• Annals of Clinical Neurophysiology
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• v.11 no.2
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• pp.48-53
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• 2009

Background: Bell's palsy produces a complex problem that involves not only facial motor weakness, but also psychiatric issues. However, the relationship between facial neuromotor system impairment and psychological adjustment has not been well understood. Methods: We have performed psychological evaluations in patients with acute unilateral Bell's palsy within 2 weeks after onset. Thirty patients with Bell's palsy (10 men, 20 women) were included, who were diagnosed by neurologic examination, electrophysiologic study and/or brain MRI. We measured facial motor scale of impairment (House-Brackmann, HB scale) and psychosocial adjustment [Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI)] at the time of initial presentation and 1 month after diagnosis. Results: The age of the enrolled patients ranged from 16 to 80 years. The mean grade of initial and follow up HB scale were 3.87 (SD: 0.63, range 2~5) and 1.77 (SD: 1.10, range 1~5). The mean score of initial and follow up BAI, BDI were 11.93 (range; 0 to 47, SD: 9.65, very low anxiety), 14.73 (range; 0 to 41, SD: 9.21 minimal depression) and 7.5 (range; 0 to 36, SD: 8.58, very low anxiety), 9.33 (range; 0 to 30, SD: 8.19 minimal depression). There was positive correlation between improvement of HB scale and improvement of BAI and BDI score. Conclusions: Bell's palsy is associated with the psychological problems such as depression and anxiety, and the improvement of motor symptom is associated with the improvement of these psychological problems.

• Archives of Plastic Surgery
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• v.33 no.2
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• pp.213-218
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• 2006

As the large defect of peripheral nerve occurs, the autologous nerve graft is the most ideal method but it has many limitations due to donor site morbidities. Various materials have been developed for the nerve defect as the conduits, but none of these materials is satisfactory. Among them, $Gore-Tex^{(R)}$ tube seems to be one of the most ideal nerve conduit materials at peripheral nerve defect. Many researches have focused on finding the neurotrophic factors. It is recently demonstrated that Valproic acid(VPA) has an effect of axonal regeneration as a neurotrophic factor without enzymatic degradation and toxicity problems. The purpose of this study is to evaluate the effect of VPA on the nerve regeneration at the peripheral nerve defect. A 10 mm gap of rat sciatic nerve was made and $Gore-Tex^{(R)}$ tube filled with biceps femoris muscle was placed at the nerve defect site. We let the rat take VPA as drinking water in experimental group and did not give VPA to the control group. We estimated the results as electrophysiologic and histological aspects for 16 weeks after the surgery. The nerve conduction velocity, total myelinated axon count, myelin sheath thickness and mean nerve fiber diameter significantly increased in VPA-treated experimental group when compared to the control (p < 0.05). From the above results, we conclude that VPA promotes the nerve regeneration at the peripheral nerve defect site. It is suggested that $Gore-Tex^{(R)}$ tube filled with skeletal muscle and VPA administration may be a good substitute for autologous nerve graft.

• Annals of Clinical Neurophysiology
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• v.19 no.1
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• pp.13-19
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• 2017

Background: Median F-wave latencies are physiologically shorter than ulnar latencies, but they are often longer relative to ulnar latencies in carpal tunnel syndrome (CTS). This study aimed to investigate the value of absolute F-waves and relative latency changes compared to ulnar latencies in the diagnosis of CTS. Methods: F-wave latencies of median and ulnar nerves in 339 hands from 339 patients with CTS and 60 hands from 60 control subjects were investigated. Mean F-wave minimal latencies of median and ulnar nerves were compared between groups. Patients were further divided into subgroups based on Canterbury grading and then analyzed using F-wave latency differences (FWLD) and F-wave ratio (FWR). Results: Of 339 hands in the CTS group, 236 hands exhibited F-wave inversion based on the FWLD criterion and 277 hands had F-wave inversion based on the FWR criterion. F-wave inversion had a sensitivity of 81.7% using the FWR criterion to diagnose CTS. The mean FWLD and FWR were significantly greater in all patient subgroups compared to the control group (p < 0.001). In addition, mean FWLD and FWR showed significant correlations (r = -0.683 and r = 0.674, respectively, p < 0.001) with disease severity. Conclusions: F-wave studies are effective supplementary diagnostic tools comparing to other standard electrophysiologic criteria for screening patients with CTS.

