• The Korean Journal of Pain
• /
• v.1 no.1
• /
• pp.34-46
• /
• 1988

Intractable pain from advanced carcinoma of the upper abdomen is difficult to manage. One method used to control pain associated with these malignancies is to block off the splanchnic nerve. In 1919 Kappis described a technique by which the splanchnic nerve of the upper abdomen could be anesthetized, using a percutaneous injection. This method has been used for the relief of upper abdominal pain due to hematoma and cancer of the pancreas, stomach, gall bladder, bile duct, and colon. During the Period from November 1968 to January 1986, this method was used in 208 cases of malignancy at Severance Hospital and clinically evaluated. Patients were retroactively grouped according to the stage of development of technique used. Twelve patients who received the treatment in the period from November 1968 to March 1977 were designate4i as group 1, 26 patients from April 1977 to April 1979 as group 2, and 170 from May 1979 to January 1986 as group 3. The results are as follows: 1) The number of patients receiving splanchnic nerve block has been increasing since 1977. 2) A total of 208 patients, including 133 males and 75 females, ranging in age from 18 to 84 and averaging 51. 3) The causes of pain were stomach cancer 90, pancreatic cancer 69, and miscellaneous cancer 49 cases respectively. 4) There were 57.7% who had surgery. and 3.7% of whom had chemotherapy before the splanchnic nerve block was done. 5) These blocks were carried out with the patient in the prone position as described by Dr. Moore. For group 2 and 3, C-arm image intensifier was used. In group 1, a 22 gauze loom long needle was inserted at the lower border of the 12th rib on each aide about 7\;cm from the midline. The average distance from the midline was $6.60{\pm}0.61\;cm$ on the left side and $6.60{\pm}0.83\;cm$ on the right side in group 2, and $5.46{\pm}0.76\;cm$ on the left side and $5.49{\pm}0.69\;cm$ on the right side in group 3. The average depth to which the needle was inserted was $8.60{\pm}0.52\;cm$ on the left side and $8.74{\pm}0.60\;cm$ on the right side in group 2, and $8.96{\pm}0.63\;cm$ on the left side and $9.18{\pm}0.57\;cm$ on the right side in group 3. 6) The points of the inserted needles were positioned in the upper quarter anteriorly, 51.8% on the left side and 54.4% n the right side of the L1 vertebra by lateral roentgenogram in group 3. The inserted needle points were located in the upper and anterolateral part, of the L1 vertebra 68.5% on the left side and 60.6won the right side, on the anteroposterior rentgenogram in group 3. The needle tip was not advanced beyond the anterior margin of the vertebral body. 7) In some case of group 3, contrast media was injected before the block was done. It shows, the spread upward along the anterior mal gin of the vertebral body. 8) The concentration and the average amount of drug used in each group was as follows: In group 1, $39.17{\pm}6.69\;ml$ of 0.5% -l% lidocaine or 0.25% bupivacaine were injected for the test block and one to three days after the test block $40.00{\pm}4.26\;ml$ of 50% alcohol was injected for the semipermanent block. In group 2, $13.75{\pm}4.88\;ml$ of 1% lidocaine were used as the test block and followed by $46.17{\pm}4.37\;ml$ of 50% alcohol was injected as the semipermanent block. In group 3, $15.63{\pm}1.19\;ml$ of 1% lidocaine for test block followed by $15.62{\pm}1.20\;ml$ of pure alcohol and $16.05{\pm}2.58\;ml$ of 50% alcohol for semipermanent block were injected. 9) The result of the test block was satisfactory in all cases. However the semipermanent block was 83.3 percent of the patients in group 1 who received relief from pain for at least 2 weeks after the block, 73.1% in group 2, and 91.8% in group 3. In these unsuccessful cases, 2 cases in group 1 were controlled by narcotics but 7 cases in group 2 and 14 cases in group 3 received the same splanchnic nerve block 1 or 2 times again within 2 weeks. But, in some cases it was 3 to i months before the 2nd block and in 1 cases even 7 years. 10) The most common complications of splanchnic nerve block were hypotensino(25.5%) occasional flushing of the face, nausea, vomiting, and chest discomfort. 11) For the patients in group 3, the supplemental block most commonly used was a continuous epidural block; it was used as a diagnostic block and to afford relief from pain before the splanchnic nerve block was done. 12) The interval between the receiving of the alcohol block and discharge was from 5 to 8 days in 61 cases(31.1%) and from 1 to 2 days in 48 cases(24.5%). From the above results, it can be concluded that the splanchnic nerve block done in the prone position with pure and 50% alcohol immediately after an effective test block with 1% lidocaine under C-arm fluoroscopic control is satisfactory and reliable. How to minimize the repeat block is still a problem to be solved.

