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1.
J Cardiothorac Surg ; 16(1): 50, 2021 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-33766091

RESUMO

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.


Assuntos
Hiperidrose/cirurgia , Simpatectomia/métodos , Adolescente , Adulto , Algoritmos , Axila/cirurgia , Endoscopia , Feminino , Humanos , Hiperidrose/psicologia , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Satisfação do Paciente , Período Pós-Operatório , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento
2.
AJR Am J Roentgenol ; 216(5): 1273-1282, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655772

RESUMO

OBJECTIVE. The purpose of this study was to assess the effects of anatomic and technical factors on the long-term outcome of CT-guided lumbar sympathectomy in patients with chronic limb-threatening ischemia. SUBJECTS AND METHODS. Thirty patients (28 men, two women; mean age, 45.8 years) with chronic limb-threatening ischemia and diffuse tibial arterial disease not amenable to revascularization were included. CT-guided lumbar sympathectomy was performed at the L2-L3 level with a 22-gauge Chiba needle and absolute alcohol. Any periprocedural complication was noted. Numeric pain score (1-10 scale) and skin ulcers were assessed before the procedure and 3 weeks, 3 months, and 1 and 2 years after the procedure. According to spread of alcohol, patients were categorized into those with medial spread and those without medial spread (lateral spread group) with the lateral edge of the vertebral body as the reference point. Treatment results were categorized as improved, unchanged, or worsened on the basis of clinical response. RESULTS. There were 22 (73.3%) patients in the medial spread group and eight (26.7%) in the lateral spread group. The mean volumes of alcohol injected per side were not significantly different (p = .50). One major complication occurred in the group with medial spread. Mean numeric pain scores before the procedure and 3 weeks, 3 months, and 1 and 2 years afterward were 7.31, 2.95, 2.47, 2.10, and 2.04 in the medial spread group and 6.25, 4.13, 4.50, 4.35 and 4.32 in the lateral spread group (p < .001). At 2 years, 16 patients in the medial spread group and two patients in the lateral spread group showed clinical improvement (p < .001), and the limb salvage rates were 100% and 87.5%, respectively. Multivariate analysis showed a trend in improvement with smoking cessation, but the difference was not statistically significant (p = .15). The direction of spread of the neurolytic agent, however, was a major determinant of outcome. CONCLUSION. CT-guided lumbar sympathectomy is a simple, safe, and effective procedure. Ensuring medial spread of the neurolytic agent significantly improves long-term results.


Assuntos
Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Radiografia Intervencionista/métodos , Simpatectomia/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Isquemia/diagnóstico por imagem , Isquemia/cirurgia , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
3.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370965

RESUMO

Tracheal tear after endotracheal intubation is extremely rare. The role of silicone Y-stent in the management of tracheal injury has been documented in the previous studies. However, none of the studies have mentioned the deployment of silicone Y-stent via rigid bronchoscope with the patient solely supported by extracorporeal membrane oxygenation (ECMO) without general anaesthesia delivered via the side port of the rigid bronchoscope. We report a patient who had a tracheal tear due to endotracheal tube migration following a routine video-assisted thoracoscopic surgery sympathectomy, which was successfully managed with silicone Y-stent insertion. Procedure was done while she was undergoing ECMO; hence, no ventilator connection to the side port of the rigid scope was required. This was our first experience in performing Y-stent insertion fully under ECMO, and the patient had a successful recovery.


Assuntos
Oxigenação por Membrana Extracorpórea , Complicações Intraoperatórias/terapia , Intubação Intratraqueal/efeitos adversos , Lacerações/terapia , Traqueia/lesões , Broncoscopia , Falha de Equipamento , Feminino , Humanos , Doença Iatrogênica , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Intubação Intratraqueal/instrumentação , Lacerações/diagnóstico , Lacerações/etiologia , Enfisema Mediastínico/etiologia , Enfisema Mediastínico/terapia , Ventilação Monopulmonar/instrumentação , Stents , Simpatectomia/efeitos adversos , Simpatectomia/métodos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos , Traqueia/diagnóstico por imagem , Adulto Jovem
4.
Medicine (Baltimore) ; 99(42): e22466, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080682

