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Purpose: To investigate the profile of hospital admissions for sympathectomies performed in the Brazilian Unified Health System (SUS), comparing open and video-assisted techniques., Methods: Data on sympathectomies were collected from the SUS Department of Informatics (DATASUS), recorded between 2014 and 2023. The data were tabulated, and descriptive statistics and correlation analyses were performed., Results: There was reduction in the number of admissions for all sympathectomies during the analyzed period. The use of video-assisted surgeries was higher than that of open surgeries for thoracic procedures, but lower for lumbar procedures. The costs of hospital admission for the procedures were similar, although the length of stay and mortality associated with open surgeries were higher, both in thoracic and lumbar sympathectomies., Conclusions: The collected data were not individualized, preventing follow-up. Additionally, the study did not account for procedures performed in the private healthcare system. Despite its limitations, this study provides an overview of sympathectomies in Brazil, indicating that, although open sympathectomies are potentially more disadvantageous, they are still widely performed, especially for lumbar procedures.

Background: Renal denervation (RDN) is under investigation for treatment of uncontrolled hypertension and might represent an attractive treatment for patients with high cardiovascular (CV) risk. It is important to determine whether baseline CV risk affects the efficacy of RDN., Objectives: The purpose of this study was to assess blood pressure (BP) reduction and event rates after RDN in patients with various comorbidities, testing the hypothesis that RDN is effective and durable in these high-risk populations., Methods: BP reduction and adverse events over 3 years were evaluated for several high-risk subgroups in the GSR (Global proSpective registrY for syMPathetic renaL denervatIon in seleCted IndicatIons Through 3 Years Registry), an international registry of RDN in patients with uncontrolled hypertension (n = 2,652). Comparisons were made for patients age ≥65 years versus age <65 years, with versus without isolated systolic hypertension, with versus without atrial fibrillation, and with versus without diabetes mellitus. Baseline cardiovascular risk was estimated using the American Heart Association (AHA)/American College of Cardiology (ACC) atherosclerosis cardiovascular disease (ASCVD) risk score., Results: Reduction in 24-h systolic BP at 3 years was -8.9 ± 20.1 mm Hg for the overall cohort, and for high-risk subgroups, BP reduction was -10.4 ± 21.0 mm Hg for resistant hypertension, -8.7 ± 17.4 mm Hg in patients age ≥65 years, -10.2 ± 17.9 mm Hg in patients with diabetes, -8.6 ± 18.7 mm Hg in isolated systolic hypertension, -10.1 ± 20.3 mm Hg in chronic kidney disease, and -10.0 ± 19.1 mm Hg in atrial fibrillation (p < 0.0001 compared with baseline for all). BP reduction in patients with measurements at 6, 12, 24, and 36 months showed similar reductions in office and 24-h BP for patients with varying baseline ASCVD risk scores, which was sustained to 3 years. Adverse event rates at 3 years were higher for patients with higher baseline CV risk., Conclusions: BP reduction after RDN was similar for patients with varying high-risk comorbidities and across the range of ASCVD risk scores. The impact of baseline risk on clinical event reduction by RDN-induced BP changes could be evaluated in further studies. (Global proSpective registrY for syMPathetic renaL denervatIon in seleCted IndicatIons Through 3 Years Registry; NCT01534299)., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Several factors that could influence the efficacy and satisfaction of patients after bilateral thoracic sympathectomy (VATS) in the treatment of hyperhidrosis (HH) have been studied, but no studies in the literature have specifically analyzed the effectiveness of treatment and variations in the quality of life of adolescents patients compared to those of adult patients (18-40 years)., Methods: We retrospectively analyzed 2431 hyperhidrosis patients who underwent bilateral VATS and divided the patients into the following groups: adolescents (472 patients) and adult group (1760 patients). Variables included quality of life prior to surgery, improvement in quality of life after surgery, clinical improvement in sweating, presence of severe compensatory hyperhidrosis and general satisfaction at one month after surgery., Results: We observed that all surgical patients presented with poor or very poor quality of life before surgery, with similar proportions in both groups. In the postoperative period, we observed improvement in quality of life in more than 90% of the patients, with no significant difference noted between the two groups of patients. We observed that all patients undergoing surgery presented poor or very poor quality of life before surgery; however, the two groups were statistically different. The quality of life of the ADOLESCENT group before surgery was statistically worse than that of the ADULT group. More than 90% of the patients in this series had great clinical improvement in the main hyperhidrosis site, with no significant difference between the two groups. Severe compensatory hyperhidrosis occurred in 23.8% of the patients in this series, with no significant difference between the two groups., Conclusions: Adolescent patients benefit just as much as adult patients from VATS performed to treat primary hyperhidrosis, presenting excellent, significant surgical results., Type of Study: Clinical research., Levels of Evidence: Level III., (Copyright © 2019. Published by Elsevier Inc.)

