Patients usually develop Horner's syndrome and Guttman's sign, stuffy nose

Salahadin Abdi, MD, PhD, Yili Zhou, MD, PhD, NileshPatel, MD, Bhupinder Saini, MD, and John Nelson, MD
A New and Easy Technique to Block the Stellate Ganglion


Patients usually develop Horner's syndrome and Guttman's sign, stuffy nose and increased temperature on the ipsilateral side of the block (face and upper extremity) within 5 minutes after the procedure.

Pain Physician Vol. 7, No. 3, 2004

Stuffy nose and orthostatic hypotension following sympathectomy

3. Dibenzyline (Smith, Kline & French Labs.): - is a congener of dibenamine in the p-alkylamine family. It is capable of producing a chemical sympathectomy by oral administration. The drug was started usually with two capsules of 10 mg. each on the first day and was daily increased by 20 mg. till the effect of adrenergic blockade viz. stuffy nose and slight orthostatic hypotension appeared, after which the patient was maintained on that very dosage for the rest of the period he was under observation. Medication should begin at a low level as some individuals show postural changes with as little as 20 mgs. of dibenzyline.

Year : 1954 | Volume : 2 | Issue : 2 | Page : 33-44

Adrenergic blocking agents in glaucoma

Srivastava SP
Department of Ophthalmology, Medical College, Agra, India

only to be performed in extreme cases

In conclusion, it must be stated that due to the potential complications and the invasiveness of the procedure, sympathectomies are only to be performed in extreme cases after extensive discussions with the patient.
http://www.jle.com/fr/revues/medecine/ejd/e-docs/00/01/87/A0/article.md

Version imprimable

Current therapeutic strategies for hyperhidrosis: a review

European Journal of Dermatology. Volume 12, Numéro 3, 219-23, May - June 2002, Revues

Auteur(s) : Barbara TOGEL, Bärbel GREVE, Christian RAULIN, University Dermatological Clinic, D-69115, Heidelberg, Germany..

sweating is preserved and becomes exaggerated in some instances

FACIAL FLUSHING AND SWEATING MEDIATED BY THE SYMPATHETIC NERVOUS SYSTEM

PETER D. DRUMMOND and JAMES W. LANCE

Department of Neurology,Prince Henry Hospital Sydney, New South Wales, Australia

It is concluded that the cervical sympathetic outflow is the main pathway for thermoregulatory flushing and emotional blushing and that diminution or absence of such vasodilator reactions is a usual component of Homer's syndrome unless the responsible lesion is confined to the first thoracic root. Gustatory vasodilatation and sweating is preserved and becomes exaggerated in some instances.

Received March 4, 1986. Revised July 22, 1986. Accepted August 5, 1986.

ETS For blushing?

Endoscopic thoracic sympathectomy for
treating facial blushing

Omar Ahmed PhD
Centre for Clinical Effectiveness
Monash Medical Centre

21 February 2001

• No systematic reviews, meta-analyses, or clinical trials that evaluated the
effectiveness of endoscopic thoracic sympathectomy for treating facial
blushing were identified. However, we have identified four case series
related to the request.
• The four case series were not critically appraised because they are prone
to bias and have significant methodological problems. These studies
represent level IV evidence according to the NHMRC criteria and one
should not draw firm conclusions from their findings.

• To date, the benefits or side effects associated with endoscopic thoracic
sympathectomy for treating facial blushing have not been properly
evaluated and reported. (Mia: there has been no evaluation since this report was completed in 2001, and the surgery is being performed without clinical evidence regarding safety and effectiveness! In Australia, it is listed on MBS, nobody is able to explain on the basis of what or which finding has it been included.)

• Further research using a well-designed controlled trial is warranted to
assess the efficacy of endoscopic thoracic sympathectomy for treating
facial blushing.

As requested by CCE, a disclaimer attached to this quotation:
Please note that this review was done in 2001 and is now 7years old. The findings are unlikely to be consistent with current information and I would hesitate to recommend it as a source of useful information. This review has been archived and is covered by the disclaimer below on the CCE website archive.

increase in plasma norepinephrine (NE), is a salient feature in congestive heart failure

http://content.onlinejacc.org/cgi/content/full/42/3/549 Activation of the sympathetic nervous system, manifested by an increase in plasma norepinephrine (NE), is a salient feature in congestive heart failure. J Am Coll Cardiol, 2003; 42:549-551, doi:10.1016/S0735-1097(03)00643-0 © 2003 by the American College of Cardiology Foundation Chang-seng Liang, MD, PhD, FACC*,* * Department of Medicine (Cardiology Unit), University of Rochester Medical Center, Rochester, New York, USA

High plasma norepinephrine and depression!

Copyright © 1999 Society of Biological Psychiatry. Published by Elsevier Science Inc.

Plasma norepinephrine and prediction of outcome in major depressive disorder

Timothy G. Johnston^a, Christopher B. Kelly^{, a}, Michael R. Stevenson^b and Stephen J. Cooper^a
a Department of Mental Health, Whitla Medical Building, The Queen’s University of Belfast, Belfast, UK (TGJ, CBK, SJC)
^b Department of Medical Statistics, Mulhouse Building, The Queen’s Unversity of Belfast, Belfast, UK (MRS)
Received 1 February 1999; revised 17 May 1999; accepted 21 May 1999. Available online 30 November 1999.

Background: Several epidemiologic and clinical factors have been shown to predict long term outcome in major depressive disorder (MDD). The value of biological predictors has not been extensively studied. This study examined whether plasma norepinephrine may be useful in predicting outcome in MDD.

Methods: Forty patients were followed up 8 years after an index major depressive episode. Three outcome variables were assessed: time to first recurrence (the primary outcome measure), the Lee and Murray criteria and the Depression Outcome Scale (DOS). The results were examined against plasma norepinephrine value, at the index episode, using survival analysis and linear regression.

