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Haider SA, Wagener M, Iqbal T, Shahzad S, Del Sole PA, Leahy N, Murphy D, Sharif R, Ullah I, Sharif F. Does renal denervation require cardiovascular outcome-driven data? Hypertens Res 2024:10.1038/s41440-024-01598-7. [PMID: 38462663 DOI: 10.1038/s41440-024-01598-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/01/2024] [Accepted: 01/13/2024] [Indexed: 03/12/2024]
Abstract
Hypertension is a major driver of cardiovascular disease with a prevalence of 32-34% in adults worldwide. This poses a formidable unmet challenge for healthcare systems, highlighting the need for enhanced treatment strategies. Since 2017, eight major sham-controlled randomised controlled trials have examined the effectiveness and safety of renal denervation (RDN) as therapy for BP control. Although most trials demonstrated a reduction in systolic 24-hour/daytime ambulatory BP compared to control groups, open to discussion is whether major adverse cardiovascular events (MACE)-driven RDN trials are necessary or whether the proof of BP reduction as a surrogate for better cardiovascular outcomes is sufficient. We conducted an analysis of the statistical methods used in various trials to assess endpoint definitions and determine the necessity for MACE-driven outcome data. Such comprehensive analysis provides further evidence to confidently conclude that RDN significantly reduces blood pressure compared to sham controls. Importantly, this enables the interpolation of RDN trial endpoints with other studies that report on outcome data, such as pharmacological trials which demonstrate a significant reduction in MACE risk with a decrease in BP. Moreover, limitations associated with directly evaluating outcome data further support the use of BP as a surrogate endpoint. For example, conducting lengthier trials with larger numbers of participants to ensure robust statistical power presents a substantial challenge to evaluating outcome data. Thus, in light of the crucial need to tackle hypertension, there are notable advantages of considering BP as a surrogate for outcome data.
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Affiliation(s)
- Syedah Aleena Haider
- Department of Cardiology, University Hospital Galway, Galway, Ireland.
- Department of Medicine, University of Galway, Galway, Ireland.
| | - Max Wagener
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Talha Iqbal
- Department of Mathematics, University of Galway, Galway, Ireland
| | - Shirjeel Shahzad
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | | | - Niall Leahy
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Darragh Murphy
- Department of Cardiology, University Hospital Galway, Galway, Ireland
- Department of Medicine, University of Galway, Galway, Ireland
| | - Ruth Sharif
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Ihsan Ullah
- Department of Mathematics, University of Galway, Galway, Ireland
| | - Faisal Sharif
- Department of Cardiology, University Hospital Galway, Galway, Ireland.
- Department of Medicine, University of Galway, Galway, Ireland.
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Zeijen VJM, Theuns DA, Feyz L, Saville KA, Bhagwandien R, Kardys I, Van Mieghem NM, Daemen J. Long-term safety and efficacy of renal sympathetic denervation in atrial fibrillation: 3-year results of the AFFORD study. Clin Res Cardiol 2023; 112:1766-1777. [PMID: 37231258 PMCID: PMC10697905 DOI: 10.1007/s00392-023-02222-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common sustained arrhythmia which has been associated with increased sympathetic nervous system activity and hypertension. Recent evidence indicated that renal sympathetic denervation (RDN) could safely contribute to an improvement in AF burden. OBJECTIVE To investigate the long-term safety and efficacy of radiofrequency RDN in hypertensive patients with symptomatic AF. METHODS This pilot study included patients with symptomatic paroxysmal or persistent AF (European Hearth Rhythm Association class ≥ II) despite optimal medical therapy, office systolic blood pressure (BP) ≥ 140 mmHg and ≥ 2 antihypertensive drugs. AF burden was measured using an implantable cardiac monitor (ICM), implanted 3 months prior to RDN. ICM interrogation and 24-h ambulatory BP monitoring were performed at baseline and at 3/6/12/24/36 months post RDN. The primary efficacy outcome was daily AF burden. Statistical analyses were performed using Poisson and negative binomial models. RESULTS A total of 20 patients with a median age [25th-75th percentiles] of 66.2 [61.2-70.8] years (55% female) were included. At baseline, office BP ± standard deviation (SD) was 153.8/87.5 ± 15.2/10.4 mmHg, while mean 24-h ambulatory BP was 129.5/77.3 ± 15.5/9.3 mmHg. Baseline daily AF burden was 1.4 [0.0-10.9] minutes/day and throughout a 3-year follow-up period, no significant change was observed (- 15.4%/year; 95% confidence interval (CI) - 50.2%, + 43.7%; p = 0.54). The number of defined daily doses of antiarrhythmic drugs and antihypertensive drugs remained stable over time, while mean 24-h ambulatory systolic BP decreased with - 2.2 (95% CI - 3.9, - 0.6; p = 0.01) mmHg/year. CONCLUSIONS In patients with hypertension and symptomatic AF, stand-alone RDN reduced BP but did not significantly reduce AF burden up until 3 years of follow-up.
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Affiliation(s)
- Victor J M Zeijen
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Room Rg-628, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Dominic A Theuns
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Room Rg-628, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Lida Feyz
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Room Rg-628, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Kari A Saville
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Room Rg-628, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Rohit Bhagwandien
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Room Rg-628, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Room Rg-628, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Room Rg-628, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Room Rg-628, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Lee DW, Hwang YS, Byeon JY, Kim JH, Choi HJ. Does the advantage of transcutaneous oximetry measurements in diabetic foot ulcer apply equally to free flap reconstruction? World J Clin Cases 2023; 11:7570-7582. [DOI: 10.12998/wjcc.v11.i31.7570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 09/25/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Transcutaneous oxygen pressure (TcpO2) is a precise method for determining oxygen perfusion in wounded tissues. The device uses either electrochemical or optical sensors.
AIM To evaluate the usefulness of TcpO2 measurements on free flaps (FFs) in diabetic foot ulcers (DFUs).
METHODS TcpO2 was measured in 17 patients with DFUs who underwent anterolateral thigh (ALT)-FF surgery and compared with 30 patients with DFU without FF surgery.
RESULTS Significant differences were observed in the ankle-brachial index; duration of diabetes; and haemoglobin, creatinine, and C-reactive protein levels between the two groups. TcpO2 values were similar between two groups except on postoperative days 30 and 60 when the values in the ALT-FF group remained < 30 mmHg and did not increase > 50 mmHg.
CONCLUSION Even if the flap is clinically stable, sympathectomy due to adventitia stripping during anastomosis and arteriovenous shunt progression due to diabetic polyneuropathy could lead to low TcpO2 values in the ALT-FF owing to its thick fat tissues, which is supported by the slow recovery of the sympathetic tone following FF. Therefore, TcpO2 measurements in patients with DFU who underwent FF reconstruction may be less accurate than in those who did not.
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Affiliation(s)
- Da Woon Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
| | - Yong Seon Hwang
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
| | - Je Yeon Byeon
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
| | - Jun Hyuk Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
| | - Hwan Jun Choi
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Cheonan-si 31151, South Korea
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Park SJ, Lee DH, Lee Y, Jung H, Cho Y. Bilateral Cardiac Sympathetic Denervation as a Safe Therapeutic Option for Ventricular Arrhythmias. J Chest Surg 2023; 56:414-419. [PMID: 37574881 PMCID: PMC10625969 DOI: 10.5090/jcs.23.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/26/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
Background The recurrence of ventricular arrhythmias (VAs) in patients who have already undergone treatment with antiarrhythmic medication, catheter ablation, and the insertion of implantable cardioverter defibrillators is not uncommon. Recent studies have shown that bilateral cardiac sympathetic denervation (BCSD) effectively treats VAs. However, only a limited number of studies have confirmed the safety of BCSD as a viable therapeutic option for VAs. Methods This single-center study included 10 patients, who had a median age of 54 years (interquartile range [IQR], 45-65 years) and a median ejection fraction of 58.5% (IQR, 56.2%-60.8%), with VAs who underwent video-assisted BCSD. BCSD was executed as a single-stage surgery for 8 patients, while the remaining 2 patients initially underwent left cardiac sympathetic denervation followed by right cardiac sympathetic denervation. We evaluated postoperative complications, the duration of hospital stays, and VA-related symptoms before and after surgery. Results The median hospital stay after surgery was 2 days (IQR, 2-3 days). The median surgical time for BCSD was 113 minutes (IQR, 104-126 minutes). No significant complications occurred during hospitalization or after discharge. During the median follow-up period of 13.5 months (IQR, 10.5-28.0 months) from surgery, no VA-related symptoms were observed in 70% of patients. Conclusion The benefits of a short postoperative hospitalization and negligible complications make BCSD a safe, alternative therapeutic option for patients suffering from refractory VAs.
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Affiliation(s)
- Soo Jung Park
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Deok Heon Lee
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Youngok Lee
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hanna Jung
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yongkeun Cho
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
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Yu F, Liu Y, Zhang C, Pang B, Zhang D, Zhao W, Li X, Yang W. Efficacy analysis of minimally invasive surgery for Raynaud's syndrome. BMC Surg 2023; 23:313. [PMID: 37838733 PMCID: PMC10576400 DOI: 10.1186/s12893-023-02225-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 10/08/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Raynaud's syndrome (RS), also referred to as Raynaud's phenomenon, is a vasospastic disorder causing episodic color changes in extremities upon exposure to cold or stress. These manifestations, either primary Raynaud's phenomenon (PRP) or associated with connective tissue diseases like systemic sclerosis (SSc) as secondary Raynaud's phenomenon (SRP), affect the quality of life. Current treatments range from calcium channel blockers to innovative surgical interventions, with evolving efficacy and safety profiles. METHODS In this retrospective study, patients diagnosed with RS were selected based on complete medical records, ensuring homogeneity between groups. Surgeries involved microscopic excision of sympathetic nerve fibers and stripping of the digital artery's adventitia. Postoperative care included antibiotics, analgesia, oral nifedipine, and heat therapies. Evaluation metrics such as the VAS pain score and RCS score were collected bi-weekly. Data analysis was conducted using SPSS 26.0, with significance set at p < 0.05. RESULTS In total, 15 patients formed the experimental group, with five presenting fingertip soft tissue necrosis and ten showing RS symptoms. Comparative analysis of demographic data between experimental and control groups, both containing 15 participants, demonstrated no significant age and gender difference. However, the "Mean Duration of RP attack" in the experimental group was notably shorter (9.47 min ± 0.31) than the control group (19.33 min ± 1.79). The RS Severity Score also indicated milder severity for the experimental cohort (score: 8.55) compared to the control (score: 11.23). Postoperative assessments at 2, 4, and 6 weeks revealed improved VAS pain scores, RCS scores, and other measures for the experimental group, showing significant differences (p < 0.05). One distinctive case showcased a variation in the common digital nerve and artery course in an RS patient. CONCLUSION Our retrospective analysis on RS patients indicates that microsurgical techniques are safe and effective in the short term. As surgical practices lean towards minimally invasive methods, our data supports this shift. However, extensive, prospective studies are essential for conclusive insights.
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Affiliation(s)
- Fengwei Yu
- Hand Microsurgery, Binzhou Medical University Hospital, Binzhou, 256600, China
| | - Yongtao Liu
- Hand Microsurgery, Binzhou Medical University Hospital, Binzhou, 256600, China.
| | - Chengnian Zhang
- Hand Microsurgery, Binzhou Medical University Hospital, Binzhou, 256600, China
| | - Botao Pang
- Hand Microsurgery, Binzhou Medical University Hospital, Binzhou, 256600, China
| | - Daijie Zhang
- Hand Microsurgery, Binzhou Medical University Hospital, Binzhou, 256600, China
| | - Wei Zhao
- Hand Microsurgery, Binzhou Medical University Hospital, Binzhou, 256600, China
| | - Xuecheng Li
- Hand Microsurgery, Binzhou Medical University Hospital, Binzhou, 256600, China
| | - Weiqiang Yang
- The First Clinical School of Binzhou Medical University, Binzhou, 256600, China
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Alkosha HM, Mohammed MIR, Abuelnasr T, Amen MM. Predictors of Compensatory Sweating following Video-Assisted Thoracoscopic Sympathectomy in Primary Palmar Hyperhidrosis. World Neurosurg 2023:S1878-8750(23)00861-6. [PMID: 37380055 DOI: 10.1016/j.wneu.2023.06.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Hazem M Alkosha
- Professor of Neurosurgery, Mansoura University, Dakahlia, Egypt.
| | | | | | - Mohamed M Amen
- Lecturer of neurosurgery, Mansoura University, Dakahlia, Egypt
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Zeijen VJM, Kroon AA, van den Born BH, Blankestijn PJ, Meijvis SCA, Nap A, Lipsic E, Elvan A, Versmissen J, van Geuns RJ, Voskuil M, Tonino PAL, Spiering W, Deinum J, Daemen J. The position of renal denervation in treatment of hypertension: an expert consensus statement. Neth Heart J 2023; 31:3-11. [PMID: 36001280 DOI: 10.1007/s12471-022-01717-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 01/07/2023] Open
Abstract
Hypertension is an important risk factor for cardiovascular disease. In the Netherlands, there are approximately 2.8 million people with hypertension. Despite treatment recommendations including lifestyle changes and antihypertensive drugs, most patients do not meet guideline-recommended blood pressure (BP) targets. In order to improve BP control and lower the risk of subsequent cardiovascular events, renal sympathetic denervation (RDN) has been introduced and studied as a non-pharmacological approach. While early data on the efficacy of RDN showed conflicting results, improvements in treatment protocols and study design resulted in robust new evidence supporting the potential of the technology to improve patient care in hypertensive subjects. Recently, 5 randomised sham-controlled trials demonstrated the safety and efficacy of the technology. Modelling studies have further shown that RDN is cost-effective in the Dutch healthcare setting. Given the undisputable disease burden along with the shortcomings of current therapeutic options, we postulate a new, clearly framed indication for RDN as an adjunct in the treatment of hypertension. The present consensus statement summarises current guideline-recommended BP targets, proposed workup and treatment for hypertension, and position of RDN for those patients with primary hypertension who do not meet guideline-recommended BP targets (see central illustration).
