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Objective The aim was to describe the microbiology of surgically treated infective native (mycotic) aortic aneurysms (INAAs), and associated survival and development of infection-related complications (IRCs). Methods Data were pooled from 2 nationwide studies on surgically treated patients with INAAs in Sweden, between 1994 – 2016. Patients were grouped and analyzed according to culture results: 1) Staphylococcus aureus, 2) Streptococcus species (sp.), 3) Salmonella sp., 4) Enterococcus sp., 5) Gram-negative intestinal bacteria, 6) Other sp. (all other species found in culture), and 7) Negative cultures. Results A sum of 182 patients were included, mean age 71 years (standard deviation; SD: 8.9). The median follow-up was 50.3 months (range 0 – 360). 128 (70.3%) patients had positive blood and/or tissue culture; Staphylococcus aureus n = 38 (20.9%), Streptococcus sp. n = 37 (20.3%), Salmonella sp. n = 19 (10.4%), Enterococcus sp. n = 16 (8.8%), Gram-negative intestinal bacteria n = 6, (3.3%), Other sp. n = 12 (6.6%) and Negative cultures n = 54 (29.7%). The estimated survival for the largest groups at 2-years after surgery was: Staphylococcus aureus 62% (95% Confidence interval 53.9 – 70.1), Streptococcus sp. 74.7% (67.4 – 82.0), Salmonella sp. 73.7% (63.6 – 83.8), Enterococcus sp. 61.9% (49.6 – 74.2), and Negative cultures 89.8% (85.5 – 94.1), P = .051. There were 37 IRCs (20.3%), and 19 (51.4%) were fatal, the frequency was insignificant between the groups. The majority of IRCs, 30/37 (81%), developed during the first postoperative year. Conclusion In this assessment of microbiological findings of INAAs in Sweden, 50% of the pathogens were Staphylococcus aureus, Streptococcus sp., or Salmonella sp.. The overall 20%-frequency of IRCs, and its association with high mortality, motivates long-term antibiotic treatment regardless of microbial findings.

To investigate the frequency of initial misdiagnosis and the clinical consequences of an initial misdiagnosis of ruptured abdominal aortic aneurysms (rAAA).This was a retrospective cohort study. Data from the Swedish National Registry for Vascular Surgery (Swedvasc) and medical charts were extracted for patients treated for rAAA in the West of Sweden in the period 2008-14. Initially misdiagnosed patients were compared with correctly diagnosed patients.In all, 261 patients were included in the study. Patients with rAAA were initially misdiagnosed in 33% (n = 86) of the cases and this caused a 4.8 hour (median time) additional delay to surgical intervention. There were no differences in 30 day mortality between initially misdiagnosed patients and correctly diagnosed patients (27.9% vs. 28.0%; p = 1.00). The adjusted odds ratio for mortality in initially misdiagnosed patients compared with correctly diagnosed patients was 0.78 (95% confidence interval 0.38-1.60). No difference was observed between the groups regarding 90 day mortality, length of intensive care, need for post-operative ventilator support, need of haemodialysis support, and length of hospital stay.Misdiagnosis is common in patients with rAAA, and treatment is significantly delayed in misdiagnosed patients. The study did not show any survival disadvantage or increased frequency of post-operative complications in misdiagnosed patients despite the delayed treatment. However, only patients who reached surgical intervention were included in the analysis.

Background Abdominal aortic aneurysm (AAA) is thought to develop as a result of inflammatory processes in the aortic wall. In particular, mast cells are believed to play a central role. The AORTA trial was undertaken to investigate whether the mast cell inhibitor, pemirolast, could retard the growth of medium-sized AAAs. In preclinical and clinical trials, pemirolast has been shown to inhibit antigen-induced allergic reactions. Methods Inclusion criteria for the trial were patients with an AAA of 39–49 mm in diameter on ultrasound imaging. Among exclusion criteria were previous aortic surgery, diabetes mellitus, and severe concomitant disease with a life expectancy of less than 2 years. Included patients were treated with 10, 25 or 40 mg pemirolast, or matching placebo for 52 weeks. The primary endpoint was change in aortic diameter as measured from leading edge adventitia at the anterior wall to leading edge adventitia at the posterior wall in systole. All ultrasound scans were read in a central imaging laboratory. Results Some 326 patients (mean age 70·8 years; 88·0 per cent men) were included in the trial. The overall mean growth rate was 2·42 mm during the 12-month study. There was no statistically significant difference in growth between patients receiving placebo and those in the three dose groups of pemirolast. Similarly, there were no differences in adverse events. Conclusion Treatment with pemirolast did not retard the growth of medium-sized AAAs. Registration number: NCT01354184 (https://www.clinicaltrials.gov).

