• Journal of Korean Neurosurgical Society
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• v.48 no.3
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• pp.240-243
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• 2010

Objective : Radiofrequency (RF) medial branch neurotomy is an effective management of lumbar facet syndrome. However, pain may recur after period of time. When pain recurs, it can be repeated, but the successful outcome and duration of relief from repeated procedures are not clearly known. The objective of this study was to determine the success rate and duration of pain relief from repeated radiofrequency medial branch neurotomy for lumbar facet syndrome. Methods : A retrospective review of medical records was done on 60 consecutive patients, from March of 2006 to February of 2009, who had an initial successful RF neurotomy but subsequently underwent repeated procedures due to recurrence of pain. All procedures were done in carefully selected patients after at least two responsive medial branch nerve blocks. C-arm fluoroscopic guide, impedance, sensory and motor threshold monitoring tools were used for the precise placement of electrodes. Responses of repeated procedures were compared with initial radiofrequency neurotomy for success rates and duration of pain relief. Results : There were 48 females and 12 males. Mean age was 52.4 years (range, 26-83). RF medial branch neurotomy was done on one side in 38 and both sides in 22 patients, each covering at least three segments. Average visual analog scale at last procedure was 6.8. Twelve patients had previous lumbar operations, including 4 patients with instrumentations. Fifty-five patients had two procedures and five patients had three procedures. Mean duration of successful pain relief (> 50% of previous pain for at least 3 months period) after initial radiofrequency neurotomy was 10.9 months (range, 3-28) in 51 (85%) patients. From repeated procedures, successful pain relief was seen in 50 (91%) patients with average duration of 10.2 months (range, 3-24). Five patients had third procedure, which was successful in 4 (80%) patients with mean duration of 9.8 months (range, 5-16). This was not statistically different from initial results. There were no permanent neurological complications from the procedures. Conclusion : Results of this study indicate that the frequency of success and durations of relief from repeated RF medial branch neurotomy for lumbar facet syndrome are similar to initial results that provided relatively prolonged period of pain relief without major side effects Each procedure seems to provide successful pain relief for about 10 months in more than 85% of carefully selected patients when properly done.

• Korean Journal of Veterinary Research
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• v.43 no.1
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• pp.57-66
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• 2003

Single and 28-day repeated dose toxicity studies of botulimnn toxin type A were carried out in ICR mice and Sprague-Dawley rats, respectively. In the single dose toxicity study, botulinwn toxin was injected intraperitoneally to male and female mice at a single dose of 40, 59, 89 133 and 200 ng/10 ml saline/kg. All animals died from 59 ng/kg group. Some clinical signs, such as decrease in locomotor activity, dyspnea, prone position and ptosis, were observed in most of both sexes from 59 ng/kg group, but no signs were seen in all animals at 40 ng/kg group. The results showed that the median lethal dose of botulinum toxin might be in the range of 40-59 ng/kg in both sexes. In the repeated dose toxicity study, the test material was administered intradermally for 28 days at doses of 0 (vehicle-treated control), 1.25, 2.5, 5.0 and $10.0ng/head/50{\mu}{\ell}$ saline in male and female rats. No test material-related changes were noted in survivals, clinical signs, food and water consumptions and gross finding in any group. Botulinum toxin treatment significantly decreased the body weight gain rate in male of 5.0 ng/head group and over and in female of 10.0 ng/head group compared to vehicle-treated control. One or more relative organ weights (i.e., spleen, thymus, liver and kidney) were increased significantly from 5.0 ng/head group compared to vehicle-treated control in both sexes. Serum biochemistry revealed increases in aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatine phosphokinase, total protein and albumin in male, and increases in AST and ALT and decreases in $K^+$ and $Cl^-$ in female without dose-pendent manners. In the histopathological study, physical stimulation by needle caused slight inflammations of dennis. In addition, botulinum toxin treatment induced denervation of nerve cell and disuse of muscle, resulting in atrophy of skeletal muscle in both sexes from 2.5 ng/head group. When the antibodies to toxin were determined in all animals, a significant increase in serum antibodies was observed from 5.0 ng/head group. The results showed that the NOAEL of botulinum toxin might be 1.25 ng/head for 28-day repeated dose toxicity in rats.

