Animal models for human chronic pain syndromes were developed and widely used for pain research. One of thsese neuropathic pain model by Kim and Chung[1992] has many advantages for operation and pain elicitation. We have examined the c-fos protein, substance P, CGRP immunoreactivity in dorsal root ganglia and dorsal horn in this neuropathic model. About 50 Sprague-Dawley rats were used for this study. L5 and L6 spinal nerve were ligated tightly to produce neuropathic pain model. After 2, 4, 8, 16, 24 hours and 1 week of surgery, rats were anesthesized and sacrificed by perfusion through the left ventricle with saline followed by 0.1M phosphate buffer[pH 7.4] containing 3% paraformaldehyde, 3% glutaraldehyde, and 0.1% picric acid. After confirmation of the roots transected by the surgery, the L5 and L6 dorsal root ganglion and spinal cord were removed and processed for immunohistochemistry. All tissue sections were immunohistochemically stained for substance P, CGRP and c-fos by using the peroxidase-antiperoxidase[PAP] method. Count the number of immunostained substance P and CGRP dorsal root ganglion cells and c-fos immunoreactive dorsal horn cells and analyzed statistically with Mann-Whitney U test. The results are as follows. 1. The number of c-fos protein immunoreactive neurons in the superficial layer of dorsal horn were increased markedly at 2 hours after operation, gradually decreased to normal level 1 week after operation. 2. The number of c-fos protein immunoreactive neurons in the deep layer of dorsal horn were gradually increased to the peak 24 hours after operation, decreased to normal level 1 week after operation. 3. The number of substance P and CGRP immunoreactive L5 and L6 dorsal root ganglion neurons were decreased markedly at 1 week after pain model operation. In conclusion, after neuropathic pain model operation, c-fos protein were immediately expressed in the superficial layer of spinal dorsal horn, thereafter c-fos protein in the deep layer of spinal dorsal horn were expressed. CGRP and substance P immunoreactive neurons were decreased markedly 1 week after neuropathic pain model operation.
Animals ; Chronic Pain ; Ganglia, Spinal* ; Glutaral ; Heart Ventricles ; Horns* ; Humans ; Immunohistochemistry ; Models, Animal ; Neuralgia ; Neurons* ; Perfusion ; Peripheral Nervous System Diseases* ; Posterior Horn Cells ; Rats* ; Rats, Sprague-Dawley ; Spinal Cord ; Spinal Nerve Roots* ; Spinal Nerves ; Substance P

This study was performed to evaluate the sedative and analgesic effects of xylazine (X) and tramadol (T) intravenously (IV) administered to horses. Six thoroughbred saddle horses each received X (1.0 mg/kg), T (2.0 mg/kg), and a combination of XT (1.0 and 2.0 mg/kg, respectively) IV. Heart rate (HR), respiratory rate (RR), rectal temperature (RT), indirect arterial pressure (IAP), capillary refill time (CRT), sedation, and analgesia (using electrical stimulation and pinprick) were measured before and after drug administration. HR and RR significantly decreased from basal values with X and XT treatments, and significantly increased with T treatment (p < 0.05). RT and IAP also significantly increased with T treatment (p < 0.05). CRT did not change significantly with any treatments. The onset of sedation and analgesia were approximately 5 min after both X and XT treatments; however, the XT combination produced a longer duration of sedation and analgesia than X alone. Two horses in the XT treatment group displayed excited transient behavior within 5 min of drug administration. The results suggest that the XT combination is useful for sedation and analgesia in horses. However, careful monitoring for excited behavior shortly after administration is recommended.
Analgesics, Opioid/administration & dosage/*pharmacology ; Animals ; Blood Pressure ; Drug Therapy, Combination ; Female ; Heart Rate ; Horses/*physiology ; Hypnotics and Sedatives/administration & dosage/*pharmacology ; Male ; Respiratory Rate ; Tramadol/administration & dosage/*pharmacology ; Xylazine/administration & dosage/*pharmacology

