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Hyperhidrosis, or excessive sweating, is characterized by overactivity of the eccrine sweat glands, usually associated with dysfunction of the autonomic nervous system. Primary focal hyperhidrosis is the most common form and can affect the axillae, palms, soles, and/or face, often leading to significantly impaired quality of life and social functioning. Treatment is complex. Topical antiperspirants are normally recommended as the first-line treatment for mild hyperhidrosis. Multiple clinical trials and prospective studies support the efficacy and tolerability of oral and topical anticholinergics in the management of hyperhidrosis. Topical glycopyrronium, which has been investigated in at least 8 clinical trials enrolling more than 2000 patients, is probably the first-line pharmacological treatment for axillary hyperhidrosis in patients with moderate to severe disease poorly controlled with topical antiperspirants. Second-line treatments include botulinum toxin injections, microwave treatment, and oral anticholinergics. We review the use of topical anticholinergics in the management of focal hyperhidrosis in adults and children., (Copyright © 2023 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Long QT syndrome (LQTS) is a potentially fatal cardiac disorder caused by channelopathies. Such arrhythmia is often life threatening and might cause sudden cardiac death. There are many reasons of LQTS especially: specific medications and/or electrolytes imbalance or congenital causes like Jervell and Lange-Nielsen or Romano- Ward syndromes. In recent years many ways of treatment have been developed. Except conservative treatment with B-blockers also two surgical methods improved, implantable cardioverter defibrillator (ICD) and left cardiac sympathetic denervation (LCSD). Techniques of LCSD evolved causing side effects more tolerable and lowering the risk of Horner's syndrome. Aim of this study is to review the role of sympathectomy in LQTS.

Hyperhidrosis is a disorder consisting of excessive sweating through the different body sweat glands, which produces a negative impact socially and in work-related activities in those that suffer this condition. There are primary and secondary forms. The primary form is a benign condition with excessive sweating mainly in palms, soles of feet, axillae and face. It affects a 1% of the population, and its cause is unknown. Most medical treatments are unsuccessful, and at best, transitory. In patients who are very troubled by the condition, videoassisted bilateral thoracic sympathicotomy has become the elective treatment. In the period ranging from 1998 to 2018, 174 procedures were undertaken for primary hyperhidrosis, of which 102 satisfied the inclusion criteria. 72 patients were excluded. A 20.5% were males, and 79.5% were females, with an average age of 29.22 years at surgery. As to localization of sweating, a 50.9% was palmar-plantar-axillary, 23.5% axillary, 10.7% palmarplantar, 7.8% palmar, 6.8% palmar-axillary, and a 5.8% facial. Those patients with palmar sweating showed a 94.9% improvement, those with axillary sweating a 88.51%, with plantar a 46.25% and those with facial sweating a 84% improvement. The average admission time was 1.1 days. As an undesired effect, compensatory sweating occurred in 53 cases and postoperative complications in 18 cases. We conclude this is a safe technique, that diminishes sweating significantly, improving patient's quality of life.

Introduction and Objectives: Renal denervation is a percutaneous intervention for the treatment of resistant hypertension. Randomized studies have shown contradictory results on its efficacy. We present the results of a renal denervation registry for the treatment of resistant hypertension in real-life patients in Spain., Methods: Multicenter registry of consecutive patients with resistant hypertension treated with renal denervation in Spain between 2009 and 2018., Results: We included 125 patients (mean age, 56 years; 41% female; mean onset of hypertension 14±9 years previously). Office systolic and diastolic blood pressure and ambulatory blood pressure monitoring decreased 6 months after the intervention (166±20/95±16 to 149±22/87±16 mmHg and 151±14/89±12 to 143±15/84±11, both P <.0001). At 12 months, the blood pressure reduction was maintained and the number of antihypertensive drugs decreased from 4.9±1.2 to 4.4±1.5 (P=.0001). There were no significant procedure-related complications. The response rate to denervation at 1 year was 80%, but there were wide differences between centers., Conclusions: In patients with resistant hypertension, treatment with renal denervation was related to a decrease in office blood pressure and, more importantly, in ambulatory blood pressure monitoring, with a significant reduction in pharmacological treatment., (Copyright © 2019. Published by Elsevier España, S.L.U.)

