• Journal of Chest Surgery
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• v.31 no.10
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• pp.999-1003
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• 1998

Background: Thoracoscopic sympathetic block in palmar hyperhidrosis has merits in its immediate responsiveness and recovery. In palmar hyperhidrosis, the level of sympathetic chain to be blocked has been somewhat obscure. Materials and methods: To compare the results of T2 with T2,3 sympathetic block, we retrospectively studied 192 patients (T2 group: 84, T23 group: 108) operated on at SNUH with palmar hyperhidrosis between April 1994 and July 1997. We reviewed medical records and recently interviewed the patients by telephone call. Sex and age distribution between two groups showed no significant differences. We performed sympathectomy at the early phase of the syudy until April 1997, and after then, we adopted sympathicotomy rather than sympathectomy. Results: All patients showed symptomatic improvement after the operation. Mean operation times of T2, T23 groups were 61.3$\pm$22.5min, 82.7$\pm$24.8min, respectively(p<0.01). Early postoperative complications, such as Horner's syndrome or chest tube insertion, were not different in two groups. There were no statistical differences of late complications such as compensatory truncal hyperhidrosis, gustatory sweating, and phantom sweating. No patient experienced recurrence of palmar hyperhidrosis during the study period. The only difference was the extent of compensatory truncal hyperhidrosis. The compensatory sweating occurred from axilla to suprapatella in T2 group whereas its extent was from nipple to suprapatella in T23 group. Conclusions: We concluded that T2 thoracic sympathetic block is mandatory for the treatment of primary palmar hyperhidrosis.

• Journal of Chest Surgery
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• v.33 no.10
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• pp.817-822
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• 2000

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 21.59$^{\circ}C$ 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.

• Journal of Chest Surgery
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• v.33 no.11
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• pp.904-905
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• 2000

28세 남자가 4년전 수장부 다한증으로 양측 제 2, 제3흉부교감신경절제술을 받고 난 후 우측 손에 한냉증이 발생하였다. 흉부교감신경절제술 후 발생한 수부 한냉증은 매우 드문 현상이다. 이 증례를 문헌 고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• v.6 no.2
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• pp.213-218
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• 1973

Raynaud attempted to clarify the situation concerning symmetrical and spontaneous gangrene in a thesis published in 1952. The disease was defined as Raynaud`s phenomenon without associated and contributing conditions or disease, and described as two types, such as, `locale syncope and asphyxia` and `gangrene`. Predilection of Raynaud`s disease for female under 40 years of age wi-thout any vascular occlusive disease beginning in the early decades of life and typical color changes in the skin of the extremities incited by coldness are outstanding features in this disease. One typical case of Raynaud`s disease is presented with relating references. Patient was 24 year old female single patient, who noted pain, numbness, and cyanosis of the finger tips of both hands for 6 years previously in the winter season, and recently such symptoms were aggravated including her both feet for two years even in the summer after exposure to cold water. Physical and laboratory examination revealed nothing specific except slightly glistening tight face and hypertrophy of both finger tips with clammy coldness. FamiliaI and past history revealed nothing specific abnormal contributory factors. Biopsy of skin on the dorsum of right foot one year before this admission revealed no evidence of scleroderma. Treatment was aimed to relieve vasospasmodic reaction to coldness and was very successful with bilateral lumbar and thoracic sympathectomy. Patient is free of symptoms relating to the Raynaud’s phenomenon after sympathectomy for 6 months including winter season.

• Journal of Chest Surgery
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• v.23 no.2
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• pp.333-341
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• 1990

