Abstract BACKGROUND: Primary hyperhidrosis is a condition characterized by excessive sweating, inconsistent with the needs for thermoregulation. OBJECTIVE: To assess the effectiveness and the change in the quality of life of patients undergoing bilateral VATS (video-assisted thoracoscopic sympathectomy) for treatment of hyperhidrosis, in a large case series. DESIGN AND SETTING: Cohort study conducted in a tertiary hospital specializing in hyperhidrosis located in São Paulo, Brazil. METHODS: A total of 2,431 patients who underwent surgery consisting of bilateral video-assisted thoracoscopic sympathectomy between January 2000 and February 2017 were retrospectively assessed in an outpatient clinic specializing in hyperhidrosis. The patients underwent clinical and quality of life assessments on two occasions: firstly, prior to surgery, and subsequently, one month after the operation. The presence or absence of compensatory hyperhidrosis (CH) and general satisfaction after the first postoperative month were also evaluated. RESULTS: All the patients operated had poor or very poor quality of life before surgery. In the postoperative period, an improvement in the quality of life was observed in more than 90% of the patients. Only 10.7% of the patients did not present CH, and severe CH occurred in 22.1% of the patients in this sample. CONCLUSION: Bilateral VATS is a therapeutic method that decreases the degree of sweating more than 90% of patients with palmar and axillary hyperhidrosis. It improves the quality of life for more than 90% of the patients, at the expense of development of CH in approximately 90% of the patients, but not intensely.

Resumo A hiperidrose (HH) é caracterizada por transpiração além da quantidade necessária para manter a regulação térmica e as necessidades fisiológicas do corpo. Aproximadamente 9,41% dos indivíduos com HH apresentam hiperidrose craniofacial (FH). Este estudo tem como objetivo revisar os dados mais atuais da literatura sobre FH, incluindo fisiopatologia, diagnóstico e apresentação clínica, opções de tratamento (clínico e cirúrgico) e desfechos. A simpatectomia por videotoracoscopia (VATS) é considerada o padrão-ouro para o tratamento definitivo da hiperidrose axilar ou palmar. Recentemente, vários estudos demonstraram a utilidade do tratamento clínico com cloridrato de oxibutinina, que leva à melhora clínica da HH em mais de 70% dos pacientes. O tratamento clínico e o cirúrgico apresentam bons resultados no tratamento da FH. No entanto, o tratamento cirúrgico da FH apresenta mais complicações. O tratamento clínico com cloridrato de oxibutinina fornece bons resultados e pode ser a primeira opção terapêutica. Quando o paciente não está satisfeito com esse tratamento e mostra boas condições clínicas, o tratamento cirúrgico pode ser usado com segurança.

Abstract Hyperhidrosis (HH) is characterized by sweating exceeding the amount necessary to meet the thermal regulation and physiological needs of the body. Approximately 9.41% of individuals with HH have craniofacial hyperhidrosis (FH). The present study aims to review the most current data in the literature regarding craniofacial hyperhidrosis, including pathophysiology, diagnosis and clinical presentation, treatment options (clinical and surgical), and outcomes. VATS (videothoracoscopy sympathectomy) is considered the gold standard for definitive treatment of axillary or palmar hyperhidrosis. Recently, several studies have shown the usefulness of clinical treatment with oxybutynin hydrochloride, leading to clinical improvement of HH in more than 70% of users. Both clinical and surgical treatment of craniofacial hyperhidrosis have good results. However, surgical treatment of FH is associated with more complications. Clinical treatment with oxybutynin hydrochloride yields good results and can be the first therapeutic option. When the patient is not satisfied with this treatment and has good clinical conditions, surgical treatment can be used safely.

