Center for
Excessive
Sweating

Center for Excessive Sweating
5225 Sheridan Drive
Williamsville, NY 14221
(716) 839-3638

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The Center for Excessive Sweating and the Buffalo Sabres

National Center of Excellence for Hyperhidrosis Treatment

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The Center for Excessive Sweating - Hyperhidrosis News

Hyperhidrosis Clinic

By: Hratch Karamanoukian, MD

August 29, 2010

Hyerhidrosis Clinic Offering Care to Western New York and Beyondb
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Topical Glycopyrrolate for Compensatory Sweating is Effective - Dr Karamanoukian

By: Hratch L Karamanoukian, MD

October 13, 2008

Use of topical Robinul has been shown to be effective for compensatory sweating in 8 out of 10 patients.
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Celebrity Sweating Pictures - You're not the only one who has a sweating problem ! - Dr. Karamanoukian of www.EliminateSweating.com

By: Staff at www.EliminateSweating.com

October 12, 2008

Celebrities in Hollywood sweat too ! Take a look at some pictures publisehd on CelebritySweating.com
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Incisions for ETS procedure for hyperhidrosis - Dr. Karamanoukian and www.EliminateSweating.com

By: Staff at www.EliminateSweating.com

October 9, 2008

Here is a cartoon diagram of the incisions for ETS - STITCH porcedure
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Read Dr. Karamanoukian's articles about hyperhidrosis on RealSelf.com

By: Staff at www.EliminateSweating.com

October 4, 2008

Dr. Karamanoukian's recent articles about hyperhidrosis posted on www.RealSelf.com - click on the links below:
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VNUS and EVLT

By: Staff at www.EliminateSweating.com

October 4, 2008

Venous Reflux Disease
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Thoracic Surgery Secrets by Dr. Karamanoukian translated into Portuguese

By: Hratch L Karamanoukian, MD

September 30, 2008

Thoracic Surgery Secrets (Elsevier Press) by Drs. Hratch Karamanoukian, Soltoski and Salerno has been translated into Portuguese.
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Dr. Karamanoukian's book Cardiac Surgery Secrets translated into Russian and Turkish Languages

By: Hratch L Karamanoukian, MD

September 29, 2008

Cardiac Surgery Secrets, 2nd Edition, by Dr. Karamanoukian and coauthors was recently translated into Russian and Turkish.
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Hyperhidrosis in Iraq - Soldiers and Excessive Sweating

By: Dr Karamanoukian at www.EliminateSweating.com

September 21, 2008

Excessive sweating in the desert is considered a normal reaction - especially at high temperatures. This is nothing to worry about and should not be treated. For more information read on ...
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Hyperhidrosis and Stem Cells - Hype or Reality

By: Dr Karamanoukian at www.EliminateSweating.com

September 18, 2008

Does stem cell therapy help individuals with hyperhidrosis ?
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Abnormal tactile discrimination and somatosensory plasticity found in familial primary hyperhidrosis

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

September 12, 2008

A recent study published in the journal Neuroscience Letters (August 2008) has shown that patients with familial hyperhidrosis have abnormal tactile discrimination and somatosensory plasticity. The study was performed at the Unit of Movement Disorders and Neuromagnetism, Section of Neurology, Fundacion Santa Fe, Bogota, Colombia. Definitions of tactile discriination and somatosensory plasticity is provided below:
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Barack Obama Health Care Plan and Treatment for Hyperhidrosis

By: Staff at www.EliminateSweating.com

September 9, 2008

See oulined health care plan for Barack Obama
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John McCain Health Care Plan and Treatment for Hyperhidrosis

By: Staff at www.EliminateSweating.com

September 9, 2008

Click on the link below to see John McCain's Health Care Plan
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Cardiopulmonary Consequences of ETS - Endoscopic Thoracic Sympathectomy for Hyperhidrosis and the Heart

By: Hratch Karamanoukian, MD

September 7, 2008

Researchers at the Department of Life Sciences, Zinman College, Wingate Institute, Netanya, Israel, have published a study that investigated the effects of Endoscopic Thoracic Sympathectomy (ETS) on cardiopulmonary responses to exercise and have reported their findings in the European Journal of Applied Physiology (September 2008)....
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www.EliminateSweating.com Reports Successful Hyperhidrosis Surgery in Pediatric Patients in Argentina

By: Hratch Karamanoukian, MD

September 5, 2008

Researchers at the Servicio de Cirugía Pediátrica, Hospital Universitario Austral in Argentina have reported their experience in treating priary hyperhidrosis in pediatric patients in the journal Arch Argent Pediatr (2008 Feb;106(1):32-5). The study, authored by Dr. J Buraschi details a 4 year experience in 25 patients, ages 8 – 18 years. All of the patients had palmar or palmar and axillary hyperhidrosis. The author reports that “hyperhidrosis disappeared in 98% of the patients” and that these results “obtained with this technique allow recommending the endoscopic thoracic sympathicolysis procedure for the treatment of this pathology in pediatric [patients]."
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Cardiac Surgery Secrets, Second Edition, Russian Translation - Секреты кардиохирургии

By: Staff at www.EliminateSweating.com

September 5, 2008

Dr. Hratch Karamanoukian's book Cardiac Surgery Secrets (Секреты кардиохирургии) has been translated into Russian.
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Cymbalta and Hyperhidrosis

By: Hratch Karamanoukian, MD

September 1, 2008

At the 12th congress of the European Federation of the Neurological Sciences, WebMD.com reports that two studies were presented that showed that the antianxiety and depression medication Cymbalta may "help ease" low back pain. Unfortunately, the side effect of hyperhidrosis was more likely to develop in patients taking Cybalta than patients taking a placebo. These are yet two other studies that have shown that hyperhidrosis is a side effect of Cymbalta.
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Hyperhidrosis Video on WNYLiving.tv with Maria Genero

By: Hratch Karamanoukian, MD

September 1, 2008

See inforational video about hyperhidrosis and excessive sweating by Maria Genero on www.WNYLiving.tv
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Hyperhidrosis Treatment in Santa Monica

By: Staff at www.EliminateSweating.com

August 31, 2008

Dr. Raffy Karamanoukian at www.KareMD.com provides evaluation and treatment at his Santa Monica office for hyperhidrosis. For ore information, contact Dr. Raffy at www.KareMD.com at 310-998-5533.
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What are Apocrine Sweat Glands ? Hyperhidrosis News and EliminateSweating.com

By: Hratch Karamanoukian, MD

August 25, 2008

Apocrine glands have a limited distribution in the body and are found in the underarms, near the anal area, around the belly button and near the external genitalia. They are a vestigial system, meaning that they are remnants of the mammalian glands producing sexual scent. Like the appendix, they are a vestigial and unnecessary organ system. Excretions from apocrine glands include protein, ammonia and lipids and bacterial decomposition of these secretants leads to the odor associated with sweating. This is what one needs to know about apocrine sweat versus eccrine sweat production: like eccrine glands, apocrine glands are activated by sympathetic nerves but by catecholamines and not acetylcholine. As such, they are not responsive to Botox injection. Eccrine glands secrete watery fluid (sweat) which is odorless. These glands are distributed in the head, underarms, palms and feet (primarily) and this type of sweat is blocked by local Botox injection.
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What is the Sweatiest City in America ?

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

August 25, 2008

For the fourth year in a row, Phoenix, Arizona has been named the Sweatiest City in America, followed by Las Vegas, Nevada and Tallahassee, Florida. What is the least Sweatiest City in America ? San Francisco, CA. This research was done by Old Spice and noted that the average Phoenix resident pumped out 26.4 ounces of sweat per hour. That's the equivalent of more than two cans of soda.
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Botox for Underarm Sweating - Use of Cold Gel Packs to Minimize Pain

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

August 22, 2008

A recent study evaluated the use of frozen gel packs applied to the underarms before Botox is injected to treat hyperhidrosis. The authors used the same patients for ‘control’ subjects, using the gel pack for one underarm and no gel pack freezing for the other underarm. The frozen gel pack was applied for 5 minutes before Botox injection. The author, Dr. Skiveren from the Department of Dermatology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, reported that “pain was assessed before, during (four times), and immediately after treatment, using a numeric rating scale. The patients experienced statistically significant pain reduction in areas cooled by frozen gel pack. However, the clinical relevance of this relatively small pain reduction is questionable”, according to Dr. Skiveren.
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What is Better, Vein Stripping or Endovenous Obliteration (VNUS, EVLLT, ELVeS)

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

August 18, 2008

How effective are endovenous obliteration techniques in the treatment of lower extremity varicose veins? This is a question I often get asked when I evaluate patients with venous reflux disease and varicose veins. A recent meta analysis of existing clinical studies looked into this topic by analyzing studies published until 2007. Dr. Van Den Bos and colleagues from the Department of Dermatology, Rotterdam, the Netherlands.published this data in the Journal of Vascular Surgery in August 2008. The researchers found that endovenous obliteration techniques, when compared to ligation and vein stripping was superior: At 3 years follow-up, vein stripping was 78% successful, radiofrequency ablation (VNUS) was 84% successful and endovenous laser therapy (e.g. EVLT) was 94% successful. The authors concluded that “in the absence of large, comparative randomized clinical trials, the minimally invasive techniques appear to be at least as effective as surgery in the treatment of lower extremity varicose veins Dr. Karamanoukian’s note – There you have it, endovenous obliteration is more effective than vein stripping and it seems that endovenous laser (EVLT, ELVeS) are more effective thatn radiofrequency obliteration (e.g. VNUS).
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What is the Genetics of Primary Hyperhidrosis ?

