16% of patients regretted the operation

http://www.ncbi.nlm.nih.gov/pubmed/15276490?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed

Unsubstantiated statements by ETS surgeon can be misleading

"The incidence of compensatory hyperhidrosis is
proportional to
the surface
area rendered anhidrotic."


"The statement is based on my own observations.  It is
original and does not refer to any other article.
You have already discovered the
original source.

It is a clinical observation.  I have done no
measurements that is/yet to be subjected to
scientific study.
You can quote it as a clinical
hypothesis that I have postulated."

Jack Collin,
consultant surgeon
Oxford

Mia: the only study done (and posted on this blog)
so far, states that 
Sympathectomy will INCREASE the total
amount of body sweat.
http://www.ncbi.nlm.nih.gov/pubmed/11193740

Sympathectomy - division of adrenergic, cholinergic and sensory fibres

In general sympathectomy has been used for one or more of the following purposes:
1) to eliminate tonic or engendered responses which depend upon impulses in adrenergic nerves;
2) to eliminate visceral stores or adrenergic substances which depend upon the integrity of the postganglionic sympathetic innervation;
3) to eliminate postganglionic sympathetic tissue as a locus for the synthesis, uptake, binding, release and metabolism of adrenergic substances;
4) to eliminate visceral afferent fibers which are frequently distributed in common with autonomic nerves. The extent to which the surgical procedure is adjudged successful is usually related to the anatomical extent of the denervation and the time after operation at which the result is evaluated.
It is clear that "sympathectomy" is not a selective excision of adrenergic elements only. It is well recognized that preganglionic sympathectomy involves division of cholinergic elements ad sensory fibers.
Pharmacological Reviews, 1966 Vol. 18, No. 1. Part I

Bilateral surgical sympathectomy provides a valuable tool for future investigations of the cellular basis of supersensitivity in the myocardium.

K Goto, PA Longhurst, LA Cassis, RJ Head, DA Taylor, PJ Rice and WW Fleming

Volume 234, Issue 1, pp. 280-287, 07/01/1985
Copyright © 1985 by American Society for Pharmacology and Experimental Therapeutics

Autonomic dysreflexia

Autonomic dysreflexia is a potentially life-threatening complication in these patients. This disorder represents an autonomic response, which is primarily sympathetic, to specific visceral stimuli in patients with spinal cord injury above the level of T6. An incomplete compensatory parasympathetic outflow will occur above the level of injury. This phenomena is more common in patients with cervical injuries, and common triggers include bowel and bladder distention. Symptoms may involve piloerection, diaphoresis, pounding headache, flushing above the level of the injury, and may be associated with sudden and severe hypertension accompanied by reflex bradycardia. Although bradycardia is most common, tachycardia and arrhythmias may be present. Hypertension may be of varying severity from causing a mild headache to a seixure or life-threatening cerebral hemorrhage.

Voiding Dysfunction

By Rodney A. Appell
Published by Humana Press, 2000

Hypotension

Orthostatic hypotension is commonly associated with prolonged bed rest (24 hours or longer). It may also result from sympathectomy, which disrupts normal vasoconstrictive mechanisms.

READ BOOK EXCERPT ONLINE »

Orthostatic hypotension [Postural hypotension]: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

reduction of catecholamines by more than 90%

Sympathectomy has been used to study the role of the sympathetic nervous system in the control of gastric acid secretion. Conflicting results may reflect differences in the sympathectomy procedures used. In a previous study we showed a reduction of catecholamines by more than 90% in the gut wall of the rat after surgical upper abdominal sympathectomy.

Total denervation, including combined surgical and chemical sympathectomy plus vagotomy, did not reduce noradrenaline levels more than surgical sympathectomy alone, suggesting that the proportion of adrenergic fibers that derive from the vagus is quantitatively insignificant but that the vagus exerts a local control of the sympathetic stores of gastric catecholamines. Thus, surgical upper abdominal sympathectomy is the method of choice in studies of the role of the sympathetic nervous system in regulating gastric functions. Adrenaline and dopamine levels were much lower than the noradrenaline levels but showed roughly the same trends of changes after the denervations (except that chemical sympathectomy did not affect dopamine).
Scandinavian Journal of Gastroenterology, Volume 20, Issue 10 December 1985 , pages 1276 - 1280
H. Graffner ^a; M. Ekelund ^a; R. Hkanson ^a; E. Rosengren ^a

Affiliation:

a Depts. of Surgery and Pharmacology, University of Lund, Lund, Sweden

Serum Dopamine-β -Hydroxylase: Decrease after Chemical Sympathectomy

Dopamine-β -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-β -hydroxylase activity.

		Weinshilboum, Richard; Axelrod, Julius
Publication:		Science, Volume 173, Issue 4000, pp. 931-934
Publication Date:		09/1971
Origin:		JSTOR

Absence of the localized Schwartzman reaction

This investigation was undertaken to determine whether the presence of catechol amines was necessary for endotoxin to be operative in the production of a localized Schwartzman reaction. Seven rabbits were pretreated with 6–OH dopamine to produce a generalized chemical sympathectomy. An attempt was made to induce a localized Schwartzman reaction in these rabbits as well as in a control group. The rabbits in the experimental group did not develop the classical localized Schwartzman reaction, while those in the control group developed the localized Schwartzman reaction both clinically and histologically.
L. Shapiro ¹ , P. Cuevas ¹ , R. E. Stallard ¹ , M. P. Ruben ¹

¹ Clinical Research Center, Boston University Medical Center, School of Graduate Dentistry, Boston, Massachusetts, USA.

Journal of Periodontal Research, Volume 9 Issue 4, Pages 207 - 210

Published Online: 30 Jun 2006

Sympathectomy decreased NE and DA concentrations of muscles to approximately 10% of control values

We studied the effect of unilateral sympathectomy on rat quadriceps and gastrocnemius muscle concentrations of endogenous dihydroxyphenylalanine (DOPA), dopamine (DA), and norepinephrine (NE) and assessed the relationships between these catecholamines in several rat tissues. Catecholamines were measured by reverse-phase high-performance liquid chromatography with electrochemical detection. Sympathectomy decreased NE and DA concentrations of muscles to approximately 10% of control values, whereas the DOPA concentration tended to increase. Relatively high concentrations of DOPA were found in the gastrointestinal tract, kidney, and spleen. No correlations were obtained between the tissue concentration of DOPA and NE. A DA-to-NE ratio approximately 1% was observed in liver, muscle, pancreas, spleen, and heart, whereas we found exponentially increasing DA values with increasing NE concentration in tissues obtained from stomach, small and large intestine, kidney, and lung. In conclusion, endogenous DOPA in muscle tissue is not located in sympathetic nerve terminals but probably in muscle cells. DA concentrations in the gastrointestinal tract and in the kidneys were greater than could be ascribed to its role as a precursor in the biosynthesis of NE.

