ABSTRACT
Abstract Hyperhidrosis (HH) is characterized by sweating exceeding the amount necessary to meet the thermal regulation and physiological needs of the body. Approximately 9.41% of individuals with HH have craniofacial hyperhidrosis (FH). The present study aims to review the most current data in the literature regarding craniofacial hyperhidrosis, including pathophysiology, diagnosis and clinical presentation, treatment options (clinical and surgical), and outcomes. VATS (videothoracoscopy sympathectomy) is considered the gold standard for definitive treatment of axillary or palmar hyperhidrosis. Recently, several studies have shown the usefulness of clinical treatment with oxybutynin hydrochloride, leading to clinical improvement of HH in more than 70% of users. Both clinical and surgical treatment of craniofacial hyperhidrosis have good results. However, surgical treatment of FH is associated with more complications. Clinical treatment with oxybutynin hydrochloride yields good results and can be the first therapeutic option. When the patient is not satisfied with this treatment and has good clinical conditions, surgical treatment can be used safely.
Resumo A hiperidrose (HH) é caracterizada por transpiração além da quantidade necessária para manter a regulação térmica e as necessidades fisiológicas do corpo. Aproximadamente 9,41% dos indivíduos com HH apresentam hiperidrose craniofacial (FH). Este estudo tem como objetivo revisar os dados mais atuais da literatura sobre FH, incluindo fisiopatologia, diagnóstico e apresentação clínica, opções de tratamento (clínico e cirúrgico) e desfechos. A simpatectomia por videotoracoscopia (VATS) é considerada o padrão-ouro para o tratamento definitivo da hiperidrose axilar ou palmar. Recentemente, vários estudos demonstraram a utilidade do tratamento clínico com cloridrato de oxibutinina, que leva à melhora clínica da HH em mais de 70% dos pacientes. O tratamento clínico e o cirúrgico apresentam bons resultados no tratamento da FH. No entanto, o tratamento cirúrgico da FH apresenta mais complicações. O tratamento clínico com cloridrato de oxibutinina fornece bons resultados e pode ser a primeira opção terapêutica. Quando o paciente não está satisfeito com esse tratamento e mostra boas condições clínicas, o tratamento cirúrgico pode ser usado com segurança.
Subject(s)
Humans , Sympathectomy , Cholinergic Antagonists/therapeutic use , Hyperhidrosis/therapy , Sweating , Botulinum Toxins/therapeutic use , Head , Hyperhidrosis/diagnosis , Hyperhidrosis/physiopathologyABSTRACT
ABSTRACT Objective: To conduct a longitudinal investigation of cardiac vagal activity (CVA) by measuring resting HR and calculating the cardiac vagal index (CVI) in individuals undergoing sympathectomy for the treatment of primary hyperhidrosis. Methods: This was a descriptive longitudinal study involving 22 patients, 13 of whom were female. The mean age was 22.5 ± 8.8 years. The palms, soles, and axillae were the most commonly affected sites. Resting HR was measured by an electrocardiogram performed 20 min before the 4-second exercise test (4sET), which was used in order to evaluate CVA at three different time points: before surgery, one month after surgery, and four years after surgery. Results: Resting HR (expressed as mean ± SE) was found to have decreased significantly at 1 month after surgery (73.1 ± 1.6 bpm before surgery vs. 69.7 ± 1.2 bpm at one month after surgery; p = 0.01). However, the HR values obtained at four years after surgery tended to be similar to those obtained before surgery (p = 0.31). The CVI (expressed as mean ± SE) was found to have increased significantly at one month after surgery (1.44 ± 0.04 before surgery vs. 1.53 ± 0.03 at one month after surgery; p = 0.02). However, the CVI obtained at four years after surgery tended to be similar to that obtained before surgery (p = 0.10). Conclusions: At one month after sympathectomy for primary hyperhidrosis, patients present with changes in resting HR and CVA, both of which tend to return to baseline at four years after surgery.
