Long-term results of endoscopic thoracic sympathectomy for upper limb hyperhidrosis

BACKGROUND: Immediate results of endoscopic thoracic sympathectomy (ETS) for hyperhidrosis are good. Adverse effects are well known but are supposed to decrease with time. We report the long-term results of ETS with regard to efficacy, side effects and patient satisfaction. METHODS: From 1993 to 1998, 382 patients suffering from hyperhidrosis of the upper limbs were operated on by means of bilateral ETS. One hundred twenty-five could be reached. There were 91 females and 34 males with a mean age of 28 years. The mean follow-up was 3.8 years (range: 24 to 84 months). Patients answered a detailed questionnaire from an independent observer addressing the following issues: stability of the initial result, outcome of side effects, degree of satisfaction. RESULTS: The global recurrence rate was 8.8%: 6.6% for palmar hyperhidrosis and 65% for axillary hyperhidrosis. Compensatory sweating was observed in 86.4% of the patients. It was considered as minor by 61% of them, as embarrassing by 31.5%, and as disabling by 7.5%. Other reported side effects were: Horner's syndrome in 3 patients (2.4%), healing in 2 of them; chronic rhinitis in 3 (2.4%); gustatory sweating in 9 (7.2%); and hand dryness in 42%. Sixty-five percent of the patients were fully satisfied, 28.7% were globally satisfied, and 6.3% regretted the operation. Ninety-two percent of the patients claimed they would ask for the operation if it were to be redone. CONCLUSIONS: This study confirms that results of ETS are good and stable for palmar hyperhidrosis but deteriorate for axillary hyperhidrosis. Compensatory sweating does not improve with time and is the main cause of dissatisfaction. Recommendations drawn from these results are the following: (1) patients suffering from isolated axillary hyperhidrosis should rather be treated by local therapy; (2) patients should be better informed of adverse effects.     

Hemolytic anemia presenting as idiopathic intracranial hypertension

The authors report three cases of ischemic stroke in young adults that occurred during or after an airplane flight. Workup was negative for any cause of stroke other than the presence of a patent foramen ovale (PFO). There is an increasing awareness of deep vein thrombosis and pulmonary embolism occurring in relation to long flights. Individuals with a PFO under these circumstances may be vulnerable to stroke from paradoxic embolism. "Economy class" stroke syndrome may be underdiagnosed and is an eminently preventable cause of stroke.     

Rhinocerebral mucormycosis: management and survival after carotid occlusion

Rhinocerebral mucormycosis is a rare but often fatal fungal infection. We present 2 patients with mucormycosis complicated by internal carotid artery thrombosis. Magnetic resonance imaging was superior to computed tomography in localizing the pathological process. Subtotal resection of devitalized tissue and intravenous amphotericin B therapy resulted in a successful outcome for both patients. Prompt recognition of this disorder by using modern diagnostic and therapeutic modalities promises to improve survival rates.     

扁果绞股蓝化学成分的研究

从扁果绞股蓝(Gynostemma compressum X. X. Chen et D. R. Liang)中分离出四个皂甙,经光谱及化学方法鉴定了它们的化学结构,分别命名为扁果绞股蓝皂甙Ⅰ～Ⅳ(gycomoside Ⅰ～Ⅳ),均为新化合物。     

顺铂乙基纤维素微球在狗颌面部动脉栓塞的药代动力学研究

报道了顺铂乙基纤维素微球的研制与药代动力学研究。对狗进行颌面部动脉栓塞实验,并与静脉滴注对照,用非火焰原子吸收分光光度法测定了外周静脉及组织的药物浓度。结果表明外周静脉血药浓度栓塞组低于对照组,而组织中的浓度则相反。故动脉栓塞化疗可提高药物在靶组织中的浓度,降低药物的全身毒副反应,从而达到靶向治疗的目的。