1:
J Thorac Cardiovasc Surg 2002
Mar;123(3):498-501
Anatomic
variations of the T2 nerve root (including the nerve of Kuntz) and
their
implications for sympathectomy.
Chung
IH, Oh CS, Koh KS, Kim HJ, Paik HC, Lee DY.
Departments
of Anatomy and Thoracic and Cardiovascular Surgery, Yonsei
University
College of Medicine, Seoul, Korea, the Department of Anatomy,
Sungkyunkwan
University School of Medicine, Suwon, Korea, the Department of
Anatomy,
Medical College, Konkuk University, Chungju, Korea, and the Department
of
Oral Biology, Yonsei University College of Dentistry, Seoul, Korea.
OBJECTIVE:
The aim of this study was to clarify the anatomic variations of the
intrathoracic
nerve of Kuntz, and this should help delineate the resection
margins
during video-assisted thoracic sympathectomy. METHODS: Sixty-six
thoracic
sympathetic chains of 39 adult Korean cadavers were dissected on both
sides
of the thorax in 27 cadavers (54 sides) and on one side in 12 cadavers (12
sides).
RESULTS: The intrathoracic nerve was observed in 45 (68.2%) sides and
was
present bilaterally in 48.1% of cadavers. No intrathoracic nerve or
ascending
ramus communicans arising from the second thoracic nerve was observed
in
only 5 (7.6%) sides. The diameter of the intrathoracic nerve was 1.25 plus
minus
0.55 mm on average. The arising point of the intrathoracic nerve from the
second
thoracic nerve was 7.3 mm on average from the sympathetic trunk. Presence
of
the stellate ganglion was noted in 56 (84.8%) sides, and 6 (9.1%) sides
showed
a single large ganglion formed by the stellate and the second thoracic
sympathetic
ganglia. The second thoracic sympathetic ganglion was most commonly
located
(50%) in the second intercostal space. CONCLUSION: The anatomic
variations
of the intrathoracic nerve of Kuntz and the second thoracic
sympathetic
ganglion were characterized in human cadavers. It is hoped that this
study
will help to improve the recurrence of symptoms caused by the
intrathoracic
nerve in an upper thoracic sympathectomy for hyperhidrosis.
PMID:
11882821 [PubMed - as supplied by publisher]
2:
J Vasc Surg 2002 Feb;35(2):382-6
Palmar
hyperhidrosis: Evidence of genetic transmission.
Ro
KM, Cantor RM, Lange KL, Ahn SS.
University
of California at Davis School of Medicine, the Department of Human
Genetics,
University of California at Los Angeles School of Medicine, and the
UCLA
Center for the Health Sciences, Division of Vascular Surgery.
BACKGROUND:
Primary palmar hyperhidrosis is a condition marked by excessive
perspiration
and is reported to have an incidence of 1% in the Western
population.
It is a potentially disabling disorder that interferes with social,
psychological,
and professional activities. Over the past several years, several
investigators
have reported a positive family history in their patients treated
for
hyperhidrosis. To date, the cause is unknown; furthermore, epidemiologic
data
are scarce and inadequate. METHODS: To characterize the genetic
contribution
to hyperhidrosis, we conducted a prospective study of 58
consecutive
patients with palmar, plantar, or axillary hyperhidrosis treated
with
thoracoscopic sympathectomy from September 1993 to July 1999. Forty-nine of
the
58 probands volunteered family history data for these analyses (84% response
rate).
A standardized questionnaire was administered during the postoperative
visit
or by phone interview, and a detailed family history was obtained. The
same
questionnaire was also administered to a set of 20 control patients. The
familial
aggregation of hyperhidrosis has been quantified by estimating the
recurrence
risks to the offspring, parents, siblings, aunts, uncles, and cousins
of
49 probands and 20 controls. We estimated the penetrance by use of a genetic
analysis
program. RESULTS: Thirty-two of 49 (65%) reported a positive family
history
in our hyperhidrosis group, and 0% reported a positive family history in
our
control group. A recurrence risk of 0.28 in the offspring of probands
compared
with frequency of 0.01 in the general population provides strong
evidence
for vertical transmission of this disorder in pedigrees and is further
supported
by the 0.14 risk to the parents of the probands. The results indicate
that
the disease allele is present in about 5% of the population and that one or
two
copies of the allele will result in hyperhidrosis 25% of the time, whereas
the
normal allele will result in hyperhidrosis less than 1% of the time.
CONCLUSIONS:
We conclude that primary palmar hyperhidrosis is a hereditary
disorder,
with variable penetrance and no proof of sex-linked transmission.
However,
this does not exclude other possible causes, and we anticipate that
genetic
confirmation of this disorder may lead to earlier diagnoses and advances
in
medical and psychosocial interventions.
PMID:
11854739 [PubMed - in process]
3:
Neurosurgery 2002 Feb;50(2):306-11;
discussion 311-2
Biportal
thoracoscopic sympathectomy: surgical techniques and clinical results
for
the treatment of hyperhidrosis.
Han
PP, Gottfried ON, Kenny KJ, Dickman CA.
Division
of Neurological Surgery, Barrow Neurological Institute, St. Joseph's
Hospital
and Medical Center, Phoenix, Arizona 85013-4496, USA.
OBJECTIVE:
To describe a bilateral thoracoscopic sympathectomy procedure, using
a
biportal approach, for the treatment of severe hyperhidrosis. METHODS: Between
May
1996 and September 2000, 103 consecutive patients underwent thoracoscopic
sympathectomy
procedures to treat bilateral hyperhidrosis (206 procedures).
Operative
results, complications, and patient satisfaction were determined by
reviews
of hospital and office charts and by follow-up assessments in the
outpatient
clinic. Long-term results were determined with clinical examinations,
follow-up
office visits, and follow-up questionnaires. RESULTS: Ninety-three
patients
presented with primary palmar hyperhidrosis, eight with primary
axillary
hyperhidrosis, and two with primary craniofacial hyperhidrosis. Rates
of
complete resolution in the primary area affected were 100% in palmar and
craniofacial
cases and 75% in axillary cases. The average length of
hospitalization
was 1.06 days, and 96 patients (93.2%) were discharged on or
before
the end of the first postoperative day. Of 59 patients (57.3%) who
developed
compensatory hyperhidrosis, only 11 patients (10.7%) reported that it
was
bothersome and none considered it disabling. All postoperative complications
were
transient; five patients experienced unilateral Horner's syndrome, three
patients
experienced intercostal neuralgia, and two patients required a chest
tube
after surgery because of a pneumothorax. CONCLUSION: Thoracoscopic
sympathectomy
using a biportal approach effectively treats hyperhidrosis and is
associated
with short hospital stays, high patient satisfaction rates, and low
rates
of compensatory hyperhidrosis or other complications.
PMID:
11844265 [PubMed - in process]
4:
Eur J Cardiothorac Surg 2002
Jan;21(1):67-70
Minimally
invasive video-endoscopic sympathectomy by use of a transaxillary
single
port approach.
Lardinois
D, Ris HB.
Division
of Thoracic Surgery, University Hospital, Inselspital, Bern,
Switzerland.
didier.lardinois@chi.usz.ch
OBJECTIVES:
This is a prospective study to evaluate the long-term outcome and
the
value of a transaxillary single port thoracic sympathectomy by use of a
modified
paediatric cystoresectoscope in a consecutive series of patients with
facial
blushing and/or hyperhidrosis. MATERIALS AND METHODS: All patients who
underwent
a thoracic transsection of the sympathetic chain from T2 to T5 by use
of
a 7-mm single port approach and a modified urologic electroresectoscope
between
1996 and 1998 were prospectively analysed regarding postoperative
morbidity
and outcome (clinical evaluation, visual analogue scale) in order to
validate
this technique. RESULTS: 37 patients (18 men, 19 women) with an age
ranging
from 18 to 67 years (mean 34 years) underwent 74 bilateral
video-assisted
thoracic sympathectomies. The indications for sympathectomy
included
facial blushing in 32%, hyperhidrosis in 52%, or both in 16% of the
patients.
Ninety-five percent of the patients were discharged from the hospital
on
the next day, the 30-day mortality was zero, and there was no conversion to
an
open procedure. A severe complication with crossed emboli and motor aphasia
was
noted. A unilateral transient Horner's syndrome was observed in two
patients.
Three-month follow-up revealed an excellent cosmetic and functional
result,
with no residual pain. Complete relief of symptoms was observed in 89%
and
in 100% of the patients with facial blushing and palmar hyperhidrosis,
respectively,
after a follow-up of 34.5 months. Recurrence of the symptoms after
initial
regression was noted in 5.7% of the patients 3 years after surgery.
Compensatory
sweating of the lower extremities was significantly increased in
patients
with hyperhidrosis and facial blushing; however, sweating of the trunk
was
only increased in patients with hyperhidrosis. Improvement of quality of
life
was observed in 94.6% of the patients. CONCLUSIONS: Single port
thoracoscopic
sympathectomy by use of a modified paediatric cystoresectoscope
and
transsection from T2 to T5 gives an excellent cosmetic and functional
outcome,
with better results in patients with hyperhidrosis.
PMID:
11788259 [PubMed - indexed for MEDLINE]
5:
J Neurosurg 2002 Jan;96(1 Suppl):68-72
Anatomical
location of T2-3 sympathetic trunk and Kuntz nerve determined by
transthoracic
endoscopy.
Wang
YC, Sun MH, Lin CW, Chen YJ.
Department
of Neurosurgery, Taichung Veterans General Hospital, Taiwan, Republic
of
China. ycwang@vghtc.vghtc.gov.tw
OBJECT:
Bilateral subaxillary transthoracic endoscopic sympathectomy (TES) is a
popular
procedure of upper thoracic sympathectomy. The anatomical locations of
the
T-2 and T-3 sympathetic trunks, as viewed under the endoscope, are varied in
the
rib head areas. In this study, the authors investigated the more visible
anatomical
locations of the T-2 and T-3 sympathetic trunks, the so-called nerves
of
Kuntz, and intercostal rami by performing transthoracic endoscopy. METHODS:
Seventy
patients with palmar hyperhidrosis undergoing bilateral TES (140 sides)
via
the anterior subaxillary approach were included in this study. The operative
findings
and video images of the T-2 and T-3 sympathetic trunks and ganglia were
recorded
and analyzed. The anatomical locations of the T-2 and T-3 sympathetic
trunks
along the horizontal axes of the rib heads were determined using a
three-region
system constructed by the authors. The area between the rib neck
and
the medial border of the rib head was equally divided into Region E
(external
half) and Region M (medial half). The area between the medial border
of
the rib head and the paravertebral ligament was defined as Region I. The
incidence
of the T-2 and T-3 sympathetic trunks found in Regions E, M, and I
were
31.4 to 42.9%, 50 to 57.1%, and 7.1 to 11.4%, respectively, on the left
side,
and 24.3 to 34.3%, 57.1 to 65.7%, and 8.6 to 10%, respectively, on the
right
side. One right (1.4%) and six left (8.6%) Kuntz nerves originating from
the
T-3 sympathetic trunk were found in seven patients (10%). The intercostal
ramus
was found around the T-2 rib neck in 24 patients (34.3%), with 18 cases
(25.7%)
for each side. The intercostal ramus around the T-3 rib neck was found
in
17 patients (24.3%): 12 (17.1%) on the right and nine (12.9%) on the left.
CONCLUSIONS:
These results indicate that approximately 90% of the T-2 or T-3
sympathetic
trunks are located on the rib head. These findings may also be used
to
assist the surgeon in fluoroscopic guidance for locating the T-2 and T-3
sympathetic
trunks during posterior percutaneous sympathectomy.
PMID:
11795717 [PubMed - indexed for MEDLINE]
6:
J Egypt Soc Parasitol 2001
Dec;31(3):835-42
Thoracoscopic
sympathectomy for treatment of hyperhidrosis surgical experience
and
results of 30 cases.
Helmy
MA, Ahmed HA, Allam MF.
Department
of General Surgery, Faculty of Medicine, Ain Shams University, Cairo,
Egypt.
The
thoracoscopic sympathectomy in treatment of primary palmar and axillary
hyperhidrosis
was performed on 30 patients complaining of hyperhidrosis admitted
to
El Demerdash University Hospital and Ain Shams University Specialised
Hospital
and The Saudi German Hospital between March 1999 and March 2001. The
indication
of surgery was primary palmar hyperhidrosis in 24 cases and combined
palmar
and axillary hyperhidrosis in 6 cases. 25 cases were males and 5 cases
were
females. The mean age in our sample was 25.7 +/- 4.05 years. There were no
major
complications in our series and 4 cases were complicated by intercostal
vessels
bleeding which were successfully controlled by cauterization during
surgery
and no one of them necessitated neither thoracotomy nor application of
intercostal
tubes. The patients were followed up for one year after operation
and
only one case had recurrence of palmar hyperhidrosis.
PMID:
11775109 [PubMed - in process]
7:
Ann Thorac Surg 2001 Nov;72(5):1801-2
Video
thoracoscopic sympathectomy with intraoperative monitoring of palmar skin
temperature
for palmar hyperhidrosis.
Kao
MC.
Publication
Types:
Letter
PMID:
11722112 [PubMed - indexed for MEDLINE]
8:
J Clin Neurosci 2001 Nov;8(6):539-41
Thoracoscopic
sympathectomy for palmar hyperhidrosis: effects on pulmonary
function.
Tseng
MY, Tseng JH.
Division
of Neurosurgery, Department of Surgery, Medical School and Hospital,
National
Taiwan University, 7 Chung-Shan South Road, Taipei, Taiwan, R.O.C.
tmy59100@ms4.hinet.net
Palmar
hyperhidrosis, probably caused by an over-reactivity of sympathetic
nerves
passing through the second and the third thoracic sympathetic ganglia (T2
&
T3 ganglia), can only be cured by sympathectomy. Such sympathetic denervation
may
also alter pulmonary function. Previous studies have shown that open
sympathectomy
can cause significant deterioration in pulmonary function,
however,
the surgical procedure itself may contribute to the change. Recently
thoracoscopic
sympathectomy has been developed as a minimally invasive but
effective
treatment for palmar hyperhidrosis. In order to investigate the effect
of
sympathectomy, pulmonary function was compared before and four weeks after
operation
in 20 patients. Forced vital capacity (FVC) (-2.3%), forced expiratory
volume
in one second (FEV1) (-6.1%), and FEV1/FVC (-4.6%) were all slightly but
significantly
decreased four weeks after thoracoscopic sympathectomy. Also the
instantaneous
forced expiratory flow at 75%, 50% and 25% of the FVC (Vmax25,
Vmax50,
Vmax75) in flow-volume curves were decreased (-1.6%, -8.4%, and -20%
respectively).
Therefore, thoracoscopic sympathectomy minimises pulmonary
restrictive
effects but allows subclinical small airway obstructive effects to
become
more evident.
PMID:
11787462 [PubMed - indexed for MEDLINE]
9:
J Clin Neurosci 2001 Nov;8(6):555-6
Endoscopic
extraperitoneal lumbar sympathectomy for plantar hyperhidrosis: case
report.
Tseng
MY, Tseng JH.
Division
of Neurosurgery, Department of Surgery, Medical School and Hospital,
National
Taiwan University, 7 Chung-Shan South Road, Taipei 100, Taiwan, R.O.C.
A
right sided endoscopic retroperitoneal lumbar sympathectomy was performed on a
23
year old female who had plantar hyperhidrosis. After the operation, the right
foot
temperature increased and the plantar hyperhidrosis was relieved. During
the
follow up period, both feet were warm and dry, although only the right side
lumbar
sympathectomy had been performed. The outcome appeared to be compatible
with
that of an open procedure but with minimal invasiveness. Copyright 2001
Harcourt
Publishers Ltd.
Publication
Types:
Technical
Report
PMID:
11683604 [PubMed - indexed for MEDLINE]
10:
Lakartidningen 2001 Oct
10;98(41):4494-5
[Sympathectomy--how
much side-effects are acceptable?]
[Article
in Swedish]
Berglund
F, Berglund E.
Publication
Types:
Letter
PMID:
11699265 [PubMed - indexed for MEDLINE]
11:
Auton Neurosci 2001 Oct 8;93(1-2):91-4
Transthoracic
endoscopic T-2, 3 sympathectomy for facial hyperhidrosis.
Chen
HJ, Lu K, Liang CL.
Department
of Neurosurgery, Chang Gung University and Memorial Hospital at
Kaohsiung,
Kaohsiung Hsien, Taiwan. chenmd@ms8.hinet.net
Twenty-five
patients (20 men and 5 women) with the chief complaint of facial
hyperhidrosis
were treated by transthoracic endoscopic T-2, 3 sympathectomy. All
patients
were essentially in good health except the embarrassment of facial
sweating.
Fifteen of them also suffered from distressing palmar hyperhidrosis.
The
ages ranged from 18 to 40 years (mean age 25 years). All of them except two
obtained
a satisfactory improvement of facial hyperhidrosis after 3 months to 2
years
of follow-up. One man demonstrated very mild ptosis in the right eye. Pre-
and
postoperative sympathetic skin response (SSR) revealed the absence rate from
20%
to 72% with electrical stimulation (p < 0.05). This study shows that T-2, 3
sympathectomy
is a choice of treatment for facial hyperhidrosis and sympathetic
supply
to the face may at least partly be from T-2, 3 level.
PMID:
11695712 [PubMed - in process]
12:
Arch Surg 2001 Oct;136(10):1115-7
Experiences
in thoracoscopic sympathectomy for axillary hyperhidrosis and
osmidrosis:
focusing on the extent of sympathectomy.
Hsu
CP, Shia SE, Hsia JY, Chuang CY, Chen CY.
Division
of Surgical Emergency, Taichung Veterans General Hospital, Building
160,
Section 3, Taichung-Kang Road, Taichung, Taiwan. cliff@vghtc.vghtc.gov.tw
HYPOTHESIS:
A more selective sympathectomy can improve the outcome of axillary
hyperhidrosis
and osmidrosis and minimize the potential sequelae. DESIGN:
Retrospective
cohort. SETTING: Tertiary care center. PATIENTS: Between July 1,
1996,
and May 30, 2000, 171 patients with axillary hyperhidrosis and osmidrosis
were
studied. INTERVENTIONS: T3-4 sympathectomies were performed in 40 patients
(group
1), T4 sympathectomies were performed in 56 patients (group 2), and T4-5
sympathectomies
were performed in 75 patients (group 3). MAIN OUTCOME MEASURES:
The
surgical outcomes were evaluated by direct patient interview in the
outpatient
clinic or by telephone or mail questionnaires. The results were
categorized
as excellent (significant or complete disappearance of symptoms),
good
(>/=50% improvement), or poor (<50% improvement). RESULTS: There were no
surgical
mortalities in this study. Twenty-eight group 1 patients (70%), 16
group
2 patients (29%), and 22 group 3 patients (29%) developed compensatory
perspiration
(P<.001). Six group 1 patients (15%), 1 group 2 patient (2%), and 1
group
3 patient (1%) developed dry hands (P =.02). In the group 1 patients, the
surgical
outcomes were excellent in 21 (52%), good in 6 (15%), and poor in 13
(32%).
In the group 2 patients, the surgical outcomes were excellent in 29
(52%),
good in 10 (18%), and poor in 17 (30%). In the group 3 patients, the
surgical
outcomes were excellent in 53 (71%), good in 11 (15%), and poor in
11(15%)
(P =.04). (Percentages may not sum to 100 because of rounding.)
CONCLUSION:
T4-5 sympathectomies provide higher patient satisfaction rates in
treating
axillary hyperhidrosis and osmidrosis, with fewer sequelae.
PMID:
11585501 [PubMed - indexed for MEDLINE]
13:
Surg Endosc 2001 Oct;15(10):1159-62
Prevention
of compensatory hyperhidrosis after thoracoscopic sympathectomy for
hyperhidrosis.
Riet
M, Smet AA, Kuiken H, Kazemier G, Bonjer HJ.
Department
of Surgery, Erasmus University Medical Center, Rotterdam, The
Netherlands.
BACKGROUND:
Compensatory hyperhidrosis is a troublesome complication of
thoracoscopic
sympathectomy for hyperhidrosis. After extensive resection of the
second
through the fourth ganglion (T2-4), as well as after limited resection of
the
second ganglion (T2), the reported incidence of compensatory hyperhidrosis
ranges
as high as 50-97%. The purpose of this study was to determine whether the
incidence
of compensatory hyperhidrosis can be reduced by limiting the
thoracoscopic
sympathectomy to another level, the third ganglion. METHODS: We
analyzed
28 thoracoscopic sympathectomies for palmar and/or axillary
hyperhidrosis.
In all patients, the sympathetic chain was transected cranially
and
caudally to the third ganglion (T3 dissection). Long-term follow-up was
conducted
by interviewing patients using standardized questionnaires. RESULTS:
The
surgery was effective in all patients. After a median follow-up of 3.5
years,
compensatory hyperhidrosis was not recorded in any of the patients. There
were
no recurrences of hyperhidrosis. CONCLUSION: Limited thoracoscopic
sympathectomy
at the level of the third ganglion is effective and seems to
prevent
compensatory hyperhidrosis.
PMID:
11727092 [PubMed - in process]
14:
Ann Thorac Surg 2001 Sep;72(3):895-8
Video-assisted
thoracoscopic "resympathicotomy" for palmar hyperhidrosis:
analysis
of 42 cases.
Lin
TS.
Division
of General Thoracic Surgery, Changhua Christian Hospital, Chung Shan
Medical
and Dental College, Taichung, Taiwan, Republic of China.
lin8065@ms14.hinet.net
BACKGROUND:
There are rare reports of video-assisted thoracoscopic
resympathicotomy
for patients with palmar hyperhidrosis. I present our
experience
in treating a persistent or recurrent palmar hyperhidrosis after
primary
endoscopic sympathectomy or sympathicotomy and discuss the perioperative
management.
METHODS: We reoperated on 42 patients using a technique of
video-assisted
thoracoscopic resympathicotomy. All patients were placed in a
semi-sitting
position under single- or double-lumen intubated anesthesia. An
8-mm,
0 degrees thoracoscope was used to interrupt the nerve conduction to the
palms
from the T2 and T3 ganglia, through one or two 0.8-cm subaxillary
incisions.
RESULTS: The reasons for failure of endoscopic sympathectomy or
sympathicotomy
in 26 patients included pleural adhesion (15 of 26, 57.7%),
incorrect
identification of T2 ganglion (3 of 26, 11.5%), vessel overriding or
close
to sympathetic nerve (3 of 26, 11.5%), incomplete interruption of
sympathetic
nerve (2 of 26, 7.7%), medially located sympathetic nerve (2 of 26,
7.7%),
and aberrant venous arch (1 of 26, 3.8%). The causes of recurrent palmar
hyperhidrosis
after primary transthoracic endoscopic sympathicotomy or
sympathectomy
(TES) in 16 patients included a possible effect of T3 ganglion (8
of
16, 50%), Kuntz fiber (3 of 16, 18.8%), nerve regeneration (3 of 16, 18.8%),
and
incomplete interruption of T2 ganglion (2 of 16, 12.5%). Surgical
complications
included pneumothorax (1 patient, 2.4%), hemothorax (1 patient,
2.4%),
and compensatory sweating (36 patients, 86%). All patients had obtained
successful
bilateral sympathectomies and had satisfactory results after a mean
of
32.1 months of follow-up. CONCLUSIONS: Video-assisted thoracoscopic
resympathicotomy
is an effective and safe method for a previously unsuccessful
sympathectomy
or recurrent palmar hyperhidrosis if the surgeon acknowledges
possible
anatomic variations and can overcome the problems related to pleural
adhesions.
PMID:
11565677 [PubMed - indexed for MEDLINE]
15:
J Thorac Cardiovasc Surg 2001
Sep;122(3):633-4
Needlescopic
surgery for palmar hyperhidrosis.
Kao
MC.
Publication
Types:
Letter
PMID:
11547332 [PubMed - indexed for MEDLINE]
16:
Neurosurgery 2001 Sep;49(3):628-34;
discussion 634-6
A
new mode of percutaneous upper thoracic phenol sympathicolysis: report of 50
cases.
Wang
YC, Wei SH, Sun MH, Lin CW.
Department
of Neurosurgery, Taichung Veterans General Hospital, Taiwan, Republic
of
China. ycwang@vghtc.vghtc.goc.tw
OBJECTIVE:
Our previous study demonstrated that a high concentration of phenol
(75-90%)
with minimal volume (0.02 ml) can elicit serious degeneration of
ganglion
cells of the stellate ganglia in cats. Another previous study in our
clinical
patients demonstrated that approximately 84 to 90% of the upper
thoracic
(T2-T3) sympathetic trunks can be found under an endoscope on the
ventral
side of the T2-T3 rib heads. In this report, we present a new mode of
dorsal
percutaneous thoracic phenol sympathicolysis (PTPS) for the treatment of
palmar
hyperhidrosis or axillary bromidrosis. METHODS: Fifty patients with
palmar
hyperhidrosis or axillary bromidrosis were injected with 75% phenol into
a
total of 98 sides of the T2-T3 or T3-T4 sympathetic trunks and ganglia. The
injected
volume was 0.6 to 1.2 ml (average, 0.8 ml) for each side. The technique
of
dorsal percutaneous injection was performed under local anesthesia or local
with
intravenous general anesthesia and under the guidance of a C-arm
fluoroscope.
RESULTS: Forty patients (80%) showed satisfactory results,
including
cessation of sweating. The success rates of PTPS were 83.7% (41 of 49
patients)
on the left side and 91.8% (45 of 49 patients) on the right side. The
skin
temperature of the thumb increased by 5.3 to 5.4 degrees C approximately 1
hour
after the phenol injection in patients with satisfactory results, whereas
it
increased by only 1.3 to 2.7 degrees C in patients who had unsatisfactory
results.
CONCLUSION: PTPS may be a good alternative to endoscopic sympathectomy
to
treat palmar hyperhidrosis and axillary bromidrosis. The skin temperature of
the
thumb is still a useful index to evaluate preliminarily whether PTPS has
been
successful.
PMID:
11523673 [PubMed - indexed for MEDLINE]
17:
Pediatr Surg Int 2001 Sep;17(7):535-7
Endoscopic
thoracic sympathetic block by clipping for palmar and axillary
hyperhidrosis
in children and adolescents.
Lin
TS, Huang LC, Wang NP, Chang CC.
Department
of Surgery, Changhua Christian Hospital, Hung Kuang Institute of
Technology,
Chung Shan Medical and Dental College, Taichung, Taiwan, ROC.
Endoscopic
thoracic sympathectomy or sympathicotomy is a safe and effective
method
of treating primary hyperhidrosis (PH), but postoperative compensatory
sweating
may be a problem. There are few reports of sympathetic blockade by
clipping
for PH. We present our experience of endoscopic thoracic sympathetic
block
(ETSB) by clipping in treating palmar (PAH) and axillary hyperhidrosis
(AH)
in children and adolescents. Between May 1997 and June 1998, a total of 78
patients
with PAH or AH underwent ETSB by clipping using an 8-mm, 0 degrees
thoracoscope.
There were 33 males and 45 females with a mean age of 14.1 years
(range
9-16 y). All patients were placed in a semi-sitting position under
single-lumen
intubation anesthesia; 52 patients with PAH underwent T2
sympathetic
block by clipping at the 2nd and 3rd rib beds, and T3 and T4
sympathetic
block was performed at the 3rd, 4th and 5th rib beds in 26 patients
with
AH. A total of 156 sympathetic blocks by clipping were achieved. The
operation
was usually accomplished within 20 min (range 16-30 min). Most
patients
were discharged within 4 h after the operation. There were neither
surgical
complications nor mortality. The mean postoperative follow-up period
was
32.7 months (range 26-40). Improvement of PAH or AH could be obtained in all
cases;
70 patients (85.4%) developed compensatory sweating of the trunk and
lower
limbs. One patient with PAH underwent a reverse operation with improvement
of
the sweating 14 days after removal of the endo-clips. ETSB by clipping is
thus
a safe and effective method for treating PH in children and adolescents;
compensatory
sweating may be improved after a reverse operation with removal of
the
endo-clip.
PMID:
11666053 [PubMed - indexed for MEDLINE]
18:
Lakartidningen 2001 Aug 22;98(34):3589
[Negative
sweating]
[Article
in Swedish]
Melander
S.
Publication
Types:
Letter
PMID:
11571806 [PubMed - indexed for MEDLINE]
19:
Ann Thorac Surg 2001 Aug;72(2):667-8
Technical
notes on thoracic sympathectomy for essential hyperhidrosis.
Kao
MC.
Publication
Types:
Letter
PMID:
11515936 [PubMed - indexed for MEDLINE]
20:
AORN J 2001 Aug;74(2):178-82, 185-6,
188; quiz 189-91, 193-4
Thoracoscopic
sympathectomy for palmar hyperhidrosis.
Allen
GM.
New
York Presbyterian Hospital, New York, USA.
Palmar
hyperhidrosis (i.e., excessive sweating of the palms) usually appears at
puberty
and causes psychological, social, educational, and occupational problems
for
people who suffer from it. Although many treatments have been used, the only
treatment
that permanently eradicates the condition is sympathectomy. The advent
of
thoracoscopic surgery has allowed surgeons to perform sympathectomy as an
outpatient
procedure that is safe and effective and produces life-changing
results
for patients.
Publication
Types:
Review
Review,
Tutorial
PMID:
11503199 [PubMed - indexed for MEDLINE]
21:
Br J Dermatol 2001 Aug;145(2):298-301
Ultrastructure
of the hyperhidrotic eccrine sweat gland.
Bovell
DL, Clunes MT, Elder HY, Milsom J, Jenkinson DM.
School
of Biological and Biomedical Sciences, Glasgow Caledonian University,
Glasgow
G4 0BA, UK.
BACKGROUND:
Hyperhidrosis is the secretion of inappropriately large amounts of
sweat
by eccrine glands; it can be very debilitating. Little is known of the
causes
of primary hyperhidrosis. OBJECTIVES: To determine whether the glands
exhibit
any structural abnormality in primary hyperhidrosis. METHODS: Skin
biopsies
were obtained from the axilla (n = 6) or neck (n = 2) of individuals
aged
26-62 years with primary hyperhidrosis and from five age- and sex-matched
normal
individuals, with informed consent and ethical committee approval.
Samples
were prepared by standard methods for light and electron microscopic
examination.
RESULTS: All characteristics observed in the hyperhidrotic
specimens
were consistent with the changes seen in normal glands following
strong
activation: degranulation of the granular (dark) cells, dilatation of the
basolateral
infoldings and the canaliculi of the non-granular (clear) cells,
contraction
of the myoepithelial cells and thickening of the basal lamina, and
presence
of cellular debris including lipid droplets in the gland lumen.
Pathological
changes were not observed. CONCLUSIONS: The present finding of the
absence
of structural defects in the glands indicates that future studies should
concentrate
on the investigation of neurohumoral or secretory cell metabolic
abnormalities.
PMID:
11531796 [PubMed - indexed for MEDLINE]
22:
Lakartidningen 2001 Jul
25;98(30-31):3356
[Surgery
of excessive hand sweating in the past and now]
[Article
in Swedish]
Rabow
L.
Publication
Types:
Historical
Article
Letter
PMID:
11521345 [PubMed - indexed for MEDLINE]
23:
J Neurosurg 2001 Jul;95(1 Suppl):58-63
Associated
change in plantar temperature and sweating after transthoracic
endoscopic
T2-3 sympathectomy for palmar hyperhidrosis.
Chen
HJ, Liang CL, Lu K.
Department
of Neurosurgery, Chang Gung University and Medical Center at
Kaohsiung,
Taiwan. chenmd@ms8.hinet.net
OBJECT:
Transthoracic endoscopic T2-3 sympathectomy is currently the treatment
of
choice for palmar hyperhidrosis. Compensatory sweating of the face, trunk,
thigh,
and sole of the foot was found in more than 50% of patients who underwent
this
procedure. The authors conducted this study to investigate the associated
intraoperative
changes in plantar skin temperature and postoperative plantar
sweating.
METHODS: One hundred patients with palmar hyperhidrosis underwent
bilateral
transthoracic endoscopic T2-3 sympathectomy. There were 60 female and
40
male patients who ranged in age from 13 to 40 years (mean age 21.6 years).
Characteristics
studied included changes in palmar and plantar skin temperature
measured
intraoperatively, as well as pre- and postoperative changes in plantar
sweating
and sympathetic skin responses (SSRs). In 59 patients (59%) elevation
of
plantar temperature was demonstrated at the end of the surgical procedure. In
this
group, plantar sweating was found to be exacerbated in three patients (5%);
plantar
sweating was improved in 52 patients (88.1%); and no change was
demonstrated
in four patients (6.8%). In the other group of patients in whom no
temperature
change occurred, increased plantar sweating was demonstrated in
three
patients (7.3%); plantar sweating was improved in 20 patients (48.8%); and
no
change was shown in 18 patients (43.9%). The difference between temperature
and
sweating change was significant (p = 0.001). Compared with the
presympathectomy
rate, the rate of absent SSR also significantly increased after
sympathectomy:
from 20 to 76% after electrical stimulation and 36 to 64% after
deep
inspiration stimulation, respectively (p < 0.05). CONCLUSIONS: In contrast
to
compensatory sweating in other parts of the body after T2-3 sympathetomy,
improvement:
in plantar sweating was shown in 72% and worsened symptoms in 6% of
patients.
The intraoperative plantar skin temperature change and perioperative
SSR
demonstrated a correlation between these changes.
PMID:
11453433 [PubMed - indexed for MEDLINE]
24:
Kyobu Geka 2001 Jul;54(7):555-9
[Endoscopic
transthoracic sympathectomy (ETS) with a fine 2-mm thoracoscope in
palmar
hyperhidrosis]
[Article
in Japanese]
Naruse
H, Moriyasu K, Yokokawa H, Ohkura T, Kamio Y, Suzuki K, Suzuki S, Kitami
A,
Tanaka H, Suzuki T.
Department
of Thoracic Surgery, TMG Totsuka Kyoritsu Hospital, Yokohama, Japan.
Endoscopic
transthoracic sympathectomy (ETS) is an efficient, safe, minimally
invasive
procedure, and requires only a short period of hospitalization. We
performed
bilateral ETS using a thoracoscope 2 mm in diameter. We performed 120
ETS
for the treatment of palmar hyperhidrosis from August 1997 to April 2000.
The
patient was placed in the semi-sitting position under general anesthesia,
one-lung
ventilation being used; the operation was performed with 2-mm
two-puncture
method. The sympathetic chain could be observed through parietal
pleura
riding on the costovertebral junctions. A 2-mm Kirschner wire was
employed
as an electrode, and the second and third thoracic sympathetic chains
were
electro cauterized. A thoracic drain was not used. The needling sites were
only
2 mm in size and could be fixed without suture. For the patient, a small
scar
of this size means virtually no scar. The operative times were from 11 min
to
81 min in bilateral ETS. Immediately and dramatic decrease in the sweat
excretion
in the palms was noted in all patients. The 95% patients were highly
satisfied
with the results. The commonest side effects were compensatory
sweating.
This procedure is recommended as the method of choice for the surgical
treatments
of palmar hyperhidrosis.
PMID:
11452523 [PubMed - indexed for MEDLINE]
25:
Am J Surg 2001 Jun;181(6):540-2
Microinvasive
video-assisted thoracoscopic sympathicotomy for primary palmar
hyperhidrosis.
Kim
BY, Oh BS, Park YK, Jang WC, Suh HJ, Im YH.
Department
of Thoracic and Cardiovascular Surgery, Sangmoo Hospital,
Chipyung-Dong
1240, Suh-Gu, 502-270, Kwang-Ju, South Korea.
bykim@mail.chosun.ac.kr
BACKGROUND:
Although video-assisted thoracoscopic surgery for palmar
hyperhidrosis
is now widely accepted as the approach of choice, the optimal
technique
has remained a subject of controversy. We have used 2-mm dual port
video-assisted
thoracoscopic sympathicotomy for primary palmar hyperhidrosis.
This
study evaluates the short-term results of the technique. METHODS: A
retrospective
review was carried out of 45 patients, 20 men and 25 women, with a
mean
age of 24.2 years. In the period from April 1998 to August 1999, 90
consecutive
video-assisted sympathicotomy for primary palmar hyperhidrosis
either
in isolation (n = 56) or in combination with axillary and plantar
hyperhidrosis
(n = 34) was performed. The mean follow-up period was 11.3 months.
Attention
was focused on patient's satisfaction, complications, and morbidity.
RESULTS:
Dry limbs were immediately achieved in all patients after surgery.
There
was no operative mortality and one case of transient Horner's syndrome
developed.
Eight of 20 with plantar hyperhidrosis showed simultaneous
improvement.
The overall mean satisfaction rate was 92% +/- 2% with a median 93%
improvement
using a visual linear analogue scale from 0% (poor) to 100%
(excellent).
Only 2 patients were dissatisfied with the operative results owing
to
compensatory hyperhidrosis, which occurred in 25 patients and improved in 20
patients
within the follow-up period. CONCLUSIONS: The video-assisted
thoracoscopic
sympathicotomy with 2-mm endoscope is a speedy and safe way of
controlling
hyperhidrosis with excellent cosmetic results while minimizing
complications.
PMID:
11513781 [PubMed - indexed for MEDLINE]
26:
Eur J Cardiothorac Surg 2001
Jun;19(6):951-2
Comment
on:
Eur J Cardiothorac Surg. 2000
Jun;17(6):691-6.
Thoracoscopic
sympathectomy for craniofacial hyperhidrosis.
Kao
MC.
Publication
Types:
Comment
Letter
PMID:
11482300 [PubMed - indexed for MEDLINE]
27:
Hawaii Med J 2001 May;60(5):126, 137
Comment
in:
Hawaii Med J. 2001 May;60(5):122, 129, 135.
Improvement
in quality of life after bilateral transthoracic endoscopic
sympathectomy
for palmar hyperhydrosis.
Lau
WT, Lee JD, Dang CR, Lee L.
OBJECTIVE:
To evaluate the efficacy of bilateral transthoracic endoscopic
sympathectomy
(TES), in alleviating symptoms and improving quality of life for
patients
in Hawaii. DESIGN: Retrospective cohort study. MATERIALS AND METHODS:
Patients
who had undergone TES were evaluated by phone interview and the SF-36
questionnaire
to assess improvements in symptoms and the development of
compensatory
hyperhydrosis. SF-36 scores were divided into 8 scales and
evaluated
by one-tailed t-test. RESULTS: Since 1999, eight patients (five women
and
three men, mean age 27.4 years old, range 15-41 yrs) underwent TES without
significant
complication. Length of hospital stay was less than one day for all
patients
except one, who stayed four days. Estimated operative blood lost was
less
than 100 ml and no blood transfusions were required. No Horner's syndrome
was
suffered. After a mean follow-up of 7.0 months (range 1.2-15.8 months), none
of
the patients had recurrent symptoms in the palms but all reported moderate
compensatory
hyperhydrosis located mainly in the trunk and lower extremities
(two
patients). SF-36 scores showed significant improvements in social
functioning
(p < 0.005), mental health (p < 0.049), and role-physical (p <
0.020)
along with an increase in bodily pain (p < 0.012). CONCLUSION: Although
TES
resulted in some bodily pain and compensatory hyperhydrosis; these elements
were
outweighed by the improvement in palmar symptoms, social, mental, and role
physical
functioning, and overall quality of life.
PMID:
11432050 [PubMed - indexed for MEDLINE]
28:
Hawaii Med J 2001 May;60(5):122, 129,
135
Comment
on:
Hawaii Med J. 2001 May;60(5):126, 137.
Severe
palmar hyperhidrosis treated by transthoracic endoscopic sympathectomy.
Goldstein
N.
Publication
Types:
Comment
Editorial
PMID:
11432048 [PubMed - indexed for MEDLINE]
29:
Kyobu Geka 2001 May;54(5):379-83
[Endoscopic
thoracic sympathectomy for palmar, axillary and plantar
hyperhidrosis:
intermediate-term results]
[Article
in Japanese]
Fukushima
H, Makimura S, Takae H, Yao Y, Ishimaru S.
Department
of Surgery II, Tokyo Medical University, Tokyo, Japan.
From
June 1996 to June 2000, 477 endoscopic thoracic sympathectomies (ETS) were
performed
in 242 patients with palmar hyperhidrosis. Among these, 190 patients
were
studied who received bilateral sympathectomy (T 2-T 3 ganglionectomy) and
were
followed for over six months. There were 114 females and 76 males with a
mean
age of 26 years. Palmar hyperhidrosis was found in all patients and
axillary
hyperhidrosis in 138 (73%) and plantar hyperhidrosis in 186 (98%)
preoperatively.
The degrees of palmar, axillary and plantar perspiration were
checked
immediately (1-2 weeks, 190 patients), as well as in the early (1 year,
190
patients) and late (2-4 years, 65 patients) postoperative periods. In all
patients,
the hands became dry or normal condition immediately after the
operation,
and this continued to late period. Disappearance or decrease of
axillary
sweating was found in 128 patients (93%) in the immediate period and
107
patients (78%) in the early period. Disappearance or decrease of plantar
sweating
was found in 134 patients (72%) in the immediate period and 115
patients
(62%) in the early period. Among 65 patients examined in the late
period,
axillary hyperhidrosis was found in 24 (37%), and plantar hyperhidrosis
was
found in 52 (80%). Compensatory sweating was found in 80 patients (42%) in
the
immediate period and 137 patients (72%) in the early period. In the late
period,
compensatory sweating developed in 56 patients (86%). In the immediate
period,
175 patients (92%) were satisfied with the results of the operation, but
this
decreased to 83% and 72% at early and late period. However ETS was
remarkably
effective for palmar or axillary hyperhidrosis and relatively
effective
for plantar hyperhidrosis, but development of compensatory sweating
did
occur in some cases.
PMID:
11357300 [PubMed - indexed for MEDLINE]
30:
Surg Endosc 2001 May;15(5):435-41
Thoracoscopic
sympathectomy for palmar hyperhidrosis. Ablate or resect?
Hashmonai
M, Assalia A, Kopelman D.
Department
of Surgery B, The Rambam Medical Center and the Faculty of Medicine,
Technion
Israel Institute of Technology, P.O. Box 9621, Haifa 31096, Israel.
hasmonai@inter.net.il
BACKGROUND:
Upper thoracoscopic sympathectomy, obtained either by ablation or
resection
of the appropriate ganglia, is now the preferred treatment for primary
palmar
hyperhidrosis. Therefore, we undertook a review to compare the relative
efficacy
of these two techniques. METHODS: A Medline search was performed for
the
years 1974-99 to identify all published studies of thoracoscopic
sympathectomy
for hyperhidrosis. RESULTS: In all, 33 studies were identified and
divided
into two groups-ablation and resection. When the resection method was
used,
the immediate success rate was 99.76%, whereas the ablation method
achieved
dry hands in 95.2% of cases (p = 0.00001). Palmar sweating recurred in
0%
of patients treated via resection and -4.4% treated with ablation. Ptosis was
noted
in 0.92% of cases after ablation and in 1.72% after resection (p = 0.017).
CONCLUSIONS:
Resection yields superior results, yet the majority of surgeons
ablate,
probably because it is easier, requires a shorter operating time, leads
to
fewer cases of Horner's syndrome, and because resympathectomy eventually
overcomes
initial failure.
Publication
Types:
Review
Review
Literature
PMID:
11353955 [PubMed - indexed for MEDLINE]
31:
Lakartidningen 2001 Apr
11;98(15):1764-5
[Postoperative
complications are frequent after surgery for palmar sweating and
facial
redness. Effects of the treatment must be considered with regard to the
risk
of side-effects]
[Article
in Swedish]
Raf
L.
Patientskadenamnden
och Landstingens Omsesidiga Forsakringsbolag, Stockholm.
lars.raef@swipnet.se
PMID:
11374001 [PubMed - indexed for MEDLINE]
32:
Lakartidningen 2001 Apr
11;98(15):1766-72
[Long-term
effects after surgery for hand sweating and facial blushing. Patients
are
satisfied in spite of troublesome side-effects]
[Article
in Swedish]
Drott
C, Claes G, Rex L, Dalman P, Gothberg G, Fahlen T.
Kirurgiska
kliniken, Boras lasarett. christer.drott@telia.com
The
thoracoscopic technique has simplified surgery on the upper thoracic chain.
This
comparatively minimally traumatic approach has resulted in a pronounced
increase
in the number of procedures. The effect of ETS on severe palmar
hyperhidrosis
and facial blushing is very good. These conditions often cause
social,
professional and emotional handicaps. Side-effects, especially
compensatory
sweating (increased sweating on the trunk and legs), can, however,
be
severe. The procedure should be used only when the hyperhidrosis or facial
blushing
is severely detrimental to the quality of life. The expected effects,
side-effects
and risks for complications must be made clear before patients are
accepted
for ETS.
PMID:
11374002 [PubMed - indexed for MEDLINE]
33:
Ann Thorac Surg 2001 Apr;71(4):1116-9
Early
complications of thoracic endoscopic sympathectomy: a prospective study of
940
procedures.
Gossot
D, Kabiri H, Caliandro R, Debrosse D, Girard P, Grunenwald D.
Thoracic
Department, Institut Mutualiste Montsouris, Paris, France.
dominique.gosso@imm.fr
BACKGROUND:
Thoracic endoscopic sympathectomy (TES) has become the surgical
technique
of choice for treating intractable palmar hyperhidrosis and is usually
considered
as a simple and safe procedure. To evaluate the complication rate of
TES,
we conducted a prospective study of peri- and postoperative complications.
METHODS:
From 1995 to 1999, 467 consecutive patients were operated on for upper
limb
hyperhidrosis. There were 164 men and 303 women, ranging in age from 15 to
59
years (mean 31 years). In all but 5 cases, the procedure was bilateral.
Eleven
patients underwent a reoperation for failure; thus the total number of
sympathectomies
was 940. The procedure was performed in two stages in 182
patients
and in one stage in 267 patients. All patients were seen 1 month after
the
operation. RESULTS: There was no mortality. The mean postoperative hospital
stay
was 2.3 days in the group of patients who were operated on in two stages
and
1.1 day in patients who were operated on in one stage. There were three
major
complications: one tear of the right subclavian artery and two
chylothoraces.
There were 25 cases (5.3%) of bleeding (300 to 600 mL) during
dissection
of the sympathetic trunk due to injury to an intercostal vein; in all
cases
it was controlled thoracoscopically. There were 12 pneumothoraces (1.3%)
after
removal of chest tubes. All of these were unilateral. Four required chest
drainage
for a period of less than 24 hours. One patient had a mild pleural
effusion.
Four patients had a unilateral partial Horner Syndrome (0.4%) that
disappeared
within 3 months in 2 patients. The other 2 patients were lost to
follow-up.
One patient complained of rhinitis. CONCLUSIONS: Although morbidity
was
low, significant complications of TES occurred. Patients should be clearly
warned
that TES is not as minor a procedure as usually asserted. Complications
as
well as adverse effects should be considered when discussing this surgical
indication.
PMID:
11308146 [PubMed - indexed for MEDLINE]
34:
Eur J Cardiothorac Surg 2001 Apr;19(4):545-6
Comment
on:
Eur J Cardiothorac Surg. 2000
Jun;17(6):697-701.
Monitoring
of palmer skin temperature in thoracoscopic sympathectomy.
Kao
MC.
Publication
Types:
Comment
Letter
PMID:
11394357 [PubMed - indexed for MEDLINE]
35:
J Laparoendosc Adv Surg Tech A 2001
Apr;11(2):59-62
Video-assisted
thoracoscopic T2 sympathetic block by clipping for palmar
hyperhidrosis:
analysis of 52 cases.
Lin
TS, Huang LC, Wang NP, Lai CY.
Department
of Surgery, Changhua Christian Hospital, Changhua City, Taiwan, ROC.
Lin8065cms14.hinet.net
BACKGROUND:
Endoscopic thoracic sympathectomy or sympathicotomy is a standard
method
in treating palmar hyperhidrosis, but postoperative compensatory sweating
may
be troublesome in some patients. Therefore, we designed a new technique for
only
T2 sympathetic blocking by clipping instead of interruption of the
sympathetic
trunk. PATIENTS and METHODS: Between September 2000 and July 2001,
we
saw a total of 100 patients with palmar hyperhidrosis who underwent
video-assisted
thoracoscopic sympathetic blocking of the T2 ganglion. All
patients
were placed in a semisitting position under single-lumen intubated
anesthesia.
We performed sympathetic blocking by clipping of the T2 ganglion at
the
level of the second and third rib beds using an 8-mm, 0 degree thoracoscope
(Storz).
RESULTS: We supposed that the postoperative improvement in palmar
hyperhidrosis
would be perfect. The operation could be accomplished within 30
minutes.
All patients were discharged within 4 hours after the operation.
Surgical
complications were minimal, without surgical mortality. A few patients
were
willing to receive the reverse operation and should get improvement of
compensatory
sweating after removal of the endo clips. CONCLUSION: We believe
that
video-assisted thoracoscopic T2 sympathetic block by clipping will be a
safe
and effective method of treating patients with palmar hyperhidrosis.
Compensatory
sweating may be improved by the reverse operation: removal of the
endo
clip.
PMID:
11327127 [PubMed - indexed for MEDLINE]
36:
Minerva Chir 2001 Apr;56(2):193-7
[Minimally-invasive
endoscopic transthoracic sympathectomy of the upper limbs. A
new
method]
[Article
in Italian]
Raposio
E, Filippi F, Renzi M, Caregnato P, Capello C, Santi PL.
Istituto
Nazionale per la Ricerca sul Cancro, Cattedra di Chirurgia Plastica,
Universita
degli Studi, Genoa, Italy.
OBJECTIVE:
Indications for endoscopic transthoracic upper dorsal sympathectomy
are
axillary and palmar hyperhidrosis, upper extremities ischemia (due to, e.g.,
Raynaud
s disease), and upper extremities causalgia. METHODS: At present, this
methodology
relies on (at least) double trocar insertion (per side) and/or
carbon
dioxide insufflation. Thus, although this approach, compared with the
traditional open
sympathectomy techniques, it guarantees the smallest number
of
postoperative complications, it still determines a certain amount of
postoperative
discomfort as well as a risk of complications related to carbon
dioxide
insufflation, as intraoperative profound bradycardia and hypotension due
to
mediastinal shift, and postoperative subcutaneous emphysema. From December
1995,
we are using a minimally-invasive endoscopic transthoracic sympathectomy
technique,
performed by a single-entry specifically modified thoracoscope and
without
the need for carbon dioxide insufflation, with the aim to reduce the
drawbacks
associated with the above-mentioned currently adopted endoscopic
techniques.
After general anesthesia with double-lumen endotracheal tube, with
the
patient placed in a half-sitting position with both arms abduced to 90
degrees,
a 1 cm incision is performed, along the midclavear line (in male
patients)
or the anterior axillary line (in female patients), in the second or
third
intercostal space. RESULTS: The effects of sympathectomy are immediate,
and
the patients wake up with warm and dry hands and axillae. CONCLUSIONS: In
personal
opinion, this single-entry technique, compared with other reported
approaches,
should minimize any damage to the intercostal neurovascular bundle,
while
avoiding the complications connected with carbon dioxide insufflation.
PMID:
11353353 [PubMed - indexed for MEDLINE]
37:
Neurosurg Clin N Am 2001
Apr;12(2):321-7
Endoscopic
upper thoracic sympathectomy.
Vallieres
E.
Division
of Cardiothoracic Surgery, University of Washington Medical Center,
Seattle
98195, USA.
Thoracoscopic
sympathectomy provides a superb surgical option for the many
patients
with incapacitating essential hyperhidrosis. Whether one thoracoscopic
approach
to sympathectomy is ever likely to prevail is doubtful, as the results
of
the various reported techniques seem to be quite similar. There are definite
advantages
to the single-port approaches, which are faster and usually do not
require
repositioning of the patient to do both sides. In the rare instances
where
dense apical adhesions are encountered or when significant bleeding is
encountered
from one of the intercostal vessels, the two- or three-port
approaches
definitely provide better control (see commentary in article by Kohno
and
Takamoto). Surgeon preference probably dictates which approach is used at
the
different centers. Compensatory sweating remains a frequent and sometimes
serious
complication of the procedure, particularly in individuals living in hot
climates.
An understanding of its mechanisms needs improvement, with the hope of
preventing
its occurrence in the future. In the meantime, patients have to be
informed
of its frequency, and operations could probably be tailored to the
patients'
needs and their local climate.
PMID:
11525210 [PubMed - indexed for MEDLINE]
38:
Pacing Clin Electrophysiol 2001
Apr;24(4 Pt 1):524-5
Bradycardia
and permanent pacing after bilateral thoracoscopic T2-sympathectomy
for
primary hyperhidrosis.
Lai
CL, Chen WJ, Liu YB, Lee YT.
Department
of Emergency Medicine, National Taiwan University, 7 Chung-Shan South
Rd.,
Taipei 10016 Taiwan.
A
23-year-old woman with craniofacial hyperhidrosis underwent bilateral
thoracoscopic
T2-sympathectomy. Marked sinus bradycardia with a mean heart rate
of
49 beats/min by Holter ECG monitoring occurred after the procedure and
persisted
for > 2 years. Normal sinus node function was found by an invasive
electrophysiological
study and unopposed vagotonia after sympathectomy was
diagnosed.
A permanent pacemaker was implanted. Although reduced heart rate is a
common
phenomenon after bilateral dorsal sympathectomy, intractable bradycardia
with
permanent pacing is rare. This patient demonstrates one of the potential
cardiac
complications of bilateral sympathectomy.
PMID:
11341096 [PubMed - indexed for MEDLINE]
39:
Surg Laparosc Endosc Percutan Tech 2001
Apr;11(2):152; discussion 153
Thoracoscopic
sympathectomy.
Ng
WT.
Publication
Types:
Letter
PMID:
11330386 [PubMed - indexed for MEDLINE]
40:
Surg Laparosc Endosc Percutan Tech 2001
Apr;11(2):152-3
Thoracoscopic
sympathectomy.
Kao
MC.
Publication
Types:
Letter
PMID:
11330385 [PubMed - indexed for MEDLINE]
41:
Contact Dermatitis 2001 Mar;44(3):200
Comment
on:
Contact Dermatitis. 2000 Feb;42(2):119-20.
Irritant
contact dermatitis of the hands following thoracic sympathectomy.
Kao
MC.
Publication
Types:
Comment
Letter
PMID:
11218010 [PubMed - indexed for MEDLINE]
42:
Eur J Surg 2001 Mar;167(3):237-8
Comment
on:
Eur J Surg. 2000 Jan;166(1):65-9.
"Operative
monitoring of hand and axillary temperature during endoscopic
superior
thoracic sympathectomy for the treatment of palmar hyperhidrosis".
Kao
MC.
Publication
Types:
Comment
Letter
PMID:
11316416 [PubMed - indexed for MEDLINE]
43:
J Am Coll Surg 2001 Mar;192(3):418-20
Posterior
approach for the simultaneous, bilateral thoracoscopic sympathectomy.
de
Haan J, Mackaay AJ, Cuesta MA, Rauwerda JA.
Department
of Surgery, Academic Hospital Vrije Universiteit, Amsterdam, The
Netherlands.
If
there is an indication for sympathectomy in the case of severe hyperhidrosis
or
rubeosis, in our opinion the posterior approach is preferable because of the
advantages
in surgical technique and anesthesia. Bilateral treatment can be
accomplished
in a single admission, with all the concomitant advantages.
PMID:
11245387 [PubMed - indexed for MEDLINE]
44:
Neurosurgery 2001 Mar;48(3):702
Comment
on:
Neurosurgery. 1992 Jan;30(1):131-5.
Neurosurgery. 1993 Feb;32(2):327-9.
Neurosurgery. 1994 Feb;34(2):262-8;
discussion 268.
Neurosurgery. 2000 May;46(5):1254-7;
discussion 1257-8.
Microinvasive
transaxillary thoracoscopic sympathectomy: technical note.
Kao
MC.
Publication
Types:
Comment
Letter
PMID:
11270568 [PubMed - indexed for MEDLINE]
45:
Dtsch Med Wochenschr 2001 Feb
23;126(8):224
[Indications
and results of video thoracoscopic sympathectomy]
[Article
in German]
Wohlrab
J, Marsch WC.
Publication
Types:
Letter
PMID:
11256032 [PubMed - indexed for MEDLINE]
46:
Surg Endosc 2001 Feb;15(2):126-8
Endoscopic
clipping in video-assisted thoracoscopic sympathetic blockade for
axillary
hyperhidrosis. An analysis of 26 cases.
Lin
TS.
Department
of Surgery, Changhua Christian Hospital, Chung Shan Medical and
Dental
College, 135 Nan-Siao Street, Changhua City, Taiwan, Republic of China.
BACKGROUND:
Endoscopic thoracic sympathectomy or sympathicotomy is the standard
method
for the treatment of axillary hyperhidrosis. But postoperative
compensatory
sweating may be troublesome in some patients. Therefore, we use
endoclips
to perform the T3 and T4 sympathetic blockade instead of permanently
interrupting
the transmission of nerve impulses from the sympathetic trunk.
METHODS:
Between May 1997 and June 1998, a total of 26 patients with axillary
hyperhidrosis
underwent video-assisted thoracoscopic sympathetic blocking of the
T3
and T4 ganglia at our hospital. There were 10 men and 16 women with a mean
age
of 31.7 years (range, 16-47). All patients were placed in a semi-sitting
position
under single-lumen intubated anesthesia. We performed the sympathetic
blockade
by clipping the T3 and T4 ganglia at the level of the third, fourth,
and
fifth rib beds using an 8-mm 0 degree thoracoscope. RESULTS: Bilateral T3
and
T4 sympathetic blockade was achieved in all 26 patients. The operation was
usually
completed within 30 min (range, 20-42). Most patients were discharged
within
4 h after the operation. Surgical complications were minimal, with only
one
case of segmental atelectasis (3.8%). There were no deaths. The mean
postoperative
follow-up period was 31.3 months (range, 24-37). Twenty-three
patients
(88.5%) developed compensatory sweating of the trunk and lower limbs.
Twenty-four
patients (92.3%) were satisfied with the results of the operation.
Improvement
of axillary hyperhidrosis was obtained in all patients. One patient
underwent
a reverse operation to remove the endoclips due to intolerable
compensatory
sweating; improvement was seen 25 days after removal of the clips.
CONCLUSION:
Video-assisted thoracoscopic T3 and T4 sympathetic blockade by
clipping
is a safe and effective method for the treatment of patients with
axillary
hyperhidrosis. Patients who experience excessive compensatory sweating
may
require a reverse operation for endoclip removal.
Publication
Types:
Evaluation
Studies
PMID:
11285952 [PubMed - indexed for MEDLINE]
47:
Surg Endosc 2001 Feb;15(2):222
Transthoracic
endoscopic sympathectomy.
Kao
MC.
Publication
Types:
Letter
PMID:
11285974 [PubMed - indexed for MEDLINE]
48:
Neurology 2001 Jan 23;56(2):254-6
Basal
forebrain malformation with hyperhidrosis and hypothermia: variant of
Shapiro's
syndrome.
Klein
CJ, Silber MH, Halliwill JR, Schreiner SA, Suarez GA, Low PA.
Department
of Neurology, Mayo Clinic, Rochester, MN, USA.
A
62-year-old woman presented with episodic sweating and shivering with reduced
core
temperature. Brain MRI demonstrated a basal forebrain malformation.
Physiologic
testing included EEG, SPECT, heat challenge, and autonomic testing.
Glycopyrrolate
aborted spells and raised core temperature. Hypothalamic
dysregulation
is likely the primary pathophysiology in the setting of other
forebrain
anomalies. These findings expand the structural abnormalities and
treatment
options within the temperature dysregulating conditions of Shapiro's
syndrome
and "diencephalic epilepsy."
PMID:
11160966 [PubMed - indexed for MEDLINE]
49:
Acta Anaesthesiol Scand 2001
Jan;45(1):123-6
Bilateral
pulmonary edema after endoscopic sympathectomy in a patient with
glucose-6-phosphate
dehydrogenase deficiency.
Lan
CJ, Luk HN, Wu CT, Chang WK, Tsou MY, Lui PW, Lee TY.
Department
of Anesthesiology, Veterans General Hospital-Taipei, School of
Medicine,
National Yang-Ming University, Taiwan, ROC. blues729@ms36.hinet.net
Transaxillary
endoscopic sympathectomy of thoracic ganglia (T2-T3) has recently
gained
wider acceptance as the treatment of choice for palmar hyperhidrosis. It
requires
one-lung ventilation to facilitate the surgery. One-lung ventilation,
however,
is not without complications, among which acute pulmonary edema has
been
reported. In this case report, we present a patient with palmar
hyperhidrosis
complicated by glucose-6-phosphate dehydrogenase (G-6-PD)
deficiency,
who received bilateral endoscopic sympathectomy under alternate
one-lung
anesthesia, and developed acute pulmonary edema immediately after
recruitment
of the successive collapsed lung. The effects of hypoxemia, G-6-PD
deficiency
and sympathectomy might all add to the development of acute pulmonary
edema
secondary to reexpansion of each individual lung after alternate one-lung
ventilation.
The possibilities of the inferred causes are herein discussed.
PMID:
11152024 [PubMed - indexed for MEDLINE]
50:
Ann Chir Gynaecol 2001;90(3):195-9
Efficacy
and safety of thoracoscopic sympathicotomy for hyperhidrosis of the
upper
limb. Results of 734 sympathicotomies.
Neumayer
CH, Bischof G, Fugger R, Imhof M, Jakesz R, Plas EG, Herbst FR, Zacherl
J.
Universitatsklinik
fur Chirurgie, Allgemeines Krankenhaus der Stadt Wien,
Universitat
Wien, Vienna, Austria.
BACKGROUND:
Thoracoscopic sympathicotomy (TS) evolved as treatment of choice in
severe
hyperhidrosis. The aim of this study was to assess the role of
video-assistance
in TS (VATS) versus conventional TS (CTS) for primary
hyperhidrosis
of the upper limb with regard to safety, side-effects and
long-term
outcome. METHODS: 734 TS were performed from below T1 to T4 in 406
patients.
In the CTS and in the VATS group 558 and 176 procedures were
performed,
respectively. Follow-up was completed in 82% of all patients after a
median
observation period of 16 years. RESULTS: Dry limbs were immediately
achieved
in 92% (CTS) and 97% (VATS, p = 0.98). Only one patient (CTS) underwent
conversion
due to bleeding. In the CTS group Horner's syndrome occurred in 2.2%
and
rhinitis in 9.9% of procedures. No patient of the VATS group experienced
Horner's
syndrome (p = 0.025), 3 patients developed rhinitis (p = 0.11). At
follow-up
compensatory sweating was observed in 67.6% vs. 55.6% (p = 0.051) and
gustatory
sweating in 50.4% and 33.3% (p = 0.01). There were 5 failures or
recurrences
(1.9%) in the CTS group and 2 (2.8; p > 0.05) in the VATS group at
reevaluation.
Overall 6.5% (CTS) and 5.6% (VATS) of patients regret the
operation
(p = 0.7). CONCLUSIONS: We observed a significant decrease of the
incidence
of complete or incomplete Horner's syndrome and gustatory sweating
when
the procedure was guided by video-imaging while success rate was similar
when
compared with CTS.
PMID:
11695794 [PubMed - in process]
51:
Ann Chir Gynaecol 2001;90(3):189-92
Efficacy
of endoscopic thoracic sympathicotomy along with severing the Kuntz
nerve
in the treatment of chronic non-infectious rhinitis.
Duarte
JB, Kux P.
Department
of Surgery, Mater Dei Hospital and Belvedere Clinic, Fundacao
Cardiovascular
Sao Francisco de Assis, Belo Horizonte, Brazil.
duartejb@horiz.com.br
BACKGROUND:
The ethiopathogenic diagnosis of rhinitis is laborious and the
clinical
treatment is unsatisfactory in many cases. After endoscopic thoracic
sympathicotomy
(ETS), some patients related improvement of the symptoms of
chronic
non-infectious rhinitis (CNIR). AIM: To study the influence of ETS
associated
with the severing of the Kuntz nerve in the follow-up of patients
suffering
from CNIR. MATERIAL AND METHOD: From October, 1993 to February, 2001,
117
patients (post-op. follow-up from 2 to 88 months; 46 males and 71 females;
median
age 24.9 years) were submitted to bilateral ETS and severing of the Kuntz
nerve
for treatment of hyperhidrosis and chronic non-festering rhinitis. The
sympathetic
trunk was severed at different levels according to hyperhidrosis
location
and rhinitis. RESULT: Rhinitis was cured in 52 patients (44.4%), was
improved
in 43 patients (36.8%), and in 22 patients (18.8%) there was no change.
