Sympathectomy significantly increases gene and protein expression of iNOS, as well as levels of PGE2 and protein expression of PGE2-EP2 receptor subtype. Isoproterenol treatment for 6 h to human retinal endothelial cells grown in high glucose medium reduced iNOS protein expression, but had no effect on PGE2 levels or PGE2 receptor protein expression. iNOS expression was attenutated by stimulation with xamoterol, while BRL37344 had no effect, suggesting that the iNOS effects are mediated by beta1-adrenergic receptors. These results suggest that loss of sympathetic activity, as occurs in diabetes, results in an upregulation of iNOS and PGE2-EP2 receptor protein expression, as well as PGE2 levels. Isoproterenol stimulation of human retinal endothelial cells cultured in a hyperglycemic environment decreased iNOS expression with no change in PGE2 levels, suggesting that only iNOS expression is modulated by sympathetic neurotransmission in endothelial cells. Overall, these results further the idea that alterations in sympathetic neurotransmission may result in many of the changes noted in the retina of the STZ-treated rat.
http://www.ncbi.nlm.nih.gov/pubmed/17067575
Thursday, March 31, 2011
Sympathectomy leading to anextracranial steal phenomenon
J Igloffstein and R Laas
J Neurol Neurosurg Psychiatry. 1983 August; 46(8): 768–773.
Unilateral cerebral infarcts were produced in the rat by ligation of one common carotid artery and subsequent exposure to carbon monoxide. The incidence and extension of brain infarcts was increased in animals with additional ipsilateral cervical preganglionic sympathectomy.Sympathectomy did not affect markedly the respiration and systemic circulation. The effect of sympathectomy was attributed to a cutaneous vasodilation, leading to anextracranial steal phenomenon
J Neurol Neurosurg Psychiatry. 1983 August; 46(8): 768–773.
Unilateral cerebral infarcts were produced in the rat by ligation of one common carotid artery and subsequent exposure to carbon monoxide. The incidence and extension of brain infarcts was increased in animals with additional ipsilateral cervical preganglionic sympathectomy.Sympathectomy did not affect markedly the respiration and systemic circulation. The effect of sympathectomy was attributed to a cutaneous vasodilation, leading to anextracranial steal phenomenon
Wednesday, March 30, 2011
CERVICAL SYMPATHECTOMY AND CEREBROSPINAL FLUID PRESSURE: THEIR RELATIONSHIP TO BRAIN METABOLISM
http://www.ncbi.nlm.nih.gov/pubmed/14247422
Factors Affecting Cerebral BloodFlow- Experimental Review:
Effects of increased cerebrospinal fluid pressure on the blood flow and on the energy metabolism of the brain. An experimental study.
Factors Affecting Cerebral BloodFlow- Experimental Review:
Sympathectomy, Hypothermia, CO2 Inhalation andPavarine
The cerebral spinal fluid pressure increased significantly (86.86to 117.34) immediately after operation but returned to normalwithin 2 weeks.
Ann Surg. 1966 May;163(5):771-7.
PMID: 5930460 [PubMed - indexed for MEDLINE]PMCID: PMC1477179
Effects of increased cerebrospinal fluid pressure on the blood flow and on the energy metabolism of the brain. An experimental study.
PMID: 4316893 [PubMed - indexed for MEDLINE]
The effect of carotid ligation and cervical sympathectomy in guinea-pigs on the ascorbic acid content of the aqueous humour at varying plasma levels
http://www.ncbi.nlm.nih.gov/pubmed/12985402
Surgical Denervation of Ocular Sympathetic Afferents Decreases Local Transforming Growth Factor-β and Abolishes Immune Privilege
Mounting evidence points to a role for the sympathetic nervous system in suppressing inflammation. This role might be of specific relevance for immune privilege in the eye, where, sporadically, patients with denervated sympathetic fibers develop chronic inflammation.
