application of thoracoscopic sympathectomy for the optimal management of hyperhidrosis and severe upper extremity ischemia

The thoracic sympathectomy is traditionally performed through open surgical thoracotomy. It is an extensive procedure associated with an unacceptable inconvenience. The present study describes a less morbid and minimally invasive thoracoscopy as the procedure of choice for thoracic sympathectomy. The present study, carried out during 2001 to 2005, was performed on 33 patients aged from 17 to 18, with a mean of 42.7 years and comprising 25 males and 8 females. They suffered from essential hyperhidrosis and severe upper extremity ischemia, which were unsuitable for revascularization. Of 33 patients, 15 had Buerger's disease, 3 emboli, 5 essential hyperhidrosis, 3 Raynaud's syndrome, 3 intra-arterial injections, 2 advanced arthrosclerosis, 1 acute thrombosis, and 1 patient post-traumatic ischemia. The patients were indicated to undergo a probable emergency thoracotomy. They were anaesthetized using one lung endobronchial intubations and underwent a two-port videothoracoscopy. Sympathetic chain resection was limited to T2-T3 and lower third of the stellate ganglion. The patients were kept under careful observation and comparisons were made between their preoperative and postoperative symptoms. Moreover, the early and late complications were carefully documented and analyzed. The presenting symptoms included 11, 4, 4 and 3 cases of ulcer and gangrene, rest pain, cyanosis and cold extremities, as well as excessive hand sweat respectively. The foregoing thoracic sympathectomy led to corresponding complete and partial recovery of 31 and 2 patients. Thoracoscopic sympathectomy is a simple, safe, reliable and cost effective therapy with surprisingly good results and low complications in patients with primary hyperhidrosis as well as limb threatening upper extremity ischemia, an entity unsuitable for revascularization. Additionally, the results of sympathectomy for ischemia of upper are much better than lower extremities, so the procedure could be advised liberally for such patients

study of 73 patients with liver trauma

Introduction: liver is one of the most injured organs in trauma. We evaluated and grouped the degree of liver trauma and management of each group

Material and Methods: 73 patients with liver trauma admitted in sugery departement from 1992-2002. The patients' informations were written in special forms

Results: 58 male and 15 female, mean age of 30 years. [6-68 years] presenting from 1992-2002 were reviewed. There were 29 cases of penetrating injury and 44 cases of blunt trauma. 7 patient were successfully managed without operation [5 with blunt injury] and were discharged after a mean hospital stay of 7 days. 51 cases were classified as group A [grade 1 and 2] and were managed by suture [with or without drainage], with 3 deaths. 15 cases were classified as group B [grade 3 and 4] and underwent one or more of the following: peri hepatic packing, resectional debridement and hepatotomy with direct suture ligature. 6 of these died from uncontrolled hemorrhage

Conclusion: Judicious clinical assessment and radiological monitoring may reduce the number of unnecessary laparatomies