RESUMO

Compensatory hyperhidrosis is a debilitating postoperative condition occurring in 30% to 90% of patients with primary hyperhidrosis. The most appropriate treatment for compensatory hyperhidrosis remains controversial.Between January 2018 and December 2019, 44 patients with intractable compensatory hyperhidrosis underwent diffuse sympathicotomy (DS). In the early study periods, DS was performed sparsely (limited DS) to avoid possible adverse effects (right R5/7/9/11, left R5/6/8/10). In the late study periods, levels of surgical interruption were further modified to maximize sympatholytic effects (extended DS; bilateral R5/6/7/8/9/10/11). Patients were followed up for symptom resolution. For objective evidence of improved hyperhidrosis, thermographic images were taken for 7 patients.Immediate resolution of compensatory hyperhidrosis was achieved in 81% of patients, as determined at the 1 to 2 week postoperative visit. With a median follow-up of 22.7 months, compensatory hyperhidrosis continued to be resolved in 46% (n = 20). Logistic regression analysis showed that persistent resolution of compensatory hyperhidrosis was independently predicted by extended DS (odds ratio, 25.67, 95% CI, 1.78-1047.6; P = .036). The presence of gender, BMI, isolated compensatory hyperhidrosis, distribution of sweating, prior operation type, reoperation interval, and same-day lumbar sympathectomy failed to gain statistical significance on maintaining persistent resolution of compensatory hyperhidrosis. No patients experienced surgery-related side effects. Thermographic images obtained before/after surgery in 10 patients showed successful denervation and sweat diminishment.This study shows the safeness and effectiveness of DS for treating compensatory hyperhidrosis, representing a new treatment option. Future research should be directed at confirming a promising result of extended DS with further follow-up.


Assuntos
Endoscopia/métodos , Hiperidrose/cirurgia , Complicações Pós-Operatórias/cirurgia , Simpatectomia/métodos , Adulto , Feminino , Humanos , Masculino , Satisfação do Paciente , Qualidade de Vida , Reoperação , Estudos Retrospectivos
6.
Rev. esp. cardiol. (Ed. impr.) ; 73(8): 615-622, ago. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-198247

RESUMO

INTRODUCCIÓN Y OBJETIVOS: La denervación renal es una intervención percutánea para el tratamiento de la hipertensión arterial resistente. Estudios aleatorizados han mostrado resultados contradictorios sobre su eficacia. Se presentan los resultados de un registro de denervación en pacientes con hipertensión resistente según práctica clínica en España. MÉTODOS: Registro multicéntrico de pacientes consecutivos con hipertensión arterial resistente tratados con denervación renal en España en el periodo 2009-2018. RESULTADOS: Se ha incluido a 125 pacientes (media de edad, 56±años; el 41% mujeres; media de 14±9 años de evolución de la hipertensión). La presión arterial sistólica y diastólica en la consulta y ambulatoria de 24 h disminuyeron a los 6 meses de la intervención (de 166±20/95±16 a 149±22/87±16mmHg y de 151±14/89±12 a 143±15/84±11; ambas, p < 0,0001). A los 12 meses se mantenía la reducción en la presión arterial con una disminución en el número de fármacos antihipertensivos de 4,9±1,2 a 4,4±1,5 (p = 0,0001). No hubo complicaciones importantes relacionadas con el procedimiento. La tasa de respuesta a la denervación al año fue del 80%, si bien con una amplia variabilidad entre centros. CONCLUSIONES: La denervación renal en pacientes con hipertensión resistente se relacionó con una disminución de las cifras de presión arterial en la consulta y, lo que es más importante, en la monitorización ambulatoria de presión arterial, con una disminución significativa del tratamiento farmacológico


