ABSTRACT
Excessive sweating of the palms, axillae, and face has a strong negative impact on the quality of life for many people. The existing non-operative therapeutic options seldom give sufficient relief and have a transient effect. But a definitive cure can be obtained by upper thoracic sympathectomy. From June 1997 to October 1997, 117 cases of the needle (2 mm) thoracoscopic thoracic sympathectomies were performed in the Department of Thoracic and Cardiovascular Surgery in the Respiratory Center Yong-dong Severance Hospital in Seoul, Korea. We have followed up on 94 cases which include palmar hyperhidrosis (n=85), facial hyperhidrosis (n=5) and axillary hyperhidrosis (n=4). There were 42 males and 52 females whose ages ranged from 14 to 63 years (median:23 years). The T2 ganglia and T3-4 ganglia were excised by electrocuting with a hook and endoscissors and were removed for histologic examination. There have been no mortalities or life-threatening complications. The surgical results were classified as excellent (much improvement,very dry) in 93.6%, good (some improvement, minimally wet) in 2.1%, and fair (slight improvement, still wet) in 4.2%. Five patients (5.3%) required closed thoracostomy drainage because of pneumothorax in the immediate postoperative day. Horner's syndrome occurred in one case. The compensatory sweating occurred in 67 cases (71.2%) and was embarrassing in 21 cases (22.3%) and disabling in 9 cases (9.6%) of these cases. Primary failure occurred in one case. The patient with primary failure underwent successful operation. Fifty-one patients had concomitant hyperhidrosis. Our experiences indicate needle thoracoscopic sympathectomy is a very effective, safe, and time-saving procedure for essential hyperhidrosis.
Subject(s)
Female , Humans , Male , Axilla , Drainage , Ganglia , Horner Syndrome , Hyperhidrosis , Korea , Mortality , Needles , Pneumothorax , Quality of Life , Respiratory Center , Seoul , Sweat , Sweating , Sympathectomy , Thoracoscopy , ThoracostomyABSTRACT
A retrospective analysis was performed on the 72 cases of peripheral artery occlusive disease treated at Yonsei Medical School Yongdong Severance Hospital, from March 1, 1990, through July 31, 1992, focusing on the operative procedures, surgical results and perioperative complications. The etiologic causes of vascular obstruction were atherosclerosis in 28 cases, Buerger's disease in 31, traumatic orgin in 7, operative complications in 4, and malignancy and arteritis in one case each. Treatment modalities, actually performed include bypass graft. (27), infusion of PGE1 (23), Embolectomy (16), Sympathectomy (4) and end-to-end anastomosis (2). There were 21 satisfactory cases and 9 unsatisfactory cases of atherosclerotive occlusive disease, defining the operative outcome as "satisfactory" if the obstructive symptoms disappeared completely and "unsatisfactory" if they did not. The patients of TAO induced Buerger's disease with preoperative Foutain class III or IV were surgically converted to class 0 in 14 cases, class I in 12 and class II in 3.
Subject(s)
Humans , Alprostadil , Arteries , Arteritis , Atherosclerosis , Embolectomy , Retrospective Studies , Schools, Medical , Surgical Procedures, Operative , Sympathectomy , Thromboangiitis Obliterans , Transplants , TroleandomycinABSTRACT
Experimental trials of unilateral lung transplantation in dogs have been attempted and satisfactory results were obtained without any noticeable difficulty in surgical techniques. Fourteen dogs with the body weight of around 25 kg were anesthesized by 20~30 mg/kg of intravenous Entobar,; one was sacrificed to make available blood for use during transplantation for the recipient dog. A mid-sternotomy incision was performed and 20 mg/kg of Prostaglandin E1 was infused through the pulmonary artery and Euro-Collin's (E-C) preservation solution, cooled down to 4degree C, was perfused at the rate of 70cc/kg by a pressure of 30 cmH2O. The heart-lung block was then resected out and promptly immersed in the prepared preservation solution at 4degree C. One lung preserved in the EC solution at 4degree C was anastomosed to the recipient dog in the order of the pulmonary vein, bronchus then pulmomary artery and the thoracotomy incision was closed after the bleeding control and tube thoracostomy. Then the pneumonectomy in the opposite side was perfomed in the same manner and the tailored lung was transplanted in the order of the pulmonary vein, bronchus, then pulmonary artery. We conclude that in the bilateral sequential lung transplantation, the right lung transplantation should precede to better expose the operative field and to prevent reperfusion injury; also, the cardiopulmonary bypass should be consider for certain appropriate cases.
Subject(s)
Animals , Dogs , Alprostadil , Arteries , Body Weight , Bronchi , Cardiopulmonary Bypass , Hemorrhage , Lung Transplantation , Lung , Pneumonectomy , Pulmonary Artery , Pulmonary Veins , Reperfusion Injury , Thoracostomy , ThoracotomyABSTRACT
We treated 654 patients with simultaneous bilateral sympathectomy for essential hyperhidrosis from March 1989 to September 1997 (354 males and 300 females). The exposure afforded by thoracoscopy is actually superior to that seen at the time of either thoracotomy or axillary thoracotomy. The use of single-lumen intubation with alternating partially collapsed lung by CO2 inflation resulted in shorter anesthesia, shorter operative time, and shorter hospitalization. 2-mm extended thoracoscopic T2-sympathectomy is not only a time-saving method but also a very simple and effective one in the treatment of hyperhidrosis by experienced surgeons. The modification on our technique of thoracoscopic sympathectomy as described allowed us to significantly improve our previous results. A majority of the patients were relieved, and over 95% were satisfied initially.