OBJECTIVES: This study compared radiofrequency ablation versus conventional surgery in patients who had not undergone previous treatment for bilateral great saphenous vein insufficiency, with each patient serving as his own control. METHOD: This was a randomized controlled trial that included 18 patients and was carried out between November 2013 and May 2015. Each of the lower limbs of each patient was randomly assigned to undergo either radiofrequency ablation or conventional surgery. Clinical features (hyperpigmentation, hematoma, aesthetics, pain, skin burn, nerve injury, and thrombophlebitis) were evaluated at one week, one month, and six months postoperatively. Hemodynamic assessments (presence of resection or occlusion of the great saphenous vein and recurrent reflux in the sapheno-femoral junction and in the great saphenous vein) were performed at one month, six months, and 12 months postoperatively. The independent observer (a physician not involved in the original operation), patient, and duplex ultrasonographer were not made aware of the treatment done in each case. Clinicaltrials.gov: NCT02588911. RESULTS: Among the clinical variables analyzed, only the aesthetic evaluation by the physicians was significant, with radiofrequency ablation being considered better than conventional surgery (average, 0.91 points higher: standard deviation: 0.31; 95% confidence interval: -1.51, -0.30; p=0.003). However, in our study, we observed primary success rates of 80% for radiofrequency ablation and 100% for conventional surgery. CONCLUSIONS: If the physician is not required to inform the patient as to the technique being performed, the patient will not be able to identify the technique based on the signs and symptoms. Our study revealed that both techniques led to high levels of patient satisfaction, but our results favor the choice of conventional surgery over radiofrequency ablation, as patients who underwent conventional surgery had better hemodynamic assessments.

OBJETIVO: A simpatectomia torácica por videotoracoscopia é atualmente o procedimento de escolha para o tratamento definitivo da hiper-hidrose palmar, pois é um método eficaz, seguro e minimamente invasivo. Na busca de melhores índices de qualidade de vida, os pesquisadores procuram por fatores preditivos de bom resultado cirúrgico. A falência do tratamento inicial, a hiper-hidrose compensatória, o índice de massa corpóreo acima de 25, o nível de ressecção ganglionar e a extensão da ressecção são alguns dos fatores que podem influenciar negativamente os resultados. O objetivo deste estudo foi comparar a qualidade de vida dos pacientes submetidos à simpatectomia torácica, de acordo com a faixa etária, numa coorte com 1.644 pacientes. MÉTODOS: De fevereiro de 2000 a outubro de 2008, foram colhidos dados de 1.644 pacientes portadores de hiper-hidrose palmar (71%) ou axilar (29%), submetidos à simpatectomia torácica por videotoracoscopia. Os pacientes foram divididos em três grupos de acordo com a idade. O primeiro grupo foi de pacientes com até 17 anos, o segundo de 18 a 30 anos, e o terceiro com pacientes com mais de 30 anos de idade. Todos os pacientes tinham índice de massa corpóreo menor que 25. RESULTADOS: Numa avaliação 30 dias após o procedimento, a melhora da qualidade de vida foi obtida nos três grupos. Não houve diferença estatística entre as diferentes faixas etárias. Neste estudo, 91,9% dos pacientes apresentaram algum grau de hiper-hidrose compensatória, novamente sem diferença entre os grupos. CONCLUSÕES: Pacientes portadores de hiper-hidrose primária apresentam melhora da qualidade de vida após o procedimento cirúrgico independentemente de sua idade.

OBJECTIVE: Video-assisted thoracic sympathectomy is currently the procedure of choice for the definitive treatment of primary hyperhidrosis, because it is an effective, safe, and minimally invasive method. In the search for better quality of life indexes, all researchers look for predictive factors indicating better surgical outcomes. Failure in the primary treatment, postoperative compensatory hyperhidrosis, body mass index over 25, level of resection of the sympathetic chain, and extent of resection are some of the factors that may negatively influence the results. The objective of this study was to compare, according to the age group, the quality of life after bilateral thoracic sympathectomy for treatment of primary hyperhidrosis in a cohort of 1,644 patients. METHODS: From February 2000 to October 2008, data were collected from 1,644 patients with palmar (71%) or axillary (29%) hyperhidrosis who underwent video-assisted thoracic sympathectomy. The patients were divided into three groups according to their ages. The first group consisted of patients up to 17 years-old, the second from 18 to 30 years-old, and the third of over 30 years-old. All patients had a body mass index of less than 25. RESULTS: In the evaluation 30 days after surgery, improvement of the quality of life in the three groups was observed. There was no significant difference between the age groups. In the present study, 91.9% of the patients presented compensatory hyperhidrosis, with no difference between the age groups. CONCLUSIONS: Patients with primary hyperhidrosis experience quality of life improvement after thoracic sympathectomy regardless of their age.

