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Journal articles on the topic 'Sympathectomy/side effects'
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Licht, Peter B., and Hans K. Pilegaard. "Gustatory Side Effects After Thoracoscopic Sympathectomy." Annals of Thoracic Surgery 81, no. 3 (March 2006): 1043–47. http://dx.doi.org/10.1016/j.athoracsur.2005.09.044.
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Telaranta, Timo, and Tuomo Rantanen. "Long-Term Effect of Endoscopic Sympathetic Nerve Reconstruction for Side Effects after Endoscopic Sympathectomy." Thoracic and Cardiovascular Surgeon 65, no. 06 (May 5, 2016): 484–90. http://dx.doi.org/10.1055/s-0036-1582431.
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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.
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Wolosker, Nelson, José Ribas Milanez de Campos, Paulo Kauffman, Marco Antonio Munia, Samantha Neves, Fábio Biscegli Jatene, and Pedro Puech-Leão. "The use of oxybutynin for treating facial hyperhidrosis." Anais Brasileiros de Dermatologia 86, no. 3 (June 2011): 451–56. http://dx.doi.org/10.1590/s0365-05962011000300005.
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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
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DETHMERS, R. S. M., and P. HOUPT. "Surgical Management of Hypothenar and Thenar Hammer Syndromes: A Retrospective Study of 31 Instances in 28 Patients." Journal of Hand Surgery 30, no. 4 (August 2005): 419–23. http://dx.doi.org/10.1016/j.jhsb.2005.02.013.
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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.
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Rodríguez, Pedro M., Jorge L. Freixinet, Mohamed Hussein, Jose M. Valencia, Rita M. Gil, Jorge Herrero, and Araceli Caballero-Hidalgo. "Side effects, complications and outcome of thoracoscopic sympathectomy for palmar and axillary hyperhidrosis in 406 patients." European Journal of Cardio-Thoracic Surgery 34, no. 3 (September 2008): 514–19. http://dx.doi.org/10.1016/j.ejcts.2008.05.036.
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Malmivaara, Antti, Pekka Kuukasjärvi, Ilona Autti-Ramo, Niina Kovanen, and Marjukka Mäkelä. "Effectiveness and safety of endoscopic thoracic sympathectomy for excessive sweating and facial blushing: A systematic review." International Journal of Technology Assessment in Health Care 23, no. 1 (January 2007): 54–62. http://dx.doi.org/10.1017/s0266462307051574.
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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.
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Maric, Nebojsa, Vojkan Stanic, Aleksandar Ristanovic, Vlado Cvijanovic, and Slobodan Milisavljevic. "A single incision transaxillary thoracoscopic sympathectomy." Vojnosanitetski pregled 71, no. 5 (2014): 432–37. http://dx.doi.org/10.2298/vsp120122047m.
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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.
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Wei, Yiping, Han Jiang, Jianjun Xu, Dongliang Yu, and Wenxiong Zhang. "R3 versus R4 Thoracoscopic Sympathectomy for Severe Palmar Hyperhidrosis." Thoracic and Cardiovascular Surgeon 65, no. 06 (March 10, 2017): 491–96. http://dx.doi.org/10.1055/s-0037-1600113.
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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.
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Kargi, Ahmet. "Plantar Sweating as an Indicator of Lower Risk of Compensatory Sweating after Thoracic Sympathectomy." Thoracic and Cardiovascular Surgeon 65, no. 06 (April 4, 2016): 479–83. http://dx.doi.org/10.1055/s-0036-1579680.
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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.
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Slavik, Eugen, and S. Ivanovic. "Cancer pain: Neurosurgical management." Acta chirurgica Iugoslavica 51, no. 4 (2004): 15–23. http://dx.doi.org/10.2298/aci0404015s.
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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).
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Cwalina, Natalia, Tomasz Stefaniak, and Lukasz Dobosz. "Influence of Body Mass Index on Compensatory Sweating in Patients after Thoracic Sympathectomy due to Palmar Hyperhidrosis." Thoracic and Cardiovascular Surgeon 65, no. 06 (March 10, 2017): 497–502. http://dx.doi.org/10.1055/s-0037-1599797.
