This is the place to find definitions to a list of commonly used terms for this website and those who suffer from excessive sweating (hyperhidrosis).
Choose a word below for detailed information:
A group of medications (Robinul, Ditropan, Propantheline) which should be used as the first line of treatment for patients who suffer from excessive hand sweating – palmar hyperhidrosis. This medication should be given by a physician and should be followed to see if there is any relief from hand sweating. Those who take those medications should keep records and receipts as proof of conservative treatment for their problem. It should be emphasized that any patient who considers surgery should try some of the alternative methods.
See also our Alternative Treatments section.
Apocrine sweat glands
There are two types of sweat glands, eccrine and apocrine. The apocrine glands are located in the groin, armpit and also in the facial regions. These glands are responsible in part for the smell aspect of sweating which also is a product of the bacteria living in those areas. This is different from one person to another. They are secreting more oily secretion rather than the watery type of sweat (watery sweat is secreted by the eccrine glands). The apocrine glands are usually less affected by the sympathectomy surgical procedure.
Excessive sweating in the armpit area. To learn more about this we suggest you visit Dr. Alon Pnini’s website. Dr. Pnini is a leading expert in the field of Superficial Suction Curettage, known to be the most effective surgical alternative to ending excessive armpit sweating.
A term used to describe an anatomical abnormality which occurs in about 1% of the population. It describes a situation in which part of the right lung is covered by a vein and veil. It has no psyiological significance and when sympathectomy is being done on the right side it can pose some difficulties when performing the operation.
– B –
A group of medications being used for the treatment of certain heart problems. Can be used for the treatment of facial blushing and social anxiety with some degree of success. Should be given by a physician and followed by a physician.
Medical term describing excessive axillary sweating, dark in color producing odor. Bromhidrosis (odor) represents a variation or accentuation of normal axillary odor. It is very bothersome and can cause a lot of problems for people socially.
A chemical product from certain bacteria that in its purified form can be used for the treatment of focal hyperhidrosis such as axillary sweating. This is not approved for the treatment of palmar hyperhidrosis.
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In the clipping/clamping method, titanium clips are applied on the nerve causing the cessation of function of that particular segment. One should be aware however that removal of the clips does not have the same results for reversibility and there are many factors that will determine the likelyhood of success when the clamps are removed.
A side effect to ETS (Endoscopic Thoracic Sympathectomy). Most everyone experiences some degree of compensatory sweating however in most cases it is preferable to the original excessive sweating. Other words used to describe the same situation is “reflex sweating.” The exact physiological explanation is known yet. It does not affect every patient the same way so there must be some individual factors that contribute to this.
A method that describes a portion in the axillary suction currettage operation. This means that you scrape the underlining of the skin from the inside to help remove the axillary sweat glands.
A term used to describe the method by which the nerve is destroyed by electrocautery, harmonic scalpel, or excision of a nerve segment during sympathectomy.
– D –
An aluminum compound that is used for the treatment of palmar hyperhidrosis. It comes in different strengths (10%, 20% and 30%) and should considered as one of the first approaches for the treatment for excessive hand sweating. Drysol should be obtained from a physician and those who use it should keep receipts of their treatment.
– E –
The eccrine glands are the glands producing sweat. The eccrine glands are known to be supplied by sympathetic nerve fibers. This is why areas that have a lot of eccrine glands will be affected by the sympathectomy procedure which interrupts the sympathetic signals to the glands.
ETS is an acronym for Endoscopic Thoracic Sympathectomy. This is the procedure performed to cure people of excessive sweating.
– F –
A clinical situation in which the patient describes redness and heat sensations in their face mainly occurring in social situations. Thought to be potentially treated with ETS but here the success rate is not as good for excessive hand sweating. ETS fell out of favor in treating this entity due to more side effects than previously thought.
Physiological condition in which the facial area and the scalp are sweating more than is needed. Those who suffer from this excessive sweating describe it as very damaging to their functional and social life. Endoscopic Thoracic Sympathectomy thought to be a remedy for that but unfortunately those patients who were operated on only for excessive facial sweating developed (statistically speaking) more severe compensatory sweating. At present Dr. Reisfeld does not recommend (ETS) for this particular problem. Medication such as anti cholinergic medications, mild sedatives should be tried before any consideration for surgical treatment is given.
See also Alternative Treatments Section
– G –
Sweating of the face, forehead, scalp, and neck. Appears as a response to spicy food, sour food, in the normal population. Described as a side effect after endoscopic thoracic sympathecoty, and it was up to 10% of the patients who underwent ETS. Since Dr. Reisfeld lowered the level of ETS to level T3 – T4 the number of patients who suffer from gustatory sweating as a side effect of ETS fell dramatically. The psyiological explanation for this is that the newer technique maintains the para-sympathetic and sympathetic balance in tact.
A mass of nerve tissue or a group of nerve cell bodies. This is used to describe where connections are made between one sympathetic area to another.
– H –
Bleeding in the chest.
A complication that can result from sympathectomy. Dr. Reisfeld has never had a Horner Syndrome case in all his years of practice (21+ years).
