SYMPATHECTOMY SUPPRESSES IMMUNE RESPONSES

we have extended these studies by determining the impact of 6-hydroxydopamine (6-OHDA)-induced peripheral sympathetic denervation on these responses. C57BL/6 mice treated with 6-OHDA (200 mg/kg) were inhibited in their ability to generate primary, HSV-specific cytotoxic T lymphocytes (CTL) in response to HSV infection. sympathectomy also suppressed the activation and function of HSV-specific memory CTL (CTLm). in addition, administration of 6-OHDA resulted in a transient but substantial increase in levels of circulating corticosterone and hypothalamic fos expression.

LEO, NICOLE A.; BONNEAU, ROBERT H. a

Department of Microbiology and Immunology and Program in Neuroscience, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA

Chemical Sympathectomy Alters Cytotoxic T Lymphocyte Responses to Herpes Simplex Virus Infection.
Source
Annals of the New York Academy of Sciences. 917:923-934, 2000.

sympathectomy generates a mild, although significant, impairment of the bronchomotor tone

Gonzalez, Miguel A. Ponce MD a; Serda, Gabriel Julia MD a; Rodriguez, Norberto Santana MD b; Suarez, Pedro Rodriguez MD b; Penate, Gregorio Perez MD a; Gilart, Jordi Freixinet MD b; Navarro, Pedro Cabrera MD a

(a)Department of Pulmonary Medicine, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
(b)Department of Thoracic Surgery, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
Title
Long-term pulmonary function after thoracic sympathectomy.[Miscellaneous Article]
Source
Journal of Thoracic & Cardiovascular Surgery. 129(6):1379-1382, June 2005.
Abstract
Background: The purpose of this study was to evaluate the long-term and midterm effects of thoracic sympathectomy on pulmonary function and to assess the influence of the sympathetic nervous system on bronchomotor tone.
We conclude that thoracic sympathectomy generates a mild, although significant, impairment of the bronchomotor tone.

sympathectomy leads to qualitative alterations in localized bone modeling and remodeling

Previous studies have indicated that regional sympathectomy leads to qualitative alterations in localized bone modeling and remodeling. In this study, unilateral cervical sympathectomy resulted in significant increases in osteoclast surface and osteoclast number within the ipsilateral bulla of experimental animals. The mechanisms by which sympathectomy leads to increased local bone loss is unknown. Potential mechanisms include disinhibition of resorption, secondary to the elimination of periosteal sympathetics, as well as indirect vascular effects.
Disruption of the control of modeling within the temporal bone may lead to various bone diseases such as otosclerosis, osteogenesis imperfecta, Paget's disease of bone, fibrous dysplasia, or the erosion of bone associated with chronic otitis media.

Sherman, Bret E.; Chole, Richard A.
Institution
Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of California, Davis, California, U.S.A.
Title
In Vivo Effects of Surgical Sympathectomy on Intramembranous Bone Resorption.[Miscellaneous]
Source
American Journal of Otology. 17(2):343-346, March 1996.

Alterations of the Bone Scan After Sympathectomy

Mailis, Angela M.D. M.Sc., F.R.C.P.C.(physMed.); Meindok, Harry M.D., B.S., F.R.C.P.C.(Lond.), F.R.C.P.C.(IntMed.); Papagapiou, Marios B.sc.(Hon.), M.Sc.; Pham, Dieu M.D., F.R.C.P.C. (Radiol.)
Institution
Pain Investigation Unit and Department of Medicine, The Toronto Hospital (Western Division), University of Toronto, and Department of Radiology, The Toronto Hospital, Toronto; and Department of Radiology, North York Branson Hospital, North York, Ontario, Canada
Title
Alterations of the Three-Phase Bone Scan After Sympathectomy.[Report]
Source
Clinical Journal of Pain. 10(2):146-155, June 1994.

Sympathectomy Suppresses Baroreflex Control of Heart Rate

Because the T2-3 or T3-4 sympathetic ganglia are involved in direct sympathetic innervation of the heart, sympathectomy at this level may alter baroreflex control of heart rate. The purpose of our study was to examine the influence of ETS on baroreflex responses to pressor and depressor stimuli under small-dose sevoflurane anesthesia.
ETS significantly altered baroreflex in both pressor and depressor tests in all patients. Baroreflex was completely suppressed in 1 of 19 patients in the pressor test and in 9 of 21 patients in the depressor test. We conclude that baroreflex responses are suppressed in patients who receive ETS.

Kawamata, Yurie T. MD *; Kawamata, Tomoyuki MD +; Omote, Keiichi MD +; Homma, Eiji MD *; Hanzawa, Tatsuo MD *; Kaneko, Toshifumi MD ++; Namiki, Akiyoshi MD +
Institution
Departments of *Anesthesiology and
++Surgery, Nippon Telegraph and Telephone East Japan Sapporo Hospital, Sapporo, Japan; and
+Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
Title
Endoscopic Thoracic Sympathectomy Suppresses Baroreflex Control of Heart Rate in Patients with Essential Hyperhidrosis.[Miscellaneous]
Source
Anesthesia & Analgesia. 98(1):37-39, January 2004.

Sympathectomy-induced ichthyosis-like eruption

Lowenstein, Eve J. MD, PhD; Gordon, Ronald E. PhD; Phelps, Robert G. MD
Institution
From the Departments of Dermatology and Pathology, Mount Sinai Medical Center, New York, New York
Title
Sympathectomy-induced ichthyosis-like eruption.[Miscellaneous Article]
Source
International Journal of Dermatology. 39(2):146-151, February 2000.

SUPRESSION OF BARORECEPTOR FUNCTION OF THE HEART

Dohi, Shuji MD; Tsuchida, Hideaki MD; Mayumi, Takehisa MD
Institution
Institute of Clinical Medicine, University of Tsukuba, Sakuramura, Ibaraki, Japan, and the Department of Anesthesiology, Sapporo Medical College and Hospital, Sapporo, Hokkaido, Japan.
Title
Baroreflex Control of Heart Rate during Cardiac Sympathectomy by Epidural Anesthesia in Lightly Anesthetized Humans.[Article]
Source
Anesthesia & Analgesia. 62(9):815-820, September 1983.
To evaluate the effects of acute sympathetic denervation on the baroreflex control of heart rate, baroreflex sensitivities were compared in lightly anesthetized humans who had either cervical (N = 20) or lumbar epidural anesthesia (N = 18). The results suggest that cardiac sympathectomy induced by epidural anesthesia can suppress partially baroreceptor function by interrupting sympathetic efferent fibers innervating the heart during high levels of epidural anesthesia, but that lumbar sympathectomy during epidural anesthesia is unlikely to affect baroreceptor activity.

SUPERSENSITIVITY TO NE AFTER SYMPATHECTOMY

EDVINSSON, L. B.M.; AUBINEAU, P. D.SC.; OWMAN, C. M.D.; SERCOMBE, R. PH.D.; SEYLAZ, J. D.SC.
Institution
Department of Histology, University of Lund, Biskopsgatan 5, S-223 62, Lund, Sweden (EDVINSSON)(OWMAN)
Department of Histology, University of Lund, Biskopsgatan 5, S-223 62, Lund, Sweden; Department de Neurophysiopathologie Humaine, Hopital Laribosisiere, Paris, France (AUBINEAU)(SERCOMBE)(SEYLAZ)

Sympathetic Innervation of Cerebral Arteries: Prejunctional Supersensitivity to Norepinephrine After Sympathectomy or Cocaine Treatment.[Article]
Source
Stroke. 6(5):525-530, September/October 1975.

