• Annals of Clinical Neurophysiology
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• v.25 no.2
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• pp.84-92
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• 2023

Background: Clinical spectrum of immunoglobulin M (IgM) monoclonal gammopathy varies from IgM monoclonal gammopathy of unknown significance (IgM-MGUS) to hematological malignancies. We evaluated the clinical features, electrophysiological characteristics, and prognosis of patients with peripheral neuropathy associated with IgM monoclonal gammopathy (PN-IgM MG). Methods: We retrospectively evaluated 25 patients with PN-IgM MG. Peripheral neuropathy was classified as axonal, demyelinating, or undetermined, based on electrophysiological studies. We classified the enrolled patients into the IgM-MGUS and malignancy groups, and compared the clinical and electrophysiological features between the groups. Results: Fifteen patients had IgM-MGUS and 10 had hematologic malignancies (Waldenström's macroglobulinemia: two and B-cell non-Hodgkin's lymphoma: eight). In the electrophysiological evaluation, the nerve conduction study (NCS) criteria for demyelination were met in 86.7% of the IgM-MGUS group and 10.0% of the malignancy group. In particular, the distal latencies of the motor NCS in the IgM-MGUS group were significantly prolonged compared to those in the malignancy group (median, 9.1 ± 5.1 [IgM-MGUS], 4.2 ± 1.3 [malignancy], p = 0.003; ulnar, 5.4 ± 1.9 [IgM-MGUS], 2.9 ± 0.9 [malignancy], p = 0.001; fibular, 9.3 ± 5.1 [IgM-MGUS], 3.8 ± 0.3 [malignancy], p = 0.01; P-posterior tibial, 8.3 ± 5.4 [IgM-MGUS], 4.4 ± 1.0 [malignancy], p = 0.04). Overall treatment responses were significantly worse in the malignancy group than in the IgM-MGUS group (p = 0.004), and the modified Rankin Scale score at the last visit was higher in the malignancy group than in the IgM-MGUS group (2.0 ± 1.1 [IgM-MGUS], 4.2 ± 1.7 [malignancy], p = 0.001), although there was no significant difference at the initial assessment. Conclusions: The risk of hematological malignancy should be carefully assessed in patients with PN-IgM MG without electrophysiological demyelination features.

• Archives of Reconstructive Microsurgery
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• v.8 no.1
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• pp.77-83
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• 1999

The skin on the dorsum of the foot is a source of the reliable thin and sensory cutaneous free tissue transplantation with or without tendon, bone and joint. A composite flap with attached vascularized tendon grafts for the combined loss of skin and tendon on the dorsum of the hand and foot offers an immediate one stage solution to this problem. The flap provides a very durable innervated tissue cover for the heel of the foot and the dorsum of the hand and an osteocutaneous transfer combined with the second metatarsal. The major dorsalis pedis artery is constant in size, but the first dorsal metatarsal artery is variable in size and location. The dorsal surface of the foot receives sensory innervation through the superficial peroneal nerve and the first web through the deep peroneal nerve. Authors had performed 5 dorsalis pedis free flap transplantation in the foot and hand at Department of Orthopedic Surgery, Chonbuk National University Hospital from August 1993 through August 1997 and followed up for the period of between 19 and 67 months until March 1999. The results were as follows 1. 5 cases dorsalis pedis free flap transfer to the foot(4 cases) and the hand(1 case) were performed and the recipient was foot dorsum and heel 2 cases each and hand dorsum 1 case. 2 All of 5 cases(100%) were survived from free flap transfer and recipient artery was dorsalis pedis artery(2 cases), anterior tibial artery(1 case), posterior tibial artery(1 case) and ulnar artery(1 case) and recipient veins were 2 in number except in the hand. 3. Long term follow up of the exterior and maceration was good and sensory recovery was poor 4. Donor site was covered with full thickness skin graft obtained from one or both inguinal areas at postoperative 3rd week and skin graft was taken good and no morbidity was showed.

