Dissertations / Theses on the topic 'Hyperhidrose'

Human skin has various pathologies in the form of acute and chronic diseases. Some are only cosmetic diseases which are not harmful for life but they can affect mental health and disrupt daily activities. Hyperhidrosis is one of these cosmetic diseases which may be caused by diabetes, infections, or thyroid hyper activity, or can be inherited. There are some examinations for testing hyperhidrosis, e.g. gravimetric and minor starch-iodine test. There are some devices that can measure sweat but are not specifically used or even intended for use on hyperhidrosis. A non-invasive prototype instrument called Electronic Sudometer using the principle of electrical impedance measurement has been developed. The philosophy behind this prototype is to make an instrument which can detect hyperhidrosis during homeostasis as well as in pathological condition. The device injects a sinusoid electric current and detects the ensuing voltage, which is proportional to the impedance of sweat on top of the skin during hyperhidrosis. For this prototype, the electrode system is made of brass rings mounted on a handle. The signal is then processed in electronic assembly. Processed output is transferred to a Laptop with specially made connecting wire. Computer having Sound Card Oscilloscope (Lab View based software) plots the signal and shows voltage level corresponding to sudor level. The signal output can also be displayed on a SmartPhone having software called Osciprime, requiring another specially made interface. Laboratory test results in the form of a plot of output voltage vs. impedance show accuracy of the device. The impedance results can be translated to sweat level because impedance decreases with increasing sweat during hyperhidrosis. The Sudometer was also calibrated using fixed precision resistors over its working range. Laboratory tests were carried out using an artificial skin at various sweat levels and to a yeast tissue model. Hydration of the artificial skin was quantified by weighing precision cut samples on a laboratory balance. Results from two test persons (the author and a student friend) are also included in this Master Thesis. During these experiments, the laptop computer and SmartPhone, respectively, were on internal battery to eliminate electric hazard. Any clinical device must be validated for accuracy and evaluated for safety before applying it on patients – the latter has not been done with the prototype. The author is aware of potential electrical risks, and thus the whole system was disconnected from mains 230V during measurements on himself and a student friend. The device output seems to be well correlated to sweat level although electrolytes were not taken into account. Being a palmar hyperhidrosis patient himself, the author applied the Electronic Sudometer on his palms and the results look quite promising. At different environmental temperatures, the author checked elicited sweat responses. Patient safety is always a concern for clinicians regarding new devices. For this reason, the device itself has been made battery operated, and a new version will be entirely powered from a SmartPhone.

Background: Hyperhidrosis (HH) is a disorder in which patient suffers from excessive sweating without any known etiology such as the rise in temperature. Although there have been some epidemiological studies on hyperhidrosis, questions still remain regarding the prevalence of hyperhidrosis and associated demographical, ethnic or geographical factors. Similarly, the association of hyperhidrosis with anxiety and depression has not been systematically investigated. Finally, the relationship between daytime hyperhidrosis and nighttime sweating has not been examined. Methods: One thousand and ten consecutive subjects attending dermatology outpatient clinics in Shanghai Skin Disease Hospital and 1017 subjects in Skin Care Center of Vancouver General Hospital were investigated for this case-control, cross-sectional study after filling out a questionnaire on their presenting concerns, demographical information and mental stress and sweating symptoms. The subjects were then classified to have primary HH subtypes using the criteria of International Hyperhidrosis Society, late onset hyperhidrosis, or no-HH. Then the prevalence of HH and its correlation with anxiety, depression and NS was examined in both single variants and multivariate logistic regression analyses, stratified according to age at examination, sex, ethnicity, presenting diagnosis, BMI, and specific study cities. Results: The prevalence of total HH is very similar in Shanghai and Vancouver (about 18%). Primary HH subtypes have the highest prevalence in those younger than 30 years old, decreasing dramatically in later years. Caucasian subjects are more likely to develop axillary hyperhidrosis compared to Chinese subjects. The prevalence of anxiety and depression was 21.3% and 27.2% in hyperhidrosis patients, respectively, and 7.5% and 9.7% in patients without hyperhidrosis. Among the effects of ethnicity, mental stress symptoms and HH, which are correlated with NS, HH is the most associated factor with NS as more than half of the patients with HH suffer from NS. Conclusion: Prevalence of total HH is similar in different geographical locations. However, certain specific HH subtypes can show great variations according to ethnicity, age, body mass index and sex and based on the severity of sweating. Similar to NS, both anxiety and depression were more prevalent in patients with HH, than those without HH.
Medicine, Faculty of
Experimental Medicine, Division of
Medicine, Department of
Graduate

Consideration of broader outcomes of disease, especially those exclusively experienced and reported by the patient, such as HRQOL, is not only consistent with the ‘whole person’ view of health contained in the 1948 WHO definition, but is also a prerequisite to building health-care systems that are responsive to the needs of the patients. For chronic skin diseases, such as hyperhidrosis, these provide a useful indicator of how a patient feels and functions disease for both practical and methodological reasons. The aims of this study therefore were to investigate the impact of hyperhidrosis on patients’ HRQoL using a mix of qualitative and quantitative methods. In addition, a further aim was to develop and validate a disease-specific instrument for assessing HRQoL in hyperhidrosis. In pursuing the above aims, the feasibility of applying online social networking sites for outcomes research in dermatology was assessed. Patients were recruited through online social networking communities related to hyperhidrosis for all stages of the study. Interviews, focus groups and surveys were used for collecting qualitative data from patients (n = 71) to understand quality of life issues of patients, and to provide the content of the new instrument. Dermatologists (n= 5) and patients (n=7) took part in the content validation of the HidroQoL©. Item reduction and the development of the scale’s structure was carried out through several field-testing studies (n: USA, 559; UK, 115), using the item response theory (IRT) Rasch model and factor analyses. Further psychometric testing was performed in a separate study (n = 241). Distribution-based methods were applied in establishing minimum clinically important difference (MCID). A thematic analysis of the qualitative data collected produced 29 quality of life themes and 102 sub-themes, forming the content for the initial 49-item HidroQoL©. The two expert panels judged the instrument as content valid, with a few suggestions. The Rasch analysis modelling led to the collapsing of response categories (from five to three) and the reduction in number of items (from 49 to 18), to ensure a perfect model fit. Factor analyses supported both a single- and a two-factor structure. In subsequent construct validation study the HidroQoL correlated with the DLQI (rs = 0.572, p < 0.01) and the Skindex-17 (rs = 0.551, p < 0.01). Reliability was high (Cronbach alpha = 0.9; test-retest ICC = 0.93). The scores were sensitive to change in patients’ disease severity (standard response mean = 0.8, 95% C.I: 0.34-1.27). The scale banding proposed for the HidroQoL score is as follows: 0 – 1, no effect at all; 2 – 11, small effect; 12 – 22, moderate effect; 23 – 32, large effect; 33 – 36, very large effect. The MCID values were 1.94 – 3.07, for generalised v hyperhidrosis, 2.16 – 4.36, for axillary hyperhidrosis, 2.15 – 3.39, for palmo-plantar hyperhidrosis. An MCID of three is currently being proposed for all types of hyperhidrosis. This study has provided the initial evidence supporting the appropriateness of the content of the HidroQoL and validity of inferences from its scores for assessing HRQoL in hyperhidrosis. In addition, the availability of MCID estimates for the HidroQoL will facilitate its clinical interpretation in both research and routine clinical practice. This study has also demonstrated how CTT and IRT can be integrated in the development and validation of a new generation of HRQoL instruments, using social network for patient recruitment.

Objectives: Patients with hyperhidrosis suffer from an extreme perspiration that cannot be aligned with natural or situ- ational standards. Endoscopic sympathectomy is a meaningful option for palmar and axillary hyperhidrosis. A stan- dardized method of monitoring the immediate intraoperative success has not been established yet. The presented investigation shows one proposed sollution by monitoring skin surface temperature. The main aspect is to demonstrate a sig- nificant rise in temperature with utility for monitoring the immediate success of surgery. Methods: Twenty patients with primary hyperhidrosis were observed and treated in a standardized setting against a control group (n = 10). We obtained diverse data that permit determination of a point of time of measurement of surface temperature and definition of a degree of temperature variance. Results: After 5 minutes a significant change of 0.5 ̊ Celcius was noted on the palms; after 10 minutes on average 1.2 ̊ Celcius. Axillary temperature had significantly changed after 10 minutes with a mean temperature variation of 0.8 ̊ Celcius on the right side and 0.6 ̊ Celcius on the left side. Conclusions: Under consideration of appropriate time intervals of measurement and determined changes in surface temperature an early control of correct clip application in ETS is possible. In the palmar aspect an increase of 0.5 ̊ Celcius at an 5 minutes interval, and more than 1 ̊ Celcius at 10 minutes after placement of the clip as compared to basic values before application of the clip can be proposed.

Thesis (M.A.)--University of North Carolina at Chapel Hill, 2010.
Title from electronic title page (viewed Jun. 23, 2010). "... in partial fulfillment of the requirements for the degree of Master of Arts in the Department of Psychology (Clinical Psychology)." Discipline: Psychology; Department/School: Psychology.

