• The Korean Journal of Pain
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• v.37 no.3
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• pp.201-210
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• 2024

The application of ultrasound (US) in pain medicine has been a rapidly growing field since the 2000s. Musculoskeletal injections, peripheral nerve blocks, and neuraxial injections under US guidance have been acknowledged for managing chronic pain. Although many studies on US-guided pain procedures have been published, there needs to be a classification system to evaluate which image device, the US or fluoroscopy, is clinically and technically better in various pain interventions. Therefore, this narrative review introduces the classification system for the US-guided pain procedures according to their clinical and technical outcomes and designates US-guided pain procedures into one of the four categories by reviewing previous prospective randomized comparative trials.

• Journal of Acupuncture Research
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• v.36 no.4
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• pp.272-276
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• 2019

Background: The purpose of this study was to assess the accuracy and safety of procedures using ultrasound equipment for acupuncture treatment. Methods: A pilot, prospective randomized, single blinded, crossover clinical study on the accuracy and safety of ultrasound-guided Gyeontonghyeol (BP-LE6) acupuncture treatment was conducted. Patients (n = 13) with shoulder pain were randomly divided into 2 groups. During Visit 1, ultrasound-guided BP-LE6 acupuncture was administered to the experimental group. In the control group, patients received BP-LE6 acupuncture (without checking ultrasound images) by manipulating the ultrasound probe as if administering ultrasound-guided acupuncture. Visit 2 was arranged within 7-14 days and the remaining procedures, other than those administered in Visit 1, were performed. In both the experimental group and control group, the number of needle insertions, and time required for the treatment to result in the patients feeling de-qi was recorded. The numeric rating scale (NRS) score for shoulder pain was recorded before and after the acupuncture treatment. Results: The number of needle insertions was $5.31{\pm}3.50$ times in the experimental group, and $6.62{\pm}3.38$ times in the control group, however, there was no statistically significant difference between the groups (p > 0.05). The mean time required to perform the procedure was $151.54{\pm}48.59$ seconds in the experimental group and $86.69{\pm}37.17$ seconds in the control group, which was statistically significantly different (p < 0.05). The changes observed in numerical rating scale scores between groups were not statistically significantly different. Conclusion: Although there was no statistically significant difference, administering acupuncture using ultrasound guidance may lead to accurate needling with a reduced number of needle insertion attempts. A large-scale clinical study of better design should be conducted in the future.

• Journal of Korean Neurosurgical Society
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• v.39 no.1
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• pp.61-63
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• 2006

We report a unique case of a neonate with an epidural hematoma induced by vacuum extraction. The epidural hematoma, communicating with a cephalhematoma through a linear skull fracture, disappeared after ultrasound-guided needle aspiration. The patient quickly recovered and one month later computed tomography revealed a complete resolution of the epidural hematoma.

• The Korean Journal of Pain
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• v.21 no.3
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• pp.224-228
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• 2008

Ulnar nerve compression in the cubital tunnel is a common entrapment syndrome of the upper limb. Pulsed radiofrequency lesioning (PRFL) has been reported as a treatment method for relieving neuropathic pain. Since the placement of the electrode in close proximity to a targeted nerve is very important for the success of PRFL, ultrasound seems to be well suited for this technique. A 36-year-old woman presented with complaints of numbness and pain on the medial aspect of the elbow and the pain radiated down to the $4^{th}$ and $5^{th}$ fingers for 10 years after she suffered an elbow contusion, we then scheduled this woman for the ultrasound guided PRFL of the ulanr nerve. The initial ultrasound examination demonstrated a swollen nerve, loss of the fascicular pattern and an increased cross sectional area of the ulnar nerve. After confirmation of the most swollen site of the nerve via ultrasound, two sessions of PRFL were performed. The postprocedural 10 cm visual analog scale score decreased from 8 to 1 after the two sessions of PRFL.

