sympathectomy can relieve symptoms of angina

Surgical sympathectomy can relieve symptoms of angina in patients with refractory angina. However, in these high-risk patients this thoracic surgery may result in significant morbidity and mortality rates.

Clinical Investigations

American Heart Journal. 133(6):648-655, June 1997.
Gramling-Babb, Patricia MD; Miller, Michael J. MD; Reeves, Scott T. MD; Roy, Raymond C. MD; Zile, Michael R. MD
http://pt.wkhealth.com/pt/re/amhj/abstract.00000406-199706000-00007.htm;jsessionid=L6WWlJ0hBkQfdvQ9pgYwy1mHSyrL4pcGKTw5PvNGJSgDFD1j8L3V!1270838445!181195628!8091!-1

disturbed peripheral vascular and heart rate responses

Thoracic sympathectomy can result in reduced sweating and disturbed peripheral vascular and heart rate responses. Patients should be warned that these mechanisms may play a role in the development of exertional heat stroke.

Is Previous Thoracic Sympathectomy a Risk Factor for Exertional Heat Stroke?
http://www.ncbi.nlm.nih.gov/pubmed/17720429

Abnormal stress responses in patients with diseases affecting the sympathetic nervous system

Patients who lack baroreceptors have exaggerated blood pressure responses to stress. They have episodes of hypertension and hypotension that cause headaches and dizziness.

Patients with diseases of the sympathetic nervous system illustrate that everyday occurrences such as a change in posture or ambient temperature are stresses requiring a marked change in sympathetic nervous activity. Both physical and psychological stresses elicit large initial sympathetic neuronal responses that are subsequently damped by feedback inhibition from structures such as the baroreceptors. Damage to part of these feedback loops leads to exaggerated pressor responses to stress.
Ziegler MG, Ruiz-Ramon P, Shapiro MH.

University of California, San Diego.

Psychosom Med. 1993 Jul-Aug;55(4):339-46.

complex alterations of vascular reactivity

Enhanced vascular reactivity in the sympathectomized rat: studies in vivo and in small isolated resistance arteries.

Conclusions: In conclusion, we showed that sympathectomy produces complex alterations of vascular reactivity both in vivo and in isolated vessels, which shift the balance of the sensitivity of the vessel between vasoconstrictor and vasodilating agents towards an increased constriction. These results are unlikely to simply reflect denervation supersensitivity; their underlying receptor, post-receptor and/or contractile mechanisms are yet to be identified.

Journal of Hypertension. 18(8):1041-1049, August 2000.
Rizzoni, Damiano 1; Perlini, Stefano 2,3; Mircoli, Luca 2; Porteri, Enzo 1; Franzelli, Cristina 2; Castellano, Maurizio 1; Rosei, Enrico Agabiti 1; Ferrari, Alberto U. 2,4

Abnormal pain following nerve sprouting

Collectively, our findings indicate that as a result of autonomic sprouting due to CCI of the MN, remaining intact nociceptive fibres may potentially develop sensitivity to sympathetic and parasympathetic stimulation, which may have a role in the generation of abnormal pain following nerve injury.

---

Received 22 October 2004, revised 17 February 2005, accepted 23 February 2005

C. Grelik ¹ , G. J. Bennett ^3,4,5 and A. Ribeiro-da-Silva ^1,2,5

¹ Department of Pharmacology & Therapeutics, McGill University, 3655 Prom. Sir-William-Osler, Montreal, Quebec, Canada H3G 1Y6
² Department of Anatomy and Cell Biology,
³ Department of Anesthesia,
⁴ Faculty of Dentistry, and
⁵ McGill Centre for Research on Pain, McGill University, Montreal, Quebec, Canada

Summary from the University of Cambridge

ANDBN, MAGNUSSON and ROSENGREN (1965)
have demonstrated a complete loss of DOPA decarboxylase activity of iris, spleen
and submaxillary gland after surgical sympathectomy, and a complete loss of tyrosine
hydroxylase activity of heart, submaxillary gland and kidney has been found after
surgical sympathectomy (POOL, COVELL, LEVITT, GIBB and BRAUNWALD, 1967;
SEDVALL and KOPIN, 1967; NAGATSU, RUST and DE QUATTRO, 1969). Although the
time course of the fall in DOPA decarboxylase and tyrosine hydroxylase activities
of operated vasa was not investigated, a preliminary experiment showed that all
DOPA decarboxylase activity was absent one day after denervation. Thus, it seems
likely that these two enzymes which are involved in the biosynthesis of NA have
a cellular localization within the sympathetic nerves of the vas deferens.
NORADRENALINE METABOLIZING ENZYMES IN
NORMAL AND SYMPATHETICALLY DENERVATED
VAS DEFERENS
B. JARROTTI and L. L. IVERSEN
Department of Pharmacology, University of Cambridge, Cambridge, England
(Received 5 May 1970. Accepted 21 May 1970)

