Hsien-Pin Li

Treatment of Palmar Hyperhidrosis: T4 Level Compared With T3 and T2

Objective:The aim of this study was to compare the outcomes of 3 different levels of sympathectomy. Summary Background Data:Most surgeons still perform T2 or T2–3 sympathectomy for palmar hyperhidrosis, but both these treatments can cause severe side effects. Some recent articles have advocated T4 sympathectomy and obtained satisfactory results. Methods:Between January 2000 and August 2004, 234 records of patients treated for palmar hyperhidrosis were retrospectively reviewed. Of them, 86 patients were treated with endoscopic thoracic sympathectomy of T2 (ETS2), 78 patients with ETS3, and 70 patients with ETS4. Follow-up data were collected using a telephone questionnaire with a scoring system. Multiple linear regressions were used to model markers for degree of satisfaction and severity of compensatory sweating (CS), including descriptive data, level of sympathectomy, clinical outcomes, and postoperative complications. Results:Mean follow-up was 47.1 ± 17.2 months. All 3 levels of sympathectomy could have achieved comparable improvement of palmar hyperhidrosis (P = 0.162). However, 88.5% of the patients noticed CS. Patients with ETS4 presented the lowest incidence of CS (P = 0.030), had the least severity of CS (β = −1.537, P = 0.002), and felt the least palmar overdryness (P < 0.001). None expressed regret for the procedure in the ETS4 group (P = 0.022). Being obese did not increase the incidence of CS, but the severity of CS was directly related to body mass index (β = 0.917, P < 0.001). The patients would be more satisfied if the severity of CS was minimal (β = −0.185, P = 0.002). The degree of satisfaction may decrease with time (β = −0.025, P = 0.003) and was lower when their palms were overdry (β = −1.463, P < 0.001). Conclusions:Different from the current procedure of T2 or T3 sympathectomy for palmar hyperhidrosis, T4 sympathectomy would be a better and more effective procedure with minimal long-term complications.

Is prophylactic treatment of contralateral blebs in patients with primary spontaneous pneumothorax indicated

OBJECTIVES More than 50% of patients with primary spontaneous pneumothorax have contralateral blebs/bullae, and about a quarter will develop a contralateral pneumothorax. The purpose of this prospective study was to determine the need for elective treatment of asymptomatic contralateral blebs/bullae in patients presenting with primary spontaneous pneumothorax. METHODS From May 2006 through June 2008, results from 35 patients with ipsilateral primary spontaneous pneumothorax without contralateral blebs receiving unilateral video-assisted thoracic surgery, 35 patients with ipsilateral primary spontaneous pneumothorax with contralateral blebs receiving unilateral video-assisted thoracic surgery, and 16 patients with ipsilateral primary spontaneous pneumothorax receiving bilateral video-assisted thoracic surgery for positive contralateral blebs were collected. Their demographic and operating data were also recorded. RESULTS There was no significant difference in age, gender, smoking percentage, body mass index (kg/m(2)), blood loss, and postoperative pain among groups. There was longer operative time and length of stay in group receiving bilateral surgery. Within the follow-up period of 16.68 +/- 9.91 months (median, 17.50), no recurrence on either lung was found in the group operated on both sides, while contralateral occurrence was found in 17.14% of the group with ipsilateral primary spontaneous pneumothorax with contralateral blebs receiving unilateral video-assisted thoracic surgery within the period of 18.15 +/- 8.07 months (median, 21). CONCLUSION The study showed that the preemptive video-assisted thoracic surgery for the contralateral blebs/bullae effectively prevented the contralateral occurrence.

Identification of biomarkers for esophageal squamous cell carcinoma using feature selection and decision tree methods.

Esophageal squamous cell cancer (ESCC) is one of the most common fatal human cancers. The identification of biomarkers for early detection could be a promising strategy to decrease mortality. Previous studies utilized microarray techniques to identify more than one hundred genes; however, it is desirable to identify a small set of biomarkers for clinical use. This study proposes a sequential forward feature selection algorithm to design decision tree models for discriminating ESCC from normal tissues. Two potential biomarkers of RUVBL1 and CNIH were identified and validated based on two public available microarray datasets. To test the discrimination ability of the two biomarkers, 17 pairs of expression profiles of ESCC and normal tissues from Taiwanese male patients were measured by using microarray techniques. The classification accuracies of the two biomarkers in all three datasets were higher than 90%. Interpretable decision tree models were constructed to analyze expression patterns of the two biomarkers. RUVBL1 was consistently overexpressed in all three datasets, although we found inconsistent CNIH expression possibly affected by the diverse major risk factors for ESCC across different areas.

Needlescopic Video-assisted Thoracic Surgery for Primary Spontaneous Pneumothorax

Minimally invasive surgery is the current trend of approach in various fields. Since May 2006, our team has started implementing needlescopic video-assisted thoracic surgery as the standard surgical treatment for primary spontaneous pneumothorax. During a seventeen-month period, 62 consecutive patients with primary spontaneous pneumothorax were operated on. The ages, sex ratio, operative times, blood loss, postoperative pain in visual analog scale (VAS), length of stay and hospital costs were recorded and compared with that of another 62 consecutive patients who received conventional video-assisted thoracic surgery between July 2004 and April 2006. Only the postoperative pain in VAS was significantly lower in the needlescopic video-assisted thoracic surgery group; the rest remained the same. Also the wounds were almost undetectable in the needlescopic video-assisted thoracic surgery patients. There were no major complications, mortality or recurrence in either group. Needlescopic video-assisted thoracic surgery is a high-tech technique which provides safety, effectiveness, economy and outcome comparable to that of conventional techniques. It is also associated with less pain and better cosmetics.

