The Heart Rate and ECG Changes after Endoscopic Thoracic Sympathectomy in Patients with Primary Hyperhidrosis / 대한흉부외과학회지

BACKGROUND: Primary focal hyperhidrosis is characterized by overactivity of the sympathetic nervous function, and this has been effectively treated with endoscopic thoracic sympathetic denervation (ESD). The imbalance of sympathetic and parasympathetic nervous system that's created by ESD may affect the heart, lung and other thoracic organs. We analyzed the heart rate and ECG changes after performing ESD at our hospital, and this is the first such study that has been conducted on this. MATERIAL AND METHOD: Of the 263 patients who underwent ESD between October 1996 and October 2006, 130 had ECG before and after ESD, and they were classified into 3 groups according to the level of ESD: Group I (n=40) patients underwent ESD at the 2nd rib (T2ESD), Group II (n=80) at the 3rd rib (T3ESD) and Group III (n=10) at the 4th rib (T4ESD). RESULT: There was no mortality or major morbidity. Heart rate (HR) was significantly decreased from 71.6+/-10.6/min to 66.8+/-10.2/min after ESD (p<0.01); however, the PR (from 148.6+/-21.2 msec to 152.8+/-20.5 msec) and QTc (from 399.2+/-15.4 msec to 404.0+/-15.1 msec) intervals were significantly increased after ESD in the patients who suffered with primary hyperhidrosis (p<0.01). According to the level of ESD, there were significant changes in the HR and QTc interval in group I (T2ESD), the HR and PR interval in group II and the QTc interval in Group III. CONCLUSION: There were significant changes in the heart rate and ECG findings after ESD. The thoracic sympathetic denervation of T2, T3 and T4 affected the electrical activity of the heart at the resting state.

Surgical management of recurrent pneumothorax in the second trimester of pregnancy / 대한주산의학회잡지

Spontaneous pneumothorax in pregnancy is generally regarded as an unusual disorder, with only approximately 44 cases having been reported in the world literature. The most common cause is the rupture of a subpleural apical bulla or bleb, due to increased respiratory demand of the peripartum period. Pneumothorax should be considered in any pregnant woman with chest pain and/or dyspnea and must be confirmed radiographically. Treatment of simple pneumothorax during pregnancy is controversal. Admission and close observation of the patient is usually done with small pneumothorax. Other treatment options are needle aspiration, needle decompression (eg, intension pneumothorax), pleurodesis, tube thoracostomy, thoracotomy, and thoracoscopy. We report a recent experience of a 34 years-old pregnant woman with recurrent pneumothorax, who was treated with thoracotomy during the 28th weeks of pregnancy. She had previously been well during pregnancy and all antenatal investigations, including ultrasound scan, were normal. Cardiovascular examination did not reveal any abnormality. On chest auscultation, air entry was reduced on the left side of the chest. Chest X-ray revealed significantly expanded left lung with a large pneumothorax. After successfully treated with surgical approach, the patient had vaginal delivery of a healthy male infant, weighing 2.93 kg, safely during 39th weeks of pregnancy.