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

August 16, 2008

To date, there are few genetic studies on palmoplantar hyperhidrosis. Japanese researchers have completed genetic linkage analysis of 11 families including 42 affected and 40 unaffected members using genome-wide DNA polymorphic markers to identify the disease locus for palmoplantar hyperhidrosis. Mapping of the primary palmoplantar hyperhidrosis was between D14S1070 and D14S990 and at maximum to about a 30-cM interval between D14S1070 and D14S70. This is the first report of systemic mapping of the PPH locus.
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Cumulative Study of Over 6,000 Patients Indicates that ETS for Hyperhidrosis is Safe

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

August 15, 2008

Researchers at the Division of Thoracic and Esophageal Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada indicate that a”cumulative experience in over 6000 patients suggests that ETS is a safe, reproducible, and effective procedure, and most patients are satisfied with the results of the surgery”. This article was published in Thoracic Surgery Clinics (volume 18; 2008) in May. They also believe that “a multicenter, adequately powered, randomized controlled trial comparing surgical to medical management of hyperhidrosis is unlikely given the current enthusiasm for same-day thoracoscopic Sympathectomy”. Drs. Henteleff and Kalavrouziotis also indicate that “future clinical trials in this area will likely compare surgical techniques. For such comparisons, procedures must be standardized and outcome measures validated for both symptoms of the disease and surgical complications. Finally, the studies must have large numbers of patients and adequate long-term follow-up if they are to detect differences in results among procedures [which have traditionally had] very high technical success rates”.
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ETS for Hyperhidrosis - What is Better ? Cutting, Burning or Clipping the Sympathetic Nerve Trunk

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

August 15, 2008

Blockage of sympathetic ganglia is achieved by segmental resection, transection and/or cauterization, and clipping of the chain. Researchers in Turkey looked at 80 patients in a standardized study where 20 were randomized to have resection of the chosen segment of the sympathetic nerve trunk; Twenty patients had transaction (cutting) of the nerve; 20 had altation of the nerve with electrocautery and 20 had titanium clipping of the nerve. The primary success rate for isolated palmar hyperhidrosis was 96.3 %; for palmar and axillary hydrosis it was 95.7 % and for palmar and face/scalp hyperhidrosis it was 66.7 %. No recurrence was observed. The overall success rate of the operation was 95 % and the differences between the four groups were not statistically significant. In the clipping group, the duration of the surgical procedure was significantly shorter than in the other groups. Complication rates were similar among the groups. The researchers at the Department of Cardiovascular Surgery, Gulhane Haydarpasa Military Academy of Medicine, Istanbul, Turkey concluded that thoracic endoscopic sympathetic blockage yields similar results irrespective of the surgical technique adopted
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Plantar Hyperhidrosis after ETS for Palmoplantar Hyperhidrosis - One Year Follow-Up Study

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

August 15, 2008

It has been reported by many surgeons that as many as 60 % of patients with palmoplantar hyperhidrosis (of the hands and feet) have unexpected improvement of plantar hyperhidrosis after endoscopic thoracic sympathectomy. A team from Dept. of Vascular and Endovascular Surgery, Hospital das Clínicas School of Medicine, University of São Paulo, São Paulo, Brazil sought to investigate this in a prospective manner in 70 patients with palmoplantar hyperhidrosis. There was a great initial improvement in plantar hyperhidrosis in 50 % of the cases after endoscpic thoracic sympathectomy (ETS) for palmoplantar hyperhidrosis. At one year follow-up, only 23.4 % still had dry feet. The researchers concluded that patients with palmar hyperhidrosis and palmoplantar hyperhidrosis who undergo ETS to treat their palmar hyperhidrosis present a good initial improvement in plantar hyperhidrosis that reduces to a lower level of improvement after the one-year period. The research was published in the journal Clin Auton Res, volume 17, pages 172-176.
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Cardiac Effects of Endoscopic Thoracic Sympathectomy (ETS)

By: Hratch Karamanoukian, MD

August 13, 2008

A study was done to determine the effect of Endoscopic Thoracic Sympathectomy (ETS) on physiological responses at rest and during exercise in ten healthy patients by researchers at the Department of Life Sciences, Zinman College, Wingate Institute, Netanya, Israel. The study published in the European Journal of Applied Physiology was authored by Dr. Inbar and colleagues and studied patients who had ETS for axillary and/or palmar hyperhidrosis.

Physiological variables were recorded at rest and during sub-maximal (steady-state) and maximal treadmill exercise immediately prior to and 70 days after bilateral ETS.

The conclusion from this study is that “thoracic-sympathetic denervation affects the heart, sweating, and circulation of the respective denervated region but does not affect exercise performance or mechanical/physiologic efficiency, despite a significant reduction in heart rate (both at rest and during exercise)”.
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ETS Surgery for Hyperhidrosis in Ireland - A 4 Year Follow-up for Quality of Life Indicators and Compensatory Sweating

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

August 12, 2008

Dr. Jeganathan and colleagues published this data in Interactive Cardiovascular Thoracic Surgery(volume 7) and noted that indications for performing ETS surgery were: for palmar hyperhidrosis (41%), axillary hyperhidrosis (17%), combined palmar and axillary hyperhidrosis (27%) and facial blushing+/-facial hyperhidrosis (15%). Success rates were for palmar hyperhidrosis 98.5%, axillary hyperhidrosis 96.4%, palmar and axillary hyperhidrosis 97.7% and facial blushing +/- facial hyperhidrosis 84%.

This series was notable for compensatory sweating in 77% of patients and its severity was related to the severity of the primary complaint, according to the authors.

The researchers showed that there was an improvement in quality of life was seen in 85%. A diminution of quality of life was noted in 5% due to compensatory sweating.

The conclusion was that this “large mature series demonstrates that bilateral thoracoscopic division of the sympathetic chain as opposed to resection can be performed effectively in patients with success rates higher than 90% and low recurrence rates” and high degree of improvement in the quality of life.


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Hyperhidrosis of the Feet (Plantar Hyperhidrosis) and Endoscopic Lumbar Sympathectomy

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

August 12, 2008

Is Treatment for Hyperhidrosis of the Feet Safe ? Plantar Hyperhidrosis and Lumbar Sympathectomy (ELS or LES) – Update 2008 -

A Brazilian study looked at the efficacy of Lumbar Endoscopic Sympathectomy (LES or ELS) for hyperhidrosis of the feet (plantar hyperhidrosis) in women. The study authored by Dr. Loureiro and colleagues from the Programa de Pós-Graduação em Ciências - Cirurgia Torácica e Cardiovascular, Faculdade de Medicina, Universidade de São Paulo, São Paulo investigated the utility of performing this procedure in women who continued to have hyperhidrosis of the feet after they had ETS (Endoscopic thoracic Sympathectomy).

It should be noted that ETS performed for palmar and/or axillary hyperhidrosis often cures hyperhidrosis of the feet in approximately 40% of 60% of patients in the published literature. The authors in this study enrolled patients who had persistent sweating in the feet after ETS. Thirty female patients were enrolled to receive ELS or no intervention at all. They showed that patients who had ELS had significant improvement in their quality of life indicators (QOL) and lower values of foot sweat. However, 20% of patients had prolonged pain after this procedure. The study conclusions were that “endoscopic retroperitoneal lumbar sympathectomy (ELS) diminishes plantar sweat and improves the quality of life of women with plantar hyperhidrosis. However, about half of the patients develop increased compensatory hyperhidrosis in other areas of the body”.

