門診時間表
    自體毛髮皮膚微移植
    王祥亞醫師特別門診
    拒當凹臉苦命婦!Sculptra舒顏萃讓媽咪美麗再現
    林口桃園龜山何文藻醫美皮膚整外愛笑大媽逆轉時光Vianne的自體補臉日記
    狐臭手術預防血腫
    修眼袋兼自體脂肪補脂
    醫療團隊發表論文
    何醫師狐臭手術刊登於國際期刊
    舒顏萃
    玻尿酸
    第三代海芙音波
    腋淨爽多汗症
    林口龜山何文藻醫美/玻尿酸/甘味人生中的薇薇回到吐司男之吻的年代
    林口龜山何文藻醫美/雙機拉提
    林口龜山何文藻醫美/自體脂肪補臉、豐頰、豐額、豐蘋果肌
    林口龜山何文藻醫美/舒顏萃
    林口龜山何文藻皮膚科/全民健保
    林口龜山何文藻醫美/舒顏萃
醫學美容 | Service
Home > 醫學美容 > 林口龜山醫美微創狐臭手術

狐臭手術國際期刊演講

分類:林口龜山醫美微創狐臭手術

狐臭手術國際期刊演講

以下我於雷射醫學會,美容醫學會分享2016年四篇在國際上發表的狐臭相關論文,與各位分享~~~

 

狐臭手術


My name is Jacob Wen-Tsao Ho. I am dermatologist in Taiwan practicing in my own private clinic. Thank you for having me here. I would like to present My new concepts in osmidrosis surgery.



Let me briefly introduce you the anatomy of sweat gland. Human has two kind of sweat glands. One is eccrine gland which is everywhere in the body, directly open to the surface and is responsible for the sweat secretion. The other is apocrine gland which is bigger and visible and attached to the follicle located in axillary area and responsible for the malodor. 狐臭,一般來說人的體味大概可以分成兩大類:一個就是汗臭味,一個就是狐臭味。基本上藉著簡單的理學檢查,就可以分辨這兩個味道。一般來說,狐臭有一股特別的味道,在理學檢查的時候,患者通常可以發現有濕耳朵的情形。在生理的結構上,我們的汗腺可以分成兩種:一個就是小汗腺,小汗腺就像毛線球一樣,互相纏繞,最後它的管子會直通到表皮,主要是將汗水排出體外,所以當我們在運動或者是體溫比較高的時候,我們就會藉著小汗腺將汗水排出來,達到調控體溫的作用。小汗腺的分布基本上廣布在全身的表皮上面。另外一個叫做大汗腺,大汗腺又叫做頂漿腺。它的分布只侷限在如腋下或者是跨下等,所以頂漿腺它主要是分泌一種特殊的脂肪酸,這些脂肪酸經過細菌酵素的催化以後,就會產生一股濃郁特殊的臭味,我們簡稱叫狐臭。

 

狐臭手術


Differential diagnosis between hyperhidrosis and osmidrosis ==PE : wet earwax, body malodor
Treatment included non-invasive antiperpiratant , fragrance, botox, Nd-Yag, Radiofrequency, microwave thermolysis (Miradry), surgical intervention: liposonix , subdermal trimming, liposuction curettage , curettage

狐臭的治療方式:

非侵入式:體香劑、止汗劑、Nd-Yag雷射、微波熱分解Miradry

侵入式:微創狐臭手術、旋轉刀刮除、傳統手術等等。


林口狐臭


I would like to share my 4 article accepted in 2016 by international journals of MJD from Malaysia, dermatologic surgery from US, JPRAS for UK and IJSSP for India.
2016年的狐臭手術國際期刊如上
1. (馬來西亞期刊)Malay journal of dermatology Genotyping at the SNP rs17822931 can help the clinical diagnosis of body malodor in doubt
2. (美國期刊)Dermatologic surgery Following Changes in the Axillary Secretions of Two Patients Before and After Bromhidrosis Surgery Using Liquid Chromatography-Mass Spectrometry. Ho WT, Lee LJ, Pan JY. Dermatol Surg. 2016 Sep 28.
3. (英國期刊)Reply "A comparison of two different sub-dermal trimming techniques for the treatment of axillary osmidrosis". Ho WT. J Plast Reconstr Aesthet Surg. 2016 Jun 16

 

 



A 37-year old patient has a chief complaint of over perspiration and body odor for a length of time and has been bothered by it. This is especially during summer or after strenuous exercise. These problems have seriously affected his personal relationships with others and the opposite sex. He had consulted many doctors who then had different diagnosis, from acidity of his sweat and body odor. At times, he would use antiperspirant, which gave some relief. The patient lost confidence because of different diagnosis from different doctors, and he was being bothered by his odor that had caused him to lose his self-esteem. How to do?