Results: High plasma norepinephrine at the index episode was positively and significantly associated with time to first recurrence for patients with nonpsychotic MDD (n = 31, χ² = 8.38, on 1 df, p < .01). Similarly, plasma norepinephrine was significantly associated with good global outcome, both using Lee and Murray criteria (n = 34, adjusted R² = .24, p < .01) and DOS criteria (n = 31, adjusted R² = .17, p < .01) for this group of patients. In contrast, plasma norepinephrine was not significantly related to outcome for MDD with psychotic features.

Conclusions: Plasma norepinephrine at index episode seems to be a predictor of outcome in MDD.

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T4S-3Y0RJKC-F&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=a88b42c007e4dcb51054a00cf6662e2d

morphological change resulting from degeneration activation

J. R. Garrett^{1, 2} and A. Thulin^{1, 2}

(1)	Department of Oral Pathology, King's College Hospital Dental School, London, England

(2)	Institute of Physiology, University of Lund, Lund, Sweden

(3)	King's College Hospital Dental School, SE5 8RX London, England

Received: 20 May 1975

Summary Parotid glands of rat have been examined 12, 24 and 48 hours after avulsion of the cervical sympathetic ganglion and compared with the normally innervated left glands. Formaldehyde-induced fluorescence showed a relatively normal complement of adrenergic nerves at 12 hours but most of the nerves had lost their noradrenaline content by 24 hours and no fluorescent nerves were detected at 48 hours. Ultrastructural degenerative changes in axons were rare at 12 hours, common at 24 hours, and the degenerating axons appeared to have disappeared by 48 hours. The glands looked whitish and pale and similar to the controls at 12 and 48 hours but were pinkish and oedematous on the sympathectomised side at 24 hours. Correspondingly the acini were loaded with secretory granules at 12 and 48 hours but were extensively depleted of granules at 24 hours. This loss of granules is considered to be due to sympathetic degeneration secretion caused by the release of noradrenaline from the degenerating adrenergic nerves between 12 and 24 hours after ganglionectomy. This is thought to be the first example of morphological change resulting from degeneration activation to be recorded microscopically.

http://www.springerlink.com/content/n08314p052546477/

Sympathetic Hyperactivity in Chronic Renal Failure: A Wake-up Call

Sympathetic Hyperactivity in Chronic Renal Failure: A Wake-up Call

Hein A. Koomans, Peter J. Blankestijn and Jaap A. Joles

Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands

Correspondence to Dr. Hein A. Koomans, Department of Nephrology and Hypertension, University Medical Center Utrecht, Room F03.223, P.O. Box 85500, 3508 GA Utrecht, The Netherlands. Phone: 31-30-2507329; Fax: 31-30-2543492; E-mail: H.A.Koomans@azu.nl

ABSTRACT. Sympathetic hyperactivity plays an important and distinct role in hypertension associated with chronic renal failure (CRF). Renal ischemia, elevated angiotensin II, and suppressed brain nitric oxide (NO) all stimulate sympathetic activity. Evidence is accumulating for a role of sympathetic hyperactivity in renal and cardiac damage in patients with CRF.

Carotid distensibility, baroreflex sensitivity, and orthostatic stress

J Appl Physiol 99: 64-70, 2005. First published February 24, 2005; doi:10.1152/japplphysiol.01248.2004
8750-7587/05 $8.00

Carotid distensibility, baroreflex sensitivity, and orthostatic stress

Craig D. Steinback,¹ Deborah D. O’Leary,² Jason Bakker,¹ Angela D. Cechetto,¹ Hanif M. Ladak,^3,4,6 and J. Kevin Shoemaker^1,5

¹Neurovascular Research Laboratory, School of Kinesiology, University of Western Ontario, London, Ontario; ²Department of Community Health Sciences, Brock University, St. Catharines, Ontario; Departments of ³Medical Biophysics, ⁴Electrical & Computer Engineering, and ⁵Physiology and Pharmacology, University of Western Ontario, London, Ontario; and ⁶Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada

Submitted 5 November 2004 ; accepted in final form 22 February 2005

In this study, we tested the hypothesis that carotid arteries undergo rapid changes in distensibility on moving from the supine to head-up tilt (HUT) postures and, subsequently, that this change in carotid distensibility (cDa) might be associated with concurrent reductions in cardiovagal baroreflex sensitivity (BRS). Thus the effect of posture on carotid vascular mechanics and cardiovagal BRS with consideration for altered central hemodynamics (i.e., stroke volume; Doppler ultrasound) was examined. Carotid pulse pressure (cPP; Millar transducer) and contralateral B-mode ultrasound images were assessed at the carotid artery during supine and 60° HUT postures. From these measures, cDa was calculated at 5-mmHg pressure increments experienced during the cardiac cycle (n = 6). cPP (n = 9) was not different in the two postures. A smaller stroke volume being ejected into a smaller carotid artery in HUT explained the maintenance of cPP in HUT. Also, compared with supine, cDa was reset to a lower level in HUT (main effect of posture; P <> BRS (sequence method) was diminished in HUT vs. supine (P < 0.05). A positive correlation was observed between the tilt-induced changes in maximal cDa (in early systole) and cardiovagal BRS (r² = 0.75; P <> between changes in cPP, systolic vessel dimensions, or average cDa and the corresponding change in BRS. The present results indicate that HUT elicits rapid changes in carotid artery mechanics and further suggest that reductions in the maximal cDa measured in early systole contribute to reduced cardiovagal BRS with HUT.

Patients with a history of sympathectomy were also excluded.

J Korean Acad Rehabil Med. 2000 Apr;24(2):193-199. Korean.

