• Journal of Chest Surgery
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• v.25 no.4
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• pp.391-397
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• 1992

Postoperative hypoxemia in the absence of hypoventilation occurs more often after thoracic or upper abdominal surgery than lower abdominal operations or surgery on extremities. Although the factors which produce postoperative alveolar collapse have not been fully evaluated, the dominant factor of postoperative hypoxia is shunt of blood passing collapsed alveoli and the postoperative pain is associated with restriction of depth of breathing, sighing and movement. In 1979, the first successful clinical usage of epidurally administered morphine was done by Behar and associates for control of postoperative pain. This study was carried out for twenty patients who received posterolateral thoracostomy with Bled resection between May 1990 and May 1991 and who were primary spontaneous recurrent pneumothoraxes. We selected ten of twenty patients, one after the other and treated with epidural analgesia as study group and the remainder ten were grouped as control. Epidural catheters were inserted for study group before operation through T12-L1, 2 interspinous process at the pain clinic or operation room by anesthesiogist and then the drugs[0.25% Bupivacaine 15ml mixing with morphine 3mg] were instillated through the catheter before extubarion and once a day until 4th day, and the patients of control group were treated intermittently by Demerol 50mg intramuscularly for postoperative pain control. The epidural catheters were removed at postoperative 4th day. Observations were done about vital aigns, a-BGA, tidal volume, FVC and occurence of adverse effects during postoperative 2hr, 8hr, 1st day, 2nd day, 7th day in both groups. The results were as follows; [1] Tidal volume[85.1$\pm$29.8%R VS 60.8$\pm$20.5%R, p<0.05] and FVC[53.7$\pm$14.2%R, VS 35.5$\pm$9.l%R, p<0.01] were significantly improved in study group compared with control group during the first day of operation. [2] But the improvement of FVC was delayed after stopping of epidural analgesia[postoperative 7th day, 97.5$\pm$12.3%R VS 83.9$\pm$15.6%R, P <0.05]. [3] Others were statistically not significant. [4] The side effects of epidural analgesia were identified such as urinary retention[2 cases], itching sensation[1 case] and headache[1 case], but there was no need for active treatments.

• The Korean Journal of Pain
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• v.29 no.2
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• pp.86-95
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• 2016

Background: The present study was designed to examine the functional recovery following spinal cord injury (SCI) by adjusting the parameters of impact force and dwell-time using the Infinite Horizon (IH) impactor device. Methods: Sprague-Dawley rats (225-240 g) were divided into eight injury groups based on force of injury (Kdyn) and dwell time (seconds), indicated as Force-Dwell time: 150-4, 150-3, 150-2, 150-1, 150-0, 200-0, 90-2 and sham controls, respectively. Results: After T10 SCI, higher injury force produced greater spinal cord displacement (P < 0.05) and showed a significant correlation (r = 0.813) between the displacement and the force (P < 0.05). In neuropathic pain-like behavior, the percent of paw withdrawals scores in the hindpaw for the 150-4, 150-3, 150-2, 150-1 and the 200-0 injury groups were significantly lowered compared with sham controls (P < 0.05). The recovery of locomotion had a significant within-subjects effect of time (P < 0.05) and the 150-0 group had increased recovery compared to other groups (P < 0.05). In addition, the 200-0 and the 90-2 recovered significantly better than all the 150 kdyn impact groups that included a dwell-time (P < 0.05). In recovery of spontaneous bladder function, the 150-4 injury group took significantly longer recovery time whereas the 150-0 and the 90-2 groups had the shortest recovery times. Conclusions: The present study demonstrates SCI parameters optimize development of mechanical allodynia and other pathological outcomes.

• Physical Therapy Korea
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• v.21 no.4
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• pp.1-8
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• 2014

Transcranial direct current stimulation (tDCS) is a neuromodulatory technique that delivers low-intensity direct current to cortical areas, thereby facilitating or inhibiting spontaneous neuronal activity. This study was designed to investigate changes in various sensory functions after tDCS. We conducted a single-center, single-blinded, randomized trial to determine the effect of a single session of tDCS with the current perception threshold (CPT) in 50 healthy volunteers. Nerve conduction studies were performed in relation to the median sensory and motor nerves on the dominant hand to discriminate peripheral nerve lesions. The subjects received anodal tDCS with 1 mA for 15 minutes under two different conditions, with 25 subjects in each groups: the conditions were as follows tDCS on the primary motor cortex (M1) and sham tDCS on M1. We recorded the parameters of the CPT a with Neurometer$^{(R)}$ at frequencies of 2000, 250, and 5 Hz in the dominant index finger to assess the tactile sense, fast pain and slow pain, respectively. In the test to measure CPT values of the M1 in the tDCS group, the values of the distal part of the distal interphalangeal joint of the second finger statistically increased in all of 2000 Hz (p=.000), 250 Hz (p=.002), and 5 Hz (p=.008). However, the values of the sham tDCS group decreased in all of 2000 Hz (p=.285), 250 Hz (p=.552), and 5 Hz (p=.062), and were not statistically significant. These results show that M1 anodal tDCS can modulate sensory perception and pain thresholds in healthy adult volunteers. The study suggests that tDCS may be a useful strategy for treating central neurogenic pain in rehabilitation medicine.

