Friday, January 18, 2008

SAMPLE OF THE SALES PITCH - THIS IS HOW IT'S DONE

Surgical sympathectomy is the gold standard of treatment for this disease, by which all other treatments must be judged. Upper thoracic sympathectomy has been performed for many years as therapy for hyperhydrosis and several other diseases. There are various surgical approaches available. Prior to the advent of endoscopic transthoracic sympathectomy (ETS), these approaches involved either painful back or neck incisions with possible risk of brachial plexus, or phrenic nerve injury, or Horners syndrome. The introduction of ETS for excessive hand and facial sweating has revolutionized the treatment of this disease. The success rate is in excess of 98%, with very few side effects or serious complications.
Endoscopic sympathectomy is a highly-effective treatment for patients with palmar or facial hyperhydrosis. ETS allows simultaneous treatment of both sides with a very low risk of complications. Attention to surgical detail is important to achieve excellent long-term results. We continue to lead the New York metropolitan area in minimally invasive thoracoscopic procedures, and especially ETS.

THE SYMPATHECTOMY FAILURE

1. Sympathectomy is analogous to the act of killing the messenger. The sympathetic nervous system has the critical job of properly controlling and preserving the circulation in different parts of the body, especially in the extremities. By paralyzing the system, the extremity will be more apt to have disturbance of circulation and is left unprotected from fluctuation in circulation.

Sympathectomy is similar to permanently removing the central heat and air-conditioning system and never replacing it because of malfunction.

Sympathectomy permanently damages the temperature regulatory system. The reason sympathectomy does not cause side effects other than ineffective control of pain as well as impotence and orthostatic hypotension is because it is invariably partial and incomplete.H. Hooshmand, M.D.: Chronic Pain

View Larger Image

9780849386671

Chronic Pain: Reflex Sympathetic Dystrophy Prevention and Management

Hooshang Hooshmand

ISBN 10: 0849386675 / 0-8493-8667-5
ISBN 13: 9780849386671
Publisher: CRC Pr I Llc
Publication Date: 1993
Binding: Hardcover

Melbourne Surgeon's definition of a very safe procedure

"Thoracoscopic cervical sympathectomy is considered a very safe procedure, with very few problems other than the transient pain mentioned above. Nonetheless, you should know that there is a very small risk - not more than 1 chance in 2000 - that you may experience numbness or weakness in the hand from other nerve damage. A droopy eyelid and small pupil can also occur as a result of the procedure affecting the nerve supply to the eyelid (1%). Excessive sweating of the lower body will occur and this is known as compensatory sweating and can be quite marked. A stuffy nose may result and this change can be permanent requiring nasal spray for life. The face will feel dry after thoracoscopic cervical sympathectomy and this may be annoying. Failure to improve your condition or failure to remove the part of the nerve can occur and this is called a therapeutic failure and is therefore also a risk. Risk to life is < 0.01%."

Not being able to sweat and cool of through the head is more than annoying. 40% of the body heat is released through the top of the head. This will be eliminated. The will be no sweating from the head, neck and shoulders.
The the skin's natural cleaning mechanism, sweating will be eliminated. The skin will become dehydrated, clogged up and more prone to acne. Sympathectomy also lowers the denervated skin's immune responses, it will be more prone to infections. Sympathectomy alters the skin's healing process. People undergoing the opearation will have scar tissue after the operation and from future cutaneous trauma.
Sympathetic denervation impairs epidermal healing in cutaneous wounds
LINCOLN R. KIM, BSCaI KEITH WHELPDALE, MSCb; MA TEUSZ ZUROWSKI, MSCb; BRUCE POMERANZ, MD, PhD°, b

INTRAOCULAR PRESSURE AND DENERVATION

Br J Ophthalmol. 1983 May; 67(5): 297-301.

Ocular sympathetic denervation associated with ocular hypertension: a case report.

D J Brazier

The exact function of the sympathetic nervous system in the regulation of intraocular pressure remains unclear. Many observers have noted reduced intraocular pressure in eyes whose sympathetic supply has been interrupted. A case of ocular sympathetic denervation associated with ocular hypertension is reported. Reports on the relationship between intraocular pressure and sympathetic denervation are reviewed and their relevance to this case discussed.

MANY PATIENTS COMPLAIN ABOUT VISUAL DISTURBANCES, BLURRY VISION AFTER THE SURGERY. THERE IS THE CASE OF ORTHOSTATIC HYPOTENSION CAUSED BY THE SURGERY BY DISABLING REGULATION OF THE BLOODPRESSURE, SO THAT BLOOD POOLS INTO THE LEGS WHEN PATIENTS STAND UP. THIS CAN CAUSE BLURRY VISION. THE SYMPATHETIC NERVES ALSO INNERVATE THE SMOOTH MUSCLE THAT IS INVOLVED IN EYEMOVEMENTS. AND NOW THIS ARTICLE TALKING ABOUT THE CONNECTION BETWEEN INNERVATION AND INTRAOCULAR PRESSURE.
IT IS A WELL-DOCUMENTED FACT THAT THE OPERATION CAN CAUSE HORNER SYNDROME, CAUSING A DROOPY EYELID AND AFFECTING THE PUPILS.

b. Cervical sympathectomy causes photoreceptor-specific cell death in the
rat retina
Jena J. Steinle , , Naarah L. Lindsay and Bethany L. Lashbrook

There was a significant reduction (30%) in photoreceptor numbers in the sympathectomized eye. This loss was due to apoptosis, as there was over a doubling in apoptotic cell numbers after sympathectomy. This loss of photoreceptors in the sympathectomized eye resulted in a significantly reduced width of the outer nuclear layer of the retina when compared to the contralateral eye. Increased glial fibrillary acidic protein (GFAP) staining was also noted after sympathectomy in the ganglion cell layer with streaking toward the bipolar cell layer. These results suggest that loss of sympathetic innervation may cause significant changes to the physiology of the choroid.
Journal of Medical Colleges of PLA

AUTOIMMUNE DISEASE AND INNERVATION

Brain Behav Immun. 2007 May 19; : 17517488
Autoimmune disease and innervation.

Rainer H Straub

In the decades before 1987, most of the research devoted to neuronal innervation was carried
out in primary and secondary lymphoid organs at very different locations. This was an important period in order to understand hard-wiring of immune organs in physiology. Between 1988 and 1997, with the appearance of specific antibodies against neuronal markers, innervation was studied in inflamed tissue of patients and of animals with autoimmune diseases. This period clearly revealed that nerve fibers of, both, the sympathetic and sensory nervous system are altered, but only small amounts of tissue have been investigated by qualitative but not quantitative techniques. Between 1998 and 2007, with the understanding that sympathetic and sensory neurotransmitters might play opposite roles in inflammation, nerve fibers of the different nervous systems have been studied in parallel using quantitative techniques. These studies have been carried out in a large number of patients with long-standing autoimmune diseases. It turned out that sympathetic nerve fibers are lost in chronically inflamed tissue, while substance P-positive nerve fibers sprout into the inflamed area. This might be important because high concentrations of sympathetic neurotransmitters are antiinflammatory whereas substance P has a proinflammatory role. The first challenge for future research is the determination of innervation in the early human autoimmune disease. The second challenge is the identification of reasons for the differential loss of sympathetic in relation to sensory nerve fibers. It might well be that nerve repellent factors specific for the sympathetic nerve fiber might play an important role for the observed differential loss. Whether, or not, a therapy can be based on these findings remains to be established.
[Pubmed] [Scholar] [EndNote] [BibTex] [Doi]

THIS IS WHAT THERMOREGULATORY DYSFUNCTION LOOKS LIKE

CONSIDERABLE HYPERTHERMIA THROUGHOUT THE FACE AND NECK, WHICH IS CONSISTENT WITH AUTONOMIC DYSFUNCTION.
A SURGICALLY INDUCED AUTONOMIC DYSFUNCTION, THAT IS CONSISTENT WITH T2 SYMPATHECTOMY.
A SIGNIFICANT PATERN OF HYPOTHERMIA EXTENDING FROM THE RIGHT ARM INTO THE RIGHT AXILLA, THIS ALSO CORRELATES WITH THERMOREGULATORY DYSFUNCTION.

MORE ON BRAIN COOLING

“The efficiency of SBC (Selective Brain Cooling) is increased by evaporation of sweat on the head and by ventilation through the nose.” (Nagasaka et al. 1998)

“A necessary condition for SBC is a high heat loss capacity from the head itself, without such a heat loss SBC is not possible.” (Cabanac 1993)

“Because the human head sweats more than the rest of the body, heat loss from the head skin could amount to 125-175 Watts under conditions of moderate hyperthermia.” (http://www.editthis.info/corposcindosis/Changes_to_Systemic_Function%2C_part_1 Cabanac 1993)

SELECTIVE BRAIN COOLING...IF THERE IS NO SWEATING FROM THE FACE...?

Selective Brain Cooling

Besides the general “heat intolerance”, ETS patients have anecdotally reported what they consider to be a “hot brain” syndrome. In particular, Taiwanese ETS patient and robotics engineer “Hpymaker” has made frequent references in the oral history to this hot brain phenomenon. Songboy1234 has also reported a very disturbing sensation like a fever that occurs when exercise is attempted.

Is there any scientific reason to suppose that ETS surgery could interfere with brain cooling, separate from the general thermoregulatory difficulties already shown? This would depend upon whether the normal human has any mechanism to selectively cool the brain; and if so, whether that mechanism is damaged by sympathectomy. The answers are yes we do; and yes it is.

Studies from decades ago began to confirm Selective Brain Cooling. “Cooling of the head skin . . .produces a significant improvement in the performance of heat-stressed humans.” (Kenney, see Williams & Shitzer, 1974).

