The function of the autonomic nervous system is divided so that the parasympathetic system spares central nervous system energy and the sympathetic system makes extra energy available and consumes it. The sympathetic nervous system then prepares our body for emergency and it always functions when our conscious or even unconscious mind notices a need for defence or to provide energy. A surgical procedure, where the upper thoracic sympathetic ganglions are ablated, either with cauterization or clamping with metallic clips, has been used to treat sweating of the hands and facial blushing for decades. Instead of ablating large areas of sympathetic trunk, which can cause severe side-effects such as reflex sweating of the body, the surgical procedure is nowadays carried out in a more precise symptom-mediating level of uppermost thoracic sympathetic ganglia. Blushing, hyperhidrosis of palms and head, and trembling are common in social phobia, and they seem to be provoked by the activation of the sympathetic nervous system. Preliminary studies show that some social phobia patients may benefit from the endoscopic sympathetic block (ESB). If the patient with generalized social phobia has not received help with adequate medication or psychotherapy, the ESB may be a new possible treatment of choice.

Objective: To analyse the severity of various symptoms and the developmental life history in social phobia. To estimate the value of ETS in the treatment of chronic social phobia. Design: Prospective study. Setting: Clinic for Psychoneurology and Surgery in Tampere, Finland. Subjects: Consecutive series of patients (n = 51). Interventions: Endoscopic thoracic sympathicotomy. Main outcome measures: Qualitative ideographic inquiry. Questionnaire of the symptom severity using visual analogue scale. Results: The life history included mental and physical abuse in 61%, paternal alcoholism in 26%. Four family subtypes were named: quarrelsome, cruel, alcoholic, and perfectionist. The pathognomonic symptoms of social phobia: hyperhidrosis, palpitation, blushing, tremor, and anxiety, were all highly significantly (p < 0.001) alleviated by ETS. 88% of the patients were satisfied with the result. There were no complications. Conclusion: ETS seems a promising alternative to conservative therapy for social phobia. Copyright © 1998 Taylor and Francis Ltd.

We managed to minimise the number of negative and unnecessary laparotomies. We emphasise that the selective approach may easily be applied in teaching hospitals.

Following surgical treatment of brachial plexus birth palsy, substantial numbers of the patients continued to need help performing activities of daily living and had pain in the affected limb, with the pain due to a clavicular nonunion in one-fourth of the patients. The strongest prognostic factor predicting outcome appears to be the extent of the primary plexus injury.

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