Endoscopic thoracic sympathicotomy in the treatment of primary hyperhidrosis based on ambulatory surgery and enhanced recovery mode: A retrospective cohort study in a single center / 中国胸心血管外科临床杂志

@#Objective    To investigate the safety of endoscopic thoracic sympathicotomy in the treatment of primary hyperhidrosis based on ambulatory surgery mode. Methods    Retrospective analysis was performed on the clinical data of 158 patients with primary hyperhidrosis who received endoscopic thoracic sympathicotomy in the Affiliated Hospital of Zunyi Medical University from January 2019 to March 2021. There were 68 (43.2%) males and 90 (56.8%) females with an average age of 14-33 (20.5±3.1) years. The basic information of the patients, operation time, intraoperative blood loss, postoperative pain score, hospitalization expenses and postoperative complications were observed and recorded. Results    All surgeries were successfully completed and the patients were discharged as planned. The operation time was 41.8±13.9 min, the intraoperative blood loss was 10.5±7.3 mL, the postoperative anesthesia recovery time was 15.0±5.9 min, and the pain score was 3.0±0.9 points. The total length of hospitalization was 1.6±1.0 days. The total postoperative expenses were 9 471.7±1 698.9 yuan. Pneumothorax occurred after the operation in 3 patients. Telephone follow-up on the 30th day after the operation showed no recurrence of sweaty hands, pneumothorax or rapid heart rate, and no serious complications or death related to the day operation within 30 days after the operation. Conclusion    Endoscopic thoracic sympathicotomy based on ambulatory surgery mode is safe and effective in the treatment of primary hyperhidrosis.

Diagnosis, impact and management of hyperhidrosis including endoscopic thoracic sympathectomy

@#Introduction: Hyperhidrosis is a disorder of excessive and uncontrollable sweating beyond the body’s physiological needs. It can be categorised into primary or secondary hyperhidrosis based on its aetiology. Detailed history review including onset of symptoms, laterality of disease and family history are crucial which may suggest primary hyperhidrosis. Secondary causes such as neurological diseases, endocrine disorders, haematological malignancies, neuroendocrine tumours and drugs should be adequately examined and investigated prior to deciding on further management. The diagnosis of primary hyperhidrosis should only be made only after excluding secondary causes. Hyperhidrosis is a troublesome disorder that often results in social, professional, and psychological distress in sufferers. It remains, however, a treatment dilemma among some healthcare providers in this region. Methods: The medical records and clinical outcomes of 35 patients who underwent endoscopic thoracic sympathectomy for primary hyperhidrosis from 2008 to 2018 in Department of Cardiothoracic Surgery were reviewed. Results: The mean age of the patients was 27±10.1years, with male and female distribution of 18 and 17, respectively. Fifty-one percent of patients complained of palmar hyperhidrosis, while 35% of them had concurrent palmaraxillary and 14% had palmar-plantar-axillary hyperhidrosis. Our data showed that 77% (n=27) of patients were not investigated for secondary causes of hyperhidrosis, and they were not counselled on the non-surgical therapies. All patients underwent single-staged bilateral endoscopic thoracic sympathectomy. There was resolution of symptoms in all 35 (100%) patients with palmar hyperhidrosis, 13(76%) patients with axillary hyperhidrosis and only 2 (50%) patients with plantar hyperhidrosis. Postoperatively 34.3% (n=12) of patients reported compensatory hyperhidrosis. There were no other complications such as pneumothorax, chylothorax, haemothorax and Horner’s Syndrome. Conclusion: Clinical evaluation of hyperhidrosis in local context has not been well described, which may inadvertently result in the delay of appropriate management, causing significant social and emotional embarrassment and impair the quality of life of the subjects. Detailed clinical assessment and appropriate timely treatment, be it surgical or non-surgical therapies, are crucial in managing this uncommon yet distressing disease.

