Surgical Endoscopy and Other Interventional Techniques, 2006
Background Bilateral upper thoracic sympathectomy or sympathicolysis, currently the standard trea... more Background Bilateral upper thoracic sympathectomy or sympathicolysis, currently the standard treatment for palmar or axillary hyperhidrosis, is regarded as a safe procedure. This study evaluates the quantitative and qualitative incidence of intraoperative and postoperative complications resulting from bilateral thoracic sympathicolysis. Methods From 1996 to 2004, 458 consecutive patients with primary hyperhidrosis underwent surgery. These patients comprised 143 men (31.2%) and 315 women (68.7%) with a mean age of 26 years (range, 14–52 years). In all but seven cases, the procedure was bilaterally synchronous. Results No mortality was recorded. The anhydrosis rate was 97.4%, with a hypohidrosis rate of 2.4% and a failure rate of 0.2%. The latter was resolved with reintervention. The mean hospital stay was 17 h. The rate of major perioperative complications with conversion to thoracotomy was 0.4%. The overall rate of postoperative complications was 3.6%. The complications and rates observed were as follows: pneumothorax (2.06%), subcutaneous emphysema (1.08%), pleural bleeding (0.2%), hemothorax (0.1%), and atelectasis (0.1%). Compensatory hyperhidrosis was observed in 48.4% of the patients, but the sensation of compensatory hyperhidrosis was reported in 85.6% of the cases. Excessive dryness of the hands was reported in 0.38%, Horner’s syndrome in 0.32%, and gustatory hyperhidrosis in 1.1% of the cases. The overall satisfaction rate was 88.5%. Conclusions The results suggest that endoscopic bilateral thoracic sympathicolysis is an effective method for managing primary hyperhidrosis, especially severe palmar hyperhidrosis, but it is necessary to inform patients fully concerning the undesirable effects.
TO determine the location of hyperhidrosis, the accompanying signs and symptoms, and patient anxi... more TO determine the location of hyperhidrosis, the accompanying signs and symptoms, and patient anxiety assessed on 2 scales and standardized psychometric instruments.A prospective study of patients with hyperhidrosis was carried out between September 1, 2001 and June 30, 2003 with a self-administered preoperative questionnaire. The variables studied included the location of hyperhidrosis, the accompanying signs and symptoms, and the self-reported degree of anxiety and perception of its effect on daily life assessed by the State-Trait Anxiety Inventory (STAI) and a questionnaire designed in our department.Palmar hyperhidrosis was reported by 93.6% of patients, plantar by 70.2%, axillary by 66.4%, facial by 12.1%, groin by 8.2%, chest by 5%, and abdominal by 2%. While more than 50% of the patients reported facial blushing and palpitations as accompanying signs and symptoms, approximately 30% experienced epigastric pain, trembling, and headaches. Over half of the patients reported that their anxiety was incapacitating, and a mere 1.2% experienced none at all. STAI scores were similar to those of the general population whereas scores on our department's questionnaire reflected those of the self-reported anxiety ratings.Primary hyperhidrosis is a disorder in which excessive sweating occurs mainly, but not exclusively, on the palms. The condition is accompanied by signs and symptoms typical of autonomic nervous system hyperactivity and by a degree of anxiety that has an incapacitating effect on normal life, although that anxiety is not detected by the STAI questionnaire alone.Determinar la localización de la hiperhidrosis, la clínica acom pa ñante y la ansiedad que refieren los pacientes tanto subjetivamente como mediante instrumentos psicométricos estandarizados.Estudio prospectivo realizado en-tre el 1 de septiembre de 2001 y el 30 de junio de 2003 mediante una encuesta autoadministrada preoperatoria a los pacientes con hiperhidrosis. Las variables de estudio fueron: localización de la hiperhidrosis, clínica acompañante, ansiedad subjetiva y percepción de ésta en la vida diaria mediante el cuestionario Escala de Ansiedad Estado-Rasgo (STAI) y un cuestionario elaborado por nuestro servicio.La localización de la hiperhidrosis fue palmar en el 93,6% de los pacientes, plantar en el 70,2%, axilar en el 66,4%, facial en el 12,1%, inguinal en el 8,2%, pectoral en un 5% y abdominal en un 2%. En cuanto a la clínica acompañante, el enrojecimiento facial y las palpitaciones superaban el 50%, mientras que alrededor de un 30% presentaba epigas-tralgia, temblor y cefalalgia. En cuanto a la ansiedad subjetiva, más de la mitad de los pacientes presentaban ansiedad in-capacitante y sólo el 1,2% no la experimentaban en ningün grado. Segün el STAI, los valores obtenidos reflejaban un pa-ralelismo con la población general, mientras que nuestro cuestionario reflejó la ansiedad autorreferida.La hiperhidrosis primaria es un trastorno que cursa principalmente con hipersudación palmar, aun-que no de forma exclusiva. Se acompaña de clínica típica de hiperactividad del sistema vegetativo y un grado de ansiedad que incapacita para Ilevar una vida normal y que, sin embargo, no se detecta mediante el cuestionario STAI.
