• The Korean Journal of Pain
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• v.26 no.1
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• pp.89-93
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• 2013

Compensatory hyperhidrosis or reflex hyperhidrosis is the increase in sweating in the postoperative stage of thoracic sympathectomy or lumbar sympathectomy. It shares several features with anxiety disorders and has a negative impact on a patient's quality of life. Oralglycopyrrolate is one of the treatment options available. This study reviewed case notes in a series of 19 patients with compensatory hyperhidrosis. We made a comparison between the Milanez de Campos score of a pre-glycopyrrolate medication group and the Milanez de Campos score of a post-glycopyrrolate medication group. The Beck Depression Inventory (BDI) score, Beck Anxiety Inventory (BAI) score, and autonomic nervous system (ANS) scale score were also compared between the pre-medication and post-medication groups. In the post-glycopyrrolate medication group, there was decrease in the Milanez de Campos score, BAI score, and BDI score (P < 0.05). But no meaningful change was seen in the ANS score in the post-glycopyrrolate medication group (P > 0.05). Glycopyrrolate is an effective medication in the treatment of compensatory hyperhidrosis that, can alleviate anxiety and improve patients' quality of life.

• The Korean Journal of Pain
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• v.27 no.1
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• pp.68-71
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• 2014

The occurrence of CRPS after a snake bite was very rare, only two cases were reported worldwide. Here we report a case that the 44-year-old female patient bitten by snakes CRPS type 1 was treated consecutive intravenous regional block, lumbar sympathectomy and antiepileptic drug therapy, also discuss the possible pathophysiology.

• Journal of Chest Surgery
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• v.6 no.2
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• pp.213-218
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• 1973

Raynaud attempted to clarify the situation concerning symmetrical and spontaneous gangrene in a thesis published in 1952. The disease was defined as Raynaud`s phenomenon without associated and contributing conditions or disease, and described as two types, such as, `locale syncope and asphyxia` and `gangrene`. Predilection of Raynaud`s disease for female under 40 years of age wi-thout any vascular occlusive disease beginning in the early decades of life and typical color changes in the skin of the extremities incited by coldness are outstanding features in this disease. One typical case of Raynaud`s disease is presented with relating references. Patient was 24 year old female single patient, who noted pain, numbness, and cyanosis of the finger tips of both hands for 6 years previously in the winter season, and recently such symptoms were aggravated including her both feet for two years even in the summer after exposure to cold water. Physical and laboratory examination revealed nothing specific except slightly glistening tight face and hypertrophy of both finger tips with clammy coldness. FamiliaI and past history revealed nothing specific abnormal contributory factors. Biopsy of skin on the dorsum of right foot one year before this admission revealed no evidence of scleroderma. Treatment was aimed to relieve vasospasmodic reaction to coldness and was very successful with bilateral lumbar and thoracic sympathectomy. Patient is free of symptoms relating to the Raynaud’s phenomenon after sympathectomy for 6 months including winter season.

• Journal of Chest Surgery
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• v.23 no.2
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• pp.333-341
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• 1990

aortoiliac pattern, Group II; femoropopliteal pattern and Group g; tibioperoneal pattern. A majority of patients belonged to group I [27 cases], 8 patients came under group II .and none in group g. Thirty patients underwent bypass operation with autogenous saphenous vein or synthetic graft with or without concomitant lumbar sympathectomy. Remaining 5 patients were operated on with sympathectomy only, Bypass procedures were anatomic bypass in 22 cases: aortoiliac artery bypass in 11 cases, femoropopliteal artery bypass in 10 cases, sequential femoropopliteal artery bypass in one case and extra-anatomic bypass in 8 cases, axillary-bifemoral artery bypass in one case and femorofemoral artery bypass in 7 cases. Postoperative complications which mainly composed of superficial wound infection[5 cases] which were treated without any significant sequel in all cases and thrombosis[2 cases]. Three patients died whose causes of death were acute renal failure in 2 cases and myocardial infarction in other, The overall patency, rate was 70Zo in 5 years. In conclusion, the clinical pattern and operative outcome were similar to he western pattern and all cases of death did not related to operative procedures and ischemic symptoms were relieved by bypass operations except several cases. I think and recommend that all patients suffering chronic arterial insufficiency by atherosclerosis obliterans ought to be managed with urgent and adequate operative procedure.