• Journal of Korean Medical Science
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• v.33 no.44
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• pp.279.1-279.16
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• 2018

Magnetic resonance-guided focused ultrasound (MRgFUS) is a new emerging neurosurgical procedure applied in a wide range of clinical fields. It can generate high-intensity energy at the focal zone in deep body areas without requiring incision of soft tissues. Although the effectiveness of the focused ultrasound technique had not been recognized because of the skull being a main barrier in the transmission of acoustic energy, the development of hemispheric distribution of ultrasound transducer phased arrays has solved this issue and enabled the performance of true transcranial procedures. Advanced imaging technologies such as magnetic resonance thermometry could enhance the safety of MRgFUS. The current clinical applications of MRgFUS in neurosurgery involve stereotactic ablative treatments for patients with essential tremor, Parkinson's disease, obsessive-compulsive disorder, major depressive disorder, or neuropathic pain. Other potential treatment candidates being examined in ongoing clinical trials include brain tumors, Alzheimer's disease, and epilepsy, based on MRgFUS abilities of thermal ablation and opening the blood-brain barrier. With the development of ultrasound technology to overcome the limitations, MRgFUS is gradually expanding the therapeutic field for intractable neurological disorders and serving as a trail for a promising future in noninvasive and safe neurosurgical care.

• Journal of Korean Neurosurgical Society
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• v.62 no.1
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• pp.10-26
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• 2019

Magnetic resonance-guided focused ultrasound (MRgFUS) is an emerging new technology with considerable potential to treat various neurological diseases. With refinement of ultrasound transducer technology and integration with magnetic resonance imaging guidance, transcranial sonication of precise cerebral targets has become a therapeutic option. Intensity is a key determinant of ultrasound effects. High-intensity focused ultrasound can produce targeted lesions via thermal ablation of tissue. MRgFUS-mediated stereotactic ablation is non-invasive, incision-free, and confers immediate therapeutic effects. Since the US Food and Drug Administration approval of MRgFUS in 2016 for unilateral thalamotomy in medication-refractory essential tremor, studies on novel indications such as Parkinson's disease, psychiatric disease, and brain tumors are underway. MRgFUS is also used in the context of blood-brain barrier (BBB) opening at low intensities, in combination with intravenously-administered microbubbles. Preclinical studies show that MRgFUS-mediated BBB opening safely enhances the delivery of targeted chemotherapeutic agents to the brain and improves tumor control as well as survival. In addition, BBB opening has been shown to activate the innate immune system in animal models of Alzheimer's disease. Amyloid plaque clearance and promotion of neurogenesis in these studies suggest that MRgFUS-mediated BBB opening may be a new paradigm for neurodegenerative disease treatment in the future. Here, we review the current status of preclinical and clinical trials of MRgFUS-mediated thermal ablation and BBB opening, described their mechanisms of action, and discuss future prospects.

• Journal of Acupuncture Research
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• v.41 no.2
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• pp.135-141
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• 2024

The use of ultrasound (US)-guided interventions has rapidly increased in Korean medicine (KM) to ensure the safety and accuracy of invasive procedures, such as pharmacopuncture and acupotomy. Although hands-on training is important for the acquisition of skills, it requires considerable time and cost. A detailed guide on the procedure and treatment regions is needed to ensure hygiene and safety during US-guided procedures in KM practice. In this study, we present the overall procedure, target structures, and treatment approaches of US-guided pharmacopuncture and acupotomy for nerve entrapment in the upper extremities of the cubital and radial tunnel, posterior interosseous nerve, carpal tunnel, and Guyon's canal syndrome. We believe that the findings of our study will serve as a foundation for future clinical research, practice, and education on US-guided KM procedures. Further research involving US-guided interventions should specify target structures in three-dimension to delineate the treatment areas.

• Journal of Embryo Transfer
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• v.14 no.2
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• pp.121-129
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• 1999

