• The Korean Journal of Pain
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• v.33 no.2
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• pp.183-191
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• 2020

Background: Opioids can present intolerable adverse side-effects to patients who use these analgesics to mitigate chronic pain. In this retrospective analysis, cooled radiofrequency (CRF) denervation was evaluated to provide pain and disability relief and reduce opioid use in patients with sacroiliac joint (SIJ) derived low back pain (LBP). Methods: Twenty-seven patients with pain from SIJ refractory to conservative treatments, and taking opioids chronically (> 3 mo), were included. Numeric rating scale (NRS) and Oswestry disability index (ODI) scores were collected at 1, 6, and 12 months post-procedure. Opioid use between baseline and each follow-up visit was compared for the entire group and for those who experienced successful (pain reduction ≥ 50% of baseline value) or unsuccessful CRF denervation. Results: Severe initial mean pain (NRS score: 7.7 ± 1.0) and disability (ODI score: 50.1 ± 9.0), and median opioid use (morphine equivalent daily dose: 40 ± 37 mg) were significantly reduced up to 12 months post-intervention. CRF denervation was successful in 44.4% of the patients at 12 months. Regardless of procedure success, patients demonstrated similar opioid reductions and changes in opioid use at 12 months. Two patients (7.4%) experienced neuritis following CRF denervation. Conclusions: CRF denervation of the SIJ can safely elicit pain and disability relief, and reduce opioid use, regardless of intervention success. Future studies may support CRF denervation as a dependable therapy to alleviate opioid use in patients with SIJ-derived LBP and show that opioid use measurements can be a surrogate indicator of pain.

• The Korean Journal of Pain
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• v.14 no.2
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• pp.218-224
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• 2001

Background: Response to diagnostic blocks does not consistently predict the outcome of interventional facet denervation. We investigated the relationship between pain relief by the percutaneous radiofrequency denervation of the lumbar zygapophysial joints with the result of facet joint diagnostic local anesthetic injection in patients with back pain originating from the lumbar zygapophysial joint. Methods: There were 35 patients enrolled, with ranging in age from 25 to 76 years ($52.6{\pm}12.7$ years, mean ${\pm}$ SD). We studied 7 men (20%) and 28 women (80%). All patients underwent double diagnostic block of $L_{3/4}$, $L_{4/5}$ and $L_5-S_1$ facet joint with 0.5% bupivacaine. The 35 patients fell into the following group. (1) Group A (n = 16): those who felt clear relief (pain free with Likert scale) from the double diagnostic block (2) Group B (n = 19): 11 patients who were always equivocal in their response to the double diagnostic block and 8 patients who were either pain free or equivocal in their response to the double diagnostic block. All 11 patients were done the facet joint denervation. The effect on the pain was evaluated with 4 point Likert scale 1, 6 and 12 weeks after the procedure. We evaluated the relationship between the pain response to diagnostic block and the pain relief with facet joint denervation. Results: Significant correlation was observed between the response to diagnostic block and pain relief with facet denervation (P < 0.05). We found no correlation between the categories of spinal operation and pain response to facet denervation (P value > 0.05). Conclusions: A satisfactory result of lumbar facet joint denervation can be obtained in many patients, especillay in patients whose pain were relieved by the diagnostic double facet joint block. It may be said that facet joint denervation for mechanical low back pain using radiofrequency thermocoagulation is a safe, easy, and repeatable technique.

• Annals of Clinical Neurophysiology
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• v.6 no.1
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• pp.26-30
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• 2004

Background: Electrophysiologic study accurately predicts the degree of degenerated motor axons but cannot give precise information on the type of injury that occurred in Bell's palsy. Because of these limitation for prognostic prediction in Bell's palsy, we evaluated divergence of electrophysiological time course for the purpose of presuming the type of injury in Bell's palsy. Methods: We did bilateral facial nerve conduction studies in 103 Bell's palsy patients, who visited to Han-Gang sacred heart hospital from 1998 to 2001. We compared the CMAP amplitude of disease site with that of normal site and suggested that decremental CMAP amplitude ratio (percentage) as a degree of denervation of affected facial nerve. Then we demonstrated the time course of denervation percentage. After defining normal range of CMAP amplitude difference from normal control group, we also evaluated if distinct time course of early minimal denervation is present. Results: Our results show that time course of the denervation in early stage of Bell's palsy reflect various injury type such as axonotmesis, neurotmesis or other unidentified type. We cannot identify the distinct time course of early minimal denervation. Conclusions: The time course as well as the maximal value of denervation are the best prognostic guidelines in Bell' s palsy. So repeated serial electrophysiologic test are inevitable to assess prognosis. As an another topic, early minimal denervation for prognostic prediction deserve to be evaluated as a future work up for prognostic prediction.