Hyperhidrosis of the palms, axillae and face has a strong negative impact on social and professional life. The existing non-operative therapeutic options seldom give sufficient relief and have a transient effect. A definitive cure can be obtained by upper thoracic sympathectomy. The traditional open surgical techniques are major procedures and few patients and surgeons have found that the risk--benefit consideration favoured surgery. Since 1987, the authors have divided the upper thoracic sympathetic chain on 1163 patients with a simple endoscopic technique by using standard urological equipment. A bilateral procedure takes less than 20 min and requires just one night in hospital. There have been no mortality or life-threatening complications. Ten patients (1%) required intercostal drainage because of haemo- or pneumothorax. Horner's syndrome occurred in four cases. Primary failure occurred in 23 cases (2%) and 24 (2%) developed recurrent symptoms. The patients with failure and recurrence were successfully reoperated on and only three have required a third operation. At the end of postoperative follow-up (median 31 months) 98% of the patients were satisfied. Endoscopic transthoracic sympathicotomy is an efficient, safe and minimally invasive surgical method for the treatment of palmar, axillary and facial hyperhidrosis.

Objectives:To test the hypothesis that oral ciprofloxacin is equally effective as intravenous cefuroxime in preventing postoperative infectious complications in patients undergoing peripheral arterial surgery involving the groins.Design:Prospective, randomised, double-blind multicentre study.Materials:580 patients undergoing arterial surgery involving the groins were randomised to ciprofloxacin (Ciproxin, Bayer) 750 mg × 2 p.o. or cefuroxime (Zinacef, Glaxo) 1.5 g × 3 i.v. given only on the day of surgery. The primary endpoint was wound/graft infection within 30 days postoperatively. Wound infection was defined as pus.Results:The wound infection rate in the ciprofloxacin group was 9.2% (27 patients) and in the cefuroxime group 9.1% (26 patients) according to intention to treat. For correct treatment the corresponding numbers were 9.5% (23 patients) and 9.7% (22 patients), respectively. There were three graft infections (0.5%). The infection rate was 7.1% (31/433) in the absence and 14.9% (22/147) in the presence of distal ulcers (p

Background The purpose of this study was to clarify the long-term effects, side-effects and overall satisfaction rates of endoscopic thoracic sympathectomy (ETS) used in the treatment of hyperhidrosis and facial blushing. Methods Some 3015 patients had bilateral ETS from 1989 to 1998. A questionnaire follow-up was used. Some of the patients had participated in a previous follow-up study, and the answers in both surveys were compared. Results A total of 1700 patients responded (56·4 per cent); mean(s.d.) follow-up was 14·6(2·4) years. The best result was achieved for palmar hyperhidrosis (95·6 per cent) compared with axillary hyperhidrosis (68·9 per cent), facial hyperhidrosis (83 per cent) and facial blushing (72·8 per cent) (P < 0·001). Compensatory sweating, the main side-effect, was present in 80·0 per cent. Some 6·5 per cent were dissatisfied and 13·5 per cent regretted having the procedure. Patients with palmar hyperhidrosis were more satisfied (86·6 per cent) than those with axillary hyperhidrosis (66·0 per cent), facial hyperhidrosis (74 per cent) or facial blushing (73·5 per cent) (P < 0·001). Women were more satisfied than men (85·4 versus 71·4 per cent; P < 0·001). The procedure regret rate rose from 7·8 per cent in the first survey to 13·5 per cent in the present one. Conclusion ETS had an excellent and lasting effect on palmar hyperhidrosis. The effect on facial and axillary hyperhidrosis and facial blushing was less rewarding. The procedure regret rate increased over time.

The thoracoscopic technique has simplified surgery on the upper thoracic chain. This comparatively minimally traumatic approach has resulted in a pronounced increase in the number of procedures. The effect of ETS on severe palmar hyperhidrosis and facial blushing is very good. These conditions often cause social, professional and emotional handicaps. Side-effects, especially compensatory sweating (increased sweating on the trunk and legs), can, however, be severe. The procedure should be used only when the hyperhidrosis or facial blushing is severely detrimental to the quality of life. The expected effects, side-effects and risks for complications must be made clear before patients are accepted for ETS.

