• 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.

• Archives of Reconstructive Microsurgery
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• v.12 no.1
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• pp.1-12
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• 2003

The bridging of nerve gaps is still one of the major problems in peripheral nerve surgery. To evaluate the role of silicon tube in nerve regeneration, gaps were made by resection of tibial components of sciatic nerves of twenty-five New Zealand rabbits. The gaps were divided into five groups. In group I, the tibial components of sciatic nerves were isolated and the incision immediately closed. In group II, 1-cm segments of the nerve were removed and the silicon tubes filled with autogenous skeletal muscle were sutured in place. In group III, 1-cm segments of the nerve were removed and the silicon tubes filled without muscle were sutured in place. In group IV, 2-cm segments of the nerve were removed and the silicon tubes filled with autogenous skeletal muscle were sutured in place. In group V, 2-cm segments of the nerve were removed and the silicon tubes filled without muscle were sutured in place. At 16th week, the eletromyography, the light and transmission electron microscopy were performed. Nerve conduction study stimulating sciatic nerve proximal to the lesion and recording at gastrocnemius muscle showed that the compound muscle action potentials of the group II with 1 cm nerve defect filled with muscle were higher amplitudes than the group III without muscle. Compound muscle action potentials of the group IV with 2 cm defect filled with muscle showed similar results in comparison with the group V. The light and transmission electron microscpy showed that a good morphological pattern of nerve regeneration in 1 cm gap than 2 cm and in gap with muscle than gap without muscle.

• Archives of Plastic Surgery
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• v.36 no.1
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• pp.84-88
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• 2009

Purpose: Compression of the ulnar nerve in the ulnar tunnel is a relatively uncommon condition. Many authors have described several etiologies of ulnar nerve compression. We experienced two cases of ulnar nerve compression in the ulnar tunnel due to an anomalous pulsatile S - shaped ulnar artery. Methods: Case 1: A 51 - year - old man was referred with numbness and paroxysmal tingling sensation along the volar side of the ring and little fingers of his right hand for 6 months. When exploration, the ulnar artery was pulsatile S - shaped and was impinging on the ulnar nerve. To decompress the ulnar nerve, the tortuous ulnar artery was mobilized and translocated radially onto the adjacent fibrous tissue. Case 2: A 41 - year - old man was referred with tingling sensation on the 4 th, 5 th finger of the right hand for 4 months. Sensory nerve conduction velocities of the ulnar nerve was delayed. Preoperative 3D angio CT scan showed an anomalous S - shaped ulnar artery. Same operation was done. Results: The postoperative course was uneventful. After decompression, paroxysmal tingling sensation decreased to less than 1 minute per episode, occurring 1 - 2 times a day. After 4 months, they had no more episodes of numbness and tingling sensation. Examination demonstrated good sensation to pinprick and touch on the ulnar aspect of the hand. Conclusion: We report two cases of ulnar nerve compressive neuropathy that was caused by an anomalous pulsatile S - shaped ulnar artery in the ulnar tunnel. Although this is an unusual cause of ulnar nerve compression, the symptoms will not spontaneously resolve. The prompt relief of compressive neuropathic symptoms following the translocation of the impinging ulnar artery from the affected ulnar nerve onto adjacent tissue proved that the ulnar nerve compression is due to the anomalous vessel.

• Journal of the Korean Academy of Clinical Electrophysiology
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• v.5 no.2
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• pp.47-59
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• 2007

The purpose of this study were to investigate the effects of electroacupuncture(EA) on sensory nerve function in acute hyperglycemia rats. Male Sprague-Dawley rats weighing 250~270 g(8 weeks of age) were used in this study, and the induced hyperglycemia rats were produced by intraperitoneal injection of streptozotocin(70 mg/kg body weight). Only animals with blood glucose levels of 300 mg/dl or higher were used in this study. Animal were divided into two groups: the control group and EA group (n=7 in each group). For EA, two stainless-steel needles were inserted into Zusanli (ST36) which is located at the anterior tibial muscle and about 10mm below the knee joint. Pulsed current(2 Hz, 0.3 ms) were applied to the inserted needle for 20 mim. We measured glucose level, weigh, sensory nerve conduction and somatosensory evoked potential(5EP) before and after injecting streptozotocin, 2 weeks, 4 weeks. The change of blood glucose on EA group trended to decrease compared with the control group and there were significant differences(p<0.05). The body weight of the EA group trended to be reduced compared with the control group and there were significant differences(p<0.05). The amplitude of sensory nerve action potential on EA group to increase compared with the control group and there were significant differences(p<0.05). There were no significant differences in SEP. These results suggest that EA has beneficial effect on diabetic neuropathy and this effect may be related in part with prevention of hyperglycemia.

