Apendicite aguda pós colonoscopia: desafio diagnóstico e tratamento minimamente invasivo - relato de caso / Case report - post-colonoscopy acute appendicitis: diagnostic challenge and minimally invasive treatment

We present a case of a 54-year-old man with abdominal pain four hours after colonoscopy and upper endoscopy. Since he had had a polipectomy and an ulcer was seen in the terminal ileum, the diagnosis of appendicitis was even more difficult. The authors discuss the rarity of this situation and the minimally invasive approach to treat appendicitis.

Endoscopic lumbar sympathectomy for women: effect on compensatory sweat

INTRODUCTION: Plantar hyperhidrosis is present in 50 percent of patients with hyperhidrosis. Thoracic sympathectomy is an important tool for the treatment of this condition, which is successful in about 60 percent of patients. For the remaining patients, lumbar sympathectomy is the procedure of choice. As new minimally invasive techniques have been developed, a significant demand for this type of access has led to its adaptation to the lumbar sympathectomy. The objective of this study was to evaluate the effectiveness of endoscopic retroperitoneal lumbar sympathectomy in controlling plantar hyperhidrosis and its effects on compensatory sweat. MATERIALS AND METHODS: Thirty female patients with persistent plantar hyperhidrosis after thoracic sympathectomy were enrolled. They were randomly assigned to laparoscopic retroperitoneal lumbar sympathectomy (Group A) or no surgical intervention (Group B - control) groups. Quality-of-life modifications were assessed by specific questionnaires before and after surgery. In the same manner, direct sweat measurements were also performed pre- and post-intervention by evaluating trans-epidermal water loss. Despite the lack of intervention, the control group was evaluated at similar timepoints. RESULTS: In Group A, no major complications occurred in the peri-operative period. During the immediate post-operative period, three patients (20 percent) experienced prolonged pain (more than ten days). Eight patients suffered from worsened compensatory sweating (53.3 percent). In Group A, after lumbar sympathectomy, the quality of life significantly improved (p<0.05, intra-group comparison) beyond that of the control group (p<0.05, inter-group comparison). Also, lumbar sympathectomy resulted in significantly lower values of foot sweat (pre- vs. post-operative periods, p<0.05; Group A vs. Group B, p<0.05). These patients also developed higher values of sweat measurements on specific points of their dorsal and abdominal...

Simpactectomia lombar retroperitoneoscópica para tratamento da hiper-hidrose plantar / Retroperitoneoscopic lumbar sympathectomy for the treatment of plantar hyperidrosis

OBJETIVO: Observar o seguimento de até quatro anos de mulheres submetidas à simpatectomia lombar por retroperitonioscopia, procurando identificar seus efeitos colaterais, bem como sua efetividade no controle da hiper-hidrose plantar. MÉTODOS: Entre junho/2002 e julho2006, operamos 44 pacientes com hiperidrose plantar. Todas apresentavam hiper-hidrose plantar persistente pós simpatectomia torácica com exceção de uma única paciente com diagnóstico de hiperidrose plantar primária. RESULTADOS: O seguimento médio de 22,3 meses, mostra grande satisfação referida pela maioria das pacientes e piora do suor compensatório em 37 por cento delas. Não houve relato de alteração sexual nesta casuística. CONCLUSÃO: A simpatectomia lombar por retroperitonioscopia é uma técnica segura, eficaz e associada a e aceitáveis efeitos colaterais, quando empregada no tratamento da hiperidrose plantar em mulheres jovens.

BACKGROUND: Describe a 4-years follow-up of females submitted to lumbar sympathectomy for hiperhidrosis. METHODS: From June 2002 to July 2006, we have operated 44 patients with plantar hyperidrosis. Only one of them had primary plantar hyperidrosis. The others had persistent plantar hyperidrosis after thoracic sympathectomy. RESULTS: We show our results with a median follow up of 22.3 months. Most patients were very satisfied and only 37 percent had worsened their compensatory sweat. CONCLUSION: Laparoscopic lumbar sympathectomy is a safe and effective technique which is associated with few and acceptable collateral effects, when it is indicated in the treatment of plantar hyperhidrosis in young women.