Percutaneous Cordotomy Using Thermocouple Electrodes / 대한마취과학회지

Effective noninvasive modalities such as radiotherapy and pharmacologic treatments have become highly developed in the treatment of intractable cancer pain. Although epidural narcotics have been considered particularly useful, limitations still remain in their effectiveness for some patients. Surgical therapy can be a useful alternative to these treatments. Cordotomy is one of the most effective surgical treatments. The first percutaneous cordotomy was attempted by Mullan and his associates in 1963. Rosomoff and his associates modified the procedure using radiofrequency two years later. Cordotomy was widely used by the late 1960's but due to its limited effectiveness and serious complications it was abandoned until 1980 when a new electrode was developed by Levin. A thermocouple cordotomy electrode such as the Levin electrode allows monitoring of impedance and tissue temperature. A radiofrequency lesion can be made by increasing the current directly to the desired temperature rather than by gradual heating with the usual incremental increases in lesion current and time. With the use of this electrode, consistent clinical effects are assured and operating time is reduced. The chances of boiling or charring are also minimized. Since this electrode was developed, cordotomy has received renewed attention virtually everywhere except in Korea. Five terminal cancer patients in whom conservative treatments had failed were treated by cordotomy using the three types of thermocouple electrodes: the levin cordotomy electrode; the TCE thermocouple electrode, and the Kanpolat CT electrode. Due to the small number of patients, a comparison of the effectiveness of these three types could not be made. Although complete pain relief was not achieved in every case, dosages of narcotics could be reduced as a result of this procedure. There were no serious complications except a transient paralysis of the ipsilateral arm in one case and headaches in four cases.

A Korean Pedigree of Paget Bone Disease: Including a Case of Panostotic Paget Bone Disease complicated with Giant Cell Reparative Granuloma / 대한내분비학회지

The polyglandular autoimmune syndrome designates the dysfunction of endocrine and nonendocrine system involving two or more organs on the basis of an autoimmune mechanism. The autoimmune nature of these diseases has been based on the presence of lymphocytic infiltration in the affected gland, organ specific autoantibodies in the serum, cellular immune defects and an association with the HLA DR/DQ genes or immune response genes. This syndrome is usually classified into three classes and their etiology or pathogenesis is still not completely understood. A 28-year-old woman developed vitiligo and insulin dependent diabetes mellitus during the treatment of Graves' disease with antithyroid drug. She had a tendency of spontaneous ketonemia and serum c-peptide levels were low(0.21, 0.16ng/mL: fasting and glucagon stimulated). Thyrotrophin binding inhibitor immunoglobulin and pancreas iIslet cell cytoplasmic antibody were positive. We report here a case of polyglandular autoimmune syndrome, type III manifesting Graves' disease, vitiligo, and insulin dependent diabetes mellitus.