Estudio Rorschach sobre control y tolerancia al estrés asociado a hiperhidrosis primaria en jóvenes hiperhidróticos / Rorschach study on stress control and tolerance associated to primary hyperhidrosis in young hyperhidrotic people

RESUMEN La hiperhidrosis primaria, enfermedad crónica por exceso de sudoración, aparece en etapas tempranas de la vida y ocasiona limitaciones que interfieren las relaciones sociales. Esta sintomatología hace que la capacidad de control y tolerancia al estrés sea limitada. Se realizó una investigación descriptiva y se aportan resultados cualitativos individuales de tres jóvenes con hiperhidrosis primaria. Por ello el objetivo del presente trabajo es caracterizar el control y tolerancia al estrés asociados a la hiperhidrosis primaria que presentan tres jóvenes hiperhidróticos (de modo individual). Fueron aplicados una entrevista semiestructurada, el Inventario de Ansiedad Rasgo-Estado y el Sistema Comprehensivo Rorschach. Los resultados son diferentes en los tres jóvenes. Se concluye que las diferencias entre las personas con hiperhidrosis primaria, en relación a su capacidad de control y tolerancia al estrés, están dadas por la combinación característica de elementos que definen la personalidad en estilos y estados en situaciones de demanda social mantenida.

ABSTRACT Primary hyperhidrosis, a chronic disease characterized by excessive sweating, appears at an early age and causes limitations that interfere with social relationships. This symptomatology limits the ability to control and tolerate stress. A descriptive research was carried out. It shows the individual qualitative results of three young primary hiperhidrotic people. Therefore, the objective of this paper is to characterize stress control and tolerance associated to primary hyperhidrosis in three young hyperhidrotic people (individually). A semistructured interview as well as the State-Feature Anxiety Inventory and the Rorschach Comprehensive System were used. Results are different in the three young people. It was concluded that differences between people with primary hyperhidrosis, with regard to their ability to control and tolerate stress, lie in the characteristic combination of elements that define the personality in styles and states in sustained social demand situations.

La simpaticotomía videtoracoscópica en el tratamiento de la hipehidrosis palmar / Videothoracoscopic simpathicotomy on the treatment of palmar hyperidrosis

Introducción: la simpaticotomía videotoracoscópica es actualmente la técnica quirúrgica de elección en el tratamiento de la hiperhidrosis esencial o primaria. Sus ventajas relacionadas con su sencillez, menor posibilidades de complicaciones transoperatorias, un tiempo quirúrgico notablemente más corto y consecuentemente menor exposición a los agentes anestésicos, mejor relación riesgo/beneficio, mejor recuperación y la disminución de los efectos secundarios como el sudor compensatorio y el alto nivel de satisfacción de los pacientes, justifican su realización. Objetivo: analizar los resultados de la generalización de la simpaticotomía T3-T4 en el tratamiento de la hiperhidrosis palmar. Método: estudio de corte transversal, observacional y descriptivo de los pacientes intervenidos por videotoracoscopia, en el Centro Nacional de Cirugía de Mínimo Acceso con el diagnóstico de hiperhidrosis primaria palmar; a los cuales se les realizó simpaticotomía videotoracoscópica desde enero de 2011 hasta diciembre del 2015. En la evaluación de los pacientes se tienen en cuenta las variables aceptadas internacionalmente: curación, efectos secundarios, complicaciones y la mejoría psíquica dada por el nivel de satisfacción de los pacientes. Resultados: se logró un 97,69 por ciento de curación de la enfermedad. La sudoración compensatoria se presentó en 48,1 por ciento de los pacientes y el nivel de satisfacción fue de 97 por ciento, logrando una mejoría evidente del estado psicológico de los mismos. Conclusiones: la simpaticotomía videotoracoscópica T3-T4 es efectiva en el tratamiento de los pacientes afectos de hiperhidrosis palmar(AU)

