• The Journal of Korean Physical Therapy
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• v.23 no.6
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• pp.31-36
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• 2011

Purpose: This pilot case series study aimed to evaluate the efficacy of continuous radiofrequency (CRF) application on dorsal root ganglia (DRG) to reduce spasticity of spinal cord lesion (SCL) patients. Methods: We performed CRF procedures on DRG in 8 subjects (7 males; mean age 39 years, range 31-53 years) with intractable spasticity that impeded activities of daily living and caregiving, although they had maximal tolerable doses of anti-spastic medications and active rehabilitative treatment. All subjects underwent CRF (90 seconds at $90^{\circ}C$) at multiple lumbosacral and/or cervical DRG. Muscle tone of the extremities was measured by the modified Ashworth scale (MAS) before and one month after procedures. Functional goals were established at baseline, and subjects' satisfaction levels were categorized one month after procedures. Results: A total of 54 CRF treatments were performed in 8 patients. In all patients, we found some improvement in muscle tone measured by the MAS. Six patients reported themselves satisfied with their current status at one month's post-treatment, and 2 patients were fairly satisfied with their gait pattern. In 3 patients, neuropathic pain was present after CRF on DRG. In 1 lumbar case, the pain subsided after several days, and the other 2 cervical cases suffered from tolerable neuropathic pain treated with anti-convulsant medication. Conclusion: CRF on DRG might be a promising alternative treatment to reduce spasticity in SCL patients. Further well-designed clinical trials on the efficacy and safety of CRF application on DRG are needed.

• The Korean Journal of Pain
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• v.4 no.2
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• pp.111-121
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• 1991

It has been well known that the splanchnic nerve block is effective for patients who suffer from intractable upper abdominal pain. However, it is unclear whether the effect of the splanchnic nerve block depends on varied alcoholic concentration. In this study, an attempt was made to use absolute ethanol on patients who recieved a splanchnic nerve block at Severance Hospital during the period from September l990 to April l991. The results are as follows; 1) Among the 33 patients, including 22 males and 1l females, the fifties and sixties were the major age groups. 2) Stomach cancer was the most common underlying disease(13 cases), with pancreatic can- cer next(9 cases). 3) The main locations of pain were the upper abdomen, epigastrium, and entire abdomen in decreasing order. 4) There were 17 cases who had had chemotherapy, and 1l cases of whom had had surgery before the splanchnic nerve block. 5) The volume of alcohol used was 12 ml bilaterally. 6) Among the 33 patients, 15.2% required a second block within two weeks of the first block. One case required a third block. 7) The most common complications of splanchnic nerve block were hypotension(33.3%), occasional transient sharp burning pain, flushing of face, pain on injection site, nausea, vomiting, dyspnea, chest discomfort and diarrhea. 8) The supplemental block most commonly used was a continuous epidural block. It was used both as a diagnostic block and to afford relief from pain before the splanchnic nerve block was done. 9) The interval between the receiving the absolute ethanol block and discharge was within 2 weeks in l5 cases. But, in the patients with poor general health, the interval between the splanchnic nerve block and discharge prolonged. The above results suggest that bilateral splanchnic nerve block done with absolute ethanol after an effective test block with 1% lidocaine under C-arm fluroscopic control is satisfactory and reliable. Still, 26.6% of the patients received a repeat block within 2 weeks. Insufficient spread of ethanol due to its small volume seems to be a major factor in the repeat block. Minimizing the incidence of repeat block remains a problem to be solved.

• The Korean Journal of Pain
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• v.3 no.2
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• pp.108-118
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• 1990

