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]