Sympathetic surgery in cerebral vascular disorders

Mars Chir. ;4 (1):83-8 14956138 (P,S,E,B)
Sympathetic surgery in cerebral vascular disorders.
J BONNAL
Mesh-terms: Brain :: blood supply; Intracranial Embolism and Thrombosis :: surgery;

Increased blood flow reduces perfusion of the small blood vessels

The action of sympathectomy is felt to be an increase in collateral flow; the circulation cannot be restored to normal since the flow in the aggregate of small arteries is less than normal.
Miller, J. E.: Anatomy cf the Heart and Great
Vessels. Angiocardiographic Study. Texas State
J. Med. 47: 5 (Jan.), 1951.

decreased nasal patency and increased nasal airflow resistance

Contralateral rhinorrhea as a feature of infantile Horner's ...
... decreased nasal airway patency, and increased nasal airflow resistance. ... Nasal obstruction after cervical sympathectomy: Horner’s syndrome revisited. ...
www.neurology.org/cgi/content/full/61/9/1309

a watery nasal fluid is formed dur-
ing a pronounced vasoconstrictor response and that the
fluid formation is reduced by ipsilateral sympathectomy
A role for the nasal cycle in respiratory defence
R. Eccles

Simultaneous optimal stimulation of the autonomic nerves resulted in vasoconstriction, especially of the capacitance vessels. Hence, nasal congestion may be related more to a withdrawal of sympathetic discharge than to an overactivity of the parasympathetic nerves.
The Role of the Autonomic Nerves in the Control of Nasal Circulation
Mary A. Lung

Department of Physiology, Faculty of Medicine, University of Hong Kong, Hong Kong
Neurosignals 1995;4:179-185

Selective brain cooling, decrease is nasal airway patency

Selective brain cooling after bilateral superior cervical sympathectomy in sheep (Ovis aries)
Mark J. M. Nijland, Duncan Mitchell and Graham Mitchell

...hypothalamic temperture during all procedures. Respiratory rate was also depressed by the sympathectomy, apparently mainly as a result of a decrease in nasal airway patency...
Pflügers Archiv European Journal of Physiology, Volume 417, Number 4 / December, 1990

Pineal gland

Loss of histochemically demonstrable catecholamines and acetylcholinesterase from sympathetic nerve fibres of the pineal body of the rat after chemical sympathectomy with 6-hydroxydopamine
Olavi Eränkö and Liisa Eränkö
The Histochemical Journal, Volume 3, Number 5 / September, 1971

Cervical sympathectomy affects ...testosterone in male rats

Cervical sympathectomy affects gonadotropin-releasing hormone, luteinizing hormone and testosterone in male rats
Hiroshi Iwama, Choichiro Tase, Yoshikazu Tonosaki and Yasuo Sugiura

Abstract To examine the effects of bilateral cervical sympathectomy on the secretion of gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH) and...
Journal of Anesthesia, Volume 9, Number 2 / June, 1995

no change in temperature of the forehead, yet, decrease of sweating?

During the procedure we found a significant acute decrease in systolic and pulse pressures, from 153 ± 10 to 127 ± 9 and from 80 ± 7 to 56 ± 4mmHg respectively, and a lesser decrease in diastolic pressure; heart rate showed no statistically significant changes.

Skin temperature at the forehead, axilla, loin, and sole of the foot, all measured bilaterally, showed no significant increase, although there was a decrease in sweating in both forehead and axillary regions.

http://www.ingentaconnect.com/content/klu/10286/2004/00000014/00000004/art00012#aff_1
Clinical Autonomic Research, Volume 14, Number 4 / August, 2004

Denervation of the eye

Journal Article
Adrenergic denervation of the eye by unilateral cervical sympathectomy
B. Ehinger, B. Falck and E. Rosengren

adrenocorticotropic hormone

Cervical sympathectomy affects adrenocorticotropic hormone and thyroid-stimulating hormone in rats
Hiroshi Iwama, Mamoru Adachi, Choichiro Tase and Yoichi Akama

Abstract To examine the effects of bilateral cervical sympathectomy on the secretion of adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), growth...
Journal of Anesthesia, Volume 10, Number 3 / September, 1996

The connection between psyche and sympathetic nervous system

Timo Telaranta M.D., Ph.D. and Paivi Pohjavaara M.D., Privatix Clinic,

Tampere, Finland

In the central nervous system the arousal requires the brain stem, the
thalamus and the cortex, attention is maintained in the right frontal
lobe; the formation of memories happens in the medial temporal lobe, certain
diencephalic nuclei and the basal forebrain. The amygdala rates the
emotions of an experience. The limbic system is the centre of the human drives,
their regulation requires an intact frontal cortex. The injury in the
frontal lobe impairs the executive functions as motivation and attention.
The sympathomedullary system and locus coerulaeus are activated in
depression, mania, panic disorder and acute phases of schizophrenia. The
autonomic nervous system is one of the most important mediators between
the mind and the body. It has two roles in this function:
the role in basic metabolic function as in energy storage and release, in
the control of exocrine secretion and thus intake, in conservation, loss, and
transformation of energy the role in behaviour, where the hypothalamus
is involved in alert and defense reactions.

The sympathetic system is defined as an energy consumption system and
the parasympathetic system is an energy conserving and balancing force.
The sympathomedullary system is activated in various mental disorders.
The biopsychosocial model is clearly seen in the social phobia. The "fight
or flight - response of the sympathetic system can also be seen in the
physical signs of the social phobia when the patient is in the centre of
attention. With sympathetic overload the patient starts to fear the
triggering situations and avoid them.

The need-adaptive approach adjusts treatment plans of socially phobic
patients who haven't had any help of medication and psychotherapy. It
seems possible to treat their symptoms and cut the vicious circle of
social phobia blocking the sympathetic system in the upper thoracic level with
a surgical procedure. If a patient with the social phobia hasn't had any
help of conventional treatment methods such as medication and psychotherapy,
the sympathetic block could be a treatment of choice for them.

Sympathectomy in the treatment of addiction

Pohjavaara P(l,2), Telaranta T(3), ja Vaisanen E(l); (i)0ulu University

Psychiatric Clinic, Finland (2)Tampere City Mental Health Care Centre,
Finland and (3)Privatix-Clinic,Tampere, Finland

Addiction problems are common in people with psychiatric disorders.
The addiction may be a primary or secondary problem.
The secondary addiction problems appear due to patients' attempts to
"treat" themselves with e.g. alcohol or excessive medication, especially
benzodiazepins. Social phobia is an example of a primary psychiatric
disorder, which leads to secondary addiction problems in about 20 % of
the patients.

Our patient had suffered from social phobia and its secondary problems
already from the childhood and she recovered from a serious alcohol and
drug addiction after successive treatment of her social phobia with ESB.

abolition of reflex secretion of adrenaline

Smithwick, R. H.: An Evaluation of the Surgical
Treatment of Hypertension. Bull. New York Acad. 1949.
The author discusses the effect upon hypertension of unilateral nephrectomy and removal of adrenal tumors but, principally, he considers his experience with operations on the sympathetic nervous system. The two principal known actions of sympathectomy are modification of blood pressure levels and modifications of the reflex regulation resulting from the inactivation of important components of the vasoconstrictor mechanism. Presumed effects of sympathectomy are abolition of reflex secretion of
adrenaline and stabilization of 1l)ood flow through the denervated vascular bed.

diminution of the myocardial concentration of epinephrine

It is known that sympathectomy is followed by a marked diminution of the myocardial concentration of epinephrine-like catechols.
Raab, W., and Lepeschkin, E.: Biochemical Versus
Hemodynamic Factors in the Origin of Hyperten-
sive Heart Disease. Acta med. Scandinav. 138:
81 (June), 1950.

Definiton of sympathectomy: interruption of the efferent motor innervation of the heart

the increased effort tolerance after sympathectomy is primarily
a result of interruption of the efferent motor in-
nervation of the heart rather than division of sen-
sory pathways.


CORONARY ARTERY DISEASE
Apthorp, G. H., Chamberlain, D. A., and Hay-
ward, G. W.: The Effects of Sympathec-
tomy on the Electrocardiogram and Effort
Tolerance in Angina Pectoris. Brit. Heart
J. 26:218 (March), 1964.

ETS attenuates autonomic circulatory response

Takashi Suzuki1, Yutaka Masuda1, Makoto Nonaka2, Mitsutaka Kadokura2 and Akiyoshi Hosoyamada1
(1) Department of Anesthesiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan, JP
(2) First Department of Surgery, Showa University School of Medicine, Tokyo, Japan, JP
Abstract
Purpose. Our purpose was to examine perioperative alterations in hemodynamic changes with head-up tilt (HUT) in patients undergoing endoscopic thoracic sympathectomy (ETS).
Methods. The subjects were 11 patients with essential hyperhidrosis scheduled to undergo ETS (ETS group) and 9 age-matched volunteers undergoing minor surgery (control group). HUT was performed (40°; 5 min) before and after the surgery, under nitrous oxide anesthesia. Orthostatic hypertension and hypotension in response to HUT were defined as changes of 10% or greater in systolic blood pressure.
Results. The increase in heart rate in response to HUT was significantly reduced after surgery in the ETS group (from 34 ± 18 to 14 ± 11 beats·min−1; P < 0.001), but not in the control group (from 23 ± 18 to 22 ± 12 beats·min−1; P = 0.911). Orthostatic hypertension disappeared completely after ETS (from 5 of 11 to none of 11 patients; P = 0.035), whereas the prevalence of orthostatic hypotension increased significantly after ETS (from 3 of 11 to 9 of 11 patients; P = 0.030). In the control group, the prevalence of neither orthostatic hypertension nor orthostatic hypotension changed after surgery.
Conclusions. ETS attenuates autonomic circulatory response under nitrous oxide anesthesia.

