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PubMed1998

Selective degeneration of sudomotor fibers in Ross syndrome and successful treatment of compensatory hyperhidrosis with botulinum toxin.

We report a 5-year follow-up of a patient with Ross syndrome. A biopsy of the anhidrotic skin immunostained with protein gene product 9.5 visualized by confocal microscopy revealed selective loss of sudomotor fibers, whereas epidermal innervation remained intact, providing the first morphologic evidence of selective loss of sudomotor fibers in this syndrome. Among the different treatment strategies employed for the patient's disabling segmental hyperhidrosis, intracutaneous injection of botulinum toxin A was the most helpful.

Adaptation, Physiological↗
PubMed1998

Thoracoscopic T2-T3 sympathicolysis for essential hyperhidrosis in childhood: effects on pulmonary function.

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.

Adult↗
PubMed2006

Primary palmar hyperhidrosis locus maps to 14q11.2-q13.

Primary palmar hyperhidrosis (PPH) is a unique disorder of unknown cause. It is characterized by excessive perspiration of the eccrine sweat gland in the palm, sole, and the axilla. It is presumed that PPH results from overactivation of the cholinergic sympathetic nerve or dysfunction of the autonomic nervous system. There have been no genetic studies on the disease. We performed a linkage analysis of 11 families including 42 affected and 40 unaffected members using genome-wide DNA polymorphic markers to identify the disease locus. Diagnosis of their PPH was made by direct inspection, interviewing and measurement of the sweating rate with perspirometer. Consequently, from data of three of the 11 families examined, the combined maximum two-point LOD scores of 3.08 and 3.16 (recombination fraction = 0) were obtained at the D14S283 and D14S264 loci, respectively, on chromosome 14q11.2-q13, under an assumption that two liability conditions depend on age. These regions were ruled out in eight other families. Haplotype analysis of the three families supported that one of the PPH locus is assigned at minimum to about a 6-cM interval between D14S1070 and D14S990 and at maximum to about a 30-cM interval between D14S1070 and D14S70. This is the first report of systemic mapping of the PPH locus.

Chromosome Mapping↗
PubMed1977

Surgical management of hyperhidrosis.

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.

Adolescent↗
PubMed2000

Alternating monomeric paresis with decreased skin temperature and hyperhidrosis in a case of thoracolumbar myelopathy.

The patient, a Japanese girl with a history suggestive of diffuse encephalitis or acute disseminated encephalomyelitis, developed weakness of the right lower limb accompanied by excessive sweating and decreased skin temperature. Magnetic resonance imaging of the thoracolumbar cord showed abnormal signal intensity with syrinx formation mainly at T12 to L1 vertebral level. Paresis and excessive sweating subsided within 3 to 4 months, but recovery of vasomotor function was delayed. Several weeks later, weakness and skin temperature reduction reappeared on the left side without hyperhidrosis, but responded well to oral prednisolone. The patient showed no recurrence during the subsequent 7 years, and the intramedullary lesion could not be seen with repeated spinal magnetic resonance imaging.

Brain↗
PubMed2006

The use of botulinum toxins to treat hyperhidrosis and gustatory sweating syndrome.

Hyperhidrosis is a chronic condition characterized by excessive sweating. Recent studies report that it affects approximately 2.8% of the population and typically begins during adolescence. Gustatory sweating usually occurs after parotid gland injury or surgery, and both disorders can be debilitating for those who are affected. Both diseases respond very well to botulinum toxin therapy and this article will review the use of botulinum toxins, including the serotypes used, dosing, and complications.

Animals↗
PubMedDate not supplied

Prospective evaluation of the efficacy of dermal botulinium toxin for primary axillary hyperhidrosis.

