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Clinical Sciences
Endoscopic Lumbar Sympathectomy for Women: Effect on Compensatory Sweat
Marcelo de Paula Loureiroa, José Ribas Milanez de Camposa, Paulo Kauffmanb, Fábio Biscegli Jatenea, Sheila Weigmannc, Aline Fontanac
a Programa de Pós-Graduação em Ciências - Cirurgia Torácica e Cardiovascular, Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
b Departamento de Cirurgia Vascular, Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
c Faculdade de Medicina da Universidade Federal do Paraná - Paraná, Brazil
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          "en" => "<p id="spara40" class="elsevierStyleSimplePara elsevierViewall">Paravertebral lumbar sympathetic trunk &#40;white arrow&#41; under the vena cava &#40;yellow arrow&#41;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle60">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">The lumbar sympathectomy was first described by Julio Diez&#44;<a class="elsevierStyleCrossRef" href="#bib1">1</a> of Buenos Aires&#44; Argentina&#44; in 1924 and subsequently by Royle<a class="elsevierStyleCrossRef" href="#bib2">2</a> in Australia and Adson<a class="elsevierStyleCrossRef" href="#bib3">3</a> in the United States&#46; It was initially utilized for the treatment of ischemic and painful disorders of the lower limbs&#46; This treatment&#44; which was popular among vascular surgeons&#44; remained unchanged for several decades&#46; Its use slowly decreased after 1960&#44; when arterial reconstruction techniques were introduced&#46; It is still useful for some patients with vascular diseases&#59; however&#44; it is particularly useful in the treatment of plantar hyperhidrosis &#40;PHH&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib4">4</a></p><p id="para20" class="elsevierStylePara elsevierViewall">Primary hyperhidrosis &#40;HH&#41; is the most frequent indication for sympathectomies&#44; both lumbar and thoracic&#46;<a class="elsevierStyleCrossRef" href="#bib4">4</a> This disease affects about 1&#37; of the population and is characterized by excessive sweating in specific regions of the body such as the hands&#44; face&#44; scalp&#44; axilla and feet&#46; The endoscopic thoracic sympathectomy &#40;ETS&#41; is indicated for the treatment of palmar&#44; axillary and craniofacial hyperhidrosis&#46; The results of plantar excessive perspiration&#44; however&#44; are less expressive &#40;improved in up to 58&#37; of cases&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib5">5</a> Many patients with PHH who have undergone ETS still continue to experience excessive sweating of the feet after surgery&#46;</p><p id="para30" class="elsevierStylePara elsevierViewall">The endoscopic retroperitoneal lumbar sympathectomy &#40;ERLS&#41; is efficient in the treatment of PHH isolated from or associated with other affected areas that persisted after ETS&#46;<a class="elsevierStyleCrossRefs" href="#bib6">6&#8211;7</a> It is believed&#44; however&#44; that there could be a worsening of compensatory sweating &#40;CS&#41;&#44; when adding the effects of ETS to the lumbar regions of the same patient&#46;<a class="elsevierStyleCrossRefs" href="#bib8">8&#8211;10</a> It is highly probable that suppression of one more segment of the sympathetic chain could actually increase CS&#46; This is one of the principal doubts concerning lumbar sympathectomy but&#44; despite this&#44; has not been well-characterized in the literature&#46;</p><p id="para40" class="elsevierStylePara elsevierViewall">The objective of this study was to evaluate whether endoscopic retroperitoneal lumbar sympathectomy is effective in controlling plantar hyperhidrosis and whether it increases the compensatory sweat generated after thoracic sympathectomy&#46; To accomplish this&#44; we utilized a quality-of-life questionnaire and evaluated for sudoresis by measuring transepidermic water loss&#46;</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle70">PATIENTS AND METHODS</span><p id="para50" class="elsevierStylePara elsevierViewall">The sample consisted of female patients who presented with PHH at the time of surgery and received ETS at our hospital&#46; Because ETS can improve PHH&#44; we exclusively selected those patients for whom this surgery had not yet caused the desired effect&#46; ERLS was offered as a form of treatment&#46; The volunteers were then evaluated for inclusion in the study&#46;</p><p id="para60" class="elsevierStylePara elsevierViewall">Thirty-one females aged 17 to 44 years &#40;mean &#61; 23&#46;3 years&#41; were included&#46; Before ETS&#44; 14 of those patients presented with palmar and plantar HH&#44; one with axillary and plantar&#44; 15 with axillary&#44; palmar&#44; and plantar&#44; and one with craniofacial and plantar&#46;</p><p id="para70" class="elsevierStylePara elsevierViewall">Of the 31 patients initially selected&#44; only one declined to participate&#46; The remaining patients met the inclusion criteria and signed an informed consent after clarification of treatment characteristics&#44; necessary evaluations&#44; and participation in scientific research&#46; In addition&#44; all were given initial data regarding results from the lumbar sympathectomy in controlling PHH&#46;</p><p id="para80" class="elsevierStylePara elsevierViewall">After the initial evaluation with the quality-of-life &#40;QOL&#41; questionnaire and sweat measurements&#44; patients were randomized into two groups&#58; Group A &#40;test&#41; and Group B &#40;control&#41;&#46; Each patient was asked to randomly select a piece of paper from a bag in order to determine placement with a specific group &#40;<a class="elsevierStyleCrossRef" href="#fig1">Figure 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig1"></elsevierMultimedia><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle80">Quality-of-life questionnaire</span><p id="para90" class="elsevierStylePara elsevierViewall">The QOL questionnaire referred to the compromising effects of HH on the patients&#8217; daily routine&#44; in social&#44; professional&#44; and emotional aspects and under specific circumstances&#46;</p><p id="para100" class="elsevierStylePara elsevierViewall">The form was developed to evaluate the results of ETS<a class="elsevierStyleCrossRef" href="#bib5">5</a>&#46; It contained 21 questions divided into five categories&#44; with five levels of responses&#46; A score of 21 represented all responses at level 1&#44; the rating of &#8220;excellent&#8221; by the patient&#46; 105 represented all responses at level 5&#44; or &#8220;poor&#8221;&#46; This rating system allows for the evaluation of quality of life before and after ETS and ERLS&#44; as well as facilitates the understanding of the impact of PHH on the patients&#8217; routine&#46;</p></span><span id="cesec40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle90">Sweat assessment</span><p id="para110" class="elsevierStylePara elsevierViewall">Sudorometry was accomplished at a specific laboratory&#44; where patients remained for at