Dr. Karamanoukian note – This study indicates to me that we have not reached the tipping point in terms of success rates with ELS and therefore I do not recommend this procedure for plantar hyperhidrosis as of this writing in 2008.
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Plantar Hyperhidrosis - Hyperhidrosis of the Feet - Chemical Lumbar Block Not Very Successful

By: Hratch Karamannoukian MD and Raffy Karamanoukian MD

August 11, 2008

Hyperhidrosis of the Feet and Chemical Sympathetic Block How Successful is Chemical Lumbar Sympathectomy for Plantar Hyperhidrosis? Plantar hyperhidrosis is treaeted with Botox or iontophoresis. In some studies, up to 30 % of patients with palmoplantar hyperhidrosis have resolution following endoscopic thoracic sympathectomy. However, this procedure is NOT advocated for patients having plantar hyperhidrosis alone. A recent study published in the June 30th issue of the journal of Dermatologic Surgery (2008) evaluated the safety and the effectiveness of a chemical lumbar sympathetic block (CLSB) with alcohol in patients with severe plantar hyperhidrosis. Sixty-nine patients were treated using a single-needle or two-needle technique in 138 limbs (69 times 2). The authors reported that of 138 procedures, the number of successful blocks was 68 (49.3%) for L3 to L4 and 28 (20.3%) for L4 to L5. The degree of anhydrosis was excellent in 6 patients (8.7%), good in 32 patients (46.4%), fair in 32 patients (34.8%), and poor in 7 patients (10.1%). Of 69 patients, 56 (81.1%) were partially or fully satisfied. Noted complications included temporary sexual dysfunction in 1 patient, compensatory hyperhidrosis in 1 patient, and transient genitofemoral neuritis in 3 patients. The authors concluded that the “careful use of chemical lumbar sympathetic block (CLSB) on an outpatient basis can be a safe, minimally invasive, and effective treatment for severe plantar hyperhidrosis”.
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Compensatory Sweating - New Details and New Information - News from EliminateSweating.com and Dr. Karamanoukian

By: Hratch Karamannoukian MD and Raffy Karamanoukian MD

August 11, 2008

Endoscopic Thoracic Sympathectomy (ETS) in Children and Adults – New Information About Compensatory Sweating Compensatory sweating (CS) is a major side effect of ETS. Researchers at the Department of Pediatric Surgery, Hillel Yaffe Medical Center, Hadera, Israel surveyed thoracic sympathectomy (ETS) patients to determine the procedure's long-term success, satisfaction, complications, the natural history of compensatory sweating – and whether those with compensatory sweating would still have undergone the procedure. 621 patients (mean age, 16.1 years) with a follow-up of more than 24 months were included in this study, published in the Journal of Pediatric Surgery (volume 42, page 1238-1242). Most participants (97%) reported complete (89.4%) or reasonable (7.6%) symptomatic relief and long-term satisfaction with ETS was high (84.5%). Of note, 41% of the participants claimed that their quality of life decreased moderately or severely as a result of compensatory sweating. About one in 5 patients stated that they would not have undergone the operation in retrospect – with a significant interesting difference regarding this issue between adults (31.4%) and children (8.8%). Some very interesting NEW findings regarding compensatory sweating from this study is that the extent of compensatory sweating did not change with time in 70% of the patients. It got worse in 10% and it diminished in 20%, usually within the first 2 postoperative years. The researchers concluded that thoracoscopic sympathectomy relieves hyperhidrosis in most cases. Hyperhidrosis is not a self-limiting condition, and we recommend not postponing ETS until adulthood.
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How does iontophoresis stop hyperhidrosis ?

By: Hratch Karamannoukian MD and Raffy Karamanoukian MD

August 10, 2008

Iontophoresis - Mechanisms of Action How does iontophoresis stop hyperhidrosis of the palms and feet? Researchers at the Department of Dermatology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan investigated the mechanism of action of iontophoresis and found that hyperhidrosis patients have significantly higher perspiration volume and sodium concentration than healthy controls. Looking at changes with iontophoresis over time, the researchers led by Dr. Oshima found that there was a significant decrease in perspiration volume and sodium concentration after six iontophoresis treatments. These findings are helpful in targeting localized treatment modalities for patients with hyperhidrosis.
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Posterior Approach Thoracic Sympathectomy For the Obese Can Cause Horner's Syndrome - Hyperhidrosis Surgery at University of Pittsburgh

By: Hratch Karamannoukian MD and Raffy Karamanoukian MD

August 10, 2008

Posterior Approach Thoracic Sympathectomy for the Obses and Patients with Pulmonary Disease - Still Experimental For the rare patient who is not a candidate for thoracic sympathectomy (previous chest surgery, poor pulmonary function), surgeons at the University of Pittsburgh in the Department of Neurosurgery have developed a posterior approach to treat palmar hyperhidrosis. The authors, led by Dr. Gardner have developed a minimal access endoscopic-assisted dorsal sympathectomy procedure, applying minimally invasive spine muscle splitting techniques. The authors believe that the development of this technique may help to minimize surgical morbidity associated with the traditional posterior approach by reducing pain, tissue damage, and length of postoperative recovery. This procedure was done on two patients alone. Interestingly, one patient suffered a unilateral Horner syndrome and underwent an eyelid lift. The other patient was readmitted to the hospital 2 days after discharge with atelectasis. The researchers concluded that “this technique may provide an alternative to thoracoscopic approaches, especially in those patients with pulmonary disease or obesity”.
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Secondary Hyperhidrosis - Side Effect of Effexor XR - Venlafaxine XR

By: Hratch Karamannoukian MD and Raffy Karamanoukian MD

August 9, 2008

Venlafaxine (Effexor) and Hyperhidrosis – A New Study Concludes that Hyperhidrosis is a Major Side Effect of Effexor (Venlafaxine). Venlafaxine (Effexor) is an antidepressant of the serotonin norepi reuptake inhibitor class (SNRI). It was introduced in 1993 by Wyeth and is prescribed for the treatment of major depression and anxiety disorders. It has been associated with suicide and as such, is not recommended as a first line treatment for depression. However, it is often effective for depression not responding to SSRIs. Effexor is the 6th most widely-used antidepressant based on the number of retail prescriptions dispensed in the United States in 2006. A research study comparing Effexor XR to bupripion XR in an eight-week, placebo-controlled, double-blind comparison showed that the most frequently reported adverse events were dry mouth and insomnia for bupropion XR, and nausea, hyperhidrosis, fatigue, and insomnia for venlafaxine XR (Effexor XR). This research study was published by Dr. Hewett et al. in the July edition of the journal Psychopharmacology (July 17th). For more information about hyperhidrosis contact Dr. H Karamanoukian at www.EliminateSweating.com and Dr. Raffy at www.KareMD.com
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Excessive Sweating and Diabetes

By: Hratch Karamannoukian MD and Raffy Karamanoukian MD

August 7, 2008

Hyperhidrosis is a medical condition in which a person sweats excessively and unpredictably. People with hyperhidrosis can sweat even when the temperature is cool, and when they are at rest. Excessive sweating (hyperhidrosis) in the palms, soles, and armpits (axillae) is not only embarrassing, but can also be a sign of an underlying disease. Before dismissing excessive sweating as simply being due to emotions or social situations, it is important to rule out other possible causes. Hyperhidrosis can be caused by dysfunction of the autonomic nervous system (ANS). Sweating is controlled through the opposing actions of the sympathetic and parasympathetic divisions of the ANS. If the sympathetic system (“fight or flight” system) is overly stimulated, for instance, excessive sweating will occur. This cause of hyperhidrosis can now be easily treated with a simple outpatient surgical procedure. The most common diseases to cause excessive sweating are diabetes and hyperthyroidism. Diabetes mellitus is a disease of poor glucose (sugar) control. Over time, diabetes disrupts the proper function of the ANS. Diabetes is also associated with obesity, which itself can cause excessive sweating. An easy way to find out if you have diabetes is to have your blood glucose (sugar) checked by your primary doctor with a simple blood test. The thyroid gland, which is located in the neck, produces important hormones in response to signals in the brain. These hormones act by either increasing or decreasing the body’s metabolic rate. Hyperthyroidism occurs when the thyroid is overactive and secretes more hormone than in the usual resting state. This stimulates a faster metabolic rate in the body, producing increased sweating, nervousness, heart palpitations and weight loss. If you are experiencing any of these symptoms, a doctor can check your thyroid function and level of thyroid hormones through a simple blood test. Other causes of excessive sweating include infections, menopause, certain medications, alcoholism, and certain types of cancers. Infections often are associated with a fever, as the body tries to fight off the bacteria or virus causing the infection. If you are experiencing other symptoms associated with sweating, such as a cough, nausea, vomiting, or fatigue, it is important to take your temperature using a thermometer, and also make an appointment to see your primary doctor. Normal body temperature is 98.6 degrees Fahrenheit taken orally. Menopause is the termination of monthly menstrual cycles in females, usually around the age 50. Common symptoms include sudden hot flashes and night sweats. If you have noticed an irregularity in your menstrual cycle, and are having hot flashes or night sweats, you should see your primary doctor or gynecologist to discuss various treatment options. A more serious cause of excessive sweating, especially night sweats, is cancer. For example, Hodgkin’s disease is a type of lymphoma often associated with night sweats. Patients also usually present with enlarged lymph nodes in the neck, axilla, or groin, unexplained fever, pruritis (itching), and weight loss. This requires a more complete work-up by your doctor including blood tests, x-rays, and CT scans. All other possible causes of excessive sweating need to be excluded first. But note, localized sweating in the palms, armpits or feet in an otherwise healthy person is primary hyperhidrosis. These can simply be treated with great success with endoscopic thoracic sympathectomy (ETS).
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Compensatory Hyperhidrosis in Children vs Adults after ETS Thoracic Sympathectomy