RESUMO Objetivo Padronizar a investigação e o manejo clínico de mulheres com anormalidades clínicas e exames laboratoriais sugestivos de trombofilia, para melhorar a abordagem antitrombótica e otimizar a indicação de exames laboratoriais. Metodologia Foi conduzida discussão incluindo 107 médicos (ginecologistas/obstetras, hematologistas e cirurgiões vasculares) participantes de um fórum realizado no Hospital Israelita Albert Einstein, em São Paulo (SP). Como critério mínimo, estabeleceu-se concordância de 80% em votação para cada recomendação de conduta registrada em documento como diretrizes finais. Os casos em que a concordância esteve abaixo de 80% foram rediscutidos, para definir consenso na conduta. Conclusão A padronização e o estabelecimento de consenso institucional, com sugestões para abordagem clínica, contribui para melhorar o manejo do grupo a ser avaliado e minimizar os riscos de intercorrências. Este foi o primeiro consenso nacional sobre investigação de trombofilia em mulheres.

ABSTRACT Objective To standardize the investigation and clinical management of women with laboratory and/or clinical abnormalities suggestive of thrombophilia, in order to optimize antithrombotic approach and indication of laboratory tests. Methodology A discussion was carried out among 107 physicians (gynecologists/obstetricians, hematologists and vascular surgeons) present at a forum held at the Hospital Israelita Albert Einstein, in São Paulo (SP), Brazil. As a minimum criterion, 80% agreement was established in the voting to each recommendation of conduct in the final document. The cases in which there was agreement below 80% were discussed again, reaching a consensual agreement of conduct for the document writing. Conclusion The standardization of an institutional consensus of suggestions of clinical approach contributes to a better management of the group to be evaluated and minimizes risks of intercurrent events. This was the first national consensus on the investigation of thrombophilia in women.

Resumo Introdução: A associação entre osmidrose e hiper-hidrose com frequência causa problemas emocionais e sociais que podem deteriorar a qualidade de vida dos pacientes. O objetivo deste estudo foi analisar os resultados terapêuticos do uso de oxibutinina associada a agentes tópicos em 89 pacientes com osmidrose e hiper-hidrose. Método: Nós conduzimos um estudo observacional em dois centros especializados em hiper-hidrose entre abril de 2007 e agosto de 2013. Oitenta e nove (89) pacientes com osmidrose associada a hiper-hidrose foram tratados com oxibutinina e agentes tópicos. Os pacientes foram avaliados antes do tratamento e após 3 e 6 semanas do início do tratamento, por meio do Questionário de Qualidade de Vida e da Escala de Evolução da Sudorese. Resultados: Antes do tratamento, 98% dos pacientes apresentavam qualidade de vida ruim ou muito ruim. Após seis semanas de tratamento, 70% classificou sua qualidade de vida como sendo pouco ou muito melhor (p<0.001) e aproximadamente 70% dos pacientes relataram melhora moderada ou grande de sudorese e odor. Houve melhora significativamente maior da osmidrose quando a região axilar era o sítio em que a hiper-hidrose mais incomodava. Conclusão: Houve melhora significativa da qualidade de vida e uma redução da sudorese e do odor após seis semanas de tratamento com agentes tópicos e oxibutinina em pacientes com hiper-hidrose associada a osmidrose. Dessa maneira, a terapia clínica deve ser considerada antes de técnicas invasivas.

Summary Introduction: The association of osmidrosis and hyperhidrosis often causes emotional and social problems that may impair the patients' quality of life. The purpose of our study was to analyze the therapeutic results of oxybutynin and topical agents in 89 patients with both osmidrosis and hyperhidrosis. Method: We conducted an observational study at two specialized centers of hyperhidrosis between April 2007 and August 2013. Eighty-nine (89) patients with both osmidrosis and hyperhidrosis were treated with oxybutynin and topical agents. Patients were evaluated before treatment and at 3 and 6 weeks after treatment started, by using the Quality of Life Questionnaire and the Sweating Evolution Scale. Results: Before treatment, 98% of the patients presented with poor or very poor quality of life. After six weeks of treatment, 70% stated their quality of life as being slightly better or much better (p<0.001) and nearly 70% of the patients experienced a moderate or great improvement in sweating and malodor. Improvement in osmidrosis was significantly greater when the axillary region was the first most disturbing site of hyperhidrosis. Conclusion: There was a significant improvement in quality of life and a reduction in sweating and malodor after six weeks of treatment with topical agents and oxybutynin in patients with both hyperhidrosis and osmidrosis. Therefore, clinical treatment should be considered before invasive techniques.

