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1.
Rev Col Bras Cir ; 47: e20202398, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32555962

RESUMO

OBJECTIVE: The purpose of this study was to assess the quality of life of patients who had undergone bilateral thoracic sympathectomy from R5 to R8 as a treatment for severe and debilitating compensatory hyperhidrosis (CH). METHODS: Twelve patients with severe and debilitating compensatory hyperhidrosis underwent extended sympathectomy (R5-R8) from September 2016 to May 2019 at the Hospital das Clínicas, Federal University of Pernambuco, Brazil. Outcomes such as the level of patient satisfaction with the operation, quality of life scores as well as postoperative complications were assessed. RESULTS: There has been a substantial improvement in the quality of life score of 66% of the sample. In all four domains, a statistical significant difference was seen, regarding the relief of compensatory hyperhidrosis symptoms. CONCLUSIONS: Extended sympathectomy from R5 to R8 was shown to be quite effective in most cases, leading us to believe that this approach could be a therapeutic option for severe compensatory hyperhidrosis.


Assuntos
Hiperidrose/cirurgia , Satisfação do Paciente/estatística & dados numéricos , Qualidade de Vida/psicologia , Simpatectomia/métodos , Humanos , Hiperidrose/psicologia , Índice de Gravidade de Doença , Simpatectomia/psicologia , Resultado do Tratamento
2.
Lancet ; 395(10234): 1444-1451, 2020 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-32234534

RESUMO

BACKGROUND: Catheter-based renal denervation has significantly reduced blood pressure in previous studies. Following a positive pilot trial, the SPYRAL HTN-OFF MED (SPYRAL Pivotal) trial was designed to assess the efficacy of renal denervation in the absence of antihypertensive medications. METHODS: In this international, prospective, single-blinded, sham-controlled trial, done at 44 study sites in Australia, Austria, Canada, Germany, Greece, Ireland, Japan, the UK, and the USA, hypertensive patients with office systolic blood pressure of 150 mm Hg to less than 180 mm Hg were randomly assigned 1:1 to either a renal denervation or sham procedure. The primary efficacy endpoint was baseline-adjusted change in 24-h systolic blood pressure and the secondary efficacy endpoint was baseline-adjusted change in office systolic blood pressure from baseline to 3 months after the procedure. We used a Bayesian design with an informative prior, so the primary analysis combines evidence from the pilot and Pivotal trials. The primary efficacy and safety analyses were done in the intention-to-treat population. This trial is registered at ClinicalTrials.gov, NCT02439749. FINDINGS: From June 25, 2015, to Oct 15, 2019, 331 patients were randomly assigned to either renal denervation (n=166) or a sham procedure (n=165). The primary and secondary efficacy endpoints were met, with posterior probability of superiority more than 0·999 for both. The treatment difference between the two groups for 24-h systolic blood pressure was -3·9 mm Hg (Bayesian 95% credible interval -6·2 to -1·6) and for office systolic blood pressure the difference was -6·5 mm Hg (-9·6 to -3·5). No major device-related or procedural-related safety events occurred up to 3 months. INTERPRETATION: SPYRAL Pivotal showed the superiority of catheter-based renal denervation compared with a sham procedure to safely lower blood pressure in the absence of antihypertensive medications. FUNDING: Medtronic.


Assuntos
Hipertensão/cirurgia , Rim/inervação , Rim/cirurgia , Adulto , Anti-Hipertensivos/normas , Austrália/epidemiologia , Áustria/epidemiologia , Teorema de Bayes , Pressão Sanguínea/fisiologia , Canadá/epidemiologia , Feminino , Alemanha/epidemiologia , Grécia/epidemiologia , Humanos , Hipertensão/diagnóstico , Hipertensão/etnologia , Irlanda/epidemiologia , Japão/epidemiologia , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Placebos/efeitos adversos , Estudos Prospectivos , Simpatectomia/métodos , Resultado do Tratamento , Reino Unido/epidemiologia , Estados Unidos/epidemiologia
3.
EuroIntervention ; 16(1): 89-96, 2020 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-32038027

