Sympathectomy disrupts feedback from the viscera

Researchers have examined the role of autonomic feedback in emotional experience using the heartbeat detection paradigm. Katkin et al. (1982) found that some normal subjects can accurately detect their heartbeats, and it was those individuals who had a stronger emotional response to negative slides as determined by self-report (hantas et al. 1982)
Experiments in animals demonstrate that sympathectomy may retard aversive conditioning (DiGusto and King, 1972) most likely because sympathectomy reduces fear.
In order for feedback to occur, there must be a means for the viscera and autonomic nervous system to become activated.

Clinical Neuropsychology

By Kenneth M. Heilman, Edward Valenstein

Published by Oxford University Press US, 2003

http://books.google.com.au/books?id=VbTKTyn-XK4C&pg=PA458&lpg=PA458&dq=viscera+sympathectomy&source=web&ots=2lCUoqE7Rs&sig=90mBXjr9IGd_Worq34KzsrZRpCc&hl=en&sa=X&oi=book_result&resnum=5&ct=result

Degeneration patterns of postganglionic fibers following sympathectomy

In the muscle nerves the first signs of an axonal degeneration of the sympathetic fibers can be recognized 4 days after surgery. The signs of axonal degeneration are most striking about 8 days p.o. They have more or less disappeared another week later. The reactions of the Schwann cells also start on the fourth day but outlast the degenerative processes by some 8 days. Thus the degenerative and reactive processes in the reg precede those in the muscle nerves by 2 days early after surgery and by 6 days 3 weeks later. Seven weeks after surgery, fragments of folded basement lamella and Remak bundles with condensed cytoplasm and numerous flat processes are persisting signs of the degeneration.
K. H. Andres, M. von Düring, W. Jänig and R. F. Schmidt
Anatomy and Embryology
Springer Berlin / Heidelberg
Volume 172, Number 2 / August, 1985
http://www.springerlink.com/content/m21m2612n2147011/

sympathectomy is associated with increased pulmonary metastases

Chemical sympathectomy is associated with increased pulmonary metastases.

Journal of Neuroimmunology 1992;37:191-202.
Brenner, GJ, Felten, SY, Felten, DL, Cohen, N and Moynihan, JA.
http://www.massgeneral.org/nprg/brenner.htm

sympathectomy involves division of adrenergic, cholinergic and sensory fibers

The excision of neural structures which elaborate adrenergic substances during the process of regulating visceral function continues to be a valuable investigative and therapeutic maneuver.
In general, sympathtectomy has been used for one or more of the following purposes:
1/ to eliminate tonic or engendered responses which depend upon impulses in adrenergic nerves;
2/ to eliminate visceral stores of adrenergic substances which depend upon the integrity of the postganglionic sympathetic innervation;
3/ to eliminate postganglionic sympathetic tissue as a locus for the synthesis, uptake, binding, release and metabolism of adrenergic substances;
4/ to eliminate visceral afferent fibers which are frequently distributed in common with autonomic nerves.
It is clear that sympathectomy is not a selective excision of adrenergic elements only. It is well recognized that preganglionic sympathectomy involves division of cholinergic elements and sensory fibers.
Although the larger portion of sympathetic inflow to an organ can be eliminated by excision of relatively large, well defined anatomical structures in the sympathetic nervous system, there may be many aberrant pathways of innervation. The structure of the terminal apparatus for innervation in most organs is not clear, and it is not known how widely or how rapidly a seemingly small residue of postganglionic fibers can proliferate or branch to occupy sites of degenerated elements.
Theodore Cooper
Surgical Sympathectomy and Adrenergic Function
Department of Surgery, St Louis University School of Medicine
Pharmacological Reviews, Vol. 18, No.1
http://pharmrev.aspetjournals.org/cgi/pdf_extract/18/1/611

Sympathectomy increases total body perspiration, not decreases it

Performing thoracoscopic T2-T3 sympathectomy for PPH affects the total body sweating response to heat.
http://www.ncbi.nlm.nih.gov/pubmed/11193740
Kopelman D, Assalia A, Ehrenreich M, Ben-Amnon Y, Bahous H, Hashmonai M.

