Jaeki Ahn

Acupuncture sensation during ultrasound guided acupuncture needling

Background Although acupuncture sensation (also known as de qi) is a cornerstone of traditional acupuncture therapy, most research has accepted the traditional method of defining acupuncture sensation only through subjective patient reports rather than on any quantifiable physiological basis. Purpose To preliminarily investigate the frequency of key sensations experienced while needling to specific, quantifiable tissue levels (TLs) guided by ultrasound (US) imaging. Methods Five participants received needling at two acupuncture points and two control points at four TLs. US scans were used to determine when each TL was reached. Each volunteer completed 32 sets of modified Southampton Needle Sensation Questionnaires. Part one of the study tested sensations experienced at each TL and part two compared the effect of oscillation alone versus oscillation + rotation. Results In all volunteers, the frequency of pricking, sharp sensations was significantly greater in shallower TLs than deeper (p=0.007); the frequency of sensations described as deep, dull and heavy, as spreading, and as electric shocks was significantly greater in deeper TLs than shallower (p=0.002). Sensations experienced did not significantly differ between real and control points within each of three TLs (p>0.05) except TL 4 (p=0.006). The introduction of needle rotation significantly increased deep, dull, heavy sensations, but not pricking and sharp sensations; within each level, the spectrum of sensation experienced during both oscillation + rotation and oscillation alone did not significantly differ between acupuncture and control points. Conclusion The preliminary study indicates a strong connection between acupuncture sensation and both tissue depth and needle rotation. Furthermore, the new methodology has been proven feasible. A further study with an objective measurement is warranted.

Ultrasound-Guided Versus Fluoroscopy-Guided Sacroiliac Joint Intra-articular Injections in the Noninflammatory Sacroiliac Joint Dysfunction: A Prospective, Randomized, Single-Blinded Study

OBJECTIVE To compare the short-term effects and safety of ultrasound (US)-guided sacroiliac joint (SIJ) injections with fluoroscopy (FL)-guided SIJ injections in patients with noninflammatory SIJ dysfunction. DESIGN Prospective, randomized controlled trial. SETTING University hospital. PARTICIPANTS Patients (N=120) with noninflammatory sacroiliac arthritis were enrolled. INTERVENTION All procedures were performed using an FL or US apparatus. Subjects were randomly assigned to either the FL or US group. Immediately after the SIJ injections, fluoroscopy was applied to verify the correct placement of the injected medication and intravascular injections. MAIN OUTCOME MEASURES Treatment effects and functional improvement were compared at 2 and 12 weeks after the procedures. RESULTS The verbal numeric pain scale and Oswestry Disability Index improved at 2 and 12 weeks after the injections without statistical significances between groups. Of 55 US-guided injections, 48 (87.3%) were successful and 7 (12.7%) were missed. The FL-guided SIJ approach exhibited a greater accuracy (98.2%) than the US-guided approach. Vascularization around the SIJ was seen in 34 of 55 patients. Among the 34 patients, 7 had vascularization inside the joint, 23 had vascularization around the joint, and 4 had vascularization both inside and around the joint. Three cases of intravascular injections occurred in the FL group. CONCLUSIONS The US-guided approach may facilitate the identification and avoidance of the critical vessels around or within the SIJ. Function and pain relief significantly improved in both groups without significant differences between groups. The US-guided approach was shown to be as effective as the FL-guided approach in treatment effects. However, diagnostic application in the SIJ may be limited because of the significantly lower accuracy rate (87.3%).

Ultrasound versus palpation guidance for intra‐articular injections in patients with degenerative osteoarthritis of the elbow

The aim of this study is to evaluate the accuracy rate of ultrasound (US) ‐guided intra‐articular (IA) injections in patients by posterior approach with osteoarthritis (OA) of the elbow.

Comparison of Changes in Biochemical Markers for Skeletal Muscles, Hepatic Metabolism, and Renal Function after Three Types of Long-distance Running: Observational Study.

Abstract The purpose of this study is to compare changes in biochemical markers for the skeletal muscles, hepatic metabolism, and renal function based on extreme long-distance running. Among healthy amateur endurance athletes who participated in a marathon, 100 km-, or 308 km ultramarathon, 15 athletes with similar physical and demographic characteristics were chosen to be the subjects in this study, upon completion of each course. The subjects’ blood was collected before and after the course to identify biochemical markers for the skeletal muscles, hepatic metabolism, and renal function. After all of the courses, creatinine kinase (CK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine transaminase (ALT), blood urea nitrogen (BUN), and creatinine were found to be significantly increased compared with values obtained before the race (P <0.05 for each marker). CK, LDH, AST, and LDH were significantly higher after completion of the 100 km race than the marathon (P <0.05) and were significantly higher after the 308 km race than the marathon or 100 km race (P <0.05). Total protein was significantly lower after the 308 km race than the marathon or 100 km race (P <0.05). Albumin significantly increased after the marathon but significantly decreased after the 308 km course (P <0.05). Total and direct bilirubin were significantly increased after the 100 km and 308 km races (P <0.05), and were significantly higher after the 308 km than the marathon or 100 km course (P <0.05). BUN was significantly higher after the 100 km race than the marathon (P <0.05) and was significantly lower after the 308 km than the 100 km race (P <0.05). Creatinine was significantly higher after the marathon and 100 km than the 308 km race (P <0.05). Uric acid significantly increased after the marathon and 100 km race (P <0.05); it was significantly higher after completing the marathon and 100 km than the 308 km race (P <0.05). Muscular damage, decline in hepatic function, and hemolysis in the blood were higher after running a 308 km race, which is low-intensity running compared with a marathon, and a temporary decline in renal function was higher after completing a 100 km race, which is medium-to-high intensity.