Comparison of Catecholamine Levels in Hemiplegic Patients with and without Reflex Sympathetic Dystrophy.

Kim EG, Kim YG, Byun SJ, Kim HS, Ahn KH.

Department of Rehabilitation Medicine, Kyung Hee University College of Medicine.
Department of Rehabilitation Medicine, Joongmoon College of Medicine.
Department of Neurology, Kyung Hee University College of Medicine.

OBJECTIVE: To determine whether the cause of sympathetic dysfunction is due to increased regional sympathetic outflow or receptor supersensitivity to circulating catecholamines in the pathogenesis of reflex sympathetic dystrophy in hemiplegia. METHOD: Ten hemiplegic patients with reflex sympathetic dystrophy were instructed to refrain from smoking or using caffeine and alcohol, and medications that influence catecholamine metabolism were witheld for 24 hours before blood sampling. Patients with cardiovascular disease, diabetes or abnormal liver and renal function tests were excluded from the study. Patients with a history of sympathectomy were also excluded.

Serum Dopamine-beta-Hydroxylase: Decrease after Chemical Sympathectomy

Serum Dopamine-beta-Hydroxylase: Decrease after Chemical Sympathectomy

Weinshilboum and Axelrod
Science 3 September 1971: 931-934
DOI: 10.1126/science.173.4000.931

Partial cardiac sympathetic denervation after bilateral thoracic sympathectomy in humans

Partial cardiac sympathetic denervation after bilateral thoracic sympathectomy in humans

Jeffrey P. Moak MD^a, Basil Eldadah MD, PhD^b, Courtney Holmes CMT^b, Sandra Pechnik RN^b and David S. Goldstein MD, PhD^b
aChildren’s National Medical Center, Washington, DC
^bClinical Neurocardiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
Received 6 January 2005; accepted 1 March 2005. Available online 25 May 2005.http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B7GW9-4G7WHD3-6&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=fd8be4ed02dd6654028265ed316ed13f

Severe bronchospasm after sympathectomy

Does bilateral thoracic sympathectomy predispose to reflex bronchospasm following tracheal intubation?

Ahed Zeidan, MD^*, Nazih Nahle, MD^* and Anis Baraka, MD FRCA

^* Sahel General Hospital,
American University of Beirut Medical Center, Beirut, Lebanon,

To the Editor:

Thoracic endoscopic sympathectomy has become the technique of choice for treating intractable essential hyperhidrosis.¹ We report severe bronchospasm following tracheal intubation in a patient with a previous history of bilateral thoracic sympathectomy.

Canadian Journal of Anesthesia 52:997-998 (2005)
© Canadian Anesthesiologists' Society, 2005

---

High plasma NOREPHRINE predicts future RENAL injury

HIGH PLASMA NOREPINEPHRINE LEVELS DETERMINED BY .BETA.2-ADRENOCEPTOR POLYMORPHISMS PREDICT THE FUTURE RENAL INJURY IN NONOBESE, NORMOTENSIVE SUBJECTS

HIGH PLASMA NOREPINEPHRINE LEVELS DETERMINED BY .BETA.2-ADRENOCEPTOR POLYMORPHISMS PREDICT THE FUTURE RENAL INJURY IN NONOBESE, NORMOTENSIVE SUBJECTS

Author;MASUO KAZUKO(Baker Heart Res. Inst., Aus) MASUO KAZUKO(Osaka Univ. Graduate School Of Medicine, Jpn) KATSUYA TOMOHIRO(Osaka Univ. Graduate School Of Medicine, Jpn) KAWAGUCHI HIDEKI(Ucla, Usa) RAKUGI HIROMI(Osaka Univ. Graduate School Of Medicine, Jpn) OGIHARA TOSHIO(Osaka Univ. Graduate School Of Medicine, Jpn) TUCK MICHAEL L.(Ucla, Usa)

Journal Title;Abstr 21st Sci Meet Int Soc Hypertens 2006

Journal Code:K20060131

Pain - increased expression of human alpha -adrenergic receptors after loss of sympathetic activity

The hypothesis proposes the increased presence of -adrenergic receptors in primary afferent neurons to result from an altered gene expression triggered by cytokines/growth factors produced by disconnection of peripheral nerve fibers from their cell bodies. These additional adrenergic receptors are suggested to make nociceptors and other primary afferent neurons excitable by local or circulating norepinephrine and epinephrine. For central pathways, the adrenergic excitation would be equivalent to that produced by noxious events and would consequently evoke pain. In support, evidence is cited for a form of denervation supersensitivity in causalgia and for increased expression of human -adrenergic receptors after loss of sympathetic activity.

Edward R. Perl^*

Department of Cell and Molecular Physiology, CB 7545, University of North Carolina, Chapel Hill, NC 27599

http://www.pnas.org/cgi/content/abstract/96/14/7664

Sympathectomy induces adrenergic excitability of cutaneous C-fiber nociceptors

Sympathectomy induces adrenergic excitability of cutaneous C-fiber nociceptors

D. F. Bossut, V. K. Shea and E. R. Perl
Department of Physiology, University of North Carolina at Chapel Hill 27599-7545, USA.

http://jn.physiology.org/cgi/content/abstract/75/1/514

J Neurophysiol 75: 514-517, 1996;
0022-3077/96 $5.0

Journal of Neurophysiology, Vol 75, Issue 1 514-517, Copyright © 1996 by APS

Sympathectomy IS the DAMAGE to the sympathetic nervous system, that will cause the pain.

