blocks the cardiac sympathetic fibers and consequently decreases heart rate, cardiac output and contractility

The CEA (Cervical Epidural Anaesthesia) blocks the cardiac sympathetic fibers and consequently decreases heart rate, cardiac output and contractility. The mean blood pressure is unchanged or decreased, depending on peripheral systemic vascular resistance changes. The baroreflex activity is also partly impaired. Sympathetic blockade also decreases myocardial ischaemia. The cardiovascular changes induced by CEA are also partly due to the systemic effect of the local anaesthetic. The respiratory effects are minimal and depend on the extent of the blockade and the concentration of the local anaesthetic. A moderate restrictive syndrome occurs. Since the phrenic nerves originate from C3 to C5, ventilation may be impaired by CEA. Extension of the block may also impair intercostal muscle function, with a risk of respiratory failure when a CEA is used in patients with compromised respiratory function. The potential specific complications, mainly cardiovascular and respiratory, are the exacerbation of the effects of CEA. Side effects such as bradycardia, hypotension and acute ventilatory failure in relation to respiratory muscle paralysis, may be observed. Close monitoring of haemodynamics, respiratory rate and level blockade is required.
Ann Fr Anesth Reanim. 1993;12(5):483-92.
PMID: 8311355 [PubMed - indexed for MEDLINE

response varies depending on the degree of sympathetic tone before the block

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

HPA-axis plays a crucial role in the development and intensity of autoimmune diseases

Like in man, in animals the HPA-axis plays a crucial role in the development and intensity of autoimmune diseases. Corticosteroids, in particular, are known to suppress T-cell induced autoimmune reaction in animal models, at the beginning, and are capable to support spontaneous recovery.

EAE derived data support that increased HPA-axis reactivity is accompanied by enlarged capacity to secrete and produce Th-2-cytokines. While decreased HPA-reactivity is accompanied by enlarged capacity to secrete and produce Th-1-cytokines.

Sympathectomy and axanotomy were accompanied by stress-induced increases of EAE immunological responses. Transferred Th1-cells of such sympathectomized animals to healthy animals resulted in increased EAE.
In: Research Focus on Cognitive Disorders ISBN 1-60021-483-5
Editor: Valerie N. Plishe © 2007 Nova Science Publishers, Inc.

sympathectomy might suppress immune functions

It has been found that sympathectomy might influence tumorigenesis. The published data suggests that sympathectomy might suppress immune functions.

Sympathectomy might influence thermogenesis by modulating the activity the activity of the immune system in two ways - by reducing the modulatory influences of catecholamines on immune cells as well as by increasing the secretion of glucocorticoids.
Seminars in Cancer Biology 18 (2008)
Bors Mravec, Yori Gidron, Ivan Hulin

The altered pattern of the response suggests that the nitric oxide-dependent portion may be accelerated in sympathectomized limbs

J Appl Physiol. 2002 Feb;92(2):685-90.

Depression of Endothelial Nitric Oxide Synthase but Increased Expression of Endothelin-1 Immunoreactivity in Rat Thoracic Aortic Endothelium Associated With Long-term, but Not Short-term, Sympathectomy

Circulation Research. 1996;79:317-323

sympathectomy results in an increased collagen content in the vascular wall

From animal experiments, it is known that long-term sympathectomy results in an increased collagen content in
the vascular wall, suggesting a stiffening of the vessel wall (9). Giannattasio et al.

MEDICINE & SCIENCE IN SPORTS & EXERCISE®
Copyright © 2005 by the American College of Sports Medicine
DOI: 10.1249/01.mss.0000174890.13395.e7

adverse effects and complications are not systematically reported

Studies (corresponding to 5,425 patients) classified compensatory hyperhidrosis either as minor (insignificant) or major (quite disabling). 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.

The weighted mean incidence of gustatory sweating after upper extremity surgical sympathectomy was 32.3% (range 0-79)

The weighted mean incidence of phantom sweating was 38.6 % (range 0-59%), with data extracted from 13 papers (that specifically reported the phenomenon) and 1,539 patients.

The weighted mean incidence of neuropathic pain complications was 11.9% (range 0-87%),with data extracted from 37 papers and 1,979 patients.

