Machine learning analysis of primary hyperhidrosis for classification of hyperhidrosis type and prediction of compensatory hyperhidrosis.

Background: Although sympathectomy is highly effective for improving symptom, compensatory hyperhidrosis (CH) is a major issue. In this study, characteristics of primary hyperhidrosis were investigated in terms of the heart rate variability (HRV) parameters. Classification of hyperhidrosis type and prediction of CH after sympathicotomy were also determined using machine learning analysis. Methods: From March 2017 to December 2021, 128 subjects who underwent HRV tests before sympathicotomy were analyzed. T2 and T3 bilateral endoscopic sympathicotomy were routinely performed in patients with craniofacial and palmar hyperhidrosis, respectively. Data collected age, sex, body mass index (BMI), hyperhidrosis type, symptom improvement after sympathicotomy, the degrees of CH after sympathicotomy, and preoperative HRV findings. The independent risk factors associated with the degree of CH after sympathicotomy were investigated. Machine learning analysis was used to determine classification of hyperhidrosis type and prediction of the degree of CH. Results: Preoperatively, patients with palmar hyperhidrosis presented with significantly larger standard deviation of normal-to-normal (SDNN), root mean square of successive differences (RMSSD), total power (TP), and low frequency (LF) than patients with craniofacial hyperhidrosis after controlling for age and sex (P=0.030, P=0.004, P=0.041, and P=0.022, respectively). More sympathetic nervous predominance was found in craniofacial type (P=0.019). Low degree of CH had significantly greater RMSSD (P=0.047), and high degree of CH showed more sympathetic nervous predominance (P=0.006). Multivariate analysis showed the type and expansion of sympathicotomy were significant factors for CH (P=0.001 and P=0.028, respectively). The neural network (NN) algorithm outperformed and showed a 0.961 accuracy, 0.961 F1 score, 0.961 precision, 0.961 recall, and 0.972 area under the curve (AUC) for classification of hyperhidrosis type. The random forest (RF) model outperformed showed a 0.852 accuracy, 0.853 F1 score, 0.856 precision, 0.852 recall, and 0.914 AUC for prediction of the degree of CH. Conclusions: The present study showed the machine learning algorithm can classify types and predict CH after sympathicotomy for primary hyperhidrosis with considerable accuracy. Further large-scale studies are needed to validate the findings and provide management guidelines for primary hyperhidrosis.

Advanced Laparoscopic Adenomyomectomy Technique for Focal Uterine Adenomyosis by Three-step Approach.

Background and Objective: Owing to the increasing trend of preserving fertility in adenomyomectomy, the need for laparoscopic adenomyomectomy has increased. This study aimed to introduce a new surgical technique, an advanced laparoscopic adenomyomectomy technique, and to evaluate its efficacy, benefits, and safety in focal uterine adenomyosis. Methods: From February 1, 2019 to February 29, 2020, 47 patients who underwent laparoscopic adenomyomectomy using the new surgical technique were enrolled in the study. The inclusion criteria were: (1) Focal-type adenomyosis, diagnosed by ultrasound or magnetic resonance imaging that was refractory to medical treatments. (2) A strong desire to preserve the uterus. All the operations were performed by a single surgeon with a uniform technique. Results: The mean patient age was 40.53 ± 5.93 years (median 38.5, range 32-47). The mean diameter of the adenomyoma lesions was 4.57 ± 1.21 cm and the mean weight of the excised lesions was 40.53 ± 35.65g (range, 15-209 g). The mean total operation time was 70.11 ± 15.05 minutes. The mean estimated blood loss was 88.88 ± 20.0 mL (20 - 500 ml). There was no conversion to laparotomy or major complications requiring reoperation. At the seven-month follow-up, there was complete remission of dysmenorrhea and menorrhagia in 97.4% and 88.9% of the patients, respectively. Conclusions: The new advanced laparoscopic adenomyomectomy technique with a three-step approach could be a safe and effective therapeutic method.

Diffuse alveolar hemorrhage following sugammadex and remifentanil administration: A case report.