Sympathectomy causes diminished capacity for physical sensation

Results: In the hot-plate analgesia test, sympathectomized rats increased their hot-plate latency time compared with that of sham-operated rats. Density of calcitonin gene-related peptide immunoreactive fibers in sympathectomy side of the lumbar dura mater decreased to 45.5% compared with the contralateral side. The number and size of calcitonin gene-related peptide immunoreactive cells in dorsal root ganglia showed no difference between sympathectomized and contralateral side.

Conclusion: Sympathectomy increased the pain threshold and made the sympathectomized rats hypesthetic.

An Anatomic Study of Neuropeptide Immunoreactivities in the Lumbar Dura Mater After Lumbar Sympathectomy.

Spine. 21(8):925-930, April 15, 1996.
Sekiguchi, Yasufumi MD *+; Konnai, Yasunobu MD *+; Kikuchi, Shinichi MD, PhD *; Sugiura, Yasuo MD, PhD +

Long-term superior cervical sympathectomy induces mast cell hyperplasia and increases histamine and serotonin content

Nerve fibres and mast cells are often described in close morphological and functional interactions in various organs such as the dura mater. The respective roles of mast cell activation and sympathetic impairment in cluster headache and migraine attacks have been repeatedly suggested. We have thus investigated the long-term effects of sympathectomy on mast cell morphology and content in the rat dura mater.
After unilateral ganglionectomy, the histamine content increased progressively and significantly 30–60 days post-surgery in both hemi-dura, whereas the serotonin content became significantly different from that of sham only 60 days post-surgery in the ipsilateral dura. After bilateral ganglionectomy, the histamine level significantly increased in both hemi-dura 15–60 days post-surgery, whereas the serotonin level had significantly increased at 60 days post-surgery.

These results clearly demonstrate, for the first time, a long-term trophic effect of sympathetic nerve degeneration on mast cells in the dura mater.

A. Bergerot^*, A. -M. Reynier-Rebuffel^†, J. Callebert^‡ and P. Aubineau

Copyright © 1999 IBRO. Published by Elsevier Science Ltd.

Mast cell hyperplasia: role of cytokines.

Bischoff SC, Sellge G.

Department of Gastroenterology, Hepatology and Endocrinology, Medical School of Hannover, Germany

Mast cell hyperplasia is found in different pathologies such as chronic inflammatory processes, fibrotic disorders, wound healing or neoplastic tissue transformation. The functional significance of the accumulation of mast cells in these processes is largely unknown. It is now established that bone marrow-derived mast cell progenitors circulate in peripheral blood and subsequently migrate into the tissue where they undergo final maturation under the influence of local microenvironmental factors. Cytokines are of particular importance for mast cell recruitment, development, and function. Stem cell factor (SCF) is a unique mast cell growth factor, since mast cells disappear completely in the absence of SCF. However, several other cytokines such as IL-3 and IL-4 have been shown to influence mast cell proliferation and function also. This review focuses on the role of cytokines in the regulation of mast cell hyperplasia. Copyright 2002 S. Karger AG, Basel

Int Arch Allergy Immunol. 2002 Feb;127(2):118-22.

Sympathectomy increases chronic DSS colitis

Sympathectomy reduced acute DSS colitis but increased chronic DSS colitis. Sympathectomy also increased chronic colitis in Il10–/– mice.

Anti-inflammatory role of sympathetic nerves in chronic intestinal inflammation

R H Straub¹, F Grum¹, U Strauch¹, S Capellino¹, F Bataille², A Bleich³, W Falk¹, J Schölmerich¹, F Obermeier¹

¹ Laboratory of Neuroendocrino-Immunology, Department of Internal Medicine I, University Hospital Regensburg, Germany
² Department of Pathology, University of Regensburg, Regensburg, Germany
³ Institute for Laboratory Animal Science and Central Animal Facility, Hannover Medical School, Hannover, Germany