Comparison of needlescopic and conventional video-assisted thoracic surgery for primary spontaneous pneumothorax

Abstract Whether the outcome of primary spontaneous pneumothorax (PSP) when treated with needlescopic video-assisted thoracic surgery is positive is still under scrutiny. The present study was conducted to compare the needlescopic approach with the conventional approach. One-hundred and six patients with primary spontaneous pneumothorax who had undergone needlescopic video-assisted thoracic surgery (NVATS) between May 2006 and August 2008 were reviewed. Their age, gender, smoking status, BMI, side of attack, operative indications, operative time, intraoperative blood loss, postoperative length of stay, postoperative pain in visual analog scale (VAS), postoperative recurrence and follow-up period were recorded. These data were compared with those of 89 patients with PSP who had undergone conventional video-assisted thoracic surgery (CVATS) between June 2002 and April 2006. The operative time was shorter (NVATS: 82.36 ± 35.58 min, CVATS: 99.78 ± 35.74 min; p = 0.008) and intraoperative blood loss was less (NVATS: 16.67 ± 25.90 ml, CVATS: 24.36 ± 26.86 ml; p = 0.04) for the NVATS group. The postoperative pain in VAS was significantly less in NVATS. No major complication or mortality was found in either group. For treatment of primary spontaneous pneumothorax, NVATS is a safe and effective option. Further, it has the added benefit of less pain and improved cosmetics.

Video-assisted thoracoscopic surgery for postoperative recurrent primary spontaneous pneumothorax

OBJECTIVES Postoperative recurrent primary spontaneous pneumothorax (PSP) is a troublesome complication and an important issue to be discussed. This study is to determine whether Re-video assisted thoracoscopic surgery (VATS) should be performed for postoperative recurrent PSP (PORP). MATERIALS AND METHODS Patients who had underwent needlescopic VATS for PSP between Jan. 2007 and Dec. 2011 were reviewed. RESULTS VATS was initially performed on 239 patients with PSP in total. Eleven patients were found to have PORP during a follow-up period of 36.95 months. Nine patients received Re-VATS and only two patients receiving conservative treatment had no further recurrence. No conversion to thoracotomy, blood transfusion and prolong air leak were recorded. CONCLUSIONS Even for smaller size cases, Re-VATS, which is technically feasible, safe and effective with better cosmetics and minor postoperative pain, should be a strong contender as priority treatment.

Aortobronchial fistula after esophagectomy for esophageal cancer—A very rare complication

Most aorto‐respiratory fistulas are related to aortic pathology or procedures, but fistula formation after esophageal resection has never been reported in the literature. We are now reporting a case of hemoptysis that occurred after esophagectomy for locally advanced esophageal cancer. Aortobronchial fistula was detected by computed tomography scan. The patient was finally saved by emergency surgery—Dacron graft interposition of the descending thoracic aorta. There was no malignant cell in the postoperative specimen of the fistula. The erosion of the ligaclips (Johnson & Johnson) might be responsible for the aortobronchial fistula formation. For esophageal surgery, avoidance of trauma to aortic wall and careful using of ligaclips are important to circumvent this complication.

Video‐assisted extrathoracic bleb excision: An ultra‐minithoracotomy for primary spontaneous pneumothorax

Video‐assisted thoracic surgery (VATS) is the treatment of choice for uncomplicated primary spontaneous pneumothorax (PSP). In this study, we design a modified thoracoscopic procedure and compare it with the standard VATS. Between January 2001 and July 2003, fifty‐two consecutive patients with PSP were managed with the modified procedure, called video‐assisted extrathoracic bleb excision (VAEB). Simultaneously, we reviewed and recorded the same data of another consecutive 52 patients who underwent standard VATS between April 1997 and December 2000. The two groups were compared regarding operative time, intraoperative blood loss, postoperative pain by visual analog scale (VAS), amount of chest tube drainage, length of hospital stay (LOS), and hospital cost. The age, gender, amount of chest tube drainage, and LOS were not significantly different (P = 0.787, 0.727, 0.660, and 0.602, respectively). The operative time was shorter (VAEB 43±6 min; VATS 63±5 min), pain was less (VAS: VAEB 6±1; VATS 7±1) and hospital cost was lower (VAEB

Enteral nutrition and quality of life in patients undergoing chemoradiotherapy for esophageal carcinoma: a comparison of nasogastric tube, esophageal stent, and ostomy tube feeding

1429±37; VATS

Expedite recovery from esophagectomy and reconstruction for esophageal squamous cell carcinoma after perioperative management protocol reinvention

2035±93) in the VAEB group. VAEB is an effective alternative procedure to standard VATS for PSP. It has the same effectiveness as VATS and catches the advantages of transaxillary minithoracotomy. In addition, it is an easier, quicker, less traumatic and more economical approach.