The most unpleasant consequence of upper thoracic sympathectomy is compensatory sweating (CS). De... more The most unpleasant consequence of upper thoracic sympathectomy is compensatory sweating (CS). Depending on the series, the incidence of CS ranges from 24% to 85%. The aim of this study was to determine the relation between CS and the following factors: distribution of hyperhidrosis, procedure performed (unilateral, synchronic bilateral, or sequential bilateral), and number of sympathetic ganglia eliminated. In addition, the degree of patient satisfaction was recorded as objectively as possible.Prospective study of 123 patients who underwent upper thoracic sympathectomy for palmar and/or axillary hyperhidrosis between 1 January, 1996 and 1 June, 2002 at our unit. All patients completed a questionnaire on symptoms 8 weeks before and after surgery to determine postoperative changes in distribution of the hyperhidrosis and the overall degree of satisfaction on a scale of 0 to 4.The sensation of CS was reported by 86.1% of the patients. When asked to relate this sensation to changes in sweating intensity in specific parts of the body, 46.54% reported CS and 48.37% no change. The trunk was the only region where statistically significant increases in CS occurred; in the feet, a decrease in sweating was noted. No differences in CS were observed with respect to the type of surgery or the number of sympathetic ganglia eliminated. The overall results were considered very satisfactory or quite satisfactory by 84.55% of the patients, while 4.88% were very dissatisfied.Although CS is a side effect of upper thoracic sympathectomy, not all patients are affected by it. Significant CS occurs mainly in the back, chest, and abdomen. Neither the type of intervention nor the number of ganglia eliminated has an effect on CS. This side effect notwithstanding, overall satisfaction with the treatment is very satisfactory given that the palmar hyperhidrosis is eliminated.Sudación compensatoria secundaria a la simpaticólisis torácica superior. Estudio prospectivo de 123 casosLa consecuencia más desagradable de la simpaticólisis torácica superior es la sudación compensatoria (SC), que oscila entre el 24 y el 85% según las series. El objetivo de este trabajo es determinar la relación de la SC en función de su distribución, del procedimiento realizado (unilateral, bilateral secuencial o sincrónica) y del número de ganglios simpáticos eliminados, así como registrar el grado de satisfacción obtenido, de la forma más objetiva.Estudio prospectivo de 123 pacientes intervenidos de simpaticólisis torácica superior por hiperhidrosis palmar y/o axilar, entre el 1 de enero de 1996 y el 1 de junio de 2002, en nuestro servicio. Todos ellos completaron, 8 semanas antes de la intervención y 8 semanas después, un cuestionario epidemiológico donde se registraban la distribución de la hiperhidrosis respecto a cómo era antes de la intervención y el grado de satisfacción global tras la intervención mediante una escala del 0 al 4.La sensación de SC se presentó en el 86,1% de los pacientes. Al relacionar esta sensación con la variación de intensidad de la sudación en las diferentes partes del cuerpo, el 46,54% reconoció sufrir SC, mientras que el 48,37% no presentó cambios. Sólo las regiones del tronco habían experimentado cambios en cuanto a la SC de una forma estadísticamente significativa, y en los pies se apreció una disminución del sudor. No se observaron diferencias en cuanto al tipo de intervención realizada ni al número de ganglios eliminados. El grado de satisfacción global fue muy aceptable en el 84,55% de los pacientes, mientras que un 4,88% no aceptaron el resultado de la intervención.La SC es un efecto secundario de la simpaticólisis torácica superior que no se presenta en la totalidad de los pacientes intervenidos. Predomina en la espalda, el tórax y el abdomen de manera significativa. No se ve modificada por el tipo de intervención ni por el número de ganglios eliminados. A pesar de este efecto secundario, la satisfacción global de la intervención es muy aceptable dada la eliminación de la hiperhidrosis palmar.
