An objective assessment of the sudomotor response after thoracoscopic sympathectomy

ObjectiveThoracoscopic sympathectomy has become an accepted therapeutic option for palmar hyperhidrosis. Objective assessment of sweat output after sympathectomy, however, has not been reported to date. We report for the first time sweat output measurements after sympathectomy during a 3-year postoperative period.MethodsThoracoscopic sympathectomy was performed by division of T2 and T3 sympathetic ganglia in 17 healthy adult patients with no comorbidities. Preoperative and postoperative sweat measurements were done at 29°C (below sweat threshold, at baseline, after conversation, and after a mental arithmetic challenge) and at 40°C (baseline and after exercise) with the ventilated capsule technique in left palm, sole, and chest wall. Serial postoperative measurements were conducted at 1 and 6 months and 1, 2, and 3 years.ResultsSweat output fell significantly after sympathectomy relative to preoperative levels under all experimental conditions (P < .001, analysis of variance) in the left palm. Differences in sweat outputs in the left palm were statistically significant between groups at baseline and postoperatively after mental arithmetic challenge and exercise at 40°C (P < .05, analysis of variance). Compensatory increases in the sweat outputs from the left sole and chest were observed after sympathectomy. No patients had recurrence of preoperative sweat output values at follow-up.ConclusionAccording to objective sweat output measurements, thoracoscopic sympathectomy results in long-term control of palmar hyperhidrosis. This evaluation method is valuable in investigating recurrence of symptoms or compensatory hyperhidrosis after sympathectomy, providing a robust and objective criterion for planning intervention

Factitious lymphoedema as a psychiatric condition mimicking reflex sympathetic dystrophy: a case report

<p>Abstract</p> <p>Introduction</p> <p>Reflex sympathetic dystrophy can result in severe disability with only one in five patients able to fully resume prior activities. Therefore, it is important to diagnose this condition early and begin appropriate treatment. Factitious lymphoedema can mimic reflex sympathetic dystrophy and is caused by self-inflicted tourniquets, blows to the arm or repeated skin irritation. Patients with factitious lymphoedema have an underlying psychiatric disorder but usually present to emergency or orthopaedics departments. Factitious lymphoedema can then be misdiagnosed as reflex sympathetic dystrophy. The treatment for factitious lymphoedema is dealing with the underlying psychiatric condition.</p> <p>Case presentation</p> <p>We share our experience of treating a 33-year-old man, who presented with factitious lymphoedema, initially diagnosed as reflex sympathetic dystrophy.</p> <p>Conclusion</p> <p>Awareness of this very similar differential diagnosis allows early appropriate treatment to be administered.</p

Surgery for fistula-in-ano in a specialist colorectal unit: a critical appraisal

ABSTRACT

The effect of endovenous laser ablation (EVLA) on venous haemodynamics and tissue perfusion in the lower limb

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Nutrient Composition, Functional and Organoleptic Properties of Complementary Foods Formulated From Sorghum, Groundnut and Crayfish

Complementary foods were formulated from sorghum, groundnut and crayfish, and examined for nutrient composition, functional properties and organoleptic attributes. The different flours were combined in ratios70:25:5, 80:15:5, 75:20:5 (protein basis) of sorghum, groundnut and crayfish. Nutrend, which is an industrially prepared food, served as control. Porridges were prepared from the composite blends for organoleptic evaluation. Standard methods were used to analyse the composite flours for nutrient composition and functional properties.The composite flours contained higher moisture, fat, energy, calcium, iron and provitamin A than the control. The protein level of the blends ranged between 8.90% and 13.99%. The blends contained low quantities of zinc. The result of the functional properties showed no significant difference (P>0.05) in both bulk density and viscosity. Allthe samples exhibited gelling properties even at the least concentration 0.02% (w/v) indicating they can serve as good complementary foods. Sensory evaluation revealed that the porridge from the control was preferred over the others. Among the blends, the porridge made from 75:20:5 sorghum/groundnut/crayfish was preferred over the others.The study showed that composite blends from sorghum, groundnut and crayfish are nutritionally adequate and possess good functional properties, which are required for the preparation of complementary foods for infants