• The Korean Journal of Physiology and Pharmacology
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• v.2 no.1
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• pp.9-19
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• 1998

The present study was primarily carried out to characterize the properties of the spinomesencephalic tract (SMT) neurons that project from the upper cervical spinal segments to the midbrain. It was also investigated whether these neurons received convergent afferent inputs from other sources in addition to cervical inputs. Extracellular single unit recordings were made from neurons antidromically activated by stimulation of midbrain. Recording sites were located in lamina $I{\sim}VIII\;of\;C1{\sim}C3$ segments of spinal cord. Receptive field (RF) and response properties to mechanical stimulation were studied in 71 SMT neurons. Response profiles were classified into six groups: complex (Comp, n=9), wide dynamic range (WDR, n=16), low threshold (LT, n=5), high threshold (HT, n=6), deep/tap (Deep, n=10), and non- responsive (NR, n=25). Distributions of stimulation and recording sites were not significantly different between SMT groups classified upon their locations and/or response profiles. Mean conduction velocity of SMT neurons was $16.7{\pm}1.28\;m/sec$. Conduction velocities of SMTs recorded in superficial dorsal horn (SDH, n=15) were significantly slower than those of SMTs recorded in deep dorsal horn (DDH, n=18), lateral reticulated area (LRA, n=21), and intermediate zone and ventral horn (IZ/VH, n=15). Somatic RFs for SMTs in LRA and IZ/VH were significantly larger than those in SDH and DDH. Five SMT units (4 Comps and 1 HT) had inhibitory somatic RFs. About half (25/46) of SMT units have their RFs over trigeminal dermatome. Excitabilities of 5/12 cells and 9/13 cells were modulated by stimulation of ipsilateral phrenic nerve and vagus nerve, respectively. These results suggest that upper cervical SMT neurons are heterogenous in their function by showing a wide range of variety in location within the spinal gray matter, in response profile, and in convergent afferent input.

• Journal of Korean Neurosurgical Society
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• v.55 no.6
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• pp.370-374
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• 2014

To present a case of cauda equina syndrome (CES) caused by chronic inflammatory demyelinating polyneuropathy (CIDP) which seemed clinically similar to Charcot-Marie-Tooth disease type1 (CMT1). CIDP is an immune-mediated polyneuropathy, either progressive or relapsing-remitting. It is a non-hereditary disorder characterized by symmetrical motor and sensory deficits. Rarely, spinal nerve roots can be involved, leading to CES by hypertrophic cauda equina. A 34-year-old man presented with low back pain, radicular pain, bilateral lower-extremity weakness, urinary incontinence, and constipation. He had had musculoskeletal deformities, such as hammertoes and pes cavus, since age 10. Lumbar spine magnetic resonance imaging showed diffuse thickening of the cauda equina. Electrophysiological testing showed increased distal latency, conduction blocks, temporal dispersion, and severe nerve conduction velocity slowing (3 m/s). We were not able to find genetic mutations at the PMP 22, MPZ, PRX, and EGR2 genes. The pathologic findings of the sural nerve biopsy revealed thinly myelinated nerve fibers with Schwann cells proliferation. We performed a decompressive laminectomy, intravenous IgG (IV-IgG) and oral steroid. At 1 week after surgery, most of his symptoms showed marked improvements except foot deformities. There was no relapse or aggravation of disease for 3 years. We diagnosed the case as an early-onset CIDP with cauda equine syndrome, whose initial clinical findings were similar to those of CMT1, and successfully managed with decompressive laminectomy, IV-IgG and oral steroid.

• Journal of Pharmacopuncture
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• v.21 no.4
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• pp.258-267
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• 2018

Objectives: The purpose of this study was to find out validity of Surface Electromyography(sEMG) compared with Nerve Conduction Study and clinical assessment scale as assessment factors for facial palsy. Methods: We investigated 50 cases of patients with peripheral facial palsy who had records of sEMG and NCS to check. Then we analyzed the correlation between sEMG and NCS that carried out around 1 week after onset. And we analyzed the correlation between sEMG and clinical assessment scales that were measured three times around 1 week, 3-4 weeks and 5-6 weeks after onset. Clinical assessment scales used in this study were House-brackmann grade, Yanagihara unweighted grading scale and Sunnybrook facial grading system. We used Pearson's correlation for statistical analysis. Results: sEMG and NCS, measured at similar times, were statistically correlated. Especially, the correlation with the forehead region was high. And sEMG and clinical assessment scale, measured at same time, were statistically correlated, especially after 5 weeks from onset. Conclusion: According to this study, sEMG is expected to be useful to assessment facial palsy.

