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이준학,김형태,박준범,박상철,권영은,Lee, Jun-Hak,Kim, Hyung-Tae,Park, Jun-Beom,Park, Sang-Cheol,Kwon, Young-Eun 한국호스피스완화의료학회 2005 한국호스피스.완화의료학회지 Vol.8 No.1
Herpes zoster (HZ) is an acute infection of the unilateral sensory dermatome caused by varicella-zoster virus (VZV) and is characterized by vesicular eruption and unilateral pain along the involved dermatome. Although the pathogenesis of HZ is incompletely understood, it is thought that when cell-mediated immunity falls below a critical level, dormant VZV within cells of the sensory ganglia are allowed to replicate and infect the host with the resultant clinical presentation of HZ. It has been associated with immunosuppressed states, such as advanced age, leukemia, lymphoma, chemotherapy and/or radiation treatment. We present a case of a 62-year-old female patient with malignant lymphoma suffering herpes zoster ophthalmicus who did not respond to conventional treatment, and in whom the application of various nerve blocks and patient-controlled analgesia produced moderate pain relief. The patient died twenty days later due to cardiopulmonary failure.
이준학,김형태,문철신,허현언,권영은,Lee, Jun-Hak,Kim, Hyung-Tae,Mun, Cheol-Sin,Heo, Hyeon-Eon,Kwon, Young-Eun 한국호스피스완화의료학회 2009 한국호스피스.완화의료학회지 Vol.12 No.2
Chest pain is a symptom observed commonly in outpatients and emergency room patients, and its causes are variable. Because treatment and prognosis of chest pain are different depending on its cause, it is more important than anything else to accurately diagnose the cause of chest pain. Most of patients complaining of chest pain undergo basic tests at a private local clinic or at the Internal medicine or chest surgery department of a general hospital and, they are referred to the pain clinic, with a note stating no particular finding. However, if they have sustained severe neuropathic pain in spite of nerve block, accurate diagnosis for chest pain is essential. We experienced rapidly developing spine breakdown and cord compression caused by metastatic spinal tumor in an inpatient who was being treated for chest pain, and thus, we report here in the case with literature review. 흉통은 외래 및 응급실에서 볼 수 있는 흔한 증상으로 그 원인 또한 다양하다. 또한 흉통의 원인에 따라 치료와 예후가 다르기 때문에 흉통의 원인을 정확히 진단하는 것은 무엇보다 중요하다. 흉통을 호소하는 환자들 중 대부분은 개인병원, 종합병원의 내과, 흉부외과 등을 거쳐 기본적인 검사를 실시하고 특별한 이상이 없다고 진단 받고 통증클리닉으로 보내지는 경우가 많지만, 최근에 다른 과를 거치지 않고 직접 통증클리닉을 찾는 환자가 많아짐을 고려할 때 정확한 진단이 필수적이다 하겠다. 본원에 흉통을 주소로 입원치료 중에 있던 환자에서 전이성 척추종양에 의해 급속도로 진행된 척추파괴 및 척수압박 증상을 경험하였기에 문헌 고찰과 함께 보고하는 바이다.
Bupivacaine 과 Morphine 의 지속적 경막외 주입 중에 발생한 호흡정지
이준학(Jun Hak Lee),이기남(Ki Nam Lee),문준일(Jun 대한통증학회 1995 The Korean Journal of Pain Vol.8 No.2
Combined infusion of local anesthetics and opioids has been a common method for providing postoperative analgesia. Complications that can occur with this method include pruritus, nau- sea and vomiting, urinary retention, hypotension, and both early and late respiratory depres- sion. Late respiratory depression is a rare but feared complication to epidural opioid therapy. We experienced a case of respiratory arrest during epidural infusion of bupivacaine and morphine.
하복부 수술에서 경막외 Bupivacaine 과 Fentanyl 에 의한 선행진통법이 술후 통증관리에 미치는 효과
이준학(Jun Hak Lee),김인령(In Ryeong Kim),윤채식(C 대한통증학회 1997 The Korean Journal of Pain Vol.10 No.2
N/A Background: Preemptive analgesia is an antinociceptive treatment that prevents the establishment of altered central processing which amplifies postoperative pain. A controversy exists over the effectiveness and clinical value of preemptive analgesia. We studied whether epidural bupivacaine and fentanyl prior to surgery could possibly affect postoperative pain and analgesic demands, as compared to administration of same at end of surgery. Methods: Forty patients scheduled for lower abdominal surgery were randomly assigned to one of two groups and prospectively studied in a double-blind method. Group 1(n 20) received epidural injection of 15 ml bupivacaine 0,25% with fentanyl 100 μg before surgery while group 2(n= 20) received the same injection at the end of their surgery respectively. Postoperative analgesia consisted of basal plus patient-controlled mode of epidural bupivacaine and fentanyl from PCA system. Postoperative visual analog pain scores(VAPS), analgesics consumption, supplementary analgesics requirement and side effects were assessed for 3 postoperative days. Results: There were no significant difference in analgesics requirement and pain scores, at any time, during rest or after movement, in measurement between the groups. Conclusions: We conclude no clinical value of effectiveness in administering epidural bupivacaine- fentanyl before surgery as compared to administration after surgery.
이준학(Jun Hak Lee),박성희(Seung Hee Park),이기남( 대한통증학회 1997 The Korean Journal of Pain Vol.10 No.1
We report a case of cauda equina syndrome following caudal anesthesia possibly caused by metastatic spine tumor. Male, 80-year-old, who had prostatic carcinoma with L3 and L4 spine metastasis was scheduled for bilateral orchiectomy. Twenty two-gauge needle was introduced at sacral hiatus and 15 ml of 2% lidocaine administered. The next morning, patient complained of perineal numbness and urination difficulty. During the next several day patient had episodes of fecal incontinence and motor weakness on both lower extremities. This case reminded us that neuroaxial blocks such as spinal, epidural and caudal anesthesia, should be used with extreme care in patients having neoplasm with high incidence of spine metastasis.
만성 안전형 협심증을 가진 대상포진 환자에서 요부 경막외 차단 후 발생한 불안전형 협심증
이준학(Jun Hak Lee),윤채식(Chae Sik Yoon),정은배(E 대한통증학회 1998 The Korean Journal of Pain Vol.11 No.1
Herpes zoster is a viral disease characterized by skin rash and persistent pain. Early treatment with epidural analgesia provides very effective pain relief and reduces the incidence of postherpetic neuralgia. However, epidural analgesia in elderly, deliberated or hypovolemic patients may complicate circulatory depression such as hypotension and bradycardia. Even if temporary, a major decrease in blood pressure may decrease coronary blood flow of patients with arteriosclerosis and ischemic accident may occur. We experienced a case of unstable angina pectoris after lumbar epidural blockade in a herpes zoster patient with chronic stable angina pectoris.