Cardiac hypertrophy accelerated by left cervical sympathectomy in spontaneously hypertensive rats

T. Matoba¹ , H. Toshima¹, K. Adachi¹, K. Ohta¹ and T. Ito¹

(1)	Department of Medicine, Kurume University School of Medicine, Kurume, (Japan)

(2)	Department of Medicine, Kurume University School of Medicine, 67 Asahimachi, 830 Kurume, Japan

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.
http://www.springerlink.com/content/k584578m848n8838/

sympathectomy - protection against noise-induced hearing loss

Strategies to enhance CBF for protection against noise

A number of the experimental and clinical approaches to protection against noise-induced hearing loss involve mechanisms related to CBF and the oxygenation of the cochlea. These are such diverse procedures as sympathectomy, hyperbaric oxygen treatment and carbogen respiration. It is not within the scope of this review to address the literature concerning these and other approaches comprehensively, but is useful to consider a few examples and their relative success. Strategies in relation to ROS are covered in the next section.

Year : 1999 | Volume : 2 | Issue : 5 | Page : 17-31

Sound-induced cochlear ischemia/hypoxia as a mechanism of hearing loss

Nuttall Alfred L Department of Otolaryngology, NRC04, Oregon Health Sciences University, Portland, Oregon, USA and Kresge Hearing Research Institute, University of Michigan, Ann Arbor, MI 97201-3098, USA,

long-term and repeated stellate ganglion block affect the pituitary secretions of ACTH and TSH.

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 long-term and repeated stellate ganglion block would affect the pituitary secretions of ACTH and TSH. (adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH)
J Anesth (1996) 10:181-184
Cervical sympathectomy affects adrenocorticotropic hormone
and thyroid-stimulating hormone in rats
Hiroshi Iwama, Mamoru Adachi, Choichiro Tase, and Yoichi Akama
Department of Anesthesiology, Fukushima Medical College, 1 Hikarigaoka, Fukushima 960-12, Japan

Selective lung ventilation during thoracoscopy: effects of insufflation on hemodynamics

RESULTS: Cardiac index, mean arterial pressure, and left ventricular stroke work index decreased, whereas pulmonary artery and central venous pressures increased (p < 0.05) at insufflation pressures of 5 mm Hg and greater. CONCLUSIONS: Positive-pressure insufflation during thoracoscopy resulted in significant hemodynamic compromise despite the use of selective lung ventilation. Conversion to thoracotomy may be an alternative if positive-pressure insufflation is necessary to perform the thoracoscopic procedure.
Hill RC, Jones DR, Vance RA, Kalantarian B
Ann Thorac Surg 1996; 61:945-8.

Haemodynamic changes during thoracoscopic surgery the effects of one-lung ventilation compared with carbon dioxide insufflation.

One-lung ventilation via a double-lumen endobronchial tube is safe and convenient for video-assisted thoracoscopic surgery. It has no further consequences on haemodynamic variables, whereas the compression of the lung by carbon dioxide insufflation may cause circulatory dysfunction.
Brock H, Rieger R, Gabriel C, Pölz W, Moosbauer W, Necek S
Anaesthesia 2000;55:10-6.
http://journals.elsevierhealth.com/periodicals/ymai/medline/record/MDLN.10594427

complications of CO2 insufflation

Catastrophic complications such as delayed recognition of tension
pneumothorax from left sided CO2 insufflation, leading to fatal and
disabling consequences was reported.

Author: Dr. Mohamed Ismail, Mansoura University, Department of
Cardiothoracic Surgery, Mansoura University, 71 el-sedek st., Ahmed Maher
St., Mansoura, 050 Egypt
Interactive CardioVascular and Thoracic Surgery 3 (2004) 437–441

Severe systemic hypotension and bradycardia have been observed during carbon dioxide insufflation in some patients undergoing sympathectomy

Anesthetic considerations for thoracic and thoracoscopic neurosurgical procedures are considered, emphasizing the need to provide anesthetic stability during prolonged periods of one-lung ventilation, while optimizing conditions for intraoperative monitoring of spinal cord integrity.
Severe systemic hypotension and bradycardia have been observed during carbon dioxide insufflation in some patients undergoing sympathectomy.

Current Opinion in Anaesthesiology. 13(1):65-69, February 2000.
Adams, David C.; Eisenkraft, James B.

Cardiovascular collapse caused by carbon dioxide insufflation during one-lung anaesthesia for thoracoscopic sympathectomy

Carbon dioxide insufflation into the pleural space during one-lung anaesthesia for thoracoscopic surgery is used in some centres to improve surgical access, even though this practice has been associated with well-described cardiovascular compromise. The present report is of a 35-year-old woman undergoing thoracoscopic left dorsal sympathectomy for hyperhidrosis. During one-lung anaesthesia the insufflation of carbon dioxide into the non-ventilated hemithorax for approximately 60 seconds, using a pressure-limited gas inflow, was accompanied by profound bradycardia and hypotension that resolved promptly with the release of the gas. Possible mechanisms for the cardiovascular collapse are discussed, and the role of carbon dioxide insufflation as a means of expediting lung collapse for procedures performed using single-lung ventilation is questioned. Australian Society of Anaesthetists 2002 Harris, R. J. Benveniste, G. Pfitzner, John http://digital.library.adelaide.edu.au/dspace/handle/2440/5894

Right vs left side thoracoscopic sympathectomy: effects of CO2 insufflation on haemodynamics

CONCLUSIONS: Compared to left side TS (thoracoscopic sympathectomy), direct compression by CO2 against the venae cava and right atrium and ventricle during right side TS caused reduction of the venous return and hence low CO (cardiac output), CI (cardiac index) and SV (stroke volume).

A A El-Dawlatly, A Al-Dohayan, A Samarkandi, F Algahdam, A Atef Department of Anaesthesia, College of Medicine, King Saud University, Riyadh, Saudia Arabia.

Ann Chir Gynaecol. 2001 ;90 (3):206-8 11695797

Sympathectomy is effective treatment of Long QT Syndrome

Current Medical Diagnosis and Treatment 2007 (Current Medical Diagnosis and Treatment)
Stephen J. McPhee, Maxine A. Papadakis, Lawrence M. Tierney

page 390:
5. Long QT Syndrome
Because this is a primary electrical disorder, usually with no evidence of structural heart disease or LV dysfunction, the long-term prognosis is excellent if arrhytmia is controlled. Long-term treatment with beta-blockers, permanent pacing, or left cervicothoracic sympathectomy is frequently effective.

Disorders associated with autonomic insufficiency

Greenspan's Basic & Clinical Endocrinology (Lange Medical Books)
David G. Gardner, Dolores M. Shoback
page 437
Table 12 - 6. Disorders associated with autonomic insufficiency
Familial dysautonomia
Shy-Drager Syndrome
Parkinson's disease
Tabes dorsalis
Cerebrovascular disease
Diabetes melitus
Idiopathic orthostatic hypotension
Sympathectomy

Decrease in peripheral vascular resistance

AWHONN's Perinatal Nursing: Co-Published with AWHONN (Simpson, Awhonn's Perinatal Nursing)
Kathleen Rice Simpson, Patricia A Creehan

page 63:
Epidural anesthesia causes a sympathectomy and a marked decrease in peripheral vascular resistance that may cause a decrease in venous return, resulting in decreased cardiac output.

Orthostatic hypotension - Sequelae of surgical sympathectomy

Current Diagnosis and Treatment: Emergency Medicine (Current Emergency Diagnosis and Treatment)
C. Keith Stone, Roger L. Humphries, Sep 14, 2007
page 270
Causes of orthostatic hypotension:
Sequelae of surgical sympathectomy

Nervous system dysfunction - Syncope

Harrison's Principles of Internal Medicine, 17th Edition (Harrison's Principles of Internal Medicine)
Anthony S. Fauci, Eugene Braunwald, Dennis L. Kasper, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, Joseph Loscalzo

page 139:
Section 3 - Nervous system dysfunction by Mark D. Carlson
Table 21 - 1
Causes of Syncope:
Sympathectomy

Sympathectomy incompatible with life

Danielopolu 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 1998
Informa Health Care
Heart
683 pages
ISBN:1899066543

Complications in Cardiothoracic Surgery: Avoidance and Treatment

The most common complications of sympathectomy are related to manipulation of the autonomic nervous system.
By Alex G. Little
Published 2004
Blackwell Publishing
Prevention & control
464 pages
ISBN:0879934271

Neurophysiological Basis of Cerebral Blood Flow

In contras, the CM-Pf elicited cerebrovasodilation is shown to be, in part dependent on the integrite of the sympathetic innervation arising from the SCG (Mraovitch et al., 1986).
After ipsilateral sympathectomy, the CP-Pf-elicited rCBF was significantly reduced on the denervated side. For example, in the frontal cortex CM-Pf stimulation increased rCBF up to 130+-11ml/100g/min. Following sympathectomy the CM-Pf elicited increase was only 102+-4ml/100g/min.
The mechanism by which acute sympathectomy coupled to the CM-Pf stimulation reduces elevated cortical blood flow remains to be elucidated.

