BACKGROUND: The pathophysiological and neurochemical changes following spinal injury are not yet elucidated. This study was designed to evaluate the morphological changes of the dorsal horn of the spinal cord and profiles of pain behaviors following intraspinal injection of NMDA in rats. METHODS: Rats were randomized into three groups: a sham-operated control group and groups where the rats received 10 mM or 100 mM N-methyl-D-aspatate (NMDA) injected into their spinal dorsal horn. Following injection, hypersensitivity to cold and mechanical stimuli and excessive grooming behaviors were assessed serially for four weeks. Morphological changes of the spinal cord were evaluated four weeks after intraspinal injection. RESULTS: Few animals in the NMDA groups developed hypersensitivity to cold and mechanical stimuli. The number of groomers and the severity of excessive grooming were significantly higher in the 100 mM NMDA group than those values of the control and 10 mM NMDA groups. The size of the neck region (lamina III-IV) was significantly smaller in the 100 mM NMDA group than in the control and 10 mM NMDA groups. CONCLUSIONS: In conclusion, intraspinal injection of NMDA in rats leads to the pathological sequela in the spinal cord and to excessive grooming behavior. These results support the use of NMDA and excessive grooming behavior after excitotoxic SCI as a model to study chronic pain after SCI.
Animals ; Chronic Pain ; Cold Temperature ; Grooming ; Horns ; Hypersensitivity ; Injections, Spinal ; N-Methylaspartate ; Neck ; Pilot Projects ; Rats ; Spinal Cord ; Spinal Cord Injuries ; Spinal Injuries

BACKGROUND: The Family Adaptability and Cohesion Evaluation Scale (FACES) III using the circumplex model has been widely used in investigating family function. However, the criticism of the curvilinear hypothesis of the circumplex model has always been from an empirical point of view. This study examined the relationship between adolescent adaptability, cohesion, and adolescent problem behaviors, and especially testing the consistency of the curvilinear hypotheses with FACES III. METHODS: We used the data from 398 adolescent participants who were in middle school. A self-reported questionnaire was used to evaluate the FACES III and Youth Self Report. RESULTS: According to the level of family adaptability, significant differences were evident in internalizing problems (P = 0.014). But, in externalizing problems, the results were not significant (P = 0.305). Also, according to the level of family cohesion, significant differences were in internalizing problems (P = 0.002) and externalizing problems (P = 0.004). CONCLUSION: The relationship between the dimensions of adaptability, cohesion and adolescent problem behaviors was not curvilinear. In other words, adolescents with high adaptability and high cohesion showed low problem behaviors.
Adaptation, Psychological ; Adolescent ; Adolescent Behavior ; Family Relations ; Humans ; Korea

BACKGROUND: Patient controlled analgesia (PCA) is now a widely accepted method of postoperative pain control. It usually begins at postanesthetic care unit, but it takes time to achieve satisfactory level. We have studied the differences in the onset of analgesic effects between starting PCA preoperatively and starting PCA postoperatively. METHODS: Forty patients for subtotal gastrectomy were randomized to two groups. In group I, we started PCA at postanesthetic care unit, in group II, PCA was begun immediately after the induction of anesthesia. We visited each patient and measured 10 cm-visual analgue scale (VAS) score at 3, 6, 9, 12 and 15 hours after the end of operation. We also measured the time taken from the end of operation to extubation. RESULTS: There were no differences in VAS score between two groups on 3 hour. But at 6, 9, and 12 hour, VAS score was significantly lower in group II (P < 0.05). On 15 hour there was no difference between two groups again. There was no significant difference in extubation time between two groups. Preemptive analgesia was not observed in group II. CONCLUSIONS: We concluded that starting PCA immediately after induction of anesthesia can achieve effective analgesia more rapidly than starting PCA at postanesthetic care unit. VAS score was lower than 3 after 12 hours after the end of operation in group II and we speculated that starting PCA 15 hours prior to operation would maximize the analgesic effect of PCA because there was approximately three hours time difference between the two groups.
Analgesia ; Analgesia, Patient-Controlled* ; Anesthesia ; Gastrectomy ; Humans ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Visual Analog Scale

