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Thoracic Surgery Clinics

Peter B Licht
No abstract text is available yet for this article.
November 2016: Thoracic Surgery Clinics
Roman Rieger
Primary plantar hyperhidrosis is defined as excessive secretion of the sweat glands of the feet and may lead to significant limitations in private and professional lifestyle and reduction of health-related quality of life. Conservative therapy measures usually fail to provide sufficient relieve of symptoms and do not allow long-lasting elimination of hyperhidrosis. Endoscopic lumbar sympathectomy appears to be a safe and effective procedure for eliminating excessive sweating of the feet and improves quality of life of patients with severe plantar hyperhidrosis...
November 2016: Thoracic Surgery Clinics
Smidfelt Kristian, Drott Christer
Facial blushing, associated with social phobia, may have severe negative impact on the quality of daily life. The first line of treatment should be psychological and/or pharmacologic. In severe cases not responding to nonsurgical treatment, surgical sympathetic denervation is an option. A thorough disclosure of effects, complications, and side effects is mandatory and patient selection is crucial to obtain high patient satisfaction from surgical treatment.
November 2016: Thoracic Surgery Clinics
Lyall A Gorenstein, Mark J Krasna
Because of video-assisted thoracic technology and increased patient awareness of treatment options for palmar hyperhidrosis, endoscopic thoracic sympathectomy (ETS) has become a well-accepted treatment for this disorder. Video assistance affords excellent visualization of thoracic anatomy, which allows the procedure to be done quickly with few complications. However, despite the ease of performing ETS, complications can occur unless thoracic anatomy and physiology are well-understood. Awareness of possible intraoperative and postoperative complications is essential if this procedure is gong to be performed safely...
November 2016: Thoracic Surgery Clinics
Nelson Wolosker, José Ribas Milanez de Campos, Juliana Maria Fukuda
Compensatory hyperhidrosis (HH) is the most common and feared side effect of thoracic sympathectomy, because patients with severe forms have their quality of life greatly impaired. The most well-known factors associated with compensatory HH are extension of manipulation of the sympathetic chain, level of sympathetic denervation, and body mass index. Technical developments as well as the proper selection of patients for surgery have been crucial in reducing the occurrence of severe forms of compensatory HH. Therapeutic options include topical agents, botulinum toxin, systemic anticholinergics, clip removal, and sympathetic chain reconstruction, although the efficacy is not well-established for all the methods...
November 2016: Thoracic Surgery Clinics
José Ribas Milanez de Campos, Hugo Veiga Sampaio da Fonseca, Nelson Wolosker
The best way to evaluate the impact of primary hyperhidrosis on quality of life (QL) is through specific questionnaires, avoiding generic models that do not appropriately evaluate individuals. QL improves significantly in the short term after sympathectomy. In the longer term, a sustained and stable improvement is seen, although there is a small decline in the numbers; after 5 and even at 10 years of follow-up it shows virtually the same numerical distribution. Compensatory hyperhidrosis is a major side effect and the main aggravating factor in postoperative QL, requiring attention to its management and prevention...
November 2016: Thoracic Surgery Clinics
Cliff P Connery
There is a small subset of patients who have undergone endoscopic thoracic sympathectomy for hyperhidrosis or facial blushing who are dissatisfied and would wish reversal. Compensatory sweating is the most common side effect that causes a person to regret surgery. Treatment options are limited and usually not effective in patients with severe side effects from sympathectomy. Nerve graft interposition has been proven to be effective in experimental models and small clinical series. Da Vinci robotic nerve graft reconstruction with interposition graft and direct suturing of nerve and high magnification dissection most closely mirrors standard nerve reconstruction principles when done as a minimally invasive procedure...
November 2016: Thoracic Surgery Clinics
Conor F Hynes, M Blair Marshall
Endoscopic thoracic sympathectomy (ETS) is an effective treatment of primary hyperhidrosis of the face, upper extremities, and axillae. The major limitation is the side effect of compensatory sweating severe enough that patients request reversal in up to 10% of cases. When ETS is performed by cutting the sympathetic chain, reversal requires nerve grafting. However, for ETS done with clips, reversal is a simple thoracoscopic outpatient procedure of removing the clips. Subsequent reversal of the sympathectomy, ie, nerve regeneration, is successful in many cases...
November 2016: Thoracic Surgery Clinics
Joel M Sternbach, Malcolm M DeCamp
Large case series and randomized trials over the past 25 years have consistently demonstrated thoracoscopic interruption of the sympathetic chain to be a safe and effective treatment of focal primary hyperhidrosis. The surgical technique has evolved toward less-invasive and less-extensive procedures in an effort to minimize perioperative morbidity and effectively balance postoperative compensatory sweating with symptomatic relief. This review summarizes available evidence regarding the surgical approach and the optimal level of interruption of the sympathetic chain based on a patient's presenting distribution of pathologic sweating...
November 2016: Thoracic Surgery Clinics
Alan Edmond Parsons Cameron
This article presents a personal view of the indications for surgical treatment of patients with hyperhidrosis based on long clinical experience. Endoscopic thoracic sympathectomy is the preferred opinion for palmar sweating. It is also useful when there is additional axillary sweating but is not the first choice for isolated armpit symptoms. Surgical treatment of craniofacial sweating is much more likely to be followed by undesirable side-effects.
