Academic literature on the topic 'Sympathectomy/side effects'

Background Endoscopic thoracic sympathectomy (ETS) is an effective treatment for primary hyperhidrosis. However, compensatory sweating (CS) may occur in many patients. Sympathetic nerve reconstruction (SNR) can be used to counteract severe CS, but the studies on the effects of SNR are few. Patients and Methods Nineteen out of 150 SNR patients were contacted by employing a long-term questionnaire. In this questionnaire, different kinds of sweating were evaluated using a four-graded symptom analysis and the visual analog scale before ETS, after ETS, and after SNR. Results The mean age of the 16 male and 3 female patients at the SNR was 32 years. The mean follow-up was 87 months. According to the long-term questionnaire, the benefit was either excellent (4 patients, 21%), good (3 patients, 15.8%), or reasonable (7 patients, 36.8%) in 14 patients (73.8%), while the benefit was questionable in 1 patient (5.3%). For three patients (15.8%), no benefit was found, and in one patient (5.3%), the situation had deteriorated. Conclusions Improvement in the side effects of ETS after SNR was found in nearly 75% of the patients. This indicates that SNR can be considered as an alternative treatment for patients with severe CS after ETS that is unresponsive to conservative treatment.

BACKGROUND: Facial hyperhidrosis is a disease that may lead patients to serious emotional disturbances. Video-assisted thoracic sympathectomy provides excellent resolution of facial hyperhidrosis, but is associated with certain complications. The most frequent and important complication is compensatory hyperhidrosis. Especially in patients who have undergone resection of the second thoracic ganglion, the risk of severe compensatory hyperhidrosis is higher, which may cause dissatisfaction with the procedure. OBJECTIVE: The aim of this study was to evaluate the efficacy of the use of low doses of oxybutynin in treating facial hyperhidrosis as well as the level of patient satisfaction with its use. METHODS: 25 patients with facial hyperhidrosis were treated with oxybutynin. The patients underwent 2 evaluations: before and after treatment. These evaluations were used to assess the patients' clinical improvement and quality of life. RESULTS: We observed that more than 75% of the patients evolved with an improvement in facial hyperhidrosis, and 52% of them presented a great improvement. CONCLUSION: Treatment of facial hyperhidrosis with oxybutynin is a good alternative to sympathectomy, since it presents good results and improves quality of life, in addition to not exposing patients to the risk of experiencing the side effects of sympathectomy

This retrospective study assessed the results of treatment of 29 cases of hypothenar hammer syndrome and two cases of thenar hammer syndrome. Three hands were symptom free, 15 were improved, 11 were unchanged and two were worse at a mean follow-up of 43 (range 4–60) months. Follow-up colour-coded Duplex sonography of revascularizations ( n = 27) revealed 13 patent, five occluded and one partially thrombosed grafts, seven grafts with aneurysmal dilatations and one coiled graft. Colour-coded Duplex sonography results after venous interposition graft combined with endoscopic thoracic sympathectomy were no better than venous interposition graft alone. All three arterial interposition grafts and two end-to-end-reconstructions were patent. The Duplex outcomes of the revascularizations did not correspond well with the clinical outcomes. Endoscopic thoracic sympathectomy was associated with a high rate of inconvenient side effects.

Objectives:Despite controversies, endoscopic thoracic sympathectomy (ETS) has been used as a treatment for excessive sweating of hands and face and for facial blushing. This study aims to evaluate the effectiveness of ETS for the current indications in a systematic review.Methods:Controlled clinical trials and cohort studies with more than 100 patients were included. Abstracts were searched from MEDLINE and CCTR from 1966 to June 2004. Two reviewers extracted the data and assessed study quality. Data on effectiveness and safety were synthesized qualitatively.Results:We did not find any controlled clinical trials. Fifteen prospective studies were included. The internal and external quality of these studies were poor overall. Follow-up was commonly less than 2 years, during which time excessive sweating and facial blushing seemed to decrease among most patients. Immediate complications related to thoracoscopy occurred in up to 10 percent of patients. Compensatory sweating below breast level was reported in up to 90 percent of the patients. Other common side effects included dryness of face and hands, gustatory sweating, and neuralgic pain. Several other less common side effects were reported.Conclusions:The evidence of the effectiveness of ETS is weak due to a lack of randomized trials. The intervention leads to severe immediate complications in some of the patients, and to persistent side-effects for many of the patients.

