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PubMed2002

Phacomatosis pigmentokeratotica (Happle) in a 23-year-old man.

Phacomatosis pigmentokeratotica is a rare but highly characteristic disease defined by the occurrence of an organoid naevus with sebaceous differentiation, a speckled-lentiginous naevus and other associated anomalies. It is probably caused by the twin-spot phenomenon. We report on a 23-year-old male electrician with 10 irregularly shaped, sharply demarcated, brownish-yellow papillomatous plaques following Blaschko's lines, as well as 6 large, sharply demarcated, round to oval, slightly greyish macules with pewit-egg-like dots, involving both buttocks, the right thigh, the right knee, the right pectoral region and the upper back. A moderate hyperhidrosis of the palms, soles and axillae was noted. All routine blood tests and laboratory findings, including chest X-ray, ECG, abdominal ultrasound, ocular and neural examination were unrevealing. Phacomatosis pigmentokeratotica may be associated with dysaesthesia, segmental hyperhidrosis, mild mental retardation, epileptic seizures, deafness, ptosis, strabismus or muscular weakness. In our patient, only slight hyperhidrosis was present, whereas all other associated anomalies could be excluded.

Adult↗

PubMed2001

Efficacy of endoscopic thoracic sympathicotomy along with severing the Kuntz nerve in the treatment of chronic non-infectious rhinitis.

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.

Adolescent↗

PubMed1979

The distribution, size and density of the apocrine glands in hidradenitis suppuritiva.

The distribution, size and density of the apocrine glands in hidradenitis suppuritiva as compared with those in axillary hyperhidrosis and normal controls have been studied. There are no significant differences in the size or density of the apocrine glands in hidradenitis suppuritiva as compared with normal controls. The apocrine glands in axillary hyperhidrosis are significantly larger than those in axillary hidradenitis and in normal controls. A simple method that can be used to demonstrate the distribution of the apocrine glands preoperatively is described. This has proved useful in delineating the area which it is necessary to excise to obtain complete apocrine gland excision in the diseased area. The apocrine gland-containing skin in the diseased region does not always correspond exactly to the hair-bearing area in that region.

Apocrine Glands↗

PubMed1998

Negative pressure pulmonary oedema induced by direct suctioning of endotracheal tube adapter.

PURPOSE: Negative pressure pulmonary oedema (NPPE) is a well-recognized but rare complication secondary to upper airway obstruction such as laryngeal spasm during emergence from general anaesthesia. Cauterization of the second and third thoracic sympathetic ganglia is a treatment for hyperhidrosis of the hands. We report a case of NPPE induced by direct suctioning of the endotracheal tube adapter during thoracic sympathetic ganglionectomy without recognized upper airway obstruction. CLINICAL FEATURES: A 19-yr-old otherwise healthy, non-smoking man was scheduled for elective bilateral chest endoscopic ablation of the second and third thoracic sympathetic ganglion for hyperhidrosis of the hands under general anaesthesia. To view and cauterize the ganglion with the endoscope, the surgeon requested cessation of positive pressure ventilation. As the surgeon could not satisfactorily visualize the target ganglia, he requested brief application of wall suction via the ETT tube adapter. A pressure of -100 mmHg was generated which lasted for three to four seconds. The goal was to reduce further the lung volume by increasing the pneumothorax produced by the endoscope. The patient developed negative pressure pulmonary oedema without upper airway obstruction. CONCLUSION: This case demonstrated that intrathoracic negative pressure generated by direct ETT adapter suctioning may produce pulmonary oedema similar to that induced by laryngeal spasm during the emergence of general anaesthesia.

Adult↗

PubMed2001

[Botulinophilia. The new life style venenophilia].

BACKGROUND AND OBJECTIVE: Botulinum toxin is effective in the treatment of hyperhidrosis and the demand for therapy is increasing. Simultaneously we have observed an increase in patients with body dysmorphic disorders who also want botulinum toxin therapy. This botulinophilie is a new variant of venenophilie. We investigated the prevalence of this new diagnosis in our patient population. PATIENTS/METHODS: In the first quarter of 2000 we studied the biopsychosocial features of 13 patients with hyperhidrosis. RESULTS: In 23.1% of our cases we were able to confirm a botulinophilie with body dysmorphic disorder and a normal Minor sweat test. CONCLUSIONS: Botulinophilie is not an indication for botulinum toxin therapy but for psychotherapy.

Adult↗

PubMed2006

Sweating dysfunctions in Parkinson's disease.