• Journal of Chest Surgery
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• v.20 no.2
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• pp.261-269
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• 1987

From 1976 through 1986, authors have experienced 127 cases of peripheral vascular surgery which had been done in this department. There were 29 cases of atherosclerosis obliterances including 7 Leriche syndrome, 32 Buerger`s diseases, 25 arterial thromboembolisms, 21 vascular injuries, 2 peripheral arterial aneurysms, 2 renovascular hypertensions, 1 congenital A-V malformation, 13 varicose vein of lower extremities, and 2 Jugular venous ectasia. Cases with vena caval disease and aortic disease were excluded. The mean age of ASO and Buerger`s disease was 56.1 yrs, 33.8 yrs respectively. The male to female ratio showed marked male preponderance [27:2, and 30:2], and almost every male patient was smoker. The indication of operation was similar in both disease entities. The method of operation for ASO were bypass procedure [17], thromboendarterectomy [6], and lumbar sympathectomy [5], and for Buerger`s disease were mainly sympathectomy and few bypass procedures and amputations. Seventeen patients with ASO were followed from 3 to 75 month and overall patency rate for bypass or endarterectomy in one and two months and 2 1/2 yr were 93%, 87%, and 31% respectively. Post operatively patient`s symptoms was relieved or alleviated in almost ASO patients, and about 60% of Buerger`s disease. We concluded that in patient with ischemic limb, we must revascularized aggressively for symptomatic relief. And choice of graft for bypass procedure was to be evaluated further.

• Journal of Chest Surgery
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• v.35 no.4
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• pp.283-289
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• 2002

Backgrouds: It is almost universally accepted that occlusive vascular diseases are best managed by anatomical reconstruction. However, the mortality and the morbidity have limited this operation for patients with high operation risks. In these patients, palliative operations such as extra-anatomic bypass and lumbar sympathectomy, are accepted as useful treatment. Material and Method: A retrospective study was conducted in 38 patients who underwent palliative operations for occlusive vascular disease at Korea University Guro Hospital between 1996 and 2000. Mean age of the patients was 60.37 $\pm$ 17.65 years, and preoperative diagnoses were atherosclerosis in 32 patients, Buerger's disease in 4 patients, Raynaud's syndrome in 1 patient and SVC syndrome in 1 patient. Result: Extra-anatomic bypass(40procedures), lumbar sympathectomy(17), thromboembolectomy(7) and femoral artery graft interposition(1) were performed. Six patients were required reoperation due to graft flow failure or fistula. Three year primary patency rate of entire operations was 78.29 $\pm$ 8.81%, and the correlation between type of operation and patency rate was not statistically significant. Conclusion: Palliative operations for occlusive vascular disease are useful treatment in limited patients with high operation risks or limited life expectancy.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.86-88
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• 1997

Regional sympathetic blockade is the most effective treatment for reflex sympathetic dystrophy (RSD). Radiofrequency thermocoagulation provides longer duration of pain relief than local anesthetics and less complication than chemical neurolytic agents for lumbar sympathectomy. Spinal cord stimulation (SCS) is thought to be an effective modality yieding good results in treating intractable neuropathic pain. Therefore RSD might be a good indication for SCS. We treated a patient with RSD who responded well to lumbar sympathetic blockade (LSB) with radiofrequency thermocoagulation and SCS. The patient had a left ankle sprain requiring a case for the lower leg for 2 weeks. The patient suffered increasing pain and swelling on the lower part of that leg. We thought to block the lumbar sympathetic chain utillzing radiofrequency thermocoagulation 2 days after LSB with local anesthetics. The results provided accepatable pain relief (VAS $8{\rightarrow}15$) but the patient still could not walk due to remaining pain which was further aggravated by walking. After SCS, pain relief improved (VAS $5{\rightarrow}13$) and patient could walk without assistance.

• Journal of Chest Surgery
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• v.38 no.2 s.247
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• pp.152-156
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• 2005

Background: Occlusive complications after arterial revascularization are difficult to treat and have high recurrence rate. This study was performed to establish an effective treatment modality and to evaluate the factors affecting the occlusive complications by analysis of clinical data. Material and Method: During the period of 5 years. 33 patients (55 reoperations) were studied at the Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital following 173 arterial revascularization surgeries. The clinical characteristics, operating methods, the time intervals of reoperation, used graft, and the results of treatment were evaluated retrospectively. Result: All the patients were men except one and the mean age was 63.5 years old. The mean time internal from first operation to reoperation was 11.9 months. The cause of arterial occlusive diseases were 28 atherosclerosis and 5 Burger's diseases, Associated diseases were Hypertension $(57.6\%)$, Diabetes mellitus $(33.3\%)$, heart failure $(18.2\%)$, and so on. The mean rate of reoperation was 1.67 times and the most common type of first operation was femoro-popliteal bypass grafting $(57.6\%)$. The graft that used revascularization surgery were 25 cases of PTFE and 6 case were Dacron. There was no statistical difference between two groups. The kinds of reoperations were thrombectomy in 20 cases, angioplasty 18 cases, re-bypass surgery in 13 cases, and lumbar sympathectomy in 4 cases. The results of reoperation were 15 cases of functional recovery, 7 cases of limb salvage, 5 cases of above-knee amputation. 3 cases of below-knee amputation and 3 deaths. Conclusion: The main cause of occlusive complications are occlusion of inflow or outflow artery. Treatments were different according to the first operation methods and graft used. The most frequent time of reoperation was within one year after the first operation. We believe that graft surveillance especially during the first year is very important factor in observing the patient. We can look forward to improving limb salvage rate to perform additional treatment such as radiological interventions and lumbar sympathectomy.