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Mitral Valvuloplasty using New Mitral Strip (Mitracon^{(R)}$) (새로운 Strip (Mitracon^{(R)}$)을 이용한 승모판막 성형술)

  • Kang, Seong-Sik;Kim, Sang-Pil;Song, Meong-Gum
    • Journal of Chest Surgery
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    • v.41 no.3
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    • pp.320-328
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    • 2008
  • Background: Numerous surgical devices for mitral repair have been used in the past with good results. In this study we describe a simple annuloplasty technique with using a new device ($Mitracon^{(R)}$). The aim of this study was to assess its efficacy and surgical results with using $Mitracon^{(R)}$. Material and Method: From May 2003 to October 2005, 46 patients (21 women and 25 men (mean age of $51.4{\pm}17.8$ years) with mitral regurgitation from various causes were treated with either the $Mitracon^{(R)}$ (the $Mitracon^{(R)}$ group) or the Capentier Edward rigid ring (the CE group). The median follow-up duration was 18.9 months. Result: The mean grade of mitral regurgitation before and immediately after surgery in the $Mitracon^{(R)}$ group and the CE group decreased from $3.2{\pm}0.8$ to $0.6{\pm}0.7$ and $3.4{\pm}0.7$ to $0.3{\pm}0.5$, respectively. There were no significant changes in the ejection fraction either between the two groups or before and immediately after surgery. No deaths were seen in either group. Early postoperative echocardiography of all 46 patients showed only trivial mitral regurgitation or none at all. Echocardiography at a median of 18.9 months also showed no progression in mitral regurgitation. The mean grade of mitral regurgitation in the $Mitracon^{(R)}$ group at this time point decreased from $3.2{\pm}0.8$ to $0.8{\pm}0.7$ (p<0.05). The CE group also showed a similar degree of decrease from $3.4{\pm}0.7$ to $0.3{\pm}0.6$ (p<0.05). The mitral valve area in the $Mitracon^{(R)}$ group at 1 year follow-up was $3.3{\pm}0.9cm^2$. The mitral valve area in the CE group was $2.7{\pm}0.6cm^2$. The mean mitral pressure gradient in the $Mitracon^{(R)}$ group at 1 year follow-up was $3.1{\pm}1.3$ mmHg. The mean pressure gradient in the CE group was $4.5{\pm}2.1$ mmHg, although any statistical significant difference for this between the groups was not reached. Conclusion: The present study showed the described technique to be safe and effective in the intermediate term. Because long term results are unavailable, a more extensive prospective randomized multicenter trial may be warranted to determine whether this procedure should be generally applied for repair of mitral valve disease.

The Status of North Korean Airspace after Reunification (북한 공역의 통일 후 지위)

  • Kwon, Chang-Young
    • The Korean Journal of Air & Space Law and Policy
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    • v.32 no.1
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    • pp.287-325
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    • 2017
  • Considering the development of aerospace, military science and technology since the 20th century, the sky is very important for the nation's existence and prosperity. The proverb "Whosoever commands the space commands the world itself!" emphasizes the need for the command of the air. This essay is the first study on the status of airspace after reunification. First, the territorial airspace is over the territory and territorial sea, and its horizontal extent is determined by the territorial boundary lines. Acceptance of the present order is most reasonable, rather than attempting to reconfigure through historical truths about border issues, and it could be supported by neighboring countries in the reunification period. For peace in Northeast Asia, the reunified Korea needs to respect the existing border agreement between North Korea and China or Russia. However, the North Korean straight baselines established in the East Sea and the Yellow Sea should be discarded because they are not available under United Nations Convention on the Law of the Sea. It is desirable for the reunified Korea to redefine the straight baselines that comply with international law and determine the territorial waters up to and including the 12-nautical mile outside it. Second, the Flight Information Region (hereinafter "FIR") is a region defined by the International Civil Aviation Organization (hereinafter "ICAO") in order to provide information necessary for the safe and efficient flight of aircraft and the search and rescue of aircraft. At present, Korea is divided into Incheon FIR which is under the jurisdiction of South Korea and Pyongyang FIR which is under the jurisdiction of North Korea. If North Korea can not temporarily exercise control of Pyongyang FIR due to a sudden change of circumstances, it is desirable for South Korea to exercise control of Pyongyang FIR, and if it is unavoidable, ICAO should temporarily exercise it. In reunified Korea, it is desirable to abolish Pyongyang FIR and integrate it into Incheon FIR with the approval of ICAO, considering systematic management and control of FIR, establishment of route, and efficiency of management. Third, the Air Defense Identification Zone (hereinafter "ADIZ") is a zone that requires easy identification, positioning, and control of aircraft for national security purposes, and is set up unilaterally by the country concerned. The US unilaterally established the Korea Air Defense Identification Area (KADIZ) by the Declaration of Commitment on March 22, 1951. The Ministry of Defense proclaimed a new KADIZ which extended to the area including IEODO on December 13, 2013. At present, North Korea's military warning zone is set only at maritime boundaries such as the East Sea and the Yellow Sea. But in view of its lack of function as ADIZ in relations with China and Russia, the reunified Korea has no obligation to succeed it. Since the depth of the Korean peninsula is short, it is necessary to set ADIZ boundary on the outskirts of the territorial airspace to achieve the original purpose of ADIZ. Therefore, KADIZ of the reunified Korea should be newly established by the boundary line that coincides with the Incheon FIR of the reunified Korea. However, if there is no buffer zone overlapping with or adjacent to the ADIZs of neighboring countries, military tensions may rise. Therefore, through bilateral negotiations for peace in Northeast Asia, a buffer zone is established between adjacent ADIZs.

