• The Journal of Korean Orthopaedic Ultrasound Society
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• v.7 no.1
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• pp.49-66
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• 2014

Traditionally, cervical interventions have been performed under fluoroscopy. But radiation exposure is the major concern when obtaining fluoroscopic images and even under real-time fluoroscopy with contrast media or CT guidance, some cases of serious spinal cord injuries, cerebellar and brain stem infarction have been reported by unintentional intra-arterial injections especially during the transforaminal root blocks. Recently, the use of ultrasound-guided cervical interventions have increased. Ultrasound offers visualization of soft tissues including major neurovascular structures and also allows to observe the spread of injectant materials around the target structure. Ultrasound is radiation free, easy to use and the image can be performed continuously while the injectant is visualized in real-time, increasing the precision of injection. Importantly, ultrasound allows visualization of major nerves and vessels and thus leads to improve safety of cervical interventions by decreasing the incidence of injury or injection into nearby vasculature. We therefore reviewed to investigate the feasibility of performing cervical interventions under real-time ultrasound guidance.

• Clinical and Experimental Pediatrics
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• v.60 no.12
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• pp.390-394
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• 2017

Purpose: Atrioventricular nodal reentry tachycardia (AVNRT) is less common in pediatric patients than in adult patients. Thus, data for pediatric AVNRT patients are insufficient. Hence, we aimed to analyze the patient characteristics, treatment, and any recurrences in pediatric AVNRT patients. Methods: We reviewed the records of 50 pediatric AVNRT patients who had undergone radiofrequency catheter ablation (RFCA) between January 1998 and December 2016 at a single regional center. The patients were aged ${\leq}18years$. Results: Among 190 pediatric patients who underwent RFCA for tachyarrhythmia, 50 (26.3%; mean age, $13.4{\pm}2.6years$) were diagnosed as having AVNRT by electrophysiological study. Twenty-five patients (25 of 50, 50%) were male. Twenty patients (20 of 50, 40%) used beta-blockers before RFCA. All patients had no structural heart disease except 1 patient with valvular aortic stenosis and coarctation of the aorta. RFCA was performed using the anatomic approach under fluoroscopic guidance. The most common successfully ablated region was the midseptal region (25 of 50, 50%). Slow pathway (SP) ablation and SP modulation were performed in 43 and 6 patients, respectively. Complication occurred in 1 patient with complete atrioventricular block. During follow-up, 6 patients had recurrence of supraventricular tachycardia, as confirmed by electrocardiography. Among them, 5 underwent successful ablation at the first procedure. In 1 patient, induction failed during the first procedure. Conclusion: RFCA is safe and effective in pediatric AVNRT patients. However, further research is needed for establishing the endpoints of ablation in pediatric AVNRT patients and for identifying risk factors by evaluating data on AVNRT recurrence after RFCA.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.30 no.2
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• pp.77-81
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• 2019

Dysphagia may result from dysfunction of any of the components involved in the complex neuromuscular interaction of swallowing. Hyperfunction of any of the muscles involved in swallowing is a frequent cause of dysphagia. The cricopharyngeus muscle (CPM) is a key component of the upper esophageal sphincter. Cricopharyngeus muscle dysfunction (CPD) refers to the muscle's failure to appropriately and completely relax or expand during deglutition. A variety of disease processes may cause CPD and accurate diagnosis is paramount for appropriate treatment. In appropriately selected patients, intervention at the CPM may yield significant improvement in dysphagia. Interventions include nonsurgical, pharyngoesophageal segment dilatation, botulinum toxin (BoNT) injection, and criccopharyngeal myotomy. Injections of BoNT in patients with CPD have been reported to result in marked relief of dysphagia. Different techniques for instilling BoNT into the CPM have been described. Awake, in-office CPM BoNT injection with electromyography and/or fluoroscopic or ultrasound guidance is performed transcervically or via flexible endoscopy. Operative CPM BoNT injection involves rigid laryngoscopy and esophagoscopy with direct visualization of the CPM. BoNT should be prepared in low-volume, high-concentration dilutions to minimize the potential for undesired diffusion of the toxin. The effects of BoNT occur within weeks of injection and typically last up to 5 or 6 months.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.89-92
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• 1997

Neurolytic splanchnic nerve block is effective for treatment of intractable upper abdominal cancer pain. Conventional approach for splanchnic nerve block is conducted in the prone position to ensure proper orientation and to allow insertion of needles on each side of the vertebral body. However, the prone position has some technical disadvantages as this position is frequently poorly tolerated by a majority of patients with advanced cancer due to severe abdominal pain, ascites and so on. Male patient, 53-year old with transverse colon cancer, carcinomatosis peritonei and $L_1,\;L_2$ vertebral body metastasis, was admitted for treatment of severe right upper quadrant and right iliac crest pain. We performed neurolytic splanchnic nerve block with transdiscal technique in the lateral decubitus position under fluoroscopic guidance, and well noted the usefulness and the advantage of this technique. The benefits of this technique are safe, simple and effective because the lateral position is better tolerated by patients and makes bony landmarks more accessible during fluoroscopy.

