Thoracic sympathectomy in the treatment of hyperhidrosis
Bibliographic record
Abstract
Epidemiology and etiology Despite patients’ reluctance to seek out medical attention, hyperhidrosis is not as rare a disorder as would be perceived and has historic roots in the medical literature. The condition is divided into primary and secondary hyperhidrosis. Secondary hyperhidrosis is a generalized sweating typically affecting the entire body and is consequent to underlying metabolic, neoplastic, infectious or endocrine conditions. Some examples of these conditions include diabetes mellitus, hyperthyroidism, carcinoid syndrome, malignancies such as lymphoma, tuberculosis, systemic shock, heart failure, Parkinson's disease and spinal cord injuries. In contrast, primary (idiopathic) hyperhidrosis is typically focal and is defined as the production of sweat by eccrine glands that is beyond the body's physiological parameters for thermoregulation. Usually this is an exaggerated response to a physiological stress or emotional/psychological stimulus. Moreover, primary hyperhidrosis is subcategorized based on location (palmar, plantar, axillary or craniofacial). For the purposes of this chapter, the term ‘hyperhidrosis’ will be used to refer more specifically to primary hyperhidrosis. The incidence of hyperhidrosis varies in the literature. An earlier Israeli study reported incidence rates of 0.6–1.0%. More recent evidence suggests that the prevalence of hyperhidrosis is higher, ranging from 2.8% in the United States to 4.6% in specific parts of China. An estimate suggests that the condition affects roughly 7.8 million individuals in the United States. The variability in epidemiologic data reflects two principles characteristic of hyperhidrosis. First, the definition of hyperhidrosis is unclear, largely leading to subjective reliance for diagnosis, as well as the potential for over- or under-reporting. Second, individuals suffering the condition often do not seek medical care, either due to social discomfort or to a lack of knowledge of possible treatment options. Commonly, individuals are diagnosed early in adulthood, considering the role of pubertal heightening of the disorder. Gender distribution is equal, with the greatest prevalence existing among working-age adults. Moreover, a genetic predilection appears to exist, with 25–50% of cases demonstrating an autosomal dominant pattern of inheritance of variable penetrance. This familiar pattern of inheritance appears to be more strongly correlated with individuals presenting prior to the age of 20. Focally, the most common site for severe disease appears to be palmoplantar hyperhidrosis of the palms and soles. Other common sites for severe disease include the combination of the palms and axillae (15–20%), the axillae alone (5–10%) and craniofacial region (5%).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.008 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".