What do sweaty palms and abnormal heart rhythms have in common? Both can be initiated by the nervous system during an adrenaline-driven "flight-or-fight" stress reaction, when the body senses danger.
Hyperhidrosis, an abnormal flight-or-fight response of the sympathetic nervous system that causes excessively sweaty palms may also contribute to problems like dangerous irregular rhythms from the lower chambers of the heart, known as ventricular arrhythmias.
UCLA cardiologists have now found that surgery to snip nerves associated with the sympathetic nervous system on both the left and right sides of the chest may be helpful in stopping dangerous, incessant ventricular arrhythmias — known as an "electrical storm" — when other treatment methods have failed. This same type of surgery has been used for years to alleviate hyperhidrosis.
The UCLA team's findings are reported in the Dec. 27–Jan. 3 issue of the Journal of the American College of Cardiology. The study is one of the first to assess the impact of bilateral cardiac sympathetic denervation (BCSD), surgery on both sides of the heart, to control arrhythmias. The research builds on previous work at UCLA in which a similar procedure was performed only on the left side. But for some patients to obtain relief, the researchers said, it must be done bilaterally.
5 (11%) thermoregulation difficulties, 4 (9%) a sensation of left arm paresthesia, and 3 (7%) sympathetic flight/fright response loss
Patients with LQTS (N=40) and catecholaminergic polymorphic ventricular tachycardia (N=7) underwent video-assisted thoracoscopic left cardiac sympathetic denervation, with a median follow-up of 29 months (range, 1-67 months). Clinical records were reviewed; 44 patients completed a telephone survey. Of 47 patients (53%), 25 were preoperatively symptomatic (15 syncope, 7 near-drowning, and 3 resuscitated sudden death). Indications for left cardiac sympathetic denervation included β-blocker intolerance (15; 32%) or nonadherence (10; 21%) and disease factors (18; 38%; catecholaminergic polymorphic ventricular tachycardia [6], near-drowning [2], exertional syncope [1], symptoms on therapy [2], LQT3 [1], QTc>520 ms [6]). Other indications were competitive sports participation (2), family history of sudden death (1), and other (1). Median QTc did not change among patients with LQTS (461±60 to 476±54 ms; P=0.49). Side effects were reported by 42 of 44 (95%). Twenty-nine patients (66%) reported dryness on left side, 26 (59%) a Harlequin-type (unilateral) facial flush, 24 (55%) contralateral hyperhidrosis, 17 (39%) differential hand temperatures, 5 (11%) permanent and 4 (9%) transient ptosis, 5 (11%) thermoregulation difficulties, 4 (9%) a sensation of left arm paresthesia, and 3 (7%) sympathetic flight/fright response loss.
Circ Arrhythm Electrophysiol. 2015 Oct;8(5):1151-8. doi: 10.1161/CIRCEP.115.003159. Epub 2015 Jul 29.
Physical and Psychological Consequences of Left Cardiac Sympathetic Denervation in Long-QT Syndrome and Catecholaminergic Polymorphic Ventricular Tachycardia.
Approved anti-depressant deemed unsafe
Approved anti-depressant deemed unsafe:
Studies suggest that patients, clinicians, and society often hold unrealistic expectations about the effectiveness of tests and treatments. Two articles in this issue add to that literature. In New Zealand, Hudson et al3 surveyed 977 primary care patients and found that many overestimated the benefits of cancer screening and chemopreventive medications. The minimum benefit from screening that respondents deemed acceptable was less than their known benefit. The survey had a modest sample size and low response rate (36%), and its findings might not be fully applicable to other countries, but US studies have reported a similar problem. For example, a variety of studies document Americans' appetite for procedures of dubious effectiveness and their overestimation of benefits.4,5
Physicians are not immune to false beliefs about clinical efficacy or complication rates.8Correcting such misperceptions has always been part of the impetus for the evidence-based medicine movement and its promulgation of systematic evidence reviews, practice guidelines, and other tools that present the facts on benefits, safety, and scientific uncertainties. Even these tools, however, can reflect the misconceptions of those who produce them. The specialists who serve on expert panels derive much of their clinical case knowledge from the patients with advanced disease who fill their clinics. Having seen the worst of the worst, they are less sympathetic to expressions of concern about the potential harms of interventions or imperfections in efficacy studies.9Whereas epidemiologists consider the population denominator to put the numerator in perspective, the world of specialists is confined to the numerator, giving them a skewed basis for judging the population prevalence of diseases or benefit-risk ratios. Were this not enough, the preeminent scientists who often serve on guideline panels bring additional biases, such as being the authors of key studies under review or having financial ties to industry.10
http://www.annfammed.org/content/10/6/491.full
Studies suggest that patients, clinicians, and society often hold unrealistic expectations about the effectiveness of tests and treatments. Two articles in this issue add to that literature. In New Zealand, Hudson et al3 surveyed 977 primary care patients and found that many overestimated the benefits of cancer screening and chemopreventive medications. The minimum benefit from screening that respondents deemed acceptable was less than their known benefit. The survey had a modest sample size and low response rate (36%), and its findings might not be fully applicable to other countries, but US studies have reported a similar problem. For example, a variety of studies document Americans' appetite for procedures of dubious effectiveness and their overestimation of benefits.4,5
Physicians are not immune to false beliefs about clinical efficacy or complication rates.8Correcting such misperceptions has always been part of the impetus for the evidence-based medicine movement and its promulgation of systematic evidence reviews, practice guidelines, and other tools that present the facts on benefits, safety, and scientific uncertainties. Even these tools, however, can reflect the misconceptions of those who produce them. The specialists who serve on expert panels derive much of their clinical case knowledge from the patients with advanced disease who fill their clinics. Having seen the worst of the worst, they are less sympathetic to expressions of concern about the potential harms of interventions or imperfections in efficacy studies.9Whereas epidemiologists consider the population denominator to put the numerator in perspective, the world of specialists is confined to the numerator, giving them a skewed basis for judging the population prevalence of diseases or benefit-risk ratios. Were this not enough, the preeminent scientists who often serve on guideline panels bring additional biases, such as being the authors of key studies under review or having financial ties to industry.10
http://www.annfammed.org/content/10/6/491.full
Baker IDI Melbourne fabricated research results
“Fabricated results” retract JAMA clinical trial, plus a sub-analysis of the data - Retraction Watch at Retraction Watch: "“Fabricated results” retract JAMA clinical trial, plus a sub-analysis of the data
with 2 comments
A JAMA clinical trial that suggested a blood pressure drug could help patients increase their physical fitness, and a sub-analysis of those data, have been retracted after “an admission of fabricated results” by the first author on both papers.
The three-year clinical trial was published in JAMA in 2013. It was retracted this morning.
The trial found ramipril helped patients with artery disease walk longer and with less pain, according to the abstract:
Among patients with intermittent claudication, 24-week treatment with ramipril resulted in significant increases in pain-free and maximum treadmill walking times compared with placebo. This was associated with a significant increase in the physical functioning component of the SF-36 score.
The retraction note explains how the fabricated data came to light: "
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with 2 comments
A JAMA clinical trial that suggested a blood pressure drug could help patients increase their physical fitness, and a sub-analysis of those data, have been retracted after “an admission of fabricated results” by the first author on both papers.
The three-year clinical trial was published in JAMA in 2013. It was retracted this morning.
The trial found ramipril helped patients with artery disease walk longer and with less pain, according to the abstract:
Among patients with intermittent claudication, 24-week treatment with ramipril resulted in significant increases in pain-free and maximum treadmill walking times compared with placebo. This was associated with a significant increase in the physical functioning component of the SF-36 score.
