Thoracoscopic sympathectomy for palmar hyperhidrosis and Raynaud's phenomenon of the upper limb and excessive facial blushing: a five year experience.

Primary hyperhidrosis of the palms, face, and axillae has a strong negative impact on social and professional life. A retrospective analysis of 40 laparoscopic transaxillary thoracic sympathectomies performed in a district general hospital over a five year period was undertaken in order to determine the effectiveness of this procedure. A postal questionnaire was sent to all patients to assess the benefit from the operation; postoperative pain and time off work were collated. Immediate failure was noted in three patients, of whom two later underwent successful reoperation. Recurrence was noted in three patients (8%). Though immediate complications were minimal, the major long term postoperative morbidity was compensatory hyperhidrosis on the back, chest, and thigh (77%) along with gustatory sweating over the face (22%). Thoracoscopic sympathectomy is a safe, effective, and minimally invasive surgical treatment for hyperhidrosis, Raynaud's phenomenon of the upper limb, and excessive facial blushing; however, the chance of long term compensatory hyperhidrosis is high.

The femoropopliteal segment as a source of peripheral atheroembolism.

The concept of atheromatous embolisation from ulcerated plaques in non-aneurysmal arteries is well recognised but little attention has been paid to lesions in arteries below the inguinal ligament as a source of emboli. Twenty eight of 42 patients (66%) who presented with atheroembolism to the lower limbs had an embolic source in the femoropopliteal segment, with only a third with an identifiable source lesion in the aorta or iliac vessels. A characteristic clinical presentation, combined with a typical appearance on arteriography, usually allows a confident diagnosis to be made, yet many of these patients still have their ischaemic symptoms and signs wrongly attributed to occlusive disease. Successful management depends on early recognition and correction of the source lesion. The treatment of choice is a bypass procedure with appropriate vessel ligation. The majority of ischaemic lesions recover, or the damage is limited to minor digital amputations which will heal primarily. Surgical correction is successful in preventing further embolic episodes.

Venous claudication. A report of 15 cases and a review of the literature.

The symptom of intermittent claudication is not invariably due to arterial disease. Exercise-related pain resulting from venous insufficiency is poorly defined, but has been described by a number of authors in the past. Fifteen patients with symptoms suggestive of venous claudication are reported. The history and clinical findings are described. The further investigation of these patients is outlined, starting with the non-invasive methods of Doppler ultrasonography and strain gauge plethysmography. Ascending phlebography was performed on all affected limbs (n. 19) and descending phlebography was performed on those shown to have a patent deep venous system. These investigations demonstrated deep venous abnormalities associated with the distinct symptom complex. Venous claudication is defined and the literature reviewed. It is hoped that a clearer understanding of the condition will result in more frequent and accurate diagnosis with subsequent benefit to the patient.

A randomised trial of bandaging after sclerotherapy for varicose veins.

169 legs with primary varicose veins suitable for sclerotherapy were entered into the trial. At the time of injection they were randomly allocated to be bandaged for three or six weeks; patients allocated to the six-week group had their legs rebandaged after the first three week. Patients were subsequently assessed blind at three months and thereafter at yearly intervals.

The excretion of cefuroxime in human bile.

Cefuroxime is a broad spectrum cephalosporin antibiotic. An intravenous injection of cefuroxime 1.5 g was administered to 25 patients after induction of anaesthesia for cholecystectomy. Concentrations of antibiotic were measured and the mean levels in microgram/ml found to be: serum 120.5, common bile duct bile 42.8, gallbladder bile 5.4, gallbladder wall 39.2. The drug levels exceeded the minimum inhibitory concentrations for most organisms commonly encountered in the biliary tract. There was no difference in cefuroxime levels in bile from functioning or non-functioning gallbladders. It is suggested that the diffusion of antibiotic into and out of the inflamed gallbladder is similar to that in abscesses and in experimental tissue cages. No side effects, toxicity or wound infections occurred.