• Archives of Reconstructive Microsurgery
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• v.6 no.1
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• pp.111-116
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• 1997

The treatment of chronic digital pain and cold intolerance due to Raynaud's phenomenon is quite difficult especially it is combined with scleroderma. Several surgical trial such as cervicothoracic sympathectomy have been attempted for the medically unresponsible Raynaud's phenomenon, but their results were unsatisfactory. We have tried peripheral periarterial sympathectomy for the 44 years old female patient who had medically unresponsible severe Raynaud's phenomenon with scleroderma. Periarterial adventitial stripping was performed at the level of wrist, superficial palmar arch, common digital artery and proper digital artery about 1.5-2 cm in length. Preoperative angiography and radioactive angiography were done and preoperatively and postoperatively the blood flow was measured by the desk top computer-aided histogram. Both hands digital pain were markedly reduced after operation and blood flow increased as compaired with the preoperative measure.

• Proceedings of the KOSOMBE Conference
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• v.1997 no.11
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• pp.443-446
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• 1997

HRV(heart rate variability) is the time series data of R-R interval time duration based on ECGs. Power spectral analysis of HRV has recently been used to define the activity of ANS(autonomic nervous system). In this study, 14 rats were divided into two groups, sympathectomy and vagotomy. During the experiments, ECGs of rats were collected three times at each experimental conditions or the duration of 5 minutes, where sampling frequency was set at 2KHz. After the application of the Berger's Serires algorithm to ECG raw data, power spectrum of HRV was obtained via FFT. Results showed that HF/LF were increased or the sympathectomy group and decreased or the vagotomy group. It implies that the variations in HF/LF components could be used or the ANS function classification.

• The Korean Journal of Pain
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• v.8 no.1
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• pp.74-77
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• 1995

Upper thoracic sympathectomy is valuable for patients with vascular occlusive disease and other painful upper extremity diseases. We performed 10 upper thoracic sympahthectomies by percutaneous radiofrequency destruction in painful disorder of upper extremity. Patients were supine and the needle was inserted paratracheally under C-arm fluoroscope. The second and third thoracic sympathetic gangla were destructed by radiofrequency lesion generator. Each lesion was made with a tip temperature of $90^{\circ}C$, 90 seconds. Good to excellent results were achieved in all patients without any adverse effect. Seven patients revealed complete sympatholytic effect and other three patients were showen signs of partial sympathetic block. Two patients were persisted sympatholytic effect for 18month in and other 5 patients were persisted sympatholytic effect at present (follow up period: mean 5.8 mon). Percutaneous radiofrequency upper thoracic sympathectomy with anterior paratracheal approach is an effective and a safe method.

• Journal of Acupuncture Research
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• v.20 no.1
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• pp.177-190
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• 2003

Objective : This study was intended to investigate the analgesic effects of electroacupuncture(EA) on mechanical allodynia according to the frequency and intensity of EA. Also to know if mechanical allodynia and the analgesic effects of EA is related to the sympathetci nervous system and/or the purinergic system. Methods : mechanical allodynia-induced rats were produced by resecting S1-S2 nerve. The zusanli(ST36) was used for acupoint and the rats were divided into 4 groups. Each group was given different stimuli[low frequency low intensity-EA(LFLI-EA), low frequency high intensity-EA(LFHI-EA), high frequency low intensity-EA(LFHI-EA), high frequency high intensity-EA(HFHI-EA)]. Futhermore, to make sympathectomy6-OHDA and phentolamine were administered intraperitonially and the concentration of norepinephrine(NE) were measured. As a ATP blocker, suramin was applied for this study. Results : Comparing to control group, each of the 4 groups(LFLI-EA, LFHI-EA, HFLI-EA, HFHI-EA) showed a significant reduction of response frequency of mechanical allodynia. LFHI-EA was more effective than that of LFLI-EA. The LFHI-EA group also had longer lasting effects from the stimulation than the other groups. Sympathectomy didn't show any reduction of response frequency of mechanical allodynia.(Each n=6, n=4). Nor did both sympathectomy and ATP block. The response frequency wasn't reduced by sympathectomy or by sympathectomy and ATP block, but was significantly reduced with LFHI-EA Conclusions : These results suggest that EA has a significant analgesic effect on mechanical allodynia which has no connection with NE and/or ATP.

