The amount of compensatory sweating depends on the patient, the damage that the white rami communicans incurs, and the amount of cell body reorganization in the spinal cord after surgery.
Other potential complications include inadequate resection of the ganglia, gustatory sweating, pneumothorax, cardiac dysfunction, post-operative pain, and finally Horner’s syndrome secondary to resection of the stellate ganglion.
www.ubcmj.com/pdf/ubcmj_2_1_2010_24-29.pdf

After severing the cervical sympathetic trunk, the cells of the cervical sympathetic ganglion undergo transneuronic degeneration
After severing the sympathetic trunk, the cells of its origin undergo complete disintegration within a year.
http://onlinelibrary.wiley.com/doi/10.1111/j.1439-0442.1967.tb00255.x/abstract

Monday, June 30, 2008

norepinephrine depletion commonly is the desired effect

Although norepinephrine depletion commonly is the desired effect, other costored neurotransmitters (eg ATP, NPY and enkephalins) are depleted by sympathetic denervation. The multitude of research studying the effects of sympathetic loss is made possible by the morphologically defined anatomy of the postganglionic sympathetic chains, the sensitivity of postganglionic NA neurons to nerve growth factor (NGF) deprivation, and the phenotypic specialty of these neurons that allows for the selective uptake of neurotoxins."

Primer on the Autonomic Nervous System
By David Robertson
Published 2004

Both responses were abolished by sympathectomy

In control rats, nicotine caused a dose-dependent tachycardiac and pressor response. Both responses were abolished by sympathectomy, whereas the α-blockade left the tachycardiac response unaffected but inhibited the pressor response; the V1 vasopressin receptor blockade had no effect on either the tachycardiac or pressor response. Conclusions: We conclude that in the conscious rat: (1) the pressor response to nicotine mainly depends on peripheral a-adrenergically-mediated vasoconstriction; (2) the vasomotor effect is caused by neural rather than adrenomedullary catecholamine release; (3) the nicotine-induced increase in heart rate (and presumably cardiac output) is per se unable to raise blood pressure, and (4) the nicotine-induced release of vasopressin plays no significant role in the pressor response.
MARANO G. (1) ; RAMIREZ A. (2 3) ; MORI I. (2 3) ; FERRARI A. U. (2 3 4) ;
http://cat.inist.fr/?aModele=afficheN&cpsidt=1739277
Cardiovascular research ISSN 0008-6363 CODEN CVREAU

1999, vol. 42, no1, pp. 201-205 (18 ref.)

Surgeon declares result of sympathectomy "almost miraculous"

The results seem almost miraculous. In over 95% of all cases, the patients hands are dry and warm right after surgery. Hyperhidrosis of the feet is eliminated in about 60% of the cases. Facial sweating is helped in about 65% to 75% of the cases. Rapid heart rate and palpitations are also reduced dramatically. (Sic!)

http://users.rcn.com/szarnick/hidrosis.html

After the operation, some patients might experience some degree of sweating in other locations such as the thighs or back. Most patients say that they are not troubled by this extra perspiration and it is preferable to sweaty palms. In most cases, the condition improves over time.

Definition

Surgical Sumpathectomy and adrenergic function

Theodore Cooper, Department of Surgery, St Louis University School of Medicine

The excision on neutral structures which elaborate adrenergic substances during the process of regulating visceral function continues to be a valuable investigative and therapeutic maneuver. In the past several years, surgical sympathectomy has helped clarify certain aspects of adrenergic function. The operation as a therepeutic tool has been favorably reconsidered particularly since it has become clear that current reconstructive techniques do not provide cure or satisfactory palliation in all instances.
In general sympathectomy has been used for one or more of the following purposes:
1) to eliminate tonic or engendered responses which depend upon impulses in adrenergic nerves;
2) to eliminate visceral stores or adrenergic substances which depend upon the integrity of the postganglionic sympathetic innervation;
3) to eliminate postganglionic sympathetic tissue as a locus for the synthesis, uptake, binding, release and metabolism of adrenergic substances;
4) to eliminate visceral afferent fibers which are frequently distributed in common with autonomic nerves. The extent to which the surgical procedure is adjudged successful is usually related to the anatomical extent of the denervation and the time after operation at which the result is evaluated.
It is clear that "sympathectomy" is not a selective excision of adrenergic elements only. It is well recognized that preganglionic sympathectomy involves division of cholinergic elements ad sensory fibers.
Pharmacological Reviews, 1966 Vol. 18, No. 1. Part I

No pain from perforated ulcer after sympathectomy

Pain impulses from the stomach are carried by visceral afferent fibers that accompany sympathetic nerves. This fact is evident because pain of a recurrent peptic ulcer may persist after complete vagatomy, whereas patients who have had a bilateral sympathectomy may have a perforated peptic ulcer and experience no pain.