SYMPATHECTOMY FOR ANGINA

Hirakawa, Naomi; Ogawa, Ikuyo; Yoshida, Kazuyo; Totoki, Tadahide
Institution
Anesthesiology and Critical Care Medicine, Cardiology, Saga Medical School, Saga, Saga, Japan.
Title
Effects of Endoscopic Thoracic Sympathectomy (ETS) for the Treatment of Patients with Intractable Vasospastic Angina. #151; Changes in Autonomic Nervous Activity and Symptomatic Change after ETS in Patients with Intractable Vasospstic Angina #151;.[Miscellaneous]
Source
ASA Annual Meeting Abstracts. LOCAL ANESTHESIA AND PAIN. 99(3A):A998, October 2003.

"paradoxic gangrene" AS A COMPLICATION OF SYMPATHECTOMY

TYLER, L TERRELL M.D.; KAPLAN, I W M.D.
Institution
From the Department of Surgery, Louisiana State University School of Medicine and Surgical Service of Touto Infirmary, New Orleans, La.
Title
Paradoxic Gangrene Following Lumbar Sympathectomy.[Article]
Source
Southern Medical Journal. 50(1):63-66, January 1957.
Abstract
The occasional complication of "paradoxic gangrene" following lumbar sympathectomy is not well understood. Several such instances are reported with the suggestion of an additional etiologic factor.

SYMPATHECTOMY BLUNTS MYOCARDIAL INTERSTITIAL FIBROSIS

Author
Perlini, Stefano; Ferrero, Ivana; Palladini, Giuseppina; Tozzi, Rossana; Facoetti, Angelica; Fallarini, Silvia; Ferrari, Alberto U
Institution
Univ Pavia, Pavia, Italy (Perlini, Ferrero, Palladini, Tozzi)
Univ Pavia, Milano, Italy (Facoetti)
Univ Pavia, Pavia, Italy (Fallarini)
Univ Milano-Bicocca, Milano, Italy (Ferrari)
Title
SYMPATHECTOMY, BUT NOT BETA-BLOCKADE, BLUNTS MYOCARDIAL INTERSTITIAL FIBROSIS IN EXPERIMENTAL PRESSURE-OVERLOAD HYPERTROPHY.[Abstract]
Source
Hypertension. 44(4):512-513, October 2004.

Sympathetic innervation affect vessel structure and sensitivity.

The results also suggest that sympathetic innervation of mesenteric resistance vessels may affect vessel structure and sensitivity.

Author
Nyborg, Niels C B 1; Korsgaard, Niels *; Mulvany, Michael J. *
Institution
*From the Institutes of Biophysics, University of Aarhus, DK-8000 Aarhus C, Denmark
(1)From the Institutes of Pharmacology University of Aarhus, DK-8000 Aarhus C, Denmark
Title
Neonatal Sympathectomy of Normotensive Wistar-Kyoto and Spontaneously Hypertensive Rats with 6-Hydroxydopamine: Effects on Resistance Vessel Structure and Sensitivity to Calcium.[Article]
Source
Journal of Hypertension. 4(4):455-461, August 1986.

SYMPATHECTOMY ON HUMAN MIDDLE CEREBRAL ARTERY FLOW VELOCITY AND CEREBROVASCULAR CO2

Yamada, Hiroyuki M.D.; Ono, Takeshi M.D.; Cho, Sungsam M.D.; Tomiyasu, Shiro M.D.; Sumikawa, Koji M.D.
Institution
Nagasaki University School of Medicine, Nagasaki, Japan
Title
EFFECTS OF THORACIC SYMPATHECTOMY ON HUMAN MIDDLE CEREBRAL ARTERY FLOW VELOCITY AND CEREBROVASCULAR CO2 RESPONSE.[Miscellaneous]
Source
ASA Annual Meeting Abstracts. Clinical Neurosciences. 91(3A):A222, October 1999.

ALTERED IMMUNERESPONSES FOLLOWING SYMPATHECTOMY

Hong, S.; Soares, J.; Bunnell, B. N.; Edwards, G. L.; Evans, D. L.; Dishman, R. K. FACSM
Institution
University of Georgia.
Title
ACTIVITY WHEEL RUNNING BLUNTS SUPPRESSION OF SPLENIC NATURAL KILLER CELL CYTOTOXICITY AFTER FOOTSHOCK AND SYMPATHECTOMY.[Abstract]
Source
Medicine & Science in Sports & Exercise. 30(5) (Supplement):298, May 1998.

Depression accompanying compensatory hyperhidrosis

Hashim, N.; Wilson, N. J. E.
Institution
Department of Dermatology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
Title
Depression accompanying compensatory hyperhidrosis following endoscopic thoracic sympathectomy.[Letter]
Source
Clinical & Experimental Dermatology. 31(6):818-819, November 2006.

dermatitis of the hands following sympathectomy

Hofbauer, Gunther F. L.; Nestle, Frank O.
Institution
Patch Test and Occupational Dermatology Unit, Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland
Title
Irritant contact dermatitis of the hands following thoracic sympathectomy.[Miscellaneous]
Source
Contact Dermatitis. 42(2):119-120, February 2000.

sympathectomy-induced adrenal hypertrophy

Regulation of adrenal angiotensin receptor subtypes: a possible mechanism for sympathectomy-induced adrenal hypertrophy

Conclusions: Impairment of the sympathetic nervous system with guanethidine withdraws the normal stimulation of this system on the circulating renin-angiotensin system, but upregulates the expression of adrenal Ang II receptors. Increased expression of adrenal AT2 and AT1A receptors may play an important role in adaptive adrenal hypertrophy and hormonal responses to sympathectomy.

Author
Qiua, Jingxin 1; Nelsona, Sharon H. 1; Spethb, Robert C. 2; Wanga, Donna H. 1,3

ETS results in bradycardia during exercise

European Journal of Cardio-Thoracic Surgery
Volume 20, Issue 6, December 2001, Pages 1095-1100

Infra-stellate upper thoracic sympathectomy results in a relative
bradycardia during exercise, irrespective of the operated side

P. Abraham , , a, J. Picquetb, S. Bickerta, X. Paponb, Y. Joussetb, J. L. Saumeta and B. Enonb

Sympathectomy and Dysautonomia

http://www.ndrf.org/NDRFHandbook.htm

Here are some of the tests listed that should be preformed after sympathectomy, to measure the damage caused on the autonomous nervous system.

