Both techniques are effective for treating axillary hyperhidrosis, but the T4 group presented milder compensatory hyperhidrosis and had a greater satisfaction rate.

The use of oxybutynin is an alternative as the first step in the treatment of palmar hyperhidrosis, given that it presents good results and improves QOL.

BACKGROUNDFacial hyperhidrosis can lead to serious emotional distress. Video-assisted thoracic sympathectomy resolves symptoms effectively, though it may be associated with compensatory hyperhidrosis, which may be more common in patients undergoing resection of the second thoracic ganglion. Oxybutynin has been used as a pharmacological approach to facial hyperhidrosis but the long-term results of this treatment are unclear.OBJECTIVETo evaluate the use of low oxybutynin doses in facial hyperhidrosis patients for at least six months.METHODS61 patients were monitored for over six months and assessed according to the following variables: impact of hyperhidrosis on quality of life (QOL) before treatment and after six weeks, evolution of facial hyperhidrosis after six weeks and at the last consultation, complaints of dry mouth after six weeks and on last return visit, and improvement at other hyperhidrosis sites.RESULTSPatients were monitored for 6 to 61 months (median=17 months). Thirty-six (59%) were female. Age ranged from 17-74 (median:45). Pre-treatment QOL was poor/very poor in 96.72%. After six weeks, 100% of patients improved QOL. Comparing results after six weeks and on the last visit, 91.8% of patients maintained the same category of improvement in facial hyperhidrosis, 3.3% worsened and 4.9% improved. Dry mouth complaints were common but not consistent throughout treatment. More than 90% of patients presented moderate/great improvement at other hyperhidrosis sites.CONCLUSIONPatients who had a good initial response to treatment maintained a good response long-term, did not display tachiphylaxis and experienced improvement on other hyperhidrosis sites.

The first adult case of a congenital communication between the biliary tract and the right main bronchus is reported. Treatment by surgical excision and pneumonectomy was successful.Since 1952, when the first case of a congenital fistula between the respiratory and biliary tract was reported by Neuhauser et al,' only 14 cases of this malformation have been described.2" All have been in infants or children and the abnormality has led to respiratory distress, with a fatal outcome in some children. Three patients had other biliary malformations.24' The following case is the first to be described in an adult. Case reportA 32 year old white woman was admitted to hospital in January 1985 because of fever and severe productive cough with greenish yellow sputum. She gave a history of continuous expectoration of golden yellow sputum, which increased greatly after meals. She had had frequent episodes of bronchopulmonary infections since she was two months old and had required two or more courses ofantibiotics a year for acute chest infections. On examination she was thin and had the appearance of being chronically unwell. Her temperature was 38°C and she was expectorating large quantities of yellow mucus.On examination there was chest wall retraction, rhonchi, and crepitations in the right hemithorax. The chest radiograph showed opacification ofthe right lung and a shift ofthe mediastinum to this side. The sputum pH was 8-0 and the bilirubin concentration was 2-2 mg/100 ml (37-6 ymol/l).

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chest, abdomen and pelvis staging scan; 3/11 scans reported pelvic metastases. The remaining 55 patients did not have pelvic imaging prior to PET. Overall radiation exposure and costs were calculated; routine imaging of the pelvis during staging CT could result in an 18% increase in radiation exposure to the population and a 2% reduction in overall cost if subsequent PET imaging decreased by 4%. Conclusion: Trust imaging protocols for CT staging of suspected lung cancer vary with regard to inclusion of the pelvis. Pelvic metastases from primary lung cancer are an uncommon finding on PET-CT scans (4%). CT chest and abdomen scans are sufficient for staging lung cancer given the low incidence of pelvic metastases and significant radiation exposure associated with pelvic imaging.