Given the fact that most of the existing literature is geared towards a) assessing only the effectiveness of the surgical sympathectomy procedures, and b) publishing only studies with positive results, adverse effects and complications are not systematically reported but rather as a secondary outcome. It seems, therefore, highly likely that the complications as reported here, are truly underestimated.

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

A Systematic Literature Review of Late Complications

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

(PhysMed) and Marios Papagapioua Msc

unable to establish the etiology of redistribution

Regarding the incidence of anhidrosis by anatomical location, statistically significant changes were recorded in the head, hands, axillas, and soles ( p < 0.001).
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

migration of adventitial fibroblasts and loss of medial smooth muscle cells

In a previous study, we showed that after sympathectomy, the femoral (FA) but not the basilar (BA) artery from non-pathological rabbits manifests migration of adventitial fibroblasts (FBs) into the media and loss of medial smooth muscle cells (SMCs). The aim of the present study was to verify whether similar behaviour of arteries occurred in the pathological context of atherosclerosis.
Our results show that in the media of FAs hypercholesterolemia induces changes similar to those observed in sympathectomized rabbits in non-pathological conditions, i.e., migration of adventitial FBs to the media and loss of medial SMCs. These latter changes, which can be ascribed to pathological events, were accentuated after sympathectomy in the hypercholesterolemic rabbits. The present study reveals that pathological events, including migration and phenotypic modulation of vascular FBs and loss of SMCs, may be under the influence of sympathetic nerves.
Acta Histochemica; Jul2008, Vol. 110 Issue 4, p302-313, 12p

elevated susceptibility to ventricular fibrillation after sympathectomy

We conclude that chemical sympathectomy downregulates the expression of selective Kv channel subunits and decreases myocardial Ito channel activities, contributing to the elevated susceptibility to ventricular fibrillation.
Canadian Journal of Physiology & Pharmacology; Oct2008, Vol. 86 Issue 10,

Side effect of elective surgery - disastrous proportions

Compensatory hyperhidrosis (CHH) remains an unexplained sequel of this treatment, attaining in a small percentage of cases disastrous proportions.

The search identified 42 techniques of sympathetic ablation. However, pertinent data for the present study were reported for only 23 techniques with multiple publications found only for 10. The only statistically valid results from this review point that T2 resection and R2 transection of the chain (over the second rib) ensue in less CHH than does electrocoagulation of T2. Further comparisons were probably prevented due to the enormous disparity in the reported results, indicating lack of standardization in definitions. The compiled results published so far in the literature do not support the claims that lowering the level of sympathetic ablation, using a method of ablation other than resection, or restricting the extend of sympathetic ablation for primary palmar hyperhidrosis result in less CHH. In the future, standardization of the methods of retrieving and reporting data are necessary to allow such a comparison of data.
World Journal of Surgery; Nov2008, Vol. 32 Issue 11, p2343-2356, 14p

High incidence of nausea and vomiting after sympathectomy

Although complications are rare, patients should be clearly warned that it is not a minor procedure [1,4]. Nevertheless, effective analgesia, radiologie follow-up and strict antiemetic prophylaxis measures are recommended [6].
Because of the high Incidence of nausea and vomiting in our study, we have reconsidered antiemetic prophylaxis in patients at moderate risk (two risk factors). We also recommend strategies for lowering underlying risk such as using total intravenous anaesthesia, keeping opioid use to a minimum and intravenously administering a large volume of preoperative balanced salt solution [6]. We found no reason to explain the high incidence of nausea and vomiting in these patients other than failure to implement these measures. There might have been an effect of starting to drink in the postoperative intensive care area;
however, we could not establish a correlation between start of drinking and the onset of nausea and vomiting.
Thoracic sympathectomy by videothoracoscopy on an outpatient basis can be performed safely if strict control
of pain is established and vomiting and surgical complications are avoided. Nevertheless, the anaesthesiologist
should be alert to the possibility of serious complications associated with this type of surgery.

European Journal of Anaesthesiology 2009, Vol 26 No 4

SNS regulates cerebral blood flow

Thus, in the conscious dog, stimulation of the carotid chemoreceptor reflex elicits significant sympathetically mediated vasoconstriction in cerebral vessels.
Am J Physiol. 1980 Apr;238(4):H594-8.

sympathetic denervation-hypersensitivity and migraine

Regional cerebral blood flow (rCBF) and cerebral vasomotor responses to 5% CO₂ inhalation were measured before and after pharmacologic μ- or β-adrenoceptor manipulation in Migraine (M) and Cluster headaches (C).
There appears to be an asymmetrical adrenoceptor disorder in M and C possibly due to sympathetic denervation-hypersensitivity.

