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.
Autonomic Nerve Block ; Ganglia, Sympathetic ; Hand ; Humans ; Hyperhidrosis* ; Interviews as Topic ; Neurons ; Postoperative Complications ; Surveys and Questionnaires ; Recurrence ; Ribs ; Sweat ; Sweating ; Sympathectomy

PURPOSE: To evaluate the relationship between postoperative optical coherence tomography (OCT) findings and visual acuity in patients who underwent vitrectomy for macular hemorrhage related to the rupture of a retinal artery macroaneurysm. METHODS: A retrospective case review was conducted for patients who underwent vitrectomy for macular hemorrhage caused by a retinal arterial macroaneurysm. The relationship between postoperative OCT findings and visual acuity was analyzed. RESULTS: This study included 12 patients whose preoperative mean best corrected visual acuity (BCVA) (logMAR) was 1.7+/-0.8 and whose mean final BCVA was 0.6+/-0.5. These values were statistically different (p=0.004). Mean foveal thickness by OCT was 437.5+/-161.5 micrometer at the preoperative period and 252.8+/-84.9 micrometer three months postoperative, and this difference was statistically significant (p=0.017). As the foveal thickness decreased after removal of the remnant organized retinal hemorrhage in the postoperative period, BCVA improved at the final follow-up (p=0.048). According to the postoperative OCT, the photoreceptor disruption group presented a lower BCVA than that of the photoreceptor preservation group at the final follow-up (logMAR: 1.4+/-0.4 vs. 0.3+/-0.2, p=0.009). CONCLUSIONS: Photoreceptor preservation as observed by OCT was significantly associated with better visual outcome after vitrectomy in patients with macular hemorrhage caused by rupture of a retinal arterial macroaneurysm.
Follow-Up Studies ; Hemorrhage ; Humans ; Postoperative Period ; Preoperative Period ; Retinal Artery ; Retinal Hemorrhage ; Retinaldehyde ; Retrospective Studies ; Rupture ; Tomography, Optical Coherence ; Visual Acuity ; Vitrectomy

PURPOSE: The purpose of this study is to correlate the MR findings with clinical stage and clinical outcome, and to describe the evolutional changes of abnormal MR findings of transverse myelitis. MATERIALS AND METHODS: Medical records and spinal MR images of 23 patients with both clinical and radiological diagnosis of transverse myelitis were retrospectively reviewed. MR findings were correlated with clinical stages including interval between MR imaging and full development of clinical symptoms, and compared with the clinical outcome. RESULTS: Diffuse high signal intensity of the spinal cord on T2-weighted image with mild cord bulging (67%) and focal contrast enhancement of the cord (75%) were observed within the first four weeks after full development of clinical symptoms. The findings decreased in extent or vanished later than four weeks on either initial or follow-up MR images. Most patients with either cord atrophy or focal hemorrhagewithin the cord lesion had poor clinical outcome. CONCLUSION: The MR findings of transverse myelitis are nonspecific, which may be seen in a variety of diseases. Serial MRIs, especially follow up examination over at least one month after full development of clinical symptoms are useful in the diagnosis of transverse myelitis and predicting its prognosis.
Atrophy ; Diagnosis ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Medical Records ; Myelitis, Transverse* ; Prognosis ; Retrospective Studies ; Spinal Cord

We performed surgical treatment in 18 cases of torsion of the spermatic cord during the past four years. Patient age ranged from 2 to 54 years old : 13 cases were 16 or less. Torsion involved the left side in 11 cases. Surgical detorsion was performed in 10 cases, but in the other 8 cases orchiectomy was unavoidable. Of 8 cases treated with orchiectomy, the diagnosis was delayed in 7 cases due to mistaken diagnosis, primarily epididymitis by doctors in local clinics and general hospitals. The time of delay in the orchiectomy group ranged from 54 hours to 2 weeks with the average of 6.28 days. For one case, the visit to our hospital was too late. In 10 cases treated with surgical detorsion, all of the patients visited our hospital within 48 hours. Improvement of the testis salvage rate requires that adolescents, their families and teachers should learn to recognize this disease, and particularly doctors of other departments should recognize it as acute scrotum.
Adolescent ; Diagnosis ; Epididymitis ; Hospitals, General ; Humans ; Male ; Middle Aged ; Orchiectomy ; Scrotum ; Spermatic Cord Torsion ; Spermatic Cord* ; Testis

PURPOSE: The purpose of this study was to evaluate the visual outcomes and complications of unilateral scleral fixation of posterior chamber intraocular lenses (SF-PCIOLs) in pediatric complicated traumatic cataracts without capsular support. METHODS: This study involved five eyes of five children who underwent unilateral SF-PCIOL. All patients had a unilateral complicated traumatic cataract associated with anterior or posterior segment injury. Visual acuity (VA), IOL position, and postoperative complications were assessed during follow-up. RESULTS: The mean age of patients at the time of SF-PCIOL was 90 months (range, 66-115). The mean duration of follow-up time after surgery was 22 months (range, 5-55). In all patients, the best-corrected VA was either improved or was stable at last follow-up following SF-PCIOL implantation. There were no serious complications. CONCLUSIONS: Unilateral scleral fixation of PCIOL can be a safe and effective procedure for pediatric, unilateral, complicated traumatic cataracts without capsular support in selected cases.
Anterior Eye Segment/injuries ; Aphakia, Postcataract/*surgery ; Cataract/*etiology/physiopathology ; Child ; Child, Preschool ; Endophthalmitis/etiology ; Eye Injuries/*complications ; Female ; Follow-Up Studies ; Humans ; Lens Implantation, Intraocular/*methods ; Male ; Postoperative Period ; Retrospective Studies ; Sclera/*surgery ; *Suture Techniques ; Visual Acuity

