SURGICAL TREATMENT IN RAYNAUD'S DISEASE

INTRODUCTION In primary or refractory cases of Raynaud's Disease (RD), with severe symptoms (pain, ulcers, and disability), minimally invasive surgical treatments such as thoracoscopic sympathectomy have recently been proposed. The objective of this study will be to evaluate the viability, feasibility and results of this therapeutic option in this type of patient. MATERIAL AND METHODS Descriptive prospective study from January 2017 to January 2019 where all patients with a diagnosis of RD, with poor clinical control and disability, and refractory to medical treatment are collected. RESULTS Seven girls (9-15 years old) were collected. All underwent bilateral thoracoscopic sympathectomy, T2-T4, with a mean surgical time of 55 min. No need for pleural drainage. All of them were discharged before 36 hours after surgery (12-36 hours) without any immediate intra or postoperative complications. All reported an immediate postoperative period without incident, without new episodes of pain or intense vasoconstriction. However, 6 months after surgery, 3 of the 7 (42.85%) presented partial reappearance of the symptoms. However, the 7 presented 100% satisfaction with the surgical results. CONCLUSIONS There are currently very few published studies regarding this surgical option. We believe that our series is the first pediatric series to be collected, although it is very limited. However, the results obtained to date, in global terms, are encouraging. We consider that thoracoscopic sympathectomy is a feasible and safe surgical technique to consider in patients with RD refractory to conservative treatment.

Medical Acupuncture in Raynaud's Disease: Protocol Development for Conducting Systematic Review and Meta-analysis

Background: Idiopathic Raynaud’s disease is twice common in women than their counterparts, and secondary Raynaud’s disease co-occurs with a variety of medicosurgical conditions. Both diseases are managed by several medications which are invariably associated with various adverse effects. Objective: This study aimed to describe several standardized SPIRIT and PRISMA steps and items that help in the development of research protocol directed towards systematic review and meta-analysis conduction concerning Raynaud’s phenomenon managed by clinical acupuncture. Methods and Results: Statements, guidelines, list of items and processes related to SPIRIT and PRISMA and their extensions and updated versions are ideal methodological tools in framing Raynaud’s disease and acupuncture research protocols for scientifically conducting not only randomized controlled trials but also systematic review and meta-analysis. By extension, these methodological tools could also be applied to develop research protocols for other diseases and nontraditional treatment interventions with some modifications. A total of 53 studies were included in this study protocol. Discussion: In line with Traditional Chinese Medicine, the pattern of Raynaud’s disease and pros and cons of medical acupuncture should make an important component of discussion, besides the details of included randomized clinical interventions in systematic review and meta-analysis, which are but not limited to treatment effects, their strengths and limitations, quality, heterogeneity and endpoints. Conclusion: The development of research protocol for conducting systematic review and meta-analysis is an art and while framing the draft researchers must take into account various SPIRIT and PRISMA statements and guidelines and their latest versions applicable to various diseases including Raynaud’s phenomenon managed by traditional and modern medications across the world.