T2 versus T2 and T3 endoscopic sympathetic ablation in primary palmar hyperhidrosis

Between June 2000 and April 2002, 112 sympathectomies were performed on 56 patients suffering from isolated palmar hyperhidrosis. Both sides were operated during the same surgical procedure using 5 mm 0-degree laparoscope. All patients were placed in a semi-sitting position under single lumen endotracheal anesthesia. Electrocute ablation of T2 ganglion and any Kuntz fibers was performed in 28 patients [group I] and similar procedure on T2 and T3 ganglion was performed in the other 28 patients [group II]. The procedure was accomplished within 12 minutes [range 7-20 minutes] for both sides. All patients were discharged within eight hours after conventional chest X-ray. Fifty-four patients were followed up for a mean of 17 months [2 patients lost the follow up]. The study concluded that the incidence of compensatory hyperhidrosis can be greatly decreased by limiting sympathetic ablation to T2 only in the treatment of primary palmar hyperhidrosis with a high subjective patient-satisfaction

Platelet aggregation index and femoropopliteal graft patency

Platelet aggregation index [PAI], based on the aggregation pattern and platelet count, was determined in the 40 patients available for platelet analysis who underwent 53 femoropopliteal bypasses with 6-mm, externally-supported, knitted Dacron grafts from 1982 to1992 mean follow up 50 months]. This index was found to be stable both pre-and postoperatively. The PAI value, the patient's age, history of hypertension atherosclerotic heart disease, diabetes, and/or smoking, the site of the distal anastomosis, previous ipsilateral bypass and state of runoff determined by preoperative angiography were analyzed for predicting closure, using the Cox proportional hazards regression model. Of the studied risk factors, the PAI was the most highly predictive variable for graft closure [P < 0.0001]. An increase of 10 units was associated with an increased relative risk of 2.02. Throughout the follow up period, 15 of l6 grafts remained patent in patients with an PAI < 15, whereas only 2 grafts out of 17 remained patent in patients with a PAI > 30. These data suggest that the PAI is an accurate predictor of the Outcome of femoropopliteal bypass using externally-supported, knitted Dacron grafts

Laparoscopic cholecystectomy for acute and chronic cholecystitis

A total of 65 patients with gall stones were considered for laparoscopic cholecystectomy [59 elective and 6 patients with acute cholecystitis. The mean age was 51 years, and 82% were women. Laparoscopic cholecystectomy was successful in all patients. There were no deaths but a major complication occurred in one patient who required laparotomy because of internal bleeding 18 hours after successful laparoscopic cholecystectomy. There were four minor complications, but no bile duct injury. The median postoperative stay was 2 days in elective cases and 3 days in acute cases. These results suggested that, Laparoscopic cholecystectomy is feasible for most patients with acute and chronic cholecystitis with minor risk of injury to the surrounding structures