RESUMO Objetivo: Investigar longitudinalmente o comportamento da atividade vagal cardíaca (AVC) por meio da FC de repouso e do índice vagal cardíaco (IVC) de indivíduos submetidos à simpatectomia para o tratamento de hiperidrose primária. Métodos: Estudo de natureza descritiva e longitudinal que avaliou 22 pacientes (13 mulheres), com média de idade de 22,5 ± 8,8 anos. Os locais mais afetados eram as mãos, pés e axilas. A FC de repouso média foi mensurada através de eletrocardiograma 20 min antes do teste de exercício de 4 segundos (T4s), que foi utilizado para a avaliação da AVC em três momentos: antes da cirurgia, um mês após a cirurgia e quatro anos após a cirurgia. Resultados: A média ± erro-padrão da FC de repouso apresentou uma redução significativa entre a avaliação pré-operatória e um mês após a cirurgia (73,1 ± 1,6 bpm vs. 69,7 ± 1,2 bpm; p = 0,01), tendendo a retornar aos valores pré-operatórios quatro anos após a cirurgia (p = 0,31). Houve um aumento significativo do IVC entre o pré-operatório e um mês após a cirurgia (1,44 ± 0,04 vs. 1,53 ± 0,03; p = 0,02), tendendo também a retornar próximo aos valores do pré-operatório após quatro anos da cirurgia (p = 0,10). Conclusões: A simpatectomia resultou em alteração na FC de repouso e na AVC um mês após a cirurgia, retornando, após quatro anos, aos valores próximos do pré-operatório.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Young Adult , Sympathectomy/methods , Heart Conduction System/physiopathology , Heart Rate/physiology , Hyperhidrosis/surgery , Rest/physiology , Thoracoscopy , Time Factors , Follow-Up Studies , Longitudinal Studies , Hyperhidrosis/physiopathologyABSTRACT
ABSTRACT Objective To evaluate the difference in transepidermal water loss in patients diagnosed with hyperhidrosis and healthy subjects, in an air-conditioned environment. Methods Twenty patients diagnosed with hyperhidrosis and 20 healthy subjects were subjected to quantitative assessment using a closed-chamber device, in six previously established sites. Results The measurements showed different transepidermal water loss values for healthy subjects and patients with hyperhidrosis, especially in the hands and feet. In the Control Group, the median for the hands was 46.4g/m2/hour (p25: 36.0; p75: 57.6), while in the Hyperhidrosis Group, the median was 123.5g/m2/hour (p25: 54.3; p75: 161.2) - p<0.001. For the feet, the Control Group had a median of 41.5g/m2/hour (p25: 31.3; p75: 63.5) and the Hyperhidrosis Group, 61.2g/m2/hour (p25: 32.3; p75: 117) - p<0.02. Measurements of the axillas also showed differences. In the Control Group, the median was 14.8g/m2/hour (p25: 11.8; p75: 19.0) and, in the Hyperhidrosis Group, 83.5g/m2/hour (p25: 29.5; p75: 161.7) - p<0.001. Conclusion Measuring transepidermal water loss is sufficient for diagnosis and follow-up of patients with hyperhidrosis.
RESUMO Objetivo Avaliar a diferença entre a perda transepidérmica de água aferida entre pacientes com e sem diagnóstico de hiperidrose, em ambiente climatizado. Métodos Foram selecionados 20 pacientes com diagnóstico de hiperidrose e 20 hígidos, submetidos à aferição de maneira quantitativa, com mensurador de câmara fechada, em seis locais previamente estabelecidos. Resultados As medidas realizadas mostraram valores diferentes de perda transepidérmica de água em pessoas hígidas e naquelas com hiperidrose, principalmente em mãos e pés. No Grupo Controle, a mediana das aferições em mãos foi 46,4g/m2/hora (p25: 36,0; p75: 57,6), enquanto, no Grupo Hiperidrose, obtivemos a mediana de 123,5g/m2/hora (p25: 54,3; p75: 161,2) - p<0,001. Já nos pés, a mediana no Grupo Controle foi 41,5g/m2/hora (p25: 31,3; p75: 63,5) e, no Grupo Hiperidrose, foi 61,2g/m2/hora (p25: 32,3; p75: 117) - p<0,02. As medidas das regiões axilares também mostraram diferença. No Grupo Controle, obtivemos mediana 14,8g/m2/hora (p25: 11,8; p75: 19,0) e, no Hiperidrose, 83,5g/m2/hora (p25: 29,5; p75: 161,7) - p<0,001. Conclusão A mensuração da perda transepidérmica de água é suficiente para diagnóstico e acompanhamento de pacientes com hiperidrose.
