[Results of video-assisted thoracoscopic sympathectomy for facial blushing]. / Resultados del tratamiento videotoracoscópico del blushing.

BACKGROUND: Involuntary craniofacial erythema, or blushing, due to autonomic dysfunction can be a cause of psychological distress. Although anecdotal reports have suggested that pharmacologic treatments or cognitive behavioral therapy can be used to treat the condition, no rigorous analyses of their efficacy have been reported. OBJECTIVES: To assess the efficacy of video-assisted thoracoscopic sympathectomy and to study phobic anxiety and other personality traits in a series of patients with involuntary facial blushing. MATERIALS AND METHODS: We carried out a retrospective observational study of patients treated with bilateral video-assisted thoracoscopic sympathectomy for blushing over a 7-year period (2001-2008). All the patients were treated by a dermatologist, a psychologist, and a thoracic surgeon and were informed of the predicted outcomes. RESULTS: A total of 204 patients with a mean age of 34 years (range, 15-67 years) were included; the numbers of males and females were similar. Only 10% had unpredicted outcomes; in such cases, either the procedure was insufficiently effective or postoperative reflex sweating developed (and was considered serious in 2%). There were no deaths and only 1 case of transient Horner syndrome. Video-assisted thoracotomy was required for pleural symphysis in 1 patient; 5 patients developed pneumothorax, but only 1 of them required pleural drainage. CONCLUSIONS: Video-assisted sympathectomy is a safe, effective and definitive treatment for disabling blushing. Anxiety that is detected before surgery is a reaction to blushing rather than a cause of it.

[Outpatient or short-stay videothoracoscopy-assisted thoracic sympathectomy: anesthesia in 445 cases]. / Anestesia para simpatectomía torácica por videotoracoscopia en régimen ambulatorio o corta estancia: experiencia en 445 casos.

OBJECTIVE: To demonstrate the safety of outpatient or short-stay bilateral videothoracoscopy-assisted thoracic sympathectomy. PATIENTS AND METHODS: The medical records of 445 who underwent bilateral videothoracoscopy-assisted thoracic sympathectomy were reviewed; the same protocols were used to guide these outpatient or short-stay procedures in all cases. Intravenous anesthesia was provided. An orotracheal tube allowed for carrying out the sympathectomy procedure during short periods of apnea. A 2% lidocaine solution was infused through the thoracic drains, which were removed soon after surgery. Data on intraoperative respiratory variables, pain, and intra- and postoperative complications were gathered. The data for patients undergoing the procedure on an outpatient or short-stay basis were compared. RESULTS: No significant differences in demographic or perioperative variables were found between the 2 groups. In 3.6% of the patients in the series, there was a record of a postoperative pulmonary complication: 4 therapeutic minithoracotomies; 1 subcutaneous emphysema without radiologic changes; 9 residual pneumothoraces, 2 requiring pleural drainage; 1 chylothorax; and 1 delayed hemothorax. With the exception of the late-developing hemothorax, all complications were diagnosed and treated in the immediate postoperative period. In the outpatient surgery group, unplanned admissions because of patient refusal to leave occurred in 6.5% of the cases. CONCLUSION: The low incidence of complications, and especially the finding that complications are detected in the early recovery period, indicate that this procedure can be performed on an outpatient basis.

Anestesia para simpatectomía torácica por videotoracoscopia en régimen ambulatorio o corta estancia: experiencia en 445 casos / Outpatient or short-stay videothoracoscopyassisted thoracic sympathectomy: anesthesia in 445 cases

OBJETIVOS: Demostrar que la inclusión de la simpatectomía bilateral por videotoracoscopia en régimen ambulatorio y corta estancia es un procedimiento seguro. PACIENTES Y MÉTODOS: Se analizaron retrospectivamente las historias clínicas de 445 pacientes intervenidos de simpatectomía torácica bilateral por videotoracoscopia con el mismo protocolo bajo régimen ambulatorio o de corta estancia. Se realizó anestesia intravenosa con tubo orotraqueal simple permitiendo periodos de apnea para la simpatectomía. Se instiló lidocaína al 2% por los drenajes torácicos que se retiraron en el postoperatorio inmediato. Se recogieron variables respiratorias intraoperatorias, el nivel de dolor y las complicaciones intraoperatorias y postoperatorias. Se compararon los datos de los pacientes operados en régimen de cirugía ambulatoria con los de corta estancia. RESULTADOS: No hubo diferencias entre los dos grupos en las variables demográficas y perioperatorias. El 3,6% de pacientes de la serie presentaron complicaciones respiratorias postoperatorias: 4 minitoracotomías de asistencia; un enfisema subcutáneo sin traducción radiológica; 9 neumotórax residuales de los que sólo dos requirieron drenaje pleural; un quilotórax y un hemotórax tardío. Excepto el hemotórax tardío, el resto de complicaciones se diagnosticaron y se tomó la decisión terapéutica en el postoperatorio inmediato. En el grupo de la cirugía ambulatoria los ingresos no planificados por negativa del paciente al alta fueron del 6,5%. CONCLUSIÓN: La baja incidencia de complicaciones, y sobre todo el hecho que se detecten en el postoperatorio inmediato permite realizar este procedimiento en régimen ambulatorio(AU)