• The Korean Journal of Pain
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• v.12 no.1
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• pp.81-86
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• 1999

Background: Essential hyperhidrosis is a condition with excessive sweating, which may be localized in any parts of the body. Thoracic sympathectomy has been a surgical procedure for the management of hyperhidrosis. Methods: We studied 30 ASA I and II patients suffering from severe hyperhidrosis. Bilateral upper thoracoscopic sympathectomy of $T_{2-4}$ was performed in 30 patients under general anesthesia. Anesthesia was induced with 2.5% thiopental sodium 5 mg/kg and succinylcholine chloride 1 mg/kg and was maintained with enflurane 1~2 Vol% and $N_2O-O_2$ mixture adjusted to maintain $SpO_2$ greater than 96%. During anesthesia, invasive arterial pressure, heart rate, EKG, $SpO_2$ and capnography were monitored. Skin temperature was measured with thermister probes attached to the index finger of each hand. An increase in temperature after cautery confirmed success of the sympathectomy. Results: There were 14 men and 16 women whose ages ranged from 16 to 46 years old (mean age 22.2). Of these patients, 13 patients had complained of palm-sole hyperhidrosis, 9 of palm-sole-axilla hyperhidrosis, 4 of palm-sole-face hyperhidrosis and 4 of palm-sole-axilla-face hyperhidrosis. The provocative factors of excessive sweating were tension and stress from interpersonal relationships. There was positive familial history in 37%. The most common complication was compensatory hyperhidrosis in 23 patients comprising 76%. Other complication included peumothorax (4 patients), hemothorax (1 patient), ipsilateral Horner's syndrome (1 patient) and paresthesia of right arm (1 patient). The degree of satisfaction was graded as good, fair and poor with 15, 12 and 3 patients, respectively. Conclusions: Thoracoscopic sympathectomy with VATS is an efficient, safe and minimally invasive surgical procedure for essential hyperhidrosis.

• Journal of Chest Surgery
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• v.31 no.5
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• pp.525-530
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• 1998

Thoracoscopic thoracic sympathectomy for primary palmar hyperhidrosis has been known to be effective and to have cosmetic merits compared to conventional open sympathectomy. In spite of its cosmetic advantages over thoracotomy, VATS using 5 mm or 10 mm instruments still has the problem of operative wound as well as pain on trocar sites. Recently, 2 mm thoracoscopic instruments have been used. The purpose of this study was to examine the results of thoracoscopic sympathectomy for palmar hyperhidrosis with 2 mm thoracoscopic instruments. From January 1997 to April 1997, 46 patients underwent bilateral thoracoscopic sympathectomy with 2mm instruments at Seoul National University Hospital. T-2 ganglion was carefully dissected and resected out in all patients. In one patient, the lower third of T-1 ganglion was inadvertently resected together with T-2 ganglion due to poor anatomical localization. In 4 patients who also complained of excessive axillary sweating, T-3 ganglion was resected as well. The instruments were removed without leaving any chest drain after reexpansion of the lung. Trocar sites were approximated with sterile tapes. All patients were relieved of excessive sweating in their upper extremities immediately after the operation. Nine patients(19.6%) showed incomplete reexpansion of the lung, and two of them required needle aspiration. Complications related to the surgical procedures, such as Horner's syndrome, hemothorax, and brachial plexus injury, were not detected in any cases. Most patientsdid not complaine of pain. All patients were discharged from the hospital on the day of operation. Despite a narrow operative viewfield, thoracic sympathectomy with 2 mm thoracoscopic instruments can be performed without increasing any severe complications. We recommend 2 mm instruments for thoracoscopic sympathectomy because they make as the more cosmetic, less painful, and equally effective compared to thoracoscopic sympathectomy using 5 mm or greater instruments.

• Journal of Chest Surgery
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• v.31 no.3
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• pp.279-285
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• 1998

Exessive sweating of the palms and soles, is a psychologically and occupationally distressing and sometimes disabling condition. Hyperhidrosis is one of the common abnormalities in autonomic nervous system. There were no specific treatment on hyperhidrosis, so invasive thoracic sympathectomy via axillary thoracotomy or cervical approach had been used. Video-assisted thoracic surgery(VATS) is now mostly performed for treating of the palmar and axillary hyperhidrosis. From March 1996 to March 1997, 15 patients with bilateral palmar hyperhidrosis had been treated by the bilateral thoracic sympathectomy(T2, T3, T4) with thoracoscopic resection. The patient were evaluated preoperative and postoperative Digital Infrared Thermographic Imaging (DITI) at Kyung-Hee University Hospital. There were no case of the thoracotomy conversion. There were 3 complications ; pulmonary edema in 1 case, Horner's syndrome in 1 case, and gustatory hyperhidrosis in 1 case. More than half of the patients also had compensatory sweating in the lower abdomen, the buttocks, the back and the thighs. In conclusion, most of the patients were satisfied with the postoperative results of the thoracoscopic sympathectomy, including no more palmar and axillary sweating, less pain, better cosmetic appearances, decreased sweating of the face and soles. In addition, intraoperative temperature monitoring of the hands could estimate the successful thoracoscopic sympathectomy and the preoperative and postoperative Digital infrared thermographic imaging(DITI) could especially be the technique for the objective manifestation of the successful results of the thoracoscopic sympathectomy.