The retraction note explains how the fabricated data came to light: "
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"for any inappropriate care to occur, complicit action on a large scale is required" - MJA
Med J Aust 2015;; 203 (4): 161-162.: "Instead of dismissing, we should consider that for any inappropriate care to occur, complicit action on a large scale is required. To deliver a do-not-do procedure a medical practitioner must first be credentialled, have a defined scope of practice and operate within their clinical team alongside support services and the governance structures of an organisation. Start counting how many people are involved. Therefore, the question we should be asking is: how is it possible for inappropriate care to occur? And what systems-level agreements perpetuate this situation?"https://www.mja.com.au/.../it-not-appropriate-dismiss...
and:
"Far too many patients in some Australian hospitals get a treatment they should not receive, against all evidence that the treatment is unnecessary or does not work.
This report identifies five treatments that should not be given to certain types of patients. Yet this happened to nearly 6000 people – or 16 people a day – in 2010-11." http://grattan.edu.au/.../questionable-care-avoiding.../
and:
"Far too many patients in some Australian hospitals get a treatment they should not receive, against all evidence that the treatment is unnecessary or does not work.
This report identifies five treatments that should not be given to certain types of patients. Yet this happened to nearly 6000 people – or 16 people a day – in 2010-11." http://grattan.edu.au/.../questionable-care-avoiding.../
Doctor Skeptic: Fixing a hole
Doctor Skeptic: Fixing a hole: Migraine is common, affecting millions of people worldwide. A patent foramen ovale (PFO – a ‘hole in the heart’ that lets blood cross from...
Sympathectomy: a neurocardiologic disorder
Bilateral thoracic sympathectomies or sympathotomies are done for refractory palmar hyperhidrosis [85–87]. Iontophoresis, botulinum toxin injection, and glycopyrrolate cream are alternatives. Because sweating is mediated mainly by sympathetic cholinergic fibers, autonomic neurosurgery is usually effective; however, a variety of expected and unexpected consequences can result, including ectopic (e.g., plantar) hyperhidrosis, gustatory sweating, Horner syndrome, and decreased heart rate responses to exercise. The latter seems to be related to partial cardiac denervation [88]. Anecdotally, fatigue, altered mood, blunted emotion, and decreased ability to concentrate can develop after bilateral thoracic sympathectomies.
β-Adrenoceptor blockers are a mainstay of treatment for CPVT. An automated defibrillator may have to be implanted. Treatment for CPVT also includes left sympathectomy. Such treatment leaves open the theoretical possibilities of denervation supersensitivity of cardiac adrenoceptors and compensatory activation of the adrenomedullary hormonal system; however, plasma levels of catecholamines have not been assessed in CPVT with or without therapeutic cardiac denervation.
Table 1. Neurocardiologic disorders that feature abnormal catecholaminergic function
Adie's syndrome Dopamine-β-hydroxylase deficiency
Sympathectomy
Disorders where abnormal catecholaminergic function is etiologic Hypofunctional states without central neurodegeneration
Acute, primary
Neurocardiogenic syncope Spinal cord transection Acute pandysautonomia Sympathectomy
Acute, secondary
Drug-related (e.g., alcohol, tricyclic antidepressant, chemotherapy, opiate, barbiturates, benzodiazepines, sympatholytics, general anesthesia)
Seizures
Guillain–Barre syndrome Alcohol
Acute, primary
Neurocardiogenic syncope Spinal cord transection Acute pandysautonomia Sympathectomy
Acute, secondary
Drug-related (e.g., alcohol, tricyclic antidepressant, chemotherapy, opiate, barbiturates, benzodiazepines, sympatholytics, general anesthesia)
Seizures
Guillain–Barre syndrome Alcohol
Chronic, primary
Pure autonomic failure
Horner's syndrome
Familial dysautonomia
Carotid sinus syncope
Horner's syndrome
Familial dysautonomia
Carotid sinus syncope
Sympathectomy
the clinical results of both surgical and neurolityc sympathectomy are uncertain
However, the clinical results of both surgical and neurolityc sympathectomy are uncertain. Indeed these procedures lead to a redistribution of the blood flow in the lower limbs from the muscle to the skin, with a concomitant fall of the regional resistance, mainly in undamaged vessels. The blood flow will be diverted into this part of the vascular tree, so that a "stealing" of the blood flow may occur.
Vito A. Peduto, Giancarlo Boero, Antonio Marchi, Riccardo Tani
Bilateral extensive skin necrosis of the lower limbs following prolonged epidural blockade
Anaesthesia 1976; 31: 1068-75.
sympathectomy created imbalance of autonomic activity and functional changes of the intrathoracic organs
Surgical thoracic sympathectomy such as ESD (endoscopic thoracic sympathectic denervation) or heart transplantation can result in an imbalance between the sympathetic and parasympathetic activities and result in functional changes in the intrathoracic organs.
Therefore, the procedures affecting sympathetic nerve functions, such as epidural anesthesia, ESD, and heart transplantation, may cause an imbalance between sympathetic and parasympathetic activities (1, 6, 16, 17). Recently, it has been reported that ESD results in functional changes of the intrathoracic organs.
In conclusion, our study demonstrated that ESD adversely affected lung function early after surgery and the BHR was affected by an imbalance of autonomic activity created by bilateral ESD in patients with primary focal hyperhidrosis.
Journal of Asthma, 46:276–279, 2009
http://informahealthcare.com/doi/abs/10.1080/02770900802660949
In conclusion, our study demonstrated that ESD adversely affected lung function early after surgery and the BHR was affected by an imbalance of autonomic activity created by bilateral ESD in patients with primary focal hyperhidrosis.
Journal of Asthma, 46:276–279, 2009
http://informahealthcare.com/doi/abs/10.1080/02770900802660949
"Since changes in old age show some similarities with those following chronic sympathectomy"
"For the tracheobronchial tree. surgical (sympathectomy) and chemical (with 6-hydroxydopamine or reserpine) interventions lead to histological disappearance of the NA and NPY." (p.435)
" Prejunctional supersensitivity to norepinephrine after sympathectomy or cocaine treatment." (p. 410)
"Following chronic sympathectomy, substance P expression in presumptive sensory nerves....and NPY-expression in parasympathetic nerves ...to autonomically innervated tissues have both been shown to increase... Experiments using NGF and anti-NGF antibodies (Kessler et al., 1983) have suggested that competition between sympathetic and sensory fibers for target-derived growth factors could explain these apparently compensatory interactions,..." (p. 33)
"Since changes in old age show some similarities with those following chronic sympathectomy, it is tempting to consider whether alterations in one group of nerves in tissues with multiple innervations trigger reciprocal changes in other populations of nerves, perhaps through the mechanism of competition for common, target-produced growth factors. The nature of these changes is such that they could be nonadaptive and even destabilizing of cardiovascular homeostasis. (p. 34)
Impairment of sympathetic and neural function has been claimed in cholesterol-fed animals (Panek et al., 1985). It has also been suggested that surgical sympathectomy may be useful in controlling atherosclerosis in certain arterial beds (Lichter et al., 1987). Defective cholinergic arteriolar vasodilation has been claimed in atherosclerotic rabbits (Yamamoto et al., 1988) and, in our laboratory, we have recently shown impairment of response to perivascular nerves supplying the mesenteric, hepatic, and ear arteries of Watanabe heritable hyperlipidemic rabbits (Burnstock et al., 1991).
