Biomedical subjects

G Holak

Publications and source records attributed to G Holak.

3 recordsLinked to original sources

PubMed2003

Limited endoscopic thoracic sympathetic block for hyperhidrosis of the upper limb: reduction of compensatory sweating by clipping T4.

BACKGROUND: Endoscopic thoracic sympathicotomy of T2 to T4 (ETS 2-4) has evolved into an effective treatment for severe hyperhidrosis of the upper limb. Complications such as bleeding or Horner's syndrome are rare, but side effects such as compensatory and gustatory sweating occur in 30-50% of patients. Following the Lin-Telaranta classification, we aimed to reduce these side-effects by clipping T4 solely [endoscopic thoracic sympathetic block (ESB 4)]. We present our experience and clinical results using this method, with emphasis on patients' quality of life. METHODS: A total of 176 procedures (91 patients) were carried out in the ETS 2-4 group and 103 procedures (53 patients) in the ESB 4 group: 60.4 and 43.4% had palmar hyperhidrosis, 8.8 and 5.7% had isolated axillary, and 30.8 and 50.9% had combined manifestations, respectively. Follow-up was 22.1 months (obtained from 79.1% of patients) for the ETS 2-4 group and 7.5 months for the ESB 4 group (obtained from 88.7%). RESULTS: The success rate was similar for both groups: 87.9 and 64.5% had completely dry limbs, 9.9 and 35.5% ( p < 0.0002) were nearly dry, and 2.1 and 0% remained wet. (ETS 2-4 vs ESB 4). Although the armpits remained slightly humid in more patients in the ESB 4 group, 100% stated full satisfaction. Complications did not differ significantly. However, compensatory sweating (55.6 vs 8.5%, p = 0.0002) and gustatory sweating (33.3 vs 2.1%, p = 0.0019) were markedly reduced (ETS 2-4 vs ESB 4). Quality of life was assessed by a hyperhidrosis index, which significantly improved in most patients. CONCLUSIONS: ETS 2-4 and ESB 4 have similar success rates in the treatment of upper limb hyperhidrosis. The major side effects of compensatory and gustatory sweating were effectively reduced by the limited method of clipping T4, and patients' satisfaction and improvement in quality of life were remarkable.

Adult↗

PubMed2000

Morphometric and functional results after CO(2) laser welding of nerve coaptations.

BACKGROUND AND OBJECTIVE: Several reports describe nerve coaptations by laser welding in combination with stay sutures and bonding material. This study was undertaken to obtain functional and morphologic information by using a nerve coaptation technique by epineurial CO(2) laser welding only. STUDY DESIGN/MATERIALS AND METHODS: The sciatic nerves of 24 rats were transected and epineurially coapted with the CO(2) laser at 60 mW or with microsutures as a control. Walking track analysis were carried out to evaluate the functional recovery, and the nerves were harvested for histology after 6 months of regeneration. RESULTS: None of the 24 nerves showed dehiscence of the coaptations, and all showed good nerve fiber regeneration. Better results were obtained for the functional evaluation of the sciatic function index (P < 0.02) and the toe spread index (P < 0.04) from the laser nerve coaptations. Likewise, the morphologic evaluations of the fiber density (P < 0.04) and area fraction (P < 0.002) were better in the laser group. CONCLUSION: CO(2) laser welded nerve coaptations are as successful as their sutured counterparts and may become a promising alternative in clinical practice.

Animals↗

PubMed1998

[Nerve coaptation using CO2 milliwatt laser].

The technique of laser tissue welding with a low-output CO2 laser has become popular due to the minimal amount of nerve tissue damage caused. The purpose of this study was to ascertain the efficacy of nerve coaptation by laser tissue welding in comparison to micro-sutures. In a first series of 15 rats, peripheral nerves were transsected. 24 nerves were coaptated by laser welding (LW) with different parameters in order to evaluate the optimal laser settings. For comparison, six nerves were coapted (NS) with four 10/0 nylon sutures. Finally, the nerves were removed and the tensile strength of the different coaptations determined. The best results of the laser welds were obtained at laser settings of 40 to 60 mW in the continuous mode resulting in a tensile strength of 9.5 +/- 2.2 g. The tensile strength was 39.3 +/- 7.3 g for the sutured coaptation. In a second series, one sciatic nerve was coapted in thirteen rats by laser welding (LW) (60 mW, cont. mode) and in eleven rats using four 10/0 nylon sutures (NS). After six months, the Sciatic Function Index (SFI) was evaluated and the nerves were harvested for histological examination of transverse and longitudinal sections. All animals showed good regeneration and none of the 24 nerve coaptations showed dehiscence. The SFI was for the NS-group -94 +/- 23 and for the LW-group -77 +/- 20. The mean number of myelinated nerve fibres (NS 10,170 +/- 2512 vs. LW 11,902 +/- 1649) and the fibre diameter (NS 4.30 +/- 0.14 um vs. LW 4.02 +/- 0.59 microns) of the nerves distal to the coaptation were similar in both groups and showed no statistical difference. We conclude that nerve coaptation by CO2-laser welds are as successful as the 10/0 nylon sutures in the animal model. Improvements of welding techniques may in the future reduce nerve damage even further and so yield even better functional results.

Animals↗