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

August 5, 2008

Compensatory Sweating in Children after ETSResearchers in Israel at the Department of Pediatric Surgery, Hillel Yaffe Medical Center have compared outcomes in children, adolescents and adults following Endoscopic Thoracic Sympathectomy (ETS). The retrospective review investigated outcomes in a telephone interview and noted that there were 325 patients with a >24-month follow-up – with 116 children and 209 adolescents and adults. The long-term postoperative satisfaction was significantly higher among children (92.2%) compared to adolescents and adults (80.7%). Most participants reported complete or reasonable symptomatic relief.from palmar hyperhidrosis with compensatory sweating appearing within 6 months postoperatively in 81.8% of all the patients but significantly less in 70 % of children compared to 89% of adolescents and adults. The researchers led by Dr. Steiner (Pediatric Surgery International 2008; volume 24) concluded that “most patients prefer relief from palmar hyperhidrosis even at the cost of moderate or severe compensatory sweating and furthermore that the rate of compensatory sweating and its severity is tolerated better by children. Unless otherwise contraindicated, the authors “recommend doing Endoscopic Thoracic Sympathectomy as early as possible.
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Taiwan Study Claims Less Compensatory Sweating after ETS for Palmar Hyperhidrosis

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

August 5, 2008

Less Compensatory Sweating with T4 Sympathectomy? A study published by Dr. Chang and colleagues from the Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan investigated the difference between T3 and T4 sympathectomy (ETS) for palmar hyperhidrosis. The results, published in Annals of Surgery (volume 246, pages 330-336) showed that patients with T4 ETS presented the lowest incidence of compensatory sweating and had the least severity of compensatory sweating. None of the patients who had T4 level ETS expressed regret for having had this procedure. The authors concluded that T4 level sympathectomy “would be a better and more effective procedure with minimal long-term complications” than T2 or T3 level Sympathectomy for palmar hyperhidrosis. Dr. Karamanoukian’s note – the real interesting finding from this study is that “being obese did not increase the incidence of compensatory sweating but that the severity of compensatory sweating was directly related to body mass index in a statistically significant manner”. For more information about hyperhidrosis and ETS contact Dr. Karamanoukian at www.EliminateSweating.com or contact the Center for Excdessive Sweating at 716-839-3638 to talk to Dr. Karamanoukian or our Nurse Practitioner.
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T4 or T3 or T2 level Endoscopic Thotacic Sympathectomy (ETS) for Palmar Hyperhidrosis (Excessive Sweating) ?

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

August 5, 2008

T4 Level Sympathectomy Favored for Palmar Hyperhidrosis – Less Compensatory Sweating for Palmar Hyperhidrosis Researchers at the Department of Surgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt have published their retrospective review looking at the efficacy of T2 and T3 Endoscopic Thoracic Sympathectomy (ETS) versus T4 ETS in relieving palmar hyperhidrosis (hyperhidrosis of the palms). The authors looked at outcomes in 60 patients and noted that treatment success at follow-up was 90% for the T2 ETS, 95% for T3 ETS and 100% for T4 ETS. Important findings again in this study (Surgery volume 143; 2008: pages 784-789) was that compensatory sweating was mild in the T4 group and moderate-to-severe in the T2 and T3 ETS groups. About 40% of T2 ETS patients and 25% of T3 ETS patients were unsatisfied with their operation as conducted by Drs. Mahdy and colleagues. However, all patients in the T4 group were satisfied with the outcome. As such, this group advocates T4 sympathectomy (ETS) for patients with palmer hyperhidrosis. Dr. Karamanoukian’s note – this is yet another study, albeit small, which advocates T4 level Sympathectomy for palmar hyperhidrosis. For more information about hyperhidrosis and ETS contact Dr. Karamanoukian at www.EliminateSweating.com or contact the Center for Excessive Sweating at 716-839-3638 to talk to Dr. Karamanoukian or our Nurse Practitioner.
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Various Uses of Botox in Medicine - Migraine Headaches, Hyperhidrosis, Gustatory Sweating ...

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

August 3, 2008

Botox in Medicine Botox has been used for hyperhidrosis and gustatory sweating syndrome, alleviation of migraine, as a treatment for overactive bladder, achalasia and anal fissure and other cosmetic needs of patients. Botox is used to temporarily eliminate rhytids by muscle weakening. Other dermatologic applications of Botox include correcting facial asymmetries.
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Suction Curettage for Axillary Hyperhidrosis - An Office Procedure Offered at the Center for Exceesive Sweating www.ElilimateSweating.com

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

August 3, 2008

www.EliminateSweating.com Dr. Raffy and Dr. H Karamanoukian perform office liposuction curettage for axillary hyperhidrosis. Researchers at the Department of Dermatology, Pusan National University School of Medicine, Seo-gu, Busan, South Korea have published their experience with liposuction curettage for adxillary hyperhidrosis in the Journal Eur Academy Dermatologic Venerealogy (2008; volume 22). The follow-up in 53 patients started 3 months after surgery and in some 54 months. Postoperative tissue specimen evidently showed removal of subcutaneous tissue, including apocrine and eccrine glands. Excellent outcomes were achieved in 72 % of patients with resolution of axillary hyperhidrosis. The authors, led by Dr. Seo concluded that axillary liposuction curettage is an effective and safe procedure for axillary hyperhidrosis. Dr. Karamanoukian’s comment – We have performed over 48 procedures (as of July 2008) and have found that axillary liposuction curettage is effective in eliminating axillary hyperhidrosis in over 90 % of patients, graded as excellent by the patients. 8% of patients had a good outcome and the rest had moderate reduction in axillary sweating. The latter is related to the learning curve of this procedure which is performed with technical details that are different than traditional liposuction. For more information about axillary liposuction curettage for hyperhidrosis, contact Dr. Raffy Karamanoukian @ www.KareMD.com and Dr. H Karamanokian at www.EliminateSweating.com
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Suction Curettage for Axillary Hyperhidrosis - An Office Procedure Offered at the Center for Exceesive Sweating www.ElilimateSweating.com

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

August 3, 2008

www.EliminateSweating.com Dr. Raffy and Dr. H Karamanoukian perform office liposuction curettage for axillary hyperhidrosis. Researchers at the Department of Dermatology, Pusan National University School of Medicine, Seo-gu, Busan, South Korea have published their experience with liposuction curettage for adxillary hyperhidrosis in the Journal Eur Academy Dermatologic Venerealogy (2008; volume 22). The follow-up in 53 patients started 3 months after surgery and in some 54 months. Postoperative tissue specimen evidently showed removal of subcutaneous tissue, including apocrine and eccrine glands. Excellent outcomes were achieved in 72 % of patients with resolution of axillary hyperhidrosis. The authors, led by Dr. Seo concluded that axillary liposuction curettage is an effective and safe procedure for axillary hyperhidrosis. Dr. Karamanoukian’s comment – We have performed over 48 procedures (as of July 2008) and have found that axillary liposuction curettage is effective in eliminating axillary hyperhidrosis in over 90 % of patients, graded as excellent by the patients. 8% of patients had a good outcome and the rest had moderate reduction in axillary sweating. The latter is related to the learning curve of this procedure which is performed with technical details that are different than traditional liposuction. For more information about axillary liposuction curettage for hyperhidrosis, contact Dr. Raffy Karamanoukian @ www.KareMD.com and Dr. H Karamanokian at www.EliminateSweating.com
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What Kind of Hyperhidrosis Do You Have ?

