Neurolytic abdominal wall blocks with alcohol for intractable gastrostomy site pain in a cancer patient -a case report- / 대한마취과학회지

Background@#There have been reports of neurolytic transversus abdominis plane (TAP) block using different agents such as alcohol or phenol for the treatment of chronic abdominal pain caused by malignant abdominal wall invasion. However, to date, there have been no reports on neurolytic abdominal wall blocks for pain with non-cancer-related origin in cancer patients. Case: We performed subcostal TAP neurolysis using ethanol in a patient with esophageal cancer with constant pain at the site of gastrostomy. After neurolysis, the patient’s overall pain decreased, with the exception of pain in the medial part of the gastrostomy site. We performed additional rectus sheath neurolysis using ethanol for the treatment of continuous pain at the medial site, and the effect of neurolysis has persisted for over 4 months. @*Conclusions@#Alcohol-based TAP neurolysis and rectus sheath neurolysis provide effective pain control in a cancer patient with chronic treatment-related pain involving the abdominal wall.

Therapeutic Effect of Microcurrent Therapy in Children With In-toeing Gait Caused by Increased Femoral Anteversion: A Pilot Study

OBJECTIVE: To investigate the efficacy of portable microcurrent therapy device (PMTD) of the hip internal rotators in the treatment of in-toeing gait caused by increased femoral anteversion in children over 8 years of age. METHODS: Eleven children (22 legs; 4 boys and 7 girls; mean age, 10.4±1.6 years) with in-toeing gait caused by increased femoral anteversion were included in the present study. All children received 60 minutes of PMTD (intensity, 25 µA; frequency, 8 Hz) applied to the hip internal rotators daily for 4 weeks. Hip internal rotation (IR) angle, external rotation (ER) angle, and midmalleolar-second toe angle (MSTA) measurement during stance phase at transverse plane and Family Satisfaction Questionnaire, frequency of tripping and fatigue like pains about the PMTD were performed before treatment and at 4 weeks after initial PMTD treatment. Paired t-test and Fisher exact test were used for statistical analysis. RESULTS: Hip IR/ER/MSTA was 70.3°±5.4°/20.1°±5.5°/–11.4°±2.7°, and 55.7°±7.8°/33.6°±8.2°/–2.6°±3.8° before treatment and at 4 weeks after initial PMTD treatment, respectively (p<0.01). Ten of 11 (91%) children's family stated that they were generally satisfied with the PMTD treatment. The frequency of tripping and fatigue like pains was significantly lower at 4 weeks after PMTD treatment (p<0.05). Excellent inter-rater and intra-rater reliability was observed for repeated MSTA measurements between the examiners (k=0.91–0.96 and k=0.93–0.99), respectively. CONCLUSION: PMTD of the hip internal rotators can be effective in improving the gait pattern of children with in-toeing gait caused by increased femoral anteversion.

Influence of Low Peak Respiratory Exchange Ratio on Cardiac Rehabilitation in Patients With Coronary Artery Disease

OBJECTIVE: To compare and analyze the effects of cardiac rehabilitation (CR) in two groups based on the peak respiratory exchange ratio (RER(peak)) 1.1 values using the exercise tolerance test (ETT) results, and to investigate the reasons for early termination of ETT. METHODS: Patients with acute coronary syndrome who participated in CR exercise training were selected and all subjects underwent 6 weeks of CR exercise training. ETT was performed on a treadmill using a Modified Bruce Protocol before and after CR exercise training. According to the result of the first ETT, the subjects were divided into two groups: those with an RER(peak)≥1.1 (n=33) and those with an RER(peak)<1.1 (n=22). We investigated the reasons for ETT termination and compared the effect of CR between the groups. RESULTS: The reasons for the early termination of the first ETT in the RER(peak)<1.1 group were subjective dyspnea, abnormal cardiovascular responses, leg fatigue and other problems. After a 6-week CR, the peak oxygen consumption (VO2(peak)) and ETT time increased, and the rate of perceived exertion (RPE) and RPP (rate pressure product) at stage 3 decreased in both the RER(peak)<1.1 and RER(peak)≥1.1 groups. CONCLUSION: CR exercise training improved exercise capacity, not only in the RER(peak)≥1.1 group, but also in the RER(peak)<1.1 group. This means that patients with a lower exercise tolerance could also benefit from the effects of CR. Thoughtful consideration to identify the direct and indirect causes for the early termination of ETT would be necessary to improve the efficiency of CR.

