• The Korean Journal of Pain
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• v.7 no.1
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• pp.53-58
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• 1994

Thermography has proven to be an effective way to monitor near-surface blood flow in the body, as well as detecting sensitive changes accompanying painful conditions. Thermography is a non-invasive technique free of biological hazards. It provides a comfortable method of diagnosis and evaluation for neuropathic disorder and its treatment. The following are 3 cases of neuropathic disorder and treatment with follow-up thermography.

• Tuberculosis and Respiratory Diseases
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• v.45 no.3
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• pp.609-613
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• 1998

A 21-year-old male was admitted for evaluation of a mass shadow on chest film. On chest computed tomography showed 5 cm sized homogeneous low density based on the second thoracic vertebral body in the posterior mediastinum. The patient had been performed thoracic sympathectomy 6 months before admission and oxidized cellulose was used for hemostasis at that operation. Surgical resection was performed and microscopic result was foreign body granuloma caused by oxidized cellulose. Oxidized cellulose is an absorbable sterile mesh and used to control capillary or venous bleeding. Although the manufacturer recommends its removal after hemostasis is achieved, in clinical practice it is usually left in situ to reabsorb spontaneously, usually with no untoward effect.

• 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.30 no.10
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• pp.1001-1004
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• 1997

Thoracic sympathectomy is the radical and definite treatment of palmar hyperhidrosis. From January 1992 to March 1997, 4 patients with recurrent hyperhidrosis underwent resympathectomy via VATS at the Department of General Thoracic and Cardiovacular Surgery, Young Dong Severance Hospital. There were 2 men and 2 women and mean age was 20.0 years. There were moderate to severe adhesions at previous resection site but no thoracotomies were performed. There was no sweating on palms in all cases and all patients were greatly 5,Btisfied with those results postoperatively. In conclusion, recurrent hyperhidrosis was successfully treated with resympathectomy via VATS. In order to prevent recurrence and minimize the postoperative complication, the proper localization of the 2nd sympathetic ganglion and the radical excision of anatomical variation including Kuntz fiber are needed.

• Journal of Chest Surgery
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• v.50 no.3
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• pp.197-201
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• 2017

Background: Video-assisted thoracoscopic sympathicotomy has been determined to be the best way to treat palmar hyperhidrosis. However, satisfaction with the surgical outcomes decreases with the onset of compensatory hyperhidrosis (CH) over time. The ideal level of sympathicotomy is controversial. Therefore, we compared the long-term results of R3 and R4 sympathicotomy. Methods: We retrospectively reviewed 186 patients who underwent video-assisted thoracoscopic sympathicotomy between September 2001 and September 2015. We analyzed the long-term results with respect to hand sweating and CH, and the overall satisfaction in 186 patients. Results: With respect to hand sweating, significantly more patients complained of overly dry hands in the R3 group (25% versus 3.7%, p<0.001) and of mildly wet hands in the R4 group (2.9% versus 13.4%, p=0.007). There was a significantly increased occurrence rate of CH in the R3 group (97.1% versus 65.9%, p< 0.001). The most frequent site of CH was the trunk area. The overall satisfaction was higher in the R4 group, but without significance (75% versus 85.4%, p=0.082). Significantly more patients reported being very satisfied in the R4 group (5.8% versus 22.0%, p=0.001). Conclusion: T he R4 group had a higher rate of satisfaction than the R3 group with respect to hand sweating. CH and hand dryness were significantly less common in the R4 group than in the R3 group. The lower occurrence of hand dryness and CH resulted in a higher satisfaction rate in the R4 group.

• The Korean Journal of Pain
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• v.18 no.2
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• pp.171-175
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• 2005

Background: Hyperhidrosis is the troublesome disorder of excessive perspiration, which affects as much as 0.15-1% of the population. There are many methods for treating hyperhidrosis. In this report, we present our experience of dorsal percutaneous thoracic sympathetic ganglion block (TSGB) using 99.9% ethyl alcohol for treating palmar hyperhidrosis. Methods: Between March 1992 and July 2003, a total of 856 patients underwent TSGB for the treatment of palmar hyperhidrosis of which 625 were followed up for 2 years. There were 297 and 328 male and female patients, respectively, with a mean age of $23.9{\pm}7.7years$. TSGB was performed under fluoroscopic guidance using 99.9% ethyl alcohol at the T2 and T3 sympathetic ganglia. Results: In the 625 patients, the recurrence rates within the 1st and 2nd years were 29 and 8%, respectively. Compensatory sweating occurred in 42.1% of patients, which was severe in 7.5%. Of the 625 patients 21.0 and 36.9% were either very satisfied or relatively satisfied with the outcome, respectively. Conclusions: Our report confirms that TSGB may be a good alternative to endoscopic thoracic sympathectomy in the treatment of palmar hyperhidrosis.

