The autonomic nervous system and cardiac arrhythmias

Disturbed autonomic nervous 'balance' of the sympathetic nervous and vagal outflows to the heart potentiates the experimental development of ventricular arrhythmias in laboratory animals. For some time the best evidence for the occurrence of a similar phenomenon in humans was provided by the long QT interval syndrome, sufferers of which are very prone to develop serious ventricular arrhythmias and in whom evidence exists of abnormal anatomy and function of the cardiac sympathetic nerves. Recently the case for disturbed autonomic function causing clinical arrhythmias has become more broadly based. Reduced baroreflex sensitivity after myocardial infarction, and low heart rate variability, both of which rest largely on vagal underactivity, have been shown to be associated with substantially increased risk of subsequent sudden death.
Esler M.
Baker Medical Research Institute, Prahran, Australia.
Clin Auton Res. 1992 Apr;2(2):133-5.

No sensation of 'thrill' on the sympathtectomized side of the body

Sweet has reported the case of a very intelligent patient, the dean of a graduate school, who after a unilateral sympathectomy to treat his upper limb hyperhydrosis, found that his previous and customary sensation of shivering while listening to a stirring passage of music
occurred in only one side and he could not be thrilled in the sympathectomized half of his body. These cases were interesting because emotions are usually experienced in a rather diffuse 
and bilateral fashion unless innervation has been specifically interrupted. 

Physical Control of the Mind: Toward a Psychocivilized Society
By José Manuel Rodríguez Delgado
Published by Harper & Row, 1969
p. 133-134

Central nervous system activation following peripheral chemical sympathectomy

Callahan TA, Moynihan JA, Piekut DT.

Brain Behav Immun. 1998 Sep;12(3):230-41.

Many studies have demonstrated that ablation of the sympathetic nervous system (SNS) alters subsequent immune responses. Researchers have presumed that the altered immune responses are predominantly the result of the peripheral phenomenon of denervation. We, however, hypothesized that chemicalsympathectomy will signal and activate the central nervous system (CNS).

Activation of the CNS was determined by immunocytochemical visualization of Fos protein in brains from male C57BL/6 mice at 8, 24, and 48 h following denervation. A dramatic induction of Fos protein was found in the paraventricular nucleus (PVN) of the hypothalamus and other specific brain regions at 8 and 24 h compared to vehicle control mice. Dual-antigen labeling demonstrates that corticotrophin releasing factor (CRF)-containing neurons in the PVN are activated by chemical sympathectomy; however, neurons containing neurotransmitters which may modulate CRF neurons, such as vasopressin, tyrosine hydroxylase, and adrenocorticotropin, do not coexpress Fos. Our findings suggest an involvement of the CNS in sympathectomy-induced alterations of immunity.

norepinephrine could not be synthesized and/or accumulated in the heart following bilateral cervical sympathectomy

After bilateral cervical sympathectomy, the norepinephrine content show a rapid decrease from 4 days to 7 days and a slow decrease within the following 14 days. No tendency of recovery was apparent in the heart for 50 days following the operation, the norepinephrine content remaining almost at an equal level.
It was postulated that norepinephrine could not be synthesized and/or accumulated in the heart following bilateral cervical sympathectomy, but that cardiac muscle might synthesize dopamine for itself.

Japanese circulation journal

Vol.29, No.1(19650120) pp. 11-15

KIMATA SHIN-ICHI ¹

¹The Third Department of Internal Medicine, Faculty of Medicine, University of Tokyo

sympathetic denervation with minor arrhythmias

Based on the above findings, we suggest myocardial sympathetic denervation with lowered initial H/M (heart-to-mediastinum count ratios) will develop following surgical sympathectomy at upper cervical ganglia, which will accompanied by compensated uptake-1 system on presynaptic nerve endings of postganglionic neuronal cells, demonstrated by lowered MWO, and preserved homodynamic function and ECG changes except for minor arrhythmias.

Hemodynamic and ECG changes associated with deteriorations in 123I-MIBG adrenergic myocardial imaging following surgical sympathectomy in SD rats

Cheng-Yi Cheng¹, Nien-Hsien Liou², Chieh-Ling Kao², An-Sui Yang³, Lei-Hang Shen³, Ging-Cheng Perng¹ and Wen-Sheng Huang¹

¹ Department of Nuclear Medicine, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan; ; ² Institute of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan; ; ³ Institute of Nuclear Energy Research, Taipei, Taiwan

http://jnumedmtg.snmjournals.org/cgi/content/meeting_abstract/48/MeetingAbstracts_2/226P-b

sympathectomy on muscle fibre composition

We have previously reported functional and histological studies in five beagle dogs with unilateral lumbar sympathectomy. Three months later, fatiguability in the gracilis muscles was increased on the denervated sides, and this was associated with an increase in the relative distribution of FT fibres. Biochemical studies now show that these changes were associated with an increase in cytosolic protein without change in DNA content; this is consistent with an increase in cell size. There was a reduction in the proportion of slow myosin light chain isoforms from 50 ± 7 to 34 ± 6%. Noradrenaline levels were increased on the denervated sides but this may reflect greater vascularity. Calcium content did not correlate with fibre type but there was a positive relation with both noradrenaline content (r= 0·73; P<0 class="i">r= 0·84; P<0 span=""> It is concluded that sympathectomy induces several biochemical changes in skeletal muscle which constitute a change and increase in fast myosin light chain synthesis and a corresponding fibre type transformation.