Background/Aim. Primary hyperhidrosis causes are unknown. The disorder begins in early childhood. It intensifies in puberty and maturity. It is equally present in both sexes. The symptoms exacerbate when the body temperature rises and due to emotional stimuli affecting the sympathetic nerve system. The aim of this study was to demonstrate that videoassisted thoracoscopic surgery (VATS) sympathectomy is a method for primary focal hyperhidrosis permanent treatment. The single incision method in properly selected patients maximizes the intervention effectiveness and minimizes aesthetic side effects. Methods. This prospective study analysed the findings in patients who had been operated on due to primary focal hyperhidrosis (face, palms, and armpits) using a single small transaxilarry incision in the third inter-rib space at the level of the anterior axillary line with two 5 mm flexible ports. All the patients, with T2-T5 thoracoscopic sympathectomy of the sympathetic chain using a single small incision in the third inter-rib space in the anterior axillary line, were analysed in the period from September 2009 to November 2010 regarding the postoperative morbidity and outcomes of the operation (clinical evaluation and visual analogue scale) with a view to assessing the effectiveness of the surgery conducted in this manner. Results. A total of 47 patients (18 men, 29 women), 18 to 48 years old (29 on average) had underwent 94 bilateral video-assisted thoracoscopic sympathectomies. The sympathectomy was indicated in cases of facial blushing and sweating (6.38%), palmary sweating (34.04%), axillary sweating (14.89%) or both palmary and axillary sweating (44.68%). The largest percentage of patients (98.6%) had left the hospital the following day. The postoperative 30 day?s mortality was 0 and the conversion into open surgery was not necessary. As for complications, there had been an occurrence of partial pneumothorax in two patients treated by means of exuflation and chest drain, and one case of unilateral transitory Horner?s syndrome. Quarterly and annual postoperative monitoring showed excellent aesthetic effects of the surgery without any residual pain. The complete withdrawal of hyperhidrosis symptoms was noted in 44 (93.62%) of the patients. The recurrence of symptoms following the initial regression was seen in 3 (6.38%) of the patients 12 months after the surgery, whereas the patients surgically treated as a result of facial hyperhidrosis saw a significantly increased sweating of feet. The quality of life improved in 45 (95.6%) of the patients. Conclusion. Single incision transaxillary thoracoscopic sympathectomy generates excellent aesthetic and functional results in patients with primary focal hyperhidrosis.

Background Thoracoscopic sympathectomy (TS) was the preferred surgical treatment for palmar hyperhidrosis (PH), but postoperative complications such as compensatory sweating (CS) were common. This study was projected to compare R3 versus R4 TS for treating severe PH. Methods From April 2009 and March 2015, 106 consecutive patients with severe PH underwent bilateral R3 (n = 62) or R4 (n = 44) TS at The Second Affiliated Hospital of Nanchang University. The patients were followed up to evaluate symptom resolution, postoperative complications, satisfaction level, and severity of CS. Results The 106 patients underwent 212 sympathecotomies and were cured with no severe complications or perioperative mortality. The incidence of minor side effects (such as pneumothorax, gustatory sweating, moist hands, and bradycardia) was similar in both groups. More patients had overdry hands in the R3 group than in the R4 group (6/62 vs. 0/44; p = 0.040). More CS occurred in the R3 group as compared with the R4 group (42/62 vs. 23/44; p = 0.156). The incidence of moderate-to-severe CS was higher in the R3 group than in the R4 group (14/62 vs. 4/40; p = 0.045). Most patients were satisfied with the results, except for three (5.84%) in the R3 group and one (2.27%) in the R4 group. Conclusion PH can be effectively treated by either R3 or R4 TS, with high rates of patient satisfaction. R4 sympathectomy appears to be associated with less severe CS and should be the choice of denervation level.