Effects of cervical sympathectomy on secondary vasodilation

Following unilateral transection of the cervical sympathetic trunk, the DMRF stimulation increased CBF bilaterally in all brain regions. In the cortical regions (frontal and parietal cortices) and in the caudate nucleus, the increase in CBF was slightly but significantly higher in the denervated side. Thus, the DMRF elicited cerebrovascular dilation is in part dependent on sympathetic excitation. However, the finding that the DMRF elicited cortical and caudate cerebrovasodilation following blockade of nerve traffic through the SCG increases in magnitude is in opposition to the finding that sympathectomy coupled to the DMRF stimulation decreased CBF responses. The reasons for this discrepancy is presently unknown.
Neurophysiological Basis of Cerebral Blood Flow
By Mraovtich, Sima Mraovitch, Richard Sercombe
Published 1996
John Libbey Eurotext
Cerebral circulation
424 pages
ISBN:0861962729

THE EFFECT OF SYMPATHECTOMY ON THE FATTY DEPOSIT IN CONNECTIVE TISSUE

A. B. L. Beznák 1 and Z. Hasch 1

1 The Institute of Experimental Pathology, University of Budapest

1. Unilateral section of both splanchnic nerves in cats diminishes the degree of fall in the amount of perirenal fat which follows laparotomy under ether anæsthesia. On the splanchnicotomised side the perirenal fat weighs 100-300 per cent. more than on the intact side.

2. The same difference is found if the cats starve after splanchnicotomy, or if cats with very little perirenal fat are fattened after the splanchnicotomy.

3. When cats are fed with a diet containing fat stained with Sudan III. the stained fat is deposited in the perirenal fat on both sides in equal concentrations. When they are starved after unilateral splanchnicotomy, the amount of the perirenal fatty tissue on the ipsilateral side is greater than on the normal. The concentration of Sudan III., however, remains on both sides the same as it was previous to the splanchnicotomy and starvation.

4. If cats and rats are kept on normal unstained diets for various periods after unilateral splanchnicotomy, are then fed with a diet containing fat stained with Sudan III. and are killed 18 hours after the feeding, the concentration of Sudan III. on the splanchnicotomised side is about of that on the normal side.

5. The conclusion is reached that, in consequence of the splanchnicotomy, changes take place in the perirenal connective tissue which slow both the deposition of fat and its mobilisation. The mobilisation is retarded more than the deposition.

Serum dopamine- -hydroxylase: decrease after chemical sympathectomy.

R Weinshilboum
J Axelrod

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

Sympathectomy and the immue system

In rodents, chemical sympathectomy attenuates primary
splenic antibody responses to systemic immunisation and lymph-node antibody responses to footpad challenge, suppresses cytotoxic T-cell responses to allogeneic cells, and reduces delayed-type hypersensitivity reactions; it is also associated with an enhancement of in-vivo lymphoproliferation in some lymph nodes and an increase in natural killer (NK) cell activity.'[ 11, 12] Chemical sympathectomy also increases the severity of experimental allergic encephalomyelitis[ 13] and adjuvant-induced arthritis in susceptible strains of rats. [ 14]
Psychoneuroimmunology: Interactions between the nervous system and the immune system.

Source: Lancet, 1/14/95, Vol. 345 Issue 8942, p99, 5p,

Author(s): Ader, Robert; Cohen, Nicholas

Cerebral venous blood oxygen content and brain blood flow

Cerebral venous blood oxygen content and brain blood flow

In both groups of patients the internal jugular blood oxygen concentration was reduced significantly from the recumbent value (p < 0.01). Comparable increases in the cerebral arteriovenous oxygen differences were observed. The increase in this oxygen difference after three minutes of tilt was significant in the patients studied after sympathectomy (p < 0.02), but was not in the pa- tients with essential hypertension. The decreases in the -oxygen content of cerebral venous blood after 20 minutes of tilt cannot be attributed to significant reductions in cerebral blood flow in either
group.

Cerebral oxygen consumption

Although the cerebral arteriovenous oxygen difference increased only 10% in the hypertensives, the 9% increase in cerebral oxygen consumption after 20 minutes of tilt proved to be highly significant (p < 0.01). Cerebral oxygen con- sumption was not increased in the postsympathetomy group.
Cerebrovascular resistance

The cerebral blood flow of the patients after sympathectomy was decreased 1 1% with a 26% reduction in "effective" mean cerebral pressure.
This can be explained by the fact that the cerebrovascular resistance decreased 17%o from 2.3 to 1.9 units, indicating a highly significant relaxation of cerebral vessels during the tilt period. A comparable reduction in cerebrovascular resistatice
was found both in the hypertensive patients and in the normotensive subjects.

By JOSEPH H. HAFKENSCHIEL, CHARLES W. CRUMPTON,2 HENRY A.
SHENKIN, JOHN H. MOYER,3 HAROLD A. ZINTEL, HERBERT
WENDEL,4 AND WILLIAM A. JEFFERS, WITH THE TECHNICAL
ASSISTANCE OF SALLY CONLIN HARNED, NELLYJ. KEFFER, AND GERALDINE CROFT

Sympathectomy-induced increases in calcitonin gene-related peptide (CGRP)-, substance P- and vasoactive intestinal peptide (VIP)-levels

The neuropeptide contents of rat salivary glands were increased four weeks after sympathetic postganglionic denervation (but not after preganglionic denervation): calcitonin gene-related peptide (CGRP) by 400 and 65% in the parotid and submandibular glands, respectively; substance P by 30% in the submandibular gland; and vasoactive intestinal peptide (VIP) by 30% in the parotid gland. The sensory neurotoxin capsaicin prevented the expected increases of CGRP and substance P in the submandibular glands and of VIP in the parotid glands. The CGRP-increase in the parotid gland was, however, only reduced (by 65%). Parasympathetic otic ganglionectomy reduced the peptide levels in the parotid glands (CGRP – 50%, VIP – 98% and substance P – 99%). From these residual levels, CGRP increased almost 8-fold and substance P 3-fold in response to the sympathetic denervation, while VIP was unaffected. In the parasympathetically denervated glands, the capsaicin-sensitive contribution to the CGRP-response to sympathetic denervation was roughly estimated to be more than 25% but less than 40%, while the corresponding contribution to the substance P-response was roughly estimated to be more than 6% but less than 58%. Most likely not only CGRP/substance P-containing sensory C-fibres (submandibular and parotid glands) but also parasympathetic VIP-containing secretomotor and vasomotor fibres (parotid glands) contributed to the capsaicin-sensitive response to sympathetic denervation.
J. Ekströma R. Ekman
2005

altering Ca2+ activity of actomyosin ATPase

Also, Sympathectomy may impair cardiac functional capacity by altering Ca2+ activity of actomyosin ATPase.

Effects of thyroid deficiency and sympathectomy on cardiac enzymes

K. M. Baldwin, P. J. Campbell, A. M. Hooker and R. E. Lewis
AJP - Cell Physiology, Vol 236, Issue 1 30-C34, Copyright © 1979

compensatory activation of these effectors maintains blood pressure at approximately normal levels

Compensatory activation of alternative effectors, such as the adrenomedullary hormonal system, arginine vasopressin system, and renin-angiotensin-aldosterone system explains why destruction of the sympathetic nervous sytem produces only relatively small influence on blood pressure. This misled Cannon into thinking that the sympathetic nervous system was unimportant in the regulation of blood pressure in organisms at rest...
In the 1980s, however, several reports showed that sympathectomy compensatorily activates other effectors...and compensatory activation of these effectors maintains blood pressure at approximately normal levels. In the setting of sympathectomy, interference with any of the other effectors evokes immediate, precipitous declines in blood pressure...
It also took decades after Cannon's death before researchers began to demonstrate effects on 'nonemergency' stressors, such as mental challenge and exercise, on sympathetic outflow to the heart. One index of this outflow is the rate of entry of norepinephrine, the main neurotransmitter released by the sympathetic nerves, into the veins draining the heart (norepinephrine spillover).

David S. Goldstein: Adrenaline and the Inner World: An Introduction to Scientific Integrative Medicine.

Norephineprine - Emotion - Memory

Dr. Walling studied the contribution of emotion to the formation of memory. Norepinephrine, a neurotransmitter released during states of heightened arousal, is considered to be the primary candidate mediating the effects of emotion on memory. Dr. Walling's study on rats provides support for the hypothesis that that short-term and long-term memory processes may be modulated by separate and distinct memory mechanisms.