Correspondence to ¹ Department of Clinical Physiology, Karolinska Hospital, S-104 01 Stockholm, SwedenReceived 24 August 1987; accepted 26 October 1987
http://www3.interscience.wiley.com/journal/119466197/abstract

irreversible deterioration in cardiac function

The concept of posterior nerve root section was resurrected 10 years later, when Danielopolu (Director of the Second Medical Clinic at the University of Bucharest) criticized the Jonnesco-type sympathectomy on the grounds that it produced an irreversible deterioration in cardiac function. He therefore directed his surgical colleague, Hristide, to cut the posterior roots of the upper thoracic spinal nerves which divided only sensory fibres.
Danielopolou later declared cervicothoracic sympathectomy to be disastrous, from the therapeutic point of view, and concluded that removal of the stellate ganglion for angina was incompatible with life.

Landmarks in Cardiac Surgery

By Stephen Westaby, Cecil Bosher
Published by Informa Health Care, 1997

Phenol application Asynchronous wall motion Impaired nerve conduction Contraction disparity

EFFECT OF LOCAL CARDIAC SYMPATHECTOMY ON REGIONAL MYOCARDIAL CONTRACTION

KOMATSU EIICHI YAMAGUCHI ICHIRO MIYAZAWA KOZUI

These observations indicated that the abnormal pressure-length loop was derived from the delayed contraction in the phenol treated region.
Japanese circulation journal

Vol.52, No.7(19880720) pp. 617-623

Sympathectomy induces novel purinergic sensitivity

Twenty eight percent of the spontaneously active afferent fibres from sciatic nerves in the sympathectomyzed rats responded to ATP, either with an increase or with a decrease in spontaneous firing. However, none of the fibres from the sciatic nerves in the intact rats was activated by ATP.

Sympathectomy induces novel purinergic sensitivity in A afferents from sciatic nerve.
It is thought that this novel purinergic sensitivity may contribute to neuropathic paraesthesia and pain.
CHEN YONG, ZHANG YI-HONG, BIE BI-HUA, ZHAO ZHI-QI
Shanghai Institute of Physiology, Chinese Academy of Sciences
Acta Pharmacol Sin, 2000 Nov; 21 (11):1002-1004

Pulmonary function abnormalities following upper dorsal sympathectomy for hyperhidrosis

Spirometry 3 months after surgery showed a significant decrease in the forced vital capacity (−5.2%), the forced expiratory volume in the first second (−6.1%), and the forced expiratory flow between 25% and 75% of vital capacity (−5.1%). Whereas methacholine challenge testing before surgery was positive in 3 subjects (2 of whom were asthmatic), it was positive in 6 patients after the procedure; differences were not statistically significant. After 12 months, forced vital capacity started recovering, and forced expiratory volume in the first second and forced expiratory flow rate 25% to 75% showed a sustained and significant reduction (−2.8% and −11.2%, respectively.

The Journal of Thoracic and Cardiovascular Surgery , Volume 129 , Issue 6 , Pages 1379 - 1382

M . Ponce González , G . Julià Serdà , N . Santana Rodríguez , P . Rodríguez Suárez , G . Pérez Peñate , J . Freixinet Gilart , P . Cabrera Navarro

Sympathectomy on the Cardiac Neurovegetative Equilibrium

Since the first attempts of T. Jonnesco’ to treat angina pectoris by
means of cervico-thoracic sympathectomy, many surgeons have applied
similar techniques with satisfactory results in the majority of instances.2
Nearly without exception, the operations were performed with the de-
clared purpose to sever sensory, pain-conveying, afferent nervous path-
ways, and without realization of the fact that (except in the case of
exclusive section of the posterior roots), the norepinephrine-discharging,
pain-producing efferent sympathetic fibers3 were, likewise, interrupted.
In animal experiments, it has been shown that electrical stimulation
of the cardiac sympathetic nerves is followed by an accumulation of
catecholamines,4.s especially of norepinephrine,’ in the myocardium,
whereas the cardiac catecholamine stores are largely depleted by sym- 
pathectomy.7” 

The prolongation of the isometric (tension) period (TP) of the left ventricle which
occurred in the majority (72 per cent) of all cases after unilateral or bilateral trans-
thoracic sympathectomy (without or with unilateral or bilateral transthoracic splanch-
nicotomy) indicates a diminution of inotropic cardiac action. It can be assumed to
correspond to the cholinergic (vagal) preponderance which results from a partial or
complete sympathetic denervation of the heart. Reduction of the pulse pressure oc-
curred in 56 per cent of the cases, probably due to the same mechanism. The be-
havior of the heart rate was too irregular to permit any conclusions. Apparently, the
Inotropic mechanisms of the heart are more sensitive to sympathetic denervation than
the chronotropic ones. 

The seemingly paradoxical shortening of TP which was persistently maintained,
e.g., in the case of patient 16 over a period of more than five months, is possibly to
be explained as a manifestation of Cannon’s “law of denervation” according to which
the catecholamine sensitivity of sympathetically denervated structures Is greatly aug-
mented, and which has more recently been confirmed also in instances of functional
sympathetic “denervation” (catecholamine deprivation of cardiovascular tissues)
through gangllomc blockade” or rauwolfia drugs.’6 This would mean in the present
cases that their partly or wholly sympathectomized hearts had become oversensitive to
whatever active catecholamines (norepinephrine, eplnephrine) may have reached them
either from remaining sympathetic fibres or through the blood stream. Individual
differences in relative reactivity to two mutually antagonistic factors ([a] absolute
loss of catecholammes, and Eb] exaggerated catecholamine sensitivity, caused by [a 1),
combined with the individual magnitude of absolute cardiac cholinergic activity, may
account for the prevalence of either negative or positive Inotropic cardiac reactions
to sympathectomy.

