Limited Sympathicotomy Using 2mm Endoscope in Palmar Hyperhidrosis

OBJECTIVE: Thoracoscopic T2 sympathicotomy had been performed as a simple and effective method in treating palmar hyperhidrosis, but some patients are not satisfied with the result of sympathicotomy due to compensatory hyperhidrosis. Therefore, a more limited T2 sympathicotomy using 2mm endoscope was introduced. We made a comparison between conventional T2 sympathicotomy and limited T2 sympathicotomy on operative results and compensatory hyperhidrosis. MATERIAL AND METHOD: From January 1998 to April 2000, 56 patients were treated by video assisted endoscopic thoracic sympathicotomy. Thirty patients of these underwent T2 sympathicotomy(Group A), and the remainders underwent limited T2 sympathicotomy(Group B). The limited T2 sympathicotomy is coagulation of the interganglionic fibers of T2 sympathetic ganglion on T2 rib head. The comparative analysis between two groups was based on the medical records and telephone interview results. RESULT: All patients were treated for excessive sweating on palms with 2mm endoscopic sympathicotmy. There were no mortalities, life-threatening complications except one recurrent patient who was treated successfully with re-operation(endoscopic sympathicotomy). Compensatory hyperhidrosis was common in group A. An individual satisfactory rate for the operations was higher in group B than in group A. CONCLUSION: The limited T2 sympathicotomy considered to be a more effective and less complicated method than the T2 sympathicotomy for the treatment of palmar hyperhidrosis.

Intraventricular Rupture of a Thalamic Abscess

The mortality of patients with brain abscess has decreased significaltly. This has been attributed to improved diagnostic imaging, the evolution of neurosurgical techniques and understanding of intracranial pressure pathophysiology, greater critical care understanding, and newer antibiotics. However, the mortality associated with intraventricular rupture of brain abscess remained consistently high at or above 80% once identified. A case of intraventicular rupture of thalamic abscess with good quality of survival is presented based on aggressive 4-component therapeutic plan used. The four components are 1) extraventricular drainage for 6 weeks, 2) lavage of the ventricular system using closed irrigation system, 3) intravenous antibiotics, 4) intraventricular gentamicin and vancomycin, twice and once daily, respectively.