remarkable changes in the nerves that remain

Chemical denervation and selected ganglionectomy studies have shown that loss of sympathetic or sensory innervation induces remarkable changes in the nerves that remain.

Sympathectomy. Unilateral removal of the SCG results in the reinnervation of the denervated cerebral vessel by sprouting nerves from the contralateral ganglion (Kahrstrom et al. 1986). Following chronic guanethidine sympathectomy there is a complete depletion of sympathetic cotransmitters NA and NPY from the dura mater but an increase in the expression of NPY in non-sympathetic axons (lacking small dense-cored vesicles) supplying cerebral vessels and the iris (Mione at al. 1990). The source of increased cerebrovasular NPY is thought to be preexisting parasympathetic cranial ganglia which normally express both NPY and VIP (Gibbins and Morris 1998).
Indeed, sympathectomy-induced DBH-immunoreactivity in the sphenopalatine (parasympathetic) ganglion occurs at the same time as a loss of VIP-immunoreactivity (Fan and Smith 1993). In the cerebral and uterine artery, loss of sympathetic nerves also leads to increased DBH-immunoreactivity in non-sympathetic nerves that lack TH and NA (Morris et al. 1991).

The loss of sympathtetic neurones and nerve fibres is also accompanied by striking increases in sensory innervation. This has been attributed to increased availability to NGF (as there are no sympathetic nerves with which to compete for uptake) which promotes the growth of sensory nerves (Kessler et al. 1983)

In the lung, sympathectomy induced a marked increase in CGRP-immunoreactive nerve density around the airways, and blood vessels.

The Autonomic Nervous System. Part I. Normal Functions by O. Appenzeller (Hardcover - Dec 1, 1999)

Category: Neurology & Clinical Neurophysiology

Publication Date: 1999-12-16 Publisher: Elsevier - Health Sciences Div

Ultrastructural changes in the pineal gland

H. J. Romijn¹

(1)	Present address: Department of Electron Microscopy, Netherlands Central Institute for Brain Research, Amsterdam, The Netherlands

Received: 3 March 1975

Summary The ultrastructure of the rabbit pineal gland was investigated after sympathectomy (extirpation or decentralization of the superior cervical ganglia), parasympathectomy, continuous illumination and continuous darkness. The similarity of the ultrastructural changes in the light pinealocytes occurring after sympathectomy and after continuous illumination was striking. It is supposed that these changes have a common cause,viz. the lack of free noradrenaline, the pinealotropic neurotransmitter.

The smooth endoplasmic reticulum present in the terminals of the offshoots of the light pinealocytes is possibly involved in pineal indoleamine synthesis.

Journal of Neural Transmission
SpringerLink DateTuesday, March 29, 2005

Denervated heart does not respons as effectively as it should

Somatic effectors are dependent on their innervation to maintain structural and functional integrity. When denervated, they eventually atrophy. This is the fate of denervated voluntary muscles as noted in a lower motor neuron paralysis.
Denervated involuntary muscles, cardiac muscle, and glands continue to function. For example, the transplanted heart may function reasonably well. However, when deprived of autonomic nervous system influences, these effectors are abnormal in that they do not respond as effectively as they should to satisfy the changind demands of the organism.

The Human Nervous System

Structure and Function

Noback, C.R.; Ruggiero, D.A.; Demarest, R.J.; Strominger, N.L. (Eds.)

2007, 416 p. 178 illus., Softcover

ISBN: 978-1-58829-040-3

Mia: Please note, that with heart transplants both, sympathetic and parasympathetic influences are disrupted , so while there is denervation, there is no obvious imbalance between these. In sympathectomy, only the sympathetic nerves are cut, and the parasympathetic influence is predominant, whic will result in slowing of the heart.

