• Proceedings of the Korean Society of Veterinary Clinics Conference
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• 2006.05a
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• pp.194-194
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• 2006

• The Korean Journal of Pain
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• v.19 no.2
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• pp.202-206
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• 2006

Background: Stellate ganglion block (SGB) might be associated with changes in the blood pressure (BP) and heart rate (HR). The heart rate variability (HRV) shows the balance state between sympathetic and parasympathetic activities of the heart. The changes in these parameters of the HRV were studied to evaluate the possible mechanism of SGB in changing the BP. Methods: SGB was performed on 26 patients, using a paratracheal technique at the C6 level, and 8 ml of 1% mepivacaine injected. The success was confirmed by check the Horner's syndrome. The BP, HR and HRV were measured before and 5, 15, 30, 45 and 60 minutes after the SGB. Results: The increases in the BP from the baseline throughout the study period were statistically, but not clinically significant. The HR and LF/HF (low frequency/high frequency) ratio were increased at 5 and 45 min, respectively, after the administration of the SGB. In a comparison of left and right SGB, no significant differences were found in the BP, HR and HRV. A correlation analysis showed that an increased BP was significantly related with the changes in the LF/HF ratio and LF at 15 and 30 minutes, respectively, after the SGB. Dividing the patients into two groups; an increased BP greater and less than 20% of that at the baseline INC and NOT groups, respectively, hoarseness occurred more often in the INC group (P = 0.02). Conclusions: It was concluded that SGB itself does not clinically increase the BP and HR in normal hemodynamic patients. However, the loss of balance between the sympathetic and parasympathetic nerve system, attenuation of the baroreceptor reflex and hoarseness are minor causes of the increase in the BP following SGB; therefore, further studies will be required.

• Journal of Chest Surgery
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• v.27 no.12
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• pp.1015-1022
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• 1994

Over the past few years, video-assisted thoracic surgery [VATS] has been used increasingly for intrathoracic pathologic problems as a less invasive operative techniques. Today it is viewed as a sparing and safe alternative to thoracotomy for a wide spectrum of indications. Using video-assisted operative thoracoscopy, we performed consecutive 150 operations on 148 patients during the initial 2 years of our experience from July 1992 with the following indications: pneumothorax [n=53], hyperhidrosis [n=29], mediastinal mass [n=23], pleural disease [n=13], diffuse parenchymal or interstitial lung disease [n=12], benign pulmonary nodule [n=7], metastatic lung mass [n=3], primary lung cancer [n=3], bronchiectasis [n=2], malignant pericardial effusion [n=2], endobronchial tuberculosis [n=1], esophageal achalasia [n=1], and pulmonary parenchymal foreign body [n=1]. There were no death, and overall complicaton rate was 24.0%[n=36]. The most prevalent complication was persistent air leakage [longer than 5 days] in 14 cases [9.3%]. Persistent pleural effusion [longer than 5 days] occurred in 6 cases [4.0%]. Six patients were converted to an open thoracotomy because of inability to control the operative bleeding [n=3], failed adhesiolysis in bronchiectasis [n=2], and radical excision of an lung cancer [n=1]. Pneumothorax recurred in 3 cases[2.0%]. Other complications were Horner`s syndrome, diaphragm tears, temporary phrenic nerve palsy, hoarseness, subsegmental atelectasis, transient respiratory difficulty, and esophageal mucosal tear. The advantages of this minimally traumatizing operative technique lie in improved visualization, decreased pain, shortened hospital stay, and less postoperative morbidity. The indications of VATS has been extended increasingly to intrathoracic pathologies, but its role in the managements of primary lung cancer and esophageal disease remains to be defined.

• The Korean Journal of Pain
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• v.12 no.1
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• pp.81-86
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• 1999

Background: Essential hyperhidrosis is a condition with excessive sweating, which may be localized in any parts of the body. Thoracic sympathectomy has been a surgical procedure for the management of hyperhidrosis. Methods: We studied 30 ASA I and II patients suffering from severe hyperhidrosis. Bilateral upper thoracoscopic sympathectomy of $T_{2-4}$ was performed in 30 patients under general anesthesia. Anesthesia was induced with 2.5% thiopental sodium 5 mg/kg and succinylcholine chloride 1 mg/kg and was maintained with enflurane 1~2 Vol% and $N_2O-O_2$ mixture adjusted to maintain $SpO_2$ greater than 96%. During anesthesia, invasive arterial pressure, heart rate, EKG, $SpO_2$ and capnography were monitored. Skin temperature was measured with thermister probes attached to the index finger of each hand. An increase in temperature after cautery confirmed success of the sympathectomy. Results: There were 14 men and 16 women whose ages ranged from 16 to 46 years old (mean age 22.2). Of these patients, 13 patients had complained of palm-sole hyperhidrosis, 9 of palm-sole-axilla hyperhidrosis, 4 of palm-sole-face hyperhidrosis and 4 of palm-sole-axilla-face hyperhidrosis. The provocative factors of excessive sweating were tension and stress from interpersonal relationships. There was positive familial history in 37%. The most common complication was compensatory hyperhidrosis in 23 patients comprising 76%. Other complication included peumothorax (4 patients), hemothorax (1 patient), ipsilateral Horner's syndrome (1 patient) and paresthesia of right arm (1 patient). The degree of satisfaction was graded as good, fair and poor with 15, 12 and 3 patients, respectively. Conclusions: Thoracoscopic sympathectomy with VATS is an efficient, safe and minimally invasive surgical procedure for essential hyperhidrosis.