Department of Surgery B, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa.

An ultrastructural study of the effects of right cervical sympathectomy on the sinuatrial and atrioventricular nodes in the heart

Axon profiles and terminals showing various degrees of degeneration were present in the vicinity of the nodal cells throughout the period of study. It is concluded that right cervical sympathectomy resulted in a rapid degeneration in some of the cells in the sinuatrial and atrioventricular nodes.
S S Tay, W C Wong, and E A Ling
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1165060

Abnormalities in autonomic cardiovascular control can impair blood supply to the brain

Abnormalities in autonomic cardiovascular control can impair blood supply to the brain and produce syncope in two different disorders: autonomic failure and neurally mediated syncope. In autonomic failure, sympathetic efferent activity is chronically impaired so that vasoconstriction is deficient, upon standing blood pressure always falls (i.e., orthostatic hypotension), and syncope or presyncope occurs. Conversely, in neurally mediated syncope, the failure of sympathetic efferent casoconstrictor traffic (and hypotension) occurs episodically and in response to a trigger. Between syncopal episodes, patients with neurally mediated syncope have normal blood pressure and orthostatic tolerance. This article reviews the characteristics of autonomic failure and describes in more detail the pathophysiology, diagnosis, and treatment of neurally mediated syncope.

Neurally Mediated Syncope and Syncope Due to Autonomic Failure: Differences and Similarities.

Review Articles

Journal of Clinical Neurophysiology. Neurocardiogenic Syncope. 14(3):183-196, May 1997.
Kaufmann, Horacio

Cannon phenomenon after sympathectomy

Sympathectomy in such cases causes classic Cannon phenomenon. This physiological phenomenon refers to the fact that the end organ that is controlled by sympathetic fibers will become uninhibited in it's chemical dysfunction. As a result, even though the sympathetic nerve fibers are not contributing to acetylcholine or norepinephrine secretion at the area of nerve damage, the partially damaged sensory nerves become uninhibited with resultant increase pain input.

In patients who have had sympathectomy, thermography shows an increase iof temperature in the focus of ephatic nerve damage (Cannon phenomenon) with secondary increase of pain and discomfort.

Chronic Pain: Reflex Sympathetic Dystrophy : Prevention and Management

By Hooshang Hooshmand

Published by CRC Press, 1993

Centre for Clinical Effectiveness and Monash University

• No systematic reviews, meta-analyses, or clinical trials that evaluated the
effectiveness of endoscopic thoracic sympathectomy for treating facial
blushing were identified. However, we have identified four case series
related to the request (Drott et al. 1998, Rex et al. 1998, Telaranta 1998,
Yilmaz et al. 1996). These studies were conducted in three countries
(Sweden, Finland and the Netherlands).

• The four case series were not critically appraised because they are prone
to bias and have significant methodological problems. These studies
represent level IV evidence according to the NHMRC criteria and one
should not draw firm conclusions from their findings.

• To date, the benefits or side effects associated with endoscopic thoracic
sympathectomy for treating facial blushing have not been properly
evaluated and reported.

Omar Ahmed PhD
Centre for Clinical Effectiveness
Monash Medical Centre
Locked Bag 29
Clayton VIC 3168
Australia

Acupuncture after sympathectomy?