Published Online First: 28 February 2008. doi:10.1136/gut.2007.125401
Gut 2008;57:911-921
Copyright © 2008 BMJ Publishing Group Ltd & British Society of Gastroenterology

destroying the sympathetic nerves and their ability to transmit impulses

Surgery (Endoscopic thoracic sympathectomy or ETS): Select sympathetic nerves or nerve ganglia in the chest are either cut or burned (completely destroying their ability to transmit impulses), or clamped (theoretically allowing for the reversal of the procedure). The procedure often causes anhidrosis from the mid-chest upwards, a disturbing condition. Major drawbacks to the procedure include thermo regulatory dysfunction (Goldstein, 2005), lowered fear and alertness and the overwhelming incidence of compensatory Hyperhydrosis. Some people find this sweating to be tolerable while others find the compensatory Hyperhydrosis to be worse than the initial condition. It has also been established that there is a low (less than 1%) chance of Horner's syndrome. Other risks common to minimally-invasive chest surgery, though rare, do exist. Patients have also been shown to experience a cardiac sympathetic denervation, which results in a 10% lowered heartbeat during both rest and exercise. ETS was thought to be helpful in treating facial blushing and facial sweating. According to Dr. Reisfeld,the only indication for ETS at present is excessive and severe palmar Hyperhydrosis (excessive hand sweating). Statistics have shown that when treated for facial blushing and/or excessive facial sweating, the failure rate of ETS for those two clinical presentations is higher and patients are more prone to side effects.
http://immersivemedical.com/hyperhydrosis_fr_2.html

Changes in Electrophysiology following sympathectomy

Chemical sympathectomy was obtained following intravenous injection of 50 mg·kg^–1 of 6-hydroxydopamine. Sympathectomised dogs presented significant increases in: basic sinus period, sino-atrial conduction time (SACT), AH and HV intervals of the His bundle electrogram, atrial functional (AFRP) and effective (AERP) refractory periods, atrio-ventricular node functional (AVNFRP) and effective (AVNERP) refractory periods, ventricular functional (VFRP) and effective (EVRP) refractory periods and atrial (AMAP) and ventricular (VMAP) monophasic action potential durations. Corrected sinus recovery time (CSRT) was not affected by chemical sympathectomy. Neither was the atrial ERP/MAP duration ratio. This new form of sympathectomy affects all the levels of the cardiac conduction system. Such results are in accordance with those obtained with surgical sympathectomy or the use of beta-blocking agents.

DIANE GODIN^*, CLAUDE GUIMOND, RÉGINALD A NADEAU and A ROBERT LEBLANC

From the Department of Physiology, Faculty of Medicine, Université de Montréal and Centre de recherche, Hôpital du Sacré-Coeur, Montréal, Canada

Cardiovascular Research 1982 16(9):524-529; doi:10.1093/cvr/16.9.524
© 1982 by European Society of Cardiology

Sympathectomy frequently causes perioperative hypotension

Vasomotor output is modified by inputs from throughout the central nervous system, including the hypothalamus, cerebral cortex, and the other areas in the brain stem. Areas in the posterolateral medulla receive input from both the vagal and the glossopharyngeal nerves and play an important role in mediating a variety of circulatory reflexes. The sympathetic system normally maintains some tonic vasoconstriction on the vascular tree. Loss of this tone following induction of anesthesia or sympathectomy frequently contributes to perioperative hypotension.

Clinical Anesthesiology

By G. Edward Morgan, Maged S. Mikhail, Michael J. Murray

Published by McGraw-Hill Professional, 2005

ISBN 0071423583, 9780071423588

hypoxic response after sympathectomy

Blockade of the sympathetic nervous system with {alpha} ... (9) reported a reduction in the hypoxic response of the lung after sympathectomy. ...
www.anesthesia-analgesia.org/cgi/content/full/88/3/494

by I Garutti - 1999

autoregulatory breakthrough is eliminated when the arterial baroreflex is interrupted

The effects of sympathetic section blockade are greater during systemic hypercapnia than during normocapnia: a decrease in cerebrovascular resistance has been demonstrated in cats and rabbits after bilateral sympathectomy when PaCO2 was below 62-67 mmHg.
Blockade of sympathetic activity causes a significant further increase in CBF during hypoxia.

..sympathetic activation exerts a significant protective action on CBF and blood-brain barrier (BBB) permeability (Bill and Lander 1976) an effect which is also seen in the presence of moderate increase increases in BP, where autoregulation maintains CBF almost constant.

The vasodilation which characterizes autoregulatory breakthrough is eliminated when the arterial baroreflex is interrupted (Talman et al. 1994), which suggests that it is an active process. It is possible that the breakthrough depends on release of nitric oxide or a NO donor associated with the removal of the sympathetic innervation of cerebral vessels (Talman and Dragon 1995).