RESUMO O aneurisma gigante da artéria esplênica constitui condição rara, que representa risco de vida iminente para o paciente, necessitando, consequentemente, de correção cirúrgica urgente. Mulher de 61 anos, ex-fumante, hipertensa, com hipercolesterolêmica e multípara nos procurou por apresentar grande tumor no mesogástrio, achado de ultrassonografia abdominal. Apesar das dimensões do tumor, era assintomática. Angiotomografia e ressonância magnética de abdômen sugeriam tratar-se de aneurisma gigante de artéria esplênica com mais de 10cm de diâmetro, confirmado por angiografia. Foi submetida a tratamento cirúrgico aberto, tendo sido realizadas esplenectomia e aneurismectomia parcial. A abordagem do tronco celíaco, que foi ligado, só foi possível com rotação visceral medial, pois não havia possibilidade de visualizá-lo pela via anterior. O exame anatomopatológico da parede do saco aneurismático revelou placas de ateroma na íntima. A paciente evoluiu sem intercorrências e teve alta hospitalar curada. Aneurismas da artéria esplênica de dimensões avantajadas, em geral, são sintomáticos, porém, como no caso em questão, podem ser assintomáticos e descobertos em exame de imagem do abdômen. Apesar de existirem métodos intervencionistas menos invasivos, como laparoscopia e técnicas endovasculares, eles não foram considerados adequados neste caso. Diante de um aneurisma gigante de artéria esplênica, a conduta terapêutica de eleição é a cirurgia convencional aberta.

ABSTRACT Giant splenic artery aneurysm is a rare condition that represents an eminent life threatening for the patient, requiring, therefore, urgent surgical correction. A 61-year-old woman, former smoker, hypertensive, hypercholesterolemic and multipara sought our service because of a large tumor in the mesogastrium, which was an abdominal ultrasound finding. Despite the size of the tumor, the patient was asymptomatic. The angiotomography and the magnetic resonance image of the abdomen were suggestive of giant splenic artery aneurysm with more than 10cm in diameter that was confirmed by an angiography. She underwent surgery, open splenectomy, and partial aneurysmectomy. The approach of the celiac artery, which was ligated, was only possible with medialvisceral rotation because there was no possibility to view it through the anterior access. The histopathological test of aneurysmatic wall revealed atheroma plaques in the intima. The patient progressed without complications and she was discharged cured. In general, giant splenic artery aneurysms are symptomatic, however, as in the case we report, it may be asymptomatic and found in abdominal imaging exam. Although less invasive Interventional methods exist, such as laparoscopy and endovascular techniques, they were considered inappropriate in this case. Conventional open surgery should be the therapy of choice for a giant splenic artery aneurysm.

RESUMO Objetivo: a avaliação de pacientes com hiperidrose (HH) pode ser realizada, entre outras maneiras, por questionários e escalas. O Hyperhidrosis Disease Severity Scale (HDSS) tem sido utilizado como uma forma simples e rápida. Embora o HDSS seja utilizado em outros idiomas, ainda não foi traduzido para o português, limitando sua utilização em pacientes brasileiros. O objetivo deste estudo foi traduzir o HDSS para o português e validá-lo em uma amostra brasileira. Método duzentos e noventa (290) pacientes brasileiros (69% mulheres, idade média de 28,7±9,6 anos e IMC médio de 22,4±3.9 kg/m2) com HH foram avaliados pelo HDSS, pelo Questionário de Qualidade de Vida (QQV) e pelo Questionário de Evolução da Sudorese (QES) antes e após 5 semanas de tratamento com oxibutinina. Para a validação de constructo do HDSS, foi realizada a associação entre seus resultados com os dos outros dois questionários. Para analisar a sua sensibilidade, foi realizada a análise do efeito pré e pós-tratamento com oxibutinina. Além disso, foi analisada a sua reprodutibilidade em uma subamostra, na qual a escala foi aplicada novamente após 7 dias da primeira consulta. Resultados observamos correlação estatística entre o HDSS e o QQV e entre o HDSS e o QES antes do tratamento e após 5 semanas. O HDSS demonstrou ser reprodutível e sensível em relação ao efeito do tratamento. Conclusão a versão em português da escala HDSS apresentou validade e reprodutibilidade em amostra brasileira e pode ser utilizada como instrumento na assistência à saúde de pacientes com HH.