• Archives of Reconstructive Microsurgery
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• v.6 no.1
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• pp.73-79
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• 1997

Complete denervation after severe brachial plexus injury make significant muscle atrophy with loss of proper function. It is much helpful to reconstruct the essential function of the elbow flexion movement in patient with total loss of elbow flexion motion after brachial plexus lesion which was not recovered with nerve surgery or long term conservative treatment from onset. In whole arm type brachial plexus injury, if there were no response to neurotization or neglected from injury, the volume of the denervated muscle is significantely reduced month by month. About 18 months most of the muscle fibers change to fibrous tissues and markedly atrophied irreversibly, further waiting is no more meaningful from that period. Authors performed 14 cases of functioning gracilis muscle transfer from 1981 to 1995 with microneurovascular technique, neuromusculocutaneous free flaps were performed for reconstruction of lost elbow flexion function. Average follow-up period was 5 years and 6 months. We used couple of intercostal nerves as a recipient nerve which were anastomosed to muscular nerve from obturator nerve in all cases. Recipient vessels were three deep brachial artery and eleven brachial artery which were anastomosed to medial femoral circumflex artery with end to end or end to side fashion. Average resting length of the transplanted gracilis were 24 cm. We can get average 54 degree flexion range of elbow with fair muscle power from flail elbow. There were one case of muscle necrosis with lately developed thrombosis of microvascular anastomosed site which comes from insufficient recipient arterial condition, 3 cases of partial marginal necrosis of distal skin of the transplanted part which were not significant problem with spontaneously solved with time goes by gracilis muscle has constant neurovascular pattern with relatively easy harvesting donor with minimal donor morbidity. Especially it has similar length and shape with biceps brachii muscle of upper arm and longer nerve pedicle which can neurorrhaphy with intercostal nerve without nerve graft if sufficient mobilization of the nerves from both sides of gracilis and intercostal region. Authors can propose gracilis muscle transplantation with intercostal nerves neurotization is helpful method with minimal donor morbidity for neglected brachial plexus palsy patients.

• Development and Reproduction
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• v.5 no.2
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• pp.181-187
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• 2001

Seasonal changes and circadian rhythm of plasma prolactin(PRL) concentration in mammals are mediated by melatonin. Pinealectomy or denervation of the pineal gland produces an increase in plasma PRL level. In the rat placenta several members of the PRL family gene are expressed during the late pregnancy. However, the full spectrum of their expression mechanisms and regulatory factors are not elucidated yet. Present study aimed to investigate the local expression of the melatonin receptor la(Me $l_{la}$ ) gene and the effect of melatonin on expression of prolactin-like protein A(PLP-A), a member of the PRL-family gene in the rat placenta. According to the RT-PCR, northern blot and in situ hybridization experiments, Me $l_{la}$ gene was locally expressed in the rat placenta, Me $l_{la}$ mRNA was localized mainly in the placental junctional and labyrinth zones. Interestingly, junctional zone of the placenta showed strong expression of Me $l_{la}$ at daytime(16:00) than at nighttime(22:00). Melatonin agonist, chlorornelatonin decreased the PLP-A mRNA levels in the rat placenta. These results suggest that melatonin coupled with Me $l_{la}$ , may act as a regulation factor that mediates the expression of the PLP-A gene in the rat placenta.

• The korean journal of orthodontics
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• v.34 no.6 s.107
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• pp.506-513
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• 2004

Osteoclast action is necessary for alveolar bone remodeling in orthodontic tooth movement. The nervous system has also been reported to be associated with bone remodeling. This study was aimed to investigate the changes of osteoclasts in the periodontal ligament (PDL) space after surgical resection of the inferior alveolar nerve (IAN). Experimental rats were divided into young and adult groups. A surgical resection procedure of the IAN was carried out in the left side of the mandible and a sham operation in the right side of the mandible. The number of osteoclasts on the bundle bone surface and the resorption activity of the osteoclasts were histomorphometrically measured. The changes in distribution of substance P (SP) immunoreactive (IR) nerve fiber were evaluated in the PDL and pulp. SP-IR nerve fiber was depleted in both the PDL and pulp of the IAN resection side in both groups, which confirmed the resection of IAN to be successfully conducted. The number of osteoclasts in the IAN resection side was significantly reduced in both the young and adult groups (p<0.01 and p<0.05), whereas the resorption activity of osteoclasts did not show any significant difference between the IAN resection side and the sham operation side in both groups (p>0.05 and p<0.05). The adult group showed that the number of osteoclasts reduced significantly (p<0.01) and the resorption activity didn't change in comparison with the young group (p>0.05). These results suggest that surgical resection of the IAN and aging reduce the population of the recruited osteoclasts within the PDL, but don't affect on the osteoclastic resorption activity.

