Feasibility of the Transradial or the Transbrachial Approach in Various Neurointerventional Procedures / 신경중재치료의학

PURPOSE: The generally preferred vascular access for neurointerventional procedures is the transfemoral approach (TFA). In complicated cases such as patients with aortic diseases or tortuous vessels, transradial or transbrachial approaches (TRA or TBA) could be good alternatives. The purpose of this study is to review a single medical center experience using the alternative accesses. MATERIALS AND METHODS: We reviewed the medical records of 30 TRA and 10 TBA cases among 2,073 cases treated between January 2010 and July 2013. We reviewed and analyzed the frequency of TRA and TBA, the reason the operator had chosen the TRA or TBA, the category of the procedure, caliber of the sheath, the success rate, and the complications rates. RESULTS: The most common reason the non-TFA route was chosen was due to the patient's tortuous vascular system (n=24, 60%). The most common category of intervention was balloon angioplasty and/or stent placement (n=18, 45%). The largest caliber of the introducing sheath was 6 Fr in TRA and 7 Fr in TBA. Procedural success was achieved in 37 cases (success rate: 92.5%), and in three cases it failed. Six patients with complications were reported. Among them, four cases of minor complications (10%) occurred. There was no serious complication directly related to the access problem. CONCLUSION: Both TRA and TBA can be good alternative access routes when TFA is not appropriate in various neurointervential procedures.

Mechanical Thrombectomy Using the Solitaire FR system for Occlusion of the Top of the Basilar Artery: Intentional Detachment of the Device after Partial Retrieval / 신경중재치료의학

Acute, distal, basilar artery occlusion is a challenging neurovascular emergency. There have been several reports regarding the successful application of the Solitaire FR device for treating this lesion. However, due to the lack of a suitable, balloon-tipped, guiding catheter for the vertebral artery, during this procedure we frequently experience the occurrence of clot fragmentation and distal migration. There may be some technical solutions to solve this problem. The purpose of this report is to present a technical variation of using the Solitaire FR, and which is referred to as the 'intentional device detachment technique.' As a clot tends to re-embolize during its passage through the tortuous cranio-cervical junction level of the vertebral artery or its passage through the tip of the guiding catheter, due to the lack of proximal flow arrest, we thought that not removing the stent segment of the device which is capturing the clot could avoid this problem. We were able to successfully apply this technique in two cases. We believe that this technique can be a possible technical option for using the Solitaire FR device when a patient has little concern regarding the subsequent use of antiplatelets.

Two Microcatheter Technique for Embolization of Arteriovenous Fistula with Liquid Embolic Agent / 신경중재치료의학

Problem with embolization of arteriovenous fistula (AVF) with liquid embolic agent is its over-penetration into the veins or regurgitation to the proximal feeder without reaching the shunt point. We present a technique that controls the flow of AVF during embolization. Two microcatheter technique consists of positioning one microcatheter close to the AVF for embolization, and with another microcatheter at the proximal feeding artery to control the AVF flow by coiling. Selective angiograms obtained using a distally positioned microcatheter before and after coiling, were compared how much stagnant effect was achieved. Using two microcatheter technique, AVF occlusion was achieved with good penetration of glue to the venous side of the AVF. Its advantage is the ability to push glue into the shunt without causing over-penetration of glue or its reflux along the feeder. Two microcatheter technique was safe and effective in glue embolization of AVF and also expected to be applied with other liquid embolic agent like Onyx.

Current Status of Neurointerventional Activities in Korea / 신경중재치료의학

Neurointervention which deals with neurovascular disease in brain, head-and-neck and spines are one of the rapidly evolving medical fields. Several indices representing neurointerventional activities are still increasing year-by-year in Korea. We review current trend in major neurovascular diseases requiring usage of specific medical devices and some issues related to administrative process of the government approval.