Beta-blockers impair working memory

Nielson KA, Jensen RA. (1994) Beta-adrenergic receptor antagonist antihypertensive medications impair arousal-induced modulation of working memory in elderly humans. Behav Neural Biol. 62: 190-200.

beta blockers which block adrenaline can affect memory

Norepinephrine has also been implicated with memory and the beta blockers which block adrenaline can affect memory. Glutamate is important for stimulation of memory and medications which block the NMDA glutamate receptors can adversely affect memory. Serotonin can also play a role in memory. Finally, as mentioned above, the dopamine system working subcortically can affect the working memory in the frontal lobes.
Symposium 1999 – "Parkinson’s Power Across America

recurrence rate 15% and 19%

Gender, age, family history, and distribution of sweating were similar in both groups. Recurrence rates 1 and 2 years after endoscopic thoracic ganglionectomy were between 0% and 3% in T2 and T3 resection, and between 15% and 19% in T2 resection only. In the combined T2 and T3 resection group, 100% of patients noticed compensatory sweating; in T2 resection, 90% of patients noticed compensatory sweating.
Yano M, Kiriyama M, Fukai I, Sasaki H, Kobayashi Y, Mizuno K, Haneda H, Suzuki E, Endo K, Fujii Y.

Department of Surgery II, Nagoya City University Graduate School of Medical Science, Japan.
2005

unable to establish the etiology of redistribution of perspiration

Bilateral upper thoracic sympathicolysis is followed by redistribution of body perspiration, with a clear decrease in the zones regulated by mental or emotional stimuli, and an increase in the areas regulated by environmental stimuli, though we are unable to establish the etiology of this redistribution.

R. Ramos1 Contact Information, J. Moya1, I. Macia2, R. Morera2, I. Escobar2, V. Perna2, F. Rivas2, C. Masuet3, J. Saumench2 and R. Villalonga4

diarrhea associated with disordered motility

III Diarrheal Diseases Lawrence R. Schiller, M.D.
Clinical Professor of Internal Medicine, Division of Gastroenterology
University of Texas Southwestern Medical Center at Dallas, 2003
Disordered motility or regulation can produce secretory diarrhea. Secretory diarrhea associated with disordered motility can occur in patients who have undergone vagotomy or sympathectomy, patients with autonomic neuropathy from diabetes or amyloidosis, and probably patients with irritable bowel syndrome.

Sympathectomy, whether chemical or surgical, leads to diarrhea

The sympathetic nervous system in the intestinal mucosa releases
norepinephrine (an a2 antagonist) and so inhibits electrolyte secretion and stimulates absorption. Sympathectomy, whether chemical or surgical, leads to diarrhea, at least transiently. Chronic diabetics with autonomic neuropathy sometimes develop persistent diarrhea that is associated with degeneration of adrenergic nerve fibers to the gut. Somatostatin and endogenous enkephalins are also antisecretory.
http://www.gastroresource.com/GITextbook/en/chapter7/7-5-pr.htm

Long term effect of sympathectomy - deterioration of the mucosa in the gut

sympathectomy in rats decreases the cell proliferation and reduces mucosal mass.
Departments of Surgery and Neurology
Institute of Biomedicine, Department of Anatomy
University of Helsinki, Finland

Nitric oxide and neuropeptides in the gut: Changes in ulcerative colitis, pouchitis
and short bowel syndrome
Pälvi Vento

Modulation of drug effects by regional sympathetic denervation and supersensitivity

These data show that regional myocardial denervation creates autonomic and electrophysiological heterogeneity and the substrate for heterogeneous drug actions. This drug-induced electrophysiological heterogeneity may be another mechanism for proarrhythmia.

MS Stanton and DP Zipes
Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis 46202.

Sympathetic surgery in cerebral vascular disorders

Mars Chir. ;4 (1):83-8 14956138 (P,S,E,B)
Sympathetic surgery in cerebral vascular disorders.
J BONNAL
Mesh-terms: Brain :: blood supply; Intracranial Embolism and Thrombosis :: surgery;

Increased blood flow reduces perfusion of the small blood vessels

The action of sympathectomy is felt to be an increase in collateral flow; the circulation cannot be restored to normal since the flow in the aggregate of small arteries is less than normal.
Miller, J. E.: Anatomy cf the Heart and Great
Vessels. Angiocardiographic Study. Texas State
J. Med. 47: 5 (Jan.), 1951.

decreased nasal patency and increased nasal airflow resistance

Contralateral rhinorrhea as a feature of infantile Horner's ...
... decreased nasal airway patency, and increased nasal airflow resistance. ... Nasal obstruction after cervical sympathectomy: Horner’s syndrome revisited. ...
www.neurology.org/cgi/content/full/61/9/1309

a watery nasal fluid is formed dur-
ing a pronounced vasoconstrictor response and that the
fluid formation is reduced by ipsilateral sympathectomy
A role for the nasal cycle in respiratory defence
R. Eccles

Simultaneous optimal stimulation of the autonomic nerves resulted in vasoconstriction, especially of the capacitance vessels. Hence, nasal congestion may be related more to a withdrawal of sympathetic discharge than to an overactivity of the parasympathetic nerves.
The Role of the Autonomic Nerves in the Control of Nasal Circulation
Mary A. Lung

Department of Physiology, Faculty of Medicine, University of Hong Kong, Hong Kong
Neurosignals 1995;4:179-185

Selective brain cooling, decrease is nasal airway patency

Selective brain cooling after bilateral superior cervical sympathectomy in sheep (Ovis aries)
Mark J. M. Nijland, Duncan Mitchell and Graham Mitchell

...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...
Pflügers Archiv European Journal of Physiology, Volume 417, Number 4 / December, 1990

Pineal gland

Loss of histochemically demonstrable catecholamines and acetylcholinesterase from sympathetic nerve fibres of the pineal body of the rat after chemical sympathectomy with 6-hydroxydopamine
Olavi Eränkö and Liisa Eränkö
The Histochemical Journal, Volume 3, Number 5 / September, 1971

Cervical sympathectomy affects ...testosterone in male rats

Cervical sympathectomy affects gonadotropin-releasing hormone, luteinizing hormone and testosterone in male rats
Hiroshi Iwama, Choichiro Tase, Yoshikazu Tonosaki and Yasuo Sugiura

Abstract To examine the effects of bilateral cervical sympathectomy on the secretion of gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH) and...
Journal of Anesthesia, Volume 9, Number 2 / June, 1995

no change in temperature of the forehead, yet, decrease of sweating?

During the procedure we found a significant acute decrease in systolic and pulse pressures, from 153 ± 10 to 127 ± 9 and from 80 ± 7 to 56 ± 4mmHg respectively, and a lesser decrease in diastolic pressure; heart rate showed no statistically significant changes.

Skin temperature at the forehead, axilla, loin, and sole of the foot, all measured bilaterally, showed no significant increase, although there was a decrease in sweating in both forehead and axillary regions.

http://www.ingentaconnect.com/content/klu/10286/2004/00000014/00000004/art00012#aff_1
Clinical Autonomic Research, Volume 14, Number 4 / August, 2004

Denervation of the eye

Journal Article
Adrenergic denervation of the eye by unilateral cervical sympathectomy
B. Ehinger, B. Falck and E. Rosengren

adrenocorticotropic hormone

Cervical sympathectomy affects adrenocorticotropic hormone and thyroid-stimulating hormone in rats
Hiroshi Iwama, Mamoru Adachi, Choichiro Tase and Yoichi Akama

Abstract To examine the effects of bilateral cervical sympathectomy on the secretion of adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), growth...
Journal of Anesthesia, Volume 10, Number 3 / September, 1996

The connection between psyche and sympathetic nervous system

Timo Telaranta M.D., Ph.D. and Paivi Pohjavaara M.D., Privatix Clinic,

Tampere, Finland

In the central nervous system the arousal requires the brain stem, the
thalamus and the cortex, attention is maintained in the right frontal
lobe; the formation of memories happens in the medial temporal lobe, certain
diencephalic nuclei and the basal forebrain. The amygdala rates the
emotions of an experience. The limbic system is the centre of the human drives,
their regulation requires an intact frontal cortex. The injury in the
frontal lobe impairs the executive functions as motivation and attention.
The sympathomedullary system and locus coerulaeus are activated in
depression, mania, panic disorder and acute phases of schizophrenia. The
autonomic nervous system is one of the most important mediators between
the mind and the body. It has two roles in this function:
the role in basic metabolic function as in energy storage and release, in
the control of exocrine secretion and thus intake, in conservation, loss, and
transformation of energy the role in behaviour, where the hypothalamus
is involved in alert and defense reactions.