RATIONALE: Diffuse alveolar hemorrhage (DAH) is a rare life-threatening condition that accompanies general anesthesia. Negative-pressure pulmonary edema (NPPE) is a rare cause of DAH. PATIENT CONCERNS: A 25-year-old male patient developed hemoptysis following remifentanil administration by bolus injection with sugammadex at the emergence from general anesthesia. DIAGNOSIS: Chest x-ray and computed tomography showed DAH. INTERVENTIONS: Conservative care was provided with 4L of oxygen via nasal prong, 20 mg of Lasix and 2500 mg of tranexamic acid. OUTCOMES: The patient was discharged uneventfully. LESSONS: Muscle rigidity by remifentanil and the dissociated reversal of neuromuscular blockade by sugammadex was suspected as the cause of NPPE-related DAH. Therefore, the possibility NPPE-related DAH should be considered when using a bolus of remifentanil and sugammadex during emergence from general anesthesia.

Transient Occlusion of Uterine Arteries in Procedures with High Risk of Uterine Bleeding.

INTRODUCTION: Uterine-conservative surgery via laparoscopy is a challengeable and high risk because of heavy intra-operative bleeding events in reproductive women with highly vascular uterine benign disease. There are three reported cases of women with highly vascular uterine benign diseases and high risk of intra-operative heavy bleeding, but were treated successfully to control intra-operative heavy bleeding risk by transient occlusion of the uterine artery (TOUA) through laparoscopy and resulted in safe conservation of the uterus. CASE PRESENTATION: The cases of women with high risk of heavy bleeding during therapeutic procedure included cesarean scar pregnancy, hydatid form mole on cesarean scar, and cervical pregnancy. All these women had the strong desire to presere their fertility and uterus. In all the three cases, we used the method of TOUA and performed therapeutic surgeries successfully, with less bleeding and safe conservation of the uterus through laparoscopy. CONCLUSION: Laparoscopic TOUA could be a therapeutic option to manage heavy intra-operative bleeding during conservative uterine surgeries associated with the risk of heavy bleeding.

Conservative surgery of uterine adenomyosis via laparoscopic versus laparotomic approach in a single institution.

AIMS: To evaluate the surgical outcomes of both approach methods (laparoscopy vs laparotomy) and to suggest the proper surgical approach according to type of uterine adenomyosis (focal vs diffuse). METHODS: We retrospectively analyzed 224 cases of uterine adenomyomectomy, 116 laparotomic and 108 laparoscopic, performed between July 2011 and June 2016 by a single surgeon (Y. S. K.). In all 224 cases, the surgeon had used transient occlusion of the uterine artery (TOUA). Surgical outcomes included weight of specimen, operating time, estimated blood loss and intraoperative injury to other organs. Postoperative clinical outcomes included symptom improvement (dysmenorrhea, menorrhagia and others) and recurrence. RESULTS: All patients in the laparoscopic group had been diagnosed with focal uterine adenomyosis, and most in the laparotomic group (85.3%) had been diagnosed with diffuse type. The largest lesion diameters were 6.48 cm in the laparotomic group and 4.34 cm in the laparotomic group. Operation time and estimated blood loss were 116.12 min and 222.67 mL in the laparotomic group and 75.09 min, respectively, and 155.33 mL in the laparoscopic group. There was no case of laparotomic conversion in patients with laparoscopic adenomyomectomy. CONCLUSION: Conservative surgery is effective to reduce the symptoms of adenomyosis regardless of approach method. For near-complete excision of adenomyosis, the diffuse type is recommended to be treated with laparotomic adenomyomectomy, and focal lesions less than 5 cm can be treated with laparoscopic conservative surgery.

Dissecting thoracic aortic aneurysm associated with tuberculous pleural effusion.

We present the case of thoracic aortic aneurysm associated with the tuberculous pleural effusion. An 82-year-old woman underwent emergency stent graft under a diagnosis of dissecting thoracic aortic aneurysm. Preoperative computed tomography revealed right pleural effusion supposed to the hemothorax caused by the dissecting aneurysm. But, the effusion was sanguineous color fluid and it was determined to result from pulmonary tuberculosis. The medical team was exposed to the pulmonary tuberculosis; fortunately no one became infected. Physicians should be aware of the possibility of an infected aortic aneurysm and prepare for pathogen transmission.

Relevance of radiological and clinical measurements in predicting difficult intubation using light wand (Surch-lite™) in adult patients.