Segmental Difference of the Hepatic Fibrosis from Chronic Viral Hepatitis due to Hepatitis B versus C Virus Infection: Comparison Using Dual Contrast Material-Enhanced MRI

OBJECTIVE: We wanted to identify the geographic differences in hepatic fibrosis and their associations with the atrophy-hypertrophy complex in patients with chronic viral hepatitis using the dual-contrast material-enhanced MRI (DC-MRI) with gadopentetate dimeglumine and ferucarbotran. MATERIALS AND METHODS: Patients with chronic C (n = 22) and B-viral hepatitis (n = 35) were enrolled for determining the subjective grade of fibrosis (the extent and thickness of fibrotic reticulations) in the right lobe (RL), the caudate lobe (CL), the medial segment (MS) and the lateral segment (LS) of the liver, with using a 5-grade scale, on the gradient echo T2*-weighted images of DC-MRI. The fibrosis grades of different segments were compared using the Kruskal-Wallis test followed by post-hoc analysis to establish the segment-by-segment differences. The incidences of two pre-established morphologic signs of cirrhosis were also compared with each other between the two groups of patients. RESULTS: There were significant intersegmental differences in fibrosis grades of the C-viral group (p = 0.005), and the CL showed lower fibrosis grades as compared with the grades of the RL and MS, whereas all lobes were similarly affected in the B-viral group (p = 0.221). The presence of a right posterior hepatic notch was significantly higher in the patients with intersegmental differences of fibrosis between the RL and the CL (19 out of 25, 76%) than those without such differences (6 out of 32, 19%) (p < 0.001). An expanded gallbladder fossa showed no significant relationship (p = 0.327) with the segmental difference of the fibrosis grades between the LS and the MS. CONCLUSION: The relative lack of fibrosis in the CL with more advanced fibrosis in the RL can be a distinguishing feature to differentiate chronic C-viral hepatitis from chronic B-viral hepatitis and this is closely related to the presence of a right posterior hepatic notch.

MLCK and PKC Involvements via Gi and Rho A Protein in Contraction by the Electrical Field Stimulation in Feline Esophageal Smooth Muscle

We have shown that myosin light chain kinase (MLCK) was required for the off-contraction in response to the electrical field stimulation (EFS) of feline esophageal smooth muscle. In this study, we investigated whether protein kinase C (PKC) may require the on-contraction in response to EFS using feline esophageal smooth muscle. The contractions were recorded using an isometric force transducer. On-contraction occurred in the presence of NG-nitro-L-arginine methyl ester (L-NAME), suggesting that nitric oxide acts as an inhibitory mediator in smooth muscle. The excitatory composition of both contractions was cholinergic dependent which was blocked by tetrodotoxin or atropine. The on-contraction was abolished in Ca2+-free buffer but reappeared in normal Ca2+-containing buffer indicating that the contraction was Ca2+ dependent. 4-aminopyridine (4-AP), voltage-dependent K+ channel blocker, significantly enhanced on-contraction. Aluminum fluoride (a G-protein activator) increased on-contraction. Pertussis toxin (a Gi inactivator) and C3 exoenzyme (a rhoA inactivator) significantly decreased on-contraction suggesting that Gi or rhoA protein may be related with Ca2+ and K+ channel. ML-9, a MLCK inhibitor, significantly inhibited on-contraction, and chelerythrine (PKC inhibitor) affected on the contraction. These results suggest that endogenous cholinergic contractions activated directly by low-frequency EFS may be mediated by Ca2+, and G proteins, such as Gi and rhoA, which resulted in the activation of MLCK, and PKC to produce the contraction in feline distal esophageal smooth muscle.