• The Korean Journal of Physiology and Pharmacology
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• v.7 no.2
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• pp.97-101
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• 2003

The salivary glands produce 1.5L of fluid per day. As in other exocrine organs, the general mechanism in the salivary glands is that water movement occurs secondary to osmotic driving forces created by active salt transport. Therefore, high water permeability in the salivary glands is expected to have a variety of aquaporin (AQP), a water channel. Although some AQPs have been known to be present in the salivary glands, roles of parasympathetic nerve in AQP expression have not yet been examined. This study was designed to examine the changes of AQPs and extracellular signal-regulated kinase (ERK) in the submandibular glands after parasympathetic denervation. Right chorda-lingual nerve was cut, and each right (experiment) and left (control) submandibular gland was excised at 1, 3, 7, 14, 30 days after denervation. The denervated right submandibular glands were resulted in weight loss and morphologic changes, including cell loss and atrophy, as the time elapsed after parasympathetic denervation increased, whereas there were no histologic alteration in control side. AQP5 which is known to reside in apical membrane and secretory caraliculi of the submandibular acini were gradually underexpressed according, as the time after denervation increased. Expression of AQP4 in submandibular ductal epithelium was down-regulated after denervation. Besides, AQP3 and 8, which is known to be present in basolateral membrane of the glandular acini, were gradually underexpressed after denervation, similar to the pattern of other types. Expression of ERK, a mitogen-activated protein kinase, was downregulated after parasympathetic denervation in the submandibular gland. These results suggest that parasympathetic nervous system regulates the expression of AQPs in salivary glands, and is in part mediated by ERK pathway.

• Journal of the korean academy of Pediatric Dentistry
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• v.24 no.3
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• pp.688-703
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• 1997

The effect of glossopharyngeal nerve transection on the taste buds of the rat vallate papilla was examined by using the method of DNA nick-end labeling (TUNEL) and standard electron microscopic technique at 1, 3, 5, 7, 9 days after denervation. In general, the number and size of taste buds decreased as more days passed after denervation. They started decreasing on day 3 post denervation and virtually all taste buds were disappeared on day 9 post denervation. In studies using TUNEL method, TUNEL postive cells markedly increased in their numbers one day post denervation, as compared with controls. The number of apoptotic taste bud cells per taste bud profile was averaged to be 0.64 and 0.44 for day 1 and 3 post denervation, respectively, whereas it was 0.10 in controls. In electron microscopy, apoptotic cells were identified by the presence of condensed and fragmentary nuclei in a cytoplasm, which resulted in increased density. In control rats, only few apoptotic cells were found. On days 1 and 3 post denervation, nerve fibers almost disappeared from the taste buds and some apoptotic cells were apparent. On days 7 and 9 post denervation, a few taste bud cells were still present in the epithelium of the bottom of the trench wall of the vallate papilla and most of them showed apoptotic changes. The results indicate that the death of taste bud cells in normal conditions is controlled by apoptosis and the decrease and disappearance of taste buds after denervation is also caused by apoptosis of taste bud cells.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.1
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• pp.24-30
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• 2005

The flow of saliva is controlled entirely by nervous stimuli. The present study was aimed to explore the role of sympathetic and parasympathetic nerves in the regulation of sodium transporters and water channels in the salivary gland. Rats were denervated of their sympathetic and parasympathetic nerves to the submandibular gland, and the expression of sodium transporters and water channels was determined. The expression of either ${\alpha}-1$ or ${\beta}-1$ subunit of Na, K-ATPase was not significantly affected by the sympathetic denervation. On the contrary, the expression of both subunits was decreased by the parasympathetic denervation. The expression of ${\alpha}-,\;{\beta}-$, and ${\gamma}$-subunits of ENaC was not significantly affected by the sympathetic denervation, but was increased by the parasympathetic denervation. On the contrary, the expression of NHE3 was markedly decreased by both the sympathetic and the parasympathetic denervation. The sympathetic denervation significantly increased the expression of AQP1, while the parasympathetic denervation was without effect. The sympathetic and parasympathetic denervation significantly increased the expression of AQP4. The sympathetic denervation did not affect the expression of AQP5, but the parasympathetic denervation significantly decreased it. These results suggest that sympathetic and parasympathetic nerves have tonic effects on the regulation of sodium transporters and AQP water channels in the salivary gland. The sympathetic and parasympathetic denervation may then result in alterations of secretory rate and electrolyte composition of the saliva.

