RESUMO
RESUMEN Antecedentes: la simpaticotomía toracoscópica demostró ser una cirugía segura para el tratamiento de la hiperhidrosis focal primaria (HFP); sin embargo, la calidad de vida no es totalmente satisfactoria en algunos pacientes, teniendo en cuenta la sudoración compensatoria como principal efecto adverso. Objetivo: evaluar la calidad de vida de los pacientes operados por HFP mediante simpaticotomía toracoscópica utilizando una encuesta anónima posoperatoria. Material y métodos: se incluyó una serie consecutiva de pacientes operados de simpaticotomía toracoscópica entre agosto de 2016 y agosto de 2019. Se excluyeron pacientes que no respondieron a la encuesta de calidad de vida telefónica o cuyo tiempo de seguimiento fue menor de 6 meses. Se evaluaron variables clínicas, quirúrgicas y posoperatorias. Resultados: durante este período se operaron 61 pacientes; del total de la muestra se excluyeron 12 pacientes. El promedio de edad fue 28,9 años. Todos tenían hiperhidrosis primaria palmar y/o axilar moderada o grave, asociadas o no a rubor facial o hiperhidrosis plantar. La encuesta fue respondida por 49 pacientes; de esta observamos una resolución total de la HFP en 32 pacientes (65,3%) y parcial en 17 pacientes (34,6%), con un porcentaje de sudoración compensatoria del 61% (30 pacientes), de los cuales a 4 (8%) la sudoración compensatoria les alteró su calidad de vida, provocando malestar e insatisfacción, la mayoría transitorios. Con un tiempo promedio de 36 meses (6-72), el 97,9% (48 pacientes) sí recomendarían realizar el procedimiento. Conclusión: la simpaticotomía toracoscópica bilateral continúa siendo el tratamiento más eficaz para HFP. El nivel de satisfacción de los pacientes operados fue elevado. Si bien la sudoración compensatoria fue el efecto adverso más frecuente, generalmente se presentó de manera leve y transitoria.
ABSTRACT Background: Thoracoscopic sympathectomy demonstrated to be a safe surgical procedure for the management of primary focal hyperhidrosis (PFH); however, some patients are not completely satisfied with their quality of life as compensatory sweating is the main adverse event. Objective: The aim of this study was to evaluate the quality of life of patients with PFH undergoing thoracoscopic sympathectomy using an anonymous postoperative survey. Material and methods: Consecutive patients undergoing thoracoscopic sympathectomy between August 2016 and August 2019 were included. Patients who did not respond the telephone survey about their quality of life or who had been followed up for < 6 months. Clinical, intraoperative and postoperative variables were analyzed. Results: During this period 61 patients were operated on and 12 of them were excluded. Mean age was 28.9 years. All the patients presented moderate or severe primary palmar and/or axillary hyperhidrosis with or without facial flushing or plantar hyperhidrosis. Forty-nine patients responded the survey. Surgery completely solved PFH in 32 patients (65.3%) while 17 patients (34.6%) achieved a partial relief; 61% (30 patients) developed compensatory sweating affecting the quality of life in 4 (8%) causing transient discomfort and dissatisfaction in most cases. After a mean follow-up of 36 months (6-72), 97.9% (48 patients) recommended the procedure. Conclusion: Bilateral thoracoscopic sympathectomy is still the most efficient treatment for PFH with high level of satisfaction among the patients operated on. Compensatory sweating was the most common adverse effect and is mild and transient in most cases.
Assuntos
Hiperidrose , Qualidade de Vida , Procedimentos Cirúrgicos Operatórios , Telefone , Terapêutica , Inquéritos e Questionários , Assistência ao Convalescente , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Rubor , Hiperidrose/tratamento farmacológico , MétodosRESUMO
El síndrome de Arlequín es una condición neurológica poco común, la mayoría de las veces benigna. Por lo general la mayor parte de los casos son de causa idiopática (aunque existen causas secundarias). Esta afección consiste en la aparición de eritema e hiperhidrosis facial unilateral desencadenado por el ejercicio, calor, emociones o estrés, la que se produce debido a una disfunción contralateral de la vía simpática vasodilatadora y sudomotora. Se presenta el caso de un paciente de sexo masculino de 49 años, que relata presentar un cuadro de 15 años de evolución caracterizado por la aparición de eritema y sudoración excesiva de la hemicara derecha, la cual termina abruptamente en la línea media de la cara, gatillado por el ejercicio y el calor en verano, mientras que la hemicara izquierda presenta anhidrosis sin eritema.
