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

Friday, June 26, 2009

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
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