• The Korean Journal of Pain
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• 제14권2호
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• pp.271-275
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• 2001

Buerger's disease is a nonatherosclerotic occlusive inflammatory disease of the small and medium arteries, and veins of the distal leg or arm. Percutaneous lumbar sympathectomy is used to lower extremity occlusive vascular disease as well as Buerger's disease. Lumbar sympathectomy improves blood flow and provides pain relief in the lower extremity. We report two cases of lumbar sympathectomy using radiofrequency thermocoagulation in patients with Buerger's disease. After no paresthesia and muscle contracture at 50 Hz, 1 volt and 2 Hz, 3 volts, respectively, radiofrequency lesioning was performed for 90 sec at $80^{\circ}C$. After the procedure, both patients showed skin temperature increases greater than $2^{\circ}C$ on the affected extremity. Both patients received relief from pain and symptoms without complications. We consider that lumbar sympathectomy using radiofrequency thermocoagulation is a safe and effective procedure that can relieve pain in patients with Buerger's disease.

• The Korean Journal of Pain
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• 제25권1호
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• pp.60-64
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• 2012

The patient was a 45-year-female who presented with pain at right shoulder and right upper arm. The patient suffered from right shoulder and arm pain for 3 years and had pain management which was performed using medication and conservative management after she had been diagnosed with calcific tendinitis. However, substantial pain relief was not consistently achieved, and recurrence of pain was reported. Therefore, we performed right axillary nerve and suprascapular nerve block through pulsed radiofrequency. Two months after the procedure, the shoulder pain gradually subsided with the size reduction of the calcified nodule and she needed no more pain management.

• The Korean Journal of Pain
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• 제24권1호
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• pp.57-60
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• 2011

Pulsed radiofrequency (PRF) treatment of nervous tissue has been proposed as a less neurodestructive technique alternative to continuous RF heat lesioning. Recently, clinical reports using PRF have shown favorable effects in the treatment of a variety of focal pain areas, even in non-nervous tissues; however, the mechanism of effect underlying this treatment to non-nervous tissue remains unclear. We report the case of a 67-year-old male who presented with pain reliving point in the posterior neck. The patient had pain in the posterior neck for 3 years. The pain subsided with pressure applied to a point in the posterior neck. There were no specific abnormal findings on laboratory testing and radiologic examinations. After PRF treatment to the pain-relieving point, he had pain relief which lasted more than 5 months.

• The Korean Journal of Pain
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• 제13권2호
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• pp.149-155
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• 2000

Background: Pulsed radiofrequency (RF) lesioning is a painless procedure and causes no neurodestruction and neuritis-like reaction are common following conventional RF lesioning. There is little data about the effect of pulsed RF especially with regard to its suitability for the treatment of acute pain. The possibility of a placebo effect cannot be ruled out because a double-blind study was not performed in previous studies. There is also no neuropathologic study about pulsed RF. Methods: The rats were anesthetized with sodium pentobarbital (40 mg/kg, i.p.; supplemented as necessary). The common sciatic nerve was exposed by blunt dissection through biceps femoris. Pulsed RF was administered to the common sciatic nerve using a 30 ms/s pulse with for 120 seconds. The temperature reached was no more than $42^{\circ}C$. Analgesia was determined using hot-plate assay shortly and, 3 days and 1 week before, and 2 weeks after operation. Lesions were examined with LM (light microscope) and EM (electron microscope) 2 weeks later. Results: There were no differences in response latencies between the control and experimental group. There were many vacuoles with hyaline bodies in the Schwann cell cytoplasm rather than axon in LM and larger electron dense bodies. No changes were found in the axon or unmyelinated fibers. Only small changes were found in the sheaths of myelinated fibers and Schwann cells. Conclusions: We therefore do think that any analgesic effect of pulsed RF is not a result of block of neural conduction. But rather than it can be attributed to others factors. It was also ineffective as a treatment for acute pain such as that caused by the hot-plate test.

• Journal of Korean Neurosurgical Society
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• 제29권10호
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• pp.1360-1364
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• 2000

This 26-year-old man gradually developed a disabling midbrain tremor involving both distal and proximal part of left upper arm. On neurologic examination, oculomotor palsy, and ataxia of the left arm were noted. Radiologic examination revealed a mass lesion on midbrain tegmentum. He was tentatively diagnosed as brain tumor (presumably germinoma) without stereotactic biopsy. Conventional radiation therapy was given for this lesion. Although there was improvement in the radiologic imaging, his midbrain tremor worsened and became untolerable. The authors performed MR-guided stereotactic Vim-thalamotomy. With macroelectrode stimulation and radiofequency lesioning, his resting, postural and action tremors were almost completely abolished in both distal and proximal part of left upper extremity. Authors consider that Vim thalamotomy is still an effective means of controlling midbrain tremor involving proximal upper limb.

• The Korean Journal of Pain
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• 제19권2호
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• pp.282-284
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• 2006

Percutaneous radiofrequency thermocoagulation has been applied in patients with various forms of chronic pain, such as facet joint pain, cancer pain and trigeminal neuralgia. A major portion of the hip joint is innervated by the articular branches of the femoral and obturator nerves. Radiofrequency thermocoagulation of the articular branches of the obturator and femoral nerves can be a good alternative treatment for patients with hip joint pain, especially in those where surgery is not applicable. A patient suffering hip joint pain due to metastatic cancer underwent multiple radiofrequency lesioning of the femoral and obturator nerves at $80^{\circ}C$ for 120 seconds, using a Racz-Finch Kit. The patient experienced about a 50% reduction in the pain, without any numbness or other side effects.

