Cohort study on 20 years' experience of bilateral video-assisted thoracic sympathectomy (VATS) for treatment of hyperhidrosis in 2431 patients

Abstract BACKGROUND: Primary hyperhidrosis is a condition characterized by excessive sweating, inconsistent with the needs for thermoregulation. OBJECTIVE: To assess the effectiveness and the change in the quality of life of patients undergoing bilateral VATS (video-assisted thoracoscopic sympathectomy) for treatment of hyperhidrosis, in a large case series. DESIGN AND SETTING: Cohort study conducted in a tertiary hospital specializing in hyperhidrosis located in São Paulo, Brazil. METHODS: A total of 2,431 patients who underwent surgery consisting of bilateral video-assisted thoracoscopic sympathectomy between January 2000 and February 2017 were retrospectively assessed in an outpatient clinic specializing in hyperhidrosis. The patients underwent clinical and quality of life assessments on two occasions: firstly, prior to surgery, and subsequently, one month after the operation. The presence or absence of compensatory hyperhidrosis (CH) and general satisfaction after the first postoperative month were also evaluated. RESULTS: All the patients operated had poor or very poor quality of life before surgery. In the postoperative period, an improvement in the quality of life was observed in more than 90% of the patients. Only 10.7% of the patients did not present CH, and severe CH occurred in 22.1% of the patients in this sample. CONCLUSION: Bilateral VATS is a therapeutic method that decreases the degree of sweating more than 90% of patients with palmar and axillary hyperhidrosis. It improves the quality of life for more than 90% of the patients, at the expense of development of CH in approximately 90% of the patients, but not intensely.

Research of primary hyperhidrosis in students of medicine of the State of Sergipe, Brazil

AbstractBACKGROUND:Hyperhidrosis or excessive sweat production occurs at 2.9-9% of the population.OBJECTIVE:To estimate the prevalence and disorders due to primary hyperhidrosis (HP) in medicine students in the state of Sergipe.METHODS:Cross-sectional study using individual interviews.RESULTS:Hyperhidrosis was found in 14.76% of subjects, the most affected regions were palmar, plantar and axillary, causing prejudice in daily activities. Family history occurred in 45% and 22.72% was diagnosed by a physician.CONCLUSION:The prevalence of hyperhidrosis in medicine students of Sergipe was high, with strong family and a small portion of diagnoses made by medical professionals.

Hiper-hidrose em paciente com traumatismo raquimedular / Hyperhidrosis in patient with spinal trauma

A hiper-hidrose é uma condição caracterizada por excessiva sudorese, sobretudo das palmas das mãos e axilas. Pode ser primária ou secundária. A primária tem sido associada com a hiperatividade do sistema nervoso simpático. A hiper-hidrose pode ser tratada clinicamente ou por meio da simpatectomia. Paciente do sexo masculino, 28 anos, ajudante de obras. Vítima de agressão física por arma de fogo. Exame neurológico: desperto. Pupilas isocóricas e ECG 15. Paraplegia crural com nível sensitivo-motor T10. TC da coluna dorsal: fratura do corpo e lâminas de T8, com fragmentos metálicos no canal medular. Quatro meses após o trauma, procurou o ambulatório de Neurocirurgia para acompanhamento do quadro neurológico e referia que após dois meses do trauma apresentou hiper-hidrose axilar e palmar bilateral. Submetido a tratamento conservador, fisioterapia motora e respiratória. Encaminhado ao serviço de Psiquiatria, que referiu a hiper-hidrose como consequência de ansiedade, sendo prescrito antidepressivo tricíclico, mas sem melhora do quadro da hiper-hidrose. Foi encaminhado para tratamento com a dermatologia e a possibilidade de ser submetido à intervenção cirúrgica endoscópica. Até a presente data não retornou ao ambulatório de neurocirurgia. Dentre as complicações clínicas do TRM, a hiper-hidrose tem sido relatada em alguns casos. A produção de suor é afetada após o trauma por causa de uma alteração do sistema nervoso simpático. O tratamento com antidepressivos proporciona apenas alívio parcial e pode apresentar efeitos colaterais. A intervenção cirúrgica, embora passível de efeitos secundários, é um método minimamente invasivo e eficiente no tratamento da hiper-hidrose primária ou secundária.