• Archives of Plastic Surgery
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• v.32 no.1
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• pp.85-92
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• 2005

Botulinum toxin type A is widely used for anti-wrinkling therapy, and correction of the square face. The toxin ultimately prevent the release of membrane-bound acetylcholine at the neuromuscular junction of striated muscles and thus produce chemical denervation and paralysis of the muscles. Our purpose of study is to know if application of botulinum toxin type A on calf reduction is effective, how much dosage is effective, and what are the possible complications. We reviewed data of 30 consecutive patients subjected to calf reduction in Dong-A University Hospital from February 2003 to April 2003. We injected normal saline 2cc on both calves region in 15 control group patients, and the other patients was divided 3 group. Group 1, Group 2, Group 3 was injected 50U, 100U, 150U botulinum toxin A on each calf region and followed up for 6 month. Maximal circumference of calf was not changed in the control group but an average of 0.7 cm reduction was noted in group 1, average 1.34 cm(right calf) and 1.26cm(left calf) in group 2, average 1.44cm(right calf) and 1.58cm(left calf) in group 3. Maximal area of calf was not changed in the control group but average reduction of 12.5%(right calf) and 12.7%(left calf) was obtained in group 1, average 19.4% (right calf) and 19.9%(left calf) in group 2, average 24.8%(right calf) and 21.07%(left calf) in group 3, as measured on CAT scan. Total fat amount and fat amount in the lower extremity was no change in all the groups, but lean body mass was decreased average 1.27%(right calf) and 1.15%(left calf) in group 1, average 3.47%(right calf) and 2.98%(left calf) in group 2, average 3.58%(right calf) and 3.95%(left calf) in group 3. Photography of the preoperative and postoperative 6 month state revealed higher satisfaction in Group 2, 3 compared to Group 1. Use of botulinum toxin type A in calf reduction is a very simple, safe, non-invasive method and effective in terms of calf contouring rather than reduction of calf circumference.

• Archives of Plastic Surgery
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• v.38 no.2
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• pp.207-211
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• 2011

Purpose: Surgery for thyroid gland requires skin incisions that can result in postsurgical neck scar. To overcome this, many surgeons performed a endoscopic thyroidectomy. But, this approach had a some problems. One of postoperative problems, iatrogenic cervical dystonia (CD) may occur. At common, CD is defined as a syndrome characterized by prolonged muscle contraction causing twisting, repetitive movements or abnormal posture. Botulinum toxin A (BTA, Botox$^{(R)}$, Allergan, Irvine, CA, USA) is well known treatment agent in the treatment of CD. So, the authors applied BTA injection in rare case with iatrogenic CD resulting in endoscopic thyroidectomy. Methods: A 43-year-old female had endoscopic subtotal thyroidectomy operation 3 years ago. She had symptoms such as progressive cervical pain, abnormal neck posture, depression, and sleep difficulty. About 1 year later, the patient who had previous myomectomy of the clavicular head of sternocleidomastoid muscle, however, symptoms were not improved. And then the patient received BTA therapy in our department. The 2 units per 0.1 mL solution was administered in a 1 mL tuberculin syringe. Results: The dose of BTA used in the patient was 36 units for vertical platysmal bands, superficially, and 10 units for ipsilateral sternocleidomastoid muscle, intramuscularly. After 2 weeks, additional the dose of BTA used in the patient was 5 points for remained scar bands, superficially. Complications related to injection such as significant swallowing difficulties, neck muscle weakness, or sensory change were not observed. In 9 months follow-up, the patient maintained a good result from the method of BTA injection alone. Conclusion: The basic concept is selective denervation for the hyperactive individual muscles and scar bands. We conclude that BTA is an effective and safe treatment for CD despite the iatrogenic and complex presentation of this complication.

• The Korean Journal of Physiology and Pharmacology
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• v.19 no.5
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• pp.427-434
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• 2015

Significant evidence supports the role of the vestibular system in the regulation of blood pressure during postural movements. In the present study, the role of the vestibulo-spino-adrenal (VSA) axis in the modulation of blood pressure via the vestibulosympathetic reflex was clarified by immunohistochemical and enzyme immunoassay methods in conscious rats with sinoaortic denervation. Expression of c-Fos protein in the intermediolateral cell column of the middle thoracic spinal regions and blood epinephrine levels were investigated, following microinjection of glutamate receptor agonists or antagonists into the medial vestibular nucleus (MVN) and/or sodium nitroprusside (SNP)-induced hypotension. Both microinjection of glutamate receptor agonists (NMDA and AMPA) into the MVN or rostral ventrolateral medullary nucleus (RVLM) and SNP-induced hypotension led to increased number of c-Fos positive neurons in the intermediolateral cell column of the middle thoracic spinal regions and increased blood epinephrine levels. Pretreatment with microinjection of glutamate receptor antagonists (MK-801 and CNQX) into the MVN or RVLM prevented the increased number of c-Fos positive neurons resulting from SNP-induced hypotension, and reversed the increased blood epinephrine levels. These results indicate that the VSA axis may be a key component of the pathway used by the vestibulosympathetic reflex to maintain blood pressure during postural movements.

