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Background -Essential hyperhidrosis is characterised by an overactivity of the sympathetic fibres passing through the upper dorsal sympathetic ganglia D2-D3. Anatomical interruption at the D2-D3 level is a highly effective treatment for essential hyperhidrosis but also causes (partial) cardiac denervation and, after surgical sympathicolysis, important impairment of cardiopulmonary exercise function has been observed. The purpose of this study was to compare the results of cardiopulmonary exercise testing between patients with essential hyperhidrosis and a normal control population, and to examine the effects of thoracoscopic D2-D3 sympathicolysis on cardiopulmonary exercise capacity in patients with essential hyperhidrosis. Methods -Maximal, symptom limited incremental exercise tests were performed in 26 patients with severe essential hyperhidrosis one week before and one month after D2-D3 thoracoscopic sympathicolysis, and in 14 age and sex matched healthy volunteers. D2-D3 thoracosopic sympathicolysis was performed using a simplified one stage bilateral procedure. Results -Palmar hyperhidrosis was relieved in every patient, confirming the D2-D3 denervation. A higher peak heart rate (7%) was seen in the patient group than in the normal subjects, but all other cardiovascular, metabolic, and respiratory parameters were similar. After D2-D3 thorascopic sympathicolysis, heart rate at rest (13%) and at peak exercise (7%) were reduced, together with an increase in oxygen pulse. All The exact cause is unknown, although overactivity of the sympathetic fibres which pass through the dorsal sympathetic ganglia D2 (and D3) has been noted.56 Interruption of the sympathetic chain at the D2-D3 level (preferably by thoracoscopic intervention) is an effective and safe treatment for essential hyperhidrosis refractory to conventional local, systemic, or other treatment.47"' However, the D2 and D3 ganglia are also in the direct pathway of sympathetic innervation ofthe heart.'0 Interruption of the upper dorsal sympathetic chain has been suggested as treatment for several cardiac disorders -for example, angina pectoris, ventricular tachycardia, and arrythmias associated with the long QT syndrome." Surgical D2-D3 sympathectomy for essential hyperhidrosis induces important cardiopulmonary impairment. After surgical excision of the D2-D3 ganglia via the supraclavicular approach, 30% of patients were unable to perform a maximal exercise test due to dyspnoea, fatigue, or dizziness. In order to study the autonomic (dys)function relative to cardiopulmonary function in patients with essential hyperhidrosis, and to study the effects of upper dorsal thoracoscopic sympathicolysis on cardiopulmonary function during exercise, exercise testing was performed on 26 patients with essential hyperhidrosis before and one month after bilateral D2-D3 thoracoscopic sympathicolysis, and in 14 age and sex matched healthy volunteers. Methods PATIENTSTwenty six patients (22 women) with essential hyperhidrosis of mean (SD) age 27 (8 7) years (range ...

A case of solitary dorsal intramedullary schwannoma diagnosed by magnetic resonance imaging and treated surgically is reported. The authors review the previously published cases. The possible etiology of the tumor as well as some difficulties encountered in the diagnostic procedure and treatment are discussed.

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