골반통을 동반한 하지마비환자에서 경추 간판적 상 하복신경총 차단 - 증례보고 -

문동언(Dong Eon Moon),최미경(Mee Kyung Choi),서재 대한통증학회 1994 The Korean Journal of Pain Vol.7 No.2

Both pelvic pain associated with cancer and chronic benign conditions may be alleviated by blocking the superior hypogastric plexus. Traditional bilateral placement of needles is the appropriate technique for the patient with pelvic pain due to the bilateral distribution of the disease as well as allowing for individual difference of pelvic cavity. However the technique is a very difficult procedure and painful for the paient. However we have performed transdiscal superior hypogastric plexus neurolysis free of com- plication.

만성 두통 환자에서 Botulinum Toxin Type A 치료

문동언 ( Dong Eon Moon ),문영은 ( Young Eun Moon ),김시현 ( Shi Hyeon Kim ),김은성 ( Eun Sung Kim ) 대한통증학회 2005 The Korean Journal of Pain Vol.18 No.1

흉강경하 흉부교감신경절제술을 이용한 안면다한증 치료

문동언(Dong Eon Moon),박병철(Byung Cheul Park),김 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.2

Endoscopic transthoracic sympathectomy(ETS) has recently become estabilished as a successful treatment for severe palmar and axillary hyperhidrosis. Descriptions have been published of neurolytic, operative and alternative endoscopic procedures involving thermocoagulation, laser coagulation, or or nonvideo-assisted ganglionectomy using equip- ment not widely available, with low morbidity and excellent results. All methods have advantage and disadvantages. A 19-year-old male who suffered from severe hyperhidrosis on face, palms and axillary areas, has been initially treated with stellate ganglion block in other pain clinic. He was transfered to our pain clinic for endoscopic thoracic sympathectomy. The patient was intu- bated left side 34 Fr. double lumen tube and positioned left semi-lateral position for right sympathectomy. Right side pneumothorax was created by clamping the ipsilateral side of the double lumen tube and aspiration of air. 11-mm trocar was introduced through incision at the third intercostal space in anterior axillary line, and then additional two 11-mm and 5-mm trocar was introduced through second and fifth intercostal space in mid axillary line. The lung was gently retracted and the parietal pleura over the heads of the appro- priate ribs excised using 5-mm sharp insulated coagulating microprocesss. The T4, T3, and T2 ganglions, as well as accompanying rami communicantes, and other branchs arising from upper thoracic nerves to the brachial plexus and surrounding tissues were carefully dissected, coagulated. During sympathectomy, skin temperature of middle was continuously monitored. Elevation of palmar skin temperature intraoperatively indicated an adequate sympathectomy with a definite therapeutic effect. A No. 28 Fr. thoracotomy tube was in- troduced through a troca under video guidance, placed under water seal after the lung was reinflated. the controlateral side was performed same procedure. After bilateral sym- pathectomy, chest tubes were removed, and then, he was discharged 2 days after operation with great satisfaction. The ETS provides a well-tolerated, cost-effective alternative to thoracic sympathectomy for primary hyperhidrosis and sympathetic mediated neuropathic pain disorder. And T2 ganglion is considered the key ganglion for the treatment of primary hyperhidrosis. The low incidence of compensatory sweating may by explained by the limited extent of the sym pathectomy.

경막외 혈액봉합술로 치험한 자발성 두개내 저압

문동언(Dong Eon Moon),김병찬(Byung Chan Kim),김영 대한통증학회 1997 The Korean Journal of Pain Vol.10 No.1

Spontaneous intracranial hypotension(SIH) is a rare syndrome of spontaneously occurring postural headache associated with low CSF pressure. It usually occur without evidence of any preceeding events such as lumbar puncture, back trauma, operative procedure, or medical illness. This syndrome usually resolves spontaneously or with strict bed rest. When the headache persists or is incapacitating, more aggressive treatment may be necessary. Autologous epidural blood patch is highly effective in the management of S1H. We experienced a case of SIH with downward displacement of brain in MRI and successfully treated with epidural blood patch.

이상근 증후군의 치료경험

문동언(Dong Eon Moon),김용신(Yong Shin Kim),서재현 대한통증학회 1993 The Korean Journal of Pain Vol.6 No.1

The pyriformis syndrome is an entrapment neuropathy in which the sciatic nerve is compro- mised by the pyriformis muscle. Using local anesthetics and steroid injection through a needle guided by an electric nerve stimulator, we satisfactorily treated a case of pyriformis syndrome.

경막외 차단 후 발생한 신경계 합병증

문동언(Dong Eon Moon),심재용(Jae Yong Shim),임용걸 대한통증학회 1997 The Korean Journal of Pain Vol.10 No.2

Technique of epidural analgesia is generally regarded a safe procedures which is widely applied in postoperative and chronic pain control. Incidence of neurologic complications following epidural analgesia are rare; however, increasing number of published reports describing transient or permanent neurologic complicatians following such procedures have been appearing more frequently. We report two cases of neurologic complications following epidural analgesia as we believe it is important to draw the attention of other anesthesiologist to the possibility of existence of other com- plications of significant medicolegal consequences.