Endoscopic transthoracic sympathicotomy, otherwise an established treatment for palmar hyperhidrosis, was used to treat patients troubled by facial blushing, one of the commonest symptoms of social phobia. The results were evaluated by means of a questionnaire answered by 90 per cent (219/244) of the patients, who rated their symptoms on a visual analogue scale (0-10) after a mean follow-up of eight months. According to the ratings, blushing was significantly reduced from a mean (+/- SEM) of 8.7 +/- 0.1 to 2.2 +/- 0.2 (p0.0001). Of the series as a whole, 85 per cent declared themselves satisfied with the outcome.

Facial blushing is one of the cardinal symptoms of social phobia and has a strong negative impact on the quality of life. Traditional therapeutic options are psychotherapy and pharmacological treatment. The results of these treatments on facial blushing are poorly documented. To investigate whether endoscopic bilateral transection of the upper thoracic sympathetic chain is efficient in the treatment of facial blushing, 244 consecutive patients were treated with bilateral endoscopic transthoracic sympathicotomy (ETS). The results were evaluated by questionnaire and symptoms assessed with visual analogue scales (0-10). There was no mortality nor conversion to open surgery. No Horner's syndrome occurred. Two patients with postoperative pneumothorax were treated with intercostal drainage and one small pulmonary embolus was detected. The questionnaire was answered by 219 patients (90%) a mean (+/- SEM) of 8 months (+/- 9 days) after surgery. Facial blushing (mean +/- SEM) was reduced from 8.7 +/- 0.1 to 2.2 +/- 0.2, P0.0001, by the operation. Heart palpitations in stressful situations were also reduced (3.7 +/- 0.3 to 1.3 +/- 0.1, P0.0001). The quality of life was substantially improved. The main side-effect was redistribution of sweating from the upper to the lower part of the body. Increased sweating of the trunk occurred in 75% of the patients. Overall, 85% of the patients were satisfied with the result and 15% were to some degree dissatisfied, mainly due to insufficient effect, but only four patients (2%) regretted the operation. As this is an open study, the results must be viewed with caution. ETS, however, appears to be an efficient, safe and minimally invasive surgical method for the treatment of facial blushing.

Transthoracic endoscopic electrocautery of the upper thoracic ganglia was applied to seven patients with sympathetically maintained pain (SMP) in the upper extremity, diagnosed by local anaesthetic stellate ganglion blocks. The mean (SD) pain intensity of 67 (13) mm as evaluated by means of a visual analogue scale was reduced by 79 (27%) postoperatively and this effect persisted after 3 months. Long term follow up comprises two patients so far (one year and two years, respectively) who have had no recurrence of SMP. No complications occurred. The operation was found to be fast, safe and effective and it highlights the enigmatic role of the sympathetic nervous system in chronic pain.

As early as in 1889 surgery on the cervical sympathetic nervous system was performed. During the following decades this operation was tried for a variety of diseases. In the early 1920s it was clarified that patients with hyperhidrosis, vasospastic conditions, and angina pectoris would benefit from stellectomy. It was, however, soon discovered that removal of the upper thoracic ganglia was required in order to obtain complete sympathetic denervation of the upper extremity. Several open surgical techniques for upper thoracic sympathectomy were described. During the 1940s a few pioneers started to excise sympathetic ganglia by thoracoscopy which had originally been described as a diagnostic tool by Jacobaeus in 1910. The endoscopic approach, amply documented by Kux in 1954, did not, however, gain widespread popularity until the 1980s. Like the general upsurge of interest in endoscopic surgery, thoracoscopic ablation of the upper thoracic sympathetic ganglia is now rapidly being adopted by surgeons.

Thoracic sympathectomy is a very effective treatment of palmar hyperhidrosis. The described endoscopic technique has given good primary results in 99% of patients. After another session with this type of "minimal invasive surgery" 100% of the hands were satisfactorily dry. The hospital stay is just one post-operative day and the sick-leave is about a week. The drawbacks are minimal. Pain is tolerable and only eight patients needed a post-operative Bülau-drainage because of pneumothorax or bleeding. About 50% of patients experience a compensatory increased sweating of the trunk, but this is related to a warm environment and regulation of body temperature and seems to decrease with time. This technique makes it possible to treat all those suffering from palmar hyperhidrosis which can be a substantial, but underestimated handicap. To meet this kind of patient after a successful operation is extremely satisfying even for the surgeon. The post-operative wet and cold hand has immediately post-operatively become warm and dry.

