Monday, March 24, 2008

Patients should be informed of the bradycardia resulting from sympathectomy.

Ann Thorac Surg. 2002 Dec;74(6):2076-81. Related Articles, Links: Holter changes resulting from right-sided and bilateral infrastellate upper thoracic sympathectomy.

Abraham P, Berthelot J, Victor J, Saumet JL, Picquet J, Enon B.
BACKGROUND: We tested the hypothesis that no right-sided dominance exists after infrastellate surgical upper-thoracic sympathectomy. We aimed to confirm whether a significant bradycardia was constant and only dependent on the right side. METHODS: We performed 24-hour Holter electrocardiographic recordings in 12 patients referred for bilateral sympathectomy. Surgery was performed at two distinct times allowing for the study of the consequences of unilateral right and bilateral 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 < size="5">Patients should be informed of the bradycardia resulting from sympathectomy.

Bone marrow

1: Cell. 2006 Jan 27;124(2):407-21.

The sympathetic nerve--an integrative interface between two supersystems: the brain and the immune system.

Pharmacol Rev. 2000 Dec;52(4):595-638. Related Articles, Links: The sympathetic nerve--an integrative interface between two supersystems: the brain and the immune system.

Elenkov IJ, Wilder RL, Chrousos GP, Vizi ES.

Inflammatory Joint Diseases Section, Arthritis and Rheumatism Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA.

awareness and autonomic arousal on functional neuroanatomy

Neuron. 2002 Feb 14;33(4):653-63. Related Articles, Links: Fear conditioning in humans: the influence of awareness and autonomic arousal on functional neuroanatomy.

Critchley HD, Mathias CJ, Dolan RJ.

Wellcome Department of Imaging Neuroscience, 12 Queen Square, Institute of Neurology and Institute of Cognitive Neuroscience, UCL, WC1N 3BG, London, United Kingdom. h.critchley@fil.ion.ucl.ac.uk

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.

Neuroendocrine regulation of autoimmune/inflammatory disease

J Endocrinol. 2001 Jun;169(3):429-35. Related Articles, Links: Neuroendocrine regulation of autoimmune/inflammatory disease.

Recent studies indicate that physiological levels of glucocorticoids are immunomodulatory rather than solely immunosuppressive, causing a shift in patterns of cytokine production from a TH1- to a TH2-type pattern. Interruptions of this loop at any level and through multiple mechanisms, whether genetic, or through surgical or pharmacological interventions, can render an inflammatory resistant host susceptible to inflammatory disease.
These interactions have been clearly demonstrated in many animal models, across species, strains and diseases, and are also relevant to human inflammatory, autoimmune and allergic illnesses, including rheumatoid arthritis, systemic lupus erythematosus, Sjogren's syndrome, allergic asthma and atopic skin disease.

plasma natriuretic peptide concentrations

Nakamura2005

Circ J. 2005 Sep;69(9):1079-83.

Effect of endoscopic transthoracic sympathicotomy on plasma natriuretic peptide concentrations in humans.

Nakamura Y, Yoshizawa H, Hirasawa M, Kida H, Matsumoto Y, Ueyama T.

denervation leads to loss of an important regulatory mechanism in immune system physiology.

Sympathectomy decreased CD4+ T-cells in lymph nodes. Alterations in lymphocyte activity does not always correlate with changes in the proportions of T- or B-lymphocyte subsets. Sympathetic denervation leads to loss of an important regulatory mechanism in immune system physiology. This is apparently site specific in that both lymph node and spleen T-cell proliferative responses are reduced.

Articles by Dr. Brian A. Smith

the australian story

May 31 2003 - Madonna has written to many Institutions in Australia, including proposed reviews
of ETS in Australia. Morgan and FFSO have researched continually for evidence of side-effects
with ETS/ESB. Patients have shared their personal and private stories on this site and the boards.
Surgeons such as Dr T and Dr Lin have admitted there are side-effects. Together we have worked as
a team and finally there is promising news. I have just received a letter from the 'Australian Safety
and Efficacy Register of New Interventional Procedures - Surgical' and they will "undertake a
systematic review of [ETS]" and "warrant it urgent attention".

note: ASERNIP-s did not review Sympathectomy and even after repeated letters and complaints from affected patients, failed to inform the Health Minister or initiate the review. Sympathectomy is listed on the MBS, even though there has been no study into the effects or the side-effect of the surgery - ever done and doctors admit, that they do not know how the patient will be affected. Sadly this admission always comes after they have performed the surgery.
ets-sideeffects.com

ARE WE PAYING A HIGH PRICE FOR SURGICAL SYMPATHECTOMY?

