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Results for “Hyperhidrosis”

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PubMed1988

[A misunderstood treatment for hyperhidrosis: ionization. Principles, material, methodology, early results].

Based on a new and specific apparatus developed by one of the authors, an original method of treatment of palmoplantar hyperhidrosis, either essential or associated with acrocyanosis, is described in detail. The extremities to be treated are placed in tanks containing tap water ensuring conduction fo current between epidermis and electrode. The recommended current of 20 milli-amperes is obtained by adjustment of a potentiometer. Treatment sessions (20 minutes for hands or feet, 40 for all four extremities) take place with a well defined frequency: 3 the first week, 2 the second, I the following two weeks. Maintenance sessions are necessary when sweating recurs. In a longitudinal series of 29 patients, 28 (96.5%) were significantly improved. From the 5th session onwards, the decrease in hyperhidrosis was evaluated by patients as very pronounced in 5 cases (17.2%) and as complete in 21 cases (72.5%). In 5 of the 6 patients with hyperhidrosis associated with acrocyanosis, the patients reported attenuation of cyanotic coloration of skin and relative warming up of extremities treated. Tolerance was excellent in 28 cases, incidents being rare and minor. Patients with pacemakers cannot be treated by this method.

Adolescent↗

PubMed1987

Surgical management of patients with hyperhidrosis.

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.

Adult↗

PubMed1994

Surgical treatment of palmar hyperhidrosis before thoracoscopy: experience with 475 patients.

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.

Hand↗

PubMed1994

[Paroxysmal unilateral hyperhidrosis].

We report the case of a 35-year-old woman with paroxysmal unilateral hyperhidrosis which developed after thoractotomy for Barret's esophagus (benign esophageal stenosis). Hyperhidrosis was on the right side of the face and in the metameric areas corresponding to the right spinal roots C2, C3 and C4. Paroxysms of sweating lasting from 15 to 30 min occurred several times daily, either spontaneously or related with acid food ingestion. The symptoms have been present for the last 10 years. Paroxysmal unilateral hyperhidrosis is a rare disorder of the autonomic nervous system. It has been reported in association with peripheral nerve, spinal cord and cerebral lesions, and in some cases the etiology is unknown.

Administration, Topical↗

PubMed1996

Interpleural bupivacaine for pain relief after transthoracic endoscopic sympathectomy for primary hyperhidrosis.

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.

Adult↗

PubMed1997

Transthoracic endoscopic sympathectomy for treatment of hyperhidrosis palmaris.

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.

Adolescent↗

PubMed1997

[Hyperhidrosis of the upper extremity: long-term outcome of endoscopic thoracic sympathicotomy].

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.

Adult↗

PubMed1998

Computed tomography guided thoracic sympatholysis for palmar hyperhidrosis.

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.

Adolescent↗

PubMed1998

Thoracoscopic sympathectomy for hyperhidrosis: is there a learning curve?

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.

Adolescent↗

PubMed1999

Treatment of palmar hyperhidrosis using tap water iontophoresis: local experience.

To evaluate the efficacy and safety of tap water iontophoresis in the treatment of severe idiopathic palmar hyperhidrosis, nine Chinese patients with severe palmar hyperhidrosis that had failed to respond to topical aluminium chloride were given 6 weeks' treatment with tap water iontophoresis at the Social Hygiene Service, Department of Health, Hong Kong. The reduction in sweat output was assessed objectively and subjectively. The mean objective reduction in sweat output was 49%, 51%, 26%, and 22% at week 3, 6, 10, and 12, respectively, since the start of treatment with tap water iontophoresis The mean subjective improvements were 43%, 59%, 30%, and 12% at week 3, 6,10, and 12, respectively. The side effects reported were all mild and transient. We conclude that tap water iontophoresis is a safe and useful treatment modality for palmar hyperhidrosis.

Journal Article↗

PubMed2006

Effect of endoscopic sympathectomy for hyperhidrosis on quality of life using the illness intrusiveness rating scale.

AIM: The objective of this study was to assess the impact of bilateral endoscopic thoracic sympathectomy (ETS) on the quality of life of patients with hyperhidrosis of the upper limbs. METHODS: This is a prospective, multicentre cohort study. Patients were studied before surgery and early (within 2 months) and late (4 months or more) after surgery. The primary outcome was the total score of the illness intrusiveness rating scale (IIRS), which on a sevenpoint Likert scale assesses the impact of their disease on each of 13 domains of quality of life. At each visit participants completed the IIRS, 10 additional questions to assess severity of disease, a global severity item, questions about employment, companionship and smoking, and a single item question reflecting the results of surgery. RESULTS: From 1994 to 2003, 22 patients underwent surgery. Early postoperative data were available in 12, and late postoperative data in 19 patients. Preoperative IIRS score was high 57 +/- 14. After surgery a statistically significant improvement was noted for the IIRS score, the severity questions, and the global severity score at both early and late postoperative time points. Preoperatively, 47% of patients were in a stable relationship, 30% were currently smoking, and 73% were employed; postoperatively, the responses were 58%, 16%, and 90%, respectively (P = NS). One patient (5%) developed a postoperative pneumothorax and one (5%) compensatory hyperhidrosis. There were no other local complications and none developed Horner's syndrome. CONCLUSIONS: Using a reliable and valid quality of life instrument we have shown that surgery is effective for the treatment of hyperhidrosis. Given the possibility of complications, we believe that surgery should be reserved for patients with the most severe form of this condition. The severity can be defined by the use of the IIRS and the 10 severity questions, which we have designed.