Percutaneous Adhesiolysis Versus Transforaminal Epidural Steroid Injection for the Treatment of Chronic Radicular Pain Caused by Lumbar Foraminal Spinal Stenosis: A Retrospective Comparative Study

OBJECTIVE: To investigate the efficacy of percutaneous adhesiolysis (PA) compared to fluoroscopy (FL)-guided transforaminal epidural steroid injection (TFESI) in patients with radicular pain caused by lumbar foraminal spinal stenosis (LFSS) by assessing pain relief and functional improvement at 4 and 12 weeks post-procedure. METHODS: This retrospective study included 45 patients who underwent PA or FL-guided TFSEI for radicular pain caused by LFSS of at least 3 months' duration. Outcomes were assessed with the Oswestry Disability Index (ODI) and Verbal Numeric Pain Scale (VNS) before the procedure and at 4 and 12 weeks post-procedure. A successful outcome was defined by >50% improvement in the VNS score and >40% improvement in the ODI score. RESULTS: ODI and VNS scores improved 4 and 12 weeks post-procedure in both groups. Statistically significant differences between groups were observed in ODI and VNS at 12 weeks (p<0.05). The proportion of patients with successful outcomes was significantly different between the two groups only at the 12-week time point. CONCLUSION: Our study suggests that PA is effective for pain reduction and functional improvement in patients with chronic radicular pain caused by LFSS. Therefore, PA can be considered for patients with previous ineffective responses to conservative treatment. Although PA seems to be more effective than TFEFI according to the results of our study, in order to fully elucidate the difference in effectiveness, a prospective study with a larger sample size is necessary.

The effect of combination treatment using palonosetron and dexamethasone for the prevention of postoperative nausea and vomiting versus dexamethasone alone in women receiving intravenous patient-controlled analgesia / 대한마취과학회지

BACKGROUND: The purpose of this study was to evaluate the effect of palonosetron combined with dexamethasone for the prevention of PONV compared to dexamethasone alone in women who received intravenous patient-controlled analgesia (IV-PCA) using fentanyl. METHODS: In this randomized, double-blinded, placebo-controlled study, 204 healthy female patients who were scheduled to undergo elective surgery under general anesthesia followed by IV-PCA for postoperative pain control were enrolled. Patients were divided into two groups: the PD group (palonosetron 0.075 mg and dexamethasone 5 mg IV; n = 102) and the D group (dexamethasone 5 mg IV; n = 102). The treatments were given after the induction of anesthesia. The incidence of nausea, vomiting, severity of nausea, and the use of rescue anti-emetics during the first 48 hours after surgery were evaluated. RESULTS: The incidence of PONV was significantly lower in the PD group compared with the D group during the 0-24 hours (43 vs. 59%) and 0-48 hours after surgery (45 vs. 63%) (P < 0.05). The severity of nausea during the 6-24 hours after surgery was significantly less in the PD group compared with the D group (P < 0.05). The incidence of rescue antiemetic used was significantly lower in the PD group than in the D group during the 0-6 hours after surgery (13.1 vs. 24.5%) (P < 0.05). CONCLUSIONS: Palonosetron combined with dexamethasone was more effective in preventing PONV compared to dexamethasone alone in women receiving IV-PCA using fentanyl.