Subject(s)
Humans , Adolescent , Adult , Water Loss, Insensible/physiology , Air Conditioning , Epidermis/physiology , Hyperhidrosis/diagnosis , Reference Values , Case-Control Studies , Hyperhidrosis/physiopathologyABSTRACT
Abstract Palmar hyperhidrosis affects up to 3% of the population and inflict significant impact on quality of life. It is characterized by chronic excessive sweating, not related to the necessity of heat loss. It evolves from a localized hyperactivity of the sympathetic autonomic system and can be triggered by stressful events. In this study, the authors discuss clinical findings, pathophysiological, diagnostic and therapeutic issues (clinical and surgical) related to palmar hyperhidrosis.
Subject(s)
Humans , Hyperhidrosis , Quality of Life , Sweat Glands/physiopathology , Sympathectomy/methods , Diagnosis, Differential , Hyperhidrosis/diagnosis , Hyperhidrosis/physiopathology , Hyperhidrosis/therapy , Medical IllustrationABSTRACT
Abstract Ross syndrome is a rare disease characterized by peripheral nervous system dysautonomia with selective degeneration of cholinergic fibers. It is composed by the triad of unilateral or bilateral segmental anhidrosis, deep hyporeflexia and Holmes-Adie's tonic pupil. The presence of compensatory sweating is frequent, usually the symptom that most afflicts patients. The aspects of the syndrome are put to discussion due to the case of a male patient, caucasian, 47 years old, with clinical onset of 25 years.
Subject(s)
Humans , Male , Middle Aged , Peripheral Nervous System Diseases/pathology , Primary Dysautonomias/pathology , Hyperhidrosis/pathology , Hypohidrosis/pathology , Syndrome , Cholinergic Fibers/pathology , Peripheral Nervous System Diseases/physiopathology , Primary Dysautonomias/physiopathology , Hyperhidrosis/physiopathology , Hypohidrosis/physiopathology , Nerve Degeneration/pathologyABSTRACT
OBJETIVO: Comparar a intensidade de transpiração em palmas das mãos e planta dos pés de indivíduos portadores de hiperidrose com a de um grupo controle. MÉTODOS: Foram selecionados 50 pacientes com diagnóstico clínico de hiperidrose palmoplantar e 25 indivíduos controles. Um método objetivo de quantificação da transpiração foi utilizado com um aparelho eletrônico portátil, não invasivo, com sensores de umidade relativa e de temperatura capazes de quantificar a perda de água transepidérmica. Todos os indivíduos apresentavam índice de massa corpórea de 20-25 kg/cm² e permaneceram em repouso por 20-30 min antes das medições para reduzir a interferência externa. A mensuração foi realizada em sala climatizada com a temperatura de 21-24ºC. Os locais determinados para a aferição foram região hipotenar da face palmar e região medial da face plantar. RESULTADOS: No grupo com hiperidrose palmoplantar, as médias da intensidade de transpiração nas mãos e nos pés foram de, respectivamente, 133,6 ± 51,0 g/m²/h e 71,8 ± 40,3 g/m²/h, enquanto, no grupo controle, essas foram de 37,9 ±18,4 g/m²/h e 27,6 ± 14,3 g /m²/h. As diferenças das médias entre os grupos foram estatisticamente significativas (p < 0,001). CONCLUSÕES: Este método de quantificação mostrou-se uma ferramenta precisa e confiável na avaliação da transpiração palmar e plantar, quando operado por um profissional treinado e capacitado.