least 30 minutes prior to measurement&#44; allowing for thermal and psychological acclimatization&#46;</p><p id="para120" class="elsevierStylePara elsevierViewall">The relative humidity of the air was maintained between 10&#37; and 60&#37;&#59; the temperature was maintained between 20 &#176;C and 25 &#176;C&#46; Neither thermal nor emotional or intellectual inducers of HH were utilized&#46;</p><p id="para130" class="elsevierStylePara elsevierViewall">The equipment chosen to measure HH was the Vapometer&#174;<a class="elsevierStyleCrossRef" href="#bib11">11</a>&#46; It is capable of measuring transepidermic water loss &#40;TEWL&#41;&#46; The evaporation rate is a measure of flow&#44; calculated by the increase in relative humidity inside the measuring chamber of the equipment&#46; After chamber contact with the skin being examined&#44; the evaporation rate is measured and expressed in grams &#40;g&#41; per square meter &#40;m<span class="elsevierStyleSup">2</span>&#41; per hour &#40;h&#41;&#46; The rate varies from 0 to 300g&#47;m<span class="elsevierStyleSup">2</span>&#47;h&#46; The examiners who performed the measurements had been trained in the correct utilization of the equipment&#46;</p><p id="para140" class="elsevierStylePara elsevierViewall">The skin regions were uncovered at least five minutes prior to measurement to facilitate natural evaporation&#46; The measurement was taken in a standardized sequence&#58; the plantar surface of the feet&#44; supra and infra-umbilical regions&#44; palmar surface of the hands&#44; and the dorsal region superior and inferior to the projection of the umbilical scar &#40;<a class="elsevierStyleCrossRefs" href="#fig2">Figures 2 and 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig2"></elsevierMultimedia><elsevierMultimedia ident="fig3"></elsevierMultimedia></span><span id="cesec50" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle100">Surgery</span><p id="para150" class="elsevierStylePara elsevierViewall">All 15 bilateral ERLSs were performed by the same surgeon with the same technical sequence from October 2005 through November 2006&#46;</p><p id="para160" class="elsevierStylePara elsevierViewall">Patients underwent general anesthesia with endotracheal intubation and were placed in a dorsal decubitus position&#44; slightly lateralized with a cushion under the lumbar region&#46; Retroperitoneal access was always obtained using an intraperitoneal view as a guide to the retroperitoneal placement of the first trocar halfway between the iliac crest and the inferior costal facet of each side&#44; at the median axillary line&#46; Once the extraperitoneal space was established&#44; the other trocars were placed equidistant to the first in a semi-lunar distribution&#46;</p><p id="para170" class="elsevierStylePara elsevierViewall">The first landmark identified was the psoas major muscle&#46; In a medial direction&#44; the genitofemoral nerve was identified above the psoas tendon&#46; The ureter was then located and isolated in the direction of the peritoneum&#46; Following this&#44; the lumbar sympathetic trunk was identified medially to the muscle where it is covered by a capsule formed by the psoas muscle insertion at the lumbar spine &#40;<a class="elsevierStyleCrossRef" href="#fig4">Figure 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig4"></elsevierMultimedia><p id="para180" class="elsevierStylePara elsevierViewall">Once the capsule was open&#44; the trunk and its ganglia were revealed&#46; After correct identification&#44; we proceeded with careful resection of the sympathetic ganglia&#44; LG2 and LG3 &#40;second and third lumbar ganglia&#41;&#46; The length of the removed chain was standardized to 4 cm&#46;</p><p id="para190" class="elsevierStylePara elsevierViewall">After release from the hospital&#44; the patients were reevaluated after one week&#44; one month&#44; and six months&#46; During these consultations&#44; they were interviewed and examined&#44; in an attempt to identify their impression of the surgery&#44; its results and the development of any side effects&#46; Perspiration and evaluation of the quality of life were re-assessed six months after the lumbar sympathectomy&#46;</p></span><span id="cesec60" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle110">Statistical analysis</span><p id="para200" class="elsevierStylePara elsevierViewall">After verification of their normal distribution&#44; the data were analyzed using the t-test for paired samples&#46; The level of significance was established at 5&#37; &#40;p&#60;0&#46;05&#41;&#46;</p><p id="para210" class="elsevierStylePara elsevierViewall">Statistical calculations were performed using the Statistical Package for Social Sciences program &#40;SPSS&#44; version 10&#46;0&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib12">12</a></p></span></span><span id="cesec70" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle120">RESULTS</span><span id="cesec80" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle130">Operatory results</span><p id="para220" class="elsevierStylePara elsevierViewall">There were no conversions from the endoscopic to open access&#46; In addition&#44; there were no perioperative complications like lumbar vessel bleeding&#44; lesions of the vena cava&#44; or lesions of the ureter or genitofemoral nerve&#46; Hospitalization varied from one to three days&#44; with a mean of 2&#46;3 days&#46;</p><p id="para230" class="elsevierStylePara elsevierViewall">In the early post-operative period&#44; some patients experienced progressively decreasing but prolonged pain for more than ten days &#40;3 patients&#59; 20&#37;&#41; or up to three months &#40;1 patient&#41;&#46; The mean time off of work was 13&#46;5 days&#59; this ranged from 5 to 22 days&#46;</p><p id="para240" class="elsevierStylePara elsevierViewall">With respect to CS&#44; we observed that six months after ERLS&#44; seven &#40;46&#46;6&#37;&#41; patients did not report worsening&#46; One patient reported slight improvement in CS development in the legs after ETS&#46; The remaining &#40;53&#46;33&#37;&#41; patients&#44; however&#44; reported an increase in CS&#46; This worsening&#44; classified on a scale of 1 to 10&#44; presented values that varied from 3 to 8 &#40;mean&#61; 5&#46;87&#41;&#46;</p><p id="para250" class="elsevierStylePara elsevierViewall">The aesthetic result&#44; evaluated six months after surgery&#44; was considered good in eight &#40;53&#46;3&#37;&#41; of the patients&#44; considered average for five &#40;33&#46;3&#37;&#41; and considered poor for two &#40;13&#46;3&#37;&#41; patients&#46;</p><p id="para260" class="elsevierStylePara elsevierViewall">Two patients &#40;13&#46;33&#37;&#41; reported sexual alterations&#58; in one&#44; an increase in libido&#59; in the other&#44; a slight decrease in vaginal lubrication&#44; without interference in sex life&#46;</p><p id="para270" class="elsevierStylePara elsevierViewall">In two patients &#40;13&#46;33&#37;&#41;&#44; there was a temporary recurrence of palmar sweating around