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C Drott

Publications and source records attributed to C Drott.

At least 19 recordsLinked to original sources
PubMed1998

[Treatment of facial blushing with endoscopic thoracal sympathicotomy. 85 per cent of patients are satisfied, but there are adverse effects].

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 (p < 0.0001). Of the series as a whole, 85 per cent declared themselves satisfied with the outcome.

Adolescent↗
PubMed1998

Vasomotor and sudomotor function in the hand after thoracoscopic transection of the sympathetic chain: implications for choice of therapeutic strategy.

The degree of sympatholysis achieved by thoracoscopic transection of the sympathetic chain (sympathicotomy) was evaluated by measuring sudo- and vasomotor function in the hands before and after surgery in 12 patients with palmar hyperhidrosis. Our results show a marked reduction in sweat production and a cutaneous vasodilatation which remained unchanged during the 6 months follow-up, whereas sudo- and vasomotor reflexes normalized within this time. Skin temperature variations did not correlate to skin perfusion changes. Since all subjects reported dry and warm hands throughout the follow-up period, our results indicate that recording reflex responses to sympathoexcitatory stimuli does not adequately reflect clinical outcome of subtotal sympatholytic procedures performed for hyperhidrosis. Monitoring of clinical outcome should therefore include measurement of baseline sweat production and skin perfusion. However, the normalized reflex responses highlight the incomplete sympatholysis achieved by thoracoscopic sympathicotomy, which may be beneficial in some pathological conditions (such as hyperhidrosis) but detrimental in others.

Adrenergic Fibers↗
PubMed1998

Successful treatment of facial blushing by endoscopic transthoracic sympathicotomy.

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, P < 0.0001, by the operation. Heart palpitations in stressful situations were also reduced (3.7 +/- 0.3 to 1.3 +/- 0.1, P < 0.0001). 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.

Adolescent↗
PubMed1998

The Borås experience of endoscopic thoracic sympathicotomy for palmar, axillary, facial hyperhidrosis and facial blushing.

OBJECTIVE: To study the outcome of endoscopic thoracic sympaticotomy (ETS) for palmar, axillary, facial hyperhidrosis and facial blushing. SUBJECTS: 1152 patients, 59% women and 41% men. INTERVENTION: ETS was performed by transection of the sympathetic chain where it overlies the second and third rib. The nerve was divided also over the fourth rib in patients with axillary hyperhidrosis. Questionnaires were sent to all patients. MAIN OUTCOME MEASURES: The effect of surgery was assessed by a 10 grad visual analogue scale (VAS) by the patients. The results were divided into effect rate (the effect on the symptom) and overall satisfaction rate, taking into account any side effects and complications apart from the effect. RESULTS: The response rate was 90%. The mean follow up time, effect rate and overall satisfaction rate were: 38 months for palmar hyperhidrosis, 99.4% and 87%; 26 months for axillary hyperhidrosis, 94.5% and 68%; 31 months for facial hyperhidrosis, 97% and 76%; 8 months for facial blushing, 96% and 85%. CONCLUSION: ETS is a very effective procedure in palmar, axillary and facial hyperhidrosis and facial blushing. The overall satisfaction rate is very good for palmar hyperhidrosis and facial blushing, not equally good but acceptable for facial hyperhidrosis. The lower satisfaction rate in patients with axillary hyperhidrosis makes this a questionable indication for ETS.

Adolescent↗
PubMed1997

Effect of endoscopic transthoracic sympathicotomy on heart rate variability in severe angina pectoris.