A Systematic Literature Review of Late Complications

Andrea Furlana,c MD, Angela Mailisa,bMD, MSc, FRCPC

(PhysMed) and Marios Papagapioua Msc

Comprehensive Pain Programaand Toronto

Western Hospital Research Instituteb,The Toronto Western Hospital, and Institute

for Work & Healthc, Toronto, Ontario,Canada.

In these studies, 26.3% or one quarter of patients with compensatory hyperhidrosis considered the complication major and disabling. The average time between surgical sympathectomy and the appearance of compensatory hyperhidrosis was 4 months (range 1-6 months). (82;93;118) The incidence of compensatory hyperhidrosis did not seem to be different after open or endoscopic approach. Irrespective of approach, two or more levels of denervation and removal of the stellate ganglion produced noticeably higher incidence.
We suggest that the

possibility of central contribution to the deregulation of sweat gland activity may be a substantial one and should constitute the subject of future research. Furthermore, our data suggest that the presence of a dysfunctional nervous system may constitute "vulnerability" to develop further neuropathic pain syndromes. Could this vulnerability be centrally mediated as well? What is the true nature of all other phenomena observed after sympathectomy (pathological gustatory sweating and what seems to be a rather innocuous complication, phantom sweating)? These and many other questions remain currently unanswered and should constitute similarly the focus of future research.

The study indicates that surgical sympathectomy, irrespective of operative approach and indication, may be associated with many and potentially serious complications.

note: There is no way for the surgeons who will end up with the disabling side-effect. Some of them attempt to guess, that it will be male and most of the time overweight. But there has been no research and there is no proof in the literature to support this claim. So who is a good candidate for ETS? There has been also no study into the severity of the side-effects, it is often the doctors or the patients who define. There is no objective study to establish the before and after state of these patients.

pituitary secretions of ACTH and TSH after sympathectomy

The present results suggest that cervical sympathectomy in the rat increases ACTH secretion and decreases TSH secretion in the pituitary. These effects seem to be due to a mildly increased secretion of melatonin in the pineal body that probably in turn increases corticotropin-releasing factor (CRF) secretion and decreases thyrotropin-releasing hormone (TRH) secretion in the hypothalamus. Extrapolation of these findings to humans suggests that longterm and repeated stellate ganglion block would affect the pituitary secretions of ACTH and TSH.

Hiroshi Iwama¹, Mamoru Adachi¹, Choichiro Tase¹ and Yoichi Akama¹

(1)	Department of Anesthesiology, Fukushima Medical College, 1 Hikarigaoka, 960-12 Fukushima, Japan

Received: 26 June 1995 Accepted: 1 March 1996

Melatonin

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

An increase in daytime melatonin excretion was observed in the patients responding to the sympathectomy with an abolished 6-sulphatoxymelatonin rhythm. This increase could indicate that the final sympathetic neurons innervating the pineal gland might have a both stimulatory and inhibitory function.
Møller M, Osgaard O, Grønbech-Jensen M.

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

Mol Cell Endocrinol. 2006 Jun 27;252(1-2):40-5. Epub 2006 May 2

Sympathectomy In Social Phobia

All aspects of social phobia, both somatic and psychological, were highly significantly improved.

Thoracic Sympathectomy In Social Phobia

Saeed Kargar, M.D.
General Surgeon
Shahid Sadooghi Hospital
Yazd Iran

Mojtaba Yasini, M.D.
Psychiatrist
Bahman Hospital
Yazd Iran

Vida Ayatollahi, M.D.
Anesthesiologist
Shahid Sadooghi Hospital
Yazd Iran

Citation:

Saeed Kargar, Mojtaba Yasini, Vida Ayatollahi: Thoracic Sympathectomy In Social Phobia: A Pilot Study. The Internet Journal of Surgery. 2006. Volume 7 Number 2.