OBJECTIVE: The purpose of this study is to document the prevalence and patterns of use of alternative therapies and effectiveness in a rehabilitation medicine outpatient practice. METHOD: This study was performed that a random sample of 200 patients of rehabilitation outpatient were given a questionnaire addressing their use of alternative therapies. RESULTS: One or more alternative therapies had been used by 51.3% of subjects for their presenting problem. The most common therapies were acupuncture, oriental medicine, chiropractic and massage. Musculoskeletal pain syndrome involving the low back and shoulder were the most common problems of use of alternative therapies. Of the patients who used alternative treatments, 40.2% reported some degree of efficacy. CONCLUSION: A significant proportion of rehabilitation outpatients use alternative therapies and frequently perceived a benefit from them. Incorporating alternative therapies into physiatric practice is a desirable future direction for the speciality.
Acupuncture ; Chiropractic ; Complementary Therapies* ; Humans ; Massage ; Medicine, East Asian Traditional ; Musculoskeletal Pain* ; Outpatients* ; Prevalence ; Surveys and Questionnaires ; Rehabilitation* ; Shoulder

OBJECTIVE: The purposes of this study are to find out the characteristics of patients with pain in outpatient practice of rehabilitation medicine and to provide basic data for outpatient management. METHOD: We surveyed a hundred one outpatient practices with questionnaire including the distribution of diagnosis, pain site, disease related with pain, pain treatment method, etc. RESULTS: 1) Distribution of diagnosis was traumatic brain injury (TBI) 10.5%, stroke 14.8%, spinal cord injury (SCI) 10.8%, musculoskeletal disorder (MSD) 55.8% and others 8.1% in training hospital, and TBI 6.7%, stroke 10.6%, SCI 14.0%, MSD 58.7% and others 10.0% in non-training general hospital, and TBI 2.6%, stroke 4.9%, SCI 2.9%, MSD 78.3% and others 11.3% in private clinic. 2) The most common site of pain was low back area. 3) The most common disease related with pain was myofascial pain syndrome. 4) Trigger point injection and physical therapy were performed for pain treatment in most of outpatient practice, whereas local injection and nerve block were less used. CONCLUSION: We believe that this study's results will provide helpful basic-data for management of outpatient with pain.
Brain Injuries ; Diagnosis ; Hospitals, General ; Humans ; Myofascial Pain Syndromes ; Nerve Block ; Outpatients* ; Surveys and Questionnaires ; Rehabilitation* ; Spinal Cord Injuries ; Stroke ; Trigger Points

Following intravenous (IV) administration of diazepam as a preanesthetic agent, sudden balance impairment, such as falling, leaning, and rolling, was identified in 2 canine cases. The 2 dogs were anesthetized for brain magnetic resonance scan to diagnose about a history of head tilt. After end of the diagnostic procedures, during the anesthetic recovery period, balance impairment was also observed. However, the symptoms gradually ceased by IV administration of flumazenil. These 2 canine cases indicated that diazepam premedication was responsible for the acute balance impairment.