INTRODUCTION AND OBJECTIVES: Renal denervation is a percutaneous intervention for the treatment of resistant hypertension. Randomized studies have shown contradictory results on its efficacy. We present the results of a renal denervation registry for the treatment of resistant hypertension in real-life patients in Spain. METHODS: Multicenter registry of consecutive patients with resistant hypertension treated with renal denervation in Spain between 2009 and 2018. RESULTS: We included 125 patients (mean age, 56 years; 41% female; mean onset of hypertension 14±9 years previously). Office systolic and diastolic blood pressure and ambulatory blood pressure monitoring decreased 6 months after the intervention (166±20/95±16 to 149±22/87±16 mmHg and 151±14/89±12 to 143±15/84±11, both P <.0001). At 12 months, the blood pressure reduction was maintained and the number of antihypertensive drugs decreased from 4.9±1.2 to 4.4±1.5 (P=.0001). There were no significant procedure-related complications. The response rate to denervation at 1 year was 80%, but there were wide differences between centers. CONCLUSIONS: In patients with resistant hypertension, treatment with renal denervation was related to a decrease in office blood pressure and, more importantly, in ambulatory blood pressure monitoring, with a significant reduction in pharmacological treatment


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Simpatectomia/métodos , Hipertensão/terapia , Hipertensão Maligna/cirurgia , Monitorização Ambulatorial da Pressão Arterial/métodos , Denervação/métodos , Prática Clínica Baseada em Evidências/tendências , Resultado do Tratamento , Resistência a Múltiplos Medicamentos , Registros de Doenças/estatística & dados numéricos , Estudos Retrospectivos , Determinação da Pressão Arterial/métodos
7.
J Cardiothorac Surg ; 15(1): 133, 2020 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-32522214

RESUMO

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.


Assuntos
Hiperidrose/cirurgia , Qualidade de Vida , Simpatectomia/métodos , Adolescente , Adulto , Bradicardia/etiologia , Dor no Peito/etiologia , Feminino , Humanos , Masculino , Parestesia/etiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos , Simpatectomia/efeitos adversos , Cirurgia Torácica Vídeoassistida , Resultado do Tratamento , Adulto Jovem
8.
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
9.
J Card Surg ; 35(7): 1708-1710, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32436599

RESUMO

BACKGROUND: Recurrent ventricular tachycardia (VT) can occur after left ventricular assist device (LVAD) implantation. In this case, medical treatment might be insufficient. We report a case of a left-sided thoracoscopic sympathectomy as a feasible treatment escalation in intractable VT. CASE REPORT: A 72-year-old patient underwent an internal cardioverter defibrillator (ICD) implantation as primary prophylaxis for VTs in the setting of staged heart failure therapy. Afterwards, due to a progressive dilative cardiomyopathy he underwent a minimal-invasive LVAD implantation (HeartWare, Medtronic). After an uneventful minimal-invasive LVAD-implantation the patient was discharged to a rehabilitation program. However, after 7 weeks he developed recurrent VTs which were successfully terminated by ICD shocks deliveries leading to severe discomfort and frequent hospitalizations. Eventually, the patient was admitted with an electrical VT storm. Successful endocardial catheter ablation of all inducible VTs were performed combined with multiple rearrangements of his oral antiarrhythmic medication. However, all these treatments could not suppress further occurrence of VTs. After an interdisciplinary discussion the patient agreed to a left-sided video-assisted thoracoscopic sympathectomy. After a follow up of 150 days the patient was free from VTs apart from one short event. CONCLUSION: We believe video-assisted thoracoscopic sympathectomy might be a surgical treatment option in patients with intractable recurrent VTs after catheter ablation of VT reentrant substrate even after minimal-invasive LVAD implantation.


Assuntos
Insuficiência Cardíaca/cirurgia , Ventrículos do Coração/cirurgia , Coração Auxiliar/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Implantação de Prótese/efeitos adversos , Simpatectomia/métodos , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Idoso , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Insuficiência da Valva Mitral/complicações , Recidiva , Resultado do Tratamento
10.
Nat Rev Cardiol ; 17(10): 614-628, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32286512