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Salimi J, Cheraghali R, Omrani Z, Farshidmehr P, Afghani R. Surgical Treatment Options for Buerger's Disease (Experience with 315 Cases in Iran). Med J Islam Repub Iran 2022; 36:134. [PMID: 36479532 PMCID: PMC9719581 DOI: 10.47176/mjiri.36.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Buerger's disease (thromboangiitis obliterans) may be a rare peripheral vascular disease that sometimes affects young male smokers. This study presents surgical treatment options for 315 Buerger's patients during a period of 18 years from 2002 to 2020. Methods: In this cross-sectional study, 315 newly diagnosed Buerger patients in a period of 18 years (by Census sampling) were evaluated. Data included age, sex, cigarette smoking status, clinical presentation, the affected limb (right or left, upper or lower extremities), and the performed therapeutic procedures such as angiography of limb arteries, amputation, sympathectomy, and vascular bypass surgery, which were collected in a data sheet. Vascular reconstruction was done if there were suitable inflow and outflow arteries. Sympathectomy was performed for the patients who were unsuitable for revascularization. All analyzes were performed using SPSSV.18 software package (SPSS Inc., Chicago, IL). Data are presented as frequency, mean ± variance (SD). Results: The mean age of patients was 42.6±9 years old, ranging from (26-75). There were 309 (98.1%) males and 6 (1.9%) females. The most common symptom was ulcer 252 (80%), and the most commonly involved arteries were the dorsal pedis (N=231; 73.4%) and posterior tibialis (N=225; 71.5%). Vascular bypass surgery, sympathectomy, and amputation were performed for patients who met surgical indications. Aortofemoral (N=9) and femoropopliteal (N=24) bypass procedures were done in 2.8% and 7.6% of patients respectively. Of nine patients who underwent aorto-femoral bypass procedure, 6 cases presented with leg claudication, 3 with an ulcer, and 3 with the Raynaud phenomenon. The digital loss rate was 9.6% (N=9) in toes and 1% (N=3) in fingers. Conclusion: As most of the Buerger patients have multi arterial involvement, bypass surgery or sympathectomy can't help treat these patients more than cigarette smoking or pharmaceutical therapy.
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Affiliation(s)
- Javad Salimi
- Department of Vascular Surgery, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Roozbeh Cheraghali
- Department of Vascular Surgery, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Zahra Omrani
- Department General Surgery, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Pezhman Farshidmehr
- Department of Vascular Surgery, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Afghani
- Department Thoracic Surgery, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran, Corresponding author:Reza Afghani,,
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Zeijen VJM, Feyz L, Nannan Panday R, Veen K, Versmissen J, Kardys I, Van Mieghem NM, Daemen J. Long-term follow-up of patients undergoing renal sympathetic denervation. Clin Res Cardiol 2022; 111:1256-1268. [PMID: 35851428 PMCID: PMC9622524 DOI: 10.1007/s00392-022-02056-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/20/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Renal denervation (RDN) proved to significantly lower blood pressure (BP) at 2-6 months in patients on and off antihypertensive drugs. Given a lack of longer-term follow-up data, our aim was to assess the safety and efficacy of RDN up to five years taking into account antihypertensive drug regimen changes over time. METHODS In the present single-center study, patients underwent RDN for (therapy resistant) hypertension. Patients underwent protocolized yearly follow-up out to five years. Data were collected on 24-h ambulatory BP and office BP monitoring, renal function, antihypertensive drug regimen, and safety events, including non-invasive renal artery imaging at 6/12 months. Efficacy analyses were performed using linear mixed-effects models. RESULTS Seventy-two patients with mean age 63.3 ± 9.5 (SD) years (51% female) were included. Median follow-up time was 3.5 years and Clark's Completeness Index was 72%. Baseline ambulatory daytime BP was 146.1/83.7 ± 17.4/12.2 mmHg under a mean number of 4.9 ± 2.7 defined daily doses (DDD). At five years, ambulatory daytime systolic BP as calculated from the mixed model was 120.8 (95% CI 114.2-127.5) mmHg and diastolic BP was 73.3 (95% CI 69.4-77.3) mmHg, implying a reduction of -20.9/-8.3 mmHg as compared to baseline estimates (p < 0.0001). The number of DDDs remained stable over time (p = 0.87). No procedure-related major adverse events resulting in long-term consequences were observed. CONCLUSIONS The BP-lowering effect of RDN was safely maintained at least five years post-procedure as reflected by a significant decrease in ambulatory daytime BP in the absence of escalating antihypertensive drug therapy over time.
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Affiliation(s)
- Victor J M Zeijen
- Department of Cardiology, Erasmus University Medical Center, Room Rg-628, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Lida Feyz
- Department of Cardiology, Erasmus University Medical Center, Room Rg-628, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Rajiv Nannan Panday
- Department of Cardiology, Erasmus University Medical Center, Room Rg-628, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Kevin Veen
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jorie Versmissen
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus University Medical Center, Room Rg-628, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Room Rg-628, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Center, Room Rg-628, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Shao GQ, Pang DZ, Zhang JT, Wang HX, Liuru TY, Liu ZH, Liang YN, Liu JS. Spontaneous ventilation anesthesia combined with uniportal and tubeless thoracoscopic sympathectomy in selected patients with primary palmar hyperhidrosis. J Cardiothorac Surg 2022; 17:177. [PMID: 35840969 PMCID: PMC9287853 DOI: 10.1186/s13019-022-01917-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 06/18/2022] [Indexed: 11/26/2022] Open
Abstract
Background To assess the feasibility and safety of tubeless video-assisted thoracoscopic sympathectomy (VATS) with a single 5 mm port under nonintubated, intravenous anesthesia with spontaneous ventilation in selected patients with primary palmar hyperhidrosis (PPH). Methods Adults (aged between 18 and 60 years) with moderate or severe PPH symptoms were enrolled. Demographic information and clinical data were obtained from 172 consecutive patients undergoing thoracoscopic surgery for PPH from March 2014 to December 2020. The primary outcomes were the rate of complications, including death, and the intraoperative conversion rate to 3-port VATS. The secondary outcomes were the conversion rate to intubated anesthesia during the operation and the surgical duration and pain score of postoperative day 0. Results In total, 172 patients were included with 88 males and 84 females. The median age was was 25 years (IQR:21–30 years). No mortalities or major morbidities occurred in any patient. The overall median surgical duration was 53 min (IQR:37–72 min). The median length of postoperative hospital stay was one day (IQR:one–one day). The median pain score of POD0 was 2 (IQR:2–2). Intraoperative conversion to 3-port VATS followed by drainage tube insertion occurred in one (0.6%) patient due to extensive pleural adhesions. No patients required conversion to intubated anesthesia during surgery. No postoperative mechanical ventilation was noted in any patient. Conclusions For selected patients with PPH, tubeless VATS with a single 5 mm port using spontaneous ventilation anesthesia can be considered a feasible and safe operation. The surgical wound is extremely small and the operation time is shorter than the conventional technique. Trial registration This study was in conformity with the Declaration of Helsinki, and was approved by the National Ethics Committee of the University of the Hong Kong-Shenzhen Hospital (Approval number: [2020]70). We registered the study in the Chinese Clinical Trial Registry (Registration number: ChiCTR2100049063) in 2021.Informed consent was collected from all the participants of this study. URL for this clinical trial registration is: https://www.chictr.org.cn/index.aspx.
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Affiliation(s)
- Guang-Qiang Shao
- Division of Thoracic Surgery, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan 1st Road, Futian District, Shenzhen City, Guangdong Province, China
| | - Da-Zhi Pang
- Division of Thoracic Surgery, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan 1st Road, Futian District, Shenzhen City, Guangdong Province, China.
| | - Ji-Tian Zhang
- Division of Thoracic Surgery, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan 1st Road, Futian District, Shenzhen City, Guangdong Province, China
| | - Hong-Xia Wang
- Division of Respiratory and Critical Care Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Tai-Yang Liuru
- Division of Thoracic Surgery, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan 1st Road, Futian District, Shenzhen City, Guangdong Province, China
| | - Zhi-Hai Liu
- Division of Thoracic Surgery, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan 1st Road, Futian District, Shenzhen City, Guangdong Province, China
| | - Ya-Nan Liang
- Division of Thoracic Surgery, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan 1st Road, Futian District, Shenzhen City, Guangdong Province, China
| | - Jing-Si Liu
- Division of Pediatric Surgery, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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Lee ACH, Ferguson MK. Knowledge of surgical management of hyperhidrosis among primary care physicians and the general public. Interact Cardiovasc Thorac Surg 2022; 34:791-798. [PMID: 35015865 PMCID: PMC9070533 DOI: 10.1093/icvts/ivab371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/21/2021] [Accepted: 12/08/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Our study examined attitudes towards initial management of hyperhidrosis, willingness to seek surgical consultation and knowledge of an appropriate specialty for surgical consultation among primary care physicians and the general public. METHODS An online survey was sent to all general medicine and paediatric residents and attending physicians at our academic medical centre. Participants were provided with a clinical scenario of palmar hyperhidrosis and were asked to select among initial management options and preferences for surgical consultation if patients failed non-operative management. To assess the general public's perspective, workers from Amazon Mechanical Turk were recruited to complete a similar survey. RESULTS The majority of primary care physicians (31/53; 58%) would prescribe topical aluminium chloride for palmar hyperhidrosis, whereas 28 of 53 (53%) would refer such patients to dermatology. Twenty-three of 53 (43%) physicians would refer such patients to surgery if conservative management failed: 18 (78%) to plastic surgery, 4 (17%) to general surgery and none to thoracic surgery. The majority of workers (130/205; 63.4%) would seek primary care treatment for palmar hyperhidrosis. Over half (113/205; 55%) would seek surgical consultation if conservative management failed: 65 (58%) general surgery and 15 (13%) neurosurgery, with only 8 (7%) selecting thoracic surgery. CONCLUSIONS Neither primary care physicians nor the general public recognize the role of thoracic surgeons in managing primary focal hyperhidrosis when medical management fails. Education of physicians and the public may mitigate this knowledge gap.
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Affiliation(s)
- Andy Chao Hsuan Lee
- Section of Thoracic Surgery, Department of Surgery, The University of Chicago, Chicago, IL, USA
| | - Mark K Ferguson
- Section of Thoracic Surgery, Department of Surgery, The University of Chicago, Chicago, IL, USA
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12
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Girotti PNC, Hufschmidt M, Tschann P, Hodja V, Lechner D, Königsrainer I. Thoracoscopic re sympathectomy for persistent or recurrent palmar hyperhidrosis: single-center experience. Gen Thorac Cardiovasc Surg 2022; 70:651-658. [PMID: 35195859 DOI: 10.1007/s11748-022-01788-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND In case of recurrence or persistent palmar hyperhidrosis, a sympathetic chain resection is suggested, however, many surgeons are still reluctant to offer further intervention because of the inability to predict the efficacy of such a procedure. We analyzed our large series of resympathectomy. METHODS Substantive retrospective analysis of 39 patients underwent a resympathectomy (minimally invasive bilaterally sympathetic chain Th2-3 resection). Patients referred from other hospitals or primarily operated at our institution for recurrence or persistence palmar hyperhidrosis were included in the study group. RESULTS No intraoperative complications were detected. Reoperation or chest tube positioning was necessary in 2 patients. Twenty-eight patients had a positive response (excellent or good results). Seven patients described a substantial, but not sufficient, reduction of the symptomatology. Four patients were very unsatisfied and regretted the operation. CONCLUSIONS Resympathectomy is highly effective procedure for patients who have persistent or recurrent symptoms. However, the indication of the operations should be more dissuasive as possible to avoid the risk of any undesirable psychologically side effects.