The mechanism of sympathectomy - unknown

Results. Sympathetic blocks and sympathectomies may provide
significant relief in 60% of patients who undergo them (19-23). The
mechanism on which this relief is based is open to question. There may
be a significant placebo effect influencing the response to sympathetic
blocks (18, 19). Mean time to pain recurrence following
sympathectomy is six months (23).
http://www.hiesiger.com/physicians/physicianrfl.html

Long-term superior cervical sympathectomy induces

Long-term superior cervical sympathectomy induces mast cell hyperplasia and increases histamine and serotonin content in the rat dura mater

These results clearly demonstrate, for the first time, a long-term trophic effect of sympathetic nerve degeneration on mast cells in the dura mater. Since mast cell activation has been described previously on the painful side of cluster headache patients during attack periods, we propose that the sympathetic impairment reported in these patients could be prominent, directly or indirectly inducing mast cell hyperplasia and changes in amine contents in the tissue concerned.http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T0F-3YKKDB8-T&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=1de581b2e86912852d82e7f89ca95aea

changed immune responses following sympathectomy

It has been shown in animals that sympathectomy of one side of the
body leads to an increase in the development of tumors on the denervated side [80].
This suggest that interference with the sympathetic nervous system (SNS) can lead to a
compromise of the body's immune system [81–82].

http://chiro.org/LINKS/FULL/VERTEBRAL_SUBLUXATION_2.shtml

Postural hypotenson following sympathectomy

postural hypotension (POS-tu-ral hi-po-TEN-shun)

–low blood pressure condition that frequently follows the operation of splanchnicectomy or sympathectomy.http://209.85.173.104/search?q=cache:b4FpIa0ycBMJ:www.haabet.dk/SpencerSystem1952/Glossary.html+muscle+atrophy+sympathectomy+inflammation&hl=en&ct=clnk&cd=25&gl=au&client=firefox-a

Hyperthermia following sympathectomy

a significant number of patients develop a tendency for
hyperthermia involving the extremity. This hyperthermia is more commonly seen among the patients
who have received multiple sympathetic ganglion nerve blocks. This is what is referred to as
"virtual sympathectomy".
THE ROLE OF INFRARED THERMOGRAPHY IN THE DIAGNOSIS AND
MANAGEMENT OF NEUROPATHIC PAIN
H. Hooshmand, M.D.
Neurological Associates
903 E. Causeway Blvd.
Vero Beach, FL 32963

Tendon inflammation & sympathectomy

Tendon Innervation: Understanding of Pathology and Potential ... - 7:19pm

role in the regulation of pain, inflammation, vasoac-. tivity, and tissue repair. This chapter presents novel. findings considering tendon innervation, ...
doi.wiley.com/10.1002/9780470757987.ch9 - Similar pages - Note this

Interruption of sensory fibres

Cutaneous innervation in man before and after lumbar sympathectomy: evidence for interruption of both sensory and vasomotor nerve fibres.
Coventry BJ, Walsh JA Department of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia.
BACKGROUND: Rest pain and severe ischaemia in patients who are unable to be offered (further) surgery to revascularize the lower limb is still problematic. Lumbar sympathectomy has been used for many years but the mechanisms by which this works are not absolutely clear. Both sensory and vasomotor fibres travel in the lumbar sympathetic chain and the effects of lumbar sympathectomy on these nerve types have been investigated in the present paper. METHODS: Immunohistochemical methods were used to detect neuropeptides contained in sensory and vasomotor nerves in the lower limb skin of (i) patients having amputations for peripheral vascular disease (PVD) after previous (chemical or surgical) sympathectomy; (ii) patients having amputations for PVD without previous (chemical or surgical) sympathectomy; and in control normal skin. The three groups are compared and the results are discussed. RESULTS: Normal and PVD controls had intact sensory and vasomotor nerves around dermal cutaneous blood vessels, but these were completely or virtually completely lost after lumbar sympathectomy, by either chemical or surgical means. CONCLUSIONS: Lumbar sympathectomy severs both vasomotor and sensory fibres, suggesting that relief of rest pain may be explained not only by increased cutaneous and muscle blood flow, but also by nociceptive sensory denervation. ANZ journal of surgery. (2003)
PMID: 12534731		Fulltext - Related articles

changes in intraocular bloodflow following sympathectomy

Control of intraocular blood flow.

Key words: sympathectomy, sympathetic stimulation, intraocular blood flow,. nuclide-labeled microspheres, sympathetic vasomotor tone. ...
www.iovs.org/cgi/reprint/12/5/332.pdf - Similar pages - Note this

Sympathectomy for Erythromelalgia

Yuki Nakajima¹ , Kiyoshi Koizumi¹, Tomomi Hirata¹, Kyoji Hirai¹, Atsuhiro Sakamoto¹ and Kazuo Shimizu¹

(1)	Department of Surgery II, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, 113-8603 Tokyo, Japan

Received: 19 January 2004 Accepted: 8 July 2004

Abstract Erythromelalgia is known as a rare syndrome of unknown etiology, characterized by redness with burning pain, edema associated with increased skin temperature in the upper and/or lower extremities. Various treatments such as drug therapies and sympathetic blockade were reported. We report two cases including a 57-year-old woman and a 64-year-old woman, showing the successful clinical outcome by bilateral thoracoscopic sympathectomy.

Key words primary erythromelalgia - sympathectomy - thoracoscopic surgery

Changes in the internal ear following sympathectomy

Vasomotor Affections of the Internal Ear

experiments have been either pericarotid sympathectomy or. injections of vasomotor drugs (stimulators or inhibitors of the ...
journals.cambridge.org/production/action/cjoGetFulltext?fulltextid=1176876 - Similar pages - Note this

Effect of Sympathectomy on vasomotor

Thoracoscopic sympathectomy in the management of vasomotor ...

Thoracoscopic sympathectomy in the management of vasomotor disturbances and complex regional pain syndrome of the hand. Rizzo M, Balderson SS, Harpole DH, ...
www.ncbi.nlm.nih.gov/pubmed/14763530 - Similar pages - Note this

ETS severs vasomotor and sensory fibres

Sympathectomy: sympathectomy severs both vasomotor and sensory fibres

Lumbar sympathectomy has been used for many years but the mechanisms by which this works are not absolutely clear. Both sensory and vasomotor fibres travel ...
sympathectomy.blogspot.com/2008/02/sympathectomy-severs-both-vasomotor-and.html - 54k - Cached - Similar pages - Note this

Vasomotor - constriction/dilation of blood vessels

THE EFFECT OF SYMPATHECTOMY ON THE VASOMOTOR, CAROTID SINUS ...

SYMPATHECTOMY. AND. VASOMOTOR. CAROTID. SINUS. REFLEXES. 201. systemic pressure fell an average of 39.2 mm. of mercury in 31 trials; on ...
ajplegacy.physiology.org/cgi/reprint/120/1/195.pdf - Similar pages - Note this

U.S. Government Studies the Neurocardiologic Dysfunction of Sympathectomy Patients

I participated in the study in November, 2004. For five days I underwent a battery of tests, including PET scans, drug tests, sweat tests, a tilt-table test, EKG, and a lumbar puncture (spinal tap). Conclusions:

1. Partial cardiac denervation as a result of bilateral thoracic sympathectomies.

2. Complete absence of blood vessel constriction in the arms, as expected in thoracic sympathectomy.

3. Complete loss of sympathetic innervation to the thyroid.

4. Abnormal catecholamine levels in the spinal fluid.

Bear in mind that these researchers are only looking at a few of the many aspects of ETS dysfunction.

http://www.truthaboutets.com/Pages/NIH.html

NIH Book: Sympathectomy is "Neurocardiologic Disorder"

Senior Clinical Investigator David S. Goldstein, M.D. Ph.D., calls ETS "surgically induced autonomic failure". learn more

Changes in Blood Flow following Sympathectomy

PDF
EFFECT OF SYMPATHECTOMY ON BLOOD FLOW IN THE HUMAN LIMB
Stein et al. Am J Physiol.1948; 152: 499-504

Blood diverted from muscle to skin after sympathectomy

However, the clinical results of both surgical and neurolityc sympathectomy are uncertain. Indeed these procedures lead to a redistribution of the blood flow in the lower limbs from the muscle to the skin, with a concomitant fall of the regional resistance, mainly in undamaged vessels. The blood flow will be diverted into this part of the vascular tree, so that a

"stealing" of the blood flow may occur.

