Clinical Results According to the Level and Extent of Sympathetic Block in Palmar Hyperhidrosis / 대한흉부외과학회지

BACKGROUND: Video assisted thoracic sympathectomy or sympathicotomy is a safe and effective therapy for the treatment of palmar hyperhidrosis with immediate symptomatic imporvement. However the degree of satisfaction may diminish with time due to cmpensatory sweating or excessive hand dryness. Therefore by comparing and assessing the degree of symptomatic improvement or compensatory sweating following sympathectomy or sympathicotomy at various levels we aim to determine the optimal level of sympathetic nerve block which will result in minimal side effects and maximal benefit. MATERIAL AND METHOD: Among 194 patients having undergone video assisted thoracic sympathectomy or sympathicotomy between January 1996 and June 1999, 137 patients who responded to either telephone interview or questionnaire were included in the current study. The patients were divided into three groups. Group I(n=61) ; patients having undergone T2,3,4 sympathectomy group II(35) ; patients having undergone T2 sympathicotomy and group III(41) ; patients having undergone limited T2 sympathicotomy which consist of block of interganglionic neuronal fiber on the third rib. The parameters studied comprised of pre- and post-operative palmar temperature change treatment satisfaction the degree of compensatory sweating or discomfort from palmar dryness postoperative complication and changes in plantar sweating. RESULT: There was no difference in age and sex among the groups and the mean postoperative elevation in palmar temperature was 21.59degrees C without any differences among the groups. Patients expressing satisfaction were 65.6%, 62.9% and 90.24% in groups I, II and III, respectively(p<0.05) Moderate to severe compensatory sweating was present in 65.6% 51.4%, and 24.39%, in group I, II, and III, respectively (p<0.05) Slight but comfortable amount of palmar humidness was expressed in decreasing order group III(41.6%) group I(24.6%) and group II(5.7%) (p<0.05) Ineffectiveness or recurrence was present in 5patients in group I(8.2%) 1 patient in group II(2.9%) and none in group III. With regards to plantar sweating decrease in sweating was expressed in 43 patients(31.4%) while similar degree of sweating in 61 patients(44.5%) and increase in sweating in another 33 patinets(24.1%). CONCLUSION: Limited T2 sympathicotomy resection of the lower interganglionic neuronal fiber of the second sympathetic ganglion on the third rib showed immediate effect in palmar hyperhidrosis and caused lesser compensatory sweating and hand dryness.

A Comparison on the Operative Results of Benign Esophageal Disease by Video-Assisted Thoracic Surgery and Thoracotomy / 대한흉부외과학회지

BACKGROUND: Video-assisted thoracic surgery (VATS) is being used as a therapeutic modality in many diseases in which thoracotomy has been used. We studied that the VATS can substitute the thoracotomy in benign esophageal disease. MATERIAL AND METHOD: Group I (n=18) underwent video-assisted thoracic surgery, and group II (n=19) thoracotomy. Group I includes 14 leiomyomas and 4 achalasias. Group II includes 16 leiomyomas and 3 achalasias. Operative technique is enucleation in the leiomyoma and modified Heller's myotomy in the achalasia. Analyzing factors of operation-efficacy are anesthetic time, operation time, hospital stay, chest tube drainage amount and chest tube removal day. The degree of the postoperative pain is assessed by the frequency of opioid analgesics injection. RESULT: There was no death in both groups. There were 5 complications in the group I and 2 in the group II. Prolonged pleural effusion and restenosis of achalasia occurred to 1 patient in each group. In the group I, there were 1 temporaty vocal cord palsy and 2 mucosal tear leading to thoracotomy. There were no differences in anesthesia time, operation time, hospital stay, total chest tube drainage amount, chest tube removal day and frequency of opioid analgesics injection. The amount of the chest tube drainage at POD 1 day was significantly lower in group I (155.6+/-77.8cc) than in group II (572.8+/-280.1cc) (p<0.05). CONCLUSION: The results of our data showed that video-assisted thoracic surgery for benign esophageal disease is as effective as thoracotomy and in addition, cosmetic effect is much better. We concluded VATS may be a substitute for thoracotomy in benign esophageal disease.

Heart Transplantaion : Early Results and 2-Year Survival

BACKGROUND: The heart transplantation is now accepted as a definitive therapeutic modality in patients with terminal heart failure. The first successful heart transplantation in human was done in 1967 and the first case in Korea was performed in November, 1992. Since the first case in 1992, more than 25 cases have been performed in Korea. The purpose of this study is to evaluate the early results and the follow-up course of 9 cases of heart transplantation done in Asan Medical Center. METHODS: Total 9 patients had orthotopic heart transplantation since November, 1992 in Asan Medicla Center. The No. of male patients was 7 and the average age of 9 patients was 41 years old(20-51). The preoperation status was status I in 5 patients and status II in 4 patients. The mean follow-up duration was 9.5 months(2-26). All patients are alive till now. RESULTS: 1) The blood type was identical in 6 and compatible in 3 patients. 2) The original heart disease was dilated cardiomyopathy in 7, ischemic cardiomyopathy in 1 and giant cell myocarditis in 1 patient. 3) IgG Ab for CMV was positive in all recipients and donors and igM Ab for CMV was positive in only one reipient. The serial cultures for CMV shell vial method have been negative till now. 4) HLA cross matching for recipient and donor was done in 8 cases and the results were all negative for T-cell and B-cell. Among 6 loci of A, B and DR, one locus was matched in 4 cases and 2 loci was matched in 2 cases. 5) The No. of acute allograft rejection per case was average 3.7(1-6) and the No. of acute allograft rejection requiring treatment was average 1.4(1-3) per case. The time interval from operation to the first acute rejection requiring treatment was 40 days(5-60). Acute humoral rejection was supected strongly in 1 case and was successfully treated. 6) The left ventricular ejection fraction measured by echocardiography and/or MUGA scan was dramatically increased from 15%(10-24) to 59%(45-70%) after heart transplantation. 7) Temporary pacing was needed in 2 parients over24 hours but normal sinus rhythm was appeared within 7 day in all cases. One patient had permanent pacemaker due to complte AV block appeared 140 days after heart transplantaion. CONCLUSION: The heart transplantation of Asan Medical Center is on developing stage but the early result is comparable to that of well established center in other countries, even though the long-term follow-up result must be reevaluated. We can conclude that the heart transplantion is a promising therapeutic option in parients with terminal heart failure.