Long-Term Comparison of Video-Assisted Thoracic Sympathectomy and Clinical Observation for the Treatment of Palmar Hyperhidrosis in Children Younger Than 14

The results of video-assisted thoracic sympathectomy (VATS)in children are unknown. To investigate the improvement in quality of life (QOL) of a group of 45 children who did and did not undergo VATS for the treatment of palmar hyperhidrosis (PH) 4 years after the initial evaluation. Forty-five children with PH were initially evaluated. Children were divided into two groups: 30 in the VATS group and 15 in the control group. We studied the evolution of PH, negative effect of hyperhidrosis on the QOL before the treatment, and improvement in QOL after treatment. Twenty-five patients (83.4%) in the VATS group experienced great improvement in PH, and five (16.6%) experienced partial improvement; 12 (80.0%) children from the control group had some type of improvement, and three (20.0%) had partial improvement. Two (13.3%) children in the control group and 23 (76.7%) in the VATS group had great improvement in QOL. For children with PH and poor QOL, VATS is better than no treatment. It produces better results with regard to sweating and greater improvement in QOL.

A randomized placebo-controlled trial of oxybutynin for the initial treatment of palmar and axillary hyperhidrosis

Introduction: Video-assisted thoracic sympathectomy provides excellent resolution of palmar and axillary hyperhidrosis but is associated with compensatory hyperhidrosis. Low doses of oxybutynin, an anticholinergic medication that competitively antagonizes the muscarinic acetylcholine receptor, can be used to treat palmar hyperhidrosis with fewer side effects. Objective: This study evaluated the effectiveness and patient satisfaction of oral oxybutynin at low doses (5 mg twice daily) compared with placebo for treating palmar hyperhidrosis. Methods: This was prospective, randomized, and controlled study. From December 2010 to February 2011, 50 consecutive patients with palmar hyperhidrosis were treated with oxybutynin or placebo. Data were collected from 50 patients, but 5 (10.0%) were lost to follow-up. During the first week, patients received 2.5 mg of oxybutynin once daily in the evening. From days 8 to 21, they received 2.5 mg twice daily, and from day 22 to the end of week 6, they received 5 mg twice daily. All patients underwent two evaluations, before and after (6 weeks) the oxybutynin treatment, using a clinical questionnaire and a clinical protocol for quality of life. Results: Palmar and axillary hyperhidrosis improved in >70% of the patients, and 47.8% of those presented great improvement. Plantar hyperhidrosis improved in >90% of the patients. Most patients (65.2%) showed improvements in their quality of life. The side effects were minor, with dry mouth being the most frequent (47.8%). Conclusions: Treatment of palmar and axillary hyperhidrosis with oxybutynin is a good initial alternative for treatment given that it presents good results and improves quality of life. (J Vasc Surg 2012;55:1696-700.)

Efectos de la simpatectomía torácica sobre la pletismografía de los miembros superiores en sujetos con hiperhidrosis palmar

Introducción: La simpatectomía es el tratamiento de la hiperhidrosis palmar y consiste en denervación simpática de miembros superiores que produce un efecto en el flujo sanguíneo al impactar la respuesta vasoconstrictora. El cambio en el flujo sanguíneo se puede evaluar a través de la onda fotopletismográfica. Metodología: Se realizaron 2 sesiones (presimpatectomía y postsimpatectomía) de 10 minutos en cada miembro superior en 28 pacientes obteniendo 79 señales fotopletismográficas distribuidas así: 37 presimpatectomía y 42 señales postsimpatectomía. De cada señal se analizó 1.5 minutos donde se tienen 80 ondas de fotopletismografía y se miden 6 variables: 1. Componente AC (componente pulsátil), 2. Componente DC (componente no pulsátil), 3. Relación entre AC/DC (índice de perfusión), 4. Area bajo la curva (AUC), 5. Tiempo entre el inicio de la onda y pico sistólico (T_DA) y 6. Tiempo entre cada onda de pulso (T_DD). Resultados: Aumentó 120% el componente AC y disminuyó 78% en DC del miembro superior derecho (MSD) con 99% de confiabilidad (p<0.001) entre presimpatectomía (n=18) y postsimpatectomía (n=21). AC/DC aumentó 55% con 95% de confiabilidad entre presimpatectomía (n=19) y postsimpatectomía (n=21) en el miembro superior izquierdo (p<0.05). No se encontró diferencia para T_DA, T_DD ni AUC. Discusión y Conclusión: La simpatectomía en pacientes con hiperhidrosis palmar produce un cambio en el flujo sanguíneo de los miembros superiores evidenciado por los cambios en el componente no pulsátil (DC) y pulsátil (AC) que es secundario a la vasodilatación consecuencia del bloqueo simpático por la denervación quirúrgica de los ganglios simpáticos torácicos.

