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Çınar HU, Çelik B. Does the Sweating Severity of Primary Hyperhidrosis Sites Affect Post-Sympathotomy Results? Thorac Cardiovasc Surg 2020; 70:159-166. [PMID: 33368108 DOI: 10.1055/s-0040-1716389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Improvement in quality of life (QOL) and patient satisfaction after endoscopic thoracic sympathotomy (ETS) in patients with primary hyperhidrosis may be affected by various factors. We examined whether the preoperative sweating severity of primary hyperhidrosis sites affects postoperative results. METHODS The records of 112 patients who underwent bilateral ETS were reviewed retrospectively. The patients were divided into three groups according to the sweating severity score obtained from all primary hyperhidrosis sites (primary hyperhidrosis severity score [PHSS]) and analyzed comparatively. Group A (PHSS = 1-4) included 22 patients, Group B (PHSS = 5-8) 36 patients, and Group C (PHSS ≥ 9) 54 patients. Outcome measures included QOL prior to surgery, improvement in QOL after surgery, degree of clinical improvement, presence, severity, localization, and site number of reflex sweating (RS) and general patient satisfaction after 6 months of surgery. RESULTS The preoperative QOL of patients with higher PHSS (groups B, C) was worse than other patients (group A). More than 91% of all patients had any level improvement in QOL, and over 96% had slight or great clinical improvement. RS developed in 80% of the patients, mostly in the back, very severe in 8%, and in median two different body areas. The overall patient satisfaction rate was more than 95%. There was no significant difference between the three groups in terms of all postoperative results. CONCLUSION Preoperative sweating severity of primary hyperhidrosis sites does not affect post-sympathotomy results. Surgeons should not be worried when deciding upon surgery, even in patients with high sweating severity.
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Affiliation(s)
- Hüseyín Ulaş Çınar
- Department of Thoracic Surgery, Medicana International Samsun Hospital, Samsun, Turkey
| | - Burçin Çelik
- Department of Thoracic Surgery, Ondokuz Mayis University Medical School, Samsun, Turkey
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Vasconcelos-Castro S, Soares-Oliveira M, Tuna T, Borges-Dias M. Thoracoscopic sympathotomy for palmar hyperhidrosis: How young is too young? J Pediatr Surg 2020; 55:2362-2365. [PMID: 31870560 DOI: 10.1016/j.jpedsurg.2019.11.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/15/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND/PURPOSE Primary hyperhidrosis affects 1%-3% of the general population, with increased incidence in teenagers, having an important impact in the quality of life. This study evaluates the efficacy and patients' satisfaction after bilateral thoracoscopic sympathotomy. METHODS Retrospective analysis of pediatric patients with palmar primary hyperhidrosis that underwent bilateral thoracoscopic sympathotomy over the last eight years. The procedure was performed with 2 ports and simple transection of the sympathetic chain. Pre and postoperative sweating severity was evaluated by telephone interview, using the Hyperhidrosis Disease Severity Scale (HDSS). RESULTS 23 patients (19 girls; 15.5 [11-19] years-old) underwent bilateral thoracoscopic sympathotomy. All complained of palmar hyperhidrosis, which resolved in all cases. Compensatory sweating occurred in 47.8% of patients. 21 patients answered the telephone interview: all of them would recommend the surgery to others. Sweating severity improved in all patients, with a mean decrease of 1.95 values of the HDSS from preoperative to postoperative evaluation (p < 0.05). There was neither morbidity nor mortality. CONCLUSIONS Bilateral thoracoscopic sympathotomy is a safe and effective treatment for primary palmar hyperhidrosis. Being the first report on pediatric application of HDSS, we conclude that children are very satisfied with the final outcome. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Miguel Soares-Oliveira
- Department of Pediatric Surgery, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Tiago Tuna
- Department of Pediatric Surgery, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Mariana Borges-Dias
- Department of Pediatric Surgery, Centro Hospitalar Universitário São João, Porto, Portugal
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3
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Over a decade of single-center experience with thoracoscopic sympathicolysis for primary palmar hyperhidrosis: a case series. Surg Endosc 2020; 35:3313-3319. [PMID: 32642844 PMCID: PMC8195767 DOI: 10.1007/s00464-020-07769-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/25/2020] [Indexed: 11/01/2022]
Abstract
