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Nelson Wolosker - One of the best experts on this subject based on the ideXlab platform.
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evaluation of Compensatory Hyperhidrosis after sympathectomy the use of an objective method
Annals of Vascular Surgery, 2021Co-Authors: Guilherme Yazbek, Paulo Kauffman, Jose Ribas Milanez De Campos, Pedro Puechleao, Miguel Lia Tedde, Augusto Ishy, Marcelo Fiorelli Alexandrino Da Silva, Andressa Cristina Sposato Louzada, Paulo Manuel Pegofernandes, Nelson WoloskerAbstract:Objective To investigate the prevalence of Compensatory Hyperhidrosis following videothoracic sympathectomy to treat palmoplantar Hyperhidrosis and its effect on sweating in the chest, abdomen, back and thighs. Furthermore, to evaluate the concordance between a subjective and an objective method of assessment for Compensatory Hyperhidrosis. Methods Forty patients with combined palmar and plantar Hyperhidrosis who underwent video-assisted thoracoscopic sympathectomy (15 women and 25 men, with a mean age of 25 years) were prospectively followed for 1 year. Subjective and objective parameters were evaluated, using respectively a questionnaire and a sudorometer (Vapometer). Results In the subjective analysis, in the first month, only 10% of patients did not have Compensatory Hyperhidrosis, and 70% continued to report it at 1 or more sites after 1 year. In the objective analysis, 35% of the patients did not present Compensatory Hyperhidrosis after 1 month, and this number persisted stable, with 30% of patients remaining free of Compensatory Hyperhidrosis after 1 year. The most frequent area affected by Compensatory Hyperhidrosis was the back in both assessments. There was no positive concordance between the results of the objective and subjective analysis at any time in any of the 4 regions studied. Conclusions Compensatory Hyperhidrosis is a very common postoperative side effect after videothoracic sympathectomy, occurring early after the procedure and persisting for prolonged periods of time. The most frequently affected body area is the back, and no concordance between objective and subjective assessments was observed.
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number of preoperative Hyperhidrosis sites does not affect the sympathectomy postoperative results and Compensatory Hyperhidrosis occurrence
Thoracic and Cardiovascular Surgeon, 2019Co-Authors: Nelson Wolosker, Paulo Kauffman, Guilherme Yazbek, Dafne Braga Diamante Leiderman, Miguel Lia Tedde, Jose Ribas Millanez De Campos, Pedro PuechleaoAbstract:Background Patients with primary Hyperhidrosis present with sweating in two or more sites in nearly 85% of cases. In this study, we examined whether the number of Hyperhidrosis sites is related to the surgery outcomes. Methods One hundred ninety-three Hyperhidrosis patients who underwent bilateral videothoracoscopic sympathectomy after failure or dissatisfaction with clinical treatment were distributed into three groups based on the number of Hyperhidrosis sites (one site, two sites, and three or more sites of Hyperhidrosis). The primary endpoints in the study were as follows: quality of life prior to surgery, improvement of quality of life after surgery, clinical improvement of sweating, presence or absence of Compensatory Hyperhidrosis, and general satisfaction after 1 month of surgery. Results Patients with two or more Hyperhidrosis sites had worse quality of life before surgery than patients with a single Hyperhidrosis site. There was an improvement in the quality of life in more than 95% of the patients, clinical improvement in more than 95% of patients, severe Compensatory Hyperhidrosis in less than 10%, and low general satisfaction after 1 month of surgery in only 2.60% of the patients, with no differences among the three groups. Conclusions Patients with more than one preoperative Hyperhidrosis site present worse quality of life prior to surgery than those with a single Hyperhidrosis site, but the number of Hyperhidrosis sites before surgery does not affect surgery outcomes.
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the relation between age and outcomes of thoracic sympathectomy for Hyperhidrosis the older the better
The Journal of Thoracic and Cardiovascular Surgery, 2018Co-Authors: Dafne Braga Diamante Leiderman, Marcelo Passos Teivelis, Paulo Kauffman, Jose Ribas Milanez De Campos, Guilherme Yazbek, Miguel Lia Tedde, Nelson WoloskerAbstract:Abstract Objective Several factors may potentially influence the efficacy and patient satisfaction after bilateral thoracic sympathectomy as the treatment for Hyperhidrosis, but few studies have specifically analyzed the impact of age on the efficacy of this treatment, the occurrence of Compensatory Hyperhidrosis (CH), and variations in the quality of life. Methods We retrospectively analyzed the effect of age, body mass index, surgical techniques, quality of life before surgery, betterment in the quality of life after surgery, clinical improvement in sweating at the main site, and the occurrence and intensity of CH in patients with Hyperhidrosis (n = 1633) who underwent bilateral sympathectomy. Results Quality of life improved in more than 90% of patients, and severe CH occurred in 5.4%. Age did not affect these outcomes. The older, the greater reduction in sweating, and CH was linked to other variables (body mass index, craniofacial Hyperhidrosis, and level of resection). Conclusions We observed that patients with old age reported an improvement in sweating in the main site of Hyperhidrosis. Sympathectomy outcomes in older patients are similar to those observed in younger patients in terms of quality of life improvement and occurrence of CH.
