the most pronounced feature is a mental change

In every case of bilateral cervical or upper dorsal sympathectomy that I have performed the most pronounced feature is a mental change in the patient from one of worry and apprehension to that of tranquillity and a sense of well-being.

Sympathectomy in Relation to Meniere's Disease, Nerve Deafness
and Tinnitus. A Report on 110 Cases
By E. R. GARNETT PASSE, F.R.C.S., F.A.C.S.

Acta Oto-laryngologica

1952, Vol. 42, No. 1-2, Pages 133-151

82.9% Were Disturbed Because CS Was More Than Expected

However, compensatory sweating (CS) developed in 97.1% of the patients, and 82.9% answered that they were disturbed because it was more than they had expected. This result makes us realize further the importance of preoperative informed consent for CS. The problem of palmar hyperhidrosis is very serious for patients, and hence it is important to give treatment with a thorough understanding of the effectiveness and problems of ETS for palmar hyperhidrosis according to the analytical results of this questionnaire.
http://ci.nii.ac.jp/naid/110006980508/en

Ultrastructural Changes in the Nerves Innervating the Cerebral Artery after Sympathectomy

TAKASHI IWAYAMA
Z. Zellforsch. 109, 465--480 (1970) 9 by Springer-Verlag 1970

An Ultrastructural Study - effects of Preganglionic Sympathectomy

The ultrastructure of satellite cells of the rat superior cervical ganglion was studied following preganglionic sympathectomy. Several distinct morphological alterations were observed: (a) enlargement of the intercellular space between the ganglion cells and the satellite cells, (b) dilation of the granular endoplasmic reticulum and loss of attached ribosomes, and (c) swelling of the mitochondria with disorganization of the cristae mitochondriales. The presence of degenerating nerve fibers and synaptic boutons was also noted.

Journal of Neural Transmission 38, 43--57 (1976)

Results of elective procedure can be "devastating"

Surgery ofthe sympathetic system is performed for a variety ofindications,hyperhidrosis being a major one. Despite excellent results, sympathectomy for hyperhidrosis bears a number of sequels, some of which may be devastating. 

Clin Auton Res (2003) 13 [Suppl 1]:I/83–I/88

lesser (sic!) imbalance of the autonomic nervous system

Ramicotomy is a surgical procedure, with less adverse effects than conventional sympathectomy, however, it was abandoned due to the high recurrence rate. 

With the purpose of using a less aggressive surgical approach and lesser imbalance of the autonomic nervous system, the ramicotomy was proposed. 

Ramicotomy allows complete section of all rami communicantes of the sympathetic ganglia. The histological regeneration might be greater than the recurrence rates of clinical symptoms seen in a human being due to non-functional regenerations. 

Interact CardioVasc Thorac Surg 2009;9:411-415.

increased blood supply is associated with decreased vascular permeability

The influence of the sympathetic nervous system on capillary permeability was studied in cats. The dye penetration from the blood through the synovial membrane was tested by perfusing the two knee joints, one of which was deprived of its sympathetic nerve supply by unilateral lumbosacral
sympathectomy.
In confirmation of previous experiments, it was found in a great majority of experiments that, in spite of marked vasodilatation, the dye excretion was considerably reduced on the sympathectomised side.
A permeability factor under the influence of the sympathetic nervous system has been postulated; its character and mechanism is still unknown.
Further unpublished experiments seem to support the view that increased blood supply is associated with decreased vascular permeability.
Res Exp Med (Berl) 173, 1--8 (1978)

lead to hyperfunction of the serotoninergic system and pathology

We studied the balance of activity of sympathetic, parasympathetic, and serotoninergic divisions of the autonomic nervous system in the regulation of the heart function in rabbits. High activities of the sympathetic and parasympathetic system are associated with antagonistic interactions between them. Moderation of activity of these systems could be accompanied by activation of the serotoninergic system. Physiological sympathectomy and parasympathectomy lead to hyperfunction of the serotoninergic system and pathology.

