Herpes zoster represents the reactivation of latent varicella-zoster virus located in the dorsal root ganglion. The virus multiplies and migrates to the skin surface producing a characteristic, usually painful, pustular eruption. Severe pain during the acute phase of herpes zoster has been associated with a higher risk of developing postherpetic neuralgia. Sympathetic ganglion block and somatic nerve block have been used for patients in the acute phase of herpes zoster to alleviate pain and prevent postherpetic neuralgia. Sympathetic nerve block appears to achieve these goals by blocking the profound sympathetic stimulation that is a result of the viral inflammation of the nerve and ganglion. However, they require repeated local anesthetic injections to relieve the symptoms of acute herpes zoster as well as to prevent the occurrence of postherpetic neuralgia. Pulsed radiofrequency has been proposed as safe, nondestructive treatment method. We present a case of acute herpes zoster that was managed with pulsed radiofrequency treatment. The results were satisfactory.
Autonomic Nerve Block ; Ganglia, Spinal ; Ganglia, Sympathetic ; Ganglion Cysts ; Herpes Zoster* ; Herpesvirus 3, Human ; Humans ; Inflammation ; Nerve Block ; Neuralgia, Postherpetic ; Pulsed Radiofrequency Treatment ; Skin ; Stellate Ganglion*

BACKGROUND: Video assisted thoracic sympathectomy or sympathicotomy is a safe and effective therapy for the treatment of palmar hyperhidrosis with immediate symptomatic imporvement. However the degree of satisfaction may diminish with time due to cmpensatory sweating or excessive hand dryness. Therefore by comparing and assessing the degree of symptomatic improvement or compensatory sweating following sympathectomy or sympathicotomy at various levels we aim to determine the optimal level of sympathetic nerve block which will result in minimal side effects and maximal benefit. MATERIAL AND METHOD: Among 194 patients having undergone video assisted thoracic sympathectomy or sympathicotomy between January 1996 and June 1999, 137 patients who responded to either telephone interview or questionnaire were included in the current study. The patients were divided into three groups. Group I(n=61) ; patients having undergone T2,3,4 sympathectomy group II(35) ; patients having undergone T2 sympathicotomy and group III(41) ; patients having undergone limited T2 sympathicotomy which consist of block of interganglionic neuronal fiber on the third rib. The parameters studied comprised of pre- and post-operative palmar temperature change treatment satisfaction the degree of compensatory sweating or discomfort from palmar dryness postoperative complication and changes in plantar sweating. RESULT: There was no difference in age and sex among the groups and the mean postoperative elevation in palmar temperature was 21.59degrees C without any differences among the groups. Patients expressing satisfaction were 65.6%, 62.9% and 90.24% in groups I, II and III, respectively(p<0.05) Moderate to severe compensatory sweating was present in 65.6% 51.4%, and 24.39%, in group I, II, and III, respectively (p<0.05) Slight but comfortable amount of palmar humidness was expressed in decreasing order group III(41.6%) group I(24.6%) and group II(5.7%) (p<0.05) Ineffectiveness or recurrence was present in 5patients in group I(8.2%) 1 patient in group II(2.9%) and none in group III. With regards to plantar sweating decrease in sweating was expressed in 43 patients(31.4%) while similar degree of sweating in 61 patients(44.5%) and increase in sweating in another 33 patinets(24.1%). CONCLUSION: Limited T2 sympathicotomy resection of the lower interganglionic neuronal fiber of the second sympathetic ganglion on the third rib showed immediate effect in palmar hyperhidrosis and caused lesser compensatory sweating and hand dryness.
Autonomic Nerve Block ; Ganglia, Sympathetic ; Hand ; Humans ; Hyperhidrosis* ; Interviews as Topic ; Neurons ; Postoperative Complications ; Surveys and Questionnaires ; Recurrence ; Ribs ; Sweat ; Sweating ; Sympathectomy