Our results show that in the absence of functional sympathetic fibers, the eye loses its ability to prevent either the immune rejection of intraocular allogeneic tumor cells or the suppression of delayed type hypersensitivity responses against soluble antigens injected in the anterior chamber. This loss of immune privilege is accompanied by a decrease in the concentration of transforming growth factor-β in the aqueous humor. These results suggest that immune privilege is lost in the absence of a functional sympathetic innervation of the eye, allowing intraocular immune responses to become exaggerated. We conclude that ocular sympathetic nerves are critical for the generation and maintenance of immune privilege in the eye through the facilitation of local transforming growth factor-β production.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2731140/
Our results show that in the absence of functional sympathetic fibers, the eye loses its ability to prevent either the immune rejection of intraocular allogeneic tumor cells or the suppression of delayed type hypersensitivity responses against soluble antigens injected in the anterior chamber. This loss of immune privilege is accompanied by a decrease in the concentration of transforming growth factor-β in the aqueous humor. These results suggest that immune privilege is lost in the absence of a functional sympathetic innervation of the eye, allowing intraocular immune responses to become exaggerated. We conclude that ocular sympathetic nerves are critical for the generation and maintenance of immune privilege in the eye through the facilitation of local transforming growth factor-β production.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2731140/
Tuesday, March 29, 2011
increased substance P within the iris, reproducing the effects of sympathectomy
www.springerlink.com/index/XHN321575M3556G3.pdf
Monday, March 28, 2011
Cervical sympathectomy causes photoreceptor-specific cell death in the rat retina
Changes in the regulation of the vasculature of the eye may be related to some age-related ocular diseases. We have previously shown that loss of sympathetic innervation, as can normally occur with age, resulted in substantial vascular growth of the choroid. The current study was designed to determine whether changes induced by sympathetic denervation causes significant loss of photoreceptors and increased glial cell reactivity in the retina. Sympathetic denervation was performed followed by immunohistochemistry, TUNEL staining, and protein expression analysis to investigate photoreceptor loss. 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, Issues 1-2, 15 June 2005, Pages 46-51
Volume 120, Issues 1-2, 15 June 2005, Pages 46-51
morphological changes in the retina noted after sympathectomy
Results: Mice treated with PDGF inhibitor AG 1296 showed an inhibition of corneal neovascularization and a reduction of pericytes in the new formed vessels compared to untreated animals.
Retina from sympathectomized eyes receiving saline treatment had significantly reduced PEDF mRNA and protein expression relative to the contralateral eye receiving saline treatment. These results are similar to previous work and indicate that injection alone did not alter the results. Intravitreal PEDF administration to sympathectomized eyes returned both mRNA and protein levels to those of the contralateral eye. PEDF administration also normalized retinal morphometry to prevent the sympathectomy-induced increases
in capillary density of the outer plexiform layers, as well as the ganglion cell layer.
Conclusions: These results suggest that one injection of PEDF can restore protein and mRNA
levels to those noted in an untreated animal. Furthermore, these results also indicate that
one injection of PEDF can reverse the morphological changes noted after sympathectomy
in the retina.
CR: J.J. Steinle, B.L. Lashbrook,
files.abstractsonline.com/SUPT/25/1421/SessionPDF/119.pdf
sympathectomy led to an exacerbation of colitis
Substance P (SP) is a pro-inflammatory neuropeptide in colitis, whereas sympathetic neurotransmitters are anti-inflammatory at high concentrations.
Results: In all layers, Crohn’s disease patients demonstrated a loss of sympathetic nerve fibres. Sprouting of SP+ nerve fibres was particularly observed in the mucosa and muscular layer in Crohn’s disease. SEMA3C was detected in epithelial cells, and there was a marked increase of SEMA3C-positive crypts in the mucosa of Crohn’s disease patients compared to controls. In Crohn’s disease, the number of SEMA3C-positive crypts was negatively related to the density of mucosal sympathetic nerve fibres. Sympathectomy reduced acute DSS colitis but increased chronic DSS colitis. Sympathectomy also increased chronic colitis in Il10−/−mice.
Gut 2008;57:911-921 doi:10.1136/gut.2007.125401
Results: In all layers, Crohn’s disease patients demonstrated a loss of sympathetic nerve fibres. Sprouting of SP+ nerve fibres was particularly observed in the mucosa and muscular layer in Crohn’s disease. SEMA3C was detected in epithelial cells, and there was a marked increase of SEMA3C-positive crypts in the mucosa of Crohn’s disease patients compared to controls. In Crohn’s disease, the number of SEMA3C-positive crypts was negatively related to the density of mucosal sympathetic nerve fibres. Sympathectomy reduced acute DSS colitis but increased chronic DSS colitis. Sympathectomy also increased chronic colitis in Il10−/−mice.