• The Korean Journal of Pain
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• v.14 no.1
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• pp.56-60
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• 2001

Background: Conventional thoracoscopic sympathectomy or sympathicotomy is an effective method in treating localized hyperhidrosis; however, this may result in a postoperatively compensatory hyperhidrosis or facial anhidrosis in the treatment of palmar hyperhidrosis. We modified the conventional sympathicotomy by limiting the extent of nerve transection (limited T3 sympathicotomy) since May 1998. However, there are many reports of a good short-term outcome of limited T3 sympathicotomy. Therefore, we reviewed long-term follow-up of limited T3 sympathicotomy based on outcomes analysis using a questionnaire. Methods: Fifty four patients with palmar hyperhidrosis underwent a limited T3 sympathicotomy between May 1998 and March 1999 and had a complete follow-up over two years using a questionnaire (the mean follow-up was 2.6 years). The patients' postoperative satisfaction was determined by their subjective responses to the questionnaires; the degree of compensatory hyperhidrosis, the effects on foot hyperhidrosis, gustatory hyperhidrosis and facial dryness, and recurrence, and patient's satisfaction. Results: Of the total, 87% of patients had a compensatory hyperhidrosis and 3.7% of them were disabled. 31.5% of patients showed improvement in foot hyperhidrosis, while 68.5% of patients demonstrated no change or got worse. 31.5% of patients had gustatory hyperhidrosis and facial dryness and 22.2% of patients showed a mild palmar hyperhidrosis. The postoperative patients' satisfaction was significantly in 96.3% of patients. Conclusions: The limited T3 sympathicotomy is a highly effective treatment of palmar hyperhidrosis and has a low rate of postoperative compensatory hyperhidrosis, gustatory hyperhidrosis, and facial dryness.

• Journal of Chest Surgery
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• v.33 no.3
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• pp.268-272
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• 2000

Thoracic sympathicotomy has been used safely and successfully to treat essential hyperhidrosis. However, it has been difficult to treat compansatory hyperhidrosis after thoracic sympathicotomy and focal hyperhidrosis. The sweat glands were innervated by post-ganglionic sympathetic fibers with acetylcholic serving as the transmitter. Botulinum A toxin has been reported to block neuro-transmission at the cholinergic autonomic nerve terminals. Prospecting its effect for the sweat gland, we treated 5 patients with focal hyperhidrosis with botulinum A toxin. Three patients received bilateral thoracic sympathectomy (1 case) and sympathicotomy(2 case) via VAT. The hyperhidrosis area was marked with betadine and was subdivided into squares of 2$\times$2 cm(4$\textrm{cm}^2$) each. Botulinum A toxin was injected intracutaneously in a dosage of 2.5U/0.1ml(100U/4ml) /4$\textrm{cm}^2$. A total dose of 100U of Botulinum A toxin was injected into the affected sites. Subjective assessment of sweat production by the patients using a visual analogue scale showed a 20~70% improvement. During the follow-up period, no toxic effects were observed.

• Journal of Chest Surgery
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• v.24 no.12
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• pp.1173-1184
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• 1991

This report is a review of 55 cases of peripheral arterial disease, who were treated at the department of thoracic and cardiovascular surgery, Masan Koryo General Hospital from January, 1986 to December, 1990. The result are summerized as follows ; 1. The incidence of peripheral arterial disease were as follows that : Arterial injury was in 21 cases(38.2%), arteriosclerosis oblitrans 18cases(32.7%), thromboembolism 9cases(16.4%), Buerger's disease was in 7cases(12.7%). 2. Overall male to female ratio was 6.8 : 1, the prevalent age was 3rd and 4th decade in arterial injury, 7th and 8th decade in atherosclerosis and thromboembolism and 5th and 6th decade in Buerger's disease. 3. The farmer was the first ranked occupation of these patients with chronic occlusive arterial disease, which was composed of 17 cases (68%). 4. 23 cases of patients with chronic occlusive disease has been smoking and most of them have been smoking over 10 years. 5. The clinical symptoms in acute and chronic arterial obstruction were pain, claudication, gangrene and coldness in order. 6. The duration of symptom of chronic arterial occlusive disease was less 1 years in 15 cases(60%). 7. The lower extremity were more affected than upper extremity in peripheral arterial disease. 8. The cause of arterial injury was traffic accident 9 cases(42.9%) stab wound 8 cases (38.1%), postangiography 2 cases(9.5%) and belt injury 1 case. 9. The etiologic factors of acute arterial occlusion was arterial fibrillation myocardial ischemia and postangiography in order. 10. Lumber sympathectomy in Buerger's disease, artificial bypass graft in atherosclerosis and thromboembolctomy in thromboembolism, end to end with vein graft in arterial injury were performed frequently. 11. Conclusively overall result was satis factory but 3 cases was below knee amputated after operation of chronic arterial occlusive disease.

• The Korean Journal of Pain
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• v.1 no.2
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• pp.211-213
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• 1988

Efforts from many different approaches have been made to cure Raynaud's phenomenon using dosal sympathectomy and topical injection of nitroglycerine, phentolamine or procaine and oral or parenteral administration of various drugs. However, there has been no successful management proven yet. In recent years, it was reported that intra-arterial adminstriation of various drugs in normal subjects as well as patients with Raynaud's syndrome, had emonstrated a significant increase in blood flow to the hands. We used an intermittent stellate ganglion block in conjunction with intra-arterial injection of reserpine and procaine in the patient suffering from finger necrosis caused by accidental intraarterial antibiotic (cephamezine) injection. The stellate ganglion block was performed via a paratracheal approach by injection of 0.5% bupivacaine 6 ml, and 1% lidocaine 6 ml, and followed by administration of reserpine 1 mg and procaine 50 mg through a butterfly needle inserted in the radial artery. The administration of reserpine and procaine was done twice. The stellate ganglion block was performed every day for about 3 days, then once every a 5 days as needed for 15 days. As the procedure was carried out, the discolored tissue improved and the pain was progressively relieved. In conclusion, it was suggested that the intra-arterial administration of reserpine and procaine helped initiate and accelerate the increasing blood flow to the hand and the stellate ganglion block continued to help revascularization by dilating the peripheral beds.