Journal Article↗

PubMed2005

Low-dose efficacy of botulinum toxin A for axillary hyperhidrosis: a randomized, side-by-side, open-label study.

OBJECTIVE: To compare 2 doses of botulinum toxin A in view of dose-dependent efficacy, longevity, and safety. DESIGN: Side-by-side, controlled, randomized clinical trial with extended follow-up over 2 treatment cycles. Patients were injected with 200 U of botulinum toxin A (Dysport; Ipsen Ltd, Wrexham, England) into one axilla and 100 U into the other axilla in a randomized fashion. After 48 weeks of follow-up, the patients were given a second treatment with identical doses to the respective axillae and were again followed up for 48 weeks. Gravimetric measurements of sweat production and the patients' own rating of sweating were monitored. SETTING: University-based outpatient clinic. PATIENTS: Forty-three subjects with primary axillary hyperhidrosis that was unresponsive to topical therapy. MAIN OUTCOME MEASURE: Absolute values of sweat production. RESULTS: Two weeks after treatment, the sweat production was significantly reduced compared with baseline levels. Both doses were equally effective. At week 48, the sweat production had returned to baseline levels irrespective of the dose. After the second treatment, both doses were again equally effective at any follow-up point. At the end of the follow-up period (96 weeks) for the second treatment, the sweat production was significantly lower than at the end of the first follow-up period (48 weeks). The treatment was well tolerated, and there were no lasting or severe adverse effects. CONCLUSIONS: Short- and long-term results show that doses of 100 and 200 U of botulinum toxin A are equally safe and effective. However, because of cost considerations and possible adverse effects, the lower dose is preferable for treating axillary hyperhidrosis.

Adult↗

PubMed2001

Idiopathic localized unilateral hyperhidrosis: case report of successful treatment with botulinum toxin type A and review of the literature.

BACKGROUND: Localized unilateral hyperhidrosis (LUH) is a rare disorder of unknown origin. We describe a patient with LUH on the forearm, where a fracture was identified as a past injury. OBSERVATIONS: We treated the patient with botulinum toxin type A injections, and he was complaint free during the 6 months after treatment. In addition, the initially strong positive results of the iodine starch test (Minor sweat test) were negative in the affected region after treatment. CONCLUSIONS: This relatively new therapeutic modality already established for axillary, palmar, and plantar hyperhidrosis seems to be efficient in LUH. As the former therapeutic approaches are rather disappointing, and as botulinum toxin type A locally applied shows limited adverse effects, we think a trial of botulinum toxin type A is justified in cases of LUH, even as a first-line treatment. In addition, the literature considering localization and causes of LUH is reviewed.

Adult↗

PubMed1978

Thoracic endoscopic sympathectomy in palmar and axillary hyperhidrosis.

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.

Adolescent↗

PubMed1979

The surgical treatment of axillary hyperhidrosis.

Axillary hyperhidrosis is a common condition and young people often suffer unnecessarily for many years in spite of the availability of good surgical methods for cure. We describe our own modification of Pettersson and Strömbäck's (1970) method of excision of the sweat glands. During the years 1972-6 218 axillary operations have been performed on 109 patients at the surgical clinic in Västerås for axillary hyperhidrosis. We reviewed 104 of these and found that 71 patients were completely satisfied and only 7 unsatisfied. Twelve patients wanted to be reoperated either because they still sweated or because they were unhappy with their scars. Thus, we found that overall the surgical methods are safe, simple and give good results.

Adolescent↗

PubMed1992

Laser endoscopic sympathectomy for palmar hyperhidrosis.

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.

Adolescent↗

PubMed1993

Segmental hyperhidrosis in syringomyelia with Chiari malformation.

Segmental hyperhidrosis was seen in three cases of syringomyelia with Chiari malformation confirmed by magnetic resonance imaging. Using the iodine-starch reaction, all three cases showed hyperhidrosis in the areas roughly corresponding to those of sensory disturbances. Two possible modes of pathogenesis are discussed: stimulation of preganglionic neurons and interference to the inhibitory tract.

Adolescent↗

PubMed1986

Hyperhidrosis and its surgical treatment.

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.

Adolescent↗