FUNDAMENTOS: Hiperidrose facial é uma doença que pode levar os pacientes a sérios distúrbios emocionais. A simpatectomia torácica vídeo-assistida proporciona excelente resolução da hiperidrose facial, mas está associada a algumas complicações, sendo a mais freqüente e mais importante a hiperidrose compensatória. Especialmente em pacientes submetidos à ressecção do segundo gânglio torácico, o risco de hiperidrose compensatória grave é maior, o que pode causar insatisfação com o procedimento. OBJETIVO: O objetivo deste estudo foi avaliar a eficácia e a satisfação dos pacientes com o uso da oxibutinina em doses baixas para tratar a hiperidrose facial em uma série grande de pacientes. MÉTODOS: 25 pacientes com hiperidrose facial foram tratados com oxibutinina. Os pacientes foram submetidos a duas avaliações: antes e depois do tratamento. Estas foram usadas para avaliar a melhoria clínica e a qualidade de vida. RESULTADOS: Observou-se que mais de 75% dos pacientes evoluíram com melhora na hiperidrose facial, sendo que 52% deles apresentaram uma grande melhora. CONCLUSÃO: O tratamento da hiperidrose facial com oxibutinina é uma boa alternativa à simpatectomia, visto que apresenta bons resultados e melhora a qualidade de vida, e os pacientes não correm o risco dos efeitos colaterais da simpatectomia

BACKGROUND: Facial hyperhidrosis is a disease that may lead patients to serious emotional disturbances. Video-assisted thoracic sympathectomy provides excellent resolution of facial hyperhidrosis, but is associated with certain complications. The most frequent and important complication is compensatory hyperhidrosis. Especially in patients who have undergone resection of the second thoracic ganglion, the risk of severe compensatory hyperhidrosis is higher, which may cause dissatisfaction with the procedure. OBJECTIVE: The aim of this study was to evaluate the efficacy of the use of low doses of oxybutynin in treating facial hyperhidrosis as well as the level of patient satisfaction with its use. METHODS: 25 patients with facial hyperhidrosis were treated with oxybutynin. The patients underwent 2 evaluations: before and after treatment. These evaluations were used to assess the patients' clinical improvement and quality of life. RESULTS: We observed that more than 75% of the patients evolved with an improvement in facial hyperhidrosis, and 52% of them presented a great improvement. CONCLUSION: Treatment of facial hyperhidrosis with oxybutynin is a good alternative to sympathectomy, since it presents good results and improves quality of life, in addition to not exposing patients to the risk of experiencing the side effects of sympathectomy

Video-assisted thoracic sympathectomy (VATS) is currently the procedure of choise for the definitive treatment of primary hyperhidrosis because it is an effective, safe, and minimally invasive method. The aim of VATS treatment is to improve the quality of life through the reduction of excessive sudoresis. The purpose of this study was to assess the quality of life after VATS for treating palmar hyperhidrosis according to gender. METHODS: A total of 1044 patients who submitted to the surgical treatment for palmar hyperhidrosis from June 2000 to February 2008 were retrospectively evaluated. The patients were divided into two groups according to gender [719 (68.8%) females and 325 (31.2%) males]. RESULTS: There are no statistically significant differences between genders with regard to the quality of life in palmar hyperhidrosis patients (p = 0.726). In the interview that was performed 30 days after surgery, the quality of life in the two groups had improved, with no statistical difference between the groups. CONCLUSION: Patients with palmar hyperhidrosis present with an improvement in the quality of life after VATS regardless of gender.

INTRODUCTION: Level T4 video-assisted thoracoscopic sympathectomy proved superior to T3-T4 treatment for controlling axillary hyperhidrosis at the initial and six-month follow-ups of these patients. OBJECTIVE: To compare the results of two levels of sympathectomy (T3-T4 vs. T4) for treating axillary sudoresis over one year of follow-up. METHODS: Sixty-four patients with axillary hyperhidrosis were randomized to denervation of T3-T4 or T4 alone and followed prospectively. All patients were examined preoperatively and were followed postoperatively for one year. Axillary hyperhidrosis treatment was evaluated, along with the presence, location, and severity of compensatory hyperhidrosis and self-reported quality of life. RESULTS: According to patient reports after one year, all cases of axillary hyperhidrosis were successfully treated by surgery. There were no instances of treatment failure. After six months, compensatory hyperhidrosis was present in 27 patients of the T3-T4 group (87.1%) and in 16 patients of the T4 group (48.5%). After one year, all T3-T4 patients experienced some degree of compensatory hyperhidrosis, compared to only 14 patients in the T4 group (42.4%). In addition, compensatory hyperhidrosis was less severe in the T4 patients (p < 0.01). Quality of life was poor before surgery, and it improved in both groups at six months and one year of follow-up (p = 0.002). There were no cases of mortality, no significant postoperative complications, and no need for conversion to thoracotomy in either group. CONCLUSION: Both techniques were effective for treating axillary hyperhidrosis, but the T4 group showed milder compensatory hyperhidrosis and greater patient satisfaction at the one-year follow-up.