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The Research on the Life-safety Implementation using the Natural Light LED Lamp in the Disaster Prevention and Safety Management (방재안전 자연광 LED 조명을 이용한 생활안전 개선에 관한 연구)

  • Lee, Taeshik;Seok, Gumcheul;So, Yooseb;Choi, Byungshik;Kim, Jaekwon;Cho, Woncheol
    • Journal of Korean Society of Disaster and Security
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    • v.9 no.2
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    • pp.53-62
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    • 2016
  • This paper is shown the new method using LED Light, which the light environment is upgraded the natural LED light in the area of Disaster Prevention and Safety Management (PDSD), which the events of deaths is reduced on the Suicide, the Infectious diseases, the safety accidents, the Traffic Accident, the crime, the fire, the Nature Disaster, and which the health and the environment and the safety is implemented using the value of the color LED Light. Research findings include,during 3 weeks in the November 2016, in the ten residents (average living 28.7 years, age 67.5 years) with depressive symptoms in the northern part of Seoul, according to the request of the user, the PDSD natural light LED lighting was installed in the home bedroom or the living room, expectations for the ability to restore physical and mental stability were high (88%), in the same way, after 1 week and 3 weeks, the physical and mental changes were compared and the results,84% in the first week and 90% in the third week and thereafter, the effect of relieving depression was high. We conclude that patients with depression have a good sleep, an uneasy feeling, a sense of security, a good night's sleep, and a good feeling. The PDSD LED Light is expected to contribute in the various areas, which reduced the suicides, which give increased immunity from infectious diseases, which give a crash to reduce accidents caused by negligence, which improve the safe operation of heavy vehicles in which a traffics accident incidence installed on the highest point, which improve the safety function on the 'safety way home' for the safety of the community, which due to fire gives alleviate the emotional anxiety of firefighters, which improve the environment for long-term control room working during decision making caused by natural disasters.

Trends and Prospects of N. Korea Military Provocations After the Sinking of ROKS Cheon-an (천안함 폭침 이후 북한의 군사도발 양상과 전망)

