Treatment of essential hyperhidrosis using thoracoscopic high dorsal sympathectomy

Essential hyperhidrosis (EH) is a little-known disorder which may have a strong adverse effect on the patient's functioning. Conservative treatment of EH is often disappointing and the 'classical' surgical treatment is very radical and complicated. Thoracoscopic sympathectomy is efficacious in the treatment of palmar (and axillary) EH.     

Results of thoracoscopic sympathectomy for 96 cases of palmar hyperhidrosis

From August 1996 to August 1997, we performed thoracoscopic sympathectomy for 96 cases of palmer hyperhidrosis. The patients' ages were from 22 to 58 years old (mean age: 28; gender ratio: male/female: 3/2). Most of them were students, workers or clerks. The patients were divided in two series: in 61 patients, the sympathetic chain before the 2nd to 4th ribs was removed in the lateral approach with a 3 hole procedure. In 35 patients, the 2nd portion of the sympathetic chain was destroyed (by electric cauter) in the posterior approach with a 2 hole procedure. The results were almost the same in the first series (all cases have a fair benefit), but in the second series, some advantages may be useful for therapy, i.e no need to turn the patients, severe compensation sweating is minimized (from 4% ==> 0%) and the amount of holes is reduced.     

针型胸腔镜下治疗手汗症的术中护理

目的:探讨针型胸腔镜T3-4交感神经链切断术治疗手汗症的最佳护理方法.方法:回顾性分析2009年12月至2010年10月我科收治的127例手汗症患者临床资料.术前患者在常规护理基础上给予心理护理及呼吸道功能锻炼;术中巡回护士、器械护士与手术者及麻醉师积极配合.结果:全组患者手术顺利,手术效果良好,住院期间未发生护理并发症,取得满意疗效.结论:针型胸腔镜治疗手汗症术前术中给予正确的指导和护理,有利于保证治疗效果,促进患者恢复.     

An 11-year-old girl with reflex sympathetic dystrophy successfully treated by thoracoscopic sympathectomy

A facile one-pot synthesis of (E)-4-hydroxy-2-alkenals such as (E)-4-hydroxy-2-nonenal, (E)-4-hydroxy-2-heptenal, and (E)-4-hydroxy-2-hexenal was achieved from the corresponding (2E,4E)-2,4-alkadienals by reduction-oxygenation with molecular oxygen and triethylsilane in the presence of cobalt(II) porphyrin as a catalyst followed by treatment with trimethylphosphite.     

The effect of cervical sympathectomy on the pituitary and pineal endocrine system

It was reported previously that continuous exposure to light in male rats increased serum luteinizing hormone (LH) and bilateral cervical sympathectomy inhibited such a change. In the present report, to examine the effect of cervical sympathectomy on the pineal endocrine function, 30 male rats were assigned to five groups. The control (C) group and the light (L) group underwent sham sympathectomy as well as sham pinealectomy. The sympathectomy (S) group underwent sympathectomy and sham pinealectomy. The pinealectomy (P) group and pinealectomy-melatonine (PM) group underwent sympathectomy and pinealectomy. The C group was kept under a normal circadian rhythm for 10 days, and the other groups were kept under continuous exposure to light for the same period. The PM group received subcutaneously 10 mg.kg-1 of melatonine every day. Serum LH levels were measured 10 days following these experiments. With regard to serum LH levels, the differences among C group, L group, and S group were similar to those previously reported. It was higher in P group (2.53 +/- 0.40 ng.ml-1) than in S group (1.58 +/- 0.61 ng.ml-1), and lower in PM group (2.08 +/- 0.31 ng.ml-1) than in P group. In conclusion, it is suggested that the endocrine activity of melatonine from the pineal gland plays an important role in the appearance of the effect of cervical sympathectomy.     

