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Nocturnal hyperhidrosis



Sweating excessive, known like hyperhidrosis, can affect people socially and functional. This relatively common disorder of the unknown origin can imply focal the glands sudaríparas of eccrine of the axillae, palmar hyperhidrosis of the soles, of the palms, or of the front, or can be generalized and implies several areas. The glands sudaríparas responsible for hyperhidrosis focal are innervated of glands of eccrine by anatomical nice, but functional cholinergic, the fibers. 1 The neurotransmitter implied, therefore, is acetylcholine. Hyperhidrosis can be classified according to the stimuli that cause the answer that sweats. These stimuli are associates with places inside the nervous system where impulses neuronales to sweat originates. The stimuli to sweat emotional (hyperhidrosis mental or sensorio) is originated in a cortical reflection, to sweat taste (the origin of medullary), thermoregulatory that sweats (the origin of hypothalamic), the injury of the spinal cord of following of hyperhidrosis, the illness, or transection (the spinal origin), and to sweat localities (axonal reflex).1 Hyperhidrosis is generally idiopathic, resulting of the hypercritical of nocturnal hyperhidrosis neurogenic of the glands sudaríparas. 2

 

Several interventions for the hyperhidrosis have been reported. Anticholinergic and medicines antidepresivas have been found to have the effects of the side, 1 aluminum chloride solutions or you leave zirconium they form a temporary plug in the gland sudarípara, 3 and sympathectomy carry the risk of 5 sweating. 4, compensatory toxin of Toxin botulínica, that inhibits the liberation of acetylcholine, has been reported for induce anhidrosis for a duration of median of 7 months that continue their injection Of hyperhidrotic and axillae; nevertheless, a last end of was not observed after numerous processing. (6,7 Another intervention that has reduced really or has eliminated to sweat excessive by variable periods of time is the electric stimulus. 8

 

The use of the electric stimulus to reduce or to eliminate to sweat excessive has been described since 1952.4-7 In a revision of the literature in the administration of hyperhidrosis of the hands and feet, palmar hyperhidrosis Bouman and Lentzer9 they reported that other investigators demanded success with the use of iontophoresis and chemical nocturnal hyperhidrosis substances such as chloride of aluminum, permanganate of potassium, and the formaldehyde. Recognizing that formaldehyde is not ionizable, Bouman and Lentzer9 they reasoned that the positive results that continue the administration of hyperhidrosis with the direct current (DC) depended simply in the passage of the continuous one-way current by the weavings without medicinal ions. In spite of the absence of medicinal ions in the running water, the impurities present commonly they are in it sufficient to carry out a current.

 

Bouman and Lentzer's9 that reasons the confusion of peak points of the "iontophoresis" of terms and "galvanism" in the literature. Iontophoresis refers to the use of DC continuous to deliver the ionic solutions medicated in sorrowful weavings, while the galvanism, a first term proposed by a German scientist in 1799.10 refers to the therapeutic effects of the passage of DC continuous one-way by weavings submerged in the running water. Apparently, prior investigators were not distinguished between iontophoresis and galvanism, because virtually all the publications we find that we described the use of DC to handle hyperhidrosis referred to the intervention as "iontophoresis". The mechanisms proposed by which electric stimulus improve hyperhidrosis includes anxiety of an endogenous electric slope that alters the flow of the sweat and the obstruction of the glands sudaríparas of eccrine, having as a result inactivation of glands sudaríparas by an unknown mechanism. 11

 

The investigators have shown the successful use of "water iontophoresis current" with DC or the alternating current (AC). For the administration of palm grove and hyperhidrosis of the plant. In a study by Reinauer and associates, 12 25 patients between 8 and 35 years of the age were handled with water iontophoresis current that utilizes or AC. (N = 5) or the therapy combined of C. TO. /DC (n=10) compared with DC (N = 10) only. A normal palm grove that sweats the level, that defined as "a constant rate gravimétricamente measure of the sweat of palm grove of less than 0 to 20 mg/min, 12(p167) was achieved after 11 processing with DC. The authors reported that a combination of AC and DC "water iontophoresis current" produced palmar hyperhidrosis the similar favorable answers nocturnal hyperhidrosis. Nevertheless, the processing of sinusoidal AC did not have virtually last effect. The authors speculated that the decrease in the production of the sweat implies "a functional disturbance of the gland sudarípara secretory mechanism interrupting the stimulus-matching of secreción" mechanism 12(p168).

 

Utilizing "water iontophoresis current" administered with DC in 10 to 20 mA, Shrivastava and Singh13 they handled 30 patients with hyperhidrosis of the palms and soles and favorable, clinical results and they reported, with occurring of normhidrosis after a non-specific number of sessions. They investigated also the effects to place the hands or the feet in a tenant of running water with 2 electrodes or to place the hands or the feet in 2 tenants separated of running water, each with an electrode. The number of processing nocturnal hyperhidrosis and the quantity of the current was larger with the method of alone-tenant (the average of 14,1 processing in 20-25 mA for 20 minutes for the method of a-tenant against the average of 7,1 processing in 10 mA for 15-25 minutes with the method of 2 tenants). The effects of their processing lasted a middle of 8,6 months with the electrodes in the same pan in 25 mA for 20 minutes. With pans separated in 10 mA for 15 minutes, the effect of the processing lasted 8,0 months against 3,37 months in 10 mA for 25 minutes. For all groups studied, the medium period of remission was 6,26 months.