• Journal of Chest Surgery
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• v.28 no.7
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• pp.684-688
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• 1995

Hyperhidrosis, one of the abnormalities in autonomic nervous system, has been treated with dermatologic principles or thoracic sympathectomy via conventional axillary thoracotomy or dorsal spinal approach. But these techniques were rather ineffective or invasive. Recently, VATS is widely applied in thoracic surgical area, and hyperhidrosis is not the exception of these cases.From May 1993 to August 1994, 30 patients with bilateral palmar hyperhidrosis underwent bilateral thoracic [T2, T3 sympathectomy with thoracoscopic surgery at Seoul National University Hospital. There were 20 men and 10 women and the mean age was 23.0 years.Mean operating time was 115 min and there was no thoracotomy conversion. Operative complications were anesthetic overdose in 1, Horner`s syndrome in 1, and small amount of residual pneumothorax in 6. Mean postoperative hospital stay was 2.3 days [range from 1 to 4 days and postoperative analgesics were required in 17 cases with a single dose.Sweating amount was measured in 12 patients, showing significantly decreased amount from 284.5 mg preoperatively to 18.9 mg postoperatively in 5 minutes [p=0.004 . There was no recurrence during mean 6 months follow up. Twenty two patients [73.3 % complained moderate compensatory hyperhidrosis on the trunk.In conclusion, all patients were greatly satisfied with those results including no more palmar sweating, less pain, better cosmetics, short hospital stay. In addition, recent use of sweating amount measurement and intraoperative temperature monitoring could make this technique more accurate, so we easily applied thoracoscopic sympathectomy with minimal risk.

• Journal of Chest Surgery
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• v.31 no.6
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• pp.598-603
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• 1998

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.

• Journal of Chest Surgery
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• v.23 no.2
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• pp.299-308
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• 1990

A review of 50 patients with primary mediastinal tumors or cysts has been done to evaluate clinical and pathological behavior of this heterogeneous group of tumors proved by either excision or biopsy from January 1980 to August 1989 at the cardiovascular department of surgery in Kyungpook National University Hospital. There were 30 males and 20 females in this series. The ages of patients ranged from 4 months to 64 years. The mean age of subjects was 30.4 years. Neurogenic tumors [14 cases, 28%] and teratoma [14 cases, 28%] were most frequently encountered and followed by thymoma [10 cases, 20%] and benign cysts [4 cases, 8%]. The anatomic location of the primary mediastinal tumors or cysts was classified as anterior mediastinum and middle or visceral mediastinum and paravertebral or costovertebral mediastinum on the basis of the Shields’ proposition. In 32 patients[64%], the tumors or cysts were located in anterior mediastinum and in 13 patients[26%], the tumors or cysts were located in paravertebral or costovertebral mediastinum. And the rest 5 patients[10%] had middle or visceral mediastinal tumors or cysts. One of the characteristic features of primary mediastinal tumors or cysts is that some mediastinal tumors or cysts have their own preferred location in the mediastinum. In our series, all of the 14 patients with teratoma and 10 patients with thymoma had the anterior mediastinal location, while 13 of the 14 patients with neurogenic tumors had the paravertebral mediastinal location. 14 patients[28%] were asymptomatic and they all were discovered via so-called “Routine” chest x-ray examination. 39 of 50 patients[78%] were benign. 11 patients[22%] were malignant and they were all symptomatic. 40 patients[80%] were treated with complete resection. 5 patients[10%] were treated with partial resection : 2 of malignant thymoma, 3 of lipoma, neuroblastoma, primary squamous cell carcinoma. The rest 5 patients[10%] were only biopsied: 2 of undetermined malignancy and 3 of hemangioma, lymphoma, primary squamous cell carcinoma. 4 of the 10 patients were treated with combination of irradiation and chemotherapy. Postoperative complications were as followings: Horner’s syndrome [4cases, ado], respiratory failure [3 cases, 6%], pleural effusion[3 cases, 6%], Wound infection[2 cases, 4%] and bleeding, pneumothorax, empyema. There were 5 postoperative deaths [10%]. One patient with neuroblastoma died from intraoperative massive bleeding, 3 patients died early postoperatively from respiratory failure with undetermined malignancy died late postoperatively from congestive heart failure due to direct invasion of the tumor to the heart.

