that share the same innervation with the ear. Disorders of the oral cavity and laryngopharynx served by the glossopharyngeal and vagus nerves are common causes of referred otalgia. Chest pain from myocardial infarction spreads through the afferent pain pathway, especially through the sympathetic nerves in the cardiac plexus and the phrenic nerve, resulting in a typical chest pain or referred pain in the left upper extremity. However, pain spreading through the vagus nerve can theoretically cause referred otalgia. This association between the heart and ear has not been widely acknowledged, even though a referred otalgia can occasionally be the only symptom of the tragic disease, myocardial infarction, and should be taken seriously. We report a patient who complained of left otalgia as the only symptom of myocardial infarction.

Risk of Encountering Dorsal Scapular and Long Thoracic Nerves during Ultrasound-guided Interscalene Brachial Plexus Block with Nerve Stimulator

  • Kim, Yeon Dong;Yu, Jae Yong;Shim, Junho;Heo, Hyun Joo;Kim, Hyungtae
    • 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.

Respiratory Arrest during Cervical Epidural Block -A case report- (경부 경막외 차단중 발생한 호흡정지 -2예 보고-)

  • Kim, Deog-Jae;Cheun, Jae-Kyu
    • The Korean Journal of Pain
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    • v.9 no.1
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    • pp.264-267
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    • 1996
  • Cervical epidural block can be useful in the management of acute and chronic pain of the head, neck, shoulder, and arm, for selected patients. In spite of the widespread use of cervical epidural blocks for pain, there is limited published data on the specific technique and complications regarding the procedure. High levels of epidural block do not appear to be associated with clinically significant circulatory or ventilatory changes unless the concentrations of local anesthetics used are great enough to produce paralysis of intercostal and phrenic nerves. However, high level of epidural block is associated with sympathetic block which may affect responses of circulatory and ventilatory systems. Accordingly, the possibility of major complications of cervical epidural block must be borne in mind. We experienced two cases of respiratory arrest during cervical epidural block with bupivacaine. This is a report regarding complications of cervical epidural block.

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Video-Assisted Thoracic Surgery Thymectomy: Subxiphoid Approach

  • Cho, Sukki
    • Journal of Chest Surgery
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    • v.54 no.4
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    • pp.314-318
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    • 2021
  • In this paper, I present the technique of subxiphoid single-port video-assisted thoracic surgery (VATS) thymectomy for thoracic surgeons to perform this procedure safely. This procedure is indicated for all anterior mediastinal masses and may be extended to lung cancer. The patient is placed in the lithotomy position, and the operator should be on the midline. Below the xiphoid process, a skin incision is made 4-5 cm horizontally at a single thumb's width down. Under two-lung ventilation, CO2 is insufflated, maintaining 10 mm Hg. The fat tissue and thymic tissue are all resected from the sternum and pericardium between both phrenic nerves using an articulated grasper and an energy device. After retrieval of the mass with a wrap bag, a Jackson-Pratt drain is inserted instead of a chest tube. One of the advantages of this procedure is less postoperative pain than intercostal VATS. The subxiphoid approach can be used for bilateral pneumothorax, bilateral pulmonary metastasectomy, and simple lobectomy for both upper lobes and the right middle lobe.

The surgical treatment of chronic constrictive pericarditis: a report of 70 cases (만성 교약성 심낭염의 외과적 치료70례 수술 보고)

  • 송명근
    • Journal of Chest Surgery
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    • v.16 no.2
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    • pp.184-189
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    • 1983
  • Between 1958 and 1982, 70 patients have undergone pericardiectomy for constrictive pericarditis at the Thoracic Department of Seoul National University Hosp. 58 males and 12 females, with an average age of 27 years [ranging 3 to 60 years], of which 55% were between 10 and 30 years old, were treated. Eight patients died, of whom 4 were in the immediate postoperative period, less that 24 hours after operation. The cause of death was myocardial failure in 3 patients and hypotension during operation in one patient. The remaining four deaths occurred between the fifth and eighteenth postoperative day, and the causes of death varied: bilateral phrenic nerves injury, congestive heart failure, dissemination of tuberculosis, and cardiac arrest. Two patients suffered from congestive heart failure pre-and postoperatively due to the associated valvular heart disease. There were 8 wound infections on which resulted in perichondritis of costal cartilages requiring segmental resection 2 months later. There was one postoperative bleeding requiring immediate reopening for bleeding control. Tuberculosis was confirmed as the cause of constrictive carditis in 27 patients [39%]. Acute pyogenic pericarditis was precursor in 8 patients [11%]. In 2 patients [2.9%], the constrictive pericarditis developed following OHS. Both suffered from congestive heart failure postoperatively due to the residual valvular heart disease. In the others, the cause of the constrictive pericarditis was considered idiopathic or non-specific inflammation.