Vito A. Peduto, Giancarlo Boero, Antonio Marchi, Riccardo Tani

Bilateral extensive skin necrosis of the lower limbs following prolonged epidural blockade

Anaesthesia 1976; 31: 1068-75.

Medical Errors Action Group in Australia

Australia has the highest rate of medical error in the world according to the World Health Organisation's 2002 Report released late last year .

16% of our hospitalised patients will suffer a significant adverse event which is totally unrelated to their original medical condition . This translates as 1 patient in 6 , which is four times the reported occurrence of medical error incidents in the United States , and a full 6% higher than Britain's 10% error rate .

18 , 000 Australian patients die each year as a direct result of avoidable injuries and complications inflicted from withn our health system environments .

Another 50 , 000 Australian patients per year are left with permanent disabilities , and hundreds of thousands more are avoidably injured to some greater or lesser degree .

80 , 000 Australian patients per year are hospitalised due to medication errors , syphoning a massive $350m from the Federal Health Budget annually .

And these figures do not take into account the recognised errors which take place in other clinical outpatient settings such as GP surgeries , radiology suites , and other outpatient clinics where the error rate has been found to be at 23% in one Sydney study .

Dr Hashmonai

　The 6th International Symposium on Sympathetic Surgery
　　　　 May 4-6, 2005 in Vienna, Austria
　　 　　http://www.medacad.org/isss2005/isss.htm

　　 　　Welcome PDF より

　 　 　" This is a field in which the unknown is still substantial
　　 　　and the some of the known - controversial. "
　　 　　Dr. M. Hashmonai　ISSS President

Dopamine - according to Oliver Sacks

"Dopamine is responsible for the flow of consciousness, flow of emotion, the flow of the mind."

Dopamine governs drive and creativity

Many patients after ETS complain about loosing their drive, their spark and creativity. Many say that they feel that part of them has been switched off.

Dopamine and sympathectomy.

Articles

Serum Dopamine--Hydroxylase: Decrease after Chemical Sympathectomy

Science 3 September 1971:
Vol. 173. no. 4000, pp. 931 - 934
DOI: 10.1126/science.173.4000.931
Richard Weinshilboum ¹ and Julius Axelrod ²

¹ Pharmacology-Toxicology Program, National Institute of General Medical Sciences, Bethesda, Maryland 20014
² Laboratory of Clinical Science, National Institute of Mental Health, Bethesda, Maryland 20014

Dopamine-- hydroxylase is an enzyme that is localized to catecholamine-containing vesicles in sympathetic nerves and the adrenal medulla, and is also found in the serum. Treatment of rats with 6-hydroxydopamine, a drug which destroys sympathetic nerve terminals, leads to a decrease in serum dopamine--hydroxylase activity. The decrease is not due to an effect on the adrenal medulla or to an increase in circulating inhibitor or inhibitors of enzyme. These data represent evidence that at least a portion of the circulating dopamine--hydroxylase activity arises from sympathetic nerve terminals.

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.

ORIGINAL ARTICLES

ANZ Journal of Surgery. 73(1-2):14-18, January 2003.
COVENTRY, BRENDON J. BM BS, PhD, FRACS *; WALSH, JOHN A. MD, FRACS +

Abstract:
Background: Rest pain and severe ischaemia in patients who are unable to be offered (further) surgery to revascularize the lower limb is still problematic. Lumbar sympathectomy has been used for many years but the mechanisms by which this works are not absolutely clear. Both sensory and vasomotor fibres travel in the lumbar sympathetic chain and the effects of lumbar sympathectomy on these nerve types have been investigated in the present paper.

Methods: Immunohistochemical methods were used to detect neuropeptides contained in sensory and vasomotor nerves in the lower limb skin of (i) patients having amputations for peripheral vascular disease (PVD) after previous (chemical or surgical) sympathectomy; (ii) patients having amputations for PVD without previous (chemical or surgical) sympathectomy; and in control normal skin. The three groups are compared and the results are discussed.

Results: Normal and PVD controls had intact sensory and vasomotor nerves around dermal cutaneous blood vessels, but these were completely or virtually completely lost after lumbar sympathectomy, by either chemical or surgical means.

Conclusions: Lumbar sympathectomy severs both vasomotor and sensory fibres, suggesting that relief of rest pain may be explained not only by increased cutaneous and muscle blood flow, but also by nociceptive sensory denervation.

ASERNIP-s never reviewed the ETS surgery. Why?

May 31 2003 - Madonna has written to many Institutions in Australia, including proposed reviews of ETS in Australia. Morgan and FFSO have researched continually for evidence of side-effects with ETS/ESB. Patients have shared their personal and private stories on this site and the boards. Surgeons such as Dr T and Dr Lin have admitted there are side-effects. Together we have worked as a team and finally there is promising news. I have just received a letter from the 'Australian Safety and Efficacy Register of New Interventional Procedures - Surgical' and they will "undertake a systematic review of [ETS]" and "warrant it urgent attention".

http://www.ets-sideeffects.netfirms.com/home3.4.html

ETS for blushing?!

Those with blushing problems are often desperate to find a cure for their excessive blushing. Many people are turning to a medical treatment called Endoscopic Thoracic Sympathectomy, frequently referred to simply as ETS, for help with their problem blushing. At first glance, ETS seems like a miracle treatment for problem blushers. Those who market and perform ETS tout the procedure as a an almost guaranteed cure to excessive blushing. For people who have invested time and money in numerous treatments such as hypnosis, cognitive behaviour therapy, and numerous potions and pills, the thought of being done with problem blushing once and for all is certainly an appealing one. However, upon further investigation, the risks and side effects of ETS seem quite consequential. Before anyone decides to pursue ETS as potential medical intervention for problem blushing, he or she certainly needs to thoroughly research all aspects of the procedure. Since blushing is triggered by the nervous system, ETS actually impacts the nerves. The procedure literally involves either clamping off or cutting the nerves responsible for the blushing reaction. While problem blushing is a serious problem for people who experience it, deliberately damaging nerves as part of a medical procedure to cure blushing is certainly not something to be taken lightly. Nerve damage is permanent and irreversible, so those who are considering the procedure must be sure they understand exactly what they are doing, and have a clear picture of the potential side effects and consequences. The nerves in the human body are all interconnected, so it is not possible to deliberately damage specific nerves without impacting other nerves in the body as well. Therefore, there are a number of side effects that people who undergo ETS can expect to experience. The nervous system is very complex, and ETS can trigger both hyper sensitive nerves in some parts of the body and nerves that are completely desensitized in other parts of the body. Additional side effects can include decreased lung capacity, decreased stamina, trouble with regulation of body temperature, and compensatory hyperhidrosis.
http://www.theinformationservice.com/index.php?option=com_a3000&task=showarticle&id=77413

British Association of Aesthetic Plastic Surgeons

Douglas McGeorge, president of the British Association of Aesthetic Plastic Surgeons, said clinics were "abusing" the fact the public did not take enough time to assess treatments.

http://news.bbc.co.uk/2/hi/health/7171789.stm

Putting sales before patient safety

Some cosmetic surgery clinics are using aggressive marketing and putting sales before patient safety, according to consumer group Which?.