Headache: The Journal of Head and Face Pain

Volume 20 Issue 6, Pages 321 - 335

Published Online: 22 Jun 2005

http://www3.interscience.wiley.com/journal/119584269/abstract

Complications of endoscopic sympathectomy

Alan E. P. Cameron

Abstract

Four cases are presented in which complications occurred during or after thoracic endoscopic sympathectomy (TES). In one patient inappropriate TES resulted in disabling hyperhidrosis. In one patient laceration of the subclavian artery required major surgery. In two cases intraoperative cerebral damage occurred. Training in TES is essential.

European Journal of Surgery

See Also:

• British Journal of Surgery

Volume 164 Issue S1, Pages 33 - 35

Published Online: 2 Dec 2003

Catastrophic complications - tension pneumothorax

Catastrophic complications such as delayed recognition of tension
pneumothorax from left sided CO2 insufflation, leading to fatal and
disabling consequences was reported.

Doolabh N, Horswell S, Williams M, Huber L, Syma Prince S, Meyer
DM, and Mack MJ. Thoracoscopic Sympathectomy for Hyperhi-
drosis: Indications and Results. Ann Thorac Surg 2004; 77: 410 – 414.

medical sects and cults that propagate the Absurd

“...when irrational beliefs are shared with a surrounding community of sympathetic thinkers, errors become institutionalized. Thus are generated medical sects and cults that propagate the Absurd....
The guardians that usually keep the institution of medicine from reeling off into irrationality are social contracts built into medical science and ethical behavior. The academic community guards the contractual borders of science, while laws and regulations encode our ethical system. For the Absurd to have advanced, there must have been some breakdown of these social guardians.”
Propagation of the Absurd: demarcation of the Absurd revisited
Wallace Sampson, MD Editor and Clinical Professor of Medicine, Stanford University
Kimball Atwood IV, MD, Anaesthesiologist; and Assistant Clinical Professor, Tufts University School of Medicine Medical Journal of Australia Dec. 2005

Arthritis exacerbated following sympathectomy

"...capsaicin-eenhanced DRRs are blocked by sympathecotmy. In contrast, arthritis even be exacerbated following sympathectomy. Surgical sympathectomy does exert profound effects on immune system stimulation in the early stages of adjuvant arthritis and may therefore affect disease progression through this action."

Furthermore, the sympathetic nervous system may play a regulatory role in secondary lymphoid organs as it has been shown that selective sympathectomy in secondary lympoid organs exacerbates experimental arthritis.

Neurogenic Inflammation in Health and Disease, Volume 8 (NeuroImmune Biology)  By Gabor Jancso

Morphological and functional studies revealed a complex system of primary sensory neurons which parallels the autonomic nervous system not only in its extent, but probably also in its significance. Neuropeptides released from activated nociceptive afferent nerves play a pivotal role in inflammatory reactions and pain, significantly modulate cardiac, vascular, respiratory, gastrointestinal and immune functions and influence the protective, restorative and trophic functions of somatic and visceral tissues.

Publication Date: 2009-01-01

Publisher: Elsevier Science & Technol

Central Nervous System Activation following Peripheral Chemical Sympathectomy: Implications for Neural–Immune Interactions

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.
Brain, Behavior, and Immunity
Volume 12, Issue 3, September 1998, Pages 230-241

International Society for Sympathetic Surgery founded

Here are the basics of our new classifications:
ESB2 (clamp upper end of T2 only): 2.5%, (in Europe 15%)
Facial blushing, Craniofacial sweating, Some psychic disorders, Rosacea, Vibration disorder (?), Parkinsonism (?)...
ESB3: 2.5%, (in Europe 50%)
Hyperhidrosis Palmaris with Craniofacial sweating, blushing, or any other craniofacial sympathetic disorders
ESB4: 95%, (in Europe 20%)
Hyperhidrosis Palmaris with or without axillary hyperhidrosis (Bromidrosis)
Unilateral ESB: (in Europe 15%)
Social phobia, schizophrenia, sleep disorders, addiction, cardiac arrhythmias

http://www.hyperhidrosis.com/symposium.htm

The 4^th International Symposium on Sympathetic Surgery was held in Finland in June 2001, and was attended by the world’s most renowned ETS surgeons, including its Chairman, Dr. Timo Telaranta. Louis Stein of Surgical Team was there to listen to the experts.

