电视胸腔镜手术治疗手汗症不同术式的选择

目的 回顾分析胸腔镜下不同术式治疗手汗症的远期疗效及术后代偿性多汗情况,供选择术式做参考.方法 对浙江省人民医院心胸外科自1995年7月至2008年8月接受电视胸腔镜双侧胸交感神经链部分切除术治疗手汗症的643例患者进行随访并分析,其中随访到498例(77.4%),按手术方式不同分为4组:A组:T2-4交感神经链切除82例;B组:T2交感神经链切断135例;C组:T2交感神经链夹闭41例;D组:T3-4交感神经链切除+旁路纤维(Kuntz纤维)切除240例.结果 4组患者均无手术死亡,手掌多汗症状治疗有效率达100%.4组代偿性多汗总体发生率分别为54.9%、48.1%、48.8%、28.8%,重度代偿性多汗发生率分别为9.8%、10.4%、9.8%、2.9%,D组与其他3组相比,无论是代偿性多汗总体发生率还是重度代偿性多汗发生率,差异均有统计学意义,D组明显低于其他3组,A、B、C 3组之间比较差异均无统计学意义.A、B、C、D 4组术后手汗症复发率分别为1.2%、2.2%、7.3%、0.8%,发现D组的手汗症术后复发率明显较C组低,差异有统计学意义(x2=8.423,P=0.004),其余互相之间的比较差异均无统计学意义.结论 胸腔镜下T3-4双侧交感神经链及旁路纤维切除术,是治疗手汗症、减少术后代偿性多汗并发症的良好选择.     

Aquagenic wrinkling of the palms in a cystic fibrosis carrier

A 16-year-old girl presented with a 3-year history of painful swelling and wrinkling of her palms on exposure to water. Physical examination, after less than 2 min of immersion, showed thickening and exaggerated wrinkling of the palms giving a whitish pebbly appearance. Aquagenic wrinkling of the palms was diagnosed. The patient was tested for the common cystic fibrosis mutations, and was found to be heterozygous for the arg117His cystic fibrosis mutation. Her sweat test was normal.     

止汗除湿散治疗高温湿热条件下局部多汗及其皮损的效果观察

 目的 观察自制外用止汗除湿散治疗高温湿热条件下局部多汗及皮损的临床疗效。方法 纳入某部官兵550例,按照足多汗、阴部多汗及足癣者分为3组,每组随机分为实验组和对照组,实验组使用附带止汗除湿散的对应生活用品,对照组使用普通的生活用品,连续使用2周,采用自创印录法测量多汗者汗液浸染面积,并对足癣者进行真菌镜检及培养。结果 实验组各组症状及测量指标与对照组相比明显改善,足多汗、足癣、阴部多汗组中实验组总有效率分别为83%、76%、86%,均明显高于对照组,差异均具有统计学意义(P＜0.05)。结论 止汗除湿散能有效地预防高温湿热条件下局部多汗及足癣。     

The evolution of botulinum neurotoxin type A for cosmetic applications

Very few pharmaceutical preparations share an evolutionary history as remarkable as that of botulinum neurotoxin (BoNT). The exotoxin of the organism Clostridium botulinum, once feared as a terrible poison, has been reborn as a highly regarded and widely used therapeutic and aesthetic agent. In less than two decades since the report of the success of BoNT type A (BoNTA) in reducing glabellar lines, injection of this product has become the most common non‐surgical cosmetic procedure performed in the USA and worldwide. In addition to temporarily eliminating rhytids by muscle weakening, other dermatologic applications of BoNTA include correcting facial asymmetries and treating hyperhidrosis. Although BOTOX is the most clinically substantiated and published of the BoNTA preparations, other BoNTA products, as well as a BoNT type B product, are available in some parts of the world, and others are in development.     

Depilatory laser: a potential causative factor for inguinal hyperhidrosis: Report of three cases

Abstract

Hyperhidrosis has recently been described as a novel adverse effect of laser-assisted hair removal in the axillary area. Inguinal Hyperhidrosis (IH) is a localized and, typically, a primary form of hyperhidrosis affecting the groin area in individuals before age 25. IH has been reported in the literature after traumas and as a dysfunction of the central sympathetic nervous system. To the best of our knowledge, IH has never been reported as secondary to laser-assisted hair removal. Herein, we report three cases of IH following depilatory laser of the inguinal zone.

Three female patients with no relevant medical history presented with the complaint of excessive sweating in the inguinal area after undergoing full bikini depilatory laser sessions.

Although never described before, depilatory laser seems to trigger the occurrence of hyperhidrosis in the inguinal zone.     

The relationship between initial closed reduction and the surgical reconstruction of the radiocarpal joint line in distal radial fractures

IntroductionWhilst initial closed reduction followed by definitive open fixation is widely applied in the treatment of distal radial fractures, the effect of the closed reduction on the reconstruction of the articular surface remains unclear. Our research questions were:

• (1)Does closed reduction followed by surgical fixation reconstruct palmar tilt and radial inclination?
• (2)Does closed reduction influence the surgically reconstructed palmar tilt and radial inclination?