Undercover researchers at 19 clinics found the risks of procedures were often played down during sales pitches.

Some of the clinics described invasive surgery as "scarless" or "minor procedure", said Which?, which wants tighter regulation of the industry.

http://news.bbc.co.uk/2/hi/health/7171789.stm

Further news from Australia - action group

As a new development a support and action group has been set up in Sydney, Australia, that will act as a representative of the victims of the ETS surgery in communication with the government organizations (MSAC, RACS, ASERNIP-s) and Health Minister to negotiate the situation that needs to be addressed following the recent suicide of Tim McCarthy, who was disabled and devastated by the side-effects of his ETS surgery.
It also will provide support with the communication for the patients distressed after undergoing the surgery. They will provide information and links to other groups overseas. The soon to be updated Australian website can be found here:
http://ets-sideeffects.net/index.html

The survey was conducted between November 2003 and June 2004 and funded by the nonprofit Institute on Medicine as a Profession, a think tank that promotes medical professionalism through a center at Columbia University. It uncovered notable gaps between ideals and practice in the areas of self-regulation, managing financial conflicts and conserving limited resources.

Study Finds Gaps Between Doctors' Standards and Actions

Physicians Think They Should Report Errors and Incompetence -- but Say They Often Do Not

By Christopher Lee

Washington Post Staff Writer
Tuesday, December 4, 2007; Page A08

and what does the Australasian College of Surgeons has to say?

ASERNIP-S has not conducted a review on sympathectomy. It was previously listed for MSAC to review (hence why ASERNIP-S did not review) however I believe instead it was referred to PBAC. I have no information as to what happened with this review although I recently found out that it was only looking at a pharmaceutical treatment. ASERNIP-S is only able to review the published evidence however our current funding does not cover conducting any new systematic reviews. We would be happy to do a full systematic review on this topic but this would require significant funding, in the order of $150,000. The reason for this is that we would need to examine all study types in detail, as it is clear from what you have provided there is an enormous evidence base.
All that I can suggest is for you to contact the federal government, possibly MSAC and state governments for funding to have a full review done.

In our searches we located a guideline paper on the procedure from 2007 which indicates that the procedure should only be considered in severe cases when alternative treatments have been tried and were unsuccessful.

The Australian Government relies on

The Government relies on the advice of the medical profession in relation to the clinical relevance of procedures already listed on the MBS. If the Royal Australasian College of Surgeons were to formally advise the Government that it no longer regards this procedure as being clinically relevant, the Government would take appropriate action in relation to the MBS.

Do you think you are too young to have grey hair?

You might be onto something. Here is a published article:


Arch Dermatol, Vol. 93, Issue 2, 235-236, February 1, 1966

ARTICLES

Gray hair and sympathectomy. Report of case

A. B. Lerner

You have reached the most complete version of this article accessible.

Has there ever been a controlled trial done on the effects of sympathectomy?

in Australia? Overseas?

Isn't the procedure considered experimental if such study/trial has not been done?
Are medical companies allowed to introduce new drugs without such trials/studies? What would happen to a company that would do that?
Who is responsible if such thing occurs?

The answer according to the Royal Australasian College of Surgeons is: NO!

ROLE OF ASERNIP-s: monitoring

New surgical procedures should be monitored after their introduction. The
approval process should decide the type of monitoring to be undertaken.
• As a minimum, audits of indications and outcomes should be done.
• Access to reliable surgical data (local and global), organised in such a
way that performance comparisons can be made.
• It is highly desirable to coordinate and standardise any study designs,
e.g. outcomes measured in the same way for case series and audits
across hospital services or as done in previous studies.
If an audit or controlled clinical study is being contemplated, consider
whether this can be done as part of a multi-centre study.
• Develop/amend internal processes for the reporting of any adverse
events from new procedures and consider external processes e.g. as
part of multicentre audits or advising the Therapeutic Goods Authority
or the New Zealand New Technology Committee re problems with
devices.

MSAC & RACS

THE Australian Story - ASERNIP-s ROLE

2.1 PriorEvaluation
Most techniques new to Australia and New Zealand will have been evaluated
or at least implemented elsewhere in the world first. Issues that should be
considered include:
• Has the technique been previously evaluated?
Hospitals/health services should establish whether an assessment has
already been done through international or national systematic review
or Health Technology Assessment (e.g. INAHTA– International
Network of Agencies for health technology assessment, ASERNIP-S –
Australian Safety and Efficacy Register of New Interventional
Procedures - Surgical, Cochrane Collaboration, MSAC – Medical
Services Advisory Committee), clinical studies, industry reports,
laboratory testing or animal studies, reports of case series overseas,
reports of experiences of the techniques in Australian and New
Zealand facilities (see Appendix 1 for a list of relevant organisations
and their web-sites).
• How reliable is the evaluation?
Interpretation of assessments should include the likely robustness of
the evidence e.g. type of study design, were studies large enough to
show reliable results for morbidity and mortality; were there possible
confounding factors, such as the age of patients?

THE Australian Story - MSAC version

The Medicare Benefits Schedule (MBS) has evolved over time in response to changes in medical practice. Medicare benefits are payable in respect of a medical service listed in the MBS where that service is:

• provided by a medical practitioner, and
• a clinically relevant service (generally accepted in the medical profession as being necessary for the appropriate treatment of the patient).

Medicare item 35003 relates to the performance of cervical or upper thoracic sympathectomy by any surgical approach (irrespective of whether it is conducted by open exposure or endoscopically). Sympathectomy has been listed on the MBS for over three decades, and permitted by any surgical approach since 1991.

The Medical Services Advisory Committee (MSAC) was established in 1998 to advise the Minister for Health and Ageing on the strength of evidence pertaining to new and emerging medical technologies and procedures in relation to their safety, effectiveness and cost-effectiveness and under what circumstances public funding should be supported. MSAC has never considered this procedure, as it was listed on the MBS prior to MSAC's formation, and is therefore not a 'new and emerging medical technology'.

The Government relies on the advice of the medical profession in relation to the clinical relevance of procedures already listed on the MBS. If the Royal Australasian College of Surgeons were to formally advise the Government that it no longer regards this procedure as being clinically relevant, the Government would take appropriate action in relation to the MBS.

Mia: Surgeons performing the surgery ARE Fellows of the Royal Australasian College.

Unstable blood pressure after sympathectomy

Risks

Side effects of sympathectomy may include decreased blood pressure while standing, which may cause fainting spells. After sympathectomy in men, semen is sometimes ejaculated into the bladder, which may impair fertility. After a sympathectomy done by inserting an endoscope in the chest cavity, patients may experience chest pain with deep breathing. This problem usually disappears within two weeks. They may also experience pneumothorax (air in the chest cavity).

http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/healthatoz/Atoz/ency/sympathectomy.jsp

Sympathectomy suppresses baroreflex control of heart rate

Endoscopic thoracic sympathectomy suppressed the baroreflex control of heart rate during pressor and depressor tests in patients with palmar or axillary hyperhidrosis.