Primary focal hyperhidrosis (PFHH) is a medical condition characterised by overactivity of the eccrine sweat glands, primarily occurring on palmar, plantar and axillary regions. PFHH can have a significant adverse impact on a patient’s quality of life. Multiple intradermal injections of a commercial formulation of botulinum toxin A (BTX A) (Botox®) is the most effective non-surgical treatment currently licensed in the UK for cases of severe PFHH. Although effective, intradermal BTX A injections are associated with considerable pain and discomfort for the patient and are time-consuming for the administering clinician. This study aims to evaluate the potential of using pocketed microneedle devices for minimally invasive intradermal delivery of BTX A, as a liquid formulation, into human skin. Pocketed microneedles, metallic 700 μm-long needles containing a cavity within the needle shaft, were selected as an appropriate and relatively untested intradermal delivery device. Pocketed microneedle devices (PMDs) were liquid loaded by immersion into a ‘Botox® like’ formulation that mimicked the composition of the commercial Botox® formulation, with the exception of BTX A, which was replaced by the model macromolecular protein β-galactosidase (~465 kDa). A water-soluble dye was also included to enable visualisation. Microneedles were assessed for loading uniformity by light microscopy and the formulation residency time was evaluated by monitoring evaporation using a digital camera. The microneedle loading capacity was determined using an established quantitative assay for β-galactosidase. Studies using excised human breast skin, maintained in organ culture, examined delivery of the model β-galactosidase from liquid loaded PMDs and the time-dependent diffusion of the protein within the dermal tissue. A more clinically representative model of BTX A, formaldehyde inactivated BTX A, i.e., botulinum toxoid, was used to determine the deposition pattern of the therapeutic within the skin. Following skin delivery the toxoid was detected by immnohistochemical staining and fluorescence imaging, following its conjugation to an appropriate fluorophore. Immersion of the PMD into a ‘Botox® like’ formulation resulted in successful uptake and retention of the model protein solution. Quantitative studies indicated that nanogram quantities (~100 ng/microneedle array) of the β-galactosidase model can be loaded and retained on individual microneedles, in a liquid state. These results suggest that the loading capacity of the microneedle device is appropriate for therapeutic botulinum toxin formulations, although loading uniformity will need to be addressed. Histological analysis revealed effective delivery of the model β-galactosidase from a PMD to the epidermal and the dermal layers of the skin. Rapid and extensive diffusion of the protein within the deeper dermis was also demonstrated. Further, immunohistochemical and fluorescence studies indicated effective PMD loading and successful delivery of botulinum toxoid to the dermis of human skin. These data suggest that it should be possible for BTX A to access its therapeutic target (the eccrine sweat glands) following delivery via PMDs. This study has demonstrated for the first time that pocketed microneedles represent a viable, minimally invasive alternative, for the intradermal delivery of botulinum toxin A (Botox®). Future pre-clinical and clinical studies are now required to test and optimize a microneedle-based delivery system that is most suited to clinical practice.

Botulinum toxin (BTX) is used in various fields of medicine, including the treatment of hyperhidrosis and cervical dystonia. Botox®, Dysport®, Xeomin® and NeuroBloc® are commercially available BTX products, which are formulated differently and their dosing units are unique. Dosage and concentration of the prepared solution for injection varies considerably among studies comparing the products. Improved guidelines on concentration and dosing when changing from one product to another are warranted. This would ensure the use of the lowest effective doses for good effect, minimal risk of antibody formation and side-effects as well as reduced costs. The aim of the present work was to find the most appropriate BTX concentration for each of the four products to achieve the highest sweat reducing effect and to investigate dose conversion ratios between Botox and Dysport in the treatment of cervical dystonia when the products are diluted to the same concentration, 100 U/ml. Paper I and II clearly confirm that it is crucial to consider the BTX concentration in a treatment regimen, especially when changing between different products. The optimal concentration to reduce sweating varies among the products and was found to be 25 U/ml for Botox and Xeomin, approximately 100 U/ml for Dysport and 50 U/ml for NeuroBloc. However, for NeuroBloc the optimal concentration might be even lower. In Paper III, which is a retrospective study using casebook notes from 75 patients with cervical dystonia, it was found that the most appropriate dose conversion ratio to use when switching from Botox to Dysport was 1:1.7. In Paper IV, Botox and Dysport were prospectively compared in a double-blind, randomized clinical trial in two different dose conversion ratios (1:3 and 1:1.7) when diluted to the same concentration (100 U/ml). No statistically significant difference was seen between Botox (1:3) and Dysport nor between Botox (1:1.7) and Dysport four weeks after treatment. Some of the secondary outcome observations, however, did indicate that the ratio 1:3 resulted in suboptimal efficacy of Botox but this must be further validated in a larger patient material.

INTRODUÇÃO: O nível ótimo de simpatectomia para a hiperidrose palmar seria aquele que resultasse na definitiva desnervação simpática da palma da mão com mínima intensidade de hiperidrose compensatória. OBJETIVOS: Comparar duas técnicas cirúrgicas (níveis de desnervação) de simpatectomia por videotoracoscopia para tratamento da hiperidrose palmar ou palmo-plantar a curto e médio prazo. MÉTODOS: De maio de 2003 a junho de 2006, 60 pacientes com hiperidrose palmar foram prospectivamente randomizados para a simpatectomia por videotoracoscopia nos níveis do gânglio T2 ou T3. Foram acompanhados pelo período médio de 20 meses avaliando-se: a resolução da hiperidrose palmar; a incidência e a intensidade da hiperidrose compensatória; sua evolução durante o estudo; e a qualidade de vida dos pacientes. RESULTADOS: 59 pacientes apresentaram resolução da hiperidrose palmar. Uma falha terapêutica ocorreu no grupo T3. A maioria dos pacientes apresentou melhora da hiperidrose plantar sem diferença entre os grupos. Após 20 meses, todos os pacientes de ambos os grupos apresentavam algum grau de hiperidrose compensatória, mas com menor intensidade no grupo T3 (p=0,007). A HC desenvolveu-se na maioria dos pacientes no primeiro mês do pós-operatório, com incidência e intensidade estáveis com o passar do tempo. Verificou-se melhora da qualidade de vida desde a primeira avaliação de pós-operatório, sem diferença em nenhum dos grupos, e assim se manteve até o fim do seguimento. CONCLUSÕES: Ambas as técnicas são efetivas para tratar a hiperidrose palmar. A complicação mais frequente foi a hiperidrose compensatória, que cronologicamente apresentou incidência e intensidade estáveis durante o estudo. A simpatectomia no nível T3 apresentou menor intensidade de HC, mas, apesar disso, a melhora da qualidade de vida foi similar em ambos os grupos.
INTRODUCTION:The optimum level for sympathectomy to treat palmar hyperhidrosis would be the level that produced definitive sympathetic denervation of the palm of the hand with minimal compensatory hyperhidrosis. OBJECTIVE: To compare two surgical techniques (denervation levels) of sympathectomy using video-assisted thoracoscopy to treat palmar or palmar-plantar hyperhidrosis for short and medium-term. METHODS: From May 2003 to June 2006, 60 patients with palmar hyperhidrosis were prospectively randomized for video-assisted thoracoscopic sympathectomy at the T2 or T3 ganglion level. They were followed up for a mean of 20 months and were evaluated regarding their degree of improvement of palmar hyperhidrosis; incidence and severity of compensatory hyperhidrosis and its evolution over time; and quality of life. RESULTS: Fifty-nine cases presented resolution of the palmar hyperhidrosis. One case of therapeutic failure occurred in the T3 group. Most of the patients presented an improvement in plantar hyperhidrosis, without any difference between the groups. Twenty months later, all of the patients in both groups presented some degree of compensatory hyperhidrosis, but with less severity in the T3 group (p = 0.007). Compensatory hyperhidrosis developed in most patients during the first month after the operation, with incidence and severity that remained stable over time. An improvement in quality of life was seen, starting from the first postoperative evaluation, but without any difference between the groups. This was maintained until the end of the follow-up. CONCLUSION: Both techniques were effective for treating palmar hyperhidrosis. The most frequent complication was compensatory hyperhidrosis, which presented stable incidence and severity over the study period. Sympathectomy at the T3 level presented compensatory hyperhidrosis of less severity. Nevertheless, the improvement in quality of life was similar between the groups.

Orientador: Antonio José Maria Cataneo
Resumo: Introdução: A hiperidrose primária (HP) é um distúrbio caracterizado pela sudorese excessiva, levando a uma piora na qualidade de vida de seus portadores. Objetivo: Determinar a efetividade da radiofrequência (RF) no tratamento da HP. Método: Revisão sistemática de ensaios clínicos randomizados, estudos controlados e estudos observacionais em indivíduos portadores de HP, nos quais foram realizados o tratamento por RF comparado com qualquer outra modalidade de tratamento ou em que foram comparados os resultados antes e após a intervenção no tratamento isolado por RF. Os desfechos avaliados foram: grau de intensidade da hiperidrose, qualidade de vida, sudorese compensatória e recorrência dos sintomas. Resultados: Foram selecionados dez estudos, oito deles (204 participantes) empregando somente a RF (74 microagulhamentos e 130 ablações) e dois (65 participantes) comparando a RF com a simpatectomia videotoracoscópica. Houve redução da intensidade da HP no subgrupo que aplicou microagulhamento (3 estudos, 74 participantes, diferença média -1,24, IC 95% -1,44 a -1,03, I2=50%). Em um estudo em que se realizou ablação simpática por RF (36 participantes) houve maior redução da intensidade da HP do que nos três estudos em que se realizou microagulhamento (-2,56, IC 95% -2,76 a -2,36 versus -1,24, IC 95% -1,44 a -1,03). Houve melhora na qualidade de vida após ablação simpática (2 estudos, diferença média -15,92, IC 95% -17,61 a -14,24, I²= 23%). No microagulhamento também houve melhora ... (Resumo completo, clicar acesso eletrônico abaixo)
Doutor