RESUMO

AIMS: We aimed to estimate the rate of renal artery adverse events following renal denervation with the most commonly applied radiofrequency catheter system based on a comprehensive review of published reports. METHODS AND RESULTS: We reviewed 50 published renal denervation (RDN) trials reporting on procedural safety including 5,769 subjects with 10,249 patient-years of follow-up. Twenty-six patients with renal artery stenosis or dissection (0.45%) were identified of whom 24 (0.41%) required renal artery stenting. The primary meta-analysis of all reports indicated a 0.20% pooled annual incidence rate of stent implantation (95% CI: 0.12 to 0.29% per year). Additional sensitivity analyses yielded consistent pooled estimates (range: 0.17 to 0.42% per year). Median time from RDN procedure to all renal intervention was 5.5 months (range: 0 to 33 months); 79% of all events occurred within one year of the procedure. A separate review of 14 clinical trials reporting on prospective follow-up imaging using either magnetic resonance imaging, computed tomography or angiography following RDN in 511 total subjects identified just 1 new significant stenosis (0.20%) after a median of 11 months post procedure (one to 36 months). CONCLUSIONS: Renal artery reintervention following renal denervation with the most commonly applied RF renal denervation system (Symplicity) is rare. Most events were identified within one year.


Assuntos
Ablação por Cateter/efeitos adversos , Denervação/efeitos adversos , Artéria Renal/lesões , Artéria Renal/efeitos da radiação , Simpatectomia/métodos , Anti-Hipertensivos , Pressão Sanguínea , Humanos , Hipertensão/cirurgia , Rim/fisiopatologia , Artéria Renal/inervação , Simpatectomia/efeitos adversos , Resultado do Tratamento
4.
Eur. j. anat ; 24(1): 1-7, ene. 2020. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-186059

RESUMO

The aim of this study is to demonstrate that the denervation of the pancreas may affect the enteric neuronal plexus, which controls both the endocrine and exocrine parts of the pancreas. By using the light microscope, the histological changes of the islets of Langerhans and the pancreatic acini in the rat pancreas were studied two and three weeks after sympathectomy and truncal vagotomy. More-over, measurements of the changes infasting blood glucose levels and glucose tolerance tests in the control and experimental animals were recorded. Atrophic changes and degeneration of the pancreatic acinar cells and islets of Langerhans cells were observed after both sympathectomy and vagotomy. Biochemical measurements of fasting blood, and the glucose tolerance tests after sympathectomy and vagotomy were increased significantly, which is consistent with the histological results. The results of this study explain that the exocrine and endocrine parts of the pancreas are dependent on both sympathetic and parasympathetic innervation via the enteric plexuses of the rat pancreas. These results establish a firm correlation between the autonomic innervation and the enteric plexus, which controls the function of the endocrine and exocrine parts of the pancreas


No disponible


Assuntos
Animais , Ratos , Pâncreas/anatomia & histologia , Pâncreas/diagnóstico por imagem , Microscopia/métodos , Microscopia/veterinária , Denervação/veterinária , Simpatectomia/métodos , Simpatectomia/veterinária , Vagotomia Troncular/métodos , Vagotomia Troncular/veterinária , Ilhotas Pancreáticas/anatomia & histologia
5.
Pain Physician ; 22(6): 591-599, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31775406