• Journal of Chest Surgery
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• v.33 no.6
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• pp.528-530
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• 2000

Thoracoscopic sympathectomy is a common technique used to treat plamar hyperhiodrosis. The complications of thoracoscopic sympathectomy are rare. Recently, we experienced a complex regional pain syndrome(CRPS) after thoracoscopic sympathecotomy in a patient with hyperhidrosis. The treatment of this complication was chemical epidural sympathetic block and conservative pain control. The result of this treatment was good. The patient was recovered after one month.

• IMMUNE NETWORK
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• v.2 no.2
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• pp.109-114
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• 2002

Background: To investigate the role of sympathetic nervous system (SNS) in moxibustion-induced immunomodulation, the effects of chemical sympathectomy on moxibustion-induced changes in splenic NK cell cytotoxicity, T and B cell proliferation were studied in Sprague-Dawley male rats. Methods: Chemical sympathectomy was achieved with intraperitoneal injection of 6-hydroxydopamine 50 mg/kg/day for 3 successive days. Direct moxibustion (6-minute interval, 9 moxa ball, each of which weighing 0.007 g and burning for 40 seconds) was applied on unilateral anterior tibial muscle region where Zusanli (ST36) acupoint is located, once a day for 7 successive days. NK cell cytotoxicity was measured by $4hr-^{51}Cr$ release assay. Mitogen-induced lymphocyte proliferation was analyzed by [$^3H$]-thymidine incorporation assay. Results: NK cell cytotoxicity was suppressed by moxibustion, more in sympathectomized rats than in vehicle-treated rats. T cell proliferation induced by concanavalin A was not affected by moxibustion. B cell proliferation induced by lipopolysaccharide showed no significant change in vehicle-treated rats, but an increase in sympathectomized rats by moxibustion. Sympathectomy alone induced augmentation of NK cell cytotoxicity and suppression of T cell proliferation. Conclusion: These results suggest that SNS has no direct relation with moxibution-induced immunomodulation but has an important role in the mechanism to keep the homeostasis of immune system by tonically inhibiting excessive changes of various immune components.

• The Korean Journal of Pain
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• v.9 no.2
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• pp.318-325
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• 1996

Background: Sympathectomy relieves pain in sympathectically maintained pain, and subcutaneous 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 $\alpha$-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 mechanical allodynia was induced by NE and clonidine injected into the left paw, which was reversed by pretreatment of phentolamine and idazoxan. Mechanical allocynia 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.) injection of NE (0.05 ${\mu}g$) into the affected paw of sympathectomized neuropathic rats rekindled previous mechanical allodynia. These effects could be mimicked by an ${\alpha}_2$-receptor agonist clonidine, but not by an ${\alpha}_1$-receptor agonist phenylephrine. The NE-induced rekindling of mechanical allodynia was significantly reduced by prior s.c. injection of a mixed $\alpha$-receptor antagonist phentolamine (20${\mu}g$) and ${\alpha}_2$-receptor antagonist idazoxan(20${\mu}g$), but not by a ${\alpha}_1$-receptor antagonist terazosin (20${\mu}g$). The pretreatment of idazoxan produced dose-related inhibition of NE-induced rekindling of mechanical allodynia. The rekindling induced by ${\alpha}_2$-receptor agonist clonidine (5${\mu}g$) was also reversed by prior s.c. injection of ${\alpha}_2$-receptor antagonist idazoxan (20${\mu}g$). Conclusion: Subcutaneous injection of NE into the paw of sympathectomized neuropathic rats rekindles mechanical allodynia, which is reversed by an ${\alpha}_2$-, but not by an ${\alpha}_1$-receptor antagonist. Therefore, rekindling of mechanical allodynia in sympathectomized neuropathic rats is mediated by ${\alpha}_2$-adrenoceptor.