Successful ablation of bifocal PVCs from both left bundle branches triggering polymorphic VT in LQTS 2—A case report

Background A 19-year-old woman with an established diagnosis of long QT syndrome (LQTS) 2 and underlying KCNH2-mutation was referred to our centre for recurrent polymorphic ventricular tachycardia (VT) and ventricular fibrillation (VF) refractory to medical therapy and bilateral thoracic sympathectomy. Case summary Holter monitoring revealed a relevant PVC burden of two different morphologies. One PVC was originating from the left anterior fascicle, the other from the left posterior fascicle. Radiofrequency ablation resulted in complete suppression of both spontaneous PVC morphologies with a favourable clinical course over the next 2 years. Discussion This case presents two interesting insights: Firstly, the consistent bigeminal pattern of the torsade de pointes triggering PVC. These were retrieved from the device interrogation and correlated with the pattern that was seen at the time of the procedure. Secondly, PVC morphologies suggested an origin from both the left ventricular (posterior and anterior) fascicles, which has not been described so far. This was confirmed by the preceding Purkinje potentials seen at the successful ablation sites in sinus rhythm and during PVC. Ablation of triggering PVCs causing recurrent VT/VF in LQT 2 syndrome is feasible and effective over a mid-term Follow-up.

Retroperitoneoscopic lumbar sympathectomy for the treatment of primary plantar hyperhidrosis

Background Primary plantar hyperhidrosis (PPH) is an idiopathic disease, characterized by excessive sweating of the feet. It leads to significant disturbance in private and professional daily lifestyle, due to excessive sweating. The aim of this study is to present the safety, efficacy and procedures of retroperitoneoscopic lumbar sympathectomy (RLS) for treatment of PPH. Methods RLS was performed 60 times in 30 patients (18 men, 12 women) with PPH in our institution from May 2019 to October 2020. All procedures were carried out by laparoscopy with retroperitoneal approach. Clinical data including patient demographics and perioperative, postoperative outcomes were evaluated. Recurrence of symptoms, and any adverse effects of surgery were evaluated after 7 to 30 days in outpatient clinic, and thereafter every 6 months. Results Mean age of patients was 33.6 (± standard deviation 10.8) years. Fourteen and fifteen patients were previously treated with medical therapy or endoscopic thoracic sympathectomy (ETS) respectively. Mean preoperative quality of life (QoL) score of patients was 91.8 (VERY BAD), but postoperative 12 months (QoL) score decreased to 29.1 (MUCH BETTER). There was no serious postoperative complication. During the mean 22 months of follow-up period, no compensatory sweating was observed. Conclusions RLS can be a safe and effective surgical treatment for severe PPH, especially for the patients with persistent plantar sweating even after conservative management and ETS. RLS also could be offered to surgeons who are familiar with retroperitoneal space anatomy as feasible surgical treatment for PPH.

Population-based Cross-sectional Analysis of the Epidemiology of the Surgical Correction of Hyperhidrosis in 1216 Patients over 11 years

BackgroundEndoscopic thoracic sympathectomy is the definitive surgical treatment for hyperhidrosis, and a nationwide study suggested that it has been performed in a higher rate than which could have been expected due to climate characteristics, comparing to the national statistics.ObjectivesTo study the epidemiology of sympathectomy to treat hyperhidrosis in São Paulo, the largest city in the Southeast.Design and settingpopulation-based cross-sectional study.Methodsdata on sympathectomies to treat hyperhidrosis between 2008 and 2018 were assessed from the database of the Municipal Health Secretary of São Paulo, Brazil.Results65.29% of the patients were female, 66.2% aged between 20 and 39 years and 37.59% had addresses registered outside São Paulo. 1216 procedures were performed in the city of São Paulo from 2008 to 2018, 78.45% of which in only two public hospitals. The number of procedures significantly declined over the years (p = 0.001). 71.63% of the procedures were associated with 2 to 3 days of hospital stay, only 78 intensive care unit days were billed and we did not observe any intra-hospital death.Conclusionssympathectomies for the treatment of HH were widely performed in the city of São Paulo (1216 procedures), mainly in young (20 -39 years) and female patients, with more than one third of the patients having addresses registered outside the city. This is a very safe surgery, with low need for intensive care units and no mortality in our series. There was a decreasing trend in the number of surgeries over the years.

