Excision of sympathetic ganglia and the rami communicantes with histological confirmation offers better early and late outcomes in Video assisted thoracoscopic sympathectomy

<p>Abstract</p> <p>Background</p> <p>Video-Assisted Thoracoscopic Sympathectomy (VATS) is an established minimally invasive procedure for thoracic sympathetic blockade in patients with hyperhidrosis, facial flushing and intractable angina. Various techniques using clips, diathermy and excision are used to perform sympathectomy. We present our technique of excision of the sympathetic chain with histological proof and the analysis of the early and late outcomes.</p> <p>Methods</p> <p>We evaluated 200 procedures in 100 consecutive patients, who underwent Video Assisted Thoracoscopic Sympathectomy by a single surgeon in our centre between September 1996 to March 2007. All patients had maximum medical therapy prior to surgery and were divided into 3 groups based on indications, Group 1(hyperhidrosis: 48 patients), Group 2 (facial flushing: 26 patients) and Group 3(intractable angina: 26 patients). The demography and severity of symptoms for each group were analysed. The endpoints were success rate, 30 day mortality, complications and patient's satisfaction.</p> <p>Results</p> <p>99 patients had bilateral VATS sympathectomy and 1 had unilateral sympathectomy. The conversion rate to open was 1(1%). All patients had successful removal of ganglia proven histologically with no perioperative mortality in our series. The complications included pneumothorax (5%), acute coronary syndrome (2%), transient Horner's syndrome (1%), transient paraesthesia (1%), wound infection (4%), compensatory hyperhidrosis (18%), residual flushing (3%) and wound pain (5%). There were five late deaths in the intractable angina group at a mean follow up of 36.7 months. Overall success rates of abolishing the symptoms were 96.3%, 87.5% and 95.2% for Group 1, 2 and 3 respectively.</p> <p>Conclusion</p> <p>Excision of the sympathetic chain with histological confirmation during VATS sympathectomy is a safe and effective method in treating hyperhidrosis, facial flushing and intractable angina with good long term results and satisfaction.</p

All-in-one synthesis of mesoporous silicon nanosheets from natural clay and their applicability to hydrogen evolution

Silicon nanosheets have attracted much attention owing to their novel electronic and optical properties and compatibility with existing silicon technology. However, a cost-effective and scalable technique for synthesizing these nanosheets remains elusive. Here, we report a novel strategy for producing silicon nanosheets on a large scale through the simultaneous molten-salt-induced exfoliation and chemical reduction of natural clay. The silicon nanosheets thus synthesized have a high surface area, are ultrathin (similar to 5 nm) and contain mesoporous structures derived from the oxygen vacancies in the clay. These advantages make the nanosheets a highly suitable photocatalyst with an exceptionally high activity for the generation of hydrogen from a water-methanol mixture. Further, when the silicon nanosheets are combined with platinum as a cocatalyst, they exhibit high activity in KOH (15.83 mmol H-2 per s per mol Si) and excellent photocatalytic activity with respect to the evolution of hydrogen from a water-methanol mixture (723 mu mol H-2 per h per g Si).clos