Hyperhidrosis of Central Hypogonadism Leading to Diagnosis of Shapiro Syndrome: Temperature Dysregulation, Hypothermia and Agenesis of the Corpus Callosum

Background: Central or hypothalamic hypogonadism as an initial manifestation of Shapiro Syndrome has not been described in the literature. Herein, we report first case in which initial presentation of central hypogonadism led to a confirmed diagnosis of Shapiro Syndrome during a casual evaluation of hypothalamic pituitary anatomy with MRI of brain. Case presentation: 53 year old Caucasian man was documented to manifest Central or hypogonadotropic hypogonadism following evaluation of excessive sweating episodes, lack of libido and erectile dysfunction for a duration of several years. Brain MRI performed for assessment of the etiology documented no pituitary abnormality. Instead agenesis of Corpus Callosum was noted. The subject had been hospitalized on many occasions at this and several other medical centers with hypothermia or hyperthermia without a documentation of a definite cause. Therefore, the diagnosis of Shapiro Syndrome was made. Conclusion: This report is the first documentation of subject manifesting central, more likely to be hypothalamic rather than hypogonadotropic hypogonadism in conjunction with Shapiro Syndrome.

Compared Evaluation of Botulinum Toxin A and a Cosmetic Antiperspirant in the Treatment of Focal Axillary Hyperhidrosis

Background: Primary focal hyperhidrosis can significantly reduce quality of life. Therefore a lot of treatment options in a range of conservative, physical and surgical techniques are available. Objective: To assess the efficacy of an antiperspirant containing aluminum chloride compared to a Botulinumtoxin A treatment for patients with primary focal hyperhidrosis. Methods and material: In this randomized, single-center, half-side trail, a clinical score was done by patients and physician to evaluate the severity of hyperhidrosis. Gravimetric tests were performed to gather the amount of sweat per unit of time. Furthermore the efficacy was determined using a four point questionnaire. Skin irritation was assessed by measuring pH value and transepidermal water loss. Results: A total of 22 patients were enrolled. Two weeks after baseline the hyperhidrosis level was significantly reduced (BTX-A: ﹣92.9%, AL: 66.7%). In addition both treatment options induced a significant reduction of sweat production (BTX-A: ﹣80.8%, AL: 68.8%). Please change in: Patients evaluated good resp, very good efficacy for both treatment options at day 28. pH value and TEWL never left physiological range. Conclusion: Both botulinum toxin A treatment and an antiperspirant containing aluminum chloride in the evaluated galenic formulation are an effective and safe treatment option for axillary focal hyperhidrosis.

Intraoperative Rise of Surface Temperature Monitors Success of Sympathectomy in Palmoaxillary Hyperhidrosis

Objectives: Patients with hyperhidrosis suffer from an extreme perspiration that cannot be aligned with natural or situational standards. Endoscopic sympathectomy is a meaningful option for palmar and axillary hyperhidrosis. A standardized method of monitoring the immediate intraoperative success has not been established yet. The presented investigation shows one proposed sollution by monitoring skin surface temperature. The main aspect is to demonstrate a significant rise in temperature with utility for monitoring the immediate success of surgery. Methods: Twenty patients with primary hyperhidrosis were observed and treated in a standardized setting against a control group (n = 10). We obtained diverse data that permit determination of a point of time of measurement of surface temperature and definition of a degree of temperature variance. Results: After 5 minutes a significant change of 0.5? Celcius was noted on the palms;after 10 minutes on average 1.2? Celcius. Axillary temperature had significantly changed after 10 minutes with a mean temperature variation of 0.8? Celcius on the right side and 0.6? Celcius on the left side. Conclusions: Under consideration of appropriate time intervals of measurement and determined changes in surface temperature an early control of correct clip application in ETS is possible. In the palmar aspect an increase of 0.5? Celcius at an 5 minutes interval, and more than 1? Celcius at 10 minutes after placement of the clip as compared to basic values before application of the clip can be proposed.

