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Mayo Clinic Proceedings Aug 2011To review surgical results of endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis during the past decade.
OBJECTIVE
To review surgical results of endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis during the past decade.
PATIENTS AND METHODS
We retrospectively reviewed 155 consecutive patients who underwent surgery from June 30, 2000, through December 31, 2009, for medically refractory palmar-plantar hyperhidrosis using a technique of T1-T2 sympathotomy disconnection, designed for successful palmar response and minimization of complications.
RESULTS
Of the 155 patients, 44 (28.4%) were male, and 111 (71.6%) were female; operative times averaged 38 minutes. No patient experienced Horner syndrome, intercostal neuralgia, or pneumothorax. The only surgical complication was hemothorax in 2 patients (1.3%); in 1 patient, it occurred immediately postoperatively and in the other patient, 10 days postoperatively; treatment in both patients was successful. All 155 patients had successful (warm and dry) palmar responses at discharge. Long-term follow-up (>3 months; mean, 40.2 months) was obtained for 148 patients (95.5%) with the following responses to surgery: 96.6% of patients experienced successful control of palmar sweating; 69.2% of patients experienced decreased axillary sweating; and 39.8% of patients experienced decreased plantar sweating. At follow-up, 5 patients had palmar sweating (3 patients, <3 months; 1 patient, 10-12 months; 1 patient, 16-18 months). Compensatory hyperhidrosis did not occur in 47 patients (31.7%); it was mild in 92 patients (62.2%), moderate in 7 patients (4.7%), and severe in 2 patients (1.3%).
CONCLUSION
In this series, a small-diameter uniportal approach has eliminated intercostal neuralgia. Selecting a T1-T2 sympathotomy yields an excellent palmar response, with a very low severe compensatory hyperhidrosis complication rate. The low failure rate was noted during 18 months of follow-up and suggests that longer follow-up is necessary in these patients.
Topics: Adult; Aged; Ambulatory Surgical Procedures; Causality; Comorbidity; Female; Follow-Up Studies; Foot Dermatoses; Galvanic Skin Response; Ganglia, Sympathetic; Hand Dermatoses; Hemothorax; Humans; Hyperhidrosis; Male; Middle Aged; Retrospective Studies; Skin Temperature; Sweating; Sympathectomy; Thoracoscopy; Treatment Outcome
PubMed: 21803954
DOI: 10.4065/mcp.2011.0199 -
European Journal of Clinical... Oct 2005Initial nerve damage in leprosy occurs in small myelinated and unmyelinated nerve fibers. Early detection of leprosy in the peripheral nervous system is challenging as...
BACKGROUND
Initial nerve damage in leprosy occurs in small myelinated and unmyelinated nerve fibers. Early detection of leprosy in the peripheral nervous system is challenging as extensive nerve damage may take place before clinical signs of leprosy become apparent.
PATIENTS AND METHODS
In order to determine the prevalence of, and factors associated with, peripheral autonomic nerve dysfunction in newly diagnosed leprosy patients, 76 Brazilian patients were evaluated prior to treatment. Skin vasomotor reflex was tested by means of laser Doppler velocimetry. Blood perfusion and reflex vasoconstriction following an inspiratory gasp were registered on the second and fifth fingers.
RESULTS
Vasomotor reflex was impaired in at least one finger in 33/76 (43%) patients. The fifth fingers were more frequently impaired and suffered more frequent bilateral alterations than the second fingers. Multivariate regression analysis showed that leprosy reaction (adjusted odds ratio = 8.11, 95% confidence interval: 1.4-48.2) was associated with overall impaired vasomotor reflex (average of the four fingers). In addition, palmar erythrocyanosis and an abnormal upper limb sensory score were associated with vasomotor reflex impairment in the second fingers, whereas anti-phenolic glycolipid-I antibodies, ulnar somatic neuropathy and a low finger skin temperature were associated with impairment in the fifth fingers.
CONCLUSIONS
A high prevalence of peripheral autonomic dysfunction as measured by laser Doppler velocimetry was observed in newly diagnosed leprosy patients, which is clinically evident late in the disease. Autonomic nerve lesion was more frequent than somatic lesions and was strongly related to the immune-inflammatory reaction against M. leprae.