Loss of adrenergic innervation has been reported in alcoholism (Low et al., 1975), amyloidosis (Rubenstein et al., 1983), orthostatic hypotension (Bannister et al., 1981), and subarachnoid haemorrhage (Hara and Kobayashi, 1988). Recent evidence shows that there is also a loss of noradrenergic innervation of blood vessels supplying malignant, as compared to benign, human intracranial tumours (Crockard et al., 1987). (p. 14)
" Prejunctional supersensitivity to norepinephrine after sympathectomy or cocaine treatment." (p. 410)
"Following chronic sympathectomy, substance P expression in presumptive sensory nerves....and NPY-expression in parasympathetic nerves ...to autonomically innervated tissues have both been shown to increase... Experiments using NGF and anti-NGF antibodies (Kessler et al., 1983) have suggested that competition between sympathetic and sensory fibers for target-derived growth factors could explain these apparently compensatory interactions,..." (p. 33)
"Since changes in old age show some similarities with those following chronic sympathectomy, it is tempting to consider whether alterations in one group of nerves in tissues with multiple innervations trigger reciprocal changes in other populations of nerves, perhaps through the mechanism of competition for common, target-produced growth factors. The nature of these changes is such that they could be nonadaptive and even destabilizing of cardiovascular homeostasis. (p. 34)
Impairment of sympathetic and neural function has been claimed in cholesterol-fed animals (Panek et al., 1985). It has also been suggested that surgical sympathectomy may be useful in controlling atherosclerosis in certain arterial beds (Lichter et al., 1987). Defective cholinergic arteriolar vasodilation has been claimed in atherosclerotic rabbits (Yamamoto et al., 1988) and, in our laboratory, we have recently shown impairment of response to perivascular nerves supplying the mesenteric, hepatic, and ear arteries of Watanabe heritable hyperlipidemic rabbits (Burnstock et al., 1991).
Loss of adrenergic innervation has been reported in alcoholism (Low et al., 1975), amyloidosis (Rubenstein et al., 1983), orthostatic hypotension (Bannister et al., 1981), and subarachnoid haemorrhage (Hara and Kobayashi, 1988). Recent evidence shows that there is also a loss of noradrenergic innervation of blood vessels supplying malignant, as compared to benign, human intracranial tumours (Crockard et al., 1987). (p. 14)
Vascular Innervation and Receptor Mechanisms: New Perspectives
Rolf Uddman
Despite the simplicity and rapidity of the procedure, some patients experience intense, in some cases persistent, postoperative pain
Jornal Brasileiro de Pneumologia - The incidence of residual pneumothorax after video-assisted sympathectomy with and without pleural drainage and its effect on postoperative pain:
"Anteroposterior chest X-ray in the orthostatic position, while inhaling, was absolutely normal in 18 patients (32.1%), and residual pneumothorax was detected in 17 patients (30.4%). When the patients were separated into two groups (those who had received drainage and those who had not), 25.9% (7 patients) and 34.4% (10 patients), respectively, presented residual pneumothorax, with no difference between the two groups (p = 0.48) (Figure 1).
The additional alterations were laminar atelectasis and emphysema of the subcutaneous cellular tissue.
Chest X-rays in the orthostatic position, while exhaling, revealed residual pneumothorax in 39.3% (22 patients) and was absolutely normal in 25% (14 patients). On the same X-rays, when patients were analyzed separately, residual pneumothorax was seen in 33.3% of the patients who had received drainage (9 patients) and in 44.8% (13 patients) of those who had not, with no difference between the two groups (p = 0.37) (Figure 1).
The low-dose computed tomography scans of the chest detected residual pneumothorax in 76.8% (43 patients). In the patients submitted to postoperative drainage, this rate was 70.3% (19 patients), compared with 82.7% (24 patients) in those without pleural drainage, with no difference between the two groups (p = 0.27) (Figure 1). Therefore, the overall rate of occult pneumothorax (only visible through tomography), revealed on anteroposterior X-rays was 35.7% (20 patients): 48.2% while patients were inhaling and 41.1% while patients were exhaling. The VAS score in the PACU ranged from 0 to 10, with a mean of 2.16 ± 0.35.
Regarding characteristics, 44.6% of the patients reported chest pain upon breathing and 32.1% reported retrosternal pain. The same evaluation performed in the infirmary, during the immediate postoperative period, ranged from 0 to 10, with a mean of 3.75 ± 0.30, being 69.6% of chest pain upon breathing and 78.6% of retrosternal pain. On postoperative day 7, according to VAS, pain ranged from 0 to 10, with a mean of 2.05 ± 0.31; regarding characteristics, it was continuous in 32.1% of the cases, and retrosternal in 26.8%. On postoperative day 28, pain ranged from 0 to 3, with a mean of 0.17 ± 0.08, 7.1% of mechanical rhythm and 5.4% upper posterior."
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132008000300003&lng=en&nrm=iso&tlng=en
"Anteroposterior chest X-ray in the orthostatic position, while inhaling, was absolutely normal in 18 patients (32.1%), and residual pneumothorax was detected in 17 patients (30.4%). When the patients were separated into two groups (those who had received drainage and those who had not), 25.9% (7 patients) and 34.4% (10 patients), respectively, presented residual pneumothorax, with no difference between the two groups (p = 0.48) (Figure 1).
The additional alterations were laminar atelectasis and emphysema of the subcutaneous cellular tissue.
Chest X-rays in the orthostatic position, while exhaling, revealed residual pneumothorax in 39.3% (22 patients) and was absolutely normal in 25% (14 patients). On the same X-rays, when patients were analyzed separately, residual pneumothorax was seen in 33.3% of the patients who had received drainage (9 patients) and in 44.8% (13 patients) of those who had not, with no difference between the two groups (p = 0.37) (Figure 1).
The low-dose computed tomography scans of the chest detected residual pneumothorax in 76.8% (43 patients). In the patients submitted to postoperative drainage, this rate was 70.3% (19 patients), compared with 82.7% (24 patients) in those without pleural drainage, with no difference between the two groups (p = 0.27) (Figure 1). Therefore, the overall rate of occult pneumothorax (only visible through tomography), revealed on anteroposterior X-rays was 35.7% (20 patients): 48.2% while patients were inhaling and 41.1% while patients were exhaling. The VAS score in the PACU ranged from 0 to 10, with a mean of 2.16 ± 0.35.
Regarding characteristics, 44.6% of the patients reported chest pain upon breathing and 32.1% reported retrosternal pain. The same evaluation performed in the infirmary, during the immediate postoperative period, ranged from 0 to 10, with a mean of 3.75 ± 0.30, being 69.6% of chest pain upon breathing and 78.6% of retrosternal pain. On postoperative day 7, according to VAS, pain ranged from 0 to 10, with a mean of 2.05 ± 0.31; regarding characteristics, it was continuous in 32.1% of the cases, and retrosternal in 26.8%. On postoperative day 28, pain ranged from 0 to 3, with a mean of 0.17 ± 0.08, 7.1% of mechanical rhythm and 5.4% upper posterior."
Jornal Brasileiro de Pneumologia
Print version ISSN 1806-3713
J. bras. pneumol. vol.34 no.3 São Paulo Mar. 2008
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132008000300003&lng=en&nrm=iso&tlng=en
This study of hype in press releases will change journalism | Science News
This study of hype in press releases will change journalism | Science News: "The most important thing to remember is that there are people, and sometimes patients, waiting on the end of the news cycle. “I wouldn’t be doing [healthnewsreviews.org] if I didn’t think that these kinds of messages and misleading conclusions and observations and statements made in many news releases have the potential — and indeed I think that potential is realized — of hurting people at the end of the food chain,” Schwitzer says. Everyone in the news cycle bears responsibility, in the end, for getting it right."
