• Journal of Chest Surgery
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• v.31 no.10
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• pp.999-1003
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• 1998

Background: Thoracoscopic sympathetic block in palmar hyperhidrosis has merits in its immediate responsiveness and recovery. In palmar hyperhidrosis, the level of sympathetic chain to be blocked has been somewhat obscure. Materials and methods: To compare the results of T2 with T2,3 sympathetic block, we retrospectively studied 192 patients (T2 group: 84, T23 group: 108) operated on at SNUH with palmar hyperhidrosis between April 1994 and July 1997. We reviewed medical records and recently interviewed the patients by telephone call. Sex and age distribution between two groups showed no significant differences. We performed sympathectomy at the early phase of the syudy until April 1997, and after then, we adopted sympathicotomy rather than sympathectomy. Results: All patients showed symptomatic improvement after the operation. Mean operation times of T2, T23 groups were 61.3$\pm$22.5min, 82.7$\pm$24.8min, respectively(p<0.01). Early postoperative complications, such as Horner's syndrome or chest tube insertion, were not different in two groups. There were no statistical differences of late complications such as compensatory truncal hyperhidrosis, gustatory sweating, and phantom sweating. No patient experienced recurrence of palmar hyperhidrosis during the study period. The only difference was the extent of compensatory truncal hyperhidrosis. The compensatory sweating occurred from axilla to suprapatella in T2 group whereas its extent was from nipple to suprapatella in T23 group. Conclusions: We concluded that T2 thoracic sympathetic block is mandatory for the treatment of primary palmar hyperhidrosis.

• Journal of Chest Surgery
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• v.32 no.9
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• pp.818-822
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• 1999

Background: Thoracoscopic T2 sympathicotomy had been performed as a simple and effective method in treating palmar hyperhidrosis, however, this method had the complications of compensatory hyperhidrosis and facial anhidrosis. Therefore, a more limited and modified methods for T2 sympathicotomies were introduced and comparative analysis of the modified upper and lower T2 sympathicotomy were made in the treatment of palmar hyperhidrosis. Material and Method: From January 1997 to December 1998, 41 patients with palmar hyperhidrosis had been treated by modified T2 sympathicotomy at the Kon-Kuk University Seoul Hospital. Twenty-four patients underwent a modified upper T2 sympathicotomy(Group A), and seventeen patients underwent a modified lower sympathicotomy(Group B). A comparison between groups A and B were made according to the medical records and interview results. Result: All patients showed symptomatic improvements after the operation. The anisocoria, facial anhidrosis and dissatisfaction for compensatory hyperhidrosis were more common in Group A and the individual satisfaction for the operations were higher in Group B. Conclusion: The modified lower T2 sympathicotomy might be a more effective and less complicated method than the modified upper T2 sympathicotomy.

• The Journal of Internal Korean Medicine
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• v.29 no.1
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• pp.1-11
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• 2008

Objectives : Essential hyperhidrosis is a socially and occupationally disabling disorder. There are many suggestions that hyperhidrosis is associated with the autonomic nervous system. This study was designed to investigate the autonomic nerve system the patients with hyperhidrosis. Methods : 348 palmar and plantar hyperhidrosis patients and 20 systemic hyperhidrosis patients in the ambulatory care were investigated. All patients were inspected at the first medical examination, using the PSA of HRV. HRV was measured for 5 minutes after 5 minutes' bed rest. We checked the frequency domain analysis of HRV (i.e. TP, VLF, LF, HF and LF/HF) which were transformed into natural logarithm of patients against the standard measures of the HRV components. Then, we compared the means of patients with means and highest values of in the normal range of Koreans 1) between the patients with palmar and plantar hyperhidrosis and the healthy controls and 2) between the patients with the systemic hyperhidrosis and healthy controls, by the frequency domain analysis of heart rate variability (HRV), respectively. We then compared the results between 1) and 2). Results : The values of natural logarithmic measures of LF/HF ratio in the patients with palmar and plantar hyperhidrosis we examined were significantly higher than the values of healthy controls, but those in the patients with systemic hyperhidrosis were not higher. Conclusion : This study suggests that the autonomic nervous function did not simply increase but that the balance between sympathetic and parasympathetic nervous function did matter in patients with palmar and plantar hyperhidrosis. This balance included that the sympathetic nervous function aggravated comparatively with parasympathetic nervous function. On the other hand, we couldn't find any significance of the patients with the systemic hyperhidrosis as for the autonomic nervous function.