Non-invasive continuous haemodynamic and PETCO2 monitoring during peroperative cardiac arrest

We describe a cardiac arrest which occurred during general anaesthesia in the prone position for surgical correction of lumbar kyphosis in a patient with Marfan's syndrome. Peroperative monitoring was routine with ECG, non-invasive arterial pressure, oximetry, PETCO2 and central venous pressure, plus aortic blood flow and and systolic time intervals via an oesophageal echo-Doppler device. Forty-five minutes after the start of surgery, a sudden decrease in aortic blood flow followed by a decrease in PETCO2 suggested acute cardiac failure despite continuation of the ECG signal. Initial CPR in the prone position produced a slight increase in PETCO2. When the patient was turned to the supine position and the legs elevated, chest compression was more efficient and spontaneous circulation was rapidly restored. Circulatory arrest could be explained by incompletely treated hypovolaemia, or by myocardial depression (decrease in aortic blood flow and lengthened pre-ejection period) combined with excessive hypotension in a patient with Marfan's syndrome, thus compromising coronary blood flow producing ST segment depression. Continuous non-invasive aortic blood flow and PETCO2 monitoring proved valuable in the early detection and treatment of circulatory arrest and in the evaluation of the efficiency of peroperative CPR.     

The effect of neonatal sympathectomy on the response of the rat submandibular gland to isoproterenol

The right superior cervical ganglion was removed from 1-day-old rat pups. For four consecutive days (22-26 days of age), the rats were injected twice daily with isoproterenol-HCl (IPR) at a dose of 2.0 mg/100 g.b.w. and killed on the 27th day of age. Control animals were injected with the solvent, 0.1% Na2S2O5, according to the same protocol. In both control and IPR-treated rats, fluorescence microscopic examination of glands prepared by the Falck-Hillarp method showed a total absence of adrenergic nerve fibers on the side of sympathectomy, and a normal innervation on the unoperated side, while light microscopic examination of Epon-embedded glands revealed no differences in structure between the noninnervated and intact glands. However, after IPR treatment the noninnervated glands consistently showed greater absolute and relative weight, and total DNA, RNA and protein than the corresponding intact gland from the same animal. It is suggested that this greater hyperplastic and hypertrophic response in the noninnervated gland represents a postjunctional supersensitivity of acinar cells to the beta agonistic action of IPR.     

The effect of local chemical sympathectomy of the rat uterus on its sensitivity to sex hormones

Chemical sympathectomy of the rat uterus did not alter the main metabolic processes maintaining the uterus weight even though it changed its response to sex steroids. Sensitivity of endo- and myometrium to progesterone significantly decreased thus inducing a relative increase in the estradiol action.     

Increased immunoexpression of atrial natriuretic peptide in the heart conduction system of the rat after cardiac sympathectomy

The present investigation was designed to elucidate which role the sympathetic nerves play in the immunoexpression of atrial natriuretic peptide in the cardiac conduction system of the rat. In order to destroy the cardiac sympathetic nerve terminals, both surgical and chemical sympathectomy were performed. By use of immunohistochemical and radioimmunoassay techniques, the immunoreactivity and level of atrial natriuretic peptide in the conduction system and in the cardiac myocardium were determined. In contrast to the low degree of immunoreaction for atrial natriuretic peptide seen in control rats, the sympathectomized rats exhibited pronounced immunoreactivity for atrial natriuretic peptide in the atrioventricular bundle and bundle branches, which normally have high numbers of sympathetic nerve fibres. On the other hand, in the peripheral parts of the conduction system, where there are ordinarily few sympathetic nerve fibres, the degree of immunoreaction was unchanged. The quantitative measurements also showed that the entire ventricles, including the conduction system, contained increased levels of atrial natriuretic peptide in the treated hearts. The present study shows that destruction of the sympathetic nervous system leads to an increased level of atrial natriuretic peptide in the Purkinje fibres of bundle branches, which thus seem to have a dormant capacity for synthesis of this peptide. The results provide new evidence about the change in atrial natriuretic peptide levels that occurs when sympathetic innervation is altered.     