Aim of the Study: Non-intubated, video-assisted thoracoscopic surgery (NiVATS) has been successfully developed in several centres worldwide. Local anaesthesia techniques and techniques to perform thoracoscopic surgery on a spontaneously breathing lung are the two key elements which must be adopted to establish a NiVATS programme. We established NiVATS by performing bilateral, uniportal sympathectomies, and compared it to classical video-assisted thoracoscopic surgery (VATS) under general anaesthesia with double-lumen intubation., Methods: Ten consecutive bilateral VATS sympathectomies were compared with ten consecutive NiVATS procedures. Nineteen of the procedures were for palmar hyperhidrosis and one was for facial blushing. Duration of anaesthesia, surgery and hospitalisation, perioperative complications, side effects and quality of life before and after sympathectomy were analysed., Results: Median age was 26.5 years (range 17&ndash;55) and mean BMI in the NiVATS group was 21.8 (range 19.1&ndash;26.3). NiVATS sympathectomies were performed as outpatient procedures significantly more often (9/10 vs 3/10, p = 0.008). Quality of life was significantly increased after sympathectomy in all patients, with no significant differences between the NiVATS and the VATS groups. There were no differences between the two groups regarding compensatory sweating (40 vs 50%, p = 0.66). The duration of anaesthesia, not including the time required for the surgery, was significantly shorter in the NiVATS group (p &lt;0.001). The duration of surgery, from the first local anaesthesia until the last skin suture, was significantly longer in the NiVATS group (p = 0.04), but showed a constant decline during the learning curve, from 95 minutes initially to 48 minutes for the last procedure. Costs were significantly lower in the NiVATS group (p = 0.04)., Conclusion: Thoracoscopic sympathectomy is a suitable procedure with which to establish a NiVATS programme. Patients are usually young and of healthy weight, facilitating the learning curve for the local anaesthesia techniques and the surgery. Compared to VATS, sympathectomy is more likely to be performed as an outpatient procedure and has a lower cost, while safety and efficacy are maintained.

Background: Renal denervation (RDN) is a catheter-based intervention to treat patients with resistant hypertension. The biological effects of RDN are not fully understood, and randomized controlled trials have generated conflicting evidence. This report presents data from the Swedish Registry for Renal Denervation, an investigator-driven nationwide registry., Purpose: To assess the safety and efficacy of RDN on patients with resistant hypertension in a real-world clinical setting., Methods: This nationwide database contains patient characteristics, procedural details, and follow-up data on all RDN procedures performed in Sweden. Consecutive procedures between 2011 and 2015 were included., Results: The data analysis consists of 252 patients (mean age 61 ± 10 years, 38% women; mean 4.5 ± 1.5 antihypertensive drugs). Office SBP and DBP and 24-h ambulatory blood pressure (BP) decreased 6 months after RDN (176 ± 23/97 ± 17 to 161 ± 26/91 ± 16 mmHg, both P < 0.001; and 155 ± 17/89 ± 14 to 147 ± 18/82 ± 12 mmHg, both P < 0.001). Significant office and ambulatory BP reductions persisted throughout the observation period of 36 months. Major procedure-related vascular complications occurred in four patients. Renal function and number of antihypertensive drugs were unchanged during follow-up., Conclusion: In this complete national cohort, RDN was associated with a sustained reduction in office and ambulatory BP in patients with resistant hypertension. The procedure proved to be feasible and associated with a low-complication rate, including long-term adverse events.