Background Hyperhidrosis is a dysfunction of the autonomic nervous system that results in regional excessive sweating, mostly in the hands, armpits, and feet. A permanent and effective treatment of hyperhidrosis can be achieved by interruption of the thoracic sympathetic chain with endoscopic thoracic sympathectomy (ETS). However, some side effects, particularly compensatory sweating (CS), are the limitations of this procedure. The mechanism of CS and the associated risk factors are still controversial. The aim of this retrospective study was to determine the relationship with various parameters associated with CS in patients undergoing ETS. Materials and Methods ETS was performed on a total of 95 patients for palmar hyperhidrosis, axillary hyperhidrosis and facial blushing by the same surgeon. The mean age of the patients was 26.41 (± 7) years, and 54 (56.8%) were males. Palmar hyperhidrosis was present in 54 (56.8%) patients, axillary hyperhidrosis in 33 (34.7%) patients, and facial blushing in 8 (8.5%) patients. Moreover, 38 (40%) patients also had plantar sweating. The severity of CS was rated into three scales as less, moderate, and severe. Results Regarding the severity of CS, 55 (57.9%) patients had no or less CS, 28 (29.5%) had moderate CS, and 12 (12.6%) patients had severe CS. Higher age group had a significant increased risk of severe CS (p = 0.03) (r = 0.262). Patients with body mass index (BMI) > 25 kg/m2 had a statistically significantly increased risk of severe CS (p = 0.016). Facial blushing resulted in severe CS in a significantly higher proportion of patients than by palmar and axillary hyperhidrosis (p = 0.001). The level of surgery was another important risk factor for CS, with the T2 level showing an increased risk of severe CS compared with T3 level (p < 0.001). Furthermore, plantar sweating was inversely and significantly related to the development of CS. Patients with plantar sweating had a significantly decreased incidence of developing CS (p = 0.015). Conclusion CS after thoracic sympathectomy for primary hyperhidrosis is the most displeasing and restrictive side effect. This study demonstrates that older age, operation level, facial blushing, and high BMI are risk factors for CS, as have been shown in several similar studies. An interesting finding of the present study is that there was a decreased incidence of CS among patients with plantar sweating. This situation may help us to distinguish high risk for CS before ETS operation.

The management of cancer pain represents a difficult diagnostic and therapeutic problem for the clinician. In a multidisciplinary approach to the management of cancer pain, neurosurgical methods are an essential part of the therapy. Frequently, patients with advanced cancer suffer from an increasing pain, requesting ever higher dosage of narcotics, and finally seeming to respond only to high dosage of intravenous narcotics. Gradually, the opioids produce less satisfactory analgetics effects an more serious side manifestations. These patients can be considered for surgical management of pain. Historically, surgery for cancer pain began with destructive procedures (neurectomy, rhizotomy, sympathectomy), often referred to as ablative. In past two decades, with the help of the current knowledge of cancer pain mechanisms and some of the technological developments, such as microsurgical and stereotactic techniques, computerized tomography and magnetic resonance imaging, the majority of ablative procedures have been replaced by new methods. Among them a few are selectively and minimally ablative (microsurgical spinothalamic cordotomy, dorsal root entry zone operation, limited midline myelotomy) and the others ones are neuroaugumentative operations ( deep brain structures and spinal cord stimulation, drugdelivery systems).