Introdução: Atualmente, a simpatectomia torácica videoassistida tornou-se o tratamento de escolha para hiperidrose palmar. O principal efeito colateral após operação é a hiperidrose compensatória (HC), sendo considerada a maior causa de insatisfação pelos pacientes. Objetivo: Comparar os resultados obtidos com a simpatectomia torácica videotoracoscópica realizada em dois níveis ganglionares distintos (terceiro versus quarto gânglio torácico) no tratamento da hiperidrose palmo-plantar, por meio de um ensaio clínico randomizado e cego. Método: Foram selecionados 40 pacientes entre fevereiro de 2007 e maio de 2009. Os participantes foram aleatorizados em dois grupos de 20 pacientes (G3 e G4) e submetidos à operação com seguimento de 12 meses (1ª semana, 1° mês, 6° mês e 12° mês). Utilizamos um método objetivo para mensuração do suor, aferindo a TEWL (transepidermal water loss) pelo VapoMeter, além da avaliação da qualidade de vida antes e após a operação. Também foram estudados: resolução da hiperidrose palmar, incidência e intensidade da HC. Resultados: Todos os pacientes apresentaram resolução da hiperidrose palmar após a operação, com diferença estatística em relação ao fator tempo, quando comparados os valores da TEWL palmar no pré-operatório com os seus respectivos valores na 1ª semana, 1° mês, 6° mês e 12° mês. O principal efeito colateral observado foi a hiperidrose compensatória, incidindo com maior frequência no grupo G3 após 12 meses de seguimento; apesar disto, não houve diferença estatística em relação à intensidade (gravidade) da HC nos grupos estudados. Verificou-se melhora da qualidade de vida desde a primeira avaliação do pós-operatório, sem diferença entre os grupos, que assim se manteve até o fim do estudo. As regiões mais acometidas pela HC foram dorso, tórax, abdome e coxas; no entanto, não houve diferença estatística da TEWL mensurada nessas regiões após 12 meses de acompanhamento. Conclusão: Ambas as técnicas foram efetivas no tratamento da hiperidrose palmar, gerando redução objetiva da TEWL independente do gânglio operado. A simpatectomia no nível de G3 apresentou maior incidência de HC; apesar disso, a melhora da qualidade de vida foi similar em ambos os grupos, não existindo diferença significativa da TEWL quantificada no dorso, abdome, coxas e pés após 12 meses
Introduction: Currently, video-assisted thoracic sympathectomy has become the preferred treatment for palmar hyperhidrosis. The main side effect after surgery remains compensatory hyperhidrosis (CH), considered the major cause of dissatisfaction for patients. Objective: To compare the results obtained of video-assisted sympathectomy performed on two distinct ganglion levels (third versus fourth thoracic ganglion) in the treatment of palmo-plantar hyperhidrosis, through a blind randomized clinical trial. Method: We selected 40 patients from February 2007 to May 2009. All participants were randomized into two groups of 20 patients (G3 and G4) and underwent the operation, being followed for 12 months (1 week, 1 month, 6 months and 12th month). We used an objective method for measuring sweat, checking the \"TEWL (transepidermal water loss) measured by the\"VapoMeter\", and evaluated the quality of life before and after the operation. Also studied were: palmar hyperhidrosis, incidence and intensity of the CH. Results: All patients ceased suffering from palmar hyperhidrosis after surgery, with statistical difference regarding the time factor when we compared the values of \"TEWL\" palmar preoperatively with their respective values at 1 week, 1 month, 6 months and 12th month. The main side effect observed was compensatory sweating, most frequent in G3 after 12 months of follow-up; despite this, there was no statistical difference regarding the intensity (severity) of CH in both groups. There was an improvement in quality of life since the first evaluation of the postoperative period, with no difference between groups, and so it remained until the end of follow-up. The areas most affected by CH were back, chest, abdomen and thighs; however, there was no statistical difference in the \"TEWL\" measured in these areas after 12 months of follow-up. Conclusion: Both techniques were effective in the treatment of palmar hyperhidrosis, generating objective reduction of \"TEWL\" regardless of the ganglion operated. Sympathectomy G3 had a higher incidence of CH, yet the improvement in quality of life was similar in both groups without significant differences of \"TEWL\" quantified on the back, abdomen, thighs and legs after 12 months of follow up

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A simpatectomia videotoracoscópica é o tratamento mais utilizado para pacientes com hiperidrose primária e o efeito colateral mais discutido é a sudorese reflexa. Contudo, os efeitos colaterais cronotrópicos e tardios são negligenciados e há discrepância de achados nos estudos que os avaliaram. Além disso, apesar de ser preconizada atualmente a abordagem do terceiro e quarto gânglios, todos os estudos encontrados na literatura endereçaram a abordagem do segundo e terceiro gânglios. Objetivo: Analisar o comportamento funcional cardiopulmonar no pós-operatório imediato, mediato e tardio de simpatectomia videotoracoscópica, bem como avaliar se a secção da cadeia simpática nos níveis de 3º e 4º gânglios torácicos interfere diretamente no desempenho em testes de exercícios cardiopulmonar, como o teste de caminhada de seis minutos e o teste de escada. Método: Testes de avaliação pulmonar, teste de caminhada de 6 minutos e o teste de escada foram realizados em 51 pacientes submetidos a simpatectomia videotoracoscópica, nos momentos do pré-operatório, primeiro dia, sétimo dia, trigésimo dia pós-operatórios e um ano após a cirurgia, bem como avaliação da dor e aplicação de escala de percepção de esforço de Borg. Resultados: A espirometria apresentou queda dos valores em torno de 50% no primeiro pós- operatório, permanecendo ainda abaixo dos valores normais até o sétimo pós- operatório. A manovacuometria apresentou queda de valores apenas no primeiro pós-operatório. Os testes de exercício mostraram alterações apenas no primeiro pós-operatório. Entretanto, a resposta cronotrópica, avaliada através da frequência de pulso ao repouso e após os testes de esforço, mostrou queda significativa logo no primeiro pós-operatório e queda gradual até a avaliação de um ano após o procedimento. Conclusão: A simpatectomia videotoracoscópica promove alterações imediatas na função cardiopulmonar que são mais pronunciadas até a 1ª semana, onde repercutem no pior desempenho durante os testes de esforço, mas desaparecem em até um mês após a cirurgia, sugerindo que as alterações mecânicas da videotoracoscopia sejam os fatores mais importantes para a queda dos parâmetros avaliados. Tardiamente há queda da frequência de pulso basal e da resposta cardíaca, após os testes de esforço, mas não no desempenho dos mesmos. Tais alterações podem ser atribuídas à desnervação simpática, mas não demonstraram repercussões clínicas na amostra avaliada.
The thoracoscopic sympathectomy is the most widely used treatment for patients with primary hyperhidrosis and the most discussed side effect is reflex sweating. However, chronotropic and late side effects are neglected and there is discrepancy findings in studies that evaluated it. Moreover, although currently recommended approach the third and fourth ganglia, all studies found in literature addressed the approach of the second and third ganglia. Objective: To assess cardiopulmonary performance in the immediate, mediate and late postoperative thoracoscopic sympathectomy period, as well as assess whether chain section to the levels of 3rd and 4th thoracic ganglia directly affects the performance on cardiopulmonary exercise testing, such as. Methods: Pulmonary evaluation tests, six minute walk test and stair climbing test were performed in 51 patients who underwent thoracoscopic sympathectomy in preoperative, first day, seventh day, thirtieth postoperative day and one year after surgery, as well as evaluation of pain and application of perceived Borg effort. Results: Spirometry showed a decrease of values around 50% in the first postoperative day, remaining still below normal values until the seventh postoperative day. The manovacuometry had reduced values only in the first postoperative day. Exercise tests showed alterations only in the first postoperative day. However, the chronotropic response as measured by pulse rate at rest and after stress tests showed significant drop right at the first postoperative day and gradually fall to the evaluation one year after the Conclusion: The thoracoscopic sympathectomy promotes procedure. immediate changes in cardiopulmonary function that are more pronounced until the 1st week, which have repercussions in the worst performance during the stress tests, but disappear within one month after surgery, suggesting that the videothoracoscopy mechanical changes is the most important factors for the fall of the evaluated parameters. Late there is a drop in baseline pulse frequency and pulse response after stress tests, but not in the performance thereof. Such changes can be attributed to sympathetic denervation, but showed no clinical repercussions in the sample investigated.

Orientador: Daniele Cristina Cataneo
Resumo: A simpatectomia videotoracoscópica é o tratamento mais utilizado para pacientes com hiperidrose primária e o efeito colateral mais discutido é a sudorese reflexa. Contudo, os efeitos colaterais cronotrópicos e tardios são negligenciados e há discrepância de achados nos estudos que os avaliaram. Além disso, apesar de ser preconizada atualmente a abordagem do terceiro e quarto gânglios, todos os estudos encontrados na literatura endereçaram a abordagem do segundo e terceiro gânglios. Objetivo: Analisar o comportamento funcional cardiopulmonar no pós-operatório imediato, mediato e tardio de simpatectomia videotoracoscópica, bem como avaliar se a secção da cadeia simpática nos níveis de 3º e 4º gânglios torácicos interfere diretamente no desempenho em testes de exercícios cardiopulmonar, como o teste de caminhada de seis minutos e o teste de escada. Método: Testes de avaliação pulmonar, teste de caminhada de 6 minutos e o teste de escada foram realizados em 51 pacientes submetidos a simpatectomia videotoracoscópica, nos momentos do pré-operatório, primeiro dia, sétimo dia, trigésimo dia pós-operatórios e um ano após a cirurgia, bem como avaliação da dor e aplicação de escala de percepção de esforço de Borg. Resultados: A espirometria apresentou queda dos valores em torno de 50% no primeiro pós- operatório, permanecendo ainda abaixo dos valores normais até o sétimo pós- operatório. A manovacuometria apresentou queda de valores apenas no primeiro pós-operatório. Os testes de... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: The thoracoscopic sympathectomy is the most widely used treatment for patients with primary hyperhidrosis and the most discussed side effect is reflex sweating. However, chronotropic and late side effects are neglected and there is discrepancy findings in studies that evaluated it. Moreover, although currently recommended approach the third and fourth ganglia, all studies found in literature addressed the approach of the second and third ganglia. Objective: To assess cardiopulmonary performance in the immediate, mediate and late postoperative thoracoscopic sympathectomy period, as well as assess whether chain section to the levels of 3rd and 4th thoracic ganglia directly affects the performance on cardiopulmonary exercise testing, such as. Methods: Pulmonary evaluation tests, six minute walk test and stair climbing test were performed in 51 patients who underwent thoracoscopic sympathectomy in preoperative, first day, seventh day, thirtieth postoperative day and one year after surgery, as well as evaluation of pain and application of perceived Borg effort. Results: Spirometry showed a decrease of values around 50% in the first postoperative day, remaining still below normal values until the seventh postoperative day. The manovacuometry had reduced values only in the first postoperative day. Exercise tests showed alterations only in the first postoperative day. However, the chronotropic response as measured by pulse rate at rest and after stress tests showed significant ... (Complete abstract click electronic access below)
Doutor

