June Lee, Ji Yun Lee, Jung Suk Choi, Sook Whan Sung. Korean J Thorac Cardiovasc Surg 2019;52:141-7. https://doi.org/10.5090/kjtcs.2019.52.3.141

Transdiaphragmatic intercostal hernia is a rare disease. It is usually caused by trauma and is rarely caused by coughing. Although a few cases of intercostal hernia induced by coughing have been reported, our case of a non traumatic acquired acute transdiaphragmatic intercostal and abdominal hernia induced by coughing is very rare. A 77-year-old woman presented with sudden-onset left lower chest pain after an episode of violent coughing. She had risk factors for intercostal hernia, including obesity, chronic obstructive pulmonary disease, oral steroid use, and diabetes mellitus. Computed tomography showed herniation of the lung and intra-abdominal organs into the thoracic and abdominal wall through a ruptured diaphragm, as well as the intercostal and abdominal muscles. Surgery was completed with interrupted sutures to close the defects after the reduction of the herniated organs. Our experience suggests that careful examinations, including the assessment of risk factors and computed tomography imaging, were essential for establishing an accurate diagnosis, and that the repair of a ruptured diaphragm with simple interrupted sutures without any prosthetic materials seems to be feasible in selected patients with a transdiaphragmatic intercostal hernia.

June Lee, M.D., Yong Han Kim, M.D., Cheul Lee, M.D.. Korean J Thorac Cardiovasc Surg 2019;52:32-5. https://doi.org/10.5090/kjtcs.2019.52.1.32

Background: Compensatory hyperhidrosis (CH) is a frequent complication following sympathectomy, influencing patient satisfaction. This study was established to evaluate the impact of bilateral thoracoscopic sympathetic nerve block (TSNB) on patient satisfaction after sympathectomy in the treatment of primary hyperhidrosis. Methods: From March 2021 to August 2023, 52 patients with primary palmar and craniofacial hyperhidrosis underwent TSNB at T3 using a 2-mm thoracoscope under local anesthesia. One week later, they decided whether to proceed with sympathectomy. Satisfaction was assessed using a 100-point scale, and patients were divided into two groups based on CH occurrence after sympathectomy. The groups were compared in terms of sex, age, hyperhidrosis site, and satisfaction scores. Results: Among 52 patients who underwent TSNB, 35 (67.31%) proceeded to sympathectomy, and CH occurred in 18 (51.43%) of these patients, while the remaining 17 patients (48.57%) did not develop CH. No significant differences were observed between the CH and no-CH groups regarding age (26.61±9.02 vs. 25.41±10.09 years, P=0.66), sex (61.11% vs. 52.94% male, P=0.88), or primary hyperhidrosis site (palmar: 77.78% vs. 88.24%, P=0.66). Satisfaction scores were comparable between the CH group (92.50±7.33) and the no-CH group (96.18±4.52), with no statistically significant difference (P=0.15). Conclusions: Sympathectomy is associated with a high incidence of CH. Through TSNB, patients could preoperatively experience potential effects, including CH, enabling informed surgical decisions. Patients who developed CH reported high satisfaction levels comparable to those without CH, underscoring the utility of TSNB in improving patient-centered outcomes.

Background: Pectus excavatum (PE) and scoliosis are widely reported to be highly associated due to the anatomical relationship between the thorax and spine. While the Nuss procedure is commonly performed to correct PE, its impact on spinal alignment remains unclear. The aim of this study is to investigate the effect of Nuss procedure on spinal curvature dynamics across different stages of the Nuss procedure. Methods: This retrospective study analyzed 177 patients who underwent the Nuss procedure for PE correction between July 2011 and July 2024. Spinal curvature was evaluated by measuring Cobb angle (CA) at four stages: pre-operative, post-operative, pre-removal, and post-removal. Subgroup analyses were performed based on sex, age, thoracic morphology (symmetry), pre-operative Haller index (HI), and baseline CA to assess their influence on CA dynamics. Results: Significant changes in CA were observed during the bar insertion and maintenance phases (pre-operative to post-operative: mean difference +1.09°, P=0.003; pre-operative to pre-removal: mean difference +1.12°, P=0.03). Subgroup analyses of CA dynamics across the four time points identified male sex (P=0.001), adolescence (10–19 years, P=0.047), asymmetric thoracic morphology (P=0.04), severe HI (HI ≥3.5, P=0.01), and baseline CA (both <10°, ≥10°, P<0.001) as key factors influencing these changes. Among patients with CA <10°, mean CA changes were 2.05°±3.59° after bar insertion and 2.10°±4.20° before removal. Conversely, in the CA ≥10° (scoliosis) group, mean changes were −3.60°±4.32° and −3.70°±4.37°, respectively. No significant CA changes were found between the pre-operative and post-removal stages. Conclusions: This study investigates the dynamic impact of the Nuss procedure on spinal curvature, with the most pronounced changes occurring during bar insertion and the maintenance phase. Yet, no significant changes were observed between the pre-operative and post-removal stages. Spinal alignment shifts throughout different stages of the procedure and is influenced by multiple factors, particularly sex, age, and pre-operative CA. Further research is needed to explore the underlying biomechanical mechanisms and to assess the long-term effects of PE correction on spinal alignment.

Eun Seok Ka, M.D., June Lee, M.D., Seha Ahn, M.D., Yong Han Kim, M.D.. J Chest Surg 2024;57:225-9. https://doi.org/10.5090/jcs.23.082