The sympathetic system is defined as an energy consumption system and
the parasympathetic system is an energy conserving and balancing force.
The sympathomedullary system is activated in various mental disorders.
The biopsychosocial model is clearly seen in the social phobia. The "fight
or flight - response of the sympathetic system can also be seen in the
physical signs of the social phobia when the patient is in the centre of
attention. With sympathetic overload the patient starts to fear the
triggering situations and avoid them.

The need-adaptive approach adjusts treatment plans of socially phobic
patients who haven't had any help of medication and psychotherapy. It
seems possible to treat their symptoms and cut the vicious circle of
social phobia blocking the sympathetic system in the upper thoracic level with
a surgical procedure. If a patient with the social phobia hasn't had any
help of conventional treatment methods such as medication and psychotherapy,
the sympathetic block could be a treatment of choice for them.

Sympathectomy in the treatment of addiction

Pohjavaara P(l,2), Telaranta T(3), ja Vaisanen E(l); (i)0ulu University

Psychiatric Clinic, Finland (2)Tampere City Mental Health Care Centre,
Finland and (3)Privatix-Clinic,Tampere, Finland

Addiction problems are common in people with psychiatric disorders.
The addiction may be a primary or secondary problem.
The secondary addiction problems appear due to patients' attempts to
"treat" themselves with e.g. alcohol or excessive medication, especially
benzodiazepins. Social phobia is an example of a primary psychiatric
disorder, which leads to secondary addiction problems in about 20 % of
the patients.

Our patient had suffered from social phobia and its secondary problems
already from the childhood and she recovered from a serious alcohol and
drug addiction after successive treatment of her social phobia with ESB.

abolition of reflex secretion of adrenaline

Smithwick, R. H.: An Evaluation of the Surgical
Treatment of Hypertension. Bull. New York Acad. 1949.
The author discusses the effect upon hypertension of unilateral nephrectomy and removal of adrenal tumors but, principally, he considers his experience with operations on the sympathetic nervous system. The two principal known actions of sympathectomy are modification of blood pressure levels and modifications of the reflex regulation resulting from the inactivation of important components of the vasoconstrictor mechanism. Presumed effects of sympathectomy are abolition of reflex secretion of
adrenaline and stabilization of 1l)ood flow through the denervated vascular bed.

diminution of the myocardial concentration of epinephrine

It is known that sympathectomy is followed by a marked diminution of the myocardial concentration of epinephrine-like catechols.
Raab, W., and Lepeschkin, E.: Biochemical Versus
Hemodynamic Factors in the Origin of Hyperten-
sive Heart Disease. Acta med. Scandinav. 138:
81 (June), 1950.

Definiton of sympathectomy: interruption of the efferent motor innervation of the heart

the increased effort tolerance after sympathectomy is primarily
a result of interruption of the efferent motor in-
nervation of the heart rather than division of sen-
sory pathways.


CORONARY ARTERY DISEASE
Apthorp, G. H., Chamberlain, D. A., and Hay-
ward, G. W.: The Effects of Sympathec-
tomy on the Electrocardiogram and Effort
Tolerance in Angina Pectoris. Brit. Heart
J. 26:218 (March), 1964.

ETS attenuates autonomic circulatory response

Takashi Suzuki1, Yutaka Masuda1, Makoto Nonaka2, Mitsutaka Kadokura2 and Akiyoshi Hosoyamada1
(1) Department of Anesthesiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan, JP
(2) First Department of Surgery, Showa University School of Medicine, Tokyo, Japan, JP
Abstract
Purpose. Our purpose was to examine perioperative alterations in hemodynamic changes with head-up tilt (HUT) in patients undergoing endoscopic thoracic sympathectomy (ETS).
Methods. The subjects were 11 patients with essential hyperhidrosis scheduled to undergo ETS (ETS group) and 9 age-matched volunteers undergoing minor surgery (control group). HUT was performed (40°; 5 min) before and after the surgery, under nitrous oxide anesthesia. Orthostatic hypertension and hypotension in response to HUT were defined as changes of 10% or greater in systolic blood pressure.
Results. The increase in heart rate in response to HUT was significantly reduced after surgery in the ETS group (from 34 ± 18 to 14 ± 11 beats·min−1; P < 0.001), but not in the control group (from 23 ± 18 to 22 ± 12 beats·min−1; P = 0.911). Orthostatic hypertension disappeared completely after ETS (from 5 of 11 to none of 11 patients; P = 0.035), whereas the prevalence of orthostatic hypotension increased significantly after ETS (from 3 of 11 to 9 of 11 patients; P = 0.030). In the control group, the prevalence of neither orthostatic hypertension nor orthostatic hypotension changed after surgery.
Conclusions. ETS attenuates autonomic circulatory response under nitrous oxide anesthesia.

SpringerLink Date Friday, February 01, 2002

Ventricular Ectopic Rhythms and Ventricular Fibrillation following Sympathectomy

Harris, A. S., Estandia, A., and Tillotson, R. F.:
Ventricular Ectopic Rhythms and Ventricular
Fibrillation following Cardiac Sympathectomy and
Coronary Occlusion. Am. J. Physiol. 165: 505
(June), 1951.
Abrupt coronary artery occlusion in dogs with
open chest is followed by a 10 minute period (phase
I) of ectopic discharges of increasing frequency which
either pass through a maximum and then decrease
or end in fibrillation. A two stage occlusion avoids
the danger of fibrillation in this phase. During the
next four and one-half to eight hours the ectopic
frequency is no more than 5 per minute (phase II)
in those animals which survive. Following this there
is a rapid increase in ectopic frequency (phase III)
which reaches a maximum in 10 to 20 hrs. after the
artery has been tied. This ectopic activity usually
lasts two to four days. Experiments were devised to
obtain evidence concerning the effects of upper
thoracic sympathectomy upon the occurrence of
ectopic ventricular complexes during each of these
three phases. The authors, as a result of their ex-
periments, came to the point of view that "multiple
excitatory factors contribute to the production of
ectopic impulses following coronary occlusion during
all three phases and that sympathetic nerve excitation is one of these factors.

disabilities or inconveniences

The symptoms referable to hypertension were
definitely reduced or eliminated by sympathectomy.
The eyeground findings were also markedly changed
in the direction of normalcy. However, there were
very few electrocardiographic alterations postopera-
tively.
The authors conclude that the extensive sympa-
thectomy performed by them retards and in some
instances arrests the progression of the hypertensive
disease process. However, they emphasize the fact
that this type of operation is associated with certain
disabilities or inconveniences, such as pain, which
may be intense, postural lowering of blood pressure,
producing dizziness and other symptoms, excessive
sweating in areas of regeneration or in areas not de-
nervated, and obstruction of nasal airways caused by
swelling of the mucous membranes.

Grimson, K. S., Orgain, E. S., Anderson, B., Broome,
R. A., Jr., and Longino, F. H.: Results of Treat-
ment of Patients with Hypertension by Total
Thoracic and Partial to Total Lumbar Sympathec-
tomy, Splanchnicectomy and Celiac Ganglionec-
tomy. Ann. Surg. 129: 850 (June), 1949.

marked athropy of the extremity, etc

Contraindications to the use of sympathectomy
are marked atrophy of the extremity with loss of
subcutaneous tissues and consequent diminution in
the available vascular bed, constant intractable pain
uninfluenced by sympathetic block, the rapid onset
of symptoms and a rapidly progressive vascular lesion.
BLOOD VESSELS AND VASCULAR
DISEASE
Blain, A., III, and Campbell, K. N.: Lumbar Sympa-
thectomy for Arteriosclerosis Obliterans. Surgery
25: 950 (June), 1949.

Neurotransmitter metabolism in the carotid body has also been shown to be regulated by the neural innervation to the organ.

Z.-Z. Wang†, a, B. Dingera, S.J. Fidonea and L.J. StensaasCorresponding Author Contact Information, a

aDepartment of Physiology, University of Utah School of Medicine, Salt Lake City, UT 84108, U.S.A.

Accepted 19 August 1997.
Available online 17 August 1998.

Role of catecholamines in Depression, Parkinson's and Hypertension

Drugs therapeutically effective in the treatment
of affective disorders and neurological and cardiovascular diseases have also
been shown to influence the uptake, storage, release, formation and metabo-
lism of catecholamines. These findings implicating the peripheral and central
synpathetic nervous system have provided insight into the causes and treat-
ment of mental depression, Parkinson’s disease and hypertension.

Julius Axelrod
NOBEL - LECTURE 1970


.