The objective of this study was to produce calves by transfer of embryos derived from slaughter house(SHD) and ultrasound-guided ovum pick-up (OPU). At 60 hrs after injection of 400 mg FSH dissolved in 25% polyvinylpyrrolidone(PVP) by single dose, ultrasound-guided follicular oocyte aspiration was ferformed. Day-7 and day-8 blastocysts produced by in vitro maturation (IVM), fertilization (IVF) and culture(IVC) of the oocytes derived from SHD and OPU were nonsurgically transferred into recipients. The results obtained were as follows. The cleavage rate and the development rate to blastocysts were not significantly (P<0.05) different between the oocytes obtained by SHD (72.9% vs. 34.1%) and OPU (75.9% vs. 38.4%). The oocyte recovery rate from the number of follicles by ultrasound-guided aspiration were not significantly (P<0.05) different between Holstein (61.7%) and Hanwoo (60.1%), but the rate of oocytes useful for IVF was significantly (P<0.05) higher in Hanwoo (69.3%) than Holstein (59.6%). The cleavage rate and the development rate to blastocysts was not significantly (P<0.05) different between Holstein (74.9% vs. 39.2%) and recipients on day 8 of estrus cycle resulted in 13 pregnancies (34.2%). One of them was sacrificed during gestation period due to mastitis and another was aborted spontaneous. The resulting 14 calves were morphologically normal at birth. Seventy eight fresh OPU-IVF embryos were transferred into 21 recipients on day 8 of estrus cycles, resulting in pregnancy of 12 recipients (41.4%). Two of them were sacrificed during gestation period due to mastitis and the other two were aborted. Nevertheless, the 11 OPU-calves have been born normally.

• The Korean Journal of Pain
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• v.35 no.2
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• pp.183-190
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• 2022

Background: To compare ultrasound-guided pulsed radiofrequency (PRF) of the genicular nerve with the genicular nerve block using local anesthetic and steroid for management of osteoarthritis (OA) knee pain. Methods: Thirty patients with OA knee were randomly allocated to receive either ultrasound-guided PRF of the genicular nerve (PRF group) or nerve block with bupivacaine and methylprednisolone acetate (local anesthetic steroid [LAS] group). Verbal numeric rating scale (VNRS) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) scores were measured at pre-procedure and 1-, 4-, and 12-weeks post-procedure. Results: VNRS scores decreased significantly (P < 0.001) in both the groups at 12 weeks and other follow up times compared to baseline. Seventy-three percent of patients in the PRF group and 66% in the LAS group achieved effective pain relief (≥ 50% pain reduction) at 12 weeks (P > 0.999). There was also a statistically significant (P < 0.001) improvement in WOMAC scores in both groups at all follow up times. However, there was no intergroup difference in VNRS (P = 0.893) and WOMAC scores (P = 0.983). No complications were reported. Conclusions: Both ultrasound-guided PRF of the genicular nerve and blocks of genicular nerve with local anesthetic and a steroid provided comparable pain relief without any complications. However, PRF of the genicular nerve is a procedure that takes much more time and equipment than the genicular nerve block.

• Journal of Korean Medicine Rehabilitation
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• v.32 no.3
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• pp.109-117
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• 2022

Objectives To compare the therapeutic effect of ultrasound guided soyeom pharmacopuncture therapy and unguided soyeom pharmacopuncture therapy on cervical facet joint of patient who have cervical pain caused by traffic accidents. Methods The study was planned as a retrospective study that analyzes the patient's medical records. We analyzed medical records of 20 patients with acute cervical pain caused by traffic accidents from April 1, 2022 to May 31, 2022. 10 patients (Group A) were treated ultrasound guided soyeom pharmacopuncture therapy on cervical facet joint, 10 patients (Group B) were treated unguided soyeom pharmacopuncture therapy on cervical facet joint. We used visual analogue scale (VAS) and neck disability index (NDI) to evaluate improvements in cervical functions and pain, five point Likert scale to estimate patient's satisfaction. We used the IBM SPSS Statistics version 25 program (IBM Co., Armonk, NY, USA) for statistical analysis. Results Group A showed a significant decrease in the VAS on the 5^th day of the soyeom pharmacopuncture therapy (p=0.001). However, there was no statistically significant difference of VAS between two groups (p=0.142). Group A showed significant decrease in the NDI on the 5^th day of the therapy (p=0.002). Also, there was statistically significant difference on NDI between two groups (p=0.018). Difference of five point Likert scale between two groups was not statistically significant (p=0.407). Conclusions In patients of acute cervical pain caused by traffic accidents, ultrasound guided soyeom pharmacopuncture therapy on cervical facet joint showed significant efficacy on reduction of neck disability compared with unguided therapy.