• Archives of Plastic Surgery
• /
• 제33권6호
• /
• pp.695-699
• /
• 2006

Purpose: In the 1990s, skin island flap supplied by the vascular axis of the sensitive superficial nerves had been introduced. For example, neurocutaneous flaps supplied by the vascular axis of the sural nerve and saphenous nerve have been used. But the flap supplied by the vascular axis of superficial peroneal nerve has not been used commonly. Because there have been few anatomical reports about the superficial peroneal nerve accessory artery(SPNAA), we could not apply the neurocutaneous flap supplied by SPNAA. The aim of this study is to investigate the anatomy of SPNAA, number and location of its perforators, and septocutaneous perforators from the anterior tibial artery in anterior intermuscular septum. Methods: So, we dissected a total of eight cadavers. Measurements were made of the positions of the dissected arteries and perforators from the head of the fibula. Results: In all cadavers the superior lateral peroneal artery was originated from the anterior tibial artery and contributed SPNAA. Arising from the anterior tibial artery an average of 5.63 cm inferior to the fibular head, it varied from 10 cm to 16 cm in length. SPNAA gave off an average of 4.38 perforators to supply lateral aspect. In one case the inferior lateral peroneal artery was present and arose from the anterior tibial artery 18 cm inferior to the fibular head. There were an average of 3.38 direct septocutaneous perforators from the anterior tibial artery. Conclusion: Septocutaneous perforators from SPNAA mainly exist from proximal 1/6 to 3/5 of lower leg. In the distal 1/3 of lower leg where the accessory artery was disappeared, exist mainly direct septocutaneous perforators from the anterior tibial artery. Our results can be helpful to applications of the neurocutaneous flap using SPNAA or fasciocutaneous flap based on direct septocutaneous perforators.

• Archives of Plastic Surgery
• /
• 제33권5호
• /
• pp.669-671
• /
• 2006

Purpose: Congenital insensitivity to pain with anhidrosis(CIPA) is a rare form of autosomal recessive peripheral sensory neuropathy. Patients with CIPA show loss of pain sensation, which leads to corneal ulcers and opacities, self-mutilation of the tongue and fingertips, as well as fractures with subsequent joint deformities and chronic osteomyelitis. The purpose of this report is to highlight the fact that pressure sores also are a potential complication of CIPA. Methods: This case report describes a patient presenting with pressure sores resulting from CIPA. A 5-year-old boy was referred to our department for the treatment of a $5{\times}5cm$ sacral pressure sore as a result of a hip spica cast applied for the treatment of a left hip joint dislocation. He had a history suggesting CIPA such as multiple bony fractures, mental retardation, recurrent hyperpyrexia, anhidrosis, and clubbing fingers due to oral mutilation. A microscopic examination of the sural nerve showed mainly large myelinated fibers, a few small myelinated fibers and an almost complete loss of unmyelinated fibers. After wound preparation for two weeks, the exposed bone was covered with two local advancement flaps. Results: Two weeks later, complete wound healing was achieved. A 16-month follow-up showed no recurrence. However, the patient presented with a new pressure sore on the left knee due to orthosis for the treatment of the left hip joint dislocation. Conclusion: The early diagnosis of CIPA and special care of pressure sores are important for preventing and treating pressure sores resulting from CIPA.