the second month after surgery&#46;</p><p id="para280" class="elsevierStylePara elsevierViewall">No patient expressed regret over having undergone the surgery&#46;</p></span><span id="cesec90" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle140">Quality of life</span><p id="para290" class="elsevierStylePara elsevierViewall">The QOL scores were expressed as minimum values&#44; maximum values&#44; means&#44; and standard deviations&#46; These are presented in <a class="elsevierStyleCrossRef" href="#fig5">Figure 5</a>&#46; We observed the best mean &#40;lowest numerical value&#41; in the test group &#40;26&#46;33&#41; after ERLS&#46; This was close to the minimum possible value of 21&#46; Patients with persistent PHH who underwent ERLS presented values close to ideal in the QOL indices related to HH&#46;</p><elsevierMultimedia ident="fig5"></elsevierMultimedia><p id="para300" class="elsevierStylePara elsevierViewall">The mean scores of QOL after ERLS in the test groups presented a considerable decrease from 48&#46;8 to 26&#46;33&#46; When comparing these scores&#44; we observed a statistical difference between the pre- and post-ERLS periods &#40;<a class="elsevierStyleCrossRef" href="#fig6">Figure 6</a>&#41;&#46; Patients with PHH who underwent ERLS commented on improvements in quality of life&#46;</p><elsevierMultimedia ident="fig6"></elsevierMultimedia><p id="para310" class="elsevierStylePara elsevierViewall">Six months after ERLS&#44; the QOL scores in the test group were compared to control group results&#46; A considerable difference between the groups &#40;means of 26&#46;33 and 47&#46;6&#44; respectively&#41; was observed &#40;<a class="elsevierStyleCrossRef" href="#fig7">Figure 7</a>&#41;&#46; After ERLS&#44; patients in the test group presented with a greater improvement in QOL relative to the control group patients&#46;</p><elsevierMultimedia ident="fig7"></elsevierMultimedia></span><span id="cesec100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle150">Sweat measurement</span><p id="para320" class="elsevierStylePara elsevierViewall">We observed that values from the sweating assessment of the right and left feet in the test group before and after ERLS were different&#44; with a decrease in the pre-operative mean from 64 to 22&#46;6g&#47;m<span class="elsevierStyleSup">2</span>&#47;h and a decrease in standard deviation from 42&#46;42 to 8&#46;88&#44; which made the group much more homogenous&#46; The comparison between the two measures demonstrates a reduction in sudoresis after surgery&#46; The values were significantly different &#40;<a class="elsevierStyleCrossRef" href="#fig8">Figure 8</a>&#41;&#46; Patients with PHH who underwent ERLS experienced less sweating&#46;</p><elsevierMultimedia ident="fig8"></elsevierMultimedia><p id="para330" class="elsevierStylePara elsevierViewall">To corroborate these results&#44; the foot sweat assessment values for the test group after ERLS were compared to the corresponding results in the control group after six months&#46; The means&#44; 22&#46;6 and 45&#46;12 g&#47;m<span class="elsevierStyleSup">2</span>&#47;h&#44; respectively&#44; were significantly different &#40;p&#60;0&#46;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig9">Figure 9</a>&#41;&#46; Patients who underwent ERLS experienced less sweating of the feet than did the control group&#46;</p><elsevierMultimedia ident="fig9"></elsevierMultimedia><p id="para340" class="elsevierStylePara elsevierViewall">With respect to compensatory sweating&#44; measurements of dorsal and abdominal sudoresis allowed for the identification of some changes&#46; With respect to the measurements of dorsal sweating in the superior &#40;supra&#41; position&#44; the values of the test group after ERLS were greater than the corresponding values of the control group&#46; A significant difference was observed between the means&#46; Compared to patients in the control group&#44; patients who underwent ERLS presented with an increase in compensatory sweating in the superior dorsal position &#40;<a class="elsevierStyleCrossRef" href="#fig10">Figure 10</a>&#41;&#46;</p><elsevierMultimedia ident="fig10"></elsevierMultimedia><p id="para350" class="elsevierStylePara elsevierViewall">The same increase occurred for values of abdominal sweating in the infra-umbilical position&#46; The test group had comparatively greater values than the control group&#46; The difference between the means was also statistically significant&#46; As compared to patients in the control group&#44; patients who underwent ERLS presented with an increase in compensatory sweating in the infra-umbilical position &#40;<a class="elsevierStyleCrossRef" href="#fig11">Figure 11</a>&#41;&#46;</p><elsevierMultimedia ident="fig11"></elsevierMultimedia></span></span><span id="cesec110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle160">DISCUSSION</span><p id="para360" class="elsevierStylePara elsevierViewall">The surgical endoscopic sympathectomy performed on the thorax is superior to any other treatment modality for HH&#46;<a class="elsevierStyleCrossRef" href="#bib5">5</a>&#44;<a class="elsevierStyleCrossRef" href="#bib13">13</a>&#44;<a class="elsevierStyleCrossRefs" href="#bib14">14&#8211;17</a> ERLS appears to be a more adequate method of obtaining the anhidrotic effect of the feet&#44; as it is minimally invasive and allows for visualization and precise identification of the sympathetic chain&#46; Resection can be safely performed without the inconvenience of open surgery&#46;</p><span id="cesec120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle170">Measurement methods</span><p id="para370" class="elsevierStylePara elsevierViewall">When one attempts to measure sympathectomy results&#44; it is fundamental to use direct sweating assessment methods&#46; A measure of transepidermic water loss &#40;TEWL&#41; was utilized in this study&#46; This measurement has been used to test new products in the cosmetic industry and has been recently tested for sweat assessment&#46;<a class="elsevierStyleCrossRef" href="#bib11">11</a>&#44;<a class="elsevierStyleCrossRef" href="#bib18">18</a>&#44;<a class="elsevierStyleCrossRef" href="#bib19">19</a> This measure of evaporation flow from the skin can be perfectly interpreted as the sudation rate&#46;<a class="elsevierStyleCrossRef" href="#bib8">8</a>&#44;<a class="elsevierStyleCrossRef" href="#bib11">11</a></p><p id="para380" class="elsevierStylePara elsevierViewall">This method was practical and capable of identifying differences in the sudation rate provoked by ERLS in this study&#46; However&#44; other studies are necessary to investigate the limitations of the TEWL measurement for the evaluation of sympathectomy results&#46;</p></span><span id="cesec130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle180">Endoscopic Surgery</span><p id="para390" class="elsevierStylePara elsevierViewall">Endoscopic surgery enabled our patients to return home quickly and resume normal activities rapidly&#46; Less surgical stress and more-controlled tissue