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management of Compensatory Hyperhidrosis
2018Co-Authors: Dafne Braga Diamante Leiderman, Guilherme Yazbec, Nelson WoloskerAbstract:Compensatory Hyperhidrosis (CH) is the most common and most feared adverse effect of thoracic sympathectomy and the complaint is mainly of increased sweat of the chest, abdomen, legs, and buttocks. Studies show that practically all patients will have some degree of this complication, but more than 11.6% of patients develop a severe CH with a social impact as bad or worse than the preoperative status. The first-line treatment is the oral use of anticholinergic medications, mainly oxybutynin.
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long term results of oxybutynin use in treating facial Hyperhidrosis
Anais Brasileiros De Dermatologia, 2014Co-Authors: Nelson Wolosker, Mariana Krutman, Marcelo Passos Teivelis, Taiz Pereira Dozono De Almeida Campbell, Paulo Kauffman, Jose Ribas Milanez De Campos, Pedro PuechleaoAbstract:BACKGROUND: Facial Hyperhidrosis can lead to serious emotional distress. Video-assisted thoracic sympathectomy resolves symptoms effectively, though it may be associated with Compensatory Hyperhidrosis, which may be more common in patients undergoing resection of the second thoracic ganglion. Oxybutynin has been used as a pharmacological approach to facial Hyperhidrosis but the long-term results of this treatment are unclear. OBJECTIVE: To evaluate the use of low oxybutynin doses in facial Hyperhidrosis patients for at least six months. METHODS: 61 patients were monitored for over six months and assessed according to the following variables: impact of Hyperhidrosis on quality of life (QOL) before treatment and after six weeks, evolution of facial Hyperhidrosis after six weeks and at the last consultation, complaints of dry mouth after six weeks and on last return visit, and improvement at other Hyperhidrosis sites. RESULTS: Patients were monitored for 6 to 61 months (median=17 months). Thirty-six (59%) were female. Age ranged from 17-74 (median:45). Pre-treatment QOL was poor/very poor in 96.72%. After six weeks, 100% of patients improved QOL. Comparing results after six weeks and on the last visit, 91.8% of patients maintained the same category of improvement in facial Hyperhidrosis, 3.3% worsened and 4.9% improved. Dry mouth complaints were common but not consistent throughout treatment. More than 90% of patients presented moderate/great improvement at other Hyperhidrosis sites. CONCLUSION: Patients who had a good initial response to treatment maintained a good response long-term, did not display tachiphylaxis and experienced improvement on other Hyperhidrosis sites.
Pedro Puechleao - One of the best experts on this subject based on the ideXlab platform.
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evaluation of Compensatory Hyperhidrosis after sympathectomy the use of an objective method
Annals of Vascular Surgery, 2021Co-Authors: Guilherme Yazbek, Paulo Kauffman, Jose Ribas Milanez De Campos, Pedro Puechleao, Miguel Lia Tedde, Augusto Ishy, Marcelo Fiorelli Alexandrino Da Silva, Andressa Cristina Sposato Louzada, Paulo Manuel Pegofernandes, Nelson WoloskerAbstract:Objective To investigate the prevalence of Compensatory Hyperhidrosis following videothoracic sympathectomy to treat palmoplantar Hyperhidrosis and its effect on sweating in the chest, abdomen, back and thighs. Furthermore, to evaluate the concordance between a subjective and an objective method of assessment for Compensatory Hyperhidrosis. Methods Forty patients with combined palmar and plantar Hyperhidrosis who underwent video-assisted thoracoscopic sympathectomy (15 women and 25 men, with a mean age of 25 years) were prospectively followed for 1 year. Subjective and objective parameters were evaluated, using respectively a questionnaire and a sudorometer (Vapometer). Results In the subjective analysis, in the first month, only 10% of patients did not have Compensatory Hyperhidrosis, and 70% continued to report it at 1 or more sites after 1 year. In the objective analysis, 35% of the patients did not present Compensatory Hyperhidrosis after 1 month, and this number persisted stable, with 30% of patients remaining free of Compensatory Hyperhidrosis after 1 year. The most frequent area affected by Compensatory Hyperhidrosis was the back in both assessments. There was no positive concordance between the results of the objective and subjective analysis at any time in any of the 4 regions studied. Conclusions Compensatory Hyperhidrosis is a very common postoperative side effect after videothoracic sympathectomy, occurring early after the procedure and persisting for prolonged periods of time. The most frequently affected body area is the back, and no concordance between objective and subjective assessments was observed.