BACKGROUND: Primary axillary hyperhidrosis (PAH) is an embarassing, socially disabling condition, most commonly seen in young people. Previous treatments for this condition have included sympathectomy or axillary skin excision. Recently botulinum toxin has been used to provide effective, non-invasive treatment for this condition. AIMS: To investigate the effect of botulinum toxin injection in patients with PAH on sweat production and psychological wellbeing. METHODS: Ten patients were assessed before treatment with botulinum toxin injection using gravimetric analysis and a psychometric questionnaire. Patients were reassessed at intervals of one, four and twelve weeks following treatment. RESULTS: Injection with botulinum toxin resulted in significant improvement in patients physical symptoms and psychological wellbeing. However, improvement was short-lived with recurrence of symptoms at three months. CONCLUSION: Botulinum toxin injection provides very effective short-term relief of PAH. While its limitations should be recognised and explained when consenting patients for treatment, this does not necessarily diminish its value in the treatment of PAH.

Axilla↗
PubMedDate not supplied

Treatment of axillary and palmar hyperhidrosis with botulinum toxin.

The author presents his experience with hyperhidrosis treatment using type-A botulinum toxin. The drug was applied on axillary, palmar, plantar, facial, inguinal, and gluteus areas for a 36-month period. The effect achieved-sweating decrease-was observed in 100% of the patients for a variable period ranging from 5 to 14 months. There was a slight decrease in hand muscle strength in some cases, which was spontaneously recovered after 2 weeks.

Adolescent↗
PubMed2002

Thoracoscopic sympathectomy using ultrasonic coagulating shears: a technical improvement in the treatment of palmar hyperhidrosis.

Thoracoscopic sympathectomy has emerged in recent years as the treatment of choice for primary palmar hyperhidrosis when medical treatment fails. Postoperative complications have been reported in large series, however, including neurologic problems such as temporary or definitive Horner syndrome and peripheral nerve injuries. The authors report the use of ultrasonic coagulating scissors instead of electrocautery for the dissection and removal of a segment of sympathetic chain in an 11-year-old girl. A bilateral procedure was performed sequentially through three 5-mm axillary trocars on each side. The use of ultrasonic shears eliminates the risk of distal nerve injury induced by the spread of electric current and could possibly reduce the incidence of the above-mentioned complications.

Child↗
PubMed2003

Intrapleural analgesia following thoracoscopic sympathectomy for palmar hyperhidrosis: a prospective, randomized trial.

BACKGROUND: Reports on intrapleural analgesia (IPA) are conflicting. The current study assessed the effect of a single-dose thoracoscopic bilateral intrapleural anesthetic administration on the immediate postoperative recovery room and 24-h pain control. METHODS: Fifty patients with primary palmar hyperhidrosis were randomly classified into two groups to receive either 20 ml of 0.5% bupivacaine and 5 mg/ml epinephrine or 0.9% NaCl in each thoracic cavity at the end of thoracoscopic T2-T3 sympathectomy. The degree of early postoperative pain was estimated by visual analog scale (VAS). The 24-h parenteral opioid analgesic requirement was recorded. RESULTS: The immediate postoperative VAS score (1.46 +/- 0.41 vs 2.0 +/- 0.61, p = 0.03), opioid consumption (0.42 +/- 0.36 vs 0.65 +/- 0.28, p = 0.0133), and 24-h opioid consumption (1.02 +/- 0.80 vs 1.48 +/- 0.84, p = 0.05) were significantly reduced following IPA compared to those of the control group. CONCLUSION: IPA is a simple and effective means for postoperative pain control following thoracoscopic upper dorsal sympathectomy.

Adult↗
PubMed2005

Azygos lobe in endoscopic thoracic sympathectomy for hyperhidrosis.

BACKGROUND: Before the introduction of endoscopic thoracic sympathectomy (ETS) for the management of hyperhidrosis, anomalous azygos lobes of the lung were rarely encountered. When performing ETS, it is important to have knowledge of and be prepared to deal with this anatomical anomaly. METHODS: A database of 2,272 patients who underwent ETS was reviewed to determine the incidence of azygos lobe, describe the characteristics of patients with azygos lobe, and evaluate the outcomes. RESULTS: Twenty cases (0.9%) of azygos lobe were identified. Two distinctive variations were encountered, one in which proximal venous drainage was present (type 2) and one in which this downward drainage system did not exist (type 1). In type 2, the vein and veil must be retracted to obtain better exposure. All patients were treated endoscopically, without conversion to open thoracotomy. Palmar sweating was cured in all cases, and all of the patients reported satisfaction with the outcome. CONCLUSIONS: Azygos lobe occurs in 1% of the population and can make ETS more difficult. If the surgeon is prepared, there are effective techniques for performing the sympathectomy. The results are similar to those obtained in patients without this anatomical variation.