RESUMO

Arterial hypertension is the most prevalent modifiable risk factor associated with cardiovascular morbidity and mortality. Although antihypertensive drugs are widely available, in many patients blood pressure control to guideline-recommended target values is not achieved. Several device-based approaches have been introduced to lower blood pressure; most of these strategies aim to modulate autonomic nervous system activity. Clinical trials have moved from including patients with resistant hypertension receiving intensive pharmacological treatment to including patients with mild-to-moderate hypertension in the presence or absence of antihypertensive medications. Renal sympathetic denervation is the most extensively investigated device-based therapy for hypertension, and randomized, sham-controlled trials have provided proof-of-principle data for its blood pressure-lowering efficacy. Unilateral electrical baroreflex activation, endovascular baroreflex amplification and pacemaker-mediated cardiac neuromodulation therapy have yielded promising results in observational trials, which need to be confirmed in larger, adequately powered, sham-controlled trials. Until further evidence becomes available, device-based therapy for hypertension should not be considered for routine treatment. However, when considering a device-based treatment for hypertension, the underlying pathophysiology in each patient has to be taken into consideration, and the procedural risks weighed against the cardiovascular risk attributable to the elevated blood pressure. This Review summarizes the pathophysiological rationale and the latest clinical evidence for device-based therapies for hypertension.


Assuntos
Terapia por Estimulação Elétrica/métodos , Hipertensão/fisiopatologia , Hipertensão/terapia , Simpatectomia/métodos , Barorreflexo/fisiologia , Pressão Sanguínea/fisiologia , Corpo Carotídeo/fisiologia , Eletrodos Implantados , Humanos , Rim/irrigação sanguínea , Rim/inervação , Marca-Passo Artificial , Ablação por Radiofrequência , Simpatectomia/instrumentação , Terapia por Ultrassom
11.
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
12.
J Pediatr Surg ; 55(3): 418-424, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32063368

RESUMO

OBJECTIVE: Several factors that could influence the efficacy and satisfaction of patients after bilateral thoracic 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 adolescents patients compared to those of adult patients (18-40 years). METHODS: We retrospectively analyzed 2431 hyperhidrosis patients who underwent bilateral VATS and divided the patients into the following groups: adolescents (472 patients) and adult group (1760 patients). Variables included quality of life prior to surgery, improvement in quality of life after surgery, clinical improvement in sweating, presence of severe compensatory hyperhidrosis and general satisfaction at one 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 two groups of patients. We observed that all patients undergoing surgery presented poor or very poor quality of life before surgery; however, the two groups were statistically different. The quality of life of the ADOLESCENT group before surgery was statistically worse than that of the ADULT group. More than 90% of the patients in this series had great clinical improvement in the main hyperhidrosis site, with no significant difference between the two groups. Severe compensatory hyperhidrosis occurred in 23.8% of the patients in this series, with no significant difference between the two groups. CONCLUSIONS: Adolescent patients benefit just as much as adult patients from VATS performed to treat primary hyperhidrosis, presenting excellent, significant surgical results. TYPE OF STUDY: Clinical research. LEVELS OF EVIDENCE: Level III.


Assuntos
Hiperidrose/cirurgia , Simpatectomia , Cirurgia Torácica Vídeoassistida , Adolescente , Humanos , Satisfação do Paciente , Complicações Pós-Operatórias , Qualidade de Vida , Estudos Retrospectivos , Simpatectomia/efeitos adversos , Simpatectomia/métodos , Simpatectomia/estatística & dados numéricos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos , Cirurgia Torácica Vídeoassistida/estatística & dados numéricos
13.
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
14.
Clin Res Cardiol ; 109(3): 289-302, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32034481