The ability to selectively cool the brain during hyperthermia (overheating) has long been an accepted fact in many mammals, such as dogs. Dogs have a network of blood vessels in the head called the “carotid rete” which allows heat exchange between warm blood in arteries and cooler blood in veins. The excess heat escapes through the mouth during panting. Humans do not have a carotid rete, so for some time the notion of selective brain cooling in humans was controversial.

However, it has been shown that at 65.8˚ F (18.8˚ C) ambient temperature the deep trunk temperature of a marathon runner may rise to 107.4˚ F (41.9˚ C) with no clinical sign of heat illness (Cabanac et al. 1979; see Maron, Wagner & Horvath, 1977). Michel Cabanac at the Department of Physiology, Laval University, Quebec has been studying Selective Brain Cooling in Humans since the 1970’s, and has evidently discovered the mechanism by which humans accomplish this.

It turns out that certain veins in the face, such as the ophthalmic veins, will actually reverse the direction of blood flow when the body begins to overheat. The blood in these veins is cooled by evaporation of facial sweat, then flows backwards into the sinus and intercranuim area, cooling the carotid artery and the brain.

“The selective influence of facial fanning on human brain temperature can be attributed, therefore, to cool venous blood perfusing the cavernous sinus and possibly cooling the blood of the internal carotid artery.” (Cabanac et al. 1979)

A group of Japanese physiologists at Kanazawa University have been confirming and expanding upon Cabanac’s findings. Their studies subject people to heat stress and exercise, and measure variables such as skin temperature, core temperature, forehead sweating, and blood flow in the ophthalmic vein. They found “that there are elements within the brain that control the mechanisms for switching the direction of venous flow through the emissary veins to keep the brain cool during hyperthermia.” (Hirashita et al. 1992)

Given that this direction-reversing mechanism requires vascular control in the face, we already have strong reason to suspect that ETS would disturb if not destroy selective brain cooling. Is head sweating also important to this process?

“The efficiency of SBC (Selective Brain Cooling) is increased by evaporation of sweat on the head and by ventilation through the nose.” (Nagasaka et al. 1998)
http://www.editthis.info/corposcindosis/Changes_to_Systemic_Function%2C_part_1

ETS SURGEON ADMITS OPERATION CAUSES HEAT INTOLERANCE

Nielson Website

Additional confirmation of thermoregulatory difficulties comes from ETS surgeon David Nielson, whose advertising website has, since 2003, listed “heat intolerance” among the “side effects” produced by the surgery.
http://www.hyperhidrosis-usa.com/sideeffects.html

ANHIDROSIS AFTER SYMPATHETOMY

Prediction: Thoracic sympathectomy will cause anhidrosis in the denerved area.

Empirical Status: Confirmed.

Anhidrosis

Sweat glands are controlled almost entirely via the sympathetic nervous system, and do not have parasympathetic innervation at all. Unlike most other sympathetic nerve terminals, the receptors in sweat glands are activated by acetylcholine, not norepinephrine. It is possible that sweat glands can be activated locally to a small degree by catecholamines in the blood, but for practical purposes sympathectomy renders sweat glands permanently non-functional in the denerved area. This dysfunction is called "anhidrosis".
Anhidrosis is considered dangerous, as we learn from the WebMD dictionary:

Anhidrosis: Not sweating. From the Greek an- meaning a lack of + hidros meaning sweat = lack of sweat. The inability to sweat may seem a blessing but it is not, since to sweat is to be able to stay cool. Anhidrosis creates a dangerous inability to tolerate heat. (WebMD dictionary)

In one clinical trial, ETS patients subjectively described the sensation of anhidrosis as “disturbing”.

“Patients undergoing T2-T4 resection often experience anhidrosis from the nipple line upwards which has been disturbing for several individuals.” (Fischel et al. 2003)

http://www.editthis.info/corposcindosis/Changes_to_Individual_Effectors,_part_2

TREATMENT NEEDED AFTER THE TREATMENT ENDED UP NOT BEING A TREATMENT ...

COMMUNICATIONS AND BRIEF REPORTS

Treatment of Unilateral Compensatory Sweating after Endoscopical Thoracic Sympathectomy for General Hyperhidrosis with Botulinum Toxin A

FALK GEORGES BECHARA, MD ^* ^* Department of Dermatology and Allergology, Ruhr-University Bochum, Bochum, Germany; ,
MICHAEL SAND, MD ^* ^* Department of Dermatology and Allergology, Ruhr-University Bochum, Bochum, Germany; ,
GEORG MOUSSA, MD ^* ^* Department of Dermatology and Allergology, Ruhr-University Bochum, Bochum, Germany; ,
DANIEL SAND, BS ^† ^† Department of Physiological Science, University of California Los Angeles (UCLA), Los Angeles, California; ,
PETER ALTMEYER, MD ^* ^* Department of Dermatology and Allergology, Ruhr-University Bochum, Bochum, Germany; ,
KLAUS HOFFMANN, MD ^* ^* Department of Dermatology and Allergology, Ruhr-University Bochum, Bochum, Germany; and
JOHANNES SCHMIDT, MD ^‡ ^‡ Department of Visceral Surgery, Lutherhaus Essen, University of Witten-Herdecke, Essen, Germany

^* Department of Dermatology and Allergology, Ruhr-University Bochum, Bochum, Germany; ^† Department of Physiological Science, University of California Los Angeles (UCLA), Los Angeles, California; ^‡ Department of Visceral Surgery, Lutherhaus Essen, University of Witten-Herdecke, Essen, Germany

BODY WEIGHT

Chemical Sympathectomy Alters Regulation of Body Weight
During Prolonged ICV Leptin Infusion

Robert L. Dobbins1, Lidia S. Szczepaniak1, Weiguo Zhang1 and J. Denis McGarry1,2

ABOUT LIPOLYSIS FOLLOWING SYMPATHECTOMY

Hormones in Muscular Activity

by Atko Viru - 1985 - Medical
121 ± 13 min).44 Consequently, following chemical sympathectomy the adrenal medulla is unable to ensure adequate lipolysis. ...

Limited preview - books.google.com/books?isbn=0849354943...

Monckeberg's sclerosis after sympathetic denervation

Goebel FD, Fuessl HS.
Medial arterial calcification is frequently seen in diabetic patients with severe diabetic
neuropathy. Sixty patients (19 diabetic and 41 non-diabetic) were examined
radiologically for typical Monckeberg's sclerosis of feet arteries 6-8 years after uni- or
bilateral lumbar sympathectomy. Fifty-five out of 60 patients (92%) revealed medial
calcification. This calcification was observed in both feet of 93% of patients, who had
undergone bilateral operation. After unilateral sympathectomy the incidence of calcified
arteries on the side of operation was significantly higher than that on the contralateral
side (88% versus 18%, p less than 0.01). Although diabetic patients showed longer
stretches of calcification than non-diabetic subjects, the difference was not significant in
terms of incidence and length. Of 20 patients who had no evidence of calcinosis
pre-operatively, 11 developed medial calcification after unilateral operation exclusively
on the side of sympathectomy. In seven patients calcinosis was detected in both feet after
bilateral operation. In conclusion, sympathetic denervation is one of the causes of
Monckeberg's sclerosis regardless of diabetes mellitus.

Reduced baroreflex sensitivity is associated with increased vascular calcification and arterial stiffness

Reduced baroreflex sensitivity is associated with increased vascular calcification and arterial stiffness

Introduction. Vascular calcification is a critical determinant of cardiovascular morbidity and mortality in chronic haemodialysis (HD) patients. The pathophysiology underlying this observation remains obscure. Baroreceptor sensitivity (BRS) is important in the maintenance of an appropriate cardiovascular status both at rest and under the physiological stress of HD. BRS is determined by both the mechanical properties of the vascular wall, mediating the transfer of transmural pressure, and afferent and efferent autonomic function. We aimed to study the association between arterial structure, function and BRS in chronic HD patients.

Conclusion. The reduction in BRS and the resulting aberrant blood pressure response to the physiological stress and volume changes of HD may be important in the further understanding of the pathophysiology of the increased mortality in HD patients with vascular calcification.

Lindsay J. Chesterton1, Mhairi K. Sigrist1, Terence Bennett2, Maarten W. Taal1 and Christopher W. McIntyre

In a person who had a sympathectomy, the sympathetic component of the baroreceptor mechanism is absent

The baroreceptor reflex is only a short-term regulator of blood pressure because the receptors adapt by raising the threshold and lowering discharge rate.
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.

Heart Physiology II

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

reflex vasoconstriction induced by mild central hypovolemia includes a significant reduction of jejunal mucosal perfusion in supine resting humans

J Auton Nerv Syst. 1998 Feb 5;68(3):157-63.

Baroreceptor-mediated reduction of jejunal mucosal perfusion, evaluated with endoluminal laser Doppler flowmetry in conscious humans.

Thorén A1, Ricksten SE, Lundin S, Gazelius B, Elam M.

