Hyperhidrosis excessive sweating
The next day, to test cardiovascular of exercise was carried out with an ergometer of the cycle (Collins CPX; Warren E. Collins; Brain-Arbol, MA) utilizing a maximal, symptom-limited the exercise of increment that hyperhidrosis feet tests protocol that consists of phases of 1 min with work load increments of 100 kilopond-meters per minute (kpm), to the maximum tolerated by hyperhidrosis excessive sweating patient, continuing the protocol of Jones. (11) Patient they breathed for a mouthpiece connected to a pneumotachograph. ECG three-main and the data of the saturation of the oxygen of transcutaneous were met continuously and they were stored in line. Each minute, BP and HOUR they were measured, and the patient was administered a questionnaire that asks by pain of chest, by the pain of leg, and by dyspnea. The patient would be able to stop the test in time. The variable measures were receptions of oxygen (V[O.sub.2]), the production of the carbon dioxide (VC[O.sub.2]), the respiratory quotient (RQ), the ventilation of minute, HOUR, and load of work maximal reached. The measures of Spirometric were carried out in the line of fund before the exercise that tests and in 1, 5, and 15 min after testing.
All interventions were carried out in a theater user and with the patient low general anesthesia and intubation selective. The patient experienced the surgery in a position of semisupine, being sat down with back maintained in a 45 [the degrees] the angle and both kidnapped armaments 90[degrees]. After the lung to be collapsed partly, a thoracoscope was put by the second or third intercostal space in the line of midaxillary. The nice chain was identifying through an electrocoagulator of monopolar and then divided into the second rib and destroyed by hyperhidrosis feet thermocoagulation that utilizes the same one coagulator. To evaluate the efficacy of the technique during the surgery, the digital temperature was measured. A gradual increase of 2 [the degrees] to 3 [the degrees] C indicated sympathectomy adequate. All patients experienced sympathectomy bilateral number by thoracoscopy of video-helped hyperhidrosis excessive sweating and electrocoagulation of D2-D3 in 1 patient, the third and fourth ganglions excessive sweat antiperspirants and medications in 6 patients, and in third parties ganglions excessive sweat antiperspirants and medications only in the 13 remaining patients.
The data are aforesaid like media (SD). A test of two-tailed T was utilized to compare the data coupled registered before and after the surgery. A model of the backward movement was utilized to compare HOUR and the load of work during the test maximal of the exercise before and after the surgery. A value P < 0,05 they were you considered statistically significant.
The return to Surpass
In all patients, the disappearance of hyperhidrosis essential after sympathectomy to be confirmed. During the period posoperatorio, only a patient one requirió the placement of a pipe of chest to treat pneumothorax. The others they were dischargeed without complications in 24 H. In the revision 1 month after the surgery, the patients expressed the high satisfaction in spite of the compensatory present of hyperhidrosis in 80%, located in the back (30%), the chest (20%) or the abdomen (15%). In the following visits, no patient complained about respiratory symptoms such as dyspnea neither hyperresponsiveness bronchial. After 3 months of the surgery, all patients had the hyperhidrosis excessive sweating normal values of spirometric, and the only change observed was a statistically significant decrease in the flow maximal of midexpiratory (MMEF), of 101% hyperhidrosis feet (SD, 26%) to 92% (SD, 27%) [Postpones 1].
Ten patients (50%) had a positive answer to the challenge of the methacholine that remained positive 3 months after sympathectomy, with a bad one [PD.sub.20] that travels through of 1,8 mg/Ml (SD, 2,3 mg/Ml) to 0,87 mg/Ml (SD, 0,79 mg/Ml). Two patients had a result bronchial negative of the test of the challenge before surgery that came be positive after the surgery.
During the test maximal of the exercise, the peak HOUR diminished significantly after surgery, of 172 blows per minute (bpm) [SD, 17 bpm] to 164 bpm (SD, 15 bpm) [P < 0,05]. The expositions of the figure 1 the relation between HOUR and the load during the test maximal of the exercise that utilizes a model of the backward movement with a RQ from 0,99 to 0,95, before and after the surgery.
[FIGURE 1 OMITTED]
The statistically significant differences between presurgical and values of 3 months of monitoring were found for maximal V[O.sub.2], maximales VC[O.sub.2], and RQ. These results are shown on the table 2. There was not the significant differences between the line of fund and the exercise maximal posoperatorio test the values.
DISCUSION hyperhidrosis feet
The modifications observed in the cardiopulmonary function after sympathectomy bilateral number sugiera that there is a light effect of the intervention in the small air route, as shown by the presence of hyperresponsiveness bronchial in the half of the patients studied and in a temperate reduction in HOUR maximal.