In this study, patients treated by thoracoscopic sympathicolysis for palmar hyperhidrosis were ev... more In this study, patients treated by thoracoscopic sympathicolysis for palmar hyperhidrosis were evaluated to determine the number and response of sweat glands to intradermal acetylcholine stimulus. A total of 30 patients were included in the study. Group A consisted of 10 patients with palmar hyperhidrosis who underwent thoracoscopic sympathicolysis in October 2005, and group B consisted of 20 patients who underwent surgery during the years 1999, 2000, and 2001. The study procedure involved applying iodine alcohol to the palm and then intradermally injecting 0.1 ml 1% acetylcholine. This activated the sweat glands, which were then photographed and counted. The study procedure was performed prospectively over different periods in group A and retrospectively in group B. In group A, the mean number of glands activated 1, 3, 6, and 12 months after surgery were 41, 174.20, 522.8, and 747.2, respectively; this gradual increase was statistically significant over the first 6 months (p = 0.004) but not between months 6 and 12 (p = 0.255). The trend towards an increasing number of active glands occurred in both groups, with a mean of 1369.8 active glands in group B compared to 747.2 (p = 0.095) in group A after 12 months. It is well-known that Cannon's law of denervation (1939) is not applicable to the sweat glands, that is, there is no hyperactivation following intradermal acetylcholine stimulation. However, some response, which increased over the first 6 months following surgery, was observed in our study. Nevertheless, this activation is subsequently self-limiting, resulting in no gland atrophy, and reinnervation occurs without patient awareness.
This study was designed to describe the characteristics and survival of NSCLC patients treated wi... more This study was designed to describe the characteristics and survival of NSCLC patients treated with surgery and single pN1 disease, multiple pN1, and single unsuspected pN2. In 2005-2009, we treated 378 lung cancer patients with surgery with radical intent; 152 cases were pN1 or pN2. We excluded patients with neoadjuvant treatment, incomplete resection, incomplete lymph node dissection, metastasis, cN2 disease, multiple pN2, SCLC, and lack of PET-CT. All patients were staged with TNM 2010. We included 72 patients: 21 single pN1, 26 multiple pN1, and 25 single unsuspected pN2. Statistical analysis included descriptive statistics, chi-square test, Kaplan-Meier, log-rank test, and Cox proportional hazard model. The sample included 62 men (86 %) and 10 women (14 %), mean age 64 ± 9 years. The three subgroups did not show statistically significant differences in the main characteristics. Adjuvant treatment was performed in 56 patients (78 %). The 5 year overall survival (OS) for single pN1 was 73 %; for multiple pN1, 34 %; and for single unsuspected pN2, 25 % (P = 0.15). The mean OS for single pN1 was 63 ± 6 months; median OS for multiple pN1 was 45 (range, 42-48) months and for single pN2 was 54 (range, 32-77) months. Multivariate analysis found the following negative prognostic factors of OS: for single pN1, age, female sex, and microscopic intratumoral lymphatic and vascular invasion; for multiple pN1, ≤10 lymph nodes resected. Patients with single pN1 had better OS than patients with multiple pN1. Patients with single unsuspected pN2 had OS similar to that of multiple pN1.