Author information

Abstract

Reduction of central blood volume elicits a peripheral vasoconstrictor reflex in various tissues including skin, skeletal muscle and the hepatomesenteric region. The aim of the present study was to investigate whether this reaction includes a decreased perfusion of the jejunal mucosa in man. Laser Doppler flowmetry (LDF) was used to monitor jejunal mucosal and skin perfusion simultaneously in eleven healthy volunteers. LDF recordings were performed during quiescent (phase 1) periods of the migrating motor complex. Seven subjects demonstrated cycling changes of jejunal mucosal perfusion (vasomotion). The average minimum jejunal flux value was 72 +/- 6 perfusion units. The average intraindividual coefficient of variation was 18 +/- 2%. Lower body negative pressure (LBNP) was used to elicit controlled reductions of central blood volume. LBNP of 10 mm Hg induced a 12 +/- 4% (P < 0.05) decrease in jejunal perfusion and a 43 +/- 11 (P < 0.001) decrease in cutaneous perfusion. Corresponding responses to LBNP of 20 mm Hg were 17 +/- 5% (P < 0.01) and 37 +/- 10% (P < 0.01) reductions in jejunal mucosal and skin perfusion, respectively. Cardiac index was significantly reduced by the LBNP procedure, whereas heart rate remained unchanged and blood pressure changes were minor and inconsistent. These findings indicate that the reflex vasoconstriction induced by mild central hypovolemia includes a significant reduction of jejunal mucosal perfusion in supine resting humans. This reflex may provide one mechanism for the intestinal ischemia often occurring in critically ill patients.

Predicting CS?

The mechanism of the so-called Compensatory Sweating is still unclear, and there are no ways to predict who will bit hit harder.
Some surgeons tell their patients that it happens mostly to men, who are overweight and had a heavy sweating prior to surgery.
This has never been proven, and my experience with people who underwent the surgery and have the debilitating CS does not indicate any group that would be more likely to be affected.
Also: these statistics are unreliable. There has been no independent study the examine the severity or extent of the CS. Many questions are not asked, so that they will not tarnish the results. These statistics are collected and questions formulated by the surgeons who offer the surgery. It would be reasonable to assume that they will look for a confirmation of the effectiveness of the operation....otherwise they would not do the surgery....

15% regretted the operation.

Evaluation of compensatory sweating after bilateral thoracoscopic sympathectomy for palmar hyperhidrosis.

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.

The study is a retrospective review of 60 patients undergoing bilateral T2-T3 thoracoscopic sympathectomy for palmar hyperhidrosis in our department between 1997 and 2003. The study was based on a telephone questionnaire and medical chart review. Forty patients (67%) replied to the questionnaire and were included in the study. Postoperative complications, therapeutic results, patient satisfaction, and the severity of compensatory sweating (CS) were assessed. In all patients both palms were dry at the end of surgery. Postoperative complications included permanent unilateral Horner syndrome, wound infection, and residual pneumothorax resolving after thoracal drainage, in one patient each. 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.

Sympathectomy potentiates the vasoconstrictor response to nitric oxide synthase

Nitric oxide exerts its cardiovascular actions at least in part by modulation of the sympathetic vasoconstrictor tone. There is increasing evidence that nitric oxide inhibits central neural sympathetic outflow, and preliminary evidence suggests that it may also modulate peripheral sympathetic vasoconstrictor tone.

METHODS:

To test this latter concept, in six subjects having undergone thoracic sympathectomy for hyperhydrosis, we compared the vascular responses to systemic L-NMMA infusion (1 mg/kg/min over 10 min) in the innervated and the denervated limb. We also studied vascular responses to the infusion of the non-nitric-oxide-dependent vasoconstrictor phenylephrine.

RESULTS:

L-NMMA infusion evoked a roughly 3-fold larger increase in vascular resistance in the denervated forearm than in the innervated calf. In the denervated forearm, vascular resistance increased by 58 +/- 10 percent (mean +/- SE), whereas in the innervated calf it increased only by 21 +/- 6 percent (P < 0.01, forearm vs. calf). This augmented vasoconstrictor response was specific for L-NMMA, and not related to augmented non-specific vasoconstrictor responsiveness secondary to sympathectomy, because phenylephrine infusion increased vascular resistance similarly in the denervated forearm and the innervated calf (by 24 +/- 7, and 29 +/- 8 percent, respectively). The augmented vasoconstrictor response was related specifically to denervation, because in control subjects, the vasoconstrictor responses to L-NMMA were comparable in the forearm and the calf.

CONCLUSIONS:

These findings indicate that in the absence of sympathetic innervation, the vasoconstrictor responses to nitric oxide synthase inhibition are augmented.

http://www.ncbi.nlm.nih.gov/pubmed/10690345

Melatonin changes after sympathectomy

Bruce J, Tamarkin L, Riedel C, Markey S, Oldfield E.

Sequential cerebrospinal fluid and plasma sampling in
humans: 24-hour melatonin measurements in normal
subjects and after peripheral sympathectomy. English.
72. 1991:819-23.

Brismar K, Mogensen L, Wetterberg L.
Depressed
melatonin secretion in patients with nightmares due to
beta-adrenoceptor blocking drugs. English. 221.
1987:155-8.

Evidence suggests a link between endogenous melatonin and the sleep cycle
• There is evidence of a link between endogenous melatonin and the temperature rhythm.

Melatonin deficiency causes SOMNOLENCE

nerve blocks as a treatment for Herpes Zoster...

Management of herpes zoster (shingles) and postherpetic neuralgia

Robert W Johnson

‌, Tessa L Whitton

‌

Pain Management Clinic, Level 4, Bristol Royal Infirmary, Bristol, BS2 8HW, UK.

The Cancer Patient with Chronic Pain Due To Herpes Zoster

... were mild and tolerable and consisted primarily of somnolence and dizziness. ... Peripheral neurectomy, cordotomy, dorsal rhizotomy, sympathectomy, ...
www.current-reports.com/article.cfm?PubID=PA04-6-1-01&Type=Article&KeyWords= -

Insulin hypersensitivity produced by sympathectomy

Insulin
hypersensitivity has been undeniably
produced by hypophysectomy, by ad-
renalectomy, by sympathectomy, by
spinal cord lesions, and by hypothalam-
ic lesions.

THE HYPOTHALAMUS: A REVIEW OF THE
EXPERIMENTAL DATA
W. R. Ingram

treatment of choice??!!

"Surgery - Endoscopic Sympathectomy, Treatment of Choice for Severe Hyperhidrosis. Interruption of nerve impulses to sweat glands of the palms, face, axillae (armpits) by cutting or electrocautery is called "Thoracic Sympathectomy". The ganglia (nerve junctions) which lead to the sweat glands of the palms, axillae, scalp and face are accessible through the chest (thoracic cavity) because they travel along the side of the spine of the back. Using a Micro Single Incision endoscopic technique, easy access to this area requires only a single 1/12th inch incision per side. In the past, a rib was removed or a large painful incision was required between two ribs to provide access to this area. Some surgeons today make three to four small incisions when performing endoscopic thoracic sympathectomy. Dr N. has applied state-of-the-art technology to his endoscopic technique and he only makes a 1/12th inch incision per side."
(internet ad for a surgeon from the US)

My comment: That is brilliant achievement! However the operation, no matter how many holes it requires, it will have the same effects on the patient.
Surely the definition of the surgery needs some rephrasing?! The operation disrupts more than the impulses to the sweat glands. It disrupts signaling between the body and the brain, partial autonomic dysfunction, disables thermoregulation, causes revascularization of the brain, reduces heart rate and blood pressure, abolishes homeostasis...a long list really.
All these effects have been proven.

As with other tissues and organs, hypoxia, such as at high altitude, causes an increase in blood flow to bone, as does hypercapnia and sympathectomy.

www.itdynamicsphil.com/pdf/orthopedics-for-mt.pdf

DENERVATION SUPERSENSITIVITY

what follows Sympathectomy..
coming soon.....

The antihypertensive effects of the drug may be enhanced in the post-sympathectomy patient.

Diovan HCT Tablets

also:

http://www.rxlist.com/lozol-drug/side-effects-interactions.htm
http://www.drugs.com/pro/hydrochlorothiazide.html
http://www.drugs.com/ppa/atenolol-chlorthalidone.html
http://www.drugs.com/pro/renese.html

Drug and SYMPATHECTOMY interaction

Tell your doctor if you have any of
the following medical conditions:
* kidney problems
* liver problems
* heart problems
* diabetes
* recent excessive vomiting or
diarrhoea
* Systemic Lupus Erythematosus
(SLE), a disease affecting the
skin, joints and kidneys
* a salt restricted diet
* a past operation known as
sympathectomy
If you have not told your doctor
about any of the above, tell
him/her before you start taking
Atacand Plus 16/12.5.

What Atacand Plus
16/12.5 is for
Atacand Plus 16/12.5 is used to treat
high blood pressure.

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Surgical and chemical sympathectomy can alter cellular proliferation

Surgical denervation and chemical sympathectomy can alter cellular proliferation, B- and T-cell responsiveness and lymphocyte migration in lymphoid organs [17].

In vitro studies have shown that neuropeptides can have numerous effects, either inhibiting or stimulating the proliferation, differentiation and functions of immune cells [19]* Development of systemic lupus erythematosus in mice is associated with alteration of neuropeptide concentrations in inﬂamed kidneys and immunoregulatory organs

Neuroscience Letters 248 (1998) 97– 100

Acquired cardiovascular disease following Sympathectomy

We found statistically significant differences (P < .05) in both time and frequency domains. Parameters that evaluate global cardiac autonomic activity (total power, SD of normal R-R intervals, SD of average normal R-R intervals) and vagal activity (rhythm corresponding to percentage of normal R-R intervals with cycle greater than 50 ms relative to previous interval, square root of mean squared differences of successive normal R-R intervals, high-frequency power, high-frequency power in normalized units) were statistically significantly increased after sympathectomy. Low-frequency power in normalized units, reflecting sympathetic activity, was statistically significantly decreased after sympathectomy. Low-/high-frequency power ratio also showed a significant decrease, indicating relative decrease in sympathetic activity and increase in vagal activity.