  • Kim, Sung-Man
    • Strategy21
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    • s.34
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    • pp.58-92
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    • 2014
  • Even after S. Korea took 5.24 Measure(24 May 2014), N. Korea has not stopped raising provocations such as the shelling of Yeonpyeong Island, electronic and cyber attacks. To make matters worse, the communist country lunched long-range missiles(twice) and conducted 3rd nuclear test, escalating tensions which could possibly lead to an all-out war. Korean Government failed to respond properly. However, escalation into an all-out war was deterred by the CFC immediately carrying out its peacetime duty(CODA). The US made a rapid dispatch of its augmentation forces(Aircraft carrier, nuclear-powered submarine, strategic bomber, F-22) to the Korean Peninsula. In recognition of the importance of the Combined Forces Command, since May 2013 the Park Geun-Hye Administration has been pushing ahead with re-postponement of Wartime Operational Control Transfer(which initially meant the disassembling of the CFC as of 1 December 2015) More recently, there has been a series of unusual indicators from the North. Judging from its inventory of 20 nuclear weapons, 1,000 ballistic missiles and biochemical weapons, it is safe to say that N. Korea has gained at least war deterrence against S. Korea. Normally a nation with nuclear weapons shrink its size of conventional forces, but the North is pursuing the opposite, rather increasing them. In addition, there was a change of war plan by N. Korea in 2010, changing 'Conquering the Korean Peninsula' to 'Negotiation after the seizure of the Greater Seoul Metropolitan Area(GSMA)' and establishing detailed plans for wartime projects. The change reflects the chain reaction in which requests from pro-north groups within the South will lead to the proclamation of war. Kim, Jeong-Un, leader of N. Korean regime, sent threatening messages using words such as 'exercising a nuclear preemptive strike right' and 'burning of Seoul'. Nam, Jae-June, Director of National Intelligence Service, stated that Kim, Jung-Un is throwing big talks, saying communization of the entire Korean Peninsula will come within the time frame of 3 years. Kim, Gwan-Jin, Defense Minister, shared an alarming message that there is a high possibility that the North will raise local provocations or a full-fledged war whenever while putting much emphasis on defense posture. As for the response concept of the Korean Government, it has been decided that 'ROK·US Combined Local Provocation Counter-Measure' will be adopted to act against local provocations from the North. Major provocation types include ▲ violation of the Northern Limit Line(NLL) with mobilization of military ships ▲ artillery provocations on Northwestern Islands ▲ low altitude airborne intrusion ▲ rear infiltration of SOF ▲ local conflicts within the Military Demarcation Line(MDL) ▲ attacking friendly ships by submarines. Counter-measures currently established by the US involves the support from USFK and USFJ. In order to keep the sworn promise, the US is reinforcing both USFK and USFJ. An all-out war situation will be met by 'CFC OPLAN5027' and 'Tailored Expansion Deterrence Forces' with the CFC playing a central role. The US augmentation forces stands at 690,000 troops, some 160 ships, 2,000 aircraft and this comprise 50% of US total forces, which is estimated to be ninefold of Korean forces. The CFC needs to be in center in handling both local provocations and an all-out war situation. However, the combat power of S. Korean conventional forces is approximately around 80% of that of N. Korea, which has been confirmed from comments made by Kim, Gwan-Jin, Defense Minister, during an interpellation session at the National Assembly. This means that S. Korean forces are not much growing. In particular, asymmetric capabilities of the North is posing a serious threat to the South including WMD, cyber warfare forces, SOF, forces targeting 5 Northwestern Islands, sub-surface and amphibious assault forces. The presence of such threats urgently requires immediate complementary efforts. For complementary efforts, the Korean Government should consider ① reinforcement of Korean forces; putting a stoppage to shrinking military, acquisition of adequate defense budget, building a missile defense and military leadership structure validity review, ② implementation of military tasks against the North; disciplinary measures on the sinking of ROKS Cheon-an/shelling of Yeonpyeong Islands, arrangement of inter-Korean military agreements, drawing lessons from studies on the correlation between aid for N. Korea, execution of inter-Korean Summit and provocations from the North, and ③ bolstering the ROK·US alliance; disregarding wartime operational control transfer plan(disassembling of CFC) and creation of a combined division.

Transition of Occupational Health Nursing Education in Korea (한국 산업간호교육의 변화추세 분석)

