Document Detail


Operative monitoring of hand and axillary temperature during endoscopic superior thoracic sympathectomy for the treatment of palmar hyperhidrosis.
MedLine Citation:
PMID:  10688220     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To find out how much the temperature in the palm rises after upper thoracic sympathectomy for palmar hyperhidrosis, and correlate the temperature with the outcome. DESIGN: Retrospective study. SETTING: University hospital, Spain. SUBJECTS: 73 patients (34 women and 39 men, age range 16-42 years, mean 26) who were operated for palmar hyperhidrosis between 1 January 1995 and 31 December 1997. INTERVENTIONS: Bilateral thoracic endoscopic sympathectomy during which the temperature was monitored on the skin of both axillae and thenar eminences, and in the oesophagus. MAIN OUTCOME MEASURES: Morbidity, alleviation of hyperhidrosis, recurrence rate, and differences in temperature postoperatively. RESULTS: There was minor bleeding during operation in 25 cases (34%), but in only 4 was it sufficient to require insertion of a drain; 2 patients developed transient Homer's syndrome; but the most common complication was compensatory hyperhidrosis (n = 52, 71%). In only 5 was this other than mild and required treatment with aluminium chloride in ethanol 25%. Palmar hyperhidrosis was alleviated in all cases, axillary sweating was considerably improved, and there was improvement in the feet in 56 (77%). There were 5 recurrences, all on the right side, during a mean follow up of 9 months (range 2-36), but in no case was the sweating severe. In almost all cases the temperature of the palm was less than that of the axilla before operation by a mean (SD) of 0.9 (0.3) degrees C. The rise in temperature varied from 1.7 (0.4) degrees C to 2.6 (0.4) degrees C. In the 5 patients who developed recurrences the increase was less (0.5 (0.4) degrees C). CONCLUSION: Thoracic endoscopic sympathectomy is safe, simple, and effective in treating palmar hyperhidrosis that has not responded to conservative treatment. Intradermal monitoring is an accurate and cost-effective way of monitoring temperature during operation. Although it is essential to achieve a rise in temperature of 1 degrees C, our most important finding was that the final temperature in both hands and axillae should be above 35 degrees C and as near as possible to 36 degrees C.
Authors:
N Sáiz-Sapena; V Vanaclocha; F Panta; C Kadri; W Torres
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The European journal of surgery = Acta chirurgica     Volume:  166     ISSN:  1102-4151     ISO Abbreviation:  Eur J Surg     Publication Date:  2000 Jan 
Date Detail:
Created Date:  2000-04-05     Completed Date:  2000-04-05     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9105264     Medline TA:  Eur J Surg     Country:  NORWAY    
Other Details:
Languages:  eng     Pagination:  65-9     Citation Subset:  IM    
Affiliation:
Department of Anaesthesiology, Clinica Universitaria, University of Navarra, Pamplona, Spain.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Axilla / physiology
Endoscopy*
Female
Ganglia, Sympathetic / surgery
Hand / physiology
Humans
Hyperhidrosis / physiopathology,  surgery*
Male
Monitoring, Intraoperative*
Retrospective Studies
Skin Temperature*
Sympathectomy / methods*
Thoracic Nerves / surgery
Thoracoscopy
Treatment Outcome
Comments/Corrections
Comment In:
Eur J Surg. 2001 Mar;167(3):237-8   [PMID:  11316416 ]

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