Introduction: Videothoracoscopic sympathicotomy is currently the surgical technique of choice in the treatment of primary or essential hyperhidrosis. Its advantages related to its simplicity, fewer possibilities of transoperative complications, remarkably shorter surgical time and consequently less exposure to anesthetic agents, better risk / benefit ratio, better recovery, limited side effects such as compensatory sweat and high level of patient satisfaction support the performance of this procedure. Objective: To analyze the results of the generalization of the T3-T4 sympathicotomy in the treatment of palmar hyperhidrosis. Method: A cross-sectional, observational and descriptive study of patients with diagnosis of palmar primary hyperhidrosis, who underwent videothoracoscopic sympathicotomy at the National Center for Minimal Access Surgery from January 2011 to December 2015. The patient assessment took into account internationally accepted variables such as healing, side effects, complications and psychic improvement according to the level of satisfaction of the patients. Results: Recovery from disease reached 97.69 percent, compensatory sweating occurred in 48.1 percent of patients and the level of satisfaction was 97 percent, thus achieving clear improvement of the psychological state of patients.. Conclusions: Videothoracoscopic sympathicotomy T3-T4 is effective in the treatment of patients with palmar hyperhidrosis(AU)

Sudor compensador, un efecto no deseado secundario al tratamiento quirúrgico de la hiperhidrosis primaria infantil / Compensatory sweating, an unwanted effect secondary to the surgical treatment of primary infant hyperhidrosis

INTRODUCCIÓN: la hiperhidrosis idiopática infantil se caracteriza por sudoración desproporcionada en manos, axilas y pies fundamentalmente, y ocasiona problemas sociales a los que la padecen. El sudor compensador es un efecto no deseado que puede aparecer después de la cirugía torácica en los pacientes. OBJETIVO: evaluar la presencia del sudor compensador en niños operados de hiperhidrosis palmar y axilar idiopática. MÉTODOS: se realizó un estudio de una serie de casos compuesta por 61 niños operados y seguidos de forma consecutiva por hiperhidrosis idiopática, con edades comprendidas de 11 a 18 años, en el Hospital Universitario Pediátrico Centro Habana, desde enero de 2011 a octubre de 2013. Las variables analizadas fueron: edad, sexo, localización de la hiperhidrosis, presencia de sudor compensador y sus localizaciones más frecuentes, así como evolución a corto y mediano plazo. RESULTADOS: fueron 42 niñas (68,9 %) y 19 varones (31,1 %), todos intervenidos mediante la técnica simpaticolisis videotoracoscópica bilateral sincrónica, por un solo puerto. Presentaron sudor compensador 17 pacientes (27,9 %), de ellos, 14 pacientes de forma ligera y 3 moderada. No hubo significación en relación con la localización de la hiperhidrosis y el desarrollar sudor compensador. En la espalda fue donde con mayor frecuencia se presentó el sudor compensador, en 6 casos (9,8 %). Hubo mejoría en el tiempo o desapareció en el 70,4 % de los pacientes. CONCLUSIONES: los pacientes que presentaron sudor compensador evalúan su situación de satisfactoria, pues resolvieron la parte molesta de las manos, y consideraron oportuno el tratamiento quirúrgico al que fueron sometidos.

INTRODUCTION: infantile idiopathic hyperhidrosis is characterized by disproportionate sweating in hands, axillae and feet fundamentally, and brings social problems to those suffering it. Compensatory sweating is unwanted effect that may occur after thoracic surgery. OBJECTIVE: to evaluate the presence of compensatory sweating in children operated on from idiopathic hyperhidrosis in hands and axillae. METHODS: a study of a case series of sixty one 11-18 years-old children operated on from idiopathic hyperhidrosis and subsequently followed-up in university pediatric hospital of Centro Habana from January 2011 to October 2013. The variables were age, sex, location of hyperhidrosis, presence of compensatory sweating and its most common locations as well as its short-and medium-term evolution. RESULTS: forty two girls (68.9 %) and 19 boys (31.1 %) were all operated through synchronic bilateral thoracoscopic sympathicholysis technique using one access port. Seventeen patients (27.9 %) presented with compensatory sweating, 14 in its slight form and 3 in its moderate form. There was no significant difference as to the location of hyperhidrosis and occurrence of compensatory sweating. The most common location was the back in 6 cases (9.8 %). This effect improved as time went by or disappeared in 70.4 % of patients. CONCLUSIONS: the patients who had compensatory sweating regarded their present situation as satisfactory because they overcame discomfort in their hands, and they also considered that the surgical treatment was timely.