구상암 환자에서의 갓세르 신경절 및 하악신경 차단 - 증례 보고-

문동언(Dong Eon Moon),박규호(Kyu Ho Park),서재현(J 대한통증학회 1994 The Korean Journal of Pain Vol.7 No.1

Most neoplasm of the floor of the mouth are squamous cell carcinoma. They originate from anterior midline floor of the mouth and penetrate into the sublingual gland. Invasion of the mandible is a late manifestation. Lymphatic spread is the submaxillary and subdigastric nodes and advanced lesions of them produce severe pain, The initial step in managing patients with cancer pain is the oncology therapy in the form of radiotherapy, surgery, or chemotherapy, alone or combined. When oncologic therapy is ineffec- tive, the pain must be treated by systemic analgesic, psychologic, neurostimulating, regional analgesic,and meuroablative techniques. We successfully treated with gasserian ganglion block on the left side and mandibular nerve block on the right side with pure alcohol in the patient having severe submandibular, lower lip and tongue pain.

제2 흉부 척추옆블록 후 동측 상지 피부온도 상승의 평가

문동언 ( Dong Eon Moon ),이재민 ( Jae Min Lee ),김은성 ( Eun Sung Kim ),문석환 ( Seok Whan Moon ) 대한통증학회 2004 The Korean Journal of Pain Vol.17 No.1

교감신경절제 받은 신경병증성 통증 쥐 모델에서 Norepinephrine에 의해 유도된 기계적 이질통의 Rekindling의 기전

문동언(Dong Eon Moon) 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.2

N/A Background: Sympathectomy relieves pain in sympathectically maintained pain, and sub- cutaneous injection of norepinephrine(NE) can rekindle mechanical allodynia. However, the mechanism of rekindling is not clear. The purpose of this study is to investigate which subtype of a-adrenoceptor is involved in NE-induced rekindling of mechanical allodynia in sympathectomized neuropathic rats. Methods: Neuropathic injury was produced by tightly ligating the left L5 and L6 spinal nerves of 36 male Sprague-Dawley rats and bilateral lumbar sympathectomy was done at two weeks postoperatively. Starting at 7 days after sympathectomy, rekindling of mechani- cal allodynia was induced by NE and clonidine injected into the left paw, which was re- versed by pretreatment of phentolamine and idazoxan. Mechanical allodynia was quantified by measuring the frequency of foot lifts to two von Frey filaments applied to the paw. Results: All tested rats displayed well-developed signs of mechanical allodynia at the left paw that were abolished by a bilateral lumbar sympathectomy. Subcutaneous(s.c.) in- jection of NE(0.05 μg) into the affected paw of sympathectomized neuropathic rats rekin- dled previous mechanical allodynia. These effects could be mimicked by an a,-receptor ago- nist clonidine, but not by an a,-receptor agonist phenylephrine. The NE-induced rekindling of mechanical allodynia was significantly reduced by prior sc. injection of a mixed a-re- ceptor antagonist phentolamine(20 μg) and a,-receptor antagonist idazoxan(20 μg), but not by a a,-receptor antagonist terazosin(20 μg). The pretreatment of idazoxan produced dose-relat- ed inhibition of NE-induced rekindling of mechanical allodynia. The rekindling induced by a-receptor agonist clonidine(5 μg) was also reversed by prior s.c. injection of a-receptor an- tagonist idazoxan(20 μg). Conclusion: Subcutaneous injection of NE into the paw of sympathectomized neuropathic rats rekindles mechanical allodynia, which is reversed by an a2-, but not by an a1-receptor antagonist. Therefore, rekindling of mechanical allodynia in sympathectomized neuropathic rats is mediated by a2-adrenoceptor.

한국 통증치료실의 현황

문동언(Dong Eon Moon),양내윤(Nae Yun Yang),최영국( 대한통증학회 1998 The Korean Journal of Pain Vol.11 No.2

N/A Background: Twelve years have passed since the Korean Pain Society was organized. Nowadays, there are so many problems to be solved in pain clinics including health insurance, pain education and public information etc. in Korea. The present study was designed to evaluate the current status of pain clinics in Korea. Methods: Eight hundred twenty regular members of Korean Pain Society were surveyed by questionnaire in October 1997. We compared the general characteristics, contents of diseases in pain clinic, treatment methods, patients satisfaction, pain educations, problems in pain treatments, requests to Korean Pain Society among the 138 respondents. Results: Thirty seven percents of the respondents worked at university hospitals, 39% at non-university hospitals and 24% at private pain clinics. The most common diseases treated in pain clinics was low back pain(32% in university and non-university hospital and 28% in private pain clinic respectively). However, cancer pain was 10% in university and non-university hospital and 0.7% in private pain clinic, Epidural block was the most frequently used procedure in chronic pain treatments. And 74.6% of the respondents were studied and learned in Korea and Japan. And then, current problems in pain mana- gement and requests to Korean Pain Society were medical insurance problems, pain education and public information of pain clinics. Conclusions: These results suggest that the Korean Pain Society should make an effort to solve these current problems in order to activate pain medicine and increase the quality of life for those suffering from pain.