  • Cho, Tong Ran;June, Kyung Ja;Kim, So Yeon
    • Korean Journal of Occupational Health Nursing
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    • v.6 no.2
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    • pp.144-155
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    • 1997
  • In December 1990, Occupational Safety and Health Law was amended to reinforce employer's responsibilities on employees' health and safety. Among the amended law it was important to expand the role of an occupational health nurse to the role of an occupational health manager. An occupational health manager should take charge of coordinating periodic health examination and environmental hazard evaluation, providing primary care, monitoring employees' health status, giving the workplace walk-through, selecting safe protection equipment, providing health information, counseling and health education, independently. This position of occupational health nurse is equivalent to the role of doctors or occupational hygienists. In 1991, government made a master plan to prevent occupational disease and injury. Under the plan, Korea Industrial Nursing Association (KINA) was established in 1994 with the purpose of improving health services and upgrading career opportunities for members. Therefore, this study was designed to analyze the transition of occupational health nursing education with the changes of law and policy in Korea between 1991 and 1996. In details, it was to analyze the rate of school providing occupational health nursing practice based lecture, lecture hours, lecture contents in undergraduate curriculum, program contents of graduate school, kinds of continuing education, etc. For this purpose, we conducted survey two times. In February 1991, baseline study was conducted with all nursing programs in Korea (19 BSN programs and 43 nursing departments of junior college). From April to May in 1996, the second survey was conducted with all nursing programs (38 BSN programs and 69 junior colleges). The first response rate was 66.1% and the second was 40.6%. Structured questionnaires were mailed to the deans or the community health nursing faculties. In the case of graduate school, telephone survey was conducted with 10 school of public health or environmental health area. Data from the yearbook of Industrial Safety Training Institute (ISTI), the history of Korea Industrial Health Association, and the journals of KINA were also included in the analysis. As the results, we found that there were remarkable improvement in undergraduate and graduate programs, obligatory as well as voluntary continuing education in terms of occupational health nursing expertise between 1991 and 1996. 1) The number of school providing occupational health nursing practice-based lecture was increased with the rate from 7.3% to 25.6%. The rate of school giving over 15 class-hours was increased from 33.3% to 46.6%. 2) Content areas were composed of introduction of occupational health, occupational epidemiology, industrial hygiene, occupational disease and injury, law and policy, health education, concept of occupational health nursing, role of occupational health nurse, occupational health nursing process, etc. Of content areas, occupational health nursing process was more emphasized with the increased rate from 43.9% to 88.4%. 3) In the case of graduate school, occupational health programs were increased from 4 to 10. One of them has developed occupational health nursing program as an independent course since 1991. 4) The law increased educational hours from 28 hours to 36 hours for introductory course at the time of appointment, and from 14 hours to 24 hours every 2 years for continuing education. Course contents were Occupational safety and health law, introduction of occupational health, health education methodology, planning and evaluation, periodic health exam, occupational disease care, primary care, emergency care, management, industrial environment evaluation, etc. In 1996, Korea Industrial Nursing Association has begun to provide continuing education after Industrial Safety Training Institute. 5) Various educational programs in voluntary base were developed such as monthly seminar, CE articles, annual academic symposium, etc. It was shown that changes of law and policy led rapid growth of occupational health nursing education in various levels. From this trend, it is expected that occupational health nurse expertise be continuously to be enhanced in Korea. Legal and political supports should proceed for the development of occupational health nursing in early stage.

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Current Situation and Development Strategy for the Korea-Good Agricultural Practices System (농산물우수관리제도의 현황과 발전방안)

  • Yoon, Deok-Hoon
    • Journal of Food Hygiene and Safety
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    • v.33 no.1
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    • pp.1-11
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    • 2018
  • It is ten years since the Good Agricultural Practices (GAP) certification system was implemented in Korea, and the government aims to acquire GAP certification up to 25% of the total agricultural areas by 2022. As of the end of 2017, 6.3% of the total cultivated area and 8.1% of the total farm households were certified, which is slower than expected. The purpose of this study was to investigate the causes of the GAP accreditation through the surveys and on site inspections of the GAP certified farmers and to propose the development plans according to the problems analysis of the current system in order to expand the GAP certification. Certified farmers recognized the need for agricultural safety and hygiene, but there were a lot of nonconformities regarding practical practices. This is due to the ambiguity of the certification standards and the wrong ways in the training method for the producers. GAP certification is slow to expand to farmers and low consumer awareness is considered a structural problem of GAP certification system, and improvement measures are needed accordingly. It is necessary to convert the state-led GAP certification system into a state-led private certification system. It is necessary for the government to focus on policy, research and follow-up management. In addition, it is necessary to establish a separate organization in the form of a contribution organization for the certification, education, and public relations. In addition, long-term plan must be established and systematically carried out. It is necessary to integrate too many certification agencies compared to the farming scale of Korea, and it is necessary to realize the application fee for realizing the financial independence of the certification body and correct certification work. In addition, inspector qualification standards should be strengthened and training system should be improved to nurture high quality inspectors. Simplified certification standards based on statutes need to be subdivided into practical action plans. In order to improve the GAP certification system, it is necessary to have a discussion through a committee composed of specialists from industry and academia, and it will be possible to contribute to the safety of the food of the people through the production of safe by drawing concrete development plans.