BACKGROUND Primary palmar hyperhidrosis is a severely debilitating condition that can affect patients of any age. We report our experience with thoracoscopic sympathicolysis in a large cohort of children less than 14 years of age. METHODS All children who underwent thoracoscopic sympathicolysis from April 2005 through January 2017 were evaluated retrospectively. The procedure entailed bilateral bipolar fulguration of the second and third thoracic ganglia with transverse disruption of collateral nerve fibers along the third and fourth rib. Demographic information, as well as postoperative outcome, complications, and satisfaction were analyzed. RESULTS Over the 12 year study interval, a total of 102 children underwent thoracoscopic sympathicolysis for palmar hyperhidrosis. Complete follow-up was available for 98 patients (median age 12 [range 5-14] years; 38 boys [39%]). Median follow-up was 4 [range 2-12] years. Complete palmar dryness was achieved in 93 (95%) cases. One patient suffered postoperative unilateral ptosis, 6 reported gustatory sweating, and 65 experienced compensatory sweating. Average postoperative rating on a 1 (lowest) to 10 (highest) rating scale was 9, with 97 (99%) patients saying that they would undergo the procedure again. CONCLUSION Our technique of thoracoscopic sympathicolysis in children was associated with very high postoperative satisfaction, despite a high rate of compensatory sweating and occasional autonomic gustatory sweating. Other more severe complications in this age group were rare.
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Nicolini EM, Costa VDO, Montessi J, Rodrigues GDA, Cangussu VV, Reis AFM, Marques Filho FV. Video-assisted thoracic sympathectomy: literature review. Rev Col Bras Cir 2019; 46:e2157. [PMID: 31141034 DOI: 10.1590/0100-6991e-20192157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/12/2019] [Indexed: 11/22/2022] Open
Abstract
Thoracic sympathectomy has been effective in relieving hyperhidrosis in several patients, with quality of life improvement. The knowledge of the clinical picture of each patient, as well as the possible postoperative complications, are fundamental to obtain good results. Thus, we performed a review of articles from the PubMed database published between 2005 and 2019 that presented, as the main topic, thoracoscopy sympathectomy for the treatment of hyperhidrosis, with the objective of evaluating the current state of art referring to postoperative quality of life, surgical time and its complications. From this analysis, we verified the importance of the level of sympathetic ganglion chain section in relation to results. The complication, although occurring, did not reduced the postoperative level of satisfaction or patients' quality of life.
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Affiliation(s)
- Eveline Montessi Nicolini
- Hospital e Maternidade Therezinha de Jesus, Serviço de Cirurgia Torácica, Juiz de Fora, MG, Brasil.,Hospital Monte Sinai, Serviço de Cirurgia Torácica, Juiz de Fora, MG, Brasil
| | - Víctor de Oliveira Costa
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Curso de Medicina, Juiz de Fora, MG, Brasil
| | - Jorge Montessi
- Hospital e Maternidade Therezinha de Jesus, Serviço de Cirurgia Torácica, Juiz de Fora, MG, Brasil.,Hospital Monte Sinai, Serviço de Cirurgia Torácica, Juiz de Fora, MG, Brasil
| | - Guilherme de Abreu Rodrigues
- Hospital e Maternidade Therezinha de Jesus, Serviço de Cirurgia Torácica, Juiz de Fora, MG, Brasil.,Hospital Monte Sinai, Serviço de Cirurgia Torácica, Juiz de Fora, MG, Brasil
| | | | - Ana Flávia Miranda Reis
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Curso de Medicina, Juiz de Fora, MG, Brasil
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Wade R, Rice S, Llewellyn A, Moloney E, Jones-Diette J, Stoniute J, Wright K, Layton AM, Levell NJ, Stansby G, Craig D, Woolacott N. Interventions for hyperhidrosis in secondary care: a systematic review and value-of-information analysis. Health Technol Assess 2019; 21:1-280. [PMID: 29271741 DOI: 10.3310/hta21800] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hyperhidrosis is uncontrollable excessive sweating that occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. The management of hyperhidrosis is uncertain and variable. OBJECTIVE To establish the expected value of undertaking additional research to determine the most effective interventions for the management of refractory primary hyperhidrosis in secondary care. METHODS A systematic review and economic model, including a value-of-information (VOI) analysis. Treatments to be prescribed by dermatologists and minor surgical treatments for hyperhidrosis of the hands, feet and axillae were reviewed; as endoscopic thoracic sympathectomy (ETS) is incontestably an end-of-line treatment, it was not reviewed further. Fifteen databases (e.g. CENTRAL, PubMed and PsycINFO), conference proceedings and trial registers were searched from inception to July 2016. Systematic review methods were followed. Pairwise meta-analyses were conducted for comparisons between botulinum toxin (BTX) injections and placebo for axillary hyperhidrosis, but