Similarities between RSD patients and post-sympathtectomy patients

Quantitative Evaluation of Sympathetic Nervous System Dysfunction in Patients with Reflex Sympathetic Dystrophy

J. IDE, M. YAMAGA, T. KITAMURA and K. TAKAGI

From the Department of Orthopaedic Surgery, Kumamoto University School of Medicine, Kumamoto, Japan

Correspondence: J. Ide MD, Department of Orthopaedic Surgery, Kumamoto University School of Medicine 1–1–1 Honjo, Kumamoto 860, Japan.

We observed an increased blood flow but an unchanged vasoconstrictor response in the affected hand in stage 1 of the disorder, but in stage 2 there was a decreased blood flow and a stronger vasoconstriction following an inspiratory gasp. These results suggest that in RSD patients the sympathetic nervous system function is altered and is different in the various stages.

fiber degeneration following Sympathectomy

Petras JM, Cummings JF. Autonomic neurons in the spinal cord
of the rhesus monkey: a correlation of the findings of cytoarchi-
tectonics and sympathectomy with fiber degeneration following
dorsal rhizotomy. J Comp Neurol 1972;146:189 –218.

All patients except one suffered from compensatory sweating

Neurosurgery. 1997 Jul ;41 (1):110-3; discussion 113-5 9218302 (P,S,E,B) Cited:1

Complications in patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy.

[My paper] Y T Lai, L H Yang, C C Chio, H H Chen

OBJECTIVE: To assess the complications in a group of patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy. The extraordinarily high incidence of postoperative compensatory hyperhidrosis in our series is stressed and explained. METHODS: The retrospective study included chart reviews and outpatient assessments. Seventy-two patients underwent T2 or T2-T3 endoscopic sympathectomy for primary palmar hyperhidrosis. Patients' hyperhidrosis severity, precipitating factors, postoperative complications, surgical results, and satisfaction were assessed. Severity of palmar hyperhidrosis and compensatory hyperhidrosis was classified by two grading scales. RESULTS: The success rate of sympathectomy was 93%. All patients except one suffered from compensatory sweating, which was the main cause of patients' dissatisfaction postoperatively. Seventeen percent of the patients (12 of 72 patients) experienced new symptoms of gustatory sweating (facial sweating associated with eating). Twenty-one patients experienced other complications, including pneumothorax, Horner's syndrome, nasal obstruction, and intercostal neuralgia.

rhinitis significantly affect nasal airflow

During sleep there is a discrete fall in minute ventilation and an associated increase in upper airway resistance. In normal subjects, the nasal part of the upper airway contributes only little to the elevation of the total resistance, which is mainly the consequence of pharyngeal narrowing. Yet, swelling of the nasal mucosa due to congestion of the submucosal capacitance vessels may significantly affect nasal airflow. In many healthy subjects an alternating pattern of congestion and decongestion of the nasal passages is observed. Some individuals demonstrate congestion of the ipsilateral half of the nasal cavity when lying down on the side. Nasal diseases, including structural anomalies and various forms of rhinitis, tend to increase nasal resistance, which typically impairs breathing via the nasal route in recumbency and during sleep. A role of nasal obstruction in the pathogenesis of sleep-disordered breathing has been implicated by many authors.

Sleep, breathing and the nose

Dirk A. Pevernagie^a, , Micheline M. De Meyer^b and Sofie Claeys^c
Department of Respiratory Diseases, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium
Available online 19 October 2005

Loosing Nerves - article in Time Magazine, 1947

Sympathectomy, cutting of the sympathetic nerves, is causing the most violent arguments of all. The operation is now prescribed for a wide variety of ailments, from excessive sweating to high blood pressure. Nobody knows how many thousands of sympathectomies surgeons perform each year; there are an estimated 1,000 in Manhattan alone. Admittedly the operation is a life-saver in many cases of gangrene, angina pectoris, hypertension. But some sympathectomies may make men sterile. And because a sympathectomy reduces pain, some doctors consider it insidiously dangerous, e.g., a patient could have a perforating ulcer without pain. The experts agree that sympathectomy, like the other nerve-cutting operations, is getting out of hand.

Jun. 30, 1947
Loosing Nerves, article in TIME MAGAZINE

Medication you can not take after you had sympathectomy

Moducren tablets

WHAT ELSE SHOULD YOU KNOW ABOUT TAKING YOUR TABLETS?

You should check with your doctor before taking ‘Moducren’ if:

A surgeon has destroyed (sic!) one of your nerves in order to either improve the blood supply to a limb or relieve chronic pain. This operation is called a sympathectomy.

http://xpil.medicines.org.uk/ViewPil.aspx?DocID=5926

Sympathectomy and Parotid Glands

THULIN, A. & GARRETr, J. R. (1976). Secretory and structural effects of 6-hydroxydopamine on normal
parotid glands of rats and at different times after surgical sympathectomy. Quarterly Journal of
Experimental Physiology 61, 15-21.

Gustatory sweating and pilomotor changes

Gustatory sweating and pilomotor changes

W. B. Ashby

Powly Surgical Registrar, David Lewis Northsrn Hospital, Lnerpool British Journal of Surgery British Journal of Surgery Volume 47, Issue 204 , Pages 406 - 410 Published Online: 6 Dec 2005 Copyright © 1960 British Journal of Surgery Society Ltd.

changes in phrenic nerve activity, blood pressure and nasal patency.

changes in phrenic nerve activity, blood pressure and nasal patency.

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.
http://ajpregu.physiology.org/cgi/content/abstract/253/3/R494

Am J Physiol Regul Integr Comp Physiol 253: R494-R500, 1987;
0363-6119/87 $5.00

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

Rhinitis - relative nasal sympathetic hyposensitivity

The exact pathophysiology of intrinsic rhinitis is not fully understood. The generally held belief is that it is due to an imbalance between the outflow of the nasal sympathetic and parasympathetic nervous systems, perhaps due to excessive parasympathetic or reduced sympathetic activity. In this study the nasal airway response to a predominantly sympathetic stimulus, isometric exercise, was studied in 19 patients with intrinsic rhinitis and compared with 16 normal patients.
The study shows that there is an abnormal response to isometric exercise in intrinsic rhinitis, perhaps due to relative nasal sympathetic hyposensitivity.