RESUMO

BACKGROUND: Hyperhidrosis is a disorder associated with detrimental effects on patients' quality of life, occupational activities, and social interactions. OBJECTIVES: This study compares C-arm guided percutaneous radiofrequency (RF) ablation of the second and third thoracic sympathetic ganglions and local intradermal botulinum toxin type A (BTX-A) injection for the treatment of primary palmar hyperhidrosis. It focuses on clinical effectiveness, patient satisfaction, quality of life, safety, and the time at which repetition of the procedure is needed over one-year follow-up. STUDY DESIGN: This is a randomized single-blinded trial. SETTING: This study took place in a single hospital. METHODS: Eighty patients with primary palmar hyperhidrosis were randomly assigned to one of 2 interventions: local intradermal BTX-A injection (n = 40) or C-arm guided percutaneous RF ablation (n = 40). The Dermatology Life Quality Index (DLQI) questionnaire and the Hyperhidrosis Disease Severity Scale (HDSS) were used for assessment at one week, one month, and 2, 6, and 12 months after intervention. The number of patients who required repetition of the procedure later on and the time at which they needed it were recorded, and possible side effects were assessed. RESULTS: HDSS scores in the RF group were statistically significantly lower than in the BTX-A group at one week, one month, and 2, 6, and 12 months of follow-up. DLQI scores in the RF group were statistically significantly lower than in the BTX-A group at 6- and 12-month follow-up, whereas at one week, one month, and 2 months of follow-up, there was no statistically significant difference between both groups. The number of patients who required that the procedure be repeated was statistically significantly lower in the RF group than in the BTX-A group. The time at which patients needed repetition of the procedure in the BTX-A group was about 3 to 7 months after the first intervention. All patients in this group showed an increase in HDSS scores within this one-year follow-up. In the RF group, however, only one patient complained of increased HDSS scores after 8 months. There was no statistically significant difference in side effects between both groups. LIMITATIONS: The first limitation of this study is that results were based on subjective scales. The second is the radiation exposure associated with the technique described. CONCLUSIONS: This study supports percutaneous C-arm guided RF ablation of the second and third thoracic sympathetic ganglions and local intradermal BTX-A injection as safe, effective options and rapid lines of treatment of primary palmar hyperhidrosis. However, percutaneous RF ablation proved to be more effective, with longer effectiveness time and better patient satisfaction, compared to local intradermal BTX-A injection. KEY WORDS: Botulinum toxin, hyperhidrosis, quality, radiofrequency ablation.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Hiperidrose/tratamento farmacológico , Hiperidrose/terapia , Simpatectomia/métodos , Procedimentos Cirúrgicos Torácicos , Adulto , Feminino , Gânglios Simpáticos/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Qualidade de Vida , Distribuição Aleatória , Resultado do Tratamento
6.
Medicine (Baltimore) ; 98(42): e17272, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626085

RESUMO

BACKGROUND: Palmar hyperhidrosis (PH) is a common sympathetic disorder that reduces patient' quality of life. Video-assisted thoracoscopic sympathectomy (VTS) is a popular and effective treatment for PH. However, there is substantial controversy about the treatment of PH with VTS at the T3 or T4 level. We will compare the quality metrics of VTS at T3 versus T4 to determine the optimal level for VTS. METHODS: We will search PubMed, Scopus, Web of Science, Embase, Cancerlit, the Cochrane Central Register of Controlled Trials, and the Google Scholar databases for relevant clinical trials published in any language before March 31, 2019. Randomized controlled trials (RCTs), quasi-RCTs, propensity score-matched comparative studies, and prospective cohort studies of interest, published or unpublished, that meet the inclusion criteria will be included. Subgroup analysis of the type of operation, sex of patient, and ethnicity of patient will be performed. RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSIONS: The results of this study will provide reliable evidence for the development of optimal treatment strategies for patients with PH. Owing to the characteristics of disease and intervention methods, randomized controlled trials may not be sufficient. We will include high-quality nonrandomized controlled trials, but this may lead to high heterogeneity and may affect the reliability of the results. PROSPERO REGISTRATION NUMBER: CRD42018116607.


Assuntos
Hiperidrose/cirurgia , Simpatectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Mãos , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto , Vértebras Torácicas/inervação
7.
World Neurosurg ; 132: 333, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31525484

RESUMO

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.


Assuntos
Hiperidrose/cirurgia , Simpatectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Mãos , Humanos , Masculino , Adulto Jovem
8.
Cir Pediatr ; 32(3): 115-120, 2019 Jul 29.
Artigo em Espanhol | MEDLINE | ID: mdl-31486302

RESUMO

JUSTIFICATION: Primary hyperhidrosis is a benign disease that consists in the excessive production of sweat, mainly in the hands, axillas and feet. It may to interfere with the social and work life of the sufferer. It affects up to 3% of the population. In Cuba there are no epidemiological studies on its prevalence. One of the treatment modalities is videothoracoscopic sympathicotomy. OBJECTIVES: To describe the results of the videothoracoscopic sympathicotomy technique for two ports using apneic oxygenation to achieve lung collapse. METHOD: Descriptive, retrospective study of 27 cases operated by primary hyperhidrosis in the period from May 2015 to June 2018. Demographic and clinical characteristics of operated patients, results of the endoscopic surgical technique, postoperative complications and satisfaction were described. RESULTS: The 27 patients were adolescents with ages ranging from 11 to 19 years old, it was more frequent in the female sex. All patients had total solution of the symptoms in the intraoperative period, demonstrated by the cessation of sweat in the palms or axillas and by the verification of the increase of the palmar temperature in the monitor. No patient had intraoperative complications. Compensatory sweating occurred in four patients and one had intercostal neuritis. 100% of the patients were satisfied with the result at 30 days of treatment. CONCLUSIONS: It is a safe technique, with few complications, high satisfaction with the results and feasible to perform in pediatric hospitals with basic resources of minimal access surgery.


