• Title/Summary/Keyword: intractable

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Persistent idiopathic facial pain treated with botulinum toxin and pulsed radiofrequency of infraorbital nerve - a case report

  • Vadhanan, Prasanna
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.22 no.1
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    • pp.67-70
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    • 2022
  • Persistent idiopathic facial pain is a rare and difficult condition to treat. Several pharmacological, nonpharmacological, and invasive treatment options have been used, with varying results. We report the case of a patient with intractable persistent idiopathic facial pain who responded favorably to a combination of botulinum toxin injections and pulsed radiofrequency treatment of the infraorbital nerve.

Dolichoectasia of vertebrobasilar artery presenting as facial pain: a case report

  • Prasanna Vadhanan
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.23 no.4
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    • pp.237-240
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    • 2023
  • Dolichoectasia of the intracranial arteries is a rare condition characterized by elongated and tortuous arteries due to progressive destruction of the vessel walls. Although most patients present with cerebrovascular accidents, our patient presented with intractable facial pain along the distribution of the trigeminal nerve. Clinical examination revealed involvement of the 5th, 7th, and 8th cranial nerves, and subsequent MRI showed dolichoectasia of the left basilar artery. The patient experienced symptomatic relief after a trial of carbamazepine along with botulinum toxin injections.

A Case of Chronic Intractable Diarrhea with IgA, $IgG_2$ and $IgG_4$ Deficiency (면역글로불린 A 및 $G_2$, $G_4$ 결핍에 동반된 만성 난치성 설사 1례)

  • Ahn, Sung-Ryon;Kim, Young-Mi;Nam, Sang-Ook;Park, Jae-Hong;Lee, Chang-Hoon
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.4 no.2
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    • pp.243-248
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    • 2001
  • In most cases, acute diarrhea in childhood heals spontaneously, but it may become the form of chronic diarrhea in immunodeficient children and then cause weight loss, dehydration, malabsorption and malnutrition. The immunodeficient diseases associated with chronic diarrhea include severe combined immunodeficiency syndrome, common variable immunodeficiency, acquired immunodeficiency syndrome, agammaglobulinemia or selective IgA deficiency. IgA deficiency is the most common primary immunodeficiency. Because many IgA deficient individuals seem to have compensated for their deficiency with increased IgM production and various nonimmunologic factors, the incidence of gastrointestinal involvement is not prominent. Some of those with IgA deficiency and recurrent infections have been found to also have IgG subclass deficiency. IgA deficiency with $IgG_2$ and $IgG_4$ subclass deficiency have high susceptability to infection and chronic diarrhea. IgG subclass deficiency, when present, is more likely to be found in association with a partial IgA deficiency rather than complete IgA deficiency. We report a 3-month-old male with intractable diarrhea accompanied by IgA, $IgG_2$, and $IgG_4$ deficiency.

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Case Study of Miso Facial Rejuvenation Acupuncture on Intractable Facial Palsy (중증 안면마비에 대한 미소안면침 증례보고)

  • Lee, Soh-Young;Ko, Jung-Min;Kim, Joo-Hee;Kwon, Hyo-Jung;Chung, Jie-Youn;Song, Jeong-Hwa;Choi, Do-Young;Lee, Jae-Dong;Lee, Sang-Hoon
    • Journal of Acupuncture Research
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    • v.26 no.1
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    • pp.163-171
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    • 2009
  • Objectives : This study was designed to evaluate the effect of Miso Facial rejuvenation Acupuncture on severe cases of facial palsy. Methods : Facial palsy patients over the age of 70 with House-Brackmann grading system(HBGS) above Grade V were treated with Miso Facial rejuvenation Acupuncture. The effects of the treatment were evaluated via scales and picture. Results : Before treatment with Miso Facial rejuvenation acupuncture, the three patients showed H-B Gr V. After treatment, they showed improvement to H-B Gr II, III, and II respectively. There also formed nasolabial folds on the palsied side, with better blinking of the eyes, and improved asymmetry of the left and right face. Conclusions : Miso Facial rejuvenation Acupuncture showed marked improvement in intractable facial palsy. Randomized-controlled trial for further evaluation will be needed in the future.