DOI 10.1378/chest.38.4.423
1960;38;423-428 Chest

W. RAAB, E. KUX and H. MARCHET

Baroreflex Control of Heart Rate during Cardiac Sympathectomy

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.
Anesth Analg 1983; 62:815-820
http://www.anesthesia-analgesia.org/cgi/content/abstract/62/9/815

Ventricular Ectopic Rhythms and Ventricular Fibrillation Following Cardiac Sympathectomy

A. Sidney Harris, Antonio Estandia and Rex F. Tillotson
From the Department of Physiology, Baylor University College of Medicine, Huston, Texas
Am J Physiol 165: 505-512, 1951;

Chemical sympathectomy-induced changes in TH-, VIP-, and CGRP-immunoreactive fibers

Journal of Cellular Physiology

Volume 194 Issue 3, Pages 341 - 348

Published Online: 10 Jan 2003

http://www3.interscience.wiley.com/journal/102523100/abstract

Heat loss due to sympathectomy-induced vasodilation

Hypothermia (a decrease in core temperature) is common in patients undergoing surgery with epidural anesthesia an is thought to result from heat loss to the cold environment due to sympathectomy-induced vasodilation.
Sympathectomy-induced vasodilation produced central hypothermia via net convection of the heat from the warmer central to cooler peripheral tissues. The net effect is an increase in peripheral tissue temperature at the expense of decreased central temperature.

Neural Blockade in Clinical Anesthesia and Management of Pain

By Michael J. Cousins, Phillip O. Bridenbaugh

Contributor Michael J. Cousins

Published by Lippincott Williams & Wilkins, 1997

p. 277

Hyperpigmentation after sympathectomy

Clin Exp Dermatol. 1980 Sep;5(3):349-50.
Samuel C, Bird DR, Burton JL.

Disabling Orthostatic Hypotension Caused by Sympathectomies for Hyperhidrosis

Syncope Cases

Published Online: 16 Nov 2007

Editor(s): Roberto Garc�a-Civera, Gonzalo Bar�n-Esquivias, Jean-Jacques Blanc, Michele Brignole, Angel Moya i Mitjans, Ricardo Ruiz-Granell, Wouter Wieling

Print ISBN: 9781405151092 Online ISBN: 9780470995013

Copyright © 2006 by Blackwell Publishing

http://www3.interscience.wiley.com/cgi-bin/summary/116842153/SUMMARY

A mismatch between intravascular volume and the required cardiac output on standing up is the most common cause of orthostatic hypotension. In a small minority of cases, however, orthostatic hypotension is not caused by volume depletion, but by impairment of the autonomic reflexes required to maintain blood pressure in the upright position. This disorder is known as autonomic failure.

In patients with autonomic failure, orthostatic hypotension is caused by an impaired capacity of sympathetic nerves to increase vascular resistance. Downward pooling of venous blood and a consequent reduction in stroke volume and cardiac output lead to the orthostatic fall in arterial pressure.

Adrenal Insufficiency after sympathectomy

A Study of Adrenal Insufficiency After Treatment of Hypertension by Bilateral Sympathectomy Plus Unilateral Adrenalectomy

Chapter Author: P. Etienne-Martin

http://www3.interscience.wiley.com/cgi-bin/summary/119228241/SUMMARY

Copyright © 1954 Ciba Foundation

Structural changes of arteries after sympathectomy

The findings indicate that in renal hypertensive rats structural changes of both large arteries and veins may develop in the absence of an intact sympathoadrenergic system.

Effect of sympathectomy on arterial and venous changes in renal hypertensive rats

G. Simon
Am J Physiol Heart Circ Physiol 241: H449-H454, 1981;

The place of sympathectomy in the treatment of young married women

J Obstet Gynaecol Br Emp. 1954 Dec;61(6):797-803.

Related Articles, Links

GRANT TP.

The obstetrical future of woman having undergoing lumbodorsal sympathectomy for hypertension

Presse Med. 1953 Feb 21;61(12):227-9.
MILLIEZ P, FRITEL D.

PET Imaging of Oxidative Metabolism Abnormalities in Sympathetically Denervated Myocardium

The average percentage of the left ventricle denervated in the group I animals was 13.1% ±7.3%.
Significant reductions in oxidative metabolism were observed in the sympathectomized tissue both at 2 and 8 wk after surgery (22% and 15% reductions, respectively).

Gary D. Hutchins, Timothy Chen, Kathy A. Carlson, Richard L. Fain, Wendy Winkle, Triad Vavrek, Bruce H. Mock
and Douglas P. Zipes
J NucÃ-Med 1999; 40:846-853

hypersensitization of adenoreceptors in the sympathectomized area

Radiofrequency neurolysis (RFN) is becoming a popular method of sympathectomy among pain specialists. The advantages of RFN over chemical and surgical sympathectomy are decrease incidence of neuritis, avoidance of tinitus, blindness and urethral stricture that can occur with chemical sympathectomy, amelioration of anesthetic and surgical risks and early ambulation of the patient. The reasons for the failure of sympathectomy are incomplete sympathectomy, extensive interconnection of chains of sympathectomy ganglia cause rerouting of sympathetic impulse after removal of short chain of ganglia, and hypersensitization of adenoreceptors in the sympathectomized area.