In
3 patients specifically operated on for treatment of CNIR, symptoms
disappeared.
CONCLUSION: The results of the present investigation confirmed the
benefits
of ETS associated with severing of the Kuntz nerve in the treatment of
CNIR.
We recommend this procedure for the treatment of rhinitis associated with
hyperhidrosis
and also for the treatment of specific, isolated cases of CNIR.
PMID:
11695792 [PubMed - in process]
52:
Ann Chir Gynaecol 2001;90(3):206-8
Right
vs left side thoracoscopic sympathectomy: effects of CO2 insufflation on
haemodynamics.
El-Dawlatly
AA, Al-Dohayan A, Samarkandi A, Algahdam F, Atef A.
Department
of Anaesthesia, College of Medicine, King Saud University, Riyadh,
Saudia
Arabia. dawlatly@ksu.edu.sa
BACKGROUND
AND AIMS: Currently, few reports of the haemodynamic impact of
intrapleural
CO2 insufflation in the clinical setting are available. Therefore,
we
conducted the present study to compare the haemodynamic changes between right
and
left side thoracoscopic sympathectomy (TS) for treatment of palmar
hyperhidrosis
(PH) under general anaesthesia. MATERIALS AND METHODS: 20 adult
patients
(17 males) undergoing TS were randomly allocated to two groups (each
10);
group A, right side and group B, left side TS procedures were performed
under
general anaesthesia with single-lumen endotracheal tube. Besides the
routine
monitoring of vital signs, non-invasive cardiac output monitor (NICO)
was
used to record the stroke volume (SV), cardiac output (CO) and cardiac index
(CI).
Intrapleural CO2 insufflation was used. Anaesthesia was maintained with 1
MAC
sevoflurane in 50% nitrous oxide in oxygen with incremental doses of
sufentanil
and atracurium when required. Haemodynamic parameters were obtained
every
3 min then averaged over the time of surgery at phases; I) after tracheal
intubation,
II) after CO2 insufflation and III) after CO2 deflation. RESULTS:
The
CO, CI and SV showed decreased trend in both groups during phase II compared
to
phase I with significant differences (P < 0.05). Comparing the CO and CI
variables
revealed lower values in group A compared to group B but with
non-significant
differences (P > 0.05). While the SV variable showed significant
low
value in group A compared to group B (P < 0.05). CONCLUSIONS: Compared to
left
side TS, direct compression by CO2 against the venae cava and right atrium
and
ventricle during right side TS caused reduction of the venous return and
hence
low CO, CI and SV.
PMID:
11695797 [PubMed - in process]
53:
Ann Chir Gynaecol 2001;90(3):170-1
Kuntz's
fiber: the scapegoat of surgical failure in sympathetic surgery.
Lin
CC, Wu HH.
Department
of Surgery, Tainan Municipal Hospital, Taiwan.
scipio54@ms46.hinet.net
Resection
of Kuntz's fiber is considered a guarantee to treat Hyperhidrosis in
sympathetic
surgery. The incidence of Kuntz's fiber is about 60.0% in clinical
studies
while the surgical failure rate is about 1.5% when Kuntz's fiber is
preserved
on Endoscopic Thoracic Sympathetic Block by clamping, which is
performed
by clamping the upper and lower end of ganglion. We found that
supererogatory
resection of Kuntz's fiber is inessential; clamping of upper and
lower
ends of the ganglia should be a complete procedure in sympathetic surgery.
Kuntz's
fiber plays only anatomic, and no clinical role in surgical failure of
sympathetic
surgery.
PMID:
11695786 [PubMed - in process]
54:
Ann Chir Gynaecol 2001;90(3):209-11
A
survey on anesthesia for thoracoscopic sympathetic surgery in treatment of
hyperhidrosis
palmaris in Taiwan.
Lee
LS, Lin CC, Chung HC, Au CF, Fang HT.
Department
of Anesthesia and Surgery, Tainan Municipal Hospital, Tainan City,
Taiwan.
sam10087@hotmail.com
Thoracoscopic
approach to sympathetic surgery has gained its popularity and
emerged
as the main stream in the treatment of hyperhidrosis palmaris in Taiwan.
Different
kinds of anesthesia have been practiced and reported in these
surgeries.
We made a survey of anesthetic methods in twelve medical centers and
regional
hospitals of the island. It was found out that the choice of the
anesthesia
was mainly dependent on the mutual trust and the full communication
between
the anesthesiologist and the surgeon, both based on their skills and the
operative
methods chosen by the surgeon. Single-lumen endotracheal tube with
general
inhalation anesthesia is practiced in most of the hospitals surveyed.
Sevoflurane
and desflurane are the choices of the inhalational anesthetic
agents.
In short, the anesthesiologists tend to practice the type of anesthesia
that
is simple but safe enough to secure the airway of the patient throughout
the
thoracoscopic sympathetic surgery.
PMID:
11695798 [PubMed - in process]
55:
Ann Chir Gynaecol 2001;90(3):172-4
Video-assisted
thoracoscopic sympathetic ramicotomy for hyperhidrosis--a way to
reduce
the complications.
Cheng
YJ, Wu HH, Kao EL.
Department
of Surgery, Kaohsiung Medical University Hospital, Taiwan, Republic
of
China. yujen.cheng@msa.hinet.net
Endoscopic
resectional surgery of sympathetic nerves is now the most acceptable
method
to treat palmar hyperhidrosis, though the resection of the sympathetic
trunk
and ganglia can result in the irreversible compensatory hyperhidrosis. The
ideal
way to treat the palmar hyperhidrosis, without the undesirable
complication
of the compensatory hyperhidrosis, is still pending. We adapt
endoscopic
cutting of the second and third sympathetic rami without injury to
the
sympathetic ganglia and trunk, and find that it is a good way to reduce the
complications.
Most importantly, it has a cure rate comparable with the
conventional
technique. The longer operation time and the higher operation risk
are
the drawbacks.
PMID:
11695787 [PubMed - in process]
56:
Ann Chir Gynaecol 2001;90(3):203-5
Upper
dorsal thoracoscopic sympathectomy for palmar hyperhidrosis. The use of
harmonic
scalpel versus diathermy.
Kopelman
D, Bahous H, Assalia A, Hashmonai M.
Faculty
of Medicine, Technion--Israel Institute of Technology, Haifa.
BACKGROUND:
Upper dorsal thoracoscopic sympathectomy, the treatment of choice
for
primary palmar hyperhidrosis, is not devoid of long-term complications, like
Horner's
syndrome and postoperative neuralgia. It has been postulated that
propagation
of heat induced by diathermy may be responsible for some of these
sequelae.
To assess this hypothesis, a study was undertaken to evaluate the use
of
harmonic scalpel, which does not dissipate heat. METHOD: Sixteen patients
with
primary palmar hyperhidrosis underwent upper dorsal thoracoscopic
sympathectomy
using the harmonic scalpel on one side and diathermy on the other.
Follow-up
was made two years postoperatively. RESULTS: The length of the
procedure
with each instrument was similar. There was no localization of
postoperative
pain, which could be attributed to either device. No Horner's
syndrome
or postoperative neuralgia occurred. CONCLUSION: The present study
proved
the safe use of harmonic scalpel for upper dorsal thoracoscopic
sympathectomy,
but did not detect any important advantage of either instrument
over
diathermy.
PMID:
11695796 [PubMed - in process]
57:
Ann Chir Gynaecol 2001;90(3):167-9
Endoscopic
t4-sympathetic block by clamping (ESB4) in treatment of hyperhidrosis
palmaris
et axillaris--experiences of 165 cases.
Lin
CC, Wu HH.
Department
of Surgery, Sinlau Christian Hospital, Tainan, Taiwan.
scipio54@ms46.hinet.net
Prevention
of postoperative complications becomes relatively important when
surgical
procedures are easy to learn and perform. Endoscopic Thoracic
Sympathetic
Surgery (ETS), which is now more accessible to surgeons after the
2nd
International Symposium of Thoracic Sympathicotomy, would be the typical
examples
in surgery. Reflex sweating is one of the famous and annoying
complications
that surgeons endeavor to avoid but in vain in ETS. Incidentally,
we
found that preservation of sympathetic tone to the head is the main
influential
factor in avoiding reflex sweating in ETS; and with the lower
sympathetic
ganglion blocked, the more sympathetic tone to the head is
preserved.
T4-sympathetic block is an ideal procedure that can treat palmar
and/or
axillary hyperhidrosis and preserve most of sympathetic tone to head. We
used
T4-sympathetic block by clamping (ESB4) in treatment of 165 cases of
Hyperhidrosis
et axillaris and attained excellent operative results without
reflex
sweating from August 1, 2000 to February 28, 2001. We concluded, ESB4 is
the
method that can treat hand and axillary hyperhidrosis without inducing
reflex
sweating.
PMID:
11695785 [PubMed - in process]
58:
Auton Neurosci 2000 Dec
28;86(1-2):99-106
Patterns
of palmar skin temperature alterations during transthoracic endoscopic
T2
sympathectomy for palmar hyperhidrosis.
Lu
K, Liang CL, Cho CL, Cheng CH, Yen HL, Rau CS, Tsai YD, Chen HJ, Lee TC.
Department
of Neurosurgery, Chang Gung Memorial Hospital, 123 Ta-Pei Road,
Niao-Sung
Hsiang, Kaohsiung Hsien 833, Taiwan, ROC.
Transthoracic
endoscopic T2 sympathectomy has been widely applied to the
treatment
of a variety of sympathetically mediated disorders. Palmar
hyperhidrosis
is probably the most common indication for thoracic sympathectomy,
especially
in certain subtropical areas. Which sympathetic ganglion is to be
ablated
and how extensive such ablation is enough to eliminate palm sweating are
two
important issues. Intraoperative monitoring of palmar skin temperature (PST)
is
the most frequently used method for assessing the accuracy as well as
adequacy
of ablation of the target sympathetic ganglia. With continuous
monitoring
of bilateral PST during the operative course of T2 sympathectomy, it
was
possible to depict the alterations of bilateral PST in response to specific
surgical
procedures in a real-time manner. For each case, a PST graph was
obtained,
which represented the graphical expression of intraoperatively
recorded
bilateral PST data plotted against time. The PST graphs of 93
consecutive
cases were analysed. Three types of PST graphs existed, reflecting
different
responses of bilateral PST to different surgical procedures during the
operation.
In Type I PST graph pattern, found in 58 cases, skin incision and
intercostal
muscle dissection caused dramatic bilateral PST drop; and unilateral
T2
sympathectomy induced synchronous bilateral PST elevation. Twenty-four cases
demonstrated
Type II PST graph pattern, in which unilateral T2 sympathectomy
caused
only ipsilateral PST elevation, although the PST-depressing effect of
skin
incision and muscle dissection was as significant as in Type I graph
pattern.
In the 11 cases who showed Type III PST graph pattern, neither skin
incision
nor T2 sympathectomy induced any apparent changes of PST on either
side,
giving rise to two rather flat PST curves on the PST graphs. These
findings
implicate that reciprocal interactions between bilateral sympathetic
activities
exist in the majority of cases, and that crossover sympathetic
modulation
may play a role in the neural control of the sudomotor and vasomotor
activities
of the palms. This study also provides information regarding how PST
would
possibly change following specific surgical procedures during
transthoracic
endoscopic T2 sympathectomy, which may be of importance to those
who
use intraoperative PST monitoring as a guide in determining whether or not
the
correct sympathetic ganglia are ablated for adequate sympathetic denervation
of
the palms.
Publication
Types:
Clinical
Trial
PMID:
11269931 [PubMed - indexed for MEDLINE]
59:
Ann Dermatol Venereol 2000
Dec;127(12):1053-4
[Hyperhidrosis:
role of surgical treatment]
[Article
in French]
Dumont
P.
Publication
Types:
Editorial
PMID:
11173677 [PubMed - indexed for MEDLINE]
60:
Ann Dermatol Venereol 2000
Dec;127(12):1065-7
[Endoscopic
thoracic sympathectomy for isolated axillary hyperhidrosis]
[Article
in French]
Gossot
D, Debrosse D, Grunenwald D.
Departement
de Chirurgie Thoracique, Institut Mutualiste Montsouris, 42,
boulevard
Jourdan, 75014 Paris. dominique-gossot@imm.fr
BACKGROUND:
Endoscopic thoracic sympathectomy is accepted as the treatment of
choice
for palmar hyperhidrosis. But the interest and the results of endoscopic
thoracic
sympathectomy for isolated axillary hyperhidrosis are still discussed.
PATIENTS
AND METHODS: In a series of 435 patients operated on for hyperhidrosis
of
the upper limbs during the 5 past years, 23 were suffering from isolated
axillary
hyperhidrosis (5.2 p. 100). All patients had been previously treated by
local
agents and 3 had iontophoresis. All patients underwent a bilateral
endoscopic
thoracic sympathectomy that was performed in one stage. Sympathectomy
was
done according to the usual technique but was extended down to T5. All
patients
were then contacted by phone to answer a detailed questionnaire. Four
patients
were lost for follow-up. The mean follow-up of the 19 remaining
patients
was 26 months (ranging 3 to 41 months). RESULTS: There was no
intraoperative
or postoperative complication. All patients were discharged the
day
after surgery. All but one (95 p. 100) were cured from their axillary
hyperhidrosis.
All of them experienced compensatory sweating (100 p. 100). This
compensatory
sweating was considered as mild by 8 patients, as embarrassing in 8
and
as distressing in 3. Eleven patients complained of excessive dryness of the
hands.
This was considered as a minor adverse effect by 8 patients and as
problematic
by 3 patients. Finally, 16 patients were satisfied while 3 claimed
they
regretted having been operated on. CONCLUSION: The rate of compensatory
sweating
and the rate of dissatisfaction are higher after endoscopic thoracic
sympathectomy
for axillary hyperhidrosis than after endoscopic thoracic
sympathectomy
for palmar hyperhidrosis. Endoscopic thoracic sympathectomy for
axillary
hyperhidrosis should be foreseen only when all other therapies have
been
attempted.
PMID:
11173680 [PubMed - indexed for MEDLINE]
61:
Ann Dermatol Venereol 2000
Dec;127(12):1057-63
[Endoscopic
sympathectomy for palmar and plantar hyperhidrosis: results in 107
patients]
[Article
in French]
Nicolas
C, Grosdidier G, Granel F, Barbaud A, Schmutz JL.
Service
de Dermatologie, Hopital Fournier, 36, quai de la bataille, 54035 Nancy
Cedex.
INTRODUCTION:
Transthoracic endoscopic sympathectomy for palmar hyperhidrosis is
a
safe and effective method. However, no radical and definite treatment exists
for
plantar hyperhidrosis. We report our experience, immediate post-operative
and
mid-term results after transthoracic and lumbar endoscopic sympathectomy for
palmar
and plantar hyperhidrosis. PATIENTS AND METHODS: One hundred and seven of
117
patients cured between January 94 and December 98, answered a questionnaire
regarding
their past history, the early post-operative results, side effects and
complications
caused by the operation and mid-term results with particular
emphasis
on patient satisfaction. RESULTS: Seventy-eight thoracic and lumbar
endoscopic
sympathectomies and 125 thoracic endoscopic sympathectomies were
performed.
The patients were 30 men (median age 30 years) and 77 women (median
age
26 years). Only women underwent lumbar endoscopic sympathectomy because of
risk
of retrograde ejaculation. No severe complications were noted. The success
rate
was 96 p. 100 for palmar hyperhidrosis and 98,5 p. 100 for plantar
hyperhidrosis.
No recurrences were noted in 97 p. 100 of the patients with
median
follow-up of 28 months. The main side effect was compensatory sweating
which
was the reason for dissatisfaction for 5 p. 100 of the patients. Cutaneous
dryness
and gustatory sweating were also described. However, 95 p. 100 of the
patients
were "satisfied" or "very satisfied". CONCLUSION: Our experience
proved
that
lumbar endoscopic sympathectomy is as safe and effective for treatment of
plantar
hyperhidrosis, as thoracic endoscopic sympathectomy for palmar
hyperhidrosis.
PMID:
11173679 [PubMed - indexed for MEDLINE]
62:
Aust N Z J Surg 2000 Nov;70(11):800
Thoracoscopic
sympathectomy: a one-port technique.
Weight
CS, Raitt D, Barrie WW.
Department
of Surgery, Leicester General Hospital, Leicestershire, UK.
scweight@rcsed.ac.uk
BACKGROUND:
The present paper describes the development of a one-port technique
for
thoracoscopic sympathectomy. METHODS: A 7-mm thorascope with a working
channel
for diathermy was used. CONCLUSION: A highly cosmetic, simple, safe,
day-case
procedure is achievable.
PMID:
11147441 [PubMed - indexed for MEDLINE]
63:
Rinsho Shinkeigaku 2000
Nov;40(11):1069-75
[Changes
of autonomic functions by endoscopic upper thoracic sympathectomy on
idiopathic
hyperhidrosis]
[Article
in Japanese]
Kondo
M, Mezaki T, Higuchi K, Watanabe Y, Kuzuhara S.
Department
of Neurology, Matsusaka Central General Hospital, Matsusaka.
Changes
of autonomic functions before and after bilateral endoscopic upper
thoracic
sympathectomy (EUTS) were evaluated in 13 patients with idiopathic
hyperhidrosis,
with the sympathetic skin response, coefficient of variation of
R-R
intervals, mean heart rate, thermography, and non-invasive Valsalva test of
the
tonometry method. EUTS electronically destructs the upper thoracic
sympathetic
ganglions which innervate the upper extremities, and partially the
heart.
The decrement of mean heart rate, and persistent inhibition of the
vascular
contraction and hidrosis of the hands appeared after EUTS. These
manifestations
were effect produced by the abortion of sympathetic activity by
EUTS.
In 10 of the 12 cases, the baroreceptor sensitivity index II of Valsalva
test
which reflects the sympathetic autonomic nervous function of the heart
showed
normal pattern after EUTS. Four cases revealed reincrement of both the
blood
pressure and heart rate at the latter half phase of the second stage of
the
Valsalva test. The sympathetic dysfunction of the heart was limited to the
decrement
of mean heart rate although EUTS partially destroys sympathetic fibers
innervating
the heart. A long-term study is necessary to evaluate the effect of
EUTS
on the cardiac function.
PMID:
11332185 [PubMed - indexed for MEDLINE]
64:
Clin Neurophysiol 2000
Oct;111(10):1767-70
Excitability
recovery curve of the sympathetic skin response in healthy
volunteers
and patients with palmar hyperhidrosis.
Manca
D, Valls-Sole J, Callejas MA.
Unitat
d'EMG, Servei de Neurologia, Departamento de Medicina, IDIBAPS, Hospital
Clinic,
Facultad de Medicina, Universitat de Barcelona, Villaroel, 170, 08036,
Barcelona,
Spain.
OBJECTIVES:
Patients with primary palmar hyperhidrosis (PPH) might exhibit
hyperexcitability
of the reflex circuits involved in sweating. We hypothesized
that
this hyperexcitability could become evident in the study of the
excitability
recovery curve of the sympathetic sudomotor skin response (SSR).
METHODS:
In 10 patients with PPH and 10 healthy volunteers used as control
subjects,
we recorded the SSR in the palm of the right hand to pairs of median
nerve
electrical shocks separated by inter-stimuli intervals (ISIs) ranging from
0.5
to 3.5 s. The amplitude of the SSR generated by the second stimulus (SSR2)
was
expressed as a percentage of that generated by the first (SSR1), and
compared
between control subjects and patients for each ISI. RESULTS: None of
the
control subjects showed a recovery of the SSR for ISIs of 1.5 s or less. On
the
contrary, patients showed a statistically significant enhancement of the SSR
excitability
recovery curve, with onset of recovery at 1.5 s in 5 patients. Two
patients
showed a double peak response to single electrical stimulation and were
not
considered in the calculation of the SSR recovery curve. Mean excitability
recovery
percentages were larger in patients than in control subjects at ISIs of
2,
2.5 and 3 s. CONCLUSIONS: The enhancement of the SSR recovery curve in
patients
with PPH suggests hyperexcitability of the somatosympathetic
polisynaptic
pathway involved in sweating. This could partly underlie the
pathophysiology
of PPH.
PMID:
11018490 [PubMed - indexed for MEDLINE]
65:
J Laparoendosc Adv Surg Tech A 2000
Oct;10(5):243-7
Transthoracic
endoscopic sympathectomy for craniofacial hyperhidrosis: analysis
of
46 cases.
Lin
TS, Fang HY.
General
Thoracic Surgery, Changhua Christian Hospital, Changhua City, Taiwan,
ROC.
Lin8065@ms14.hinet.net
BACKGROUND
AND PURPOSE: Craniofacial hyperhidrosis may result in social phobia
and
has a strong negative impact on the quality of life. The traditional
therapeutic
options are psychotherapy and pharmacologic treatment, but these
often
fail. We wished to investigate whether transthoracic endoscopic
sympathectomy
(TES) of the lower part of the stellate ganglion is efficient and
safe
in the treatment of craniofacial hyperhidrosis. PATIENTS AND METHODS:
Between
July 1995 and September 1999, a total of 21 men and 25 women with a mean
age
of 41.2 years (range 22-58 years) underwent TES for craniofacial
hyperhidrosis.
All patients were placed in a semisitting position under
single-lumen
intubated anesthesia. We ablated the lower part of the stellate
ganglion
at the second rib using a storz 8-mm 0 degrees thoracoscope via one
0.8-cm
incision just below each axilla. Questionnaires were sent to all patients
postoperatively.
RESULTS: Among these 46 patients, 92 sympathectomies were
performed.
Usually, TES was accomplished within 15 minutes (range 7-20 minutes).
The
surgical complications were minimal: one segmental atelectasis of the lung
(2%).
There was no surgical mortality. With a mean postoperative follow-up of
32.1
months (range 3-51 months), the results of TES were highly satisfactory in
most
patients although 37 (80%) developed compensatory sweating of the trunk and
lower
limbs, the distribution being the axillae in 15 (33%), back in 36 (78%),
lower
chest and abdomen in 22 (48%), lower limbs in 34 (74%) and sole in 1. The
recurrence
rates of craniofacial hyperhidrosis were 0 in the first and the
second
years and 2% each in the third and fourth years. CONCLUSION:
Transthoracic
endoscopic sympathectomy is a safe and effective method for
treating
craniofacial hyperhidrosis.
Publication
Types:
Clinical
Trial
PMID:
11071402 [PubMed - indexed for MEDLINE]
66:
J Neurosurg 2000 Oct;93(2 Suppl):342-3
Comment
on:
J Neurosurg. 2000 Jan;92(1 Suppl):44-9.
Endoscopic
sympathectomy.
Kao
MC.
Publication
Types:
Comment
Letter
PMID:
11012078 [PubMed - indexed for MEDLINE]
67:
Surg Laparosc Endosc Percutan Tech 2000
Oct;10(5):338-9
Comment
on:
Surg Laparosc Endosc Percutan Tech. 2000
Feb;10(1):5-10.
Endoscopic
thoracic sympathectomy (ETS) is a simple, safe, and effective method
for
treating palmar hyperhidrosis.
Kao
MC.
Publication
Types:
Comment
Letter
PMID:
11083223 [PubMed - indexed for MEDLINE]
68:
Surg Laparosc Endosc Percutan Tech 2000
Oct;10(5):314-8
Thoracoscopic
sympathectomy.
Krasna
MJ, Jiao X, Sonett J, Gamliel Z, King K.
University
of Maryland School of Medicine, Baltimore, USA.
The
objective was to evaluate the safety and effectiveness of endoscopic
thoracic
sympathectomy (ETS) for treatment of a variety of sympathetic
disorders,
including hyperhidrosis, splanchnic pain, reflex sympathetic
dystrophy,
and Raynaud upper extremity ischemia. Sixty-three ETS procedures were
performed
in 34 patients at the University of Maryland Medical System between
March
1992 and August 1999 (14 male patients, 20 female patients; mean age 22
years).
The indications for surgery were hyperhidrosis in 26 patients, upper
extremity
ischemia in 3 patients, splanchnic pain and reflex sympathetic
dystrophy
in 2 patients each, and facial blushing in 1 patient. Preoperative
symptoms
resolved completely or improved significantly in 97.1% (33/34) of
patients.
One patient with left reflex sympathetic dystrophy had symptoms that
recurred
shortly after surgery. There were no major complications; one patient
with
hyperhidrosis reported significant compensatory hyperhidrosis. These
findings
suggest that ETS is a safe and effective procedure for treatment of a
variety
of sympathetic disorders. Its application for hyperhidrosis is very
effective,
and its treatment of splanchnic pain, reflex sympathetic dystrophy,
and
Raynaud syndrome are rewarding. With increasing experience, ETS should
become
established in the repertoire of the thoracic surgeon.
Publication
Types:
Evaluation
Studies
PMID:
11083216 [PubMed - indexed for MEDLINE]
69:
BMJ 2000 Sep 16;321(7262):703
Comment
on:
BMJ. 2000 May 6;320(7244):1221-2.
Treating
hyperhidrosis. Anticholinergic drugs were not mentioned.
Klaber
M, Catterall M.
Publication
Types:
Comment
Letter
PMID:
11202933 [PubMed - indexed for MEDLINE]
70:
BMJ 2000 Sep 16;321(7262):703
Comment
on:
BMJ. 2000 May 6;320(7244):1221-2.
Treating
hyperhidrosis. Treatment options must be balanced against each other.
de
Berker D.
Publication
Types:
Comment
Letter
PMID:
11202934 [PubMed - indexed for MEDLINE]
71:
BMJ 2000 Sep 16;321(7262):702-3
Comment
on:
BMJ. 2000 May 6;320(7244):1221-2.
Treating
hyperhidrosis. Iontophoresis should be tried before other treatments.
Murphy
R, Harrington CI.
Publication
Types:
Comment
Letter
PMID:
11202931 [PubMed - indexed for MEDLINE]
72:
J Thorac Cardiovasc Surg 2000
Aug;120(2):276-9
Needlescopic
surgery for palmar hyperhidrosis.
Yamamoto
H, Kanehira A, Kawamura M, Okada M, Ohkita Y.
Department
of Surgery, Division II, Kobe University School of Medicine, Kobe,
Japan.
hideyama@mua.biglobe.ne.jp
OBJECTIVE:
The aim of this study was to develop a less invasive technique for
video-assisted
thoracic sympathectomy. METHODS: A newly designed trocar was
used.
A skin incision of 2.0 to 2.5 mm in length was made in the third or fourth
intercostal
space at the midaxillary line. After insertion of the trocar,
thoracic
sympathectomy with electrocautery was carried out at the level of the
second
and third ribs. RESULTS: From October 1998 to March 1999, 180 patients
with
palmar hyperhidrosis underwent this technique. No complications related to
the
technique occurred, and within 1 week the operative wound had almost
completely
disappeared. There were recurrences necessitating reapplication of
the
technique. CONCLUSION: The technique allowed healing without a scar and
improved
the patient's cosmesis.
PMID:
10917942 [PubMed - indexed for MEDLINE]
73:
Surg Laparosc Endosc Percutan Tech 2000
Aug;10(4):226-9
Video-assisted
transthoracic sympathectomy in the treatment of primary
hyperhidrosis:
friend or foe?
Fredman
B, Zohar E, Shachor D, Bendahan J, Jedeikin R.
Department
of Anesthesiology and Critical Care, Meir Hospital, Kfar Saba,
Israel.
The
authors hypothesize that palmar hyperhidrosis is a systemic manifestation of
abnormal
sudomotor function; consequently, thoracoscopic sympathectomy to
alleviate
symptoms in the hands may result in heat dissipation because sweating
is
transferred to other sites. To investigate this phenomenon and to determine
whether
it adversely affects patient satisfaction, a standard questionnaire was
administered
to 626 patients who underwent sympathectomy at a
university-associated
public hospital between 1991 and 1998; only patients
treated
at least 6 months before questionnaire distribution were included in the
study.
Replies were received from 336 (53.7%) individuals. The surveyed patients
underwent
bilateral T2, T3 (palmar sweating), or T3, T4 (axillary sweating)
sympathectomy
by a standard video-assisted transthoracic technique. Main outcome
measures
included the incidence of dry hands, compensatory sweating, chest pain,
upper-limb
muscle weakness, shortness of breath, and gustatory phenomena; in
addition,
patient perception of the success of the surgical procedure was
assessed.
After sympathectomy, 97.3% (P < 0.0001) and 29.2% (P < 0.001) of
patients
reported significant improvement in palmar hyperhidrosis and axillary
sweating,
respectively. Postsurgery, severe compensatory sweating was
experienced
in 90% of patients (P < 0.0001). The sites of compensatory sweating
were
the back (75%), abdomen (51%), feet (23%), groin and thigh (13%), chest
(13%),
and axillae (8%). Transient whole-body sweating for no apparent reason
was
experienced in 30% of patients. Thirty-seven patients (11%) regretted having
undergone
the surgical procedure. In contrast, 25% and 64% of patients were
either
satisfied or very satisfied with the outcome of the procedure. From the
survey
results, the authors conclude that palmar hyperhidrosis is a systemic
manifestation
of abnormal sudomotor function and that thoracic sympathectomy may
alleviate
symptoms in a large proportion of patients. However, for some
individuals,
compensatory sweating may prove to be an equally troublesome
handicap.
Because the occurrence of severe compensatory sweating is
unpredictable,
a reversible sympathectomy may be desirable.
PMID:
10961751 [PubMed - indexed for MEDLINE]
74:
Dtsch Med Wochenschr 2000 Jul
7;125(27):817-21
[The
indications for and results of video thoracoscopic sympathectomy]
[Article
in German]
Heuberger
J, Furrer M, Habicht J, Inderbitzi R.
Lungenzentrum
Hirslanden, Zurich.
BACKGROUND
AND OBJECTIVES: Thoracoscopic sympathectomy, for years an effective
way
to treat mainly palmar and axilla hyperhidrosis, experienced a revival since
the
application of the principles of minimally invasive surgery. We report the
personal
experiences of three surgeons with this technique, as well as patients'
view
of the outcome. PATIENTS AND METHODS: Between January 1990 and November
1997,
73 procedures were performed in 43 patients (23 males, 20 females, mean
age
38.1 years, range 15-82 years), and the outcome was prospectively studied.
Palmar
hyperhidrosis without axilla symptoms was the indication for the
operation
in 27 patients (54 sympathectomies), Raynaud's syndrome in 15 (18
sympathectomies),
and causalgia in one. Thoracic ganglia 2-4 were always
completely
resected. Perioperative morbidity as well as patient satisfaction in
the
long-term course (standardized interview) 25.8 (1-77) months postoperatively
were
assessed. RESULTS: The complication rate in all 73 sympathectomies was
8.2%.
Only two severe incidents were observed: in one patient intermittent
Horner's
syndrome (1.4%) occurred, and in another severe bleeding required
conversion
to open surgery (1.4%). Both complications occurred in the early
study
phase. The initial success rate in all 27 patients with hyperhidrosis was
100%.
In 30% of these cases a mild partial relapse was observed, which did not
interfere
with their daily activities. 53% of the patients reported compensatory
and
23% gustatory sweating. 9% would have refused the operation, had they known
these
side effects. In all patients with Raynaud's disease the ulcerations
healed
completely. At the time of the interview, two patients (13%) complained
of
painless relapses. They too stated that they had refused the operation, if
they
had known about the relapses. CONCLUSIONS: Even in the longer-term course,
thoracoscopic
sympathectomy is rated subjectively successful by 93% of patients
after
treatment of hyperhidrosis of the upper extremities, and by 87% of
patients
after treatment of Raynaud's disease, despite some untoward effects and
partial
relapses.
PMID:
10929535 [PubMed - indexed for MEDLINE]
75:
Ann Thorac Surg 2000 Jul;70(1):240-2
Needlescopic
thoracic sympathectomy: treatment for palmar hyperhidrosis.
Goh
PM, Cheah WK, De Costa M, Sim EK.
Minimally
Invasive Surgical Center, Department of Surgery, National University
Hospital,
Singapore. surgohmy@nus.edu.sg
BACKGROUND:
Open thoracic sympathectomy has been the established option for
patients
with essential hyperhidrosis. Recently, video-assisted endoscopic
sympathectomy
has provided a simple, safe, reliable, and cost-effective
alternative
to the earlier technique. With advances in instrumentation,
performing
the procedure through 2-mm and 3-mm needlescopic ports is now
possible.
The authors evaluate the effectiveness of so-called needlescopic
thoracic
sympathectomy for the treatment of primary hyperhidrosis. METHODS:
Thirty
five consecutive patients with a mean age of 24 years, including 23 men
and
12 women, underwent bilateral needlescopic thoracic sympathectomies at the
National
University Hospital of Singapore. RESULTS: The mean operative duration
was
56 minutes, and the mean hospital stay was 1.2 days. In no patient did
Horner's
syndrome or significant pneumothorax develop. The rate of success,
defined
as completely dry hands, was 97%. Two patients had unilateral
recurrences
that responded well to repeat needlescopic sympathectomies. We
performed
a total of 72 sympathectomies. CONCLUSIONS: Our study demonstrates
that
the use of miniature port access sites produces excellent medical and
cosmetic
results and is associated with a short hospital stay and low risk of
complications.
Publication
Types:
Clinical
Trial
PMID:
10921715 [PubMed - indexed for MEDLINE]
76:
Ann Thorac Surg 2000 Jul;70(1):314-7
Thoracoscopic
sympathectomy for hyperhidrosis palmaris: a periareolar approach.
Kesler
KA, Brooks-Brunn JA, Campbell RL, Brown JW.
Department
of Surgery, Indiana University School of Medicine, Indianapolis
46202,
USA. kkesler@iupui.edu
Severe
hyperhidrosis palmaris represents a disabling problem for many patients.
Thoracoscopic
techniques that involve dissection and removal of the upper
thoracic
sympathetic chain are believed to result in the lowest incidence of
recurrent
symptoms. However, aside from an axillary incision, an additional
upper
anterior chest wall approach is usually required. Over the past 2 years,
we
have used a periareolar incision in eight patients to improve postoperative
cosmesis
for this benign condition.
PMID:
10921742 [PubMed - indexed for MEDLINE]
77:
Eur J Cardiothorac Surg 2000
Jul;18(1):7-11
Early
and long-term complaints following video-assisted thoracoscopic surgery:
evaluation
in 173 patients.
Stammberger
U, Steinacher C, Hillinger S, Schmid RA, Kinsbergen T, Weder W.
Division
of Thoracic Surgery, University Hospital, Ramistrasse 100, CH-8091,
Zurich,
Switzerland.
OBJECTIVE:
Minimal invasive surgical techniques have gained high acceptance in
thoracic
surgery during the last 10 years. However, up to now, only scant
information
exists on chronic postoperative pain and discomfort in patients who
underwent
video-assisted thoracoscopy. Therefore, a retrospective study was
performed
with the aid of a self-reported questionnaire. METHODS: Two hundred
and
thirteen patients (of whom 79 females) with a mean age of 48 (range 15-88)
years
were operated on for a total of 225 procedures. Thoracoscopy was performed
for
pneumothorax (n=70), pulmonary nodules (n=44), interstitial lung diseases
(n=20),
pleural effusion (n=20), and empyema (n=19). Various indications
included
therapeutic or diagnostic procedures in bullous disease, mediastinal
tumors,
carcinoma, inflammatory lung disease, hyperhidrosis mani and
bronchiectasis.
RESULTS: Mean drainage time was 6.0+/-4.7 days and hospital stay
8.4+/-6.6
days. One patient died on the ninth postoperative day after lobectomy
for
bronchial carcinoma due to cardiac failure, five patients needed a short
period
of reintubation due to acute respiratory failure. In two patients,
thoracoscopic
reoperation was necessary for closure of bronchopleural fistula.
The
self-reported questionnaire was returned by 173 (81%) of all patients within
a
mean follow-up of 18 (3-38) months. More than half of the patients (53%)
reported
no thoracic pain as early as 2 weeks after the procedure. At 2 weeks
after
the operation, 13% of patients suffered from localized pain and 31% from
diffuse
discomfort. Twelve percent needed pain medication regularly, and 3%
occasionally.
At 6 months postoperatively, three quarters of the patients had no
complaints,
5% suffered from scar pain, and 20% had diffuse chest discomfort.
One
year after the procedure, 86% of the patients had no complaints, 9% suffered
from
minimal pain, and 5% from moderate pain. Two years after the procedure, 96%
of
the patients had no complaints at all. One hundred and twenty-five of the 140
patients
(89%) working preoperatively went back to work within 2 weeks after the
operation.
Fifteen patients did not work between 3 and 16 weeks; 14 due to chest
pain,
one due to shoulder pain. CONCLUSION: Video-assisted thoracoscopy permits
very
early recovery with rapid reintegration into the working process. Long-term
complaints
after videothoracoscopy are rare.
PMID:
10869933 [PubMed - indexed for MEDLINE]
78:
Surg Neurol 2000 Jul;54(1):96-7
Comment
on:
Surg Neurol. 1999 Nov;52(5):453-7.
Transthoracic
endoscopic sympathectomy.
Kao
MC.
Publication
Types:
Comment
Letter
PMID:
11203125 [PubMed - indexed for MEDLINE]
79:
Circulation 2000 Jun 13;101(23):2716-20
Sympathetic
denervation of the upper limb improves forearm exercise performance
and
skeletal muscle bioenergetics.
Kardos
A, Taylor DJ, Thompson C, Styles P, Hands L, Collin J, Casadei B.
University
Department of Cardiovascular Medicine, University of Oxford, UK.
BACKGROUND:
Sympathetic activation may limit exercise performance by restraining
muscle
blood flow or by negatively affecting skeletal muscle metabolic behavior.
To
test this hypothesis, we studied the effect of thoracoscopic sympathetic
trunkotomy
(TST) on forearm exercise duration, blood flow, and muscle
bioenergetics
in 13 patients with idiopathic palmar hyperhidrosis. METHODS AND
RESULTS:
Heart rate and beat-by-beat mean arterial pressure were recorded at
rest
and during right and left rhythmic handgrip before and 4 to 7 weeks after
right
TST. Forearm blood flow was measured bilaterally at rest and on the right
during
exercise. Right forearm muscle phosphocreatine content and intracellular
pH
were assessed by (31)phosphorus magnetic resonance spectroscopy. After right
TST,
exercise duration increased from 8.9+/-1.4 to 13.4+/-1.8 minutes (P<0.0001)
with
the right forearm and from 5.7+/-0.4 to 7.6+/-0.9 minutes (P<0.05) with the
left
(P<0.05 for the interaction between treatment and side). Right forearm
blood
flow at rest was 66% higher (P<0.01) after right TST, but this difference
decreased
as the exercise progressed. After right TST, a significant reduction
occurred
in muscle acidification and phosphocreatine depletion during
ipsilateral
forearm exercise. This was associated with a significantly reduced
mean
arterial pressure response to right handgrip, whereas the pressor response
to
left handgrip did not change. CONCLUSIONS: Sympathetic denervation of the
upper
limb significantly improves forearm skeletal muscle bioenergetics and
exercise
performance in patients with idiopathic palmar hyperhidrosis.
PMID:
10851209 [PubMed - indexed for MEDLINE]
80:
Eur J Cardiothorac Surg 2000
Jun;17(6):691-6
Comment
in:
Eur J Cardiothorac Surg. 2001
Jun;19(6):951-2.
Ultra-thin
needle thoracoscopic surgery for hyperhidrosis with excellent
cosmetic
effects.
Sung
SW, Kim YT, Kim JH.
Department
of Thoracic and Cardiovascular Surgery, Seoul National University
Hospital,
28 Yongon, Chongno, 110-744, Seoul, South Korea. swsung@snu.ac.kr
BACKGROUND:
In spite of its cosmetic benefits over open surgical techniques,
endoscopic
sympathectomy using 5 mm or larger instruments still has the problems
of
operative scar as well as pain on the trocar sites. Recently we have begun
using
2 mm endoscopic instruments. The purpose of this study was to confirm the
safety
and feasibility of fine needle endoscopic instruments in thoracic
sympathetic
ablation. METHODS: We have exclusively used 2 mm endoscopic
instruments
since January 1997, and from that time to May 1999 417 patients were
underwent
surgical procedures for hyperhidrosis. T2 or T2/T3 sympathectomy was
performed
for the first 56 patients, after June 1997, in 361 patients the
interconnecting
sympathetic trunk was divided instead of ganglion resection, and
this
procedure was named sympathicotomy. Palmar hyperhidrosis was presented in
375
patients (89.9%) and facial in 28 (6.7%) and axillary in 14 (3.4%). The
level
of division or resection of the ganglion differed according to the
patient's
symptoms. RESULTS: Sympathicotomy and sympathectomy were successful
and
all patients were satisfied with immediate dryness of affected sites. There
were
not any cases of bleeding or reoperation or hospital mortality. A large
endoscope
was required to eliminate the pleural adhesion in fourteen cases
(7.7%).
Thoracotomy conversion was required in two pleural adhesion cases. Minor
complications
were occurred in 17 patients (4.1%); such as closed thoracostomy
in
ten cases, peripheral nerve injury in three, pulmonary parenchymal injury in
two,
Horner's syndrome in two and atrial fibrillation in one. We have five cases
of
recurrent symptoms (1.2%). CONCLUSION: Our experience indicates that, for the
treatment
of hyperhidrosis, 2 mm ultra-thin needle endoscopic instruments are
safe
and effective to operate on palmar and facial hyperhidrosis patients.
PMID:
10856861 [PubMed - indexed for MEDLINE]
81:
Eur J Cardiothorac Surg 2000
Jun;17(6):697-701
Comment
in:
Eur J Cardiothorac Surg. 2001
Apr;19(4):545-6.
'Needlescopic'
video-assisted thoracic surgery for palmar hyperhidrosis.
Yim
AP, Liu HP, Lee TW, Wan S, Arifi AA.
Division
of Cardio-thoracic Surgery, The Chinese University of Hong Kong, Prince
of
Wales Hospital, Shatin, N.T., People's Republic of, Hong Kong, China.
yimap@cuhk.edu.hk
OBJECTIVE:
The video-assisted thoracic surgery (VATS) approach for thoracodorsal
sympathectomy
has been well accepted. We report the use of ultra-fine
thoracoscopic
equipment for this procedure, based on the experience from two
centers
in Asia. MATERIALS AND METHODS: Thirty-eight patients with palmar
hyperhidrosis
underwent bilateral VATS thoracodorsal sympathectomy using 2-mm
instruments
exclusively. General anesthesia with selective one lung ventilation
was
used. Carbon dioxide insufflation was used when lung collapse was found to
be
inadequate. In 11 patients, the sympathetic chain was excised (T2-T3 for
palmar
hyperhidrosis alone, extending to T4 for axillary hyperhidrosis), and in
27
patients, the chain was cauterized. The choice of procedure reflects the
surgeon's
preference. No chest drains were left after the procedure and no
stitching
of the wound was necessary. RESULTS: There was no mortality or major
complications.
A small pneumothorax was found in the postoperative chest X-ray
in
three patients. They all resolved without further intervention. Twenty-seven
patients
were discharged on the same day of admission, and 11 patients were
discharged
on postoperative day one. After an average follow-up of 16 months
(range
5-28), there has been no recurrence of symptoms. Compensatory truncal
hyperhidrosis
was encountered in two patients, but the symptoms were not severe
enough
to interfere with lifestyle, and this required no further treatment.
CONCLUSION:
Thoracodorsal sympathectomy using 2-mm instruments is technically
feasible
and is associated with an excellent clinical outcome. Limitations of
the
equipment, however, exist (narrow field of vision, lower resolution and
difficulty
in maintaining fine control), and we are currently restricting its
use
to relatively simple procedures.
Publication
Types:
Clinical
Trial
PMID:
10856862 [PubMed - indexed for MEDLINE]
82:
Harefuah 2000 Jun 1;138(11):913-6, 1008
[Videothorascopic
sympathectomy (VATS) for palmar hyperhidriosis:summary of a
clinical
trial and surgical results]
[Article
in Hebrew]
Nesher
N, Galili R, Sharony R, Uretzky G, Saute M.
Dept.
of Cardiothoracic Surgery, Lady Davis-Carmel Medical Center, Haifa.
Palmar
hyperhidriosis is not a life-threatening disease but leads to loss in the
quality
of life. Conservative treatment is ineffective and major surgery
involves
perioperative complications and esthetic impairment. From 1992 to 1998
we
treated 156 patients with palmar hyperhidriosis using a single port,
drainless
videothoracoscopic procedure with almost no complications.
Publication
Types:
Clinical
Trial
PMID:
10979397 [PubMed - indexed for MEDLINE]
83:
J Formos Med Assoc 2000
Jun;99(6):466-71
Thermographic
study of palmar and facial skin temperature of hyperhidrosis
patients
before and after thoracic sympathectomy.
Tsai
JC, Lim KB, Lin SY, Kao MC.
Laser
Medicine Research Center, College of Medicine, National Taiwan University,
Taipei,
Taiwan.
PURPOSE:
The purpose of this study was to investigate the roles of the second
thoracic
sympathetic segment in the sympathetic innervation of the hands and
face,
and to compare skin temperature changes in the palms, fingers, face, and
neck
of palmar hyperhidrosis (PH) patients before and after endoscopic thoracic
sympathectomy.
METHODS: Twenty-two patients, 14 women and eight men, with severe
PH
were treated with endoscopic ablation of the T2 segment. The skin
temperatures
of the hands, neck, and face were assessed by infrared thermography
both
before and after operation. RESULTS: All obtained satisfactory relief of
PH.
Before sympathectomy, thermography revealed that the palmar skin temperature
(PST)
was significantly lower than the facial temperature by 1.3 degrees C
(paired
t-test, p < 0.005). After sympathectomy, thermography showed significant
elevations
in temperature mainly of the thenars, palms, digits, and nose, but
not
of the forehead, mandible, or neck (ANOVA, p < 0.05 with Bonferroni t-test).
The
variations in PST among PH patients were much greater preoperatively than
postoperatively.
More prominent postoperative PST elevation was found in PH
patients
with lower preoperative PST (r = 0.898, p < 0.001). CONCLUSIONS: These
findings
demonstrate that the T2 segment is the key source of sympathetic
innervation
to the hand and that the T2 segment contributes only trivial
sympathetic
innervation to the face. The results of the present thermography
studies
offer descriptive information about the autonomic innervation of the
upper
thoracic sympathetic trunk.
PMID:
10925552 [PubMed - indexed for MEDLINE]
84:
Neurol Res 2000 Jun;22(4):420-4
Histopathological
examination of chemo-sympathectomy in cats.
Wang
YC, Lee WH, Chen WY, Fu YM.
Department
of Neurosurgery, Taichung Veterans General Hospital, Taiwan, ROC.
ycwang@vghtc.vghtc.gov.tw
In
recent decades, there has been an increase in both the number of
sympathectomy
techniques, as well as the surgical findings of sympathetic
anatomy.
Currently the advanced technique of C-arm guided percutaneous thoracic
chemo-sympathectomy
is widely used for the treatment of palmar hyperhidrosis.
However,
a better understanding of chemical agents in sympathectomy is required.
In
this study, chemo-sympathectomy was performed in cats, using alcohol,
glycerol
and various concentrations of phenol, to determine the chronic
neurotoxic
effects of these chemical agents on the stellate ganglia. The
stellate
ganglia of 24 cats were exposed under endotracheal general anesthesia,
then
injected with about 0.02 ml of absolute alcohol, glycerol and phenol (10%,
25%,
50%, and 75% concentration) solutions, respectively. The stellate ganglia
were
taken for histological examination three weeks after the chemical
injection.
The results showed that the degenerative changes in the cytoplasm and
nucleus
of ganglionic cells and intercellular tissue were moderate and
relatively
moderate after the injection of alcohol and glycerol, respectively.
Meanwhile,
the stellate ganglia revealed mild, relatively moderate, serious and
extremely
serious degeneration after injection of 10%, 25%, 50%, and 75% phenol,
respectively.
In conclusion, we recommend a high concentration of phenol, in the
least
volume, as a chemical agent for clinical injection in the upper thoracic
sympathetic
ganglion.
PMID:
10874694 [PubMed - indexed for MEDLINE]
85:
Neurosurgery 2000 May;46(5):1254-7;
discussion 1257-8
Comment
in:
Neurosurgery. 2001 Mar;48(3):702.
Microinvasive
transaxillary thoracoscopic sympathectomy: technical note.
Wahlig
JB Jr, Welch WC, Weigel TL, Luketich JD.
Department
of Neurological Surgery, University of Pittsburgh, Presbyterian
University
Hospital, Pennsylvania 15213, USA.
OBJECTIVE:
To describe a two-port transaxillary thoracoscopic approach for
thoracic
sympathectomy that maximizes working space, improves manipulative
ability,
and enhances visualization of the surgical field. METHODS: Positioning
of
the patients was optimized to displace the scapula posteriorly, widen the
avenue
of approach to the sympathetic ganglia, and create a more direct route to
the
target. The semi-Fowler position permitted the lung apex to fall away from
mediastinal
structures, obviating a separate retraction port. A 30-degree
endoscope
allowed an unobstructed view of surgical progress, and anatomic
relationships
were manipulated in a temporal sequence to facilitate dissection.
RESULTS:
Microinvasive transaxillary sympathectomy was performed successfully in
13
patients, all of whom had a good outcome without complications. CONCLUSION:
The
modifications implemented increase the speed and safety of thoracoscopic
sympathectomy
while minimizing complications.
PMID:
10807262 [PubMed - indexed for MEDLINE]
86:
Neurosurgery 2000 Apr;46(4):924-8
Uniportal
endoscopic superior thoracic sympathectomy.
Vanaclocha
V, Saiz-Sapena N, Panta F.
Division
of Neurosurgery, Clinica Universitaria, University of Navarra,
Pamplona,
Spain.
OBJECTIVE:
A retrospective study presenting our experience with upper thoracic
endoscopic
sympathectomy in patients with primary palmar hyperhidrosis. METHODS:
One
hundred patients (46 women and 54 men) underwent bilateral uniportal
endoscopic
thoracic sympathectomy since January 1, 1995. Age distribution ranged
from
12 to 54 years (mean, 23.4 yr). RESULTS: Sympathectomy on both sides was
accomplished
within 30 minutes in a single stage. Ninety-six patients (96%) had
an
uneventful postoperative course and were discharged the following day. Four
patients
with residual hemothorax required intercostal drainage and were
discharged
on the third postoperative day. Ninety-six patients were completely
satisfied
with immediate and permanent relief of palmar perspiration.
Compensatory
hyperhidrosis was the major complication, which was usually mild
and
tolerable after reassurance. In only eight patients (8%) was the
compensatory
hyperhidrosis considered bothersome, requiring treatment with
aluminum
chloride in ethanol solution at 25%. There was no mortality. Recurrence
of
palmar hyperhidrosis has been noticed in five patients (5%) during the
follow-up
period (range, 2-56 mo; mean, 12 mo). At the time of reoperation, a
remaining
branch of the sympathetic chain could be observed and coagulated.
CONCLUSION:
We consider thoracoscopic sympathectomy to be a simple, safe, and
effective
method for treating palmar hyperhidrosis. It is an effective method
for
treating patients with palmar hyperhidrosis, with a shorter operation time,
fewer
hospital days, and a better cosmetic result, as compared with the open
approaches.
PMID:
10764266 [PubMed - indexed for MEDLINE]
87:
Dtsch Med Wochenschr 2000 Mar
10;125(10):290
[Essential
hyperhidrosis]
[Article
in German]
Wollina
U.
Klinik
fur Dermatologie und Allergologie der Friedrich-Schiller-Universitat,
07740
Jena. uwol@derma.uni-jena.de
Publication
Types:
Review
Review,
Tutorial
PMID:
10755853 [PubMed - indexed for MEDLINE]
88:
Arch Dermatol 2000 Mar;136(3):393-9
Hypnosis
in dermatology.
Shenefelt
PD.
Department
of Internal Medicine, College of Medicine, University of South
Florida,
Tampa 33612, USA. pshenefe@hsc.usf.edu
BACKGROUND:
Hypnosis is an alternative or complementary therapy that has been
used
since ancient times to treat medical and dermatologic problems. OBJECTIVE:
To
describe the various uses for hypnosis as an alternative or complementary
therapy
in dermatologic practice. METHODS: A MEDLINE search was conducted from
January
1966 through December 1998 on key words related to hypnosis and skin
disorders.
RESULTS: A wide spectrum of dermatologic disorders may be improved or
cured
using hypnosis as an alternative or complementary therapy, including acne
excoriee,
alopecia areata, atopic dermatitis, congenital ichthyosiform
erythroderma,
dyshidrotic dermatitis, erythromelalgia, furuncles, glossodynia,
herpes
simplex, hyperhidrosis, ichthyosis vulgaris, lichen planus,
neurodermatitis,
nummular dermatitis, postherpetic neuralgia, pruritus,
psoriasis,
rosacea, trichotillomania, urticaria, verruca vulgaris, and vitiligo.
CONCLUSION:
Appropriately trained clinicians may successfully use hypnosis in
selected
patients as alternative or complementary therapy for many dermatologic
disorders.
Publication
Types:
Review
Review,
Tutorial
PMID:
10724204 [PubMed - indexed for MEDLINE]
89:
Biol Psychol 2000 Feb;52(1):85-90
Nonresponders
among hyperhidrotics.
Kerassidis
S, Charistou A.
Department
of Basic Sciences, Laboratory of Functional Brain Imaging, Division
of
Medicine, School of Health Sciences, University of Crete, Greece.
eploropo@otenet.gr
In
the context of our investigation on palmar sweating and hyperhidrosis we
subjected
40 individuals (20 hyperhidrotic and 20 normal) to noise stimulation.
The
participants received ten startling auditory tones (square pulse of 400 ms
duration,
1000 Hz frequency and 105-dB intensity) at random intervals varying
from
15-55 s. Hyperhidrotic subjects, relative to controls, responded with
greater
amplitude and habituated later, but a subset of these subjects failed to
respond
at all to the tone. In this report, we focus on the finding that some
hyperhidrotics
were nonresponders. We discuss the consequences of this finding,
both
its implication for understanding hyperhidrosis and nonresponsiveness, as
well
as the complexity of sympathetic nervous system activation.
PMID:
10686374 [PubMed - indexed for MEDLINE]
90:
Ear Nose Throat J 2000 Feb;79(2):111-2
Gustatory
sweating syndrome of the submandibular gland.
Persaud
NA, Myer CM 3rd, Rutter MJ.
Department
of Otolaryngology, Metropolitan Hospital, Grand Rapids, Mich. 49506,
USA.
Gustatory
sweating syndrome involving the submandibular gland is rare. We
present
a case of a patient who experienced this syndrome 5 years after
undergoing
submandibular gland resection. Our patient was satisfied simply with
an
explanation of the disorder and reassurance. But in cases where further
intervention
is sought, medical and surgical options are available and should be
individualized
for the patient.
PMID:
10697935 [PubMed - indexed for MEDLINE]
91:
Kyobu Geka 2000 Feb;53(2):136-40
[Ineffective
and recurrent cases of thoracoscopic sympathectomy for
hyperhidrosis
and intractable pain]
[Article
in Japanese]
Hoshina
K, Amemiya R, Asato Y, Hishikawa S, Nemoto K, Kiyoshima M, Kohno S,
Shida
D, Tanaka R, Suzuki A, Yoshimi F, Koizumi S.
Department
of Surgery, Ibaraki Prefectural Central Hospital and Cancer Center,
Japan.
We
reported the cases of thoracoscopic sympathectomy, that is, six cases of
hyperhidrosis,
three of post herpetic neuralgia, and four of reflex sympathetic
dystrophy,
including recurrent or incompletely resected or ineffective ones.
Recently
this procedure for hyperhidrosis had been performed frequently because
of
its effectiveness, less pain, early discharge and cosmetic aspect. For an
ineffective
case of hyperhidrosis abdominal respiration which emphasized the
exhalation
and using an upper abdomen decreased the sweating. The balance of
autonomic
nerve system, toward parasympathetic dominant, was thought to be
improved
by conscious respiration. The decrease of sweating right after the
operation
in a case of incomplete resection indicated that intraoperative
maneuver
could restrict the sympathetic nerve. This procedure for a pain control
could
be less effective than that for hyperhidrosis, so an adequate preoperative
informed
consent was thought to be necessary.
PMID:
10667025 [PubMed - indexed for MEDLINE]
92:
Surg Endosc 2000 Feb;14(2):134-6
Repeat
transthoracic endoscopic sympathectomy for palmar and axillary
hyperhidrosis.
Lin
TS, Fang HY, Wu CY.
General
Thoracic Surgery, Changhua Christian Hospital, No. 135, Nan-Siau Street,
Changhua
City, Taiwan, ROC.
BACKGROUND:
Patients undergoing an unsuccessful sympathectomy experience dryness
on
one hand and excessive sweating on the other. This is embarrassing for the
patients,
and resolution of both a previous failed sympathectomy and recurrent
hyperhidrosis
is important. METHODS: From September 1995 to January 1998, 24
patients
(11 men and 13 women; mean age, 28.2 years) underwent repeat
transthoracic
sympathectomy (TES). The repeat TES was performed with patients
under
general anesthesia using either a standard single-lumen endotracheal tube
(12
patients) or a double-lumen endotracheal tube (12 patients). Ablation of T2
and
T3 ganglia and any Kuntz fiber was performed in treating patients with
palmar
hyperhidrosis, and a similar procedure was performed on T3 and T4 ganglia
for
patients with axillary hyperhidrosis. RESULTS: The reasons for failure of
the
previous TES were pleural adhesion (14/24), intact T2 ganglion (5/24),
aberrant
venous arch drainage to the superior vena cava (2/24), incomplete
interruption
of sympathetic nerve (2/24), and possible reinnervation (1/24). The
mean
operation time was 28 min (range, 18-72 min). In all, 23 patients had a
satisfactory
result, without recurrence of palmar or axillary hyperhidrosis. The
mean
follow-up time was 22 months (range, 5-30 months). The average hospital
stay
was 1.8 days. There was no surgical mortality. CONCLUSION: Repeat TES is a
safe
and effective method for treating both an unsuccessful sympathectomy and
recurrent
palmar or axillary hyperhidrosis.
PMID:
10656945 [PubMed - indexed for MEDLINE]
93:
Surg Laparosc Endosc Percutan Tech 2000
Feb;10(1):5-10
Comment
in:
Surg Laparosc Endosc Percutan Tech. 2000
Oct;10(5):338-9.
Endoscopic
thoracic sympathectomy for treatment of essential hyperhidrosis
syndrome:
experience with 650 patients.
Reisfeld
R, Nguyen R, Pnini A.
The
Center for Hyperhidrosis at The Beverly Hills Center for Special Surgery,
Los
Angeles, California 90035, USA.
Patients
with essential hyperhidrosis (EH) syndrome may experience subjective
suffering
and social/occupational challenges. We examined the safety and
efficacy
of minimally invasive endoscopic surgery for treating EH. Single
bilateral
incisions, followed by endoscopic thoracic sympathectomy
(ETS)-mediated
bilateral ablation of the T2 sympathetic ganglia, were used to
treat
650 patients with a primary diagnosis of palmar (90%) or facial
hyperhidrosis
(10%). Palmar and facial hyperhidrosis were resolved in 584 of 585
(>99%)
and 62 of 65 (95%) patients, respectively. Surgery required less than 1
hour,
and no patient experienced a life-threatening adverse event. Compensatory
sweating
was observed in 83% of patients and was considered mild or moderate in
approximately
67% of those patients. Innovations in ETS have resulted in
minimally
invasive, highly efficient, safe treatment of EH. Surgery is minimally
intrusive
to patients, who were usually discharged within 2 hours after surgery
and
able to resume normal activities within 1 week.
PMID:
10872518 [PubMed - indexed for MEDLINE]
94:
Acta Neurochir (Wien) 2000;142(6):691-6
Endoscopic
transthoracic sympathicotomy affects the autonomic modulation of
heart
rate in patients with palmar hyperhidrosis.
Wiklund
U, Koskinen LO, Niklasson U, Bjerle P, Elfversson J.
Department
of Biomedical Engineering & Informatics, University Hospital, Umea,
Sweden.
BACKGROUND:
Palmar hyperhidrosis has been associated with an increased activity
of
the sympathetic nervous system. The objective of this study was to assess the
immediate
and long-term effects of endoscopic transthoracic sympathicotomy on
the
autonomic modulation of the heart rate in patients with palmar
hyperhidrosis.
METHODS: Power spectrum analysis of heart rate variability in the
lying
position and after passive tilt to the upright position was performed in
thirteen
patients the day before and after sympathicotomy. A follow-up recording
was
performed in ten patients approximately six months later. Recordings from 26
healthy
subjects were used as a reference group. FINDINGS: The patients had a
tendency
to higher power of the low-frequency (LF: 0.04-0.15 Hz) and
high-frequency
(HF; above 0.15 Hz) components than controls in the upright
position.
After sympathicotomy LF power was reduced, but HF power was unchanged.
At
follow-up LF power remained at a lower level, but now HF power was reduced.
INTERPRETATION:
Patients with palmar hyperhidrosis have a sympathetic
overactivity
but also a compensatory high parasympathetic activity.
Sympathicotomy
results in an initial sympathovagal imbalance with a
parasympathetic
predominance, which is restored on a long-term basis.
PMID:
10949445 [PubMed - indexed for MEDLINE]
95:
Ann Thorac Surg 2000 Jan;69(1):251-3
Needle
thoracic sympathectomy for essential hyperhidrosis: intermediate-term
follow-up.
Lee
DY, Yoon YH, Shin HK, Kim HK, Hong YJ.
Respiratory
Center, Department of Thoracic and Cardiovascular Surgery, Yongdong
Serverance
Hospital, Yonsei University College of Medicine, Seoul, Korea.
dylee@yumc.yonsei.ac.kr
BACKGROUND:
Essential hyperhidrosis is a condition with excessive sweating
localized
to certain part of the body. A definitive cure can be obtained by
upper
thoracic sympathectomy. METHOD: Between June and October 1997, 117
patients
with essential hyperhidrosis underwent needle thoracoscopic
sympathectomy.
Of the 94 patients, 42 were men and 52 women. Their ages ranged
from
14 to 63 years, with a mean age of 23 years. RESULTS: There were no
mortality
or life-threatening complications. Symptomatic improvement was found
in
95.7%. Compensatory hyperhidrosis was found in 71.2% of the patients, but in
these
compensatory hyperhidrosis were mostly tolerable. CONCLUSIONS: This
therapeutic
procedure is minimally invasive and very effective. Further
development
of the new device and surgical technique are expected to follow.
PMID:
10654524 [PubMed - indexed for MEDLINE]
96:
Aust N Z J Surg 2000 Jan;70(1):57-9
Skin
wrinkling for the assessment of sympathetic function in the limbs.
Vasudevan
TM, van Rij AM, Nukada H, Taylor PK.
Department
of Vascular Surgery, Dunedin Hospital, University of Otago Medical
School,
New Zealand.
BACKGROUND:
Wrinkling of the skin of the palm and sole is considered to be
dependent
on the presence of intact sympathetic nervous activity. Loss of
sympathetic
integrity could be simply and usefully assessed by the absence of
wrinkling.
To test this hypothesis, the skin wrinkle test was compared with the
starch-iodine
sweat test and sympathetic skin response (SSR) in patients with
abnormal
sympathetic function. METHODS: The three tests were carried out in 34
patients
(68 limbs) undergoing temporary or permanent disruption of the
sympathetic
chain to upper or lower limbs. Included in this group were six
diabetics
undergoing chemical or surgical sympathectomy, lumbar epidural
infusions
following vascular surgery, and patients for whom sympathectomy was
being
considered. Sensitivity and specificity analysis and predictive values of
the
wrinkling response and the starch-iodine test were related to the SSR as the
standard.
RESULTS: The wrinkle test showed a sensitivity of 97% and specificity
of
95%, and bore good correlation to the SSR. The starch-iodine test showed
sensitivity
of 55% and specificity of 93%. A hypothesis for the mechanism of
wrinkling
based on the observations of the present study is proposed.
CONCLUSION:
The wrinkle test is a reliable test of sympathetic function, is
inexpensive
and is easy to perform at the bedside. The sweat gland
myo-epithelial
cells and absence of sebum could play an important role in the
wrinkling
response. It can be used to select patients who will benefit from
sympathectomy,
and can adequately evaluate sympathetic blockade.
