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PubMed2001

[Long-term effects after surgery for hand sweating and facial blushing. Patients are satisfied in spite of troublesome side-effects].

The thoracoscopic technique has simplified surgery on the upper thoracic chain. This comparatively minimally traumatic approach has resulted in a pronounced increase in the number of procedures. The effect of ETS on severe palmar hyperhidrosis and facial blushing is very good. These conditions often cause social, professional and emotional handicaps. Side-effects, especially compensatory sweating (increased sweating on the trunk and legs), can, however, be severe. The procedure should be used only when the hyperhidrosis or facial blushing is severely detrimental to the quality of life. The expected effects, side-effects and risks for complications must be made clear before patients are accepted for ETS.

Adolescent↗
PubMed2004

Sudomotor function in familial dysautonomia.

BACKGROUND: Patients with familial dysautonomia (FD) manifest episodic hyperhidrosis despite the reduction of sudomotor fibres and sweat glands associated with this autonomic neuropathy. We assessed peripheral sudomotor nerve fibre and sweat gland function to determine if this symptom was due to peripheral denervation hypersensitivity. METHODS: In 14 FD patients and 11 healthy controls, direct and axon reflex mediated sweat responses were determined by measuring transepidermal water loss (TEWL) after application of acetylcholine via a microdialysis membrane, a novel method to evaluate sudomotor function in neuropathy patients. Results were compared with data from conventional quantitative sudomotor axon reflex testing (QSART). Using microdialysis, interstitial fluid was analysed for plasma proteins to evaluate protein extravasation induced by acetylcholine as an additional parameter of C-fibre function. RESULTS: Although reduced axon reflex sweating was expected in FD patients, neither direct or axon reflex mediated sweat responses, nor acetylcholine induced protein extravasation differed between control and patient groups. However, the baseline resting sweat rate was higher in FD patients than controls (p<0.05). TEWL and QSART test results correlated (r = 0.64, p = 0.01), proving the reliability of TEWL methodology in evaluating sudomotor function. CONCLUSION: The finding of normal direct and axon reflex mediated sweat output in FD patients supports our hypothesis that, in a disorder with severe sympathetic nerve fibre reduction, sudomotor fibres, but not the sweat gland itself, exhibit chemical hypersensitivity. This might explain excessive episodic hyperhidrosis in situations with increased central sympathetic outflow.

Acetylcholine↗
PubMed2004

[Thoracic sympathectomy performed by videothoracoscopic technique].

UNLABELLED: Thoracic sympathectomy is a method for a segmental elimination of functions of the sympathetic system by the excision of its Th2-Th3 ganglia. The procedure can be performed both using open and videoscopic technique. OBJECTIVE: The purpose of the study was the evaluation of efficacy of videoscopic thoracic sympathectomy. MATERIAL AND METHOD: From 1993 to 2003 we performed 53 videoscopic thoracic sympathectomies in patients with Raynaud's syndrome and upper limb hyperhidrosis. RESULTS: In all patients that underwent thoracic sympathectomy we obtained a positive reaction to a segmental excision of the sympathetic trunk. Patients with Raynaud's showed a significant improvement in symptoms in 76% of cases after a 4-year observation while patients with hyperhidrosis in 100%. The time of hospitalisation was 3.5 days in average. Postoperative complications were observed in two patients (3.7%). Videoscopic thoracic sympathectomy provides good therapeutic and cosmetic results and deserves more common use compared with open technique.

Ganglia, Sympathetic↗
PubMed2005

Clinical application of botulinum toxin type B in movement disorders and autonomic symptoms.

