• The Korean Journal of Pain
• /
• 제2권2호
• /
• pp.198-202
• /
• 1989

우측 암면부, 특히 안구주위에 심한 통증을 호소하고 안검하수와 더불어 우측안구의 완전마비를 동반한 선천성 난장이 환자를 경험하였던 바 이는 신경방사선과학적소견, 검사실 검사소견, 전신적 corticosteroid치료에 대한 반응이 전형적인 Tolosa-Hunt Syndrome과는 다른 비전형적인 Tolosa-Hunt Syndrome이었기에 문헌적 고찰과 함께 보고하는 바이다.

• The Korean Journal of Pain
• /
• 제8권2호
• /
• pp.347-349
• /
• 1995

A 43 year old man who suffered from right facial palsy was treated successfully with the application of both magnetic resonance diagnostic analyser(MRA) and drug therapy. Treatment of facial palsy is generally composed of stellate ganglion block(SGB), drug therapy and operative intervention. Short periods of exposure to appropriate magnetic resonance can beneficially modulate the balance of autonomic nervous system that are responsible for sympathetic overflow. It was concluded that recovery of facial palsy by application of both MRA and drug therapy was effective in patient who refused SGB.

• Journal of Oral Medicine and Pain
• /
• 제26권2호
• /
• pp.157-160
• /
• 2001

Facial nerve paralysis(or Bell's palsy) which commonly occurs unilaterally, gives rise to paralysis of facial expression muscle. This condition is classified into symptomatic facial nerve paralysis due to intracranial tumor, post operative trauma, etc. and idiopathic facial nerve paralysis. To explain the etiology of idiopathic facial nerve paralysis, many hypothesis including ischemic theory, viral infection, exposure to cold, immune theory etc. were suggested, but there is no agreement at this point. The method to evaluate the facial nerve paralysis, when it occurs, consists of three stage scale method, image thechnics like CT and MRI, laboratory test to examine the antibody titers of viral infection, neurophysiologic test to evaluate the degree and prognosis of paralysis. Treatment includes medication, stellate ganglion block(SGB), surgery, physical therapy and other home care therapy. In medication, systemic steroids, vitamins, vasodilating-drug and ATP drugs were used. SGB was also used repeatedly to attempt the improvement of circulation and to stimulate the recovery of nerve function. Physical therapy including electric acupuncture stimulation therapy(EAST) and hot pack was used to prevent the muscle atrophy. When No response was showed to this conservative therapies, surgery was considered. After treating two patients complaining of Bell's palsy with medication(systemic steroids) and EAST, favorable result was obtained. so author report the case of facial nerve paralysis.

• The Korean Journal of Pain
• /
• 제9권2호
• /
• pp.399-402
• /
• 1996

Endoscopic transthoracic sympathectomy (ETS) has recently become estabilished as a successful treatment for severe palmar and axillary hyperhidrosis. Descriptions have been published of neurolytic, operative and alternative endoscopic procedures involving thermocoagulation, laser coagulation, or or nonvideo-assisted ganglionectomy using equipment not widely available, with low morbidity and excellent results. All methods have advantage and disadvantages. A 19-year-old male who suffered from severe hyperhidrosis on face, palms and axillary areas, has been initially treated with stellate ganglion block in other pain clinic. He was transfered to our pain clinic for endoscopic thoracic sympathectomy. The patient was intubated left side 34 Fr. double lumen tube and positioned left semi-lateral position for right sympathectomy. Right side pneumothorax was created by clamping the ipsilateral side of the double lumen tube and aspiration of air. 11-mm trocar was introduced through incision at the third intercostal space in anterior axillary line, and then additional two 11-mm and 5-mm trocar was introduced through second and fifth intercostal space in mid axillary line. The lung was gently retracted and the parietal pleura over the heads of the appropriate ribs excised using 5-mm sharp insulated coagulating microprocesss. The T4, T3, and T2 ganglions, as well as accompanying rami communicantes, and other branchs arising from upper thoracic nerves to the brachial plexus and surrounding tissues were carefully dissected, coagulated. During sympathectomy, skin temperature of middle was continuously monitored. Elevation of palmar skin temperature intraoperatively indicated an adequate sympathectomy with a definite therapeutic effect. A No. 28 Fr. thoracotomy tube was introduced through a troca under video guidance, placed under water seal after the lung was reinflated. the controlateral side was performed same procedure. After bilateral sympathectomy, chest tubes were removed, and then, he was discharged 2 days after operation with great satisfaction. The ETS provides a well-tolerated, cost-effective alternative to thoracic sympathectomy for primary hyperhidrosis and sympathetic mediated neuropathic pain disorder. And T2 ganglion is considered the key ganglion for the treatment of primary hyperhidrosis. The low incidence of compensatory sweating may by explained by the limited extent of the sympathectomy.

