The Effects of Thoracic Sympathotomy on Heart Rate Variability in Patients with Palmar Hyperhidrosis

PURPOSE: To observe the evolution of heart rate variability (HRV) in patients with palmar hyperhidrosis before and after endoscopic thoracic sympathotomy and to evaluate the effects of the surgery on the autonomic nervous system. MATERIALS AND METHODS: Endoscopic thoracic sympathotomy was performed on 20 patients with palmar hyperhidrosis. The thoracic sympathetic chain at the level of the third to fourth rib (R3-R4) was transected, but the ganglia were left in position without removal. A slightly larger ramus, in comparison to the other rami, that arose laterally from the sympathetic chain was interrupted to achieve adequate sympathetic denervation of the upper extremity. Before and on the day after the surgery, 24-hour Holter Electrocardiograph was performed, obtaining time domain and frequency domain parameters. RESULTS: Compared with preoperative variables, there was a significant increase in the number of adjacent normal R wave to R wave (R-R) intervals that differed by more than 50 ms, as percent of the total number of normal RR intervals (pNN50); root mean square difference, the square root of the mean of the sum of squared differences between adjacent normal RR intervals over the entire 24-hour recording; standard deviation of the average normal RR interval for all 5-minute segments of a 24-hour recording (SDANN) after thoracic sympathotomy. Low frequencies (LF, 0.04 to 0.15 Hz) decreased significantly. There was no statistical difference in high frequencies (HF, 0.15 to 0.40 Hz), LF/HF ratio (LF/HF), or standard deviation for all normal RR intervals for the entire 24-h recording (SDNN) before and after thoracic sympathotomy. CONCLUSION: There was a significant improvement in HRV in patients with palmar hyperhidrosis after thoracic sympathotomy. This may be attributable to an improvement autonomic nervous system balance and parasympathetic predominance in the early postoperative stage.

Tratamiento quirúrgico de la hiperhidrosis / Hyperhidrosis surgical treatment

La hiperhidrosis es una condición idiopática con una sudoración excesiva, en condiciones fisiológicas normales, generalmente localizada en manos, axilas, cara y pies. Esta condición puede afectar social, psíquica y profesionalmente a los pacientes más comprometidos. El tratamiento médico ha sido poco efectivo y a menudo lleva a los pacientes a usar múltiples terapias con una mejoría escasa y muchas veces transitoria. Una posibilidad de tratamiento definitivo, en los casos más severos, es la videocirugía, utilizando micro instrumentos, con resección de la cadena simpática, en T2 a T4, con una morbilidad mínima y con resultados a largo plazo muy satisfactorios. Este trabajo explica las indicaciones quirúrgicas, los detalles técnicos y los resultados obtenidos.

Sistema nervioso autónomo y páncreas. (Análise da influencia de diversos tipos de denervación outonómica en los fenómenos de regeneración glandular y en las de las interaciones del eje endocrino-exocrino / Autonomic nervous system and pancreas. (Analysis of the influence of different types of autonomic denervation in glandular regeneration phenomena and the interactions of the exocrine-endocrine-Axis)

The present tests, in male Wistar rsts, center around the trophic and functional changes of the pancreatic gland (R G), both exocrine and endocrine, induced by different types of autonomic nervous interruptions. First Group of Tests: Following one year celiac ganglionectomy (CG), nonpancreatectomized (Non-Pt) rats showed, basally, in blood, adrop of glucose (G), without changes of insulin (I). At autpsy, the CG animals showed an increase of the pancreatic we weight, of the total protein, of the RNA but not DNA. In the Pt. 95 per cent rats, superimposing CG triggered, on the one hand, a drop to control values of the raised G blood levels, and on the other, a rise of I Besides, in feces, a rising of chymotrypsin concentration. At autopsy, in the PG, an increase of total protein and of RNA. Second Group of Tests: CG, after 6 months, induced, in blood, both basally and a 2 h glucose tolerance test, significant opposite enzyme activities changes in respect to C. Indeed, as amylase (A) was increased, that of lipase (L) was depressed. When alcohol feeding (AF) was superimposed to CG rats, a reversal of the L values was observed. The latter reached levels significantly higher those of the C. In in-vitro tests, the isolated islets of CG disclosed to release more I to the bath medium than those of the C animals. Third Group of Tests: Analyzing, in conscious animal, the L excretory changes in the basal bile pancreatic secretion (BB-PS) induced by chronic (2 months interruption of the autonomic nervous innervation of the PG, it was found that CG, truncal vagotomy (V), the association of CG + V, peri-Vaterian duodenotomy (PV-D), but not bilateral splachnicectomy (Spl), inhibit, significantly the L output. It was also shown that superimosing AF to the V or CG + V animals reverted to C values the I depressed levels...

Utilizaçäo terapêutica da via autonoma periférica / Therapeutic use of peripheral autonomic pathway

O tratamento de várias doenças por cirurgia no Sistema Nervoso Autônomo tem se baseado fundamentalmente na fisiologia e fisiopatologia. As condiçöes em que se atua sobre o sistema, comumente, resulta de alteraçöes patológicas em algum outro sistema. Para se obter uma completa supressäo da atividade nervosa, existem dificuldades, considerando-se as variaçöes anatômicas, bem como a possibildiade de restauraçäo das vias interrompidas. Este trabalho tem como objetivo comentar as possibilidades de abordagens sobre a via autônoma periférica no tratamento de enfermidades que näo afetam o próprio sistema