'via Blog this'
'via Blog this'
Exaggeration in health science news releases -exaggerations communicated by reporters are frequently already present in press releases put out by academic institutions
Exaggeration in health science news releases & what we're going to do about it: "“For me, the takeaway from this study is that there are multiple messengers to blame when it comes to exaggeration in health care news stories. As we’ve shown at HealthNewsReview.org, journalists often need to do a better job of vetting scientific research in their stories. But according to these results, the exaggerations communicated by reporters are frequently already present in press releases put out by academic institutions. This suggests that press officers who write the releases, and the researchers who collaborate on them, are also key players when it comes to the promotion of misinformation.
The study authors make a great point, which is that if academic institutions are the ones initiating the introduction of misleading claims, then there’s a tremendous opportunity for them to improve the quality of health care news if they can change their ways. I think our new effort to review news releases will help with that transition, because it provides a level of accountability that’s been missing until now. I’m really excited to see that our instincts about the need for this service are being emphatically confirmed by these results.”"
'via Blog this'
The study authors make a great point, which is that if academic institutions are the ones initiating the introduction of misleading claims, then there’s a tremendous opportunity for them to improve the quality of health care news if they can change their ways. I think our new effort to review news releases will help with that transition, because it provides a level of accountability that’s been missing until now. I’m really excited to see that our instincts about the need for this service are being emphatically confirmed by these results.”"
'via Blog this'
Evidence based medicine is broken | The BMJ
"How many people care that the research pond is polluted,5 with fraud, sham diagnosis, short term data, poor regulation, surrogate ends, questionnaires that can’t be validated, and statistically significant but clinically irrelevant outcomes? Medical experts who should be providing oversight are on the take. Even the National Institute for Health and Care Excellence and the Cochrane Collaboration do not exclude authors with conflicts of interest, who therefore have predetermined agendas.6 7 The current incarnation of EBM is corrupted, let down by academics and regulators alike.8"
http://www.bmj.com/content/348/bmj.g22
http://www.bmj.com/content/348/bmj.g22
"sympathectomy, although having varying results, does seem to increase the severity of autoimmune disorders "
Allostasis - a state of imbalance responsible for Autoimmune disorders
In general, enhancing the sympathetic tone decreases both T0-cell and NK cell functions but not the proliferation of splenic B cells (Dowdell and Whitacre, 2000). In contrast, chemical sympathectomy, although having varying results, does seem to increase the severity of autoimmune disorders (Dowdell and Whitacre, 2000)
As far as metabolism, catecholamines promote mobilization of fuel stores at time of stress and act synergistically with glucocorticoids to increased glycogenolysis, gluconeogenesis, and lipolysis but exert opposing effects of protein catabolism, as noted earlier. One important aspect is regulation of body temperature (Goldsttein and Eisenhofer, 2000) Epinephrine levels are also positively related to serum levels of HDL cholesterol and negatively related to triglycerines. However, perturbing the balance of activity of various mediators or metabolism and body weight regulation can lead to well-known metabolic disorders such as type 2 diabetes and obesity.
At the same time, increased sympathetic activitation and nerephinephrine release is elevated in hypertensive individuals and also higher levels of insulin, and there are indications that insulin further increases sympathetic activity in a vicious cycle (Arauz-Pacheco et al.,1996)
As a result of either local production, cytokines often enter the the circultion and can be detected in plasma samples. Sleep deprivation and psychological stress, such as public speaking, are reported to elevate inflammatory cytokine level in blood (Altemus et al., 2001) Circulting levels of a number of inflammatory cytokines are elevated in relation to viral and other infections and contirbute to the feeling of being sick, as well as sleepiness, wiht both direct and indirect effects on the central nervous system (Arkins et al., 2000; Obal and Kueger, 2000)
Inflammatory autoimmune diseases, such as multiple sclerosis, rheumatoid arthritis, and type 1 diabetes, reflect an allostatic state that consists of at least three principal causes: genetic risk factors, (...) factors that contribute to the development of tolerance of self-antigens (...) and the hormonal mikieu that regulates adaptive immunes responses (Dowdell and Whitacre, 2000)
As far as metabolism, catecholamines promote mobilization of fuel stores at time of stress and act synergistically with glucocorticoids to increased glycogenolysis, gluconeogenesis, and lipolysis but exert opposing effects of protein catabolism, as noted earlier. One important aspect is regulation of body temperature (Goldsttein and Eisenhofer, 2000) Epinephrine levels are also positively related to serum levels of HDL cholesterol and negatively related to triglycerines. However, perturbing the balance of activity of various mediators or metabolism and body weight regulation can lead to well-known metabolic disorders such as type 2 diabetes and obesity.
At the same time, increased sympathetic activitation and nerephinephrine release is elevated in hypertensive individuals and also higher levels of insulin, and there are indications that insulin further increases sympathetic activity in a vicious cycle (Arauz-Pacheco et al.,1996)
As a result of either local production, cytokines often enter the the circultion and can be detected in plasma samples. Sleep deprivation and psychological stress, such as public speaking, are reported to elevate inflammatory cytokine level in blood (Altemus et al., 2001) Circulting levels of a number of inflammatory cytokines are elevated in relation to viral and other infections and contirbute to the feeling of being sick, as well as sleepiness, wiht both direct and indirect effects on the central nervous system (Arkins et al., 2000; Obal and Kueger, 2000)
Inflammatory autoimmune diseases, such as multiple sclerosis, rheumatoid arthritis, and type 1 diabetes, reflect an allostatic state that consists of at least three principal causes: genetic risk factors, (...) factors that contribute to the development of tolerance of self-antigens (...) and the hormonal mikieu that regulates adaptive immunes responses (Dowdell and Whitacre, 2000)
Allostasis, homeostasis and the costs of physiological adaptation
By Jay SchulkinCambridge University Press, 2004
Allostasis is the process of achieving stability, or homeostasis, through physiological or behavioral change. This can be carried out by means of alteration in HPA axishormones, the autonomic nervous system, cytokines, or a number of other systems, and is generally adaptive in the short term [1]
Doctor falsifies cancer diagnoses to defraud millions | Medical Error Action Group
Doctor falsifies cancer diagnoses to defraud millions | Medical Error Action Group: "Detroit, MI
An American oncologist faces up to 175 years in prison for a scam in which he reaped millions of dollars by putting patients on chemotherapy drugs they didn’t need, in order to defraud public and private insurers.
Dr Farid FATA, 49, pleaded guilty to 13 counts of healthcare fraud, one count of conspiring to receive kickbacks and one count of money laundering as the owner of a cancer treatment clinic and a diagnostic testing facility.
“Dr FATA… admitted he put greed before the health and safety of his patients, putting them through unnecessary chemotherapy and other treatments just so that he could collect additional millions from MEDICARE,” said US Assistant Attorney- General Leslie CALDWELL.
“The mere thought of what he did is chilling.”
The US Federal Bureau of Investigation said FATA was swiftly arrested after agents were alerted to the scam in mid-2013.
FATA submitted approximately $225 million in claims to MEDICARE – the US federal-funded program in the US that provides health insurance to the disabled and people over 65 – between August 2007 and July 2013.
The claims included about $109 million for chemotherapy and other cancer treatments.
MEDICARE paid the fraudster $91 million, of which over $48 million was for chemotherapy and other cancer treatments.
Employees of FATA’s Michigan Hematology Oncology Clinic (MHO), which had six offices in the Detroit area, gave damning evidence of dangerous prescribing practices."
'via Blog this'
An American oncologist faces up to 175 years in prison for a scam in which he reaped millions of dollars by putting patients on chemotherapy drugs they didn’t need, in order to defraud public and private insurers.
