Efficacy of Systemic Postoperative Pulmonary Rehabilitation After Lung Resection Surgery

OBJECTIVE: To investigate the efficacy of systemic pulmonary rehabilitation (PR) after lung resection in patients with lung cancer. METHODS: Forty-one patients undergoing lung resection were enrolled and classified into the experimental (n=31) and control groups (n=10). The experimental group underwent post-operative systemic PR which was conducted 30 min/day on every hospitalization day by an expert physical therapist. The control group received the same education about the PR exercises and were encouraged to self-exercise without supervision of the physical therapist. The PR group was taught a self-PR program and feedback was provided regularly until 6 months after surgery. We conducted pulmonary function testing (PFT) and used a visual analog scale (VAS) to evaluate pain, and the modified Borg Dyspnea Scale (mBS) to measure perceived respiratory exertion shortly before and 2 weeks, 1, 3, and 6 months after surgery. RESULTS: A significant improvement on the VAS was observed in patients who received systemic PR >3 months. Significant improvements in forced vital capacity (FVC) and mBS score were observed in patients who received systemic PR >6 months (p<0.05). Other PFT results were not different compared with those in the control group. CONCLUSION: Patients who received lung resection suffered a significant decline in functional reserve and increases in pain and subjective dyspnea deteriorating quality of life (QoL). Systemic PR supervised by a therapist helped improve reduced pulmonary FVC and QoL and minimized discomfort during the postoperative periods in patients who underwent lung resection.

Histological Changes after Intradiscal Steroid Injection to the Intervertebral Disc in Disc Injury Rabbit Model

OBJECTIVE: To evaluate the degeneration changes of disc injury rabbit model produced by needle puncture to intervertebral disc and to observe the histological changes of the degenerated disc treated with intradiscal steroid. METHOD: The subjects were composed of 10 L4-5 intervertebral discs (study group) and 10 L3-4 intervertebral discs (control group) of Newzealand white rabbits. The rabbits' discs were exposed by anterior approach and degeneration was elicited by 21 G needle puncture. After 4 weeks, the study group was injected with 0.2 ml triamcinolone acetonide (Tamcetone 40 mg/ml) and the control group was injected with 0.2 ml normal saline, intradiscally. The discs were extracted on 4 weeks after degeneration and stained with Hematoxylin-Eosin and investigated by light microscopy. RESULTS: Degenerative changes, including fissuring and focal fibrosis, were elicited in the all groups, but there were no significant histological differences between the two groups. CONCLUSION: We concluded that the degenerative changes are well observed in disc injury rabbit model. The mollification of discogenic pain following intradiscal steroid injection in practice may not be explained from light microscopic histological changes of the disc. Further biochemical or electromicroscopic study will be necessary to clarify the mechanism of alleviation of discogenic pain by intradiscal steroid.

Hemispheric Asymmetry of Median Nerve Somatosensory Evoked Potential

OBJECTIVE: To elucidate interhemispheric asymmetry of the neural generators of somatosensory evoked potential (SEP). METHOD: Median nerve SEP was recorded over 5 sites of each hemisphere in 20 healthy subjects and 23 stroke patients. One electrode was placed over C3'/C4' (position B) and two electrodes were located 2 cm medial (position A) and lateral (position C) to position B, respectively. Additional two electrodes were positioned at 3 cm anterior (position F) and posterior (position P) to position B. The common reference electrode was placed at Fz. RESULTS: In healthy subjects, P22 was more frequently evoked than P27 in position F of the nondominant hemisphere and P27 in position P of the dominant hemisphere. In stroke subjects, fourteen patients demonstrated SEP waveforms over the affected hemisphere. In them, SEP amplitude significantly correlated with proprioception. However, distribution of the recording position showing significant correlation between SEP amplitude and proprioception was different according to dominancy of the affected hemisphere. CONCLUSION: P22 was more dominant in the nondominant hemisphere and P27 in the dominant hemisphere of normal group. Furthermore, clinical correlation of SEP amplitude was affected by the injured hemisphere dominancy in stroke group. These results demonstrate that asymmetry of neural generator distribution can be presumed.

Effect of Radiofrequency Lesioning on Peripheral Nerve Conductivity in Relation to Distance between Lesioning Electrode and Target Tissue in Rats

OBJECTIVE: To investigate neurophysiologic changes of peripheral nerves, which were injured by radiofrequency thermocoagulation and evaluate an effective distance between the lesioning electrode and target nerve tissue. METHOD: Thirty Sprague-Dawley rats were used and divided into three groups by the distance between the lesioning electrode and the sciatic nerve: 2 mm, 4 mm, 6 mm for each group (10 rats for each group). Radiofrequency lesioning was performed with 1.5 Volt, 1 MHz-frequency and 1 ms duration current for 90 sec. On the first and the fifth day after radiofrequency lesioning, latencies and amplitudes of compound muscle action potential were compared with the baseline values. RESULTS: No statistically significant latency change was observed on the first and the fifth day after lesioning. The amplitude was significantly reduced in group I and II on the first and the fifth day after lesioning, in contrast that, there was no significant change in the group III. CONCLUSION: There was significant decrement in the amplitude after effective radiofrequency lesioning to the sciatic nerve with the distance of 4 mm or less. However, changes of the latencies was not significant. It was suggested that effective distance between raidiofrequency lesioning electrode and target peripheral nerve was 4 mm or less.