• The Korean Journal of Pain
• /
• 제21권1호
• /
• pp.11-17
• /
• 2008

Background: Peripheral nerve injury induces up-regulation of the calcium channel alpha2delta (${\alpha}2{\delta}$) subunit and TRPM8 in the dorsal root ganglion (DRG) which might contribute to allodynia development. We investigated the expression of the ${\alpha}2{\delta}$ subunit and TRPM8 in the DRG of sympathetically maintained pain (SMP) and sympathetic independent pain (SIP) rat model. Methods: For the SMP model, the L5 and L6 spinal nerves were ligated tightly distal to the DRG. For the SIP model, the tibial and sural nerves were transected, while the common peroneal nerve was spared. After a 7 day postoperative period, tactile and cold allodynia were assessed using von Frey filaments and acetone drops, respectively. Expression of the ${\alpha}2{\delta}$ subunit and TRPM8 in the L5 and L6 DRG were subsequently examined by a Western blot. Results: There were no significant differences between the two models for the thresholds of tactile and cold allodynia. Expression of the ${\alpha}2{\delta}$ subunit in the ipsilateral DRG to the injury was increased as determined on a Western blot as compared to that in the contralateral or sham-operated DRG of the SMP model, but there was no difference in expression seen with the use of the SIP model. There was no difference in the expression of TRPM8 in the ipsilateral DRG to the injury and the contralateral or sham-operated DRG of either model. Conclusions: Up-regulation of the ${\alpha}2{\delta}$ subunit in injured DRG may play a role that contributes to tactile allodynia development in SMP, but not TRPM8 to cold allodynia after peripheral nerve injury.

• 대한정형외과 초음파학회지
• /
• 제5권1호
• /
• pp.15-21
• /
• 2012

상완골 골절에 동반된 요골 신경 마비는 전체 상완골 골절의 약 10%에서 발생하는 것으로 보고되고 있으며, 상완골 골절 수술과 관련하여 발생하는 의인성 요골 신경 마비는 10~20%로 알려져 있어 임상에서 흔히 경험하게 된다. 상완골 골절에 동반된 원발성 요골 신경 마비나 의인성 요골 신경 마비가 발생한 경우 요골 신경이 단열된 것인지 아니면 주위 구조물에 압박된 것인지 등의 요골 신경의 해부학적 상태의 평가는 자연회복을 기다릴 것인지 아니면 수술적 탐색술을 실시할 것인지 여부를 결정하는데 중요하다. 저자들은 상완골 골절에 동반된 원발성 요골 신경 마비 1예와 수술과 관련한 의인성 요골 신경 마비 1예를 초음파 검사로 신경의 해부학적 상태를 확인한 후 신경의 단열이 있었던 1예는 비복신경 이식술을 시행하였고, 신경유착이 있었던 1예는 신경박리술을 시행하여 만족할 만한 임상결과를 얻었기에 초음파를 이용한 요골 신경 검사를 중심으로 문헌 고찰과 함께 보고하고자 한다.

• Journal of Acupuncture Research
• /
• 제21권1호
• /
• pp.240-251
• /
• 2004

Objective: We have studied to know effects of acupuncture at SI3, BL40, SI3 BL40 on mechnical allodynia, cold allodynia and c-fos protein expression in a model of neuropathic pain of rat. Methods: A model of neuropathic pain was made by injuring tibial nerve and sural nerve while common peroneal nerve was maintained. after 2 weeks, we performed behavioral tests for 7 days to try out mechnical allodynia using von frey filament and cold allodynia using acetone, which are calculated by counting withdrawal response on foot. Rat brains removed and sliced on 8th days. Serial sections were immunohistochemically reacted with polyclonal c-fos antibody. The numbers of c-Fos protein immunoreactive neurons in the central gray were examined using scion image program. Results: Mechanical allodynia in the SI3, BL40, SI3 BL40 groups were diminished compared with the control group. Cold allodynia in the SI3, BL40, SI3 BL40 groups were diminished compared with the control group. c-Fos protein expression on the central gray in the SI3 group were lower than that of the control group. Conclusions: We have noticed that acupuncture at SI3, BL40, SI3 BL40 diminished mechanical allodynia and cold allodynia in a model of neuropathic pain compared with the control group. c- Fos protein expression in the central gray of that group was also decreased compared with the control group. pain control using acupunture was accumulated as time goes by. This study can be used as a basic resource on a study and a treatment of pain.