OBJECTIVE: To determine the correlation between anatomical features of the upper airway (evaluated via computed tomography imaging) and the ease of light wand-assisted endotracheal intubation in patients undergoing ear, nose and throat surgery under general anaesthesia. METHODS: Mallampati class, laryngoscopic grade, thyromental distance, neck circumference, body mass index, mouth opening and upper lip bite class were assessed. Epiglottis length and angle, tongue size and narrowest pharyngeal distance were determined using computed tomography imaging. Intubation success rate, time to successful intubation (intubating time) and postoperative throat symptoms were documented. RESULTS: Of 152 patients, 148 (97.4%) were successfully intubated on the first attempt (mean intubating time 11.5 ± 6.7 s). Intubating time was positively correlated with laryngoscopic grade and body mass index in both male and female patients, and Mallampati class and neck circumference in male patients. Epiglottis length was positively correlated with intubating time. CONCLUSIONS: Ease of intubation was influenced by epiglottis length. Radiological evaluation may be useful for preoperative assessment of patients undergoing endotracheal intubation with light wand.

Laparoscopic Management of Heterotopic Interstitial Pregnancy with Subsequent Term Delivery.

A 35 year-old woman at 7-week gestational age was referred to our hospital. The patient was diagnosed with the heterotopic interstitial pregnancy by transvaginal ultrasonogra- phy after receiving in vitro fertilization (IVF) and embryo transfer. Laparoscopic excision and curettage was successfully performed at 8.4-gestational age under general anesthesia and the patient was discharged 2 days after operation without any post-operative complications. The woman had normal antenatal follow-up and deliv- ered a healthy baby at term by cesarean section.

Transient occlusion of uterine arteries in laparoscopic uterine surgery.

BACKGROUND AND OBJECTIVES: This study was conducted to determine the feasibility and effectiveness of transient occlusion of the uterine arteries (TOUA) during laparoscopic surgery for benign uterine tumors, with preservation of fertility. METHODS: Patients with uterine myoma or adenomyoma underwent laparoscopic uterine surgery, with or without TOUA, performed by a single surgeon (Y.-S.K.). Surgical outcomes included operative time; occurrence of intraoperative injury of blood vessels, nerves, and pelvic organs; and intraoperative blood loss. RESULTS: Of the 168 surgical patients included in this study, 144 were enrolled consecutively during the study period, and 24 had undergone adenomectomy before the study period. A total of 104 women (70 with myoma; 34 with adenomyoma) seeking uterine preservation underwent laparoscopic surgery with TOUA for benign uterine tumors. Sixty-four women (40 with myoma; 24 with adenomyoma) underwent surgery without TOUA. The mean total surgical time of the TOUA groups was 74.85 minutes for uterine myoma and 84.09 minutes for uterine adenomyoma. The mean estimated blood loss during laparoscopic myomectomy and adenomyomectomy was less in the TOUA groups than in the non-TOUA groups (109 vs. 203.4 mL in myomectomy, P < .05; 148.1 vs. 158.9 mL in adenomyomectomy; P < .05). Time to perform TOUA was 13.9 minutes in laparoscopic myomectomy and 7.33 minutes in laparoscopic adenomyomectomy. The hospital stay of the TOUA groups was 3.32 days for uterine myoma and 3.82 days for uterine adenomyoma. No intraoperative conversion to laparotomy was necessary, and no major complications occurred during any of the procedures. CONCLUSION: Laparoscopic uterine surgery with TOUA could be a safe and effective surgical method for women with symptomatic benign uterine tumors who wish to preserve fertility.

Conservative adenomyomectomy with transient occlusion of uterine arteries for diffuse uterine adenomyosis.