Splanchnic nerve block (SNB) is performed to relieve intractable upper abdominal pain caused by carcinoma of the upper G-I tract. Not all patients achieve satisfactory pain relief; therefore, a second or third nerve block trial may need to be performed. In this study, an attempt was made to analyze the possible factors which might affect the result of repeated SNB in 42 the patients among 264 patients who received SNB at Severance Hospital during the period from January 1985 to December 1989. The results are as follows: 1) Among the 42 patients, including 30 males and 12 females, the fifties and forties were the major age groups. 2) Among the underlying diseases, stomach cancer was the most common (18 cases) and pancreatic cancer was next (14 cases). 3) The main locations of pain were the upper abdomen, epigastrium and entire abdomen in decreasing order. 4) Among the thirty-nine cases of first SNB combined with ascites, 13 cases received a repeat block, 81.0% of whom had had metastatic lesion. 5) There were 54.2% who had had single or combined treatment, operation, chemotherapy or radiotherapy before SNB. 6) Twently seven cases (64.3%) had received opioid medication for pain control. 7) In the 75% alcohol group, 11.7% of patients required a second block, and in the pure and 50% alcohol group, 9.6% of patients required a second block within two weeks of the first block. Three cases in both of these repeated block groups required a third block; representing 3.9%, of the 75% alcohol group and 1.6% of the pure and 50% alcohol group. 8) The volume of alcohol used was more than 16 ml bilaterally in both cases. 9) The points of the inserted needle were positioned in the upper and anterolateral part of the $L_1$ vertebra on both sides on the anteroposterior roentgenogram. The contrast media was spread upward along the anterior margin of the vertebral body and posteriorly in repeat block. The frequency of repeat block was higher in cases with ascites or metastasis. The instance of repeat block within 2 weeks of the first block was lower in the pure and 50% alcohol group than in the 75% alcohol group. Thus, alcohol concentration and patient status may be considered factors which influence the result of repeated SNB. We suggest early application of SNB in upper abdominal cancer patients.

• Journal of Korea Entertainment Industry Association
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• v.13 no.4
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• pp.311-320
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• 2019

Discogenic pain which develops during the degenerative process of intervertebral disc is an intractable disease of musculoskeletal system. Unlike other diseases in modern medical science, it is not clinically confirmed through objective imaging and clinicopathologic index. Moreover, current technology has been facing difficulties finding fundamental treatment. This study examined through reviewing literature whether the therapeutic rationales of interventional procedures for the discogenic pain, such as nerve block, intradiscal electrothermal therapy and nucleoplasty, are valid and whether safety reviews such as preclinical tests are carried out faithfully during the technology development process. As a result, it is presumed that there is not yet an interventional treatment for discogenic pain, whose therapeutic rationale has been objectively verified. And there are some cases of interventional treatment that have not been adequately equipped with the preclinical test steps necessary to review the safety of the procedure during the technology development process. In conclusion, since there is still no interventional treatment for discogenic pain which has clear therapeutic rationale, it is necessary to recognize that a more careful approach is needed to judge whether the procedure is performed in clinical settings. And medical ethical issues may arise for some interventional treatment that are deemed to have been carried out without a thorough review of safety.

• Journal of Korean Neurosurgical Society
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• v.42 no.4
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• pp.317-325
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• 2007

Objective : The purpose of the study was to determine the clinical effects of anterior radical debridement on a series of patients with spontaneous spinal infection. Methods : We retrospectively analyzed the clinical characteristics of 32 patients who underwent surgical treatment from January 2000 to December 2005 in our department. The average follow-up Period was 33.4 months (range, 6 to 87 months). Thirty-two patients presented with the following : 23 cases with pyogenic spondylitis, eight with tuberculous spondylitis and one with fungal spondylitis. The indications for surgery were intractable pain, failure of medical management, neurological impairment with or without an associated abscess, vertebral destruction causing spinal instability and/or segmental kyphosis. Results : The study included 15 (46.9%) males and 17 (53.1%) females ranging in age from 26 to 75 years (mean, 53.1 years). Diabetes mellitus (DM) and pulmonary Tbc were the most common predisposing factors for pyogenic spondylitis and tuberculous spondylitis. Staphylococcus aureus (13%) was the main organism isolated. The most prevalent location was the lumbar spine (75%). Changes in the pain score, Frankel's classification, and laboratory parameters demonstrated a significant clinical improvement in all patients. However, there were recurrent infections in two patients with tuberculous spondylitis and inappropriate debridement and intolerance of medication and noncompliance. Autologous rib, iliac bone and allograft(fibular) were performed in most patients. However, 10 patients were grafted using a titanium mesh cage after anterior radical debridement. There were no recurrent infections in the 10 cases using the mesh cage with radical debridement. Conclusion : The findings of this study indicate that surgery based on appropriate surgical indications is effective for the control of spinal infection and prevention of recurrence with anterior radical debridement, proper drug use and abscess drainage.