E. Eldrup, E. A. Richter and N. J. Christensen
Department of Internal Medicine and Endocrinology, Herlev University Hospital, Denmark.

Am J Physiol Endocrinol Metab 256: E284-E287, 1989;

sympathectomy abolished the differences in body fat accumulation

There is evidence to suggest that obese individuals,
and those predisposed to obesity, may have a defective
thermogenic response to meal ingestion when compared
with lean individuals (Raben et al. 1994; Napoli &
Horton, 1996; Matsumoto et al. 2001). De Jonge & Bray
(1997) concluded that DIT was lower in obesity, an out-
come demonstrated in twenty-two of twenty-nine studies
The role of the sympathetic nervous system may be
important to the results documented here (Fagius &
Berne, 1994). There is evidence for a reduced sympathetic
nervous system activity in the aetiology of obesity in ani-
mals and man (Bray, 1990; Matsumoto et al. 2001).
While all macronutrients stimulate the sympathetic nervous
system (Fagius & Berne, 1994), the type of dietary fat has
important influences as well (Young & Walgren, 1994).
Takeuchi et al. (1995) and Matsuo et al. (1995) have
demonstrated a lower sympathetic activity and low DIT,
but a higher carcass fat content in rats fed beef tallow
(saturated fat) as compared with safflower oil (unsaturated
fat). Importantly, sympathectomy abolished the differences
in body fat accumulation and DIT between the two dietary
fat groups.
M. J. Soares*, S. J. Cummings, J. C. L. Mamo, M. Kenrickand L. S. Piers1
Department of Nutrition, Dietetics and Food Science, School of Public Health, Curtin University of Technology,
Department of Human Movement and Exercise Science, University of Western Australia,
British Journal of Nutrition (2004), 91, 245–252

Influence of vagatomy and sympathectomy on thermogenesis

P. L. Andrews, N. J. Rothwell and M. J. Stock

Infusion of rats with insulin (8 U/day via implanted minipump) for 7 days caused a 22% rise in resting oxygen consumption, which was inhibited by acute injection of the beta-adrenergic antagonist propranolol. Insulin treatment produced significant increases in brown fat mass, protein content, and total thermogenic activity (assessed from binding of guanosine diphosphate to isolated brown fat mitochondria), but these responses were inhibited by prior surgical sympathectomy of the tissue. Animals subjected to subdiaphragmatic vagotomy gained more weight than pair-fed, sham-operated controls and showed reductions in total energy expenditure, the acute thermogenic response to a meal and brown adipose tissue activity. Daily injections of insulin (1 U/day) prevented all of these effects of vagotomy. These data demonstrate that the changes in brown fat activity induced by exogenous insulin are mediated by the sympathetic nervous system and that the depressed thermogenesis and brown fat activity associated with vagotomy appear to be due to a relative insulin deficiency and can be reversed by treatment with the hormone.

Am J Physiol Endocrinol Metab 249: E239-E243, 1985;

Brown adipose tissue - thermogenesis

The sympathetic nervous system (SNS) plays a critical role in the regulation of mammalian thermogenic responses to cold exposure and dietary intake. Catecholamine-stimulated thermogenesis is mediated by the beta-adrenergic receptor. In the rat brown adipose tissue is the major site of metabolic heat production in response to both cold (nonshivering thermogenesis) and diet (diet-induced thermogenesis). Measurements of norepinephrine turnover rate in interscapular brown adipose tissue of the rat demonstrate increased sympathetic activity in response to both cold exposure and overfeeding. In adult humans, a physiologically significant role for brown adipose tissue has not been established but cannot be excluded.
http://www.ncbi.nlm.nih.gov/pubmed/6380306?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=4&log$=relatedreviews&logdbfrom=pubmed
Landsberg L, Saville ME, Young JB.
Am J Physiol. 1984 Aug;247(2 Pt 1):E181-9.

sympathectomy induces a disappearance of diurnal fluctuation in the sensitivity to injected noradrenaline

In sympathectomized animals a depletion of noradrenaline from interscapular brown adipose tissue and the heart was observed. Besides, a change in adrenaline/noradrenaline ratio was found in the adrenals.
Petrović VM, Maksimović K, Davidović V.
Arch Int Physiol Biochim. 1980 Aug;88(3):273-6.
http://www.ncbi.nlm.nih.gov/pubmed/6159854

Surgical aspects of chronic post-thoracotomy pain

Chronic post-thoracotomy pain is a continuous dysaesthetic burning and aching in the general area of the incision that persists at least 2 months after thoracotomy. It occurs in approximately 50% of patients after thoracotomy and is usually mild or moderate. However, in 5% the pain is severe and disabling. No one technique of thoracotomy has been shown to reduce the incidence of chronic postthoracotomy pain. The most likely cause is intercostal nerve damage, although the precise mechanism for this is not known. Future work needs to examine surgical technique in detail. Until then, patients need to be adequately warned of this sequela of thoracotomy.
Mark L. Rogers, John P. Duffy

Department of Cardiothoracic Surgery, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK
Received 16 May 2000;

Autonomic neuropathy in the skin following sympathectomy

In diabetics with the anhidrotic syndrome, autonomic nerve fibres were studied in skin biopsies using argentic techniques and light microscopy. The Minor test was used to differentiate normal from anhidrotic skin areas. In the anhidrotic areas, histology of the nerve fibres showed beading, spindle-shaped thickening and fragmentation adjacent to the sweat glands. These changes were similar to those observed in two patients who had previously undergone lumbar sympathectomy. No abnormalities of the sympathetic nerve endings could be found in biopsies taken from normal areas of the forearm of the same patients. We conclude that the diabetic anhidrotic syndrome, a form of diabetic autonomic neuropathy, is due to a lesion of the sympathetic nerve supply to the skin.
I. Faerman¹, E. Faccio³, I. Calb², J. Razumny¹, N. Franco², A. Dominguez² and H. A. Podestá¹
Diabetologia
Volume 22, Number 2 / February, 1982

relevant to the pathogenesis of human dysautonomias

Systemic injection of monoclonal antibodies to neural acetylcholinesterase in adult rats caused a syndrome with permanent, complement-mediated destruction of presynaptic fibers in sympathetic ganglia and adrenal medulla. Ptosis, hypotension, bradycardia, and postural syncope ensued. In sympathetic ganglia, acetylcholinesterase activity disappeared from neuropil but not from nerve cell bodies. Choline acetyltransferase activity and ultrastructurally defined synapses were also lost. Electrical stimulation of presynaptic fibers to the superior cervical ganglion ceased to evoke end-organ responses.
This model of selective cholinergic autoimmunity represents another tool for autonomic physiology and may be relevant to the pathogenesis of human dysautonomias.
S Brimijoin and V A Lennon

Department of Pharmacology, Mayo Clinic, Rochester, MN 55905.