Assuntos
Hiperidrose/cirurgia , Simpatectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Adolescente , Axila , Criança , Cuba , Feminino , Mãos , Humanos , Masculino , Satisfação do Paciente , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
9.
Curr Cardiol Rep ; 21(10): 124, 2019 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-31486924

RESUMO

PURPOSE OF REVIEW: Sympathetic overactivity plays an important role in the progression of pulmonary arterial hypertension (PAH). The purpose of this review is to illustrate localization of pulmonary arterial sympathetic nerves, the key steps of pulmonary artery denervation (PADN) procedure, and to highlight clinical outcomes. RECENT FINDINGS: Sympathetic nerves mostly occurred in the posterior region of the bifurcation and pulmonary trunk. Emerging preclinical data provided the potential of PADN for PAH. PADN, produced at bifurcation area, improved a profound reduction of pulmonary arterial pressure and ameliorated clinical outcomes with an exclusive ablation catheter. The application of PADN in the patients of PAH or combined pre-capillary and post-capillary PH (CpcPH) improved the hemodynamic parameters and increased 6MWD. Sympathetic overactivity aggravates PAH. PADN is a promising interventional treatment for PAH and CpcPH. Additional clinical trials are warranted to confirm the efficacy of PADN.


Assuntos
Denervação , Hemodinâmica/fisiologia , Hipertensão Arterial Pulmonar/cirurgia , Artéria Pulmonar/inervação , Simpatectomia/métodos , Sistema Nervoso Simpático/cirurgia , Humanos , Hipertensão Pulmonar , Pressorreceptores/fisiopatologia , Pressorreceptores/cirurgia , Hipertensão Arterial Pulmonar/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Sistema Nervoso Simpático/fisiopatologia , Resultado do Tratamento
10.
Surgery ; 166(6): 1092-1098, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31378477

RESUMO

BACKGROUND: This study aimed to evaluate the clinical efficacy and safety of endoscopic thoracic sympathicotomy and to explore strategies to decrease the incidence of transfer hyperhidrosis (TH). METHODS: From January 2003 to July 2016, 10,275 patients with primary palmar hyperhidrosis underwent endoscopic thoracic sympathicotomy in 15 different institutions. We carried out a retrospective analysis of these patients who were grouped into group A, those with nonretained R2 (R2, R2-3, or R2-4 ablation), and group B, those with retained R2 (single R3 or R4 ablation). RESULTS: All procedures were performed successfully. Both hands of all patients became warm and dry immediately after endoscopic thoracic sympathicotomy. Pneumothorax occurred in 146 patients, and 39 patients had intraoperative bleeding. Follow-up was carried out from 6 months to 13 years. A total of 531 patients (5.2%) were lost to follow-up. The effective rate for primary palmar hyperhidrosis was 100%. Palmar hyperhidrosis recurred in 73 patients (0.7%). Transfer hyperhidrosis appeared in 7,678 patients (78.8%). For groups A and B, the incidence of TH was 80.4% and 78.5%, respectively (P > .05), but the incidence of grade III+IV TH in group B (1.6%) was less than that in group A (4.8%; P < .001). CONCLUSION: Endoscopic thoracic sympathicotomy is a minimally invasive, safe, and effective therapeutic method for primary palmar hyperhidrosis. Although the overall incidence of TH is high, the incidence of grade III to IV TH can be decreased by reserving R2, lowering the level of thoracic sympathicotomy, and single severing of R3 or R4.


Assuntos
Hiperidrose/cirurgia , Complicações Pós-Operatórias/epidemiologia , Simpatectomia/efeitos adversos , Nervos Torácicos/cirurgia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Adolescente , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , China , Eletrocoagulação/efeitos adversos , Eletrocoagulação/métodos , Feminino , Seguimentos , Mãos/inervação , Humanos , Hiperidrose/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Recidiva , Estudos Retrospectivos , Simpatectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Resultado do Tratamento , Adulto Jovem
11.
Hypertension ; 74(3): 536-545, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31327262

