• The Korean Journal of Pain
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• v.22 no.1
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• pp.16-20
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• 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.

• 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.

• Archives of Reconstructive Microsurgery
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• v.9 no.2
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• pp.114-119
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• 2000

The soft tissue defects including the Achilles tendon are complex and very difficult to reconstruct. Recently, several free composite flaps including the tendon have been used to reconstruct large defects in this area in an one-stage effort. Our case presents a patient reconstructed with free composite dorsalis pedis flap along with the extensor digitorum longus and superficial peroneal nerve for extensive defects of the Achilles tendon and surrounding soft tissue. A 36-year-old-man sustained an open injury to the Achilles tendon. He was referred to our department with gross infection of the wound and complete rupture of the tendon associated with loss of skin following reduction of distal tibial bone fracture. After extensive debridement, $6{\times}8cm$ of skin loss and 8cm of tendon defect was noted. Corresponding to the size of the defect, the composite dorsalis pedis flap was raised as a neurosensory unit including the extensor digitorum longus to provide tendon repair and sensate skin for an one-stage reconstruction. One tendon slip was sutured to the soleus musculotendinous portion, the other two were sutured to the gastrocnemius musculotendinous portion with 2-0 Prolene. The superficial peroneal nerve was then coaptated to the medial sural cutaneous nerve. The anterior tibial artery and vein were anastomosed to the posterior tibial artery and accompanying vein in an end to end fashion. After 12 months of follow-up, 5 degrees of dorsiflexion due to the checkrein deformity and 58 degrees of plantar flexion was achieved. The patient was able to walk without crutches. Twopoint discrimination and moving two-point discrimination were more than 1mm at the transferred flap site. The donor site healed uneventfully. Of the various free composite flaps for the Achilles tendon reconstruction when skin coverage is also needed, we recommand the composite dorsalis pedis flap. The advantages such as to control infection, adequate restoration of ankle contour for normal foot wear, transfer of the long tendinous portion, and protective sensation makes this flap our first choice for reconstruction of soft tissue defect including the Achilles tendon.

• The Korean Journal of Pain
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• v.21 no.1
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• pp.11-17
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• 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.

• Journal of Acupuncture Research
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• v.21 no.1
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• pp.240-251
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• 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.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.605-610
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• 2009

Purpose: Substantial tissue necrosis after snake bites requiring coverage with flap surgery is extremely rare. In this article, we report 7 cases of soft tissue defects in the upper and the lower extremities caused by snake bites, which needed to be covered with flaps. Among the vast mass of publications on snake bites there has been no report that focuses on flap coverage of soft tissue defects due to snake bite sequelae. Methods: Seven cases of soft tissue defects with tendon, ligament, or bone exposure after snake bites were included. All patients were males without comorbidities, the average age was 35 years. All of them required coverage with a flap. In 6 cases, the defect was localized on the upper extremity, in one case the lesion was on the lower extremity. Local flaps were used in 6 cases, one case was covered with a free flap. The surgical procedures included one kite flap, one cross finger flap and digital nerve reconstruction with a sural nerve graft, one reverse proximal phalanx island flap, one groin flap, one adipofascial flap, one neurovascular island flap, and one anterolateral thigh free flap. The average interval from injury to flap surgery was 23.7 days. Results: All flaps survived without complication. All patients regained a good range of motion in the affected extremity. Donor site morbidities were not observed. The case with digital nerve reconstruction recovered a static two point discrimination of 7 mm. The patient with foot reconstruction can wear normal shoes without a debulking procedure. Conclusion: The majority of soft tissue affection after snake bites can be treated conservatively. Some severe cases, however, may require the coverage with flap surgery after radical debridement, especially, if there is exposure of tendon, bone or neurovascular structures. There is no doubt that definite coverage should be performed as soon as possible. But we also want to point out that this principle must not lead to a premature coverage. If the surgeon is not certain that the wound is free of necrotic tissue or remnants of venom, it is better to take enough time to get a proper wound before flap surgery in order to obtain a good functional and cosmetic result.

• Journal of Korean Foot and Ankle Society
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• v.8 no.1
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• pp.46-51
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• 2004

Purpose: Problematic late sequelae are common following a calcaneal fracture regardless of the initial treatment. We retrospectively evaluated the painful conditions and reviewed the results of the operative treatment in patients with previously treated calcaneal fractures. Materials and Methods: Between October 1996 and September 2001, forty-three patients who underwent subsequent surgical treatment for late sequelae of calcaneal fracture were reviewed. The initial treatment consisted of only immobilization in a cast in 7 patients, closed reduction with pin fixation (Essex-Lopresti technique) in 22 and open reduction and internal fixation in 14. Painful conditions in the hind foot included subtalar arthritis in 31 patients, calcaneofibular impingement in 13, peroneal tendinitis in 6, displaced posterior bony fragment in 3, sural neuritis in 2, subtalar and midtarsal arthritis in 1 and displaced plantar bony fragment in 1. The surgical procedures for the late complications were performed at a mean of 19 months (range, 6 to 35 months) after the injury and consisted of lateral wall ostectomy and in situ subtalar fusion in 28 patients, only lateral wall ostectomy in 5 patients, lateral wall ostectomy and subtalar distraction arthrodesis in 3, removal of displaced posterior bony fragment in 3, sural nerve transposition in the peroneus brevis in 2, triple arthrodesis in 1 and removal of displaced plantar bony fragment in 1. Mean postoperative follow up period was 57 months (range, 33 to 82 months). The results of treatment were evaluated on the basis of pain, improvement in the ability to perform activities of daily living, to return to work or to a pre-injury level of activity. Results: Pain was partially relieved in 38 patients (88%), but not relieved in 5. Function improved in 34 patients (79%), and 32 (74%) returned to work or to a pre-injury level of activity. There was a trend that the longer the interval between the injury and the operation, the longer the subsequent interval until the patient returned to full activities or work. Conclusion: Meticulous physical examination and intensive prompt treatment for remaining pain after initial treatment of calcaneal fractures are recommended for patient's satisfaction and returning to work.