The Journal of Thoracic and Cardiovascular Surgery
Volume 137, Issue 3, March 2009, Pages 664-669

sympathectomy interrupts neural messages to many different organs, glands and muscles

RESPONSE TO SYMPATHETIC BLOCKADE DEPENDS ON THE DEGREE OF SYMPATHETIC TONE BEFORE THE BLOCK

Denervation of preganglionic cardiac accelerator fibres leaving the cord at T1-T5 results in minimal vasodilatory consequences. Changes however in heart rate, left ventricular function and myocardial oxygen demand may occur due to high thoracic epidural blockade and are discussed below.

The major determinant of heart rate is the balance between sympathetic and parasympathetic systems with the latter predominating. A high thoracic epidural anaesthesia (TEA) covering the cardiac segments (T1-T4) produces small but significant reductions in heart rate4-8. During cardiac sympathetic denervation, parasympathetic cardiovascular responses, including those involved in baroreflexes, may dominate.

Individual cardiovascular response to different levels of sympathetic blockade varies widely, depending on the degree of sympathetic tone before the block.
Anaesth Intensive Care 2000; 28: 620-635
B. T. VEERING*, M. J. COUSINS†
Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands and Department of Anaesthesia and
Pain Management, University of Sydney, Royal North Shore Hospital, Sydney, New South Wales

decreased conditioning-related activity in insula and amygdala after autonomic denervation

The degree to which perceptual awareness of threat stimuli and bodily states of arousal modulates neural activity associated with fear conditioning is unknown. We used functional magnetic neuroimaging (fMRI) to study healthy subjects and patients with peripheral autonomic denervation to examine how the expression of conditioning-related activity is modulated by stimulus awareness and autonomic arousal. In controls, enhanced amygdala activity was evident during conditioning to both "seen" (unmasked) and "unseen" (backward masked) stimuli, whereas insula activity was modulated by perceptual awareness of a threat stimulus. Absent peripheral autonomic arousal, in patients with autonomic denervation, was associated with decreased conditioning-related activity in insula and amygdala. The findings indicate that the expression of conditioning-related neural activity is modulated by both awareness and representations of bodily states of autonomic arousal.

http://www.ncbi.nlm.nih.gov/pubmed/11856537

cell body reorganization in the spinal cord after surgery for sweaty hands

The amount of compensatory sweating depends on the patient, the damage that the white rami communicans incurs, and the amount of cell body reorganization in the spinal cord after surgery.

Other potential complications include inadequate resection of the ganglia, gustatory sweating, pneumothorax, cardiac dysfunction, post-operative pain, and finally Horner’s syndrome secondary to resection of the stellate ganglion.
www.ubcmj.com/pdf/ubcmj_2_1_2010_24-29.pdf

After severing the cervical sympathetic trunk, the cells of the cervical sympathetic ganglion undergo transneuronic degeneration

After severing the sympathetic trunk, the cells of its origin undergo complete disintegration within a year.
http://onlinelibrary.wiley.com/doi/10.1111/j.1439-0442.1967.tb00255.x/abstract

Spinal cord infarction occurring during thoraco-lumbar sympathectomy
J Neurol Neurosurg Psychiatry 1963;26:418-421 doi:10.1136/jnnp.26.5.418

In conclusion, our results suggest that cross-inhibitory control by various afferents in the spinal cord may exist in the feet as well as in the contralateral hand. The release of cross-inhibitory control by T3 sympathicotomy results in vasoconstriction and a decrease of skin temperature on the contralateral hand and the feet.

The basic neuronal network for this reciprocal organization is probably located in the spinal level (15). Therefore, the reduction in the contralateral skin temperature may be explained by cross-inhibitory control of various afferent in the spinal cord.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2722005/

Contralateral temperature changes of the finger surface during video endoscopic sympathectomy for palmar hyperhidrosis
http://www.ncbi.nlm.nih.gov/pubmed/8832515

Segmental myoclonus was associated with thoracic sympathectomy

Spinal myoclonus was associated with laminectomy, remote effect of cancer, spinal cord injury, post-operative pseudomeningocele, laparotomy, thoracic sympathectomy, poliomyelitis, herpes myelitis, lumbosacral radiculopathy, spinal extradural block, and myelopathy due to demyelination, electrical injury, acquired immunodeficiency syndrome, and cervical spondylosis.

http://www.ncbi.nlm.nih.gov/pubmed/3753263

Spinal myoclonus is typically associated with a localized area of damaged tissue (focal lesion). The injured area may include direct damage of the spinal cord or may cause abnormal changes in the function of the spinal cord.

http://www.wemove.org/myo/myo_pc.html

Spinal myoclonus following a peripheral nerve injury: a case report

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2526081/

painful vasospastic condition in the right arm following surgical sympathectomy on the left side

second thoracic sympathetic ganglion was most commonly located (50%) in the second intercostal space

anatomic variations of the T2 nerve root

6 (9.1%) sides showed a single large ganglion formed by the stellate and the second thoracic sympathetic ganglia. The second thoracic sympathetic ganglion was most commonly located (50%) in the second intercostal space. Conclusion: The anatomic variations of the intrathoracic nerve of Kuntz and the second thoracic sympathetic ganglion were characterized in human cadavers. Journal of thoracic and cardiovascular surgery Y. 2002, vol. 123, No. 3, pages 498-501 [bibl. : 14 ref. http://www.refdoc.fr/Detailnotice?idarticle=9466218

cervical sympathectomy is a psychosurgery

Hemodynamic changes in vertebral and carotid arteries were observed after sympathicotomy for PH

decline in external heart work due to sympathectomy both at rest and under exercise

hyperhidrosis is not related with social phobia or personality disorder

The total reward dependence and persistence scores were significantly higher in hyperhidrosis patients. The fear of uncertainty in the harm avoidance scale was found to be significantly greater in hyperhidrosis patients. Regarding character dimensions, the total score in each of the subscales self-directedness, cooperativeness and self-transcendence was found to be higher in hyperhidrosis patients. Conclusion: The higher scores of all subscales of character dimensions in hyperhidrosis patients suggest that hyperhidrosis is not related with social phobia or personality disorder.

http://www.online.karger.com/ProdukteDB/produkte.asp?Aktion=ShowFulltext&ArtikelNr=99589&Ausgabe=232867&ProduktNr=224164

Effects of upper abdominal sympathectomy on gastric acid, serum gastrin, and catecholamines

Selective upper abdominal sympathectomy increased basal acid output in rats but was without effect on stimulated acid output, serum gastrin concentration, and gastric mucosal histidine decarboxylase activity. The sympathectomy was verified by fluorescence histochemistry and determination of tissue catecholamines. A drastic reduction in tissue noradrenaline, adrenaline, and dopamine levels occurred after sympathectomy, and fluorescence microscopy showed a complete loss of adrenergic nerve fibers. Vagotomy reduced catecholamine levels in the stomach wall by 50% but did not affect the catecholamine content in the pancreas and small bowel. Surprisingly, combined vagotomy and upper abdominal sympathectomy resulted in lower catecholamine levels than sympathectomy alone in extragastric but not in gastric tissues.

http://www.ncbi.nlm.nih.gov/pubmed/6515311

Following sympathectomy, severe discomfort with alarming frequency and intensity

a reduction of the muscular tone and to a secondary neurovascular disorder after sympathecomy

ATELECTASIS IS A COMMON PULMONARY COMPLICATION FOLLOWING THORACIC AND UPPER ABDOMINAL PROCEDURES

General anesthesia and surgical manipulation lead to atelectasis by causing diaphragmatic dysfunction and diminished surfactant activity. The atelectasis is typically basilar and segmental in distribution. After induction of anesthesia, atelectasis increases from 1 to 11% of total lung volume. End-expiratory lung volume is also found to be decreased.

Postoperative atelectasis is extremely common. Lobar atelectasis is also common. The incidence and prevalence of this disorder are not well documented.

http://emedicine.medscape.com/article/296468-overview#a0104

Atelectasis occurs regularly after induction of general anesthesia, persists postoperatively, and may contribute to significant postoperative morbidity and additional health care costs. Laparoscopic surgery has been reported to be associated with an increased incidence of postoperative atelectasis.

Anesth Analg 2009; 109:1511-1516

the muscles that are supplied by these nerves shorten and tighten (due to the supersensitivity

This now well-established but generally under-appreciated principle of physiology is aptly known as 'Cannon's Law of Denervation Supersensitivity'. It describes the wide ranging effects of the complete loss of nerve inputs to a variety of bodily structures under experimental conditions. One of the many responses to nerves that are sick or dysfunctional (now termed Disuse Supersensitivity) is that the muscles that are supplied by these nerves shorten and tighten (due to the supersensitivity of both the muscle's specialized stretch receptors and motor nerve-muscle junctions), resulting not only in muscle spasm and stiffness which limit flexibility, but a whole sequence of pain compounding reactions. The two earliest are that localized taut bands of muscle fibers begin to compress the small specialized pain sensing (and now extra-sensitive) nerve fibers within the muscle (known as myofascial tender or trigger points) causing type 1 pain, and the compressed muscles do not allow proper blood flow in, or waste products to be removed. This leads to a build up of lactic acid, which further enhances the perception of pain through type 2 pain mechanisms. Continued and prolonged muscle shortening or contracture gradually leads to increased mechanical tension on the muscle's tendonous attachments to bone, causing all of the various tendonitis (types 1 & 2 pain) syndromes throughout the body. The end result is a truly vicious snowballing cycle of pain, with the muscle shortening further increasing pressure on the nerves.

www.northwestims.com/faq-4.html

Cannon's law of denervation tells us that if a post-ganglionic neurone has it's pre-ganglionic input removed, then it will become super-sensitive to the normal neurotransmitters that mediate that pre-ganglionic input. There is a variety of reasons for this, including up-regulation of receptors for the neurotransmitter(s), post-receptor effects, and impaired removal of neurotransmitters from the synapse

www.anaesthetist.com/anaes/patient/ans/

Most authors do not describe clinically significant capsular adhesions as a predominant finding in the chronic phase of this condition. Instead, pathologic data confirm an active process of hyperplastic fibroplasia and excessive type III collagen secretion that lead to soft-tissue contractures of the aforementioned structures (ie, the coracohumeral ligament, soft tissues of rotator interval, the subscapularis muscle, the subacromial bursae). However, these findings were observed in surgical patients who had severe and late-phase disease and cannot be applied to early phases of the disease.