Background/objectives: Short-term blood pressure variability (BPV) is affected by multiple factors including the sympathetic nervous system drive. Regarding the latter, the novel interventional technology of renal denervation (RDN), by modulating the sympathetic system activation, could have a beneficial impact on BPV. The aim of the current study is to review and meta-analyze the available evidence on the effect of RDN on short-term BPV., Methods: We searched Medline/PubMed database until October 2016 for studies with eligible content. We performed random-effect meta-analyses for 12 outcomes of interest: the standard deviation (SD) of SBP (24 h, daytime and night-time) and DBP (24 h, daytime and night-time), the weighted SD of SBP and DBP across 24 h, the coefficient of variation of SBP and DBP across 24 h and the average real variability of SBP and DBP across 24 h., Results: RDN reduced the SD of SBP across 24 h [mean change: -1.212 (95% confidence intervals (CIs): -2.354/-0.071), P = 0.037] and decreased the SD of systolic daytime BP [mean difference: -1.617 (95% CIs: -3.21/-0.026), P = 0.046] and diastolic daytime BP (marginally) [mean difference: -2.605 (95% CIs: -5.21/-0.003), P = 0.05]. The effect of RDN in reducing SD of SBP across 24 h or DBP across daytime was not influenced by absolute or relative reduction in SBP and DBP indices. (P > 0.1 for all)., Conclusion: Catheter-based RDN in resistant hypertensive patients can favorably affect short-term BPV, independent of the level of BP reduction. Further investigation of the effect of RDN on BPV is needed with large randomized trials.

Purpose: Left sympathetic cardiac denervation (LSCD) may be beneficial in treating electrical storm (ES) of varied aetiologies. The present study analyse the outcome and long term follow up of LSCD in treating ES., Methods: This is a retrospective study of patients with ES who underwent LSCD., Results: Nine patients (majority males (88.89 %), median age 52 years, IQR 50.5-56.5) underwent LSCD. Coronary artery disease was the commonest substrate (7 (77.78 %)). Five patients, who had hypotension and unstable hemodynamics, underwent percutaneous stellate ganglion blockade. Three of the survivors subsequently underwent surgical sympathectomy. In the remaining four, video assisted thoracoscopy (VATS) guided sympathectomy was performed. Five (55 %) and seven (77.78 %) had a >90 and 80 % reduction in ventricular arrhythmias (VA), respectively. LSCD was ineffective in one patient, who succumbed to ES. There was no difference in outcome between patients with monomorphic versus polymorphic VA (60 vs 70 %, respectively, p = 0.82). One (11.1 %) patient had sudden death on the fifth day after LSCD. The median hospital stay was 13 days (IQR 11-16). During median 34 months of (IQR 18-46) follow up, one patient died of heart failure, and another had recurrence of ES. There was sustained reduction in VA burden in others., Conclusion: LSCD is effective in controlling ES and continues to reduce the incidence of VAs during long term follow up. Pharmacological LSCD needs particular emphasis, as it can be performed at bedside, and can be a bail-out procedure in centres where sophisticated procedures like VATS-guided LSCD or radiofrequency ablation are not readily available.

Background: Percutaneous renal denervation (RDN) has recently been introduced as a treatment for therapy-resistant hypertension. Also, it has been suggested that RDN may be beneficial for other conditions characterised by increased sympathetic nerve activity. There are still many uncertainties with regard to efficacy, safety, predictors for success and long-term effects. To answer these important questions, we initiated a Dutch RDN registry aiming to collect data from all RDN procedures performed in the Netherlands., Methods: The Dutch RDN registry is an ongoing investigator-initiated, prospective, multicentre cohort study. Twenty-six Dutch hospitals agreed to participate in this registry. All patients who undergo RDN, regardless of the clinical indication or device that is used, will be included. Data are currently being collected on eligibility and screening, treatment and follow-up., Results: Procedures have been performed since August 2010. At present, data from 306 patients have been entered into the database. The main indication for RDN was hypertension (n = 302, 99%). Patients had a mean office blood pressure of 177/100 (±29/16) mmHg with a median use of three (range 0-8) blood pressure lowering drugs. Mean 24-hour blood pressure before RDN was 157/93 (±18/13) mmHg. RDN was performed with different devices, with the Simplicity™ catheter currently used most frequently., Conclusion: Here we report on the rationale and design of the Dutch RDN registry. Enrolment in this investigator-initiated study is ongoing. We present baseline characteristics of the first 306 participants.