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number of preoperative Hyperhidrosis sites does not affect the sympathectomy postoperative results and Compensatory Hyperhidrosis occurrence
Thoracic and Cardiovascular Surgeon, 2019Co-Authors: Nelson Wolosker, Paulo Kauffman, Guilherme Yazbek, Dafne Braga Diamante Leiderman, Miguel Lia Tedde, Jose Ribas Millanez De Campos, Pedro PuechleaoAbstract:Background Patients with primary Hyperhidrosis present with sweating in two or more sites in nearly 85% of cases. In this study, we examined whether the number of Hyperhidrosis sites is related to the surgery outcomes. Methods One hundred ninety-three Hyperhidrosis patients who underwent bilateral videothoracoscopic sympathectomy after failure or dissatisfaction with clinical treatment were distributed into three groups based on the number of Hyperhidrosis sites (one site, two sites, and three or more sites of Hyperhidrosis). The primary endpoints in the study were as follows: quality of life prior to surgery, improvement of quality of life after surgery, clinical improvement of sweating, presence or absence of Compensatory Hyperhidrosis, and general satisfaction after 1 month of surgery. Results Patients with two or more Hyperhidrosis sites had worse quality of life before surgery than patients with a single Hyperhidrosis site. There was an improvement in the quality of life in more than 95% of the patients, clinical improvement in more than 95% of patients, severe Compensatory Hyperhidrosis in less than 10%, and low general satisfaction after 1 month of surgery in only 2.60% of the patients, with no differences among the three groups. Conclusions Patients with more than one preoperative Hyperhidrosis site present worse quality of life prior to surgery than those with a single Hyperhidrosis site, but the number of Hyperhidrosis sites before surgery does not affect surgery outcomes.
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long term results of oxybutynin use in treating facial Hyperhidrosis
Anais Brasileiros De Dermatologia, 2014Co-Authors: Nelson Wolosker, Mariana Krutman, Marcelo Passos Teivelis, Taiz Pereira Dozono De Almeida Campbell, Paulo Kauffman, Jose Ribas Milanez De Campos, Pedro PuechleaoAbstract:BACKGROUND: Facial Hyperhidrosis can lead to serious emotional distress. Video-assisted thoracic sympathectomy resolves symptoms effectively, though it may be associated with Compensatory Hyperhidrosis, which may be more common in patients undergoing resection of the second thoracic ganglion. Oxybutynin has been used as a pharmacological approach to facial Hyperhidrosis but the long-term results of this treatment are unclear. OBJECTIVE: To evaluate the use of low oxybutynin doses in facial Hyperhidrosis patients for at least six months. METHODS: 61 patients were monitored for over six months and assessed according to the following variables: impact of Hyperhidrosis on quality of life (QOL) before treatment and after six weeks, evolution of facial Hyperhidrosis after six weeks and at the last consultation, complaints of dry mouth after six weeks and on last return visit, and improvement at other Hyperhidrosis sites. RESULTS: Patients were monitored for 6 to 61 months (median=17 months). Thirty-six (59%) were female. Age ranged from 17-74 (median:45). Pre-treatment QOL was poor/very poor in 96.72%. After six weeks, 100% of patients improved QOL. Comparing results after six weeks and on the last visit, 91.8% of patients maintained the same category of improvement in facial Hyperhidrosis, 3.3% worsened and 4.9% improved. Dry mouth complaints were common but not consistent throughout treatment. More than 90% of patients presented moderate/great improvement at other Hyperhidrosis sites. CONCLUSION: Patients who had a good initial response to treatment maintained a good response long-term, did not display tachiphylaxis and experienced improvement on other Hyperhidrosis sites.
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a randomized placebo controlled trial of oxybutynin for the initial treatment of palmar and axillary Hyperhidrosis
Journal of Vascular Surgery, 2012Co-Authors: Nelson Wolosker, Paulo Kauffman, Jose Ribas Milanez De Campos, Pedro PuechleaoAbstract:Introduction Video-assisted thoracic sympathectomy provides excellent resolution of palmar and axillary Hyperhidrosis but is associated with Compensatory Hyperhidrosis. Low doses of oxybutynin, an anticholinergic medication that competitively antagonizes the muscarinic acetylcholine receptor, can be used to treat palmar Hyperhidrosis with fewer side effects. Objective This study evaluated the effectiveness and patient satisfaction of oral oxybutynin at low doses (5 mg twice daily) compared with placebo for treating palmar Hyperhidrosis. Methods This was prospective, randomized, and controlled study. From December 2010 to February 2011, 50 consecutive patients with palmar Hyperhidrosis were treated with oxybutynin or placebo. Data were collected from 50 patients, but 5 (10.0%) were lost to follow-up. During the first week, patients received 2.5 mg of oxybutynin once daily in the evening. From days 8 to 21, they received 2.5 mg twice daily, and from day 22 to the end of week 6, they received 5 mg twice daily. All patients underwent two evaluations, before and after (6 weeks) the oxybutynin treatment, using a clinical questionnaire and a clinical protocol for quality of life. Results Palmar and axillary Hyperhidrosis improved in >70% of the patients, and 47.8% of those presented great improvement. Plantar Hyperhidrosis improved in >90% of the patients. Most patients (65.2%) showed improvements in their quality of life. The side effects were minor, with dry mouth being the most frequent (47.8%). Conclusions Treatment of palmar and axillary Hyperhidrosis with oxybutynin is a good initial alternative for treatment given that it presents good results and improves quality of life.