Sympathectomy abolishes trigger points activity.
Dr Simon L Strauss
http://www.pain-education.com/100125.php

Perioperative Thermoregulation

Neuraxial (spinal and epidural) anesthesia also impairs central thermoregulatory control via mechanisms that remain unclear. Regional anesthesia also causes a sympathectomy that prevents lower-body vasoconstriction and paralysis that prevents lower-body shivering. Consequently, hypothermia during neuraxial anesthesia is as common, and nearly as serious, as during general anesthesia.
Daniel I. Sesler, M.D.
Australian and New Zealand College of Anaesthetists.


http://www.anzca.edu.au/events/asm/asm2007/Sessler3.htm

Long QT treatment in AU

In patients who do not respond to medication, the insertion of a pacemaker or the automatic defibrillator, or the surgical cutting of certain nerves in the neck, called cervico-thoracic sympathectomy, can be utilised.
http://www.sads.org.au/sads_info.html

sympathectomy highly controversial

This highly controversial treatment involves the destruction of nerves using surgery or chemicals, and is indicated only for profoundly disabled patients who have responded positively to sympathetic blockade and have no other treatment options. Evidence to support the use of sympathectomy is limited, and as such its use is not widely recommended. Some retrospective studies of surgical sympothectomy have shown long-term success (Schwartzman, 1997; Kim, 2002; Brandyk, 2002). However, these successful outcomes should be balanced with reports
of the negative impact of surgical sympathectomy (Furlan, 2001).

Sympathectomy causes changes in the wool growth of sheep

The left superior cervical ganglion was removed from 18 sheep. The animals were exposed to a cold environment and ear temperature was monitored to indicate the likely release of noradrenaline in the skin of the cheeks or adrenaline from the adrenals. With respect to the sympathectomized side, a reduction in ear temperature on the unoperated side was associated with lowered mitotic rate at the unoperated cheek site (P < 0.026). However, when the temperature of the unoperated side was not lowered, mitotic rate was not consistently lower on one side with respect to the other. Physiological levels of noradrenaline therefore mimicked the effects observed during the pharmacological studies, and the catecholamines may therefore play an important role in the regulation of wool growth.
DR Scobie, PI Hynd and BP Setchell
Australian Journal of Agricultural Research 45(6) 1159 - 1169

Full text doi:10.1071/AR9941159

© CSIRO 1994

Sympathectomy in the treatment of RSD

The book classifies the different stages of RSD and describes the qualitative and quantitative differences between natural endorphins and synthetic narcotics. Included are long-term follow-ups on sympathectomy patients. This important reference explains why sympathectomy fails, but nerve block and physiotherapy is successful in the treatment of RSD.
Author: H. Hooshmand
Chronic Pain
Publisher: Taylor & Francis
ISBN: 9780849386671
http://www.theaustralian.seekbooks.com.au/popcat.asp?storeURL=theaustralian&CatMain=MED071000&CatSub=MED022000&CatMinor=&PageNo=1&CatMode=2&a=c

Response:

However, please advise people that even after a sympathectomy the patients that have Reflex Sympathetic Dystrophy, aka, Complex Regional Pain Syndrome, could still have extreme pain.

Sympathectomy may provide temporary pain relief, but after a few weeks to months it loses its effect.

http://www.rsdinfo.com/crps_and_sympathectomy.htm

Christine
http://AfflictedWithRSD.com
http://blog.christineleiendecker.com

Sympathectomy also cuts sensory nerves

Thoracoscopic Splanchnicectomy, first proposed by Dr. Lin in 1992, is a lower position of sympathetic procedure. It can relieve abdominal cancer pain originating from Pancreas, Liver, Gall Bladder, Upper GI and right Hemi-colon. Nearly hundred percent of effective pain relief is found especially on the case of pancreatic cancer.

http://www.sweathand.com/four_e.htm

Mia: is there a possibility that people who have undergone sympathectomy will not feel when they are having a heart attack, or feel the pain from internal injury, or stomach ulcers?!

Dr Lin treats these conditions with sympathectomy:

A certain percentage of Angina, Reflex sympathetic dystrophy and pain, Raynaud’s syndrome, Asthma, Schizophrenia, Social phobia, Rhinitis, Migraine, Tremoring disorders, Parkinsonism … can be treated by sympathetic surgery. Stellate Ganglion Block (SGB) is one of the best method for preoperative evaluation, which is the best way to avoid unnecessary sympathetic operation.

http://www.sweathand.com/five_e.htm#index_3

Patients receiving treatment for sweaty hands also receive surgery for Hypertension? Are they told that they are also having heart surgery?