PMID:
10696945 [PubMed - indexed for MEDLINE]
97:
Br J Dermatol 2000 Jan;142(1):194-5
A
caution about surgical treatment for facial blushing.
Drummond
PD.
Publication
Types:
Letter
PMID:
10819557 [PubMed - indexed for MEDLINE]
98:
Eur J Surg 2000 Jan;166(1):65-9
Comment
in:
Eur J Surg. 2001 Mar;167(3):237-8.
Operative
monitoring of hand and axillary temperature during endoscopic superior
thoracic
sympathectomy for the treatment of palmar hyperhidrosis.
Saiz-Sapena
N, Vanaclocha V, Panta F, Kadri C, Torres W.
Department
of Anaesthesiology, Clinica Universitaria, University of Navarra,
Pamplona,
Spain.
OBJECTIVE:
To find out how much the temperature in the palm rises after upper
thoracic
sympathectomy for palmar hyperhidrosis, and correlate the temperature
with
the outcome. DESIGN: Retrospective study. SETTING: University hospital,
Spain.
SUBJECTS: 73 patients (34 women and 39 men, age range 16-42 years, mean
26)
who were operated for palmar hyperhidrosis between 1 January 1995 and 31
December
1997. INTERVENTIONS: Bilateral thoracic endoscopic sympathectomy during
which
the temperature was monitored on the skin of both axillae and thenar
eminences,
and in the oesophagus. MAIN OUTCOME MEASURES: Morbidity, alleviation
of
hyperhidrosis, recurrence rate, and differences in temperature
postoperatively.
RESULTS: There was minor bleeding during operation in 25 cases
(34%),
but in only 4 was it sufficient to require insertion of a drain; 2
patients
developed transient Homer's syndrome; but the most common complication
was
compensatory hyperhidrosis (n = 52, 71%). In only 5 was this other than mild
and
required treatment with aluminium chloride in ethanol 25%. Palmar
hyperhidrosis
was alleviated in all cases, axillary sweating was considerably
improved,
and there was improvement in the feet in 56 (77%). There were 5
recurrences,
all on the right side, during a mean follow up of 9 months (range
2-36),
but in no case was the sweating severe. In almost all cases the
temperature
of the palm was less than that of the axilla before operation by a
mean
(SD) of 0.9 (0.3) degrees C. The rise in temperature varied from 1.7 (0.4)
degrees
C to 2.6 (0.4) degrees C. In the 5 patients who developed recurrences
the
increase was less (0.5 (0.4) degrees C). CONCLUSION: Thoracic endoscopic
sympathectomy
is safe, simple, and effective in treating palmar hyperhidrosis
that
has not responded to conservative treatment. Intradermal monitoring is an
accurate
and cost-effective way of monitoring temperature during operation.
Although
it is essential to achieve a rise in temperature of 1 degrees C, our
most
important finding was that the final temperature in both hands and axillae
should
be above 35 degrees C and as near as possible to 36 degrees C.
PMID:
10688220 [PubMed - indexed for MEDLINE]
99:
Eur Neurol 2000;44(2):112-6
Cardiac
autonomic function in patients suffering from primary focal
hyperhidrosis.
Birner
P, Heinzl H, Schindl M, Pumprla J, Schnider P.
Division
of Neurological Rehabilitation, Department of Neurology, University of
Vienna,
Austria. peter.birner@akh-wien.ac.at
Cardiac
autonomic function in patients (n = 63) with primary focal hyperhidrosis
and
healthy controls (n = 28) was investigated by short-term frequency domain
power
spectral analysis of heart rate variability. The power of the
very-low-frequency
band (0.01-0.05 Hz) was significantly lower in patients with
axillary
hyperhidrosis than in controls. No differences between groups could be
observed
at investigation of the low-frequency band (0.05-0.15 Hz), which was a
surprising
finding because this band represents also sympathetic cardiac
innervation.
At the high-frequency band (0.15-0.5 Hz), which represents
parasympathetic
cardiac innervation, an interaction of type and position
influencing
spectral power was detected. Our highly interesting findings
indicate
that primary focal hyperhidrosis is based on a much more complex
autonomic
dysfunction than generalised sympathetic overactivity and seems to
involve
the parasympathetic nervous system as well. Copyright 2000 S. Karger AG,
Basel
PMID:
10965164 [PubMed - indexed for MEDLINE]
100:
Isr J Psychiatry Relat Sci
2000;37(1):25-31
Impairment
in quality of life among patients seeking surgery for hyperhidrosis
(excessive
sweating): preliminary results.
Amir
M, Arish A, Weinstein Y, Pfeffer M, Levy Y.
Department
of Behavioral Sciences, Ben-Gurion University of the Negev,
Beer-Sheva,
Israel. Mamir@Bgumail.bgu.ac.il
BACKGROUND:
The present paper describes the initial stages of the development
and
administration of a short, disease-specific, health related questionnaire to
assess
the impact of suffering from hyperhidrosis (excessive sweating) on the
Quality
of Life (QoL) of patients who are anticipating surgery for this
disorder.
METHOD: The study was performed in two stages: 1. The life domains in
which
the condition impairs QoL were assessed by in-depth interviews with 10
patients
suffering from hyperhidrosis. 2. A questionnaire covering five life
domains
was built based on these interviews. 3. This questionnaire was
administered
to 48 patients, 30 females and 18 males between the ages 15 and 48.
RESULTS:
Results showed that subjective QoL was significantly lower among
females
in four of the five life areas and that duration of the condition
correlates
with a lower quality of life. A regression analysis showed that the
subjective
suffering of the patients was explained mainly by social aspects.
CONCLUSIONS:
The questionnaire is a novel attempt to assess QoL in a disorder
with
strong esthetic and social consequences and could improve communication
between
patients and their physicians.
PMID:
10857268 [PubMed - indexed for MEDLINE]
101:
J Neurosurg 2000 Jan;92(1 Suppl):44-9
Comment
in:
J Neurosurg. 2000 Oct;93(2 Suppl):342-3.
Changes
of bilateral palmar skin temperature in transthoracic endoscopic T-2
sympathectomy.
Lu
K, Liang CL, Lee TC, Chen HJ, Su TM, Liliang PC.
Department
of Neurosurgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
OBJECT:
Transthoracic endoscopic T-2 sympathectomy is currently the treatment of
choice
for palmar hyperhidrosis (PH). Intraoperative monitoring of palmar skin
temperature
(PST) is often used to assess the adequacy of sympathetic ablation.
The
aim of this study was to investigate the time course of PST changes during
the
operation and to determine factors involved in the sympathetic modulation of
the
palmar skin blood flow. METHODS: Eighty-one patients with PH underwent
bilateral
transthoracic endoscopic sympathectomy of T-2 in which continuous
intraoperative
PST monitoring was used. Palmar skin temperature data, recorded
every
30 seconds throughout the operation, were plotted against time, and a
graph
of two PST curves was obtained in each case. A multiphasic curve pattern
of
great similarity was observed in nearly 70% of cases. Specific PST readings
at
different operative stages were collected and averaged for all cases. The
trend
of PST changes in response to different procedures during the operation
was
analyzed. It was found that unilateral procedures caused simultaneous
bilateral
PST alterations. In almost all cases, bilateral PST was dramatically
lowered
when unilateral skin incision and intercostal muscle dissection were
performed.
The temperature remained low until the T-2 sympathectomy was finished
on
one side. In addition, unilateral T-2 sympathectomy induced synchronous
elevation
of bilateral PST. However, the ipsilateral response was significantly
stronger
than that on the contralateral side. CONCLUSIONS: Although
intraoperative
monitoring of PST is a reliable guide for surgeons performing
endoscopic
transthoracic sympathectomy, it is important to realize that PST
fluctuates
at different stages during the operation and that surgical procedures
themselves
can significantly influence PST readings. The PST data recorded at
specific
time points, therefore, can be misleading in terms of accuracy and the
completeness
of ablation of the target sympathetic ganglia, especially when the
sympathetic
trunk or ganglia are anatomically aberrant.
PMID:
10616057 [PubMed - indexed for MEDLINE]
102:
Minerva Chir 2000 Jan-Feb;55(1-2):17-23
[Video-thoracoscopic
sympathectomy in the treatment of Raynaud's disease and
palmar
hyperhidrosis]
[Article
in Italian]
Trignano
M, Boatto R, Mastino GP, Ferrandu T, Padula G, Loi V, Pala C.
Istituto
di Patologia Chirurgica, Facolta di Medicina e Chirurgia, Universita
degli
Studi, Sassari.
BACKGROUND
AND AIM: Raynaud's syndrome is a clinical entity characterised by
episodic
vascular spasm, digital ischemia in response to cold or emotional
stimuli
and hyperhidrosis. Many patients suffering from Raynaud's syndrome are
successfully
treated using medical therapy alone. Those patients who do not
respond
to medical treatment undergo surgery but the indications continue to be
a
source of controversy. A modern approach to thoracic sympathectomy requires a
video-assisted
technique. The aim of this study is to attempt to use
mini-invasive
type surgery to treat Raynaud's disease and hyperhidrosis in order
to
evaluate the real efficacy of thoracic sympathectomy in a large number of
patients.
The results of this method were compared for the two different
pathologies
in question. METHODS: The methodology used by this study is based on
instrumental
and clinical tests performed before and after surgery on treated
patients
using a comparative criterion and with a minimum 5-year follow-up. The
pre-
and postoperative diagnostic tests were performed by the vascular surgery
laboratory
and using a C.W. Doppler and a reflected light photoplethysmograph.
Capillaroscopy
and laboratory evaluations relating to secondary Raynaud's
disease
were carried out by internist type structures. The patients enrolled in
the
study responded to the following criteria: primary Raynaud's disease, palmar
hyperhidrosis
and associated syndromes. The population came from a mixed
sociodemographic
background, albeit within a strictly regional zone (Sardinia).
A
total of 42 patients were studied. The surgical technique used consisted of
the
ablation of thoracic ganglia from the 2nd to the 4th. RESULTS: The results
showed
a resolution of symptoms in 95% of patients treated for hyperhidrosis,
whereas
a 50% recidivation rate was observed in patients with Raynaud's disease
alone,
although symptoms were less intense. The results for Raynaud's disease
were
more disappointing, but it is important to remember that surgery is the
ultimate
choice for cases with advanced lesions which do not respond to medical
treatment.
Under these circumstances, the possibility of halting the evolution
of
the pathology represents an auspicious achievement. CONCLUSIONS: The authors
affirm
that mini-invasive surgical treatment of hyperhidrosis was resolutive
during
a mean follow-up of 3 years. It therefore represents a valid method which
causes
minimum esthetic damage to the patient and the greatest functional
benefit.
The postoperative period is short (about 3 days) and free of major
complications.
There is virtually no post-surgical pain.
PMID:
10832279 [PubMed - indexed for MEDLINE]
103:
Surg Today 2000;30(12):1089-92
The
effect of upper dorsal thoracoscopic sympathectomy on the total amount of
body
perspiration.
Kopelman
D, Assalia A, Ehrenreich M, Ben-Amnon Y, Bahous H, Hashmonai M.
Department
of Surgery B, Rambam Medical Center and Faculty of Medicine,
Technion-Israel
Institute of Technology, Haifa.
Thoracoscopic
T2-T3 sympathectomy is the treatment of choice for primary palmar
hyperhidrosis
(PPH); however, compensatory hyperhidrosis (CH) is a disturbing
sequela
of this operation, the mechanism of which is poorly understood. This
study
was conducted to evaluate the effect of heat stress on total body
perspiration
after thoracoscopic T2-T3 sympathectomy, and determine its
correlation
with CH. A total of 17 patients with PPH who underwent bilateral
T2-T3
sympathectomy were subjected to heat stress induced by a 10-min sauna bath
(ambient
temperature 70 degrees C), 1 day before and 1 month after surgery. The
naked
body weight was recorded before and immediately following the sauna bath,
and
the patients were followed up to assess whether CH had developed and the
degree
of its severity. Postoperatively, the amount of perspiration increased in
13
patients and decreased in 1. The amount of perspiration induced by the sauna
bath
ranged from 60 to 480 g, with a mean value of 185.29 +/- 125.80 g, before
the
operation, and from 60 to 540 g, with a mean value of 265.88 +/- 154.05 g,
after
the operation (P = 0.0113). There was no correlation between the degree of
alteration
in total body perspiration and the development of CH. Performing
thoracoscopic
T2-T3 sympathectomy for PPH affects the total body sweating
response
to heat; however, the development of CH does not correlate with this
alteration.
Publication
Types:
Clinical
Trial
PMID:
11193740 [PubMed - indexed for MEDLINE]
104:
Zhonghua Wai Ke Za Zhi 2000
Jan;38(1):64-66
[Partial
sympathectomy for treating palmar hyperhidrosis with VATS]
[Article
in Chinese]
Yan
Z, Zhu L, Ni K, et Al.
Department
of Cardiothoracic Surgery, Zhejiang Provincial People's Hospital,
Hangzhou
310014, China.
OBJECTIVE:
To review the experience with partial sympathectomy for treating
palmar
hyperhidrosis with VATS. METHODS: Between July 1995 and June 1999, 50
patients
with palmar hyperhidrosis (26 males and 24 females, mean age 26.7
years)
were operated. The major symptom was excessive sweating of hands, feet,
and
axcillaries, sometimes in drops. Thoracoscopy was performed under general
anesthesia
with a standard single-lumen endotracheal intubation with the patient
in
a semi-sitting position and arms stretched at 90 degree. The approach through
two
small ports on the chest wall was done using VATS. As the lung was depressed
by
CO(2) insufflation in a low pressure, an excellent view of the upper
mediastinum
was obtained. Ganglia T(2) through T(4), sometimes T(5) were
resected
with a electrocautery probe. Bilateral procedures were completed in the
same
position. RESULTS: All patients after operation became dry immediately
after
sympathetic denervation with a few minor complications. Occasional side
effect
was moderate compensatory sweating of the trunk. One case had recurrence
but
sweating was much less than before operation. CONCLUSIONS: Because of
excellent
view of the upper mediastinum for sympathetic denervation of the hand
and
axcillaryies, the effect of partial sympathectomy for palmar hyperhidrosis
is
satisfactory and permanent.
PMID:
11831992 [PubMed - as supplied by publisher]
105:
Acta Anaesthesiol Sin 1999 Dec;37(4):221-4
Unilateral
vocal cord paralysis following endotracheal intubation--a case
report.
Lu
YH, Hsieh MW, Tong YH.
Division
of Anesthesia, Taichung Hospital, Taiwan, R.O.C.
A
41-year-old man of ASA physical status class I was scheduled to receive the
video-assisted
thoracoscopic T2 sympathectomy for hyperhidrosis palmaris. The
elective
surgery was performed smoothly under general anesthesia with
endotracheal
intubation. However, the patient complained of hoarseness in the
postoperative
period. A stroboscopic examination showed that the left vocal cord
remained
stationary in the paramedian position, signifying left vocal cord
paralysis.
In the case, we believed it was most likely that endotracheal
intubation
might be responsible for the unilateral vocal cord paralysis. The
possible
cause was that during placement or thereafter during positioning, the
endotracheal
tube was malposed or slipped upward, rendering its inflated cuff to
rest
against the vocal cords. Another reason was that the cuff which was over
inflated
made the vocal cords under constant pressure. Both conditions may cause
damage
to the anterior branch of the recurrent laryngeal nerve. We also
discussed
the general management and prophylaxis for the unilateral vocal cord
paralysis.
PMID:
10670122 [PubMed - indexed for MEDLINE]
106:
Ann Thorac Surg 1999 Dec;68(6):2361-3
Clinical
experience with video-assisted thoracic sympathectomy through the
retrosternal
pulmonary junction.
Yamamoto
H, Okada M, Kanehira A, Yamada A, Kawamura M.
Department
of Surgery, Kobe University School of Medicine, Japan.
A
new technique of video-assisted thoracic sympathectomy through retrosternal
pulmonary
junction can be done safely using a scope guide and a flexible scope.
Bilateral
thoracic sympathectomy was performed, employing a single skin
incision,
in 18 patients with palmar hyperhidrosis. The advantages include
minimal
neuralgia and superior cosmesis.
PMID:
10617045 [PubMed - indexed for MEDLINE]
107:
Eur J Vasc Endovasc Surg 1999
Dec;18(6):543-4
Comment
on:
Eur J Vasc Endovasc Surg. 1999
Apr;17(4):343-6.
Results
of thoracoscopic sympathetic trunk transection.
Ahn
S.
Publication
Types:
Comment
Letter
PMID:
10637163 [PubMed - indexed for MEDLINE]
108:
J Pediatr Surg 1999 Dec;34(12):1839-42
Long-term
results of 45 thoracoscopic sympathicotomies for primary hyperhidrosis
in
children.
Imhof
M, Zacherl J, Plas EG, Herbst F, Jakesz R, Fugger R.
University
Clinic of Surgery, University of Vienna, Austria.
BACKGROUND/PURPOSE:
Thoracoscopic sympathicotomy (TS) is successful in treatment
of
excessive hyperhidrosis of the upper limb after limited follow-up
observation.
The aim of the study was to assess for the first time long-term
results
of TS in children. METHODS: A total of 26 children (9 boys, 17 girls)
aged
11 to 17 years with severe palmar or axillar hyperhidrosis underwent TS,
and
19 patients were treated bilaterally. A total of 19 patients were observed
after
a median follow-up period of 16 years by questionnaire or clinical
examination.
RESULTS: Permanent relief from palmar hyperhidrosis was given in
all
examined patients. Twelve patients had compensatory and 12 patients
gustatory
sweating. Postoperatively, 1 subcutaneous emphysema and 1 temporary
miosis
and ptosis were noted. Eleven patients were fully satisfied with the
result.
Seven patients were only partially satisfied because of compensatory or
gustatory
sweating but would again undergo operation. One patient was not
satisfied
because of excessive compensatory sweating. CONCLUSIONS: TS is a safe
and
efficient procedure even after long-term follow-up. Severe palmar
hyperhidrosis
often starts in childhood; thus, early surgical treatment can
improve
social development. Compensatory and gustatory sweating are the most
frequent
and enduring side effects and should be mentioned in preoperative
patient
and parent information.
PMID:
10626868 [PubMed - indexed for MEDLINE]
109:
Qual Life Res 1999 Dec;8(8):693-8
The
Illness Intrusiveness Rating Scale: a measure of severity in individuals
with
hyperhidrosis.
Cina
CS, Clase CM.
Department
of Surgery, McMaster University, Hamilton, Canada.
cinacs@fhs.mcmaster.ca
OBJECTIVE:
We estimated the reliability and validity of the Illness
Intrusiveness
Ratings Scale (IIRS) in hyperhidrosis, using an electronic mail
form
of administration. METHODS: Recent contributors to an electronic mail
discussion
group on hyperhidrosis responded to the IIRS, questions about
surgical
history, items designed to assess severity, and demographic questions,
on
two occasions four weeks apart. A variety of hypotheses regarding the
relationships
between these variables were constructed a priori. RESULTS:
Sixty-eight
people replied on two occasions. Internal consistency was high
(Cronbach's
alpha 0.88), as was test-retest reliability (kappa 0.89). The total
IIRS
score correlated with a global severity question (0.61; p < 0.001). Total
IIRS
score was lower in participants who had previously had surgery for
hyperhidrosis,
compared with those who had not (47 vs. 36; p = 0.02), and
changed
dramatically in the direction of diminished severity in four patients
who
underwent surgery during the course of the study (54 vs. 17; p = 0.01).
Weak-to-moderate
correlations were observed between total score and use of
topical
preparations, use of medications, number of clothing changes during a
day,
and limitations in choice of wardrobe. CONCLUSIONS: The IIRS is both
reliable
and valid in the assessment of patients with hyperhidrosis. A novel
form
of administration does not appear to affect its properties.
PMID:
10855343 [PubMed - indexed for MEDLINE]
110:
Yonsei Med J 1999 Dec;40(6):589-95
Thoracoscopic
sympathetic surgery for hyperhidrosis.
Lee
DY, Hong YJ, Shin HK.
Department
of Thoracic Surgery, Yongdong Severance Hospital, Yonsei University
College
of Medicine, Seoul, Korea. dylee@yumc.yonsei.ac.kr
Resectional
surgery of sympathetic nerves has been known to be the most
effective
treatment for essential hyperhidrosis and the application of
thoracoscopic
electrocauterization has provided a minimally-invasive procedure
with
the least morbidity and a resultant higher satisfaction rate. This paper
describes
our experience on the 1,167 cases of thoracoscopic sympathetic surgery
for
the treatment of essential hyperhidrosis. A total of 1,167 patients (674
males
(58%) and 493 females (42%), mean age of 26.4 years with palmar (930),
craniofacial
(190) or axillary (47) hyperhidrosis underwent thoracoscopic
sympathetic
surgery from July 1992 to March 1999. Since the T2-4 sympathectomy,
first
performed in July 1992 for a patient of palmar hyperhidrosis, the
operative
methods have been altered to achieve a higher satisfaction level with
the
least complication by adopting less invasive procedures. Our current
standard
procedures being performed are T3 and T2 clipping for palmar and
craniofacial
hyperhidrosis and T3,4 sympathicotomy for axillary hyperhidrosis,
all
using a 2 mm needle thoracoscope. As the surgical procedures have been
transited
to a less invasive method with limited resection using the newest
endoscopic
devices, the average operation time and complications such as
Horner's
syndrome and compensatory hyperhidrosis have gradually decreased and
thus
the long-term satisfaction rate has been raised up to 98% for palmar
hyperhidrosis,
92% for craniofacial hyperhidrosis and 89% for axillary
hyperhidrosis.
The recurrent cases (14/1167) were treated successfully with
reoperations
of thoracoscopic sympathetic surgery. The optimal goal of therapy
could
be achieved by complete elimination of the hyperhidrotic symptom, by
decreasing
the incidence and degree of compensatory hyperhidrosis through a
selective
and limited resection, and by adopting the least invasive procedures.
Sympathicotomy
has provided the advantages of a limited extent of denervation
and
the resultant decrease of compensatory hyperhidrosis compared to
sympathectomy.
The reversible method of clipping may be an effective,
provisionary
means for cases of severe, intractable compensatory sweating. For
craniofacial
hyperhidrosis, T2 sympathicotomy or clipping has been proven to be
superior
to the T1 sympathectomy due to the decreased occurrence of Horner's
syndrome
and T3,4 sympathicotomy providing a satisfactory outcome with less
compensatory
hyperhidrosis for axillary hyperhidrosis.
PMID:
10661037 [PubMed - indexed for MEDLINE]
111:
Ann Vasc Surg 1999 Nov;13(6):582-5
Thoracoscopic
cervicodorsal sympathectomy with diathermy.
Cartier
B, Cartier P.
Centre
Hospitalier Regional du Suroit, Valleyfield, Quebec, Canada.
This
study reports our experience of using thoracoscopic cervicodorsal
sympathectomy
with diathermy. From December 1994 to September 1998, we performed
53
thoracoscopic sympathectomies in 35 patients. There were 15 men and 20 women,
ages
18 to 61 years. Ten surgeries were performed on the right side, 7 were the
left,
and 18 were bilateral. Indications for surgery were causalgia/reflex
sympathetic
dystrophy in 8 patients, Raynaud's/vasculitis in 6, intractable
Raynaud's
disease in 4, and hyperhydrosis in 17 (bilateral procedure). Operating
time
ranged from 10 to 50 min for unilateral procedures and from 45 to 80 min
for
bilateral procedures. Patients stayed in the hospital 1 to 4 days. From
favorable
immediate and follow-up results we conclude that thoracoscopic
cervicodorsal
sympathectomy using diathermy is feasible, safe, and effective.
PMID:
10541610 [PubMed - indexed for MEDLINE]
112:
Cell Transplant 1999
Nov-Dec;8(6):583-91
Xenografting
human T2 sympathetic ganglion from hyperhidrotic patients provides
short-term
restoration of catecholaminergic functions in hemiparkinsonian
athymic
rats.
Liu
DM, Lin SZ, Wang SD, Wu MY, Wang Y.
Tri-Service
General Hospital, National Defense Medical Center, Taipei, Taiwan.
Previous
studies have suggested that allografting peripheral sympathetic
ganglia,
such as superior cervical ganglia, partially relieves clinical or
behavioral
deficits in parkinsonian patients and animals. However, removal of
these
ganglia can cause Homer's syndrome, which limits the utilization of this
approach.
Hyperhidrosis, a disease of excessive sweating, is commonly seen in
young
Orientals. Treatment of hyperhidrosis often involves surgical removal of
the
second thoracic sympathetic ganglia (T2G), which contain catecholaminergic
neurons.
The purpose of our study was to investigate behavioral responses and
tyrosine
hydroxylase (TH) immunoreactivity in hemiparkinsonian rats at different
time
points after transplantation of human T2G from hyperhidrotic patients.
Athymic
Fisher 344 rats were injected unilaterally with 6-hydroxydopamine into
the
medial forebrain bundle to destroy the nigrostriatal dopaminergic (DA)
pathway.
The effectiveness of lesions was tested by measuring methamphetamine
(MA)-induced
rotations. These unilaterally lesioned rats were later transplanted
with
T2G or T2 fiber tract (T2F) obtained from adult hyperhidrotic patients.
Animals
grafted with T2G showed a reduction in MA-induced rotation by 2 weeks;
however,
rotation returned to the pregrafting levels by 3 months. Animals
receiving
T2F grafts did not show any reduction of rotation over a 3-month
period.
Animals were later sacrificed for TH immunostaining at different time
points.
Tyrosine hydroxylase-positive [TH(+)] cell bodies and fibers were found
in
the lesioned striatum 2-4 weeks after T2G grafting, suggesting the survival
of
transplants. Two to 3 months after grafting, TH(+) fibers were still found in
almost
all the recipients. However, TH(+) cell bodies were found in only three
of
seven rats studied. Animals receiving T2F grafting did not show any TH
immunoreactivity
in the lesioned striatum over the 3-month period. These data
indicate
that T2G transplants from adult hyperhidrotic patients can survive and
provide
transient normalization of the motor behavior in the hemiparkinsonian
athymic
rats. Because of the short-term improvement in behavior after grafting,
the
use of T2G in human trials should be cautious at the present time. Further
laboratory
research is required.
PMID:
10701487 [PubMed - indexed for MEDLINE]
113:
Hosp Med 1999 Nov;60(11):807-11
Current
practice in thoracic sympathectomy.
Chaudhuri
N, Birdi I, Ritchie AJ.
Department
of Cardiothoracic Surgery, Papworth Hospital.
Thoracic
sympathectomy has been performed for many years. With the recent
development
of video assisted thoracic surgical techniques the indications for
surgery
have increased, and the outcome is much better.
Publication
Types:
Review
Review,
Tutorial
PMID:
10707191 [PubMed - indexed for MEDLINE]
114:
Surg Endosc 1999 Nov;13(11):1139-42
Outpatient
endoscopic thoracic sympathectomy using 2-mm instruments.
Reardon
PR, Preciado A, Scarborough T, Matthews B, Marti JL.
Department
of Surgery, Baylor College of Medicine and The Methodist Hospital,
6550
Fannin Street, Suite 2435, Houston, TX 77030, USA.
BACKGROUND:
For a long time it has been known that sympathectomy is an effective
treatment
for hyperhidrosis and other conditions. The surgical options available
until
recently usually have required thoracotomy or large posterior incisions,
and
physicians generally have been reluctant to recommend surgery for most
patients
with "benign" disorders. Recently, thoracoscopic techniques have
allowed
surgeons to offer these patients a permanent solution with minimal
surgical
trauma. METHODS: In 20 patients, 30 endoscopic thoracic sympathectomies
(ETS)
were performed for several indications. Nine patients had bilateral
sympathectomies.
The procedures were performed on the day of admission, with the
patient
under general anesthesia using double lumen endotracheal intubation and
hand
temperature monitoring. Each lung was reinflated on completion of the
sympathectomy,
and residual pneumothorax aspirated before closure of the
incisions.
No placement of chest tubes was performed in the operating room.
RESULTS:
All sympathectomies were completed thoracoscopically. There were no
major
complications, and 90% of the patients were discharged within 24 hours of
admission.
The average operative time was 69 min. CONCLUSIONS: Findings from
this
study show that ETS is a safe and effective procedure that can be performed
routinely
on an outpatient basis. The use of miniendoscopic (2-mm)
instrumentation
is safe and effective in most patients and a helpful adjunct in
providing
these patients with minimally traumatic surgery. Long-term results
should
be evaluated on the basis of specific indications for sympathectomy.
PMID:
10556455 [PubMed - indexed for MEDLINE]
115:
Surg Neurol 1999 Nov;52(5):453-7
Comment
in:
Surg Neurol. 2000 Jul;54(1):96-7.
Transthoracic
endoscopic sympathectomy in the treatment of palmar
hyperhidrosis--with
emphasis on perioperative management (1,360 case analyses).
Lin
TS, Fang HY.
Department
of Surgery, Changhua Christian Hospital, Chung Shan Medical and
Dental
College, Taichung, Taiwan, ROC.
BACKGROUND:
Primary palmar hyperhidrosis (PH) is very common, and can be
disabling.
Various surgical methods for endoscopic sympathectomy have been
advocated.
We present a simple and effective method of treating PH by means of
transthoracic
endoscopic sympathectomy (TES). METHODS: From July 1994 to May
1998,
a total of 1,360 patients with hyperhidrosis palmaris underwent TES. There
were
544 males and 816 females with a mean age of 23.1 years old (range, 5 to 60
years).
All patients were placed in a half-sitting position under single-lumen
intubational
anesthesia. We performed the ablation of the T2 ganglion using
either
a 6- or 8-mm, 0-degree thoracoscope (Karl Storz Company, Germany)
RESULTS:
In these 1,360 patients, 2,715 sympathectomies were performed. TES was
usually
accomplished within 15 min. Surgical complications were minimal: six
cases
of pneumothorax (0.44%), four cases of segmental collapse of lung (0.29%),
and
two wound infections (0.15%). There was no surgical mortality. The mean
postoperative
follow-up period was 27.8 months. A total of 1,292 patients (95%)
had
highly satisfactory results, although 1,140 patients (84%) have developed
compensatory
sweating of the trunk and lower limbs. The affected area was the
axillae,
back, abdomen, lower limbs (16%, 82%, 52%, and 78%, respectively). The
recurrence
rates of PH were 0.4% in the first year, 0.6% in the second year, and
1.1%
in the third year. CONCLUSIONS: TES is a simple, safe, and effective method
of
treating PH.
PMID:
10595764 [PubMed - indexed for MEDLINE]
116:
J Auton Nerv Syst 1999 Oct 8;78(1):64-7
Left
stellate stimulation increases left ventricular ejection fraction in
patients
with essential palmar hyperhidrosis.
Wong
CW, Wang CH.
Division
of Neurosurgery, Chang Gung Memorial Hospital at Keelung, Taiwan.
c1951@netvigator.com
Left
stellate stimulation increases cardiac contractility, heart rate, systolic
blood
pressure, and QT interval in experimental animals. To see if these changes
occur
in humans, we stimulated the left stellate ganglia with a monopolar
coagulation
power of 5 W in 10 patients with palmar hyperhidrosis, axillar
hyperhidrosis,
or both. We also stimulated the right stellate ganglia of the
other
10 patients. The mean left ventricular ejection fraction (LVEF, measured
with
M-mode echocardiography), QT interval, heart rate and systolic blood
pressure
of the baseline were 54.72%, 403 ms, 65/min, and 115 mmHg, whereas
those
after 45 s of left stellate stimulation were 62.84%, 434 ms, 73/min, and
123
mmHg respectively. We compared these data with those of the baseline and the
two-tailed
P values were 0.005 for both LVEF and QT interval, 0.052 for heart
rate,
and 0.050 for systolic blood pressure respectively (Wilcoxon Matched-Pairs
Signed-Ranks
Test). The corresponding P-values for those of the right stellate
stimulation
were 0.721, 0.203, 0.260, and 0.326 respectively. All these suggest
that
the left stellate ganglia predominate the right ones in affecting LVEF, QT
interval,
heart rate and systolic blood pressure in humans, that left stellate
stimulation
increases LVEF and prolongs QT interval significantly, and that left
stellate
stimulation accelerates heart rate and elevates systolic blood pressure
marginally.
PMID:
10589825 [PubMed - indexed for MEDLINE]
117:
Ann Thorac Surg 1999 Oct;68(4):1177-81
Video
assistance reduces complication rate of thoracoscopic sympathicotomy for
hyperhidrosis.
Zacherl
J, Imhof M, Huber ER, Plas EG, Herbst F, Jakesz R, Fugger R.
University
Clinic of Surgery, Vienna General Hospital, Austria.
johannes.zacherl@akh-wien.ac.at
BACKGROUND:
Thoracoscopic sympathicotomy has proved successful in the treatment
of
palmar hyperhidrosis. However, up to 8% of patients experience Horner's
syndrome,
and about 50% show compensatory sweating. This study evaluates the
role
of video assistance in thoracoscopic sympathicotomy for primary
hyperhidrosis
of the upper limb. METHODS: Six hundred fifty-six thoracoscopic
sympathicotomies
were performed from below T1 to T4 in 369 patients. Of the
operations,
558 were done under direct view (CTS group) and 98, with video
assistance
(VATS group). Follow-up was complete for 78.3% of patients after a
median
observation period of 16 years. RESULTS: Dry limbs were immediately
achieved
in 93% of the CTS group and 98% VATS group (p = 0.98). In the CTS
group,
Horner's syndrome occurred after 2.2% of all operations and rhinitis in
8.3%.
No patient in the VATS group showed any symptom of Homer's triad (p = 0.03
versus
CTS group) or rhinitis (p = 0.02 versus CTS group). Compensatory sweating
was
observed in 66.8% in the CTS group versus 69% in the VATS group (p = 0.73)
and
gustatory sweating, in 50.4% versus 27.6%, respectively (p = 0.01).
CONCLUSIONS:
In performing thoracoscopic sympathicotomy for excessive upper-limb
hyperhidrosis,
we observed a significant decrease in the incidence of Horner's
syndrome,
rhinitis, and gustatory sweating when the procedure was guided by
video
imaging.
PMID:
10543476 [PubMed - indexed for MEDLINE]
118:
Surg Laparosc Endosc Percutan Tech 1999
Oct;9(5):317-21
Transaxillary
thoracoscopic sympathectomy experience in a hot climate:
management
of the dominant hand.
Al
Dohayan A.
Department
of Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia.
Primary
palmar hyperhydrosis is a functionally and socially disabling problem of
unknown
etiology, affecting adolescents and young adults, especially in hot
climates.
Thoracoscopic sympathectomy is the most effective treatment for palmar
hyperhydrosis.
Postsympathectomy rebound hyperhydrosis may limit its success,
especially
in hot climates. The aim of this study is to report experience with
thoracoscopic
sympathectomy in a hot climate, managing the dominant hand
(unilateral),
followed by the other hand at a later date, based on the patient's
choice.
One hundred twenty patients were operated on during a 3 year period. The
mean
operative time was 25 minutes. The procedure was successfully completed in
169
operated limbs and was abandoned in one limb because of severe pleural
adhesions.
The procedure was done for the dominant hand (unilateral) in 120
patients.
Fifty patients returned for contralateral thoracoscopic sympathectomy.
There
were 18 postoperative complications. Most of the patients (95%) were
discharged
after an overnight stay. The early observed cure rate was high (97%).
During
the mean follow-up period of 300 days, there was no recurrence of the
original
symptoms, except for one patient in whom the nerve of Kuntz was found
and
diathermized on the second thoracoscopy with symptomatic relief. Rebound
hyperhydrosis
occurred in 40 patients (33% of the total; 21% in the unilateral
group
and 42% in the bilateral group). In conclusion, it seems that
transaxillary
endoscopic sympathectomy of the dominant hand is an alternative
method
of treatment for patients with hyperhydrosis. Managing the dominant hand
first
and giving the patient the chance to observe the severity of the rebound
hyperhydrosis
may facilitate the decision for contralateral sympathectomy.
PMID:
10803392 [PubMed - indexed for MEDLINE]
119:
Cardiovasc Res 1999 Aug 15;43(3):739-43
Sympathectomy
potentiates the vasoconstrictor response to nitric oxide synthase
inhibition
in humans.
Lepori
M, Sartori C, Duplain H, Nicod P, Scherrer U.
Department
of Internal Medicine, Centre Hospitalier Universitaire Vaudois,
Lausanne,
Switzerland.
OBJECTIVE:
Nitric oxide exerts its cardiovascular actions at least in part by
modulation
of the sympathetic vasoconstrictor tone. There is increasing evidence
that
nitric oxide inhibits central neural sympathetic outflow, and preliminary
evidence
suggests that it may also modulate peripheral sympathetic
vasoconstrictor
tone. METHODS: To test this latter concept, in six subjects
having
undergone thoracic sympathectomy for hyperhydrosis, we compared the
vascular
responses to systemic L-NMMA infusion (1 mg/kg/min over 10 min) in the
innervated
and the denervated limb. We also studied vascular responses to the
infusion
of the non-nitric-oxide-dependent vasoconstrictor phenylephrine.
RESULTS:
L-NMMA infusion evoked a roughly 3-fold larger increase in vascular
resistance
in the denervated forearm than in the innervated calf. In the
denervated
forearm, vascular resistance increased by 58 +/- 10 percent (mean +/-
SE),
whereas in the innervated calf it increased only by 21 +/- 6 percent (P <
0.01,
forearm vs. calf). This augmented vasoconstrictor response was specific
for
L-NMMA, and not related to augmented non-specific vasoconstrictor
responsiveness
secondary to sympathectomy, because phenylephrine infusion
increased
vascular resistance similarly in the denervated forearm and the
innervated
calf (by 24 +/- 7, and 29 +/- 8 percent, respectively). The augmented
vasoconstrictor
response was related specifically to denervation, because in
control
subjects, the vasoconstrictor responses to L-NMMA were comparable in the
forearm
and the calf. CONCLUSIONS: These findings indicate that in the absence
of
sympathetic innervation, the vasoconstrictor responses to nitric oxide
synthase
inhibition are augmented.
PMID:
10690345 [PubMed - indexed for MEDLINE]
120:
Int J Dermatol 1999 Aug;38(8):561-7
Comment
in:
Int J Dermatol. 2000 Feb;39(2):160.
Hyperhidrosis.
Leung
AK, Chan PY, Choi MC.
Department
of Pediatrics, University of Calgary, Alberta Children's Hospital,
and
Asian Medical Centre (affiliated with the University of Calgary Medical
Clinic),
Canada.
Publication
Types:
Review
Review,
Tutorial
PMID:
10487442 [PubMed - indexed for MEDLINE]
121:
J Laparoendosc Adv Surg Tech A 1999
Aug;9(4):331-4
Transthoracic
endoscopic sympathectomy for palmar hyperhidrosis in children and
adolescents:
analysis of 350 cases.
Lin
TS.
General
Thoracic Surgery, Changhua Christian Hospital, Chung Shan Medical and
Dental
College, Taichung, ROC. Lin8065@ms14.hinet.net
Primary
palmar hyperhidrosis (PH) often commences in childhood and adolescence
and
can be a disabling condition. There are few reports regarding endoscopic
sympathectomy
for PH in children and adolescents. Therefore, I present our
experience
with transthoracic endoscopic sympathectomy (TES) in treating PH in
children
and adolescents. From July 1994 to March 1998, a total of 350 patients
underwent
TES. There were 93 males and 257 females with a mean age of 12.9 years
(range
5-17 years). All patients were placed in a half-sitting position under
single-lumen
intubated anesthesia. We performed ablation of the T2 ganglion
using
either a 6- or an 8-mm 0 degree thoracoscope (Karl Storz Company, Germany)
via
one 0.8-cm incision just below each axilla. Among these 350 patients, 699
sympathectomies
were performed. Usually, TES was accomplished within 15 minutes
(range
7-20 minutes). The surgical complications were minimal: one pneumothorax
and
one segmental lung collapse. There were no surgical deaths. With a mean
postoperative
follow-up period of 25 months (range 5-44 months), the result of
TES
was highly satisfactory in 331 patients (94.6%), although 301 patients (86%)
developed
compensatory sweating of the trunk and lower limbs, the distribution
being
the axillae (12%), back (86%), abdomen (48%), or lower limbs (78%). The
recurrence
rates of palmar hyperhidrosis were 0.6% in the first year, 1.1% in
the
second year, and 1.7% in the third year. Transthoracic endoscopic
sympathectomy
is a safe and effective method for treating PH in children and
adolescents.
PMID:
10488827 [PubMed - indexed for MEDLINE]
122:
Br J Surg 1999 Jul;86(7):969-70
Comment
on:
Br J Surg. 1999 Jan;86(1):45-7.
Intermediate-term
results of endoscopic transaxillary T2 sympathectomy for
primary
palmar hyperhidrosis.
Hashmonai
M, Kopelman D, Assalia A.
Publication
Types:
Comment
Letter
PMID:
10475703 [PubMed - indexed for MEDLINE]
123:
J Neurosurg 1999 Jul;91(1 Suppl):90-7
Comment
in:
J Neurosurg. 2000 Jan;92(1 Suppl):124.
Endoscopic
thoracic sympathectomy.
Johnson
JP, Obasi C, Hahn MS, Glatleider P.
Division
of Neurosurgery, University of California, Los Angeles, USA.
johnson@surgery.medsch.ucla.edu
OBJECT:
Thoracic sympathectomy has evolved as a treatment option for patients
with
hyperhidrosis and pain disorders. In the past, surgical procedures were
highly
invasive and caused significant morbidity, but the minimally invasive
thoracoscopic
procedure provides detailed visualization of the sympathetic
ganglia
and is associated with minimal postoperative morbidity. METHODS: The
authors
performed 112 thoracoscopic sympathectomy procedures in 65 patients, and
the
outcomes were equivalent to those previously established for open surgical
techniques;
however, the rate of surgery-related morbidity, length of hospital
stay,
and time until return to normal activity were substantially reduced.
Complications
and recurrence of symptoms were comparable with those demonstrated
in
previous reports. Overall patient satisfaction and willingness to undergo a
repeated
operative procedure ranged from 66 to 99%. Postoperatively, higher
satisfaction
rates were observed in patients with hyperhidrosis whereas in those
with
pain syndromes, satisfaction rates were lower. CONCLUSIONS: Minimally
invasive
thoracoscopic sympathectomy procedures are useful in treating
sympathetically
mediated disorders, and the results indicate that the procedure
is
associated with reduced morbidity and similar outcome when compared with
results
obtained after open surgery. Hyperhidrosis is well treated, but patients
with
pain syndromes have significantly poorer outcomes.
PMID:
10419374 [PubMed - indexed for MEDLINE]
124:
Can J Anaesth 1999 May;46(5 Pt 1):515
Non-dependent
axillary artery compression during needlescopic thoracic
sympathectomy.
Liu
EH, Yih PS, Goh PM.
Publication
Types:
Letter
PMID:
10349939 [PubMed - indexed for MEDLINE]
125:
Masui 1999 May;48(5):481-6
[Intraoperative
assessment by laser-Doppler skin blood flowmetry of the efficacy
of
endoscopic thoracic sympathectomy]
[Article
in Japanese]
Sano
T, Fukushige T, Miyagawa Y, Yamada S, Kano T.
Department
of Anesthesiology, Kurume University School of Medicine.
We
have investigated whether laser-Doppler (L-D) skin blood flowmetry on the
finger
could be useful for an intraoperative assessment of the efficacy of
endoscopic
thoracic sympathectomy (ETS) under general anesthesia. Subjects were
5
young adults receiving ETS for palmar hyperhidrosis. ETS was performed with
the
patients in the semi-sitting position under one lung ventilation. A pair of
LDF
probes were placed on the palmar side of the both second fingers. Palmar
hyperhidrosis
disappeared after ETS in all cases, but compensatory hyperhidrosis
developed
in the back of the body and the thigh. After completion of ETS on one
side,
the L-D skin blood flow increased to 267.6 +/- 211.1% on the side of ETS,
and
it increased in 2 other cases and decreased on the contrary in 3 cases on
the
other side. After ETS on both sides the L-D skin blood flow increased to
265.0
+/- 185.9% on the side of initial ETS and to 211.4 +/- 172.8% on the side
of
subsequent ETS. The initial EST induced reflex vasoconstriction on the finger
of
both sides and also on the toe. Spontaneous fluctuation and reflex
vasoconstriction
of the skin blood flow were still observed, although the
periodicity
of spontaneous fluctuation between the right and the left finger was
lost
in some of the cases. An increase in L-D skin blood flow on the side of
ongoing
ETS is useful for intraoperative assessment of ETS.
PMID:
10380502 [PubMed - indexed for MEDLINE]
126:
Eur J Vasc Endovasc Surg 1999
Apr;17(4):343-6
Comment
in:
Eur J Vasc Endovasc Surg. 1999
Dec;18(6):543-4.
The
results of thoracoscopic sympathetic trunk transection for palmar
hyperhidrosis
and sympathetic ganglionectomy for axillary hyperhidrosis.
Fox
AD, Hands L, Collin J.
University
of Oxford, Nuffield Department of Surgery, John Radcliffe Hospital,
Headington,
U.K.
OBJECTIVES:
To review our total experience of thoracoscopic sympathetic trunk
transection
for the treatment of palmar hyperhidrosis and second and third
thoracic
sympathetic ganglionectomy for axillary hyperhidrosis. DESIGN:
Longitudinal
cohort study following up consecutive patients for 0.3 to 5.5
years.
SUBJECTS: Fifty-four consecutive patients undergoing thoracoscopic
sympathectomy
for hyperhidrosis. METHODS: Prospective evaluation of immediate
technical
success, complications, late recurrence of hyperhidrosis and patient
acceptability.
RESULTS: 100% initial cure for palmar hyperhidrosis, 91% of
sympathetic
ganglionectomies for axillary hyperhidrosis were technically
successful
and initially curative. Compensatory sweating 44% patients, most
severe
after bilateral sympathetic ganglionectomy. Complications occurred in 14%
patients,
all resolving without further intervention. There were no cases of
Horner's
syndrome. 13% patients reported a return of some palmar sweating. 5.4%
patients
developed recurrent palmar hyperhidrosis at 6, 15 and 21 months
postoperatively.
CONCLUSION: Transection of the sympathetic trunk between the
first
and second thoracic sympathetic ganglia initially cures 100% of patients
treated
primarily for palmar hyperhidrosis. Technically successful 2nd and 3rd
thoracic
sympathetic ganglionectomy initially cures 100% of patients with
axillary
hyperhidrosis. Compensatory sweating is common after bilateral
sympathectomy.
Recurrent palmar hyperhidrosis occurs in 5.4% of cases, but can
be
cured by a second thoracoscopic sympathectomy. Horner's syndrome is an
avoidable
complication of thoracoscopic sympathectomy.
PMID:
10204058 [PubMed - indexed for MEDLINE]
127:
Lakartidningen 1999 Mar 3;96(9):980-1
[Need
for more careful alternative to sympathectomy. Complications following
surgery
for palmar sweating are more common than previously thought]
[Article
in Swedish]
Meyerson
B.
PMID:
10093434 [PubMed - indexed for MEDLINE]
128:
Internist (Berl) 1999 Mar;40(3):316
[Hyperhidrosis]
[Article
in German]
Brehler
R.
Zentrum
fur Dermatologie, Westfalische Wilhelms-Universitat, Munster.
PMID:
10205758 [PubMed - indexed for MEDLINE]
129:
J Neurosurg 1999 Mar;90(3):463-7
Changes
in hemodynamics of the carotid and middle cerebral arteries before and
after
endoscopic sympathectomy in patients with palmar hyperhidrosis:
preliminary
results.
Jeng
JS, Yip PK, Huang SJ, Kao MC.
Department
of Neurology, National Taiwan University Hospital, Taipei.
OBJECT:
The purpose of this study was to analyze the change in carotid and
middle
cerebral artery (MCA) hemodynamics before and after endoscopic upper
thoracic
sympathectomy in patients with palmar hyperhidrosis (PH). METHODS:
Sixty-eight
patients with PH (35 males and 33 females) for whom the average age
was
24.5+/-10.7 years (+/- standard deviation) were recruited into this study.
These
patients all underwent routine upper T-2 sympathectomy to treat their PH.
Ultrasonography
studies of the carotid arteries (CAs) and MCA were obtained in
each
patient before and after T-2 sympathectomy. The blood flow volume, flow
velocity,
and resistivity index (RI) in the bilateral common CAs (CCAs),
internal
CAs (ICAs), and external CAs (ECAs) were evaluated using duplex
ultrasonography.
The systolic peak velocity, mean velocity, diastolic peak
velocity,
pulsatility index, and RI of the bilateral MCAs were evaluated using
transcranial
Doppler ultrasonography. Blood pressure and heart rate were also
recorded
during this study. The Student paired t-test was used to analyze the
differences
between studies before and after bilateral T-2 sympathectomy. There
was
a significant reduction in diastolic pressure after T-2 sympathectomy (p =
0.003),
but not in systolic pressure or heart rate. The vessel diameter was
increased
after sympathectomy in the left CAs and right CCA. The T-2
sympathectomy
led to significant elevation of blood flow volume and RI in the
left
CCA, ICA, and ECA (p < 0.05). The authors found significant increases in
maximum
flow velocity and RI in the left MCA (p < 0.05). CONCLUSIONS: Patients
who
underwent T-2 sympathectomy demonstrated a significant increase in blood
flow
volume and flow velocities of the CAs and MCA, especially on the left side.
Asymmetry
of sympathetic influence on the hemodynamics of the CAs and MCA was
noted.
The usefulness of sympathectomy for the treatment of ischemic
cardiovascular
and cerebrovascular disease deserves further investigation.
PMID:
10067914 [PubMed - indexed for MEDLINE]
130:
Kyobu Geka 1999 Mar;52(3):204-9
[Current
appraisal of endoscopic thoracic sympathectomy: results of the national
questionnaire
surgery]
[Article
in Japanese]
Uchino
T, Ishimaru S, Makimura S, Fukushima H.
Department
of Surgery II, Tokyo Medical University, Japan.
A
questionnaire survey was performed in order to investigate the current status
of
endoscopic thoracic sympathectomy in Japan. Four hundred and twenty-nine
(429)
university, national or public hospitals with a minimum of 400 beds were
included.
A total of 248 of these hospitals responded. Among them 63 (25%)
performed
this procedure. The total of the cases was 1116. The number of access
port
and the technique for defunctioning the sympathetic chain were broadly
divided
into three methods. These methods were equally carried out among the
departments.
The clinical results were judged as satisfactory in the great
majority
of patients and the frequency of complications was low. On the other
hand,
the overall incidence of compensatory sweating remained relatively high
and
accumulated as the number of cases increased. But the reported frequency
differed
strikingly from hospital probably for lack of an objective way of
quantifying
following sympathectomy. Although overall complications were
infrequent,
the need for conventional thoracotomy to stop bleeding occurred in
some
cases. Therefore even this simple endoscopic operation demands the utmost
surgical
care, skill and experience. A few recurrences of preoperative symptoms
were
seen in the follow-up suggesting that all patients must be continually
monitored
after the operation.
PMID:
10097547 [PubMed - indexed for MEDLINE]
131:
Lakartidningen 1999 Feb 24;96(8):930-2
[Complications
are frequent after surgery for excessive hand sweating. Patient
should
be informed about the risks]
[Article
in Swedish]
Claes
G, Raf L.
Kirurgiska
kliniken, Boras lasarett.
PMID:
10089743 [PubMed - indexed for MEDLINE]
132:
Eur J Cardiothorac Surg 1999
Feb;15(2):194-8
Influences
of bilateral endoscopic transthoracic sympathicotomy on cardiac
autonomic
nervous activity.
Tedoriya
T, Sakagami S, Ueyama T, Thompson L, Hetzer R.
German
Heart Institute Berlin, Germany. 1064601102@compuserve.com
OBJECTIVES:
Endoscopic transthoracic sympathicotomy (ETS) is a minimal invasive
procedure
of thoracic sympathetic blockage. The purpose of this study was to
evaluate
cardiac autonomic nervous activity after ETS in order to confirm the
reliability
and safety of ETS. METHODS: A series of electrophysiological studies
were
performed before and 1 week after bilateral 2nd and 3rd thoracic
sympathicotomy
in 13 patients with primary palmar hyperhydrosis. Palmar
perspiration
was measured under sympathetic stress, and body surface mapping was
recorded
in a supine position. In the head-up tilt test of 0, 30, 60 and 90
degrees,
corrected QT interval (QTc) and T wave amplitude (Twa) were assessed.
The
power spectral analysis of heart rate variability was processed to attain
power
values of the low-frequency (0.04-0.15 Hz), the high-frequency (0.15-0.40
Hz)
and the low/high frequency ratio. RESULTS: In all patients, the perspiration
response
on the palm to sympathetic stimulation was completely inhibited after
ETS.
Isointegral mapping revealed that ETS altered electroactivity on the heart.
In
the head-up tilt study, R-R intervals significantly increased after the
surgery
in the head-up tilt positions (P < 0.05), although there was no
significant
difference in the supine position. There is no significant
difference
in QTc and Twa before and after the surgery, both in the supine and
the
head-up tilt positions. There was no significant difference in the LF or HF
before
and after surgery, either in the supine position or the head-up tilt
positions.
In the LF/HF, there was no significant difference before and after
surgery
in the supine position. However, the LF/HF in the head-up tilt positions
was
significantly decreased after surgery (P < 0.05). Sympathetic suppression of
ETS
was recognized more obviously under the steeper head-up tilt positions.
CONCLUSIONS:
The influences on the cardiac autonomic nerve system of the ETS of
upper
thoracic sympathetic nerve were seen to be of a lesser degree at rest.
However,
the response to sympathetic stimulation was suppressed after the
surgery.
PMID:
10219553 [PubMed - indexed for MEDLINE]
133:
Acta Neurochir (Wien) 1999;141(8):855-9
Sensitivity,
specificity and predictive value of intra-operative elevation of
hand
temperature to ensure a successful T2-sympathectomy in patients with palmar
hyperhidrosis.
Chiou
SM, Chen SC.
Department
of Neurosurgery, Chung Shan Medical and Dental College Hospital,
Taichung,
Taiwan, R.O.C.
To
appraise the validity, intra-operative elevation of hand temperature ensuring
a
successful T2-sympathectomy, we conducted a randomized, self-compared,
case-control
study on 40 consecutive patients with palmar hyperhidrosis. All
patients
had a postoperative follow-up of at least 18 months without recurrence.
During
operation, dynamic temperature changes on their thenar eminence of both
the
surgically treated and non-surgically treated hands were simultaneously
measured
just before (baseline) and after completion of T2-sympathectomy, and
again
5 and 10 minutes later. An elevation of the temperature by at least 0.5
degree
C from the baseline temperature was recognized as an "elevated"
temperature.
The relationship between sensitivity and specificity of temperature
changes
was compared using receiver operator characteristic (ROC) analysis.
Sensitivity
was defined as the proportion of temperature-elevating procedures in
the
group of operated hands. As a whole, post-sympathectomy elevation of hand
temperature
is a useful, but not an ideal, indicator for assuring a successful
T2-sympathectomy
due to its low sensitivity. At the 5-minute point, if the hand
temperature
was elevated by 1 degree C, its sensitivity, specificity and
positive
predictive value were 40%, 80% and 66.7%. In comparison, a 2 degrees C
elevation
at the 10-minute point had a sensitivity, specificity and positive
predictive
value of 30%, 90% and 75% (p < 0.05). We suggest that correct
localization
of the T2 ganglion followed by adequate ablation should be the
prerequisite
for use of this monitoring system.
PMID:
10536722 [PubMed - indexed for MEDLINE]
134:
Acta Otolaryngol 1999;119(5):599-603
New
objective and quantitative tests for gustatory sweating.
Dulguerov
P, Quinodoz D, Vaezi A, Cosendai G, Piletta P, Lehmann W.
Division
of Head and Neck Surgery, Geneva University Hospital, Switzerland.
pavel.dulguerov@hcuge.ch
Two
newly developed tests for gustatory sweating, providing both quantitative
and
topographic information, are presented. In both tests a paper stencil shaped
to
fit the complex anatomy of the parotid region is used. The blotting paper
technique
uses the difference in weight before and after gustatory stimulation
to
measure the amount of sweating. The iodine-sublimated paper histogram (ISPH)
uses
iodine sublimated office paper that changes colour when wet. The paper
stencil
is than digitized and a histogram algorithm applied to measure the area
of
sweating. A calibration of these tests with known and appropriate quantities
of
saline is presented.
PMID:
10478603 [PubMed - indexed for MEDLINE]
135:
Aust N Z J Surg 1999 Jan;69(1):60-4
Endoscopic
thoracic sympathectomy for primary palmar hyperhidrosis: intermediate
term
results.
Erak
S, Sieunarine K, Goodman M, Lawrence-Brown M, Bell R, Chandraratna H,
Prendergast
F.
Department
of Vascular Surgery, Royal Perth Hospital, Western Australia,
Australia.
BACKGROUND:
The authors' experience of the efficacy and safety of endoscopic
thoracic
sympathectomy in the treatment of primary palmer hyperhidrosis was
examined.
METHODS: A retrospective study of 71 patients (126 sympathectomies)
was
undertaken. Data were retrieved by hospital records and telephone interview.
RESULTS:
Follow-up was possible for 92 sympathectomies in 53 patients. Overall,
satisfactory
results were achieved in 93% of patients and complications were
uncommon.
Compensatory hyperhidrosis was the most common complication, which
occurred
in 64% of patients; the trunk and feet were the most common sites.
Horner's
syndrome occurred in five patients, although in two it was a permanent
complication.
No patient expressed dissatisfaction with the procedure as a
consequence
of this complication. Pneumothorax occurred in 17.5% of cases,
although
the vast majority were incidental findings on a postoperative chest
X-ray,
and none required drainage. With the newer techniques of access, patient
dissatisfaction
with the cosmetic appearance has fallen from 27.3 to 6.4%.
Overall
90% of patients said they would have the operation again, which
represents
a high level of patient satisfaction. CONCLUSIONS: Endoscopic
thoracic
sympathectomy is a safe and effective technique for primary palmer
hyperhidrosis.
Evolution of the technique has resulted in improvement in patient
satisfaction.
PMID:
9932925 [PubMed - indexed for MEDLINE]
136:
Br J Surg 1999 Jan;86(1):139
Comment
on:
Br J Surg. 1998 Sep;85(9):1266.
Early
experience with day-case transthoracic endoscopic sympathectomy.
Cameron
A.
Publication
Types:
Comment
Letter
PMID:
10027386 [PubMed - indexed for MEDLINE]
137:
Br J Surg 1999 Jan;86(1):45-7
Comment
in:
Br J Surg. 1999 Jul;86(7):969-70.
Intermediate-term
results of endoscopic transaxillary T2 sympathectomy for
primary
palmar hyperhidrosis.
Chiou
TS, Chen SC.
Department
of Neurosurgery, Chung Shan Medical and Dental College Hospital,
Taichung,
Taiwan, Republic of China.
BACKGROUND:
This report examines the intermediate-term results of endoscopic
transaxillary
T2 sympathectomy for palmar hyperhidrosis. METHODS: A
retrospective
review was carried out of 91 consecutive patients, 38 men and 53
women,
with a mean age of 23 years. Attention was focused on patient
satisfaction,
late complications and morbidity. RESULTS: After operation, no
patient
died or developed Horner's syndrome. Nine of 21 patients with
craniofacial,
five of 16 with axillary and 17 of 73 with plantar hyperhidrosis
showed
simultaneous improvement. Fifteen patients (16 per cent) developed
recurrent
sweating, but none required reoperation. The overall mean satisfaction
rate
was 78 per cent with a median 80 per cent improvement using a visual linear
analogue
scale from 0 (poor) to 100 per cent (excellent). Twelve patients (13
per
cent) were dissatisfied with the operative results, mainly owing to
compensatory
hyperhidrosis, which occurred in 88 patients (97 per cent) within
the
first year. CONCLUSION: The results of endoscopic sympathectomy deteriorate
progressively
from the immediate outcome.
PMID:
10027358 [PubMed - indexed for MEDLINE]
138:
Pediatr Surg Int 1999;15(7):475-8
Transthoracic
endoscopic sympathectomy for palmar and axillary hyperhidrosis in
children
and adolescents.
Lin
TS.
Department
of General Thoracic Surgery, Changhua Christian Hospital, Chung Shan
Medical
and Dental College, Taichung, Taiwan, Republic of China.
Primary
hyperhidrosis (PH) often starts in childhood and adolescence and can be
a
troublesome condition. In Taiwan, there is a high incidence in childhood
(1.6%-2.0%)
and adolescence (2.2%-2.6%). There are few reports regarding
transthoracic
endoscopic sympathectomy (TES) for PH in children and adolescents.
From
July 1994 to April 1998, a total of 438 patients underwent TES. There were
174
males and 264 females with a mean age of 14.2 years (range 5-17 years). All
patients
were placed in a semi-sitting position under single-lumen intubation
anesthesia.
We performed ablation of the T2 ganglion and any Kuntz fibers in 350
patients
with palmar hyperhidrosis and a similar procedure on the T2 and T3
ganglia
in 88 patients with palmar and axillary hyperhidrosis using either a 6-
or
8-mm thoracoscope via one 0.8-cm incision just below each axilla. In the 438
patients,
875 sympathectomies were performed. There was 1 technical failure due
to
severe pleural adhesions. TES was usually accomplished within 15 min (range
7-20
min). All except 5 patients were discharged within 4 h after operation. The
surgical
complication rate was minimal: 1 pneumothorax (0.23%) and 2 segmental
lung
collapses (0.46%). There was no surgical mortality. The mean postoperative
follow-up
period was 25.2 months (range 4-45 months). The result was highly
satisfactory
in 408 patients (93.2%), although 377 (86%) developed compensatory
sweating
of the trunk and lower limbs, the distribution affecting the back
(86%),
abdomen (48%), lower limbs (78%), and soles (1.4%). The recurrence rate
of
palmar hyperhidrosis was 0.6% in the 1st, 1.1% in the 2nd, and 1.7% in the
3rd
year. TES is thus a safe and effective method for treating palmar and
axillary
hyperhidrosis in children and adolescents.
PMID:
10525902 [PubMed - indexed for MEDLINE]
139:
Surg Today 1999;29(3):209-13
The
long-term results of upper dorsal sympathetic ganglionectomy and endoscopic
thoracic
sympathectomy for palmar hyperhidrosis.
Lin
CL, Yen CP, Howng SL.
Department
of Neurosurgery, Kaohsiung Medical College Hospital, Taiwan.
To
assess and compare the long-term results of upper dorsal sympathetic
ganglionectomy
(UDS) and endoscopic thoracic sympathectomy (ETS), we examined 84
patients
who underwent UDS and 71 patients who underwent ETS for the treatment
of
palmar hyperhidrosis. The period of follow-up ranged from 37 to 228 months.
The
immediate success rate was 100% in the UDS group and 98.6% in the ETS group.
Troublesome
compensatory hyperhidrosis occurred in 67.8% of the UDS patients and
84.8%
of the ETS patients; however, 55% of the UDS patients and 63% of the ETS
patients
felt satisfied with their operation. The main reasons for
dissatisfaction
were recurrence and compensatory hyperhidrosis. Interestingly,
simultaneous
cure of plantar hyperhidrosis occurred in 28 (40%) of the UDS
patients
and 28 (44%) of the ETS patients with concomitant plantar
hyperhidrosis.
ETS required both a shorter operation time and hospital stay than
UDS.
Thus, we now perform ETS as the treatment of choice because of its
excellent
illumination and adequate magnification via a minimally invasive
approach.
The use of ETS as the first choice of treatment for palmar
hyperhidrosis
is supported not only by the immediate results, complications, and
cure
of plantar hyperhidrosis, but also by the long-term results. Nevertheless,
compensatory
hyperhidrosis was also a major complication after ETS.
Publication
Types:
Clinical
Trial
PMID:
10192729 [PubMed - indexed for MEDLINE]
140:
Kyobu Geka 1998 Dec;51(13):1087-9
[Dorsal
sympathectomy for palmar hyperhidrosis by the thin thoracoscope]
[Article
in Japanese]
Sugiyama
S, Ikeya T, Hara H, Ichiki K, Yanagi K, Doki Y, Tsuda M, Misaki T.
Department
of Surgery, Toyama Medical and Pharmaceutical University, Japan.