Dr Farid FATA, 49, pleaded guilty to 13 counts of healthcare fraud, one count of conspiring to receive kickbacks and one count of money laundering as the owner of a cancer treatment clinic and a diagnostic testing facility.
“Dr FATA… admitted he put greed before the health and safety of his patients, putting them through unnecessary chemotherapy and other treatments just so that he could collect additional millions from MEDICARE,” said US Assistant Attorney- General Leslie CALDWELL.
“The mere thought of what he did is chilling.”
The US Federal Bureau of Investigation said FATA was swiftly arrested after agents were alerted to the scam in mid-2013.
FATA submitted approximately $225 million in claims to MEDICARE – the US federal-funded program in the US that provides health insurance to the disabled and people over 65 – between August 2007 and July 2013.
The claims included about $109 million for chemotherapy and other cancer treatments.
MEDICARE paid the fraudster $91 million, of which over $48 million was for chemotherapy and other cancer treatments.
Employees of FATA’s Michigan Hematology Oncology Clinic (MHO), which had six offices in the Detroit area, gave damning evidence of dangerous prescribing practices."
'via Blog this'
"Similar low values are observed in patients with sympathectomy and in patients with tetraplegia"
Information about surgery for sweaty hands: "Patients with progressive autonomic dysfunction (including diabetes) have little or no increase in plasma noradrenaline and this correlates with their orthostatic intolerance (Bannister, Sever and Gross, 1977). In patients with pure autonomic failure, basal levels of noradrenaline are lower than in normal subjects (Polinsky, 1988). Similar low values are observed in patients with sympathectomy and in patients with tetraplegia. (p.51)
The finger wrinkling response is abolished by upper thoracic sympathectomy. The test is also abnormal in some patients with diabetic autonomic dysfunction, the Guillan-Barre syndrome and other peripheral sympathetic dysfunction in limbs. (p.46)
Other causes of autonomic dysfunction without neurological signs include medications, acute autonomic failure, endocrine disease, surgical sympathectomy . (p.100)
Anhidrosis is the usual effect of destruction of sympathetic supply to the face. However about 35% of patients with sympathetic devervation of the face, acessory fibres (reaching the face through the trigeminal system) become hyperactive and hyperhidrosis occurs, occasionally causing the interesting phenomenon of alternating hyperhidrosis and Horner's Syndrome (Ottomo and Heimburger, 1980). (p.159)
Disorders of the Autonomic Nervous System
By David Robertson, Italo Biaggioni
Edition: illustrated
Published by Informa Health Care, 1995
ISBN 3718651467, 9783718651467"
'via Blog this'
The finger wrinkling response is abolished by upper thoracic sympathectomy. The test is also abnormal in some patients with diabetic autonomic dysfunction, the Guillan-Barre syndrome and other peripheral sympathetic dysfunction in limbs. (p.46)
Other causes of autonomic dysfunction without neurological signs include medications, acute autonomic failure, endocrine disease, surgical sympathectomy . (p.100)
Anhidrosis is the usual effect of destruction of sympathetic supply to the face. However about 35% of patients with sympathetic devervation of the face, acessory fibres (reaching the face through the trigeminal system) become hyperactive and hyperhidrosis occurs, occasionally causing the interesting phenomenon of alternating hyperhidrosis and Horner's Syndrome (Ottomo and Heimburger, 1980). (p.159)
Disorders of the Autonomic Nervous System
By David Robertson, Italo Biaggioni
Edition: illustrated
Published by Informa Health Care, 1995
ISBN 3718651467, 9783718651467"
'via Blog this'
"the standards for the evidence are often low and tainted by commercial or personal interests"
In the eyes of doctors and the public, evidence-based medicine is the gold standard of clinic practice. If it’s based on evidence from trials and laboratories, it must be right.
However, evidence-based medicine has its critics, as a bilious outbreak of comment and letters in the BMJ demonstrated recently. Early last month a Glasgow GP, Des Spence, said that the system of EBM had been corrupted. “If we don’t tackle the flaws of EBM there will be a disaster, but I fear it will take a disaster before anyone will listen,” he wrote.
How could anyone fault the notion of treatment based on scientifically validated evidence? No one. But the critics of EBM argue heatedly that the standards for the evidence are often low and tainted by commercial or personal interests. Dr Spence accuses drug companies of
manipulating the gold standard to their own benefit. “Today EBM is a loaded gun at clinicians’ heads. ‘You better do as the evidence says,’ it hisses, leaving no room for discretion or judgment. EBM is now the problem, fueling overdiagnosis and overtreatment.”
A number of letters pointed out that, while EBM had its flaws, doctors still need to exercise their clinical judgement. They write the prescriptions, not the drug companies.
Dr Spence was supported by Dr Miran Epstein, a medical ethicist at The London School of Medicine. He writes that “EBM “does not regard polluted information, whether it involves misconduct or not, as a sufficient condition for rendering disclosure inadequate. Thus, it lets informed consent degenerate into a legal fiction and the principle of autonomy into a cynical farce. Worst of all, it is perfectly ethical: being the codified expression of the collective conscience of our medicine, it naturally purports to be moral.”
manipulating the gold standard to their own benefit. “Today EBM is a loaded gun at clinicians’ heads. ‘You better do as the evidence says,’ it hisses, leaving no room for discretion or judgment. EBM is now the problem, fueling overdiagnosis and overtreatment.”
A number of letters pointed out that, while EBM had its flaws, doctors still need to exercise their clinical judgement. They write the prescriptions, not the drug companies.
Dr Spence was supported by Dr Miran Epstein, a medical ethicist at The London School of Medicine. He writes that “EBM “does not regard polluted information, whether it involves misconduct or not, as a sufficient condition for rendering disclosure inadequate. Thus, it lets informed consent degenerate into a legal fiction and the principle of autonomy into a cynical farce. Worst of all, it is perfectly ethical: being the codified expression of the collective conscience of our medicine, it naturally purports to be moral.”
And he was supported by lawyer and ethicist Charles Foster, writing in the Practical Ethics blog. He believes that the editors of journals need the help of a regulator to sift the wheat from the chaff. “Journals can’t do it all. We need a cynical, skeptical, well-funded, well-staffed and ideologically very left-wing regulator. With huge teeth.”
Evidence-based medicine comes under attack
by Michael Cook | 8 Feb 2014 |
tags: commercialization, evidence-based medicine
http://www.bioedge.org/index.php/bioethics/bioethics_article/10841
by Michael Cook | 8 Feb 2014 |
tags: commercialization, evidence-based medicine
http://www.bioedge.org/index.php/bioethics/bioethics_article/10841
Publication bias distorting evidence base, systematic reviews and clinical guidelines
For decades, the systematic review of published randomised controlled trials has been considered the gold standard in medical research, and this was what the original Cochrane reviewers did.
By combining data from all published trials on a particular subject, researchers are able to see effects in much larger numbers of people than would typically be included in a single trial, in theory making their conclusions more powerful.
In theory. The problem in reality is a small thing called publication bias.
Some trials are simply more likely to be published than others, potentially skewing the results of this kind of meta-analysis.
MJA InSIght, Monday, 14 October, 2013
Jane McCredie: Sharing evidence
"the most dangerous pseudoscience is not produced by amateurish cranks, but by a minority of qualified scientists and doctors"
"Their pseudoscience is promoted as science by think tanks and sections of the media, with serious consequences."
"Why do a minority of scientists produce pseudoscience? Clearly some pseudoscience is strongly associated with ideological beliefs, and motivated reasoning can overwhelm data, logic and years of training. Perhaps some scientists get complacent, expecting their hunches to always be correct.
But perhaps there’s another reason that’s closer to home. Is part of the problem how we educate prospective scientists?