November 2016: Thoracic Surgery Clinics
Anastasia O Kurta, Dee Anna Glaser
A variety of available treatment options are available for primary focal hyperhidrosis, and some can be combined to obtain maximum effective results. Most treatment options have only been studied in patients with axillary hyperhidrosis, and more studies are needed to develop therapies for other body regions. Several clinical trials are underway with promising preliminary results; however, there is still a large need for new therapies.
November 2016: Thoracic Surgery Clinics
Christoph H Schick
Studies and case reports on excessive sweating frequently state that hyperhidrosis is a disease whose origin and mechanism are unknown. However, the term excessive is rarely based on systematic diagnostic measurements, instead being a description of the symptoms from patient histories, which suggests that hyperhidrosis is purely a problem involving the quantity of sweat, whereas it is a change in the control mechanism of sweating in which the need for and production of sweat are strongly disproportionate. This lack of proportion is perceived by those affected to be a limitation of activities of daily living and is thus pathologic...
November 2016: Thoracic Surgery Clinics
Moshe Hashmonai
At present, primary hyperhidrosis is the main indication for sympathectomy. For upper thoracic sympathetic ablation, excision of the second thoracic ganglion alone or with the first and/or third ganglia was the standard during the open surgery era. With the advent of thoracoscopy, modifications related to the level, extent, and type of ablation were proposed to attenuate compensatory hyperhidrosis. The ideal operation for sympathetic denervation of the face and upper limbs remain to be defined. Controlled double-blind studies with quantitave measurements of sweat production are required...
November 2016: Thoracic Surgery Clinics
Michael Lanuti
No abstract text is available yet for this article.
August 2016: Thoracic Surgery Clinics
Andrea S Wolf, Raja M Flores
The role of surgical resection in malignant pleural mesothelioma (MPM) is based on the principle of macroscopic resection of a solid tumor with adjuvant therapy to treat micrometastatic disease. Extrapleural pneumonectomy (EPP) and pleurectomy decortication (P/D) have been developed in this context. Cancer-directed surgery for MPM is associated with a 5-year survival rate of 15%. Evidence indicates that P/D is better tolerated by patients and suggests survival is no worse when compared with EPP. Although EPP is still performed in highly selected cases, the authors advocate radical P/D whenever possible for patients with MPM...
August 2016: Thoracic Surgery Clinics
Jose Ribas Milanez de Campos, Paulo Kauffman, Oswaldo Gomes, Nelson Wolosker
By the 1980s, endoscopy was in use by some groups in sympathetic denervation of the upper limbs with vascular indications. Low morbidity, cosmetic results, reduction in the incidence of Horner syndrome, and the shortened time in hospital made video-assisted thoracic sympathectomy (VATS) better accepted by those undergoing treatment for hyperhidrosis. Over the last 25 years, this surgical procedure has become routine in the treatment of hyperhidrosis, leading to a significant increase in the number of papers on the subject in the literature...
August 2016: Thoracic Surgery Clinics
Eitan Podgaetz, Rafael Garza-Castillon, Rafael S Andrade
Diaphragmatic eventration and diaphragmatic paralysis are 2 entities with different etiology and pathology, and are often clinically indistinguishable. When symptomatic, their treatment is the same, with the objective to reduce the dysfunctional cephalad excursion of the diaphragm during inspiration. This can be achieved with diaphragmatic plication through the thorax or the abdomen with either open or minimally invasive techniques. We prefer the laparoscopic approach, due to its easy access to the diaphragm and to avoid pain associated with intercostal incisions and instrument use...
August 2016: Thoracic Surgery Clinics
Usman Ahmad, James Huang
Thymomas are uncommon tumors that can present as locally advanced tumors in approximately 30% of the patients. Stage and complete resection are the strongest prognostic factors. For locally advanced tumors, induction treatment may improve the ability to achieve a complete resection. Combination treatment with cisplatin, doxorubicin, and cyclophosphamide is the most commonly used induction regimen. Similar rates of resectability are noted with the use of induction chemotherapy and chemoradiation therapy; however, more tumor necrosis is noted with the addition of radiation...
August 2016: Thoracic Surgery Clinics
Smita Sihag, Ashok Muniappan
Unexpected lymph node involvement is observed in approximately 20% of all patients undergoing pulmonary metastasectomy. Lymph node metastasis is often associated with decreased survival in patients with pulmonary metastases. The incidence of lymph node involvement is related to a variety of patient and tumor variables. This article reviews the indications and role for lymph node assessment at pulmonary metastasectomy.
August 2016: Thoracic Surgery Clinics
Argenis Herrera, Richard K Freeman
Esophageal stent placement was used primarily for the treatment of malignant strictures until the development of a new generation of biomaterials allowed the production of easily removable, occlusive stents in 2001. Since then, thoracic surgeons have gained experience using esophageal stents for the treatment of acute esophageal perforation. As part of a hybrid treatment strategy, including surgical drainage of infected spaces, enteral nutrition, and aggressive supportive care, esophageal stent placement has produced results that can exceed those of traditional surgical repair...
August 2016: Thoracic Surgery Clinics
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