Sympathectomy and blood sugar levels

4. Journal of Tissue Research Vol. 4 (1) 89-94 (2004)

Interactions of autonomic nervous system, pituitary-adrenocortical axis and corticotrophin and cortico-sterone in the regulation of blood sugar level in rats

Pilo, B. and Sule, J.

Division of Neuroendocrinology, Department of Zoology, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara-390 002 India.

Chemical sympathectomy (CSX) reduced the corticosterone concentration slightly but the ACTH level increased significantly. When sympathectomy was combined with vagotomy (CSX+VGX) an increase in both corticosterone and ACTH levels was observed. Chemical sympathectomy and adrenalectomy (CSX+ADX) also produced a maximum decrease in corticosterone level and a maximum level of ACTH. Vagotomy (VGX) alone or together with CSX or ADX produced hyperglycaemia while chemical sympathectomy alone or together with adrenalectomy produced hypoglycaemia. In conclusion it could be stated that in rats in which vagotomy was performed singly and in combination with sympathectomy, glucocorticoid secretion increased along with increased corticosterone. Chemical sympathectomy alone or together with adrenalectomy reduced the corticosterone concentration in blood together with hypoglycaemic condition. ACTH concentration by and large was more when corticosterone secretion was decreased.

Effect on insulin

Similar result was obtained with rat treated for chemical sympathectomy and vagotomy together and this slight decrease in insulin level could favour marginal hyperglycaemia.

3. Journal of Tissue Research Vol. 4 (1) 83-88 (2004)

Effect of autonomic and adrenal manipulation on the serum insulin level in rats

Pilo, B. and Yadav, V.

Division of Neuroendocrinology, Department of Zoology, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara-390 002 India

Substance-P and bone resorption

Sympathectomy is known to result in localized bone resorption in the middle ear and at other sites. (Sandhu et al 1989) Sherman & Chole (1996) found that sympathectomy induced bone resorption could be blocked by capsaicin in vivo. It was concluded that sympathectomy led to a secondary release of substance-P and then directly or indirectly to the activation of osteoclasts. Substance-P also stimulates bone resorption in vitro. It was hypothesized that substance-P is required for other types of bone remodleing, including adaptive bone remodeling.

1997, 190, Session F8, Poster

Adaptive bone remodeling in the middle ear is substance-p dependent

*R.A. Chole, S.P. Tinling (University of California School of Medicine, Davis, California)

causes increased root resorption

Sympathectomy causes increased root resorption after orthodontic tooth movement in rats: immunohistochemical study

Sivakami Rethnam Haug¹, Pongsri Brudvik², Inge Fristad³ and Karin J. Heyeraas¹

(1)	Department of Physiology, University of Bergen, Årstadveien 19, 5009 Bergen, Norway

(2)	Department of Orthodontics and Facial Orthopedics, School of Dentistry, University of Bergen, Årstadveien 17, 5009 Bergen, Norway

(3)	Department of Odontology-Endodontics, School of Dentistry, University of Bergen, Årstadveien 17, 5009 Bergen, Norway

Biomedical and Life Sciences
	Thursday, February 19, 2004

imbalance of sympathetic nerves may induce inflammation and pain in teeth.

Our results demonstrate, for the first time, a trophic effect of the sympathetic nerves on cells in the dental pulp, indicating that an imbalance of sympathetic nerves may induce inflammation and pain in teeth.

The Effect of Unilateral Sympathectomy and Cavity Preparation on Peptidergic Nerves and Cells in Rat Dental Pulp

Sivakami Rethnam Haug, Ellen Berggreen and Karin J. Heyeraas
Department of Physiology, University of Bergen, 5009, Bergen, Norway
Received 7 July 2000; accepted 8 January 2001. ; Available online 4 March 2002.

Sympathectomy Enhances Calcitonin Gene-Related Peptide and Substance-P Expression

Ethridge, Richard T.; Supowit, Scott C.; Zhao, Huawei; DiPette, Donald J.
Institution
University of Texas Medical Branch, Galveston, TX.