Introduction and Objectives: The Working Group on Cardiac Catheterization and Interventional Cardiology presents its annual report on the data from the registry of the activity in Spain in 2014., Methods: Data were voluntarily provided by participating centers. The information was introduced online and was analyzed by the Steering Committee of the Working Group on Cardiac Catheterization and Interventional Cardiology., Results: Data were reported by 106 hospitals. A total of 140 461 diagnostic procedures (125 484 coronary angiograms) were performed, representing a rate of 3014 diagnostic studies per million population. This year, the number of percutaneous coronary interventions increased to 67 611, giving a rate of 1447 interventions per million population. A total of 94 458 stents were implanted, including 64 057 drug-eluting stents and 2424 biodegradable intracoronary devices. Of the total number of percutaneous coronary interventions, 17 825 were in acute myocardial infarction, representing 26.4% of all coronary interventions. A radial approach was used in 74% of diagnostic procedures and in 70.4% of interventional procedures. The use of renal denervation decreased, whereas over 125 mitral leak closures were performed. Transcatheter aortic valve implantation procedures exceeded 1300 implantations per year, a 27% increase from 2013., Conclusions: The registry for 2014 shows a slight increase in coronary disease activity despite no increase in the management of ST-segment elevation myocardial infarction. Drug-eluting intracoronary devices now comprise over 70% of all intracoronary devices. A continual increase is only seen in certain structural interventional techniques, such as transcatheter aortic valve implantation and perivalvular leak closure., (Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Limited procedures at the T4 ganglion show low rates of compensatory sweating (CS). The aim of the study was to compare endoscopic sympathetic block (ESB) via clip application with endothoracic sympathicotomy (ETS) via diathermy with special regard on patients' quality of life (Qol)., Patients and Methods: Treatment success, side effects and patient satisfaction were evaluated in a prospectively gathered database of a tertiary-care referral hospital. Two disease-specific Qol questionnaires were used (Keller, Milanez de Campos)., Results: 406 operations were performed in 205 patients (ESB4 N = 114, ETS4 N = 91) with a median follow-up of 12 months. Both procedures improved Qol significantly (P < 0.001) and the degree of improvement was equal in both groups. Palmar and axillary HH were ameliorated after both procedures (P < 0.001). Accordingly, plantar HH decreased after ESB4 (P = 0.002), while remaining unaltered after ETS4. Nineteen patients (9.3%) reported CS and 10 patients (4.9%) judged it as "disturbing". Nine of the latter belonged to the ETS4 group compared to one ESB patient (P = 0.015). Patients developed higher rates of plantar CS after ETS4 compared to ESB4 (P = 0.006). Five patients (2.4%) from both cohorts reported persistence of axillary HH. Recurrence of axillary symptoms was found in 5 ESB4 patients. Satisfaction rates did not differ significantly., Conclusion: Patients' Qol and satisfaction rates are similar in both treatment groups for upper limb HH. Outcome and recurrence rates speak in the favor of ETS4, severity of CS and potential reversibility argue for ESB4., (Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.)

Objective: To review surgical results of endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis during the past decade., Patients and Methods: We retrospectively reviewed 155 consecutive patients who underwent surgery from June 30, 2000, through December 31, 2009, for medically refractory palmar-plantar hyperhidrosis using a technique of T1-T2 sympathotomy disconnection, designed for successful palmar response and minimization of complications., Results: Of the 155 patients, 44 (28.4%) were male, and 111 (71.6%) were female; operative times averaged 38 minutes. No patient experienced Horner syndrome, intercostal neuralgia, or pneumothorax. The only surgical complication was hemothorax in 2 patients (1.3%); in 1 patient, it occurred immediately postoperatively and in the other patient, 10 days postoperatively; treatment in both patients was successful. All 155 patients had successful (warm and dry) palmar responses at discharge. Long-term follow-up (>3 months; mean, 40.2 months) was obtained for 148 patients (95.5%) with the following responses to surgery: 96.6% of patients experienced successful control of palmar sweating; 69.2% of patients experienced decreased axillary sweating; and 39.8% of patients experienced decreased plantar sweating. At follow-up, 5 patients had palmar sweating (3 patients, <3 months; 1 patient, 10-12 months; 1 patient, 16-18 months). Compensatory hyperhidrosis did not occur in 47 patients (31.7%); it was mild in 92 patients (62.2%), moderate in 7 patients (4.7%), and severe in 2 patients (1.3%)., Conclusion: In this series, a small-diameter uniportal approach has eliminated intercostal neuralgia. Selecting a T1-T2 sympathotomy yields an excellent palmar response, with a very low severe compensatory hyperhidrosis complication rate. The low failure rate was noted during 18 months of follow-up and suggests that longer follow-up is necessary in these patients.