RESUMO

Renal nerve stimulation (RNS) can result in substantial blood pressure (BP) elevation, and the change was significantly blunted when repeated stimulation after ablation. However, whether RNS could provide a meaningful renal nerve mapping for identification of optimal ablation targets in renal denervation (RDN) is not fully clear. Here, we compared the antihypertensive effects of selective RDN guided by two different BP responses to RNS and explored the nerve innervations at these sites in Kunming dogs. Our data indicated that ablation at strong-response sites showed a more systolic BP-lowering effect than at weak-response sites (P=0.002), as well as lower levels of tyrosine hydroxylase and norepinephrine in kidney and a greater reduction in plasma norepinephrine (P=0.004 for tyrosine hydroxylase, P=0.002 for both renal and plasma norepinephrine). Strong-response sites showed a greater total area and mean number of renal nerves than weak-response sites (P=0.012 for total area and P<0.001 for mean number). Systolic BP-elevation response to RNS before RDN and blunted systolic BP-elevation to RNS after RDN were correlated with systolic BP changes at 4 weeks follow-up (R=0.649; P=0.012 and R=0.643; P=0.013). Changes of plasma norepinephrine and renal norepinephrine levels at 4 weeks were also correlated with systolic BP changes at 4 weeks (R=0.837, P<0.001 and R=0.927, P<0.001). These data suggest that selective RDN at sites with strong BP-elevation response to RNS could lead to a more efficient RDN. RNS is an effective method to identify the nerve-enriched area during RDN procedure and improve the efficacy of RDN.


Assuntos
Ablação por Cateter/métodos , Estimulação Elétrica/métodos , Hipertensão/cirurgia , Nervos Esplâncnicos/cirurgia , Simpatectomia/métodos , Análise de Variância , Animais , Determinação da Pressão Arterial/métodos , Modelos Animais de Doenças , Cães , Feminino , Hipertensão/fisiopatologia , Rim/inervação , Masculino , Norepinefrina/sangue , Distribuição Aleatória , Valores de Referência , Cirurgia Assistida por Computador/métodos , Resultado do Tratamento
12.
Hypertension ; 74(3): 546-554, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31303108

RESUMO

Radiofrequency renal denervation is under investigation for treatment of hypertension with variable success. We developed preclinical models to examine the dependence of ablation biomarkers on renal denervation treatment parameters and anatomic variables. One hundred twenty-nine porcine renal arteries were denervated with an irrigated radiofrequency catheter with multiple helically arrayed electrodes. Nerve effects and ablation geometries at 7 days were characterized histomorphometrically and correlated with associated renal norepinephrine levels. Norepinephrine exhibited a threshold dependence on the percentage of affected nerves across the range of treatment durations (30-60 s) and power set points (6-20 W). For 15 W/30 s treatments, norepinephrine reduction and percentage of affected nerves tracked with number of electrode treatments, confirming additive effects of helically staggered ablations. Threshold effects were only attained when ≥4 electrodes were powered. Histomorphometry and computational modeling both illustrated that radiofrequency treatments directed at large neighboring veins resulted in subaverage ablation areas and, therefore, contributed suboptimally to efficacy. Account for measured nerve distribution patterns and the annular geometry of the artery revealed that, regardless of treatment variables, total ablation area and circumferential coverage were the prime determinants of renal denervation efficacy, with increased efficacy at smaller diameters.


Assuntos
Ablação por Cateter/métodos , Hipertensão/cirurgia , Rim/inervação , Norepinefrina/sangue , Artéria Renal/cirurgia , Simpatectomia/métodos , Animais , Biópsia por Agulha , Modelos Animais de Doenças , Eletrodos , Feminino , Humanos , Hipertensão/fisiopatologia , Imuno-Histoquímica , Masculino , Distribuição Aleatória , Valores de Referência , Suínos , Resultado do Tratamento
13.
J Thorac Cardiovasc Surg ; 158(5): 1481-1488, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31358338