From the chromosomal, cytochemical, and histologic points of view, the soft-tissue contractures are identical to those seen in a Dupuytren contracture of the hand. These contractures result in the classic progressive loss of ROM of the glenohumeral joint, which affects external rotation and abduction, then flexion, adduction, and extension (in descending order of severity). Despite these histopathologic similarities, the favorable and regressive outcome of adhesive capsulitis differs from the unfavorable and progressive outcome of Dupuytren disease.

http://emedicine.medscape.com/article/326828-overview#a0104

slowing of the heart rate usually occurs on the second to fourth day after sympathectomy

The rate fell to a level between 40 and 6o per minute, the maximal slowing usually occurring on the second to fourth day after operation. Consistent slowing of the rate was not observed after a unilateral thoracic sympathectomy of either side. While there was some recovery from the maximum bradycardia with the passage of time in most patients, relatively slow resting cardiac rates and failure of tachycardia to develop with postural hypotension or exercise persisted in all patients.

Skoog's12 work has shown that there are marked differences in the number and precise location of the accessory ganglion cells in the cervical region in different patients and on the two sides in the same patient.
Annals of Surgery, 1949 October, Volume 130 Number 4

LIMITED SYMPATHECTOMY DOES NOT REDUCE SEVERITY OF SIDE-EFFECTS

Limited sympathectomy does not reduce severity of side-effects

On univariate and multivariate analysis, the extent of denervation was not associated with the occurrence or the severity of compensatory sweating.

Compensatory sweating and temporary relief/recurrence were equally considered to be the main causes of dissatisfaction. CONCLUSION: Compensatory sweating was the most common long-term complication of thoracodorsal sympathectomy for primary hyperhidrosis. Its incidence and severity were not associated with the extent of sympathectomy.

http://www.ncbi.nlm.nih.gov/pubmed/12514588

Receptor hypersensitivity is a common problem

Because of their size and location, injuries to the sympathetic ganglia or chain is rarely indicated or performed. Receptor hypersensitivity is a common problem after significant sympathetic injury, including clammy hands, erythema, and allodynia. When sympathetic nerves regenerate, they may establish aberrant connections to sensory receptors, muscles, or other sympathetics receptors; this may lead to an over-response or abnormal response.
http://wiki.cns.org/wiki/index.php/Injury,_Sympathetic_Nerve

All patients except one suffered from compensatory sweating

Complications in patients with palmar hyperhidrosis treated with transthoracic endoscopicsympathectomy.

Neurosurgery. 1997 Jul ;41 (1):110-3; discussion 113-5 9218302

OBJECTIVE: To assess the complications in a group of patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy. The extraordinarily high incidence of postoperative compensatory hyperhidrosis in our series is stressed and explained. METHODS: The retrospective study included chart reviews and outpatient assessments. Seventy-two patients underwent T2 or T2-T3 endoscopic sympathectomy for primary palmar hyperhidrosis. Patients' hyperhidrosis severity, precipitating factors, postoperative complications, surgical results, and satisfaction were assessed. Severity of palmar hyperhidrosis and compensatory hyperhidrosis was classified by two grading scales. RESULTS: The success rate of sympathectomy was 93%. All patients except one suffered from compensatory sweating,which was the main cause of patients' dissatisfaction postoperatively. Seventeen percent of the patients (12 of 72 patients) experienced new symptoms of gustatory sweating (facial sweating associated with eating). Twenty-one patients experienced other complications, including pneumothorax, Horner's syndrome,nasal obstruction, and intercostal neuralgia.

our ignorance of the mechanisms of primary hyperhidrosis and of the effect of sympathetic ablation

Muliptle organ failure as a consequence of elective sympathectomy

In the post-sympathectomy patient, the abnormalsympathetic skin response may lead to peripheral vascular failureor the reduced cardiac chronotropic response may impair thebody’s capacity to compensate for shock. These may havecontributed to the rapid development of shock and severe multipleorgan dysfunction syndrome in this patient.
He had multiple organ dysfunction syndrome develop, with severerenal and hepatic failure, grade II hepatic encephalopathy,and disseminated intravascular coagulation. He responded remarkablywell to aggressive supportive measures including forced alkalinediuresis, and he was eventually discharged home after 1 month. The patient was previously a healthy, physically fit, nonsmoker.He worked as a body building trainer and led an active, sportylifestyle. The only significant medical history was that hehad received thoracic sympathectomy for axillary hyperhidrosis4 years ago at another hospital.

http://ats.ctsnetjournals.org/cgi/content/full/84/3/1025

'Emotional' sweating regulated by neocortex and limbic cortex

Careful observations showed that the forearm sweating responded diversely to various mental stimuli, unlike the palmar sweating whose response was always an increase. Mental arithmetic, mental testing and physical exercise caused an immediate increase in the palmar sweating but often elicited a transient decrease in the forearm sweating, whereas pain, noise, and emotional stimuli consistently provoked an increase of sweating on the forearm as well as on the palm. These observations suggest that the activities of higher centers, presumably involving neocortex and limbic cortex, exert various influences on the central mechanisms of palmar and generalized sweating.
Jpn J Physiol. 1975;25(4):525-36.
http://www.ncbi.nlm.nih.gov/pubmed/1206808

Autonomic dysequilibrium (local sympathectomy) leading to obesity

A similar reduction of fat mobilization from fat depots occurs after VMH lesions, as after local sympathectomy, suggesting that the sympathetic pathway to the adipose tissue runs through the VMH.
Bray and York hypothesize that the change in energy balance in animals after VMH lesions is a result of autonomic dysequilibrium. The sympathetic outflow is reduced and the parasympathetic outflow increased. This shift in balance results in hyperinsulinemia and altered metabolic pathways leading to obesity. During the digestion and metabolism of a meal, the autonomic nervous system provides important (but not sole) feedback control on satiety.

The Nervous System and Adipose Tissue, By Katharine Dalziel, MD, MBBS, MRCP
Clinics in Dermatology
October-December 1989, Volume 7, Number 4, pages 62-77

Use of stellate ganglion block for the treatment of psychiatric and behavioral disorders

The present invention is directed to a method for the treatment of a patient suffering from psychiatric and behavioral disorders, including post partum depression, post traumatic stress disorder, compulsive smoking, attention deficit hyperactivity disorder, gambling addiction, comprising the step of administering a stellate ganglion block to the patient to alleviate the symptoms. The stellate ganglion block may be followed by a sympathectomy to provide permanent relief.

United States Patent 20070135871

Kind Code: A1

http://www.freepatentsonline.com/y2007/0135871.html

These gustatory phenomena were quite different from physiologic gustatory sweating

In a series of 100 bilateral upper dorsal sympathectomiesperformed for palmar hyperhidrosis, gustatory sweating and othergustatory phenomena were reported by 68 of 93 patients (73%),followed up for an average of 11/2 years. These gustatory phenomenawere quite different from physiologic gustatory sweating: awide range of gustatory stimuli caused a variety of phenomenain varied locations. There was a negative correlation betweenthe incidence of these phenomena and the occurrence of Horner'ssyndrome after sympathectomy. Analysis of our observations,and of clinical and experimental work of others, leads to theconclusion that gustatory phenomena after upper dorsal sympathectomyare the result of preganglionic sympathetic regeneration orcollateral sprouting with aberrant synapses in the superiorcervical ganglion.

http://archneur.ama-assn.org/cgi/content/abstract/34/10/619

causes of autonomic dysfunction - sympathectomy

The finger wrinkling response is abolished by upper thoracic sympathectomy. The test is also abnormal in some patients with diabetic autonomic dysfunction, the Guillan-Barre syndrome and other peripheral sympathetic dysfunction in limbs. (p.46)

Other causes of autonomic dysfunction without neurological signs include medications, acute autonomic failure, endocrine disease, surgical sympathectomy . (p.100)

Disorders of the Autonomic Nervous System

By David Robertson, Italo Biaggioni

Edition: illustrated

Published by Informa Health Care, 1995

ISBN 3718651467, 9783718651467

Neuroma following nerve injury/surgery

When a nerve is cut, the piece of nerve that is beyond the cut point eventually dies, however, its Schwann cells, the cells that encircle the nerve fibers remain for a much longer time. These Schwann cells secrete a chemical messenger known as nerve growth factor that tells the cut end of nerve where to grow back. So the cut end of nerve will send out multiple sprouts in the direction of the nerve growth factor, however, these sprouts do not go out in an orderly manner, instead they grow out in all directions and eventually cluster and form a knot of nerve fibers. This eventually leads to the formation of a TRUE neuroma or a END BULB or STUMP neuroma.

www.tarsaltunnelcenter.com/assets/recurrent.shtml

the primary event of gustatory sweating is a degeneration of the cervical sympathetic neurons

The development of gustatory sweating after cervical sympathectomy can only be explained if one is to admit that the primary event of gustatory sweating is a degeneration of the cervical sympathetic neurons. The initial event is the loss of postganglionic sympathetic neurons and the resulting denervation of the corresponding facial sweat glands. Regeneration of parasympathetic fibers, within the degenerating sympathetic neurilemmal sheets, is a secondary event although it accounts for the observed symptoms.

