BACKGROUND: Palmar and axillary hyperhidrosis causes important consequences to the social and professional life of the affected patient. Endoscopic thoracic sympathectomy is considered the treatment of choice, because it causes minimal morbidity and high initial success rates. Therefore we used a single-site access technique for primary hyperhidrosis patients. METHOD: The operation was done under general anesthesia with the patient in a half-sitting position. Through an incision made along the line between lateral 1/3 portion of the clavicle and ipsilateral nipple, a Verres needle was introduced below the second rib. About 1.5L of CO2 was insufflated into the pleural cavity. The needle was changed to a 5 mm trochar through which the electroresectoscope was introduced. The heads of the upper 2nd-4th ribs were identified and the sympathetic chain could be seen through the pleura riding over the ribs close to the costovertebral junction. The 2nd-4th ganglia were coagulated and divided down to the periosteum. Finally the lung was expanded by limiting flow until the airway pressure reach 30~40 cmH2O. The wound was closed after the removal of electroresectoscope. The procedure was then repeated on the opposite side. RESULT: There were no postoperative mortality and major complications requring surgical reintervention. The preoperatively wet and cold hands had became warm and dry immediately after operation. All patients were very satisfied. CONCLUSION: Endoscopic thoracic sympathetic ganglion cauterization is a minimally invasive and highly successful treatment for the patients with primary hyperhidrosis.
Anesthesia, General ; Cautery* ; Clavicle ; Ganglia ; Ganglia, Sympathetic* ; Hand ; Head ; Humans ; Hyperhidrosis* ; Lung ; Mortality ; Needles ; Nipples ; Periosteum ; Pleura ; Pleural Cavity ; Ribs ; Sympathectomy ; Wounds and Injuries

No abstract available.
Animals ; Dogs* ; Lactic Acid*

No abstract available.
Animals ; Calcium Channels* ; Calcium* ; Rats*

No abstract available.
Catheterization* ; Catheters* ; Hemothorax* ; Subclavian Vein*

No abstract available.
Coronary Vessels*

No abstract available.
Pain, Postoperative*

Total surgical corrections of complicated heart defects with the aid of moderate hypothermic and extracorporeal circulation in conjunction with light general anesthesia were undertaken since 1963 in Yonsei Medical Center. In order to determine the better hypothermic technique, 39 cases were divided into 2 groups. While in group 1 we performed the cardio-pulmonary by-pass with heat exchanger using only core cooling techniques, in group 2 we used combined surface and core cooling techniques. The results obtained are summerized as follows; 1. Mean rectal temperatures just before by-pass in group 1 and 2 were 36. 5 and 33. 5C respectively and a moderate hypothermic state after by-pass was obtained about 15 minutes earlier in group 2 than in group 1. 2. Mean arterial pressures during by-pass in group 1 were higher than in group 2. Therefore chlorpromazine was required more often in group l. 3. Arterial oxygen and carbon dioxide tensions (uncorrected) were maintained with about 100-300 and 32-40 mmHg during by-pass in both groups. 4. Arterial pH and base excess in group 1 during by-pass were lower than in group 2, therefore sodium bicarbonate injections were required more often in group 1 . The incidence of use of the electrical defibrillator attle and of the main surgical procedure was higher in group 1. There were 5 post-operative intrapericardial bleeding cases in group 1 and 2 cases in group 2. There was 1 post-operative mortality case in each group. From the above results, it may be concluded that combined and surface and core cooling in conjunction with light general anesthesia, proved to be the better method to provide optimal working conditions for the surgeon.
Anesthesia, General ; Arterial Pressure ; Carbon Dioxide ; Chlorpromazine ; Clinical Study* ; Defibrillators ; Extracorporeal Circulation ; Heart* ; Hemorrhage ; Hot Temperature ; Hydrogen-Ion Concentration ; Incidence ; Methods ; Mortality ; Oxygen ; Sodium Bicarbonate ; Thoracic Surgery*

Anesthesia, General*

It is rare to meet an uncontrolled hyperthyroid patient in elective surgery. But, in emergency surgery, recognition of hyperthyroidism may be difficult, as trauma or pain may mask hyperthyroidism. The patient may be unaware of its existence or incapable of transmitting the information. During or after surgery, untreated hyperthyroidism can cause thyrotoxic crisis (thyroid storm), which may be a highly fatal complication. Thyrotoxic crisis is an extreme accentuation of signs and symptoms of throtoxicosis. Clinical manifestations are sinus tachycardia or atrial fibrillation, marked increase in systolic pressure and pulse pressure, high temperature, profuse sweating, tremor, dehydration, tachypnea, extreme restlessness and agitation, delirium, and frank psychosis. In this case, atrial fibrillation and hypertension developed after induction, and severe thyrotoxic symptoms appeared after emergence, which were caused by undetected hyperthyroidism.
Anesthesia* ; Atrial Fibrillation ; Blood Pressure ; Dehydration ; Delirium ; Dihydroergotamine ; Emergencies ; Humans ; Hypertension ; Hyperthyroidism ; Masks ; Psychomotor Agitation ; Psychotic Disorders ; Sweat ; Sweating ; Tachycardia, Sinus ; Tachypnea ; Thyroid Crisis ; Tremor

A 54 year old man who had taken puffer fish and noticed generalized weakness 1 hour and 30 minutes afterward was admitted to our I.C.U. due to respiratory arrest and cardiac arrhythmia. He was treated with artificial respiration via pressure cycled respirator, supportive therapy including frequent endotracheal suctioning. fluid administration, correction of acid base imbalance, change of position and antibiotics for prevention of secondary infection. 31 hours afterward, he resumed normal respiration and clear mentality. After 5 days of total admission days, he was discharged without any sequelae.
Acid-Base Imbalance ; Anti-Bacterial Agents ; Arrhythmias, Cardiac ; Coinfection ; Poisoning* ; Respiration ; Respiration, Artificial ; Respiratory Paralysis* ; Suction ; Tetraodontiformes ; Tetrodotoxin* ; Ventilators, Mechanical