Meraj Siddiqui, Shazia Siddiqui, J. Sue Ranasinghe & Fred Furgang: Complex Regional Pain Syndrome: A Clinical Review: Pain, Symptom Control and Palliative Care. 2001; Volume 2, Number 1.

http://ispub.com/IJPSP/2/1/8541

cardiovascular adjustment to exercise and sympathectomy

Mean arterial pressure and total peripheral resistance were significantly reduced at rest and during steady state of exercise as compared to controls prior to sympathectomy identical vO₂, whereas CO remained unchanged.

The significant fall in left circumflex coronary flow was proportional to the decline in external heart work due to sympathectomy both at rest and under exercise.

http://www.springerlink.com/content/k2n6j4555g16x773/

Coronary blood flow reduced by 50% after sympathectomy

However, at each level of exercise, mean coronary flow in sympathectomized ventricles was reduced by about 50% compared to control values. The slopes of coronary flow on pressure-rate product and tension-time index were also reduced. No difference in left ventricular oxygen extraction between control and sympathectomized hearts were observed. Thus, chronic ventricular sympathectomy altered the relationships between coronary flow and oxygen consumption, on the one hand, and ventricular oxygen-dependent performance and whole-body exercise level, on the other hand.
Med Sci Sports Exerc. 1988 Apr;20(2):126-35.
http://www.ncbi.nlm.nih.gov/pubmed/3367747

Sympathectomy impaired the PTH response to hypocalcaemia

Clinical Physiology and Functional Imaging

Volume 10 Issue 1, Pages 37 - 53
Published Online: 28 Jun 2008

surgical sympathectomy is known to induce resorption within mandibular and auditory bulla bone

Bone destruction causes hearing loss in various middle ear disorders. The mechanisms of such pathological remodeling are unknown.
Unilateral surgical sympathectomy is known to induce resorption within mandibular and auditory bulla bone. Explanation of the cause of this effect, however, may be confounded by hemodynamic changes induced by hemicranial sympathectomy and by uncertainty as to the neuroanatomical origins of sympathetic fibers.
Ann Otol Rhinol Laryngol. 1999 Nov;108(11 Pt 1):1078-87.
http://www.ncbi.nlm.nih.gov/pubmed/10579236

Changes in Parathyroid Hormone and Calcium Levels after Superior Cervical Ganglionectomy of Rats

Changes in Parathyroid Hormone and Calcium Levels after Superior Cervical Ganglionectomy of Rats

23-26 h after SCGx there is a significant impairment of homeostatic iPTH responses to low Ca levels which can be overcome by suitable Ca stimulus; (3) circulating catecholamines may affect denervated parathyroid cells, as revealed by the changes in serum iPTH and Ca elicited by - and -adrenoceptor-blocker treatment of SCGx rats.

Daniel P. Cardinali, Marta G. Ladizesky

Vol. 40, No. 4, 1985

Amygdala and aversive conditioning

Lesioned rats and controls were again tested for aversive conditioning to explicit and contextual cues. Rats with cell body lesions of the hippocampus showed normal suppression of drinking in the presence of the conditioned stimulus, but were severely impaired in choosing the safe environment based on contextual cues alone. These results suggest a double dissociation of the effects of amygdala and hippocampal damage on fear conditioning to explicit and contextual cues.

Complementary roles for the amygdala and hippocampus in aversive conditioning to explicit and contextual cues.

[My paper] N R Selden, B J Everitt, L E Jarrard, T W Robbins

Department of Experimental Psychology, University of Cambridge, U.K.

Neuroscience. 1991 ;42:335-50 1832750

Peripheral sympathectomy resulted in 2- to 5-fold increases in NGF protein levels in heart atrium and ventricle

Peripheral sympathectomy carried out in the adult rat resulted in 2- to 5-fold increases in NGF protein levels in heart atrium and ventricle, as well as submandibular gland, with no concomitant increase in NGF mRNA.

Increased beta-nerve growth factor messenger RNA and protein levels in neonatal rat hippocampus following specific cholinergic lesions.

[My paper] S R Whittemore, L Lärkfors, T Ebendal, V R Holets, A Ericsson, H Persson

J Neurosci. 1987 Jan ;7 (1):244-51 3806196

Sympathectomy Attenuates the Maintenance but Not Initiation of L-NAME– Induced Hypertension

We measured intra-arterial pressure in conscious, unrestrained rats with and without guanethidine-induced sympathectomy during varying durations of intravenous N-nitro-L-arginine methyl ester (L-NAME). The major new finding is that sympathectomy had no effect on the hypertensive response to bolus injections of L-NAME but in the same rats it produced a greater than 50% attenuation in the hypertension seen after 6 days of continuous L-NAME (change in mean arterial pressure, 23±4 versus 55±4 mm Hg,
P<.01, sympathectomy versus control). Using 8-hour infusions of L-NAME, we found that 60 minutes was the minimum time required for detecting a sympathectomy-sensitive component of L-NAME–induced hypertension. Furthermore, we demonstrate that the magnitude of this component increases further between 8 hours to 6 days of continuous L-NAME: it accounted for only 18% of the total hypertensive response at 8 hours but 61% after 6 days. From these experiments, we conclude that the importance of the sympathetic system in the pathogenesis of L-NAME–induced hypertension accrues slowly over hours and days, and thus its importance can be overlooked by focusing on the initial phase of the hypertension. (Hypertension. 1997;30[part 1]:64-70.) Sander, Mikael; Hansen, Jim; Victor, Ronald G.

