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Biomedical subjects

G Claes

Publications and source records attributed to G Claes.

At least 19 recordsLinked to original sources
PubMed1995

Endoscopic transthoracic sympathicotomy for severe angina.

We evaluated the antianginal effects of endoscopic transthoracic sympathicotomy (ETS) in 24 patients not eligible for coronary bypass surgery or angioplasty. In this procedure, the sympathetic chain is electrocoagulated under general anaesthesia. No major surgical complications occurred. The frequency of anginal attacks was significantly reduced (p = 0.001). The mean increase in maximum exercise capacity was 13 (SD 21) W (p = 0.009). ST depression at maximum comparable workload was reduced by 0.052 (0.10) mV (p = 0.005). Global ejection fraction during exercise and metaiodobenzylguanidine uptake were unchanged. Heart rate variability analysis showed a reduction of the ratio between low and high frequencies at tilt test (-1.00 [0.96]; p < 0.001). We conclude that ETS can be done without major complications, alleviates angina, and increases maximum working capacity in patients with advanced coronary disease.

Aged↗
PubMed1995

Endoscopic transthoracic sympathectomy: an efficient and safe method for the treatment of hyperhidrosis.

BACKGROUND: Hyperhidrosis of the palms, axillae, and face has a strong negative impact on the quality of life for many persons. Existing nonsurgical therapeutic options are far from ideal. Definitive cure can be obtained by upper thoracic sympathectomy. The traditional open surgical technique is a major procedure; few patients and doctors have found that risk-benefit considerations favor surgery. Endoscopic minimal invasive surgical techniques are now available. OBJECTIVE: We investigated whether endoscopic ablation of the upper thoracic sympathetic chain is efficient and safe in the treatment of hyperhidrosis. METHODS: We treated 850 patients with bilateral endoscopic transthoracic sympathectomy. RESULTS: There was no mortality or life-threatening complication. Nine patients (1%) required intercostal drainage because of hemothorax or pneumothorax. Treatment failure occurred in 18 cases (2%) and symptoms recurred in 17 patients (2%). At the end of follow-up (median, 31 months) 98% of the patients reported satisfactory results. CONCLUSION: Endoscopic transthoracic sympathectomy is an efficient, safe, and minimally invasive surgical method for the treatment of palmar, axillary, and facial hyperhidrosis.

Adolescent↗
PubMed1994

Hyperhidrosis.

Explore the source record for details and available documents.

Humans↗
PubMed1994

Thoracoscopic sympathicotomy for hyperhidrosis--surgical technique, complications and side effects.

Thoracic sympathectomy is a very effective treatment of palmar hyperhidrosis. The described endoscopic technique has given good primary results in 99% of patients. After another session with this type of "minimal invasive surgery" 100% of the hands were satisfactorily dry. The hospital stay is just one post-operative day and the sick-leave is about a week. The drawbacks are minimal. Pain is tolerable and only eight patients needed a post-operative Bülau-drainage because of pneumothorax or bleeding. About 50% of patients experience a compensatory increased sweating of the trunk, but this is related to a warm environment and regulation of body temperature and seems to decrease with time. This technique makes it possible to treat all those suffering from palmar hyperhidrosis which can be a substantial, but underestimated handicap. To meet this kind of patient after a successful operation is extremely satisfying even for the surgeon. The post-operative wet and cold hand has immediately post-operatively become warm and dry.

Adolescent↗
PubMed1994

Endoscopic electrocautery of the upper thoracic sympathetic chain: a safe and simple technique for treatment of sympathetically maintained pain.

Transthoracic endoscopic electrocautery of the upper thoracic ganglia was applied to seven patients with sympathetically maintained pain (SMP) in the upper extremity, diagnosed by local anaesthetic stellate ganglion blocks. The mean (SD) pain intensity of 67 (13) mm as evaluated by means of a visual analogue scale was reduced by 79 (27%) postoperatively and this effect persisted after 3 months. Long term follow up comprises two patients so far (one year and two years, respectively) who have had no recurrence of SMP. No complications occurred. The operation was found to be fast, safe and effective and it highlights the enigmatic role of the sympathetic nervous system in chronic pain.

Adult↗
PubMed1994

Thoracoscopic sympathicotomy for arterial insufficiency.

Arterial insufficiency of the hands due to vascular spasm-morbus Raynaud is an extremely unpleasant condition. Elicited by cold temperatures, the disease can make it impossible for the patient to go out in cold environments. The condition seldom leads to skin necrosis, which is the case in arterial insufficiency caused by vascular occlusion. In both cases arterial insufficiency may be diminished by thoracic sympathectomy. Our test series of operations included 14 patients with m. Raynaud or vascular occlusion. All experienced improvement, with warm, dry hands and satisfactory healing after thoracoscopic sympathicotomy. However, after six months, the original symptoms recurred in all the patients with m. Raynaud, while the improvement continued in the patients with vascular occlusion during the two to four year period of observation.

Arterial Occlusive Diseases↗
PubMed1994

Cardiac effects of endoscopic electrocautery of the upper thoracic sympathetic chain.