Pain Control Effect of Block of Sciatic Nerve in the Popliteal Fossa after Hallux Valgus Surgery

OBJECTIVE: We evaluated the pain-control effect and overall satisfaction of block of sciatic nerve in the popliteal fossa after hallux valgus surgery. METHOD: 33 cases with elective operation for hallux valgus were prospectively investigated. All blocks were performed with the aid of a peripheral nerve stimulator, and 0.5% pucaine was injected in a dose of 1.5 mg/kg when minimal stimulator output still elicited a slight motor response of the foot. In evaluating the analgesics effects of the nerve block, the intensity of pain was assessed by using VAS before, immediately after, and at given time intervals during 36 hours. In the control group, the pain scores were assessed after immediate post-operation and at the given time intervals during 36 hours. The nerve block group rated their level of satisfaction at the first visit of out-patient clinic after discharge. RESULTS: There was significant pain-control effect at least during 24 hours after the nerve block. The patient's satisfaction was high and they had no severe complications. CONCLUSION: Block of sciatic nerve in the popliteal fossa provides high satisfaction as the safe effective pain-control method after hallux valgus surgery, so it may be available method for postoperative analgesia after another foot surgery.

A Usefulness of Pudendal Nerve Block in the Dorsal Approach under EMG Monitoring: A case report

This study was designed to evaluate the usefulness of pudendal nerve block in the dorsal approach under EMG monitoring. The patient is placed in the prone position. The location of pudendal nerve is identified using the both ischial tuberosities and greater trochanter. We have performed the pudenal nerve block with 5% phenol solution, under the EMG monitoring. The patient was able to void with percussion method. There has been no impairment in urinary continence. We experienced an excellent effect of bilateral pudendal nerve block in the dorsal approach, under EMG montoring, using 5% phenol solution in detrusor sphincter dyssynergia of neurogenic bladder.

Cloning and Localization of Developmentally Regulated Gene, Glutamate/Aspartate Transporter (GLAST) Gene, in the Developing Rat Cerebellum / 대한해부학회지

In this study, S59158, a gene of GLAST (L-Glutamate/L-Aspartate transporter), was cloned by ordered differential display PCR with developing rat brains. The mRNA expression of this gene in the developing rat brain and the effect of kainic acid (KA), glutamate analogue, on this gene were investigated with in situ hybridization histochemistry. The expression of S59158 was restricted to nervous system and observed from E12 (embryonic day 12), peaked at E20, and gradually decreased to adult level. In embryos, S59158 was prominently expressed in the subventricular zones throughout the brain. After birth, strong expression was observed in the purkinje cell layer of cerebellum and moderate level of expression was observed in the subventricular zone, olfactory bulb, hippocampal formation, and cerebral cortex. In the KA treated rat brains, the expression of S59158 was significantly increased in dentate gyrus, hippocampus, and cerebral cortex. From these results, it may be suspected that S59158 is related to the development of the brain and is induced by increased extracellular glutamate level.

Estimation of Motor Unit Number According to Severity of Peripheral Nerve Injury in Rat

OBJECTIVE: To evaluate the changes of motor unit number estimation (MUNE) and the amplitude of compound muscle action potential (CMAP) according to severity of nerve injury in rat. METHOD: The sciatic nerve was compressed with two different severity (mild, severe) in 20 rats each. MUNE was performed in gastrocnemius of rat using the Poisson statistics. MUNE and amplitude of CMAP were compared according to severity of injury at two and four weeks after injury. RESULTS: The MUNE and amplitude of CMAP were significantly diminished at two and four weeks after nerve injury in severely injured rat. Both values were also diminished at two weeks after injury in mildly injured rat. The amplitude of CMAP was slightly increased at four weeks after mild injury despite of further decrement of MUNE. CONCLUSION: The MUNE and amplitude of CMAP changed differently according to severity of nerve injury in rat, which might represent different denervation and reinnervation process.