• Journal of Chest Surgery
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• v.44 no.2
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• pp.154-158
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• 2011

Background: Video-assisted thoracic sympathicotomy plays an important for the treatment of essential hyperhidrosis. Patients are usually satisfied with the surgical outcome at the early post-operative period, but suffer recurrence and compensatory sweating in the late post-operative period. There are many sympathicotomy methods to minimize recurrence and compensatory sweating. We compared the outcome of sympathicotomy methods above the third rib (R3) and the fourth rib (R4) with regards to symptoms, satisfaction, recurrence, and compensatory palmar and axillary hyperhydrosis. Materials and Methods: From January 1999 to April 2009, 39 cases of thoracoscopic sympathicotomy at the third rib (R3), and 94 cases of thoracoscopic sympathicotomy at the fourth rib (R4) for palmar and axillary hyperhidrosis were compared for early and late post-operative satisfaction, compensatory sweating and recurrence. Results: There was no sex or age difference between groups. Early satisfaction was 94.9% and 98.9% in the R3 group and R4 group, respectively. There was no difference in early satisfaction (94.9% in R3 and 98.9% in R4), late satisfaction (84.6% in R3 and 89.4% in R4), or recurrence (17.9% in R3 and 17.0% in R4) between groups. There was significant difference in compensatory sweating (71.8% in R3 and 33% in R4, p=0.002). Conclusion: R4 sympathicotomy demonstrated superior efficacy in the treatment of compensatory sweating compared to R3 in palmar and/or axillary hyperhidrosis.

• Journal of Chest Surgery
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• v.35 no.10
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• pp.724-729
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• 2002

Although variable surgical methods of sympathetic nerve for palmar hyperhidrosis are curative and safe therapeutic options, they have some limitations such as compensatory sweating and anhidrosis of hand in long term satisfaction rate. Material and Method: Therefore, we tried to decrease severity of compensatory sweating and prevent excessive dryness of hand through selective division of rami communicantes of thoracic sympathetic ganglia distributed to the hands(ramicotomy). Result: In postoperative results, about half of the patients maintained humidity of hands and most of them showed no more than mild degree of compensatory sweating. Conclusion: Therefore, ramicotomy of thoracic sympathetic ganglia can be recommended as selective and physiologic surgical method for palmar hyperhidrosis.

• Journal of Chest Surgery
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• v.32 no.8
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• pp.739-744
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• 1999

Background: This study was designed to evaluate the effectiveness of T3 sympathicotomy in treatment of palmar hyperhidrosis. Material and Method: During the period of June to December 1998, 50 patients (24 females and 26 males) suffering from palmar hyperhidrosis either in isolation (n=37) or in combination with axillary hyperhidrosis (n=13) were operated. The mean age of the patients was 20 years. The bilateral sympathetic trunks were severed on the 3rd rib (2nd and 3rd ganglia) for the isolated palmar hyperhidrosis and on the 3rd and 4th ribs for the combined type using electrocoagulation scissors. A linear analogue scale was used to assess the degree of sweating on the palms, face, trunk, and feet (ranged 0 to 10:0 = anhidrosis: 10 = excessive sweating) as well as the patient's satisfaction with the surgery (ranged 0 to 10:0 = regret; 10 = completely satisfied). Result: All of the patients were relieved from palmar hyperhidrosis. A mean palmar sweat production score after T3 sympathicotomy was $1.5\pm$0.8. Some degree of compensatory sweating had occurred in 39 patients (78%) with a mean score of 3.4$\pm$1.6. Gustatory sweating occurred in 2 patients (4%). The mean score of the patient's satisfaction after the surgery was 8.5$\pm$1.2. Conclusion: Palmar hyperhidrosis can be successfully relieved by the T3 sympathicotomy. When considering the advantages of T3 sympathicotomy with respects to a better preservation of facial sympathetic function, less occurrence of severe compensatory sweating, and lower incidence of gustatory sweating. We recommend T3 sympathicotomy as a treatment of choice for palmar hyperhidrosis.

• The Journal of Internal Korean Medicine
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• v.28 no.3
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• pp.597-607
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• 2007

Backgrounds and Objectives: Primary hyperhidrosis deeply affect a patient's quality of life, resulting in impairments of daily activities, social interactions and occupational activities. The objectives of the study were to assess quality of life(QOL) in patients with primary hyperhidrosis before and after treatment with oriental medicine. Methods : Between December 2006 and July 2007, 26 patients underwent oriental medicine treatment. which consisted of herb medicine. acupuncture and iontophosis (if palmar/plantar hyperhidrosis) treatment. QOL questionnaires comprised of dermatology life quality index (DLQI) and visual analogue scale (VAS) were employed before and after treatment Results : All 26 patients were evaluated. The treatment controlled primary hyperhidrosis in 84.6% of cases. The mean of DLQI score before treatment was 16.65 after treatment mean DLQI score was 8.18. The mean of VAS before treatment was 91.35 after treatment mean VAS was 49.92. QOL in patients with primary hyperhidrosis significantly improved after oriental medicine treatment. The improvements in QOL were similar in patientswith palmar/plantar, head, and systemic hyperhidrosis. Conclusions : Oriental medicine treatment leads to significantly improved QOL in patients with primary hyperhidrosis. Further studies are needed to evaluate the objective efficacy in patients with primary hyperhidrosis before and after oriental medicine treatment.