BACKGROUND: To obtain optimal results with stellate ganglion block, it is necessary to have a precise knowledge of the exact location of the stellate ganglion and its relationship to the upper thoracic and lower cervical ganglia, in the procedure, the landmark is C6 transverse process, and the drugs for sympathetic block is injected into it. METHODS: We attempted to show the correlation between the height and the distance from C6 transverse process to stellate ganglion and T2 sympathetic ganglion, and respective means and standard deviations in 10 cadavers to estimate whether the height can be used as one of the factors to decide injection dosage for stellate ganglion block, or not. RESULTS: The mean of height was 161.20 5.89 cm and the mean of the distance from left C6 transverse process to T2 sympathetic ganglion was 44.88 6.76, the mean of the distance from right C6 transverse process to stellate ganglion was 40.73 7.47 mm, and the correlation coefficient and regression equation were 0.29 and y=0.38 20.55, respectively, the mean of the distance from left C6 transverse process to T2 sympathetic ganglion was 65.02 11.12 mm, and the correlation coefficient and regression equation were 0.75 and y=1.42 164.01, respectively, the mean of the distance from right C6 transverse process to T2 sympathetic ganglion was 61.38 9.20 mm, and the correlation coefficient and regression equation were 0.74 and y=1.16 125.88, respectively. CONCLUSIONS: It is concluded that we can used the height as one of effective factors to decide drug dosage for stellate ganglion block in Korean.
Cadaver ; Ganglia ; Ganglia, Sympathetic* ; Stellate Ganglion*

PURPOSE: Serotonin has effects on the bladder contraction or urethral sphincter tone. Different subtypes of 5-hydroxytriptamine (5-HT) receptors appear to mediate the effects of serotonin on voiding. 5-HT1 and 5-HT2, metamorphic receptors, are examined well. However 5-HT3, ionotrophic receptors, are not examined well. Pelvic ganglia provide the majority of the innervation of the lower urinary tract. Major pelvic ganglia (MPG) in rats are autonomic ganglia, containing both sympathetic and parasympathetic neurons related with voiding. We examined the modulatory role of adenylyl cyclase (AC) and protein kinase A (PKA) in 5-HT3 induced intra cellular calcium increase in rat MPG. MATERIALS AND METHODS: The regulatory effects by AC and PKA were investigated in a single neuron of male rat major pelvic ganglia using patch clamp and fluorescence Ca2+ measurement techniques. RESULTS: Inward currents were induced by 5-HT (10microM) at only parasympathetic neurons of MPG. MDL7222 (10(-6)M), selective 5-HT3 receptor antagonists, completely abolished the 5-HT induced inward currents. 5-HT (10microM) induced intracelluar increases of calcium. These increases were blocked by an AC inhibitor SQ22536 (2x10(-5M)) and myristoylated PKA inhibitor (10(-7)M). Furthermore, foskolin (10(-6)M), AC activator, augmented the 5-HT induced intracellular calcium increase. CONCLUSIONS: The activation of AC/PKA-dependent pathway could enhance 5-HT3 induced intacellular calcium increase in parasympathetic neurons of rat MPG and these is helpful for the better understanding the mechanisms of the bladder contraction or urethral sphincter tone.
Adenylyl Cyclases* ; Animals ; Calcium* ; Cyclic AMP-Dependent Protein Kinases* ; Fluorescence ; Ganglia* ; Ganglia, Autonomic ; Ganglia, Parasympathetic ; Humans ; Male ; Neurons* ; Protein Kinases* ; Rats* ; Receptors, Serotonin, 5-HT3 ; Serotonin ; Urethra ; Urinary Bladder ; Urinary Tract