Glossopharyngeal neuralgia (GPN) is a pain syndrome characterized by unilateral sharp pain in the sensory distribution of the ninth cranial nerve. The first line of treatment for GPN is medical. However, it usually provides only partial relief. Pulsed radiofrequency has been proposed as safe, nondestructive treatment method. We present two cases of secondary GPN that was managed with pulsed radiofrequency by extraoral approach. The results were satisfactory.
Glossopharyngeal Nerve ; Glossopharyngeal Nerve Diseases* ; Neuralgia ; Pulsed Radiofrequency Treatment*

Biplane fluoroscopy is usually used in angiography. Biplane fluoroscopy gives a biplane image with high resolution during the performance of operations. Trigeminal nerve blocks are effective treatment modalities for trigeminal neuralgia, and maxillary nerve block is the most dangerous procedure among them. The anatomic structures can change after head and neck surgery, so the trigeminal nerve block procedures cannot be done so easily. We used biplane fluoroscopy in these difficult cases. Our first case was a 60-year-old man who had undergone maxillary nerve block. The second case was of a 64-year-old man who had pulsed radiofrequency lesioning of mandibular nerve performed after head and neck surgery. With biplane fluoroscopy, we got good results without any complications.
Angiography ; Fluoroscopy* ; Head ; Humans ; Mandibular Nerve* ; Maxillary Nerve* ; Middle Aged ; Neck ; Trigeminal Nerve ; Trigeminal Neuralgia

Cervical radicular pain has been recognized as a common cause of neck, shoulder and arm pain. The initial recommended therapy is based on the medical treatment by anti-inflammatory, analgesic agents, rest, traction and physical therapy. In the case of failure with these therapies, the classical alternative is a surgical discectomy, but this is associated with numerous risks inherent to invasive procedures. As a result, a number of percutaneous intradiscal therapies have developed over the last 3 decades, which have specifically focused on the pathology of the disc. However, these treatments have considerable limitations and success rates, and none allow for the extraction of a quantifiable amount of nucleus pulposus via a 17 gauge introducer using fluoroscopic guidance alone. Herein, we describe our experience using a Dekompressor(R) on a 52 year-old female patient with a cervical disc herniation. Percutaneous decompression in the treatment of cervical disc herniation was successfully performed, with a good outcome.
Analgesics ; Arm ; Decompression ; Diskectomy* ; Female ; Humans ; Middle Aged ; Neck ; Pathology ; Shoulder ; Traction

PURPOSE: HBV prophylaxis is necessary to prevent de novo hepatitis B infection from HBcAb positive donors. However, it is somewhat controversial in which protocol is more effective, and whether it is necessary to administer the HBV prophylaxis for HBsAb positive recipients. In this study, we attempted to elucidate whether it is necessary to administer the HBV prophylaxis for HBsAb positive patients and to evaluate the efficacy of HBIG monotherapy protocol. METHODS: From May 1996 to July 2001, 58 donors (45.3%) were HBcAb positive among 128 donors who were examined for HBcAb. Eighteen HBcAb positive grafts were transplanted to HBsAg negative recipients. Four patients died of unrelated causes were excluded. Of 14 study cases, 12 recipients were HbsAb positive, and 2 were negative. Among 12 HBsAb positive recipients, 3 were HbcAb positive simultaneously. In early period (Nov. 1997~Nov. 1998), only HBV vaccination was applied for de novo infection prophylaxis. In late period (since Dec. 1998), regardless of HBsAb positivity in recipients, HBIG was administered from the beginning of liver transplantation. RESULTS: The overall de novo HBV infection from HBcAb positive donors was 21.4 % (3/14). All 3 recipients without HBIG prophylaxis presented de novo HBV infection. Two of them were HBsAb positive postoperatively. No de novo HBV infection occurred in recipients with HBIG prophylaxis. CONCLUSION: It is necessary to administer the HBV prophylaxis even for vaccinated HBsAb positive patients and HBIG monotherapy protocol is effective to prevent de novo hepatitis B infection from HBcAb positive donors in living donor liver transplantation.
Hepatitis B Surface Antigens ; Hepatitis B* ; Hepatitis* ; Humans ; Liver Transplantation* ; Liver* ; Living Donors* ; Tissue Donors* ; Transplantation ; Transplants ; Vaccination