INTRODUÇÃO: O nível ótimo de simpatectomia para a hiperidrose axilar seria aquele que resultasse no tratamento definitivo da hiperidrose, associado à mínima intensidade de hiperidrose compensatória. OBJETIVO: Comparar duas técnicas cirúrgicas (níveis de desnervação) de simpatectomia por videotoracoscopia para o tratamento da hiperidrose axilar em um período de 12 meses. MÉTODO: De janeiro de 2004 a julho de 2007, foram seguidos 64 pacientes portadores de hiperidrose axilar randomizados para a simpatectomia por videotoracoscopia nos níveis dos gânglios T3-T4 ou T4. O acompanhamento ocorreu pelo período de 12 meses avaliando-se: a resolução da hiperidrose axilar; a incidência e intensidade da hiperidrose compensatória; sua evolução durante o estudo; e a qualidade de vida dos pacientes. RESULTADOS: Todos os pacientes apresentaram resolução da hiperidrose axilar. Não houve falhas terapêuticas. Após 12 meses, 57,6% dos pacientes do grupo T4 e 6,5% dos pacientes de T3-T4 apresentavam-se sem hiperidrose compensatória (p<0,001). Os pacientes do grupo T4 que apresentaram hiperidrose compensatória mostraram menor intensidade que os do grupo T3-T4, não sendo observada HC intensa (p<0,001). Verificou-se melhora da qualidade de vida desde a primeira avaliação, sendo que no grupo T4 esta se mostrou maior que no grupo T3-T4 a partir de seis meses de seguimento (p=0,002). CONCLUSÕES: Ambas as técnicas são efetivas para tratar a hiperidrose axilar. A complicação mais frequente foi a hiperidrose compensatória, que, cronologicamente, apresentou-se estável durante o estudo. A simpatectomia no nível T4 apresentou menor intensidade de HC, com melhora da qualidade de vida ao longo do seguimento.
INTRODUCTION: The optimum level of sympathectomy for axillary hyperhidrosis is one that would result in a definitive treatment of hyperhidrosis, associated with a lower severity of compensatory hyperhidrosis. OBJECTIVE: To compare two surgical techniques (denervation levels) of sympathectomy with video-assisted thoracic sympathectomy to treat axillary hyperhidrosis in a period of 12 months. METHODS: From January 2004 to July 2007, 64 patients with axillary hyperhidrosis were randomized for videoassisted thoracic sympathectomy at the T3-T4 or T4 ganglia level; they were followed up for a 12-month period in order to evaluate axillary hyperhidrosis, the incidence and severity of compensatory hyperhidrosis, its evolution throughout the study, and the patients\' quality of life. RESULTS: Sixty four patients presented resolution of the axillary hyperhidrosis. No therapeutic failures occurred. After 12 months, 57.6% of the patients of the T4 group and 6. 5% of the T3-T4 group had not developed compensatory hyperhidrosis (p<0.001). Patients of the T4 group who experienced compensatory hyperhidrosis presented a rate lower than those in the T3-T4 group, and no severe CH (p<0.001) was observed. Improvement in the quality of life was reported since the first evaluation, proving to be higher in the T4 group than in the T3-T4 group, starting after six months of follow-up (p=0.002). CONCLUSIONS: Both techniques are effective for treating axillary hyperhidrosis. The most frequent complication was compensatory hyperhidrosis, which remained chronologically stable throughout the study. The T4-level sympathectomy group presented a less severe compensatory hyperhidrosis,

Introdução: A hiperidrose primária consiste em uma sudorese excessiva em regiões limitadas do corpo. A simpatectomia torácica videotoracoscópica é um dos tratamentos propostos para a hiperidrose primária palmar, aliando alto sucesso terapêutico com baixo risco. A fisiopatologia da hiperidrose primária ainda não está totalmente esclarecida. Objetivos: Analisar as características morfométricas dos gânglios simpáticos torácicos (G3), removidos cirurgicamente de pacientes portadores de hiperidrose palmar. Como controle foram utilizados os gânglios simpáticos, removidos no mesmo nível (G3), de pacientes doadores de órgãos por morte encefálica, sabidamente sem hiperidrose. Foram estudadas a estereologia e a apoptose celular e as fibras do sistema colágeno /elastina da matriz extracelular. Métodos: Estudo transversal, no qual foram incluídos 40 gânglios simpáticos torácicos (G3) removidos do hemitórax esquerdo, provenientes de pacientes com hiperidrose palmar (Grupo I), submetidos à simpatectomia videotoracoscópica, e 14 gânglios simpáticos de pacientes controle sabidamente sem hiperidrose (Grupo II), removidos por esternotomia mediana. Resultados: Em relação ao sexo, a proporção de mulheres e homens foi de 30:10, no Grupo I, e 7:7 no Grupo II, com p = 0,103. A idade no Grupo I, variou de 10 a 42 anos, com uma média de 23,73 (+ 7,51) e no Grupo II variou de 17 a 68 anos, com uma média de 37,57 (+ 16,65) , apresentando um p = 0,009. A média das células ganglionares nos pacientes do Grupo I foi de 14,25 (+ 3,81) e no Grupo II foi de 10,65 (+ 4,93) com p = 0,007. A média das células ganglionares coradas pela caspase (apoptose) no Grupo I foi de 2,37 (+ 0,79) e no Grupo II foi de 0,77 (+ 0,28) com p < 0,001. A mediana da área de colágeno corada pelo Picrosírius no Grupo I foi de 0,80 IQ (0,08-1,87) e no Grupo II foi de 2,36 IQ (0,49-5,98) com p = 0,061. Conclusões: Os pacientes portadores de hiperidrose primária palmar apresentam um maior número de células ganglionares no gânglio simpático, em relação aos do grupo controle. Há um número maior de células ganglionares simpáticas em apoptose na hiperidrose. Os pacientes portadores de hiperidrose apresentam menos colágeno no gânglio simpático
Introduction: Primary hyperhidrosis consists of excessive sweating in small areas of the body. The video-assisted thoracic sympathectomy is one of the suggested treatments for primary palmar hyperhidrosis, which combines high therapeutic success with low risk. The pathophysiology of primary hyperhidrosis is not fully understood yet. Objectives: Analyzing the morphometric characteristics of the thoracic sympathetic ganglion (G3) surgically removed from patients with palmar hyperhidrosis. The sympathetic ganglion removed at the same level (G3) from patients who are organ donors after brain death and who did not have hyperhidrosis were used as control. Stereology and cellular apoptosis, as well as the fibers of the collagen/elastin system of the extracellular matrix were subjected to scrutiny. Methods: Cross-sectional study, which included 40 thoracic sympathetic ganglion (G3) removed from the left hemithorax of patients who have palmar hyperhidrosis (Group I) and underwent video-assisted thoracoscopic sympathectomy, and also 14 sympathetic ganglion from control patients who did not have hyperhidrosis (Group II), which were removed with median sternotomy. Results: In regards to gender , the proportion of women to men was 30:10 in Group I and 7:7 in Group II, with p = 0.103. The age Group I ranged from 10 to 42 years, with an average of 23.73 (+ 7.51) years and in Group II, from to 17 to 68 years, with an average of 37.57 (+ 16.65) years, with p = 0.009. The average of ganglion cells in Group I was 14.25 (+ 3.81) and in Group II, 10.65 (+ 4.93) with p = 0.007. The average ganglion cells stained by Caspase (apoptosis) in Group I was 2.37 (+0.79) and in Group II, 0.77 (+ 0.28) with p = 0.001. The median collagen area by Picrosirius in Group I was 0.80 IQ (0.08-1.87) and in Group II, 2.36 IQ (0.49-5.98) with p = 0.061. Conclusions: Patients with primary palmar hyperhidrosis have an increased number of ganglion cells in the sympathetic ganglion in comparison to the control group. There are a higher number of sympathetic ganglion cells in apoptosis in hyperhidrosis. Patients with hyperhidrosis have less collagen in sympathetic ganglion