Bilateral endoscopic electrocautery of the upper thoracic sympathetic ganglia (T2-4) was performed, mainly for palmar hyperhidrosis, on 535 patients. The aim of this study was to evaluate the effects of this procedure on cardiac and physical performance. A subgroup of 18 patients underwent cycle ergometer test with ECG recordings before and three months after surgery. After the operation, a significantly reduced heart rate at rest (12%) as well as during exercise and during recovery after exercise was found. The systolic blood pressure was reduced only at rest (7%) and the diastolic blood pressure was not significantly altered. Maximal workload was not affected by the operation and only a few patients had noticed their reduced heart rate. Three patients with angina pectoris and three with incapacitating tachycardia related to mental stress were operated on with excellent results. Thoracoscopic sympathicotomy is a safe, fast, cheap and efficient method for cardiac sympathetic denervation. This procedure might constitute an alternative to long-term thoracic epidural anaesthesia and implantation of thoracic electric stimulation devices in patients not suited for aortocoronary by-pass. Patients who require cardiac beta-receptor blockers and suffer from side effects of these drugs might also benefit from surgical cardiac sympathetic denervation.

Arterial insufficiency of the hands due to vascular spasm-morbus Raynaud is an extremely unpleasant condition. Elicited by cold temperatures, the disease can make it impossible for the patient to go out in cold environments. The condition seldom leads to skin necrosis, which is the case in arterial insufficiency caused by vascular occlusion. In both cases arterial insufficiency may be diminished by thoracic sympathectomy. Our test series of operations included 14 patients with m. Raynaud or vascular occlusion. All experienced improvement, with warm, dry hands and satisfactory healing after thoracoscopic sympathicotomy. However, after six months, the original symptoms recurred in all the patients with m. Raynaud, while the improvement continued in the patients with vascular occlusion during the two to four year period of observation.

Open surgical sympathectomy has previously been shown effective in relieving severe angina pectoris. The method was hampered by high morbidity and mortality. The authors have developed a minimally invasive technique of dividing only the sympathetic chain endoscopically and obtained good results with no serious complications in patients operated on for severe palmar hyperhidrosis. This method was used in 43 patients with severe angina pectoris who were not eligible for coronary artery bypass grafting or percutaneous transluminal coronary angioplasty. There was no mortality or any severe complications. Some 19 patients became symptom-free while 22 were improved and two unchanged after surgery. The frequency of anginal attacks was significantly reduced, as was the consumption of nitroglycerine tablets. The maximum exercise capacity was significantly increased and ST-segment depression reduced.

We evaluated the antianginal effects of endoscopic transthoracic sympathicotomy (ETS) in 24 patients not eligible for coronary bypass surgery or angioplasty. In this procedure, the sympathetic chain is electrocoagulated under general anaesthesia. No major surgical complications occurred. The frequency of anginal attacks was significantly reduced (p = 0.001). The mean increase in maximum exercise capacity was 13 (SD 21) W (p = 0.009). ST depression at maximum comparable workload was reduced by 0.052 (0.10) mV (p = 0.005). Global ejection fraction during exercise and metaiodobenzylguanidine uptake were unchanged. Heart rate variability analysis showed a reduction of the ratio between low and high frequencies at tilt test (-1.00 [0.96]; p < 0.001). We conclude that ETS can be done without major complications, alleviates angina, and increases maximum working capacity in patients with advanced coronary disease.

Malnutrition, as well as malignancy, induces alterations in heart metabolism and performance. Previous studies have implicated adrenergic mechanisms as the cause. The present study was undertaken to investigate if the adenylate cyclase system in the rat heart was affected by malnutrition. Three different animal groups with malnutrition were compared with a control group: rats with acute starvation for 14-96 hours, rats with protein-calorie malnutrition for 2 weeks, and rats with tumors. Stimulation by beta-adrenergic receptors and inhibition by muscarinic receptors of adenylate cyclase activity were not altered by malnutrition. However, conditions used for in vitro adenylate cyclase determinations were, of necessity, not physiological. Neither did the number of beta-adrenergic and muscarinic receptors change. When competition-binding experiments were performed, differences comprising agonist affinity and affinity state distribution were noted among the groups. The myocardial beta-adrenergic receptors formed a reduced number of high-affinity sites in all groups as compared with the control rats. All high-affinity sites displayed a more than 10-fold increase in affinity toward isoproterenol and an impaired sensitivity to guanine nucleotides except in heart membranes derived from rats starved less than 48 hours. While the protein-calorie restricted and the tumor-bearing rats had myocardial beta-adrenergic receptors that were unresponsive to guanine nucleotides, after 48 hours of starvation the rats exhibited an attenuated guanine-nucleotide-induced affinity shift. No changes associated with malnutrition in myocardial membrane levels of the of the stimulatory guanine-nucleotide-binding protein were detected by cholera-toxin-induced ADP-ribosylation.(ABSTRACT TRUNCATED AT 250 WORDS)