aortoiliac pattern, Group II; femoropopliteal pattern and Group g; tibioperoneal pattern. A majority of patients belonged to group I [27 cases], 8 patients came under group II .and none in group g. Thirty patients underwent bypass operation with autogenous saphenous vein or synthetic graft with or without concomitant lumbar sympathectomy. Remaining 5 patients were operated on with sympathectomy only, Bypass procedures were anatomic bypass in 22 cases: aortoiliac artery bypass in 11 cases, femoropopliteal artery bypass in 10 cases, sequential femoropopliteal artery bypass in one case and extra-anatomic bypass in 8 cases, axillary-bifemoral artery bypass in one case and femorofemoral artery bypass in 7 cases. Postoperative complications which mainly composed of superficial wound infection[5 cases] which were treated without any significant sequel in all cases and thrombosis[2 cases]. Three patients died whose causes of death were acute renal failure in 2 cases and myocardial infarction in other, The overall patency, rate was 70Zo in 5 years. In conclusion, the clinical pattern and operative outcome were similar to he western pattern and all cases of death did not related to operative procedures and ischemic symptoms were relieved by bypass operations except several cases. I think and recommend that all patients suffering chronic arterial insufficiency by atherosclerosis obliterans ought to be managed with urgent and adequate operative procedure.

• Journal of Chest Surgery
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• v.20 no.2
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• pp.261-269
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• 1987

From 1976 through 1986, authors have experienced 127 cases of peripheral vascular surgery which had been done in this department. There were 29 cases of atherosclerosis obliterances including 7 Leriche syndrome, 32 Buerger`s diseases, 25 arterial thromboembolisms, 21 vascular injuries, 2 peripheral arterial aneurysms, 2 renovascular hypertensions, 1 congenital A-V malformation, 13 varicose vein of lower extremities, and 2 Jugular venous ectasia. Cases with vena caval disease and aortic disease were excluded. The mean age of ASO and Buerger`s disease was 56.1 yrs, 33.8 yrs respectively. The male to female ratio showed marked male preponderance [27:2, and 30:2], and almost every male patient was smoker. The indication of operation was similar in both disease entities. The method of operation for ASO were bypass procedure [17], thromboendarterectomy [6], and lumbar sympathectomy [5], and for Buerger`s disease were mainly sympathectomy and few bypass procedures and amputations. Seventeen patients with ASO were followed from 3 to 75 month and overall patency rate for bypass or endarterectomy in one and two months and 2 1/2 yr were 93%, 87%, and 31% respectively. Post operatively patient`s symptoms was relieved or alleviated in almost ASO patients, and about 60% of Buerger`s disease. We concluded that in patient with ischemic limb, we must revascularized aggressively for symptomatic relief. And choice of graft for bypass procedure was to be evaluated further.

• Journal of Physiology & Pathology in Korean Medicine
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• v.16 no.2
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• pp.233-238
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• 2002

Moxibustion is one of major healing technique in oriental medicine. It has been widely used in many diseases such as rheumatoid arthritis, Hashimoto disease, breech presentation, etc. However, till now, effects of moxibustion on NK cell activity and relations between sympathetic nerve system(SNS) and the immune alteration induced by moxibustion were not well studied. This study was designed to evaluate effects of moxibustion on NK cell activity and the intervention of SNS in the alteration of NK cell activity induced by moxibustion. Splenic NK cytotoxity was measured in a standard 4-h 51Cr release assay. We measured the NK cytotoxity at after moxibustion stimulation for 1,3,5, and 7 days, and also measured the NK cell cytotoxity after 3 and 7 days burn stimulation with similar temperature. IL-2, IL-4, INF-γ in serum were measured by rat IL-2, IL-4, INF-γ ELISA TEST KIT. To evaluate the effects of sympathectomy on alteration of NK cell cytotoxity, 6-hydroxydopamine(6-OHDA : 5Omg/kg) was used. We showed that NK cell activity of moxibustion stimulation group increased at the 3rd day, and declined at 7th day in comparison with that of contol group. In moxibustion stimulation group, NK cell activity of 3 day stimulation group was significantly higher than sham group. On the contrary, in burn stimulation group, NK cell activity was significantly higher than that of sham groups at 3rd, 7th days. Patterns between moxibustion and burns were different. INF- γ level of 3 days moxibustion stimulation group significantly higher than sham group. IL 2 level among groups were not different. IL-4 was not detected in serum with this method. Sympathectomy abolished the NK cell activity alteration induced by moxibustion. The results suggest that moxibustion induces the alteration of NK cell activity, along with INF-γ and SNS is related to these effects.