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/cm². 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 (21-24ºC). 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/m²/h and 71.8 ± 40.3 g/m²/h, respectively, compared with 37.9 ± 18.4 g/m²/h and 27.6 ± 14.3 g/m²/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.
Subject(s)
Humans , Hyperhidrosis/diagnosis , Severity of Illness Index , Case-Control Studies , Foot , Hand , Hyperhidrosis/physiopathology , Reproducibility of Results , Sweating/physiologyABSTRACT
Introdução: A hiperidrose primária (HP) é uma desordem que afeta negativamente a qualidade de vida de seus portadores. A fisiopatologia da HP não é bem compreendida e acredita-se que uma complexa disfunção do sistema nervoso simpático esteja relacionada com sua etiologia. A ressecção de um ou mais gânglios da cadeia simpática torácica constitui-se como o método mais eficiente de controle da HP; apesar disso, pouco se sabe sobre o funcionamento dos gânglios simpáticos em indivíduos normais e em portadores de HP. Objetivos: Analisar a expressão de acetilcolina e das subunidades 3 e 7 de seu receptor nicotínico neuronal em gânglios da cadeia simpática torácica de portadores de HP palmar e comparar estes resultados com os obtidos de não portadores; avaliar se existe diferença de tamanho entre esses gânglios. Métodos: Estudo transversal, no qual foram analisados dois grupos de 20 participantes: no grupo Hiperidrose, portadores de HP palmar, candidatos a simpatectomia torácica; no grupo Controle, doadores falecidos de órgãos sem história prévia de sudorese excessiva. Em todos os indivíduos foram realizados: ressecção do 3º gânglio simpático esquerdo; aferição do maior diâmetro do gânglio; avaliação imunohistoquímica pela quantificação das áreas de expressão forte e fraca de anticorpos primários contra acetilcolina e contra as subunidades 3 e 7 de seu receptor nicotínico neuronal. Resultados: A mediana da idade dos participantes foi menor no grupo Hiperidrose em relação ao Controle; a proporção de homens e mulheres foi de 3:17 no grupo Hiperidrose e 9:11 no Controle. A expressão da subunidade 3 foi semelhante em ambos os grupos (p = 0,78 para expressão forte e p = 0,31 para expressão fraca). A área de expressão forte da subunidade 7 correspondeu a 4,85% da área total em portadores de HP e a 2,34% nos controles (p < 0,001), enquanto a área de expressão fraca foi de 11,48% no grupo Hiperidrose e de 4,59% no Controle (p < 0,001). Expressão forte da acetilcolina...
Introduction: Primary hyperhidrosis (PH) is a disorder that impairs the quality of life of its bearers. The PH physiopathology is not well understood and a complex sympathetic nervous system dysfunction seems to be related with its etiology. The resection of one or more thoracic sympathetic chain ganglia is the most effective PH treatment; however sympathetic ganglia function in normal subjects and in PH patients is unknown. Objectives: Analyzing the immunohistochemical expression of acetylcholine and its neuronal nicotinic receptors 3 and 7 subunits in thoracic sympathetic ganglia of PH patients and compare the results with those obtained from subjects without this disorder; identifying possible differences in size of these ganglia. Methods: Cross-sectional study, in which two groups of 20 subjects were analyzed: the Hyperhidrosis group, with palmar PH patients eligible to thoracic sympathectomy and the Control group, with organ donators after brain death without hyperhidrosis historical. For each subject it were performed: resection of the third left sympathetic ganglion; measurement of the ganglions diameter; immunohistochemical evaluation by quantification of intense and mild expression areas of primary antibodies against acetylcholine and its neuronal nicotinic receptors 3 and 7 subunits. Results: The median of participants age was smaller in Hyperhidrosis group than in Control; the male/female ratio was 3:17 in Hyperhidrosis group and 9:11 in Control. The 3 subunit expression was similar in both groups (p = 0.78 for intense expression and p = 0.31 for mild expression). Intense 7 subunit expression area was 4.85% in PH patients and 2.34% in controls (p < 0.001) whereas mild expression area was 11.48% in Hyperhidrosis group and 4.59% in Control (p < 0.001). Intense acetylcholine expression was found in 4.95% of total area in Hyperhidrosis group and in 1.19% in Control (p < 0.001)...