• Archives of Plastic Surgery
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• v.37 no.2
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• pp.137-142
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• 2010

Purpose: Tumor ablation and traumatic intractable ulceration of the plantar surface of the foot results in skin and soft tissue defects of the weight-bearing sole. Simple skin grafting is not sufficient for reconstruction of the weight-bearing areas. Instead, the island medial plantar flap (instep flap) and distally-based island medial plantar flap was used for proper reconstruction of the weight bearing area. However, there are some disadvantages. In particular, an island medial plantar flap has a short pedicle limiting the mobility of the flap and the distally-based island medial plantar flap is based on a very small vessel. We investigated whether good results could be obtained using a reverse island medial plantar flap based on the lateral plantar vessel as a solution to the above limitations. Methods: Three patients with malignant melanoma were cared for in our tertiary hospital. The tumors involved the lateral forefoot, the postero-lateral heel, and the medial forefoot area. We designed and harvested the flap from the medial plantar area, dissected the lateral and medial plantar artery and vena comitans, and clamped and cut the vessel 1 cm proximal to the branch from the posterior tibial artery and vena comitans. The medial plantar nerve fascicles of these flaps anastomosed to the sural nerve, the 5th interdigital nerve, and the 1st interdigital nerve of each lesion. The donor sites were covered with skin grafting. Results: The mean age of the 3 subjects was 64.7 years (range, 57 - 70 years). Histologically, all cases were lentiginous malignant melanomas. The average size of the lesion was $5.3\;cm^2$. The average size of the flap was $33.1\;cm^2$. The flap color and circulation were intact during the early postoperative period. There was no evidence of flap necrosis, hematomas or infection. All patients had a normal gait after the surgery. Sensory return progressively improved. Conclusion: Use of an island medial plantar flap based on the lateral plantar vessel to the variable weight-bearing sole is a simple but useful procedure for the reconstruction of any difficult lesion of the weight-bearing sole.

• The Journal of Korean Medicine
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• v.32 no.3
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• pp.1-9
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• 2011

Objectives: This study was carried out to observe the foot gworeum meridian muscle from a viewpoint of human anatomy on the assumption that the meridian muscle system is basically matched to the meridian vessel system as a part of the meridian system, and further to support the accurate application of acupuncture in clinical practice. Methods: Meridian points corresponding to the foot gworeum meridian muscle at the body surface were labeled with latex, being based on Korean standard acupuncture point locations. In order to expose components related to the foot gworeum meridian muscle, the cadaver was then dissected, being respectively divided into superficial, middle, and deep layers while entering more deeply. Results: Anatomical components related to the foot gworeum meridian muscle in human are composed of muscles, fascia, ligament, nerves, etc. The anatomical components of the foot gworeum meridian muscle in cadaver are as follows: 1. Muscle: Dorsal pedis fascia, crural fascia, flexor digitorum (digit.) longus muscle (m.), soleus m., sartorius m., adductor longus m., and external abdominal oblique m. aponeurosis at the superficial layer, dorsal interosseous m. tendon (tend.), extensor (ext.) hallucis brevis m. tend., ext. hallucis longus m. tend., tibialis anterior m. tend., flexor digit. longus m., and internal abdominal oblique m. at the middle layer, and finally posterior tibialis m., gracilis m. tend., semitendinosus m. tend., semimembranosus m. tend., gastrocnemius m., adductor magnus m. tend., vastus medialis m., adductor brevis m., and intercostal m. at the deep layer. 2. Nerve: Dorsal digital branch (br.) of the deep peroneal nerve (n.), dorsal br. of the proper plantar digital n., medial br. of the deep peroneal n., saphenous n., infrapatellar br. of the saphenous n., cutaneous (cut.) br. of the obturator n., femoral br. of the genitofemoral n., anterior (ant.) cut. br. of the femoral n., ant. cut. br. of the iliohypogastric n., lateral cut. br. of the intercostal n. (T11), and lateral cut. br. of the intercostal n. (T6) at the superficial layer, saphenous n., ant. division of the obturator n., post. division of the obturator n., obturator n., ant. cut. br. of the intercostal n. (T11), and ant. cut. br. of the intercostal n. (T6) at the middle layer, and finally tibialis n. and articular br. of tibial n. at the deep layer. Conclusion: The meridian muscle system seemed to be closely matched to the meridian vessel system as a part of the meridian system. This study shows comparative differences from established studies on anatomical components related to the foot gworeum meridian muscle, and also from the methodical aspect of the analytic process. In addition, the human foot gworeum meridian muscle is composed of the proper muscles, and also may include the relevant nerves, but it is as questionable as ever, and we can guess that there are somewhat conceptual differences between terms (that is, nerves which control muscles in the foot gworeum meridian muscle and those which pass nearby) in human anatomy.