RESUMO

OBJECTIVE: The main therapeutic method of treatment for local hyperhidrosis is endoscopic thoracic sympathectomy. Generally, resections of the sympathetic trunk or ganglia are performed between the second rib and sixth rib. However, this procedure can result in compensatory sweating, in which excess sweating occurs on the back, chest, and abdomen. Compensatory sweating has been regarded as a thermoregulatory response and thought to be untreatable. This study suggests that compensatory sweating is not a physiologic reaction and is indeed treatable. METHODS: Eight patients with severe compensatory sweating were treated by observing blood perfusion of the skin with laser speckle flowgraphy, which determines the sympathetic nerves related to the area of skin with compensatory sweating. When intraoperative monitoring with laser speckle flowgraphy indicated the position of compensatory sweating by electrical stimulation of the sympathetic ganglion, ganglionectomy was performed. RESULTS: The skin domain that each sympathetic nerve controls was able to be detected by laser speckle flowgraphy. In all patients, compensatory sweating was resolved after interruption of the ganglia or sympathetic nerves related to compensatory sweating. CONCLUSIONS: Our results demonstrate that compensatory sweating is caused by denatured sympathetic nerves influenced by endoscopic thoracic sympathectomy and is not the result of a physiological response. With laser speckle flowgraphy, the sympathetic nerve related to the sweating of various parts of the body could be identified. The treatment of compensatory sweating on the back, chest, and stomach was previously considered to be difficult; however, compensatory sweating is demonstrated to be treatable with this technique.


Assuntos
Estimulação Elétrica/métodos , Hiperidrose , Monitorização Intraoperatória , Simpatectomia , Procedimentos Cirúrgicos Torácicos , Adulto , Endoscopia/efeitos adversos , Endoscopia/métodos , Feminino , Ganglionectomia/métodos , Humanos , Hiperidrose/diagnóstico , Hiperidrose/etiologia , Hiperidrose/fisiopatologia , Hiperidrose/terapia , Fluxometria por Laser-Doppler/métodos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/instrumentação , Monitorização Intraoperatória/métodos , Imagem de Perfusão/métodos , Glândulas Sudoríparas/inervação , Sudorese/fisiologia , Simpatectomia/efeitos adversos , Simpatectomia/métodos , Sistema Nervoso Simpático/cirurgia , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Procedimentos Cirúrgicos Torácicos/métodos , Resultado do Tratamento
14.
Curr Opin Nephrol Hypertens ; 28(5): 498-506, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31268917

RESUMO

PURPOSE OF REVIEW: Although sound physiological principles and surgical precedent underpin renal denervation as a therapy for treatment resistant hypertension, and early clinical studies had produced encouraging results, the first sham-controlled study (SYMPLICITY HTN-3) failed to achieve its primary efficacy endpoint. Lessons learnt from this trial, and the knowledge derived from further animal and autopsy work, have been applied in three recently published sham-controlled trials. RECENT FINDINGS: These trials - SPYRAL OFF-MED, RADIANCE SOLO and SPYRAL ON-MED - using newer technologies, demonstrate a 5-10 mmHg incremental reduction in ambulatory SBP from RDN against sham-control, in patients with mild-to-moderate hypertension taking 0-3 drugs. SUMMARY: These results provide proof of principle of the blood pressure-lowering effect of renal denervation. We now require data on long-term safety and durability of the procedure. Research is needed to identify predictive markers of response as about one-third of individuals do not respond to renal denervation. Hard-outcome data would be welcome but might be difficult to acquire. Individuals with treatment resistance are obvious treatment candidates, but RDN may also potentially benefit those with medication nonadherence and/or intolerance and those unwilling to take pills.


Assuntos
Hipertensão/cirurgia , Rim/inervação , Simpatectomia/métodos , Ensaios Clínicos como Assunto , Humanos , Hipertensão/fisiopatologia
15.
Jpn J Radiol ; 37(9): 642-650, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31301000

RESUMO

PURPOSE: To investigate the effects of renal denervation (RDN) on left ventricular (LV) mass, myocardial strain and diastolic function in patients with treatment-resistant arterial hypertension by cardiac magnet resonance imaging on a 12-month follow-up. MATERIALS AND METHODS: Sixteen patients (38% female) were examined before and 12 months after RDN. LV morphology and strain were analyzed. Diastolic function was determined by early (EPFR) and atrial peak filling rates (APFR) derived from differential volume-time-curve analysis. Clinical visits included 24-h ambulant blood pressure monitoring (ABPM). RESULTS: Twelve months after RDN LV mass decreased from 80 ± 21 g/m2 to 74 ± 20 g/m2 (P < 0.05). Global radial (35 ± 12% vs. 41 ± 10%, P < 0.05) and longitudinal strain improved (- 15 ± 4% vs. - 17 ± 3%, P < 0.05). Global circumferential strain (- 16 ± 5% vs. - 18 ± 4%, P = 0.12) remained unchanged. The parameter of diastolic LV function PFRR (EPFR/APFR) improved following RDN (0.9 ± 0.4 vs. 1.1 ± 0.5, P < 0.05). Individual changes of LV mass were associated with an increase of EPFR (r = - 0.54, P < 0.05) and a reduction of APFR by trend (r = 0.45, P = 0.08). Systolic ABPM showed a decrease by trend (152 mmHg vs. 148 mmHg, P = 0.08). CONCLUSIONS: After RDN we observed a reduction of LV mass, improvement of global strain and diastolic function.