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Affiliation(s)
- Paolo N C Girotti
- Department of General, Visceral and Thoracic Surgery, Landeskrankenhaus Feldkirch, Carinagasse 47, 6807, Feldkirch, Austria.
| | - Martin Hufschmidt
- Department of General, Visceral and Thoracic Surgery, Landeskrankenhaus Feldkirch, Carinagasse 47, 6807, Feldkirch, Austria
| | - Peter Tschann
- Department of General, Visceral and Thoracic Surgery, Landeskrankenhaus Feldkirch, Carinagasse 47, 6807, Feldkirch, Austria
| | - Vebi Hodja
- Department of General, Visceral and Thoracic Surgery, Landeskrankenhaus Feldkirch, Carinagasse 47, 6807, Feldkirch, Austria
| | - Daniel Lechner
- Department of General, Visceral and Thoracic Surgery, Landeskrankenhaus Feldkirch, Carinagasse 47, 6807, Feldkirch, Austria
| | - Ingmar Königsrainer
- Department of General, Visceral and Thoracic Surgery, Landeskrankenhaus Feldkirch, Carinagasse 47, 6807, Feldkirch, Austria
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13
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Travin N, Dalinin V, Salimov D. Thoracic bilateral sympathectomy as a new method of pulmonary arterial hypertension treatment: gaps of evidence. Eur J Cardiothorac Surg 2022; 61:1346-1347. [PMID: 35026003 DOI: 10.1093/ejcts/ezac008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/23/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nikolay Travin
- Department of Cardiovascular Surgery, Central Military Clinical Hospital n.a. P.V. Mandryka, Moscow, Russia
| | - Vadim Dalinin
- Department of Cardiovascular Surgery, Central Military Clinical Hospital n.a. P.V. Mandryka, Moscow, Russia
| | - Dmitry Salimov
- Department of Thoracic Surgery, Central Military Clinical Hospital n.a. P.V. Mandryka, Moscow, Russia
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14
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Vanlommel J, Van Look L, Peetermans M, Uyttebroek L, van Nassauw L, Van Schil P. Anatomical variations of the upper thoracic sympathetic chain: a review. Eur J Cardiothorac Surg 2021; 61:515-522. [PMID: 34676399 DOI: 10.1093/ejcts/ezab445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/09/2021] [Accepted: 09/19/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The objective of this study is to provide a thorough overview of the anatomical variations of the upper thoracic sympathetic trunk to improve clinical results of upper thoracic sympathectomy. In addition, this study strives for standardization of future studies regarding the anatomy of the upper thoracic sympathetic chain. METHODS The Web of Science, PubMed and Google Scholar databases were searched using keywords, alone or combined, regarding the anatomy of the thoracic sympathetic chain. The search was limited to studies performed in humans. RESULTS Fifteen studies were finally included. Cervicothoracic ganglion and nerve of Kuntz were present in 77% and 53%, respectively. The upper thoracic ganglia were predominantly located in their corresponding intercostal space with a relatively downwards shift at the lower thoracic levels. The right sympathetic trunk is prone to have more communicating rami then the left. The lower levels of ganglia tend to have more normal rami. No clear pattern was found concerning the presence of the ascending rami and there was a decrease in the number of descending rami as the chain runs caudally. The intercostal rami remain a rare anatomical variation. CONCLUSIONS This study presents an overview of the anatomy of the upper thoracic sympathetic chain. Its results may guide upper thoracic sympathectomy to improve clinical results. This review also provides a baseline for future studies on anatomical variations of the thoracic sympathetic trunk. More uniform reporting is necessary to compare different anatomical studies.
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Affiliation(s)
- Jens Vanlommel
- Department ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Lawrence Van Look
- Department ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Maxime Peetermans
- Department ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Leen Uyttebroek
- Department ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Luc van Nassauw
- Department ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Paul Van Schil
- Department ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
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15
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Mohammad Khalil A, Makram Botros J, Boules ML, Salama AK, Gaber Ragab S. Safety of Radiofrequency Ablation of Thoracic T2 and T3 Sympathectomy in Palmar Hyperhidrosis: A Case Report. Anesth Pain Med 2021; 11:e114827. [PMID: 34540640 PMCID: PMC8438739 DOI: 10.5812/aapm.114827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/16/2021] [Accepted: 05/20/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Hyperhidrosis is the maladjustment of excess sweating in specific parts of the body. Radiofrequency (RF) therapy has been successfully used to treat hyperhidrosis with a success rate of 85% - 95% in patients refractory to sympathectomy. The main hypothesis was the association between reduced palmar hyperhidrosis and radiofrequency RF therapy. The RF therapy is a less invasive technique, including the utilization of electromagnetic energy that is deposited near the nerve tissue. The mechanism of action of continuous RF could be explained by the destruction of afferent nerve fibers on their way from a nociceptive focus to the central nervous system. Pulsed RF was invented to explore this possibility, with the sole purpose of finding a less destructive and equally effective technique for the application of RF to afferent pathways. Herein, we further evaluated whether the procedure was safe without any complications in routine follow-up in palmar hyperhidrosis. Case Presentation Herein, we report the case of a male patient with an age of 22 years undergoing thermal RF sympathectomy therapy of thoracic T2 and T3 sympathetic ganglia for the palmar hyperhidrosis of his right hand observed for 3 months. The patient developed a contraction of the flexor involving the small muscles of the right hand with severe pain and congestion 17 days after the procedure without any other complications. The contraction was relieved by a sonar-guided median nerve block at the wrist with two injections of 2 mL lidocaine 2% and 2 mL dexamethasone. Conclusions This study has been the first clinical case report complicated by the development of a contraction of the flexor muscles of the right hand with severe pain and congestion. The spasm was gradually relieved by sonar-guided median nerve injection at the level of the wrist and intended to assess the role of RF ablation with a success rate of 85% - 95% in palmar hyperhidrosis.
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Affiliation(s)
- Atef Mohammad Khalil
- Fayoum University Hospital, Fayoum, Egypt
- Corresponding Author: Fayoum University Hospital, Fayoum, Egypt.
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16
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Rodríguez Alcalá C, Maestro Borbolla A, Rodríguez Pérez E, Sanabria Carretero P, Reinoso Barbero F. Perioperative management of patients with arrhythmogenic syndromes refractory to medical treatment: A clinical case report. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:353-356. [PMID: 34130934 DOI: 10.1016/j.redare.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 07/13/2020] [Indexed: 06/12/2023]
Abstract
Family heart diseases related to sudden death are a group of cardiovascular diseases (cardiomyopathies, channelopathies, aortic diseases …) that require familiarity of the anesthesiologist with the perioperative treatment of complex hemodynamic disorders, as well as their surgical treatment.1 We present the case of a 12-year-old man diagnosed with non-obstructive hypertrophic cardiomyopathy (MHNO), after cardiorespiratory arrest (PCR), who underwent video-guided thoracoscopy-guided left sympathectomy (VATS) for frequent syncope, despite pharmacological treatment and implantation of an implantable automatic defibrillator (ICD). Whenever arrhythmic syncope occurs in the setting of familial heart disease, left heart denervation should be considered as the next step in the treatment plan.2.
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Affiliation(s)
- C Rodríguez Alcalá
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, Spain.
| | - A Maestro Borbolla
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, Spain
| | - E Rodríguez Pérez
- Servicio de Anestesiología y Reanimación Infantil, Hospital Universitario La Paz, Madrid, Spain
| | - P Sanabria Carretero
- Servicio de Anestesiología y Reanimación Infantil, Hospital Universitario La Paz, Madrid, Spain
| | - F Reinoso Barbero
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, Spain
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17
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Rodríguez Alcalá C, Maestro Borbolla A, Rodríguez Pérez E, Sanabria Carretero P, Reinoso Barbero F. Perioperative management of patients with arrhythmogenic syndromes refractory to medical treatment: A clinical case report. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:353-356. [PMID: 32892995 DOI: 10.1016/j.redar.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 07/02/2020] [Accepted: 07/13/2020] [Indexed: 06/11/2023]
Abstract
Family heart diseases related to sudden death are a group of cardiovascular diseases (cardiomyopathies, channelopathies, aortic diseases...) that require familiarity of the anesthesiologist with the perioperative treatment of complex hemodynamic disorders, as well as their surgical treatment1. We present the case of a 12-year-old man diagnosed with non-obstructive hypertrophic cardiomyopathy, after cardiorespiratory arrest, who underwent video-guided thoracoscopy-guided left sympathectomy for frequent syncope, despite pharmacological treatment and implantation of an implantable automatic defibrillator. Whenever arrhythmic syncope occurs in the setting of familial heart disease, left heart denervation should be considered as the next step in the treatment plan2.
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Affiliation(s)
- C Rodríguez Alcalá
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz , Madrid, España.
| | - A Maestro Borbolla
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz , Madrid, España
| | - E Rodríguez Pérez
- Servicio de Anestesiología y Reanimación Infantil, Hospital Universitario La Paz, Madrid, España
| | - P Sanabria Carretero
- Servicio de Anestesiología y Reanimación Infantil, Hospital Universitario La Paz, Madrid, España
| | - F Reinoso Barbero
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz , Madrid, España
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18
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Jo IS, Kim HJ, Chae MH, Kwon UC, Ju GH, Song U, Hyon CH, Kim IS. Combination of intramuscular transplantation of autologous mononuclear bone marrow cells with sympathectomy (L2, 3) in patients with peripheral arterial disease(PAD). Surgeon 2021; 20:e3-e6. [PMID: 33931346 DOI: 10.1016/j.surge.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 01/21/2021] [Accepted: 02/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In most patients with severe, chronic extremity ischemic diseases, intervention or surgical treatment is often not suitable. Combination of intramuscular transplantation of autologous monocular bone marrow cells (AMBMCs) and sympathectomy (L2, 3) has been proved therapeutically beneficial. METHODS We studied 170 patients (combined group 80, control group 90) with extremity ischemia (TAO, ASO FontaineⅡ,Ⅲ, Ⅳ) between January 2013 and September 2019. RESULTS In contrast to pre-operation, the walking distance of patients increased significantly (from 61.34 ± 52.23 m to 156.0 ± 32.4 m, p < 0.01), and the ankle-brachial index (ABI) remarkably improved (from 0.28 ± 0.13 to 0.59 ± 0.23, p < 0.05). CONCLUSION Combined therapy is feasible and effective for patients with peripheral arterial disease (PAD).
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Affiliation(s)
- Il-Su Jo
- Department of Thoracic Surgery, Pyongyang University of Medical Sciences, Democratic Peoples Republic of Korea.
| | - Hyon-Jong Kim
- Department of Thoracic Surgery, Pyongyang General Hospital, Democratic Peoples Republic of Korea
| | - Myong-Hwan Chae
- Department of Thoracic Surgery, Pyongyang University of Medical Sciences, Democratic Peoples Republic of Korea
| | - Un-Chol Kwon
- Department of Thoracic Surgery, Pyongyang University of Medical Sciences, Democratic Peoples Republic of Korea
| | - Gwang-Hak Ju
- Department of Thoracic Surgery, Pyongyang University of Medical Sciences, Democratic Peoples Republic of Korea
| | - Un Song
- Department of Thoracic Surgery, Pyongyang University of Medical Sciences, Democratic Peoples Republic of Korea
| | - Chol-Ho Hyon
- Department of Thoracic Surgery, Pyongyang University of Medical Sciences, Democratic Peoples Republic of Korea
| | - Il-Su Kim
- Institute of Medical Genetics, Pyongyang University of Medical Sciences, Democratic Peoples Republic of Korea
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Xu Z, Agbigbe O, Nigro N, Yakobi G, Shapiro J, Ginosar Y. Use of high-resolution thermography as a validation measure to confirm epidural anesthesia in mice: a cross-over study. Int J Obstet Anesth 2021; 46:102981. [PMID: 33906822 DOI: 10.1016/j.ijoa.2021.102981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/17/2021] [Accepted: 03/14/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Effective epidural anesthesia is confirmed in humans by sensory assessments but these tests are not feasible in mice. We hypothesized that, in mice, infrared thermography would demonstrate selective segmental warming of lower extremities following epidural anesthesia. METHODS We anesthetized 10 C57BL/6 mice with isoflurane and then inserted a PU-10 epidural catheter under direct surgical microscopy at T11-12. A thermal camera (thermal sensitivity ±0.05°C, pixel resolution 320x240 pixels, and spatial resolution 200 μm) recorded baseline temperature of front and rear paws, tail and ears. Thermography was assessed at baseline and 2, 5, 10, and 15 min after an epidural bolus dose of 50 μL bupivacaine 0.25% or 50 μL saline (control) using a cross-over design with dose order randomized and investigators blinded to study drug. Thermal images were recorded from video and analyzed using FLIR software. Effect over time and maximal effect (Emax) were assessed by repeated measures ANOVA and paired t-tests. Comparisons were between bupivacaine and control, and between lower vs upper extremities. RESULTS Epidural bupivacaine caused progressive warming of lower compared with upper extremities (P <0.001), typically returning to baseline by 15 min after administration. Mean (±SD) Emax was +3.73 (±1.56) °C for lower extremities compared with 0.56 (±0.68) °C (P=0.03) for upper extremities. Following epidural saline, there was no effect over time (Emax for lower extremities -0.88 (±0.28) °C compared with the upper extremities -0.88 (±0.19) °C (P >0.99). CONCLUSIONS Thermography is a useful tool to confirm epidural catheter placement in animals for which subjective, non-noxious, sensory measures are impossible.
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Affiliation(s)
- Z Xu
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA
| | - O Agbigbe
- Washington University School of Medicine, St Louis, MO, USA
| | - N Nigro
- Washington University School of Medicine, St Louis, MO, USA
| | - G Yakobi
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Hebrew University Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - J Shapiro
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Hebrew University Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Y Ginosar
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA; Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Hebrew University Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Wohl Institute of Translational Medicine, Hadassah Hebrew University Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
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20
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Kuijpers M, Peeters G, Harms PW, Bouma W, DeJongste MJ, Mariani MA, Klinkenberg TJ. Bilateral one-stage single-port sympathicotomy in primary focal hyperhidrosis, a prospective cohort study: treat earlier? J Cardiothorac Surg 2021; 16:50. [PMID: 33766091 PMCID: PMC7992325 DOI: 10.1186/s13019-021-01430-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Primary Focal Hyperhidrosis (PFH) has a detrimental effect on Quality of Life. Repetitive, non-curative symptomatic strategies dominate current treatment of PFH, in spite of the availability of an effective and permanent curative treatment like Endoscopic Thoracic Sympathectomy (ETS). Current surgical optimization may allow for a re-established position of sympathetic modulation in this treatment algorithm. We sought to evaluate the safety, effectiveness, and long-term results of a Bilateral One-stage Single-port Sympathicotomy (BOSS) procedure in PFH patients and to identify subgroups benefitting most. Methods Prospective analysis of 163 patients, 35 (21.5%) underwent Rib-3 (R3) BOSS for palmar PFH, 58 (35.6%) R3-R5 BOSS for axillary PFH and 70 (42.9%) R3-R5 BOSS for combined palmar/axillary PFH. Effectiveness was measured using Skindex-29 and the Hyperhidrosis Disease Severity Scale (HDSS). Results Overall Skindex-29-rating (46.5 ± 14.8 preoperatively vs 20.1 ± 20.6 postoperatively, p < 0.001), and HDSS score (3.71 ± 0.45 preoperatively vs 1.82 ± 0.86 postoperatively, p < 0.001) indicated a significant improvement in health-related quality of life after BOSS. R3 BOSS was superior to R3-R5 BOSS in terms of HDSS score (1.49 vs 1.91 respectively, p = 0.004) and in terms of severe compensatory hyperhidrosis, a frequently reported side-effect (17.1% vs 32.8% respectively, p < 0.001). No major complications occurred. Conclusions BOSS is safe, effective, and offers a long-term curative solution in the treatment of PFH. Especially in the palmar PFH subgroup, R3 BOSS treatment results compare favorably to the treatment results of non-curative alternatives published in the current literature. Therefore, R3 BOSS should be offered to all patients with severe PFH, reporting insufficient benefit of treatment options such as oral and/or local agents.