SUMMARY Introduction The evaluation of patients with hyperhidrosis (HH) can be accomplished, among other ways, through questionnaires and scales. The Hyperhidrosis Disease Severity Scale (HDSS) has been used as a simple and quick tool to perform this evaluation. Although HDSS has been well established in several languages, it has not been translated into Portuguese, restricting its specific use for Brazilian patients. The aim of this study was to translate HDSS into Portuguese and validate it in a sample of Brazilian subjects. Method 290 Brazilian patients (69% women, with a mean age of 28.7±9.6 years and BMI 22.4±3.9 kg/m2) diagnosed with HH were evaluated using HDSS, Quality of Life Questionnaire (QLQ) and Sweating Evolution Questionnaire (SEQ) before and after a five-week oxybutynin treatment. Regarding validation, an association between HDSS results and two other questionnaires was performed. To analyze HDSS sensitivity, evaluation of effects pre- and post-treatment with oxybutynin was conducted. Furthermore, HDSS reproducibility was analyzed in a subsample in which the scale was applied again after 7 days of the first follow-up appointment. Results There was statistical correlation between HDSS and QLQ and between HDSS and SEQ before treatment and after 5 weeks. Additionally, HDSS was reproducible and sensitive to clinical changes after the treatment period. Conclusion The Portuguese version of HDSS has been validated and shown to be reproducible in a Brazilian sample. Therefore it can be used as a tool to improve medical assistance in patients with HH.

BACKGROUND: Facial hyperhidrosis can lead to serious emotional distress. Video-assisted thoracic sympathectomy resolves symptoms effectively, though it may be associated with compensatory hyperhidrosis, which may be more common in patients undergoing resection of the second thoracic ganglion. Oxybutynin has been used as a pharmacological approach to facial hyperhidrosis but the long-term results of this treatment are unclear. OBJECTIVE: To evaluate the use of low oxybutynin doses in facial hyperhidrosis patients for at least six months. METHODS: 61 patients were monitored for over six months and assessed according to the following variables: impact of hyperhidrosis on quality of life (QOL) before treatment and after six weeks, evolution of facial hyperhidrosis after six weeks and at the last consultation, complaints of dry mouth after six weeks and on last return visit, and improvement at other hyperhidrosis sites. RESULTS: Patients were monitored for 6 to 61 months (median=17 months). Thirty-six (59%) were female. Age ranged from 17-74 (median:45). Pre-treatment QOL was poor/very poor in 96.72%. After six weeks, 100% of patients improved QOL. Comparing results after six weeks and on the last visit, 91.8% of patients maintained the same category of improvement in facial hyperhidrosis, 3.3% worsened and 4.9% improved. Dry mouth complaints were common but not consistent throughout treatment. More than 90% of patients presented moderate/great improvement at other hyperhidrosis sites. CONCLUSION: Patients who had a good initial response to treatment maintained a good response long-term, did not display tachiphylaxis and experienced improvement on other hyperhidrosis sites.

A claudicação intermitente está frequentemente associada à doença aterosclerótica, mas diagnósticos diferenciais devem ser pesquisados em pacientes sem fatores de risco tradicionais. A doença cística adventicial, de etiologia incerta, acomete em maior proporção a artéria poplítea e, eventualmente, apresenta-se como claudicação intermitente. Apresentamos um caso da doença e seu manejo cirúrgico, e discutimos a etiopatogenia, os aspectos diagnósticos e terapêuticos da enfermidade.

Intermittent claudication is frequently associated with atherosclerotic disease, but differential diagnosis must be sought in patients with no traditional risk factors. Cystic adventitial disease, of unknown etiology, most frequently affects the popliteal artery, and occasionally presents as intermittent claudication. We report a case of this disease and the surgical treatment, and discuss some aspects related to etiopathogenesis, diagnosis and treatment of this condition.