TO determine the location of hyperhidrosis, the accompanying signs and symptoms, and patient anxi... more TO determine the location of hyperhidrosis, the accompanying signs and symptoms, and patient anxiety assessed on 2 scales and standardized psychometric instruments.A prospective study of patients with hyperhidrosis was carried out between September 1, 2001 and June 30, 2003 with a self-administered preoperative questionnaire. The variables studied included the location of hyperhidrosis, the accompanying signs and symptoms, and the self-reported degree of anxiety and perception of its effect on daily life assessed by the State-Trait Anxiety Inventory (STAI) and a questionnaire designed in our department.Palmar hyperhidrosis was reported by 93.6% of patients, plantar by 70.2%, axillary by 66.4%, facial by 12.1%, groin by 8.2%, chest by 5%, and abdominal by 2%. While more than 50% of the patients reported facial blushing and palpitations as accompanying signs and symptoms, approximately 30% experienced epigastric pain, trembling, and headaches. Over half of the patients reported that their anxiety was incapacitating, and a mere 1.2% experienced none at all. STAI scores were similar to those of the general population whereas scores on our department's questionnaire reflected those of the self-reported anxiety ratings.Primary hyperhidrosis is a disorder in which excessive sweating occurs mainly, but not exclusively, on the palms. The condition is accompanied by signs and symptoms typical of autonomic nervous system hyperactivity and by a degree of anxiety that has an incapacitating effect on normal life, although that anxiety is not detected by the STAI questionnaire alone.Determinar la localización de la hiperhidrosis, la clínica acom pa ñante y la ansiedad que refieren los pacientes tanto subjetivamente como mediante instrumentos psicométricos estandarizados.Estudio prospectivo realizado en-tre el 1 de septiembre de 2001 y el 30 de junio de 2003 mediante una encuesta autoadministrada preoperatoria a los pacientes con hiperhidrosis. Las variables de estudio fueron: localización de la hiperhidrosis, clínica acompañante, ansiedad subjetiva y percepción de ésta en la vida diaria mediante el cuestionario Escala de Ansiedad Estado-Rasgo (STAI) y un cuestionario elaborado por nuestro servicio.La localización de la hiperhidrosis fue palmar en el 93,6% de los pacientes, plantar en el 70,2%, axilar en el 66,4%, facial en el 12,1%, inguinal en el 8,2%, pectoral en un 5% y abdominal en un 2%. En cuanto a la clínica acompañante, el enrojecimiento facial y las palpitaciones superaban el 50%, mientras que alrededor de un 30% presentaba epigas-tralgia, temblor y cefalalgia. En cuanto a la ansiedad subjetiva, más de la mitad de los pacientes presentaban ansiedad in-capacitante y sólo el 1,2% no la experimentaban en ningün grado. Segün el STAI, los valores obtenidos reflejaban un pa-ralelismo con la población general, mientras que nuestro cuestionario reflejó la ansiedad autorreferida.La hiperhidrosis primaria es un trastorno que cursa principalmente con hipersudación palmar, aun-que no de forma exclusiva. Se acompaña de clínica típica de hiperactividad del sistema vegetativo y un grado de ansiedad que incapacita para Ilevar una vida normal y que, sin embargo, no se detecta mediante el cuestionario STAI.
In this study, patients treated by thoracoscopic sympathicolysis for palmar hyperhidrosis were ev... more In this study, patients treated by thoracoscopic sympathicolysis for palmar hyperhidrosis were evaluated to determine the number and response of sweat glands to intradermal acetylcholine stimulus. A total of 30 patients were included in the study. Group A consisted of 10 patients with palmar hyperhidrosis who underwent thoracoscopic sympathicolysis in October 2005, and group B consisted of 20 patients who underwent surgery during the years 1999, 2000, and 2001. The study procedure involved applying iodine alcohol to the palm and then intradermally injecting 0.1 ml 1% acetylcholine. This activated the sweat glands, which were then photographed and counted. The study procedure was performed prospectively over different periods in group A and retrospectively in group B. In group A, the mean number of glands activated 1, 3, 6, and 12 months after surgery were 41, 174.20, 522.8, and 747.2, respectively; this gradual increase was statistically significant over the first 6 months (p = 0.004) but not between months 6 and 12 (p = 0.255). The trend towards an increasing number of active glands occurred in both groups, with a mean of 1369.8 active glands in group B compared to 747.2 (p = 0.095) in group A after 12 months. It is well-known that Cannon's law of denervation (1939) is not applicable to the sweat glands, that is, there is no hyperactivation following intradermal acetylcholine stimulation. However, some response, which increased over the first 6 months following surgery, was observed in our study. Nevertheless, this activation is subsequently self-limiting, resulting in no gland atrophy, and reinnervation occurs without patient awareness.