OBJECTIVE: To demonstrate the safety of outpatient or short-stay bilateral videothoracoscopy-assisted thoracic sympathectomy. PATIENTS AND METHODS: The medical records of 445 who underwent bilateral videothoracoscopy-assisted thoracic sympathectomy were reviewed; the same protocols were used to guide these outpatient or shortstay procedures in all cases. Intravenous anesthesia was provided. An orotracheal tube allowed for carrying out the sympathectomy procedure during short periods of apnea. A 2% lidocaine solution was infused through the thoracic drains, which were removed soon after surgery. Data on intraoperative respiratory variables, pain, and intra- and postoperative complications were gathered. The data for patients undergoing the procedure on an outpatient or short-stay basis were compared. RESULTS: No significant differences in demographic or perioperative variables were found between the 2 groups. In 3.6% of the patients in the series, there was a record of a postoperative pulmonary complication: 4 therapeutic minithoracotomies; 1 subcutaneous emphysema without radiologic changes; 9 residual pneumothoraces, 2 requiring pleural drainage; 1 chylothorax; and 1 delayed hemothorax. With the exception of the late-developing hemothorax, all complications were diagnosed and treated in the immediate postoperative period. In the outpatient surgery group, unplanned admissions because of patient refusal to leave occurred in 6.5% of the cases. CONCLUSION: The low incidence of complications, and especially the finding that complications are detected in the early recovery period, indicate that this procedure can be performed on an outpatient basis(AU)

[Hyperhydrosis update]. / Actualización en hiperhidrosis.

Nearly 3% of the population has hyperhidrosis. Quality of life is affected, impacting on social relationships and professional activity, and social anxiety disorder can sometime develop. We review the definition and causes of hyperhidrosis and the clinical evaluation of patients. After describing the different clinical aspects of the condition, we discuss the medical and surgical treatments. Of such treatments currently available, particular mention is made of the use of botulinum toxin in some forms of hyperhidrosis as an intermediate option between the traditional treatments and surgery. We also draw attention to the use of minimal access surgical techniques (videothoracoscopy), which, over the past decade, have become established as an effective, safe, and permanent approach for the treatment of hyperhidrosis when indicated.

Estudio multicéntrico en pacientes afectos de hiperhidrosis primaria: experiencia de un Grupo Cooperativo Español / Multicenter study in patients suffering primary hyperhydrosis: an experience of a Spanish Cooperative Group

Objetivos: Determinar los datos demográficos de la hiperhidrosis primaria en un estudio multicéntrico en nuestro medio. Asimismo, se han analizado la eficacia de otros tratamientos diferentes al quirúrgico, la técnica quirúrgica utilizada, las complicaciones y los resultados.Pacientes y métodos: Estudio descriptivo y multicéntrico, retrospectivo entre enero de 1995 y diciembre de 2002. Han participado 16 unidades o servicios de cirugía torácica del país con un protocolo común en el que se incluyeron pacientes intervenidos de simpatectomía torácica endoscópica.Resultados: Hubo un total de 1.392 pacientes (68% de mujeres y 32% de hombres). Un 63% de pacientes realizaron tratamientos tópicos antes de la cirugía y un 22% no llevaron a cabo ningún tratamiento previo a la misma. Un 9% efectuaron tratamiento con toxina botulínica, un 3% iontoforesis y un 2% otros tratamientos. La localización más frecuentefue la palmar sola o asociada a otras localizaciones. El decúbito lateral fue la posición operatoria más utilizada. Se realizó toracotomía de asistencia en ocho ocasiones. La estancia media fue de 1,9 días. La complicación más frecuente fue el neumotórax. La espalda y el abdomen fueron las localizaciones más frecuentes del sudor reflejo postoperatorio. Elseguimiento medio de los pacientes fue de 8,6 meses. La recidiva fue de un 3%.Conclusiones: La hiperhidrosis palmar sola o asociada a otras localizaciones es la forma más frecuente de hiperhidrosis en nuestro estudio. La simpatectomía torácica endoscópica es la única técnica que proporciona resultados definitivos con escasa tasa de recidiva