• Journal of Acupuncture Research
• /
• 제22권5호
• /
• pp.67-77
• /
• 2005

Objectives : The purpose of this study is to examine if Bee Venom 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 alloynia. The allodynia was assessed by stimulating the medial malleolus with von Frey filament and acetone. Three weeks after the neuropathic surgery, Bee Venom 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 yon 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 : The Bee Venom Acupuncture injected Hwando(GB30) decreased the withdrawl response of mechanical allodynia in BV-2, BV-3 group as compared with control group. The Bee Venom Acupuncture injected Hwando(GB30) decreased the withdrawl response of chemical allodynia(cold allodynia) in BV-2, BV-3 group as compared with control group. The Bee Venom Acupuncture injected Hwando(GB30) showed the significant difference between control group and BV-2 group, control group and BV-3 group in the c-Fos expression and U count. Conclusion : We have noticed that Bee Venom Acupuncture at Hwando(GB30) decreased mechanical allodynia and cold allodynia in the model of neuropathic pain compared with the control group. C-Fos expression in the central gray of that group was also decreased compared with the control group. Psin control using Bee Venom Acupuncture was accumulated as time goes by. This study can be used as a basic resource on a study and a treatment of pain.

• 농촌의학ㆍ지역보건
• /
• 제24권1호
• /
• pp.1-11
• /
• 1999

본 연구는 농약에 직업적으로 폭로되고 있는 농부들의 말초신경 기능을 평가하고자 농약살포 남성 농민 34명을 대상으로, 1998년 5월부터 1999년 2월에 걸쳐 실시하였다. 연구내용으로는 말초신경병변을 평가하기 위한 방법으로 현재 가장 많이 사용되고 있는 신경전도 검사를 우세 상하지의 청중신경, 척골신경, 비골신경, 후경골신경, 비복신경 대해 각 구간별로 나누어 실시하였다. 조사결과 조사대상자들은 평균 60세로서 농약살포 경력은 평균 33년이었다. 농사 유형은 주로 논, 밭, 고추 농사를 경작하고 있었으며 년간 평균 약 35일간 농약을 살포하였고 1일 살포시간은 약 9시간이었다. 또한 농약 중독 관련 증상을 경험한 적이 약 82%이상에서 보고되었다. 신경전도 검사상 조사원 모든 신정에서의 값이 정상범위에는 포함되었지만, 일부구간(척골감각 신경의 wrist-elbow, 후경골신경의 terminal latency)을 제외하고는 모두 참고치의 평균값보다 유의하게 낮은 것으로 나타났다. 또한 상대적 고폭로군과 저폭로군 간의 신경전도 검사치 비교에 의하면 정중감각 및 운동, 비골신경의 일부 구간 값이 고폭로군에서 높은 것을 제외하고는 유의한 차이를 발견할 수 없었다. 이것은 고폭로군의 연령이 저폭로군보다 유의하게 낮기 때문으로 판단되며, 조사 대상자들의 값이 참고치 평균보다 떨어진 것도 연령이 높음으로 인한 것임을 연령군별 비교에 의해 확인할 수 있었다. 따라서 향후 농약 폭로로 인한 미세한 말초신경 기의 이상여부를 조기에 파악하기 위해서는 감각역치 검사등 다론 신경학적 검사들을 함께 실시하는 것이 바람직하다고 판단되었다.

• The Korean Journal of Pain
• /
• 제22권1호
• /
• pp.16-20
• /
• 2009

Background: Zaprinast is an inhibitor of phosphodiesterase 5, 6 and 9. Phosphodiesterase inhibitors could produce anti-nociceptive effects by promoting the accumulation of cGMP. We hypothesized that intrathecal zaprinast could attenuate the allodynia induced by chronic constriction injury of the sciatic nerve in rat. Methods: Sprague-Dawley rats were prepared with four loose ligations of the left sciatic nerve just proximal to the trifurcation into the sural, peroneal and tibial nerve branches. Tactile allodynia was measured by applying von Frey filaments to the lesioned hindpaw. The thresholds for the withdrawal responses were assessed. Zaprinast ($3-100{\mu}g$) was administered intrathecally by the direct lumbar puncture method to obtain the dose-response curve and the 50% effective dose ($ED_{50}$). Measurements were taken before and 15, 30, 45, 60, 90, 120, and 180 min after the intrathecal doses of zaprinast. The side effects were also observed. Results: Intrathecal zaprinast resulted in a dose-dependent antiallodynic effect. The maximal effects occurred within 15-30 min and then they gradually decreased down to the baseline level over time in all the groups. There was a dose dependent increase in the magnitude and duration of the effect. The $ED_{50}$ value was $17.4{\mu}g$ (95% confidence intervals; $14.7-20.5{\mu}g$). No severe motor weakness or sedation was observed in any of the rats. Conclusions: Intrathecally administered zaprinast produced a dose-dependent antiallodynic effect in the chronic constriction injury neuropathic pain model. These findings suggest that spinal phosphodiesterase 5, 6 and 9 may play an important role in the modulation of neuropathic pain.

