• The Korean Journal of Pain
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• v.11 no.1
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• pp.127-129
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• 1998

Intractable chest and abdominal wall pain responds well to root surgery. But it is better to perform this procedure less invasively with less complications. Cryoanalgesia has been developed to relieve several neurogenic pain without causing irrversible nerve damage. Well-selected percutaneous cryoablative procedure could be one of the technique of choice for some chronic pains because it has the advantage of easy application without any remarkable side effect. We did percutaneous cryoneurolysis of the spinal nerve root at the thoracic level to treat one patient with severe cancer pain on the chest wall(T4, 5, and 8 dermatomes) after successful percutaneous radiofrequency T6 and T7 posterior root rhizotomy. This procedure was performed under fluoroscopic guidance. We advanced 2 mm cryoprobe to the posterior, superior aspect of vertebral foramen on lateral view until the patient felt paresthesia. 3 times of 2 minutes freezing was applied to each spinal nerve root. The patient got immediate pain relief without any side effect.

• The Korean Journal of Pain
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• v.7 no.1
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• pp.116-118
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• 1994

Neurolytic splanchnic nerve block is effective for treatment of intractable upper abdominal cancer in. The possibility of neurologic complication cannot be completely precluded. A 53 year-old female patient with hepatoma and lung metastasis was submitted for splanchnic nerve block with alcohol. Splanchnic nerve block was performed under radiologic control by image intensifier without any difficulty during procedure. One day after the block, she complained of numbness with sensory deficit in bilateral inguinal area. Neurologic examination revealed that asymmetrical anesthesia, hypoesthesia at $T_{12}-L_2$. She was discharged 70 days after the block with partial improvement. The possibility of alcohol spreading to the low theracic and upper lumbar somatic nerves cannot be excluded.

• The Korean Journal of Pain
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• v.18 no.2
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• pp.263-266
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• 2005

The ganglion impar is a solitary retroperitoneal structure at the caudal end of the paravertebral sympathetic chain. Block of this ganglion has been advocated as a means of managing intractable perineal pain. In 1990, Plancarte et al performed a neurolytic block of the ganglion impar using 4-6 ml of 10% phenol through the intergluteal skin over the anococcygeal ligament. However, technical difficulties are encountered with the placement of the needle while performing this technique, with complications from the injection of phenol also being a possibility. In 1995, a modified approach for blocking the ganglion impar through the sacrococcygeal ligament was introduced by Wemm and Saberski. We used a radiofrequency (RF) lesion generator to create a controlled and localized lesion with a lower incidence of neural damages compared to chemical neurolysis. RF thermocoagulation of the ganglion impar through the sacrococcygeal ligament was performed on a 70-year-old male patient with constant anal pain using a curved TEW electrode. The patient has been relieved of his pain, without serious complication. Therefore, this technique may be an easier and safer approach, which is associated with fewer chances of complications.

• Journal of Pharmacopuncture
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• v.4 no.2
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• pp.87-93
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• 2001

Objectives : Through the literature on the effect of Aconiti Cliare Tuber, Radix Aconiti, we are finding out the clinical posibility and revealing the more effective to intractable disease. Methods : We inverstigated the literatures of Oriental Medicine and experimental reports about Aconiti Cliare Tuber, Radix Aconiti. Results : 1. The taste of Aconiti Cliare Tuber, Radix Aconiti is hot, sweet, bitter, warm and hot, and the effect is dehumidification, warm up and relieve the pain, so it can be used for arthritis, hemiplegia, carpopedal spasm, sciatica, cancer, numbness. 2. A toxic constituent of Aconiti Cliare Tuber, Radix Aconitiis is induced by aconitine alkaloid, develope toxic symptoms and result in death. So it needs suitabe treatment for safety. 3. It is known that the toxicopathy due to Radix Aconiti was 3-30g(dosage for adult) and Aconiti Ciliare Tuber was 1-9g. But only using aconitine alkaloid to oral feeding, the toxicopathy due to 0.2mg/kg and lethal dose is 3-4mg. So we using this for treating, we must be careful and need more varialble study about toxicopathy, lethal dose. 4. On clinical treatment, we thought Aconiti Cliare Tuber, Radix Aconiti is so effective to intractable disease after control the toxicity, it may be need variable study on toxicity and clinical effects.

• The Korean Journal of Pain
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• v.9 no.2
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• pp.407-411
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• 1996

Stereotactic radiofrequency dorsal root ganglionotomy can be very useful procedures for the treatment of pain emanating from the lumbar segmental nerves. This procedure is reserved for patients who have failed conservative interventional treatments and in whom open surgical intervention is not an option. The advantages of the radiofrequency lesion method are presented, excellent control of the lesion process using temperature monitoring to quantify the lesion size, prevent boiling, and to produce differential destruction of neural tissue. The afferent fibers in the ventral root which are spared by dorsal rhizotomy but nerve fibers with their cells in the ganglion from either dorsal or ventral root can be destructed with stereotactic radiofrequency ganglionotomy. This technique is performed using a 100 mm cannula with a 5 mm active tip. Repeated lateral fluoroscopic view should be taken to make sure that cannlua still resides within the superior, dorsal quadrant or the foramen. With the cannula in this position, electrostimulation is performed and good paresthesia on the leg should be noted with 0.3 and 0.5 volt at 50 Hz stimulation. At 2Hz stimulation distinct dissociation between motor and sensory should be shown. Percutaneous lumbar ganglionotomy have carried out under local anesthesia on inpatient basis in 6 patients. A series of 5 patients with metastatic cancer pain and a patient with compression fracture have been relieved of pain without serious complications.