Bilateral endoscopic electrocautery of the upper thoracic sympathetic ganglia (T2-4) was performed, mainly for palmar hyperhidrosis, on 535 patients. The aim of this study was to evaluate the effects of this procedure on cardiac and physical performance. A subgroup of 18 patients underwent cycle ergometer test with ECG recordings before and three months after surgery. After the operation, a significantly reduced heart rate at rest (12%) as well as during exercise and during recovery after exercise was found. The systolic blood pressure was reduced only at rest (7%) and the diastolic blood pressure was not significantly altered. Maximal workload was not affected by the operation and only a few patients had noticed their reduced heart rate. Three patients with angina pectoris and three with incapacitating tachycardia related to mental stress were operated on with excellent results. Thoracoscopic sympathicotomy is a safe, fast, cheap and efficient method for cardiac sympathetic denervation. This procedure might constitute an alternative to long-term thoracic epidural anaesthesia and implantation of thoracic electric stimulation devices in patients not suited for aortocoronary by-pass. Patients who require cardiac beta-receptor blockers and suffer from side effects of these drugs might also benefit from surgical cardiac sympathetic denervation.

Adolescent↗
PubMed1993

Endoscopic procedures of the upper-thoracic sympathetic chain. A review.

The upsurge of endoscopic surgical procedures now includes procedures of the thoracic sympathetic chain. The number of articles on this issue is rapidly increasing. This article reviews the indications for as well as the technique, complications, side effects, and results of endoscopic upper-thoracic sympathetic ablation. Since 1977, nearly 900 cases have been described in the literature. The main indication is usually hyperhidrosis. The described techniques vary in detail, but the common denominators are simplicity, expedience, minimal surgical trauma, few complications, and low cost compared with standard methods of open surgery. The results are excellent, durable, and stand well compared with results of previous open techniques. Due to the overwhelming advantages of endoscopic methods, we can foresee an increasing adoption of these techniques and a subsequent relegation of the various open surgical procedures of the upper-thoracic sympathetic chain.

Humans↗
PubMed1993

Thoracoscopy for autonomic disorders.

Sympathetic denervation of the arm, the hand, and the heart may now be performed using minimal thoracoscopic procedures. During a 5-year period more than 500 patients were operated on with no major and only a few minor complications. An operation time of 25 minutes, a hospital stay of 1 day, and sick leave of less than 1 week have made the operation suitable for autonomous disorders such as hyperhidrosis. Other conditions such as causalgia, vascular insufficiency, and angina pectoris may be improved or disappear after sympathectomy, but the recurrence rate in Raynaud's disease is high.

Autonomic Nervous System Diseases↗
PubMed1993

Endoscopic electrocautery of the thoracic sympathetic chain. A minimally invasive way to treat palmar hyperhidrosis.

Four hundred and fifty patients with palmar hyperhidrosis have undergone endoscopic thoracic sympathetic electrocautery since 1987 in our department. The procedure requires only minor modifications of standard laparoscopic and urological equipment. The median operating time for a bilateral procedure was 31 minutes (15-120), hospital stay was 1 day postoperatively (1-8), and patients returned to work within 4 (1-40) days. Complications in the whole material were few and mild, pneumothorax (n = 2), haemothorax (n = 1), and Horner's syndrome (n = 1). Five patients required reoperation (four because of primary failure to destroy the nerve and one for recurrent symptoms). The first consecutive 130 of these patients have been followed up by a questionnaire. At follow-up (median 196 days after operation, range 35-1419) all patients but three, who are awaiting reoperation were satisfied with the result. The discomfort and side effects of the operation were in most cases mild and short. This technique makes it possible to widen the indications for operation for people with palmar hyperhidrosis.

Adult↗
PubMed1991

Acute lower limb ischemia: failure of anticoagulant treatment to improve one-month results of arterial thromboembolectomy. A prospective randomized multi-center study.

The value of short-term anticoagulant treatment in improving the early outcome in patients operated on for acute lower-limb ischemia has been debated and so far unproven. In this prospective randomized multi-center study, 188 such patients were randomized on admission, either to preoperative and postoperative anticoagulant medication (AC group, n = 94) or no anticoagulant treatment during the first month after surgery (O group, n = 94). Background factors were evenly distributed in the two groups, and 89% of the cases were considered as embolic. Analysis on an intention-to-treat basis showed no differences in outcome after 30 days. Good results, survivors who had amputation, and patients who died in the two groups are given respectively: AC group, 61%, 9%, 30%; O group, 65%, 11%, 24%. The results were similar in the two treatment groups also if only patients with a cardiac source of embolism were analyzed. Local bleeding complications were more common in the AC group (17% vs 2%, p less than 0.01). It is concluded that preoperative and early postoperative anticoagulant medication should not be routinely administered since such treatment is unlikely to improve the short-term results of lower-limb arterial thromboembolectomy while bleeding complications increase. The possible value of late (beyond 1 month) long-term anticoagulant treatment remains to be studied.

Amputation, Surgical↗
PubMed1990

A stable prostacyclin analogue (iloprost) in the treatment of ischaemic ulcers of the lower limb. A Scandinavian-Polish placebo controlled, randomised multicenter study.

The clinical efficacy of the prostacyclin analogue iloprost was studied during a 2 week treatment and 6 month follow-up period in 103 patients with ischaemic ulcers who were randomised to receive active treatment or placebo. Responders were defined as those patients who achieved healing of at least one third of the ulcer area during the study period. The overall responder rate was 41.3%, compared with 25% for the control group (P = 0.086). Side effects including flushing and headache, were common. The study population had a mortality of 23% during the 6 month period, the amputation rate was 43.5% for iloprost and 50% for placebo treated patients. In this severely diseased population of patients a treatment period limited to 2 weeks did not sufficiently improve ulcer healing.

Adult↗