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@#Objective To evaluate the quality of life (QOL) in patients with primary palmar hyperhidrosis (PPH) after endoscopic thoracic sympathicotomy (ETS) and analyze the influencing factors. Methods A total of 243 patients (118 males and 125 females, with an average age of 21.99±6.31 years) with PPH who were successfully treated with ETS (only T3 level thoracic sympathicotomy) in our hospital from January 2017 to January 2018 were enrolled, and the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) was used to assess the QOL scores before and after ETS. By establishing a linear regression model of gender, age, body mass index, compensatory hyperhidrosis (CH) and palm dryness, and the relationship between the changes of the QOL scores and various factors was studied. Results The total QOL score after surgery was higher than that before surgery (63.01±4.58 vs. 48.11±1.95, P<0.05). Compared with the negative group of CH, the QOL score decreased by 4.662 in the postoperative CH patients. For every grade of CH severity increasing, the QOL score decreased by 3.449. Compared with the negative group, the QOL scores decreased by 1.804 and 2.400 respectively for every grade of CH severity increasing in the patients with postoperative chest and back CH. Conclusion ETS can not only improve the symptoms of abnormal palmar hyperhidrosis, but also significantly improve the QOL. Severe chest and back CH is an important factor affecting the QOL of patients.
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@#This guideline systematically reviewed and summarized the 20 years' clinical and basic research experience of minimally invasive treatment of palmar hyperhidrosis (PH) in China, and discussed the hot and difficult issues of minimally invasive treatment of PH. We have formed a new consensus of PH in terms of its definition, clinical manifestations, diagnostic criteria and classification, surgical indications and contraindications, surgical procedures and management of complications, especially in the area of postoperative compensatory hyperhidrosis (CH). This guideline confirmed that endoscopic thoracic sympathicotomy (ETS) was the most effective treatment for PH and that CH was the most common side effect. In order to reduce the incidence of CH, eliminate patient's distress and improve patient's satisfaction, the guideline emphasized that the keys to prevent CH were to pay attention to pre-operative interview, communicate with patients, select patients carefully, avoid the enlargement of operative indication and optimize operative procedure. This guideline also introduced the advantages and disadvantages of various methods to reduce the incidence of CH. We provided this authoritative guidance document in order to avoid the surgical risk, strengthen the perioperative management and improve the sugery effect.
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<p><b>BACKGROUND</b>Endostar™ (rh-endostatin, YH-16) is a new recombinant human endostatin developed by Medgenn Bioengineering Co. Ltd., Yantai, Shandong, P.R.China. Pre-clinical study indicated that YH-16 could inhibit tumor endothelial cell proliferation, angiogenesis and tumor growth. Phase I and phase II studies revealed that YH-16 was effective as single agent with good tolerance in clinical use.The current study was to compare the response rate , median ti me to progression (TTP) ,clinical benefit andsafety in patients with advanced non-small cell lung cancer ( NSCLC) , who were treated with YH-16 plus vi-norelbine and cisplatin (NP) or placebo plus NP.</p><p><b>METHODS</b>Four hundred and ninety-three histologically or cy-tologically confirmed stage IIIB and IV NSCLC patients , withlife expectancy > 3 months and ECOG perform-ance status 0-2 , were enrolledin a randomized ,double-blind ,placebo-controlled , multicenter trial ,either trialgroup : NP plus YH-16 (vinorelbine 25 mg/m² on day 1 and day 5 ,cisplatin 30mg/m² on days 2 to 4 , YH-167.5mg/m² on days 1 to 14) or control group : NP plus placebo (vinorelbine 25 mg/m² on day 1 and day 5 ,cis-platin 30 mg/m² on days 2 to 4 ,0.9% sodium-chloride 3 .75 ml on days 1 to 14) every 3 weeks for 2-6 cycles .The trial endpoints included response rate ,clinical benefit rate ,time to progression,quality of life and safety .</p><p><b>RESULTS</b>Of 486 assessable patients , overall response rate was 35.4% in trial group and 19.5% in controlgroup (P=0 .0003) . The median TTP was 6 .3 months and 3 .6 months for trial group and control group respectively (P < 0 .001) . The clinical benefit rate was 73 .3 %in trial group and 64.0% in control group (P=0 .035) .In untreated patients of trial group and control group ,the response rate was 40 .0% and 23.9%(P=0 .003) ,the clinical benefit rate was 76 .5 % and 65 .0 % (P=0 .023) ,the median TTP was 6 .6 and 3 .7months (P=0 .0000) ,respectively .In pretreated patients of trial group and control group ,the response ratewas 23.9% and 8.5%(P=0 .034) ,the clinical benefit rate was 65.2% and 61.7%(P=0 .68) ,the median TTP was 5 .7 and 3 .2 months (P=0 .0002) ,respectively . The relief rate of clinical symptoms in trial groupwas higher than that of those in control group ,but no significance existed (P > 0 .05) . The score of quality oflife in trial group was significantly higher than that in control group (P=0 .0155) after treatment . There were no significant differences in incidence of hematologic and non-hematologic toxicity , moderate and severe sideeffects betweentrial group and control group .</p><p><b>CONCLUSIONS</b>The addition of YH-16 to NP regimen results in significantly and clinically meaningful improvement in response rate , median time to tumor progression,and clinical benefit rate compared with NP alone in advanced NSCLC patients . YH-16 in combination with chemotherapy shows a synergic activity and a favorable toxic profile in advanced cancer patients .</p>
