Suction–curettage with combination of two different cannulae in the treatment of axillary osmidrosis and hyperhidrosis

Objective  To investigate the efficacy and safety of suction–curettage with a combination of two different cannulae for treatment of axillary osmidrosis and hyperhidrosis.
Design  Retrospective analysis of patients who underwent surgery from September 2004 to September 2006.
Setting  Outpatient clinic for hyperhidrosis at a university-affiliated hospital.
Subjects  Sixty-five patients who were treated for axillary malodor and hyperhidrosis.
Interventions  Patients were sequentially treated with Fatemi and Cassio cannulae.
Main outcome measures  Demographic data, severity data (assessment of malodor), degree of satisfaction, sweating, hair growth, scarring, recurrence and complications.
Results  Sixty of the 65 patients (96.9%) had excellent to fair results, and only 2 patients (3.1%) had poor results. Complications occurred in 4 patients (6.2%). Recurrence occurred in 3 patients (4.6%).
Conclusions  This simplified and inexpensive method resulted in a high success rate with low complications and high satisfaction with minimal scarring and rapid recovery.     

Sensitivity, Specificity and Predictive Value of Intra-Operative Elevation of Hand Temperature to Ensure a Successful T2-Sympathectomy in Patients with Palmar Hyperhidrosis

Summary  To appraise the validity, intra-operative elevation of hand temperature ensuring a successful T2-sympathectomy, we conducted a randomized, self-compared, case-control study on 40 consecutive patients with palmar hyperhidrosis. All patients had a postoperative follow-up of at least 18 months without recurrence. During operation, dynamic temperature changes on their thenar eminence of both the surgically treated and non-surgically treated hands were simultaneously measured just before (baseline) and after completion of T2-sympathectomy, and again 5 and 10 minutes later. An elevation of the temperature by at least 0.5°C from the baseline temperature was recognized as an “elevated” temperature. The relationship between sensitivity and specificity of temperature changes was compared using receiver operator characteristic (ROC) analysis. Sensitivity was defined as the proportion of temperature-elevating procedures in the group of operated hands. As a whole, post-sympathectomy elevation of hand temperature is a useful, but not an ideal, indicator for assuring a successful T2-sympathectomy due to its low sensitivity. At the 5-minute point, if the hand temperature was elevated by 1°C, its sensitivity, specificity and positive predictive value were 40%, 80% and 66.7%. In comparison, a 2°C elevation at the 10-minute point had a sensitivity, specificity and positive predictive value of 30%, 90% and 75% (p<0.05). We suggest that correct localization of the T2 ganglion followed by adequate ablation should be the prerequisite for use of this monitoring system.     

Compensatory hyperhidrosis: a consequence of truncal sympathectomy treated by video assisted application of botulinum toxin and reoperation

Hyperhidrosis is a debilitating condition characterised by sweating that exceeds the need of normal thermoregulation. Surgical management of primary hyperhidrosis by upper dorsal sympathectomy is the treatment of choice for intractable hyperhidrosis, however, paradoxically it may be followed by troublesome compensatory hyperhidrosis in a significant number of patients. The frequency of compensatory hyperhidrosis often reflects the extensiveness of the denervation. We report for the first time the successful treatment of a patient who developed compensatory hyperhidrosis following sympathectomy using video assisted extension of the sympathectomy by application of botulinum toxin (BTX-A). In addition, this case highlights the use of botulinum toxin as a guide for the potential successful management of compensatory hyperhidrosis prior to definitive extension of a sympathectomy.     

Intrarater and interrater reliability of a hand-held dynamometric technique to quantify palmar thumb abduction strength in individuals with and without carpal tunnel syndrome

Study Design

Clinical measurement.

Plasma catecholamine concentrations in essential hyperhidrosis and effects of thoracoscopic D2–D3 sympathicolysis

Essential hyperhidrosis (EH) is caused by a poorly understood overactivity of the sympathetic fibres passing through the upper dorsal sympathetic ganglia D₂ and D₃. These ganglia are also in the pathway of the sympathetic innervation of the heart and lungs. Therefore, although the predominant sympathetic neurotransmitter at the eccrine sweat glands is acetylcholine, the plasma concentration of noradrenaline (NA) (which is the main sympathetic neurotransmitter at the end organs including the heart and the lungs) may be elevated. Furthermore, as there are some indications for generalized sympathetic overactivity in EH, the plasma concentration of adrenaline (A) may also be elevated. Plasma levels of NA and A were therefore determined in 13 EH patients before and after thoracoscopic D₂–D₃ sympathicolysis (TS). Preoperative NA and A plasma levels were all within the normal limits used in our laboratory. After TS, mean NA plasma levels are significantly decreased, whereas mean A are unchanged. We conclude that sympathetic overactivity in EH is limited to the upper dorsal sympathetic ganglia and that some of the cardiovascular and pulmonary effects that are observed after TS may be associated with the decrease in NA.     

Presence of Pig IgG and IgM in Sera Samples From Baboons After an Orthotopic Liver Xenotransplantation

Introduction

The immunorejection in xenotransplantation has mostly been studied from the host's immune system activation point of view and there is very little information about the graft-vs-host reaction.

计算机辅助下胸交感神经阻滞治疗手汗症

目的：观察利用计算机辅助下胸交感神经阻滞治疗手汗症的效果。方法：对6例原发性手多汗症患者,术前行CT扫描,应用Mimics软件对患者进行三维重建,设计手术路径,根据设计方案完成手术。结果：术前的模拟手术使手术时间明显缩短,减少了术中气胸和出血概率。6例患者均获得了良好效果。结论：计算机辅助下胸交感神经阻滞治疗手汗症可以在临床中推广应用,并发症减少,手术时间缩短,手术的精确度提高。     

大鼠前肢足垫皮肤交感神经HRP逆行示踪研究

目的研究支配大鼠前肢足垫皮肤的交感节后神经元在交感神经链内的定位。方法选择15只正常大鼠,左侧为实验组,右侧为对照组。30%HRP10μL注入左侧前肢足垫皮下,右侧注射10μL生理盐水作为对照。60～72h后切除两侧的交感神经节,连续冰冻切片,按TMB法呈色反应。结果 15例大鼠共找到3150个标记细胞,分别为同侧颈中神经节741个(23.5%)、颈胸神经节2297个(72.9%)、T3神经节88个(2.8%)、T4神经节21个(0.7%)、T5神经节3个(0.1%),其分布的差异有统计学意义(P<0.05)。结论支配大鼠前肢足垫皮肤的交感节后神经元主要位于颈中神经节、颈胸神经节、T3神经节。治疗手汗症没有必要行交感神经节切除术,低位切断交感神经干可以减少术后代偿性多汗。