The
purpose of this study was to examine the efficiency to use by the thin
thoracoscope
for the palmar hyperhidrosis. General anesthesia with double lumen
endotracheal
intubation was used in all cases. A 2 mm incision made in the
anterior
axillary line in the third intercostal space. Pneumothorax was obtained
by
insufflation 1.5-2 L of CO2. A 2 mm endoscopic trocar was inserted through
this
incision, and a 2 mm, 0-degree scope (Autosuture, USA) was introduced. A
second
2 mm trocar was inserted in the middle axillary line in the fourth
intercostal
space, through which a straight endoscopic seizer was introduced.
The
chain was dissected by electrocutting the white and gray rami and was
incised
over the second and third ribs. To avoid puemothorax, 8 F thoracic
catheter
was introduced through a guide wire which was inserted through a 2 mm
trocar.
The lung was expanded, and then the thoracic catheter was removed. We
performed
six sympathectomies on three female patients. All patients was
satisfied
of their results. This technique used by thin thoracoscope was
cosmetic
and a skin incision did not need to close too small.
PMID:
9866340 [PubMed - indexed for MEDLINE]
141:
Br J Surg 1998 Nov;85(11):1504-5
Resympathectomy
for palmar and axillary hyperhidrosis.
Hsu
CP, Chen CY, Hsia JY, Shai SE.
Department
of Surgery, Taichung Veterans General Hospital, Taiwan, Republic of
China.
BACKGROUND:
The aim was to analyse patterns of failure or symptom recurrence
after
primary sympathectomy for palmar or axillary hyperhidrosis, and to carry
out
tactical problem-solving for resympathectomy and review the operative
findings.
METHODS: Over a 2-year period, 20 patients (six men and 14 women)
underwent
resympathectomy for palmar hyperhidrosis (13 patients, 20 sides) or
axillary
hyperhidrosis (seven patients, ten sides). T2-3 sympathectomy for
palmar
hyperhidrosis or T4-5 sympathectomy for axillary hyperhidrosis was
performed
during the repeat procedure. Criteria for evaluation by means of
patient
questionnaire included good (more than 80 per cent), fair (50-80 per
cent)
and poor (less than 50 per cent) improvement. RESULTS: Operative findings
included
inadequate sympathectomy on 19 sides, nerve regeneration on eight sides
and
no evidence of previous sympathectomy on three sides. One patient had Kuntz
fibre
in addition to inadequate sympathectomy. In the palmar hyperhidrosis
group,
good results were obtained in all 13 patients on all 20 sides after
resympathectomy.
In the axillary hyperhidrosis group, six of seven patients, or
eight
of ten sides, showed good results after resympathectomy. CONCLUSION: The
main
cause of primary sympathectomy failure was inadequate surgery, and
recurrence
of palmar or axillary hyperhidrosis was seldom caused by nerve
regeneration.
The key factor for preventing failed sympathectomy or recurrent
palmar
or axillary hyperhidrosis is a first-time sympathectomy that is both
accurate
and adequate. Most patients with recurrent symptoms can be cured by
resympathectomy.
PMID:
9823911 [PubMed - indexed for MEDLINE]
142:
Int J Clin Pract 1998
Nov-Dec;52(8):537-8
Thoracoscopic
(upper thoracic) sympathectomy for primary palmar hyperhidrosis in
children.
Rashid
HI, Osman HS, McIrvine AJ.
Department
of Surgery, Joyce Green Hospital, Dartford, Kent, UK.
Primary
palmar hyperhidrosis is a disabling disorder that starts in childhood
and
causes physical and psychological inconvenience. Conservative treatment is
not
effective in severe cases. Thoracoscopic sympathectomy is the treatment of
choice.
It is a safe minimally invasive procedure with good results. There are
few
reports in the UK regarding surgical treatment in children. Post-operative
compensatory
hyperhidrosis of the trunk and thighs occurs in up to 50% of cases.
We
report on three cases involving six procedures.
PMID:
10622050 [PubMed - indexed for MEDLINE]
143:
Muscle Nerve 1998 Nov;21(11):1486-92
Vasomotor
and sudomotor function in the hand after thoracoscopic transection of
the
sympathetic chain: implications for choice of therapeutic strategy.
Rex
L, Claes G, Drott C, Pegenius G, Elam M.
Department
of Surgery, Boras Hospital, Sweden.
The
degree of sympatholysis achieved by thoracoscopic transection of the
sympathetic
chain (sympathicotomy) was evaluated by measuring sudo- and
vasomotor
function in the hands before and after surgery in 12 patients with
palmar
hyperhidrosis. Our results show a marked reduction in sweat production
and
a cutaneous vasodilatation which remained unchanged during the 6 months
follow-up,
whereas sudo- and vasomotor reflexes normalized within this time.
Skin
temperature variations did not correlate to skin perfusion changes. Since
all
subjects reported dry and warm hands throughout the follow-up period, our
results
indicate that recording reflex responses to sympathoexcitatory stimuli
does
not adequately reflect clinical outcome of subtotal sympatholytic
procedures
performed for hyperhidrosis. Monitoring of clinical outcome should
therefore
include measurement of baseline sweat production and skin perfusion.
However,
the normalized reflex responses highlight the incomplete sympatholysis
achieved
by thoracoscopic sympathicotomy, which may be beneficial in some
pathological
conditions (such as hyperhidrosis) but detrimental in others.
PMID:
9771674 [PubMed - indexed for MEDLINE]
144:
Med Clin (Barc) 1998 Oct 17;111(12):479
Comment
on:
Med Clin (Barc). 1998 Feb 28;110(7):279.
[Craniofacial
hyperhidrosis: a treatment with sympathectomy through
videothoracoscopy]
[Article
in Spanish]
Callejas
MA, Jimenez MJ, Catalan M, Baldo X.
Publication
Types:
Comment
Letter
PMID:
9842536 [PubMed - indexed for MEDLINE]
145:
Ann Thorac Cardiovasc Surg 1998
Oct;4(5):244-6
Results
of thoracoscopic sympathectomy for 96 cases of palmar hyperhidrosis.
Tan
V, Nam H.
Binh
Dan Hospital, 371 Dien Bien Phu St, 3rd District, Ho Chi Minh City,
Vietnam.
From
August 1996 to August 1997, we performed thoracoscopic sympathectomy for 96
cases
of palmer hyperhidrosis. The patients' ages were from 22 to 58 years old
(mean
age: 28; gender ratio: male/female: 3/2). Most of them were students,
workers
or clerks. The patients were divided in two series: in 61 patients, the
sympathetic
chain before the 2nd to 4th ribs was removed in the lateral approach
with
a 3 hole procedure. In 35 patients, the 2nd portion of the sympathetic
chain
was destroyed (by electric cauter) in the posterior approach with a 2 hole
procedure.
The results were almost the same in the first series (all cases have
a
fair benefit), but in the second series, some advantages may be useful for
therapy,
i.e no need to turn the patients, severe compensation sweating is
minimized
(from 4% ==> 0%) and the amount of holes is reduced.
PMID:
9828280 [PubMed - indexed for MEDLINE]
146:
Pediatr Pulmonol 1998 Oct;26(4):262-4
Thoracoscopic
T2-T3 sympathicolysis for essential hyperhidrosis in childhood:
effects
on pulmonary function.
Noppen
M, Dab I, D'Haese J, Meysman M, Vincken W.
Respiratory
Division, Academic Hospital AZ-VUB, University of Brussels (V.U.B.),
Belgium.
pnennm@az.vub.ac.be
Thoracoscopic
T2-T3 sympathicolysis (TS) is a minimally invasive treatment for
patients
suffering from severe, refractory essential hyperhidrosis (EH). TS has
previously
been shown to be safe and efficacious in children. In order to
examine
the effects of TS on respiratory function, pulmonary function tests
(PFT)
were performed prior to and 6 weeks and 6 months after TS in 12 children
with
EH (3 boys; mean age 12.8+/-2.5 years). Small asymptomatic decreases in
forced
expiratory volume in one second (FEV1; -2%), forced expiratory flow after
expiration
of 75% of vital capacity (FEF75; -9.6%), total lung capacity (TLC;
-1%),
transfer factor for diffusion of carbon monoxide (T(LCO); -7.6%), and
transfer
coefficient for diffusion of carbon monoxide (K(CO); -1.5%) were
observed
6 weeks after TS. These changes are comparable to those observed in
adults
but did not reach statistical significance in small children. In line
with
observations in adults, TLC (and T(L,CO)) returned to baseline values 6
months
after TS, whereas FEV1, FEF75, and K(CO) remained at their 6-week level.
In
conclusion, TS causes only small, statistically insignificant, and
asymptomatic
decreases in pulmonary function in children. TS can, therefore, be
considered
a safe treatment option in children suffering from severe, refractory
EH.
PMID:
9811076 [PubMed - indexed for MEDLINE]
147:
Plast Reconstr Surg 1998
Oct;102(5):1629-32
Endoscopic
transthoracic dorsal sympathectomy for the treatment of upper
extremity
hyperhidrosis: a new minimally invasive approach.
Raposio
E, Filippi F, Nordstrom RE, Santi P.
Department
of Plastic and Reconstructive Surgery, National Institute for Cancer
Research,
University of Genova, Italy.
Palmar
and axillary hyperhidrosis are best treated surgically by endoscopic
transthoracic
upper dorsal sympathectomy. At present, this methodology relies on
(at
least) double trocar insertion (per side), carbon dioxide insufflation, or
both.
We present a new minimally invasive endoscopic transthoracic technique,
performed
by a single-entry specifically modified thoracoscope and without the
need
for carbon dioxide insufflation, with the aim to reduce the drawbacks
associated
with the above-mentioned, currently adopted endoscopic technique. In
our
opinion, this "single-entry" technique, compared with the other
reported
approaches,
should theoretically minimize any damage to the intercostal
neurovascular
bundle, while avoiding the complications related to carbon dioxide
insufflation.
PMID:
9774023 [PubMed - indexed for MEDLINE]
148:
Surg Laparosc Endosc 1998
Oct;8(5):370-5
Thoracoscopic
sympathectomy for hyperhidrosis: is there a learning curve?
Kopelman
D, Hashmonai M, Ehrenreich M, Assalia A.
Department
of Surgery B, Rambam Medical Center, and the Faculty of Medicine,
Technion,
Israel Institute of Technology, Haifa.
The
aim of this study was to evaluate the learning curve of upper dorsal
thoracoscopic
sympathectomy. From June 1993 to December 1996, we performed 232
sympathectomies
on 116 patients with primary palmar hyperhidrosis. The T2-T3
ganglia
were resected by electrocuting and were removed for histologic
examination.
The series was divided into two groups of 58 patients each, and
operations
in each group occurred during a period of 21 months. Follow-up was
obtained
on 111 patients for a mean of 25.06+/-12.62 months. All limbs were dry
after
the operation, and hyperhidrosis did not recur. The anesthesia time was
reduced,
but the operating time, the difficulty in identifying and in resecting
the
ganglia, compensatory hyperhidrosis, postoperative neuralgia, and subjective
satisfaction
with the procedure were similar in both groups. The learning curve
in
the present study was mainly reflected by a reduction in the incidence of
Horner's
syndrome.
PMID:
9799148 [PubMed - indexed for MEDLINE]
149:
Br J Surg 1998 Sep;85(9):1266
Comment
in:
Br J Surg. 1999 Jan;86(1):139.
Early
experience with day-case transthoracic endoscopic sympathectomy.
Grabham
JA, Raitt D, Barrie WW.
The
Minimal Access Surgery Trent Training Centre, Leicester General Hospital,
UK.
PMID:
9752873 [PubMed - indexed for MEDLINE]
150:
Lakartidningen 1998 Aug
26;95(35):3660-2
[Treatment
of facial blushing with endoscopic thoracal sympathicotomy. 85 per
cent
of patients are satisfied, but there are adverse effects]
[Article
in Swedish]
Claes
G, Drott C, Dalman P, Rex L, Gothberg G, Fahlen T.
Kirurgiska
kliniken, Boras lasarett.
Endoscopic
transthoracic sympathicotomy, otherwise an established treatment for
palmar
hyperhidrosis, was used to treat patients troubled by facial blushing,
one
of the commonest symptoms of social phobia. The results were evaluated by
means
of a questionnaire answered by 90 per cent (219/244) of the patients, who
rated
their symptoms on a visual analogue scale (0-10) after a mean follow-up of
eight
months. According to the ratings, blushing was significantly reduced from
a
mean (+/- SEM) of 8.7 +/- 0.1 to 2.2 +/- 0.2 (p < 0.0001). Of the series as
a
whole,
85 per cent declared themselves satisfied with the outcome.
PMID:
9748777 [PubMed - indexed for MEDLINE]
151:
Surg Laparosc Endosc 1998
Aug;8(4):257-60
Resympathectomy
for sympathetic regeneration.
Singh
B, Moodley J, Haffejee AA, Ramdial PK, Robbs JV, Rajaruthnam P.
Department
of Surgery, University of Natal, Durban, South Africa.
Explanations
for recurrent sympathetic activity after an apparently successful
sympathectomy
are varied and often tenuous. Among the theories given for
recurrent
sympathetic activity are the development of alternate neuroanatomic
pathways,
the possibility of an incomplete operation (failure to appreciate an
alternative
anatomic pathway at the time of surgery, i.e., nerve of Kuntz), and
sympathetic
regeneration. The latter, although long suspected, has never been
conclusively
demonstrated in humans. In this report, a case of recurrent
sympathetic
activity with conclusive evidence of sympathetic regeneration is
described.
PMID:
9703595 [PubMed - indexed for MEDLINE]
152:
J Cardiovasc Surg (Torino) 1998
Jun;39(3):387-9
Computed
tomography guided thoracic sympatholysis for palmar hyperhidrosis.
Lucas
A, Rolland Y, Journeaux N, Kerdiles Y, Chevrant-Breton J, Duvauferrier R.
Vascular
Surgical Department, Hopital Sud, C.H.R.U. de Rennes, France.
METHODS:
Sixteen patients (mean age 26.3 years; range 18-38) with palmar
hyperhidrosis
underwent 29 sympatholyses after unsuccessful medical, and in 8
ionophoresis,
treatments. Sympatholysis was performed under local anesthesia
with
computed tomographic guidance. After opacification of the injection site at
T3
with Iopamiron 200, phenolization was performed with 10 ml 6% phenol.
RESULTS:
Good immediate results evaluated on the basis of venous dilatation, and
dryness
and warmth of the skin were obtained in 23 cases (80%). There were 6
immediately
unsuccessful procedures in 4 patients. At 20 months, good results,
assessed
on the basis of objective criteria and subjective patient
self-evaluation
were obtained in 22 cases (75% including immediate failures).
Computed
tomography guided thoracic sympatholysis performed under local
anesthesia
is an effective treatment for palmar hyperhidrosis. Morbidity is low
and
hospital stay is short. CONCLUSIONS: Our findings suggest that thoracic
sympatholysis
should be indicated as the first intention procedure when surgery
is
required in patients with palmar hyperhidrosis.
PMID:
9678568 [PubMed - indexed for MEDLINE]
153:
J Laparoendosc Adv Surg Tech A 1998
Jun;8(3):161-5
Endoscopic
transthoracic sympathectomy with a fine (2-mm) thoracoscope in palmar
hyperhidrosis:
a case report.
Okura
T, Suzuki T, Suzuki S, Kitami A, Hori G.
Department
of Thoracic and Cardiovascular Surgery, Showa University Fujigaoka
Hospital,
Yokohama, Kanagawa, Japan.
Endoscopic
transthoracic sympathectomy (ETS) is a minimally invasive method,
causing
only small injuries and few complications, and requires only a short
period
of hospitalization. Therefore, this method has been applied to patients
with
palmar hyperhidrosis to whom the conventional transthoracic sympathectomy,
which
is much more invasive, or thoracic sympathetic blockade, which often
causes
complications, cannot be applied. Conventional thoracoscopes, such as a
resectoscope
8 mm in diameter for urological operations, or a thoracoscope 5 mm
in
diameter, were usually used for this purpose, but they cause operative
injuries.
We performed ETS using a thoracoscope 2 mm in diameter (MiniSite 2 mm
0
degrees, USSC171303). Its visual field and handling were not inferior to those
of
conventional thoracoscopes, and the operative injuries were only 2 mm in
size.
For the patient, a small scar of this size means virtually no scar.
PMID:
9681430 [PubMed - indexed for MEDLINE]
154:
Neurosurgery 1998 Jun;42(6):1403-4
Comment
on:
Neurosurgery. 1997 Jul;41(1):110-3;
discussion 113-5.
Complications
in patients with palmar hyperhidrosis treated with transthoracic
endoscopic
sympathectomy.
Heckmann
M.
Publication
Types:
Comment
Letter
PMID:
9632210 [PubMed - indexed for MEDLINE]
155:
Lancet 1998 Apr 11;351(9109):1136
Comment
on:
Lancet. 1998 Jan 24;351(9098):231-2.
Compensatory
hyperhidrosis after thoracic sympathectomy.
Collin
J.
Publication
Types:
Comment
Letter
PMID:
9660614 [PubMed - indexed for MEDLINE]
156:
Lancet 1998 Apr 11;351(9109):1136
Comment
on:
Lancet. 1998 Jan 24;351(9098):231-2.
Compensatory
hyperhidrosis after thoracic sympathectomy.
Shuster
S.
Publication
Types:
Comment
Letter
PMID:
9660615 [PubMed - indexed for MEDLINE]
157:
Br J Surg 1998 Apr;85(4):570
Comment
on:
Br J Surg. 1997 Dec;84(12):1702-4.
Predicting
changes in the distribution of sweating following thoracoscopic
sympathectomy.
Collin
J.
Publication
Types:
Comment
Letter
PMID:
9607547 [PubMed - indexed for MEDLINE]
158:
Neurosurgery 1998 Apr;42(4):951-2
Comment
on:
Neurosurgery. 1997 Jul;41(1):110-3;
discussion 113-5.
Complications
in patients with palmar hyperhidrosis treated with transthoracic
endoscopic
sympathectomy.
Kao
MC.
Publication
Types:
Comment
Letter
PMID:
9574667 [PubMed - indexed for MEDLINE]
159:
Clin Physiol 1998 Mar;18(2):103-7
Finger
skin blood flow in response to indirect cooling in normal subjects and in
patients
before and after sympathectomy.
Bornmyr
S, Svensson H, Soderstrom T, Sundkvist G, Wollmer P.
Department
of Clinical Physiology, Malmo University Hospital, Sweden.
Finger
skin blood flow was measured in 80 healthy subjects, using laser Doppler
imaging
during basal vasodilatation at a local temperature of 40 degrees C. The
response
to cooling of the contralateral hand at 15 degrees C was studied. A
vasoconstriction
index was calculated in all subjects and a nomogram was
constructed,
taking age into consideration. Compared with these normal subjects,
four
patients operated on with transthoracic endoscopic sympathectomy due to
hand
hyperhidrosis showed clearly attenuated responses. The results indicate
that
the test can be used to assess disturbances in the sympathetic regulation
of
the peripheral blood flow.
PMID:
9568348 [PubMed - indexed for MEDLINE]
160:
Eur J Vasc Endovasc Surg 1998
Mar;15(3):239-43
Sympathetic
skin response and patient satisfaction on long-term follow-up after
thoracoscopic
sympathectomy for hyperhidrosis.
Lewis
DR, Irvine CD, Smith FC, Lamont PM, Baird RN.
Department
of Surgery, Bristol Royal Infirmary.
OBJECTIVES:
To determine effect of sympathectomy for hyperhidrosis on
sympathetic
skin response (SSR) during long-term follow-up. Patient satisfaction
was
assessed and surgical complications noted. DESIGN: Prospective, Open,
Non-randomised
study. MATERIALS AND METHODS: Patients who had undergone
bilateral
thoracoscopic sympathectomy for hyperhidrosis underwent postoperative
assessment
of SSRs. A 15 mA stimulus was applied over the median nerve
contralateral
to the sympathectomy and evoked electrodermal activity was
recorded
from the sympathectomised palm using a Dantec Counterpoint Mk 2.
Patient
satisfaction with surgery was assessed by questionnaire and visual
analogue
score (0-1.0). RESULTS: Of 26 patients, 21 were female. Mean (range)
age
was 23 (9-36) years. Mean (range) follow up was 39 (4-138) months. 12% of
cases
had residual or recurrent symptoms. Median (range) patient satisfaction
was
0.83 (0.06-1.0). In 7/52 palms recurrent SSRs were not detected. Repeated
measures
analysis of variance found amplitude of SSR to be of low significance
with
respect to time since surgery (F = 0.48; p = 0.49) and incidence of
compensatory
sweating (F = 2.38; p = 0.14). CONCLUSION: Thoracoscopic
sympathectomy
for hyperhidrosis is an effective procedure. Following
sympathectomy
SSRs are not permanently abolished, but return of SSRs does not
correspond
with symptom recurrence. As such, SSRs are a poor tool for objective
assessment
of long-term outcome following sympathectomy.
PMID:
9587338 [PubMed - indexed for MEDLINE]
161:
Kyobu Geka 1998 Mar;51(3):206-9
[Surgical
technique of endoscopic transthoracic sympathicotomy: axillary
approach]
[Article
in Japanese]
Ushijima
T, Akemoto K, Kawakami K, Matsumoto Y, Tedoriya T, Ueyama T.
Department
of Cardiovascular Surgery, National Hospital of Kanazawa, Japan.
A
total of 181 endoscopic transthoracic sympathicotomy were performed at our
hospital
from December, 1992 to March, 1997. After single-lumen endotracheal
intubation
for general anesthesia, the patient was placed in half sitting
position.
A small (1 cm) incision was made in the anterior axillary line through
the
third intercostal space and an apical pneumothorax was created by
insufflation
of 1.8 L of CO2 in the pleural cavity through a Surgineedle. A 24
Fr.
urological transurethral electroresectoscope was introduced through the same
incision.
The sympathetic chain could be observed through parietal pleura riding
on
the costovertebral junctions. In palmar hyperhidrosis the second and third
thoracic
sympathetic ganglia were electrocoagulated. In axillary hyperhidrosis
the
forth ganglion was included. The lung was expanded by limiting expiration
and
sucking CO2. The operation was repeated on the other side. Endoscopic
transthoracic
sympathicotomy was an efficient, safe and low invasive surgical
procedure
for the treatment of palmar, axillary hyperhidrosis, Raynaud's disease
and
Buerger disease.
PMID:
9528226 [PubMed - indexed for MEDLINE]
162:
Med Clin (Barc) 1998 Feb 28;110(7):279
Comment
in:
Med Clin (Barc). 1998 Oct 17;111(12):479.
[Treatment
of palmar hyperhidrosis by video-thoracoscopic thoracic
sympathectomy]
[Article
in Spanish]
Buitrago
LJ, Molins L, Vidal G.
Publication
Types:
Letter
PMID:
9562958 [PubMed - indexed for MEDLINE]
163:
Arch Bronconeumol 1998 Feb;34(2):57-8
[Treatment
of primary hyperhidrosis: a new indication for video thoracoscopy]
[Article
in Spanish]
Callejas
MA.
Publication
Types:
Editorial
PMID:
9557176 [PubMed - indexed for MEDLINE]
164:
Cardiovasc Surg 1998 Feb;6(1):94-6
Primary
palmar hyperhidrosis presenting with unilateral symptoms: a report of
two
cases and review of the literature.
Kopelman
D, Hashmonai M, Assalia A, Bahous H.
Department
of Surgery B, The Rambam Medical Center, and the Faculty of Medicine,
Technion-Israel
Institute of Technology, Haifa, Israel.
Two
cases of primary palmar hyperhidrosis are presented. T2-T3 sympathetic
ganglionectomy
of the affected side completely alleviated perspiration of the
palms,
but oversweating of the contralateral palms appeared a few weeks later. A
similar
sympathetic ganglionectomy of the second side, 1 month and 1 year later,
resulted
in renewed oversweating of the palm on the first operated side within 3
months
of the second operation. During the same period, 127 other patients with
primary
palmar hyperhidrosis underwent a bilateral upper dorsal sympathectomy,
though
the condition did not recur in any of these patients. The possible
mechanism(s)
of why overperspiration of the second hand developed after the
first
sympathectomy in these two patients, and why it recurred in the first hand
after
the second operation are examined, but remain obscure.
Publication
Types:
Review
Review
of Reported Cases
PMID:
9546853 [PubMed - indexed for MEDLINE]
165:
Lancet 1998 Jan 24;351(9098):231-2
Comment
in:
Lancet. 1998 Apr 11;351(9109):1136.
Lancet. 1998 Apr 11;351(9109):1136.
Compensatory
hyperhidrosis after thoracic sympathectomy.
Adar
R.
Tel
Aviv University Sackler Faculty of Medicine, Tel Hashomer, Israel.
PMID:
9457090 [PubMed - indexed for MEDLINE]
166:
Clin Exp Dermatol 1998 Jan;23(1):45-6
Essential
hyperhidrosis: no evidence of abnormal personality features.
Kwon
OS, Kim BS, Cho KH, Kwon JS, Shin MS, Youn JI, Chung JH.
Publication
Types:
Letter
PMID:
9667113 [PubMed - indexed for MEDLINE]
167:
Eur J Surg Suppl 1998;(580):33-5
Complications
of endoscopic sympathectomy.
Cameron
AE.
Department
of Surgery, The Ipswich Hospital, Suffolk, UK.
Four
cases are presented in which complications occurred during or after
thoracic
endoscopic sympathectomy (TES). In one patient inappropriate TES
resulted
in disabling hyperhidrosis. In one patient laceration of the subclavian
artery
required major surgery. In two cases intraoperative cerebral damage
occurred.
Training in TES is essential.
PMID:
9641383 [PubMed - indexed for MEDLINE]
168:
Eur J Surg Suppl 1998;(580):39-42
Quality
of life after transthoracic endoscopic sympathectomy for upper limb
hyperhidrosis.
Sayeed
RA, Nyamekye I, Ghauri AS, Poskitt KR.
Department
of Vascular Surgery, Cheltenham General Hospital, Gloucestershire,
UK.
OBJECTIVE:
To assess the outcome after transthoracic endoscopic sympathectomy
(TES)
for upper limb hyperhidrosis. DESIGN: Prospective cohort study. SETTING:
District
general hospital. SUBJECTS: Consecutive patients undergoing TES for
upper
limb hyperhidrosis over a fifteen month period. INTERVENTIONS: One-stage
bilateral
TES. MAIN OUTCOME MEASURES: Change in quality of life as shown by the
Short
Form-36 health assessment questionnaire. RESULTS: Sixteen patients (11
women
and 5 men, median age 26 years) underwent operation without complications.
At
median follow-up of 6.2 months, symptomatic improvement was found in 26 of 32
limbs
treated (82%). Truncal compensatory hyperhidrosis was reported by 13
patients
but was severe in only three. There were significant improvements in
social
function (p = 0.01) and mental health (p = 0.025) as assessed by the
SF-36.
CONCLUSION: Despite a high incidence of compensatory hyperhidrosis, TES
improved
both the symptoms and overall quality of life in patients with upper
limb
hyperhidrosis.
PMID:
9641385 [PubMed - indexed for MEDLINE]
169:
Eur J Surg Suppl 1998;(580):13-6
Thoracoscopic
T2-sympathetic block by clipping--a better and reversible
operation
for treatment of hyperhidrosis palmaris: experience with 326 cases.
Lin
CC, Mo LR, Lee LS, Ng SM, Hwang MH.
Department
of Surgery, Tainan Municipal Hospital, Taiwan, ROC.
Although
thoracoscopic sympathectomy or sympathicotomy is the best treatment for
hyperhidrosis
palmaris, a new approach of clipping only without transection of
T2-sympathetic
trunk is just as effective. Aside from the guaranteed cure of
hyperhidrosis,
this new method has fewer complications and has the advantage of
recovery
of the sympathetic tone in the hands if the procedure is reversed by
the
removal of the clips. Between March 18 and September 30 of 1996, 326
patients
(190 female and 136 male with a mean age of 20.5 years) underwent
thoracoscopic
T2-sympathetic block by clipping to treat hyperhidrosis. Good
results
and few complications were noted during follow up six months to one year
postoperatively.
Five of the 326 patients, all female, had the operation
reversed
because of intolerable compensatory sweating. Three recovered from the
compensatory
sweating within two months and had less palmar sweating than before
their
sympathetic block; the fourth achieved relief of compensatory sweating
after
nine months, and the fifth reported no improvement.
PMID:
9641378 [PubMed - indexed for MEDLINE]
170:
Eur J Surg Suppl 1998;(580):17-8
Secondary
sympathetic chain reconstruction after endoscopic thoracic
sympathicotomy.
Telaranta
T.
Privatix
Clinic, Tampere, Finland. timo@privatix.fi
Thoracoscopic
sympathicotomy by electrocautery is an irreversible procedure.
Thus
the indications must be meticulously considered before the final decision
to
operate is taken by both the surgeon and the patient. All possible side
effects
should be dealt with and written informed consent required. A case of an
open
nerve reconstruction of the divided sympathetic chains is presented. One
year
after the reconstruction the patient reported subjective relief of the
compensatory
oversweating and restoration of sweating in the face and the
armpit.
Reversible methods like clipping the sympathetic chain should be
considered
whenever feasible instead of the irreversible electrocoagulation of
the
sympathetic chain.
PMID:
9641379 [PubMed - indexed for MEDLINE]
171:
Eur J Surg Suppl 1998;(580):9-11
Improvements
in video-endoscopic sympathicotomy for the treatment of palmar,
axillary,
facial, and palmar-plantar hyperhidrosis.
Duarte
JB, Kux P.
Department
of Surgery, Mater Dei Hospital and Belvedere Clinic, Belo Horizonte,
Minastierais,
Brazil.
Video-endoscopic
sympathicotomy for the treatment of palmar, axillary, facial
and
palmar-plantar hyperhidrosis was modified as to the type of surgical access
and
the level of incision in the sympathetic chain and communicating rami,
depending
on the clinical indications. Under general anaesthesia, using a single
lumen
endotracheal tube, the patient is put in lateral decubitus and
pneumothorax
is induced. The patient is then placed in ventral decubitus, with
the
head elevated, to make two punctures in the posterior axillary line, at the
level
of the 4th and 7th intercostal spaces, to introduce two ports of 5 and 10
mm
in size, respectively. The sympathetic chain and the communicating rami are
viewed
and severed, according to the indications, at different levels to treat
palmar,
axillary, facial and palmar-plantar hyperhidrosis and combinations of
the
above. The operation is performed on both sides of the thorax during the
same
period of anaesthesia. One hundred-forty patients (280 procedures) have
been
operated on from 1993 to 1997 using this technique. All were operated on as
outpatients.
Our results are: 100% of those with facial and palmar hyperhidrosis
and
96% of those with axillar hyperhidrosis were cured, and 94% with plantar
hyperhidrosis
were relieved from 50 to 100%, with the follow-up of between one
and
47 months.
PMID:
9641377 [PubMed - indexed for MEDLINE]
172:
Eur J Surg Suppl 1998;(580):19-21
Thoracoscopic
sympathectomy: the U.S. experience.
Krasna
MJ, Demmy TL, McKenna RJ, Mack MJ.
Department
of Surgery, University of Maryland School of Medicine, USA.
mkrasna@surgery1.ab.umd.cdu
OBJECTIVE:
48 patients underwent TSSYM. Charts of patients undergoing
thoracoscopy
were reviewed to assess the safety and efficacy of thoracoscopic
sympathectomy
(TSSYM). DESIGN: A retrospective review was undertaken at four
United
States medical centers. RESULTS: TSSYM was performed for reflex
sympathetic
dystrophy in 27 patients, hyperhydrosis palmaris in 15 patients, and
Raynaud's
upper extremity ischemia and splanchnic pain in 2 patients each.
Anesthesia
with one lung ventilation was used. 2.9 ports were used per patient
and
0.8 chest tubes were placed per patient. All patients underwent resection of
the
sympathetic chain, usually with a clip along the bottom of the resected
chain.
Laser, electro-ablation and electroresection were not used by any of the
surgeons
in his series. The mean length of hospital stay was 1.8 days.
CONCLUSIONS:
TSSYM is a safe and effective technique for treatment of a variety
of
thoracic disorders.
Publication
Types:
Multicenter
Study
PMID:
9641380 [PubMed - indexed for MEDLINE]
173:
Eur J Surg Suppl 1998;(580):43-6
Long-term
results of 630 thoracoscopic sympathicotomies for primary
hyperhidrosis:
the Vienna experience.
Zacherl
J, Huber ER, Imhof M, Plas EG, Herbst F, Fugger R.
Department
of General Surgery, University Clinic of Surgery, University of
Vienna,
Vienna General Hospital, Austria. johannes.zacherl@akh-wien.ac.at
OBJECTIVE:
To evaluate of the results of thoracoscopic sympathicotomy for upper
limb
hyperhidrosis with a median observation period of more than 15 years.
DESIGN:
Retrospective clinical observation study. SETTING: University-affiliated
tertiary
referral centre. SUBJECTS: 630 consecutive operations in 352 patients
(median
age 30.1 yrs) for primary palmar (68%), axillary (12.7%) and combined
hyperhidrosis
(19.3%). INTERVENTIONS: Thoracoscopic sympathicotomy from below T1
to
T4 including the fibres of Kuntz using electrocautery through single site
access.
MAIN OUTCOME MEASURES: Perioperative success and complication rates (all
patients);
long-term follow-up by a questionnaire and/or clinical examination
(83.3%
of patients) after a median period of 16 yrs. Calculation of statistical
significance
of differences between groups with c2-test. RESULTS: 67.8% of
patients
were fully satisfied, 25.7% were partially satisfied and would again
agree
to the operation. In 93% the procedure cured hyperhidrosis permanently.
Compensatory
and gustatory sweating was observed in 67% and 47% of cases,
respectively.
Overall success was significantly (p < 0.001) lower in the group
with
axillary hyperhidrosis. Main complications: drainage for pneumothorax 1.3%,
Horner's
syndrome in 3.8%, subcutaneous emphysema 2.1%. CONCLUSION:
Thoracoscopic
sympathicotomy proved to be highly effective even after long-term
follow-up.
Compensatory sweating impairs patients' satisfaction in some cases.
PMID:
9641386 [PubMed - indexed for MEDLINE]
174:
Eur J Surg Suppl 1998;(580):23-6
The
Boras experience of endoscopic thoracic sympathicotomy for palmar, axillary,
facial
hyperhidrosis and facial blushing.
Rex
LO, Drott C, Claes G, Gothberg G, Dalman P.
Department
of Surgery, Boras Hospital, Sweden.
OBJECTIVE:
To study the outcome of endoscopic thoracic sympaticotomy (ETS) for
palmar,
axillary, facial hyperhidrosis and facial blushing. SUBJECTS: 1152
patients,
59% women and 41% men. INTERVENTION: ETS was performed by transection
of
the sympathetic chain where it overlies the second and third rib. The nerve
was
divided also over the fourth rib in patients with axillary hyperhidrosis.
Questionnaires
were sent to all patients. MAIN OUTCOME MEASURES: The effect of
surgery
was assessed by a 10 grad visual analogue scale (VAS) by the patients.
The
results were divided into effect rate (the effect on the symptom) and
overall
satisfaction rate, taking into account any side effects and
complications
apart from the effect. RESULTS: The response rate was 90%. The
mean
follow up time, effect rate and overall satisfaction rate were: 38 months
for
palmar hyperhidrosis, 99.4% and 87%; 26 months for axillary hyperhidrosis,
94.5%
and 68%; 31 months for facial hyperhidrosis, 97% and 76%; 8 months for
facial
blushing, 96% and 85%. CONCLUSION: ETS is a very effective procedure in
palmar,
axillary and facial hyperhidrosis and facial blushing. The overall
satisfaction
rate is very good for palmar hyperhidrosis and facial blushing, not
equally
good but acceptable for facial hyperhidrosis. The lower satisfaction
rate
in patients with axillary hyperhidrosis makes this a questionable
indication
for ETS.
PMID:
9641381 [PubMed - indexed for MEDLINE]
175:
Eur J Surg Suppl 1998;(580):5-8
Thoracoscopic
upper thoracic sympathectomy for primary palmar hyperhidrosis--the
combined
paediatric, adolescents and adult experience.
Cohen
Z, Levi I, Pinsk I, Mares AJ.
Department
of Paediatric Surgery, Soroka Medical Centre, Faculty of Health
Sciences,
Ben-Gurion University of the Negev, Beer-Sheva, Israel.
OBJECTIVE:
To present our experience, over the past 4 years, of thoracoscopic
upper
thoracic sympathectomy in patients with primary palmar hyperhidrosis.
DESIGN:
Retrospective study. SETTING: University hospital, Israel. SUBJECTS: 402
thoracoscopic
upper thoracic sympathectomies in 223 patients over a period of 4
years.
INTERVENTIONS: Thoracoscopic ablation of ganglia and severing of the
sympathetic
chain at the level of T2 and T3. 142 patients underwent bilateral
simultaneous
sympathectomy, 37 had bilateral non-simultaneous sympathectomy and
44
had unilateral sympathectomy. RESULTS: 220 patients (98.7%) had an uneventful
postoperative
course and were discharged the following day. Three patients with
residual
pneumothorax required intercostal drainage and were discharged on the
third
postoperative day. 219 patients (98.2%) were completely satisfied, having
immediate
and permanent relief of palmar sweating. Four patients were
dissatisfied.
CONCLUSION: The thoracoscopic approach to the upper thoracic
sympathectomy
is at present the procedure of choice. Early operation for severe
palmar
hyperhidrosis is indicated to save a child many years of frustration and
discomfort.
PMID:
9641376 [PubMed - indexed for MEDLINE]
176:
Eur J Surg Suppl 1998;(580):27-32
Treatment
of social phobia by endoscopic thoracic sympathicotomy.
Telaranta
T.
Privatix
Clinic, Tampere, Finland. timo@privatix.fi
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.
PMID:
9641382 [PubMed - indexed for MEDLINE]
177:
J Auton Nerv Syst 1997 Dec
11;67(3):121-4
The
second thoracic sympathetic ganglion determines palm skin temperature in
patients
with essential palmar hyperhidrosis.
Wong
CW.
Division
of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung Medical
College,
Taipei, Taiwan, ROC. c1951@ms12.hinet.net
Sympathectomy
of the second (T2) and third (T3) thoracic ganglion is frequently
performed
for essential palmar hyperhidrosis and occasionally performed, in
addition
to stellectomy, for idiopathic Raynaud's disease. The increased palm
skin
temperature after the operation probably results from increased skin
perfusion.
To determine whether it was possible to limit the extent of
sympathectomy
for these patients, we recorded palm skin temperature after
electric
stimulation of stellate, T2 and T3 ganglia, and after randomized
electrocautery
of T2 and T3 ganglia in 20 patients. We analyzed the statistics
according
to paired t-test with Bonferroni adjustment. We found that palm skin
temperature
decreases significantly after stellate stimulation. While rising
significantly
after destruction of T2 ganglion in the presence of intact T3
ganglion
(P = 0.00001), palm skin temperature did not rise significantly after
T3
destruction in the presence of intact T2 (P = 0.779). Following T2 and T3
destruction,
however, palm skin temperature rose despite stellate stimulation.
This
suggests that T2 ganglion determines palm skin temperature while stellate
and
other upper thoracic ganglia may play a minor role, that T2 sympathectomy
suffices
for the treatment of essential palmar hyperhidrosis, and that
sympathectomy
for Raynaud's disease might skip stellectomy.
PMID:
9479662 [PubMed - indexed for MEDLINE]
178:
Anesth Analg 1997 Dec;85(6):1312-6
Transdiscal
lumbar sympathetic block: a new technique for a chemical
sympathectomy.
Ohno
K, Oshita S.
Pain
Clinic, Takamatsu Red Cross Hospital, Kagawa, Japan.
Genitofemoral
neuritis, which occurs when the neurolytic solution spreads into
the
psoas muscle, is the most common complication after neurolytic lumbar
sympathetic
block. We developed a transdiscal approach for neurolytic lumbar
sympathetic
block to reduce the danger of genitofemoral neuritis by making a
sympathectomy
without penetration of the psoas muscle, through which the
genitofemoral
nerve passes. We attempted transdiscal lumbar sympathetic block in
14
patients for whom the last previous lumbar sympathetic block performed by
using
the conventional paravertebral method was unsuccessful. Under fluoroscopic
guidance,
the needle was inserted transdiscally at L2-3 and/or L3-4 and was
advanced
until its tip pierced the anterior longitudinal ligament. Radiography
and
computed tomography revealed that the injected contrast media spread along
the
anterolateral surface of the vertebral column without any flow into the
psoas
muscle. Alcohol was injected successfully in all patients. During the 1-mo
follow-up
period, no patients had any symptom of genitofemoral neuritis.
Thirteen
patients who had been suffering from lower extremity pain achieved
partial
or complete pain relief. One patient with plantar hyperhidrosis achieved
persistent
anhidrosis. These results suggest that the transdiscal approach can
be
a technical option for neurolytic lumbar sympathetic block. Implications:
Neurolytic
lumbar sympathetic block was performed with the needle advanced
through
the intervertebral disc. With this technique, the risk of genitofemoral
neuritis,
the most common complication after neurolytic lumbar sympathetic
block,
was reduced because the needle does not penetrate the psoas muscle,
through
which the genitofemoral nerve passes.
PMID:
9390600 [PubMed - indexed for MEDLINE]
179:
Br J Anaesth 1997 Nov;79(5):688
Comment
on:
Br J Anaesth. 1997 Jul;79(1):113-9.
Thorascopic
sympathectomy.
Parry-Jones
AJ.
Publication
Types:
Comment
Letter
PMID:
9422913 [PubMed - indexed for MEDLINE]
180:
Am J Physiol 1997 Oct;273(4 Pt
2):H1696-8
Stimulation
of left stellate ganglion prolongs Q-T interval in patients with
palmar
hyperhidrosis.
Wong
CW.
Division
of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung Medical
College,
Taipei, Taiwan, Republic of China.
With
the advent of transthoracic video-assisted endoscopic electrocautery of the
second
and the third sympathetic ganglia for the treatment of palmar
hyperhidrosis,
it is possible to approach the stellate ganglia with ease. To see
whether
stimulation of stellate ganglia in humans is similar to the case in
dogs,
we stimulated the sympathetic ganglia in 18 palmar hyperhidrosis patients
with
a coagulation power of 5 W at a frequency of three times every 2 s. We
found
that left stellate stimulation prolongs the Q-T interval and increases the
heart
rate, whereas right stellate stimulation affects the Q-T interval and
heart
rate insignificantly, just like the case in dogs in which the left
stellate
ganglion predominates the right one in determining the Q-T interval.
Left
stellate stimulation after destruction of the left second and third ganglia
also
prolongs the Q-T interval, suggesting that the left stellate ganglion is
more
important in determining the Q-T interval.
PMID:
9362232 [PubMed - indexed for MEDLINE]
181:
Ann Thorac Surg 1997 Oct;64(4):975-8
Thoracoscopic
sympathectomy for upper limb hyperhidrosis: looking for the right
operation.
Gossot
D, Toledo L, Fritsch S, Celerier M.
Department
of Surgery, Saint-Louis Hospital, Paris, France.
d.gossot@chu-stlouis.fr
BACKGROUND:
Thoracoscopic sympathectomy is the most effective treatment for
upper
limb hyperhidrosis. However, this is offset by the occurrence of a high
rate
of side effects, such as embarrassing compensatory sweating. Anticipating
that
a technique that respects the sympathetic chain and divides only the rami
communicantes
may lead to fewer side effects, we assessed the technique
described
by R. Wittmoser, comparing it with conventional thoracoscopic
sympathecomy.
METHODS: A total of 240 thoracoscopic sympathectomies were
performed
in 124 patients suffering from upper limb hyperhidrosis. Fifty-four
patients
underwent a conventional sympathectomy (group TS), 62 underwent
division
of the rami communicantes with respect to the main trunk (group SS),
and
8 underwent both procedures (group TS/SS) because of accidental division of
the
chain during dissection. The mean follow-up is 8 months. RESULTS: No
recurrence
was observed in group TS whereas six (5%) occurred in group SS (p <
0.05).
The global rate of compensatory sweating was about the same in both
groups:
72.2% in group TS and 70.9% in group SS. However, the rate of
embarrassing
or disabling compensatory sweating was significantly higher in
group
TS (50%) than in group SS (21%) (p < 0.001). CONCLUSIONS: Although
selective
division of the rami communicantes results in a significant decrease
in
the rate of disturbing side effects, it also leads to recurrences that are
usually
not observed at that level in patients treated with the conventional
technique.
Therefore other means of achieving the ideal operation should be
explored,
that is, a technique associated with a high success rate but a minimal
number
of side effects.
PMID:
9354512 [PubMed - indexed for MEDLINE]
182:
J R Coll Surg Edinb 1997
Aug;42(4):287-8
Comment
on:
J R Coll Surg Edinb. 1996 Jun;41(3):160-3.
Assessment
of outcome after thoracoscopic sympathectomy for hyperhidrosis in a
specialized
unit.
Sayeed
RA, Ghauri AS, Nyamekye I, Poskitt KR.
Publication
Types:
Comment
Letter
PMID:
9276577 [PubMed - indexed for MEDLINE]
183:
Pediatr Surg Int 1997 Jul
18;12(5/6):356-9
Laproscopic
and thoracoscopic surgery in children and adolescents: A 3-year
experience
Cohen
Z, Shinhar D, Kurzbart E, Finaly R, Mares AJ.
Department
of Pediatric Surgery, Soroka Medical Center, Faculty of Health
Sciences,
Ben-Gurion University of the Negev, Beer-Sheva, Israel
Our
initial experience over the last 3 years with laparoscopic and thoracoscopic
surgery
in children and adolescents is reported. Between September 1992 and
August
1995, a total of 215 laparoscopic and thoracoscopic procedures were
performed:
32 appendectomies for acute appendicitis, 10 cholecystectomies for
symptomatic
gallstones, 11 procedures for adnexal pathology, 6 laparoscopies in
children
with nonpalpable testes, 3 diagnostic laparoscopies, and 153
thoracoscopic
sympathectomies in children suffering from primary palmar
hyperhidrosis.
The post-operative course was uneventful in all cases. In 2
children
with acute appendicitis we converted to the open technique due to
technical
difficulties. We are encouraged by the results of our initial
experience.
There is no doubt that laparoscopic cholecystectomy, laparoscopic
surgery
of adnexal pathology, and thoracoscopic sympathectomy, because of their
numerous
benefits - shorter operative time, hospitalization, and convalescence
as
well as less postoperative pain and improved cosmetic results - are replacing
the
open techniques. We are not convinced as yet of the advantages of
laparoscopic
appendectomy in children; we are presently performing both
laparoscopic
and conventional techniques and studying the various parameters in
order
to reach a more definite conclusion. Various other endoscopic surgical
procedures
will be carefully considered in the near future.
PMID:
9216899 [PubMed - as supplied by publisher]
184:
Br J Anaesth 1997 Jul;79(1):113-9
Comment
in:
Br J Anaesth. 1997 Nov;79(5):688.
Br J Anaesth. 1998 Jul;81(1):100.
Thorascopic
sympathectomy in the treatment of palmar hyperhidrosis: anaesthetic
implications.
Fredman
B, Olsfanger D, Jedeikin R.
Department
of Anesthesiology and Critical Care, Meir Hospital, Kfar Sava,
Israel.
Publication
Types:
Review
Review,
Academic
PMID:
9301398 [PubMed - indexed for MEDLINE]
185:
Neurosurgery 1997 Jul;41(1):110-3;
discussion 113-5
Comment
in:
Neurosurgery. 1998 Apr;42(4):951-2.
Neurosurgery. 1998 Jun;42(6):1403-4.
Complications
in patients with palmar hyperhidrosis treated with transthoracic
endoscopic
sympathectomy.
Lai
YT, Yang LH, Chio CC, Chen HH.
Department
of Surgery, National Cheng-Kung University Hospital, Tainan, Taiwan,
Republic
of China.
OBJECTIVE:
To assess the complications in a group of patients with palmar
hyperhidrosis
treated with transthoracic endoscopic sympathectomy. The
extraordinarily
high incidence of postoperative compensatory hyperhidrosis in
our
series is stressed and explained. METHODS: The retrospective study included
chart
reviews and outpatient assessments. Seventy-two patients underwent T2 or
T2-T3
endoscopic sympathectomy for primary palmar hyperhidrosis. Patients'
hyperhidrosis
severity, precipitating factors, postoperative complications,
surgical
results, and satisfaction were assessed. Severity of palmar
hyperhidrosis
and compensatory hyperhidrosis was classified by two grading
scales.
RESULTS: The success rate of sympathectomy was 93%. All patients except
one
suffered from compensatory sweating, which was the main cause of patients'
dissatisfaction
postoperatively. Seventeen percent of the patients (12 of 72
patients)
experienced new symptoms of gustatory sweating (facial sweating
associated
with eating). Twenty-one patients experienced other complications,
including
pneumothorax, Horner's syndrome, nasal obstruction, and intercostal
neuralgia.
CONCLUSION: Transthoracic endoscopic sympathectomy is an effective
and
simple modality to treat palmar hyperhidrosis. However, all patients need to
be
warned of the common complications, particularly compensatory hyperhidrosis,
before
surgery.
PMID:
9218302 [PubMed - indexed for MEDLINE]
186:
Pediatr Surg Int 1997 Jul;12(5-6):356-9
Comment
in:
Pediatr Surg Int. 1998 Nov;14(1-2):151.
Laparoscopic
and thoracoscopic surgery in children and adolescents: a 3-year
experience.
Cohen
Z, Shinhar D, Kurzbart E, Finaly R, Mares AJ.
Department
of Pediatric Surgery, Soroka Medical Center, Faculty of Health
Sciences,
Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Our
initial experience over the last 3 years with laparoscopic and thoracoscopic
surgery
in children and adolescents is reported. Between September 1992 and
August
1995, a total of 215 laparoscopic and thoracoscopic procedures were
performed:
32 appendectomies for acute appendicitis, 10 cholecystectomies for
symptomatic
gallstones, 11 procedures for adnexal pathology, 6 laparoscopies in
children
with nonpalpable testes, 3 diagnostic laparoscopies, and 153
thoracoscopic
sympathectomies in children suffering from primary palmar
hyperhidrosis.
The post-operative course was uneventful in all cases. In 2
children
with acute appendicitis we converted to the open technique due to
technical
difficulties. We are encouraged by the results of our initial
experience.
There is no doubt that laparoscopic cholecystectomy, laparoscopic
surgery
of adnexal pathology, and thoracoscopic sympathectomy, because of their
numerous
benefits - shorter operative time, hospitalization, and convalescence
as
well as less postoperative pain and improved cosmetic results - are replacing
the
open techniques. We are not convinced as yet of the advantages of
laparoscopic
appendectomy in children; we are presently performing both
laparoscopic
and conventional techniques and studying the various parameters in
order
to reach a more definite conclusion. Various other endoscopic surgical
procedures
will be carefully considered in the near future.
PMID:
9244098 [PubMed - indexed for MEDLINE]
187:
J Auton Nerv Syst 1997 Jun
6;64(2-3):65-73
Altered
response in cutaneous sympathetic outflow to mental and thermal stimuli
in
primary palmoplantar hyperhidrosis.
Iwase
S, Ikeda T, Kitazawa H, Hakusui S, Sugenoya J, Mano T.
Department
of Autonomic and Behavioral Neurosciences, Nagoya University, Japan.
iwase@riem.nagoya-u.ac.jp
Skin
sympathetic nerve activities (SSNAs) were recorded simultaneously from the
tibial
and peroneal nerves by microneurography at an ambient temperature of 25
degrees
C in five subjects with primary palmoplantar hyperhidrosis. The resting
of
the tibial SSNA innervating the sole (glabrous skin) increased moderately
(36.5
+/- 1.5 bursts/min), while mental arithmetic provoked marked responses
(1,003.3
+/- 457.4% compared with the resting level) in the hyperhidrosis group
compared
with the control normohidrosis group (n = 5, 25.3 +/ 4.2 bursts/min and
142.2
+/- 58.4%, respectively). Differentiation of the tibial SSNA into
sudomotor
(innervating sweat glands) and vasoconstrictor (innervating
presphincter
of skin vessels) revealed that this SSNA enhancement was
attributable
to not only sudomotor but also vasoconstrictor components during
mental
arithmetic. In contrast, the responses in the peroneal SSNA (innervating
the
dorsum pedis, hairy skin) of the hyperhidrosis group were only slightly
changed,
exhibiting no significant difference from those in the normohidrosis
group.
Reflex bursts elicited by sound and electric stimulation were normal in
amplitude
and latency. When the ambient temperature was elevated to 30 degrees
C,
the tibial SSNAs became more enhanced than did the peroneal SSNAs. The tibial
SSNA
was markedly enhanced in the hyperhidrosis group (290.0 +/- 78.5%) compared
with
the normohidrosis group (78.3 +/- 25.4%). We conclude that the excessive
responses
in SSNA to the plantar glabrous skin to both mental and thermal
stimuli
may be responsible for the profuse sweating in subjects with primary
palmoplantar
hyperhidrosis.
PMID:
9203126 [PubMed - indexed for MEDLINE]
188:
J Vasc Surg 1997 May;25(5):961-2
Comment
on:
J Vasc Surg. 1996 Aug;24(2):194-9.
Regarding
"Upper dorsal thoracoscopic sympathectomy for palmar hyperhidrosis:
improved
intermediate-term results".
Deblier
I, Breek JK, Herregodts P, Rutsaert R.
Publication
Types:
Comment
Letter
PMID:
9152333 [PubMed - indexed for MEDLINE]
189:
Eur J Cardiothorac Surg 1997
Apr;11(4):774-5
Bilateral
thoracoscopy for sympathectomy in the treatment of hyperhidrosis.
Dumont
P, Hamm A, Skrobala D, Robin P, Toumieux B.
Department
of Thoracic Surgery, Hopital Trousseau, Tours, France.
Thoracoscopic
sympathectomy has been established as the least invasive technique
with
high success rates for treatment of palmary hyperhidrosis [1,4,5]. In our
procedure
both sides are treated during the same operation. A bilateral
thoracoscopy
was performed in 20 patients for incapacitating hyperhidrosis.
Immediate
complications at operation were minimal. All patients reported
satisfaction
with the procedure in spite of compensatory sweating. The short
hospital
stay has significant financial benefits and these are increased if both
sides
are treated at the same time. This procedure is more aggressive than the
single
side procedure but the morbidity is not increased.
PMID:
9151052 [PubMed - indexed for MEDLINE]
190:
J Neurosurg 1997 Apr;86(4):738-9
Comment
on:
J Neurosurg. 1996 Aug;85(2):310-5.
Hyperhidrosis.
Kao
MC.
Publication
Types:
Comment
Letter
PMID:
9120647 [PubMed - indexed for MEDLINE]
191:
Minn Med 1997 Apr;80(4):50-2
Thoracoscopic
sympathectomy for palmar hyperhidrosis. A case report.
Graupman
PC, Rockswold GL, Blake D.
University
of Minnesota, USA.
Palmar
hyperhidrosis is a disabling condition that manifests itself as excessive
sweating
of the hands. Although the exact cause is unknown, several medical and
surgical
therapies are available to treat it. Recent developments in surgical
technique
have made the less invasive thoracoscopic sympathectomy a viable
alternative
to the open sympathectomy for medically refractory cases. We believe
that
thoracoscopic sympathectomy is a safe and effective treatment for palmar
hyperhidrosis.
PMID:
9128044 [PubMed - indexed for MEDLINE]
192:
Clin Biochem 1997 Mar;30(2):171-5
Effects
of non-pharmacological sympathetic sudomotor denervation on sweating in
humans
with essential palmar hyperhidrosis.
Noppen
M, Sevens C, Vincken WG.
Respiratory
Division, Academic Hospital A.Z.-V.U.B., Free University of
Brussels,
Belgium.
OBJECTIVE:
Quantitative sweat production and -ionic composition in Essential
Hyperhidrosis
(EH), and the effects of T2-T3 thoracoscopic sympathicolysis (TS)
hereon,
are unknown. Standardised pilocarpine iontophoresis sweat tests were
performed
before and after TS in order to study these issues. DESIGN AND
METHODS:
Pilocarpine iontophoretic sweat tests measuring maximal sweat
production
(mg) and sweat Na+, K+ and Cl- concentrations (mMol/L) were performed
on
both forearms of 10 EH patients, before and six weeks after TS, and in normal
volunteers.
RESULTS: As compared to normals, preoperative maximal sweat
production
was 30% higher (199.4 +/- 68.8 (SD) vs. 150.6 +/- 45.6 mg) in EH
patients;
due to type II error, however, statistical significance was not
reached.
Na+ and Cl- concentrations were similar, and K+ concentration was
slightly
lower in EH patients. After TS, sweat production had decreased to equal
levels
as in normals (149.1 +/- 52.1 mg), whereas the Na+ (from 33.6 +/- 6.9 to
51.0
+/- 6.4 mMol/L), Cl- (from 21.5 +/- 6.6 to 37.2 +/- 7.1 mMol/L) and K+
(from
7.5 +/- 1.3 to 8.6 +/- 2.2 mMol/L) concentrations had increased.
CONCLUSIONS:
EH patients present 30% higher maximal sweat production at their
forearms.
This increase may be due to an increased activity of the adrenergic
component
of sweat gland innervation. The post-TS increase in Na+, Cl- and K+
concentrations
suggests that the adrenergic component of sweat gland innervation
in
itself decreases sweat ion concentrations.
PMID:
9127700 [PubMed - indexed for MEDLINE]
193:
Eur J Clin Invest 1997 Mar;27(3):202-5
Plasma
catecholamine concentrations in essential hyperhidrosis and effects of
thoracoscopic
D2-D3 sympathicolysis.
Noppen
M, Sevens C, Gerlo E, Vincken W.
Respiratory
Division, Academic Hospital AZ-VUB, Free University of Brussels,
Belgium.
Essential
hyperhidrosis (EH) is caused by a poorly understood overactivity of
the
sympathetic fibres passing through the upper dorsal sympathetic ganglia D2
and
D3. These ganglia are also in the pathway of the sympathetic innervation of
the
heart and lungs. Therefore, although the predominant sympathetic
neurotransmitter
at the eccrine sweat glands is acetylcholine, the plasma
concentration
of noradrenaline (NA) (which is the main sympathetic
neurotransmitter
at the end organs including the heart and the lungs) may be
elevated.
Furthermore, as there are some indications for generalized sympathetic
overactivity
in EH, the plasma concentration of adrenaline (A) may also be
elevated.
Plasma levels of NA and A were therefore determined in 13 EH patients
before
and after thoracoscopic D2-D3 sympathicolysis (TS). Preoperative NA and A
plasma
levels were all within the normal limits used in our laboratory. After
TS,
mean NA plasma levels are significantly decreased, whereas mean A are
unchanged.
We conclude that sympathetic overactivity in EH is limited to the
upper
dorsal sympathetic ganglia and that some of the cardiovascular and
pulmonary
effects that are observed after TS may be associated with the decrease
in
NA.
PMID:
9088855 [PubMed - indexed for MEDLINE]
194:
Kaohsiung J Med Sci 1997
Mar;13(3):162-8
Transthoracic
endoscopic sympathectomy for treatment of hyperhidrosis palmaris.
Chu
D, Shi PK, Wu CM.
Department
of Neurosurgery, Taipei Municipal Jen-Ai Hospital, Taiwan, Republic
of
China.
The
objective of this study was to determine the effectiveness of modified
transthoracic
endoscopic sympathectomy (TES) being used in our institute for
treatment
of hyperhidrosis palmaris (HP). One hundred and eight cases of HP were
treated
using TES from June 1991 to June 1992. All underwent TES bilaterally.
Palmar
temperature was monitored during the operation as an indicator of a
successful
lesioning of the sympathetic trunk at the T2-level. The ages of the
patients
ranged from 10 to 61 years. Fifty-one percent of these patients had a
positive
family history. Seventy-three percent had onset during childhood.
Eighty-nine
percent had excessive plantar sweating in addition to hyperhidrosis
palmaris.
The increase in palmar temperature after lesioning the sympathetic
trunk
was inversely related to the preoperative temperature of the palms (r =
0.81,
p < 0.005). Our treatment resulted in improvement of palmar sweating in
all
of the patients. Decrease of plantar sweating was also noted in 68% of the
patients
at follow up. No neurological deficits were found. Transient
post-operative
chest discomfort and compensatory hyperhidrosis (87%) were the
most
common complications. TES is an effective method for treating patients with
HP,
with a shorter operation time, fewer hospital days, and a better cosmetic
result,
as compared with the dorsal approach for thoracic sympathectomy.
PMID:
9109303 [PubMed - indexed for MEDLINE]
195:
Surg Neurol 1997 Mar;47(3):224-9;
discussion 229-30
Transthoracic
video endoscopic electrocautery of sympathetic ganglia for
hyperhidrosis
palmaris: special reference to localization of the first and
second
ribs.
Wong
CW.
Division
of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung Medical
College,
Taipei, Taiwan, R.O.C.
BACKGROUND:
The surgical technique for transthoracic endoscopic sympathectomy
varies
from one to three skin incisions, room air to carbon dioxide
pneumothorax,
and destruction of the second (T2), third (T3), and fourth
sympathetic
ganglia to destruction of the T2 ganglion only. A knowledge of the
surgical
anatomy of the apex may help the surgeon to safely use this technique.
METHODS:
Forty-seven patients with palmar hyperhidrosis underwent video-assisted
endoscopic
electrocautery of the T2 and T3 ganglia with the use of one-lumen
endotracheal
tube for general anesthesia, one skin incision, and carbon dioxide
pneumothorax.
Surgical anatomy, palm temperature, and surgical results were
analyzed.
RESULTS: The first ribs of 23 patients were endoscopically visible and
most
of these first ribs were not as parallel to the second ribs as the third
ribs
were. The first ribs of the remaining 24 patients were palpable with a
diathermy
bar. In all but three patients with dense pulmonary adhesions, the
distal
end of the intrathoracic segment of the subclavian artery was seen to
pierce
the pleura at the upper border of the first rib. Ninety-one palms remain
dry
and 27 patients develop compensatory sweating in an average follow-up of 12
months.
Excluding three patients whose sympathetic ganglia could not be
electrocauterized
because of severe pulmonary adhesions, 95% of the remaining 44
patients
are satisfied with the results. CONCLUSIONS: Transthoracic video
endoscopic
electrocautery of the T2 and T3 ganglia for patients with palmar
hyperhidrosis
may yield excellent results if the first rib can be properly
identified.
PMID:
9068691 [PubMed - indexed for MEDLINE]
196:
Clin Auton Res 1997 Feb;7(1):1-4
Patterns
of sympathetic skin response in palmar hyperhidrosis.
Chu
EC, Chu NS.
Department
of Neurology, Chang Gung Memorial Hospital, Taipei, Taiwan.
Sympathetic
skin responses (SSRs) were studied in 44 patients with palmar
hyperhidrosis.
The mean age was 19 +/- 4 years and the mean age of onset 9.1 +/-
3.6
years. Palmar SSRs were evoked by median nerve stimulation and by magnetic
stimulation
of the neck. Four types of SSR were identified: normal response,
small-amplitude
response, multiphasic response and absent response. Four palmar
conditions
were also identified: warm-wet in 26 patients, warm-dry in seven,
cold-wet
in seven, and cold-dry in four. Normal SSRs were present in about 25%
of
patients and absent SSRs in another 25%. The other two types of SSR were
evenly
distributed among patients, except those with cold-dry palms, who only
had
absent responses. There was no apparent difference between centrally and
peripherally
activated SSRs. It is concluded that skin temperature and moisture
of
the palms play an important role in producing different types of SSR in
palmar
hyperhidrosis.
Publication
Types:
Clinical
Trial
PMID:
9074822 [PubMed - indexed for MEDLINE]
197:
Arch Phys Med Rehabil 1997
Jan;78(1):85-8
Intraoperative
monitoring of skin temperature changes of hands before, during,
and
after endoscopic thoracic sympathectomy: using infrared thermograph and
thermometer
for measurement.
Chuang
TY, Yen YS, Chiu JW, Chan RC, Chiang SC, Hsiao MP, Lee LS.
Department
of Physical Medicine and Rehabilitation, Veterans General
Hospital-Taipei;
National Yang-Ming University School of Medicine, Taiwan,
R.O.C.
OBJECTIVE:
To investigate the roles of the second and third thoracic spinal
segments
in the preganglionic sympathetic innervation of the hand, and to
compare
skin temperature changes between thenar and other parts of palm before,
during,
and after endoscopic thoracic sympathectomy. DESIGN: Twelve patients,
four
women and eight men, with severe palmar hyperhydrosis underwent endoscopic
thoracic
sympathectomy. The T3 segment was identified and dissected first,
followed
by T2 segment extirpation. Skin temperature changes of the hand were
assessed
by thermograph and thermometer simultaneously before, during, and after
sympathectomy.