Anti-inflammatory role of the sympathetic nerves

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.

http://gut.bmj.com/cgi/content/abstract/57/7/911

In a person who had a sympathectomy, the sympathetic component of the baroreceptor mechanism is absent

A patient with a sympathectomy would experience what's referred to as orthostatic hypotension (which might lead to syncope). Orthostatic hypotension is a decrease in arterial pressure when going from supine to a standing position. A person with a normal baroreceptor mechanism will try to restore MAP. In a person who had a sympathectomy, the sympathetic component of the baroreceptor mechanism is absent.
M.A.S.T.E.R. Learning Program, UC Davis School of Medicine
Date Revised: Jan 16, 2002
Revised by: Gordon Li and Carolyn Nguyen

Sympathectomy causes ejaculatory dysfunction

We conclude that sympathectomy delays the transit of sperm through the cauda epididymidis and produces ejaculatory dysfunction but does not compromise sperm quality in the distal cauda epididymidis.
Biology of Reproduction 59, 897-904 (1998)

http://www.biolreprod.org/cgi/content/full/59/4/897

Sympathectomy reduces catecholamines

Sympathectomy has been used to study the role of the sympathetic nervous system in the control of gastric acid secretion. Conflicting results may reflect differences in the sympathectomy procedures used. In a previous study we showed a reduction of catecholamines by more than 90% in the gut wall of the rat after surgical upper abdominal sympathectomy.
Scand J Gastroenterol. 1985 Dec;20(10):1276-80.
http://www.ncbi.nlm.nih.gov/pubmed/4095497

Informed consent - from the ets forum

Physicians are required to gain informed consent prior to administering a treatment. Informed consent is gained by providing patients with a full accounting of the risks of the treatment as documented in peer-reviewed, published medical/scientific literature.

Your scenario of surgeons being flummoxed by unhappy patients complaining after surgery doesn't hold water. The rules of professional medical ethics require that the treating physician be well versed in the published literature on the treatments he delivers.

There is a mountain of published research (spanning nearly a century) documenting the adverse effects of sympathectomy. There are numerous studies, for example, showing very high rates of severe side effects and studies showing that satisfaction diminishes substantially over the long term.

It is a doctors job to know this stuff and it is their ethical duty to disclose that information to patients.

So, I see the blame thing as pretty cut and dry. Surgeons perfoming sympathectomies routinely withhold information vital to informed consent. Anyone who does objective comparison between what is documented in medical/scientific literature and what is typically disclosed to prospective ETS patients has no choice but reach this conclusion.

And, to make matters worse, many surgeons use testimonials from a hand-selected group of their happiest patients to advocate the surgery. That practice is considered unethical by all medical professional organizations.

http://etsandreversals.yuku.com/directory

Adrenal Tyrosine Hydroxylase: Compensatory Increase in Activity after Chemical Sympathectomy

Destruction of peripheral sympathetic nerve endings with 6-hydroxydopamine causes a disappearance of cardiac tyrosine hydroxylase, accompanied by a twofold increase in adrenal tyrosine hydroxylase and a small increase in phenyl-ethanolanine-N-methyl transferase.
Robert A. Mueller ¹, Hans Thoenen ¹, and Julius Axelrod ¹
Science 31 January 1969:
Vol. 163. no. 3866, pp. 468 - 469
DOI: 10.1126/science.163.3866.468

Cardiac hypertrophy accelerated by left cervical sympathectomy

Cellular and Molecular Life Sciences (CMLS)
Volume 37, Number 7 / July, 1981

Summary Cardiac hypertrophy in spontaneously hypertensive rats was accelerated by denervation of the left cervical sympathetic ganglia. Supersensitivity due to denervation may also exist in cardiac muscles.

This work was supported by a grant of the Ministry of Education for 1980.

Joint inflammation is reduced by dorsal rhizotomy and not by sympathectomy or spinal cord transection

Ann Rheum Dis. 1994 May; 53(5): 309–314.

PMCID: PMC1005329

Joint inflammation is reduced by dorsal rhizotomy and not by sympathectomy or spinal cord transection.

K A Sluka, N B Lawand, and K N Westlund

Marine Biomedical Institute, University of Texas Medical Branch, Galveston 77555-0843
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1005329

NMDA and Sympathectomy

CONCLUSIONS: NMDA receptor is related to the induction and maitenance of neuropatic pain, and sympathetic nervous system has a main role in the already induced neuropathic pain.
The Effects of NMDA Antagonists and Sympathectomy on the c-Fos mRNA Expression in the Neuropathic Rat.
http://www.koreamed.org/SearchBasic.php?DT=1&RID=47481

Role of Dopamine in behavior modulation

These findings support the idea that DA signals errors in expectancy and that DA signaling is necessary for certain behavioral responses to unexpected events.
Behavioural Brain Research
Volume 122, Issue 2, 1 October 2001, Pages 193-199
Mitchell F. Roitman^a, Gertjan van Dijk^b, Todd E. Thiele^c and Ilene L. Bernstein^{, ,}

Sympathectomy eliminates the fight-or flight response and is used as a surgical treatment of anxiety disorders and phobias

What the myriad of anxiety disorders have in common is a state of increased arousal or fear. Anxiety disorders often are conceptualized as an abnormal or exaggerated version of arousal. Much is known about arousal because of decades of study in animals and humans of the so-called fight-or-flight response, which also is referred to as the acute stress response. The acute stress response is critical to understanding the normal response to stressors and has galvanized research, but its limitations for understanding anxiety have come to the forefront in recent years.