Salivary gland disorders

Eugene N. Myers, Robert L. Ferris

Springer, 2007 - Medical - 517 pages

the primary event of gustatory sweating is a degeneration of the cervical sympathetic neurons

Salivary gland disorders

Eugene N. Myers, Robert L. Ferris

Springer, 2007 - Medical - 517 pages

Australian Review of ETS surgery

"A lack of high quality randomised trial evidence on ETS means that it is difficult to make a judgment on the safety and effectiveness of this technique. There is potentially a number of safety issues associated with this procedure. ASERNIP-s suggests that a full systematic review including all available comparative and case series information, together with clinical inpuut, should be undertaken to provide up-to-date and comprehensive assessment of the safety and effectiveness of ETS." (ASERNIP-s Report No. 71, August 2009)

Australian Review of ETS surgery - 2001

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.

Further research using a well-designed controlled trial is warranted to assess the efficacy of endoscopic thoracic sympathectomy for treating facial blushing.

Centre for Clinical Effectiveness - Monash

Swedish Review - Findings by SBU Alert

Finnish Review

UK Review of ETS surgery

We did not identify any controlled trials or cohort studies. The
evidence about effectiveness, based on three case series, was
therefore very limited. The main weakness of these studies was their lack of a comparison group and their resulting inability to exclude a placebo response to surgery. In addition, the methods of assessing outcome were poorly described and not validated, and the range of outcomes assessed was limited. The studies provided very limited evidence that sympathectomy improves blushing. Side effects were common.
London: Bazian Ltd (Editors), Wessex Institute for Health Research and Development, University of Southampton 2003: 11

Wiley & Sons, Inc, news release - 2004

"Lifestyle" surgical procedure carries unrecognized risk of complications.”
Hoboken, NJ: John Wiley & Sons, Inc, British Journal of Surgery, Feb 5, 2004

STEER 2003
We found insufficient evidence about the benefits of sympathectomy for blushing, psychosocial health or quality of life. We found one systematic review of the effects of endoscopic thoracic sympathectomy. It found four papers (describing three case series) but no controlled trials or cohort studies. It concluded that the evidence that cosmetic surgery improved psychosocial wellbeing was limited. We found no eligible studies published after the systematic review.

Sympathectomy for facial blushing
Dr Colin Fischbacher
Clinical Research Fellow
University of Edinburgh
Search date: February 2003
STEER 2003; Vol 3: No.4

"most physicians do not recommend ETS surgery because
of the serious negative side effects of the procedure"
http://www.sweathelp.org/English/PFF_Treatment_Surgery.asp

The authors found that the incidence of hypotension was a function of the level of sympathetic denervation, occurring in 60% of patients with a T7 sympathectomy, and in 100% of patient with a T4 or higher level of sympathectomy.
(p 226)

"Inappropriate" bradycardia (i.e. "normal" HR in face of ↓MAP with sensory level T3-T4)
Peripheral vasodilation should evoke an ↑ HR. But ↓ venous return → ↑vagal tone, so HR remains at preblock rate but is "inappropriately" slow.

Central neuraxial anesthesia-induced sympathectomy leads to peripheral vasodilation, reduced preload, and subsequently decreased cardiac output. The incidence and extent of hypotension depends on the height of the block, the patient's position, and whether appropriate measures were instituted prophylactically to minimize hypotension.

After thoracoscopic sympathectomy for hyperhidrosis, very severe discomfort and hyperhidrosis in the neighboring non-sympathectomized regions occurred with alarming frequency and intensity.
(p.879)

Cousins and Bridenbaugh's Neural Blockade in Clinical Anesthesia and Pain Medicine by Michael J Cousins, Phillip O Bridenbaugh, Daniel B Carr, and Terese T Horlocker

Wolters Kluwer Health
Edition: 4 - 2008

Permanent thermoregulatory Dysfunction after Sympathectomy

The autonomic dysfunction you see on this thermal image is not a result of the surgery gone wrong, this is the result of a ...successful operation; it is the inevitable consequence of cutting/clamping the sympathetic chain, independently of skill of the surgeon, experience of the surgeon, T2, or T3, T4, or method used. Once the communication is disrupted, (and it happens with the clamping as well), it will disable the body's thermoregulation and will cause malfunctioning of the sympathetic nervous system. This damage is permanent and irreversible. "Sympathectomy is analogous to the act of killing the messenger. The sympathetic nervous system has the critical job of properly controlling and preserving the circulation in different parts of the body, especially in the extremities. By paralyzing the system, the extremity will be more apt to have disturbance of circulation and is left unprotected from fluctuation in circulation. Sympathectomy is similar to permanently removing the central heat and air-conditioning system and never replacing it because of malfunction." H. Hooshamand, MD Neurological Associates, Pain Management Center, Vero Beach, Florida

There is potentially a number of safety issues associated with this procedure

Australian Review of ETS surgery

"A lack of high quality randomized trial evidence on ETS means that it is difficult to make a judgment on the safety and effectiveness of this technique. There is potentially a number of safety issues associated with this procedure. ASERNIP-s suggests that a full systematic review including all available comparative and case series information, together with clinical input, should be undertaken to provide up-to-date and comprehensive assessment of the safety and effectiveness of ETS." (ASERNIP-s Report No. 71, August 2009)

Australian Review of ETS surgery - 2001

Swedish Review

Finnish Review

Conclusions: The evidence of the effectiveness of ETS is weak due to a lack of randomized trials. The intervention leads to severe immediate complications in some of the patients, and to persistent side-effects for many of the patients.
University of Ouluand
Finnish Ofﬁce for HealthTechnology Assessment
University of Helsinki
Finnish Ofﬁce for Health Technology Assessment
University of Copenhagen

For a small group of patients sympathectomy can have devastating effects

ETS is a very effective way to treat hyperhidrosis and FB in the vast majority of the cases, but a small group of patients have devastating effects. Unfortunately, we do not know who these patients are before we operate.

Dr. Giudiceandrea Alberto, general and vascular surgeon
http://sympathectomy.info/

Possible side effects, ranging from trivial to devastating, are of even greater importance with these more permanent procedures.

G D Schott Consultant neurologist
Interrupting the sympathetic outflow in causalgia and reflex sympathetic dystrophy - A futile procedure for many patients
The National Hospital for Neurology and Neurosurgery, London
1998;316;789-790 BMJ

Sympathectomy reduces DOPAMINE - Latent inhibition and creative drive

Dopamine in the mesolimbic pathway increases general arousal and goal directed behaviors and decreases latent inhibition; all three effects increase the creative drive of idea generation. This has led to a three-factor model of creativity involving the frontal lobes, the temporal lobes, and mesolimbic dopamine.^[34]

This calcification was observed in both feet of 93% of patients, who had
undergone bilateral operation. After unilateral sympathectomy the incidence of calcified arteries on the side of operation was significantly higher than that on the contralateral side (88% versus 18%, p less than 0.01). Although diabetic patients showed longer stretches of calcification than non-diabetic subjects, the difference was not significant in terms of incidence and length. Of 20 patients who had no evidence of calcinosis pre-operatively, 11 developed medial calcification after unilateral operation exclusively on the side of sympathectomy. In seven patients calcinosis was detected in both feet after
bilateral operation. In conclusion, sympathetic denervation is one of the causes of Monckeberg's sclerosis regardless of diabetes mellitus.
Diabetologia. 1983 May;24(5):347-50, PMID: 6873514 [PubMed - indexed for MEDLINE]
Goebel FD, Fuessl HS.

Some of these side-effects, as listed on the Swedish support group website:

Side effects of the elective surgery:
Severe compensatory sweating = disabling sweating
Decreased physical capacity
Reduced blood circulation
Stomach problems (constipation or diarrhea)
Impotence
Oversensitivity to stress
Oversensitivity to sounds
Oversensitivity to light
Muscle weakness ("lactic acid in the arms")
Cold hands and feet - denervation supersensitivity
Horners syndrome
Reduced pulse reaction - delay in heart rate and BP responses, dizziness
Shortness of breath
Pain in arms and back - due to nerve sprouting
Chronic fatigue, lack of energy - S affects adrenaline levels
Raynauds disease - denervation supersensitivity

and from research:

Autonomic dysfunction
Vascular disturbances
Calcification of arteries
Permanently disabled thermoregulation
blocked nose or watery discharge/dripping from nose
dry, inflamed eyes
Reduced physical capacity, even when going up a flight of stairs - HR and BP responses delayed
depression - ETS reduces NE and catecholamines, increases serotonin
mood-swings
Altered sympathetic tone, feeling sedated/detached - beta-blocker effect
Inability to experience/respond to strong emotions - S disrupts signals from the viscera
Reduces/eliminates fear
difficulty concentrating, foggyness, memory affected
lack of motivation/drive/cognitive function - reduction of small vessels in the anterior cingulate cortex, altered catecholamines
overheating due to disabled thermoregulation, even when extreme sweating present - fever in hot weather or with physical activity/brain overheating
difficulty falling asleep/getting up - S eliminates circadian rhythm
Destabilized heart rate, arrythmia, dropped beats, morphofunctional changes in the myocardium
Reduced heart rate = reduced alertness, reduced emotional responses, ('not feeling alive'), all affecting long term memory (encoding).
Suppressed or eliminated Baroreflex = MAP instability
Mean Arterial Pressure instability, reduced short-term haemodynamic variability ('not feeling alive')
Hair loss, loss of eyebrows, eyelashes - altered blood flow in the skin
Dehydrated skin on upper body, face, scalp, - dandruff, skin infections, reduced immune responses
Reduced antibody responses - altered immune system

Several publications/books interchange 'Sympathectomy' and 'Spinal Cord Injury' due to the similarity in presentation/ symptoms.