INTRODUÇÃO: A simpatectomia é o tratamento de escolha para hiperidrose localizada primária. A evolução da técnica visa à melhora dos resultados operatórios e à minimização dos efeitos colaterais, sendo o principal deles o suor reflexo. Esse suor reflexo pode afetar a satisfação em longo prazo, e pode variar conforme as estações do ano, juntamente com a satisfação dos pacientes com os resultados da operação. No entanto, não há dados objetivos quanto ao efeito da sazonalidade sobre os resultados operatórios e sobre os fatores relacionados à satisfação. Os objetivos do presente estudo são: avaliação da variabilidade sazonal sobre o grau das resoluções da sudorese palmar e plantar, bem como a incidência e a intensidade do suor reflexo e análise da influência desses fatores sobre a satisfação; avaliação da dor como fator relacionado à satisfação imediata; avaliação da segurança dos métodos de expansão pulmonar pós-operatória com e sem drenagem pleural e relação dos mesmos à dor. MÉTODOS: Estudo clínico, prospectivo, em duas fases. A primeira, para avaliação de fatores imediatos relacionados à satisfação (fatores antropométricos, dor, presença e intensidade do suor reflexo, grau de resolução da sudorese palma r e plantar, época do ano em que a simpatectomia foi realizada) e segurança dos métodos de expansão pulmonar, cujo desenho é prospectivo, aleatorizado e cego. A segunda, para as avaliações tardias e sazonais dos fatores relacionados à satisfação (fatores antropométricos, presença e intensidade do suor reflexo, grau de resolução da sudorese palmar e plantar), possui desenho prospectivo de coorte. Foram eleitos para o estudo pacientes com hiperidrose palmo-plantar primária submetidos à simpatectomia torácica videoassistida; o período de inclusão foi de 16 meses e o seguimento médio final de 623,63 ± 15,13 dias. Foram então avaliados no período de hospitalização (avaliação da dor, método de expansão pulmonar e do pneumotórax residual) e no sétimo dia de pós-operatório (dor, resultados operatórios e satisfação). Então, tardiamente, na primavera, no verão e no outono/inverno (resultados operatórios e satisfação). Foram considerados resultados operatórios os graus de resolução palmar e plantar e a presença e a intensidade do suor reflexo. Foram estudadas como variáveis independentes relacionadas à satisfação a época do ano onde a simpatectomia foi feita, a dor, os graus de resolução palmar e plantar, presença e intensidade do suor reflexo e fatores antropométricos, a saber, idade, gênero, etnia, índice de massa corporal. RESULTADOS: Foram incluídos 82 pacientes consecutivos, sendo que 80 completaram o seguimento imediato e 75 completaram todo o seguimento. Os resultados operatórios (resolução palmar e plantar, presença e intensidade do suor compensatório) tiveram variação entre todas as estações do ano. A satisfação teve igual variação sazonal e os fatores que estiveram relacionados à queda da satisfação foram distintos, conforme a estação do ano. A drenagem pleural tubular fechada e a expansão com Valsalva foram igualmente eficientes quanto à presença de pneumotórax residual, porém a drenagem pleural em selo d\'água aumentou o tempo cirúrgico e a dor pós-operatória nas primeiras 12 horas; o pneumotórax residual não aumentou a dor. CONCLUSÕES: OS melhores resultados operatórios foram obtidos imediatamente e na primavera, os piores no verão e em nível intermediário no outono/inverno. Na primavera, o único parâmetro relacionado à queda na satisfação foi a não resolução plantar; já no verão e no outono/inverno, foi a presença do suor reflexo, indepedente da sua intensidade. A drenagem pleural tubular fechada teve desempenho inferior à expansão pulmonar sob visão direta com manobra de Valsalva. O pneumotórax residual não influenciou a intensidade dor pós-operatória.