OBJECTIVE: [corrected] To evaluate efficacy and safety of botulinum toxin type B (BTX-B) in treatment of movement disorders including blepharospasm, oromandibular dystonia, hemifacial spasm, tremor, tics, and hypersecretory disorders such as sialorrhea and hyperhidrosis. METHODS: A retrospective study of BTX-B injections in treatment of 58 patients with various neurological disorders was performed. The mean follow-up time was 0.9 +/- 0.8 years. Results of the first and last treatment of patients with at least 3 injection sessions were compared. RESULTS: The response of 58 patients to a total of 157 BTX-B treatment sessions was analyzed. Of the 157 treatment sessions, 120 sessions (76.4%) resulted in moderate or marked improvement while 17 sessions (10.8%) had no response. The clinical benefits after BTX-B treatment lasted an average of 14 weeks. Of the 41 patients with at least 3 injection sessions (mean 10 +/- 8.6), most patients needed increased dosage upon the last session compared to the first session. Nineteen patients (32.8%) with 27 sessions (17.2%) reported adverse effects with BTX-B treatment. CONCLUSIONS: Though most patients require increased dosage to maintain effective response after repeated injections, BTX-B is an effective and safe treatment drug for a variety of movement disorders, as well as drooling and hyperhidrosis.

Anti-Dyskinesia Agents↗
PubMed1992

[Tests for autonomic functions: sudomotor function].

Sudomotor function tests provide information on the functional state of the sympathetic system innervating skin, the postganglionic fibers of which are cholinergic. Various methods for sweat elicitation and its qualitative or quantitative detection are described here, but most practical combinations vary depending on the purpose of testing and possible pathophysiology of each patient; 1) hyperhidrosis vs. hypo- or anhidrosis, 2) central vs. peripheral or postganglionic lesions, 3) generalized vs. focal disturbances. When these are unknown, thermal sweating of the whole body is most informative. Comparison of thermal and pharmacological sweating enables one to estimate the extent and possible site of sympathetic disturbance. In evaluating the results of sudomotor function tests, factors due to employed methods, age, sex, posture, medication, etc must be taken into consideration. In general, hyperhidrosis is more difficult than hypohidrosis to estimate its underlying mechanism, since the functional relation between the facilitatory hypothalamo-spinal pathway and other central structures still remains largely unknown.

Female↗
PubMed1989

[Eccrine hidrocystoma].

Most eccrine hidrocystomas are solitary, asymptomatic lesions. Multiple hidrocystomas are very rare and are probably caused by dilatation of eccrine ducts. Immunohistochemical investigations are helpful in distinguishing whether a solitary or multiple form is present. An isolated hidrocystoma can be treated by surgery or electrocautery. Multiple eccrine hidrocystomas are more difficult to treat. Topical atropine may be successful for multiple lesions. We observed a patient with more than 100 lesions associated with significant hyperhidrosis. Although several systemic drugs were used, no relief of the hyperhidrosis could be achieved. During topical administration of atropine some shrinkage of cysts was seen.

Administration, Topical↗
PubMed1988

[Symmetrical lividity of the fingers].

Symmetric lividity of the soles of the feet was first reported in two children in 1925 by Pernet. The characteristic manifestation of this dermatosis consisted in hyperkeratosis and hyperhidrosis with livid discoloration of the pressure areas of the soles. Later the same name was applied to a similar dermatosis in which the hyperkeratotic and hyperhidrotic patches of skin on the soles had a whitish grey discoloration and the livid color, if present at all, was seen only over the marginal areas not affected by the keratosis. Similar livid keratoses affecting the palmar sides of the fingers have been seen only occasionally. The 17-year-old girl presented in this paper had a 11-year history of emotional hyperhidrosis and is a rare illustration of symmetrical lividity in its original form, localized to the fingers only.

Adolescent↗
PubMed1985

[Prospective study of the importance of constitutional parameters in the development of eczema in hairdressers and construction workers].