otherwise, owing to evidence limitations, data were synthesised narratively. A decision-analytic model assessed the cost-effectiveness and VOI of five treatments (iontophoresis, medication, BTX, curettage, ETS) in 64 different sequences for axillary hyperhidrosis only. RESULTS AND CONCLUSIONS Fifty studies were included in the effectiveness review: 32 randomised controlled trials (RCTs), 17 non-RCTs and one large prospective case series. Most studies were small, rated as having a high risk of bias and poorly reported. The interventions assessed in the review were iontophoresis, BTX, anticholinergic medications, curettage and newer energy-based technologies that damage the sweat gland (e.g. laser, microwave). There is moderate-quality evidence of a large statistically significant effect of BTX on axillary hyperhidrosis symptoms, compared with placebo. There was weak but consistent evidence for iontophoresis for palmar hyperhidrosis. Evidence for other interventions was of low or very low quality. For axillary hyperhidrosis cost-effectiveness results indicated that iontophoresis, BTX, medication, curettage and ETS was the most cost-effective sequence (probability 0.8), with an incremental cost-effectiveness ratio of £9304 per quality-adjusted life-year. Uncertainty associated with study bias was not reflected in the economic results. Patients and clinicians attending an end-of-project workshop were satisfied with the sequence of treatments for axillary hyperhidrosis identified as being cost-effective. All patient advisors considered that the Hyperhidrosis Quality of Life Index was superior to other tools commonly used in hyperhidrosis research for assessing quality of life. LIMITATIONS The evidence for the clinical effectiveness and safety of second-line treatments for primary hyperhidrosis is limited. This meant that there was insufficient evidence to draw conclusions for most interventions assessed and the cost-effectiveness analysis was restricted to hyperhidrosis of the axilla. FUTURE WORK Based on anecdotal evidence and inference from evidence for the axillae, participants agreed that a trial of BTX (with anaesthesia) compared with iontophoresis for palmar hyperhidrosis would be most useful. The VOI analysis indicates that further research into the effectiveness of existing medications might be worthwhile, but it is unclear that such trials are of clinical importance. Research that established a robust estimate of the annual incidence of axillary hyperhidrosis in the UK population would reduce the uncertainty in future VOI analyses. STUDY REGISTRATION This study is registered as PROSPERO CRD42015027803. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Ros Wade
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Stephen Rice
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Alexis Llewellyn
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Eoin Moloney
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Julija Stoniute
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Nick J Levell
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Gerard Stansby
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Dawn Craig
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nerys Woolacott
- Centre for Reviews and Dissemination, University of York, York, UK
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6
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Bernhard MK, Krause M, Syrbe S. Sweaty feet in adolescents-Early use of botulinum type A toxin in juvenile plantar hyperhidrosis. Pediatr Dermatol 2018; 35:784-786. [PMID: 30178509 DOI: 10.1111/pde.13628] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Plantar hyperhidrosis can have severe social effects on children and adolescents. Therapeutic options include antiperspirants and surgical interventions (eg, sympathectomy). Botulinum type A toxin is approved for axillary hyperhidrosis in adults only. The aim of the study was the determination of effect and safety of botulinum type A toxin in plantar hyperhidrosis in juvenile patients. METHODS Children and adolescents with idiopathic focal plantar hyperhidrosis were treated with 50-100 U of botulinum type A toxin per sole. Local anesthesia was provided using topical eutectic mixture of local anesthetics cream and ice, in combination with midazolam as an anxiolytic. RESULTS Fifteen patients (aged 12-17) were included in the study. Best results were achieved with a dose of 75-100 U of botulinum type A toxin per sole. Two patients did not benefit from the therapy, and 11 (73%) were satisfied with the results. Nine patients (60%) experienced pain at the injection site for a maximum duration of 3 days. One patient reported transient focal weakness for 4 weeks. CONCLUSION Botulinum type A toxin seems to be a safe secondary treatment option for plantar hyperhidrosis in adolescents aged 12 and older. A dose of 75-100 U per sole resulted in a good therapeutic effect of variable duration in most patients. There were no severe side effects.