No abstract available.
Incontinentia Pigmenti*

There was no significant difference in morbidity and mortality between those that received simultaneous operation for coronary artery disease and peripheral vascular disease versus those that received coronary artery bypass graft alone. Simultaneous operation is also cost effective. A 46 year-old patient with resting chest pain and intermittent claudication was diagnosed as unstable angina and Leriche's syndrome. We performed simultaneous revascularization for coronary artery stenosis with internal mammary artery and right gastroepiploic artery and a bifurcated vascular graft interposition between in the aorta, left common iliac and right femoral arteries for Leriche's syndrome. The postoperative coronary angiogram and aortogram revealed a good patency of the arterial conduits and vascular graft. He has been followed for 12 months without any problem.
Angina, Unstable ; Aorta ; Chest Pain ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Stenosis* ; Coronary Vessels* ; Femoral Artery ; Gastroepiploic Artery ; Humans ; Intermittent Claudication ; Leriche Syndrome ; Mammary Arteries ; Middle Aged ; Mortality ; Peripheral Vascular Diseases* ; Transplants

Cushing's syndrome associated with nodular adrenal glands will be divided into four main categories: adrenal adenoma, adrenal carcinoma, primary pigmented nodular adrenal dysplasia (PPNAD) and macronodular adrenal hyperplasia(MAH). The term macronodular adrenal hyperplasia is restricted to the presence of multiple nodules visible to the naked eye, ranging in size from 0.5 to 7.0 cm. We report a case of Cushings syndrome caused by bilateral macronodular adrenal hyperplasia (MAH). A 45-year-old man presented with Cushingoid features, hypertension and diabetes mellitus. Urine free cortisol was 449.9 mmol/day(27-276) and were not suppressed after administration of low-dose and high-dose dexamethasone. Plasma ACTH was very low(1.87 pmol/L(18)) and was not stimulated by administration of ovine CRH. In abdominal CT, both adrenal glands were markedly enlarged and nodular in appearance. Pituitary MRI showed no abnormal finding. Bilateral adrenalectomy was done. Histologic examination revealed multiple nodules and internodular hyperplasia. This case and other reports suggested that because of variable biochemical, radiologic and pathologic findings, macronodular adrenal hyperplasia represents a heterogeneous group of patients with varying degrees of adrenal autonomy.
Adenoma ; Adrenal Glands ; Adrenalectomy ; Adrenocorticotropic Hormone ; Cushing Syndrome ; Dexamethasone ; Diabetes Mellitus ; Humans ; Hydrocortisone ; Hyperplasia ; Hypertension ; Magnetic Resonance Imaging ; Middle Aged ; Plasma ; Tomography, X-Ray Computed

Carcinoma of the parathyroid gland is rare, comprising only 0.1% to 5% of all patients with primary hyperparathyroidism. It presents with severe hypercalcemia, bone disease, palpable neck mass, renal involvement and etc. Since the initial operation offers the best chance for cure, preoperative localization and intraoperative recognition of parathyroid cancer are essential. Recently parathyroid imaging has been described with 99mTc-sestamibi as an alternative to 201Tl. This newer agent has many physical and dosirnetric advantages and represents higher detection sensitivity than 201Tl-99mTc subtraction scan. We experienced a 41-year-old man presenting with recurrent hyperparathyroidism in spite of 2 previous operations. In preoperative localization, there was no abnormal uptake in 201Tl-99mTc subtraction scan but 99mTc-sestamibi scan revealed metastatic foci on right cervical area. He was successfully treated with modified radical neck dissection.
Adult ; Bone Diseases ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Neck ; Neck Dissection ; Parathyroid Glands ; Parathyroid Neoplasms* ; Technetium Tc 99m Sestamibi*

Background: Whole body scan using 131-iodine is performed to detect local recurrence or metastasis after thyroidectorny in differenciated thyroid cancer patients. The sensitivity of this procedure is related to the dose of radiopharmaceutical administered. It was reported that 131I posttreatment whole body scan demonstrate foci of tracer uptake not previously observed in diagnostic scan in 10~30% of cases. Posttreatment scans were most likely to reveal new foci in young patients(<45) and patients who had previously received radioactive iodine therapy. Method: We observed the frequency of discordant posttreatment scans and analysed the clicnical significance in 33 differenciated thyroid cancer patients who were admitted for radioiodine ablation from June, 1995 to April, 1996. Results: In 7 cases(21.2%), post treatment scan demonstrated cme or more foci of uptake and revealed less sites of uptake than diagnostic scan in 3 cases(9.1%). In one case with elevated thyroglobulin level and negative diagnostic scan, post treatment scan revealed new uptake sites with thyroid bed and cervical 1ymph node. The sites of discordant uptake were cervical lymph nodes in 4 cases and rnediastinal lymph node in one case, lung in one case, thyroid bed and cervical lymph nodes in one case, 3 cases of 7 pts(43%), demonstrated ane or more foci of uptake in post treatment scan, had history of previous radioiodine treatent. Conclusion: Post treatment scan confirmed uptake into remnant and metaststic tissues identified on the corresponding low dose diagnostic scans. Scanning after high dose radioiodine treatment frequently demonstrated one or more foci of uptake, especially in patients with previous radioiodine treatment, which were not visualized on the diagnostic low dose scan. Treatment scan may be useful for detection of remnant tissue or metastatic lesion in patients with elevated thyroglobulin and negative diagnostic scan.
Humans ; Iodine ; Lung ; Lymph Nodes ; Methods ; Neoplasm Metastasis ; Recurrence ; Thyroglobulin ; Thyroid Gland ; Thyroid Neoplasms ; Whole Body Imaging