Navegando por Palavras-chave "Hyperhidrosis"
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- ItemSomente MetadadadosEstudo Anatômico Do Segundo, Terceiro E Quarto Gânglios Simpáticos Torácicos Utilizando Imagens Vídeo-Toracoscópicas E Sua Implicação Na Simpatectomia Torácica Para Tratamento Cirúrgico Da Hiperidrose Primária(Universidade Federal de São Paulo (UNIFESP), 2017-09-28) Leao, Eduardo Iwanaga [UNIFESP]; Leao, Luiz Eduardo Villaca [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Leão EI. Anatomical study of the second, third and fourth thoracic sympathetic ganglia using video-thoracoscopic images and their implication in thoracic sympathectomy for surgical treatment of primary hyperhidrosis. [Thesis] São Paulo: Escola Paulista de Medicina, Federal University of São Paulo; 2017 Introduction: Currently, thoracic thoracoscopy sympathectomy has been widely used in the surgical treatment of focal hyperhidrosis. The outcome of the proposed procedure, however, is directly related to the level where the sympathetic chain is disrupted. Usually the surgeon uses only the ribs as reference points, not considering the anatomical variations that these ganglia could present and thus interfering with the surgical result. Objectives: Through video-thoracoscopic recordings of bilateral thoracic sympathectomies in patients with localized primary hyperhidrosis: analyze and determine the anatomical variations of the second, third and fourth thoracic sympathetic ganglia and their relationship with the corresponding ribs. Method: We evaluated 70 video recordings of routine operations in patients with localized hyperhidrosis obtained at random. The 2nd, 3rd and 4th thoracic sympathetic ganglia (T2, T3 and T4) were directly identified and their anatomical relationships established with the corresponding ribs. The relationships between the sympathetic ganglia and the ribs were classified according to their location in the intercostal space (type A); On top of the lower rib (type B); At the body of the lower rib (type C) and located below the lower rib (type D). Results: On both, right and left sides, the location of T2 in 69 cases (98.5%) was in the second intercostal space, with only one case (1.5%), where the location occurred at the top of the third rib. On the right side, T3 had 49 cases (70%) in the third intercostal space, 18 cases (25.7%) on the top of the fourth rib and 3 cases (4.3%) on the fourth rib body. On the other hand, on the left side, prevalence also occurred as type A with 48 cases (68.5%), 20 cases (28.5%) as type B, 1 case (1.5%) type C and 1 case (1.5%) type D. Finally, the location of T4 on the right side presented 15 cases (21.4%) in the fourth intercostal space, 37 cases (52.8%) on the top of the fifth rib, 14 cases (20%) in the fifth rib body and 4 cases (5.8%) below this rib in the fifth intercostal space. On the left, 16 cases (22.8%) were type A, 39 cases (55.7%) type B, 14 cases (20%) type C and 1 case (1.5%) type D. Regarding the symmetry between the sides operated, we can say that there were 28 symmetrical (40%) and 42 asymmetric (60%) cases. Conclusion: Through the evaluation of the recorded videos obtained in routine operations, it was possible to identify the sympathetic ganglia T2, T3 and T4, as well as some of their anatomical variations and their relations with the ribs during thoracic sympathectomies for the treatment of primary hyperhidrosis.