By: Staff at HyperhidrosisNews.com

August 3, 2008

What kind of hyperhidrosis do you have ? An Interview with Dr. Raffy Karamanoukian - “That is the ultimate question that needs to be answered when you see a hyperhidrosis specialist”, said Dr. Raffy Karamanoukian, a plastic surgeon in Santa Monica and Beverly Hills, CA. Dr. Raffy, as he is called affectionately by his patients sees a large number of patients with hyperhidrosis in the Los Angeles area. He says that “as much as 4% of the population has hyperhidrosis” but some studies “realistically show that 1.2% of the general population has hyperhidrosis”. The question therefore is to know which of these patients have primary hyperhidrosis and which have secondary hyperhidrosis. Primary hyperhidrosis is idiopathic and involves primarily the head, underarms, palms and feet or “any combination thereof” says Dr. Raffy. Primary hyperhidrosis is not associated with any underlying medical disorders, as in secondary hyperhidrosis, which is “secondary” to some underlying medical conditions such as diabetes, chronic infection, thyroid disorder, cancer, sarcoidosis or others. In a typical week, Dr. Raffy sees a dozen patients with hyperhidrosis and says that he “cannot overemphasize the need to thoroughly evaluate these patients” who are in desperate need of treatment. “Once secondary causes are eliminated, treatment is individualized and an algorhythm is used to figure out what each patient needs, whether it is medication, Botox, suction curettage or Endoscopic thoracic Sympathectomy”. For more information about hyperhidrosis and its treatments, contact Dr. Raffy at www.KareMD.com and Dr. Hratch Karamanoukian at the Center for Excessive Sweating at www.EliminateSweating.com
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Axillary Hyperhidrosis and Liposuction Curettage

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

August 2, 2008

Axillary Liposuction Curettage and www.EliminateSweating.com Researchers at the Department of Dermatology and Allergology, Ruhr University Bochum, Bochum, Germany investigated changes in skin blood flow using a laser Doppler scan in patients who had liposuction curettage for hyperhidrosis. This was done in 11 patients at 24 hours, 7 days and 1 month after liposuction curettage for axillary hyperhidrosis. The lead author of the study, Dr. Bechara reported that axillary liposuction curettage causes a slight reduction in axillary skin blood flow following the procedure but that this had no clinical significance and was not related to surgical outcome post liposuction. Dr. Karamanoukian’s comment – This study is important in that it shows that this procedure does not devascularize the skin. We have performed axillary liposuction curettage at the Center for Excessive Sweating and it works very nicely in eliminating axillary hyperhidrosis without any problems with the skin.
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Botox Injected for Palmar Hyperhidrosis Can Cause Severe Atrophy of the Hand Muscles

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

August 2, 2008

Botox for Palmar Hyperhidrosis and Atrophy of the Hand Musculature An article published in the Journal of Plastic Reconstructive Aesthetic Surgery (June 2008) reports a case of an individual with hyperhidrosis of the palms who had Botulinum toxin type A (Botox) injected – this treated the hyperhidrosis but was associated with the development of severe atrophy of the intrinsic muscle s of the hands. Although hyperhidrosis of the hands has been shown to be effectively treated with Botox injections, such atrophy of the intrinsic muscles of the hand have not been reported to date.
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Lasers for Endoscopic Thoracic Sympathectomy ?

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

July 30, 2008

Can Laser Technology be Used to Perform Endoscopic Thoracic Sympathectomy ? The answer is YES. Researchers at the Department of Vascular Surgery, St Peter's Hospital, Chertsey, Surrey, UK have reported a study where laser technology was used to destroy the thoracic sympathetic nerve as opposed to diathermy (heat energy). As is known, thoracic symathectomy is performed by cutting the nerve, burning the nerve (diathermy) or clipping the nerve. The surgeon performed a total of 233 thorascopic sympathectomy procedures in 123 patients between 1987 and 2006. The lead researcher, Dr. Black, concluded that “thorascopic sympathectomy is safe and can be carried out as a single bilateral procedure in the majority of cases. The laser allows the use of a single port, requires less dissection than surgical or clipping techniques, is more precise than diathermy and may be less likely to cause a Horner's syndrome”. The study was reported in the Annals of the Royal College of Surgeons of England, volume 90, March 2008 (pages 142-145). Dr. Karamanoukian comments – I believe that there is no need to use a laser to perform Sympathectomy as titanium clips are superior to techniques used to destroy the nerve, whether by diathermy, cutting or laser. If one is going to use diathermy, there is risk of Horner’s syndrome which is unlikely or impossible with clips.
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Groin Hyperhidrosis Can be Embarrasing

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

July 30, 2008

Groin or Inguinal Hyperhidrosis What is the optimal treatment for hyperhidrosis of the groin? Hyperhidrosis in general can be embarassing and there are individuals who suffer from severe hyperhidrosis limited to the groin, so much so that they have to change their undergarments several times a day. Botox is a great treatment modality for these patients, especially if oral medications are ineffective and at the Center for Excessive Sweating, we typically use between 100-150 units of Botox to treat this area effectively. Over 25 patients have had treatments for inguinal or groin hyperhidrosis in the last year and have been very happy with the outcome.
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Subdermal Laser for Axillary Hyperhidrosis - Pilot Study is Promising

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

July 30, 2008

Subdermal Laser for Axillary Hyperhidrosis - Pilot Study is Promising Researchers at the Clinica Goldman of Plastic Surgery, Porto Alegre, Brazil have investigated the clinical effectiveness of a subdermal (under the skin) 1064 nm Nd-YAG laser to treat axillary hyperhidrosis. Objective improvement was measured with iodine starch test and planimetry in 17 patients in a seminal pilot study. The study was conducted between 2002 and 2007. The lead author of this study, Dr. Goldman reported that the “treatment of axillary hyperhidrosis using the 1,064-nm Nd-YAG laser has the advantage of [being] a minor invasive procedure without leaving large scars and [not] causing temporary impairment. The laser proved to be effective and safe. Although the laser treatment has shown promising results in this pilot trial, further studies are necessary for final conclusions”. Dr. Karamanoukian’s comment – this is a novel study which may have significant utility in the future. Dr. Golman has used laser technology in a novel way to treat hyperhidrosis of the axilla, which is a debilitating condition for many in the U.S.
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Hyperhidrosis Surgery in China - ETS in China

By: Hratch Karamanoukian, MD

July 30, 2008

Chinese Study Cites Utility and Success of Endoscopic Thoracic Sympathectomy An article written in Chinese and published in the journal Zhonghua Wai Ke Za Zhi evaluated the efficacy of video-assisted thoracoscopic sympathicotomy in the treatment of palmar hyperhidrosis. The study reviewed the charts of 588 patients with palmar hyperhidrosis who underwent bilateral Sympathectomy (ETS) from January 2003 and March 2007. The authors state that the “cure rate” of palmar hyperhidrosis was 99.8%. All of their patients were seen at a follow-up for 1 to 48 months with an average time of (20.3 +/- 2.3) months. The authors concluded that video-assisted thoracoscopic sympathicotomy (ETS) is an effective, safe and minimally invasive method for the treatment of hyperhidrosis. Dr. Karamanoukian’s note – It seems that the Chinese are finally catching up with the latest techniques utilized in the West for treating hyperhidrosis.
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Compensatory Sweating and Quality of Life After Sympathicotomy for Hyperhidrosis and Facial Blushing

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

July 30, 2008

Dr. Krasna and colleagues from the Division of Thoracic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland have published a retrospective analysis of clinical outcomes following sympathicotomy for hyperhidrosis and facial blushing. 232 patients with at least 6 month follow-up were included in this study, published in the Annals of Thoracic Surgery, volume 85 (2008). Preoperative and postoperative quality-of-life indices (range, 0 to 3) were used to measure impact of surgery, and comparisons were indexed to preoperative symptoms. Postoperative compensatory sweating was analyzed with respect to the level(s) of sympathetic chain division. In hyperhidrosis patients, mean preoperative quality-of-life index was 2.0 and postoperative quality-of-life index was 0.4 (p < 0.001). Facial blushers had preoperative and postoperative quality-of-life index of 2.6 and 1.0, respectively – meaning improvement. Significant compensatory sweating was seen in 33% patients overall and occurred in 29% of patients with palmar symptoms, 26% of axillary hyperhidrosis patients, and 42% of patients with facial blushing. Dr. Krasna has concluded from this important study that “significant improvement in quality of life can result from surgery for hyperhidrosis. However, the incidence of postoperative compensatory sweating may be dependent on the level of sympathicotomy performed. The choice of sympathicotomy level(s) should be directed toward reducing the incidence of significant compensatory sweating while simultaneously ensuring relief of primary preoperative symptoms”. Dr. Karamanoukian’s note – Compensatory sweating in this study for facial blushing and hyperhidrosis occurred in 45 % of patients and as noted was more likely the higher the level of sympathicotomy and number of levels of sympathetic chain division.
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Compensatory Sweating Following Endoscopic Thoracic Sympathectomy (ETS)