El síndrome de hiperhidrosis esencial de los miembros superiores es una afección rara., que supone habitualmente un impedimento laboral o social importante. Se trata tal vez de una hipersimpaticotonía a veces de base sicosomática, y que en 2 de las observaciones relatadas, tenía un carácter familiar. El tratamiento médico -a base de anticolinérgicos- suele ser de éxito relativo y con efectos secundarios molestos. Por ello se prefiere la denervación simpática elel miembro superior que los autores realizan a nivel preganglionar, por resección del 2" y 3er. ganglios torácicos. Utilizan el abordaje extra.pleural llosterior ele Smithwick. Los resultados fueron muy buenos en los 6 enfermos operados y no hubo ninguna recidiva en la serie.

Introduction: Division of the thoracic sympathetic chain is the standard treatment for severe palmar and/or axillary hyperhidrosis and facial flushing. Clipping is an alternative option which allows the block to be reverted in cases of intolerable compensatory sweating., Methods: This is a prospective study performed to assess: a) results of clipping of the thoracic sympathetic chain in patients with palmar and/or axillary hyperhidrosis and facial flushing; and b) to determine the improvement obtained after removal of the clip in patients with unbearable compensatory sweating. We included 299 patients (598 procedures) diagnosed with palmar hyperhidrosis (n=110), palmar and/or axillary hyperhidrosis (n=78), axillary hyperhidrosis (n=35), and facial flushing (n=76), who underwent videothoracoscopic clipping between 2007 and 2015., Results: 128 men and 171 women were treated, with mean age of 28 years. A total of 290 patients (97.0%) were discharged within 24hours. The procedure was effective in 92.3% (99.1% in palmar hyperhidrosis, 96,1% in palmar and/or axillary hyperhidrosis, 74.3% in axillary hyperhidrosis, and 86.8% in facial flushing). Nine patients (3%) presented minor complications. Compensatory sweating developed in 137 patients (45.8%): moderate in 113 (37.8%), severe in 16 (5.3%) and unbearable in 8 (2.7%). The clip was removed in these 8 patients; symptoms improved in 5 (62.8%), with sustained effect on hyperhidrosis in 4 of them., Conclusions: Clipping of the thoracic sympathetic chain is an effective and safe procedure. If incapacitating compensatory sweating develops, this technique allows the clips to be removed with reversion of symptoms in a considerable number of patients., (Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introducción. La hiperhidrosis primaria localizada y el rubor facial patológico son manifestaciones de hiperfunción del sistema autónomo simpático, que se presentan en casi el 3 % de la población y afectan en forma importante la vida cotidiana de muchas de estas personas. La simpatectomía videotoracoscópica es actualmente el tratamiento de elección. Materiales y métodos. Estudio descriptivo de una serie de 44 pacientes con síntomas de hiperhidrosis a quienes se les practicó simpatectomía videotoracoscópica bilateral, entre los años 2000 y 2003, para evaluar el nivel de satisfacción con los resultados clínicos. Resultados. Se pudieron localizar 18 pacientes en el 2014, con más de 10 años de evolución desde la cirugía (41 %). La satisfacción inicial, evaluada una semana después de la cirugía, fue excelente (90 %) en 42 de 44 pacientes, moderada, en uno, y solo en uno, inferior a 50 %. Diez años después de la cirugía, el promedio de satisfacción fue de 81,7 %. De 18 pacientes, 15 continuaban estando muy satisfechos o satisfechos (71-100 %) y 2 estaban insatisfechos (50 % o menos): uno por sudoración compensatoria grave y otro por recidiva de los síntomas. Conclusiones. Se encontró que la satisfacción de los pacientes con los resultados a largo plazo no parece depender de la gravedad de la hiperhidrosis compensatoria. Parece, entonces, que la hiperhidrosis compensatoria puede ser mejor tolerada con el paso del tiempo, ya que el paciente se acostumbra a esta situación y ya no lo afecta tanto en su vida cotidiana.

