Waldemar Schreiner

Hyperhidrosis, or sweating beyond the physiological amount, can be either focal or generalized and sometimes runs in families. The prevalence of primary idiopathic hyperhidrosis is 2–5%. Secondary hyperhidrosis is associated with specific illnesses and medications. In this article, we discuss the diagnostic evaluation of hyperhidrosis and treatments for it, along with their efficacy and side effects. This narrative review is based on publications retrieved from the Medline and Cochrane databases with the search term “hyperhidrosis” and other specific terms relating to treatment. Expert recommendations and guidelines were considered as well. The diagnostic evaluation consists of a clinical history, a Minor (starch-iodine) test, gravimetry, and dynamic sudometry. There have been no more than a few high-quality published studies on specific interventions. Depending on the severity and symptom burden, aluminum chloride and anticholinergic drugs are used first, followed by botulinum toxin injections and subcutaneous curettage for axillary hyperhidrosis. These treatments reportedly bring about marked improvement in 60–70 % of patients; their side effects, depending on the particular treatment used, include local reactions such as itch, pain, and cutaneous irritation and anticholinergic effects such as dry mouth, mydriasis, urinary retention, and headache. Further therapeutic options are tap water iontophoresis; radiofrequency, focused ultrasound, and microwave treatment; systemically administered anticholinergic drugs; and thoracic or lumbar sympathectomy for palmar or plantar hyperhidrosis, respectively. A variety of methods can be used to relieve hyperhidrosis and improve these patients’ quality of life. There have been no more than a few high-quality studies on their efficacy and long-term results.

Background: Tumor spread through air spaces (STAS) has been proposed as a histopathological marker of aggressive tumor biology in adenocarcinoma of the lung (ADCL). Its independent prognostic significance and clinical implications regarding surgical strategy remain controversial. This study evaluated clinicopathological correlates and the prognostic impact of STAS in a homogeneous cohort of resected ADCL. Methods: We retrospectively analyzed 100 patients with primary ADCL resected between 2009 and 2018. STAS was classified as absent, low (1–4 clusters), or high (≥5) by an experienced pathologist. Associations between STAS and clinical, surgical, and pathological variables were tested with univariate analyses and multivariable logistic regression. Overall survival (OS) was evaluated using Kaplan–Meier and Cox regression. Results: STAS was present in 46% of tumors and was significantly associated with a higher pathological N category (pN0-pN3; p = 0.005), more advanced UICC stage (p = 0.049), lymphovascular invasion (LVI; p = 0.008), and perineural invasion (PnI; p = 0.012). In univariate survival analysis, patients with STAS had shorter OS than patients without STAS (p = 0.047). After limited resection, OS did not differ (p = 0.864), whereas after radical anatomical resection, patients with STAS showed reduced OS (p = 0.034). In multivariable Cox regression analysis, STAS did not retain independent prognostic significance. Conclusions: STAS is frequent in resected ADCL and correlates with adverse pathological features and reduced OS in univariate models. In multivariate analysis, STAS did not emerge as an independent prognostic factor. These findings support the interpretation of STAS as a marker of aggressive tumor biology rather than an independent determinant of prognosis or surgical decision-making.

Background: Solitary fibrous tumor of the pleura are rare neoplasms, and follow-up protocol is lacking. Various risk stratification systems have been proposed to predict recurrence. The aim of this study is to evaluate common risk scores and risk factors leading to a recommendation for follow-up frequency. Methods: We pooled data as part of a multicenter international study with the participation of eight centers in Germany, Switzerland, Denmark, and Austria. Kaplan–Meier survival-curves were used comparing several risk stratification system(s). A Log-rank test was performed to analyze prognostic clinical and pathological factors affecting overall and recurrence-free survival. Results: We included 155 patients from 2004 to 2024: 52.3% were male, median age was 64 years (range 32 to 89). Recurrence rate was 17.4% with median recurrence-free survival of 131 months. Mean time to recurrence was 64.4 (range 9–151) months. Analysis showed that age, tumor morphology, necrosis, and increased mitotic activity were independent prognostic factors for RFS. Conclusions: The WHO risk stratification system demonstrated the highest discriminatory power for recurrence-free survival in the Kaplan–Meier analyses, indicating that the WHO classification remains the most accurate predictor to date. We modified the commonly used risk systems to achieve improved stratification into low-, intermediate- and high-risk groups. The occurrence of late recurrences underscores the need for long-term follow-up.

