Sustained benefit lasting one year from T4 instead of T3-T4 sympathectomy for isolated axillary hyperhidrosis.

INTRODUCTION: Level T4 video-assisted thoracoscopic sympathectomy proved superior to T3-T4 treatment for controlling axillary hyperhidrosis at the initial and six-month follow-ups of these patients. OBJECTIVE: To compare the results of two levels of sympathectomy (T3-T4 vs. T4) for treating axillary sudoresis over one year of follow-up. METHODS: Sixty-four patients with axillary hyperhidrosis were randomized to denervation of T3-T4 or T4 alone and followed prospectively. All patients were examined preoperatively and were followed postoperatively for one year. Axillary hyperhidrosis treatment was evaluated, along with the presence, location, and severity of compensatory hyperhidrosis and self-reported quality of life. RESULTS: According to patient reports after one year, all cases of axillary hyperhidrosis were successfully treated by surgery. There were no instances of treatment failure. After six months, compensatory hyperhidrosis was present in 27 patients of the T3-T4 group (87.1%) and in 16 patients of the T4 group (48.5%). After one year, all T3-T4 patients experienced some degree of compensatory hyperhidrosis, compared to only 14 patients in the T4 group (42.4%). In addition, compensatory hyperhidrosis was less severe in the T4 patients (p < 0.01). Quality of life was poor before surgery, and it improved in both groups at six months and one year of follow-up (p = 0.002). There were no cases of mortality, no significant postoperative complications, and no need for conversion to thoracotomy in either group. CONCLUSION: Both techniques were effective for treating axillary hyperhidrosis, but the T4 group showed milder compensatory hyperhidrosis and greater patient satisfaction at the one-year follow-up.

Sustained benefit lasting one year from T4 instead of T3-T4 sympathectomy for isolated axillary hyperhidrosis

INTRODUCTION: Level T4 video-assisted thoracoscopic sympathectomy proved superior to T3-T4 treatment for controlling axillary hyperhidrosis at the initial and six-month follow-ups of these patients. OBJECTIVE: To compare the results of two levels of sympathectomy (T3-T4 vs. T4) for treating axillary sudoresis over one year of follow-up. METHODS: Sixty-four patients with axillary hyperhidrosis were randomized to denervation of T3-T4 or T4 alone and followed prospectively. All patients were examined preoperatively and were followed postoperatively for one year. Axillary hyperhidrosis treatment was evaluated, along with the presence, location, and severity of compensatory hyperhidrosis and self-reported quality of life. RESULTS: According to patient reports after one year, all cases of axillary hyperhidrosis were successfully treated by surgery. There were no instances of treatment failure. After six months, compensatory hyperhidrosis was present in 27 patients of the T3-T4 group (87.1 percent) and in 16 patients of the T4 group (48.5 percent). After one year, all T3-T4 patients experienced some degree of compensatory hyperhidrosis, compared to only 14 patients in the T4 group (42.4 percent). In addition, compensatory hyperhidrosis was less severe in the T4 patients (p < 0.01). Quality of life was poor before surgery, and it improved in both groups at six months and one year of follow-up (p = 0.002). There were no cases of mortality, no significant postoperative complications, and no need for conversion to thoracotomy in either group. CONCLUSION: Both techniques were effective for treating axillary hyperhidrosis, but the T4 group showed milder compensatory hyperhidrosis and greater patient satisfaction at the one-year follow-up.

[Cancer mortality among rubber industry workers in São Paulo, Brazil]. / Mortalidade por câncer em trabalhadores da indústria da borracha de São Paulo.