RESUMO Objetivo: avaliar a qualidade de vida de pacientes submetidos à simpatectomia por videotoracoscopia para tratamento de hiperidrose primária. Métodos: foram avaliados os pacientes submetidos à simpatectomia por videotoracoscopia para tratamento de hiperidrose primária pela equipe de cirurgia torácica do Hospital Universitário Gafrée e Guinle-UNIRIO entre julho de 2004 e agosto de 2013. Foi aplicado um questionário sobre qualidade de vida relacionada à hiperidrose desde o pré-operatório até um ano após a operação. Resultados: o questionário foi aplicado em 122 pacientes com média de idade de 25 anos, sendo 57% mulheres. Quanto à severidade da hiperidrose primária, 83% dos pacientes referiam como pouco tolerável ou intolerável, associada com grande limitação da qualidade de vida, sendo esta pobre ou muito pobre em 82% dos casos. No pós operatório a hiperidrose compensatória ocorreu em 78% dos pacientes, entretanto foi considerada como imperceptível ou pouco perceptível por 85% destes pacientes, classificando-a como aceitável. Em 15% dos pacientes a hiperidrose compensatória foi classificada como perturbadora. Conclusão: a simpatectomia videotoracoscópica melhora a qualidade de vida dos pacientes com hiperidrose primária. A hiperidrose compensatória transitória ocorreu na maioria dos pacientes, mas não alterou de maneira significativa a melhora da qualidade de vida.

Objective: To assess quality of life before and after thoracoscopic sympathectomy for treatment of primary hyperhidrosis.Methods: we conducted an observational, analytical, cross-sectional and quantitative study. We evaluated patients undergoing thoracoscopic sympathectomy for primary axillary hyperhidrosis, primary palmar hyperhidrosis, and axillary hyperhidrosis associated with palmar one. We applied a questionnaire on quality of life related to hyperhidrosis before and after the operation.Results: The questionnaire was administered to 51 patients with a mean age of 32.4 years, 45 women and six men. The average quality of life related to hyperhidrosis in a score of 0-100 before sympathectomy was 34.6 and after the operation it was 77.1. Compensatory hyperhidrosis occurred in 84.3% of patients.Conclusion: thoracoscopic sympathectomy improves the quality of life of patients with primary hyperhidrosis, with results supported over time. Compensatory hyperhidrosis occurred in most patients, but did not significantly influence the improved quality of life.

OBJETIVO: Avaliar a qualidade de vida e a presença de compensação pós-operatória de pacientes submetidos a simpatectomia torácica. MÉTODOS: Foram avaliados 50 pacientes consecutivos submetidos a tratamento cirúrgico para hiperidrose palmar. Avaliou-se: o motivo principal que levou o paciente a procurar atendimento médico, a realização prévia de tratamento clínico para hiperidrose, incidência e localização corporal de hiperidrose compensatória e sua relação com a personalidade do indivíduo e o grau de satisfação do paciente com o tratamento. RESULTADOS: Entre todos os entrevistados, 27 (54%) relataram que o incômodo pessoal com o suor excessivo, os levou a procurar atendimento médico; 23 (46%) tiveram prejuízo na relação social; 22 (44%) tiveram dificuldade relativa ao ambiente escolar, enquanto 20 (40%) relataram que o incômodo causado pela hiperidrose nas atividades relacionadas ao trabalho levou-o a procurar atendimento médico. 21 (42%) foram considerados tímidos pelas pessoas de seu convívio. 33 (66%) começaram a manifestar a doença na infância (até os 12 anos); 15 (30%) na adolescência e apenas um (2%) na fase adulta. O calor foi responsável pela crise de suor em 17 (34%) pacientes e a ansiedade esteve presente em 19 (38%). Irritação gerava crise de suor em 31 (62%). Hiperidrose compensatória ocorreu em 39 (78%) pacientes, sendo que três (6%) tiveram compensação plantar e 28 (56%) no dorso e oito (16%) simultaneamente no dorso e plantar, 46 (92%) consideram que a qualidade de vida após a operação "melhorou". CONCLUSÃO: O tratamento cirúrgico da hiperidrose melhora a qualidade de vida, porém a hiperidrose compensatória ocorre em quase todos os pacientes.