Adolescent↗
PubMed1999

Sensitivity, specificity and predictive value of intra-operative elevation of hand temperature to ensure a successful T2-sympathectomy in patients with palmar hyperhidrosis.

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.

Adolescent↗
PubMed2003

Blood pressure and heart rate variability in patients with essential hyperhidrosis.

INTRODUCTION: Essential hyperhidrosis (EH) is often considered to be related to an increased activity of sympathetic nervous system (SNS). However, there is a lack of studies comparing autonomic nervous system (ANS) activity in controls and in EH patients. The aim of the present study was to simultaneously investigate in patients with severe EH, blood pressure, heart rate variability and plasma catecholamine levels in comparison with controls. METHODS: 19 EH patients and 20 controls with normal ANS function assessed by clinical testing were included. Blood pressure (BP) and heart rate (HR) were measured using a Finapres beat-to-beat monitor. BP and HR variabilities (Fast Fourier transformation) and plasma catecholamine levels (HPLC) were obtained at rest and during a 15 min 70 degrees head-up tilt test. RESULTS: At rest, a significantly higher relative energy of low frequency band (LF) of systolic BP was observed in EH in comparison with controls contrasting with the lack of difference in BP, HR, plasma catecholamine levels and in other spectral parameters. During tilt, all changes were comparable in EH and in control subjects excepting relative energy of LF of SBP which remained unchanged when compared to the resting condition in EH group. CONCLUSIONS: In EH, SNS is not over-reactive even if resting overactivity cannot be excluded.

Adolescent↗
PubMed2003

Experience with limited endoscopic thoracic sympathetic block for hyperhidrosis and facial blushing.

Endoscopic thoracic sympathetic block (ESB) has recently become a popular modification of sympathetic surgery, as it offers the potential chance of reversibility. In order to reduce side effects such as compensatory sweating limited ESB at the levels of the T2, T3 or T4 ganglia has been recommended (Lin/Telaranta classification). We present our experience and initial results with this technique. From 6/2001 to 2/2003, 184 ESB procedures were performed in 94 patients. ESB4 was carried out in 53 patients for hyperhidrosis (HH) of the upper limb. In 23 patients ESB3 was performed for craniofacial HH and 18 patients suffering from facial blushing were treated by ESB2. Median follow-up was 5.2-7.5 months.Success rates were similar (~100%) in all groups. Compensatory sweating was found in 25% in the ESB3 compared to 12.5 % in the ESB2 and 8.5 % in the ESB4 group (p < 0.05). Gustatory sweating did not differ significantly between the groups (6.3 % in ESB2, 5% in ESB3 and 2.1 % in ESB4 group). Five patients were reoperated in the ESB3 group (3 because of a side-difference of the effect in the face, 1 patient due to incomplete Horner's syndrome and 1 due to massive compensatory sweating). In the ESB4 group all patients were satisfied with the outcome, whereas in the ESB2 group 6.3% and in the ESB3 group 13.9% were partly satisfied. Limited sympathetic surgery offers comparably high success and satisfaction rates along with a low rate of side effects.

Adaptation, Physiological↗
PubMed2005

Oculosympathetic hyperactivity in idiopathic hyperhidrosis.

We describe a patient suffering from idiopathic hyperhidrosis, more pronounced on the right side, who presented with intermittent oculosympathetic hyperactivity (mydriasis, lid retraction and more rapid pupillary dilatation) on the same side. Mydriasis was induced by stress, loss of sleep and cold pressor test. The clinical features in this patient suggest an involvement of the hypothalamic structures.

Adult↗
PubMed1995

Thoracoscopic upper thoracic sympathectomy for primary palmar hyperhidrosis in children and adolescents.

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.

Adolescent↗
PubMed1996

Contralateral temperature changes of the finger surface during video endoscopic sympathectomy for palmar hyperhidrosis.

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.

Adolescent↗