Permanent Sympathectomy Enhances Calcitonin Gene-Related Peptide and Substance-P Expression In Dorsal Root Ganglion Neurons.

Hypertension. 32(3):604, September 1998.

Substance P: In the central nervous system, substance P has been associated in the regulation of mood disorders, anxiety, stress, reinforcement, neurogenesis, respiratory rhythm, neurotoxicity, nausea / emesis and pain.
It also has effects as a potent vasodilator. This is caused by the release of nitric oxide from the endothelium. Its release can cause hypotension.

http://en.wikipedia.org/wiki/Substance_P

Effect of Sympathectomy on the Role of Endothelin in DOCA Hypertension

Lange, Darrell L.; Haywood, Joseph R.; Hinojosa-Laborde, Carmen
Institution
University of Texas Health Science Center, San Antonio, TX.
Title
Effect of Sympathectomy on the Role of Endothelin in DOCA Hypertension.
Source
Hypertension. 32(3):595, September 1998.

Cervical sympathectomy causes photoreceptor-specific cell death in the rat retina

Jena J. Steinle, Naarah L. Lindsay and Bethany L. Lashbrook
Department of Physiology, Southern Illinois University School of Medicine, Carbondale, IL 62901, United States
Received 6 December 2004; revised 12 March 2005; accepted 19 March 2005. Available online 18 April 2005.

Effect of Acute Sympathectomy on Responses to Angiotensin and Norepinephrine

The present evidence suggests that the tonic discharge of normally functioning sympathetic nerves is capable of facilitating the response to angiotensin and that sympathectomy results in an abolition of this effect.
Zimmerman, B. G. Ph.D.

Section of Experimental Therapeutics, Lederle Laboratories Pearl River, New York
Title
Effect of Acute Sympathectomy on Responses to Angiotensin and Norepinephrine.[Article]
Source
Circulation Research. 11(5):780-787, November 1962.

SYMPATHECTOMY FOR TACHYCARDIA

Turley, A J; Thambyrajah, J; Harcombe, A A
Institution
Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, UK

Bilateral thoracoscopic cervical sympathectomy for the treatment of recurrent polymorphic ventricular tachycardia.[Report]
Source
Heart. 91(1):15-17, January 2005.

EFFECT OF SYMPATHECTOMY ON MECHANICAL PROPERTIES OF ARTERIES

Mangoni, Arduino A.; Mircoli, Luca; Giannattasio, Cristina; Mancia, Giuseppe; Ferrari, Alberto U.

From the Centro di Fisiologia Clinica e Ipertensione (A.A.M., L.M.), Ospedale Maggiore, Milano; the Cattedra di Medicina Interna (C.G., G.M.), Universita di Milano, Ospedale S. Gerardo, Monza; and the Divisione di Cardioribilitazione (A.U.F.), Ospedale di Seregno, Az/U.S.S.L. 30, Desio, Italy.
Correspondence to Alberto U. Ferrari, MD, Centro Fisiologia Clinica e Ipertensione, Via F. Sforza, 35, 20122 Milano, Italy.

Effect of Sympathectomy on Mechanical Properties of Common Carotid and Femoral Arteries.
Source
Hypertension. 30(5):1085-1088, November 1997.

CATECHOLAMINE LEVELS FOLLOWING SYMPATHECTOMY

Kawamura, Minoru 1,2; Schwartz, Joan P. 1; Nomura, Takuo 1; Kopin, Irwin J. 1; Goldstein, David S. 1; Huynh, Thanh-Truc 1; Hooper, Douglas R. 1; Harvey-White, Judith 1; Eisenhofer, Graeme 1,3

(1)Clinical Neuroscience Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda MD 20892.
(2)Institute of Bio-Active Science, Nippon Zoki Pharmaceutical Co., Ltd. Hyogo 673-14, Japan
Title
Differential Effects of Chemical Sympathectomy on Expression and Activity of Tyrosine Hydroxylase and Levels of Catecholamines and DOPA in Peripheral Tissues of Rats.[Article]
Source
Neurochemical Research. 24(1):25-32, January 1999.

