Longitudinal follow-up of cardiac vagal activity in individuals undergoing endoscopic thoracic sympathectomy

ABSTRACT Objective: To conduct a longitudinal investigation of cardiac vagal activity (CVA) by measuring resting HR and calculating the cardiac vagal index (CVI) in individuals undergoing sympathectomy for the treatment of primary hyperhidrosis. Methods: This was a descriptive longitudinal study involving 22 patients, 13 of whom were female. The mean age was 22.5 ± 8.8 years. The palms, soles, and axillae were the most commonly affected sites. Resting HR was measured by an electrocardiogram performed 20 min before the 4-second exercise test (4sET), which was used in order to evaluate CVA at three different time points: before surgery, one month after surgery, and four years after surgery. Results: Resting HR (expressed as mean ± SE) was found to have decreased significantly at 1 month after surgery (73.1 ± 1.6 bpm before surgery vs. 69.7 ± 1.2 bpm at one month after surgery; p = 0.01). However, the HR values obtained at four years after surgery tended to be similar to those obtained before surgery (p = 0.31). The CVI (expressed as mean ± SE) was found to have increased significantly at one month after surgery (1.44 ± 0.04 before surgery vs. 1.53 ± 0.03 at one month after surgery; p = 0.02). However, the CVI obtained at four years after surgery tended to be similar to that obtained before surgery (p = 0.10). Conclusions: At one month after sympathectomy for primary hyperhidrosis, patients present with changes in resting HR and CVA, both of which tend to return to baseline at four years after surgery.

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Long-Term Effect of Endoscopic Sympathetic Nerve Reconstruction for Side Effects after Endoscopic Sympathectomy

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0036-1582431 ◽

2016 ◽

Vol 65 (06) ◽

pp. 484-490 ◽

Cited By ~ 3

Author(s):

Timo Telaranta ◽

Tuomo Rantanen

Keyword(s):

Side Effects ◽

Sympathetic Nerve ◽

Nerve Reconstruction ◽

Endoscopic Thoracic Sympathectomy ◽

Thoracic Sympathectomy ◽

Long Term Effect ◽

Primary Hyperhidrosis ◽

The Mean

Background Endoscopic thoracic sympathectomy (ETS) is an effective treatment for primary hyperhidrosis. However, compensatory sweating (CS) may occur in many patients. Sympathetic nerve reconstruction (SNR) can be used to counteract severe CS, but the studies on the effects of SNR are few. Patients and Methods Nineteen out of 150 SNR patients were contacted by employing a long-term questionnaire. In this questionnaire, different kinds of sweating were evaluated using a four-graded symptom analysis and the visual analog scale before ETS, after ETS, and after SNR. Results The mean age of the 16 male and 3 female patients at the SNR was 32 years. The mean follow-up was 87 months. According to the long-term questionnaire, the benefit was either excellent (4 patients, 21%), good (3 patients, 15.8%), or reasonable (7 patients, 36.8%) in 14 patients (73.8%), while the benefit was questionable in 1 patient (5.3%). For three patients (15.8%), no benefit was found, and in one patient (5.3%), the situation had deteriorated. Conclusions Improvement in the side effects of ETS after SNR was found in nearly 75% of the patients. This indicates that SNR can be considered as an alternative treatment for patients with severe CS after ETS that is unresponsive to conservative treatment.

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A retrospective review on minimally invasive technique via endoscopic thoracic sympathectomy (ETS) in the treatment of severe primary hyperhidrosis: Experiences from the National Heart Institute, Malaysia

F1000Research ◽

10.12688/f1000research.14777.1 ◽

2018 ◽

Vol 7 ◽

pp. 670

Author(s):

Ahmad Farouk Musa ◽

Vignaa Prashanth Gandhi ◽

Jeswant Dillon ◽

Rusli Bin Nordin

Keyword(s):