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Hyperhidrosis is an idiopathic condition characterized by excessive sweating. Symptoms generally begin in childhood or early adolescence, and rarely improve with age. The excessive localized sweating generally occurs either spontaneously, or in association with stressful or emotionally charged situations. This prospective study aimed to investigate predictive factors for compensatory hyperhidrosis after thoracoscopic sympathicotomy. From 2000 to 2002, 80 patients (53 female and 27 male) underwent hyperhidrosis surgery. The patients, ranging from 12 to 56 years old, were studied and followed-up for 42.51 ?5.98 months. A satisfaction grading using a visual analogue scale -VAS (0 = not at all satisfied, and 10 = fully satisfied) was used. The surgical procedure was performed bilaterally on the second ganglion (T2) for facial hyperhidrosis, on the third and fourth ganglia (T3 and T4) for axillary hyperhidrosis, and on the third ganglion (T3) for palmar hyperhidrosis. The results showed that, 68 patients (85%) presented with compensatory sweating (CS), which was classified as mild (33.8%), moderate (33.8%) and severe (32.4%). Considering the final surgical results, 70 patients (87.5%) were satisfied with the outcome of the operation, while 10 patients (12.5%) were dissatisfied. Degrees of satisfaction varied according to sex, age, BMI and extent of denervation. Moreover, the compensatory hyperhidrosis was more severe in abdomen and back than in legs. In conclusion, although CS is a frequent adverse effect of sympathicotomy, the degree of patient satisfaction was high. Some factors were related to the occurrence and severity of CS and the most adequate patients to be submitted to this operation are young adult women whose BMI is less than 24.9
A hiperidrose prim?ria localizada ? um dist?rbio que atinge em algumas regi?es at? 4,6% da popula??o. Caracteriza-se por uma transpira??o em excesso, que vai al?m da necessidade de perda de calor corporal. Manifesta-se mais frequentemente nas m?os, face, axilas e p?s. Identifica de forma negativa o paciente no seu ?mbito familiar, profissional e psicol?gico, levando a uma queda na sua qualidade de vida. As pessoas acometidas limitam seu tempo despendido no ambiente do trabalho, em atividades sociais e recreativas, decorrente ao constrangimento. Muitas delas passam a ser reclusas e a ter problemas de conv?vio social, que pode culminar em fobia social. A simpatectomia tor?cica ? uma forma eficaz no tratamento da hiperidrose localizada. O trabalho visou investigar fatores preditivos para a hiperidrose compensat?ria ap?s a simpaticotomia tor?cica videoendosc?pica. Quanto ? metodologia, entre os anos de 2000 e 2002, 80 pacientes (53 mulheres e 27 homens) foram operados de hiperidrose e acompanhados durante 42,51 ? 5,98 meses, com idade variando de 12 a 56 anos. A satisfa??o destes pacientes quanto aos resultados do procedimento foi aferida por meio de uma escala de avalia??o. O procedimento foi executado bilateralmente no g?nglio T2 para a hiperidrose facial, nos g?nglios T3 e T4 para a hiperidrose axilar, e no g?nglio T3 para a hiperidrose palmar. De acordo com os dados obtidos, 68 pacientes (85%) apresentaram hiperidrose compensat?ria, que foi classificada como leve (33,85), moderada (33,8) e severa (32,4%). Quanto aos resultados da cirurgia, na avalia??o dos pacientes, 70 deles (87,5%) se consideraram satisfeitos, enquanto 10 pacientes (12,5%) disseram estar insatisfeitos. O grau de satisfa??o variou de acordo com o sexo, a idade, o IMC e a extens?o da opera??o. A hiperidrose compensat?ria foi mais intensa no abdome e dorso, comparando-se com as pernas. Em conclus?o, embora a hiperidrose compensat?ria seja um efeito adverso freq?ente ap?s a simpaticotomia, o grau de satisfa??o dos pacientes foi elevado. Alguns fatores foram relacionados ? ocorr?ncia e ? severidade deste problema. Pacientes mais adequados para essa opera??o devem ser mulheres adultas jovens com IMC inferior a 24,9. O car?ter multidisciplinar desse estudo fica atestado pela intera??o de profissionais de ?reas diversas como a epidemiologia, cirurgia geral, cirurgia experimental e cirurgia tor?cica

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Introduction: The human skin is 15% of the total body weight and has a vital function to promote the homeostasis of the organism by means of thermoregulation, hemodynamic control, production and excretion of metabolites. Hyperhidrosis (HH) is a pathological condition in which sweat production by the sweat glands is increased beyond the normal physiological needs of the body required to maintain thermo homeostasis. The pathophysiology of Focal Primary Hyperhidrosis (HHPF) remains poorly understood despite suggesting evidence of the occurrence of hyperactivity of the sympathetic nervous system. Objective: To investigate the functions of the Autonomic Nervous System (ANS), in patients with HHPF compared to a control group, apparently healthy, matched by gender, age and body mass index, using the HRV analysis in the time domain, frequency and nonlinearity. Material and Methods: 34 patients with primary hyperhidrosis focal, and the control group of 34 subjects were submitted to analysis of HRV in the time domain, frequency and non-linearity and the results were compared. Results: HRV parameters including mean RR, SDNN, RMSSD, PNN50, low frequency (LF) and high frequency (HF), did not show any difference between the two groups. The same occurred in the nonlinear domain, the SD1 parameters, SD2, ApEn, RP_Lmean% and REC. Conclusion: The findings suggest that the pathophysiology of the Focal Primary Hyperhidrosis , may be due to the peripheral involvement of the sympathetic nervous system (glandular level or nerve endings) since there was no difference between groups. More specific studies should help to elucidate the problem.
Introdução: A pele humana corresponde a 15% do peso total do corpo e tem como função vital promover a homeostasia do organismo por meio da termorregulação, controle hemodinâmico, produção e excreção de metabolitos. Hiperidrose (HH) é a condição patológica na qual a produção do suor pelas glândulas sudoríparas está aumentada além das necessidades fisiológicas normais do organismo requerida para manter a termo homeostasia. A fisiopatologia da hiperidrose primária focal (HHPF) permanece pouco compreendida apesar de sugerir a ocorrência de hiperatividade do sistema nervoso simpático. Objetivo: investigar as funções do Sistema Nervoso Autonômico (SNA), em pacientes com HHPF comparativamente a um grupo controle, aparentemente saudável, pareado por gênero, idade e índice de massa corporal, utilizando a análise da VFC nos domínios do tempo, da frequência e da não linearidade. Material e Método: 34 pacientes portadores de Hiperidrose Primária Focal, e o grupo controle de 34 indivíduos, foram submetidos à análise da VFC nos domínios do tempo, da frequência e da não linearidade e os resultados foram comparados. Resultados: os parâmetros da VFC incluindo RR médio, SDNN, RMSSD, PNN50, baixa frequência (LF) e alta frequência (HF), não evidenciaram qualquer diferença entre os dois grupos. O mesmo ocorreu no domínio não linear, nos parâmetros SD1, SD2, ApEn, RP_Lmean e %REC. Conclusão: os achados sugerem que a Hiperidrose Primária Focal do ponto de vista fisiopatológico, pode ser devida ao comprometimento periférico do sistema nervoso simpático (nível glandular ou de terminações nervosas) já que não houve diferença entre os grupos estudados. Estudos mais específicos deverão ajudar na elucidação do problema.

Introdução: A hiperidrose primária (HP) é uma desordem que afeta negativamente a qualidade de vida de seus portadores. A fisiopatologia da HP não é bem compreendida e acredita-se que uma complexa disfunção do sistema nervoso simpático esteja relacionada com sua etiologia. A ressecção de um ou mais gânglios da cadeia simpática torácica constitui-se como o método mais eficiente de controle da HP; apesar disso, pouco se sabe sobre o funcionamento dos gânglios simpáticos em indivíduos normais e em portadores de HP. Objetivos: Analisar a expressão de acetilcolina e das subunidades 3 e 7 de seu receptor nicotínico neuronal em gânglios da cadeia simpática torácica de portadores de HP palmar e comparar estes resultados com os obtidos de não portadores; avaliar se existe diferença de tamanho entre esses gânglios. Métodos: Estudo transversal, no qual foram analisados dois grupos de 20 participantes: no grupo Hiperidrose, portadores de HP palmar, candidatos a simpatectomia torácica; no grupo Controle, doadores falecidos de órgãos sem história prévia de sudorese excessiva. Em todos os indivíduos foram realizados: ressecção do 3º gânglio simpático esquerdo; aferição do maior diâmetro do gânglio; avaliação imunohistoquímica pela quantificação das áreas de expressão forte e fraca de anticorpos primários contra acetilcolina e contra as subunidades 3 e 7 de seu receptor nicotínico neuronal. Resultados: A mediana da idade dos participantes foi menor no grupo Hiperidrose em relação ao Controle; a proporção de homens e mulheres foi de 3:17 no grupo Hiperidrose e 9:11 no Controle. A expressão da subunidade 3 foi semelhante em ambos os grupos (p = 0,78 para expressão forte e p = 0,31 para expressão fraca). A área de expressão forte da subunidade 7 correspondeu a 4,85% da área total em portadores de HP e a 2,34% nos controles (p < 0,001), enquanto a área de expressão fraca foi de 11,48% no grupo Hiperidrose e de 4,59% no Controle (p < 0,001). Expressão forte da acetilcolina foi encontrada em 4,95% da área total no grupo Hiperidrose e 1,19% no Controle (p < 0,001); expressão fraca foi encontrada em 18,55% e 6,77%, respectivamente (p < 0,001). O diâmetro dos gânglios ressecados foi de 0,71cm no grupo Hiperidrose e de 0,53cm no Controle (p < 0,001). Conclusões: Existe um aumento da expressão de acetilcolina e da subunidade 7 do seu receptor nos gânglios simpáticos de portadores de HP; a subunidade 3 do receptor nicotínico de acetilcolina tem expressão semelhante em gânglios simpáticos de portadores de HP e de não portadores; gânglios da cadeia simpática torácica apresentam diâmetro maior em portadores de HP
Introduction: Primary hyperhidrosis (PH) is a disorder that impairs the quality of life of its bearers. The PH physiopathology is not well understood and a complex sympathetic nervous system dysfunction seems to be related with its etiology. The resection of one or more thoracic sympathetic chain ganglia is the most effective PH treatment; however sympathetic ganglia function in normal subjects and in PH patients is unknown. Objectives: Analyzing the immunohistochemical expression of acetylcholine and its neuronal nicotinic receptors 3 and 7 subunits in thoracic sympathetic ganglia of PH patients and compare the results with those obtained from subjects without this disorder; identifying possible differences in size of these ganglia. Methods: Cross-sectional study, in which two groups of 20 subjects were analyzed: the Hyperhidrosis group, with palmar PH patients eligible to thoracic sympathectomy and the Control group, with organ donators after brain death without hyperhidrosis historical. For each subject it were performed: resection of the third left sympathetic ganglion; measurement of the ganglions diameter; immunohistochemical evaluation by quantification of intense and mild expression areas of primary antibodies against acetylcholine and its neuronal nicotinic receptors 3 and 7 subunits. Results: The median of participants age was smaller in Hyperhidrosis group than in Control; the male/female ratio was 3:17 in Hyperhidrosis group and 9:11 in Control. The 3 subunit expression was similar in both groups (p = 0.78 for intense expression and p = 0.31 for mild expression). Intense 7 subunit expression area was 4.85% in PH patients and 2.34% in controls (p < 0.001) whereas mild expression area was 11.48% in Hyperhidrosis group and 4.59% in Control (p < 0.001). Intense acetylcholine expression was found in 4.95% of total area in Hyperhidrosis group and in 1.19% in Control (p < 0.001); mild expression was found in 18.55% and 6.77%, respectively (p < 0.001). Ganglia diameter was 0.71cm in Hyperhidrosis group and 0.53cm in Control (p < 0.001). Conclusions: There is a higher expression of acetylcholine and its neuronal nicotinic receptors 7 subunit in sympathetic ganglia of PH patients; the 3 subunit of the neuronal nicotinic acetylcholine receptor shows similar expression in sympathetic ganglia of PH patients and subjects without this disorder; thoracic sympathetic chain ganglia diameter is bigger in PH patients