Hyperhidrosis palmaris (HP) is a rather common disease in Taiwan. Taiwan is a leading nation in terms of the surgical treatment of this disease using thoracic endoscopic sympathectomy. However, the currently available epidemiological information regarding HP is insufficient. To date, the incidence of HP and the percentage of patients treated surgically have not been reported. We investigated the incidence of HP treated in 2004 by sampling Taiwan's National Health Insurance database. Patients who were diagnosed with HP during 2004 were identified by International Classification of Diseases, 9(th) Clinical Modification code 780.8 from a database of about 22 million beneficiaries, and were followed to 2006. Those who had been diagnosed as HP in 2002 or 2003 were excluded. Patients who underwent surgery were identified by the treatment codes 83026C (dorsal sympathectomy) and 83085B (transendoscopic dorsal sympathectomy, TES). Factors included in the analysis included age, sex, time of operation and hospitalization for surgery. In total, 15,839 patients with HP were identified. The incidence was 7.2 per 10,000 beneficiaries. The study sample included 7,603 males with an incidence of 6.9 per 10,000 beneficiaries, and 8,236 females with an incidence of 7.4 per 10,000 beneficiaries. The incidence was highest among patients aged 20-29 years old. The incidence decreased with increasing age (Mantel-Haenszel chi(2) test for trend, p < 0.001), and 3,755 cases (23.7%) received an operation, of which 1,733 were male (22.8% of all male patients) and 2,022 were female (24.6% of all female patients) (p = 0.009). Of these, 99.3% underwent transendoscopic dorsal sympathectomy, and 94.7% underwent surgery within 1 month of the initial diagnosis. Males underwent surgery sooner than females (p = 0.004). Adjusted multivariate logistic regression analysis showed that patients aged 20-29 were more likely to undergo surgery than the other age groups (odds ratio: 2.28; 95% confidence interval: 2.07-2.52). Regional hospitals had the highest chance to perform the operation (odds ratio: 4.87; 95% confidence interval: 4.41-5.37). Here, we have reported the incidence of HP in Taiwan in 2004 and concluded that the incidence was higher in females than in males. About one-quarter of patients underwent surgery, mostly within 1 month after attending an outpatient clinic; most surgical interventions involved endoscopic sympathectomy. This report fulfills the epidemiological information gap of HP and provides important data for future health care delivery., (Copyright 2010 Elsevier. Published by Elsevier B.V. All rights reserved.)

Background: Endoscopic thoracic sympathectomy (ETS) was overused for treating patients with hyperhidrosis in Taiwan., Objectives: To determine whether use of evidence and a consensus-building exercise can reduce rates of surgery., Methods: We invited all surgeons in Taiwan who performed five or more ETSs per year for treating patients with hyperhidrosis to join this study. A structured questionnaire was mailed to surgeons asking about their management decisions based on clinical scenarios. Then we provided surgeons with evidence synopses and used the Delphi method to reach consensus. We analyzed healthcare utilization data during 2000 to 2005 and calculated total numbers of ETSs performed per 12 months to examine the effect on surgeons' behavior., Results: Of 155 surgeons invited, 61 (40%) completed this study. They agreed that observation or topical therapy was appropriate for patients with mild palmar hyperhidrosis, whereas ETS was appropriate for children, adolescents, and young and middle-aged adults who had severe symptoms. Surgeons became more willing to recommend botulinum toxin injection after we provided evidence synopses. We found a 52% reduction in mean total ETSs per 12 months in surgeons receiving evidence synopses. A higher percentage of reduction occurred in patients younger than 12 and aged 60 and older., Conclusion: Evidence-based consensus development is helpful in decreasing overuse of ETS in treating patients with hyperhidrosis in Taiwan.

Objective: Endoscopic thoracic sympathectomy (ETS) remains the definitive treatment for primary focal hyperhidrosis. Compensatory hyperhidrosis (CH) is a significant drawback of ETS. We sought to identify the predictors for the development of severe CH after ETS, its anatomic locations, and its frequency of occurrence, and we analyzed the impact of CH on patient satisfaction with ETS., Methods: Bilateral ETS for primary focal hyperhidrosis was performed in 220 patients, and a retrospective chart review was conducted. Follow-up evaluation was conducted using a telephone questionnaire, and 73% of all patients were contacted. Patients' responses regarding CH and their level of satisfaction after ETS were analyzed. Statistical analysis was performed using SPSS software (Version 14.0; SPSS, Inc., Chicago, IL). A P value of <0.05 was considered statistically significant., Results: Some degree of CH developed in 94% of patients. The number of levels treated was not related to the occurrence of severe CH. Isolated T3 ganglionectomy led to a significantly lower incidence of severe CH, when compared with all other levels (P < 0.03). Ninety percent of patients were satisfied with the procedure. The development of severe CH, as opposed to mild or moderate CH, significantly correlated with a lower satisfaction rate (P = 0.003)., Conclusion: CH is common after ETS procedures, and the occurrence of severe, but not mild or moderate, CH is a major source of dissatisfaction after ETS. The overall occurrence of severe CH is reduced after T3 ganglionectomy as opposed to ganglionectomies performed at all other levels. The level of satisfaction with ETS is high.