The origin of sympathetic and sensory nerves innervating heart in the cat was investigated using HRP (Horseradish peroxidase) and WGA-HRP (Wheat germ agglutinin-horseradish peroxidase) as neuronal tracers. The neural tracers were injected into subepicardial layer and myocardium of the right atrium, left atrium, right ventricle and left ventricle, respectively. Labeled sympathetic neuronal cell bodies were found in superior cervical ganglia, middle cervical ganglia, stellate ganglia and 4th and 5th thoracic ganglia, mainly in middle cervical ganglia and stellate ganglia. Heavier labeled neuronal cell bodies were found in the middle cervical ganglia and stellate ganglia when the neural tracers were injected into left atrium, right ventricle and left ventricle. Labeled sensory neuronal cell bodies were found in nodose ganglia and T1-T6 spinal ganglia, mainly in T1-T5 spinal ganglia. Heavier labeled neuronal cell bodies were found in the nodose ganglia when the neural tracers were injected into left atrium and right ventricle. These results may provide a neuroanatomical data on origin of sensory nerves innervating the heart of the cat.
Animals ; Cats* ; Ganglia ; Ganglia, Sensory ; Ganglia, Spinal ; Ganglia, Sympathetic ; Heart Atria ; Heart Ventricles ; Heart* ; Horseradish Peroxidase ; Myocardium ; Neurons* ; Nodose Ganglion ; Sensory Receptor Cells ; Stellate Ganglion ; Superior Cervical Ganglion ; Wheat Germ Agglutinin-Horseradish Peroxidase Conjugate*

This study examined the net changes in temperature at various regions of the lower extremities in an attempt to identify the regions demonstrating the most significant temperature changes following a lumbar sympathetic ganglion block (LSGB). Thermography was performed before and after the LSGB in 26 sympathetic nerve system disorder cases. The inspection points were the anterior and posterior surfaces of the thigh, the knee and leg, and the dorsal and plantar surfaces of the feet. The net increases in skin temperature following the LSGB (deltaT (net) ) at the plantar and dorsal surfaces of the feet, were 6.2 +/- 2.68 degrees C (mean +/- SD) and 3.9 +/- 1.89degrees C, respectively, which were higher than those observed in the other regions of the lower extremities (p < 0.05). The areas, in order of decreasing deltaT (net), are as follows: the plantar surface of the foot, the dorsal surface of the foot, the shin, the anterior surface of the knee, the calf, the posterior surface of the knee, the anterior surface of the thigh, and the posterior surface of the thigh. There was one case of orthostatic hypotension during the thermography procedure. In conclusion, thermographic imaging is a useful method for demonstrating the success of a LSGB in various diseases. An evaluation of the deltaT (net) on the plantar surface of the feet using thermographic imaging is the most effective, simple, and safe method for assessing a successful LSGB.
Adult ; Aged ; *Autonomic Nerve Block ; Back Pain/surgery ; Body Temperature ; Complex Regional Pain Syndromes/physiopathology ; Female ; *Ganglia, Sympathetic ; Human ; Hyperhidrosis/physiopathology ; Infrared Rays/*diagnostic use ; Leg/physiopathology ; Lumbosacral Region ; Male ; Middle Aged ; Syndrome ; *Thermography ; Treatment Failure

BACKGROUND: It has been known that the most effective treatment method of hyperhidrosis is video-assisted thoracoscopic sympathetic nerve block. Postoperative compensatory hyperhidrosis and anhidrosis are major factors that decrease the postoperative satisfaction. Although sympathetic rami have been selectively blocked to decrease the complications, technical difficulties and excessive bleeding have prevented the universal application. MATERIAL AND METHOD: Three pre-fixative cadavers were dissected before clinical application. Bilateral sympathetic chains were exposed in supine position after the whole anterior chest wall was removed. Second and third sympathetic rami were blocked using clips. After the sympathetic chains including ganglia were removed, we evaluated the extents of rami block. Twenty-five patients were subjected to the clinical application. Surgeries were performed in semi- fowlers position under general anesthesia and bilateral ventilation. 2 mm thoracoscopy and 5 mm trocar were introduced through third and fourth intercostal space, respectively. Second and third sympathetic rami were blocked using thoracoscopic clips. The postoperative complications, satisfaction, and compensatory hyperhidrosis rate were evaluated retrospectively. RESULT: Sympathetic rami were completely blocked in cadaver dissection study. Hyperhidrosis symptom was improved in all patients without operative complication. Operative time was shorter than that of traditional ramicotomy. All patients, except four, were satisfied with postoperative palmar hyperhidrosis. Compensatory hyperhidrosis was more severely happened in fifteen patients (60%). The remaining six patients had no complaint. Two patients had a minimal degree of gustatory hyperhidrosis. CONCLUSION: This operative method had shorter operative time and less complication rate, compared with traditional ramicotomy. Operative success rate was similar to the traditional sympathicotomy; lower extent and occurrence rate of compensatory hyperhidrosis. The thoracic sympathetic rami clipping was suggested as an alternative method for treatment of palmar hyperhidrosis.
Anesthesia, General ; Autonomic Nerve Block ; Cadaver* ; Ganglia ; Hemorrhage ; Humans ; Hyperhidrosis* ; Hypohidrosis ; Operative Time ; Postoperative Complications ; Retrospective Studies ; Supine Position ; Surgical Instruments ; Sweating, Gustatory ; Sympathetic Nervous System ; Thoracic Wall ; Thoracoscopy ; Ventilation