Regulation of Stem Cell Fate by ROS-mediated Alteration of Metabolism

Stem cells have attracted much attention due to their distinct features that support infinite self-renewal and differentiation into the cellular derivatives of three lineages. Recent studies have suggested that many stem cells both embryonic and adult stem cells reside in a specialized niche defined by hypoxic condition. In this respect, distinguishing functional differences arising from the oxygen concentration is important in understanding the nature of stem cells and in controlling stem cell fate for therapeutic purposes. ROS act as cellular signaling molecules involved in the propagation of signaling and the translation of environmental cues into cellular responses to maintain cellular homeostasis, which is mediated by the coordination of various cellular processes, and to adapt cellular activity to available bioenergetic sources. Thus, in this review, we describe the physiological role of ROS in stem cell fate and its effect on the metabolic regulation of stem cells.

Comparison of the Effects of 1 Hz and 20 Hz rTMS on Motor Recovery in Subacute Stroke Patients

OBJECTIVE: To compare the low frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) with high frequency (20 Hz) rTMS on motor functional improvement of the affected upper extremity in subacute stroke patients. METHODS: Forty patients with subacute ischemic stroke participated in this study. The first group received 10 sessions of 20 Hz rTMS at ipsilesional M1 area and the other group received 10 sessions of 1 Hz rTMS at contralesional M1 area. Motor training of the hemiparetic hand was conducted after each rTMS train. All the patients received conventional occupational therapy immediately after each rTMS session. Manual function test (MFT), Fugl-Meyer Assessment scale (FMS), Modified Barthel Index (MBI), Brunnstrom recovery stage, and grip strength were used to assess motor function before, at the end of, and one month after the last session of rTMS. RESULTS: No adverse side effects were reported during the course of the experiment using rTMS. No significant difference in motor function of the affected upper extremity was observed between the two groups before rTMS. Significant improvements in MFT, FMS, MBI, and Brunnstrom stage were observed in the both groups at the end of the last rTMS session and one month later (p0.05). CONCLUSION: There was no significant difference in motor function of the affected upper extremity between 1 Hz and 20 Hz rTMS during the subacute period of ischemic stroke. Thus, we cannot conclude which has a greater effect.

Impact of serum C-reactive protein level on the prognosis of patients with hepatocellular carcinoma undergoing TACE

BACKGROUND/AIMS: The aim of this study was to determine the relationship between serum CRP levels and the prognosis of hepatocellular carcinoma (HCC) patients. METHODS: HCC patients who underwent the first session of transcatheter arterial chemoembolization (TACE) between January 2005 and December 2009 (n=211) were analyzed retrospectively. The patients were divided into two groups: high C-reactive protein (CRP; > or =1 mg/dL, n=51) and low CRP ( or =5 cm. In addition, subgroup analysis of matched CRP according to TNM stage revealed that elevated serum CRP was independently associated with tumor type, WBC count, and tumorprogression-free survival. CONCLUSIONS: A high serum CRP level is associated with large tumors and a poorly defined tumor type, and is significantly associated with 10-month mortality in patients with large HCC (size > or =5 cm) who undergo TACE.

Urinary Difficulty in Brain Lesion: Impact on Quality of Life: Multicenter Prospective Epidemiologic Study

OBJECTIVE: To asses the prevalence of urinary difficulty and the relationship of urinary difficulty and type of brain lesion from multicenter prospective epidemiologic study. METHOD: 394 patients including outpatients and inpatients who visited from multicenter department of rehabilitation medicine from January 2008 to June 2008 were evaluated. Study based on international prostate symptom score (IPSS) and Quality of life (QoL) score were assessed, and the correlation between the two indexes was analyzed. RESULTS: 140 patients (35.5%) complained urinary difficulty as patient's main symptom, while IPSS score was 13.7 showing above moderate symptom at 77.5%. For patients complained urinary difficulty, the average of quality of life score was 3.1. Among stroke, 37% of infarction and 34% of hemorrhage complained urinary difficulty while 40% of traumatic brain injury did. Patients with ACA infarction reported urinary difficulty most frequently. Nocturia (71%), frequency (53.3%), incomplete emptying (30%) were the most frequent symptoms. Sixty-six patients (46%) complaining urinary difficulty were taking medications and anticholinergics were most widely used (75%). Scores of IPSS and QoL according to type and site of brain lesion didn't show meaningful difference while QoL score correlated significantly with IPSS score (p<0.05). CONCLUSION: Among all the brain lesion patients, 35.5% complained urinary difficulty while IPSS and QoL score according to type and site of brain lesion didn't show meaningful difference. Urinary difficulty affects the life quality of brain lesion patients.