lesions enabled the patient to move about and also reduced complications&#46; The concept of endoscopic surgery incorporated for thoracic sympathectomy brings about a great technical advance&#46; A surgery that was at one time performed using large incisions&#44; causing intense discomfort and high morbidity&#44; has become minimally invasive&#46; The innovation of minimal invasiveness has rapidly been adapted to surgical manipulation of the sympathetic chain due to its simplicity&#44; rapidity&#44; efficacy and less-aggressive nature&#46; Similarly&#44; the choice of a surgical method for controlling PHH should be endoscopic&#46; ERLS comparisons with open surgery demonstrated its clear aesthetic superiority as well as overall functional recovery&#46;<a class="elsevierStyleCrossRef" href="#bib21">21</a>&#44;<a class="elsevierStyleCrossRef" href="#bib22">22</a></p></span><span id="cesec140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle190">Resection level and pre-operative localization</span><p id="para400" class="elsevierStylePara elsevierViewall">In this study&#44; we performed a LG2 and LG3 sympathectomy&#44; following the principle that LG2 is situated along the lumbar spine&#44; below the inferior renal pole&#44; which should be our superior limit of dissection&#46; Once the ganglion was located&#44; its resection followed&#44; as well as resection of the next ganglion immediately inferior to it&#46; The anatomic location of the kidneys was confirmed by the pre-operative ultrasonography in all patients&#46; Lumbar sympathectomy is predominantly a pre-ganglion surgery when LG4 is left intact because that&#8217;s where the majority of the synapses of pre- and post-ganglion fibers occur&#46;<a class="elsevierStyleCrossRef" href="#bib9">9</a> We decided to remove only LG2 and LG3&#46; This delimits the sympathetic denervation to the territory below the knee line&#46;</p></span><span id="cesec150" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle200">Discussion of results</span><p id="para410" class="elsevierStylePara elsevierViewall">Fifteen patients in each of the groups does not seem to be a large group&#44; but compared to the ERLS series described in the literature&#44;<a class="elsevierStyleCrossRef" href="#bib22">22</a>&#44;<a class="elsevierStyleCrossRefs" href="#bib24">24&#8211;27</a> this can be considered expressive&#46;</p><p id="para420" class="elsevierStylePara elsevierViewall">Despite the minimal cuts&#44; the aesthetic outcome was only considered good for 53&#37; of patients&#46; This fact demonstrates a high degree of aesthetic exigency in this population&#44; making conventional surgery for PHH almost unacceptable for these young patients&#46; Hyperhidrosis interferes with patient self-esteem and vanity&#44; which obliges surgeons to search for the best possible cosmetic results in this type of treatment&#46;</p></span><span id="cesec160" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle210">Compensatory sweating</span><p id="para430" class="elsevierStylePara elsevierViewall">In the present study&#44; CS characterization was performed by directed questions&#44; analyses of QOL and sweating assessment&#46; When patients were asked for their impression about CS at six months after the operation&#44; the results were similar to those of our previous study&#46;<a class="elsevierStyleCrossRef" href="#bib28">28</a> Of the 15 patients&#44; 53&#37; reported worsening of CS&#44; mainly on hotter days or when performing physical activities&#46; The mean BMI &#40;body mass index&#41; of the operated group was low &#40;21&#46;7 kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#59; the group consisted of thin patients&#46; It is known that the greater the BMI the worse is CS development&#46;<a class="elsevierStyleCrossRef" href="#bib5">5</a> The only participant with a BMI greater than 25 kg&#47;m<span class="elsevierStyleSup">2</span> was the patient who presented with the worst CS&#46; Considering only the subjective impression of patients&#44; we observe that there is an increase in CS after ERLS&#59; this could be related to BMI&#46;</p></span><span id="cesec170" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle220">Quality of Life</span><p id="para440" class="elsevierStylePara elsevierViewall">Analyzing the means and standard deviations of the QOL scores in the test group&#44; we observed a considerable drop in QOL values after ERLS&#46; The mean decreased from 73&#46;08 points to 26&#46;33 &#40;best possible score&#58; 21&#41;&#46; This reflects the effectiveness of ERLS in the control of PHH and the inconvenience that the disease generated in these patients&#46;</p><p id="para450" class="elsevierStylePara elsevierViewall">These results are confirmed in the comparison between post-ERLS scores of the test and control groups six months after the first interview&#46; The mean scores were 26&#46;3 and 47&#46;6&#44; respectively&#44; with a significant advantage for the test group&#46; The improvement of plantar sweating supplanted even the occasional inconvenience caused by the development or worsening of CS&#46; For these patients&#44; CS is not as important as PHH&#44; even if it might be considered more visible than foot sweat&#46; The ability to use an open shoe&#44; to dance&#44; and to be free of foot infection should not be underestimated for a woman&#44; especially in a hot climate&#46;</p></span><span id="cesec180" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle230">Sweat Measurement</span><p id="para460" class="elsevierStylePara elsevierViewall">With the aim of objectively proving ERLS effectiveness with respect to the control of foot sweating&#44; two comparisons were made&#46; In the test group&#44; the amounts of foot sweating were compared before and after ERLS&#46; The observed values demonstrate that patients presented with significantly lower measures of plantar sudoresis after the procedure&#46; A second comparison examined plantar sudoresis of the test group after ERLS versus the equivalent measures of the control group&#46; In this case&#44; we also observed measurements of plantar sudoresis of the test group to be significantly lower than those of the control group&#46; Therefore&#44; this confirms that the patients who underwent ERLS experienced less sweating of the feet&#59; this alteration is directly assessed by the TEWL measurement&#44; as previously observed in other studies &#40;Pedevilla et all&#44; 7th International Society of Sympathetic Surgery&#59; 2007&#41;&#46;</p><p id="para470" class="elsevierStylePara elsevierViewall">Prior to the present study&#44; some evidence suggested that surgery did indeed&#44; provide control in PHH&#46; At that point&#44; the evidence for sudoresis control was limited to the degree of patient satisfaction after ERLS&#44; as well as the clinical observation of dry feet skin&#46; Currently&#44; we have more objective criteria for this evaluation at our disposal&#46; Combining these analyses with improvements in quality of life and results