Sympathetic skin responses were undertaken 1 day preoperatively
and
followed up 6 months postoperatively. SETTING: An electrophysiological
laboratory
and operating room in a national medical center. SUBJECTS: Twelve
patients
who sustained a profound degree of palmar hyperhydrosis. INTERVENTIONS:
Skin
temperature differences of the hands were measured by infrared thermograph
and
thermometer before, during, and after endoscopic thoracic sympathectomy.
MAIN
OUTCOME MEASURES: Group's average temperature differences, and sympathetic
skin
response (all or none response). RESULTS: The T2 spinal segment is thought
to
be the main source of sympathetic outflow to the sweat glands of the hand.
The
group's average temperature changes were significantly higher at the 2nd
through
5th fingers' tips than at the thenar after completion of T2 extirpation
(p
< .005). CONCLUSIONS: Intraoperative monitoring of palmar skin temperature,
as
judiciously measured by infrared thermograph, yields useful information about
the
locations of the sympathetic segments and confirmation of their entire
ablation
by endoscopic thoracic sympathectomy.
PMID:
9014964 [PubMed - indexed for MEDLINE]
198:
J Palliat Care 1997 Autumn;13(3):53-4
Comment
on:
J Palliat Care. 1997 Spring;13(1):22-6.
Patients
with troublesome sweating.
Miller
M.
Publication
Types:
Comment
Letter
PMID:
9354042 [PubMed - indexed for MEDLINE]
199:
Langenbecks Arch Chir Suppl Kongressbd
1997;114:1287-9
[Hyperhidrosis
of the upper extremity: long-term outcome of endoscopic thoracic
sympathicotomy]
[Article
in German]
Zacherl
J, Imhof M, Plas EG, Herbst F, Fugger R.
Klinische
Abteilung fur Allgemeinchirurgie, Universitat Wien.
A
total of 630 endoscopic thoracal sympathicotomies were performed for
hyperhidrosis
of the upper limbs, and complications and success rates were
analyzed
after a median follow-up period of 16 years (83% of patients). In all,
67.8%
of patients were fully satisfied, 25.7% were partially satisfied and would
again
agree to the operation, and 93% the procedure terminated hyperhidrosis
permanently.
Compensatory and gustatory sweating was observed in 67% und 47% of
cases,
respectively, impairing the patients satisfaction. Overall success was
significantly
(p < 0.001) lower in the group with axillary hyperhidrosis.
PMID:
9574405 [PubMed - indexed for MEDLINE]
200:
Neurosurgery 1997 Jan;40(1):216-7
Comment
on:
Neurosurgery. 1996 Apr;38(4):715-25.
Percutaneous
radiofrequency upper thoracic sympathectomy.
Kao
MC.
Publication
Types:
Comment
Letter
PMID:
8971848 [PubMed - indexed for MEDLINE]
201:
Stereotact Funct Neurosurg 1997;69(1-4
Pt 2):274-7
Video-endoscopic
and mini-endoscopic sympathectomy for hyperhidrosis.
Pillay
PK, Kumar K, Tang KK.
Asian
Brain-Spine-Nerve Center, Singapore. neuro@pacific.net.sg
Video-endoscopic
sympathectomy (VES) is currently the method of choice for the
minimally
invasive treatment of hyperhidrosis involving the palms, armpit and
facial
areas. Over a 7-year period from 1991 to 1997 our technique of performing
VES
has evolved during the performance of 800 endoscopic sympathectomies from
the
use of 3 ports to a single 10-mm port to finally a 3-mm port using a
mini-endoscope.
In comparison to standard VES, mini-endoscopic sympathectomy is
simpler,
less invasive, causes less postoperative discomfort and consistently
allows
patients to return home the same day.
PMID:
9711766 [PubMed - indexed for MEDLINE]
202:
Br J Surg 1996 Dec;83(12):1782
Abnormal
suntanning following transthoracic endoscopic sympathectomy.
Whiteley
MS, Ray-Chaudhuri SB, Galland RB.
Department
of Surgery, Royal Berkshire Hospital, Reading, UK.
PMID:
9038569 [PubMed - indexed for MEDLINE]
203:
Cardiovasc Surg 1996 Dec;4(6):788-90;
discussion 790-1
Hyperhidrosis
treated by thoracoscopic sympathicotomy.
Drott
C, Claes G.
Department
of Surgery, Boras Hospital, Sweden.
Hyperhidrosis
of the palms, axillae and face has a strong negative impact on
social
and professional life. The existing non-operative therapeutic options
seldom
give sufficient relief and have a transient effect. A definitive cure can
be
obtained by upper thoracic sympathectomy. The traditional open surgical
techniques
are major procedures and few patients and surgeons have found that
the
risk--benefit consideration favoured surgery. Since 1987, the authors have
divided
the upper thoracic sympathetic chain on 1163 patients with a simple
endoscopic
technique by using standard urological equipment. A bilateral
procedure
takes less than 20 min and requires just one night in hospital. There
have
been no mortality or life-threatening complications. Ten patients (< 1%)
required
intercostal drainage because of haemo- or pneumothorax. Horner's
syndrome
occurred in four cases. Primary failure occurred in 23 cases (< 2%) and
24
(< 2%) developed recurrent symptoms. The patients with failure and
recurrence
were
successfully reoperated on and only three have required a third operation.
At
the end of postoperative follow-up (median 31 months) 98% of the patients
were
satisfied. Endoscopic transthoracic sympathicotomy is an efficient, safe
and
minimally invasive surgical method for the treatment of palmar, axillary and
facial
hyperhidrosis.
Publication
Types:
Clinical
Trial
PMID:
9013011 [PubMed - indexed for MEDLINE]
204:
Harefuah 1996 Nov 1;131(9):303-5, 374
[Thoracoscopic
upper thoracic sympathectomy for primary palmar hyperhidrosis]
[Article
in Hebrew]
Cohen
Z, Shinhar D, Mordechai J, Mares AJ.
Dept.
of Pediatric Surgery, Soroka Medical Center, Ben-Gurion University of the
Negev,
Beer Sheba.
We
report our initial experience, over the past 3 years, with thoracoscopic
sympathectomy
for severe, primary, palmar hyperhidrosis in children and
adolescents.
From 1992-1995, 179 thoracoscopic sympathectomies were performed in
61
girls and 35 boys, 5.5 to 18 years old (mean 14.8). During the first 2 years
the
procedures were performed bilaterally but not simultaneously. During the
past
years, 65 underwent bilateral, simultaneous sympathectomy, using a single
10
mm subaxillary port of entry. 94 (98%) had immediate and permanent relief of
palmar
sweating. The immediate postoperative course was uneventful in all except
2
who had residual pneumothorax that required 24-hour intercostal drainage.
These
results compare favorably with the open method and are actually better in
terms
of less pain, early discharge, quicker return to normal activity and a
smaller
and less conspicuous scar. We emphasize the benefits of early surgery in
children
with severe, palmer hyperhidrosis, to avoid the many years of
psychological,
social and physical discomfort during adolescent growth and
development.
PMID:
8981795 [PubMed - indexed for MEDLINE]
205:
Arch Surg 1996 Oct;131(10):1091-4
Endoscopic
sympathectomy treatment for craniofacial hyperhidrosis.
Kao
MC, Chen YL, Lin JY, Hsieh CS, Tsai JC.
Department
of Surgery, National Taiwan University Hospital, Taipei.
OBJECTIVE:
To present endoscopic T-2 sympathectomy as a minimally invasive
therapy
for craniofacial hyperhidrosis (CH). DESIGN: Follow-up study of 30
patients
with CH treated by the new method in a 4-year period. The duration of
follow-up
was from 8 to 44 months (mean, 15 months). SETTING: University
hospital.
PATIENTS: Thirty consecutive patients with CH (18 men, 12 women)
treated
by the new method. All patients were essentially in good health except
that
they suffered from distressing CH to the extent that their daily activities
were
often disturbed. Their ages ranged from 7 to 63 years (mean age, 42.8
years).
INTERVENTION: Endoscopic sympathectomy on both sides was carried out in
a
1-stage operation for all patients. MAIN OUTCOME MEASURES: The patients were
interviewed
1 week and then 3 months after surgery and then followed up by
telephone
interview about the alleviation or recurrence of CH and complications.
RESULTS:
All of the treated patients obtained a satisfactory alleviation of CH.
One
case was complicated by a mild and transient ptosis of the left eye. No
recurrence
of CH was noticed during the follow-up period. CONCLUSIONS: This
therapeutic
procedure is minimally invasive and effective. It causes minimal
discomfort
and was associated with no major complications in this series. The
patients
require only an overnight hospital stay and the operation scars are
small.
Endoscopic sympathectomy has proven to be an effective method in treating
patients
with distressing CH.
PMID:
8857909 [PubMed - indexed for MEDLINE]
206:
J Cardiothorac Vasc Anesth 1996
Oct;10(6):767-71
Total
intravenous anesthesia and high-frequency jet ventilation during
transthoracic
endoscopic sympathectomy for treatment of essential hyperhidrosis
palmaris:
a new approach.
D'Haese
J, Camu F, Noppen M, Herregodts P, Claeys MA.
Department
of Anesthesiology, University Hospital. Vrye Universiteit Brussel,
Belgium.
OBJECTIVE:
To evaluate the effects of high-frequency jet ventilation (HFJV)
applied
to both lungs on hemodynamic parameters, oxygenation, and operating
conditions
during bilateral videothoracoscopic sympathectomy. DESIGN: A
prospective,
unblinded study. SETTING: An ambulatory surgical unit at a
university
medical center. PARTICIPANTS: 30 patients (11 men, 19 women), ASA
status
1. INTERVENTION: Bilateral videothoracoscopic sympathectomies were
performed
using total intravenous anesthesia with propofol, alfentanil, and
atracurium,
and the patients were ventilated with an oxygen-air mixture using
HFJV
delivered to both lungs with a Hi-Lo Jet tracheal tube (Mallinckrodt).
MEASUREMENTS
AND MAIN RESULTS: Mean total anesthesia time was 55 +/- 13 minutes.
Hemodynamic
parameters remained stable during surgery, although ablation of the
sympathetic
ganglia induced three incidences of bradycardia (10% of the
patients),
which were responsive to atropine. Four patients developed oxygen
desaturation
(Sa O2 < 90%) after the creation of the pneumothorax. Surgical
conditions
were considered excellent by the surgeons. Concerning postoperative
complications,
a temporary Horner's syndrome was observed in one patient.
Another
patient had a mild residual pneumothorax on the first postoperative day
that
resolved without insertion of a chest tube. CONCLUSIONS: It was concluded
that
HFJV applied to both lungs is an easy and safe anesthetic technique that
provides
excellent surgical conditions and causes a minor incidence of
morbidity.
PMID:
8910157 [PubMed - indexed for MEDLINE]
207:
Surg Endosc 1996 Oct;10(10):1029-30
Simultaneous
vs staged bilateral video-assisted thoracoscopic surgery.
Yim
AP.
Department
of Surgery, The Chinese University of Hong Kong, Prince of Wales
Hospital,
Shatin, N. T., Hong Kong.
It
is generally thought that simultaneous bilateral chest surgery carries a high
morbidity.
We reviewed the results of simultaneous (under one anesthesia) vs
staged
bilateral video-assisted thoracoscopic surgery (VATS) from a single
institution
over a 35-month period. From September 1992 to July 1995, we
performed
simultaneous bilateral VATS on 37 patients (31 males, six females, age
ranging
from 15 to 55 years) with spontaneous pneumothorax (20) for bleb
resections
and pleurodesis; thoracodorsal sympathectomy (12) for palmar
hyperhidrosis
and vasospastic disease; and metastatic sarcomas (five) for wedge
lung
resections. During the same period, nine patients with metachronous
bilateral
spontaneous pneumothorax had staged procedures, as did two with
digital
ischemic ulcers for sympathectomy and three with metastatic pulmonary
osteosarcomas
for resection. Mean postoperative hospital stays in days for the
simultaneous
groups were 3.3 for spontaneous pneumothorax, 2.1 for
sympathectomy,
and 1.5 for wedge resection, compared to 2.9, 2.5, and 2.2 for
the
staged groups, respectively (p > 0.05 by Mann-Whitney U tests). Likewise,
pain
assessment by visual analogue scale as well as analgesic requirement showed
no
significant difference between the simultaneous and the staged groups. We
conclude
that simultaneous VATS is not associated with increased morbidity or
prolonged
hospital stay compared to the staged counterparts and provides an
attractive
alternative to the median sternotomy, bilateral posterolateral
thoracotomy,
or transternal (clam-shell) thoracotomy for selected cases of
simultaneous
bilateral lung surgery.
PMID:
8864102 [PubMed - indexed for MEDLINE]
208:
J Auton Nerv Syst 1996 Sep 12;60(3):115-20
Changes
in cardiocirculatory autonomic function after thoracoscopic upper dorsal
sympathicolysis
for essential hyperhidrosis.
Noppen
M, Dendale P, Hagers Y, Herregodts P, Vincken W, D'Haens J.
Respiratory
Department of the University Hospital AZ-VUB, Free University,
Brussels,
Belgium.
Essential
hyperhidrosis (EH) is caused by an unexplained overactivity of the
sympathetic
fibers which pass through the upper dorsal sympathetic ganglia D2
and
D3. Since the D2 and D3 ganglia are also involved in the sympathetic cardiac
innervation,
cardiocirculatory autonomic function may also be abnormal in EH. In
order
to study the function of the sympathetic nervous system in EH, and to
assess
the effects of thoracoscopic sympathiocolysis, cardiocirculatory
autonomic
function tests were performed in 13 consecutive patients with EH,
before
(baseline) and 6 weeks after the thoracoscopic intervention. Baseline
data
were also compared with data obtained from 13 matched healthy volunteers:
EH
patients showed an increased heart rate at rest, but only in the standing
position
(94 +/- 18.5 vs 78 +/- 10.9 bpm, P < 0.01), as well as an increased
ratio
of low to high frequency power of the heart rate variability in the
standing
position (5.92 +/- 4.4 vs 2.8 +/- 2.5, P < 0.05). Exercise tests were
normal
in every EH patient. After sympathiocolysis, heart rate at rest (sitting
on
the cycloergometer) had decreased (75.4 +/- 13 vs 90.4 +/- 16.5 bpm, P <
0.05),
as well as heart rate at maximal exercise (165.2 +/- 14.8 vs 180 +/- 10
bpm,
P < 0.05). Exercise capacity and the cardiorespiratory responses to
exercise
were, however, unchanged after sympathicolysis. Resting heart rate in
the
lying (66 +/- 10 vs 76 +/- 15 bpm, P < 0.05) and standing positions (82 +/-
13.8
vs 94 +/- 18.5 bpm, P < 0.05), and the diastolic blood pressure reaction to
a
handgrip test (73.6 +/- 8.6 vs 84.7 +/- 11.6 mmHg, P < 0.05) were also
lowered
after
sympathicolysis. In conclusion, patients with EH show an overfunctioning
of
the sympathetic system which is characterised by an increased reaction to
stress
(standing, exercise), whereas resting sympathetic tone is unaffected.
Thoracoscopic
D2-D3 sympathicolysis corrects this hyperfunction and has a
partial
beta-blocker-like activity, which results in a decrease in heart rate at
rest
and during maximal exercise, and in the diastolic blood pressure response
to
the handgrip test. Further studies are needed to assess the long-term
consequences
of this procedure.
PMID:
8912261 [PubMed - indexed for MEDLINE]
209:
Ann Acad Med Singapore 1996
Sep;25(5):673-8
Minimally
invasive surgery: video endoscopic thoracic sympathectomy for palmar
hyperhidrosis.
Kao
MC, Lin JY, Chen YL, Hsieh CS, Cheng LC, Huang SJ.
Department
of Surgery, National Taiwan University Hospital, Taipei, ROC.
Palmar
hyperhidrosis (PH) is a common disorder in Taiwan. It often causes social
embarrassment
and occupational handicaps. So far, there has been no satisfactory
treatment
for PH. In 1990, we first developed a minimally invasive technique:
video
endoscopic sympathectomy to treat PH. The procedure has subsequently
proven
to be a standard treatment for PH. In this study, a survey of 9988 cases
of
PH patients from 17 hospitals in Taiwan treated by this method during the
past
5 years is presented. Although there were some variations in the model of
anaesthesia,
technique and extent of sympathectomy, the postoperative results
were
generally satisfactory. Both sides of sympathectomy were mostly
accomplished
within half an hour in one stage. The operative scars were tiny and
concealed
in the axillary region. The patients were discharged from the hospital
after
an overnight stay. Complications such as pneumothorax, haemothorax (0.3%)
or
Horner's syndrome (0.1%) were rare. There was no surgical mortality in this
series.
The most common complication was compensatory hyperhidrosis which was
usually
mild to moderate and tolerable after reassurance. The recurrence rate of
PH
was approximately 1% in the first year and less than 3% during the 3 years of
follow
up. Intraoperative monitoring of palmar skin temperature (PST) was
advocated
to confirm an adequate sympathectomy warranting a definite result. En
bloc
ablation of T2 segment invariably resulted in a rise of PST to about 2
degrees
C and was considered as an adequate extent of sympathectomy for PH. The
refined
technique was extended to treat young children with PH and patients with
craniofacial
hyperhidrosis. The therapeutic results were generally excellent
with
minimal morbidity and rare recurrence. It is concluded that video
endoscopic
en bloc T2 sympathectomy is a simple, minimally invasive and
effective
treatment for both adults and children with PH and also for patients
with
craniofacial hyperhidrosis.
PMID:
8924003 [PubMed - indexed for MEDLINE]
210:
Neurosci Behav Physiol 1996
Sep-Dec;26(5):482-8
State
of the peripheral nervous system in patients with hypothalamic
insufficiency.
Filatova
EG, Solov'eva AD, Kanavets EV, Rogovina EG.
Department
of Nervous Diseases, Faculty of Advanced Postdiploma Education, I. M.
Sechenov
Moscow Medical Academy.
An
investigation was carried out by non-invasive techniques of the state of the
peripheral
nervous system in patients with a constitutional-acquired form of
hypothalamic
insufficiency. Ten healthy individuals were included in the control
group.
The presence of subclinical parasympathetic vegetative insufficiency was
identified
by cardiovascular tests. It was more marked in patients with an early
onset
of the neuroendocrine disturbances and longer course of the disease. In
the
opinion of the authors, this suggests the constitutional-acquired character
of
the vegetative disturbances. In addition, a slowing of the speed of
conduction
through the sudomotor preganglionic sympathetic fibers in the upper
and
lower extremities and the predominance of these disturbances in the group of
patients
with pronounced dysraphic status were identified. The latter suggests a
defect
of the laying down of these peripheral vegetative fibers. This
investigation
makes it possible to hypothesize that subclinical peripheral
insufficiency
is one of the factors governing the occurrence of both permanent
(tachycardia,
elevations of AP, hyperhidrosis) and paroxysmal vegetative
disturbances
(panic attacks, migraine) in hypothalamic insufficiency.
Publication
Types:
Clinical
Trial
Controlled
Clinical Trial
PMID:
9000222 [PubMed - indexed for MEDLINE]
211:
Surg Endosc 1996 Sep;10(9):949
Chylothorax
after endoscopic thoracic sympathectomy.
Gossot
D.
Publication
Types:
Letter
PMID:
8703162 [PubMed - indexed for MEDLINE]
212:
Eur Respir J 1996 Aug;9(8):1660-4
Thoracoscopic
sympathicolysis for essential hyperhidrosis: effects on pulmonary
function.
Noppen
M, Vincken W.
Respiratory
Division, Academic Hospital, AZ-VUB, University of Brussels,
Belgium.
Bilateral
interruption of the upper dorsal sympathetic chain at the D2 and D3
level
represents the only permanent cure for essential hyperhidrosis. Following
surgical
sympathectomy, significant and symptomatic changes in pulmonary
function
have been observed. Since functional effects of the surgical
intervention
cannot be excluded, we wondered whether such alterations also
occurred
after thoracoscopic sympathicolysis; these should then be attributable
to
the surgical denervation itself. Pulmonary function tests (PFTs), including
spirometry
and body plethysmographic measurement of lung volumes and airway
resistance
and conductance, were compared before and 6 weeks after thoracoscopic
sympathicolysis
in 47 patients. In order to virtually exclude any effects of
thoracoscopy
on the test results PFTs were repeated 6 months after thoracoscopic
sympathicolysis
in 35 patients. Essential hyperhidrosis was completely relieved
in
all patients, thereby confirming the interruption of the D2-D3 sympathetic
chain.
None of the patients developed respiratory symptoms after thoracoscopic
sympathicolysis.
Forced expiratory volume in one second (FEV1) (-3%), forced
expiratory
flow after exhaling 75% of vital capacity (FEF75) (-8%) and total
lung
capacity (TLC) (-3%) were slightly but significantly reduced at six weeks
after
thoracoscopic sympathicolysis; whereas airway resistance (Raw) had
increased
(+12%). After correction for the small decrease in lung volume
(FEV1/forced
vital capacity (FVC), specific airway resistance (sRaw), specific
airway
conductance (sGaw))significant changes in "volume-dependent" PFT
parameters
were no longer observed. Smoking status had no influence on the
reduction
in FEF75. At 6 months after thoracoscopic sympathicolysis, TLC had
returned
to preoperative values, whereas FEF75 remained decreased (-8.6%). The
decrease
in airway calibre was confirmed by small but significant changes in
FEV1/FVC
(-2%) and Raw (+29%). We conclude that thoracoscopic sympathicolysis in
patients
with essential hyperhidrosis causes only minimal and subclinical
changes
in pulmonary function secondary to a temporary small decrease in lung
volume,
which in turn is probably inherent to the thoracoscopic procedure. D2-D3
sympathicolysis,
in itself, is responsible only for a small and permanent
decrease
in forced expiratory flow, which suggests that, at least in essential
hyperhidrosis
patients, airway bronchomotor tone is influenced by sympathetic
innervation.
PMID:
8866591 [PubMed - indexed for MEDLINE]
213:
J Neurosurg 1996 Aug;85(2):310-5
Comment
in:
J Neurosurg. 1997 Apr;86(4):738-9.
Orientation
landmarks of endoscopic transaxillary T-2 sympathectomy for palmar
hyperhidrosis.
Chiou
TS, Liao KK.
Department
of Neurosurgery, Chung Shan Medical and Dental College Hospital,
Taichung,
Taiwan, Republic of China.
The
identification of the T-2 ganglion through a narrow operative viewfield is
the
greatest challenge in performing endoscopic transaxillary T-2 sympathectomy,
especially
for a surgeon who is unfamiliar with the technique. The authors
describe
a simple anatomical method for identifying the T-2 ganglion during the
operation,
based on a study of 17 adult cadavers. First, a similar clinical
procedure
was performed along the anterior or middle axillary line via the
second
to fourth intercostal spaces to measure the aiming angles and
intrathoracic
depth needed. Second, the regional anatomical structures and their
relationship
to bilateral T-2 ganglia were delineated. It was discovered that
the
superior intercostal artery, a branch of the subclavian artery, was an
accessible
landmark. This small vessel existed in 87.5% of the cadavers studied.
It
consistently runs lateral to the parallel sympathetic chain at an average
distance
of 10 mm. Most important is that it can be easily distinguished where
it
runs across the inner part of the second rib. The authors emphasize that the
superior
intercostal artery should be a very beneficial landmark for surgical
orientation.
PMID:
8755761 [PubMed - indexed for MEDLINE]
214:
J Vasc Surg 1996 Aug;24(2):194-9
Comment
in:
J Vasc Surg. 1997 May;25(5):961-2.
Upper
dorsal thoracoscopic sympathectomy for palmar hyperhidrosis: improved
intermediate-term
results.
Kopelman
D, Hashmonai M, Ehrenreich M, Bahous H, Assalia A.
Department
of Surgery B, Rambam Medical Center, Haifa, Israel.
PURPOSE:
The purpose of this study was to examine the immediate and mid-term
results
of thoracoscopic upper dorsal (T2-T3) sympathectomy for primary palmar
hyperhidrosis.
METHODS: From June 1993 to October 1994 we performed 106
sympathectomies
on 53 patients with palmar hyperhidrosis. Thirty-four female
patients
and 19 male patients ranging in age from 15 to 44 years, (mean 23.1
years)
were studied. Both sides were operated during the same surgical
procedure.
The T2-T3 ganglia were resected by electrocuting with a hook and were
removed
for histologic examination. Follow-up for a mean of 19.25 months was
obtained
on 52 patients (104 operated limbs). RESULTS: All limbs were completely
dry
at the end of the procedure, and hyperhidrosis did not recur during the
whole
follow-up period. Short-term postoperative complications (mainly
atelectasis,
pneumonia, pneumothorax, and hemothorax) occurred in six (11.3%)
patients.
Long-term sequelae were observed in 43 (81.1%) patients and included
Horner's
syndrome (9 patients, 17.3%, one side only in each patient), neuralgia
(7
patients, 13.5%), and compensatory hyperhidrosis (35 patients, 67.3%). These
sequelae
were not permanent in all cases, and the degree of severity was
variable.
Six (11.5%) patients, three of whom regretted being operated, were
dissatisfied
with their results: one because of Horner's syndrome, one because
of
persisting neuralgia, and four because of compensatory sweating. CONCLUSIONS:
Despite
the large number of postoperative long-term sequelae, 88.5% of patients
expressed
subjective satisfaction from the procedure. Obtaining 100% of dry
hands
on mid-term follow-up makes this approach rewarding.
PMID:
8752028 [PubMed - indexed for MEDLINE]
215:
Surg Laparosc Endosc 1996
Aug;6(4):258-61
Experience
in thoracoscopic sympathectomy for hyperhidrosis with concomitant
pleural
adhesion.
Lin
CC, Mo LR.
Department
of Surgery, Tainan Municipal Hospital, Taiwan.
Thoracoscopic
(transthoracic endoscopic) sympathectomy, known worldwide as the
best
method for treatment of hyperhidrosis, is regarded as having two major
contraindications:
pleural adhesion and coagulopathy. We embarked on this study
to
prove that it is possible and highly feasible to do thoracoscopic
sympathectomy,
even in the presence of severe pleural adhesion, as long as the
surgeon
knows anatomy and is well-trained in performing this procedure. From
October
1, 1989, through December 31, 1992, we treated 719 cases of
hyperhidrosis
palmaris (325 male and 394 female patients), by the thoracoscopic
method
at Tainan Municipal Hospital. Among them, 24 cases (3.5%), 19 male and 5
female
patients, had concomitant pleural adhesions. The causes of pleural
adhesion
were pulmonary tuberculosis, chronic bronchitis, previous operations
for
hyperhidrosis, and a few with uncertain origins. Except for the first
encountered
case of hyperhidrosis with pleural adhesion, which was treated by
mini-thoracotomy
after failure of a thoracoscopic approach through the right
thoracic
cavity, the remainder of the 23 cases were treated successfully by the
thoracoscopic
method. In cases with bilateral pleural adhesions, the right
thoracic
cavity was more frequently involved and more severely. The incidence of
pleural
adhesion in hyperhidrosis is 3.5% in our series; all, except the first
case,
were treated thoracoscopically. Coagulopathy is for us, therefore, the
only
remaining contraindication of thoracoscopic sympathectomy.
PMID:
8840445 [PubMed - indexed for MEDLINE]
216:
J Auton Nerv Syst 1996 Jul
5;59(3):98-102
Contralateral
temperature changes of the finger surface during video endoscopic
sympathectomy
for palmar hyperhidrosis.
Wu
JJ, Hsu CC, Liao SY, Liu JC, Shih CJ.
Department
of Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan, ROC.
One
hundred and eight consecutive patients with primary palmar hyperhidrosis
were
surgically managed by coagulation of bilateral T2 sympathetic ganglia using
video
thoracoscopic techniques. Patients were divided into two groups. In the
first
group (N = 46), finger surface temperature of the ipsilateral index finger
was
recorded before and after T2 ganglionectomy. The average increase of
post-operative
temperature was 2.74 +/- 0.27 degrees C (mean +/- SE) on the
right
side and 2.67 +/- 0.33 degrees C on the left (P < 0.05). The significant
rise
of temperature resulting from sympatholytic vasodilatation was only noted
in
cases of exact ablation of the T2 ganglion. In the second group (N = 62),
surface
temperatures of both index fingers were monitored and recorded
simultaneously.
These patients were arbitrarily subdivided into Group 2-A (N =
29)
when right side ganglionectomy was performed first and Group 2-B (N = 33)
when
left side ganglionectomy was done initially. After the first ganglionectomy
was
completed, an ipsilateral increase with a contralateral decrease of
temperature
was observed; the average increase of temperature was 1.92 +/- 0.35
degrees
C and 2.19 +/- 0.30 degrees C, and the average decrease was 1.50 +/-
0.51
degrees C and 1.67 +/- 0.39 degrees C for Group 2-A and 2-B respectively (P
<
0.05). The authors postulate that a cross-inhibitory effect by the
post-ganglionic
neurons innervating blood vessels of the upper extremities may
exists
in humans and this effect is released after ganglionectomy, resulting in
contralateral
vasoconstriction and decrease of finger surface temperature.
PMID:
8832515 [PubMed - indexed for MEDLINE]
217:
Surg Endosc 1996 Jul;10(7):721-3
Advantages
of limited thoracoscopic sympathectomy.
Bonjer
HJ, Hamming JF, du Bois NAJJ, van Urk H.
Department
of Surgery, University Hospital Dijkzigt, Dr. Molewaterplein 40, 3015
GD
Rotterdam, The Netherlands.
BACKGROUND:
Thoracoscopic resection of the first through the fourth thoracic
sympathetic
ganglion for palmary and axillary hyperhidrosis and Raynaud's
syndrome
is associated with a high initial success rate. However, the reported
incidence
of compensatory hyperhidrosis of the trunk and legs and Horner's
syndrome
are high. This study assesses the results of thoracoscopic
sympathectomy
limited to transection of the interganglionic trunk or resection
of
one or two thoracic ganglia. METHODS: Twenty-eight thoracoscopic
sympathectomies
were done for dystrophy of the hand (n = 9), palmar and axillary
hyperhidrosis
(n = 6), and Raynaud's syndrome (n = 4). The extent of
sympathectomy
varied from interganglionic division between the second and third
ganglion
(n = 12), to resection of the third ganglion (n = 12), to resection of
the
second and third ganglion (n = 4). RESULTS: Sympathectomy resulted initially
in
relief of symptoms in all cases. Horner's syndrome did not occur.
CONCLUSIONS:
After a median follow-up of 11 months, two of nine patients with
dystrophy
judged the result of operation as good. All patients with
hyperhidrosis
and Raynaud's syndrome judged the result of sympathectomy as good.
Compensatory
hyperhidrosis was experienced by two patients with dystrophy of the
hand
who had removal of the second and third sympathetic ganglion.
PMID:
8662426 [PubMed - indexed for MEDLINE]
218:
J Laparoendosc Surg 1996 Jun;6(3):151-9
A
simplified T2-T3 thoracoscopic sympathicolysis technique for the treatment of
essential
hyperhidrosis: short-term results in 100 patients.
Noppen
M, Herregodts P, D'Haese J, D'Haens J, Vincken W.
Respiratory
Department, Academic Hospital A.Z.-V.U.B., Free University of
Brussels,
Belgium.
A
simplified one-time bilateral thoracoscopic T2-T3 sympathicolysis technique
using
single-lumen endotracheal intubation with high frequency jet ventilation
and
electrocautery destruction ("sympathicolysis") of the sympathetic
ganglia
was
applied in 100 consecutive patients with severe essential hyperhidrosis
(EH).
Providing a pleural space can be created, this technique was proven simple
and
safe, and short-term clinical results were excellent: palmar hyperhidrosis
was
cured in 98% of patients, and axillar and plantar improvement was achieved
in
62 and 65% of patients, respectively. Side-effects and complications were
minor
(compensatory hyperhidrosis) or self-limiting (pain). These data confirm
the
safety and efficacy of thoracoscopic sympathetic interventions for the
treatment
of EH, and support the evolution toward simplified methodologies.
PMID:
8807515 [PubMed - indexed for MEDLINE]
219:
J R Coll Surg Edinb 1996
Jun;41(3):160-3
Comment
in:
J R Coll Surg Edinb. 1997 Aug;42(4):287-8.
Assessment
of outcome after thoracoscopic sympathectomy for hyperhidrosis in a
specialized
unit.
Graham
AN, Owens WA, McGuigan JA.
Regional
Thoracic Surgery Department, Royal Victoria Hospital, Belfast UK.
Transthoracic
endoscopic electrocautery of the sympathetic chain is increasingly
being
used as a technique for producing the effects of upper thoracic
sympathectomy.
In November 1990 we introduced this operation as a regional
service
in Northern Ireland and have assessed the results in patients with
idiopathic
hyperhidrosis of the palms and axillae. There were 92 sympathectomics
carried
out for hyperhidrosis on 47 patients between 26 November 1990 and 6
September
1993. Full follow-up was possible in 45 patients (96%) at a median of
13
months (range 3-36) after the operation. Symptoms were improved in 43
patients
(96%) at review. In three patients surgery failed to control symptoms
on
one side, and in two there was bilateral recurrence at 4 and 8 months after
initial
good results. Compensatory hyperhidrosis occurred in 35 patients (56%)
and
was severe in 4 (9%). Nine of 34 patients (34%) with plantar symptoms
reported
improvement in these post-operatively. This paper, with its high level
of
full follow-up, confirms thoracoscopic sympathectomy to be effective
treatment
for both palmar and axillary hyperhidrosis. Patient selection,
however,
is important and the risk of compensatory hyperhidrosis must be fully
explained.
PMID:
8763178 [PubMed - indexed for MEDLINE]
220:
Muscle Nerve 1996 May;19(5):581-6
Abolition
of sympathetic skin responses following endoscopic thoracic
sympathectomy.
Lefaucheur
JP, Fitoussi M, Becquemin JP.
Department
of Physiology, Henri Mondor Hospital, Creteil, France.
The
recording of sympathetic skin responses (SSRs) is a simple,
electrophysiological
method to assess sympathetic nerve function. Within the
last
10 years, SSRs have mainly been applied to delineate peripheral and central
nervous
system diseases, although the sympathetic nature of these responses was
not
fully documented, e.g., by a study of sympathectomy. We therefore recorded
SSRs
before and after 30 cases of endoscopic thoracic sympathectomy. The main
indication
was palmar hyperhidrosis, in which we found two types of SSR
abnormalities.
Most patients exhibited normal SSR waveforms but with increased
amplitudes.
The other patients exhibited abnormal SSRs which did not occur as
single
responses but as several consecutive waves. Thoracic sympathectomy always
led
to significant clinical improvement and to the abolition of ipsilateral
palmar
SSRs, demonstrating the sympathetic origin of these responses. We suggest
that
the assessment of sympathetic nerve activity by SSR recordings may be
useful
in sympathectomy.
PMID:
8618555 [PubMed - indexed for MEDLINE]
221:
Arch Surg 1996 Apr;131(4):355-9
Technical
considerations in endoscopic cervicothoracic sympathectomy.
Josephs
LG, Menzoian JO.
Section
of Vascular Surgery, Center of Minimal Access Surgery, Department of
General
Surgery, Boston University School of Medicine, Mass, USA.
OBJECTIVE:
To evaluate the technique and results of videoendoscopic
cervicothoracic
sympathectomy in patients who have reflex sympathetic dystrophy
or
hyperhidrosis of the upper extremity. DESIGN: Clinical case series. The
cohort
underwent diagnostic evaluation and surgical intervention, and had a mean
postoperative
follow-up of 14 months. SETTING: An urban, university-affiliated
tertiary
referral medical center. PATIENTS: A consecutive, referred sample.
Seven
of the nine patients had reflex sympathetic dystrophy and two had
bilateral
upper extremity hyperhidrosis. Five were women and four were men, with
a
mean age of 44 years. INTERVENTIONS: Ten thoracoscopic sympathectomies,
encompassing
the lower third of the stellate ganglion to the fourth thoracic
ganglion,
in nine patients. The technique is performed under general anesthesia,
using
three 1-cm incisions for instrument placement. Patients had bilateral hand
temperature
probes intraoperatively. Six of the procedures were in the left
hemithorax,
four in the right. MAIN OUTCOME MEASURES: Relief of the symptoms for
which
the patient was referred. Perfection and alteration of the technique also
were
measured. RESULTS: The average operating time was 91 minutes. The average
length
of hospital stay was 3.5 days. The mean increase in skin temperature was
2.4
degrees C. Nine of 10 patients had partial or complete relief of symptoms.
One
patient with severe dystrophic reflex sympathetic dystrophy has persistent
symptoms.
One patient had a pneumothorax for 48 hours. Horner's syndrome did not
develop
in any patient. CONCLUSION: Endoscopic cervicothoracic sympathectomy is
an
effective, minimally invasive therapy for upper extremity reflex sympathetic
dystrophy
and hyperhidrosis.
PMID:
8615718 [PubMed - indexed for MEDLINE]
222:
Neurosurgery 1996 Apr;38(4):715-25
Comment
in:
Neurosurgery. 1997 Jan;40(1):216-7.
Percutaneous
radiofrequency upper thoracic sympathectomy.
Wilkinson
HA.
Division
of Neurological Surgery, University of Massachusetts Medical School,
Worchester,
USA.
Between
June 1979 and May 1994, I performed 148 unilateral or bilateral
sympathectomies
on 247 limbs in 110 patients using a percutaneous radiofrequency
technique,
usually on an outpatient surgery basis. Patient ages ranged from 10
to
81 years, with 45 male and 65 female patients. Four patients had
unsuccessfully
undergone prior open surgical sympathectomy. Patients suffered
from
hyperhidrosis, vascular occlusion, Raynaud's disease or other chronic
vasculopathies,
painful causalgia or reflex sympathetic dystrophy, or
Prinzmetal's
angina. The sympathectomy technique has evolved over this 15-year
period
and is currently in its third phase. Changes in the procedure were based
on
anatomic and clinical/radiographic correlations and careful patient
follow-up.
Current modifications have reduced the frequency of both early and
late
failures. The present technique (Phase III) relies on neuroleptanalgesia
with
superficial local anesthesia only and does not require general anesthesia,
intubation,
or lung collapse. Two 18-gauge radiofrequency TIC needle electrodes
(Radionics,
Burlington, MA) are used. A series of three lesions is
rostrocaudally
made at each of the ganglion sites selected in an attempt to
destroy
the entire fusiform ganglion. Lesion sites are targeted by C-arm
fluoroscopy
and electrical stimulation, which produces a threshold of sensory
awareness
of > 1.0 V. Lesion effectiveness is monitored by bilateral finger
plethysmography
and hand skin temperature measurement. With the Phase III
technique,
the sympathetic activity in 96% of operated limbs after 2 years and
in
91% of operated limbs after 3 years continues to be completely or largely
interrupted.
By comparison, I achieved similar success in 83 and 72% operated
limbs
with the Phase I technique and in 77 and 71% with the Phase II technique.
Symptomatic
pneumothorax, in six patients, has been the only serious
complication.
When necessary, a subsequent operation can easily be performed and
is
effective.
PMID:
8692390 [PubMed - indexed for MEDLINE]
223:
Acta Anaesthesiol Sin 1996
Mar;34(1):21-5
Interpleural
bupivacaine for pain relief after transthoracic endoscopic
sympathectomy
for primary hyperhidrosis.
Lieou
FJ, Lee SC, Ho ST, Wang JJ.
Division
of Anesthesiology, 804 Army General Hospital, Taipei, Taiwan, R.O.C.
BACKGROUND:
Interpleural local anesthetic has been reported to provide good
postoperative
pain relief in patients receiving thoracotomy or upper abdominal
surgery.
However, there were few reports regarding interpleural local anesthetic
for
postoperative pain relief in patients receiving transthoracic endoscopic
sympathectomy
for palmar hyperhidrosis. The aim of the present study was to
evaluate
the effect of interpleural bupivacaine for postoperative pain relief in
patients
receiving transthoracic endoscopic sympathectomy for palmar
hyperhidrosis.
METHODS: Sixty adult patients undergoing bilateral transthoracic
endoscopic
sympathectomy were randomly divided into two groups (n = 30, each
group)
for study. At the end of surgery, patients in group 1 were given
bilaterally
an injection of 0.5% interpleural bupivacaine (10 ml) through the
surgical
endoscope, whereas those in the group 2 who were not given any
treatment
at the juncture served as control. Postoperatively, intravenous
morphine
2.5 mg was given luxuriously to the patients at their request at
intervals
of 30 min. The intensity of postoperative pain was assessed at rest
and
during cough with visual analogue scale (VAS, 0-10 points). RESULTS: It was
showed
that at rest the pain scores were less in group 1 than in group 2 within
4 h
postoperatively. During cough, group 1 also had less VAS scores than group 2
within
5 h postoperatively. Furthermore, patients in group 1 consumed less
intravenous
morphine than those in group 2 within 6 h postoperatively.
CONCLUSIONS:
Interpleural bupivacaine significantly decreased the intensity of
postoperative
pain and morphine consumption in patients undergoing transthoracic
endoscopic
sympathectomy for palmar hyperhidrosis. We are looking forward to
seeing
that with the addition of epinephrine to the anesthetic solution and a
considerable
increase of dosage and/or volume of bupivacaine may provide a
better
and longer pain relief, about which further studies are needed.
Publication
Types:
Clinical
Trial
Randomized
Controlled Trial
PMID:
9084515 [PubMed - indexed for MEDLINE]
224:
J Neurosurg 1996 Mar;84(3):484-6
Video
endoscopic sympathectomy for palmar hyperhidrosis.
Lee
KH, Hwang PY.
Department
of Neurosurgery, Tan Tock Seng Hospital, Singapore.
Palmar
hyperhidrosis has been treated using a variety of medical and surgical
techniques
with varying degrees of success. The authors report their experience
in
82 patients in whom they performed 164 sympathectomies using a video
endoscope,
a laparoscopic grasper, and microscissors. Patients were monitored by
palm
temperature electrodes. An intraoperative histological confirmation of the
sympathetic
chain and a temperature rise of at least 1 degree C after the
procedure
resulted in complete relief of the hyperhidrosis. All the patients
were
relieved of their symptoms, and 41 experienced decreased plantar
hyperhidrosis
as well. Compensatory hyperhidrosis in 50 patients was the only
significant
side effect, which improved 6 months after the surgery. Video
endoscopic
thoracic sympathectomy is a safe, easy, reliable, and cost-effective
way
to treat palmar hyperhidrosis.
Publication
Types:
Clinical
Trial
PMID:
8609562 [PubMed - indexed for MEDLINE]
225:
J Vasc Surg 1996 Mar;23(3):539-40
Disadvanyages
of previous phenol blocks in thoracoscopic upper dorsal
sympathectomy.
Kopelman
D, Hashmonai M.
Publication
Types:
Letter
PMID:
8601903 [PubMed - indexed for MEDLINE]
226:
S Afr J Surg 1996 Feb;34(1):11-4, 16;
discussion 16, 18
Endoscopic
transthoracoscopic sympathectomy--the Durban experience.
Singh
B, Haffejee AA, Moodley J, Naidu AG, Rajaruthnam P.
Department
of Surgery, University of Natal, Durban.
Advances
in optics, illumination and video-technology together with refinements
in
operative technique have made endoscopic transthoracoscopic sympathectomy
(ETS)
the method of choice for upper thoracic sympathectomy. Palmar
hyperhidrosis
is by far the main indication for ETS. The procedure is
technically
easy and well tolerated by patients, and complications are few and
minor.
PMID:
8629183 [PubMed - indexed for MEDLINE]
227:
Acta Clin Belg 1996;51(4):244-53
Thoracoscopic
sympathicolysis for essential hyperhidrosis: immediate and one
year
follow-up results in 35 patients and review of the literature.
Noppen
M, Vincken W, Dhaese J, Herregodts P, D'haens J.
Respiratory
Division, Academic Hospital AZ-VUB, Vrije Universiteit Brussel,
Belgium.
Various
treatments for essential hyperhidrosis are available. The aim of this
study
is to present our experience with a simplified thoracoscopic
sympathicolysis
technique in this disorder, and to confront our results with
data
in the literature, 35 consecutive patients (11 male, 24 female, age 12-44
years)
with essential hyperhidrosis, refractory to "conventional" medical
treatment
presenting between August 1993 and May 1994 were studied. Bilateral
D2-D3
sympathicolysis was performed using a simplified one-time bilateral
thoracoscopic
procedure under general anaesthesia. Clinical scores,
complications
and side effects were recorded one week, one month and one year
after
the intervention. Severe hyperhidrosis was present in the hands in 100%,
axillae
in 66% and soles of the feet in 86% of patients. In one patient, only a
unilateral
intervention was possible due to pleural adhesions. In the other 34
patients,
palmar hyperhidrosis was completely and permanently relieved in 100%
of
cases. Axillar hyperhidrosis was significantly improved after one year in 91%
of
patients, 52% of which showed a complete disappearance of hyperhidrosis. Side
effects
and complications were minimal. There were no permanent pleural,
neurological
(Horner) or other sequellae. Patient satisfaction was invariably
very
high. These findings compare favourably with historical data in the
literature.
Publication
Types:
Review
Review,
Tutorial
PMID:
8858890 [PubMed - indexed for MEDLINE]
228:
Eur J Cardiothorac Surg
1996;10(3):168-72
Endoscopic
versus transaxillary thoracic sympathectomy for primary axillary and
palmar
hyperhidrosis and/or facial blushing: 5-year-experience.
Yilmaz
EN, Dur AH, Cuesta MA, Rauwerda JA.
Department
of Vascular Surgery, Free University Hospital, Amsterdam, The
Netherlands.
Thoracic
sympathectomy is effective in the permanent cure of primary axillary
and
palmar hyperhidrosis and facial blushing, which can be so troublesome for
patients
that their social and professional relations can be affected. Between
October
1988 and April 1994, a total of 50 thoracic sympathectomies (10 surgical
and
40 endoscopic) were performed on 5 and 23 patients, respectively. The
operations
were performed unilaterally, followed by the contralateral
intervention
after a period of 6-8 weeks. The thoracic ganglia T2-T5 were
resected
for hyperhidrosis. If the patient suffered from blushing, the lower 1/3
of
the stellate ganglion was also resected. Postoperatively, all the operated
limbs
were warm and dry. In the group of patients who were operated bilaterally,
only
one had persistent facial blushing. The efficacy for blushing in this
series
was therefore 93.3%. The late relapse rate of sympathetic activity was
14.3%.
Compensatory sweating was seen in 67%, gustatory sweating in 37.5% and
phantom
sweating in 29% of the patients. None of them considered these side
effects
to be troublesome. Although there is no difference between transaxillary
thoracic
sympathectomy and the endoscopic intervention in terms of efficacy, the
latter
is associated with less postoperative pain, shorter hospital stay and a
rapid
recovery. The thoracic sympathectomy is the treatment of choice for
primary
hyperhidrosis and excessive facial blushing.
PMID:
8664016 [PubMed - indexed for MEDLINE]
229:
Khirurgiia (Mosk) 1996;(1):63-5
[Thoracoscopic
sympathectomy in the surgical treatment of axillary and palmar
hyperhidrosis]
[Article
in Russian]
Anikin
V, Graham A, MacGuigan D.
47
patients with axillary palmar hyperhydrosis underwent this surgery. There
were
36 women (76.6%) and 11 men (23.4%) among them. The sympathetic trunk has
been
coagulated on the level between 2d and 4th ribs on both sides. There were
no
surgical mortality in this group. Nine patients (9.1%) had a pneumothorax,
one
patient (2.1%) had a subcutaneous emphysema, the other one had pneumonia and
one
had wound pyosis. In 43 cases the result of the surgery was very good. In 2
cases
bilateral relapse and in 2 cases marked compensatory hyperhydrosis were
resistered.
PMID:
8683926 [PubMed - indexed for MEDLINE]
230:
Somatosens Mot Res 1996;13(2):147-52
Sympathectomy
does not influence experimental itch and cutaneous temperature
perception
thresholds.
Ekblom
A, Lind G, Meyerson BA, Lengstam I, Wahlgren CF.
Department
of Anaesthesiology and Intensive Care, Karolinska Hospital,
Stockholm,
Sweden.
The
effect of endoscopic thoracic sympathectomy on experimentally
histamine-induced
itch was studied in seven patients, all of whom were suffering
from
palmar hyperhidrosis; cutaneous warm, cold, and heat pain perception
thresholds
were also studied in five of these seven patients. Surgery was
effective
in abolishing palmar sweating in all patients. No significant
differences
were seen in itch, flare, wheal, or thermal perception thresholds
following
sympathectomy as compared to the preoperative period. These findings
suggest
that the sympathetic system may be of limited importance for
somatosensory
perception in healthy humans during normal conditions.
PMID:
8844963 [PubMed - indexed for MEDLINE]
231:
Arch Surg 1995 Nov;130(11):1244
Comment
on:
Arch Surg. 1994 Jun;129(6):630-3.
Transthoracic
endoscopic sympathectomy in the treatment of palmar hyperhidrosis.
Kao
MC.
Publication
Types:
Comment
Letter
PMID:
7487471 [PubMed - indexed for MEDLINE]
232:
Lakartidningen 1995 Oct 4;92(40):3661
Comment
on:
Lakartidningen. 1995 May 31;92(22):2310-2
[Misleading
information about patients with palmar sweating]
[Article
in Swedish]
Koskinen
LO, Algers G.
Publication
Types:
Comment
Letter
PMID:
7564608 [PubMed - indexed for MEDLINE]
233:
Ann Clin Biochem 1995 Sep;32 ( Pt
5):509-10
Hyperhidrosis
and iron deficiency.
Labib
M, Obeid D.
Department
of Clinical Biochemistry, Russells Hall Hospital, Dudley, West
Midlands,
UK.
PMID:
8830629 [PubMed - indexed for MEDLINE]
234:
Muscle Nerve 1995 Aug;18(8):917-9
Abnormal
sympathetic skin response in patients with palmar hyperhidrosis.
Lin
TK, Chee EC, Chen HJ, Cheng MH.
Department
of Neurology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
PMID:
7630357 [PubMed - indexed for MEDLINE]
235:
J Am Acad Dermatol 1995 Jul;33(1):78-81
Endoscopic
transthoracic sympathectomy: an efficient and safe method for the
treatment
of hyperhidrosis.
Drott
C, Gothberg G, Claes G.
Department
of Surgery, Boras Hospital, Sweden.
BACKGROUND:
Hyperhidrosis of the palms, axillae, and face has a strong negative
impact
on the quality of life for many persons. Existing nonsurgical therapeutic
options
are far from ideal. Definitive cure can be obtained by upper thoracic
sympathectomy.
The traditional open surgical technique is a major procedure; few
patients
and doctors have found that risk-benefit considerations favor surgery.
Endoscopic
minimal invasive surgical techniques are now available. OBJECTIVE: We
investigated
whether endoscopic ablation of the upper thoracic sympathetic chain
is
efficient and safe in the treatment of hyperhidrosis. METHODS: We treated 850
patients
with bilateral endoscopic transthoracic sympathectomy. RESULTS: There
was
no mortality or life-threatening complication. Nine patients (1%) required
intercostal
drainage because of hemothorax or pneumothorax. Treatment failure
occurred
in 18 cases (2%) and symptoms recurred in 17 patients (2%). At the end
of
follow-up (median, 31 months) 98% of the patients reported satisfactory
results.
CONCLUSION: Endoscopic transthoracic sympathectomy is an efficient,
safe,
and minimally invasive surgical method for the treatment of palmar,
axillary,
and facial hyperhidrosis.
Publication
Types:
Clinical
Trial
PMID:
7601951 [PubMed - indexed for MEDLINE]
236:
Acta Anaesthesiol Sin 1995
Jun;33(2):73-7
Intravenous
tenoxicam reduces dose and side effects of PCA morphine in patients
after
thoracic endoscopic sympathectomy.
Liaw
WJ, Day YJ, Wang JJ, Ho ST.
Department
of Anesthesiology, Tri-Service General Hospital, Taipei, Taiwan,
R.O.C.
BACKGROUND:
Among surgical modalities for treatment of palmar hyperhidrosis,
endoscopic
sympathectomy is the most popular choice in recent years. After
surgery,
the major complaint was anterior chest pain. This study was conducted
to
evaluate the analgesic efficacy and side effects of tenoxicam (a
thienothiazine
derivative) in combination with patient-controlled analgesia
(PCA)
using morphine in patients who received thoracic endoscopic sympathectomy.
METHODS:
Forty-one ASA class I patients who underwent endoscopic sympathectomy
(T2
and T3 ganglia) were randomly divided into two groups. Operation was
conducted
under general anesthesia with single lumen endotracheal intubation. No
narcotic
was given during the operation except for fentanyl (3 micrograms/kg)
during
induction. After surgery, patients in group I received PCA morphine only
and
patients in group II received PCA morphine plus tenoxicam (20 mg, i.v.)
immediately
for pain relief. In addition, rescue analgesia with intramuscular
meperidine
(1 mg/kg) was available to each patient every 4 h prn. The intensity
of
pain was assessed with VAS pain score every 4 h for 24 h. The frequency of
demand
and doses of delivered PCA morphine were recorded. RESULTS: Results
showed
no statistically significant difference between groups in respect of age,
body
height, body weight and pain scores. However, based upon similar
qualitative
pain relief, patients in group II revealed less demand for
analgesic,
less doses of morphine requirement and less side effects.
CONCLUSIONS:
Tenoxicam may be an effective adjuvant to PCA morphine for
postoperative
pain control. This combination reduces the total consumption of
PCA
morphine with less side effects.
Publication
Types:
Clinical
Trial
Randomized
Controlled Trial
PMID:
7663867 [PubMed - indexed for MEDLINE]
237:
Acta Anaesthesiol Sin 1995
Jun;33(2):113-8
[Changes
of arterial oxygen tension in supine position during one-lung
anesthesia]
[Article
in Chinese]
Day
YB, Lee CG, Tseng CC, Chiang MH, Chang CL.
Department
of Anesthesiology, Navy General Hospital, Tainan, Taiwan, R.O.C.
BACKGROUND:
One-lung ventilation during anesthesia (one-lung anesthesia) in
patients
under lateral decubitus position to help performing intra-thoracic
surgical
procedures was well known to have larger alveolar-to-arterial oxygen
tension
difference and lower arterial oxygen tension (PaO2) as compared to
two-lung
ventilation. In the present study, we investigate the changes of
arterial
oxygen tension in the supine position during one-lung anesthesia.
METHODS:
Forty-two patients of palmar hyperhidrosis, ASA class I-II, scheduled
to
receive bilateral transthoracic endoscopic sympathectomy were studied. After
anesthetic
induction (fentanyl, thiopental, and succinylcholine), a 35 (for
female)
or 37 (for male) French left-sided Robertshaw double-lumen endobronchial
tube
was intubated. Anesthesia was maintained with isoflurane 1.0-1.5% and 50%
O2-N2O.
They were changed to isoflurane 1.5-2.0% and 100% O2 during one-lung
ventilation.
Once the surgical operation is completed, they were changed to 100%
O2
and two-lung ventilation. Arterial blood gases were measured at 4 phases: 5
min
after endobronchial intubation (two-lung ventilation), 5 min after left
one-lung
ventilation, 5 min after right one-lung ventilation, and 5 min after
accomplishing
operation (two-lung ventilation). RESULTS: The results showed PaO2
were
significantly lower in left and right one-lung ventilation with 100% O2 as
compared
with that obtained from two-lung ventilation with 50% O2 5 min after
endobronchial
intubation (p < 0.05). Furthermore, right one-lung ventilation had
a
lower PaO2 than left one-lung ventilation (p < 0.05). CONCLUSIONS: We
conclude
that
arterial oxygen tension can be safely maintained during one-lung anesthesia
with
pure oxygen in healthy patients lying in a supine position.
PMID:
7663862 [PubMed - indexed for MEDLINE]
238:
Lakartidningen 1995 May 31;92(22):2310-2
Comment
in:
Lakartidningen. 1995 Oct 4;92(4):3661
[Hand
perspiration was his death. The cause was sympathetic imbalance]
[Article
in Swedish]
Hedman
A.
Medicinska
kliniken, Ludvika lasarett.
PMID:
7783492 [PubMed - indexed for MEDLINE]
239:
Clin Exp Dermatol 1995 May;20(3):230-3
Recurrence
of hyperhidrosis after endoscopic transthoracic sympathectomy--case
report
and review of the literature.
Orteu
CH, McGregor JM, Almeyda JR, Rustin MH.
Dermatology
Department, Royal Free Hospital, London, UK.
Publication
Types:
Review
Review
of Reported Cases
PMID:
7671419 [PubMed - indexed for MEDLINE]
240:
J Auton Nerv Syst 1995 Apr
8;52(2-3):117-24
Mechanisms
of physiological gustatory sweating and flushing in the face.
Drummond
PD.
Division
of Psychology, Murdoch University, Perth, Western Australia.
Mechanisms
of physiological gustatory sweating and flushing were investigated in
21
patients with a facial nerve lesion compromising parasympathetic outflow to
the
lacrimal gland, and in 13 patients undergoing diagnostic blockade of the
stellate
ganglion. Vascular responses and electrodermal activity (which reflects
sweating)
were monitored on each side of the forehead before and during
gustatory
stimulation with chillies or Tabasco sauce (derived from chillies).
Vascular
responses in the cheeks were also monitored in 14 patients with a
facial
nerve lesion. Sympathetic blockade increased gustatory vasodilatation but
prevented
gustatory sweating on the blocked side of the forehead. A facial nerve
lesion
did not affect gustatory sweating in the forehead or vasodilatation in
the
cheeks. However, a facial nerve lesion impaired vasodilatation in the
forehead
in all six patients who ate chillies, and also in four of five patients
whose
blood vessels dilated extensively on the normally-innervated side of the
forehead
when the patients tasted Tabasco sauce. These findings suggest that
sympathetic
sudomotor activity mediates physiological gustatory sweating in the
forehead,
whereas sympathetic vasoconstrictor tone inhibits gustatory
vasodilatation
in the forehead. A parasympathetic vasodilator reflex in the
facial
nerve contributes actively to gustatory flushing in the forehead, but
some
other unidentified mechanism influences vascular responses in the cheeks.
Publication
Types:
Clinical
Trial
PMID:
7615894 [PubMed - indexed for MEDLINE]
241:
J Chir (Paris) 1995 Apr;132(4):222-3
[Palmar
hyperhidrosis and arteritis of the finger: value of sympathectomy and
videothoracoscopy]
[Article
in French]
Mouroux
J, Bernard JL, Hassen Kodja R, Batt M, Lebas P, Richelme H.
Publication
Types:
Letter
PMID:
7635902 [PubMed - indexed for MEDLINE]
242:
Lancet 1995 Mar 25;345(8952):803-4
Comment
on:
Lancet. 1995 Jan 14;345(8942):97-8.
Thoracoscopic
sympathicotomy.
Noppen
M, Dendale P, Hagers Y.
Publication
Types:
Comment
Letter
PMID:
7891518 [PubMed - indexed for MEDLINE]
243:
Acta Anaesthesiol Sin 1995
Mar;33(1):21-6
Use
of a single lumen endotracheal tube and continuous CO2 insufflation in
transthoracic
endoscopic sympathectomy.
Wong
RY, Fung ST, Jawan B, Chen HJ, Lee JH.
Department
of Anesthesiology, Chang-Gung Memorial Hospital, Taiwan, R.O.C.
BACKGROUND:
Transthoracic endoscopic sympathectomy (TES) is an accepted standard
surgical
treatment for palmar hyperhidrosis. For anesthetic management, a double
lumen
endobronchial tube is usually used to deflate the lung on the operative
side.
Recently we have applied continuous insufflation of carbon dioxide (CO2)
into
the pleural cavity to merely compress one lung while ventilating both lungs
with
a conventional single lumen endotracheal tube. METHODS: We have studied 45
patients
(ASA I and II) who underwent bilateral TES, Thirty-three were
ventilated
by single lumen tube and the other 12 by double lumen endobronchial
tube
with one lung ventilation. In both groups I and II, CO2 was insufflated
slowly
through the scope to a intrapleural pressure of 20 cm H2O. Both lungs
were
ventilated with peak pressure of less than 20 cmH2O at tidal volume of 5-12
ml/kg
at 10-16 beats/min. RESULTS: In these patients, no CO2 retention was
noted.
Oxygenation and cardiovascular stability were maintained and there were
no
complications. In the double lumen series, we found that oxygen saturation
was
less uniform and less stable than those in the single lumen series.
CONCLUSIONS:
It is concluded that the use of single lumen endotracheal tube with
continuous
insufflation of CO2 in TES is easy, simple and safe.
PMID:
7788194 [PubMed - indexed for MEDLINE]
244:
J Pediatr Surg 1995 Mar;30(3):471-3
Thoracoscopic
upper thoracic sympathectomy for primary palmar hyperhidrosis in
children
and adolescents.
Cohen
Z, Shinar D, Levi I, Mares AJ.
Department
of Pediatric Surgery, Soroka Medical Center, Faculty of Health
Sciences,
Ben-Gurion University of the Negev, Beer-Sheva, Israel.
After
20 years of experience with the "open" transaxillary approach, the
authors
are
presently performing the thoracoscopic technique for upper thoracic
sympathectomy
in severe primary hyperhidrosis. During a period of 14 months, 23
operations
were performed and 22 patients had immediate and permanent relief of
palmar
sweating. The immediate postoperative course was uneventful in all cases.
Hospitalization
was short, and all patients returned to school and full activity
3
to 5 days after operation. These initial results compare favorably to the
"open"
method and, pending further experience, are actually better in terms of
less
pain, early discharge, quicker return to normal activity, and a smaller,
less
conspicuous scar.
PMID:
7760245 [PubMed - indexed for MEDLINE]
245:
Br J Anaesth 1995 Feb;74(2):141-4
Tracheal
anaesthesia for transthoracic endoscopic sympathectomy: an alternative
to
endobronchial anaesthesia.
Olsfanger
D, Jedeikin R, Fredman B, Shachor D.
Department
of Anaesthesia and Intensive Care, Meir Hospital, Kfar Saba, Israel.
When
using endobronchial anaesthesia for the management of transthoracic
endoscopic
sympathectomy (TES), excessive insufflation of carbon dioxide into
the
pleural space may cause haemodynamic instability, hypoxaemia and tension
pneumothorax.
We prospectively studied an alternative technique using a tracheal
tube,
i.v. fentanyl, propofol, atracurium and nitrous oxide in 82 consecutive
healthy
patients (31 male, 51 female; mean age 26.48 (range 14-50) yr, weight
61.26
(33-100)kg.) They were suffering from severe palmar hyperhidrosis and they
underwent
bilateral TES (mean duration of operation 34.57 (15-90) min). After
being
placed in a 30-40 degree head-up position, three patients required
ephedrine
to treat arterial hypotension. A capnograph was used to confirm
correct
placement of the Verres needle in the pleural space. In two groups of 13
patients
undergoing ventilation with an FlO2 of either 0.3 or 0.4, during
partial
collapse of the operative lung, PaO2 and the PaO2:FlO2 ratio decreased
significantly
(P < 0.001). TES was unsuccessful in three patients because of
pleural
adhesions. After operation five patients required chest drains; two for
haemothorax
and three for pneumothorax. Seventy-seven patients without
complications
were discharged from hospital within 24 h.
Publication
Types:
Clinical
Trial
Controlled
Clinical Trial
PMID:
7696060 [PubMed - indexed for MEDLINE]
246:
J Am Coll Surg 1995 Feb;180(2):253-4
Comment
on:
J Am Coll Surg. 1994 Jul;179(1):59-64.
Video-assisted
thoracoscopic T2 sympathectomy for hyperhidrosis palmaris.
Kopelman
D, Assalia A, Hashmonai M.
Publication
Types:
Comment
Letter
PMID:
7850067 [PubMed - indexed for MEDLINE]
247:
Ann Chir 1995;49(9):858-62
[Upper
thoracic sympathectomy by thoracoscopic approach. A method of choice for
the
treatment of palmar hyperhidrosis]
[Article
in French]
Levy
I, Ariche A, Sebbag G, Khodda J.
Service
de Chirurgie A, Chirurgie Generale et Vasculaire, Centre
Hospitalo-Universitaire
Soroka, Universite Ben-Gourion du Neguev, Beer Sheva,
Israel.
