Sonoanatomical Change of Phrenic Nerve According to Posture During Ultrasound-Guided Stellate Ganglion Block

OBJECTIVE: To evaluate the risk of phrenic nerve injury during ultrasound-guided stellate ganglion block (US-SGB) according to sonoanatomy of the phrenic nerve, and determine a safer posture for needle insertion by assessing its relationship with surrounding structure according to positional change. METHODS: Twenty-nine healthy volunteers were recruited and underwent ultrasound in two postures, i.e., supine position with the neck extension and head rotation, and lateral decubitus position. The transducer was placed at the anterior tubercle of the C6 level to identify phrenic nerve. The cross-sectional area (CSA), depth from skin, distance between phrenic nerve and anterior tubercle of C6 transverse process, and the angle formed by anterior tubercle, posterior tubercle and phrenic nerve were measured. RESULTS: The phrenic nerve was clearly identified in the intermuscular fascia layer between the anterior scalene and sternocleidomastoid muscles. The distance between the phrenic nerve and anterior tubercle was 10.33±3.20 mm with the supine position and 9.20±3.31 mm with the lateral decubitus position, respectively. The mean CSA and skin depth of phrenic nerve were not statistically different between the two positions. The angle with the supine position was 48.37°±27.43°, and 58.89°±30.02° with the lateral decubitus position. The difference of angle between the two positions was statistically significant. CONCLUSION: Ultrasound is a useful tool for assessing the phrenic nerve and its anatomical relation with other cervical structures. In addition, lateral decubitus position seems to be safer by providing wider angle for needle insertion than the supine position in US-SGB.

Ultrasound-Guided Lateral Femoral Cutaneous Nerve Conduction Study

OBJECTIVE: To verify the utility of the lateral femoral cutaneous nerve (LFCN) ultrasound-guided conduction technique compared to that of the conventional nerve conduction technique. METHODS: Fifty-eight legs of 29 healthy participants (18 males and 11 females; mean age, 42.7+/-14.9 years) were recruited. The conventional technique was performed bilaterally. The LFCN was localized by ultrasound. Cross-sectional area (CSA) of the LFCN and the distance between the anterior superior iliac spine (ASIS) and the LFCN was measured. The nerve conduction study was repeated with the corrected cathode location. Sensory nerve action potential (SNAP) amplitudes of the LFCN were recorded and compared between the ultrasound-guided and conventional techniques. RESULTS: Mean body mass index of the participants was 23.7+/-3.5 kg/m2, CSA was 4.2+/-1.9 mm2, and the distance between the ASIS and LFCN was 5.6+/-1.7 mm. The mean amplitude values were 6.07+/-0.52 microV and 6.66+/-0.54 microV using the conventional and ultrasound-guided techniques, respectively. The SNAP amplitude of the LFCN using the ultrasound-guided technique was significantly larger than that recorded using the conventional technique. CONCLUSION: Correcting the stimulation position using the ultrasound-guided technique helped obtain increased SNAP amplitude.

Shoulder Manipulation After Distention Arthrography: Does Audible Cracking Affect Improvement in Adhesive Capsulitis? A Preliminary Study

OBJECTIVE: To investigate whether an audible cracking sound during shoulder manipulation following distention arthrography is clinically significant in patients with adhesive capsulitis of the shoulder. METHODS: A total of 48 patients (31 women, 17 men) with primary adhesive capsulitis of the shoulder completed the study. All participants underwent C-arm-guided arthrographic distention of the glenohumeral joint with injections of a corticosteroid and normal saline. After distention, we performed flexion and abduction manipulation of the shoulder. The patients were grouped into sound and non-sound groups based on the presence or absence, respectively, of an audible cracking sound during manipulation. We assessed shoulder pain and disability based on a Numeric Rating Scale (NRS), the Shoulder Pain and Disability Index (SPADI), and passive range of motion (ROM) measurements (flexion, abduction, internal and external rotation) before the procedure and again at 3 weeks and at 6 weeks after the intervention. RESULTS: The patients were divided into two groups: 21 were included in the sound group and 27 in the non-sound group. In both groups, the results of the NRS, SPADI, and ROM assessments showed statistically significant improvements at both 3 and 6 weeks after the procedure. However, there were no significant differences between the two groups except with respect to external rotation at 6 weeks, at which time the sound group showed a significant improvement in external rotation when compared with the non-sound group (p<0.05). CONCLUSION: These findings showed that manipulation following distention arthrography was effective in decreasing pain and increasing shoulder range of motion. In addition, the presence of an audible cracking sound during manipulation, especially on external rotation, was associated with better shoulder range of motion.

