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Published in: Surgical Endoscopy 2/2009

01-02-2009

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

Authors: Ricard Ramos, Cristina Masuet, Maria Badia, Valerio Perna, Ivan Macia, Ignacio Escobar, Rosa Villalonga, Juan Moya

Published in: Surgical Endoscopy | Issue 2/2009

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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.
Literature
1.
go back to reference Altomare DF, Pilot M-A, Scott M, Williams M, Rubino N, Ilincic L, Waldron D (1992) Detection of subclinical autonomic neuropathy in constipated patients using a sweat test. Gut 33:1539–1543PubMedCrossRef Altomare DF, Pilot M-A, Scott M, Williams M, Rubino N, Ilincic L, Waldron D (1992) Detection of subclinical autonomic neuropathy in constipated patients using a sweat test. Gut 33:1539–1543PubMedCrossRef
2.
go back to reference Altomare DF, Regina G, Lovreglio R, Memeo V (1994) Acetylcholine sweat test: an effective way to select patients for lumbar sympathectomy. Lancet 344(8928):976–978PubMedCrossRef Altomare DF, Regina G, Lovreglio R, Memeo V (1994) Acetylcholine sweat test: an effective way to select patients for lumbar sympathectomy. Lancet 344(8928):976–978PubMedCrossRef
3.
go back to reference Andrews BT, Rennie JA (1997) Predicting changes in the distribution of sweating following thoracoscopic sympathectomy. Br J Surg 84:1702–1704PubMedCrossRef Andrews BT, Rennie JA (1997) Predicting changes in the distribution of sweating following thoracoscopic sympathectomy. Br J Surg 84:1702–1704PubMedCrossRef
4.
go back to reference Birklein F, Eisenbarth G, Erbguth F, Winterholler M (2003) Botulinum toxin type B blocks sudomotor function effectively: a 6 month follow up. J Invest Dermatol 121(6):1312–1316PubMedCrossRef Birklein F, Eisenbarth G, Erbguth F, Winterholler M (2003) Botulinum toxin type B blocks sudomotor function effectively: a 6 month follow up. J Invest Dermatol 121(6):1312–1316PubMedCrossRef
5.
go back to reference Bovell DL, Clunes M, Elder H, Milson J, McEwan J (2001) Ultrastructure of the hyperhidrotic eccrine sweat gland. Br J Dermatol 145:298–301PubMedCrossRef Bovell DL, Clunes M, Elder H, Milson J, McEwan J (2001) Ultrastructure of the hyperhidrotic eccrine sweat gland. Br J Dermatol 145:298–301PubMedCrossRef
6.
go back to reference Cannon WB (1939) A law of denervation. Am J Med Sci 198:739–750 Cannon WB (1939) A law of denervation. Am J Med Sci 198:739–750
7.
go back to reference Chalmers TM, Keele A (1952) The nervous and chemical control of sweating. Br J Dermatol 62:43–54CrossRef Chalmers TM, Keele A (1952) The nervous and chemical control of sweating. Br J Dermatol 62:43–54CrossRef
8.
go back to reference Kahn D, Rothman S (1942) Sweat response to acetylcholine. J Dermatol Invest 5:431–444 Kahn D, Rothman S (1942) Sweat response to acetylcholine. J Dermatol Invest 5:431–444
9.
go back to reference Minor V (1927) Ein Neues Verfahren zu der klinischen Untersuchung der Schweissabsonderung. Z Neurol 101:302–308 Minor V (1927) Ein Neues Verfahren zu der klinischen Untersuchung der Schweissabsonderung. Z Neurol 101:302–308
10.
go back to reference Moya J, Ramos R, Morera R, Villalonga R, Perna V, Macia I, Ferrer G (2006) Results of high bilateral endoscopic thoracic sympathectomy and sympatholysis in the treatment of primary hyperhidrosis: a study of 1016 procedures. Arch Bronconeumol 42(5):230–234PubMed Moya J, Ramos R, Morera R, Villalonga R, Perna V, Macia I, Ferrer G (2006) Results of high bilateral endoscopic thoracic sympathectomy and sympatholysis in the treatment of primary hyperhidrosis: a study of 1016 procedures. Arch Bronconeumol 42(5):230–234PubMed
