ABSTRACT
BACKGROUND: Axillary hyperhidrosis is a common and distressing problem interfering with the life of affected individuals. Currently, local surgery is the treatment of choice once conservative treatment has failed. OBJECTIVES: To evaluate the clinical efficacy and safety of tumescent suction curettage (TSC) in treating axillary hyperhidrosis and to correlate it with histological markers. METHODS: Thirty patients (17 females and 13 males, average age 29.9 years) underwent TSC. After tumescent anaesthesia, a suction cannula was inserted in the axilla on each side through two tiny incisions and subcutaneous tissue was removed by suction. We evaluated the clinical efficacy and complications, and in a subset of patients performed biopsies before surgery, as well as 1 month and 1 year after the operation. RESULTS: In comparison with preoperative values, the sweat rate was diminished by 85% after 1 month, 71% after 6 months, 77% after 12 months and 61% after 24 months. The reduced efficacy with time was histologically correlated with an increase in the innervation, whereas the number of sweat glands continued to diminish. The majority of patients were satisfied with the operation but the satisfaction diminished with time. Patients with the highest preoperative sweat rates were the most satisfied after the intervention. CONCLUSION: TSC is an effective and safe treatment for axillary hyperhidrosis. The long-term recurrence may be due to reinnervation.
Subject(s)
Anesthesia/methods , Curettage , Hyperhidrosis/surgery , Adolescent , Adult , Aged , Axilla , Biopsy , Curettage/adverse effects , Female , Humans , Hyperhidrosis/pathology , Hyperhidrosis/physiopathology , Male , Middle Aged , Patient Satisfaction , Prospective Studies , Severity of Illness Index , Skin/innervation , Subcutaneous Tissue/surgery , Suction , Sweat Glands/pathology , Sweating , Time Factors , Treatment Outcome , Young AdultABSTRACT
Surgery of pancreatic and biliary tract carcinomas includes an extensive surgical dissection with removal of all neural and lymphoid tissue together with a skeletonization of hepatoduodenal structures. Skeletonization or autodigestion may lead to pseudaneurysms of perihepatic arteries. Rupture of one of these aneurysms may cause a severe upper gastrointestinal bleeding. Only a few cases of these serious complications are reported in literature.
Subject(s)
Ampulla of Vater/surgery , Anastomosis, Surgical , Aneurysm, False/surgery , Aneurysm, Ruptured/surgery , Common Bile Duct Neoplasms/surgery , Gastrointestinal Hemorrhage/surgery , Hepatic Artery/injuries , Pancreaticoduodenectomy , Pancreaticojejunostomy , Postoperative Complications/surgery , Surgical Wound Dehiscence/surgery , Aneurysm, False/diagnosis , Aneurysm, Ruptured/diagnosis , Combined Modality Therapy , Embolization, Therapeutic , Gastrointestinal Hemorrhage/diagnosis , Hepatic Artery/surgery , Humans , Male , Middle Aged , Postoperative Complications/diagnosis , Reoperation , Surgical Wound Dehiscence/diagnosisABSTRACT
Intrathoracic, totally ectopic goiters are rare, but have to be considered as a diagnostic possibility in all mediastinal masses. The displacement of the thyroid tissue inferiorly in connection with the embryogenesis of the heart and the large vessels explains the aetiology of the disease. Ectopic goiters are often asymtomatic or oligosymptomatic. They may be classified into two groups according to their location in the anterior or posterior mediastinum. The diagnostic procedures include standard X-ray and CT scan imaging, eventually combined with radionuclide scintigraphy. Once the diagnosis of a intrathoracic goiter is obtained the treatment is surgical (unknown dignity, risk of compression or other symptoms). The approach of choice is through a median sternotomy in case of a anterior location and a posterolateral thoracotomy in case of a posterior location. We discuss the diagnostic and therapeutic approach in 2 patients with mediastinal goiters--one located in the anterior and one in the posterior mediastinum.
