• The Korean Journal of Pain
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• v.32 no.3
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• pp.178-186
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• 2019

Background: Epidural steroid injections (ESIs) have been widely used in managing spinal pain. Dexamethasone has recently emerged as a useful drug in this setting, relative to particulate steroids, although the associated systemic effects have not been fully elucidated. This study aimed to investigate the incidences and types of systemic effects after fluoroscopically guided ESI with dexamethasone. Methods: This retrospective study included 888 ESIs with dexamethasone (fluoroscopically guided at the cervical and lumbosacral levels) performed on 825 patients during January to June 2017. Data regarding systemic effects were collected via telephone interviews using a standardized questionnaire at 2 weeks after the procedure. Data on patient demographic, clinical, and procedural characteristics were collected and analyzed to identify factors that were associated with systemic effects. All statistical analyses were performed using the chi-squared test. Results: Among the 825 patients, 40 patients (4.8%) experienced systemic effects during the 2-week follow-up period. The most common systemic effect was facial flushing (12 patients, 1.5%), which was followed by urticaria (7 patients, 0.8%) and insomnia (7 patients, 0.8%). A history of spine surgery was significantly associated with the occurrence of systemic effects (P = 0.036). Systemic effects were significantly more common for injections at the cervical level than at the lumbar level (P = 0.019). Conclusions: Approximately 4.8% of the patients who underwent ESI with dexamethasone experienced minor and transient systemic effects. These effects were more common in patients who had undergone a previous spine surgery or received a cervical ESI.

• Clinics in Shoulder and Elbow
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• v.23 no.4
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• pp.169-177
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• 2020

Background: We evaluated the need for arthroscopic capsular release (ACR) in refractory primary frozen shoulder (FS) by comparing clinical outcomes of patients treated with ACR and manipulation under anesthesia (MUA). Methods: We assessed patients with refractory primary FS, 57 patients (group A) who were treated with MUA and 22 patients (group B) who were treated with ACR. In group A, manipulation including a backside arm-curl maneuver was performed under interscalene brachial block. In group B, manipulation was performed only to release the inferior capsule before arthroscopic circumferential capsular release, which was carried out for the unreleased capsule after manipulation. Pain, range of shoulder motion, and American Shoulder and Elbow Surgeons score were recorded at 1 week, 3 months, 6 months, and 1 year after surgery. We compared outcome variables between treatment groups and between diabetics and non-diabetics and also evaluated the numbers of patients receiving additional intra-articular steroid injection. Results: Outcome variables at 3 months after surgery and improvements in outcome variables did not differ between groups. Group A showed significantly better results than group B in the evaluation of pain and range of motion at 1 week. Diabetics showed comparable outcomes to non-diabetics for most variables. Eleven patients required additional steroid injections between 8 to 16 weeks after surgery: 12.2% in group A, 18.2% in group B. Additional injections were given three times more often in diabetics compared to non-diabetics. Conclusions: MUA alone can yield similar clinical outcomes to ACR in refractory FS.

• Tuberculosis and Respiratory Diseases
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• v.41 no.5
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• pp.568-573
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• 1994

Corticosteroids are widely used in the treatment of various diseases because of its potent antiinflammatory effect. According to recent knowledge, bronchial asthma is also chronic inflammatory disease. Therefore antiinflammtory agent such as cromoyln sodium and corticosteroid is highly recommended for treament of chronic bronchial asthma. Especially hydrocortisone succinate (Solu-Cortef) is commonly used for treament to acute asthmatic attack via intravenous injection due to have rapid therapeutic onset and short duration. Since Sunaga et al. reported acute asthma attack after hydrocortisone injection in 1973, several cases of bronchospam with or without angioedema and urticaria after intravenous injection of hydrocortisone have been reported. We experienced a case of severe bronchospasm and acute respiratory failure after intraveous injection of hydrocortisone succinate in 64 year-old female asthmatic patient who visited to emergency room for acute asthmatic attack. About 5 minites after Solu-Cortef injection, a severe bronchospasm with arterial hypoxemia was developed. In order to confirm the suspected relationship between the offending drug(Solu-Cortef) and acute bronchospasm, we examed intravenous and inhalation provocation test by hydrocortisone succinate and methylprednisolone(control). After administration of hydrocortisone succinate via intravenous and inhalation route, severe asthmatic attack occurred. But administration of intravenous methylprednisolone and orall triamcinolone and saline were not provoke bronchospasm. Skin test using hydrocortisone sodium succinate was also positive. Administration of hydrocortisone is very serious to asthmatic patient with hydrocortisone hypersensitivity. Therefore, the clinician must be have history taking about previous adverse reaction of steroid before its clinical use. And methylprednisone may be useful and safe drug to the treatment of acute asthmatic patient with hydrocortisone hypersensitivity.