• Journal of Acupuncture Research
• /
• 제17권2호
• /
• pp.95-117
• /
• 2000

The purpose of this morphological studies was to investigate the relation between the meridian, acupoints and viscera using neuroanatomical tracers. The common locations of the spinal ganglia, sympathetic chain ganglia, spinal cord and brain projecting to the large intestine meridian were observed following injection of transganglionic tracer, WGA-HRP and transsynaptic neurotropic virus, pseudorabies virus(PRV), Bartha strain(Ba) and PRV-Ba-Gal (Galactosidase)) into the the large intestine(cecum, colon and rectum), ST37 and LI4. After survival times of 96 hours following injection into the thirty rats with WGA-HRP, PRV-Ba and PRV-Ba-Gal. They were perfused, and their spinal ganglia, sympathetic chain ganglia, spinal cord and brain were frozen sectioned($30{\mu}m$). These sections were stained by HRP and X-gal histochemical and PRV immunohistochemical staining method, and observed with a light microscope. The results were as follows : 1. WGA-HRP labeled neurons innervating the large intestine were observed bilaterally within the T13-L4 sympathetic chain ganglia, and T9-11 spinal ganglia. WGA-HRP labeled neurons innervating ST37 were observed within the L3-5 sympathetic chain ganglia, and L2-4 spinal ganglia. WGA-HRP labeled neurons innervating LI4 were observed in the middle cervical ganglion and stellate ganglion, and C5-8 spinal ganglia. 2. In spinal cord, PRV-Ba labeled neurons projecting to the large intestine, ST37 and LI4 were found in thoracic, lumbar and sacral spinal segments. Densely labeled areas of each spinal cord segment were founded in lamina N, V, VII(intermediolateral nucleus), Ⅸ, X and dorsal nucleus. 3. In medulla oblongata, PRV-Ba and PRV-Ba-Gal labeled neurons projecting to the large intestine, ST37 and LI4 were commonly found in the A1 noradrenalin cells/C1 adrenalin cells/caudoventrolateral reticular nucleus, dorsal motor nucleus of vagus nerve, nucleus tractus solitarius, raphe obscurus nucleus, raphe pallidus nucleus, raphe magnus nucleus and gigantocellular nucleus. 4. In pons, PRV-Ba and PRV-Ba-Gal labeled neurons were commonly found in locus coeruleus, Kolliker-Fuse nucieus and A5 cell group. 5. In midbrain, PRV-Ba and PRV-Ba-Gal labeled neurons were commonly found in central gray matter. 6. In diencephalon, PRV-Ba and PRV-Ba-Gal labeled neurons were commonly found in paraventricular hypothalamic nucleus. These results suggest that PRV-Ba and PRV-Ba-Gal labeled common areas projecting to the large intestine may be correlated to that of the large intestine meridian, ST37 and LI4. Especially, These morphological results provide that interrelationship of meridian-acupoints -viscera may be related to the central autonomic pathways.

• The Korean Journal of Pain
• /
• 제13권1호
• /
• pp.97-100
• /
• 2000

Thoracic outlet syndrome (TOS) is a combination of signs and symptoms caused by the compression of the vital neurovascular structure at the thoracic outlet region. It may stem from a number of abnormalities, including degenerative or bony disorders, trauma to cervical spine, fibromuscular bands, vascular abnormalities and spasm of the anterior scalene muscle. CPT (current perception threshold) is defined as the minimum amount of current applied transcutaneously that an individual consciously perceives. It enables quantification of the hyperesthesia that precedes progressive nerve impairment, as well as hypoesthetic conditions. We experienced a case of thoracic outlet syndrome caused by fibrosis of anterior scalene muscle. The patient was a 30 years old woman with a 3 years history of numbness on the ulnar side, progressive weakness and coldness of both hand, tiredness in the left arm, nocturnal pain in the left forearm, and pain in the left elbow, shoulder and neck. Conservative treatment, stellate ganglion block, cervical epidural block, anterior scalene block and previous operation, including both carpal tunnel release, provided no remarkable relief to the patient. A left scalenectomy and first rib resection were performed by transaxillary approach and left cervical root neurolysis was done. After surgery, we measured CPT using neurometer and found conditions worsening in the opposite arm. We performed the same procedure on right side, and followed by CPT measurement. This case suggests that CPT is a useful measurement of recovery and progression of TOS.

