• The Korean Journal of Pain
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• v.23 no.1
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• pp.65-69
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• 2010

Chronic perineal pain is an often encountered problem, which produces a great degree of functional impairment and frustration to the patient and a challenge to the treating physician. The reason for this problem is that the region contains diverse anatomic structures with mixed somatic, visceral and autonomic innervations affecting bladder and bowel control and sexual function. A blockade of nociceptive and sympathetic supply to the perineal region, supplied through the ganglion impar has been shown to benefit patients with chronic perineal pain. Several options to this block have been described that chemical neurolysis, radiofrequency ablation etc. Although the analgesic effect of Botulinum toxin type A (BoNT-A) has long been considered secondary to its action for muscle relaxation, BoNT-A also affects the release of the neurotransmitters that are involved in pain perception. We describe a patient who was successfully given ganglion impar block with BoNT-A.

• Journal of Korean Neurosurgical Society
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• v.50 no.1
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• pp.36-39
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• 2011

Objective : To evaluate the efficacy of scalene injection in patients with thoracic outlet syndrome. Methods : We selected 142 patients diagnosed with thoracic outlet syndrome between January 2005 and October 2009. We performed a series of scalene injection with conservative treatment in all cases. Patients rated their pain degrees using a visual analogue scale. We also evaluated the time to return to everyday life and work, and patients' functional capacity. Results : There were no complications or instances of inadvertent somatic or sympathetic ganglionic blockade after scalene injection. Overall, 111 patients (76.5%) experienced improved symptoms after the first set of scalene injection and 128 patients (88.2%) improved after scalene injection followed by conservative treatment. Of the 68 patients who returned to work during the study period, 54 returned within 1 week, and 62 within 2 weeks. Of those who returned to work, 61 reported nearly full functional capacity. We found that scalene injection was more effective in cases of thoracic outlet syndrome related to trauma than in those related to work-related repetitive stress. Conclusion : In patients with thoracic outlet syndrome, scalene injection effectively reduces pain. We recommend scalene injection as an adjunct to conservative treatment.

• Journal of Dental Anesthesia and Pain Medicine
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• v.23 no.1
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• pp.45-51
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• 2023

Andersen-Tawil syndrome (ATS) is a rare genetic disease characterized by a triad of episodic flaccid muscle weakness, ventricular arrhythmias, and physical anomalies. ATS patients have various cardiac arrhythmias that can cause sudden death. Implantation of an implantable cardioverter-defibrillator (ICD) is required when life-threatening cardiac arrhythmias do not respond to medical treatment. An 11-year-old girl underwent surgery for an ICD implantation. For general anesthesia in ATS patients, anesthesiologists should focus on the potentially difficult airway, serious cardiac arrhythmias, such as ventricular tachycardia (VT), and delayed recovery from neuromuscular blockade. We followed the difficult airway algorithm, avoided drugs that can precipitate QT prolongation and fatal cardiac arrhythmias, and tried to maintain normoxia, normocarbia, normothermia, normoglycemia, and pain control for prevention of sympathetic stimulation. We report the successful application of general anesthesia for ICD implantation in a pediatric patient with ATS and recurrent VT.

• Journal of Life Science
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• v.28 no.1
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• pp.116-129
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• 2018

Living creatures possess long-conserved mechanisms to maintain homeostasis in response to various stresses. However, chronic and continuous exposure to stress can result in the excessive production of stress hormones, including catecholamines, which have harmful effects on health. Studies on the relationship between the sympathetic nervous system (SNS) and cancer have been conducted based on the traditional hypothesis that stress can promote cancer progression. Many preclinical and epidemiological studies have suggested that the regulation of ${\beta}$-adrenergic signaling, which mediates SNS activity, can suppress the progression of solid tumors. SNS activation has highly pleiotropic effects on tumor biology, as it stimulates oncogenes, survival pathways, the epithelial - mesenchymal transition, and invasion. Moreover, it inhibits DNA repair and programmed cell death and regulates the tumor microenvironment, including immune cells, endothelial cells, the extracellular matrix, mesenchymal cells, and adipocytes. Although targeted therapies on the molecular basis of tumor proliferation are currently receiving increased attention, they have clinical limitations, such as the compensatory activation of other signaling pathways, emergence of drug resistance, and various side effects, which raise the need for pleiotropic cancer regulation. This review summarizes the effects of the SNS on the development and progression of cancer and discusses the clinical perspectives of ${\beta}$-blockade as a novel therapeutic strategy for this disease.