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Management of Intractable Cerebrospinal Fluid Collection after Cerebellar Tumor Resection: A Case Report (소뇌 종양 적출 후 두개강 내 발생한 난치성 뇌척수액 고임의 치험례)

  • Rha, Eun Young;Oh, Deuk Young;Kim, Hye Young;Lee, Jung Ho;Moon, Suk Ho;Seo, Je Won;Rhie, Jong Won;Ahn, Sang Tae
    • Archives of Craniofacial Surgery
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    • v.11 no.2
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    • pp.95-98
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    • 2010
  • Purpose: CSF (Cerebrospinal fluid) leakage is the most common complication of neurosurgery. Early management with conservative care or surgery must be followed appropriately due to the increased risk of lethal complications, such as meningitis. We report a case of intractable CSF leakage that occurred after a cerebellar tumor resection, which was treated successfully. Methods: A 53-year old male consulted our department for continuous CSF leakage for 3 months after having received conservative care and lumbar drainage. CSF collection was observed in the dead space of the posterior fossa after a cerebellar tumor resection and postoperative radiotherapy. Using a free latissimus dorsi muscle flap, the dead space within the skull was filled and the defects were covered successfully. Results: At 6 weeks after surgery, the follow-up MRI and CT revealed proper coverage and filling in the area where cerebellar tumor had been removed. No CSF leakage was observed at the postoperative 3 month follow-up. Conclusion: Recurrent CSF leakage was treated after cerebellar tumor resection with a relatively satisfactory result. In terms of the patient's treatment, much better results can be achieved by performing dead space filling using a flap with a sufficient size, in addition to coverage of the defects of the dura.

A comparative Study on the Combined Oriental and Western Medicine(COWM) in Four Northeast Countries (동북아시아 4개국의 양.한방 의료협진체계 비교)

  • 문옥륜;김은영;신은영;김혜영;천희란
    • Health Policy and Management
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    • v.13 no.2
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    • pp.1-22
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    • 2003
  • Since 1990s, the use of Complementary and Alternative Medicine(CAM) has been rising rapidly all of the world. In 1983, WHO recommended that the traditional medicine actively be utilized. At the end of 20th century, as chronic and intractable diseases increased in western countries, traditional medicine has attracted considerable attention. COWM shows possibilities of new approaches for these intractable diseases. Thus, we try to show our proper approach of COWM through the international comparative study. In order to fulfill the objectives, we applied the following methodology: 1) Literature review on previous study, 2) Local survey using self-administered questionnaire, and 3) FGI(Focus Group Interview) with local experts. The results were as follows : Three Asian countries, China, Korea and Taiwan, are very active in implementing COWM policy. Japan, however, has independent system of unified medicine. In regards to the combined care policy and system, China has the most advanced COWM system among four countries. In respect to combined care education, it is needed to increase the COWM education contents and the amount of cross educational curriculum. Based on the current COWM system, Chinese, Japanese and Taiwanese doctors can prescribe both oriental and western drugs. But, Korean medical law prohibits western doctors and oriental doctors from prescribing the counterpart´s medicine. So, the revision of current medical law is urgent for COWM in Korea. And when it comes to patient satisfaction, more than fifty percent responded positively in China, Korea and Taiwan. To achieve the goal of COWM ; 1) mutual understanding and recognition of COWM is essential. 2) institutional and legal support system for COWM is desperately urgent. 3) possible international collaboration and cooperation should be sought to untangle these complex cultural dilemmas.

A Case of Surgical Treatment of Intractable Vocal Fold Scar Using Basic Fibroblast Growth Factor and Collagen Scaffold (기본섬유아세포 성장인자와 콜라겐 골격으로 치료한 난치성 성대 반흔 1예)

  • Kang, Hyun Tag;Kim, Hyo Jun;Park, Ki Nam;Lee, Seung Won
    • Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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    • v.30 no.2
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    • pp.124-127
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    • 2019
  • Vocal fold scarring is an intractable phonosurgical condition. The number of patients with vocal fold scars is increasing with the aging of society and with the increasing application of laryngeal microsurgery. Many methods are available to treat these, including voice therapy, stem cells, regenerative scaffolds, and growth factors. However, no standard treatment strategy has yet been established, and novel techniques are required. Basic fibroblast growth factor has been shown to be effective for the treatment of mild chronic vocal fold scarring. The combined use of basic fibroblast growth factor and regenerative scaffolds is currently under investigation. Here, we report a female patient in whom vocal fold scarring developed after two laryngeal microsurgeries. We performed laryngeal microsurgery to remove the scar tissue and used basic fibroblast growth factor and a collagen scaffold to promote healing. The patient's voice quality was greatly increased, and she was content with her voice after 2 years of follow-up. This is the first report of this methodology in Korea and is presented along with a review of the literature.