Adrenal Tyrosine Hydroxylase: Compensatory Increase in Activity after Chemical Sympathectomy

Robert A. Mueller 1, Hans Thoenen 1, and Julius Axelrod 1

1 Laboratory of Clinical Science, National Institute of Mental Health, Bethesda, Maryland 20014

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.
Science 31 January 1969:
Vol. 163. no. 3866, pp. 468 - 469

Postoperative complications are frequent after ETS

[Postoperative complications are frequent after surgery for palmar sweating and facial redness. Effects of the treatment must be considered with regard to the risk of side-effects]
[Article in Swedish]

Räf L.

Patientskadenämnden och Landstingens Omsesidiga Försäkringsbolag, Stockholm.

sympathectomy, preventing noradrenaline release

Bretylium
Class III
Mode of action
- increases action potential duration and refractory period of cardiac cells
- antifibrillatory effect on ventricular muscle - may be more important than class
III effects in emergency treatment of malignant ventricular arrhythmias
- initially causes noradrenaline release and then produces the equivalent of a
sympathectomy, preventing noradrenaline release (class II effect)

ANTIARRHYTHMICS
© Charles Gomersall July 1999

BP reduction

Thus sympathectomy enhances sensory neuron CGRP and SP expression that contributes to the BP reduction.


S. C. Supowit,1 R. T. Ethridge,2 H. Zhao,3 K. A. Katki,1 and D. J. DiPette

Am J Physiol Heart Circ Physiol 289
Submitted 21 September 2004 ; accepted in final form 4 May 2005

Sympathetic regulation of the cerebral circulation by the carotid chemoreceptor reflex

S. F. Vatner, L. L. Priano, J. D. Rutherford and W. T. Manders

The effects of carotid chemoreceptor reflex stimulation (intracarotid injection of nicotine 0.2 microgram/kg) were examined in conscious dogs on the cerebral circulation, using the radioactive microsphere technique to measure cerebral blood flow. In intact dogs (n = 18) with ventilation controlled, carotid chemoreceptor reflex stimulation increased (P less than 0.01) mean arterial pressure by 36 +/- 5% (SE) and calculated cerebral vascular resistance by 58 +/- 13%, whereas cerebral blood flow fell by 7 +/- 6% (NS). After bilateral cervical sympathectomy (n = 9), carotid chemoreceptor reflex stimulation induced significantly different (P less than 0.01) effects on cerebral blood flow, which rose by 42 +/- 8%, and cerebral vascular resistance, which did not change. To determine whether the difference in effect was due to the sympathectomy or merely to the repetition of the stimulus, another group of dogs (sham; n = 6) that had intact sympathetic nerves were studied a second time. In "sham" dogs, the repeat response to carotid chemoreceptor stimulation also induced significantly different effects from those in dogs with sympathectomy. Thus, in the conscious dog, stimulation of the carotid chemoreceptor reflex elicits significant sympathetically mediated vasoconstriction in cerebral vessels.
Am J Physiol Heart Circ Physiol 238: H594-H598, 1980;

study demonstrates that cerebral autoregulation is influenced by the autonomic innervation of cerebral vessels

Alpha adrenergic blockade improves impaired autoregulation when cerebral perfusion pressure (CPP) is lowered but worsens it when CPP is raised, indicating that PBZ impairs the ability of cerebral vessels to constrict during induced hypertension and improves their ability to dilate during induced hypotension.

JOHN STIRLING MEYER M.D.1; KUNIO SHIMAZU M.D.1; SHIGEMICHI OKAMOTO M.D.1; ATSUO KOTO M.D.1; TADAO OHUCHI M.D.1; ATSUO SARI M.D.1; ARTHUR DALE ERICSSON M.D.1

1 Department of Neurology, Baylor College of Medicine, and the Baylor-Methodist Center for Cerebrovascular Research, Houston, Texas 77025
© 1973 American Heart Association, Inc.

Changes of Catecholamines

1. The contents of norepinephrine, epinephrine, dopamine, and dopa of the heart were determined fluorimetrically in 24 dogs from 1 to 50 days following bilateral cervical sympathectomy. The results were compared with those obtained from intact dogs in the previous studies. 2. 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. The same operative procedure, however, had no significant effect on the concentrations of dopamine and dopa 3. 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

sympathectomy – its effect in the treatment of refractory angina pectoris

To document an improvement in the quality of life in a group of patients with refractory angina and videothoracoscopic sympathectomy (VTSY) during the early postoperative period and a six-month follow-up. Methods: Ten patients with angina CCS IV refractory to a conventional therapy underwent VTSY between the years 1998 and 2002 at our institution. All patients underwent a complex preoperative evaluation, including pain assessment using a visual analog scale (VAS). Proximal thoracic sympathetic blockage was performed in all patients as a diagnostic test. The resection of bilateral Th2-Th4 ganglions was performed under general anesthesia and selective lung ventilation. All patients were monitored 6 months after the VTSY. Results: No deaths occurred in our group of patients, with an average hospital stay of 4.1 days. Nine of the ten operated patients referred an important subjective relief of pain. There was a drop from 10 to 4 according to VAS (P<0.05), and from 4 to 2.4 according to CCS (P<0.05). Decreases in basal heart rate, norepinephrine level, and an occurrence of ventricular premature beats reached the level of statistical significance. Conclusions: The increasing number of patients with refractory angina prompted a search for an effective and safe therapy to improve the quality of their life. New evidence in the pathophysiology of an ischemic myocardium and investigation of the impact of thoracic sympathectomy suggests sympathetic denervation seems to be a possible alternative method for the treatment of refractory angina pectoris.

Martin Striteskya, Milos Dobiasa, Rudolf Demesb, Michal Semradc,*, Eva Poliachovaa, Tomas Cermaka, Jiri Charvatd and Ivan Maleke
Interact CardioVasc Thorac Surg 2006;5:464-468. doi:10.1510/icvts.2005.118976
© 2006 European Association of Cardio-Thoracic Surgery

Dopamine

Adrenalectomy, adrenal demedullation, denervation and chemical sympathectomy have been reported to decrease plasma dopamine levels.

Autonomic Pharmacology
By Kenneth J. Broadley
Published 1996
CRC PRESS

Sympathectomy alters acetylcholinesterase expression

Acetylcholinesterase was analysed after destruction of adrenergic nerves by 6-hydroxy-dopamine or bilateral stellate sympathectomy. Effectiveness of treatment was verified by determining noradrenaline concentrations in right ventricle. Acetylcholinesterase activity was assayed in homogenates of atria and portions of left ventricular free wall.

Sympathectomy caused a small decrease in acetylcholinesterase activity, due to a decrease in the activity of the tetrameric globular form of the enzyme. Choline acetylcholinesterase activity was not altered by sympathectomy, which is an indication that cholinergic nerves were not affected.

Conclusions – The contribution of adrenergic neurones to the cardiac pool of acetylcholinesterase is measurable and consists primarily of the tetrameric globular form of the enzyme.
Copyright © 1990, European Society of Cardiology
Cynthia Nyquist Battie and Nancy Moran

Serum Dopamine-beta-Hydroxylase: Decrease after Chemical Sympathectomy

Dopamine-{beta}-hydroxylase, the enzyme which converts dopamine to norepinephrine, is released into the perfusate upon stimulation of the isolated perfused adrenal gland and after stimulation of the nerves to the isolated perfused spleen. This study was undertaken to determine whether dopamine-{beta}-hydroxylase activity could be detected circulating in blood. By using a sensitive new enzymatic assay, a dopamine-{beta}-hydroxylase activity was found in the blood of both man and the rat. It is located in the serum and is not associated with the formed elements of blood. The serum activity is similar to that of purified bovine adrenal dopamine-{beta}-hydroxylase in that it requires the presence of ascorbic acid, catalase, fumarate and oxygen for full activity. Furthermore, as is also the case with the adrenal enzyme, serum activity is increased in the presence of cupric ions. The Km values for substrate in human and rat sera are similar, and both are close to values determined in rat adrenal glands and stellate ganglia. The mean activity ±SE in the serum of six rats was 2.27±.04 nmoles/ml serum/20 min, and that of four normal humans ranged from 96.2 to 284 nmoles/ml/20 min.
1 Laboratory of Clinical Science, National Institute of Mental Health, Bethesda, Maryland 20014
RICHARD WEINSHILBOUM 1 JULIUS AXELROD
(Circulation Research. 1971;28:307.)
© 1971 American Heart Association, Inc.

