Objective : Gamma knife radiosurgery (GKRS) is the least invasive surgical option for patients with trigeminal neuralgia (TN). However, the indications and long term outcomes of GKRS are still controversial. Additionally, a series with uniform long-term follow-up data for all patients has been lacking. In the present study, the authors analyzed long-term outcomes in a series of patients with TN who underwent a single GKRS treatment followed by a minimum follow-up of 60 months. Methods : From 1994 to 2009, 40 consecutive patients with typical, intractable TN received GKRS. Among these, 22 patients were followed for >60 months. The mean maximum radiation dose was 77.1 Gy (65.2-83.6 Gy), and the 4 mm collimator was used to target the radiation to the root entry zone. Results : The mean age was 61.5 years (25-84 years). The mean follow-up period was 92.2 months (60-144 months). According to the pain intensity scale in the last follow-up, 6 cases were grades I-II (pain-free with or without medication; 27.3%) and 7 cases were grade IV-V (<50% pain relief with medication or no pain relief; 31.8%). There was 1 case (facial dysesthesia) with post-operative complications (4.54%). Conclusion : The long-term results of GKRS for TN are not as satisfactory as those of microvascular decompression and other conventional modalities, but GKRS is a safe, effective and minimally invasive technique which might be considered a first-line therapy for a limited group of patients for whom a more invasive kind of treatment is unsuitable.
The etiology of chronic headache is not yet fully explained, the treatment of this symptom is not simple. We show the effect of Qigong therapeutics applied on chronic headache patient, in order to establish a primary data for further studies of new treatments. We treated 2 times a weeks for 3 weeks. The acupoints, (太陽穴)(Ex-HN5), (老龍穴), (大趾甲下穴), and (百會穴)(GV20) were stimulated for 10 seconds by Qigong-Acupuncture, and after that Qigong therapy was performed for 30 minutes The effects were analyzed using VAS scores, PPI(Present Pain Intensity), HI(Headache Index) and HDI(The Henry Ford Headache Disability Inventory). We concluded that Qigong therapeutics applied on chronic headache patient showed effects of relieving pain, improving general activities and changing the mood. Further researches are needed to evaluate the distinct functional mechanism of Qigong therapeutics, hut this study is meaningful in the sense that it will act as a fundamental study to build on.
Background: Shivering related to spinal anesthesia may interfere with monitoring and is uncomfortable. The aim of the present study was to investigate low-dose intrathecal meperidine for the prevention of shivering after induction of spinal anesthesia in parturients with cesarean section. Methods: This was a prospective randomized, double-blind, placebo-controlled trial including 100 parturients, of American Society of Anesthesiologists (ASA) physical status I or II, scheduled for elective cesarean section under spinal anesthesia who were randomly assigned to a meperidine (0.2 mg/kg) plus hyperbaric lidocaine (5%, 75 mg, n = 50; group M) group or a placebo plus hyperbaric lidocaine (5%, 75 mg, n = 50; group L) group. Demographic and surgical data, adverse events, and the mean intensity for each parturient were assessed during the entire study period by a blinded observer. Results: There were no significant differences between the two study groups regarding the demographic and surgical data (P > 0.05). The incidence of shivering during the entire study period significantly decreased in the group of parturients who received intrathecal meperidine (P = 0.04). There were no significant differences in nausea and vomiting between the two groups. Conclusions: Low-dose intrathecal meperidine (10 mg) is safe and effective in reducing the incidence and severity of shivering associated with spinal anesthesia in parturients with cesarean section.
Recently in HCI research, emotion recognition is one of the core processes to implement emotional intelligence. There are many studies using bio signals in order to recognize human emotions, but it has been done merely for the basic emotions and very few exists for the other emotions. The purpose of present study is to confirm the difference of autonomic nervous system (ANS) response in three emotions (boredom, pain, and surprise). There were totally 217 of participants (male 96, female 121), we presented audio-visual stimulus to induce boredom and surprise, and pressure by using the sphygmomanometer for pain. During presented emotional stimuli, we measured electrodermal activity (EDA), skin temperature (SKT), electrocardiac activity (ECG) and photoplethysmography (PPG), besides; we required them to classify their present emotion and its intensity according to the emotion assessment scale. As the results of emotional stimulus evaluation, emotional stimulus which we used was shown to mean 92.5% of relevance and 5.43 of efficiency; this inferred that each emotional stimulus caused its own emotion quite effectively. When we analyzed the results of the ANS response which had been measured, we ascertained the significant difference between the baseline and emotional state on skin conductance response, SKT, heart rate, low frequency and blood volume pulse amplitude. In addition, the ANS response caused by each emotion had significant differences among the emotions. These results can probably be able to use to extend the emotion theory and develop the algorithm in recognition of three kinds of emotions (boredom, surprise, and pain) by response measurement indicators and be used to make applications for differentiating various human emotions in computer system.