Palmar
hyperhidrosis is excessive sweating beyond physiological needs in the
palm
without recognized etiology. Although a benign disease, it is annoying to
most
patients. Currently the best treatment for this condition is upper thoracic
sympathectomy
via many different approaches. The video-thoracoscopic approach
has
been recommended a a minimally invasive procedure. We report our 1-year
experience
with transaxillary endoscopic sympathectomy in 99 patients with
palmar
hyperhidrosis. Standard video-laparoscopy was used via a transaxillary
approach
to perform sympathectomy. The mean operating time of this operation was
12
minutes and mean hospital stay was 32 hours. The results in terms of warm and
dry
hands were excellent. Only one case of transitory Horner syndrome was noted.
Transaxillary
thoracoscopic sympathectomy for palmar hyperhidrosis is a
relatively
simple and effective procedure which can be performed with standard
laparoscopic
instruments. The advantages are, short recovery time and hospital
stay
along with excellent functional and cosmetic results. We are convinced that
thoracoscopic
sympathectomy is the procedure of choice for the treatment of
palmar
hyperhidrosis.
Publication
Types:
Review
Review
Literature
PMID:
8554286 [PubMed - indexed for MEDLINE]
248:
Ann R Coll Surg Engl 1995 Jan;77(1):70
Comment
on:
Ann R Coll Surg Engl. 1994 Sep;76(5):311-4.
Endoscopic
transthoracic sympathectomy: successful in hyperhidrosis but can the
indications
be extended?
Cameron
A.
Publication
Types:
Comment
Letter
PMID:
7772180 [PubMed - indexed for MEDLINE]
249:
Arch Phys Med Rehabil 1995
Jan;76(1):104-7
Gustatory
facial sweating subsequent to upper thoracic sympathectomy.
Nesathurai
S, Harvey DT, Schatz SW.
Department
of Physical Medicine and Rehabilitation, McMaster University,
Hamilton,
Ontario, Canada.
Gustatory
facial sweating has been described as a consequence of upper thoracic
sympathectomy.
Patients may also develop compensatory hyperhidrosis, sensory
deficits,
nipple hypersensitivity, and Horner's syndrome. In this article, we
have
reviewed three patients with reflex sympathetic dystrophy who developed
gustatory
facial sweating subsequent to endoscopic T2 and T3 ganglionectomy.
This
article also discusses the possible mechanisms of gustatory facial
sweating.
PMID:
7811168 [PubMed - indexed for MEDLINE]
250:
Stereotact Funct Neurosurg
1995;64(4):214-20
Recordings
of pre- and postoperative sympathetic skin response in patients with
palmar
hyperhidrosis.
Chen
HJ, Cheng MH, Lin TK, Chee EC.
Department
of Neurosurgery, Chang Gung Medical College, Taiwan, R.O.C.
Transthoracic
endoscopic sympathectomy is an accepted standard surgical
treatment
for hyperhidrosis palmaris. During the past 4 years, more than 500
patients
underwent this kind of surgical treatment at our institution with a 98%
success
rate. About 50% of cases were found to have compensatory sweating. We
measured
the sympathetic skin response (SSR) and R-R interval variation (RRIV)
in
38 normal control subjects, and 50 consecutive patients with palmar
hyperhidrosis
before and 2 weeks after transthoracic endoscopic T2-3
sympathectomy.
Before sympathectomy SSR was absent in 36% of patients on deep
inspiratory
stimulation and in 20% on electrical stimulation. After T2-3
sympathectomy,
SSR in the palms was absent in 64% of patients with deep
inspiration
stimulation and in 76% on electrical stimulation. A decrease in the
SSR
amplitude in the soles was found in 40% on deep inspiration and in 54% of
patients
on electrical stimulation. RRIV was not significantly influenced 2
weeks
after sympathectomy. The high abnormal rate of SSR in the patient group
indicated
that an abnormal regulation of the sudomotor control center played an
important
role in palmar hyperhidrosis.
PMID:
8817808 [PubMed - indexed for MEDLINE]
251:
Otolaryngol Head Neck Surg 1994
Dec;111(6):838-40
Nasal
obstruction and Horner's syndrome.
Shaari
CM, Scherl MP.
Department
of Otolaryngology, Mount Sinai School of Medicine, City University of
New
York, NY 10029-6574.
Publication
Types:
Review
Review
of Reported Cases
PMID:
7991269 [PubMed - indexed for MEDLINE]
252:
Acta Physiol Scand 1994 Nov;152(3):259-63
Is
palmar and plantar sweating thermoregulatory?
Kerassidis
S.
Department
of Basic Sciences, School of Health Science, University of Crete,
Greece.
We
tested the hypothesis that palmar and plantar sweating has a thermoregulatory
role
and is mediated by the same thermoregulatory mechanisms that control
sweating
in the rest of the body surface. In a series of empirical tests
involving
34 participants (five of whom exhibited palmar hyperhydrosis), the
effect
of high environmental temperature on sweating was examined. Wilcott's
finding,
that effects at the palm are of considerable magnitude, was confirmed
only
in subjects who were in a state of excitement. In relaxed subjects, the
effects
of high environmental temperature on palmar and plantar sweating was
negligible.
We conclude that the palms and soles do not directly participate in
thermoregulation.
PMID:
7872003 [PubMed - indexed for MEDLINE]
253:
J Vasc Surg 1994 Oct;20(4):511-7;
discussion 517-9
Thoracoscopic
cervicodorsal sympathectomy: preliminary results.
Ahn
SS, Machleder HI, Concepcion B, Moore WS.
UCLA
Center for the Health Sciences.
PURPOSE:
The purpose of this study was to determine the feasibility, safety, and
efficacy
of thoracoscopic cervicodorsal sympathectomy. METHODS: From March 1990
to
December 1993, we performed 21 thoracoscopic sympathectomies in 19 patients.
There
were 13 women and six men; age 17 to 64 years, mean 37 years. Thirteen
procedures
were performed on the left side and eight on the right. Indications
for
surgery were causalgia/reflex sympathetic dystrophy in nine patients,
Raynaud's/vasculitis
in six, hyperhidrosis in five, and medically refractory
cardiac
arrhythmia in one. RESULTS: The T1-4 sympathetic ganglia were readily
identified,
dissected free, and resected thoracoscopically in 19 cases, and the
T3-7
ganglia were resected with thoracoscopy in one case. One case required
conversion
to an open thoracotomy because of dense scar from a previous first
rib
resection, which obscured the anatomy. Histologic confirmation of ganglia
were
obtained in all 21 cases. Operative duration ranged from 1.0 to 3.5 hours.
Estimated
blood loss was 5 to 300 cc, mean 42 cc, median 10 cc. No patient
required
transfusion. All 21 patients had an excellent immediate sympathectomy
response.
Transient Horner's syndrome developed in two patients. Postoperative
residual
pneumothorax (< 10%) occurred in three cases and resolved spontaneously
without
further treatment. In one patient pleural effusion and pneumothorax
developed,
which were treated with the reinsertion of the chest tube.
Postoperative
pain was well controlled with oral analgesics. Hospital stay was 1
to
4 days, mean 2 days, median 1 day. Follow-up at 1 to 42 months, mean 11
months,
median 6 months, showed continued evidence of sympathectomy effect in
all
patients, except one who died of her underlying disease 1 month after
operation.
CONCLUSIONS: We conclude that thoracoscopic sympathectomy is
feasible,
safe, and effective. Further studies are indicated to confirm its
long-term
benefits and to determine optimal thoracoscopic techniques.
Publication
Types:
Clinical
Trial
PMID:
7933252 [PubMed - indexed for MEDLINE]
254:
Singapore Med J 1994 Oct;35(5):460-3
Video-assisted
endoscopic thoracic sympathectomy in the management of
intractable
palmar hyperhydrosis.
Thomas
J, Pillay P, Mack P, Ooi LL, Nachiappan M.
Department
of Neurosurgery, Singapore General Hospital.
Minimally
invasive endoscopic surgical techniques have revolutionised patient
management.
We present our findings in our first 10 cases of bilateral
video-assisted
endoscopic thoracic sympathectomy in the management of
intractable
palmar hyperhydrosis including the first such procedure in
Singapore.
We have found the procedure to have minimal morbidity, good patient
acceptance
and all patients have remained with dry palms.
PMID:
7701362 [PubMed - indexed for MEDLINE]
255:
Ann R Coll Surg Engl 1994
Sep;76(5):311-4
Comment
in:
Ann R Coll Surg Engl. 1995 Jan;77(1):70.
Endoscopic
transthoracic sympathectomy: successful in hyperhidrosis but can the
indications
be extended?
Nicholson
ML, Dennis MJ, Hopkinson BR.
Department
of Surgery, University Hospital Nottingham.
Endoscopic
transthoracic sympathectomy (ETS) has recently become established as
a
successful treatment for severe palmar and axillary hyperhidrosis. In this
unit
the indications for ETS have been broadened to include patients with
Raynaud's
syndrome and critical upper limb ischaemia and this paper is primarily
concerned
with analysing outcome in relation to the indication for operation. In
all,
68 operations have been attempted in 40 patients and complete follow-up
details
are available on 62 treated limbs. One operation was a technical failure
because
of an obliterated pleural cavity. In the hyperhidrosis group (n = 28),
all
the affected areas showed symptomatic improvement at a median follow-up of
17
months. In the Raynaud's group (n = 30), 28 limbs (93%) were improved to some
degree
at the time of discharge, but at a median follow-up of 18 months only 15
limbs
(50%) remained symtomatically improved to some degree. The four upper
limbs
treated for critical ischaemia were improved by ETS and no amputations
were
necessary. Significant postoperative chest pain was noted by nine patients
(23%).
There were three postoperative pneumothoraces, two intercostobrachial
neuralgias
and one transient Horner's syndrome. The cosmetic result was reported
as
excellent or good by 97% of patients. As with other forms of surgical
thoracic
sympathectomy, excellent early results are not maintained in the longer
term
when ETS is used to treat Raynaud's syndrome. Nevertheless, the greater
simplicity
and lower morbidity of the endoscopic method suggest that it can be
offered
to Raynaud's sufferers with greater impunity than open sympathectomies.
PMID:
7979070 [PubMed - indexed for MEDLINE]
256:
Eur J Vasc Surg 1994 Sep;8(5):627-31
Comment
in:
Eur J Vasc Surg. 1995 Oct;10(3):384-5
Transthoracic
endoscopic sympathectomy for hyperhidrosis and Raynaud's
phenomenon.
Sayers
RD, Jenner RE, Barrie WW.
Department
of Surgery, Leicester General Hospital, U.K.
Over
an 80 month period, 53 transthoracic endoscopic sympathectomies were
performed
in 34 patients. The indications for surgery were palmar hyperhidrosis
in
20 procedures (38%), palmar and axillary hyperhidrosis in eight procedures
(15%),
Raynaud's phenomenon in 23 procedures (43%), and combined palmar
hyperhidrosis
and Raynaud's phenomenon in two procedures (4%). Follow-up data,
obtained
by a self-assessment postal questionnaire, was available for 47
procedures
in 30 patients (91%). Fourteen out of 15 procedures (93%) performed
for
palmar hyperhidrosis, all eight procedures (100%) for palmar and axillary
hyperhidrosis
and 14 out of 22 procedures (64%) performed for Raynaud's
phenomenon
produced an immediate improvement in symptoms. These improvements
were
sustained in 13 procedures (87%) performed for palmar hyperhidrosis, all
procedures
performed for palmar and axillary hyperhidrosis (100%) but only 10
procedures
(45%) performed for Raynaud's phenomenon at a median follow-up of 16,
34
and 44.5 months respectively. There were no deaths nor postoperative Horner's
syndrome
in these patients. The only minor complications were two small
pneumothoraces.
Compensatory sweating was observed after 24 procedures (51%).
These
results confirm that transthoracic endoscopic sympathectomy is a simple,
safe
and effective procedure. In patients with hyperhidrosis, the results are
excellent
and prolonged; in patients with Raynaud's phenomenon, immediate
improvement
can be achieved but the symptoms may return with time.
PMID:
7813733 [PubMed - indexed for MEDLINE]
257:
Chirurg 1994 Aug;65(8):677-9
[Thoracoscopic
sympathicotomy]
[Article
in German]
Flora
G.
Abteilung
fur Gefasschirurgie, I. Universitatsklinik fur Chirurgie Innsbruck.
Surgical
endoscopic endothoracic denervation (severing the n. vagus and the
sympathetic
trunk with the nn. splanchnici) was developed by Kux at Innsbruck
University
Surgical Clinic in the 1950's and applied in thousands of patients
with
a very wide range of indications. The thoracoscopic sympathicotomy has
remained,
in the hands of the experienced surgeon, a minor intervention with low
complication
rate and no mortality. For functional and organic angiopathies as
well
as for hyperhidrosis of the upper extremities it provides very good early
and
satisfactory late results.
PMID:
7956532 [PubMed - indexed for MEDLINE]
258:
J Dermatol 1994 Aug;21(8):575-81
Sympathetic
ganglion blockade for the management of hyperhidrosis.
Kobayashi
K, Omote K, Homma E, Abe T, Iitoyo M.
Department
of Dermatology, Sapporo Hospital of Hokkaido Railway Company, Japan.
We
present three patients with severe primary hyperhidrosis, refractory to
conservative
medical treatment, who were successfully managed with sympathetic
ganglion
blockade with ethanol. We also summarize 10 patients with hyperhidrosis
who
underwent sympathetic ganglion blockade in the past 2 years. This closed
percutaneous
method offers the patients considerably less discomfort and less
stress
with minimal morbidity and has a efficacy similar to that of surgical
sympathectomy,
which has previously been the only effective and permanent
therapy
for severe primary hyperhidrosis. It is concluded that chemical
sympathectomy
is an effective and useful method for treating severe
hyperhidrosis
which has advantages over surgical sympathectomy.
PMID:
7962955 [PubMed - indexed for MEDLINE]
259:
Neurosurgery 1994 Aug;35(2):330-2;
discussion 332
Chylothorax
after endoscopic sympathectomy: case report.
Cheng
WC, Chang CN, Lin TK.
Department
of Surgery, Chang Gung Medical College, Taiwan, Republic of China.
Endoscopic
sympathectomy is a new trend for the treatment of hyperhidrosis
palmaris.
It is a simple and effective technique; however, it carries some
recognized
risks such as Horner's syndrome and pneumohemothorax. We recently
encountered
a case complicated by the development of a chylothorax. The patient
was
a 23-year-old healthy women with profuse palmar sweating. She developed an
intractable
dry cough after a transthoracic endoscopic sympathectomy. A chest
x-ray
revealed a left pleural effusion. A chylous effusion was found after
thoracentesis
and fluid analysis. The pleural effusion resolved after chest tube
drainage
and diet control. Although endoscopic sympathectomy is a simple and
quick
procedure, unusual complications, such as chylothorax, may occur.
Appropriate
early recognition and treatment can prevent a disastrous result.
PMID:
7969846 [PubMed - indexed for MEDLINE]
260:
J Am Coll Surg 1994 Jul;179(1):59-64
Comment
in:
J Am Coll Surg. 1995 Feb;180(2):253-4.
Video-assisted
thoracoscopic T2 sympathectomy for hyperhidrosis palmaris.
Hsu
CP, Chen CY, Lin CT, Wang JH, Chen CL, Wang PY.
Department
of Surgery, Taichung Veterans General Hospital, Taiwan, Republic of
China.
BACKGROUND:
Hyperhidrosis palmaris is a functionally and socially disabling
problem.
Thoracic sympathectomy of the T2 ganglion has proved to be the
time-honored
treatment modality. STUDY DESIGN: The results of this study
demonstrate
the effectiveness of video-assisted thoracoscope for treatment of
hyperhidrosis
palmaris. The possibility to apply different anesthetic techniques
and
to measure surface temperature change of the hand were documented as well.
RESULTS:
Eighty consecutive cases (159 procedures) of essential hyperhidrosis
palmaris
were treated by video-assisted thoracoscopic T2 sympathectomy between
January
1991 and December 1992. The surgical results were classified as
excellent
(much improved, very dry) in 88.1 percent, good (improved, minimal
wet)
in 9.4 percent, and fair (slightly improved, still wet) in 2.5 percent of
the
patients. The postoperative complications included one prolonged air
leakage,
one hemothorax, two wound infections, and 15 cases of facial
anhidrosis.
There were no recurrent cases (mean follow-up, 14.5 months).
Fifty-six
patients had concomitant hyperhidrosis pedum. Interestingly enough,
through
unknown mechanism, 64.3 percent of the patients with concomitant
hyperhidrosis
pedum were cured after this procedure. CONCLUSIONS: Video-assisted
thoracoscopy
provides magnified surgical fields, which make thoracoscopic
sympathectomy
for hyperhidrosis palmaris an effective, safe, easy to use, and
time-saving
procedure. This technique is also excellent for teaching purposes
and
allows the assistant to participate in the operation.
PMID:
8019726 [PubMed - indexed for MEDLINE]
261:
Arch Surg 1994 Jun;129(6):630-3
Comment
in:
Arch Surg. 1995 Nov;130(11):1244.
Transthoracic
endoscopic sympathectomy in the treatment of palmar hyperhidrosis.
Chen
HJ, Shih DY, Fung ST.
Department
of Surgery, Chang Gung Medical College, Kaohsiung, Taiwan, Republic
of
China.
OBJECTIVE:
Transthoracic endoscopic electrocauterization of the sympathetic
chain
for palmar hyperhidrosis is presented. DESIGN: A retrospective study of
180
patients during a 2-year period was carried out. The duration of follow-up
was
from 2 to 12 months. SETTING: General community, referral center, and
hospitalized
care. PATIENTS: This study was carried out in 180 patients (116
female
and 64 male). The age distribution was between 13 and 43 years (mean age,
21.6
years). They complained of palmar hyperhidrosis without other underlying
diseases.
INTERVENTIONS: One-stage bilateral surgery except for three patients
with
unilateral pleural adhesions. MAIN OUTCOME MEASURES: Patients were
interviewed
1 week after surgery and then they were contacted by a questionnaire
about
improvement of hyperhidrosis and complications. RESULTS: This procedure
shows
a success rate in 98% of the patients. No pneumothorax requiring a chest
tube
drainage and no Horner's syndrome were recorded. The most common side
effect
was compensatory sweating in 70% of these patients. CONCLUSION: This
procedure
is effective, simple, and requires only an overnight study. It is
recommended
as the method of choice for surgical treatment of upper extremity
hyperhidrosis.
PMID:
8204038 [PubMed - indexed for MEDLINE]
262:
J Clin Laser Med Surg 1994 Apr;12(2):93-5
Craniofacial
hyperhidrosis treated with video endoscopic sympathectomy.
Kao
MC, Chen YL, Lee YS, Hung CC, Huang SJ.
Department
of Surgery, Laser Medicine Research Center, National Taiwan
University
Taipei, R.O.C.
Craniofacial
hyperhidrosis as well as palmar hyperhidrosis is an abnormal state
of
local excessive sweating of unclear etiology.
The hyperhidrosis may be
isolated
in the craniofacial region or associated with palmar hyperhidrosis.
The
patient's face is so wet with sweat that their daily activities are often
seriously
disturbed. To the best of our
knowledge, there has been no
satisfactory
medical therapy, nor any effective surgical treatment reported in
the
literature. In 1991, we started to
treat a patient with such distress using
endoscopic
ablation of the sympathetic T2 segment, because we mastered the
technique
after treating a large series of palmar hyperhidrosis patients.
Furthermore,
we were impressed by concomitant reduction of craniofacial sweating
after
T2-3 sympathectomy resulting from the relatively different domination of
sympathetic
supply between the eye and face. It
appears possible to relieve
excessive
sweating of the head and face, without producing ptosis or miosis by
ablation
of the T2 segment. During the past 2
years, 7 patients with severe
craniofacial
hyperhidrosis have been successfully treated with the method and
all
obtained a satisfactory result. No
complete Horner's syndrome has been
produced
except in one patient, who showed a mild and transient left eye ptosis,
in
whom coagulation of the sympathetic trunk higher than the T2 segment was
performed.
Intraoperative monitoring of forehead skin perfusion and observation
of
the change of pupillary size is emphasized during the lesion making. The
longest
postoperative follow-up was 2 years, with a mean follow-up of 12.4
months.(ABSTRACT
TRUNCATED AT 250 WORDS)
PMID:
10147184 [PubMed - indexed for MEDLINE]
263:
Oral Surg Oral Med Oral Pathol 1994
Apr;77(4):317
Submandibular
gustatory sweating.
Haddock
A, Porter SR, Scully C, Smith I.
Publication
Types:
Letter
PMID:
8015791 [PubMed - indexed for MEDLINE]
264:
Dtsch Med Wochenschr 1994 Mar
4;119(9):321-2
[Hyperhidrosis]
[Article
in German]
Nachbar
F, Blecher P, Ruzicka T.
Dermatologische
Klinik und Poliklinik, Universitat, Munchen.
PMID:
8119114 [PubMed - indexed for MEDLINE]
265:
Acta Anaesthesiol Sin 1994
Mar;32(1):1-6
[Alternative
one lung ventilation anesthesia for bilateral thoracoscopic
sympathectomy]
[Article
in Chinese]
Ho
CS, Kao MC.
Department
of Anesthesiology, Taiwan Adventist Hospital.
Palmar
hyperhidrosis (PH) is a common disorder in the oriental subtropical area.
There
have been many therapeutic methods, such as: oral medication, local
treatment
and traditional surgical operation, but none of them has proved
entirely
satisfactory. Since the development of video endoscopic surgery,
transthoracic
endoscopic sympathectomy has been increasing day by day. This
study
consisted of 124 PH patients under alternative one lung ventilation
anesthesia
for bilateral thoracoscopic laser sympathectomy. The age of patients
ranged
from 13 to 64 years, male 45 and female 79. The average anesthesia
duration
was 60 min. We used glycopyrrolate 0.03 mg/kg, decardon 1 mg/10 kg for
premedication.
Induction was with fentanyl 0.07 ml/kg, atracurium 0.6 mg/kg and
thiopental
4 mg/kg. Maintenance was with isoflurane in 3L/min. oxygen
inhalation.
The alternative one lung ventilation anesthesia was achieved with
double-lumen
endobronchial tube. Fr 37, Fr 35, Fr 28 Sheridan Lt. double-lumen
bronchial
tube were used depending upon the sex and fudgement of the individual
patient.
All patients tolerated the procedure well so that sympathectomy could
be
performed smoothly and uneventfully. Immediately after the operation, a
transient
mild to moderate degree of difficult breathing and substernal
discomfort
were experienced in the majority of patients. These suffering often
relieved
spontaneously or with some common analgesic.
PMID:
8199806 [PubMed - indexed for MEDLINE]
266:
Acta Anaesthesiol Sin 1994
Mar;32(1):13-20
[Experience
of anesthesia during transthoracic endoscopic sympathectomy for
palmar
hyperhidrosis: comparison between double-lumen endobronchial tube
ventilation
and laryngeal mask ventilation]
[Article
in Japanese]
Hsieh
YJ, Chen CM, Lin HY, Young TF.
Department
of Anesthesiology, Provincial Taichung General Hospital.
In
the past year we had 36 patients operated for transthoracic endoscopic
sympathectomy
to treat palmar hyperhidrosis. The first group composed of 17
patients
receiving anesthesia with double-lumen endobronchial-tube ventilation
from
July-92 to April-93, and the second group composed of 19 patients receiving
anesthesia
with laryngeal mask ventilation from April-93 to August-93. During
right
lung collapse for sympathectomy, the first group patients' SaO2 (oxygen
saturation)
decreased from 99.65 +/- 0.62 mmHg (pre-operation) to 95.12 +/- 5.48
mmHg
(at cauterization), 95.24 +/- 5.41 mmHg (5 minutes after cauterization) and
resumed
99.53 +/- 0.62 mmHg after the procedure completed. During left lung
collapse
for left side sympathectomy, the same group patients' SaO2 decreased
from
99.59 +/- 0.62 mmHg to 97.35 +/- 3.06 mmHg, 97.82 +/- 2.53 mmHg and resumed
99.65
+/- 0.49 mmHg respectively. The second group using laryngeal mask
ventilation
had SaO2 changes during right side sympathectomy from 99.68 +/- 0.58
mmHg
(pre-cauterization) to 99.74 +/- 0.45 mmHg (when cauterization), 99.79 +/-
0.42
mmHg (5 minutes after cauterization) and resumed 99.84 +/- 0.37 mmHg after
the
procedure completed. During left side sympathectomy the second group
patients'
SaO2 changed from 99.84 +/- 0.39 mmHg to 99.42 +/- 1.50 mmHg, 99.47
+/-
1.46 mmHg and resumed 99.74 +/- 0.59 mmHg respectively. After 2-Way ANOVA
with
repeated measures of the SaO2 value, we could see that no matter what side
operation,
there were differences existed between these two groups (<
0.001).(ABSTRACT
TRUNCATED AT 250 WORDS)
PMID:
8199807 [PubMed - indexed for MEDLINE]
267:
Acta Anaesthesiol Sin 1994
Mar;32(1):57-60
Experience
of anesthesia for transthoracic endoscopic sympathectomy in palmar
hyperhidrosis--110
cases.
Chen
YP, Ting MC, Hwang YS, Chow TC, Lin JC.
Department
of Anesthesiology, Show Chwan Memorial Hospital, Changhua, R.O.C.
Transthoracic
endoscopic sympathectomy (TES) is an effective treatment for
palmar
hyperhidrosis. We review our experience and discuss the anesthetic
technique
and perioperative complications encountered in 110 patients undergoing
TES
for palmar hyperhidrosis. All patients were monitored with EKG, NIBP and
pulse
oximetry (SPO2) during the operation. The trachea was intubated with a
single
lumen endotracheal tube and ventilation was controlled manually. 100%
inspired
oxygen was necessary during TES to avoid hypoxia. One patient developed
sudden
cardiac arrest during electrocauterization of the left sympathetic chain
and
two patients required underwater drainage for hemothorax. Minimal
pneumothorax
was diagnosed in 4 patients and all cases resolved spontaneously
without
active treatment.
Publication
Types:
Review
Review,
Multicase
PMID:
8199812 [PubMed - indexed for MEDLINE]
268:
Acta Anaesthesiol Sin 1994
Mar;32(1):7-12
[Comparison
of double-lumen endobnonchial versus single-lumen endotracheal tube
anesthesia
in bilateral thoracoscopic sympathectomy]
[Article
in Chinese]
Ho
CS, Huang CL.
Department
of Anesthesiology, Taiwan Adventist Hospital, Taipei, R.O.C.
Since
the development of video endoscopic surgery, the number of transthoracic
endoscopic
sympathectomy has been increasing. The use of double-lumen
endobronchial
tube or single-lumen endobronchial tube during anesthesia for
these
surgeries has been a controversial. 385 palmar hyperhidrosis patients
divided
into three groups: group I, under alterative one lung ventilation
anesthesia
with double-lumen endobronchial tube; group II, under alterative one
lung
ventilation anesthesia with single-lumen endobronchial tube; group III,
under
two lung ventilation anesthesia with single-lumen endobronchial tube were
studied.
All had received bilateral thoracoscopic sympathectomy. The age of
patients
ranged from 8 to 64 years old. There were 154 male and 231 female. The
average
anesthesia durations for group I, II and III were 38.56 +/- 10.28, 34.14
+/-
5.21, 31.83 +/- 3.34 min respectively. The variables considered in the study
were:
physique of the patients; duration of anesthesia; airway pressure changes;
SaO2
changes during the operation and post-anesthesia complaints. We found that
upon
using double-lumen endobronchial tube, SaO2 levels was better maintained
especially
in the obese patients and the patients who had received a traditional
surgical
operation before.
PMID:
8199816 [PubMed - indexed for MEDLINE]
269:
Arch Surg 1994 Mar;129(3):241-4
Endoscopic
transthoracic sympathectomy in the treatment of primary
hyperhidrosis.
A review of 290 sympathectomies.
Shachor
D, Jedeikin R, Olsfanger D, Bendahan J, Sivak G, Freund U.
Department
of Surgery, Meir Hospital, Kfar Saba, Israel.
OBJECTIVES:
To describe the surgical technique of endoscopic transthoracic
sympathectomy
for the treatment of palmar hyperhidrosis and to identify
associated
complications. DESIGN: Prospective clinical study. SETTING:
University
referral center. PATIENTS: A consecutive series of 150 patients with
primary
palmar hyperhidrosis. INTERVENTION: The surgical procedure is performed
under
general anesthesia. A trocar and endoscope are inserted into the chest
cavity.
The sympathetic chain and the second, third, and fourth ganglia are then
identified,
cauterized, and cut. After reinflation of the lung, the procedure is
repeated
on the other side. RESULTS: Two hundred ninety sympathectomies were
performed
with a 98% success rate. Complications of the procedure included
pneumothorax
in seven patients (2.4%), hemothorax in three (1.0%), and temporary
Horner's
syndrome in two (0.7%). Severe postoperative pain during the first 2 to
4
hours required treatment. Of 60 patients who were followed up for 12 months,
50%
developed compensatory sweating and 8.3% developed rebound sweating.
Hyperhidrosis
recurred in three patients. CONCLUSION: Endoscopic transthoracic
sympathectomy
is an effective form of treatment for palmar primary
hyperhidrosis,
is associated with a low morbidity, and can be performed as an
ambulatory
procedure.
Publication
Types:
Clinical
Trial
PMID:
8129596 [PubMed - indexed for MEDLINE]
270:
Eur J Vasc Surg 1994 Mar;8(2):129-37
The
role of sympathectomy in current surgical practice.
Gordon
A, Zechmeister K, Collin J.
University
of Oxford, Nuffield Department of Surgery, John Radcliffe Hospital,
U.K.
Historically
sympathectomy has been employed in the treatment of a variety of
disparate
disorders but in most there is little if any objective clinical
evidence
of its efficacy. Review of the literature confirms that sympathectomy
provides
an effective and permanent cure for hyperhidrosis of the hands and
feet,
and at present palmar hyperhidrosis is the major indication for its
regular
use. Sympathetic denervation of the hands is currently most easily
achieved
with minimal morbidity by thoracoscopic ablation of the second thoracic
ganglion.
Some evidence testifies to the efficacy of sympathectomy in the rare
patients
with true major causalgia. Clinical experience suggests that Raynaud's
phenomenon
in the feet can be usefully ameliorated by sympathectomy but in the
hands
any benefit is short lived and there is no effect on the prognosis of the
disease.
A weak case can be made for sympathectomy for ischaemic rest pain when
arterial
surgery is impractical but there is no reliable evidence to support its
use
in Buerger's disease, intermittent claudication, diabetic vascular disease
or
ischaemic ulceration or gangrene.
Publication
Types:
Review
Review,
Tutorial
PMID:
8181604 [PubMed - indexed for MEDLINE]
271:
J Pediatr Surg 1994 Mar;29(3):382-6
Transaxillary
upper thoracic sympathectomy for primary palmar hyperhidrosis in
children
and adolescents.
Mares
AJ, Steiner Z, Cohen Z, Finaly R, Freud E, Mordehai J.
Department
of Pediatric Surgery, Soroka Medical Center, Faculty of Health
Sciences,
Ben-Gurion University of the Negev, Beer-Sheba, Israel.
Primary
palmar hyperhidrosis is part of a triad of palmar, plantar, and axillary
hyperhidrosis
of unknown etiology, affecting children, adolescents, and young
adults.
Sixty-seven children and young adolescents were operated on during a
10-year
period. A total of 103 transaxillary upper thoracic sympathectomies (36
bilateral)
were performed, with no mortality. The immediate postoperative course
was
uneventful in 90%; the other 10% had mostly minor problems. The average
hospitalization
period was 3 to 4 days. Total abolition of palmar sweating was
achieved
in all but two patients in whom some residual moisture remained.
Long-term
extreme satisfaction was reported by 64 of 67 patients (94%). One was
moderately
satisfied, and two were not satisfied because of excessive
"compensatory"
sweating elsewhere. Compensatory sweating of some degree was
reported
by 45% of patients but did not alter satisfaction. By further limiting
ganglionectomy
to just one ganglion (T2 or T3), compensatory sweating possibly
may
be reduced further. Early surgery for severe palmar hyperhidrosis will save
a
child many years of agony and social discomfort because all types of
conservative
therapy are ineffective and cause unnecessary delay. A limited
transaxillary
upper thoracic sympathectomy is presently the authors' preferred
approach,
although ablation via thoracoscopy should not be excluded as further
experience
is gained with this modality.
PMID:
8201503 [PubMed - indexed for MEDLINE]
272:
J Pediatr Surg 1994 Mar;29(3):387-91
Palmar
hyperhidrosis in children: treatment with video endoscopic laser
sympathectomy.
Kao
MC, Lee WY, Yip KM, Hsiao YY, Lee YS, Tsai JC.
Department
of Surgery, College of Medicine, National Taiwan University, Taipei,
Republic
of China.
Palmar
hyperhidrosis (PH) often starts in childhood and can be a disabling
condition
for a significant number of young children at the age they begin
primary
school. There are few reports regarding the surgical treatment of PH in
children.
The authors report on 40 PH patients under 16 years of age treated
with
video thoracoscopic laser sympathectomy; there has been substantial
experience
with this procedure for the treatment of adults with PH. A
satisfactory
result, with very low morbidity, was achieved for all 40 children.
The
surgical technique is described briefly. With the technique, the proper
sympathetic
segment is visualized in almost all cases and then definitely
ablated
with a fiberoptic low-power laser while under the aid of sympathetic
monitoring.
Consequently, an adequate sympathectomy warranting a long-lasting
therapeutic
effect can be achieved without the need of tissue diagnosis. No case
required
conversion to open sympathectomy. Neither injury to the lung nor
bleeding
was encountered. Horner's syndrome did not occur in any case. Bilateral
sympathectomy
was accomplished generally within 30 minutes. All patients were
discharged
after an overnight stay and are doing well with normal activities.
The
most frequent complication was compensatory hyperhidrosis, which was
tolerable
after reassurance. Based on the accumulated experience, it is
justified
to recommend early surgery, with this refined technique, in cases of
severe
PH in children.
PMID:
8201504 [PubMed - indexed for MEDLINE]
273:
Cardiovasc Surg 1994 Feb;2(1):9-15
Sympathectomy:
quo vadis?
Barnes
RW.
Department
of Surgery, University of Arkansas for Medical Sciences, Little Rock.
This
paper reviews the evolution of sympathectomy in the management of vascular
disease,
hyperhidrosis and reflex sympathetic dystrophy over the past 26 years.
The
average general surgery resident has never been exposed to the procedure.
The
author feels that sympathectomy should be part of the armamentarium of
vascular
surgeons. An understanding of physiologic screening tests is necessary
for
the proper selection of patients who may benefit from sympathectomy. There
has
been a progressive decline in the number of publications on sympathectomy
during
this period. While the procedure is less commonly performed for vascular
disease,
sympathectomy remains a useful treatment for uncontrolled hyperhidrosis
and
for reflex sympathetic dystrophy.
Publication
Types:
Review
Review,
Tutorial
PMID:
8049934 [PubMed - indexed for MEDLINE]
274:
Eur J Pediatr Surg 1994 Feb;4(1):3-6
Trans-axillary
transpleural sympathectomy for Palmar hyperhidrosis in
children--a
3 to 7 year follow-up of 9 cases.
Millar
AJ, Steiner Z, Rode H, Cywes S.
Department
of Paediatric Surgery, University of Cape Town, South Africa.
Primary
palmar hyperhidrosis can be a most unpleasant and distressing
affliction.
When normal daily activities, viz. writing, schoolwork, are
interfered
with and other treatments have failed, surgery is indicated. Between
1983-1987
9 children (6 F, 3 M), mean age 10.2 years (range 5-14 years)
underwent
bilateral transaxillary sympathectomy, 4 simultaneous and 5 1-4 weeks
apart.
On 14 sides a standard excision of dorsal ganglia (DG) 2, 3, and 4 was
performed.
The technique of lateral displacement of the sympathetic chain after
transection
distal to DG 4 and division of preganglionic fibres of DG 4, 3 and 2
was
used on 5 sides. In addition to clinical evaluation a pilocarpine
stimulation
test was performed on the palms of the hands before and at follow-up
3-7
years after surgery. 17/18 hands appeared sympathectomised at early
follow-up.
One inadequate result required reoperation. Other complications
included
2 Horner's syndromes--1 transient and 1 mild but permanent; 3 temporary
intercostobrachial
paraesthesias, 2 mild late recurrences of sweating and 2
compensatory
increases in sweating. In 14 palms where sweat volume was measured
before
and 3-7 years after surgery there was a mean decrease in sweat of 84%
(mg),
those sweating the most prior to surgery having the best response. In 2
further
palms insufficient sweat was obtained for testing. All but 1 considered
the
procedure worthwhile. Transaxillary transpleural sympathectomy is a safe,
effective,
and cosmetically acceptable operation to control symptoms of
excessive
palmar sweating.(ABSTRACT TRUNCATED AT 250 WORDS)
PMID:
8199129 [PubMed - indexed for MEDLINE]
275:
Neurosurgery 1994 Feb;34(2):262-8;
discussion 268
Comment
in:
Neurosurgery. 2001 Mar;48(3):702.
Autonomic
activities in hyperhidrosis patients before, during, and after
endoscopic
laser sympathectomy.
Kao
MC, Tsai JC, Lai DM, Hsiao YY, Lee YS, Chiu MJ.
Department
of Surgery, National Taiwan University, Taipei, Republic of China.
Three
hundred palmar hyperhidrosis (PH) patients have been treated with video
endoscopic
laser sympathectomy during the last 2 years. Monitoring the palmar
skin
perfusion (PSP) and palmar skin temperature (PST) has been used
intraoperatively
to aid the confirmation of the correct sympathetic segment for
laser
ablation. The preoperative and postoperative PSP and PST and sympathetic
skin
response (SSR) also have been measured to evaluate the therapeutic effect
of
this method. An apparent increase of PSP would occur intraoperatively after
the
interruption of the T2 sympathetic segment, and then a gradual elevation of
PST
would follow after the extirpation of the segment. A rise of PST of about 3
degrees
C after laser ablation of the appropriate segment indicated sufficient
denervation
of the hand and predicted long-lasting relief of PH. Furthermore,
both
PSP and PST also significantly increased after the operation. The
postoperative
elevation of the PST (usually about 3 degrees C) is similar to
that
recorded during intraoperative monitoring. The amplitude and the latency of
SSR
in the palm and sole were recorded both before and after sympathectomy. A
remarkable
decrease of palmar SSR amplitude and its ratio was found
postoperatively
by comparing it with that of plantar SSR in the same patient.
These
autonomic activity changes have correlated well with the postoperative
satisfaction
of the patients. Based on our study, the anatomic identification
confirmed
by the sympathetic monitorings has proved essential to achieve a
definite
and adequate sympathectomy leading to a satisfactory resolution of PH
without
the need of a tissue diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)
PMID:
8177387 [PubMed - indexed for MEDLINE]
276:
Lancet 1994 Jan 29;343(8892):247-8
Hyperhidrosis.
Claes
G, Drott C.
Department
of Surgery, Boras Hospital, Sweden.
PMID:
7905089 [PubMed - indexed for MEDLINE]
277:
Ann Acad Med Singapore 1994
Jan;23(1):38-42
Video
thoracoscopic laser sympathectomy for palmar hyperhidrosis.
Kao
MC, Chern SH, Cheng LC, Hsiao YY, Lee YS, Tsai JC.
Department
of Surgery, College of Medicine, National Taiwan University, Taipei,
ROC.
Palmar
hyperhidrosis (PH) is common in Orientals from subtropical areas. Many
therapeutic
modalities are used in practice, but none has proved to be entirely
satisfactory.
We have developed a new therapeutic technique by combining a video
thoracoscopic
system with a surgical laser unit (both waveguide CO2 laser and
fibre-optic
Nd:YAG laser). The operation was performed under general anaesthesia
with
alternative one-lung ventilation. With this technique, we are able to
identify
the sympathetic trunk on the TV screen and confirm its proper level
with
accurate ablation by intraoperative vasomotor monitoring. Consequently, an
adequate
sympathectomy can be definitely achieved through laser extirpation. We
have
successfully treated 300 PH patients with this technique from 1990 to 1992.
The
ages ranged from six to 63 years with a mean of 26.6. There were 125 males
and
175 females. Most patients underwent en bloc ablation of the T2 segment
which
includes a major part of the T2 ganglion with its adjacent trunk which
overlays
the T2 rib head. All of them obtained a satisfactory relief of PH
except
13 patients. The procedure did not result in a change of vital signs.
There
was neither obvious injury to lung nor bleeding. No Horner's syndrome was
produced.
The commonest complication was compensatory hyperhidrosis in various
degrees
encountered in about half of the cases. Two-thirds of the patients were
followed
up for more than 12 months and only three had recurrence. Based on our
experience,
the technique is considered to be a minor and safe procedure and
able
to achieve a definite and long-lasting therapeutic effect. It causes
minimal
discomfort and scarring. Particularly, the operation time and hospital
stay
were markedly shortened in comparison with other conventional open
sympathectomy
procedures.
PMID:
8185269 [PubMed - indexed for MEDLINE]
278:
Eur J Surg Suppl 1994;(572):51-3
Thoracoscopic
sympathicotomy for hyperhidrosis--surgical technique,
complications
and side effects.
Gothberg
G, Drott C, Claes G.
Department
of Pediatric Surgery, East Hospital Goteborg, Sweden.
Thoracic
sympathectomy is a very effective treatment of palmar hyperhidrosis.
The
described endoscopic technique has given good primary results in 99% of
patients.
After another session with this type of "minimal invasive surgery"
100%
of the hands were satisfactorily dry. The hospital stay is just one
post-operative
day and the sick-leave is about a week. The drawbacks are
minimal.
Pain is tolerable and only eight patients needed a post-operative
Bulau-drainage
because of pneumothorax or bleeding. About 50% of patients
experience
a compensatory increased sweating of the trunk, but this is related
to
a warm environment and regulation of body temperature and seems to decrease
with
time. This technique makes it possible to treat all those suffering from
palmar
hyperhidrosis which can be a substantial, but underestimated handicap. To
meet
this kind of patient after a successful operation is extremely satisfying
even
for the surgeon. The post-operative wet and cold hand has immediately
post-operatively
become warm and dry.
PMID:
7524785 [PubMed - indexed for MEDLINE]
279:
Eur J Surg Suppl 1994;(572):5-7
The
history of cervicothoracic sympathectomy.
Drott
C.
Department
of Surgery, Boras Hospital, Sweden.
As
early as in 1889 surgery on the cervical sympathetic nervous system was
performed.
During the following decades this operation was tried for a variety
of
diseases. In the early 1920s it was clarified that patients with
hyperhidrosis,
vasospastic conditions, and angina pectoris would benefit from
stellectomy.
It was, however, soon discovered that removal of the upper thoracic
ganglia
was required in order to obtain complete sympathetic denervation of the
upper
extremity. Several open surgical techniques for upper thoracic
sympathectomy
were described. During the 1940s a few pioneers started to excise
sympathetic
ganglia by thoracoscopy which had originally been described as a
diagnostic
tool by Jacobaeus in 1910. The endoscopic approach, amply documented
by
Kux in 1954, did not, however, gain widespread popularity until the 1980s.
Like
the general upsurge of interest in endoscopic surgery, thoracoscopic
ablation
of the upper thoracic sympathetic ganglia is now rapidly being adopted
by
surgeons.
Publication
Types:
Historical
Article
PMID:
7524784 [PubMed - indexed for MEDLINE]
280:
Eur J Surg Suppl 1994;(572):43-5
Intraoperative
cardiac arrest: a rare complication of T2,3-sympathicotomy for
treatment
of hyperhidrosis palmaris. Two case reports.
Lin
CC, Mo LR, Hwang MH.
Surgical
Department, Tainan Municipal Hospital, Taiwan.
Endoscopic
surgery, including thoracoscopic sympathicotomy for treatment of
hyperhidrosis,
is thought to be safe and entail fewer complications as compared
with
open methods. A total of more than 719 patients with hyperhidrosis have
undergone
thoracoscopic T2,3-sympathicotomy for treatment of hyperhidrosis at
Tainan
Municipal Hospital since October 1, 1989. Most of the complications have
been
minor; however, two of the patients suffered from sudden cardiac arrest at
the
time when the left T2,3-sympathetic nerve trunk was transected by the
thoracoscopic
method. Vigorous cardiopulmonary resuscitation was performed and
both
patients recovered completely without any sequelae. The purpose of this
paper
was to discuss the possible mechanism of cardiac arrest in thoracoscopic
sympathicotomy,
and to emphasise this rare but potentially fatal complication in
the
treatment of hyperhidrosis palmaris.
PMID:
7524782 [PubMed - indexed for MEDLINE]
281:
Eur J Surg Suppl 1994;(572):65-70
Cardiac
effects of endoscopic electrocautery of the upper thoracic sympathetic
chain.
Drott
C, Claes G, Gothberg G, Paszkowski P.
Department
of Surgery, Boraas Hospital, Sweden.
Bilateral
endoscopic electrocautery of the upper thoracic sympathetic ganglia
(T2-4)
was performed, mainly for palmar hyperhidrosis, on 535 patients. The aim
of
this study was to evaluate the effects of this procedure on cardiac and
physical
performance. A subgroup of 18 patients underwent cycle ergometer test
with
ECG recordings before and three months after surgery. After the operation,
a
significantly reduced heart rate at rest (12%) as well as during exercise and
during
recovery after exercise was found. The systolic blood pressure was
reduced
only at rest (7%) and the diastolic blood pressure was not significantly
altered.
Maximal workload was not affected by the operation and only a few
patients
had noticed their reduced heart rate. Three patients with angina
pectoris
and three with incapacitating tachycardia related to mental stress were
operated
on with excellent results. Thoracoscopic sympathicotomy is a safe,
fast,
cheap and efficient method for cardiac sympathetic denervation. This
procedure
might constitute an alternative to long-term thoracic epidural
anaesthesia
and implantation of thoracic electric stimulation devices in
patients
not suited for aortocoronary by-pass. Patients who require cardiac
beta-receptor
blockers and suffer from side effects of these drugs might also
benefit
from surgical cardiac sympathetic denervation.
PMID:
7524789 [PubMed - indexed for MEDLINE]
282:
Eur J Surg Suppl 1994;(572):27-31
Single-lumen
endotracheal intubated anaesthesia for thoracoscopic
sympathectomy--experience
of 719 cases.
Lee
LS, Ng SM, Lin CC.
Department
of Anaesthesia, Tainan Municipal Hospital, Taiwan, Republic of China.
A
total of 719 thoracoscopic sympathicotomies were performed at our hospital
from
October, 1989 to December, 1992. We have been practicing single-lumen
endotracheal
intubation for general anaesthesia in all of our cases. We will
review
our experience and discuss our anaesthetic technique and the
intraoperative
complications encountered as well as post-operative pain control.
General
anaesthesia with controlled manual ventilation assisted the surgeon well
and
created clear access for electro-cauterisation of the sympathetic chain.
Thirty
patients were randomly chosen for arterial blood gas analysis. There was
no
evidence of systemic hypoxaemia or clinically significant carbon dioxide
retention
throughout the surgery or afterwards in the recovery room. In our
experience
of 719 cases, single-lumen endotracheal intubated anaesthesia is safe
and
economic for thoracoscopic sympathicotomy.
PMID:
7524778 [PubMed - indexed for MEDLINE]
283:
Eur J Surg Suppl 1994;(572):23-5
Intraoperative
anaesthetic management of hypoxaemia during transthoracic
endoscopic
sympathectomy.
Jedeikin
R, Olsfanger D, Shachor D.
Department
of Anaesthesia and Intensive Care, Sackler School of Medicine,
University
of Tel Aviv, Meir Hospital, Kfar Saba, Israel.
OBJECTIVE:
To present our experience and evaluate intraoperative arterial oxygen
desaturation
during anaesthesia for transthoracic endoscopic sympathectomy
(TES).
DESIGN: Prospective open study. SETTING: University Hospital in Israel.
SUBJECTS:
Consecutive series of patients (n = 210), suffering from upper limb
hyperhidrosis,
anaesthetised for TES. MAIN OUTCOME MEASURES: Peripheral oxygen
saturation
(SpO2), haemodynamic status, complications, postoperative pain (n =
210)
and arterial blood gases (n = 10). RESULTS: 407 TES; 195 bilateral, 17
unilateral.
Surgical time range 20-75 minutes. SpO2 decreased below 98% in 58
patients.
Sudden hypotension and bradycardia in two patients. The mean PaO2 was
significantly
(p = 0.03) decreased during two-lung ventilation (TLV), after
reinflation
of the right lung, compared with TLV after endobronchial intubation.
There
was no significant difference in mean PaO2 during one-lung ventilation of
both
lungs. Lowest PaO2 observed during one-lung ventilation was less than 13.3
kPa
in three sympathectomies. Postoperative pain, severe on awakening and mainly
retrosternal,
was relieved with i.v. opiates. CONCLUSION: Controlled ventilation
with
100% inspired O2, SpO2 monitoring and one to two gentle manual ventilations
when
it decreases is the cornerstone of the management of hypoxaemia, a
potentially
serious complication of TES.
PMID:
7524777 [PubMed - indexed for MEDLINE]
284:
Eur J Surg Suppl 1994;(572):21
Thoracoscopic
surgery of palmar hyperhidrosis.
Svartholm
E, Asking B.
Department
of Surgery, Regional Hospital Ryhov, Jonkoping, Sweden.
New
thoracoscopic methods have been reported to minimise the operative trauma
after
surgical treatment of primary hyperhidrosis of the palms. We therefore
began
with this minimally invasive technique for sympathetic ablation in 1990.
Our
first 81 patients presented here confirm earlier results of excellent
effects,
few complications and mild side-effects when treating palmar
hyperhidrosis
with thoracoscopic sympathectomy.
PMID:
7524776 [PubMed - indexed for MEDLINE]
285:
Eur J Surg Suppl 1994;(572):17-9
Present
and future trends in thoracoscopic sympathectomy.
Hederman
WP.
Mater
Misericordiae Hospital, Dublin, Ireland.
PMID:
7524775 [PubMed - indexed for MEDLINE]
286:
Eur J Surg Suppl 1994;(572):13-6
Thoracoscopic
versus open supraclavicular upper dorsal sympathectomy: a
prospective
randomised trial.
Hashmonai
M, Kopelman D, Schein M.
Department
of Surgery B, Rambam Medical Centre, Haifa, Israel.
The
purpose of the present study was to compare the short term results of the
"open"
supraclavicular approach with the thoracoscopic access for T2-T4
sympathetic
ganglionectomy in patients with palmar hyperhidrosis. Patients were
randomly
allocated into two groups of 12 each, and were operated on: one by the
open
supraclavicular access; the other by the transthoracoscopic approach. The
effect
on palmar perspiration, operative data, postoperative complications and
patients's
satisfaction on short term follow up were examined. All operations
achieved
dry hands. Only two significant differences were observed: longer
anaesthesia
and poorer patient satisfaction in the thoracoscopic group one week
after
surgery (probably because a higher proportion of cases developed prolonged
postoperative
chest pain). Both techniques similarly achieve dry hands. The open
method
is not longer or more difficult, is possibly associated with less
morbidity,
and gives a higher subjective satisfaction.
Publication
Types:
Clinical
Trial
Randomized
Controlled Trial
PMID:
7524774 [PubMed - indexed for MEDLINE]
287:
Eur J Surg Suppl 1994;(572):9-11
Surgical
treatment of palmar hyperhidrosis before thoracoscopy: experience with
475
patients.
Adar
R.
Department
of General and Vascular Surgery, Sheba Medical Center, Tel Hashomer,
Israel.
Between
the years 1968-1992, 475 patients underwent simultaneous bilateral upper
dorsal
sympathectomy by the supraclavicular approach for severe palmar
hyperhidrosis.
For the purpose of comparing outcomes of the open surgical method
with
the increasingly used thoracoscopic procedure, we reviewed the clinical
data
of our patients. The incidence of severe palmar hyperhidrosis in the young
population
in Israel is 1-2/1,000. Surgical excision of the T2 and T3 ganglia
was
effective in drying the hands of all patients, who had frozen section
confirmation
of removal of a ganglion. At follow-up, hyperhidrosis recurred in
5.3%
of limbs. Mild transient Horner's syndrome occurred in 12% of procedures,
but
only in 5 patients was it permanent. The main drawback of the open surgical
approach
lies in the postoperative complications. The effectiveness of the
thoracoscopic
approach will be judged by immediate and late results, and by the
expected
reduction in postoperative morbidity.
PMID:
7524790 [PubMed - indexed for MEDLINE]
288:
Eur J Surg Suppl 1994;(572):41-2
Degeneration
activity: a transient effect following sympathectomy for
hyperhidrosis.
Asking
B, Svartholm E.
Department
of Surgery, Jonkoping Hospital, Sweden.
The
degeneration activity of effector organs is due to a period of transmitter
release
from degenerating sympathetic post-ganglionic nerve endings. This is the
theoretical
explanation for a period of sweating some days following
sympathectomy
for hyperhidrosis seen in some patients operated on with the
thoracoscopic
technique in Jonkoping, Sweden. The reasons for degeneration
activity,
well documented in animal experiments, are discussed in this paper.
PMID:
7524781 [PubMed - indexed for MEDLINE]
289:
Eur J Surg Suppl 1994;(572):37-9
Total
intravenous anaesthesia with single-lumen endotracheal intubation for
thoracoscopic
sympathectomy.
Harlid
R.
Department
of Anaesthesia and Intensive Care, Boras Hospital, Sweden.
The
aim of this paper was to discuss the stress applied to the circulatory and
respiratory
systems by the combination of general anaesthesia and thoracoscopic
sympathectomy
and to show the benefits of an intravenous anaesthetic technique
together
with a single-lumen endotracheal tube as a safe method of anaesthesia
for
this procedure. In a retrospective study, 125 cases of thoracoscopic
sympathectomy
were reviewed. The anaesthesia was a totally intravenous technique
with
propofol, alfentanil, and atracurium and a gas mixture of 40% oxygen in
air.
The degree of hypoxaemia during inflation of carbon dioxide into the thorax
was
assessed. The results showed that hypoxaemia caused no problems in any of
the
patients. Three patients with severe angina pectoris were also studied using
the
same anaesthetic technique and they showed marked haemodynamic instability
throughout
the procedure requiring inotropic support. Haemodynamic values
obtained
through a Swan-Ganz catheter in one patient showed marked changes
during
the procedure, but values returned to normal after the operation.
Although
these patients were haemodynamically unstable there was no problem with
hypoxaemia.
PMID:
7524780 [PubMed - indexed for MEDLINE]
290:
Eur J Surg Suppl 1994;(572):33-6
Anaesthetic
implications for transthoracic endoscopic sympathectomy.
Hartrey
R, Poskitt KR, Heather BP, Durkin MA.
Department
of Anaesthesia, Cheltenham General Hospital, England.
Transthoracic
endoscopic sympathectomy is now considered the treatment of choice
for
patients with upper limb hyperhidrosis requiring sympathetic ablation. This
procedure
requires the use of an endobronchial double lumen tube and subsequent
one-lung
anaesthesia, a technique that is associated with a number of potential
problems.
Full patient monitoring is thus required and includes pulse, ECG,
non-invasive
blood pressure measurement, pulse oximetry, end-tidal carbon
dioxide
concentration and peak inspiratory airway pressure. We reviewed our
anaesthetic
technique and peri-operative complications in 26 patients, to assess
patient
safety. In our study hypoxaemia occurred commonly but was transient in
all
bar one case where re-expansion of the lung was required. Hypotension
occurred
at two stages of the procedure, but active intervention was not
required,
and two patients required underwater drainage of the pleural cavity
for
treatment of pneumothorax. With skilled anaesthetic personnel and adequate
monitoring
this procedure may be carried out safely.
PMID:
7524779 [PubMed - indexed for MEDLINE]
291:
Stereotact Funct Neurosurg 1994;63(1-4):198-202
Thoracoscopic
ganglionectomy for hyperhidrosis.
Pillay
PK, Thomas J, Mack P.
Department
of Neurosurgery, Singapore General Hospital.
Thoracoscopic
sympathectomy for the treatment of hyperhidrosis has been carried
out
with techniques that involve either monopolar coagulation or laser injury to
the
T2 ganglion. Although this has the advantage of being minimally invasive, it
has
not been established whether these techniques are superior to complete
ganglion
excision, as carried out during open surgery. A new technique of
complete
T2 ganglion excision for palmar hyperhidrosis (with T3 ganglionectomy
for
axillary sweating) was developed using thoracoscopic techniques. Sixteen
patients
were treated with thoracoscopic T2 ganglion excision on the right side,
and
simple coagulation (Nd-YAG laser or monopolar) on the left side. Results
were
excellent with no posttreatment differences between hands at 1 year
follow-up.
However, long-term follow-up of these patients will be carried out to
determine
whether differences exist between these two techniques.
PMID:
7624635 [PubMed - indexed for MEDLINE]
292:
Dtsch Med Wochenschr 1993 Dec
23;118(51-52):1910
[Palmoplantar
hyperhidrosis]
[Article
in German]
Lamminger
C, Petzoldt D.
Abteilung
Dermatologie I mit Poliklinik der Universitats-Hautklinik, Heidelberg.
PMID:
8287784 [PubMed - indexed for MEDLINE]
293:
Clin Pediatr (Phila) 1993
Oct;32(10):629-31
Gustatory
flushing syndrome. A pediatric case report and review of the
literature.
Kozma
C, Gabriel S.
Department
of Pediatrics, Georgetown University Medical Center, Washington, D.C.
20007.
Publication
Types:
Review
Review
of Reported Cases
PMID:
8261729 [PubMed - indexed for MEDLINE]
294:
Endosc Surg Allied Technol 1993
Oct-Dec;1(5-6):261-5
Thoracoscopic
sympathectomy.
Byrne
J, Walsh TN, Hederman WP.
Dept.
of Surgery, Liandough Hospital, Cardiff, Wales.
Surgical
sympathectomy has traditionally been achieved by 'open' surgical
techniques.
The transaxillary, cervical, or dorsal approaches have not been
without
morbidity and cosmetically have been found to be less than ideal. The
main
indication for sympathectomy in most units is palmar and axillary
hyperhidrosis
refractory to medical treatment, although it has been used with
some
success in troublesome causalgia. Use of sympathectomy in Raynaud's disease
remains
disappointing. In our unit thoracoscopic sympathectomy has been
performed
since 1980. A CO2 pneumothorax is initially created in the usual
manner.
This is followed by electrocoagulation of the sympathetic chain under
direct
vision using a unipolar diathermy. The lung is then reinflated under
direct
vision. Chest drains are not inserted. Both sides are performed at the
same
sitting, and the patient usually leaves hospital the following day. The
functional
and cosmetic results are excellent on short and long term follow-up
with
few side effects. Permanent Horner's syndrome has not been reported using
this
technique. As with all upper limb sympathectomies, patients should be
warned
of possible compensatory hyperhidrosis. Embracing the tenets of minimally
invasive
surgery, thoracoscopic sympathectomy should be considered the approach
of
choice for surgical sympathectomy.
PMID:
8081893 [PubMed - indexed for MEDLINE]
295:
Surg Laparosc Endosc 1993
Oct;3(5):365-9
Transaxillary
endoscopic sympathectomy--a report of experience in 150 patients
with
palmar hyperhidrosis.
Chao
C, Tsai CT, Hsiao HC, Wu WC, Lee CK.
Department
of Surgery, Naval General Hospital, Kaohsiung, Taiwan, R.O.C.
We report
our 1-year experience with transaxillary endoscopic sympathectomy in
150
patients with palmar hyperhidrosis (PH). The double-puncture technique of
video
laparoscopy was used in a transaxillary approach to perform the
sympathectomy
by either electrocautery (EC; 93.3%) or electroresection (ER;
7.7%).
The procedure was successfully completed in 299 operated limbs and
required
conversion to open surgery in 1 operated limb because of extensive
pleural
adhesions. The mean operative time of EC was significantly less than
that
of ER. In a total of 29 procedures, there were three technical
complications.
Most patients (92.7%) were discharged after an overnight hospital
stay.
On the seventh postoperative day, the cure rate was 99.3%. During the mean
follow-up
period of 200.1 days, there was no recurrence in 130 patients.
Apparent
compensatory hyperhidrosis occurred in 28 patients (21.5%). In
conclusion,
transaxillary endoscopic sympathectomy offers a simple and effective
treatment
to patients with PH, resulting in a shorter hospital stay and
convalescent
period.
PMID:
8261263 [PubMed - indexed for MEDLINE]
296:
Surg Laparosc Endosc 1993
Oct;3(5):391-4
Thoracoscopic
sympathectomy.
Krasna
MJ, Flowers J, Morvick R.
Department
of Surgery, University of Maryland School of Medicine, Baltimore
21201.
With
the advent of advanced video and laparoscopic techniques, new applications
have
been found for thoracoscopy's expanding role in thoracic surgery. Described
herein
are three cases of thoracoscopic sympathectomy for three different
indications.
The evaluation and surgical technique are described in detail.
Thoracoscopic
sympathectomy is an excellent alternative to open transthoracic
approach.
PMID:
8261268 [PubMed - indexed for MEDLINE]
297:
Ann Thorac Surg 1993 Sep;56(3):715-6
Thoracoscopy
for autonomic disorders.
Claes
G, Drott C, Gothberg G.
Department
of Surgery, Boras Hospital, Sweden.
Sympathetic
denervation of the arm, the hand, and the heart may now be performed
using
minimal thoracoscopic procedures. During a 5-year period more than 500
patients
were operated on with no major and only a few minor complications. An
operation
time of 25 minutes, a hospital stay of 1 day, and sick leave of less
than
1 week have made the operation suitable for autonomous disorders such as
hyperhidrosis.
Other conditions such as causalgia, vascular insufficiency, and
angina
pectoris may be improved or disappear after sympathectomy, but the
recurrence
rate in Raynaud's disease is high.
PMID:
8379778 [PubMed - indexed for MEDLINE]
298:
Br J Theatre Nurs 1993 Aug;3(5):17-9
How
recovery helped me to recover. Experiences of hyperhydrosis.
Sumner
J.
PMID:
8400531 [PubMed - indexed for MEDLINE]
299:
J Neurosurg 1993 Aug;79(2):238-40
Video-assisted
endoscopic thoracic ganglionectomy.
Robertson
DP, Simpson RK, Rose JE, Garza JS.
Department
of Neurosurgery, Baylor College of Medicine, Houston, Texas.
Sympathetic
nerve disorders of the upper extremities can be treated by
neurosurgeons
using upper thoracic sympathectomy via a posterior approach.
Descriptions
have been published of alternative endoscopic procedures involving
thermocoagulation,
laser coagulation, or nonvideo-assisted ganglionectomy using
equipment
not widely available, with low morbidity and excellent results. The
authors
describe the use of an endoscopic approach to the thoracic sympathetic
ganglia
with systems designed for laparoscopic cholecystectomy. Thoracic
ganglionectomy
is reported in 22 patients with primary palmar hyperhidrosis and
eight
patients with reflex sympathetic dystrophy. The patients underwent
double-lumen
endotracheal intubation, after which 11- and 5.5-mm trocars were
introduced
into the chest cavity. Pneumothorax was produced with CO2
insufflation.
Fiberoptic closed-circuit television was used to visualize the
structures
to be dissected. The parietal pleura over the heads of the first and
second
ribs was excised using 5-mm blunt and sharp insulated coagulating
microscissors.
The stellate and upper thoracic ganglia were clearly identified
and
dissected. The T-2 and T-3 ganglia were grasped with forceps and excised. A
No.
16 French chest tube was introduced through a trocar, placed under water
seal
after the lungs were reinflated, and removed in the recovery room. The
average
hospital stay was 15.4 hours. There were no intraoperative
complications.
The average operating time was 30 minutes per side. Five patients
had
mild pleuritic pain which resolved within 2 weeks after surgery. Six (75%)
of
the eight patients with reflex sympathetic dystrophy had complete or partial
relief
of their symptoms (average follow-up period 5 months), and all patients
had
complete relief of hyperhidrosis (average follow-up period 8 months).
Endoscopic
ganglionectomy requires readily available and easily used
instrumentation
and provides a well-tolerated, cost-effective alternative to
posterior
thoracic sympathectomy for primary palmar hyperhidrosis and reflex
sympathetic
dystrophy.
PMID:
8331407 [PubMed - indexed for MEDLINE]
300:
Thorac Cardiovasc Surg 1993
Aug;41(4):245-8
Selective
video-assisted thoracoscopic sympathectomy.
Friedel
G, Linder A, Toomes H.