• Biomolecules & Therapeutics
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• v.2 no.3
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• pp.229-235
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• 1994

In dogs, renal denervation did not affect the diuretic action accompanied with renal hemodynamic chanties and inhibition of electrolytes reabsorption rates in renal tubules by methoxyverapamil infused into the vein or into a renal artery, while renal denervation blocked the antidiuretic action due to the decreased free water and osmolar clearances along with the reduced sodium amounts excreted in urine by methoxyverpamil infused into the carotid artery. These experimental results suggest that methoxyverapamil may cause diuresis by direct action in kidney but the antidiuretic action through central function mediated by renal nerves.

• YAKHAK HOEJI
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• v.43 no.5
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• pp.674-681
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• 1999

This study was performed to investigate the effects of renal denervation and cromakalim, a K+ Channel opener, on central diuretic action of glibenclamide, an ATP-dependent K+ Channel blocker, in dog. Diuretic action of glibenclamide administered into the vein was weakened markedly by renal denervation and pretreatment of of cromakalim. Above results suggest that central diuretic action of glibenclamide is mediated by renal nerves and K+ Channel localized in kidney.

• Journal of Korean Neurosurgical Society
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• v.38 no.5
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• pp.344-349
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• 2005

Objective : The Bertrand's method of selective peripheral denervation for spasmodic torticollis has already been established as being an effective and safe method. However, such effectiveness has not yet been established in Korea. The authors have performed several cases of selective denervation for the treatment of spasmodic torticollis and we hereby describe the details of the operative method to determine the effectiveness of the method. Methods : Ten patients who had the selective denervation for the spasmodic torticollis from October 1997 to December 2003, were analyzed. There were 4 rotational and 6 combined types [3 rotational plus retrocollis, 3 rotational plus laterocollis]. We performed preoperative electromyograms and neck muscle tonograms in all cases. The technique was used to involve denervation of the ipsilateral posterior paraspinal muscles. Denervation of the sternocleidomastoid muscle was performed on the contralateral side for rotational torticollis and on the ipsilateral side for laterocollis combined type. The surgery was followed by a rigorous physical therapy program. Results : The surgical results were divided into 4 groups labeled excellent, good, fair, and poor. There were 5 excellent patients who showed no detectable abnormal movements, 4 good patients who showed slight residual deviations or slight residual abnormal movements, and 1 fair patient with appreciable residual abnormal movements. Postoperative pain was well tolerated. There was no significant surgical complications. Conclusion : The study confirms that selective peripheral denervation for the treatment of spasmodic torticollis is a very useful and safe surgical technique.

• The Journal of Korean Physical Therapy
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• v.13 no.3
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• pp.665-675
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• 2001

The aim of this study was to compare features of muscle atrophy induced by cast fixation. denervation and suspension of rat hindimb. Muscle mass and glycogen of the soleus and plantaris muscles were studied after 3, 7, or 14 days of cast fixation, denervation and suspension. The results as follows: 1. Body weight of rats decreased significantly after 3 days and showed gradually increase after 7 and 14 days of hindlimb cast fixation, denervation and suspension. Particularly hindlimb suspended rats showed a rapid decrease after 3 days in body weight. 2. Relative weight of soleus and plantaris musclcs decreased significantly by hindlimb cast fixation, denervation and suspension, particularly after 7 days. The decrease rate was the lowest in suspended rats. 3. Glycogen content of soleus muscle decreased significantly after 14 days of hindlimb cast fixation, denervation and suspension. Also glycogen content of plantaris muscle decreased significantly after 14 days of hindlimb cast fixation and denervation, but not significantly after hindlimb suspension. These results indicate that suspension of hindlimb muscles causes less atropy than cast fixation or denervation, likely due to maintainment a few activities during hindlimb suspension. We concluded that the decrease in mechanical strains imposed on the muscle during inactivity was the main factor for the development of atrophy. These basic data suggest that some experimental conditions such as electrostimulation or stretching, participate in countermeasure programmes.