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Background Thoracic sympathectomy (TS) is one of the most effective methods of treatment of primary hyperhidrosis. One of the side effects of this procedure is compensatory sweating (CS). Objective The aim of our study was to evaluate the influence of body mass index (BMI) on CS in patients after TS due to palmar hyperhidrosis. Methods Data from 157 patients with palmar hyperhidrosis who underwent TS were collected. The patients were subsequently divided in two groups according to their initial BMI: group A, BMI < 25 kg/m2, and group B, BMI ≥ 25 kg/m2. Objective (gravimetry) and subjective (VAS) measurements of the intensity of hyperhidrosis were taken from the patients' bodies prior to surgery, as well as 3 and 12 months after TS. Results Average palmar hyperhidrosis levels before the surgery did not differ significantly between the two groups (238.65 vs. 190.15; p = 0.053). A statistically significant decrease in palmar hyperhidrosis was noted in both groups, both 3 and 12 months after surgery (238.65 vs. 11.86 vs. 13.5; p < 0.05, and 190.15 vs. 16.67 vs. 11.81; p < 0.05, respectively). The intensity of sweating over the abdomino-lumbar area differed significantly between the groups before the surgery, both in subjective (1.71 vs. 3.61; p < 0.05) and objective (13.57 vs. 35.95; p < 0.05) evaluations. Three months after surgical intervention, an intensification of CS was observed in both the groups; however, no statistically significant differences were observed between the two sets of patients (VAS: 4.58 vs. 5.16; p = 0.38; gravimetry: 33.87 vs. 53.89; p = 0.12). Twelve months after TS, CS was higher in the group with an initial BMI ≥ 25 kg/m2, both in subjective and objective evaluations (3.23 vs. 4.94; p = 0.03 and 18.08 vs. 80.21; p = 0.026, respectively). Conclusion Patients with a BMI ≥ 25 kg/m2 experience more severe CS after TS, both in subjective and objective evaluations.
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Mostafa, Tarek A. H. "C-Arm Guided Percutaneous Radiofrequency Thoracic Sympathectomy for Treatment of Primary Palmar Hyperhidrosis in Comparison with Local Botulinum Toxin Type A Injection, Randomized Trial." November 2019 6, no. 22;6 (November 14, 2019): 591–99. http://dx.doi.org/10.36076/ppj/2019.22.591.
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Background: Hyperhidrosis is a disorder associated with detrimental effects on patients’ quality of life, occupational activities, and social interactions. Objectives: This study compares C-arm guided percutaneous radiofrequency (RF) ablation of the second and third thoracic sympathetic ganglions and local intradermal botulinum toxin type A (BTX-A) injection for the treatment of primary palmar hyperhidrosis. It focuses on clinical effectiveness, patient satisfaction, quality of life, safety, and the time at which repetition of the procedure is needed over one-year follow-up. Study Design: This is a randomized single-blinded trial. Setting: This study took place in a single hospital. Methods: Eighty patients with primary palmar hyperhidrosis were randomly assigned to one of 2 interventions: local intradermal BTX-A injection (n = 40) or C-arm guided percutaneous RF ablation (n = 40). The Dermatology Life Quality Index (DLQI) questionnaire and the Hyperhidrosis Disease Severity Scale (HDSS) were used for assessment at one week, one month, and 2, 6, and 12 months after intervention. The number of patients who required repetition of the procedure later on and the time at which they needed it were recorded, and possible side effects were assessed. Results: HDSS scores in the RF group were statistically significantly lower than in the BTX-A group at one week, one month, and 2, 6, and 12 months of follow-up. DLQI scores in the RF group were statistically significantly lower than in the BTX-A group at 6- and 12-month follow-up, whereas at one week, one month, and 2 months of follow-up, there was no statistically significant difference between both groups. The number of patients who required that the procedure be repeated was statistically significantly lower in the RF group than in the BTX-A group. The time at which patients needed repetition of the procedure in the BTX-A group was about 3 to 7 months after the first intervention. All patients in this group showed an increase in HDSS scores within this one-year followup. In the RF group, however, only one patient complained of increased HDSS scores after 8 months. There was no statistically significant difference in side effects between both groups. Limitations: The first limitation of this study is that results were based on subjective scales. The second is the radiation exposure associated with the technique described. Conclusions: This study supports percutaneous C-arm guided RF ablation of the second and third thoracic sympathetic ganglions and local intradermal BTX-A injection as safe, effective options and rapid lines of treatment of primary palmar hyperhidrosis. However, percutaneous RF ablation proved to be more effective, with longer effectiveness time and better patient satisfaction, compared to local intradermal BTX-A injection.
