• Journal of Korean Neurosurgical Society
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• 제37권5호
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• pp.354-356
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• 2005

Objective: Thoracoscopic sympathicotomy is effective in treating not only palmar hyperhidrosis, but also axillary hyperhidrosis. But studies for axillary hyperhidrosis accompanying osmidrosis are few. We report the outcome of six axillary hyperhidrosis with osmidrosis with literatures review. Methods: Using a minimally invasive technique, thoracoscopic T3-4 sympathicotomy was performed. The results of sympathicotomy of third and fourth sympathetic chains of six patients from January 1999 to August 2003 for axillary hyperhidrosis with osmidrosis were reviewed. Results: All patients had a successful outcomes, their profuse sweating ceased. Two patients suffered from compensatory hyperhidrosis. Three patients disappeared or diminished foul odor but three patients complained remained osmidrosis. Conclusion: In the treatment of axillary hyperhidrosis, the sympathicotomy of T3 and T4 chain is an effective method but osmidrosis must be treated according to its cause.

• Journal of Korean Neurosurgical Society
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• 제37권4호
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• pp.272-274
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• 2005

Objective: Surgical treatment of focal axillary hyperhidrosis is often unsatisfactory because of compensatory hyperhidrosis. The purpose of this study is to evalute the effect of decreased sweating production using 20% aluminum chloride on axillary hyperhidrosis. Methods: From February to December, 2002, 10 patients (mean age 25.2 male 2, female 8) with clinical diagnosis of axillary hyperhidrosis were treated by 20% aluminum chloride solution. Until the desired degree of symptom relief was obtained, they were educated to apply every day and thereafter, the agent would be applied as often as is necessary. We analyzed patient's satisfaction and application time at onset of desired dryness, application interval to maintain the relief of symptom and side effects. Results: Aluminum chloride solution was effective in treatment of axillary hyperhidrosis showing excellent result in 60% of patients and good in 40%. Application time at onset of desired dryness ranged from 1 to 6 days(mean 3 days). Application interval to maintain the relief of symptom ranged from 5 to 45 days(mean 12 days). There were no significant complications but just mild irritation and miliaria in seven patients. Conclusion: 20% aluminum chloride solution is the simple, safe and less expensive method for initial treatment for axillary hyperhidrosis not accompanying osmidrosis.

• Journal of Chest Surgery
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• 제36권4호
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• pp.297-299
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• 2003

흉강내시경을 이용한 교감신경 절단술은 수장부 다한증뿐만 아니라 액와부 다한증에 대해서도 효과가 좋다고 알려져 있다. 이전에 R2, 3, 4교감신경 절단술의 여러 가지 조합 방법들과 다르게 R4, 5절단 방법 효과를 알아보고자 한다. 액와부 액취증 없이 과다한 땀이 나는 환자들을 대상으로 2002년 2월부터 8월까지 2mm 흉강내시경 이용하여 5예의 흉강경 교감신경절단술 시행하였다. 모든 환자들 수술 결과에 만족하였고 과다한 땀은 더 이상 없었다. 총 5예 중, 3예에서(60%) 보상성 다한증을 경험하였는데, 그중 1예만(20%) 의미 있게(불편한 정도는 아니지만) 보상성 다한증을 허리 및 허벅지에 보였다. 액와부 다한증에 대한 치료로 R4, 5 교감신경절단술은 효과적인 치료 방법으로 생각한다.

• Journal of Chest Surgery
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• 제38권8호
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• pp.570-575
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• 2005

배경: 다한증의 치료에 있어서 흉강내시경을 이용한 흉부교감신경절단술은 매우 중요한 역할을 한다. 하지만 액와부 다한증의 경우 술 후 보상성 발한 및 액와부의 재발한으로 인해 술 후 만족도가 높지 못하다 이에 흥부교감신경의 차단범위에 따른 증상의 호전 및 만족도를 비교 평가하여 수술방법의 선택에 도움을 주려하였다. 대상 및 방법: 2001년 1월부터 2003년 12월까지 액와부 다한증으로 흥부 교감신경차단술을 시행한 70명의 환자 중 술 후 추적이 가능했던 57명을 대상으로 하였다. 제 3, 4, 5번 늑골상연에서 교감신경절간신경을 차단한 25예(1군)와 제 3, 4번 늑골 상연에서 교감신경절간신 경을 차단한 32예(2군)로 나누어서 수술 후 만족도의 변화와 보상성 발한의 정도를 비교하였다 결과: 두 군간의 연령 및 성별, 가족력, 동반된 다한증, 술 후 추적기간에 있어서 유의한 차이는 없었으나, 수술 후 만족도에 있어서는 1군에서 $88.0\%$, 2군에서는 $56.3\%$의 만족도를 보여 유의한 차이를 보였다 (p=0.02). 일상생활에 불편함을 초래하는 중등도 이상의 보상성발한은 1군에서 25예 중 13예$(52.0\%)$, 2군에서 32예 중 20예$(62.5\%)$였으나 통계적으로 유의한 차이를 보이지는 않았다. 걸론: 액와부다한증 을 동반한 일차성 다한증의 수술 치료에 있어서 R3, 4, 5 교감신경 차단술이 R3, 4 교감신경 차단술에 비해서 보상성 발한에 차이가 없고 술 후 만기추적상의 만족도가 높았다.