This article reports an investigation of the technical and economic aspects of the multiple use of bibliographic data and abstracts of articles in machine readable format. Various techniques such as OCR, word processing, and photocomposition are available for data acquisition and transmission. There is also sufficient economic justification to encourage sharing of such data among publishers. But questions of cost sharing, standards copyright, and procedural adjustments in management and accounting are powerful deterrents to the multiple use of publication data both within an organization and among different publishing concerns. The advantages of sharing bibliographic data can be achieved only if publishing concerns in both the public and private sectors are willing to cooperate and adjust.

Objectives To test the hypothesis that long-term postoperative dalteparin (Fragmin®, Pharmacia Corp) treatment improves primary patency of peripheral arterial bypass grafts (PABG) in lower limb ischemia patients on acetylsalicylic acid (ASA) treatment. Design Prospective randomised double blind multicenter study. Materials and methods Using a computer algorithm 284 patients with lower limb ischemia, most with pre-operative ischemic ulceration or partial gangrene, from 12 hospitals were randomised, after PABG, to 5000 IU dalteparin or placebo injections once daily for 3 months. All patients received 75 mg of ASA daily for 12 months. Graft patency was assessed at 1, 3 and 12 months. Results At 1 year, 42 patients had died or were lost to follow-up. Compliance with the injection schedule was 80%. Primary patency rate, in the dalteparin versus the control group, respectively, was 83 versus 80% (n.s.) at 3 months and 59% for both groups at 12 months. Major complication rates and cardiovascular morbidity were not different between the two groups. Conclusions In patients on ASA treatment, long-term postoperative dalteparin treatment did not improve patency after peripheral artery bypass grafting. Therefore, low molecular weight heparin treatment cannot be recommended for routine use after bypass surgery for critical lower limb ischemia.

This article reports on five separate studies designed for the National Library of Medicine (NLM) to develop and test methodologies for evaluating the products of large databases. The methodologies were tested on literatures of the medical behavioral sciences (MBS). One of these studies examined how well NLM covered MBS monographic literature using CATLINE and OCLC. Another examined MBS journal and serial literature coverage in MEDLINE and other MBS-related databases available through DIALOG. These two studies used 1010 items derived from the reference lists of sixty-one journals, and tested for gaps and overlaps in coverage in the various databases. A third study examined the quality of the indexing NLM provides to MBS literatures and developed a measure of indexing as a system component. The final two studies explored how well MEDLINE retrieved documents on topics submitted by MBS professionals and how online searchers viewed MEDLINE (and other systems and databases) in handling MBS topics. The five studies yielded both broad research outcomes and specific recommendations to NLM.

Growing rats and adult weight-stable mice bearing a transplantable methylcholanthrene-induced sarcoma were compared with animals with various states of malnutrition. Heart protein synthesis was measured in vivo. Myocardial RNA, myofibrillar protein composition and the Ca2+-activated ATPase activity in heavy chains of native myosin were measured. ‘Fingerprints’ were made from myosin by trypsin treatment to evaluate possible structural changes in the protein. Cardiac protein-synthesis rate was decreased by 20% in growing tumour-bearing rats, by 35% in protein-malnourished (rats) and by 47% in starved rats, compared with freely fed controls (P less than 0.05). Adult tumour-bearing mice showed no significant decrease in myocardial protein synthesis. Pair-weighed control mice had significantly depressed heart protein synthesis. Protein translational efficiency was maintained in both tumour-bearing rats and mice, but was decreased in several groups of malnourished control animals. The Ca2+-activated myosin ATPase activity was decreased in all groups of malnourished animals, including tumour-bearing mice and rats, without any evidence of a change in cardiac isomyosin composition. We conclude that loss of cardiac muscle mass in tumour disease is communicated by both depressed synthesis and increased degradation largely owing to anorexia and host malnutrition. Increased adrenergic sensitivity in hearts from tumour-bearing and malnourished animals is not communicated by increased Ca2+-activated ATPase activity. This may be down-regulated in all groups with malnutrition, without any observable alterations in the isomyosin profile.

