Is clipping the preferable technique to perform sympathicotomy? A retrospective study and review of the literature

PURPOSE Thoracoscopic sympathetic surgery is nowadays a broadly accepted technique in the treatment of primary hyperhidrosis as well as facial blushing. The objective of this study was to compare the two currently most commonly used methods for thoracic sympathicotomy: transection (ETS) and clipping (ETC.). METHODS This is a retrospective study on a total of 63 patients, who underwent rib-oriented sympathicotomy, either by transection (n = 36, 57 %) or by clipping (n = 27, 43 %). Moreover, the up-to-date international literature is reviewed concerning which level(s) of the sympathetic trunk should be addressed, depending on the patients underlying condition. Furthermore, the highly controversial topic of reversibility of sympathetic clipping is debated. RESULTS Our results confirm that clipping is at least as effective as transection of the sympathetic chain in the treatment of hyperhidrosis and facial blushing. Furthermore, the analysis of all larger studies on unclipping in humans shows a surprisingly high reported reversal rate between 48 and 77 %. CONCLUSIONS Depending on the symptoms of the patient, different levels of the sympathetic chain should be addressed. When a higher rib level such as R2 is approached, which more likely will result in moderate to severe compensatory sweating, clipping should be preferred as it seems that this technique has indeed a potential for reversibility. As demonstrated, this method is at least as effective as an irreversible transection of the sympathetic chain.

Unusual Eruptions Associated with Mycoplasma pneumoniae Respiratory Infections: Review of the Literature.

BACKGROUND Maculopapular or urticarial eruptions and erythema multiforme sometimes occur in patients affected with Mycoplasma pneumoniae respiratory infections. Further eruptions have also been reported. OBJECTIVE To review the literature addressing M. pneumoniae respiratory infection and rather unusual eruptions. METHODS Computer-based search in the U.S. National Library of Medicine database as well as in the search engine Google. RESULTS We found a possible relationship between M. pneumoniae infection and Fuchs' syndrome (n = 37), varicella-like eruptions (n = 8), Henoch-Schönlein syndrome and further leukocytoclastic vasculitides (n = 21) and erythema nodosum (n = 11). A temporal relationship was also observed with 2 cases of Gianotti-Crosti syndrome. Finally, there exists reasonable evidence that pityriasis rosea Gibert and pityriasis lichenoides et varioliformis acuta Mucha-Habermann are not associated with Mycoplasma infections. CONCLUSION This review implies that M. pneumoniae may cause, in addition to erythematous maculopapular (or urticarial) eruptions and erythema multiforme, Fuchs' syndrome and varicella-like eruptions. Furthermore, there is an intriguing link with leukocytoclastic vasculitides or erythema nodosum that deserves further investigation.

(Appendix) Benthic foraminifera distribution of upper Creatceous and Paleocene at DSDP Hole 72-516F

Benthic foraminifers of the Coniacian-Santonian through the Paleocene were recovered from a continuous pelagic carbonate section from Hole 516F on the Rio Grande Rise. Sixty-five genera and 153 species have been identified, most of which have been reported from other localities. Bathyal depths are reflected in the benthic assemblages dominated by gavelinellids (Gavelinella beccariiformis, G. velascoensis), Nuttallides truempyi, and various gyroidinids and buliminids. Rapid subsidence during the Coniacian-Santonian from nearshore to upper to middle bathyal depths was followed by much reduced subsidence, with the Campanian-Paleocene interval accumulating at middle bathyal to lower bathyal depths. A census study based on detailed sampling reveals major changes in benthic faunal composition at the Cretaceous/Tertiary boundary transition. It was a time of rapid turnover, with the extinctions of numerous species and the introduction of many new species. Overall, species diversity decreases about 20%, and approximately one-third of latest Maestrichtian species do not survive to the end of the Cretaceous. This shift indicates a significant environmental change in the deep sea, the precise nature of which is not apparent from the foraminifers or their enclosing sediments.

Cenozoic planktonic foraminifera in the Goban Spur Region

Cenozoic planktonic foraminiferal biostratigraphy at DSDP-IPOD Leg 80 sites documents the existence of regionwide stratigraphic gaps in the Paleocene and middle Miocene. Episodes of carbonate dissolution also occurred during the Paleocene at several sites, particularly at Site 549, where destruction of foraminiferal tests may obscure evidence of an unconformity. The middle Miocene hiatus is apparent at each site where Neogene sediments were continuously cored. Upper Miocene sediments at Site 550 (the only abyssal site) are characterized by moderate to extensive dissolution of planktonic foraminifers, but they contain abundant specimens of Bolboforma that mark this stratigraphic interval (von Daniels and Spiegler, 1974, doi:10.1007/BF02986990; Roegl, 1976, doi:10.2973/dsdp.proc.35.133.1976; Murray, 1979, doi:10.2973/dsdp.proc.48.116.1979; Müller et al., 1985, doi:10.2973/dsdp.proc.80.117.1985). Although foraminiferal evidence is not conclusive, nannofossils indicate a widespread Oligocene unconformity (Müller, 1985). Several oceanographic factors, not just simple sea-level change, probably interacted to produce these regional unconformities. There are also dramatic differences in the Cenozoic sedimentary record among Leg 80 sites, indicating that each has had a distinct geologic history. The thickness of the Cenozoic section varies from 100 m at Site 551 to 471 m at Site 548. The thickness of individual chronostratigraphic units also varies, as do the number and stratigraphic position of unconformities other than those mentioned. Differences in the stratigraphic record from site to site across the continental slope result from (1) location in separate half-graben structures, (2) varying location across the developing margin, and (3) difference in position relative to the seaward edge of the enclosing half-graben. Except for turbidites, deposition at Site 550 (abyssal) was largely independent of developments on the continental slope; but it was affected by oceanographic events widespread in the North Atlantic.