- ItemAcesso aberto (Open Access)Randomized trial - oxybutynin for treatment of persistent plantar hyperhidrosis in women after sympathectomy(Faculdade de Medicina / USP, 2014-02-01) Costa Junior, Altair da Silva [UNIFESP]; Leao, Luiz Eduardo Villaca [UNIFESP]; Succi, José Ernesto [UNIFESP]; Perfeito, João Aléssio Juliano [UNIFESP]; Castelo Filho, Adauto [UNIFESP]; Rymkiewicz, Erika; Marchetti-Filho, Marco Aurelio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: Hyperhidrosis is a common disease, and thoracoscopic sympathectomy improves its symptoms in up to 95% of cases. Unfortunately, after surgery, plantar hyperhidrosis may remain in 50% of patients, and compensatory sweating may be observed in 70%. This clinical scenario remains a challenge. Our objective was to evaluate the effectiveness of oxybutynin in the treatment of persistent plantar hyperhidrosis and compensatory sweating and its effects on quality of life in women after thoracoscopic sympathectomy. METHOD: We conducted a prospective, randomized study to compare the effects of oxybutynin at 10 mg daily and placebo in women with persistent plantar hyperhidrosis. The assessment was performed using a quality-of-life questionnaire for hyperhidrosis and sweating measurement with a device for quantifying transepidermal water loss. Clinicaltrials.gov: NCT01328015. RESULTS: Sixteen patients were included in each group (placebo and oxybutynin). There were no significant differences between the groups prior to treatment. After oxybutynin treatment, there was a decrease in symptoms and clinical improvement based on the quality-of-life questionnaire (before treatment, 40.4 vs. after treatment, 17.5; p = 0.001). The placebo group showed modest improvement (p = 0.09). The outcomes of the transepidermal water loss measurements in the placebo group showed no differences (p = 0.95), whereas the oxybutynin group revealed a significant decrease (p = 0.001). The most common side effect was dry mouth (100% in the oxybutynin group vs. 43.8% in the placebo group; p = 0.001). CONCLUSION: Oxybutynin was effective in the treatment of persistent plantar hyperhidrosis, resulting in a better quality of life in women who had undergone thoracoscopic sympathectomy.
- ItemAcesso aberto (Open Access)Role of video-assisted thoracoscopic sympathectomy in the treatment of primary hyperhidrosis(Associação Paulista de Medicina - APM, 2003-01-01) Leao, Luiz Eduardo Villaca [UNIFESP]; Oliveira, Renato de [UNIFESP]; Szulc, Renuzza [UNIFESP]; Mari, Jair de Jesus [UNIFESP]; Crotti, Pedro Luis Reis [UNIFESP]; Goncalves, Jose Julio Saraiva [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)CONTEXT: Essential hyperhidrosis is a frequent disorder causing significant functional impairment. The advent and development of video-assisted thoracoscopic techniques now allows thoracic sympathectomy to be carried out precisely and safety with good results and minimal morbidity. OBJECTIVE: To assess the impact of video-assisted thoracic sympathectomy in patients diagnosed as presenting severe and disabling hyperhidrosis. TYPE OF STUDY: This was a longitudinal study of the clinical course of all hyperhidrosis cases selected for surgery between May 1999 and January 2003. SETTING: Division of Thoracic Surgery, Universidade Federal de São Paulo (UNIFESP). PARTICIPANTS: 743 patients with surgery indicated due to palmar hyperhidrosis (49.8%), palmar-axillary hyperhidrosis (38.1%), craniofacial hyperhidrosis (8.9%) or isolated axillary hyperhidrosis (2.8%). PROCEDURES: Video-thoracoscopic sympathectomy was performed, isolating the second thoracic ganglion (T2) in all patients, with additional sympathectomy of T3 and T4 if necessary. MAIN MEASUREMENTS:The clinical course was followed up via questionnaires, phone calls, letters and statements. Simple questions were asked regarding the disappearance of symptoms and presence and intensity of compensatory sweating. RESULTS: The surgery was regarded as efficient in all cases of palmar hyperhidrosis. In the craniofacial hyperhidrosis cases, partial recurrence of the symptoms occurred in 2 cases (3.0%). Partial recurrence or persistence of symptoms occurred in 20% of the patients with predominantly axillary symptomatology. The compensatory sweating was considered disagreeable or uncomfortable by about 30% of the patients, but it only reached the level of regretting the operation for 3% of them. This occurred more frequently in patients with axillary hyperhidrosis. Ten cases of complications occurred. CONCLUSION: Thoracoscopic sympathectomy provides very good results in most patients, with a very low complication rate. However, the assessment of surgical results using conventional methods is imprecise and inaccurate. Different methodology, including quality of life assessment, must be used for comparing results and providing objective data on the results of this operation.