Thoracic Sympathectomy In Social Phobia: A Pilot Study

http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijs/vol7n2/social.xml

Recurrent and enhanced vasoconstrictor function makes Sympathectomy a questionable treatment for vascualr disorders

T2 sympathectomy leads to long-lasting inhibition of palmar sweating, which does not correlate to loss of vasoconstriction. Recurrent and enhanced vasoconstrictor function 3 months following endoscopic sympathetic block has major implications for its use to treat enhanced vasoconstriction.
http://www.neurology.org/cgi/content/abstract/60/11/1770
Neurology 2003;60:1770-1776
© 2003 American Academy of Neurology

Norepinephrine activates pain pathways after nerve injury

According to MedicineNet, RSD involves "irritation and abnormal excitation of nervous tissue, leading to abnormal impulses along nerves that affect blood vessels and skin."

Animal studies indicate that norepinephrine, a catecholamine released from sympathetic nerves, acquires the capacity to activate pain pathways after tissue or nerve injury, resulting in RSD.
http://arthritis.about.com/od/rsd/a/rsd.htm

Autonomic Hyperreflexia is caused by noxious stimulation below the level of the lesion in a patient with a sympathectomy at or above T6

...The efferent sympathetic fibers recover from the initial injury but remain unaffected by central inhibitory input from the brain stem and hypothalamus.
The severity and manifestations of autonomic hyperreflexia are affected by the level of the sympathectomy. With mid-thoracic lesions below the level of cardiac accelerator fibers, hypertension is accompanied by reflex bradycardia transmitted via cardiac accelerator fibers and the vagus. In patients whose sympathectomy is above the level of the thoracic cardiac accelerator fibers, tachycardia may occur because cardiac accelerator fibers become part of the efferent sympathetic activity rather than part of the central inhibitory input from the brain stem and hypothalamus. Arrythmias and occasional heart block may accompany changes in heart rate.
Clinical manifestations of autonomic hyperreflexia include vasodilation, decresed sympathetic activity, and increased vagal activity above the level of the lesion such as nasal congestion, flushing, headache, dyspnea, nausea, and visceral muscle contraction. Vasoconstriction and increased sympathetic activity below the level of the lesion cause vasoconstrictive pallor, sweating, piloerection, and somatic muscle fasciculation. Patients also develop hypertension with headache, blurred vision, myocardial infarction, andretinal, subarachnoid and cerebral hemorrhages that may lead to syncope, convulsion and death.
Handbook of Neuroanesthesia
page 343

By Philippa Newfield, James E. Cottrell

Contributor Philippa Newfield, Stephen Onesti, James E. Cottrell

Published 2006, Lippincott Williams & Wilkins

Sympathectomy suppresses cell-mediated (T helper-1) responses

In vivo, chemical sympathectomy suppresses cell-mediated (T helper-1) responses, and may enhance antibody (T helper-2) responses. Noradrenergic innervation of spleen and lymph nodes is diminished progressively during aging, a time when cell-mediated immune function also is suppressed. In animal models of autoimmune disease, sympathetic innervation is reduced prior to onset of disease symptoms, and chemical sympathectomy can exacerbate disease severity.
Annu Rev Pharmacol Toxicol. 1995;35:417-48.

Substance P has a proinflammatory role

These studies have been carried out in a large number of patients with long-standing autoimmune diseases. It turned out that sympathetic nerve fibers are lost in chronically inflamed tissue, while substance P-positive nerve fibers sprout into the inflamed area.

Brain Behav Immun. 2007 Jul;21(5):528-34. Epub 2007 May 22. Links

http://www.ncbi.nlm.nih.gov/pubmed/17517488?ordinalpos=58&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Brain-Adipose tissue cross talk

Local injections of the sensory nerve neurotoxin capsaicin into WAT selectively destroy this innervation. Just as surgical removal of WAT pads triggers compensatory increases in lipid accretion by non-excised WAT depots, capsaicin-induced sensory denervation triggers increases in lipid accretion of non-capsaicin-injected WAT depots, suggesting that these nerves convey about body fat levels to the brain.
Proc Nutr Soc. 2005 Feb;64(1):53-64.
http://www.ncbi.nlm.nih.gov/pubmed/15877923?ordinalpos=21&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSuminformation

risk of vascular insufficieny and subsequent dysfunction of thoracolumbar autonomic outflow to the head and neck

Cadaveric studies of the blood supply to the human cervical sympathetic chain and ganglia are lacking in the English literature. This study seeks to elucidate the gross blood supply of the cervical sympathetic chain so as to avoid surgical disruption of these vessels and thus decrease the risk of vascular insufficieny and subsequent dysfunction of thoracolumbar autonomic outflow to the head and neck.

Conclusions: Although sympathetic injury is a rare consequence of cervical operations, the current data should be useful to the surgeon who operates in the cervical region so as to avoid potential complications from disruption of the primary blood supply of the cervical sympathetic chain and ganglia.
European Journal of Morphology, Volume 40, Issue 5 December 2002 , pages 283 - 288
http://www.informaworld.com/smpp/content~content=a725290831~db=all

Parallels between post sympathectomy symptoms and Spinal Cord Injury symptoms

Autonomic component of spinal cord injury:

Hypotension, Skin Hyperaemia, Bradycardia (unopposed vagatonia), Low body temperature - high skin temperature,

Spinal shock involves loss of sympathetic autonomic function.

