Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Thoracic sympathectomy is a valuable treatment option for patients with primary hyperhidrosis. However, controversies exist about the optimal technique of sympathectomy and the association between localisation of the focal hyperhidrosis and postoperative results. ⋯ Video-assisted thoracoscopic resection of the sympathetic chain from T2 to T4-5 is safe and effective and leads in almost 100% of cases to the elimination of palmar and axillary hyperhidrosis. In contrast to the excellent results in patients with palmar-plantar and palmar-axillary hyperhidrosis, outcome in patients with isolated axillary hyperhidrosis was impaired by a high rate of disturbing compensatory sweating.
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Pancreatic cancer is one of the most aggressive tumours. Despite enormous progress in multimodal therapeutic options, surgical resection remains the only chance for curative treatment. Several surgical procedures have been developed with the intention to improve the outcome of this disease. ⋯ In case of tumour infiltration of the portal or the superior mesenteric vein, survival seems to be improved by resection of the affected vessel. Resection of the portal vein can be done safely without affecting morbidity or mortality. In the presence of tumour infiltrating the hepatic artery or other arterial vessels, there is still a need for controlled clinical trials to confirm any survival benefit from arterial resection.
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Osteoarthritis or instability of the acromioclavicular (AC) joint may cause significant impairment or pain in the shoulder. If symptoms of osteoarthritis persist despite conservative treatment, distal clavicular resection is usually curative. Injuries and instability are classified according to Rockwood. ⋯ An underestimated acute injury to the AC joint may result in chronic instability. Different techniques are presented for operative treatment of significant acute or chronic instability. Arthroscopic methods are now available for treating both acute and chronic instability.
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A young male patient presented with right lower quadrant abdominal pain 3 years after laparoscopic appendectomy. Clinical and radiological findings were in keeping with acute appendicitis and the diagnosis of stump appendicitis could be confirmed by laparoscopy. This case serves as a reminder of this differential diagnosis and to discuss therapy and prevention of this rare condition.