Proc Natl Acad Sci U S A. 1990 December; 87(24): 9630–9634.

James-Lang Theory of Emotion

We have experiences, and as a result, our autonomic nervous system creates physiological events such as muscular tension, heart rate increases, perspiration, dryness of the mouth, etc. This theory proposes that emotions happen as a result of these, rather than being the cause of them.

The sequence thus is as follows:

Event ==> arousal ==> interpretation ==> emotion

The bodily sensation prepares us for action, as in the Fight-or-Flight reaction. Emotions grab our attention and at least attenuate slower cognitive processing.

http://changingminds.org/explanations/theories/james_lange_emotion.htm

DURATION OF VASODILATATION AFTER LUMBAR SYMPATHECTOMY

A. Mcpherson M.B. Lpool, M.R.C.P, LAMING EVANS RESEARCH FELLOW, and A. W. L. Kessel M.B.E., M.C., F.R.C.S, CLINICAL RESEARCH ASSISTANT, INSTITUTE OF ORTHOPÆDICS, LONDON

ROYAL COLLEGE OF SURGEONS OF ENGLAND., United Kingdom

Copyright © 1956 Published by Elsevier Science Ltd.
Available online 5 September 2003.

STERILITY AND PSYCHONEUROSES FOLLOWING LUMBAR SYMPATHECTOMY

ArthurF. Hurst M.D. Oxon., F.R.C.P. Lond., SENIOR PHYSICIAN TO GUY'S HOSPITAL

Copyright © 1935 Published by Elsevier Science Ltd.
Available online 22 September 2003.

LACK OF RETURN OF VASCULAR TONE IN THE FEET AFTER SYMPATHECTOMY

R. B. Lynn M.D. Queen's Univ., Ont., F.R.C.S., F.R.C.S.E., ASSISTANT LECTURER IN SURGERY and Peter Martin V.R.D., M.Chir. Camb., F.R.C.S.E., ASSISTANT SURGEON AND LECTURER IN SURGERY POSTGRADUATE MEDICAL SCHOOL OF LONDON

Copyright © 1950 Published by Elsevier Science Ltd.
Available online 20 September 2003.

Postsympathectomy pain and changes in sensory neuropeptides

Postsympathectomy limb pain, postsympathectomy parotid pain, and Raeder's paratrigeminal syndrome are pain states associated with the loss of sympathetic fibres and in particular with postganglionic sympathetic lesions. There is a characteristic interval of about 10 days between surgical sympathectomy and onset of pain. It is proposed that this pain in man is correlated with the delayed rise in sensory neuropeptides seen in rodents after sympathectomy. These chemical changes probably reflect the sprouting of sensory fibres and may result from the greater availability of nerve growth factor after sympathectomy. The balance between the sensory and sympathetic innervations of a peripheral organ may be determined by competition for a limited supply of nerve growth factor.
Schon F.
Lancet. 1985 Nov 23;2(8465):1158-60.

Pain after sympathectomy

Surgical sympathectomies and chemical sympatholyses bring about a true sympathetic deafferentation. This leads to central retrograde degenerescence reactions of the pre-ganglionic neurons, to a reduction of the muscular tone and to a secondary neurovascular disorder at the edge of the sympathetic denervation zone.
Farcot JM, Grasser C, Muller JF.
Clinique de la Toussaint, Strasbourg.
Agressologie. 1990 Apr;31(4):191-7.

M.D.s Knock Surgery for Hyperhidrosis & Huge Insurance Scam includes ETS

(March 2005) The Canadian news magazine "Macleans" reaches nearly 3 million readers every week. In early March, this publication ran a story about the risks of severe compensatory sweating after endoscopic thoracic sympathectomy (ETS) surgery for the treatment of hyperhidrosis. The story's headline read, "Doctors knock controversial sweating treatment; Surgical procedure leaves many people dripping wet on other parts of the body." (Editor's note: As of July 2007, this article was no longer available free online. You may, however, purchase the March 2005 edition of Macleans by visiting
this link.)
According to the article, the most common problem following ETS is increased and profuse sweating on other parts of the body, most often the back, legs, groin, and abdomen. This compensatory sweating, reports Macleans, can be mild to severe and occurs in 80 to 90 percent of patients. In one study of people who had surgery for excessive underarm sweating, 90 percent of the patients reported compensatory sweating and half of them were forced to change their clothes during the day because of it.

In related news, major news outlets (including "The New York Times") have reported this week on a massive insurance scam in the US in which thousands of patients from 40 states had been transported to California to undergo unnecessary surgical and diagnostic procedures. Insurers and employers have lost US $350 million in claims paid to date due to the illegal operations.

As part of the scheme, patients traveled to outpatient surgery clinics in California to receive three or more procedures in a single week. Among the procedures unnecessarily performed on these patients, according to The New York Times, was "...a highly unusual procedure to treat 'sweaty palms.'" The paper quoted an expert who said this particular surgery "posed potential risks to the patient because it involved collapsing the patient's lungs and deactiviating a nerve near the spine."

In return for undergoing unnecessary colonoscopies, endoscopies, and surgeries for "sweaty palms", participating patients were paid anywhere from $200 to $2,000 each and may have received discounts on cosmetic surgery.
http://www.sweatsolutions.org/sweatsolutions/Article.asp?ArticleCode=19570137&EditionCode=95129982

Cervical sympathectomy affects gonadotropin-releasing hormone, luteinizing hormone and testosterone in male rats

	Journal of Anesthesia
Publisher	Springer Japan
ISSN	0913-8668 (Print) 1438-8359 (Online)
Issue	Volume 9, Number 2 / June, 1995

Hiroshi Iwama¹ , 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

http://www.springerlink.com/content/t2v222700m284612/

a defect at the adrenoceptor level in patients with sympathectomy

Intradermal injection of 0.5 ug histamine produced equal skin reactions in normal individuals and in diabetic patients with or without evidence of autonomic neuropathy as well as in patients after lumbar sympathectomy. Addition of noradrenaline (0.1 µg) resulted in a significantly smaller skin reaction (mean ± SEM) in normals and in diabetic patients without autonomic neuropathy, but remained unchanged in diabetic patients with autonomic neuropathy and after lumbar sympathectomy when compared with the reaction to histamine alone. Addition of terbutaline produced similar results as observed with noradrenaline. These findings suggest a defect at the adrenoceptor level in diabetic patients with autonomic neuropathy and in patients with lumbar sympathectomy. Thus, the combined intradermal injection of histamine and the adrenoceptor agonists noradrenaline or terbutaline represents a simple and useful test for identifying patients with impaired adrenergic function.