A Study on Piracy Matters and Introduction of the Privately Contracted Armed Security Personnel on Board Ships (해적사건 대응을 위한 무장경비원제도 도입방안에 관한 연구)

  • Roh, Ho-Rae
    • Korean Security Journal
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    • no.41
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    • pp.293-326
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    • 2014
  • Piracy is a worldwide issue, but the deteriorating security situation in the seas off Somalia, the Gulf of Aden and the wider Western Indian Ocean between 2005 and 2012 and in the increasing number of attacks in the Gulf of Guinea are a major problem. The depth of concern for the problem internationally is amply demonstrated by the levels of co-operation and coordination among naval and other forces from several countries that have assembled in the west Indian Ocean region and the Gulf of Aden to escort ships carrying humanitarian aid to Somalia and to protect vulnerable shipping. Notwithstanding this unprecedented effort, the vast sea area in which the pirates now operate makes it difficult to patrol and monitor effectively, particularly with the limited resources available. More resources, in the form of naval vessels and aircraft, are needed and at every opportunity the IMO encourages Member Governments to make greater efforts to provide the additional naval, aerial surveillance and other resources needed through every means possible. IMO provide interim guidance and recommendations to be taken into account when considering the use of PCASP(privately contracted armed security personnel) if and when a flag State determines that such a measure would be lawful and, following a full risk assessment, appropriate. The interim guidance and recommendations of IMO are not intended to endorse or institutionalize the use of armed guards. Therefore, they do not represent any fundamental change of policy by the Organization in this regard. It is for each flag State, individually, to decide whether or not PCASP should be authorized for use on board ships flying their flag. If a flag State decides to permit this practice, it is up to that State to determine the conditions under which authorization will be granted. Therefore, Korea should be introduced rationally PCASP for safe shipping. PCASP on board ships is much the same to special guard personnel of security services industry act. Act plan of Oceans and fisheries ministry on PCASP collides with special guard personnel system of National Police Agency. Rather than new law making, PCASP regukations have to be included in security services industry act. Management Agency of PCASP is to not Oceans and fisheries ministry, but Central Headquarters Korea Coast Guard of Public Safety and Security Ministry because of specialty and closely connection.

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Clinical Analysis of Mitral Valve Repair with Artificial Chordae (인공 건삭을 이용한 승모판성형술의 임상적 고찰)

  • 이석기;김정중;오삼세;백만종;나찬영;김욱성
    • Journal of Chest Surgery
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    • v.37 no.9
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    • pp.768-773
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    • 2004
  • Failure of mitral valve repair sometimes may be ascribed to severe or progressive alteration of the subvalvar apparatus. The aim of this study was to evaluate the effects of new chordae formation on mitral repair. Material and Method: From March 1997 to february 1999, 26 patients underwent mitral valve repairs with new chordae formation, we compared the symptoms and echocardiographic findings checked at preoperative state, and intraoperative period, discharge, and their last OPD visit. There were 45 male, and 11 female patients, and their mean age was 51.2$\pm$43.4 years. Etiology of the lesions was degenerative (18), rheumatic (6), infective (1) and ischemic (1). Chordal lesions were caused by rupture (18), elongation (6), and a combination of two causes (2). Associated lesions included atrial septal defect (2), tricuspid insufficiency (7), aortic insufficiency(4), and a combination of previous two factors (2). The number of mean artificial chordae was 3.6$\pm$1.6. Annuloplasty was per-formed in all cases. The CPB time was 182,1$\pm$63.7 minutes and the ACC time was 133.1$\pm$45.6 minutes. Aver-age follow up period was 49.2$\pm$7.1 months. Result: There was no early death. Early reoperation was performed in bud patients, one patient received mitral valve replacement because of an abnormality of annuloplasty and ano-ther received pericardiostomy due to postoperative pericardial effusion. During the follow up of 49.2$\pm$7.1 moths, there was no late mortality. Postoperative NYHA functional class checked at last OPD visit was class I in 22 patients (88%), class II in 2 (8%), and class III in 1 (4%). Regarding the late echocardiogram MR was absent in 20 patients (78%), 1 in 4 (15%), and II in 1 (4%). The postrepair mitral valve area was 2.2$\pm$0.35 $\textrm{cm}^2$ Conclusion: This study suggests that mitral valve repair using new chordae formation provides good early and mid term survivals and functional improvement. We think that the artificial chorda formation with polytetrafluoroethylene suture might be safe and effective technique for mitral valve repair.

