• 제목/요약/키워드: phrenic nerve

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악성 흉선종 절제술 중의 성공적인 횡격막 신경 직접 재건술 (A Successful Direct Phrenic Nerve Reconstruction in the Course of Malignant Thymoma Resection)

  • 이성광;김연수;박경택;장우익;류지윤;김창영;조성준;최현민
    • Journal of Chest Surgery
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    • 제42권3호
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    • pp.401-403
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    • 2009
  • 63세 여자 환자의 악성 흉선종 절제수술 시에 횡격막 신경의 절제 및 복원술이 시행되었다. 수술 소견상 좌측 횡격막 신경이 2 cm정도의 길이로 종양에 완전히 둘러싸여 있어서 위아래로 5 mm 길이의 여유를 두고 3 cm정도의 횡격막 신경을 절제하였으며 직접 단단 문합 하였다. 수술 후 11개월에 시행한 투시진단에서 양측 횡격막은 적절하고 대칭적인 움직임을 보임으로서 신경기능의 회복을 시사했다. 수술 후 30개월에 시행한 폐 기능 검사 결과는 수술 전의 소견과 유사하였다. 환자는 재발 없이 현재 외래 추적 관찰 중이다.

소아 심혈관 수술 후 발생한 횡격신경마비가 술후 호흡관리에 미치는 영향 (The Effect of Phrenic Nerve Paralysis After Pediatric Cardiac Surgery on Postoperative Respiratory Care)

  • 윤태진;이정렬
    • Journal of Chest Surgery
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    • 제29권10호
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    • pp.1118-1122
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    • 1996
  • 1990년 1월부터 1995년 12월가지 43명의 환아가 다양한 심혈관수술로 인해 유발된 횡격막 마비로횡 격막 습벽형성술을 시행 받았다. 환아의 평균연령은 11.1개월이었고, 남녀 비율은 31:12였다. 횡격막 마비의 원인이 된 수술로는 변형 Blalock-Taussig단락술 및 활로씨 4징증의 전교정술이 각각 7례로 가장 많았고, 기타 동맥 전환술 6례, 심실중격결손을 동반한 폐동맥 폐쇄증에서의 unifocalization 및 변형 Fontan수술, 심실중격결손 교정 등이 각각 3례씩이었다. 마비된 부위는 우측이 17례, 좌측이 23례, 양측성이 3례였으며, 원인은 대부분 과도한 심낭 절제 및 심낭 절개면 부위의 전기소작으로 추정되었다. 원인이 된 수술후 횡격막 습벽형성술까지의 기간은 수술 당일로부터 98일까지로 대부분 2주이내에 습 벽형성술이 이루어졌다 수술방법은 2례를 제외하고 모두 횡격막 신경분지를 피해서 횡격막을 접어주는 central pleating technique 이 적용되었다. 10명의 환아가 습벽형성술후 사망했으며(조기: 7, 만기: 3), 사망원인은 전례 에서 습벽 형성술과는 무관한 것으로 사료되 었다. 36명의 조기생존자들은 습벽 형성술후 1일에서 24일 사이에 양압호\ulcorner으로 부터 벗어날 수 있었다(평균 4.5일). 6명의 환아가 습벽 형성술후 8개 월에서 52개월 사이에 fluoroscopy를 시행하였으며, 대부분 횡격막의 위치 및 운동성이 양호하였다. 결 론적으로 불가역적인 횡격막 신경 손상이 없다면 횡격막 습벽형성술은 단기적으로는 환아의 양압호흡 의존기 간을 단축시키고 장기적으로는 횡격막 기능의 완전회복을 유도할 수 있다.

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개의 횡격막신경섬유(橫隔膜神經纖維)에 관(關)한 연구(硏究) 제(第)II보(報) 횡격막신경(橫隔膜神經)의 횡격막내분기(橫隔膜內分技)의 유수섬유(有髓纖維)에 관(關)하여 (Studies on the Phrenic Nerve Fibers in the dog II. On the Myelinated Fibers of the Intradiaphragmatic Branches)