Bulletin of Experimental Biology and Medicine, Vol. 140, No. 5, 2005 PHYSIOLOGY

In all cases wrinkling was abolished after interruption of the hand sympathetic innervation

In the study, the effect ofcervical sympathectomy on water immersion wrinkling was examined in 12 patients treated for palmar hyperhidrosis.

In all cases wrinkling was abolished after interruption of the hand sympathetic innervation. A separate study in patients with diabetic neuropathy noted that reduced or absent water immersion wrinkling was linked to autonomic dysfunction as indicated by diarrhea and orthostatic hypotension [3]. Two clinical studies on patients with leprosy further strengthened deficient water immersion wrinkling as an indicator ofperipheral sympathetic nerve damage [14,18]. Interestingly, central nervous system sympathetic dysfunction has also been shown to affect finger wrinkling.In a study of patients with unilateral Parkinsonism, wrinkling was significantly reduced on the side not affected by motor signs.
Clin Auton Res (2004) 14:125–131

Autonomic neuropathy simulating the effects of sympathectomy

Autonomic neuropathy simulating the effects of sympathectomy as a complication of diabetes mellitus. Diabetes 1955;4:92-97. 112.

Sympathectomy = autonomic neuropathy

A number of papers have been published which
stressed [22-24] the high failure rate of sympathecto-
my operations in diabetics. We believe that the failure
of the operation is due to the fact that diabetic auto-
nomic neuropathy has already sympathectomized the
patient. The results of the present study are compati-
ble with this idea. It is also of interest that the histolog-
ical abnormalities found in the present study are simi-
lar to those described in the bladder [15], in the corpo-
ra cavernosa [16] and in the myocardium [17], all of
which are typical sites of diabetic autonomic neuro-
pathy. Thus, autonomic neuropathy is a very com-
mon feature in diabetes and an important back-
ground to the development of other complications.
For example, although the chronic dryness of the skin
is rarely troublesome for the patient, it may lead to
skin shrinkage and cracking which may, in turn, pre-
dispose to infection.

Diabetologia, Volume 22, Number 2 / February, 1982

severe compensatory sweating was experienced in 90% of patients

Postsurgery, severe compensatory sweating was experienced in 90% of patients (P < 0.0001). The sites of compensatory sweating were the back (75%), abdomen (51%), feet (23%), groin and thigh (13%), chest (13%), and axillae (8%). Transient whole-body sweating for no apparent reason was experienced in 30% of patients. Thirty-seven patients (11%) regretted having undergone the surgical procedure.

Main outcome measures included the incidence of dry hands, compensatory sweating, chest pain, upper-limb muscle weakness, shortness of breath, and gustatory phenomena;

Surg Laparosc Endosc Percutan Tech. 2000 Aug;10(4):226-9.
http://www.ncbi.nlm.nih.gov/pubmed/10961751

Pulmonary Functional Abnormalities after Upper Dorsal Sympathectomy

Results of pulmonary function studies were compared in two groups of 12 patients each, in whom upper dorsal sympathectomy was performed by the supraclavicular or by the fransaxillary approach. Patients were evaluated clinically, radiologically and functionally before operation and again three weeks, three months and six months after denervation. Findings suggest that an increase in small airway resistance concomitant with some degree of paeumoconstricfion occurred after upper dorsal sympathectomy by both routes. Muscular transection and possible phrenic nerve retraction dam-
age due to the operative procedure could not be the cause of the above abnormalities because the Iuspiratory and expiratory forces, inspiratory peak flow and diaphragmatic movement were not significantly reduced after operation by both approaches. (Adar)
1980;77;651-655 Chest

Gustatory Phenomena After Upper Dorsal Sympathectomy

In a series of 100 bilateral upper dorsal sympathectomies performed for palmar hyperhidrosis, gustatory sweating and other gustatory phenomena were reported by 68 of 93 patients (73%), followed up for an average of 11/2 years. These gustatory phenomena were quite different from physiologic gustatory sweating: a wide range of gustatory stimuli caused a variety of phenomena in varied locations. There was a negative correlation between the incidence of these phenomena and the occurrence of Horner's syndrome after sympathectomy. Analysis of our observations, and of clinical and experimental work of others, leads to the conclusion that gustatory phenomena after upper dorsal sympathectomy are the result of preganglionic sympathetic regeneration or collateral sprouting with aberrant synapses in the superior cervical ganglion. (Adar)

Arch Neurol. 1977;34(10):619-623.