Reduced Heart Rate Variability and Increased C-reacitve protein - predicts death and myocardial infarction

Increased C-reactive protein (CRP) and reduced heart rate variability (HRV) both indicate poor prognosis. An inverse association between HRV and CRP has been reported, suggesting an interaction between inflammatory and autonomic systems. However, the prognostic impact of this interaction has not been studied. We thus investigated the prognostic impact of CRP, HRV and their combinations.

Conclusions: The combination of CRP and HRV or heart rate (HR) predicts death and myocardial infarction with synergism, indicating interaction between inflammatory and autonomic systems with a prognostic significance.

Journal of Internal Medicine. 260(4):377-387, October 2006.
SAJADIEH, A. 1; NIELSEN, O. W. 1; RASMUSSEN, V. 2; HEIN, H. O. 3; HANSEN, J. F. 1

Sympathectomy is known to alter immunity

Chemical Sympathectomy, as well as manipulation of the autonomic nervous system, is known to alter lymphocyte dependent immunity.
The stress induced by autonomic dysregulation after SCI, and especially by episodes of autonomic dysreflexia, may well be an important cause of immune suppression in this group.

Neurologic events are known to affect immunologic function indirectly, through the pituitary adrenal axis, and through endocrine and neuropeptide regulation. Stress induces the release of adrenocorticotrophic hormone from the pituitary. This induces the release of immuno-suppressive glucocorticoids. In addition, the adrenal medulla releases catecholamines that alter leukocyte migration and lymphocyte responsiveness. Other hormones, including insulin, thyroxin, growth hormones, samostatin, and the sex hormones modulate T- and B-cell functions in complex ways. A number of abnormalities in endocrine function accompany SCI. Abnormal endocrine physiology involving sex hormones, aldosterone, catecholamines, and methylhydroxymandelic acid have been described.
Spinal Cord Medicine: Principles and Practice Spinal Cord Medicine: Principles and practiceby Vernon W. Lin, Diana D. Cardenas, Nancy C., MD Cutter,
Published by Demos Medical Publishing, LLC. 2002

efficacy ranging from 13% to 80% ?

Lumbar sympathetic blockade is indicated for diagnosis, prognosis, and therapy of painful and other conditions presumably associated with sympathetic nervous system dysfunction. Anatomy of the lumbar sympathetic chain and the rationale for the block are essential to know before performing the block. Different techniques have been described for the lumbar sympathetic blockade, with efficacy ranging from 13% to 80%, which varies according to the initial patient pathology. Genito-femoral neuralgia occurs in about 5% of patients after neurolytic block. Other potential complications are infection, hematomas, and somatic nerve damage. Copyright © 2001 by W.B. Saunders Company

Techniques in Regional Anesthesia and Pain Management, Volume 5, Issue 3, Pages 99-101
N.Mekhail, O.Malak

cervical sympathectomy resulted in a rapid degeneration in some of the cells in the sinuatrial and atrioventricular nodes

J Anat. 1984 October; 139(Pt 3): 449–461.

PMCID: PMC1165060

Copyright notice

An ultrastructural study of the effects of right cervical sympathectomy on the sinuatrial and atrioventricular nodes in the heart of the monkey (Macaca fascicularis).

S S Tay, W C Wong, and E A Ling

This study describes the ultrastructural changes in the sinuatrial and atrioventricular nodes of the heart of the monkey (Macaca fascicularis) after right cervical sympathectomy. Obvious changes in the nodal cells were seen one day after operation. Numerous glycogen particles grouped together to form electron-dense patches containing vacuoles in the cytoplasm. At three days after operation, intracellular organelles exhibited fragmentation and dissolution. By five and seven days after operation, the affected cells were vacuolated and some were swollen and appeared to have degenerated. Simultaneously, there was massive infiltration of macrophages were present nodal tissues. Axon profiles and terminals showing various degrees of degeneration were present in the vicinity of the nodal cells throughout the period of study. It is concluded that right cervical sympathectomy resulted in a rapid degeneration in some of the cells in the sinuatrial and atrioventricular nodes.