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Affiliation(s)
- Matthias K Bernhard
- Department of Neuropediatrics, University Hospital of Children, Leipzig, Germany
| | - Matthias Krause
- Department of Neurosurgery, University Leipzig, Leipzig, Germany
| | - Steffen Syrbe
- Hospital for Children and Adolescents, University of Heidelberg, Heidelberg, Germany
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Leiderman DBD, Milanez de Campos JR, Kauffman P, Tedde ML, Yazbek G, Teivelis MP, Wolosker N. The relation between age and outcomes of thoracic sympathectomy for hyperhidrosis: The older the better. J Thorac Cardiovasc Surg 2018; 156:1748-1756. [PMID: 30054140 DOI: 10.1016/j.jtcvs.2018.05.084] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 05/07/2018] [Accepted: 05/09/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Several factors may potentially influence the efficacy and patient satisfaction after bilateral thoracic sympathectomy as the treatment for hyperhidrosis, but few studies have specifically analyzed the impact of age on the efficacy of this treatment, the occurrence of compensatory hyperhidrosis (CH), and variations in the quality of life. METHODS We retrospectively analyzed the effect of age, body mass index, surgical techniques, quality of life before surgery, betterment in the quality of life after surgery, clinical improvement in sweating at the main site, and the occurrence and intensity of CH in patients with hyperhidrosis (n = 1633) who underwent bilateral sympathectomy. RESULTS Quality of life improved in more than 90% of patients, and severe CH occurred in 5.4%. Age did not affect these outcomes. The older, the greater reduction in sweating, and CH was linked to other variables (body mass index, craniofacial hyperhidrosis, and level of resection). CONCLUSIONS We observed that patients with old age reported an improvement in sweating in the main site of hyperhidrosis. Sympathectomy outcomes in older patients are similar to those observed in younger patients in terms of quality of life improvement and occurrence of CH.
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Affiliation(s)
| | - Jose Ribas Milanez de Campos
- Division of Thoracic Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil; Thoracic Surgery Division, Department of Surgery, University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
| | - Paulo Kauffman
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil; Vascular and Endovascular Division, Department of Surgery, University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
| | - Miguel Lia Tedde
- Thoracic Surgery Division, Department of Surgery, University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
| | - Guilherme Yazbek
- Department of Vascular and Endovascular Surgery, A.C. Camargo Cancer Center, Fundação Antônio Prudente, São Paulo, São Paulo, Brazil
| | - Marcelo Passos Teivelis
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Nelson Wolosker
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil; Vascular and Endovascular Division, Department of Surgery, University of São Paulo School of Medicine, São Paulo, São Paulo, Brazil
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8
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Estevan FA, Wolosker MB, Wolosker N, Puech-Leão P. Epidemiologic analysis of prevalence of the hyperhidrosis. An Bras Dermatol 2018; 92:630-634. [PMID: 29166497 PMCID: PMC5674693 DOI: 10.1590/abd1806-4841.20175551] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 07/10/2016] [Indexed: 11/21/2022] Open
Abstract
Background The present paper aims to study the prevalence of the various manifestations
of hyperhidrosis in patients who sought treatment in a specialized
ambulatory in the state of São Paulo. Objectives Opposite to previous studies, this paper studies the different combinations
of sweating sites, not being restricted to the main complaint site of the
patients, but taking into consideration secondary complaints patients may
present. Methods This was a retrospective approach of a database containing more than 1200
patients in which were mapped: combination of sweating sites, age of onset,
age spectrum, mean age, body mass index and gender of patients. Patients
were categorized into four groups based on their main sweating site -
palmar, plantar, axillary and facial. Results We concluded that hyperhidrosis appears frequently in more than one site,
being the main complaint that affects the most patients palmar
hyperhidrosis, which appears early in the patients during adolescence. When
there are two sites of sweating, the most frequent combination is palmar +
plantar, and when there are three sites of sweating the most frequent
combinations are palmar + plantar + axillary and axillary + palmar +
plantar. Study limitations This research has casuistics limited to a single care service for patients
with hyperhidrosis. Conclusion It is necessary to keep in mind that the disease manifests itself mainly in
more than one location, with different intensities in each of the patients,
generating a significant impairment of their quality of life.