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Affiliation(s)
- Michiel Kuijpers
- Department of Cardiothoracic Surgery, University Medical Center Groningen, AB32, Postbus 30.001, Groningen, 9700, RB, The Netherlands. .,Hyperhidrosis Expert Center, Dermatology, Martini Hospital, Groningen, The Netherlands.
| | - Gwen Peeters
- Department of Cardiothoracic Surgery, University Medical Center Groningen, AB32, Postbus 30.001, Groningen, 9700, RB, The Netherlands
| | - Petra W Harms
- Hyperhidrosis Expert Center, Dermatology, Martini Hospital, Groningen, The Netherlands
| | - Wobbe Bouma
- Department of Cardiothoracic Surgery, University Medical Center Groningen, AB32, Postbus 30.001, Groningen, 9700, RB, The Netherlands.,Hyperhidrosis Expert Center, Dermatology, Martini Hospital, Groningen, The Netherlands
| | | | - Massimo A Mariani
- Department of Cardiothoracic Surgery, University Medical Center Groningen, AB32, Postbus 30.001, Groningen, 9700, RB, The Netherlands
| | - Theo J Klinkenberg
- Department of Cardiothoracic Surgery, University Medical Center Groningen, AB32, Postbus 30.001, Groningen, 9700, RB, The Netherlands.,Hyperhidrosis Expert Center, Dermatology, Martini Hospital, Groningen, The Netherlands
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21
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Gomez-Flores R, Gutierrez-Leal I, Caballero-Hernández D, Orozco-Flores A, Tamez-Guerra P, Tamez-Guerra R, Rodríguez-Padilla C. Association of tyrosine hydroxylase expression in brain and tumor with increased tumor growth in sympathectomized mice. BMC Res Notes 2021; 14:94. [PMID: 33691777 PMCID: PMC7945299 DOI: 10.1186/s13104-021-05507-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/01/2021] [Indexed: 11/10/2022] Open
Abstract
Objective Lymphocytes express tyrosine hydroxylase (TH), the rate-limiting enzyme for the synthesis of dopamine, norepinephrine and epinephrine. This suggests a broader role for cathecholamines in lymphocyte function, as well as the potential secretion of catecholamines by tumors of lymphoid origin. Our aim was to evaluate the expression of Th by murine lymphoma cells in an in vivo mouse model. For this, L5178Y-R lymphoma cells were implanted in nerve-intact and sympathectomized male BALB/c mice. Relative Th gene expression in tumor and brain was determined by quantitative PCR. Body composition, tumor volume, and plasma TH1/TH2/TH17 cytokines were also evaluated as markers of tumor-host condition and anti-tumor immune response in absence of adrenergic innervation. Results We found a significant (p = 0.045) 3.3-fold decrease of Th gene expression in tumor and a non-significant (p = 0.60) 6.9-fold increase in brain after sympathectomy. Sympathectomized mice also showed a significant increase in tumor mass at days 18 (p = 0.032) and 28 (p = 0.022) and increased interscapular fat (p = 0.04). TH1/TH2 and TH17 cytokines levels in plasma from sympathectomized tumor-bearing mice were not different from control mice. Conclusion The L5178Y-R lymphoma does not express Th during in vivo progression.
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Affiliation(s)
- R Gomez-Flores
- Laboratorio de Inmunología y Virología, Departamento de Microbiología e Inmunología, Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, Apartado postal 46 F, San Nicolás de los Garza, 66451, NL, México
| | - I Gutierrez-Leal
- Laboratorio de Inmunología y Virología, Departamento de Microbiología e Inmunología, Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, Apartado postal 46 F, San Nicolás de los Garza, 66451, NL, México
| | - D Caballero-Hernández
- Laboratorio de Inmunología y Virología, Departamento de Microbiología e Inmunología, Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, Apartado postal 46 F, San Nicolás de los Garza, 66451, NL, México.
| | - A Orozco-Flores
- Laboratorio de Inmunología y Virología, Departamento de Microbiología e Inmunología, Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, Apartado postal 46 F, San Nicolás de los Garza, 66451, NL, México
| | - P Tamez-Guerra
- Laboratorio de Inmunología y Virología, Departamento de Microbiología e Inmunología, Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, Apartado postal 46 F, San Nicolás de los Garza, 66451, NL, México
| | - R Tamez-Guerra
- Laboratorio de Inmunología y Virología, Departamento de Microbiología e Inmunología, Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, Apartado postal 46 F, San Nicolás de los Garza, 66451, NL, México
| | - C Rodríguez-Padilla
- Laboratorio de Inmunología y Virología, Departamento de Microbiología e Inmunología, Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, Apartado postal 46 F, San Nicolás de los Garza, 66451, NL, México
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Yang C, Li Z, Bai H, Mao H, Li JX, Wu H, Wu D, Mu J. Long-Term Efficacy of T3 Versus T3+T4 Thoracoscopic Sympathectomy for Concurrent Palmar and Plantar Hyperhidrosis. J Surg Res 2021; 263:224-229. [PMID: 33691245 DOI: 10.1016/j.jss.2020.11.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 11/03/2020] [Accepted: 11/15/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND More than 50% of patients with palmar hyperhidrosis (PAH) also have plantar hyperhidrosis (PLH). We compared the long-term results of T3 sympathectomy with those of combined T3+T4 sympathectomy among patients with concurrent PAH and PLH. MATERIALS AND METHODS We retrospectively analyzed the records of patients with concurrent PAH and PLH who underwent T3 alone or T3+T4 sympathectomy from January 1, 2012, to December 31, 2017. Preoperative and postoperative sweating (hyperhidrosis index) was evaluated through questionnaires, physical examination, and outpatient follow-up. The relief rates and hyperhidrosis index were used as outcome measures to compare the efficacy of the two approaches. Patients' satisfaction and side effects were also evaluated. RESULTS Of the 220 eligible patients, 60 underwent T3 sympathectomy (T3 group), and 160 underwent T3+T4 sympathectomy (T3+T4 group). Compared with the T3 group, the T3+T4 group showed higher symptom relief rates both for PAH (98.75% versus 93.33%, P = 0.048) and PLH (65.63% versus 46.67%, P = 0.01), and a greater postoperative decrease in both hyperhidrosis indices. The rate of severe compensatory hyperhidrosis also increased (10% versus 5%, P = 0.197), although the rates of overall satisfaction were comparable between the groups. The incidence of postoperative pneumothorax requiring chest tube placement and postoperative neuralgia was also similar. There were no cases of perioperative death, secondary operation, wound infection, or Horner syndrome in either group. CONCLUSIONS Compared with T3 alone, T3+T4 sympathectomy achieved a higher symptom relief rate and a lower hyperhidrosis index. T3+T4 sympathectomy may be a choice for the treatment of concurrent PAH and PLH; however, patients need to be informed that this kind of surgery may increase the risk of compensatory sweating.
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Affiliation(s)
- Chenglin Yang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China; Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
| | - Zifan Li
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
| | - Huiwen Bai
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
| | - Hailong Mao
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
| | - Jie Xiong Li
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
| | - Hao Wu
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China
| | - Da Wu
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, China.
| | - Juwei Mu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.
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Khalsa SS, Clausen AN, Shahabi L, Sorg J, Gonzalez SE, Naliboff B, Shivkumar K, Ajijola OA. Cardiac sympathetic denervation and mental health. Auton Neurosci 2021; 232:102787. [PMID: 33631539 DOI: 10.1016/j.autneu.2021.102787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bilateral cardiac sympathetic denervation (BCSD) is a surgical treatment for refractory ventricular arrhythmias. Although the procedure has shown efficacy at reducing cardiac arrhythmias, its impact on mental health is unknown. In the current study we examined associations between the BCSD procedure and mental health. METHODS 10 ventricular arrhythmia patients undergoing BCSD completed assessments of anxiety, depression, and posttraumatic stress symptoms at pre- and post-BCSD time points. Wilcoxon signed rank and Mann-Whitney U tests were used to examine differences in mental health symptoms in the pre- and post-BSCD states. Point biserial correlations were used to explore associations between BCSD response and mental health symptoms. RESULTS A significant reduction of anxiety symptoms was observed from pre- to post-BCSD. At the post-BCSD assessment, participants who successfully responded to the BCSD procedure exhibited lower anxiety symptoms compared to non-responders. However, no significant relationships were identified for depressive or PTSD symptoms. CONCLUSION The BCSD procedure is associated with reduced anxiety shortly after successful treatment for refractory ventricular arrhythmias in a small sample. Longitudinal surveillance of mental health symptoms after BCSD may be warranted to monitor the impact of this procedure on mental health.
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Affiliation(s)
- Sahib S Khalsa
- Laureate Institute for Brain Research, Tulsa, OK, United States of America; Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States of America.
| | - Ashley N Clausen
- Department of Behavioral Health, Kansas City VA Medical Center, Kansas City, MO, United States of America; Department of Psychiatry and Behavioral Science, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Leila Shahabi
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Julie Sorg
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Sarah E Gonzalez
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Bruce Naliboff
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Oppenheimer Center for Neurobiology of Stress and Resilience, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Kalyanam Shivkumar
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Olujimi A Ajijola
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
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Zacharias NA, Karri J, Garcia C, Lachman LK, Abd-Elsayed A. Interventional Radiofrequency Treatment for the Sympathetic Nervous System: A Review Article. Pain Ther 2021; 10:115-41. [PMID: 33433856 DOI: 10.1007/s40122-020-00227-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/24/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction Interventional techniques such as radiofrequency (RF) treatment can be used to interrupt pain signals transmitted through the sympathetic nervous system (SNS). RF treatments including the pulsed (PRF) and continuous (CRF) modalities show enhanced control over lesion size and enhanced ability to confirm accurate positioning compared to other interventional methods. PRF also acts to reduce the area of the lesion. In this article, we characterize the currently available evidence supporting the use and efficacy of RF treatments in sympathetically mediated pain (SMP) conditions. Study Design A comprehensive literature review. Methods A PubMed and Cochrane Library database search was performed for human studies applying RF treatment at sympathetic sites (sphenopalatine ganglion, stellate ganglion, cervical, thoracic, or lumbar sympathetic ganglia, celiac plexus, splanchnic nerves, superior hypogastric plexus, and ganglion impar) between January 1970 to May 2020. Data were extracted, summarized into tables, and qualitatively analyzed. Results PRF and CRF both show promise in relieving SMP conditions, such as complex regional pain syndrome (CRPS), pain in the perineal region, headache and facial pain, and oncologic and non-oncologic abdominal pain, in addition to other types of pain, with minimal complications. Furthermore, in most comparative studies, outcomes using RF treatments exceeded other interventional techniques, such as anesthetic block and chemical neurolysis. Conclusions RF treatments can be effective in carefully selected patients who are refractory to conservative management. However, further randomized controlled studies are needed prior to implementing it into common practice.
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Abstract
Sudden cardiac death (SCD) due to recurrent ventricular tachycardia is an important clinical sequela in patients with structural heart disease. As a result, ventricular tachycardia (VT) has emerged as a major clinical and public health problem. The mechanism of VT is predominantly mediated by re-entry in the presence of arrhythmogenic substrate (scar), though focal mechanisms are also important. Catheter ablation for VT, when compared to standard medical therapy, has been shown to improve VT-free survival and burden of device therapies. Approaches to VT ablation are dependent on the underlying disease process, broadly classified into idiopathic (no structural heart disease) or structural heart disease (ischemic or non-ischemic heart disease). This update aims to review recent advances made for the treatment of VT ablation, with respect to current clinical trials, peri-procedure risk assessments, pre-procedural cardiac imaging, electro-anatomic mapping and advances in catheter and non-catheter based ablation techniques.
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Affiliation(s)
- Timothy Campbell
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Richard G Bennett
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Yasuhito Kotake
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, New South Wales, Australia.
