Bong-Suk Oh

Microinvasive video-assisted thoracoscopic sympathicotomy for primary palmar hyperhidrosis

BACKGROUND Although video-assisted thoracoscopic surgery for palmar hyperhidrosis is now widely accepted as the approach of choice, the optimal technique has remained a subject of controversy. We have used 2-mm dual port video-assisted thoracoscopic sympathicotomy for primary palmar hyperhidrosis. This study evaluates the short-term results of the technique. METHODS A retrospective review was carried out of 45 patients, 20 men and 25 women, with a mean age of 24.2 years. In the period from April 1998 to August 1999, 90 consecutive video-assisted sympathicotomy for primary palmar hyperhidrosis either in isolation (n = 56) or in combination with axillary and plantar hyperhidrosis (n = 34) was performed. The mean follow-up period was 11.3 months. Attention was focused on patients satisfaction, complications, and morbidity. RESULTS Dry limbs were immediately achieved in all patients after surgery. There was no operative mortality and one case of transient Horners syndrome developed. Eight of 20 with plantar hyperhidrosis showed simultaneous improvement. The overall mean satisfaction rate was 92% +/- 2% with a median 93% improvement using a visual linear analogue scale from 0% (poor) to 100% (excellent). Only 2 patients were dissatisfied with the operative results owing to compensatory hyperhidrosis, which occurred in 25 patients and improved in 20 patients within the follow-up period. CONCLUSIONS The video-assisted thoracoscopic sympathicotomy with 2-mm endoscope is a speedy and safe way of controlling hyperhidrosis with excellent cosmetic results while minimizing complications.

Pilomatrix Carcinoma in the Chest Wall Around an Eloesser Open Window - A case report -

Pilomatrix carcinoma originates in the matrix cell and is marked by exophytic growing and common local recurrence. There is no established treatment for wide local invasion and metastasis of the pilomatrix besides wide surgical resection. We report a case of rapidly progressive pilomatrix carcinoma, which arose around an Eloesser open window with direct invasion to the adjacent tissue.

Prenatal Diagnosis of Severe Tricuspid Insufficiency in Ebstein's Anomaly with Pulmonary Atresia and Intact Ventricular Septum: A Case Report

Pulmonary atresia with intact ventricular septum is an uncommon congenital cardiac anomaly which very often present varying degrees of downward displacement and dysplasia of the tricuspid valve.

Mid- to Long-term Results of Surgical Treatment of ASD in Patients over 60 Years Old.

Background There is controversy about the benefit of surgical correction of an atrial septal defect (ASD) in patients over 60 years old. The purpose of this study was to determine whether surgical treatment is beneficial in those 60 years of age or older. Materials and Methods We reviewed the clinical course of 57 patients (mean age: 63.54±5.59 years) diagnosed with an isolated secundum ASD after the age of 60. The 24 patients (group A) who underwent surgical repair were compared with the 33 patients (group B) who were treated non-surgically. The mean follow-up period was 6.8±4.5 years. Results One operative death, 5 late deaths (20.8%) in group A, and 9 deaths (27.3%) in group B occurred in the study period. Symptomatic improvement was noted in 18 patients (75%) of group A after surgery. However 13 patients (39.4%) of group B showed symptomatic improvement during the follow-up period (p=0.012). The incidence of new atrial arrhythmia of the two groups was significantly different (16.7% vs 36.7%, p=0.038). The actuarial 10 year survival rate was 79% in group A and 73% in group B. Conclusion Although surgical correction of ASD did not increase survival in patients over 60 years old, the surgical outcomes of ASD showed low operative mortality and resulted in symptomatic improvement in the majority of these patients. This study has shown the benefits of surgical closure of ASD even in advanced age in comparison to medical treatment.

Nosocomial Infection in Adult Patients Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation

Data on the frequency of nosocomial infections during extracorporeal membrane oxygenation (ECMO) in adult populations remain scarce. We investigated the risk factors for nosocomial infections in adult patients undergoing venoarterial ECMO (VA-ECMO) support. From January 2011 to December 2015, a total of 259 patients underwent ECMO. Of these, patients aged 17 years or less and patients undergoing ECMO for less than 48 hours were excluded. Of these, 61 patients diagnosed with cardiogenic shock were evaluated. Mean patient age was 60.6 ± 14.3 years and 21 (34.4%) patients were female. The mean preoperative Sequential Organ Failure Assessment (SOFA) score was 8.6 ± 2.2. The mean duration of ECMO support was 6.8 ± 7.4 days. The rates of successful ECMO weaning and survival to discharge were 44.3% and 31.1%, respectively. There were 18 nosocomial infections in 14 (23.0%) patients. These included respiratory tract infections in 9 cases and bloodstream infections in a further 9. In multivariate analysis, independent predictors of infection during ECMO were the preoperative creatinine level (hazard ratio [HR], 2.176; 95% confidence interval [CI], 1.065–4.447; P = 0.033) and the duration of ECMO support (HR, 1.400; 95% CI, 1.081–1.815; P = 0.011). A higher preoperative creatinine level and an extended duration of ECMO support are risk factors for infection. Therefore, to avoid the development of nosocomial infections, strategies to shorten the length of ECMO support should be applied whenever possible.