11.
go back to reference Moya J, Ramos R, Morera R, Villalonga R, Perna V, Macia I, Ferrer G (2006) Thoracic sympathicolysis for primary hyperhidrosis. Surg Endosc 20:598–602PubMedCrossRef Moya J, Ramos R, Morera R, Villalonga R, Perna V, Macia I, Ferrer G (2006) Thoracic sympathicolysis for primary hyperhidrosis. Surg Endosc 20:598–602PubMedCrossRef
12.
go back to reference Moya J, Ramos R, Vives N, Perez J, Morera R, Perna V, Villalonga R, Ferrer G (2004) Compensatory sweating after upper thoracic sympathectomy. Prospective study of 123 cases. Arch Bronconeumol 40(8):360–363PubMedCrossRef Moya J, Ramos R, Vives N, Perez J, Morera R, Perna V, Villalonga R, Ferrer G (2004) Compensatory sweating after upper thoracic sympathectomy. Prospective study of 123 cases. Arch Bronconeumol 40(8):360–363PubMedCrossRef
13.
go back to reference Ramos R, Moya J, Morera R, Masuet C, Perna V, Macia I, Escobar I, Villalonga R (2006) An assessment of anxiety in patients with primary hyperhidrosis before and after endoscopic thoracic sympathicolysis. Eur J Cardiothorac Surg 30(2):228–231PubMedCrossRef Ramos R, Moya J, Morera R, Masuet C, Perna V, Macia I, Escobar I, Villalonga R (2006) An assessment of anxiety in patients with primary hyperhidrosis before and after endoscopic thoracic sympathicolysis. Eur J Cardiothorac Surg 30(2):228–231PubMedCrossRef
14.
go back to reference Ramos R, Moya J, Macia I, Morera R, Escobar I, Perna V, Rivas F, Masuet C, Saumench J, Villalonga R (2007) Anatomical redistribution of sweating after T2–T3 thoracoscopic sympathicolysis. A study of 210 patients. Surg Endosc 21(11):2030–2033PubMedCrossRef Ramos R, Moya J, Macia I, Morera R, Escobar I, Perna V, Rivas F, Masuet C, Saumench J, Villalonga R (2007) Anatomical redistribution of sweating after T2–T3 thoracoscopic sympathicolysis. A study of 210 patients. Surg Endosc 21(11):2030–2033PubMedCrossRef
15.
go back to reference Randall W (1946) Quantitation and regional distribution of sweat glands in man. Am J Physiol 147:761–767 Randall W (1946) Quantitation and regional distribution of sweat glands in man. Am J Physiol 147:761–767
16.
go back to reference Ryder REJ, Marshall R, Johnson KJ, Ryder AP, Owens DR, Hayes TM (1988) Acetylcholine sweat-spot test for autonomic denervation. Lancet I:1303–1305CrossRef Ryder REJ, Marshall R, Johnson KJ, Ryder AP, Owens DR, Hayes TM (1988) Acetylcholine sweat-spot test for autonomic denervation. Lancet I:1303–1305CrossRef
17.
go back to reference Sato K (1977) The physiology, pharmacology and biochemistry of the eccrine sweat gland. Rev Physiol Biochem Pharmacol 79:52–131 Sato K (1977) The physiology, pharmacology and biochemistry of the eccrine sweat gland. Rev Physiol Biochem Pharmacol 79:52–131
18.
go back to reference Simonetta MM, Cauhepe C, Magues JP, Senard JM (2003) A double-blind, randomized, comparative study of Dysport versus Botox in primary palmar hyperhidrosis. Br J Dermatol 149(5):1041–1045CrossRef Simonetta MM, Cauhepe C, Magues JP, Senard JM (2003) A double-blind, randomized, comparative study of Dysport versus Botox in primary palmar hyperhidrosis. Br J Dermatol 149(5):1041–1045CrossRef
Metadata
Title
Quantification of eccrine sweat glands with acetylcholine sweat-spot test and anatomical redistribution of sweating after T2–T3 thoracoscopic sympathicolysis
Authors
Ricard Ramos
Cristina Masuet
Maria Badia
Valerio Perna
Ivan Macia
Ignacio Escobar
Rosa Villalonga
Juan Moya
Publication date
01-02-2009
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 2/2009
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-008-9922-z

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