ideas

My feeling is that this is a viscous cycle.  
There is not one cause (physical or psychological) but a mutually re-enforcing relationship between the two.

How is HH controlled with Aluminum Chloride solution? 
 

• Answer:

(taken from THE MERCK MANUAL) 
For localized hyperhidrosis, aluminum chloride as a 20% solution of aluminum chloride hexahydrate in absolute ethyl alcohol, applied at night to the dried axillae, palms, or soles and covered tightly with a thin polyethylene film, is usually effective. In the morning, the polyethylene film is removed and the area is washed free of salt. Two applications usually protect the area for 1 wk. If the aluminum chloride under occlusion is irritating, it should be tried without occlusion. 

What is the T in T2? 
 

• Answer: 

posted by Timo Telaranta, M.D. on Apr 23 1998 4:33 PM

Quite right John. 

More accurately this T referring to thoracal means thoracal segment of spinal cord and the # of the respective spinal nerve which gives rise to the short preganglionic neurons of the corresponding ganglion. From the ganglion the long postganglionic fibers then travel towards the periphery. Between the ganglia are other preganglionic neurons to form the sympathetic trunk, and from the ganglia parallel white communicating rami which bypass some ganglia and interconnect again to the spinal column. There are 11 thoracal ganglia, of which the uppermost T1 is fused to the inferior cervical ganglion and they together form the stellate ganglion or cervicothoracic ganglion. 
 
 

• Answer: 

Posted by David H. Nielson, M.D. on October 20, 1997 at 02:00:28:

In Reply to: t1-t4 nerves and their functions posted by Chris on September 26, 1997 at 15:12:32: 

C7/C8 (upper 2/3 of the Stellate Ganglion) provides sympathetic innervation to the levator palpebrae superioris muslce of the upper eyelid helping raise or open the upper eyelid, innervation to the Dilator pupillae muscle causing pupil dilation. Lacrimal and parotid gland innervation also.  Pulling or cutting or cauterizing, etc these causes Horner's syndrome (Drooping of the upper eyelid and smaller pupil) 

T1 (lower 1/3 of the Stellate Ganglion) provides innervation to the facial sweat glands and a variable componenet to the small arteries. There may be a variable component in some people of innervation to the upper eyelid muslce (as mentioned above) and to the dilator muscle (dilator pupillae). No facial muscles are innervated by T1. 

T2 innervation to sweat glands in the face and palms, to the small arteries in the face and hands, to the heart to speed up the heart rate and increase contractility, to the trachea and bronchioles in the lungs, to submandibular and sublingual glands. 

T3 innervates sweat glands and small arteries in the axilla, goes to the heart and trachea and bronchioles. 

T4 innervates the heart, lungs, uppper chest, and sometimes part of the axille. 

Sensory nerve fibers run alongside T2, T3, T4, T5 from the heart to the brain. Sensory nerve fibers from the heart also run alongside parasympathetic nerves as well. Therefore, ETS of T2, T3, T4 won't cause a dennervated heart condition where the person wouldn't be able to feel angina (impending heart attack). 
 

• Answer:

posted by Timo Telaranta, M.D. on May 10 1998 10:31 AM

Due to recurring requests I post here the method and principles of its use with the clamps. It is a modification of the published method by C-C Lin et al.: Thoracoscopic T2-Sympathetic Block by Clipping – A Better and Reversible Operation for Treatment of Hyperhidrosis Palmaris: Experience with 326 Cases. 
European Journal of Surgery 1998; suppl. 580: 13-16. 

INTRODUCTION 

Within the chest cavity, just beside the vertebral column, runs a double nervous trunk structure, the sympathetic nervous system, which has beside every vertebra a knotlike ganglion. This is actually a relay station for the neural impulses 

1) centripetally to the spinal cord and further to the brainstem, to thalamic structures, further to prefrontal cortex, again down to the limbic system in the hippocampus and back to the spinal cord and the very same ganglia as a brain processed information 

2) to the periphery centrifugally causing the various physical reactions the processing in the brain has induced, e.g. blushing, palmar and plantar sweating, heart racing, and hand trembling 

3) along the sympathetic trunk up- and downwards to fur-ther proc-ess the information with the other systems taking care of the body’s hormonal and arousal balance, for instance to the supe-rior cervical ganglion in the neck regulating thyroid and adrenal function. 

It is convenient to call this whole as the Stress Nerve, because its functions are mostly stress-induced changes. Though, it is good to remember that it is not an anatomic nerve but a highly complicated, yet sophisticated nervous system. 

RELAY STATIONS T1, T2, AND T3 

The three uppermost ganglia are the most important ones in regulating bodily responses of stress. T1 or Stellate ganglion is the most important of these. It regulates most of the rhythm balance of the heart as well as its coronary blood flow. The left sided Stellate ganglion is the crucial element in causing ectopic beats, heart racing, blood pressure rising and coronary vessel constriction. When most of the patients symptoms are heart related, the best effect is got with the elimination of these noxious impulses. T1 is, however, the ganglion which also regulates the pupil size and the lid drooping (Horner’s sign). Thus, it can not be resected without these side effects. Luckily, due to the up- and downwards flowing neural information, these noxious cardiac impulses can sufficiently be eliminated by compressing the downflowing trunk between T1 and T2. This is best done above the second rib by clamping. The trunk can not be coagulated at this level without increasing highly the risk of Horner’s sign. Also blushing and facial sweating must be dealt at this level to ensure a safe but required diminishing of the blushing or facial sweating. 

T2 controls alone the sweating of the hands. When it is eliminated, the hands remain dry. This can be done either by electrocoagulating the nerve trunk on the second rib and third rib, when T2 remains between them. There is no need to burn the ganglion, nor actually to perform the third rib cautery unless the sweating is very heavy. By burning the nerve trunk it is not possible to ensure integrity of the communicating pre- and postganglionary fibers. Thus by coagulating part of the fine-tuning of the system is missed. The sweating effect can be eliminated, however, completely by mere compressing the nerve trunk between T1 and T2 and in the case of overt sweating also between T2 and T3. Then the white communicating rami remain intact and the nervous fine-tuning is less deranged. This re-stricts the possibility of the side effects. 

T3 regulates the sweating of the armpits and also part of plantar sweating. Also T 4 participates in these functions. It is, however, not wise to eliminate these ganglia, while the risk of compensatory sweating then increases tremendously. So, it is always mandatory to individually discuss the various symptom complexes to reach the sufficient yet not exaggerated amount of Stress Nerve Block. 

When the individual points to be eliminated have been chosen, an Autosuture clip or Ligaclip Allport endoclip, both of which have been in normal endoscopic use for years in US and other countries without any product complications, is placed around the sympathetic trunk. To do this, two ports, each 3-4 mm need to be used in the axillary area. No visible scar remain. 

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