ABSTRACT Objective: to compare the intensity of reflex sweating with the degree of anxiety and its interference in the quality of life of patients undergoing Thoracoscopic (VATS) sympathectomy in the pre- and postoperative period. Methods: we evaluated 54 patients with a mean age of 26 years (16-49 years) undergoing sympathectomy in the R3-R4 level. We applied two questionnaires at three different times: "Quality of life in patients with primary hyperhidrosis" and "Scale for anxiety and depression". Results: of the patients studied, 93% showed significant improvement in quality of life 30 days after surgery, the effects remaining after six months. There were no postoperative complications. The patient's level of anxiety is highly correlated with the intensity of reflex sweating after 30 and 180 days. Conclusion: Thoracoscopic sympathectomy improves quality of life of patients with primary hyperhidrosis, even with the emergence of reflex sweating. Anxiety directly relates to the intensity of reflex sweating, without compromising the degree of patient satisfaction.

OBJETIVO: Observar o seguimento de até quatro anos de mulheres submetidas à simpatectomia lombar por retroperitonioscopia, procurando identificar seus efeitos colaterais, bem como sua efetividade no controle da hiper-hidrose plantar. MÉTODOS: Entre junho/2002 e julho2006, operamos 44 pacientes com hiperidrose plantar. Todas apresentavam hiper-hidrose plantar persistente pós simpatectomia torácica com exceção de uma única paciente com diagnóstico de hiperidrose plantar primária. RESULTADOS: O seguimento médio de 22,3 meses, mostra grande satisfação referida pela maioria das pacientes e piora do suor compensatório em 37% delas. Não houve relato de alteração sexual nesta casuística. CONCLUSÃO: A simpatectomia lombar por retroperitonioscopia é uma técnica segura, eficaz e associada a e aceitáveis efeitos colaterais, quando empregada no tratamento da hiperidrose plantar em mulheres jovens.

RESUMO Objetivo: Avaliar a qualidade de vida de pacientes submetidos a simpatectomia torácica bilateral de R5 a R8 como forma de tratamento da hiperidrose compensatória (HC) grave e debilitante em pacientes que foram previamente submetidos a simpatectomia torácica bilateral para tratamento da hiperidrose localizada. Métodos: Doze pacientes com hiperidrose compensatória grave e debilitante foram submetidos a simpatectomia estendida no Hospital das Clínicas da Universidade Federal de Pernambuco, Brasil, entre setembro de 2016 e maio de 2019. Os seguintes desfechos foram estudados: nível de satisfação com a operação, escore de qualidade de vida e as possíveis complicações cirúrgicas. Resultados: Houve significativa melhora na qualidade de vida em 66% da amostra. Em todas as esferas de função, foi evidenciada relevância estatística no que se refere ao alívio dos sintomas relacionados à hiperidrose compensatória. Conclusões: A simpatectomia estendida de R5 a R8 mostrou-se efetiva na maioria dos casos operados, caracterizando este procedimento como promissor, podendo, após estudos futuros, ser incluído como uma opção terapêutica para a hiperidrose compensatória.

A patient with resistant hypertension successfully treated with sympathetic renal denervation (SRD) is reported. This novel therapy is based on the partial ablation of the renal nerves by applying radiofrequency to the luminal surface of the renal arteries using vascular catheterization techniques. This first case performed in Mexico has two particular features: (i) an electrophysiology ablation catheter was employed due to the unavailability of the system specifically designed for SDR, and (ii) under current denervation protocols, the anatomical complexity of the targeted renal arteries would have excluded our patient from this procedure and thus deprived her of the benefit provided.