Objectives: To set the demographic data of the primary hyperhidrosis in a multicentric data in our environment. In this way, different treatments apart from the surgical have been analyzed, and also the surgical technique, the complications and the results.Patients and methods: Multicentric and descriptive study, retrospective from January of 1995 and December of 2002. 16 units or thoracic surgical departments around the country has participated in it following a common protocol in which have been included thoracic endoscopic sympatechtomy operated patients.Results: 1392 patients has been treated in this study (68% of women and 32% of men). External treatments before the surgery was followed by 63% of patients and 22% of patients didn’t follow any treatment before the surgery. In the group of patients that followed a treatment before the surgery, botulinum toxin treatment was followed by 9%, iontophoresis wasfollowed by 3 % and other treatments were followed by 2% of them. Palmar hyperhidrosis or associated with other locations were the most common location of the hyperhidrosis. Lateral decubitus was the most common surgical position used. Videoassisted thoracotomy was performed eight times. The average stay was 1,9 days. The most common complication was pneumothorax. Compensatory sweating was mainly located in the back and in the abdomen. The average monitoring time of the patients was 8,6 months. The relapse was 3%.Conclusions: The most common type of hyperhidrosis in our study was palmar hyperhidrosis or associated with other locations. In this study it has been shown that the only technique that give definitive results with very low relapse rate for the hyperhidrosis treatment is the endoscopic thoracic sympathectomy (AU)

Changes in the sympathetic skin response after thoracoscopic sympathectomy in patients with primary palmar hyperhidrosis.

OBJECTIVE: To investigate whether thoracic sympathectomy induced any change in the pattern of abnormalities or in the waveform of the sudomotor skin response (SSR) in patients with primary palmar hyperhidrosis (PPH). METHODS: We recorded the SSR to median nerve electrical stimuli before and after bilateral thoracoscopic sympathectomy in 27 patients with PPH. We analyzed the changes in amplitude, type of waveform and pattern of abnormality. RESULTS: All patients reported symptomatic improvement. The amplitude of the SSR decreased significantly in patients examined within 1 year after surgery, but was not different in patients examined after 1 year. The number of abnormally enhanced responses reduced after surgery, but there was no significant change in the number of patients with enhanced excitability recovery or with double-peak responses to single stimuli. There was a significant increase in the number of SSRs with a predominantly negative waveform after surgery. CONCLUSIONS: The persistence of SSR abnormalities after surgery suggests that the central nervous system dysfunction is not modified by sympathectomy. The change of the waveform to predominantly negative type after surgery could be the consequence of the decrease in the production of sweating. SIGNIFICANCE: Our results show the effects of sympathectomy on the SSR and on its abnormal patterns in patients with PPH.

[Video-assisted thoracoscopic sympathectomy for the treatment of facial flushing: ultrasonic scalpel versus diathermy]. / Simpatectomía torácica por videotoracoscopia para el tratemiento del rubor facial: bisturí ultrasónica frente a diaterma.

OBJECTIVE: To evaluate the advantages of the ultrasonic scalpel compared to electrocoagulation in patients undergoing video-assisted thoracoscopic sympatholysis or sympathectomy for uncontrolled facial blushing. METHODS: Two hundred bilateral video-assisted thoracoscopic procedures to interrupt transmission in the thoracic sympathetic nerve were performed in 100 patients with incapacitating facial blushing. In 2 cases, the video-assisted approach was chosen because of pleural symphysis. The mean age of patients was 34 years (range: 15 to 67). The sympathetic chain was interrupted from the lower portion of the first thoracic ganglion through the third. RESULTS: All patients were discharged within 24 hours with the exception of one on whom an emergency thoracotomy had been performed. No complications were reported in the group in which a harmonic scalpel was used. One case of temporary Horner syndrome (4 months) and 3 cases of persistent chest pain (more than 2 weeks) were reported in the diathermy group. There were 9 cases of partial and asymptomatic pneumothorax that resolved without treatment or prolonged hospital stays. CONCLUSION: Dissection of the sympathetic nerve is accomplished more reliably and with better visualization with the ultrasonic scalpel. Peripheral lesions in lung parenchyma and adjacent tissues (intercostal vessels and nerves) are avoided, as is Horner syndrome, which can be caused by dispersion of heat. Use of the ultrasonic scalpel would also lead to a lower incidence of postoperative neuralgia.