· International Society for Sympathetic Surgery founded
International Society for Sympathetic Surgery was founded during the Symposium. It has a council of five members:

- Dr. Christer Drott from Sweden - The Society’s first Chairman
- Dr. Christoph Schick from Germany
- Dr. Timo Telaranta from Finland
- Dr. Chien-Chih Lin from Taiwan
- Dr. Moshe Hashmonai from Israel

Dr. Alan Cameron from England joined as an English language expert, especially for the revision of the by-laws.

Significant reductions in maximal heart rate (HR) and oxygen and carbon dioxide uptakes were observed

Ten patients had positive bronchial challenge test results that remained positive 3 months after surgery, and 2 patients whose challenge test results were negative before surgery became positive after sympathectomy. Significant reductions in maximal heart rate (HR) and oxygen and carbon dioxide uptakes were observed during the maximal exercise test.
CHEST October 2005 vol. 128 no. 4 2702-2705

Role of sympathoadrenergic mechanisms in arrhythmogenesis

The NA content in the heart was not measured but it is likely to be small at least at the 10-day period. It is known that three days after chemical sympathectomy NA content is only 7% of normal value [6]. Second, the development of adrenoceptor supersensitivity in the transplanted heart was demonstrated clearly with enhanced heart rate responses to NA or propranolol (at Day 10) [1]. As dennervation sensitization increases the arrhythmia susceptibility [6], it is thus possible that, in the presence of receptor supersensitivity, adrenergic activation occurs by either increase in circulating catecholamines and possibly local release of residual NA, which might still have been sufficient to contribute to arrhythmia development.
Role of sympathoadrenergic mechanisms in arrhythmogenesis
Xiao-Jun Du* and Anthony M. Dart
Baker Medical Research Institute, Melbourne, Victoria, Australia
Cardiovascular Research 1999 43(4):832-834;

Surgeons should be aware of adverse effects such as bradycardia

The heart rate and systolic blood pressure decreased significantly after T2-T3 ganglionectomy.

A prolonged QT interval was also recorded (p<> 0.05). The decrease was significant in the sympathectomy group.

Our study also, it was revealed that sympathectomy significantly prolonged the QT interval.

Surgeons should be aware of adverse effects such as bradycardia during thoracic sympathectomy. This study suggested that careful monitoring was required during thoracic sympathectomy and early postoperative period.

Orhan YÜCEL, MD

GATA, Department of

Thoracic Surgery, Ankara,

TÜRKİYE/TURKEY

Sympathetic nervous system regulation of immunity

"suppressor T cells through an immune-privileged site requires an intact sympathetic nervous system."

Journal of Neuroimmunology
Volume 147, Issues 1-2, February 2004, Pages 87-90

Sympathectomy-induced alterations in immunity

These experiments indicate that an inflammatory response is not likely to be responsible for sympathectomy-induced immune alterations, eliminating a potential confounding factor in interpreting sympathectomy studies.
Brain, behavior and immunity ISSN 0889-1591
2002, vol. 16, n^o1, pp. 33-45 [13
CALLAHAN Tracy A. ; MOYNIHAN Jan A. ;

Reduced Heart Rate Variability associated with incresed mortality

These results support an association between CAN (cardiovascular autonomic neuropathy) and increased risk of mortality. The stronger association observed in studies defining CAN by the presence of two or more abnormalities may be due to more severe autonomic dysfunction in these subjects or a higher frequency of other comorbid complications that contributed to their higher mortality risk. Future studies should evaluate whether early identification of subjects with CAN can lead to a reduction in mortality.

1. Raelene E. Maser, PHD1,
2. Braxton D. Mitchell, PHD2,
3. Aaron I. Vinik, MD, PHD3 and
4. Roy Freeman, MD4

Sympathectomy also results in reduced heart rate variability

"Cardiovascular autonomic neuropathy (CAN) is the most prominent focus because of the life-threatening consequences and the availability of direct tests of cardiovascular autonomic function.. .CAN results from damage due to the autonomic nerve fibers that innervate the heart and blood vessels and results in abnormalities in heart rate control and vascular dynamics. Reduced heart variation is the earliest indicator of CAN."

