Hyperhidrosis, Raynaud's Disease Abstracts
Dr. Nielson's research is based on Micro ETS patients from around the world.

Abstract #1
Severity of Compensatory Sweating using Micro ETS not different comparing T2(above) vs T2,T3 groups.

477 patients underwent micro ETS of T2(above) and 252 patients underwent micro ETS of T2,T3. The mean severity of compensatory sweating on a scale from 0 to 3 (with 0 for none, 1 for mild, 2 for moderate, and 3 for severe) for the two groups was 0.88 for the T2 group and 0.95 for the T2,T3 group one week after surgery. The severity slightly increased by three months to 1.16 and 1.30 for the T2 and T3 groups respectively.

Severity of compensatory sweating is mild using the less disturbing-to-the-tissue (less thermal and mechanical injury) micro ETS technique and is similar in both T2 and T2,T3 groups.

Abstract #2
Ability to Breast Feed is not impaired after upper thoracic sympathectomy.

Five patients between the ages of 29 and 33 were actively breast feeding and underwent upper thoracic micro ETS. They pumped their milk daily for 3 to 7 days following micro ETS then resumed breast feeding. None of them experienced a decrease or change in nipple sensation. None reported any difference in time required for milk letdown reflex to occur. None reported any change in quantity, consistency, temperature, or color of milk production. None reported any change in length of time that milk continued to flow after the baby stopped the nursing session.

Breast feeding can successfully be resumed after undergoing upper thoracic sympathectomy.

Abstract #3
Ocular Rosacea can be successfully treated with micro ETS of the upper thoracic sympathetic nervous system.

Four patients, 2 female and 2 male, between the ages of 29 and 70 underwent micro ETS including precise division of T2 Kuntz nerves (3 received T2 and 1 T2-above) for ocular rosacea. All of these patients had accessory sympathetic nerve branches (Kuntz) at the T2 level. Symptoms included ocular burning, scleral and conjunctival burning and erythema and one even complained of pain associated with the ocular symptoms. Two patients experienced moderate resolution and two excellent resolution of their ocular symptoms.

Ocular Rosacea symptoms of burning, scleral/conjunctival erythema and even ocular pain can be successfully treated with micro ETS of T2 which includes accessory nerve (Kuntz) branches.

Abstract #4
Recurrent Symptoms following upper thoracic sympathectomy may be related to several factors.

36 patients, 18 male and 18 female, ages 14 to 56 underwent re-do ETS of the upper thoracic sympathetic level(s). 35 patients had recurrent symptoms and 1 had developed new symptoms following the original ETS procedure. Intra-operatived finding during re-exploration included, 35 patients had at least one Kuntz nerve intact, 1 patient had regeneration of the the main sympathetic nerve trunk and 7 patients had Titanium clamps previously placed across the main sympathetic nerve trunk. During the re-explorations, 21 patients had T2-above, 2 had T3, 10 had T2 (above and below the T2 ganglion) and 3 had T2-below ETS performed. Recurrent symptoms and the new symptoms in one patient resolved in all patients following re-do ETS.

Kuntz nerves at the T2 ganglion level, left intact in this sub-population of ETS patients developing recurrent symptoms, led to recurrent symptoms of facial/palmar hyperhidrosis and facial blushing and in one patient, new symptoms of facial hyperhidrosis and blushing did develop. Highly selective precise division of these intact Kuntz nerve branches was curative for their facial and palmar symptoms.

Citation 9
Authors
Noppen M. Herregodts P. D’Haese J. D’Haens J. Vincken W . Institution Respiratory Department, Academic Hospital A.Z.-V.U.B., Free University of Brussels, Belgium.

Title
A simplified T2-T3 thoracoscopic sympathicolysis technique for the treatment of essential hyperhidrosis: short-term results in 100 patients.

Source
Journal of Laparoendoscopic Surgery. 6(3):151-9, 1996 Jun.

Abstract
A simplified one-time bilateral thoracoscopic T2-T3 sympathicolysis technique using single-lumen endotracheal intubation with high frequency jet ventilation and electrocautery destruction (“sympathicolysis”) of the sympathetic ganglia was applied in 100 consecutive patients with severe essential hyperhidrosis (EH). Providing a pleural space can be created, this technique was proven simple and safe, and short-term clinical results were excellent: palmar hyperhidrosis was successfully treated in a majority of patients, and axillar and plantar improvement was achieved many patients as well. Side-effects and complications were minor (compensatory hyperhidrosis) or self-limiting (pain). These data confirm the safety and efficacy of thoracoscopic sympathetic interventions for the treatment of EH, and support the evolution toward simplified methodologies.