Secondary Effects of Sympathectomy - Disturbance of Sexual Function
If a portion of the autonomic nervous system is removed to modify a specific disease process, unrelated physiologic mechanisms will also be affected. The degree to which these other mechanisms may be affected often governs the selection of operative procedures. The results produced by interfering with mechanisms other than those for which the operation is performed might be designated as side-effects or secondary effects. . . .
N Engl J Med 1951; 245:121-130July 26, 1951
http://www.nejm.org/doi/full/10.1056/NEJM195107262450401
N Engl J Med 1951; 245:121-130July 26, 1951
http://www.nejm.org/doi/full/10.1056/NEJM195107262450401
Sunday, March 27, 2011
Massive intestinal infarction following retroperitoneoscopic right lumbar sympathectomy
We describe a fatal case of intestinal infarction following an elective retroperitoneoscopic right sympathectomy.
J Minim Access Surg. 2006 December; 2(4): 222–223.
J Minim Access Surg. 2006 December; 2(4): 222–223.
Thursday, March 24, 2011
sympathectomy controversial
"This is a field in which the unknown is still substantial and the some of the known - controversial."
M. Hashmonai, 2005
President of the International Society of Sympathetic Surgery
M. Hashmonai, 2005
President of the International Society of Sympathetic Surgery
Tuesday, March 22, 2011
The role of sympathectomy to treat RSD/CRPS is controversial and in some cases, the procedure worsens symptoms
http://www.neurologychannel.com/rsd/treatment.shtml
Friday, March 18, 2011
symptoms of Autonomic Neuropathy closely resemble the symptoms described by many who have undergone sympathectomy
the symptoms of Autonomic Neuropathy closely resemble the symptoms described by many who have undergone sympathectomy - a surgery where the surgeon destroys part of the ANS, a surgery that can result in a deranged functioning of the ANS. Surgeons are allowed to market ETS/ESB as an elective (life-style) procedure, often referred to as a 'cure'. Autonomic neuropathy: | |
"Cardiovascular symptoms: exercise intolerance, fatigue, sustained heart rate, syncope, dizziness, lightheadedness, balance problems | |
Gastrointestinal symptoms: dysphagia, bloating, nausea and vomiting, diarrhea, constipation, loss of bowel control | |
Genitourinary symptoms: loss of bladder control, urinary tract infection, urinary frequency or dribbling, erectile dysfunction, loss of libido, dyspareunia, vaginal dryness, anorgasmia | |
Sudomotor (sweat glands) symptoms: pruritus, dry skin, limb hair loss, calluses, reddened areas | |
Endocrine symptoms: hypoglycemic unawareness | |
Other symptoms: difficulty driving at night, depression, anxiety, sleep disorders, cognitive changes" |
Thursday, March 17, 2011
Iontophoresis should be tried before other treatments
Iontophoresis is easy to perform, effective in about 90% of patients in two studies with 54 and 30 participants, free of hazardous side effects, and well accepted by almost all patients.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118569/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118569/
We disagree that surgery and botulinum toxin are treatments of choice in severe cases of hyperhidrosis
The truth is exactly the opposite. Surgery is only rarely necessary, and the editorial quite properly warns of numerous surgical pitfalls, which include recurrence of hyperhidrosis, almost certain impotence, compensatory sweating, permanent neurological damage from anoxia, and death (their words). Botulinum toxin, which they recommend for axillary or plantar hyperhidrosis, requires 12 injections per axilla and 24-36 injections per foot. Even this horrendous procedure gives only 11 months' relief, and antibody formation may reduce long term efficiency.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118569/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118569/
Wednesday, March 16, 2011
the Kuntz nerve played no part in the success or failure of ETS surgery
If you research the topic of ETS, you will come across various claims and counter-claims
about the importance or otherwise of the Kuntz nerve. The Kuntz nerve is a small nerve
fibre sometimes seen on the second rib not far from the main sympathetic chain. Its
function is not known in humans. Some web-sites on ETS claim success rates of up to
100% for facial blushing because they search for and destroy the Kuntz nerve(s). These
same people also claim to be able to correct failed ETS operations by reoperating and
destroying the Kuntz nerve.
