Ming-Chien Kao

Video Endoscopic Sympathectomy Using a Fiberoptic CO2 Laser to Treat Palmar Hyperhidrosis

Palmar hyperhidrosis is a common disorder among orientals. A new therapeutic technique for this disorder has been designed by combining a computer compact disc video endoscopic system with a fiberoptic CO2 surgical laser unit. The operation is performed under general anesthesia with alternating one-lung ventilation. There are three important aids in localizing the correct sympathetic segment: 1) direct visualization of its magnified image on the television monitor; 2) identification with an electrode probe palpation at its presumed location; and 3) monitoring the microvasomotor changes on the skin of the finger resulting from electrical stimulation of the sympathetic trunk. Subsequently, the confirmed sympathetic target is vaporized using a low power CO2 laser under direct vision on the television monitor. The laser is delivered to the target by a small optical fiber passing through a throacoscope, which is introduced into the thoracic cavity via the intercostal space between the second and third ribs at the midclavicular line. Fourteen palmar hyperhidrosis patients were successfully treated by this method. No complications, such as Horners syndrome, bleeding, or intercostal neuralgia, were encountered. Although the number of cases treated was small, and the follow-up period was short, the evidence indicates that a definite sympathectomy on a confirmed segment under magnified vision is possible with this procedure, and could warrant a definite and long-lasting therapeutic effect. Based on our experience, the method is considered a relatively minor and safe procedure, causing minimal discomfort and almost invisible scars. The operation time and hospital stay were remarkably shortened in comparison with other conventional sympathectomy procedures.

Autonomic Activities in Hyperhidrosis Patients before, during, and after Endoscopic Laser Sympathectomy

Three hundred palmar hyperhidrosis (PH) patients have been treated with video endoscopic laser sympathectomy during the last 2 years. Monitoring the palmar skin perfusion (PSP) and palmar skin temperature (PST) has been used intraoperatively to aid the confirmation of the correct sympathetic segment for laser ablation. The preoperative and postoperative PSP and PST and sympathetic skin response (SSR) also have been measured to evaluate the therapeutic effect of this method. An apparent increase of PSP would occur intraoperatively after the interruption of the T2 sympathetic segment, and then a gradual elevation of PST would follow after the extirpation of the segment

Palmar hyperhidrosis in children: Treatment with video endoscopic laser sympathectomy

Palmar hyperhidrosis (PH) often starts in childhood and can be a disabling condition for a significant number of young children at the age they begin primary school. There are few reports regarding the surgical treatment of PH in children. The authors report on 40 PH patients under 16 years of age treated with video thoracoscopic laser sympathectomy; there has been substantial experience with this procedure for the treatment of adults with PH. A satisfactory result, with very low morbidity, was achieved for all 40 children. The surgical technique is described briefly. With the technique, the proper sympathetic segment is visualized in almost all cases and then definitely ablated with a fiberoptic low-power laser while under the aid of sympathetic monitoring. Consequently, an adequate sympathectomy warranting a long-lasting therapeutic effect can be achieved without the need of tissue diagnosis. No case required conversion to open sympathectomy. Neither injury to the lung nor bleeding was encountered. Horners syndrome did not occur in any case. Bilateral sympathectomy was accomplished generally within 30 minutes. All patients were discharged after an overnight stay and are doing well with normal activities. The most frequent complication was compensatory hyperhidrosis, which was tolerable after reassurance. Based on the accumulated experience, it is justified to recommend early surgery, with this refined technique, in cases of severe PH in children.

Comparative study on the ALA photodynamic effects of human glioma and meningioma cells

The purpose of this study was to compare the differential susceptibility to photodynamic therapy (PDT) mediated damage in human U‐105MG glioma cells and CH‐157MN meningioma cells in vitro using 5‐aminolevulinic acid (ALA) as photosensitizer, and to determine if growth factors would enhance PDT‐mediated damage of these cells.

Severe Rhabdomyolysis with Good Recovery in a Patient with Head Injury: Case Report

OBJECTIVE AND IMPORTANCE We report a case of head injury, in which a hyperosmolar state evolved during the course of treatment, complicated by severe rhabdomyolysis and acute renal failure, which subsequently resulted in a good recovery after intensive supportive treatment. To our knowledge, such high levels of creatine kinase in a patient with head injury and rhabdomyolysis have not been reported. CLINICAL PRESENTATION AND INTERVENTION A 19-year-old male patient with head injury sustained a compound fracture of the frontal region. He received a hyperosmolar agent to treat brain edema and developed a hyperosmolar state and diabetes insipidus 1 day after the accident. There were no obvious associated injuries at physical examination. After admission to the intensive care unit, the patient developed myoglobinuria and rhabdomyolysis; serum creatine kinase was elevated to a peak of 650,000 IU/L. Four days later, acute renal failure was noted. The patients myoglobinuria and rhabdomyolysis gradually declined, and he eventually recovered from acute renal failure after supportive treatment and dialysis. CONCLUSION We postulate that the hyperosmolar state of the patient was the major cause of his severe rhabdomyolysis. Associated hypokalemia and hypophosphatemia are also predisposed to rhabdomyolysis. The most serious complication in rhabdomyolysis is acute renal failure, but most patients who receive supportive treatment and can survive despite the complications can expect to have normal renal function restored.

Intracranial Hemangiopericytoma with Multiple Extracranial Metastasis - Case Report and Literature Review

Hemangiopericytoma is a rare type of vascular tumor that is highly aggressive and has a high recurrence rate. We report the case of a 44 year old woman in whom intracranial meningeal hemangiopericytoma with multiple extracranial metastasis involving the liver, left lung, cervical and lumbosacral spine was diagnosed. She had previously received surgery to excise the left parasagittal tumor in 1986 and had undergone two subsequent operations for tumor recurrence in 1990 and 1992, respectively. She had also received an operation to excise a midline posterior fossa tumor in 1994. A lung tumor in the left upper lobe and a liver mass in the lateral segment of the left hepatic lobe were also discovered during her hospitalization in 1994, and video-assissted thoracoscopic wedge resection of the left lung tumor and laparoscopic biopsy of the liver mass were performed. In 1995, resection of a right side cerebellpontine angle tumor and a subsequent operation for resection of a cervical spinal tumor were performed. The histopathology of tissue specimens obtained in all of the above mentioned eight operations revealed meningeal hemangiopericytoma. The clinical, radiological and pathological features of the meningeal hemangiopericytoma of the patient are presented with a discussion of difference in the histopathological features of meningioma and meningeal hemangiopericytoma.(Tzu Chi Med J 1997;9:307-313)