Sweat Glands ◽

Invasive Technique ◽

Moderate Degree ◽

Endoscopic Thoracic Sympathectomy ◽

Thoracic Sympathectomy ◽

Primary Hyperhidrosis ◽

Response To Stress ◽

Pertinent Information

Background: Hyperhidrosis is due to the hyperactive autonomic stimulation of the sweat glands in response to stress. Primary hyperhidrosis is a common yet psychologically disabling condition. This study will describe our experience in managing hyperhidrosis via endoscopic thoracic sympathectomy (ETS). Methods: The information was obtained from the patient records from 1st January 2011 until 31st December 2016. Pertinent information was extracted and keyed into a study proforma. Results: 150 patients were operated on but only 118 patients were included in this study. The mean age was 22.9±7.3 years. The majority (54.2%) had palmar-plantar hyperhidrosis and 39.8% had associated axillary hyperhidrosis. Excision of the sympathetic nerve chain and ganglia were the main surgical technique with the majority (55.9%) at T2-T3 level. Mean ETS procedure time was 46.6±14.29 minutes with no conversion. Surgical complications were minimal and no Horner’s Syndrome reported. Mean hospital stay was 3.5±1.05 days. The majority of patients (67.8%) had only one follow-up and only half of the study sample (58.5%) complained mild to moderate degree of compensatory sweating, even though the long-term resolution is yet to be determined by another study. Following ETS, 98.3% of patients had instant relief and resolved their palmar hyperhidrosis. Predictors of CS were sympathectomy level and follow-up. The odds of reporting CS was 2.87 times in patients undergoing ETS at the T2-T3 level compared to those undergoing ETS at the T2-T4 level. The odds of reporting CS was 13.56 times in patients having more than one follow-up compared to those having only one follow-up. Conclusion: We conclude that ETS is a safe, effective and aesthetically remarkable procedure for the treatment of primary hyperhidrosis with only half of the patients developing mild to moderate degree of CS. Significant predictors of CS were sympathectomy level during ETS and frequency of follow-up after ETS.

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Endoscopic thoracic sympathectomy for primary hyperhidrosis: A 16-year follow up in a single UK centre

The Surgeon ◽

10.1016/j.surge.2012.09.002 ◽

2013 ◽

Vol 11 (3) ◽

pp. 130-133 ◽

Cited By ~ 13

Author(s):

Alan Askari ◽

Ali Kordzadeh ◽

Gui Han Lee ◽

Michael Harvey

Keyword(s):

Endoscopic Thoracic Sympathectomy ◽

Thoracic Sympathectomy ◽

Primary Hyperhidrosis

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Endoscopic thoracic sympathectomy for primary hyperhidrosis: A 16-year follow up in a single UK centre

The Surgeon ◽

10.1016/j.surge.2013.10.002 ◽

2014 ◽

Vol 12 (1) ◽

pp. 59

Author(s):

A.E.P. Cameron ◽

C.P. Connery ◽

J.R.M. De Campos ◽

M. Hashmonai ◽

P.B. Licht ◽

...

Keyword(s):

Endoscopic Thoracic Sympathectomy ◽

Thoracic Sympathectomy ◽

Primary Hyperhidrosis

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Endoscopic thoracic sympathectomy or sympathicotomy versus clipping in the surgical management of primary hyperhidrosis: a systematic review and meta-analysis

Shanghai Chest ◽

10.21037/shc.2019.07.08 ◽

2019 ◽

Vol 3 ◽

pp. 36-36

Author(s):

Duilio Divisi ◽

Gino Zaccagna ◽

William Di Francescantonio ◽

Dorian Bardhi ◽

Federico Calvaruso ◽

...

Keyword(s):

Systematic Review ◽

Surgical Management ◽

Meta Analysis ◽

Endoscopic Thoracic Sympathectomy ◽

Thoracic Sympathectomy ◽

Primary Hyperhidrosis

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Results of High Bilateral Endoscopic Thoracic Sympathectomy and Sympatholysis in the Treatment of Primary Hyperhidrosis: a Study of 1016 Procedures

Archivos de Bronconeumología (English Edition) ◽

10.1016/s1579-2129(06)60451-5 ◽

2006 ◽

Vol 42 (5) ◽

pp. 230-234 ◽

Cited By ~ 2

Author(s):

J. Moya ◽

R. Ramos ◽

R. Morera ◽

R. Villalonga ◽

V. Perna ◽

...

Keyword(s):

Endoscopic Thoracic Sympathectomy ◽

Thoracic Sympathectomy ◽

Primary Hyperhidrosis

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Long-term outcome of pallidal stimulation for Meige syndrome

Journal of Neurosurgery ◽

10.3171/2017.7.jns17323 ◽

2018 ◽

Vol 130 (1) ◽

pp. 84-89 ◽

Cited By ~ 8

Author(s):

Shiro Horisawa ◽

Taku Ochiai ◽

Shinichi Goto ◽

Takeshi Nakajima ◽

Nobuhiko Takeda ◽

...

