Video endoscopic transthroracic sympathectomy [ETS] for pediatric palmar and / or axillary hyperhidrosis a comparison with open upper dorsal sympathectomy [UDS]

This study was done at Al-Azhar University Hospitals and Health Insurance Hospitals in the period from April 998 to July 2001. A total of thirty patients with idiopathic palmar and/or axillary hyperhidrosis were the materials of this work. Their ages ranged from eight to sixteen years old. They were seventeen females and thirteen males. The aim of this work was to evaluate and compare the immediate and late results of Endoscopic Transthorathic Sympathectomy [ETS] versus traditional open Upper Dorsal Sympathectomy [UDS]. All children were classified into two groups. Group [I]: included 16 patients for whom E.T.S. were attempted on 31 sites as one patient underwent unilateral [E.T.S.] while bilateral ETS was done for the other 15 cases. Group [II]: included 11 patients, for whom traditional open Upper Dorsal Sympathectomy [UDS] was done by the supraclavicular approach on 24 sites as 10 patients underwent bilateral and 4 patients unilateral open sympathectomy by the same group of surgeons in an overlapping period. The overall results of [E.T, S.] in group [I] were successful in all cases 100% and more superior than those in group [II] for whom open Upper Dorsal sympathectomy [UDS] was done. The thoracoscopic view of sympathetic chain is better than that provided by open [UDS]. So there was no intra operative complication. The operative time of the [E.T.S] is shorter than open [UDS]. The postoperative pain was less than that after open [UDS]. So the need for postoperative analgesia was much reduced. The mean hospital stay was 2 days, after [E.T.S.], while the average hospital stay after open [UDS] was 5 days. The scars of the [E.T.S.] were cosmetically more superior than those of open [UDS] The postoperative complications after [E.T.S.] were fewer than those after open [UDS]. So we conclude that E.T.S is fast, safe, economic, and effective method for the treatment of hyperhidrosis palmar is in adolescents and old children

Role of vascularized pedicled sternomastoid muscle flap in esophageal anastomosis: an experimental simulator of congenital esophageal atresia

This study was done at Al-Azhar University Hospitals in the period from April 1996 to July 2001. A total of 30 male new Zealand rabbits 4-6 months old weighting about 2.5 Kg were the materials of this work. In this work, 3 cm segment was resected from the cervical oesophagus and the oesophagus was anastomosed to create some sort of tension similar to that is present in congenital oesophageal atresia. Pedicled sternomoistoid muscle flap was used to reinforce the anastomsis in 15 rabbit [group B]. while in the other 15 rabbits [group A] no flaps were used, Five rabbits in-group [A] and one in-group [B] developed leakage and died in the first 2 weeks postoperatively. Three rabbits from each group were sacrificed 3 weeks postoperatively and the remaining alive rabbits are 11 in-group [B] and 7 in-group [A], were sacrificed 8 weeks postoperatively. All rabbits underwent clinical examination gastrograffin swallow, postmortem macroscopical examination and histopathological study using 4 types of dyes. The aim was to study the effect of muscle flap on the incidence of leakage and stricture and the mechanism of its action. The results of the study revealed that, the muscle flaps decreases remarkably the incidence of leakage, gives an extra blood supply to the anastomotic area and decreases the fibrosis in the anastomolic area, The mucosa was healed by regeneration and not by fibrous tissue excluding its role in incidence of stricture, The muscle flap itself was gradually infiltrated by increasing fibrous tissue by time