Assuntos
Coração/fisiopatologia , Hipertensão/complicações , Hipertrofia Ventricular Esquerda/complicações , Rim/cirurgia , Imagem por Ressonância Magnética/métodos , Simpatectomia/métodos , Diástole , Feminino , Seguimentos , Ventrículos do Coração/diagnóstico por imagem , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/terapia , Rim/inervação , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
16.
Cir. pediátr ; 32(3): 115-120, jul. 2019. graf
Artigo em Espanhol | IBECS | ID: ibc-183729

RESUMO

Fundamentación: La hiperhidrosis primaria es una enfermedad benigna que consiste en la excesiva producción de sudor, principalmente en manos, axilas y pies, y por ello puede llegar a condicionar la vida social y laboral de quien la padece. Afecta hasta el 3% de la población. En Cuba no hay estudios epidemiológicos sobre su prevalencia. Una de las modalidades de tratamiento es la simpaticotomía videotoracoscópica. Objetivos: Describir los resultados de la técnica de simpaticotomía videotoracoscópica por dos puertos usando oxigenación apneica para lograr el colapso pulmonar. Método: Estudio descriptivo, retrospectivo, de una serie de 27 casos operados por hiperhidrosis primaria en el periodo de mayo de 2015 a junio de 2018. Se describen características demográficas y clínicas de pacientes operados, resultados de la técnica quirúrgica endoscópica, complicaciones postoperatorias y satisfacción. Resultados: Los 27 pacientes eran adolescentes con edades comprendidas entre 11 y 19 años, siendo más frecuente en el sexo femenino. Todos los pacientes tuvieron solución total de los síntomas en el periodo intraoperatorio, demostrados por el cese del sudor en palmas o axilas y por la comprobación del aumento de la temperatura palmar en el monitor. Ningún paciente tuvo complicaciones intraoperatorias. El sudor compensatorio se presentó en cuatro pacientes y un paciente tuvo neuritis intercostal. El 100% de los pacientes estuvieron satisfechos con el resultado a los 30 días del tratamiento. Conclusiones: Es una técnica segura, con pocas complicaciones, elevada satisfacción con los resultados y factible de realizar en hospitales pediátricos con recursos básicos de cirugía de mínimo acceso


Justification: Primary hyperhidrosis is a benign disease that consists in the excessive production of sweat, mainly in the hands, axillas and feet. It may to interfere with the social and work life of the sufferer. It affects up to 3% of the population. In Cuba there are no epidemiological studies on its prevalence. One of the treatment modalities is videothoracoscopic sympathicotomy. Objectives: To describe the results of the videothoracoscopic sympathicotomy technique for two ports using apneic oxygenation to achieve lung collapse. Method: Descriptive, retrospective study of 27 cases operated by primary hyperhidrosis in the period from May 2015 to June 2018. Demographic and clinical characteristics of operated patients, results of the endoscopic surgical technique, postoperative complications and satisfaction were described. Results: The 27 patients were adolescents with ages ranging from 11 to 19 years old, it was more frequent in the female sex. All patients had total solution of the symptoms in the intraoperative period, demonstrated by the cessation of sweat in the palms or axillas and by the verification of the increase of the palmar temperature in the monitor. No patient had intraoperative complications. Compensatory sweating occurred in four patients and one had intercostal neuritis. 100% of the patients were satisfied with the result at 30 days of treatment. Conclusions: It is a safe technique, with few complications, high satisfaction with the results and feasible to perform in pediatric hospitals with basic resources of minimal access surgery


Assuntos
Humanos , Criança , Adolescente , Adulto Jovem , Hiperidrose/diagnóstico , Hiperidrose/terapia , Simpatectomia/métodos , Toracoscopia/métodos , Estudos Retrospectivos , Qualidade de Vida
19.
Respir Res ; 20(1): 121, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200778