A Skin Test for Autonomic Neuropathy
A. Hoffmann, D. Conen, U. Leibundgut, W. Berger

Copyright © 1982 S. Karger AG, BaselMedizinische Universitäts-Poliklinik, Departement für Innere Medizin, Kantonsspital, Basel, Schweiz

Eur Neurol 1982;21:29-33
http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ArtikelNr=115450&Ausgabe=234380&ProduktNr=223840

The global recurrence rate was 8.8%

The global recurrence rate was 8.8%: 6.6% for palmar hyperhidrosis and 65% for axillary hyperhidrosis. Compensatory sweating was observed in 86.4% of the patients.

Dominique Gossot, MD^a*, Domenico Galetta, MD^a, Antoine Pascal, MD^a, Denis Debrosse, MD^a, Raffaele Caliandro, MD^a, Philippe Girard, MD^a, Jean-Baptiste Stern, MD^a, Dominique Grunenwald, MDa

Thoracic Department, Institut Mutualiste Montsouris, Paris, France

Ann Thorac Surg 2003;75:1075-1079

symptoms subsequently deteriorated

We describe a patient who underwent upper thoracic sympathectomy for palmar hyperhidrosis, and whose symptoms subsequently deteriorated, becoming worse than those on initial presentation.

---

Recurrence of hyperhidrosis after endoscopic transthoracic sympathectomy—case report and review of the literature

C.H. ORTEU ¹ , J.M. MCGREGOR ¹ , J.R. ALMEYDA ¹ M.H.A. RUSTIN ¹

¹ Dermatology Departments, The Royal Free Hospital, Pond Street, London NW3 2QG and The North Middlesex Hospital, London N18 1QX, UK

Copyright 1995 Blackwell Science Ltd

Accepted for publication 6 January 1995

The results of endoscopic sympathectomy deteriorate progressively from the immediate outcome

Intermediate-term results of endoscopic transaxillary T2 sympathectomy for primary palmar hyperhidrosis
The results of endoscopic sympathectomy deteriorate progressively from the immediate outcome.
Dr T. S.-M. Chiou ^{1 *}, S.-C. Chen ²¹Department of Neurosurgery, Chung Shan Medical and Dental College Hospital, 23, Section 1, Taichung Kang Road, Taichung, Taiwan, Republic of China
British journal of surgery
ISSN 0007-1323 CODEN BJSUAM

1999, vol. 86, n^o1, pp. 45-47 (12 ref.)

ROLE OF THE SYMPATHETIC NERVOUS SYSTEM IN THE ONSET OF HYPERTENSION IN THE RAT: THE EFFECT OF 6-OH-DOPAMINE

The magnitude of the blood pressure rise on ACTH was greater in 6-OHDA-treated rats than in intact control rats. Metabolic changes were similar.

Ming Li 1 Judith A. Whitworth 1 , 2
1 Department of Nephrology, Royal Melbourne Hospital and Howard Florey Institute of Experimental Physiology and Medicine, University of Melbourne, Victoria, Australia
Correspondence to 2 Professor J. A. Whitworth, School of Medicine, St George's Hospital, Kogarah, NSW 2217, Australia.
Clinical and Experimental Pharmacology and Physiology
Volume 18 Issue 4, Pages 197 - 204
Published Online: 28 Jun 2007
12 October 1990 7 December 1990

ETS for severe cases of LQT

Left cervical sympathectomy:

Selective left cervical sympathectomy
may be considered for:
1. Those with severe disease and in
whom beta blockers are contra-
indicated or AICD cannot be placed or
is not wanted. 2. Controlling VT
storms in those with an AICD, 3.
LQT3 or a personal or family history
of events during rest or sleep.


From the publication by the Cardiac Society of Australia and New Zealand,
Volume XVIII, No. 1, March 2006
This document represents the views of the Cardiac Society of Australia and New Zealand. The guidelines were approved by the Council of the CSANZ on 25th November, 2005.

Sympathectomy disrupts feedback from the viscera

Researchers have examined the role of autonomic feedback in emotional experience using the heartbeat detection paradigm. Katkin et al. (1982) found that some normal subjects can accurately detect their heartbeats, and it was those individuals who had a stronger emotional response to negative slides as determined by self-report (hantas et al. 1982)
Experiments in animals demonstrate that sympathectomy may retard aversive conditioning (DiGusto and King, 1972) most likely because sympathectomy reduces fear.
In order for feedback to occur, there must be a means for the viscera and autonomic nervous system to become activated.

Clinical Neuropsychology

By Kenneth M. Heilman, Edward Valenstein

Published by Oxford University Press US, 2003

http://books.google.com.au/books?id=VbTKTyn-XK4C&pg=PA458&lpg=PA458&dq=viscera+sympathectomy&source=web&ots=2lCUoqE7Rs&sig=90mBXjr9IGd_Worq34KzsrZRpCc&hl=en&sa=X&oi=book_result&resnum=5&ct=result

Degeneration patterns of postganglionic fibers following sympathectomy

In the muscle nerves the first signs of an axonal degeneration of the sympathetic fibers can be recognized 4 days after surgery. The signs of axonal degeneration are most striking about 8 days p.o. They have more or less disappeared another week later. The reactions of the Schwann cells also start on the fourth day but outlast the degenerative processes by some 8 days. Thus the degenerative and reactive processes in the reg precede those in the muscle nerves by 2 days early after surgery and by 6 days 3 weeks later. Seven weeks after surgery, fragments of folded basement lamella and Remak bundles with condensed cytoplasm and numerous flat processes are persisting signs of the degeneration.
K. H. Andres, M. von Düring, W. Jänig and R. F. Schmidt
Anatomy and Embryology
Springer Berlin / Heidelberg
Volume 172, Number 2 / August, 1985
http://www.springerlink.com/content/m21m2612n2147011/

sympathectomy is associated with increased pulmonary metastases

Chemical sympathectomy is associated with increased pulmonary metastases.

Journal of Neuroimmunology 1992;37:191-202.
Brenner, GJ, Felten, SY, Felten, DL, Cohen, N and Moynihan, JA.
http://www.massgeneral.org/nprg/brenner.htm

sympathectomy involves division of adrenergic, cholinergic and sensory fibers

The excision of neural structures which elaborate adrenergic substances during the process of regulating visceral function continues to be a valuable investigative and therapeutic maneuver.
In general, sympathtectomy has been used for one or more of the following purposes:
1/ to eliminate tonic or engendered responses which depend upon impulses in adrenergic nerves;
2/ to eliminate visceral stores of adrenergic substances which depend upon the integrity of the postganglionic sympathetic innervation;
3/ to eliminate postganglionic sympathetic tissue as a locus for the synthesis, uptake, binding, release and metabolism of adrenergic substances;
4/ to eliminate visceral afferent fibers which are frequently distributed in common with autonomic nerves.
It is clear that sympathectomy is not a selective excision of adrenergic elements only. It is well recognized that preganglionic sympathectomy involves division of cholinergic elements and sensory fibers.
Although the larger portion of sympathetic inflow to an organ can be eliminated by excision of relatively large, well defined anatomical structures in the sympathetic nervous system, there may be many aberrant pathways of innervation. The structure of the terminal apparatus for innervation in most organs is not clear, and it is not known how widely or how rapidly a seemingly small residue of postganglionic fibers can proliferate or branch to occupy sites of degenerated elements.
Theodore Cooper
Surgical Sympathectomy and Adrenergic Function
Department of Surgery, St Louis University School of Medicine
Pharmacological Reviews, Vol. 18, No.1
http://pharmrev.aspetjournals.org/cgi/pdf_extract/18/1/611

Sympathectomy increases total body perspiration, not decreases it

Performing thoracoscopic T2-T3 sympathectomy for PPH affects the total body sweating response to heat.
http://www.ncbi.nlm.nih.gov/pubmed/11193740
Kopelman D, Assalia A, Ehrenreich M, Ben-Amnon Y, Bahous H, Hashmonai M.