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twenty months of evolution following sympathectomy on patients with palmar Hyperhidrosis sympathectomy at the t3 level is better than at the t2 level
Clinics, 2009Co-Authors: Guilherme Yazbek, Nelson Wolosker, Paulo Kauffman, Jose Ribas Milanez De Campos, Pedro Puechleao, Fabio Biscegli JateneAbstract:OBJECTIVE: To compare two surgical techniques (denervation levels) for sympathectomy using video-assisted thoracoscopy to treat palmar Hyperhidrosis in the long-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 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 palmar Hyperhidrosis, without any difference between the groups. Twenty months later, all 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 improvement 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 with less severity. Nevertheless, the improvement in quality of life was similar between the groups.
Jose Ribas Milanez De Campos - One of the best experts on this subject based on the ideXlab platform.
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evaluation of Compensatory Hyperhidrosis after sympathectomy the use of an objective method
Annals of Vascular Surgery, 2021Co-Authors: Guilherme Yazbek, Paulo Kauffman, Jose Ribas Milanez De Campos, Pedro Puechleao, Miguel Lia Tedde, Augusto Ishy, Marcelo Fiorelli Alexandrino Da Silva, Andressa Cristina Sposato Louzada, Paulo Manuel Pegofernandes, Nelson WoloskerAbstract:Objective To investigate the prevalence of Compensatory Hyperhidrosis following videothoracic sympathectomy to treat palmoplantar Hyperhidrosis and its effect on sweating in the chest, abdomen, back and thighs. Furthermore, to evaluate the concordance between a subjective and an objective method of assessment for Compensatory Hyperhidrosis. Methods Forty patients with combined palmar and plantar Hyperhidrosis who underwent video-assisted thoracoscopic sympathectomy (15 women and 25 men, with a mean age of 25 years) were prospectively followed for 1 year. Subjective and objective parameters were evaluated, using respectively a questionnaire and a sudorometer (Vapometer). Results In the subjective analysis, in the first month, only 10% of patients did not have Compensatory Hyperhidrosis, and 70% continued to report it at 1 or more sites after 1 year. In the objective analysis, 35% of the patients did not present Compensatory Hyperhidrosis after 1 month, and this number persisted stable, with 30% of patients remaining free of Compensatory Hyperhidrosis after 1 year. The most frequent area affected by Compensatory Hyperhidrosis was the back in both assessments. There was no positive concordance between the results of the objective and subjective analysis at any time in any of the 4 regions studied. Conclusions Compensatory Hyperhidrosis is a very common postoperative side effect after videothoracic sympathectomy, occurring early after the procedure and persisting for prolonged periods of time. The most frequently affected body area is the back, and no concordance between objective and subjective assessments was observed.
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the relation between age and outcomes of thoracic sympathectomy for Hyperhidrosis the older the better
The Journal of Thoracic and Cardiovascular Surgery, 2018Co-Authors: Dafne Braga Diamante Leiderman, Marcelo Passos Teivelis, Paulo Kauffman, Jose Ribas Milanez De Campos, Guilherme Yazbek, Miguel Lia Tedde, Nelson WoloskerAbstract:Abstract Objective Several factors may potentially influence the efficacy and patient satisfaction after bilateral thoracic sympathectomy as the treatment for Hyperhidrosis, but few studies have specifically analyzed the impact of age on the efficacy of this treatment, the occurrence of Compensatory Hyperhidrosis (CH), and variations in the quality of life. Methods We retrospectively analyzed the effect of age, body mass index, surgical techniques, quality of life before surgery, betterment in the quality of life after surgery, clinical improvement in sweating at the main site, and the occurrence and intensity of CH in patients with Hyperhidrosis (n = 1633) who underwent bilateral sympathectomy. Results Quality of life improved in more than 90% of patients, and severe CH occurred in 5.4%. Age did not affect these outcomes. The older, the greater reduction in sweating, and CH was linked to other variables (body mass index, craniofacial Hyperhidrosis, and level of resection). Conclusions We observed that patients with old age reported an improvement in sweating in the main site of Hyperhidrosis. Sympathectomy outcomes in older patients are similar to those observed in younger patients in terms of quality of life improvement and occurrence of CH.