Single-Port Bilateral Thoracscopic Dorsal Sympathectmy for Primary Hyperhidrosis:Long-Term Outcome

Background: Primary hyperhidrosis of the upper limbs is characterized by over activity of the eccrine sweat glands, primarily occurring on palmar, plantar and axillary regions. It is distressing and often socially disabling condition. Conservative treatment is usually not effective in controlling the disease mainly due to adverse effect of therapies. Endoscopic thoracic sympathectomy is considered as the treatment of choice, causing minimal morbidity and high success rates and patient satisfaction. Objective: The study aims to evaluate the long-term outcomes of single port bilateralthoracoscopic dorsal sympathectomyin treatment of primary hyperhidrosis of the palm and axilla. Methods: In this prospective study, performed primarily by a single surgeon, between August 1st 2010, and August 1st 2012, we performed 200 thoracoscopies on 100 patients with signs and symptoms of primary palmar and axillary hyperhidrosis in different age groups and in both genders, and all were studied and analyzed following treatment by single-port bilateral thoracoscopic dorsal sympathectomy in Sulaimani teaching hospital. Results: Total of 99 patients were satisfied with the outcome of post-surgery with a follow-up in the mean of 27 months and only one patient was reported no change in symptoms postoperatively. Complications reported in 6 patients inform of compensatory sweating (n = 2), Gestatory sweating (n = 1), Pneumothorax (n = 1), Intraoperative minor bleeding (n = 1) and only 1% failure rate was reported. No mortality was reported. Conclusions: Single port bilateral thoracoscopic thoracic sympathectomy is a very effective method in the management of primary hyperhidrosis. Single port provides less postoperative pain, safety, short operative time, and quick method for the treatment of primary hyperhidrosis in comparison to two or three ports approaches.

Chinese expert consensus on the surgical treatment of primary palmar hyperhidrosis(2021 version)

Primary palmar hyperhidrosis(PPH)is a pathologic condition of excessive sweating on hands that has adverse impacts on patients’social activity,professional life,and psychological state.Endoscopic thoracic sympathicotomy(ETS)is by far the treatment choice for PPH with the most stable and durable curative effects,but special attention should be given to the side effects of the surgery,especially compensatory hyperhidrosis(CH).This consensus is the second version of the Chinese Expert Consensus on the Surgical Treatment of PPH by the China Expert Committee on Palmar Hyperhidrosis(CECPH),which was published 10 years ago.This consensus emphasizes the need for special attention and careful assessment of the patients’feelings,as well as their emotional and mental state,and emphasizes that distress due to palmar sweating and the desire for treatment are prerequisites for diagnosis.It also provides a more nuanced delineation of CH and reviews all new attempts to prevent and treat this side effect.New evidence of the epidemiology,pathogenesis of PPH,and indications for surgery were also assessed or recommended.

Uniportal versus biportal video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis

Background Video-assisted thoracoscopic sympathectomy had replaced open surgery. The aim of this study was to compare the outcomes of using a single port and two ports to perform video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis. Methods Between April 2006 and February 2008, 20 cases underwent video-assisted thoracoscopic sympathectomy through one port （uniportal group） and 25 cases through two ports （biportal group）. The variables including the operating time, hospital stay, pain scores, postoperative complications, incidence of symptom recurrence and patient satisfaction were compared. The mean postoperative follow-up period was 11.5 months （range, 3-25 months）. Results The hands of all patients were warm and dry after operation. No conversion to open surgery was necessary, and no operative mortality was recorded in either group. The mean inpatient pain scores were significantly higher in the biportal group （1.2±0.6） than that in the uniportal group （0.8±0.5, P=0.025）. For the first three weeks after operation, four out of 20 （20%） patients in the uniportal group constantly suffered from mild or moderate residual pain while eight out of 25 （32%） cases in the biportal group （P=0.366）. Among them, two cases in the uniportal group and five cases in the biportal group need to take analgesics. Our mean operative time （bilateral sympathectomy） in the uniportal group （（39.5±10.0） minutes） was shorter than that in biportal group （（49.7±10.6） minutes, P=0.02）. There were no significant differences between two groups in terms of the mean hospital stay, compensatory sweating, and patient satisfaction. Two patients in the biportal group and three in the uniportal group experienced a unilateral pneumothorax. None of them required chest drainage. No patient experienced Homer＇s syndrome, and no recurrent symptoms were observed in either groups Conclusions Both uniportal and biportal video-assisted thoracoscopic sympathectomy are effective, safe, and minimally invasive for palmar hyperhidrosis. Comparing with the biportal approach, the uniportal approach causes less postoperative pain and less operative time, and is a more reasonable procedure in treatment of palmar hyperhidrosis.

