[Show abstract][Hide abstract] ABSTRACT: A 42-year-old woman with short-term memory loss visited Gangnam Severance Hospital, and her chest X-ray and computed tomography revealed a right anterior mediastinal mass. On hospital day two, she suddenly presented personality changes and a drowsy mental status, so she required ventilator care in the intensive care unit. She underwent thymectomy, and was pathologically diagnosed with thymoma, type B1. Her mental status eventually recovered by postoperative day 90. Paraneoplastic encephalopathy associated with thymoma is very rare, and symptoms can be improved by thymectomy. We report a case of paraneoplastic encephalopathy associated with a thymoma.
The Korean journal of thoracic and cardiovascular surgery. 06/2013; 46(3):234-6.
[Show abstract][Hide abstract] ABSTRACT: Prolonged air leakage is a major cause of morbidity in pneumothorax. When conservative management is not effective, surgery should be performed. However, surgery is not appropriate in patients with low pulmonary function. In these patients, occlusion of the airway with endobronchial blockers may be attempted under bronchoscopy. We treated two patients with prolonged air leakage using endobronchial Watanabe spigots under fibrobronchoscopy.
The Korean journal of thoracic and cardiovascular surgery. 06/2013; 46(3):226-9.
[Show abstract][Hide abstract] ABSTRACT: Aiming to improve outcome of lung transplantation (LTx) patients, we reviewed risk factors and treatment practices for the LTx recipients who experienced respiratory infection in the late post-LTx period (>1 month after LTx).
We analyzed the clinical data of 48 recipients and donors from 61 LTx, who experienced late respiratory infections. Late respiratory infections were classified according to the etiology, time of occurrence, and frequency of donor-to-host transmission or colonization of the recipient prior to transplantation.
During the period of observation, 42 episodes of respiratory infections occurred. The organisms most frequently involved were gram (-) bacteria: Acinetobacter baumannii (n=13, 31.0%), Pseudomonas aeruginosa (n=7, 16.7%), and Klebsiella pneumoniae (n=4, 10.0%). Among the 42 episodes recorded, 14 occurred in the late post-LTx period. These were bacterial (n=6, 42.9%), fungal (n=2, 14.3%), viral (n=4, 28.5%), and mycobacterial (n=2, 14.3%) infections. Of 6 bacterial infections, 2 were from multidrug-resistant (MDR) A. baumannii and one from each of MDR P. aeruginosa, extended spectrum β-lactamase (+) K. pneumoniae, methicillin-resistant Staphylococcus aureus and Streptococcus pneumoniae. Infection-related death occurred in 6 of the 14 episodes (43%).
Although the frequency of respiratory infection decreased sharply in the late post-LTx period, respiratory infection was still a major cause of mortality. Gram (-) MDR bacteria were the agents most commonly identified in these infections.
Tuberculosis and Respiratory Diseases 02/2013; 74(2):63-69.
[Show abstract][Hide abstract] ABSTRACT: PURPOSE: Endoscopic thoracic sympathetic surgery is effective for treating palmar hyperhidrosis, although compensatory sweating (CS) is a significant and annoying side effect. The purpose of this study was to compare the results of limited resection at two different locations. METHODS: From May 2004 to June 2009, T3 sympathicotomy (group I) was performed in 46 patients and T3,4 ramicotomy (group II) was performed in 43 patients during the same period. T3 sympathicotomy (group I) and T3,4 ramicotomy (group II) were performed during the same period. Using questionnaires, completed by the patients, the satisfaction rates and grades of CS were analyzed. RESULTS: No significant differences in age distribution or sex ratios were observed between the two groups. The satisfaction rate was 91.3 % in group I and 79.1 % in group II. The operation time was 19.8 (±6.6) min in group I, and 51.6 (±18.8) min in group II, showing a statistically significant difference (p < 0.002). The incidence of persistent hand sweating in group II (16.3 %) was higher than that observed in group I (2.2 %). The incidence of compensatory sweating on the lower extremities was higher in group II (37.2 %) than in group I (10.9 %). CONCLUSIONS: Although ramicotomy is considered to be an effective method for treating hyperhidrosis and has a theoretical advantage of allowing greater anatomical resection, it requires longer operation time and induces more severe compensatory sweating in the lower limbs resulting in reduced satisfaction rates.