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

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

Autonomic Neuroscience, Volume 120, Issue 1, Pages 46-51
J. Steinle, N. Lindsay, B. Lashbrook

Interview with Dr Telaranta

Do you find ETS patients less satisfied with their decision over time due
to CS or other factors & have there been adequate studies on the long term
effects of ETS on cardiac, skin function, etc..?

-My opinion is, that during time the past slowly gets into oblivion, the patients don’t remember any more the original situation. Also, I believe that the first hype of enthusiasm goes away with the central nervous system getting used to the new situation. It may even be that the initial effect on the thalamic structures is some kind of euphoric hybris due to the sudden increase of the serotonine-like overflow.

http://www.angelfire.com/journal2/sadhelp/Interview1.htm

Science 3 September 1971: Vol. 173. no. 4000, pp. 931 - 934 DOI: 10.1126/science.173.4000.931

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Serum Dopamine--Hydroxylase: Decrease after Chemical Sympathectomy

Richard Weinshilboum ¹ and Julius Axelrod ²

¹ Pharmacology-Toxicology Program, National Institute of General Medical Sciences, Bethesda, Maryland 20014
² Laboratory of Clinical Science, National Institute of Mental Health, Bethesda, Maryland 20014

Dopamine-- hydroxylase is an enzyme that is localized to catecholamine-containing vesicles in sympathetic nerves and the adrenal medulla, and is also found in the serum. Treatment of rats with 6-hydroxydopamine, a drug which destroys sympathetic nerve terminals, leads to a decrease in serum dopamine--hydroxylase activity. The decrease is not due to an effect on the adrenal medulla or to an increase in circulating inhibitor or inhibitors of enzyme. These data represent evidence that at least a portion of the circulating dopamine--hydroxylase activity arises from sympathetic nerve terminals.

abnormal heart rate recovery predicts death

5234 adults without evidence of cardiovascular disease who were enrolled in the Lipid Research Clinics Prevalence Study.

Measurements: Heart rate recovery was defined as the change from peak heart rate to that measured 2 minutes later (heart rate recovery was defined as 42 beats/min).

Results: During 12 years of follow-up, 312 participants died. Abnormal heart rate recovery predicted death (relative risk, 2.58 [CI, 2.06 to 3.20]). After adjustment for standard risk factors, fitness, and resting and exercise heart rates, abnormal heart rate recovery remained predictive (adjusted relative risk, 1.55 [CI, 1.22 to 1.98]) (P <>

Conclusion: Even after submaximal exercise, abnormal heart rate recovery predicts death.

4 April 2000 | Volume 132 Issue 7 | Pages 552-555

The thermoregulatory control of human skin blood flow is vital to the maintenance of normal body temperatures

The thermoregulatory control of human skin blood flow is vital to the maintenance of normal body temperatures during challenges to thermal homeostasis. Sympathetic neural control of skin blood flow includes the noradrenergic vasoconstrictor system and a sympathetic active vasodilator system, the latter of which is responsible for 80% to 90% of the substantial cutaneous vasodilation that occurs with whole body heat stress.
Raynaud phenomenon and erythromelalgia represent cutaneous microvascular disorders
whose pathophysiology appears to relate to disorders of local and/or reflex
thermoregulatory control of the skin circulation.
© 2003 Mayo Foundation for Medical Education and Research

Cerebral Blood Flow after Sympathectomy

After sympathectomy, CBF (Cerebral Blood Flow) increases (26.5% +-3.6%) and CVR (Cerebral Vascular Resistance) decreases (-21.8% +-2.1%) during REM were less (p <0.05).

