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Quantification of eccrine sweat glands with acetylcholine sweat-spot test and anatomical redistribution of sweating after T2–T3 thoracoscopic sympathicolysis

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Abstract

Background

In this study, patients treated by thoracoscopic sympathicolysis for palmar hyperhidrosis were evaluated to determine the number and response of sweat glands to intradermal acetylcholine stimulus.

Methods

A total of 30 patients were included in the study. Group A consisted of 10 patients with palmar hyperhidrosis who underwent thoracoscopic sympathicolysis in October 2005, and group B consisted of 20 patients who underwent surgery during the years 1999, 2000, and 2001. The study procedure involved applying iodine alcohol to the palm and then intradermally injecting 0.1 ml 1% acetylcholine. This activated the sweat glands, which were then photographed and counted. The study procedure was performed prospectively over different periods in group A and retrospectively in group B.

Results

In group A, the mean number of glands activated 1, 3, 6, and 12 months after surgery were 41, 174.20, 522.8, and 747.2, respectively; this gradual increase was statistically significant over the first 6 months (p = 0.004) but not between months 6 and 12 (p = 0.255). The trend towards an increasing number of active glands occurred in both groups, with a mean of 1369.8 active glands in group B compared to 747.2 (p = 0.095) in group A after 12 months.

Conclusion

It is well-known that Cannon’s law of denervation (1939) is not applicable to the sweat glands, that is, there is no hyperactivation following intradermal acetylcholine stimulation. However, some response, which increased over the first 6 months following surgery, was observed in our study. Nevertheless, this activation is subsequently self-limiting, resulting in no gland atrophy, and reinnervation occurs without patient awareness.

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Authors and Affiliations

  1. Department of Thoracic Surgery and Unit of Human Anatomy and Embryology, Servei de Cirurgia Toràcica, Hospital Universitari de Bellvitge, School of Medicine, University of Barcelona, L’Hospitalet de Llobregat, Feixa Llarga s/n 08907, Barcelona, Spain

    Ricard Ramos & Juan Moya

  2. Department of Preventive Medicine and Biostatistics, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain

    Cristina Masuet

  3. Department of Pharmacology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain

    Maria Badia

  4. Department of Thoracic Surgery, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain

    Valerio Perna, Ivan Macia, Ignacio Escobar & Rosa Villalonga

Authors
  1. Ricard Ramos
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  2. Cristina Masuet
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  3. Maria Badia
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  4. Valerio Perna
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  5. Ivan Macia
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  6. Ignacio Escobar
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  7. Rosa Villalonga
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  8. Juan Moya
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Corresponding author

Correspondence to Ricard Ramos.

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Ramos, R., Masuet, C., Badia, M. et al. Quantification of eccrine sweat glands with acetylcholine sweat-spot test and anatomical redistribution of sweating after T2–T3 thoracoscopic sympathicolysis. Surg Endosc 23, 321–326 (2009). https://doi.org/10.1007/s00464-008-9922-z

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  • DOI: https://doi.org/10.1007/s00464-008-9922-z

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