The impact of endoscopic thoracic sympathectomy on sudomotor function in patients with palmar hyperhidrosis.

PURPOSE: When performing endoscopic thoracic sympathectomy (ETS) in palmar hyperhidrosis patients, a device can be used to measure sweat volume pre- and postoperatively in order to assess indications and treatment effects. In this study, we measured changes in the dynamics of sweating in hyperhidrosis patients pre- and postoperatively and compared the values with those in healthy subjects without hyperhidrosis. METHODS: The patient group comprised 25 persons with palmar hyperhidrosis who were scheduled for ETS. The dynamics of sweating was measured at 1 day prior to surgery and at 2 days postoperatively, in 18 patients at > 1 year postoperatively in another palmar hyperhidrosis group, and in 20 healthy subjects without hyperhidrosis. A device for measuring local sweat volume was applied at the thenar eminence of both palms. Indicators established were basal sweat rate (BSR; mg/min/cm2), peak sweat rate (PSR; mg/min/cm2) during mental stress (sympathetic sweating response), sweat volume (SV), and sweat time (ST; s). RESULTS: After surgery, all of the indicators were significantly reduced in hyperhidrosis patients and there was very little response to mental stress. The subgroup of these patients assessed at > 1 year after ETS showed a trend of increased BSR similar to that of healthy subjects. These changes did not correlate with the extent of the removal surgery. Preoperatively, hyperhidrosis patients had significantly greater BSR, PSR, and SV and longer ST than healthy subjects. CONCLUSION: All of the sweating parameters were increased in palmar hyperhidrosis patients prior to surgery. Immediately after ETS, all these parameters were significantly reduced. At > 1 year after ETS, the BSR had increased to a level similar to that of the healthy volunteers, although PSR did not respond to mental stress.

Iodoform intoxication; a case report of prolonged consciousness disturbance in a patient with a high plasma iodine level.

This report describes a case in which a consciousness disturbance was associated with a high plasma iodine level and which improved after the removal of iodoform gauze that had been applied to infected wounds. A 71-year-old male with poorly controlled diabetes underwent a laminectomy for an epidural abscess. On the 6th and 8th postoperative days, he underwent debridement for fasciitis in the both arms and iodoform gauze was applied to the wounds (both arms and lumbar region) at the end of the first debridement and then changed every day. His consciousness then gradually deteriorated after the debridement. His plasma iodine level was measured and was shown to be remarkably high (6,280 microg/dl) 19 days after the laminectomy (13 days after the beginning of iodoform application). His consciousness recovered gradually with a concomitant decrease in the plasma iodine level. Three months after the removal of the iodoform he became almost alert. Caution should be exercised in using iodoform gauze because of the possibility that it could affect consciousness.

Primary palmar hyperhidrosis locus maps to 14q11.2-q13.

Primary palmar hyperhidrosis (PPH) is a unique disorder of unknown cause. It is characterized by excessive perspiration of the eccrine sweat gland in the palm, sole, and the axilla. It is presumed that PPH results from overactivation of the cholinergic sympathetic nerve or dysfunction of the autonomic nervous system. There have been no genetic studies on the disease. We performed a linkage analysis of 11 families including 42 affected and 40 unaffected members using genome-wide DNA polymorphic markers to identify the disease locus. Diagnosis of their PPH was made by direct inspection, interviewing and measurement of the sweating rate with perspirometer. Consequently, from data of three of the 11 families examined, the combined maximum two-point LOD scores of 3.08 and 3.16 (recombination fraction = 0) were obtained at the D14S283 and D14S264 loci, respectively, on chromosome 14q11.2-q13, under an assumption that two liability conditions depend on age. These regions were ruled out in eight other families. Haplotype analysis of the three families supported that one of the PPH locus is assigned at minimum to about a 6-cM interval between D14S1070 and D14S990 and at maximum to about a 30-cM interval between D14S1070 and D14S70. This is the first report of systemic mapping of the PPH locus.