Subject(s)
Humans , Acetylcholine , Brain Death , Ganglia, Sympathetic , Hyperhidrosis/physiopathology , Immunohistochemistry , Receptors, NicotinicABSTRACT
Com o objetivo de se estabelecer diretrizes para a prevenção, o diagnóstico e o tratamento da hiperidrose compensatória, foram realizadas reuniões consensuais com a participação de cirurgiões torácicos filiados à Sociedade Brasileira de Cirurgia Torácica e um cirurgião geral em que foram abordados tópicos de modo a abranger conhecimentos multidisciplinares. A partir de textos recentes com diretrizes para a prevenção, o diagnóstico e tratamento (clínico e cirúrgico) da hiperidrose compensatória, e baseados em revisão bibliográfica, os participantes elaboraram um texto preliminar, cujas recomendações foram submetidas à aprovação dos participantes, possibilitando uma revisão geral do texto final. Deste modo, obteve-se um texto básico que, veiculado pela internet, tornou-se objeto de novas correções e revisões até alcançar a forma final atual.
With the objective of establishing guidelines for the prevention, diagnosis and treatment of compensatory hyperhidrosis, consensus meetings were held. Attendees included a general surgeon and thoracic surgeons affiliated with the Brazilian Society of Thoracic Surgery. The topics addressed were those that would ostensibly broaden multidisciplinary knowledge. Based on recent guidelines for the prevention, diagnosis and (clinical and surgical) treatment of compensatory hyperhidrosis, as well as on a review of the medical literature, the participants prepared a preliminary text, whose recommendations were revised and subsequently approved by all of the participants. The consensus text was posted on the Internet, becoming the object of further corrections and revisions prior to taking on its present form.
Subject(s)
Humans , Hyperhidrosis , Hyperhidrosis/physiopathology , Hyperhidrosis/prevention & control , Hyperhidrosis/therapy , Lumbosacral Plexus/surgery , Patient Care Team , Practice Patterns, Physicians' , Severity of Illness Index , SympathectomyABSTRACT
INTRODUCTION: Plantar hyperhidrosis is present in 50 percent of patients with hyperhidrosis. Thoracic sympathectomy is an important tool for the treatment of this condition, which is successful in about 60 percent of patients. For the remaining patients, lumbar sympathectomy is the procedure of choice. As new minimally invasive techniques have been developed, a significant demand for this type of access has led to its adaptation to the lumbar sympathectomy. The objective of this study was to evaluate the effectiveness of endoscopic retroperitoneal lumbar sympathectomy in controlling plantar hyperhidrosis and its effects on compensatory sweat. MATERIALS AND METHODS: Thirty female patients with persistent plantar hyperhidrosis after thoracic sympathectomy were enrolled. They were randomly assigned to laparoscopic retroperitoneal lumbar sympathectomy (Group A) or no surgical intervention (Group B - control) groups. Quality-of-life modifications were assessed by specific questionnaires before and after surgery. In the same manner, direct sweat measurements were also performed pre- and post-intervention by evaluating trans-epidermal water loss. Despite the lack of intervention, the control group was evaluated at similar timepoints. RESULTS: In Group A, no major complications occurred in the peri-operative period. During the immediate post-operative period, three patients (20 percent) experienced prolonged pain (more than ten days). Eight patients suffered from worsened compensatory sweating (53.3 percent). In Group A, after lumbar sympathectomy, the quality of life significantly improved (p<0.05, intra-group comparison) beyond that of the control group (p<0.05, inter-group comparison). Also, lumbar sympathectomy resulted in significantly lower values of foot sweat (pre- vs. post-operative periods, p<0.05; Group A vs. Group B, p<0.05). These patients also developed higher values of sweat measurements on specific points of their dorsal and abdominal...