Clinically Oriented Anatomy, page 257

By Keith L. Moore, Arthur F. Dalley, A. M. R. Agur
Published 2006
Lippincott Williams
& Wilkins
Human anatomy
1209 pages
ISBN:0781736390

Blocked the vomiting response...

Nausea and Vomiting: Recent Research and Clinical Advances - Google Books Result

by John Kucharczyk, David J. Stewart, Alan D. Miller - 1991 - Medical - 251 pages
Vagotomy and sympathectomy blocked the vomiting response, ... The role of visceral afferents in radiation sickness is discussed in Chapter 6, ...
books.google.com.au/books?isbn=0849367816...

Sympathectomy - impaired wound healing

The involvement of peripheral nerves in dermal wound healing, particularly in the inflammatory response has not been extensively studied. Therefore, this study was performed to examine the role of peripheral nerves in the healing of rat skin linear incisions. We report that chemical sympathectomy with 6-hydroxydopamine significantly impaired wound healing as measured on days 7, 11, and 14 postsurgery (by day 14, 48% of the sympathectomized rats were healed in contrast with 84% of the controls; p = 0.0104)...
These results support the hypothesis that sympathetic efferents are important for wound healing. Unlike previous research, which showed that peripheral nerves influence ischemic skin flaps, we are the first to demonstrate a role for peripheral nerves in the healing of skin incisions. Because inflammation is an important step in cutaneous wound healing, we propose that a reduction of neurogenic inflammation caused by sympathectomy may explain the impaired wound healing that we observed in our study.
Kim LR, Whelpdale K, Zurowski M, Pomeranz B.

Departments of Physiology and Zoology, University of Toronto, Toronto, Ontario, Canada.


http://www.ncbi.nlm.nih.gov/pubmed/9776863

Sympathectomy reduces immune responses

Sympathectomy Protects Denervated Skin from Graft-Versus-Host Disease

Mohamed A. Kharfan-Dabaja MDa, Claudio Anasetti MDa and James L.M. Ferrara MDb

Division of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute and University of South Florida, Tampa, Florida

Departments of Pediatrics and Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan

Biology of Blood and Marrow Transplantation
Volume 13, Issue 3, March 2007, Pages 369-370

T2 - innervation to the face/head

T2 Sympathetic Innervation to The Sweat Glands of the Face

Over several years of experience in treating patients with recurrent and/or persistent sweating of the face after undergoing T2 sympathectomy, Dr. Nielson has found that persistence of any sympathetic nerve innervation across the second rib level, just above the T2 ganglion, plays a significant role in persistent sweating conditions of the face after undergoing a T2. T3, or T4 sympathectomy.

It is apparent in some patients that there are neuronal contributions from lower levels such as the T3 that pass up over the second rib level on their way to the face that participate in the sweating symptoms of the face. Some physicians misunderstand the sympathetic nerve innervation of the face and believe in order to cure facial sweating it is important to cut the sympathetic nerve at the T1 level or above, thereby causing the dreaded Horner’s Syndrome. In Dr. Nielson's experience, he has found this not to be the case.

In summary, for successful treatment of facial sweating, it is imperative that all sympathetic nerve innervation crossing the second rib level be divided as opposed to clamped or having lower levels cut or clamped. Also, accessory nerve branch pathways bypassing the T2 ganglion can or may contribute to persistent facial symptoms.

http://www.hyperhidrosis-usa.com/Facial_Blushing.html

Every surgeon decides which complication and side effect to disclose:

ETS Side Effects | Potential Complications

Possible perforation of breast implants if present
Sensitive Pleurae (chest lining sensitivity) limiting exercise
Horners Syndrome occurrence rate 0.3%
Heat intolerance
Pneumothorax (collapsed lung)
Bleeding
Postop Neuralgia and parasthesias are uncommon
 Possible hair loss
 Bradycardia (slow heart rate) possibly requiring a pacemaker
Subcutaneous emphysema
Possible conversion to open thoracotomy
Possible recurrence of symptoms
Possible necessity for re-do operations

Gustatory sweating (increased sweating while smelling or eating) occurs in some patients.
http://www.hyperhidrosis-usa.com/SideEffects.html

MIA: DOES THIS SOUND LIKE A DESCRIPTION OF A SAFE PROCEDURE?!
The essential conflict lies in the fact that the surgeons are partly right: the surgery is relatively safe (to perform) and immediate outcome, if only palmar sweating is taken into account - would indicate it as an effective surgery. BUT at what cost?! The success rates decline with time, as sweating seems to return with nerve regeneration (even after cutting), in some cases within 6 months. (This is as long as the Botox treatment would last...without any of the adverse effects of the surgery....) Most importantly these exclamations re safety and effectiveness do not take into account the damage caused by the autonomic dysfunction. As the saying goes: The operation was successful, the patient did not make it...