• Archives of Plastic Surgery
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• v.37 no.1
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• pp.95-98
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• 2010

Purpose: One of the most common cause of upper extremity lymphedema is breast cancer surgery. We experienced the nerve entrapment syndrome which was associated with postmastectomy lymphedema. To the best of our knowledge, this is the first case report of lymphedema induced nerve entrapment syndrome on upper extremity in Korea. Methods: A 54-year-old woman presented with a tingling sensation on her right hand, which had been present for 1 year. On her history, she had a postmastectomy lymphedema on her right upper extremity for 20 years. Initial electromyography (EMG) showed that the ampulitude of the median, ulnar, and dorsal ulnar cutaneous nerve were decreased, and conduction block was also seen in median nerve across the wrist. In needle EMG, incomplete interference patterns were observed in the muscles innervated by median and ulnar nerves. In conclusion, electrophysiologic study and clinical findings suggested right median and ulnar neuropathy below the elbow. Therefore, we performed surgical procedures, which were release of carpal tunnel, Guyon's canal, and cubital tunnel. Results: The postoperative course was uneventful until the first two years. The tingling sensation and claw hand deformity were improved, however, the motor function decreased progressively. In 7 years after the operation, patient could not flex her wrist and thumb sufficiently. EMG which was performed recently showed that ulnar motor response was of low ampulitude. Moreover, median, ulnar, dorsal ulnar cutaneous, lateral antecubital cutaneous and median antebrachial cutaneous sensory response were unobtainable. Abnormal spontaneous activities were observed in upper arm muscles. In conclusion, multiple neuropathies were eventually developed at above elbow level. Conclusion: On treating nerve entrapments associated with lymphedema, medical professionals should be fully aware of the possibility of unpredictable results after the surgery, because of the pathophysiologic traits of chronic lymphedema.

• Journal of Korean Neurosurgical Society
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• v.29 no.3
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• pp.372-378
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• 2000

The carpal tunnel syndrome is one of the most common entrapment neuropathy. Surgical treatments consist of conventional open technique, alternative technique using retinaculatome, and endoscopic surgery. This study compares the outcomes of surgical treatment of carpal tunnel syndrome following conventional versus endoscopic release. The authors reviewed 56 cases of 33 patients with carpal tunnel syndrome treated surgically in our institute from January 1991 to May 1998. The follow-up evaluation was possible in 36 cases of 20 patients who had conventional release and in 11 cases of 7 patients with endoscopic release. The following parameters were evaluated for comparison : improvement of symptom, return to normal work, recovery of strength of grip and pinch, rate of complication, follow-up electrophysiologic finding. Compared with open decompression, the group of endoscopic decompression needed significantly less time to go back to work(p<0.001). Also strength of grip and pinch improved faster in the group of endoscopic decompression as well, compared with open decompression(p<0.05). These results indicate that endoscopic procedure is an excellent, minimally invasive method to treat carpal tunnel syndrome, performed by surgeons who are fully aware of the anatomy.

• Journal of Korean Neurosurgical Society
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• v.55 no.3
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• pp.148-151
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• 2014

Objective : Posture-induced radial neuropathy, known as Saturday night palsy, occurs because of compression of the radial nerve. The clinical symptoms of radial neuropathy are similar to stroke or a herniated cervical disk, which makes it difficult to diagnose and sometimes leads to inappropriate evaluations. The purpose of our study was to establish the clinical characteristics and diagnostic assessment of compressive radial neuropathy. Methods : Retrospectively, we reviewed neurophysiologic studies on 25 patients diagnosed with radial nerve palsy, who experienced wrist drop after maintaining a certain posture for an extended period. The neurologic presentations, clinical prognosis, and electrophysiology of the patients were obtained from medical records. Results : Subjects were 19 males and 6 females. The median age at diagnosis was 46 years. The right arm was affected in 13 patients and the left arm in 12 patients. The condition was induced by sleeping with the arms hanging over the armrest of a chair because of drunkenness, sleeping while bending the arm under the pillow, during drinking, and unknown. The most common clinical presentation was a wrist drop and paresthesia on the dorsum of the 1st to 3rd fingers. Improvement began after a mean of 2.4 weeks. Electrophysiologic evaluation was performed after 2 weeks that revealed delayed nerve conduction velocity in all patients. Conclusion : Wrist drop is an entrapment syndrome that has a good prognosis within several weeks. Awareness of its clinical characteristics and diagnostic assessment methods may help clinicians make diagnosis of radial neuropathy and exclude irrelevant evaluations.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.22 no.6
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• pp.518-526
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• 2019

