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Chen SH, Lien PH, Lee CH, Huang RW, Hsu CC, Lin CH, Lin YT, Tsai CH, Tsai HI, Liu YC. Neurectomy of the Nerve of Henle Associated with Periarterial Sympathectomy for Management of Intractable Raynaud Phenomenon. Plast Reconstr Surg 2024; 153:1333-1344. [PMID: 37384892 DOI: 10.1097/prs.0000000000010902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
BACKGROUND In periarterial sympathectomy for intractable Raynaud phenomenon, the extent of adventitectomy and postoperative outcomes and hand perfusion assessment tools remain debatable. The authors evaluated the outcome of neurectomy of the nerve of Henle combined with ulnar tunnel release and periarterial adventitectomy in the treatment of refractory Raynaud phenomenon using objective measurements and patient-reported outcomes. METHODS Nineteen patients with 20 affected hands were prospectively enrolled and underwent the proposed procedures from 2015 to 2021. Relevant data, including Michigan Hand Outcomes Questionnaire and 36-Item Short Form health questionnaire scores, were documented for analysis during a 3-year follow-up. RESULTS The average ingress value of the three measured fingers (index, long, and ring) on indocyanine green angiography increased after surgery ( P = 0.02). The median number of ulcers decreased ( P < 0.001), and the median digital skin temperature increased ( P < 0.001). Questionnaire scores showed improvement in physical aspects, such as overall hand function ( P ≤ 0.001), activities of daily living ( P = 0.001), work performance ( P = 0.02), pain ( P < 0.001), physical function ( P = 0.053), and general health ( P = 0.048), and mental aspects, such as patient satisfaction ( P < 0.001) and mental health ( P = 0.001). The average indocyanine green ingress value of the three measured fingers significantly correlated with the patient-reported outcomes, including overall hand function ( r = 0.46, P = 0.04), work performance ( r = 0.68, P = 0.001), physical function ( r = 0.51, P = 0.02), and patient satisfaction ( r = 0.35, P= 0.03). CONCLUSIONS The proposed surgical procedures provided satisfactory outcomes, both subjectively and objectively, over a follow-up period of up to 3 years. Indocyanine green angiography may provide rapid and quantitative measurements for perioperative hand perfusion assessment. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Shih-Heng Chen
- From the Departments of Plastic and Reconstructive Surgery
| | - Po-Hao Lien
- Chang-Gung Memorial Hospital, Keelung Branch, Chang-Gung University and Medical College
| | - Che-Hsiung Lee
- From the Departments of Plastic and Reconstructive Surgery
| | - Ren-Wen Huang
- From the Departments of Plastic and Reconstructive Surgery
| | | | - Cheng-Hung Lin
- From the Departments of Plastic and Reconstructive Surgery
| | - Yu-Te Lin
- From the Departments of Plastic and Reconstructive Surgery
| | | | | | - Yuan-Chang Liu
- Medical Imaging and Intervention, Institute for Radiologic Research, Chang-Gung Memorial Hospital, Linkou Branch
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Oshima Y, Fujimoto T, Nomoto M, Fukui J, Ikoma A. Hyperhidrosis: A targeted literature review of the disease burden. J Dermatol 2023; 50:1227-1236. [PMID: 37519134 DOI: 10.1111/1346-8138.16908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 06/23/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023]
Abstract
Hyperhidrosis is a chronic skin condition characterized by excessive sweating. It poses a burden on affected people, reducing their quality of life and productivity. We undertook a targeted literature review (TLR) to gather current evidence on the epidemiology as well as the human and economic burden posed on patients with hyperhidrosis. Searches were performed in Medline database (access via OVID interface) and ICHUSHI database. Articles published between January 2000 and September 2020 that analyzed at least 50 patients were included. Sixty-four publications were identified and 38 publications covering a unique domain were selected to inform this TLR. The incidence of hyperhidrosis ranged from 0.13% in the UK to 0.28% in the USA, with a higher rate in females. The prevalence of hyperhidrosis varied from 2.8%-4.8% in the US general population to 18.40% in Chinese inpatients, while the prevalence of axillary hyperhidrosis varied from 1.4% in the US general population to 5.75% in Japanese employees/students. Due to excessive sweating, hyperhidrosis was reported to be a moderate-to-extreme limitation at work for the US patients, with 33.5% feeling unhappy. Patients' satisfaction was high post-treatment. Considerable costs were related to the treatment with botulinum toxin and surgery. Hospital stays for surgery lasted from 10 h to 3 days. The percentage of patients who sought a medical consultation varied from 6.3% for Japanese patients with primary focal hyperhidrosis to 51% for the US general population with any type of hyperhidrosis. There is limited evidence of the hyperhidrosis burden, particularly among Japanese patients; however, the burden was high and limited patients' daily functioning. Future actions should include implementation of educational programs to raise awareness of the condition, conduct of larger studies, and generation of more evidence. Understanding the nature of hyperhidrosis and the burden it poses is of utmost importance.