• Journal of Yeungnam Medical Science
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• v.6 no.1
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• pp.151-163
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• 1989

Nerve conduction studies help delineate the extent and distribution of the neural lesion. The nerve conduction was studied on upper(median, ulnar and radial nerves) and lower(personal, posterior tibial and sural nerves) extremities in 83 healthy subjects 23 to 66 years of age. and normal values were established(Table 1). The mean motor terminal latency (TL) were : median. 3.6(${\pm}0.6$)milliseconds ; ulnar. 2.9(${\pm}0.5$) milliseconds ; radial nerve. 2.3(${\pm}0.4$) milliseconds. Mean motor nerve conduction velocity(MNCV) along distal and proximal segments: median. 61.2(${\pm}9.1$) (W-E) and 57.8(${\pm}13.2$) (E-Ax) meters per second ; ulnar. 63.7(${\pm}9.1$) (W-E) and 50.(${\pm}10.0$) meters per second. Mean sensory nerve conduction velocity(SNCV) : median. 34.7(${\pm}6.7$) (F-W), 63.7(${\pm}7.1$) (W-E) and 62.8(${\pm}12.3$) (E-Ax)meters per second ; ulnar. 38.0(${\pm}6.7$)(F-W), 63.4(${\pm}7.5$) (W-E) and 57.0(${\pm}10.1$) (E-Ax)meters per second ; radial, 45.3(${\pm}6.8$) (F-W) and 64.2(${\pm}11.0$) (W-E) meters per second ; sural nerve, 43.4(${\pm}6.1$) meters per second. The amplitudes of action potential and H-reflex were also standardized. Mean H latency was 28.4(${\pm}3.2$) milliseconds. And. the fundamental principles, several factors altering the rate of nerve conduction and clinical application of nerve stimulation techniques were reviewed.

• Journal of the Korean Academy of Clinical Electrophysiology
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• v.5 no.2
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• pp.1-9
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• 2007

Purpose: The purpose of this study was to investigate influence of superficial heat and deep heat for lumbo-sacral segment on H-reflex. Methods: Subjects of this research were 12 normal men and women (6 men and 6 women) and they were assigned to superficial heat group (6) and deep heat group (6). Heat treatment was applied between Th12-L2 by placing them at prone posture. superficial heat was applied for 20 min at 30 cm height with infrared lamp. Deep heat was applied for 20 mm at 5 cm height with 100 watt of microwave diathermy. H-reflex used diagnostic electromyography, active electrode was placed at muscle belly of medial gastrocnemius muscle at prone posture and electrical stimulation was given to posterior tibial nerve. Measurement was made before and after experiment and 10 min. and 20 min. after experiment. All data were analyzed with window 12.0 program, comparison of differences among measured items of groups according to repeated measurement was made with repeated measures ANOVA and significance level a was 0.05. Results: M latency at latency analysis showed little changes at two groups. H latency was reduced a little immediately after experiment and recovered to original state, there was significant difference. In analysis of amplitude, Mmax amplitude showed rise a little immediately after.