[Show abstract][Hide abstract] ABSTRACT: Non-small cell lung cancer (NSCLC) invading the visceral pleura is classified as T2 stage, and NSCLC invading the chest wall, diaphragm, phrenic nerve, mediastinal pleura or parietal pleura is classified as T3. But, there is no definition as to whether tumours directly invading an adjacent lobe beyond the fissure should be classified as T2 or T3. We assessed whether these tumours should be classified as T2 or T3.
We evaluated patients with NSCLC who, between 1992 and 2009, underwent complete resection and were pathologically diagnosed as T2 or T3 according to the 7th edition of the TNM classification. To evaluate the effect of the T-stage only, the patients with nodal- and distant metastasis were excluded.
Among 837 patients, 499 (59.6%) were pathologically staged as T2a, 91 (10.9%) as T2b and 201 as T3 (24.0%). Forty-six (5.5%) patients had NSCLC with a direct invasion of the adjacent lobe. The mean age (P = 0.102) and sex distribution (P = 0.084) were not statistically significant, but there were more adenocarcinomas in the T2 group than that in the T3 group. The overall survival of the patients with adjacent lobe invasion was statistically worse than that of T2 patients (P = 0.042), but was not statistically different from that of T3 (P = 0.368) patients. There was no difference between the disease-free survival of patients with adjacent lobe invasion and T3 patients (P = 0.306), but disease-free survival of the patients with adjacent lobe invasion was worse than that of T2 (P = 0.003) patients.
Considering that the overall survival and disease-free survival of patients with direct adjacent lobe invasion are similar to those of T3, NSCLC with direct invasion to the adjacent lobe should be classified as T3 rather than T2.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 06/2012; 42(5):807-11. · 2.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We performed sympathetic nerve reconstruction using intercostal nerve in patients with severe compensatory hyperhidrosis after sympathetic surgery for primary hyperhidrosis, and analyzed the surgical results. From February 2004 to August 2007, sympathetic nerve reconstruction using intercostal nerve was performed in 19 patients. The subjected patients presented severe compensatory hyperhidrosis after thoracoscopic sympathetic surgery for primary hyperhidrosis. Reconstruction of sympathetic nerve was performed by thoracoscopic surgery except in 1 patient with severe pleural adhesion. The median interval between the initial sympathetic surgery and sympathetic nerve reconstruction was 47.2 (range: 3.5-110.7) months. Compensatory sweating after the reconstruction surgery improved in 9 patients, and 3 out of them had markedly improved symptoms. Sympathetic nerve reconstruction using intercostal nerve may be one of the useful surgical options for severe compensatory hyperhidrosis following sympathetic surgery for primary hyperhidrosis.
Journal of Korean medical science 04/2010; 25(4):597-601. · 0.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine the diagnostic efficacy of magnetic resonance imaging (MRI) in pulmonary hamartoma and observe the significant MRI features, other than fat or characteristic calcification revealed by computed tomography (CT).
Six hamartomas were included and surgically resected, and we prospectively studied MRI in cases showing suggestive findings of hamartoma or indeterminate nodule on CT. We analyzed the tumor on CT and MRI (available enhancement study in 4) focusing on cleftlike structure in comparison with specimen MRI (n = 3) and histopathologic findings: presence, shape, and distribution of the cleftlike structure and signal intensity and enhancement of the cleftlike structure and main portion.
Computed tomography revealed suggestive findings of pulmonary hamartoma (fat or popcorn calcification) in only 3. All MRI revealed cleftlike structures particularly evident on T2-weighted images with same detectability as its specimen MRI: peripheral linear or curvilinear inclusions with sometimes intratumoral cleftlike space (n = 3), variable signal intensity, and frequent enhancement (3 in 4) pathologically correlated with the variable mesenchymal tissue components and amount arrayed along respiratory epithelial cells lining the cleft and richer vascularity than main portion of pulmonary hamartoma.
Magnetic resonance imaging study is a useful diagnostic tool, when a discrete pulmonary nodule demonstrates neither fat nor calcification on CT, for detecting the quite typical cleftlike structure in a pulmonary hamartoma and could provide diagnostic confidence.
[Show abstract][Hide abstract] ABSTRACT: Anatomical variation of the sympathetic nervous system is known to be one of the main causes of failure and dissatisfaction after sympathetic surgery. However, there are only few reports on the descriptive analysis of sympathetic nerve variants. The purpose of this study is to investigate the anatomical variations of the sympathetic trunk at the levels of T3 and T4 ganglia considered in a topographic approach for sympathetic procedures and to further improve the postoperative outcome.