• Development and Reproduction
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• v.11 no.3
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• pp.187-193
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• 2007

Ethane 1,2-dimethane sulfonate(EDS), a Leydig cell specific toxicant, has been widely used to create the reversible testosterone withdrawal rat model. Though the maintenance of epididymal structure and function is highly dependent on the testosterone secreted from testis, its derivatives, dihydroxytestosterone(DHT) and estrogen, might have crucial roles. The aim of present study was to monitor the expression patterns of sex steroid receptors, cytochrome P450 aromatase(P450arom) and $5{\alpha}$-reductase in the rat epididymis up to 7 weeks after EDS injection. Adult male rats($350{\sim}400g$) were injected with a single does of EDS(75 mg/kg i.p.) and sacrificed on weeks 0, 1, 2, 3, 4, 5, 6 and 7. The transcriptional activities of the target genes were evaluated by semi-quantitative RT-PCRs. The transcript level of estrogen receptor alpha($ER{\alpha}$) in EDS group was significantly higher than control level on week 1(P<0.01). After week 2, there was no significant difference in $ER{\alpha}$ levels between EDS group and control. The transcript level of estrogen receptor beta($ER{\beta}$) in EDS group was significantly higher than control level on week 1(P<0.05), lowered on weeks 2 and 3(P<0.05 and P<0.01, respectively), fluctuated during weeks 4 and 6, and elevated on week 7(P<0.05). The androgen receptor (AR) message levels increased significantly week 2(P<0.01), then returned to control level on week 3. In contrast, expression of cytochrome P450 aromatase(P450arom) decreased sharply during weeks $1{\sim}3$(P<0.01 on weeks 1 and 2; P<0.05 on week 3), then went back to control level on week 4. The mRNA level of $5{\alpha}$-reductase type 2($5{\alpha}$-RT2) increased significantly on week 4(P<0.01), then returned to control level. The present study indicated that EDS administration could induce reversible alterations in the transcriptional activities of sex steroid hormone receptors and androgenconverting enzymes in rat epididymis. EDS injection model will be useful to clarify the regulation mechanism of mammalian epididymal physiology.

• The Journal of the Korean bone and joint tumor society
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• v.20 no.1
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• pp.14-21
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• 2014

Purpose: To analyze the clinical features and treatment outcome of Langerhans' cell histocytosis. Materials and Methods: From August 1996 to June 2013, 28 patients who histologically proven with LCH were analyzed of medical records, radiography, pathologic character retrospectively. Results: A total of 28 cases of LCH including 22 child has been reported. Onset age was 0.6 to 51 years old, occurred in the average age was 14.8 years. Follow-up period was 6 months to 134 months average was 44.6 months. The M:F ratio was 2.5:1. The initial symptoms was pain in 18 cases, 5 cases of pathologic fracture, 3 case of palpable mass, 1 case of discovered by accident in radiography, 1 case of torticollis. In radiological examination osteolysis was seen all cases, 7 cases showed a periosteal reaction, 1 case showed soft tissue extension. Clinical type of all cases were eosinophilic granuloma. 25 cases were classified as unifocal disease and 3 cases were multifocal single systemic diseases. In all cases, incisional biopsy was performed. After histologic confirmed, 14 cases was treated with curettage or surgical excision of the lesion and the other 14 cases were followed up without treatment. There is no death during follow up period. 11 cases has no radiological improvement after 3-6 months observation, intralesional steroid injection was performed. Conclusion: Patients with LCH who has rapid systemic onset is very rare, so if you meet the young children who suspected LCH, you shoulder avoid the examination which cause excessive radiation exposure to the young patient. In order to confirm the diagnosis of disease, biopsy is needed. Close observation after confirmed by histological method will bring the satisfactory results. But the patients who had pathologic fracture or wide bone destruction already may need curettage and bone grafting to lesion or internal fixation. The lesion which has no radiological improvement after 3-6 months observation or appear with pain interferes daily life may need local steroid injection as a good treatment.

