• The Korean Journal of Pain
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• v.4 no.2
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• pp.122-126
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• 1991

Continuous epidural analgesia with intermittent morphine injection is a good technique for the management of intractabie cancer pain. Since epidural tunnelling was introduced for the first time to our institution in 1988, it has been widely used for the cancer pain management. Recently epidural tunnelling was introduced for the keeping an inserted catheter for a long period of time. Twenty-five patients with terminal cancer had been used an epidural tunnelling at the pain clinic of Dongsan Medical Center during the period of 3 months in 1991. Among the 25 patients, 14 were male and 11 were female, and most of them were at the ages of 6th decade. The causes of pain were from stomach cancer in 12, CBD cancer in 3, hepatoma in 2, pancreatic cancer in 2, uterine cervical cancer in 2, and miscellaneous cancer in 4 cases respectively. The outcome of treatment were excellent results in 14(56%), good in 9(36%), and moderate in 2.patients(8%). Accordingly satisfactory pain relief was achieved in 92% of the patients. It is suggested that this long-term management of intractable cancer pain by epidural bupivacaine and morphine with epidural tunnelling is satisfactory and reliable.

• The Korean Journal of Pain
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• v.13 no.1
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• pp.105-110
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• 2000

Central neuropathic pain may occur in 10~20% of the patients after spinal cord injury. The central pain syndrome include spontaneous continuing and intermittent pain as well as evoked pain. The pain is evoked by non-noxious stimulation of the region (allodynia) and repeated stimulation (wind-up phenomenon). Four patients were referred suffering from severe pain, allodynia and hyperaesthesia after spinal cord injury. They had received conventional treatment with non-steroidal anti-inflammatory drugs, steroid, anticonvulsant, antidepressant and rehabilitation which failed to provide pain relief. We administered combination of low doses of morphine and ketamine (10 mg) through the epidural catheter with other conventional therapy. Satisfactory pain relief was achieved in each patient. The reduction of pain was not associated with severe side effects. The most bothersome side effect of ketamine was dizziness in one patient, only caused by bolus injection (ketamine 10 mg with normal saline 10 ml). This suggests synergy from this combination that provides an alternative treatment for central pain.

• The Korean Journal of Pain
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• v.19 no.1
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• pp.119-122
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• 2006

Upper thoracic back pain can be musculoskeletal in origin or it could be visceral referred pain, which may be indicative of a serious medical condition. We experienced a case of a 55-years-old female patient who complained of upper thoracic back pain for 1 month, which started 10 days after a traffic accident. She described the pain as being a dull, constant nagging sensation with an intensity of 4/10 on the visual analogue scale. Her pain did not subside after trigger point injection of the rhomboid and trapezius muscles. She reported intermittent palpitation, which indicated that the cardiovascular or pulmonary systems were involved. She was diagnosed with pulmonary thromboembolism by the imaging studies. Refractory upper thoracic back pain should be investigated to rule out this treatable, but potentially fatal condition.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.4
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• pp.345-348
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• 2004

Cephalic tetanus is a rare subtype of tetanus in which trismus is a charateristic symptom. The paralysis of one or more cranial nerves can occur. The 7th cranial nerve is most frequently involved. It account for 1 to 3% of the tetanus and has a mortality of 15 to 30%. The incubation period is 1 to 14 days, and approximately two thirds of tetanus cases progress to generalized tetanus. Generally, the symptoms of cephalic tetanus can include : facial pain, trismus, dysphagia, muscle twitching spasms of the face and jaw (risus sardonicus), neck stiffness and malaise. We present a case of cephalic tetanus who 54-year male patient had trismus and dysphagia. There was no history of trauma. As there was a delay in diagnosis of cephalic tetanus, respiratory disorder and intermittent general spasm occurred. The patient was treated by injection of antibiotics, muscle relaxant, and human anti-tetanus immunoglobulin. His symptoms were disappeared, and he was discharged ambulatory.

• Fire Science and Engineering
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• v.11 no.4
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• pp.15-23
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• 1997

A series of measurements and visualization to investigate the extingushiment of water sprays with pool fires is presented. Fire source is a small-scale pool burner with methanol, ethanol and gasoline. Measurements of temperature, O2, CO2, and CO concentrations along the plume centerline are carried out to observe pool structures without water sprays. Visualization by the Ar-ion laser sheet flow pattern of droplets of the sprays above the pool fires. It is observed than in the case of methanol and ethanol, water sprays continuously penetrate into the center of fuel surfaces. The gasoline pool fire allows intermittent penetration of water sprays because of pulsating characteristics of the gasoline flame. To evaluate the cooling effect of the fuel surface by the sprays, the temperature was measured at the fuel surface. As soon as the mists reach the fuel surface of methanol and ethanol, the temperatures of the fuel surface decrease rapidly below the boiling point, and then the fires are extinguished. Due to the application of mist upon the gasoline fire, though the fuel temperature decrease abruptly at the time of the injection, such a repid decrease do not continue till the extinction point.

