Kyung Joon Lim

Clinical Experience of Symptomatic Sacral Perineural Cyst

Tarlov or perineural cysts are nerve root cysts found most commonly at the sacral spine level arising between covering layers of the perineurium and the endoneurium near the dorsal root ganglion and are usually asymptomatic. Symptomatic sacral perineural cysts are uncommon but sometimes require surgical treatment. A 69-year-old male presented with pain in the buttock. He was diagnosed as having a sacral cyst with magnetic resonance imaging. For the nonoperative diagnosis and treatment, caudal peridurography and block were performed. After the treatment, the patients symptom was relieved. We suggest a caudal peridural block is effective in relieving pain from a sacral cyst.

The Effect of Urinary Trypsin Inhibitor Against Neuropathic Pain in Rat Models

Background Nerve injury sometimes leads to chronic neuropathic pain associated with neuroinflammation in the nervous system. In the case of chronic neuropathic pain, the inflammatory and algesic mediators become predominant and result in pain hypersensitivity following nervous system damage. It is well known that urinary trypsin inhibitor (ulinastatin, UTI) has an anti-inflammatory activity. Recently, the neuroprotective action of UTI on the nervous system after ischemic injury has been reported. Thus, we evaluated the neuroprotective effect of ulinastatin in a rat model of neuropathic pain. Methods Neuropathic pain was induced with L5 spinal nerve ligation (SNL) in male Sprague-Dawley rats weighing 100-120 g. The rats were divided into 3 groups, with n = 8 in each group. The rats in the control group (group 1) were administered normal saline and those in group 2 were administered UTI (50,000 U/kg) intravenously through the tail vein for 3 days from the day of SNL. Rats in group 3 were administered UTI (50,000 U/kg) intravenously from the 5th day after SNL. The paw withdrawal threshold was measured using the von Frey test for 3 days starting from the 5th day after SNL. Results The paw withdrawal thresholds were significantly increased in the rats of group 2 compared to the other groups (P < 0.05). Conclusions Ulinastatin, which was administered for 3 days after SNL, increased the paw withdrawal threshold and it could have a neuroprotective effect in the rat model of neuropathic pain.

Curcumin, COX-2, and Protein p300/CBP

Recently, curcumin has received great interest for its emerging role in pain modulation and management [1]. Its anti-nociceptive mechanism is not clear; however, it is part of numerous mechanisms involved in CX3CR1 expression, Mu and Delta opioid receptors, 5-HT (1A) receptors, TNF-α, etc [1]. Recently, I read a report on curcumin which attenuated the pain behavior and serum COX-2 concentration in a rat model of neuropathic pain [2]. That report was of great interest. I have some additional comments about that study. First, you explained that the decreased COX-2 level after curcumin treatment is associated with the down regulation of the expression of the NF-κB-regulated gene products such as COX-2 [3]. However, interaction of the RelA subunit of NF-κB with the general co-activator protein p300/CBP is vital for RelA-dependent gene transcription [4]. Moreover, disruption of this interaction deregulates the NF-κB pathway by interfering with its negative feedback loop. Another recent study also showed that treatment with 60 mg/kg of curcumin increased the mechanical threshold, as in your study, and reduced COX-2 gene expression [5]. That study revealed that curcumin treatment downregulated the recruitment and altered the binding of protein p300/CBP at the BDNF and COX-2 promoters. Curcumin seems to alleviate neuropathic pain by inhibiting p300/CBP which acts as a vital co-activator of NF-κB instead of direct down regulation of the expression of NF-κB. Second, curcumin was used 24 hours before making the CCI model and was continued daily to day 7 post-ligation. However, in a clinical situation, neuropathic pain cannot be easily expected and usually treatment starts after neuropathic pain has developed. Thus, further studies on curcumin as a therapy for neuropathic pain is necessary for application in clinical settings.

Effects of Palonosetron, a 5-HT3 Receptor Antagonist, on Mechanical Allodynia in a Rat Model of Postoperative Pain

Background 5-hydroxytryptamine 3 (5-HT3) receptors have been known to be associated with the modulation of nociceptive transmission. However, it is uncertain whether 5-HT3 plays a role in the antinociceptive or pronociceptive pathway for incisional pain. In this study, we evaluated the effects of palonosetron, a 5-HT3 receptor antagonist, on incisional pain in rats when administered intrathecally or intraplantarly. Methods An intrathecal catheter was implanted through the cisterna magna and placed in the intrathecal space of rats. An incision in the plantaris muscle of the right hind paw was done under anesthesia with sevoflurane. Withdrawal thresholds were evaluated with the von Frey filament after 2 hours. Palonosetron (0.5 and 0.1 µg intrathecally; 0.5 µg intraplantarly) was administered and the thresholds were observed for 4 hours. Results Mechanical hypersensitivity developed after the incision. Intrathecal palonosetron (0.5 µg and 0.1 µg) did not alter the paw withdrawal threshold. Intraplantar palonosetron (0.5 µg) also did not change the paw withdrawal threshold. Conclusions Intrathecal and intraplantar palonosetron (0.5 µg) had no effect on modulating the mechanical hypersensitivity in the incisional pain model of rats.

Urinary trypsin inhibitor attenuates the development of neuropathic pain following spinal nerve ligation.