It is worthy to notice that facial sweating is also an indicator of hypertensive cardiovascular disease. Dr. Lin found that sympathetic procedures could concommitantly treat both facial sweating and hypertension. Of course, long-term follow-up is necessary to evaluate its therapeutic and preventive effects to hypertensive cardiovascular disease.

http://www.sweathand.com/one_e.htm

Conditions treated by SYMPATHECTOMY

Lin-Telaranta Classifications

Group 1: Facial Blushing, Tremoring disorder, Rhinitis, Schizophrenia, Parkinsonism, Migraine, Raynaud’s Syndrome, Angina.

Group 2: Facial sweating with or without hand sweating; Facial sweating
and blushing, Hypertension, Angina (Hypertensive cardiac
disease), …
Group 3: Hand sweating with or without axillar sweating.
Group 4: Axillar sweating (Bromidrosis), Myofascial syndrome.
Others: Psychic disorders: Schizophrenia, Social phobia, Upper
abdominal cancer pain from Stomach, Liver, Pancreas, ….;
Plantar Hyperhidrosis.

http://www.sweathand.com/two_e.htm#Linclass

Dr Lin performed over 6000 surgeries

Postoperative sweating phenomenon is a reflex response between sympathetic system and Hypothalamus, it is absolutely not a compensatory mechanism that other parts of human body take over the sweating function of hands after operation. This is the reason why Dr. Lin insisted to use the term of reflex sweating instead of compensatory sweating. Hypothalamus is the center of Autonomic Nervous System, which influences human mind, mentality and endocrine system. Dr. Lin emphasized, “Endoscopic Sympathetic Surgery helps us open a gate to Autonomic Nervous System”.
http://www.sweathand.com/introduce_e.htm

Partial cardiac sympathetic denervation after bilateral thoracic sympathectomy in humans

Upper thoracic sympathectomy is used to treat several disorders. Sympathetic nerve fibers emanating from thoracic ganglia innervate the heart.
METHODS: Nine patients with previous upper thoracic sympathectomies (four right-sided, one left-sided, four bilateral) underwent thoracic 6-[18F]fluorodopamine scanning between 1 and 2 hours after injection of the imaging agent. In each case, a low rate of entry of norepinephrine into the arm venous drainage (norepinephrine spillover) verified upper limb sympathectomy. Data were compared with those from the interventricular septum of patients with cardiac sympathetic denervation associated with pure autonomic failure and from normal volunteers. RESULTS: All four patients with bilateral sympathectomy had low septal myocardial 6-[18F]fluorodopamine-derived radioactivity (2,673 +/- 92 nCi-kg/cc-mCi at an average of 89 minutes after injection) compared with normal volunteers (3,634 +/- 311 nCi-kg/cc-mCi at 83 minutes, N = 22, P = .007) and higher radioactivity than in patients with pure autonomic failure (1,320 +/- 300 nCi-kg/cc-mCi at 83 minutes, N = 7, P = .003).
CONCLUSIONS: Bilateral upper thoracic sympathectomy partly decreases cardiac sympathetic innervation density.

Heart Rhythm. 2005 Jun ;2:602-9 15922266
Jeffrey P Moak, Basil Eldadah, Courtney Holmes, Sandra Pechnik, David S Goldstein
http://lib.bioinfo.pl/pmid:15922266

Holter changes resulting from right-sided and bilateral infrastellate upper thoracic sympathectomy

RESULTS: Heart rate was 77 +/- 8 beats per minute before surgery on the 24-hour recording and significantly decreased after bilateral (67.8 +/- 6.5 beats per minute; p < 0.05) but not after unilateral right sympathectomy. Consistently spectral analysis variables significantly changed after bilateral surgery but showed no right-sided dominance. Little effect of sympathectomy was found on the QT interval, which tended to decrease after bilateral sympathectomy. CONCLUSIONS: Patients should be informed of the bradycardia resulting from sympathectomy.

