• The Korean Journal of Pain
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• v.14 no.1
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• pp.56-60
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• 2001

Background: Conventional thoracoscopic sympathectomy or sympathicotomy is an effective method in treating localized hyperhidrosis; however, this may result in a postoperatively compensatory hyperhidrosis or facial anhidrosis in the treatment of palmar hyperhidrosis. We modified the conventional sympathicotomy by limiting the extent of nerve transection (limited T3 sympathicotomy) since May 1998. However, there are many reports of a good short-term outcome of limited T3 sympathicotomy. Therefore, we reviewed long-term follow-up of limited T3 sympathicotomy based on outcomes analysis using a questionnaire. Methods: Fifty four patients with palmar hyperhidrosis underwent a limited T3 sympathicotomy between May 1998 and March 1999 and had a complete follow-up over two years using a questionnaire (the mean follow-up was 2.6 years). The patients' postoperative satisfaction was determined by their subjective responses to the questionnaires; the degree of compensatory hyperhidrosis, the effects on foot hyperhidrosis, gustatory hyperhidrosis and facial dryness, and recurrence, and patient's satisfaction. Results: Of the total, 87% of patients had a compensatory hyperhidrosis and 3.7% of them were disabled. 31.5% of patients showed improvement in foot hyperhidrosis, while 68.5% of patients demonstrated no change or got worse. 31.5% of patients had gustatory hyperhidrosis and facial dryness and 22.2% of patients showed a mild palmar hyperhidrosis. The postoperative patients' satisfaction was significantly in 96.3% of patients. Conclusions: The limited T3 sympathicotomy is a highly effective treatment of palmar hyperhidrosis and has a low rate of postoperative compensatory hyperhidrosis, gustatory hyperhidrosis, and facial dryness.

• The Korean Journal of Pain
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• v.21 no.3
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• pp.206-210
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• 2008

Background: Although the cause of hyperhidrosis has not been the subject of close investigation, there are cases for which excessive sweating happens at the hands, feet and armpits due to hyperactivity of the sympathetic nervous system. This usually occurs in people less than 25 years old and it often causes difficulties for their social and occupational life and there is a decrease in the quality of life. Therefore, this should also be examined according to the mental state of the patient who suffers from hyperhidrosis. Methods: The Minnesota Multiple Personality Inventory was administered to 59 patients in the Hyperhidrosis Center from March, 2006 to March, 2007. The MMPI's validity and 10 clinic standards were analyzed. The results were compared according to gender and age. Results: Of the standard clinical items, psychopathy and conversion hysteria were 21.1% and 17.5%, respectively. On comparison between males (47.5%) and females (52.5%), the females had a higher score for the hypochondriasis item. The patients above 18 years old had a significantly higher level of hypochondriasis and hypomania compared to the patients below 18 years old. Conclusions: When analyzing the personality of the patients with essential hyperhidrosis with using the MMPI, it was difficult to look for relations with the mental factor. Therefore, it is necessary to develop diagnostic tests for younger people with considering the relations with the period of morbidity.

• The Korean Journal of Pain
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• v.11 no.2
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• pp.220-225
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• 1998

Background: The patients of facial hyperhidrosis have been known that they had much difficulties in interpersonal relationships and social activities due to excessive hidrosis when they were in stress, hot weather, or having meals. Previous drug therapy and stellate ganglion block have only temporary effects. The surgical method, $T_1$ sympathetomy has the risk of Hornor's syndrome. For that reasons, the sympathicotomy of proximal and distal portions of $T_2$ sympathetic ganglion with electroresectoscope used in transurethral resection seemed to be appropriate procedure, and we would like to report the results of our procedure. Method: Under the general anesthesia with semi-sitting position, and the portal was made through the small incision along the upper border of the 4th rib at the crossing point of mid-axillary line. After the partial collapse of lung by insufflation of 300 to 500 ml of $CO_2$, $T_2$ sympathetic ganglion was identified and resected proximally and distally with electro-cauterization. Finally the lung was expanded by limiting flow until the airway pressure reached 30 to 40 cm$H_2O$, and the wound was closed after removal of electroresectoscope. Result: There was no postoperative complication requiring surgical interventions. The facial sweating was stopped immediately after the operation and all the patients appeared to be satisfied. Conclusion: $T_2$ sympathicotomy with TUR electroresectoscope is thought be the minimal invasive and highly successful method in the treatment of facial hyperhidrosis. But longer terms follow-up will be needed to prove this result.