SpringerLink Date Friday, February 01, 2002

Ventricular Ectopic Rhythms and Ventricular Fibrillation following Sympathectomy

Harris, A. S., Estandia, A., and Tillotson, R. F.:
Ventricular Ectopic Rhythms and Ventricular
Fibrillation following Cardiac Sympathectomy and
Coronary Occlusion. Am. J. Physiol. 165: 505
(June), 1951.
Abrupt coronary artery occlusion in dogs with
open chest is followed by a 10 minute period (phase
I) of ectopic discharges of increasing frequency which
either pass through a maximum and then decrease
or end in fibrillation. A two stage occlusion avoids
the danger of fibrillation in this phase. During the
next four and one-half to eight hours the ectopic
frequency is no more than 5 per minute (phase II)
in those animals which survive. Following this there
is a rapid increase in ectopic frequency (phase III)
which reaches a maximum in 10 to 20 hrs. after the
artery has been tied. This ectopic activity usually
lasts two to four days. Experiments were devised to
obtain evidence concerning the effects of upper
thoracic sympathectomy upon the occurrence of
ectopic ventricular complexes during each of these
three phases. The authors, as a result of their ex-
periments, came to the point of view that "multiple
excitatory factors contribute to the production of
ectopic impulses following coronary occlusion during
all three phases and that sympathetic nerve excitation is one of these factors.

disabilities or inconveniences

The symptoms referable to hypertension were
definitely reduced or eliminated by sympathectomy.
The eyeground findings were also markedly changed
in the direction of normalcy. However, there were
very few electrocardiographic alterations postopera-
tively.
The authors conclude that the extensive sympa-
thectomy performed by them retards and in some
instances arrests the progression of the hypertensive
disease process. However, they emphasize the fact
that this type of operation is associated with certain
disabilities or inconveniences, such as pain, which
may be intense, postural lowering of blood pressure,
producing dizziness and other symptoms, excessive
sweating in areas of regeneration or in areas not de-
nervated, and obstruction of nasal airways caused by
swelling of the mucous membranes.

Grimson, K. S., Orgain, E. S., Anderson, B., Broome,
R. A., Jr., and Longino, F. H.: Results of Treat-
ment of Patients with Hypertension by Total
Thoracic and Partial to Total Lumbar Sympathec-
tomy, Splanchnicectomy and Celiac Ganglionec-
tomy. Ann. Surg. 129: 850 (June), 1949.

marked athropy of the extremity, etc

Contraindications to the use of sympathectomy
are marked atrophy of the extremity with loss of
subcutaneous tissues and consequent diminution in
the available vascular bed, constant intractable pain
uninfluenced by sympathetic block, the rapid onset
of symptoms and a rapidly progressive vascular lesion.
BLOOD VESSELS AND VASCULAR
DISEASE
Blain, A., III, and Campbell, K. N.: Lumbar Sympa-
thectomy for Arteriosclerosis Obliterans. Surgery
25: 950 (June), 1949.

Neurotransmitter metabolism in the carotid body has also been shown to be regulated by the neural innervation to the organ.

Z.-Z. Wang†, a, B. Dingera, S.J. Fidonea and L.J. StensaasCorresponding Author Contact Information, a

aDepartment of Physiology, University of Utah School of Medicine, Salt Lake City, UT 84108, U.S.A.

Accepted 19 August 1997.
Available online 17 August 1998.

Role of catecholamines in Depression, Parkinson's and Hypertension

Drugs therapeutically effective in the treatment
of affective disorders and neurological and cardiovascular diseases have also
been shown to influence the uptake, storage, release, formation and metabo-
lism of catecholamines. These findings implicating the peripheral and central
synpathetic nervous system have provided insight into the causes and treat-
ment of mental depression, Parkinson’s disease and hypertension.

Julius Axelrod
NOBEL - LECTURE 1970


.

Adrenal Tyrosine Hydroxylase: Compensatory Increase in Activity after Chemical Sympathectomy

Robert A. Mueller 1, Hans Thoenen 1, and Julius Axelrod 1

1 Laboratory of Clinical Science, National Institute of Mental Health, Bethesda, Maryland 20014

Destruction of peripheral sympathetic nerve endings with 6-hydroxydopamine causes a disappearance of cardiac tyrosine hydroxylase, accompanied by a twofold increase in adrenal tyrosine hydroxylase and a small increase in phenyl-ethanolanine-N-methyl transferase.
Science 31 January 1969:
Vol. 163. no. 3866, pp. 468 - 469

Postoperative complications are frequent after ETS

[Postoperative complications are frequent after surgery for palmar sweating and facial redness. Effects of the treatment must be considered with regard to the risk of side-effects]
[Article in Swedish]

Räf L.

Patientskadenämnden och Landstingens Omsesidiga Försäkringsbolag, Stockholm.

sympathectomy, preventing noradrenaline release

Bretylium
Class III
Mode of action
- increases action potential duration and refractory period of cardiac cells
- antifibrillatory effect on ventricular muscle - may be more important than class
III effects in emergency treatment of malignant ventricular arrhythmias
- initially causes noradrenaline release and then produces the equivalent of a
sympathectomy, preventing noradrenaline release (class II effect)

ANTIARRHYTHMICS
© Charles Gomersall July 1999

BP reduction

Thus sympathectomy enhances sensory neuron CGRP and SP expression that contributes to the BP reduction.


S. C. Supowit,1 R. T. Ethridge,2 H. Zhao,3 K. A. Katki,1 and D. J. DiPette

Am J Physiol Heart Circ Physiol 289
Submitted 21 September 2004 ; accepted in final form 4 May 2005

Sympathetic regulation of the cerebral circulation by the carotid chemoreceptor reflex

S. F. Vatner, L. L. Priano, J. D. Rutherford and W. T. Manders

The effects of carotid chemoreceptor reflex stimulation (intracarotid injection of nicotine 0.2 microgram/kg) were examined in conscious dogs on the cerebral circulation, using the radioactive microsphere technique to measure cerebral blood flow. In intact dogs (n = 18) with ventilation controlled, carotid chemoreceptor reflex stimulation increased (P less than 0.01) mean arterial pressure by 36 +/- 5% (SE) and calculated cerebral vascular resistance by 58 +/- 13%, whereas cerebral blood flow fell by 7 +/- 6% (NS). After bilateral cervical sympathectomy (n = 9), carotid chemoreceptor reflex stimulation induced significantly different (P less than 0.01) effects on cerebral blood flow, which rose by 42 +/- 8%, and cerebral vascular resistance, which did not change. To determine whether the difference in effect was due to the sympathectomy or merely to the repetition of the stimulus, another group of dogs (sham; n = 6) that had intact sympathetic nerves were studied a second time. In "sham" dogs, the repeat response to carotid chemoreceptor stimulation also induced significantly different effects from those in dogs with sympathectomy. Thus, in the conscious dog, stimulation of the carotid chemoreceptor reflex elicits significant sympathetically mediated vasoconstriction in cerebral vessels.
Am J Physiol Heart Circ Physiol 238: H594-H598, 1980;

study demonstrates that cerebral autoregulation is influenced by the autonomic innervation of cerebral vessels

Alpha adrenergic blockade improves impaired autoregulation when cerebral perfusion pressure (CPP) is lowered but worsens it when CPP is raised, indicating that PBZ impairs the ability of cerebral vessels to constrict during induced hypertension and improves their ability to dilate during induced hypotension.

JOHN STIRLING MEYER M.D.1; KUNIO SHIMAZU M.D.1; SHIGEMICHI OKAMOTO M.D.1; ATSUO KOTO M.D.1; TADAO OHUCHI M.D.1; ATSUO SARI M.D.1; ARTHUR DALE ERICSSON M.D.1

1 Department of Neurology, Baylor College of Medicine, and the Baylor-Methodist Center for Cerebrovascular Research, Houston, Texas 77025
© 1973 American Heart Association, Inc.