Keyword(s):

Rating Scale ◽

Small Scale ◽

Initial Symptom ◽

Long Term Outcome ◽

Time Points ◽

Meige Syndrome ◽

Pallidal Stimulation ◽

The Mean

OBJECTIVEMeige syndrome is characterized by blepharospasm and varied subphenotypes of craniocervical dystonia. Current literature on pallidal surgery for Meige syndrome is limited to case reports and a few small-scale studies. The authors investigated the clinical outcomes of deep brain stimulation (DBS) of the globus pallidus internus (GPi) in patients with Meige syndrome.METHODSSixteen patients who underwent GPi DBS at the Tokyo Women’s Medical University Hospital between 2002 and 2015 were included in this study. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) movement subscale (BFMDRS-M) scores (range 0–120) obtained at the following 3 time points were included in this analysis: before surgery, 3 months after surgery, and at the most recent follow-up evaluation.RESULTSThe patients’ mean age (± SD) at symptom onset was 46.7 ± 10.1 years, and the mean disease duration at the time of the authors’ initial evaluation was 5.9 ± 4.1 years. In 12 patients, the initial symptom was blepharospasm, and the other 4 patients presented with cervical dystonia. The mean postoperative follow-up period was 66.6 ± 40.7 months (range 13–150 months). The mean total BFMDRS-M scores at the 3 time points were 16.3 ± 5.5, 5.5 ± 5.6 (66.3% improvement, p < 0.001), and 6.7 ± 7.3 (58.9% improvement, p < 0.001).CONCLUSIONSThe results indicate long-term efficacy for GPi DBS for the majority of patients with Meige syndrome.

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Endoscopic Thoracic sympathectomy for Primary Palmar hyperhidrosis

Nepal Journal of Neuroscience ◽

10.3126/njn.v17i1.28347 ◽

2020 ◽

Vol 17 (1) ◽

pp. 59-62

Author(s):

Rupesh Chakradhar ◽

Amit Thapa

Keyword(s):

Negative Impact ◽

Botulinum Toxin Injection ◽

Endoscopic Thoracic Sympathectomy ◽

Medical Treatments ◽

Thoracic Sympathectomy ◽

Minimally Invasive Surgical ◽

Post Operative Period ◽

Primary Hyperhidrosis ◽

Surgical Modality

Primary hyperhidrosis is a disorder in which there is an excessive amount of sweating more than required for the body’s thermoregulation. It is due to excessive function of the sudomotor sweat control system in the absence of a sweating trigger. We had a 25-year-old engineer, who presented with complaints of profuse sweating in both his palms, feet and axillae for more than 10 years. He had distressing symptoms disabling his daily activities and causing negative impact in his social, professional, recreational and quality of life. He took medical treatments including topical agents, anticholinergics, iontophoresis and even botulinum toxin injection. All these not only failed to give relief but only aggravated his disappointment. Endoscopic thoracic bilateral sympathectomy was performed from T2 to T4 level. Drastic improvement was seen in immediate post-operative period. Pre-operative palmar temperature of 90° Fahrenheit increased to 96.5° Fahrenheit in immediate post-operative period. His post-operative period was uneventful and was discharged on the second postoperative day. On follow-up after 30 days, the patient was asymptomatic, fully satisfied with the surgery and without any complications. Endoscopic thoracic sympathectomy is a safe, effective, fast and minimally invasive surgical modality of treatment for primary hyperhidrosis.

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Thoracoscopic surgical resection of thoracic neurogenic tumors

Neurosurgical FOCUS ◽

10.3171/foc.1999.7.5.4 ◽

1999 ◽

Vol 7 (5) ◽

pp. E3 ◽

Cited By ~ 4

Author(s):

Patrick P. Han ◽

Curtis A. Dickman

Keyword(s):

Tumor Resection ◽

Open Thoracotomy ◽

Total Resection ◽

Thoracic Sympathectomy ◽

Neurogenic Tumors ◽

Normal Tissues ◽

Intercostal Neuralgia ◽

The Mean ◽

Intraspinal Extension

Five patients who harbored large intrathoracic paraspinal neurogenic tumors were treated using thoracoscopic techniques to achieve gross-total tumor resection. All tumors were entirely intrathoracic except one that had an intraspinal extension, and all tumors were treated entirely thoracoscopically except for this one. Gross-total resection was achieved in all cases. The mean clinical follow-up period was 6.8 months. Postoperatively, one patient developed Horner's syndrome. The only other complication was transient intercostal neuralgia (two patients), which has resolved in both patient. No evidence of disease was demonstrated clinically or on follow-up imaging in any patient. Thoracoscopy is an excellent modality with which to treat these tumors, in part because it is associated with significantly less morbidity than open thoracotomy and costotransversectomy procedures. Endoscopic transthoracic approaches reduce the approach-related soft-tissue morbidity by preserving the normal tissues of the chest wall, avoiding rib retraction and muscle transection, reducing postoperative pain, and facilitating recovery. This technique has become the senior author's (C.A.D.'s) surgical approach of choice for the removal of intrathoracic benign paraspinal neurogenic tumors. It has also become the preferred method by which to perform thoracic sympathectomy and remove central, herniated thoracic discs.

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