• The Korean Journal of Pain
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• 제34권4호
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• pp.437-446
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• 2021

Background: Non-invasive painless signaling therapy (NPST) is an electro-cutaneous treatment that converts endogenous pain information into synthetic non-pain information. This study explored whether pain improvement by NPST in failed back surgery syndrome (FBSS) patients is related to cerebral modulation. Methods: Electroencephalography (EEG) analysis was performed in 11 patients with FBSS. Subjects received daily NPST for 5 days. Before the first treatment, patients completed the Brief Pain Inventory (BPI) and Beck Depression Inventory and underwent baseline EEG. After the final treatment, they responded again to the BPI, reported the percent pain improvement (PPI), and then underwent post-treatment EEG. If the PPI grade was zero, they were assigned to the ineffective group, while all others were assigned to the effective group. We used standardized low-resolution brain electromagnetic tomography (sLORETA) to explore the EEG current-source distribution (CSD) associated with pain improvement by NPST. Results: The 11 participants had a median age of 67.0 years, and 63.6% were female. The sLORETA images revealed a beta-2 CSD increment in 12 voxels of the right anterior cingulate gyrus (ACG) and the right medial frontal area. The point of maximal CSD changes was in the right ACG. The alpha band CSD increased in 2 voxels of the left transverse gyrus. Conclusions: Pain improvement by NPST in FBSS patients was associated with increased cerebral activity, mainly in the right ACG. The change in afferent information induced by NPST seems to be associated with cerebral pain perception.

• Journal of Chest Surgery
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• 제29권8호
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• pp.836-843
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• 1996

본 연세대학교 의과대학 흉부외과학 교실에서는 1985년 부터 1992년까지 청색성 선천성 심장기형환자에서 시행한 체 폐동맥 단락술에 사용되 었던 PTFE (polytetrafluoroethylene) 인조 혈관을 재수술시 절 제하여 꽝학 현미경 및 전자 현미경으로 관찰하였다. 체폐 동맥 단락술의 종류는 Blalock-Taussig형 10 례. Waterstone-Cooley형 1례, Pott 형 1례등이었다. 사용된 PTFE 인조 혈관의 크기는 5mm가 10개, 4mm가 1개, 6mm가 1개였다 이들의 평균 사용 시간은 31개월(12개월에서 55개월)이었다. 10개월에서 20개월사이의 PTFE 인조 혈관은 틈새에 매우 많은 혈소판이 끼어 있었고 내막 비후가 관찰되었다. 40 개월이상 기능을 하는 PTFE 인조 혈관에서는 혈관 내피 세포가 광학 및 전자 현미경으로 관찰되었다. 막힌 PTFE 인조 혈관의 내면은 매우 심한 내막 비후와 혈전으로 차 있었다. 이와 같은 우리의 경험을 토대로 PTFE인조 혈관과 자신의 혈관이 연결되는 부위에 결체조직이 잘붙어 혈관내피세포가 덮을수 있게 된다면 혈소판의 응집을 막아 오랫동안 기능을 유지할 수 있을 것으로 생각된다.

• Journal of Chest Surgery
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• 제29권1호
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• pp.7-13
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• 1996

The conventional glutaraldehyde (GA) fixation method of tissue valves is considered to be responsible for accelerated valve degeneration. The release of toxic GA from the valve tissue is believed to limit endothelial cell (EC) ingrowth. Removal of toxic GA by reaction with L-glutamic acid and storage in a Paraben solution may offer good EC growth. To investigate the conditions for endothelialization of tissue valves, the growth properties of ECs on the conventionally and alternatively treated pericardial tissue were compared. Conventional preparation included zero-pressure fixation for 72 hours in phosphated-buffered saline (PBS) solution containing 0.5% GA at 4$^{\circ}C$ and storage into PBS containing 0.2% GA(group I). Alternatively treated pericardial tissues were divided into three postfixation treatment groups : (1) storage in PBS solution containing Paraben(group II), (2) treatment with PBS containing 8$^{\circ}C$ L-glutamic acid(PH 7.35) and storage in PBS solution containing Paraben (g oup III), (3) treatment with L-glutamic acid dissolved in distilled water (PH 3.5) (group IV). Pericardial tissue were transferred into the 24-well plate after storage for 4 weeks. ECs were harvested enzymatically from the bovine pulmonary artery and grown to confluence on culture flask surfaces. Detached ECs by trypsin were incubated into the each well of the 24-well plate including test pericardial tissues. Cells were detached by trypsin, 1, 2, 3, 5, 7 days after incubation and counted on the hemacytometer. Cell viability test was performed by frypan-blue exclusion method. Acute cell death in the group I were found even after prolonged washing. The group II showed prolonged cell survival compared with the group I. Both group III and group IV showed better cell growth than group II. There was no statistically significant difference between group III and group IV method in terms of EC growth. This results suggest that treatment by L-glutamic ac id and storage in a Paraben solution be a promising approach for improvement of durability of GA-treated tissue valves.