The haemodynamic effects of milrinone HCl in halothane anaesthetised horses

The haemodynamic effects of milrinone hydrochloride were determined in halothane-anaesthetised horses. Six healthy adult horses were anaesthetised with guaifenesin and thiamylal and maintained with halothane in oxygen (end-tidal halothane concentration of 1.15%). Baseline haemodynamic data were recorded after a 45 min stabilisation period. All 6 horses received a single loading dose of milrinone HCl, 0.2 microgram/kg i.v., followed by progressively increasing infusions of 2.5, 5, 10 and 20 micrograms/kg bwt/min. Each infusion lasted for 15 min and produced dose related increases in heart rate, mean arterial blood pressure, cardiac output, maximum rate of increase and decrease of left ventricular pressure (+/- dP/dtmax) and ejection fraction in halothane anesthetised horses. Median artery blood flow increased following milrinone administration. Right atrial and pulmonary artery pressures, systemic vascular resistance and left ventricular end-diastolic and end-systolic volumes decreased. Most haemodynamic changes were sustained throughout the infusion period and for 30 min following the termination of milrinone infusion. Systemic vascular resistance was increased above baseline values at 30 min following the termination of milrinone infusion. No adverse side effects were observed during this study although a milrinone infusion rate of 20 micrograms/kg bwt/min increased heart rate to values greater than 50 beats/min. The results of this study suggest that milrinone produces beneficial haemodynamic effects in halothane anaesthetised horses and is potentially useful in the treatment of patients with a reduced cardiac output.     

The haemodynamic effects of dopexamine infusion in the critically ill

Superficial dorsal penile vein thrombosis was diagnosed 8 times in 7 patients between 19 and 40 years old (mean age 27 years). All patients related the onset of the thrombosis to vigorous sexual intercourse. No other etiological medications, drugs or constricting devices were implicated. Three patients were treated acutely with anti-inflammatory medications, while 4 were managed expectantly. The mean interval to resolution of symptoms was 7 weeks. Followup ranged from 3 to 30 months (mean 11) at which time all patients noticed normal erectile function. Only 1 patient had recurrent thrombosis 3 months after the initial episode, again related to intercourse. We conclude that this is a benign self-limited condition. Anti-inflammatory agents are useful for acute discomfort but they do not affect the rate of resolution.     

Method of thoracoscopic pleurectomy

A method of thoracoscopic pleurectomy using hydrodissection is presented. The results of its use in 8 patients are described, and pleurectomy as a form of pleurodesis is discussed.     

The effect of transfusion on cardiac function in patients with chronic anemia

BACKGROUND: The deteriorating cardiac function of patients with chronic anemia may be improved with transfusion. The effect of transfusion on cardiac function was evaluated in patients with chronic anemia. STUDY DESIGN AND METHODS: In a prospective study, ejection fraction (EF) was determined before and after transfusion in 41 patients with chronic anemia. The results were compared and analyzed. RESULTS: The volume of red cells transfused and the levels of pretransfusion hemoglobin, hematocrit, and red cell, white cell, and platelet counts did not affect the posttransfusion EF, whereas the pretransfusion EF of the right or left ventricle inversely affected the posttransfusion change in EF in the respective ventricle (p < 0.001 and r = -0.5022; p = 0.01 and -0.3917, respectively). There was no significant difference in the change in EF in the right and left ventricles. CONCLUSION: Transfusion produced little immediate effect on cardiac function, but did change the EF to an extent that aided cardiac function in chronic anemia patients. The pretransfusion EF itself, but not the degree of anemia or volume of red cells transfused, affected the posttransfusion change in EF.     

