OBJECTIVE: The purpose of this study is to determine neurotrophin effect in Fe++-induced experimental spinal cord injury in adult female rat. METHOD: Thirty Long-Evans rats (weight, 250 to 300 gr) were divided into 6 groups. Group I was control group. Group II was Fe-only group. Group III was NGF-only group. Group IV was NGF-Fe group. Group V was NT4-only group. Group VI was NT4-Fe group. For all experimental animals spinal cord was exposed by T10 laminectomy. Neurtrophin and Fe++ was injected at spinal cord directly by glass needle with ~100 um diameter mounted on Hamilton syringe. Animals were sacrificed, spinal cord was extracted and prepared in sagittal section. Tissues were stained with LFB, NeuN and APC staining method. The amount of spinal cord damage was measured at 3 different locations under the microscope. RESULTS: Fe-only group showed more damage than the control group. NGF-only group showed the same result as the control group. NT4-only group showed more damage than the control group in LFB staining. NGF-Fe group showed the same result as Fe-only group. NT4-Fe group showed more damage than Fe-only group. CONCLUSION: NGF has no additional effect, but NT4 potentiated Fe toxicity in Fe-induced experimental spinal cord injury. NT4 seems to be toxic to rat spinal cord in high dose.
Adult ; Animals ; Female ; Glass ; Humans ; Laminectomy ; Models, Animal ; Needles ; Nerve Growth Factor ; Rats* ; Rats, Long-Evans ; Spinal Cord Injuries* ; Spinal Cord* ; Syringes

The evaluation of peripheral nerve disorders has traditionally relied on clinical history, physical examination and electrodiagnostic studies. The electrodiagnostic study is currently the most popular procedure to analyse the nerve lesion, but it is painful and its result is operator dependent. The purpose of this study is to evaluate the significance of MRI signal change of denervated muscle in peripheral nerve as an adjuvant study of electrodiagnostic study. After the compression of sciatic nerves in 20 rabbits and severance of scitic nerve in 10 rabbits, the signal change of both T1WI(TR; 450 msec, TE; 15 msec) and T2WI(TR; 3,000 msec TE; 90 msec) of calf muscles were compared with EMG findings of the same muscles. Signal intensity ratio(SIR) of calf muscles was measured and compaired with the grade of abnormal spontaneous activity in the same muscles in needle EMG study. Serial studies were done on 4th day, 1 week, 2 weeks, 3 weeks, 4 weeks, 6 weeks, 8 weeks, 10 weeks after sciatic nerve injury. Among 25 rabbits showing abnormal spontaneous activity in needle EMG, the signal intensity of both T1WI and T2WI was increased in 13 rabbits. The signal intensity began to increase at 1 week in 10 rabbits and 2 weeks in 3 rabbits following nerve injury which was about 1 week later than appearance of abnormal spontaneous activity in needle EMG study. There were no signal intensity increase in rabbits which showed no abnormal spontaneous activity in needle EMG study. The signal intensity ratio and grade of abnormal spontaneous activity had a good correlation(Spearman's correlation coefficiency : 0.635). The signal intensity of 3 rabbits which showed regeneration evidence in needle EMG study returned to normal. These findings suggest that MRI study of denervated muscle can be used as an evaluation method for severe peripheral nerve injury, howeverits value is doubtful in mild peripheral nerve injury.
Magnetic Resonance Imaging* ; Muscles ; Needles ; Peripheral Nerve Injuries ; Peripheral Nerves ; Physical Examination ; Rabbits ; Regeneration ; Sciatic Nerve*

Acute spinal cord injury (SCI) is a catastrophic traumatic event that affects the physical and psychological well-being of individuals and results in considerable socio-economic losses. SCI is an incurable condition; therefore, prevention is critical. Thorough understanding of the epidemiology of SCI is essential to implement optimal preventive measures and effectively plan clinical services. The incidence of SCI was 54 and 40.2 cases per million population in the United States and Japan, respectively; however, national statistical data regarding SCI are unavailable in Korea. Considering that the incidence in Korea is similar to that observed in the United States or Japan, it is estimated that 2,000 to 2,500 new cases of SCI are observed in Korea annually. The male:female ratio is 3:1 to 5:1 in most countries and 3:1 in Korea. More than 50% of patients with SCI are aged <30 years at the time of the injury. However, the incidence of SCI is rapidly increasing in elderly individuals and in women. The most common causes of SCI in descending order of frequency include traffic accidents, falls, sports injuries, and violence. Incomplete injury is increasingly being observed in recent times in contrast to a higher incidence of complete injury reported previously. It is important to establish an accurate comprehensive statistical database in Korea, similar to The National Spinal Cord Injury Statistical Center, USA.

