The main objective of this study was to determine if there are variations in the level of improvement of the palmar and plantar hyperhidrotic symptoms, as well as the incidence and intensity of the sudomotor reflex, throughout the seasons of the year, after thoracic sympathectomy for hyperhidrosis. The study also looks for the real impact of these variables in the long-term satisfaction. A cohort of 75 patients was followed through distinct seasons. A multivariate analysis was performed to identify possible variables responsible for dissatisfaction. Both the palmar (P=0.002) and plantar (P<0.001) symptoms and the presence and the intensity of the sudomotor reflex varies significantly throughout the seasons of the year. The sudomotor reflex was the main factor associated with low satisfaction in our patients in the summer (P=0.025) and winter (P<0.001) but in spring the lack of improvement in the hyperhidrosis in the foot was the unique factor related to dissatisfaction (P<0.001). The sudomotor reflex is the main negative factor in the summer and in the winter, independent of its intensity. However, at least in spring, the lack of removal of the plantar symptoms had a negative impact on satisfaction.

RESUMO: Objetivo:Conduziu-se este estudo prospectivo a fim de avaliar-se a influência do uso da braçadeira sobre o acúmulo de coágulos dentro dos drenos pleurais. Método: Os drenos pleurais foram pesados logo após sua retirada, lavados e secados e pesados novamente. A diferença entre a primeira e a segunda pesagem foi admitida como a quantidade de coágulos acumulada. Resultados: Houve maior acúmulo de coágulo nos drenos temporariamente obstruídos por braçadeira em relação àqueles não obstruídos. Conclusão: Notou-se, neste estudo, maior acúmulo de coágulo dentro de drenos pleurais obstruídos, mesmo que intermitentemente, o que pode levar ao mau funcionamento de todo o sistema de drenagem. A discussão sobre o correto uso dos drenos pleurais deve ser constante e fazer parte de programas de educação continuada para médicos e enfermagem, a fim de que este sistema, amplamente utilizado e altamente eficiente, seja otimizado (Rev. Col. Bras. Cir. 2008; 35(2): 079-082). AgradecimentosAgradecemos à colaboração dos laboratórios de patologia clínica do Hospital Estadual Sumaré e do Hospital das Clínicas da Unicamp por ceder seus equipamentos de precisão e seu espaço físico. Congratulamo-nos com a equipe de enfermagem do Hospital Estadual Sumaré pela predisposição à discussão e à educação continuada. ABSTRACT Background: A prospective study was done to evaluate the influence of clamp usage on clot formation inside thoracic drains.Methods: Each drain was weighed soon after removal; they were then washed, dried and weighed again. The difference between the first and second weights was taken as the amount of clot deposit formed. Results: We found more clots accumulated inside the drains that were temporarily obstructed by the clamp. Conclusion: In this study, there were more clots formation inside thoracic drains clamped, even if they were occluded intermittently. This can lead thoracic drains to function improperly. The discussion about the correct usage of thoracic drains must be a subject for educational programs for physicians and nurses, to aim for the safest use of this widely used and highly efficient system.

Objective: To determine the incidence of residual pneumothorax after video-assisted thoracic sympathectomy, with and without postoperative pleural drainage, and to evaluate the possible influence of this type of pneumothorax on postoperative pain within the first 28 postoperative days. Methods: All patients presenting symptoms consistent with primary palmoplantar hyperhidrosis and treated at the Thoracic Surgery Outpatient Clinic of the State Hospital of Sumaré between July and December of 2006 were included. All were submitted to sympathectomy up to the third ganglion using video-assisted thoracoscopy and were randomized to receive or not receive postoperative pleural drainage for 3 h. Chest X-rays and low-dose computed tomography scans of the chest were performed on the first postoperative day in order to determine the incidence of residual pneumothorax. At different time points up to postoperative day 28, patient pain was assessed using a visual numeric scale and by measuring the quantity of opioid analgesics required. Results: This study comprised 56 patients, 27 submitted to bilateral pleural drainage and 29 not submitted to drainage. There was no statistical difference between the two groups in terms of the incidence of post-sympathectomy residual pneumothorax. Residual pneumothorax diagnosed through any of the methods did not influence pain within the first 28 postoperative days. Conclusion: Performing closed pleural drainage for 3 h immediately after video-assisted thoracic sympathectomy did not affect lung re-expansion or the incidence of residual pneumothorax. When residual pneumothorax was present, it did not affect pain within the first 28 postoperative days.Keywords: Hyperhidrosis; Sympathectomy; Pain, postoperative; Pneumothorax; Drainage; Pleura. ResumoObjetivo: Avaliar se o pneumotórax residual após simpatectomia torácica videotoracoscópica tem incidência diferente quando utilizada a drenagem pleural pós-operatória ou não e se este pneumotórax residual, quando presente, pode influenciar a dor pós-operatória até o 28º dia. Métodos: Foram incluídos todos os pacientes com queixa de hiperidrose palmoplantar primária atendidos no Ambulatório de Cirurgia Torácica do Hospital Estadual Sumaré, de julho a dezembro de 2006. Todos foram submetidos à simpatectomia do terceiro gânglio torácico por videotoracoscopia e aleatorizados para receber ou não drenagem pleural pós-operatória por 3 h. Todos foram avaliados no pós-operatório imediato com radiogramas de tórax e tomografia computadorizada de tórax de baixa emissão de energia para detecção de pneumotórax residual. Foram avaliados quanto à dor pós-operatória em diferentes momentos até o 28º dia de pós-operatório, por meio de escala numérica visual e dosagem requerida de analgésicos opióides. Resultados: Foram incluídos 56 pacientes neste estudo, 27 com drenagem pleural bilateral e 29 sem drenagem pleural. Não houve diferença estatística entre a incidência de pneumotórax residual após simpatectomia com e sem drenagem pleural. O pneumotórax residual, q...

This was a retrospective analysis of the medical charts of 145 patients treated at the Bronchoscopy and Thoracic Surgery Clinic of the Hospital das Clínicas da Universidade Estadual de Campinas (HC-Unicamp, State University of Campinas Hospital das Clínicas) over a period of 10 years. There was a significant difference related to the site of first medical visit (Unicamp-HC versus other institutions) in terms of the time elapsed between the suspicion of bronchial aspiration and the actual respiratory endoscopic examination. However, no significant difference was found in the rate of positive results. The low number of referral centers that provide emergency respiratory endoscopy can negatively influence the treatment of patients under suspicion of bronchial aspiration, jeopardizing the overall recovery in the mid- and long-term.