Conclusions: T4 endothoracic sympathetic clip application is effective and safe for treatment of patients with upper limb hyperhidrosis, particularly for those with isolated palmar hyperhidrosis but also to a lesser extent for those with combined palmoaxillary hyperhidrosis.Summary: Endothoracic sympathectomy has been established as an effective and safe therapeutic option for patients with primary upper extremity hyperhidrosis. The major drawback, however, is compensatory sweating. Limited intervention at the fourth thoracic ganglion (T4) should result in lower levels of compensatory sweating in patients treated for upper limb hyperhidrosis. Preservation of inhibitory reflex mechanisms above T4 inhibits increased sweating from other body regions (Lin CC et al, Ann Chir Gynaecol 2001;90:161-6). In this study, the authors sought to evaluate long-term outcomes of endothoracic sympathetic block at T4 (EST4). Special emphasis was placed on evaluation of disease-specific quality of life (QoL) through review of a prospectively accumulated database. This was a prospective study conducted at a university hospital where patients treated with EST4 for palmar or palmoaxillary hyperhidrosis between 2001 and 2008 were evaluated. Questionnaires were developed by Keller and Milanez de Campos to evaluate disease-specific QoL. There were 374 EST4 procedures performed in 189 patients. Of 174 evaluated patients, 54 (31.0%) had palmar and 120 (69.0%) had palmoaxillary hyperhidrosis. Median follow-up was 92 months. EST4 successfully reduced hyperhidrosis in both groups (P < .001) and improved QoL (P < .001). Improvement remained stable after 5 years. However, the overall satisfaction rate did decrease secondary to the development of compensatory sweating and recurrence during follow-up. Compensatory sweating affected 41 patients (23.6%) and was severe in 11 of the 163 patients (6.7%) with 5-year follow-up. Severity of compensatory sweating did not further worsen with time, but occurrence of severe hyperhidrosis increased to 11% at the end of follow-up. Severe compensatory sweating was twice as common in patients treated for palmoaxillary sweating than those treated for palmar sweating (13.2% vs 6.1%).Comment: The most irritating side effect after upper extremity sympathectomy is compensatory sweating. In such cases, sweating is activated by stressors such as physical examination, heat, and psychologic stress. However, no patient in this study apparently considered the compensatory sweating, even when "severe" to be intolerable. Although there are other therapies for severe hyperhidrosis, such as botulinum toxin injections and axillary sweat gland aspiration, overall endoscopic sympathectomy at T4 seems to result in both favorable and durable clinical outcomes, particularly for patients with palmar hyperhidrosis, but to a lesser extent, for those with combined palmoaxillary hyperhidrosis as well.

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Resumo Objetivos: verificar a prevalência de dispareunia no terceiro trimestre gestacional e fatores associados. Métodos: foram avaliadas 202 puérperas. Para a coleta de dados foram utilizados um questionário sociodemográfico; questionário ICIQ-Short Form; questionário de constipação intestinal e, para a avaliação da dispareunia foram utilizadas as questões do questionário FSFI. Os dados foram analisados com os testes qui quadrado, U de Mann Whitney e teste de Wilcoxon, p<0,05. Resultados: a prevalência de dispareunia no 3º trimestre gestacional foi de 48,5% (n=98), enquanto antes da gestação era de 15,3% (n=31). Os fatores associados à dispareunia nesse período foram: constipação no terceiro trimestre da gestação (p=0,05); incontinência urinária no terceiro trimestre da gestação (p<0,001) e dispareunia antes da gestação (p=0,01). A média de idade das mulheres com dispareunia foi significativamente maior que as sem dispareunia (p=0,01). Conclusões: a prevalência da dispareunia é alta no período gestacional e esta associada a alterações das funções do assoalho pélvico, como presença de incontinência urinária e constipação, além da presença prévia de dispareunia.

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Participation in sports influenced the sexual adjustment of the men with paraplegia, even when controlled for psychological (resilience and body and sexual esteem) and physical (functional independence) aspects.