Upper Extremity Proprioceptive Assessment Test Using Virtual Environment Technique in Patients with Stroke

OBJECTIVE: To examine the reliability of upper extremity proprioceptive assessment test using virtual environment technique (VET) in patients with stroke with test-retest paradigm and define criterion for normal value by comparing with unimpaired control group. METHOD: Thirty stroke patients and 30 control groups were recruited. The VET apparatus is consisted of virtual reality upper extremity tester (VRUPT), encoder, and head-mounted display (HMD). VET-based test is composed of two tasks. Angle assessment task is required matching of imposed joint positions without visual feedback for checking angle error. Reaching assessment task is required matching of imposed cylinder with visual feedback for checking time, number of click, total interaction error. RESULTS: In the test-retest analysis, correlation coefficients ranged from 0.73 to 0.99 (p<0.01). Significant differences consistently found between affected upper extremity joint of stroke group and corresponding upper extremity joint of control group for the major variables (p<0.05). The cut off value in shoulder, elbow, wrist joints were calculated as 8.24degrees, 8.41degrees, 10.31degrees and the frequency of proprioceptive abnormalities based on these cut off value of angle error in shoulder, elbow, wrist joints showed 60%, 67%, 83% respectively, in our stroke group. CONCLUSION: This VET-based proprioceptive assessment test shows promise in assessing proprioception in patients with stroke more objectively and quantitatively.

Activity of the Quadriceps during Semisquat and Squat Exercises with Isometric Hip Adduction and Abduction in Young Healthy Persons

OBJECTIVE: To determine the effects of isometric hip adduction and abduction on the activity of vastus medialis obliquus (VMO) and vastus lateralis (VL) during semisquat and squat exercise. METHOD: Thirty healthy male subjects without history of knee pain were recruited. Subjects performed a traditional exercise combined with hip adduction and abduction during semisquat and squat exercise. A total of 3 repetitions lasting 6 seconds each were executed following two-minute intervals. The EMG signals were collected from VMO and VL of the dominant leg. The data were normalized to the maximal isometric voluntary contraction of VMO and VL at 90degrees of knee flexion using isokinetic dynamometer and analysed in terms of their RMS values. RESULTS: The activity of both VMO and VL was significantly greater during both semisquat and squat exercise with hip adduction and abduction than without hip adduction and abduction. The VMO/VL ratio was significantly greater. The squat exercise produced significantly greater VMO and VL activity than the semisquat exercise, regardless of hip position. However, there were no significant differences in VMO/VL ratio between semisquat and squat exercise. CONCLUSION: Combining isometric hip adduction using theraband during semisquat exercise produced higher VMO/ VL ratio through more selective VMO activation and could be easy and effective rehabilitation program in patellofemoral pain syndrome.

Hypertrophic Obstructive Cardiomyopathy with Infundibular Stenosis Treated by Alcohol Ablation Therapy

This report describes an uncommon case of hypertrophic obstructive cardiomyopathy (HOCM) accompanying infundibular stenosis of the right ventricle treated by alcohol ablation therapy, in a 28-yr-old male patient presenting with dyspnea on exertion. HOCM with infundibular stenosis was detected by echocardiogram and cardiac catheterization and patient has dynamic obstructions of both ventricular outflow tracts. We performed alcohol ablation therapy to improve clinical symptoms and to relieve dynamic obstructions of both ventriclular outflow tracts. This is the first case in which HOCM with infundibular stenosis of the right ventricle was treated by alcohol ablation therapy.