The nasal response to isometric exercise in non-eosinophilic intrinsic rhinitis

• A. D. WILDE¹¹Department of Otolaryngology, Royal Liverpool University Hospital, Liverpool, UK, ²²Mr A. Wilde, Department of Otolaryngology, Royal Liverpool University Hospital, Prescott Street, Liverpool, L69 3BX, UK.,
• J. A. COOK¹¹Department of Otolaryngology, Royal Liverpool University Hospital, Liverpool, UK and
• A. S. JONES¹¹Department of Otolaryngology, Royal Liverpool University Hospital, Liverpool, UK

• ¹Department of Otolaryngology, Royal Liverpool University Hospital, Liverpool, UK

²Mr A. Wilde, Department of Otolaryngology, Royal Liverpool University Hospital, Prescott Street, Liverpool, L69 3BX, UK.

Clinical Otolaryngology

Volume 21 Issue 1 Page 84-86, February 1996

unavoidable consequence of sympathectomy

Pathological gustatory sweating and flushing can develop after injury to preganglionic cervico-thoracic sympathetic fibres, an unavoidable consequence of resecting that part of the sympathetic chain. The mechanism of this abnormal response is uncertain; conceivably, though, regeneration of injured salivatory fibres or collateral sprouting from nearby intact fibres creates aberrant connections between salivatory fibres and denervated vasomotor and sudomotor neurons in the superior cervical ganglion.(7) Commands to salivate would then be translated into commands to sweat and flush in the distribution of sympathetic denervation. Cross-innervation lower down in the stellate ganglion can also produce unusual and potentially distressing autonomic disturbances in the sympathetically-denervated arm (e.g., piloerection while eating).(8)
Drummond PD. A caution about surgical treatment for facial blushing. British Journal of Dermatology 2000; volume 142: pages 194-195.

Sweating = supersensitivity to neurotransmitters and not sympathetic overactivity

These findings do not support the widely held view that autonomic disturbances in reflex sympathetic dystrophy are due to sympathetic overactivity. Rather, they suggest that sweating and changes in peripheral blood flow result from supersensitivity to sympathetic neurotransmitters. After injury, supersensitivity to noradrenaline may also contribute to spontaneous pain and allodynia by disrupting efferent sympathetic modulation of sensation. This would explain why pain and allodynia are relieved by sympathetic blockade, and why noradrenaline rekindles pain in sympathectomized skin.

REFLEX SYMPATHETIC DYSTROPHY: THE SIGNIFICANCE OF DIFFERING PLASMA CATECHOLAMINE CONCENTRATIONS IN AFFECTED AND UNAFFECTED LIMBS

PETER D. DRUMMOND^1,, PHILIP M. FINCH² and GEORGE A. SMYTHE³
http://brain.oxfordjournals.org/cgi/content/abstract/114/5/2025
Brain, Vol. 114, No. 5, 2025-2036, 1991
© 1991 Guarantors of Brain

SEVERE CS in 90 % of patients!

"Postsurgery, severe compensatory sweating was experienced in 90% of patients".

Video-assisted transthoracic sympathectomy in the treatment of primary
hyperhidrosis: friend or foe?
Surg Laparosc Endosc Percutan Tech. 2000 Aug;10(4):226-9.
Fredman B, Zohar E, Shachor D, Bendahan J, Jedeikin R.
Department of Anesthesiology and Critical Care, Meir Hospital, Kfar Saba, Israel. hyperhidrosis.

Patients should be informed of the bradycardia resulting from sympathectomy.

Ann Thorac Surg. 2002 Dec;74(6):2076-81.

Related Articles, Links

Holter changes resulting from right-sided and bilateral infrastellate upper thoracic sympathectomy.

Abraham P, Berthelot J, Victor J, Saumet JL, Picquet J, Enon B.

BACKGROUND: We tested the hypothesis that no right-sided dominance exists after infrastellate surgical upper-thoracic sympathectomy. We aimed to confirm whether a significant bradycardia was constant and only dependent on the right side. METHODS: We performed 24-hour Holter electrocardiographic recordings in 12 patients referred for bilateral sympathectomy. Surgery was performed at two distinct times allowing for the study of the consequences of unilateral right and bilateral sympathectomy. RESULTS: Heart rate was 77 +/- 8 beats per minute before surgery on the 24-hour recording and significantly decreased after bilateral (67.8 +/- 6.5 beats per minute; p < size="5">Patients should be informed of the bradycardia resulting from sympathectomy.

Bone marrow

1: Cell. 2006 Jan 27;124(2):407-21.

Related Articles, Links

Comment in:

• Cell. 2006 Jan 27;124(2):253-5.

Signals from the sympathetic nervous system regulate hematopoietic stem cell egress from bone marrow.

Katayama Y, Battista M, Kao WM, Hidalgo A, Peired AJ, Thomas SA, Frenette PS.

Department of Medicine, Immunobiology Center and Black Family Stem Cell Institute, Mount Sinai School of Medicine, New York, NY 10029, USA.

The sympathetic nerve--an integrative interface between two supersystems: the brain and the immune system.

Pharmacol Rev. 2000 Dec;52(4):595-638.

Related Articles, Links

The sympathetic nerve--an integrative interface between two supersystems: the brain and the immune system.

Elenkov IJ, Wilder RL, Chrousos GP, Vizi ES.