RESUMO

BACKGROUND: The SPYRAL HTN clinical trial program was initiated with two 80-patient pilot studies, SPYRAL HTN-OFF MED and SPYRAL HTN-ON MED, which provided biological proof of principle that renal denervation has a blood pressure-lowering effect versus sham controls for subjects with uncontrolled hypertension in the absence or presence of antihypertensive medications, respectively. TRIAL DESIGN: Two multicenter, prospective, randomized, sham-controlled trials have been designed to evaluate the safety and efficacy of catheter-based renal denervation for the reduction of blood pressure in subjects with hypertension in the absence (SPYRAL HTN-OFF MED Pivotal) or presence (SPYRAL HTN-ON MED Expansion) of antihypertensive medications. The primary efficacy endpoint is baseline-adjusted change from baseline in 24-h ambulatory systolic blood pressure. The primary safety endpoint is incidence of major adverse events at 1 month after randomization (or 6 months in cases of new renal artery stenosis). Both trials utilize a Bayesian design to allow for prespecified interim analyses to take place, and thus, the final sample sizes are dependent on whether enrollment is stopped at the first or second interim analysis. SPYRAL HTN-OFF MED Pivotal will enroll up to 300 subjects and SPYRAL HTN-ON MED Expansion will enroll up to 221 subjects. A novel Bayesian power prior approach will leverage historical information from the pilot studies, with a degree of discounting determined by the level of agreement with data from the prospectively powered studies. CONCLUSIONS: The Bayesian paradigm represents a novel and promising approach in device-based hypertension trials. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02439749 (SPYRAL HTN-OFF MED Pivotal) and NCT02439775 (SPYRAL HTN-ON MED Expansion).


Assuntos
Anti-Hipertensivos/administração & dosagem , Ablação por Cateter/métodos , Hipertensão/terapia , Simpatectomia/métodos , Teorema de Bayes , Pressão Sanguínea , Denervação/métodos , Humanos , Hipertensão/fisiopatologia , Estudos Prospectivos , Método Simples-Cego
15.
World Neurosurg ; 138: 740-748, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31953102

RESUMO

BACKGROUND: We evaluated the improvement in the gray and white matter functional areas in children with cerebral palsy (CP) after common carotid artery sympathetic neural network ablation. We also analyzed the relationship between the values of the diffusion kurtosis imaging (DKI) parameters and clinical signs in children with CP. METHODS: We collected data from 22 children with unilateral spastic CP who had undergone common carotid sympathetic neural network ablation in our hospital from January 1, 2014 to December 1, 2018, using magnetic resonance kurtosis imaging technology parameters. RESULTS: The study found that the changes from preoperatively to postoperatively in the kurtosis fractional anisotropy (KFA) values for the frontal lobe, parietal lobe, temporal lobe, internal sac forelimb, and corpus callosum were statistically significant. However, the changes in the internal sac forelimb, corpus callosum, and KFA values were not statistically significant. The changes from preoperatively to postoperatively in the mean kurtosis (MK) values for the frontal lobe, parietal lobe, temporal lobe, hindlimb of the internal capsule, corpus callosum, and caudate nucleus were statistically significant. However, the MK values for the forelimb, corpus callosum, and thalamus were not statistically significant. The 66-item gross motor function measure scores correlated negatively with the KFA value and positively with the MK value. CONCLUSION: Therefore, it can be concluded that DKI technology can more accurately reflect the gray and white matter damage in children with CP, and the DKI parameters can be used as a monitoring and evaluation index for children with CP.


Assuntos
Artéria Carótida Primitiva/inervação , Substância Cinzenta/diagnóstico por imagem , Simpatectomia/métodos , Substância Branca/diagnóstico por imagem , Estudos de Casos e Controles , Núcleo Caudado/diagnóstico por imagem , Córtex Cerebral/diagnóstico por imagem , Paralisia Cerebral , Criança , Pré-Escolar , Corpo Caloso/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Cápsula Interna/diagnóstico por imagem , Masculino
16.
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
17.
Gen Thorac Cardiovasc Surg ; 68(5): 516-522, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31786724

RESUMO

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.


Assuntos
Hiperidrose/psicologia , Hiperidrose/cirurgia , Simpatectomia/métodos , Adolescente , Adulto , Ansiedade/etiologia , Pressão Sanguínea , Depressão/etiologia , Teste de Esforço , Feminino , Volume Expiratório Forçado , Frequência Cardíaca , Humanos , Masculino , Período Pós-Operatório , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Toracoscopia , Capacidade Vital , Adulto Jovem
18.
Ann Vasc Surg ; 63: 63-67.e1, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31629129