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Markov, M. A., M. P. Davydova, D. U. Usachev, Vasilii A. Lukshin, T. V. Balakhonova, O. V. Rodnenkov, and T. V. Martynyuk. "Pulmonary hypertension in patients with hemodynamically significant atherosclerotic lesion of a common carotid artery: new pathophysiological mechanisms of the disease." Systemic Hypertension 17, no. 2 (September 22, 2020): 61–64. http://dx.doi.org/10.26442/2075082x.2020.2.200221.
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Background. Pulmonary hypertension (PH) is a severe pathology that often leads a patient to death or disability. Recently, the development of PH associated with activation of the sympathetic nervous system (SNS) has been of interest. Some results obtained in an acute experiment on rats showed that activation of the carotid bodies of one external carotid artery is a sufficient stimulus to increase the tone of pulmonary arteries. Obviously, this effect is mediated by the sympathetic nervous system. However, the long-term effects of unilateral hypoxia of the carotid bodies on the morphofunctional state of the pulmonary arteries are not described in the literature.
Aim. Effect assessment of common carotid artery bifurcation region ischemia due to the atherosclerotic process on the pulmonary arteries in patients.
Materials and methods. The retrospective study was conducted in the Burdenko Neurosurgical Center and in the National Medical Research Center for Cardiology. A total of 60 case histories were analyzed in detail. All patients underwent Duplex scanning of the brachiocephalic arteries, as well as transthoracic echocardiography. The study included patients with atherosclerotic plaque in the area of the common carotid artery bifurcation on either one side or both. Exclusion criteria consisted of diseases that lead to the development of PH. The relationship between the presence of hemodynamically significant atheroma and the development of PH was evaluated.
Results. Patients were divided into two groups those with hemodynamically significant atherosclerotic plaque in the common carotid artery bifurcation region at least on one side (more than 75% of the vascular obstruction) and hemodynamically insignificant atheromas in the common carotid artery bifurcation region on one or both sides (less than 45%). Among patients from the first group, 52.8% of the patients had signs of PH. Among patients from the second group, only 16.7% of the patients had signs of PH. The difference in the frequency of PH occurrence between the two selected groups is statistically significant (p=0.005). There were no differences in red blood cells number, platelets number, glucose concentration and lipid composition of blood plasma.
Conclusion. Activation of SNS due to hemodynamically significant atherosclerotic plaque in the area of the bifurcation of the common carotid artery may be an independent mechanism for the development of PH.
Key words: pulmonary hypertension, carotid bodies, atherosclerotic plaque, sympathectomy of pulmonary arteries.
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Carrier, M., F. Tronc, D. Stewart, and L. C. Pelletier. "Dose-dependent effect of cyclosporin on renal arterial resistance in dogs." American Journal of Physiology-Heart and Circulatory Physiology 261, no. 6 (December 1, 1991): H1791—H1796. http://dx.doi.org/10.1152/ajpheart.1991.261.6.h1791.
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Important side effects of cyclosporin (CSA) are renal insufficiency and hypertension. They might be related to a renal vasoconstrictive effect of CSA, and this vascular response might be due to a local mechanism. CSA was injected in isolated renal artery perfused at constant flow in dogs. Changes in renal perfusion pressure reflected variations in vascular resistance. Pure CSA was dissolved in autologous blood and injected at doses of 0.5, 1, 5, and 10 mg. The infusion of 0.5 and 1 mg caused averaged renal perfusion pressure increases of 8 +/- 4 mmHg and 15 +/- 8 mmHg. Renal venous CSA levels averaged 32 +/- 3 and 49 +/- 9 nmol/l, respectively, at the end of injections. Infusion of 5 and 10 mg of CSA caused averaged renal perfusion pressure increases of 32 +/- 12 mmHg and 81 +/- 21 mmHg. Renal venous CSA levels at the end of injections averaged 142 +/- 30 and 382 +/- 82 nmol/l, respectively. A positive correlation was found between the changes in renal perfusion pressure and renal venous CSA levels. Blockade of alpha-adrenergic receptors, surgical renal sympathectomy, administration of thromboxane receptor antagonist, and endothelial-dependent vasodilation by acetylcholine infusion did not affect the renal vasoconstriction effect of CSA; renal response to CSA was prevented by blockade of the Ca channels with diltiazem, and the plasma endothelin concentration in renal venous blood increased significantly after injection of CSA. A dose-dependent increase in renal arterial resistance occurs with therapeutic blood levels of CSA. Renal vasoconstriction is induced by a local effect at the arterial wall, which is independent of neurogenic, adrenergic, and prostaglandin mechanisms.(ABSTRACT TRUNCATED AT 250 WORDS)
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Bollag, Laurent A., Srdjan Jelacic, Carlos Delgado Upegui, Cynthia Wu, and Philippe Richebe. "The nociception level index (NOL) response to intubation and incision in patients undergoing video-assisted thoracoscopic surgery (VATS) with and without thoracic epidural analgesia. A pilot study." F1000Research 7 (June 22, 2018): 875. http://dx.doi.org/10.12688/f1000research.15279.1.
