Chun-Gu Cheng1, Chun-An Cheng2, Wu-Chien Chien3, Chi-Hsiang Chung3, Jiunn-Tay Lee4. 1. Department of Emergency Medicine, Xin Tai General Hospital, New Taipei, Taiwan; Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Emergency, Armed Taoyuan General Hospital, Taoyuan, National Defense Medical Center, Taipei, Taiwan. 2. Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. 3. Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan. 4. Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. Electronic address: jiunntay@gmail.com.
Abstract
BACKGROUND: Endoscopic thoracic sympathectomy (ETS) was performed to cure palmar hyperhidrosis (PH). After ETS, blood pressure decreased, and cerebral flow velocity increased within 1 month. However, no studies distinguish between subsequent ischemic and hemorrhagic stroke following ETS for PH. The association between stroke type and PH after ETS must be evaluated. METHODS: We surveyed newly diagnosed patients with PH using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic code 780.8 from the Taiwan Longitudinal National Health Insurance Database. We matched patients with PH who underwent ETS (procedure code 05.29) and without surgery in the database between 2000 and 2010. We defined events as ischemic stroke (ICD-9-CM codes from 433 to 437) or hemorrhagic stroke (ICD-9-CM codes from 430 to 432). Patients were followed up until the first event or December 31, 2010. Risk factors for ischemic stroke and hemorrhagic stroke were analyzed using multivariable Cox proportional hazard regression. RESULTS: The incidence of ischemic stroke was significantly lower in patients who underwent ETS (.22%) than in patients without surgery (.65%). The patients with PH who received ETS exhibited a reduced risk of ischemic stroke (adjusted hazard ratio [HR] .3; 95% confidence interval [CI] .12-.77). ETS treatment was not associated with a reduction in hemorrhagic stroke (adjusted HR .81; 95% CI .22-3; P = .755). CONCLUSIONS: ETS in patients with PH was associated with reduced subsequent ischemic stroke risk. This additional ischemic stroke preventive effect should encourage health-care supporters to perform ETS in patients with severe PH.
BACKGROUND: Endoscopic thoracic sympathectomy (ETS) was performed to cure palmar hyperhidrosis (PH). After ETS, blood pressure decreased, and cerebral flow velocity increased within 1 month. However, no studies distinguish between subsequent ischemic and hemorrhagic stroke following ETS for PH. The association between stroke type and PH after ETS must be evaluated. METHODS: We surveyed newly diagnosed patients with PH using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic code 780.8 from the Taiwan Longitudinal National Health Insurance Database. We matched patients with PH who underwent ETS (procedure code 05.29) and without surgery in the database between 2000 and 2010. We defined events as ischemic stroke (ICD-9-CM codes from 433 to 437) or hemorrhagic stroke (ICD-9-CM codes from 430 to 432). Patients were followed up until the first event or December 31, 2010. Risk factors for ischemic stroke and hemorrhagic stroke were analyzed using multivariable Cox proportional hazard regression. RESULTS: The incidence of ischemic stroke was significantly lower in patients who underwent ETS (.22%) than in patients without surgery (.65%). The patients with PH who received ETS exhibited a reduced risk of ischemic stroke (adjusted hazard ratio [HR] .3; 95% confidence interval [CI] .12-.77). ETS treatment was not associated with a reduction in hemorrhagic stroke (adjusted HR .81; 95% CI .22-3; P = .755). CONCLUSIONS:ETS in patients with PH was associated with reduced subsequent ischemic stroke risk. This additional ischemic stroke preventive effect should encourage health-care supporters to perform ETS in patients with severe PH.
Authors: Chun-An Cheng; Yu-Cheng Liang; Yin-Han Chang; Chun-Gu Cheng; Chi-Hsiang Chung; Wu-Chien Chien Journal: Int J Environ Res Public Health Date: 2021-04-28 Impact factor: 3.390
Authors: Jae-Min Park; Duk Hwan Moon; Hye Sun Lee; Ju-Young Park; Ji-Won Lee; Sungsoo Lee Journal: Int J Environ Res Public Health Date: 2019-10-15 Impact factor: 3.390