The cilio-spinal center is not sharply confined to TI spinal level, but may extend downwards as low as T5.
Brachial plexus contusion resulting from pressure of retractors usually involved the lower trunk (spinal roots C8 TI, Klumpke's Syndrome). It was usually mild and transient, and became less frequent with increasing experience.
Other complaints of post operative pain were of three types: 1) Post sympathetic neuralgia in 6 patients
usually mild and always transient. 2) Muscular type pains in the neck, back and abdomen, probably secondary to the fasciculations induced by succinylcholine, or to the hyperextension of the neck during the operation. 3) Pleuritic type chest pain probably due to irritation of the apical pleura by the inevitable small hematoma in the operative field.
Average post-operative stay after the operation was four days, considerably shorter than in any other approach to UDS.
Ptosis and miosis are the most constant elements of the post-operative Homer's syndrome. In some of the patients only one of the two was prominent. Facial anhydrosis although common did not correlate with the
previous two signs. Of the ocular complaints only conjunctival hyperemia correlated well with ptosis
and miosis. Mild impairment of vision was noted by 18 patients, non specific complaints of pain or itching
were reported by 12, and in two patients a unilateral decreased secretion of tears was documented
On the surgical treatment of HH. Some describe the operation as a minor procedure with excellent results and very few complications. Others completely object to surgery for what they consider to be a benign functional disorder.' In our extensive experience the truth lies somewhere in between these two extreme views.
Severe palmar HH can be quite crippling, but the operation in spite of giving good results, should not be
taken lightly. Apart from sequellae described in this report, some other aspects have not yet been fully
investigated. These include possible denervation effects on bronchi and lungs, on the myocardium
and the coronary circulation, on salivation and dental health, and on ophthalmic functions such as lacrimation
and accomodation.
Palmar Hyperhidrosis and its Surgical Treatment: A Report of 100 Cases
RAPHAEL ADAR, M.D., F.A.C.S., ALEXANDER KURCHIN, M.D. AMIKAM ZWEIG, M.D., MARK MOZES, M.D., F.A.C.S.
