• Journal of Korean Neurosurgical Society
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• 제30권3호
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• pp.325-333
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• 2001

Objective : To clarify the benefits and therapeutic effects of intra-arterial papaverine infusion on the symptomatic cerebral vasospasm, we analyzed the results of treatment in 32 patients retrospectively. Methods : A total of 510 patients underwent surgical clipping or endovascular intra-aneurysmal treatment for ruptured intracranial aneurysm between May, 1996 and June, 1999. The delayed ischemic deficit(DID) was developed in 90 of 510 patients. Of these 90 patients, 32 developed symptomatic vasospasm inspite of using modest "3H therapy". The brain CT scan was taken before the intra-arterial infusion of papaverine. The 32 patients underwent 42 intra-arterial papaverine infusion. The symptomatic vasospasm was divided into three groups : deterioration of mental status(Group 1), appearance of a focal neurologic deficit(Group 2), or both(Group 3). We measured Glasgow Coma Scale(GCS), arterial diameters, and cerebral circulation time(CCT) at the time of pre- and postangioplasty. Results : The number of patients in group 1, 2 and 3 were 26, 7, 9 respectively. Eighteen cases showed improvement of GCS more than 2 scores, 16 more than 1, and 8 showed no change of GCS. Average cerebral circulation time(CCT) was decreased ranging from 0.0%-67.5%, and arterial diameters were increased in 21 cases ranging from 1 to 4 folds. Conclusion : Intra-arterial papaverine infusion seemed to have therapeutic effects on symptomatic vasospasm by improving the neurological signs and increasing the arterial diameter. We suggest that intra-arterial papaverine infusion would be an useful adjunctive therapeutic modality in symptomatic vasospasm.

• The Korean Journal of Pain
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• 제1권1호
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• pp.16-19
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• 1988

Raynaud 증후군 환자 10명에게 procaine과 reserpine을 1~2회 동맥주사하고 성상교감신경절 차단을 주기적으로 장기간 시행하여 통증의 소실, 수지괴사의 치유등 증상이 호전된 10예를 보고하였다.

• Restorative Dentistry and Endodontics
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• 제29권3호
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• pp.239-248
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• 2004

The purpose of this study was to investigate the influence of NK1 receptor antagonists on the pulpal blood flow (PBF) when applied iontophoretically through the dentinal cavity of the teeth in order to understand whether iontophoretically applied NK1 receptor antagonists can control the pulpal inflammation. Eleven cats were anesthetized with alpha-chloralose and urethane, and substance P (SP) was administered to the dental pulp through the catheterized lingual artery in doses that caused PBF change without the influence of systemic blood pressure. NK1 receptor antagonists were applied iontophoretically to the prepared dentinal cavity of ipsilateral canine teeth of the drug administration, and PBF was monitored. Data were analyzed statistically with paired t-test. PBF increase after iontophoretic application of the NK1 receptor antagonists followed by the intra-arterial administration of SP was significantly less than PBF increase after iontophoretic application of the 0.9% saline followed by the intra-arterial administration of SP as a control (p < 0.05). Iontophoretic application of the NK1 receptor antagonists (0.2~3.4 mM) following the intra-arterial administration of SP resulted in less increase of PBF than the iontophoretic application of the 0.9% saline following the intra-arterial administration of SP as a control (p < 0.05). Therefore. the results of the present study provide evidences that the iontophoretic application is an effective method to deliver drugs to the dental pulp. and that iontophoretically applied NK1 receptor antagonists block SP-induced vasodilation effectively. The above results show the possibility that the iontophoretical application of NK1 receptor antagonists can control the neurogenic inflammation in the dental pulp.

• Journal of Korean Neurosurgical Society
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• 제30권5호
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• pp.638-641
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• 2001

Carboplatin intra-arterial chemotherapy(IAC) has an advantage of increased uptake during the first passage of the drugs through tumor capillaries. Although not common, this type of therapy is known to cause neurological complications, myelosuppression, and ototoxicity. However, the incidence of ocular toxicity is reported to be rare. Eleven of our patients with glioma(Grade II Astrocytoma : 3, Grade III Astrocytoma : 1, Grade IV Astrocytoma : 5, Gliofibroma : 1, Oligodendroglioma : 1) underwent IAC regimen with carboplatin($300mg/m^2$) which were administrated after blood-brain barrier disruption. Of there, 3 patients had ocular complications after supra-ophthalmic IAC injection of carboplatin but fully recovered following steroid therapy. Although our results from IAC seem to be favorable for these patients, we suggest that its complications, such as ocular toxicity, need to be carefully considered prior to treatment.

• Journal of Chest Surgery
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• 제41권4호
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• pp.508-511
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• 2008

서구인에 비해 동양인, 특히 극동지방의 버거씨 발병률은 높으나 우회로술 단독만의 성적은 아직 만족할 만하지 못하다고 알려져 있다. 따라서 우회론수술과 함께 교감신경 차단술, 금연, 정맥 내 혈관 확장제 투여 등의 보다 적극적이고 다양한 치료법이 요구되고 있다. 본 논문은 49세의 버거씨병 환자에게 복제정맥을 이용한 대퇴동맥-슬와동맥간 우회로술 및 교감 신경 차단술과 함께 동맥 내(intra-arterial) 프로스타글란딘 투여를 시행한 증례이다.