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Objective To compare laparoscopic with endoscopic procedures in the treatment of gastroesophageal reflux disease(GERD).Methods A retrospective study on 52 cases of laparoscopic Nissen procedure(Laparoscopic Group) and 28 cases of endoscopic gastroplication procedure(Endoscopic Group) was carried out.The patient's general data,operative outcomes,and follow-up results(at 1 and 3 postoperative months) were reviewed. Results The symptoms severity scores and the total reflux time were significantly decreased in both groups.The heartburn index,the regurgitation index,and the reflux time percentile were decreased from 72.2?7.3,1.80?0.45,and 11.2%?6.2% to 14.5?4.8(P
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Objective To summarize the experience of perioperative management of lung volume reduction surgery(LVRS) under video-assisted thoracoscopy.Methods A total of 40 patients with severe chronic obstructive pulmonary disease(COPD) underwent LVRS under video-assisted thoracoscopy.A mini-incision thoracotomy was given in 23 of them.During the operation,the Endo-GIA was utilized to resect 20%~30% of total volume of affected lung.Results The LVRS was performed in bilateral lungs in 13 patients(under thoracoscopy only in 7 patients and with the assistance of mini-incision thoracotomy in 6 patients) and in unilateral lung in 27 patients(under thoracoscopy only in 10 patients and with the assistance of mini-incision thoracotomy in 17 patients).There were no surgery-related deaths.All the patients were discharged from the hospital 9~41 days(mean,18 days) after operation.Not only symptoms of dyspnea were obviously relieved but also the respiratory index was upgraded by 1~2 grades.The comparisons on pulmonary functions between preoperative time and 1 month after operation indicated a great improvement postoperatively,including the forced expiratory volume in 1 second(FEV_1)(48.3%?4.9% vs 68.5%?5.6% predicted;t=17.169,P=0.000),the residual volume(RV)(270.0%?23.6% vs 188.0%?19.8% predicted;t=16.835,P=0.000),and the total lung capacity(TLC)((123.0%?9.8%) vs 102.0%?8.7% predicted;t=10.135,P=0.000).Postoperative complications included air leakage in 10 patients,lung infection in 5 patients,and bronchial asthma in 3 patients,all of whom were cured after symptomatic management.A follow-up was conducted in 37 patients for 3~77 months(mean,46 months).Three patients died of lung cancer at 6,10, and 20 postoperative months,respectively.Two patients died of esophageal cancer at 3 and 8 postoperative months,respectively.And one patient died of cerebrovascular disease at 6 postoperative months.The remaining 31 patients survived. Conclusions Proper perioperative management is of great importance for a successful surgery and a rapid postoperative recovery.
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Objective To summarize the experience of 200 cases of endoscopic thoracic sympathectomy(ETS). Methods Clinical materials of T_2~T_4 sympathectomy under thoracoscope for treating palmar hyperhidrosis from January 2003 to April 2005 were analysed. Results [WTBZ] All the 200 cases of operation were successfully completed.Symptoms of hyperhidrosis vanished with both hands dry and warm in all the patients.Plamar temperature increased by a mean of(3.1?0.9)℃ after operation.Follow-up observations in 192 cases for 1~28 months(mean,18.4 months) found no recurrence.Compensatory hyperhidrosis was found in 52 cases(27.1%). Conclusions Endoscopic thoracic sympathectomy is a safe,effective,and micro-invasive treatment for palmar hyperhidrosis.
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Objective To assess the outcomes,complications,and quality of life following endoscopic thoracic sympathectomy(ETS) of the T2~T4 ganglia for treating primary palmar hyperhidrosis(PH). Methods A total of 200 cases were followed with clinic checkups or telephone inquiries for a period of 1~28 months(mean,18.4 months). Results Of the 200 cases,8 cases were loss of follow-up and 192 cases obtained a complete and fully satisfactory alleviation of palmer and axillary hyperhidrosis.No recurrence and severe complications were found.The prime complication was compensatory hyperhidrosis(52/192,27.1%),whose incidence was slightly higher in female and severe patients and unrelated to age.Other complications included 1 case of pneumothorax and 1 case of pulmonary atelectasis. Conclusions Endoscopic thoracic sympathectomy of the T_2~T_4 ganglia for palmar hyperhidrosis is effective,safe and reliable.The procedure improves patients' quality of life and gives satisfactory outcomes.However,all patients should be informed of the common complications,particularly compensatory hyperhidrosis,before the surgery.
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Objective Assess the value of intraoperative palmar temperature and brachial artery blood flow monitring during sympathectmy. Methods 150 cases palmar hyperhidrosis underwent transthoracic endoscopic sympathectomy. Palmar temperature was all monitored and brachial artery blood flow is also detected by ultrasonography in 33 cases. Results Palmar temperature increase (2.8?1.0)℃ after sympathetic chain has been destroyed [(include a high level increase of (3.24?0.20)℃ in 125 cases and a low level increase of (0.64?0.12)℃ in 25 cases]. Ultrasonography indicate brachial artery radius (R) and blood flow volume (VOL) are significantly increased, Maximum (Vmax) and Minimum (Vmin) speed of blood flow at systole and diastole, pulse index (PI) and systole/diastole blood flow ratio (S/D) are also increased (P
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Objective To investigate clinical effects of video assisted thoracoscopic lung volume reduction surgery(LVRS) for severe emphysema. Methods Six patients with severe emphysema underwent lung volume reduction surgery by video assisted thoracoscopy.The LVRS was performed unilateraly in 4 and bilateraly in 2 through median stemination.20%～30% of total volume of lung was resected. Results There was no operative death.All patients were followed up for 3 to 17 months.After LVRS,the mean forced expiratory volume in 1 second(FEV 1) and PaO 2 increased by 24 6% and 8 3%,respectively,Total lung capacity(TLC),residual volume(RV) and ventilatory assistance decreased by 24 6%,20 3% and 47 1% respectively Conclusions LVRS by video-assited thoracoscopy is an effective and safe technique for patients with severe emphysema.It can relieve dyspnea and improve excise tolerance and the quality of life.