Is T3 and T6 sympathetic clipping more effective in primary palmoplantar hyperhydrosis?

OBJECTIVE: Our aim was to establish a standardized approach for patients with palmoplantar and axillary hyperhidrosis and to compare patient satisfaction and complication rates for two different operations. MATERIALS AND METHODS: Between 2008 and 2010, 30 patients underwent conventional T3/4 clipping (group A), and 30 underwent only T3 and T6 clipping (group B). Both groups were compared with regard to compensatory sweating (CS), complications, patient satisfaction and recovery of plantar hyperhidrosis. RESULTS: The CS rate was 60 % in group A and 47 % in group B. CS was significantly less in group B compared to group A ( P ≤ 0.001). The plantar hyperhidrosis recovery rate was higher in group B (n = 19) compared to group A (n = 13), but the difference was not statistically significant ( P ≥ 0.299). Patient satisfaction rate was 93.3 % in group A and 96.6 % in group B. CONCLUSIONS: Our study showed that T3/6 clipping was as effective as T3/4 clipping for palmar and axillary hyperhidrosis. Our results revealed that this technique is more effective than T3/4 sympathectomy to treat plantar hyperhidrosis.

Effects of hyperbaric oxygen therapy on wound healing after tracheal resection and end-to-end anastomoses in rats: results of early observations.

BACKGROUND: Proliferating scar tissue is an important problem after tracheal surgery. Hyperbaric oxygen (HBO) provides good support to the poorly perfused tissues. We aimed to evaluate the early effects of HBO therapy on tracheal healing after tracheal resection. METHODS: A total of 15 Wistar rats were divided into two groups and two tracheal rings of each rat were resected. A control group received no therapy while the other group was treated with HBO. At the end of the study or when a rat died, a histopathological examination was performed to assess neovascularization, necrosis and epithelization. RESULTS: HBO treatment caused better epithelization and inflammation scores compared to the control group. In the HBO group the intraluminal purulent exudates were limited (P=0.001). Healing of the damaged mucosal epithelium was better in the HBO group (P=0.031). In the HBO-treated group, neovascularization also started earlier than in the group without HBO. CONCLUSION: Our short-term observation results demonstrate that HBO treatment increases tracheal healing and decreases the complication ratios. HBO may be preferred as a supportive treatment modality during the healing period after tracheal surgery.

Completion pneumonectomy for bronchiectasis: morbidity, mortality and management.

BACKGROUND: Completion pneumonectomy performed for benign causes is associated with a high morbidity and mortality. We analyzed the patients who underwent completion pneumonectomy procedure for bronchiectasis, which constitutes a specific benign condition, together with the indications for surgery, the difficulties encountered during operations and the postoperative results. METHODS: Records of all patients who underwent completion pneumonectomy for the diagnosis of brochiectasis between January 1991 and April 2006 at the thoracic surgery clinic of a training and research hospital specializing in chest diseases and chest surgery were retrospectively evaluated. The age and the gender of the patients, etiologic factors, symptoms, characteristics of the first operation, the time between the first operation and completion pneumonectomy, and postoperative follow-up are examined. RESULTS: During the evaluation period of more than 15 years, 23 patients underwent completion pneumonectomy. The median age of these 23 patients was 28 (range: 9 - 53); 17 of the patients were male and 6 were female. The most common indication for surgery was recurrent lung infections (n = 15). The most common symptoms were cough (n = 21), expectoration (n = 19), and hemoptysis (n = 15). The mean time between the first operation and the completion pneumonectomy was 4.9 years (range: 5 months - 11 years). Left completion pneumonectomy was performed in 14 and right completion pneumonectomy was performed in 9 cases. The mean duration of hospital stay was 16.7 days (range: 12 - 42 days). The course after surgery was uneventful in all patients. The mortality rate was 0 % and morbidity was 43.5 %. CONCLUSION: Although completion pneumonectomy for benign causes is a high risk procedure, it can be performed in selected patients with an acceptable morbidity and mortality after an effective preoperative medical therapy for inflammation of the lungs and with careful dissection at the operation.

A huge mass destroying the fifth rib: a rare case of cavernous haemangioma.