Hyperhidrosis is a condition characterized by excessive sweating, especially of the hands palms and armpits. It may be primary or secondary. The primary has been associated with hyperactivity of the sympathetic nervous system. Hyperhidrosis can be treated medically or by sympathectomy. Patients, male patient, 28 years old, assistant works. Victim of physical assault by a firearm. Neurological exam: awake. Pupils isochoric and ECG 15. Crural paraplegia with sensory-motor level T10. CT of the spine: fracture of the blades and vertebral body T8, with metal fragments in the spinal canal. Four months after the trauma, came to the neurosurgery clinic for follow-up of the neurological status and stated that two months after the trauma had bilateral palmar and axillary hyperhidrosis. The patient underwent conservative treatment, physical and respiratory therapy. Referred to the Department of Psychiatry, where he was informed that the hyperhidrosis was a consequence of anxiety, and it was prescribed tricyclic antidepressant, but without hyperhidrosis cure. He was referred to dermatology for treatment and the possibility of undergoing surgery as the evolution of endoscopic. To date not returned to the clinic of neurosurgery. Among the clinical complications of SCI, hyperhidrosis has been reported in some cases. The production of sweat is affected after trauma due to a change in the sympathetic nervous system. Treatment with antidepressants provides only partial relief and can have side effects. Surgical intervention, although susceptible to side effects, is a minimally invasive and effective treatment of primary or secondary hyperhidrosis.

Hiperhidrosis esencial, recomendaciones para su tratamiento / Essential hyperhidrosis, recommendations for its treatment

La hiperhidrosis esencial, más que un aumento profuso y desproporcionado en la producción y excreción de sudor, de manos y pies, u otras zonas, es una entidad clínica propia, con una sintomatología específica y una manera de sudar cuyas características la hacen patonegmónica. Etiológicamente no está confirmado su origen, pero sí está claro que constituye un problema de salud más frecuente, y a su vez desconocido y subvalorado, que otras tantas enfermedades. Afortunadamente en la actualidad existe un interés científico internacional en el tema y la cirugía se ha convertido en una herramienta útil, considerada esta la mejor opción de tratamiento. Algunos efectos indeseables en su evolución posoperatoria ensombrecen el pronóstico y motivan a los investigadores a buscar variantes técnicas que permitan mejorar los resultados que se tienen hoy. Con este mismo interés se celebra en el Centro Nacional de Cirugía de Mínimo Acceso un taller nacional e internacional de hiperhidrosis cada año. En los últimos 3 años se han realizado reuniones de consensos al final de estos eventos científicos, con los profesares nacionales y foráneos invitados. Las conclusiones de estas reuniones constituyen el motivo de esta presentación, y tiene el objetivo de protocolizar su tratamiento para evitar al máximo efectos indeseables o resultados negativos(AU)

The essential hyperhidrosis more than a profuse and disproportionate increase in production and excretion of sweat in hands and feet and other sites, is an own clinical entity with a specific symptomatology and a way of to sweat whose features becomes pathognomonic. From the etiological point of view its origin is not confirmed but it is clear that it is a frequent health problem and in turn unknown and undervalued than many other diseases. Fortunately nowadays there is an international scientific interest on this subject and surgery becomes a useful tool, considered it as the better option of treatment. Some undesirable effects in its postoperative evolution cast a shadow on the prognosis and motivate researchers to look for techniques variants allowing for improve the current results. With this same interest in the National Center of Minimal Access a national and international workshop on hyperhidrosis is held each year. In past three years at the end of these scientific events consensus meeting have been held together with the invited national and foreign professors. Conclusions from these meeting are the objective of present paper to add its treatment to protocol avoiding most of undesirable effects or the negative effects(AU)

Compensatory sweating after thoracoscopic sympathectomy: characteristics, prevalence and influence on patient satisfaction / Hiperhidrose compensatória após simpatectomia toracoscópica: características, prevalência e influência na satisfação do paciente