• Archives of Plastic Surgery
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• 제38권4호
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• pp.421-426
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• 2011

Purpose: Although the sural nerve is the most commonly used donor for autologous nerve graft, its morbidity after harvesting is sparsely investigated. The sural nerve being a sensory nerve, complications such as sensory changes in its area and neuroma can be expected. This study was designed to evaluate the donor site morbidity after sural nerve harvesting. Methods: Among the 13 cases, who underwent sural nerve harvesting between January 2004 and August 2009, 11 patients with proper follow up were included in the study. The collected data included harvested graft length, actual length of the grafted nerve, anesthetic and paresthetic area, presence of Tinel sign and symptomatic neuroma, and scar quality. Results: In 7 patients, no anesthetic area could be detected. Of the patients with a follow up period of more than 2 years, all the patients showed no anesthetic area except two cases who had a very small area of sensory deficit ($225mm^2$) on the lateral heel area, and large deficit ($4,500mm^2$) on the lateral foot aspect. The patients with a short follow up period (1~2 m) demonstrated a large anesthetic skin area ($6.760mm^2$, $12,500mm^2$). Only one patient had a Tinel sign. This patient also showed a subcutaneous neuroma, which was visible, but did not complain of discomfort during daily activities. One patient had a hypertrophic scar in the retromalleolar area, whereas the two other scars on the calf were invisible. Conclusion: After a period of 2 years the size of anesthetic skin in the lateral retromalleolar area is nearly zero. It is hypothesized that the size of sensory skin deficit may be large immediately after the operation. This area decreases over time so that after 2 years the patient does not feel any discomfort from nerve harvesting.

• Journal of Dental Anesthesia and Pain Medicine
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• 제22권3호
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• pp.217-226
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• 2022

Background: Intraosseous anesthesia is the process by which an anesthetic solution, after penetration of the cortical bone, is directly injected into the spongiosa of the alveolar bone supporting the tooth. This study aimed to compare the effectiveness of the traditional inferior alveolar nerve block (IANB) and computerized intraosseous anesthesia in the surgical extraction of impacted lower third molars, compare their side effects systemically by monitoring heart rate, and assess patients' a posteriori preference of one technique over the other. Methods: Thirty-nine patients with bilaterally impacted third molars participated in this study. Each patient in the sample was both a case and control, where the conventional technique was randomly assigned to one side (group 1) and the alternative method to the contralateral side (group 2). Results: The traditional technique was faster in execution than anesthesia delivered via electronic syringe, which took 3 min to be administered. However, it was necessary to wait for an average of 6 ± 4 min from the execution to achieve the onset of IANB, while the latency of intraosseous anesthesia was zero. Vincent's sign and lingual nerve anesthesia occurred in 100% of cases in group 1. In group 2, Vincent's sign was recorded in 13% of cases and lingual anesthesia in four cases. The average duration of the perceived anesthetic effect was 192 ± 68 min in group 1 and 127 ± 75 min in group 2 (P < 0.001). The difference between the heart rate of group 1 and group 2 was statistically significant. During infiltration in group 1, heartbeat frequency increased by 5 ± 13 beats per minute, while in group 2, it increased by 22 ± 10 beats per minute (P < 0.001). No postoperative complications were reported for either technique. Patients showed a preference of 67% for the alternative technique and 20% for the traditional, and 13% of patients were indifferent. Conclusion: The results identified intraosseous anesthesia as a valid alternative to conventional anesthesia in impacted lower third molar extraction.