The Harlequin syndrome is a rare neurological condition, most of the time benign. In general, most cases are idiopathic (although there are secondary causes). This condition consists in the appearance of unilateral facial erythema and hyperhidrosis triggered by exercise, heat, emotions or stress, which occurs due to a contralateral dysfunction of the sympathetic vasodilator and sudomotor pathway. We present the case of a 49-year-old male patient, with no relevant morbid history, who reports a medical history of 15 years of evolution, characterized by the appearance of erythema and excessive sweating of the right side of his face, which ends abruptly in the middle line of the face, triggered by exercise and heat during the summer. While the left side presents anhidrosis without erythema.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Autônomo/diagnóstico , Rubor/diagnóstico , Hiperidrose/diagnóstico , Eritema , Face , Hipo-HidroseRESUMO
INTRODUCCIÓN: La forma clínica de presentación más común del neuroblastoma es el de una masa abdominal, pero puede presentarse con sintomatología menos habitual, como es la crisis adrenérgica por liberación de catecolaminas. OBJETIVO: Describir una forma de presentación inusual de neuroblastoma y el amplio diagnóstico diferencial que existe en un lactante con síntomas adrenérgicos. CASO CLÍNICO: Lactante femenina de 7 semanas de vida, consultó por historia de tres semanas de sudoración e irritabilidad a lo que se asoció fiebre de 24 h de evolución y dificultad respiratoria. Al ingreso presentaba mal esta do general, irritabilidad, sudoración, enrojecimiento facial, taquipnea y palidez cutánea, taquicardia sinusal extrema e hipertensión arterial (HTA), interpretadas como sintomatología adrenérgica. Se completó el estudio con una ecografía abdominal y resonancia magnética que mostraron una gran masa retroperitoneal compatible con neuroblastoma. Las catecolaminas en sangre y en orina mostraron altos niveles de dopamina, adrenalina y noradrenalina, probablemente de origen tumoral. Se inició tratamiento antihipertensivo con fármacos alfa bloqueantes con buen control de la tensión arterial. Se resecó quirúrgicamente el tumor sin incidencias y con una adecuada recuperación posterior. La paciente presentó evolución favorable a tres años de seguimiento. CONCLUSIONES: en un lactante con sintomatología adrenérgica como irritabilidad, enrojecimiento, sudoración asociada a HTA, se debe descartar patología cardiaca, metabólica (hipoglucemia), intoxicaciones y/o patología suprarrenal. Dentro de esta última, el neuroblastoma es la primera posibilidad diagnóstica, por ser uno de los principales tumores en la infancia y aunque esta presentación no es habitual puede producir estos síntomas.
INTRODUCTION: The most common clinical presentation of neuroblastoma is an abdominal mass, but it can present with uncommon symptoms, such as adrenergic storm due to catecholamine release. OBJECTIVE: To describe an unusual presentation of neuroblastoma and the wide differential diagnosis that exists in an infant with adrenergic symptoms. CLINICAL CASE: A 7-week old female infant was evaluated due to a 3-week history of sweating and irritability associated with a 24-hour fever and respiratory distress. At admission, she presented poor general condition, irritability, sweating, facial redness, tachypnea and skin paleness, extreme sinus tachycardia, and high blood pressure (HBP), interpreted as adrenergic symptoms. The study was completed with abdominal ultrasound and magnetic reso nance imaging that showed a large retroperitoneal mass compatible with neuroblastoma. Plasma and urinary catecholamines tests showed high levels of dopamine, adrenaline, and noradrenaline, probably of tumor origin. We started antihypertensive treatment with alpha-blocker drugs, showing a good blood pressure control. The tumor was surgically resected without incidents and adequate subsequent recovery. The patient presented a favorable evolution after three years of follow-up. CONCLUSIONS: In an infant with adrenergic symptoms such as irritability, redness, sweating associated with HBP, it should be ruled out pathology heart or metabolic (hypoglycemia) pathology, intoxications, and/or adrenal pathology. Within this last one, neuroblastoma is the first diagnostic possibility, since it is one of the main tumors in childhood and, although this presentation is not usual, it can produce these symptoms.