Changes of Catecholamines

1. The contents of norepinephrine, epinephrine, dopamine, and dopa of the heart were determined fluorimetrically in 24 dogs from 1 to 50 days following bilateral cervical sympathectomy. The results were compared with those obtained from intact dogs in the previous studies. 2. After bilateral cervical sympathectomy, the norepinephrine content show a rapid decrease from 4 days to 7 days and a slow decrease within the following 14 days. No tendency of recovery was apparent in the heart for 50 days following the operation, the norepinephrine content remaining almost at an equal level. The same operative procedure, however, had no significant effect on the concentrations of dopamine and dopa 3. It was postulated that norepinephrine could not be synthesized and/or accumulated in the heart following bilateral cervical sympathectomy, but that cardiac muscle might synthesize dopamine for itself.
Japanese circulation journal
Vol.29, No.1(19650120) pp. 11-15
KIMATA SHIN-ICHI 1
1The Third Department of Internal Medicine, Faculty of Medicine, University of Tokyo

sympathectomy – its effect in the treatment of refractory angina pectoris

To document an improvement in the quality of life in a group of patients with refractory angina and videothoracoscopic sympathectomy (VTSY) during the early postoperative period and a six-month follow-up. Methods: Ten patients with angina CCS IV refractory to a conventional therapy underwent VTSY between the years 1998 and 2002 at our institution. All patients underwent a complex preoperative evaluation, including pain assessment using a visual analog scale (VAS). Proximal thoracic sympathetic blockage was performed in all patients as a diagnostic test. The resection of bilateral Th2-Th4 ganglions was performed under general anesthesia and selective lung ventilation. All patients were monitored 6 months after the VTSY. Results: No deaths occurred in our group of patients, with an average hospital stay of 4.1 days. Nine of the ten operated patients referred an important subjective relief of pain. There was a drop from 10 to 4 according to VAS (P<0.05), and from 4 to 2.4 according to CCS (P<0.05). Decreases in basal heart rate, norepinephrine level, and an occurrence of ventricular premature beats reached the level of statistical significance. Conclusions: The increasing number of patients with refractory angina prompted a search for an effective and safe therapy to improve the quality of their life. New evidence in the pathophysiology of an ischemic myocardium and investigation of the impact of thoracic sympathectomy suggests sympathetic denervation seems to be a possible alternative method for the treatment of refractory angina pectoris.

Martin Striteskya, Milos Dobiasa, Rudolf Demesb, Michal Semradc,*, Eva Poliachovaa, Tomas Cermaka, Jiri Charvatd and Ivan Maleke
Interact CardioVasc Thorac Surg 2006;5:464-468. doi:10.1510/icvts.2005.118976
© 2006 European Association of Cardio-Thoracic Surgery

Dopamine

Adrenalectomy, adrenal demedullation, denervation and chemical sympathectomy have been reported to decrease plasma dopamine levels.

Autonomic Pharmacology
By Kenneth J. Broadley
Published 1996
CRC PRESS

Sympathectomy alters acetylcholinesterase expression

Acetylcholinesterase was analysed after destruction of adrenergic nerves by 6-hydroxy-dopamine or bilateral stellate sympathectomy. Effectiveness of treatment was verified by determining noradrenaline concentrations in right ventricle. Acetylcholinesterase activity was assayed in homogenates of atria and portions of left ventricular free wall.

Sympathectomy caused a small decrease in acetylcholinesterase activity, due to a decrease in the activity of the tetrameric globular form of the enzyme. Choline acetylcholinesterase activity was not altered by sympathectomy, which is an indication that cholinergic nerves were not affected.

Conclusions – The contribution of adrenergic neurones to the cardiac pool of acetylcholinesterase is measurable and consists primarily of the tetrameric globular form of the enzyme.
Copyright © 1990, European Society of Cardiology
Cynthia Nyquist Battie and Nancy Moran

Serum Dopamine-beta-Hydroxylase: Decrease after Chemical Sympathectomy

Dopamine-{beta}-hydroxylase, the enzyme which converts dopamine to norepinephrine, is released into the perfusate upon stimulation of the isolated perfused adrenal gland and after stimulation of the nerves to the isolated perfused spleen. This study was undertaken to determine whether dopamine-{beta}-hydroxylase activity could be detected circulating in blood. By using a sensitive new enzymatic assay, a dopamine-{beta}-hydroxylase activity was found in the blood of both man and the rat. It is located in the serum and is not associated with the formed elements of blood. The serum activity is similar to that of purified bovine adrenal dopamine-{beta}-hydroxylase in that it requires the presence of ascorbic acid, catalase, fumarate and oxygen for full activity. Furthermore, as is also the case with the adrenal enzyme, serum activity is increased in the presence of cupric ions. The Km values for substrate in human and rat sera are similar, and both are close to values determined in rat adrenal glands and stellate ganglia. The mean activity ±SE in the serum of six rats was 2.27±.04 nmoles/ml serum/20 min, and that of four normal humans ranged from 96.2 to 284 nmoles/ml/20 min.
1 Laboratory of Clinical Science, National Institute of Mental Health, Bethesda, Maryland 20014
RICHARD WEINSHILBOUM 1 JULIUS AXELROD
(Circulation Research. 1971;28:307.)
© 1971 American Heart Association, Inc.

NE synthesis was abolished by chronic sympathectomy

This study presents evidence that dopaminergic neurons innervate the cat carotid body. Immunocytochemical studies revealed many tyrosine hydroxylase (TH)-positive nerve fibers in the carotid body which establish extensive contacts with type I cells. All TH-positive intralobular profiles disappeared with chronic carotid sinus nerve (CSN) section, but survived sympathectomy following removal of the superior cervical ganglion. The level of endogenous dopamine (DA) in the CSN was higher than that for norepinephrine (NE). While both catecholamines were synthesized by the nerve at similar rates, NE synthesis was abolished by chronic sympathectomy, but DA synthesis remained largely unchanged following this procedure. Our data indicate that DA is not present in the CSN as a mere precursor of NE. Following a 3-hour incubation of carotid bodies with their attached nerves in media containing 20 µM3H-tyrosine, electrical stimulation of CSN C-fibers in chronically sympathectomized preparations provoked the release of 3H-DA, but not 3H-NE.

Copyright © 1993 S. Karger AG, Basel

Neurosignals 1993;2:16-26 (DOI: 10.1159/000109474)

L. Almaraz, Z.-Z. Wang, L.J. Stensaas, S.J. Fidone

sympathectomy on dopamine, noradrenaline and adrenaline content in some peripheral tissues

Dopamine, noradrenaline (NA) and adrenaline (Ad) depletion by 6-hydroxydopamine (6-OHDA) and pargyline plus 6-OHDA was investigated in the cat left ventricle, mesenteric and renal arteries, renal cortex, renal medulla and adrenal medulla. Catecholamine concentrations in plasma were also analyzed in these two experimental conditions. 6-OHDA alone or in combination with pargyline induced parallel decreases of NA and dopamine contents in the left ventricle. In the main trunk and proximal branches of the mesenteric artery and renal artery 6-OHDA selectively reduced NA without a parallel decrease in dopamine content. Previous treatment with pargyline abolished this selectivity. In the kidney of control animals, dopamine content was greater than could be attributed to its presence only in noradrenergic neurones. In the renal cortex 6-OHDA reduced significantly dopamine and NA contents, and in the renal medulla only NA levels were decreased by this drug. Pargyline plus 6-OHDA did not deplete the NA content either in the renal cortex or in the renal medulla, and only reduced significantly the dopamine content in the renal cortex. NA concentrations in plasma were increased by pargyline plus 6-OHDA whilst Ad remained unaffected. In the adrenal medulla only NA content was reduced either by 6-OHDA or pargyline plus 6-OHDA.
Br J Pharmacol. 1985 October; 86(2): 351–356.
M. M. Caramona and P. Soares-da-Silva

Sympathectomy also reduced the percent of DA (Dopamine)

The catecholamines (CAs), dopamine (DA) and norepinephrine (NE), are synthesized and stored in carotid body chemosensory type I cells. Previous studies in our laboratory demonstrated that low concentrations of nicotine preferentially evoke the release of NE from rabbit type I cells, whereas hypoxia mobilizes DA and NE in proportion to their stores in the tissue. The primary objective of the present study was to examine whether hypoxia, nicotine and elevated concentrations (30 mM) of K+ evoke the preferential release of DA vs. NE from cat carotid bodies superfused in vitro. In this species, where tissue stores of DA and NE are nearly equal, hypoxia evoked the preferential release of DA from normal carotid bodies. This pattern of release evoked by low O2 was also present following chronic removal of the superior cervical ganglion, which eliminated NE contained in the sympathetic innervation to the carotid body. In contrast, nicotine and high-K + preferentially mobilized NE in these sympathectomized animals. Sympathectomy also reduced the percent of DA (but not NE) content released from type I cells in response to any of the three stimuli. Our findings suggest that chemosensory type I cells possess stimulus-specific mechanisms for CA mobilization and that the sympathetic innervation modulates the metabolism and release of CAs in the cat carotid bodv.


CHEN J. (1) ; GOMEZ-NINO A. (2) ; GONZALEZ C. (2) ; DINGER B. (1) ; FIDONE S. (1) ;
Journal of the autonomic nervous system ISSN 0165-1838 CODEN JASYDS
Source / Source
1997, vol. 67, no1-2, pp. 109-113 (17 ref.)