• 감성과학
• /
• 제19권4호
• /
• pp.111-118
• /
• 2016

당뇨병 환자들은 말초신경 손상의 합병증으로서 이상감각과 통증을 느낄 수 있는데 이는 날카로운 느낌, 차갑고 시린 느낌, 무딘 느낌, 살갗이 벗겨진 듯한 예민한 느낌, 화끈거리는 느낌, 따끔하고 가려운 느낌 등 다양하게 나타날 수 있다. 이를 진단하기 위해서 여러 선별검사와 전기생리학적 검사를 활용할 수 있다. 본 연구에서는 신경병통증척도와 미시간 신경병증 선별도구 및 신경전도검사를 통해 이상감감/통증을 호소하는 당뇨병 환자 11명과 호소하지 않는 당뇨병 환자 10명 간에 차이점 및 특징을 분석하였고, 세부 감각양상과 신경전도검사 지표간 상관성을 분석하였다. 그 결과 이상감각/통증을 호소하는 환자군에서 신경병통증척도와 미시간 신경병증 선별검사의 점수가 통계적으로 유의하게 높았고 신경전도검사에서는 주로 정중신경 운동신경과 비골신경이 의미 있는 기능 변화를 보였다. 세부 감각양상에 따른 신경전도검사 지표는 주로 정중신경 운동신경, 후경골신경, 장딴지신경에서 유의한 변화를 보였다. 이러한 결과들은 감각이상과 통증이 실제 말초신경 이상과 관련이 있음을 시사한다. 향후 많은 수의 대상자를 포함한 추가적인 연구가 필요하다.

• Journal of Acupuncture Research
• /
• 제30권4호
• /
• pp.69-78
• /
• 2013

Objectives : The purpose of this study is to examine whether Eucommiae Cortex pharmacopuncture may affect to the neuropathic pain in a rat model. Methods : To produce the model of neuropathic pain, under isoflurane 2.5 % anesthesia, underwent tight ligation by 6.0 silk thread and transection of the tibial and sural nerves, leaving the common peroneal nerve intact. After neuropathic surgery, the author examined if the exhibited the behavioral sign of allodynia. The allodynia was assessed by stimulating the plantar with Dynamic Plantar Aesthesiometer. Three days after the neuropathic surgery, Eucommiae Cortex pharmacopuncture was injected at Sinsu($BL_{23}$) once every week for 6 weeks. After that, the author examined the withdrawal response of neuropathic rats' leg by Dynamic Plantar Aesthesiometer. And also the author examined Bax, Bcl-2, Bax/Bcl-2 ratio in the spinal cord of neuropathic rats and the change of WBC, RBC, HGB, HCT count in the blood of neuropathic rats. Results : 1. The Eucommiae Cortex pharmacopuncture decreased the withdrawal response of mechanical allodynia that assessed with Dynamic Plantar Aesthesiometer in EC2-$BL_{23}$ group as compared with control group. 2. The Eucommiae Cortex pharmacopuncture decreased Bax/Bcl-2 ratio in EC1-$BL_{23}$, EC2-$BL_{23}$ group. But The Eucommiae Cortex pharmacopuncture injected at Sinsu($BL_{23}$) didn't change Bax, Bcl-2 expression level in the all group. 3. The Eucommiae Cortex pharmacopuncture decreased WBC count in EC1-$BL_{23}$, EC2-$BL_{23}$ group. Conclusions : We have noticed that Eucommiae Cortex pharmacopuncture decreased mechanical allodynia in the model of neuropathic pain compared with the control group. Bax/Bcl-2 ratio in spinal cord of that group was also decreased compared with the control group. This study can be used as a basic resource on a study and a treatment of neuropathic pain.