• Journal of Korean Neurosurgical Society
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• v.41 no.5
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• pp.291-294
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• 2007

Objective : The purpose of this retrospective clinical study was to describe a treatment for osteoporotic burst fracture in the setting of severe fractures involving fragmentation of the posterior wall and neural compromise with symptoms of cord compression. Methods : Indication for microscopic decompression and open kyphoplasty were intractable pain at the level of a known osteoporotic burst fractures involving neural compression or posterior wall fragmentation. A total of 18 patients [mean age, 74.6 years] with osteoporotic thoracolumbar burst fractures [3 males, 15 females] were included in this study. In all cases, microscopic decompressive laminectomy was followed by open kyphoplasty. Clinical outcome using VAS score and modified MacNab's grade was assessed on last clinical follow up [mean 6.7 months]. Radiological analysis of sagittal alignment was assessed preoperatively, immediately postoperatively, and at final follow up. Results : One level augmentation and 1.8 level microscopic decompression were performed. Mean blood loss was less than 100 ml and there were no major complications. The mean pain score before operation and at final follow up was 7.2 and 1.9, respectively. Fourteen of 18 patients were graded as excellent and good according to the modified MacNab's criteria. Overall, 6.0 degrees of sagittal correction was obtained at final follow-up. Conclusion : The combined thoracolumbar microscopic decompression and open kyphoplasty for severe osteoporotic fractures involving fragmentation of posterior wall and neural compromise provide direct visualization of neural elements, allowing safe cement augmentation of burst fractures. Decompressive surgery is possible and risk of epidural cement leakage is controlled intraoperatively.

• Clinical and Experimental Pediatrics
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• v.59 no.10
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• pp.421-424
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• 2016

Recurrent macrophage activation syndrome (MAS) is very rare. We present the case of an adolescent boy with human leukocyte antigen (HLA) B27-positive ankylosing spondylitis (AS), who experienced episodes of recurrent MAS since he was a toddler. A 16-year-old boy was admitted because of remittent fever with pancytopenia and splenomegaly after surgical intervention for an intractable perianal abscess. He had been diagnosed with hemophagocytic lymphohistiocytosis (HLH) 4 different times, which was well controlled with intravenous immunoglobulin and steroids since the age of 3. We were unable to identify the cause for the HLH. He remained symptom-free until the development of back pain and right ankle joint pain with swelling at 15 years of age. He was diagnosed with HLA B27-positive AS with bilateral active sacroiliitis. He showed symptom aggravation despite taking naproxen and methotrexate, and the symptoms improved with etanercept. On admission, his laboratory data showed leukopenia with high ferritin and triglyceride levels. Bone marrow biopsy examination showed histiocytic hyperplasia with hemophagocytosis. There was no evidence of infection. He received naproxen alone, and his symptoms and laboratory data improved without any other immunomodulatory medications. Genetic study revealed no primary HLH or inflammasome abnormalities. In this case, underlying autoimmune disease should have been considered as the cause of recurrent MAS in the young patient once primary HLH was excluded.

• Journal of Pharmacopuncture
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• v.4 no.2
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• pp.35-47
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• 2001