T_3/T_4 thoracic sympathictomy and compensatory sweating in treatment of palmar hyperhidrosis

Background Compensatory sweating （CS） is one of the most common postoperative complications after thoracic sympathectomy, sympathicotomy or endoscopic sympathetic block （ESB） for palmar hyperhidrosis. This study was conducted to examine the relevance between CS and the sympathetic segment being transected in the surgical treatment of palmar hyperhidrosis, and thus to detect the potential mechanism of the occurrence of CS. Methods Between October 2004 and June 2006, 163 patients with primary hyperhidrosis were randomly divided into two groups, T3 sympathicotomy （78 patients） and T4 sympathicotomy（85）, who were operated upon under general anesthesia via single lumen intubation and intercostal video-mediastinoscopy （VM）. Results No morbidity or mortality occurred. Palmar hyperhidrosis was cured in all patients. Follow-up（mean （13.8i-6.2） months） showed no recurrence of palmar hyperhidrosis. The difference of rates of mild CS in groups T3 and T4 was of no statistical significance. The rate of moderate CS was significantly lower in group T4 than in group T3. No severe CS occurred. Conclusion The rates of occurrence and severity of CS are lowered with the lower sympathetic chain being transected.

Comparison of compensatory sweating and quality of life following thoracic sympathetic block for palmar hyperhidrosis： electrocautery hook versus titanium clip

Background Video-assisted thoracic sympathetic block is an effective, safe, and minimally invasive method for treatment of primary hyperhidrosis. The purpose of this study was to decide which one of using electrocautery hook and titanium clip is the appropriate procedure for primary palmar hyperhidrosis by assessing the compensatory sweating （CS） and quality of life （QOL） of patients after sympathetic block. Methods Between October 2007 to August 2010, 120 patients with primary palmar hyperhidrosis were randomly divided into two groups, electrocautery hook group （60 patients） and titanium clip group （60 patients）. All patients were treated by sympathetic block at T4 level. The CS was graded based on severity and location; the QOL was classified to 5 different levels based upon the summed total scores （range from 20 to 100） before and after surgery. The variables were compared. Results The postoperative follow-up period was 2 months. All patients were cured. Three patients in electrocautery hook group and 1 patient in titanium clip group had a unilateral pneumothorax on chest X-ray, but none of them was necessary to have chest drainage. Neither perioperative mortality nor serious complications such as cardiac arrhythmia or arrest were observed during the operation. No bradycardia or Horner＇s syndrome occured. CS was not more common in patients in titanium clip group than in those in electrocautery hook group （P=0.001）. Moderate and severe CS was few in all patients, and there was no significant difference between two groups （P=0.193）. Most of the patients feel a notable improvement of the the QOL; nevertheless, there was no significant difference between the groups （P=0.588）. Conclusions Both electrocautery hook and titanium clip used for sympathetic block at the T4 level are effective, safe, and minimally invasive for palmar hyperhidrosis. Because of the lower severity of CS and the similar improvements in the QOL after operation, we prefer to use of titanium clip for treating palmar hyperhidrosis.

Epidemiological survey of primary palmar hyperhidrosis in adolescents

Background Despite recent advances in recognition and treatment of primary palmar hyperhidrosis （PPH）, the epidemiological survey has hardly been conducted. The aim of this study was to investigate the prevalence and epidemiological characteristics of primary PPH among adolescents in three cities of southeast China. Methods Stratified-cluster sampling was carried out and cross-sectional epidemiological survey by questionnaire was applied among 33 000 college and high school students. Results The prevalence rate of PPH was 4.36% affecting both sexes equally. Prevalence rate of severe PPH was 0.27%. The average age of onset was 12.27±2,12 years. The peak age of onset was 6-16 years, accounting for 97.2% of PPH population. Positive family history was found in 17.9% PPH cases. Besides palms, axillae and soles can be also affected. Conclusions PPH affects a larger group of individual than previously reported. More measures should be taken to enhance the recoanition, diaanosis, and treatment of PPH.

