Humans ; Sympathectomy ; adverse effects ; methods ; Thoracoscopy ; adverse effects ; methods

Gustatory hyperhidrosis is facial sweating usually associated with the eating of hot spicy food or even smelling this food. Current options of treatment include oral anticholinergic drugs, the topical application of anticholinergics or aluminum chloride, and the injection of botulinum toxin. Thirteen patients have been treated to date with 1.5% or 2% topical glycopyrrolate. All patients had gustatory hyperhidrosis, which interfered with their social activities, after transthroacic endoscopic sympathectomy, and which was associated with compensatory focal hyperhidrosis. After applying topical glycopyrrolate, the subjective effect was excellent (no sweating after eating hot spicy food) in 10 patients (77%), and fair (clearly reduced sweating) in 3 patients (23%). All had reported incidents of being very embrasssed whilst eating hot spicy foods. Adverse effects included a mildly dry mouth and a sore throat in 2 patients (2% glycopyrrolate), a light headache in 1 patient (1.5% glycopyrrolate). The topical application of a glycopyrrolate pad appeared to be safe, efficacious, well tolerated, and a convenient method of treatment for moderate to severe symptoms of gustatory hyperhidrosis in post transthoracic endoscopic sympathectomy or sympathicotomy patients, with few side effects.
Administration, Topical ; Adolescent ; Adult ; Cholinergic Antagonists/*administration & dosage ; Endoscopy/adverse effects ; Female ; Glycopyrrolate/*administration & dosage ; Human ; Male ; Sweating, Gustatory/*drug therapy/etiology ; Sympathectomy/adverse effects/methods

OBJECTIVETo investigate the feasibility, safety and prospect application value of video-assisted thoracoscopic sympathectomy utilized in the treatment of craniofacial hyperhidrosis.

METHODSEighteen patients with craniofacial hyperhidrosis underwent sympathectomy from January 2003 to December 2004, including 10 cases combined with palmar hyperhidrosis. There were 17 males and 1 females with a mean age of 36.5 years (ranges, 25-42). Sympathetic chain was transected just below the stellate ganglion in pure craniofacial hyperhidrosis. Additional T(3) sympathectomy was performed in those patients combined with palmar hyperhidrosis.

RESULTSThere were no surgical complication or surgical mortality cases. Seventeen patients achieved improvement of craniofacial hyperhidrosis without recurrent symptoms, but one had partial remission due to thoracic adhesion and false location of the ganglions. The effective rate was 97% (35/36). No recurrent symptoms occurred after a mean of 8.3 months of follow-up. No relapse occurred. Fifteen patients (83%) developed compensatory sweating of the trunk and lower limbs. Six patients (33%) presented palmar dry (severe hypohidrosis) and they all can tolerate the condition. All patients were satisfied with the outcomes of their operations.

CONCLUSIONThe initial results show that thoracoscopic sympathectomy is a safe and effective method for the treatment of craniofacial hyperhidrosis.

Adult ; Face ; pathology ; Female ; Follow-Up Studies ; Head ; Humans ; Hyperhidrosis ; surgery ; Male ; Sympathectomy ; adverse effects ; methods ; Thoracic Surgery, Video-Assisted ; adverse effects ; Treatment Outcome

OBJECTIVEThis study investigated the effect of catheter-based renal sympathetic denervation (RDN) in pigs with rapid pacing induced heart failure.

METHODSHeart failure was induced by rapid right ventricular pacing in 12 pigs and pigs were randomly divided into RDN group (n = 6): pacing+RDN at 7 days post pacing; control group (n = 6): pacing only. Echocardiography examination (LVEF, LVEDD and LVESD) was performed before pacing and at 1 and 2 weeks post pacing. Serum biochemical markers including renin, aldosterone and creatinine were also measured at baseline, 1 and 2 weeks after pacing. Repeated renal artery angiography was performed at 1 week after RDN. All pigs were sacrificed to examine the heart and renal pathology and renal artery sympathetic nerve staining at 2 weeks post pacing.

RESULTSLVEF decreased 1 week after rapid pacing from (60.5 ± 6.0)% to (35.3 ± 9.8)%. LVEF was significantly higher [(42.8 ± 5.9) % vs. (33.4 ± 9.7)%, P = 0.001 8] while LVESD was significantly lower [(28.4 ± 3.7) mm vs. (33.0 ± 2.0) mm, P = 0.001 6] in the RDN group than in the control group at 2 weeks post pacing. At 2 weeks after pacing, plasma concentrations of renin and aldosterone were significantly lower in RDN group compared to the control group (all P < 0.05) . Kidney function and blood pressure were comparable between the two groups at 2 weeks post pacing. There were no signs of renal damages such as renal artery stenosis, dissection and thrombus in all pigs after 2 weeks pacing. Sympathetic neurons of adventitia were injured in RND group.

CONCLUSIONRDN could significantly improve cardiac function and attenuate left ventricular remodeling via inhibiting renin-angiotensin-aldosterone system in this pacing induced pig heart failure model.

Animals ; Cardiac Pacing, Artificial ; adverse effects ; Catheter Ablation ; methods ; Disease Models, Animal ; Female ; Heart Failure ; etiology ; surgery ; Kidney ; innervation ; Male ; Swine ; Sympathectomy ; methods

BACKGROUNDCompensatory sweating (CS) is one of the most common postoperative complications after thoracic sympathectomy, sympathicotomy or endoscopic sympathetic block (ESB) for palmar hyperhidrosis. This study was conducted to examine the relevance between CS and the sympathetic segment being transected in the surgical treatment of palmar hyperhidrosis, and thus to detect the potential mechanism of the occurrence of CS.

METHODSBetween October 2004 and June 2006, 163 patients with primary hyperhidrosis were randomly divided into two groups, T(3) sympathicotomy (78 patients) and T(4) sympathicotomy (85), who were operated upon under general anesthesia via single lumen intubation and intercostal video-mediastinoscopy (VM).

RESULTSNo morbidity or mortality occurred. Palmar hyperhidrosis was cured in all patients. Follow-up (mean (13.8 +/- 6.2) months) showed no recurrence of palmar hyperhidrosis. The difference of rates of mild CS in groups T(3) and T(4) was of no statistical significance. The rate of moderate CS was significantly lower in group T(4) than in group T(3). No severe CS occurred.

CONCLUSIONThe rates of occurrence and severity of CS are lowered with the lower sympathetic chain being transected.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Humans ; Hyperhidrosis ; surgery ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Prospective Studies ; Sweating ; Sympathectomy ; adverse effects ; methods ; Thoracic Surgery, Video-Assisted