There is a high frequency of dyshidrosis in Parkinson's disease. Daily use of an antiparkinsonian drug does not affect sweating. Mental sweating relates to the contraction period and seriousness. However, hyperthermic sweating does not necessarily relate to the contraction period or seriousness. Abnormalities in mental sweating are not necessarily correlated with cardiovascular autonomic disturbances. As the autonomic disturbance becomes more advanced, dyshidrosis becomes more common. Hyperhidrosis may develop with dyskinesia. Hyperhidrosis may be improved by the temporally administration of levodopa. Dyshidrosis might be caused by a centrally-acting abnormality during its early stage. However, postganglional abnormalities as well as central changes may increase as the disease progresses. The presence of dyshidrosis affects the QOL and depression in patients with Parkinson's disease. The only therapy for hyperhydrotic sweating disorders is the administration of levodopa or dopaminagonist. Additional studies including therapy for sweating disorders are necessary.

Humans↗

PubMed2000

The effect of upper dorsal thoracoscopic sympathectomy on the total amount of body perspiration.

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.

Adolescent↗

PubMed2003

Fast track endoscopic thoracic sympathicotomy.

The length of hospital stay is an important factor of cost and psychological discomfort in the treatment of hyperhidrosis by endoscopic thoracic sympathicotomy (ETS). Our experience enrolls 1587 patients operated on an outpatient basis in the last 10 years and seven months. This study aimed to confirm that ETS can be performed on an outpatient basis. Fifty-two consecutive patients (30 males and 22 females) were submitted to ETS under general anesthesia using a single lumen endotracheal tube, with lung collapse by intrapleural injection of CO(2). The sympathetic chain and the communicating rami were severed at different levels according to hyperhidrosis location. Patients were physical state American Society of Anesthesiologists 1 and 2. Age varied between 13 and 55 years (27.3 +/- 10.2 years). They were monitored with ECG, SPO2, NIBP, expired CO(2), sevoflurane analyzer, and airway pressure. Normal saline (40.0 +/- 2.7 ml/kg) was infused intravenously. The drugs used were propofol, alfentanil, rocuronium, ondansetron, dexamethasone, dipyrone, cetoprofene and sevoflurane. Anesthesia and post-operative data were analyzed. Post-operative thoracic X-rays were taken in 20 patients before discharge. Anesthesia lasted 67.2 +/- 20.8 minutes, and the surgical procedure took 46.3 +/- 20.9 minutes. The patients stayed 18.0 +/- 11.0 minutes in the post-anaesthetic care unit and were discharged from hospital after 150.3 +/- 43.1 minutes. The only abnormal post-operative event observed was insignificant residual carbothorax, found in 2 (10%) of the thoracic X-rays taken. In conclusion, this study confirmed that ETS can be performed safely on an outpatient basis.

Adolescent↗

PubMed2003

Effects of gender and level of surgical sympathetic block on vasoconstrictor function.

Interruption of sympathetic outflow by surgical sympathetic block has been used to treat hyperhidrosis for decades. In this study the effect of gender and the level of sympathetic block (T2 vs. T3) on the rewarming kinetics following ice water immersion were assessed in a prospective study on 60 hyperhidrosis patients before, 2 days, and 3 months postoperatively. Rewarming kinetics following endoscopic sympathetic block (ESB) was massively enhanced 2 days post-operatively, but had returned to pre-operative conditions at the 3 month follow-up for ESB at level T3. ESB at level T2 provoked significantly faster rewarming as compared to T3 at the 2 day and 3 month follow-up. Independent of the level of ESB, there was a slower rewarming in women already pre-operatively. This gender difference was clearly reduced at the 2 day follow-up, but had increased again at the 3 month follow-up. There was no correlation between the rewarming kinetics of the fingertips and palmar sweating. We conclude that for the sympathetic vasoconstriction of the fingertips the sympathetic ganglion T2 is crucial. Gender differences have to be taken into account when assessing effect of ESB by cold induced vasoconstriction. It remains to be established whether the quantification of vasoconstriction has some predictive value for the long-term prognosis of sudomotor blockade.

Adolescent↗

PubMed2005

Intraoperative prediction of compensatory sweating for thoracic sympathectomy.

OBJECTIVE: Postoperative compensatory sweating (PCS) is an important problem impacting on quality of life for patients after endoscopic thoracic sympathectomy (ETS). The present study investigated whether intraoperative palmar temperature and blood flow are useful for assessing PCS after ETS. METHODS: Retrospectively, results were evaluated for ETS in 27 consecutive patients with primary palmar hyperhidrosis between 1996 and 2002. For all patients, bilateral nerve conduction to the palms was interrupted. The relationship between the range of PCS and intraoperative changes in palmar temperature and blood flow was investigated. RESULTS: PCS developed in all cases. After completion of ETS, mean blood flow and temperature increased respectively. Significant correlations were found between the range of PCS and increases in palmar temperature (p<0.05) and blood flow (p<0.05). CONCLUSION: Intraoperative monitoring of increases in palmar temperature and blood flow may be useful in patients with primary hyperhidrosis, to predict the range of PCS after ETS.

Adolescent↗

PubMed2006

Radical treatment of axillary osmidrosis by subdermal excision of apocrine glands: a prospective study in 31 cases.