Endoscopic Thoracic Sympathectomy Suppresses Baroreflex Control of Heart Rate in Patients with Essential Hyperhidrosis

Yurie T. Kawamata, MD^*, Tomoyuki Kawamata, MD, Keiichi Omote, MD, Eiji Homma, MD^*, Tatsuo Hanzawa, MD^*, Toshifumi Kaneko, MD, and Akiyoshi Namiki, MD
2004 International Anesthesia Research Society

Australian Story 3!

from: http://ets-sideeffects.net/index.html
TIMBO McCarty, an Australian/New Zealander who has been suffering from the side-effects of ETS for eight years and has been working on this website alongside me as well as helping organise meetings, had enough of the side-effects and committed suicide on October 29 at the age of 45. His Father and Mother asked me to put this on the website and to let everyone know that he had had enough. Timbo was always there for me as a friend to talk when I felt everything was getting to me. Timbo was also was a fighter. He wanted ETS surgery to be stopped and was depressed that the surgery is still being performed routinely. He was aghast that his surgeon, Dr Lin in Taiwan, who performed ESB (clamping of the T2 nerve), removed his clamps at a fee yet still performed reversals routinely even though so many people have come forward with complaints.....
This is the second suicide in two years from people who have had terrible side-effects.

Support groups for people who had sympathectomy and ended up with disabling side-effects

World Against Sympathectomy	http://www.truthaboutets.com/
The Sympathetic Association	http://home.swipnet.se/sympatiska/index3.htm
Patients Against Sympathetic Surgery	http://www.ets-sideeffects.netfirms.com/
Radisson Group	http://www.noetsuk.com/
Family of Compensatory Sweating Sufferers	http://home.pchome.com.tw/family/vivi12175/
ETS Side Effects	http://www.geocities.jp/etscontroversialop/index.html
Hyperhidrosis Forum	http://www.terra.es/personal8/hiperhidrosis/principal.htm

Sympathectomy is prohibited for patients under 20 years in Taiwan. Why?

Endoscopic thoracic sympathectomy is prohibited for patients under 20 years old in Taiwan 10 January 2005
Min-Huei Hsu Department of Neurourgery, Taipei City Hospital, Zhongxiao Branch Send letter to journal: Re: Endoscopic thoracic sympathectomy is prohibited for patients under 20 years old in Taiwan Email Min-Huei Hsu	Endoscopic thoracic sympathectomy (ETS) has come into widespread use for palmar hyperhidrosis. Side sffects after ETS was widely discussed in Taiwan society in the past few months. Lots of people in Taiwan suffer from hyperhidrosis palmaris. ETS is covered by the National Health Insurance, and patient billing for this operation does not exceed US$ 60. This is why this operation is so popular here 1 . Patients with severe compensatory sweating after ETS must change clothes several times a day (some patients complained that they change as often as 10 times a day), resulting in serious impact on work and social interaction. Patients suffering from such serious side effects in Taiwan have formed a support group based on an Internet discussion forum to request the government to take this problem seriously. Starting in October 2004, The Department of Health, Executive Yuan, Taiwan, has prohibited surgeons from performing this operation on patients under 20 years old. To our knowledge, this type of support group also exists in United States, England, Sweden, Spain and Japan (Table 1). ETS is a relatively safe and simple procedure. However the side effects are possibly devastating 2 . All physicians providing this service and all peoples preparing to undergo this treatment should know this well.

calcium accumulation following sympathectomy

Developmental status of sympathetic innervation in relation to calcium accumulation by submandibular gland following reserpine, surgical sympathectomy or cyclocytidine

CA Schneyer and JH Yu
Proceedings of the Society for Experimental Biology and Medicine, Vol 179, 143-146, Copyright © 1985 by Society for Experimental Biology and Medicine

number of hemorrhages in the denervated half of the brain...

Sh. S. Tashaev

Received: 17 March 1980

---

Adaptive function of the sympathetic innervation of the cerebral vessels during rapid changes in systemic arterial pressure


The number of hemorrhages in the denervated half of the brain, which was twice that. in the intact half, is evidence that the sympathetic innervation of the ...
www.springerlink.com/index/T8J46575171L3G34.pdf - Similar pages - Note this
Without Abstract

Key Words adaptation - hemorrhage - hypotension - hypertension - reinfusion

Laboratory of Physiology of the Cerebral Circulation, Professor A. L. Polenov Leningrad Neurosurgical Research Institute. (Presented by Academician of the Academy of Medical Sciences of the USSR V. N. Chernigovskii.) Translated from Byulleten'' Éksperimental''noi Biologii i Meditsiny, Vol. 90, No. 11, pp. 543–546, November, 1980.

sympathetic innervation, adrenergic receptors, and a possible local catecholamine production in the development of patellar tendinopathy (tendinosis)

Studies on the importance of sympathetic innervation, adrenergic receptors, and a possible local catecholamine production in the development of patellar tendinopathy (tendinosis) in man

Patrik Danielson 1 *, Håkan Alfredson 2, Sture Forsgren 1

1Department of Integrative Medical Biology, Section for Anatomy, Umeå University, Umeå, Sweden 2Department of Surgical and Perioperative Science, Sports Medicine, Umeå University, Umeå, Sweden

email: Patrik Danielson (patrik.danielson@anatomy.umu.se)

^*Correspondence to Patrik Danielson, Department of Integrative Medical Biology, Section for Anatomy, Umeå University, SE-901 87 Umeå, Sweden

Funded by:
Faculty of Medicine at Umeå University
The Swedish National Centre for Research in Sports
The County Council of Västerbotten
The Arnerska Research Foundation

Keywords

tyrosine hydroxylase • (alpha)-1 • (alpha)-2A • (beta)-1 • adrenoreceptors • tenocytes

Abstract

Changes in the patterns of production and in the effects of signal substances may be involved in the development of tendinosis, a chronic condition of pain in human tendons. There is no previous information concerning the patterns of sympathetic innervation in the human patellar tendon. In this study, biopsies of normal and tendinosis patellar tendons were investigated with immunohistochemical methods, including the use of antibodies against tyrosine hydroxylase (TH) and neuropeptide Y, and against 1-, 2A-, and 1-adrenoreceptors. It was noticed that most of the sympathetic innervation was detected in the walls of the blood vessels entering the tendon through the paratendinous tissue, and that the tendon tissue proper of the normal and tendinosis tendons was very scarcely innervated. Immunoreactions for adrenergic receptors were noticed in nerve fascicles containing both sensory and sympathetic nerve fibers. High levels of these receptors were also detected in the blood vessel walls; 1-adrenoreceptor immunoreactions being clearly more pronounced in the tendinosis tendons than in the tendons of controls. Interestingly, immunoreactions for adrenergic receptors and TH were noted for the tendon cells (tenocytes), especially in tendinosis tendons. The findings give a morphological correlate for the occurrence of sympathetically mediated effects in the patellar tendon and autocrine/paracrine catecholamine mechanisms for the tenocytes, particularly, in tendinosis. The observation of adrenergic receptors on tenocytes is interesting, as stimulation of these receptors can lead to cell proliferation, degeneration, and apoptosis, events which are all known to occur in tendinosis. Furthermore, the results imply that a possible source of catecholamine production might be the tenocytes themselves. Microsc. Res. Tech., 2007. © 2007 Wiley-Liss, Inc.

---

Received: 4 July 2006; Accepted: 26 October 2006

If you are wondering why did you gain weight since your sympathectomy....

: Am J Physiol Regul Integr Comp Physiol. 2004 Jun;286(6):R1167-75.

Sympathetic innervation of white adipose tissue and its regulation of fat cell number.

Bowers RR, Festuccia WT, Song CK, Shi H, Migliorini RH, Bartness TJ.