Inflammatory Joint Diseases Section, Arthritis and Rheumatism Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA.

awareness and autonomic arousal on functional neuroanatomy

Neuron. 2002 Feb 14;33(4):653-63.

Related Articles, Links

Fear conditioning in humans: the influence of awareness and autonomic arousal on functional neuroanatomy.

Critchley HD, Mathias CJ, Dolan RJ.

Wellcome Department of Imaging Neuroscience, 12 Queen Square, Institute of Neurology and Institute of Cognitive Neuroscience, UCL, WC1N 3BG, London, United Kingdom. h.critchley@fil.ion.ucl.ac.uk

The degree to which perceptual awareness of threat stimuli and bodily states of arousal modulates neural activity associated with fear conditioning is unknown. We used functional magnetic neuroimaging (fMRI) to study healthy subjects and patients with peripheral autonomic denervation to examine how the expression of conditioning-related activity is modulated by stimulus awareness and autonomic arousal. In controls, enhanced amygdala activity was evident during conditioning to both "seen" (unmasked) and "unseen" (backward masked) stimuli, whereas insula activity was modulated by perceptual awareness of a threat stimulus. Absent peripheral autonomic arousal, in patients with autonomic denervation, was associated with decreased conditioning-related activity in insula and amygdala. The findings indicate that the expression of conditioning-related neural activity is modulated by both awareness and representations of bodily states of autonomic arousal.

Neuroendocrine regulation of autoimmune/inflammatory disease

J Endocrinol. 2001 Jun;169(3):429-35.

Related Articles, Links

Neuroendocrine regulation of autoimmune/inflammatory disease.

Recent studies indicate that physiological levels of glucocorticoids are immunomodulatory rather than solely immunosuppressive, causing a shift in patterns of cytokine production from a TH1- to a TH2-type pattern. Interruptions of this loop at any level and through multiple mechanisms, whether genetic, or through surgical or pharmacological interventions, can render an inflammatory resistant host susceptible to inflammatory disease.

These interactions have been clearly demonstrated in many animal models, across species, strains and diseases, and are also relevant to human inflammatory, autoimmune and allergic illnesses, including rheumatoid arthritis, systemic lupus erythematosus, Sjogren's syndrome, allergic asthma and atopic skin disease.

plasma natriuretic peptide concentrations

Nakamura2005

Circ J. 2005 Sep;69(9):1079-83.

Effect of endoscopic transthoracic sympathicotomy on plasma natriuretic peptide concentrations in humans.

Nakamura Y, Yoshizawa H, Hirasawa M, Kida H, Matsumoto Y, Ueyama T.

denervation leads to loss of an important regulatory mechanism in immune system physiology.

Sympathectomy decreased CD4+ T-cells in lymph nodes. Alterations in lymphocyte activity does not always correlate with changes in the proportions of T- or B-lymphocyte subsets. Sympathetic denervation leads to loss of an important regulatory mechanism in immune system physiology. This is apparently site specific in that both lymph node and spleen T-cell proliferative responses are reduced.

Articles by Dr. Brian A. Smith

the australian story

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".

note: ASERNIP-s did not review Sympathectomy and even after repeated letters and complaints from affected patients, failed to inform the Health Minister or initiate the review. Sympathectomy is listed on the MBS, even though there has been no study into the effects or the side-effect of the surgery - ever done and doctors admit, that they do not know how the patient will be affected. Sadly this admission always comes after they have performed the surgery.
ets-sideeffects.com

ARE WE PAYING A HIGH PRICE FOR SURGICAL SYMPATHECTOMY?

ARE WE PAYING A HIGH PRICE FOR SURGICAL SYMPATHECTOMY?

A Systematic Literature Review of Late Complications

Andrea Furlana,c MD, Angela Mailisa,bMD, MSc, FRCPC

(PhysMed) and Marios Papagapioua Msc

Comprehensive Pain Programaand Toronto

Western Hospital Research Instituteb,The Toronto Western Hospital, and Institute

for Work & Healthc, Toronto, Ontario,Canada.

In these studies, 26.3% or one quarter of patients with compensatory hyperhidrosis considered the complication major and disabling. The average time between surgical sympathectomy and the appearance of compensatory hyperhidrosis was 4 months (range 1-6 months). (82;93;118) The incidence of compensatory hyperhidrosis did not seem to be different after open or endoscopic approach. Irrespective of approach, two or more levels of denervation and removal of the stellate ganglion produced noticeably higher incidence.
We suggest that the

possibility of central contribution to the deregulation of sweat gland activity may be a substantial one and should constitute the subject of future research. Furthermore, our data suggest that the presence of a dysfunctional nervous system may constitute "vulnerability" to develop further neuropathic pain syndromes. Could this vulnerability be centrally mediated as well? What is the true nature of all other phenomena observed after sympathectomy (pathological gustatory sweating and what seems to be a rather innocuous complication, phantom sweating)? These and many other questions remain currently unanswered and should constitute similarly the focus of future research.

The study indicates that surgical sympathectomy, irrespective of operative approach and indication, may be associated with many and potentially serious complications.

note: There is no way for the surgeons who will end up with the disabling side-effect. Some of them attempt to guess, that it will be male and most of the time overweight. But there has been no research and there is no proof in the literature to support this claim. So who is a good candidate for ETS? There has been also no study into the severity of the side-effects, it is often the doctors or the patients who define. There is no objective study to establish the before and after state of these patients.

pituitary secretions of ACTH and TSH after sympathectomy

The present results suggest that cervical sympathectomy in the rat increases ACTH secretion and decreases TSH secretion in the pituitary. These effects seem to be due to a mildly increased secretion of melatonin in the pineal body that probably in turn increases corticotropin-releasing factor (CRF) secretion and decreases thyrotropin-releasing hormone (TRH) secretion in the hypothalamus. Extrapolation of these findings to humans suggests that longterm and repeated stellate ganglion block would affect the pituitary secretions of ACTH and TSH.