Quantitative Evaluation of Denervation Potentials in Gastrocnemius of Rats Using Power Spectrum Analysis

OBJECTIVE: To evaluate the changes of maximum fibrillation potential amplitude and root- mean-square (RMS) value of denervation potential after nerve injury using power spectrum analysis. METHODS: The sciatic nerve was transected in 8 rats, and was compressed in 6 rats. Denervation potentials were collected in gastrocnemius using monopolar needle weekly after nerve injury. The change of RMS value of 1 second epoch of denervation potentials with time was evaluated and compared with the change of maximun fibrillation potential amplitude. RESULTS: In nerve-transected rat, the RMS value declined linearly with time after injury. On the contrary, the amplitude of fibrillation potentials declined much rapidly during first 3 weeks. In nerve-compressed rat, both the RMS value and amplitude of fibrillation potential increased for 2 weeks after injury, and declined thereafter. As the result of simple regression analysis, the changes of RMS value correlated better than changes of fibrillation amplitude in all 8 nerve-transected rat. CONCLUSION: The RMS value of denervation potentials correlated well with time after nerve injury in animal experiments. Measurement of the RMS value might be helpful to evaluate the time after peripheral nerve injury, but long-term human data should be essential for clinical application.

Multiple Cranial Nerve Injury by Single Cervical Stab Wound: A case report

The cranial nerve lesions can occur from a stroke, traumatic brain injury or direct cervical injury, and can produce various functional problems of the craniofacial structures. Usually the cranial nerve injury can be diagnosed by a simple clinical manifestation, and physical or neurological examination. Electrophysiologic study and imaging study such as MRI are frequently used as the sequential follow up studies for the objective evaluation of neurologic regeneration process. We report a case of multiple cranial nerve injuries, of the fifth, seventh, tenth, eleventh and twelfth cranial nerves from a single deep cervical stab wound of 4 cm in length from 0.5 cm anterior of the tragus to 1 cm posterior to the mandibular angle. Electrophysiologic study including an electromyography of tongue and vocal cord, blink reflex and facial nerve conduction study were used for the diagnosis and follow up.

Evoked EMG Monitoring During Transpedicular Fixation of Lumbosacral Spine

OBJECTIVE: The purpose of this study is to evaluate the searching stimulus intensity at each pedicle and to identify the most vulnerable roots in transpedicular screw fixation of lumbosacral spine. METHOD: Thirty-two patients with unstable lumbosacral vertebra were treated with intrapedicular screw fixation. Small holes were made by an air drill on the pedicle from L2 to S1 for screw fixation. Constant current stimulation pulses(0.2 msec duration) were delivered through a ball-tipped nasopharyngeal probe used to palpate the walls of each pedicle, and observation was made of electromyogram(EMG) evoked lower extremity muscles. The probes were placed in each pedicular wall manually, and evaluated for searching stimulus intensity, the current necessary to evoked EMG. RESULTS: The cases that the searching stimulus intensity was above 5 mA were 99 cases(97%), above 10 mA were 61 cases(59.8%) and below 5 mA were 3 cases(2.9%). The vastus medialis muscle is most sensitive in L2(100%) and L3(78.9%), tibialis anterior is in L4(81.8%), Peroneus longus is in L5(50.5%) and gastrocnemius is in S1(87.5%). CONCLUSION: We can regard the searching stimulus intensity as 5 mA and the root located at Infero-medial side of pedicle is most vulnerable in transpedicular screw fixation. Furthermore, stimulus-evoked EMG monitoring during transpedicular spine instrumentation is helpful to avoid neural tissue injury.