Dopamine-beta-Hydroxylase: Decrease after Chemical Sympathectomy

Serum Dopamine-beta-Hydroxylase: Decrease after Chemical Sympathectomy
Richard Weinshilboum 1 and Julius Axelrod 2

1 Pharmacology-Toxicology Program, National Institute of General Medical Sciences, Bethesda, Maryland 20014
2 Laboratory of Clinical Science, National Institute of Mental Health, Bethesda, Maryland 20014

Dopamine-beta- hydroxylase is an enzyme that is localized to catecholamine-containing vesicles in sympathetic nerves and the adrenal medulla, and is also found in the serum. Treatment of rats with 6-hydroxydopamine, a drug which destroys sympathetic nerve terminals, leads to a decrease in serum dopamine-beta-hydroxylase activity. The decrease is not due to an effect on the adrenal medulla or to an increase in circulating inhibitor or inhibitors of enzyme. These data represent evidence that at least a portion of the circulating dopamine-beta-hydroxylase activity arises from sympathetic nerve terminals.

structural damage to the peripheral arteries

Longterm sympathetic denervation has been shown to
cause structural damage to the peripheral arteries.
The effects of long-term sympathectomy include
smooth muscle atrophy in the vessels, leading to
ultimate structural changes in the arterial tree. This in-
crease in blood flow has been implicated as an impor-
tant factor in the development of Charcot joint and
pedal ulceration. Ward et al.16 postulated that, flow in
the small distal vessels is inadequate as a result of
faster flow from ateriovenous shunting. Abnormally
high blood flow, vasodilation, and arteriovenous
shunting that result from sympathetic denervation
lead to abnormal venous pooling.

Richard M. Stess
Marilyn J. Waller

Hemodynamic responses were abolished after bilateral sympathectomy

Hemodynamic responses were diminished after bilateral vagotomy and abolished after bilateral
sympathectomy.
Conclusion Since activation of cardiac afferent nerves and reflex responses remained intact after
TMLR, but changed after vagotomy or sympathectomy, TMLR does not denervate the heart sufficiently
to be the cause of improved angina after TMLR (Transmyocardial laser revascularization)


Chemoreflexes
An Experimental Study
Benjamin B. Y. Chiang, MD; Andrew M. Roberts, PhD; Abul M. Kashem, MD, PhD;
William P. Santamore, PhD; Sufan Chien, MD; Laman Gray, Jr, MD;
Robert Dowling, MD

Vol. 135 No. 5, May 2000 Archives
Arch Surg.

ipsilateral ptosis, miosis, facial anhydrosis, vasomotor rhinitis

In contrast, cosmetic complications from ETS include Horner syndrome (ipsilateral ptosis, miosis, facial anhydrosis, vasomotor rhinitis) and, most importantly from a patient-satisfaction perspective, an increase in sweating elsewhere on the body (CH). To minimize these complications, much attention has been focused on how, and how much, sympathetic nerve innervation should be interrupted.

With traditional sympathectomies or ganglionectomies (Figure 3), severe CH may occur in 10% to 40% of postoperative patients.37 It is interesting that the sites affected with CH are generally the thermoregulatory, nonglabrous skin regions of the trunk/back, buttocks, groin, and thighs that sweat normally before ETS.

This may lead ultimately to long-term debilitating CH with few treatment options, and at least 5% of patients may regret undergoing the operation.

Mayo Clin Proc. 2005;80:824-828
Hyperhidrosis: Evolving Therapies for a Well-Established Phenomenon
JOHN H. EISENACH, MD; JOHN L. D. ATKINSON, MD; ROBERT D. FEALEY, MD

Sympathectomy in the treatment of Tinnitus

Sympathectomy is an effective treatment of certain forms of of tinnitus, such as that which occurs in Meniere's disease and it has therefore been suggested that the sympathetic nervous system may modulate (increase) the sensitivity of cochlear hair cells.

Aage R. Moller:
Hearing: Anatomy, Physiology, and Disorders of the Auditory System
Academic Press, 2006
ISBN: 0123725194

Sympathectomy for moyamoya disease

The history of neurosurgical procedures for moyamoya disease

Other options such as cervical carotid sympathectomy and superior cervical ganglionectomy have also been proposed. In this paper the authors describe the history of the development of surgical techniques for treating moyamoya disease.

Keywords: moyamoya disease; superficial temporal artery–middle cerebral artery bypass; encephaloduroarteriosynangiosis; bur hole.

Cassius V. C. Reis, M.D., Sam Safavi-Abbasi, M.D., Ph.D., Joseph M. Zabramski, M.D., Sebastião N. S. Gusmão, M.D., Ph.D., Robert F. Spetzler, M.D., and Mark C. Preul, M.D.

Alteration of antioxidant status following sympathectomy

Toleikis, P.M., and Godin, D.V., Alteration of antioxidant status following sympathectomy: differential effects of modified plasma levels of adrenaline and noradrenaline, Molecular and Cellular Biology (1995) 152:39-49.

PROTECTION OF CEREBRAL VESSELS BY SYMPATHETIC NERVES

PROTECTION OF CEREBRAL VESSELS BY SYMPATHETIC NERVES*
Donald D. Heistad
Cardiovascular Division
Dept. Internal Medicine and Cardiovascular Ctr.
University of Iowa Coil. Med. and
Veterans Administration Hosp., Iowa City

Intracerebral gas partial pressure changes under vasoactive drugs

Pflügers Archiv European Journal of Physiology
Publisher Springer Berlin / Heidelberg
0031-6768 (Print) 1432-2013 (Online)
Volume 375, Number 1 / June, 1978

Prejunctional Supersensitivity to Norepinephrine after Sympathectomy

Sympathetic Innervatlon of Cerebral Arteries: Prejunctional Super-
sensitivity to Norepinephrine After Sympathectomy or Cocaine
Treatment
L. Edvinsson, P Aubineau, C. Owman, R. Sercombe, and J. Seylaz

Sympathectomy in the treatment of chronic pelvic pain

Presacral neurectomy and ovarian sympathectomy in treatment of chronic pelvic pain in young women - JR Fliegner


Melbourne Research Office
Research Data Collection & Performance Statistics
University of Melbourne

Sympathectomy in the treatment of pancreatic cancer pain

Krishna S, Chang VT, Shoukas JA, Donahoo J. Video assisted thora-
scopic sympathectomy-splanchnicectomy for pancreatic cancer pain.
J Pain Symptom Manage 2001;22:610–6.

Sympathectomy in the treatment of Tako-tsubo cardiomyopathy

Lastly, there is some evidence that TTC may be neurally mediated. Similar transient wall motion abnormalities are seen frequently in patients with subarachnoid haemorrhage, in whom the wall motion abnormality is thought to be due to neurally mediated localised microvascular ischaemia. Histopathological features of the myocardium are very similar, with contraction band necrosis,27 and can be prevented by cardiac sympathectomy.

eMJA The Medical Journal of Australia

Tako-tsubo cardiomyopathy: how stress can mimic acute coronary occlusion
Irfan Abdulla and Michael R Ward

many people have a decreased quality of life after this procedure.

Sympathectomy for hyperhidrosis is not considered as a reliable treatment and recent research has shown that many people have a decreased quality of life after this procedure.

http://www.skinrevision.net.au/hyperhidrosis

porcine femoral arteries following sympathectomy

Lamawansa, M.D., Wysocki, S.J., House, A.K. and Norman, P.E. The changes seen in balloon-injured porcine femoral arteries following sympathectomy, Cardiovascular Surgery, 7:5, pp 526 - 531 (1999)

Sympathectomy abolishes trigger points activity.

http://www.pain-education.com/100125.php

Medical Pain Education


Liason Officer Marilyn Strauss

Sympathectomy in the treatment on Long QT syndrome

A Charles Sturt University (CSU) biomedical science lecturer has returned home after performing life-saving surgery in China.

Dr Lexin Wang, who was attending the first international conference on Long QT syndromes in Beijing, worked side-by-side with thoracic surgeons from Taiwan and Peking universities to perform a sympathectomy on four patients with life-threatening Long QT syndrome – the first operation of its kind in the world.

Dr Wang said the heart condition can often go unnoticed and is more prevalent in children, with frequent blackouts a symptom. The operations were broadcast live to the conference and featured in two major national Chinese newspapers.

“One of the patients was only six years old with frequent blackouts weeks before the surgery – none have been reported four weeks after the operation,” Dr Wang said.

“We have seen an immediate reversal of electrocardiogram (ECG) abnormalities. It’s a huge progression in the overall treatment and management of this condition.”