• The Korean Journal of Pain
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• v.20 no.1
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• pp.26-30
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• 2007

Background: Epidural steroid injections (ESI) are a common treatment for spinal disorders. Previous research has shown that aspiration of the syringe is not a sensitive test for placement of an intravascular needle. Serious complications have been reported from injection of steroids and local anesthetics into the vascular space. In addition to safety concerns, the efficacy may decline with partial injection outside the desired epidural location. We hypothesized that incidence of vascular problems is increased in patients who undergo spine surgery compared with the patients who don't undergo spine surgery. We investigated the incidence of vascular problems during lumbosacral transforaminal ESI and we compared the difference of vascular problems between the patients who undergo spinal surgery and those patients who don't undergo spinal surgery. Methods: Two hundreds and three patients were consecutively recruited and they received 299 fluoroscopically guided lumbosacral transforaminal ESIs. Injection of contrast was performed under live dynamic fluoroscopy with using digital substraction analysis. The observed uptake pattern was classified into one of three categories: flashback, aspirated, and positive contrast with negative flashback and aspiration. Results: The vascular incidence rate was 20.4%. Transforaminal ESIs performed at S1 had avascular incidence rate of 27.8% compared with 17.7% for all the other lumbar injection sites. The sensitivity of spontaneous observation of blood in the needle hub or blood aspirate for predicting an intravascular injection in lumbar transforaminal ESIs was 70.4%. Conclusions: There is a high incidence of intravascular problems when performing transforaminal ESIs, and this is significantly increased in patients with previous spine surgery. Using a flash or blood aspiration to predict an intravascular injection is not sensitive therefore; a negative flash or aspiration is not reliable. Fluoroscopically guided procedures without contrast confirmation are prone to instill medications intravascularly. This finding confirms the need for not only fluoroscopic guidance, but also for contrast injection instillation when performing lumbosacral transforaminal ESIs, and especially for patients with previous spine surgery.

• Journal of Acupuncture Research
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• v.21 no.3
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• pp.145-167
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• 2004

Objective : Neuropathic pain can be caused by a partial peripheral nerve injury. This kind of pain is usually accompanied by spontaneous burning pain, allodynia and hyperalgesia. It is not clear that scolopendrid aqua-acupuncture can control neuropathic pain effectively. The purpose of this study is to examine if scolopendrid aqua-acupuncture may be effective to the neuropathic pain (mechanical allodynia, cold allodynia) in a rat model of neuropathic pain. Methods : To produce the model of neuropathic pain, under isoflurane 2.5% anesthesia, tibial nerve and sural nerve was resected. After the neuropathic surgery, the author examined if the animals exhibited the behavioral signs of allodynia. The allodynia was assessed by stimulating the medial malleolus with von Frey filament and acetone. Three weeks after the neuropathic surgery, scolopendrid aqua-acupuncture was injected at Hwando(GB30) one time a day for one week. After that the author examined the withdrawl response of neuropathic rats' legs by von Frey filament and acetone stimulation. And also the author examined c-fos in the midbrain central gray of neuropathic rats and the change of WBC count in the blood of neuropathic rats. Results & Conclusion : 1. The scolopendrid aqua-acupuncture injected at Hwando(GB30) decreased the withdrawl response of mechanical allodynia in SHA-1, SHA-2 and SAH-3 group as compared with control group. 2. The scolopendrid aqua-acupuncture injected at Hwando(GB30) decreased the withdrawl response of chemical allodynia(cold allodynia) in SHA-1, SHA-2 and SAH-3 group as compared with control group. 3. The scolopendrid aqua-acupuncture injected at Hwando(GB30) showed the significant difference between sham group and control group(p=0.01), sham and SHA-3 group(p=0.026), control group and SHA-1 group(p=0.01), control group and SHA-2 group(p=0.024) in the c-fos expression. 4. The scolopendrid aqua-acupuncture injected at Hwando(GB30) showed the significant difference between sham group and SHA-3 group(p=0.010), control group and SHA-3 group(p=0.006) in the WBC count.