NE synthesis was abolished by chronic sympathectomy

This study presents evidence that dopaminergic neurons innervate the cat carotid body. Immunocytochemical studies revealed many tyrosine hydroxylase (TH)-positive nerve fibers in the carotid body which establish extensive contacts with type I cells. All TH-positive intralobular profiles disappeared with chronic carotid sinus nerve (CSN) section, but survived sympathectomy following removal of the superior cervical ganglion. The level of endogenous dopamine (DA) in the CSN was higher than that for norepinephrine (NE). While both catecholamines were synthesized by the nerve at similar rates, NE synthesis was abolished by chronic sympathectomy, but DA synthesis remained largely unchanged following this procedure. Our data indicate that DA is not present in the CSN as a mere precursor of NE. Following a 3-hour incubation of carotid bodies with their attached nerves in media containing 20 µM3H-tyrosine, electrical stimulation of CSN C-fibers in chronically sympathectomized preparations provoked the release of 3H-DA, but not 3H-NE.

Copyright © 1993 S. Karger AG, Basel

Neurosignals 1993;2:16-26 (DOI: 10.1159/000109474)

L. Almaraz, Z.-Z. Wang, L.J. Stensaas, S.J. Fidone

sympathectomy on dopamine, noradrenaline and adrenaline content in some peripheral tissues

Dopamine, noradrenaline (NA) and adrenaline (Ad) depletion by 6-hydroxydopamine (6-OHDA) and pargyline plus 6-OHDA was investigated in the cat left ventricle, mesenteric and renal arteries, renal cortex, renal medulla and adrenal medulla. Catecholamine concentrations in plasma were also analyzed in these two experimental conditions. 6-OHDA alone or in combination with pargyline induced parallel decreases of NA and dopamine contents in the left ventricle. In the main trunk and proximal branches of the mesenteric artery and renal artery 6-OHDA selectively reduced NA without a parallel decrease in dopamine content. Previous treatment with pargyline abolished this selectivity. In the kidney of control animals, dopamine content was greater than could be attributed to its presence only in noradrenergic neurones. In the renal cortex 6-OHDA reduced significantly dopamine and NA contents, and in the renal medulla only NA levels were decreased by this drug. Pargyline plus 6-OHDA did not deplete the NA content either in the renal cortex or in the renal medulla, and only reduced significantly the dopamine content in the renal cortex. NA concentrations in plasma were increased by pargyline plus 6-OHDA whilst Ad remained unaffected. In the adrenal medulla only NA content was reduced either by 6-OHDA or pargyline plus 6-OHDA.
Br J Pharmacol. 1985 October; 86(2): 351–356.
M. M. Caramona and P. Soares-da-Silva

Sympathectomy also reduced the percent of DA (Dopamine)

The catecholamines (CAs), dopamine (DA) and norepinephrine (NE), are synthesized and stored in carotid body chemosensory type I cells. Previous studies in our laboratory demonstrated that low concentrations of nicotine preferentially evoke the release of NE from rabbit type I cells, whereas hypoxia mobilizes DA and NE in proportion to their stores in the tissue. The primary objective of the present study was to examine whether hypoxia, nicotine and elevated concentrations (30 mM) of K+ evoke the preferential release of DA vs. NE from cat carotid bodies superfused in vitro. In this species, where tissue stores of DA and NE are nearly equal, hypoxia evoked the preferential release of DA from normal carotid bodies. This pattern of release evoked by low O2 was also present following chronic removal of the superior cervical ganglion, which eliminated NE contained in the sympathetic innervation to the carotid body. In contrast, nicotine and high-K + preferentially mobilized NE in these sympathectomized animals. Sympathectomy also reduced the percent of DA (but not NE) content released from type I cells in response to any of the three stimuli. Our findings suggest that chemosensory type I cells possess stimulus-specific mechanisms for CA mobilization and that the sympathetic innervation modulates the metabolism and release of CAs in the cat carotid bodv.


CHEN J. (1) ; GOMEZ-NINO A. (2) ; GONZALEZ C. (2) ; DINGER B. (1) ; FIDONE S. (1) ;
Journal of the autonomic nervous system ISSN 0165-1838 CODEN JASYDS
Source / Source
1997, vol. 67, no1-2, pp. 109-113 (17 ref.)

Dopamine-beta-Hydroxylase: Decrease after Chemical Sympathectomy

Serum Dopamine-beta-Hydroxylase: Decrease after Chemical Sympathectomy
Richard Weinshilboum 1 and Julius Axelrod 2

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

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

structural damage to the peripheral arteries

Longterm sympathetic denervation has been shown to
cause structural damage to the peripheral arteries.
The effects of long-term sympathectomy include
smooth muscle atrophy in the vessels, leading to
ultimate structural changes in the arterial tree. This in-
crease in blood flow has been implicated as an impor-
tant factor in the development of Charcot joint and
pedal ulceration. Ward et al.16 postulated that, flow in
the small distal vessels is inadequate as a result of
faster flow from ateriovenous shunting. Abnormally
high blood flow, vasodilation, and arteriovenous
shunting that result from sympathetic denervation
lead to abnormal venous pooling.

Richard M. Stess
Marilyn J. Waller

Hemodynamic responses were abolished after bilateral sympathectomy

Hemodynamic responses were diminished after bilateral vagotomy and abolished after bilateral
sympathectomy.
Conclusion Since activation of cardiac afferent nerves and reflex responses remained intact after
TMLR, but changed after vagotomy or sympathectomy, TMLR does not denervate the heart sufficiently
to be the cause of improved angina after TMLR (Transmyocardial laser revascularization)


Chemoreflexes
An Experimental Study
Benjamin B. Y. Chiang, MD; Andrew M. Roberts, PhD; Abul M. Kashem, MD, PhD;
William P. Santamore, PhD; Sufan Chien, MD; Laman Gray, Jr, MD;
Robert Dowling, MD

Vol. 135 No. 5, May 2000 Archives
Arch Surg.

ipsilateral ptosis, miosis, facial anhydrosis, vasomotor rhinitis

In contrast, cosmetic complications from ETS include Horner syndrome (ipsilateral ptosis, miosis, facial anhydrosis, vasomotor rhinitis) and, most importantly from a patient-satisfaction perspective, an increase in sweating elsewhere on the body (CH). To minimize these complications, much attention has been focused on how, and how much, sympathetic nerve innervation should be interrupted.

With traditional sympathectomies or ganglionectomies (Figure 3), severe CH may occur in 10% to 40% of postoperative patients.37 It is interesting that the sites affected with CH are generally the thermoregulatory, nonglabrous skin regions of the trunk/back, buttocks, groin, and thighs that sweat normally before ETS.

This may lead ultimately to long-term debilitating CH with few treatment options, and at least 5% of patients may regret undergoing the operation.

Mayo Clin Proc. 2005;80:824-828
Hyperhidrosis: Evolving Therapies for a Well-Established Phenomenon
JOHN H. EISENACH, MD; JOHN L. D. ATKINSON, MD; ROBERT D. FEALEY, MD

Sympathectomy in the treatment of Tinnitus

Sympathectomy is an effective treatment of certain forms of of tinnitus, such as that which occurs in Meniere's disease and it has therefore been suggested that the sympathetic nervous system may modulate (increase) the sensitivity of cochlear hair cells.

Aage R. Moller:
Hearing: Anatomy, Physiology, and Disorders of the Auditory System
Academic Press, 2006
ISBN: 0123725194

Sympathectomy for moyamoya disease

The history of neurosurgical procedures for moyamoya disease

Other options such as cervical carotid sympathectomy and superior cervical ganglionectomy have also been proposed. In this paper the authors describe the history of the development of surgical techniques for treating moyamoya disease.

Keywords: moyamoya disease; superficial temporal artery–middle cerebral artery bypass; encephaloduroarteriosynangiosis; bur hole.

Cassius V. C. Reis, M.D., Sam Safavi-Abbasi, M.D., Ph.D., Joseph M. Zabramski, M.D., Sebastião N. S. Gusmão, M.D., Ph.D., Robert F. Spetzler, M.D., and Mark C. Preul, M.D.

Alteration of antioxidant status following sympathectomy

Toleikis, P.M., and Godin, D.V., Alteration of antioxidant status following sympathectomy: differential effects of modified plasma levels of adrenaline and noradrenaline, Molecular and Cellular Biology (1995) 152:39-49.

