• Korean Journal of Otorhinolaryngology-Head and Neck Surgery
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• v.60 no.6
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• pp.322-325
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• 2017

Otalgia consists of primary otalgia associated with disorders of the ear itself and referred otalgia due to disorders of organs that share the same innervation with the ear. Disorders of the oral cavity and laryngopharynx served by the glossopharyngeal and vagus nerves are common causes of referred otalgia. Chest pain from myocardial infarction spreads through the afferent pain pathway, especially through the sympathetic nerves in the cardiac plexus and the phrenic nerve, resulting in a typical chest pain or referred pain in the left upper extremity. However, pain spreading through the vagus nerve can theoretically cause referred otalgia. This association between the heart and ear has not been widely acknowledged, even though a referred otalgia can occasionally be the only symptom of the tragic disease, myocardial infarction, and should be taken seriously. We report a patient who complained of left otalgia as the only symptom of myocardial infarction.

• The Journal of Internal Korean Medicine
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• v.30 no.1
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• pp.191-199
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• 2009

Objectives : The aim of this study was to evaluate the therapeutic effect of acupuncture and herbal medicine in patients who had hvpoactivity of the gastric vagus nerve and pyloric valve disturbance simultaneously with function dyspepsia by bowel sounds analysis. Methods : Bowel sounds of 10 patients (male 1, female 9) were recorded and their % of bowel sound (%BS) and ratio of dominant frequency (DF) were analyzed before and after treatment. Hypoactivity of the gastric vagus nerve was considered if % BS was <6%. and pyloric valve disturbance was accepted if DF ratio (e.g.. postprandial DF/fasting DF) was <1. Electroacupuncture at Zusanli (ST36, 3Hz, 30 minutes) and manual acupuncture at other meridian points were applied daily for 2 weeks. Herbal medicine, Pyengwi-san. was administered to all patients (100cc, 3 times/day). Results : DF ratio significantly increased from $0.93\pm0.06$ to $1.06\pm0.04$ after treatment for 2 weeks (p=0.005). 9 of 10 patients were improved to DF ratio>1. %BS also increased from $2.97\pm1.17%$ to $4.49\pm4.27%$. not significantly. 3 patients showed a remarkable elevation, and their %BS reached >6% of normal value. Conclusions : Combined effect of electroacupuncture at Zusanli (ST36), manual acupuncture. and Pyengwi-san was shown effective in the improvement of pyloric valve disturbance more than hypoactivity of gastric vagus nerve on patients with functional dyspepsia.

• The Journal of Internal Korean Medicine
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• v.30 no.1
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• pp.173-180
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• 2009

Objectives : The aim of this study was to investigate the evaluation of gastrointestinal parasympathetic nerve activity by comparing between HRV and bowel sound parameters in patients with functional dyspepsia. Methods : 62 patients (male 22, female 40) were enrolled. HRV was measured in all patients. and TP (total power), LF (low frequency density: 0.04$\sim$0.15Hz), HF (high frequency density: 0.15$\sim$0.4Hz). and LF/HF ratio were analyzed. HF band is a reflection of parasympathetic activity. and the LF-to-HF ratio is considered a marker of sympathovagal balance. Bowel sounds were recorded at the day after, and postprandial %BS was used to indicate the gastric vagal activity after eating. HRV and bowel sound parameters were compared. and correlation between them was analyzed. Results : There was no difference in LF/HF ratio between patient group and healthy group of other report. According to values of %BS, each patient was classified into a normal (>6 %BS) or hypoactivity (<6 %BS) of gastric vagus nerve group. HF component of the hypoactivity group was not significantly higher than that of the normal group. There was no correlation between HRV and bowel sound parameters. Conclusions : Because no correlation was found between HRV and bowel sound parameters in patients with functional dyspepsia, we concluded that it is not proper to evaluate gastric vagus nerve activity by HRV measurement.

