Introducción. La simpaticotomía toracoscópica aplicada al tratamiento de los pacientes con hiperhidrosis palmar esencial obtiene excelentes resultados con escasas complicaciones. Sin embargo, en la mayor parte de los pacientes intervenidos aparece sudación compensadora, la cual se considera el principal efecto secundario de esta técnica quirúrgica. La incidencia de sudación compensadora oscila entre el 50% y el 97% según las series, tanto tras la resección de T2-T4, como tras la resección limitada a nivel de T2. El objetivo de este estudio fue determinar si la incidencia de sudación compensadora podía reducirse limitando la simpaticomía a otro nivel, el tercer ganglio.Métodos. Entre Julio de 2002 y Agosto de 2003, se sometió a una simpaticotomía selectiva bilateral a nivel de T3 a 20 pacientes diagnosticados de hiperhidrosis palmar esencial. El seguimiento se llevó a cabo mediante entrevistas pre y post intervención, tests de la sudación palmar (método del yodo-almidón de Minor), pruebas de reactividad bronquial (test de la metacolina), y tests de función pulmonar.Resultados. La cirugía fue efectiva en el 95% de los pacientes. Tras un seguimiento medio de 4 meses, se registró sudación compensadora en el 55% de los pacientes. El 81% la calificaron como mínima. No se observaron complicaciones mayores.Conclusión. La simpaticotomía selectiva a nivel de T3 es un método seguro y efectivo para el tratamiento de los pacientes con hiperhidrosis esencial. No reduce los índices de sudación compensadora, sin embargo sí parece disminuir la intensidad en la mayor parte de casos. / Background. Thoracoscopic sympathicotomy in patients with essential palmar hyperhidrosis may produce successful results with fewer complications. However in most patients compensatory hyperhidrosis appears to be a troublesome side effect. After extensive resection of the second through the fourth ganglion (T2-4), as well as after limited resection of the second ganglion (T2), the reported incidence of compensatory hyperhidrosis ranges as high as 50-97%. The purpose of this study was to determine whether the incidence of compensatory hyperhidrosis can be reduced by limiting the thoracoscopic sympathicotomy to another level, the third ganglion.Methods. Twenty patients underwent a selective T3 sympathicotomy from July 2002 to August 2003. Follow-up was conducted by interviewing patients, performing pre and postoperative starch-iodine tests, bronchial reactivity evaluation (methacolin test), and pulmonary function tests.Results. The surgery was effective in 95% of the patients. After a median follow-up of 4 months, compensatory hyperhidrosis was recorded in 55% of the patients. 81% of them graded it as minimal. No major complications were observed.Conclusion. Selective T3 thoracoscopic sympathicotomy is a safe and effective method in the treatment of patients with essential hypehidrosis. It does not result in a decrease of compensatory hyperhidrosis, however it seems to decrease its intensity in most of the cases.

Made available in DSpace on 2014-12-17T14:13:24Z (GMT). No. of bitstreams: 1 CarlosAAA.pdf: 153996 bytes, checksum: 5df16895ded0d4a8843735806657602d (MD5) Previous issue date: 2008-09-29 / Hyperhidrosis is an idiopathic condition characterized by excessive sweating. Symptoms generally begin in childhood or early adolescence, and rarely improve with age. The excessive localized sweating generally occurs either spontaneously, or in association with stressful or emotionally charged situations. This prospective study aimed to investigate predictive factors for compensatory hyperhidrosis after thoracoscopic sympathicotomy. From 2000 to 2002, 80 patients (53 female and 27 male) underwent hyperhidrosis surgery. The patients, ranging from 12 to 56 years old, were studied and followed-up for 42.51 ?5.98 months. A satisfaction grading using a visual analogue scale -VAS (0 = not at all satisfied, and 10 = fully satisfied) was used. The surgical procedure was performed bilaterally on the second ganglion (T2) for facial hyperhidrosis, on the third and fourth ganglia (T3 and T4) for axillary hyperhidrosis, and on the third ganglion (T3) for palmar hyperhidrosis. The results showed that, 68 patients (85%) presented with compensatory sweating (CS), which was classified as mild (33.8%), moderate (33.8%) and severe (32.4%). Considering the final surgical results, 70 patients (87.5%) were satisfied with the outcome of the operation, while 10 patients (12.5%) were dissatisfied. Degrees of satisfaction varied according to sex, age, BMI and extent of denervation. Moreover, the compensatory hyperhidrosis was more severe in abdomen and back than in legs. In conclusion, although CS is a frequent adverse effect of sympathicotomy, the degree of patient satisfaction was high. Some factors were related to the occurrence and severity of CS and the most adequate patients to be submitted to this operation are young adult women whose BMI is less than 24.9 / A hiperidrose prim?ria localizada ? um dist?rbio que atinge em algumas regi?es at? 4,6% da popula??o. Caracteriza-se por uma transpira??o em excesso, que vai al?m da necessidade de perda de calor corporal. Manifesta-se mais frequentemente nas m?os, face, axilas e p?s. Identifica de forma negativa o paciente no seu ?mbito familiar, profissional e psicol?gico, levando a uma queda na sua qualidade de vida. As pessoas acometidas limitam seu tempo despendido no ambiente do trabalho, em atividades sociais e recreativas, decorrente ao constrangimento. Muitas delas passam a ser reclusas e a ter problemas de conv?vio social, que pode culminar em fobia social. A simpatectomia tor?cica ? uma forma eficaz no tratamento da hiperidrose localizada. O trabalho visou investigar fatores preditivos para a hiperidrose compensat?ria ap?s a simpaticotomia tor?cica videoendosc?pica. Quanto ? metodologia, entre os anos de 2000 e 2002, 80 pacientes (53 mulheres e 27 homens) foram operados de hiperidrose e acompanhados durante 42,51 ? 