Background: The purpose of this study is to evaluate the safety and efficacy of thoracoscopic sympathectomy for the treatment of hyperhidrosis, blushing, reflex sympathetic dystrophy, and digital ischemia., Methods: We conducted a retrospective review of 202 patients who underwent thoracoscopic sympathectomy at the University of Maryland from March 1992 to April 2003., Results: Three hundred ninety-seven procedures were performed on 202 patients (105 women, 97 men). Mean age was 29 years (range, 9 to 65). Indications for surgery included hyperhidrosis, facial blushing, digital ischemia, and reflex sympathetic dystrophy. Synchronous bilateral sympathectomies were performed in 194 patients; right side alone (n = 6); left side alone (n = 1); 1 patient had staged bilateral sympathectomies. Single incision with lung isolation technique was used. There was no mortality. Preoperative symptoms resolved completely or significantly improved in greater than 90% of patients. One patient with reflex sympathetic dystrophy recurred and 1 patient with hyperhidrosis complained of significant compensatory sweating. Compensatory sweating to a lesser degree occurred in approximately one third of patients. Complications included asymptomatic pleural effusion (n = 1), pneumothorax (n = 1), and reoperation for chylothorax that was identified early (n = 1). In 2 patients treated for facial blushing, Horner's syndrome developed postoperatively; 1 of them subsequently underwent blepharoplasty. In 3 patients, hyperesthesias developed at the incision., Conclusions: Thoracoscopic sympathectomy can be performed safely and with excellent results. Compensatory sweating is the main side effect, although significant complaints from this are rare. Horner's syndrome remains an extremely uncommon complication as a result of thoracoscopic sympathectomy at our institution.

Operative treatment of patients with Raynaud's Syndrome is rarely used, and is recommended by most authors only in the case of disthrophic changes or so advanced symptoms, which disturb normal social and daily life. Recently, thoracoscopic sympathectomy is applied more frequently. The aim of this study was to assess the usefulness of thoracoscopic sympathectomy by the presentation of early and long-term outcome of 43 thoracic and eight lumbar sympathectomies performed in 41 patients with Raynaud's Syndrome. Transpleural posterio-lateral thoracotomy was performed 29 times in 27 patients, whereas thoracoscopic sympatectomy 14 times in 8 patients. Surgical techniques, early and long-term results were discussed. Based on early and long-term outcome, there were no significant differences between applied surgical techniques. Moreover, thoracoscopic sympathectomy was safe in the aspect of a short duration as well as good therapeutic and cosmetic effect of the procedure. It should be applied instead of others, so far used methods, with the exception of patients with massive pleural adhesions, which need thoracotomy.

Sympathectomy of the thoracic chain is an effective surgical procedure for treating axillary and palmar hyperhidrosis. The procedure has been performed with minimal invasion and good results in recent years through the use of videothoracoscopic surgery. This paper describes the technique and our experience with a series of 50 patients between 16 and 48 years old. The earliest approach was unilateral in successive operations. The procedure was later performed bilaterally, at first with the patients in sequential lateral decubitus positions and later in semi-seated position. Complications were 1 case of incomplete Claude-Bernard-Horner syndrome that resolved spontaneously two months after surgery; 1 failure when sympathectomy was performed without location of the chain, obliging rapid re-operation; laminar pneumothorax in 12% of the series; compensatory hyperhidrosis in 26%; 10% with chest pain due to intercostal involvement, resolving with time; and slight bleeding in 8%. Outcome was excellent, with complete disappearance of axillary and palmar perspiration. Patient satisfaction was 9.2/10 one year after surgery. Mean hospital stay was less than 36 h.

Background: Primary palmar hyperhidrosis is a functionally and socially disabling condition. The choice of treatment is controversial., Objective: To examine the clinical presentation of primary palmar hyperhidrosis and the results of treatment with thoracoscopic sympathectomy in a local setting., Materials and Methods: A retrospective study of 7 patients involving 10 sympathectomies between October 1997 and October 2000 was undertaken., Results: The duration of anaesthesia ranged from 55 to 130 minutes with the majority being 1 hour. The immediate results were good, with all operated limbs dry soon after operation. There was no mortality or serious morbidity in this study. All were satisfied with the results of surgery., Conclusions: Primary palmar hyperhidrosis is not uncommon but rather underdiagnosed. Thoracoscopic sympathectomy is an effective treatment with minimal complications.

