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PubMed1994

Experience of anesthesia for transthoracic endoscopic sympathectomy in palmar hyperhidrosis--110 cases.

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.

Adolescent↗

PubMed1993

Transaxillary endoscopic sympathectomy--a report of experience in 150 patients with palmar hyperhidrosis.

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.

Adolescent↗

PubMed1993

[Total intravenous anesthesia with O2 mask in transthoracic endoscopic sympathectomy for palmar hyperhidrosis].

Using non-invasive monitors (such as blood pressure, O2 saturation, end-tidal CO2 pressure monitors and electrocardiograms), the application of total intravenous anesthesia with O2 mask in transthoracic endoscopic sympathectomy was evaluated. A total of 198 palmar hyperhidrosis patients were studied. In the study, the durations of surgery were 5-15 min (mean 8 min) with anesthesia duration of 8-20 min (mean 12 min), respectively. The cardiovascular system was quite stable during operation, with systolic blood pressures of 90-165 mmHg (mean 132 mmHg), diastolic blood pressures of 50-106 mmHg (mean 92 mmHg) and heart rates of 56-130 beats/min (mean 104 beats/min). The respiratory function was maintained within a safety range with O2 saturation of 95-100% (mean 99%) and end-tidal CO2 pressure of 32-40 mmHg (mean 36 mmHg). After surgery, the major discomfort was chest pain (132/198), but this could be improved with intravenous analgesics. Patients' consciousness returned within 1-3 min. After ensuring their general condition was stable, patients were discharged within 24 hr. Preliminary study showed that total intravenous anesthesia plus muscle relaxant, with O2 mask and assisted ventilation, could serve as a safe and simple anesthesia for palmar hyperhidrosis patients who received transthoracic endoscopic sympathectomy.

Adolescent↗

PubMed1993

[Thoracoscopic resection of upper dorsal sympathetic chain for palmar hyperhidrosis].

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%).

Follow-Up Studies↗

PubMed1979

'Rusters'. The corrosive action of palmar sweat: II. Physical and chemical factors in palmar hyperhidrosis.

When measuring sweating rates, close correspondence was found with the clinical estimation of hyperhidrosis. Corrosion was seen to increase with increasing sweat rates, reaching its maximum after an assumed rise in the actual sodium chloride concentration on the skin surface due to evaporation of water. The findings confirm that hyperhidrosis is of primary importance in the constitution of a 'ruster', and are also in good agreement with experimental reports. The small variations in palmar skin pH had no influence on the degree of corrosion; nor had the character of the metal surface. Of the two types of metal studied. corrosion was much more severe on the type having the lowest concentration of copper, thus confirming that increasing copper concentrations have a positive effect in reducing corrosion rates. At 50--60% relative humidity (RH) corrosion increased as time elapsed, whereas at 40% RH no corrosion developed on a sweat-contaminated plate. When exposed to 75% RH, metal samples became severely corroded in the course of a few days. Protective methods for the avoidance of rust are mentioned, with special emphasis on frequent handwashing.

Adolescent↗

PubMed1995

[Treatment of primary hyperhidrosis of the upper limbs by transthoracic endoscopic sympathectomy].

Primary hyperhidrosis of the upper limbs has an important impact on the subject's social and psycho-affective equilibrium. These patients have two main problems. First physicians are not sufficiently aware of the therapeutic possibilities and secondly the generally poor reputation of surgery in this indication. Transthoracic endoscopic sympathectomy has completely changed the treatment of hyperhidrosis of the upper limbs. It is now considered to be the reference treatment in severe cases. The surgical procedure is simple and allows simultaneous treatment of both sides. There is no mortality and morbidity is extremely low quantitatively and of little consequence qualitatively. The therapeutic protocol is short and immediate and long-term results are excellent in 98 to 100% of the patients.

Arm↗

PubMed1995

[Selective endoscopic sympathectomy for palmar hyperhidrosis].