PROTECTION OF CEREBRAL VESSELS BY SYMPATHETIC NERVES

PROTECTION OF CEREBRAL VESSELS BY SYMPATHETIC NERVES*
Donald D. Heistad
Cardiovascular Division
Dept. Internal Medicine and Cardiovascular Ctr.
University of Iowa Coil. Med. and
Veterans Administration Hosp., Iowa City

Intracerebral gas partial pressure changes under vasoactive drugs

Pflügers Archiv European Journal of Physiology
Publisher Springer Berlin / Heidelberg
0031-6768 (Print) 1432-2013 (Online)
Volume 375, Number 1 / June, 1978

Prejunctional Supersensitivity to Norepinephrine after Sympathectomy

Sympathetic Innervatlon of Cerebral Arteries: Prejunctional Super-
sensitivity to Norepinephrine After Sympathectomy or Cocaine
Treatment
L. Edvinsson, P Aubineau, C. Owman, R. Sercombe, and J. Seylaz

Sympathectomy in the treatment of chronic pelvic pain

Presacral neurectomy and ovarian sympathectomy in treatment of chronic pelvic pain in young women - JR Fliegner


Melbourne Research Office
Research Data Collection & Performance Statistics
University of Melbourne

Sympathectomy in the treatment of pancreatic cancer pain

Krishna S, Chang VT, Shoukas JA, Donahoo J. Video assisted thora-
scopic sympathectomy-splanchnicectomy for pancreatic cancer pain.
J Pain Symptom Manage 2001;22:610–6.

Sympathectomy in the treatment of Tako-tsubo cardiomyopathy

Lastly, there is some evidence that TTC may be neurally mediated. Similar transient wall motion abnormalities are seen frequently in patients with subarachnoid haemorrhage, in whom the wall motion abnormality is thought to be due to neurally mediated localised microvascular ischaemia. Histopathological features of the myocardium are very similar, with contraction band necrosis,27 and can be prevented by cardiac sympathectomy.

eMJA The Medical Journal of Australia

Tako-tsubo cardiomyopathy: how stress can mimic acute coronary occlusion
Irfan Abdulla and Michael R Ward

many people have a decreased quality of life after this procedure.

Sympathectomy for hyperhidrosis is not considered as a reliable treatment and recent research has shown that many people have a decreased quality of life after this procedure.

http://www.skinrevision.net.au/hyperhidrosis

porcine femoral arteries following sympathectomy

Lamawansa, M.D., Wysocki, S.J., House, A.K. and Norman, P.E. The changes seen in balloon-injured porcine femoral arteries following sympathectomy, Cardiovascular Surgery, 7:5, pp 526 - 531 (1999)

Sympathectomy abolishes trigger points activity.

http://www.pain-education.com/100125.php

Medical Pain Education


Liason Officer Marilyn Strauss

Sympathectomy in the treatment on Long QT syndrome

A Charles Sturt University (CSU) biomedical science lecturer has returned home after performing life-saving surgery in China.

Dr Lexin Wang, who was attending the first international conference on Long QT syndromes in Beijing, worked side-by-side with thoracic surgeons from Taiwan and Peking universities to perform a sympathectomy on four patients with life-threatening Long QT syndrome – the first operation of its kind in the world.

Dr Wang said the heart condition can often go unnoticed and is more prevalent in children, with frequent blackouts a symptom. The operations were broadcast live to the conference and featured in two major national Chinese newspapers.

“One of the patients was only six years old with frequent blackouts weeks before the surgery – none have been reported four weeks after the operation,” Dr Wang said.

“We have seen an immediate reversal of electrocardiogram (ECG) abnormalities. It’s a huge progression in the overall treatment and management of this condition.”

Sympathectomy in the treatment of vulvodynia -

Third, four subjects having successful blocks had laparoscopic presacral neurectomy, yielding one durable success, two transient remissions, and one nonresponse. We investigated open dissection instead. Six patients with disabling pain (including two who failed laparoscopic procedures) underwent complete pelvic sympathectomy (superior hypogastric plexus and lateral chains). Five have no vulvar pain and one has a bizarre but generally transient pain (sympathalgia).58 Fourth, since the peripheral sympathetic nerve fibers are primarily an efferent system, it has been postulated that the afferent limb of this reflex arc is provided by "sensitization" of otherwise silent somatic C fibers that travel in the adventitia of musculocutaneous blood vessels .58, 71 Sensitization means that the polymodal nociceptors (pain receptors) on these C fibers can be fired by noradrenalin, rather than acetylcholine, hence producing a pain loop maintained by activity within the adjacent sympathetic efferents. Preliminary experience with a quantitative thermal testing machine in vulvodynia patients has shown microneurographic patterns of chronic C fiber inflammation.

http://www.vulvodynia.com.au/articles/002.htmlhttp://www.vulvodynia.com.au/index.html

Sympathectomy for chronic inflammation of the pancreas - Brisbane, AU

The operation, a thoroscopic
sympathectomy, is not a particu-
larly common procedure, but for
patients suffering from chronic
inflammation of the pancreas it
provides significant pain relief.
Thoroscopic sympathectomy
surgery is performed at the Royal
Brisbane and Women’s Hospital
about 15 to 20 times a year.

An official publication of Queensland Health Vol 9 No 1 February 2004

The hypothalmus also regulates body temperature

Question:

The hypothalamus controls hunger, thirst, [1] fatigue, anger, and circadian cycles.It also regulates body temperature. Can the subsequent Compensatory Sweating that follows after Symoathectomy be a symptom of the dysregulated hypotalamus. Can the severity of the CS be a reflection of the extent of the damage?

The acute effect of superior cervical ganglionectomy

The acute effect of superior cervical ganglionectomy (SCGx) on the pituitary-thyroid axis was examined in rats subjected to surgery 3-24 h earlier. SCGx caused an abrupt decline in thyroid norepinephrine content (an index of degeneration of sympathetic nerve terminals) to 5-10% of controls between 8 and 16 h. Rats subjected to SCGx 14 h earlier exhibited a significant depression of thyroid 131I uptake, total and free serum T4 levels and serum TSH levels.
Efferent Neuroendocrine Pathways of Sympathetic Superior Cervical Ganglia
Early Depression of the Pituitary-Thyroid Axis after Ganglionectomy
D.P. Cardinali, M.A. Pisarev, M. Barontini, G.J. Juvenal, R.J. Boado, M.I. Vacas
Neuroendocrinology 1982;35:248-254

The results further support that a regional sympathectomy causes qualitative alterations in bone modeling and remodeling, leading to bone resorption.

To assess the effect of a local sympathectomy on bone metabolism, the effect of a unilateral superior cervical ganglionectomy (Gx) on growth and bone mineral content and density of the ipsi- and contralateral mandibles was examined in female rats. A significant increase in the hemi-mandibular bone ipsilateral to Gx was found as compared to the contralateral, sham-operated side 30 days, but not 15 days, after surgery. Bone mineral content of the hemi-mandibular bones was significantly lower in the side ipsilateral to Gx in the group of rats killed on the 30th day after surgery. Since no difference in areas between innervated and denervated hemi-mandibles was found, bone mineral density was also significantly lower in the hemi-mandible ipsilateral to Gx. The results further support that a regional sympathectomy causes qualitative alterations in bone modeling and remodeling, leading to bone resorption.

Marta G. Ladizeskya, Rodolfo A. Cutrerab, Verónica Boggiob, Carlos Mautalena and Daniel P. Cardinalib, *

a Sección Osteopatías Médicas, Hospital de Clínicas “José de San Martín”, Argentina

b Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, 7o. Piso, 1121 Buenos Aires, Argentina

Received 27 May 1999;
revised 12 August 1999;
accepted 23 August 1999.
Available online 21 January 2000.

Cervical sympathectomy affects gonadotropin-releasing hormone, luteinizing hormone and testosterone

Therefore, long-term and repeated stellate ganglion block may inhibit the increases of GnRH, LH, and TS secretions induced by continuous light.

Hiroshi Iwama1 Contact Information, Choichiro Tase1, Yoshikazu Tonosaki2 and Yasuo Sugiura2
(1) Department of Anesthesiology, Fukushima Medical College, 1 Hikarigaoka, 960-12 Fukushima, Japan
(2) Department of Anatomy, Fukushima Medical College, 1 Hikarigaoka, 960-12 Fukushima, Japan

Received: 24 August 1994 Accepted: 16 December 1994

Sympathectomy decreases and adrenergic stimulation increases the release of tissue plasminogen activator (t-PA) from blood vessels

Our recent morphologic studies indicated that peripheral nervous system (PNS) adrenergic neurons synthesize, transport, and store the serene protease, tissue plasminogen activator (t-PA) in axon terminals, many of which innervate vessel walls. Sympathoadrenal stimulation induces a surge of t-PA from vessel walls into the blood. The vascular endothelium, which constitutively secretes t-PA into blood also has long been widely assumed to be the principal source of this stress-induced release, but has not been verified as such. A neurologically regulated release from adrenergic stores could thus augment the known constitutive endothelial release. To functionally test this possibility, we quantitated the effects of guanethidine-induced systemic sympathectomy on the basal and stimulated release of t-PA from isolated vessel explants in superfused organ cultures. Moment-to-moment changes in the release rate were plotted from serial assays of the t-PA free activity. The effects of endothelial and adventitial nerve plexus ablations were also tested. Sympathectomy induced 30-50% reductions in t-PA release from both arterial and microvascular explants. An acute release induced by alpha-1 adrenergic receptor stimulations was also strongly suppressed, as were basal levels of the circulating enzyme in vivo. Adventitial and endothelial ablations from normal large vessel explants produced greater reductions than small vessel endothelial ablations. Ganglion electrical stimulation also induced an acute microvascular release in vivo. These and past morphologic findings indicate a physiological infusion of t-PA into the vessel walls, blood, and other innervated matricesby sympathetic neurons. J. Neurosci. Res. 57:680-692, 1999. © 1999 Wiley-Liss, Inc.
Tao Peng 1, Xi Jiang 1, Yafei Wang 1, Arthur Hand 2, Concettina Gillies 1, Robert E. Cone 1, James O'Rourke 1 *
1Department of Pathology, University of Connecticut Health Center, Farmington
2Central Electron Microscope Facility, University of Connecticut Health Center, Farmington

Sympathectomy - surgical treatment for endometriosis

Pre-sacral neurectomy: An operation in which the nerves that transmit pain from the uterus to the brain are cut. Very rarely done in Australia. Also known as pre-sacral sympathectomy.