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Analyze, in patients with primary hyperhidrosis (PH) who was undergone to videothoracoscopic sympathicotomy, the degree of vascular denervation after surgical transection of the thoracic sympathetic chain by measuring ultrasonografic parameters in carotid and vertebral arteries. Methods: Twenty-four patients with PH underwent forty-eight endoscopic thoracic sympathicotomy and were evaluated by duplex eco-doppler measuring systolic peak velocity (SPV), diastolic peak velocity (DPV), pulsatility index (PI) and resistivity index (RI) in bilateral common, internal and external carotids, besides bilateral vertebral arteries. The exams were performed before operations and a month later. Wilcoxon test was used to analyse the differences between the variables before and after the sympatholisis. Results: T3 sympathicotomy segment was the most frequent transection done (95,83%), as only ablation (25%) or in association with T4 (62,50%) or with T2 (8,33%). It was observed increase in RI and PI of the common carotid artery ( p<0,05). The DPV of internal carotid artery decreased in both sides (p<0,05). The SPV and the DPV of the right and left vertebral arteries also increased (p<0,05). Asymmetric findings were observed so that, arteries of the right side were the most frequently affected. Conclusions: Hemodynamic changes in vertebral and carotid arteries were observed after sympathicotomy for PH. SPV was the most often altered parameter, mostly in the right side arteries, meaning significant asymmetric changes in carotid and vertebral vessels. Therefore, the research findings deserve further investigations to observe if they have clinical inferences
O delineamento desse estudo objetiva a an?lise das repercuss?es na hemodin?mica das art?rias car?tidas e vertebrais, respons?veis pela irriga??o do enc?falo, ap?s a desnerva??o da cadeia simp?tica ao n?vel de T2, T3 e/ou T4, provocada pela simpaticotomia tor?cica videotoracosc?pica para tratamento da hiperidrose prim?ria. Foram estudados pacientes submetidos a 48 simpaticotomias tor?cicas por v?deo, utilizando como par?metros de compara??o pr? e p?s-operat?rios vari?veis num?ricas de velocidade de pico sist?lico, velocidade de pico diast?lico, ?ndice de resist?ncia e ?ndice de pulsatibilidade. As vari?veis foram obtidas a partir do exame de eco-doppler das art?rias car?tidas e vertebrais bilateralmente utilizando o mesmo aparelho de ultrassom e o mesmo examinador no per?odo de uma semana que antecedeu ao procedimento cir?rgico e 30 dias depois da opera??o. As diferen?as das vari?veis do pr? e do p?s-operat?rio foram mensuradas pelo teste de Wilcoxon, utilizando o software SPSS? 7.5 for Windows (SPSS, Inc., Chicago, IL). Os achados de altera??es significativas foram discutidos, observando os dados da literatura m?dica relacionados com estudos na mesma linha de investiga??o e enfatizando os aspectos de interdisciplinaridade cient?fica

INTRODUÇÃO: Com o avanço da tecnologia, alguns equipamentos vêm sendo incorporados ao ato operatório, dentre eles os robôs, que apesar da notoriedade ainda são considerados controversos. MÉTODO: Trabalho clínico aleatorizado, duplo cego, avaliando a segurança e a eficiência, na cirurgia torácica videoassistida, para o tratamento da hiperidrose palmar/axilar, comparando o grupo \"Hu\" (auxiliar humano) e o grupo \"Ro\" (auxiliar robô), na manipulação da ótica. Foram analisados 38 casos, 19 casos em cada grupo, \"Hu\" e \"Ro\". Todos os procedimentos foram realizados sob anestesia geral, com secção do nervo simpático ao nível T3, T4 e G3. Os procedimentos foram filmados e gravados, sendo que dois observadores independentes avaliaram: número de movimentos inadvertidos, toques em estruturas da cavidade torácica e número de vezes em que a ótica foi retirada para limpeza. Foram avaliados, ainda, os seguintes parâmetros: 1. quanto à segurança - intercorrências cirúrgicas, dor torácica e aspecto da cicatriz; 2. quanto à eficácia - tempos total, cirúrgico e de utilização de ótica, presença de anidrose palmar/axilar, permanência hospitalar, hiperidrose vicariante e satisfação com o resultado do procedimento. RESULTADOS: Os resultados obtidos comparando o grupo \"Hu\" e \"Ro\", quanto à segurança, mostram que não houve diferença estatisticamente significativa nos seguintes parâmetros: intercorrências cirúrgicas, movimentos inadvertidos, dor torácica e aspecto da cicatriz entre os dois grupos. Porém, o número de toques em estruturas na cavidade torácica foi menor no grupo \"Ro\" (p<0,001). Quanto à eficácia, não ocorreu diferença estatisticamente significativa entre os dois grupos nos seguintes parâmetros: número de vezes em que a ótica foi retirada para limpeza, presença de anidrose palmar/axilar, permanência hospitalar, hiperidrose vicariante e grau de satisfação com o resultado do procedimento. Porém, o grupo \"Hu\" apresentou menor tempos total, de cirurgia e de utilização da ótica (p<0,001), quando comparado ao grupo \"Ro\". CONCLUSÕES: Podemos concluir que o auxílio da robótica no manuseio da ótica, na cirurgia videoassistida para realização de simpatectomia torácica para tratamento da hiperidrose, é seguro e eficiente, quando comparado ao auxílio humano.
INTRODUCTION: With the advance of technology, some pieces of equipment have been incorporated into the surgical act, among which robots, that, in spite of their notoriety, are still considered controversial. METHOD: A randomized double blind clinical study to evaluate the safety and efficiency in video-assisted thoracic surgery for the treatment of palmar/axillary hyperhidrosis, comparing the \"Hu\" (human-assisted) group and the \"Ro\" (robot-assisted) group, in the manipulation of the optics. Thirty-eight cases were analyzed, 19 cases in each group, \"Hu\" and \"Ro\". All the procedures were conducted under general anesthesia, with the ablation of the sympathetic nerve at T3, T4 and G3 levels. The procedures were recorded, in that two independent observers assessed: the number of involuntary movements, contact with structures of the thoracic cavity, and the number of times in which the optics was removed to be cleaned. The following parameters were also assessed: 1. on safety - surgical events, thoracic pain and scar appearance; 2. on efficiency - total times, surgical and optics use, presence of palmar/axillary anhydrosis, hospital stay, vicarious hyperhidrosis and satisfaction with the result of the procedure. RESULTS: The results obtained by comparing the \"Hu\" and \"Ro\" groups on safety show there was no significant statistical difference in the following parameters: surgical events, involuntary movements, thoracic pain and scar appearance between the two groups. However, the number of contacts with structures in the thoracic cavity was less in the \"Ro\" group (p<0.001). On efficiency, there was no significant statistical difference between the two groups in the following parameters: number of times in which the optics was removed to be cleaned, presence of palmar/axillary anhydrosis, hospital stay, vicarious hyperhidrosis, and the level of satisfaction with the result of the procedure. However, the \"Hu\" group presented less total time of surgery and of optics use (p<0.001), when compared to the \"Ro\" group. CONCLUSIONS: We can conclude that the robot-assisted procedure in handling the optics in video-assisted thoracic sympathectomy for the treatment of hyperhidrosis is safe and efficient when compared to the human-assisted procedure.

Thesis deals with the design and realization of revisions devices for the treatment of hyperhidrosis. One of the methods how to treat hyperhidrosis is iontophoresis. This prevents sweating using an electric current. The work is divided on the parts. First part is a theory, which deals with basic principles of treatment. Next part is the analysis of original solutions and hardware design of new solutions. In conclusion I revive device by microcontroller programming and checking its functionality. I was able to create a prototype board, programmable firmware and successfully tested a prototype.