Tratamento da hiperidrose palmar com onabotulinumtoxinA veiculada por iontoforese ou fonoforese: relato de casos

Hiperidrose palmar idiopática é doença frequente, que tem grande impacto na qualidade de vida dos pacientes, e seu tratamento definitivo (simpatectomia) associa-se a risco cirúrgico e efeitos adversos. Fármacos, como onabotulinumtoxinA, podem ser veiculados percutaneamente por iontoforese ou fonoforese e contribuir no tratamento da hiperidrose. Os autores apresentam quatro casos em que houve melhora objetiva e subjetiva da sudorese após dez sessões consecutivas de iontoforese ou fonoforese, sem evidências de efeitos adversos. Os resultados clínicos mantiveram-se por 16 semanas de observação após a interrupção do tratamento. Técnicas de veiculação percutânea de medicamentos devem ser percebidas como opções nos tratamentos dermatológicos.

Evaluation of quality of life over time among 453 patients with hyperhidrosis submitted to endoscopic thoracic sympathectomy

Objectives: Current data do not provide enough information on how quality of life (QoL) evolves over time in cases of endoscopic thoracic sympathectomy (ETS). The purpose of this study was to ascertain whether the immediate improvement in QoL after the surgery was sustained until the fifth postoperative year. Methods: This was a prospective, nonrandomized and uncontrolled study. From March 2001 to December 2003, 475 consecutive patients with hyperhidrosis submitted to ETS were included. A QoL questionnaire was applied at the preoperative day, around the 30th postoperative day, and after the fifth year. Results: After excluding 22 patients who did not answer all the questions, we analyzed 453 patients. Their ages ranged from 11 to 57 years old, with a mean of 25.3 + 7.9 years, including 297 female patients (65.6%). All patients were assessed on three occasions: before surgery, around the 30th postoperative day, and after the fifth postoperative year. The QoL before surgery was considered to be poor or very poor for all patients. The QoL around 30 days after surgery was better in 412 patients (90.9%), the same in 27 patients (6.0%), and worse in 14 patients (3.1%). After 5 years, 409 patients (90.3%) were better, 27 (6.0%) were the same, and 14 (3.1%) were worse. There were no differences between these postoperative times according to the McNemar statistical test. Conclusion:The patients had an immediate improvement in QoL after ETS, and this improvement was sustained until the fifth postoperative year. (J Vase Surg 2012;55:154-6.)

Hiperidrose compensatória após simpatectomia toracoscópica: características, incidência e influência na satisfação do paciente