Topics: Adolescent; Adult; Autonomic Nervous System Diseases; Child; Female; Fingers; Humans; Laser-Doppler Flowmetry; Leprosy; Male; Middle Aged; Reflex, Abnormal; Vasomotor System
PubMed: 16178886
DOI: 10.1111/j.1365-2362.2005.01554.x -
Journal of Psychosomatic Research Nov 1967
Clinical Trial Randomized Controlled Trial
Topics: Adult; Anxiety; Arousal; Depression; Female; Galvanic Skin Response; Humans; Hypnotics and Sedatives; Interpersonal Relations; Male; Phobic Disorders; Sound
PubMed: 6076920
DOI: 10.1016/0022-3999(67)90021-9 -
Annals of Internal Medicine Apr 1982Six postmenopausal women (ages 50 to 65 years) developed palmar fasciitis and polyarthritis associated with a malignant ovarian tumor. Rheumatic signs preceded the...
Six postmenopausal women (ages 50 to 65 years) developed palmar fasciitis and polyarthritis associated with a malignant ovarian tumor. Rheumatic signs preceded the diagnosis of adenocarcinoma of the ovary by 5 to 25 months. All had bilateral pain and limitation of motion of the shoulders and hands as well as prominent palmar fasciitis and polyarthritis. Arthritis of the elbows, wrists, knees, ankles, and feet was also common. Two patients had carpal tunnel syndrome. Nonresectable tumor with ascites and peritoneal metastatic seeding was found in all patients. Endometrioid carcinoma, poor tumor differentiation, and unusually severe stromal proliferation of fibrous tissue were seen. There was no consistent improvement of the musculoskeletal syndrome after corticosteroid treatment or chemotherapy. All patients died 2 to 17 months after diagnosis of the neoplasm.
Topics: Adenocarcinoma; Aged; Arthritis; Cystadenocarcinoma; Diagnosis, Differential; Endometriosis; Fasciitis; Female; Hand; Humans; Middle Aged; Ovarian Neoplasms; Reflex Sympathetic Dystrophy; Scleroderma, Systemic; Shoulder
PubMed: 7065557
DOI: 10.7326/0003-4819-96-4-424 -
Sensors (Basel, Switzerland) Sep 2023Electrodermal activity (EDA) usually relates to variations in the electrical properties of palmar or plantar skin sites. EDA responses, namely skin conductance responses...
Electrodermal activity (EDA) usually relates to variations in the electrical properties of palmar or plantar skin sites. EDA responses, namely skin conductance responses (SCRs), skin potential responses (SPRs) and skin susceptance responses (SSRs) are shown to be sensitive indexes of sympathetic nervous system activation and are studied in many research projects. However, the association between EDA responses and the five basic human senses has not been investigated yet. Our study aimed to explore the relationship between the three EDA responses (SCRs, SSRs and SPRs) and the five basic human senses. These three EDA responses were measured simultaneously at the same skin site on each of the 38 volunteers. The tested five senses were sight, hearing, touch, taste and smell. The results showed that the different tested senses led to different degrees of EDA responses due to activation of the sympathetic nervous system and corresponding secretion of sweat. Although a controlled study on the degree of EDA as a function of the strength of each stimulus was not performed, we noted that the largest EDA responses were typically associated with the smell sense test. We conclude that EDA responses could be utilized as measures for examining the sensitivity of the human senses. Hence, EDA devices may have important roles in sensory systems for future clinical applications.
Topics: Humans; Galvanic Skin Response; Skin Physiological Phenomena; Skin; Touch; Touch Perception
PubMed: 37837011
DOI: 10.3390/s23198181 -
Clinical Autonomic Research : Official... Feb 2011We studied patients with palmar hyperhidrosis before and after endoscopic thoracic sympathotomy (ETS) to determine the effect of chronic sympathetic denervation on (1)...
PURPOSE
We studied patients with palmar hyperhidrosis before and after endoscopic thoracic sympathotomy (ETS) to determine the effect of chronic sympathetic denervation on (1) forearm blood flow (FBF) response to mental stress and (2) exercise tolerance.