Uvod: Primarna fokalna hiperhidroza (PFH) je poremećaj nepoznate etiologije koji se karakteriše prekomernim znojenjem na predilekcionim mestima. Podjednako se javlja kod osoba muškog i ženskog pola tokom dvadesetih i početkom tridesetih godina života, pri čemu se smatra da je učestalos PFH oko 2,8% u ukupnoj populaciji. Nastaje kao posledica hiperaktivnosti simaptičkog nervnog sistema ka znojnim žlezdama. Karakteristično je za PFH da se ne javlja noću, što sugeriše da emocionalni stimulus igra bitnu ulogu u nastanku ovog poremećaja. Bilateralna torakoskopska simpatektomija (BTS) je minimalno invazivna hirurška procedura koja se danas primenjuje u trajnom lečenju PFH, sa niskom stopom komplikacija i omogućava lečenje kao jednodnevne hirurške procedure. Ciljevi ovog istraživanja su bili: a) da se ispita ukupna efikasnost BTS na trajno smanjenje PFH predilekcionih delova tela - dlanova, pazušnih jama, lica i stopala; b) da se ispita efiksanost BTS kod osoba sa PFH u odnosu na različite nivoe transekcije simpatičkog lanca; c) da se ispita uticaj BTS na plućnu i srčanu funkciju kod operisanih osoba sa PFH; d) da se ispita pojava, trajanje i intenzitet kompenzatornog znojenja nakon BTS kod operisanih osoba sa PFH; e) da se ispita pojava, trajanje, lokalizacija i tretman postoperativnog bola nakon BTS kod osoba sa PFH; f) da se utvrde postoperativne komplikacije BTS kod osoba sa PFH; i g) da se ispita uticaj BTS na kvalitet života kod operisanih osoba sa PFH. Radna hipoteza istraživanja je bila da hirurška procedura - minimlano invazivna BTS ima značajan efekat na prekomerno znojenje na predilekcionim mestima kod osoba sa PFH, da je praćena sa minimalnim morbiditetom, bez kliničkog uticaja na plućnu i srčanu funkciju i da značajno poboljšava kvalitet života operisanih osoba. Materijal i metod: Urađena je prospektivna klinička studija koja je uključila 435 osoba sa PFH, koji su operisani bilateralnom torakoskopskom simpatektomijom, na Klinici za grudnu hirurgiju, Instituta za plućne bolesti Vojvodine u Sremskoj Kamenici između 2010 i 2014 godine. Kriterijumi za uključivanje u studiju bili su: a) da su osobe sa utvrđenom i procenjenom PFH pristale da učestvuju u istraživanju ispunjavajući preoperativno i postoperativno upitnike o efektima BTS i kvalitetu života nakon operacije; b) da nisu imali prethodne grudno hirurške intervencije, frakture rebara, masivne pneumonije ili empijem pleure; c) da nisu imali teški poremećaj plućne ili srčane funkcije; d) da ne boluju od sekundarne hiperhidroze. Primarna fokalna hiperhidroza je bila ustanovljena i procenjena anamnestičkim podacima, kliničkom slikom i pregledom koji je bio fokusiran na kvalitativno ispitivanje. Bilateralna torakoskopska simpatektomija izvođena je u opštoj anesteziji, a transekcija simpatičkog lanca je rađena pomoću ultrazvučno aktiviranog skalpela. Osobe sa izvedenom BTS zbog PFH bile su klasifikovane u tri grupe, u zavisnosti od nivoa transekcije simpatičkog lanca: a) transekcija na nivou drugog do četvrtog torakalnog gangliona (T2-T4); b) transekcija na nivou trećeg do četvrtog torakalnog gangliona (T3-T4); i c) transekcija na nivou drugog do trećeg torakalnog gangliona (T2-T3). Za procenu kompenzatornog znojenja i kvaliteta života korišćene je: Hyperhidrosis Disease Severity Scale (HDSS) za intenzitet kompenzatornog znojenja i kvaliteta života nakon BTS. Rezultati: Od 435 osoba sa PFH kod kojih je urađena BTS, bilo je 142 (32,64%) osobe muškog pola i 293 (67,36%) osoba ženskog pola, prosečne starosti od 29,68±7,6 godina. Pozitivan nasledni faktor navelo je 167 osoba (38,62%). Najčešća lokalizacija prekomernog znojenja kod osoba u ovom istraživanju je bila kombinacija dlanova, pazušnih jama i tabana, koju je imalo 167 osoba (38,39%). Pre operacije, preko 60% ispitivanih osoba je navelo da im je kvalitet života loš ili izuzetno loš. Kod svih operisanih osoba u ovom istraživanju, operacija je izvedena uspešno obostrano. Nije bilo smrtnih ishoda. Od intraoperativnih komplikacija zabeležena je jedna konverzija (0,23%) u minitorakotomiju zbog krvavljenja iz interkostalne vene. Neposredni postoperativni uspeh BTS kod operisanih osoba zbog PFH, a na osnovu prve kontrole posle nedelju dana bio je zabeležen kod svih (99,54%), osim kod dve osobe (0,46%) koje su imale postoperativne komplikacije: pareza n. ulnarisa i Hornerov sindrom kod jedne osobe i Horner sindrom kod druge osobe. Postoperativni morbiditet nakon BTS bio je zabeležen kod 32 osobe (7,35%). Izrazito poboljšanje, odnosno značajno smanjenje znojenja kod osoba sa PFH zabeleženo je kod 428 operisanih (98,39%). Osobe sa transekcijom simpatičkog lanca na nivou gangliona T3-T4 imali su najbolji rezultat sa poboljšanjem kvaliteta života u 85,03% operisanih. Kompenzatorno znojenje se nakon BTS javilo kod 316 (72,64%) operisanih osoba, a samo 2,53% je navelo da je postoperativno kompenzatorno znojenje izuzetno jakog intenziteta. Postoperativni bol bio je prisutan kod 79,77% operisanih osoba, sa prosečnim trajanjem do dve nedelje. Analgetike je postoperativno koristilo 24,21% anketiranih osoba. Od 287 operisanih osoba u ovom istraživanju, koji su pre operacije naveli da su imali i prekomerno znojenje tabana, nakon 6 meseci 185 osoba (64,46%) je navelo da se prekomerno znojenje tabana smanjilo. Iako postoji statistička značajnost u promeni vitalnog kapaciteta u smislu njegovog povećanja šest meseci nakon BTS (sa 4,49±1,15 L na 4,54±1,11 L), ta promena nije bila klinički relevantna. Promene u krvnom pritisku i srčanom pulsu, iako zabeležene, takođe nisu imale klinički značaj. Kvalitet života, pre BTS ocenjen kao loš (i izuzetno loš) bio je prisutan kod 265 osoba (60, 92%), a 6 meseci posle operacije ocenjen je kao odličan i dobar kod 428 osoba (98,39%). Zaključak: BTS kao minimalno invazivna hirurška procedura kod osoba sa PFH ima minimalni morbiditet, a visoku uspešnost u smanjenju prekomernog znojenja na predilekcionim mestima, sa poboljšanjem kvaliteta života kod 98,39% operisanih, sa minimalnim promenama plućne i srčane funkcije koje nisu klinički relevantne.
Primary focal hyperhidrosis (PFH) is a disorder of an unknown etiology, characterized by excessive sweating of predilective parts of the body. It affects men and women equally, with a peak incidence in the later second and early third decades of life, with incidence of up to 2,8% of the world population. It is caused by hyperactivity of the sympathetic nervous system to the sweat glands. It has been shown that PFH does not occur during the sleeping times, which suggests that emotional stimuli play an important role in this disorder. Bilateral thoracoscopic sympathectomy (BTS) is minimal invasive surgical procedure, which has evolved into an effective and permanent treatment for severe PFH, with low rate of morbidity and it can be performed as the one day surgical procedure. The aims of this investigation were: a) to examine the overall efficiency of BTS on permanent reduction of PFH of predilective parts of the body-palms, armpits, faces and soles; b) to examine the efficiency of BTS with different levels of transection among the persons with the PFH; c) to examine the influence of BTS on cardio-pulmonary function tests in persons with PFH after the operation; d) to examine the incidence, duration and intensity of compensatory sweating after BTS among persons with PFH; e) to examine the incidence, duration, localization and treatment of postoperative pain after BTS among persons with PFH; f) to determine postoperative complications of BTS among persons with PFH; g) to examine the influence of BTS on quality of life among persons with PFH. The working hypothesis of this investigation is that surgical procedure – minimal invasive BTS has the permanent effect on excessive sweating of predilective parts of the body among persons with PFH, followed by minimal morbidity, without clinical influence on cardio-pulmonary function and significantly improves the quality of life among persons with PFH. This was a prospective clinical study which included 435 patients with PFH, who have been operated with BTS, at the Clinic for Thoracic surgery, the Institute for pulmonary diseases of Vojvodina, Sremska Kamenica, between 2010 and 2014. The including criteria for the investigation were: a) persons with confirmed and estimated PFH accepted to participate in this investigation, fulfilling pre and postoperatively questionnaire about BTS effects and quality of life after the operation; b) absence of previous thoracic surgical procedures, rib fractures, massive pneumonias or pleural empyema; c) satisfactory cardio-respiratory function; d) absence of secondary hyperhidrosis. Primary focal hyperhidrosis was confirmed and estimated by anamnesis, clinical examination focused on qualitatively examination. Bilateral thoracoscopic sympathectomy was performed with general anesthesia, using harmonic scalpel for transection of sympathetic chain. Persons with PFH who underwent the BTS were classified into three groups, depending the level of transaction of sympathetic chain: a) transection at the level from the second to the forth thoracic sympathetic ganglion (T2-T4); b) transection at the level from the third to the forth thoracic sympathetic ganglion (T3-T4); c) transection at the level from the second to the third thoracic sympathetic ganglion (T2-T3). For the assessment of postoperative pain, compensatory sweating and quality of life next scales have been used: standardized numeric pain rating scale and Hyperhidrosis Disease Severity Scale (HDSS) for intensity of compensatory sweating and quality of life. Among 435 persons with PFH who underwent the BTS in this investigation, 142 (32,64%) were male and 293 (67,36%) female persons, with mean age of 29,68±7,6. There was no mortality or serious intraoperative complications that required operative conversio from minimal invasive surgical procedure to thoracotomy. Among 435 persons with PFH who underwent the BTS in this investigation, 142 (32,64%) were male and 293 (67,36%) female persons, with mean age of 29,68±7,6. Positive genetic factor has been found in 167 persons (38,62%). The most common localisation of excessive sweating in this investigation was the combination of palms, armpits and soles in 167 persons (38,39%). Before the operation, over 60% of persons estimated their quallity of life as bad or very bad. The operation was successfully performed in all patients bilaterally. There was no mortality in this investigation. There was one intraoperative complication, bleeding from intercostal vein, requiring conversion to minithoracotomy. Immediatelly postoperative success after BTS seven days after the operation was achieved in all persons accepted in two persons (0,46%) due to the postoperative complications: nervous ulnaris paresis and Horner syndrome in one person and Horener syndome in the other person. Postoperative morbidity after the BTS was recoreded in 32 persons (7,35%). Marked improvement, as significant reduction of sweating in persons with PFH was achieved in 428 operated persons (98,39%). Transection of sympathetic chain on level T3-T4 achieved improvement of quality of life in 85,03% operated persons with PFH. Compensatory sweating after the BTS has occurred in 316 (72,64%) operated persons, but only 2,53% operated persons declared compensatory sweating as severe. Postoperative pain was presented in 79,77% operated persons, with average duration of two weeks. Analgetics used only 24,21% of operated persons. There were 287 operated persons in this investigation, who claimed to have plantar hyperhidrosis before the operation and six months after the operation 185 persons (64,46%) claimed to have a reduction of plantar sweating. Although there was a clinical significance in changes of vital capacity after the BTS (from 4,49±1,15 L to 4,54±1,11 L), ther was no clinical significance. Changes in blood pressure and heart rate, although recoreded, had no clinical significance. Quality of life, before the BTS was recorded as bad or very bad in 265 persons (60,92%), and six months after the operation as excellent or good in 428 persons (98,39%) persons. Conclusion: In patients with PFH, BTS as minimal invasive surgical procedure, has a minimal morbidity and high success in treatment of excessive sweating, with improvemnet of quality of life in 98,39% operated person, with changes in cardio-pulmonary functions that are not clinical relevant.