• Journal of Korean Society of Forest Science
• /
• v.29 no.1
• /
• pp.20-53
• /
• 1976

For the purpose of detecting the capability of the trees to resist air pollution and of determining the tree species best suited for purification of polluted air, particularly with regard to $SO_2$ contamination, six following ornamental tree species were selected as experimental materials: i.e., Hibiscus syriacus L., Ginkgo biloba L., Forsythia koreana Nak., Syringa dilatata Nak., Larix leptolepis Gordon, and Pinus rigida Miller. The susceptiblities of the trees were observed and analyzed on the basis of area ratio of smoke injury spots to the total leaf area. The results of the experiments are as follows: I. The Susceptibilities to Sulfur Dioxide. (1) The decreasing order of tolerance to $SO_2$ by species was as follows: 1. Hibiscus syriacus 2. Ginkgo biloba, 3. Forsythia koreana, 4. Syringa dilatata, 5. Larix leptolepis, and 6. Pinus rigida. In general, Hibiscus syriacus and Ginkgo biloba can be grouped as the most resistant and Larix leptolepis and Pinus rigida as the least resistant and Forsythia koreana and Syringa dilatata as of intermediate resistance. (2) The sulfur content of the leaves treated by $SO_2$ increased in proportion to the increase of the concentration of the fumigation. The content in the coniferous species proved to be less than that of the broad-leaved species, but Ginkgo biloba proved to contain as much sulfur as broad-leaved species. (3) The earlier-stage leaves fumigated in June with the $SO_2$ concentration up-to-l-ppm showed that sulfur content increases in proportion to the increase of the concentration of the fumigation, but the difference between concentration was not so significant. (4) The later-stage leaves fumigated in October showed higher sulfur content than the earlier stage leaves, and a wider range of difference in sulfur content was detected among different concentrations. The limit of fumigation resulting in culmination of sulfur absoption in broad-leaved species, such as Syringa dilatata, Hibiscus syriacus, and Forsythia koreana proved to be around 0.6 ppm. (5) Due to the sprouting ability and the adventitious bud formation, the recovery from $SO_2$ fumigation was prominent in Hibiscus syriacus, Syringa dilatata, and Forsythia koreana. (6) The differences in the smoke spot color were recognized by species: namely, dirt-brown in Syringa dilatata, brilliant yellowish-brown in Pinus rigida and Ginkgo biloba, whitish-yellow in Hibiscus syriacus and reddish-brown in Forsythia koreana. (7) The leaf margins proved to be most susceptible, and the leaf bases of the mid-rib most tolerant. In both Ginkgo biloba and Larix leptolepis, the younger leaves were more resistant to $SO_2$ than the older ones. II. The ulfur Content of the Leaves of the Ornamental Trees Growing in the City of Seoul. (1) The sulfur contents in the leaves of the Seoul City ornamental trees showed a remarkably higher value than those of the leaves in the non-polluted areas. The sulfur content of the leaves in the non-polluted area proved to be in the following descending order: Salix pseudo-lasiogyne Leveille, Ginkgo biloba L., Alianthus altissima swingle, Platanus orientalis L., and Populus deltoides Marsh. (2) In respect to the sulfur contents in the leaves of the ornamental trees in the city of Seoul, the air pollution proved to be the worst in the areas of Seoul Railroad Station, the Ahyun Pass, and the Entrance to Ewha Womans University. The areas of Deogsu Palace, Gyeongbog Palace, Changdeog Palace, Changgyeong Park and the Hyehwa Intersection were least polluted, and the areas of the East Gate, the Ulchi Intersection and the Seodaemun Intersection are in the intermediate state.