• Journal of Chest Surgery
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• v.37 no.1
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• pp.64-71
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• 2004

Background: Video-assisted sympathicotomy is a safe and effective method for the treatment of essential hyperhidrosis with immediate symptomatic improvement. However, this is offset by the occurrence of a high rate of side-effects, such as embarrassing compensatory hyperhidrosis. Therefore, by comparing and assessing the relationship between temperature change measured by DITI (digital infrared thermographic imaging) and clinical results according to the level and extent of sympathicotomy in essential hyperhidrosis. we tried to obtain a more precisely and objectively, the distribution and degree of compensatory sweating by DITI and also for ascertaining the clinical usefulness. Material and Method: From January 2000 to June 2002, the thoracoscopic sympathicotomy was performed in 28 patients suffering from essential hyperhidrosis in Dept. of Thoracic and Cardiovascular Surgery, Wonkwang University Hospital. The patients were divided into four groups, Group I: patients having undergone T2 sympathicotomy, Group II: patients having undergone T3 sympathicotomy, Group III: patients having undergone T3,4 sympathicotomy, and Group IV: patients having undergone T2,3,4 sympathicotomy. The parameters were composed of the satisfaction rate of treatment, the degree of compensatory and plantar sweating, and temperature changes of entire body measured by DITI Result: There was no difference in age and follow-up period among the groups. All of the treated patients obtained satisfactory alleviation of essential hyperhidrosis in immediate postoperative period. However, the rate of long-term satisfaction were 85.8%, 85.8%, 42.9%, and 28.6% in group I, II, III, and IV (p<0.05). More than embarrassing compensatory sweating was present in 14.2%, 14.2%, 57.1%, 71.4% in group I, II, III, and IV (p<0.05) In regard to plantar sweating, decrease in sweating was expressed in each of four groups, but was not significant between groups. An apparent increase of temperature measured by DITI indicated sufficient denervation and predicted long-lasting relief of essential hyperhidrosis and also decrease in temperature of trunk and lower extremity by DITI had correlated well with postoperative satisfaction, and also postoperative compensatory sweating. Conclusion: We suggested that the incidence and degree of compensatory sweating was closely related to the site and the extent of thoracic sympathicotomy. Resection of the lower interganglionic neural fiber of the second thoracic sympathetic ganglion on the third rib is the most practical and minimally invasive treatment than other surgical methods. We were also to anticipated the distribution and degree of compensatory sweating by DITI precisely and objectively and for ascertaining the clinical usefulness.

• The Korean Journal of Pharmacology
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• v.10 no.1 s.15
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• pp.31-40
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• 1974

1. The authors investigated the effects of $PGE_1$ on the action of sympathomimetics in the vas deferens of guinea-pig, comparing with those in the rat vas deferens, and also the action of $PGE_1$ on the motility of nerve-free smooth muscle of chick amnion. 2. In the isolated guinea-pig vas deferens, the actions of phenylephrine and norepinephrine were much potentiated by pretreatment with $PGE_1$. Futher, in the isolated hypogastric nerve-vas deferens preparation of guinea-pig, effects of phenylephrine, norepinephrine and tyramine on the contractile response of vas to the hypogastric nerve stimulation and to the transmural stimulation were also augumented especially in tension by $PGE_1$-pretreatment. 3. In the isolated hypogastric nerve-vas preparation of rat, both contractile responses to hypogastric nerve and transmural stimulation were slowly reduced by treatment with $PGE_1$ and the potentiated effect of phenylephrine or norepinephrine was not observed in spite of pretreatment with $PGE_1$. 4. The actions of phenylephrine and norepinephrine on the denervated vas deferens of guinea-pig were also enhanced by $PGE_1$ as it were in the intact vas deferens, but there was no significant effect by $PGE_1$ on the action of norepinephrine in the denervated rat vas deferens. 5. $PGE_1$ in low concentration $(10^{-8}g/ml)$ did not affect the spontaneous motility of nerve-free smooth muscle of chick amnion ($9{\sim}11$ th day incubated chick), but in large concentration $(5{\times}10^{-8}g/ml)$ it caused irregular and slightly inhibitory movement. Pretreatment with $PGE_1$ on chick amnion did not exert any change on the action of phenylephrine applied. However, the stimulatory action of physostigmine on the chick amnion was a little antagonized by the low concentration of $PGE_1$. 6. It might be summarized that there is species difference between the actions of $PGE_1$ on the vas deferens of guinea-pig and that of rat, and the action of $PGE_1$ on the guinea-pig vas deferens might be mediated by the other mechanism rather than by direct action on the vas musculature.