• The Korean Journal of Pain
• /
• 제18권2호
• /
• pp.218-221
• /
• 2005

This report describes a case of dizziness in a patient with trigeminal neuralgia that was caused by a vestibular schwannoma. A 60-year-old man with a history of pain on his left cheek, chin, molar and tongue for 5 months was diagnosed as suffering with trigeminal neuralgia of the left mandibular nerve, and this was caused by a left vestibular schwannoma. The diagnosis of the tumor was confirmed with magnetic resonance imaging (MRI), and so gamma knife surgery was performed 1 month later. At that time, the patient had been referred to the pain clinic due to allodynia on the tongue and gingival, and hypesthesia was also present on the left half of the face. Trigeminal nerve block with dehydrogenated alcohol and stellate ganglion block with 1% mepivacaine were performed and oral medication with diphenylhydantoin was started. The symptoms were alleviated after nerve block and oral medication. Dizziness, blurred vision and ataxia then developed from the 13th hospital day. We considered the symptoms as a side effect of diphenylhydantoin and we reduced the dose of diphenylhydantoin. However, the symptoms grew worse. Another brain MRI showed a slight increase of the tumor size and a mass effect with displacement of the adjacent organs, and hydrocephalus was also noted. This case shows the importance of considering the secondary symptoms that are due to brain tumor while treating trigeminal neuralgia. The changes of the brain tumors should also be considered along with the presence of new side effects.

• Journal of Yeungnam Medical Science
• /
• 제4권1호
• /
• pp.145-149
• /
• 1987

경피요골동맥삽관후 수지괴사가 발생되어 손목을 절단한 1례를 보고하며, 동맥삽관후 수지괴사가 유발될 수 있는 요인으로는 사용된 카테터의 크기, 종류, 천자횟수, 삽관거치기간 및 카테터삽관후 유지방법외에도 환자의 혈액구성성분변화, 혈액응고장애, 심박출량감소상태, 성별 등을 들 수 있으며, 본원에서 발생된 예에서는 수술후 환자가 심히 움직여 끈으로 동맥삽관된 손목을 침대에 묶어 놓음으로써 카테터에 의한 혈관손상이 심했음이 가장 큰 원인일 것으로 추측되며 그 외에도 혈액성분변화 및 응고장애에 의해 심한 혈전형성이나 heparin용액의 간헐적 관류시 발생될 수 있는 혈전의 전색도 가능성이 있을 것으로 사료된다.

• The Korean Journal of Pain
• /
• 제7권2호
• /
• pp.242-248
• /
• 1994

Postherpetic neuralgia is frequently painful, incapacitating, mood depressing, and sometimes lifelong. We investigated the influence of duration from eruption to nerve blocks in conjunction with patients age on analgesic and preventive effect for postherpetic neuralgia. We retrospectively evaluated 50 outpatient medical records for the above T4 dermatome. Patients had been referred to pain clinic and were treated over 2weeks from Jan. 1988 to Dec. 1993. Fifty patients were divided into 4 groups as follows: Group I (a): less than 4weeks from eruption to nerve block and younger than 65 years old. Group I (b): less than 4weeks from eruption to nerve block and older than 65 years old. Group II (a): more than 4weeks from eruption to nerve block and younger than 65 years old. Group II(b): more than 4weeks from eruption to nerve block and older than 65 years old. Mean number of stellate ganglion blocks were 29.7. Tramadol, amitriptyline, nicardipine were most commonly prescribed. Group I (a): had the most improvement rate(77.8%) as compared with other group(46.6, 52.7, 56.0%). Number of patients who complained of severe pain (VAS > 5) were 0, 3(39%), 2(15.4%), 5(30%) in I (a), I (b), II (a), II (b) group respectively. In conclusion, analgesic effect was best in cases of patients younger than 65 years old whose treatment were started within 4 weeks of eruption. Patients older than 65 yrs, analgesic effect did not vary on the timing of treatment.

• The Korean Journal of Pain
• /
• 제2권1호
• /
• pp.57-60
• /
• 1989

The Melkersson-Rosenthal (M-R) syndrome consists of a triad of (1) recurrent peripheral facial nerve paralysis which develops alternately on both sides of face, (2) non-inflammatory facial edema, and (3) fissuring of tongue. A 59 years old female patient developed the left facial palsy on September, 1988. Right facial palsy developed continuously 2 months later after the spontaneous remission of left facial palsy. On February, 1989, we have found out M-R syndrome which accompanied with migraine type of intermittent headache, and hypertension in one attack of cerebral stroke several years ago, there were no diabetes mellitus, pulmonary tuberculosis and brain tumor in clinical studies. Although the causes of this syndrome were not noted, we performed the stellate ganglion block and transcutaneous electrical nerve stimulation for treatment of the palsy, but the clinical effectiveness of these were not satisfactory.