Secondary changes:
-Accumulation of extracellular neurotransmitters: Serotonin, Catecholamines, Glutamate are TOXIC to cells
-Free radical accumulation

http://209.85.173.132/search?q=cache:Yir6NMnAPdEJ:www.drramani.com/presentations/Acute_Spinal_Cord_Injury.pdf+compression+of+the+cervical+sympathetic+chain&hl=en&ct=clnk&cd=69&gl=au&client=firefox-a

Sympathetic chain injury called 'complication'. Now this same 'complication' is marketed for people with palmar hyperhidrosis and blushing.

Cervical sympathetic chain injury is a rare complication of surgery for thyroid and parathyroid conditions.
ANZ Journal of Surgery. 74(6):442-445, June 2004.
HARDING, JANE L. MB BS; SYWAK, MARK S. MB BS, FRACS; SIDHU, STAN MB BS, PhD, FRACS; DELBRIDGE, LEIGH W. MD, FRACS

Eye innervation - part of the thermoregulatory system

Our results show that cold thermoreceptors sensitive to small temperature changes are distributed throughout the entire ocular surface, most frequently in the highly vascularized perilimbal episclera, but also in the posterior segment of the eye. Nerve fibers activated by cold had spotlike receptive fields and responded to temperature reductions with a nerve impulse discharge that started as soon as the local temperature began to decline, and increased monotonically in firing frequency in parallel with the decrease in temperature.
http://www.iovs.org/cgi/content/full/44/2/697

Transection of the sympathetic chain

Activating transcription factor 3 immunoreactivity identifies small populations of axotomized neurons in rat cervical sympathetic ganglia after transection of the preganglionic cervical sympathetic trunk.

These data indicate that, after transection of the CST, neuronal labeling in the SCG and MICG is restricted to axotomized neurons but that in addition there is extensive labeling of glial cells associated with anterograde degeneration within the SCG.
http://www.nextbio.com/b/literature/literature.nb?id=17583680&query=Right+cervical+sympathetic+trunk&author=

Selective brain cooling following sympathectomy

We have investigated the role of the sympathetic innervation of the vasculature of the head in the control of selective brain cooling of sheep, during exposure to high and low ambient temperatures and during endotoxin-induced fever. Bilateral removal of the superior cervical ganglia resulted in a significant reduciton of hypothalamic temperture during all procedures. Respiratory rate was also depressed by the sympathectomy, apparently mainly as a result of a decrease in nasal airway patency. Rectal temperature changes after sympathectomy were dependent on the experimental conditions, and the rectal — hypothalamic temperature difference was enhanced during heat exposure and fever. Our results support the contention that sympathetically mediated changes in nasal blood flow and in venous return from the nasal cavity, via the angularis oculi and facial veins, may be involved in the control of selective brain cooling in sheep.

	Pflügers Archiv European Journal of Physiology
Publisher	Springer Berlin / Heidelberg
ISSN	0031-6768 (Print) 1432-2013 (Online)
Issue	Volume 417, Number 4 / December, 1990

various other central physiological and metabolic events in cervical sympathectomized animals

Studies were conducted confirming supersensitivity to catecholamines on intraocular pressure and pupil size following bilateral superior cervical ganglionectomy in rabbits.
At the termination of these studies we examined changes in cyclic adenylic acid and prostaglandin content in jugular vein effluent and various brain and ocular tissues and fluids of the sympathectomized versus control animals. In the blood effluent we found significant elevation of cyclic adenylic acid and significant lowering of prostaglandin F1alpha in the sympathectomized animals. Although we found elevation of prostaglandin in certain tissues of the sympathectomized animals, there were no significant changes in cyclic adenylic acid levels between sympathectomized and control animals in the tissues examined. The findings of prostaglandin (blood and tissue) and cyclic adenylic acid (blood) changes in sympathectomized animals, associated with known changes in intraocular pressure and pupil size (due to catecholamine supersensitivity) must elicit further interest in the correlation and interpretation of various other central physiological and metabolic events in cervical sympathectomized animals.
http://www.ncbi.nlm.nih.gov/pubmed/213796?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=3&log$=relatedarticles&logdbfrom=pubmed

Sympathectomy can result in Dysautonomia

Dysautonomia is any disease or malfunction of the autonomic nervous system.
In some cases, dysautonomia results in a reduction in the ability of the heart and circulatory system to compensate for changes in posture, such as causing dizziness or fainting when standing or even sitting up. In other cases, inappropriate sinus tachycardia may cause the heart to race for no apparent reason. Other symptoms can include severe migraines, excessive urination.
Causes of dysautonomias are not fully understood, but they are thought to include viral illness, genetic factors, exposure to chemicals, pregnancy, autoimmune disorders, and a physical trauma or injury which damages the autonomic nervous system.^[3]

There is no cure for dysautonomia, medications are used to stablize the condition on a long-term basis.
http://www.reference.com/browse/dysautonomia,+familial

galanin and VIP mRNA after sympathectomy

Large changes in neuronal gene expression occur in adult peripheral neurons after axonal transection. In the rat superior cervical ganglion, for example, neurons that do not normally express vasoactive intestinal peptide (VIP) or galanin do so after postganglionic nerve transection. These effects of axotomy could result from a number of aspects of the surgical procedure. To test the idea that the important variable might be the disconnection of axotomized neuronal cell bodies from their target tissues, we examined the effects of producing such a disconnection by means of the compound 6-hydroxydopamine (6-OHDA), a neurotoxin that causes degeneration of sympathetic varicosities and avoids many of the complications of surgery. Two days after 6-OHDA treatment, VIP and galanin immunoreactivities had increased two- and 40-fold, respectively. Nevertheless, these increases were substantially smaller than the 30- and 300-fold changes seen after surgical axotomy. When expression of VIP and galanin was examined at the mRNA level, however, comparable increases were found after either procedure. The results indicate that chemical destruction of sympathetic varicosities produces an equivalent signal for increasing VIP and galanin mRNA as does axonal transection.

