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At least 1,081 records · Page 60Linked to original sources
PubMed1995

[Treatment of primary hyperhidrosis of the upper limbs by transthoracic endoscopic sympathectomy].

Primary hyperhidrosis of the upper limbs has an important impact on the subject's social and psycho-affective equilibrium. These patients have two main problems. First physicians are not sufficiently aware of the therapeutic possibilities and secondly the generally poor reputation of surgery in this indication. Transthoracic endoscopic sympathectomy has completely changed the treatment of hyperhidrosis of the upper limbs. It is now considered to be the reference treatment in severe cases. The surgical procedure is simple and allows simultaneous treatment of both sides. There is no mortality and morbidity is extremely low quantitatively and of little consequence qualitatively. The therapeutic protocol is short and immediate and long-term results are excellent in 98 to 100% of the patients.

Arm↗
PubMed1996

Technique and early results of videoscopic lumbar sympathectomy.

The authors describe their technique of videoscopic (VS) lumbar sympathectomy (LSE), compared to the open LSE. From 1992 to 1994, 21 open and 19 VS LSE were performed. The indication was reflex sympathetic dystrophy in 17 and arterial insufficiency in 23 patients. In the open LSE the mean duration of anaesthesia was 80 min (55-115) and of surgery 37 min (25-65). The length of the chain removed varied from 1 to 3 ganglia (6-7 cm). Complications were noted in 5 patients: 1 pneumonia, 2 superficial wound problems and 2 cases of postsympathectomy neuralgia. Hospital stay of patients with RSD varied from 2 to 5 days. Of the 19 attempts to perform a VS LSE 4 had to be converted to the open technique. The duration of anesthesia was 150 min (90-280) and of surgery 92 min (45-240). Lengths of chain removed varied from 1 to several ganglia (6-7 cm). A pneumoperitoneum was present in 10 procedures, but a Veress needle was placed in only 4 of these. Complications were present in 9 patients: 1 important subcutaneous emphysema, 1 severe costal pain, 2 neuralgia, 1 temporary psoas dysfunction, 1 haemorrhage from a lumbar vein with conversion to the open technique and 3 minor superficial wound problems. The hospital stay ranged from 2 to 5 days. This study suggests that the VS LSE has no benefit over the open technique as far as the operative and early results are concerned. Whether this technique avoids some of the late disadvantages of a lumbotomy remains to be seen.

Adolescent↗
PubMed1996

Totally extraperitoneal laparoscopic lumbar sympathectomy: an initial case report.

A 27-year-old man with a diagnosis of Buerger's disease presented with vasospastic symptoms of coldness and pain at rest of his right foot. Physical examination of his affected limb revealed absent popliteal pulse, cool skin hyperhidrosis and dry gangrene of the big toe. He had been operated on for a ruptured liver and liver abscess 20 years ago. He was scheduled for totally extraperitoneal laparoscopic lumbar sympathectomy on July 26, 1994. The technique was performed under general anesthesia and the patient was put in a supine position with slight extension between the rib and the iliac crest. The working space was created by digital blunt dissection and direct insufflation of carbon dioxide. The right sympathetic trunk was found between the medial edge of the psoas muscle and inferior vena cava. The L2, L3, L4 sympathetic ganglia were identified above the vertebral column and meticulously dissected cephalocaudally. Based on the concept of traditional approach, we believe that this laparoscopic technique is relatively safe and should become the procedure of choice in the future.

Adult↗
PubMed1995

Correlation of pain with temperature and blood-flow changes in the lower limb following chemical lumbar sympathectomy in reflex sympathetic dystrophy. A case report.

Temperature and microcirculatory blood flow studies have been measured before and after chemical sympathectomy in a patient with reflex sympathetic dystrophy of the left leg present for at least three years following surgery for glomus tumour. Normalisation of temperature and blood flow was associated with the relief of pain, present initially when the limb was hypothermic and vasoconstricted and recurring when the limb was hyperthermic and vasodilated. It is possible that such objective measurement may be used to determine the optimal management of RSD.

Aged↗
PubMed1996

[Percutaneous thoracic sympathectomy under x-ray computed tomographic control in hyperhidrosis and refractory ischemia. Apropos of 17 cases].

