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PubMed1986

Transthoracic sympathectomy.

Excision of the upper thoracic sympathetic chain can be performed effectively and safely by a transthoracic approach. The most valuable indication is for severe idiopathic hyperhidrosis of the hands for which it produces a most satisfactory and lasting relief. It is also indicated for severe Raynaud's phenomenon that does not respond to conservative measures but here there is a tendency to progressive relapse following surgery so that only about half the patients show improvement several years later.

Ganglia, Sympathetic↗
PubMed1979

Ocular manifestations after upper dorsal sympathectomy.

Fifty patients underwent ophthalmologic examination before and after bilateral upper dorsal sympathectomy performed for palmar hyperhidrosis. Postoperative examination was done during the first week, at 3 to 4 weeks and at 6 to 12 months after the operation. Immediately after surgery there were 18 patients with ptosis (6 severe) and 23 with miosis (12 severe). There were 19 patients with excessive lacrimation and some degree of congestion of conjunctival blood vessels was present in almost all patients. Uniocular decrease in tears was present in 2 patients. Most of these manifestations decreased with passage of time. At one year there remained only 3 patients with severe ptosis and 4 with severe miosis. The results suggest that the classical anatomic explanation of Horner's syndrome may require some modification.

Adult↗
PubMed1977

[Syndrome of the ingrown nails?].

Among the 20 patients with ingrowing toenails operated on in the Department of Dermatoloy in Cologne in 1976, we noticed a combination of the following signs: ingrowing big toenail, latent diabetes, tall stature, pseudo-acromegaly, hyperhidrosis and a preponderance of the male sex and of the age group 12-16 years. Our findings indicate that all patients with ingrowing toenails should be examined for latent diabetes, and that ingrowing toenails are mainly to be found in young male patients with a particular type of constitution.

Acromegaly↗
PubMed1978

Office surgical management of recalcitrant axillary lesions.

Hidradenitis suppurativa, hyperhidrosis, and Fox-Fordyce disease represent some of the surgical conditions seen by the dermatologist in office practice. These chronic, distressing, socially inhibiting diseases are extremely difficult to treat conservatively and ultimately require surgical intervention. Using local anesthesia, we have successfully managed these disorders on an outpatient basis by surgical excision, achieving excellent cosmetic and functional results, minimal discomfort, and absence of recurrence.

Adolescent↗
PubMed1984

Current status of thoracic dorsal sympathectomy.

This article summarizes over 20 years of experience (1962 to 1982) with cervical sympathectomy (thoracic dorsal sympathectomy) in 46 patients undergoing 68 sympathectomies. All operations were performed through an anterior supraclavicular approach. Indications for surgery were intractable Raynaud's disease (26 patients), atherosclerotic obliterative arterial disease (five), causalgia (five), posttraumatic sympathetic dystrophy (seven), collagen vascular disorders (eight), hyperhidrosis (12), occupational-related digital thrombosis (four), and thrombosis secondary to intra-arterial injection (one). The incidence of complications and side effects, both temporary and permanent, including Horner's syndrome, is reviewed in detail. Particular reference is made to the various surgical techniques of managing the stellate ganglion; four patients had two-third to three-fourth resection of the stellate ganglion down to and including the T-3 thoracic ganglion, two had preservation of the stellate ganglion and resection of the T-2 through T-4 ganglia, seven had excision of the entire stellate ganglion down to and including the T-4 ganglion, seven had resection of the lower third of the stellate ganglion down to and including the T-4 ganglion, and 48 had removal of the lower half of the stellate ganglion down to and including the T-3 ganglion. The study reviews the literature germane to anatomic considerations and suggests revisions in current texts and atlases. By retrospective analysis of the records and a follow-up questionnaire, which provided an 86% follow-up (average 8.4 years), the paper points to the distinctive clinical characteristics of the different groups within the population undergoing the operation and provides guidelines for patient selection and conclusions on the place for this operation in the management of vascular diseases involving the upper extremity.

Adult↗
PubMed1983

[Contact sensitization to an antiperspirant with the active ingredient propantheline bromide].