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long term results of oxybutynin use in treating facial Hyperhidrosis
Anais Brasileiros De Dermatologia, 2014Co-Authors: Nelson Wolosker, Mariana Krutman, Marcelo Passos Teivelis, Taiz Pereira Dozono De Almeida Campbell, Paulo Kauffman, Jose Ribas Milanez De Campos, Pedro PuechleaoAbstract:BACKGROUND: Facial Hyperhidrosis can lead to serious emotional distress. Video-assisted thoracic sympathectomy resolves symptoms effectively, though it may be associated with Compensatory Hyperhidrosis, which may be more common in patients undergoing resection of the second thoracic ganglion. Oxybutynin has been used as a pharmacological approach to facial Hyperhidrosis but the long-term results of this treatment are unclear. OBJECTIVE: To evaluate the use of low oxybutynin doses in facial Hyperhidrosis patients for at least six months. METHODS: 61 patients were monitored for over six months and assessed according to the following variables: impact of Hyperhidrosis on quality of life (QOL) before treatment and after six weeks, evolution of facial Hyperhidrosis after six weeks and at the last consultation, complaints of dry mouth after six weeks and on last return visit, and improvement at other Hyperhidrosis sites. RESULTS: Patients were monitored for 6 to 61 months (median=17 months). Thirty-six (59%) were female. Age ranged from 17-74 (median:45). Pre-treatment QOL was poor/very poor in 96.72%. After six weeks, 100% of patients improved QOL. Comparing results after six weeks and on the last visit, 91.8% of patients maintained the same category of improvement in facial Hyperhidrosis, 3.3% worsened and 4.9% improved. Dry mouth complaints were common but not consistent throughout treatment. More than 90% of patients presented moderate/great improvement at other Hyperhidrosis sites. CONCLUSION: Patients who had a good initial response to treatment maintained a good response long-term, did not display tachiphylaxis and experienced improvement on other Hyperhidrosis sites.
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Compensatory Hyperhidrosis: Results of Pharmacologic Treatment With Oxybutynin
The Annals of thoracic surgery, 2014Co-Authors: Marcelo Passos Teivelis, Nelson Wolosker, Mariana Krutman, Paulo Kauffman, Jose Ribas Milanez De Campos, Pedro Puech-leãoAbstract:Background Hyperhidrosis may affect nearly 3% of the population, and thoracic/lumbar sympathectomy has been highly effective. Compensatory Hyperhidrosis is a risk associated with surgical procedures, and its treatment is both complex and not well defined. Treatment of primary Hyperhidrosis with oxybutynin has yielded positive results; however, its use in Compensatory Hyperhidrosis (CH) has not been described. Methods Twenty-one patients (11 female patients) received oxybutynin for severe CH at a median of 5 years after sympathectomy. Patients were evaluated to determine quality of life before starting oxybutynin and 6 weeks afterward; they assigned grades to determine improvement after 6 weeks and at their last consult visit for each site at which they complained of symptoms. Results Six and 15 patients underwent operation for axillary Hyperhidrosis and palmar Hyperhidrosis, respectively. Median follow-up time with oxybutynin was 377 days (49–1,831 days). Most common CH sites were the back (n = 8) and abdomen (n = 5). After 6 weeks, the quality of life improved in 71.4% of patients. Five patients stopped treatment: 2 because of unbearable dry mouth, 1 because of absence of pharmacologic response, 1 because of excessive somnolence, and 1 because of probable tachyphylaxis. At the last visit, 71.4% of patients presented with moderate to major improvement at the main sites at which sweating was noted. Conclusions More than 70% of patients presented with improved overall quality of life and improvement at the most prominent site of Compensatory sweating. Long-term treatment was ineffective in less than 25% of patients, primarily because of the side effects of dry mouth and somnolence. Oxybutynin appears to be effective in treating bothersome CH.
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technical difficulties and complications of sympathectomy in the treatment of Hyperhidrosis an analysis of 1731 cases
Annals of Vascular Surgery, 2013Co-Authors: Laert Oliveira Andrade Filho, Nelson Wolosker, Paulo Kauffman, Guilherme Yazbek, Sergio Kuzniec, Jose Ribas Milanez De CamposAbstract:Background The aim of this study was to ascertain the technical difficulties and complications of video-assisted thoracic sympathectomy (VTAS) in the treatment of Hyperhidrosis in a large group of patients. Methods Between October 1995 and February 2008, 1731 patients with palmar, axillary, or craniofacial Hyperhidrosis, who were treated using bilateral VTAS, were studied. We assessed the technical difficulties, early and late complications, and the approaches that were used to resolve them. Results Therapeutic success was achieved in 91% of the cases as evidenced by anhidrosis. The most common and severe technical difficulty during the procedure was pleural adhesions in 116 cases (6.7%); azygos lobes were seen in 7 patients (0.4%) and apical blebs in 3 patients (0.2%). The most frequent postoperative immediate complication was postoperative pain in 1685 (97.4%) patients; pneumothorax with chest drainage was seen in 60 cases (3.5%), neurologic disorders involving the upper limbs in 36 cases (2.1%), Horner’s syndrome in 11 cases (0.9%), significant bleeding in 8 cases (0.4%), and 1 patient had extensive subcutaneous emphysema. The most frequent late complication was Compensatory Hyperhidrosis, which occurred in 1531 cases (88.4%). Although 27.2% of the patients reported severe Compensatory Hyperhidrosis, only 2.5% expressed regret for undergoing surgery. Gustatory sweating occurred in 334 patients (19.3%). No deaths occurred in this series. Conclusions VTAS is safe and has shown good results. The major complication is Compensatory Hyperhidrosis and, when severe, the patient may express regret for undergoing surgery. Improvements in instrumentation, adequate training, and careful patient selection may help to reduce the number of drawbacks associated with VTAS.
