The purposes of this study are to describe the psychological characteristics of face and palm hyperhidrosis patients and to compare the psychological features of the patients before and after endoscopic thoracic sympathectomy (ETS). We conducted three psychological tests before and three months after ETS; Tokyo University Egogram (TEG), Profile of Mood States (POMS), and Minnesota Multiphasic Personality Inventory (MMPI). The patients also were given our unique questionnaire for compensatory hyperhidrosis after ETS.
The result of TEG showed that the hyperhidrosis patients had passive and dependent character, and changed to a more adaptive character after ETS, although the percentages of adaptive and maladaptive patterns in males were not significantly different between subjects and controls. We found by POMS that mood condition of the patients did not statistically differ from that of controls, but improved after ETS. MMPI proved that about 10% of patients had high scores on Psychasthenia scale, Paranoia scale and Depression scale, and that these scores decreased after ETS. We found by our questionnaire that compensatory hyperhidrosis existed in all cases, of which 40% experienced disturbances in their daily lives, but about 95% of all cases were satisfied with the ETS.
In conclusion, we found that the ego state of hyperhidrosis patients changed more adaptively and self-positively, and mood condition was improved after ETS. However the result of our questionnaire suggested that patient's character should be considered profoundly before ETS.

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We compared the analgesic effect of diclofenac suppository, bupivacaine or morphine infiltration into surgical wounds in patients who underwent lumbar spinal surgery.
Thirty-two patients who were scheduled for herniotomy or fenestration under general anesthesia were assigned randomly to four groups: D-group (n=7) was administered with 50mg diclofenac suppository after induction of general anesthesia. LB-group (n=8) received infiltration into surgical wound of 10ml of 0.25% bupivacaine before wound closure. HB-group (n=9) received infiltration of 10ml of 0.5% bupivacaine and M-group (n=8) received 3mg of morphine in 9.7ml of saline in the same manner as in the LB-group. Postoperative pain was assessed using pain score (0: none-4: severe) at 0, 1, 3, 6, 24 and 48 hours during the postoperative periods. Duration of postoperative analgesia, amount of supplemental analgesics used over the 24-h and 48-h periods and side effects were evaluated.
Pain scores in LB-group and HB-group were lower than those of M-group when patients arrived in the ICU. Duration of periods of postoperative analgesia in HB-group and D-group were longer than those of M-group. No significant differences were found among the groups in the frequency of postoperative analgesics administered over the 24-h and 48-h period. In the HB-group, however, the percentage of patients who did not require supplemental analgesics throughout 24-h and 48-h postoperative hours was greater than that of M-group. No significant side effects were observed.
Infiltration of surgical wound with 0.5% bupivacaine before wound closure was useful and safe for postoperative pain relief following lumber spinal sugery.

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We report three successful cases of epidural blood patch for postdural puncture headache (PDPH). PDPH causes marked damage to patients and lowers their quality of life. Epidural blood patch is an excellent treatment with regard to immediate effectiveness and reliability, however it occasionally causes pain on injection or radicular pain. We performed epidural blood patch with less (7-8ml) than the recommended dose to patients with PDPH. Their headaches lessened, and they did not feel any pain on injection. We injected the blood into the epidural space at a lower intervertebral space than the portion of the dural puncture because injected blood tends to spread cephalad. Also, we administered antibiotics prior to blood extraction in order to prevent infection.

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A 34-year-old man diagnosed with lumbar disc herniation has suffered from chronic sciatica for several years. Conventional conservative treatment, such as epidural block, nerve root block, and medication had little effect. We performed videoendoscopic epiduroplasty using Video-Guided Catheter^™ in this patient, and excellent results were obtained. This method is a minimally invasive technique that may provide an excellent outcome in patients with lumbar disc herniation.

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Nitric oxide (NO), which has been recognized as the endotherium-derived relaxing factor (EDRF), induces vascular relaxation, which leads to lowered vascular resistance. In this study we examined the effects of stellate ganglion block (SGB) on the circulating NO₃^- levels, as a measure of ongoing NO production in adults, and on the urine levels which integrate the total body production.
The subjects of the study were eighteen healthy adults (21 hands). They received SGB at the C₇ levels with 8ml of 1 per cent mepivacaine. NO₃^- was measured by HPLC. Heart rate, blood pressure, hematocrit, red blood cell count, white blood cell count, platelet count, and electrolytes were measured as hemodynamic variables before and after SGB.
The plasma NO₃^- levels after SGB 34.5±18.2μmol/l in the affected side were significantly lower compared to the those before SGB 37.4±21.9μmol/l (p<0.05). Red blood cell, hematocrit, and platelet count decreased. Blood pressure and heart rate had no significant differences.
Depressed NO₃^- levels in the plasma were observed after SGB, suggesting that SGB inhibits NO production in vivo.

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