A 28-year-old female patient presented with back pain, dyspnea and coughing. Chest radiograph showed a mass in the middle zone of the right hemithorax. CT confirmed the mass was confined to the 5th rib. During the exploratory thoracotomy, a smooth, firm mass measuring 7 x 9 x 5 cm was found to have destroyed the middle and posterior parts of the 5th rib. Together with the adjacent intercostal muscles, the 5th rib was excised en-block. Postoperative pathology was cavernous haemangioma. Cavernous haemangioma of the rib is very rare, and very few cases have been reported in the literature.

Acquired pulmonary arteriovenous malformation secondary to hydatid cyst operation.

Pulmonary arteriovenous malformations are abnormal communications between pulmonary arteries and pulmonary veins. The majority of the cases are congenital in origin, and acquired pulmonary arteriovenous malformations are very rare. We present a case here, which - to the best of our knowledge - is the first acquired pulmonary arteriovenous malformation secondary to a hydatid cyst operation in the literature, and we discuss the etiology, clinical presentation, diagnostic modalities and treatment of acquired pulmonary arteriovenous malformations.

Utility of intraoperative frozen section examination in thoracic surgery. A review of 721 cases.

AIM: Intraoperative frozen section examination (FSE) is an important tool for determining how extensive a surgical procedure needs to be. In this study we reviewed the indications for FSE, the correlation between FSE and postoperative histopathology, and the contribution of intraoperative FSE in determining the extent of the surgical procedure. METHODS: A total of 744 FSE performed in 721 patients between January 1995 and January 2004 were reviewed retrospectively. The FSE were divided into 7 groups according to the indications of the request for frozen section. False positivity and false negativity were evaluated. RESULTS: The indications for FSE included intraoperative diagnosis of pulmonary masses (311, 41.8%), determination of N2 status with mediastinoscopy and mediastinotomy (153, 20.6%), staging of pulmonary carcinomas during the operation (86, 11.6%), assessment of the margin of bronchial surgical resection following pulmonary resection (54, 7.2%), presence of solitary pulmonary nodules (75, 10.1%), presence of mediastinal masses (39, 5.2%), and pleural thickening (26, 3.5%). When compared to postoperative paraffin sections, FSE was found to have a 1.9% (8) rate of false negatives and a 0.2% (1) rate of false positives (P < 0.001). CONCLUSIONS: Intraoperative FSE in thoracic surgery is a rather reliable method. When FSE indicates malignancy, it is a valuable guide in directing the extent of the ongoing surgical procedure. However, when FSE indicates a benign lesion, surgeons should interpret this in the light of the patient's clinical and radiological features and the lesion's macroscopic nature when deciding how extensive an operation needs to be.

The relationship between time of admittance and complications in paediatric tracheobronchial foreign body aspiration.

PURPOSE: Majority of tracheobronchial foreign body aspirations occur in paediatric age group and may constitute a life hazard. We examined the relationship between the time of admittance and complications in children with tracheobronchial foreign body aspiration. MATERIAL AND METHODS: Sex, age, time of admittance, presenting symptoms, radiological findings, and the nature of the foreign body were reviewed retrospectively in patients aged 16 and under follow-up for tracheobronchial foreign body aspiration between January 1990 and January 2005. Cases were randomly assigned into 6 groups based on admittance times. RESULTS: Within 15-year period, 263 children under the age of 16 were followed-up for tracheobronchial aspiration of foreign body. The most commonly aspirated foreign bodies included sunflower seed, peanut, hazelnut, walnut. While the pathology could be detected radiographically in 80.3% (n : 211) of the cases, in 19.7% (n : 52) radiology was normal. All cases had rigid bronchoscopy under general anaesthesia. In 220 cases foreign body was detected and could successfully be removed in 209 cases. The remaining 11 cases required bronchotomy or pneumotomy to remove the foreign body. Among 679 cases operated for bronchiectasis during the same period, 22 cases (3.2%) had foreign body as the aetiology. No complications were observed when the patients presented to the hospital within the first 24 hours after the aspiration while fever, purulent sputum, haemoptysis and bronchiectasis were noted in those presented later. Most of the complications were medically treated. CONCLUSION: Paying medical attention within the first 24 hours after the aspiration of foreign bodies is critical in order to accomplish a complication-free course. Organic foreign bodies and retention period of 30 days and over, constitute major risk factors in the development of bronchiectasis. It is advisable to perform bronchoscopy in the early stages of all suspected cases to avoid serious complications such as bronchiectasis.