• Journal of Korean Neurosurgical Society
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• v.56 no.1
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• pp.71-74
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• 2014

Cancer-related facial pain refractory to pharmacologic management or nondestructive means is a major indication for destructive pain surgery. Stereotactic mesencephalotomy can be a valuable procedure in the management of cancer pain involving the upper extremities or the face, with the assistance of magnetic resonance imaging (MRI) and electrophysiologic mapping. A 72-year-old man presented with a 3-year history of intractable left-sided facial pain. When pharmacologic and nondestructive measures failed to provide pain alleviation, he was reexamined and diagnosed with inoperable hard palate cancer with intracranial extension. During the concurrent chemoradiation treatment, his cancer-related facial pain was aggravated and became medically intractable. After careful consideration, MRI-based stereotactic mesencephalotomy was performed at a point 5 mm behind the posterior commissure, 6 mm lateral to and 5 mm below the intercommissural plane using a 2-mm electrode, with the temperature of the electrode raised to $80^{\circ}C$ for 60 seconds. Up until now, the pain has been relatively well-controlled by intermittent intraventricular morphine injection and oral opioids, with the pain level remaining at visual analogue scale 4 or 5. Stereotactic mesencephalotomy with the use of high-resolution MRI and electrophysiologic localization is a valuable procedure in patients with cancer-related facial pain.

• The Korean Journal of Pain
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• v.7 no.2
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• pp.249-253
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• 1994

Postherpetic neuralgia is one of the most troublesome disease in pain clinic. Nine patients who suffered from postherpetic neuralgia for 1.5 to 8 month, has been treated with the epidural block for prognostic or therapeutic purpose. Epidural catheter was inserted as close to the involved neural roots as possible, and tip of epidural catheter was confirmed under fluroscopic guide. Epidural neurolysis was performed out intermittent injection of 1~3 ml of 6% phenol in saline and repeated 2~6 times over one or 7 days interval. Two patients reported satisfactory pain relief and 3 patients reported some pain relief. But 4 patients unchanged after phenol block. The overall duration of pain relief was not studied. Validity and safety of epidural phenol block was not confined. Further study will be necessary before application of epidural phenol block to postherpetic neuralgia.

• The Korean Journal of Pain
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• v.6 no.2
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• pp.251-254
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• 1993

Hemifacial spasm is a distressing condition characterized by involuntary, intermittent, unilateral twitching of all or parts of the muscles innervated by the facial nerve. This occurrence is most common in middle-aged women. Because etiology of idiopathic hemifacial spasm has remained undefined, no causative agent nor reliable treatment has been established. This report describes a case of CT guided chemical facial nerve block for the treatment of hemifacial spasm. An injection of small amount(0.1 ml) of alcohol(95%) provided relief of the facial spasms.

• The Korean Journal of Pain
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• v.20 no.2
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• pp.246-250
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• 2007

We report here on a case of right side spasmodic torticollis (ST) that was refractory to botulinum toxin type A injection and medication. The patient finally underwent a selective ramisectomy with ipsilateral sternocleidomastoid muscle (SCM) resection, but the remaining symptoms slowly aggravated, and a contralateral left side SCM spasm began. As conservative therapy for reducing the spasmodic symptoms, accessory nerve block, upper cervical plexus block and stellate ganglion block were performed twice in a week. After 6 months, the spasmodic symptoms significantly decreased. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) decreased by more than 70%. After one year of serial intermittent local anesthetic blockade therapy, the patient became almost free from the original ST symptoms (TWSTRS = 1). Serial local anesthetic interventions for the ST patient may have a beneficial role on the pathological peripherocentral neural activity of the ST patient and can modulate motor-sensory integration in the patient.

• The Korean Journal of Physiology and Pharmacology
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• v.16 no.6
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• pp.379-386
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• 2012

The purpose of this study was to evaluate whether berberine (BER) administration could attenuate depression- and anxiety-like behaviors and increase corticotrophin-releasing factor (CRF) and tyrosine hydroxylase (TH) expression following chronic morphine withdrawal in rats. Male rats were exposed to chronic, intermittent, escalating morphine (10~50 mg/kg) for 10 days. After the last morphine injection, depression- and anxiety-like beahvior associated with morphine discontinuation persisted for at least three days during withdrawal without any change in ambulatory activity. Daily BER administration significantly decreased immobility in the forced swimming test and increased open-arm exploration in the elevated plus maze test. BER administration also significantly blocked the increase in hypothalamic CRF expression and TH expression in the locus coeruleus (LC) and the decrease in hippocampal brain-derived neurotrophic factor (BDNF) mRNA expression. Taken together, these findings demonstrated that BER administration significantly reduced morphine withdrawal-associated behaviors following discontinuation of repeated morphine administration in rats, possibly through modulation of hypothalamic CRF and the central noradrenergic system. BER may be a useful agent for treating or alleviating complex withdrawal symptoms and preventing morphine use relapses.