Schillerhohe
Hospital, Center for Pneumology and Thoracic Surgery, Gerlingen,
Germany.
Video-assisted
and thermometrically controlled thoracoscopic sympathectomy
demonstrates
new ways in the treatment of upper-limb hyperhidrosis. An
anatomical
portrayal of the sympathetic chain is possible as a result of the
improved
visualization and magnification of the operative area provided by the
video-optic
technique. The difference in temperature, registered by means of a
thermometric
sensor in the palm of the hand, indicates that the sympathetic
nerves
responsible for the hyperhidrotic segments have been severed. The number
of
postoperative Horner's syndromes will be reduced significantly with this
method.
Until now, we have successfully treated six thermometrically controlled
patients.
No recurrences have arisen during an 18 months observation period.
Neither
intraoperative nor postoperative complications were recorded. One
patient
complained of increased compensatory sweating of the trunk.
Thermometrically
controlled thoracoscopic sympathectomy is expected to improve
the
various forms of treatment available for sympathetic reflex dystrophies in
the
future.
PMID:
8211930 [PubMed - indexed for MEDLINE]
301:
Br J Surg 1993 Jul;80(7):862
Electrocautery
of the upper thoracic sympathetic chain: a simplified technique.
Gothberg
G, Claes G, Drott C.
Department
of Surgery, Boras Hospital, Sweden.
PMID:
8369917 [PubMed - indexed for MEDLINE]
302:
J Pediatr Surg 1993 Jul;28(7):909-11
Long-term
results of limited thoracic sympathectomy for palmar hyperhidrosis.
Hehir
DJ, Brady MP.
Department
of Surgery, Regional Hospital Cork, Ireland.
Eighteen
children (15 females, 3 males) aged 7 to 15 years underwent resection
of
the thoracic sympathetic chain for severe palmar hyperhidrosis. A localized
section
of chain immediately below the first thoracic ganglion and including the
second
thoracic sympathetic ganglion was removed. Patients were followed for 24
to
136 months. All patients had immediate and permanent abolition of palmar
hyperhidrosis.
There was no mortality, one patient developed intermittent ptosis
and
myosis, three patients reported compensatory hyperhidrosis and one girl was
unhappy
with the cosmetic results. We conclude that thoracic sympathectomy is a
safe
and permanent treatment for severe palmar hyperhidrosis in children. In
addition,
limited sympathetic resection is associated with a lower incidence of
compensatory
hyperhidrosis than conventional more radical sympathectomy.
PMID:
8229566 [PubMed - indexed for MEDLINE]
303:
BMJ 1993 Jun 26;306(6894):1752
Comment
on:
BMJ. 1993 May 8;306(6887):1221-2.
Treating
hyperhidrosis. Reserve sympathectomy for palmar hyperhidrosis.
Gordon
A, Collin J.
Publication
Types:
Comment
Letter
PMID:
8343646 [PubMed - indexed for MEDLINE]
304:
BMJ 1993 Jun 26;306(6894):1752
Comment
in:
BMJ. 1993 Jul 31;307(6899):326.
Comment
on:
BMJ. 1993 Jun 26;306(6894):1752
Treating
hyperhidrosis. Complications of endoscopic sympathectomy.
Quinn
AC, Edwards RE, Newman PJ, Fawcett WJ.
Publication
Types:
Comment
Letter
PMID:
8343645 [PubMed - indexed for MEDLINE]
305:
Harefuah 1993 Jun 15;124(12):748-50, 796
[Thoracoscopic
resection of upper dorsal sympathetic chain for palmar
hyperhidrosis]
[Article
in Hebrew]
Kopelman
D, Schein M, Hashmonai M.
Dept
of Surgery B, Rambam Medical Center, Haifa.
During
the past year we have used the thoracoscopic approach in performing
bilateral
upper dorsal sympathectomies for the treatment of palmar
hyperhidrosis.
We present our first 16 patients. Histological examination proved
that
sympathetic ganglia had been resected in all 32 procedures. Immediately
after
operation all hands were completely dry and 31 of them remained so on
follow-up
5 months later (97% success rate). The main operative complications
were
bleeding in 3 cases (9.4%; only 1 severe), and chest and back pain for more
than
1 week in 8 (50%). The main late sequela was compensatory hyperhidrosis of
the
chest and back in 10 cases (62%).
PMID:
8375765 [PubMed - indexed for MEDLINE]
306:
Br J Surg 1993 Jun;80(6):687-8
Comment
in:
Br J Surg. 1993 Oct;80(10):1351.
Endoscopic
sympathectomy.
Hederman
WP.
Department
of Surgery, Mater Misericordiae Hospital, Dublin, Ireland.
PMID:
8305007 [PubMed - indexed for MEDLINE]
307:
J Vasc Surg 1993 Jun;17(6):1137-9
Comment
on:
J Vasc Surg. 1992 Jul;16(1):121-3.
Thoracic
dorsal sympathectomy for hyperhidrosis: a new approach.
Schein
M, Kopelman D, Hashmonai M.
Publication
Types:
Clinical
Trial
Comment
Letter
Randomized
Controlled Trial
PMID:
8505796 [PubMed - indexed for MEDLINE]
308:
Thorac Cardiovasc Surg 1993
Jun;41(3):140-6
Prerequisites,
indications, and techniques of video-assisted thoracoscopic
surgery.
Linder
A, Friedel G, Toomes H.
Schillerhohe
Hospital, Gerlingen, Germany.
During
the last two years video-assisted operative thoracoscopy has introduced
new
impetus into thoracic surgery. Today it is viewed as a sparing and safe
alternative
to thoracotomy for a wide spectrum of indications. The
prerequisites,
instruments, and operative techniques are discussed. In
oncological
thoracic surgery it still remains to be verified whether the
criteria
of radicality are fulfilled by this new technique. Using video-assisted
operative
thoracoscopy, we have successfully operated on 209 patients with the
following
indications: recurrent pneumothorax (n = 94), interstitial lung
disease
(n = 25), coin lesion (n = 20), pleural effusion (n = 17), hyperhidrosis
(n
= 14), mediastinal tumor or lymphoma (n = 10), thoracic empyema (n = 9),
bullous
emphysema (n = 8), pleural tumor (n = 5), hematothorax (n = 3),
malignant
pericardial effusion (n = 3), and chylothorax (n = 1). The advantages
of
this minimally traumatizing operating technique lie in a better view of the
operative
site, the objectively measurable reduction in postoperative
restriction,
less pain, earlier postoperative mobilization, and shorter hospital
stay.
This operating technique, in addition to being sparing, requires markedly
less
time than a thoracotomy. The disadvantages are the two-dimensional monitor
picture
and, especially, the loss of palpation.
PMID:
8367865 [PubMed - indexed for MEDLINE]
309:
BMJ 1993 May 8;306(6887):1221-2
Comment
in:
BMJ. 1993 Jun 26;306(6894):1752.
Treating
hyperhidrosis.
Quraishy
MS, Giddings AE.
Publication
Types:
Editorial
PMID:
8499848 [PubMed - indexed for MEDLINE]
310:
Baillieres Clin Endocrinol Metab 1993
Apr;7(2):465-90
Sympathetic
nervous system disorders in man.
Mathias
CJ.
Department
of Medicine, St Mary's Hospital Medical School, Imperial College of
Science,
Technology and Medicine, London, UK.
The
sympathetic nervous system innervates most organs in the body and controls
their
function. A variety of disease processes, surgery or drugs can result in
disordered
sympathetic nerve function, which can be either localized or more
generalized.
Malfunction can result in either sympathetic underactivity (causing
postural
hypotension, impotence or anhidrosis) or overactivity (causing
paroxysmal
hypertension or hyperhidrosis). The investigation of sympathetic
disorders
depends upon the system and organs involved and should include, where
relevant,
investigation of the possible aetiological processes. The clinical
features
and management of some of the major disorders affecting the sympathetic
nervous
system, including the recently described syndrome of DBH deficiency, are
described.
Publication
Types:
Review
Review,
Tutorial
PMID:
8489487 [PubMed - indexed for MEDLINE]
311:
Arch Surg 1993 Feb;128(2):237-41
Comment
in:
Arch Surg. 1995 Nov;130(11):1243-4.
Endoscopic
procedures of the upper-thoracic sympathetic chain. A review.
Drott
C, Gothberg G, Claes G.
Department
of Surgery, Boras Hospital, Sweden.
The
upsurge of endoscopic surgical procedures now includes procedures of the
thoracic
sympathetic chain. The number of articles on this issue is rapidly
increasing.
This article reviews the indications for as well as the technique,
complications,
side effects, and results of endoscopic upper-thoracic
sympathetic
ablation. Since 1977, nearly 900 cases have been described in the
literature.
The main indication is usually hyperhidrosis. The described
techniques
vary in detail, but the common denominators are simplicity,
expedience,
minimal surgical trauma, few complications, and low cost compared
with
standard methods of open surgery. The results are excellent, durable, and
stand
well compared with results of previous open techniques. Due to the
overwhelming
advantages of endoscopic methods, we can foresee an increasing
adoption
of these techniques and a subsequent relegation of the various open
surgical
procedures of the upper-thoracic sympathetic chain.
Publication
Types:
Review
Review,
Tutorial
PMID:
8431126 [PubMed - indexed for MEDLINE]
312:
Neurosurgery 1993 Feb;32(2):327-9
Comment
in:
Neurosurgery. 2001 Mar;48(3):702.
Comment
on:
Neurosurgery. 1992 Jan;30(1):131-5.
Video
endoscopic sympathectomy using a fiberoptic CO2 laser to treat palmar
hyperhidrosis.
Chung
HY, Seo CG, Lee SG.
Publication
Types:
Comment
Letter
PMID:
8437676 [PubMed - indexed for MEDLINE]
313:
Surg Gynecol Obstet 1993
Feb;176(2):151-4
Limiting
the anatomic extent of upper thoracic sympathectomy for primary palmar
hyperhidrosis.
O'Riordain
DS, Maher M, Waldron DJ, O'Donovan B, Brady MP.
University
Department of Surgery, University College and Regional Hospital,
Cork,
Ireland.
Ninety-four
consecutive patients undergoing bilateral sympathectomy of the upper
part
of the thorax for primary palmar hyperhidrosis were reviewed. The
supraclavicular
operative approach was used and a limited sympathectomy was
performed
from below T1 to above T3, denervating the palm only. Follow-up
evaluation
was complete in 86 patients at a median period of 31 months. All
patients
had complete and permanent relief of palmar hyperhidrosis. However, 19
had
compensatory hyperhidrosis and this was the common cause of patient
dissatisfaction.
Although axillary denervation was not performed, axillary
sweating
was a problem postoperatively in only two patients. Significant
morbidity
was minimal; the only permanent disability was in one patient with
Horner's
syndrome. Upper thoracic sympathectomy is a safe and effective method
of
treatment for primary palmar hyperhidrosis. The low incidence of compensatory
sweating
may be explained by the limited extent of the sympathectomy. Axillary
sweating
is rarely a significant postoperative problem, and extensive
sympathectomy
to include axillary denervation is unnecessary and should be
avoided
to minimize compensatory hyperhidrosis.
PMID:
8421803 [PubMed - indexed for MEDLINE]
314:
Ann Chir 1993;47(8):769-72
[Chylothorax:
a rare complication of transaxillary thoracic sympathectomy]
[Article
in French]
Levy
I, Ariche A, Sebbag G, Hoda J.
Service
de Chirurgie A, Hospitalo-Universitaire Soroka, Universite Ben Gourion
du
Neguev, Beer Sheva 84101, Israel.
Transaxillary
upper thoracic sympathectomy is a safe surgical procedure for the
treatment
of palmar hyperhidrosis. Although thoracic complications such as
hemothorax
and pneumothorax occasionally occur following this procedure
chylothorax
is an extremely rare complication. From 1978 to 1991, 215
consecutive
patients underwent upper thoracic sympathectomy for the treatment of
palmar
hyperhidrosis in our institution. We report the surgical management of
one
patient who developed an intractable chylous fistula which did not respond
to
non-surgical treatment. Attempts at non-surgical management of the disease,
with
aspiration therapy, tube thoracostomy and the administration of medium
chain
triglyceride diet, should be tried first. If, however, this is not
successful
within two weeks, one should not wait for further metabolic and
nutritional
impairment before instituting surgical treatment. We believe that
proximal
thoracic duct ligation is a relatively simple and effective means of
controlling
chylothorax.
PMID:
8311411 [PubMed - indexed for MEDLINE]
315:
Scand J Plast Reconstr Surg Hand Surg
1993;27(1):29-33
Endoscopic
electrocautery of the thoracic sympathetic chain. A minimally
invasive
way to treat palmar hyperhidrosis.
Claes
G, Drott C, Gothberg G.
Department
of Surgery, Boras Hospital, Sweden.
Four
hundred and fifty patients with palmar hyperhidrosis have undergone
endoscopic
thoracic sympathetic electrocautery since 1987 in our department. The
procedure
requires only minor modifications of standard laparoscopic and
urological
equipment. The median operating time for a bilateral procedure was 31
minutes
(15-120), hospital stay was 1 day postoperatively (1-8), and patients
returned
to work within 4 (1-40) days. Complications in the whole material were
few
and mild, pneumothorax (n = 2), haemothorax (n = 1), and Horner's syndrome
(n
= 1). Five patients required reoperation (four because of primary failure to
destroy
the nerve and one for recurrent symptoms). The first consecutive 130 of
these
patients have been followed up by a questionnaire. At follow-up (median
196
days after operation, range 35-1419) all patients but three, who are
awaiting
reoperation were satisfied with the result. The discomfort and side
effects
of the operation were in most cases mild and short. This technique makes
it
possible to widen the indications for operation for people with palmar
hyperhidrosis.
PMID:
8493481 [PubMed - indexed for MEDLINE]
316:
J Auton Nerv Syst 1992 Dec;41(3):215-9
Normal
sympathetic nerve activity in a reflex sympathetic dystrophy with marked
skin
vasoconstriction.
Casale
R, Elam M.
Service
of Clinical Neurophysiology, Foundation Clinica del Lavoro IRCCS-Pavia,
Montescano,
Italy.
Intraneural
recording in skin fascicles of the left ulnar nerve was performed in
a
51 year old patient with reflex sympathetic dystrophy (allodynia, marked
vasoconstriction
in the ulnar part of the left hand) following Vth finger
amputation.
Skin sympathetic activity showed normal characteristics with a weak
discharge
at rest whereas bursts of impulses could be evoked by
sympatho-excitatory
stimuli. Sympathetic bursts induced by painful stimuli were
few,
also during long-lasting allodynic pain. Sympathetic bursts induced by
inspiratory
gasps were not associated with excacerbation of pain. The
discrepancy
between the marked skin vasoconstriction and the low resting
sympathetic
discharge underlines the fact that sympathetic effector organ
hyperactivity
(i.e. vasoconstriction and/or hyperhidrosis) cannot be taken as
evidence
for increased sympathetic discharge. In the present case, the
neuropathic
pain syndrome cannot be considered as maintained by an increased
sympathetic
neural discharge to the symptomatic limb.
PMID:
1289385 [PubMed - indexed for MEDLINE]
317:
Ma Zui Xue Za Zhi 1992 Dec;30(4):277-82
Sudden
cardiac arrest during left thoracoscopic T2 sympathectomy.
Chow
TC, Tan CT, Hwang YS, Ting MC, Chen YP, Lin JC, Lin CC.
Department
of Anesthesiology, Show Chwan Memorial Hospital, Changhua.
PMID:
1344244 [PubMed - indexed for MEDLINE]
318:
Semin Neurol 1992 Dec;12(4):394-407
Autonomic
neurodermatology (Part II): Disorders of sweating and flushing.
Freeman
R, Waldorf HA, Dover JS.
Division
of Neurology, New England Deaconess Hospital, Boston, MA 02215.
Publication
Types:
Review
Review,
Academic
PMID:
1485049 [PubMed - indexed for MEDLINE]
319:
Br J Anaesth 1992 Oct;69(4):349-51
Comment
in:
Br J Anaesth. 1993 Apr;70(4):491-2.
Br J Anaesth. 1993 Apr;70(4):492.
Anaesthesia
for transthoracic endoscopic sympathectomy in the treatment of upper
limb
hyperhidrosis.
Jedeikin
R, Olsfanger D, Shachor D, Mansoor K.
Department
of Anaesthesiology and Intensive Care, Sackler School of Medicine,
University
of Tel Aviv, Meir Hospital, Kfar Saba, Israel.
Renewed
interest has been shown in transthoracic endoscopic sympathectomy (TES)
for
the treatment of upper limb hyperhidrosis. We review our experience and
discuss
the anaesthetic technique and perioperative problems encountered in 58
patients
undergoing TES for hyperhidrosis. Patients were monitored for arterial
pressure,
heart rate, ECG, pulse oximetry (SpO2), end-tidal carbon dioxide
concentration,
peak inspired airway pressure and skin temperature. General
anaesthesia,
with a double-lumen endobronchial tube, enabled the lungs to be
collapsed
alternately, thereby ensuring easy and clear access to the sympathetic
chain.
Controlled ventilation with 100% inspired oxygen was necessary to obviate
hypoxaemia.
In two patients, severe hypotension and bradycardia occurred during
insufflation
of carbon dioxide into the chest cavity. Four patients required
underwater
drainage of the pleural cavity for treatment of pneumothorax or
haemothorax.
The success and safety of the procedure depends on a scrupulous
anaesthetic
technique.
PMID:
1419441 [PubMed - indexed for MEDLINE]
320:
Can J Surg 1992 Oct;35(5):509-11
Thoracoscopic
transthoracic dorsal sympathectomy.
Pace
RF, Brown PM, Gutelius JR.
Department
of Surgery, Queen's University, Kingston General Hospital, Ont.
The
authors report on the three patients who underwent thoracoscopic
transthoracic
dorsal sympathectomies by the techniques of minimal-access surgery
learned
from laparoscopic cholecystectomy. All three had histologic confirmation
of
removal of the sympathetic chain and have had an encouraging early
postoperative
result. The authors believe that thoracoscopic transthoracic
dorsal
sympathectomy can be accurately and safely performed and will become the
method
of choice for dorsal sympathectomy.
PMID:
1393866 [PubMed - indexed for MEDLINE]
321:
Clin Auton Res 1992 Oct;2(5):349-52
Endoscopic
transthoracic sympathectomy for idiopathic upper limb hyperhidrosis.
Masters
A, Rennie JA.
Department
of Surgery, King's College Hospital, Denmark Hill, London, UK.
A
5-year experience of 51 endoscopic transthoracic dorsal sympathectomies for
idiopathic
palmar hyperhidrosis in 26 patients is presented. Fifty-two percent
complained
of excessive sweating over their hands, 28% of axillary sweating and
20%
over both areas, with a mean duration of 10 years. The second, third and
fourth
thoracic ganglia and their interconnecting fibres on the affected side
were
ablated using diathermy cautery. Over a mean follow up time of 26 months,
this
procedure was successful in curing or improving intractable sweating in
92%.
However, axillary sweating was less well controlled than in the palms with
20%
of patients describing residual wetness in the axilla. Compensatory sweating
(75%)
and gustatory sweating (48%) were the commonest side effects; despite
this,
most patients were satisfied with the functional and cosmetic outcome.
Other
complications included a temporary Horner's syndrome in one patient, a
pneumothorax
in the immediate post-operative period in another and a unilateral
non-infective
reactionary pleural effusion in a third. Two patients developed
recurrence
of palmar hyperhidrosis within 6 months of surgery. One has been
successfully
treated by re-operation on the affected side. All patients
complained
of mild to moderate interscapular chest pain which was easily
controlled
by non-steroidal anti-inflammatory agents, and resolved within 7-10
days
post-operatively. The technique of endoscope transthoracic sympathectomy is
effective,
relatively simple to perform and usually requires only an overnight
stay.
It is recommended as the surgical treatment of choice for upper limb
hyperhidrosis
unresponsive to conservative measures.
PMID:
1422103 [PubMed - indexed for MEDLINE]
322:
Br J Surg 1992 Sep;79(9):975-6
Comment
on:
Br J Surg. 1992 Mar;79(3):268-71.
Upper
thoracic sympathectomy for primary palmar and axillary hyperhidrosis:
long-term
follow up.
Byrne
J, Walsh TN, Hederman WP.
Publication
Types:
Comment
Letter
PMID:
1422775 [PubMed - indexed for MEDLINE]
323:
Eur J Vasc Surg 1992 Sep;6(5):558-62
Endoscopic
transthoracic sympathectomy: experience in the south west of England.
Adams
DC, Wood SJ, Tulloh BR, Baird RN, Poskitt KR.
Department
of Vascular Surgery, Cheltenham General Hospital, U.K.
Thoracic
sympathectomy has an established role in the management of primary
palmar
and axillary hyperhidrosis, Raynaud's phenomenon and occlusive vascular
disease.
Potential problems with traditional surgical approaches to the
sympathetic
chain include poor exposure, risk of damage to adjacent structures
and
postoperative pain. A minimally invasive endoscopic approach helps to
overcome
these problems. Using this technique, 45 procedures have been performed
on
26 patients in two districts in the South West of England over the past five
years.
Follow-up information was available for 39 procedures. All 27 procedures
for
hyperhidrosis and both for occlusive vascular disease have produced a
long-term
improvement. Nine of the 10 procedures for Raynaud's phenomenon have
also
produced some degree of long-term improvement. Complications included four
asymptomatic
pneumothoraces, two patients with temporary unilateral Horner's
syndrome
and two instances of intercosto-brachial numbness. On the positive
side,
patients expressed satisfaction with the efficacy, rapid recovery and
small
unobtrusive scars produced by the procedure. Endoscopic transthoracic
sympathectomy
is effective, safe and well accepted by patients and we believe is
now
the method of choice for this procedure.
PMID:
1397353 [PubMed - indexed for MEDLINE]
324:
Br J Surg 1992 Aug;79(8):752
Efficacy
of endoscopic transthoracic sympathectomy assessed by peroperative
palmar
temperature measurement.
Chester
JF, Jeddy TA, Taylor RS, Dormandy JA, Allt-Graham J.
Department
of Surgery, Taunton and Somerset Hospital, Taunton, UK.
PMID:
1393460 [PubMed - indexed for MEDLINE]
325:
Can J Surg 1992 Aug;35(4):414-6
Transaxillary
endoscopic laser sympathectomy.
Austin
JJ, Doobay B, Schatz SW.
McMaster
University Clinic, Hamilton General Hospital, Ont.
The
authors describe a technique of achieving sympathetic denervation of the
upper
limbs in a 20-year-old woman with hyperhidrosis. A thoracoscope was
inserted
through a short incision in the axilla. A fibreoptic wave guide was
passed
through the thoracoscope to allow photocoagulation of the second thoracic
sympathetic
ganglion by Nd:YAG laser irradiation. The procedure was well
tolerated
and subsequent scar formation was unobtrusive.
PMID:
1498742 [PubMed - indexed for MEDLINE]
326:
Ann Vasc Surg 1992 Jul;6(4):390-2
Transthoracic
endoscopy for upper thoracic chemical sympathectomy.
Bardaxoglou
E, Reigner B, Enon B, Tolstuchow N, Lescalie F, Peret M, Chevalier
JM.
Service
de Chirurgie Vasculaire et Thoracique, Centre Hospitalier et
Universitaire,
Angers, France.
Beginning
in April 1989, we have performed eight upper thoracic chemical
sympathectomies
by transthoracic endoscopy. The indications were occlusive
arterial
disease in four patients and Raynaud's syndrome and palmar
hyperhidrosis
in two patients each. Transthoracic endoscopy was performed under
general
anesthesia, through the third costal interspace on the anterior
mid-clavicular
line. Five ml of phenol were injected into the parietal pleura
covering
the three proximal thoracic ganglia. The duration of thoracic drainage
was
24 hours. The postoperative course was uneventful except for one case of
subcutaneous
emphysema and transient Horner's syndrome in three instances. There
were
no initial failures. Because of its simplicity and the short
hospitalization
period, chemical sympathectomy by transthoracic endoscopy
constitutes
a valuable alternative to conventional surgery. This technique is,
however,
limited in the case of antecedent pleuropulmonary disorders.
PMID:
1390030 [PubMed - indexed for MEDLINE]
327:
J Vasc Surg 1992 Jul;16(1):121-3
Comment
in:
J Vasc Surg. 1993 Jun;17(6):1136.
J Vasc Surg. 1993 Jun;17(6):1137-9.
Thorascopic
dorsal sympathectomy for hyperhidrosis: a new approach.
Appleby
TC, Edwards WH Jr.
Department
of Surgery, St. Thomas Hospital, Nashville, TN.
PMID:
1619713 [PubMed - indexed for MEDLINE]
328:
Lakartidningen 1992 Apr
22;89(17):1477-8
[Good
results and low number of complications with minimal invasive endoscopic
surgery
of palmar sweating]
[Article
in Swedish]
Claes
G, Drott C, Gothberg G.
Kirurgiska
kliniken, bada vid Boras lasarett, Boras.
PMID:
1573936 [PubMed - indexed for MEDLINE]
329:
Lakartidningen 1992 Apr 22;89(17):1478
[Endoscopic
thoracic sympathectomy is a simple and effective method against
palmar
sweating]
[Article
in Swedish]
Norback
B, Svartholm E.
Bada
vid kirurgiska kliniken, Lanssjukhuset, Jonkoping.
PMID:
1573937 [PubMed - indexed for MEDLINE]
330:
Angiology 1992 Apr;43(4):336-41
Telford's
operation for primary palmar hyperhidrosis.
Gyftokostas
D, Koutsoumbelis C, Daskalakis E, Bouhoutsos J.
Unit
of Peripheral Vascular Surgery, 401 Army Hospital, Athens, Greece.
Bilateral
upper dorsal sympathectomy via the supraclavicular approach was
performed
in 42 patients for palmar hyperhidrosis. In 16 patients (32
extremities)
the effect of sympathectomy on digital circulation was evaluated
objectively,
in comparison with that of 15 control subjects. Mean values of
finger
temperature and of digital systolic pressure increased by 6.9 degrees C
and
36 mmHg respectively after operation, whereas an increase of digital blood
flow
and a decrease of the time of the clearance of 99mTc by approximately 60%
were
recorded. Differences between preoperative and postoperative values and
those
of controls were statistically significant. Clinical results of treatment
remain
satisfactory after a mean follow-up period of thirty-two months with no
case
of recurrence. Permanent decrease of plantar hyperhidrosis was recorded by
14
patients. The advantages of Telford's operation over other methods of upper
extremity
sympathetic denervation are discussed.
PMID:
1558319 [PubMed - indexed for MEDLINE]
331:
Ann Surg 1992 Mar;215(3):289-93
Endoscopic
transthoracic sympathectomy in the treatment of hyperhidrosis.
Edmondson
RA, Banerjee AK, Rennie JA.
Department
of Surgery, King's College Hospital, Denmark Hill, London, England.
A
5-year experience of 50 endoscopic transaxillary dorsal sympathectomies is
presented.
The procedure was successful in either curing or improving the
symptoms
of hyperhidrosis in the great majority of patients. The commonest side
effects
were compensatory sweating (75%) and gustatory sweating (48%); despite
this,
there was an extremely high level of patient satisfaction. Permanent
Horner's
syndrome did not occur. The procedure is effective, simple, cheap, and
requires
only an overnight stay; and is recommended as the method of choice for
the
surgical treatment of upper limb hyperhidrosis.
PMID:
1543403 [PubMed - indexed for MEDLINE]
332:
Br J Surg 1992 Mar;79(3):268-71
Comment
in:
Br J Surg. 1992 Sep;79(9):975-6.
Upper
thoracic sympathectomy for primary palmar hyperhidrosis: long-term
follow-up.
Hashmonai
M, Kopelman D, Kein O, Schein M.
Department
of Surgery B, Rambam Medical Centre, Haifa, Israel.
Primary
palmar hyperhidrosis is a functionally and socially disabling condition.
Upper
thoracic sympathectomy is the best curative treatment. Several surgical
approaches
have been suggested and, recently, less invasive techniques have been
communicated.
To evaluate which method is the best, the short- and particularly
the
long-term results must be compared. A series is presented of 170 upper
thoracic
sympathectomies by the supraclavicular approach performed on 85
patients
with palmar hyperhidrosis. Follow-up for a mean of 8.3 years was
obtained
on 124 operated limbs. The immediate failure rate for relief from
hyperhidrosis
was 2.4 per cent and hyperhidrosis recurred in another 4.1 per
cent
of limbs after a period of between 2 and 18 months. Thirteen per cent of
patients
were dissatisfied with the results of operation, one because of
persisting
vasomotor rhinitis, two because of Horner's syndrome and five because
of
persisting or recurrent hyperhidrosis. Satisfactory results in approximately
87
per cent of cases make the operation rewarding. This outcome should be
compared
with the long-term results of other methods, such as percutaneous
phenol
injection and the transthoracoscopic approach, when such data are
compiled
and published.
PMID:
1555100 [PubMed - indexed for MEDLINE]
333:
J Laparoendosc Surg 1992 Feb;2(1):1-6
Extended
thoracoscopic T2-sympathectomy in treatment of hyperhidrosis:
experience
with 130 consecutive cases.
Lin
CC.
Surgical
Department, Tainan Municipal Hospital, Taiwan, Republic of China.
A
new method of thoracoscopic T2-sympathectomy mentioned in a previous report
was
used on 36 cases of hyperhidrosis at Tainan Municipal Hospital in Taiwan
between
October 1, 1989 and July 31, 1990. To reduce the possibility of
incomplete
resection of sympathetic nerve tracts, including ganglions and their
regeneration,
the method was modified on August 1, 1990. Thereafter, routine
total
removal of T2 and T3 sympathetic ganglions, as well as wide lateral
incisions
of the pleura on the second, third, and fourth rib beds were performed
for
treatment of hyperhidrosis. This newly modified method, "extended
thoracoscopic
T2-sympathectomy," can be performed easily by thoracoscopic
approach
in the treatment of hyperhidrosis palmaris. From August 1, 1990 to May
31,
1991, 130 consecutive cases of hyperhidrosis (56 males and 74 females)
ranging
in age from 8 to 51 years underwent extended thoracoscopic
T2-sympathectomy.
In addition to a nearly 100% cure rate of hyperhidrosis
palmaris,
significant saving in operative time and hospital stay were achieved.
High
simultaneous cure rate (70.6%) and subjective improvement (17.4%) of
excessive
sweating of feet (hyperhidrosis plantaris) were also noted in the 109
cases
followed up, and complications were minor. Extended thoracoscopic
T2-sympathectomy
is not only a time-saving method but also a very simple and
effective
method in the treatment of hyperhidrosis. It is worthy of being
propagated
worldwide.
PMID:
1576368 [PubMed - indexed for MEDLINE]
334:
Lasers Surg Med 1992;12(3):308-12
Laser
endoscopic sympathectomy for palmar hyperhidrosis.
Kao
MC.
Department
of Surgery, College of Medicine, National Taiwan University, Taipei,
Republic
of China.
Hyperhidrosis
palmaris is a common disorder among the Orientals. Despite
numerous
therapeutic modalities in practice, none has proved entirely
satisfactory.
With the introduction of video-endoscopic surgery, we combined
this
system with a fiber optic Nd-YAG laser unit, electrocautery, and a laser
Doppler
flowmeter to design a new and promising therapeutic technique for palmar
hyperhidrosis.
General anesthesia with alternating one-lung ventilation is
essential
for a safe and smooth endoscopic sympathectomy. An operating endoscope
was
introduced into thoracic cavity via the second intercostal space and then
attached
to a CCD camera video system, which provided clear visibility of the
sympathetic
trunk in most cases. The proper level of the sympathetic trunk was
further
confirmed with the aid of vasomotor response of the palmar skin
resulting
from electric stimulation on the related sympathetic trunk. Finally,
the
confirmed target was precisely vaporized with a low power Nd-YAG laser
through
an endoscope. Twenty patients underwent bilateral sympathectomy, mostly
on
T2 and its adjacent trunk. This technique did not cause any injury to the
lung
or bleeding. No Horner's syndrome was produced. It provided a precise
ganglionectomy
on a confirmed target under clear magnified vision. Consequently,
a
definite and long-lasting therapeutic effect seemed warranted. It was
considered
to be a relative minor and safe procedure causing minimal discomfort
and
an almost invisible scar without producing serious complications. It also
shortened
the operation time and hospital stay remarkably in comparison with
other
open sympathectomy procedures.
PMID:
1508026 [PubMed - indexed for MEDLINE]
335:
Neurosurgery 1992 Jan;30(1):131-5
Comment
in:
Neurosurgery. 1993 Feb;32(2):327-9.
Neurosurgery. 2001 Mar;48(3):702.
Video
endoscopic sympathectomy using a fiberoptic CO2 laser to treat palmar
hyperhidrosis.
Kao
MC.
Department
of Surgery, Laser Medicine Research Center, College of Medicine,
National
Taiwan University, Taipei, Republic of China.
Palmar
hyperhidrosis is a common disorder among orientals. A new therapeutic
technique
for this disorder has been designed by combining a computer compact
disc
video endoscopic system with a fiberoptic CO2 surgical laser unit. The
operation
is performed under general anesthesia with alternating one-lung
ventilation.
There are three important aids in localizing the correct
sympathetic
segment: 1) direct visualization of its magnified image on the
television
monitor; 2) identification with an electrode probe palpation at its
presumed
location; and 3) monitoring the microvasomotor changes on the skin of
the
finger resulting from electrical stimulation of the sympathetic trunk.
Subsequently,
the confirmed sympathetic target is vaporized using a low power
CO2
laser under direct vision on the television monitor. The laser is delivered
to
the target by a small optical fiber passing through a throacoscope, which is
introduced
into the thoracic cavity via the intercostal space between the second
and
third ribs at the midclavicular line. Fourteen palmar hyperhidrosis patients
were
successfully treated by this method. No complications, such as Horner's
syndrome,
bleeding, or intercostal neuralgia, were encountered. Although the
number
of cases treated was small, and the follow-up period was short, the
evidence
indicates that a definite sympathectomy on a confirmed segment under
magnified
vision is possible with this procedure, and could warrant a definite
and
long-lasting therapeutic effect. Based on our experience, the method is
considered
a relatively minor and safe procedure, causing minimal discomfort and
almost
invisible scars. The operation time and hospital stay were remarkably
shortened
in comparison with other conventional sympathectomy procedures.
PMID:
1738444 [PubMed - indexed for MEDLINE]
336:
Br J Surg 1991 Nov;78(11):1401
Comment
on:
Br J Surg. 1991 Mar;78(3):279-83.
Surgical
management of primary hyperhidrosis.
Pillay
PK.
Publication
Types:
Comment
Letter
PMID:
1760714 [PubMed - indexed for MEDLINE]
337:
Br J Surg 1991 Aug;78(8):1019-20
Comment
on:
Br J Surg. 1991 Mar;78(3):279-83.
Surgical
management of primary hyperhidrosis.
Adams
DC, Poskitt KR.
Publication
Types:
Comment
Letter
PMID:
1913099 [PubMed - indexed for MEDLINE]
338:
Br J Surg 1991 Jun;78(6):760
Comment
on:
Br J Surg. 1990 Sep;77(9):1046-9.
Endoscopic
transthoracic electrocautery of the sympathetic chain for palmar and
axillary
hyperhidrosis.
Claes
G, Gothberg G.
Publication
Types:
Comment
Letter
PMID:
2070248 [PubMed - indexed for MEDLINE]
339:
Br J Surg 1991 Jun;78(6):761
Comment
on:
Br J Surg. 1991 Mar;78(3):279-83.
Surgical
management of primary hyperhidrosis.
Birnstingl
M.
Publication
Types:
Comment
Letter
PMID:
2070250 [PubMed - indexed for MEDLINE]
340:
Br J Surg 1991 May;78(5):635
Comment
on:
Br J Surg. 1990 Sep;77(9):1046-9.
Endoscopic
transthoracic electrocautery of the sympathetic chain for palmar and
axillary
hyperhidrosis.
Weale
F.
Publication
Types:
Comment
Letter
PMID:
2059831 [PubMed - indexed for MEDLINE]
341:
Singapore Med J 1991 Apr;32(2):119-20
Sympathectomy
for wet, dripping palms.
Tan
KK.
Department
of Neurosurgery, Tan Tock Seng Hospital, Singapore.
An
analysis of upper thoracic sympathectomy for palmar hyperhydrosis performed
in
a Neurological Department for the past ten years via several surgical
approaches
suggests that the posterior median approach is preferable.
Histological
confirmation of ganglion cells at time of surgery is recommended.
PMID:
2042071 [PubMed - indexed for MEDLINE]
342:
Br J Surg 1991 Mar;78(3):279-83
Comment
in:
Br J Surg. 1991 Aug;78(8):1019-20.
Br J Surg. 1991 Jun;78(6):761.
Br J Surg. 1991 Nov;78(11):1401.
Surgical
management of primary hyperhidrosis.
Moran
KT, Brady MP.
University
Department of Surgery, Regional Hospital, Cork, Ireland.
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. Iontophoresis may provide relief especially
in
patients with plantar or palmar involvement. In severe cases operative
intervention
is necessary. Excision of sweat glands is successful in patients
with
axillary hyperhidrosis but the role of suction-assisted removal of axillary
sweat
glands remains to be determined. Sympathectomy remains the standard by
which
other treatments must be judged. 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.
Publication
Types:
Review
Review,
Tutorial
PMID:
2021839 [PubMed - indexed for MEDLINE]
343:
JAMA 1991 Feb 6;265(5):651
Hyperhidrosis.
Sato
K.
University
of Iowa Medical School, Iowa City.
PMID:
1987421 [PubMed - indexed for MEDLINE]
344:
Br J Surg 1991 Feb;78(2):252
Comment
on:
Br J Surg. 1990 Sep;77(9):1046-9.
Endoscopic
transthoracic electrocautery of the sympathetic chain for palmar and
axillary
hyperhidrosis.
Cameron
A.
Publication
Types:
Comment
Letter
PMID:
2015492 [PubMed - indexed for MEDLINE]
345:
J R Soc Med 1991 Feb;84(2):114-5
Thoracic
endoscopic sympathectomy for palmar hyperhidrosis in an adolescent
female.
Salob
SP, Atherton DJ, Kiely EM.
Department
of Dermatology, Hospital for Sick Children, London.
PMID:
1999811 [PubMed - indexed for MEDLINE]
346:
Br J Surg 1990 Dec;77(12):1435
Comment
on:
Br J Surg. 1990 Sep;77(9):1046-9.
Endoscopic
transthoracic electrocautery of the sympathetic chain for palmar and
axillary
hyperhidrosis .
Banerjee
AK, Edmonson R, Rennie JA.
Publication
Types:
Comment
Letter
PMID:
2276033 [PubMed - indexed for MEDLINE]
347:
Lakartidningen 1990 Oct
10;87(41):3318-9
[Endoscopic
thoracic sympathectomy. A surgical method employed in severe hand
sweating]
[Article
in Swedish]
Gothberg
G, Hyltander A, Claes G.
Sahlgrenska
sjukhuset, Goteborg.
PMID:
2233003 [PubMed - indexed for MEDLINE]
348:
J Invest Dermatol 1990 Oct;95(4):393-6
The
innermost cell layer of the outer root sheath is positive with Ki-67.
Miyauchi
S, Hashimoto K, Miki Y.
Department
of Dermatology, University of Ehime, School of Medicine, Japan.
The
expression of a cell proliferation-associated human nuclear antigen was
immunohistochemically
studied in human anagen hair and hair follicles using the
monoclonal
antibody Ki-67. The reaction of Ki-67 in mature anagen hair follicles
was
observed in the hair matrix cells and outer root sheath (ORS) cells. Nuclear
staining
was seen in a small number of matrix cells and in some ORS cells; this
finding
corresponded to the thymidine or bromodeoxyuridine labeling studies
previously
reported. In addition, there were two different patterns of
cytoplasmic
staining in the ORS: strong staining of the innermost cells (IMC)
and
weaker staining of the other ORS cells in the isthmus. Ki-67 reactivity of
the
IMC layer was observed at each stage of anagen and was regularly seen from
the
upper bulb to the isthmus. Ki-67 is a commercially available antibody that
detects
cycling cells. However, the IMCs in anagen hair follicles showed
cytoplasmic
labeling by Ki-67 from the matrix cells in the upper bulb to the
distal
portion of the isthmus.
PMID:
2212724 [PubMed - indexed for MEDLINE]
349:
Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 1990 Oct;153(4):400-3
Palmar
hyperhidrosis CT guided chemical percutaneous thoracic sympathectomy.
Adler
OB, Engel A, Rosenberger A, Dondelinger R.
Department
of Diagnostic Radiology, Rambam Medical Center, Faculty of Medicine,
Technion-Israel
Institute of Technology, Haifa.
Palmar
hyperhidrosis or excessive sweating of the hands causes, to those
affected,
emotional and physical disturbance and impediment in professional and
social
life. The cause is unknown. Sweat glands are innervated by the
sympathetic
chain of the autonomous nervous system. The center of sympathetic
regulation
of the upper extremities is located between the segments of D.2-D.9
of
the spinal cord. Accepted treatment consists of surgery aimed to excise the
third
thoracic sympathetic ganglion. Besides the surgical procedure as such, and
its
complications, there are complications inherent to the excision of the
ganglion.
These are Horner's syndrome, compensatory sweating in other parts of
the
body, and recurrence of sweating. CT guided chemical percutaneous thoracic
sympathectomy
presents an alternative, which in the event of failure does not
prevent
ensuing surgery. The preliminary experience with this procedure in 50
patients
is presented and discussed.
PMID:
2171085 [PubMed - indexed for MEDLINE]
350:
Ugeskr Laeger 1990 Sep
24;152(39):2863-4
[Hyperhidrosis.
Hypnotherapy of 2 patients with hyperhidrosis]
[Article
in Danish]
Zachariae
B, Bjerring P.
Psykologisk
Institut, Aarhus Universitet.
Two
cases of hypnotherapeutic treatment of psychogenic hyperhidrosis are
presented.
In both cases, organic aetiology could be excluded and conventional
medical
treatment modalities had no effect. In both cases, it was possible to
modulate
sweating in the trance state within less than a minute, thus supporting
other
reported cases of the effect of hypnotically induced modulation of
autonomic
responses. In the first case the psychological dynamics behind the
physiological
symptoms seemed unrelated to fundamental emotional and personal
problems
and relaxation and conditioning techniques in hypnosis had a positive
effect
in reducing the sweating to both objectively and subjectively socially
acceptable
standards. In the second case the hyperhidrosis was related to more
fundamental
personality problems and short term hypnotherapy proved ineffective
in
treating the condition.
PMID:
2219522 [PubMed - indexed for MEDLINE]
351:
Br J Surg 1990 Sep;77(9):1046-9
Comment
in:
Br J Surg. 1990 Dec;77(12):1435.
Br J Surg. 1991 Feb;78(2):252.
Br J Surg. 1991 Jun;78(6):760.
Br J Surg. 1991 May;78(5):635.
Endoscopic
transthoracic electrocautery of the sympathetic chain for palmar and
axillary
hyperhidrosis.
Byrne
J, Walsh TN, Hederman WP.
Department
of Surgery, Mater Misericordiae Hospital, Dublin, Ireland.
Endoscopic
transthoracic electrocautery of the sympathetic chain has been the
preferred
treatment for palmar or axillary hyperhidrosis in this unit since
1980.
A retrospective study was carried out of the first 112 patients with case
material
derived from a postal questionnaire, chart review and outpatient
assessment.
Eighty-five patients undergoing bilateral transthoracic
electrocautery
who replied to the questionnaire (76 per cent response rate) form
the
basis of this study. There were 65 females and 20 males with a mean age of
24.3
years (range 15-40 years). The hands alone were affected in 20 patients (24
per
cent), the axillae alone in 17 (20 per cent) and both areas in 48 (56 per
cent).
Mean hospital stay was 3.1 days (range 1-7 days). Outcome was assessed by
92
per cent of patients immediately after operation as 'very much improved' or
'moderately
improved', and this assessment persisted in 85 per cent after a mean
follow-up
of 43 months (range 3-95 months). Cosmetic results were rated as
satisfactory
by 95 per cent. Apart from pain after operation, morbidity was
limited
to transient Horner's syndrome in three patients, surgical emphysema in
three,
and pneumothorax requiring a chest drain in one. A repeat procedure was
needed
in one patient because of an inadequate first operation. Some
compensatory
hyperhidrosis occurred in 54 (64 per cent) patients. As a minimally
invasive
procedure, endoscopic transthoracic electrocautery should be considered
the
treatment of choice for palmar and axillary hyperhidrosis.
PMID:
2131796 [PubMed - indexed for MEDLINE]
352:
J Formos Med Assoc 1990 May;89(5):403-5
Bilateral
simultaneous transaxillary sympathectomy in treatment of palmar
hyperhidrosis:
report of 60 cases.
Chao
C, Lin HE, Lo WT, Hung SY.
Department
of Surgery, Naval General Hospital, Tsoying, Kaohsiung.
Bilateral
simultaneous transaxillary sympathectomies (BSTS) were established in
order
to achieve a one-stage transaxillary sympathectomy in the treatment of
palmar
hyperhidrosis. The features of the BSTS were the patient's supine
operative
position, parapectoral incision, and bilateral simultaneous
procedures.
BSTS were safely performed on 60 patients during a 5-year period. No
serious
complications or recurrences were encountered. The clinical results
suggest
that BSTS is the technique of choice for one-stage transaxillary
sympathectomy
in the treatment of palmar hyperhidrosis.
PMID:
1977853 [PubMed - indexed for MEDLINE]
353:
J Am Acad Dermatol 1990
Apr;22(4):699-700
Comment
on:
J Am Acad Dermatol. 1989 May;20(5 Pt
1):713-26.
Biology
of the sweat glands.
Tapper
R.
Publication
Types:
Comment
Letter
PMID:
2319034 [PubMed - indexed for MEDLINE]
354:
Neurology 1990 Mar;40(3 Pt 1):556-7
A
syndrome of hyperhidrosis, hypothermia, and bradycardia possibly due to
central
monoaminergic dysfunction.
Arroyo
HA, Di Blasi AM, Grinszpan GJ.
Hospital
Nacional de Pediatrics Prof. Dr. Juan P. Garrahan, Buenos Aires,
Argentina.
PMID:
2314606 [PubMed - indexed for MEDLINE]
355:
Neth J Med 1990 Feb;36(1-2):53-7
Orthostatic
hypotension caused by sympathectomies performed for hyperhidrosis.
van
Lieshout JJ, Wieling W, Wesseling KH, Endert E, Karemaker JM.
Department
of Medicine, Academic Medical Centre, University of Amsterdam.
We
studied sympathetic cardiovascular control in a patient after sympathectomies
and
found severe hypoadrenergic orthostatic hypotension before and after, but
not
during upright exercise. This report is the first to correlate in man
anatomical
sympathetic lesions with autonomic function test results and to
document
that in a sequence of sympathectomies orthostatic hypotension does not
develop
until the major part of splanchnic sympathetic outflow is destroyed.
PMID:
2314521 [PubMed - indexed for MEDLINE]
356:
Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir 1990;:1325-31
[Surgical
thoracoscopy]
[Article
in German]
Wittmoser
R.
Institut
fur Neurovegetative Chirurgie und Endoskopie, Dusseldorf.
Thoracoscopic
adhesiolysis since 1913 (Jacobaeus). Thoracoscopic targets:
Sympathetic
system, vagus system, lymphatic system, lung. Indications: Arterial
circulation
disturbances, posttraumatic reflexdystrophy ("Sudeck"),
Hyperhidrosis
syndromes, erythrodermy syndromes; pain syndromes: causalgiform,
splanchnicotomy
for chronic pancreatitis. For peptic jejunal ulcer thoracoscopic
splanchnico-vagotomy.
For bronchial asthma selective vagotomy of bronchial rami.
Operative
techniques. Hemostasis: low-frequency thermocoagulation, unipolar and
bipolar
high-frequency coagulation, with thermostabilisation. Videoendoscopy
with
minicameras. Electronic frame freezing for colour slides.
PMID:
1983538 [PubMed - indexed for MEDLINE]
357:
Surg Endosc 1990;4(4):224-6
A
new method of thoracoscopic sympathectomy in hyperhidrosis palmaris.
Lin
CC.
Department
of Surgery, Tainan Municipal Hospital, Taiwan, Republic of China.
Although
hyperhidrosis palmaris is a benign condition, it may cause considerable
psychological,
social, and occupational disturbances. There are many
conservative
measures used to treat hyperhidrosis, but surgical sympathectomy is
the
only permanent cure. Of the various surgical approaches to the upper
thoracic
sympathetic ganglia, one must select the approach that combines good
functional
results and a satisfactory cosmetic outcome with only minor
complications.
Twenty-one patients (10 men and 11 women) with hyperhidrosis
palmaris
underwent synchronous bilateral T2 sympathectomy between 1 October 1989
and
30 April 1990. These patients underwent a new method of thoracoscopic
sympathectomy
without preoperative pneumothorax. All were relieved of excessive
sweating
in their upper extremities immediately after the operation. In
addition,
the technique led to significant savings in operation and
hospitalization
time. We recommend thoracoscopic sympathectomy as the best
approach
for sympathectomy in cases of hyperhidrosis palmaris.
PMID:
2291165 [PubMed - indexed for MEDLINE]
358:
Arch Phys Med Rehabil 1989 Jul;70(7):544-6
Management
of reflex sweating in spinal cord injured patients.
Staas
WE Jr, Nemunaitis G.
Department
of Rehabilitation Medicine, Thomas Jefferson University,
Philadelphia,
PA.
Reflex
sweating can be a problem for cervical spinal cord injured patients.
Patient
comfort and skin breakdown have been the major concerns. Five patients
were
studied prospectively, using a patch containing 1.5mg of scopolamine.
Patches
were changed every third day. Each patient was carefully monitored
before
and after application of the patch for signs and symptoms of
anticholinergic
side effects such as dizziness, blurred vision and dry mouth.
Patients
were also monitored for changes in patch signs before and after use,
including
residual urine volumes, blood pressure, heart rate, and mental status.
Our
study indicates that topical scopolamine successfully controlled reflex
sweating
in 5 patients without anticholinergic side effects.
PMID:
2742472 [PubMed - indexed for MEDLINE]
359:
J Am Acad Dermatol 1989 May;20(5 Pt
1):713-26
Comment
in:
J Am Acad Dermatol. 1990 Apr;22(4):699-700.
Biology
of sweat glands and their disorders. II. Disorders of sweat gland
function.
Sato
K, Kang WH, Saga K, Sato KT.
Marshall
Dermatology Research Laboratories, University of Iowa College of
Medicine,
Iowa City 52242.
Part
I of this article (J Am Acad Dermatol 1989; 20:537-63) focused on normal
sweat
gland function. Part II provides a discussion of hyperhidrosis and
hypohidrosis.
Hyperhidrotic disorders affect the palms and soles and the axillae
and
are associated with previous spinal cord injuries, peripheral neuropathies,
brain
lesions, intrathoracic neoplasms, systemic illness, and gustatory
sweating.
Hypohidrotic disorders include anhidrotic ectodermal dysplasia,
hereditary
sensory neuropathy, Holmes-Adie syndrome, and generalized anhidrosis.
Publication
Types:
Review
Review,
Tutorial
PMID:
2654213 [PubMed - indexed for MEDLINE]
360:
J Am Acad Dermatol 1989
Apr;20(4):537-63
Biology
of sweat glands and their disorders. I. Normal sweat gland function.
Sato
K, Kang WH, Saga K, Sato KT.
Marshall
Dermatology Research Laboratories, University of Iowa College of
Medicine,
Iowa City 52242.
The
basic mechanisms of sweat gland function and an updated review of some
relatively
common disorders of sweat secretion, are presented. Although sweat
secretion
and ductal absorption are basically biophysical and biologic cellular
processes,
a detailed description of the basic biophysical principles of
membrane
transport has been avoided to make the discussion more readable. The
cited
references will, however, help those readers primarily interested in the
basic
details of sweat gland function. Part I of this article includes a
discussion
of morphologic characteristics, central and peripheral nervous
control
of sweat secretion, neurotransmitters, intracellular mediators and
stimulus
secretion coupling, Na-K-Cl cotransport model for the ionic mechanism
of
sweat secretion, ingredients of sweat, ductal function, the pathogenesis of
abnormal
sweat gland function in cystic fibrosis, and the discovery of the
apoeccrine
sweat gland. Part II, to be published in the May issue of the
Journal,
reviews reports of all those major disorders of hyperhidrosis and
hypohidrosis
that have appeared in the literature during the past 10 years. It
is
hoped that this review will serve as a resource for clinicians who encounter
puzzling
disorders of sweating in their patients, as well as for investigators
who
wish to obtain a quick update on sweat gland function.
Publication
Types:
Review
Review,
Academic
PMID:
2654204 [PubMed - indexed for MEDLINE]
361:
J Fam Pract 1989 Apr;28(4):412-5
Hyperhidrosis:
a management dilemma.
Manusov
EG, Nadeau MT.
475th
Medical Group, Yokota Air Base, Japan.
Hyperhidrosis
is excessive sweating in response to psychological stress and
emotional
stimuli. The sweat is usually limited to the palms, soles, and
axillae,
and is greatly accentuated by mental stimuli rather than temperature
and
exercise. The severity is such that for many, sweating has become socially
and
emotionally devastating and may predispose to other cutaneous diseases. More
than
60 research papers on eccrine glands and sweating have been published since
1978.
Little progress, however, has been made on the control of hyperhidrosis,
and
the process remains a treatment dilemma among both family physicians and
dermatologists.
The many treatment modalities documented in the literature have
been
for the most part unsuccessful or unacceptable. This report describes the
use
of phenoxybenzamine, an alpha-adrenergic antagonist, for control of
excessive
sweating in two patients. After a trial of topical medication,
phenoxybenzamine
is useful for the reduction of sweating to an acceptable level.
PMID:
2703812 [PubMed - indexed for MEDLINE]
362:
Neurosurgery 1989 Mar;24(3):449-52
Electrophysiological
aid in high thoracic sympathectomy for palmar
hyperhidrosis.
Lindquist
C, Fedorcsak I, Steig PE.
Department
of Neurosurgery, Karolinska Institute, Stockholm, Sweden.
High
upper thoracic sympathectomy using microsurgical techniques aided by
electrical
stimulation of the sympathetic chain is described. Use of the
microscope
facilitates identification and dissection of the sympathetic chain
and
minimizes the risk of pleural damage. Electrical stimulation of the
sympathetic
chain establishes the correct functional level for surgical
excision.
At the correct level, the threshold for piloerection, sudomotor
response,
and decrease in blood flow of the ipsilateral hand to electrical
stimulation
was minimal, and a six-fold increase in stimulus current causing
current
spread was required to dilate the ipsilateral pupil. After
identification
of the proper level, surgical excision can be done without
risking
postoperative Horner's syndrome. Excision of the appropriate ganglia and
intervening
sympathetic chain with placement of surgical clips on the proximal
and
distal nerve stumps provides tissue for histological analysis, decreases the
opportunity
for regeneration, and facilitates localization on postoperative
x-rays.
PMID:
2927620 [PubMed - indexed for MEDLINE]
363:
Pneumologie 1989 Feb;43(2):107-8
[Thoracoscopic
sympathectomy in hyperhidrosis]
[Article
in German]
Toomes
H, Linder A.
The
effectivity of sympathectomy performed via thoracoscopy as initiated by Kux,
has
been confirmed by examining two cases reported here.
PMID:
2717549 [PubMed - indexed for MEDLINE]
364:
Ann R Coll Surg Engl 1989
Jan;71(1):70-1
Transthoracic
sympathectomy for palmar hyperhidrosis in children under 16 years
of
age.
Law
NW, Ellis H.
Professorial
Surgical Unit, Westminster Hospital, London.
Palmar
hyperhidrosis can be a disabling condition in children. We report the
results
of transthoracic sympathectomy in 18 children aged 16 years or under.
Follow-up,
1 to 11 years after surgery, revealed a high incidence of late
sequelae,
but these were not significant when compared to the primary condition.
Transthoracic
sympathectomy is recommended for children with severe palmar
hyperhidrosis.
PMID:
2923427 [PubMed - indexed for MEDLINE]
365:
Practitioner 1988 Sep 8;232(1454 ( Pt
1)):953-6
Comment
in:
Practitioner. 1989 Jun 22;233(1471):895.
Treating
hyperhidrosis.
Grice
K.
Publication
Types:
Review
Review,
Tutorial
PMID:
3076945 [PubMed - indexed for MEDLINE]
366:
Br Med J (Clin Res Ed) 1988 May
14;296(6633):1345
Treating
hyperhidrosis.
Simpson
N.
Glasgow
Royal Infirmary.
PMID:
3134977 [PubMed - indexed for MEDLINE]
367:
Surgery 1988 May;103(5):568-72
Dorsal
sympathectomy for hyperhidrosis--the posterior paravertebral approach.
Golueke
PJ, Garrett WV, Thompson JE, Talkington CM, Smith BL.
Department
of Surgery, Baylor University Medical Center, Dallas, Texas.
Definitive
therapy for hyperhidrosis is sympathectomy. The authors have used a
posterior
approach to perform 36 dorsal sympathectomies for upper extremity
hyperhidrosis
in 18 patients (12 female, 6 male). All 18 patients suffered from
excessive
sweating of the upper extremity (17 palmar, 1 axillary) that caused
significant
psychological and occupational problems. Eleven patients (61.1%) had
lower
extremity involvement as well. For all 18 patients conservative medical
treatment
had failed. Bilateral operations were performed, via a posterior
extrapleural
approach, through the bed of the third rib. All 36 limbs were
relieved
of excess sweating. There were no deaths and only two minor wound
complications.
In no patient did Horner's syndrome develop. Long-term follow-up
did
not reveal any recurrence of hyperhidrosis. Two patients did complain of
compensatory
hyperhidrosis of the lower extremities. Dorsal sympathectomy was
effective
in all of the patients with upper extremity hyperhidrosis in this
series.
The posterior approach is technically simple, allows simultaneous
bilateral
operations, and is associated with only infrequent minor
complications.
PMID:
3363492 [PubMed - indexed for MEDLINE]
368:
Neurosurgery 1988 Mar;22(3):600-4
New
stereotactic technique for percutaneous thermocoagulation upper thoracic
ganglionectomy
in cases of palmar hyperhidrosis.
Chuang
KS, Liou NH, Liu JC.
Department
of Surgery, National Defense Medical Center, Taipei, Taiwan, Republic
of
China.
To
perform unilateral or bilateral upper thoracic ganglionectomy, we established
a
three-dimensional system of coordinates for T2 and T3 ganglia. For this
purpose,
the spatial relations were represented by drawings obtained from 50
Chinese
cadavers. A simple stereotactic frame was constructed as an aid in
performing
the procedure. Then, according to the established three-dimensional
system
of coordinates, percutaneous thermocoagulation of both T2 and T3 ganglia
was
performed on 10 patients (20 sides) with palmar hyperhidrosis, under local
anesthesia
and fluoroscopic guidance at the posteroanterior projection.
Excellent
relief of abnormal sweating in 19 of the 20 hands was achieved.
Partial
relief was obtained in the remaining hand. No complication was observed
in
our patients. The technique has been proved to be safe, effective, and
simpler
than other methods now in use.
PMID:
3283596 [PubMed - indexed for MEDLINE]
369:
Dig Dis Sci 1988 Feb;33(2):157-60
Effects
of upper dorsal sympathectomy on esophageal motility in humans.
Soffer
EE, Schneiderman J, Schwartz I, Halpern Z, Adar R, Weissberg D, Bar-Meir
S.
Department
of Gastroenterology, Edith Wolfson Hospital, Holon, Israel.
To
evaluate the role of the sympathetic nervous system in modulating esophageal
motility,
esophageal manometry was performed on two groups of patients who
underwent
upper dorsal sympathectomy for relief of palmar hyperhydrosis. In six
patients
sympathectomy was done by the supraclavicular approach, with removal of
T2
and T3 ganglia. Manometry was performed before the operation and three weeks
after
it. In seven other patients sympathectomy was done by the axillary
approach,
with removal of T2-T4 ganglia. Manometry in this group was performed
28.4
+/- 22.4 months after the operation. Fifteen individuals with an intact
sympathetic
system served as controls. Manometric parameters evaluated were
esophageal
contraction amplitude and duration and lower esophageal sphincter
pressure.
The difference between the results obtained in the pre- and
postoperative
periods in the first group was not statistically significant. The
differences
between the two patient groups and between the patient groups and
the
control group were not statistically significant either. We conclude that
upper
dorsal sympathectomy does not affect esophageal motility in man.
PMID:
3338363 [PubMed - indexed for MEDLINE]
370:
Ann Dermatol Venereol
1988;115(10):1063-6
[Treatment
of hyperhidrosis]
[Article
in French]
Lazareth
I, Priollet P.
Service
de Pathologie vasculaire et de Medecine interne, Hopital Broussais,
Paris.
PMID:
3232914 [PubMed - indexed for MEDLINE]
371:
ORL J Otorhinolaryngol Relat Spec
1988;50(4):246-50
Nasal
obstruction after cervical sympathectomy: Horner's syndrome revisited.
Whittet
HB, Fisher EW.
Royal
National Throat, Nose and Ear Hospital, London, UK.
Horner's
syndrome (cervical sympathetic paralysis) typically includes ptosis,
miosis,
enophthalmos and facial anhidrosis. However, the effect of sympathetic
denervation
upon the nasal mucosa should be included as a prominent feature,
since
nasal obstruction is often the most disabling sequel. The anatomical,
physiological,
and historical basis is discussed and surgical management
suggested.
PMID:
3174078 [PubMed - indexed for MEDLINE]
372:
Gaoxiong Yi Xue Ke Xue Za Zhi 1987
Nov;3(11):703-7
Long-term
follow up of upper dorsal sympathetic ganglionectomy for palmar
hyperhidrosis--a
scale of evaluation.
Howng
SL, Loh JK.
PMID:
3482266 [PubMed - indexed for MEDLINE]
373:
S Afr Med J 1987 Oct 17;72(8):538-9
Surgical
management of patients with hyperhidrosis.
Cilliers
PH.
Department
of Surgery, University of the Orange Free State, Bloemfontein.
Eighteen
patients with hyperhidrosis affecting different anatomical areas were
treated
with a variety of surgical methods. Bilateral axillary gland excision is
an
appropriate and cosmetically acceptable method of treating axillary
hyperhidrosis
(11 patients). Bilateral supraclavicular cervical sympathectomy
was
performed for excessive sweating of the hands (7 patients). Bilateral lumbar
sympathectomy
was necessary in only 3 patients with excessive sweating of the
feet.
When perineal hyperhidrosis is present, the first lumbar ganglia must be
excised.
Transaxillary, transpleural sympathectomy, removing the first to fourth
thoracic
ganglia, is successful in treating failures of sweat gland excision or
troublesome
sweating of hands and axillae.
PMID:
3672271 [PubMed - indexed for MEDLINE]
374:
Clin Physiol 1987 Oct;7(5):403-9
A
comparison between 133Xenon washout technique and Laser Doppler flowmetry in
the
measurement of local vasoconstrictor effects on the microcirculation in
subcutaneous
tissue and skin.
Kastrup
J, Bulow J, Lassen NA.
Department
of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital,
Copenhagen,
Denmark.
Changes
in skin blood flow measured by Laser Doppler flowmetry and changes in
subcutaneous
blood flow measured by 133Xenon washout technique were compared
during
activation of the local sympathetic mediated veno-arteriolar
vasoconstrictor
reflex by lowering the area of investigation below heart level.
The
measurements were performed in tissue with and without sympathetic
innervation.
In five subjects, who all had been cervically sympathectomized for
manual
hyperhidrosis, the Laser Doppler and 133Xenon blood flow measurements
were
performed simultaneously on the sympathetically denervated forearm, and on
the
calf with preserved sympathetic nerve supply. The Laser Doppler method
registered
a 23% reduction in skin blood flow during lowering of the extremities
independently
of the sympathetic nerve supply to the skin. The 133Xenon method
recorded
a 44% decrease in blood flow in innervated and unchanged blood flow in
denervated
subcutaneous tissue during lowering of the extremities. Our results
indicate
that the Laser Doppler method and 133Xenon method are not comparable,
and
that the Laser Doppler method is not useful in measuring local sympathetic
mediated
blood flow changes.
PMID:
2959430 [PubMed - indexed for MEDLINE]
375:
Acta Radiol 1987 Sep-Oct;28(5):511-5
Percutaneous
phenol block of the upper thoracic sympathetic chain with computed
tomography
guidance. A new technique.