OBJECTIVE: This prospective study aimed at investigating predictive factors for compensatory sweating after thoracoscopic sympathectomy. METHODS: From 2000 to 2002, 80 patients (53 females and 27 males) underwent thoracoscopic sympathectomy to treat hyperhidrosis. Patient ages ranged from 12 to 56 years, and the mean post-operative follow-up period was 42.51 ± 5.98 months. Patient satisfaction with the results was evaluated through the use of a rating scale. The procedure was performed bilaterally: at the T2 level for facial hyperhidrosis; at the T3-T4 level for axillary hyperhidrosis; and at the T3 level for palmar hyperhidrosis. RESULTS: Post-operatively, 68 patients (85.0 percent) presented compensatory sweating, which was classified as mild in 23 (33.8 percent), moderate in 23 (33.8 percent) and severe in 22 (32.4 percent). Considering the final surgical results, 70 patients (87.5 percent) were satisfied with the outcome of the operation, whereas 10 patients (12.5 percent) were dissatisfied. The level of patient satisfaction varied according to gender, age, body mass index (BMI) and extent of denervation. The compensatory sweating was more severe on the abdomen and back than on the legs. CONCLUSIONS: Although compensatory sweating, which is a common adverse effect of sympathectomy, occurred in the majority of cases, the level of patient satisfaction was high. The best candidates for thoracoscopic sympathectomy are young adult women with a BMI < 24.9 kg/m².

OBJETIVO: Este estudo prospectivo visou investigar fatores preditivos para a hiperidrose compensatória após a simpatectomia toracoscópica. MÉTODOS: De 2000 a 2002, 80 pacientes (53 mulheres e 27 homens), com idade entre 12 e 56 anos, foram submetidos à simpatectomia toracoscópica para o tratamento de hiperidrose e acompanhados em média por 42,51 ± 5,98 meses. A satisfação destes pacientes quanto aos resultados do procedimento foi aferida por meio de uma escala de avaliação. O procedimento foi executado bilateralmente: no nível de T2 para a hiperidrose facial; de T3 e T4 para a hiperidrose axilar; e de T3 para a hiperidrose palmar. RESULTADOS: No período pós-operatório, 68 pacientes (85,0 por cento) apresentaram hiperidrose compensatória, que foi classificada como leve em 23 (33,85 por cento), moderada em 23 (33,8 por cento) e grave em 22 (32,4 por cento). Quanto aos resultados da cirurgia, na avaliação dos pacientes, 70 deles (87,5 por cento) se consideraram satisfeitos, enquanto 10 pacientes (12,5 por cento) disseram estar insatisfeitos. O grau de satisfação do paciente variou de acordo com o sexo, a idade, o índice de massa corpórea (IMC) e a extensão da operação. A hiperidrose compensatória foi mais intensa no abdome e dorso do que nas pernas. CONCLUSÕES: Embora a hiperidrose compensatória seja um efeito adverso frequente após a simpatectomia, o grau de satisfação dos pacientes foi elevado. Os melhores candidatos para simpatectomia toracoscópica são mulheres adultas jovens com IMC < 24,9 kg/m².

Twenty months of evolution following sympathectomy on patients with palmar hyperhidrosis: sympathectomy at the T3 level is better than at the T2 level

OBJECTIVE: To compare two surgical techniques (denervation levels) for sympathectomy using video-assisted thoracoscopy to treat palmar hyperhidrosis in the long-term. METHODS: From May 2003 to June 2006, 60 patients with palmar hyperhidrosis were prospectively randomized for video-assisted thoracoscopic sympathectomy at the T2 or T3 ganglion level. They were followed for a mean of 20 months and were evaluated regarding their degree of improvement of palmar hyperhidrosis, incidence and severity of compensatory hyperhidrosis and its evolution over time, and quality of life. RESULTS: Fifty-nine cases presented resolution of the palmar hyperhidrosis. One case of therapeutic failure occurred in the T3 group. Most of the patients presented an improvement in palmar hyperhidrosis, without any difference between the groups. Twenty months later, all patients in both groups presented some degree of compensatory hyperhidrosis but with less severity in the T3 group (p = 0.007). Compensatory hyperhidrosis developed in most patients during the first month after the operation, with incidence and severity that remained stable over time. An improvement in quality of life was seen starting from the first postoperative evaluation but without any difference between the groups. This improvement was maintained until the end of the follow-up. CONCLUSION: Both techniques were effective for treating palmar hyperhidrosis. The most frequent complication was compensatory hyperhidrosis, which presented stable incidence and severity over the study period. Sympathectomy at the T3 level presented compensatory hyperhidrosis with less severity. Nevertheless, the improvement in quality of life was similar between the groups.