Surgical Endoscopy and Other Interventional Techniques, 2006
Background Bilateral upper thoracic sympathectomy or sympathicolysis, currently the standard trea... more Background Bilateral upper thoracic sympathectomy or sympathicolysis, currently the standard treatment for palmar or axillary hyperhidrosis, is regarded as a safe procedure. This study evaluates the quantitative and qualitative incidence of intraoperative and postoperative complications resulting from bilateral thoracic sympathicolysis. Methods From 1996 to 2004, 458 consecutive patients with primary hyperhidrosis underwent surgery. These patients comprised 143 men (31.2%) and 315 women (68.7%) with a mean age of 26 years (range, 14–52 years). In all but seven cases, the procedure was bilaterally synchronous. Results No mortality was recorded. The anhydrosis rate was 97.4%, with a hypohidrosis rate of 2.4% and a failure rate of 0.2%. The latter was resolved with reintervention. The mean hospital stay was 17 h. The rate of major perioperative complications with conversion to thoracotomy was 0.4%. The overall rate of postoperative complications was 3.6%. The complications and rates observed were as follows: pneumothorax (2.06%), subcutaneous emphysema (1.08%), pleural bleeding (0.2%), hemothorax (0.1%), and atelectasis (0.1%). Compensatory hyperhidrosis was observed in 48.4% of the patients, but the sensation of compensatory hyperhidrosis was reported in 85.6% of the cases. Excessive dryness of the hands was reported in 0.38%, Horner’s syndrome in 0.32%, and gustatory hyperhidrosis in 1.1% of the cases. The overall satisfaction rate was 88.5%. Conclusions The results suggest that endoscopic bilateral thoracic sympathicolysis is an effective method for managing primary hyperhidrosis, especially severe palmar hyperhidrosis, but it is necessary to inform patients fully concerning the undesirable effects.
TO determine the location of hyperhidrosis, the accompanying signs and symptoms, and patient anxi... more TO determine the location of hyperhidrosis, the accompanying signs and symptoms, and patient anxiety assessed on 2 scales and standardized psychometric instruments.A prospective study of patients with hyperhidrosis was carried out between September 1, 2001 and June 30, 2003 with a self-administered preoperative questionnaire. The variables studied included the location of hyperhidrosis, the accompanying signs and symptoms, and the self-reported degree of anxiety and perception of its effect on daily life assessed by the State-Trait Anxiety Inventory (STAI) and a questionnaire designed in our department.Palmar hyperhidrosis was reported by 93.6% of patients, plantar by 70.2%, axillary by 66.4%, facial by 12.1%, groin by 8.2%, chest by 5%, and abdominal by 2%. While more than 50% of the patients reported facial blushing and palpitations as accompanying signs and symptoms, approximately 30% experienced epigastric pain, trembling, and headaches. Over half of the patients reported that their anxiety was incapacitating, and a mere 1.2% experienced none at all. STAI scores were similar to those of the general population whereas scores on our department's questionnaire reflected those of the self-reported anxiety ratings.Primary hyperhidrosis is a disorder in which excessive sweating occurs mainly, but not exclusively, on the palms. The condition is accompanied by signs and symptoms typical of autonomic nervous system hyperactivity and by a degree of anxiety that has an incapacitating effect on normal life, although that anxiety is not detected by the STAI questionnaire alone.Determinar la localización de la hiperhidrosis, la clínica acom pa ñante y la ansiedad que refieren los pacientes tanto subjetivamente como mediante instrumentos psicométricos estandarizados.Estudio prospectivo realizado en-tre el 1 de septiembre de 2001 y el 30 de junio de 2003 mediante una encuesta autoadministrada preoperatoria a los pacientes con hiperhidrosis. Las variables de estudio fueron: localización de la hiperhidrosis, clínica acompañante, ansiedad subjetiva y percepción de ésta en la vida diaria mediante el cuestionario Escala de Ansiedad Estado-Rasgo (STAI) y un cuestionario elaborado por nuestro servicio.La localización de la hiperhidrosis fue palmar en el 93,6% de los pacientes, plantar en el 70,2%, axilar en el 66,4%, facial en el 12,1%, inguinal en el 8,2%, pectoral en un 5% y abdominal en un 2%. En cuanto a la clínica acompañante, el enrojecimiento facial y las palpitaciones superaban el 50%, mientras que alrededor de un 30% presentaba epigas-tralgia, temblor y cefalalgia. En cuanto a la ansiedad subjetiva, más de la mitad de los pacientes presentaban ansiedad in-capacitante y sólo el 1,2% no la experimentaban en ningün grado. Segün el STAI, los valores obtenidos reflejaban un pa-ralelismo con la población general, mientras que nuestro cuestionario reflejó la ansiedad autorreferida.La hiperhidrosis primaria es un trastorno que cursa principalmente con hipersudación palmar, aun-que no de forma exclusiva. Se acompaña de clínica típica de hiperactividad del sistema vegetativo y un grado de ansiedad que incapacita para Ilevar una vida normal y que, sin embargo, no se detecta mediante el cuestionario STAI.