Simpatectomía torácica por videotoracoscopia para el tratamiento del rubor facial: bisturí ultrasónico frente a diatermia / Video-assisted thoracoscopic sympathectomy for the treatment of facial blushing: ultrasonic scalpel versus diathermy

OBJETIVO: Valorar las ventajas de la utilización del bisturí ultrasónico frente a la electrocoagulación, en los pacientes operados de rubor facial incontrolable mediante simpaticólisis o simpaticotomía torácica por videotoracoscopia. MÉTODO: Se han realizado 200 interrupciones del simpático torácico bilaterales por videotoracoscopia en 100 pacientes afectados de rubor facial invalidante. Dos de ellas se realizaron mediante cirugía videoasistida por presentar sínfisis pleural. La edad media de los pacientes fue de 34 años (rango: 15-67). La cadena simpática fue interrumpida desde la porción inferior de T1 hasta T3 inclusives. RESULTADOS: Todos los pacientes fueron dados de alta en 24 h, a excepción del paciente en el que se realizó toracotomía de asistencia. En el grupo en que se utilizó el bisturí armónico no hubo complicaciones. En el grupo de diatermia hubo un caso de síndrome de Horner transitorio (4 meses) y tres casos de dolor torácico persistente (superior a dos semanas). En total, hubo 9 neumotórax parcelarios y asintomáticos que no requirieron tratamiento ni prolongaron la estancia hospitalaria. CONCLUSIONES: El bisturí ultrasónico permite una sección del simpático más firme y con mejor visualización. Evita lesiones periféricas en el parénquima pulmonar y tejidos adyacentes (vasos y nervios intercostales), así como el síndrome de Horner que se puede producir por efecto calorífico. Produciría también una menor incidencia de neuralgias posquirúrgicas (AU)

Microwave single walled carbon nanotubes purification.

A new single walled carbon nanotubes (SWCNTs) purification procedure has been developed; it consists in a combination of air treatment and acid microwave digestion leading to a high purity SWCNTs material; the procedure reaches high metal removal percentages and the operation time is drastically reduced compared to conventional acid reflux treatments.

Excitability recovery curve of the sympathetic skin response in healthy volunteers and patients with palmar hyperhidrosis.

OBJECTIVES: Patients with primary palmar hyperhidrosis (PPH) might exhibit hyperexcitability of the reflex circuits involved in sweating. We hypothesized that this hyperexcitability could become evident in the study of the excitability recovery curve of the sympathetic sudomotor skin response (SSR). METHODS: In 10 patients with PPH and 10 healthy volunteers used as control subjects, we recorded the SSR in the palm of the right hand to pairs of median nerve electrical shocks separated by inter-stimuli intervals (ISIs) ranging from 0.5 to 3.5 s. The amplitude of the SSR generated by the second stimulus (SSR2) was expressed as a percentage of that generated by the first (SSR1), and compared between control subjects and patients for each ISI. RESULTS: None of the control subjects showed a recovery of the SSR for ISIs of 1.5 s or less. On the contrary, patients showed a statistically significant enhancement of the SSR excitability recovery curve, with onset of recovery at 1.5 s in 5 patients. Two patients showed a double peak response to single electrical stimulation and were not considered in the calculation of the SSR recovery curve. Mean excitability recovery percentages were larger in patients than in control subjects at ISIs of 2, 2.5 and 3 s. CONCLUSIONS: The enhancement of the SSR recovery curve in patients with PPH suggests hyperexcitability of the somatosympathetic polisynaptic pathway involved in sweating. This could partly underlie the pathophysiology of PPH.

[Our experience in treating obstructive lesions of the main airway by Nd-Yag laser resection]. / Nuestra experiencia en el tratamiento de las lesiones obstructivas de la vía aérea principal mediante fotorresección con láser Yag-Nd.