Ayesha S. Bryant - One of the best experts on this subject based on the ideXlab platform.
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satisfaction and Compensatory Hyperhidrosis rates 5 years and longer after video assisted thoracoscopic sympathotomy for Hyperhidrosis
The Journal of Thoracic and Cardiovascular Surgery, 2014Co-Authors: Ayesha S. Bryant, Robert J CerfolioAbstract:Objective The objective of the present study was to determine the long-term fate and factors of Compensatory Hyperhidrosis (CH) in patients who have undergone video-assisted thoracoscopic sympathotomy for focal Hyperhidrosis. Methods The same quality-of-life survey was administered 6 months postoperatively and then annually to all patients who underwent video-assisted thoracoscopic sympathotomy for Hyperhidrosis. A second rib (R2)/R3 sympathotomy was most commonly performed until September 2007 and then R4/R5 sympathotomy was used. Results From January 1999 until December 2012, 193 patients underwent video-assisted thoracoscopic sympathotomy for Hyperhidrosis, of whom, 173 had provided ≥1 year of postoperative survey information. No operative mortalities occurred. Of the 173 patients, 133 (77%) reported "clinically bothersome" CH. This rate had decreased to an average of 35% at 5 and 12 years postoperatively. Univariate analysis showed the CH incidence was significantly greater for the patients who had undergone R2/R3 versus R4/R5 sympathotomy ( P P P = .022), or were female ( P = .002). On multivariate analysis, only R2/R3 versus R4/R5 sympathotomy ( P P Conclusions Patients who undergo sympathotomy for Hyperhidrosis will commonly report "clinically bothersome" Compensatory Hyperhidrosis. CH will more likely if R2/R3 sympathetic interruption has been performed instead of R4/R5 and in patients who present with multiple areas of sweating. The severity of clinically bothersome CH decreased during the first 3 years postoperatively.
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the society of thoracic surgeons expert consensus for the surgical treatment of Hyperhidrosis
The Annals of Thoracic Surgery, 2011Co-Authors: Robert J Cerfolio, Daniel L. Miller, Ayesha S. Bryant, Jose Ribas Milanez De Campos, Cliff P Connery, Malcom Mcavoy Decamp, Robert J Mckenna, Mark J KrasnaAbstract:Significant controversies surround the optimal treatment of primary Hyperhidrosis of the hands, axillae, feet, and face. The world's literature on Hyperhidrosis from 1991 to 2009 was obtained through PubMed. There were 1,097 published articles, of which 102 were clinical trials. Twelve were randomized clinical trials and 90 were nonrandomized comparative studies. After review and discussion by task force members of The Society of Thoracic Surgeons' General Thoracic Workforce, expert consensus was reached from which specific treatment strategies are suggested. These studies suggest that primary Hyperhidrosis of the extremities, axillae or face is best treated by endoscopic thoracic sympathectomy (ETS). Interruption of the sympathetic chain can be achieved either by electrocautery or clipping. An international nomenclature should be adopted that refers to the rib levels (R) instead of the vertebral level at which the nerve is interrupted, and how the chain is interrupted, along with systematic pre and postoperative assessments of sweating pattern, intensity and quality-of-life. The recent body of literature suggests that the highest success rates occur when interruption is performed at the top of R3 or the top of R4 for palmar-only Hyperhidrosis. R4 may offer a lower incidence of Compensatory Hyperhidrosis but moister hands. For palmar and axillary, palmar, axillary and pedal and for axillary-only Hyperhidrosis interruptions at R4 and R5 are recommended. The top of R3 is best for craniofacial Hyperhidrosis.
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Effect of sympathectomy level on the incidence of Compensatory Hyperhidrosis after sympathectomy for palmar Hyperhidrosis.