In five patients developing axillary contact dermatitis subsequent to the use of an antiperspirant containing propantheline bromide patch testing was performed. Three patients reacted to propantheline bromide. The other two patients exhibited positive patch test reactions to the proprietary product; in these cases, the active ingredient was not tested individually. In all five patients, in addition to the antiperspirant, at least one other contact allergen was identified. In case of localized adverse reactions due to topical treatment of hyperhidrosis axillaris patch testing is recommended. If contact allergy to propantheline bromide is revealed, one should be aware of cross sensitization to methantheline bromide.

Adult↗
PubMed1980

[Aplasia of the premolars as a leading symptom of ectodermal dysplasia].

The primary symptom in the tooth system, a tendency toward aplasia of the bicuspid teeth in both dentition periods, was reported for an ectodermal syndrome which has seldom been described. In agreement with the observation by BOOK (1950), we also observed excessive perspiration (hyperhidrosis) and premature graying of the scalp hair (canities prematura). The syndrome, which is limited to ectodermal disturbances, is a dominant trait, the incidence of which is apparently higher in Northern European countries. Trigeminal neuralgias seem to appear in conjunction with this genetic disturbance. Compared with other partial anodontic and oligodontic syndromes, it is striking that no other groups of teeth are affected; the bicuspid teeth however show signs of aplasia, hypoplasia, structural disturbances (discoloration), and premature loss of even the deciduous teeth.

Bicuspid↗
PubMed1978

[Late results of thoracic sympathectomy in various diseases].

The late results of 171 thoracal sympathectomies performed on 142 patients in the 20-year period 1952 to 1971 are described. Favourable results were achieved in Raynaud's disease, obliterating endarteritis and other occlusive vascular diseases, and also in hyperhidrosis.

Endarteritis↗
PubMed1982

The acromegaly syndrome. Relation between clinical features, growth hormone values and radiological characteristics of the pituitary tumours.

One hundred and fifty-five acromegalics, 76 males (mean age 44 +/- 1.3 years) and 79 females (45 +/- 1.4 years) were studied. The frequency of clinical features were: acral enlargement 100 per cent, hyperhidrosis 65 per cent, headache 55 per cent, paraesthesiae 49 per cent, cardiac problems 34 per cent, hypertension 32 per cent, diabetes mellitus (clinical and chemical) 27 per cent, and visual field defects 6 per cent. Signs and symptoms, and particularly headache, did not show any relation with the size or shape of pituitary tumours, nor with growth hormone (GH) values, age, sex or weight. Mean of GH values at 60, 90 and 120 minutes during a GTT averaged 135 mIU/l, range 8-1833. Diabetes mellitus was more frequent and severe in patients with higher GH values, occurring in 32 per cent of patients with mean GH values greater than or equal to 50 mIU/l and only in 16 per cent of the rest (p less than 0.05). GH values correlated positively with size of tumours. Forty-nine per cent of patients presented with entirely intrasellar tumours, 27 per cent with suprasellar extensions and 23 per cent with partially empty sellae. The mean GH (238 mIU/l) of patients with suprasellar extensions was significantly higher (p less than 0.004) than those of the others. Younger acromegalics showed a tendency to larger tumours. Early treatment of acromegaly, particularly in young patients and those presenting with high GH values, is recommended.

Acromegaly↗
PubMed1982

[Current indications for superior dorsal sympathectomy. Apropos of 84 cases].

Results of dorsal sympathectomy in patients (67 operations) for vasomotor disorders of the upper limbs were assessed after follow-up for between 6 months and 15 years, in order to determine the best indications for surgery. Based on clinical results, sympathectomy should be performed not only when medical treatment fails, but also in the presence of a severe clinical picture of trophic disturbances or pain of the ischemic type. Two types of investigation are essential before deciding on operative therapy:--plethysmography with a hyperemia test,--arteriography of the hand. Assessment of results as a function of etiology demonstrated that they were excellent in cases of hyperhidrosis, very satisfactory in atheromatous digital arteritis or a thoracic inlet syndrome (associated with rib resection in the latter case), but only moderately good in scleroderma or post-traumatic lesions. Finally, Raynaud's disease or thromboangiitis do not appear to be indications for this operative procedure.

Adolescent↗
PubMed1978

[Oral treatment of severe psoriasis with a new aromatic retinoid (Ro 10-9359) (author's transl)].