• The Korean Journal of Pain
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• v.22 no.3
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• pp.253-256
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• 2009

Conventional thoracoscopic sympathectomy is an effective method in treating palmar-axillary hyperhidrosis. However, this may result in a postoperatively compensatory hyperhidrosis. Conservative treatments of compensatory hyperhidrosis consist of aluminum chloride, anticholinergics, iontrophoresis, and botulinum toxin A injections. Surgical treatments in compensatory hyperhidrosis include excision of axillary tissue, liposuction, and thoracoscopic sympathectomy. Intradermal injection of botulinum toxin A has used to treat focal axillary or palmar hyperhidrosis. Botulinum toxin A bestows significant benefits with few side-effects and is well-tolerated, with beneficial results lasting from 4-16 months. We report a case illustrating the beneficial use of botulinum toxin A in a 25-year-old healthy male patient with compensatory sweating of the flank after thoracoscopic sympathectomy. Modified Minor's starch iodine test was used to allow accurate assess the impact of hyperhidrosis on the patient. In conclusion, Botulinum toxin type A is a valuable therapy for compensatory sweating after endoscopic thoracic sympathectomy.

• The Journal of Internal Korean Medicine
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• v.31 no.1
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• pp.118-127
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• 2010

Objective : Hyperhidrosis is the secretion of sweat in amounts greater than physiologically needed for thermoregulation. Ryodoraku is a physiological function test using electric current, and is closely related to skin sympathetic tone. The aim of this study was to investigate the characteristics of Ryodoraku and association of Ryodoraku with hyperhidrosis. Methods : For this study, we conducted Ryodoraku on 56 people, comprising 33 with palmar-plantar hyperhidrosis and 23 with head-face hyperhidrosis, who visited the 5th Internal Department of the Oriental Medicine Hospital of Kyung Hee University during the period from March 1, 2008 to May 31, 2009. Ryodoraku scores were evaluated and compared by 7 indices(upper, lower, left, right, yin, yang, total score). Results : Ryodoraku scores were significantly higher in hyperhidrosis patients than the normal group. Ryodoraku scores of palmar-plantar hyperhidrosis patients were significantly higher than of head-face hyperhidrosis patients and the normal group. The difference of Ryodoraku indices among palmar-plantar hyperhidrosis patients were insignificant. In head-face hyperhidrosis patients, the upper index was significant higher than the lower index. Conclusions : In hyperhidrosis patients, all indices were significant higher than lower. The upper/lower ratio was significant higher in head-face hyperhidrosis patients.

• Journal of Chest Surgery
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• v.33 no.3
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• pp.268-272
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• 2000

Thoracic sympathicotomy has been used safely and successfully to treat essential hyperhidrosis. However, it has been difficult to treat compansatory hyperhidrosis after thoracic sympathicotomy and focal hyperhidrosis. The sweat glands were innervated by post-ganglionic sympathetic fibers with acetylcholic serving as the transmitter. Botulinum A toxin has been reported to block neuro-transmission at the cholinergic autonomic nerve terminals. Prospecting its effect for the sweat gland, we treated 5 patients with focal hyperhidrosis with botulinum A toxin. Three patients received bilateral thoracic sympathectomy (1 case) and sympathicotomy(2 case) via VAT. The hyperhidrosis area was marked with betadine and was subdivided into squares of 2$\times$2 cm(4$\textrm{cm}^2$) each. Botulinum A toxin was injected intracutaneously in a dosage of 2.5U/0.1ml(100U/4ml) /4$\textrm{cm}^2$. A total dose of 100U of Botulinum A toxin was injected into the affected sites. Subjective assessment of sweat production by the patients using a visual analogue scale showed a 20~70% improvement. During the follow-up period, no toxic effects were observed.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.94-97
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• 1996

Two hundred and eighty eight patients suffering from excessive sweating of palms, soles and axillae etc., visited our Neuro-Pain clinic from November 1991 to March 1996. The sex ratio was 1:1.2. the third decade of age was the major age group. the onset time of hyperhidrosis was prepubertal period (in 95.1% of them). the provocative factors fo excessive sweating were tension and stress from interpersonal relationship. they had the family history (30.9%) and the past history treated with herb medication (56.9%), medicine (30.6%), operation (1.4%), and no treatment (39.6%). We treated 113 patients by sympathetic ganglion block with pure alcohol. the average times of thoracic sympathetic ganglion block were 2.1 (left), 2.4 (right) and those of lumbar sympathetic ganglion block were 1.2 (left), 1.6 (right). Average admission period was 14.7 days. Recurrence rare was 7.1%. Most longstanding effective period was 45 months. We conclude from our results that sympathetic ganglion block is one of the most effective treatments for hyperhidrosis owing to its simple technique and low recurrence rate.

