Vasomotor and sudomotor function in the hand after thoracoscopic transection of the sympathetic chain: Implications for choice of therapeutic strategy

Rex, Lars; G, Claes; Drott, Christer; Pegenius, Göran; Elam, Mikael

doi:10.1002/(sici)1097-4598(199811)21:11<1486::aid-mus18>3.3.co;2-a

Cited by 7 publications

(7 citation statements)

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“…A relationship between laser Doppler recordings of SkVR responses and direct intraneural recordings of skin sympathetic activity has been reported (Lundin et al 1990). SkVR responses require intact peripheral sympathetic nerves as shown by studies in surgically sympathectomised subjects (Bolton et al 1936;Rex et al 1998) and temporary nerve blocks (Netten et al 1995;Lehtipalo et al 2000). In PAF, the lesion site affects the peripheral, postganglionic autonomic nerves (Matthews 2002), which is the final common pathway involved in all SkVRs.…”

Section: Discussionmentioning

confidence: 99%

Skin vasomotor reflex responses in two contrasting groups of autonomic failure

et al. 2006

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PAF showed a decreased SkVR response to all 4 stimuli, the response being significantly less than controls (for inspiratory gasp and cutaneous cold) or MSA (cutaneous cold inspiratory gasp). The decreased responses in PAF may reflect the extensive postganglionic sympathetic denervation seen in this group. The measurement of SkVR may therefore provide a non-invasive aid to the differentiation of MSA and PAF.

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Section: Discussionmentioning

confidence: 99%

Skin vasomotor reflex responses in two contrasting groups of autonomic failure

et al. 2006

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“…There have been reports on variable GSR results in hyperhidrosis patients before [3]. While 1 week following ESB no GSR can be recorded in 50 % of the patients, the incidence of a positive GSR increases to 100 % six months later [18], although the patients still report a satisfactory reduction of palmar sweating. Results in spinal cord injury patients have shown that the palmar GSR is abolished after complete spinal cord injury above the thoracic level T6 [2].…”

Section: Discussionmentioning

confidence: 99%

Effects of gender and level of surgical sympathetic block on vasoconstrictor function

Fronek

Schmelz

Krüger

et al. 2003

Clinical Autonomic Research

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Interruption of sympathetic outflow by surgical sympathetic block has been used to treat hyperhidrosis for decades. In this study the effect of gender and the level of sympathetic block (T2 vs. T3) on the rewarming kinetics following ice water immersion were assessed in a prospective study on 60 hyperhidrosis patients before, 2 days, and 3 months postoperatively. Rewarming kinetics following endoscopic sympathetic block (ESB) was massively enhanced 2 days post-operatively, but had returned to pre-operative conditions at the 3 month follow-up for ESB at level T3. ESB at level T2 provoked significantly faster rewarming as compared to T3 at the 2 day and 3 month follow-up. Independent of the level of ESB, there was a slower rewarming in women already pre-operatively. This gender difference was clearly reduced at the 2 day follow-up, but had increased again at the 3 month follow-up. There was no correlation between the rewarming kinetics of the fingertips and palmar sweating. We conclude that for the sympathetic vasoconstriction of the fingertips the sympathetic ganglion T2 is crucial. Gender differences have to be taken into account when assessing effect of ESB by cold induced vasoconstriction. It remains to be established whether the quantification of vasoconstriction has some predictive value for the long-term prognosis of sudomotor blockade.

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“…Severe hand sweating is cured in almost 100 % of patients by ETS despite neurophysiological evidence of far from total sympathetic denervation [49]. Recurrence is almost nonexistent after resection and the rate is 0-4.4 % after ablation [22].…”

Section: Hyperhidrosis S Palmar Hyperhidrosismentioning

confidence: 93%

Results of endoscopic thoracic sympathectomy (ETS) on hyperhidrosis, facial blushing, angina pectoris, vascular disorders and pain syndromes of the hand and arm

Drott

2003

Clinical Autonomic Research

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Endoscopic thoracic sympathectomy (ETS) has gained increasing popularity due to its minimally invasive character. Despite the simplicity of the procedure, non-surgical options should always be considered as the first line of treatment. The complication risk of ETS is low but side effects, primarily compensatory sweating (CS) of mainly the trunk, may be severe enough to cause regret of the procedure. The risk/benefit ratio should always be discussed with the patient. Severe palmar hyperhidrosis and facial blushing respond very well to ETS with a high patient satisfaction rate. Facial hyperhidrosis is effectively treated with ETS, but is associated with a high risk for severe CS. Axillary hyperhidrosis is best treated by means other than ETS. The use of ETS for pain syndromes, vascular insufficiency and angina pectoris is not well supported by scientific evidence, making careful patient selection mandatory.

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Vasomotor and sudomotor function in the hand after thoracoscopic transection of the sympathetic chain: Implications for choice of therapeutic strategy

Cited by 7 publications

References 0 publications

Skin vasomotor reflex responses in two contrasting groups of autonomic failure

Skin vasomotor reflex responses in two contrasting groups of autonomic failure

Effects of gender and level of surgical sympathetic block on vasoconstrictor function

Results of endoscopic thoracic sympathectomy (ETS) on hyperhidrosis, facial blushing, angina pectoris, vascular disorders and pain syndromes of the hand and arm

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