The aromatic retinoic acid derivative Ro 10-9359 was administered orally to 25 severe psoriatic patients (14 with generalized plaques, 7 erythrodermic, 4 pustular). The initial dose was 25 mg/20 kg body weight daily for 4 weeks; afterwards the same posology was given every other day during several months (Max : 18 months). Excellent results were obtained in 16 patients (64 p. 100) particularly in severe erythrodermic and pustular psoriasis. However, under follow-up therapy relapses sometimes occurred leading to temporary resumption of initial posology. The most important side effects are cheilitis, palmoplantar scaling with thinning of the skin, hyperhidrosis and diffuse hair loss. A slight increase of transaminases and of alkaline phosphatases was found in a few patients. The Ro 10-9359 compound is a very useful new therapy of severe psoriasis.

Administration, Oral↗
PubMed1994

Thoracoscopic versus open supraclavicular upper dorsal sympathectomy: a prospective randomised trial.

The purpose of the present study was to compare the short term results of the "open" supraclavicular approach with the thoracoscopic access for T2-T4 sympathetic ganglionectomy in patients with palmar hyperhidrosis. Patients were randomly allocated into two groups of 12 each, and were operated on: one by the open supraclavicular access; the other by the transthoracoscopic approach. The effect on palmar perspiration, operative data, postoperative complications and patients's satisfaction on short term follow up were examined. All operations achieved dry hands. Only two significant differences were observed: longer anaesthesia and poorer patient satisfaction in the thoracoscopic group one week after surgery (probably because a higher proportion of cases developed prolonged postoperative chest pain). Both techniques similarly achieve dry hands. The open method is not longer or more difficult, is possibly associated with less morbidity, and gives a higher subjective satisfaction.

Adolescent↗
PubMed1994

Intraoperative anaesthetic management of hypoxaemia during transthoracic endoscopic sympathectomy.

OBJECTIVE: To present our experience and evaluate intraoperative arterial oxygen desaturation during anaesthesia for transthoracic endoscopic sympathectomy (TES). DESIGN: Prospective open study. SETTING: University Hospital in Israel. SUBJECTS: Consecutive series of patients (n = 210), suffering from upper limb hyperhidrosis, anaesthetised for TES. MAIN OUTCOME MEASURES: Peripheral oxygen saturation (SpO2), haemodynamic status, complications, postoperative pain (n = 210) and arterial blood gases (n = 10). RESULTS: 407 TES; 195 bilateral, 17 unilateral. Surgical time range 20-75 minutes. SpO2 decreased below 98% in 58 patients. Sudden hypotension and bradycardia in two patients. The mean PaO2 was significantly (p = 0.03) decreased during two-lung ventilation (TLV), after reinflation of the right lung, compared with TLV after endobronchial intubation. There was no significant difference in mean PaO2 during one-lung ventilation of both lungs. Lowest PaO2 observed during one-lung ventilation was less than 13.3 kPa in three sympathectomies. Postoperative pain, severe on awakening and mainly retrosternal, was relieved with i.v. opiates. CONCLUSION: Controlled ventilation with 100% inspired O2, SpO2 monitoring and one to two gentle manual ventilations when it decreases is the cornerstone of the management of hypoxaemia, a potentially serious complication of TES.

Adolescent↗
PubMed1994

Cardiac effects of endoscopic electrocautery of the upper thoracic sympathetic chain.

Bilateral endoscopic electrocautery of the upper thoracic sympathetic ganglia (T2-4) was performed, mainly for palmar hyperhidrosis, on 535 patients. The aim of this study was to evaluate the effects of this procedure on cardiac and physical performance. A subgroup of 18 patients underwent cycle ergometer test with ECG recordings before and three months after surgery. After the operation, a significantly reduced heart rate at rest (12%) as well as during exercise and during recovery after exercise was found. The systolic blood pressure was reduced only at rest (7%) and the diastolic blood pressure was not significantly altered. Maximal workload was not affected by the operation and only a few patients had noticed their reduced heart rate. Three patients with angina pectoris and three with incapacitating tachycardia related to mental stress were operated on with excellent results. Thoracoscopic sympathicotomy is a safe, fast, cheap and efficient method for cardiac sympathetic denervation. This procedure might constitute an alternative to long-term thoracic epidural anaesthesia and implantation of thoracic electric stimulation devices in patients not suited for aortocoronary by-pass. Patients who require cardiac beta-receptor blockers and suffer from side effects of these drugs might also benefit from surgical cardiac sympathetic denervation.