Hematology Week. Atlanta: Dec 29, 2008. pg. 430

The intracerebral vessels constrict in response to cervical sympathetic stimulation and dilate when these fibres are interrupted

• BJA: British Journal of Anaesthesia
• Volume 95, Number 5
• Pp. 669-673, 2005

Changes in cerebral morphology consequent to peripheral autonomic denervation

Our findings suggest that peripheral autonomic denervation is associated with grey matter loss in cortical regions encompassing areas that we have previously shown are functionally involved in generation and representation of bodily states of autonomic arousal. The nature of these changes cannot be determined from morphometric analysis alone, but we suggest that they reflect experience-dependent change consequent upon loss of afferent input to brain regions involved in representation of autonomic states.
Critchley, H.D. and Good, C.D. and Ashburner, J. and Frackowiak, R.S. and Mathias, C.J. and Dolan, R.J. (2003) Changes in cerebral morphology consequent to peripheral autonomic denervation. NeuroImage, 18 (4). pp.908 - 916. ISSN 10538119

blockade of the sympathetic nervous system substantially degrades ligament

THE PERIPHERAL NERVOUS SYSTEM (PNS) has three primary functions: 1) relaying sensorimotor information to and from the central nervous system; 2) controlling local blood flow; and 3) influencing inflammatory, proliferative, and reparative processes in injured tissue. In the PNS, neurogenic factors, such as neuropeptides and neurotransmitters, are chemical agents that mediate these functions (35). These factors can influence PNS-related actions by modulating immune cell responses, cytokine response, and local blood flow (5, 35). Although neurogenic factors are released from stimulated nerve endings, their actions are not restricted to the point of stimulation (10). For example, the autonomic neuropeptides vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY) can have angiogenic, vasoregulatory, and cell proliferative actions hours to days after release from nerve endings (35, 44). In addition, Ackermann et al. (1) recently reported a role for peripheral neuropeptides in healing of tendon tissue. The above observations make it likely that these neurogenic factors play an important role in tissue homeostasis.

Clinically, chemical inhibition of the PNS is used to manage joint pain. Chemical blockade of the sympathetic nervous system is often accomplished through the administration of guanethidine. Guanethidine blocks the release and subsequent reuptake of norepinephrine (NE) (a major sympathetic neurotransmitter) in patients with osteoarthritis, rheumatoid arthritis, and reflex sympathetic dystrophy (12, 13, 24, 38, 40). This treatment, while effective in relieving pain, may have undesirable effects on connective tissues, because it alters the normal concentration of neurogenic factors.

Growing anatomic and physiological evidence suggest that the PNS is important to ligament and joint homeostasis.
Denervation of peripheral nerves leads to decreased healing of the MCL and promotes the onset of osteoarthritis (22, 34). Partial injury to the MCL can lead to increases in vascular volume, a factor that is largely controlled by ligament innervation (7). During periods of chronic overuse or disuse, homeostatic changes can be detrimental to the structural integrity of ligaments. Although the above evidence suggests that peripheral nerves play an essential role in ligament homeostasis, few studies exist that directly investigate this role.

J Appl Physiol 96: 711-718, 2004

Muscle Nerve. 1996 May;19(5):581-6.Links

Abolition of sympathetic skin responses following endoscopic thoracic sympathectomy.

Lefaucheur JP, Fitoussi M, Becquemin JP.

Department of Physiology, Henri Mondor Hospital, Creteil, France.

Sympathectomy eliminates the psychogalvanic reflex

Anaesth Intensive Care. 1979 Nov;7(4):353-7.Links

Assessment of sympathectomy--the skin potential response.

Cronin KD, Kirsner RL.

Objective assessment of the results of surgical sympathectomy and sympathetic block (both temporary and permanent) are not widely practised. This article comments briefly on the available methods, and describes the use of the abolition of the skin potential response (formerly known as the psychogalvanic reflex) to assess the abolition of sympathetic function. This method of assessment has proved useful in clinical practice.