• Archives of Pharmacal Research
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• v.11 no.1
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• pp.65-73
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• 1988

The effects of clonidine on the negative chronotropic response induced by stimulation of vagus nerve were studied in the presence of propranolol in reserpinized and anesthetized rats. When the heart rate was decreased by stimulation of the vagus nerve, clonidine significantly inhibited vagally induced heart rate decrease (negative chronotropic response) in dose dependent manner. This inhibitory effect of clonidine was virtually abolished by phentolamine, ${\alpha}_1-\;and\;{\alpha}_2-adrenoceptor$ antagonist, and partially antagonized by prazosin, ${\alpha}_1-adrenoceptor$ antagonist. On the other hand, when the heart rate was decreased by the infusion of bethanechol, a muscarinic parasympathetic stimulant, clonidine had no effect on the bethanechol-induced heart rate decrease. These results suggest that clonidine inhibits vagally induced negative chronotropic response by activation of presynaptic ${\alpha}-adrenoceptors$ located on the parasympathetic cholinergic nerve terminal in the heart and this effect of clonidine is more related to ${\alpha}_2-adrenoceptors$ than ${\alpha}_1-adrenoceptors$.

• Journal of Acupuncture Research
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• v.20 no.1
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• pp.97-103
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• 2003

Objective : Auricular acupuncture is a method of treatment that involves needling the ear in order to produce relief of symptoms. This concept was first developed by P.Nogier, french doctor and referred to as somatotopic representation. Many authors have commented the fact that the vagus nerve supplies the external auditory and the concha. The aim of this randomised, single blind study was to investigate whether auricular acupuncture of the ear produced changes in the pulse rate, an indicator of vagal tone. Methods: 10 healthy man volunteers were divided into normal and epinephrine stimulation group. Then each group was divided into vagus area acupuncture and control area acupuncture group again. Epinephrine stimulation group was injected by epinephrine 0.3cc twice, first. All of them were needled in either the vagus area or control area of the ear, and pulse rate changes were measured by patient monitor over 1 hour. Results : In the epinephrine stimulation group, there was significant differences in the pulse rate change between vagus area acupuncture and control area acupuncture group. After injection of epinephrine, the basal pulse rate was increased 1.3~1.4 times in the control group. However, in the vagus area acupuncture group the basal pulse rate was increased only 1.1~1.2 times.

• The Korean Journal of Physiology
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• v.23 no.2
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• pp.401-408
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• 1989

This study was conducted to investigate whether an electrical stimulation of medial amygdaloid nucleus in rats increases pancreatic secretion. And an involvement of vagus nerve or plasma secretin in this process was also studied. In fasting rats anesthetized with urethane, a monopolar stainless steel electrode was stereotaxically inserted into the right medial amygdaloid nucleus. Pancreatic juice was collected for 20 minutes, during which physiological saline or 0.01 N HCI (0.18 ml/min) was perfused into the duodenum with or without bilateral subdiaphragmatic vagotomy. In the medial amygdaloid group, an electrical stimulation was continuously applied to the medial amygdaloid nucleus during the perfusion period. After collection of pancreatic juice, blood was drawn from the abdominal aorta for determination of the plasma secretin level. The results were as follows: 1) The electrical stimulaion of the medial amygdaloid nucleus did not influence the pancreatic secretion in response to intraduodenal saline perfusion. 2) The stimulation of the medial amygdaloid nucleus significantly increased the pancreatic secretory response (volume, bicarbonate output) to the intraduodenal 0.01 N HCI perfusion, and the increases were abolished by vagotomy. 3) The plasma secretin concentration after the intraduodenal 0.01 N HCI perfusion was higher than that after the saline perfusion. However, neither the electrical stimulation of the medial amygdaloid nucleus nor vagotomy affected the plasma secretin concentration during the intraduodenal perfusion with saline or 0.01 N HCI. It is, therefore, suggested that the medial amygdaloid nucleus facilitates the pancreatic secretion (volume, bicarbonate) elicited by intraduodenal HCI perfusion through the vagus nerve.

• Journal of Korean Neurosurgical Society
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• v.44 no.4
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• pp.196-198
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• 2008

Objective : Vagus nerve stimulation (VNS) has been used in epilepsy patients refractory to standard medical treatments and unsuitable candidates for resective or disconnective surgery. In this study, we investigated the efficacy of VNS to patients who had refractory result to epilepsy surgery and patients with post-traumatic epilepsy. Methods : We analyzed the effect of VNS in 11 patients who had undergone previous epilepsy surgery and patients with intractable post-traumatic epilepsy associated with brain injury. All patients underwent VNS implantation between October 2005 and December 2006. Results : We evaluated seizure frequency before and after implantation of VNS and maximum follow up period was 24 months. In the first 6 months, 11 patients showed an average of 74.3% seizure reduction. After 12 months, 10 patients showed 85.2% seizure reduction. Eighteen months after implantation, 9 patients showed 92.4% seizure reduction and 7 patients showed 97.2% seizure reduction after 24 months. Six patients were seizure-free at this time. Conclusion : We conclude that the VNS is a helpful treatment modality in patients with surgically refractory epilepsy and in patients with post-traumatic epilepsy due to severe brain injury.