• Korean Journal of Acupuncture
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• v.38 no.3
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• pp.151-161
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• 2021

Objectives : The effects of a combined stimulation of 658 nm, 830 nm, 904 nm, and 1064 nm laser acupuncture treatment (LAT) and electroacupuncture treatment (EAT) on GB39 and GB34 on neuropathic pain in rats induced by tibial and sural nerve transection were studied in this paper. Methods : To express a neuropathic pain model, surgery was performed to transection rats' tibial and sural nerves. The rats were divided into normal group, control group, and experimental groups. In addition, the experimental groups were divided into 658 nm laser and electroacupuncture (LAT658+EAT), 830 nm laser and electroacupuncture (LAT830+EAT), 904 nm laser and electroacupuncture (LAT904+EAT), and 1064 nm laser and electroacupuncture (LAT830+EAT). For the treatment of the experimental groups, electroacupuncture and different laser wavelengths were alternately applied to GB34 and GB39 twice a week for 3 weeks for 1 minute 30 seconds. The withdrawal response of neuropathic rats' legs by acetone stimulation was observed, as well as the c-Fos in the central gray region in the midbrain of neuropathic rats together with Bax, Bcl2, and mGluR5 expressions associated with apoptosis. Results : Compared with the control group, a significant decrease in the frequency of paw withdrawal in response to acetone allodynia was observed in LAT658+EAT and LAT830+EAT groups in 6th times, LAT904+EAT group in 2^nd, 3^rd, and 6^th times, and LAT1064+EAT group in 2^nd and 6^th times, respectively. For c-fos positive cells in the central gray region, a significant decrease was observed in LAT830+EAT, LAT904+EAT, and LAT1064+EAT groups in comparison with the control group. In Bax expression, LAT1064+EAT group showed a significant decrease compared to the control group. In Bcl-2 expression, the LAT658+EAT,the LAT904+EAT, and the LAT1064+EAT groups increased significantly compared to the control group. LAT830+EAT, LAT904+EAT, and LAT1064+EAT groups showed significantly increased mGlu5 expression compared to the control group. Conclusions : The combination of laser for each wavelength and electroacupuncture alternately performed in this study is thought to be effective in improving neuropathic pain and apoptosis.

• Journal of Korean Foot and Ankle Society
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• v.9 no.2
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• pp.162-166
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• 2005

Purpose: To analyze the clinical and radiological feature of Os subfibulare and to evaluate the results after anatomical reduction and internal fixation with bone graft for Os subfibulare. Materials and Methods: Forty-two cases, which underwent anatomic reduction and bone graft for Os subfibulare from October 1998 to September 2004 were reviewed. We analysed preopertive symptoms and onset of symptoms and radiologically measured the size and amounts of displacement of Os subfibulare under the inversion stress. Postoperatively we evaluated the clinical results measured by Hasegawa method and evidence of union. Results: Preoperatively there were only pain around the lateral malleolus in 16 cases, only instability of ankle joint in 3 cases, and pain and instability in 23 cases. The age of symptom onset averaged 23 years(range, 13-38 years). Radiographically Os sufibulare anteriorly located from lateral malleolus were in 40 cases, posteriorly situated in 2 cases. The size of Os subfibulare ranged from $1{\times}4\;mm$ to $8{\times}17\;mm$. In 22 cases of inversion stress view, displacement of the Os sbufibulare averaged $1.5{\pm}1.1\;mm$ (0 to 5 mm). The postoperative clinical results were excellent in 41 cases, poor in 1 case. There were complications of 1 case of irritation of sural nerve, 1 case of nonunion. Conclusion: Anatomic reduction and bone graft is effective treatment method for symptomatic Os subfibulare.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.18 no.1
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• pp.50-60
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• 2005

Objective : We have studied to know effects of Ligigeopoongsan(LGS, 理氣祛風散) on mechanical allodynia, cold allodynia and c-Fos protein expression in the model of neuropathic pain of rats. Methods : The model of neuropathic pain was made by injured tibial nerve and sural never while common peroneal never was maintained. After 2weeks, we performed behavioral test for 7 days to try out mechanical 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 : 1. Mechanical allodynia in LGS-2, LGS-3 groups were significantly diminished compared with the control group. 2. Cold allodynia in LGS-3 group was significantly diminished compared with the control group. 3. c-Fos protein expression on the central gray LGS-2, LGS-3 groups were significantly lower than that of control group. conclusions : We have noticed that LGS(理氣祛風散) diminished mechanical and cold allodynia in the 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 group were LGS was accumulated time goes by. This study can be used as a basic resource on a study and a treatment of pain.