The most unpleasant consequence of upper thoracic sympathectomy is compensatory sweating (CS). De... more The most unpleasant consequence of upper thoracic sympathectomy is compensatory sweating (CS). Depending on the series, the incidence of CS ranges from 24% to 85%. The aim of this study was to determine the relation between CS and the following factors: distribution of hyperhidrosis, procedure performed (unilateral, synchronic bilateral, or sequential bilateral), and number of sympathetic ganglia eliminated. In addition, the degree of patient satisfaction was recorded as objectively as possible.Prospective study of 123 patients who underwent upper thoracic sympathectomy for palmar and/or axillary hyperhidrosis between 1 January, 1996 and 1 June, 2002 at our unit. All patients completed a questionnaire on symptoms 8 weeks before and after surgery to determine postoperative changes in distribution of the hyperhidrosis and the overall degree of satisfaction on a scale of 0 to 4.The sensation of CS was reported by 86.1% of the patients. When asked to relate this sensation to changes in sweating intensity in specific parts of the body, 46.54% reported CS and 48.37% no change. The trunk was the only region where statistically significant increases in CS occurred; in the feet, a decrease in sweating was noted. No differences in CS were observed with respect to the type of surgery or the number of sympathetic ganglia eliminated. The overall results were considered very satisfactory or quite satisfactory by 84.55% of the patients, while 4.88% were very dissatisfied.Although CS is a side effect of upper thoracic sympathectomy, not all patients are affected by it. Significant CS occurs mainly in the back, chest, and abdomen. Neither the type of intervention nor the number of ganglia eliminated has an effect on CS. This side effect notwithstanding, overall satisfaction with the treatment is very satisfactory given that the palmar hyperhidrosis is eliminated.Sudación compensatoria secundaria a la simpaticólisis torácica superior. Estudio prospectivo de 123 casosLa consecuencia más desagradable de la simpaticólisis torácica superior es la sudación compensatoria (SC), que oscila entre el 24 y el 85% según las series. El objetivo de este trabajo es determinar la relación de la SC en función de su distribución, del procedimiento realizado (unilateral, bilateral secuencial o sincrónica) y del número de ganglios simpáticos eliminados, así como registrar el grado de satisfacción obtenido, de la forma más objetiva.Estudio prospectivo de 123 pacientes intervenidos de simpaticólisis torácica superior por hiperhidrosis palmar y/o axilar, entre el 1 de enero de 1996 y el 1 de junio de 2002, en nuestro servicio. Todos ellos completaron, 8 semanas antes de la intervención y 8 semanas después, un cuestionario epidemiológico donde se registraban la distribución de la hiperhidrosis respecto a cómo era antes de la intervención y el grado de satisfacción global tras la intervención mediante una escala del 0 al 4.La sensación de SC se presentó en el 86,1% de los pacientes. Al relacionar esta sensación con la variación de intensidad de la sudación en las diferentes partes del cuerpo, el 46,54% reconoció sufrir SC, mientras que el 48,37% no presentó cambios. Sólo las regiones del tronco habían experimentado cambios en cuanto a la SC de una forma estadísticamente significativa, y en los pies se apreció una disminución del sudor. No se observaron diferencias en cuanto al tipo de intervención realizada ni al número de ganglios eliminados. El grado de satisfacción global fue muy aceptable en el 84,55% de los pacientes, mientras que un 4,88% no aceptaron el resultado de la intervención.La SC es un efecto secundario de la simpaticólisis torácica superior que no se presenta en la totalidad de los pacientes intervenidos. Predomina en la espalda, el tórax y el abdomen de manera significativa. No se ve modificada por el tipo de intervención ni por el número de ganglios eliminados. A pesar de este efecto secundario, la satisfacción global de la intervención es muy aceptable dada la eliminación de la hiperhidrosis palmar.