• The Journal of Internal Korean Medicine
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• v.33 no.1
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• pp.26-38
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• 2012

Objectives : The aim of this study was to investigate the effect of partial pyloric obstruction on body weight, gastric juice, gastric surface area and gastric edema in normal intact and/or vagotomized rats. Methods : Partial pyloric obstruction was performed by wrapping a non-absorbable rubber ring (D:6 mm, W:4 mm, T:1 mm) around the 1st portion of the duodenum. Vagotomy was performed by resecting the branches around the esophagogastric junction. Pre-post body weight differential, fasting gastric juice volume, gastric surface area and gastric edema were measured at 8 weeks and 20 weeks. For the effect of pyloric reperfusion the rubber ring was removed after 8 weeks and then an additional 12 weeks of observation was performed to the end of the 20-week experimental period. Results : In the initial 8 weeks observation, the effect of pylorus obstruction and/or vagotomy was significantly remarkable in the pylorus obstructed and vagotomized group; slowdown of weight gain, increase of fasting gastric juice volume, dilatation of gastric surface area and severe gastric edema were shown. In the remaining 12 weeks observation, the effect of reperfusion was significantly remarkable in the ring-removed antral dilated group; recovery of weight gain, decrease of gastric surface area and decrease of gastric edema were shown. However, gastric juice volume was not significantly different from the other group. Conclusions : Partial pyloric obstruction plays a aggravating role and the vagus nerve plays a protective role in body weight, gastric juice, gastric surface area, and gastric edema. Furthermore, pyloric valve dysfunction as an aggravating factor strengthened in defect of the vagus nerve. These results suggest that patients with both functional pyloric outlet obstruction and hypofunction of vagus nerve need to be diagnosed in good time and treated properly.

• Journal of Yeungnam Medical Science
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• v.39 no.3
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• pp.235-243
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• 2022

Background: Intrahepatic cholangiocarcinoma (ICC) of the left liver often shows left-sided lymph node (LN) metastasis. If gastric lesser curvature is extensively dissected, it can induce an iatrogenic injury to the extragastric vagus nerve branches that control motility of the pyloric sphincter and lead to gastric stasis. To cope with such LN dissection-associated gastric stasis, we performed pyloroplasty preemptively. The objective of this study was to analyze our 20-year experience of preemptive pyloroplasty performed in 10 patients. Methods: We investigated clinical sequences of 10 patients with ICC who underwent preemptive pyloroplasty following left hepatectomy and extended left-sided LN dissection. Incidence of gastric stasis and oncological survival outcomes were analyzed. Results: All 10 patients were classified as stage IIIB due to T1-3N1M0 stage according to the 8th edition of American Joint Committee on Cancer staging system. The overall patient survival rate was 51.9% at 1 year, 25.9% at 2 years, and 0% at 3 years. Seven patients showed uneventful postoperative recovery after surgery. Two patients suffered from gastric stasis, which was successfully managed with supportive care. One patient suffered from overt gastric paresis, which was successfully managed with azithromycin administration for 1 month. Conclusion: We believe that preemptive pyloroplasty is an effective surgical option to prevent gastric stasis in patients undergoing extensive left-sided LN dissection. Azithromycin appears to be a potent prokinetic agent in gastroparesis.

• The Korean Journal of Physiology and Pharmacology
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• v.21 no.2
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• pp.145-152
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• 2017

Remote ischemic preconditioning (RIPC) is an intrinsic phenomenon whereby 3~4 consecutive ischemia-reperfusion cycles to a remote tissue (non-cardiac) increases the tolerance of the myocardium to sustained ischemia-reperfusion induced injury. Remote ischemic preconditioning induces the local release of chemical mediators which activate the sensory nerve endings to convey signals to the brain. The latter consequently stimulates the efferent nerve endings innervating the myocardium to induce cardioprotection. Indeed, RIPC-induced cardioprotective effects are reliant on the presence of intact neuronal pathways, which has been confirmed using nerve resection of nerves including femoral nerve, vagus nerve, and sciatic nerve. The involvement of neurogenic signaling has been further substantiated using various pharmacological modulators including hexamethonium and trimetaphan. The present review focuses on the potential involvement of neurogenic pathways in mediating remote ischemic preconditioning-induced cardioprotection.