Assuntos
Humanos , Feminino , Lactente , Neoplasias Retroperitoneais/diagnóstico , Sudorese , Taquicardia/etiologia , Catecolaminas/urina , Rubor/etiologia , Hipertensão/etiologia , Neuroblastoma/diagnóstico , Neoplasias Retroperitoneais/complicações , Neoplasias Retroperitoneais/urina , Taquicardia/diagnóstico , Humor Irritável , Biomarcadores Tumorais/urina , Diagnóstico Diferencial , Hipertensão/diagnóstico , Neuroblastoma/complicações , Neuroblastoma/urinaAssuntos
Encéfalo/diagnóstico por imagem , Neuroborreliose de Lyme/diagnóstico , Meningites Bacterianas/diagnóstico , Mielite/diagnóstico , Medula Espinal/diagnóstico por imagem , Administração Intravenosa , Adolescente , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Viroses do Sistema Nervoso Central/diagnóstico , Diagnóstico Diferencial , Diarreia , Rubor/fisiopatologia , Síndrome de Guillain-Barré/diagnóstico , Cefaleia/fisiopatologia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Humor Irritável , Neuroborreliose de Lyme/líquido cefalorraquidiano , Neuroborreliose de Lyme/fisiopatologia , Neuroborreliose de Lyme/terapia , Imageamento por Ressonância Magnética , Masculino , Meningites Bacterianas/líquido cefalorraquidiano , Meningites Bacterianas/fisiopatologia , Meningites Bacterianas/terapia , Mielite/líquido cefalorraquidiano , Mielite/fisiopatologia , Mielite/terapia , Cervicalgia/fisiopatologia , Parestesia/fisiopatologia , Neuropatias Fibulares/fisiopatologia , Pneumonia Bacteriana , Reflexo Anormal , Sudorese , Retenção Urinária/fisiopatologia , Febre do Nilo Ocidental/diagnósticoRESUMO
INTRODUCTION: The most common clinical presentation of neuroblastoma is an abdominal mass, but it can present with uncommon symptoms, such as adrenergic storm due to catecholamine release. OBJECTIVE: To describe an unusual presentation of neuroblastoma and the wide differential diagnosis that exists in an infant with adrenergic symptoms. CLINICAL CASE: A 7-week old female infant was evaluated due to a 3-week history of sweating and irritability associated with a 24-hour fever and respiratory distress. At admission, she presented poor general condition, irritability, sweating, facial redness, tachypnea and skin paleness, extreme sinus tachycardia, and high blood pressure (HBP), interpreted as adrenergic symptoms. The study was completed with abdominal ultrasound and magnetic reso nance imaging that showed a large retroperitoneal mass compatible with neuroblastoma. Plasma and urinary catecholamines tests showed high levels of dopamine, adrenaline, and noradrenaline, probably of tumor origin. We started antihypertensive treatment with alpha-blocker drugs, showing a good blood pressure control. The tumor was surgically resected without incidents and adequate subsequent recovery. The patient presented a favorable evolution after three years of follow-up. Con clusions: In an infant with adrenergic symptoms such as irritability, redness, sweating associated with HBP, it should be ruled out pathology heart or metabolic (hypoglycemia) pathology, intoxications, and/or adrenal pathology. Within this last one, neuroblastoma is the first diagnostic possibility, since it is one of the main tumors in childhood and, although this presentation is not usual, it can produce these symptoms.