• Journal of Physiology & Pathology in Korean Medicine
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• v.17 no.2
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• pp.428-435
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• 2003

This research was performed to examine an anti-inflammatory effects of Gamisangryosamul-Tang(GSS) and anti-pruritus effects of Ziyang-Go(Salve). This study was processed by three experiments; Experiment 1: Inhibitory activity of GSS extract on the degranulation of mast cell and histamine release in plasma induced by compound 48/80 i.p, injection after the pretreatment of GSS extract i.p, injection in Sprague-Dawley rats, Experiment 2: Anti-inflammatory effect of GSS extract on macropharge raw 264,7 cells treated by LPS 250 ppm (before 2 hours). Experiment 3: Measurement of passive cutaneous anaphylaxis and atopic dermatitis using NC/Nga mice, GSS extract inhibited histamine release by 70% compared to compound 48/80 treated control group and histologically significantly reduced (P<0,01) the degranulation of mast cell in SD rats. In GSS extract treated group, the expression of TNF-α in macropharge cell showed the remarkable inhibitory effect about 62% (P<0,01) compared to LPS treated control group. The expression of IL-6 appeared more effective by 46% than the LPS treated control group and by 6% compared to hydrocortison treated group, Comparing with steroid (0.05% prednisolon) ointment, Ziyan-Go treated group showed the significant(30%) recovery on skin response index in atopic dermatis like anaphylaxis mice(NC/Nga), Finally, in scratching behavioral tests of NC/Nga mice for three weeks, Ziyang-Go treated group significantly (P<0.05) suppressed the pruritus on the face, neck, ears and dorsal skin than inbred NC/Nga mice. However, the change of IgE and IFN-γ from the spleen cell of NC/Nga mice was not significantly different between the oral intake of GSS extract group and of saline intaked control group. Summary and Conclusion: This study demons trates that Ziyang-go have the equal anti-pruritus effect to steroid ointment and GSS extract have the notable immunologic activity on inflammatory in vivo and in vitro model. Advanced experiment of this study will be required for more reliable information about the correlation between the lymphokine (i.e. IgE) and the anti-allergic effects of GSS.

• The Korean Journal of Pain
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• v.22 no.2
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• pp.151-157
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• 2009

Background: We hypothesized that if a fluoroscopic image of the lumbar sympathetic ganglion block (LSGB) showed the spread patterns of contrast at both the L2/3 and L4/5 disc areas, then this would demonstrate a more profound blockade effect because the spread patterns are close to sympathetic ganglia. In addition, we compared the effects of LSGB and transforaminal epidural steroid injection (TFESI) for the patients suffering with spinal stenosis. Methods: Eighty patients were divided into two groups (Group S: the patients treated with TFESI, Group L: the patients treated with LSGB). The patients of group L were classified into three groups (groups A, B and, C) according to their contrast spread pattern. The preblock and postblock temperature difference between the ipsilateral and contralateral great toe ($DT^{pre}$, $DT^{post}$, $^{\circ}C$), and the DTnet were calculated as follows. $DT^{net}$ = $DT^{post}$ - $DT^{pre}$. Results: Both group showed a significant reduction of the visual analogue score (VAS) and the Oswestry disability index (ODI) score. Only the patients of group L showed a significant increase of their walking distance (WD). Group A showed the most significant changes in the $DT^{post}$ ($6.1{\pm}1.2^{\circ}C$, P = 0.021), and the DTnet ($6.0{\pm}1.0^{\circ}C$, p = 0.023), as compared to group C. Conclusions: LSGB showed a similar effect on the VAS, and ODI, and a significant effect, on WD, compared with TFESI. Group A showed a significant sympatholytic effect, as compared to group C.

