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.
Nevus

No abstract available.
Hair ; Humans ; Piedra ; Scalp ; Trichosporon

No abstract available.
Onychomycosis

No abstract available.
Candida ; Onychomycosis

No abstract available.
Candida

BACKGROUND: Few studies have compared the efficacy, cosmetic outcomes, and adverse events between 5-aminolevulinic acid photodynamic therapy (ALA-PDT) and methyl aminolevulinate-PDT (MAL-PDT) for actinic keratoses (AKs) in Asian ethnic populations with dark-skin. OBJECTIVE: We retrospectively compared the long-term efficacy, recurrence rates, cosmetic outcomes, and safety of ALA-PDT versus MAL-PDT for facial AKs in Koreans. METHODS: A total of 222 facial AKs in 58 patients were included in this study. A total of 153 lesions (29 patients) were treated with 5-ALA, and 69 lesions (29 patients) with MAL. ALA and MAL creams were applied for 6 hours and 3 hours, respectively; the lesions were then illuminated with a halogen lamp at 150 J/cm2 for ALA-PDT and a diode lamp at 37 J/cm2 for MAL-PDT. RESULTS: The complete response rates of ALA-PDT and MAL-PDT were 56.9% and 50.7%, respectively, with no significant difference at 12 months after treatment. No significant difference in recurrence rates was observed between the 2 PDT modalities at either 6 or 12 months after treatment. There was no significant difference in the cosmetic outcomes between the 2 treatment modalities at 12 months after PDT. However, ALA-PDT caused significantly more painful than MAL-PDT (p=0.005). The adverse events were mild to moderate, transient, and self-limiting for both modalities. CONCLUSION: MAL-PDT was similar to ALA-PDT in terms of long-term efficacy, recurrence rates, cosmetic outcomes, and adverse events; however, it was a significantly less painful procedure than ALA-PDT in our study.
Asian Continental Ancestry Group ; Follow-Up Studies* ; Humans ; Keratosis, Actinic* ; Photochemotherapy* ; Recurrence ; Retrospective Studies

During laparoscopic surgery with carbon dioxide (CO2) pneumoperitoneum, PaCO2 (arterial CO2 gas tension) and P(ET)O2 (end-tidal CO2 gas tension) will be affected by the durations of CO2 pneumo-peritoneum and the body positions. PaCO2 and P(ET)CO2 were investigated 5 minutes after induction of general anesthesia(control value), 10 minutes, 30 minutes and 60 minutes after CO2 gas insufflation, and 15 minutes after CO2 gas excretion. Seventy-two patients undergoing laparoscopic surgery under general anesthesia were allocated to two study groups: group I, laparoscopic appendectomy under the Trendelenburg position; group II, laparoscopic cholecystectomy under the reverse Trendelenburg position. In results, PaCO2 and P(ET)CO2 were significantly increased during laparoscopic surgery that associated with times of CO2 pneumoperitoneum. PaCO2 and P(ET)CO2 at 60 minutes after CO2 gas insufflation were increased from P(ET)CO2 control value 35.8+/-4.2 mmHg, P(ET)CO2 . control value 34.0+/-3.6 mmHg to P(ET)CO2 . 39.98.0 mmHg, P(ET)CO2 42.3+/-4.7 mmHg(p<0.05). PaCO2 and PO in group I were more increased compared with group II. PaCO and P(ET)CO2 in group I were increased from PaCO2 control value 35.9+/-4.8 mmHg, P(ET)CO2 control value 34.9+/-3.7 mmHg to PaCO2 45.7+/-2.5 mmHg, P(ET)CO2 48.0+/-3.6 mmHg(p<0.05), in group II from PaCO control value 35.7+/-3.2 mmHg, P(ET)CO2 control value 32.8+/-3.0 mmHg to PaCO2 38.4+/-8.3 mmHg, P(ET)CO2 40.4+/-3.2 mmHg(p<0.05). In conclusion, to minimize the risk of a carbon dioxide retension during laparoscopy especially under the Trendelenburg position, we recommend that ventilation should be adjusted to to the normal range of PaCO2 and P(ET)CO2.
Anesthesia, General ; Appendectomy ; Carbon Dioxide ; Cholecystectomy, Laparoscopic ; Head-Down Tilt ; Humans ; Insufflation ; Laparoscopy* ; Pneumoperitoneum* ; Reference Values ; Ventilation