Assuntos
Catecolaminas/urina , Rubor/etiologia , Hipertensão/etiologia , Neuroblastoma/diagnóstico , Neoplasias Retroperitoneais/diagnóstico , Sudorese , Taquicardia/etiologia , Biomarcadores Tumorais/urina , Diagnóstico Diferencial , Feminino , Humanos , Hipertensão/diagnóstico , Lactente , Humor Irritável , Neuroblastoma/complicações , Neuroblastoma/urina , Neoplasias Retroperitoneais/complicações , Neoplasias Retroperitoneais/urina , Taquicardia/diagnósticoRESUMO
Objective: to verify the extent of impairment of the clinical indicators of the nursing outcome Dry Eye Severity in patients admitted to the Intensive Care Unit. Method: cross-sectional, descriptive study developed with 206 patients. Based on the result listed, six indicators of the Classification of Nursing Results were evaluated with a questionnaire containing clinical variables and the Likert scale of the Classification of Nursing Results with constructed definitions, which varies from more impaired to non-impaired. The data were analyzed using descriptive and inferential statistics. Results: the decrease in lacrimal production and the presence of redness in the conjunctiva were more impaired. The other indicators were more frequent for the absence of impairment: incomplete eyelid closure 81% (167), excessive tearing 95.1%(196), excessive mucous secretion 78.7% (162) and decreased blinking mechanism 50.5% (104). The clinical characteristics of hospitalization for neurological disorders, invasive mechanical ventilation, chemosis, use of sedatives, vasoconstrictors, benzodiazepines, antibiotics and corticosteroids interfered in the impairment of the dry eye severity. Conclusion: the result indicators show that the clinical characteristics of patients in the intensive care unit interfere in the impairment and in the dry eyes severity. According to these results, the importance of assistance directed to the prevention of eye diseases is emphasized.
Objetivo: verificar o grau de comprometimento dos indicadores clínicos do Resultado de Enfermagem Gravidade do Olho Seco em pacientes internados em unidades de terapia intensiva. Método: estudo transversal e descritivo desenvolvido com 206 pacientes. Do resultado elencado, seis indicadores da classificação dos Resultados de Enfermagem foram avaliados com questionário contendo variáveis clínicas e com a escala de Likert com definições construídas, que varia de mais comprometido a sem comprometimento. Os dados foram analisados mediante estatística descritiva e inferencial. Resultados: a diminuição da produção lacrimal e a presença de vermelhidão na conjuntiva estiveram associadas com maior comprometimento. Os demais indicadores foram mais frequentes para a ausência de comprometimento: fechamento palpebral incompleto 81% (167), lacrimejamento excessivo 95,1% (196), excesso de secreção mucosa 78,7% (162) e mecanismo de piscar diminuído 50,5% (104). As características clínicas internação por distúrbios neurológicos, ventilação mecânica invasiva, quemose, uso de sedativos, vasoconstrictores, benzodiazepínicos, antibióticos e corticoides interferiram no comprometimento na gravidade do olho seco. Conclusão: os indicadores do resultado mostram que as características clínicas dos pacientes da unidade de terapia intensiva interferem no comprometimento e gravidade do olho seco. A partir das relações, ressalta-se a importância da assistência direcionada à prevenção de agravos oculares.
Objetivo: verificar el grado de deterioro de los indicadores clínicos del resultado de enfermería Gravedad del ojo seco en pacientes ingresados en la Unidad de Cuidados Intensivos. Método: estudio descriptivo transversal desarrollado con 206 pacientes. A partir del resultado listado, se evaluaron seis indicadores de la Clasificación de Resultados de Enfermería con un cuestionario que contenía variables clínicas y la escala Likert de la Clasificación de Resultados de Enfermería con definiciones construidas, que varía desde más deteriorada hasta no deteriorada. Los datos se analizaron mediante estadísticas descriptivas e inferenciales. Resultados: La disminución de la producción lagrimal y el enrojecimiento en la conjuntiva mostraron un mayor deterioro. Los otros indicadores fueron más frecuentes en ausencia de deterioro: cierre incompleto de párpados 81% (167), lagrimeo excesivo 95.1% (196), secreción mucosa excesiva 78.7% (162), y disminución del mecanismo de parpadeo 50.5% (104). Las características clínicas de la hospitalización por trastornos neurológicos, ventilación mecánica invasiva, quemosis, uso de sedantes, vasoconstrictores, benzodiacepinas, antibióticos y corticosteroides interfieren en el deterioro en la gravedad del ojo seco. Conclusión: Los indicadores de resultados muestran que las características clínicas de los pacientes de la unidad de cuidados intensivos interfieren en el deterioro y en la gravedad del ojo seco. A partir de estas relaciones, se enfatiza la importancia de la asistencia dirigida a la prevención de enfermedades oculares.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Síndromes do Olho Seco , Prevalência , Oftalmopatias , Rubor , Unidades de Terapia IntensivaRESUMO
El rubor facial transitorio se define como una sensación de calor, acompañada de enrojecimiento de la piel, causada por una respuesta vasomotora con el resultante incremento en el flujo sanguíneo regional, debido a la acción directa de diferentes mediadores liberados por los nervios. Los cuadros pueden ser episódicos o constantes y se relacionan con respuestas fisiológicas y con patologías de origen benigno y maligno. El objetivo de la revisión es realizar un abordaje racional de esta condición en el escenario de atención primaria, con el fin de llegar a un diagnóstico precoz y completo, abordando los principales diagnósticos diferenciales asociados con esta condición.