Despite advances in the pharmacological treatment of arterial hypertension (AHT) and the use of multiple antihypertensive drugs, a small but significant percentage of true severe refractory arterial hypertension patients are still not reaching their target blood pressure. In these cases, renal sympathetic denervation (RSD) seems to be a safe and effective method for severe hypertensive patients who are resistant to multiple drug treatment. We present the case of a 52-year-old patient diagnosed with essential hypertension, resistant to treatment with seven antihypertensive drugs. After 10 hospitalisations without achieving adequate blood pressure control, we decided to propose renal sympathetic denervation as an addition to medical treatment. The procedure was performed without complications in the short to medium-long term, achieving a significant improvement in blood pressure with the intention of reducing overall vascular risk.

Objective: To demonstrate the safety of outpatient or short-stay bilateral videothoracoscopy-assisted thoracic sympathectomy., Patients and Methods: The medical records of 445 who underwent bilateral videothoracoscopy-assisted thoracic sympathectomy were reviewed; the same protocols were used to guide these outpatient or short-stay procedures in all cases. Intravenous anesthesia was provided. An orotracheal tube allowed for carrying out the sympathectomy procedure during short periods of apnea. A 2% lidocaine solution was infused through the thoracic drains, which were removed soon after surgery. Data on intraoperative respiratory variables, pain, and intra- and postoperative complications were gathered. The data for patients undergoing the procedure on an outpatient or short-stay basis were compared., Results: No significant differences in demographic or perioperative variables were found between the 2 groups. In 3.6% of the patients in the series, there was a record of a postoperative pulmonary complication: 4 therapeutic minithoracotomies; 1 subcutaneous emphysema without radiologic changes; 9 residual pneumothoraces, 2 requiring pleural drainage; 1 chylothorax; and 1 delayed hemothorax. With the exception of the late-developing hemothorax, all complications were diagnosed and treated in the immediate postoperative period. In the outpatient surgery group, unplanned admissions because of patient refusal to leave occurred in 6.5% of the cases., Conclusion: The low incidence of complications, and especially the finding that complications are detected in the early recovery period, indicate that this procedure can be performed on an outpatient basis.

Primary hyperhidrosis-PH is an excessive sweating without known etiology. The PH is more frequent in women and in palms, soles and axillae. Medical treatment is not effective. The objective of the surgery is to remove or to disconnect sympathetic ganglia T2 (craniofacial PH or facial blushing), T3 (palmar PH) and T3-T4 (axillary PH). The surgical techniques are mainly resection/transection, ablation with electrocoagulation, sympathetic block by clipping and radiofrequency. Anhidrosis is achieved in 95% of the patients. The overall rate of complications is less than 5% and these are minor complications. The most important unwanted effect is reflex sweating, presented in 48% of the patients. Reflex sweating is more frequent in back, thorax and abdomen and it appears independently of the surgical technique. Ninety percent of the patients are very satisfied after surgery. Nowadays, thoracic sympathetic surgery is the gold standard for primary hyperhidrosis., (Copyright © 2009 AEC. Published by Elsevier Espana. All rights reserved.)

Nearly 3% of the population has hyperhidrosis. Quality of life is affected, impacting on social relationships and professional activity, and social anxiety disorder can sometime develop. We review the definition and causes of hyperhidrosis and the clinical evaluation of patients. After describing the different clinical aspects of the condition, we discuss the medical and surgical treatments. Of such treatments currently available, particular mention is made of the use of botulinum toxin in some forms of hyperhidrosis as an intermediate option between the traditional treatments and surgery. We also draw attention to the use of minimal access surgical techniques (videothoracoscopy), which, over the past decade, have become established as an effective, safe, and permanent approach for the treatment of hyperhidrosis when indicated.