5,98 meses, com idade variando de 12 a 56 anos. A satisfa??o destes pacientes quanto aos resultados do procedimento foi aferida por meio de uma escala de avalia??o. O procedimento foi executado bilateralmente no g?nglio T2 para a hiperidrose facial, nos g?nglios T3 e T4 para a hiperidrose axilar, e no g?nglio T3 para a hiperidrose palmar. De acordo com os dados obtidos, 68 pacientes (85%) apresentaram hiperidrose compensat?ria, que foi classificada como leve (33,85), moderada (33,8) e severa (32,4%). Quanto aos resultados da cirurgia, na avalia??o dos pacientes, 70 deles (87,5%) se consideraram satisfeitos, enquanto 10 pacientes (12,5%) disseram estar insatisfeitos. O grau de satisfa??o variou de acordo com o sexo, a idade, o IMC e a extens?o da opera??o. A hiperidrose compensat?ria foi mais intensa no abdome e dorso, comparando-se com as pernas. Em conclus?o, embora a hiperidrose compensat?ria seja um efeito adverso freq?ente ap?s a simpaticotomia, o grau de satisfa??o dos pacientes foi elevado. Alguns fatores foram relacionados ? ocorr?ncia e ? severidade deste problema. Pacientes mais adequados para essa opera??o devem ser mulheres adultas jovens com IMC inferior a 24,9. O car?ter multidisciplinar desse estudo fica atestado pela intera??o de profissionais de ?reas diversas como a epidemiologia, cirurgia geral, cirurgia experimental e cirurgia tor?cica

Made available in DSpace on 2014-12-17T14:13:57Z (GMT). No. of bitstreams: 1 JeanCarloFC.pdf: 596709 bytes, checksum: 314bab688733510c66bd2bd077bef4f9 (MD5) Previous issue date: 2005-04-14 / Analyze, in patients with primary hyperhidrosis (PH) who was undergone to videothoracoscopic sympathicotomy, the degree of vascular denervation after surgical transection of the thoracic sympathetic chain by measuring ultrasonografic parameters in carotid and vertebral arteries. Methods: Twenty-four patients with PH underwent forty-eight endoscopic thoracic sympathicotomy and were evaluated by duplex eco-doppler measuring systolic peak velocity (SPV), diastolic peak velocity (DPV), pulsatility index (PI) and resistivity index (RI) in bilateral common, internal and external carotids, besides bilateral vertebral arteries. The exams were performed before operations and a month later. Wilcoxon test was used to analyse the differences between the variables before and after the sympatholisis. Results: T3 sympathicotomy segment was the most frequent transection done (95,83%), as only ablation (25%) or in association with T4 (62,50%) or with T2 (8,33%). It was observed increase in RI and PI of the common carotid artery ( p<0,05). The DPV of internal carotid artery decreased in both sides (p<0,05). The SPV and the DPV of the right and left vertebral arteries also increased (p<0,05). Asymmetric findings were observed so that, arteries of the right side were the most frequently affected. Conclusions: Hemodynamic changes in vertebral and carotid arteries were observed after sympathicotomy for PH. SPV was the most often altered parameter, mostly in the right side arteries, meaning significant asymmetric changes in carotid and vertebral vessels. Therefore, the research findings deserve further investigations to observe if they have clinical inferences / O delineamento desse estudo objetiva a an?lise das repercuss?es na hemodin?mica das art?rias car?tidas e vertebrais, respons?veis pela irriga??o do enc?falo, ap?s a desnerva??o da cadeia simp?tica ao n?vel de T2, T3 e/ou T4, provocada pela simpaticotomia tor?cica videotoracosc?pica para tratamento da hiperidrose prim?ria. Foram estudados pacientes submetidos a 48 simpaticotomias tor?cicas por v?deo, utilizando como par?metros de compara??o pr? e p?s-operat?rios vari?veis num?ricas de velocidade de pico sist?lico, velocidade de pico diast?lico, ?ndice de resist?ncia e ?ndice de pulsatibilidade. As vari?veis foram obtidas a partir do exame de eco-doppler das art?rias car?tidas e vertebrais bilateralmente utilizando o mesmo aparelho de ultrassom e o mesmo examinador no per?odo de uma semana que antecedeu ao procedimento cir?rgico e 30 dias depois da opera??o. As diferen?as das vari?veis do pr? e do p?s-operat?rio foram mensuradas pelo teste de Wilcoxon, utilizando o software SPSS? 7.5 for Windows (SPSS, Inc., Chicago, IL). Os achados de altera??es significativas foram discutidos, observando os dados da literatura m?dica relacionados com estudos na mesma linha de investiga??o e enfatizando os aspectos de interdisciplinaridade cient?fica