大部分有狐臭的患者到門診,有經驗的醫師通常可以給予正確的診斷,藉著嗅聞患者的腋下味道,問診上可能搭配濕耳朵wet ear-wax增加佐證,或者家族中有明顯的遺傳證據,就可以輕易地決定是否可以接受狐臭手術。但是在案例眾多的裡面,我們仍然會遇到診斷上不是那麼容易,或者是模稜兩可的情形。最多混淆的情形就是多和造成的汗臭味或者是狐臭因此對於下一步的治療上,會對臨床醫師造成困擾。
一位37歲的患者到門診主訴容易流汗且長期被體味所困擾,
自覺影響其人際關係,間斷曾經求診多位醫師,有些醫師理學檢查覺得味道像汗酸臭味,有些覺得像狐臭期間雖然使用止汗劑會稍微改善,但他想要知道自己到底有沒有狐臭。因為狐臭通常伴隨濕耳朵,但病患自己耳道覺得不會溼也不會乾,理學檢查也無法提供濕耳朵的證據,因此此部分的佐證證據不強。病患對不同醫師反覆不同的診斷漸漸失去信心,但又被體味困擾,造成其心情下沉。


林口狐臭


According to literature, Yoshiura et al. publised that a SNP, 538G > A (rs17822931), in the ABCC11 gene, can determine the dry or wet type of the earwax. The AA genotype corresponds to dry earwax, and the GA and GG to wet type. The strong association between the wet earwax-related genotypes (GG and GA) and bromhidrosis suggest SNP genotype can be a good marker for the diagnosis of bromhidrosis.

目前有許多的文獻告訴我們溼耳朵和基因有很強的相關性,而臨床上溼耳朵和狐臭又有很強的關聯性。我們針對他基因檢查有SNP rs1782291的Genotype,有此佐證則加強了狐臭診斷,建議患者做狐臭手術,若沒有則建議單純處理多汗的問題。

 

林口狐臭


狐臭基因檢測,在臨床上,常遇到做過狐臭手術又復發的案例。他們最大的困擾在於自己的味道是純粹汗臭還是真狐臭?
雖然大部分的狐臭患者伴有濕耳朵(耳屎是濕的)現象,但這只能說兩者具相關性卻不能作為診斷的工具。醫學的發展雖然日新月異,針對這類病人,大部分臨床醫師在診斷上卻沿用了最古老直接的方式〜〜聞聞看。雖然很方便但準確度實在不夠精確。所以針對那些無法100%確認自己是否患有狐臭的患者,狐臭基因檢測(SNP rs17822931 in the ABCC11 gene)。

 

 

We decided to do a genetic study which was positive for Single nucleotide polymorphism (SNP) rs1782291 with G genotype. Polymerase chain reaction (PCR) amplification with around 300bp product including rs17822931 was performed. Restriction fragment length polymorphism analysis (RFLP) was done with non-template control. The existence of allele A generates a 200bp and 100bp product following BseMII digestion. The AG and AA genotypes of rs17822931 gave three bands and two bands respectively in 2% agarose gel electrophoresis (fig.1)

Sequencing chromatogram of the sample indicated AG heterozygous


狐臭手術


Although the mutation found in this report is not novel, we would like to emphasize genetic studies can further help in the diagnosis of patients with a strong family history or whose diagnosis is in doubt.

微創狐臭

 

狐臭手術


As many of you know, lots of bromhidrosis surgery studies can be found on the PUBMED. Try doing searches on either osmidrosis or recurrence, you will find quite a lot, talked about relapse rate but few uses objective and quantitative way to define what the recurrence is; is it simply the smell called by one or the others?
So, that’s the reason behind my study and I would like to share with you all of my findings.
為什麼我要做這個狐臭手術效果的研究呢?
因為當我們上PUBMED上閱讀關於狐臭手術,您會發現有很多談到關於”復發”比率,簡單用osmidrosis(狐臭)和recurrence(復發)做搜尋,你會發現有很多文章提到recurrence(復發)。可是我們卻很少有一個客觀定量的方式去表明何謂recurrence(復發),是主觀上有一點點的味道或全然的味道出現稱為復發?或是客觀上被聞到叫復發? 我們也不知道復發的嚴重情形是如何?