Herpes zoster (HZ) is the secondary manifestation of an earlier infection with the varicella-zoster virus in one or more dermatomes. As reactivation of the virus is linked to an age-related diminished virus-specific and cell-mediated immunity, HZ develops mainly in elderly people. Acute zoster is painful, but does not incur lasting morbidity. Reactivation of the varicella-zoster virus in the trigeminal nerve (Herpes zoster) occur with severe pain and rash in the oro-facial region. The acute pain decreases as the rash begins to heal. Postherpetic neuralgia(PHN), the most frequent complication of herpes zoster, is usually defined as pain in the involved dermatome that is still present 3 month after rash onset. The clinical characteristics of PHN are, eposodic stabbing pain, burning pain and allodynia, with hypoesthesia and/or dysesthesia. $Neurometer^{(R)}$(neuroselective sensory nerve conduction threshold: sNCT, Automated current perception threshold: CPT, neurotron incorporated. Baltimore, Maryland. 21209 U.S.A.) is convenient, rapid and noninvasive, and allows objective assessment of sensory disturbance. This case is about the postherptic neuralgia patient assessed with $Neurometer^{(R)}$. From this case, we reviewed the pathophysiology and the treatment of PHN and recommend the assessment of pain intensity with $Neurometer^{(R)}$ as quantitative and objective method.
Park, Sung-Ik;Koo, Sung-Tae;Hwang, Jae-Ho;Shin, Jong-Keun;Sohn, In-Chul;Kim, Kyung-Sik
Korean Journal of Acupuncture
/
v.21
no.1
/
pp.113-127
/
2004
Objectives : The usage of acupuncture has gained popularity as an alternative method of treatment for certain chronic pain conditions. However, the efficacy of acupuncture in various diseases has not been fully established and the underlying mechanism is not clearly understood. In the present study, the effect of electroacupuncture (EA) applied to foot samli$(ST_{36})$ on the carrageenan-induced knee arthritic pain was examined. Methods : A common source of persistent pain in humans is the knee arthritis. Knee arthritis was induced by injection of 2 % carrageenan $50\;{\mu}l$ into the knee joint cavity. When rats developed pain behaviors, EA was applied for 30 min. under enflurane anesthesia with repeated train stimuli at the intensity of 10X of muscle twitch threshold. The weight bearing force of the hind limb was measured for an indicator of pain level after each manipulation. Results : The average weight borne by the hind limb during normal gait was 55% of total body weight, which was reduced to less than 10% after knee arthritis. EA improved the weight bearing of the arthritic hind limb significantly for the duration of 4 hr. EA applied to $ST_{36}$ point produced a significant improvement of stepping force of the arthritic foot lasting for at least 4 h. However, $GB_{31}$ point did not produce any significant increase of weight bearing force. The analgesic effect was specific to the acupuncture point since the analgesic effect on the knee arthritis model could not be mimicked by EA applied to a nearby point, $GB_{31}$. The relations between EA-induced analgesia and endogenous nitric oxide(NO) and inducible NO synthase(iNOS)/neuronal NOS was also examined. Results were turned out that both NO production and nNOS/iNOS protein expression which is increased by arthritis were suppressed by EA stimulation applied to $ST_{36}$ point. Conclusions : The data suggest 1) that EA produces a potent analgesic effect on the rat model of chronic knee arthritis pain in a point specific manner and 2) that EA-induced analgesia modulate endogenous NO through the suppression of nNOS/iNOS protein expression.
Objective : The purpose of the present study is to assess the long-term results of microsurgical dorsal root entry zonotomy (MDT) for the treatment of medically intractable upper-extremity spasticity. Methods : The records of nine adult patients who underwent MDT by one operating neurosurgeon from March 1999 to June 2004 were retrospectively reviewed by another investigator who had no role in the management of these patients. In all patients, MDT was performed on all roots of the upper limb (from C5 to T1) for spasticity of the upper extremity. The degree of spasticity was measured by the Modified Ashworth Scale (grade 0-4). Severity of the pain level was determined using the Numeric Rating Scale (NRS, score 0-10). Also, patient satisfaction of the post-operative outcome was assessed. Results : Comparing the preoperative and postoperative spasticity using the Modified Ashworth Scale, we observed improvement in all patients, particularly in five of the nine patients (55.6%) who improved by three grades over an average of 66.4 months (range, 40-96). Regarding patient satisfaction, seven patients (77.8%) had affirmative results. None of the patients experienced severe, life-threatening, postoperative complications. We observed a decrease in the intensity of painful spasms to less than three scores as measured by NRS in all four patients with associated pain. Conclusion : This study shows that MDT provides significant, long-term reduction of harmful spasticity and associated pain in the upper limbs.