Hyperhidrosis: An Approach to Assessment in a Primary Care Setting

A 77-year-old woman presented with a complaint of persistent diarrhea. While eliciting the history, sweating was noted. This was further explored and on questioning, the patient also reported poor sleep with symptoms of profound heat intolerance and significant weight loss in the last 6 months despite a normal appetite. On examination, the patient was found to have generalised sweating. While this presentation highlights textbook symptoms of thyrotoxicosis, the question of diagnosis of conditions presenting with hyperhidrosis was raised. This in turn led to a search for criteria to improve the diagnosis of hyperhidrosis in the primary care setting. Other issues discussed include the differential diagnoses of hyperhidrosis, red flags that can present with hyperhidrosis and potential complications of hyperhidrosis as a chronic disease.

Efficacy of Glycopyrrolate in Primary Hyperhidrosis Patients

BACKGROUND: Primary hyperhidrosis is a disorder of excessive sweating, which shares several features with anxiety disorders and has a negative impact on a patient's quality of life. Oral glycopyrrolate is one of the treatments available. There are a few published studies on the use of glycopyrrolate given orally in the treatment of hyperhidrosis. METHODS: Thies is study was a review of case notes in a series of 36 patients with primary hyperhidrosis. We made a comparison between the Keller's scale score of a pre-glycopyrrolate medication group and the Keller's scale score f a post-glycopyrrolate medication group. The Milanez de Campos score, Short Form_36 (SF-36) score, Beck Depression Inventory (BDI) score, Beck Anxiety Inventory (BAI) score, and autonomic nervous system (ANS) scale score were also compared between the two groups. RESULTS: In the post-glycopyrrolate medication group, there were declines in Keller's scale, and Milanez de Campos scale score and BAI score (P < 0.001). In addition, there were increases in SF_36 score in the post-glycopyrrolate medication group (P = 0.03) However, no changes were seen in, BDI score and ANS score in the post-glycopyrrolate medication group (P < 0.001). CONCLUSIONS: Glycopyrrolate is an effective initial method of treating primary hyperhidrosis that, reduces anxiety and improve patients' quality of life.

Calidad de vida en pacientes con hiperhidrosis primaria sometidos a simpatectomía videotoracoscópica / Quality of life after videothoracic simpathectomy in patients with primary hyperhidrosis

Introduction: Primary hyperhidrosis is characterized by excessive sweating that exceeds the physiological needs to maintain thermal homeostasis of the body. This study aims to assess the change in quality of life of patients operated on videothoracoscopic sympathectomy. Materials and Methods: We included all patients operated with this technique in the period between 2004 and 2010, in FACh Hospital. A standardized cuestionary was used to measure severity of hyperhidrosis and quality of life during pre and postoperative. Results: 61 patients, 57 percent female and mean age of 25 years. Preoperative sweating was barely tolerable or unacceptable in 81 percent, and preoperative quality of life was poor or very poor in 82 percent of patients. After surgery sweating was never noticed or tolerable at 85 percent and the quality of life was better in 84 percent of patients. 78 percent of patients developed compensatory sweating; however the 87 percent were satisfied with the outcome of surgery. Conclusion: Videothoracoscopic sympathectomy offers excellent results that are measurable in terms of improvement of quality of life, but often associated with the phenomenon of compensatory sweating. Despite the development of this sequel, the majorities of operated patients are satisfied with the surgical results and improve their quality of life.

