• The Korean Journal of Pain
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• v.18 no.1
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• pp.34-38
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• 2005

Background: Over the years, disc surgery has progressively evolved in the direction of decreasing trauma and its invasiveness. Conventional open surgery has many complications, such as scarring, instability, bleeding and a relative high mortality rate. Minimally invasive spinal surgery is now an alternative to a traditional discectomy. Herein, we present an operative technique, and the early results, for a percutaneous endoscopic lumbar discectomy in herniated lumbar disc disease. Methods: 43 patients, including 27 men and 16 women, with ages ranging from 18 to 66 years, were enrolled in this study. All the patients showed a protruded or extruded soft disc herniation at the lumbar level on magnetic resonance imaging and computed tomography. A percutaneous endoscopic lumbar discectomy was applied to the patients, and clinical responses evaluated using MacNab's criteria. Results: 40 patients were regarded as showing successful responses (93.1%), and there were no severe complications, such as a hematoma, nerve injury, postoperative dysesthesia or death. One patient underwent fusion surgery for remnant back pain six month later. Conclusions: We conclude that, in properly selected patients, a percutaneous endoscopic lumbar discectomy is a safe, noninvasive and effective treatment modality for herniated lumbar intervertebral disc disease.

• The Korean Journal of Cytopathology
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• v.4 no.1
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• pp.35-40
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• 1993

We describe a case of fine needle aspiration cytology of metastatic nasopharyngeal carcinoma in the lymph node of the neck presenting a predominantly spindle cell pattern. A 36 year-old male patient complained of dysesthesia on the right face and a palpable neck mass. Fine needle aspiration was done on the neck mass. Tumor cells were present in syncytial groups or singly with mainly spindle shaped nuclei, vesicular chromatin, thin and regular nuclear membrane, occasional prominent nucleoli and a few fool of cellular cohesiveness. The cytoplasm was scant and pale with ill-defined borders. Mature lymphocytes were present in the background of aspirates and within the tumor cell clusters. Histologically, the tumor of nasopharynx showed several areas of spindle cell pattern. Because the tumor cells showed a predominantly spindle shape with vesicular nuclear chromatin, the differential diagnosis of spindle cell sarcoma or granuloma of epithelioid clils were considered, but the characteristic morphology of the nuclei with vesicular chromatin and prominent nucleoli, and cellular cohesiveness were important in making the diagnosis of nasopharyngeal carcinoma. The possibility of metastatic carcinoma should always be considered in fine needle aspiration cytology of the lymph node in the neck because the incidence of metastatic carcinoma, particularly of the nasopharyngeal carcinoma in the lymph nodes of the neck is relatively high.

• Journal of Oral Medicine and Pain
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• v.44 no.1
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• pp.40-44
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• 2019

Third molar extraction, one of the important surgical treatments commonly practiced in dentistry, presents various symptoms after surgery ranging from temporary or mild symptoms to permanent or severe complications. However, oral burning pain, dysesthesia, parageusia, dry mouth, headache and pain in multiple teeth are not the common symptoms that patients often complain after dental extraction. Here, the authors report two cases who presented acute neuropathic symptoms mentioned above in the orofacial regions following third molar extraction. At the initial examination, the healing of the tooth sockets of two patients was normal. One patient was diagnosed as megaloblastic anemia associated with Vitamin $B_{12}$ deficiency and was referred to the Department of Hematology for assessing the underlying etiology of anemia. The laboratory test for the other patient revealed microcytic anemia related to iron deficiency. The patient with iron deficiency anemia was successfully treated with iron supplement. These two cases suggest that anemia, as an underlying systemic disease, may be a rare etiology explaining acute onset of peripheral neuropathy in the orofacial regions after third molar extraction and should be considered in the assessment of patients who report neuropathic symptoms after dental extraction.

• Clinical Pain
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• v.20 no.2
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• pp.122-126
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• 2021

When a patient represents pain in foot, physician can easily overlook compression neuropathy of peripheral nerve as it is uncommon. Among nerve entrapment syndrome encountered in the foot, selective compression in lateral branch of deep peroneal nerve (DPN) is rare. We report a case of a patient with pain and dysesthesia in dorsolateral foot which turned out as lateral branch of deep peroneal nerve entrapment syndrome caused by talonavicular joint effusion. We would like to share diagnostic work up flow and conservative treatment courses. This case manifests the importance of the deep peroneal nerve and its branches in clinical setting of pain and ankle instability.