Department of Surgery B, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa.

An ultrastructural study of the effects of right cervical sympathectomy on the sinuatrial and atrioventricular nodes in the heart

Axon profiles and terminals showing various degrees of degeneration were present in the vicinity of the nodal cells throughout the period of study. It is concluded that right cervical sympathectomy resulted in a rapid degeneration in some of the cells in the sinuatrial and atrioventricular nodes.
S S Tay, W C Wong, and E A Ling
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1165060

Abnormalities in autonomic cardiovascular control can impair blood supply to the brain

Abnormalities in autonomic cardiovascular control can impair blood supply to the brain and produce syncope in two different disorders: autonomic failure and neurally mediated syncope. In autonomic failure, sympathetic efferent activity is chronically impaired so that vasoconstriction is deficient, upon standing blood pressure always falls (i.e., orthostatic hypotension), and syncope or presyncope occurs. Conversely, in neurally mediated syncope, the failure of sympathetic efferent casoconstrictor traffic (and hypotension) occurs episodically and in response to a trigger. Between syncopal episodes, patients with neurally mediated syncope have normal blood pressure and orthostatic tolerance. This article reviews the characteristics of autonomic failure and describes in more detail the pathophysiology, diagnosis, and treatment of neurally mediated syncope.

Neurally Mediated Syncope and Syncope Due to Autonomic Failure: Differences and Similarities.

Review Articles

Journal of Clinical Neurophysiology. Neurocardiogenic Syncope. 14(3):183-196, May 1997.
Kaufmann, Horacio

Cannon phenomenon after sympathectomy

Sympathectomy in such cases causes classic Cannon phenomenon. This physiological phenomenon refers to the fact that the end organ that is controlled by sympathetic fibers will become uninhibited in it's chemical dysfunction. As a result, even though the sympathetic nerve fibers are not contributing to acetylcholine or norepinephrine secretion at the area of nerve damage, the partially damaged sensory nerves become uninhibited with resultant increase pain input.

In patients who have had sympathectomy, thermography shows an increase iof temperature in the focus of ephatic nerve damage (Cannon phenomenon) with secondary increase of pain and discomfort.

Chronic Pain: Reflex Sympathetic Dystrophy : Prevention and Management

By Hooshang Hooshmand

Published by CRC Press, 1993

Centre for Clinical Effectiveness and Monash University

• 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 (Drott et al. 1998, Rex et al. 1998, Telaranta 1998,
Yilmaz et al. 1996). These studies were conducted in three countries
(Sweden, Finland and the Netherlands).

• 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.

Omar Ahmed PhD
Centre for Clinical Effectiveness
Monash Medical Centre
Locked Bag 29
Clayton VIC 3168
Australia

Acupuncture after sympathectomy?

Sympathectomy abolishes trigger points activity.
Dr Simon L Strauss
http://www.pain-education.com/100125.php

Perioperative Thermoregulation

Neuraxial (spinal and epidural) anesthesia also impairs central thermoregulatory control via mechanisms that remain unclear. Regional anesthesia also causes a sympathectomy that prevents lower-body vasoconstriction and paralysis that prevents lower-body shivering. Consequently, hypothermia during neuraxial anesthesia is as common, and nearly as serious, as during general anesthesia.
Daniel I. Sesler, M.D.
Australian and New Zealand College of Anaesthetists.


http://www.anzca.edu.au/events/asm/asm2007/Sessler3.htm

Long QT treatment in AU

In patients who do not respond to medication, the insertion of a pacemaker or the automatic defibrillator, or the surgical cutting of certain nerves in the neck, called cervico-thoracic sympathectomy, can be utilised.
http://www.sads.org.au/sads_info.html

sympathectomy highly controversial

This highly controversial treatment involves the destruction of nerves using surgery or chemicals, and is indicated only for profoundly disabled patients who have responded positively to sympathetic blockade and have no other treatment options. Evidence to support the use of sympathectomy is limited, and as such its use is not widely recommended. Some retrospective studies of surgical sympothectomy have shown long-term success (Schwartzman, 1997; Kim, 2002; Brandyk, 2002). However, these successful outcomes should be balanced with reports
of the negative impact of surgical sympathectomy (Furlan, 2001).

Sympathectomy causes changes in the wool growth of sheep

The left superior cervical ganglion was removed from 18 sheep. The animals were exposed to a cold environment and ear temperature was monitored to indicate the likely release of noradrenaline in the skin of the cheeks or adrenaline from the adrenals. With respect to the sympathectomized side, a reduction in ear temperature on the unoperated side was associated with lowered mitotic rate at the unoperated cheek site (P < 0.026). However, when the temperature of the unoperated side was not lowered, mitotic rate was not consistently lower on one side with respect to the other. Physiological levels of noradrenaline therefore mimicked the effects observed during the pharmacological studies, and the catecholamines may therefore play an important role in the regulation of wool growth.
DR Scobie, PI Hynd and BP Setchell
Australian Journal of Agricultural Research 45(6) 1159 - 1169

Full text doi:10.1071/AR9941159

© CSIRO 1994

Sympathectomy in the treatment of RSD

The book classifies the different stages of RSD and describes the qualitative and quantitative differences between natural endorphins and synthetic narcotics. Included are long-term follow-ups on sympathectomy patients. This important reference explains why sympathectomy fails, but nerve block and physiotherapy is successful in the treatment of RSD.
Author: H. Hooshmand
Chronic Pain
Publisher: Taylor & Francis
ISBN: 9780849386671
http://www.theaustralian.seekbooks.com.au/popcat.asp?storeURL=theaustralian&CatMain=MED071000&CatSub=MED022000&CatMinor=&PageNo=1&CatMode=2&a=c

Response:

However, please advise people that even after a sympathectomy the patients that have Reflex Sympathetic Dystrophy, aka, Complex Regional Pain Syndrome, could still have extreme pain.