Spinal cord injury (SCI) may lead to urinary system disturbances. Patients with SCI usually have neurogenic bladder, and treatment optionss for this condition include clean intermittent catheterization and a permanent indwelling urethral or suprapubic catheter. Complications of catheterization include urinary tract infection, calculi, urinary tract injury, bladder contraction, bladder spasm, renal dysfunction, bladder cancer, and so forth. To the best of our knowledge, ureteral rupture is an unusual complication of catheterization, and ureteral rupture has been rarely reported in SCI patients. Therefore, here we report a case of ureteral rupture caused by a suprapubic catheter used for the treatment of neurogenic bladder with vesicoureteral reflux in a male patient with SCI. Due to SCI with neurogenic bladder, ureteral size can be reduced and the suprapubic catheter tip can easily migrate to the distal ureteral orifice. Thus, careful attention is required when a catheter is inserted into the bladder in patients with SCI.
Catheterization ; Catheters* ; Humans ; Intermittent Urethral Catheterization ; Male* ; Rupture* ; Spasm ; Spinal Cord Injuries* ; Spinal Cord* ; Ureter* ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Bladder, Neurogenic ; Urinary Calculi ; Urinary Catheterization ; Urinary Tract Infections ; Vesico-Ureteral Reflux

The evaluation of peripheral nerve disorders has traditionally relied on clinical history, physical examination, and electrodiagnostic studies. The electrodiagnostic study is currently most popular procedure. The purpose of this study is to assess the significance of the changes of amplitude and area of compound muscle action potentials(CMAPs) in peripheral nerve injury. After compression of sciatic nerve in 65 Korean house rabbits, the amplitude and the area of CMAPs were compared to each other before and after compression injury. The correlation coefficients between the changes of the parameters, amplitude and area, were obtained at a scheduled interval, and the parameters were also assessed when the evidence of denervation and regeneration was seen. In addition, the relationship between the degree of abonormal spontaneous activities and each parameter was assessed. At preinjury state, there was a significantly high correlationship between two parameters. The correlation coefficients were 0.764 and 0.756 with distal and proximal stimulations respectively in abductor hallucis recordings, and 0.649 in gastrocnemius recording. At postinjury, there was more significant high correlationship between two parameters. The correlation coefficients were 0.955 and 0.962 with distal and proximal stimulations respectively in abductor hallucis recordings, and 0.930 in gastrocnemius recording. Nineteen cases showed denervation activities at postinjury 4th day. Of those cases, the amplitude was decreased earlier in 2 cases and the area in 3 cases at the same day. Of 10 cases regenerated, the amplitude was normalized earlier than the area in 2 cases. There was a significant decrement tendency in both amplitude and area with the degree of abnormal spontaneous activities. Therefore, both the amplitude and the area of CMAPs are good quantitative indices of peripheral neuropathy and useful parameters in long-term follow up study.
Action Potentials* ; Denervation ; Follow-Up Studies ; Peripheral Nerve Injuries* ; Peripheral Nerves* ; Peripheral Nervous System Diseases ; Physical Examination ; Rabbits ; Regeneration ; Sciatic Nerve

BACKGROUND: Remifentanil requires a long acting agent for postoperative pain control, and Nalbuphine, a long acting agonist-antagonist, causes less respiratory depression than pure mu-agonists. However, Nalbuphine can also cause additional distress when used with a pure mu-agonist. Therefore, we evaluated the effects of nalbuphine during TIVA with remifentanil and propofol. METHODS: 56 ASA class I, II adult patients undergoing minor surgery were included in this study. After maintaining BIS values between 40-60 as well as a relatively similar blood pressure (BP) and heart rate (HR) for 20 minutes without changing the target concentrations of anesthesia during surgical procedures, the subjects received either 0.1 ml/kg of normal saline or nalbuphine intravenously. Hemodynamic and BIS variables were then recorded for 20 minutes, during which time the target concentrations were not modified. The BIS values, heart rate, and mean arterial pressure were then compared between groups using t-tests, with a P < 0.05 being considered statistically significant. RESULTS: The mean BIS and HR measured at each interval in the nalbuphine group were not significantly different from those of the control group. However, 10, 15 and 20 minutes after the administration of nalbuphine, the mean systolic BP and the mean arterial BP of the treatment and control groups were significantly different (P < 0.05). In addition, the mean diastolic BP was also significantly different 10 and 20 minutes after the treatment was administered (P < 0.05). Postoperative pain was well controlled and none of the patients reported intraoperative awareness. CONCLUSIONS: Although nalbuphine seems to cause distress, which appeared as an increase in BP, it may still be used in combination with propofol and remifentanil because it did not cause a significant increase in the HR and BIS values.
Adult ; Anesthesia ; Anesthesia, Intravenous* ; Arterial Pressure ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intraoperative Awareness ; Nalbuphine* ; Pain, Postoperative ; Propofol* ; Respiratory Insufficiency ; Surgical Procedures, Minor