OBJECTIVES: Thoracic sympathectomy is the radical and usually definite treatment of palmar hyperhidrosis. Improvement of surgical endoscopy techniques makes it possible to perform the procedure through thoracoscopy, thus minimizing operative trauma and sequellae. However, thoracic sympathectomies give rise to a high rate of compensatory sweating which is the most important adverse effect of the technique. METHODS: We developed a technique of selective sympathectomy which only divides the rami communicanti from the first to the fourth thoracic ganglion. We performed 90 thoracic sympathectomies in 46 patients. They were performed in a truncal manner in 32 patients while it was selective in the last 14 patients. RESULTS: The success rate was 97.5% (2 failures). After reoperation of these 2 failures, the success rate was 100%. The global rate of compensatory sweating was 47.5%. In the 14 last patients who underwent a selective sympathectomy, only one complained of compensatory sweating. CONCLUSION: Endoscopic sympathectomy is an effective means of treating palmar hyperhidrosis. Rigorous technique should help reduce the risk of compensatory sweating.

Adult↗

PubMed1996

[Thoracoscopic upper thoracic sympathectomy for primary palmar hyperhidrosis].

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.

Adolescent↗

PubMed1996

[Percutaneous thoracic sympathectomy under x-ray computed tomographic control in hyperhidrosis and refractory ischemia. Apropos of 17 cases].

We report our experience with percutaneous thoracic sympathectomy using computed tomography-guided injection of phenol in 17 patients. A total of 24 neurolyses were performed in outpatients. Indications were palmo-plantar hyperhidrosis in 10 patients and severe Raynaud phenomena in 7 cases (Sharp's syndrome = 2. sclerodermia = 3, Raynaud's syndrome = 1, digital arteritis = 1). Conventional treatment had failed in all patients. Cure was obtained in all cases of hyperhidrosis. For the patients with critical ischemia, there was temporary improvement which allowed wound healing, but recurrence was the rule within 6 months on average. Complications included pneumothorax, brachial nevralgia which persisted for 4 months and 3 partial Claude-Bernard-Horner syndromes. This technique is an inexpensive reliable method which can be used in case of contraindications or to avoid certain complications of endoscopic surgery which remains the standard treatment. Percutaneous sympatholysis in thus an interesting simple alternative.

Adolescent↗

PubMed1997

Thoracoscopic sympathectomy for palmar hyperhidrosis. A case report.

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.

Adult↗

PubMed1976

The surgical treatment of hyperhidrosis.

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.

Adolescent↗

PubMed2005

Treatment of palmar hyperhidrosis with botulinum toxin type A: 44 months of experience.

BACKGROUND: Palmar hyperhidrosis (PH) can produce social and occupational difficulties and reduce the quality of life of those who suffer from this kind of problem. When dealing with focal hyperhidrosis, the patients' attitudes and their subjective approaches regarding the process may influence the objective evaluation of the disorder. OBJECTIVE: To evaluate, by means of a scale, the subjective improvement of sweat production after treatment with botulinum toxin type A (BTX-A) in a group of patients with severe, invalidating PH. Patients and methods Over a period of 44 months, 69 patients were treated and followed-up, 27 patients had to be treated twice, and 11 patients required a third application; 80-100 U was injected in each palm. Regional nerve block was performed before the procedure. The patients were asked to evaluate their improvement at 1, 3, 6, 9, and 12 months of baseline. RESULTS: At 1 month, 53.6% of the patients reported an excellent improvement. Three months later, results were still excellent in 33.3% of the patients, and acceptable in 29%. From then on there was a statistically significant decrease of BTX-A effectiveness. A second application was carried out at an interval of 7.5 +/- 2.6 months, and a third one at 9 +/- 4.4 months. The following complications could be observed: transitory weakness of hand muscles in 13 patients, wrist pain in 5 patients, and cramps in 1 patient. CONCLUSIONS: Botulinum toxin is an effective alternative for the treatment of severe, invalidating PH. The maximum improvement persists up to 3 months; from then on, the effects slowly diminish. In our experience, there were no statistically significant differences with further applications of BTX-A. The patients' subjective assessment can be used to evaluate the sweat production after treatment with BTX-A in those medical centers where a more objective evaluation becomes difficult or impossible.

Journal Article↗

PubMed2005

[Effects of endoscopic sympathicotomy in carotid and vertebral arteries in the surgical treatment of primary hyperhidrosis].