• The Korean Journal of Pain
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• v.18 no.2
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• pp.246-250
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• 2005

Facet joint synovial cysts are uncommon intraspinal abnormalities, which appear to be secondary to degenerative changes of the joints. They can cause chronic back pain and radiculopathy, as shown in spinal stenosis. When symptomatic cysts fail to respond to conservative measurements, surgical decompression is known as the standard treatment. Percutaneous steroid injections, and distension of the cysts under fluoroscopic guidance, may be a minimally invasive treatment option. Here, the case of a patient with a symptomatic L5-S1 facet joint synovial cyst and left S1 radiculopathy, who responded satisfactorily to percutaneous treatment, is presented.

• The Korean Journal of Pain
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• v.19 no.1
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• pp.63-67
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• 2006

Background: Pain due to spinal stenosis is one of the major causes of low back pain, and it sometimes does not respond to conservative treatment. We postulated that anterior epidural irrigation could be a good choice for treating lumbar spinal stenosis patients. However, the effects and theoretical basis of anterior epidural irrigation have not been investigated for spinal stenosis. So, this study was designed to identify the clinical efficacy of anterior epidural irrigation for treating lumbar spinal stenosis. Methods: 71 patients with lumbar spinal stenosis underwent anterior epidural irrigation. Anterior epidural irrigation was performed with normal saline and a mixture of local anesthetic with steroid through a catheter under fluoroscopic guidance. The findings were evaluated with using visual analogue scales for low back pain and leg symptoms. Results: Relief from low back pain and leg pain was observed for up to 12 months after anterior epidural irrigation. None of the patients showed any deterioration of their motor or sensory deficits during follow up. Conclusions: Anterior epidural irrigation is effective for the relief of back and leg pain in spinal stenosis patients.

• The Korean Journal of Pain
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• v.18 no.2
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• pp.161-164
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• 2005

Background: Chemical lumbar sympathetic ganglion block could potentially be used to treat plantar hyperhidrosis; therefore, we analyzed the outcome of lumbar sympathetic ganglion block using alcohol for the treatment of plantar hyperhidrosis. Methods: Between March 1992 and June 2003, 356 patients with plantar hyperhidrosis underwent lumbar sympathetic ganglion block using alcohol. All 356 patients were followed up for 2 years and the results evaluated. There were 185 and 171 male and female patients, respectively, with a mean age of 25.1 years, ranging from 15.3 to 56.5 years old. Lumbar sympathetic ganglion block using alcohol was performed with fluoroscopic guidance under local anesthesia. Results: The recurrence rate after 2 years was 34%. Compensatory hyperhidrosis, ejaculation failure, lower back pain and genitofemoral neuritis developed as complications in 132, 4, 12 and 2 patients, respectively. Of the 356 patients, 65% were satisfied. Conclusions: Lumbar sympathetic ganglion block using alcohol is an effective and safe method for the treatment of plantar hyperhidrosis, but more information about the complications and relatively high recurrence rates should be provided to the patient.

• 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.

• Journal of Korean Neurosurgical Society
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• v.51 no.2
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• pp.120-123
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• 2012

Objective : Percutaneous vertebroplasty (PVP) is usually carried out under three-dimensional (2D) fluoroscopic guidance. However, operative complications or bone cement distribution might be difficult to assess on the basis of only 2D radiographic projection images. We evaluated the feasibility of performing an intraoperative and postoperative examination in patients undergoing PVP by using three-dimensional (3D) reconstructive C-arm. Methods : Standard PVP procedures were performed on 14 consecutive patients by using a Siremobil Iso-$C^{3D}$ and a multidetector computed tomography machine. Post-processing of acquired volumetric datasets included multiplanar reconstruction (MPR) and surface shaded display (SSD). We analyzed intraoperative and immediate postoperative evaluation of the needle trajectory and bone cement distribution. Results : The male : female ratio was 2 : 12; mean age of patients, 70 (range, 77-54) years; and mean T score, -3.4. The mean operation time was 52.14 min, but the time required to perform and post-process the rotational acquisitions was 7.76 min. The detection of bone cement distribution and leakage after PVP by using MPR and SSD was possible in all patients. However, detection of the safe trajectory for needle insertion was not possible. Conclusion : 3D rotational image acquisition can enable intra- or post-procedural assessment of vertebroplasty procedures for the detection of bone cement distribution and leakage. However, it is difficult to assess the safe trajectory for needle insertion.

• Korean Journal of Head & Neck Oncology
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• v.18 no.1
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• pp.84-86
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• 2002

Plunging ranula is occured in about 10% of all ranula cases although surgery is the first choice therapy. However, frequent recurrences of the disease due to insufficient surgery have been reported, and various therapies have been designed in addition to surgery. We here report a case on whom we conducted intralesional injection of OK-432 for recurrent plunging ranula. A 36-year-old man was admitted who had a 2-months history of swelling of right submandibular area. He had been operated for right plunging ranula twice, 7 years ago. Under fluoroscopic guidance, contents of the ranula were aspirated and OK-432 solution was injected twice with 3-week interval. Examination after 6 weeks showed that the cystic ranula seen before therapy had disappeared completely and no recurrence was encountered after 18months. Therefore the intralesional injection of OK-432 is effective method for treatment of the plunging ranula.