RESUMO

BACKGROUND: Primary hyperhidrosis is defined as excessive sweating of idiopathic etiology, associated with sympathetic hyperactivity, which greatly impacts patients' quality of life (QoL). The definitive treatment for palmar and axillary hyperhidrosis (PAH) is video-assisted thoracic sympathectomy (VATS). The objective of this study was to evaluate the quality of life of patients with PAH before and after VATS according to the level of sympathectomy performed, as well as the presence of compensatory hyperhidrosis (CH) and other complications. METHODS: All patients who underwent VATS in our vascular surgery department between January 2011 and December 2016 were included in the analysis. From 120 contact attempts, 88 interviews were carried out. Patients were divided into 2 groups according to the intervened thoracic level: high thoracic ganglion (HTG; T2, T2-T3, T2-T3-T4; n = 68) and low thoracic ganglion (LTG; T3, T3-T4, T4; n = 20). The questionnaire evaluated preoperative PAH severity, the presence of CH, preoperative and postoperative QoL, and postoperative satisfaction. RESULTS: The median age of patients was 29 years, and the median follow-up period was 32 months (IQR of 34 months). Most patients had severe or very severe PAH (97.7%) and preoperative QoL was bad or very bad (95.5%). Postoperatively, QoL was significantly improved in all domains evaluated, with no differences observed between the groups. The overall percentage of complications was 11.4%, mostly pneumothorax, but there was a significantly lower incidence of complications in the HTG group (P = 0.029). Compensatory hyperhidrosis developed in 85.2% of cases, but it was only considered intolerable in 10.2%. The incidence of CH was 82.4% in the HTG group and 95% in the LTG group, with no statistically significant differences between the groups (P = 0.147). CONCLUSIONS: Palmar and axillary hyperhidrosis severely affects QoL, and video-assisted thoracic sympathectomy was proven to be effective regardless of the target ganglion resected. Although CH was frequent, it was tolerated in most cases.


Assuntos
Gânglios Simpáticos/cirurgia , Hiperidrose/cirurgia , Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Sudorese , Simpatectomia/efeitos adversos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Adolescente , Adulto , Feminino , Gânglios Simpáticos/fisiopatologia , Humanos , Hiperidrose/diagnóstico , Hiperidrose/fisiopatologia , Hiperidrose/psicologia , Masculino , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/psicologia , Fatores de Risco , Simpatectomia/métodos , Resultado do Tratamento , Adulto Jovem
19.
Rheumatology (Oxford) ; 59(5): 1021-1025, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31529103

RESUMO

OBJECTIVE: To assess the minimally invasive single-port thoracoscopic sympathicotomy feasibility and efficacy in patients with treatment-resistant RP. METHODS: Single-port thoracoscopic sympathicotomy was performed unilaterally on the left side in eight patients with RP (six males, two females, with a median age of 45.2 years). Five patients had primary and three had secondary RP. Perfusion effects in the hands were assessed at baseline and after 1 month by using a cooling and recovery procedure, and by using laser speckle contrast analysis. Number and duration of RP attacks were reported over a 2-week period. RESULTS: Patient satisfaction was 100% after surgery. After surgery, a unilateral improvement in perfusion was observed in the left hand compared with the right hand, with cooling and recovery (P = 0.008) and with laser speckle contrast analysis (P = 0.023). In addition, the number and duration of the attacks in the left hand decreased compared with the right hand (both P = 0.028). No serious adverse events occurred in a follow-up period of at least 10 months. CONCLUSION: Single-port thoracoscopic sympathicotomy is feasible and can be effective in improving hand perfusion in patients with RP. However, long-term efficacy needs to be established. CLINICAL TRIAL REGISTRATION NUMBER: NCT02680509.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Satisfação do Paciente , Doença de Raynaud/cirurgia , Simpatectomia/métodos , Toracoscopia/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Doença de Raynaud/diagnóstico , Medição de Risco , Resultado do Tratamento
20.
Ann Vasc Surg ; 65: 107-112, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31494263

RESUMO

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.


Assuntos
Hiperidrose/cirurgia , Sudorese , Simpatectomia/métodos , Sistema Nervoso Simpático/cirurgia , Cirurgia Torácica Vídeoassistida , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Hiperidrose/diagnóstico , Hiperidrose/fisiopatologia , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Qualidade de Vida , Estudos Retrospectivos , Simpatectomia/efeitos adversos , Sistema Nervoso Simpático/fisiopatologia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
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