• The Korean Journal of Pain
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• 제1권2호
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• pp.211-213
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• 1988

Efforts from many different approaches have been made to cure Raynaud's phenomenon using dosal sympathectomy and topical injection of nitroglycerine, phentolamine or procaine and oral or parenteral administration of various drugs. However, there has been no successful management proven yet. In recent years, it was reported that intra-arterial adminstriation of various drugs in normal subjects as well as patients with Raynaud's syndrome, had emonstrated a significant increase in blood flow to the hands. We used an intermittent stellate ganglion block in conjunction with intra-arterial injection of reserpine and procaine in the patient suffering from finger necrosis caused by accidental intraarterial antibiotic (cephamezine) injection. The stellate ganglion block was performed via a paratracheal approach by injection of 0.5% bupivacaine 6 ml, and 1% lidocaine 6 ml, and followed by administration of reserpine 1 mg and procaine 50 mg through a butterfly needle inserted in the radial artery. The administration of reserpine and procaine was done twice. The stellate ganglion block was performed every day for about 3 days, then once every a 5 days as needed for 15 days. As the procedure was carried out, the discolored tissue improved and the pain was progressively relieved. In conclusion, it was suggested that the intra-arterial administration of reserpine and procaine helped initiate and accelerate the increasing blood flow to the hand and the stellate ganglion block continued to help revascularization by dilating the peripheral beds.

• Journal of Korean Neurosurgical Society
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• 제43권3호
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• pp.162-164
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• 2008

Post-clipping intraparenchymal hemorrhage of the contralateral hemisphere is a very unusual phenomenon in a patient with aneurysmal subarachnoid hemorrhage, unless there is an underlying condition. We report a complicated case of 47-year-old man, who underwent uneventful clipping of ruptured aneurysm and experienced vasospasm two weeks later. Vasospasm was treated by intra-arterial nimodipine and systemic hyperdynamic therapy. One week thereafter, he became unconscious due to intraparenchymal hemorrhage on the anterior border-zone of contalateral hemisphere, but intraoperative and pathologic findings failed to disclose any vascular anomaly. We suggest that the anti-spastic regimens cause local hemodynamic redistribution through the vasodilatory effect and in turn, resulted in such an unexpected bleeding.

• Journal of Korean Neurosurgical Society
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• 제49권2호
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• pp.112-115
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• 2011

The intra-arterial administration of nimodipine (IAN) is commonly used for cerebral vasospasm refractory to medical treatments. We report two cases of vasogenic edema after IAN. Our patients with aneurismal subarachnoid hemorrhage presented with vasospasm, which was treated by IAN. Consequently, vasogenic edema developed in the basal ganglia. Reperfusion following IAN for vasospasm may have the potential for inciting vasogenic edema in the ischemic brain.

• Journal of Korean Neurosurgical Society
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• 제52권3호
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• pp.172-178
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• 2012

Objective : The aim of this study was to determine the role of intra-arterial (IA) nimodipine injections for cerebral vasospasm secondary to ruptured subarachnoid hemorrhage (SAH) and to investigate the factors that influence vasodilation and clinical outcomes. Methods : We enrolled 29 patients who underwent aneurysm clipping for ruptured cerebral aneurysms between 2009 and 2011, and who received IA nimodipine after subsequently presenting with symptomatic vasospasm. The degree of vasodilation shown in angiography was measured, and the correlation between the degree of vasodilation and both the interval from SAH to cerebral vasospasm and the interval from clipping to cerebral vasospasm was determined. The change in blood flow rate after IA injection was assessed by transcranial Doppler ultrasound. Multiple clinical parameters were completed before and after IA nimodipine injection to evaluate any improvements in clinical symptoms. Results : For eight patients, Glasgow Coma Scale (GCS) scores increased by two or more points. The regression analysis demonstrated a positive correlation between the change in GCS scores after IA nimodipine injection and the change in blood vessel diameter (p=0.025). A positive correlation was also observed between the interval from SAH to vasospasm and the change in diameter (p=0.040); and the interval from clipping to vasospasm and the change in diameter (p=0.022). Conclusion : IA nimodipine injection for SAH-induced vasospasm led to significant vasodilation in angiography and improvement in clinical symptoms without significant complications. Our findings suggest that IA nimodipine injection should be utilized when intractable vasospasm develops despite rigorous conservative management.

• Clinical and Experimental Pediatrics
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• 제56권6호
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• pp.254-259
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• 2013

Purpose: Retinoblastoma (RB) is the most common primary malignant intraocular tumor in children. Although systemic chemotherapy has been the primary treatment, intra-arterial chemotherapy (IAC) represents a new treatment option. Here, we performed alternate systemic chemotherapy and IAC and retrospectively reviewed the efficacy and safety of this approach. Methods: Patients diagnosed with intraocular RB between January 2000 and December 2011 at Severance Children's Hospital, Yonsei University, were reviewed. Before February 2010, the primary treatment for RB was chemotherapy (non-IAC/CTX). Since February 2010, the primary treatment for RB has been IAC (IAC/CTX). External beam radiotherapy or high-dose chemotherapy were used as "last resort" treatments just prior to enucleation at the time of progression or recurrence during primary treatment. Enucleation-free survival (EFS) and progression-free survival were assessed. Results: We examined 19 patients (median age, 11.9 months; range, 1.4 to 75.6 months) with a sum of 25 eyes, of which, 60.0% were at advanced Reese Ellsworth (RE) stages. The enucleation rate was 33.3% at early RE stages and 81.8% at advanced RE stages (P=0.028). At 36 months, EFS was significantly higher in the IAC/CTX group than in the non-IAC/CTX group (100% vs. 40.0%, P=0.016). All 5 patients treated with IAC achieved eye preservation, although most patients were at advanced RE stages (IV-V). Conclusion: Despite the limitation of a small sample size, our work shows that an alternative combined approach using IAC and CTX may be safe and effective for eye preservation in advanced RB.