• Journal of Chest Surgery
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• v.32 no.5
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• pp.456-460
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• 1999

Background: Thoracic sympathectomy for hyperhidrosis has been recognized as an effective treatment using thoracoscopic devices and operative techniques, but the satisfaction has decreased due to a compensatory hyperhidrosis. Therefore, the postoperative results and compensatory hyperhidrosis were analyzed. We also measured the temperature differences in the hand and foot during the preoperative and postoperative periods and measured the blood flow of upper and lower extremities. Material and Method: From December 1995 to July 1998, total of 47 patients with hyperhidrosis underwent sympathectomy via VATS at the Department of Thoracic and Cardiovascular Surgery, Kangnam St. Mary's Hospital. The patients were evaluated for preoperative and postoperative temperature changes on the finger and toe, and preoperative and postoperative blood flows were measured by the Doppler examination on the digital artery, radial artery and dorsalis pedis artery. Result: There were no operative deaths but some complications existed: 7 pneumothorax, 3 recurrence and 1 Honor syndrome. Ninety-five percent of the patients also had compensatory sweating especially in the trunk. There were 5 patients who regretted recurring the operation because of the compensatory sweating. Sweating decreased in 46% of the sole hyperhidrosis patients. The temperature difference between preoperation and postoperation was 1$^{\circ}C$ on the right hand side and 1.9$^{\circ}C$ on the left hand side(P<0.05). There was no significant temperature difference on the sole. Blood flow increased significantly in the palm, but no difference in the sole. Conclusion: In conclusion, thoracic sympathectomy for hyperhidrosis is a safe and effective treatment but satisfaction has been decreased by the compensatory sweating; therefore, it is important to thoroughly explain the compensatory sweating prior to surgery. Improvement of the plantar hyperhidrosis is not due to a physiological change, but to a psychological stability.

• Journal of Chest Surgery
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• v.35 no.4
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• pp.283-289
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• 2002

Backgrouds: It is almost universally accepted that occlusive vascular diseases are best managed by anatomical reconstruction. However, the mortality and the morbidity have limited this operation for patients with high operation risks. In these patients, palliative operations such as extra-anatomic bypass and lumbar sympathectomy, are accepted as useful treatment. Material and Method: A retrospective study was conducted in 38 patients who underwent palliative operations for occlusive vascular disease at Korea University Guro Hospital between 1996 and 2000. Mean age of the patients was 60.37 $\pm$ 17.65 years, and preoperative diagnoses were atherosclerosis in 32 patients, Buerger's disease in 4 patients, Raynaud's syndrome in 1 patient and SVC syndrome in 1 patient. Result: Extra-anatomic bypass(40procedures), lumbar sympathectomy(17), thromboembolectomy(7) and femoral artery graft interposition(1) were performed. Six patients were required reoperation due to graft flow failure or fistula. Three year primary patency rate of entire operations was 78.29 $\pm$ 8.81%, and the correlation between type of operation and patency rate was not statistically significant. Conclusion: Palliative operations for occlusive vascular disease are useful treatment in limited patients with high operation risks or limited life expectancy.

• Journal of Chest Surgery
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• v.31 no.2
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• pp.208-211
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• 1998

Reflex sympathetic dystrophy is an important clinical entity that is characterized by excessive or prolonged pain, vasomotor and other autonomic disturbances, delayed recovery of function, and trophic changes. This syndrome is among the most frequently encountered problems in clinical medicine, and proper diagnosis and therapy are critical. Accidental or surgical trauma or one of a variety of disease states may become a precipitating factor. Proper recognition and treatment result in rapid elimination of symptoms and complete recovery. A 56-years old male accidented total amputation of the proxomal part of the left index finger in May, 1996. Emergently, complete replantation procedure was successfully performed in the department of reconstructive surgery, medical center, Korea University. Afterward, he began to suffer from uncontrolled, prolonged pain in left index finger, proximally spreading pain to the left upper extremity and limited joint movement of the left shoulder. Although many treatments were used for this syndrom, not all of them were effective. Furthermore, the treatments which proved effective had detrimental side effects. However, thoracoscopic left thoracic sympathectomy was performed in our department. This therapy successfully relieved the pain and improved shoulder joint movement.