Avaliação clínica do tratamento cirúrgico da hiperidrose / Clinical evaluation of surgical treatment of hyperhidrosis

Contexto: A hiperidrose consiste em uma disfunção simpática que acomete 0,6 por cento a 1 por cento da população mundial. Essa produção excessiva de suor afeta significativamente a qualidade de vida desses pacientes. Objetivo: Aplicar um questionário aos pacientes operados de hiperidrose para comparar a qualidade de vida desses pacientes antes e após a cirurgia. Além disso, identificas os diferentes tipos de hiperidrose e os possíveis efeitos colaterais ou complicações pós-operatórias. Métodos: Foi feita uma análise retrospectiva dos prontuários de 30 pacientes (21 mulheres e nove homens) submetidos à simpatectomia por videotoracoscopia no Hospital Universitário Antônio Pedro, no Hospital Santa Cruz e no Hospital de Clínicas Niterói, entre os anos de 2001 a 2005. Resultado: A cirurgia foi bem sucedida em 86,6 por cento dos casos. Em 13,3 por cento dos pacientes houve recorrência de hiperidrose axilar. Destes, um foi reoperado, não obtendo, no entanto, o resultado esperado. Houve somente uma complicação cirúrgica e 86,6 por cento dos pacientes afirmaram ter melhora em sua qualidade de vida. Conclusão: A pesquisa pode comprovar que a simpatectomia por videotoracoscopia é capaz de promover melhorias na qualidade de vida da maioria dos pacientes operados.

Aortic dissection presenting as a febrile disease and atrial fibrillation / Síndrome febril y fibrilación auricular como presentación de la disección aórtica

Aortic dissection is a cardiovascular emergency. Its main manifestation is severe chest pain, and approximately 50% of patients present with an elevated systemic blood pressure. Rare reported physical findings include a pulsatile sterno-clavicular joint, dysphagia or testicular tenderness. The absence of sudden onset of pain lowers the likelihood of aortic dissection. We describe a patient in whom aortic dissection was accompanied by fever, nightsweats, suprasternal pain and atrial fibrillation.

La disección aórtica es una emergencia cardiovascular. La principal manifestación clínica es el dolor torácico severo y agudo. Se acompaña de presión arterial sistémica hasta en 50% de los pacientes en el momento de su presentación. Otras formas inusuales han sido reportadas en la literatura médica como disfagia, movimiento pulsátil en la unión esterno-clavicular y dolor testicular. La ausencia de dolor torácico disminuye la probabilidad de la disección aórtica. Se describe el caso de una paciente en quien la disección aórtica se presentó con fiebre, sudoración profunda, dolor supraesternal y fibrilación auricular.

An intramedullary tumor presenting with hyperhidrosis.

A case of a cervical intramedullary tumor is reported whose presentation was with disabling hyperhidrosis. The symptom resolved after surgical debulking of the tumor. Hyperhidrosis as a presenting manifestation of an intramedullary tumor has not been reported earlier.

T2 versus T2 and T3 endoscopic sympathetic ablation in primary palmar hyperhidrosis

Between June 2000 and April 2002, 112 sympathectomies were performed on 56 patients suffering from isolated palmar hyperhidrosis. Both sides were operated during the same surgical procedure using 5 mm 0-degree laparoscope. All patients were placed in a semi-sitting position under single lumen endotracheal anesthesia. Electrocute ablation of T2 ganglion and any Kuntz fibers was performed in 28 patients [group I] and similar procedure on T2 and T3 ganglion was performed in the other 28 patients [group II]. The procedure was accomplished within 12 minutes [range 7-20 minutes] for both sides. All patients were discharged within eight hours after conventional chest X-ray. Fifty-four patients were followed up for a mean of 17 months [2 patients lost the follow up]. The study concluded that the incidence of compensatory hyperhidrosis can be greatly decreased by limiting sympathetic ablation to T2 only in the treatment of primary palmar hyperhidrosis with a high subjective patient-satisfaction