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Background: The PMD100™ (Medasense Biometrics Ltd., Ramat Yishai, Israel) is a novel non-invasive nociception monitor that integrates physiological parameters to compute a real-time nociception level index (NOL) in the anesthetized patients. Thoracic epidural analgesia provides effective analgesia and improves surgical outcomes. Side effects include sympathectomy, hypotension, changes in skin temperature and a decreased cardiac accelerator fiber tone. The purpose of this pilot study was to evaluate changes in NOL values after incision in patients with and without epidural analgesia. Methods: Half of the patients scheduled for Video-Assisted Thoracoscopic Surgery (VATS) received a thoracic epidural catheter, placed and tested 2h before surgery and activated prior to incision. The other half of the patients received i.v. fentanyl (1 mcg/kg) five minutes before incision. Anesthesia and analgesia were maintained in a standardized manner. NOL and heart rate (HR) were compared before and after the nociceptive stimuli intubation and skin incision. Results: NOL significantly increased in all patients after intubation by 10.2 points (CI: 4.5-16.0; p=0.002) as well as HR by 9 beats per minute after intubation in all patients (CI: 3.3-15.6; p=0.01). After incision, in patients without epidural analgesia the NOL increased by 13.9 points (CI: 7.4-20.3; p=0.0001), compared to 5.4 points (CI: -6.3-17.1; p=0.29) in patients with epidural analgesia. HR did not significantly vary after incision in both groups. The area under the curve of delta NOL and delta HR variations after incision were significantly different (p<0.05) between groups and delta NOL variations were significantly different from baseline values but not the delta HR variations. Conclusions: This pilot study suggests that the PMD100™ Monitor may be a useful tool to evaluate the efficacy of an intraoperative thoracic epidural analgesia. Clinical Trial Registry Number: ClinicalTrials.gov record ID: NCT01978379 registered 10/25/2014.
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Ryazanov, A. N., I. D. Magamedov, V. V. Soroka, S. P. Nokhrin, E. P. Mikhelson, and A. B. Kurilov. "Сlinical Case of Successful Lumbar Sympathectomy in the Treatment of Complex Regional Pain Syndrome." Russian Sklifosovsky Journal "Emergency Medical Care" 9, no. 1 (October 20, 2020): 136–39. http://dx.doi.org/10.23934/2223-9022-2020-9-1-136-139.
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ABSTRACT. A 53-year-old male patient had extensive traumatic damage to the right lower limb in a car accident that happened 17 years ago, which subsequently led to a large amputation at the hip level. Later, adduction contracture in the right hip joint with a complex regional pain syndrome developed. Due to the ineffectiveness of various methods of conservative treatment, it was decided to perform right-sided lumbar sympathectomy. Ten days later, the patient was discharged for outpatient treatment. The result of the operation was a complete relief of pain syndrome both in the early postoperative and in the long-term periods of time. Despite the large number of types of conservative therapy in modern clinical practice, none of them is perfect. Doctors decide to operate less often, trying to minimize the intervention. However, therapeutic effects are not always possible as monotherapy, often requiring additional treatments. Due to the wide development and distribution of medical products, doctors often neglect or forget about such a method as lumbar sympathectomy. Therefore, the problem of complex regional pain syndrome remains relevant today.
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Maryanovich, Maria, Ali H. Zahalka, Halley Pierce, Sandra Pinho, Fumio Nakahara, Noboru Asada, Avigdor Leftin, Jan Vijg, and Paul S. Frenette. "Loss of Adrenergic Nerves in the Bone Marrow Microenvironment Drives an Aging HSC Niche Phenotype." Blood 128, no. 22 (December 2, 2016): 169. http://dx.doi.org/10.1182/blood.v128.22.169.169.