• Proceedings of the Ginseng society Conference
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• 2002.10a
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• pp.392-400
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• 2002

We have previously found that the saponins but not other components in the ginseng reduce the secretion of catecholamines (CAs) from bovine adrenal chromaffin cells, a model of sympathetic nerves, evoked by acetylcholine (ACh) due to the blockade of $Na^+$ influx through nicotinic ACh receptor-operated cation channels, and it has been concluded that the inhibitory effect may be associated with the anti-stress action of ginseng. However, the saponins, which showed the great reduction of the CA secretion, were mainly the protopanaxiatriols. The protopanaxadiol and oleanolic acid saponins had a little or little such effect. Recent studies demonstrated that the oligosaccharides connected to the hydroxyl groups of the aglycones of the saponins are in turn hydrolyzed by gastric acid and enzymes in the intestinal bacteria when the ginseng is orally administrated. In this study, the effects of their major 6 kinds of metabolites on the secretion of CAs were investigated. All metabolites (M1, 2, 3 and 5 derived from the protopanaxadiols, and M4 and 11 from the protopanaxiatriols) reduced the ACh-evoked secretion from the cells. In the metabolites, the M4 inhibition was the most potent ($IC_{50}({\mu}M):M4(9)$ < M2 (18) < M3 (19) < M1l (22) < M5 (36) < MI (38)). Although M4 also reduced the CA secretion induced by high $K^+$, a stimulation activating voltage-sensitive $Ca^{2+}$ channels, the inhibitory effect was much less than that on the ACh-evoked secretion. M4 inhibited the ACh-induced $Na^+$ influx into the cells in a concentration-dependent manner similar to that of the inhibition of the ACh-evoked secretion. When the cells were washed by the incubation buffer after the preincubation of the cells with M4 and then incubated without M4 in the presence of ACh, the M4 inhibition was not completely abolished. On the other hand, its inhibition was maintained even by increasing the external ACh concentration. These results indicate that the saponins are metabolized to the more active substances in the digestive tract and the metabolites attenuate the secretion of CAs from bovine adrenal chromaffin cells stimulated by ACh due to the noncompetitive blockade of the ACh-induced $Na^+$ influx into the cells. These findings may further explain the anti-stress action of ginseng.

• Journal of Chest Surgery
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• v.32 no.5
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• pp.465-470
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• 1999

Background: Facial hyperhidrosis patients have as much difficulty in personal relationships as the palmar and axillary hyperhidrosis patients. There have been no appropriate treatment, but recently, satisfactory results have been obtained through sympathetic blockade. Thoracoscopic thoracic sympathectomy for facial hyperhidrosis has been known to resect cervicothoracic (stellate) ganglion, but its inherent complications such as Horner syndrome have made the surgeons hesitant to use this method. We, through our experiences in treating palmar and axillary hyperhidrosis for the past 6 years, believed that T2 sympathicotomy would be enough for facial hyperhidrosis and have experimented and obtained satisfactory results. Material and Method: From June 1997 to May 1998, 38 consecutive patients underwent bilateral thoracoscopic T2 sympathicotomy with 2mm instruments at Seoul National University Hospital. Result: All patients were relieved of excessive sweating in their faces immediately after the operation. Postoperatively, 5 patients (13.2%) required insertion of chest tubes because 3 had incomplete reexpansion of the lung, and 2 had hemothorax from severe adhesion. Other complications related to the surgical procedures, such as Horner's syndrome, and brachial plexus injury, were not detected in any cases. The mean hospital stay was mean 1.7$\pm$0.9 days after surgery. Conclusion: T2 sympathetic ganglion is the appropriate resection site for facial hyperhidrosis, and complications such as Horner syndrome can be prevented by not cutting the stellate ganglion. In addition, it is possible to perform the operation by using a 2 mm thoracoscopic instrument, and may obtain much better results.

• The Korean Journal of Pharmacology
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• v.26 no.2
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• pp.101-111
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• 1990

The effect of physostigmine (PS), which has been shown to act on the muscarinic receptors in the brains of the rat, dog and cat, on the arterial blood pressure (BP) was investigated in urethane-anesthetized rabbits. Intravenous (iv) PS, $25{\sim}300\;{\mu}g/kg$, caused little change in BP. However, after treatment of rabbits with either of chlorisondamine (CS), hexamethonium, intracerebroventricular (icv) clonidine, icv xylazine and icy reserpine iv PS produced a pressor response. Spinalization of the rabbit also caused iv PS to increase BP. The pressor effect of iv PS in CS-treated rabbits was markedly reduced after prazosin or pirenzepine. Iv PS inhibited the pressor response to McN-A-343 in CS-treated and in spinal rabbits; alternately during the infusion of McN-A-343 iv PS failed to produce the pressor response. The pressor response to DMPP was not affected by iv PS. Icv PS, $12{\sim}200\;{\mu}g/kg$, produced a pressor response which was accentuated after CS-treatment. This pressor effect was inhibited, though not complete, by prazosin or by pirenzepine. A simultaneous treatment of rabbits with both $[Sar^{1},\;Ala^{8}]-angiotensin$ II, an angiotensin II antagonist, and prazosin or pirenzepine almost completely abolished the pressor effect of icv PS, whereas the angiotensin II antagonist did not enhance the inhibitory effect of pirenzepine and prazosin on the pressor response to iv PS . Icv pirenzepine blocked the pressor response to icv PS without affecting that to iv PS. The present results show that the pressor response to iv PS in CS-treated and in spinal rabbits arises from stimulation of the muscarinic receptors in the sympathetic ganglia, whereas the pressor response by icv PS via activation of the muscarinic receptors in the brain which causes an enhancement in the outflow of sympathetic discharge and angiotensin. The results also suggest that iv PS is unable to produce a pressor response in the rabbit unless the sensitivity of the gangionic muscarinic receptors is altered by ganglionic nicotinic blockade, by the decrease of central sympathetic outflow on the sympathetic ganglia or by spinalization.

