Essential Hyperhidrosis Cured by Sympathetic Ganglionectomy and Trunk Resection

Human sweating response to electrophoresed acetylcholine: a test of postganglionic sympathetic function.

“…It occurs even in areas which show thermal anhidrosis due to spinal cord lesion (List and Peet, 1938b) or preganglionic sympathectomy (Hyndman andWolkin, 1941: Netsky, 1948). Procaine block or recent section of a peripheral nerve does not abolish this type of sweating (List and Peet, 1938b, c), but one to eight weeks after , , peripheral nerve section the sweating response is absent or very slight (Adson, Craig, and Brown, 1935;List and Peet, 1938 b;Hyndman and Wolkin, 1941). The local sweating response to deep intradermal injection of parasympathomimetic drugs changes similarly.…”

“…The concentration of acetylcholine or mecholyl required to provoke local sweating is little changed by preganglionic sym-1 2 4 MORE pathectomy or procaine nerve block (Gurney and Bunnell, 1942;Chalmers, 1950) but is absent or very slight in two to 62 days after postganglionic sympathectomy (Kahn and Rothman, 1942; 'hold dose for local Janowitz and Grossman, 1950) and after ulnar e, 197 observations nerve section (Chalmers and Keele, 1952;Silver, Versuci, and Montagna, 1963). The denervated sweat glands are histologically normal (Adson et al, 1935;Lofgren, 1950), except that there is disappearance of nearby acetylcholine-esterase ring four months (Silver et al, 1963). iowed complete Disadvantages of injecting acetylcholine or :h was examined mecholyl subcutaneously or intradermally as a test and legs they of postganglionic function are that sweating does horesis of to not always occur in normal subjects (List and Peet, ionse which falls 1938b, c;Chalmers andKeele, 1951, 1952) and that 2).…”

Treatment of Hyperidrosis

“…On the other hand, section of the sympathetic pathway to the affected part provides a safe and certain cure. This procedure cuts off all sudomotor activity and results in an immediate and profound dryness of the skin in the distribution of the divided fibres.Previous reports (Adson, Craig, and Brown, 1935;Telford, 1938;White, 1939) have shown that hyperidrosis can be abolished by such operations, but the follow-up periods were short. (Out of five cases in each of the series by Adson et al and by White only one was seen more than twelve months after operation, and out of three cases reported by Telford only one had been followed up for a prolonged period.)…”

“…Previous reports (Adson, Craig, and Brown, 1935;Telford, 1938;White, 1939) have shown that hyperidrosis can be abolished by such operations, but the follow-up periods were short. (Out of five cases in each of the series by Adson et al and by White only one was seen more than twelve months after operation, and out of three cases reported by Telford only one had been followed up for a prolonged period.)…”

Chemical Sympathectomy

“…Reviews of large numbers of cases (Telford, 1944;Haxton, 1947a) have established the value of this treatment for a greater variety of circulatory disorders than is generally appreciated, and much discomfort and suffering can be relieved by its application. In addition to its beneficial effects in arteriosclerosis, thrombo-angiitis obliterans, erythrocyanosis, poliomyelitis, Raynaud's disease, perniosis, and erythromelalgia, sympathectomy has been found to effect a prolonged and apparently permanent cure of hyperidrosis (Adson, Craig, and Brown, 1935 ;Telford, 1938White, 1939Haxton, 1948). But to achieve such benefits one or more open operations of a major character are required, and although the mortality rate is very small in expert hands (Telford, 1944) the treatment entails a good deal of -discomfort and a convalescence of several weeks at least.…”