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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.
서재현(Jae Hyun Suh),박병철(Byung Cheul Park) 대한통증학회 1995 The Korean Journal of Pain Vol.8 No.1
Writer's cramp is a gradual onset and the disorder shows itself at first only when the pa- tient is fatigued or stressed, or when a difficulty in controlling the pen leads to inaccurate writing. The prognosis is poor and treatment is often difficult and unsatisfactory. We have administered stellate ganglion block for a treatment of writer's cramp. Case l: A-30-year old male, who had a difficulty in writing with palpitation for 10 years in front of the other men. After 5 times of stellate ganglion block, palpitation during writing did not appear and after 15 times, he could write with a slight spasm of hand muscles. Case 2: A-40-year old male, who had a difficulty in writing in a stressful situation. After 28 times of stellate ganglion block, he could write in normal work except in the strong stressful situation. From our experience, we recommend the stellate ganglion block may be an effective treat- ment for a writers cramp.