Background: Major surgery is associated with significant morbidity and a reduced quality of life, particularly among older adults and individuals with frailty and impaired functional capacity. Multimodal prehabilitation can enhance functional recovery after surgery and reduce postoperative complications. Digital prehabilitation has the potential to be a resource-sparing and patient-empowering tool that improves patients’ preoperative status; however, little remains known regarding their safety and accuracy as medical devices. Objective: This study aims to test the accuracy and validity of a new software in comparison to the gold-standard electrocardiogram (ECG)-based heart rate measurement. Methods: The PROTEGO MAXIMA trial was a prospective interventional pilot trial assessing the validity, accuracy, and safety of an app-based exercise program. The Prehab App calculates a personalized, risk-stratified aerobic interval training plan based on individual risk factors and utilizes wearables to monitor heart rate. Healthy students and patients undergoing major surgery were enrolled. A structured risk assessment was conducted, followed by a 6-minute walking test and a 37-minute supervised interval session. During the exercise, patients wore app-linked wearables for heart rate and distance measurements, which were compared with standard ECG and treadmill measurements. Safety, accuracy, and usability assessments included testing alarm signals, while the occurrence of adverse events served as the primary and secondary outcome measures. Results: A total of 75 participants were included. The mean heart rate differences between wearables and standard ECG were ≤5 bpm (beats per minute) with a mean absolute percentage error of ≤5%. Regression analysis revealed a significant impact of the BMI (odds ratio 0.90, 95% CI 0.82-0.98, P=.02) and Timed Up and Go Test score (odds ratio 0.12, 95% CI 0.03-0.55, P=.006) on the accuracy of heart rate measurement; 29 (39%) patients experienced adverse events: pain (5/12, 42%), ECG electrode–related skin irritations (2/42, 17%), dizziness (2/42, 17%), shortness of breath (2/42, 17%), and fatigue (1/42, 8%). No cardiovascular or serious adverse events were reported, and no serious device deficiency was detected. There were no indications of clinically meaningful overexertion based on laboratory values measured before and after the 6-minute walking test and exercise. The differences in means and ranges were as follows: lactate (mmol/l), mean 0.04 (range –3 to 6; P=.47); creatinine kinase (U/l), mean 12 (range –7 to 43; P<.001); and sodium (mmol/l), mean –2 (range –11 to 12; P<.001). Conclusions: The interventional trial demonstrated the high safety of the exercise program and the accuracy of heart rate measurements using commercial wearables in patients before major surgery, paving the way for potential remote implementation in the future. Trial Registration: German Clinical Trials Register DRKS00026985; https://drks.de/search/en/trial/DRKS00026985 and European Database on Medical Devices (EUDAMED) CIV-21-07-0307311. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2022-069394

Intraoperative neuromuscular monitoring (IONM) is a widespread procedure to identify and protect the recurrent laryngeal nerve (RLN) during thyroid surgery. However, for left thoracic surgery with high risk of RLN injury, both reliable recurrent laryngeal nerve monitoring and one-lung ventilation could interfere. In this prospective study, a new method for IONM during one-lung ventilation combining RLN monitoring with an electromyographic (EMG) endotracheal tube (ETT) and lung separation using the EZ-Blocker (EZB) is described and its clinical feasibility and effectiveness were assessed. A total of 14 patients undergoing left upper lobe surgery and left upper mediastinal lymph node dissection were enrolled. The EZB was introduced and positioned without any problems and sufficient lung collapse was achieved in all patients. No tracheobronchial injuries or immediate complications occurred. A stable EMG signal was present in all patients and no RLN palsy and no negative side effects of the NIM EMG ETT or the EZB were observed postoperatively. The described method is technically feasible, easy to apply and save. It provides both reliable IONM and independent lung separation for optimal surgical exposure. The combined use of the EZB and the NIM EMG ETT might reduce the risk for RLN palsy and impaired lung separation during left thoracic surgery with high risk for RLN injury.