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

July 28, 2008

Compensatory Sweating Following Thoracic Sympathectomy (ETS) Dr. Baumgartner and colleagues investigated the safety, efficacy, and side effects of the various medical treatments versus bilateral thoracoscopic sympathectomy for palmoplantar hyperhidrosis in 192 consecutive patients in a prospective manner and reported their findings in the Annals of Vascular Surgery (July 9, 2008). Of the 47 patients, 46 received topical aluminum chloride, 40 anticholinergics, six iontophoresis, and 45 endoscopic thoracic Sympathectomy. Interestingly, only one patient was successfully treated with aluminum chloride (2.2%) and one successfully treated with anticholinergics (2.5%), and these did not undergo surgery. All medical treatments failed with the exception that one patient was satisfied with anticholinergic treatment (2.6%), and this patient did not undergo Sympathectomy. As such, Sympathectomy was found to be “superior in treating palmar hyperhidrosis compared to aluminum chloride, anticholinergics, iontophoresis, and Botox”. Overall, compensatory hyperhidrosis (CH) was present in 56% of patients undergoing thoracic Sympathectomy. Only 3.2% of thoracic Sympathectomy patients had severe compensatory sweating with significant discomfort. Dr. Baumgartner concluded that the “safety and overwhelming efficacy of thoracic Sympathectomy compared to medical management of severe palmoplantar hyperhidrosis is demonstrated in this study”. Furthermore, he concluded that “Rather than being a "last resort," Endoscopic thoracic Sympathectomy can be confidently recommended as first-line treatment for the typical, severe form of palmoplantar hyperhidrosis”. For more information go to www.EliminateSweating.com
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Can You Predict Who Will Get Severe Compensatory Sweating Before ETS ?

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

July 28, 2008

Severe Compensatory Sweating Predicted with Endoscopic Thoracic Sympathetic Block Dr. Daniel Miller from the Section of General Thoracic Surgery, Department of General Surgery, Emory University School of Medicine, Atlanta, Georgia has reported an interesting study in the Annals of Thoracic Surgery (April 2008) regarding compensatory sweating following Endoscopic Thoracic Sympathectomy (ETS). Dr. Miller states that the “fear of compensatory hyperhidrosis is the most common reason why patients do not undergo a sympathectomy, because it is an irreversible procedure unless removal clips are used. Unfortunately, clip removal for reversal of postsympathectomy compensatory hyperhidrosis has not been reliable”. To address this issue, Dr. Miller has performed temporary thoracoscopic sympathetic block to predict if postsympathectomy compensatory hyperhidrosis is going to occur after Sympathectomy. All patients enrolled in his study were concerned about the development of compensatory sweating and requested the possibility of a reversible procedure. Sympathetic blockade was performed at each level of the planned sympathectomy (T2, T3, and accessory nerves) with 2.5 cc 0.25% marcaine with epinephrine per level without complications. All patients had temporary relief of hyperhidrosis ranging from 1 to 10 days with a median of 4 days after the block. 12% had temporary compensatory sweating after the thoracoscopic block, 2 mild and 1 severe. All but 1 (4%) patient who had severe compensatory sweating elected to proceed with the planned sympathectomy. Dr. Miller concluded that “temporary thoracoscopic sympathetic block is a reversible and accurate procedure for the determination of postsympathectomy compensatory sweating. Temporary thoracoscopic sympathetic block followed by sympathectomy may be the best approach for the treatment of medically refractory primary hyperhidrosis in patients who are concerned about the development of postsympathectomy compensatory sweating. For more information go to www.EliminateSweating.com
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Can You Safely Perform Endoscopic Thoracic Sympathectomy (ETS) After Breast Augmentation

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

July 28, 2008

Can you safely perform endoscopic thoracic sympathectomy after breast augmentation surgery ? The answer is YES, YES and YES. I have performed this ETS procedure in over 20 patients who have had breast augmentation surgery. No additional risks except to let the patient know that there is an extremely small risk that the implants could get infected. It is unlikely in a healthy patient without diabetes.
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Sudomotor Response Following Endoscopic Thoracic Sympathectomy

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

July 28, 2008

What is Sudomotor Response ? Sudomotor is a medical term used to describe something that stimulates the sweat gland. Objective assessment of sweat output after Sympathectomy has not been reported following thoracic Sympathectomy (ETS). Researchers at the Department of Cardiothoracic Surgery, Royal Victoria Hospital, Belfast, UK looked into this phenomenon in individuals who underwent T2 and T3 sympathectomy for hyperhidrosis. The authors showed that sweat output in the palm fell significantly after sympathectomy relative to preoperative levels. Differences in sweat outputs in the left palm were statistically significant between groups at baseline and postoperatively after mental arithmetic challenge and exercise at 40 degrees Celsius. Compensatory increases in the sweat outputs from the left sole and chest were observed after sympathectomy. Dr. Bonde, the lead researcher concluded in this study that “according to objective sweat output measurements, thoracoscopic sympathectomy results in long-term control of palmar hyperhidrosis. This evaluation method is valuable in investigating recurrence of symptoms or compensatory hyperhidrosis after sympathectomy, providing a robust and objective criterion for planning [additional] intervention”.
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Tea Bags for Hyperhidrosis of the Feet ? Dr. Oz said on Oprah ...

By: Hratch Karamanoukian, MD

July 27, 2008

Tea bags for Hyperhidrosis of the Feet ? Dr. Oz said on Oprah ... Dr. Oz mentioned this on an Oprah episode and I have had many patients who have tried this and have heard very ambiguous and inconsistent results. It seems to help with smell but not with the volume of sweat that is produced. As you know, sympathectomy done in the lumbar region can stop hyperhidrosis of the feet - it does result in swexual dysfunction in males and therefore I do not recommend it. In my clinical experience, over 40% of patients who have thoracic sympathectomy (micro ETS) have resolution of sweating in the feet. When patients have palmoplantar, namely sweating in the feet and palms, in 40% there is resolution of sweating in the feet and 99% in the palms.
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Aluminum Chloride is Tolerated in Less Than 30% of Patients with Hyperhidrosis of the Underarms - Botox or Aluminum Chloride ?

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

July 27, 2008

Effectiveness of Botox and Aluminum Chloride for Hyperhidrosis of the Underarms ? As is well known, first line therapy for hyperhidrosis of the underarms is topical agents such as aluminum chloride. Botulinum toxin type A (BTX-A) is FDA-approved for the treatment of primary hyperhidrosis of the underarms which is unresponsive to topical therapy. Researchers at the Department of Dermatology, Saint Louis University School of Medicine, St. Louis, MO investigated BTX-A with 20% aluminum chloride in a prospective randomized fashion for 12 weeks in patients with primary focal axillary hyperhidrosis.
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Do Hyperhidrosis Patients Have Personality Disorders ?

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

July 27, 2008

There are those who have questioned whether patients with hyperhidrosis have some personality disorders such anxiety or stress. Researchers from the Department of Dermatology, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey investigated the temperament and character dimensions in patients with hyperhidrosis with a psychobiological inventory. Patients with hyperhidrosis were recruited and compared to normal healthy patients without hyperhidrosis and patients with chronic renal failure. All subjects were required to perform a temperament and character inventory. These researchers found that “total novelty seeking score in hyperhidrosis was significantly lower than in controls. There was no significance in total harm avoidance scores between hyperhidrosis patients and controls. The total reward dependence and persistence scores were significantly higher in hyperhidrosis patients. The fear of uncertainty in the harm avoidance scale was found to be significantly greater in hyperhidrosis patients. Regarding character dimensions, the total score in each of the subscales self-directedness, cooperativeness and self-transcendence was found to be higher in hyperhidrosis patients”. These researchers led by Dr. Karaca concluded that “the higher scores of all subscales of character dimensions in hyperhidrosis patients suggest that hyperhidrosis is not related with social phobia or a personality disorder”. Dr. Karamanoukian – I wholeheartedly agree with these observations and conclusions. Having treated several thousand patients with hyperhidrosis and operated on a large number, I believe that patients with hyperhidrosis do not have personality disorders or anxiety disorders. This is counter to what some insurance companies think which on occasion ask their enrollees to get psychiatric evaluation.
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Facial Blushing, Social Phobia and Endoscopic Thoracic Sympathectomy (ETS)

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

July 27, 2008

Facial Blushing, Social Phobia and Endoscopic Thoracic Sympathectomy (ETS) Researchers at the Division of Thoracic Surgery, San Gerardo dei Tintori Hospital, Via Pergolesi, Monza, Italy have investigated the effectiveness of Endoscopic thoracic Sympathectomy (ETS) in facial blushing. According to the researchers, “facial blushing represents the peculiar symptom in social phobia and is defined as the ''hallmark of embarrassment''. Agreeably, at present, endoscopic thoracic sympathectomy (ETS) is the only technique that treats symptomatic facial blushing with long term success. In a retrospective review of 52 subjects who underwent standard ETS by clamping the second thoracic ganglion (T2) between September 2002 and April 2005, the authors investigated the efficacy of this technique for facial blushing. The lead researcher, Dr. Sciuchetti reported that the effectiveness of T2 sympathectomy via ETS was excellent in all patients. This research study was published in the journal Minerva Chir, volume 61, pages 417-420.
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Does Quality of Life Improve after Endoscopic Thoracic Sympathectomy (micro ETS) ?