RESUMO

BACKGROUND: Abnormal sympathetic hyperactivity has been shown to lead to pulmonary arterial hypertension (PAH) deterioration. The purpose of this study was to examine whether the transection of the cervical sympathetic trunk (TCST) can inhibit the progression of PAH in a monocrotaline (MCT)-induced PAH model and elucidate the underlying mechanisms. METHODS: Rats were randomly divided into four groups, including a control group, an MCT group, an MCT + sham group and an MCT + TCST group. After performing haemodynamic and echocardiographic measurements, the rats were sacrificed for the histological study, and the norepinephrine (NE) concentrations and protein expression level of tyrosine hydroxylase (TH) were evaluated. The protein expression levels of extracellular signal-regulated kinase (ERK)-1/2, proliferating cell nuclear antigen (PCNA), cyclin A2 and cyclin D1 in pulmonary artery vessels and pulmonary arterial smooth muscle cells (PASMCs) were determined. RESULTS: Compared with the MCT + sham group, TCST profoundly reduced the mean pulmonary arterial pressure (mPAP) (22.02 ± 4.03 mmHg vs. 31.71 ± 2.94 mmHg), right ventricular systolic pressure (RVSP) (35.21 ± 5.59 mmHg vs. 48.36 ± 5.44 mmHg), medial wall thickness (WT%) (22.48 ± 1.75% vs. 46.10 ± 3.16%), and right ventricular transverse diameter (RVTD) (3.78 ± 0.40 mm vs. 4.36 ± 0.29 mm) and increased the tricuspid annular plane systolic excursion (TAPSE) (2.00 ± 0.12 mm vs. 1.41 ± 0.24 mm) (all P < 0.05). The NE concentrations and protein expression levels of TH were increased in the PAH rats but significantly decreased after TCST. Furthermore, TCST reduced the increased protein expression of PCNA, cyclin A2 and cyclin D1 induced by MCT in vivo. We also found that NE promoted PASMC viability and activated the ERK-1/2 pathway. However, the abovementioned NE-induced changes could be suppressed by the specific ERK-1/2 inhibitor U0126. CONCLUSION: TCST can suppress pulmonary artery remodelling and right heart failure in MCT-induced PAH. The main mechanism may be that TCST decreases the NE concentrations in lung tissues, thereby preventing NE from promoting PASMC proliferation mediated by the ERK-1/2 signalling pathway.


Assuntos
Vértebras Cervicais , Progressão da Doença , Sistema de Sinalização das MAP Quinases/fisiologia , Hipertensão Arterial Pulmonar/cirurgia , Nervos Espinhais/fisiologia , Simpatectomia/métodos , Animais , Masculino , Hipertensão Arterial Pulmonar/fisiopatologia , Hipertensão Arterial Pulmonar/prevenção & controle , Ratos , Ratos Sprague-Dawley , Nervos Espinhais/cirurgia
20.
J Am Coll Cardiol ; 73(23): 3006-3017, 2019 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-31196459

RESUMO

Three recent renal denervation studies in both drug-naïve and drug-treated hypertensive patients demonstrated a significant reduction of ambulatory blood pressure compared with respective sham control groups. Improved trial design, selection of relevant patient cohorts, and optimized interventional procedures have likely contributed to these positive findings. However, substantial variability in the blood pressure response to renal denervation can still be observed and remains a challenging and important problem. The International Sympathetic Nervous System Summit was convened to bring together experts in both experimental and clinical medicine to discuss the current evidence base, novel developments in our understanding of neural interplay, procedural aspects, monitoring of technical success, and others. Identification of relevant trends in the field and initiation of tailored and combined experimental and clinical research efforts will help to address remaining questions and provide much-needed evidence to guide clinical use of renal denervation for hypertension treatment and other potential indications.


Assuntos
Monitorização Ambulatorial da Pressão Arterial/tendências , Congressos como Assunto/tendências , Hipertensão/cirurgia , Internacionalidade , Rim/inervação , Simpatectomia/tendências , Pressão Sanguínea/fisiologia , Denervação/métodos , Denervação/tendências , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Rim/fisiologia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Literatura de Revisão como Assunto , Simpatectomia/métodos , Sistema Nervoso Simpático/fisiologia , Sistema Nervoso Simpático/fisiopatologia
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