OBJECTIVES: Primary hyperhidrosis usually affects the hands, armpits, feet and cranio-facial region. Sweating in other areas is common in secondary hyperhidrosis (after surgery or in specific clinical conditions). Oxybutynin has provided good results and is an alternative for treating hyperhidrosis at common sites. Our aim was to evaluate the efficacy of oxybutynin as a treatment for primary sweating at uncommon sites (e.g., the back and groin). METHODS: This retrospective study analyzed 20 patients (10 females) who received oxybutynin for primary focal hyperhidrosis at uncommon sites. The subjects were evaluated to determine quality of life before beginning oxybutynin and six weeks afterward and they were assigned grades (on a scale from 0 to 10) to measure their improvement at each site of excessive sweating after six weeks and at the last consult. RESULTS: The median follow-up time with oxybutynin was 385 days (133-1526 days). The most common sites were the back (n = 7) and groin (n = 5). After six weeks, the quality of life improved in 85% of the subjects. Dry mouth was very common and was reported by 16 patients, 12 of whom reported moderate/severe dry mouth. Five patients stopped treatment (two: unbearable dry mouth, two: excessive somnolence and one: palpitations). At the last visit, 80% of patients presented with moderate/great improvement at the main sites of sweating. CONCLUSION: After six weeks, more than 80% of the patients presented with improvements in their overall quality of life and at the most important site of sweating. Side effects were common (80% reported at least one side effect) and caused 25% of the patients to discontinue treatment. Oxybutynin is effective for treating bothersome hyperhidrosis, even at atypical locations and most patients cope well with the side effects.

Objetivo : Analisar a efetividade da oxibutinina para tratamento da hiperidrose em pacientes com mais de 40 anos. Métodos : Oitenta e sete pacientes com idade superior a 40 anos foram divididos em dois grupos: o primeiro com 48 pacientes (55,2%), com idades entre 40 e 49 anos. O segundo com 39 pacientes (44,8%), com mais de 50 anos (intervalo: 50 a 74 anos). Uma análise comparativa da Qualidade de Vida e do nível de hiperidrose entre os grupos foi realizada 6 semanas após o início do tratamento com oxibutinina. Para isso, foi utilizado um questionário validado para Qualidade de Vida. Resultados : No grupo mais jovem, 75% dos pacientes referiram melhora “parcial” ou “ótima” no nível de hiperidrose após o tratamento. Esse número foi particularmente impressionante em pacientes acima de 50 anos, sendo que 87,2% apresentaram níveis similares de melhora. Mais de 77% dos pacientes, em ambos os grupos, demonstraram melhora na Qualidade de Vida. Desfechos excelentes foram observados em pacientes mais idosos, dentre os quais 87,1% dos pacientes apresentaram melhora “pouco melhor” (41%) ou “muito melhor” (46,1%). Conclusão : Os pacientes acima de 40 anos com hiperidrose tiveram excelentes resultados com o tratamento com oxibutinina. Esses desfechos foram particularmente importantes nos pacientes com mais de 50 anos, nos quais a maioria apresentou melhora da Qualidade de Vida e da hiperidrose.

Objective : Our aim was to analyze the effectiveness of oxybutynin for hyperhidrosis treatment in patients over 40 years. Methods : Eighty-seven patients aged over 40 years were divided into two groups. One group consisted of 48 (55.2%) patients aged between 40 and 49 years, and another was composed of 39 (44.8%) patients aged over 50 years (50 to 74 years). A comparative analysis of Quality of Life and level of hyperhidrosis between the groups was carried out 6 weeks after a protocol treatment with oxybutynin. A validated clinical questionnaire was used for evaluation. Results : In the younger age group, 75% of patients referred a “partial” or “great” improvement in level of hyperhidrosis after treatment. This number was particularly impressive in patients over 50 years, in which 87.2% of the cases demonstrated similar levels of improvement. Over 77% of patients in both groups demonstrated improvement in Quality of Life. Excellent outcomes were observed in older patients, in which 87.1% of patients presented “slightly better” (41%) or “much better” (46.1%) improvement. Conclusion : Patients aged over 40 years with hyperhidrosis presented excellent results after oxybutynin treatment. These outcomes were particularly impressive in the age group over 50 years, in which most patients had significant improvement in Quality of Life and in level of hyperhidrosis.