Hypothesis
Pseudoscience mimics aspects of science while fundamentally denying the scientific method. A useful definition of the scientific method is:
principles and procedures for the systematic pursuit of knowledge involving the recognition and formulation of a problem, the collection of data through observation and experiment, and the formulation and testing of hypotheses.
A key phrase is “testing of hypotheses”. We test hypotheses because they can be wrong.
Hypothesis testing is the first victim of pseudoscience. The conclusions are already known, and the data and analyses are (consciously or unconsciously) chosen to reach the desired conclusion.
Unfortunately, high school and undergraduate science students may have limited exposure to hypothesis testing. A student laboratory exercise may repeat an experiment from decades ago, which has been simplified for teaching, and whose conclusions are well known.
Such an exercise teaches technical skills at the expense of hypothesis testing. Should we expect students to “get” hypothesis testing without real experience? No, and without real experience of hypothesis testing we may undermine years of education."
http://theconversation.com/scientists-can-learn-from-pseudoscience-thats-a-fact-17376
"the pharma giant used fictitious patient quotes to promote its fluticasone product"
"GLAXOSMITHKLINE is among three companies to be fined for breaches of Medicines Australia’s Code of Conduct after the pharma giant used fictitious patient quotes to promote its fluticasone product, Seretide.
MA said in its July–September quarterly report that the Code of Conduct committee dealt with allegations by Mundipharma that GSK’s promotional material on Seretide was false and misleading.
The committee said that while publishing fictitious patient quotes is itself a breach of the code, GSK had exacerbated its breach by placing the statements in quote marks beside the image of a young woman.
“GSK had agreed during intercompany dialogue to make clear that the statements were not from real patients,” the committee said."
The committee said that while publishing fictitious patient quotes is itself a breach of the code, GSK had exacerbated its breach by placing the statements in quote marks beside the image of a young woman.
“GSK had agreed during intercompany dialogue to make clear that the statements were not from real patients,” the committee said."
Medical Observer,
False claims: Pharma companies fined
Warwick Stanley 3rd Nov 2014
The so called 'compensatory sweating' is NOT compensatory - BMJ Best Practice
"When patients with intense CH are analyzed, we observe that the amount of released sweat seems to be much greater than was that occurring at the primary hyperhidrosis location, not translating a simple compensation or sweating transference from one site to the other. Therefore, this hyperhidrosis seems to be reflex, mediated neurologically in the sweating regulatory center in the hypothalamus.
In order to avoid this neurologically mediated reflex, the sympathetic afferents to the hypothalamus should be restored, allowing negative feedback to block the efferent projection of the sweating regulatory center on the periphery.(14) Therefore, only the reinnervation of the sectioned sympathetic chain could recover this reflex."
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132008001100013&lng=en&nrm=iso&tlng=en
https://archive.today/7B795
http://bestpractice.bmj.com/best-practice/search.html?searchableText=Hyperhidrosis&aliasHandle=guidelines&languageCode=en
https://archive.today/0UXdW
In order to avoid this neurologically mediated reflex, the sympathetic afferents to the hypothalamus should be restored, allowing negative feedback to block the efferent projection of the sweating regulatory center on the periphery.(14) Therefore, only the reinnervation of the sectioned sympathetic chain could recover this reflex."
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132008001100013&lng=en&nrm=iso&tlng=en
https://archive.today/7B795
Jornal Brasileiro de Pneumologia
Print version ISSN 1806-3713
J. bras. pneumol. vol.34 no.11 São Paulo Nov. 2008
Guidelines for the prevention, diagnosis and treatment of compensatory hyperhidrosis*
Roberto de Menezes LyraI; José Ribas Milanez de CamposII; Davi Wen Wei KangIII; Marcelo de Paula LoureiroIV; Marcos Bessa FurianV; Mário Gesteira CostaVI; Marlos de Souza CoelhoVII
IThoracic Surgeon. Hospital do Servidor Público Estadual de São Paulo - HSPE/SP, São Paulo Hospital for State Civil Servants - São Paulo, Brazil
IIAssistant Professor in the Department of Thoracic Surgery. University of São Paulo Hospital das Clínicas, São Paulo, Brazil
IIIThoracic Surgeon. Hospital Israelita Albert Einstein - HIAE - São Paulo, Brazil
IVGeneral Surgeon. Hospital Nossa Senhora das Graças, Curitiba, Brazil
VThoracic Surgeon. Hospital Santa Lúcia, Cruz Alta, Brazil
VIAdjunct Professor of Surgery. University of Pernambuco School of Medical Sciences, Recife, Brazil
VIIAdjunct Professor of Surgery. Pontifícia Universidade Católica do Paraná - PUCPR, Pontifical Catholic University of Paraná Curitiba, Brazil
IIAssistant Professor in the Department of Thoracic Surgery. University of São Paulo Hospital das Clínicas, São Paulo, Brazil
IIIThoracic Surgeon. Hospital Israelita Albert Einstein - HIAE - São Paulo, Brazil
IVGeneral Surgeon. Hospital Nossa Senhora das Graças, Curitiba, Brazil
VThoracic Surgeon. Hospital Santa Lúcia, Cruz Alta, Brazil
VIAdjunct Professor of Surgery. University of Pernambuco School of Medical Sciences, Recife, Brazil
VIIAdjunct Professor of Surgery. Pontifícia Universidade Católica do Paraná - PUCPR, Pontifical Catholic University of Paraná Curitiba, Brazil
https://archive.today/0UXdW
Pain in the form of intercostal neuralgia with dysesthesia at the site of trocar insertion is rarely documented but more frequent than generally recognized
Pain in the form of intercostal neuralgia with dysesthesia at the site of trocar insertion is rarely documented but more frequent than generally recognized. Many centres perform short-stay surgery that may lead to underestimation of pain results. In most series pain resolves within months, but Walles and colleagues could detect a persistence for years (Walles et al., 2008).
http://www.intechopen.com/books/topics-in-thoracic-surgery/surgical-management-of-primary-upper-limb-hyperhidrosis-a-review
Patients with surgical sympathectomies have low plasma levels of DA and NE [49], whereas EPI:NE ratios are increased
Patients with surgical sympathectomies have low plasma levels of DA and NE [49], whereas EPI:NE ratios are increased (unpublished observations), suggesting decreased sympathetically mediated exocytosis and compensatory adrenomedullary activation.
Catecholamines 101, David S. Goldstein
Clin Auton Res (2010) 20:331–352
"Please note, due to the complications of the ETS procedure and the few people who need it, ETS is NOT offered anymore at The Whiteley Clinic."
"Please note, due to the complications of the ETS procedure and the few people who need it, ETS is NOT offered anymore at The Whiteley Clinic."
http://www.sweating.co.uk/treatments_ETS-endoscopic-transthoracic-sympathectomy.htm
or archived page:
https://archive.today/PCmQf#selection-409.0-409.141
He had several websites promoting the procedure and used the media to advertise ETS:
http://www.sweating.co.uk/press-mark-whiteley.htm
or archived page:
https://archive.today/GKztq
http://www.sweating.co.uk/treatments_ETS-endoscopic-transthoracic-sympathectomy.htm
or archived page:
https://archive.today/PCmQf#selection-409.0-409.141
He had several websites promoting the procedure and used the media to advertise ETS:
http://www.sweating.co.uk/press-mark-whiteley.htm
or archived page:
https://archive.today/GKztq
“In no other area than Sympathetic Surgery, disagreement, conflicting opinion, different definitions and misleading interpretations of the data exist"
8th ISSS Symposium New York, 2009:
“In no other area than Sympathetic Surgery, disagreement, conflicting opinion, different definitions and misleading interpretations of the data exist. Mainly regarding surgical indications, the level and extent of the procedure and results evaluation”.