Functional Severity of Coronary Stenosis in Relation to Luminologic Severity in AMI: Comparison with Angina

BACKGROUND AND OBJECTIVES: Positive correlations between quantitative coronary angiography and functional indexes of coronary stenosis are well known in angina pectoris. However, there is little data concerning correlations with acute myocardial infarction (AMI). The objective of this study was to evaluate the differences in correlation of functional severity and luminologic severity between patients with angina and acute myocardial infarction. SUBJECTS AND METHODS: The study population consisted of 23 patients with AMI and 25 patients with angina pectoris. We performed intravascular ultrasound (IVUS) and intracoronary pressure measurement following diagnostic coronary angiography, and measured angiographic diameter stenosis (DST), minimal luminal diameter (MLD), minimal luminal area (MLA), and reference area stenosis (r-AST). Additionally, the fractional flow reserve (FFR) was defined by the ratio of the distal mean coronary pressure (Pd) to the aortic mean pressure (Pa). RESULTS: The IVUS parameters and DST in patients with AMI showed more severe stenosis than seen in patients with angina; MLD (1.37+/-0.30 mm vs 1.73+/-0.63 mm, p0.05). FFR was correlated less with r-AST in patients with myocardial infarction than angina ( - 0.55 vs - 0.84). The r-AST in patients with AMI, in order to be the best cut-off values that fit with a FFR<0.75, was higher than seen in patients with angina (83% vs 67%). CONCLUSION: FFR in AMI was not significantly different from that seen in angina despite the presence of a significant difference of IVUS parameters between the two patient groups. The functional severity of stenosis in relation to its luminologic severity may be lessened following acute myocardial infarction.

Comparison between Fractinal Flow Reserve and Intravascular Ultrasound for Evaluation of Optimal Coronary Angioplasty

BACKGROUND: Intravascular ultrasound (IVUS) is one of the golden standards for the assessment of optimal angioplasty. Pressure-derived myocardial fractional flow reserve (FFRmyo) is a lesion-specific functional index of epicardial conduit and may be particularly useful for the assessment of optimal coronary angioplasty. The purpose of this study was to assess IVUS parameters and FFRmyo after successful angioplasty on coronary angiogram and compare them between balloon and stent group. METHODS: The study population consisted of 28 patients who underwent revascularization (14 cases of balloon angioplasty only, 14 cases of angioplasty with stent) from Jan. 1999 to Aug. 2000 at Inha University Hospital. After successful angioplasty on coronary angiogram, we measured minimal luminal diameter (MLD), minimal luminal area (MLA), lesion area stenosis (l-AST) and reference area stenosis (r-AST) with IVUS imaging. And we calculated FFRmyo from the ratio of mean coronary pressure distal to the stenosis (Pd) to the aortic mean pressure (Pa) during maximum coronary hyperemia (Pd/Pa). RESULTS: There was significant difference of MLD (2.2+/-0.4 vs 2.6+/-0.3), MLA (4.4+/-1.1 vs 6.4+/-1.7), r-AST (43.7+/-9.2 vs 29.8+/-9.4) and FFRmyo (0.89+/-0.07 vs 0.93+/-0.03) between balloon and stent group. All IVUS parameters (MLD, MLA, r-AST) are well correlated with FFRmyo after angioplasty (r=0.52, p<0.05, r=0.48, p<0.05 and r=-0.72, p<0.05 respectively). By multiple regression analysis, r-AST showed the best correlation with FFRmyo among IVUS parameters. CONCLUSION: Coronary angioplasty with stent showed more favorable MLD, MLA, r-AST and FFRmyo than balloon angioplasty. FFRmyo may be seemed to be alternative to IVUS for estimating the result of coronary angioplasty.