Hiroshi Iwama¹ , Mamoru Adachi¹, Choichiro Tase¹ and Yoichi Akama¹

(1)	Department of Anesthesiology, Fukushima Medical College, 1 Hikarigaoka, 960-12 Fukushima, Japan

Received: 26 June 1995 Accepted: 1 March 1996

Melatonin

Influence of sympathectomy in humans on the rhythmicity of 6-sulphatoxymelatonin urinary excretion.

An increase in daytime melatonin excretion was observed in the patients responding to the sympathectomy with an abolished 6-sulphatoxymelatonin rhythm. This increase could indicate that the final sympathetic neurons innervating the pineal gland might have a both stimulatory and inhibitory function.
Møller M, Osgaard O, Grønbech-Jensen M.

Inst. Med. Anatomy, University of Copenhagen, Panum Institute, Blegdamsvej 3, DK-2200 Copenhagen, Denmark.

Mol Cell Endocrinol. 2006 Jun 27;252(1-2):40-5. Epub 2006 May 2

Sympathectomy In Social Phobia

All aspects of social phobia, both somatic and psychological, were highly significantly improved.

Thoracic Sympathectomy In Social Phobia

Saeed Kargar, M.D.
General Surgeon
Shahid Sadooghi Hospital
Yazd Iran

Mojtaba Yasini, M.D.
Psychiatrist
Bahman Hospital
Yazd Iran

Vida Ayatollahi, M.D.
Anesthesiologist
Shahid Sadooghi Hospital
Yazd Iran

---

Citation:

Saeed Kargar, Mojtaba Yasini, Vida Ayatollahi: Thoracic Sympathectomy In Social Phobia: A Pilot Study. The Internet Journal of Surgery. 2006. Volume 7 Number 2.

Sympathectomy and blood sugar levels

4. Journal of Tissue Research Vol. 4 (1) 89-94 (2004)

Interactions of autonomic nervous system, pituitary-adrenocortical axis and corticotrophin and cortico-sterone in the regulation of blood sugar level in rats

Pilo, B. and Sule, J.

Division of Neuroendocrinology, Department of Zoology, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara-390 002 India.

Chemical sympathectomy (CSX) reduced the corticosterone concentration slightly but the ACTH level increased significantly. When sympathectomy was combined with vagotomy (CSX+VGX) an increase in both corticosterone and ACTH levels was observed. Chemical sympathectomy and adrenalectomy (CSX+ADX) also produced a maximum decrease in corticosterone level and a maximum level of ACTH. Vagotomy (VGX) alone or together with CSX or ADX produced hyperglycaemia while chemical sympathectomy alone or together with adrenalectomy produced hypoglycaemia. In conclusion it could be stated that in rats in which vagotomy was performed singly and in combination with sympathectomy, glucocorticoid secretion increased along with increased corticosterone. Chemical sympathectomy alone or together with adrenalectomy reduced the corticosterone concentration in blood together with hypoglycaemic condition. ACTH concentration by and large was more when corticosterone secretion was decreased.

Effect on insulin

Similar result was obtained with rat treated for chemical sympathectomy and vagotomy together and this slight decrease in insulin level could favour marginal hyperglycaemia.

3. Journal of Tissue Research Vol. 4 (1) 83-88 (2004)

Effect of autonomic and adrenal manipulation on the serum insulin level in rats

Pilo, B. and Yadav, V.

Division of Neuroendocrinology, Department of Zoology, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara-390 002 India

Substance-P and bone resorption

Sympathectomy is known to result in localized bone resorption in the middle ear and at other sites. (Sandhu et al 1989) Sherman & Chole (1996) found that sympathectomy induced bone resorption could be blocked by capsaicin in vivo. It was concluded that sympathectomy led to a secondary release of substance-P and then directly or indirectly to the activation of osteoclasts. Substance-P also stimulates bone resorption in vitro. It was hypothesized that substance-P is required for other types of bone remodleing, including adaptive bone remodeling.

1997, 190, Session F8, Poster

Adaptive bone remodeling in the middle ear is substance-p dependent

*R.A. Chole, S.P. Tinling (University of California School of Medicine, Davis, California)

causes increased root resorption

Sympathectomy causes increased root resorption after orthodontic tooth movement in rats: immunohistochemical study

Sivakami Rethnam Haug¹ , Pongsri Brudvik², Inge Fristad³ and Karin J. Heyeraas¹

(1)	Department of Physiology, University of Bergen, Årstadveien 19, 5009 Bergen, Norway

(2)	Department of Orthodontics and Facial Orthopedics, School of Dentistry, University of Bergen, Årstadveien 17, 5009 Bergen, Norway

(3)	Department of Odontology-Endodontics, School of Dentistry, University of Bergen, Årstadveien 17, 5009 Bergen, Norway

Biomedical and Life Sciences
	Thursday, February 19, 2004

imbalance of sympathetic nerves may induce inflammation and pain in teeth.

Our results demonstrate, for the first time, a trophic effect of the sympathetic nerves on cells in the dental pulp, indicating that an imbalance of sympathetic nerves may induce inflammation and pain in teeth.

The Effect of Unilateral Sympathectomy and Cavity Preparation on Peptidergic Nerves and Cells in Rat Dental Pulp

Sivakami Rethnam Haug, Ellen Berggreen and Karin J. Heyeraas
Department of Physiology, University of Bergen, 5009, Bergen, Norway
Received 7 July 2000; accepted 8 January 2001. ; Available online 4 March 2002.