Secondary aortoenteric fistulas are seen with an increasing frequency which parallels the expansion of reconstructive vascular surgery. During a 12-year period 42 cases have been collected from the hospitals, which perform most of the vascular surgery in Sweden (0.7% of vascular operations). Twenty-five were seen after operation for aortic aneurysm, 15 for aortoiliac occlusive disease, one after renal artery ligation (as a part of reconstruction for renovascular hypertension) and one after operation for an iliac pseudoaneurysm. The frequency of complications during and after the primary operation was high. The interval between operation and onset of fistula symptoms was significantly shorter if there had been infectious complications, the median interval was 32 months, the longest being 10 years. The most important symptom was gastrointestinal haemorrhage, consisting of several small bleeds often combined with septic complications. A large number of negative investigations usually preceded the final diagnosis which was made at exploratory laparotomy. After surgery for the fistula the frequency of complications and mortality, were very high. Mortality was 58%, the most common cause of death being a blow out of the aortic stump. Of those leaving hospital, several further operations were performed with a high mortality. Recurrence of the fistula occurred in 16 out of 34 patients who survived surgery. At follow-up (12-74 months after fistula closure) seven patients were still alive.

Plasma concentrations and in-vitro production of interleukin-1 and tumour necrosis factor were evaluated in 23 weight-losing patients with cancer, six bacterially infected patients without cancer and six healthy controls. Bioactivity of interleukin-1 was found in the plasma from five of six bacterially infected patients but only from one of 23 cancer patients. Tumour necrosis factor activity was not detected in the plasma of any patient. In four of 23 patients with cancer, in-vitro stimulation of peripheral blood monocytes by either endotoxin or heat-killed Staphylococcus albus resulted in no significant production of interleukin-1. Such a defect was not seen in any of the bacterially infected or control patients. Tumour necrosis factor production by endotoxin-stimulated blood monocytes was unaffected by the presence of cancer or bacterial infections and was normal in the four individuals with defective interleukin-1 production. We can therefore conclude that interleukin-1 bioactivity is not generally found in the plasma of weight-losing cancer patients. Furthermore, in a fraction of such cancer patients, monocytic production of interleukin-1 is markedly down-regulated. However, this defect appears to be specific for interleukin-1 since in-vitro tumour necrosis factor production is normal.

A 4-year-old boy presented with recurrent abdominal pain and melena. X-ray studies of the gastrointestinal tract and technetium scanning of the abdomen were normal. Laparotomy revealed a large duplication cyst in the proximal part of the jejunum. The cyst was intramesenteric and contained gastric mucosa with three peptic ulcers. The cyst was removed without bowel resection.

A 19-year-old previously healthy youth developed a deep venous thrombosis and a pulmonary embolism in connection with rupture of a ligament of the left ankle. Two months later, while on effective (thrombotest value 21%) oral anticoagulant therapy, the patient had massive thrombosis of the superior mesenteric splenic and portal veins and died. There was no known predisposition to thrombosis, such as tumour, infection, or trauma. A later examination of a 12-year-old brother revealed decreased fibrinolytic activity in the vessel wall as well as a decreased fibrinolytic response to venous occlusion. Since decreased fibrinolytic activity in the vessel wall is sometimes familial, it seems reasonable to suspect that the same defect might have occurred in the patient with the fatal massive thromboembolic disease.

Endoscopic thoracic sympathectomy (ETS) has gained increasing popularity due to its minimally invasive character. Despite the simplicity of the procedure, non-surgical options should always be considered as the first line of treatment. The complication risk of ETS is low but side effects, primarily compensatory sweating (CS) of mainly the trunk, may be severe enough to cause regret of the procedure. The risk/benefit ratio should always be discussed with the patient. Severe palmar hyperhidrosis and facial blushing respond very well to ETS with a high patient satisfaction rate. Facial hyperhidrosis is effectively treated with ETS, but is associated with a high risk for severe CS. Axillary hyperhidrosis is best treated by means other than ETS. The use of ETS for pain syndromes, vascular insufficiency and angina pectoris is not well supported by scientific evidence, making careful patient selection mandatory.