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PubMed1995

[Compensatory hyperhidrosis on one side in a patient with Ross syndrome].

Ross syndrome involves three clinical signs: tonic pupil, hyporeflexia and segmental hypohidrosis. Sometimes the clinical picture also includes autonomic dysfunction. To our knowledge only 24 cases have been described in the literature, indicating that the syndrome is rare. We present a new case in which contralateral hemicorporal hyperhidrosis was, as usual, the key complementary feature leading to diagnosis.

Adie Syndrome↗
PubMed1994

[Experience of anesthesia during transthoracic endoscopic sympathectomy for palmar hyperhidrosis: comparison between double-lumen endobronchial tube ventilation and laryngeal mask ventilation].

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)

Adolescent↗
PubMed1978

Axillary hyperhidrosis: local treatment with aluminum chloride hexahydrate 25% in absolute ethanol.

Eleven women (group I) with axillary hyperhidrosis were treated ad modum Shelley & Hurley with local application of aluminium chloride hexahydrate 25% in absolute ethanol and plastic foil occlusion during two successive nights once a week. The patients were observed for 24 weeks. Another 12 women (group II) were treated for up to 12 weeks with aluminium chloride hexahydrate 25% in absolute ethanol but without using plastic foil occlusion. We have attempted to determine the effect of the treatment by sweat measurements, leaving the left axilla untreated during the initial 1--2 weeks as a control. An immediate reduction in sweat production of the treated axilla was found in both groups. The reduction increased during the first weeks and was maintained thereafter. The degree of sweat reduction was the same during standardized work and during rest (group II). At the final controls all patients in group I had discontinued the occlusion and had individualized the treatment, most of them using local application 1--2 times weekly. Two patients in group I had to stop the treatment because of unbearable itching. The other patients found the treatment completely satisfactory. All patients had experienced itching and smarting when starting the treatment. Often these discomforts were temporary but they seem to require active support by close medical control during the initital period of treatment. In contrast to previous investigations, effective treatment was achieved both with and without occlusion.

Adolescent↗
PubMed1993

Apert's syndrome (acrocephalosyndactyly) in a patient with hyperhidrosis.

Apert's syndrome, also known as acrocephalosyndactyly, is a rare type of premature craniofacial synostosis characterized by the clinical triad of cranial and facial malformations along with syndactyly of the hands and feet. Acne vulgaris involving atypical sites such as the upper extremities constitutes the dermatologic hallmark of this rare genodermatosis. We report a patient who demonstrates the classic findings of Apert's syndrome. Our patient also presented with severe hyperhidrosis, which may represent a new clinical finding not previously reported in association with this syndrome.

Acrocephalosyndactylia↗
PubMed1993

[Treatment of hyperhidrosis with caudal epidural alcohol block in a patient with cervical cord injury].

A 44-year-old man complained of intermittent and excessive sweating of head and neck throughout the day, followed by severe lower abdominal spasms. He had been suffering from complete paraplegia with neurogenic bladder for 16 years, due to C7 spinal cord injury. In the last 16 years he had four episodes of hyperhidrosis, and these were treated by subarachnoid phenol block. The patient was referred to our clinic this time because of the dry tap during attempted subarachnoid phenol block. We tried several test blocks, lumbar epidural block, inferior mesenteric plexus block, celiac plexus block and caudal epidural block in order to clarify the afferent route of this reflex, because as a cause of this reflex sweating, no physical abnormality was detected. With caudal epidural block abnormal sweating disappeared completely. This finding led us to conclude that the somatic sacral nerves from bladder were afferent routes. We injected 20 ml of 75% alcohol into the caudal epidural space to destroy sacral nerves 5 times in 4 weeks. In a follow up examination, 5 months after his discharge, except minimal complaints about mild lower abdominal spasms, there were no complications from alcohol injection.

Adult↗
PubMed1996

[Thoracic sympathectomy in palmar hyperhidrosis: comparison of open with thorascopic procedure].

Between 1976 and 1994 we performed 26 thoracic sympathectomies for treatment of therapy-resistant palmar hyperhidrosis. Until the end of 1992 the operation was performed using an open transaxillary approach, since 1993 sympathectomy was done by video-assisted thoracoscopy. Both procedures consisted in excision of the thoracic ganglia T2 to T5. The only complication was a pneumothorax in the open surgery group (successfully treated by drainage). Compensatory sweating occurred in 70% of our patients, compared to results in the literature of 60-90%. We did not note further complications, e.g. no Horner's syndrome. All of our patients were satisfied with the result of the operation. Comparison of the two collectives shows significant advantages for video-assisted thoracoscopic surgery. the procedure is easier to perform, exposure is better, cosmetic results are favourable, operation-time and hospital stay are reduced.

Adult↗
PubMed1977

[Operative therapy of hyperhidrosis axillaris (author's transl)].

Development and problems connected with the surgical treatment of hyperhidrosis are considered. 32 patients were operated according to the method of Préaux. The results are good, both cosmetically and with regard to the diminution of the excessive sweat production.