We performed 164 laser resections with a neodymiumyttrium-aluminum-garnet (Nd-Yag) laser in 116 patients between January 1992 and December 1997. Seventy-eight patients had malignant neoplasms, 5 had neoplasms of intermediate malignancy and 33 had inflammatory tracheal lesions. Eighteen resections were emergency procedures. All resections were performed with the patient under general anesthesia and preferably breathing spontaneously. Immediate results varied according to the nature and location of the lesion. Treatment was palliative for tumors showing intraluminal proliferation, providing successful reopening of the airway as shown endoscopically in 70% of patients. Mean survival of the 44 patients with malignant lesions who could be followed was 29 weeks, with a median of 15.19 (range, 1-120). The tracheas of patients with inflammatory stenosis were reopened rapidly and emergency tracheostomy was avoided in all cases. One patient with malignant tracheal tumors died during the procedure due to asphyxia related to tracheal hemorrhage.

Outcome of patients after curative resection of pulmonary metastases.

BACKGROUND: Resective surgery can play a role in solitary pulmonary metastasis or in a few multiple metastases of the lungs. METHODS: We performed a retrospective analysis of the cure rate and survival in patients with pulmonary metastases after surgical resection. Inclusion criteria included no evidence of extrapulmonary metastases or local control of the primary neoplasia. Selective adjunctive therapy was added when applicable. RESULTS: Twenty-five out of 53 patients with resected pulmonary metastases are still alive and disease free. After a 5-year period of follow-up the cure rate obtained was 42%. CONCLUSIONS: In selected patients, resective surgery of solitary or limited multiple pulmonary metastases should be useful, offering the patients a high rate of curability and long term survival. These positive results suggest that adjunctive therapies should be added after resective surgery.

Tumor markers in response monitoring and prognosis of non-small cell lung cancer: preliminary report.

BACKGROUND: The significance of tumor markers in lung cancer is not well established. PATIENTS AND METHODS: We analyzed level of serum markers as prognostic factor of response and survival in 46 evaluable patients with locally advanced or metastasic non small cell lung cancer. All patients were treated with cisplatin 120 mg/m2 or carboplatin 400 mg/m2 day 1, plus etoposide 80 mg/m2 days 1 to 3. RESULTS: Partial response was obtained in 11 patients (24%), stabilization in 18 and progression in 17. Tumor marker sensitivities were: CEA 37%, CA 125 54.5%, SCC 17.5%, NSE 30.5%, and CYFRA 52%. Higher levels of CEA and NSE correlated with more probability of response (p < 0.001 and p = 0.002). The survival probability of patients with normal pretreatment levels of NSE was significantly better than those with NSE over normal level (15.2 vs 7.2 months) p = 0.02. In patients who achieved partial response, CEA, CA 125 and CYFRA levels decreased significantly with respect to the pretreatment values. CONCLUSIONS: Patients with high CEA and NSE serum level have an increased probability of response than patients with low initial levels; however, patients with high initial level of NSE have poor survival. The decrease in CEA, CA 125 and CYFRA values at the moment of response evaluation could help in response assessment.

[Traumatic pulmonary pseudocysts]. / Seudoquistes pulmonares traumáticos.

Two cases of traumatic pulmonary pseudocysts in young patients are presented. Blunt chest injuries resulting from traffic accidents were the causes in both cases. Air cavities were seen on chest films 12 hours and one hour, respectively, after trauma. In both cases, self-limited hemoptysis preceded the appearance of an air-fluid level on X-rays. The diagnoses of pulmonary pseudocyst were made after excluding other possible cause and the outcomes were satisfactory after treatment of symptoms and associated lesions.

Mediastinoscopy as an emergency diagnostic procedure in superior vena cava syndrome.

Seven men and one woman (aged 20-70 years) with superior vena cava syndrome underwent diagnostic mediastinoscopy to elucidate the cause, which other, lesser procedures had not identified. Intraoperative frozen-section studies of the biopsy specimens revealed small-cell carcinoma (4 cases), large-cell carcinoma (1), squamous-cell carcinoma (1), large-cell lymphoma (1) and Hodgkin's lymphoma (1). Radiotherapy or chemotherapy was initiated within the following 24 hours in six cases. One of the tumors intraoperatively diagnosed as small-cell carcinoma was subsequently reclassified as lymphocytic lymphoma. Complicating hemorrhage from the right carotid artery required median sternotomy in one case and wound infection occurred in another. There was no mediastinoscopy-related mortality. Mediastinoscopy is useful and reliable in the diagnostic emergency posed by the superior vena cava syndrome.