BACKGROUND: Transpedicular percutaneous vertebroplasty, along with kyphoplasty of the thoracic vertebrae, is technically more difficult than those of the lumbar vertebrae due to the anatomical differences. During the last four years, all the percutaneous vertebroplasty and kyphoplasty of the thoracic vertebrae carried out at our institution were performed using a transpedicular approach; therefore, we tried to find if there were any problems or complications associated with the process. METHODS: The medical records of all the patients who had undergone thoracic percutaneous vertebroplasty or kyphoplasty were retrospectively reviewed. The following were looked up: the procedure name, unipedicular or bipedicular, the level of the thoracic vertebrae treated, and the pre- and postoperative changes in the Visual Analog Scales (VAS), the volume of cement injected and complications. RESULTS: In the last four years, 58 vertebral bodies in 58 patients were treated. Twelve and 46 vertebral bodies were treated by kyphoplasty and vertebroplasty, respectively. A total of 58 mid and lower thoracic levels were treated: T5 (n=1), T6 (n=1), T7 (n=3), T8 (n=4), T9 (n=1), T10 (n=4), T11 (n=14) and T12 (n=30). The mean preoperative and postoperative VAS scores were 8.1+/-1.4 and 5.2+/-1.7, respectively. The mean volume of cement injected was 4.01+/-1.85 ml; 3.18+/-0.60 ml at T5-8 and 4.22+/-2.27 ml at T9-12. There were no clinical complications, such as pedicular fracture or cement leakage. CONCLUSIONS: Although transpedicular vertebroplasty and kyphoplasty at the mid to lower thoracic vertebral bodies is technically difficult compared to that at the lumbar region, the procedures can be performed safely.
Humans ; Kyphoplasty* ; Lumbar Vertebrae ; Lumbosacral Region ; Medical Records ; Retrospective Studies ; Thoracic Vertebrae ; Vertebroplasty* ; Visual Analog Scale

BACKGROUND: Discogenic leg pain is a major cause of health problems, often due to herniation of the intervertebral disc, and has traditionally been treated conservatively or with an open surgical discectomy. Conventional open surgery has many complications, such as nerve root injury, discitis and a relatively high mortality rate; failure of conservative treatments is also common. Recently, the Dekompressor(R) Percutaneous Lumbar Discectomy probe was developed. Herein, we present the early results for a percutaneous lumbar discectomy in herniated lumbar disc disease. METHODS: Eleven patients, including 8 men and 3 women, with ages ranging from 22 to 78 years, were enrolled in this study. Those patients with a previous history of back surgery were not excluded from the study. All patients were postoperatively evaluated for their clinical outcomes, such as visual analogue scale (VAS) for pain after 1 and 3 months, reduction in analgesics, functional improvement and overall satisfaction. RESULTS: The percutaneous lumbar discectomy was completed in 11 patients (17 levels), with average reductions in pre-VAS of 61.3 and 60.2% at 1 and 3 months, respectively. Also, 72.7% of patients reported functional improvement, with 81.1% expressing overall satisfaction. There were no procedural related complications. CONCLUSIONS: We concluded that a percutaneous lumbar discectomy is a safe and effective treatment modality for a herniated lumbar disc.
Analgesics ; Discitis ; Diskectomy* ; Female ; Humans ; Intervertebral Disc ; Leg ; Male ; Mortality

BACKGROUND: We investigated the effect of spinal cord stimulation on intractable chronic pain retrospectively and report our 5-year experience. METHODS: 49 patients with the medical history of trial spinal cord stimulation have been retrospectively analyzed. They consist of 34 men and 15 women, ranging in age from 22 to 89 years. Causes of intractable chronic pain included postherpetic neuralgia, failed back surgery syndrome, complex regional pain syndrome, chronic back and leg pain, cauda equina syndrome, perineal pain, diabetic polyneuropathy, and spinal cord injury. RESULTS: The pain due to failed back surgery syndrome, complex regional pain syndrome, chronic low back and leg pain, and spinal cord injury was well controlled by using spinal cord stimulation system. After a trial period of stimulation, 20 patients had permanent stimulators implanted. Most of them reported satisfactory pain relief for maximum 60 months and minimum 9 months. Noticeable complications included electrode displacement and hemorrhage. CONCLUSIONS: We may suggest that spinal cord stimulation is an effective and safe therapy for chronic intractable pain.
Chronic Pain* ; Diabetic Neuropathies ; Electrodes ; Failed Back Surgery Syndrome ; Female ; Hemorrhage ; Humans ; Leg ; Male ; Neuralgia, Postherpetic ; Pain, Intractable ; Polyradiculopathy ; Retrospective Studies ; Spinal Cord Injuries ; Spinal Cord Stimulation* ; Spinal Cord*