• Journal of Korean Neurosurgical Society
• /
• v.56 no.4
• /
• pp.323-329
• /
• 2014

Objective : Vertebral body replacement following corpectomy in thoracic or lumbar spine is performed with titanium mesh cage (TMC) containing any grafts. Radiological changes often occur on follow-up. This study investigated the relationship between the radiological stability and clinical symptoms. Methods : The subjects of this study were 28 patients who underwent corpectomy on the thoracic or lumbar spine. Their medical records and radiological data were retrospectively analyzed. There were 23 cases of tumor, 2 cases of trauma, and 3 cases of infection. During operation, spinal reconstruction was done with TMC and additional screw fixation. We measured TMC settlement in sagittal plane and spinal angular change in coronal and sagittal plane at postoperative one month and last follow-up. Pain score was also checked. We investigated the correlation between radiologic change and pain status. Whether factors, such as the kind of graft material, surgical approach, and fusion can affect the radiological stability or not was analyzed as well. Results : Mean follow-up was 23.6 months. During follow-up, $2.08{\pm}1.65^{\circ}$ and $6.96{\pm}2.08^{\circ}$ of angular change was observed in coronal and sagittal plane, respectively. A mean of cage settlement was $4.02{\pm}2.83mm$. Pain aggravation was observed in 4 cases. However, no significant relationship was found between spinal angular change and pain status (p=0.518, 0.458). Cage settlement was seen not to be related with pain status, either (p=0.644). No factors were found to affect the radiological stability. Conclusion : TMC settlement and spinal angular change were often observed in reconstructed spine. However, these changes did not always cause postoperative axial pain.

• The Korean Journal of Pain
• /
• v.28 no.3
• /
• pp.198-202
• /
• 2015

Background: Lack of proper control of acute postoperative pain often leads to lingering or chronic pain. Several studies have emphasized the role of beta-blockers in reducing postoperative pain. Esmolol is a selective short-acting beta-blocker that produces few side effects. The purpose of this study was to examine the effect of intravenous intraoperative esmolol on postoperative pain reduction following orthopedic leg fracture surgery. Methods: In a clinical trial, 82 patients between 20-65 years of age with tibia fractures and American Society of Anesthesiologists (ASA) physical status I & II who underwent surgery were divided into two groups. Group A received esmolol and group B received normal saline. Postoperative pain was measured at three time points: entering the recovery unit, and at 3 h and 6 h following surgery, using the Visual Analogue Scale (VAS). A P value of < 0.05 was considered significant. Results: Mean VAS scores at all three time points were significantly different between the two test groups (P = 0.02, P = 0.0001, and P = 0.0001, respectively). The consumption of pethidine was lower in group A than in group B (P = 0.004) and the duration of its effect was significantly longer in time (P = 0.026). Conclusions: Intravenous intraoperative esmolol is effective in the reduction of postoperative pain following leg fracture surgery. It reduced opioid consumption following surgery and delayed patient requests for analgesics.

• The Korean Journal of Physiology and Pharmacology
• /
• v.22 no.5
• /
• pp.525-538
• /
• 2018

Post-traumatic stress disorder (PTSD) is a trauma-induced psychiatric disorder characterized by impaired fear extermination, hyperarousal, and anxiety that may involve the release of monoamines in the fear circuit. The reported pharmacological properties of tetramethylpyrazine (TMP) include anti-cancer, anti-diabetic, anti-atherosclerotic, and neuropsychiatric activities. However, the anxiolytic-like effects of TMP and its mechanism of action in PTSD are unclear. This study measured several anxiety-related behavioral responses to examine the effects of TMP on symptoms of anxiety in rats after single prolonged stress (SPS) exposure by reversing the serotonin (5-HT) and hypothalamic-pituitary-adrenal (HPA) axis dysfunction. Rats were given TMP (10, 20, or 40 mg/kg, i.p.) for 14 days after SPS exposure. Administration of TMP significantly reduced grooming behavior, increased the time spent and number of visits to the open arm in the elevated plus maze test, and significantly increased the number of central zone crossings in the open field test. TMP administration significantly reduced the freezing response to contextual fear conditioning and significantly restored the neurochemical abnormalities and the SPS-induced decrease in 5-HT tissue levels in the prefrontal cortex and hippocampus. The increased 5-HT concentration during TMP treatment might be partially attribute to the tryptophan and 5-hydroxyindoleacetic acid mRNA level expression in the hippocampus of rats with PTSD. These findings support a role for reducing the altered serotonergic transmission in rats with PTSD. TMP simultaneously attenuated the HPA axis dysfunction. Therefore, TMP may be useful for developing an agent for treating psychiatric disorders, such those observed in patients with PTSD.