Subject(s)
Adolescent , Adult , Female , Humans , Young Adult , Endoscopy/methods , Hyperhidrosis/surgery , Sweating/physiology , Sympathectomy/methods , Foot/physiopathology , Hand/physiopathology , Hyperhidrosis/physiopathology , Lumbosacral Region , Psoas Muscles/surgery , Quality of Life , Retroperitoneal Space , Sympathectomy/adverse effects , Treatment Outcome , Young AdultABSTRACT
OBJETIVO: Comparar grau de satisfação dos pacientes simpatectomizados e presença de sudorese reflexa, de acordo com diferentes níveis de ablação. MÉTODOS: Estudo retrospectivo de 521 pacientes com hiperidrose primária, submetidos à simpatectomia torácica no Hospital Monte Sinai e Hospital Universitário da Universidade Federal de Juiz de Fora - UFJF, de janeiro de 2001 a dezembro de 2005. Grupo I (n = 162): termoablação do tronco simpático, tendo T2 como nível mais cranial da ressecção, independentemente de outros níveis seccionados caudalmente. Grupo II (n = 65): termoablação do tronco simpático, tendo T3 como nível mais alto. Grupo III (n = 294): termoablação do tronco simpático, tendo T4 como nível mais alto. RESULTADOS: Pós-operatório ótimo no controle da hiperidrose palmar/axilar em, respectivamente, 94/82 por cento dos pacientes do grupo I, 89/89 por cento do grupo II e 80/80 por cento do grupo III. Sudorese reflexa em 67 por cento dos pacientes dos grupos I e II, caindo para 61,29 por cento no grupo III devido à maior termoablação a partir de T4. Ocorreu sudorese reflexa severa em 32 por cento dos pacientes do grupo I, 9 por cento do grupo II e 4 por cento do grupo III. CONCLUSÃO: A simpatectomia propiciou excelente grau de satisfação e baixo índice de complicações. Não houve diferença na incidência de sudorese reflexa com diferentes níveis seccionados; porém, a intensidade desta complicação se mostrou menor quando optamos por níveis de bloqueio mais baixos, principalmente T4.
OBJECTIVE: To compare different levels of ablation in terms of the degree of patient satisfaction and extent of postoperative reflex sweating in sympathectomized patients. METHODS: A retrospective study involving 521 patients with primary hyperhidrosis, submitted to thoracic sympathectomy at the Monte Sinai Hospital and University Hospital of the Federal University of Juiz de Fora, from January of 2001 to December 2005. All patients were submitted to thermal ablation of the sympathetic stem and were divided into three groups: up to T2 (group I, n = 162); up to T3 (group II, n = 65); and up to T4 (group III, n = 294). RESULTS: Optimal postoperative control of palmar/axillary hyperhidrosis was achieved in, respectively, 94/82 percent of the patients of group I, 89/89 percent of those in group II and 80/80 percent of those in group III. Postoperative reflex sweating was observed in 67 percent of the patients in groups I and II, compared with 61.29 percent of those in group III. Severe reflex sweating occurred in 32 percent of the group I patients, 9 percent of the group II patients and 4 percent of the group III patients. CONCLUSION: Sympathectomy provided excellent patient satisfaction and a low incidence of complications. There was no significant difference between the levels of ablation in terms of reflex sweating, although the intensity of this complication decreased when lower levels of blockage, principally at the T4 level, were employed.
Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Hyperhidrosis/surgery , Patient Satisfaction , Sympathectomy/methods , Thoracic Surgery, Video-Assisted , Axilla , Chi-Square Distribution , Follow-Up Studies , Hand , Hyperhidrosis/physiopathology , Retrospective Studies , Reflex/physiology , Sweating/physiology , Treatment Outcome , Thoracic Nerves/surgeryABSTRACT
Unilateral thoracic sympathectomy in patients with palmar hyperhidrosis causes a skin temperature drop in the contralateral hand. A cross-inhibitory effect by the post-ganglionic neurons innervating hands is postulated as a mechanism of contralateral vasoconstriction. The purpose of our study was to evaluate whether this cross-inhibitory effect also occurs in the feet. Twenty patients scheduled for thoracoscopic sympathicotomy due to palmar hyperhidosis were studied. Right T3 sympathicotomy was performed first, followed by left T3 sympathicotomy. The thenar skin temperatures of both hands and feet were continuously monitored using a thermometer and recorded before induction of anesthesia, during the operation, 4 hr after and 1 week later. Following right T3 sympathicotomy, the skin temperature of the ipsilateral hand gradually increased, however the skin temperature of the contralateral hand gradually decreased. Immediately after bilateral sympathicotomy, the skin temperature differences between hands and feet increased, but these differences decreased 1 week later. Our results show that cross-inhibitory control may exist in feet as well as in the contralateral hand. Thus, the release of cross-inhibitory control following T3 sympathicotomy results in vasoconstriction and decrease of skin temperature on the contralateral hand and feet. One week later, however, the temperature balance on hands and feet recovers.
Subject(s)
Male , Humans , Female , Adult , Adolescent , Thoracoscopy , Sympathectomy/methods , Skin Temperature , Hyperhidrosis/physiopathology , Hand/physiology , Foot/physiology , Body Temperature RegulationABSTRACT
La Hiperhidrosis es una afección caracterizada por una excesiva producción de sudor, mediada por el sistema nervioso simpático que se presenta especialmente a nivel axilopalmar y craneofacial. Produce importantes problemas psicosociales y laborales, además de irritación e infecciones a nivel local. El único tratamiento definitivo es la cirugía a través de la simpatectomía torácica bilateral, que se realiza por videotoracoscopía con excelentes resultados estéticos, funcionales y gran satisfacción postoperatoria por parte de los pacientes.
Subject(s)
Humans , Hyperhidrosis/surgery , Sympathectomy , Thoracoscopy , Hyperhidrosis/physiopathology , Hyperhidrosis/drug therapy , ThoraxABSTRACT
El término tormenta simpática paroxística se utiliza como sinónimo de alteraciones episódicas de la temperatura corporal, la presión arterial, la frecuencia respiratoria y cardíaca, el tamaño pupilary el nivel de conciencia, que coinciden con hiperhidrosis, salivación excesiva y postura extensora. Esto siempreen el contexto de una injuria axonal difusa grave que sigue a un traumatismo encéfalo-craneano (TEC) grave.Presentamos dos pacientes jóvenes con injuria axonal difusa secundaria a TEC grave, que desarrollan en suevolución cuadros de hipertensión arterial, taquicardia y fiebre, sin evidencia durante los episodios de actividad epileptiforme y habiéndose descartado la causa infecciosa, que responden favorablemente al tratamiento con beta-bloqueantes y morfina. Consideramos que el correcto diagnóstico de esta entidad minimiza la solicitud de estudios innecesarios permitiendo iniciar un tratamiento adecuadoc
The term paroxysmal sympatheticstorms is used to define episodic alterations in body temperature, blood pressure, heart and respiratoryrate, size of pupil, and level of consciousness coinciding with hyperhidrosis, excessive salivation and extensor posturing. All the cases were presented after severe diffuse axonal head injury. We present two young patients with diffuse axonal head injury that develop in their evolution hypertension, tachycardia and fever without evidence during theepisodes of epileptiform activity and without any infectious cause with excellent answer to the treatment withbeta-blockers and morphine. We consider that the correct diagnosis of this entity minimizes the application ofunnecessary studies allowing an appropriate treatment
Subject(s)