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

July 27, 2008

Researchers at the Department of Anesthesiology, Fujita Health University, School of Medicine, Banbuntane-Hotokukai Hospital, Japan have looked at Quality of Life measures after Endoscopic Thoracic Sympathectomy (micro ETS). The research was published in Annals of Thoracic Surgery (volume 80, pages 461-466) by lead author Dr. Kumagai. The author states that “improvement of the quality of life is a major goal of treatment. However, little attention has been given to quality of life after thoracoscopic sympathectomy, which is the first line of treatment for palmar hyperhidrosis. This study investigated the impact of thoracoscopic sympathectomy on subjective health-related quality of life (HRQoL) and psychological properties”. According to the authors, this study is “the first to show the pattern of impairment in health status and therapeutic impact in palmar hyperhidrosis patients. Hyperhidrosis is associated with impaired HRQoL. It was also demonstrated that thoracoscopic sympathectomy is safe, minimally invasive, and improves HRQoL, even if compensatory hyperhidrosis occurs.
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Quality of Life Measures after Sympathectomy for Facial Blushing and Hyperhidrosis

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

July 27, 2008

Quality of Life Measures after Sympathectomy (micro ETS) for Facial Blushing and Hyperhidrosis Dr. Jeganathan and colleagues at the Department of Thoracic Surgery, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland, UK have reported on quality of life issues after Sympathectomy for facial blushing and hyperhidrosis. The aim of this study was to evaluate the efficacy of bilateral thoracoscopic sympathectomy in alleviating symptoms and improving quality of life in patients with hyperhidrosis or facial blushing. As well, the researchers sought to determine the occurrence, severity and possible underlying factors to compensatory sweating after surgery. One hundred and sixty-three patients in a single institution were investigated who underwent bilateral thoracoscopic sympathectomy with a mean follow-up period of 51 months. Success rates were palmar 98.5%, axillary 96.4%, palmar and axillary 97.7% and facial blushing +/- facial hyperhidrosis 84%. The researchers found that compensatory sweating occurred in 77% of patients and its severity was related to the severity of the primary complaint. The research showed that “an improvement in quality of life was seen in 85% and a diminution of quality of life was noted in 5% due to compensatory sweating”. Dr. Jeganathan concluded from this study that bilateral thoracoscopic division of the sympathetic chain as opposed to resection can be performed effectively in patients with success rates higher than 90% and low recurrence rates.
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Saphenous Nerve Injury after Vein Stripping

By: Hratch Karamanoukian, MD

July 26, 2008

A prospective study looked at the incidence of saphenous nerve injury with total stripping of the great saphenous vein. The swtudy was performed by Dr. Flu and colleagues at the Department of Vascular Surgery, HagaHospital, The Hague, The Netherlands.
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Awake Sympathectomy for Hyperhidrosis Without Anesthesia - Are You Nuts ?

By: Hratch Karamannoukian MD

July 26, 2008

A study done in Rome at the Division of Thoracic Surgery, Tor Vergata School of Medicine, Policlinico Tor Vergata University looked at the feasibility of doing thoracic sympathectomy on awake patients using local anesthesia ! The surgeons compared bilateral thoracic sympathectomy using general anesthesia, as is typically used, to local anesthesia in awake patients. Dr. Elia anc colleagues reported in the European Journal of Cardiothoracic Surgery (volume 28; pages 312-317) that “awake one stage bilateral thoracoscopic sympathectomy for palmar hyperhidrosis could be safely and effectively performed as an outpatient procedure in patients refusing general anesthesia. Postoperative quality of life was equal to that in patients undergone the same procedure under general anesthesia, while patient satisfaction was better and cost were significantly reduced”. Having done well over a thousand cases myself, I would rather have this procedure under general anesthesia myself.
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Do Hyperhidrosis Patients Have Poor Tactile Acuity ?

By: Hratch Karamannoukian MD and Raffy Karamanoukian MD

July 25, 2008

That is the $ 64,000 question. What is tactile acuity? It is defined as “the keenness or sharpness of the sense of touch, usually measured by the two-point threshold. Also called touch acuity. Investigators at the Unit of Movement Disorders and Neuromagnetism, Section of Neurology, Fundacion Santa Fe, Bogota, Colombia; Uni.ciencias Research Group, Universidad Nacional, Bogota, Colombia looked at this phenomenon of tactile acuity in patients with hyperhidrosis and published the article in Neuroscience Letters in August 2008 (volume 29, pages 332-334). To test this hypothesis, they investigated tactile acuity and cortical plastic changes in patients with primary hyperhidrosis and their relatives who do not have hyperhidrosis. They found that “sensory processing is abnormal in primary hyperhidrosis, with a lack of plastic cortical somatosensory changes regardless of clinical condition. These modulatory abnormalities would affect gating processes in the somatosensory cortex of the brain.” These findings are interesting and their clinical significance should be elucidated in the future. Editor: I don't know what this means for patients with hyperhidrosis as the clinical significance of these findings are intersting - I question their clinical relevance.
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Is air pollution related to clots in the leg veins (DVT)?

By: Hratch Karamannoukian MD and Raffy Karamanoukian MD

July 24, 2008

A study published in the Archives of Internal Medicine 2008 (May 12th edition) by baccarelli and colleagues investigated wheter particulate air pollution exposure is related to venous thrombosis. The researchers showed in this landmark study that indeed "long-term exposure to particulate air pollution is associated with altered coagulation function and DVT risk and that other risk factors for DVT may modulate the effect of particulate air pollution". Needless to say, this study has caused a stir recently in the lay papers and magazines.
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Does air pollution alter blood coagulation and cause cardiovascular disease?

By: Hratch Karamannoukian MD and Raffy Karamanoukian MD

July 24, 2008

Consistent evidence has indicated that air pollution increases the risk of cardiovascular diseases. The underlying mechanisms linking air pollutants to increased cardiovascular risk have not been elucidated. A seminal study published in 2007 by a research group at Harvard “investigated the association between the pollution levels and changes in such global coagulation tests as the prothrombin time (PT) and the activated partial thromboplastin time (APTT)” to see if this would be a clue as to why air pollution increased the risk of developing cardiovascular disorders. The investigation by Dr. Baccarelli from the Department of Environmental Health, Harvard School of Public Health, Boston, MA shows that air pollution is associated with changes in the global coagulation function, suggesting a tendency towards hypercoagulability after short-term exposure to air pollution. The authors concluded further that “whether these changes contribute to trigger cardiovascular events remains to be established”.
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Eccrine Sweat Glands in Patients with Hyperhidrosis

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

July 24, 2008

Are there differences between eccrine sweat glands in patients with hyperhidrosis and patients without hyperhidrosis? A study published in the British Journal of Dermatology looked at the ultrastructural characterisitics of eccrine sweat glands in patients with hyperhidrosis. To determine whether the glands exhibit any structural abnormality in primary hyperhidrosis, skin biopsies were obtained from the underarms or neck of individuals aged 26-62 years with primary hyperhidrosis and from five normal individuals without hyperhidrosis.
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What are Eccrine Sweat Glands ? Hyperhidrosis

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

July 23, 2008

Eccrine sweat is produced via merocrine secretion and is composed of water, sodium, potassium lactate, urea, ammonia, serine, aspartic acid, heavy metals, organic compounds and proteolytic enzymes.
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Exercise Induced Asthmatics Less Likley to Have Hyperhidrosis

By: Hratch Karamanoukian, MD

July 22, 2008

An article published in the July edition of Chest reported thatn patients with exercise induced asthma have decreased muscarinic receptor dependent sweat gland secretion.
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Hyperhidrosis Caused by Drugs - Drug Induced Hyperhidrosis

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

July 21, 2008

Drugs that induce hyperhidrosis, or sweating in excess of that needed to maintain thermoregulation, can cause patient discomfort and embarrassment - these drugs include cholinesterase inhibitors, selective serotonin reuptake inhibitors, opioids and tricyclic antidepressants.
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Axillary Liposuction for Hyperhidrosis - Center for Excessive Sweating and EliminateSweating.com

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

July 20, 2008

This procedure has been done at the Center for Excessive Sweating for 2 years this July. We have been very successful in eliminating sweating in 95 % of patients, with 5 % requiring a second procedure for late relapse of underarm sweating at an average of 6 months after the procedure. The total number of patients treated so far has been 48.
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Is there a time of day at which antiperspirant should be applied in order to best relieve excessive sweating ?