Effects of the calcium channel antagonist mibefradil on haemodynamic and morphological parameters in myocardial infarction-induced cardiac failure in rats

OBJECTIVE: Calcium channel antagonists (CCA) have been proposed for the prevention of cardiac events after myocardial infarction (MI). Mibefradil is a CCA featuring a selective blockade of T-type Ca2(+)-channels. The aim of the study was to characterize the effects of mibefradil on haemodynamic and morphological parameters in a model of postMI chronic heart failure and to establish the "therapeutic window" for the start of therapy. METHODS: MI was induced by permanent ligation of the left coronary artery in male normotensive Wistar rats. Animals were assigned to placebo- or mibefradil-treated (10 mg/kg/day p.o.) groups as follows: (1) sham operation; (2) MI placebo treatment; (3) 7 days preMI start of treatment; (4) 3 h postMI start of treatment; (5) 24 h postMI start of treatment; (6) 3 days postMI start of treatment; (7) 7 days postMI start of treatment. Treatment was continued for 6 weeks postMI. At this time point, mean arterial blood pressure (MAP), heart rate, left ventricular enddiastolic pressure (LVEDP) and contraction force (dP/dtmax) were measured in conscious rats at baseline and after methoxamine (MEX; 0.5-1.0 mg/h i.v.) stimulation to increase afterload. The hearts were subjected to histological determination of infarct size (IS), infarct length (IL), noninfarcted length (NL), left ventricular circumference (LVC), inner LV-diameter (LVD) and septal thickness (ST). RESULTS: Six weeks after MI, MAP was lowered, LVEDP increased and dP/dtmax reduced. Mibefradil treatment increased basal MAP in groups 3-5 compared to the placebo-treated MI group. Under mibefradil, LVEDP was reduced at baseline in groups 3-6 and, after MEX, in all groups. dP/dtmax was increased in groups 3-4 at baseline and after MEX. In the placebo-treated MI group, the infarcted area was 39% of the LV and heart weight, LVD and LVC were increased. Heart weights of mibefradil-treated rats (groups 3-6) did not differ from those of the placebo-treated group. Early onset of treatment with mibefradil reduced IS and IL and increased NL in groups 3-4. LVD and LVC were decreased in group 3 only. ST was increased in groups 3-5. CONCLUSION: Chronic treatment with mibefradil exerts beneficial actions on cardiac structure and performance in postMI cardiac failure in rats, especially when the onset of treatment is either prior to or within hours after the acute ischemic event.     

The application of lumbar sympathectomy in complex of treatment of obliterating atherosclerosis

The lumbar sympathectomy was conducted for the grade II (according to Fontaine) obliterating atherosclerosis of the lower extremities arteries in 309 cases as the main method of surgery, and in 426--in concurrence with reconstructive intervention on the main vessels. The indications for and the efficacy of the desympathization in various levels of the main arterial bed affection are discussed.     

The haemodynamic effects and pharmacokinetics of intravenous nicorandil in healthy volunteers

Psychotherapy research with children is based mainly on adult methodologies. Common issues include bias in recruitment of subjects, demographics, developmental concerns, and control group considerations. The advantages and drawbacks of various types of control groups, such as wait-list controls, and placebo conditions are discussed along with ethical issues. Instrument choice, validity and reliability, and standardization of procedures in conducting research are addressed. Finally, the therapist as a variable is reviewed, including selection and assignment of therapists, and therapist bias.     

Acute hemodynamic effects of lumbar sympathectomy

Lumbar sympathectomy increases total limb blood flow after aortofemoral bypass in a high percentage of cases. This was true in eleven of fourteen extremities (78.6 per cent) in our series even though no specific selection criteria for entry into the study, other than the need for aortofemoral bypass, were used: that is, patients were entered into the study irrespective of preoperative ankle/arm pressure indexes or results of hyperemia testing. Overall, flow rates after sympathectomy was added to aortofemoral bypass were 1.55 times greater than after aortofemoral bypass alone. This degree of augmentation of flow may be important, particularly in cases of limited outflow.     

Indications and results of lumbar sympathectomy

According to our experience the lumbar sympathectomy is not indicated for the treatment in clinical stage II. The best results for lumbar sympathectomy are to be expected in clinical stage III. We consider the protective sympathectomy combined with reconstructive arterial surgery indicate only in individual cases.