PMID: 525760 [PubMed - indexed for MEDLINE]

Sympathectomy listed as Neurologic disorder

Other neurologic disorders

• Idiopathic orthostatic hypotension

• Multiple sclerosis

• Parkinsonism

• Posterior fossa tumor
• Shy-Drager syndrome
• Spinal cord injury with paraplegia
• Surgical sympathectomy
• Syringomyelia
• Syringobulbia
• Tabes dorsales (syphilis)
• Wernicke's encephalopathy

Dizziness in Orthopaedic Physical Therapy Practice: Classification
and Pathophysiology
Peter Huijbregts, PT, MSc, MHSc, DPT, OCS, MTC, FAAOMPT, FCAMT
Paul Vidal, PT, MHSc, DPT, OCS, MTC
The Journal of Manual & Manipulative Therapy
Vol. 12 No. 4 (2004), 199 - 214

Fifty-one percent of the participants claimed that their quality of life decreased

Quote: "Fifty-one percent of the participants claimed that their quality of life decreased moderately or severely as a result of CS, but only one-third of them (7.9% children vs. 22.4% others, P = 0.001) would not have undergone the operation in retrospect." *


Comment from CSMESS: Half of patients felt their quality of life was lowered by the surgery! Half! One out of three patients regretted the surgery!! Worse yet, they try to make that out to be a surprisingly low percentage by stating the statistic as "only one-third".

"Only"?? Are you kidding me? Since when is having one third of your patients end up worse off after a permanent, destructive nerve surgery considered a surprisingly good result?

How can a surgery for a benign condition -- a surgery performed for the sole purpose of increasing quality of life -- be considered justified when over half of the patients end up with lower quality of life?

And then on top of it all, they recommend ETS for children -- creatures whose minds and bodies have not fully developed -- based on the answers these children give to questions posed by adult authority figures? Doctors, no less.

I guess I should be happy they published these numbers. I believe that they are representative of reality in terms of the percentage of people who end up with lower quality of life from ETS. It's a far cry from the "5% get bad side effects" crap that most prospective patients are told in order to get them to have the surgery. Still, it is unfathomable to me that an article citing a lowering of quality of life for half the patients and a third regretting the surgery can be spun positively. (http://etsandreversals.yuku.com/directory)

*Pediatr Surg Int. 2007 Nov 13 [Epub ahead of print] Links
Do children tolerate thoracoscopic sympathectomy better than adults?Steiner Z, Cohen Z, Kleiner O, Matar I, Mogilner J.
Department of Pediatric Surgery, Hillel Yaffe Medical Center, P. O. Box 169, Hadera, 38100, Israel, steiner@hy.health.gov.il.

Effects of stellate ganglion block on cerebral haemodynamics as assessed by transcranial Doppler ultrasonography

M. M. Gupta¹, P. K. Bithal^1,*, H. H. Dash¹, A. Chaturvedi¹ and R. P. Mahajan²

¹ Department of Neuroanaesthesiology, All India Institute of Medical Sciences (A.I.I.M.S.), New Delhi, India. ² University Department of Anaesthesia and Intensive Care, Queen's Medical Centre, Nottingham, UK

^* Corresponding author. E-mail: pkbithal@hotmail.com

Accepted for publication July 11, 2005.

Relationship of cerebral bloodflow and metabolism to neurological symptoms

Reduced cerebral vascular tone

This is manifested by the following rheoencephalographic findings: steep rise of the anacrotic section of the curve, high amplitude, sharp peak, overt incisure with low localization (in the lower third of the curve or very close to the baseline), prominent post-incisure wave. These rheoencephalographic changes may be observed after inhalation of 5 to 7% CO2 or cervical sympathectomy (Jenkner, 1962), resulting in dilation of the cerebral vessels. Analogous deviations may be induced by vasodilative drugs.
UnderThese signs of reduced cerebral vascular tone may be observed alsi in a variety of pathologic conditions associated with cerebral hyperemia, such as contusion of the brain (Jenkner, 1962), following electroshock (Lifshitz. 1963) and others.