reported by the patients&#44; we can confirm the efficiency of the ERLS in PHH treatment&#46;</p><p id="para480" class="elsevierStylePara elsevierViewall">The development or worsening of CS was reported by 8 &#40;53&#46;3&#37;&#41; of our patients&#46; Several comparisons were made with the intent to confirm this observation&#46; The values for sweating in the abdominal and dorsal regions were compared between the test and control groups and between the pre- and post-ERLS period&#44; grouping the supra- and infra-umbilical measurements&#44; as well as measuring them separately&#46;</p><p id="para490" class="elsevierStylePara elsevierViewall">Comparing sweat from the supra-umbilical region of the test group to the corresponding values of the control group&#44; and consecutively for the infra-umbilical&#44; superior dorsal&#44; and inferior dorsal regions&#44; we were able to obtain some significant information&#46; There was a statistical difference between the superior dorsal and infra-umbilical regions&#46; Patients of the test group presented with more sweating in these regions relative to the control group&#46; These data&#44; in association with those obtained in the post-ERLS interview&#44; led to the observation that this surgery can provoke an increase in CS&#44; for patients who have undergone prior ETS&#46; Furthermore&#44; these data corroborate previous studies&#46;<a class="elsevierStyleCrossRef" href="#bib9">9</a>&#44;<a class="elsevierStyleCrossRef" href="#bib10">10</a></p></span><span id="cesec190" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle240">Future Perspectives</span><p id="para500" class="elsevierStylePara elsevierViewall">The TEWL utilized in this study demonstrates a practical&#44; reliable&#44; and easily reproducible method of measuring sudoresis&#46; It should be adopted as the method of choice for objective measurement of sweating in future studies&#46; On the other hand&#44; QOL questionnaires also demonstrate their importance in the analysis of diseases such as HH&#46; The improvement of quality of life is a target parameter in the quality of treatment&#46; New models of questionnaires should be developed and validated for each region affected by HH&#46;</p><p id="para510" class="elsevierStylePara elsevierViewall">Randomized studies can serve to improve the quality of future studies&#46; Similar methodology can be utilized in the evaluation of other sympathectomy results&#46;</p><p id="para520" class="elsevierStylePara elsevierViewall">ERLS was determined to be safe&#44; rapid and efficient in the control of PHH&#46; Its complications are acceptable and well-tolerated by patients&#46; We believe that this technique should become the treatment of choice for primary or persistent PHH after ETS&#44; due to the tremendous benefit to patients&#46; Its development also depends upon strict participation on the part of the patients&#44; to whom falls the burden of observing and reporting all possible and long-term side effects&#46;</p><p id="para530" class="elsevierStylePara elsevierViewall">Finally&#44; data generated by ETS should be incorporated logically into the ERLS&#46; Specifically&#44; future studies should investigate the use or non-use of electrocautery&#44; resection or clipping of the sympathetic chain&#44; and definition of the level of the sympathectomy according to the desired anhidrotic effects&#46;</p></span></span><span id="cesec200" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle250">CONCLUSIONS</span><p id="para540" class="elsevierStylePara elsevierViewall">The endoscopic retroperitoneal sympathectomy in women is a safe surgery with very few and very tolerable side effects&#46; It decreases plantar sudoresis and improves the quality of life of patients with plantar hyperhidrosis&#46;</p><p id="para550" class="elsevierStylePara elsevierViewall">On the other hand&#44; this surgery also promotes an increase in compensatory sweating in the dorsal and abdominal regions of patients&#44; who previously underwent thoracic endoscopic sympathectomy&#46;</p></span></span>"
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              "titulo" => "Quality-of-life questionnaire"
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          "titulo" => "RESULTS"
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              "titulo" => "Operatory results"
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              "titulo" => "Resection level and pre-operative localization"
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              "titulo" => "Discussion of results"
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    "fechaRecibido" => "2007-10-01"
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          "palabras" => array:5 [
            0 => "Retroperitoneal space"
            1 => "Sympathectomy"
            2 => "Quality of life"
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            4 => "Women"
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        "resumen" => "<span id="ceabs10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">INTRODUCTION</span><p id="spara120" class="elsevierStyleSimplePara elsevierViewall">Plantar hyperhidrosis is present in 50&#37; of patients with hyperhidrosis&#46; Thoracic sympathectomy is an important tool for the treatment of this condition&#44; which is successful in about 60&#37; of patients&#46; For the remaining patients&#44; lumbar sympathectomy is the procedure of choice&#46; As new minimally invasive techniques have been developed&#44; a significant demand for this type of access has led to its adaptation to the lumbar sympathectomy&#46; The objective of this study was to evaluate the effectiveness of endoscopic retroperitoneal lumbar sympathectomy in controlling plantar hyperhidrosis and its effects on compensatory sweat&#46;</p></span> <span id="ceabs20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">MATERIALS AND METHODS</span><p id="spara130" class="elsevierStyleSimplePara elsevierViewall">Thirty female patients with persistent plantar hyperhidrosis after thoracic sympathectomy were enrolled&#46; They were randomly assigned to laparoscopic retroperitoneal lumbar sympathectomy &#40;Group A&#41; or no surgical intervention &#40;Group B - control&#41; groups&#46; Quality-of-life modifications were assessed by specific questionnaires before and after surgery&#46; In the same manner&#44; direct sweat measurements were also performed pre- and post-intervention by evaluating trans-epidermal water loss&#46; Despite the lack of intervention&#44; the control group was evaluated at similar timepoints&#46;</p></span> <span id="ceabs30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">RESULTS</span><p id="spara140" class="elsevierStyleSimplePara elsevierViewall">In Group A&#44; no major complications occurred in the peri-operative period&#46; During the immediate post-operative period&#44; three patients &#40;20&#37;&#41; experienced prolonged pain &#40;more than ten days&#41;&#46; Eight patients suffered