 


This article shown 5% recurrence occurred was mentioned, but we do not know precisely how the author defines it. Is a slight relapse? Or utter relapse?
這篇提到追蹤復發,但是我們不知道它如何定義狐臭手術的復發

 


This article referred to comparing the recurrence rate of two procedures, but we do not know how to accurately compare the smell. Based on the above factors, I would like to find a quantitative measurement for surgeons so that each has a scientific communication platform. 這篇都提到兩種術式去比較狐臭手術後的復發率,但是我們不知道它如何精確地去比較兩者的味道。基於上述的因素,我們想要去找的一個科學話定量的方式,讓每位施作狐臭手術醫師有科學化的溝通平台。

 

狐臭

 

狐臭


Proposed scheme for the release of odoriferous acids by skin bacteria. 這是狐臭氣味的化學結構,圖示被細菌代謝的路徑。

 


The 2 patients ran on a treadmill for 20 min at room temperature for 3 consecutive days before surgery and 2 months and 6 months after surgery. Factors such as room temperature, mood, and body condition were controlled. The bilateral armpits were washed repeatedly with a total of 5 mL distilled water on each side, and the water and sweat were collected together. The specimens collected on the 3 consecutive days before surgery were combined, leaving three pools for analysis: before, 2 months after, and 6 months after surgery. Surgical satisfaction was also measured.



Perhaps you might ask why use 5cc of distilled water to rinse the armpits
If pre-surgery is x, and post-generate y, the molecule concentration before surgery is x/5cc; same thing goes for post-surgery (y/5cc). Which means the proportion is still divided between x and y.
It wouldn’t matter much water used, as long as the same amount of the water use for pre and post operation; more flushing water used, the more we can ignore the sweat volume effect. 或許你會問為何用5cc蒸餾水去沖洗腋下,如果術前是x,術後產生y,術前的味道分子濃度 x/5cc,術前的味道分子濃度 y/5cc,兩者相除比例仍為x/y
不因為你用多少水有影響,只要術前術後等量即可,而且沖洗的水體積越多,越能夠忽略流汗體積的效應。

 

 


We aimed to evaluate these physiological changes in patients Using Liquid Chromatography-Mass Spectrometry. Apocrine gland secretions contain many odorous fatty acids, including linear saturated, linear unsaturated, and branched unsaturated C6-C11 acids.1, 2 Here, we measured (E)-3-methyl-2-hexenoic acid (3M2H), a C7 branched unsaturated fatty acid found in human apocrine gland secretions that has a particularly strong stench, especially in Caucasians and Asians



~~~~~the 3M2H change on the 1st patient.
Pre-OP: 223,796 (two hundred twenty-three thousands, seven hundred and ninety-six) caps
2 months after the surgery, dropped down to 3,069 (three thousand and sixty-nine) caps, a decrees of 98% compare to pre-op.
But, six month after the surgery, the number went up a little to 13,154 (thirteen thousand one hundred and fifty four) caps; slight increase from four month ago.
~~~~the HMHA change on the 1st patient.
Pre-OP: 658,062 (six hundred fifty-eight thousands and sixty-two) caps
2 months after the surgery, dropped down to 9,284 (ninety-two hundred and eighty-four) caps, a decrees of 98% compare to pre-op.
But, six month after the surgery, the number went up to 41,544 (forty-one thousand five hundred and forty-four) caps; an increase of 3.5% from four month ago.
~~~~ the 3M3SH change on the 1st patient.
Pre-OP: 102,965 (one hundred and two thousands, nine hundred and sixty-five) caps
2 months after the surgery, dropped down to 1,367 (thirteen thousand and sixty-seven) caps, a decrees of 98% compare to pre-op.
But, six month after the surgery, the number went up a little to 5,352 (five thousand three hundred and fifty two) caps; slight increase from four month ago.

林口狐臭手術

 

Copyright © 2015 何文藻皮膚科診所暨醫學美容 All Rights Reserved 請尊重智慧財產權,勿任意轉載,違者依法必究。
新北市林口醫美整型, 電話:02-26084383 醫美專線:02-26069627