The considerable rate of professional hand eczema in hairdressers, especially in young ones, emphasizes the necessity of practicable methods for early diagnosis of risk and manifestation of eczema. Therefore, we investigated different constitutional parameters of the skin (hyperhidrosis, dyshidrosis and acrocyanosis of the hands, seborrhea, sebostasis, white dermographism) in a prospective study of 210 hairdressers' and 95 bricklayers' apprentices over 3 years. In addition, the alkali resistance and the permeability of the horny layers (by nitrazine yellow) were examined every year in each of the probands. Among other results dyshidrosis and sebostasis proved to be statistically relevant in the development of hand eczema, whereas no statistic causality was seen for acrocyanosis and hyperhidrosis. Risk of eczema could not be diagnosed early by alcali resistance tests. Frequent wet-work and insufficient skin protection were further factors causing eczema, especially in atopic subjects. There was also a statistically relevant correlation between a periumbilical eczema (caused by metallic buttons on jeans), indicating allergy against nickel, and pierced earlobes. The results of this prospective study show that by simple clinical methods serious risks of eczema in hairdressers and bricklayers can be detected already in the first years of work. Several practical recommendations for prevention of occupational eczema in hairdressers are given.

Adolescent↗
PubMed1987

Treatment of excess sweating of the palms by iontophoresis.

Eighteen subjects were treated for palmar hyperhidrosis by tap water iontophoresis. Only one hand was treated; the other served as a control. Fifteen of the 18 subjects became euhidrotic. Iontophoresis is a suitable alternative to long-term drug therapy and should be offered to patients for the control of palmar hyperhidrosis prior to surgical intervention.

Adult↗
PubMedDate not supplied

Thoracoscopic sympathectomy.

Surgical sympathectomy has traditionally been achieved by 'open' surgical techniques. The transaxillary, cervical, or dorsal approaches have not been without morbidity and cosmetically have been found to be less than ideal. The main indication for sympathectomy in most units is palmar and axillary hyperhidrosis refractory to medical treatment, although it has been used with some success in troublesome causalgia. Use of sympathectomy in Raynaud's disease remains disappointing. In our unit thoracoscopic sympathectomy has been performed since 1980. A CO2 pneumothorax is initially created in the usual manner. This is followed by electrocoagulation of the sympathetic chain under direct vision using a unipolar diathermy. The lung is then reinflated under direct vision. Chest drains are not inserted. Both sides are performed at the same sitting, and the patient usually leaves hospital the following day. The functional and cosmetic results are excellent on short and long term follow-up with few side effects. Permanent Horner's syndrome has not been reported using this technique. As with all upper limb sympathectomies, patients should be warned of possible compensatory hyperhidrosis. Embracing the tenets of minimally invasive surgery, thoracoscopic sympathectomy should be considered the approach of choice for surgical sympathectomy.

Axilla↗
PubMed1993

[Chylothorax: a rare complication of transaxillary thoracic sympathectomy].

Transaxillary upper thoracic sympathectomy is a safe surgical procedure for the treatment of palmar hyperhidrosis. Although thoracic complications such as hemothorax and pneumothorax occasionally occur following this procedure chylothorax is an extremely rare complication. From 1978 to 1991, 215 consecutive patients underwent upper thoracic sympathectomy for the treatment of palmar hyperhidrosis in our institution. We report the surgical management of one patient who developed an intractable chylous fistula which did not respond to non-surgical treatment. Attempts at non-surgical management of the disease, with aspiration therapy, tube thoracostomy and the administration of medium chain triglyceride diet, should be tried first. If, however, this is not successful within two weeks, one should not wait for further metabolic and nutritional impairment before instituting surgical treatment. We believe that proximal thoracic duct ligation is a relatively simple and effective means of controlling chylothorax.

Adolescent↗
PubMed1997

Predicting changes in the distribution of sweating following thoracoscopic sympathectomy.