"CAN is the most studied and clinically important form of DAN. Meta-analyses of published data demonstrate that reduced cardiovascular autonomic function as measured by heart rate variability (HRV) is strongly associated with an increased risk of silent myocardial ischemia and mortality. The determination of the presence of CAN is usually based on a battery of autonomic function tests..."

TECHNICAL REVIEW: Standard of Care - Diabetic Autonomic Neuropathy

Aaron I. Vinik, MD, PHD; Braxton D. Mitchell, PHD
Raelene E. Maser, PHD; Roy Freeman, MD

Skin denervation

Epidermal nerve fiber densities were significantly reduced in the skin of all patients, consistent with concomitant small-fiber neuropathies. Perivascular infiltration by T cells and macrophages was demonstrated by immunohistochemistry. All patients experienced neurologic improvement in muscle strength and alleviation of sensory symptoms after immunotherapy with corticosteroids, plasma exchange, or cyclophosphamide. Conclusions: Small-diameter sensory nerves are affected in vasculitis in addition to the well-known effect of vasculitis on large-diameter nerves. Significant inflammatory vasculopathy is present in the skin despite the absence of clinically active vasculitic lesions.
Archives of neurology ISSN 0003-9942 CODEN ARNEAS
2005, vol. 62, n^o10, pp. 1570-1573 [4 page(s) (article)] (24 ref.)

sympathetic vascular innervation in sympathectomized patients

We measured arterial and venous plasma catecholamines and used laser-Doppler flowmetry to measure cutaneous microcirculatory flow in the sympathectomized and in the intact limbs of 3 patients who had undergone regional sympathectomies. Venous concentrations of norepinephrine, the sympathetic neurotransmitter, exceeded arterial concentrations in the intact limbs--a normal finding--but invariably were less than arterial in the sympathectomized limbs of the same patients, both during baseline conditions and during sympathetic stimulation using tilt, standing and the cold pressor test (mean arteriovenous decrement about 40%). Arterial epinephrine levels exceeded venous levels with or without sympathectomy. Skin microvascular flow rapidly decreased during the cold pressor test and the Valsalva maneuver in the intact but not in the sympathectomized limbs, and spontaneous flow oscillations occurred in the sympathectomized limbs. The results suggest that an arteriovenous increment in plasma norepinephrine reflects local release of norepinephrine from sympathetic nerve endings, whereas removal of circulating catecholamines can occur with or without sympathetic neural impulses. Laser-Doppler flowmetry can measure reflexive sympathetically mediated responses of skin microvascular flow and so can detect sympathetic denervation.
PMID: 3517118 [PubMed - indexed for MEDLINE

Impaired skin vasomotor reflexes

Not surprisingly, diminished vasoconstrictor responses, similar to the current findings, have been found
in patients with sympathetic dystrophies [26], dysautomias [27], post-regional sympathectomy [28] and
diabetic neuropathies [11].


Additionally, there have been a few reports of EM patients benefitting from sympathectomy or neurolitic
irreversible blocks of the lumbar sympathetic ganglia [22,23], while others have found the symptoms of EM to
be aggravated by such treatment [24,25], possibly as a result of denervation supersensitivity.
Clinical Science (1999) 96, 507ñ512 (Printed in Great Britain)
Roberta C. LITTLEFORD, Faisel KHAN and Jill J. F. BELCH
University Department of Medicine, Section of Vascular Medicine and Biology, Ninewells Hospital and Medical School,
Dundee DD1 9SY, Scotland, U.K.

Peripheral Nervous System Disease

Combined with loss of active vasodilation, anhidrosis places tetraplegic patients at risk for hyperthermia.

Peripheral Nervous System Disease

With normal aging, thermoregulatory sweat output declines due to peripheral neural and eccrine glandular factors, which vary in degree depending on genetic predisposition and level of physical conditioning.^[75] Extensive anhidrosis may also accompany disease of the peripheral nervous system. When exposed to an elevated ambient temperature or physical exercise, these individuals may present with symptoms of heat intolerance, dizziness, weakness, flushing, dyspnea, or palpitations and may be at risk for heat exhaustion and hyperthermia.