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Studies on the Experimental Heart and Heart-Lung Transplantation in the Mongrel Dogs for the Purpose of Clinical Application (임상적용을 위한 한국산 잡견에서의 실험적 심장및 심폐 이식술)

  • 이정렬
    • Journal of Chest Surgery
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    • v.25 no.5
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    • pp.458-468
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    • 1992
  • With the aid of extracorporeal circulation, nine dogs underwent orthotopic cardiopulmonary transplantation after preservation of the donor heart in a hypothermic amino acid[glutamate, aspartate] enriched high potassium extracellular solution, and preservation of the donor lung with hypothermic low potassium dextran solution from June 1990 to May 1991. The mean body weights of dogs were 20kg and the recipients` preoperative hematologic and hemodynamic pictures were within normal range except slightly decreased level of albumin and total protein, which was supposed to be due to malnutrition. The following modifications of the original Stanford technique were emphasized: [1] the posterior mediastinum is dissected as little as possible with meticulous hemostasis; [2] the surgical procedure is kept away from the phrenic and vagus nerves; [3] the tracheal anastomosis may be wrapped with recipient`s pulmonary artery flap or surrouding soft tissues. A combination of Cyclosporine, Azathioprine, corticosteroid was used as perioperative immunosuppressive therapy. Postoperatively all recipients could be weaned from extracorporeal circulation, showing favorable vital signs, but within 24 hours, irreversible congetive heart failure, ascites, arrhythmias developed with a mean survival time 13.6$\pm$6.6[n=9, range=6~26] hours. Hemoglobin and platelet counts were significantly[p<0.05] decreased postoperatively, which is thought to be attributed to blood damage by cardiopulmonary bypass and hemodilution. Postmortem finding included multiple subendocardial patch hemorrhage in both atrial and ventricular cavities, pulmonary and liver congestion, and all tracheal anastomoses were intact. Further consideration about quality control of the animal, infection, rejection, the effect of cardiopulmonary bypass on the experimental animal is required to improve the results.

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A Case of Persistent Hiccup in a Patient with Non-small Cell Lung Cancer (비소세포폐암 환자에서 발생한 지속성 딸꾹질 1예)

  • Park, Hye Sung;Sim, Yun Su;Lim, So Yeon;Jo, Jung Youn;Kwon, Sung Shin;Roh, Sun Hee;Kim, Yoo Ri;Chun, Eun Mi;Lee, Jin Hwa;Ryu, Yon Ju;Song, Dong Eun;Moon, Jin Wook
    • Tuberculosis and Respiratory Diseases
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    • v.64 no.1
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    • pp.39-43
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    • 2008
  • A hiccup is caused by involuntary, intermittent, and spasmodic contractions of the diaphragm and intercostal muscles. It starts with a sudden inspiration and ends with an abrupt closure of the glottis. Even though a hiccup is thought to develop through the hiccup reflex arc, its exact pathophysiology is still unclear. The etiologies include gastrointestinal disorders, respiratory abnormalities, psychogenic factors, toxic-metabolic disorders, central nervous system dysfunctions and irritation of the vagus and phrenic nerves. Most benign hiccups can be controlled by traditional empirical therapy such as breath holding and swallowing water. However, though rare, a persistent hiccup longer than 48 hours can lead to significant adverse effects including malnutrition, dehydration, insomnia, electrolyte imbalance, and cardiac arrhythmia. An intractable hiccup can sometimes even cause death. We herein describe a patient with non-small cell lung cancer who was severely distressed by a persistent hiccup.