BACKGROUND: Compensatory sweating is a common symptom following thoracic sympathectomy; however, the reported incidence of this complication varies greatly, and its severity has not been quantified. METHODS: In this study changes in the distribution of sweating following bilateral T2-3 thoracoscopic sympathectomy for hyperhidrosis were assessed in 42 patients. Sweat production in the palms, axillae, face, trunk and feet was assessed using a linear analogue scale. RESULTS: The operation was most successful in reducing sweat production in the palms, axillae and face (in descending order). The operation also reduced pedal sweat production in 12 of the 29 patients who suffered concomitant pedal hyperhidrosis. Compensatory truncal sweating occurred in 36 of the 42 patients; it was severe in ten, moderate in 16 and minimal in ten. CONCLUSION: Patients should be warned about compensatory sweating before thoracic sympathectomy.

Adult↗
PubMed1997

Treatment of gustatory sweating with botulinum toxin.

Gustatory sweating is an autonomic disorder that frequently occurs after parotid gland surgery. We investigated the action of intracutaneous injections of botulinum toxin (BTX) (1.0-2.0 mouse units/2.25-cm2 skin area) in 45 patients (mean age, 52 years) with gustatory sweating. The area of hyperhidrosis was determined by Minor's iodine test before and up to 24 weeks after the injection. The effect of BTX was assessed by measuring the hyperhidrotic area. The maximum BTX-induced reduction of gustatory sweating was seen at 7.4 +/- 4.5 days after injection. The area of sweating decreased from 17.6 +/- 8.6 cm2 before BTX to 1.3 +/- 1.6 cm2 after BTX (p < 0.0001). Half the patients rated gustatory sweating subjectively as completely abolished, and the remainder felt pronounced improvement. No toxic effects were observed. In none of the patients did hyperhidrosis recur over a 6-month follow-up. We conclude that BTX is a safe and effective treatment that can be recommended as the therapy of choice in gustatory sweating.

Adult↗
PubMed2004

Drawbacks of endoscopic thoracic sympathectomy.

BACKGROUND: Endoscopic thoracic sympathectomy (ETS) has come into widespread use for palmar hyperhidrosis and other complaints of the upper limb and of the head and neck, but there are concerns about its safety. This review highlights the operative complications and long-term side-effects that may occur. METHODS: A Medline search was carried out using the terms 'thoracoscopic sympathectomy', 'endoscopic thoracic sympathectomy' and 'complications'. References from identified articles were handsearched for further relevant articles. The senior author's experience and personal communications were also taken into account. RESULTS AND CONCLUSION: No death following ETS has ever been reported in the literature, but nine anecdotal fatalities are known, five resulting from major intrathoracic bleeding and three from anaesthetic mishap. Significant intrathoracic bleeding may occur in up to 5 per cent of patients but only a minority require thoracotomy; pneumothorax occurs in 2 per cent of patients and two instances of brain damage are known. In the longer term compensatory hyperhidrosis is extremely common and 1-2 per cent of patients regret having had surgery because of its severity. Horner's syndrome, on the other hand, is rare. Improvements in instrumentation, adequate training and careful patient selection may help reduce the drawbacks of ETS.

Humans↗
PubMed2001

Analysis of the factors influencing the therapeutic effects of onychomycosis.

In order to improve the curative effect of onychomycosis, the factors influencing the therapeutic effects were investigated. 545 cases including 245 males and 300 females, who were diagnosed both clinically and mycologically, were treated by Intraconazole with intermittent pulse therapy. The therapeutic effects were judged by the following observations regularly and analyzed from the factors as follows: age; growing speed of nails; accompanied diseases; family history; trauma of nails; infection ways of the pathogens; manifestation of the injury; pathogens; duration of the treatment. The results showed that the recovery rate was higher in younger patients (P < 0.01) with a quicker recovery rate (P < 0.001), and a lower recurrent rate (P < 0.01), as well as in those with quicker growing speed of new-born nail. Also the patients with WSO and DLSO manifestation had a higher recovery rate. The patients with onychomycosis caused by T. rubrum had a higher recovery rate (P < 0.01 to 0.001) no matter whether to prolong the treatment duration. The patients with diabetes mellitus or hyperhidrosis, as well as with positive family history or basic nail diseases such as trauma and paronychia, had a lower recovery rate and the curative effects were not satisfactory. It was concluded that although the single and some DLSO-manifestation nail injury could be cured by internal and external treatments with the help of removing the sick nail and the duration of the treatment could be shortened. The treatment duration should be prolonged in order to increase the curative effects and decrease the recurrence under such conditions as following: old patients above 60 years; patients with low-growing-speed new-borne nails; patients with thumb and big toel injury and ingrowing nail; patients with diabetes mellitus, hyperhidrosis or Renauld's phenomenon; patients with nail trauma before or during the treatment; patients with PSO or TDO manifestation; patients with onychomycosis caused by Candida or Aspergillus; patients with abnormal new-borne nails of abnormal color, coarse surface or abnormal thickness.