OBJETIVO: A falta de alternativas terapêuticas para o tratamento de pacientes obesos com Hiperidrose hiperidrose deixa essa população sem perspectiva de melhorar suas condições clínicas e qualidade de vida. Resultados do tratamento com oxibutinina especificamenteempacientes com sobrepeso ou obesidade são desconhecidos até o presente momento. Este estudo tem como objetivo investigar os resultados relacionados à melhora clínica e qualidade de vida dessa população, após um protocolo de tratamento de 12 semanas com oxibutinina. MÉODOS: 559 pacientes com hiperidrose palmar e axilar, foram divididos em três grupos, de acordo com seu índice de massa corporal (IMC) (< 25 kg/m²; 25 < IMC < 30 kg/m², > 30 kg/m²). Dados sobre evolução na qualidade de vida e nível de hiperidrose foram avaliados com base em um questionário validado cientificamente, aplicado antes e após o tratamento com oxibutinina. RESULTADOS: 67.8% dos pacientes com sobrepeso e 63% dos obesos apresentaram melhora clínica "grande" ou "parcial" no nível da hiperidrose. Mais de 65% dos pacientes relataram melhora na qualidade de vida ("muito melhor" ou "um pouco melhor") para os três grupos, sem diferença estatística entre eles. O único efeito colateral observado foi boca seca, presente em 63.0% da amostra. CONCLUSÃO: Pacientes com sobrepeso e obesidade portadores de hiperidrose palmar ou axilar apresentaram melhora significativa na qualidade de vida após o tratamento com oxibutinina, sendo os resultados comparáveis aos de indivíduos com peso normal.

OBJECTIVE: Until the present moment, the lack of efficient therapeutic options available for hyperhidrosis treatment in obese patients has left this population without prospect of clinical or quality of life (QOL) improvements. Outcomes of oxybutynin treatment for overweight and obese patients with hyperhidrosis are unknown. This study aims to investigate the results related to clinical and QOL improvements in this specific population, submitted to a 12-week protocol treatment with oxybutynin. METHODS: 559 patients with palmar and axillary hyperhidrosis, routinely followed in this service, were divided into the groups, according to their body mass index (BMI) (< 25 kg/m²; 25 < bmi < 30 kg/m², > 30 kg/m²). Improvements in QOL and in the level of hyperhidrosis were analyzed after 12 weeks of protocol treatment with oxybutynin. These parameters were investigated using a scoring system based on a scientifically validated clinical questionnaire, applied before and after treatment. RESULTS: 67.8% of the overweight sample group and 63% of the obese patients presented "partial" or "great" improvement in the level of hyperhidrosis. Over 65% of patients demonstrated improvement in QOL ("much better" or "slightly better") for all three groups, with no statistical difference between them. The only adverse event associated with oxybutynin was dry mouth, observed in 63.0% of the patients. CONCLUSION: Overweight and obese patients with palmar or axillary hyperhidrosis present significant improvement in QOL after treatment with oxybutynin, and the results are comparable to those of normal weight individuals.

OBJECTIVE: The aim of the present study was to prospectively, randomly, blindly, and objectively investigate how surgery affects plantar sudoresis in patients with palmar and plantar hyperhidrosis over a one-year period using a sudorometer (VapoMeter). METHODS: From February 2007 to May 2009, 40 consecutive patients with combined palmar hyperhidrosis and plantar hyperhidrosis underwent video-assisted thoracic sympathectomy at the T3 or T4 ganglion level (15 women and 25 men, with a mean age of 25 years). RESULTS: Immediately after the operation and during the one-year follow-up, all of the patients were free from palmar hyperhidrosis episodes. Compensatory hyperhidrosis of varying degrees was observed in 35 (87.5%) patients after one year. Only two (2.5%) patients suffered from severe compensatory hyperhidrosis. There was a large initial improvement in plantar hyperhidrosis in 46.25% of the cases, followed by a progressive regression of that improvement, such that only 30% continued to show this improvement after one year. The proportion of patients whose condition worsened increased progressively (from 21.25% to 47.50%), and the proportion of stable patients decreased (32.5% to 22.50%). This was not related to resection level; however, a lower intensity of plantar hyperhidrosis prior to sympathectomy correlated with worse evolution. CONCLUSION: Patients with palmar hyperhidrosis and plantar hyperhidrosis who underwent video-assisted thoracic sympathectomy to treat their palmar hyperhidrosis exhibited good initial improvement in plantar hyperhidrosis, which then decreased to lesser degrees of improvement over a one-year period following the surgery. For this reason, video-assisted thoracic sympathectomy should not be performed when only plantar hyperhidrosis is present.