PURPOSES: Analyze, in patients with primary hyperhidrosis (PH) who was undergone to videothoracoscopic sympathicotomy, the degree of vascular denervation after surgical transection of the thoracic sympathetic chain by measuring ultrasonografic parameters in carotid and vertebral arteries. METHODS: Twenty-four patients with PH underwent forty-eight endoscopic thoracic sympathicotomy and were evaluated by duplex eco-Doppler measuring systolic peak velocity (SPV), diastolic peak velocity (DPV), pulsatility index (PI) and resistivity index (RI) in bilateral common, internal and external carotids, besides bilateral vertebral arteries. The exams were performed before operations and a month later. Wilcoxon test was used to analyse the differences between the variables before and after the sympatholisis. RESULTS: T3 sympathicotomy segment was the most frequent transection done (95.83%), as only ablation (25%) or in association with T4 (62.50%) or with T2 (8.33%). It was observed increase in RI and PI of the common carotid artery (p < 0.05). The DPV of internal carotid artery decreased in both sides (p < 0.05). The SPV and the DPV of the right and left vertebral arteries also increased (p < 0.05). Asymmetric findings were observed so that, arteries of the right side were the most frequently affected. CONCLUSIONS: Hemodynamic changes in vertebral and carotid arteries were observed after sympathicotomy for PH. SPV was the most often altered parameter, mostly in the right side arteries, meaning significant asymmetric changes in carotid and vertebral vessels. Therefore, the research findings deserve further investigations to observe if they have clinical inferences.

Adolescent↗

PubMed1978

Unilateral segmental hyperhidrosis. Response to 20% aluminum chloride solution and plastic wrap.

A young woman had unilateral dermatomal hyperhidrosis documented by a starch-iodine technique. Evaluation failed to reveal any associated causative conditions. She was treated with 20% aluminum chloride hexahydrate solution in absolute alcohol (Drysol) with a favorable response. With recurrent use, however, she developed miliaria following exertion. Aluminum chloride hexahydrate was shown to be an effective agent to treat this unusual condition, but miliaria with exertion secondary to its use may be a limiting factor.

Adult↗

PubMed1984

Clonidine treatment in paroxysmal localized hyperhidrosis.

We report two cases of paroxysmal localized hyperhidrosis (PLH), a rare disorder usually of undetermined origin. The patients were treated with clonidine hydrochloride on the assumption that this paroxysmal phenomenon is of CNS origin, probably hypothalamic. Both patients responded favorably to treatment. In treating PLH, clonidine may serve as an alternative approach to local or surgical treatment.

Aged↗

PubMed2005

Effect of endoscopic thoracic sympathetic block on plantar hyperhidrosis.

HYPOTHESIS: Endoscopic thoracic sympathetic block at T4 (ESB4) provides excellent results in patients with primary hyperhidrosis (HH) of the upper limb. Most patients have combined palmo-plantar or palmo-axillary-plantar HH. This study evaluates the clinical outcome of patients with upper limb HH with special emphasis on plantar sweating and patients' quality of life. DESIGN: Review of a prospectively gathered database. SETTING: Tertiary care university teaching hospital. PATIENTS: The cohort included 73 patients (50 women and 23 men; mean age, 30.2 years). Twenty-six patients had palmar; 3, isolated axillary; and 44, combined HH. Sixty-six patients (90.4%) had concomitant plantar HH. INTERVENTIONS: One hundred forty-five operations were performed by applying one 5-mm clip above and below the fourth sympathetic ganglion. RESULTS: Of palms, 71.9% were completely and 28.1% were nearly dry. Corresponding percentages were 45.1% and 50.5% for armpits and 4.5% and 37.9% for the soles, respectively. Of soles, 42.4% remained unchanged and 15.2% became slightly worse. Compensatory sweating occurred in 19.4% of patients, with 2.8% having severe compensatory sweating. Feet were rarely affected by compensatory sweating (5.6%). Gustatory sweating was reported by 31.9% of patients but did not bother them. Quality of life improved significantly after ESB4. Most patients (87.5%) were completely satisfied with the outcome; 9.7% were partly satisfied. CONCLUSIONS: In the treatment of upper limb HH, ESB4 yields excellent success rates. Plantar sweating can be relieved in nearly half of patients, although exact neurophysiologic mechanisms remain unclear. Incidence of compensatory and gustatory sweating is low, contributing to a high patient satisfaction and improvement in quality of life.

Adult↗

PubMed1983

Surgical treatment of primary hyperhidrosis. A report of 42 cases.

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.

Adolescent↗

PubMed1996

Endoscopic sympathectomy treatment for craniofacial hyperhidrosis.

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.

Adolescent↗