Axillary osmidrosis is a troublesome and distressing problem. Medical treatment is only temporally effective. From March 2003 to November 2004, 36 patients with axillary osmidrosis (nine cases combined with axillary hyperhidrosis) have been treated by excision of the subcutaneous glands via a small transverse incision, of which 31 cases could be followed up for a minimum of 3 months (average 7.3 months). In terms of malodour elimination, 30 cases had good results, one had fair result, and none had a poor result. All patients reported significant reducing of sweating, especially those with hyperhidrosis. Postoperative complications were minor, including small haematoma (one axillae), small seroma (two axillae), and superficial epidermal necrosis (21 axillae) which were all spontaneously healed within a week. Twenty-nine (93.5%) patients were very satisfied with the procedure and two (6.5%) patients satisfied, with none regretful. The operation has the advantage of a high success rate in radical elimination of the malodour with minor complications.

Adolescent↗

PubMed2004

Eccrine nevus.

Localized hyperhidrosis on the left forearm of a 7-year-old girl is described. Biopsy revealed an eccrine nevus. The differential diagnosis of localized hyperhidrosis is discussed.

Child↗

PubMed2004

Upper thoracic sympathectomy for axillary osmidrosis or bromidrosis.

The difference between axillary osmidrosis (AO) and axillary bromidrosis (AB) is the degree of odor and quantity of sweat, which is associated with selection of therapeutic modality theoretically. Upper thoracic sympathectomy has been used for both diseases but its effect needs to be further evaluated with more clinical data. We collected 108 patients with AO or AB treated by upper thoracic sympathectomy from July 1995 to July 2002. Of these patients, 42 suffered AO alone, 17 had AB (AO with axillary hyperhidrosis [AH]), and 49 had AO with palmar hyperhidrosis (PH). Ninety-two patients (183 sides) received anterior subaxillary transthoracic endoscopic sympathectomy (TES) and 17 patients (33 sides) received posterior percutaneous thoracic phenol sympathicolysis (PTPS). The levels of sympathectomy or sympathicolysis were T3-4 for AO and AB, and T2-4 for AO with PH. Mean follow-up period was 45.2 months (13-97 months). The satisfaction rates of patients were 52.4%, 70.6% and 61.2% for AO, AB and AO with PH, respectively. The rates of patients with improvement and satisfaction were 78.6%, 88.2% and 85.7% for AO, AB, and AO with PH, respectively. These results suggest that upper thoracic sympathectomy may be an acceptable treatment for AB or AO with PH rather than AO only.

Adolescent↗

PubMed2001

Early complications of thoracic endoscopic sympathectomy: a prospective study of 940 procedures.

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.

Adolescent↗

PubMed2003

[Sympathetic dermatomes corresponding to T2 and T3 ganglia. A prospective study of 100 superior thoracic sympathicolytic procedures].

UNLABELLED: The autonomic nervous system adjusts sweating on the body's skin surface. The skin areas corresponding to the various sympathetic ganglia are not yet clearly defined. The purpose of this study was to define the skin areas corresponding to the T2 and T3 sympathetic ganglia. METHODS AND MATERIALS: We performed bilateral thoracic sympathicolysis endoscopically on the T2 and T3 ganglia of 50 patients with primary hyperhidrosis. All answered a questionnaire before surgery and at least two months later. The questionnaire asked about sweating at different points, but in order to estimate the cutaneous projection of T2 and T3 we only analyzed anhidrotic regions. RESULTS: Denervation resulted in anhidrotic hands (98.11%); axillas (73.58%); arms (39.62%); forehead (20.75%); chin, cheeks, neck and the nape of the neck (16.98%); sides of the chest (13.2%); front of the chest (7.54%); and back (1.88%). CONCLUSIONS: The territory influenced by the T2 and T3 sympathetic ganglia is more extensive than has been described by classical anatomical studies. The cutaneous area innervated by the sympathetic T2 and T3 ganglia extends to zones influenced by T1 in up to 20.75% of patients with primary hyperhidrosis.

Axilla↗

PubMed2000

Nonresponders among hyperhidrotics.

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.

Acoustic Stimulation↗

PubMed2000

Asymmetric sweating in a child with multiple sclerosis.

A 10-year-old male with multiple sclerosis complained of excessive sweating on the right side of the forehead and shoulder on relapse 3 months after the onset of multiple sclerosis. Because the neurologic evaluation revealed no abnormalities in the sudomotor function, it is likely that the hyperhidrosis resulted from a lesion in the central or preganglionic sympathetic nervous system. Magnetic resonance imaging demonstrated a high-intensity lesion involving the left hypothalamus on T(2)-weighted imaging. Thus hypothalamic involvement might be the reason for the hyperhidrosis in this patient.

Abducens Nerve Diseases↗

PubMed1994

The role of sympathectomy in current surgical practice.

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.

Causalgia↗