Cerebral blood flow: Relationship of cerebral bloodflow and metabolism to neurological symptoms

By John Stirling Meyer, J. P. Schadé

Contributor John Stirling Meyer

Edition: illustrated

Published by Elsevier, 1972

It has to push us to publish our works, to inform the medical corps, relentlessly and without restraint

7th International Symposium on Sympathetic Surgery 20th-22nd March 2007 Muro Alto (PE), Brazil
Clinical Autonomic Research. New York:Apr 2007. Vol. 17, Iss. 2, p. 126-44 (19 pp.)

Pity colleagues, pity for these poor patients!
Gross Michel* Institution: Private Cabinet*; Grone - Switzerland
A desperate 22-year-old man comes to consult and tells me about his idea of committing suicide. Since the age of 9, he suffers from a severe cephalic ephidrosis, with blushing face, intensifying with years, to such an extent that it became unbearable over the last year:
''It is a real Calvary''. His family GP assures him that his troubles are going to disappear as he will get older and ''ut aliquid fieri'' he prescribes sage drops and anxiolytic. As these prescriptions do not improve his situation, his GP sends him to an endocrinologist who performs many exams to exclude an hyperthyreosis, a carcinoıd tumor or a pheochromocytoma. Among the considerable number of blood exams, one appears to be out of normal ranges. The patient goes therefore to an haematologist, who does not find anything
abnormal. A neurologist, then consulted, does not suspect anything in particular, but asks however for some radiology exams, including a brain MRI, as well as a Pet-scan, to exclude an adrenal gland tumor. All these exams being normal, the patient is sent to a behaviour therapist to begin a psychotherapy. Exhausted by the
weight of these useless consultations here and there, our young patient, always seeking for the solution to his problems, decides to turn to an acupuncturist, an osteopath, a healer and a radiesthesist, in vain. He then decides to consult a dermatologist and shares with him a summary of information gathered on Internet, including information from my site. Finally, the patient was referred to me.
Aware of that, the GP warns his colleagues by sending a letter indicating that any therapeutic measure other than psychotherapy is not recommended, considering the surgical alternative as irresponsible. I did by the way, not get any call from any of my colleagues. The patient had successful surgery 2 weeks later
(sympathicotomy T2-3-4-5) This recent history redraws, once again, iatrogenic caricatural wandering to which our patients are too often subjected. It has to push us to publish our works, to inform the medical corps, relentlessly and without restraint. The information could also, throughout the public, reach our colleagues. It is at the end an interesting paradox to note that physicians, whose primary role is to relieve patients, are also the primary actors of a film where patients are maintained in a ''medical jail''.

J Thorac Cardiovasc Surg. 2009 Mar;137(3):664-9. Epub 2008 Sep 24. Links

Effects of endoscopic thoracic sympathectomy for primary hyperhidrosis on cardiac autonomic nervous activity.

Cruz J, Sousa J, Oliveira AG, Silva-Carvalho L.

Service of Cardiothoracic Surgery, Hospital de Santa Maria, Lisbon, Portugal. costacruzjorge@gmail.com

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.

These results provide, for the first time to our knowledge, clear evidence of increased vagal and global cardiac autonomic activity and decreased sympathetic activity after endoscopic thoracic sympathectomy.

PMID: 19258086 [PubMed - indexed for MEDLINE]

Changes in cerebral morphology consequent to peripheral autonomic denervation

Our findings suggest that peripheral autonomic denervation ( ETS= peripheral autonomic denervation) is associated with grey matter loss in cortical regions encompassing areas that we have previously shown are functionally involved in generation and representation of bodily states of autonomic arousal. http://www.ncbi.nlm.nih.gov/pubmed/12725766 Neuroimage. 2003 Apr;18(4):908-16. Links Critchley HD, Good CD, Ashburner J, Frackowiak RS, Mathias CJ, Dolan RJ. Wellcome Department of Imaging Neuroscience, Institute of Neurology, UCL, 12 Queen Square, London WC1N 3BG, UK. j.critchley@fil.ion.ucl.ac.uk

Emotion - Autonomic activation - Feedback

Background: Following emotional stimuli, changes in heart rate,
blood pressure and sudomotor activity, which are associated with
changes in regional cerebral activity, feedback to influence the
expression of emotional feelings. In spinal cord injury (SCI), the
efferent generation of sympathetic responses and afferent sensory
feedback of visceral state is impaired, and the integration of bodily
arousal and emotion is altered.