La hiperhidrosis primaria esencial es una entidad clínica caracterizada, principalmente, por una sudoración excesiva a nivel palmar, plantar y axilar, asociándose una sintomatología general sugestiva de hiperactividad simpática, como es el enrojecimiento facial, palpitaciones, temblor, cefalea y un elevado nivel de ansiedad, síntomas difíciles de considerar como causa o consecuencia. No se conoce la etiología de este trastorno; sin embargo, existen diferentes explicaciones acerca del mecanismo de producción del mismo, y tampoco se conoce con exactitud la anatomía del sistema nervioso simpático de la vía ocular. Los tratamientos médicos son ineficaces y/o temporales, lo cual ha motivado la búsqueda de una solución quirúrgica. Por el momento, la denervación simpática torácica es un procedimiento eficaz para el control de la sudoración palmar, axilar y plantar. La simpaticolisis torácica superior puede presentar el inconveniente de presentar efectos colaterales secundarios a la propia denervación simpática, tanto a nivel sistémico, como sobre la región craneofacial, siendo la función oculomotora una de ellas. La simpaticolisis lumbar puede presentar complicaciones graves como eyaculación precoz en el caso de los hombres, o problemas en el control de esfínteres en el caso de las mujeres. Al estar implicados en el tratamiento quirúrgico de este trastorno, una vez confirmado y ratificado el tratamiento quirúrgico como tratamiento estándar nos vemos obligados a enfocar nuestra investigación sobre los efectos secundarios de la técnica quirúrgica y sus repercusiones. Por todo ello hemos dirigido la atención al estudio de la denervación simpática T2-T3 y su efecto sobre la vía óculo-simpática y la redistribución del sudor en pacientes con hiperhidrosis primaria.

Die vorliegende Arbeit analysiert retrospektiv die funktionellen Beeinträchtigungen und Einschränkungen der Lebensqualität von Kindern und Jugendlichen mit primärer fokaler Hyperhidrose. Grundlage der vorliegenden Untersuchung bildeten ein selbst entworfener Fragebogen sowie die Auswertung der Ambulanzkarten von 35 Kindern und Jugendlichen mit primärer fokaler Hyperhidrose im Alter von unter 18 Jahren, die sich im Zeitraum von Januar 2000 bis Dezember 2009 in der Hyperhidrose-Sprechstunde der Hautklinik des Universitätsklinikums Würzburg vorstellten. Die vorliegende Arbeit spezifiziert die täglichen Einschränkungen, welche die Kinder und Jugendlichen erleben. Für zwei Drittel der Patienten war das Schwitzen nach Maßgabe der Hyperhidrosis Disease Severity Scale kaum zu ertragen oder unerträglich und beeinträchtige häufig oder immer die täglichen Aktivitäten. Zwei Drittel der Patienten gaben an, derart stark unter der Krankheit zu leiden, dass sie ihre Lebensweise der Krankheit anpassten. Weiter konnte gezeigt werden, dass die Einschränkungen ähnlich gravierend sind wie bei Erwachsenen und anderen Dermatosen in der Kindheit. Die psychische und soziale Entwicklung kann bei einigen Betroffenen nachhaltig beeinträchtigt werden, was sich auch auf das spätere Leben auswirken kann. Diese Erkenntnis ist wichtig, um eine frühzeitige Diagnose und adäquate Behandlung voranzutreiben
The present paper analyses the functional impairment and limitation of the quality of life of children and adolescents with primary focal hyperhidrosis. This study is based on a newly designed questionnaire and the analysis of the files of 35 underaged patients in the period from January 2000 to December 2009. This paper specifies the daily impairment of children and adolescents. For two third their sweating was barely tolerable or intolerable and frequently or always interfered with their daily activities according to the Hyperhidrosis Disease Severity Scale. Two third had to change their way of life because of the disease. Furthermore the impairment was comparable to the impairment of the adults or to the impairment of other dermatologic diseases. Their psychological and social development was restricted and inflicts their future. Awareness of these facts is essential to provide an early diagnosis and treatment

A dissertation submitted in partial compliance with the requirements for the Master's Diploma in Technology: Homoeopathy, Technikon NataI, 1994.
The efficacy of Pilocarpus Jaborandi in the management of emotional palmar hyperhidrosis was studied. It was hypothesised that this homoeopathic drug would cause a significant decrease in sweat production rates. The study was double blinded and consisted of thirty treated patients, with fifteen patients in group and fifteen patients in the the placebo group. Patients were chosen by convenience sampling with no specifications of age or sex. The treated group received Pilocarpus Jaborandi 9 CH, and were instructed to take five pills on waking everyday for ninety days. The other group received a placebo also for ninety days. Quantification of the first day, on ninetieth day of sweat production was done on the forty-fifth day and treatment, by means of on the sweat collection tests. In each test sweat was
M

碩士
中國醫藥大學
醫務管理學系碩士班
100
Objective: Hyperhidrosis palmaris could seriously affect the quality of life of patients. In spite that operations are regarded as the optimal treatment, the quality of life after the operation is not satisfactory. Aiming at hyperhidrosis palmaris operations, Bureau of National Health Insurance conducted the precertification review policy in 2006. This study tends to understand the effects of such a payment policy on the operation acceptance of hyperhidrosis palmaris and the trend. Moreover, the different impact of the policy on distinct patients and institutes are analyzed. Method: Based on 2000 and 2005 population-based National Health Insurance Research Database, hyperhidrosis palmaris patients with the age above 20 and ICD-9 being 780.8 within 1999-2009 were acquired for the analyses. In addition to descriptive analysis and bivariate analysis, logistic regression with Generalized Estimating Equations (GEE) is further utilized for inferential statistics. Results: Among 4,328 hyperhidrosis palmaris patients, 23.49% of them received the operations. 1,016 patients who accepted the operations, most of them were female (56.50%), aged 20-29 years (62.89%), without catastrophic illness(98.13%), Charlson comorbidity index score being 0 (43.25%), with the premium-based monthly salary below NT$22800 (64.76%), not low-income household (99.7%), and living in the area of Taipei branch (37.3%) with the urbanization degree 2 & 3 (47.05%), their medical treatment in private hospital(42.91%) or district hospitals (35.24%). From GEE, the significant factors in operations include gender, age, policy, comorbidity, branches of Bureaus of National Health Insurance, degree of urbanization, and the accreditation level and the ownership of the hospital. Conclusion: Hyperhidrosis palmaris operations dropped from 37.39% in 2000 to 0.79% in 2006, and the drop was even more obvious after the implementation of the precertification review policy. Personal traits, health conditions, payment policy, and the institutes’ characteristics were considered as the major factors in accepting hyperhidrosis palmaris operations.