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Affiliation(s)
- Yuichiro Oshima
- Department of Dermatology, Aichi Medical University School of Medicine, Aichi, Japan
| | - Tomoko Fujimoto
- Ikebukuro Nishiguchi Fukurou Dermatology Clinic, Tokyo, Japan
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Pei G, Meng S, Yang Y, Wang X, Liu Q, Wang S, Huang Y. Anatomical variations of the thoracic sympathetic ganglions and their effects on sympathicotomy for primary palmar hyperhidrosis. Clin Auton Res 2023; 33:111-120. [PMID: 37017809 PMCID: PMC10182923 DOI: 10.1007/s10286-023-00932-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/13/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE The results and side effects of sympathicotomy for primary palmar hyperhidrosis (PPH) can vary due to anatomical variations of the sympathetic ganglions. The aim of our study was to clarify anatomical variations of the sympathetic ganglions by near-infrared (NIR) thoracoscopy and determine their effects on sympathicotomy for PPH. METHODS The cases of 695 consecutive patients with PPH treated with either R3 or R4 sympathicotomy either by normal thoracoscopy or by NIR fluorescent thoracoscopy between March 2015 and June 2021 were retrospectively reviewed and followed up. RESULTS The variation rate of third and fourth ganglions was 14.7% and 13.3% on the right side and 8.3% and 11.1% on the left side. Real T3 sympathicotomy (RTS3) was more effective than real T4 sympathicotomy (RTS4) in the short-term and long-term follow-up (p < 0.001 and p < 0.001, respectively). RTS3 was more satisfactory than RTS4 in the long-term follow-up (p = 0.03), but no significant difference was found in the short-term follow-up (p = 0.24). The incidence and severity of compensatory hyperhidrosis (CH) in the areas of the chest and back in the RTS4 group were significantly lower than those in the RTS3 group according to both the short-term results (12.92% vs. 26.19%, p < 0.001; 17.97% vs. 33.33%, p = 0.002, respectively) and the long-term results (19.66% vs. 28.57%, p = 0.017; 21.35% vs. 34.52%, p < 0.001, respectively). CONCLUSIONS RTS3 may be more effective than RTS4 for PPH. However, RTS4 appears to be associated with a lower incidence and severity of CH in the areas of the chest and back than RTS3. NIR intraoperative imaging of thoracic sympathetic ganglions may improve the quality of sympathicotomy surgeries.
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Affiliation(s)
- Guotian Pei
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), No 29, Zhongguancun Street, Haidian District, Beijing, 100080, China
| | - Shushi Meng
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), No 29, Zhongguancun Street, Haidian District, Beijing, 100080, China
| | - Yingshun Yang
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), No 29, Zhongguancun Street, Haidian District, Beijing, 100080, China
| | - Xiao Wang
- Shanxi Key Laboratory of Artificial Intelligence-Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Shanxi, China
| | - Qiang Liu
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), No 29, Zhongguancun Street, Haidian District, Beijing, 100080, China
| | - Shuai Wang
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), No 29, Zhongguancun Street, Haidian District, Beijing, 100080, China
| | - Yuqing Huang
- Department of Thoracic Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), No 29, Zhongguancun Street, Haidian District, Beijing, 100080, China.