Skin Lesions Other than Pressure Ulcers of the Patients in a Rehabilitation Unit

OBJECTIVE: The purpose of this study is to investigate the incidence and types of skin lesions occurring in the patients with a spinal cord injury(SCI), traumatic brain injury(TBI), cerebrovascular accident(CVA), and an amputation. METHOD: Five hundred and eighty-nine charts from 1991 to 1997 were retrospectively reviewed. During the hospitalization, the skin lesions were examined by the dermatologists upon consultations. The patients were divided by their diagnosis of the SCI, TBI, CVA, and amputation. The incidence of the skin lesions were analysed. RESULTS: The number of patients was as follows; SCI 228, TBI 181, CVA 143, and amputation 37. The skin lesions occurred in 72 cases(12.9%) of which 30 cases(13.2%) occured in SCI, 21 cases(11.6%) in TBI, 15 cases(9.8%) in CVA and 7 cases(18.9%) in amputation. These include dermatophytosis 23 cases(23.9%), seborrheic dermatitis 21 cases(21.8%), pilosebaceous disorder 17 cases(17.7%) such as folliculitis, acne, and acneiform eruption, eczema 11 cases(11.4%), drug eruption 9 cases(9.4%), candidiasis 6 cases(6.3%), and others 9 cases(9.4%) such as steatocytoma multiplex, epidermal cyst, intertrigo, alopecia areata, and etc. The incidence of ANS related skin lesion such as seborrheic dermatitis and pilosebaceous disorder in SCI was significantly higher than in TBI and stoke, which the defect is in the brain(p0.05). The number of cases of ANS related skin lesions was 21(52.5%) and 3(42.9%) in SCI patients whose level of injury was from C1 to T6(in 40) and at or below T7(in 7) respectively. In contrast, the number of cases of other skin lesions such as dermatophytosis, eczema, and candidiasis was 15(37.5%) of C1 to T6 level and 4(57.1%) of at or below T7 level in the same SCI patients groups. CONCLUSION: This study illustrates that the incidence of skin lesion in rehabilitation unit is 72 cases of 589 patients(12.9%). The incidence of ANS related skin lesion is higher in the patients with spinal cord injury than brain lesion. And the level of injury is higher in SCI, the more skin lesions occur.

Hand Rehabilitation with New Device of Wrist Driven Prehension Prosthesis in Partial Hand Amputation

Partial hand amputation may leave a significant functional limitations for amputee that are difficult to ameliorate by either orthoses or prostheses. Many kinds of devices have been tried to promote the function and cosmesis. Cosmetic hand was the best answer to the person with first and second metacarpophalangeal joint disarticulation and the strength and range of motion of remaining three fingers were not in optimal status till now. We applied a new device of wrist driven prehension prosthesis consist of forearm stabilizer, short opponens, actuator rod, artificial thumb, artificial index and attached 2 rings was designed and fabricated. As a result, it is possible to provide considerable improvement in function and cosmesis with this new device.

A Clinical Study of Ifosfamide/Mesna and Cisplatin in Recurrent Epithelial Ovarian Cancer / 대한산부인과학회잡지

This study was planned to evaluate the efficacy and toxicity of fosfamide/mesna plus cisplatin combined regimen in patients with recurrent and initial therapy-resistant epithelial ovarian cancer. Controversy still remains over the efficacy of cisplatin containing combined chemotherapy as the treatment of recurrent ovarian cancer and refractory to first line chemotherapy. Ifosfamide(isophosphamide) is an analog of cyclophosphamide. It has shown evidences of activity in ovarian cancer and lack of cross-resistance with cyclophosphamide. This study was undertaken for the clinical analysis and evaluation on 16 patients, who were admitted and treated with advanced or recurrent ovarian cancer at the Sooncheunhyang University Chunan Hospital from January 1994 to July 1996. The results were as follows: 1. The mean age of patients was 62 year old with range from 44 to 72. 2. The most frequent side effect was nausea and vomiting(75%), followed by leukocytopenia(68%), alopecia(44%), nephrotoxicity(37%), neurotoxicity(25%), and hepatotoxicity(12%). 3. The mean survival period was 24 months in clinical response cases ranged from 11 months to 36 months, 5 months in progressive cases ranged from 1 month to 14 months. 4. In clinical stages, stage II was 6 cases(37.5%), III was 6 cases(37.5%) and IV was 4 cases(25%). 5. Previously all patients were received debulking surgery and PAC hemotherapy. 6. Overall respons rate was 44%(7/16).

Nerve conduction studies of anterior interosseous nerve in healthy adults

No abstract available.

Assessment method of subjective pain; study of clinical applicationto Korean

No abstract available.