  • 고광두;윤석봉;이준섭
    • 대한수의학회지
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    • 제9권1호
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    • pp.1-9
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    • 1969
  • The experimental studies were performed to observe the characteristics of the myelinated nerve fibers of the tradiaphragmatic branches of phrenic nerves in dog In the work to be reported five mixed breed Korean dog were used, they were one year old and he body eights were about 12 Kgm. in average with healthy conditions. The specimens (nerve) were taken at the point of 1.5 cm posterior part from the left and right phrenic nerves entrance to the diaphragm, and the dorso-lateral and dorso-medial branches of phrenic nerves vere also, taken at the point of 0.5 cm distal part from their branching portion. The specimens were fixed for 24 hrs. in Flemming's solution, and embedded in paraffin. The paraffin section. were cut at 6 microns and stained with Walter's modification of Weigert-pal method for the myelinated fibers. Microphotographs were taken and enlarged into 750 times of the actual size, and the diameter of the photographic images of the myelinated fibers were measured by the scale on the transparent Percepex Plate. The following conclusions were made: 1. The percentage of distribution of the several intradiaphragmatic branches of phrenic nerves were as follows. Ventral branches were 34.97%, lateral branches were 37.90%, dorsal branches were 27.13%, and the dorsal branches were branched again into dorso-lateral branches(54.22%) and dorso-medial branches (45. 78%). 2. The mean value and S.D. of the total numbers of the myelinated nerve fibers at the left ventral branches were $490.80{\pm}12$, and at the right ventral branches were $486.6{\pm}13$. Total average cross sectional area on the left ventral branches were 38,000. $6{\pm}136{\mu}^2$, and the right ventral branches were $37,150.2{\pm}1.782{\mu}^2$. 3. The mean value and S.D. of the total numbers of the myelinated nerve fibers at the left lateral branches were $533.8{\pm}8$, and at the right lateral branches were $525.6{\pm}7$. Total average cross sectional area of the left lateral branches were $41,582{\pm}1,170{\mu}^2$, and the right lateral branches were $40,454.8{\pm}812{\mu}^2$. 4. The mean value and S.D. of the total numbers of the myelinated nerve fibers at the left dorsal branches were $378.2{\pm}14$, and at the right dorsal branches were $380.2{\pm}8$. Total average cross sectional area of the left dorsal branches were $27,771{\pm}1,256{\mu}^2$, and the right dorsal branches were $27,507.2{\pm}645{\mu}^2$. 5. The mean value and S.D. of the total numbers of the myelinated fibers at the left dorso-lateral branches were $205.4{\pm}15$, and at the right dorso-lateral branches were $210.6{\pm}17$. Total average cross sectional area of the left dorso lateral branches were $15,354. 8{\pm}1,519{\mu}^2$, and the right dorsal branches were $15,887{\pm}1,297{\mu}^2$. 6. The mean value and S.D. of the total numbers of the myelinated nerve fibers at the left dorso-medial branches were $175{\pm}14$, and at the right dorso-medial branches were $176.2{\pm}17$. Total average cross sectional area of the left dorso-medial branches were $13,037.4{\pm}944{\mu}^2$, and at the right dorso-medial branches were, $13,103{\pm}1,373{\mu}^2$. 7. The highest frequent distribution of the intradiaphragmatic branches of phrenic nerves were found in the $10-12{\mu}^2$ groups, and they were almost 30% of the total groups. 8. The largest fibers diameter were in the $14-16{\mu}^2$ groups, and these were shown the lowest frequent distribution. 9. The largest cross sectional area of the intradiaphragmatic branches of phrenic nerves were found in the $10-12{\mu}^2$ groups. 10. All of the intradiaphragmatic branches of phrenic nerves were unimodal which has a peak in the $10-12{\mu}^2$ groups.

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Ultrasound-guided Pulsed Radiofrequency Lesioning of the Phrenic Nerve in a Patient with Intractable Hiccup

  • Kang, Keum-Nae;Park, In-Kyung;Suh, Jeong-Hun;Leem, Jeong-Gill;Shin, Jin-Woo
    • The Korean Journal of Pain
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    • 제23권3호
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    • pp.198-201
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    • 2010
  • Persistent and intractable hiccups (with respective durations of more than 48 hours and 1 month) can result in depression, fatigue, impaired sleep, dehydration, weight loss, malnutrition, and aspiration syndromes. The conventional treatments for hiccups are either non-pharmacological, pharmacological or a nerve block treatment. Pulsed radiofrequency lesioning (PRFL) has been proposed for the modulation of the excited nervous system pathway of pain as a safe and nondestructive treatment method. As placement of the electrode in close proximity to the targeted nerve is very important for the success of PRFL, ultrasound appears to be well suited for this technique. A 74-year-old man suffering from intractable hiccups that had developed after a coronary artery bypass graft and had continued for 7 years was referred to our pain clinic. He had not been treated with conventional methods or medications. We performed PRFL of the phrenic nerve guided by ultrasound and the hiccups disappeared.