Objectives : Through the literatures on the effets of Bufonis Venenum, we are finding out the clinical possibility and revealing the more effective to intractable diseases. Methods : We investigated the literatures of Oriental Medicine and experimental reports about Bufonis Venenum. Results : 1. Bufonis Venenum is made of bufonidae bufo bufo gargarizans cantor or bufo melanostictus schneider of white serum which secreted from parotid gland or dermato gland, and it is dried for using. 2. In oriental medicine, Bufonis Venenum has been mainly used on the tumors, cacanthrax and dermatic disease, and then it has been clinically used on infantile athrepsia, tetanus, sore throat, toothache, and so on. 3. The pharmacological effects of Bufonis Venenum are cardiotonic, respiration stimulation, depressor or vasopressor, topical anesthcsia, hallucination, striped muscle stimulation, antiasthmatic, antibacterial, antiinflammatory, anticancer, diuretic, immuno effects, etc. 4. Bufonis Venenum is largely divided in ether binding steroid compound, hydroxyl steroid compound, carboxyl or aldehyde steroid compound, indole compound, and adrenaline, cholesterole, etc. 5. Symptoms of Bufonis Venenum poisoning in digestive system are vommitig, abdominal pain, diarrhea, dehydration, in circulatory system are palpitation, shock, bradycardia, in nervous system are vertigo, somnolentia, muscle-tendon reflex weakness, and critical conditions to tissue necrosis and heart attack. 6. Ways to treat Bufonis Venenum poisoning include gastric irrigation with $0.2~0.5\%$ potassium permanganate fluid and atropine $0.5{\sim}1.0mg$ subcutaneous injection. From the chinese book of Bon Cho Gang Moke(本草綱目), if white serum of Bufonis Venenum enter the eyes, it happens the edema and pain. And then washed the eyes by juice of Lithospermi Radix(紫草) that the edema is removed. Conclusions and Discussion : The results from above literary studies show that prescriptions and Aqua-acupuncture of Bufonis Venenum could be clinically used to sedative, anticonvulsant, antibacterial, antiinflammatory, anticancer and topical ataralgesia. However it is expected that pharmacological and side effects of Bufonis Venenum are further studied.

• Journal of Korean Neurosurgical Society
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• v.62 no.4
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• pp.467-475
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• 2019

Objective : There is a lack of knowledge regarding whether decompression is necessary in treating patients with epidural spinal cord compression (ESCC) grade 2. The purpose of this study was to compare the outcomes of minimally invasive surgery (MIS) without decompression and conventional open surgery (palliative laminectomy) for patients with hepatocellular carcinoma (HCC) spinal metastasis of ESCC grade 2. Methods : Patients with HCC spinal metastasis requiring surgery were retrospectively reviewed. Patients with ESCC grade 2, medically intractable mechanical back pain, a Nurick grade better than 3, 3-6 months of life expectancy, Tomita score ${\geq}5$, and Spinal Instability Neoplastic Score ${\geq}7$ were included. Patients with neurological deficits, other systemic illnesses and less than 1 month of life expectancy were excluded. Thirty patients were included in the study, including 17 in the open surgery group (until 2008) and 13 in the MIS group (since 2009). Results : The MIS group had a significantly shorter operative time ($94.2{\pm}48.2minutes$ vs. $162.9{\pm}52.3minutes$, p=0.001), less blood loss ($140.0{\pm}182.9mL$ vs. $1534.4{\pm}1484.2mL$, p=0.002), and less post-operative intensive care unit transfer (one patient vs. eight patients, p=0.042) than the open surgery group. The visual analogue scale for back pain at 3 months post-operation was significantly improved in the MIS group than in the open surgery group ($3.0{\pm}1.2$ vs. $4.3{\pm}1.2$, p=0.042). The MIS group had longer ambulation time ($183{\pm}33days$ vs. $166{\pm}36days$) and survival time ($216{\pm}38days$ vs. $204{\pm}43days$) than the open surgery group without significant difference (p=0.814 and 0.959, respectively). Conclusion : MIS without decompression would be a good choice for patients with HCC spinal metastasis of ESCC grade 2, especially those with limited prognosis, mechanical instability and no neurologic deficit.

• Journal of Korean Neurosurgical Society
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• v.61 no.1
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• pp.1-9
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• 2018

Posttraumatic delayed vertebral collapse, known as Kummell's disease, is increasing in number of patients. This disease is already progressive kyphosis due to vertebral collapse at the time of diagnosis and it causes intractable pain or neurologic deficit due to intravertebral instability. Treatment is very difficult after progression of the disease, and the range of treatment, in hospital day, and cost of treatment are both increased. Clinical features, pathogenesis and radiologic findings of these disease groups were reviewed to determine risk factors for delayed vertebral collapse. The purpose of this article is to suggest appropriate treatment before vertebral collapse for patients with osteoporotic vertebral compression fracture who have risk factors for posttraumatic delayed vertebral collapse.