Chemical sympathectomy and postganglionic nerve transection produce similar increases in galanin and VIP mRNA but differ in their effects on peptide content.

H. Hyatt-Sachs, M. Bachoo, R. Schreiber, S. A. Vaccariello, R. E. Zigmond *

Department of Neurosciences, Case Western Reserve University, School of Medicine, Cleveland, Ohio 44106-4975

Received: 9 January 1996; Accepted: 3 April 1996

Journal of Neurobiology

A reduction in heat tolerance after Sympathectomy

Role of splanchnic and lumbar sympathetic nerves in physiologic responses to fever and hypoxia in dogs

W. G. Kubicek ¹, W. F. Geber ¹, J. W. Geiger ¹, and E. A. Johnson ¹
Am J Physiol 196: 685-690, 1959;
The most important function of the splanchnic and lumbar sympathetic nerves was apparently the control of the circulatory system and secondly the partial regulation of blood glucose probably through liberation of epinephrine from the adrenal medulla. A reduction in heat tolerance of the animals was observed after sympathectomy.

DOPAMINE, AROUSAL, CREATIVE DRIVE AND IDEA GENERATION

Dopamine in the mesolimbic pathway increases general arousal and goal directed behaviors and decreases latent inhibition; all three effects increase the creative drive of idea generation. This has led to a three-factor model of creativity involving the frontal lobes, the temporal lobes, and mesolimbic dopamine.^[34]

Behavior disorders

Pharmacological blockade of brain dopamine receptors increases rather than decreases drug-taking behavior. Since blocking dopamine decreases desire, the increase in drug-taking behaviour may be seen as not a chemical desire but as a deeply psychological desire to just 'feel something'.

The effect of reduced DOPAMINE

In humans, however, drugs that reduce dopamine activity (neuroleptics, e.g. some antipsychotics) have been shown to reduce motivation, and to cause anhedonia a.k.a. the inability to experience pleasure.^[13] Selective D2/D3 agonists pramipexole and ropinirole, used to treat Restless legs syndrome, have limited anti-anhedonic properties as measured by the Snaith-Hamilton Pleasure Scale.^[14] (The Snaith-Hamilton-Pleasure-Scale (SHAPS), introduced in English in 1995, assesses self-reported anhedonia in psychiatric patients.)

Additionally, users of stimulants often have depleted dopamine levels after withdrawal from these sometimes addictive substances.

Sociability is also closely tied to dopamine neurotransmission. Low D2 receptor-binding is found in people with social anxiety. Traits common to negative schizophrenia (social withdrawal, apathy, anhedonia) are thought to be related to a hypodopaminergic state in certain areas of the brain.

Abnormalities in dopaminergic neurotransmission have also been demonstrated in painful clinical conditions, including burning mouth syndrome,^[26] fibromyalgia ^{[27] [28]} and restless legs syndrome.^[29]

Salience

Dopamine may also have a role in the salience ('noticeableness') of perceived objects and events, with potentially important stimuli such as: 1) rewarding things or 2) dangerous or threatening things seeming more noticeable or important.^[31] This hypothesis argues that dopamine assists decision-making by influencing the priority, or level of desire, of such stimuli to the person concerned.

Since blocking dopamine decreases desire, the increase in drug-taking behaviour may be seen as not a chemical desire but as a deeply psychological desire to just 'feel something'.

Deficits in dopamine levels are implicated in attention-deficit hyperactivity disorder (ADHD), and stimulant medications used to successfully treat the disorder increase dopamine neurotransmitter levels, leading to decreased symptoms.

Dopamine is reduced by Sympathectomy

Dopamine has many functions in the brain, including important roles in behavior and cognition, motor activity, motivation and reward, inhibition of prolactin production (involved in lactation), sleep, mood, attention, and learning. Dopaminergic neurons (i.e., neurons whose primary neurotransmitter is dopamine) are present chiefly in the ventral tegmental area (VTA) of the midbrain, substantia nigra pars compacta, and arcuate nucleus of the hypothalamus.
In the frontal lobes, dopamine controls the flow of information from other areas of the brain. Dopamine disorders in this region of the brain can cause a decline in neurocognitive functions, especially memory, attention, and problem-solving. Reduced dopamine concentrations in the prefrontal cortex are thought to contribute to attention deficit disorder. It has been found that D1 receptors are responsible for the cognitive-enhancing effects of dopamine.^[7]

Effect of reduced Dopamine

Enlargement of the Breast—A New Side Effect of Transaxillary Cervical Sympathectomy: Case Report

http://ves.sagepub.com/cgi/content/abstract/20/1/50

Breast enlargement after thoracoscopic sympathectomy
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B7XNJ-4S7S2X0-1&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=3f96573d845688f9c13551c594353d73

Mia: Dopamine is also a neurohormone released by the hypothalamus. Its main function as a hormone is to inhibit the release of prolactin from the anterior lobe of the pituitary.
Prolactin has many effects including regulating lactation, orgasms, and stimulating proliferation of oligodendrocyte precursor cells.
It stimulates the mammary glands to produce milk (lactation): Increased serum concentrations of prolactin during pregnancy cause enlargement of the mammary glands of the breasts.