Sympathectomy may provide temporary pain relief, but after a few weeks to months it loses its effect.

http://www.rsdinfo.com/crps_and_sympathectomy.htm

Christine
http://AfflictedWithRSD.com
http://blog.christineleiendecker.com

Sympathectomy also cuts sensory nerves

Thoracoscopic Splanchnicectomy, first proposed by Dr. Lin in 1992, is a lower position of sympathetic procedure. It can relieve abdominal cancer pain originating from Pancreas, Liver, Gall Bladder, Upper GI and right Hemi-colon. Nearly hundred percent of effective pain relief is found especially on the case of pancreatic cancer.

http://www.sweathand.com/four_e.htm

Mia: is there a possibility that people who have undergone sympathectomy will not feel when they are having a heart attack, or feel the pain from internal injury, or stomach ulcers?!

Dr Lin treats these conditions with sympathectomy:

A certain percentage of Angina, Reflex sympathetic dystrophy and pain, Raynaud’s syndrome, Asthma, Schizophrenia, Social phobia, Rhinitis, Migraine, Tremoring disorders, Parkinsonism … can be treated by sympathetic surgery. Stellate Ganglion Block (SGB) is one of the best method for preoperative evaluation, which is the best way to avoid unnecessary sympathetic operation.

http://www.sweathand.com/five_e.htm#index_3

Patients receiving treatment for sweaty hands also receive surgery for Hypertension? Are they told that they are also having heart surgery?

It is worthy to notice that facial sweating is also an indicator of hypertensive cardiovascular disease. Dr. Lin found that sympathetic procedures could concommitantly treat both facial sweating and hypertension. Of course, long-term follow-up is necessary to evaluate its therapeutic and preventive effects to hypertensive cardiovascular disease.

http://www.sweathand.com/one_e.htm

Conditions treated by SYMPATHECTOMY

Lin-Telaranta Classifications

Group 1: Facial Blushing, Tremoring disorder, Rhinitis, Schizophrenia, Parkinsonism, Migraine, Raynaud’s Syndrome, Angina.

Group 2: Facial sweating with or without hand sweating; Facial sweating
and blushing, Hypertension, Angina (Hypertensive cardiac
disease), …
Group 3: Hand sweating with or without axillar sweating.
Group 4: Axillar sweating (Bromidrosis), Myofascial syndrome.
Others: Psychic disorders: Schizophrenia, Social phobia, Upper
abdominal cancer pain from Stomach, Liver, Pancreas, ….;
Plantar Hyperhidrosis.

http://www.sweathand.com/two_e.htm#Linclass

Dr Lin performed over 6000 surgeries

Postoperative sweating phenomenon is a reflex response between sympathetic system and Hypothalamus, it is absolutely not a compensatory mechanism that other parts of human body take over the sweating function of hands after operation. This is the reason why Dr. Lin insisted to use the term of reflex sweating instead of compensatory sweating. Hypothalamus is the center of Autonomic Nervous System, which influences human mind, mentality and endocrine system. Dr. Lin emphasized, “Endoscopic Sympathetic Surgery helps us open a gate to Autonomic Nervous System”.
http://www.sweathand.com/introduce_e.htm

Partial cardiac sympathetic denervation after bilateral thoracic sympathectomy in humans

Upper thoracic sympathectomy is used to treat several disorders. Sympathetic nerve fibers emanating from thoracic ganglia innervate the heart.
METHODS: Nine patients with previous upper thoracic sympathectomies (four right-sided, one left-sided, four bilateral) underwent thoracic 6-[18F]fluorodopamine scanning between 1 and 2 hours after injection of the imaging agent. In each case, a low rate of entry of norepinephrine into the arm venous drainage (norepinephrine spillover) verified upper limb sympathectomy. Data were compared with those from the interventricular septum of patients with cardiac sympathetic denervation associated with pure autonomic failure and from normal volunteers. RESULTS: All four patients with bilateral sympathectomy had low septal myocardial 6-[18F]fluorodopamine-derived radioactivity (2,673 +/- 92 nCi-kg/cc-mCi at an average of 89 minutes after injection) compared with normal volunteers (3,634 +/- 311 nCi-kg/cc-mCi at 83 minutes, N = 22, P = .007) and higher radioactivity than in patients with pure autonomic failure (1,320 +/- 300 nCi-kg/cc-mCi at 83 minutes, N = 7, P = .003).
CONCLUSIONS: Bilateral upper thoracic sympathectomy partly decreases cardiac sympathetic innervation density.

Heart Rhythm. 2005 Jun ;2:602-9 15922266
Jeffrey P Moak, Basil Eldadah, Courtney Holmes, Sandra Pechnik, David S Goldstein
http://lib.bioinfo.pl/pmid:15922266

Holter changes resulting from right-sided and bilateral infrastellate upper thoracic 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 < 0.05) but not after unilateral right sympathectomy. Consistently spectral analysis variables significantly changed after bilateral surgery but showed no right-sided dominance. Little effect of sympathectomy was found on the QT interval, which tended to decrease after bilateral sympathectomy. CONCLUSIONS: Patients should be informed of the bradycardia resulting from sympathectomy.

Ann Thorac Surg. 2002 Dec ;74 (6):2076-81 12643398
Pierre Abraham, Jean Berthelot, Jacques Victor, Jean-Louis Saumet, Jean Picquet, Bernard Enon Department of Vascular Investigation and Sports Medicine, University Hospital, Angers, France

THE EFFECT OF CERVICAL SYMPATHECTOMY ON POSTERIOR PITUITARY OXYTOCIC ACTIVITY IN RATS UNDER CHRONIC STRESS.

FENDLER K, ENDROCZI E, LISSAK K.
Acta Physiol Acad Sci Hung. 1965;27:275-8.Links
http://www.ncbi.nlm.nih.gov/pubmed/14333014

Sympathectomy-induced alterations of immunity

Many studies have demonstrated that ablation of the sympathetic nervous system (SNS) alters subsequent immune responses. Researchers have presumed that the altered immune responses are predominantly the result of the peripheral phenomenon of denervation. We, however, hypothesized that chemical sympathectomy will signal and activate the central nervous system (CNS). Activation of the CNS was determined by immunocytochemical visualization of Fos protein in brains from male C57BL/6 mice at 8, 24, and 48 h following denervation. A dramatic induction of Fos protein was found in the paraventricular nucleus (PVN) of the hypothalamus and other specific brain regions at 8 and 24 h compared to vehicle control mice. Dual-antigen labeling demonstrates that corticotrophin releasing factor (CRF)-containing neurons in the PVN are activated by chemical sympathectomy; however, neurons containing neurotransmitters which may modulate CRF neurons, such as vasopressin, tyrosine hydroxylase, and adrenocorticotropin, do not coexpress Fos. Our findings suggest an involvement of the CNS in sympathectomy-induced alterations of immunity.
Tracy A. Callahan, Jan A. Moynihan and Diane T. Piekut
Brain, Behavior, and Immunity
Volume 12, Issue 3, September 1998, Pages 230-241
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WC1-45JK31F-F&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_version=1&_urlVersion=0&_userid=10&md5=d3d36bb1041938df0f68d43389b44414