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Abstract Hematopoietic stem cell (HSC) aging is accompanied by an expansion of myeloid-biased HSCs with declined long-term self-renewal functions, contributing to the development of hematologic malignancies. Recent studies have suggested a role for the bone marrow microenvironment in HSC aging but the extrinsic molecular mechanisms driving their aging remain largely unknown. Mesenchymal stem cells (MSCs) form a critical component of the HSC niche, promoting HSC quiescence and balanced differentiation. Some MSC activity is found associated with arterioles, which are densely innervated by the sympathetic nervous system (SNS). We used tridimensional whole-mount bone marrow confocal immunofluorescence imaging of HSCs and vascular structures to investigate the effects of aging on the HSC microenvironment. Comparative bone marrow analyses of aged (20-24 months) C57BL/6 and Nestin-GFP transgenic mice (where GFP marks MSCs) with young (2 month-old) C57BL/6 mice, revealed significant reductions in sympathetic innervation (3-fold, p<0.01) as determined by staining for tyrosine hydroxylase expressing nerve fibers. The SNS neuropathy of aged mice was accompanied with vascular remodeling characterized by an increase in total vascular density marked by CD31+/CD144+ (2-fold, p<0.01) and shortening of arterioles marked by CD31+/CD144+ and Nestin-GFP+ (5-fold reduction, p<0.001), reduction in α-smooth muscle actin (αSMA) pericytes (12-fold, p<0.01) and expansion of Nestin+ MSCs (4 fold, p<0.05). Whereas a subset of HSCs (~35%) are associated with arterioles in young mice, analyses of HSC localization in aged bone marrow revealed that HSCs were redistributed and expanded away from arterioles (p=0.0047). Functional analysis revealed a diminished in vitro clonal capacity of aged MSCs (determined by CFU-F and mesensphere assays; 3-fold, p<0.0001), reduced HSC maintenance activity determined by the ability to produce HSC maintenance factors (Cxcl12, Scf and Angpt1, 2-fold, p<0.01), and increased proliferative state (2-fold, p<0.0001), all indicative of reduced activity. Since SNS nerves regulate circadian egress of HSCs through regulation of MSC activity, we evaluated the circadian oscillations of HSCs in blood and niche factors in Nestin-GFP+ stromal cells. Aged mice exhibited ablated oscillations of progenitor release determined by peripheral blood colony-forming units in culture (CFU-C/ml blood) and phenotypic progenitors (LSK/ml blood). Furthermore, unlike the robust circadian oscillations of Cxcl12 levels of young MSCs, no circadian expression pattern was detected in aged mice, suggesting that the SNS neuropathy associated with aging has functional consequences by leading to disrupted circadian rhythms and expanded MSC populations with reduced HSC maintenance activity. To determine whether the loss of SNS nerves drives bone marrow vascular remodeling and HSC aging, we surgically sympathectomized young Nestin-GFP mice by unilateral microsection of both the sciatic and femoral nerves, while the sham-operated contralateral side served as control. Strikingly, four months following surgery, phenotypic HSCs selectively expanded in sympathectomized femurs (2-fold, p<0.05) and exhibited myeloid-biased differentiation upon competitive bone marrow transplantation compared to control (3-fold, p<0.01). Furthermore, similar to our observations in aged mice, chronic surgical sympathectomy (16 weeks) induced dramatic "aging-like" alterations of bone marrow arteriolar structures characterized with arteriolar shortening and loss of αSMA+ and Nestin-GFP+ arterioles (4-fold, p<0.01; 3 fold, p<0.001). These results thus suggest that aging-associated sympathetic neuropathy and the loss of β-adrenergic signals in the bone marrow microenvironment drive aging of HSCs by remodeling vascular niches and thus represent a potent therapeutic target for stem cell rejuvenation. Disclosures Frenette: Pfizer: Consultancy; GSK: Research Funding; PHD Biosciences: Research Funding.
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Andresen, Julian Ramin, Fabian Scheer, Eric Schlöricke, Aria Sallakhi, Marc Olaf Liedke, and Reimer Andresen. "CT-guided thoracic sympathicolysis versus VATS sympathectomy in the therapeutic concept for severe primary palmar Hyperhidrosis." Thoracic and Cardiovascular Surgeon, April 15, 2021. http://dx.doi.org/10.1055/s-0041-1725205.