Introducción: La hiperhidrosis primaria se caracteriza por sudoración excesiva que supera las necesidades fisiológicas para mantener la homeostasis térmica del cuerpo. El objetivo de este trabajo es evaluar el cambio en la calidad de vida de los pacientes operados de simpatectomía videotoracoscópica. Material y Método: Estudio de tipo transversal del total de pacientes operados con esta técnica en el Hospital Fuerza Aérea de Chile (FACh) en el período entre 2004 y 2010. Se utilizó una encuesta estandarizada y validada en la literatura para medir severidad de la hiperhidrosis y calidad de vida en período pre y postoperatorio. Resultados: 61 pacientes, 57 por ciento de género femenino y promedio de edad 25 años. La sudoración preoperatoria era apenas tolerable o intolerable en 81 por ciento y la calidad de vida preoperatoria era pobre o muy pobre en 82 por ciento de los pacientes. Posterior a la cirugía la sudoración nunca se notaba o era tolerable en 85 por ciento y la calidad de vida era mejor en 84 por ciento de los pacientes. El 78 por ciento de los pacientes operados desarrolló sudoración compensatoria, sin embargo, el 87 por ciento de los pacientes estaban satisfechos con el resultado de la cirugía. Conclusión: La simpatectomía videotoracoscópica ofrece excelentes resultados que son medibles en términos de mejoría de la calidad de vida, pero asociado frecuentemente al fenómeno de sudoración compensatoria. Pese al desarrollo de esta secuela, la mayoría de los pacientes operados están satisfechos con los resultados quirúrgicos y mejoran su calidad de vida.

Skin Hydration, Transepidermal Water Loss and Relation with Tinea Pedis in Patients with Primary Hyperhidrosis / 대한의진균학회지

BACKGROUND: Primary hyperhidrosis (PHH) is the disease of production of excessive sweat mainly localized in palm, sole, and craniofacial area. The characteristics of the lesional skin and the relationship with fungal infection in patients with PHH are still not known in Korean literature. OBJECTIVE: The aim of the present study was to compare the skin hydration and transepidermal water loss (TEWL) in patients with PHH with those in control group and to determine the relation of PPH to tinea pedis. METHODS: A prospective case-control study of patients with PHH was conducted. We have measured the skin hydration and TEWL on the skin of palm, sole and forehead in patients with PPH and those in control group. A total of 67 patients with PHH and 50 volunteers of control group were examined for the presence of tinea pedis. Information on the treatment history of tinea pedis were provided by means of reviewing the medical records. RESULTS: Of 67 patients with PHH included, mean age was 28.1 years. Distributional patterns of PHH were palmoplantar (50.7%), isolated palmar (19.4%), isolated plantar (7.5%), and craniofacial (22.4%). Age at onset for palmoplantar HH (12.9+/-7.5 years) was significantly younger than that of craniofacial HH (26.8+/-10.5 years) (p < 0.05). Compared with the skin of those in control group, the values of the skin hydration and TEWL were significantly higher in the skin of patients with PHH. The risk of tinea pedis were increased in patients with primary palmoplantar hyperhidrosis compared with controls (Odds ratio: 2.44). CONCLUSION: Skin physiological parameters of patients with PHH and normal subjects were evaluated by non-invasive skin bioengineering methods which show quantitative modifications in physiological conditions. On the basis of current data, we can expect great advances in the curative value for treatment in patients with PHH.

An Epidemiological Study of Hyperhidrosis Patients Visiting the Ajou University Hospital Hyperhidrosis Center in Korea

Hyperhidrosis is a disorder of perspiration in excess of the body's physiologic need and significantly impacts one's occupational, physical, emotional, and social life. The purpose of our study was to investigate the characteristics of primary hyperhidrosis in 255 patients at Ajou University Hospital Hyperhidrosis Center from March 2006, to February 2008. Information collected from the medical records was: sex, sites of hyperhidrosis, age at visit, age of onset, aggravating factors, hyperhidrosis disease severity scale (HDSS) rank, family history, occupation, and past treatment. A total of 255 patient records were reviewed; 57.6% were male. Patients with a family history (34.1%) showed a lower age of onset (13.21+/-5.80 yr vs. 16.04+/-9.83 yr in those without family history); 16.5% had previous treatment, most commonly oriental medicine. Palmar and plantar sites were the most commonly affected, and 87.9% of patients felt their sweating was intolerable and always interfered with their daily activities. Our study provides some original information on the Korean primary hyperhidrosis population. Patients who have a family history show signs of disease in early age than those without family history.