Objective: Microvascular disease is one of the hallmarks of systemic sclerosis (SSc, scleroderma), but macrovascular involvement also exists in some patients. Patients with SSc may have severe Raynaud's phenomenon (RP) characterized by refractory digital ulcerations. We investigated if large artery involvement, that is, ulnar artery occlusion, has a role in the development of refractory digital ulcerations, and if both screening for this involvement and revascularization of the ulnar artery occlusive disease may improve digital ulcer healing., Methods: A retrospective chart review was performed of 15 patients with SSc, all of whom had severe RP and digital ulceration, together with a positive Allen test and ulnar artery occlusive disease documented by angiography., Results: Women outnumbered men 2:1, with limited disease predominating (7), 5 patients having diffuse cutaneous disease and 3 overlap syndromes. All patients had positive antinuclear antibody and capillary microscopy findings consistent with SSc. Antiphospholipid antibodies were present in 4 of 6 patients tested. Tobacco use was seen in 5 patients, only 2 of whom were current smokers. All patients failed conventional medical therapy (nitrates, calcium channel blockers, antiplatelet agents) for RP and digital ulceration. Only 1/8 patients improved with stellate ganglion block, and one patient had no improvement following digital sympathectomy. Eight patients underwent ulnar artery revascularization combined with digital sympathectomy, and 8 experienced dramatic improvement in RP and healing of digital ulcers., Conclusion: An Allen test should be performed routinely on all SSc patients with severe RP and refractory digital ulceration to investigate the possibility of ulnar artery occlusive disease. If suspected ulnar artery occlusion is confirmed by angiography or ultrasonography, ulnar artery revascularization with or without digital sympathectomy should be considered in patients who fail conventional medical therapy.

We sent our members questionnaire asking about their activities. From December 1992 to the end of 2000, endoscopic thoracic sympathicotomy (ETS) was utilized in 7,017 cases in 50 hospitals and institutes. Of which 6,776 (96.6%) were performed on hypersweating. There have been no deaths related to ETS either during the hospital stay or following discharge. Intraoperative bleeding was reported in 28 cases (0.3%) and an open chest procedure to stop bleeding was required in 6 cases (0.08%). Short term Horner's syndrome after the operation was found in a few cases, however, permanent symptoms were recognized in only 18 (0.28%). The most common postoperative complaint was compensatory sweating on the chest, back, or abdomen. Most of these patients countered this condition by using several methods of prevention or protection and continued on their daily life with little restriction. However, 83 cases (1.2%) experienced severe compensatory sweating and consulted their doctors repeatedly for more than one year. All operators who perform ETS recognized the excellent results for hand and facial sweating. Further, many doctors prefer this procedure as a first treatment for vascular disorders in upper extremities.

A questionnaire survey was performed in order to investigate the current status of endoscopic thoracic sympathectomy in Japan. Four hundred and twenty-nine (429) university, national or public hospitals with a minimum of 400 beds were included. A total of 248 of these hospitals responded. Among them 63 (25%) performed this procedure. The total of the cases was 1116. The number of access port and the technique for defunctioning the sympathetic chain were broadly divided into three methods. These methods were equally carried out among the departments. The clinical results were judged as satisfactory in the great majority of patients and the frequency of complications was low. On the other hand, the overall incidence of compensatory sweating remained relatively high and accumulated as the number of cases increased. But the reported frequency differed strikingly from hospital probably for lack of an objective way of quantifying following sympathectomy. Although overall complications were infrequent, the need for conventional thoracotomy to stop bleeding occurred in some cases. Therefore even this simple endoscopic operation demands the utmost surgical care, skill and experience. A few recurrences of preoperative symptoms were seen in the follow-up suggesting that all patients must be continually monitored after the operation.