24% ETS PATIENTS END UP WITH SEVERE FULL BODY SWEATING AFTER SURGERY

Compensatory truncal sweating occurred in 36 of the 42 patients; it was severe in ten, moderate in 16 and minimal in ten.

ANDREWS, B. T.; RENNIE, J. A.

Department of Surgery, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
Correspondence to: Mr J. A. Rennie.
Paper accepted 14 February 1997.

sympathetic nerves on early embryonic development and immune modulation of uterus

Role of sympathetic nerves on early embryonic development and immune modulation of uterus in pregnant mice

the CD4⁺/CD8⁺ T cells ratio significantly decreased, while the IL-2/IL-4 ratio significantly increased. These findings indicated that the activation of sympathetic nerves might be favorable to fetal survival and development during early pregnancy through influencing on immune function and decidua formation of uterus.

Yulan Dong^a, Yaoxing Chen^a^, Zixu Wang^a, Jumpei Naito^b and Ji-long Chen^c
^aLaboratory of Veterinary Anatomy, College of Animal Medicine, China Agricultural University, Haidian, Beijing 100094, China
^bDepartment of Animal Science, School of Sciences and Engineering, Teikyo University of Science and Technology, Yamanashi 409–0193, Japan
^cDepartment of Internal Medicine, College of Medicine, University of Iowa, Iowa City, IA 52242, USA
Received 24 October 2005; revised 1 August 2006; accepted 2 August 2006. Available online 26 September 2006.

RESULTS DETERIORATE PROGRESSIVELY

Intermediate-term results of endoscopic transaxillary T2 sympathectomy for primary palmar hyperhidrosis.
Authors:: Chiou
Chen
Source:: British Journal of Surgery; Jan1999, Vol. 86 Issue 1, 1 chart
Document Type:

The results of endoscopic sympathectomy deteriorate progressively from the immediate outcome.

Complications of Endoscopic Sympathectomy.

Complications of Endoscopic Sympathectomy.

In two cases intraoperative cerebral damage occurred.

Cameron, Alan E. P.
: European Journal of Surgery; Apr98 Supplement 580, Vol. 164 Issue 1, p33-35, 3p

HAEMODYNAMIC CHANGES FOLLOWING SYMPATHECTOMY

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.

The Haemodynamic Effect of Thoracoscopic Cardiac Sympathectomy.
Authors:: Lee, Lim-Sim
Lin, Chien-Chih
Ng, Seok-Mun
Au, Chung-Fai
Source:: European Journal of Surgery; Apr98 Supplement 580, Vol. 164 Issue 1, p37-38, 2p

INFLUENCE OF SYMPATHECTOMY ON CEREBRAL AND MUSCULAR ARTERIES

Differing influence of sympathectomy on smooth muscle cells and fibroblasts in cerebral and peripheral muscular arteries
Autonomic Neuroscience, Volume 124, Issues 1-2, 30 January 2006, Pages 38-48
K. Kacem and R. Sercombe

SYMPATHECTOMY SUPPRESSES IMMUNE RESPONSES

we have extended these studies by determining the impact of 6-hydroxydopamine (6-OHDA)-induced peripheral sympathetic denervation on these responses. C57BL/6 mice treated with 6-OHDA (200 mg/kg) were inhibited in their ability to generate primary, HSV-specific cytotoxic T lymphocytes (CTL) in response to HSV infection. sympathectomy also suppressed the activation and function of HSV-specific memory CTL (CTLm). in addition, administration of 6-OHDA resulted in a transient but substantial increase in levels of circulating corticosterone and hypothalamic fos expression.