The localizations of efferent and afferent neurons were observed following injection of neural tracers, cholera toxin B subunit (CTB) and wheat germ agglutinin-horseradish peroxidase (WGA-HRP) into the rat thymus with ages. Thirty Sprague-Dawley rats were examined at 3 weeks, 5~6 and 20 months of age. After survival times of 48~96 hours following injection of neural tracers, the rats were perfused and their brain, spinal cord, sympathetic ganglia, dorsal root ganglia and vagal ganglia were frozen sectioned (40 mm). These sections were stained by CTB immunohistochemical and HRP histochemical staining methods, and observed with polarized dark and light microscope. The results were as follows: 1. WGA-HRP and CTB labeled parasympathetic neurons were bilaterally seen in the nucleus ambiguus and medullary reticular formation of medulla with all ages. 2. WGA-HRP labeled sympathetic neurons were bilaterally labeled in superior cervical ganglia, middle cervical ganglia, stellate ganglia and T4-8 sympathetic chain ganglia. The number of labeled sympathetic neurons was increased in the thymus at 20 months of age. According to the aging, sympathetic neuronal processes were more developed, and the nerve fibers were coarse and more branched. 3. WGA-HRP labeled sensory neurons were bilaterally observed within the vagal and C1-6 dorsal root ganglia. The number of labeled sensory neurons was decreased in the thymus at 20 months of age.
Aging ; Animals ; Brain ; Cholera Toxin ; Ganglia ; Ganglia, Spinal ; Ganglia, Sympathetic ; Nerve Fibers ; Neurons ; Neurons, Afferent* ; Peroxidase ; Rats* ; Rats, Sprague-Dawley ; Reticular Formation ; Sensory Receptor Cells ; Spinal Cord ; Stellate Ganglion ; Superior Cervical Ganglion ; Thymus Gland* ; Triticum ; Wheat Germ Agglutinin-Horseradish Peroxidase Conjugate

Facial hyperhidrosis has a symptom of excessive sweating on the face with or without underlying disease. It can be surgically treated by video-assisted thoracic surgery (VATS). We encountered three cases of facial hyperhidrosis which we treated by VATS, which was performed by resection of the lower third of stellate ganglion and T2-T3 sympathetic ganglia with chains. Postoperative symptom was improved in all cases. There were no postoperative complications such as Horner's syndrome or postsympathectomy neuralgia.
Ganglia, Sympathetic ; Horner Syndrome ; Hyperhidrosis* ; Neuralgia ; Postoperative Complications ; Stellate Ganglion ; Sweat ; Sweating ; Sympathectomy* ; Sympathetic Nervous System ; Thoracic Surgery, Video-Assisted

Orthostatic hypotension with other signs of progressive neuronal degeneration particularly affecting the autonomic nervous system has been recognized independently and is called Shy-Drager syndrome. Degenerative changes in the autonomic ganglia, loss of neurons in the intermediolateral columns and degenerative changes in the neurons of the cortex and basal ganglia have been reported on examination of this condition. The authors report a case of Shy-Drager Syndrome with symptoms of orthosatatic hypotension, dysarthria, Parkinson's features, muscle wasting, sexual impotence, atonic bladder and loss of sweating.
Autonomic Nervous System ; Basal Ganglia ; Dysarthria ; Erectile Dysfunction ; Ganglia, Autonomic ; Hypotension ; Hypotension, Orthostatic ; Male ; Neurons ; Shy-Drager Syndrome* ; Sweat ; Sweating ; Urinary Bladder