• Physical Therapy Rehabilitation Science
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• v.12 no.1
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• pp.12-18
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• 2023

Objective: Chemotherapy is usually given to inhibit cancer progression. It is the most common side effect of chemotherapyinduced peripheral neuropathy (CIPN) after chemotherapy, and its symptoms include pain such as paresthesia, dysesthesia, allodynia, hyperalgesia, and electrical stimulation. Therefore, in this review, randomized controlled trials (RCTs) were combined to analyze the effect qualitatively and quantitatively in order to find out the effect of manual therapy on patients with CIPN through a meta-analysis. Design: A systematic review and meta-analysis Methods: This review conducted a literature search through international databases (CINAHL, Embase, MEDLINE, Web of Science) in December 2022 to synthesize the effect of manual therapy on the symptomatic improvement of CIPN. Qualitative evaluation (risk of bias) and quantitative evaluation using ReVMan provided by the Cochrane Group were expressed as a random effect model and standardized mean difference (SMD). Results: In four RCTs 165 patients with CIPN were evaluated for symptoms of neuropathy. The experimental group consisting of manual therapy and its subcategories showed significant improvement compared to the control group. The results analyzed through the random effects model were SMD=-1.11; 95% confidence interval, -1.97 to -0.24. Conclusions: We came to the conclusion that manual therapy could significantly contribute to improving the symptoms of CIPN, and since it may vary depending on the technique of manual therapy, further studies on manual therapy suitable for neuropathy are needed.

• Journal of Korean Neurosurgical Society
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• v.51 no.5
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• pp.276-280
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• 2012

Objective : Gamma knife radiosurgery (GKRS) is the least invasive surgical option for patients with trigeminal neuralgia (TN). However, the indications and long term outcomes of GKRS are still controversial. Additionally, a series with uniform long-term follow-up data for all patients has been lacking. In the present study, the authors analyzed long-term outcomes in a series of patients with TN who underwent a single GKRS treatment followed by a minimum follow-up of 60 months. Methods : From 1994 to 2009, 40 consecutive patients with typical, intractable TN received GKRS. Among these, 22 patients were followed for >60 months. The mean maximum radiation dose was 77.1 Gy (65.2-83.6 Gy), and the 4 mm collimator was used to target the radiation to the root entry zone. Results : The mean age was 61.5 years (25-84 years). The mean follow-up period was 92.2 months (60-144 months). According to the pain intensity scale in the last follow-up, 6 cases were grades I-II (pain-free with or without medication; 27.3%) and 7 cases were grade IV-V (<50% pain relief with medication or no pain relief; 31.8%). There was 1 case (facial dysesthesia) with post-operative complications (4.54%). Conclusion : The long-term results of GKRS for TN are not as satisfactory as those of microvascular decompression and other conventional modalities, but GKRS is a safe, effective and minimally invasive technique which might be considered a first-line therapy for a limited group of patients for whom a more invasive kind of treatment is unsuitable.

• The Journal of Internal Korean Medicine
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• v.41 no.5
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• pp.787-799
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• 2020

Objectives: Pityriasis rubra pilaris (PRP) is a rare papulosquamous disorder with unknown etiology. Studies on adults have not been conducted yet in Korean medicine. We report the progress of Korean medicine treatment for adult-type pityriasis rubra pilaris. Methods: A 62-year-old female patient was diagnosed with PRP in June 2019. After the diagnosis of PRP, retinoid treatment was continued for about 6 months, and then the drug was switched to an oral immunosuppressant. However, the patient's symptoms did not improve, but instead worsened. The patient was treated with Mihudeungsikjang-tang and acupuncture therapy. We evaluated her treatment progress based on the Dermatology Life Quality Index (DLQI), a visual analogue scale (VAS), and the changes in the patient's subjective symptoms. Results: After Korean medicine treatment, the DLQI and VAS scores improved from 18 points to 16 points and from 6 points to 4 points, respectively. The whole-body itching and scaling were reduced by 30% compared to pretreatment. The itching and pain in the neck, which had been severely symptomatic, decreased by 50%. The pain and dysesthesia in the upper and lower extremities disappeared, but the erythema still remained. Conclusions: Conventional treatments for PRP have limitations due to adverse effects and difficulty in treating refractory forms. Korean medicine treatment is worth considering as it can complement the limitations of conventional treatments, although more studies will be needed.