LEO, NICOLE A.; BONNEAU, ROBERT H. a

Department of Microbiology and Immunology and Program in Neuroscience, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA

Chemical Sympathectomy Alters Cytotoxic T Lymphocyte Responses to Herpes Simplex Virus Infection.
Source
Annals of the New York Academy of Sciences. 917:923-934, 2000.

sympathectomy generates a mild, although significant, impairment of the bronchomotor tone

Gonzalez, Miguel A. Ponce MD a; Serda, Gabriel Julia MD a; Rodriguez, Norberto Santana MD b; Suarez, Pedro Rodriguez MD b; Penate, Gregorio Perez MD a; Gilart, Jordi Freixinet MD b; Navarro, Pedro Cabrera MD a

(a)Department of Pulmonary Medicine, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
(b)Department of Thoracic Surgery, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
Title
Long-term pulmonary function after thoracic sympathectomy.[Miscellaneous Article]
Source
Journal of Thoracic & Cardiovascular Surgery. 129(6):1379-1382, June 2005.
Abstract
Background: The purpose of this study was to evaluate the long-term and midterm effects of thoracic sympathectomy on pulmonary function and to assess the influence of the sympathetic nervous system on bronchomotor tone.
We conclude that thoracic sympathectomy generates a mild, although significant, impairment of the bronchomotor tone.

sympathectomy leads to qualitative alterations in localized bone modeling and remodeling

Previous studies have indicated that regional sympathectomy leads to qualitative alterations in localized bone modeling and remodeling. In this study, unilateral cervical sympathectomy resulted in significant increases in osteoclast surface and osteoclast number within the ipsilateral bulla of experimental animals. The mechanisms by which sympathectomy leads to increased local bone loss is unknown. Potential mechanisms include disinhibition of resorption, secondary to the elimination of periosteal sympathetics, as well as indirect vascular effects.
Disruption of the control of modeling within the temporal bone may lead to various bone diseases such as otosclerosis, osteogenesis imperfecta, Paget's disease of bone, fibrous dysplasia, or the erosion of bone associated with chronic otitis media.

Sherman, Bret E.; Chole, Richard A.
Institution
Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of California, Davis, California, U.S.A.
Title
In Vivo Effects of Surgical Sympathectomy on Intramembranous Bone Resorption.[Miscellaneous]
Source
American Journal of Otology. 17(2):343-346, March 1996.

Alterations of the Bone Scan After Sympathectomy

Mailis, Angela M.D. M.Sc., F.R.C.P.C.(physMed.); Meindok, Harry M.D., B.S., F.R.C.P.C.(Lond.), F.R.C.P.C.(IntMed.); Papagapiou, Marios B.sc.(Hon.), M.Sc.; Pham, Dieu M.D., F.R.C.P.C. (Radiol.)
Institution
Pain Investigation Unit and Department of Medicine, The Toronto Hospital (Western Division), University of Toronto, and Department of Radiology, The Toronto Hospital, Toronto; and Department of Radiology, North York Branson Hospital, North York, Ontario, Canada
Title
Alterations of the Three-Phase Bone Scan After Sympathectomy.[Report]
Source
Clinical Journal of Pain. 10(2):146-155, June 1994.

Sympathectomy Suppresses Baroreflex Control of Heart Rate

Because the T2-3 or T3-4 sympathetic ganglia are involved in direct sympathetic innervation of the heart, sympathectomy at this level may alter baroreflex control of heart rate. The purpose of our study was to examine the influence of ETS on baroreflex responses to pressor and depressor stimuli under small-dose sevoflurane anesthesia.
ETS significantly altered baroreflex in both pressor and depressor tests in all patients. Baroreflex was completely suppressed in 1 of 19 patients in the pressor test and in 9 of 21 patients in the depressor test. We conclude that baroreflex responses are suppressed in patients who receive ETS.

Kawamata, Yurie T. MD *; Kawamata, Tomoyuki MD +; Omote, Keiichi MD +; Homma, Eiji MD *; Hanzawa, Tatsuo MD *; Kaneko, Toshifumi MD ++; Namiki, Akiyoshi MD +
Institution
Departments of *Anesthesiology and
++Surgery, Nippon Telegraph and Telephone East Japan Sapporo Hospital, Sapporo, Japan; and
+Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
Title
Endoscopic Thoracic Sympathectomy Suppresses Baroreflex Control of Heart Rate in Patients with Essential Hyperhidrosis.[Miscellaneous]
Source
Anesthesia & Analgesia. 98(1):37-39, January 2004.