• Journal of Biomedical Engineering Research
• /
• v.39 no.1
• /
• pp.30-35
• /
• 2018

Conventional drug delivery methods mainly include subcutaneous injection and oral administration. Subcutaneous injection has the advantages of delivering the correct concentration, but it might cause pain and trauma to patients. Although oral administrations do not accompany pain as the subcutaneous injection, unexpected side effects may occur because they undergo digestion process and it is not easy for many drugs to be exposed to targeted sites with proper concentration. While dissolving microneedles have been extensively studied to overcome the limitations of conventional subcutaneous injection, the effects on microneedle shapes for drug release have not been fully explored. In this study, the characteristics of hyaluronic acid microneedles for cone and quadrangular pyramidal shapes were examined by the size, volume, contact surface area, skin permeability, and dissolution rate. As a result, the cone shapes of hyaluronic acid microneedles had high skin permeability, and the quadrangular pyramid of shapes hyaluronic acid microneedles showed a fast dissolution rate, given by the large contact area on the skin. Based on the results, we could confirm that the shape of a dissolving microneedles can affect skin permeability and the drug delivery rate.

• Archives of Plastic Surgery
• /
• v.35 no.2
• /
• pp.159-164
• /
• 2008

Purpose: Microvascular free tissue transfer has become a reliable technique for the reconstruction of complex wounds. Occasionally, unexpected intraoperative thrombosis and/or spasm of recipient artery might be annoying problems even for the technically competent microvascular surgeons. If such problems are not treated properly, they will inevitably cause to flap failure. Methods: From January 2006 to February 2007, soft tissue reconstructions by free tissue transfers were performed on 21 patients having complex defects in the lower extremity. Although segmental revision and various pharmacologic agents were repeatedly applied, arterial occlusions were not managed in 6 cases. For removal of thrombi and release of spasm, Fogarty No. 2 or No. 3 catheters were inserted into the lumen to the proximal recipient artery. Its balloon was then inflated after passing through a resistant area. Next, the catheter was gently withdrawn backward. Results: After the Fogarty catheter was inserted two or three times, the pulsatile arterial flow was restored. When the catheter was inserted into the lumen, a feeling of resistance existed in a 5-10cm more proximal portion that could not be easily accessed from the vascular end. After the reestablishment of blood flow, successful anastomoses were achieved and immediate rethrombosis or spasm did not occur. No long-term sequelae associated with balloon trauma to the arterial wall were observed. Conclusion: The use of the Fogarty catheter can be an effective method in treating pedicle thrombosis and spasm. This is a very simple and rapid technique that offers microvascular surgeons another option to increase the success rate of microvascular anastomosis in free tissue transfers.

• Anxiety and mood
• /
• v.10 no.1
• /
• pp.3-10
• /
• 2014

Reactive disorder is a group of diagnosis with a definitely known etiology and whose etiological factor is essential to the diagnosis. In DSM system, such reactive disorders are listed as adjustment disorder, acute stress disorder, brief psychotic disorder with marked stressor and posttraumatic stress disorder (PTSD). However, a growing number of individuals is suffering from a prolonged feeling of embitterment after exceptional negative life events and this condition could be diagnosed neither PTSD nor adjustment disorder nor depressive disorder in the context of DSM-IV diagnostic system. This clinical condition can be described as 'posttraumatic embitterment disorder' (PTED). PTED is a reactive disorder triggered by exceptional, though normal negative life events such as conflict in the workplace, unemployment, death of a relative, divorce, severe illness, or experience of loss or separation. The common feature of such events is that they are experienced as unjust, as a personal insult, accompanied by psychological violation of basic beliefs and values. The central psychopathological response pattern in PTED is a prolonged feeling of embitterment. In particular, the core emotion of embitterment can lead to the rejection of treatment. Therefore, "wisdom therapy" as a new treatment approach specifically designed for PTED has been developed. It is assumed that many patients suffering from PTED are often misunderstood and misdiagnosed. This review would help to introduce PTED into the clinical field in psychiatry.

• The Korean Journal of Pain
• /
• v.10 no.2
• /
• pp.225-230
• /
• 1997

Background: Authors modified the traditional continuous axillary brachial plexus block technique of Selander for purpose of increasing success rate and decreasing complications by use of commercial epidural anesthesia set. Method: Thirty-nine patients scheduled for upper extremity operations were injected with 40 ml of anesthetic solution by axillary perivascular technique, using 23~25G immobile needle at 2 cm from the pectoralis major. Tuohy needle was immediately introduced at 4 cm from the pectoralis major and pierced the expanded neurovascular sheath at an angle of 30 degree to the skin. The "pop" was well noted well. Needle was advanced 0.5 to 3.0 cm and epidural catheter introduced through the needle. After removal of needle, occlusive dressing was done. Tip of catheter and spread of solution were demonstrated by fluoroscopy with contrast dye after completion of procedure. Result: Catheter insertion was successful at first attempt for all case. Total length of insertion was from 6 to 13($10.0{\pm}1.7$) cm. Tip of catheter was placed in infraclavicular space(66.7%), about the humeral head(17.9%) and in upper arm in 3 cases as U-shape(7.9%). Catheters were maintained for $6.7{\pm}2.6$(3-12) days. There were no complications such as: perforation of major vessels, needle trauma to nerve, infection, bleeding or hematoma. Conclusion: This study demonstrated continuous axillary brachial plexus block with epidural anesthesia set is safe, easy and convenient modification of technique of Selander.