Oxytocin and adrenaline after sympathectomy

It is suggested that sympathetic nerves to vascular smooth muscle have a function or functions other than transmitter release and that when crushed nerves regenerate the functions do not recover at the same rate.
Sybil Lloyd and Mary Pickford
J Physiol Vol 192, Issue 1 pp 43-52
Copyright © 1967 by The Physiological Society

http://jp.physoc.org/cgi/content/abstract/192/1/43

defects in regulation of heat production, sweat and vasoconstriction - sympathectomy creates the same effect as high level spinal cord lesions

A number of workers have studied the altered vasomotor responses after sympathectomy. Usually consistently elevated basal flow was described after sympathectomy. However, reports have varied as to the changes in response to vasodilator and vasoconstrictor stimuli. Goetz found that flow to the toe did not respond to either constrictor or dilator stimuli after sympathectomy and that in some cases blood flow was decreased in response to vasodilator stimuli and increased in response to vasoconstrictor stimuli.
These authors could not correlate the changes in blood flow with changes in blood pressure. Ahmad reported a case of hyperhidrosis with homolateral sympathectomy in whom local
warming of the sympathectomized hand to 41 C caused vasoconstriction, while the nor-
mally innervated hand responded with vasodilation.

Pollock and co-workers observed what they called "defects in regulation of heat production, sweat and vasoconstriction" in patients with spinal cord lesions. They believed these defects to be due to interruption of "impulses from suprasegmental levels." In 1953 Armin, Grant, and co-workers demonstrated increased reactivity to vasoconstrictor stimuli in the denervated rabbit's ear and referred to a similar phenomenon in the human finger after sympathectomy.
The results, however, of studies on surgically sympathectomized patients are quite clearcut.
In none of the limbs studied after sympathectomy could an increase in blood flow be produced reflexly by warming; in the majority of instances the opposite response, a decrease in blood flow, was observed. The regularity with which these carefully sympathectomized limbs fail to respond to a vasodilator stimulus suggests that this procedure might be useful as a test for completeness of sympathectomy.
The vasomotor responses to the Gibbon-Landis procedure (reflex response to warming)
were studied in hemiplegic patients, subjects with "high transection" of the cord, and in
sympathectomized patients. The response in hemiplegic patients was vasodilator in nature
just as in the 3 control groups (young normal subjects, elderly subjects without demonstrable
vascular disease, and patients with arterio-sclerosis). One patient with documented tran-
section of the cord above T5 behaved like subjects after surgical sympathectomy. The differences in response in 3 other paraplegic patients may be due to differences in location
and extent of their cord lesions. Basal blood flow was higher in sympathectomized limbs
than in comparable controls. Of 11 sympathectomized limbs tested for vasodilatation in
response to the Gibbon-Landis procedure, 4 showed no response, while 7 responded with decrease in blood flow (vasoconstriction).
1957;15;518-524 Circulation Dorothy Andrews
WERTHEIMER, ARTHUR J. LEWIS, J. MURRAY STEELE and WALTER REDISCH, FRANCISCO T. TANGCO, LOTHAR
Vasomotor Responses in the Extremities of Subjects with Various Neurologic Lesions: I. Reflex Responses to Warming

CS is a serious complication and a significant number of patients may regret undergoing the operation

CS with different severity occurred in 35 patients (87.5%). Six patients (15%) regretted undergoing the operation due to the extent and severity of the CS seriously affecting their quality of life. Thoracoscopic sympathectomy is a simple procedure with a high success rate. However, CS is a serious complication and a significant number of patients may regret undergoing the operation; a careful selection of patients and comprehensive explanation are advisable.
Libson S, Kirshtein B, Mizrahi S, Lantsberg L.

Department of Surgery "A," Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Surg Laparosc Endosc Percutan Tech. 2007 Dec;17(6):511-3

http://www.ncbi.nlm.nih.gov/pubmed/18097311?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=5&log$=relatedarticles&logdbfrom=pubmed

same hospital, same team: 51% of the patients claim decreased quality of life

"The severity of the CS was also lower in children: it was absent or mild in 54.3% of the children versus 38.0% of the others, and moderate or severe in 45.7 versus 62%, respectively (P = 0.004). Fifty-one percent of the participants claimed that their quality of life decreased moderately or severely as a result of CS."
Steiner Z, Cohen Z, Kleiner O, Matar I, Mogilner J.

Department of Pediatric Surgery, Hillel Yaffe Medical Center, PO Box 169, Hadera 38100, Israel.

Pediatr Surg Int. 2008 Mar;24(3):343-7. Epub 2007 Nov 13

http://www.ncbi.nlm.nih.gov/pubmed/17999068?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed

41% of the patients claim quality of life decreased

41% of the participants claimed that their quality of life decreased moderately or severely as a result of CS. Only (sic!) 19.6% would not have undergone the operation in retrospect; there was a significant interesting difference regarding this issue between adults (31.4%) and children (8.8%). The extent of the CS did not change with time in 70% of the patients. It exacerbated in 10% and it diminished in 20%, usually within the first 2 postoperative years. CONCLUSIONS: Thoracoscopic sympathectomy relieves hyperhidrosis in most cases. Patients prefer relief from palmar hyperhidrosis even at the cost of a high rate of CS.
J Pediatr Surg. 2007 Jul;42(7):1238-42.
Steiner Z, Kleiner O, Hershkovitz Y, Mogilner J, Cohen Z.

Department of Pediatric Surgery, Hillel Yaffe Medical Center, Hadera 38100, Israel.

http://www.ncbi.nlm.nih.gov/pubmed/17618887?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus

CS severe in 35% of patients

Compensatory sweating occurred in 89% of patients and was so severe in 35% that they often had to change their clothes during the day. The frequency of compensatory sweating was not significantly different among the three groups, but severity was significantly higher after Th2-4 sympathectomy for axillary hyperhidrosis (p = 0.04). Gustatory sweating occurred in 38% of patients, and 16% of patients regretted the operation. CONCLUSIONS: Compensatory and gustatory sweating were remarkably frequent side effects after thoracoscopic sympathectomy for primary hyperhidrosis.
We encourage informing patients thoroughly about these side effects before surgery.