Objectives : The present study aimed to examine the analgesic effect of electroacupuncture(EA) applied to the brook point of the Liver meridian in the rat model of inflammatory pain and to investigate involvement of endogenouse opioid in the EA-induced analgesia. Methods : Knee arthritis was induced by injection of $125{\mu}l$ of complete Freund's adjuvant into the knee joint cavity unilaterally. To examine the level of pain, weight bearing forces(WBFs) of affected limb was measured. EA treatment was given at the LR2, LI4 or non-acupoint on the contralateral limb with frequency of 2 Hz and intensity of 2 mA under gaseous anesthesia. Results : After induction of arthritis, rats subsequently showed a reduced stepping force of the affected hindlimb due to a painful knee. EA applied to the LR2 point on the contralateral hind limb produced a significant improvement of stepping force of the hind limb lasting for at least 2 h, and this effect was equivalent to that obtained by 5 mg/kg of oral indomethacin. The effect of EA was specific to the acupoint since it could not be mimicked by EA applied to the LI4 point or the arbitrary non-acupoint. The analgesic effect was blocked by pretreatment with naltrexone(10 mg/kg, i.p.). Conclusions : These results suggest that acupuncture applied to LR2, brook point of Liver meridian suppresses inflammatory pain in a rat model of knee arthritis and this effect seems to be mediated by endogenous opioid systems.
Gang, Byeong-gu;Jeon, Se Hwan;Cho, Yongkyu;Lee, Keunjae;Yoon, Youngsuk;Kim, Jongho;Lee, Won Jun;Han, Subin;Kum, Chang Jun;Koh, Wonil
Journal of Korean Medicine Rehabilitation
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v.28
no.4
/
pp.51-57
/
2018
Objectives Low back disability, along with low back pain, places a significant social burden in terms of work loss and medical expenses. Motion-Style-Acupuncture-Treatment using Traction (T-MSAT) is employed as one of the conservative treatments to such conditions. In the present study, effectiveness of Korean Medical treatments, including T-MSAT, was investigated in inpatients with low back disability and low back pain. Methods Among the patients who were admitted between January 2018 to June 2018 with disabled low back function, ones that were treated with T-MSAT were identified. Pain and function were compared at the point of admission and discharge, using Numerical Rating Scale (NRS) and Oswestry Disability Index (ODI), respectively. Results Over the hospitalization period of 34.55 days, pain intensity significantly decreased from NRS score of 6.14 to 3.26 and low back function also significantly improved from ODI score of 50.93 to 33.73 upon receiving Korean Medical treatments including T-MSAT. Conclusions Korean Medical treatments including T-MSAT were found to be effective in inpatients with low back disability with a statistical significance. To evaluate the sole effectiveness of T-MSAT, rigorous clinical trials are necessitated in future.
Peripheral nerve injury results in plastic changes in the dorsal ganglia (DRG) and spinal cord, and is often complicated with neuropathic pain. The mechanisms underlying these changes are not known, but these changes seem to be most likely related to the neurotrophic factors. This study investigated the effects of mechanical peripheral nerve injury on expression of brain-derived neurotrophic factor(BDNF) in the DRG and spinal cord in rats. 1) Bennett model and Chung model groups showed significantly increased percentage of small, medium and large BDNF-immunoreactive neurons in the ipsilateral $L_4$ DRG compared with those in the contralateral side at 1 and 2 weeks of the injury. 2) In the ipsilateral $L_5$ DRG of the Chung model, percentage of medium and large BDNF-immunoreactive neurons increased significantly at 1 week, whereas that of large BDNF-immunoreactive neurons decreased at 2 week when compared with those in the contralateral side. The intensity of immunoreactivity of each neuron was lower in the ipsilateral than in the contralateral DRG. 3) In the spinal cord, the Bennett and Chung model groups showed a markedly increased BDNF-immunoreactivity in axonal fibers of both superficial and deeper laminae. The present study demonstrates that peripheral nerve injury in neuropathic models altered the BDNF expression in the DRG and spinal cord. This may suggest important roles of BDNF in sensory abnormalities after nerve injury and in protecting the large-sized neurons in the damaged DRG.
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