Sweating after sympathetic surgery is a reflex cycle between the sympathetic system and the anterior portion of the hypothalamus according to our investigations. Reflex sweating will not happen if hand sweating can be stopped without interrupting sympathetic tone to the human brain. (sic!)
Chien-Chih Lin, M.D., *Timo Telaranta, M. D.

Presentation at the 4th International Symposium on Sympathetic Surgery

ETS is a relatively safe and simple procedure. However the side effects are possibly devastating All physicians providing this service and all peoples preparing to undergo this treatment should know this well.
Min-Huei Hsu (10 January 2005)
http://www.cmaj.ca/cgi/eletters/172/1/69#1908

Cervical sympathectomy inhibits axonal transport of gonadotropin-releasing hormone during continuous exposure to light

Department of Anesthesiology, Fukushima Medical College, 1 Hikarigaoka, 960-12 Fukushima, Japan
http://www.springerlink.com/content/q261272138632p52/

GNRH secretion is pulsatile in all vertebrates, and is necessary for correct reproductive function. Thus, a single hormone, GNRH1, controls a complex process of follicular growth, ovulation, and corpus luteum maintenance in the female, and spermatogenesis in the male.
http://en.wikipedia.org/wiki/Gonadotropin-releasing_hormone

The severity and manifestations of autonomic hyperreflexia are affected by the level of the sympathectomy. With mid-thoracic lesions below the level of cardiac accelerator fibers, hypertension is accompanied by reflex bradycardia transmitted via cardiac accelerator fibers and the vagus. In patients whose sympathectomy is above the level of the thoracic cardiac accelerator fibers, tachycardia may occur because cardiac accelerator fibers become part of the efferent sympathetic activity rather than part of the central inhibitory input from the brain stem and hypothalamus. Arrythmias and occasional heart block may accompany changes in heart rate.
Clinical manifestations of autonomic hyperreflexia include vasodilation, decresed sympathetic activity, and increased vagal activity above the level of the lesion such as nasal congestion, flushing, headache, dyspnea, nausea, and visceral muscle contraction. Vasoconstriction and increased sympathetic activity below the level of the lesion cause vasoconstrictive pallor, sweating, piloerection, and somatic muscle fasciculation. Patients also develop hypertension with headache, blurred vision, myocardial infarction, andretinal, subarachnoid and cerebral hemorrhages that may lead to syncope, convulsion and death.
Handbook of Neuroanesthesia
page 343
By Philippa Newfield, James E. Cottrell

Sympathectomy has a beta-blocker effect on the healthy patient

Cardiovascular changes after bilateral upper dorsal sympathectomy.

Papa MZ, Bass A, Schneiderman J, Drori Y, Tucker E, Adar R.
"The effect of bilateral upper dorsal sympathectomy (UDS) on cardiac function was investigated in two groups of young healthy patients who underwent bilateral excision of T2 and T3 ganglia for palmar hyperhidrosis.
The mean pulse rate decreased significantly in patients after they underwent bilateral UDS.
Pulse rates taken at rest and after effort were significantly lower than those taken after operation, and the blood pressure response to exercise was blunted. ECG tracings showed a significant change in the electrical frontal plane axis and shortening of
the QTc interval. These changes were evident 30 days after operation and persisted for 2 years. In conclusion, bilateral UDS has no overt arrhythmogenic effect in the young, healthy heart and its beta-blocker-like effect persists for at least 2 years." (the time of the tests performed)

Beta blockers block the action of endogenous catecholamines (epinephrine (adrenaline) and norepinephrine (noradrenaline) in particular), on β-adrenergic receptors, part of the sympathetic nervous system which mediates the fight or flight response.

The increase in heart rate in response to HUT (head-up tilt) was significantly reduced after surgery in the ETS group (from 34 ± 18 to 14 ± 11 beats·min⁻¹). Orthostatic hypertension disappeared completely after ETS , whereas the prevalence of orthostatic hypotension increased significantly after ETS (from 3 of 11 to 9 of 11 patients). http://www.springerlink.com/content/dk8tq89wnhq4naqy/

Cardiac arrest - a major complication of bilateral sympathectomy

Thoracic sympathectomy has usually minimal consequences if unilateral, especially on the right side. For
bilateral procedures, a mean reduction of the heart rate of 12% was reported. Around 50% of patients have bradycardia in the following minutes of abilateral surgery and mean and diastolic blood pressures significantly reduced.
Since the sympathectomy will block the chronotropic response, a significant increase of the ejection volume is observed when the patient moves in the erect position from dorsal decubitus.
Interact Cardiovasc Thorac Surg. 2008 Nov 27. [Epub

Chronotropic incompetence, an attenuated heart rate response to exercise, is a predictor of all-cause mortality in healthy populations. This association may be independent of exercise-induced myocardial perfusion defects.
Impaired Chronotropic Response to Exercise Stress Testing as a Predictor of Mortality
Michael S. Lauer, MD; Gary S. Francis, MD; Peter M. Okin, MD; Fredric J. Pashkow, MD; Claire E. Snader, MS; Thomas H. Marwick, MD
JAMA. 1999;281:524-529.

The haemodynamic effect of thoracoscopic cardiac sympathectomy
Lim-Sim Lee, Chien-Chih Lin, Seok-Mun Ng, Chung-Fai Au
The haemodynamic response to cardiac sympathetic denervation corresponded to the efferent effect of beta-receptor blockade.

Volume 164 Issue S1, Pages 37 - 38, Published Online: 2 Dec 2003

http://www3.interscience.wiley.com/journal/106568649/abstract

After sympathectomy, BP is maintained at nearly normal levels mainly through activation of the renin angiotensin system.

Heart and Circulatory Physiology, Vol 259, Issue 5 1337-H1342, Copyright © 1990 by American Physiological Society

Angiotensin receptor blockers reduce the frequency of atrial fibrillation and stroke. Renin-angiotensin system blockade delays or avoids the onset of type 2 diabetes and prevents cardiovascular and renal events in diabetic patients. Thus, blockade of this system will remain a cornerstone of our strategies to reduce cardiovascular risk.

Lancet. 2007 Apr 7;369(9568):1208-19.

Renin-angiotensin system and cardiovascular risk

Schmieder RE, Hilgers KF, Schlaich MP, Schmidt BM.

A patient with angina pectoris who had been successfully treated by thoracoscopic cardiac sympathectomy was scheduled to have scalp debridement under general anaesthesia for a scald burn. There were haemodynamic changes during and after the operation including anaesthetic induction, endotracheal intubation, maintenance, and early recovery period. The sympathetic denervated heart showed little chronotropic response to anaesthetic and surgical stimulation. On the contrary, the parasympathetic response was predominant. An episode of severe bradycardia occurred during endotracheal suctioning prior to extubation. The haemodynamic response to cardiac sympathetic denervation corresponded to the efferent effect of beta-receptor blockade.
http://www3.interscience.wiley.com/journal/106568649/abstract

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.
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

Marked MAP instability following sympathectomy

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 (mean arterial pressure). 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: Proceedings of the 7th International Symposium on SHR and Related Studies Held in Lyon (France), Ecole Normale Supérieure, October 28-30, 1991

By Jean Sassard

These results indicate that chronic surgical sympathectomy of the heart can be successfully accomplished in the rat and guinea pig. Such sympathectomy induces a postjunctional supersensitivity in guinea- pig right atria which is qualitatively and quantitatively similar to that described previously for chronic treatment with reserpine. Bilateral surgical sympathectomy provides a valuable tool for future investigations of the cellular basis of supersensitivity in the myocardium.

What is ETS or Sympathectomy?

If you do a quick search on google because you want to find a solution for your sweaty palms, or do not want to blush every time someone looks at you, you will be flooded by all the information from the surgeons offering this procedure. If you only read these and do not have a medical background, you might fall for their statements and think to yourself: well, isn't medical science wonderful?!
You make your booking with one of the surgeons who will charm you and soon you are being wheeled in for the surgery with the promise from the surgeon, that it will change your life. You don't even know how true that is, until you wake up.
Here you will find the other side of the sales pitch and some answers to just how your life will never be the same.

Are we paying a high price for surgical sympathectomy? - A systematic literature review of late complications.

Surgical sympathectomy, irrespective of approach, is accompanied by several potentially disabling complications. Detailed informed consent is recommended when surgical sympathectomy is contemplated.
J Pain. 2000 Winter;1(4):245-57.

Sympathectomy supressed baroreflex control of heart rate

Loss of Baroreflex = aberrant blood pressure

Reduced baroreflex sensitivity is associated with increased vascular calcification and arterial stiffness

The reduction in BRS and the resulting aberrant blood pressure response to the physiological stress and volume changes of HD may be important in the further understanding of the pathophysiology of the increased mortality in HD patients with vascular calcification.

Lindsay J. Chesterton1, Mhairi K. Sigrist1, Terence Bennett2, Maarten W. Taal1 and Christopher W. McIntyre

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

Sympathectomy can be considered a psychiatric surgery

ETS can alter many bodily functions, including sweating, heart rate, heart stroke volume, blood pressure, thyroid, baroreflex, lung volume, pupil dilation, skin temperature, goose bumps and other aspects of the autonomic nervous system. It can diminish the body's physical reaction to exercise and/or strong emotion, and thus is considered psychiatric surgery. In rare cases sexual function or digestion may be modified as well.
©2006 LVHyperhidrosis.com
Dr Nagy, Las Vegas

Prof. Justin Oakley in Morality and the Emotions:
"an emotion is a complex which involves dynamically related elements of cognition, desire and affectivity.