Complicated Wound Infection Following Transvenous Endocardial Pacemaker (경정맥(經靜脈) 내적(內的) Pacemaker 이식후(移植後) 발생(發生)한 복잡한 감염합병증(感染合?症)의 1치험례(治驗例))

  • Lee, D.Y.;Yoon, Y.J.;Cho, B.K.;Hong, S.N.
    • Journal of Chest Surgery
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    • v.9 no.2
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    • pp.265-270
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    • 1976
  • Implantation of a permanent pacemaker is a widely accepted procedure for the patient with complete heart block.As a result of these device, the prognosis for patients with Adams-Stokes syndrome caused by complete A-V block and other cardiac arrhythmia have become much more optimistic. Permanent pacemaker implantation by means of a transvenous approach has made the operative risk much less and the procedure simpler. However, a number of complications have been reported in the literature regarding transvenous endocardial pacemaker implantation during the last a decade. The patient presented in this paper is a 26-year old girl who was implanted with a permanent pacemaker at 14 years of age because of a congenital A-V block. Following first exchange of pulse generator, the electrode (lead) was fractured, so that by the pulse generator, a change to the transvenous technique of implantation was made, After this, there were episodes of recurrent wound infection on three occasions, even though the site of pulse generator implantation was exchanged to the contralateral side of chest wall, massive doses of antibiotics were administered and sensitivity tests for coagulase positive staphylococcal infection were performed. Though there was no definite evidence of blood stream infection by blood culture, we decided not to use the transvenous technique and not to implant the pulse generator in the chest wall because the venous system and the entire anterior chest wall appeared to be diseased or contaminated by virulent pyogenic organisms. Finally this intractable systemic and local wound infection was successfully controlled by myocardial lead implantation via a subxiphoid approach and implantation of the pulse generator far down in the abdominal wall. The causes and routes of recurrent wound infection and possible blood born infection in this particular patient are still obscure. We strongly believe that myocardial pacemaker implantation is much safer than transvenous endocardial pacemaker implantation & myocardial pacemaker implantation is a definite method for controlling such an intractable wound infection. following transvenous pacemaker implantation.

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Bronchial Artery Embolization of Massive Hemoptysis -2 cases- (대량 객혈에 대한 기관지동맥 색전술 -치험 2례-)

  • 강경훈
    • Journal of Chest Surgery
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    • v.21 no.6
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    • pp.1117-1123
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    • 1988
  • Prolapse of the aortic valve is the main cause of insufficiency of the aortic valve as a complication of ventricular septal defect. Aortic insufficiency gets worse by the progress of prolapse of aortic valve due to lack of support of the valve and the hemodynamic effect of blood flow through the ventricular septal defect. This produces typical clinical picture, that may be serious and threatening when it is untreated. Type and timing for the surgical treatment of the ventricular septal defect with aortic insufficiency is considered. Among 113 ventricular septal defect, 9 patients of ventricular septal defect with associated aortic insufficiency were experienced from June. 1983 to June 1988 at the Department of Thoracic and Cardiovascular Surgery, Chon-Buk University Hospital. Male was 6 patients and female was 3 patients. Ages were from 7 years to 24years. 5 patients were from 10 to 19 years age. 3 patients were below 10 years age. The ratio of pulmonary blood flow to systemic f low [Qp/Qs] was 1.53 and in pulmonary vascular resistance, normal or slight increase was 7 patients, moderate 1 patient, and severe 1 patient. Ventricular septal defect was subpulmonic in 5 patients and infracristal in 4 patients. Prolapse of right coronary cusp was 7 patients, right and non coronary cusp 1 patient and non coronary cusp 1 patient. Teflon patch closure of ventricular septal defect was undertaken in 3 patients and primary closure in 1 patient. Among the 4 patients of defect closure alone, one patient performed valve replacement 7 months later due to progressive regurgitation and cardiac failure and the result was good. The other 3 patients were good result. Closure of ventricular septal defect and aortic valvuloplasty performed in 4 patients. 2 patients of these required valve replacement for the sudden intractable cardiac failure and died due to low cardiac output. The cause of intractable cardiac failure was tearing of repaired valve at the fixed site. The other 2 patients were good result. Closure of ventricular septal defect and valve replacement performed in 1 patient with good result.

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