Introduction: Lewy body disorders such as Parkinson's disease (PD) and Lewy body dementia (LBD) are associated with cardiac sympathetic denervation, which can be visualized on 123I-MIBG scintigraphy. Our objectives were to study the diagnostic value of this technique in Lewy body disorders and its relationship with PD clinical variables., Patients and Methods: We studied 90 patients: 51 with PD, 19 with LBD, 9 with multiple system atrophy (MSA) and 11 controls. Scintigraphy images were qualitatively evaluated and early and delayed heart-to-mediastinum ratios (HMR) were calculated. The main confounding factors (ischemic heart disease, diabetes, hypertension and drugs) were controlled by multivariate linear regression analysis. We investigated correlations between scintigraphy variables and PD variables., Results: The delayed HMR, which showed better discriminative ability was 2.03 +/- 0.32 in controls, 1.37 +/- 0.30 in PD (p<0.001 vs controls), 1.47+/-0.45 in LBD (p=0.001 vs controls) and 1.69+/-0.28 in MSA (p=0.02 vs controls; p=0.004 vs PD). This ratio was influenced by PD/LBD diagnosis (beta= -0.638; p<0.001) and to a lesser degree, by ischemic heart disease (beta= -0.244; p=0.028). Optimal cut-off value between PD/LBD and controls was 1.71 (83% sensitivity and 82% specificity). Within the PD group, those with a family history of PD/LB showed higher delayed HMR values (1.65+/-0.34 vs 1.30+/-0.24 without history; p<0.001) and proportion with normal scintigraphy (56% vs 5%; p=0.001)., Conclusions: Cardiac 123I-MIBG scintigraphy is useful in the diagnosis of Lewy body disorders, although its value in PD is conditioned by having a family history of PD.

Chronic low back pain and ciatica after surgery is one of the main reasons for referring patients to multidisciplinary pain units (MPU). The future expansions of MPU have promted neurosurgeons in Spain to re-enter the field of chronic pain management and to recover their enthusiam, that have been lost severel years ago for various reasons. We do not intend dealing with the new instrumented surgical options for the post-laminectoy pain, but rather into the indications and descriptions of the interventional techniques for lumbar and sciatic pain managemet. Currently there are a great number of percutaneous techniques to achieve pain control in the post-laminectomy syndrome. Traditional neuroablative techniques at the spinal cord or the cerebral levels are not any longer indicated. Nonetheless, lumbar sympathectomy and thermo-neurolisis either with chilling or heating, are back in favour, due to the development of new devices and applications. Neuromodulation techniques which are also applicable to this pathology will be the subjet of another article. Pulsed radio-frecuency apperars to favour the safe application of electricity to the dorsal root ganglion or to the root itself thus avoiding the fear of permanent root and/or ganglion thermal lesions that frecuently occurred with the older techniques. Several strategies for pain relief are described, step by step and real figures are depicted in order to make the procedures more understandable and for the easier transmission of knowledge.

Buerger's disease is uncommon arterial disease that affects mainly young people with heavy smoking history. Ischemic symptoms of upper and lower extremities are clearly defined as the most common kind of presentation. Visceral arteries are rarely affected. We report a case of a 44 year old young female with Buerger's disease and mesenteric ischemic involvement, and a revision of the literature about Buerger's disease with visceral affection. Due to the extreme rarity of the intestinal involvement of Buerger's disease, the early diagnosis is difficult, for this reason all patients affected by Buerger's disease who present intestinal symptoms should be carefully evaluated. Aortography and early laparoscopic revision are very important to limit ischemic intestinal injury and later complications. If hemodynamic instability is present emergency laparotomy at the operating theatre is recommended.

Preliminary results from the Spanish cooperative group for the treatment of palmar hyperhidrosis by video-assisted thoracoscopic surgery are presented in this paper. We have reviewed the cases of all patients with this disease treated by the group, especially noting the technique, the early results and complications. Video-assisted thoracoscopy emerges as the treatment of choice, given the ease with which the thoracic sympathetic chain can be resected, its safety, the lack of observed complications, and the good short-term results.