Hyperhidrosis is an idiopathic condition characterized by excessive sweating. Symptoms generally begin in childhood or early adolescence, and rarely improve with age. The excessive localized sweating generally occurs either spontaneously, or in association with stressful or emotionally charged situations. This prospective study aimed to investigate predictive factors for compensatory hyperhidrosis after thoracoscopic sympathicotomy. From 2000 to 2002, 80 patients (53 female and 27 male) underwent hyperhidrosis surgery. The patients, ranging from 12 to 56 years old, were studied and followed-up for 42.51 ±5.98 months. A satisfaction grading using a visual analogue scale -VAS (0 = not at all satisfied, and 10 = fully satisfied) was used. The surgical procedure was performed bilaterally on the second ganglion (T2) for facial hyperhidrosis, on the third and fourth ganglia (T3 and T4) for axillary hyperhidrosis, and on the third ganglion (T3) for palmar hyperhidrosis. The results showed that, 68 patients (85%) presented with compensatory sweating (CS), which was classified as mild (33.8%), moderate (33.8%) and severe (32.4%). Considering the final surgical results, 70 patients (87.5%) were satisfied with the outcome of the operation, while 10 patients (12.5%) were dissatisfied. Degrees of satisfaction varied according to sex, age, BMI and extent of denervation. Moreover, the compensatory hyperhidrosis was more severe in abdomen and back than in legs. In conclusion, although CS is a frequent adverse effect of sympathicotomy, the degree of patient satisfaction was high. Some factors were related to the occurrence and severity of CS and the most adequate patients to be submitted to this operation are young adult women whose BMI is less than 24.9

Segurança e eficácia da analgesia interpleural com ropivacaína em simpatectomia torácica videoassistida

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Preservation of Alpha-3 Neuronal Nicotinic Acetylcholine Receptor Expression in Sympathetic Ganglia After Brain Death

The goal of this study was to evaluate if the immunohistochemical expression of alpha-3 neuronal nicotinic acetylcholine receptor subunit in sympathetic ganglia remains stable after brain death, determining the possible use of sympathetic thoracic ganglia from subjects after brain death as study group. The third left sympathetic ganglion was resected from patients divided in two groups: BD-organ donors after brain death and CON-patients submitted to sympathectomy for hyperhidrosis (control group). Immunohistochemical staining for alpha-3 neuronal nicotinic acetylcholine receptor subunit was performed; strong and weak expression areas were quantified in both groups. The BD group showed strong alpha-3 neuronal nicotinic acetylcholine receptor expression in 6.55% of the total area, whereas the CON group showed strong expression in 5.91% (p = 0.78). Weak expression was found in 6.47% of brain-dead subjects and in 7.23% of control subjects (p = 0.31). Brain death did not affect the results of the immunohistochemical analysis of sympathetic ganglia, and its use as study group is feasible.

Efecto de los dispositivos de emisión de microondas, radiofrecuencia no ablativa y ultrasonido microfocalizado en el tratamiento de la hiperhidrosis primaria revisión sistemática de la literatura

Antecedentes y objetivos: La hiperhidrosis primaria afecta el 2,8% de la población de Estados Unidos. Condición que impacta el desarrollo social de los individuos afectados, ocasionando fobia social. Existen opciones disponibles para el tratamiento de la hiperhidrosis incluyendo medicamentos tópico, sistémico, inyectable y quirúrgico. El objetivo de ésta revisión sistemática de la literatura es determinar la efectividad y seguridad de los dispositivos de emisión de microondas, radiofrecuencia no ablativa y sistema de ultrasonido microfocalizado para el tratamiento de la hiperhidrosis primaria. Materiales y métodos: Se realizó una revisión sistemática de la literatura de artículos obtenidos de bases de datos: Medline, Cochrane, Embase, Ovid y Scielo. Se incluyeron ensayos clínicos aleatorizados controlados, ensayos cuasiexperimentales desde el 2011; donde evaluaran el uso de estos dispositivos en el manejo de hiperhidrosis primaria. Resultados: Se seleccionaron 21 artículos en total. Se encontró que con los tres dispositivos se logra una reducción significativa a puntajes entre 1 y 2 de la escala de Severidad de la Hiperhidrosis; en 3 estudios se encontró mejoría en la calidad de vida; los eventos adversos fueron transitorios, siendo más frecuentes con el dispositivo de emisión de microondas. Conclusión: Primera revisión sistemática de la literatura sobre el efecto de estos tres dispositivos en el manejo de hiperhidrosis. Se espera aportar a la literatura existente una recomendación acerca de la efectividad y seguridad de estos dispositivos para que sea aplicado en los pacientes con diagnóstico de hiperhidrosis primaria.