Ann Thorac Surg. 2002 Dec ;74 (6):2076-81 12643398
Pierre Abraham, Jean Berthelot, Jacques Victor, Jean-Louis Saumet, Jean Picquet, Bernard Enon Department of Vascular Investigation and Sports Medicine, University Hospital, Angers, France

THE EFFECT OF CERVICAL SYMPATHECTOMY ON POSTERIOR PITUITARY OXYTOCIC ACTIVITY IN RATS UNDER CHRONIC STRESS.

FENDLER K, ENDROCZI E, LISSAK K.
Acta Physiol Acad Sci Hung. 1965;27:275-8.Links
http://www.ncbi.nlm.nih.gov/pubmed/14333014

Sympathectomy-induced alterations of immunity

Many studies have demonstrated that ablation of the sympathetic nervous system (SNS) alters subsequent immune responses. Researchers have presumed that the altered immune responses are predominantly the result of the peripheral phenomenon of denervation. We, however, hypothesized that chemical sympathectomy will signal and activate the central nervous system (CNS). Activation of the CNS was determined by immunocytochemical visualization of Fos protein in brains from male C57BL/6 mice at 8, 24, and 48 h following denervation. A dramatic induction of Fos protein was found in the paraventricular nucleus (PVN) of the hypothalamus and other specific brain regions at 8 and 24 h compared to vehicle control mice. Dual-antigen labeling demonstrates that corticotrophin releasing factor (CRF)-containing neurons in the PVN are activated by chemical sympathectomy; however, neurons containing neurotransmitters which may modulate CRF neurons, such as vasopressin, tyrosine hydroxylase, and adrenocorticotropin, do not coexpress Fos. Our findings suggest an involvement of the CNS in sympathectomy-induced alterations of immunity.
Tracy A. Callahan, Jan A. Moynihan and Diane T. Piekut
Brain, Behavior, and Immunity
Volume 12, Issue 3, September 1998, Pages 230-241
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WC1-45JK31F-F&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_version=1&_urlVersion=0&_userid=10&md5=d3d36bb1041938df0f68d43389b44414

Oxytocin and adrenaline after sympathectomy

It is suggested that sympathetic nerves to vascular smooth muscle have a function or functions other than transmitter release and that when crushed nerves regenerate the functions do not recover at the same rate.
Sybil Lloyd and Mary Pickford
J Physiol Vol 192, Issue 1 pp 43-52
Copyright © 1967 by The Physiological Society

http://jp.physoc.org/cgi/content/abstract/192/1/43

defects in regulation of heat production, sweat and vasoconstriction - sympathectomy creates the same effect as high level spinal cord lesions

A number of workers have studied the altered vasomotor responses after sympathectomy. Usually consistently elevated basal flow was described after sympathectomy. However, reports have varied as to the changes in response to vasodilator and vasoconstrictor stimuli. Goetz found that flow to the toe did not respond to either constrictor or dilator stimuli after sympathectomy and that in some cases blood flow was decreased in response to vasodilator stimuli and increased in response to vasoconstrictor stimuli.
These authors could not correlate the changes in blood flow with changes in blood pressure. Ahmad reported a case of hyperhidrosis with homolateral sympathectomy in whom local
warming of the sympathectomized hand to 41 C caused vasoconstriction, while the nor-
mally innervated hand responded with vasodilation.