We report our experience with percutaneous thoracic sympathectomy using computed tomography-guided injection of phenol in 17 patients. A total of 24 neurolyses were performed in outpatients. Indications were palmo-plantar hyperhidrosis in 10 patients and severe Raynaud phenomena in 7 cases (Sharp's syndrome = 2. sclerodermia = 3, Raynaud's syndrome = 1, digital arteritis = 1). Conventional treatment had failed in all patients. Cure was obtained in all cases of hyperhidrosis. For the patients with critical ischemia, there was temporary improvement which allowed wound healing, but recurrence was the rule within 6 months on average. Complications included pneumothorax, brachial nevralgia which persisted for 4 months and 3 partial Claude-Bernard-Horner syndromes. This technique is an inexpensive reliable method which can be used in case of contraindications or to avoid certain complications of endoscopic surgery which remains the standard treatment. Percutaneous sympatholysis in thus an interesting simple alternative.

Adolescent↗
PubMed1997

Unilateral left-sided thoracoscopic sympathectomy for visceral pain control: a pilot study.

OBJECTIVE: To examine the effect of unilateral left sided thoracoscopic denervation of the upper gastrointestinal tract for treatment of chronic pain. DESIGN: Prospective study. SETTING: University hospital, Sweden. SUBJECTS: Patients with intractable upper abdominal pain. Nine patients were treated who had the following diagnosis: pancreatic carcinoma (4), duodenal carcinoma (n = 1), chronic pancreatitis (3), and portal vein thrombosis (n = 1). INTERVENTIONS: Left-sided thoracoscopy with the patient anaesthetised using double-lumen endotracheal intubation that allowed ventilation of the right lung only. The sympathetic chain and splanchnic branches were divided from level IV to X-XI. MAIN OUTCOME MEASURES: Severity of pain assessed by a visual analogue scale and mean consumption of analgesic drugs. RESULTS: All patients reported substantial relief of pain postoperatively when they were studied during a mean follow-up period of 3 months. However, two patients (1 with pancreatic carcinoma and 1 with portal vein thrombosis) had recurrent pain after 3 months. CONCLUSION: Unilateral thoracoscopic sympathectomy induces adequate and lasting relief of pain caused by benign as well as malignant diseases originating from the pancreatic region.

Abdominal Pain↗
PubMed1996

[Minimal invasive lumbar sympathectomy--technique and outcome, retroperitoneoscopic approach]].

Peripheral vascular obliteration of the leg provides an indication for a retroperitoneoscopic lumbal sympathectomy initially using a balloon dilator to create a transitional retroperitoneal cavity. After introducing carbon dioxide and two 5-mm instruments, we perform the resection and extirpation of the lumbal sympathetic nerve from L 2 to L 4. No complications occurred in 29 patients except conversion to open surgery in two cases because of gas loss into the peritoneum after causing peritoneal lesions.

Arterial Occlusive Diseases↗
PubMed1997

[Treatment of essential hyperhidrosis using thoracoscopic high dorsal sympathectomy].

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

Humans↗
PubMed1997

[Surgical treatment of therapy refractory Sudeck's dystrophy by transaxillary decompression of the neurovascular bundle and sympathectomy. On the pathogenesis of Sudeck's disease].

Since 1984, altogether nine cases of otherwise untreatable reflex sympathetic dystrophy (RSD) of the upper extremity were treated by transaxillary decompression of the neurovascular bundle with resection of the upper thoracic ganglia. This resulted in an immediate improvement of the local findings and the entire post-operative course of treatment as well as significantly improved functional results (seven excellent, one good, one fair). Average follow-up was 7.5 years. All patients returned to their original work. Clinical as well as intraoperative studies show that the acute edema of RSD is caused by a stenosis of the subclavian vein, which was proven in all cases by preoperative phlebography. Surgical decompression of the subclavian vein thus can result in an essential improvement of venous backflow and also significant improvement of the lesion-caused misproportion between increased arterial inflow and venous outflow with all resulting consequences for peripheral edema, subfascial pressure, microcirculation, perfusion of tissue and metabolism. By decompression of the subclavian artery and the lower plexus roots as well as by simultaneous transaxillary sympathectomy, the sympathetic efferents are drastically reduced or rather interrupted, leading to immediate improvement of the acute pain-syndrome. The so-called "individual predisposition" for RSD can mainly be attributed to a venous stenosis in the area of the subclavian vein and to an increase in sympathetic tonus by irritation of the lower parts of the brachial plexus and the postganglionic fibres accompanying the subclavian artery. The consequences for the pathogenesis of RSD are discussed in detail.