• Journal of the Korean Academy of Clinical Electrophysiology
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• v.9 no.2
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• pp.19-24
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• 2011

Purpose : This study is to examine the effects of transcranial direct current stimulation on the excitability of the central neuron. Methods : This study selected 24 suitable women in their twenties. A positive electrode of transcranial direct current stimulation was placed on the primary motor area (M1) C4 and a negative electrode was placed on the left supraobital. A stimulation of 0.04mA/$cm^2$ was applied for 20 minutes. H-reflex and V wave used diagnostic electromyography. An active electrode was placed at the muscle belly of the medial gastrocnemius muscle at a prone posture. An electrical stimulation was given to the posterior tibial nerve. Measurements were made before and after the stimulation. All data were analyzed with SPSS 12.0 and between each measuring before and after the change of the H-reflex and V wave amplitude. Results : There were no significant differences in all H wave, M wave, and V wave amplitude before and after transcranial direct current stimulation. There were no significant differences in the change of H/M ratio and V/M ratio before and after transcranial direct current stimulation. Conclusion : We know that transcranial direct current stimulation cannot have an influence on a normal grown-up person's central neuron.

• Journal of Veterinary Clinics
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• v.17 no.2
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• pp.388-394
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• 2000

이 실험은 소형견종에 대한 정상 SEPs의 범위를 알아내기 위해 실시되었다. 임상증 상이 정상인 28두를 대상으로 자극점에서 channel 1 까지의 Pl(LPI), channel 1까지의 Nl (LN1), 자극점에서 channel 2가지의 Pl(TP1), channel 2까지의 N1(TNI)의 절대잠복기와 LP1-TN1` 의 파간잠복기를 알아내기 위해서 실시하였다. 이번 실험에서 LPI, LNI, TPI, TNI의 절대잠복기 (absolute latency)의 평균값은 2.69$\pm$0.31 msec, 4.91$\pm$0.49m/sec, 4.64$\pm$0.39 msec, 5.21$\pm$0.42 msec 띠었다. LP1과 TN1 사이의 파간절대잠복기의 핑균값은 2.52$\pm$7.19 msec 이었다. 측정 치들을 속도로 변환하였을 경우 다음과 같았다. 측, LPI, LNI. Tfl, TNI 그리고 LP1-TN1 에서의 속도의 평균값은 각각 93.11$\pm$ 8.58 m/sec, 50.99$\pm$ 5.36m/sec. 80.18$\pm$ sec, 71.31$\pm$4.79m/sec그리고 49.50$\pm$3.58m/sec 이었고. 71.66m/sec, 37.79m/sec, 65.75m/ sec, 59.33 m/sec, 40.55m/sec 의 최저속도를 초과하였을 때 정상범위로 간주하였다. LPI, LNI, TPI,TN1까지의 절대잠복기와 자극전극에 시 측정전극가지의 거리 사이에는 상관관계가 있었다 LP1, LN1, TP1, TN1의 상관계수는 각각 0.621, 0.494. 0.577,0.618 이었다 요추에서 기록된 SEPs갈은 LP1의 상관계수가 LN1 보다 높았으며 흉추에서 기록된 SEPs값은 TN1의 상관계수가 TP1보다 높았다. LP1과 TN1의 파간잠복기와 channel 1과 2의 거리차이와의 상관계수는 0.571이다. 따라서 LPI, LNI. TPI, TNI그리고 LPI-TNI 들의 최저속도를 이용 하여 척수 손상 여부를 판단할 수 있다고 생각된다.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup2
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• pp.281-288
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• 2001

