The British journal of surgery
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Primary hyperhidrosis, although lacking a precise definition and of unknown aetiology, disrupts professional and social life and may lead to emotional problems. A variety of treatment methods are used to control or reduce the profuse sweating which involves mainly the palms, soles and axillae. The simplest method, the application of topical agents, is usually attempted first for axillary and plantar sweating. ⋯ For upper thoracic sympathectomy a variety of surgical approaches are used with satisfactory relief of hyperhidrosis. Complications related to the surgical approach, such as Horner's syndrome, brachial plexus injuries, pneumothorax and painful scars may occur, while following sympathectomy compensatory hyperhidrosis is usual and hyperhidrosis may recur. Plantar hyperhidrosis which may be exacerbated or ameliorated by upper thoracic sympathectomy and which fails to respond to non-operative intervention is relieved by lumbar sympathectomy.
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Amputation for peripheral ischaemia still has a depressingly high early and late mortality, and morbidity and the end result are usually less than satisfactory. Individual surgeons probably see too few amputees to treat them with maximal efficiency, and these patients create a large burden on beds and resources. There is room for improvement in all aspects of our management of amputees. ⋯ Tight bandaging and the intra-operative fitting of prostheses are undesirable. Simple tests of skin blood pressure may aid prediction of the degree of ischaemia at the proposed level of limb section and the chances of healing. The late mortality is high and merits study of methods designed to reduce it such as long term anticoagulation.