Endoscopic transthoracic sympathicotomy (ETS) is a recently developed technique to divide sympathetic nerves. ETS has been shown to improve symptoms and reduce ischemia in patients with severe angina pectoris. Low heart rate variability (HRV) in patients with ischemic heart disease carries an adverse prognosis. HRV reflects autonomic response of the heart and a shift in the sympathovagal balance towards parasympathetic dominance could be a marker of improved prognosis. HRV might also be used as an indicator of surgical success in sympathetic heart denervation. Heart rate was recorded in 57 patients before and after ETS. Registration was recorded during controlled respiration in the supine position and at tilt test over 10 minutes and spectral analysis was performed. Twenty-four hour Holter recordings were analyzed in the time domain. During the controlled setting, the high-frequency (HF) component (0.15 to 0.40 Hz) increased significantly whereas the low-frequency (LF) component (0.04 to 0.15 Hz) did not change significantly. The LF/HF ratio at tilt test was reduced from 1.3 to 0.8 (p <0.01). The time-domain analysis showed a significant increase of the mean RR interval (923 to 1,006 ms, p <0.001) and indexes reflecting parasympathetic tone also increased significantly (the root-mean square of difference measured from 24.3 to 29.5 ms, p <0.001 and the proportion of adjacent RR intervals >50% measured from 5.5% to 8.2%, p <0.01), whereas measurements reflecting global HRV did not change. In addition to relief of symptoms and reduced ischemia in severe angina pectoris, ETS caused a shift of sympathovagal balance toward parasympathetic tone. This might explain the anti-ischemic effect and have prognostic implications.

Aged↗
PubMed1996

Angina pectoris treated by thoracoscopic sympathecotomy.

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.

Aged↗
PubMed1996

Hyperhidrosis treated by thoracoscopic sympathicotomy.

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.

Adolescent↗
PubMed1995

Endoscopic transthoracic sympathicotomy for severe angina.

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.

Aged↗
PubMed1995

Endoscopic transthoracic sympathectomy: an efficient and safe method for the treatment of hyperhidrosis.

BACKGROUND: Hyperhidrosis of the palms, axillae, and face has a strong negative impact on the quality of life for many persons. Existing nonsurgical therapeutic options are far from ideal. Definitive cure can be obtained by upper thoracic sympathectomy. The traditional open surgical technique is a major procedure; few patients and doctors have found that risk-benefit considerations favor surgery. Endoscopic minimal invasive surgical techniques are now available. OBJECTIVE: We investigated whether endoscopic ablation of the upper thoracic sympathetic chain is efficient and safe in the treatment of hyperhidrosis. METHODS: We treated 850 patients with bilateral endoscopic transthoracic sympathectomy. RESULTS: There was no mortality or life-threatening complication. Nine patients (1%) required intercostal drainage because of hemothorax or pneumothorax. Treatment failure occurred in 18 cases (2%) and symptoms recurred in 17 patients (2%). At the end of follow-up (median, 31 months) 98% of the patients reported satisfactory results. CONCLUSION: Endoscopic transthoracic sympathectomy is an efficient, safe, and minimally invasive surgical method for the treatment of palmar, axillary, and facial hyperhidrosis.

Adolescent↗
PubMed1995

Oral ciprofloxacin versus intravenous cefuroxime as prophylaxis against postoperative infection in vascular surgery: a randomised double-blind, prospective multicentre study.

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 x 2 p.o. or cefuroxime (Zinacef, Glaxo) 1.5 g x 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 < 0.05). S. allreus was the most common bacteria isolated. Forty percent of the wound infections were localised to the groins. By multivariate analysis presence of distal ulcer was the only factor of prognostic significance. CONCLUSIONS: The infection rate was similar in the two groups. Thus, oral administration of ciprofloxacin is an attractive, cost-effective and safe alternative to prophylaxis in vascular patients capable of taking oral medication on the day of surgery.

Administration, Oral↗
PubMed1994

Hyperhidrosis.

Explore the source record for details and available documents.

Humans↗
PubMed1994

The history of cervicothoracic sympathectomy.

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.

Ganglia, Sympathetic↗
PubMed1994

Thoracoscopic sympathicotomy for hyperhidrosis--surgical technique, complications and side effects.

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.

Adolescent↗
PubMed1994

Endoscopic electrocautery of the upper thoracic sympathetic chain: a safe and simple technique for treatment of sympathetically maintained pain.

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.

Adult↗
PubMed1994

Thoracoscopic sympathicotomy for arterial insufficiency.

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.

Arterial Occlusive Diseases↗
PubMed1994

Cardiac effects of endoscopic electrocautery of the upper thoracic sympathetic chain.

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.

Adolescent↗