Successful Treatment of Severe Sympathetically Maintained Pain Following Anterior Spine Surgery

Sympathetic dysfunction is one of the possible complications of anterior spine surgery; however, it has been underestimated as a cause of complications. We report two successful experiences of treating severe dysesthetic pain occurring after anterior spine surgery, by performing a sympathetic block. The first patient experienced a burning and stabbing pain in the contralateral upper extremity of approach side used in anterior cervical discectomy and fusion, and underwent a stellate ganglion block with a significant relief of his pain. The second patient complained of a cold sensation and severe unexpected pain in the lower extremity of the contralateral side after anterior lumbar interbody fusion and was treated with lumbar sympathetic block. We aimed to describe sympathetically maintained pain as one of the important causes of early postoperative pain and the treatment option chosen for these cases in detail.

MMPI Analysis of Patients with Essential Hyperhisrosis / 대한통증학회지

BACKGROUND: Although the cause of hyperhidrosis has not been the subject of close investigation, there are cases for which excessive sweating happens at the hands, feet and armpits due to hyperactivity of the sympathetic nervous system. This usually occurs in people less than 25 years old and it often causes difficulties for their social and occupational life and there is a decrease in the quality of life. Therefore, this should also be examined according to the mental state of the patient who suffers from hyperhidrosis. METHODS: The Minnesota Multiple Personality Inventory was administered to 59 patients in the Hyperhidrosis Center from March, 2006 to March, 2007. The MMPI's validity and 10 clinic standards were analyzed. The results were compared according to gender and age. RESULTS: Of the standard clinical items, psychopathy and conversion hysteria were 21.1% and 17.5%, respectively. On comparison between males (47.5%) and females (52.5%), the females had a higher score for the hypochondriasis item. The patients above 18 years old had a significantly higher level of hypochondriasis and hypomania compared to the patients below 18 years old. CONCLUSIONS: When analyzing the personality of the patients with essential hyperhidrosis with using the MMPI, it was difficult to look for relations with the mental factor. Therefore, it is necessary to develop diagnostic tests for younger people with considering the relations with the period of morbidity.

Clinical Application of I-123 MIBG Cardiac Imaging / 대한핵의학회잡지

Cardiac neurotransmission imaging allows in vivo assessment of presynaptic reuptake, neurotransmitter storage and postsynaptic receptors. Among the various neurotransmitter, I-123 MIBG is most available and relatively well- established. Metaiodobenzylguanidine (MIBG) is an analogue of the false neurotransmitter guanethidine. It is taken up to adrenergic neurons by uptake-1 mechanism as same as norepinephrine. As tagged with I-123, it can be used to image sympathetic function in various organs including heart with planar or SPECT techniques. I-123 MIBG imaging has a unique advantage to evaluate myocardial neuronal activity in which the heart has no significant structural abnormality or even no functional derangement measured with other conventional examination. In patients with cardiomyopathy and heart failure, this imaging has most sensitive technique to predict prognosis and treatment response of betablocker or ACE inhibitor. In diabetic patients, it allow very early detection of autonomic neuropathy. In patients with dangerous arrhythmia such as ventricular tachycardia or fibrillation, MIBG imaging may be only an abnormal result among various exams. In patients with ischemic heart disease, sympathetic derangement may be used as the method of risk stratification. In heart transplanted patients, sympathetic reinnervation is well evaluated. Adriamycin-induced cardiotoxicity is detected earlier than ventricular dysfunction with sympathetic dysfunction. Neurodegenerative disorder such as Parkinson's disease or dementia with Lewy bodies has also cardiac sympathetic dysfunction. Noninvasive assessment of cardiac sympathetic nerve activity with I-123 MIBG imaging may be improve understanding of the pathophysiology of cardiac disease and make a contribution to predict survival and therapy efficacy.

Hemodynamic Study of Foot in Diabetic Patient Using Portable Doppler Machine

The importance of neuropathy in the pathogenesis of foot lesions has been well recognized in diabetes. Blood flow in ischemic limbs has been extensively investigated but the circulation of limbs affected by peripheral neu ropathy has received little attention. Some studies on blood flow in peripheral neuropathy have shown a remarkable increase in resting flow, transcutaneous venous oxygen tension, and vascularity, along with loss of the spontaneous variations which occur normally with sympathetic activity of the foot in patients with diabetes. The aim of present study is to find out the effects of somatic and autonomic nervous function in early change of blood flow of foot in diabetic patients, We have studied fifty-one patients of non-insulin-dependent(type II) diabetes with no history of hypertension of diabetic foot ulcers. The evidence of neuropathy was screened by nerve conduction studies and sympathetic skin response of both lower extremities. Blood flow of dorsalis pedls and posterior tibial arteries was measured by portable doppler machine and presented as pressure index(ankle-to-arm systolic pressure ratio). The patients with sympathetic dysfunction showed significant decrease in pressure index compared to normal control and diabetic patients with normal sympathetic function, suggesting that changes of the blood flow occur in diabetic patients with sympathetic dysfunction.