Sympathectomy-induced ichthyosis-like eruption

Lowenstein, Eve J. MD, PhD; Gordon, Ronald E. PhD; Phelps, Robert G. MD
Institution
From the Departments of Dermatology and Pathology, Mount Sinai Medical Center, New York, New York
Title
Sympathectomy-induced ichthyosis-like eruption.[Miscellaneous Article]
Source
International Journal of Dermatology. 39(2):146-151, February 2000.

SUPRESSION OF BARORECEPTOR FUNCTION OF THE HEART

Dohi, Shuji MD; Tsuchida, Hideaki MD; Mayumi, Takehisa MD
Institution
Institute of Clinical Medicine, University of Tsukuba, Sakuramura, Ibaraki, Japan, and the Department of Anesthesiology, Sapporo Medical College and Hospital, Sapporo, Hokkaido, Japan.
Title
Baroreflex Control of Heart Rate during Cardiac Sympathectomy by Epidural Anesthesia in Lightly Anesthetized Humans.[Article]
Source
Anesthesia & Analgesia. 62(9):815-820, September 1983.
To evaluate the effects of acute sympathetic denervation on the baroreflex control of heart rate, baroreflex sensitivities were compared in lightly anesthetized humans who had either cervical (N = 20) or lumbar epidural anesthesia (N = 18). The results suggest that cardiac sympathectomy induced by epidural anesthesia can suppress partially baroreceptor function by interrupting sympathetic efferent fibers innervating the heart during high levels of epidural anesthesia, but that lumbar sympathectomy during epidural anesthesia is unlikely to affect baroreceptor activity.

SUPERSENSITIVITY TO NE AFTER SYMPATHECTOMY

EDVINSSON, L. B.M.; AUBINEAU, P. D.SC.; OWMAN, C. M.D.; SERCOMBE, R. PH.D.; SEYLAZ, J. D.SC.
Institution
Department of Histology, University of Lund, Biskopsgatan 5, S-223 62, Lund, Sweden (EDVINSSON)(OWMAN)
Department of Histology, University of Lund, Biskopsgatan 5, S-223 62, Lund, Sweden; Department de Neurophysiopathologie Humaine, Hopital Laribosisiere, Paris, France (AUBINEAU)(SERCOMBE)(SEYLAZ)

Sympathetic Innervation of Cerebral Arteries: Prejunctional Supersensitivity to Norepinephrine After Sympathectomy or Cocaine Treatment.[Article]
Source
Stroke. 6(5):525-530, September/October 1975.

SYMPATHECTOMY FOR ANGINA

Hirakawa, Naomi; Ogawa, Ikuyo; Yoshida, Kazuyo; Totoki, Tadahide
Institution
Anesthesiology and Critical Care Medicine, Cardiology, Saga Medical School, Saga, Saga, Japan.
Title
Effects of Endoscopic Thoracic Sympathectomy (ETS) for the Treatment of Patients with Intractable Vasospastic Angina. #151; Changes in Autonomic Nervous Activity and Symptomatic Change after ETS in Patients with Intractable Vasospstic Angina #151;.[Miscellaneous]
Source
ASA Annual Meeting Abstracts. LOCAL ANESTHESIA AND PAIN. 99(3A):A998, October 2003.

"paradoxic gangrene" AS A COMPLICATION OF SYMPATHECTOMY

TYLER, L TERRELL M.D.; KAPLAN, I W M.D.
Institution
From the Department of Surgery, Louisiana State University School of Medicine and Surgical Service of Touto Infirmary, New Orleans, La.
Title
Paradoxic Gangrene Following Lumbar Sympathectomy.[Article]
Source
Southern Medical Journal. 50(1):63-66, January 1957.
Abstract
The occasional complication of "paradoxic gangrene" following lumbar sympathectomy is not well understood. Several such instances are reported with the suggestion of an additional etiologic factor.