During conditioning-related brain
activity SCI patients, compared to controls, showed attenuation of
subgenual cingulate, ventromedial prefrontal and posterior cingu-
late cortex activity and enhancement of dorsal anterior cingulate,
periaqueductal grey matter and superior temporal gyrus activity.
Conclusion. Our findings suggest impairment in emotion-related
generation of autonomic bodily responses and abnormalities in
brain regions associated with emotional control in patients with
SCI. These early findings warrant further development to support
prevention of emotional dysfunction in SCI.

Clin Auton Res (2007) 17:264–327

Bradycardia likely, compensatory sweating obligatory

Patient?s informed consent should include and define side effects like gustatory sweating, olfactory sweating and bradycardia as likely, and compensatory sweating as obligatory.

Clinical Autonomic Research; Dec2003 Supplement 1, Vol. 13, p0, 1p

Sympathectomy on cerebral and peripheral muscular arteries

Differing influence of sympathectomy on smooth muscle cells and fibroblasts in cerebral and peripheral muscular arteries.

Source:

Autonomic Neuroscience: Basic & Clinical; Jan2006, Vol. 124 Issue 1/2, p38-48, 11p

In contrast to intact FAs, the external layers of sympathectomized FAs revealed migration of fibroblasts from the adventitia and death of SMCs. These results strongly suggest that sympathetic nerves intervene in the cytoskeletal protein remodelling through phenotypic modulation of both SMCs and MFBs during post-natal development, and in pathologies involving similar phenomena, such as atherosclerosis. [Copyright 2006 Elsevier] ( femoral (FA) and basilar (BA) arteries.)

unable to establish the etiology of 'Compensatory Sweating'

Bilateral upper thoracic sympathicolysis is followed by redistribution of body perspiration, with a clear decrease in the zones regulated by mental or emotional stimuli, and an increase in the areas regulated by environmental stimuli, though we are unable to establish the etiology of this redistribution.
Surgical Endoscopy; Nov2007, Vol. 21 Issue 11, p2030-2033, 4p, 2 charts

Impaired chronotropic response to exercise stress testing as a predictor of mortality

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.
Michael S Lauer, Gary S Francis, Peter M Okin, Fredric J Pashkow, et al. JAMA. Chicago:Feb 10, 1999. Vol. 281, Iss. 6, p. 524-9 (6 pp.)

cardiopulmonary function impairment after ETS

This article focuses on a study related to evaluating the cardiopulmonary function impairment after sympathectomy in patients with essential hyperhidrosis. The observed modifications in cardiopulmonary function after bilateral dorsal sympathectomy suggest that there is a slight effect of the intervention on the small airway, as evidenced by the presence of bronchial hyperresponsiveness in half of the studied patients and on a mild reduction in maximal hear rate.

CHEST; Oct2005, Vol. 128 Issue 4, p2702-2705, 4p

disturbances in the sympathetic regulation of the peripheral blood flow

Finger skin blood flow was measured in 80 healthy subjects, using laser Doppler imaging during basal vasodilatation at a local temperature of 40°C. The response to cooling of the contralateral hand at 15°C was studied. A vasoconstriction index was calculated in all subjects and a nomogram was constructed, taking age into consideration. Compared with these normal subjects, four patients operated on with transthoracic endoscopic sympathectomy due to hand hyperhidrosis showed clearly attenuated responses. The results indicate that the test can be used to assess disturbances in the sympathetic regulation of the peripheral blood flow.
Clinical Physiology; Mar1998, Vol. 18 Issue 2, p103-107, 5p

Reduced HRV and baroreflex sensitivity as universally applicable cardiovascular “risk factors”

Murray Esler
Elisabeth Lambert

Reduced HRV and baroreflex sensitivity as universally applicable cardiovascular “risk factors”: waiting for the bubble to burst

Clin Auton Res (2003) 13:170–172

cardiovascular response to different levels of sympathetic blockade varies widely

Individual cardiovascular response to different levels of sympathetic blockade varies widely, depending on the degree of sympathetic tone before the block.