• The Journal of the Korean Society for Microbiology
• /
• v.22 no.4
• /
• pp.393-402
• /
• 1987

The halophilic bacterium Vibrio vulnificus, previously called lactose-positive(L+) Vibrio and Beneckea vulnifica, causes acute, fulminating wound infections and septicemia in humans. Septicemia is very serious infection with a fatality rate of about 50%. Most patients with primary septicemia due to V. vulnificus have preexisting liver disease. V. vulnificus also cause severe wound infections usually after trauma and exposure to marine animals or the marine environment. The mortality rate is not nearly as high as in primary septicemia caused by this organism. In most cases human disease results from ingestion of contaminated seafood or from infection of a wound, frequently of seawater or crab origin. The author made an attempt to isolation of the V vulnificus from seawater, seamud, fish, shellfish, and algae on the southern sea of Korea from January to September in 1987, using for the purpose of vaccine preparation. The author investigated for bacteriological identification, hemolysis and determination of serotypes of isolated V. vulnificus strains. Eighty-five strains(5.9%) out of 1450 specimens collected of V. vulnificus were isolated. The distribution of the 85 isolates were as follows: 21 strains from seawater, 11 strains from seamud, 28 strains from fish, 19 strains from shellfish, and 6 strains from algae, respectively. All 85 isolates were positive reaction on human blood agar. The distribution of serotypes of V. vulnificus isolates were O1 to O8: 13 strains of O1, 6 strains of O2, 11 strains of O3, 9 strains of O4, 10 strains of O5, 7 strains of O6, 15 strains of O7, and 10 strains of O8, respectively. Eighty-one strains showed agglutination with O antisera, but 4 strains failed to show agglutination. In this study, the author suspected that serotypes of V. vulnificus isolates distributed also in the seaside of Korea as well as in most seaside of the world, and new serotypes were in existence in the seaside of Korea except reported up to now.

• Archives of Reconstructive Microsurgery
• /
• v.13 no.1
• /
• pp.58-62
• /
• 2004

Purpose: To cover the exposed tendons and bones after trauma and cure the concomitant osteomyelitis in the lower extremities, gracilis muscle free flaps are frequently preferred. 32 cases of gracilis muscle free flap we had done were analysed according to the indications, specification of flap length and width, pedicle length, vessels used in the anastomosis and final healing after at least over 1 year follow up. Materials and methods: From August 1995 through November 2002, we have performed 32 cases of gracilis muscle free flap transplantation with the general microsurgical procedures in the lower extremities. Open fracture of the middle and distal tibia were 12, exposed heel 6, crushing injury in the foot 5 cases, open fracture of the ankle 4, chronic osteomyelitis of the tibia 3 and osteomyelitis of the tarsal bones 2. Tailored flap length were ranged from 16 cm to 4 cm, width were from 5cm to 4cm. Pedicle length averaged around 4 cm. Anastomosis of one artery and two veins in both of donor and recipient were performed in 17 cases and one artery and one vein in 15 cases. Results: All flaps were survived, except 2 cases. Final flap healing was satisfactory to both of the patients and microsurgeon. Conclusion: Gracilis muscle free flaps are frequently chosen to cover the exposed components and cure the osteomyelitis in the lower extremities.

• Archives of Reconstructive Microsurgery
• /
• v.17 no.2
• /
• pp.82-86
• /
• 2008

Purpose: Soft tissue defect can occur on the posterior aspect of the elbow after trauma or fracture fixation. To cover the defect and maintain elbow functions, various flap surgeries including latissimus dorsi muscle flap, lateral arm flap and radial forearm flap can be performed. We present the clinical results of transposition lateral arm flap for coverage of the elbow defect and discuss the cause of posterior soft tissue necrosis after fracture fixation. Materials and Methods: Two patients who had posterior soft tissue defect of the elbow after open reduction of the fractures around the elbow were treated with transposition lateral arm flap. The mean size of skin defect was 20 $cm^2$. The flap was elevated with posterior radial collateral artery pedicle and transposed to the defect area. Donor defect was covered with split thickness skin graft. The elbow was immobilized for 1 week in extended position and active range of motion was permitted. Results: All two cases of transposition lateral arm flap survived without marginal necrosis. The average range of motion of the elbow was 10~115 degrees. Mayo elbow performance score was 72 and Korean DASH score was 23. Conclusion: When elbow fractures are fixed with three simultaneous plates and screws, skin necrosis can occur on the posterior aspect of the elbow around olecranon area. If the size of skin defect is relatively small, transposition lateral arm flap is very useful option for orthopaedic surgeons without microsurgical technique.