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da Silva MFA, Louzada ACS, Teivelis MP, Stabellini N, Leiderman DBD, de Campos JRM, Amaro E, Wolosker N. Population-based analysis of the epidemiology of the surgical correction of hyperhidrosis in 1,216 patients over 11 years: a cross-sectional study. SAO PAULO MED J 2022; 140:775-780. [PMID: 36102451 PMCID: PMC9671571 DOI: 10.1590/1516-3180.2021.0773.r2.14022022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/14/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Endoscopic thoracic sympathectomy is the definitive surgical treatment for hyperhidrosis and a nationwide study has suggested that cultural and socioeconomic factors play a role in the numbers of operations performed. Thus, there is a need to evaluate local data in order to understand the local epidemiology and trends in hyperhidrosis treatment. OBJECTIVE To study the epidemiology of sympathectomy for treating hyperhidrosis in São Paulo, the largest city in Brazil. DESIGN AND SETTING Population-based retrospective cross-sectional study. METHODS Data on sympathectomies for treating hyperhidrosis between 2008 and 2018 were assessed from the database of the Municipal Health Department of São Paulo, Brazil. RESULTS 65.29% of the patients were female, 66.2% were aged between 20 and 39 years and 37.59% had registered with addresses outside São Paulo. 1,216 procedures were performed in the city of São Paulo from 2008 to 2018, and 78.45% of them were in only two public hospitals. The number of procedures significantly declined over the years (P = 0.001). 71.63% of the procedures were associated with 2-3 days of hospital stay, only 78 intensive care unit days were billed and we did not observe any intra-hospital death. CONCLUSION The profile of patients operated on in São Paulo (young women) is similar to that described in other populations. Sympathectomy is a very safe procedure, with no mortality in our series. There was a decreasing trend in the number of surgeries over the years.
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Affiliation(s)
| | | | - Marcelo Passos Teivelis
- MD, PhD. Attending Professor, Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), Hospital Israelita Albert Einstein, São Paulo (SP), Brazil
| | - Nickolas Stabellini
- Undergraduate Medical Student, Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), Hospital Israelita Albert Einstein, São Paulo (SP), Brazil
| | - Dafne Braga Diamante Leiderman
- MD, PhD. Attending Physician, Department of Vascular and Endovascular Surgery, Hospital Israelita Albert Einstein, São Paulo (SP), Brazil
| | - José Ribas Milanez de Campos
- MD, PhD. Associate Professor, Department of Surgery, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo (SP), Brazil
| | - Edson Amaro
- MD, PhD. Associate Professor, Department of Radiology, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo (SP), Brazil
| | - Nelson Wolosker
- MD, PhD. Full Professor, Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), Hospital Israelita Albert Einstein, São Paulo (SP), Brazil
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A Practical Approach to the Diagnosis and Treatment of Palmar Hyperhidrosis. Plast Reconstr Surg Glob Open 2022; 10:e4172. [PMID: 35265447 PMCID: PMC8901220 DOI: 10.1097/gox.0000000000004172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Abstract
Palmar hyperhidrosis (PH), a condition characterized by excess sweating of the palms, is a common concern that presents to the plastic surgeon, which can have major impacts on patient confidence and quality of life. While several studies summarize treatment options for hyperhidrosis in general, few outline the therapeutic options available specifically for PH.
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Selective T 3-T 4 sympathicotomy versus gray ramicotomy on outcome and quality of life in hyperhidrosis patients: a randomized clinical trial. Sci Rep 2021; 11:17628. [PMID: 34475473 PMCID: PMC8413289 DOI: 10.1038/s41598-021-96972-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 08/11/2021] [Indexed: 11/21/2022] Open
Abstract
Compensatory hyperhidrosis is the leading cause of patients' dissatisfaction after thoracic sympathicotomy. The study aimed to reduce compensatory hyperhidrosis to increase patients’ satisfaction. A prospective randomized study on palmar hyperhidrosis, May 2016–September 2019. Twenty-one patients T3–T4 sympathicotomy and 21 T3–T4 gray ramicotomy. Data prospectively collected. Analysis at study's end. Focus on the sweating, temperature, quality of life baseline and postoperatively, compensatory hyperhidrosis, hand dryness, patients' satisfaction, and if they would undergo the procedure again and recommend it. No baseline differences between groups. Hyperhidrosis was controlled postoperatively in all patients. No mortality, serious complications, or recurrences. Sympathicotomy worse postoperative quality of life (49.05 (SD: 15.66, IR: 35.50–63.00) versus ramicotomy 24.30 (SD: 6.02, IR: 19.75–27.25). After ramicotomy, some residual sweating on the face, hands, and axillae. Compensatory sweating worse with sympathicotomy. Satisfaction higher with ramicotomy. Better results with ramicotomy than sympathicotomy regarding hand dryness, how many times a day the patients had to shower or change clothes, intention to undergo the procedure again or recommend it to somebody else, and how bothersome compensatory hyperhidrosis was. T3–T4 gray ramicotomy had better results than T3–T4 sympathicotomy, with less compensatory sweating and higher patients' satisfaction.
