Ganglión dorsal de muñeca: resección artroscópica con técnica “en seco”. seguimiento mínimo de dos años / Dorsal wrist ganglion: arthroscopic resection with “dry” technique. minimum follow-up of two years

Introducción: el objetivo de este estudio fue comunicar los resultados a mediano plazo de la resección artroscópica de gangliones dorsales de muñeca utilizando la técnica “en seco”. Materiales y Métodos: Se evaluó retrospectivamente a 22 pacientes (22 muñecas) con un seguimiento mínimo de 2 años. Once mujeres y 11 hombres con una edad promedio de 29 años (rango 18-57). Se realizaron evaluaciones clínicas preoperatoria, al mes de la cirugía y en el último control. Se evaluaron la movilidad y la fuerza de puño comparativas, el dolor y la función según la escala analógica visual, los puntajes funcionales QuickDASH y de Wrightington, el retorno laboral y las complicaciones intraquirúrgicas y posquirúrgicas. Seguimiento promedio: 42 meses (rango 24-60). Se realizó un análisis estadístico mediante la prueba t. Resultados: Hubo 2 recidivas del ganglión. No se registraron otras complicaciones. La movilidad y la fuerza de puño comparativas mejoraron significativamente, 99% y 100%, respectivamente. El dolor y la función también mejoraron significativamente, al igual que el puntaje QuickDASH. Según la escala de Wrightington, 18 casos resultaron excelentes; 3, buenos, y uno fue malo. Veintiuno de los 22 pacientes retornaron a sus tareas laborales sin limitaciones, 20 refirieron estar satisfechos con el resultado. Conclusión: La resección artroscópica utilizando la técnica “en seco” representa una alternativa segura y eficaz para el tratamiento de los gangliones dorsales de muñeca, logra aliviar el dolor, y una mejoría funcional y estética en la mayoría de los pacientes mediante una rehabilitación temprana, con una baja incidencia de recidiva.

Introduction: the purpose of this study is to describe the medium-term results of arthroscopic resection of dorsal wrist ganglia using the “dry technique”. Methods: Twenty-two patients (22 wrists) were retrospectively evaluated with a minimum follow-up of 2 years. Eleven women and 11 men with an average age of 29 years (range 18-57). A clinical evaluation was performed preoperatively, at one month, and at the last control visit. Comparative wrist motion and grip strength, pain and function according to the visual analogue scale, functional QuickDASH and Wrightington scores, return to work, and intra and postoperative complications were evaluated. Mean follow-up was 42 months (range 24-60). Statistical analysis was performed using t test. Results: Two cases of ganglion recurrence were observed. No other complication was reported. Wrist motion and grip strength improved significantly, reaching 99% and 100%, respectively. Pain and function also improved significantly, as the functional QuickDASH score. According to Wrightington score, 18 cases were excellent, 3 were good, and one por result. Twenty-one patients returned to their tasks without limitation, 20 of them refered to be satisfied with the final result. Conclusion: Arthroscopic resection using the “dry technique “ represents a safe and effective alternative for the treatment of dorsal wrist ganglia, achieving pain relief, and functional and aesthetic improvement in most patients with early rehabilitation and a low incidence of recurrence.

The effects of superior cervical ganglionectomy on the ability of spatial memory using radial arm maze in the rats

BACKGROUND: Stress, elevated sympathetic nervous system, glucocorticoid concentration affect learning and memory. The aim of this study was to evaluate the effects of superior cervical ganglionectomy on the spatial memory using radial arm maze test. METHODS: Male Sprague-Dawley rats were used. Rats were divided into two groups: a superior cervical ganglionectomy group and a control group. Each rat was put into the radial arm maze two times per day for 4 days. We checked the number of the total visit, the total error, the reference memory error, the working memory error. And then a superior cervical ganglionectomy group received bilateral superior cervical ganglionectomy, and a control group received a sham operation. The radial arm maze test was then repeated and we evaluated the effect of superior cervical ganglionectomy on spatial memory. RESULTS: There were no significant differences in ratio of total error, reference memory error, and working memory error. CONCLUSIONS: Bilateral superior cervical ganglionectomy in rats does not effect the spatial memory. However, further studies are needed to determine the effect of superior cervical ganglionectomy on spatial memory.

The effects of superior cervical ganglionectomy on the anxiety in the rats / 대한마취과학회지

BACKGROUND: Therapeutic indications for stellate ganglion block range from head and upper arm disease to general disease including psychosomatic disorders. The aim of this study was to evaluate the effects of superior cervical ganglionectomy on anxiety using the elevated plus maze test. METHODS: Male Sprague-Dawley rats (150-250 g) were used. Each rat was put into the elevated plus maze 5 minutes per day for 10 days. We checked the number of entries into each arm (open arm and closed arm) and the duration of time staying in each arm. Rats were then divided into two groups: a group that received bilateral superior cervical ganglionectomy, and a control group that received a sham operation. The elevated plus maze test was then repeated and we evaluated the effect of superior cervical ganglionectomy on anxiety. RESULTS: Although there was an increased tendency of ganglionectomized rats to enter each arm, there were no significant differences in number of entries or in duration of stay between experimental and control groups. CONCLUSIONS: Bilateral superior cervical ganglionectomy in rats does not reduce anxiety. However, further studies are needed, ones combined with neuroendocrine and clinical studies, to determine the effect of superior cervical ganglionectomy on behavioral responses.

