| Myung Hyun Kim | 6 Articles |
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[English]
Inflammatory response may play role in symptomatic nerve irritation that is associated herniated disc. Steroids decrease neurogenic inflamation, inhibit phospholipase A2 and produce membrane stabilization that result in pain relief. Local anesthetics are believed to break the cycle of pain that exists between local pain and a secondary muscle spasm. Epidural block with steroid combined with local anesthetics(EBSL) are recommended in patients with sign and symptoms of nerve root irritation. The purpose of this study was to asses of ESBL. A retrospective study undertaken of 20 patients who received ESBL from May 2004 to November 2005 at the pain clinic of Mokdong Hospital Ewha Womans Medical Center. The mean age of the patients was 52, with range from 18-82 years. Nine patients was male, eleven were female. The etiologies of the pain were low back strain(3 patients), bulging disc(9 patients), degenerative disc(4 patients), lumbar stenosis(2 patients) and spondylolisthesis(2 patients). Diagnostic workouts were history, physical and neurologic examinations, and labo-rative studies including simple X-ray and magnetic resonance image. The steroid preparation usedis methylprednisolone and the use of dilute local anesthetics Is mepibacaine. The method of technique of EBSL was median approach with loss of resistance technique. The clinical responsefall into four categories, 6 months follow up after therapy. An excellent response was defined ascomplete resolution of presenting symptoms. A good response was judged to greater than 75%improvement in symptoms with full resumption of the patients life style. A fair response was defined as improvement in the patients condition, whereas a poor response indicated little or noimprovement. The total numbers of blocks were 48 in 20 patients and 2.4/per patient. The duration symptoms within one month were 8 patients and the other 12 patients over one month. A detailed follow-up of 20 patients with EBSL showed a successful rate(good to excellent) 65%, fair 25%, and poor 10%. The effective responses of EBSL were depend on the etiologies, duration of pains and patients age. All patients of low back strain with one month duration or less have a response rate of very successful excellent. Also all patient with bulging disc who present with pain within one month have a response rate of excellent 3(60%), good 2(40%) and the patient who present with pain of over one month or more have a response rate excellent 1(25%), fair 2(50%) and poor 1(25%). All patients of degenerative disc present with pain of over one month have 50% relative success rate and good 2 patients. The response rate of two patients of spinal stenosis and two patients of spondylolisthesis present pain of long time(2-6 months) and response rate showed fair 3, poor 1, and 0% of successful rate. EBSL can safely performed and its efficacy has been established in patients with low back strain and bulging disc. The success of this therapeutic procedure depends on attention to selected of patient etiologies and concomitant therapies. In addition, well controlled studics are needed to evaluate any effectivness of EBSL on back pain and radiculopathy.
[English]
Of all the chronic pain syndromes postherpetic neuralgia ranks the most refractory to treatment. The eight postherpetic neuralgia patients have been treated with nerve blocks or neurolysis and obtained good result. We evaluate the therapeutic effect of nerve blocks for postherpetic neuralgia and reviewed the pathology, clinical consideration, treatments and prevention. Eight patients with established postherpetic neuralgia enrolled in pain clinic of Mokdong Hospital of Ewha Womans University from March,2004 to December. Average age at 58 and about 63% of patients were over 68 years. Affected area of forehead was two patients. They have been treated with stellate ganglion block (SCB), two times supraorbital and supratrochlear nerves blocks and neurolysis with absolute alcohol. Face affected patient has was one and has been treated with 5 times SGB, 2 times supraorbital and supratrochlear nerves blocks, infraorbital and mental nerves blocks, and then 2times maxillary and mandibular nerves blocks. Chest affected two patients were treated with intercostal nerve blocks. Thoracic wall affected one patient received 2 times thoracic epidural blocks and thoracic nerve block. Scapalur and thoracic wall affected patient has been treated with SGB and 2 times thoracic epidural block. The chest and thoracic wall affected patient received 10 times intercostal blocks,2 times thoracic epidural blocks,3 times thoracic root block and neurolysis of intercostal nerves with absolute alcohol. The injected agents were 1% mepibacaine or 0.25% mercain heavy and methylprednisolone succinated, and at weekly intervals the agents were injected. All patient having been treated with nerve blocks were free of pain at 3-9 months. Although no controlled trial has been done of nerve blocks to treat postherpetic neuralgia, this technique is safe in experienced hands and, if effected, may be repeated. It suggested that local anesthetics and steroid are the effective components in nerve blocks. Data on the relief of acute pain with nerve blocks, however cannot be extrapolated to predict the prevention of postherpetic neuralgia. The best way to prevent herpes zoster becasuse of post herpetic neuralgia is so difficult to treat.