Background: Studies on anesthetized dogs regarding pulse pressure variation (PPV) are increasing. The influence of respiratory rate (RR) on PPV, in mechanically ventilated dogs, has not been clearly identified. Objectives: This study evaluated the influence of RR on PPV in mechanically ventilated healthy dogs after hemorrhage. Methods: Five healthy adult Beagle dogs were premedicated with intravenous (IV) acepromazine (0.01 mg/kg). Anesthesia was induced with alfaxalone (3 mg/kg IV) and maintained with isoflurane in 100% oxygen. The right dorsal pedal artery was cannulated with a 22-gauge catheter for blood removal, and the left dorsal pedal artery was cannulated and connected to a transducer system for arterial blood pressure monitoring. The PPV was automatically calculated using a multi-parameter monitor and recorded. Hemorrhage was induced by withdrawing 30% of blood (24 mL/kg) over 30 min. Mechanical ventilation was provided with a tidal volume of 10 mL/kg and a 1:2 inspiration-to-expiration ratio at an initial RR of 15 breaths/min (baseline). Thereafter, RR was changed to 20, 30, and 40 breaths/min according to the casting lots, and the PPV was recorded at each RR. After data collection, the blood was transfused at a rate of 10 mL/kg/h, and the PPV was recorded at the baseline ventilator setting. Results: The data of PPV were analyzed using the Friedman test followed by the Wilcoxon signed-rank test (p < 0.05). Hemorrhage significantly increased PPV from 11% to 25% at 15 breaths/min. An increase in RR significantly decreased PPV from 25 (baseline) to 17%, 10%, and 10% at 20, 30, and 40 breaths/min, respectively (all p < 0.05). Conclusions The PPV is a dynamic parameter that can predict a dog’s hemorrhagic condition, but PPV can be decreased in dogs under high RR. Therefore, careful interpretation may be required when using the PPV parameter particularly in the dogs with hyperventilation.

BACKGROUND: This study was to verify the necessity of a control program developed to improve compliance, by conducting a research on the status of medication compliance in the elderly with chronic diseases in rural area and analyzing the related variables. METHODS: The organized questionnaire and pill-count were used to collect information on personal details, physical status, drugs taken in the elderly over 65 years old suffering from more than two chronic diseases in one rural area. RESULTS: The mean age of the subjects was 73.13+/-6.36 (65~93), and the number of the subjects in compliance group was 60 (77.9%) and the accuracy of self-report which was identified by pill-count was 0.86. Polypharmacy and visiting several clinics were the main factors that decided a low- degree of compliance, with OR of 5.92 (95% CI 1.11~31.44, P=0.037), and 4.25 (95% CI 1.03~17.53, P=0.045), respectively. CONCLUSION: Systematic efforts are necessary and plans must be established without delay to increase compliance in the elderly in the rural, expansively to manage chronic diseases in stay-at-home elders.
Aged ; Chronic Disease ; Compliance ; Humans ; Medication Adherence ; Polypharmacy ; Republic of Korea ; Stress, Psychological ; Surveys and Questionnaires

BACKGROUND: Direct measurements of ionized magnesium (iMg) in serum by ion-selective electrodes have recently become available in clinical practice, and its usefulness needs to be investigated in dialysis patients because chronic renal failure is associated with disturbances in magnesium metabolism. METHODS: We measured serum iMg in 29 hemodialysis (HD) patients and 24 peritoneal dialysis (CAPD) patients using an ion-selective electrode. The results were compared with those from 30 age- matched control patients who were admitted due to non-renal diseases and were confirmed to have normal serum total magnesium (tMg) levels. RESULTS: Serum tMg was significantly higher in both HD (0.95 [0.81-1.06] mmol/L) and CAPD (0.86 [0.74-0.99] mmol/L) patients compared with the controls (0.74 [0.70-0.78] mmol/L). Serum iMg was significantly higher in HD patients (0.65 [0.60-0.72] mmol/L) compared with the controls (0.55 [0.51-0.57] mmol/L), but was not higher in CAPD patients (0.54 [0.50-0.60] mmol/L). Thus, the ionized fraction of serum magnesium (iMg/tMg) was significantly lower in CAPD patients (65.3 [58.8-68.2]%), but not in HD patients (68.7 [63.6-77.0]%), compared with the controls (72.2 [67.2-78.3]%). In dialysis patients, iMg/ tMg was significantly lower in those with residual renal function than in anuric patients (67.5 [63.6-74.8]% vs. 61.4 [56.4-70.7]%). CONCLUSION: In current practice, true hypermagnesemia may exist frequently in HD patients (at predialysis), but not in CAPD patients. The ionized fraction of serum magnesium may be reduced in CAPD patients, but not in HD patients.
Dialysis* ; Humans ; Ion-Selective Electrodes ; Kidney Failure, Chronic ; Magnesium* ; Metabolism ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Renal Dialysis