Emotion - memory

Phelps EA.

Department of Psychology, 6 Washington Place, 8(th) floor, New York, New York 10003, USA. liz.phelps@nyu.edu

The amygdala and hippocampal complex, two medial temporal lobe structures, are linked to two independent memory systems, each with unique characteristic functions. In emotional situations, these two systems interact in subtle but important ways. Specifically, the amygdala can modulate both the encoding and the storage of hippocampal-dependent memories. The hippocampal complex, by forming episodic representations of the emotional significance and interpretation of events, can influence the amygdala response when emotional stimuli are encountered. Although these are independent memory systems, they act in concert when emotion meets memory.

Curr Opin Neurobiol. 2004 Apr;14(2):198-202.Click here to readhttp://www.ncbi.nlm.nih.gov/pubmed/15082325?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=3&log$=relatedarticles&logdbfrom=pubmed

Feedback - integreation of emotion and bodily arousal

In health, emotions are integrated with autonomic bodily
responses. Emotional stimuli elicit changes in somatic
(including autonomic) bodily states, which feedback to
influence the expression of emotional feelings. In patients with
spinal cord injury (SCI), this integration of emotion and bodily
arousal is partially disrupted, impairing both efferent generation
of sympathetic responses and afferent sensory feedback of
visceral state via the spinal cord. A number of theoretical
accounts of emotion predict emotional deficits in SCI patients, particularly at the level of emotional
feelings, yet evidence for such a deficit is equivocal. We used functional MRI (fMRI) and a basic
emotional learning paradigm to investigate the expression of emotion-related brain activity
consequent upon SCI.

We suggest that the observed functional abnormalities including enhanced anterior cingulate and PAG reflect central sensitization of the pain matrix, while decreased subgenual cingulate activity may represent a substrate underlying affective vulnerability in SCI patients consequent upon perturbation of autonomic control and afferent visceral representation. Together these observations may account for motivational and affective sequelae of SCI in some individuals.

Alessia Nicotra1,2, Hugo D. Critchley1,3,4,
Christopher J. Mathias1,2 and Raymond J. Dolan3
Brain 2006 129(3):718-728; doi:10.1093/brain/awh699

Norepinephrine - motivation and pleasure

Both norepinephrine and dopamine (sometimes called the "feelgood" chemical, because it's associated with motivation and pleasure) are the triggers for communication along the pathways between the basal ganglia, deep in the brain, and the prefrontal cortex, sometimes referred to as the brain's command centre because it controls executive functions such as problem-solving, attention and reasoning. It's believed (though it's hard to find strong evidence) that ADHD results from function reduction in dopamine and/or norepinephrine levels in the brain.
Nikki Barrowclough

31 March 2007
The Age

Hypoperfusion - risk of cerebral infarct

Current Opinion in Neurology - Fulltext: Volume 15(2) April 2002 p ...
Other work has described variations in sympathectomy and omental ... studies that show regions of cortex at risk of infarct secondary to hypoperfusion. ...
www.co-neurology.com/pt/re/coneuro/fulltext.00019052-200204000-00007.htm;jsessionid=HysC8T2LJypVjsV5nPrwS... -

Sympathectomy - Neurologic disorder

Other neurologic disorders
• Idiopathic orthostatic hypotension
• Multiple sclerosis
• Parkinsonism
• Posterior fossa tumor
• Shy-Drager syndrome
• Spinal cord injury with paraplegia
• Surgical sympathectomy
• Syringomyelia
• Syringobulbia
• Tabes dorsales (syphilis)
• Wernicke’s encephalopathy

Dizziness in Orthopaedic Physical Therapy Practice: Classification
and Pathophysiology
Peter Huijbregts, PT, MSc, MHSc, DPT, OCS, MTC, FAAOMPT, FCAMT
Paul Vidal, PT, MHSc, DPT, OCS, MTC
The Journal of Manual & Manipulative Therapy
Vol. 12 No. 4 (2004), 199 - 214

Syncope and sudden loss of consciousness

Causes of *Collapse and Acute Decreased Conscious State
(* = collapse, as in sudden loss of consciousness)

*Syncope via autonomic failure:
i) Neuropathy with autonomic involvement
ii) Antihypertensives, esp. beta-blockers
iii) Surgical sympathectomy
iv) CNS autonomic failure: eg.primary autonomic failure, MSA, spinal cord lesion

www.medicine.utas.edu.au/teaching/year6/cam615_616/info/additionaltutes/additionaltutes/med.pdf
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