AIM: This study aimed to determine the feasibility and safety of adenomyomectomy with transient occlusion of uterine arteries (TOUA) in patients with symptomatic diffuse uterine adenomyosis. MATERIAL AND METHODS: Twenty-six patients with symptomatic diffuse uterine adenomyosis underwent adenomyomectomy with TOUA by a single surgeon at Ulsan University Hospital between May 2011 and September 2012. Surgical outcomes included operative time, intraoperative injury to blood vessels, nerves, and pelvic organs and operative blood loss. We assessed the degree of improvement in dysmenorrhea and menorrhagia at the 4-month follow-up after completion of adjuvant gonadotrophin-releasing hormone agonist. RESULTS: The mean age of patients was 37.73 years (range, 27-49 years). The mean total surgical time was 95.0 min (range, 60-145 min; SD, 34.49). The mean estimated blood loss was 191.54 mL (range, 80-400 mL; SD, 110.91) and there were no cases of injury to the uterine arteries or pelvic nerves. The mean time of TOUA was 9.79 min (range, 6-16 min; SD, 2.74). The mean duration of hospital stay was 5.65 days (range, 4-7 days; SD, 0.85). There were no major complications requiring reoperation or readministration during the mean follow-up period of 13.5 months. At the 7-month follow-up after adenomyomectomy with TOUA, complete remission of dysmenorrhea and menorrhagia was observed in 94.4% and 100% of patients, respectively. CONCLUSIONS: Adenomyomectomy with TOUA could be a safe and effective surgical method in women with symptomatic diffuse uterine adenomyosis to preserve fertility.

Laparoscopic adenomyomectomy under transient occlusion of uterine arteries with an endoscopic vascular clip.

BACKGROUND: To introduce the safe and effective surgical technique of laparoscopic adenomyomectomy with transient occlusion of uterine arteries (TOUA) in patients with symptomatic uterine adenomyoma. SUBJECTS AND METHODS: In a prospective case study, we examined all cases of laparoscopic adenomyomectomy with TOUA performed by a single surgeon at Ulsan University Hospital, Ulsan, Korea, between May 2011 and September 2012. Surgical outcomes included operative time, intraoperative injury of blood vessels, nerves, and pelvic organs, as well as intraoperative blood loss. We assessed the degree of improvement in dysmenorrhea and menorrhagia and the recurrence of adenomyomic lesions by ultrasonography at the 6-month follow-up after laparoscopic adenomyomectomy with TOUA. RESULTS: Thirty-four women who were refractory to medical treatment or who wanted surgical treatment for preserving their uterus underwent laparoscopic adenomyomectomy with TOUA using an endoscopic vascular clip. The mean age was 43.79 ± 4.94 years. The mean diameter of the adenomyomas was 5.29 ± 1.82 cm. The mean TOUA time, operation time, and hospital stay were 7.33 ± 4.12 minutes, 84.09 ± 31.48 minutes, and 3.82 ± 1.24 days, respectively. The mean estimated blood loss was 148.18 ± 93.99 mL, and no injury to the uterine arteries or pelvic nerves occurred. No cases of conversion to a laparotomy or major complications occurred. At the 6-month follow-up, complete remission of dysmenorrhea and menorrhagia occurred in 72.2% and 87.5% of patients, respectively. CONCLUSIONS: Laparoscopic adenomyomectomy with TOUA could be a safe and effective surgical method for women with symptomatic uterine adenomyoma who want to preserve their fertility.

Cardiopulmonary bypass weaning difficulty due to anomalous origin of coronary artery -A case report-.

We report a case of hemodynamic instability after aortic valve replacement, due to the anomalous origin of the right coronary artery. During the cardiopulmonary bypass weaning process, hemodynamic instability occurred. The cause was not identified at first, and compression of the anomalous right coronary artery was thought to be the culprit, thereafter.

Transient occlusion of uterine arteries with endoscopic vascular clip preceding laparoscopic myomectomy.

BACKGROUND: To determine whether performing transient occlusion of uterine arteries (TOUA) immediately before laparoscopic myomectomy can reduce intraoperative complications. SUBJECTS AND METHODS: In a retrospective case-control study, laparoscopic myomectomy with and without TOUA was examined. Data were analyzed from 89 laparoscopic myomectomies performed by a single surgeon (Y.-S. Kwon) at Ulsan University Hospital (Ulsan, Korea) between March 2011 and December 2011. Surgical outcomes included preoperative myoma size, number of myoma, operative time, and operative blood loss. RESULTS: Forty-nine women underwent laparoscopic myomectomy with TOUA with endoscopic vascular clipping, whereas 40 control patients underwent laparoscopic myomectomy alone. The TOUA group had no case of nerve or vascular injury during the operation time. The mean time of occlusion of both the uterine arteries was 15 minutes. The TOUA group had less mean blood loss during the operation than the group with laparoscopic myomectomy alone (111.9 versus 203.4 mL; P<.001). There were no significant differences in size and number of uterine myomas and intraoperative complications between the two groups. Moreover, there was not even a single case of conversion of laparoscopy to laparotomy in either group. CONCLUSIONS: TOUA performed immediately before laparoscopic myomectomy facilitated minimally invasive surgery with lower blood loss and no differences in other intraoperative complications.

