Résumé
BACKGROUND: Thoracoscopic sympathicotomy was, at first, thought to be a simple and safe method for treatment of hyperhydrosis. However, the main disadvantage of this procedure is irreversibility in additions so-called rebound sweating occurred in 30 40% of patients during the first 1 2 weeks after operation. Some patients regret the surgery, even to the extend of preferring the original sweaty hands. Recently clipping has been suggested one of the way to minimize such problem. Hypothesis of this study was that sympathetic nerve block effect by clipping may be weak compared to sympathicotomy. The aim of this study was to evaluate and compare the sympathicotomy by clipping effect on cardiovascular system. METHODS: Sixty-five patients with essential hyperhydrosis in ASA physical status class 1 undergoing thoracoscopic sympathetic block were randomly divided into two groups: The Clipping group (N = 21) and the sympathicotomy (N = 44) group. Anesthesia was induced with thiopental sodium (5 mg/kg) and pancuronium (0.05 mg/kg) and maintained with enflurane. The operation was done to the left side first and the to the right by an experienced surgeon. During the procedure, we measured blood pressure using a non invasive technique at the right forearm, heart rate and temperature after anesthetic induction as baseline values, immediately after the left side resection of the T2 sympathetic trunk or clipping, and after completely both sides resection. All the records were coded and analysed single blind by one author. RESULTS: After the T2 sympathicotomy, heart rate decreased from 87 +/- 14 to 76 +/- 17 (P < 0.05) and the mean blood pressure was reduced from 77 +/- 14 to 64 +/- 10 mmHg (P < 0.05). After T2 clipping, heart rate decrease from 88 +/- 18 to 73 +/- 14 (P < 0.05) and mean blood pressure was reduced from 74 +/- 12 to 67 +/- 13 mmHg (P < 0.05). CONCLUSION: The main result of this study was that there was no significant difference in sympathetic block effects on blood pressure and heart rate between clipping and sympathicotomy during the procedure.
Sujets)
Humains , Anesthésie , Bloc anesthésique du système nerveux autonome , Pression sanguine , Système cardiovasculaire , Enflurane , Avant-bras , Main , Rythme cardiaque , Coeur , Pancuronium , Sueur , Sudation , ThiopentalRésumé
Pleural aspergillosis is an uncommon disease; only 29 cases have reported in the literature since 1958. We reported a patient with a pleural aspergillosis complicated a preexisting chronic empyema. Treatment consisted of pleuropneumonectomy, creation of an pleurocutaneous window followed by an intrapleural instillation of nystatin.