Botulinum Toxin Type A Satisfaction in Different Neurological Disorders

Background: The botulinum toxin type A (BoNT-A) is used in a wide range of neurological diseases. We aimed to study the overall patients/caregivers’ satisfaction with BoNT-A treatment in different neurological conditions. Methods: Prospective study included patients who had received at least two BoNT-A treatment sessions. They were asked to rate overall treatment satisfaction at the peak of treatment effect on a 1 to 10 scale (1 = not at all satisfied;10 = fully satisfied). Subjects with a rating of 1to3 were classified as not at all satisfied, those with a rating of 4 to7 as somewhat satisfied, and those with a rating of 8 to10 as very satisfied. Treatment satisfaction questionnaire for medicine (TSQM) was assessed at the end of observational period. Quality of life QOL was assessed before BoNT-A treatment and at the last visit. Results: The study was conducted from first April 2014 to August 2021. 548 patients were identified with mean age 43.66 ± 14.50. Most of participants 389 (71%) were female. At the end of observational period, the mean satisfaction was 7.28 ± 1.78. There was a highly significant difference (P P P = 0.001). Conclusion: Satisfaction with BoNT-A therapy for different neurological disorders is overall good. The highest patient satisfaction was observed with primary focal HH, and the least satisfaction was observed in writer’s cramp. BoNT-A therapy improved QOL.

Functional Cardiological Changes Resulting from Thoracoscopic Thoracic Sympathectomy: Systematic Review

Hyperhidrosis is a condition resulting from a systemic sympathetic hyperactivity. The gold standard treatment is the resection or surgical ablation of the paravertebral sympathetic chain: the endoscopic thoracoscopic sympathectomy (ETS). Non-cardiac thoracic surgeries carry a considerable incidence of pathological postoperative cardiac events, raising attention to possible worsen cardiac functional capacity after the resection of a pair of thoracic sympathetic ganglia. The aim of this study is to investigate literature evidences of postoperative cardiovascular functional changes on patients submitted to ETS as treatment for hyperidrosis. This is a systematic review of the literature. Clinical studies published between January 1999 and April 2019 were analyzed. The PICO strategy was used to construct the question of systematic reviews research. The process of selecting articles was organized according to PRISMA Diagram. The search in electronic databases resulted in seven articles, of which one was excluded for being out of scope of the research, leaving six articles. All studies showed a pattern of heart rate (HR) reduction after endoscopic thoracic sympathectomy. It was suggested a relation between the extension of the procedure and the presence of cardiac functional alterations. There was an improvement in myocardial physical conditioning and maintenance of functional capacity. To elucidate the real mechanisms involved in the maintenance of myocardial function, and even its improvement, it is necessary to develop further studies that directly evaluate them.

Prescriptions from Traditional Chinese Medicine compared with salbutamol and montelukast for the treatment of pediatric asthma： a randomized controlled trial

OBJECTIVE: To compare the effects of a series of Traditional Chinese Medicine(TCM) empirical prescriptions with salbutamol and montelukast(SM) in children with asthma.METHODS: A total of 182 children with asthma were randomized into the TCM group(n = 97) or SM group(n = 85). Patients in the TCM group were treated with a series of TCM prescriptions, whereas those in the SM group received salbutamol and montelukast; both groups received their respective treatment for 12 weeks. Asthma control, changes in scores of TCM symptom patterns, and asthma symptom control(SC) scores after treatment were compared between the two groups.RESULTS: A higher percentage of patients in the TCM group had asthma control compared withthose in the SM group(91.67% and 76.83%, respectively, P = 0.006). Scores for abnormal feces(P <0.001), hyperhidrosis(P < 0.001), and tongue appearance(P = 0.001) in the TCM group were significantly better than those in the SM group. However,the total scores of TCM symptom patterns and SC scores did not differ significantly between the two groups(P > 0.05).CONCLUSION: Compared with salbutamol and montelukast, the TCM prescriptions tested were better for symptom control in children with asthma.