Access Restriction by Packet Capturing during the Internet based Class (인터넷을 이용한 수업에서 패킷캡쳐를 통한 사이트 접속 제한)

  • Yi, Jungcheol;Lee, Yong-Jin
    • 대한공업교육학회지
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    • v.32 no.1
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    • pp.134-152
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    • 2007
  • This study deals with the development of computer program which can restrict students to access to the unallowable web sites during the Internet based class. Our suggested program can find the student's access list to the unallowable sites, display it on the teacher's computer screen. Through the limitation of the student's access, teacher can enhance the efficiency of class and fulfill his educational purpose for the class. The use of our results leads to the effective and safe utilization of the Internet as the teaching tools in the class. Meanwhile, the typical method is to turn off the LAN (Local Area Network) power in order to limit the student's access to the unallowable web sites. Our program has been developed on the Linux operating systems in the small network environment. The program includes following five functions: the translation function to change the domain name into the IP(Internet Protocol) address, the search function to find the active students' computers, the packet snoop to capture the ongoing packets and investigate their contents, the comparison function to compare the captured packet contents with the predefined access restriction IP address list, and the restriction function to limit the network access when the destination IP address is equal to the IP address in the access restriction list. Our program can capture all passing packets through the computer laboratory in real time and exactly. In addition, it provides teacher's computer screen with the all relation information of students' access to the unallowable sites. Thus, teacher can limit the student's unallowable access immediately. The proposed program can be applied to the small network of the elementary, junior and senior high school. Our research results make a contribution toward the effective class management and the efficient computer laboratory management. The related researches provides teacher with the packet observation and the access limitation for only one host, but our suggested program provides teacher with those for all active hosts.

Long Term Outcome of Endoscopically Clipping the Upper Part of R4 Sympathetic Block and R4 Sympathetic Block for the Treatment of Palmar Hyperhidrosis (수장부 다한증에서 Clipping에 의한 흉부4번 교감신경절 상부 차단술과 흉부4번 교감신경절 완전 차단술에 대한 장기성적 비교)

  • Choi, Bong-Chun;Kim, Yong-Han;Sa, Young-Jo;Park, Jae-Kil;Lee, Sun-Hee;Sim, Sung-Bo
    • Journal of Chest Surgery
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    • v.40 no.11
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    • pp.752-758
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    • 2007
  • Background: Thoracic sympathetic block surgery is a safe and effective procedure for palmar hyperhydrosis, and this maintains sufficient moisture and prevents compensatory hyperhidrosis. To avoid compensatory hyperhidrosis, the authors performed sympathetic block surgery just above the R4 level to maintain sympathetic tone affecting the caudal area. Material and Method: A total of 71 subjects (45 males and 26 females) were categorized into two groups. Group 1 (31 patients, mean age: 25.5 years) had clips placed both on the upper and lower part of R4 sympathetic ganglion, and group 2 (40 patients, mean age: 25.9 years) underwent clipping of the upper part of R4. Telephone surveys were done to collect data on 8 categories, and the average follow up interval was 24.9 months (group 1) and 18.9 months (group 2). Result: For group 1, 41.9% experienced no sweating and 48.4% re-plied they experienced some sweating depending on the surrounding conditions. Group 2 showed that 60% experienced no sweating and 35% replied they experienced some sweating depending on the surrounding conditions, 58.1% in group 1 experienced sweating right after the surgery, and 40.0% in group 2 experienced the same. Group 1 (38.1%) and group 2 (37.5%) replied they experienced no hand dryness and more patients in group 2 than in group 1 had hand dryness, but without uncomfortable symptoms. 71.0% (group 1) and 62.5% (group 2) replied they had no compensatory hyperhidrosis or related symptoms. One patient in group 1 and two in group 2 reported they regretted undergoing the procedure. The regions of compensatory hyperhidrosis were the back, thigh and chest in group 1 and the group 2 reported the back, chest, and abdomen in the order of frequency. Fewer incidences of the gustatory hyperhidrosis were noted in group 2. Most of the patients were satisfied with their treatment. Conclusion: Clipping the upper part of the R4 ganglion or R4 sympathetic block are both effective for treating palmar hyperhidrosis and these treatments decrease the occurrence or symptoms of compensatory hyperhidrosis. The upper R4 sympathetic block procedure is easier and safer with fewer incidences of gustatory hyperhidrosis and a higher percentage of patient satisfaction.