BACKGROUND AND OBJECTIVES: Chronic kidney disease (CKD) is known to be a major adverse predictor in diabetes mellitus (DM) patients undergoing percutaneous coronary intervention (PCI). It is expected that the use of newer-generation drug-eluting stents (DES) would improve clinical outcomes in these patients. We evaluated the impact of CKD on clinical outcomes in diabetic patients undergoing PCI using newer-generation DES in a real-world setting. SUBJECTS AND METHODS: A total of 887 patients who underwent PCI with newer-generation DES and who had a history of DM or HbA1c >6.5% at the time of hospitalization were analyzed. These patients were divided into groups without CKD (n=549) and with CKD (n=338). Among survivors at discharge, a patient-oriented composite outcome (POCO) including all-cause mortality, myocardial infarction (MI), and revascularization was evaluated, together with a device-oriented composite outcome (DOCO) including cardiac death, target vessel-related MI, and target lesion revascularization at a follow-up period of one year. RESULTS: The incidence of POCO (5.4% vs. 14.0%, log-rank p<0.001) and DOCO (1.1% vs. 4.1%, log-rank p<0.001) was higher in patients with CKD. According to multivariate analysis, which was adjusted for baseline differences in demographic, clinical, and angiographic factors, the presence of CKD was an independent predictor of POCO (hazard ratio [HR]: 1.82, 95% confidence interval [CI]: 1.07 to 3.12), but not of DOCO (HR 2.08, 95% CI: 0.69-6.28). CONCLUSION: In DM patients, CKD is an independent and powerful predictor of patient-related outcomes, but not of device-related outcomes in the era of newer-generation DES.
Death ; Diabetes Mellitus ; Drug-Eluting Stents* ; Follow-Up Studies ; Hospitalization ; Humans ; Incidence ; Mortality ; Multivariate Analysis ; Myocardial Infarction ; Percutaneous Coronary Intervention* ; Prognosis ; Renal Insufficiency, Chronic* ; Survivors

This survey was performed to analyze the usability of the third edition of the Korean breast cancer clinical practice guidelines (KBCCPG) in clinical practice. We made a questionnaire composed of 18 general and 82 specific questions regarding benign breast disease (B; 1 question); non-invasive disease (N; 12 questions); early-stage disease (E; 26 questions); advanced disease (A; 24 questions); and metastatic (M) breast cancer-related problems (19 questions). A total of 100 questionnaires, with a link to an online survey, were delivered via e-mail to over 700 members of the Korean Breast Cancer Society (KBCS), and associated academy members, over 20 days between 26th February and 16th May 2010. Out of 270 respondents who read the e-mail, 96 answered the questionnaire. Participants included 87 surgical oncologists, 5 radiation oncologists, 2 oncoplastic surgeons, 1 pathologist, and 1 medical oncologist. The third KBCCPG were perceived as differing from the second guidelines in terms of the level of clinical evidence required before choosing a recommendation. For the progress of the KBCCPG, the guideline committee should try to reinforce all courses of guideline development with several elements including data from clinical trials of Korean breast cancer patients, securing a multidisciplinary approach, developing consistent and reasonable processes for each step of the revision of the guidelines, induction of liberal scientific and ethical discussion about all issues with all KBCS members. The cost-effectiveness of healthcare and the logical development of the KBCCPG would also be ensured. Timely updates of the clinical guidelines for breast cancer treatment are essential to facilitate optimal decision-making in daily practice, and to ensure adequate patient feedback.
Aluminum Hydroxide ; Breast ; Breast Diseases ; Breast Neoplasms ; Carbonates ; Surveys and Questionnaires ; Delivery of Health Care ; Dietary Sucrose ; Electronic Mail ; Humans ; Korea ; Logic