Adolescent↗
PubMed2003

History of sympathetic surgery.

The first reported operation on the upper sympathetic system was performed by Alexander in 1889. The initial indications (epilepsy, exophthalmic goiter, idiocy, glaucoma) are obsolete. For some subsequent indications (angina pectoris, vasospastic disorders, and painful conditions) sympathectomy has still a limited application. The main indications today are hyperhidrosis (since 1920) and blushing. Renewed attempts to perform the operation for psychological conditions have been reported. The technique of sympathectomy has been modified over the century, with a trend to minimize the extent of surgery: from open to endoscopic approaches; from resection of ganglia to thermoablation, thermotransection, and clipping. The sequelae of the operation (mainly compensatory hyperhidrosis) present a major problem in a small percentage of operated patients. Techniques of reversal (by nerve grafting and unclipping) have been proposed. Meticulous follow-up studies are required to evaluate the merits of these techniques. Improved knowledge of the functions and interrelations of the autonomic nervous system is required to understand the mechanism of these sequelae and learn how to avoid or treat them.

History, 19th Century↗
PubMed2003

In vivo extracellular recording of sympathetic ganglion activity in a chronic animal model.

Surgery of the sympathetic system is performed for a variety of indications, hyperhidrosis being a major one. Despite excellent results, sympathectomy for hyperhidrosis bears a number of sequels, some of which may be devastating. Several surgical methods, empirically advocated to alleviate these problems, have only limited success. Chronic in vivo recording of the electrical activity from sympathetic ganglia may assist in understanding and clarifying complex problems of sympathetic surgery; however, no suitable method has been reported. An electrode device developed by our group was implanted on the stellate ganglion, in a chronic animal model (dog). The signals obtained were amplified, filtered, and transmitted via an A/D interface to be acquired and saved on a computer, using special software which we developed. Our method enabled the separate recording of neuroelectrical signals, ECG, and respiration waves. An additional software program, also developed by our group, was used to analyze the data. This chronic animal model allows investigation of surgical and pharmacological manipulations of the sympathetic system.

Animals↗
PubMed1985

Upper dorsal sympathectomy.

Over a 20 year period, 60 patients underwent 76 procedures for upper dorsal sympathectomy, usually with a transaxillary approach but occasionally with an anterior approach. Procedures in male patients and in those that were carried out on the right side were most frequent. There were few simultaneous procedures. The extent of sympathectomy included resection of the lower half of the stellate ganglion through the fourth thoracic ganglion. The results were satisfying for patients with vasospastic disorders and hyperhidrosis and quite acceptable for those with causalgia and vaso-occlusive disorders. Complication rates and the incidence of postoperative Horner's syndrome were low. There were prominent differences in results among the various age groups. In addition, female patients and those with bilateral procedures had less favorable results. Factors that did not appear to affect results included technique of surgical approach, extent of sympathectomy, presence of Horner's syndrome, or the addition of other procedures. Current indications for upper dorsal sympathectomy include cases of Raynaud's and Buerger's diseases refractory to drug therapy, causalgia, vaso-occlusive disorders, and hyperhidrosis.

Adolescent↗