Intoxications of the Nervous System

By Pierre J. Vinken, F. A. de Wolff, George W. Bruyn, Otto Appenzeller, Harold L. Klawans

Published by Elsevier Health Sciences, 1999

ISBN 0444828133, 9780444828132

Effects of Sympathetic Nervous System activation

Our previous work indicates that myocardial ischemia could be the mechanism responsible for the left ventricular (LV) dysfunction that frequently develops after massive sympathetic nervous system (SNS) activation. In this study, coronary blood flow (CBF) and myocardial ATP, creatine phosphate, and lactate concentrations were measured after massively activating the SNS of anesthetized rabbits with an intracisternal injection of veratrine. CBF was measured at time 0 (baseline), and at 2, 10, and 20 min after SNS activation in one group, and at 0, 45, 90, and 150 min in a second group. Myocardial ATP, creatine phosphate, and lactate were measured at 0, 2, 10, 20, 90, and 150 min in separate groups of rabbits. SNS activation caused LV dysfunction in 60% of the rabbits. SNS-related increases in CBF kept pace with the increases in myocardial energy demand as determined from the systolic pressure-heart rate product. The subendocardial-to-subepicardial blood flow ratio did not change significantly. Myocardial creatine phosphate concentration was depressed 2 min after SNS activation and remained depressed for at least 20 min. ATP fell continuously and was significantly lower than baseline by 20 min. Tissue lactate concentration was elevated at this time.
Jennifer M. Smith and Charles F. Pilati^,1

Department of Physiology, Northeastern Ohio University College of Medicine, Rootstown, Ohio 44272

Experimental Biology and Medicine 227:125-132 (2002)
© 2002 Society for Experimental Biology and Medicine

---

Orthostatic hypotension following sympathectomy can lead to syncope

8. Describe the reflex compensations when someone suddenly stands up from a supine position. What would happen in a patient who just had a sympathectomy?

Sudden standing causes pooling of blood in the leg veins. This results in decreased venous return to the heart, which leads to decreased cardiac output (Frank-Starling mechanism), which leads to decreased MAP. This decrease in MAP is detected by the carotid sinus baroreceptors, which relay a message to the medullary cardiovascular control center, which increases sympathetic outflow and decreases parasympathetic outflow, this causes:

• An increase in HR and myocardial contractility, tending to restore cardiac output.
• Vasoconstriction in skeletal musculature, skin, kidneys and gut, reducing blood flow to these organs and increasing TPR.
• Venoconstriction decreasing capacitance and increasing venous return

A patient with a sympathectomy would experience what's referred to as orthostatic hypotension (which might lead to syncope). Orthostatic hypotension is a decrease in arterial pressure when going from supine to a standing position. A person with a normal baroreceptor mechanism will try to restore MAP. In a person who had a sympathectomy, the sympathetic component of the baroreceptor mechanism is absent.

9. Will the capillary pressure increase or decrease in the following situations?

1. Arteriolar vasodilation: increase

2. Venodilation: decrease (however, Dr. Gray points out that capillary beds of lower extremities will experience an increase in pressure due to back pressure exerted by the column of blood in the dilated veins!)

M.A.S.T.E.R. Learning Program, UC Davis School of Medicine

Date Revised: Jan 16, 2002

Revised by: Gordon Li and Carolyn Nguyen

Marked MAP instability following sympathectomy

In this study, conscious freely behaving rats with functional sympathetic denervation of the vessels, as evidenced by the disappearance of pressor responses to tyramine, did not show any change in the mean level of blood pressure but had a striking increase in the spontaneous MAP (mean arterial pressure) variability as compared with intact rats. This exaggerated blood pressure lability was associated with an increase in the variability of mesentric conductance with no change in that of the hindquarters vascular bed, which is the sum of vascular conductances of all regional hemodynamic changes after sympathectomy and suggest that the sympathetic nervous system may play an important role in reducing short-term hemodynamic variability.
In conclusion, the results of the present study suggest a major role for the sympathetic nervous system in the regulation of regional circulations, the loss of which in sympathectomized rats results in a marked instability of MAP. The vasodilator component of MAP lability after sympathectomy does not appear to depend on an episodic release of NO synthesized by the L-arginine pathway.

Genetic Hypertension, by Jean Sassard

Under the patronage of: Ministère de la recherche et de la technologie, Ministère délégué à la santé, INSERM, CNRS (Départment des sciences de la vie), Conseil général du Rhône, Mairie de Lyon, Chambre de commerce et d'industrie de Lyon
Genetic Hypertension: Proceedings of the 7th International Symposium on SHR and Related Studies Held in Lyon (France), Ecole Normale Supérieure, October 28-30, 1991 = Hypertension Génétique

Sympathectomy for the treatment of Tachycardia

Bilateral thoracoscopic cervical sympathectomy for the treatment of recurrent polymorphic ventricular tachycardia

A J Turley, J Thambyrajah, A A Harcombe

Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, UK

She was ultimately treated successfully with bilateral thoracoscopic cervicothoracic sympathectomies. This is the first reported bilateral thoracoscopic treatment of a patient with LQTS and symptomatic life threatening ventricular tachyarrhythmias refractory to current pharmacological and pacing techniques.