Objectives : The purpose of this study is to evaluate the usefulness of SSEP monitoring during intracranial aneurysm surgery and compare the characteristics of wave change in relation to neurologic changes between ACA aneurysms and MCA aneurysms. Methods : During recent three years(between January 1997 and November 1999), intraoperative SSEP monitoring had been done in 63 operations for intracranial aneurysms. We had monitored the median nerve SSEP during surgery for aneurysms of MCA and the posterior tibial nerve SSEP for aneurysms of ACoA or ACA. A more than 50% reduction of any cortical SEP response was considered to be a significant SEP change, compared to its baseline value before the start of surgery. Changes in the SEPs were categorized as follows : Type IA, no significant amplitude changes without temporary clipping ; Type IB, no significant amplitude changes with temporary clipping ; Type II, significant changes with temporary clipping and complete return to control amplitude ; Type III, significant changes with temporary clipping and incomplete return to control amplitude ; Type IV, significant changes with temporary clipping and more decreased amplitude changes. Results : Among the 63 intraoperative monitoring, there were 37 cases of ACA aneurysms(An), and 26 of MCA An. The temporary proximal arterial occlusion during surgery were performed in 31(83.8%)cases of ACA An, 22(84.6%) of MCA An. Seven of the 31 ACA An(22.6%) and ten of the 22 MCA An(45.5%) had significant changes. The type were as follows : 4 patients with type II and 3 with type III in the ACA An ; 3 patients with type II and 3 with type III and 4 with type IV in the MCA An. In both group type II changes had no new postoperative neurological deficit. All 6 patients with type III had new neurological deficits ; However, One case in the ACA An and two cases in the MCA An. had transient neurologic deficit and improved markedly over the next two months. All 4 type IV changes in the MCA An. had permanant neurologic deficits. Two out of 30 cases(6.7%) in the ACA An. and one out of 16 cases(6.3%) in the MCA An. without significant amplitude change had new neurologic deficit postoperatively. Conclusion : Based on this study, Intraoperative SSEP monitoring during aneurysm surgery would provide useful information for detecting cerebral ischemia. SSEP response during surgery for MCA An. is more sensitive than ACA An. Otherwise, there were no meaningful difference in rate of false negativity.

• Journal of Korean Orthopaedic Sports Medicine
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• v.1 no.1
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• pp.21-25
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• 2002

Purpose: To evaluate the clinical results after anterior cruciate ligament (ACL) reconstruction with hamstring tendon and Ligament Anchor (LA) screw, which is newly designed for fixation of graft into femur. Materials and Methods: Fifty eight patients who were followed up at least more than 2 years after ACL reconstruction with four strands of Hamstring tendon and LA screw were included in this study. The graft was fixed with LA screw at femoral tunnel and with only bioabsorbable interference screw at tibial tunnel. The mean follow-up period was 28 months. The clinical results were evaluated by physical examination and Lysholm knee score. Widening of bony tunnel and anterior laxity difference compared with normal side by instrumented anterior laxity test with Telos(R) (Telos stress device; Austin & Associates, Inc., Polston, US) were evaluated. Results: The Lysholm knee score improved from 60.0 points preoperatively to 94.0 points at last follow up. On the Lachman test, there were mild (+) instability in 16 cases, moderate (++) in 24,severe (+++) in 18 preoperatively. 50 cases were converted to negative and 8 to mild instability at postoperative follow up. On instrumented anterior laxity test with Telos(R), difference between normal and affected knee on 20 lb was 12.9 mm in average preoperatively, and was decreased to 3.1mm at last follow-up. The femoral tunnel was widened from 10.6 mm postoperatively to 12.7 mm (21.1$\%$) at follow up on antero-posterior plane and from 10.7 mm to 12.4 mm (16.5$\%$) on lateral plane. Tibial tunnels was also widened from 9.8mm to 11.8mm (20.7$\%$) on antero-posterior plane and from 9.9mm to 11.7 mm ($18.9\%$) on lateral plane. Complications were: anterior knee crepitus in 17 case, quadriceps muscle atrophy(>3 cm) in 6, penetration of screw over the lateral femoral cortex in 5, saphenous nerve paresthesia in 2.Conclusions: ACL reconstruction with hamstring tendon and LA screw was one of the choice of grafts and fixation devices in restoring knee stability and in improving clinical results with little complications such as excessive widening of bony tunnel and anterior knee pain