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Affiliation(s)
| | - Marina Borri Wolosker
- School of Medicine of the Universidade de São Paulo (FMUSP) - São Paulo (SP), Brazil
| | - Nelson Wolosker
- Department of Surgery - Division of Vascular and Endovascular Surgery of the Clinics Hospital of the School of Medicine of the Universidade de São Paulo (HCFMUSP) - São Paulo (SP), Brazil.,Department of Vascular and Endovascular Surgery of the Hospital Israelita Albert Einstein - São Paulo (SP), Brazil
| | - Pedro Puech-Leão
- Department of Surgery - Division of Vascular and Endovascular Surgery of the Clinics Hospital of the School of Medicine of the Universidade de São Paulo (HCFMUSP) - São Paulo (SP), Brazil
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9
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Lembrança L, Wolosker N, de Campos JRM, Kauffman P, Teivelis MP, Puech-Leão P. Videothoracoscopic Sympathectomy Results after Oxybutynin Chloride Treatment Failure. Ann Vasc Surg 2017; 43:283-287. [PMID: 28478174 DOI: 10.1016/j.avsg.2017.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/21/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Videothoracoscopy sympathectomy (VATS) is the only definitive treatment for primary hyperhidrosis (HH). Since 2007, in our institution, patients with HH were initially treated with oxybutynin chloride to avoid VATS and reduce compensatory hyperhidrosis incidence with good results. The aim of this study was to analyze the surgical response of patients suffering from essential hyperhidrosis after failure of oxybutynin chloride treatment. METHODS This was an observational retrospective study that included 737 patients who were diagnosed with palmar or axillary hyperhidrosis and received VATS from January 2007 to January 2014. Patients were selected for 2 different groups: The post-oxybutynin surgery group consisted of 167 patients that were initially treated with oxybutynin chloride for 6 weeks and then received VATS after drug treatment failure. The primary surgery group consisted of a historic control group of 570 patients who were referred directly to surgical treatment. We evaluated the degree of improvement in symptoms 30 days after surgery and quality of life before and after the surgical treatment. RESULTS All patients showed poor or very poor quality of life before surgery. Most patients showed a response between moderate and high after surgical treatment. However, those in primary surgery group responded better (95.1% vs. 98.2%). In the quality of life after surgery, most of the patients reported improvement, and the primary surgery group had better improvement (92.2% vs. 95.1%). CONCLUSIONS VATS showed good results in patients with palmar or axillary hyperhidrosis regarding surgical response and improvement on quality of life even when the previous oxybutynin chloride treatment failed.
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Affiliation(s)
| | | | | | - Paulo Kauffman
- Department of Thoracic Surgery, University of São Paulo, São Paulo, Brazil
| | | | - Pedro Puech-Leão
- Department of Vascular Surgery, University of São Paulo, São Paulo, Brazil
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10
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Abstract
By the 1980s, endoscopy was in use by some groups in sympathetic denervation of the upper limbs with vascular indications. Low morbidity, cosmetic results, reduction in the incidence of Horner syndrome, and the shortened time in hospital made video-assisted thoracic sympathectomy (VATS) better accepted by those undergoing treatment for hyperhidrosis. Over the last 25 years, this surgical procedure has become routine in the treatment of hyperhidrosis, leading to a significant increase in the number of papers on the subject in the literature.