From June 2003 to January 2004, 44 patients with palmar hyperhidrosis underwent bilateral T3,4 ramicotomy via video-assisted thoracoscopic surgery. The anatomy of T3 and T4 sympathetic ganglia, pathway of sympathetic trunk, and rami-communicantes were recorded on video and still cut images for descriptive analysis.
The thoracic sympathetic trunks were mostly lying against the heads of the ribs, but there were variants of sympathetic trunk running along the medial side of the rib heads of 3rd, 4th and 5th ribs, respectively in 9.0%, 18.0% and 37.5% of the cases. There were also variants running along the lateral side of rib heads near the neck portion in 12.5%, 10.2% and 8.0% of the cases. The 3rd ganglion was located within the intercostal space (59.1%) or at the level of the upper border of the 4th rib (36.4%) or upon the 4th rib (4.5%). The location of the 4th ganglion was in the intercostal space (18.2%), the upper border of the 5th rib (44.3%) or upon the 5th rib (37.5%). The ascending rami were found at the level of the 3rd ganglion in 48.8% and the 4th ganglion in 45.5% of the cases. The descending rami were located at the level of 3rd and the 4th ganglion in 8.0% and 6.8%, respectively. And the middle rami were found in all cases except one.
It may be difficult to localize the sympathetic trunk in some cases of severe obesity; a careful inspection has to be performed from the medial side of the rib heads to the neck portion. The obvious 'downward shift of ganglion' in the position shown as the thoracic sympathetic trunk descends is to be deliberated in T4 sympathetic surgery. Many ascending and descending accessory pathways of sympathetic nerve were observed; therefore, a lateral extension of electrocoagulation at the level of upper and lower rib border is necessary to impose a complete blockage of sympathetic nerve stimulus.
European Journal of Cardio-Thoracic Surgery 06/2008; 33(5):786-9. · 2.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this report is to describe our experience in the successful treatment of two patients with postpneumonectomy bronchopleural fistula (BPF). With use of computed tomography reformatting, the stent-graft occluders were tailored to precisely fit the fistula site and remnant bronchus stump. These were placed under fluoroscopic guidance via a preexisting chest tube tract in one case and via an open thoracostomy window site in the other. The BPFs were successfully occluded without complications, and the stent-graft occluders remained stable in position for 1 year and 6 months of follow-up, respectively.
Journal of Vascular and Interventional Radiology 10/2006; 17(9):1539-43. · 2.00 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Nuss procedure is a newly developed operative method for minimally invasive repair of pectus excavatum in pediatric patients. However, the surgical indication for this procedure has been extended into adult patients. The aim of this study was to assess the surgical outcome of the Nuss procedure in different age groups and to analyze its feasibility in the adult population.
From December 1999 to March 2003, 51 patients (40 males and 11 females) with pectus excavatum underwent the Nuss procedure. We classified patients into three groups based on age (pediatric, adolescent, and adult), retrospectively analyzed demographic, intraoperative and postoperative data, and compared outcomes among each group.
Mean operation time was 52.0 +/- 22.9 minutes, 80.4 +/- 27.4 minutes, and 127.3 +/- 44.9 minutes in the pediatric, adolescent, and adult groups, respectively (p < 0.001). Postoperative complications occurred in 3 of 27 patients (11.1%) in the pediatric group and in 7 of 12 patients (58.3%) in both the adolescent and adult groups (p = 0.002). Reoperations were performed due to complications in 1 of 27 patients (3.7%) in the pediatric group, 2 of 12 patients (16.6%) in the adolescent group, and 5 of 12 patients (41.7%) in the adult group (p = 0.001).
The Nuss procedure is highly recommended in pediatric patients with pectus excavatum. However, in adults it is necessary to select patients carefully because of the longer operation time and higher incidence of complications associated with the procedure in this population.
The Annals of thoracic surgery 10/2005; 80(3):1073-7. · 3.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The characteristics and causes of re-sweating after sympathetic surgery in hyperhidrosis patients have yet to be clearly documented due primarily to low incidence of re-sympathetic surgery. The purpose of this study is to identify the causes of re-sweating following sympathetic surgery, and to assess the outcomes of re-sympathetic surgery.
From February 1997 to July 2003, 36 patients underwent re-sympathetic surgery in order to treat re-sweating. Patients originally underwent sympathetic surgery due to facial (14 cases), palmar (21 cases), and axillary (1 case) hyperhidrosis.