Iatrogenic intrathoracic encapsulated siliconoma from a ruptured breast implant

Our patient was a 57-year-old woman with a history of bilateral retropectoral silicone breast augmentation and axillary hyperhidrosis who underwent a bilateral thoracic sympathectomy via video-assisted thoracoscopic surgery by a surgeon at an outside hospital approximately 20 years ago. The left side required an open thoracotomy. Shortly after the surgery, she developed a left-sided Baker 4 capsular contracture and the left implant was noted to be ruptured. Both implants were exchanged. Several years later the patient began to experience progressive fatigue. Work-up revealed a left lung nodule and she underwent a biopsy that confirmed silicone granulomas. It was hypothesised that at the time of her initial thoracotomy the implant was violated resulting in silicone spillage into the thoracic cavity. The patient was referred to our institution for advanced management of her intrathoracic silicosis. The patient underwent bilateral removal of her silicone implants, total capsulectomy and needle-localised removal of her left thoracic silicone masses. She had an uneventful postoperative course with resolution of her fatigue.

Outcome Using Either Intradermal Botox Injection or Endoscopic Thoracic Sympathectomy for Patients with Primary Palmar Hyperhidrosis: A Comparative Study

Hyperhidrosis, or excessive sweating, negatively impacts patients both physically and psychologically. It may be primary or secondary: the primary form is a benign condition, with its growing prevalence reaching 5% recently. Its medical treatments are transitory. Objectives: Comparison of the outcomes of patients with primary palmar hyperhidrosis (PPH) after intradermal Botox injection (IBI) versus endoscopic thoracic sympathectomy (ETS). Methods: Forty patients were randomly divided into two equal groups. Patients in the IBI group received an intradermal injection of a botulinum toxin A. Patients in the EST group received endoscopic electrocautery of the sympathetic chain. The patients were evaluated biweekly for 12 weeks, and patient satisfaction by outcome was evaluated using a 4-point satisfaction score. Results: At 12 weeks, 60% of the IBI group patients had maintained an improvement. Meanwhile, 40% of the patients were improved compared to pre-intervention scores, despite deterioration after remarkable improvement. On the other hand, 80% of ETS group patients maintained their Hyperhidrosis Disease Severity Scale (HDSS) up until the end of follow-up. Patient satisfaction scores were significantly higher for the IBI group compared to the ETS group. Conclusions: Intradermal Botox injection is a simple, safe, non-invasive, and effective therapeutic modality for PPH and achieved higher patient satisfaction compared to ETS.

Thermosemiotics of the hands. Report 2. Thermal patterns of the hands in patients with upper limbs vascular disorders, Raynaud’s phenomenon, after thoracic sympathectomy, in ischemic heart disease and a number of other diseases

This review is devoted to the thermogaphic hands examination in patients with upper limbs vascular disorders (both arterial and venous), Raynaud’s phenomenon, ischemic heart disease and after surgical interventions on the vessels of the upper extremities, thoracic sympathectomy, as well as a number of more rare diseases and clinical situations. Studies of temperature distributions on the hands of such patients are promising in terms of creating, on their basis, decision support systems in screening, diagnostics and treatment monitoring.

Cardiorespiratory synchronisation and systolic blood pressure correlation of peripheral arterial stiffness during endoscopic thoracic sympathectomy

Muscle sympathetic nerve activity (MSNA) is known as an effective measure to evaluate peripheral sympathetic activity; however, it requires invasive measurement with the microneurography method. In contrast, peripheral arterial stiffness affected by MSNA is a measure that allows non-invasive evaluation of mechanical changes of arterial elasticity. This paper aims to clarify the features of peripheral arterial stiffness to determine whether it inherits MSNA features towards non-invasive evaluation of its activity. To this end, we propose a method to estimate peripheral arterial stiffness $$\beta$$ β at a high sampling rate. Power spectral analysis of the estimated $$\beta$$ β was then performed on data acquired from 15 patients ($$23.7 \pm 9.0$$ 23.7 ± 9.0 years) who underwent endoscopic thoracic sympathectomy. We examined whether $$\beta$$ β exhibited the features of MSNA where its frequency components synchronise with heart and respiration rates and correlates with the low-frequency component of systolic blood pressure. Regression analysis revealed that the local peak frequency in the range of heartbeat frequency highly correlate with the heart rate ($$R^{2}=0.85$$ R 2 = 0.85 , $$p=6.3\times 10^{-13}$$ p = 6.3 × 10 - 13 ) where the regression slope was approximately 1 and intercept was approximately 0. Frequency analysis then found spectral peaks of $$\beta$$ β approximately 0.2 Hz that correspond to the respiratory cycle. Finally, cross power spectral analysis showed a significant magnitude squared coherence between $$\beta$$ β and systolic blood pressure in the frequency band from 0.04 to 0.2 Hz. These results indicate that $$\beta$$ β inherits the features observed in MSNA that require invasive measurements, and thus $$\beta$$ β can be an effective non-invasive substitution for MSNA measure.