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11
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Up-to-date Treatments of Primary Hyperhidrosis with Focus on Sympathectomy and Sympathicotomy; A Narrative Review. HOSPITAL PRACTICES AND RESEARCH 2016. [DOI: 10.20286/hpr-01013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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12
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Wolosker N, Teivelis MP, Krutman M, de Paula RP, Schvartsman C, Kauffman P, de Campos JRM, Puech-Leão P. Long-Term Efficacy of Oxybutynin for Palmar and Plantar Hyperhidrosis in Children Younger than 14 Years. Pediatr Dermatol 2015; 32:663-7. [PMID: 25490865 DOI: 10.1111/pde.12385] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Oxybutynin for treating hyperhidrosis in children has been evaluated only in short-term studies. We aimed to investigate the long-term effects of oxybutynin in treating children with palmar and plantar hyperhidrosis who had not undergone surgery and who were monitored for at least 6 months (median 19.6 mos). A cohort of 97 patients was evaluated retrospectively, with particular attention to 59 children (ages 4-14 yrs) who were treated for longer than 6 months. Their quality of life (QOL) was evaluated using a validated clinical questionnaire before and after 6 weeks of pharmacologic therapy. A self-assessment of hyperhidrosis was performed after 6 weeks and after the last consultation. By their final office visit, more than 91% of the children with hyperhidrosis treated with oxybutynin experienced moderate or great improvement in their level of sweating and 94.9% experienced improvement in QOL. More than 90% of children reported improvement of hyperhidrosis at other sites. Dry mouth was the most common side effect. Oxybutynin appears to be an effective treatment option for children with hyperhidrosis, and positive results are maintained over the long term (median 19.6 mos).
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Affiliation(s)
- Nelson Wolosker
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.,Vascular and Endovascular Division, Department of Surgery, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Marcelo P Teivelis
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Mariana Krutman
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Rafael P de Paula
- Hospital das Clínicas, University of São Paulo, São Paulo, SP, Brazil
| | - Claudio Schvartsman
- Division of Pediatrics, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Paulo Kauffman
- Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - José R M de Campos
- Hospital das Clínicas, University of São Paulo, São Paulo, SP, Brazil.,Division of Thoracic Surgery, Hospital das Clinicas, University of São Paulo and Division of Thoracic Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Pedro Puech-Leão
- Vascular and Endovascular Division, Department of Surgery, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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14
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Wolosker N, Schvartsman C, Krutman M, Campbell TPDA, Kauffman P, de Campos JRM, Puech-Leão P. Efficacy and quality of life outcomes of oxybutynin for treating palmar hyperhidrosis in children younger than 14 years old. Pediatr Dermatol 2014; 31:48-53. [PMID: 23627681 DOI: 10.1111/pde.12142] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The effects of oxybutynin for treating hyperhidrosis in children are still unknown. Therefore the aim of this study was to investigate the effects of oxybutynin on improving symptoms of hyperhidrosis and quality of life (QOL) in children with palmar hyperhidrosis (PH). Forty-five children ages 7-14 years with PH were evaluated 6 weeks after protocol treatment with oxybutynin. QOL was evaluated before and after treatment using a validated clinical questionnaire. More than 85% of the children with PH treated with oxybutynin experienced moderate or greater improvement in the level of sweating and 80% experienced improvement in QOL. Children who initially presented with very poor QOL were those who benefited most from oxybutynin therapy. Side effects occurred in 25 children (55.5%) and were mainly dry mouth. Only one patient had neurologic symptoms, which was reported as drowsiness. Oxybutynin is an effective treatment option for children with PH because it improves clinical symptoms and QOL. Further studies are required to determine the long-term outcomes of treatment with oxybutynin.
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Affiliation(s)
- Nelson Wolosker
- Division of Vascular Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil; Department of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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