Thoracoscopic Limited T3 Sympathicotomy for Primary Hyperhidrosis: Prevention for Compensatory Hyperhidrosis

OBJECTIVE: This study evaluates the role of thoracoscopic T3 sympathicotomy for the treatment of primary hyperhidrosis and the prevention of compensatory hyperhidrosis. METHODS: Thoracoscopic T3 sympathicotomy was performed on 27 patients with either isolated palmar hyperhidrosis (n=24) or in combination with axillary hyperhidrosis (n=3), from February 1999 to February 2002. In the case of combined palmar and axillary hyperhidrosis, additional coagulation of T4 sympathetic ganglion was performed. The mean follow-up period was 26.7 months. Operative results were determined on the basis of complications, compensatory hyperhidrosis, and patient satisfaction. RESULTS: The immediate postoperative results showed that all 24 patients with palmar hyperhidrosis reported complete alleviation of their symptoms. One patient with palmar and axillary hyperhidrosis for whom the axillary hyperhidrosis was not completely resolved underwent a second T4 sympathicotomy one month after first operation. There were two patients who suffered mild compensatory hyperhidrosis(7.4%). All 27 patients reported a high long-term satisfactory rate (average score; 7.93/10). One patient required a chest tube for treating pneumothorax. Other complications such as Horners syndrome, intercostal neuralgia, gustatory hyperhidrosis, and pulmonary edema were not observed. CONCLUSION: Thoracoscopic limited T3 sympathicotomy is an effective method to treat primary hyperhidrosis with a low rate of compensatory hyperhidrosis and a high rate of long-term satisfaction.

Clinical Analysis on the Therapeutic Efficacy of 20% Aluminum Chloride Solution in Primary Hyperhidrosis / 대한피부과학회지

BACKGROUND: A large number of therapeutic options are used for the treatment of primary hyperhidrosis. These include application of topical agents, iontophoresis, sympathectomy and recently botulium toxin injection. But, It should be desirable as first treatment to choice a simple, safe, and less expensive method that also proved to be effective. OBJECTIVE: The aim of this study was to clinically prove 20% aluminum chloride solution to deserve to be the initial choice of treatment modality for primary hyperhidrosis. METHODS: A total of 22 patients(mean age 24.1, male 3, female 19) with clinical diagnosis of primary hyperhidrosis were treated by 20% aluminum chloride solution. Until the desired degree of dryness was obtained, they were educated to apply everyday and thereafter, the agent would be applided as often as is necessary. By regular meeting including telephone interview, we analyzed patient satisfaction and other clinical parameters such as application time at onset of desired dryness, applicaton interval to maintain the relief of symptoms, and side effects during various follow-up periods. RESULT: Aluminum chloride solution was effective not only in axillary hyperhidrosis but also in palmoplantar hyperhidrosis(patient satisfaction, axillae:excellent, 12 of 16(75%); good, 4(25%), palms or soles:excellent, 3 of 6(50%); good, 2(33%)). Applicaton interval to maintain the relief of symptoms ranged from 5 to 60 days with mean 10 days. There were no significant complications(mild irritation 50%). CONCLUSION: Aluminum chloride solwtion is the simplest, safest and least expensive method for initial treatment of primary hyperhidrosis. And its effect could be maintainable for a relatively long-term period.

Efficacy of a 20% Aluminum Chloride in Alcohol Solution in the Treatment of Hyperhidrosis: A Study Using a Hydrometer

BACKGROUND: Excessive sweating, especially of the palms, soles and axillae, is a socially and an occupationally distressing, and sometimes disabling condition. A variety of treatment methods are used to reduce profuse sweating including topical agents, iontophoresis and symphatectomy. OBJECTIVE: We investigated whether a 20% aluminum chloride solution is efficient in the treatment of axillary and palmoplantar hyperhidrosis using a skin surface hydrometer. METHODS: We treated 31 patients (7; male, 24; female) by Drysol once a day at bedtime for four weeks. We had measured the conductances on the stratum corneum of the palms, soles and axillae using a skin surface hydrometer before and after treatment every week for four week RESULTS: There was a reduction of conductances after the treatment by Drysol (p<0.05). The reduction of conductances was continued for four weeks (p<0.05). CONCLUSION: Drysol is an efficient, safe, and simple method for initial treatment of the primary hyperhidrosis.