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Yazbek G, Ishy A, Alexandrino da Silva MF, Sposato Louzada AC, de Campos JRM, Kauffman P, Tedde ML, Puech-Leão P, Pêgo-Fernandes PM, Wolosker N. Evaluation of compensatory hyperhidrosis after sympathectomy: The use of an objective method. Ann Vasc Surg 2021; 77:25-30. [PMID: 34411664 DOI: 10.1016/j.avsg.2021.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the prevalence of compensatory hyperhidrosis following videothoracic sympathectomy to treat palmoplantar hyperhidrosis and its effect on sweating in the chest, abdomen, back and thighs. Furthermore, to evaluate the concordance between a subjective and an objective method of assessment for compensatory hyperhidrosis. METHODS Forty patients with combined palmar and plantar hyperhidrosis who underwent video-assisted thoracoscopic sympathectomy (15 women and 25 men, with a mean age of 25 years) were prospectively followed for 1 year. Subjective and objective parameters were evaluated, using respectively a questionnaire and a sudorometer (Vapometer). RESULTS In the subjective analysis, in the first month, only 10% of patients did not have compensatory hyperhidrosis, and 70% continued to report it at 1 or more sites after 1 year. In the objective analysis, 35% of the patients did not present compensatory hyperhidrosis after 1 month, and this number persisted stable, with 30% of patients remaining free of compensatory hyperhidrosis after 1 year. The most frequent area affected by compensatory hyperhidrosis was the back in both assessments. There was no positive concordance between the results of the objective and subjective analysis at any time in any of the 4 regions studied. CONCLUSIONS Compensatory hyperhidrosis is a very common postoperative side effect after videothoracic sympathectomy, occurring early after the procedure and persisting for prolonged periods of time. The most frequently affected body area is the back, and no concordance between objective and subjective assessments was observed.
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Affiliation(s)
- Guilherme Yazbek
- Department of Vascular and Endovascular Surgery, AC Camargo Cancer Center, Rua Tamandaré, São Paulo, Brazil.
| | - Augusto Ishy
- Department of Thoracic Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | | | | | - José Ribas Milanez de Campos
- Department of Thoracic Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil; Department of Thoracic Surgery, Albert Einstein Israeli Faculty of Health Sciences, São Paulo, Brazil
| | - Paulo Kauffman
- Department of Vascular and Endovascular Surgery, Albert Einstein Israeli Faculty of Health Sciences, São Paulo, Brazil
| | - Miguel Lia Tedde
- Department of Thoracic Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Pedro Puech-Leão
- Department of Vascular and Endovascular Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Paulo Manuel Pêgo-Fernandes
- Department of Thoracic Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil; Department of Thoracic Surgery, Albert Einstein Israeli Faculty of Health Sciences, São Paulo, Brazil
| | - Nelson Wolosker
- Department of Vascular and Endovascular Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil; Department of Vascular and Endovascular Surgery, Albert Einstein Israeli Faculty of Health Sciences, São Paulo, Brazil
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Li DC, Hulbert A, Waldbaum B, Ober C, Hooker CM, Huang P, Molena D, Yang SC, Ito T, Perry-Parrish C, Brock MV. Endoscopic thoracic sympathectomy for primary focal hyperhidrosis: impact on psycho-social symptomatology and psychotropic medication use. Eur J Cardiothorac Surg 2019; 54:904-911. [PMID: 29860276 DOI: 10.1093/ejcts/ezy211] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/01/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The tendency for patients with primary focal hyperhidrosis (PFH), characterized by excessive sweating, to experience psycho-social deficits is well documented. In addition, although endoscopic thoracic sympathectomy (ETS) effectively corrects PFH, its role in the psycho-social management of these patients remains unclear. Here, we examined changes in psychiatric symptomatology and psychotropic medication usage in PFH patients following ETS. METHODS In total, 106 PFH patients underwent ETS and were compared against 213 matched controls. Information on psychiatric diagnosis and prescription was obtained through a retrospective chart review. Prospectively, PFH patients completed Hyperhidrosis Impact Questionnaires, Leibowitz Social Anxiety Scales and Center for Epidemiological Studies Depression Scales to evaluate pre- and postoperative quality-of-life and psycho-social impairment. RESULTS A significantly greater proportion of PFH patients had been prescribed psychotropic medication (37.7%) compared to controls (14.1%) despite no differences in the proportion of psychiatric diagnoses. Following ETS, 52.5% of the PFH patients who were using psychotropic medications reduced their prescription regimen, compared to only 10% of control patients (P < 0.01). Additionally, scores improved dramatically in each Hyperhidrosis Impact Questionnaires category, and in both the Leibowitz Social Anxiety Scales and Center for Epidemiological Studies Depression Scales (P < 0.01). CONCLUSIONS We demonstrate that in over half of PFH patients, psychotropic medication usage was discontinued after ETS, which is consistent with our findings on postoperative improvements in Hyperhidrosis Impact Questionnaires, Leibowitz Social Anxiety Scales and Center for Epidemiological Studies Depression Scales scores. Furthermore, our findings suggest that a considerable proportion of PFH patients who experience psychopathology may be doing so secondary to excessive sweating. Thus, improved awareness or recognition of these associations in the diagnosis and management of PFH patients is warranted.