Influence of preganglionic cervical sympathectomy

Thus, the dilating effect of the sympathectomy on
the skin vessels appeared to predominate in our
experiments, representing an extracranial steal from
the cerebral circulation.

Cerebral infarction due to carotid occlusion and
carbon monoxide exposure
II. Influence of preganglionic cervical sympathectomy
JORG IGLOFFSTEIN, RUDOLF LAAS
From the Department of Neuropathology, Eppendorf Hospitals, University of Hamburg, H,-mburg, FederalRepublic of Germany
Journal of Neurology, Neurosurgery, and Psychiatry 1983;46:768-773

HR as indicator of arrousal

A Neuropsychological Model Relating Self-Awareness to
Hostility
Heath A. Demaree1,2 and David W. Harrison1,3


Neuropsychology is an approach that may be
beneficial in the attempt to relate mental proc-
esses—awareness, behaviors, cognitions, and emo-
tions—to the brain, its structures, and processes
including arousal of brain systems (Heilman and Va-
lenstein, 1993). Rather than ignore the role of the
cortex, view the brain as a "black box," or vaguely
describe different cortical processes, neuropsychol-
ogy purportedly evaluates how and where compo-
nents of mental processes occur. In accordance with
Mill, this approach assumes that all mental processes
result from physical processes within the central
nervous system. Accordingly, a change in any mental
process is associated with changes in the brain's
physical state. Conversely, an altered brain state simi-
larly affects mental processes.

The effect of sympathectomy on blood flow in bone

Sympathectomy as a therapeutic modality has been
employed for a variety of pathological states. It first
gained popularity in the 1920’s and 1930’s for improving
peripheral circulation, but soon its limitations began to be
apparent. The initial vasodilation after sympathectomy de-
creases some days after the procedure is performed. Results
for denervation of the upper extremity are not as long-lasting
as those for denervation of the lower extremity. A variety
of mechanisms have been proposed for the apparent return
of vasomotor tone, including: (1) development of intrinsic
tone in smooth muscle, (2) partial anatomical denervation
at the time of the operation, (3) post-denervation sensiti-
zation, (4) post-denervation sprouting, (5) hypertrophy of
the extraganglionic sympathetic nervous system, and (6)
cross-over of the lumbar sympathetic systems30. The pres-
ence or absence of inflow obstruction appears to be impor-
tant. The work of Rutherford and Valenta indicated that
while sympathectomy may increase flow in the resting state
and after exercise, the presence of inflow obstruction in a
patient who has a sympathectomy might actually interfere
with the increased distribution of the flow of blood to ex-
ercising muscle.
1987;69:1384-1390. J Bone Joint Surg Am.RF Davis, LC Jones and DS Hungerford

The effect of sympathectomy on blood flow in bone. Regional distribution and effect over time

Imbalances of sympathetic nervous system - autoimmune inflammatory diseases

Interruptions of the HPA axis at any level
and through multiple mechanisms, whether on a genetic
basis, through surgical means such as adrenalectomy or
hypophysectomy, or with pharmacological interventions
such as treatment with the glucocorticoid receptor antag-
onist RU 486, can render an inflammatory resistant host
susceptible to inflammatory disease (Sternberg 1997a,b).

Imbalances of sympathetic nervous system responses are
also associated with autoimmune inflammatory diseases
such as arthritis in both humans and rodents. Human
juvenile rheumatoid arthritis has been associated with both
abnormal HPA axis and sympathoneuronal responses (Kuis
et al. 1996). Inflammatory susceptible LEW/N rats show
not only blunted HPA axis responsiveness, but also
blunted sympathoneuronal activity in response to gluco-
privic stress (Goldstein et al. 1993). This raises the question
of whether in such susceptible hosts multiple factors may
account for overall susceptibility to autoimmune/ inflammatory disease.

While this review has focused on the HPA axis and
glucocorticoids and their role in susceptibility to inflam-
matory disease, estrogen is known to play an extremely
important role in immune modulation, and contributes to
the approximately two- to tenfold higher ratio of most
autoimmune diseases in females of all species (Wilder
& Sternberg 1990, Ahmed et al. 1999, Lahita 1999).
Ovariectomy has been shown to reduce, while replace-
ment of estrogen re-constitutes, this di

Influence of Endoscopic Thoracic Sympathectomy on Baroreflex Control of Heart Rate

Before and after the ETS, there were no significant differences in resting SBP (105.0±8.7 and 105.3±13.7 mmHg, respectively)
and heart rate (88.9±14.4 and 86.0±15.1 beats/min, respectively). In the pressor test, the ETS produced a significant
suppression of baroreflex response in all petient studied; baroreflex sensitivity before and after the ETS were 7.6±2.8 and
3.4±2.5 msec/mmHg, respectively (P<0.05). In the depressor test, the ETS also suppressed baroreflex response. In two of
eight patients, baroreflex response was completely suppressed after the ETS. Baroreflex sensitivity before and after the ETS
were 3.8±0.4 and 1.2±1.4 msec/mmHg, respectively (P<0.05). All patients showed the increase in skin temperatures of bilateral
palmars and arms, and the ceasing sweat after the ETS, indicating successful T2-3 sympathectomy.
Conclusion
Our results indicated that T2-3 sympathectomy suppressed baroreflex control of heart rate in both pressor and depressor tests
in the patients with palmar hyperhidrosis. We should note that baroreflex response for maintaining cardiovascular stability is
suppressed in the patients who received the ETS.
Anesthesiology 2001; 95:A160

Yurie T. Kawamata, M.D.; Eiji Homma, M.D.; Tomoyuki Kawamata, M.D.; Kiichi Omote, M.D.; Akiyoshi Namiki, M.D.
Anesthesiology, Sapporo Medical University, Sapporo, Hokkaido, Japan

Sympathectomy - extracranial steal phenomenon

Unilateral cerebral infarcts were produced in the rat by ligation of one common carotid artery and subsequent exposure to carbon monoxide. The incidence and extension of brain infarcts was increased in animals with additional ipsilateral cervical preganglionic sympathectomy. Sympathectomy did not affect markedly the respiration and systemic circulation. The effect of sympathectomy was attributed to a cutaneous vasodilation, leading to an extracranial steal phenomenon.

Cerebral infarction due to carotid occlusion and carbon monoxide exposure. II. Influence of preganglionic cervical sympathectomy.
J Igloffstein and R Laas

J Neurol Neurosurg Psychiatry. 1983 August; 46(8): 768–773.

Cerebral blood flow is no longer constant after sympathectomy

Cerebral blood flow remains relatively constant and is in-
dependent of modest fluctuations in arterial pressure,
presumably because of its capacity for autoregulation.22-23
After cervical sympathectomy, however, one group reported
that cerebral blood flow rate is no longer constant but varies
with arterial pressure.

The demonstration that non-uniform changes in blood flow
between cortical lobes and between hemispheres could be in-
duced by ischemia26 and neurogenic stimulation26 probably
implicates neurogenic factors. There is some evidence for
heterogeneity of the function of the sympathetic neurons
originating from the superior cervical ganglion.



Adrenergic lnnervation of Large Cerebral Blood
Vessels of the Rabbit Studied by Fluorescence Microscopy
Absence of Features That Might Contribute to Non-Uniform Change
in Cerebral Blood Flow
RALPH E. PURDY, PH.D.,* AND JOHN A. BEVAN, M.D.

STROKE VOL 8, No 1, JANUARY-FEBRUARY 1977