• Journal of Korean Neurosurgical Society
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• v.41 no.1
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• pp.7-10
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• 2007

Objective : The aim of this study was to determine the efficacy of percutaneous radiofrequency neurotomy[RFN] of ramus communicans nerve in patients suffering from severe low back pain due to osteoporotic compression fracture. Methods : Twenty two patients with lumbar osteoporotic compression fracture who had intractable back pain for less than two weeks and were performed with RFN at L1-L4 from May 2004 to December 2005 were retrospectively analyzed. Clinical outcome using visual analogue scale[VAS] pain scores and modified MacNab's grade was tabulated. Complications related to the procedure were assessed. Results : Twenty-two female patients [age from 63 to 81 years old] were included in this study. The mean VAS score prior to RFN was 7.8, it improved to 2.6 within postoperative time of 48 hours, and the mean VAS score after 3 months was 2.8, which was significantly decreased. Eighteen of 22 patients were graded as excellent and good according to modified MacNab's criteria at final follow up. All patients recovered uneventfully, and the neurologic examination revealed no deficits. Two patients showing poor results worsened in symptom. Percutaneous was performed eventually resulting in symptom improvement. There were no significant complications related to the procedure such as sensory dysesthesia, numbness or permanent motor weakness. Conclusion : RFN is safe and effective in treating the painful osteoporotic compression fracture. in patients with intractable back pain due to lumbar osteoporotic compression fracture, RFN of gray ramus communicans nerve should be considered as a treatment option prior to vertebroplasty.

• Journal of Korean Neurosurgical Society
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• v.43 no.4
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• pp.186-189
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• 2008

Objective : We assessed the surgical results of percutaneous balloon compression in 50 patients with idiopathic trigeminal neuralgia. Methods : Fifty patients with follow-up period of more than 12 months were retrospectively analyzed. The mean follow-up period was 42 months (range, 12-82). The mean age was 65.8 years (range, 27-83). Seventeen patients (34%) had other previous surgical procedures. The balloon was inflated by injecting radio-contrast media under brief general anesthesia according to Mullan’s technique. The mean inflating time was 88 seconds (range, 60-120). The whole procedure took about 20 minutes. Results : We reported excellent and good results in 70% of the cases, poor in 6% as annoying dysesthesia, recurrence in 16%, and 8% failure due to technical deficiencies. Forty-six patients (92%) were initially relieved of their pain. There were permanent motor weakness of the masseter muscle in 4% of patients and transitory diplopia in 8%. Neither anesthesia dolorosa nor keratitis occurred. Almost all patients (92%) were discharged postoperatively within two days. Conclusion : These results indicate that balloon compression would be an effective method with acceptable morbidity, technically, It can be performed rapidly and simply in the treatment of idiopathic trigeminal neuralgia.

• Archives of Plastic Surgery
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• v.38 no.1
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• pp.81-84
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• 2011

Purpose: Nerve injury is one of the complication which can develop after brow lift. Peripheral nerve ending which is stretched from supraorbital nerve and supratrochlear nerve can be injured and symptoms such as pain, dysesthesia may appear. Usually, developed pain disappeared spontaneously and does not go on chronic way. We experienced a case that a patient complained chronic pain after brow lift which was not controlled by conservative management such as medications, local nerve block and report a successful surgical treatment of chronic pain after brow lift. Methods: A 24-year-old male who received brow lift with hairline incision at local hospital was admitted for chronic pain at the right forehead. The pain was continued for 3 months even though fixed thread was removed. Local nerve block at trigger point with mixed 1 mL 2% lidocaine and 1 mL Triamcinolone acetonide was done and oral medications, Gabapentine and carbamazepine, were also applied but there was no difference in the degree of pain. Therefore the operation was performed so that careful dissection was carried out at right supraorbital neurovascular bundle and adhered supraorbital nerve was released from surrounding tissues and covered with silastic sheet to prevent adhesion. Results: The pain was gradually relieved for a week. The patient was discharged without complications. No evidence of recurrence has been observed for 2 years. Conclusion: The pain developed after brow lift was engaged with nerve injury and sometimes remains chronically. Many kinds of conservative management to treat this complication such as medications, local nerve block have been reported and usually been used. But there are some chronic cases that conservative treatment do not work. In sum, we report 1 case of successful surgical treatment for relief of intractable pain developed after brow lift surgery.