SYMPATHECTOMY BLUNTS MYOCARDIAL INTERSTITIAL FIBROSIS

Author
Perlini, Stefano; Ferrero, Ivana; Palladini, Giuseppina; Tozzi, Rossana; Facoetti, Angelica; Fallarini, Silvia; Ferrari, Alberto U
Institution
Univ Pavia, Pavia, Italy (Perlini, Ferrero, Palladini, Tozzi)
Univ Pavia, Milano, Italy (Facoetti)
Univ Pavia, Pavia, Italy (Fallarini)
Univ Milano-Bicocca, Milano, Italy (Ferrari)
Title
SYMPATHECTOMY, BUT NOT BETA-BLOCKADE, BLUNTS MYOCARDIAL INTERSTITIAL FIBROSIS IN EXPERIMENTAL PRESSURE-OVERLOAD HYPERTROPHY.[Abstract]
Source
Hypertension. 44(4):512-513, October 2004.

Sympathetic innervation affect vessel structure and sensitivity.

The results also suggest that sympathetic innervation of mesenteric resistance vessels may affect vessel structure and sensitivity.

Author
Nyborg, Niels C B 1; Korsgaard, Niels *; Mulvany, Michael J. *
Institution
*From the Institutes of Biophysics, University of Aarhus, DK-8000 Aarhus C, Denmark
(1)From the Institutes of Pharmacology University of Aarhus, DK-8000 Aarhus C, Denmark
Title
Neonatal Sympathectomy of Normotensive Wistar-Kyoto and Spontaneously Hypertensive Rats with 6-Hydroxydopamine: Effects on Resistance Vessel Structure and Sensitivity to Calcium.[Article]
Source
Journal of Hypertension. 4(4):455-461, August 1986.

SYMPATHECTOMY ON HUMAN MIDDLE CEREBRAL ARTERY FLOW VELOCITY AND CEREBROVASCULAR CO2

Yamada, Hiroyuki M.D.; Ono, Takeshi M.D.; Cho, Sungsam M.D.; Tomiyasu, Shiro M.D.; Sumikawa, Koji M.D.
Institution
Nagasaki University School of Medicine, Nagasaki, Japan
Title
EFFECTS OF THORACIC SYMPATHECTOMY ON HUMAN MIDDLE CEREBRAL ARTERY FLOW VELOCITY AND CEREBROVASCULAR CO2 RESPONSE.[Miscellaneous]
Source
ASA Annual Meeting Abstracts. Clinical Neurosciences. 91(3A):A222, October 1999.

ALTERED IMMUNERESPONSES FOLLOWING SYMPATHECTOMY

Hong, S.; Soares, J.; Bunnell, B. N.; Edwards, G. L.; Evans, D. L.; Dishman, R. K. FACSM
Institution
University of Georgia.
Title
ACTIVITY WHEEL RUNNING BLUNTS SUPPRESSION OF SPLENIC NATURAL KILLER CELL CYTOTOXICITY AFTER FOOTSHOCK AND SYMPATHECTOMY.[Abstract]
Source
Medicine & Science in Sports & Exercise. 30(5) (Supplement):298, May 1998.

Depression accompanying compensatory hyperhidrosis

Hashim, N.; Wilson, N. J. E.
Institution
Department of Dermatology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
Title
Depression accompanying compensatory hyperhidrosis following endoscopic thoracic sympathectomy.[Letter]
Source
Clinical & Experimental Dermatology. 31(6):818-819, November 2006.

dermatitis of the hands following sympathectomy

Hofbauer, Gunther F. L.; Nestle, Frank O.
Institution
Patch Test and Occupational Dermatology Unit, Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland
Title
Irritant contact dermatitis of the hands following thoracic sympathectomy.[Miscellaneous]
Source
Contact Dermatitis. 42(2):119-120, February 2000.

sympathectomy-induced adrenal hypertrophy

Regulation of adrenal angiotensin receptor subtypes: a possible mechanism for sympathectomy-induced adrenal hypertrophy

Conclusions: Impairment of the sympathetic nervous system with guanethidine withdraws the normal stimulation of this system on the circulating renin-angiotensin system, but upregulates the expression of adrenal Ang II receptors. Increased expression of adrenal AT2 and AT1A receptors may play an important role in adaptive adrenal hypertrophy and hormonal responses to sympathectomy.

Author
Qiua, Jingxin 1; Nelsona, Sharon H. 1; Spethb, Robert C. 2; Wanga, Donna H. 1,3

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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