• Journal of Korean Neurosurgical Society
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• v.30 no.8
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• pp.992-997
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• 2001

Objectives : Essential hyperhidrosis is a common condition characterized by excessive body sweating. Excessive sweating beyond what is necessary to maintain normal body temperature need not be considered pathological unless it interferes with one's occupation and/or life-style. The existing non-operative therapeutic options seldom give sufficient relief or show a transient effect. In this regard, the thoracic sympathectomy may provide a definitive cure. In the past, surgical procedures were highly invasive and caused significant morbidity, but the minimally invasive thoracoscopic procedure provided detailed visualization of sympathetic ganglia and is associated with minimally postoperative morbidity. Nowadays, thoracoscopic transthoracic sympathectomy is accepted as the treatment of choice for essential hyperhidrosis. In palmar hyperhidrosis, however, the level of sympathetic chain to be blocked has been somewhat obscure. It is assumed that the incidence of compensatory hyperhidrosis may closely related to the extent of thoracic sympathectomy. Material & Methods : To compare the results of posterior midline approach with endoscopic sympathectomy, and the results of T2 with T2, 3 sympathectomy or sympathicotomy, we retrospectively studied 62 patients treated for palmar hyperhidrosis between September 1993 and May 2000. We reviewed medical records and recently interviewed the patients by telephone calls. Results : The treatment effect of T2 sympathectomy is no different from T2, 3 sympathectomy. But, the incidence of compensatory hyperhidrosis is less in the T2 sympathectomy group than the T2, 3 sympathectomy group. Conclusion : Thoracoscopic sympathectomy is considered a simple, safe, and effective method for treating palmar hyperhidrosis, with a shorter operation time, fewer hospital days, and a better cosmetic result, as compared with the open approaches. However, sympathicotomy seems to provide the advantages of a limited extent of denervation and the resultant decrease of compensatory hyperhidrosis compared to sympathectomy.

• Journal of Chest Surgery
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• v.33 no.10
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• pp.817-822
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• 2000

Video assisted thoracic sympathectomy or sympathicotomy is a safe and effective therapy for the treatment of palmar hyperhidrosis with immediate symptomatic imporvement. However the degree of satisfaction may diminish with time due to cmpensatory sweating or excessive hand dryness. Therefore by comparing and assessing the degree of symptomatic improvement or compensatory sweating following sympathectomy or sympathicotomy at various levels we aim to determine the optimal level of sympathetic nerve block which will result in minimal side effects and maximal benefit. Material and Method: Among 194 patients having undergone video assisted thoracic sympathectomy or sympathicotomy between January 1996 and June 1999, 137 patients who responded to either telephone interview or questionnaire were included in the current study. The patients were divided into three groups. Group I(n=61) ; patients having undergone T2,3,4 sympathectomy group II(35) ; patients having undergone T2 sympathicotomy and group III(41) ; patients having undergone limited T2 sympathicotomy which consist of block of interganglionic neuronal fiber on the third rib. The parameters studied comprised of pre- and post-operative palmar temperature change treatment satisfaction the degree of compensatory sweating or discomfort from palmar dryness postoperative complication and changes in plantar sweating Result : There was no difference in age and sex among the groups and the mean postoperative elevation in palmar temperature was 21.59$^{\circ}C$ without any differences among the groups. Patients expressing satisfaction were 65.6%, 62.9% and 90.24% in groups I, II and III, respectively(p<0.05) Moderate to severe compensatory sweating was present in 65.6% 51.4%, and 24.39%, in group I, II, and III, respectively(p<0.05) Slight but comfortable amount of palmar humidness was expressed in decreasing order group III(41.6%) group I(24.6%) and group II(5.7%) (p<0.05) Ineffectiveness or recurrence was present in 5patients in group I(8.2%) 1 patient in group II(2.9%) and none in group III. With regards to plantar sweating decrease in sweating was expressed in 43 patients(31.4%) while similar degree of sweating in 61 patients(44.5%) and increase in sweating in another 33 patinets(24.1%) Conclusion : Limited T2 sympathicotomy resection of the lower interganglionic neuronal fiber of the second sympathetic ganglion on the third rib showed immediate effect in palmar hyperhidrosis and caused lesser compensatory sweating and hand dryness.

• Journal of Chest Surgery
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• v.31 no.4
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• pp.388-392
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• 1998

Hyperhidrosis is one of abnormalities in autonomic nervous system, it has been treated with dermatologic principles or thoracic sympathectomy via thoracotomy. But these techniques were rather ineffective or invasive. Recently, Video Assisted Thoracoscopic Surgery(VATS) is widely applided in thoracic surgical area, and palmar & axillary hyperhidrosis is not the exception. From August 1995 to February 1997, 52 patients with bilateral palmar hyperhidrosis underwent bilateral thoracic sympathectomy with VATS in the department of thoracic & cardiovascular surgery, Inje university, Pusan Paik Hospital. There were 27 men and 25 women and the mean age was 22 years. Mean operating time was 172 min and unilateral sympathectomy via minithoracotomy was applied in one patient due to severe pleural adhesion. Mean postoperative hospital stay was 2.6 days. During mean 12.5 months follow-up, there was no recurrence of sweating in the both hands. Thirty patients(57.7%) complained moderate degree of compensatory sweating, but the discomfort was decreased in severity. 83.8% of all patients were satisfied with the result of operation.