Horner Syndrome is characterized by Sinking in of one eyeball, ipsilateral ptosis (drooping of the upper eyelid on the same side) and miosis (constriction of the pupil of that eye) together with anhidrosis (lack of sweating) and flushing of the affected side of the face.
The Horner Syndrome was a relative common complication when sympathectomy was done through the open approach through the neck. It happened in up to 15% of the cases. Performing the operation endscopically now a days cut the incidents to a very negligible number (less than 0.001%).
A physiological situation in which patients have excessive outpouring of sympathetic mediators such as adrenaline can result in excessive hand sweating (palmar hyperhidrosis), anxiety, palpitations, etc.
There are two basic approaches to the treatment of hyperhidrosis; conservative measures and surgical approaches. Everyone who suffers from hyperhidrosis should try some conservative approaches which might consist of lotions, pills, electric devices BOTOX® Cosmetic injections or behavioral modification. In the majority of the severe cases none of the above will be effective but never the less should be tried. If any of those conservative measures failed then the option of the surgical treatment should be considered. Please see our hyperhidrosis treatment page for more information.
– I –
A conservative method to treat palmar hyperhidrosis is the use of the drionic machine or the Fisher Iontophoresis equipment. Those instruments are sending mild electrical shocks to the palms of the hands of the plantar surface of the feet and by doing so changing electrical balance across the membrames in the sweat glands. One has to use it very often and it can cause some pain while using it. Never the less a patient should try iontophoresis as a treatment for their excessive hand sweating before a decision is made to go for surgery.
A method described by Dr. Lin from Taiwan to restore continuity of the sympathetic chain for those patients who wanted a reversal. So far no definite data of proven success is available.
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– K –
Dr. Reisfeld believes that the Kuntz nerve is a misused term. In the 1920’s, Doctor A. Kuntz wrote a paper regarding a nerve he found in cats. That paper was written about the high failure rates when sympathectomies were done for vascular problems with the hands. We know now that the failure rate in those types of operations are related to post-denervation hypersensitivity. In the last symposium on sympathetic surgery in Finland, the overall consensus was that the Kuntz nerve has no bearing on the failure rate of sympathectomy (the actual ETS operation).
For a much more in-depth explanation click here
– L –
The lungs are divided into lobes. There are three on the right side and two on the left side.
Over the last 15 years when thoracic sympathectomy became more and more widespread it became evident that excessive foot sweating (plantar hyperhidrosis) was not helped as much as palmar hyperhidrosis (hand sweating) after ETS. Since 2006 Lumbar Sympathectomy was added to the surgical options to treat excessive foot sweating. To learn more visit our excessive foot sweating page.
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– O –
A clinical description that describes a fall in blood pressure that occurs when a person assumes a standing position usually after a prolonged period of rest. Usually it does not happen after limited endoscopic thoracic sympathectomy is done at the level of T3-T4. In case reports where it was described after ETS it usually involved cases of multiple level sympathectomies. Related information Syncope
– P –
A physiological condition describing excessive hand sweating beyond the physiological need. Obviously there are different levels to excessive hand sweating and it can range for mild cases of moisture to severe cases of water drops dripping from the hands. See also our Palmar Hyperhidrosis page.
The parasympathetic nervous system together with the sympathetic nervous system (that accelerates the heart rate, constricts blood vessels, and raises blood pressure) constitute the autonomic nervous system, the branch of the nervous system that performs involuntary functions.
Free air in the chest outside the lung.
– Q –
– R –
This describes a situation where part of the semen ejaculate partially goes back to the bladder instead of coming forward through penis opening. An incorrect and misunderstood fear is that lumbar sympathectomy causes this problem. As long as lumbar sympathectomy is done below the level of the second lumbar vertebrae this condition should not happen.
This is related to the reversal of the ETS procedure. The method to accomplish this depends on the type of ETS procedure performed as well as other factors. For more information on this please view click here.
See our Reflex Sympathetic Dystrophy page.
Even though Robotic surgery is used in certain operations it does not yet have any place in thoracic sympathectomy cases. With regard to lumbar sympathectomy the robotic device needs 8cm of distance between each arm. Since lumbar sympathectomy is done through a smaller space the use of a robotic device is not yet practical.
– S –
While doing surgical thoracic procedures the anesthesiologist can put the patient to sleep with a single lumen intubation versus double lumen intubation. The first one is a much simpler approach done with a smaller sized tube and at the same time both lungs are continuing to be aerated. The end result is a simpler procedure for both the patient and anesthesiologist and less throat discomfort. On the other hand the double lumen intubation is done with a larger tube and demands a high technical knowledge of this specific intubation. In summary single lumen intubation is simpler, safer and causes less problem for the patients.
Area of the nervous system that serves to accelerate the heart rate, constrict blood vessels, and raise blood pressure. The sympathetic nervous system and the parasympathetic nervous system constitute the autonomic nervous system, the branch of the nervous system that performs involuntary functions.
– T –
A common terminology used by surgeons who perform ETS to describe where the sympathectomy was done (clamping vs. cutting). The T stands for the area of the sympathetic of the chain parallel to a specific rib. T2 means second rib, T3 means third rib, and T4 means fourth rib.
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