Background: This paper reports the findings of a prospective multicenter study whose main objective was to determine the indications for video-assisted thoracoscopic surgery (VATS), as well as the techniques used, results and complications., Methods: Seventeen chest surgery units provided data on 1,573 procedures performed over a period of two years (July 1996 to July 1998)., Results: Spontaneous pneumothorax (45.4%), lung biopsy (18.4%), pulmonary nodes (13.3%) and thoracic sympathectomy (5.3%) accounted for over 80% of the indications for VATS. An assistive mini-thoracotomy was required in 5.6%. A change to standard thoracotomy was needed in 167 cases (10.6%). Complications were observed in 10.8%, persistent air leakage being the most important. Spontaneous pneumo-thorax recurred in 17 cases (2.4%). Ten patients (0.6%) died., Conclusions: Technological developments have led to new applications for VATS as well as improved outcome for the most common, well established indications. It is advisable to continue to perform prospective, randomized, controlled trials to validate techniques for which little experience has accumulated.

We describe a case of left sided paraplegia after chemical lumbar sympathectomy in which recovery was nearly total. The cause was probably an ischemic myelopathy due to spasm or damage to Adamkiewicz's radicular artery after puncture or direct infiltration during the procedure.

Basic knowledge of clinical management of Raynaud's phenomenon was established and reviewed. Body protection against cold weather and the avoiding of all activities which cause the setting off of the ischemic episodic trigger are the first step in the therapy for this type of patient. Medical treatment includes vasoactive drugs and other drugs which act against the different factors such as plasmapheresis, sympathectomy and electric neurostimulation must be reserved for patients with severe vascular symptoms.

In order to evaluate the results of the lumbar sympathectomy, we studied 49 patients in the National Institute of Angiology and Vascular Surgery during two years. The hemodynamic tests were performed the day before and one month after the surgical intervention; they included: skin thermometry, measurement of arterial blood flow and resistance in the foot and in the leg, and reactive hyperemia under photoplethysmographic control. Objectively, it could be seen only an increase in the distal skin temperature and an increase of skin blood flow after this treatment.

A sympathectomy of the left thyroid lobe was carried out in 17 guinea pigs by sectioning the inferior thyroid artery. Thirty days after the surgical procedure, the animals were killed and the thyroids, together with the trachea and esophagus, were collected for histological processing. Histological, caryometric, and folliculometric studies revealed that the nuclei and thyroid follicles of the operated lobe were significantly larger than in the control lobe. Five guinea pigs were subjected to a temperature of 2 degrees C for 10 hours prior to killing; the thyroid lobe of the control showed a significant increase in the size of the nuclei and follicles. The operated lobe, on the other hand, showed no change. These results favour the hypothesis that sympathetic innervation plays an important role in the normal functioning of the thyroid as well as in a stress situation caused by cold.

A comparative study of fertility among rats with different ovarian neurotomies (splanchnicotomy, vagotomy and pelvicotomy) with or without contralateral ovariectomy has been carried out. The aim of this study was to investigate the role of the autonomic nervous system on the function of the ovary. Unilateral ovariectomy increased the fertility rate from 90% to 100%. Following left splanchnicotomy, the fertility was 40%; with left vagotomy and pelvicotomy, it was 60%. In the animals with one of these neurotomies plus contralateral ovariectomy, the fertility increased to 100%. The number of embryos implanted in the uterine horns was different on the side of neurotomy and in the contralateral one: 2 and 9.3 for the splanchnicotomy; 6.3 and 8.3 for the vagotomy, and 4.3 and 6.3 for the pelvicotomy, respectively. The cases with ovarian neurotomy and contralateral ovariectomy exhibited a greater number of implantations in the uterine horn on the side of the neurotomy as compared with the control rats. The number of implantations showed a parallelism with the number of corpora lutea in the ovaries of non pregnant rats with the same neurotomies. These results lead to the following conclusions: 1. Unilateral ovariectomy increases the fertility; 2. Ovarian splanchnicotomy, vagotomy and pelvicotomy reduce the fertility; 3. After contralateral ovariectomy, this lower fertility is transformed into an increased fertility; and 4. neurotomy, especially splanchnicotomy, reduces the number of embryos implanted in the uterine horn on the side of the neurotomy.