OBJETIVO: Diversos fatores preditivos de evolução de enxertos arteriais em pacientes com isquemia grave foram definidos em estudos clínicos como diabetes mellitus, insuficiência renal, fumo e vasão distal. O objetivo deste estudo foi verificar se pacientes com isquemia grave submetidos a revascularização nos quais as lesões apareceram espontaneamente apresentam evolução diferente daquela em que as lesões apareceram após uma agressão externa ao membro. MÉTODOS: De fevereiro de 2002 a janeiro de 2004, 100 pacientes submetidos a revascularizações infra-inguinais foram seguidos. Eles foram divididos em 2 grupos: 1) Grupo com lesão espontânea (52 pacientes), que compreendia pacientes apresentando lesões isquêmicas de origem espontânea e 2) Grupo de lesão por agressão externa (48 pacientes) que compreendia pacientes em que um mecanismo externo era identificado como causa do aparecimento da lesão isquêmica. As variáveis analisadas foram salvamento de membro e índices de perviedade dos enxertos. RESULTADOS: Pacientes com lesão espontânea apresentam índices de salvamento de membro e perviedade do enxerto significativamente menores que pacientes com lesões secundárias a agressão externa (42,3% x 87,5%, respectivamente para ambos itens de estudo;p<0,01). CONCLUSÕES: A ausência de agressão externa para o aparecimento de lesões tróficas em membros inferiores isquêmicos é fator prognóstico de pior evolução tanto para o funcionamento dos enxertos como para o salvamento do membro nos pacientes submetidos a revascularizações infra-inguinais. No entanto esse fator não é suficiente para definir uma conduta médica, visto que metade dos pacientes que apresentaram lesão espontânea também tiveram boa evolução. O fator prognóstico deve ser usado como todos os outros - para oferecer aos pacientes e aos médicos uma idéia melhor sobre a possível evolução do caso.

PURPOSE: A variety of predictive factors for the evolution of arterial grafts in patients with critical ischemia have been well defined in clinical studies, including diabetes mellitus, dialytic renal insufficiency, smoking, and distal arterial runoff. The goal of this study was to determine whether patients with critical ischemia undergoing arterial reconstruction in which ischemic lesions appeared spontaneously, compared to those in which the ischemic lesion appeared following an external aggression to the limb present different patterns of evolution. METHODS: From February 2002 to January 2004, 100 patients undergoing infra-inguinal arterial reconstruction were followed. They were divided into 2 groups: 1) the spontaneous group (n = 52), comprising individuals presenting with ischemic lesions of spontaneous origin and 2) the external aggression to the limb group (n = 48), comprising individuals for which an external causal mechanism for the appearance of the ischemic lesion was identified. The variables analyzed were limb salvage and graft functioning rates. RESULTS: Patients with spontaneous lesions had rates of limb salvage and graft functioning significantly lower than those for patients with lesions that were secondary to external aggression (42.3% versus 87.5%, respectively for both outcomes; P <.001). CONCLUSIONS: The absence of an external aggression as a contributing factor to a critical ischemic lesion in the lower limb may result in a poorer evolution of both graft function and limb salvage following arterial revascularization. However, this factor is not expected to directly influence the case conduct, since almost half of the patients without evident external aggression had good graft functioning and limb salvage. This prognostic factor should be used just as all others are, i.e., to give patients and doctors a better idea of the possible evolution in such cases.