The Journal of thoracic and cardiovascular surgery, 2009Co-Authors: Daniel L. Miller, Ayesha S. Bryant, Seth D. Force, Joseph I. MillerAbstract:Objective Palmar Hyperhidrosis can be psychosocially devastating. Sympathectomy provides effective treatment. The most common side effect after sympathectomy is Compensatory Hyperhidrosis, which can be debilitating. Controversy exists as to which and how many levels treated carry the lowest incidence of Compensatory Hyperhidrosis after sympathectomy for palmar Hyperhidrosis. Methods Retrospective review was conducted on a video-assisted thoracoscopic surgical database including all patients who underwent video-assisted thoracoscopic surgical sympathectomy for palmar Hyperhidrosis. Results Video-assisted sympathectomy was performed in 282 patients for palmar Hyperhidrosis from May 2002 through July 2005; in all, 179 patients (64%) underwent division at T2 level only and 103 at levels T2, T3, and T4. The groups were similar in age and sex distribution. The rate of Compensatory Hyperhidrosis was significantly less in the T2 group (23 patients, 13%) than in the T2 through T4 group (35 patients, 34%)( P = .011). The most common site of Compensatory Hyperhidrosis in both groups was the lower back. Patients with Compensatory Hyperhidrosis were older (median 31 years vs 23 years, P = .037), had body mass index greater than 28 ( P = .048), and underwent multiple level sympathectomy ( P = .004). Conclusion Compensatory Hyperhidrosis continues to occur after sympathectomy for palmar Hyperhidrosis; however, a significant reduction in incidence can be achieved by dividing the sympathetic chain at a single level (T2). Patients who are older and/or have increased body mass index should be warned of their increased risk of Compensatory Hyperhidrosis after sympathectomy.
Paulo Kauffman - One of the best experts on this subject based on the ideXlab platform.
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evaluation of Compensatory Hyperhidrosis after sympathectomy the use of an objective method
Annals of Vascular Surgery, 2021Co-Authors: Guilherme Yazbek, Paulo Kauffman, Jose Ribas Milanez De Campos, Pedro Puechleao, Miguel Lia Tedde, Augusto Ishy, Marcelo Fiorelli Alexandrino Da Silva, Andressa Cristina Sposato Louzada, Paulo Manuel Pegofernandes, Nelson WoloskerAbstract:Objective To investigate the prevalence of Compensatory Hyperhidrosis following videothoracic sympathectomy to treat palmoplantar Hyperhidrosis and its effect on sweating in the chest, abdomen, back and thighs. Furthermore, to evaluate the concordance between a subjective and an objective method of assessment for Compensatory Hyperhidrosis. Methods Forty patients with combined palmar and plantar Hyperhidrosis who underwent video-assisted thoracoscopic sympathectomy (15 women and 25 men, with a mean age of 25 years) were prospectively followed for 1 year. Subjective and objective parameters were evaluated, using respectively a questionnaire and a sudorometer (Vapometer). Results In the subjective analysis, in the first month, only 10% of patients did not have Compensatory Hyperhidrosis, and 70% continued to report it at 1 or more sites after 1 year. In the objective analysis, 35% of the patients did not present Compensatory Hyperhidrosis after 1 month, and this number persisted stable, with 30% of patients remaining free of Compensatory Hyperhidrosis after 1 year. The most frequent area affected by Compensatory Hyperhidrosis was the back in both assessments. There was no positive concordance between the results of the objective and subjective analysis at any time in any of the 4 regions studied. Conclusions Compensatory Hyperhidrosis is a very common postoperative side effect after videothoracic sympathectomy, occurring early after the procedure and persisting for prolonged periods of time. The most frequently affected body area is the back, and no concordance between objective and subjective assessments was observed.
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number of preoperative Hyperhidrosis sites does not affect the sympathectomy postoperative results and Compensatory Hyperhidrosis occurrence
Thoracic and Cardiovascular Surgeon, 2019Co-Authors: Nelson Wolosker, Paulo Kauffman, Guilherme Yazbek, Dafne Braga Diamante Leiderman, Miguel Lia Tedde, Jose Ribas Millanez De Campos, Pedro PuechleaoAbstract:Background Patients with primary Hyperhidrosis present with sweating in two or more sites in nearly 85% of cases. In this study, we examined whether the number of Hyperhidrosis sites is related to the surgery outcomes. Methods One hundred ninety-three Hyperhidrosis patients who underwent bilateral videothoracoscopic sympathectomy after failure or dissatisfaction with clinical treatment were distributed into three groups based on the number of Hyperhidrosis sites (one site, two sites, and three or more sites of Hyperhidrosis). The primary endpoints in the study were as follows: quality of life prior to surgery, improvement of quality of life after surgery, clinical improvement of sweating, presence or absence of Compensatory Hyperhidrosis, and general satisfaction after 1 month of surgery. Results Patients with two or more Hyperhidrosis sites had worse quality of life before surgery than patients with a single Hyperhidrosis site. There was an improvement in the quality of life in more than 95% of the patients, clinical improvement in more than 95% of patients, severe Compensatory Hyperhidrosis in less than 10%, and low general satisfaction after 1 month of surgery in only 2.60% of the patients, with no differences among the three groups. Conclusions Patients with more than one preoperative Hyperhidrosis site present worse quality of life prior to surgery than those with a single Hyperhidrosis site, but the number of Hyperhidrosis sites before surgery does not affect surgery outcomes.