As a adjuvant, 99m Tc-IDA complex cholescintigraphy has been used to differentiate the causes of jaundice,hepatocellular jaundice from the obstructive jaundice. So we conducted the retrospective study from the 41 casesof cholescintigraphy from the Mar, 83 to Sept. 84 at the Dept. of radiology in the Sonnchyunhyang university todetermine the etiology and differential points in the diagnosing the Jaundice. The following results wereobtainend; 1. As a 1st-ordered parameter, the leading edge hepatic parenchymal transit time was very significant in differentiating the causes of jaundice, among the hepatocellular jaundice, obstructive jaundice due to tumor,and obstructive jaundice due to cholelithiasis. (P<0.01 by X2-test) 2. As a 2nd-ordered parameter, hepaticclearance was very significant in differentiating the hepatocellular jaundice from the jaundice due to partialbiliary obstruction. (P>0.01 by t-test) 3. The difference in hepatic clearance between the biliary obstruction dueto tumor and that of the cholelithiasis, was not significant. (P>0.05 by X2-test) 4. The difference in bile ductdilatation among the hepatocellular jaundice obstructive jaundice due to tumor, and obstructive jaundice due tocholelithiasis, was singnificant in differentiating the causes of jaundice. (P<0.05 by X2-test) 5. Intrahepaticstone showed scintigraphic pooling with partial stasis. 6. Cholescintigraphy was useful to differentiated the Rotor's syndrome from the Dubin-Johnson syndrome, supplying the additional criteria.
Bile ; Cholelithiasis ; Jaundice ; Jaundice, Chronic Idiopathic ; Jaundice, Obstructive ; Retrospective Studies

A 69 year-old male patient was admitted for lumboperitoneal shunt operation due to normotensive hydrocephalus. There was not significant laboratory findings except slightly increased serum potassium(5.0 mEq/1). But we ignored this hyperkalemia probably due to hemolysis because ECG at word and operation room did not reveal any evidence of hyperkalemia. Following induction of an anesthesia with fentanyl 100 ug thiopental(2.5%) 100 mg injection, succinylcholine 60 mg was administered intravenously, and endotracheal intubation was performed. Vecuronium 5 mg was administered intravenously for neuromscular blook. Anesthesia was maintained with nitrous oxide, oxygen and enflurane. During the course of operative procedure, his vital signs were stable(blood pressure 120/70 mmHg, pulse 60/min). After lumboperitoneal shunt was completed without problem, neostigmine 5 mg and glycopyrrolate 0.2 mg was administered for reversal of vecuronium. About 10 minutes after arrival in recovery room, his general condition deteriorated suddenly and radial arterial pulse could not be palpated. Radial arteiial blood pressure wave did not appear and ECG showed asystole and stand-still. Cardiopulmonary resuscitation(CPR) was started with Ambu-bagging, sodium bicarbonate and epinephrine injection with external cardiac massage, but the immediate response was not so good. We re-examined the patients chart and found the past history of chronic renal function impairment. CPR was directed for hyperkalemia including calcium chloride, sodium bicar-bonate and 10% dextrose with insulin. At 5 minutes after CPR, ECG showed regular sinus rhythm with stable vital signs. But ECG still showed hyperkalemic pattern(high tented T wave and prolonged P-R interval). After vigorous and continous treatment for hyperkalemia in recovery room, he regained consciousness and he was transfered to the neurosurgical intensive care unit for further evaluation and treatment. Postoperative course was relatively good and he was discharged on 25th postoperative day without any sequale of cardiac arrest.
Aged ; Anesthesia ; Blood Pressure ; Calcium Chloride ; Cardiopulmonary Resuscitation ; Consciousness ; Electrocardiography ; Enflurane ; Epinephrine ; Fentanyl ; Glucose ; Glycopyrrolate ; Heart Arrest* ; Heart Massage ; Hemolysis ; Humans ; Hydrocephalus ; Hyperkalemia ; Insulin ; Intensive Care Units ; Intubation, Intratracheal ; Male ; Neostigmine ; Nitrous Oxide ; Oxygen ; Recovery Room ; Sodium ; Sodium Bicarbonate ; Succinylcholine ; Surgical Procedures, Operative ; Vecuronium Bromide ; Vital Signs