Treatment for postoperative wound pain in gynecologic laparoscopic surgery: topical lidocaine patches.

BACKGROUND: This article reports our early experience with the use of lidocaine patches for pain control in the immediate postoperative period after laparoscopic gynecologic surgery. SUBJECTS AND METHODS: A prospective, double-blind, placebo-controlled clinical trial was conducted on 40 patients undergoing a gynecologic laparoscopy who were randomized to receive either topical patches of 700 mg of lidocaine (n=20) or placebo patches (n=20). The patch was divided evenly into four smaller patches, which were applied at the four port sites and changed every 12 hours for 36 hours after surgery. Postoperative pain was evaluated using the visual analog scale (VAS) score and the Prince Henry and 5-point verbal rating pain scale (VRS), and the analgesic requirement was also evaluated at 1, 6, 12, 24, and 36 hours after surgery. RESULTS: The VAS score for wound pain was lower in the lidocaine patch group at 1 and 6 hours after surgery than the control group (P=.005 and <.0005, respectively). The VAS scores for postoperative pain were lower in the lidocaine patch group at rest 1 hour after surgery (P=.045). The 5-point VRS score for postoperative pain was lower in the lidocaine patch group at 6 and 12 hours after surgery (P=.015 and .035, respectively) than in the control group. CONCLUSIONS: Topical lidocaine patches at the laparoscopic port sites reduced postoperative pain, particularly postoperative wound pain after gynecological laparoscopic procedures.

Mature cystic teratoma of the uterosacral ligament successfully treated with laparoendoscopic single-site surgery.

OBJECTIVE: Although the majority of teratomas are encountered in the ovary, extragonadal mature cystic teratoma is an unusual disease entity, and the most common site is the omentum. CASE REPORT: The occurrence of this tumor on a uterosacral ligament is extremely rare with enigmatic etiology. To our knowledge, there have been only three cases reported to date that describe a mature cystic teratoma of the uterosacral ligament, and this is the first report of successful treatment of these rare tumors with laparoendoscopic single-site surgery (LESS). CONCLUSION: In the present study, we report a mature cystic teratoma of the uterosacral ligament successfully treated with LESS in a 34-year-old woman with a preoperative diagnosis of mature cystic teratoma of the left ovary.

The antinociceptive effect of acetaminophen in a rat model of neuropathic pain.

Acetaminophen is one of the most popular and widely used analgesics for the treatment of pain and fever but few studies have evaluated its effects on neuropathic pain. This study examined the effect of acetaminophen on thermal hyperalgesia, mechanical and cold allodynia in a rat model of neuropathic pain. Male Sprague-Dawley rats were prepared by tightly ligating the left L5 and L6 spinal nerves to produce a model of neuropathic pain. Sixty neuropathic rats were assigned randomly into six groups. Normal saline and acetaminophen (25, 50, 100, 200 and 300 mg/kg) were administered intraperitoneally to these individual groups. Thermal hyperalgesia, mechanical and cold allodynia were examined at preadministration and at 15, 30, 60, 90, 120, 180, 240 and 360 min after administering the drug. Mechanical allodynia was quantified by measuring the paw withdrawal threshold to stimuli with von Frey filaments. Cold allodynia was quantified by measuring the frequency of foot lift after applying 100% acetone. Thermal hyperalgesia was quantified by measuring the thermal withdrawal threshold. The rotarod performance was measured to detect any drug-induced adverse effects, such as drowsiness. The hepatic and renal adverse effect was also assessed by measuring the serum levels of aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen and creatinine. The paw withdrawal thresholds to mechanical stimuli and the thermal withdrawal threshold were increased significantly and withdrawal frequencies to cold stimuli were reduced by acetaminophen administration in a dose-dependent manner. Acetaminophen reduces thermal hyperalgesia, mechanical and cold allodynia in a rat model of neuropathic pain, and might be useful for managing neuropathic pain.