At the meeting of the International Society for Sympathetic Surgery in Germany, May
2003, attended by a majority of the world’s experts in ETS surgery (including us), all but
one of the surgeons present were of the opinion that the Kuntz nerve played no part in the
success or failure of ETS surgery for facial blushing. We share this majority opinion.
www.lapsurgeryaustralia.com.au
about the importance or otherwise of the Kuntz nerve. The Kuntz nerve is a small nerve
fibre sometimes seen on the second rib not far from the main sympathetic chain. Its
function is not known in humans. Some web-sites on ETS claim success rates of up to
100% for facial blushing because they search for and destroy the Kuntz nerve(s). These
same people also claim to be able to correct failed ETS operations by reoperating and
destroying the Kuntz nerve.
At the meeting of the International Society for Sympathetic Surgery in Germany, May
2003, attended by a majority of the world’s experts in ETS surgery (including us), all but
one of the surgeons present were of the opinion that the Kuntz nerve played no part in the
success or failure of ETS surgery for facial blushing. We share this majority opinion.
www.lapsurgeryaustralia.com.au
Sympathectomy is a technique about which we have limited knowledge, applied to disorders about which we have little understanding."
http://www.pfizer.no/templates/Page____886.aspx
Following sympathectomy the basal t-PA activity in plasma was 70% less than controls
Following sympathectomy: (i) the basal t-PA activity in plasma was 70% less than controls (2.92 ± 1.96 versus 9.33 ± 1.72 IU/ml;P ≤ 0.001); (ii) the acute release from isolated vessels induced by bradykinin or phenylephrine was comparably reduced; and (iii) the greatest reductions occurred in densely innervated small vessel explants. The results provide new support for an autonomic regulation of neural t-PA release into the vessel wall matrix and blood of densely innervated thin-walled microvessels.
Blood Coagulation & Fibrinolysis:
September 2002 - Volume 13 - Issue 6 - pp 471-481
reparative dentin formation was reduced after sympathectomy
Textbook of Endodontology, By Gunnar Bergenholtz, Preben Hørsted-Bindslev, Claes Reit
John Wiley and Sons, 2009
POSTSYMPATHECTOMY PAIN AND CHANGES IN SENSORY NEUROPEPTIDES
Postsympathectomy limb pain, postsympathectomy parotid pain, and Raeder's paratrigeminal syndrome are pain states associated with the loss of sympathetic fibres and in particular with postganglionic sympathetic lesions. There is a characteristic interval of about 10 days between surgical sympathectomy and onset of pain. It is proposed that this pain in man is correlated with the delayed rise in sensory neuropeptides seen in rodents after sympathectomy. These chemical changes probably reflect the sprouting of sensory fibres and may result from the greater availability of nerve growth factor after sympathectomy. The balance between the sensory and sympathetic innervations of a peripheral organ may be determined by competition for a limited supply of nerve growth factor.
The Lancet, Volume 326, Issue 8465, Pages 1158 - 1160, 23 November 1985
The Lancet, Volume 326, Issue 8465, Pages 1158 - 1160, 23 November 1985
link between sympathectomy and osteoclast-mediated bone resorption
Recent investigations have demonstrated a link between sympathectomy and osteoclast-mediated bone resorption. The exact nature of this link, however, is unknown, We hypothesize that substance P, a potent vasoconstrictive neuropeptide found in peripheral sensory fibers, including those innervating bone, is the mediator of this phenomenon. To test this theory, the effects of substance P on in vitro calcium release from cultured neonatal mouse calvaria were assessed. In addition, an in vivo study was conducted whereby gerbils were injected with capsaicin to eliminate substance P-containing fibers before sympathectomy with 6-hydroxydopamine. If the effects of 6-hydroxydopamine were eliminated by prior administration of capsaicin, the role of sensory nerves in sympathectomy-induced resorption would be strongly implicated.
The results indicate that substance P is capable of inducing resorption and that substance P-containing sensory nerves are required for the induction of resorption after sympathectomy in the gerbil.
Otolaryngol Head Neck Surg November 1, 1995 vol. 113 no. 5 569-581
The results indicate that substance P is capable of inducing resorption and that substance P-containing sensory nerves are required for the induction of resorption after sympathectomy in the gerbil.
Otolaryngol Head Neck Surg November 1, 1995 vol. 113 no. 5 569-581
Monday, March 14, 2011
diabetic autonomic neuropathy is due to a lesion of the sympathetic nerve supply to the skin
"We conclude that the diabetic anhidrotic syndrome, a form of diabetic autonomic neuropathy, is due to a lesion of the sympathetic nerve supply to the skin."
Sympathectomy IS a (surgically caused) lesion of the sympathetic nerve supply to the skin
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