Sympathectomy in the treatment of vulvodynia -

Third, four subjects having successful blocks had laparoscopic presacral neurectomy, yielding one durable success, two transient remissions, and one nonresponse. We investigated open dissection instead. Six patients with disabling pain (including two who failed laparoscopic procedures) underwent complete pelvic sympathectomy (superior hypogastric plexus and lateral chains). Five have no vulvar pain and one has a bizarre but generally transient pain (sympathalgia).58 Fourth, since the peripheral sympathetic nerve fibers are primarily an efferent system, it has been postulated that the afferent limb of this reflex arc is provided by "sensitization" of otherwise silent somatic C fibers that travel in the adventitia of musculocutaneous blood vessels .58, 71 Sensitization means that the polymodal nociceptors (pain receptors) on these C fibers can be fired by noradrenalin, rather than acetylcholine, hence producing a pain loop maintained by activity within the adjacent sympathetic efferents. Preliminary experience with a quantitative thermal testing machine in vulvodynia patients has shown microneurographic patterns of chronic C fiber inflammation.

http://www.vulvodynia.com.au/articles/002.htmlhttp://www.vulvodynia.com.au/index.html

Sympathectomy for chronic inflammation of the pancreas - Brisbane, AU

The operation, a thoroscopic
sympathectomy, is not a particu-
larly common procedure, but for
patients suffering from chronic
inflammation of the pancreas it
provides significant pain relief.
Thoroscopic sympathectomy
surgery is performed at the Royal
Brisbane and Women’s Hospital
about 15 to 20 times a year.

An official publication of Queensland Health Vol 9 No 1 February 2004

The hypothalmus also regulates body temperature

Question:

The hypothalamus controls hunger, thirst, [1] fatigue, anger, and circadian cycles.It also regulates body temperature. Can the subsequent Compensatory Sweating that follows after Symoathectomy be a symptom of the dysregulated hypotalamus. Can the severity of the CS be a reflection of the extent of the damage?

The acute effect of superior cervical ganglionectomy

The acute effect of superior cervical ganglionectomy (SCGx) on the pituitary-thyroid axis was examined in rats subjected to surgery 3-24 h earlier. SCGx caused an abrupt decline in thyroid norepinephrine content (an index of degeneration of sympathetic nerve terminals) to 5-10% of controls between 8 and 16 h. Rats subjected to SCGx 14 h earlier exhibited a significant depression of thyroid 131I uptake, total and free serum T4 levels and serum TSH levels.
Efferent Neuroendocrine Pathways of Sympathetic Superior Cervical Ganglia
Early Depression of the Pituitary-Thyroid Axis after Ganglionectomy
D.P. Cardinali, M.A. Pisarev, M. Barontini, G.J. Juvenal, R.J. Boado, M.I. Vacas
Neuroendocrinology 1982;35:248-254

The results further support that a regional sympathectomy causes qualitative alterations in bone modeling and remodeling, leading to bone resorption.

To assess the effect of a local sympathectomy on bone metabolism, the effect of a unilateral superior cervical ganglionectomy (Gx) on growth and bone mineral content and density of the ipsi- and contralateral mandibles was examined in female rats. A significant increase in the hemi-mandibular bone ipsilateral to Gx was found as compared to the contralateral, sham-operated side 30 days, but not 15 days, after surgery. Bone mineral content of the hemi-mandibular bones was significantly lower in the side ipsilateral to Gx in the group of rats killed on the 30th day after surgery. Since no difference in areas between innervated and denervated hemi-mandibles was found, bone mineral density was also significantly lower in the hemi-mandible ipsilateral to Gx. The results further support that a regional sympathectomy causes qualitative alterations in bone modeling and remodeling, leading to bone resorption.

Marta G. Ladizeskya, Rodolfo A. Cutrerab, Verónica Boggiob, Carlos Mautalena and Daniel P. Cardinalib, *

a Sección Osteopatías Médicas, Hospital de Clínicas “José de San Martín”, Argentina

b Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, 7o. Piso, 1121 Buenos Aires, Argentina

Received 27 May 1999;
revised 12 August 1999;
accepted 23 August 1999.
Available online 21 January 2000.

Cervical sympathectomy affects gonadotropin-releasing hormone, luteinizing hormone and testosterone

Therefore, long-term and repeated stellate ganglion block may inhibit the increases of GnRH, LH, and TS secretions induced by continuous light.

Hiroshi Iwama1 Contact Information, Choichiro Tase1, Yoshikazu Tonosaki2 and Yasuo Sugiura2
(1) Department of Anesthesiology, Fukushima Medical College, 1 Hikarigaoka, 960-12 Fukushima, Japan
(2) Department of Anatomy, Fukushima Medical College, 1 Hikarigaoka, 960-12 Fukushima, Japan

Received: 24 August 1994 Accepted: 16 December 1994

Sympathectomy decreases and adrenergic stimulation increases the release of tissue plasminogen activator (t-PA) from blood vessels

Our recent morphologic studies indicated that peripheral nervous system (PNS) adrenergic neurons synthesize, transport, and store the serene protease, tissue plasminogen activator (t-PA) in axon terminals, many of which innervate vessel walls. Sympathoadrenal stimulation induces a surge of t-PA from vessel walls into the blood. The vascular endothelium, which constitutively secretes t-PA into blood also has long been widely assumed to be the principal source of this stress-induced release, but has not been verified as such. A neurologically regulated release from adrenergic stores could thus augment the known constitutive endothelial release. To functionally test this possibility, we quantitated the effects of guanethidine-induced systemic sympathectomy on the basal and stimulated release of t-PA from isolated vessel explants in superfused organ cultures. Moment-to-moment changes in the release rate were plotted from serial assays of the t-PA free activity. The effects of endothelial and adventitial nerve plexus ablations were also tested. Sympathectomy induced 30-50% reductions in t-PA release from both arterial and microvascular explants. An acute release induced by alpha-1 adrenergic receptor stimulations was also strongly suppressed, as were basal levels of the circulating enzyme in vivo. Adventitial and endothelial ablations from normal large vessel explants produced greater reductions than small vessel endothelial ablations. Ganglion electrical stimulation also induced an acute microvascular release in vivo. These and past morphologic findings indicate a physiological infusion of t-PA into the vessel walls, blood, and other innervated matricesby sympathetic neurons. J. Neurosci. Res. 57:680-692, 1999. © 1999 Wiley-Liss, Inc.
Tao Peng 1, Xi Jiang 1, Yafei Wang 1, Arthur Hand 2, Concettina Gillies 1, Robert E. Cone 1, James O'Rourke 1 *
1Department of Pathology, University of Connecticut Health Center, Farmington
2Central Electron Microscope Facility, University of Connecticut Health Center, Farmington

Sympathectomy - surgical treatment for endometriosis

Pre-sacral neurectomy: An operation in which the nerves that transmit pain from the uterus to the brain are cut. Very rarely done in Australia. Also known as pre-sacral sympathectomy.

Influence of preganglionic cervical sympathectomy

Thus, the dilating effect of the sympathectomy on
the skin vessels appeared to predominate in our
experiments, representing an extracranial steal from
the cerebral circulation.

Cerebral infarction due to carotid occlusion and
carbon monoxide exposure
II. Influence of preganglionic cervical sympathectomy
JORG IGLOFFSTEIN, RUDOLF LAAS
From the Department of Neuropathology, Eppendorf Hospitals, University of Hamburg, H,-mburg, FederalRepublic of Germany
Journal of Neurology, Neurosurgery, and Psychiatry 1983;46:768-773

HR as indicator of arrousal

A Neuropsychological Model Relating Self-Awareness to
Hostility
Heath A. Demaree1,2 and David W. Harrison1,3


Neuropsychology is an approach that may be
beneficial in the attempt to relate mental proc-
esses—awareness, behaviors, cognitions, and emo-
tions—to the brain, its structures, and processes
including arousal of brain systems (Heilman and Va-
lenstein, 1993). Rather than ignore the role of the
cortex, view the brain as a "black box," or vaguely
describe different cortical processes, neuropsychol-
ogy purportedly evaluates how and where compo-
nents of mental processes occur. In accordance with
Mill, this approach assumes that all mental processes
result from physical processes within the central
nervous system. Accordingly, a change in any mental
process is associated with changes in the brain's
physical state. Conversely, an altered brain state simi-
larly affects mental processes.

The effect of sympathectomy on blood flow in bone

Sympathectomy as a therapeutic modality has been
employed for a variety of pathological states. It first
gained popularity in the 1920’s and 1930’s for improving
peripheral circulation, but soon its limitations began to be
apparent. The initial vasodilation after sympathectomy de-
creases some days after the procedure is performed. Results
for denervation of the upper extremity are not as long-lasting
as those for denervation of the lower extremity. A variety
of mechanisms have been proposed for the apparent return
of vasomotor tone, including: (1) development of intrinsic
tone in smooth muscle, (2) partial anatomical denervation
at the time of the operation, (3) post-denervation sensiti-
zation, (4) post-denervation sprouting, (5) hypertrophy of
the extraganglionic sympathetic nervous system, and (6)
cross-over of the lumbar sympathetic systems30. The pres-
ence or absence of inflow obstruction appears to be impor-
tant. The work of Rutherford and Valenta indicated that
while sympathectomy may increase flow in the resting state
and after exercise, the presence of inflow obstruction in a
patient who has a sympathectomy might actually interfere
with the increased distribution of the flow of blood to ex-
ercising muscle.
1987;69:1384-1390. J Bone Joint Surg Am.RF Davis, LC Jones and DS Hungerford

The effect of sympathectomy on blood flow in bone. Regional distribution and effect over time

Imbalances of sympathetic nervous system - autoimmune inflammatory diseases

Interruptions of the HPA axis at any level
and through multiple mechanisms, whether on a genetic
basis, through surgical means such as adrenalectomy or
hypophysectomy, or with pharmacological interventions
such as treatment with the glucocorticoid receptor antag-
onist RU 486, can render an inflammatory resistant host
susceptible to inflammatory disease (Sternberg 1997a,b).