Peripheral Neuropathy

Distal anhidrosis, although often subclinical, is detectable by clinical sudomotor testing in many patients with peripheral neuropathy.^[76,77] Diabetes mellitus, the most common cause of autonomic neuropathy in the developed world, typically impairs thermoregulatory sweating in a stocking and glove distribution.^[78] As the neuropathy progresses, asymmetric truncal anhidrosis or global anhidrosis may develop.^[76]

Some immune-mediated neuropathies selectively target the autonomic neuron. Autoimmune autonomic neuropathy typically presents with sicca complex, anhidrosis, gastrointestinal hypomotility, orthostatic hypotension, abnormal pupillary light reflexes, and neurogenic bladder that may be subacute or insidious in onset. Autoantibodies to the ganglionic acetylcholine receptor have been demonstrated in these patients.^[29,79,80] Subacute autonomic neuropathy may signal an occult malignancy, most commonly small cell lung carcinoma. The dysautonomia in paraneoplastic autonomic neuropathy can be manifested mainly by cholinergic failure presenting as gastrointestinal dysfunction and anhidrosis.

Hypohidrosis commonly occurs in the autonomic neuropathy associated with Sjögren's syndrome.^[83,84] Hypohidrosis also accompanies neuropathies due to amyloidosis, alcoholism, Tangier disease, vasculitis, and Fabry's disease.^[85] Focal areas of hypohidrosis may be found in patients with leprosy.^[86]

Anhidrosis is a prominent feature of hereditary sensory and autonomic neuropathies type IV and V (congenital insensitivity to pain with anhidrosis), in which absent skin innervation is associated with mutations of the NTRK1 gene encoding the neurotrophic tyrosine kinase receptor type 1.^[30]

^{http://www.medscape.com/viewarticle/473206_3}

Link between skin innervation and neuropathic pain

Nerve conduction studies for large-diameter motor and sensory nerves were normal. This report documents a pure small-fibre sensory neuropathy after prolonged use of linezolid, and the relationship between skin innervation and corresponding neuropathic pain.

Journal of Neurology, Neurosurgery, and Psychiatry 2008;79:97-99

Some patients demonstrate unexpected responses

The indications for neurolytic or surgical sympathectomy are uncertain. There is no clear correlation between the degree or duration of pain relief and the actual period of sympathetic blockade and the same patient may show variable responses on different occasionsv (Loh et al 1980). Some patients demonstrate unexpected responses such as contralateral or delayed blocks and some are made worse (Purcell-Jones &Justins 1988, Evans et al 1980, Kleiman 1954)

Neurological Rehabilitation

by R. Greenwood
"All neurological diseases can cause short- and long-term disability..."

• Publisher: Psychology Press; New edition edition (February 1, 1997)
• Language: English
• ISBN-10: 0863774849

Nerve 'injury' and consequences well observed in animals

Ligation injury of the L5/L6 nerve roots in rats produces behavioral signs representative of clinical conditions of neuropathic pain, including tactile allodynia and thermal and mechanical hyperalgesia.

Anesthesiology:

January 1997 - Volume 86 - Issue 1 - pp 196-204

Laboratory Investigation

the ablated segment becomes hypersensitive to acetylcholine

The injured tissue distal to the ablated segment becomes hypersensitive to acetylcholine. This can explain why CH may appear very early after sympathectomy.

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.

CONCLUSION: Transthoracic endoscopic sympathectomy is an effective and simple modality to treat palmar hyperhidrosis. However, all patients need to be warned of the common complications, particularly compensatory hyperhidrosis, before surgery.

by MC Kao - 1998

Neurosurgery:

July 1997 - Volume 41 - Issue 1 - pp 110-115

sympathectomy abolished the Psychogalvanic Reflex

Some P.G.R. studies in a female subject who had bilateral cervical sympathectomy were described. It was found that sympathectomy abolished P.G.R. and that intra-arterial infusion of acetylcholine evoked marked P.G.R. changes in the sympathectomized limb. These findings support the theory that the P.G.R. is mediated through the cholinergic fibres of the sympathetic nervous system.