Pollock and co-workers observed what they called "defects in regulation of heat production, sweat and vasoconstriction" in patients with spinal cord lesions. They believed these defects to be due to interruption of "impulses from suprasegmental levels." In 1953 Armin, Grant, and co-workers demonstrated increased reactivity to vasoconstrictor stimuli in the denervated rabbit's ear and referred to a similar phenomenon in the human finger after sympathectomy.
The results, however, of studies on surgically sympathectomized patients are quite clearcut.
In none of the limbs studied after sympathectomy could an increase in blood flow be produced reflexly by warming; in the majority of instances the opposite response, a decrease in blood flow, was observed. The regularity with which these carefully sympathectomized limbs fail to respond to a vasodilator stimulus suggests that this procedure might be useful as a test for completeness of sympathectomy.
The vasomotor responses to the Gibbon-Landis procedure (reflex response to warming)
were studied in hemiplegic patients, subjects with "high transection" of the cord, and in
sympathectomized patients. The response in hemiplegic patients was vasodilator in nature
just as in the 3 control groups (young normal subjects, elderly subjects without demonstrable
vascular disease, and patients with arterio-sclerosis). One patient with documented tran-
section of the cord above T5 behaved like subjects after surgical sympathectomy. The differences in response in 3 other paraplegic patients may be due to differences in location
and extent of their cord lesions. Basal blood flow was higher in sympathectomized limbs
than in comparable controls. Of 11 sympathectomized limbs tested for vasodilatation in
response to the Gibbon-Landis procedure, 4 showed no response, while 7 responded with decrease in blood flow (vasoconstriction).
1957;15;518-524 Circulation Dorothy Andrews
WERTHEIMER, ARTHUR J. LEWIS, J. MURRAY STEELE and WALTER REDISCH, FRANCISCO T. TANGCO, LOTHAR
Vasomotor Responses in the Extremities of Subjects with Various Neurologic Lesions: I. Reflex Responses to Warming

CS is a serious complication and a significant number of patients may regret undergoing the operation

CS with different severity occurred in 35 patients (87.5%). Six patients (15%) regretted undergoing the operation due to the extent and severity of the CS seriously affecting their quality of life. Thoracoscopic sympathectomy is a simple procedure with a high success rate. However, CS is a serious complication and a significant number of patients may regret undergoing the operation; a careful selection of patients and comprehensive explanation are advisable.
Libson S, Kirshtein B, Mizrahi S, Lantsberg L.

Department of Surgery "A," Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Surg Laparosc Endosc Percutan Tech. 2007 Dec;17(6):511-3

http://www.ncbi.nlm.nih.gov/pubmed/18097311?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=5&log$=relatedarticles&logdbfrom=pubmed

same hospital, same team: 51% of the patients claim decreased quality of life

"The severity of the CS was also lower in children: it was absent or mild in 54.3% of the children versus 38.0% of the others, and moderate or severe in 45.7 versus 62%, respectively (P = 0.004). Fifty-one percent of the participants claimed that their quality of life decreased moderately or severely as a result of CS."
Steiner Z, Cohen Z, Kleiner O, Matar I, Mogilner J.

Department of Pediatric Surgery, Hillel Yaffe Medical Center, PO Box 169, Hadera 38100, Israel.

Pediatr Surg Int. 2008 Mar;24(3):343-7. Epub 2007 Nov 13

http://www.ncbi.nlm.nih.gov/pubmed/17999068?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed

41% of the patients claim quality of life decreased

41% of the participants claimed that their quality of life decreased moderately or severely as a result of CS. Only (sic!) 19.6% would not have undergone the operation in retrospect; there was a significant interesting difference regarding this issue between adults (31.4%) and children (8.8%). The extent of the CS did not change with time in 70% of the patients. It exacerbated in 10% and it diminished in 20%, usually within the first 2 postoperative years. CONCLUSIONS: Thoracoscopic sympathectomy relieves hyperhidrosis in most cases. Patients prefer relief from palmar hyperhidrosis even at the cost of a high rate of CS.
J Pediatr Surg. 2007 Jul;42(7):1238-42.
Steiner Z, Kleiner O, Hershkovitz Y, Mogilner J, Cohen Z.