Humans , Male , Adult , Autonomic Nervous System Diseases/diagnosis , Brain Injuries/physiopathology , Diffuse Axonal Injury/physiopathology , Autonomic Nervous System Diseases/etiology , Autonomic Nervous System Diseases/physiopathology , Brain Injuries/complications , Diagnosis, Differential , Diffuse Axonal Injury/etiology , Fever/physiopathology , Glasgow Outcome Scale , Hyperhidrosis/physiopathology , Hypertension/physiopathology , Tachycardia, Paroxysmal/physiopathologyABSTRACT
OBJETIVOS: Analisar, em pacientes submetidos a simpaticotomia videotoracoscópica para tratamento da Hiperidrose Primária (HP), as conseqüências hemodinâmicas da desnervação vascular das artérias carótidas e vertebrais após a trans-secção cirúrgica da cadeia simpática torácica (simpaticotomia), através da mensuração de parâmetros ultra-sonográficos. MÉTODO: Vinte e quatro pacientes portadores de HP submetidos a quarenta e oito simpaticotomias torácicas endoscópicas foram avaliados através da mensuração da velocidade de pico sistólico (VPS), velocidade de pico diastólico (VPD), índice de pulsatibilidade (IP) e índice de resistência (IR) nas artérias carótidas comuns, internas e externas, além da artéria vertebral bilateralmente usando o eco-doppler duplex scan. As avaliações foram realizadas antes da intervenção cirúrgica e trinta dias após o procedimento. O teste de Wilcoxon foi usado na análise das diferenças entre as variáveis antes e depois da simpaticotomia. RESULTADOS: A simpaticotomia no nível de T3 foi a trans-secção mais realizada (95,83 por cento), seja isoladamente (25 por cento) ou associada a T4 (62,50 por cento) ou a T2 (8,33 por cento). Houve aumento significativo no IR e no IP da artéria carótida comum bilateralmente (p<0,05). A VPD da artéria carótida interna diminuiu em ambos os lados (p<0,05). A VPS e a VPD da artéria vertebral direita também aumentaram (p<0,05). Achados assimétricos foram observados, de modo que artérias do lado direito foram as mais freqüentemente afetadas. CONCLUSÕES: Alterações hemodinâmicas foram observadas nas artérias vertebral e carótida após simpaticotomia para tratamento de HP. VPS foi o parâmetro mais freqüentemente alterado, principalmente nas artérias do lado direito, representando alterações assimétricas significantes nas artérias carótida e vertebral. Entretanto, são necessárias pesquisas subseqüentes para verificar se essas alterações são definitivas ou temporárias, uma vez que as inferências clínicas somente terão validação se as alterações forem permanentes.
Subject(s)
Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Carotid Arteries/innervation , Hyperhidrosis/surgery , Sympathectomy/methods , Thoracic Surgery, Video-Assisted , Vertebral Artery/innervation , Blood Flow Velocity/physiology , Carotid Arteries , Hyperhidrosis/physiopathology , Pulsatile Flow/physiology , Regional Blood Flow , Statistics, Nonparametric , Treatment Outcome , Ultrasonography, Doppler, Color , Vertebral ArteryABSTRACT
This study examined the net changes in temperature at various regions of the lower extremities in an attempt to identify the regions demonstrating the most significant temperature changes following a lumbar sympathetic ganglion block (LSGB). Thermography was performed before and after the LSGB in 26 sympathetic nerve system disorder cases. The inspection points were the anterior and posterior surfaces of the thigh, the knee and leg, and the dorsal and plantar surfaces of the feet. The net increases in skin temperature following the LSGB (deltaT (net) ) at the plantar and dorsal surfaces of the feet, were 6.2 +/- 2.68 degrees C (mean +/- SD) and 3.9 +/- 1.89degrees C, respectively, which were higher than those observed in the other regions of the lower extremities (p < 0.05). The areas, in order of decreasing deltaT (net), are as follows: the plantar surface of the foot, the dorsal surface of the foot, the shin, the anterior surface of the knee, the calf, the posterior surface of the knee, the anterior surface of the thigh, and the posterior surface of the thigh. There was one case of orthostatic hypotension during the thermography procedure. In conclusion, thermographic imaging is a useful method for demonstrating the success of a LSGB in various diseases. An evaluation of the deltaT (net) on the plantar surface of the feet using thermographic imaging is the most effective, simple, and safe method for assessing a successful LSGB.