Background Major pathologic response (MPR) determines favorable outcome in locally advanced non-small cell lung cancer after induction therapy (IT) followed by lung resection. The aim of this retrospective study was to identify the prognostic relevance of MPR in long-term interval. Methods In 55 patients, the survival rate according to MPR and non-MPR was estimated by Kaplan–Meier method and compared using log-rank, Breslow, and Tarone–Ware tests. Results The IT included chemoradiation with 50.4 Gy (range: 45–56.4 Gy) combined with platinum-based chemotherapy in 52 patients (94.5%) and platinum-based chemotherapy in 3 patients (5.5%). Perioperative morbidity and 30-day mortality were 36 and 3.6%, respectively. The estimated 5-year postoperative and progressive-free survivals were statistically significantly improved in MPR versus non-MPR with 53.5 versus 18% and 49.4 versus 18.5%, respectively. According to the log-rank, Breslow, and Tarone–Ware tests, the MPR demonstrates prognostic significance in early, long-term, and whole postoperative interval. Conclusion MPR is associated with a robust correlation to long-term postoperative and recurrence-free survival improvement, and can potentially simplify the multidisciplinary debate and allow further stratification of adjuvant treatment in multimodality therapy.

Zusammenfassung: Einleitung Die Hyperhidrose (HH) geht mit einer physischen und psychischen Einschränkung einher. Die Behandlung umfasst sowohl konservative als auch operative Methoden und strebt eine dauerhafte Verbesserung der Lebensqualität (LQ) der Betroffenen an. Die endoskopische Sympathikusblockade (ESB) stellt eine etablierte operative Therapiemethode dar und gilt als ein effektives chirurgisches Verfahren bei Versagen der konservativen Therapieoptionen. Das Ziel unserer Studie war, die LQ-Veränderung und die Patientenzufriedenheit nach ESB durch umfangreiche Analyseverfahren zu untersuchen und entsprechende Einflussfaktoren zu identifizieren. Methoden Von Juli 2008 bis April 2016 wurden 105 Patienten wegen therapierefraktärer HH operiert. In allen Fällen wurde ein ESB entsprechend vorliegenden Hyperhidroseform und dem STS-Expertenkonsens (STS: Society of Thoracic Surgeons) durchgeführt. Die LQ und das Hyperhidrosestatus wurden anhand von detaillierten Fragebogen (ein selbst entwickelter Fragebogen, SF36, DLQI, Hyperhidrose LQ (HidroQoL)) selektiv prä- und postoperativ analysiert und bewertet. Die statistische Bearbeitung erfolgte anhand SPSS Statistics Version 21.0.0.2 für Windows (Armonk, NY: IBM Corp.). Die statistische Analyse erfolgte anhand deskriptiver Analyse und nicht parametrischer Tests. Ergebnisse 105 Patienten zwischen Juli 2008 bis April 2016 wurden mittels bilateralem ESB operiert und evaluiert: 73 Frauen (69,5%) und 31 Männer (29,5%) im Medianalter von 26 Jahren (16 – 64), mit fokaler palmarer und axillarer (HPA) 13 (12,4%), palmoplantarer (PPH) 20 (19%), palmoplantarer und axillarer (PPAH) 47 (44,8%), axillarer Hyperhidrose (HA) 11 (10,5%) und Gesichtshyperhidrose (HF) 14 (13,3%). HydroQoL-Score zeigte eine Verbesserung in allen HH-Formen. Das DLQI wies eine Verbesserung in allen Patientengruppen auf, während die LQ-Analyse mittels SF36 eine Verbesserung in sozialer Funktionsfähigkeit und dem psychischen Wohlbefinden in allen HH-Formen außer HA aufzeigte. Mit postoperativem Ergebnis waren 86,7% (91) Patienten zufrieden. Das kompensatorische Schwitzen (KS) wurde in 76,2% (80) der Fälle beobachtet ohne einen eindeutigen LQ-Einfluss. Keine signifikante Korrelation zwischen KS und der Hyperhidroseform war feststellbar. Schlussfolgerungen Die ESB geht mit einer dauerhaften LQ-Verbesserung in der sozialen Funktionsfähigkeit, dem psychologischen Wohlbefinden und der hohen Patientenzufriedenheit einher. Das Auftreten vom KS hat keine eindeutige Korrelation zu LQ und Patientenzufriedenheit.

Plastic and Aesthetic Research is an open acccess journal, which publishes articles on technical and clinical studies related to plastic and aesthetic surgery.