ATS Expert Consensus for the Surgical Treatment of Hyperhidrosis powerpoint presentation – October 6, 2012, XVI Congreso Boliviana de Cirugia Cardiaca, Toracica y Vascular, Santa Cruz de la Sierra, Bolivia.
http://cirugiadetorax.org/2012/10/09/vats-sympathectomy-for-hyperhidrosis-dr-jose-ribas-de-milanez-de-campos/
or:
https://archive.today/Q047q
Inflammation in dorsal root ganglia after peripheral nerve injury: Effects of the sympathetic innervation
Following a peripheral nerve injury, a sterile inflammation develops in sympathetic and dorsal root ganglia (DRGs) with axons that project in the damaged nerve trunk. Macrophages and T-lymphocytes invade these gan- glia where they are believed to release cytokines that lead to hyperexcitability and ectopic discharge, possibly contributing to neuropathic pain. Here, we examined the role of the sympathetic innervation in the inflammation of L5 DRGs of Wistar rats following transection of the sciatic nerve, comparing the effects of specific surgical in- terventions 10–14 days prior to the nerve lesion with those of chronic administration of adrenoceptor antago- nists. Immunohistochemistry was used to define the invading immune cell populations 7 days after sciatic transection. Removal of sympathetic activity in the hind limb by transecting the preganglionic input to the rele- vant lumbar sympathetic ganglia (ipsi- or bilateral decentralization) or by ipsilateral removal of these ganglia with degeneration of postganglionic axons (denervation), caused less DRG inflammation than occurred after a sham sympathectomy. By contrast, denervation of the lymph node draining the lesion site potentiated T-cell in- flux. Systemic treatment with antagonists of α1-adrenoceptors (prazosin) or β-adrenoceptors (propranolol) led to opposite but unexpected effects on infiltration of DRGs after sciatic transection. Prazosin potentiated the influx of macrophages and CD4+ T-lymphocytes whereas propranolol tended to reduce immune cell invasion. These data are hard to reconcile with many in vitro studies in which catecholamines acting mainly via β2-adrenoceptors have inhibited the activation and proliferation of immune cells following an inflamma- tory challenge.
Autonomic Neuroscience: Basic and Clinical 182 (2014) 108–117
Neuroscience Research Australia, Randwick, NSW 2031, and the University of New South Wales, Sydney, NSW 2052, Australia
"patient information must include the long-term substantial risk for severe CS and regret of the procedure"
http://www.ncbi.nlm.nih.gov/pubmed/22191130
lowering of heart rate and blood pressure, decreased responsiveness of the cardiocirculatory system to emotional stimuli after sympathectomy
"lowering of heart rate and blood pressure, decreased responsiveness of the cardiocirculatory system to emotional stimuli: it is an effect that is especially noticeable in patients operated on for erythrophobia and less evident in those operated for hyperhidrosis. It is almost always a welcome phenomenon, which contributes considerably to the feeling of tranquility and serenity that generally supersedes anxiety. Excessive reduction in blood pressure or heart rate may lead to a state of weakness and fatigue that may require removal of the clips in approx. 2%. This rare state of asthenia contrasts with the increased energy and vigor that most patients experience when they feel freed from overwhelming anxiety."
"The neurovegetative nervous system is, however, very dynamic and tends to adapt continuously during lifetime to all environmental or organic changes and conditions. Therefore, it reacts very individually when a reflex circuit has been blocked. The resulting side effects cannot be predicted in detail, and though they in most patients are relatively mild or even absent, there is a small group of patients developing heavy side effects. Therefore, surgery should only be considered in carefully selected cases in whom non-invasive treatment has failed and in whom the detrimental consequences of erythrophobia regarding the psychosocial situation and the quality of life is such to justify more adverse side effects. It should also always be kept in mind that therapy can be ineffective and that, in the long term, 10-15% of patients do not consider themselves satisfied with the result of surgery. In any case, the author prefers the use of a potentially reversible surgical technique (ESB), instead of destructive techniques (cutting, coagulation, removal of ganglia)."
http://www.chir.it/en_erythrophobia.php
medical procedures are misrepresented in the media
"If your patients rely on the mainstream media for medical advice, they may well think that cancer has been cured many times over, and have other inflated views about the benefits of new treatments and tests.
AND they probably would be shocked to learn about the potential downsides of many medical interventions, let alone costs.
That’s the conclusion of a comprehensive analysis of almost 2000 medical news items published in the US by print, online and television outlets between 2006 and 2013.
It was undertaken by the media watchdog Health News Review, and recently published in JAMA Internal Medicine (5 May, 2014). Most stories were judged unsatisfactory in how they covered the costs, benefits, harms and quality of the evidence supporting the new treatment or test, and how it was compared to alternatives.
“Drugs, medical devices, and other interventions were usually portrayed positively; potential harms were minimised and costs were ignored,” wrote the founder of Health News Review, Gary Schwitzer."
Melissa Sweet, Medical Observer, 24th Jun 2014
Chest wall paresthesia affects a significant but previously overlooked proportion of patients following sympathectomy
Paresthetic discomfort distinguishable from wound pain was described by 17 patients (50.0%). The most common descriptions were of ‘bloating’ (41.2%), ‘pins and needles’(35.3%), or ‘numbness’ (23.5%) in the chest wall. The paresthesia resolved in less than two months in 12 patients (70.6%), but was still felt for over 12 months in three patients (17.6%). Post-operative paresthesia and pain did not impact on patient satisfaction with the surgery, whereas compensatoryhyperhidrosis in 24 patients (70.6%) did (P=0.001). The rates and characteristics of the paresthesia following needlescopic VATS are similar to those observed after conventional VATS. Conclusions: Chest wall paresthesia affects a significant but previously overlooked proportion of patients following needlescopic VATS.
Eur J Cardiothorac Surg 2005;27:313-319
Eur J Cardiothorac Surg 2005;27:313-319
the severity of post-sympathectomy (post-SE) dysfunction
injury to the sympathetic chain during surgery must be avoided in Links to Published Research Forum: "The aim of this study was to identify retrospectively, lumbar sympathectomy (SE) using thermography (TG) and to evaluate clinically, the severity of post-sympathectomy (post-SE) dysfunction after anterior and lateral lumbar interbody fusion procedures (ALIF, XLIF).
METHODS:
Twenty eight patients with suspected SE were referred for TG to both legs. They completed our questionnaire on severity of difficulties after SE. We evaluated the ability of physical examinations to reveal the SE in contrast to TG and compared the symptoms (warmer leg and inhibited leg sweating) of SE with questionnaire responses as subjective measure and TG as objective measure.
RESULTS:
SE was diagnosed in 0.5% after ALIF at L5/S1, in 15% after ALIF at Th12-L5 and in 4% after XLIF at T12-L5. SE severely reduced the quality of life in two cases. The ability to distinguish differences in leg temperature by palpation after SE was found in 32%. All physical examinations together were insufficient for reliably disclosing SE. Subjective symptoms of SE were often false positive and proven SE by TG was often a clinically false negative.
CONCLUSION:
This is the first study to examine post-SE dysfunction objectivelya using TG after ALIF and XLIF, and the first to evaluate clinically, the severity of the post-SE syndrome. Before surgery we cannot foresee potentially poor SE results. For this reason, injury to the sympathetic chain during surgery must be avoided. The advantage of TG for identifying SE is its non-invasiveness and reliability.
http://www.ncbi.nlm.nih.gov/pubmed/24263213"
'via Blog this'
METHODS:
Twenty eight patients with suspected SE were referred for TG to both legs. They completed our questionnaire on severity of difficulties after SE. We evaluated the ability of physical examinations to reveal the SE in contrast to TG and compared the symptoms (warmer leg and inhibited leg sweating) of SE with questionnaire responses as subjective measure and TG as objective measure.