Adult↗
PubMedDate not supplied

[Right laparoscopic lumbar sympathectomy].

Laparoscopic lumbar sympathectomy was performed on a young man with thromboangiitis obliterans (Buerger's disease). The surgeons disposition, trocars placement and dissection technique are described in detail. The retroperitoneal approach was done in a manner similar to laparoscopic properitoneal hernia repair. The operation can be carried out with common laparoscopic equipment (for cholecystectomy) and offers the benefits of minimally invasive surgery.

Adult↗
PubMedDate not supplied

[Left lumbar sympathectomy via the retro-pneumoscopic approach. The technical considerations].

Retropneumoscopic lumbar sympathectomy is performed with an increasing frequency as a treatment of chronic obstructive arteriopathies; though the method has limited indications. We present the operative technique as it was performed în the Colţea Surgical Department in 2 patients. We highlights on difficulties advantages and disadvantages of the method.

Arterial Occlusive Diseases↗
PubMed1997

[Sympathetic tonus and lumbar sympathectomy in arteriosclerosis obliterans of the arteries of the lower extremities].

The Doppler laser flowmetry was used in order to study the microcirculation in the skin, muscles and bone marrow at different stages of obliterating atherosclerosis of the lower extremity arteries. Progress of the disease is characterized by a decrease of the absolute indices of blood flow in combination with disturbed regulation of vascular tension. The lumbar sympathectomy causes intensification of microcirculation not only in the skin, but also in the muscular and bone marrow tissues.

Arteriosclerosis Obliterans↗
PubMed1976

Sweat studies in hyperhidrosis palmaris and plantaris. A survey of 60 patients before and after cervical sympathectomy.

60 patients suffering from excessive sweating in the hands underwent cervical sympathectomy. At follow-up 1-7 years after operation the hands were dry in 55. No differences in electrolyte concentrations were found in the sweat from palms, arms, or body prior to and after the surgical intervention. Similarly no differences were found in electrolyte concentrations between healthy subjects and hyperhidrotics. Palmar sweat was hypertonic in comparison to arm or body sweat. The Na and K sweat concentrations were: palmar 50 +/- 20 and 16 +/- 7 mEq/1; arm 30 +/- 11 and 8 +/- 2 mEq/1; and body 21 +/- 20 and 4 +/- 3 mEq/1, respectively. Na/K ratio was: palmar 3.2; arms 3.6 and body 5.8. Total sweat loss prior to the operation was 5.7 +/- 4.2 g/kg BW/h; afterwards it was 5.9 +/- 4 g/kg BW/h. These equal sweat rates were associated with compensatory sweating in areas of the body not affected prior to the operation.

Adolescent↗
PubMed1998

[Indications for and prognostication of results of lumbar sympathectomy in patients with obliterating atherosclerosis of the lower limbs with chronic critical ischemia].

The instrumental methods of investigation data, permitting to estimate the regional hemodynamics state in affected extremity, was used for the lumbar sympathectomy (LS) result prognosis in patients with obliterating atherosclerosis of the lower extremities vessels while chronic critical ischemia. The LS conduction is indicated in patients with critical ischemia in the stage of the regional blood flow compensation if it is impossible to conduct the restorative operation.

Adult↗
PubMed1998

The haemodynamic effect of thoracoscopic cardiac sympathectomy.

A patient with angina pectoris who had been successfully treated by thoracoscopic cardiac sympathectomy was scheduled to have scalp debridement under general anaesthesia for a scald burn. There were haemodynamic changes during and after the operation including anaesthetic induction, endotracheal intubation, maintenance, and early recovery period. The sympathetic denervated heart showed little chronotropic response to anaesthetic and surgical stimulation. On the contrary, the parasympathetic response was predominant. An episode of severe bradycardia occurred during endotracheal suctioning prior to extubation. The haemodynamic response to cardiac sympathetic denervation corresponded to the efferent effect of beta-receptor blockade

Aged↗
PubMed1998

[Lumbar sympathectomy].

Indications for application of lumbar sympathectomy (LS) in chronic arterial insufficiency of the lower extermities are analyzed. The results of the use of lumbar chemical desympathisation under computer tomography (CT) control in 10 patients are represented. Prevalences of chemical desympathisation and LS were revealed which allow us to recommend it for clinical practice.

Adult↗