OBJETIVO: Avaliar os resultados do tratamento com baixas doses de oxibutinina em homens e mulheres com hiperidrose palmar e axilar. MÉTODOS: Análise retrospectiva de 395 mulheres e 170 homens acompanhados em nosso serviço com queixa de hiperidrose palmar e plantar, submetidos a um protocolo de 12 semanas de tratamento com oxibutinina. Melhora clínica da hiperidrose e da qualidade de vida foram estudadas por meio de um questionário específico, aplicado antes e após o tratamento. RESULTADOS: Dentre os pacientes em ambos os grupos, 70% apresentaram melhoria parcial ou grande no nível de hiperidrose após o tratamento. Os melhores resultados foram obtidos no grupo feminino, no qual 40% classificaram sua evolução como "ótima". Aproximadamente 70% dos pacientes em ambos os grupos melhoraram sua qualidade de vida após a terapia médica e 30% não apresentaram mudança da condição inicial. CONCLUSÃO: Gênero é um fator que não interfere significativamente nos resultados do tratamento com oxibutinina. Os índices de qualidade de vida e o grau de melhora clínica da hiperidrose foram semelhantes em homens e mulheres.

OBJECTIVE: To assess the results of palmar and axillary hyperhidrosis treatment in males and females using low doses of oxybutynin. METHODS: A retrospective analysis was conducted in 395 women and 170 men followed up in our service with complaint of palmar and axillary hyperhidrosis. RESULTS: A total of 70% of patients in both groups presented partial or great improvement in the level of hyperhidrosis after treatment. The best results were obtained in the female group, in which 40% classified their improvement as "great". Approximately 70% of the patients in both groups improved their quality of life after medical therapy and 30% presented no change in condition. CONCLUSION: Gender is not a factor that significantly interferes in oxybutynin treatment results. Quality of life indices and clinical improvement level were similar in men and women.

OBJETIVO: Comparar a intensidade de transpiração em palmas das mãos e planta dos pés de indivíduos portadores de hiperidrose com a de um grupo controle. MÉTODOS: Foram selecionados 50 pacientes com diagnóstico clínico de hiperidrose palmoplantar e 25 indivíduos controles. Um método objetivo de quantificação da transpiração foi utilizado com um aparelho eletrônico portátil, não invasivo, com sensores de umidade relativa e de temperatura capazes de quantificar a perda de água transepidérmica. Todos os indivíduos apresentavam índice de massa corpórea de 20-25 kg/cm² e permaneceram em repouso por 20-30 min antes das medições para reduzir a interferência externa. A mensuração foi realizada em sala climatizada com a temperatura de 21-24ºC. Os locais determinados para a aferição foram região hipotenar da face palmar e região medial da face plantar. RESULTADOS: No grupo com hiperidrose palmoplantar, as médias da intensidade de transpiração nas mãos e nos pés foram de, respectivamente, 133,6 ± 51,0 g/m²/h e 71,8 ± 40,3 g/m²/h, enquanto, no grupo controle, essas foram de 37,9 ±18,4 g/m²/h e 27,6 ± 14,3 g /m²/h. As diferenças das médias entre os grupos foram estatisticamente significativas (p < 0,001). CONCLUSÕES: Este método de quantificação mostrou-se uma ferramenta precisa e confiável na avaliação da transpiração palmar e plantar, quando operado por um profissional treinado e capacitado.

