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

Saturday, October 11, 2008

sympathectomy highly controversial

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

Sympathectomy causes changes in the wool growth of sheep

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

Full text doi:10.1071/AR9941159

© CSIRO 1994

Sympathectomy in the treatment of RSD

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

Response:

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


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

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

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

Sympathectomy also cuts sensory nerves

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

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

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

Dr Lin treats these conditions with sympathectomy:

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

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

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

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

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

Conditions treated by SYMPATHECTOMY

Lin-Telaranta Classifications

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


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

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

Dr Lin performed over 6000 surgeries

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

Partial cardiac sympathetic denervation after bilateral thoracic sympathectomy in humans

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

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

RESULTS: Heart rate was 77 +/- 8 beats per minute before surgery on the 24-hour recording and significantly decreased after bilateral (67.8 +/- 6.5 beats per minute; p < 0.05) but not after unilateral right sympathectomy. Consistently spectral analysis variables significantly changed after bilateral surgery but showed no right-sided dominance. Little effect of sympathectomy was found on the QT interval, which tended to decrease after bilateral sympathectomy. CONCLUSIONS: Patients should be informed of the bradycardia resulting from sympathectomy.
Ann Thorac Surg. 2002 Dec ;74 (6):2076-81 12643398
Pierre Abraham, Jean Berthelot, Jacques Victor, Jean-Louis Saumet, Jean Picquet, Bernard Enon Department of Vascular Investigation and Sports Medicine, University Hospital, Angers, France

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

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

Sympathectomy-induced alterations of immunity

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

Oxytocin and adrenaline after sympathectomy

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

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