OBJECTIVE: To assess the intra-rater and inter-rater reliability for measuring femoral anteversion angle (FAA) by a radiographic method using three-dimensional computed tomography reconstruction (3D-CT). METHODS: The study included 82 children who presented with intoeing gait. 3D-CT data taken between 2006 and 2014 were retrospectively reviewed. FAA was measured by 3D-CT. FAA is defined as the angle between the long axis of the femur neck and condylar axis of the distal femur. FAA measurement was performed twice at both lower extremities by each rater. The intra-rater and inter-rater reliability were calculated by intraclass correlation coefficient (ICC). RESULTS: One hundred and sixty-four lower limbs of 82 children (31 boys and 51 girls, 6.3±3.2 years old) were included. The ICCs of intra-rater measurement for the angle of femoral neck axis (NA) were 0.89 for rater A and 0.96 for rater B, and those of condylar axis (CA) were 0.99 for rater A and 0.99 for rater B, respectively. The ICC of inter-rater measurement for the angle of NA was 0.89 and that of CA was 0.92. By each rater, the ICCs of the intrarater measurement for FAA were 0.97 for rater A and 0.95 for rater B, respectively and the ICC of the inter-rater measurement for FAA was 0.89. CONCLUSION: The 3D-CT measures for FAA are reliable within individual raters and between different raters. The 3D-CT measures of FAA can be a useful method for accurate diagnosis and follow-up of femoral anteversion.
Axis, Cervical Vertebra ; Bone Anteversion ; Child ; Diagnosis ; Female ; Femur ; Femur Neck ; Follow-Up Studies ; Gait ; Humans ; Imaging, Three-Dimensional ; Lower Extremity ; Retrospective Studies

Noonan syndrome is a condition involving facial, cardiovascular and skeletal abnormalities that may pose problems to anesthesiologists during surgery. Propofol, which is used as an induction agent for noncardiac surgery, produces little or no change in the heart rate. Remifentanil decreases the sympathetic and somatic responses to noxious stimuli and can be given in high doses without negative inotropic effects. We report successful management of a patient with Noonan syndrome, hypertrophic cardiomyopathy, and atrial fibrillation, undergoing laparoscopic cholecystectomy using the the total intravenous anesthesia with propofol and remifentanil.
Anesthesia, Intravenous* ; Atrial Fibrillation ; Cardiomyopathy, Hypertrophic ; Cholecystectomy, Laparoscopic ; Heart Rate ; Humans ; Noonan Syndrome* ; Propofol

Medial antebrachial cutaneous (MABC) nerve injury associated with iatrogenic causes has been rarely reported. Local anesthesia may be implicated in the etiology of such injury, but has not been reported. Two patients with numbness and painful paresthesia over the medial aspect of the unilateral forearm were referred for electrodiagnostic study, which revealed MABC nerve lesion in each case. The highly selective nature of the MABC nerve injuries strongly suggested that they were the result of direct nerve injury by an injection needle during previous brachial plexus block procedures. Electrodiagnostic studies can be helpful in evaluating cases of sensory disturbance after local anesthesia. To our knowledge, these are the first documented cases of isolated MABC nerve injury following ultrasound-guided axillary brachial plexus block.
Anesthesia, Local ; Brachial Plexus* ; Electrodiagnosis ; Forearm ; Humans ; Hypesthesia ; Needles ; Paresthesia ; Peripheral Nerve Injuries

PURPOSE: This study investigated visual acuity (VA) values and differences depending on optical coherence tomography (OCT) findings in patients with acute central retinal artery occlusion (CRAO). METHODS: A retrospective chart review was performed on patients with acute CRAO who underwent macular and disc OCT. We evaluated changes in macular thickness and retinal nerve fiber layer (RNFL) thickness after acute CRAO onset based on OCT. We also determined the association of thickness changes with VA improvement. RESULTS: This study involved both eyes in a total of 12 patients with acute CRAO. A significant increase was observed in foveal (1 mm) thickness (p = 0.002), parafoveal (3 mm) thickness (p = 0.002), and peripapillary RNFL thickness (p = 0.005) in affected eyes with CRAO, but not in central foveal thickness (p = 0.266). A significant small difference in both eyes (affected eye – fellow eye) was shown in foveal (1 mm) and mean parafoveal (3 mm) thickness in the improved VA group (p = 0.008 and p = 0.004, respectively), but not in central foveal or peripapillary RNFL thickness (both p = 0.283). CONCLUSIONS: Both macular and RNFL thickness increased in patients with acute CRAO. RNFL thickness decreased over time with progression of RNFL atrophy. Less macular damage caused by acute CRAO could be predicted by a small difference in macular thickness between eyes (affected eye – fellow eye). In such cases, patients had a greater chance of VA improvement.
Atrophy ; Humans ; Nerve Fibers ; Retinal Artery Occlusion* ; Retinal Artery* ; Retinaldehyde ; Retrospective Studies ; Tomography, Optical Coherence* ; Visual Acuity