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Edalatyzadeh Z, Aghajani M, Imani A, Faghihi M, Sadeghniiat-Haghighi K, Askari S, Choopani S. Cardioprotective effects of acute sleep deprivation on ischemia/reperfusion injury. Auton Neurosci 2020; 230:102761. [PMID: 33310629 DOI: 10.1016/j.autneu.2020.102761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/08/2020] [Accepted: 12/02/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Modulation of sympathetic activity during acute sleep deprivation can produce various effects on body functions. We studied the effects of acute sleep deprivation before ischemia/reperfusion on myocardial injury in isolated rat hearts, and the role of sympathetic nervous system that may mediate these sleep deprivation induced effects. METHODS The animals were randomized into four groups (n = 11 per group): Ischemia- Reperfusion group (IR), Acute sleep deprivation group (SD), Control group for sleep deprivation (CON-SD) and Sympathectomy + ASD group (SYM-SD). In SD group, sleep deprivation paradigm was used 24 h prior to induction of ischemia/reperfusion. In SYM-SD group, the animals were chemically sympathectomized using 6-hydroxydopamine, 24 h before sleep deprivation. Then, the hearts of animals were perfused using Langendorff setup and were subjected to 30 min regional ischemia followed by 60 min of reperfusion. Throughout the experiment, the hearts were allowed to beat spontaneously and left ventricular developed pressure (LVDP) and rate pressure product (RPP) were recorded. At the end of study, infarct size and percentage of the area at risk were determined. RESULTS We found that SD increased LVDP and RPP, while reducing the myocardial infarct size. Moreover, sympathectomy reversed SD induced reduction in infarct size and showed no differences as compared to IR. CONCLUSION This study shows cardioprotective effects of acute sleep deprivation, which can be abolished by chemical sympathectomy in isolated hearts of rats.
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Affiliation(s)
- Zohreh Edalatyzadeh
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Aghajani
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Department of Physiology, School of Medicine, Shahed University, Tehran, Iran
| | - Alireza Imani
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Occupational Sleep Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mahdieh Faghihi
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sahar Askari
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Choopani
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Forssell C, Bjarnegård N, Nyström FH. A Pilot Study of Perioperative External Circumferential Cryoablation of Human Renal Arteries for Sympathetic Denervation. Vasc Specialist Int 2020; 36:151-157. [PMID: 32868486 PMCID: PMC7531304 DOI: 10.5758/vsi.200023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/11/2020] [Accepted: 07/26/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose Cryoablation, which induces cellular death without extensive tissue damage, has been extensively used to denervate the myocardium. However, periadventitial external circumferential application of cryotherapy to denervate the renal artery sympathetic nerves has, to our knowledge, never been tested in humans. The main aim of this study was to examine the safety and potential effects of cryotherapy on ambulatory blood pressure levels and other outcomes that are indirectly related to sympathetic tone, including pulse-wave velocity, central pulse pressure, and glucose levels. Materials and Methods Five patients who underwent the denervation of the renal arteries during open surgery of the abdominal aortic aneurysm and four controls who did not undergo denervation during the surgery were enrolled. An argon-powered cryotherapy catheter (Cardioblate; Medtronic Inc., USA) was applied periadventitially to each renal artery in the five patients and then activated by infusion with liquid nitrogen for 1 minute. Results No cryoablation-related complications occurred in the five consecutive patients. Their ambulatory blood pressures 3 to 5 months after surgery did not demonstrate any general blood pressure-reducing effects, but two patients responded favorably with the reduction of antihypertensive medication and decreased 24-hour blood pressure. The patients’ mean HbA1C levels decreased from 5.9±0.78% to 5.6±0.71% (P=0.042). Conclusion This pilot study suggests that periadventitial cryoablation during open surgery can be used in the study of renal denervation in humans, as it had no complications in five patients in this study. The effectiveness of cryoablation for treating hypertension should be proven in a phase II clinical trial.
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Affiliation(s)
- Claes Forssell
- Departments of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Niclas Bjarnegård
- Departments of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Fredrik H Nyström
- Departments of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
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Aljehani Y, Alhouri A, Turkistani A, ShahBahai R, AlQatari AA. Bilateral uniportal video-assisted thoracoscopic sympathectomy for managing secondary Raynaud's in CREST syndrome: A case report. Int J Surg Case Rep 2020; 75:203-206. [PMID: 32961460 PMCID: PMC7505751 DOI: 10.1016/j.ijscr.2020.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Secondary Raynaud's is a manifestation that can present in CREST syndrome as a variant of five different diseases: Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia. Secondary Raynaud's presents as a result of an imbalance between vasoconstriction and vasodilation potentially leading to tissue ischemia. The mainstay treatment is medical while surgery treatment preserved as a last resort. PRESENTATION OF CASE A 28-year-old female presented with secondary Raynaud's and was subsequently diagnosed with CREST syndrome. The patient failed to respond to medical treatment, and gangrene of the right fourth distal phalanx developed. Stellate ganglion block was successfully used as a bridge to surgery. Uniportal video-assisted thoracoscopic surgery (VATS) sympathectomy was performed via a 2-cm incision, the sympathetic ganglia were identified and transected by cauterization at the level of the 3rd, 4th, and 5th intercostal spaces extending for a distance of 5 cm to ensure that the nerve of Kuntz was transected. The postoperative outcome was satisfactory, and the condition of the patient improved in a few months. DISCUSSION Different management modalities have been used to relieve the symptoms of secondary Raynaud's. The treatment ranges from lifestyle modification, medical treatment, and lastly surgical intervention. Sympathectomy has been suggested for the management of refractive secondary Raynaud's owing to its considerable clinical response. CONCLUSION The use of uniportal VATS sympathectomy results in favorable cosmetic and clinical outcomes including reduced length of hospital stay and postoperative pain.
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Affiliation(s)
- Yasser Aljehani
- Division of Thoracic Surgery, Department of General Surgery, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Atteia Alhouri
- Division of Rheumatology, Department of Internal Medicine, Qatif Central Hospital, AlQatif, Saudi Arabia
| | - Alaa Turkistani
- Division of Thoracic Surgery, Department of General Surgery, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rahma ShahBahai
- Department of General Surgery, Airbase Hospital, Dhahran, Saudi Arabia
| | - Abdullah A AlQatari
- Division of Thoracic Surgery, Department of General Surgery, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Hamilton NN, Tedde ML, Wolosker N, Aguiar WWS, Ferreira HPDC, Oliveira HAD, Lima AMR, Westphal FL, Oliveira MVBD, Riuto FDO, Pereira STLF, Rezende GC, Valero CEB, Pego-Fernandes PM. A prospective controlled randomized multicenter study to evaluate the severity of compensatory sweating after one-stage bilateral thoracic sympathectomy versus unilateral thoracic sympathectomy in the dominant side. Contemp Clin Trials Commun 2020; 19:100618. [PMID: 32715152 PMCID: PMC7369506 DOI: 10.1016/j.conctc.2020.100618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/27/2020] [Accepted: 07/12/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the contribution that unilateral thoracic sympathectomy in dominant side or two-stage bilateral thoracic sympathectomy can have as strategies to reduce the incidence of compensatory sweating after sympathectomy for palmar hyperhidrosis. METHODS This is a prospective, controlled, randomized multicenter trial of 200 participants with palmar hyperhidrosis, which will be randomized into two arms: (a) one-stage bilateral thoracic sympathectomy (control arm); or (b) unilateral thoracic sympathectomy in dominant side (intervention arm). At six months the participants submitted to unilateral procedure can make the contralateral surgery if they wanted it, creating a third group called two-stage bilateral sympathectomy. Participants will be evaluated for the degree of sweating by the Hyperhidrosis Disease Severity Scale (HDSS) and of quality of life questionnaires. RESULTS 96 participants out of the 200 proposed have been included so far, with 48 participants randomized to each arm. From the sample 61 (63.5%) are female, with a mean age of 24 (20-32) years. There were exclusive palmar hiperhydrosis in 14 cases (14.5%), palmar and plantar hyperhidrosis in 36 (37.5%) cases, palmar and axillar hyperhidrosis in 12 (12,5%) cases and palmar-axillary-plantar hyperhidrosis in 34 (35,4%) cases. The age at the beginning of the disease was childhood (78%), with mean of time of disease 15 (11-22) years. CONCLUSIONS If one or both hypothesis: (a) unilateral sympathectomy in dominant hand is a satisfactory treatment; b) two-stage bilateral sympathectomy causes less compensatory sweating than in one stage are confirmed there is a chance that surgical therapy for palmar hyperhidrosis can be changed for better.
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Affiliation(s)
- Niura Noro Hamilton
- Heart Institute (InCor) Hospital das Clinicas, University of Sao Paulo, R. Dr. Eneas de Carvalho Aguiar, 44, 05403-900, Sao Paulo, SP, Brazil
- Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1815, 01327-001, São Paulo, SP, Brazil
| | - Miguel Lia Tedde
- Heart Institute (InCor) Hospital das Clinicas, University of Sao Paulo, R. Dr. Eneas de Carvalho Aguiar, 44, 05403-900, Sao Paulo, SP, Brazil
- Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1815, 01327-001, São Paulo, SP, Brazil
| | - Nelson Wolosker
- Hospital das Clinicas, University of Sao Paulo, R. Dr. Eneas de Carvalho Aguiar, 255, 05403-000, São Paulo, SP, Brazil
| | | | | | | | | | - Fernando Luiz Westphal
- Hospital da Universidade Federal do Amazonas, Av. Gen. Rodrigo Octávio, 6200, 69080-900, Manaus, AM, Brazil
| | - Marina Varela Braga de Oliveira
- Hospital das Clinicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110, 30130-100, Belo Horizonte, MG, Brazil
| | - Fabio de Oliveira Riuto
- Hospital da Universidade Federal da Grande Dourados, R. Ivo Alves da Rocha, 558, 79823-501, Dourados, MS, Brazil
| | | | - Guilherme Cançado Rezende
- Hospital Universitário de Brasília, Setor de Grandes Áreas Norte, 605, 70840-040, Brasília, DF, Brazil
| | | | - Paulo M. Pego-Fernandes
- Heart Institute (InCor) Hospital das Clinicas, University of Sao Paulo, R. Dr. Eneas de Carvalho Aguiar, 44, 05403-900, Sao Paulo, SP, Brazil
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Velásquez M, Fernández L, Leib CS, Orozco V, Pava F, Perafan P. Cardiac sympathetic denervation for conventional treatment refractory arrhythmias. Arch Cardiol Mex 2020; 89:191-195. [PMID: 31967585 DOI: 10.24875/acme.m19000059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objetivo La denervación simpática cardiaca izquierda (DSCI) por toracoscopia se ha convertido en una alternativa terapéutica para el manejo de arritmias cardíacas refractarias al tratamiento convencional en pacientes con cardiopatía estructural, principalmente isquémicos, y enfermedades hereditarias asociadas con muerte súbita como el síndrome de QT largo. Generalmente se realiza en quienes manifiestan episodios recurrentes de arritmias ventriculares o incluso tormenta eléctrica a pesar del tratamiento convencional. El objetivo de este estudio es mostrar la experiencia de esta institución con la DSCI en pacientes refractarios al manejo convencional y los resultados derivados de su aplicación. Métodos Se revisaron los registros de 6 pacientes con antecedente de arritmias ventriculares tratados previamente con medicamentos y en algunos casos con ablación con catéter y la mayoría con desfibrilador automático implantable, que fueron llevados DSCI por toracoscopia video-asistida (VATS). Resultados La principal enfermedad de base fue la cardiopatía estructural, la indicación más prevalente fue tormenta arrítmica incontrolable, la edad promedio fue de 56 ± 16 años, el 67% de los individuos fueron hombres. Este procedimiento no mostró complicaciones en ninguno de los pacientes y se encontró mejoría sintomática en todos los casos. Se realizó seguimiento por 24 meses; dos pacientes tuvieron recurrencias por taquicardia ventricular lenta sin síntomas severos y uno por fibrilación ventricular. Conclusion La DSCI por VATS debe considerarse como opción terapéutica para pacientes con arritmias de difícil manejo.
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Affiliation(s)
| | - Liliana Fernández
- Internal Medicine, Pneumology, Biomedical Research in Thorax, Cali, Colombia
| | - Carl S Leib
- Clinical Research Center, Biomedical Research in Thorax, Cali, Colombia
| | - Viviana Orozco
- Clinical Research Center, Biomedical Research in Thorax, Cali, Colombia
| | - Fernando Pava
- Internal Medicine, Cardiology, Electrophysiology, Fundación Valle del Lili, Faculty of Health Sciences, Universidad ICESI, Cali, Colombia
| | - Pablo Perafan
- Internal Medicine, Cardiology, Electrophysiology, Fundación Valle del Lili, Faculty of Health Sciences, Universidad ICESI, Cali, Colombia
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Sinkar K, Bagchi A, Mahajan A, Vadivelu R, Venkatraman M, Motwani R, Vichare S, Joshi S, Parikh D, Vaz J, Lokhandwala Y. Acute hemodynamics of cardiac sympathetic denervation. Indian Pacing Electrophysiol J 2020; 20:237-242. [PMID: 32553637 PMCID: PMC7691767 DOI: 10.1016/j.ipej.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/02/2020] [Accepted: 06/11/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION We aimed to study the immediate hemodynamic effects of thoracoscopic bilateral cardiac sympathetic denervation (CSD) for recurrent ventricular tachycardia (VT) or VT storm. METHOD We studied a group of 18 adults who underwent bilateral thoracoscopic CSD; the blood pressure (BP) and Heart Rate (HR) were continuously monitored during the surgery and up to 6 h post-operatively. RESULTS Immediately on removal of the sympathetic ganglia, the patients had a drop in both the systolic (110 mm Hg to 95.8 mm Hg, p < 0.001) and diastolic BP (69.4 mm Hg to65 mm Hg, p = 0.007) along with a drop in the HR (81.6 bpm to 61.2 bpm, p < 0.001).At 6 h after CSD, the systolic and diastolic BP did not recover significantly, while there was recovery in HR (61.2 bpm to 66 bpm, p = 0.02). There was no significant difference between those with and without left ventricular (LV) systolic dysfunction. CONCLUSION The acute hemodynamic changes during the perioperative period of CSD are significant but not serious. Awareness of this is useful for peri-operative management.