• Archives of Plastic Surgery
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• 제35권6호
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• pp.709-715
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• 2008

Purpose: Axillary osmidrosis is caused by excessive apocrine gland secretion, which causes an unpleasant odor. Axillary osmidrosis causes difficulty in social activities and personal handicap. We studied the long term follow up results of our surgical procedures and sought to find a best surgical treatment methods. Methods: From January 1991 to December 2006, a total of 1864 patients(587 men, 1277 women) had been treated with this procedure for axillary osmidrosis and hyperhidrosis. Follow up periods varied from 10 to 15 years. We used the subdermal excision technique, using two small incisions over the axilary folds and using a Kawata dissector(instrumental shaving) and additional manual subdermal excision(manual shaving). Results: Among the total patients, 782 patients were followed up. Except a pure hyperhidrosis patients, 759 osmidrosis patients was included. 588 patients(77.4%) had a good results, 148 patients(19.5%) had a moderate results and 23 patients(3.1%) had a recurrence. Complication developed in 189 patients(10.1%): hematoma or seroma in 25 patients, wound dehiscence in 86 patients, partial skin necrosis in 45 patients, and infection in 28 patients. Conclusion: We conclude that our method has several advantages such as 1) short operation time, 2) minimal scaring, 3) lower complication rates, 4) high satisfactory rates.

• The Korean Journal of Pain
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• 제22권3호
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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 Korean Journal of Pain
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• 제8권1호
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• pp.139-143
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• 1995

Hyperhidrosis is the state of abnormal sweating on the palm, sole and axillary region. The main treatment of hyperhidrosis are surgical sympathectomy and a thoracic sympathetic ganglion block with neurolytics. Among them, a thoracic sympathetic ganglion block is used in pain clinic for the treatment of hyperhidrosis. I have successfully performed a thoracic sympathetic ganglion block on a 21 year old female patients with pure alcohol. I concluded that the thoracic sympathetic ganglion block was one of the most effective treatment of hyperhidrosis.

• Journal of Chest Surgery
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• 제44권2호
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• pp.154-158
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• 2011

Background: Video-assisted thoracic sympathicotomy plays an important for the treatment of essential hyperhidrosis. Patients are usually satisfied with the surgical outcome at the early post-operative period, but suffer recurrence and compensatory sweating in the late post-operative period. There are many sympathicotomy methods to minimize recurrence and compensatory sweating. We compared the outcome of sympathicotomy methods above the third rib (R3) and the fourth rib (R4) with regards to symptoms, satisfaction, recurrence, and compensatory palmar and axillary hyperhydrosis. Materials and Methods: From January 1999 to April 2009, 39 cases of thoracoscopic sympathicotomy at the third rib (R3), and 94 cases of thoracoscopic sympathicotomy at the fourth rib (R4) for palmar and axillary hyperhidrosis were compared for early and late post-operative satisfaction, compensatory sweating and recurrence. Results: There was no sex or age difference between groups. Early satisfaction was 94.9% and 98.9% in the R3 group and R4 group, respectively. There was no difference in early satisfaction (94.9% in R3 and 98.9% in R4), late satisfaction (84.6% in R3 and 89.4% in R4), or recurrence (17.9% in R3 and 17.0% in R4) between groups. There was significant difference in compensatory sweating (71.8% in R3 and 33% in R4, p=0.002). Conclusion: R4 sympathicotomy demonstrated superior efficacy in the treatment of compensatory sweating compared to R3 in palmar and/or axillary hyperhidrosis.