A Case of Idiopathic Hypereosinophilic Syndrome Manifested by Massive Pericardial Effusion

Idiopathic hypereosinophilic syndrome is a state of marked eosinophilia of unknown cause accompanied by multiple organ involvement. Any organ may be involved including bone marrow, heart, lung, gastrointestinal tract, liver, kidney and the nervous system. The common cardiac manifestations of hypereosinophlic syndrome are myocarditis, endocardial fibrosis, formation of mural thrombi, valvular hearat disease, restrictive cardiomyopathy and congestive heart failure. We report a case of a 61-year-old man with idiopathic hypereosinophilic syndrome manifested by myocarditis and severe pericardial effusion on transthoracicechocardiography that was successfully treated by pericardiocentesis and on-going steroid therapy.

Early dipyridamole stress myocardial SPECT to detect residual stenosis of infarct related artery: comparison with coronary angiography and fractional flow reserve

BACKGROUND: The detection of residual stenosis of infarct related artery (IRA) at early stage after acute myocardial infarction (AMI) is crucial in clinical decision making for interventional revascularization. The aim of this study was to evaluate the relevancy of early dipyridamole stress myocardial SPECT to detect functionally and luminologically significant residual stenosis of IRA after AMI. METHOD: Twenty five consecutive patients (M:F=19:6, age: 56+/-13yrs) with AMI underwent SPECT and coronary angiography within 5 days of the attack. Infarct related arteries with FFR 70% were regarded to have functionally and morphologically significant residual stenosis. Reversible perfusion defect was defined if there was improvement of the perfusion score more than one grade in infarct segments on rest images of SPECT compared with stress images. RESULTS: Mean FFR and DST were 0.76+/-0.14 and 74+/-15%. SPECT showed no significant correlation with both FFR and DST with Kendall's coefficiency of 0.28 (p=0.05) and 0.13 (p=0.35). The sensitivity and specificity of SPECT to detect functionally and morphologically significant residual stenosis were 92%, 31% and 83%, 29%. CONCLUSION: The early dipyridamole stress myocardial SPECT after AMI does not seem to be a useful non-invasive test for the detection of functionally and luminologically significant residual stenosis of IRA.

The Effect of Gabapentin and Clonidine on Neuropathic Pain in an Experimental Pain Model

OBJECTIVE: To evaluate the effects of gabapentin and clonidine on neuropathic pain in an experimental pain model. METHOD: 24 male adult rats were anesthetized and the sciatic nerve was exposed. Each exposed nerve was electrically injured with 10 volts for 10 seconds by two needle electrodes. Rats were divided into three groups by treating with gabapentin, clonidine and sham. Gabapentin and clonidine were given orally from post operation day 3 to 7 in gabapentin and clonidine groups respectively. To evaluate the presence of mechanical allodynia, withdrawal frequency was tested by Von Frey hair in the same days. After post operation day 7, all the medications were discontinued and mechanical allodynia was evaluated at post operation day 14. RESULT: Neuropathic pain was developed after electrical injury in all the rats. Withdrawal frequency is more decreased in gabapentin and clonidine groups than sham group in post operation day 4 to 7. The withdrawal frequency was 2.88+/-0.83, 2.75+/-0.89, 3.13+/-0.99, 3.25+/- 1.28 in gabapentin group and 3.38+/-0.92, 4.50+/-2.20, 3.25+/-1.17, 3.50+/-0.93 in clonidine group in post operation day 4, 5, 6, 7, respectively. In post operation day 14, withdrawal frequency was increased and showed no difference compared to the sham group. CONCLUSION: Gabapentin and clonidine can suppress the neuropathic pain in an experimental pain model. There was no different effect on the neuropathic pain suppression between gabapentin and clonidine.