Background: The authors' experience of the efficacy and safety of endoscopic thoracic sympathectomy in the treatment of primary palmer hyperhidrosis was examined., Methods: A retrospective study of 71 patients (126 sympathectomies) was undertaken. Data were retrieved by hospital records and telephone interview., Results: Follow-up was possible for 92 sympathectomies in 53 patients. Overall, satisfactory results were achieved in 93% of patients and complications were uncommon. Compensatory hyperhidrosis was the most common complication, which occurred in 64% of patients; the trunk and feet were the most common sites. Horner's syndrome occurred in five patients, although in two it was a permanent complication. No patient expressed dissatisfaction with the procedure as a consequence of this complication. Pneumothorax occurred in 17.5% of cases, although the vast majority were incidental findings on a postoperative chest X-ray, and none required drainage. With the newer techniques of access, patient dissatisfaction with the cosmetic appearance has fallen from 27.3 to 6.4%. Overall 90% of patients said they would have the operation again, which represents a high level of patient satisfaction., Conclusions: Endoscopic thoracic sympathectomy is a safe and effective technique for primary palmer hyperhidrosis. Evolution of the technique has resulted in improvement in patient satisfaction.

Objectives: To assess temporal trends in the incidence of surgical procedures for peripheral occlusive arterial disease (POAD) and associated changes in outcome as measured by the rate of major lower limb amputations for POAD., Design: A retrospective descriptive population-based study was conducted of the geographically isolated population of Western Australia between 1980 and 1992., Methods: Vascular procedures with an accompanying diagnosis of POAD were identified in a computerised system of name-identified records of all discharges from hospital for the population. These procedures were detected using relevant codes from the International Classification of Diseases and Procedures. Records of angioplasty and thrombolysis procedures were augmented by searches of hospital-based registers of invasive radiological procedures. The data for the remaining procedures were validated by a review of a random sample of medical records., Results: Over the 13 years of the study, rates of major amputations fell significantly for women under 70 years of age and for men under 80 years from 1983. At the same time there was a significant fall in non-amputation vascular surgery for individuals under the age of 60. In addition, rather than an overall rise in surgery there was shift away from sympathectomy and thromboendarterectomy to angioplasty and bypass surgery. Furthermore, an increasing proportion of all major amputations had a prior attempt at arterial reconstruction., Conclusion: These observations suggest the decrease in major amputations for POAD may reflect a fall in the incidence of POAD, possibly aided by more effective surgery, rather than increased rates of vascular surgery.

This study includes our 12-year experience with chemical sympathetic blocks and surgical sympathectomies for causalgic pain of reflex sympathetic dystrophy (RSD) with emphasis on factors affecting clinical outcome. Medical records of patients undergoing sympathectomies for causalgic pain were analyzed. The patients were classified according to Drucker et al. as stage I, II, or III. Results of chemical and surgical sympathectomies were analyzed using both univariate and multivariate methods. Twenty-one patients had lumbar and seven had cervicodorsal sympathectomies for RSD. The mean duration between initial injury and chemical sympathetic block was 10 months with a mean of 11.4 months to surgical sympathectomy. Ten patients (36%) had overt extremity trauma as the precipitating event. Ten patients (36%) had a lumbar laminectomy, three of whom developed the syndrome bilaterally. There was no operative mortality; however, 25% had transient postoperative sympathetic neuralgia. The early and late (> 6 months) satisfactory outcomes after surgical sympathectomy were 82% and 71%, respectively. Patients with stage II presentations were significantly more likely to have satisfactory early (92%) and late (79%) outcomes than stage III patients, 0% and 0% (p = 0.019). Patients with an excellent response to chemical sympathetic block were more likely to have satisfactory early and late surgical outcomes. The time between injury and chemical block and surgical sympathectomy was significantly shorter in patients who had satisfactory early and late surgical outcomes (p < 0.0001). Multivariate analyses demonstrated that the most important independent factor in determining early and late satisfactory outcomes of sympathectomy was the time between injury and sympathectomy (p = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

The technique of minimal invasive surgery has successfully been introduced into the area of thoracic surgery. Surgery of the intrathoracic organs may now be performed without compromise of respiratory mechanics, thus allowing the operative treatment of an ever widening range of pathological conditions. An analysis of our experience (287 thoracoscopic interventions in the last three years) reveals that the diverse procedures performed on the pleura (pleurectomy and pleurodesis), on the lung (wedge resection, fistula closure and ligature of parenchymatous leaks) and on other defined anatomical structures such as the sympathetic nerves or the thoracic duct, are effective in the therapy of intrathoracic disease. The most important pathological conditions which may be treated by thoracoscopy are listed. The range of complications and their causes, which developed in 8% of all procedures, are discussed. The current limitations of this method are defined in the context of the situations where thoracoscopy was discontinued (9 times), a thoracotomy performed (17 times) or a further procedure became necessary (14 times). Current developments and innovations are summarized by a short review of the literature.