Purpose: Limited means exist to assess gastrointestinal activity in pediatric patients postoperatively. Recently, myoelectric gastrointestinal activity recorded by cutaneous patches has been shown in adult patients to be predictive of clinical return of gastrointestinal function postoperatively. The aim of this case series is to demonstrate the feasibility of this system in pediatric patients and to correlate myoelectric signals with return of bowel function clinically. Methods: Pediatric patients undergoing abdominal surgery were recruited to have wireless patches placed on the abdomen within two hours postoperatively. Myoelectric data were transmitted wirelessly to a mobile device with a user-interface and forwarded to a cloud server where processing algorithms identified episodes of motor activity, quantified their parameters and nominally assigned them to specific gastrointestinal organs based on their frequencies. Results: Three patients (ages 5 months, 4 year, 16 year) were recruited for this study. Multiple patches were placed on the older subjects, while the youngest had a single patch due to space limitations. Rhythmic signals of the stomach, small intestine, and colon could be identified in all three subjects. Patients showed gradual increase in myoelectric intestinal and colonic activity leading up to the first recorded bowel movement. Conclusion: Measuring myoelectric intestinal activity continuously using a wireless patch system is feasible in a wide age range of pediatric patients. The increase in activity over time correlated well with the patients' return of bowel function. More studies are planned to determine if this technology can predict return of bowel function or differentiate between physiologic ileus and pathologic conditions.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.3
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• pp.199-218
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• 2005

Purpose of Study: Peripheral nerve regeneration depends on neurotrophism of distal nerve stump, recovery potential of neuron, supporting cell like Schwann cell and neurotrophic factors such as BDNF. Peripheral nerve regeneration can be enhanced by the conduit which connects the both sides of transected nerve. The conduit maintains the effects of neurotrophism and BDNF produced by Schwann cells which can be made by gene therapy. In this study, we tried to enhance the peripheral nerve regeneration by using calcium phosphate coated porous conduit and BDNF-Adenovirus infected Schwann cells in sciatic nerve of rats. Materials and Methods: Microporous filter which permits the tissue fluid essential for nerve regeneration and does not permit infiltration of fibroblasts, was made into 2mm diameter and 17mm length conduit. Then it was coated with calcium phosphate to improve the Schwann cell adhesion and survival. The coated filter was evaluated by SEM examination and MTT assay. For effective allogenic Schwann cell culture, dorsal root ganglia of 1-day old rat were extracted and treated with enzyme and antimitotic Ara-C. Human BDNF cDNA was obtained from cDNA library and amplified using PCR. BDNF gene was inserted into adenovirus shuttle vector pAACCMVpARS in which E1 was deleted. We infected the BDNF-Ad into 293 human mammary kidney cell-line and obtained the virus plaque 2 days later. RT-PCR was performed to evaluate the secretion of BDNF in infected Schwann cells. To determine the most optimal m.o.i of BDNF-Ad, we infected the Schwann cells with LacZ adenovirus in 1, 20, 50, 75, 100, 250 m.o.i for 2 hours and stained with ${\beta}$-galactosidase. Rats(n=24) weighing around 300g were used. Total 14mm sciatic nerve defect was made and connected with calcium phosphate coated conduits. Schwann cells$(1{\times}10^6)$ or BDNF-Ad infected Schwann cells$(1{\times}10^6)$ were injected in conduit and only media(MEM) was injected in control group. Twelve weeks after surgery, degree of nerve regeneration was evaluated with gait analysis, electrophysiologic measurements and histomorphometric analysis. Results: 1. Microporous Millipore filter was effective conduit which permitted the adhesion of Schwann cells and inhibited the adhesion of fibroblast. We could enhance the Schwann cell adhesion and survival by coating Millipore filter with calcium phosphate. 2. Schwann cell culture technique using repeated treatment of Ara-C and GDNF was established. The mean number of Schwann cells obtained 1 and 2 weeks after the culture were $1.54{\pm}4.0{\times}10^6$ and $9.66{\pm}9.6{\times}10^6$. 3. The mRNA of BDNF in BDNF-Ad infected Schwann cells was detected using RT-PCR. In Schwann cell $0.69\;{\mu}g/{\mu}l$ of DNA was detected and in BDNF-Adenovirus transfected Schwann cell $0.795\;{\mu}g/{\mu}l$ of DNA was detected. The most effective infection concentration was determined by LacZ Adenovirus and 75 m.o.i was found the most optimal. Conclusion: BDNF-Ad transfected Schwann cells successfully regenerated the 14mm nerve gap which was connected with calcium phosphate coated Millipore filter. The BDNF-Ad group showed better results compared with Schwann cells only group and control group in aspect to sciatic function index, electrophysiologic measurements and histomorphometric analysis.