Molecular and Cellular Biology and Pathobiology Program, Medical University of South Carolina, Charleston, South Carolina 29425, USA.

White adipose tissue (WAT) is innervated by the sympathetic nervous system (SNS), and the central origins of this innervation have been demonstrated for inguinal and epididymal WAT (iWAT and eWAT, respectively) using a viral transneuronal tract tracer, the pseudorabies virus (PRV). Although the more established role of this sympathetic innervation of WAT is as a major stimulator of lipid mobilization, this innervation also inhibits WAT fat cell number (FCN); thus, local denervation of WAT leads to marked increases in WAT mass and FCN. The purpose of this study was to extend our understanding of the SNS regulation of FCN using neuroanatomical and functional analyses. Therefore, we injected PRV into retroperitoneal WAT (rWAT) to compare the SNS outflow to this pad from what already is known for iWAT and eWAT. In addition, we tested the ability of local unilateral denervation of rWAT or iWAT to promote increases in WAT mass and FCN vs. their contralateral neurally intact counterparts. Although the overall pattern of innervation was more similar than different for rWAT vs. iWAT or eWAT, its SNS outflow appeared to involve more neurons in the suprachiasmatic and solitary tract nuclei. Denervation produced significant increases in WAT mass and FCN for both iWAT and rWAT, but FCN was increased significantly more in iWAT than in rWAT. These data suggest differences in origins of the sympathetic outflow to WAT and functional differences in the WAT SNS innervation that could contribute to the differential propensity for fat cell proliferation across WAT depots in vivo.

The nervous system and adipose tissue

THE NERVOUS SYSTEM AND ADIPOSE TISSUE
Katharine Dalziel, MD, MBBS, MRCP
1989

...whereas sympathectomy abolishes the
vasoconstrictor reaction, indicating that it is mediated by a local sympathetic axon
reflex.

Extraneous agents, such as large doses of alcohol and morphine, cause increased
lipolysis. This action can be blocked by chemical sympathectomy and is believed to be
due to stimulation of the sympathetic system within the central nervous system.9
Thus the control of metabolism in white fat is complex and dependent on many factors,
both within the adipocytes themselves and in the organism as a whole.

Total chemical sympathectomy in experimental
animals results in loss of shivering and nonshivering thermogenesis, and death within a
few hours.9

Since the effects of sympathectomy on the denervated
area are profound with increased blood flow and warmth and decreased sweating, it is
possible that pain relief is secondary to these phenomena without requiring any sort of
aberrant neural conduction.


This has occurred after stellate ganglion
block37 and lumbar sympathectomy.38 McCallurn and Glynn37 propose that increased
activity in the sympathetic nerves as the effects of the anesthetic block lessen cause
pain, particularly in circumstances where there was abnormal sympathetic activity
before the procedure (such as sympathetic dystrophy). This type of pain is often
resistant to opioid analgesics but may respond well to transcutaneous nerve stimulation.

A similar reduction of fat
mobilization from fat depots occurs after VMH lesions, as after local sympathectomy,
suggesting that the sympathetic pathway to the adipose tissue runs through the VMH.71
These hypothalamic control areas are themselves sensitive to feedback mechanisms.

Lactation and sympathectomy

Cannon and Bright (1) concluded that the autonomic nervous system was
essential to lactation, from their work with a sympathectomized dog. They
describe the effect as a belated one which caused the mother to be indifferent
to her young and the gathering of a viscous, creamy material in the glands.

FACTORS INVOLVED IN THE EJECTION OF MILK*
FORDYCE ELY
Kent~wky Agricultural Experiment Station
AND
W. E. PETERSEN
Minnesota Agricultilral Experiment Station

effect on lactation

A BELATED EFFECT OF SYMPATHECTOMY ON LACTATION
Cannon and Bright Am J Physiol.1931; 97: 319-321

Sympathectomy side effects on the Fox News...

http://www.livevideo.com/video/DA86D572A6634B558B52B5B5AF79DE42/ets-fox-news-sympathectomy-sid.aspx

Australian Story2 (rant)

quote from the ets forum:
"I do realise there are sweat tests conducted after a reversal but my point is that doctors do not do these tests on ETS patients. Therefore how can they generalise and say that after ETS CS will be mild or severe?? They do not do follow ups on ETS patients and if a patient complains of heavy CS the doctor may see it as mild and normal CS for statistical purposes."

http://etsandreversals.yuku.com/topic/3016/t/Eastern-Surgical-Australia.html

My question is: did anybody ever made an attempt at quantifying the scale of the 'compensatory sweating" after the surgery? Is there an attempt made to measure the amount of sweating before and after the surgery? Surely not, it would provide the proof that Sympathectomy causes profound sweating. What else could be the reason for not measuring this very significant side-effect? And then, - based on what!!!? - are the surgeons making the sweeping statements about the % of the people and the severity or scale of sweating after the surgery? Or about patient satisfaction rates??? How are these figures made up? Surely nobody bothered to ask any questions from me...

Why are the surgeons not accountable by providing statistical information on the side-effects after the surgery??? Don't they want to know how effective their surgery is? If it is safe ?! Reliable? Does more good then harm???
My surgeon did not schedule a follow up consultation. If I would have not called him (which I almost didn't), he would have never been told about the side-effects I have experienced. Did he file a report on my condition/case? Of course not. It would harm the statistics. (What statistics?!)

Slowly the surgeons admit to more and more side-effects

Go to Dr Reisfeld's web site to read his new comments about ETS: www.sweaty-palms.com/blushing.html

"Another clinical observation which will need more time for verification is the thought that the higher failure rate of sympathectomy when ETS is done only for facial blushing has to do with the fact that when the sympathectomies were done in the past for vascular problems the success rate was very minimal. At this time we know that higher failure rate was due to a clinical situation which we call denervation hypersensitivity. In essense the blood vessels become very sensitive to certain circulating hormones within the blood system. Dr. Reisfeld believes that the same phenomenon happens in this facial blushing presentation. More time and more clinical experience is needed before there can be a more definite conclusion."

Hopefully this may assist court cases but it sounds like Reisfeld is trying to cover his legal liability in his "at the time we thought..." comments.

Also see how the Australian site www.easternsurgical.com.au (click on blushing) have now admitted "some failures" and had to remove their biased comments about 500 consecutive successes.

Unfortunately the more people who have ETS side effects, the more the statistics become 'significant' to such doctors.

Madonna

Australian Story1

ETS studies are not done in the Australian climate and resulting CS means ETS should never have been allowed here without a review. One conducted by Monash University concluded not enough evidence on ETS is available and that existing ETS studies are flawed.These boards are accountable.
.....Madonna Aussie

Norepinephrine Turnover - increase in plasma NE=increase in brain NE

Norepinephrine Turnover Is Increased in Suprabulbar Subcortical Brain Regions and Is Related to Whole-Body Sympathetic Activity in Human Heart Failure

Anuradha Aggarwal, MBBS; Murray D. Esler, MBBS, PhD; Gavin W. Lambert, PhD; Jacqueline Hastings, PhD; Leonie Johnston, RN; David M. Kaye, MBBS, PhD

From the Baker Medical Research Institute, Melbourne, Australia.

© 2002 American Heart Association, Inc.