Imbalances of sympathetic nervous system responses are
also associated with autoimmune inflammatory diseases
such as arthritis in both humans and rodents. Human
juvenile rheumatoid arthritis has been associated with both
abnormal HPA axis and sympathoneuronal responses (Kuis
et al. 1996). Inflammatory susceptible LEW/N rats show
not only blunted HPA axis responsiveness, but also
blunted sympathoneuronal activity in response to gluco-
privic stress (Goldstein et al. 1993). This raises the question
of whether in such susceptible hosts multiple factors may
account for overall susceptibility to autoimmune/ inflammatory disease.

While this review has focused on the HPA axis and
glucocorticoids and their role in susceptibility to inflam-
matory disease, estrogen is known to play an extremely
important role in immune modulation, and contributes to
the approximately two- to tenfold higher ratio of most
autoimmune diseases in females of all species (Wilder
& Sternberg 1990, Ahmed et al. 1999, Lahita 1999).
Ovariectomy has been shown to reduce, while replace-
ment of estrogen re-constitutes, this di

Influence of Endoscopic Thoracic Sympathectomy on Baroreflex Control of Heart Rate

Before and after the ETS, there were no significant differences in resting SBP (105.0±8.7 and 105.3±13.7 mmHg, respectively)
and heart rate (88.9±14.4 and 86.0±15.1 beats/min, respectively). In the pressor test, the ETS produced a significant
suppression of baroreflex response in all petient studied; baroreflex sensitivity before and after the ETS were 7.6±2.8 and
3.4±2.5 msec/mmHg, respectively (P<0.05). In the depressor test, the ETS also suppressed baroreflex response. In two of
eight patients, baroreflex response was completely suppressed after the ETS. Baroreflex sensitivity before and after the ETS
were 3.8±0.4 and 1.2±1.4 msec/mmHg, respectively (P<0.05). All patients showed the increase in skin temperatures of bilateral
palmars and arms, and the ceasing sweat after the ETS, indicating successful T2-3 sympathectomy.
Conclusion
Our results indicated that T2-3 sympathectomy suppressed baroreflex control of heart rate in both pressor and depressor tests
in the patients with palmar hyperhidrosis. We should note that baroreflex response for maintaining cardiovascular stability is
suppressed in the patients who received the ETS.
Anesthesiology 2001; 95:A160

Yurie T. Kawamata, M.D.; Eiji Homma, M.D.; Tomoyuki Kawamata, M.D.; Kiichi Omote, M.D.; Akiyoshi Namiki, M.D.
Anesthesiology, Sapporo Medical University, Sapporo, Hokkaido, Japan

Sympathectomy - extracranial steal phenomenon

Unilateral cerebral infarcts were produced in the rat by ligation of one common carotid artery and subsequent exposure to carbon monoxide. The incidence and extension of brain infarcts was increased in animals with additional ipsilateral cervical preganglionic sympathectomy. Sympathectomy did not affect markedly the respiration and systemic circulation. The effect of sympathectomy was attributed to a cutaneous vasodilation, leading to an extracranial steal phenomenon.

Cerebral infarction due to carotid occlusion and carbon monoxide exposure. II. Influence of preganglionic cervical sympathectomy.
J Igloffstein and R Laas

J Neurol Neurosurg Psychiatry. 1983 August; 46(8): 768–773.

Cerebral blood flow is no longer constant after sympathectomy

Cerebral blood flow remains relatively constant and is in-
dependent of modest fluctuations in arterial pressure,
presumably because of its capacity for autoregulation.22-23
After cervical sympathectomy, however, one group reported
that cerebral blood flow rate is no longer constant but varies
with arterial pressure.

The demonstration that non-uniform changes in blood flow
between cortical lobes and between hemispheres could be in-
duced by ischemia26 and neurogenic stimulation26 probably
implicates neurogenic factors. There is some evidence for
heterogeneity of the function of the sympathetic neurons
originating from the superior cervical ganglion.



Adrenergic lnnervation of Large Cerebral Blood
Vessels of the Rabbit Studied by Fluorescence Microscopy
Absence of Features That Might Contribute to Non-Uniform Change
in Cerebral Blood Flow
RALPH E. PURDY, PH.D.,* AND JOHN A. BEVAN, M.D.

STROKE VOL 8, No 1, JANUARY-FEBRUARY 1977

Sympathetic regulation of cerebral blood flow

AJP - Heart and Circulatory Physiology, Vol 249, Issue 3 672-H680, Copyright © 1985 by American Physiological Society


Sympathetic regulation of cerebral blood flow during reflex hypertension

P. Lacombe, M. C. Miller and J. Seylaz

Sympathectomy may result in profound hypotension

Regional anesthetic techniques such as
spinal or epidural anesthesia, though efficacious in
providing surgical anesthesia and sensory deafferenta-
tion, are often avoided because they produce bilateral
sympathectomy. This may result in profound hypoten-
sion that can be difficult to treat in HOCM patients.
Paravertebral somatic nerve blocks for breast
surgery in a patient with hypertrophic obstructive
cardiomyopathy

Chester C. Buckenmaier III MD, Susan M. Steele MD, Karen C. Nielsen MD, Stephen M. Klein MD
CAN J ANESTH 2002 / 49: 6 / pp 571–574

Follow-up surgery after ETS to reduce axillary HH

Many of the patients attend after thorascopic sympathectomy which resolved their palmar, but not axillary, hyperhidrosis. Surgical excision of axillary tissue remains an important treatment modality for a large proportion of hyperhidrotic patients. It has the ability to provide a permanent and satisfactory solution to a frustrating problem. It is not as yet a redundant method of treatment.

J L Atkins, senior house officer, plastic surgery.
P E M Butler, consultant plastic surgeon.
Royal Free Hospital, London NW3 2QG
BMJ 2000;321:702 ( 16 September )
Letters
Treating hyperhidrosis
Excision of axillary tissue may be more effective

Skin in 'overdrive' following sympathectomy

I. Kelman Cohen1 Contact Information and Barbara J. McCoy1
(1) Division of Plastic Surgery, Department of Surgery, Medical College of Virginia, 23298 Richmond, Virginia, USA

Lesions of “surface overhealing” include keloid, hypertrophic scar, and burn scar. All are characterized by overabundant collagen deposition. The biology of these lesions is reviewed, suggesting that abnormal collagen metabolism results from alterations in the inflammatory/immune response. Practical and theoretical treatment plans are outlined based on methods that alter collagen metabolism, the inflammatory/immune system or rely on physical alterations (surgery, pressure).

Structural changes and in situ aortic pressure-diameter relationship

These results suggest that intact sympathetic nerves are necessary to maintain normal functional and structural properties of large arteries in rat. The reduction in aortic distensibility, in long-term sympathectomized rats, could have resulted from complex interactions between local aortic denervation, change in the set point of distending pressure, and changes in aortic smooth muscle tone and/or wall composition.

Auteur(s) / Author(s)
LACOLLEY P. ; GLASER E. ; CHALLNDE P. ; BOUTOUYRIE P. ; MIGNOT J.-P. ; DURIEZ M. ; LEVY B. ; SAFAR M. ; LAURENT S. ;
American journal of physiology. Heart and circulatory physiology ISSN 0363-6135 COD

1995, vol. 38, no2, pp. H407-H416 (36 ref.)

Sequential cerebrospinal fluid and plasma sampling in humans: 24-hour melatonin measurements in normal subjects and after peripheral sympathectomy

In the patient with hyperhidrosis, a prominent melatonin rhythm was observed preoperatively in the CSF and plasma. After bilateral T1-T2 ganglionectomy, however, melatonin levels were markedly reduced, and the diurnal rhythm was abolished. These results provide direct evidence in humans for a diurnal melatonin rhythm in CSF and plasma as well as regulation of this rhythm by sympathetic innervation.

J Bruce, L Tamarkin, C Riedel, S Markey and E Oldfield
Surgical Neurology Branch, National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892.

Journal of Clinical Endocrinology & Metabolism, Vol 72, 819-823, Copyright © 1991 by Endocrine Society

Melatonin - Circadian Cycle - Delayed sleep phase syndrome

Main article: Circadian rhythm sleep disorder

Delayed sleep-phase syndrome (DSPS), also known as delayed sleep-phase disorder (DSPD) or delayed sleep-phase type (DSPT), is a circadian rhythm sleep disorder, a chronic disorder of the timing of sleep, peak period of alertness, core body temperature, hormonal and other daily rhythms. People with DSPS tend to fall asleep well after midnight and have difficulty waking up in the morning.

DSPS is a disorder of the body's timing system - the biological clock. Individuals with DSPS might have an unusually long circadian cycle, or might have a reduced response to the re-setting effect of light on the body clock.