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Abstract Background The objective was to compare computed tomography (CT)-guided thoracic sympathicolysis (CTSy) and video-assisted thoracoscopic sympathectomy (VATS) with regard to their feasibility, the occurrence of minor and major complications, and the clinical outcome. Materials and Methods In this study, 88 patients treated by CTSy and 86 patients treated by VATS were retrospectively included. CTSy was performed after establishing the entry plane below the level of the intervertebral space T2/3 via a dorsolateral approach using a 22-G coaxial needle. On average of 5 mL of a sympathicolytic mixture was instilled. VATS was performed under intubation anesthesia. After insertion of the instruments via a minithoracotomy, the parietal pleura was dissected and the sympathetic trunk severed below T2. The interventions were performed unilaterally, the contralateral side being treated after approximately 6 weeks. All patients evaluated their sense of discomfort before treatment as well as 2 days, 6, and 12 months after, on the basis of a Dermatology Quality of Life Index and additionally the side effects that occurred. Results Both treatments led to a marked reduction of symptoms, whereby mild recurrent sweating occurred over the further course, significantly higher in the CTSy patient group. Short-term miosis and ptosis were rarely found in both groups. As the most common side effect, transient compensatory sweating was reported by 16/88 patients after CTSy and 10/86 patients after VATS. Pneumothoraces developed postoperatively in 7/86 cases. Temporary pain after thoracotomy was experienced by 12/86 patients. Conclusion For patients with palmar hyperhidrosis, CTSy and VATS represented a minimally invasive treatment option that provided a high and largely equivalent level of benefit.
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"Nonpharmacological treatments for anxiety disorders." Cerebral Aging 4, no. 3 (September 2002): 305–19. http://dx.doi.org/10.31887/dcns.2002.4.3/jcottraux.
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An evidence-based review of nonpharmacological treatments for anxiety disorders is presented. The vast majority of the controlled research is devoted to cognitive behavior therapy (CBT) and shows its efficiency and effectiveness in all the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) anxiety disorders in meta-analyses. Relaxation, psychoanalytic therapies, Rogerian nondirective therapy, hypnotherapy and supportive therapy were examined in a few controlled studies, which preclude any definite conclusion about their effectiveness in specific phobias, agoraphobia, panic disorder, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD), CBT was clearly better than psychoanalytic therapy in generalized anxiety disorder (GAD) and performance anxiety Psychological debriefing for PTSD appeared detrimental to the patients in one high-quality meta-analysis. Uncontrolled studies of psychosurgery techniques for intractable OCD demonstrated a limited success and detrimental side effects. The same was true for sympathectomy in ereutophobia. Transcranial neurostimulation for OCD is under preliminary study. The theoretical and practical problems of CBT dissemination are discussed.
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Accetto, Rok, Barbara Salobir, Dimitrij Kuhelj, and Nina Božič. "Zdravljenje odporne arterijske hipertenzije z renalno denervacijo – da ali ne?" Slovenian Medical Journal 84, no. 4 (May 29, 2015). http://dx.doi.org/10.6016/zdravvestn.1265.
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The true resistant hypertension is rare. The reasons are not entirely clear, but undoubtedly vegetative nervous system (renal afferent and efferent nerves) plays an important role. Surgical sympathectomy is effective but because of serious side effects is inappropriate. In recent years, a special catheter for endovascular renal radiofrequent denervation has been developed. With this method we have treated in accordance with the Slovenian and European recommendations, five patients with resistant hypertension. The radiofrequent ablation of renal arteries was not effective in our patients which is not what we expected because of the results of the first two non-randomized uncontrolled studies - Simplicity HTN 1 and 2. The third in a series of international multicentre studies - a randomized, controlled, single-blind study Simplicity HTN 3 showed, however, that renal denervation is not effective method for the treatment of resistant hypertension. A detailed overview of enrolled patients suggests that certain patients may be eligible for intervention, but have not yet been identified.
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"Left Stellate Ganglion Block for Refractory Ventricular Tachycardia: A Case Series." Journal of the Medical Association of Thailand 104, no. 3 (March 15, 2021): 506–11. http://dx.doi.org/10.35755/jmedassocthai.2021.03.10010.
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Ventricular arrhythmias are usually well controlled with medical management, cardiac implantable electronic devices, or catheter ablation. However, the refractory ventricular tachycardia or fibrillation (VT/VF) is life threatening and challenging. The authors reported a case series of left stellate ganglion blocks (LSGB) in patients with refractory VT/VF, who failed pharmacological treatment and multiple traditional cardiac interventions. Five patients underwent six LSGB. Four patients had significant decreased in ventricular arrhythmia burden. Among the responders, the LSGB suppressed significant VT/VF for three to seven days. Blocks did not only temporary suppress ventricular arrhythmia, but also stabilized the condition and served as a bridge to definitive treatment such as EP ablation or heart transplantation. There was no significant hemodynamic change or devastating side effects. The outcome from the present case series suggested that LSGB could be an effective treatment and a lifesaving intervention frintractable VT/VF. Keywords: Stellate ganglion block, Refractory ventricular tachycardia, Sympathectomy