Ultrasound-Guided Versus Fluoroscopy-Guided Caudal Epidural Steroid Injection for the Treatment of Unilateral Lower Lumbar Radicular Pain: Case-Controlled, Retrospective, Comparative Study.

AbstractThe aim of the article is to investigate the efficacy of ultrasound (US)-guided Caudal Epidural Steroid Injection (CESI) compared with fluoroscopy (FL)-guided CESI in patients with unilateral lower lumbar radicular pain.This case-controlled, retrospective, comparative study was done at the university hospital. A total of 110 patients treated with US- or FL-guided CESI were administered a mixture of 20 cc (0.5% lidocaine 18.0 mL + dexamethason 10 mg 2 mL). Outcome measurement was assessed by Oswestry Disability Index (ODI), verbal numeric pain scale (VNS) before injections and at 3, 6, and 12 months after the last injections. Successful outcome was defined as measured by >50% improvement in the VNS score and >40% improvement in the ODI.ODI and VNS showed improvement at 3, 6, and 12 months after the last injection in both groups. No statistical differences in ODI, VNS were observed between groups (P < 0.05). No significant differences in the proportion of patients with successful treatment were observed between the groups from the 3-month to 6-month to 12-month outcomes.US-guided CESI is deserving of consideration in conservative management of unilateral lower lumbar radicular pain.

Plexiform Neurofibroma of the Posterior Tibial Nerve Misdiagnosed as Proximal Tarsal Tunnel Syndrome: A Case Report

Plexiform neurofibromas of the foot are rare, benign tumors of the peripheral nerves. Diagnosis can be challenging if they present with symptoms mimicking other peripheral nerve pathologies. Tarsal tunnel syndrome is an entrapment syndrome of the entire tibial nerve behind the medial malleolus and under the flexor retinaculum. The clinical presentation typically includes posteromedial pain, positive Tinels sign, and neurogenic signs, including both the sensation of numbness and the actual hypoesthesia and clawing of the toes. Here, we report the case of a 59-year-old female patient with plexiform neurofibroma with symptoms similar to those of tarsal tunnel syndrome. The plexiform neurofibroma was surgically excised and the nerve function was partially preserved.

Effects of Long-Distance Running on Cardiac Markers and Biomarkers in Exercise-Induced Hypertension Runners: An Observational Study

Objective To investigate changes of cardiac and muscle damage markers in exercise-induced hypertension (EIH) runners before running (pre-race), immediately after completing a 100-km ultramarathon race, and during the recovery period (24, 72, and 120 hours post-race). Methods In this observational study, volunteers were divided into EIH group (n=11) whose maximum systolic blood pressure was ≥210 mmHg in graded exercise testing and normal exercise blood pressure response (NEBPR) group (n=11). Their blood samples were collected at pre-race, immediately after race, and at 24, 72, and 120 hours post-race. Results Creatine kinase (CK) and cardiac troponin I (cTnI) levels were significantly higher in EIH group than those in the NEBPR group immediately after race and at 24 hours post-race (all p<0.05). However, lactate dehydrogenase (LDH), creatine kinase-myocardial band (CKMB), or CKMB/CK levels did not show any significant differences between the two groups in each period. N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were significantly higher in EIH group than those in NEBPR group immediately after race and at 24 and 72 hours post-race (all p<0.05). A high sensitivity C-reactive protein (hs-CRP) level was significantly higher in EIH group than that in NEBPR group at 24 hours post-race (p<0.05). Conclusion The phenomenon of higher inflammatory and cardiac marker levels in EIH group may exaggerate cardiac volume pressure and blood flow restrictions which in turn can result in cardiac muscle damage. Further prospective studies are needed to investigate the chronic effect of such phenomenon on the cardiovascular system in EIH runners.

Poster 313 A Retrodiskal Approach of Lumbar Transforaminal Epidural Block in a Case of Severe Foraminal Stenosis

Disclosures: C. J. Moon, none. Objective: To compare the accessibility and the effect of retrodiskal (RD) approach of lumbar transforaminal epidural block with conventional subpediular (SP) approach in severe foraminal stenosis. Design: Case control study. Setting: Tertiary hospital. Participants: Patients with L5 radiculopathy who were planned to receive transforaminal epidural block were consecutively included as subjects and were randomly divided into the RD group and the SP group. Interventions: A mixture of triamcinolone 20 mg and 0.5% lidocaine 1.5 mL was injected in both groups after confirming a contrast spread by retrodiskal approach through L5-S1 foramen at intervertebral disk level on prone position 40°-45° off the AP axis. Main Outcome Measures: The diffusion pattern of contrast dye, easiness of needle’s target attainment, and visual analog scale (VAS), which had been recorded before and after 2 weeks of the treatment, of the 2 groups. Results: There were no differences in subjects’ demographic data and early VAS of the RD (n 13) and SP (n 8) groups, which were 6.9 0.8 and 6.6 0.7, respectively. After 2 weeks of treatment, VAS of the RD group was 2.4 0.9, much lower than 3.8 0.7 of the SP group (P .05). We failed to insert the needle tip into the target point in 3 patients of the SP group due to severe foraminal stenosis. In the SP group, 2 patients had nerve root irritation symptoms during the procedure. In 10 cases of the RD group and 4 cases of the SP group, contrast dye diffused to the proximal nerve root, and, in 5 cases of the RD group and 3 cases of SP group, contrast dye diffused to the distal nerve root, but there was no significant difference between the 2 groups except for failed approach. Conclusions: The RD approach of lumbar transforaminal epidural block might be a useful technique, especially in the case of severe foraminal stenosis.