Quantitative assessment of the intensity of palmar and plantar sweating in patients with primary palmoplantar hyperhidrosis

Objective: To compare individuals with and without hyperhidrosis in terms of the intensity of palmar and plantar sweating. Methods: We selected 50 patients clinically diagnosed with palmoplantar hyperhidrosis and 25 normal individuals as controls. We quantified sweating using a portable noninvasive electronic device that has relative humidity and temperature sensors to measure transepidermal water loss. All of the individuals had a body mass index of 20-25 kg/cm(2). Subjects remained at rest for 20-30 min before the measurements in order to reduce external interference. The measurements were carried out in a climate-controlled environment (21-24 degrees C). Measurements were carried out on the hypothenar region on both hands and on the medial plantar region on both feet. Results: In the palmoplantar hyperhidrosis group, the mean transepidermal water loss on the hands and feet was 133.6 +/- 51.0 g/m(2)/h and 71.8 +/- 40.3 g/m(2)/h, respectively, compared with 37.9 +/- 18.4 g/m(2)/h and 27.6 +/- 14.3 g/m(2)/h, respectively, in the control group. The differences between the groups were statistically significant (p < 0.001 for hands and feet). Conclusions: This method proved to be an accurate and reliable tool to quantify palmar and plantar sweating when performed by a trained and qualified professional.

Tratamiento de la hiperhidrosis palmar primaria por acupuntura: a propósito de un caso

Primary hyperhidrosis is an excessive sweating disorder that occurs in axillae, palms, soles, and craniofacial region. According to Traditional Chinese Medicine (TCM) it is a water metabolism disorder. This study presents a case report treated with TCM, showing more satisfactory results than those by conventional treatments.

Oxybutynin treatment for hyperhidrosis: a comparative analysis between genders

OBJECTIVE: To assess the results of palmar and axillary hyperhidrosis treatment in males and females using low doses of oxybutynin. METHODS: A retrospective analysis was conducted in 395 women and 170 men followed up in our service with complaint of palmar and axillary hyperhidrosis. RESULTS: A total of 70% of patients in both groups presented partial or great improvement in the level of hyperhidrosis after treatment. The best results were obtained in the female group, in which 40% classified their improvement as "great". Approximately 70% of the patients in both groups improved their quality of life after medical therapy and 30% presented no change in condition. CONCLUSION: Gender is not a factor that significantly interferes in oxybutynin treatment results. Quality of life indices and clinical improvement level were similar in men and women.

Sole depth and weight-bearing characteristics of the palmar surface of the feet of feral horses and domestic Thoroughbreds

Objective: To determine solar load-bearing structures in the feet of feral horses and investigate morphological characteristics of the sole in feral horses and domestic Thoroughbreds. Sample: Forelimbs from cadavers of 70 feral horses and 20 domestic Thoroughbreds in Australia. Procedures: Left forefeet were obtained from 3 feral horse populations from habitats of soft substrate (SS [n = 10 horses]), hard substrate (HS [10]), and a combination of SS and HS (10) and loaded in vitro. Pressure distribution was measured with a pressure plate. Sole depth was measured at 12 points across the solar plane in feet obtained from feral horses from SS (n = 20 horses) and HS (20) habitats and domestic Thoroughbreds (20). Results: Feet of feral horses from HS habitats loaded the periphery of the sole and hoof wall on a flat surface. Feral horses from HS or SS habitats had greater mean sole depth than did domestic Thoroughbreds. Sole depth was greatest peripherally and was correlated with the loading pattern. Conclusions and Clinical Relevance: The peripheral aspect of the sole in the feet of feral horses had a load-bearing function. Because of the robust nature of the tissue architecture, the hoof capsule of feral horses may be less flexible than that of typical domestic horses. The application of narrow-web horseshoes may not take full advantage of the load-bearing and force-dissipating properties of the peripheral aspect of the sole. Further studies are required to understand the effects of biomechanical stimulation on the adaptive responses of equine feet.

Aspectos de las relaciones arteriales en la región palmar

Tesis (Doctorado en Medicina) UANL