• Journal of Chest Surgery
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• 제41권4호
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• pp.469-475
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• 2008

배경: 비디오흉강경에 의한 흉부 교감신경차단술은 겨드랑이다한증을 치료하는데 최소침습 치료방법의 하나이다. 여러 다른 수기들이 겨드랑이다한증을 치료하는데 이용되고 있으나 효과가 일시적이고 고비용인 단점이 있다. 본 연구는 겨드랑이다한증 치료에 있어서 2개 부위의 흉부교감신경차단수술(T3-4대 T4)후 조기와 만기 결과를 비교하였다. 대상 및 방법: 2002년 6월부터 2007년 5월까지 원광대학교병원 흉부외과에서 겨드랑이다한증환자 30명에서 2개 부위(T3-4대 T4)의 흉부 교감신경차단 수술 후 후향적으로 조사를 하였다. 모든 환자에서 수술은 단일기도관을 이용한 전신마취하에서 양측으로 동시에 2개의 2 mm 투관침과 2 mm 흉강경을 이용하여 시행하였다. T3-4군은 2002년 6월부터 2004년 6월까지 15명으로 T3-4 교감신경차단수술을 늑골 3, 4번 늑골 상에서 시행하였고, T4군은 15명으로 4번 늑골 상에서 4번 흉부 교감신경차단수술을 시행하였다. 양군의 치료의 만족도, 보상성 다한증의 빈도와 정도, 그리고 술 후의 합병증을 조사하였고, 또한 T.I.P.I에 의한 술 전 후의 체열변화를 조사하였다. 만기의 결과는 환자와의 전화면담으로 시행하였다. 결과: 평균 추적기간은 T3-4군은 $38.7{\pm}6.5$개월, T3군은 $18.7{\pm}3.6$개월이었다. 수술 직후의 만족도는 양군에서 100%이었으나 만기의 만족도는 보상성다한증의 정도에 의해서 T3-4군은 53.3%,74군은 93.3%를 보였다. 보상성다한증은 불편한 정도 이상이 T3-4군은 46.7%를 보였으나 T4군은 6.7%를 보여 만기의 만족도는 보상성다한증의 정도와 일치하였다. 또한 T.I.P.I에 의한 체열검사에서는 양군 모두 의의 있는 체열상승을 보여주었다. 술 후의 합병증으로는 경도의 공기가슴증과 늑간신경통을 보였으나 모두 다 문제없이 해결되었다. 결론: 양 수술의 수기는 겨드랑이다한증을 치료하는 데 효과적이었다. T4교감신경차단수술이 보다 높은 만족도를 보였고 보상성다한증의 정도와 빈도는 낮았다.

• The Korean Journal of Pain
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• 제9권2호
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• pp.399-402
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• 1996

Endoscopic transthoracic sympathectomy (ETS) has recently become estabilished as a successful treatment for severe palmar and axillary hyperhidrosis. Descriptions have been published of neurolytic, operative and alternative endoscopic procedures involving thermocoagulation, laser coagulation, or or nonvideo-assisted ganglionectomy using equipment not widely available, with low morbidity and excellent results. All methods have advantage and disadvantages. A 19-year-old male who suffered from severe hyperhidrosis on face, palms and axillary areas, has been initially treated with stellate ganglion block in other pain clinic. He was transfered to our pain clinic for endoscopic thoracic sympathectomy. The patient was intubated left side 34 Fr. double lumen tube and positioned left semi-lateral position for right sympathectomy. Right side pneumothorax was created by clamping the ipsilateral side of the double lumen tube and aspiration of air. 11-mm trocar was introduced through incision at the third intercostal space in anterior axillary line, and then additional two 11-mm and 5-mm trocar was introduced through second and fifth intercostal space in mid axillary line. The lung was gently retracted and the parietal pleura over the heads of the appropriate ribs excised using 5-mm sharp insulated coagulating microprocesss. The T4, T3, and T2 ganglions, as well as accompanying rami communicantes, and other branchs arising from upper thoracic nerves to the brachial plexus and surrounding tissues were carefully dissected, coagulated. During sympathectomy, skin temperature of middle was continuously monitored. Elevation of palmar skin temperature intraoperatively indicated an adequate sympathectomy with a definite therapeutic effect. A No. 28 Fr. thoracotomy tube was introduced through a troca under video guidance, placed under water seal after the lung was reinflated. the controlateral side was performed same procedure. After bilateral sympathectomy, chest tubes were removed, and then, he was discharged 2 days after operation with great satisfaction. The ETS provides a well-tolerated, cost-effective alternative to thoracic sympathectomy for primary hyperhidrosis and sympathetic mediated neuropathic pain disorder. And T2 ganglion is considered the key ganglion for the treatment of primary hyperhidrosis. The low incidence of compensatory sweating may by explained by the limited extent of the sympathectomy.