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BioMed Research International 2014Persistent pain is a serious problem that often contributes to a poor quality of life in pancreatic cancer patients. Medical management by opioid analgesics is often... (Review)
Review
Persistent pain is a serious problem that often contributes to a poor quality of life in pancreatic cancer patients. Medical management by opioid analgesics is often accompanied by side effects and incomplete pain relief. A celiac plexus block is a simple treatment which relieves pain, but the procedure demands a certain degree of proficiency and the duration of the effects obtained can be rather limited. Transhiatal bilateral splanchnicectomy achieves a certain denervation of splanchnic nerves, but it requires a laparotomy. Unilateral thoracoscopic splanchnicectomy is a minimally invasive procedure to cause definite denervation. Bilateral thoracoscopic splanchnicectomy is recommended for unsatisfactory cases or recurrent pain occurring after the initial unilateral splanchnicectomy. It is important to select the most suitable treatment depending on patients' actual medical state and the predicted outcomes.
Topics: Denervation; Humans; Pain; Pain Management; Pancreatic Neoplasms; Splanchnic Nerves; Sympathectomy
PubMed: 24868557
DOI: 10.1155/2014/941726 -
Methodist DeBakey Cardiovascular Journal 2015Patients with resistant hypertension are a subgroup of the hypertensive population that are at even greater risk of cardiovascular outcomes. Therapeutic options for... (Review)
Review
Patients with resistant hypertension are a subgroup of the hypertensive population that are at even greater risk of cardiovascular outcomes. Therapeutic options for these patients are limited to antihypertensive medications. However, renal denervation (RDN) is a novel nonpharmacologic intervention that involves a catheter-based ablation of the sympathetic nerves within the renal artery wall. The procedure initially showed promise with remarkable blood pressure reductions until the pivotal SYMPLICITY HTN-3 trial failed to demonstrate superiority of RDN over control. This trial was notable for a substantial placebo effect and an attenuated response to RDN. These findings, which contradicted those of prior studies, have raised numerous questions, including whether adequate RDN occurred in those patients. Further research is planned to resolve some of these questions and to clarify the role of RDN in treating patients with resistant hypertension.
Topics: Antihypertensive Agents; Blood Pressure; Catheter Ablation; Drug Resistance; Humans; Hypertension; Kidney; Randomized Controlled Trials as Topic; Renal Artery; Sympathectomy; Treatment Outcome
PubMed: 27057294
DOI: 10.14797/mdcj-11-4-240 -
Archives of Cardiovascular Diseases Mar 2013
Topics: Antihypertensive Agents; Blood Pressure; Drug Resistance; Evidence-Based Medicine; Humans; Hypertension; Kidney; Patient Selection; Risk Assessment; Sympathectomy; Sympathetic Nervous System; Treatment Outcome
PubMed: 23582673
DOI: 10.1016/j.acvd.2013.02.002 -
Arquivos Brasileiros de Cardiologia Oct 2013The authors review the concept of resistant hypertension and the involvement of the sympathetic nervous system in hypertension as a rational basis for the technique of... (Review)
Review
The authors review the concept of resistant hypertension and the involvement of the sympathetic nervous system in hypertension as a rational basis for the technique of renal sympathetic denervation (RSD) performed percutaneously. This revision is the result of an active search for scientific articles with the term "renal denervation" in the Medline and PubMed databases. The techniques and devices used in the procedure are presented, as well as clinical outcomes at six, 12 and 24 months after the intervention with the Symplicity catheter. Significant decreases and progressively higher reductions of systolic and diastolic blood pressure were observed after RSD. The complication rate was minimal. New devices for RSD and its ongoing clinical studies are cited. In conclusion, the RSD presents itself as an effective and safe approach to resistant hypertension. Results from ongoing studies and longer follow-up of these patients are expected to confirm the initial results and put into perspective the expansion of the procedure use in hypertension approach.
Topics: Blood Pressure; Catheter Ablation; Coronary Vasospasm; Humans; Hypertension; Kidney; Sympathectomy; Sympathetic Nervous System; Time Factors; Treatment Outcome
PubMed: 24029963
DOI: 10.5935/abc.20130187 -
Indian Heart Journal 2018In the field of medicine and cardiology newer therapy and devices have been launched with a huge promise and a lot of hype. Unfortunately, over the course of time, a...
In the field of medicine and cardiology newer therapy and devices have been launched with a huge promise and a lot of hype. Unfortunately, over the course of time, a good many of them like biovascular scaffold, renal denervation and intra-aortic balloon pump have failed to live up to their initial promise so much so that some of them have been withdrawn. The reason for this downfall may be multifold from incomplete understanding of the patho-physiology of disease, incomplete understanding of mechanism of action of the therapy, in-appropriate application in clinical practice, in-efficient therapy development related to flawed trial design, regulatory impediments placed on the trials or deficits in application of scientific techniques. Here-in we investigate the specific reason for failure for some of these therapies and attempt to suggest a way forward.