Sonographic Evaluation of the Peripheral Nerves in Hereditary Neuropathy With Liability to Pressure Palsies: A Case Report

Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal dominantly inherited disorder that affects peripheral nerves by repeated focal pressure. HNPP can be diagnosed by clinical findings, electrodiagnostic studies, histopathological features, and genetic analysis. Ultrasonography is increasingly used for the diagnosis of neuromuscular diseases; however, sonographic features of HNPP have not been clearly defined. We report the sonographic findings and comparative electrodiagnostic data in a 73-year-old woman with HNPP, confirmed by genetic analysis. The cross-sectional areas of peripheral nerves were enlarged at typical nerve entrapment sites, but enlargement at non-entrapment sites was uncommon. These sonographic features may be helpful for diagnosis of HNPP when electrodiagnostic studies are suspicious of HNPP and/or gene study is not compatible.

Physical and chemical properties of experimental mixture of mineral trioxide aggregate and glass ionomer cement / 대한치과보존학회지

OBJECTIVES: The purpose of this study was to determine the setting time, compressive strength, solubility, and pH of mineral trioxide aggregate (MTA) mixed with glass ionomer cement (GIC) and to compare these properties with those of MTA, GIC, IRM, and SuperEBA. MATERIALS AND METHODS: Setting time, compressive strength, and solubility were determined according to the ISO 9917 or 6876 method. The pH of the test materials was determined using a pH meter with specified electrode for solid specimen. RESULTS: The setting time of MTA mixed with GIC was significantly shorter than that of MTA. Compressive strength of MTA mixed with GIC was significantly lower than that of other materials at all time points for 7 days. Solubility of 1 : 1 and 2 : 1 specimen from MTA mixed with GIC was significantly higher than that of other materials. Solubility of 1 : 2 specimen was similar to that of MTA. The pH of MTA mixed with GIC was 2-4 immediately after mixing and increased to 5-7 after 1 day. CONCLUSIONS: The setting time of MTA mixed with GIC was improved compared with MTA. However, other properties such as compressive strength and pH proved to be inferior to those of MTA. To be clinically feasible, further investigation is necessary to find the proper mixing ratio in order to improve the drawbacks of MTA without impairing the pre-existing advantages and to assess the biocompatibility.

Biocompatibility of experimental mixture of mineral trioxide aggregate and glass ionomer cement / 대한치과보존학회지

OBJECTIVES: The purpose of the present in vitro study was to evaluate the biocompatibility of mineral trioxide aggregate (MTA) mixed with glass ionomer cement (GIC), and to compare it with that of MTA, GIC, IRM and SuperEBA. MATERIALS AND METHODS: Experimental groups were divided into 3 groups such as 1 : 1, 2 : 1, and 1 : 2 groups depending on the mixing ratios of MTA powder and GIC powder. Instead of distilled water, GIC liquid was mixed with the powder. This study was carried out using MG-63 cells derived from human osteosarcoma. They were incubated for 1 day on the surfaces of disc samples and examined by scanning electron microscopy. To evaluate the cytotoxicity of test materials quantitatively, XTT assay was used. The cells were exposed to the extracts and incubated. Cell viability was recorded by measuring the optical density of each test well in reference to controls. RESULTS: The SEM revealed that elongated, dense, and almost confluent cells were observed in the cultures of MTA mixed with GIC, MTA and GIC. On the contrary, cells on the surface of IRM or SuperEBA were round in shape. In XTT assay, cell viability of MTA mixed with GIC group was similar to that of MTA or GIC at all time points. IRM and SuperEBA showed significantly lower cell viability than other groups at all time points (p < 0.05). CONCLUSIONS: In this research MTA mixed with GIC showed similar cellular responses as MTA and GIC. It suggests that MTA mixed with GIC has good biocompatibility like MTA and GIC.