In this study, patients treated by thoracoscopic sympathicolysis for palmar hyperhidrosis were ev... more In this study, patients treated by thoracoscopic sympathicolysis for palmar hyperhidrosis were evaluated to determine the number and response of sweat glands to intradermal acetylcholine stimulus. A total of 30 patients were included in the study. Group A consisted of 10 patients with palmar hyperhidrosis who underwent thoracoscopic sympathicolysis in October 2005, and group B consisted of 20 patients who underwent surgery during the years 1999, 2000, and 2001. The study procedure involved applying iodine alcohol to the palm and then intradermally injecting 0.1 ml 1% acetylcholine. This activated the sweat glands, which were then photographed and counted. The study procedure was performed prospectively over different periods in group A and retrospectively in group B. In group A, the mean number of glands activated 1, 3, 6, and 12 months after surgery were 41, 174.20, 522.8, and 747.2, respectively; this gradual increase was statistically significant over the first 6 months (p = 0.004) but not between months 6 and 12 (p = 0.255). The trend towards an increasing number of active glands occurred in both groups, with a mean of 1369.8 active glands in group B compared to 747.2 (p = 0.095) in group A after 12 months. It is well-known that Cannon's law of denervation (1939) is not applicable to the sweat glands, that is, there is no hyperactivation following intradermal acetylcholine stimulation. However, some response, which increased over the first 6 months following surgery, was observed in our study. Nevertheless, this activation is subsequently self-limiting, resulting in no gland atrophy, and reinnervation occurs without patient awareness.
This study was designed to describe the characteristics and survival of NSCLC patients treated wi... more This study was designed to describe the characteristics and survival of NSCLC patients treated with surgery and single pN1 disease, multiple pN1, and single unsuspected pN2. In 2005-2009, we treated 378 lung cancer patients with surgery with radical intent; 152 cases were pN1 or pN2. We excluded patients with neoadjuvant treatment, incomplete resection, incomplete lymph node dissection, metastasis, cN2 disease, multiple pN2, SCLC, and lack of PET-CT. All patients were staged with TNM 2010. We included 72 patients: 21 single pN1, 26 multiple pN1, and 25 single unsuspected pN2. Statistical analysis included descriptive statistics, chi-square test, Kaplan-Meier, log-rank test, and Cox proportional hazard model. The sample included 62 men (86 %) and 10 women (14 %), mean age 64 ± 9 years. The three subgroups did not show statistically significant differences in the main characteristics. Adjuvant treatment was performed in 56 patients (78 %). The 5 year overall survival (OS) for single pN1 was 73 %; for multiple pN1, 34 %; and for single unsuspected pN2, 25 % (P = 0.15). The mean OS for single pN1 was 63 ± 6 months; median OS for multiple pN1 was 45 (range, 42-48) months and for single pN2 was 54 (range, 32-77) months. Multivariate analysis found the following negative prognostic factors of OS: for single pN1, age, female sex, and microscopic intratumoral lymphatic and vascular invasion; for multiple pN1, ≤10 lymph nodes resected. Patients with single pN1 had better OS than patients with multiple pN1. Patients with single unsuspected pN2 had OS similar to that of multiple pN1.