• Journal of Hospice and Palliative Care
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• v.11 no.2
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• pp.106-110
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• 2008

Palliative sedation has been used in patients who undergo intractable suffering at the end of life. Its implementation, however, may be complicated due to resistance of clinicians and barrier of bioethical issues. Here, we present 50-year-old man with stomach cancer and multiple bone metastasis who was treated with palliative chemotherapy and radiotherapy. He suffered from refractory pain on the whole body even after standard analgesics and multidisplinary effort to relieve. Upon shared decision for sedation, he was given midazolam until discharge. Literature reviews reveal cases similar to the present case.

• The Korean Journal of Pain
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• v.7 no.2
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• pp.211-216
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• 1994

Celiac plexus block is performed to relieve intractable upper abdominal cancer pain. Generally, celiac plexus blocks have been performed under control of X-ray fluoroscopy to determine the position of the needle tip and the spread of contrast media. During the period from March 1992 to February 1994, we have performed 21 cases of neurolytic celiac plexus block to alleviate pain of intra-abdominal malignancy. We retrospectively evaluated the location of the needle tip and the spread of contrast media. P-A views of simple abdomen demonstrated the locations of the needle tip: 66.7% of the left needle tips were in upper 3/1 of L1 (6 cases) and $T_{12}-L_1$ interspace (8 cases), 50% of the right needle tips were in upper 1/3 of $L_1$, (6 cases) and $T_{12}-L_1$ interspace (4 cases). Contrast media from the right needle spread upward to middle 1/3 of $T_{10}$ (5 cases) and middle 1/3 of $T_{11}$ (5 cases), downward to middle 1/3 of $L_1$ (6 cases) and lower 1/3 of $L_1$ (3 cases). Contrast media from the left needle were spread upward to middle 1/3 of $T_{10}$ (5 cases) and evenly to other spaces, downward to middle 1/3 of $L_1$, (4 cases) and $L_1-L_2$ interspace (6 cases). We analyze the spread of contrast media according to distance from needle tip by authors score system. Contrast media of right needle spread upward 6.1 and downward 3.4, that of left needle spread upward 6.5 and downward 3.7.

• 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 Gastric Cancer
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• v.13 no.2
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• pp.121-125
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• 2013

Gastric cancer patients with acute disseminated intravascular coagulation experiences a rare but severe complication resulting in a dismal prognosis. We report a case of advanced gastric cancer complicated with disseminated intravascular coagulation with intractable tumor bleeding which was successfully treated with chemotherapy consisting of 5-fluorouracil and oxaliplatin. The patient was a 63-yearold man who complained of abdominal pain, melena, and dyspnea on 24 November 2010. We diagnosed stage IV gastric cancer complicated by disseminated intravascular coagulation. Gastric tumor bleeding was not controlled after procedures were repeated three times using gastrofiberscopy. With the patient's consent, we selected the 5-fluorouracil and oxaliplatin combination chemotherapy for treatment. After one cycle of 5-fluorouracil and oxaliplatin therapy, symptoms of bleeding improved and the disseminated intravascular coagulation process was successfully controlled. The primary tumor and multiple metastatic bone lesions were remarkably shrunken and metabolically remitted after eight cycles of chemotherapy. In spite of progression, systemic chemotherapy is effective in disease control; further, the patient gained the longest survival time among cases of gastric cancer with disseminated intravascular coagulation.

• Journal of Pharmacopuncture
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• v.5 no.1 s.8
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• pp.181-188
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• 2002

Objective: Through the literatures on the effects of Buthus martensii Karsch, we are finding out the clinical possibility and revealing the more effctive to intractable diseases. Method: We investigated the literatures of Oriental Medicine and experimental reports about Buthus martensii Karsch. Results: 1. The taste of Buthus martensii Karsch is salty, hot and toxic, and the effect of this is tetanus, headache, facial palsy and convulsion. 2. The venom of Buthus martensii Karsch is anaesthetic and toxic protein, composed of buthotoxin, lecithin, trimethylamine, betaine, taurine, cholesterol, stearic acid and palmitic acid and similar to the snake venom. 3. The pharmacological effects ofButhus martensii Karsch are anti-convulsion, depressor, anesthesia, anti-thrombosis and anti-cancer. 4. Symptoms of Buthotoxin poisoning are local pain, vomiting, fever, hypertension and palpitaion, and critical condition to Dyspnea, coma and death.