[My paper] Peter B Licht, Hans K Pilegaard

Department of Cardiothoracic Surgery, Skejby Sygehus, Aarhus University Hospital, Aarhus,
Ann Thorac Surg. 2004 Aug ;78 (2):427-31 15276490

T2 results in complete sympathectomy

Removal of only the second dorsal sympathetic. ganglion is stated to result in as complete sympathectomy, in so far. as central connections are concerned.
Annual Review of Physiology
Vol. 6: 365-390 (Volume publication date March 1944)
(doi:10.1146/annurev.ph.06.030144.002053)

Visceral Functions of the Nervous System

B A McSwiney

The pathophysiology of cervical and upper thoracic sympathetic surgery

T₂-T₃ ganglionectomy significantly decreases pulse rate and systolic blood pressure, reduces myocardial oxygen demand, increases left ventricular ejection fraction and prolongs Q-T interval. A certain loss of lung volume and decrease of pulmonary diffusion capacity for CO result from sympathectomy. Histomorphological muscle changes and neuro-histochemical and biochemical effects have also been observed.

M. Hashmonai^{1, 2} and D. Kopelman^{1, 3}

(1)	Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel http://www.springerlink.com/content/jrcm3h5k8pye9yyu/ Volume 13, Supplement 1 / December, 2003 Clinical Autonomic Research

11 of 72 patients were not able to accept the severe compensatory (reflex) sweating

Compensatory hyperhidrosis is the most common complication and the major reason for patient dissatisfaction with the procedure. In a recent report on the complications experienced by 72 patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy, all patients except one complained of compensatory hyperhidrosis, with 41.7% complaining of moderate hyperhidrosis and 43.1% severe! In this study, 11 patients were not able to accept the consequences of compensatory hyperhidrosis, even though their palms had become dry postoperatively. Compensatory hyperhidrosis following sympathectomy can be far more life disrupting than palmar hyperhidrosis in that afflicted individuals may have to change sweat-soaked clothing five or six times per day. Moran states it quite succinctly: Complications related to the surgical approach, such as Horner's syndrome, brachial plexus injuries, pneumothorax, and painful scars may occur, while following sympathectomy compensatory hyperhidrosis is usual and hyperhidrosis may recur.

TREATMENT OF HYPERHIDROSIS

Lewis P. Stolman MD, FRCP(C)

---

University of Medicine and Dentistry of New Jersey, New Jersey Medical School; and the Dermatology and Laser Center of Northern New Jersey, Livingston, New Jersey
Dermatologic Clinics
Volume 16 • Number 4 • October 1998

Exam question:

S. Neurogenic Causes (of Hypotension)
10. Post-sympathectomy
http://www.fpnotebook.com/CV/Exam/OrthstcHyptnsn.htm

Medial arterial calcification in 93% of patients who underwent sympathectomy

MAC was noted in both feet in 93 % of patients who had. undergone bilateral lumbar sympathectomy; ...
www.springerlink.com/index/EYA170TL7F6HKGVV.pdf - Similar pages - Note this
by ME Edmonds - 2000 - Cited by 45 - Related articles - All 3 versions

Mechanisms of Skeletal Tracer Uptake

However, if the sympathetic nervous control of the microvasculature is interfered with, vessels that are normally closed now open up (mechanism 5, "recruitment"), and areas of osteoid not
normally exposed to tracer are able to take it up. This "hyperemic" phenomenon is seen after
sympathectomy, stroke, fracture, osteomyelitis, and peripheral neuropathies; the counting rate will be less than twice that over normal bone.

Mechanisms of Skeletal Tracer Uptake
N. David Charkes
Temple University Hospital, Philadelphia, Pennsylvania
J Nucl Med 20: 794-795, 1979

Cardiac Supersensitivity after Sympathectomy

Cardiac postjunctional supersensitivity to beta-agonists after chronic chemical sympathectomy with 6-hydroxydopamine.
Chess-Williams RG, Grassby PF, Culling W, Penny W, Broadley KJ, Sheridan DJ
Naunyn Schmiedebergs Arch Pharmacol 1985; 329:162-6.

Functional and morphological alterations have been reported in cerebral arteries after cervical sympathectomy

Innervation of the human carotid vessels is supplied by the sympathetic system, originating mainly from the superior cervical ganglion, but also from the inferior. Different methods have demonstrated profuse adrenergic innervation of the cerebral blood vessels and regulation of blood flow by the sympathetic system. Functional and morphological alterations have been reported in cerebral arteries after cervical sympathectomy, but vasospasm pathogenesis after subarachnoid haemorrhage remain controversial.

RESULTS

Histological examinations of surgical specimens confirmed ganglion tissues in all cases.

Table 1 shows mean basilar artery diameters for all groups. There were significant statistical differences between groups.

Effects of cervical sympathectomy on vasospasm induced by meningeal haemorrhage in rabbits

Antônio Tadeu de Souza Faleiros^I; Francisco Humberto de Abreu Maffei^II; Luiz Antonio de Lima Resende^III

Sympathectomy for Peripheral Arterial Insufficiency?

SYMPATHECTOMY has been performed frequently on patients with peripheral arterial insufficiency. Clinical results have varied from excellent to very poor, and, in some instances, the insufficiency has been worsened. These varying clinical results have not been completely explained by previous experimental studies.

Effect of Sympathectomy on Blood Flow in Arterial Stenosis *
ALLYN G. MAY, M.D., JAMES A. DE WEESE, M.D., CHARLES G. ROB, M.D.
From the Department of Surgery, University of Rochester School of Medicine and
Dentistry, Rochester 20, New York

sympathectomy improves skin blood flow at the thermoregulatory but not the nutritive level of skin microcirculation

The role of lumbar sympathectomy in the treatment of limb ischemia secondary to arteriosclerosis obliterans has been controversial. Increased temperature and rubor of the skin, which usually follow sympathectomy, have generally been interpreted as indicative of improved nutritive skin blood flow. However, the existence of a (nonnutritive) thermoregulatory level of skin microcirculation makes such an extrapolation questionable.

These results indicate that in case of lower limb ischemia, sympathectomy improves skin blood flow at the thermoregulatory but not the nutritive level of skin microcirculation. This may be related to the fact that the thermoregulatory vessels are mainly sympathetically controlled, whereas the nutritive capillaries are mainly controlled by local (nonneural) factors.

François M.H. van Dielen¹, Harrie A.J.M. Kurvers¹, Ruben Dammers¹, Mirjam G.A. oude Egbrink², Dick W. Slaaf³, Jan H.M. Tordoir¹ and Peter J.E.H.M. Kitslaar¹

(1)	Department of General Surgery, Cardiovascular Research Institute Maastricht and University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands, NL

(2)	Department of Physiology, Cardiovascular Research Institute Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands, NL

(3)	Department of Biophysics, Cardiovascular Research Institute Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands, NL

Sympathectomy - decreased vascular permeability

The influence of the sympathetic nervous system on capillary permeability was studied in cats. The dye penetration from the blood through the synovial membrane was tested by perfusing the two knee joints, one of which was deprived of its sympathetic nerve supply by unilateral lumbosacral sympathectomy.
Further unpublished experiments seem to support the view that increased blood supply is associated with decreased vascular permeability.

Research in Experimental Medicine D. Engel1