OBJECTIVE: To compare individuals with and without hyperhidrosis in terms of the intensity of palmar and plantar sweating. METHODS: We selected 50 patients clinically diagnosed with palmoplantar hyperhidrosis and 25 normal individuals as controls. We quantified sweating using a portable noninvasive electronic device that has relative humidity and temperature sensors to measure transepidermal water loss. All of the individuals had a body mass index of 20-25 kg/cm². Subjects remained at rest for 20-30 min before the measurements in order to reduce external interference. The measurements were carried out in a climate-controlled environment (21-24ºC). Measurements were carried out on the hypothenar region on both hands and on the medial plantar region on both feet. RESULTS: In the palmoplantar hyperhidrosis group, the mean transepidermal water loss on the hands and feet was 133.6 ± 51.0 g/m²/h and 71.8 ± 40.3 g/m²/h, respectively, compared with 37.9 ± 18.4 g/m²/h and 27.6 ± 14.3 g/m²/h, respectively, in the control group. The differences between the groups were statistically significant (p < 0.001 for hands and feet). CONCLUSIONS: This method proved to be an accurate and reliable tool to quantify palmar and plantar sweating when performed by a trained and qualified professional.

OBJETIVO: A simpatectomia torácica por videotoracoscopia é atualmente o procedimento de escolha para o tratamento definitivo da hiper-hidrose palmar, pois é um método eficaz, seguro e minimamente invasivo. Na busca de melhores índices de qualidade de vida, os pesquisadores procuram por fatores preditivos de bom resultado cirúrgico. A falência do tratamento inicial, a hiper-hidrose compensatória, o índice de massa corpóreo acima de 25, o nível de ressecção ganglionar e a extensão da ressecção são alguns dos fatores que podem influenciar negativamente os resultados. O objetivo deste estudo foi comparar a qualidade de vida dos pacientes submetidos à simpatectomia torácica, de acordo com a faixa etária, numa coorte com 1.644 pacientes. MÉTODOS: De fevereiro de 2000 a outubro de 2008, foram colhidos dados de 1.644 pacientes portadores de hiper-hidrose palmar (71%) ou axilar (29%), submetidos à simpatectomia torácica por videotoracoscopia. Os pacientes foram divididos em três grupos de acordo com a idade. O primeiro grupo foi de pacientes com até 17 anos, o segundo de 18 a 30 anos, e o terceiro com pacientes com mais de 30 anos de idade. Todos os pacientes tinham índice de massa corpóreo menor que 25. RESULTADOS: Numa avaliação 30 dias após o procedimento, a melhora da qualidade de vida foi obtida nos três grupos. Não houve diferença estatística entre as diferentes faixas etárias. Neste estudo, 91,9% dos pacientes apresentaram algum grau de hiper-hidrose compensatória, novamente sem diferença entre os grupos. CONCLUSÕES: Pacientes portadores de hiper-hidrose primária apresentam melhora da qualidade de vida após o procedimento cirúrgico independentemente de sua idade.

OBJECTIVE: Video-assisted thoracic sympathectomy is currently the procedure of choice for the definitive treatment of primary hyperhidrosis, because it is an effective, safe, and minimally invasive method. In the search for better quality of life indexes, all researchers look for predictive factors indicating better surgical outcomes. Failure in the primary treatment, postoperative compensatory hyperhidrosis, body mass index over 25, level of resection of the sympathetic chain, and extent of resection are some of the factors that may negatively influence the results. The objective of this study was to compare, according to the age group, the quality of life after bilateral thoracic sympathectomy for treatment of primary hyperhidrosis in a cohort of 1,644 patients. METHODS: From February 2000 to October 2008, data were collected from 1,644 patients with palmar (71%) or axillary (29%) hyperhidrosis who underwent video-assisted thoracic sympathectomy. The patients were divided into three groups according to their ages. The first group consisted of patients up to 17 years-old, the second from 18 to 30 years-old, and the third of over 30 years-old. All patients had a body mass index of less than 25. RESULTS: In the evaluation 30 days after surgery, improvement of the quality of life in the three groups was observed. There was no significant difference between the age groups. In the present study, 91.9% of the patients presented compensatory hyperhidrosis, with no difference between the age groups. CONCLUSIONS: Patients with primary hyperhidrosis experience quality of life improvement after thoracic sympathectomy regardless of their age.