Dosal Root Ganglionectomy for a Post-Herpetic Neuralgia: Case Report

We report a case of thoracic post-herpetic neuralgia which was improved by dorsal root ganglionectomy. The patient had failed to obtain adequate pain relief from conservative therapy such as carbamazepine, amitriptyline, thioridazine, gabapentin, and transcutaneous lidocaine infiltration. Thoracic dorsal root ganglionectomy from T5 to T7 on left side was performed and satisfactory pain relief without significant postoperative neurologic deficit was achieved. Although dorsal root entry zone operation for refractory pain was the most commonly performed procedure in past, dorsal root ganglionectomy is an alternative anatomically and technically safe procedure for the pain in the thoracic lesion. The clinical feature, operative technique and clinical result are presented with review of the literatures.

The Adequate Extent of Thoracic Sympathectomy for Essential Palmar Hyperhidrosis

Essential palmar hyperhidrosis is a disease characterized by excessive perspiration on the palms and hands due to the hyperaction of sympathetic nervous discharge. In severe cases, excessive sweating is seen on the face, axilla, trunk, and soles. Several therapeutic modalities were applied but surgical resection of the sympathetic ganglion is the only curative method. Numerous open surgeries of the thoracic sympathetic ganglia for the treatment of palmar hyperhidrosis have been advocated, but they have also produced several complications. A new therapeutic technique for this disorder has been introduced by combining a thoracoscope and video system. Nowadays, thoracoscopic transthoracic sympathectomy is accepted as the treatment of choice for essential palmar hyperhidrosis. This technique is safe and easy. It also reduces the operating time and admission period. It has also very few complications. Compensatory hyperhidrosis on the trunk, back, and thigh, etc. is commonly an unwanted and unsolved complication after thoracic sympathectomy. Through my experience of thoracic sympathectomy, I thought that the incidence of compensatory hyperhidrosis was closely related to the extent of thoracic sympathectomy. So I restricted the extent of thoracic sympathectomy as a T2 sympathetic ganglion from September 1995. From Mar., 1989 To Aug., 1995, T2, T3 sympathetic ganglionectomies were performed for palmar hyperhidrosis patients and from Sept. 1995 T2 sympathetic ganglionectomies were performed. Using questionnaires, I compared these 2 groups. The results of this study are summarized as follows; 1) Using thoracoscopic transthoracic sympathectomy, operating time, admission period and complications could be reduced. 2) The risk of bleeding during the operation(especially bleeding from the hemiazygous vein) could be reduced in the T2 sympathectomy group. 3) The treatment effect of T2 sympathectomy is no different from T2, T3 sympathectomy for essential palmar hyperhidrosis. 4) The incidence of compensatory hyperhidrosis is less in the T2 sympathectomy group than in the T2, T3 sympathectomy group. From the above results, I concluded thoracoscopic transthoracic sympathectomy is the treatment of choice for essential palmar hyperhidrosis and the adequate extent for sympathectomy is T2 sympathetic ganglion.

The New Diagnostic Method for Hyperhidrosis: Digital Infrared Thermographic Imaging

Essential palmar hyperhidrosis is a disease characterized by excessive sweating on palms and hands due to hyperaction of sympathetic nervous discharge. It develops severe hypothermia on both hands because of loss of surface heat by evaporation of the sweating. Numerous tests including starch-iodine test were used to detect sweating status. But they were complicated and unpleasant to patients. Digital infrared Thermographic Imaging(DITI) can show a thermal difference very clearly. We have used DITI not only for the diagnosis, but for planning of the operation and operative follow up of the disease since 1990. 343 cases of bilateral upper thoracic(T2 & T3) sympathetic ganglionectomy were performed from Mar. 1989 to Dec. 1996 in our spine center. Among them, open surgery with posterior midline approach were initially carried out in 54 cases and recently percutaneous endoscopic sympathectomy were carried out in 289 additional cases. Digital Infrared Thermographic Imaging has been taken pre and postoperatively in 339 cases. Preoperatively, severe hypothermia is noted in 96.2% in both hands and feet. Immediately after operation, the sweating ceased in all cases and marked hyperthermia was noted in both hands compared to preoperative status due to sympathetic denervation. DITI is more accurate and easier than any other method for diagnosis and evaluation of treatment effect in hyperhidrosis. DITI is simple, accurate, comfortable and objective diagnostic tool for hyperhidrosis patient.