슬관절 자극이 횡격신경 및 흡식중추신경에 미치는 영향 (Effect of Knee Joint Stimulation on the Activity of Phrenic Nerve and Inspiratory Nuron in the Cat)

  • 조동일;한희철;남숙현
    • Tuberculosis and Respiratory Diseases
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    • 제40권6호
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    • pp.683-693
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    • 1993
  • 연구배경 : 생체의 운동은 움직임 자체를 수행하기 위한 근육, 관절 및 이를 관장하는 신경계와 운동중 적절한 산소를 공급하기 위한 심혈관계 및 호흡계의 조절이 동반되는 매우 복잡한 기전에 의하여 유지되고 있다. 이들의 상호관련성을 밝히기 위하여 많은 연구들이 진행중이나 특히 관절과 호흡중추의 연계성에 대하여는 아직도 연구가 미진한 편이다. 이에 본 연구는 관절의 정상적인 움직임이 호흡계에 어떠한 영향을 미치는지를 규명하고자 $\alpha$-chloralose로 마취한 고양이의 분당 호흡수, 횡격신경과 흡식신경섬유의 변화를 관찰하였다. 방법 : 26마리의 성숙한 숫고양이에서 슬관절 자극중 횡격신경 및 흡식중추신경의 활동성을 기록하기 위하여 쌍극백금전극과 탄소섬유전극을 이용하여 세포외에서 기록하였다. 슬관절을 자극하기 위하여 슬관절의 굴곡-신전운동, 슬관절 동맥을 통한 화학적인 자극 및 슬관절 신경의 전기적인 자극법 등을 사용하였다. 결과 : 슬관절의 정상 운동각도내에서 120 Hz.의 빠른 운동을 1분간 시킨 경우에는 분당호흡수와 분당호흡신경활동이 유의하게 증가하였으며 3분간 운동을 시킨 경우에는 호흡수, 일회호흡신경활동 및 분당호흡신경활동이 모두 유의하게 증가하였다. 그러나 60Hz.의 운동에 대하여는 전체적인 호흡활동에 뚜렸한 변화가 없었다. 과격한 운동중에 형성되는 젖산의 혈중농도와 같은 농도의 젖산을 슬관절내에 주입한 결과 주입후 30초 동안에 호흡수 이외의 일회호흡신경활동과 분당 호흡신경 활동이 유의한 증가를 보였다. 또한 potassium chloride에 대하여는 젖산의 경우와 유사한 반응을 보였으나 반응기간이 짧았다. 구심성 신경중 I, II군만을 선택적으로 흥분시킬 수 있는 강도인 1V로 슬관적 신경을 자극한 경우 자극기간에 한하여 호흡수를 제외한 일회호흡신경활동 및 분당호흡신경활동이 유의한 증가를 보였다. 또한 구심성 신경을 모두 흥분시키는 강도인 20V 자극에 대하여는 호흡계의 전체적인 항진효과가 있었으며 1V 자극에 비하여 매우 큰 반응을 나타내었다. 흡식중추의 신경세포에서 기록한 결과 횡격신경에서 나타난 반응과 유사한 결과를 얻었다. 결론 : 슬관절 구심성 신경중 제 I, II 군 신경의 흥분에 의하여 호흡중추는 직접적으로 활성화될 수 있으며 이러한 효과는 운동중의 슬관절로부터 중추로 유입되는 정보의 양에 비례하여 증가하는 것으로 생각된다. 따라서 이러한 사실은 슬관절의 정상적인 움직임에 의해서도 생체의 호흡기능이 항진될 수 있다는 것을 시사하고 있다.

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Treatment of Lung Cancer-Related Intractable Hiccups Using Pulsed Radiofrequency: Clinical Experience

  • Cho, Suk Ju
    • Journal of Hospice and Palliative Care
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    • 제21권3호
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    • pp.104-107
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    • 2018
  • 딸꾹질은 대개의 경우에는 특별한 처치 없이도 고식적인 방법으로 멈추지만, 한 달 이상 지속되는 지속성 딸꾹질은 생명을 위협할 정도의 심각한 부작용을 초래한다. 특히 정확한 치료방법 또한 확립되어 있지 않고, 몇몇 보고에서 양측 횡격막 신경차단이 보고되어 있을 뿐이다. 56세 남환의 우측 횡격막을 침범한 말기폐암환자에서 발생한 난치성 지속성 딸꾹질에 대해 박동성 고주파술을 시행하여 좋은 치료 결과를 얻은 바, 문헌고찰과 함께 보고하고자 한다.