• The Korean Journal of Physiology and Pharmacology
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• 제8권5호
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• pp.245-251
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• 2004

The effects of fetal mesencephalic cell grafts on the restoration of nigrostriatal dopaminergic function were studied in the intrastriatal 6-hydroxydopamine-lesioned rats. Four weeks after lesioning, transplantation of ventral mesencephalic cells from embryonic day 14 fetuses showed the number of tyrosine hydroxylase (TH) positive cells and fiber outgrowth in the grafted striatum, and significantly ameliorated symptomatic motor behavior of the animals, as determined by apomorphine-induced rotation. Furthermore, in substantia nigra pars compacta (SNc), the numbers of TH + cells and fibers were markedly restored. Dopamine content of ipsilateral SNc was close to that of contralateral SNc $(91.9{\pm}9.8%)$ in the transplanted animals, while the ratio was approximately 32% in sham-grafted animals. These results indicate that grafted cells restored the activity for the dopaminergic neurons located in SNc, although they were transplanted into striatum. In addition, we showed that the implanted fetal cells expressed high level of glial cell line-derived neurotrophic factor (GDNF), suggesting that the transplanted fetal cells might serve as a dopamine producer and a reservoir of neurotrophic factors. These results may be helpful in consideration of the therapeutic transplantation at early stage of PD.

• 생약학회지
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• 제42권4호
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• pp.341-347
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• 2011

The neuroprotective effects of herbal ethanol extracts from Gynostemma pentaphyllum (GP-EX) in 6-hydroxydopamine (6-OHDA)-lesioned rat model of Parkinson's disease treated with L-DOPA were investigated. Rats were prepared for the Parkinson's disease model by 6-OHDA-lesioning for 14 days. The rats were then treated with L-DOPA (10 and 20 mg/kg) with or without the oral administration of GP-EX (30 mg/kg, daily) for 28 days. L-DOPA (20 mg/kg) treatment for 28 days enhanced dopaminergic neuronal cell death in 6-OHDA-lesioned rat groups, but L-DOPA (10 mg/kg) did not. However, the oral administration of GP-EX (30 mg/kg) for 28 days ameliorated the enhanced neurotoxic effects induced by chronic L-DOPA treatment in 6-OHDA-lesioned rat groups by increasing tyrosine hydroxylase (TH)-immunohistochemical staining and the number of TH-immunopositive cells surviving in the substantia nigra. In addition, GP-EX administration (30 mg/kg) for 28 days recovered the levels of dopamine and norepinephrine of the striatum in 6-OHDA-lesioned rat groups, which were markedly reduced by L-DOPA treatment (20 mg/kg). GP-EX (30 mg/kg) did not produce any signs of toxicity, such as weight loss, diarrhea, or vomiting in rats during the 28-day treatment period. These results suggest that GP-EX has protective functions against chronic L-DOPA-induced neurotoxic reactions in dopaminergic neurons in the 6-OHDA-lesioned rat model of Parkinson's disease. Therefore, GP-EX may be beneficial in the prevention of adverse symptoms in parkisonian patients.

• Journal of Korean Neurosurgical Society
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• 제61권4호
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• pp.427-433
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• 2018

Obsessive compulsive disorder is a debilitating condition characterized by recurrent obsessive thoughts and compulsive reactions. A great portion of the obsessive compulsive disorder (OCD) patients are managed successfully with psychiatric treatment such as selective serotonin-reuptake inhibitor and cognitive behavioral psychotherapy, but more than 10% of patients are remained as non-responder who needs neurosurgical treatments. These patients are potential candidates for the neurosurgical management. There had been various kind of operation, lesioning such as leucotomy or cingulotomy or capsulotomy or limbic leucotomy, and with advent of stereotaxic approach and technical advances, deep brain stimulation was more chosen by neurosurgeon due to its characteristic of reversibility and adjustability. Gamma knife radiosurgery are also applied to make lesion targeting based on magnetic resonance (MR) imaging, but the complication of adverse radiation effect is not predictable. In the neurosurgical field, MR guided focused ultrasound has advantage of less invasiveness, real-time monitored procedure which is now growing to attempt to apply for various brain disorder. In this review, the neurosurgical treatment modalities for the treatment of OCD will be briefly reviewed and the current state of MR guided focused ultrasound for OCD will be suggested.

• The Korean Journal of Pain
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• 제23권1호
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• pp.11-17
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• 2010

Background: The target of lumbar sympathetic ganglion block is the anterolateral surface of the L2, 3 and 4 vertebral bodies, where the lumbar sympathetic ganglion usually lies. In most cases, a block-needle is inserted approximately 5-8 cm lateral to spinous process on the skin and directed to the anterolateral surface of vertebral body obliquely. The purpose of this study is to determine the safe entry angle and entry point in Korean by using the abdominal CT scan images. Methods: The abdominal CT images of eighty five patients were recruited to this study. The minimal angle aimed at the lumbar sympathetic ganglion that can pass through the lateral aspect of body and maximal angle that avoids puncturing the kidney, ureter or retroperitoneal space were measured. The distance from midline to skin entry point was also measured. Results: There was no significant difference in entry angle among L2, 3, and 4 level. The entry angle was similar in the right and left side, and in males and females. The entry angle of old age group was significantly smaller than that of young age group. The calculated safe entry angle was $30.5{\pm}0.4^{\circ}$ and entry point was $7.7{\pm}0.2\;cm$ and $6.7{\pm}0.1\;cm$ lateral from midline in males and females respectively. Conclusions: These measurements can be used as a reference for lumbar sympathetic ganglion block and radiofrequency lesioning. Prior to performing the lumbar sympathetic ganglion block for cancer patients, the abdominal CT scan should be reviewed to prevent complications.