• The Journal of Internal Korean Medicine
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• v.28 no.3
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• pp.597-607
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• 2007

Backgrounds and Objectives: Primary hyperhidrosis deeply affect a patient's quality of life, resulting in impairments of daily activities, social interactions and occupational activities. The objectives of the study were to assess quality of life(QOL) in patients with primary hyperhidrosis before and after treatment with oriental medicine. Methods : Between December 2006 and July 2007, 26 patients underwent oriental medicine treatment. which consisted of herb medicine. acupuncture and iontophosis (if palmar/plantar hyperhidrosis) treatment. QOL questionnaires comprised of dermatology life quality index (DLQI) and visual analogue scale (VAS) were employed before and after treatment Results : All 26 patients were evaluated. The treatment controlled primary hyperhidrosis in 84.6% of cases. The mean of DLQI score before treatment was 16.65 after treatment mean DLQI score was 8.18. The mean of VAS before treatment was 91.35 after treatment mean VAS was 49.92. QOL in patients with primary hyperhidrosis significantly improved after oriental medicine treatment. The improvements in QOL were similar in patientswith palmar/plantar, head, and systemic hyperhidrosis. Conclusions : Oriental medicine treatment leads to significantly improved QOL in patients with primary hyperhidrosis. Further studies are needed to evaluate the objective efficacy in patients with primary hyperhidrosis before and after oriental medicine treatment.

• The Korean Journal of Pain
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• v.12 no.1
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• pp.81-86
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• 1999

Background: Essential hyperhidrosis is a condition with excessive sweating, which may be localized in any parts of the body. Thoracic sympathectomy has been a surgical procedure for the management of hyperhidrosis. Methods: We studied 30 ASA I and II patients suffering from severe hyperhidrosis. Bilateral upper thoracoscopic sympathectomy of $T_{2-4}$ was performed in 30 patients under general anesthesia. Anesthesia was induced with 2.5% thiopental sodium 5 mg/kg and succinylcholine chloride 1 mg/kg and was maintained with enflurane 1~2 Vol% and $N_2O-O_2$ mixture adjusted to maintain $SpO_2$ greater than 96%. During anesthesia, invasive arterial pressure, heart rate, EKG, $SpO_2$ and capnography were monitored. Skin temperature was measured with thermister probes attached to the index finger of each hand. An increase in temperature after cautery confirmed success of the sympathectomy. Results: There were 14 men and 16 women whose ages ranged from 16 to 46 years old (mean age 22.2). Of these patients, 13 patients had complained of palm-sole hyperhidrosis, 9 of palm-sole-axilla hyperhidrosis, 4 of palm-sole-face hyperhidrosis and 4 of palm-sole-axilla-face hyperhidrosis. The provocative factors of excessive sweating were tension and stress from interpersonal relationships. There was positive familial history in 37%. The most common complication was compensatory hyperhidrosis in 23 patients comprising 76%. Other complication included peumothorax (4 patients), hemothorax (1 patient), ipsilateral Horner's syndrome (1 patient) and paresthesia of right arm (1 patient). The degree of satisfaction was graded as good, fair and poor with 15, 12 and 3 patients, respectively. Conclusions: Thoracoscopic sympathectomy with VATS is an efficient, safe and minimally invasive surgical procedure for essential hyperhidrosis.

• Journal of Chest Surgery
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• v.31 no.5
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• pp.513-517
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• 1998

Video-assisted thoracoscopic surgery has recently evolved as an alternative to thoracotomy for several thoracic disorders. Today it is viewed as a sparing and safe alternative to thoracotomy for a wide spectrum of indication. Using video-assisted operative thoracoscopy, we operated on 33 patients during the 2 years of our experience from June 1993 to June 1995. They were diagnosed as recurrent pneumothorax in 16, visible bulla on X-ray in 6, prolonged air leakage(longer than 7days) in 4, bilataral pneumothorax in 3, hyperhidrosis in 2, previous contralateral pneumothorax in 1, primary hemopneumothorax 1. The average duration of chest tube placement was 2.1${\pm}$0.4 days. The mean postoperative hospital stay was 3.4${\pm}$0.6 days. The complication was persistent air leakage(longer than 48 hours) in 3 case. Video-assisted thoracic surgery is safe, decreased pain, and shortens hospital stay.