By: Dr. Hratch Karamanoukian

July 18, 2008

An important study published in 2001 shows that there is a daily variation in the pH of skin and that this may influence effectiveness of aluminum chloride solutions for hyperhidrosis. Skin pH is highest in the morning and falls, meaning it becomes more acidic as the day goes on. The antiperspirants therefore are more effective when they are applied in the morning when skin pH is higher. This study was published in Int J Cosm Sci in 2001.
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How Does Aluminum Chloride Stop Excessive Sweating (Hyperhidrosis) ?

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

July 18, 2008

Aluminum chloride solutions work by the 'plug theory' - first proposed by Reller and Luedders - it utilizes the expression of eccrine sweat onto the surface of the skin into which the solid antiperspirant salts, typically an aluminium chlorohydrate dissolve. The resultant acidic 'solution' then diffuses with time into the sweat glands, where it hydrolyses in more alkaline sweat and forms an amorphous metal hydroxide agglomerate that physically plugs the ducts some 20-100 micrometers into the glands.
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Diabetes and Hyperhidrosis

By: Hratch Karamanoukian, MD

July 18, 2008

Diabetics can have anhidrosis or hyperhidrosis. Initially, patients display a loss of thermoregulatory sweating in a glove and stocking distribution that, with progression of autonomic neuropathy, extends from the lower to the upper extremities and to the anterior belly, conforming to the length of time one has had diabetes. This process ultimately may result in global anhidrosis. Hyperhidrosis may also accompany diabetic autonomic neuropathy. Excessive sweating may occur in diabetics as a compensatory phenomenon involving the head and trunk. Gustatory sweating, the abnormal production of sweat that appears over the face, head, neck, shoulders, and chest after eating even nonspicy foods, is occasionally seen in diabetics.
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Special Discount for Military Service and Family Members, Students at EliminateSweating.com for Hyperhidrosis Surgery

By: Dr. Hratch Karamanoukian

July 16, 2008

Call for our special discount to all U.S. Military service men and women, veterans and their family members. As well, college students get the same discount for hyperhidrosis surgery. Call 716-839-3638 for details. This applies to cash or credit card payments only.
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Palmoplantar Hyperhidrosis - Botox or Sympathectomy ?

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

July 16, 2008

A new study published by Baumgartner and colleagues in the July 2009 issue of the Annals of Vascular Surgery regarding thoracic Sympathectomy for palmar hyperhidrosis shows that “ 1. Compensatory hyperhidrosis was present in 56% of patients but only 3.2% of these had severe compensatory hyperhidrosis with significant discomfort. 2. All patients with severe compensatory hyperhidrosis were men. 3. There were no other significant operative complications. 4. The safety and overwhelming efficacy of sympathectomy compared to medical management of severe palmoplantar hyperhidrosis was demonstrated in this study. According to the authors, “rather than being a last resort," thoracic Sympathectomy can be confidently recommended as first-line treatment for the typical, severe form of palmoplantar hyperhidrosis
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New Study Shown Being Female is A Risk Factor for Compensatory Sweating

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

July 14, 2008

A study published in the European Journal of Cardiothoracic Surgery in July 2008 by Dr. PM Rodriguez and colleagues shows that "quality of life was excellent at discharge, 6 and 12 month in 100%, 100% and 97% of patients after thoracic sympathectomy". They also demonstrated once again that compensatory sweating is "the main and undesirable side effect, which is not related to the "extension" of thoracic sympathectomy (T2 vs T3/T4). However, these researchers have shown that "being female is the only predictor factor of suffering from compensatory sweating.
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Chemical Lumbar Sympathectomy for Hyperhidrosis of the feet

By: Hratch Karamanoukian, MD

July 13, 2008

A study in Korea by Dr. Kim and colleagues have investigated the use of chemical sympathectomy in the lumbar area to treat plantar hyperhidrosis, hyperhidrosis of the feet. Of 138 procedures, the number of successful blocks was 68 (49.3%) for L3 to L4 and 28 (20.3%) for L4 to L5. The degree of anhydrosis was excellent in 6 patients (8.7%), good in 32 patients (46.4%), fair in 32 patients (34.8%), and poor in 7 patients (10.1%). Of 69 patients, 56 (81.1%) were partially or fully satisfied.
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Children Tolerate Compensatory Sweating Better than Adolescents

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

July 9, 2008

A study published by researchers at the Hillel Yafee Medical Center in Israel shows that "the rate of compensatory sweating and its severity is tolerated better by children than adolescents. Children are defined as ages less than 14 years and adolescents above 14 years. They also show that "their postoperative satisfaction is higher than that of adolescents and adults".
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Axillary Hyperhidrosis at www.KareMD.com - Botox and Suction Curettage in Santa Monica - KareD.com

By: Hratch Karamanoukian, MD

June 1, 2008

Dr. Raffy Karamanoukian and Dr. Hratch Karamanoukian provide Botox therapy for axillary hyperhidrosis and Suction Curettage for axillary hyperhidrosis at Kare Medical Aesthetics in Santa Monica, California. To contact the office call 310-998-5533 or go to www.KareMD.com
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Hyperhidrosis Treatment in Los Angeles - Dr. Reisfeld and micro ETS procedure

By: Hratch Karamanoukian, MD

August 3, 2007

There is finally an effective surgical breakthrough for the treatment of excessive sweating! Excessive sweating of the hands, feet, and face, excessive facial blushing, or any combination of these conditions is known as hyperhidrosis. The surgical solution is available and in practice at The Center for Hyperhidrosis in Los Angeles, California. Here, leading expert Dr. Rafael Reisfeld can often times eliminate the discomfort and embarrassment of excessive sweating once and for all with a simple surgical procedure. For more information about the mocro ETS sympathectomy procedure for hyperhidrosis costing less than $7500 total call 716-839-3638 or visit www.EliminateSweating.com
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Women more likely to seek help for sweating

By: Reuters Life!

February 1, 2007

Women with clammy handshakes are twice as likely to seek medical attention as men with sweaty palms, according to a new U.S. study.
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Excessive Sweating: Primary Hyperhidrosis or Sign of an Underlying Disease?

By: Dr. Hratch L. Karamanoukian

December 20, 2006

Localized sweating in the palms, armpits or feet in an otherwise healthy person is primary hyperhidrosis, but it is important to rule out other possible causes.
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Hyperhidrosis in The Buffalo News

By: Dr. Hratch L. Karamanoukian

December 20, 2006

"When Sweating is a Problem"
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Anti-depressants and Excessive Sweating

By: Dr. Hratch L. Karamanoukian and Dr. Raffy Karamanoukian

December 20, 2006

Unwanted sweating is a common side effect of treatment with anti-depressants.
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Newly Published Research on Inheritance of Hyperhidrosis

By: Dr. Hratch L. Karamanoukian

November 23, 2006

Study reiterated that a large percent (62%) of patients with primary hyperhidrosis indicated that they had a family history of hyperhidrosis.
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Stigma Associated with Hyperhidrosis

By: Dr. Hratch L. Karamanoukian

September 23, 2006

Patients were surveyed regarding this subject and found to have significant social phobias associated with having hyperhidrosis.
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Hyperhydrosis Surgery: Clipping the Correct Nerve Trunk

By: Dr. Hratch L. Karamanoukian

April 23, 2006

Explanation of which nerve trunks should be clipped to treat each problem area.
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The Autonomic Nervous System - A Preview to the Nervous System that is Responsible for Hyperhidrosis

By: Dr. Cristina Lampuri

July 2, 2005

The ANS is an involuntary and reflexive system working to control blood vessels, the heart, and all organs in the chest, abdomen, and pelvis, without our conscious control.
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Researchers Assess the Quality of Life of Patients Who Underwent Thoracic Sympathectomy

By: Dr. Hratch L. Karamanoukian

July 2, 2005

The authors concluded that "thoracic sympathectomy is a simple, effective, safe method for the treatment of hyperhidrosis, resulting in an improved quality of life for patients."
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