Immunohistochemical Study on the Distribution of Insulin-like Growth Factor Binding Protein 7 (IGFBP7) in the Central Nervous System of Adult Rats / 체질인류학회지

In the present study, we performed immunohistochemical studies to investigate the detailed distribution of insulin-like growth factor binding protein 7 (IGFBP7) in the central nervous system of adult rats. Twelve adult (4~6 month old) Sprague-Dawley rats were examined in this study. Immunohistochemistry using specific antibodies against IGFBP7 was performed in accordance with the free-floating method. In the present study, IGFBP7 immunoreactivity was observed in the cerebral cortex, hippocampus, brainstem, cerebellum and spinal cord. In the cerebral cortex, heavily stained neurons were seen in layers II-VI. In the hippocampus, pyramidal cells in CA1-3 region were strongly immunoreactive for IGFBP7. Strong immunoreactive neurons were also found in the supraoptic nucleus, paraventricular nucleus, periaqueductal gray and oculomotor nucleus. In the cerebellum, IGFBP7 immunoreactivity was prominent in the Purkinje cells and cerebellar output neurons. IGFBP7-immunoreactive neurons were prominent in the superior vestibular nucleus, cochlear nucleus, trigeminal motor nucleus, nucleus of the trapezoid, and facial nucleus. IGFBP7-immunoreactive neurons were also observed mainly in the anterior horn of the spinal cord. The first demonstration of IGFBP7 localization in the whole brain may provide useful data for the future investigations on the structural and functional properties of IGFBP7.

Differential Expression of Neuronal Death-related Factors in Aged Rat Cerebellum / 체질인류학회지

In the present study, we investigated the expression of apoptosis-associated proteins in the cerebellum of aged rats: IGF-I receptor (IGF-IR), nitrotyrosine (NT), p53, key pro-apoptotic gene ICH-1 (caspase-2), c-Fos and Bcl-2 family members (Bcl-2 and Bax). Twelve adult (4~6 month old) and 15 aged (24~29 month old) Sprague-Dawley rats were examined in this study. We performed immunohistochemical staining, in situ hybridization and densitometric measurement using a NIH image program (Scion Image) to determine the staining density. In adult rats, there were no immunoreactivities for insulin-like growth factor-I receptor (IGF-IR), nitrotyrosine (NT) or p53 in any region of cerebellum. However, IGF-IR immunoreactivity was found in some Purkinje cells in aged rat cerebellum. The prominent staining of NT or p53 was also localized in the Purkinje cell layer in aged rats. A high density of ICH-1 (caspase-2) immunoreactivity was observed in the molecular and Purkinje cell layers in aged rats. Immunoreactivity for c-Fos was significantly decreased in the granule cells in aged rats. Positive signal for bcl-2 was significantly decreased in the Purkinje cells and granule cells of aged rats. The most intense staining for Bax was observed in the soma of Purkinje cells of adult rats. However, Bax immunoreactivity was not changed in any layers in the cerebellar cortex of aged rats. In conclusion, this study provides the first morphological data concerning the differential regulation of apoptosisrelated genes in rat cerebellum during aging.

Laparoscopic Varicocelectomy: 20 Cases / 대한비뇨기과학회지

PURPOSE: Laparoscopy is a signigicant step forward in the evolution of minimally invasive surgery and laparoscopic varicocelectomy can be an alternative approach to the conventional open surgery or embolization. MATERIALS AND METHODS: Between July, 1994 and July 1995, laparoscopic varicocelectomies were performed in 20 clinical patients whose age ranged 6-29 years. TITLES: Spermatic artery saving was performed successfully in 16 cases. Hospitalization was 1 day and only 1 patient complained of persistent scorotal discomfort and palpable varicocele mass(grade 1). Conclusions : Early return to normal activity, simplicity of spermatic vein dissection, preservation of spermatic artery, access to bilateral veins have do this new technique an alternatives to routine high ligation.

The Occurrence of Antisperm Antibodies in Patients of Scrotal Diseases / 대한비뇨기과학회지

The aim of this investigation was to determine the incidence of sperm antibodies in serum using indirect immunobead test (IBT) in 113 patients of scrotal disease. The results of this survey showed that 17.7% of 113 men had antisperm antibodies of IgG and/or IgA class bound to the surface of at least 20% of motile spermatozoa of normal donor. There were positive immunobead test in 16 of 36(44.4% ) vasovasostomy patients, 1 of 18 testicular trauma, 1 of 15 primary infertility, 1 of 4 obstructive infertility, 1 of 7 hydrocele. There were no statistical differences in sperm count, sperm morphology between the groups of patients with positive or negative IBT results. As for the immunoglobulins, the most frequent class was IgG, and in terms of morphological sites, tail binding was most frequent. The results of this investigation therefore suggest that the IBT is an excellent test for sperm antibodies in scrotal disease.