METHODS AND RESULTS
Twenty-two healthy patients were evaluated before ETS, and 17 returned after surgery (11 F; 19-32 years). We measured heart rate (HR; 12 lead), blood pressure, and FBF (plethysmography, ml dl(-1) min(-1)). Supine HR tended to decrease after ETS (69 ± 10 vs. 66 ± 6, p = 0.2). Mental stress FBF was recorded during baseline, 3-min Stroop color word test, and 2-min recovery. Mental stress responses were unaffected by ETS. However, during post-mental stress recovery period, ETS resulted in a significant elevation in FBF (2 ± 1 vs. 3 ± 1), FVC (3 ± 1 vs. 4 ± 2), and a decrease in FVR (52 ± 22 vs. 32 ± 16, p < 0.01 for all). ETS resulted in a reduction in pre-exercise seated baseline HR (94 ± 2.5 beats/min preoperatively vs. 84 ± 4.3 beats/min postoperatively, p < 0.05), maximal HR response to cycle exercise, and exercise systolic blood pressure (172 ± 5.2 mmHg pre-op vs. 158 ± 5.9 mmHg post-op, p < 0.05) but not mean or diastolic pressure. VO(2)max and exercise duration determined by cycle ergometry was unchanged.
CONCLUSIONS
Functional evidence of upper limb denervation is observed during the FBF recovery period from mental stress and hemodynamic alterations associated with upright cycle exercise. However, the sustained exercise capacity suggests modest clinical consequences.
Topics: Adolescent; Adult; Baroreflex; Endoscopy; Exercise Test; Female; Forearm; Hand; Heart Rate; Hemodynamics; Humans; Hyperhidrosis; Male; Middle Aged; Oxygen Consumption; Postoperative Period; Prospective Studies; Regional Blood Flow; Stress, Psychological; Stroop Test; Sympathectomy; Vasodilation; Young Adult
PubMed: 20700642
DOI: 10.1007/s10286-010-0078-2 -
Journal of Speech and Hearing Research Dec 1978Stapedial reflex thresholds were obtained from fluent and disfluent subjects with and without anxiety. Anxiety conditions were measured by monitoring palmar skin...
Stapedial reflex thresholds were obtained from fluent and disfluent subjects with and without anxiety. Anxiety conditions were measured by monitoring palmar skin resistance with a psychogalvanometer. Eight of nine disfluent speakers had decreased mean stapedial-reflex thresholds ( -2.5 to -10 dB) at 500 or 1000 Hz or both when anxiety was present. This phenomenon did not occur in the fluent group. Only two of the nine fluent subjects showed reflex change with anxiety and the mean reflex change was shown in an increase of +2.5 dB. The disfluent group's mean stapedial reflex was significantly different with and without anxiety status (a = 0.01). Mean reflex for the fluent group did not change with anxiety.
Topics: Adolescent; Adult; Anxiety; Humans; Male; Muscle Contraction; Muscles; Reflex; Speech; Speech Disorders; Stapedius
PubMed: 745375
DOI: 10.1044/jshr.2104.762 -
Frontiers in Neuroscience 2019In the critical period of neurodevelopment (gestation and lactation), maternal consumption of essential fatty acids (FAs) can alter the offspring cognitive function...
In the critical period of neurodevelopment (gestation and lactation), maternal consumption of essential fatty acids (FAs) can alter the offspring cognitive function permanently causing damage. Lipids can regulate neurotrophin and compose brain tissue. However, the effects of maternal consumption of a mixture of conjugated linoleic acid (CLA) on an offspring nervous system are not completely clear. We aimed to investigate the impacts of different CLA concentrations mixed into the maternal diet during early life on neonatal reflex maturation and cognitive functions of the offspring. Three groups were formed: control (CG): receiving a standard diet; CLA1: receiving a diet containing 1% of CLA, and CLA3: receiving a diet containing 3% of CLA, offered during gestation and lactation. After birth, the reflex responses of the offspring were observed from the 1st to the 21st day. After weaning, the animals' anxiety and memory were assessed using open field (OF) and novel object recognition tests. Fatty acids in the breast milk and the offspring's brain were also quantified. The data were analyzed using one-way ANOVA and the Kruskal-Wallis test. CLA1 presented accelerated palmar grasp disappearance versus CLA3 and negative-geotaxis versus CG; and the CLA3 presented increases for most reflexes (cliff-avoidance, vibrissa-placing, negative-geotaxis, and auditory-startle response), and decrease in reflexes palmar grasp and free-fall righting versus CG ( < 0.05). CLA3 group explored less of the OF in the second exposure. CLA1 and CLA3 presented an increased exploration ratio for new objects, which indicates memory improvement. The milk tested from CLA3 demonstrated an increase in polyunsaturated fatty acids (PUFAs), and a decrease in monounsaturated fatty acids. The amount of CLA in milk was greater in CLA1 and CLA3 and in the brain offspring both presented moderated amounts of CLA. Maternal treatment with the CLA mixture induced anticipated reflex maturation and improved memory in the offspring. Even though CLA was detected in the brains in only trace amounts, offspring's brain PUFA and SFA levels were increased. Further studies aimed to delineate the effect of maternal CLA supplementation on offspring's brain lipid metabolism and long-term neurologic outcome are needed to confirm these findings.