Sympathectomy was performed as a primary surgical intervention in 7 cases (19.4%), sympathicotomy in 12 cases (33.3%), and sympathetic clipping in 17 cases (47.3%). Thirteen patients complained of re-sweating on both sides, and 23 patients exhibited unilateral re-sweating. The onset of re-sweating occurred after an average of 3.1+/-3.4 months (range, 1-12 months) after the operation. The causes of re-sweating after sympathetic surgery included an intact sympathetic chain in 4 cases (11.1%), incomplete resection in 6 cases (16.7%), partial reattachment in 6 cases (16.7%), improper ganglion location in 4 cases (11.1%), clip slipping out in 11 cases (30.5%), and unknown in 5 cases (13.9%). Twenty-seven patients (75.0%) exhibited re-sweating within 3 months, and 9 patients (25.0%) experienced re-sweating after 6 months. During the second operation, sympathicotomy was performed in 20 cases (55.6%) and sympathetic clipping in 16 cases (44.4%) in which 32 patients (88.9%) reported decreased sweating.
Surgical errors during the initial operation constituted the main cause of re-sweating following sympathetic surgery. Re-sympathetic surgery was necessary in order to treat re-sweating, and was associated with favorable outcomes.
European Journal of Cardio-Thoracic Surgery 06/2005; 27(5):741-4. · 2.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to clearly delineate the anatomical variations of the communicating rami in the upper thoracic sympathetic nervous system and to help develop better surgical method for essential palmar hyperhidrosis.
Anatomical dissections of the upper thoracic sympathetic chains with sympathetic ganglia and communicating rami have been carried out in 42 adult Korean cadavers (male 26, female 16). The rami communicantes were classified into three types (Normal: transverse or oblique rami connected to the intercostal nerve of the same level; AR: ascending rami connected to the higher level; DR: descending rami to the lower level) based on the anatomical relationship of the thoracic sympathetic ganglia to the intercostal nerves. Both sides of the upper thoracic sympathetic nervous system were compared in the same individual. The number of the communicating rami was recorded in 32 cadavers (64 sides). The distance from the rami communicantes to the sympathetic trunk was measured in 26 cadavers (52 sides).
The incidence of AR (ascending rami) and DR (descending rami) arising from the second sympathetic ganglion was 53.6% (45/84), 46.4% (39/84). From the third thoracic sympathetic ganglion, the incidence of AR was 5.9% (5/84) and that of DR was 26.2% (22/84). And in the fourth thoracic sympathetic ganglion, the incidence of AR was 4.8% (4/84) and DR was 8.3% (7/84), respectively. When we compared anatomical structures of both sides among the 42 cadavers dissected, only 14.3% (6/42) had similar anatomy of the rami communicantes bilaterally. Among 32 cadavers (64 sides), the mean number of rami communicantes at the second thoracic sympathetic ganglion was 2.1/2.5 in the left and the right side. At the third and the fourth thoracic sympathetic ganglion, the mean number was 1.9/1.6 and 1.7/1.7 in each side. The mean distance from the thoracic sympathetic chain to the most distal communicating rami of the left and right side at the second intercostal nerve was 7.81/9.40 mm among 26 cadavers. The mean distance of each side was 6.81/7.94 mm at the level of the third intercostal nerve. And at the level of the fourth intercostal nerve, the mean distance was 7.48/10.92 mm, respectively.
On the basis of this study, the anatomical variations of communicating rami could explain some surgical failures and recurrences. Moreover, in addition to the conventional surgical methods (sympathectomy, sympathicotomy, clipping of sympathetic chain and ramicotomy), dividing the inconstant sympathetic pathways (nerve of Kuntz, ascending or descending rami communicantes) on the second, the third and the fourth ribs will help to get better surgical effect.