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Affiliation(s)
- Kunal Sinkar
- Holy Family Hospital, Bandra West, Mumbai, 400050, India
| | - Avishek Bagchi
- Holy Family Hospital, Bandra West, Mumbai, 400050, India.
| | - Ankit Mahajan
- Holy Family Hospital, Bandra West, Mumbai, 400050, India
| | | | | | - Reshma Motwani
- Holy Family Hospital, Bandra West, Mumbai, 400050, India
| | | | - Suresh Joshi
- Holy Family Hospital, Bandra West, Mumbai, 400050, India
| | - Dinesh Parikh
- Holy Family Hospital, Bandra West, Mumbai, 400050, India
| | - Jude Vaz
- Holy Family Hospital, Bandra West, Mumbai, 400050, India
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Divisi D, Zaccagna G, Imbriglio G, Di Francescantonio W, De Vico A, Barone M, Crisci R. Video-assisted thoracoscopic sympathectomy versus modified Wittmoser method in surgical management of primary hyperhidrosis. J Cardiothorac Surg 2020; 15:133. [PMID: 32522214 PMCID: PMC7285583 DOI: 10.1186/s13019-020-01176-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/31/2020] [Indexed: 11/24/2022] Open
Abstract
Purposes We compared two different surgical methods evaluating the effectiveness of procedures and the quality of life (QoL) of patients. Methods From January 2010 to November 2017 we carried out 476 biportal video-assisted thoracoscopic surgery (VATS) approaches of sympathetic chain in 238 patients. One hundred and twenty-nine (54%) patients underwent conventional sympathectomy (CS) while 109 (46%) patients underwent sympathicotomy associated with the division of the rami communicantes (MWT). Quality of Life (QoL) was classified as follows: from 20 to 35 excellent; from 36 to 51 very good; from 52 to 68 good; from 69 to 84 poor; and > 84 very poor. Results We noticed statistical significant reduction of complications comparing CS with MWT approaches (chest pain from 36.4 to 4.5%; paresthesias from 8.5 to 3.6%; bradycardia from 28.6 to 10%, respectively). The preoperative and postoperative QoL index evaluation revealed a statistically significant improvement after surgery (CS: 86 ± 2 versus 35 ± 1, p = 0.00001; MWT: 85 ± 1 versus 33 ± 2, p = 0.00001), with general satisfaction of the two techniques. Conclusion Modified Wittmoser method seems to be a valid alternative to conventional sympathectomy, minimizing the percentage rate of complications and showing significant effectiveness in the quality of life improvement.
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Affiliation(s)
- Duilio Divisi
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, 64100, Teramo, Italy.
| | - Gino Zaccagna
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, 64100, Teramo, Italy
| | - Giovanna Imbriglio
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, 64100, Teramo, Italy
| | - William Di Francescantonio
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, 64100, Teramo, Italy
| | - Andrea De Vico
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, 64100, Teramo, Italy
| | - Mirko Barone
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, 64100, Teramo, Italy
| | - Roberto Crisci
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Piazza Italia 1, 64100, Teramo, Italy
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Yalin K, Liosis S, Palade E, Fink T, Schierholz S, Sawan N, Eitel C, Heeger CH, Sciacca V, Sano M, Vogler J, Tilz RR. Cardiac sympathetic denervation in patients with nonischemic cardiomyopathy and refractory ventricular arrhythmias: a single-center experience. Clin Res Cardiol 2020; 110:21-28. [PMID: 32328735 DOI: 10.1007/s00392-020-01643-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Cardiac sympathetic denervation (CSD) is an effective therapy for selected patients with drug refractory ventricular arrhythmias (VA). Data about the role of CSD in patients with structural heart disease and VAs are sparse. We herein present our experience of CSD in patients with nonischemic cardiomyopathy and VAs despite prior ablation procedure and/or antiarrhythmic drug (AAD) therapy. METHODS A total of ten patients (mean age 61.6 ± 19.6, mean LVEF 29.5 ± 12.1%) with nonischemic dilated cardiomyopathy (NICM) (n = 9) and hypertrophic cardiomyopathy (HCM) (n = 1) underwent CSD (left sided in six and bilateral in four patients) due to refractory VA despite multiple AADs (mean number of AADs was 1.6 ± 0.7) and prior VT ablation (mean number of procedures per patient was 1.5 ± 1.3). RESULTS Mean follow-up was 10.1 ± 6.9 months. The median number of VA and ICD shocks decreased significantly from 9.0 and 2.5 episodes 6 months prior to CSD to 0 and 0 episodes within 6 months after CSD (p = 0.012 and p = 0.011). Five patients remained free from sustained VA recurrences. Two patients experienced single ICD shock due to a polymorphic VT (triggered by severe hypokalemia in one patient) and one patient a single shock due to monomorphic VT. One patient had five episodes of slow VT under amiodarone therapy (three of them terminated by antitachycardia pacing) and underwent endo- epicardial re-ablation. Two patients died 1 month after CSD. One of them due to electrical storm and cardiogenic shock and the second one due to refractory cardiogenic shock, without recurrence of VAs though. No major complications of CSD occurred. No patient suffered from Horner syndrome. CONCLUSION In this study, CSD was effective for treatment of VAs in patients with structural heart disease refractory to antiarrhythmic drugs and catheter ablation. Further larger studies are required to confirm these findings.
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Affiliation(s)
- Kivanc Yalin
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany. .,Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Spyridon Liosis
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
| | - Emanuel Palade
- Department of Surgery, Medical University of Schleswig-Holstein, Campus, Lübeck, Germany
| | - Thomas Fink
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
| | - Stefanie Schierholz
- Department of Surgery, Medical University of Schleswig-Holstein, Campus, Lübeck, Germany
| | - Noureddin Sawan
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
| | - Charlotte Eitel
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
| | - Christian H Heeger
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
| | - Vanessa Sciacca
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
| | - Makoto Sano
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
| | - Julia Vogler
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany
| | - Roland Richard Tilz
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany. .,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Lübeck, Germany.
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Gupta A, Prince M, Bob-Manuel T, Jenkins JS. Renal denervation: Alternative treatment options for hypertension? Prog Cardiovasc Dis 2019; 63:51-57. [PMID: 31884099 DOI: 10.1016/j.pcad.2019.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 12/17/2022]
Abstract
Hypertension affects millions of Americans and has adverse long-term consequences increasing morbidity and mortality. Resistant hypertension (RH) continues to be difficult to treat with medications alone which may be associated with significant side effects. Alternate therapies have been evaluated for treating RH and renal denervation has been investigated extensively. We review the data from renal denervation trials and other novel technologies which are not FDA approved to date.
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Affiliation(s)
- Aashish Gupta
- Department of Cardiology at Ochsner Clinic Foundation, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, United States of America.
| | - Marloe Prince
- Department of Cardiology at Ochsner Clinic Foundation, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, United States of America
| | - Tamunoinemi Bob-Manuel
- Department of Cardiology at Ochsner Clinic Foundation, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, United States of America
| | - J Stephen Jenkins
- Department of Cardiology at Ochsner Clinic Foundation, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, United States of America
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Oz G, Gunay E, Dumanli A, Cilekar S, Yucens B, Gokaslan S, Dogan Baki E. Effects of clipping endoscopic thoracal sympathectomy at Th 4 on cardiopulmonary functions, quality of life and psychosocial functions. Gen Thorac Cardiovasc Surg 2019; 68:516-522. [PMID: 31786724 DOI: 10.1007/s11748-019-01259-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND In this study, we evaluated the cardiopulmonary and psychosocial effects of endoscopic thoracal sympathectomy (ETS) by clipping procedure at the level of Th4 and effects of ETS on quality of life of patients with hyperhidrosis. METHODS We performed a prospective study in 52 patients complaining of local sweating who applied to our clinic. Cardiac maximal treadmill stress test (CMTST), pulmonary function tests, Beck anxiety-depression inventory, Liebowitz social anxiety scale and SF-36 quality of life questionnaires were administered at preoperative period and postoperative 6th month. RESULTS In the pulmonary function test, we found a minimal decrease in FEV1, and FEV1/FVC. There were no significant change in 'resting pulse rate', 'resting systolic and diastolic blood pressures' during CMTST between before and after operation. There was a significant difference in peak heart rate before CMTST, post-exercise diastolic blood pressure, and age-predictive maximal heart rate between before and after clipping procedure. In the SF-36 questionnaire, all parameters were improved. In the Beck depression-anxiety inventory and the Liebowitz social anxiety scale significant improvement was achieved in all parameters. CONCLUSION ETS by clipping procedure at the Th4 level is advised to be a safe and effective method for management of hyperhidrosis patients.
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Affiliation(s)
- Gurhan Oz
- Department of Thoracic Surgery, Afyon Kocatepe University School of Medicine, 03200, Afyonkarahisar, Turkey.
| | - Ersin Gunay
- Department of Chest Diseases, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Ahmet Dumanli
- Department of Thoracic Surgery, Afyon Kocatepe University School of Medicine, 03200, Afyonkarahisar, Turkey
| | - Sule Cilekar
- Department of Chest Diseases, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Bengu Yucens
- Department of Psychiatry, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Serkan Gokaslan
- Department of Cardiology, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Elif Dogan Baki
- Department of Anesthesiology, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
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Velásquez M, Fernández L, Leib CS, Orozco V, Pava F, Perafan P. Cardiac sympathetic denervation for conventional treatment refractory arrhythmias. Arch Cardiol Mex 2019; 89:211-215. [PMID: 31588139 DOI: 10.24875/acm.m19000052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Cardiac sympathetic denervation (CSD) using video-assisted thoracoscopy is a therapeutic alternative for cardiac arrhythmias refractory to conventional treatment in patients with ventricular structural heart disease, mainly due to ischemia, and in patients with hereditary conditions associated with sudden death such as long QT syndrome. In general, it is performed in cases with recurrent episodes of ventricular tachycardia or electrical storm, in spite of conventional treatment. The objective of this study is to show the experience of this institution with DSCI in refractory patients to conventional management and the results derived from its application. Methods This was an observational retrospective study. The records of patients with a history of ventricular arrhythmias treated in our center with pharmacological treatment, catheter ablation, or implantation of an implantable cardioverter-defibrillator (ICD), who underwent video-assisted CSD were analyzed and described. Results A total of six patients were included in the study. Patients with structural heart disease were the most frequent, median age was 56 ± 16 years; 67% were male. The procedure evolved without complications in any of the patients and an overall significant improvement was observed. A 24-month follow-up was conducted; two patients had recurrence episodes presenting as slow ventricular tachycardia without severe symptoms and a third patient presented an episode of ventricular fibrillation aborted by the ICD. Conclusion Video-assisted CSD should be considered as a treatment option for patients with potentially dangerous arrhythmias that do not respond to conventional treatment, especially in recurrent ventricular tachycardia.
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Affiliation(s)
- Mauricio Velásquez
- Thoracic Surgery, Biomedical Research in Thorax. Universidad ICESI, Cali, Colombia
| | - Liliana Fernández
- Internal Medicine, Pneumology, Biomedical Research in Thorax. Universidad ICESI, Cali, Colombia
| | - Carl S Leib
- Clinical Research Center, Biomedical Research in Thorax. Universidad ICESI, Cali, Colombia
| | - Viviana Orozco
- Clinical Research Center, Biomedical Research in Thorax. Universidad ICESI, Cali, Colombia
| | - Fernando Pava
- Internal Medicine, Cardiology, Electrophysiology, Fundación Valle del Lili, Faculty of Health Sciences. Universidad ICESI, Cali, Colombia
| | - Pablo Perafan
- Internal Medicine, Cardiology, Electrophysiology, Fundación Valle del Lili, Faculty of Health Sciences. Universidad ICESI, Cali, Colombia
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Hasimoto FN, Cataneo DC, Hasimoto EN, Ximenes AMG, Cataneo AJM. Radiofrequency in the treatment of primary hyperhidrosis: systematic review and meta-analysis. Clin Auton Res 2019; 30:111-120. [PMID: 31552511 DOI: 10.1007/s10286-019-00640-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 09/13/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate, via a systematic review, the effectiveness of radiofrequency (RF) for treatment of primary hyperhidrosis (PH). METHODS Experimental or observational studies were included where RF treatment (ablation or microneedling) was performed, comparing the periods before and after treatment. RESULTS Nine studies were considered eligible and included for analysis. In seven of nine studies, patients were subjected to RF only, and in two of nine studies RF was compared to video-assisted thoracoscopic sympathectomy (VATS). There was a reduction in the severity of PH in microneedling (three studies, mean difference -1.24, 95% CI -1.44 to -1.03). In a study that performed sympathetic RF ablation there was a greater reduction in PH severity compared to studies that performed microneedling (-2.42, 95% CI -2.55 to -2.29). There was improvement in the quality of life (QoL) after sympathetic RF ablation (two studies, mean difference -15.92, 95% CI -17.61 to -14.24). Regarding the microneedling procedure, there was a lower improvement in QoL, (two studies, -9.0, 95% CI -9.15 to -8.85). One study comparing sympathetic RF ablation with VATS applied the QoL questionnaire, and the VATS showed superior results. One of the two studies comparing compensatory sweating in RF ablation with VATS showed that compensatory hyperhidrosis was higher in VATS; however, the other study did not observe this difference. One study compared the recurrence of symptoms between VATS and RF ablation; symptom recurrence was shown to be higher in RF. CONCLUSIONS RF is effective for PH treatment, with superior results obtained with sympathetic ablation compared to microneedling.