from worsened compensatory sweating &#40;53&#46;3&#37;&#41;&#46; In Group A&#44; after lumbar sympathectomy&#44; the quality of life significantly improved &#40;p&#60;0&#46;05&#44; intra-group comparison&#41; beyond that of the control group &#40;p&#60;0&#46;05&#44; inter-group comparison&#41;&#46; Also&#44; lumbar sympathectomy resulted in significantly lower values of foot sweat &#40;pre- vs&#46; post-operative periods&#44; p&#60;0&#46;05&#59; Group A vs&#46; Group B&#44; p&#60;0&#46;05&#41;&#46; These patients also developed higher values of sweat measurements on specific points of their dorsal and abdominal regions after the procedure &#40;p&#60;0&#46;05&#41;&#46;</p></span> <span id="ceabs40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle40">CONCLUSIONS</span><p id="spara150" class="elsevierStyleSimplePara elsevierViewall">The endoscopic retroperitoneal lumbar sympathectomy diminishes plantar sweat and improves the quality of life of women with plantar hyperhidrosis&#46; However&#44; about half of the patients develop increased compensatory hyperhidrosis in other areas of the body&#46;</p></span>"
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          "bibliografiaReferencia" => array:28 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Um nuevo m&#233;todo de simpatectom&#237;a perif&#233;rica para el tratamiento de las afecciones tr&#243;ficas y gangrenosas de los miembros&#58; la dissociaci&#243;n fascicular"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              J Diez \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Bol Soc Cir B Aires"
                        "fecha" => "1924"
                        "volumen" => "8"
                        "paginaInicial" => "792"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A new operative procedure in the treatment of spastic paralysis and its experimental basis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              ND Royle \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5694/j.1326-5377.1983.tb136043.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med J Aust"
                        "fecha" => "1924"
                        "volumen" => "1"
                        "paginaInicial" => "77"
                        "paginaFinal" => "86"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6400587"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of Raynaud&#8217;s disease by lumbar ramisection and ganglionectomy and perivascular sympathectomy of the common iliacs"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              AW Adson \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              GE Browm \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Med Assoc"
                        "fecha" => "1925"
                        "volumen" => "84"
                        "paginaInicial" => "1908"
                        "paginaFinal" => "1910"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Laparoscopic lumbar sympathectomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              N Kathouda \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              S Wattanasirichaigoon \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              E Tang \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              P Yassini \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              U Ngaorungsri \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s004649900338"
                      "Revista" => array:6 [
                        "tituloSerie" => "Surg Endosc"
                        "fecha" => "1997"
                        "volumen" => "11"
                        "paginaInicial" => "257"
                        "paginaFinal" => "260"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9079604"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Quality of life before end after thoracic sympathectomy&#46; Report on 378 operated patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              JRM Campos \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              P Kauffman \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              EC Werebe \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              LOF Andrade \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              S Kusniek \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              N Wolosker \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0003-4975(03)00895-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2003"
                        "volumen" => "76"
                        "paginaInicial" => "886"
                        "paginaFinal" => "891"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12963223"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Endoscopic extraperitoneal lumbar sympathectomy for plantar hyperhidrosis&#58; case report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              MY Tseng \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              JH Tseng \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1054/jocn.2000.0725"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Neurosci"
                        "fecha" => "2001"
                        "volumen" => "8"
                        "paginaInicial" => "555"
                        "paginaFinal" => "556"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11683604"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical management of primary hyperhidrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              KT Moran \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              MP Brady \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/bjs.1800780306"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Surg"
                        "fecha" => "1991"
                        "volumen" => "78"
                        "paginaInicial" => "279"
                        "paginaFinal" => "283"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2021839"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predicting changes in the distribution of sweating following thoracoscopic sympathectomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              BT Andrews \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              JA Rennie \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Br J Surg"
                        "fecha" => "1997"
                        "volumen" => "84"
                        "paginaInicial" => "1702"
                        "paginaFinal" => "1704"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9448619"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0012369221004682"
                          "estado" => "S300"
                          "issn" => "00123692"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Simpatectomias"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              P Kauffman \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:6 [
                        "editores" => "AARaia, EJZerbini"
