Biomedical subjects

Fritz J Baumgartner

Publications and source records attributed to Fritz J Baumgartner.

2 recordsLinked to original sources

PubMed2003

Severe hyperhidrosis: clinical features and current thoracoscopic surgical management.

BACKGROUND: Severe hyperhidrosis is a debilitating disorder primarily affecting the palmar, plantar, and axillary regions. The purpose of our study was to review patient characteristics, surgical technique, and outcome of patients undergoing outpatient thoracoscopic sympathectomy for severe hyperhidrosis. METHODS: A series of 309 hyperhidrosis patients underwent thoracoscopy for T2-T3 sympathectomy. Of these, 180 underwent prospective evaluation to more precisely identify pre- and postoperative features. RESULTS: The primary indication for surgery was palmar hyperhidrosis (PH) in 302 of 309 patients (97.7%), although in 7 patients (2.3%) axillary hyperhidrosis (AH) was the primary indication. A family history was elicited in 74 of 132 (56.1%) and a provocative response to hand lotion was present in 101 of 132 (76.5%). Thoracoscopic sympathectomy afforded almost instantaneous cures for PH, with marked improvement in 100% for whom the sympathectomy was done. Of 180 patients prospectively questioned in detail, 173 (96.1%) had some degree of plantar hyperhidrosis. Of these, 148 (84.4%) had some improvement, with 70 (40.5%) achieving complete relief of the plantar hyperhidrosis. In 98 patients who had some complaints of AH, 68 (69.4%) were completely relieved of the AH, while 25 (25.5%) were relieved but not completely cured. In 7 patients, the primary indication for sympathectomy was AH and of these, 3 (42.9%) had complete relief, 2 (28.6%) had partial relief, and 2 (28.6%) had no relief. Of the entire series of 309 patients, 4 (1.3%) developed severe compensatory hyperhidrosis (CH). In 180 prospectively questioned patients, CH was present in 81 (45%). CONCLUSIONS: The most frequent presentation of hyperhidrosis involves the hands and feet. A family history of the disorder is common, and there is usually a provocative effect with hand lotion. Sympathectomy at the level of the T2-T3 ganglia is curative for PH, and in 80% of instances will improve plantar hyperhidrosis when in combination with PH. Sympathectomy for AH is not as effective as for PH. CH is common, occurring in nearly half, but only rarely is extreme and problematic. Bilateral thoracoscopic sympathectomy may be safely done as an outpatient procedure for most patients.

Adolescent↗

PubMed2002

The presenting chest roentgenogram in acute type A aortic dissection: a multidisciplinary study.

Acute type A aortic dissection requires early diagnosis and prompt surgical intervention. It is not entirely clear whether patients with this form of dissection have clear-cut chest roentgenogram (CXR) patterns or whether the CXR can guide the physician in directing further workup for acute aortic dissection. The purpose of this study is to evaluate the impact of the initial CXR in arousing suspicion for acute type A aortic dissection. Twelve physicians from four specialties (emergency medicine, radiology, cardiology, and cardiothoracic surgery) evaluated the presenting CXR of ten patients with acute type A aortic dissection and the CXRs of ten normal individuals in a blinded manner. They were asked whether the CXRs were normal or abnormal (part A) and what the findings were and then were asked whether the CXRs were suspicious for acute aortic dissection (part B) and what the findings were. In part A, of the normal CXRs 81 of 120 (68%) readings were recorded as normal. Of the dissection CXRs 112 of 120 (93%) readings were recorded as abnormal (P < 0.001). In part B, the physicians were asked specifically about suspicion for aortic dissection. Of the normal CXRs 101 of 120 (84%) readings were listed as not suspicious for dissection (i.e., 16% of the normal CXRs were listed as supsicious for dissection). Of the dissection CXRs 88 of 120 (73%) readings were recorded as suspicious for dissection (p < 0.001). The most frequent findings on a dissection CXR when physicians were specifically asked about dissection included widened mediastinum in 46 of 120 (38%) followed by not suspicious for dissection in 32 of 120 (27%). Among the physician specialties the only statistically significant finding was that the cardiology group was the most likely group to find an abnormality in a "normal" CXR. This data indicates that the presenting CXR is neither sensitive nor specific for acute type A dissection. In a patient with a suspicious history or physical examination, however, a CXR showing mediastinal widening or other aortic abnormalities should increase the suspicion for dissection and warrant further workup. Furthermore in a patient with a clinical suspicion a normal CXR reading should not delay echocardiography to rule out type A dissection.

Acute Disease↗