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Affiliation(s)
- Fabio Nishida Hasimoto
- Post-Graduation Program on General Basis of Surgery, School of Medicine, São Paulo State University-UNESP, Botucatu, SP, CEP 18618-970, Brazil
| | - Daniele Cristina Cataneo
- Division of Thoracic Surgery, Botucatu School of Medicine, São Paulo State University-UNESP, Botucatu, SP, CEP 18618-970, Brazil
| | - Erica Nishida Hasimoto
- Division of Thoracic Surgery, Botucatu School of Medicine, São Paulo State University-UNESP, Botucatu, SP, CEP 18618-970, Brazil
| | - Aglaia Moreira Garcia Ximenes
- Post-Graduation Program on Medicine, Botucatu School of Medicine, São Paulo State University-UNESP, Botucatu, SP, CEP 18618-970, Brazil
| | - Antônio José Maria Cataneo
- Division of Thoracic Surgery, Botucatu School of Medicine, São Paulo State University-UNESP, Botucatu, SP, CEP 18618-970, Brazil.
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ReFaey K, Grewal SS, Segura-Duran I, Thomas M, Wharen RE. Video-Assisted Bilateral Thoracoscopic Sympathotomy for Palmar Hyperhidrosis. World Neurosurg 2019; 132:333. [PMID: 31525484 DOI: 10.1016/j.wneu.2019.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/06/2019] [Accepted: 09/07/2019] [Indexed: 10/26/2022]
Abstract
In this video, we demonstrate a case of a 21-year-old right-handed man who presented with palmar hyperhidrosis. His symptoms started at the age of 4 years and progressively worsened throughout his life. Multiple medical treatments were used without significant benefit. His symptoms worsened to the limit that it affected his work and lifestyle. The patient was taken to the operating room in a supine position with both arms abducted 90°. The right and left chest were prepped and draped in a sterile fashion. The skin incision was done on the left side first, the left lung was isolated, and two 5-mm thoracoports were placed in the sixth and third intercostal spaces, respectively. Carbon dioxide insufflation was used to a pressure of 6 mm Hg for exposure. The chest was visualized, and the sympathetic chain was identified. Ribs were counted and then cautery at a low setting was used. The sympathetic chain was transected at the level of the head of the second rib. Accessory nerves of Kuntz were identified and resected. Carbon dioxide was then evacuated from the left chest using a bronchial tube exchanger and Valsalva maneuver. The lung was completely reinflated and skin was closed in a normal fashion. The same procedure was repeated on the right side. A chest radiograph was obtained intraoperatively, and no pneumothorax was observed. At the end of the procedure, both upper extremity temperature probes showed a significant increase from baseline. Informed patient consent was obtained.
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Affiliation(s)
- Karim ReFaey
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Sanjeet S Grewal
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Ivan Segura-Duran
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Mathew Thomas
- Department of Thoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Robert E Wharen
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA.
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Mousazadeh B, Sharebiani H, Taheri H, Valizedeh N, Fazeli B. Unexpected inflammation in the sympathetic ganglia in thromboangiitis obliterans: more likely sterile or infectious induced inflammation? Clin Mol Allergy 2019; 17:10. [PMID: 31316304 PMCID: PMC6612411 DOI: 10.1186/s12948-019-0114-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 06/22/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction The aim of this study was to determine if the inflammation of the sympathetic ganglia (SG) in thromboangiitis obliterans (TAO) is induced by an infectious pathogen inside or if it is a reactive sterile inflammation. Methods For the purpose of this study, the gene expression of high-mobility group box 1 (HMGB1), toll-like receptor 4 (TLR4), toll-like receptor 9 (TLR9), and the receptor for advanced glycation end-products (RAGE) were evaluated on the complementary DNA (cDNA) of the SG tissues of 24 TAO patients and two controls with hyperhidrosis by real-time polymerase chain reaction (PCR) and analysed by the Pfaffl method. Results The gene expression of HMGB1 and TLR9 increased by about 25- and 2-fold changes in the SG of the TAO patients, respectively. However, there was no change in the gene expression of TLR4 or RAGE. Conclusion It appears that the inflammation in the SG of TAO patients is more likely a sterile inflammation, and its trigger may be mitochondrial DNA (mtDNA). Cadmium in cigarettes could be responsible for the induction of mtDNA release to the cell cytoplasm. In addition, the high expression of HMGB1 may play a role in the pathogenesis of TAO and may be responsible for both clinical manifestation of the disease and the imaging findings. Moreover, HMGB1 may be a target for treatment protocols for TAO. Further studies are highly recommended.
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Affiliation(s)
- Behzad Mousazadeh
- 1Immunology Research Center, Inflammation and Inflammatory Diseases Division, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hiva Sharebiani
- 1Immunology Research Center, Inflammation and Inflammatory Diseases Division, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Narges Valizedeh
- 1Immunology Research Center, Inflammation and Inflammatory Diseases Division, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bahare Fazeli
- 1Immunology Research Center, Inflammation and Inflammatory Diseases Division, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Vascular Independent Research and Education, European Foundation, Milan, Italy
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Abstract
PURPOSE OF REVIEW Refractory angina (RA), which is characterized by tissue ischemia along with neurological, mitochondrial, and psychogenic dysfunction, is becoming a major cause of morbidity in patients with advanced coronary artery disease. In this review, we discuss in detail the invasive mechanical non-cell therapy-based options, the evidence behind these therapies, and future trends. RECENT FINDINGS There is extensive ongoing research in the areas of spinal-cord stimulation, transmyocardial laser revascularization, sympathectomy, angiogenesis, and other non-cell-based therapies to explore the best therapy for refractory angina. There is conflicting data in the literature suggesting subjective improvement in angina, but very few studies boast improvement in core objective parameters such as myocardial blood flow, survival, or rehospitalizations. Patients with refractory angina are a complex group of patients that need novel approaches to help alleviate their symptoms and reduce mortality. A carefully selected sequence of therapies may provide the best results in this patient population.
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Affiliation(s)
- Amod Amritphale
- Oklahoma University Health Sciences Center, Oklahoma City, OK, USA.
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Kara M, Kose S, Ozkan B, Sertcakacilar G. Does clip removal help for compensatory hyperhidrosis complicating thoracic sympathetic clipping? Clin Auton Res 2019; 29:353-355. [PMID: 30859345 DOI: 10.1007/s10286-019-00599-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/26/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Murat Kara
- Istanbul University, Faculty of Medicine, Department of Thoracic Surgery, Istanbul, Turkey.
| | - Selcuk Kose
- Department of Thoracic Surgery, Bakirkoy Research and Training Hospital, Istanbul, Turkey
| | - Berker Ozkan
- Istanbul University, Faculty of Medicine, Department of Thoracic Surgery, Istanbul, Turkey
| | - Gokhan Sertcakacilar
- Department of Anesthesiology and Reanimation, Bakirkoy Research and Training Hospital, Istanbul, Turkey
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Fibla Alfara JJ, Molins López-Rodó L, Hernández Ferrández J, Guirao Montes Á. Effectiveness of bilateral clipping of the thoracic sympathetic chain for the treatment of severe palmar and/or axillary hyperhidrosis and facial flushing. Cir Esp 2019; 97:196-202. [PMID: 30685056 DOI: 10.1016/j.ciresp.2018.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/14/2018] [Accepted: 11/16/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Division of the thoracic sympathetic chain is the standard treatment for severe palmar and/or axillary hyperhidrosis and facial flushing. Clipping is an alternative option which allows the block to be reverted in cases of intolerable compensatory sweating. METHODS This is a prospective study performed to assess: a) results of clipping of the thoracic sympathetic chain in patients with palmar and/or axillary hyperhidrosis and facial flushing; and b) to determine the improvement obtained after removal of the clip in patients with unbearable compensatory sweating. We included 299 patients (598 procedures) diagnosed with palmar hyperhidrosis (n=110), palmar and/or axillary hyperhidrosis (n=78), axillary hyperhidrosis (n=35), and facial flushing (n=76), who underwent videothoracoscopic clipping between 2007 and 2015. RESULTS 128 men and 171 women were treated, with mean age of 28 years. A total of 290 patients (97.0%) were discharged within 24hours. The procedure was effective in 92.3% (99.1% in palmar hyperhidrosis, 96,1% in palmar and/or axillary hyperhidrosis, 74.3% in axillary hyperhidrosis, and 86.8% in facial flushing). Nine patients (3%) presented minor complications. Compensatory sweating developed in 137 patients (45.8%): moderate in 113 (37.8%), severe in 16 (5.3%) and unbearable in 8 (2.7%). The clip was removed in these 8 patients; symptoms improved in 5 (62.8%), with sustained effect on hyperhidrosis in 4 of them. CONCLUSIONS Clipping of the thoracic sympathetic chain is an effective and safe procedure. If incapacitating compensatory sweating develops, this technique allows the clips to be removed with reversion of symptoms in a considerable number of patients.
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Affiliation(s)
| | - Laureano Molins López-Rodó
- Cirugía Torácica, Hospital Universitari Sagrat Cor, Barcelona, España; Cirugía Torácica, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | | | - Ángela Guirao Montes
- Cirugía Torácica, Hospital Universitari Sagrat Cor, Barcelona, España; Cirugía Torácica, Hospital Clínic, Universitat de Barcelona, Barcelona, España
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Téllez LJ, Garzón JC, Vinck EE, Castellanos JD. Video-assisted thoracoscopic cardiac denervation of refractory ventricular arrhythmias and electrical storms: a single-center series. J Cardiothorac Surg 2019; 14:17. [PMID: 30665431 PMCID: PMC6341718 DOI: 10.1186/s13019-019-0838-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 01/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The combined treatment of beta-blockers with ablation and Implanted cardioverter defibrillation therapy, continues to be the mainstay treatment for ventricular arrhythmias (VAs). Despite treatment, some patients remain refractory. Recent studies have shown success rates using video-assisted thoracoscopic (VATS) cardiac denervation as an effective therapeutic option for these patients. CASE SERIES PRESENTATION During a period of three years, from 2015 through 2017, twenty patients (N = 20) failed traditional medical and interventional treatment for the management of ventricular arrhythmias and electrical storms. After remaining refractory, the patients were referred to our thoracic surgery department for a VATS based treatment. The patients all had ventricular arrhythmias and electrical storms secondary to different cardiomyopathies. The patients were refractory to combined medical (beta-blockers), Implanted Cardioverter defibrillation (ICD) and ablation therapy. All twenty patients agreed to surgery and were taken to cardiac denervation using a bilateral VATS approach by two thoracic surgeons at a single Cardiothoracic center. During the month prior to bilateral VATS denervation a combined total of twenty-nine (N = 29) ICD shocks were registered in addition to six (N = 6) cases of electrical storms averaging three (N = 3) shocks per day. Mean shocks per patient was 2.3. During the first three months following VATS, the patients had a 90% (N = 18/20) total resolution of ICD registered shocks, a 100% (N = 6/6) resolution of electrical storms, and a 92% (N = 11/12) resolution of shocks in patients having previous ablation therapy. No complications were documented following surgery except for one case of pneumothorax as a result of the procedure, and there were no peri-operative mortalities. CONCLUSIONS Bilateral thoracoscopic cardiac denervation can be a safe and seemingly effective therapeutic option for patients presenting with life-threatening refractory ventricular arrhythmias and electrical storms in a variety of cardiomyopathies including Chagas disease.
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Affiliation(s)
- Luis Jaime Téllez
- Department of Thoracic Surgery, Fundación Cardioinfantil, Bogotá, Colombia
| | - Juan Carlos Garzón
- Department of Thoracic Surgery, Fundación Cardioinfantil, Bogotá, Colombia
| | - Eric Edward Vinck
- Department of Surgery, El Bosque University, Av. Cra 9 No. 131 A - 02, Bogotá, Colombia.
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Kara M, Kose S, Cayirci CE, Koksal A. Can we predict the compensatory hyperhidrosis following a thoracic sympathectomy? Indian J Thorac Cardiovasc Surg 2018; 35:190-195. [PMID: 33061004 DOI: 10.1007/s12055-018-0769-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/01/2018] [Accepted: 11/09/2018] [Indexed: 01/25/2023] Open
Abstract
Background Primary hyperhidrosis is a functionally and socially disabling condition resulting in social embarrassment and low quality of life. Thoracic sympathectomy is a definitive choice of treatment with favorable results. However, patients may face another embarrassing condition following surgery as compensatory hyperhidrosis which has no definitive treatment. The predictors of compensatory hyperhidrosis are controversial and remain unclear. Patients and methods A total of 74 patients underwent a videothoracoscopic sympathectomy for primary hyperhidrosis. We statistically analyzed our patients with correlations and uni-multivariate logistic regression models to outline the possible predictors of compensatory hyperhidrosis. Results A total of 45 (60.8%) patients had compensatory hyperhidrosis. The correlations showed that patients, with age greater than 21 years (P = 0.018), with body mass index (BMI) greater than 22 kg / m2 (P = 0.045), with isolated facial hyperhidrosis (P = 0.044), and with smoking status (P = 0.015), had significantly greater rates of compensatory hyperhidrosis. Similarly, the significant univariate predictors of compensatory hyperhidrosis were age > 21 (P = 0.020), BMI > 22 kg / m2 (P = 0.048), and the presence of smoking status (P = 0.015). Multivariate analysis revealed only smoking as a predictor within the threshold of significance (P = 0.078). Conclusion The clinical predictors of compensatory hyperhidrosis following a thoracic sympathectomy appear as older age, greater body mass index, and smoking.