                        "titulo" => "Cl&#237;nica cir&#250;rgica Alipio Correia Neto"
                        "paginaInicial" => "84"
                        "paginaFinal" => "101"
                        "edicion" => "4"
                        "serieFecha" => "1988"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The lumbar sympathetic"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              FA Simeone \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Acta Chirurgica Belg"
                        "fecha" => "1977"
                        "volumen" => "1"
                        "paginaInicial" => "18"
                        "paginaFinal" => "26"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Measurement of water evaporation rates with a closed chamber TEWLmeter"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => """
                              J Nuutinen \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              E Alanen \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              T Lahtinen \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Skin Res Technol"
                        "fecha" => "2003"
                        "volumen" => "9"
                        "paginaInicial" => "183"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              A Pereira \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:5 [
                        "edicion" => "4"
                        "titulo" => "Guia pr&#225;tico de utiliza&#231;&#227;o do SPSS &#8211; an&#225;lise de dados para ci&#234;ncias sociais e psicologia"
                        "fecha" => "2003"
                        "editorial" => "Edi&#231;&#245;es Silabo"
                        "editorialLocalizacion" => "Lisboa"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of palmar hyperhidrosis by endoscopic clipping of the upper part of the T4 sympathetic ganglion&#58; Preliminary results"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => """
                              BC Choi \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              YC Lee \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              SB Sim \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Auton Res"
                        "fecha" => "2003"
                        "volumen" => "13"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "I&#47;48"
                        "paginaFinal" => "I&#47;51"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Compensatory hyperhidrosis of sympathectomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              WB Selley \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              R Florence \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1960"
                        "volumen" => "263"
                        "paginaInicial" => "1056"
                        "paginaFinal" => "1058"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Compensatory sweating after upper thoracic sympathectomy&#46; Prospective study of 123 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              J Moya \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              R Ramos \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              N Vives \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              J P&#233;rez \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              R Morera \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              V Perna \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s1579-2129(06)60321-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2004"
                        "volumen" => "40"
                        "paginaInicial" => "360"
                        "paginaFinal" => "363"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15274865"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Video-assisted thoracoscopic T2 sympathetic block by clipping for palmar hyperidrosis &#40;analysis of 52 cases&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              TS Lin \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Laparoendosc Adv Surg Techn"
                        "fecha" => "2001"
                        "volumen" => "11"
                        "paginaInicial" => "59"
                        "paginaFinal" => "62"
                        "itemHostRev" => array:3 [
                          "pii" => "S0012369221013544"
                          "estado" => "S300"
                          "issn" => "00123692"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Endoscopic thoracic sympathectomy for hyperhidrosis&#58; experience with both cauterization and clamping methods"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => """
                              R Reisfeld \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              R Nguyen \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              A Pnini \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00129689-200208000-00011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Surg Laparosc Endosc Percutan Tech"
                        "fecha" => "2002"
                        "volumen" => "12"
                        "paginaInicial" => "255"
                        "paginaFinal" => "267"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12193821"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of objective methods to diagnose palmar hyperhidrosis and monitor effects of botulinun toxin treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              AL Krogstad \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              A Skymne \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              BSG Pegenius \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              M Elam \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              BG Wallin \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clinph.2004.03.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Neurophysiol"
                        "fecha" => "2004"
                        "volumen" => "115"
                        "paginaInicial" => "1909"
                        "paginaFinal" => "1916"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15261869"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "No compensatory sweating after botulinun toxin treatment of palmar hyperhidrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              AL Krogstad \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              A Skymne \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              BSG Pegenius \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              M Elam \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              BG Wallin \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2004.06255.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2005"
                        "volumen" => "152"
                        "paginaInicial" => "329"