 

Similar et al14 explored the use of a stimulator of DC for at home use with the patients that adjust the present intensity to the maximum tolerable production. They utilized the Unit of Fisherman Drionic,* a stimulator to batteries that provides DC for TWG. The stimulator, that produces a production from 7 to 20 mA, was utilized for the administration of hyperhidrosis of the palms, of the soles, or of axillae. The present durations of amplitudes and processing they were not specified. The investigators found that, after 20 consecutive days of the intervention, the 10 treated hands had diminished to sweat as measured utilizing role of Persprint [dagger] and photodensitometry.

 

In a descriptive account, Levit15 reported that a device of nowobsolete called the RA Fischer the Galvanic Generator handled successfully of the plant and hyperhidrosis of palm grove. This stimulator delivered to 90 V to rise to 20 mA of DC in the skin. It based on its observation that the ánodo can be more effective than the cátodo to suppress sweat, Levit16 recommended to invest the polarity for the second time of the processing of 20 minutes.

 

Stolman11 described the use of "water iontophoresis current" -90 V, 12 to 20 mA of DC for 20 minutes, changing the polarity after 10 minutes of handling hyperhidrosis of palm grove in 18 patients. The intervention was carried out 3 times a week for 3 weeks that utilize a RA Fischer the Galvanic Generator. Stolman documented to sweat reduced in 15 of the 18 patients as shown by impression of starch-iodine. Because the evidence for the administration of palmar hyperhidrosis with the electric stimulus reported nocturnal hyperhidrosis in clinical studies suggests that that running water administered with DC is cash, we chose to utilize this method to handle a patient that developed hyperhidrosis the surgery of following. To revise the literature, we were able odd to find any reference that directed the development of hyperhidrosis that continues an incident traumático.

 

Pack the Description

 

Patient

 

The patient was a 36-year-old male electrician that got the left hand in a machine of puller of cable. When did he try to remove the left hand with its right hand, he wounded also that hand, that implied fracture of the phalanx and the next injury to the bed of the nail of the digit V. The left hand had the amputaciones traumáticas partial of digits II to V and the fracture of the radio and the next ulna. The developed a syndrome of compartment in the left forearm. After its graft of skin, the patient to be referred for the physiotherapy by the orthopedist, as indicated on the table.

 

Exam

 

During the initial exam for the hyperhidrosis, the patient reported that, on account of the excessive humidity of hands, he would not be able to maintain his reach in instruments neither in the steering wheel of his car. The he indicated also that was necessary to carry constantly towels or washcloths or to carry gloves of cotton (6 peers a day) to absorb the excessive sweat. The hyperhidrosis came be a labor risk for him as an electrician because the gloves that carried to absorb the sweat diminished its dexterity upon manipulating wires and the instruments. The goal of the patient was to reduce the quantity to sweat to work again and for the cosmetic and social reasons. The patient was tried initially for its range of the movement, of nocturnal hyperhidrosis edema, and of the deficit of the palmar hyperhidrosis force; still, like its hyperhidrosis came be more apparent and prohibited its return to work, we recognized that that intervention for this diagnosis was essential. The consent reported was obtained for purposes of the health information liberation in this report of the case. The return to Surpass

 

Intervention

 

The water the current galvanism was administered 2 3 times to the week for 10 processing that utilize a generator fallen in disuse of DC (Fisherman Co S.a.). Besides TWG, the patient received employment therapy and physiotherapy at hand twice a week that consisted of muscle the exercises fortificantes and an of 30 upper minutes raising circuit to 22,7 kg (50 lb), ultrasonido for the mobility of the scar, the range of the movement, and of simulation of work. The patient had an average of 5 processing for month for 4 months, for a sum of 20 processing, without the observable evidence to sweat reduced before initiating electrotherapy.

 

During TWG, the hands of patient were submerged individually in 2 trays (8 38×26× cm), each he filled of 2 L of running water that was maintained in 21°C (70°F), or the temperature environment, for the patient consolation with an electrode submerged in each tray. The water covered the surface of palm grove of both hands. We treat each hand with 30 minutes of TWG in 12 mA and we invest the polarity after the first one of 15 minutes of the intervention. Thus, both hands received anodal and cathodal TWG in the same dose of the current.

 

TWG following, the hands of patient were dried with a cotton dispensary towel. Before initiating TWG, hyperhidrosis was measured taking a line of fund 5 second impression of the left hand in the washcloth of dry role. This hand was measured alone because exhibited the the majority of the to sweat. The area of hyperhidrosis in the washcloth of role was determined by drawing immediately the borders of the saturation. The length that outline and the width then was measured to the most nearby nocturnal hyperhidrosis millimeter. In the time that this method was the the majority of the easily palmar hyperhidrosis available one to us in the dispensary. The measures of hyperhidrosis were larger in the patient left hand that in its right hand an area 10.3-×12.0-cm to left compared with a small area 1.0-×1.0-cm initial in the correct eminence of thenar of palm grove. The patient did not have the excessive complaints to sweat of the right hand.
 
   
   
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