Wednesday, May 7, 2008
Sympathectomy - surgical treatment for endometriosis
Pre-sacral neurectomy: An operation in which the nerves that transmit pain from the uterus to the brain are cut. Very rarely done in Australia. Also known as pre-sacral sympathectomy.
Influence of preganglionic cervical sympathectomy
Thus, the dilating effect of the sympathectomy on
the skin vessels appeared to predominate in our
experiments, representing an extracranial steal from
the cerebral circulation.
Cerebral infarction due to carotid occlusion and
carbon monoxide exposure
II. Influence of preganglionic cervical sympathectomy
JORG IGLOFFSTEIN, RUDOLF LAAS
From the Department of Neuropathology, Eppendorf Hospitals, University of Hamburg, H,-mburg, FederalRepublic of Germany
Journal of Neurology, Neurosurgery, and Psychiatry 1983;46:768-773
the skin vessels appeared to predominate in our
experiments, representing an extracranial steal from
the cerebral circulation.
Cerebral infarction due to carotid occlusion and
carbon monoxide exposure
II. Influence of preganglionic cervical sympathectomy
JORG IGLOFFSTEIN, RUDOLF LAAS
From the Department of Neuropathology, Eppendorf Hospitals, University of Hamburg, H,-mburg, FederalRepublic of Germany
Journal of Neurology, Neurosurgery, and Psychiatry 1983;46:768-773
HR as indicator of arrousal
A Neuropsychological Model Relating Self-Awareness to
Hostility
Heath A. Demaree1,2 and David W. Harrison1,3
Neuropsychology is an approach that may be
beneficial in the attempt to relate mental proc-
esses—awareness, behaviors, cognitions, and emo-
tions—to the brain, its structures, and processes
including arousal of brain systems (Heilman and Va-
lenstein, 1993). Rather than ignore the role of the
cortex, view the brain as a "black box," or vaguely
describe different cortical processes, neuropsychol-
ogy purportedly evaluates how and where compo-
nents of mental processes occur. In accordance with
Mill, this approach assumes that all mental processes
result from physical processes within the central
nervous system. Accordingly, a change in any mental
process is associated with changes in the brain's
physical state. Conversely, an altered brain state simi-
larly affects mental processes.
Hostility
Heath A. Demaree1,2 and David W. Harrison1,3
Neuropsychology is an approach that may be
beneficial in the attempt to relate mental proc-
esses—awareness, behaviors, cognitions, and emo-
tions—to the brain, its structures, and processes
including arousal of brain systems (Heilman and Va-
lenstein, 1993). Rather than ignore the role of the
cortex, view the brain as a "black box," or vaguely
describe different cortical processes, neuropsychol-
ogy purportedly evaluates how and where compo-
nents of mental processes occur. In accordance with
Mill, this approach assumes that all mental processes
result from physical processes within the central
nervous system. Accordingly, a change in any mental
process is associated with changes in the brain's
physical state. Conversely, an altered brain state simi-
larly affects mental processes.
The effect of sympathectomy on blood flow in bone
Sympathectomy as a therapeutic modality has been
employed for a variety of pathological states. It first
gained popularity in the 1920’s and 1930’s for improving
peripheral circulation, but soon its limitations began to be
apparent. The initial vasodilation after sympathectomy de-
creases some days after the procedure is performed. Results
for denervation of the upper extremity are not as long-lasting
as those for denervation of the lower extremity. A variety
of mechanisms have been proposed for the apparent return
of vasomotor tone, including: (1) development of intrinsic
tone in smooth muscle, (2) partial anatomical denervation
at the time of the operation, (3) post-denervation sensiti-
zation, (4) post-denervation sprouting, (5) hypertrophy of
the extraganglionic sympathetic nervous system, and (6)
cross-over of the lumbar sympathetic systems30. The pres-
ence or absence of inflow obstruction appears to be impor-
tant. The work of Rutherford and Valenta indicated that
while sympathectomy may increase flow in the resting state
and after exercise, the presence of inflow obstruction in a
patient who has a sympathectomy might actually interfere
with the increased distribution of the flow of blood to ex-
ercising muscle.
1987;69:1384-1390. J Bone Joint Surg Am.RF Davis, LC Jones and DS Hungerford
The effect of sympathectomy on blood flow in bone. Regional distribution and effect over time
employed for a variety of pathological states. It first
gained popularity in the 1920’s and 1930’s for improving
peripheral circulation, but soon its limitations began to be
apparent. The initial vasodilation after sympathectomy de-
creases some days after the procedure is performed. Results
for denervation of the upper extremity are not as long-lasting
as those for denervation of the lower extremity. A variety
of mechanisms have been proposed for the apparent return
of vasomotor tone, including: (1) development of intrinsic
tone in smooth muscle, (2) partial anatomical denervation
at the time of the operation, (3) post-denervation sensiti-
zation, (4) post-denervation sprouting, (5) hypertrophy of
the extraganglionic sympathetic nervous system, and (6)
cross-over of the lumbar sympathetic systems30. The pres-
ence or absence of inflow obstruction appears to be impor-
tant. The work of Rutherford and Valenta indicated that
while sympathectomy may increase flow in the resting state
and after exercise, the presence of inflow obstruction in a
patient who has a sympathectomy might actually interfere
with the increased distribution of the flow of blood to ex-
ercising muscle.