Dondelinger
RF, Kurdziel JC.
Department
of Radiology, Centre Hospitalier, Luxembourg.
Twenty-one
percutaneous neurolyses of the upper thoracic sympathetic chain were
performed
in 12 patients with CT guidance by a single injection of 1 to 3 ml of
phenol
at the level of Th3. Results were assessed after a follow-up period
varying
from 4 to 33 months. Three patients with hyperhidrosis had immediate and
complete
disappearance of symptoms, but only one patient remained dry. In 7/14
procedures
done for Raynaud's disease symptoms disappeared or diminished. These
long
term results are competitive with surgery. Three transitory Horner
syndromes
and one pneumothorax occurred.
PMID:
2960340 [PubMed - indexed for MEDLINE]
376:
Arch Dermatol 1987 Jul;123(7):883-4
Treatment
of hyperhidrosis.
Dobson
RL.
Publication
Types:
Editorial
PMID:
3606165 [PubMed - indexed for MEDLINE]
377:
Arch Dermatol 1987 Jul;123(7):925-9
Emotional
eccrine sweating. A heritable disorder.
James
WD, Schoomaker EB, Rodman OG.
A
family with hereditary emotional hyperhidrosis is described. The inheritance
pattern
is autosomal dominant. A simple quantitative palmar sweat test was used
to
objectively confirm historical data. Of two family members tested, both had a
marked
decrease in palmar sweat secretion during administration of diltiazem, a
calcium-channel
blocker. Additional studies in a large group of patients are
needed
to extend this observation.
PMID:
3606171 [PubMed - indexed for MEDLINE]
378:
Br J Surg 1987 Jul;74(7):651
Upper
dorsal sympathectomy for palmar hyperhidrosis.
Conlon
KC, Keaveny TV.
PMID:
3620881 [PubMed - indexed for MEDLINE]
379:
Hawaii Med J 1987 Jul;46(7):238, 259-60
Erratum
in:
Hawaii Med J 1987 Oct;46(10):372. Tsuhima
WT[corrected to Tsushima WT]
Behavioral
treatment of palmar hyperhidrosis.
Tsushima
WT, Glamb RW, Pang DB, Tsuhima WT.
PMID:
3305418 [PubMed - indexed for MEDLINE]
380:
Ann Surg 1986 Dec;204(6):715-8
Cardiovascular
changes after bilateral upper dorsal sympathectomy. Short- and
long-term
effects.
Papa
MZ, Bass A, Schneiderman J, Drori Y, Tucker E, Adar R.
The
effect of bilateral upper dorsal sympathectomy (UDS) on cardiac function was
investigated
in two groups of young healthy patients who underwent bilateral
excision
of T2 and T3 ganglia for palmar hyperhidrosis. In ten patients
echocardiography
of left ventricular function (LVF) was performed before
operation
and 2 weeks after operation. Electrocardiograms (ECG) were done before
operation,
during operation immediately after sectioning each sympathetic chain,
and
at 2 weeks after operation. The mean pulse rate decreased significantly in
patients
after they underwent bilateral UDS. There were no clinical arrhythmias
or
changes in LVF in any patient. Submaximal exercise testing and ECG tracings
done
at rest and after effort were obtained for 29 patients before undergoing
bilateral
UDS, 30 days after operation, and 1-3 more times within a 2-year
postoperative
period. Pulse rates taken at rest and after effort were
significantly
lower than those taken after operation, and the blood pressure
response
to exercise was blunted. ECG tracings showed a significant change in
the
electrical frontal plane axis and shortening of the QTc interval. These
changes
were evident 30 days after operation and persisted for 2 years. In
conclusion,
bilateral UDS has no overt arrhythmogenic effect in the young,
healthy
heart and its beta-blocker-like effect persists for at least 2 years.
PMID:
3789841 [PubMed - indexed for MEDLINE]
381:
Mayo Clin Proc 1986 Dec;61(12):951-6
Treatment
of primary hyperhidrosis.
White
JW Jr.
Primary
hyperhidrosis is a physically and emotionally distressing condition.
Physicians
should be aware of the various treatment modalities available for
controlling
or reducing the profuse sweating, which involves mainly the palms,
soles,
and axillas. The simplest methods, such as topical application of
aluminum
chloride, should be attempted first. If topical medications are
ineffective,
iontophoresis may provide relief, especially in patients with
plantar
or palmar involvement. When patients are unresponsive to other treatment
options,
surgical intervention may be warranted-excision of sweat glands in
patients
with axillary hyperhidrosis and upper thoracic sympathectomy in those
with
palmar involvement. Although excellent results have been reported,
complications
and resumption of sweating have occurred.
PMID:
3095597 [PubMed - indexed for MEDLINE]
382:
Clin Exp Dermatol 1986 Nov;11(6):543-52
Characterization
and quantification of sweating in a systemic hyperhidrotic
patient.
Kenney
MJ, Owen MD, Wall PT, Gisolfi CV.
PMID:
3665143 [PubMed - indexed for MEDLINE]
383:
Ann R Coll Surg Engl 1986 Sep;68(5):292-3
Endoscopic
thoracic sympathectomy in the treatment of upper limb hyperhydrosis.
Publication
Types:
Letter
PMID:
3789630 [PubMed - indexed for MEDLINE]
384:
Br J Dermatol 1986 Jul;115(1):81-4
The
surgical treatment of upper limb hyperhidrosis.
Malone
PS, Cameron AE, Rennie JA.
Primary
hyperhidrosis is a common and poorly understood condition. Surgical
thoracic
sympathectomy, either by the cervical or transaxillary route, entails
major
surgery, so there is a tendency to offer this only to those most severely
affected.
Endoscopic thoracic sympathectomy is a simple, safe and effective
procedure.
The technique and results are described and it is recommended as the
appropriate
procedure for treating upper limb hyperhidrosis, including localized
axillary
sweating.
PMID:
3730280 [PubMed - indexed for MEDLINE]
385:
Br J Hosp Med 1986 Feb;35(2):124-5
Lumbar
sympathectomy.
Ellis
H.
Lumbar
sympathectomy is used in patients with threatened or early gangrene of
the
toes where reconstructive arterial surgery is not possible--usually because
arteriography
has demonstrated absence of a "run off" suitable for
endarteriectomy
or a bypass graft. It may also be a supplement to reconstructive
surgery
of the aorta or the common iliac arteries. It is indicated in
intractable
Raynaud's disease affecting the feet and is particularly helpful in
severe
hyperhidrosis of the feet. In many cases the procedure can be performed
nonoperatively
by chemical sympathectomy using an injection of aqueous phenol
into
the lumbar chain.
PMID:
3730665 [PubMed - indexed for MEDLINE]
386:
Acta Neurochir (Wien)
1986;81(3-4):128-31
Hyperhidrosis
and its surgical treatment.
Gruszkiewicz
J, Doron Y, Guilburd JN, Zaaroor M.
111
sections of high thoracic sympathectomies in 60 cases suffering from primary
palmar
hyperhidrosis are reported. Surgical results and postoperative
complications
are discussed in detail. Complications were few in number and were
of
a transitory nature. No mortality occurred in our series. Various surgical
and
nonsurgical procedures of treatment are reviewed. Surgical intervention
remains
the treatment of choice in essential idiopathic hyperhidrosis.
PMID:
3751696 [PubMed - indexed for MEDLINE]
387:
Br J Hosp Med 1986 Jan;35(1):50-1
Transthoracic
sympathectomy.
Ellis
H.
Excision
of the upper thoracic sympathetic chain can be performed effectively
and
safely by a transthoracic approach. The most valuable indication is for
severe
idiopathic hyperhidrosis of the hands for which it produces a most
satisfactory
and lasting relief. It is also indicated for severe Raynaud's
phenomenon
that does not respond to conservative measures but here there is a
tendency
to progressive relapse following surgery so that only about half the
patients
show improvement several years later.
PMID:
3955290 [PubMed - indexed for MEDLINE]
388:
Cleve Clin Q 1986 Spring;53(1):83-8
Essential
hyperhidrosis. Current therapy.
Tabet
JC, Bay JW, Magdinec M.
PMID:
3708849 [PubMed - indexed for MEDLINE]
389:
Am J Surg 1985 Dec;150(6):762-6
Upper
dorsal sympathectomy.
Manart
FD, Sadler TR Jr, Schmitt EA, Rainer WG.
Over
a 20 year period, 60 patients underwent 76 procedures for upper dorsal
sympathectomy,
usually with a transaxillary approach but occasionally with an
anterior
approach. Procedures in male patients and in those that were carried
out
on the right side were most frequent. There were few simultaneous
procedures.
The extent of sympathectomy included resection of the lower half of
the
stellate ganglion through the fourth thoracic ganglion. The results were
satisfying
for patients with vasospastic disorders and hyperhidrosis and quite
acceptable
for those with causalgia and vaso-occlusive disorders. Complication
rates
and the incidence of postoperative Horner's syndrome were low. There were
prominent
differences in results among the various age groups. In addition,
female
patients and those with bilateral procedures had less favorable results.
Factors
that did not appear to affect results included technique of surgical
approach,
extent of sympathectomy, presence of Horner's syndrome, or the
addition
of other procedures. Current indications for upper dorsal sympathectomy
include
cases of Raynaud's and Buerger's diseases refractory to drug therapy,
causalgia,
vaso-occlusive disorders, and hyperhidrosis.
PMID:
4073370 [PubMed - indexed for MEDLINE]
390:
J R Coll Surg Edinb 1985
Aug;30(4):221-3
Transthoracic
endoscopic sympathectomy.
Milewski
PJ, Hodgson SP, Higham A.
PMID:
4057135 [PubMed - indexed for MEDLINE]
391:
Tex Med 1985 May;81(5):49-53
Palmar
hyperhidrosis.
Haar
FL, Rosen T, Fayle RW.
PMID:
4002174 [PubMed - indexed for MEDLINE]
392:
Acta Neurochir (Wien)
1985;74(3-4):152-3
Thoracodorsal
sympathectomy en bloc. Anatomical variations versus results.
Lemmens
HA, Drukker J.
PMID:
3984793 [PubMed - indexed for MEDLINE]
393:
Acta Neurochir (Wien)
1985;74(3-4):153-4
Treatment
of sweating and blushing by endoscopic surgery.
Wittmoser
R.
PMID:
3984794 [PubMed - indexed for MEDLINE]
394:
Acta Neurochir (Wien)
1985;74(3-4):154-5
"Gestalt"
therapy in blushing and sweating.
Siemens
H.
PMID:
3984795 [PubMed - indexed for MEDLINE]
395:
Neurosurgery 1984 Dec;15(6):811-4
Percutaneous
radiofrequency upper thoracic sympathectomy: a new technique.
Wilkinson
HA.
The
author describes a new technique for performing unilateral or bilateral
upper
thoracic sympathectomy safely, effectively, and more easily than by any of
the
surgical methods now in use. The technique described is one of percutaneous
radiofrequency
sympathectomy, which is usually done on a day surgery or
outpatient
surgery basis. The technique has been effective and well tolerated in
a
small group of patients.
PMID:
6514152 [PubMed - indexed for MEDLINE]
396:
N Engl J Med 1984 Jul 5;311(1):34-6
Radiofrequency
percutaneous upper-thoracic sympathectomy. Technique and review
of
indications.
Wilkinson
HA.
PMID:
6727962 [PubMed - indexed for MEDLINE]
397:
J R Coll Surg Edinb 1984
May;29(3):162-6
Modified
supraclavicular approach for upper thoracic sympathectomy.
Soliman
SM.
PMID:
6747921 [PubMed - indexed for MEDLINE]
398:
Hautarzt 1984 Mar;35(3):142-7
[Tap
water iontophoresis in the treatment of hyperhidrosis of the hands and
feet]
[Article
in German]
Holzle
E, Pauli M, Braun-Falco O.
Seven
patients with hyperhidrosis of the palms or soles resistant to topical
application
of aluminum chloride solution were treated successfully with tap
water
iontophoresis. After an average of 10 or 11 treatments 80% sweating
suppression
was found on palms and 74% suppression on soles. As side effects of
treatment
discomfort and transient skin irritation were observed depending on
the
amperage used. The effect lasts up to several weeks; however, maintenance
treatment
on an individual schedule is required.
PMID:
6715169 [PubMed - indexed for MEDLINE]
399:
J Vasc Surg 1984 Jan;1(1):202-14
Current
status of thoracic dorsal sympathectomy.
Welch
E, Geary J.
This
article summarizes over 20 years of experience (1962 to 1982) with cervical
sympathectomy
(thoracic dorsal sympathectomy) in 46 patients undergoing 68
sympathectomies.
All operations were performed through an anterior
supraclavicular
approach. Indications for surgery were intractable Raynaud's
disease
(26 patients), atherosclerotic obliterative arterial disease (five),
causalgia
(five), posttraumatic sympathetic dystrophy (seven), collagen vascular
disorders
(eight), hyperhidrosis (12), occupational-related digital thrombosis
(four),
and thrombosis secondary to intra-arterial injection (one). The
incidence
of complications and side effects, both temporary and permanent,
including
Horner's syndrome, is reviewed in detail. Particular reference is made
to
the various surgical techniques of managing the stellate ganglion; four
patients
had two-third to three-fourth resection of the stellate ganglion down
to
and including the T-3 thoracic ganglion, two had preservation of the stellate
ganglion
and resection of the T-2 through T-4 ganglia, seven had excision of the
entire
stellate ganglion down to and including the T-4 ganglion, seven had
resection
of the lower third of the stellate ganglion down to and including the
T-4
ganglion, and 48 had removal of the lower half of the stellate ganglion down
to
and including the T-3 ganglion. The study reviews the literature germane to
anatomic
considerations and suggests revisions in current texts and atlases. By
retrospective
analysis of the records and a follow-up questionnaire, which
provided
an 86% follow-up (average 8.4 years), the paper points to the
distinctive
clinical characteristics of the different groups within the
population
undergoing the operation and provides guidelines for patient
selection
and conclusions on the place for this operation in the management of
vascular
diseases involving the upper extremity.
PMID:
6481864 [PubMed - indexed for MEDLINE]
400:
Arch Surg 1983 Sep;118(9):1065-7
Surgical
treatment of primary hyperhidrosis. A report of 42 cases.
Bogokowsky
H, Slutzki S, Bacalu L, Abramsohn R, Negri M.
Forty-two
patients suffering from primary hyperhidrosis underwent upper dorsal
sympathectomy
using the supraclavicular approach. The postoperative course and
results
were devoid of complications. All the patients except one were satisfied
with
the results of surgery, which greatly improved the quality of their lives.
PMID:
6615216 [PubMed - indexed for MEDLINE]
401:
Ugeskr Laeger 1983 Aug
15;145(33):2536-8
[Treatment
of sweating]
[Article
in Danish]
Christensen
JD.
PMID:
6612879 [PubMed - indexed for MEDLINE]
402:
Anasth Intensivther Notfallmed 1983
Aug;18(4):174-6
[Endobronchial
ventilation in transthoracic endoscopic sympathectomy]
[Article
in German]
Eilenberger
K, Lackner F, Funovics J, Porges P.
Thoracic
endoscopic sympathectomy (TES) is a short surgical procedure used for
the
treatment of axillary and palmar hyperhydrosis. It involves creation of
tension
pneumothorax, lateral and head-up position and necessitates minimal lung
excursions
during breathing, so that a special anaesthetic technique is
required.
In six otherwise healthy patients an endobronchial double lumen tube
was
used for one-lung ventilation with intravenous anaesthesia and muscular
relaxation,
and circulatory response, FE CO2 and blood gases were monitored in
order
to compare this anaesthetic technique to conventional endotracheal
intubation
in previous patients. Some difficulties with inserting and securing
the
double lumen tube were encountered, but were far outweighed by the
advantages
of stable circulation, physiological blood gas values and easy access
to
a calm surgical field.
Publication
Types:
Clinical
Trial
Controlled
Clinical Trial
PMID:
6638418 [PubMed - indexed for MEDLINE]
403:
Harefuah 1983 Jun;104(11-12):533-4
[Palmar
hyperhidrosis--surgical treatment]
[Article
in Hebrew]
Mozes
M.
Publication
Types:
Editorial
PMID:
6680716 [PubMed - indexed for MEDLINE]
404:
J Auton Nerv Syst 1983 May;8(1):33-43
Autonomic
dysfunction in palmar hyperhidrosis.
Shih
CJ, Wu JJ, Lin MT.
The
autonomic (including sudomotor, baroreceptor, and vasomotor) functions were
assessed
in 3 groups of individuals, comprising normal, hyperhidrotic, and
denervated
subjects. The normal group had no palmar hyperhidrosis, with intact
T2-3
ganglia, the hyperhidrotic group had palmar hyperhidrosis with intact T2-3
ganglia,
and the denervated group had palmar hyperhidrosis treated with T2-3
ganglionectomy.
Compared with both the normal and hyperhidrotic subjects, the
denervated
subjects had a much smaller sweating response of both the forehead,
the
upper chest region and the upper extremities, and a much greater sweating
response
of both the lateral lumbar and ventral thigh regions in response to
body
exercise. In addition, cardiovascular responses to either the Valsalva
manoeuver,
face immersion, or finger immersion were evaluated in these groups of
subjects.
When compared with those of either the normal or the denervated
subjects,
the hyperhidrotic subjects had less reflex bradycardia in response to
either
Valsalva manoeuver or face immersion. In contrast, when compared with
those
of either the normal or the denervated subjects, the hyperhidrotic
subjects
had a higher degree of cutaneous vasoconstriction in response to finger
(or
cold) immersion. The data indicate that the sympathetic fibers passing
through
the T2-3 ganglia play an important role in the elaboration or modulation
of
autonomic function elsewhere. Probably, the hyperhidrotic subjects have an
over-functioning
of the sympathetic nervous fibers which pass through the T2-3
ganglia,
which leads to autonomic dysfunction. The autonomic dysfunctions
observed
in the hyperhidrotic subjects could be eliminated after the
interruption
of the excessive sympathetic activities passing through the T2-3
ganglia
level. A preliminary report of this work was delivered at the 15th
Congress
of the Pan-Pacific Surgical Association, January 12-18, 1980 and the
12th
World Congress of Neurology, September 20-25, 1981.
PMID:
6875200 [PubMed - indexed for MEDLINE]
405:
World J Surg 1983 May;7(3):437-9
Axillary
transpleural sympathectomy: indication, technique, and results.
Linder
F, Jenal G, Assmus H.
PMID:
6880233 [PubMed - indexed for MEDLINE]
406:
J R Coll Surg Edinb 1983
Mar;28(2):116-20
The
surgical treatment of associated axillary and palmar hyperhidrosis.
Kenawi
MM, El Mofty M, Wishahy AH.
PMID:
6864604 [PubMed - indexed for MEDLINE]
407:
Br Med J (Clin Res Ed) 1983 Feb
19;286(6365):580-1
Excessive
sweating of the palms and armpits.
Savin
JA.
Publication
Types:
Editorial
PMID:
6402154 [PubMed - indexed for MEDLINE]
408:
Isr J Med Sci 1983 Feb;19(2):112-5
Upper
dorsal sympathectomy for palmar hyperhidrosis.
Bass
A, Inovrotzlavski S, Adar R.
The
treatment results in 133 patients who underwent bilateral upper dorsal
sympathectomy
(BUDS) for palmar hyperhidrosis (HH) are reported. Group 1 (67
patients)
was followed for 5 to 10 yr (mean 7) and Group 2 (66 patients) was
followed
for 1 to 4 yr (mean 2). Early results and complications, early and late
sequelae,
late recurrence and patient satisfaction with the results of the
operation
were analyzed. The immediate success rate was 98%, and late recurrence
of
HH was noted in 5.3% of the patients. The incidence of technical
complications
was lower in Group 2 than in Group 1, otherwise both groups were
similar.
Persistent, severe Horner's syndrome was present in only one patient at
late
follow-up. Troublesome compensatory HH persisted in one-third of the
patients.
Overall patient satisfaction was good, and only 10 patients regretted
having
undergone the operation. BUDS appears to be the best solution for severe
palmar
HH in properly selected patients.
PMID:
6841033 [PubMed - indexed for MEDLINE]
409:
Annu Rev Med 1983;34:429-52
Sweating
and its disorders.
Quinton
PM.
Eccrine
sweat is produced by millions of miniscule glands buried in the skin.
Eccrine
sweating from the general body surface is an extremely important
function
in human thermoregulation; disturbances either in the control of
sweating
activity or in the glands themselves can result in problems ranging
from
minor social embarrassment to fatal hyperpyrexia. A general review of the
function
and control of normal sweating precedes an overview of sweating
abnormalities.
Publication
Types:
Review
PMID:
6344770 [PubMed - indexed for MEDLINE]
410:
Duodecim 1983;99(2):158-60
[Treatment
of hyperhidrosis]
[Article
in Finnish]
Hannuksela
M.
Publication
Types:
Review
PMID:
6347638 [PubMed - indexed for MEDLINE]
411:
Minerva Chir 1982 Sep 15;37(17):1369-72
[Complications
following thoracic gangliectomy. Analysis of cases]
[Article
in Italian]
Giordanengo
F, Odero A, Mingazzini P, Soleri V.
PMID:
7145146 [PubMed - indexed for MEDLINE]
412:
World J Surg 1982 Jul;6(4):458-63
Transaxillary
thoracic sympathectomy for primary hyperhidrosis of the upper
limbs.
Sternberg
A, Brickman S, Kott I, Reiss R.
PMID:
7123983 [PubMed - indexed for MEDLINE]
413:
Br J Surg 1982 Jun;69 Suppl:S29-31
Transaxillary
sympathectomy--is a one-stage bilateral procedure safe?
Campbell
WB, Cooper MJ, Sponsel WE, Baird RN, Peacock JH.
PMID:
7082970 [PubMed - indexed for MEDLINE]
414:
Chirurgie 1982;108(2):197-201
[Sympathectomy
in the palmar and plantar hyperhidrosis. Thirty seven operations]
[Article
in French]
Bouchet
A, Putot JP, Maurin T.
PMID:
7117025 [PubMed - indexed for MEDLINE]
415:
Ir Med J 1982 Jan;75(1):20-1
Transthoracic
electrocoagulation (T.T.E.C.)--a new and simple approach to upper
limb
sympathectomy.
Malone
PS, Duignan JP, Hederman WP.
PMID:
7085234 [PubMed - indexed for MEDLINE]
416:
Harefuah 1981 Oct;101(7-8):166-7
[Surgical
treatment of primary hyperhidrosis]
[Article
in Hebrew]
Bogokowsky
H, Abramsohn R, Bacalu L, Negri M.
PMID:
7333547 [PubMed - indexed for MEDLINE]
417:
Przegl Dermatol 1981
Sep-Dec;68(5-6):593-7
[Surgical
treatment of hyperhidrosis of the hands]
[Article
in Polish]
Smolarek
F, Olewinski J, Plachta H.
PMID:
7347413 [PubMed - indexed for MEDLINE]
418:
Psychosomatics 1981 Jun;22(6):536-8
Treatment
of essential hyperhidrosis by psychotherapy.
Lerer
B, Jacobowitz J.
PMID:
7255644 [PubMed - indexed for MEDLINE]
419:
Anaesthesist 1980 Nov;29(11):613-5
[Choice
of anaesthesia technique in thoracic endoscopic sympathectomy (author's
transl)]
[Article
in German]
Mauritz
W, Czech K, Funovics J, Lackner F, Porges P, Schemper M.
Thoracic
endoscopic sympathectomy (TES) is a short surgical procedure used for
the
treatment of palmar and axillary hyperhidrosis. It involves pneumothorax,
the
lateral and head up position, and necessitates minimal chest excursions
during
breathing, so that a special type of anaesthesia is required. In 13
patients
two different methods were compared and blood gas analysis as well as
circulatory
parameters were studied. We therefore propose an anaesthetic method
using
controlled mechanical ventilation; relaxation; intravenous anaesthesia; at
least
1 1 fluid replacement; and careful monitoring.
Publication
Types:
Clinical
Trial
Randomized
Controlled Trial
PMID:
7457801 [PubMed - indexed for MEDLINE]
420:
J Neurosurg 1980 Nov;53(5):684-9
Effects
of cholinomimetic drugs on sudomotor, metabolic, respiratory, vasomotor,
and
temperature response in palmar hyperhidrosis.
Shih
CJ, Lin MT.
The
effects of cholinomimetic drugs such as mecholyl (methacholine) and
pilocarpine
on autonomic functions (including sudomotor, metabolic, respiratory,
vasomotor,
and temperature responses) were assessed at room temperature (24
degrees
C) in three groups of individuals, including normal, hyperhidrotic, and
denervated
subjects. The normal group had no palmar hyperhidrosis, with intact
T2-3
ganglia, the hyperhidrotic group had palmar hyperhidrosis with intact T2-3
ganglia,
and the denervated group had palmar hyperhidrosis treated with T2-3
ganglionectomy.
Subcutaneous administration of mecholyl and pilocarpine each
produced
a fall in oral temperature in the normal group. The hypothermia was
brought
about by a decrease in metabolic rate, an increase in local sweating
rate
(mainly of the upper limb and trunk), and an increase in cutaneous
circulation
(estimated by an increase in the upper limb and trunk skin
temperatures).
The autonomic functions induced by these cholinomimetic drugs
were
antagonized by pretreatment with atropine sulfate (an antagonist of
cholinergic
receptors). Moreover, the hypothermia induced by mecholyl or
pilocarpine
was greatly reduced in the hyperhidrotic group. The reduction in the
cholinomimetic-induced
hypothermia in the hyperhidrotic group was due to the
reduced
sudomotor and metabolic responses after the injections of these
cholinomimetic
drugs, as compared to those of the normal group. However, neither
the
excessive sweating of the palms nor the reduced cholinergic responses in the
hyperhidrotic
group was observed after T2-3 ganglionectomy. The data indicate
that
the T2-3 ganglia play a role in the elaboration or modulation of the
sudomotor
and metabolic responses induced by activation of certain cholinergic
receptors
in humans.
PMID:
7431077 [PubMed - indexed for MEDLINE]
421:
Lakartidningen 1980 May
21;77(21):1999-2000
[Quality
of life and hyperhidrosis]
[Article
in Swedish]
Mindus
P.
PMID:
7401748 [PubMed - indexed for MEDLINE]
422:
Ugeskr Laeger 1980 May
5;142(19):1199-201
[Surgical
treatment of axillary hyperhidrosis. A comparison between 3 surgical
methods]
[Article
in Danish]
Sorensen
U.
PMID:
7404696 [PubMed - indexed for MEDLINE]
423:
J Pediatr Surg 1980 Apr;15(2):172-4
Palmar
primary hyperhidrosis in children.
O'Donoghue
G, Finn D, Brady MP.
Palmar
Primary Hyperhidrosis, though an uncommon problem in the paediatric age
group,
is an unpleasant and socially disabling one for the affected child.
Although
the condition occurring in adults has been extensively documented,
little,
if any, attention has been given to the problem in children. We describe
the
clinical presentation of four such patients who presented in our unit over
the
past 4 yr. All had an upper dorsal sympathectomy performed with excellent
results.
PMID:
7373494 [PubMed - indexed for MEDLINE]
424:
Int J Psychiatry Med
1980-81;10(1):59-67
Personality
features in essential hyperhidrosis.
Lerer
B, Jacobowitz J, Wahba A.
PMID:
7380618 [PubMed - indexed for MEDLINE]
425:
Z Arztl Fortbild (Jena) 1980;74(2):60-1
[Excessive
hyperhidrosis and possibilities of surgical therapy]
[Article
in German]
Strauchmann
G, Willenberg E.
PMID:
7415236 [PubMed - indexed for MEDLINE]
426:
Br Med J 1979 Nov 10;2(6199):1225
Treatment
of hyperhidrosis.
Bedford
B, McKinnon EV.
Publication
Types:
Letter
PMID:
519387 [PubMed - indexed for MEDLINE]
427:
Pediatrics 1979 Nov;64(5):698
Excessive
sweating in an apparently normal teenager.
Fan
WJ, Cohen NM.
Publication
Types:
Letter
PMID:
492848 [PubMed - indexed for MEDLINE]
428:
Am Surg 1979 Sep;45(9):546-51
Transaxillary
sympathectomy in the treatment of hyperhidrosis of the upper limb.
Ellis
H.
Idiopathic
(primary) hyperhidrosis is a common and distressing condition.
Excessive
axillary sweating responds to local excision of the eccrine glands. In
severe
cases, sympathectomy may be indicated to deal with hyperhidrosis of the
hands
and feet. The surgical anatomy of transthoracic sympathectomy is
described.
PMID:
507560 [PubMed - indexed for MEDLINE]
429:
J Neurosurg 1979 Sep;51(3):424-5
Compensatory
sweating after upper dorsal sympathectomy.
Adar
R.
Publication
Types:
Letter
PMID:
469591 [PubMed - indexed for MEDLINE]
430:
J Neurosurg 1979 Sep;51(3):425
Compensatory
sweating after upper dorsal sympathectomy.
Shih
GJ.
Publication
Types:
Letter
PMID:
469592 [PubMed - indexed for MEDLINE]
431:
Ann Ophthalmol 1979 Jul;11(7):1083-6
Ocular
manifestations after upper dorsal sympathectomy.
Romano
A, Kurchin A, Rudich R, Adar R.
Fifty
patients underwent ophthalmologic examination before and after bilateral
upper
dorsal sympathectomy performed for palmar hyperhidrosis. Postoperative
examination
was done during the first week, at 3 to 4 weeks and at 6 to 12
months
after the operation. Immediately after surgery there were 18 patients
with
ptosis (6 severe) and 23 with miosis (12 severe). There were 19 patients
with
excessive lacrimation and some degree of congestion of conjunctival blood
vessels
was present in almost all patients. Uniocular decrease in tears was
present
in 2 patients. Most of these manifestations decreased with passage of
time.
At one year there remained only 3 patients with severe ptosis and 4 with
severe
miosis. The results suggest that the classical anatomic explanation of
Horner's
syndrome may require some modification.
PMID:
485002 [PubMed - indexed for MEDLINE]
432:
J Cardiovasc Surg (Torino) 1979
May-Jun;20(3):283-8
The
anatomy of the lumbar sympathetic trunks in man (with special reference to
the
question of regeneration after sympathectomy).
Simeone
FA.
Although
possible to decentralize the sympathetic outflow to the leg, below the
knee,
by resecting only the third lumbar sympathetic ganglion, the likelihood of
restoration
of normal vasoconstrictor activity warrants a more extensive
resection
to include at least the second and third lumbar ganglia, and
preferably
the second, third, and fourth lumbar ganglia. When cross-over fibers
are
suspected or demonstrated following unilateral sympathectomy, the
denervation
should include the fourth and fifth lumbar ganglia. The first lumbar
ganglion
should be spared at least unilaterally if interference with
reproductive
function is to be avoided.
PMID:
447765 [PubMed - indexed for MEDLINE]
433:
Med Hypotheses 1979 Mar;5(3):317-22
Hyperhidrosis
and the sympatho-adrenal system.
Robertshaw
D.
Some
disorders in which excessive sweating, hyperhidrosis, is a symptom are also
characterized
by increased sympatho-adrenal activity. Such disorders are
hypotension,
hypoglycemia, pheochromocytoma and hyperthyroidism. Sweat glands
are
controlled by a cholinergic innervation but can also be stimulated by
adrenergic
agents whose effects can be blocked by both alpha- and beta-receptor
blocking
drugs. An adrenergic innervation has also been demonstrated. There is
evidence
that the adrenergic component of sweating particularly secretion of the
adrenal
medulla, is responsible for the enhancement of sweating during exercise
but
not for the hyperhidrosis present in these disorders since sweating in these
circumstances
can be effectively blocked by cholinergic blocking compounds.
Cutaneous
vasoconstriction due to elevated plasma catecholamines reduces the
rate
of evaporation of sweat and allows sweat to accumulate on the skin. It is
suggested
that in the case of hypotension and insulin hypoglycemia sweating
results
from general sympathetic stimulation and that adrenal medullary hormones
are
not an essential component of the response. Hyperhidrosis in
pheochromocytoma
may be due to central activation of heat loss mechanisms
resulting
from the passage of plasma catecholamines across the blood-brain
barrier
combined with increased thermogenesis and cutaneous vasoconstriction.
The
hyperhidrosis of hyperthyroidism is probably due to increased thermogenesis.
PMID:
459985 [PubMed - indexed for MEDLINE]
434:
J Neurosurg 1979 Jan;50(1):88-94
Thermoregulatory
sweating in palmar hyperhidrosis before and after upper
thoracic
sympathectomy.
Shih
CJ, Lin MT.
To
assess thermoregulatory sweating in palmar hyperhidrosis, the authors
determined
the responses of three groups of normal, hyperhidrotic, and
denervated
subjects to a variety of ambient temperatures (TA's), 22 degrees, 28
degrees,
and 41 degrees C. The normal group had no hyperhidrosis, with intact
T2-3
ganglia, the hyperhidrotic group had palm hyperhidrosis with intact T2-3
ganglia,
and the denervated group had hyperhydrosis treated with T2-3
ganglionectomy.
Both groups of hyperhidrotic and denervated subjects maintained
oral
and mean skin temperatures within normal limits displayed by the normal
group
over a wide range of TA's tested. The local sweating rate (LSR) of both
the
palms and the soles of the feet in the hyperhidrotic group was decreased to
a
minimal level by either the T2-3 ganglionectomy or the subcutaneous
administration
of atropine sulfate. Furthermore, the denervated group had a
significantly
lower LSR of both the forehead and the upper chest regions, but
showed
a higher LSR or both the ventral thigh and the lateral lumbar regions at
a
TA of 41 degrees C when compared to the LSR of either the normal or the
unoperated
hyperhidrotic group. The data demonstrate that the surgical removal
of
both the T-2 and the T-3 ganglia, although producing no alterations in the
thermal
balance, does produce abnormalities in quantitative distribution of
thermoregulatory
sweating in man.
PMID:
758384 [PubMed - indexed for MEDLINE]
435:
Surg Neurol 1978 Nov;10(5):291-6
Thoracic
sympathectomy for palmar hyperhidrosis: report of 457 cases.
Shih
CJ, Wang YC.
A
thoracic sympathetic ganglionectomy was performed on 457 patients with palmar
hyperhidrosis,
resulting in a complete cessation of the excessive palmar
sweating
but not a total abolition of the sweating of the upper extremity,
forehead,
face, neck, upper chest and upper back. This procedure does not
produce
a Horner's syndrome. The present data provide evidence that sympathetic
pathways
for controlling sweating of the above-mentioned skin areas come mainly
through
the second thoracic ganglion, and therefore from the spinal cord segment
below
T1 in man.
PMID:
725736 [PubMed - indexed for MEDLINE]
436:
JAMA 1978 Oct 6;240(15):1588
Gustatory
sweating.
Schultz
GT.
Publication
Types:
Letter
PMID:
691144 [PubMed - indexed for MEDLINE]
437:
Dermatol Monatsschr 1978
Oct;164(10):727-8
[Metal
corrosion (rust) as a result of hyperhidrosis (author's transl)]
[Article
in German]
Zschunke
E.
PMID:
738492 [PubMed - indexed for MEDLINE]
438:
Br Med J 1978 Aug 12;2(6135):503-4
Treatment
of hyperhidrosis.
Publication
Types:
Letter
PMID:
678946 [PubMed - indexed for MEDLINE]
439:
Dtsch Med Wochenschr 1978 Jul
28;103(30):1198
[Hyperhidrosis]
[Article
in German]
Brautigam
W.
Publication
Types:
Letter
PMID:
668559 [PubMed - indexed for MEDLINE]
440:
Angiologia 1978 Jul-Aug;30(4):131-3
[Palm
hyperhidrosis. 100 cases surgically treated by cervicodorsal
sympathectomy]
[Article
in Spanish]
Galindo
N, Osso J, Orti M, Conill C, Sainz de la Maza T.
PMID:
677524 [PubMed - indexed for MEDLINE]
441:
Ann Dermatol Venereol 1978
May;105(5):555
[Surgical
treatment for excessive sweating of the upper extremities]
[Article
in French]
Bureau
H, Magalon G, de Tadeo P, Tramier H.
PMID:
707949 [PubMed - indexed for MEDLINE]
442:
Dtsch Med Wochenschr 1978 Apr
7;103(14):632
[Hyperhidrosis]
[Article
in German]
Entzian
W.
Publication
Types:
Letter
PMID:
639699 [PubMed - indexed for MEDLINE]
443:
Arch Surg 1978 Mar;113(3):264-6
Thoracic
endoscopic sympathectomy in palmar and axillary hyperhidrosis.
Kux
M.
An
endoscopic technique is described for thoracic sympathectomy. After
establishment
of a pneumothorax, the thoracoscope is introduced into the pleural
cavity.
The telescope is equipped with a wire electrode, a grasping forceps, and
a
suction coagulation probe for endoscopic electroresection of the sympathetic
trunk.
In 63 patients, 124 endoscopic sympathectomies were performed. All
patients
were relieved of sweating in the hands; 18.6% still had some
perspiration
of the axilla. Side effects of thoracic sympathectomy were
compensatory
and gustatory sweating that, in four patients, were more
embarrassing
than the original form of hyperhidrosis. Fifty-five patients were
highly
satisfied with the result of endoscopic sympathectomy, which is
considered
the appropriate minor procedure for the treatment of upper limb
hyperhidrosis,
causing minimal discomfort to the patient and almost invisible
scars.
PMID:
637691 [PubMed - indexed for MEDLINE]
444:
Dtsch Med Wochenschr 1978 Feb
17;103(7):292
[Hyperhidrosis]
[Article
in German]
von
Eiff AW.
Publication
Types:
Letter
PMID:
627189 [PubMed - indexed for MEDLINE]
445:
Acta Chir Acad Sci Hung
1978;19(1):69-74
[Late
results of thoracic sympathectomy in various diseases]
[Article
in German]
Sebesteny
M, Mogan I, Papp S, Szabo I, Soltesz L.
The
late results of 171 thoracal sympathectomies performed on 142 patients in
the
20-year period 1952 to 1971 are described. Favourable results were achieved
in
Raynaud's disease, obliterating endarteritis and other occlusive vascular
diseases,
and also in hyperhidrosis.
PMID:
706955 [PubMed - indexed for MEDLINE]
446:
AMB Rev Assoc Med Bras 1978
Jan;24(1):29-30
[Treatment
of palmar hyperhidrosis by cervico-thoracic sympathectomy]
[Article
in Portuguese]
Kauffman
P, Cinelli M Jr, Wolosker M, Leao LE.
PMID:
305592 [PubMed - indexed for MEDLINE]
447:
Clin Neurosurg 1978;25:637-50
Sympathectomy
for vascular syndromes and hyperhidrosis of the upper extremities.
Dohn
DF, Sava GM.
PMID:
710016 [PubMed - indexed for MEDLINE]
448:
Psychosomatics 1977 Dec;18(5):28-31
Hyperhidrosis:
a review of its psychological aspects.
Lerer
B.
PMID:
605206 [PubMed - indexed for MEDLINE]
449:
Angiology 1977 Nov;28(11):799-802
Phantom
sweating.
Kurchin
A, Mozes M, Walden R, Adar R.
Phantom
sweating is a sensation in which the patient feels that sweat is about
to
burst out of skin pores, but in which sweating never actually occurs. In a
series
of 100 patients undergoing bilateral upper dorsal sympathectomy for
palmar
hyperihidrosis, 82 patients were specifically questioned and 48 (59%)
reported
phantom sweating. Phantom sweating started soon after the operation,
was
triggered by the same stimuli that caused hyperhidrosis preoperatively,
lasted
for a few seconds, and tended to diminish with time. In an average
follow-up
of 18 months, the phenomenon disappeared in 11 patients (23%). Phantom
sweating
is probably a symptom of residual sympathetic activity.
PMID:
911065 [PubMed - indexed for MEDLINE]
450:
Arch Neurol 1977 Oct;34(10):619-23
Gustatory
phenomena after upper dorsal sympathectomy.
Kurchin
A, Adar R, Zweig A, Mozes M.
In
a series of 100 bilateral upper dorsal sympathectomies performed for palmar
hyperhidrosis,
gustatory sweating and other gustatory phenomena were reported by
68
of 93 patients (73%), followed up for an average of 1 1/2 years. These
gustatory
phenomena were quite different from physiologic gustatory sweating: a
wide
range of gustatory stimuli caused a variety of phenomena in varied
locations.
There was a negative correlation between the incidence of these
phenomena
and the occurrence of Horner's syndrome after sympathectomy. Analysis
of
our observations, and of clinical and experimental work of others, leads to
the
conclusion that gustatory phenomena after upper dorsal sympathectomy are the
result
of preganglionic sympathetic regeneration or collateral sprouting with
aberrant
synapses in the superior cervical ganglion.
PMID:
907534 [PubMed - indexed for MEDLINE]
451:
Arch Phys Med Rehabil 1977
Oct;58(10):435-7
Reflex
sweating in patients with spinal cord injury: a review.
Fast
A.
Sweat
glands derive their innervation from the sympathetic nervous system. The
spinal
sympathetic structures that are located in the intermediolateral areas
extend
from T1-L2 segments and are under the control of hypothalamic centers.
Cord
transection abolishes the supraspinal control of sudorimotor function.
Since
sympathetic innervation does not follow a clear segmental distribution,
normal
sweating may be preserved at a higher or lower level than skin sensation.
Nonthermoregulatory
reflex sweating is an indication of unchecked spinal cord
facilitation
and is precipitated by afferent stimuli from bladder, rectum, and
various
other sources. It is usually a manifestation of mass reflex or autonomic
crisis
and occurs particularly in cervical or high thoracic lesions. Transection
below
T8-T10 is not accompanied by reflex sweating. The phenomenon of thermal
relfex
sweating is controversial. Although some aspects of nonthermoregulatory
reflex
sweating are still unclear, proper immediate and continuing preventive
management
will reduce the incidence of this and other autonomic manifestations.
Chemical
sympathectomy should be a last resort in case of emergency or when the
source
of facilitation cannot be ascertained.
Publication
Types:
Review
PMID:
334108 [PubMed - indexed for MEDLINE]
452:
Med J Aust 1977 Sep 10;2(11):348
Symposium
on sweating.
Publication
Types:
Editorial
PMID:
927260 [PubMed - indexed for MEDLINE]
453:
Arch Neurol 1977 Sep;34(9):536-9
Hyperhydrosis
in paraplegia.
Kneisley
LW.
A
20-year-old man suffered head, chest, and abdominal trauma in an auto accident
resulting
in a traumatic dissecting aneurysm of the thoracic aorta. Hypotension
developed.
The aneurysm was resected and replaced with a prosthetic graft.
Postoperatively,
the patient was found to be paraplegic below T-9, areflexic and
anesthetic
to pain and temperature, with preservation of vibration and position
senses.
In the ensuing nine months, the patient regained considerable sensory
function
in his lower extremities and had severe constant hyperhydrosis below
the
T-9 dermatome. The exaggerated sweating was unaffected by temperature change
and
anxiety. It was diminished by methantheline bromide treatment but never
abolished.
The spinal cord lesion is postulated to be anterior horn cell loss,
with
preservation of interneurons and intermediolateral gray columns.
Disinhibition
of sympthetic circuits or sprouting of axons are proposed
mechanisms.
PMID:
889495 [PubMed - indexed for MEDLINE]
454:
World J Surg 1977 Sep;1(5):667-74
Upper
dorsal sympathectomy for palmar primary hyperhidrosis by the
supraclavicular
approach.
Kurchin
A, Zweig A, Adar R, Mozes M.
PMID:
602239 [PubMed - indexed for MEDLINE]
455:
Br J Surg 1977 Aug;64(8):570-1
Surgical
management of hyperhidrosis.
Keaveny
TV, Fitzgerald PA, Donnelly C, Shanik GD.
Sixty-five
patients with severe disabling hyperhidrosis were subjected to
operation.
Eighty-nine sympathectomies and 42 axillary skin excisions were
performed
to abolish sweating. Almost 90% of these patients were extremely
satisfied
with the outcome of surgery which resulted in a change for the better
in
their social and working lives. When conservative therapy fails, we recommend
these
procedures, which often alleviate this most distressing symptom.
PMID:
890279 [PubMed - indexed for MEDLINE]
456:
Ann Surg 1977 Jul;186(1):34-41
Palmar
hyperhidrosis and its surgical treatment: a report of 100 cases.
Adar
R, Kurchin A, Zweig A, Mozes M.
One
hundred patients with primary palmar hyperhidrosis (HH) underwent bilateral
upper
dorsal sympathectomy (UDS) by the supraclavicular approach. Pre-operative
epidemiological
and clinical data are described. The immediate and late results,
as
well as the complications and side-effects are detailed. Follow-up was
completed
on 93 patients between four and 50 months after the operation (average
18
months). Of 93 patients, 91 had drying of the hands. In 58% some moisture
returned
to the hands but in no case did the hyperhidrotic state recur.
Subjective
patient evaluation was excellent or good in 83 patients (89%) and
only
one patient (a technical failure) was completely dissatisfied. Reasons for
some
degree of dissatisfaction with operation were mainly compensatory HH in non
denervated
areas, and Horner's syndrome. Compensatory HH usually decreased with
passage
of time and, permanent Horner's syndrome occurred in 8% of patients (4%
of
procedures). Technical failure can be avoided by use of frozen section
examination
intraoperatively. For severe cases of palmar HH that cause social,
professional
and emotional embarassment, bilateral simultaneous UDS by the
supraclavicular
approach is the procedure of choice: Morbidity is small, and
almost
all patients enjoy improved quality of life after the operation.
PMID:
879872 [PubMed - indexed for MEDLINE]
457:
Lancet 1977 Jun 18;1(8025):1320
Thoracic
endoscopic sympathectomy for treatment of upper-limb hyperhidrosis.
Kux
M.
Publication
Types:
Letter
PMID:
68424 [PubMed - indexed for MEDLINE]
458:
Anaesth Intensive Care 1977
Feb;5(1):76-7
Case
report: hazards associated with cervico-thoracic sympathectomy.
Zee
RF.
PMID:
320907 [PubMed - indexed for MEDLINE]
459:
Australas J Dermatol 1976
Dec;17(3):90-1
Surgical
aspects of hyperhidrosis.
Jepson
RP, Harris JD.
PMID:
1023878 [PubMed - indexed for MEDLINE]
460:
Australas J Dermatol 1976
Dec;17(3):82-6
Sweating--physiology
and pathophysiology.
Frewin
DB, Downey JA.
PMID:
1023876 [PubMed - indexed for MEDLINE]
461:
Practitioner 1976 Sep;217(1299):416-9
The
surgical treatment of hyperhidrosis.
Ellis
H.
The
diagnosis of primary hyperhidrosis is one of exclusion, but it is not a
difficult
one to make. It is a common, embarrassing and even disabling
condition.
If it does not respond to simple conservative therapy, the
practitioner
should not hesitate to advise sympathectomy for hyperhidrosis of
the
upper or lower limbs, or some simple local operation on the affected skin
area
for localized excessive axillary sweating.
PMID:
981132 [PubMed - indexed for MEDLINE]
462:
Acta Physiol Scand 1976
Jul;97(3):385-91
Local
nervous mechanism in regulation of blood flow in human subcutaneous
tissue.
Henriksen
O.
The
effect of local venous stasis upon blood flow in human subcutaneous adipose
tissue
on the distal part of the forearm was investigated in three healthy
subjects
and two chronically sympathectomized patients suffering from manual
hyperhidrosis.
The area under study was separated into two parts by means of a
lead
shield exerting a pressure of about 360 mmHg on the skin. The effect of
venous
stasis of about 40 mmHg on one side of the shield upon blood flow
measured
simultaneously on both sides of the shield by the local 133Xenon
washout
technique was investigated. During venous stasis on one side of the
shield,
blood flow decreased about 40% on both sides. The vasoconstrictor
impulse
could be transmitted over a distance of about 1-2 cm. The phenomenon was
unaffected
by nerve blockade induced 3 cm proximally, medially, and laterally to
the
area by infiltration the skin with lidocaine. Thus a vasoconstrictor impulse
could
be transmitted from the side of stasis to the non stasis side of the lead
shield.
The transmission was not affected by phentolamine but was blocked by
lidocaine
and chronic sympathetic denervation. The vasoconstrictor impulse
elicited
during venous stasis is therefore most likely transmitted by means of a
local
nervous mechanism involving sympathetic adrenergic vasoconstrictor fibres.
PMID:
961451 [PubMed - indexed for MEDLINE]
463:
Acta Physiol Scand 1976
Jul;97(3):377-84
Effect
of chronic sympathetic denervation upon local regulation of blood flow in
human
subcutaneous tissue.
Henriksen
O.
The
effect of chronic sympathetic denervation upon the vasoconstrictor response
to
an increase of vascular transmural pressure in human subcutaneous adipose
tissue
was investigated in 6 patients suffering from manual hyperhidrosis.
Changes
in transmural pressure were obtained either by postural changes of a
forearm
or by venous stasis of 30 mmHg. Blood flow was measured in the distal
part
of the forearm or crus by means of the local 133Xenon washout technique. 2
patients
were studied before and after sympathectomy. When the area under study
was
lowered about 40 cm below the jugular notch, blood flow decreased about 50%
preoperatively,
about 30% 24 h after the operation, but remained constant 4 days
after
or later. Similar results were obtained during venous stasis. Hence about
4
days after sympathectomy, the vasoconstrictor response to an increase in
vascular
transmural pressure was abolished. In 3 chronically sympathectomized
patients
blood flow remained constant in the denervated limb, but decreased
significantly
in the control limb. In another patient studied 580 days after
surgery
blood flow remained constant during lowering of the denervated forearm
as
well as during venous stasis. These findings might indicate that the
vasoconstrictor
response to an increase in vascular transmural pressure in human
subcutaneous
adipose tissue is due to a local nervous mechanism involving
symphathetic
adrenergic nerves, but a myogenic mechanism cannot be definitively
excluded.
PMID:
961450 [PubMed - indexed for MEDLINE]
464:
Harefuah 1976 Apr 1;90(7):309-11
[Phenomena
associated with sympathectomy following hyperhidrosis]
[Article
in Hebrew]
Shoenfeld
Y, Kurchin A, Shapiro Y, Machtiger A, Adar R.
PMID:
1278790 [PubMed - indexed for MEDLINE]
465:
Practitioner 1976 Feb;216(1292):149-53
Hyperhidrosis
and hypohidrosis.
Tan
SG, Cutliffe WJ.
Sweating
has an important physiological function concerned with both temperature
and
fluid balance. Hypohidrosis is uncommon and rarely recognized by the
patient.
It usually represents damage to the central nervous system or
peripheral
nerves. Hyperhidrosis may be a feature of general medical diseases
such
as thyrotoxicosis and fevers. It may also be due to damage of the central
of
peripheral sympathetic nerves. Localized hyperhidrosis tends to occur on the
palms,
the soles, the axillae and, to a lesser extent, the face. Treatment of
local
hyperhidrosis with topical aluminium salts, or with topical or oral
anticholinergics,
may help some patients but surgery may be indicated in those
with
severe hyperhidrosis.
Publication
Types:
Review
PMID:
177967 [PubMed - indexed for MEDLINE]
466:
Arch Surg 1976 Jan;111(1):13
Editorial:
The treatment of axillary hyperhidrosis.
Goldwyn
RM.
PMID:
1106354 [PubMed - indexed for MEDLINE]
467:
Dermatologica 1976;152(5):257-62
Sweat
studies in hyperhidrosis palmaris and plantaris. A survey of 60 patients
before
and after cervical sympathectomy.
Shoenfeld
Y, Shapiro Y, Machtiger A, Magazanik A.
60
patients suffering from excessive sweating in the hands underwent cervical
sympathectomy.
At follow-up 1-7 years after operation the hands were dry in 55.
No
differences in electrolyte concentrations were found in the sweat from palms,
arms,
or body prior to and after the surgical intervention. Similarly no
differences
were found in electrolyte concentrations between healthy subjects
and
hyperhidrotics. Palmar sweat was hypertonic in comparison to arm or body
sweat.
The Na and K sweat concentrations were: palmar 50 +/- 20 and 16 +/- 7
mEq/1;
arm 30 +/- 11 and 8 +/- 2 mEq/1; and body 21 +/- 20 and 4 +/- 3 mEq/1,
respectively.
Na/K ratio was: palmar 3.2; arms 3.6 and body 5.8. Total sweat
loss
prior to the operation was 5.7 +/- 4.2 g/kg BW/h; afterwards it was 5.9 +/-
4
g/kg BW/h. These equal sweat rates were associated with compensatory sweating
in
areas of the body not affected prior to the operation.
PMID:
955224 [PubMed - indexed for MEDLINE]
468:
J Chir (Paris) 1976;112(5):307-14
[Surgical
indications and results of thoracic sympathectomy]
[Article
in French]
Gruss
JD, Bartels D, Stojanovic R.
Between
the 1st of July 1971 and the 31st of December 1974, among 1,459
operations
on vascular surgery, we carried out 77 thoracic sympathectomies in 46
patients.
In most patients there was an oblitering angiopathie of digital type,
stage
II to IV, confirmed by angiography. Two patients had mixed type
obstructions,
two others had hyperhidrosis, one patient suffered from
cleroderma,
another had a thoracic outlet syndrome with digital arterial
obstruction.
In all cases, the transaxillary approach was that which caused the
least
complications and which permitted satisfactory exposure of the sympathetic
nerve.
The cosmetic results were good. The second and third thoracic ganglia
were
resected and the planes of cleavage marked with silver clips. In advanced
stage
III and stage IV, we noted 92 p. 100 improvements i.e. return to stages I
or
II. The operative mortality was nil. The most serious complication was a case
of
hemothorax which required later pulmonary decortication. We noted in two
cases,
a Horner's syndrome.
PMID:
1010860 [PubMed - indexed for MEDLINE]
469:
J Physiol 1976 Jan;254(1):74P-75P
Proceedings:
Physiological gustatory sweating.
Allen
JA, Morton WS, Roddie IC.
PMID:
1249770 [PubMed - indexed for MEDLINE]
470:
Scand J Plast Reconstr Surg
1976;10(2):107-12
Innervation
of human axillary sweat glands. Histochemical and electron
microscopic
study of hyperhidrotic and normal subjects.
Rechardt
L, Waris T, Rintala A.
Adrenergic
nerves were demonstrated by formaldehyde-induced fluorescence and
cholinergic
nerves using thiocholine techniques to demonstrate
acetylcholinesterase
activities at the light and electron microscopic levels.
The
specimens were taken during surgery from the axillae of hyperhidrotic
patients
and normal voluntary controls. No fluorescent nerves were found around
eccrine
or apocrine sweat glands in hyperhidrotic or normally sweating axillae.
Both
eccrine and apocrine sweat glands exhibited a nerve network showing
acetylcholinesterase
activity. There was no marked difference in the innervation
patterns
or in the intensity of the acetylcholinesterase reaction of the nerves
in
the hyperhidrotic patients or normal subjects. Ultrastructurally the
acetylcholinesterase-positive
nerves were seen in the vicinity of both eccrine
and
apocrine glands, but these nerves were outside the basement membrane.
PMID:
1019585 [PubMed - indexed for MEDLINE]
471:
Acta Physiol Scand 1975 Sep;95(1):83-8
Effect
of spinal sympathetic blockade upon local regulation of blood flow in
subcutaneous
tissue.
Henriksen
O, Alsner T.
The
influence of spinal sympathetic blockade upon local regulation of blood flow
in
subcutaneous adipose tissue was investigated in six subjects. The effect of
changes
in orthostatic pressure on blood flow in subcutaneous tissue in the crus
and
distal forearm was measured before and after sympathetic blockade obtained
by
epidural anesthesia in 4 subjects and by a bilateral sympathectomy in 2
patients
suffering from manual hyperhidrosis. Blood flow in subcutaneous tissue
measured
by 133Xe washout technique decreased by about 40 per cent when the limb
was
lowered, and remained constant during 30 cm elevation. This was found both
before
and after the blockade, though in one of the patients, the orthostatic
decrease
in blood flow was less pronounced 24 h after sympathectomy. Hence
central
sympathetic reflexes do not alter local orthostatic changes of blood
flow
in subcutaneous tissue. These changes therefore are most likely due to
local
mechanisms.
PMID:
1180107 [PubMed - indexed for MEDLINE]
472:
Postgrad Med 1975 Sep;58(3):191-6
Hyperhidrosis
and its surgical management.
Ellis
H.
PMID:
1161657 [PubMed - indexed for MEDLINE]
473:
Aust N Z J Surg 1975 May;45(2):143-6
A
comparison of the supraclavicular and axillary approaches to upper thoracic
sympathectomy.
Little
JM, May J.
Twenty-nine
upper dorsal sympathectomies have been carried out in 18 patients
and
a comparison made of the supraclavicular with the axillary approach to the
upper
thoracic sympathetic chain. Thirteen of these operations were carried out
for
essential hyperhidrosis, 15 for ischaemia in the hand and one for
post-traumatic
pain syndrome. Fourteen sympathectomies were carried out through
the
axilla and 15 through the supraclavicular approach. Post-operative pain was
felt
to be somewhat more severe when the axillary approach was used, but other
complications
were infrequent and hospital stay was slightly shorter in the
axillary
group. The axillary approach was felt to offer superior exposure, the
capability
for wider sympathetic excision, good cosmetic results, avoidance of
Horner's
syndrome and low morbidity. In the absence of lung disease or the need
for
a direct exploration of the root of the neck, the axillary approach is to be
preferred
for upper dorsal sympathectomy.
PMID:
1059396 [PubMed - indexed for MEDLINE]
474:
Med J Aust 1975 Mar 1;1(9):267-70
Upper
dorsal sympathectomy.
Atkinson
L.
PMID:
1128419 [PubMed - indexed for MEDLINE]
475:
Acta Neurol Scand 1975 Feb;51(2):167-72
Palmar
hyperhidrosis. Long-term results following high thoracic sympathectomy.
Gjerris
F, Olesen HP.
Fourteen
men and 22 wemon, with an average of 23 years (range 14-36 years) were
operated
on for hyperhidrosis of the upper extremity during the period from 1955
to
1970. Twenty-eight had had symptoms for more than 10 years. Resection of the
2nd
and 3rd thoracic ganglia and the connecting sympathetic chain was carried
out
using a posterior approach; in 33 cases the operation was bilateral, and in
three
unilateral. Thirty-five patients were followed up after an average of 7.8
years
(range 2-17 years). In one patient unilateral reoperation was carried out
four
months after the first operation. Since the first operation 34 patients had
suffered
from neither palmar nor axillary sweating. However 20 had permanent
compensatory
hyperhidrosis, and 15 suffered from gustatory facial sweating,
which
had usually started within six months of operation. Four, in whom two
spinal
thoracic nerves had also been resected, reported marked dysaesthesia over
the
front of the chest and in the axilla, lasting for several years.
PMID:
1114879 [PubMed - indexed for MEDLINE]
476:
Ir Med J 1974 Oct 26;67(20):544-5
The
surgical treatment of hyperhidrosis.
Keaveny
TV, Fitzpatrick J, Fitzgerald PA.
PMID:
4443195 [PubMed - indexed for MEDLINE]
477:
Br J Plast Surg 1974 Apr;27(2):196-7
A
serious complication of an operation for axillary hyperhidrosis.
Shaw
MH.
PMID:
4834034 [PubMed - indexed for MEDLINE]
478:
Harefuah 1974 Mar 1;86(5):238-9
[The
electroencephalogram in hyperhidrosis palmo-plantaris]
[Article
in Hebrew]
Shafrir
A, Haim S, Cohen A, Yahel M.
PMID:
4830204 [PubMed - indexed for MEDLINE]
479:
Otolaryngol Clin North Am 1974
Feb;7(1):217-50
Physiologic
problems following ablative surgery of the head and neck.
Summers
GW.
PMID:
4812642 [PubMed - indexed for MEDLINE]
480:
Ann Chir Gynaecol Fenn
1974;63(4):318-25
Upper
limb sympathectomy.
Koikkalainen
K, Luosto R, Keskitalo E, Melartin E.
PMID:
4416798 [PubMed - indexed for MEDLINE]
481:
Contemp Neurol Ser 1974;(11):179-98
Disorders
of the autonomic nervous system.
Chapter 10. Sweating.
Johnson
RH, Spaulding JM.
Publication
Types:
Review
PMID:
4375553 [PubMed - indexed for MEDLINE]
482:
J Am Med Womens Assoc 1973
Nov;28(11):581-5
The
surgical management of axillary hyperhidrosis.
Letterman
G, Schurter M.
Publication
Types:
Review
PMID:
4358475 [PubMed - indexed for MEDLINE]
483:
Harefuah 1973 Oct 15;85(8):357-9
[Upper
thoracic sympathectomy for palmar hyperhidrosis]
[Article
in Hebrew]
Walden
R, Adar R, Zur N, Mozes M.
PMID:
4775983 [PubMed - indexed for MEDLINE]
484:
Dtsch Med Wochenschr 1973 Mar
9;98(10):518
[Hyperhidrosis]
[Article
in German]
Delius
L.
PMID:
4691577 [PubMed - indexed for MEDLINE]
485:
Surg Gynecol Obstet 1972
Oct;135(4):586-8
Hyperhidrosis
of the upper extremity and its treatment.
Hartfall
WG, Jochimsen PR.
PMID:
5077726 [PubMed - indexed for MEDLINE]
486:
Plast Reconstr Surg 1972
Jun;49(6):639-42
Further
concepts in gustatory sweating.
McGibbon
BM, Paletta FX.
PMID:
4337454 [PubMed - indexed for MEDLINE]
487:
Med J Aust 1971 Aug 21;2(8):446-7
Essential
hyperhidrosis.
Collison
DR.
PMID:
5095712 [PubMed - indexed for MEDLINE]
488:
Med J Aust 1971 Aug 14;2(7):390
Essential
hyperhidrosis.
Grant
G.
PMID:
5092900 [PubMed - indexed for MEDLINE]
489:
Med J Aust 1971 Jul 17;2(3):135-8
Essential
hyperhidrosis.
Harris
JD, Jepson RP.
PMID:
5096178 [PubMed - indexed for MEDLINE]
490:
Br Med J 1971 Feb 6;1(744):332-4
Role
of sympathectomy for hyperhidrosis.
Greenhalgh
RM, Rosengarten DS, Martin P.
PMID:
5100267 [PubMed - indexed for MEDLINE]
491:
Cleve Clin Q 1969 Apr;36(2):79-83
Essential
hyperhidrosis--pathogenesis and treatment. Report of seven cases
treated
by upper horacic sympathectomy.
Dohn
DF, Zraik O.
PMID:
5789155 [PubMed - indexed for MEDLINE]
492:
Aust N Z J Surg 1969 Feb;38(3):221-3
Cervico-dorsal
sympathectomy in the management of essential hyperhidrosis in the
upper
limb.
Renwick
S, Loewenthal J.
PMID:
5251158 [PubMed - indexed for MEDLINE]
493:
Aust N Z J Surg 1968 Nov;38(2):98-103
Gustatory
sweating.
Adie
R.
PMID:
4302030 [PubMed - indexed for MEDLINE]
494:
Fortschr Neurol Psychiatr Grenzgeb 1968
May;36(5):261-74
[The
so-called gustatory sweating]
[Article
in German]
Schiffter
R, Schliack H.
PMID:
4307534 [PubMed - indexed for MEDLINE]
495:
Nurs Mirror Midwives J 1968 Mar
29;126(10):40
Hyperhidrosis.
Corrigan
MJ, Kildea MM.
PMID:
5184802 [PubMed - indexed for MEDLINE]
496:
Eye Ear Nose Throat Mon 1967
Mar;46(3):316-20 passim
Gustatory
sweating.
Holloway
RM.
PMID:
4292468 [PubMed - indexed for MEDLINE]
497:
Bull Soc Fr Dermatol Syphiligr
1967;74(6):730-3
[The
surgical treatment of axillary hyperhidrosis]
[Article
in French]
Preaux
J.
PMID:
5590517 [PubMed - indexed for MEDLINE]
498:
Arch Otolaryngol 1966 Mar;83(3):260-5
Gustatory
sweating. Report of a case treated by tympanic neurectomy.
Hunt
W, Joseph D, Newell R, Hanna HH.
PMID:
5904049 [PubMed - indexed for MEDLINE]
499:
Berufsdermatosen 1965 Jun;13(3):159-70
[On
experiments in the prevention of professional hyperhidrosis of the hands]
[Article
in German]
Borelli
S, Graf W.
PMID:
5851684 [PubMed - indexed for MEDLINE]