TO determine the location of hyperhidrosis, the accompanying signs and symptoms, and patient anxi... more TO determine the location of hyperhidrosis, the accompanying signs and symptoms, and patient anxiety assessed on 2 scales and standardized psychometric instruments.A prospective study of patients with hyperhidrosis was carried out between September 1, 2001 and June 30, 2003 with a self-administered preoperative questionnaire. The variables studied included the location of hyperhidrosis, the accompanying signs and symptoms, and the self-reported degree of anxiety and perception of its effect on daily life assessed by the State-Trait Anxiety Inventory (STAI) and a questionnaire designed in our department.Palmar hyperhidrosis was reported by 93.6% of patients, plantar by 70.2%, axillary by 66.4%, facial by 12.1%, groin by 8.2%, chest by 5%, and abdominal by 2%. While more than 50% of the patients reported facial blushing and palpitations as accompanying signs and symptoms, approximately 30% experienced epigastric pain, trembling, and headaches. Over half of the patients reported that their anxiety was incapacitating, and a mere 1.2% experienced none at all. STAI scores were similar to those of the general population whereas scores on our department's questionnaire reflected those of the self-reported anxiety ratings.Primary hyperhidrosis is a disorder in which excessive sweating occurs mainly, but not exclusively, on the palms. The condition is accompanied by signs and symptoms typical of autonomic nervous system hyperactivity and by a degree of anxiety that has an incapacitating effect on normal life, although that anxiety is not detected by the STAI questionnaire alone.Determinar la localización de la hiperhidrosis, la clínica acom pa ñante y la ansiedad que refieren los pacientes tanto subjetivamente como mediante instrumentos psicométricos estandarizados.Estudio prospectivo realizado en-tre el 1 de septiembre de 2001 y el 30 de junio de 2003 mediante una encuesta autoadministrada preoperatoria a los pacientes con hiperhidrosis. Las variables de estudio fueron: localización de la hiperhidrosis, clínica acompañante, ansiedad subjetiva y percepción de ésta en la vida diaria mediante el cuestionario Escala de Ansiedad Estado-Rasgo (STAI) y un cuestionario elaborado por nuestro servicio.La localización de la hiperhidrosis fue palmar en el 93,6% de los pacientes, plantar en el 70,2%, axilar en el 66,4%, facial en el 12,1%, inguinal en el 8,2%, pectoral en un 5% y abdominal en un 2%. En cuanto a la clínica acompañante, el enrojecimiento facial y las palpitaciones superaban el 50%, mientras que alrededor de un 30% presentaba epigas-tralgia, temblor y cefalalgia. En cuanto a la ansiedad subjetiva, más de la mitad de los pacientes presentaban ansiedad in-capacitante y sólo el 1,2% no la experimentaban en ningün grado. Segün el STAI, los valores obtenidos reflejaban un pa-ralelismo con la población general, mientras que nuestro cuestionario reflejó la ansiedad autorreferida.La hiperhidrosis primaria es un trastorno que cursa principalmente con hipersudación palmar, aun-que no de forma exclusiva. Se acompaña de clínica típica de hiperactividad del sistema vegetativo y un grado de ansiedad que incapacita para Ilevar una vida normal y que, sin embargo, no se detecta mediante el cuestionario STAI.
In this study, patients treated by thoracoscopic sympathicolysis for palmar hyperhidrosis were ev... more In this study, patients treated by thoracoscopic sympathicolysis for palmar hyperhidrosis were evaluated to determine the number and response of sweat glands to intradermal acetylcholine stimulus. A total of 30 patients were included in the study. Group A consisted of 10 patients with palmar hyperhidrosis who underwent thoracoscopic sympathicolysis in October 2005, and group B consisted of 20 patients who underwent surgery during the years 1999, 2000, and 2001. The study procedure involved applying iodine alcohol to the palm and then intradermally injecting 0.1 ml 1% acetylcholine. This activated the sweat glands, which were then photographed and counted. The study procedure was performed prospectively over different periods in group A and retrospectively in group B. In group A, the mean number of glands activated 1, 3, 6, and 12 months after surgery were 41, 174.20, 522.8, and 747.2, respectively; this gradual increase was statistically significant over the first 6 months (p = 0.004) but not between months 6 and 12 (p = 0.255). The trend towards an increasing number of active glands occurred in both groups, with a mean of 1369.8 active glands in group B compared to 747.2 (p = 0.095) in group A after 12 months. It is well-known that Cannon's law of denervation (1939) is not applicable to the sweat glands, that is, there is no hyperactivation following intradermal acetylcholine stimulation. However, some response, which increased over the first 6 months following surgery, was observed in our study. Nevertheless, this activation is subsequently self-limiting, resulting in no gland atrophy, and reinnervation occurs without patient awareness.
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