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[English]
Cysticercosis is the most frequent parasitosis of the central nervous system. Often medical treatment does not influence on ventricular or cisternal cysts or doesn't prevent the occurence of complications, such as hydrocephalus. So a considerable group of patients require surgical procedures, especially in cases of neural compression or intracranial hypertension or epilepsy. Recently stereotactic endoscopic removal of intraaxial small lesions using a stereotactic guiding tube and a fine endoscope was reported. We tried to control the symptomatic neurocy-sticercosis using the stereotatic endoscopic system. We operated 4 cases of neurocysticercosis. Cerebrospinal fluid(CSF)analysis, enhanced com-puterized tomogram(CT) and magnetic resonance image(MRI) scan were performed. There were no specific findings in CSF analysis. CT and MRI scan showed single intraparenchymal lesion in 2 cases, one was cystic and the other was solid, multiple intraventricular cysts with obstructive hydrocephalus in 1 case and mixed type in 1 case. Seizures occured in all patients, partial sensory type in 3 cases who had reciprocal intraparenchymal lesion, generalized type in 1 case who had obstructive hydrocephalus by multple ventricular cysts. For parenchymal lesions, we planned stereotactic open system endoscopic surgery with variable forceps, laser and suction. Cystic forms were removed successfully but in solid form additional transgyral microscopic removal was needed. In intraventricular lesions, we first placed stereotactic guiding tube via frontal burr hole, then replaced this to 14 Fr peelaway patheter. Through the peelaway catheter we inserted closed system endoscopy and removed the cysts with variable forceps and suctions. All intraparenchymal and intraventricular lesions were removed without specific complications except transient chemical meningitis in one case. Stereotactic endoscopic surgery make it possible to operate cystic lesions without dege-neration(vesicular stage)wherever they locate.
[English]
The assessment of the vasoreactivity measured with transcranial doppler(TCD) provides information regarding to the reserve capacity of the cerebral circulation in patients with acute head injuries, which has important therapeutic consequencies because it allows for the diagnosis of impending ischemia and for the control of the effect of initiated corrective measures. The authors performed TCD study to measure the CO2 reactivity to the entire basal cerebral arteries in 30 cases of control group and 14 cases of head inury group between the 3rd and the 7th day after insult. All patients were examined by single photon emission computed tomography and their results were compared to CO2 reactivities at 8 basal cerebral arteries. All of these results were analyzed by statistical analysis system(SAS). The increase of MBFV(mean blood flow velocity) and decrease of PI(pulsatility index)were noted in the cerebral arteries with decreased CO2 reactivity. It meant that the arterial walls were dilated. There was no close relationship between region of interest(ROI) index and CO2 index but CO2 reactivity was remarkably decreased in the region which showed abnormal regional cerebral blood flow in SPECT(single photon emission computed tomogram)(P=0.04). In the relationship between the variables, ROI increased as the clinical status worsen(r=0.5, P=0.0008), the prognosis of the patients had positive correlation with CO2 index(r=0.32, P=0.04) or clinical status had negative correlation with ROI index(r=0.40, P=0.0094). The doppler CO2 test in patients with head injury provides useful information regarding hemodynamic state, prognosis and determination of beneficial effects of specific therapy, especially during subacute stage. In the various TCD parameters CO2 index was correlated well with prognosis.
[English]
The neuroendoscopic third ventriculostomy is becoming the standard treatment for aquired aqueduct stenosis because of its exellent results and very low morbidity. Usually the floor of third ventricle is perforated by closed forcep. Fogarty catheter, laser, saline torch, monopolar coagulator and endoscope itself. Whatever the method of ventriculostomy, the obstruction may occur. Recently the author experienced a case of obstruction at the previous site of third ventriculostomy. A 54 yr old man who had long standing ataxia developed headache, vomiting and urinary incontinence suddenly. It was revealed that he had cerebellar tumor, which had compressed the aqueduct of Sylvius anteriorly. I performed the endoscopic third ventriculostomy by monopolar coagulator and Fogarty ballon catheter. During this procedure, there was some bleeding from opening margin but all these bleedings were stopped by rinsing and electric coagulation. He was improved immediately in the postoperative period. 1 month later, the reattack of hydrocephalus developed and it was operated. On intraoperative view, the newly grown gliotic plug originated from the right mammillary body. On 5th day after reoperation., the patency of the artficial aqueduct was confirmed by 2-D cine PC MR CSF(2 dimensional cine phase contrast magnetic resonance cerebrospinal fluid) flow study. I may suggest that in order to minimize the occlusion the opening should be made at the center of midline, thinnest area in front of both mammillary bodies, with less bleeding and without electric coagulation.
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, Yong Jae Cho