It was suggested that the sympathetic control of heart rate modified the dominating parasympathetic tone, rather than functioning as an active cardiac accelerator. In this study there was no compensation for changes in preload; therefore cardiopulmonary baroreceptors affected by changes in central volume secondary to peripheral vasodilatation or vasoconstriction might have altered arterial baroreceptor heart rate reflex as well. To minimize that influence, Goertz et al gave plasma volume expanders to equalize left ventricular preload conditions as assessed by transesophageal echocardiography". 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. However general anaesthesia, in addition to high levels of epidural anaesthesia, may have modified the balance between sympathetic and parasympathetic tone as well.

B T Veering, M J Cousins. Anaesthesia and Intensive Care. Edgecliff:Dec 2000. Vol. 28, Iss. 6, p. 620-35 (16 pp.)
Copyright Australian Society of Anaesthetists Dec 2000

integration of somatosensory and phasic baroreceptor information at cortical, limbic and brainstem levels

Following one's heart: cardiac rhythms gate central initiation of sympathetic reflexes.

Gray MA, Rylander K, Harrison NA, Wallin BG, Critchley HD.

Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Brighton, East Sussex BN1 9RR, United Kingdom. m.a.gray@bsms.ac.uk

Central nervous processing of environmental stimuli requires integration of sensory information with ongoing autonomic control of cardiovascular function. Rhythmic feedback of cardiac and baroreceptor activity contributes dynamically to homeostatic autonomic control. We examined how the processing of brief somatosensory stimuli is altered across the cardiac cycle to evoke differential changes in bodily state. Using functional magnetic resonance imaging of brain and noninvasive beat-to-beat cardiovascular monitoring, we show that stimuli presented before and during early cardiac systole elicited differential changes in neural activity within amygdala, anterior insula and pons, and engendered different effects on blood pressure. Stimulation delivered during early systole inhibited blood pressure increases. Individual differences in heart rate variability predicted magnitude of differential cardiac timing responses within periaqueductal gray, amygdala and insula. Our findings highlight integration of somatosensory and phasic baroreceptor information at cortical, limbic and brainstem levels, with relevance to mechanisms underlying pain control, hypertension and anxiety.

J Neurosci. 2009 Feb 11;29(6):1817-25.

Fear conditioning dependent on autonomic awareness

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.

Author/s: Critchley, Hugo D (HD); Mathias, Christopher J (CJ); Dolan, Raymond J (RJ);

Affiliation: Department of Imaging Neuroscience, 12 Queen Square, Institute of Neurology and Institute of Cognitive Neuroscience, UCL, WC1N 3BG, London, United Kingdom.

Journal: Neuron (Neuron), published in United States. (Language: eng)

Reference: 2002-Feb; vol 33 (issue 4) : pp 653-63

Changes in cerebral morphology consequent to peripheral autonomic denervation

Our findings suggest that peripheral autonomic denervation (ETS = peripheral autonomic denervation) is associated with grey matter loss in cortical regions encompassing areas that we have previously shown are functionally involved in generation and representation of bodily states of autonomic arousal.

Neuroimage. 2003 Apr;18(4):908-16. Links

Critchley HD, Good CD, Ashburner J, Frackowiak RS, Mathias CJ, Dolan RJ.

Wellcome Department of Imaging Neuroscience, Institute of Neurology, UCL, 12 Queen Square, London WC1N 3BG, UK. j.critchley@fil.ion.ucl.ac.uk