Submitted on May 22, 1967
The British Journal of Psychiatry (1968) 114: 639-642. doi: 10.1192/bjp.114.510.639
© 1968 The Royal College of Psychiatrists

Sympathetic Innervation of Cerebral Arteries: Prejunctional Supersensitivity to Norepinephrine After Sympathectomy

© 1975 American Heart Association, Inc.

Cold Hypersensitivity after Sympathectomy for Raynaud's Disease

Scandinavian Cardiovascular Journal, Volume 14, Issue 1 1980 , pages 109 - 111

augmented cholinergic preponderance in cardiac dynamics

In the majority of 16 non-cardiac and in two angina pectoris patients, unilateral
or bilateral endoscopic transthoracic sympathectomy (method of Kux) was followed
by signs of augmented cholinergic preponderance in cardiac dynamics (especially
prolongation of the Isometric period of the left ventricle).

The findings obtained in 16 non-cardiac patients concerning the length
of the isometric or tension period (TP), heart rate and pulse pressure
are represented in Table 1.
In response to transthoracic sympathectomy, all three parameters
varied from person to person in wide ranges in both directions. However,
when the tests were repeated in the same patients at different time inter-
vals after the operation (with or without a second contralateral syrn-
pathectomy inbetween), their qualitative pattern of response (either
upward or downward) remained the same in nearly all instances, as
far as the TP and pulse pressure were concerned. The responses of the
heart rate, on the other hand, were less striking percentage-wise and
varied in quite an irregular fashion in identical individuals.
No significant relationship existed between the magnitude of the pre-
operative average values and the type (positive or negative) or degree
of the postoperative deviations in either one of the three recorded pa-
rameters.

DOI 10.1378/chest.38.4.423
1960;38;423-428
Dis Chest
W. RAAB, E. KUX and H. MARCHET
Effect of Transthoracic Endoscopic Sympathectomy
on the Cardiac Neurovegetative Equilibrium
and on Angina Pectoris

not found any improvement in ulcer healing with sympathectomy

We have not found any improvement in ulcer healing with sympathectomy as compared with local wound care and have not performed upper extremity sympathectomy for upper extremity ischemia in over a decade.

Noninvasive Vascular Diagnosis:

A Practical Guide to Therapy

By Ali F. AbuRahma, John J. Bergan
2nd ed., 2007
ISBN: 978-1-84628-446-5

sympathectomy severs both vasomotor and sensory fibres

CUTANEOUS INNERVATION IN MAN BEFORE AND AFTER LUMBAR SYMPATHECTOMY: EVIDENCE FOR INTERRUPTION OF BOTH SENSORY AND VASOMOTOR NERVE FIBRES.
ANZ Journal of Surgery. 73(1-2):14-18, January 2003.
COVENTRY, BRENDON J. BM BS, PhD, FRACS *; WALSH, JOHN A. MD, FRACS +

INFLUENCES OF SHORT-TERM SYMPATHECTOMY ON THE COMPOSITION OF PROTEINS

The protein constituents in parasympathetically evoked saliva from normal and short-term sympathectomized parotid glands were compared. There was a reduction in all proline-rich proteins (PRP) in the saliva following sympathectomy. The decrease was quantified for acidic PRP by high-performance ion-exchange chromatography, which showed an increase in the ratio of amylase to other proteins. These results suggest that sympathetic impulses influence the synthesis of PRP and amylase in opposite directions.
http://ep.physoc.org/content/73/1/139.abstract

Enhanced vascular reactivity

In conclusion, we showed that sympathectomy produces complex alterations of vascular reactivity both in vivo and in isolated vessels, which shift the balance of the sensitivity of the vessel between vasoconstrictor and vasodilating agents towards an increased constriction. These results are unlikely to simply reflect denervation supersensitivity; their underlying receptor, post-receptor and/or contractile mechanisms are yet to be identified.

Journal of Hypertension:

August 2000 - Volume 18 - Issue 8 - p 1041-1049

An adrenergic sensitivity in nociceptive afferents might contribute to pain and hyperalgesia

Normal inhibitory influences on pain during sympathetic arousal are compromised in the majority of patients with CRPS. The augmented vasoconstrictor response in the symptomatic limb during sympathetic arousal is consistent with adrenergic supersensitivity. An adrenergic sensitivity in nociceptive afferents might contribute to pain and hyperalgesia during sympathetic arousal in certain patients with CRPS.