• Asian Pacific Journal of Cancer Prevention
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• 제15권10호
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• pp.4211-4215
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• 2014

Background: Although roles of genetic polymorphisms of leptin receptor (LEPR) gene in several cancers have been documented, the association between polymorphisms of LEPR and clear cell renal cell carcinoma (CC-RCC) remains unknown. The aim of this study was to explore any relation. Materials and Methods: The study population consisted of 77 patients with CC-RCC and 161 healthy control subjects. Polymorphism analyses of Lys109Arg and Gln223Arg were performed by direct DNA sequencing and PCR-restriction fragment length polymorphism approaches respectively. Results: Comparisons of allelic and genotypic frequencies in Lys109Arg and Gln223Arg showed no significant difference between the cases and controls. However, when evaluating the combined genotype of Lys109Arg and Gln223Arg, risk with GG/GG was increased (OR=1.85, 95%CI=1.04-3.30) and with GA/GG or GG/GA was decreased (OR=0.07, 95%CI=0.01-0.54; OR and 95%CI of the latter could not be calculated for a value of zero). Furthermore, the G-G haplotype frequency of Lys109Arg and Gln223Arg in the cases was higher (OR=1.68; 95%CI=1.02-2.76). In contrast, the A-G and G-A haplotype frequencies in the cases were lower than those in the controls (OR=0.06; 95%CI=0.01 to 0.47; OR and 95%CI of the latter could not be calculated for a value of zero). In addition, the Lys109Arg A allele was in LD with the Gln223Arg A allele (d'=0.9399) in the CC-RCC subjects, but not in the controls. Conclusions: Our data suggest that the GG/GG combined genotype and G-G haplotype of Lys109Arg and Gln223Arg can act as evaluating factors for CC-RCC risk.

• Journal of Dental Anesthesia and Pain Medicine
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• 제20권3호
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• pp.129-135
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• 2020

Background: Postoperative fluid retention is a factor that causes delay in recovery and unexpected adverse events. It is important to prevent intraoperative fluid retention, which is putatively caused by intraoperative release of stress hormones, such as ADH (anti-diuretic hormone) or others. We hypothesized that intraoperative analgesia may prevent pathological fluid retention. We retrospectively explored the relationship between analgesics and in-out balance in surgical patients from anesthesia records. Methods: Anesthetic records of 80 patients who had undergone orthognathic surgery were checked in this study. Patients were anesthetized with either TIVA (propofol and remifentanil) or inhalational anesthesia (sevoflurane and remifentanil). During surgery, acetated Ringer's solution was infused for maintenance at a rate of 3-5 ml/kg/h at the discretion of the anesthetist. The perioperative parameters, including the amount of crystalloid and colloid infused, and the amount of urine and bleeding were checked. Furthermore, we checked the amount and administration rate of remifentanil during the surgical procedure. The correlation coefficient between the remifentanil dose and the in-out balance or the urinary output was analyzed using the Pearson correlation coefficient. The contributing factor to fluid retention, including urinary output, was statistically examined by means of multivariate logistic regression analysis. Results: A significant positive correlation was found between remifentanil dose and urinary output. Urinary output less than 0.04 ml/kg/min was suggested to cause positive fluid balance. Although in-out balance approaches zero balance with increase in remifentanil administration rate, no contributing factor for near-zero fluid balance was statistically picked up. The remifentanil administration rate was statistically picked up as the significant factor for higher urinary output (> 0.04 ml/kg/min) (OR, 2,644; 95% CI, 3.2-2.2 × 10⁶) among perioperative parameters. Conclusions: In conclusion, remifentanil contributes in maintaining the urinary output during general anesthesia. Although further prospective study is needed to confirm this hypothesis, it was suggested that fluid retention could be avoided through suppressing intraoperative stress response by means of appropriate maintenance of remifentanil infusion rate.