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Affiliation(s)
- Dan C Li
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alicia Hulbert
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Benjamin Waldbaum
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cecily Ober
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Craig M Hooker
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peng Huang
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniela Molena
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen C Yang
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tomoaki Ito
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carisa Perry-Parrish
- Department of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Malcolm V Brock
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Du X, Zhu X, Wang T, Hu X, Lin P, Teng Y, Fan C, Li J, Xi Y, Xiao J, Liu W, Zhang J, Zhou H, Tian D, Yuan S. Compensatory hyperhidrosis after different surgeries at the same sympathetic levels: a meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:203. [PMID: 30023366 DOI: 10.21037/atm.2018.05.24] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Different techniques of video-assisted thoracoscopic sympathetic surgery have become the radical treatments for palmar and axillary hyperhidrosis (AH). However, there is no consensus over which technique can make a minimal incidence of compensatory hyperhidrosis (CH). This study was designed to compare the incidence of CH after different techniques at the same sympathetic levels in the treatment of upper limb and facial hyperhidrosis (FH). Methods The databases of PubMed, Web of Science, ScienceDirect, Ovid Medline, Embase, and Cochrane Library were searched to identify studies comparing different surgical techniques at the same sympathetic levels for upper limb and FH. The data was analyzed by Revman 5.3 software. Results A total of ten studies involving 896 patients were included, of whom 149 underwent sympathectomy, 435 underwent sympathicotomy, and 312 under endoscopic sympathetic clip (ESC). Meta-analysis showed that the difference of incidence of CH and patients' satisfaction was not significant between sympathectomy and sympathicotomy (P=0.05, 0.19, respectively). But, the incidence of CH is significant lower after ESC than after sympathicotomy (OR: 1.58, 95% CI: 1.04-2.38, P=0.03). However, the incidence of moderate/severe CH between these two groups is not significant different (OR: 1.49, 95% CI: 0.93-2.39, P=0.10). Conclusions If only CH and the same sympathetic levels concerned, sympathectomy and sympathicotomy is equal for upper limb hyperhidrosis and FH. And, ESC should be recommended for a lower incidence of CH, comparing with sympathicotomy.
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Affiliation(s)
- Xiaojun Du
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Xu Zhu
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Tao Wang
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Xiao Hu
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Peng Lin
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Yin Teng
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Chao Fan
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Jianglun Li
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Yang Xi
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Jiarong Xiao
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Wen Liu
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Jian Zhang
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Haiyu Zhou
- Department of Thoracic Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Dan Tian
- Department of Thoracic Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Shizhang Yuan
- Department of Thoracic Surgery, Guiyang Public Health Clinical Center, Guiyang 550003, China
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Lembrança L, Wolosker N, de Campos JRM, Kauffman P, Teivelis MP, Puech-Leão P. Videothoracoscopic Sympathectomy Results after Oxybutynin Chloride Treatment Failure. Ann Vasc Surg 2017; 43:283-287. [PMID: 28478174 DOI: 10.1016/j.avsg.2017.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/21/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Videothoracoscopy sympathectomy (VATS) is the only definitive treatment for primary hyperhidrosis (HH). Since 2007, in our institution, patients with HH were initially treated with oxybutynin chloride to avoid VATS and reduce compensatory hyperhidrosis incidence with good results. The aim of this study was to analyze the surgical response of patients suffering from essential hyperhidrosis after failure of oxybutynin chloride treatment. METHODS This was an observational retrospective study that included 737 patients who were diagnosed with palmar or axillary hyperhidrosis and received VATS from January 2007 to January 2014. Patients were selected for 2 different groups: The post-oxybutynin surgery group consisted of 167 patients that were initially treated with oxybutynin chloride for 6 weeks and then received VATS after drug treatment failure. The primary surgery group consisted of a historic control group of 570 patients who were referred directly to surgical treatment. We evaluated the degree of improvement in symptoms 30 days after surgery and quality of life before and after the surgical treatment. RESULTS All patients showed poor or very poor quality of life before surgery. Most patients showed a response between moderate and high after surgical treatment. However, those in primary surgery group responded better (95.1% vs. 98.2%). In the quality of life after surgery, most of the patients reported improvement, and the primary surgery group had better improvement (92.2% vs. 95.1%). CONCLUSIONS VATS showed good results in patients with palmar or axillary hyperhidrosis regarding surgical response and improvement on quality of life even when the previous oxybutynin chloride treatment failed.