Adolescent↗
PubMed1994

[Thoracoscopic sympathicotomy].

Surgical endoscopic endothoracic denervation (severing the n. vagus and the sympathetic trunk with the nn. splanchnici) was developed by Kux at Innsbruck University Surgical Clinic in the 1950's and applied in thousands of patients with a very wide range of indications. The thoracoscopic sympathicotomy has remained, in the hands of the experienced surgeon, a minor intervention with low complication rate and no mortality. For functional and organic angiopathies as well as for hyperhidrosis of the upper extremities it provides very good early and satisfactory late results.

Arm↗
PubMed1993

[Accidents caused by iontophoresis].

Ionophoresis is a well-established treatment for idiopathic hyperhidrosis. Modern apparatuses are reliable as long as the electrical equipment is used correctly. The authors present five cases of cutaneous incidents resulting in burns and secondary necrosis. Two of the cases could be explained by defective protection and the other three were apparently of the same type although non confirmation could be established. In comparison with uneventful incidences (pruritus, erythematous reactions, dysaesthesia) these spectacular burns should not exist. Machines must be regularly check and only electrodes with optimal protection should be used.

Adult↗
PubMed1994

[Alternative one lung ventilation anesthesia for bilateral thoracoscopic sympathectomy].

Palmar hyperhidrosis (PH) is a common disorder in the oriental subtropical area. There have been many therapeutic methods, such as: oral medication, local treatment and traditional surgical operation, but none of them has proved entirely satisfactory. Since the development of video endoscopic surgery, transthoracic endoscopic sympathectomy has been increasing day by day. This study consisted of 124 PH patients under alternative one lung ventilation anesthesia for bilateral thoracoscopic laser sympathectomy. The age of patients ranged from 13 to 64 years, male 45 and female 79. The average anesthesia duration was 60 min. We used glycopyrrolate 0.03 mg/kg, decardon 1 mg/10 kg for premedication. Induction was with fentanyl 0.07 ml/kg, atracurium 0.6 mg/kg and thiopental 4 mg/kg. Maintenance was with isoflurane in 3L/min. oxygen inhalation. The alternative one lung ventilation anesthesia was achieved with double-lumen endobronchial tube. Fr 37, Fr 35, Fr 28 Sheridan Lt. double-lumen bronchial tube were used depending upon the sex and fudgement of the individual patient. All patients tolerated the procedure well so that sympathectomy could be performed smoothly and uneventfully. Immediately after the operation, a transient mild to moderate degree of difficult breathing and substernal discomfort were experienced in the majority of patients. These suffering often relieved spontaneously or with some common analgesic.

Adolescent↗
PubMed1994

[Comparison of double-lumen endobnonchial versus single-lumen endotracheal tube anesthesia in bilateral thoracoscopic sympathectomy].

Since the development of video endoscopic surgery, the number of transthoracic endoscopic sympathectomy has been increasing. The use of double-lumen endobronchial tube or single-lumen endobronchial tube during anesthesia for these surgeries has been a controversial. 385 palmar hyperhidrosis patients divided into three groups: group I, under alterative one lung ventilation anesthesia with double-lumen endobronchial tube; group II, under alterative one lung ventilation anesthesia with single-lumen endobronchial tube; group III, under two lung ventilation anesthesia with single-lumen endobronchial tube were studied. All had received bilateral thoracoscopic sympathectomy. The age of patients ranged from 8 to 64 years old. There were 154 male and 231 female. The average anesthesia durations for group I, II and III were 38.56 +/- 10.28, 34.14 +/- 5.21, 31.83 +/- 3.34 min respectively. The variables considered in the study were: physique of the patients; duration of anesthesia; airway pressure changes; SaO2 changes during the operation and post-anesthesia complaints. We found that upon using double-lumen endobronchial tube, SaO2 levels was better maintained especially in the obese patients and the patients who had received a traditional surgical operation before.

Adolescent↗