INTRODUCTION: Sympathectomy is the treatment of choice for primary and localized hyperhidrosis. Efforts in evolution of this technique have the aim to improve the surgical results and minimizing the collateral effects, witch told to be the sudomotor reflex. This sudomotor reflex could influence the long term satisfaction; it also could change between the seasons of the year, as well as the satisfaction could change in this matter. However, there is no objective data regarding the influence of the seasonality over the surgical results and satisfaction. The objectives of this study is to assess the seasonal variability of palmar and plantar resolution, as well as the incidence of sudomotor reflex and its intensity; to correlate this factors with satisfaction. To evaluate the pain as a factor related to immediate satisfaction; to assess the safety of lung expansion methods and relate this with postoperative pain. METHODS: A two stage prospective clinical assay. The first stage consists of assessment of the immediate factors related to satisfaction (anthropometrics factors, pain, presence and intensity of the sudomotor reflex, palmar and plantar resolutions, season of the year in witch the operation was performed) and the safety of lung expansion methods; it is a prospective, randomized and blinded study. The second stage is a cohort study, assessing the late factors related to satisfaction (anthropometrics factors, presence and intensity of the sudomotor reflex and palmar and plantar resolutions), under distinct climatic situations. There were included patients with typical palmar and plantar primary hyperhidrosis treated by thoracic video-assisted sympathectomy; the inclusion period was 16 months and the final follow-up time was 623 ± 15,13 days in average. They were assessed in hospital stay (pain, lung expansion technique and residual pneumothorax) and at seventh postoperative day (pain, surgical results and satisfaction). Thereafter they were assessed in spring, summer and autumn/winter (surgical results and satisfaction). The surgical results were palmar and plantar resolutions and presence and intensity of the sudomotor reflex. The independent variables related to satisfaction were season of the year in that the sympathectomy was performed, pain, palmar and plantar resolutions, sudomotor reflex (presence and intensity) and anthropometric parameters (age, gender, ethnics, body mass index). RE8UL T8: 82 consecutives patients were included; thereafter, 80 completed the immediate assess and 75 completed the long term follow-up. The surgical results (palmar and plantar resolutions, presence and intensity of the sudomotor reflex) had significant variation throughout the seasons of the year. Equally, the satisfaction had significant variation, as well as the factor related to dissatisfaction, throughout the seasons of the year. The underwater pleural drainage and the lung expansion with Valsalva maneuver were equally efficient in matter of residual pneumothorax; however the underwater pleural drainage was more painful and more operating time consuming; the residual pneumothorax do not increased the postoperative pain. CONCLUSIONS: The best results are obtained in immediate postoperative period and in spring; the worst results are seen in spring; the intermediate results are obtained in autumn/winter. In the spring, the unique factor related to dissatisfaction was the non resolution of plantar hyperhidrotic symptoms; in the summer and in the autumn/winter the presence of the sudomotor reflex, independently of its intensity, was related to dissatisfaction. The underwater pleural drainage should not be indicating after thoracic video-assisted sympathectomy for lung expansion. The residual pneumothorax does not influence the postoperative pain.

This chapter addresses pain management in pancreatic cancer patients undergoing a Whipple procedure, in whom controlling pain is challenging in the presence of patient comorbidities such as liver cirrhosis, chronic kidney disease, and atrial fibrillation on anticoagulants. Most drugs are metabolized by the liver and excreted by the kidneys. A multimodal pain management approach can most effectively minimize the undesirable side effects of opioids. Peripheral nerve blocks and neuraxial blocks are excellent options. Traditionally, epidurals were commonly used for pain management for Whipple surgeries. However, transversus abdominis plane blocks have gained popularity partly with the increasing availability of portable ultrasounds, the lack of sympathectomy and resultant hypotension with the transversus abdominis plane (TAP) block, and the presence of contraindications to neuraxial anesthesia. The World Health Organization devised a 3-step ladder to guide physicians worldwide in the management of cancer pain, and this guide serves as an important conceptual framework for the treatment of chronic somatic, visceral, and neuropathic pain. The ladder is also useful for “step-down” analgesia in the perioperative period.