The effect of cervical sympathectomy on retinal vessel responses to systemic autonomic stimulation

The retinal vessel calibre responses to systemic sympathetic stimulation, were studied in nine patients (eight male; mean age: 31.7 years; range: 19-58 years) with unilateral disruption of their cervical sympathetic tract. All patients had ipsilateral decreased/absent facial sweating and a Horners syndrome, evidence of unilateral sympathetic denervation. Both eyes of each patient were studied and the results were analysed in two groups: the group of nine sympathectomised eyes and the control group of unaffected fellow eyes. During handgrip contraction there was a significant difference in the mean retinal arteriolar constriction (mean +/- SEM) between the group of sympathectomised eyes (4.6 +/- 0.89%) and control eyes (7.1 +/- 1.13%), p less than 0.01. Similarly, there was a significant difference in mean venule constriction during sustained handgrip contraction between the group of sympathectomised eyes (1.5 +/- 0.67%) and control eyes (4.9 +/- 0.98%), p less than 0.05.

Eye (Lond). 1990;4 ( Pt 1):181-9.

PMID: 2323469 [PubMed - indexed for MEDLINE]

Neuromodulation Of Cerebral Blood Flow

After the demonstration that spinal cord stimulation (SCS) can improve peripheral blood flow, Hosobuchi in 1986 first studied the effect of SCS on cerebral blood flow (CBF) in human beings. The group found that SCS could produce either an increase of CBF, a reduction, or no effect at all. A reduction of CBF is very rare and occurs when electrodes are place in a more caudal location, while cervical stimulation produces, more frequently, an increase in CBF (61% of cervical stimulations). The effect of SCS on CBF in rabbits suggests that a reversible functional sympathectomy occurs during SCS.
Neuromodulation; Jul2003, Vol. 6 Issue 3, p192-192, 1p

Visocchi, Massimiliano¹
Meglio, Mario¹

Complications of sympathectomy

The excision of axillary sweat glands can cause unsightly scarring and transthoracic sympathectomy (either open or endoscopic) can be associated with complications of compensatory and gustatory hyperhidrosis, Horner syndrome and neuralgia, some of which patients may find worse than the condition itself.
American Journal of Clinical Dermatology; 2003, Vol. 4 Issue 10, p681-697, 17p

Effect of sympathetic denervation on the rate of protein synthesis in rat skeletal muscle

Soleus isolated after 2 and 4 days of chemical sympathectomy or after 3 days of lumbar denervation showed a 17–20% statistically significant decrease in in vitro rates of protein synthesis.
American Journal of Physiology: Endocrinology & Metabolism; Apr2004, Vol. 49 Issue 4, pE642-E647, 6p

sweat response often to emotional stimuli in body regions influenced by the anterior cingulate cortex

A common link among these disorders is an excessive, nonthermoregulatory sweat response often to emotional stimuli in body regions influenced by the anterior cingulate cortex as opposed to the thermoregulatory sweat response regulated by the preoptic-anterior hypothalamus.
Mayo Clinic Proceedings; May2005, Vol. 80 Issue 5, p657-666, 10p

Eisenach, John H.¹ eisenach.john@mayo.edu
Atkinson, John L. D.²
Fealey, Robert D.³

Immunoglobulin producing cells in the rat dental pulp after unilateral sympathectomy.