• Annals of Clinical Neurophysiology
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• v.23 no.2
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• pp.99-107
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• 2021

Background: Pain and autonomic dysfunction are prominent symptoms in some patients with carpal tunnel syndrome (CTS). Infrared thermography (IRT) has been used to evaluate CTS by measuring the cutaneous temperature and sympathetic vasomotor function. Methods: This study enrolled the 66 hands of 33 subjects, some of which had clinical CTS and the others were healthy. The enrolled patients completed the Boston Carpal Tunnel Questionnaire (BCTQ) and Historical-Objective scale, and underwent nerve conduction studies (NCSs) and IRT. Skin temperature was measured at the fingertips and the thenar and hypothenar regions in each hand. We analyzed (1) the correlations between self-reported severity, physician-assessed severity, and test results, and (2) the sensitivity and specificity of IRT in diagnosing CTS. Results: No significant correlation was observed between the results of the BCTQ, NCS, and IRT. IRT had a low sensitivity and high specificity in diagnosing CTS. Conclusions: IRT cannot replace NCS in diagnosing CTS, nor did it provide an advantage in combination with NCS. However, lower temperatures at the median nerve in some hands with moderate-to-severe CTS suggested the involvement of sympathetic nerve fiber function. Follow-up studies with a larger-scale and complementary design are required to elucidate the relationships.

• Archives of Plastic Surgery
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• v.37 no.5
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• pp.676-680
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• 2010

Purpose: Median nerve entrapment syndrome within carpal tunnel is usually called carpal tunnel syndrome and it is the most common form of peripheral nerve entrapment syndrome. Many factors such as diabetes mellitus, hypothyroidism, hormonal replacement theraphy, corticosteroid use, rhematoid arthritis and wrist fractures may cause carpal tunnel syndrome. To the best of our knowledge, this is the first case report of median nerve entrapment syndrome due to adhesion of laceration wound after suicidal attempt. Methods: A 28-year-old woman presented with a sensory change and thenar hypotrophy on her left hand. On her history, she attempted suicide by slashing her wrist. Initial electromyography (EMG) showed that the nerve conduction velocities of median nerve was delayed. Therefore, we performed surgical procedures. When exploration, Fibrous scar tissue observed around the median nerve but nerve had not been injured. Transcarpal ligament was completely released and adjacent fibrous tissue was removed to decompress the median nerve. Results: The postoperative course was uneventful until the first year. Opposition difficulty and thenar hypotrophy were improved progressively after the surgery. Sensory abnormality was slowly improved over one year. Conclusion: We report a case of median nerve entrapment syndrome that was caused by adhesion of laceration wound after suicidal attempt. This is an unusual cause of median nerve entrapment syndrome, the symptoms were relieved after transcarpal ligament release and fibrous scar tissue removal.

• Journal of Korean Dental Science
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• v.6 no.2
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• pp.58-66
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• 2013

Purpose: The inferior alveolar nerve (IAN) can be damaged as a result of minor oral surgical procedure such as third molar extraction or implant placement. Repair of the injured IAN involves difficulty of access, and research studies are limited to elucidating the process of regeneration by surgical methods. This study sought to establish the rabbit animal model to apply polymeric membrane functionalized with nerve growth factor after a crush lesion for the evaluation of nerve regeneration using the electrophysiologic method. Materials and Methods: The IAN of 2 adult male New Zealand white rabbits (4 nerves) were exposed bilaterally, and crush injury rendered by jeweler's forceps was applied. Nerve conduction velocity was examined electrophysiologically using electromyography before, after, and 4 weeks after the crush injury. To evaluate the regeneration, the pattern of action potential of IAN was recorded, and the characteristics of neurons were histologically observed. Result: After the crush injury, afferent activity decreased in the injured group. Electromyography could not be recorded after four weeks because tissues surrounding the injured nerve collapsed. Decrease in the mean number of axons was observed in the injured part with membrane. Conclusion: Despite the limited result, the present animal model study may provide a possible way to research on the methods of enhancing the recovery of nerve injuries in clinical situations. For clinically widespread acceptance, however, it should gain more consecutive and scientific evidences.