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Affiliation(s)
| | | | | | - Paulo Kauffman
- Department of Thoracic Surgery, University of São Paulo, São Paulo, Brazil
| | | | - Pedro Puech-Leão
- Department of Vascular Surgery, University of São Paulo, São Paulo, Brazil
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11
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Wolosker N, Milanez de Campos JR, Fukuda JM. Management of Compensatory Sweating After Sympathetic Surgery. Thorac Surg Clin 2016; 26:445-451. [DOI: 10.1016/j.thorsurg.2016.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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13
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Scuderi S, Manoharan P, Lim D, Manoharan S. A survey of patient satisfaction with use of microwave device for axillary hyperhidrosis. Australas J Dermatol 2016; 58:126-129. [PMID: 26802036 DOI: 10.1111/ajd.12448] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 11/28/2015] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Davin Lim
- Westside Dermatology; Brisbane Queensland Australia
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Wolosker N, Teivelis MP, Krutman M, de Paula RP, de Campos JRM, Kauffman P, Puech-Leão P. Long-term results of oxybutynin treatment for palmar hyperhidrosis. Clin Auton Res 2014; 24:297-303. [PMID: 25427685 DOI: 10.1007/s10286-014-0264-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 10/27/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE Palmar hyperhidrosis (PH) is a common illness that significantly impacts Quality of Life (QOL). Oxybutynin offers excellent short-term results, but long-term follow-up results are limited. We evaluated its effectiveness in a large group of patients who did not have surgery and who had at least 6 months of follow-up. METHODS Between September 2007 and September 2013, 570 consecutive patients were enrolled in our institutional protocol regarding the "pharmacological-first" treatment of primary PH with oxybutynin. Fifty-nine were lost to follow-up, and the data were available for 511 patients treated for at least 6 weeks. Data recorded at the start of the protocol, 6 weeks after beginning treatment, and during patients' final visits were analyzed. RESULTS 112 patients (21.9 %) did not improve and were referred for surgery (sympathectomy). Eight (1.56 %) developed significant side effects (e.g., dry mouth) and discontinued therapy. Thirty (5.9 %) preferred surgery over pharmacological treatment. 111 have not yet received treatment for 6 months. The 246 patients with more than 6 months of follow-up (median 16 months, range 6-72) were analyzed, as follows: 90.2 % experienced moderate or great improvement in their PH; 90.34 % experienced improvement at other sites of hyperhidrosis following a median of 16 months. CONCLUSION Among patients with good initial responses to oxybutynin, more than 90 % experienced moderate or great improvement in their palmar sweating, as well as in their hyperhidrosis in other sites, after 6 months. The results were particularly favorable in those patients with BMI <25 kg/m(2), and in those who noted an improved QOL after 6 weeks.
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Affiliation(s)
- Nelson Wolosker
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 Room 423, A1 Building São Paulo, São Paulo, 05652-000, Brazil
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Expanded level of sympathetic chain removal does not increase the incidence or severity of compensatory hyperhidrosis after endoscopic thoracic sympathectomy. J Thorac Cardiovasc Surg 2014; 148:2673-6. [PMID: 25131173 DOI: 10.1016/j.jtcvs.2014.06.080] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/03/2014] [Accepted: 06/12/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Compensatory hyperhidrosis is a common devastating adverse effect after endoscopic thoracic sympathectomy for patients undergoing surgical treatment of primary hyperhidrosis. We sought to determine whether a correlation existed in our patient population between the level and extent of sympathetic chain resection and the subsequent development of compensatory hyperhidrosis. METHODS All patients undergoing endoscopic thoracic sympathectomy in the T2-T3, T2-T4, T2-T5, or T2-T6 levels for palmar or axillary hyperhidrosis at the University of Iowa Hospital and Clinics (n = 97) from January 2004 to January 2013 were retrospectively reviewed. RESULTS Differences in the preoperative patient characteristics were not statistically significant among the patients receiving T2-T3, T2-T4, T2-T5, or T2-T6 level resections. Of the 97 included patients, 28 (29%) experienced transient compensatory hyperhidrosis and 4 (4%) complained of severe compensatory hyperhidrosis and required additional treatment. No operative mortalities occurred, and the morbidity was similar among the groups. CONCLUSIONS Most patients had successful outcomes after undergoing extensive resection without changes in the incidence of compensatory hyperhidrosis. Therefore, we recommend performing complete and adequate resection for relief of symptoms in patients with primary hyperhidrosis.