European Journal of Cardio-Thoracic Surgery 03/2005; 27(2):320-4. · 2.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Lung transplantation is a viable option for patients with chronic obstructive pulmonary disease (COPD), and emphysema is the most common indication to undergo lung transplantation. A total of seven lung and one heart-lung transplantations were performed between July 1996 and June 2004 at the Yongdong Severance Hospital, and herein, three emphysema patients who underwent single lung transplantations are reviewed. There were 2 males and 1 female, with a mean age of 50 years (35, 57 and 58 years). They all underwent an operation, without cardiopulmonary bypass, and there was no operative mortality. The mean survival was 12 months (4 months, 15 months and 17 months) and all succumbed to death due to activation of pulmonary tuberculosis, post-transplantation lymphoproliferative disease and cytomegalovirus (CMV) gastritis associated with asphyxia. Infection was the most common postoperative complication, resulting in longer hospital stays, higher medical expenses and shorter survival rates, necessitating aggressive prophylactic management. The accumulation of experience, modifications to operative procedures and perioperative care may lead to improved early and long-term survival in patients with emphysema undergoing single or bilateral lung transplantations.
Yonsei Medical Journal 01/2005; 45(6):1181-90. · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the usefulness of computed tomography (CT) in the localization of parenchymal pulmonary endometriosis and to correlate the CT findings with fiberoptic bronchoscopic and pathologic findings.
A prospective study of 5 patients presenting with catamenial hemoptysis was conducted. The CT scans and fiberoptic bronchoscopy were performed twice during and 2 weeks after menstruation. After the localization of the presumed bleeding focus, surgical resection was performed.
The CT scans obtained during menstruation revealed a well-demarcated area of consolidation (n = 4) and ground-glass opacity (n = 5), whereas CT scans obtained after menstruation demonstrated ground-glass opacity (n = 4) or complete resolution of the previously noted lesion (n = 1). Fiberoptic bronchoscopy exhibited trails of blood clot at the orifice of the involved bronchi unilaterally (n = 4) or a thin bloody secretion in the bronchi bilaterally. Histopathologic examination of the resected specimens showed typical findings of pulmonary endometriosis.
Computed tomography scans during and after menstruation were useful for the precise preoperative localization of parenchymal pulmonary endometriosis.
[Show abstract][Hide abstract] ABSTRACT: Compensatory sweating (CS) is the main cause of a patient's dissatisfaction after sympathetic surgery for palmar hyperhidrosis. Preservation of the sympathetic nerve trunk and limitations on the range of dissection are necessary to reduce CS.
We compared 64 patients (31 male, 33 female) (group 1) who underwent a T2 sympathicotomy between July 1998 and February 1999 and 83 patients (58 male, 25 female) (group 2) who underwent a T3 ramicotomy between August 2000 and December 2002.
In group 1, 60 patients (93.8%) exhibited a decreased sweating on both hands, but 4 patients (6.2%) exhibited a persistent sweating on both hands. For group 2, 58 patients (69.9%) experienced a decreased sweating on both hands, 15 patients (18.1%) experienced a persistent sweating on both hands, and 10 patients (12.0%) experienced a persistent sweating on one hand. The grade of CS in group 2 was significantly lower than in group 1 (p < 0.001) and, notably, the rate of embarrassing and disabling CS in group 2 (15.5% [9 out of 58]) was significantly lower than in group 1 (43.3% [26 out of 60], p value < 0.001). The rate of satisfaction was 78.1% (50 out of 64) for group 1 and 68.6% (57 out of 83) for group 2 with no significant statistical difference indicated (p = 0.202).
The incidence of sweating postoperatively was relatively high in the T3 ramicotomy group, although the T3 surgery did result in a lower incidence of CS when compared with a T2 sympathicotomy.
The Annals of thoracic surgery 10/2004; 78(3):1052-5. · 3.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To retrospectively evaluate computed tomographic (CT) features of pleomorphic carcinoma of the lung and to compare these features with pathologic findings.
Ten patients (10 men, three women; mean age at diagnosis, 64.1 years; range, 43-75 years) with pleomorphic carcinoma treated from June 2000 to January 2003 were selected from two institutions. Two radiologists retrospectively reviewed CT features, which included size and location of tumor, presence of calcification, attenuation values and internal architecture of the mass, and invasion of pleura and chest wall. Attenuation values of the mass on CT scans were compared with pathologic findings in tumors in available gross specimens. Follow-up CT scans were not routinely obtained except in two patients with progressive pleural effusion and rapid growth of the tumor as seen on serial chest radiographs.
On unenhanced CT scans, attenuation of the tumor was similar to that of the surrounding muscle. Calcification within the tumor was visible in one patient. Invasion of chest wall was noted in two patients. Seven patients had pleural invasion. Tumors were located at the lung periphery in nine patients. On contrast material-enhanced CT scans, lesions with the longest diameter larger than 5 cm showed central low-attenuation areas with substantial enhancement in the tumor periphery; in comparison, lesions with the longest diameter smaller than 5 cm showed homogeneous enhancement. Size of two lesions with the longest diameter larger than 5 cm increased rapidly after a follow-up of shorter than 3 weeks. Low-attenuation areas on contrast-enhanced CT scans were found to correspond to areas of myxoid degeneration, necrosis, or hemorrhage in pathologic specimens.