OBJETIVO: Estudar a longo prazo (média de 76 meses de seguimento) os resultados obtidos com o tratamento endovascular em pacientes que não melhoram com o tratamento clínico, MÉTODOS: De Janeiro de 1992 a Janeiro de 2002, 62 pacientes de um grupo de 1380 claudicantes foram submetidos a tratamento endovascular, representando 4,5% do total. As variáveis analisadas foram o funcionamento do segmento arterial submetido ao procedimento endovascular, a evolução da distância máxima de marcha e a ocorrência de morbi-mortalidade. RESULTADOS: Cinqüenta e dois (84%) pacientes não apresentaram restrições à deambulação após o procedimento. Seis pacientes melhoraram, representando um benefício de 94%. Não houve mortalidade intra-operatória. Uma falência primária e uma trombose imediata foram corrigidas cirurgicamente. Seis pacientes apresentaram trombose da artéria tratada 12, 16, 25, 29, 62 e 66 meses após o procedimento e voltaram a apresentar Claudicação Intermitente para as mesmas distâncias referidas antes da cirurgia. Durante o seguimento foi observada taxa de mortalidade de 12,9% (8 pacientes), dos quais 6 por infarto do miocárdio e dois por acidente vascular cerebral. Três pacientes foram submetidos à revascularização miocárdica 22, 36 e 55 meses após o procedimento endovascular e duas angioplastias foram realizadas com 6 e 26 meses de seguimento. O tempo médio de segmento foi de 76 meses (0 a 120 meses). CONCLUSÃO: O tratamento endovascular da Claudicação Intermitente levou a melhora das condições da marcha em um número significativo de pacientes, com excelentes taxas de patência (82,0%). Concluímos que esta é uma boa alternativa para determinados pacientes, com poucas complicações e resultados positivos a longo prazo.

PURPOSE: To study the results including long-term follow-up obtained with endovascular treatment of patients with intermittent claudication who did not experience clinical improvement with conservative treatment. METHODS: From January 1992 to January 2002, 62 of 1380 patients (4.5%) with intermittent claudication underwent endovascular treatment and were followed up for up to 120 months (mean 76 months). The variables analyzed were the functioning of the arterial segment undergoing the endovascular procedure, the evolution of the maximum walking distance, and incidence of related morbidity and mortality. RESULTS: Fifty-two patients (84%) experienced no walking limitation after the procedure, and 6 patients (10%) improved but still exhibited some degree of limitation, for a total improved outcome of 94%. The patency rate was 82%. There was no intraoperative mortality. One primary failure and one immediate thrombosis occurred, and both were surgically corrected. Thrombosis of the treated artery occurred in 6 patients 12, 16, 25, 29, 62, and 66 months after the procedure. These patients started to experience intermittent claudication with a walking distance to onset that was similar to their presurgical distance to onset. During follow-up, a mortality rate of 12.9% (8 patients) was observed, 6 due to myocardial infarctions and 2 due cerebral infarction. Three patients underwent coronary bypasses 22, 36, and 55 months after the endovascular surgery, and 2 patients underwent coronary angioplasty after 6 and 26 months. The mean follow up period was 76 months (range 0-120 months). CONCLUSION: This study shows that endovascular treatment of intermittent claudication brought about a lasting regression of the ischemic conditions in a significant number of patients, with excellent patency rates. It was concluded that this is a good alternative for selected patients, with low rates of complications and positive long-term results.

OBJETIVO: Estudar prospectivamente os resultados obtidos com o tratamento cirúrgico de portadores de claudicação intermitente que não obtiveram melhora clínica com o tratamento conservador, acompanhados, em média, por 6 anos. MÉTODOS: De janeiro/1992 a janeiro/2002 foram acompanhados 26 pacientes tratados cirurgicamente de um grupo de 1380 portadores de claudicação intermitente, admitidos num ambulatório de doença arterial obstrutiva periférica e claudicação intermitente, representando 1,88% do total. RESULTADOS: Não referiam limitação para deambular após a cirurgia 16 pacientes. Experimentaram melhora nove, porém com algum grau de limitação, e dois, pequena melhora na distância máxima de marcha. Não houve mortalidade intra-operatória. Três pacientes apresentaram trombose da artéria tratada 6,48 e 60 meses após o procedimento e passaram a apresentar claudicação intermitente para as distâncias prévias à cirurgia. Durante o seguimento a longo prazo observamos uma mortalidade de 23,0% devido a infarto agudo do miocárdio (4 casos), insuficiência renal (um) e acidente vascular cerebral (um). Dois pacientes foram submetidos a revascularização do miocárdio 2 e 4 anos após a reconstrução arterial e um ainda necessitou angioplastia coronariana com 3 anos de seguimento. O tempo de seguimento médio foi de 73 meses. CONCLUSÃO: O tratamento cirúrgico diminuiu sintomas isquêmicos da claudicação intermitente em muitos pacientes, com excelente taxa de patência (88,4%) dos enxertos, tornando-se em pacientes que não apresentam melhora com tratamento clínico, boa alternativa com baixas taxas de complicações e bons resultados a longo prazo.

