Sequelae of endoscopic sympathetic block

Schick, Christoph; Horbach, Thomas

doi:10.1007/s10286-003-1111-5

Cited by 10 publications

(7 citation statements)

References 36 publications

(29 reference statements)

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“…25,69 Because sympathetic cardiac accelerator fibers exit the spinal cord from segments T1 to T4, ETS is believed to simulate a mild physiological β-adrenergic blockade. 70 This is because the heart rate at rest and during maximal exercise is lower 6 weeks postoperatively, 69,71 but exercise capacity is not affected. As for pulmonary sympathetic denervation, no significant detrimental effect on pulmonary function has been shown in children and adults.…”

Section: Sympathetic Denervationmentioning

confidence: 99%

Hyperhidrosis: Evolving Therapies for a Well-Established Phenomenon

Eisenach

Atkinson²,

Fealey³

2005

Mayo Clinic Proceedings

166

123

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The socially embarrassing disorder of excessive sweating, or hyperhidrosis, and its treatment options are gaining widespread attention. In order of frequency, palmar-plantar, palmar-axillary, Isolated axillary, and cranlofacial hyperhidrosis are distinct disorders of sudomotor regulation. A common link among these disorders is an excessive, nonthermoregulatory sweat response often to emotional stimuli in body regions influenced by the anterior cingulate cortex as opposed to the thermoregulatory sweat response regulated by the preoptic-anterior hypothalamus. Diagnosis of these mechanistically ambiguous disorders is primarily from patient history and physical examination, whereas results of laboratory studies performed with indicator powder reveal the distribution and severity of resting hyperhidrosis and document the integrity of thermoregulatory sweating. Treatment options lie on a continuum based on the severity of hyperhidrosis and the risks and benefits of therapy. In general, therapy begins with antiperspirants or anticholinergics. Iontophoresis is available for palmar-plantar and axillary hyperhidrosis. Botulinum toxin type A or local excision/curettage is effective for isolated axillary hyperhidrosis not responsive to topical application of aluminum chloride. Endoscopic thoracic sympathectomy may be used for severe cases of palmar-plantar and palmar-axillary hyperhidrosis. No sole therapy of choice has emerged for craniofacial sweating. The long-term sequelae of hyperhidrosis and its treatment also are discussed.

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Section: Sympathetic Denervationmentioning

confidence: 99%

Hyperhidrosis: Evolving Therapies for a Well-Established Phenomenon

Eisenach

Atkinson²,

Fealey³

2005

Mayo Clinic Proceedings

166

123

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“…27 Other authors reported CS ranging between 44% and 86% after ESB at different levels ranging between T1 and T4. 28 In another study, clipping of the upper part of the T4 ganglion resulted in 87.5% of patients exhibiting CS. 29 According to Reisfeld et al, 3 these numbers are of minor interest because the percentage of patients with severe CS is of major importance.…”

Section: Commentmentioning

confidence: 95%

Effect of Endoscopic Thoracic Sympathetic Block on Plantar Hyperhidrosis

Neumayer

Panhofer²,

Zacherl³

et al. 2005

Arch Surg

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Hypothesis: Endoscopic thoracic sympathetic block at T4 (ESB4) provides excellent results in patients with primary hyperhidrosis (HH) of the upper limb. Most patients have combined palmo-plantar or palmo-axillaryplantar HH. This study evaluates the clinical outcome of patients with upper limb HH with special emphasis on plantar sweating and patients' quality of life. Design: Review of a prospectively gathered database. Setting: Tertiary care university teaching hospital. Patients: The cohort included 73 patients (50 women and 23 men; mean age, 30.2 years). Twenty-six patients had palmar; 3, isolated axillary; and 44, combined HH. Sixty-six patients (90.4%) had concomitant plantar HH. Interventions: One hundred forty-five operations were performed by applying one 5-mm clip above and below the fourth sympathetic ganglion. Results: Of palms, 71.9% were completely and 28.1% were nearly dry. Corresponding percentages were 45.1% and 50.5% for armpits and 4.5% and 37.9% for the soles, respectively. Of soles, 42.4% remained unchanged and 15.2% became slightly worse. Compensatory sweating occurred in 19.4% of patients, with 2.8% having severe compensatory sweating. Feet were rarely affected by compensatory sweating (5.6%). Gustatory sweating was reported by 31.9% of patients but did not bother them. Quality of life improved significantly after ESB4. Most patients (87.5%) were completely satisfied with the outcome; 9.7% were partly satisfied. Conclusions: In the treatment of upper limb HH, ESB4 yields excellent success rates. Plantar sweating can be relieved in nearly half of patients, although exact neurophysiologic mechanisms remain unclear. Incidence of compensatory and gustatory sweating is low, contributing to a high patient satisfaction and improvement in quality of life.

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“…The exact mechanism for this is still unknown. It may be a consequence of particular surgical methods [4,8,9,24]. Some surgeons report a lesser incidence of compensatory sweating after an extensive sympathectomy [11] and others after a limited surgical procedure [13].…”

Section: Discussionmentioning

confidence: 98%