Heart 2005;91:15-17
© 2005 by BMJ Publishing Group & British Cardiac Society

Fertility following sympathectomy

Both chemically and surgically induced sympathectomy increased the weight of the epididymis and seminal vesicles/coagulating glands as well as the number and the transit time of cauda epididymal sperm. Neither serum testosterone levels nor LH was affected by treatment with guanethidine. Using natural mating, no litters were produced by guanethidine-treated rats. Chemically denervated rats failed to produce copulatory plugs or ejaculate into the uterus. However, distal cauda epididymal sperm from chemically or surgically denervated rats displayed normal fertilization ability (80%) using in utero inseminations.
Biology of Reproduction 59, 897-904 (1998)
©Copyright 1998 Society for the Study of Reproduction, Inc.

Fertility of Rat Epididymal Sperm after Chemically and Surgically Induced Sympathectomy¹

Wilma De G. Kempinas^2,a, Juan D. Suarez^b, Naomi L. Roberts^b, Lillian F. Strader^b, Janet Ferrell^b, Jerome M. Goldman^b, Michael G. Narotsky^b, Sally D. Perreault^b, Donald P. Evenson^c, Deborah D. Ricker^d, , and Gary R. Klinefelter^b

Norepinephrine loss produces motor deficits

Norepinephrine loss produces more profound motor deficits than MPTP treatment in mice

1. K. S. Rommelfanger*,
2. G. L. Edwards†,
3. K. G. Freeman†,
4. L. C. Liles*,
5. G. W. Miller‡, and
6. D. Weinshenker*,§


Departments of *Human Genetics and
‡Environmental and Occupational Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322; and
†Department of Physiology and Pharmacology, College of Veterinary Medicine, University of Georgia, Athens, GA 30602
Edited by Richard D. Palmiter, University of Washington School of Medicine, Seattle, WA, and approved June 25, 2007 (received for review March 27, 2007)

Effect of adrenalectomy or sympathectomy on spinal cord blood flow

We conclude that adrenalectomy near-totally ablates the hypothermia-associated increase in RSCBF (regional spinal cord blood flow) measured in intact rats and that abdominal sympathectomy totally ablates it. This evidence complements morphological evidence for adrenergic innervation of the spinal cord vasculature.

Heart and Circulatory Physiology, Vol 260, Issue 3 827-H831, Copyright © 1991 by American Physiological Society

A. Iwai, W. W. Monafo and S. G. Eliasson
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110.

http://ajpheart.physiology.org/cgi/content/abstract/260/3/H827

Morphofunctional changes in the myocardium following sympathectomy

Vestn Akad Med Nauk SSSR. 1984;(2):80-5.
Related Articles, Links

[Morphofunctional changes in the myocardium following sympathectomy and their role in the development of sudden death from ventricular fibrillation]

[Article in Russian]

Beskrovnova NN, Makarychev VA, Kiseleva ZM, Legon'kaia , Zhuchkova NI.

Publication Types:

* English Abstract

Postoperative complications are frequent after sympathectomy

[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]
[My paper] L Räf

Lakartidningen. 2001 Apr 11;98 (15):1764-5 11374001 (P,S,E,B)

inhalation of carbon dioxide

Minerva Med. 1958 Feb 14;49(13):514-6.Links
[Behavior of liquoral pressure after inhalation of carbon dioxide, as evaluative test of cerebral circulation with particular regard to treatment by sympathetic block in focal vascular cerebropathies.]
[Article in Italian]

POLETTI T, CAMERON-CURRY V, SGARBI M.

PMID: 13516803 [PubMed - OLDMEDLINE]

Cerebral accidents of vascular origin and cervical sympathectomy

Progr Med (Paris). 1955 Feb 10;83(3):43-7.Links
[Cerebral accidents of vascular origin and cervical sympathectomy.]
[Article in French]

CHAVANY JA, DJINDJIAN R, HAGEN-MULLER D.

Role of sympathectomy in the treatment of cerebrovascular occlusion

J Albert Einstein Med Cent (Phila). 1960 Jan;8:31-8.Links
Role of sympathectomy in the treatment of cerebrovascular occlusion.
SHENKIN HA, FINNESON BE.