• Journal of Acupuncture Research
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• v.32 no.4
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• pp.203-211
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• 2015

Objectives : The purpose of this study was to assess the effectiveness of integrative Korean Medical treatments for patients with L-spine disk herniation that showed no response to Epidural Steroid Injections (ESI). Methods : In this study, we reviewed the medical records of ten patients who showed no improvement or relapsed after ESI. The patients each received more than three weeks of integrative treatments at Mokhuri Neck&Back Hospital. The Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) was measured before and after treatment. A statistical analysis to compare before and after treatments was assessed using paired t-test the SPSS 12.0 Windows program. Results : After three weeks of treatment, patients showed a significant decrease in VAS and ODI scores compared to before receiving treatment. VAS scores decreased from $5.3{\pm}1.25$ to $1.9{\pm}0.99$ (p<0.001), and ODI scores decreased from $59.8{\pm}22.2$ to $32.7{\pm}14.11$ (p<0.001). Conclusions : Complex Korean Medical treatment showed effectiveness in the treatment of L-spine HIVD patients that showed no response to ESI, and more objective research is needed.

• Journal of Pharmacopuncture
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• v.18 no.1
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• pp.79-85
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• 2015

Objectives: A vertebral compression fracture (VCF) is characterized by back pain and fracture of a vertebral body on spinal radiography. VCFs of the thoraco lumbar spine are common in the elderly. In general, appropriate analgesics should be prescribed to reduce pain and, thus, promote early mobilization. The ideal treatment approach for VCFs has not been determined. In Korea, acupuncture and herbal medication have been used to treat VCFs for many years. There is empirical evidence that acupuncture might benefit patients with a VCF. However, no randomized, controlled, clinical trials evaluating the efficacy and the safety of acupuncture for treating a VCF have been published. Therefore, we designed a randomized, controlled, pilot, clinical trial to obtain information for the design of a further full scale trial. Methods: A five week protocol for a randomized, controlled, pilot, clinical trial is presented. Fourteen patients will be recruited and randomly allocated to two groups: a control group receiving interlaminar epidural steroid injections once a week for three weeks, and an experimental group receiving interlaminar epidural steroid injections plus acupuncture treatment (three acupuncture sessions per week for three weeks, nine sessions in total). The primary outcomes will be the pain intensity (visual analogue scale and PainVision$^{TM}$ system). The secondary outcome measurements will be the answers on the short form McGill pain questionnaire and the oswestry disability index. Assessments will be made at baseline and at one, three, and five weeks. The last assessment (week five) will take place two weeks after treatment cessation. This study will provide both an indication of feasibility and a clinical foundation for a future large scale trial. The outcomes will provide additional resources for incorporating acupuncture into existing treatments, such as nonsteroidal anti-inflammatory medications, narcotics and vertebral augmentation. This article describes the protocol.

• Asian-Australasian Journal of Animal Sciences
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• v.32 no.11
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• pp.1673-1685
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• 2019

Objective: To evaluate the efficacy of treatments based on gonadotrophin-releasing hormone (GnRH), GnRH-prostaglandin $F2{\alpha}$ ($PGF2{\alpha}$), and/or intense exposure to novel rams to induce fertile estrus without the use of steroid hormones in seasonally anestrous Suffolk ewes. Methods: In the first experiment, ewes were treated with one injection of GnRH, two injections of GnRH administered 7 days apart, or a sequence of GnRH-$PGF2{\alpha}$-GnRH (GPG). In the second experiment anestrous ewes were exposed, for 36 days starting on the day of weaning, to groups of four rams of three different breeds that were alternated every day. Besides exposure to the male effect (ME), the ewes were injected with saline solution (ME group, n = 20), with GnRH (ME-GnRH group, n = 20) or with a sequence of GnRH-$PGF2{\alpha}$-GnRH (ME-GPG group, n = 20). The rams used for male-effect were fitted with aprons to prevent mating, and ewes detected in estrus were bred to selected fertile rams. Ovarian activity was monitored by progesterone determinations in both experiments. Results: In the first experiment sustained induction of ovarian activity was not achieved and no ewe was detected in estrus. In the second experiment induction of sustained ovarian activity was achieved in all groups. Most of the ewes were detected in estrus, 76.7% of the ewes were mated during a 36-d breeding period and 71.7% of all the ewes became pregnant during that period. No significant differences between groups were found for any of these variables. However, estrus detection efficiency was higher in the ME-GnRH group than in the ME group (p<0.05). Conclusion: An intense male-effect, that included the continuous presence and frequent alternation of several rams of different breeds, was sufficient to induce ovarian activity and fertile estrus in Suffolk ewes during the period of deep anestrus without the use of hormones, although addition of GnRH improved the efficiency of estrus detection.