• The Korean Journal of Pain
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• v.14 no.1
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• pp.110-113
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• 2001

In controlling chronic intractable pains, the current therapeutic methods used are exercise, over the counter medication, cognitive-behavioral therapy, opioid medication, neural blockade, operation, etc., spinal cord stimulation being the last resort. Spinal cord stimulation was initiated when Shearly and others clinically tested the Gate control theory of Melzack and Wall. This had triggered the advancement of theoretic research on the mechanism and hardware necessary and has resulted in an accumulation of clinical experiences. This is known to be effective for treating sympathetic pain, arachnoiditis, failed back pain syndrome, radiculopathy, peripheral vascular disease, phantom limb syndrome, post-herpetic neuralgia, peripheral neuropathy, and angina pectoris. This report describes our experience in experimental spinal cord stimulation in patients with simultaneous post-herpetic neuralgia and herniated intervertebral disc. There wasn't any improvement in the post-herpetic neuralgia but the symptoms of a herniated intervertebral disc was much ameliorated. This was quite an unexpected result. The patient's back pain returned when the stimulation stopped.

• The Korean Journal of Pain
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• v.19 no.1
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• pp.68-71
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• 2006

Background: Stellate ganglion block (SGB) is a selective sympathetic blockade that affects the head, neck and the upper extremities. It is an important method that has been frequently used in pain clinics due to its wide range of indications. But there were some problem with performing SGB at C6 or C7. Thus, various techniques have been recently introduced to successfully perform SGB; among them, there is the oblique approach. This study was performed to evaluate the effectiveness of the oblique approach for performing SGB in C7. Methods: Forty six patients with sudden hearing loss were studied. In group I, the patient underwent C7 oblique SGB with 1% mepivacaine (3 ml) under fluoroscopic guidance. In group II, the patients underwent the C7 classical anterior approach SGB with 1% mepivaine (5 ml) under fluoroscopic guidance. We compared the occurrence of Horner's syndrome, the side effects and the changes of temperature of the skin of the hand. Results: The rate of Horner's syndrome was 81.5% in the group I and 84.2% in the group II. The rate of incurring increased skin temperature (${\geq}34^{\circ}C$) of the fingers was 77.7% and 79.4% in each group, respectively. Conclusions: The C7 oblique approach for SGB showed the same SGB effect compared with the C7 anterior approach for SGB, and there were also fewer complications. We conclude that C7 oblique SGB may be a beneficial method for treating patients with this particular malady.

• The Korean Journal of Pain
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• v.35 no.1
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• pp.106-113
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• 2022

Background: Coccygodynia is one of the chronic, refractory painful musculoskeletal disorders. Interventional procedures are applied to patients unresponsive to initial treatment in coccygodynia. This study aims to compare the treatment outcomes of ganglion impar block (GIB) and caudal epidural steroid injection (CESI) in patients with chronic coccygodynia. Methods: This study was a prospective randomized comparison study conducted between June 2019 and January 2021. Patients diagnosed with chronic coccygodynia were randomly divided into two groups: the GIB group and the CESI group. The severity of pain, presence of neuropathic pain, and quality of life were evaluated using the Numeric Rating Scale, Leeds Assessment of the Neuropathic Symptoms and Signs Scale, and Short Form-12 Health Survey (SF-12), respectively. Results: A total of 34 patients in each group were included in the final analyses. While there was a significant decrease in pain intensity in both groups in the 3-month follow-up, this decrease was more significant in the GIB group at the 3rd week. There was a significant improvement in the SF-12 physical score and the number of patients with neuropathic pain in both groups in the 3rd week, but this improvement was not observed in the 3rd month. Conclusions: Although GIB may provide more pain relief in short term, both GIB and CESI are useful treatment methods in coccygodynia unresponsive to more conservative treatments.