Sympathectomy results in recruitment of cells expressing κ and λ light chains into the dental pulp (P=0.005). Electron microscopy revealed these cells to be mainly plasma cells and Mott cells. We conclude that neural imbalance caused by unilateral sympathectomy recruits immunoglobulin producing cells in the dental pulp. Our results are in agreement with a model of immune regulation in which the sympathetic nervous system exerts a tonic regulatory effect over lymphocyte proliferation and migration. [Copyright &y& Elsevier]
Neuroscience; Jan2006, Vol. 136 Issue 2, p571-577, 7p

Haug, S.R. sivakami.rethnam@biomed.uib.no
Heyeraas, K.J.¹

Severe Bronchospasm Following Bilateral T2-T5 Sympathectomy

We describe a case report of a 32-year-old woman who suffered severe bronchospasm following a bilateral T2-T5 video assisted thoracoscopic sympathetic ganglion ablation. The patient required overnight sedation, mechanical ventilation, nebulized albuterol and a prednisone taper prior to extubation. The combination of the patient's asthma, and the bilateral sympathectomy, enhanced the risk and severity of this complication. A heightened awareness for bronchospasm should be considered when planning surgical therapy and anesthesia in patients being treated for hyperhydrosis, and special consideration be given to the risk benefit ratio of performing bilateral versus staged surgery in patients with reactive airway disease.
Internet Journal of Anesthesiology, 1092406X, 2007, Vol. 12, Issue 2

Anti-inflammatory role of sympathetic nerves in chronic intestinal inflammation

Sympathectomy reduced acute DSS colitis but increased chronic DSS colitis. Sympathectomy also increased chronic colitis in II10^-/- mice. Conclusions: This study demonstrated a loss of sympathetic and an increase of SP⁺ nerve fibres in Crohn's disease. SEMA3C, a sympathetic nerve repellent factor, is highly expressed in the epithelium of Crohn's disease patients. In chronic experimental colitis, the sympathetic nervous system confers an anti-inflammatory influence. Thus, the loss of sympathetic nerve fibres in the chronic phase of the disease is most probably a pro-inflammatory signal, which might be related to repulsion of these fibres by SEMA3C and other repellents.
Straub, R. H.¹ rainer.straub@klinik.uni-regensburg.de
Gut; Jul2008, Vol. 57 Issue 7, p911-921,

Similar pathological effects of sympathectomy and hypercholesterolemia on arterial smooth muscle cells and fibroblasts

Summary: 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. Thus, similar experiments were conducted on hypercholesterolemic rabbits, which were chemically sympathectomized with 6-hydroxydopamine (n=4) or treated with vehicle for control (n=5).

Both intact and sympathectomized BA and FA developed atherosclerotic plaques, but the thickening of the intima was more advanced in sympathectomized animals, as judged by increased plaque frequency and by the phenotypic modulation of SMCs in the intima. 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

Kacem, K.¹ kamel.kacem@fsb.rnu.tn
Sercombe, R.² r.sercombe@orange.fr

About 40% of ETS2 groups and 25% of ETS3 group patients were unsatisfied with their operation.

(Surgery 2008;143:784-9.)

Thoracoscopic Sympathectomy at the T2 or T3 Level Facilitates Bradykinin-Induced Protein Extravasation in Human Forearm Skin

The endogenous peptide bradykinin (BK) is an inflammatory mediator that induces nociceptor activation and sensitization as well as protein extravasation and vasodilation.

Conclusions. Forearm skin perfusion is increased after ETSC on the T2 or T3 level indicating decreased sympathetic activity while BK-induced protein extravasation was increased. These results show that preganglionic sympathectomy does not diminish bradykinin-induced protein extravasation as found for postganglionic sympathectomy in rats.
Stefan Leis, MD,*^† Nicola Meyer, MD, ^† Andreas Bickel, MD, ^† Christoph H. Schick, MD, ^‡§ Sophie Krüger, MD, ^§ Martin Schmelz, MD, ^¶ and Frank Birklein, MD**

Pain Medicine

Published Online: 1 Mar 2010

© 2010 American Academy of Pain Medicine