Drummond PD, Finch PM, Skipworth S, Blockey P.

School of Psychology, Murdoch University, Perth, Western Australia. drummond@central.murdoch.edu.au

PMID: 11591852 [PubMed - indexed for MEDLINE

Persistence of pain induced by startle and forehead cooling after sympathetic blockade

J Neurol Neurosurg Psychiatry. 2004 Jan;75(1):98-102.

These findings suggest that stimuli arousing sympathetic activity act by a central process to exacerbate pain in some patients, independent of the peripheral sympathetic nervous system. This may account for the lack of effect of peripheral sympathetic blockade on pain in some CRPS patients.

Drummond PD, Finch PM. School of Psychology, Murdoch University, Perth, Western Australia,
PMID: 14707316 [PubMed - indexed for MEDLINE

enhanced hyperalgesic response following sympathectomy

We report on the ability of a delayed sympathectomy after a prolonged hyperalgesia to result in a subsequent enhanced hyperalgesic response. Sympathectomy was performed one day after injection of prostaglandin E₂ plus rolipram, which induces a prolonged sympathetically-maintained hyperalgesia [Aley K. O. and Levine J. D. (1995) Eur. J. Pharmac. 273, 107-112].
http://cat.inist.fr/?aModele=afficheN&cpsidt=3017786

Sympathectomy mimicks SART stress-induced hyperalgesia

Frontiers in Bioscience 11, 2179-2192, September 1, 2006

Joint inflammation is reduced by dorsal rhizotomy and not by sympathectomy

Joint inflammation is reduced by dorsal rhizotomy and not by sympathectomy or spinal cord transection.

Annals of the Rheumatic Diseases 1994;53:309-314
http://ard.bmj.com/cgi/content/abstract/53/5/309

Sympathectomy alters bone architecture

Journal of Cellular Biochemistry

Volume 104 Issue 6, Pages 2155 - 2164

Allostasis - a state of imbalance responsible for Autoimmune disorders

In general, enhancing the sympathetic tone decreases both T0-cell and NK cell functions but not the proliferation of splenic B cells (Dowdell and Whitacre, 2000). In contrast, chemical sympathectomy, although having varying results, does seem to increase the severity of autoimmune disorders (Dowdell and Whitacre, 2000)
As far as metabolism, catecholamines promote mobilization of fuel stores at time of stress and act synergistically with glucocorticoids to increased glycogenolysis, gluconeogenesis, and lipolysis but exert opposing effects of protein catabolism, as noted earlier. One important aspect is regulation of body temperature (Goldsttein and Eisenhofer, 2000) Epinephrine levels are also positively related to serum levels of HDL cholesterol and negatively related to triglycerines. However, perturbing the balance of activity of various mediators or metabolism and body weight regulation can lead to well-known metabolic disorders such as type 2 diabetes and obesity.

At the same time, increased sympathetic activitation and nerephinephrine release is elevated in hypertensive individuals and also higher levels of insulin, and there are indications that insulin further increases sympathetic activity in a vicious cycle (Arauz-Pacheco et al.,1996)

As a result of either local production, cytokines often enter the the circultion and can be detected in plasma samples. Sleep deprivation and psychological stress, such as public speaking, are reported to elevate inflammatory cytokine level in blood (Altemus et al., 2001) Circulting levels of a number of inflammatory cytokines are elevated in relation to viral and other infections and contirbute to the feeling of being sick, as well as sleepiness, wiht both direct and indirect effects on the central nervous system (Arkins et al., 2000; Obal and Kueger, 2000)

Inflammatory autoimmune diseases, such as multiple sclerosis, rheumatoid arthritis, and type 1 diabetes, reflect an allostatic state that consists of at least three principal causes: genetic risk factors, (...) factors that contribute to the development of tolerance of self-antigens (...) and the hormonal mikieu that regulates adaptive immunes responses (Dowdell and Whitacre, 2000)

Allostasis, homeostasis and the costs of physiological adaptation

By Jay Schulkin
Cambridge University Press, 2004

Allostasis is the process of achieving stability, or homeostasis, through physiological or behavioral change. This can be carried out by means of alteration in HPA axis hormones, the autonomic nervous system, cytokines, or a number of other systems, and is generally adaptive in the short term ^[1]