The definición of flushing involves a sensation of heat along with redness of the skin, caused by vasomotor influx resulting in an increased of the regional vascular blood flow due to the direct action of different mediators through the vasomotor nerves. These symptoms can be episodio or repetitive and they' can be related to benign or malignant conditions. The objective of this review is to develope a racional approach of the condition at primary care, with the purpose of an early and complete diagnosis, covering the main differential diagnosis related to this condition.
Assuntos
Sinais e Sintomas , Fogachos/diagnóstico , Diagnóstico Diferencial , Rubor/diagnósticoRESUMO
Harlequin syndrome is a rare condition in which one half of the face fails to flush and sweat due to damage of the sympathetic fibers on the ipsilateral side. The majority of cases are idiopathic, but may be iatrogenic or caused by space-occupying lesions or brainstem infarction. We report a case of idiopathic harlequin syndrome in a 34-year-old man with a 5-month history of unilateral facial flushing and sweating after exercise. Despite the rarity of this syndrome, dermatologists should be aware of this condition in order to diagnose properly and provide multidisciplinary assistance.
Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Rubor/diagnóstico , Hipo-Hidrose/diagnóstico , Adulto , Humanos , MasculinoRESUMO
Abstract: Harlequin syndrome is a rare condition in which one half of the face fails to flush and sweat due to damage of the sympathetic fibers on the ipsilateral side. The majority of cases are idiopathic, but may be iatrogenic or caused by space-occupying lesions or brainstem infarction. We report a case of idiopathic harlequin syndrome in a 34-year-old man with a 5-month history of unilateral facial flushing and sweating after exercise. Despite the rarity of this syndrome, dermatologists should be aware of this condition in order to diagnose properly and provide multidisciplinary assistance.
Assuntos
Humanos , Masculino , Adulto , Doenças do Sistema Nervoso Autônomo/diagnóstico , Rubor/diagnóstico , Hipo-Hidrose/diagnósticoRESUMO
PURPOSE: Results of a study to test the hypothesis that taking niacin simultaneously with different forms of aspirin would reduce the occurrence of niacin-induced flushing are reported. METHODS: Traditionally, taking enteral absorbed aspirin 30 minutes before a niacin dose has been shown to reduce flushing by 30-50% relative to nonuse of aspirin. The objective of the study was to evaluate the efficacy of enteral absorbed and orally dissolved aspirin, taken at the same time as niacin, in reducing the frequency of moderate-to-severe flushing. In a prospective, double-blind, placebo-controlled crossover trial, healthy adult male and female volunteers were asked to take aspirin or a placebo (both agents were taken in both orally dissolved and swallowed formulations) immediately before niacin administration. Subjects then self-evaluated flushing symptoms on a validated scale. RESULTS: Simultaneous administration of swallowed aspirin and niacin reduced moderate-to-severe flushing events by a mean of 36.1%, from 2.35 to 1.5 events per subject (p = 0.003), relative to event rates with use of niacin alone. In a subset of subjects who had experienced moderate-to-severe flushing symptoms despite taking swallowed aspirin, flushing in response to subsequent niacin use was decreased by 20.5% (p = 0.05) with coadministration of orally dissolved aspirin and by 18.0% with a regimen containing both orally dissolved and swallowed aspirin (p = 0.03). CONCLUSION: Novel regimens of niacin and aspirin, including orally dissolved aspirin, were effective in reducing niacin-induced flushing in a small sample of healthy adult volunteers.