Sympathectomy Enhances Calcitonin Gene-Related Peptide and Substance-P Expression

Ethridge, Richard T.; Supowit, Scott C.; Zhao, Huawei; DiPette, Donald J.
Institution
University of Texas Medical Branch, Galveston, TX.

Permanent Sympathectomy Enhances Calcitonin Gene-Related Peptide and Substance-P Expression In Dorsal Root Ganglion Neurons.

Hypertension. 32(3):604, September 1998.



Substance P: In the central nervous system, substance P has been associated in the regulation of mood disorders, anxiety, stress, reinforcement, neurogenesis, respiratory rhythm, neurotoxicity, nausea / emesis and pain.
It also has effects as a potent vasodilator. This is caused by the release of nitric oxide from the endothelium. Its release can cause hypotension.

http://en.wikipedia.org/wiki/Substance_P

Effect of Sympathectomy on the Role of Endothelin in DOCA Hypertension

Lange, Darrell L.; Haywood, Joseph R.; Hinojosa-Laborde, Carmen
Institution
University of Texas Health Science Center, San Antonio, TX.
Title
Effect of Sympathectomy on the Role of Endothelin in DOCA Hypertension.
Source
Hypertension. 32(3):595, September 1998.

Cervical sympathectomy causes photoreceptor-specific cell death in the rat retina

Cervical sympathectomy causes photoreceptor-specific cell death in the rat retina

Jena J. Steinle, Naarah L. Lindsay and Bethany L. Lashbrook
Department of Physiology, Southern Illinois University School of Medicine, Carbondale, IL 62901, United States
Received 6 December 2004; revised 12 March 2005; accepted 19 March 2005. Available online 18 April 2005.

Effect of Acute Sympathectomy on Responses to Angiotensin and Norepinephrine

The present evidence suggests that the tonic discharge of normally functioning sympathetic nerves is capable of facilitating the response to angiotensin and that sympathectomy results in an abolition of this effect.
Zimmerman, B. G. Ph.D.

Section of Experimental Therapeutics, Lederle Laboratories Pearl River, New York
Title
Effect of Acute Sympathectomy on Responses to Angiotensin and Norepinephrine.[Article]
Source
Circulation Research. 11(5):780-787, November 1962.

SYMPATHECTOMY FOR TACHYCARDIA

Turley, A J; Thambyrajah, J; Harcombe, A A
Institution
Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, UK

Bilateral thoracoscopic cervical sympathectomy for the treatment of recurrent polymorphic ventricular tachycardia.[Report]
Source
Heart. 91(1):15-17, January 2005.

EFFECT OF SYMPATHECTOMY ON MECHANICAL PROPERTIES OF ARTERIES

Mangoni, Arduino A.; Mircoli, Luca; Giannattasio, Cristina; Mancia, Giuseppe; Ferrari, Alberto U.

From the Centro di Fisiologia Clinica e Ipertensione (A.A.M., L.M.), Ospedale Maggiore, Milano; the Cattedra di Medicina Interna (C.G., G.M.), Universita di Milano, Ospedale S. Gerardo, Monza; and the Divisione di Cardioribilitazione (A.U.F.), Ospedale di Seregno, Az/U.S.S.L. 30, Desio, Italy.
Correspondence to Alberto U. Ferrari, MD, Centro Fisiologia Clinica e Ipertensione, Via F. Sforza, 35, 20122 Milano, Italy.

Effect of Sympathectomy on Mechanical Properties of Common Carotid and Femoral Arteries.
Source
Hypertension. 30(5):1085-1088, November 1997.

CATECHOLAMINE LEVELS FOLLOWING SYMPATHECTOMY

Kawamura, Minoru 1,2; Schwartz, Joan P. 1; Nomura, Takuo 1; Kopin, Irwin J. 1; Goldstein, David S. 1; Huynh, Thanh-Truc 1; Hooper, Douglas R. 1; Harvey-White, Judith 1; Eisenhofer, Graeme 1,3

(1)Clinical Neuroscience Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda MD 20892.
(2)Institute of Bio-Active Science, Nippon Zoki Pharmaceutical Co., Ltd. Hyogo 673-14, Japan
Title
Differential Effects of Chemical Sympathectomy on Expression and Activity of Tyrosine Hydroxylase and Levels of Catecholamines and DOPA in Peripheral Tissues of Rats.[Article]
Source
Neurochemical Research. 24(1):25-32, January 1999.

24% ETS PATIENTS END UP WITH SEVERE FULL BODY SWEATING AFTER SURGERY

Compensatory truncal sweating occurred in 36 of the 42 patients; it was severe in ten, moderate in 16 and minimal in ten.

ANDREWS, B. T.; RENNIE, J. A.

Department of Surgery, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
Correspondence to: Mr J. A. Rennie.
Paper accepted 14 February 1997.

sympathetic nerves on early embryonic development and immune modulation of uterus

Role of sympathetic nerves on early embryonic development and immune modulation of uterus in pregnant mice

the CD4⁺/CD8⁺ T cells ratio significantly decreased, while the IL-2/IL-4 ratio significantly increased. These findings indicated that the activation of sympathetic nerves might be favorable to fetal survival and development during early pregnancy through influencing on immune function and decidua formation of uterus.

Yulan Dong^a, Yaoxing Chen^a, Zixu Wang^a, Jumpei Naito^b and Ji-long Chen^c
aLaboratory of Veterinary Anatomy, College of Animal Medicine, China Agricultural University, Haidian, Beijing 100094, China
^bDepartment of Animal Science, School of Sciences and Engineering, Teikyo University of Science and Technology, Yamanashi 409–0193, Japan
^cDepartment of Internal Medicine, College of Medicine, University of Iowa, Iowa City, IA 52242, USA
Received 24 October 2005; revised 1 August 2006; accepted 2 August 2006. Available online 26 September 2006.