Topics: Afghanistan; Cardiology; Clinical Trials as Topic; Heart Diseases; Heart-Assist Devices; Humans; Intra-Aortic Balloon Pumping; Sympathectomy; Tissue Scaffolds
PubMed: 29455762
DOI: 10.1016/j.ihj.2018.01.019 -
Kidney International May 2014
Topics: Antihypertensive Agents; Blood Pressure; Catheter Ablation; Drug Resistance; Humans; Hypertension; Kidney; Randomized Controlled Trials as Topic; Research Design; Sympathectomy; Treatment Outcome
PubMed: 24786869
DOI: 10.1038/ki.2014.153 -
Archives of Cardiovascular Diseases Oct 2018
Topics: Blood Pressure; Humans; Hypertension; Kidney; Sympathectomy; Sympathetic Nervous System
PubMed: 30219622
DOI: 10.1016/j.acvd.2018.08.001 -
Reviews in Cardiovascular Medicine Mar 2019Hypertension remains a major public health problem and one of the most relevant causes of cardiovascular mortality and morbidity worldwide. Roughly 10% of hypertensive... (Review)
Review
Hypertension remains a major public health problem and one of the most relevant causes of cardiovascular mortality and morbidity worldwide. Roughly 10% of hypertensive individuals are considered as "resistant" as they are not able to achieve and maintain optimal blood pressure values despite the concurrent use of 3 antihypertensive agents of different classes at optimal doses. As resistant hypertension conveys a higher risk of adverse outcomes, the search for effective treatments to properly manage this condition has progressively surged as a true health priority. The renal nerve plexus plays a central role in regulating arterial blood pressure and renal sympathetic overactivity is a major component in the development and progression of hypertension. On these premises, minimally-invasive catheter based devices for renal nerve ablation have been developed and tested as an alternative treatment for resistant hypertension, but clinical study results have been ambiguous. This review provides a historical perspective on the scientific evidence forming the foundation of renal never ablation from accrued clinical evidence to possible future applications, reaching a tentative conclusion that more research and clinical experience is needed to fully reveal limits and potential indications of this procedure.
Topics: Antihypertensive Agents; Blood Pressure; Catheter Ablation; Clinical Trials as Topic; Drug Resistance; Humans; Hypertension; Kidney; Renal Artery; Sympathectomy; Treatment Outcome
PubMed: 31184091
DOI: 10.31083/j.rcm.2019.01.51 -
EuroIntervention : Journal of EuroPCR... Apr 2024Arterial hypertension is a global leading cause of cardiovascular, cerebrovascular, and renal disease, as well as mortality. Although pharmacotherapy is safe and...
Arterial hypertension is a global leading cause of cardiovascular, cerebrovascular, and renal disease, as well as mortality. Although pharmacotherapy is safe and effective in lowering blood pressure (BP) and cardiovascular disease risk, BP control remains poor, and the mortality rates associated with high BP have been steadily increasing. Device-based therapies have been investigated to overcome barriers to pharmacotherapy, including non-adherence and low rates of persistence to daily medications. Among these device-based therapies, catheter-based renal denervation (RDN) has been most extensively examined over the past 15 years. In this state-of-the-art article, we summarise the rationale for RDN, review the available evidence, provide recommendations for a safe procedure, and discuss the role of RDN in current guidelines and clinical practice.
Topics: Humans; Blood Pressure; Antihypertensive Agents; Sympathectomy; Treatment Outcome; Hypertension; Kidney; Denervation
PubMed: 38629418
DOI: 10.4244/EIJ-D-23-00836 -
Annals of Medicine Dec 2021Primary hyperhidrosis is a disorder that involves excessive sweat production, which has a negative impact on the quality of life. (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Primary hyperhidrosis is a disorder that involves excessive sweat production, which has a negative impact on the quality of life.
OBJECTIVE
To evaluate the effectiveness and safety of video-assisted thoracoscopic sympathectomy (VATS) for treating primary axillary hyperhidrosis (PAH) and determine which level of ganglion resection offers the best outcome.
METHOD
This was a systematic review and proportional meta-analysis of observational studies. The result was evaluated for satisfaction, control of symptoms, compensatory sweating and complications. A subgroup analysis was performed to compare the sympathetic trunk resection at high and low levels.
RESULTS
Thirteen studies were selected with a total of 1463 patients. The satisfaction rate was 92% (95% CI = 88-95%, =47.5%), the symptom control rate was 96% (95% CI = 93-99%, =48.2%), and the presence of compensatory sweating could not be assessed because of high heterogeneity among studies. The complications were rare.
CONCLUSION
This review demonstrated that thoracic sympathectomy by VATS is a viable and safe option for the treatment of PAH. There was no difference between high and lower levels of resection. However, the estimation of the effect is quite uncertain because the quality of evidence was extremely low.Key messagePure axillary hyperhidrosis has great potential to compromise quality of life.Surgery should be indicated only when clinical treatment fails.Thoracic sympathectomy by video-assisted thoracoscopy is a viable and safe option for the treatment of primary axillary hyperhidrosis.
Topics: Humans; Hyperhidrosis; Quality of Life; Sympathectomy; Thoracic Surgery, Video-Assisted; Thoracoscopy; Treatment Outcome
PubMed: 34282698
DOI: 10.1080/07853890.2021.1953126