This study, for the first time, demonstrates elevated suprabulbar subcortical noradrenergic activity in human CHF and identifies a positive correlation between this and the level of whole-body NE spillover. The findings suggest that the activation of noradrenergic neurons projecting rostrally from the brain stem mediates sympathetic nervous stimulation in CHF.

cerebrovascular CO2 reactivity

Acta Physiol Scand. 1977 Sep;101(1):122-5.Links

Effects of intraventricular 6-hydroxydopamine on cerebrovascular CO2 reactivity in anesthetized rats.

Edvinsson L, Hardebo JE, MacKenzie ET.

Regional cerebral blood flow was measured by the 14C-ethanol technique in anesthetized rats before and after intraventricular injection of 6-hydroxydopamine. This treatment reduced the fluorescence of the central noradrenaline and dopamine nerve terminals, as well as of the perivascular nerve terminals in cerebral vessels. The administration of 6-hydroxydopamine had no significant effect on cerebral blood flow at normocapnia. The cerebrovascular reactivity to hypercapnia was significantly increased in the 6-hydroxydopamine treated animals. The results indicate an involvement of central catecholamine pathways in the cerebrovascular reactivity to hypercapnia.

PMID: 906856 [PubMed - indexed for MEDLINE]

catecholamine neuron in cerebral circulation

J Neurosurg. 1986 Sep;65(3):370-5

A role of the central catecholamine neuron in cerebral circulation.

Yokote H, Itakura T, Nakai K, Kamei I, Imai H, Komai N.

The effect of the central catecholaminergic neurons on the cerebral microcirculation was investigated by means of a unilateral intracerebral injection of 6-hydroxydopamine (6-OHDA) which produced the degeneration of catecholamine (CA) nerve terminals. Subsequent observation with CA histofluorescence revealed an absence of CA fibers in the vicinity of the 6-OHDA injection site. A significant increase in regional cerebral blood flow (rCBF), measured by the hydrogen clearance method, was demonstrated in the CA-depleted cortex under normocapnia as compared with rCBF in the control cortex (CA-depleted cortex 47.0 +/- 2.8 ml/100 gm/min; control cortex 38.5 +/- 3.5 ml/100 gm/min; p less than 0.005). The increased rCBF in the cortex treated with 6-OHDA was suppressed by the iontophoretic replacement of noradrenaline (NA) to the CA-depleted cortex. An iontophoretic replacement of 10(-5) M dopamine (DA) mildly suppressed the increased rCBF in the 6-OHDA-treated cortex. The CO2 reactivity in the CA-depleted cortex was significantly lower than that of the control cortex (CA-depleted cortex 2.13% +/- 0.6%/mm Hg; control cortex 3.53% +/- 0.70%/mm Hg). No change was noticeable in the cerebral glucose metabolism in the CA-depleted cortex in an investigation based on tritiated (3H)-deoxyglucose uptake. It is suggested that the 6-OHDA-induced change in cerebral blood flow (CBF) is not secondary to alterations in cerebral metabolic rate, and that the central NA neuron system innervating intraparenchymal blood vessels regulates CBF through a direct vasoconstrictive effect on the cerebral blood vessels. The central DA neuron system may modulate the cerebral circulation as a mild vasoconstrictor.

Why many patients who undergo SYMPATHECTOMY complain about stuffy nose/a cold for life...?!

AJP - Regulatory, Integrative and Comparative Physiology, Vol 253, Issue 3
494-R500, Copyright © 1987 by American Physiological Society

Articles by Haxhiu, M. A.
Articles by Cherniack, N. S.
A role for the ventral surface of the medulla
in regulation of nasal resistance
M. A. Haxhiu, K. P. Strohl, M. P. Norcia, E. van Lunteren,
E. C. Deal Jr and N. S. Cherniack
Nasal resistance is known to be affected by changes in nasal blood volume
and hence to depend on sympathetic discharge to nasal blood vessels.
Structures located superficially near the ventrolateral surface of the medulla
significantly affect respiratory and sympathetic activity and the tone of the
trachea. To assess the importance of these structures on nasal patency, we
measured transnasal pressure at a constant flow and examined the change in
pressure produced by topically applied N-methyl-D-aspartic acid (NMDA).
Experiments were performed in chloralose-anesthetized, paralyzed, and
artificially ventilated cats. NMDA administered on the intermediate area of
the ventral surface of the medulla decreased transnasal pressure and increased phrenic nerve activity. The response to
NMDA could be diminished or abolished by application to the ventral medullary surface of the NMDA antagonist
2-amino-5-phosphonovalerate (2-APV) or the local anesthetic lidocaine. Carotid sinus denervation and
posthypothalamic decerebration did not alter the nasal and phrenic nerve responses to NMDA; however, cervical
sympathetic denervation decreased these responses, both in intact and in bilaterally adrenalectomized animals. Therefore,
activation of NMDA receptors on structures near the ventral surface of the medulla increases tone in the nasal
vasculature and leads to a response pattern that includes changes in not only phrenic nerve activity and blood pressure
but also nasal patency.

Noradrenaline (NA) has been shown to influence astrocytic and vascular functions related to brain homeostasis

Journal of Cerebral Blood Flow & Metabolism (1997) 17, 894–904;
doi:10.1097/00004647-199708000-00008
Astroglial and Vascular Interactions of Noradrenaline Terminals
in the Rat Cerebral Cortex
Noradrenaline (NA) has been shown to influence astrocytic and vascular functions related
to brain homeostasis, metabolism, local blood flow, and blood-brain barrier permeability.
In the current study, we investigate the possible associations that exist between
NA-immunoreactive nerve terminals and astrocytes and intraparenchymal blood vessels
in the rat frontoparietal cortex, both at the light and electron microscopic levels. As a
second step, we sought to determine whether the NA innervation around intracortical
microvessels arises from peripheral or central structures by means of injections of
N-(2-chloroethyl-N-ethyl-2-bromobenzylamine) (DSP-4), a neurotoxin that specifically
destroys NA neurons from the locus ceruleus. At the light microscopic level, 6.8% of all
NA-immunoreactive nerve terminals in the frontoparietal cortex were associated with
vascular walls, and this perivascular noradrenergic input, together with that of the cerebral
cortex, almost completely disappeared after DSP-4 administration. When analyzed at the
ultrastructural level in control rats, NA terminals in the neuropil had a mean surface area
of 0.53 0.03 m2 and were rarely junctional (synaptic incidence close to 7%). Perivascular
terminals (located within a 3-m perimeter from the vessel basal lamina) counted at the
electron microscopic level represented 8.8% of the total NA terminals in the cortical tissue.
They were smaller (0.29 0.01 m2, P < 0.05) than their neuronal counterparts and were
located, on average, 1.34 0.08 m away from intracortical blood vessels, which consisted
mostly of capillaries (65%). None of the perivascular NA terminals engaged in junctional
contacts with surrounding neuronal or vascular elements. The primary targets of both
neuronal and perivascular NA nerve terminals consisted of dendrites, nerve terminals,
astrocytes, and axons, whereas in the immediate vicinity (0.25 m or less) of the
microvessels, astrocytic processes represented the major target. The results of the current
study show that penetrating arteries and intracortical microvessels receive a central NA
input, albeit parasynaptic in its interaction, originating from the locus ceruleus.
Particularly, they point to frequent appositions between both neuronal and perivascular
NA terminals and astroglial cells and their processes. Such NA neuronal-glial and
neuronal-glial-vascular associations could be of significance in the regulation of local
metabolic and vascular functions under normal and pathologic situations.