1987;69:1384-1390. J Bone Joint Surg Am.RF Davis, LC Jones and DS Hungerford
The effect of sympathectomy on blood flow in bone. Regional distribution and effect over time
Imbalances of sympathetic nervous system - autoimmune inflammatory diseases
Interruptions of the HPA axis at any level
and through multiple mechanisms, whether on a genetic
basis, through surgical means such as adrenalectomy or
hypophysectomy, or with pharmacological interventions
such as treatment with the glucocorticoid receptor antag-
onist RU 486, can render an inflammatory resistant host
susceptible to inflammatory disease (Sternberg 1997a,b).
Imbalances of sympathetic nervous system responses are
also associated with autoimmune inflammatory diseases
such as arthritis in both humans and rodents. Human
juvenile rheumatoid arthritis has been associated with both
abnormal HPA axis and sympathoneuronal responses (Kuis
et al. 1996). Inflammatory susceptible LEW/N rats show
not only blunted HPA axis responsiveness, but also
blunted sympathoneuronal activity in response to gluco-
privic stress (Goldstein et al. 1993). This raises the question
of whether in such susceptible hosts multiple factors may
account for overall susceptibility to autoimmune/ inflammatory disease.
While this review has focused on the HPA axis and
glucocorticoids and their role in susceptibility to inflam-
matory disease, estrogen is known to play an extremely
important role in immune modulation, and contributes to
the approximately two- to tenfold higher ratio of most
autoimmune diseases in females of all species (Wilder
& Sternberg 1990, Ahmed et al. 1999, Lahita 1999).
Ovariectomy has been shown to reduce, while replace-
ment of estrogen re-constitutes, this di
and through multiple mechanisms, whether on a genetic
basis, through surgical means such as adrenalectomy or
hypophysectomy, or with pharmacological interventions
such as treatment with the glucocorticoid receptor antag-
onist RU 486, can render an inflammatory resistant host
susceptible to inflammatory disease (Sternberg 1997a,b).
Imbalances of sympathetic nervous system responses are
also associated with autoimmune inflammatory diseases
such as arthritis in both humans and rodents. Human
juvenile rheumatoid arthritis has been associated with both
abnormal HPA axis and sympathoneuronal responses (Kuis
et al. 1996). Inflammatory susceptible LEW/N rats show
not only blunted HPA axis responsiveness, but also
blunted sympathoneuronal activity in response to gluco-
privic stress (Goldstein et al. 1993). This raises the question
of whether in such susceptible hosts multiple factors may
account for overall susceptibility to autoimmune/ inflammatory disease.
While this review has focused on the HPA axis and
glucocorticoids and their role in susceptibility to inflam-
matory disease, estrogen is known to play an extremely
important role in immune modulation, and contributes to
the approximately two- to tenfold higher ratio of most
autoimmune diseases in females of all species (Wilder
& Sternberg 1990, Ahmed et al. 1999, Lahita 1999).
Ovariectomy has been shown to reduce, while replace-
ment of estrogen re-constitutes, this di
Influence of Endoscopic Thoracic Sympathectomy on Baroreflex Control of Heart Rate
Before and after the ETS, there were no significant differences in resting SBP (105.0±8.7 and 105.3±13.7 mmHg, respectively)
and heart rate (88.9±14.4 and 86.0±15.1 beats/min, respectively). In the pressor test, the ETS produced a significant
suppression of baroreflex response in all petient studied; baroreflex sensitivity before and after the ETS were 7.6±2.8 and
3.4±2.5 msec/mmHg, respectively (P<0.05). In the depressor test, the ETS also suppressed baroreflex response. In two of
eight patients, baroreflex response was completely suppressed after the ETS. Baroreflex sensitivity before and after the ETS
were 3.8±0.4 and 1.2±1.4 msec/mmHg, respectively (P<0.05). All patients showed the increase in skin temperatures of bilateral
palmars and arms, and the ceasing sweat after the ETS, indicating successful T2-3 sympathectomy.
Conclusion
Our results indicated that T2-3 sympathectomy suppressed baroreflex control of heart rate in both pressor and depressor tests
in the patients with palmar hyperhidrosis. We should note that baroreflex response for maintaining cardiovascular stability is
suppressed in the patients who received the ETS.
Anesthesiology 2001; 95:A160
Yurie T. Kawamata, M.D.; Eiji Homma, M.D.; Tomoyuki Kawamata, M.D.; Kiichi Omote, M.D.; Akiyoshi Namiki, M.D.
Anesthesiology, Sapporo Medical University, Sapporo, Hokkaido, Japan
and heart rate (88.9±14.4 and 86.0±15.1 beats/min, respectively). In the pressor test, the ETS produced a significant
suppression of baroreflex response in all petient studied; baroreflex sensitivity before and after the ETS were 7.6±2.8 and
3.4±2.5 msec/mmHg, respectively (P<0.05). In the depressor test, the ETS also suppressed baroreflex response. In two of
eight patients, baroreflex response was completely suppressed after the ETS. Baroreflex sensitivity before and after the ETS
were 3.8±0.4 and 1.2±1.4 msec/mmHg, respectively (P<0.05). All patients showed the increase in skin temperatures of bilateral
palmars and arms, and the ceasing sweat after the ETS, indicating successful T2-3 sympathectomy.
Conclusion
Our results indicated that T2-3 sympathectomy suppressed baroreflex control of heart rate in both pressor and depressor tests
in the patients with palmar hyperhidrosis. We should note that baroreflex response for maintaining cardiovascular stability is
suppressed in the patients who received the ETS.
Anesthesiology 2001; 95:A160
Yurie T. Kawamata, M.D.; Eiji Homma, M.D.; Tomoyuki Kawamata, M.D.; Kiichi Omote, M.D.; Akiyoshi Namiki, M.D.
Anesthesiology, Sapporo Medical University, Sapporo, Hokkaido, Japan
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