Axilla↗
PubMed1997

Double-blind trial of botulinum A toxin for the treatment of focal hyperhidrosis of the palms.

We performed a randomized double-blind study within-group comparison in 11 patients to study the effect of subcutaneous injections of botulinum A toxin in focal hyperhidrosis of the palms. A total dose of 120 mU (mouse units) of botulinum A toxin (Dysport) was injected into six different sites on one palm, whereas the other was injected with sterile saline. Objective quantification of sweat production was performed using digitized ninhydrin-stained sheets. Three weeks after treatment, the mean reduction of sweat production in the botulinum A toxin-treated palms was 26% (P < 0.001), after 8 weeks 26% (P = 0.002) and after 13 weeks 31% (P < 0.001). Subjective assessment of sweat production by the patients using a visual analogue scale showed a 38% improvement in the botulinum A toxin-treated palms at 3 weeks (P = 0.002), 40% at 8 weeks (P = 0.002) and 38% at 13 weeks (P = 0.002). Neither the objective measurement nor the subjective rating showed a statistically significant reduction of sweating in the placebo-treated palms. Three patients reported reversible minor weakness of powerful handgrip after injection at the toxin-treated site, lasting between 2 and 5 weeks.

Adult↗
PubMed1997

[Treatment of essential hyperhidrosis using thoracoscopic high dorsal sympathectomy].

Essential hyperhidrosis (EH) is a little-known disorder which may have a strong adverse effect on the patient's functioning. Conservative treatment of EH is often disappointing and the 'classical' surgical treatment is very radical and complicated. Thoracoscopic sympathectomy is efficacious in the treatment of palmar (and axillary) EH.

Humans↗
PubMed1979

Inhibition of hyperhidrosis by topical application of a local anesthetic composition.

An eutectic mixture of 5% lidocaine and 5% prilocaine applied locally to the skin inhibited epinephrine-induced sweating in healthy subjects. It also inhibited palmar and axillary hyperhidrosis from 1 to 6 hours after application to 15 of 17 patients tested. A placebo lotion was without effect. When used daily for 3--4 weeks, only 25% of the patients were very pleased with the treatment. The reason for the decrease of efficacy is uncertain.

Administration, Topical↗
PubMed1998

Results of thoracoscopic sympathectomy for 96 cases of palmar hyperhidrosis.

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.

Adrenergic Fibers↗
PubMed1998

[Dorsal sympathectomy for palmar hyperhidrosis by the thin thoracoscope].

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.

Endoscopy↗
PubMed2002

Endoscopic thoracic sympathectomy attenuates reflex tachycardia during head-up tilt in lightly anesthetized patients with essential plamar hyperhidrosis.

PURPOSE: Our purpose was to examine perioperative alterations in hemodynamic changes with head-up tilt (HUT) in patients undergoing endoscopic thoracic sympathectomy (ETS). METHODS: The subjects were 11 patients with essential hyperhidrosis scheduled to undergo ETS (ETS group) and 9 age-matched volunteers undergoing minor surgery (control group). HUT was performed (40 degrees; 5 min) before and after the surgery, under nitrous oxide anesthesia. Orthostatic hypertension and hypotension in response to HUT were defined as changes of 10% or greater in systolic blood pressure. RESULTS: The increase in heart rate in response to HUT was significantly reduced after surgery in the ETS group (from 34 +/- 18 to 14 +/- 11 beats.min(-1); P < 0.001), but not in the control group (from 23 +/- 18 to 22 +/- 12 beats.min(-1); P = 0.911). Orthostatic hypertension disappeared completely after ETS (from 5 of 11 to none of 11 patients; P = 0.035), whereas the prevalence of orthostatic hypotension increased significantly after ETS (from 3 of 11 to 9 of 11 patients; P = 0.030). In the control group, the prevalence of neither orthostatic hypertension nor orthostatic hypotension changed after surgery. CONCLUSIONS: ETS attenuates autonomic circulatory response under nitrous oxide anesthesia.

Journal Article↗
PubMed2004

Iontophoresis for palmoplantar hyperhidrosis.

The pathogenesis of palmoplantar hyperhidrosis (HH) remains unknown. A causative therapy is therefore not possible yet. Step by step treatment for palmoplantar HH is advised. This includes: topical aluminium salts, tap water iontophoresis (TWI), botulinum toxin (BTX) injections and endoscopic thoracoscopic sympathectomy (ETS). The mechanism of action of TWI has been previously studied but is still not completely understood. A widely accepted hypothesis is that the anodal current causes accumulation of H(+) within the sweat duct. It is presumed that this causes an unknown lesion in the acrosyringium that inhibits sweating. TWI is non-invasive, safe, well tolerated, efficient and cheap. The patient can perform the therapy at home without medical assistance. TWI remains the best treatment for palmoplantar HH that has defied aluminium salts. This article provides a review of the literature concerning TWI, including its historical development, its mechanism of action and its indication and also describes the method of administration of this helpful treatment.

Journal Article↗