경부 경막외 신경차단을 이용한 2주간 계속된 딸꾹질의 치료 경험 -증례보고- (Cervical Epidural Block Can Relieve Persistent Hiccups -Case report-)

  • 이경진;박원선;전태완;김찬;남용택
    • The Korean Journal of Pain
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    • 제8권1호
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    • pp.131-134
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    • 1995
  • Hiccup is characterized by a myoclonus in the diaphragm, resulting in a sudden inspiration associated with an audible closure of the glottis. The reflex arc in hiccups comprises three pars: an afferent, a central and an efferent part. The afferent portion of the neural pathway of hiccup formation is composed of the vagus nerve, the phrenic nerve, and the sympathetic chain arising from T6 to T12. The hiccup center is localised in the brain stem and the efferent limb comprises phrenic pathways. All stimuli affecting the above mentioned reflex arc may produce hiccups. The pathogenesis of persistent hiccups is not known. Hiccup can present a symptom of a subphrenic abscess or gastric distention, and metabolic alterations may also cause hiccups. Numerous treatment modalities have been tried but with questionable success. We describe a patient whose persistant hiccups was treated successfully by a cervical epidural block.

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수축성 심막염에 대한 심막절제술 전후의 수술방법에 따른 혈역학적 비교 (Pre- and Postoperative Hemodynamic Studies in the Patients with Constrictive Pericarditis)

  • 조인택
    • Journal of Chest Surgery
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    • 제19권1호
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    • pp.68-74
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    • 1986
  • 15 patients with constrictive pericarditis who underwent interphrenic pericardiectomy from January, 1981 to April, 1983 and 11 patients who underwent radical pericardiectomy from May, 1983 to September, 1984 were compared to the clinical improvement and the results of pre- and postoperative cardiac catheterization. In the group of partial pericardiectomy the pericardium was removed anteriorly from the left phrenic nerve to the right phrenic nerve and in the group of radical pericardiectomy the pericardium was removed from almost entire surface of the heart including diaphragmatic surface and posterior wall of the left ventricle. The following results were obtained. 1. Both group of the patients showed marked symptomatic improvement early after operation. 2. The central venous pressure was decreased significantly after operation in both group of the patients. 3. The right atrial mean pressure and pulmonary arterial mean pressure decreased significantly after operation in both group of the patients and there was no significant difference in the amplitude of decrease between the two groups. 4. The right ventricular end-diastolic pressure and left ventricular end-diastolic pressure were decreased postoperatively in both group of the patients and the patients of the radical pericardiectomy showed more decrease than the patients of interphrenic pericardiectomy, and in the group of radical pericardiectomy the right and left ventricular end-diastolic pressure were normalized postoperatively but in the group of partial pericardiectomy they showed abnormally high pressure persistently. 5. The ejection fraction showed normal level pre- and postoperatively in both group of the patients.

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Sensory Inputs to Upper Cervical Spinal Neurons Projecting to Midbrain in Cats

  • Kim, Jong-Ho;Jeong, Han-Seong;Park, Jong-Seong;Kim, Jong-Keun;Park, Sah-Hoon
    • The Korean Journal of Physiology and Pharmacology
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    • 제2권1호
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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.

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Costoclavicular brachial plexus block reduces hemidiaphragmatic paralysis more than supraclavicular brachial plexus block: retrospective, propensity score matched cohort study

  • Oh, Chahyun;Noh, Chan;Eom, Hongsik;Lee, Sangmin;Park, Seyeon;Lee, Sunyeul;Shin, Yong Sup;Ko, Youngkwon;Chung, Woosuk;Hong, Boohwi
    • The Korean Journal of Pain
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    • 제33권2호
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    • pp.144-152
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    • 2020
  • Background: Hemidiaphragmatic paralysis, a frequent complication of the brachial plexus block performed above the clavicle, is rarely associated with an infraclavicular approach. The costoclavicular brachial plexus block is emerging as a promising infraclavicular approach. However, it may increase the risk of hemidiaphragmatic paralysis because the proximity to the phrenic nerve is greater than in the classical infraclavicular approach. Methods: This retrospective analysis compared the incidence of hemidiaphragmatic paralysis in patients undergoing costoclavicular and supraclavicular brachial plexus blocks. Of 315 patients who underwent brachial plexus block performed by a single anesthesiologist, 118 underwent costoclavicular, and 197 underwent supraclavicular brachial plexus block. Propensity score matching selected 118 pairs of patients. The primary outcome was the incidence of hemidiaphragmatic paralysis, defined as a postoperative elevation of the hemidiaphragm > 20 mm. Factors affecting the incidence of hemidiaphragmatic paralysis were also evaluated. Results: Hemidiaphragmatic paralysis was observed in three patients (2.5%) who underwent costoclavicular and 47 (39.8%) who underwent supraclavicular brachial plexus blocks (P < 0.001; odds ratio, 0.04; 95% confidence interval, 0.01-0.13). Both the brachial plexus block approach and the injected volume of local anesthetic were significantly associated with hemidiaphragmatic paralysis. Conclusions: The incidence of hemidiaphragmatic paralysis is significantly lower with costoclavicular than with supraclavicular brachial plexus block.