RESULTS:
SE was diagnosed in 0.5% after ALIF at L5/S1, in 15% after ALIF at Th12-L5 and in 4% after XLIF at T12-L5. SE severely reduced the quality of life in two cases. The ability to distinguish differences in leg temperature by palpation after SE was found in 32%. All physical examinations together were insufficient for reliably disclosing SE. Subjective symptoms of SE were often false positive and proven SE by TG was often a clinically false negative.
CONCLUSION:
This is the first study to examine post-SE dysfunction objectivelya using TG after ALIF and XLIF, and the first to evaluate clinically, the severity of the post-SE syndrome. Before surgery we cannot foresee potentially poor SE results. For this reason, injury to the sympathetic chain during surgery must be avoided. The advantage of TG for identifying SE is its non-invasiveness and reliability.
http://www.ncbi.nlm.nih.gov/pubmed/24263213"
'via Blog this'
most of the existing literature is geared towards assessing only the effectiveness of the surgical sympathectomy
"Given the fact that most of the existing literature is geared towards a) assessing only the effectiveness of the surgical sympathectomy procedures, and b) publishing only studies with positive results, adverse effects and complications are not systematically reported but rather as a secondary outcome. It seems, therefore, highly likely that the complications as reported here, are truly underestimated.
The study indicates that surgical sympathectomy, irrespective of operative approach and indication, may be associated with many and potentially serious complications."
Are We Paying a High Price for Surgical Sympathectomy? A Systematic Literature Review of Late Complications
http://www.jpain.org/article/S1526-5900%2800%2944124-6/abstract
The study indicates that surgical sympathectomy, irrespective of operative approach and indication, may be associated with many and potentially serious complications."
Are We Paying a High Price for Surgical Sympathectomy? A Systematic Literature Review of Late Complications
http://www.jpain.org/article/S1526-5900%2800%2944124-6/abstract
33% of patients reported compensatory hyperhidrosis that was either 'severe' or 'incapacitating'
Endoscopic thoracic sympathectomy for primary hyperhidrosis of the...IPG487 Safety: "Compensatory hyperhidrosis was reported in 92% (416/453), 86% (1720/2000) and 74% (1265/1700) of patients in 3 case series. In 2 of these studies 33% (557/1700 and 150/453) of patients reported compensatory hyperhidrosis that was either 'severe' or 'incapacitating'."
Louise Field, 27, died after ETS surgery (1/3) | VerySweatyBetty.com
Louise Field, 27, died after ETS surgery (1/3) | VerySweatyBetty.com: "A ‘fit and healthy’ young woman was left brain dead after a pioneering operation to reduce her excessive sweating went catastrophically wrong, a medical panel has heard. Louise Field, 27, suffered severe brain damage when doctors accidentally punctured her lung and pumped gas into her stomach, the General Medical Council heard. She died two days later. Vascular surgeon Dr Michael Ormiston and anaesthetist Dr Wasfy Yanny face a catalogue of charges arising from the bungled operation at a Bupa Hospital in Harpenden, Hertfordshire.
Dr Ormiston, who had carried out the operation a handful of times, first punctured the keen sportswoman’s lung with a needle then pumped carbon dioxide into her stomach. Dr Yanny failed to take action when Ms Field’s oxygen levels dropped dangerously low and should have realised this damaged the patient’s brain, the hearing was told. Ms Field had
Louise Field
chosen to undergo an operation to reduce heavy sweating on her hands and feet, the GMC heard.
Sarah Plaschkes, for the GMC, told the hearing: ‘She was born on February 18, 1975, and was to die tragically on March 22, 2002, aged just 27. ‘She was fit and healthy and played a lot of sport however she was embarrassed by excessive sweating of the hands and feet."
'via Blog this'
Dr Ormiston, who had carried out the operation a handful of times, first punctured the keen sportswoman’s lung with a needle then pumped carbon dioxide into her stomach. Dr Yanny failed to take action when Ms Field’s oxygen levels dropped dangerously low and should have realised this damaged the patient’s brain, the hearing was told. Ms Field had
Louise Field
chosen to undergo an operation to reduce heavy sweating on her hands and feet, the GMC heard.
Sarah Plaschkes, for the GMC, told the hearing: ‘She was born on February 18, 1975, and was to die tragically on March 22, 2002, aged just 27. ‘She was fit and healthy and played a lot of sport however she was embarrassed by excessive sweating of the hands and feet."
'via Blog this'
"He knows the procedure is controversial because of the unpredictability of side-effects"
Information about surgery for sweaty hands: "surgeon "knows the procedure is controversial because of the unpredictability of side-effects"
"Ferrar believes much of the controversy lies in surgeons, mainly in America, who perform the surgery on anyone who asks for it, rather than the severe end of the spectrum.
"In America there are so many that have been operated on when it hasn't been necessary, or the surgeon has given the patient false expectations, that there are support groups for people who've had complications or adverse effects. The people that come to me are almost self-selecting; they've tried everything else."
The youngest patient he has performed an endoscopic thoracic sympathectomy on was 8 years old, with most being in puberty (when the condition tends to arise). Or they are in their 20s when they are beginning relationships and jobs."
Publication info: Waikato Times [Hamilton, New Zealand] 07 Apr 2012: 22."
"Ferrar believes much of the controversy lies in surgeons, mainly in America, who perform the surgery on anyone who asks for it, rather than the severe end of the spectrum.
"In America there are so many that have been operated on when it hasn't been necessary, or the surgeon has given the patient false expectations, that there are support groups for people who've had complications or adverse effects. The people that come to me are almost self-selecting; they've tried everything else."
The youngest patient he has performed an endoscopic thoracic sympathectomy on was 8 years old, with most being in puberty (when the condition tends to arise). Or they are in their 20s when they are beginning relationships and jobs."
Publication info: Waikato Times [Hamilton, New Zealand] 07 Apr 2012: 22."
Sympathectomy is by no means a benign procedure, and sympathectomy for sweating can induce pain and allodynia
"Sympathectomy is by no means a benign procedure, and sympathectomy for sweating can induce pain and allodynia at the border zone which is sometimes associated with pronounced increase in sweating in that area." (p. 534) Surgical Disorders of the Peripheral Nerves by Rolfe Birch Springer, Jan 21, 2011 - Medical - 512 pages original article published in Ann R Coll Surg Engl 2002; 84:181-184"
Patients who undergo sympathotomy for hyperhidrosis will commonly report "clinically bothersome" compensatory hyperhidrosis.
J Thorac Cardiovasc Surg. 2014 Apr;147(4):1160-1163.e1. doi: 10.1016/j.jtcvs.2013.12.016. Epub 2014 Jan 2.
"The custom of a majority is no guarantee of safety and is seldom a guide to best medical practice." in Legal Forum
Cameron`s claim that there has been only one death attributable to synchronous bilateral thoracoscopic sympathectomy is implausible. Surgeons and anaesthetists are reticent in publicizing such events and Civil Law Reports of settled cases are an inadequate measure of the current running total. The custom of a majority is no guarantee of safety and is seldom a guide to best medical practice.
Jack Collin,
Consultant Surgeon
Oxford
http://www.bmj.com/content/320/7244/1221?tab=responses
Jack Collin,
Consultant Surgeon
Oxford
http://www.bmj.com/content/320/7244/1221?tab=responses
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