• Advances in biomechanics and applications
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• 제1권3호
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• pp.169-185
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• 2014

Computational multibody models of the elbow can provide a versatile tool to study joint mechanics, cartilage loading, ligament function and the effects of joint trauma and orthopaedic repair. An efficiently developed computational model can assist surgeons and other investigators in the design and evaluation of treatments for elbow injuries, and contribute to improvements in patient care. The purpose of this study was to develop an anatomically correct elbow joint model and validate the model against experimental data. The elbow model was constrained by multiple bundles of non-linear ligaments, three-dimensional deformable contacts between articulating geometries, and applied external loads. The developed anatomical computational models of the joint can then be incorporated into neuro-musculoskeletal models within a multibody framework. In the approach presented here, volume images of two cadaver elbows were generated by computed tomography (CT) and one elbow by magnetic resonance imaging (MRI) to construct the three-dimensional bone geometries for the model. The ligaments and triceps tendon were represented with non-linear spring-damper elements as a function of stiffness, ligament length and ligament zero-load length. Articular cartilage was represented as uniform thickness solids that allowed prediction of compliant contact forces. As a final step, the subject specific model was validated by comparing predicted kinematics and triceps tendon forces to experimentally obtained data of the identically loaded cadaver elbow. The maximum root mean square (RMS) error between the predicted and measured kinematics during the complete testing cycle was 4.9 mm medial-lateral translational of the radius relative to the humerus (for Specimen 2 in this study) and 5.30 internal-external rotation of the radius relative to the humerus (for Specimen 3 in this study). The maximum RMS error for triceps tendon force was 7.6 N (for Specimen 3).

• Journal of Chest Surgery
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• 제19권3호
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• pp.443-448
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• 1986

Aortic dissection is a serious disease that mortality does not approach to zero despite of medical and surgical improvement. Recently two cases of aortic dissection were treated with good results by the two other methods. Case 1 [57-Y-0-Male]; Chief complaint was chest pain radiating to the back. Preoperatively he was controlled by Minipress, dichlotride, & sodium nitroprusside. Aortography showed DeBakey Type III aortic dissection extending from just below the Lt. subclavian artery to the proximal portion of the origin of the renal artery. Through the midline long incision Flow reversal & Thrombo-exclusion method was used, and bypass course was proximal anastomosis at the ascending aorta - through the Rt. thoracic cavity - midportion of the diaphragm - posterior to the liver, stomach, & pancreas - distal anastomosis at the abdominal aorta proximal to its bifurcation. Bypass graft was preclotted 20 mm Dacron Woven Graft, and the aortic arch between the Lt. subclavian artery & Lt. common carotid artery was divided and meticulously sutured. Control aortogram which was done at 4th postoperative month revealed obstruction of the false lumen by thrombosis, and complications were not noticed. Case 2 [53-Y-0-Male]; Chief complaint was chest pain radiating to the abdomen. DeBakey Type III aortic dissection which was similar to the case 1 was detected by the aortography, and involvement of the Lt. subclavian & common carotid arteries was suspicious. Through the Lt. posterolateral thoracotomy the Ringed Intraluminal Sutureless Graft, No. 22 mm, was inserted from just below the Lt. common carotid artery to the midportion of the descending thoracic aorta under total circulation arrest using a F-F bypass, and the Lt. subclavian artery was ligated. Postoperatively hospital course was uneventful with antihypertensive drugs, and any specific complications were not noticed.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제20권1호
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• pp.55-60
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• 2017

Intestinal hypoganglionosis is a rare innervation disorder that provides numerous nutritional, medical and surgical challenges. In this case report, we present a case of a newborn with intestinal hypoganglionosis leading to intestinal failure and intestinal failure-associated liver disease who responded to $Omegaven^{TM}$, a fat emulsion comprised of omega-3 fatty acids. $Omegaven^{TM}$ has been shown to be beneficial in the management of cholestatic liver injury. Clinical success with $Omegaven^{TM}$ was seen in this patient with a clear decrease in aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and complete resolution of cholestasis with a direct bilirubin of zero within two weeks of initiation of $Omegaven^{TM}$. No current guidelines for the diagnosis and management of hypoganglionosis are available. We recommend a multidisciplinary approach and the use of novel therapies such as fat emulsions composed of omega-3 fatty acids for improved patient outcomes. Appropriate compassionate use protocols should be obtained from the Food and Drug Administration prior to initiation of $Omegaven^{TM}$.