                        "paginaFinal" => "333"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15727647"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Are patients better than the laboratory in assessing sweating&#63; validation study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              AL Krogstad \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              SK Piechnik \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2310/6350.2005.31210"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2005"
                        "volumen" => "31"
                        "paginaInicial" => "1434"
                        "paginaFinal" => "1437"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16416613"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Retroperitoneoscopic lumbar sympathectomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              N Beglaibter \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              Y Berlatzky \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              O Zamir \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              R Spira \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              H Freund \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Vas Surg"
                        "fecha" => "2002"
                        "volumen" => "35"
                        "paginaInicial" => "815"
                        "paginaFinal" => "817"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Technique and early results of videoscopic lumbar sympathectomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              H Lacroix \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              V G Velpen \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              F Penninckx \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              A Nevelsteen \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              R Suy \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Chir Belg"
                        "fecha" => "1996"
                        "volumen" => "96"
                        "paginaInicial" => "11"
                        "paginaFinal" => "14"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8629381"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lumbar sympathectomy performed by means of videoscopy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              J Wronski \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0967-2109(98)00053-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cardiovasc Surg"
                        "fecha" => "1998"
                        "volumen" => "6"
                        "paginaInicial" => "453"
                        "paginaFinal" => "456"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9794263"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Retroperitoneoscopic lumbar sympathectomy for the treatment of plantar hyperhidrosis&#58; technique and preliminary findings"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              R Rieger \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              S Pedevilla \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00464-005-0690-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Surg Endosc"
                        "fecha" => "2007"
                        "volumen" => "21"
                        "paginaInicial" => "129"
                        "paginaFinal" => "135"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16960674"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sympathectomie lombaire para r&#233;trop&#233;ritoneoscopie&#58; &#233;tude de faisabilit&#233;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              P Soury \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              N Cailleux \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              D Plissonier \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              C Peillon \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              N Liberge \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              N Roulle \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Mal Vasc"
                        "fecha" => "1997"
                        "volumen" => "22"
                        "paginaInicial" => "200"
                        "paginaFinal" => "202"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9303937"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "La coeliochirurgie reabilite-t-elle la sympatehctomie lombaire&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              JM Chevalier \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              JF Duchemin \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              A Cavillon \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              M Gayral \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              F Beck \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              T Strikenberger \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:5 [
                        "editores" => "MCormier"
                        "titulo" => "Techniques et strat&#233;gies em chirurgie vasculaire"
                        "paginaInicial" => "117"
                        "paginaFinal" => "122"
                        "serieFecha" => "1995"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Endoscopic sympathectomy for palmar and plantar hyperhidrois&#58; results in 107 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              C Nicolas \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              G Greosdidier \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              F Granel \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              A Barbaud \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              D Schmutz \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Annal Dermatol V&#233;n&#233;r&#233;ol"
                        "fecha" => "2000"
                        "volumen" => "127"
                        "paginaInicial" => "1057"
                        "paginaFinal" => "1063"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Simpatectomia lombar retroperitoneosc&#243;pica para tratamento da hiper-hidrose plantar"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              MP Loureiro \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              N Roman \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              SC Weigmann \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              A Fontana \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              PCB Boscardim \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Col Bras Cir"
                        "fecha" => "2007"
                        "volumen" => "34"
                        "paginaInicial" => "222"
                        "paginaFinal" => "224"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
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es en pt

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