Circadian Rhythm eliminated by Sympathectomy

The abrupt increase and decrease in BP observed at the time when the lighting conditions are changed are eliminated by chemical sympathectomy

The disruption of the baroreflex selectively eliminatesthe circadian rhythm of BP, and the circadian rhythms of BP andHR are modulated by the autonomic nervous system in rats. The circadianrhythms of BP and HR are regulated by different mechanisms involvingthe autonomic nervous system.
(Circulation. 1997;96:1667-1674.)
© 1997 American Heart Association, Inc.

Morphofunctional changes in the myocardium following sympathectomy

Vestn Akad Med Nauk SSSR. 1984;(2):80-5.

Morphofunctional changes in the myocardium following sympathectomy and their role in the development of sudden death from ventricular fibrillation
Beskrovnova NN, Makarychev VA, Kiseleva ZM, Legon'kaia , Zhuchkova NI.

Individual cardiovascular response to different levels of sympathetic blockade varies widely, depending on the degree of sympathetic tone before the block.
High TEA added to general anaesthesia significantly decreased the cardiac acceleration in response to decreasing blood pressure, suggesting that baroreflex-mediated heart rate response to a decrease in arterial blood pressure depends on the integrity of the sympathetic nervous system.
Anaesthesia and Intensive Care. Edgecliff: Dec 2000. Vol. 28, Iss. 6, p. 620-35 (16 pp.) Australian Society of Anaesthetists

Marked Mean Arterial Pressure instability following sympathectomy

all regional hemodynamic changes after sympathectomy and suggest that the sympathetic nervous system may play an important role in reducing short-term hemodynamic variability.
Proceedings of the 7th International Symposium on SHR and Related Studies Held in Lyon (France), Ecole Normale Supérieure, October 28-30, 1991
Genetic Hypertension, by Jean Sassard

Changes in Electrophysiology following sympathectomy

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{dagger}, RÉGINALD A NADEAU{ddagger} and A ROBERT LEBLANC§

Cardiovascular Research 1982 16(9):524-529;
© 1982 by European Society of Cardiology

retarded adaptation of hemodynamics to a sudden start of exercise following sympathectomy

The exercise capacity and the increase of coronary and systemic hemodynamics under treadmill exercise were studied in 5 dogs, chemically sympathectomized with 6-hydroxy-dopamine.

Completeness of adrenergic denervation was verified by stimulation of the right stellate ganglion, by intravenous administration of tyramine, and by demonstration of supersensitivity to exogenous norepinephrine.

These dogs demonstrated a retarded adaptation of hemodynamics to a sudden start of exercise. A fall in mean arterial pressure below 45 mmHg within 10 to 15 sec lead to collapse.
steady state attainment of hemodynamic parameters was considerably delayed.

E. Bassenge¹, J. Holtz¹, W. v. Restorff¹ and K. Oversohl¹

Received: 18 April 1973

Denervation supersensitivity leads to Raynaud's Disease

Cannon and his colleagues showed in the 1930s that section and subsequent degeneration of the sympathetic nerves led to a marked supersensitivity of the sturcture to exogenous catecholamines. The increase in sensitivity ranged from 10-to 100-fold in different tissues, such as the spleen on section of the splenic nerves, or the nictitating membrane on section of the postganglionic cervical sympathetic nerve or the heart on removal of the stellate ganglion. In smooth muscle the increase in sensitivity is mostly explained by the associated loss of neuronal re-uptake of noradrenaline, with only a lesser role for the increase in receptor numbers. Mechanisms of Drug Action on the Nervous System by Ronald W. Ryall, Cambridge University Press, 1989

Changes in Electrophysiology following sympathectomy

Cardiovascular collapse caused by carbon dioxide insufflation during sympathectomy

Carbon dioxide insufflation into the pleural space during one-lung anaesthesia for thoracoscopic surgery is used in some centres to improve surgical access, even though this practice has been associated with well-described cardiovascular compromise. The present report is of a 35-year-old woman undergoing thoracoscopic left dorsal sympathectomy for hyperhidrosis. During one-lung anaesthesia the insufflation of carbon dioxide into the non-ventilated hemithorax for approximately 60 seconds, using a pressure-limited gas inflow, was accompanied by profound bradycardia and hypotension that resolved promptly with the release of the gas.
Australian Society of Anaesthetists 2002

Sympathetic regulation of the cerebral circulation by the carotid chemoreceptor reflex

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.
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;

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.

Sympathectomy induced adrenal hypertropy

Journal of Hypertension. 17(7):933-940, July 1999.
Qiua, Jingxin 1; Nelsona, Sharon H. 1; Spethb, Robert C. 2; Wanga, Donna H. 1,3

Objective: Previous studies indicate that the adrenal gland plays a compensatory role in the maintenance of blood pressure in chemically sympathectomized rats. However, the mechanisms responsible for compensatory adrenal responses are poorly understood. This study examined the regulation of adrenal growth and type 1A, 1B, and type 2 angiotensin II (Ang II) receptor (AT1A, AT1B and AT2) expression in the adrenal gland induced by sympathectomy.

Definition of the sympathetic ganglionic chain, that is cut/clamped during surgery

sympathetic ganglionic chain

From: A Dictionary of Psychology | Date: 2001 | Author: ANDREW M. COLMAN

sympathetic ganglionic chain n. A string of ganglia running down each side of the spinal cord throughout most of its length, containing cell bodies of neurons that belong to the sympathetic nervous system and that project axons to muscles and glands, controlling the smooth muscles of the blood vessels, eyelids, hair follicles, sweat, tear, and salivary glands, respiratory organs, irises, and also the heart and other organs. Also called the chain ganglia or sympathetic trunk.[From Greek syn with + pathos suffering + ganglion a cystic tumour]

Severe Hyperhidrosis as a side effect of ETS surgery to treat Palmar Hyperhidrosis...

Another example of the thermoregulatory dysfunction. However the whole body Hyperhidrosis is much more difficult to live with or cover up, as it soaks through clothes within minutes. The true number of people having disabling full body HH after this surgery is unknown. Surgeons maintain that it is a minute percentage of people. However there are too many who request reversals due to this side-effect. In fact the controversial reversal surgeries have become a very profitable part of the ETS surgeries. There are surgoens who specialize in doing reversals only. ETS is often covered by health insurance. Reversals are not. Surgeons and medical professionals NOT involved with the surgery maintain that the damage to the sympathetic chain can not be repaired. This applies to the clamping method as well. In that case the clamps would have to be removed within 24 hours. Usually it takes longer for the full body Hyperhidrosis to appear.

Thermoregulatory Disfuction - Severe CS. One of many of the side-effects of the elective surgery.

Note sharp line on upper chest: upper part of shoulders, neck, head and arms: anhidrosis, the inability to sweat and dissipate heat. 40% of the body heat exits the body through the top of the head. This aspect of the thermoregulation is disabled. Below the line of the T2 cut: PATHOLOGICAL sweating that requires complete change of clothes several times during the day. Sweating is not limited to the chest but includes full body surface. Constant wet skin is vulnerable to various skin diseases. CS is not only thermoregulatory. It can be triggered by stress, even in cold/winter conditons! This is the result for a patient who underwent the elective cosmetic surgery - that is hailed a a gold standard for palmar HH treatment. And this is only one side-effect of the many that are the necessary consequence of disrupting the sympathetic chain, irrespective of the surgeon's expertise or experience in executing the procedure. Post ETS sweating can not be predicted. Sweating patterns prior to surgery is not an indication of the CS post surgery. There is no difference in gender or weight when it comes to CS.

Nerve regeneration aka nerve sprouting leads to abnormal nerve function and pathological conditions

Regenerating sympathetic fibers create connections with nociceptive C-fibres, causing abnormal, sympathetically maintained pain conditions. Clinical studies in humans support the idea that nociceptors develop catecholamine sensitivity after complete or partial nerve lesions.
Sympathectomy, denervation has been linked to the development of Reflex Regional Pain Syndrome.
The regeneration of the sympathetic fibers is also responsible for the abnormal sweating during eating or smelling (food). This reaction can be triggered by any taste or smell, including spicy or hot food, apples, anything sour, chocolate, sweets etc. For the post-sympathectomy patient the otherwise anhydriotic areas of the face, upper body and arms will react with abnormal sweating and chills to these flavors/smells. The condition is called Frey's Syndrome and is caused by abnormal connections/interactions between the salivary gland and the sprouting sympathetic fibers.

Immune response and sympathectomy

Bone remodeling and resorption

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, *
Received 27 May 1999;

Signals from the sympathetic nervous system regulate hematopoietic stem cell egress from bone marrow.

Katayama Y, Battista M, Kao WM, Hidalgo A, Peired AJ, Thomas SA, Frenette PS.

Department of Medicine, Immunobiology Center and Black Family Stem Cell Institute, Mount Sinai School of Medicine, New York, NY 10029, USA

Worth considering:

If you damage your sympathetic nerve/chain - let's say - in a car accident, it it treated as a 'damage' and the symptoms that necessarily follow: 'illness'. You will - if lucky - have a diagnosis - most likely dysautonomia, the same condition (with numberless symptoms) people with spinal cord injuries suffer from. The imbalance between the (now disabled) sympathetic and parasympathetic nervous system will be responsible for the body's malfunctioning - physically and emotionally. So how can the same, destructive, surgical procedure be called CURE for people with non-life threating conditions, such as facial blushing, palmar or axillary sweating? And how can doctors, well aware of the impact the surgery will have, offer the surgery? When did the wellbeing of the patient become an obsolete aim?
This truly defies reason.

Patients with hyperhidrosis of the palm or soles, who fail to respond to topical agents, deserve a trial of conservative therapy, botulinum toxin, or iontophoresis, before aggressive surgical techniques that carry with them the risk of lifelong troublesome side effects are offered.

Lewis P Stolman, MD, FACP, FRCP(C)

Department of Dermatology, New York University School of Medicine, New York, NY
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2344132