Mark Mozes

Palmar hyperhidrosis and its surgical treatment: a report of 100 cases.

One hundred patients with primary palmar hyperhidrosis (HH) underwent bilateral upper dorsal sympathectomy (UDS) by the supraclavicular approach. Pre-operative epidemiological and clinical data are described. The immediate and late results, as well as the complications and side-effects are detailed. Follow-up was completed on 93 patients between four and 50 months after the operation (average 18 months). Of 93 patients, 91 had drying of the hands. In 58% some moisture returned to the hands but in no case did the hyperhidrotic state recur. Subjective patient evaluation was excellent or good in 83 patients (89%) and only one patient (a technical failure) was completely dissatisfied. Reasons for some degree of dissatisfaction with operation were mainly compensatory HH in non denervated areas, and Horners syndrome. Compensatory HH usually decreased with passage of time and, permanent Horners syndrome occurred in 8% of patients (4% of procedures). Technical failure can be avoided by use of frozen section examination intraoperatively. For severe cases of palmar HH that cause social, professional and emotional embarassment, bilateral simultaneous UDS by the supraclavicular approach is the procedure of choice: Morbidity is small, and almost all patients enjoy improved quality of life after the operation.

Cellular Sensitivity to Collagen in Thromboangiitis Obliterans

We studied 39 patients with thromboangiitis obliterans to determine their cellular and humoral immune responses to native human collagen Type I and Type III, which are constituents of blood vessels. Cell-mediated sensitivity to these collagens was measured by an antigen-sensitive thymidine-incorporation assay. The mean stimulation index--the ratio of thymidine incorporation in the presence of antigen to that in its absence--with both Type I and Type III collagens used as antigens was significantly higher in patients with thromboangiitis obliterans than in patients with arteriosclerosis obliterans or in healthy male controls. Lymphocytes from 77 per cent of the patients with thromboangiitis obliterans exhibited cellular sensitivity to human Type I or Type III collagens (or both). Furthermore, in 17 of 39 serum samples from the patients with thromboangiitis obliterans a low but significant level of anticollagen antibody activity was detected, whereas there was no antibody activity in serum samples from controls. These results suggest that there is a distinct etiologic factor in this disease and also raise the possibility of differentiating between thromboangiitis obliterans and arteriosclerosis obliterans by immunologic means.

Gangrene of toes with normal peripheral pulses.

Ten patients with pregangrenous and gangrenous changes of the toes in the presence of normal peripheral pulses are described. In the absence of diabetes this is an uncommon condition and is only rarely reported upon in the literature. Four patients had non occlusive artcriosclerotic changes in large arteries; three suffered from thrombocytosis and one from polycythemia vera; one patient had a monoclonal gamopathy and one was exposed to cold three months before the onset of gangrene. None of these patients smoked regularly.Severe pain usually preceded the gangrene. The process did not progress proximally in any patients, and in those who underwent toe amputations the healing was uneventful. Vasodilators and low-molecular dextran were not effective. Lumbar sympathectomy was performed in three patients, also with no effect on the course of the disease. Treatment of hematological disorders gave relief in three patients. Proximal arteriosclerotic changes should be corrected if possible to eliminate a source of emboli. In two patients anti-platelet aggregation agents provided relief. Toe amputation should be conservative and performed when definite demarcation appears between necrotic and viable tissue. This condition has a benign prognosis.

Vena caval obstruction: some epidemiological observations in 76 patients.

Obstruction of the superior vena cava (SVC) or the inferior vena cava (IVC), each with its typical clinical picture, are usually easily diagnosed but their clinical significance is sometimes obscure. Most cases of caval obstruction are not primary, and the diagnosis of the primary underlying condition is not always immediately apparent. There are indications that within the last 20-25 years there is a change in the pattern of conditions associated with caval obstruction.1-3 A knowledge of the epidemiology of caval obstruction may assist in evaluation of its clinical significance in some obscure cases. The present report deals with an analysis of the clinical conditions associated with 79 caval obstructions in 76 patients.

Renal venography in the diagnosis of agenesis and small contracted kidney

Selective renal venography was found to be the most reliable method in the differentiation between unilateral renal agenesis and non-functioning contracted kidney. Examples are given that demonstrate that all the other diagnostic methods, including abdominal aortography, cystoscopy and retrograde pyelography, may be misleading in the diagnosis of renal agenesis or a non-functioning small kidney. In renal agenesis the lobar veins of the kidney are absent and only the non-renal tributaries of the renal vein, i.e. adrenal and sex veins, are visualized. In a non-functioning small contracted kidney a normal or a diminished-sized main renal vein with its corresponding lobar veins is demonstrated.

Angiographic diagnosis of leiomyomatous small bowel tumors.

The angiographic features of leiomyomatous tumors of the small bowel are described in three cases. Selective celiac and superior-mesenteric angiography disclose large, sometimes multiple, feeding arte

Angiographic demonstration of systemic portal collaterals in renal vein occlusion.

A patient with left renal vein occlusion due to carcinoma of the kidney is reported in whom selective renal angiography demonstrated venous drainage from the affected kidney to the portal system. This shunt was effected by the opening up of collateral channels extending from the intrarenal veins via perforating and pararenal capsular veins, retroperitoneal veins and finally by way of the inferior mesenteric to the superior mesenteric vein.

Angiography in the diagnosis of subphrenic abscess

Coeliac angiography was diagnostic in one acute and two chronic right-sided subphrenic abscesses. The main angiographic features were: 1. stretching of the main branches of the hepatic artery, and 2. displacement of the sharply defined right border of the liver from the lateral abdominal wall, best seen during the hepatographic phase. The difficulties in diagnosis of subphrenic abscesses by other diagnostic methods is described and the importance of angiography in certain cases of acute and chronic subphrenic abscesses is stressed.

A Clinical Study of Buerger's Disease in Israel.

Excerpt In view of the long held association of Buergers disease in Jews and the recent controversy concerning this disease and arteriosclerosis obliterans (ASO), a clinical investigation of Buerg...