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Affiliation(s)
- Murat Kara
- Department of Thoracic Surgery, Istanbul University School of Medicine, Istanbul, Turkey
| | - Selcuk Kose
- Department of Thoracic Surgery, Bakirkoy Research and Training Hospital, Istanbul, Turkey
| | | | - Ayhan Koksal
- Department of Neurology, Bakirkoy Research and Training Hospital, Istanbul, Turkey
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Chidiac JJ, Kassab A, Rifai K, Al-Chaer ED, Saadé NE. Contribution of capsaicin-sensitive innervation to the continuous eruption of the rat mandibular incisors. Anat Sci Int 2018; 94:136-143. [PMID: 30229540 DOI: 10.1007/s12565-018-0460-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/10/2018] [Indexed: 12/20/2022]
Abstract
A major component of tooth innervation is made of capsaicin-sensitive primary afferents (CSPA). These fibers play a key role in tooth pain and inflammation; little is known, however, about the role of CSPA in tooth eruption. The aim of this study was to examine the role of the capsaicin-sensitive afferents in the process of eruption of intact rat incisors. CSPA fibers in several rat groups, were subjected to one of the following experimental procedures: systemic chemical ablation, systemic ablation followed by chemical sympathectomy and localized activation. The observed effects on incisor eruption were compared to those made on controls. The total amount of eruption in control/naïve rats, measured over a total period of 144 h, was 3.18 ± 0.07 mm and decreased to 2.43 ± 0.08 mm (n = 7; p < 0.001) following systemic ablation of CSPA. Further decrease to 2.24 ± 0.08 mm (n = 7; p < 0.001) was noticed when chemical sympathectomy was added to CSPA ablation. The average rate of eruption was 1.7 ± 0.25 mm following CSPA activation, compared to an average of 0.8 ± 0.07 mm for controls (n = 7; p < 0.001). Capsaicin sensitive fibers play an important role in tooth homeostasis, and intact neural supply is required for tooth growth under normal conditions.
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Affiliation(s)
| | - Ammar Kassab
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Khaldoun Rifai
- School of Dentistry, Lebanese University, Beirut, Lebanon
| | - Elie D Al-Chaer
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Nayef E Saadé
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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Assis FR, Yu DH, Zhou X, Sidhu S, Bapna A, Engelman ZJ, Misra S, Okada DR, Chrispin J, Berger R, Mandal K, Lee H, Tandri H. Minimally invasive transtracheal cardiac plexus block for sympathetic neuromodulation. Heart Rhythm 2019; 16:117-24. [PMID: 30075280 DOI: 10.1016/j.hrthm.2018.07.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Bilateral thoracoscopic stellectomy has antiarrhythmic effects, but the procedure is invasive with associated morbidity. Sympathetic nerves from both stellate ganglia form the deep cardiac plexus (CP) in the aortopulmonary window, anterior to the trachea. OBJECTIVE The purpose of this study was to demonstrate a novel and minimally invasive transtracheal approach to block the CP in porcine models. METHODS In 12 Yorkshire pigs, right (RSG) and left (LSG) stellate ganglia were electrically stimulated and sympathetic baseline response recorded (hemodynamic parameters and T-wave pattern). Aortopulmonary window was accessed transtracheally with endobronchial ultrasound guidance, and local stimulation of CP confirmed the location. Injection of 1% lidocaine (n = 10) or saline solution (n = 2) was performed, and RSG and LSG responses were re-evaluated and compared with baseline. RESULTS Transtracheal lidocaine injection into the CP successfully blocked bilateral sympathetic induced changes (%) in T-wave amplitude (282.8% ± 152.2% vs 20.1% ± 16.5%; P <.001 [LSG]; 338.9% ± 189.8% vs 28% ± 18.3%; P <.001 [RSG]), Tp-Te interval (87.9% ± 37.2% vs 6.9% ± 6.7%; P <.001 [LSG]; 32.6% ± 27.4% vs 6.9% ± 4.7%; P <.035 [RSG]), and left ventricular dP/dTmax (148.3% ± 108.5% vs 16.5% ± 13.4%; P <.001 [LSG]; 243.1% ± 105.2% vs 19.0% ± 12.4%; P <.001 [RSG]). RSG-induced elevations of systemic, left ventricular, and pulmonary arterial pressures were blocked by lidocaine injection into CP (P <.005 for all comparisons). Stellate ganglia response was not affected in sham studies. No complications were observed during the procedures. CONCLUSION Minimally invasive transtracheal injection of lidocaine into the CP blocked the sympathetic response of either RSG and LSG. Transtracheal assessment of CP may allow for minimally invasive and selective ablation of cardiac innervation, extending the cardiac sympathectomy denervation benefits to those not suitable for surgery.
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Abstract
This review summarizes the evidence derived from studies utilizing denervation procedures to demonstrate sympathetic control of white adipose tissue metabolism and body fat mass. A majority of the work demonstrating neural control of white fat was performed in the Bartness laboratory with Siberian hamsters as the predominant experimental model. These animals experience dramatic changes in body fat mass in response to changes in photoperiod, however, the mechanisms identified in hamsters have been reproduced or further elucidated by experiments with other animal models. Evidence for the role of sympathetic innervation contributing to the control of white adipocyte lipolysis and preadipocyte proliferation is summarized. In addition, evidence from denervation experiments for neural communication between different white fat depots as well as for a feedback control loop between sensory afferents from individual fat depots and sympathetic efferents to the same or distant white fat depots is discussed.
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Affiliation(s)
- Ruth B S Harris
- Medical College of Georgia, Augusta University, Augusta, GA 30912, United States.
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Wang HY, Zhu YJ, Liu J, Li LW, Liu YH. The relationship between preoperative psychological evaluation and compensatory sweating. J Cardiothorac Surg 2018; 13:42. [PMID: 29776420 PMCID: PMC5960156 DOI: 10.1186/s13019-018-0728-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 05/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study analyzes the relationship between preoperative psychological states of primary palmar hyperhidrosis patients and postoperative compensatory sweating. METHODS We evaluated the psychological states of patients with primary palmar hyperhidrosis who received sympathectomy in our hospital from 2016 to 2017. The relationship between preoperative psychological states and postoperative compensatory sweating were assessed using Spearman's rank-order correlation. RESULTS Fifty-five patients who received R4 + R3 bypass transection accepted the preoperative questionnaire survey; 35 were males and 20 were females. The average age was 24.0 ± 6.3 years (range, 14-44 years). Depression symptoms were present in 21.9% (12/55) of the patients; the incidence of anxiety was almost similar, at 23.7% (13/55). Compensatory sweating occurred in 67.3% (37/55) of the patients; of these, 56.4% (31/55) was mild and 10.9% (6/55) was moderate. None of the patients had severe compensatory sweating. There was no significant relationship between the scores of SDS, SAS, and the incidence of postoperative compensatory sweating (P>0.05). However, the psychoticism scale displayed a strong impact on the degree of compensatory sweating (P<0.05). The higher the degree of psychoticism scale, the more serious the degree of compensatory sweating. CONCLUSIONS The results of this study showed that patients with primary palmar hyperhidrosis are more likely to have mild or moderate mental disorders, and that postoperative compensatory sweating may impact the satisfaction of surgery. In addition, the personality characteristics of patients are related to compensatory sweating.
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Affiliation(s)
- Huai-Yu Wang
- Thoracic Surgery Department of General Hospital of Air-Force PLA, No.30 Fucheng Road, Haidian District, Beijing, PC: 100142, China.
| | - Yan-Jun Zhu
- Thoracic Surgery Department of General Hospital of Air-Force PLA, No.30 Fucheng Road, Haidian District, Beijing, PC: 100142, China
| | - Jie Liu
- Thoracic Surgery Department of General Hospital of Air-Force PLA, No.30 Fucheng Road, Haidian District, Beijing, PC: 100142, China
| | - Li-Wei Li
- Nuclear Medicine Department of General Hospital of Air-Force PLA, No.30 Fucheng Road,Haidian District, Beijing, 100142, China
| | - Ying-Hui Liu
- Thoracic Surgery Department of General Hospital of Air-Force PLA, No.30 Fucheng Road, Haidian District, Beijing, PC: 100142, China
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Wang L, Wei G, Song L, Li C, Zhang F, Yang Y, Lu C. Effect of renal sympathetic denervation on ventricular and neural remodeling. Herz 2018; 44:717-725. [PMID: 29651618 PMCID: PMC6890580 DOI: 10.1007/s00059-018-4698-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/11/2018] [Accepted: 03/18/2018] [Indexed: 12/31/2022]
Abstract
Background This study assessed the therapeutic effects of renal sympathetic denervation (RDN) on post-myocardial infarction (MI) ventricular remodeling and sympathetic neural remodeling in dogs. The possible mechanisms and optimal time for treatment are discussed. Methods We randomly assigned 30 dogs to five groups: RDN 1 week before MI (RDN1w + MI; n = 6), RDN 1 week after MI (MI1w + RDN; n = 6), RDN 2 weeks after MI (MI2w + RDN; n = 6), control (N; n = 6), and MI (n = 6). A canine model of myocardial infarction was established by interventional occlusion with a gelatin sponge via the femoral artery. Brain natriuretic peptide (BNP) and endothelin-1 (ET-1) levels were measured and echocardiography was performed to assess cardiac function and heart size. All dogs were killed at the end of the experiment and samples of cardiac and renal arteries were obtained. The expression of matrix metalloproteinase (MMP)-2 and MMP-9 in cardiac and of tyrosine hydroxylase (TH) in renal arteries was assessed by immunohistochemistry. Sympathetic innervations in the infarction border zone were investigated via Western blotting and real-time PCR. Results Left ventricular function in the MI group decreased significantly, while plasma BNP and ET-1 levels as well as MMP-2 and MMP-9 expression increased. Compared with the MI group, the RD groups showed significantly reduced MMP‑2, MMP‑9, TH, and growth-associated protein (GAP) 43 expression in the RDN1w + MI, MI1w + RDN, and MI2w + RDN groups was significantly improved. Additionally, the expression of TH in renal arteries decreased after RDN. Conclusion RDN has preventive and therapeutic effects on post-MI ventricular remodeling and sympathetic neural remodeling. The mechanism of RDN is likely mediated through restraint of renal sympathetic nerve activity.
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Affiliation(s)
- L Wang
- Tianjin First Center hospital, Clinical medical college of Tianjin Medical university, Tianjin, China.,Deparment of Caridiology, Tianjin First Center Hospital, 24 Fukang Road,Naikai District, 300192, Tianjin, China
| | - G Wei
- Tianjin First Center hospital, Clinical medical college of Tianjin Medical university, Tianjin, China
| | - L Song
- Department of Digestion, Tianjin First Center Hospital, Tianjin, China
| | - C Li
- Deparment of Caridiology, Tianjin First Center Hospital, 24 Fukang Road,Naikai District, 300192, Tianjin, China
| | - F Zhang
- Deparment of Caridiology, Tianjin First Center Hospital, 24 Fukang Road,Naikai District, 300192, Tianjin, China
| | - Y Yang
- Department of Cardiology, Danzhou People's Hospital, Danzhou, China
| | - C Lu
- Deparment of Caridiology, Tianjin First Center Hospital, 24 Fukang Road,Naikai District, 300192, Tianjin, China.
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Maguire SC, Fleming CA, O'Brien G, McGreal G. Lumbar sympathectomy can improve symptoms associated with ischaemia, vasculitis, diabetic neuropathy and hyperhidrosis affecting the lower extremities-a single-centre experience. Ir J Med Sci 2018. [PMID: 29516399 DOI: 10.1007/s11845-018-1775-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lumbar sympthectomy (LS) was traditionally performed for intermittent claudication but is now eclipsed by revascularisation for that indication. However, it retains a role in the management of critical limb ischaemia and other conditions causing lower limb pain with or without ischaemia. We report the role of LS in modern surgical practice when revascularisation and pain management options have been exhausted. METHODS A medical chart review was performed on all patients who underwent LS in our unit from 2005 to 2016 (inclusive). Symptomatology, surgical indications and patient outcomes were reported. RESULTS Twenty-seven cases were performed in total (21 unilateral, 3 bilateral). Underlying diagnoses were as follows: PAD [59.3% (n = 16)], hyperhidrosis [18.5% (n = 5)] and equal numbers of complex regional pain syndrome, diabetic neuropathy and vasculitis [7.4% (n = 2) each]. Overall, 85.2% (n = 23) had improvement or resolution of symptoms at 1 month and 70.3% (n = 19) had persistent improvement of symptoms at 1 year. Non-PAD patients had superior outcomes with 90.9% (n = 10) reporting improved symptomatology at 1 month and nearly three quarters [72.8% (n = 8)] maintaining this improvement at 1 year. Only four patients required subsequent major amputation, all in the severe PAD group. CONCLUSION Lumbar sympathectomy can improve symptoms associated with ischaemia, vasculitis, diabetic neuropathy and hyperhidrosis. Non-PAD patients have the greatest benefit.
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Affiliation(s)
- Sean C Maguire
- Department of Vascular Surgery, Mercy University Hospital, Cork, Ireland.
| | | | - Gavin O'Brien
- Department of Vascular Surgery, Mercy University Hospital, Cork, Ireland
| | - Gerald McGreal
- Department of Vascular Surgery, Mercy University Hospital, Cork, Ireland
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