Palmar hyperhidrosis. Long-term results following high thoracic sympathectomy

Fourteen men and 22 wemon, with an average of 23 years (range 14-36 years) were operated on for hyperhidrosis of the upper extremity during the period from 1955 to 1970. Twenty-eight had had symptoms for more than 10 years. Resection of the 2nd and 3rd thoracic ganglia and the connecting sympathetic chain was carried out using a posterior approach; in 33 cases the operation was bilateral, and in three unilateral. Thirty-five patients were followed up after an average of 7.8 years (range 2-17 years). In one patient unilateral reoperation was carried out four months after the first operation. Since the first operation 34 patients had suffered from neither palmar nor axillary sweating. However 20 had permanent compensatory hyperhidrosis, and 15 suffered from gustatory facial sweating, which had usually started within six months of operation. Four, in whom two spinal thoracic nerves had also been resected, reported marked dysaesthesia over the front of the chest and in the axilla, lasting for several years.

Warning signs in intracranial aneurysms

Warning signs preceding major hemorrhage were analyzed in 192 patients with intracranial aneurysms. One hundred and thirteen (59 percent) had warning signs. The average interval between the last warning signs and the major attacks was 16.9 ddays with anterior communicating and anterior cerebral aneurysms, 6 days with middle cerebral aneurysms, and 7.3 days with intradural internal carotid aneurysms. The incidence was much higher in aneurysms (69 percent) and with location of the aneurysms. Early recognition of warning signs may protect patients from the devasting effects of major hemmorhage.

Unilateral facial hyperhidrosis

Two patients with unilateral facial hyperhidrosis, a rare disorder of the sweat glands, are described. Employing thermal and carbachol stimulation tests, the functional status of sweat glands on the affected sites were studied. A marked increase in sweat gland activity was noted on the affected areas as compared to the contralateral normal sites. The histological examination of the affected skin revealed considerable enlargement of the sweat glands with dilatation of the sweat ducts and an intense mononuclear infiltrate in the periductal area. The epidermis, at places, showed spongiform vesiculation invaded by an identical inflammatory infiltrate. The striking histological resemblance of this condition to the dyshidrotic eruption commonly encountered on the hands and the feet is stressed.

Genetic heterogeneity in hyperkeratosis palmaris et plantaris

More than one form of 'simple' hyperkeratosis palmaris et plantaris (tylosis) probably exists. Two unrelated patients showing hyperkeratosis of relatively late onset have been found who developed esophageal carcinoma, while previously reported families with dominantly inherited esophageal cancer and with esophageal stricture, also showed late onset of hyperkeratosis. In contrast the more usual families with onset of hyperkeratosis in the first six months of life show no association with esophageal or other disease.