PubMed: 31068778
DOI: 10.3389/fnins.2019.00370 -
Folia Psychiatrica Et Neurologica... 1981In order to investigate the sympathetic nervous function of the aged, the skin potential reflex (SPR) and serum dopamine-beta-hydroxylase activity (SDBH) were examined... (Comparative Study)
Comparative Study
In order to investigate the sympathetic nervous function of the aged, the skin potential reflex (SPR) and serum dopamine-beta-hydroxylase activity (SDBH) were examined in 25 healthy aged and 25 healthy young subjects. In the case of SPR, the reflex to sound stimuli was analyzed and the following results were obtained: (1) the aged group habituated more rapidly than the young group, (2) the amplitude of the SPR in the aged group was lower than that of the young, and (3) the negative wave of the SPR appeared more dominantly in the aged than in the young group. These results indicated that the sympathetic activation level of the aged decreased in comparison with that of the young. On the other hand, SDBH showed no difference between the aged and young. This discrepancy between the SPR and SDBH is discussed.
Topics: Adult; Age Factors; Aged; Dopamine beta-Hydroxylase; Evoked Potentials; Female; Galvanic Skin Response; Habituation, Psychophysiologic; Humans; Male; Middle Aged; Reflex; Skin; Sympathetic Nervous System
PubMed: 7274868
DOI: 10.1111/j.1440-1819.1981.tb00196.x -
Journal of Burn Care & Research :... Jul 2023Children are at risk for sustaining hand burns due to their innate curiosity, slow withdrawal reflexes, and thin palmar epidermis. We sought to summarize our recent...
Children are at risk for sustaining hand burns due to their innate curiosity, slow withdrawal reflexes, and thin palmar epidermis. We sought to summarize our recent experience managing pediatric hand burns, focusing on injuries that required surgical management. This was a retrospective review of children with burn-injured hands managed at a quaternary referral children's hospital between 2016 and 2020. Demographics and mechanisms of injury were collected for all patients. Initial management of all wounds included pain control, deflation of blisters, and mechanical debridement. Wounds were then dressed, and a plaster-backed soft cast was applied for positioning if the swelling was controlled. Wounds were reassessed in 4-7 days, at which time a nonadherent dressing with antifungal ointment or a bismuth dressing was applied to partial-thickness wounds, vs an active silver dressing for deep partial-thickness burns. For patients who underwent split-thickness or full-thickness skin grafting, additional wound care, operative, and short-term outcomes data were collected. A total of 3715 children were seen for burn injuries during the study period, of which 2100 (56.5%) were seen for hand burns. In total, 123 (5.8%) required a skin graft an average of 11.7 days from the date of their burn injury. Surgical complications were minimal with 5 (4.1%) incomplete graft takes, though none required reoperation, and 1 (0.8%) experiencing a postoperative wound infection. Pediatric hand burns are common. A multidisciplinary treatment approach, including standardized wound care and adept therapeutic interventions, will lead to spontaneous healing in approximately 95% of patients.
Topics: Child; Humans; Burns; Wound Healing; Skin; Skin Transplantation; Hand Injuries
PubMed: 36394415
DOI: 10.1093/jbcr/irac174