People with normal circadian systems can generally fall asleep quickly at night if they slept too little the night before. Falling asleep earlier will in turn automatically advance their circadian clocks due to decreased light exposure in the evening. In contrast, people with DSPS are unable to fall asleep before their usual sleep time, even if they are sleep-deprived. Research has shown that sleep deprivation does not reset the circadian clock of DSPS patients, as it does with normal people.[10]

People with the disorder who try to live on a normal schedule have difficulty falling asleep and difficulty waking because their biological clocks are not in phase with that schedule. Normal people who do not adjust well to working a night shift have similar symptoms.

People with the disorder also show delays in other circadian markers, such as melatonin-secretion and the core body temperature minimum, that correspond to the delay in the sleep/wake cycle. The timing of sleepiness, spontaneous awakening, and these internal markers are all delayed by the same number of hours. Non-dipping blood pressure patterns are also associated with the disorder when present in conjunction with socially unacceptable sleeping and waking times.

In most cases, it is not known what causes the abnormality in the biological clocks of DSPS patients. DSPS tends to run in families,[11] and a growing body of evidence suggests that the problem is associated with the hPer3 (human period 3) gene.[12][13] There have been several documented cases of DSPS and non-24 hour sleep-wake syndrome developing after traumatic head injury.[14][15]

There have been a few cases of DSPS developing into non 24-hour sleep-wake syndrome, a more severe and debilitating disorder in which the individual sleeps later each day.[16]

In humans, melatonin is produced by the pineal gland, a gland about the size of a pea, located in the center of the brain. The melatonin signal forms part of the system that regulates the circadian cycle by chemically causing drowsiness and lowering the body temperature, but it is the central nervous system that controls the daily cycle in most components of the paracrine and endocrine systems[23][24] rather than the melatonin signal (as was once postulated).

Reduced melatonin production has been proposed as a likely factor in the significantly higher cancer rates in night workers

Reduced melatonin production has been proposed as a likely factor in the significantly higher cancer rates in night workers,[28] and the effect of modern lighting practice on endogenous melatonin has been proposed as a contributory factor to the larger overall incidence of some cancers in the developed world.

^ Schernhammer E, Rosner B, Willett W, Laden F, Colditz G, Hankinson S (2004). "Epidemiology of urinary melatonin in women and its relation to other hormones and night work". Cancer Epidemiol Biomarkers Prev 13 (62): 936-43. PMID 15184249

CCS alone significantly decreased melatonin concentrations in serum at the time of highest secretory activity of the pineal gland

J. GORSKI, D. KAJDANIUK, J. GLOGOWSKA-SZELAG, Z. OSTROWSKA, M. NOWAK, B. BUNTNER

I Department of Pathophysiology and Medical Analytics, Silesian University School of Medicine, 41-800 Zabrze, Poland

The study showed that morphine alone significantly increased melatonin concentrations in serum. CCS alone significantly decreased melatonin concentrations in serum at the time of highest secretory activity of the pineal gland. Long-term morphine treatment of rats subjected to CCS significantly increased the serum concentration of melatonin. Therefore, it may be concluded that the central adrenergic system does not take part in the morphine-stimulated secretion of melatonin.

procarbazine

Sensitivity to procarbazine
»Caution should be used also in patients who have had previous cytotoxic drug therapy or radiation therapy. »In addition, caution should be used in patients who have undergone sympathectomy, who may be more sensitive to the hypotensive effects of MAO inhibitors.

Other medical problems, especially active alcoholism, bone marrow depression, cardiac arrhythmias, chickenpox or recent exposure, congestive heart failure, coronary insufficiency, severe or frequent headaches, hepatic function impairment, herpes zoster, other infection, paranoid schizophrenia or other hyperexcitable personality states, pheochromocytoma, sympathectomy, or renal function impairment


Indications
Systemic

Lymphomas, Hodgkin's (treatment) or [Lymphomas, non-Hodgkin's (treatment)]

Procarbazine is indicated, in combination with other agents, for treatment of Hodgkin's disease (Stage III and IV) and some non-Hodgkin's lymphomas .
[Tumors, brain, primary (treatment)]

Procarbazine is indicated for treatment of primary brain tumors .
[Multiple myeloma (treatment)]

Procarbazine is indicated for treatment of multiple myeloma.

neuroaxial block may produce profound bradycardia and hypotension

A high level of neuroaxial block may produce profound bradycardia and hypotension, possibly as a result of an imbalance between sympathetic and parasympathetic control of heart rate.

Our results indicate that cervical, but not lumbar, epidural anesthesia depresses phasic and tonic dynamic modulation of the cardiac cycle by the vagal nerve in conscious humans.

IMPLICATIONS: Cervical epidural anesthesia with lidocaine produces depressed heart rate variability and baroreflex control of heart rate, whereas lumbar epidural anesthesia exerts minimal effects on autonomic nervous system activity in conscious humans.

Anesth Analg 2004;99:924-929
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000131966.61686.66
REGIONAL ANESTHESIA
The Effects of Cervical and Lumbar Epidural Anesthesia on Heart Rate Variability and Spontaneous Sequence Baroreflex Sensitivity
Makoto Tanaka, MD, Toru Goyagi, MD, Tetsu Kimura, MD, and Toshiaki Nishikawa, MD

Influence of sympathectomy in humans on the rhythmicity of 6-sulphatoxymelatonin urinary excretion

The amount of 6-sulphatoxymelatonin, the chief metabolite of melatonin, in the urine was measured in nine patients, who were subjected to bilateral sympathectomy at the second thoracic ganglionic level for treatment of hyperhidrosis of the palms. All patients showed before surgery a normal 6-sulphatoxymelatonin excretion with a peak in the excretion during the night time. After the sympathectomy, the high night time excretion was clearly abolished in five patients but remained high in four patients. This indicates that the segmental locations of the preganglionic sympathetic perikarya in the spinal cord, stimulating the melatonin secretion in the pineal gland in humans, vary between individuals. An increase in daytime melatonin excretion was observed in the patients responding to the sympathectomy with an abolished 6-sulphatoxymelatonin rhythm. This increase could indicate that the final sympathetic neurons innervating the pineal gland might have a both stimulatory and inhibitory function.
Morten Møllera, Corresponding Author Contact Information, E-mail The Corresponding Author, Ole Osgaardb and Michael Grønbech-Jensenc

aInst. Med. Anatomy, University of Copenhagen, Panum Institute, Blegdamsvej 3, DK-2200 Copenhagen, Denmark

bDepartment Neurosurgery, Rigshospitalet, Copenhagen, Denmark

cNeurological Specialist Clinic Copenhagen, Christianshavns Torv 2, Copenhagen, Denmark

Does the pineal gland have a role in the psychological mechanisms involved in the progression of cancer?

Department of Anatomical Sciences, University of Adelaide, Adelaide, Australia

Received 9 November 2001;
accepted 13 February 2002.
Available online 28 August 2002.

Psychological factors, e.g., depression and psychological stress have been implicated in the progress of cancer. Similarly, the pineal gland and its principal secretion, melatonin, are known to influence the initiation and progress of cancer. Furthermore, changes in melatonin secretion have been linked with psychological stress and depression, and both the pineal gland and the cerebral cortex act via the limbic system in producing their effects. Both psychological stress and melatonin affect the immune system, as does the hypothalamus and the autonomic nervous system. The pineal gland has both a direct effect on cancer, and via the immune system. Psychological treatment and melatonin treatment have both been found to alleviate the course of cancer clinically. It is thus hypothesized that the pineal gland, and melatonin, are involved in the mechanism of psychological effects in the promotion of the progress of cancer.

Two cases of symptomatic cluster-like headache suggest the importance of sympathetic/parasympathetic balance

Despite several reports on symptomatic cluster-like headache, there is no clear explanation of how different lesions thought to be causative are related to cluster-like headache. On the basis of two additional cases of symptomatic cluster headache, we discuss the possibility that an acute imbalance of the autonomic nervous system, namely a net overactivity of the parasympathetic system, may be able to trigger these headache attacks in patients who probably have an additional individual predisposition to react with a cluster-like headache. Such an imbalance can be due to an increase in parasympathetic tone (e.g. stimulation of parasympathetic fibres) or to a reduction of the sympathetic tone (e.g. a lesion of the sympathetic fibres).
Two cases of symptomatic cluster-like headache suggest the importance of sympathetic/parasympathetic balance

* A Straube,
* T Freilinger,
* T Rüther &
* C Padovan

*
Department of Neurology, Klinikum Großhadern, Ludwig-Maximilians-University Munich, Germany
----------------------------------



A chronobiological study of melatonin, cortisol growth hormone and prolactin secretion in cluster headache

Results from this study suggest a neuroendocrine dysregulation in cluster headache in the endogenous clock which controls the pineal rhythmicity.