OBJECTIVE: To investigate cancer deaths among rubber industry workers according to company size. METHODS: This historical cohort study included 9,188 male workers, engaged as members of a workers' union in São Paulo, Southeastern Brazil, between 1975 and 1985, alive in January 1990 and followed until the end of 2000. Overall and specific cancer deaths were compared within the cohort, with subjects stratified according to company size and economic activity, sector of work, and worker qualification. Risk set assessment and conditional logistic regression were used to estimate relative risks, adjusted for age, time since first job, and duration of employment in the rubber industry. RESULTS: When compared to employees of larger companies, workers employed in small companies showed greater risk of death due to any type of cancer (RR=2.33, 95% CI: 0.90-6.03), stomach tumors (RR=3.47; 95% CI: 2.57-4.67), and upper aero-digestive tract tumors (RR=2.49; 95% CI: 1.78-3.48). Risk of death was greater among workers employed in maintenance (RR=2.23; 95% CI: 0.73-6.76); expedition, storage and transportation (RR=2.97; 95% CI: 0.77-11.38); and production (RR=3.51; 95% CI: 1.07-11.57), when compared to workers engaged in clerical work and support activities. CONCLUSIONS: Our results provide further evidence for an increased risk of stomach and upper aero-digestive tract tumors--and possibly of all types of cancer--among rubber industry workers employed in small companies when compared to employees of larger companies.

Mortalidade por câncer em trabalhadores da indústria da borracha de São Paulo / Cancer mortality among rubber industry workers in São Paulo, Brazil

OBJETIVO: Avaliar as mortes por câncer em trabalhadores da indústria da borracha de acordo com o tamanho da empresa. MÉTODOS: Coorte histórica com 9.188 trabalhadores masculinos, matriculados em sindicato de trabalhadores da indústria de borracha do Estado de São Paulo entre 1975 e 1985, sobreviventes em janeiro de 1990 e acompanhados até o final de 2000. As mortes por câncer foram comparadas internamente à coorte, cujos membros foram subdivididos em estratos por porte e sub-ramo da empresa, setor de trabalho e qualificação profissional. A abordagem por conjuntos de risco e regressão logística condicional foi utilizada para o cálculo dos riscos relativos, ajustados por idade, tempo desde o primeiro emprego e tempo de trabalho na indústria da borracha. RESULTADOS: Quando comparados aos empregados de grandes empresas, trabalhadores de pequenas empresas mostraram excesso de mortes por todos tipos de câncer (RR=2,33; IC 95 por cento: 0,90-6,03); tumores de estômago (RR=3,47; IC 95 por cento: 2,57-4,67) e do trato aero-digestivo superior (RR=2,49; IC 95 por cento: 1,78-3,48). Identificou-se excesso de mortes por câncer nos trabalhadores dos setores de manutenção (RR=2,23; IC 95 por cento: 0,73-6,76); expedição, armazenamento e transporte (RR=2,97; IC 95 por cento: 0,77-11,38); e produção (RR=3,51; IC 95 por cento: 1,07-11,57), comparados aos trabalhadores dos setores administrativos. CONCLUSÕES: Os resultados mostram evidências de aumento do risco de tumores de estômago e do trato aero-digestivo superior e, possivelmente, por câncer em geral em trabalhadores de empresas de pequeno porte da indústria da borracha quando comparados aos trabalhadores das grandes empresas.

Avaliaçäo da velocidade de fluxo sanguineo na arteria cerebral media, pelo Doppler transcraniano, na cirurgia de endarterectomia da carotida / Evaluation of middle cerebral artery blood flow velocity with transcranial Doppler in carotid endarterectomy

Foi estudada a velocidade de fluxo sanguineo na arteria cerebral media com o Doppler transcraniano em 30 pacientes submetidos a cirurgia de endarterectomia da carotida, num total de 34 procedimentos, no Hospital Albert Einstein, Säo Paulo, de setembro de 1992 a abril de 1996. Os dados obtidos foram avaliados em tres fases : antes do pincamento, durante o pincamento e após retirada das pincas das carotidas. Nos pacientes com pressäo de refluxo do coto distal da carotida interna a 54,4 mmHg, após o pincamento, foi colocada derivaçäo interna temporaria. Os resultados mostraram que o Doppler transcraniano e util na detecçäo de embolizaçäo e na necessidade de uso da derivaçäo interna temporaria, por estabelecer relaçäo de risco de isquemia cerebral com variaçäo da velocidade de fluxo na arteria cerebral media