Analysis of the Results of Videotoracoscopic Sympathectomy in the Treatment of Hyperhidrosis in Patients 40 Years or Older.

BACKGROUND: Several factors that could influence the efficacy and satisfaction of patients after bilateral thoracic sympathectomy (video-assisted thoracoscopic sympathectomy [VATS]) in the treatment of hyperhidrosis (HH) have been studied, but no studies in the literature have specifically analyzed the effectiveness of treatment and variations in the quality of life of patients aged 40 years or older compared with those of young adult patients (19-40 years). METHODS: We retrospectively analyzed 2,431 HH patients who underwent bilateral VATS and divided the patients into the following groups: a group younger than 40 years old (1,760 patients) and a group 40 years and older (142 patients). Variables included quality of life before surgery, improvement in quality of life after surgery, clinical improvement in sweating, the presence of severe compensatory hyperhidrosis (CH), and general satisfaction at 1 month after surgery. RESULTS: We observed that all surgical patients presented with poor or very poor quality of life before surgery, with similar proportions in both groups. In the postoperative period, we observed improvement in quality of life in more than 90% of the patients, with no significant difference noted between the 2 groups of patients. More than 90% of the patients in this series had great clinical improvement in the main HH site, with no significant difference between the 2 groups. Severe CH occurred in 23.8% of the patients in this series, with no significant difference between the 2 groups. CONCLUSIONS: Patients 40 years of age or older benefit just as much as younger patients from VATS performed to treat primary HH, presenting excellent significant surgical results.

[Left atrial myxoma: three-dimensional echocardiographic assessment]. / Mixoma de átrio esquerdo: avaliação ecocardiográfica tridimensional.

The patient was a 70-year-old female with antecedents of diabetes mellitus and hypertension, being followed up in the outpatient care clinic due to chronic anemia after corrective surgery for angiodysplasia of the proximal jejunum, in whom an image suggestive of left atrial myxoma was found on routine transthoracic echocardiography. Then multiplanar transesophageal echocardiography and 3-dimensional echocardiography were performed, showing the latter better anatomical details of the tumor. The patient underwent exeresis of the mass with anatomicopathological confirmation of the tumor. Three-dimensional echocardiography proved to be a technique that can provide additional contributions to the diagnostic investigation of structural heart diseases.

Mixoma de átrio esquerdo: avaliação ecocardiográfica tridimensional

Mulher de 70 anos, com antecedentes de diabetes mellitus e hipertensão arterial sistêmica, em acompanhamento ambulatorial por anemia crônica após cirurgia corretiva de angiodisplasia de jejuno proximal, apresentou imagem de mixoma em átrio esquerdo em exame ecocardiográfico transtorácico de rotina. Foi submetida a investigação ecocardiográfica transesofágica multiplanar e a estudo ecocardiográfico tridimensional. O ecocardiograma tridimensional propiciou melhor detalhamento anatômico da tumoração. A paciente foi submetida a exérese da massa, com confirmação anatomopatológica. O ecocardiograma tridimensional mostrou ser técnica que apresenta contribuição adicional à investigação diagnóstica das cardiopatias estruturais.

Insuficiência valvar mitral isquêmica: incidência, diagnóstico e tratamento cirúrgico / The Influence of Atrial Fibrillation in the Natural History of Hypertrophic Cardiomyopathy

PURPOSE--To study the incidence of ischemic mitral regurgitation (MR) and the mortality. METHODS--One-hundred-five cases of acute myocardial infarction (AMI) with MR were reviewed. Patients were divided in two groups: group A-59 (56.2 per cent) necropsied patients without previous surgical procedures to correlate clinical pictures with the aim to determine the cause of death; group B-46 (43.8 per cent) patients were submitted to surgical treatment. This group was subdivided in mild, moderate and severe forms of MR, and studied comparatively the type of surgical treatment and its evolution. RESULTS--Group A-23 (39 per cent) patients with mild forms and predominant ischemic heart disease, responsible for death; 18 (30.5 per cent) patients without previous diagnosis, masked by myocardial failure and 18 (30.5 per cent) with severe MR and coronary heart disease; group B-14 (30.4 per cent) patients died at the immediate post-operatory period. Higher mortality associated to ejection fraction (EF) below 35 per cent (47.6 per cent; p = 0.022), severe MR (41.7 per cent; p = 0.044) and cardiogenic shock (52.9 per cent; p = 0.14). In 41 (89.1 per cent), the mitral valve repair was combined to coronary artery bypass grafting operation (CABG), in 4 (8.7 per cent) this last procedure was made without mitral repair and in the remaining patients the surgery was limited to the valve. Mitral valvuloplasty was performed in 23 (50 per cent) patients with 3 (13 per cent) deaths, and in 19 (42.3 per cent) the mitral valve was replaced with 9 (47.4 per cent) deaths. CONCLUSION--The prognosis is related to the grade of EF and to the severity of MR. In mild to moderate forms, the surgical indication is due to the associated coronary heart disease and the valvuloplasty is preferred, in this instance. In severe forms, surgical intervention must be performed as soon as possible, before cardiogenic shock appears