* Guy Chazot11Unite Neurométabolique, Hôpital Neurologique. 59 boulevard Pinel, 69003 Lyon, France; ,
* Bruno Claustrat22Service de Radiopharmacie et Radioanalvse. Centre de Médecine Nucléaire, 59 boulevard Pinel, 69003 Lyon, France; ,
* Jocelyne Brun22Service de Radiopharmacie et Radioanalvse. Centre de Médecine Nucléaire, 59 boulevard Pinel, 69003 Lyon, France; ,
* Daniel Jordan33Laboratoire de Médecine Expérimentale, INSERM U. 197-UER, Médecine Alexis Carrel, rue Guillaume Paradin. 69008 Lyon, France; ,
* Geneviève Sassolas44Unite de Soins, Centre de Médecine Nucléaire, 59 boulevard Pinel, 69003 Lyon, France,
* Bernard Schott

Cephalalgia

Volume 4 Issue 4 Page 213-220, December 1984

Although migraineurs appear in general to be hypersensitive to external stimuli, they maybe also have increased daytime sleepiness and complain of fatigue. Neurophisiological studies between attacks have shown that for a number of different sensory modalities the migrainous brain is characterised by a lack of habituation of evoked responses. Whether this is due to increased cortical hyperexcitability, possibly due to decreased inhibition, or to an abnormal responsivity of the cortex due a decreased preactivation level remains disputed. Studies using transcranial magnetic stimulation in particular have yielded contradictory results. We will review here the available data on cortical excitability obtained with different methodological approaches in patients over the migraine cycle. We will show that these data congruently indicate that the sensory cortices of migraineurs react excessively to repetitive, but not to single, stimuli and that the controversy above hyper- versus hypo-excitability is merely a semantic misunderstanding. Describing the migrainous brain as ‘hyperresponsive’ would fit most of the available data. Deciphering the precise cellular and molecular underpinnings of this hyperresponsivity remains a challenge for future research. We propose, as a working hypothesis, that a thalamo-cortical dysrhythmia might be the culprit.
Is the cerebral cortex hyperexcitable or hyperresponsive in migraine?

* G Coppola11G.B. Bietti Eye Foundation-IRCCS, Department of Neurophysiology of Vision and Neurophthalmology, ,
* F Pierelli2,32University of Rome ‘La Sapienza’ Polo Pontino—I.C.O.T., Rome and 3IRCCCS-Neuromed, Pozzilli (IS), Italy, &
* J Schoenen4,5

Comparison of the Emotional Effects of a Beta-Adrenergic Blocking Agent and a Tranquilizer

This study investigated the emotional effects of the beta-adrenergic blocking agent oxprenolol (40 mg, p.o.) and the tranquilizing agent diazepam (5 mg, p.o.) in healthy subjects under three situational conditions:an emotionally neutral control situation and two situations designed to arouse different levels of anxiety. Both oxprenolol and diazepam induced positive emotional changes only in the more strongly anxiety-arousing situation. Significant differences between oxprenolol and diazepam in inducing emotional stabilization were not demonstrable.

Gisela Erdmann, Wilhelm Janke, Sigrid Köchers, Brunhild Terschlüsen

Institut fur Psychologie, Technische Universität Berlin; Lehrstuhl fur Psychologie I, Universität Würzburg, BRD


Neuropsychobiology 1984;12:143-151 (DOI: 10.1159/000118129)

when sympathectomy results in excessive hypotension, vasoconstrictor drugs may be needed

High spinal anaesthesia may block the
nociceptive and haemodynamic responses to common
surgical events such as sternotomy. The extensive sym-
pathectomy provided by high spinal anaesthesia has po-
tential benefits and risks. If cardiac sympathectomy is achieved, there may be improvements in coronary per-
fusion. Stress response may be diminished. However,
when sympathectomy results in excessive hypotension, va-
soconstrictor drugs may be needed. These agents may
have detrimental effects on the coronary circulation, by-
pass grafts, and other organs.30"32
11 Parsonnet V, Dean D, Bernstein AD. A method of uni-
form stratification of risk for evaluating the results of
surgery in acquired adult heart disease. Circulation 1989;
79 (Suppl I): 13-112.
12 Robbins GR, Wynands JE, Whalley DG, et al.

Heart rate, heart rate variability and skin conductance as indicators of arousal

Arousal is a physiological and psychological state of being awake. It involves the activation of the reticular activating system in the brain stem, the autonomic nervous system and the endocrine system, leading to increased heart rate and blood pressure and a condition of sensory alertness, mobility and readiness to respond.

There are many different neural systems involved in what is collectively known as the arousal system. Four major systems originating in the brainstem, with connections extending throughout the cortex, are based on the brain's neurotransmitters, acetylcholine, norepinephrine, dopamine, and serotonin. When these systems are in action, the receiving neural areas become sensitive and responsive to incoming signals.

Importance

Arousal is important in regulating consciousness, attention, and information processing. It is crucial for motivating certain behaviours, such as mobility, the pursuit of nutrition, the fight or flight response and sexual activity (see Masters and Johnson's human sexual response cycle, where it is known as the arousal phase). It is also very important in emotion, and has been included as a part of many influential theories such as the James-Lange theory of emotion. According to Hans Eysenck, differences in baseline arousal level lead people to be either extraverts or introverts.

Adrenaline or peripheral noradrenaline depletion and passive avoidance in the rat

Physiol Behav. 1972 Jun;8(6):1059-62.

Adrenaline or peripheral noradrenaline depletion and passive avoidance in the rat.

Di Giusto EL.


J Comp Physiol Psychol. 1972 Dec;81(3):491-500.Links

Chemical sympathectomy and avoidance learning in the rat.

Di Giusto EL, King MG.

Heart rate and blood pressure responses to signaled and unsignaled shocks: effects of cardiac sympathectomy

J Comp Physiol Psychol. 1969 Jun;68(2):163-74.Links
Heart rate and blood pressure responses to signaled and unsignaled shocks: effects of cardiac sympathectomy.
Katcher AH, Solomon RL, Turner LH, LoLordo V, Overmier JB, Rescorla RA.

adrenergic nerve degeneration after sympathectomy of the pineal gland

Electron microscopic evidence that bretylium and pargyline delay adrenergic nerve degeneration after sympathectomy of the pineal gland
Journal Naunyn-Schmiedeberg's Archives of Pharmacology
Publisher Springer Berlin / Heidelberg
ISSN 0028-1298 (Print) 1432-1912 (Online)
Issue Volume 319, Number 2 / May, 1982

Effects of thoracoscopic upper dorsal sympathicolysis for essential hyperhidrosis on bronchial responsiveness

Respirology. 1996 Sep;1(3):195-9.Links
Effects of thoracoscopic upper dorsal sympathicolysis for essential hyperhidrosis on bronchial responsiveness to histamine: implications on the autonomic imbalance theory of asthma.

Noppen MM, Vincken WG.

Respiratory Division, Academic Hospital AZ-VUB, Free University of Brussels, Belgium.

Three of the 26 patients (12%) without pre-operative bronchial hyperresponsiveness became hyperresponsive after TS, whereas 1 of the 9 patients with pre-operative BHR lost hyperresponsiveness. Upper dorsal thoracoscopic D2-D3 sympathicolysis performed for the treatment of EH has no significant effects on mean PD20 His and individual loss (11%) or development (12%) of BHR occurs only in 12% of patients.

beta 1-adrenoreceptor-mediated change in pulmonary capillary membrane permeability

Respir Med. 1997 Oct;91(9):537-45.Click here to read Links
Partial pulmonary sympathetic denervation by thoracoscopic D2-D3 sympathicolysis for essential hyperhidrosis: effect on the pulmonary diffusion capacity.
Noppen MM, Vincken WG.

Respiratory Division, Academic Hospital, University of Brussels, Belgium.

In patients with essential hyperhidrosis (EH), a pathological condition characterized by increased activity of the upper dorsal sympathetic ganglia D2-D3, anatomical interruption at the D2-D3 level by thoracoscopic sympathicolysis (TS) is a safe and effective treatment. The D2 and D3 ganglia, however, are also in the pathway of sympathetic lung innervation, which may influence the pulmonary diffusion capacity for carbon monoxide (expressed as transfer factor for CO:TLCO, and as transfer coefficient for CO:KCO). We therefore studied the effect of TS on TLCO and KCO in 50 EH patients: compared with pre-operative values, both TLCO (-6.7%, P < 0.001) and KCO (-4.2%, P = 0.002) were significantly decreased at 6 weeks after bilateral TS, an effect which was independent of the smoking status of the patients. In order to explain this phenomenon, the following pharmacological interventions were studied: (1) oral beta 1 + 2-adrenoreceptor blockade with propranolol caused a comparable decrease of TLCO (-6.3%) and KCO (-7.5%) in matched normal subjects, but had no effect on TLCO and KCO in EH patients prior to TS; and (2) subsequent inhalation of the beta 2-adrenoreceptor agonist salbutamol in a dosage suspected to cause alveolar beta-receptor stimulation had no effect on TLCO and KCO, neither in the normal subjects, nor in EH patients (before and after TS). Although the exact mechanism of the TS-induced decrease in TLCO and KCO remains speculative, these findings suggest that they may be related to a beta 1-adrenoreceptor-mediated change in pulmonary capillary membrane permeability, although TS-induced changes in pulmonary blood flow or an interplay of both mechanisms cannot be excluded.