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the relation between age and outcomes of thoracic sympathectomy for Hyperhidrosis the older the better
The Journal of Thoracic and Cardiovascular Surgery, 2018Co-Authors: Dafne Braga Diamante Leiderman, Marcelo Passos Teivelis, Paulo Kauffman, Jose Ribas Milanez De Campos, Guilherme Yazbek, Miguel Lia Tedde, Nelson WoloskerAbstract:Abstract Objective Several factors may potentially influence the efficacy and patient satisfaction after bilateral thoracic sympathectomy as the treatment for Hyperhidrosis, but few studies have specifically analyzed the impact of age on the efficacy of this treatment, the occurrence of Compensatory Hyperhidrosis (CH), and variations in the quality of life. Methods We retrospectively analyzed the effect of age, body mass index, surgical techniques, quality of life before surgery, betterment in the quality of life after surgery, clinical improvement in sweating at the main site, and the occurrence and intensity of CH in patients with Hyperhidrosis (n = 1633) who underwent bilateral sympathectomy. Results Quality of life improved in more than 90% of patients, and severe CH occurred in 5.4%. Age did not affect these outcomes. The older, the greater reduction in sweating, and CH was linked to other variables (body mass index, craniofacial Hyperhidrosis, and level of resection). Conclusions We observed that patients with old age reported an improvement in sweating in the main site of Hyperhidrosis. Sympathectomy outcomes in older patients are similar to those observed in younger patients in terms of quality of life improvement and occurrence of CH.
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long term results of oxybutynin use in treating facial Hyperhidrosis
Anais Brasileiros De Dermatologia, 2014Co-Authors: Nelson Wolosker, Mariana Krutman, Marcelo Passos Teivelis, Taiz Pereira Dozono De Almeida Campbell, Paulo Kauffman, Jose Ribas Milanez De Campos, Pedro PuechleaoAbstract:BACKGROUND: Facial Hyperhidrosis can lead to serious emotional distress. Video-assisted thoracic sympathectomy resolves symptoms effectively, though it may be associated with Compensatory Hyperhidrosis, which may be more common in patients undergoing resection of the second thoracic ganglion. Oxybutynin has been used as a pharmacological approach to facial Hyperhidrosis but the long-term results of this treatment are unclear. OBJECTIVE: To evaluate the use of low oxybutynin doses in facial Hyperhidrosis patients for at least six months. METHODS: 61 patients were monitored for over six months and assessed according to the following variables: impact of Hyperhidrosis on quality of life (QOL) before treatment and after six weeks, evolution of facial Hyperhidrosis after six weeks and at the last consultation, complaints of dry mouth after six weeks and on last return visit, and improvement at other Hyperhidrosis sites. RESULTS: Patients were monitored for 6 to 61 months (median=17 months). Thirty-six (59%) were female. Age ranged from 17-74 (median:45). Pre-treatment QOL was poor/very poor in 96.72%. After six weeks, 100% of patients improved QOL. Comparing results after six weeks and on the last visit, 91.8% of patients maintained the same category of improvement in facial Hyperhidrosis, 3.3% worsened and 4.9% improved. Dry mouth complaints were common but not consistent throughout treatment. More than 90% of patients presented moderate/great improvement at other Hyperhidrosis sites. CONCLUSION: Patients who had a good initial response to treatment maintained a good response long-term, did not display tachiphylaxis and experienced improvement on other Hyperhidrosis sites.
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Compensatory Hyperhidrosis: Results of Pharmacologic Treatment With Oxybutynin
The Annals of thoracic surgery, 2014Co-Authors: Marcelo Passos Teivelis, Nelson Wolosker, Mariana Krutman, Paulo Kauffman, Jose Ribas Milanez De Campos, Pedro Puech-leãoAbstract:Background Hyperhidrosis may affect nearly 3% of the population, and thoracic/lumbar sympathectomy has been highly effective. Compensatory Hyperhidrosis is a risk associated with surgical procedures, and its treatment is both complex and not well defined. Treatment of primary Hyperhidrosis with oxybutynin has yielded positive results; however, its use in Compensatory Hyperhidrosis (CH) has not been described. Methods Twenty-one patients (11 female patients) received oxybutynin for severe CH at a median of 5 years after sympathectomy. Patients were evaluated to determine quality of life before starting oxybutynin and 6 weeks afterward; they assigned grades to determine improvement after 6 weeks and at their last consult visit for each site at which they complained of symptoms. Results Six and 15 patients underwent operation for axillary Hyperhidrosis and palmar Hyperhidrosis, respectively. Median follow-up time with oxybutynin was 377 days (49–1,831 days). Most common CH sites were the back (n = 8) and abdomen (n = 5). After 6 weeks, the quality of life improved in 71.4% of patients. Five patients stopped treatment: 2 because of unbearable dry mouth, 1 because of absence of pharmacologic response, 1 because of excessive somnolence, and 1 because of probable tachyphylaxis. At the last visit, 71.4% of patients presented with moderate to major improvement at the main sites at which sweating was noted. Conclusions More than 70% of patients presented with improved overall quality of life and improvement at the most prominent site of Compensatory sweating. Long-term treatment was ineffective in less than 25% of patients, primarily because of the side effects of dry mouth and somnolence. Oxybutynin appears to be effective in treating bothersome CH.