Bone Metabolism in the Hemiplegic Patients after Stroke

OBJECTIVE: To assess change of bone metabolism in hemiplegic patients after stroke. METHOD: Sera were collected from 19 hemiplegic patients after stroke. Sera were assayed for 25-hydroxyvitamin D (25-OHD), 1,25-dihydroxyvitamin D (1,25-(OH)2D), parathyroid hormone (PTH), calcium and osteocalcin. RESULTS: Serum 25-OHD and 1,25-(OH)2D concentration were 15.13 mg/mL and 20.88 pg/mL, respectively. Serum PTH was 47.23 pg/mL. In 5 (26%) of the patients, the serum 25-OHD concentration were < 10 ng/mL (deficient level). Ten (52%) of the patients had vitamin D concentrations between 10 and 20 ng/mL (insufficient level). The mean PTH concentration was not significantly higher in patients with deficient levels of 25-OHD (61.80 pg/mL) than those with insufficient (43.63 pg/mL) or sufficient (38.05 pg/mL) levels of 25-OHD. Serum 25-OHD concentration were lower in the late group (11.11 mg/mL) than in the early group (18.05 mg/mL), whereas serum PTH concentration were higher in the late group (58.96 pg/mL) than in the early group (38.70 pg/mL). CONCLUSION: Compensatory hyperparathyroidism with hypovitaminosis D occurred in the hemiplgic patients after stroke, especially more than one year from onset.

Early dipyridamole stress myocardial SPECT to detect residual stenosis of infarct related artery: comparison with coronary angiography and fractional flow reserve / 대한내과학회지

BACKGROUND: The detection of residual stenosis of infarct related artery (IRA) at early stage after acute myocardial infarction (AMI) is crucial in clinical decision making for interventional revascularization. The aim of this study was to evaluate the relevancy of early dipyridamole stress myocardial SPECT to detect functionally and luminologically significant residual stenosis of IRA after AMI. METHODS: Twenty five consecutive patients (M:F=19:6, age: 56+/-13yrs) with AMI were underwent SPECT and coronary angiography within 5 days of the attack. Infarct related arteries with FFR 70% were regarded to have functionally and morphologically significant residual stenosis. Reversible perfusion defect was defined if there was improvement of pefusion score more than one grade in infarct segments on rest images of SPECT compared with stress images. RESULTS: Mean FFR and DST were 0.76+/-0.14 and 74+/-15%. SPECT showed no significant correlation with both FFR and DST with Kendall's coefficiency of 0.28 (p=0.05) and 0.13 (p=0.35). The sensitivity and specificity of SPECT to detect functionally and morphologically significant residual stenosis were 92%, 31% and 83%, 29%. CONCLUSION: The early dipyridamole stress myocardial SPECT after AMI dose not seem to be a useful non-invasive test for the detection of functionally and luminologically significant residual stenosis of IRA.

Neuropathic Pain Model Induced by Electrical Injury of Sciatic Nerve in Rats

OBJECTIVE: The purpose of this study was to develop a new neuropathic pain model in rat. METHOD: Twenty Sprague-Dawley adult male rats, 10 for control and 10 for experimental, were anesthetized and their sciatic nerves were exposed. In an experimental group, exposed nerve was injured with 10 volts electrical current for 10 seconds. The mechanical and thermal allodynia and pain behavior were evaluated in pre-electrical injury and post-injury 1, 2, 3 days, 1, 2, 3, 4, 6 and 8 weeks. The mechanical allodynia was evaluated by the frequency of response to 5 stimulations of von Frey hairs (4.31 and 4.56) and the thermal allodynia was tested by withdrawal latency to stimulation with radiant heat. Spontaneous pain behavior (paw shaking, paw elevation) was observed for 5 minutes in the cage. RESULTS: The experimental group exhibited significantly higher withdrawal frequency to mechanical stimulation: from post-injury 3 days to 6 weeks for von Frey hair 4.31 and from 2 days to 4 weeks for von Frey hair 4.56 (p<0.05). There was no difference between two groups in withdrawal latency to radiant heat stimulation. The experimental group showed spontaneous pain behavior but control group did not. In electron microscopic finding, prominent myelin destruction and axonal sprouting were observed in experimental group. CONCLUSION: These results suggest that a new neuropathic pain model can be made by 10 volts electrical injury for 10 seconds to rat sciatic nerve.