• The Korean Journal of Nuclear Medicine
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• v.39 no.1
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• pp.9-14
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• 2005

Purpose: Abnormal myocardial perfusion may be caused by ventricular preexcitation, but its location, extent, severity and correlation with accessory pathway (AP) are not established. We evaluated perfusion patterns on myocardial perfusion SPECT and location of AP in patients with WPW (Wolff-Parkinson-White) syndrome. Materials and Methods: Adenosine Tc-99m MIBI or Tl-201 myocardial perfusion SPECT was performed in 11 patients with WPW syndrome. Perfusion defects (PD) were compared to AP location based on ECG with Fitzpatrick's algorithm or electrophysiologic study and radiofrequency catheter ablation. Results: Patients had atypical chest discomfort or no symptom. Risk of coronary artery disease (CAD) was below 0.1 in 11 patients using the nomogram to estimate the probability of CAD. Coronary angiography was performed in 4 patients (mid-LAD 50% in one, normal in others). In 4 patients, AP localization was done by electrophysiologic study and radiofrequency catheter ablation (RFCA). Small to large extent ($11.0{\pm}8.5%$, range:$3{\sim}35%$) and mild to moderate severity ($-71{\pm}42.7%$, range:$-2l7{\sim}-39%$) of reversible (n=9) or fixed (n=1) perfusion defects were noted. One patient with right free wall (right lateral) AP showed normal. PD locations were variable following the location of AP. One patient with left lateral wall AP was followed 6 weeks after RFCA and showed significantly decreased PD on SPECT with successful ablation. Conclusion: Myocardial perfusion defect showed variable extent, severity and location in patients with WPW syndrome. Abnormal perfusion defect showed in most of all patients, but it did not seem to be correlated specifically with location of accessory pathway and coronary artery disease. Therefore myocardial perfusion SPECT should be interpreted carefully in patients with WPW syndrome.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.10 no.1
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• pp.129-145
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• 2004

Many physical therapy who graduate department of physical therapy interested in physical therapy specialist. The boundary of physical therapy specialist is consist of 7 parts; CCS(Cardiopulmonary Certified Specialist), ECS(Clinical Electrophysiologic Certified Specialist), GCS(Geriatric Certified Specialist), NCS(Neurologic Certified Specialist), NCS(Neurologic Certified Specialist), OCS(Orthopaedic Certified Specialist), PCS(Pediatric Certified Specialist), SCS(Sports Certified Specialist). So the purpose of this study was to investigate of undergraduate student's interest about the area of special physical therapy and its academy. The data were collected from May 17 to 24, 2004 and 158 valid questionnaires were obtained and analyzed. It was for undergraduate students who major in physical therapy in college and university which are located in Busan, Ulsan and Kyoungnam province. The result is follows: 1. The research about the study of physical therapy after graduation was that 45.5% of female thought that they going to study as possible as they can was the best. In the case of men, 54.3% of male thought that they going to study was the best. 2. The result about recognition of special physical therapy was that 62.0% of people answered CCS, 69.6% of people answered GCS. The most familiar part of special physical therapy at course of school curriculum was that 88.0% of people answered OCS, and 84.2% of people answered NCS. 3. The result about the most interesting part of special physical therapy was that 68.6% of male and 36.1% of female answered OCS. On the other hand, the least part that people doesn't care was that 41.2% of male answered PCS, and 41.0% of female answered CCS. 4. About educational matters of special physical therapy and its academy was that 60% of answered 'Not enough'. An answer to question of special physical therapy and its academy's educational necessity. At the a course of faculty and clinical practice was that 58.9% of answered 'somewhat necessary'. After graduation, study a plan of special physical therapy was that 59.5% of answered 'immediate academy'. 5. Recognize scale in alternation physical therapy, think of extend physical therapy's territory is 'necessary of extend territory' was 78% the highest answer. 57.6% of answered was concerned about alternating physical therapy, and want to study.