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Wolosker N, Teivelis MP, Krutman M, de Paula RP, Kauffman P, de Campos JRM, Puech-Leão P. Long-term Results of the Use of Oxybutynin for the Treatment of Axillary Hyperhidrosis. Ann Vasc Surg 2014; 28:1106-12. [DOI: 10.1016/j.avsg.2013.12.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 12/12/2013] [Accepted: 12/15/2013] [Indexed: 11/24/2022]
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Bryant AS, Cerfolio RJ. Satisfaction and compensatory hyperhidrosis rates 5 years and longer after video-assisted thoracoscopic sympathotomy for hyperhidrosis. J Thorac Cardiovasc Surg 2014; 147:1160-1163.e1. [DOI: 10.1016/j.jtcvs.2013.12.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 11/26/2013] [Accepted: 12/09/2013] [Indexed: 11/28/2022]
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Atkinson JLD, Fode-Thomas NC, Fealey RD, Eisenach JH, Goerss SJ. Endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis: outcomes and complications during a 10-year period. Mayo Clin Proc 2011; 86:721-9. [PMID: 21803954 PMCID: PMC3146372 DOI: 10.4065/mcp.2011.0199] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To review surgical results of endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis during the past decade. PATIENTS AND METHODS We retrospectively reviewed 155 consecutive patients who underwent surgery from June 30, 2000, through December 31, 2009, for medically refractory palmar-plantar hyperhidrosis using a technique of T1-T2 sympathotomy disconnection, designed for successful palmar response and minimization of complications. RESULTS Of the 155 patients, 44 (28.4%) were male, and 111 (71.6%) were female; operative times averaged 38 minutes. No patient experienced Horner syndrome, intercostal neuralgia, or pneumothorax. The only surgical complication was hemothorax in 2 patients (1.3%); in 1 patient, it occurred immediately postoperatively and in the other patient, 10 days postoperatively; treatment in both patients was successful. All 155 patients had successful (warm and dry) palmar responses at discharge. Long-term follow-up (>3 months; mean, 40.2 months) was obtained for 148 patients (95.5%) with the following responses to surgery: 96.6% of patients experienced successful control of palmar sweating; 69.2% of patients experienced decreased axillary sweating; and 39.8% of patients experienced decreased plantar sweating. At follow-up, 5 patients had palmar sweating (3 patients, <3 months; 1 patient, 10-12 months; 1 patient, 16-18 months). Compensatory hyperhidrosis did not occur in 47 patients (31.7%); it was mild in 92 patients (62.2%), moderate in 7 patients (4.7%), and severe in 2 patients (1.3%). CONCLUSION In this series, a small-diameter uniportal approach has eliminated intercostal neuralgia. Selecting a T1-T2 sympathotomy yields an excellent palmar response, with a very low severe compensatory hyperhidrosis complication rate. The low failure rate was noted during 18 months of follow-up and suggests that longer follow-up is necessary in these patients.
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Affiliation(s)
- John L D Atkinson
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
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Jeong JY, Park HJ. Sympathicotomy Under Local Anesthesia: A Simple Way to Treat Primary Hyperhidrosis. Ann Thorac Surg 2010; 90:1730-1. [DOI: 10.1016/j.athoracsur.2009.12.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2009] [Revised: 11/20/2009] [Accepted: 12/15/2009] [Indexed: 11/29/2022]
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Valls-Sole J, Castillo CD, Casanova-Molla J, Costa J. Clinical consequences of reinnervation disorders after focal peripheral nerve lesions. Clin Neurophysiol 2010; 122:219-28. [PMID: 20656551 DOI: 10.1016/j.clinph.2010.06.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 06/27/2010] [Accepted: 06/28/2010] [Indexed: 12/12/2022]
Abstract
Axonal regeneration and organ reinnervation are the necessary steps for functional recovery after a nerve lesion. However, these processes are frequently accompanied by collateral events that may not be beneficial, such as: (1) Uncontrolled branching of growing axons at the lesion site. (2) Misdirection of axons and target organ reinnervation errors, (3) Enhancement of excitability of the parent neuron, and (4) Compensatory activity in non-damaged nerves. Each one of those possible problems or a combination of them can be the underlying pathophysiological mechanism for some clinical conditions seen as a consequence of a nerve lesion. Reinnervation-related motor disorders are more likely to occur with lesions affecting nerves which innervate muscles with antagonistic functions, such as the facial, the laryngeal and the ulnar nerves. Motor disorders are better demonstrated than sensory disturbances, which might follow similar patterns. In some instances, the available examination methods give only scarce evidence for the positive diagnosis of reinnervation-related disorders in humans and the diagnosis of such condition can only be based on clinical observation. Whatever the lesion, though, the restitution of complex functions such as fine motor control and sensory discrimination would require not only a successful regeneration process but also a central nervous system reorganization in order to integrate the newly formed peripheral nerve structure into the prepared motor programs and sensory patterns.