• Journal of Chest Surgery
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• v.37 no.2
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• pp.166-172
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• 2004

When compare with blebectomy or bullaectomy simply and pleurodesis together in treatment of primary spontaneous pnevmthorax, the later has been realized as the method that can reduce the recurrent rate after surgical operation. Therefore, in this study, we compared the merits and demerits of the clinical result of chemical pleurodesis that use Talcum powder in pleurodesis and mechanical pleurodesis that use apical pleurectomy and analyzed the reappearance rate etc. Material and Method: The Pleurodesis through the apical pleurectomy and talc powder insufflation had been used as secondary procedure after blebectomy of spontaneous pneumothorax from January 1, 2000 to June 30, 2002. This study consisted of a retrospective review of 68 patients who were treated with apical pleurectomy, and 84 patients treated with talc powder insufflation. We compaired the apical pleurectomy and talc powder insufflation in terms of age, sex, cause of operation, number of used autosuture staple, tine duration of procedure after blebectomy, severity of pain and complication after operation, postoperative air leakage period, duration of chest tube insertion, hospitalization, and recurrence rate of pneumothorax. Result: Time required for secondary procedure was longer in apical pleurectomy than talc powder insufflation. Postoperative pain was more severe in talc powder insufflation than apical pleurectomy. Otherwise there was no significant difference between two methods. Conclusion: Although Talc powder insufflation is more convenient than apical pleurectomy, the difference is not large and, the severity of postoperative pain is worse in talc powder insufflation. Therefore apical pleurectomy can be recommended for the secondary surgical procedure after blebectomy of primary spontaneous pneumothorax can be recommended.

• Clinical and Experimental Pediatrics
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• v.49 no.6
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• pp.696-699
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• 2006

Tolosa-Hunt syndrome is a rare disease in children characterized by dull, persistent pain around the affected eye and ophthalmoplegia caused by granulomatous inflammation in the cavernous sinus, superior orbital fissure, or orbit. Although spontaneous remission can occur, corticosteroids frequently have a dramatic response; however, recurrence can transpire after complete remission. We report an 11-year-old girl with Tolosa-Hunt syndrome who responded to corticosteroid promptly, without complications, but suffered three recurrences of headache and retro-orbital pain and required maintenance on a low dose of steroid.

• Biomolecules & Therapeutics
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• v.1 no.1
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• pp.37-43
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• 1993

Electrical or chemical stimulation of many areas in the brainstem modulates activity of dorsal horn neurons (DHN). This is known to be mediated by a population of bulbospinal neurons. Yet, little is known about responses of DHNs to stimulation of the caudal ventrolateral medulla (CVLM). Thus, the purpose of the present study is to see if there is any change in activity of DHNs when CVLM is stimulated electrically. Thirty-one DHNs were recorded from dorsal horn of the spinal cord. Fourteen DHNs (45%) were classified as wide dynamic range neurons and 9 (19%) were high threshold cells, and 4 (13%) and 4 (13%) were deep and low threshold neurons, respectively. Among 31 neurons tested for responses to stimulation of CVLM, 21 DHNs (68%) were inhibited by the electrical stimulation of CVLM ($200{\mu}A,\;100{\mu}s$ duration, 100 Hz), and 9 cells (39%) did not show any change in neuronal activity. One neuron was excited by the stimulation. The electrical stimulation of CVLM not only inhibited spontaneous activity of DHNs but also inhibited evoked responses of DHNs to somatic stimulation in the receptive field. These data suggest that CVLM is one of the pain-modulatory areas that control transmission of ascending information of noxious input to the brain from the spinal cord.

• International Journal of Oral Biology
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• v.32 no.4
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• pp.153-160
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• 2007

The superficial dorsal horn, particularly substantia gelatinosa (SG) in the spinal cord, receives inputs from small-diameter primary afferents that predominantly convey noxious sensation. Reactive oxygen species (ROS) are toxic agents that may be involved in various neurodegenerative diseases. Recent studies indicate that ROS are also involved in persistent pain through a spinal mechanism. In the present study, whole cell patch clamp recordings were carried out on SG neurons in spinal cord slice of young rats to investigate the effects of hydrogen peroxide on neuronal excitability and excitatory synaptic transmission. In current clamp condition, tert-buthyl hydroperoxide (t-BuOOH), an ROS donor, depolarized membrane potential of SG neurons and increased the neuronal firing frequencies evoked by depolarizing current pulses. When slices were pretreated with phenyl-N-tert-buthylnitrone (PBN) or ascorbate, ROS scavengers, t-BuOOH did not induce hyperexcitability. In voltage clamp condition, t-BuOOH increased the frequency and amplitude of spontaneous excitatory postsynaptic currents (sEPSCs), and monosynaptically evoked excitatory postsynaptic currents (eEPSCs) by electrical stimulation of the ipsilateral dorsal root. These data suggest that ROS generated by peripheral nerve injury can modulate the excitability of the SG neurons via pre- and postsynaptic actions.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.9 no.1
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• pp.70-74
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• 2006

Isolated small bowel intussusception accounts for 10% of all pediatric intussusception. It is more common in children older than 2 years of age. Presentation usually is with vomiting and abdominal pain. Currant jelly stool and palpable mass are less frequent than typical intussusception. There are few reported cases of children with transient small bowel intussusception. We describe 3-year-old boy presented with intermittent cyclic crampy abdominal pain for 6 months was diagnosed as having recurrent transient small bowel intussusception by abdominal ultrasonography and small bowel series.