Department of Pediatric Surgery, Hillel Yaffe Medical Center, Hadera 38100, Israel.

http://www.ncbi.nlm.nih.gov/pubmed/17618887?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus

CS severe in 35% of patients

Compensatory sweating occurred in 89% of patients and was so severe in 35% that they often had to change their clothes during the day. The frequency of compensatory sweating was not significantly different among the three groups, but severity was significantly higher after Th2-4 sympathectomy for axillary hyperhidrosis (p = 0.04). Gustatory sweating occurred in 38% of patients, and 16% of patients regretted the operation. CONCLUSIONS: Compensatory and gustatory sweating were remarkably frequent side effects after thoracoscopic sympathectomy for primary hyperhidrosis.
We encourage informing patients thoroughly about these side effects before surgery.

[My paper] Peter B Licht, Hans K Pilegaard

Department of Cardiothoracic Surgery, Skejby Sygehus, Aarhus University Hospital, Aarhus,
Ann Thorac Surg. 2004 Aug ;78 (2):427-31 15276490

T2 results in complete sympathectomy

Removal of only the second dorsal sympathetic. ganglion is stated to result in as complete sympathectomy, in so far. as central connections are concerned.
Annual Review of Physiology
Vol. 6: 365-390 (Volume publication date March 1944)
(doi:10.1146/annurev.ph.06.030144.002053)

Visceral Functions of the Nervous System

B A McSwiney

The pathophysiology of cervical and upper thoracic sympathetic surgery

T₂-T₃ ganglionectomy significantly decreases pulse rate and systolic blood pressure, reduces myocardial oxygen demand, increases left ventricular ejection fraction and prolongs Q-T interval. A certain loss of lung volume and decrease of pulmonary diffusion capacity for CO result from sympathectomy. Histomorphological muscle changes and neuro-histochemical and biochemical effects have also been observed.

M. Hashmonai^{1, 2} and D. Kopelman^{1, 3}

(1)	Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel http://www.springerlink.com/content/jrcm3h5k8pye9yyu/ Volume 13, Supplement 1 / December, 2003 Clinical Autonomic Research

11 of 72 patients were not able to accept the severe compensatory (reflex) sweating

Compensatory hyperhidrosis is the most common complication and the major reason for patient dissatisfaction with the procedure. In a recent report on the complications experienced by 72 patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy, all patients except one complained of compensatory hyperhidrosis, with 41.7% complaining of moderate hyperhidrosis and 43.1% severe! In this study, 11 patients were not able to accept the consequences of compensatory hyperhidrosis, even though their palms had become dry postoperatively. Compensatory hyperhidrosis following sympathectomy can be far more life disrupting than palmar hyperhidrosis in that afflicted individuals may have to change sweat-soaked clothing five or six times per day. Moran states it quite succinctly: Complications related to the surgical approach, such as Horner's syndrome, brachial plexus injuries, pneumothorax, and painful scars may occur, while following sympathectomy compensatory hyperhidrosis is usual and hyperhidrosis may recur.

TREATMENT OF HYPERHIDROSIS

Lewis P. Stolman MD, FRCP(C)

---

University of Medicine and Dentistry of New Jersey, New Jersey Medical School; and the Dermatology and Laser Center of Northern New Jersey, Livingston, New Jersey
Dermatologic Clinics
Volume 16 • Number 4 • October 1998

Exam question:

S. Neurogenic Causes (of Hypotension)
10. Post-sympathectomy
http://www.fpnotebook.com/CV/Exam/OrthstcHyptnsn.htm

Medial arterial calcification in 93% of patients who underwent sympathectomy

MAC was noted in both feet in 93 % of patients who had. undergone bilateral lumbar sympathectomy; ...
www.springerlink.com/index/EYA170TL7F6HKGVV.pdf - Similar pages - Note this
by ME Edmonds - 2000 - Cited by 45 - Related articles - All 3 versions

Mechanisms of Skeletal Tracer Uptake

However, if the sympathetic nervous control of the microvasculature is interfered with, vessels that are normally closed now open up (mechanism 5, "recruitment"), and areas of osteoid not
normally exposed to tracer are able to take it up. This "hyperemic" phenomenon is seen after
sympathectomy, stroke, fracture, osteomyelitis, and peripheral neuropathies; the counting rate will be less than twice that over normal bone.

