Thoracoscopic Sympathectomy for Hyperhidrosis Lowers Arterial Pressure Measured in Ipsilateral Arm / 대한마취과학회지

BACKGROUND: Thoracoscopic sympathectomy seems to be a safe therapeutic procedure without a severe complication. Hypotension has been often reported as one of postoperative complications, but intraoperative changes in blood pressure (BP) were not studied. However, authors' past experience of thoracic sympathectomy told that intraoperative BP reduction could be observed only when measured in ipsilateral arm. During general anesthesia, BP reduction might be a crucial, which could be associated with complication. Authors conducted this study to establish whether BP reduction is confined to ipsilateral arm, or is systemic phenomenon in thoracoscopic sympathectomy. METHODS: Twenty healthy, male and female patients scheduled for one stage thoracoscopic thoracic sympathectomy were prepared for this study. Without premedication, invasive BP monitoring was taken place in bilateral radial arteries. General anesthesia was induced with low dose of fentanyl, propofol and vecuronium. Endotracheal intubation was done with double lumen tube and anesthesia was maintained with variable concentrations of isoflurane in 100% oxygen. Sympathetomies were done for T2~3 during one lung ventilation. BP and palmar temperature were recorded at arrival, after one lung ventilation, after sympathectomy, 5 min, 10 min, after two lung ventilation. BPs and temperatures were analyzed by time and groups. RESULTS: Concurrent with initiation of sympathectomy, BP was reduced only in ipsilateral radial artery. Mean BP decrement was almost 11% (right side: 80 +/- 11 mmHg -> 71 +/- 15 mmHg; left side: 80 +/- 14 mmHg -> 71 +/- 9 mmHg; both of p<0.05). It was accompanied with ipsilateral palmar temperature elevation (right side: 1.28 degrees C; left side: 1.19 degrees C; both of p<0.05). CONCLUSION: Conclusively, BP reduction in thoracic sympathectomy is a change confined to ipsilateral arm, which seems because of peripheral vasodilation.

Clinical Report of Peumatic Retinopexy

Pneumatic retinopexy was introduced by Hilton in 1986, and this methed is a recently described procedure used for the treatment of primary rhegmatogenous retinal detachment. A gas bubble is injected into the vitreous cavity so that the bubble closes the retinal break, permitting resorption of subretinal fluid. A chorioretinal adhesion formed around the break by cryotherapy or laser photocoagulation secures the retina in place. Indication of pneumatic retinopexy in A Two-step Outpatient Operation Without Conjuntival Incision described by Hilton in 1986 is retinal detachments secondary to one break or group of breaks no larger than 1 o'clock hour located within the superior 8 o'clock hours of the fundus. The ocular conditions of the 26 cases included in this study were proliferative vitreoretinopathy C1, C2, aphakia, multiple breaks in multiple quadrants, extensive retinal detachment more than 3 quadrants in size, pseudophakia. The overall success rate for primary pneumatic retinopexy was 73.1%(19 eyes). The greatest number of failure were due to delayed absorption of subretinal fluid (5 eyes). With subsequent procedure, 7 eyes that failed with primary pneumatic retinopexy were reattached.

Ultrastructural Studies of Retina and Proliferative Membranes in Coats' Disease Complicated by Proliferative Vitreoretinopathy

Proliferative vitreoretinopathy is the most common complication of retinal reattachment surgery. The condition is characteristerized by the proliferation of cells on both surface of retina resulting in membrane formation and traction on retina. The authors studied the ultrastructural features of preretinal, subretinal membrane and peripheral retinal tissue which were removed during vitreous surgery in eye with Coats' disease complicated by proliferative vitreoretinopathy (Grade D-l). In preretinal membrane, fibrocytes, fibroblasts, myofibroblasts, macrophages and collagen fibrils were observed in central retinal area and fibrocyte, collagen fibril and retinal pigment epithelium in periphe ral retinal area. In subretinal membreane, retinal pigment epithelial cells, macrophage-like cells, fibrin, collagen fibrils and amorphorous materials were observed.