MethodsPalmar tilt and radiocarpal inclination of 425 patients were measured at admission, following initial closed reduction and after surgical reconstruction.ResultsClosed reduction increased palmar tilt by 12.1° and radial inclination by 2.7°. Open surgical reduction further corrected palmar tilt by 17.88° and radial inclination by 3.5°. Whilst there was no association between postoperative palmar tilt and initially achieved closed reduction, a significant association between radial inclination following closed reduction and surgical fixation was found.ConclusionOur retrospective study challenges the existence of a relationship between the initial closed reduction and the reconstruction of the anatomic joint line in surgically treated distal radial fractures.     

No compensatory sweating after botulinum toxin treatment of palmar hyperhidrosis

BACKGROUND: Primary focal hyperhidrosis is caused by excessive secretion by eccrine sweat glands, usually at the palms, soles and axillae. The underlying mechanism is unclear. In recent years botulinum toxin A has emerged as a useful treatment. Compensatory sweating, which is a major problem in many patients who have undergone transthoracic endoscopic sympathectomy for hyperhidrosis, has only rarely been reported after botulinum toxin. However, this potential side-effect of botulinum toxin treatment has not been systematically examined. OBJECTIVES: To investigate if treatment with botulinum toxin A in hyperhidrotic hands may cause compensatory sweating at other skin locations. METHODS: In 17 patients with a history of palmar hyperhidrosis repeated measurements of evaporation were made before and up to 6 months after treatment of the hands with botulinum toxin A. Recordings were made at 16 skin areas and compared with subjective estimates of sweating. RESULTS: Following treatment, palmar evaporation decreased markedly and then returned slowly towards pretreatment values, but was still significantly reduced 6 months after treatment. No significant increase of sweating was found after treatment in any nontreated skin area. CONCLUSIONS: Successful treatment of palmar hyperhidrosis with botulinum toxin does not evoke compensatory hyperhidrosis in nontreated skin territories.     

A review of peripheral nerve blockade as local anaesthesia in the treatment of palmar hyperhidrosis

Injection of botulinum toxin type A (BTX-A) is an effective method of controlling palmar hyperhidrosis. It is, however, an uncomfortable procedure without adequate anaesthesia. We outline the techniques used, the reasons for them and potential pitfalls that can be avoided, with an outline of the neural anatomy relevant to the palmar injection of BTX-A. We have been using peripheral nerve blockade as local anaesthesia during BTX-A treatment of palmar hyperhidrosis for the last few years, and have found it an effective method of providing pain relief during the procedure, giving greater anaesthesia than that given by topical anaesthetic cream under occlusion and ice. It has been our experience that patients prefer wrist blockade to topical anaesthesia and ice when receiving BTX-A injections for treatment of palmar hyperhidrosis.     

Effect of botulinum toxin type A on quality of life measures in patients with excessive axillary sweating: a randomized controlled trial

BACKGROUND: Botulinum toxin type A (BTX-A) has been shown to be a safe and effective treatment for primary focal hyperhidrosis. However, the effect of BTX-A therapy on quality of life (QOL) in patients with this condition has only recently begun to be studied in controlled clinical trials. OBJECTIVES: To assess the impact on QOL of BTX-A treatment in patients with bilateral primary axillary hyperhidrosis. METHODS: A multicentre, randomized, double-blind, placebo-controlled trial enrolled 320 patients who exhibited persistent, bilateral, primary axillary hyperhidrosis sufficient to interfere with daily activities. These patients were treated with either 50 U BTX-A (Botox, Allergan, Inc., Irvine, CA, U.S.A.) or placebo in each axilla. QOL was assessed using the Hyperhidrosis Impact Questionnaire (HHIQ) at baseline and 1, 4, 8, 12 and 16 weeks post-treatment, as well as the Medical Outcomes Trust Short Form-12 Health Survey(SF-12) at baseline and 16 weeks post-treatment. RESULTS: At baseline, participants reported a marked negative impact of hyperhidrosis on various measures, including emotional status, ability to participate in daily and social activities, productivity at work and number of clothing changes per day. During the post-treatment period, statistically and clinically significantly greater improvements in all of these parameters were observed for the BTX-A group compared with the placebo group (P < 0.01). The BTX-A group improvements were observed within 1 week of treatment, and were sustained with little or no decline throughout the 16-week follow-up period. Compared with the baseline HHIQ responses regarding treatment history, BTX-A treatment resulted in a greater level of overall treatment satisfaction than did many other hyperhidrosis treatments. In addition, patients treated with BTX-A exhibited statistically significantly greater improvement in the physical component summary score of the SF-12 at 16 weeks than did placebo-treated patients (P < or = 0.019). CONCLUSIONS: Hyperhidrosis is associated with a substantial QOL burden; however, QOL is markedly improved with BTX-A treatment.