• Journal of Chest Surgery
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• v.31 no.10
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• pp.999-1003
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• 1998

Background: Thoracoscopic sympathetic block in palmar hyperhidrosis has merits in its immediate responsiveness and recovery. In palmar hyperhidrosis, the level of sympathetic chain to be blocked has been somewhat obscure. Materials and methods: To compare the results of T2 with T2,3 sympathetic block, we retrospectively studied 192 patients (T2 group: 84, T23 group: 108) operated on at SNUH with palmar hyperhidrosis between April 1994 and July 1997. We reviewed medical records and recently interviewed the patients by telephone call. Sex and age distribution between two groups showed no significant differences. We performed sympathectomy at the early phase of the syudy until April 1997, and after then, we adopted sympathicotomy rather than sympathectomy. Results: All patients showed symptomatic improvement after the operation. Mean operation times of T2, T23 groups were 61.3$\pm$22.5min, 82.7$\pm$24.8min, respectively(p<0.01). Early postoperative complications, such as Horner's syndrome or chest tube insertion, were not different in two groups. There were no statistical differences of late complications such as compensatory truncal hyperhidrosis, gustatory sweating, and phantom sweating. No patient experienced recurrence of palmar hyperhidrosis during the study period. The only difference was the extent of compensatory truncal hyperhidrosis. The compensatory sweating occurred from axilla to suprapatella in T2 group whereas its extent was from nipple to suprapatella in T23 group. Conclusions: We concluded that T2 thoracic sympathetic block is mandatory for the treatment of primary palmar hyperhidrosis.

• Journal of Chest Surgery
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• v.31 no.3
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• pp.279-285
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• 1998

Exessive sweating of the palms and soles, is a psychologically and occupationally distressing and sometimes disabling condition. Hyperhidrosis is one of the common abnormalities in autonomic nervous system. There were no specific treatment on hyperhidrosis, so invasive thoracic sympathectomy via axillary thoracotomy or cervical approach had been used. Video-assisted thoracic surgery(VATS) is now mostly performed for treating of the palmar and axillary hyperhidrosis. From March 1996 to March 1997, 15 patients with bilateral palmar hyperhidrosis had been treated by the bilateral thoracic sympathectomy(T2, T3, T4) with thoracoscopic resection. The patient were evaluated preoperative and postoperative Digital Infrared Thermographic Imaging (DITI) at Kyung-Hee University Hospital. There were no case of the thoracotomy conversion. There were 3 complications ; pulmonary edema in 1 case, Horner's syndrome in 1 case, and gustatory hyperhidrosis in 1 case. More than half of the patients also had compensatory sweating in the lower abdomen, the buttocks, the back and the thighs. In conclusion, most of the patients were satisfied with the postoperative results of the thoracoscopic sympathectomy, including no more palmar and axillary sweating, less pain, better cosmetic appearances, decreased sweating of the face and soles. In addition, intraoperative temperature monitoring of the hands could estimate the successful thoracoscopic sympathectomy and the preoperative and postoperative Digital infrared thermographic imaging(DITI) could especially be the technique for the objective manifestation of the successful results of the thoracoscopic sympathectomy.

• Journal of Chest Surgery
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• v.31 no.5
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• pp.525-530
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• 1998

Thoracoscopic thoracic sympathectomy for primary palmar hyperhidrosis has been known to be effective and to have cosmetic merits compared to conventional open sympathectomy. In spite of its cosmetic advantages over thoracotomy, VATS using 5 mm or 10 mm instruments still has the problem of operative wound as well as pain on trocar sites. Recently, 2 mm thoracoscopic instruments have been used. The purpose of this study was to examine the results of thoracoscopic sympathectomy for palmar hyperhidrosis with 2 mm thoracoscopic instruments. From January 1997 to April 1997, 46 patients underwent bilateral thoracoscopic sympathectomy with 2mm instruments at Seoul National University Hospital. T-2 ganglion was carefully dissected and resected out in all patients. In one patient, the lower third of T-1 ganglion was inadvertently resected together with T-2 ganglion due to poor anatomical localization. In 4 patients who also complained of excessive axillary sweating, T-3 ganglion was resected as well. The instruments were removed without leaving any chest drain after reexpansion of the lung. Trocar sites were approximated with sterile tapes. All patients were relieved of excessive sweating in their upper extremities immediately after the operation. Nine patients(19.6%) showed incomplete reexpansion of the lung, and two of them required needle aspiration. Complications related to the surgical procedures, such as Horner's syndrome, hemothorax, and brachial plexus injury, were not detected in any cases. Most patientsdid not complaine of pain. All patients were discharged from the hospital on the day of operation. Despite a narrow operative viewfield, thoracic sympathectomy with 2 mm thoracoscopic instruments can be performed without increasing any severe complications. We recommend 2 mm instruments for thoracoscopic sympathectomy because they make as the more cosmetic, less painful, and equally effective compared to thoracoscopic sympathectomy using 5 mm or greater instruments.