Following nerve injury, inflammatory and algesic mediators are released. This neuroinflammatory outbreak causes neuronal damage and chronic neuropathic pain. Urinary trypsin inhibitor (ulinastatin, UTI), which has anti-inflammatory properties and neuroprotective effects, is used to lower the levels of inflammatory factors during surgery. This study evaluated the effect of ulinastatin in a rat model of spinal nerve ligation (SNL). Neuropathic pain was induced by L5 and L6 SNL in male Sprague-Dawley rats. Rats were divided into three groups: group N (control) received normal saline through the tail vein for three days immediately following SNL, group U pre received ulinastatin (50,000 U/kg) intravenously for three days immediately following SNL, and group U post received ulinastatin (50,000 U/kg) intravenously for three days from the 3rd day following SNL. The paw withdrawal threshold was examined and the development of mechanical allodynia was confirmed with a behavioral test using a von Frey filament three days following SNL. On the 3rd, 5th, 7th, 14th, and 28th day following SNL, the paw withdrawal threshold was examined and the levels of inflammatory mediators (i.e., tumor necrosis factor alpha [TNF-α], interleukin-1β [IL-1β], and interleukin-6 [IL-6]) were measured by ELISA. The paw withdrawal threshold was significantly increased in the rats from group U pre compared with the rats from groups N and U post until the 7th post-SNL day (P<0.05). The levels of IL-6 also were significantly decreased in the rats from group U pre compared with the rats from group N and U post until the 7th post-SNL day (P<0.05). Ulinastatin increased the paw withdrawal threshold following SNL when it was administered before the development of neuropathic pain, and may attenuate the development of neuropathic pain.

Effect on thermoregulatory responses in patients undergoing a tympanoplasty in accordance to the anesthetic techniques during PEEP: a comparison between inhalation anesthesia with desflurane and TIVA

Background It has been known that positive end-expiratory pressure (PEEP) increases the vasoconstriction threshold by baroreceptor unloading. We compared the effect on the thermoregulatory responses according to anesthetic techniques between an inhalation anesthesia with desflurane and a total intravenous anesthesia (TIVA) with propofol and reminfentanil when PEEP was applied in patients undergoing tympanoplasty. Methods Forty-six patients with a scheduled tympanoplasty were enrolled and the patients were divided in two study groups. Desflurane was used as an inhalation anesthetic in group 1 (n = 22), while TIVA with propofol and remifentanil was used in group 2 (n = 24). PEEP was applied by 5 cmH2O in both groups and an ambient temperature was maintained at 22-24℃ during surgery. The core temperature and the difference of skin temperature between forearm and fingertip were monitored for about 180 minutes before and after the induction of general anesthesia. Results The final core temperature was significantly higher in group 2 (35.4 ± 0.7℃) than in group 1 (34.9 ± 0.5℃). Peripheral thermoregulatory vasoconstriction was found in 5 subjects (23%) in group 1 and in 21 subjects (88%) in group 2. The time taken for reaching the thermoregulatory vasoconstriction threshold was 151.4 ± 19.7 minutes in group 1 and 88.9 ± 14.4 minutes in group 2. Conclusions When PEEP will be applied, anesthesia with TIVA may have more advantages in core temperature preservation than an inhalation anesthesia with desflurane.

The effects of intrathecal fentanyl for spinal anesthesia in lower extremity surgery

BACKGROUND Intrathecal opioids in combination with bupivacaine has been shown to provide adequate sensory blockade and early recovery from spinal anesthesia. This study was investigated the added effects of intrathecal fentanyl 10 microgram to bupivacaine for spinal anesthesia. METHODS Sixty patients undergoing lower extremity surgery were into three groups. Group I received bupivacaine 10 mg (0.5%), gruop II received bupivacaine 5 mg with normal saline 1 ml, and group III received bupivacaine 5 mg with fentanyl 10 microg and normal saline 0.8 ml. RESULTS There was no significant difference between group I and group III in the peak level and duration of sensory block. But the intensity of motor blockade was decreased in group III compared with group I and side effects of spinal anesthesia with local anesthetics was decreased in group III compared with group I. In Group II, 7 patients were complained the pain during surgery. CONCLUSIONS Intrathecal fentanyl 10 microgram with bupivacaine 5 mg on spinal blockade provide reliable anesthesia for lower extremity surgery.

Hyperosmolar dextrose solution injection on lumbosacral medial branch and bilateral sacro-iliac joint for remnant buttock pain after vertebral augmentation procedures

Abstract Introduction: Osteoporotic vertebral compression fractures (VCFs) in the elderly patient can cause significant pain and lead to restrictions in daily life activities. Augmentation procedures (vertebroplasty and kyphoplasty) have been reported as a standard treatment of VCFs in cases of unresponsiveness to conservative treatment. However, patients who have remnant pain after augmentation procedures are a challenge to doctors and require the definite treatment. We have injected hyperosmolar dextrose solution into the lumbosacral medial branch and bilateral sacro-iliac joint for remnant buttock pain and report our results. Patients and methods: Thirty-six patients with remnant pain were identified after augmentation procedures on 321 patients. Remnant pain was defined as occurring when patients complained of pain 2 days postoperatively. Patients were treated with bilateral lumbosacral (L4, L5, S1) medial branch injections and bilateral sacro-iliac joint injection using hyperosmolar dextrose solution...

Movement information measurement based on Boolean edge detection and modified HT

In this paper, we proposed a method, which is very fast and gives better moving information of the objects in the image sequences. The possible locations of moving objects are found first, and then we apply the Hough Transform only on the detected moving regions to find the optical flow vectors for those regions only. So we save lot of time for not finding optical flow for the still or background parts in the image sequences. The new Boolean based edge detection is applied on the two consecutive input images, and then the differential edge image of the resulting two edge maps is found. A mask for detecting the moving regions is made by dilating the differential edge image. After getting the moving regions in the image sequence with the help of the mask obtained already, we use the Hough Transform and voting accumulation methods for solving optical flow constraint equations. The voting based Hough transform avoids the errors associated with least squares techniques. Calculation of a large number of points along the constraint line is also avoided by using the transformed slope-intercept parameter domain. The simulation results show that the proposed method is very effective for extracting optical flow vectors and hence tracking moving objects in the images.