Primary palmar hyperhidrosis is a kind of benign disease characterized by abnormally increasing sweat. Various treatments for it exist in clinic currently and the one of them is endoscopic thoracic sympathectomy. But due to the different choice of surgery path, surgery method and the way or the level to block the sympathetic chain, the surgical curative effect and the incidence of postoperative complications vary hugely. This review provides an update report on the surgery method and the way or the level to block the sympathetic chain to treat palmar hyperhidrosis by endoscopic thoracic sympathectomy.
ObjectiveTo discuss the importance of early identification and effective management of puncture-associated complications after trans-radial percutaneous coronary procedures. MethodsA total of 698 patients undergoing trans-radial percutaneous coronary procedures from June to December 2012 were included and followed up. The puncture associated complications and their clinical managements were summarized in the present study. ResultsWe found that trans-radial approach was safe. The main puncture-associated complications included access-site pain, tension blisters and hemorrhagic complication. Complications with severe clinical consequence were rare. Most of the complications could be successfully treated with conservative management including access-site nursing and psychological nursing. ConclusionTrans-radial approach is safe for percutaneous coronary procedures, but close clinical monitoring and nursing are essential.
ObjectiveTo analyze the early results and risk factors of surgical revascularization for patients with ischemic heart disease and left ventricular dysfunction. Methodsclinical data of 318 patients with ischemic heart disease and left ventricular dysfunction with left ventricular ejection fraction (LVEF)≤50% who underwent coronary artery bypass grafting (cABG) from January 2003 to July 2013 was retrospectively reviewed. There were 266 males and 52 females with a mean age of 62.6±9.2 years (range 36 to 83). seventy-six patients underwent off-pump cABG (oPcAB) and 242 patients underwent conventional cABG. Fifteen patients underwent concomitant mitral valve repair or replacement. The patients who underwent left ventricular aneurysmectomy (LVA) were excluded from this study. Perioperative data were collected including the risk factors, echocardiographic results, morbidities and mortalities. The risk factors were analyzed with the endpoints of adverse events and mortalities to find the elements that influence the early results of the procedure. ResultsThe EuroscorE Ⅱ predicted operative mortality rate was 2.78±4.02% (range 1.00% to 45.00%) and actual mortality rate was 1.9% (6/318). Three of 6 patients died from low cardiac output syndrome. Totaladverse events rate was 47.2% (150/318) including prolonged ventilation (25.2%), low cardiac output syndrome (6.3%),ventricular arrhythmia (4.4%), acute renal dysfunction (4.1%), myocardial infarction (3.8%), cerebralvascular accident(2.8%), and re-exploration for bleeding (0.6%). Compared with those preoperatively, the LVEF was significantly improvedfrom 42.14%±5.94% to 45.64%±8.33% (t=6.084, P=0.000), and the left ventricular end diastolic dimension (LVEDD) wassignificantly reduced from 53.96±6.28 mm to 48.64±7.50 mm (t=-9.681, P=0.000) postoperatively. The logistic multiplevariables regression analysis showed perioperative intra-aortic balloon pump (IABP) implantation was mutual risk factorof prolonged ventilation and low cardiac output syndrome. ConclusionSurgical revascularization is an effective optionfor patients with ischemic heart disease and left ventricular dysfunction, demonstrated by improved LVEF and reducedLVEDD. Low cardiac output syndrome is the main cause of operative death. Perioperative IABP implantation is mutualrisk factor of prolonged ventilation and low cardiac output syndrome. Meticulous perioperative management plays a keyrole in satisfactory early results.