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Affiliation(s)
- Josep Valls-Sole
- Department of Neurology, Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), Spain.
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Wolosker N, Munia MAS, Kauffman P, de Campos JRM, Yazbek G, Puech-Leão P. Is gender a predictive factor for satisfaction among patients undergoing sympathectomy to treat palmar hyperhidrosis? Clinics (Sao Paulo) 2010; 65:583-6. [PMID: 20613933 PMCID: PMC2898554 DOI: 10.1590/s1807-59322010000600004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 03/08/2010] [Accepted: 03/15/2010] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED Video-assisted thoracic sympathectomy (VATS) is currently the procedure of choice for the definitive treatment of primary hyperhidrosis because it is an effective, safe, and minimally invasive method. The aim of VATS treatment is to improve the quality of life through the reduction of excessive sudoresis. The purpose of this study was to assess the quality of life after VATS for treating palmar hyperhidrosis according to gender. METHODS A total of 1044 patients who submitted to the surgical treatment for palmar hyperhidrosis from June 2000 to February 2008 were retrospectively evaluated. The patients were divided into two groups according to gender [719 (68.8%) females and 325 (31.2%) males]. RESULTS There are no statistically significant differences between genders with regard to the quality of life in palmar hyperhidrosis patients (p = 0.726). In the interview that was performed 30 days after surgery, the quality of life in the two groups had improved, with no statistical difference between the groups. CONCLUSION Patients with palmar hyperhidrosis present with an improvement in the quality of life after VATS regardless of gender.
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Wasserman A, Brahn E. Systemic sclerosis: bilateral improvement of Raynaud's phenomenon with unilateral digital sympathectomy. Semin Arthritis Rheum 2009; 40:137-46. [PMID: 19878974 DOI: 10.1016/j.semarthrit.2009.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2009] [Revised: 08/10/2009] [Accepted: 08/24/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To demonstrate that unilateral digital sympathectomy, in patients with Raynaud's phenomenon (RP) and systemic sclerosis (SSc), may result in bilateral resolution of RP and digital ulcerations. METHODS We report a case of SSc and RP that had bilateral benefits from unilateral digital sympathectomy. A computer-assisted Medline/PubMed search of the medical literature was performed for 1960 through June 2009 using the keywords sympathectomy, Raynaud's phenomenon, systemic sclerosis, CREST, and digital ulcers. These searches were also combined with text words unilateral, ipsilateral, bilateral, digital sympathectomy, selective sympathectomy, autonomic nervous system, hyperhidrosis, etiology, pathogenesis, hypothesis, and treatment. Only pertinent literature, primarily in the English language, was included. RESULTS The majority of patients with SSc have RP and many suffer from digital ulcerations. Medical and behavioral management may have limited benefit and surgical intervention can be considered in recalcitrant cases, although efficacy data are sparse. We describe a man with limited SSc who underwent unilateral digital sympathectomy but manifested bilateral benefit. To our knowledge, this is the first published report of contralateral response with this procedure. The patient ultimately demonstrated these digital benefits when stressed with extreme cold and hypoxia while mountaineering. Despite the onset of high-altitude sickness and cerebral edema, his fingers remained unaffected while other mountaineers sustained severe frostbite or died of hypothermia. CONCLUSIONS Selective unilateral sympathectomy in SSc, for RP with digital ulcerations, can result in bilateral benefits despite intense challenge with cold and hypoxia.
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Affiliation(s)
- Amy Wasserman
- Division of Rheumatology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095-1670, USA
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