Findings of this study suggest that pleomorphic carcinomas of the lung preferentially manifest as large peripheral lung neoplasms with a central low-attenuation area and frequently invade the pleura and chest wall.
[Show abstract][Hide abstract] ABSTRACT: The main cause of dissatisfaction after sympathetic trunk blocking surgery (T2 sympathectomy, sympathetic clipping) for craniofacial hyperhidrosis is compensatory sweating. Preserving sympathetic trunk may decrease the incidence of compensatory sweating, and we introduce T2 ramicotomy, which may better preserve the sympathetic nerve trunk in order to reduce compensatory sweating.
From January 2000 to November 2002, video-assisted thoracoscopic (VAT) T2 sympathetic clipping and VAT ramicotomy were performed in 44 patients suffering from craniofacial hyperhidrosis. Twenty-two patients underwent T2 sympathetic clipping (group 1), and 22 underwent division of T2 rami-communicantes (group 2). We retrospectively analyzed the rate of satisfaction, dryness of face, and grade of compensatory sweating.
Both groups were similar with respect to facial dryness (P = 0.099). Group 1: excessive dry 5 patients (22.7%), dry 17 patients (77.3%); group 2: excessive dry 3 patients (13.6%), dry 15 patients (68.1%), and persistent sweating 4 patients (18.3%). The rate of satisfaction was 77.3% in group 1, and 63.6% in group 2 with no significant difference (P > 0.05). The rate of compensatory sweating in group 2 (72.7%) was significantly lower than in group 1 (95.4%) (P < 0.039). The chance of embarrassing and disabling compensatory sweating was lower in group 2 than in group 1; 76.5% (embarrassing in 8 patients, disabling in 9) in group 1, and 36.4% (embarrassing in 7 patients, disabling in 1) in group 2 which was statistically significant (P < 0.006).
T2 ramicotomy for craniofacial hyperhidrosis lowers the rate of compensatory sweating and excessive dryness of face compared to T2 clipping.
European Journal of Cardio-Thoracic Surgery 08/2004; 26(2):396-400. · 2.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Gastrointestinal complications may follow organ transplantation. A patient who underwent heart lung transplantation due to patent ductus arteriosus and Eisenmenger's syndrome had an episode of acute cardiac rejection and was treated with a bolus injection of methylprednisolone followed by a high oral dose of prednisone. On the 22nd postoperative day, the patient complained of acute abdominal pain with muscular rigidity and a plain chest x-ray showed free air in the right subdiaphragmatic area. Under the suspicion of bowel perforation, an emergency laparotomy was performed and the perforated stomach had a wedge-shaped resection that included the perforation. Following the laparotomy, the postoperative course was uneventful and the patient was discharged on post-laparotomy day 10.
Yonsei Medical Journal 01/2004; 44(6):1094-7. · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Compensatory sweating is a major complaint following endoscopic thoracic sympathetic surgery in treatment of palmar hyperhidrosis. T3 ramicotomy was applied in order to decrease compensatory sweating. From Oct 1999 to June 2002, forty patients underwent T3 sympathetic clipping (group I), and 68 patients underwent T3 ramicotomy (group II) to treat palmar hyperhidrosis. We retrospectively analyzed the rate of satisfaction, result of operation, and grade of compensatory sweating. In group I, 36 patients (90%) showed decreased sweating on both hands, 4 patients (10 %) persistent sweating on both hands. In group II, 46 patients (67.6%) had decreased sweating on both hands, 14 patients (23.5 %) had persistent sweating on both hands, and 8 patients (8.9 %) had persistent sweating in one hand. The rate of satisfaction was 82.5 % (33/40) in group I and 67.6 % (46/68) in group II with no significant statistic difference (p = 0.067). Excluding patients with persistent sweating postoperatively, the rate of compensatory sweating in group II was 67.4%, which was significantly lower than in group I 94.1%, with a p value of 0.003. Although the rate of persisting sweating after operation was high, T3 ramicotomy resulted in lower rate of compensatory sweating compared to T3 sympathetic clipping.