OBJECTIVE: To study the results obtained with surgical treatment of patients with intermittent claudication (IC) who did not clinically improve with conservative treatment, accompanied by a long follow-up (average 6 years). METHODS: From January 1992 to January 2002, 26 patients treated surgically in a group of 1380 IC patient, representing 1.88% of the total. RESULTS: Sixteen patients did not experience walking limitations after the surgery. Nine patients improved, however, with some degree of limitation. No intraoperative mortalities occurred. Three patients experienced thrombosis of the treated artery 6, 48, and 60 months after the procedure and started to suffer IC with onset at the same distances as before the surgery. During the long-term follow-up, we observed a mortality rate of 23.0% due to myocardial infarctions (4 patients), renal insufficiency (1 patient), and cerebral infarction (1 patient). Two patients underwent coronary bypasses 2 and 4 years after the vascular surgery, and one underwent coronary angioplasty after 3 years of follow-up. The mean follow-up was 73 months. CONCLUSION: In our study, the results from surgical treatment of IC brought about a lasting regression of the ischemic conditions in a significant number of patients, with excellent patency rates (88.4%). We conclude that this is a good alternative for select patients, with low rates of complications and positive long-term results.

CONTEXTO: Os dispositivos totalmente implantáveis vêm sendo cada vez mais utilizados para quimioterapia de pacientes oncológicos, porém poucos são os estudos em nosso meio que analisam os resultados obtidos com a implantação e utilização desses cateteres. OBJETIVO: Estudar os resultados obtidos com a implantação de cateteres totalmente implantáveis em pacientes submetidos a quimioterapia. TIPO DO ESTUDO: Prospectivo. LOCAL: Hospital do Câncer A.C. Camargo, São Paulo, Brasil. MÉTODOS: Foram colocados 519 cateteres totalmente implantáveis em 500 pacientes a serem submetidos a regime de quimioterapia preferencialmente utilizando-se a veia jugular externa direita. Foram avaliadas as complicações precoces, as tardias e a evolução até a retirada do dispositivo, morte ou fim de tratamento. RESULTADOS: A análise prospectiva mostrou duração média dos cateteres de 353 dias. Em 427 (82,2%) cateteres não se observou nenhuma complicação. Entre as complicações precoces, observamos 15 hematomas de trajeto, oito tromboflebites de coto distal de veia jugular externa e uma infecção de bolsa de subcutâneo. Entre as complicações tardias, observamos 43 complicações infecciosas (0,23/1000 dias de uso de cateter), 11 obstruções (0,06/1000 dias de uso de cateter) e 14 tromboses venosas profundas (0,07/1000 dias de uso de cateter). Foram retirados 101 cateteres, 35 devido às complicações e 66 por final de tratamento. 240 pacientes foram a óbito com o cateter funcionante e 178 pacientes ainda o utilizavam para quimioterapia. CONCLUSÃO: As baixas taxas de complicação obtidas nesse estudo confirmam a segurança e conveniência do uso dos acessos totalmente implantáveis em pacientes em regime prolongado de quimioterapia.

CONTEXT: Totally implantable devices are increasingly being utilized for chemotherapy treatment of oncological patients, although few studies have been done in our environment to analyze the results obtained from the implantation and utilization of such catheters. OBJECTIVE: To study the results obtained from the implantation of totally implantable catheters in patients submitted to chemotherapy. TYPE OF STUDY: Prospective. SETTING: Hospital do Câncer A.C. Camargo, São Paulo, Brazil. METHODS: 519 totally implantable catheters were placed in 500 patients submitted to chemotherapy, with preference for the use of the right external jugular vein. Evaluations were made of the early and late-stage complications and patient evolution until removal of the device, death or the end of the treatment. RESULTS: The prospective analysis showed an average duration of 353 days for the catheters. There were 427 (82.2%) catheters with no complications. Among the early complications observed, there were 15 pathway hematomas, 8 cases of thrombophlebitis of the distal stump of the external jugular vein and one case of pocket infection. Among the late-stage complications observed, there were 43 infectious complications (0.23/1000 days of catheter use), 11 obstructions (0.06/1000 days of catheter use) and 14 cases of deep vein thrombosis (0.07/1000 days of catheter use). Removal of 101 catheters was performed: 35 due to complications and 66 upon terminating the treatment. A total of 240 patients died while the catheter was functioning and 178 patients are still making use of the catheter. CONCLUSION: The low rate of complications obtained in this study confirms the safety and convenience of the use of totally implantable accesses in patients undergoing prolonged chemotherapy regimes.