In 1980, before the development of the present surgical technique, Molho et to the (2) described the symptomatic changes in the pulmonary function in 15 patients, specifically a decrease from 20 to 25% in MMEF as a consequence of sympathectomy of supraclavicular. Later, in 1995, when Noppen et to the (5) compared spirometry and flow-volume the ties before and before 6 weeks after video-helped thoracoscopy nice in D2-D3 in a group of 47 patients with hyperhidrosis essential, they did not observe to last the respiratory symptoms such as dyspnea. Although those authors found a statistically significant decreases in MMEF [FEV.sub.1],, and in TLC in 6 weeks of sympathectomy, the reevaluation of 35 patients in 6 months shown that TLC had been normalized the values and MMEF remained altered. They concluded that sympathectomy of thoracoscopic causes only most minimum, subclinical changes in the secondary pulmonary function to a small hyperhidrosis excessive sweating temporary decrease in the pulmonary volume, that is inherent in the procedure of the thoracoscopic. The permanent decrease in MMEF was attributed to the denervation surgical, and they suggested that that tone of bronchomotor can be influenced for the nice nervous system, by contrast with the present opinion that air route the bronchial motor tone is not influenced for this system.
Although the etiopathogenesis of the asthma now be considered for to be related to the chronic inflammation of the air route, (13 ours results reveal that deterioration in the nice nervous system in these patients can be able to produce an increase in the bronchial motor tone. The half of our patients had a methacholine positive the bronchial result of the test of the hyperhidrosis feet challenge before the surgery, but only two patients had a prior history of the asthma. This observation is consistent with the proposed theory by Szentivany (14) in the end of the sixties that that asthma is caused for an imbalance between two antagonistic systems: the hypercritical of [alpha]-adrenergic system and cholinergic, and hyporesponsiveness of the system [beta]-adrenergic. This theory is maintained partly by our conclusions, specifically by the implication that that hyperreactivity is related to the nice activity of the nervous system in different locations: the skin, the lung, and the heart. The bronchial tubes of patients with hyperhidrosis essential behave as the bronchial tubes of patients of "pseudoasthmatic" before surgery, and that conduct persist and they can enlarge after the surgery, declared by a decrease of MMEF and methacholine positive challenges the results of the test.
Sympathectomy of Thoracoscopic, nevertheless, does not seem to influence the capacity of the exercise, as produces the effects only minimums in the answer of the heart. Our results suggest that that hypercritical of the nice nervous system has a most minimum effect in the cardiac function in a test maximal of the exercise, coherent with the fact that HOUR stop is under the influence of the tone of hyperhidrosis excessive sweating, while during the exercise HOUR enlarged is due to a decrease of the tone of vagal and an increase of the nice tone. (15) Our find that HOUR maximal diminished significantly after the surgery was different from the results reported by Noppen et to the, (6) that found that HOUR diminished stopped and in the exercise maximal. Other investigators (16) has found the conduct of HOUR during the exercise after the surgery to be similar around a patient that takes [beta]-blockers, and that the hyperfunction of nice fibers is revoked completely by sympathectomy of thoracoscopic. The differences observed in metabolic parameters can be attributable to the fact that in testing of symptom-limited of ours patient, V[O.sub.2] and VC[O.sub.2] they would be reduced on account of the lack of the instruction after the surgery.
The clinical repercussions of these respiratory events (hyperresponsiveness bronchial, the decrease in MMEF and HOUR maximal) they are light for the patient, as is shown for the fact that not patient reported the respiratory neither cardiac symptoms after the surgery. We conclude that sympathectomy video-helped of thoracoscopic is a sure surgical processing for the hyperhidrosis essential. In the relation to respiratory symptoms, this surgery produces light bronchial obstruction, suggesting that in patients with hyperhidrosis essential the bronchial motor tone is influenced for the nice nervous system. Still more, in the relation to the cardiac function, sympathectomy of thoracoscopic does not affect the metabolic parameters, and the patients can carry out a test maximal of the exercise without complications, in spite of presenting a decrease in HOUR stop.
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The Wakefulness of Laura , MD ; Nuria Calaf , ND ; Esperanca Codina , ND ; Juan Jose Fibla, MD; Guillermo Gomez , MD ; and Pere Marry, MD
* Of the Departments of the Pulmonary Function (Dres. The wakefulness, Calaf, Codina, and they Marry) and the Surgery Thoracic (Dres. Fibla and Gomez), the Hospital of the Holy one Creu I Sant Pau, Barcelona , Spain . The manuscript received February 21, 2005 ; the revision accepted April 28, 2005 .
The reproduction of this article is prohibited without the permission writing of the American School of Doctors of Chest (www.chestjournal. Org/misc/reprints.htm).
The correspondence to: The Wakefulness of Laura, MD, the hyperhidrosis excessive sweating Department of the Pulmonary Function, the Hospital of the Holy one Creu I Sant Pau, Sant Antoni l Mrs Claret 167, Barcelona 08025, Spain; hyperhidrosis feet
Postpone 1 -- the Changes in the Pulmonary Function before and Later
Video-helped Thoracoscopic Sympathectomy *
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