Mechanisms of Skeletal Tracer Uptake
N. David Charkes
Temple University Hospital, Philadelphia, Pennsylvania
J Nucl Med 20: 794-795, 1979

Cardiac Supersensitivity after Sympathectomy

Cardiac postjunctional supersensitivity to beta-agonists after chronic chemical sympathectomy with 6-hydroxydopamine.
Chess-Williams RG, Grassby PF, Culling W, Penny W, Broadley KJ, Sheridan DJ
Naunyn Schmiedebergs Arch Pharmacol 1985; 329:162-6.

Functional and morphological alterations have been reported in cerebral arteries after cervical sympathectomy

Innervation of the human carotid vessels is supplied by the sympathetic system, originating mainly from the superior cervical ganglion, but also from the inferior. Different methods have demonstrated profuse adrenergic innervation of the cerebral blood vessels and regulation of blood flow by the sympathetic system. Functional and morphological alterations have been reported in cerebral arteries after cervical sympathectomy, but vasospasm pathogenesis after subarachnoid haemorrhage remain controversial.

RESULTS

Histological examinations of surgical specimens confirmed ganglion tissues in all cases.

Table 1 shows mean basilar artery diameters for all groups. There were significant statistical differences between groups.

Effects of cervical sympathectomy on vasospasm induced by meningeal haemorrhage in rabbits

Antônio Tadeu de Souza Faleiros^I; Francisco Humberto de Abreu Maffei^II; Luiz Antonio de Lima Resende^III

Sympathectomy for Peripheral Arterial Insufficiency?

SYMPATHECTOMY has been performed frequently on patients with peripheral arterial insufficiency. Clinical results have varied from excellent to very poor, and, in some instances, the insufficiency has been worsened. These varying clinical results have not been completely explained by previous experimental studies.

Effect of Sympathectomy on Blood Flow in Arterial Stenosis *
ALLYN G. MAY, M.D., JAMES A. DE WEESE, M.D., CHARLES G. ROB, M.D.
From the Department of Surgery, University of Rochester School of Medicine and
Dentistry, Rochester 20, New York

sympathectomy improves skin blood flow at the thermoregulatory but not the nutritive level of skin microcirculation

The role of lumbar sympathectomy in the treatment of limb ischemia secondary to arteriosclerosis obliterans has been controversial. Increased temperature and rubor of the skin, which usually follow sympathectomy, have generally been interpreted as indicative of improved nutritive skin blood flow. However, the existence of a (nonnutritive) thermoregulatory level of skin microcirculation makes such an extrapolation questionable.

These results indicate that in case of lower limb ischemia, sympathectomy improves skin blood flow at the thermoregulatory but not the nutritive level of skin microcirculation. This may be related to the fact that the thermoregulatory vessels are mainly sympathetically controlled, whereas the nutritive capillaries are mainly controlled by local (nonneural) factors.

François M.H. van Dielen¹, Harrie A.J.M. Kurvers¹, Ruben Dammers¹, Mirjam G.A. oude Egbrink², Dick W. Slaaf³, Jan H.M. Tordoir¹ and Peter J.E.H.M. Kitslaar¹

(1)	Department of General Surgery, Cardiovascular Research Institute Maastricht and University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands, NL

(2)	Department of Physiology, Cardiovascular Research Institute Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands, NL

(3)	Department of Biophysics, Cardiovascular Research Institute Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands, NL