integration of somatosensory and phasic baroreceptor information at cortical, limbic and brainstem levels

Following one's heart: cardiac rhythms gate central initiation of sympathetic reflexes.

Gray MA, Rylander K, Harrison NA, Wallin BG, Critchley HD.

Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Brighton, East Sussex BN1 9RR, United Kingdom. m.a.gray@bsms.ac.uk

Central nervous processing of environmental stimuli requires integration of sensory information with ongoing autonomic control of cardiovascular function. Rhythmic feedback of cardiac and baroreceptor activity contributes dynamically to homeostatic autonomic control. We examined how the processing of brief somatosensory stimuli is altered across the cardiac cycle to evoke differential changes in bodily state. Using functional magnetic resonance imaging of brain and noninvasive beat-to-beat cardiovascular monitoring, we show that stimuli presented before and during early cardiac systole elicited differential changes in neural activity within amygdala, anterior insula and pons, and engendered different effects on blood pressure. Stimulation delivered during early systole inhibited blood pressure increases. Individual differences in heart rate variability predicted magnitude of differential cardiac timing responses within periaqueductal gray, amygdala and insula. Our findings highlight integration of somatosensory and phasic baroreceptor information at cortical, limbic and brainstem levels, with relevance to mechanisms underlying pain control, hypertension and anxiety.

J Neurosci. 2009 Feb 11;29(6):1817-25.

Fear conditioning dependent on autonomic awareness

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

Author/s: Critchley, Hugo D (HD); Mathias, Christopher J (CJ); Dolan, Raymond J (RJ);

Affiliation: Department of Imaging Neuroscience, 12 Queen Square, Institute of Neurology and Institute of Cognitive Neuroscience, UCL, WC1N 3BG, London, United Kingdom.

Journal: Neuron (Neuron), published in United States. (Language: eng)

Reference: 2002-Feb; vol 33 (issue 4) : pp 653-63

Changes in cerebral morphology consequent to peripheral autonomic denervation

Our findings suggest that peripheral autonomic denervation (ETS = peripheral autonomic denervation) is associated with grey matter loss in cortical regions encompassing areas that we have previously shown are functionally involved in generation and representation of bodily states of autonomic arousal.

Neuroimage. 2003 Apr;18(4):908-16. Links

Critchley HD, Good CD, Ashburner J, Frackowiak RS, Mathias CJ, Dolan RJ.

Wellcome Department of Imaging Neuroscience, Institute of Neurology, UCL, 12 Queen Square, London WC1N 3BG, UK. j.critchley@fil.ion.ucl.ac.uk

Unforeseeable and unacceptable complications

Thorac Surg Clin. 2008 May;18(2):193-207.Links

Side effects and complications of surgery for hyperhidrosis.

Dumont P.

Most of the difficulties associated with hyperhidrosis surgery are due to unavoidable side effects and unforeseeable and unacceptable complications. Careful patient selection is important before surgery so surgeons can avoid some of these pitfalls.

Patients should also be fully informed of all potential side effects and complications before surgical treatment.

the lack of uniform outcome measures makes these data difficult to interpret

The great majority of the currently available evidence supporting sympathectomy for primary hyperhidrosis is observational, coming from a variety of prospective and restrospective clinical series as well as comparative studies.

Thorac Surg Clin. 2008 May;18(2):209-16.Links

Evidence-based review of the surgical management of hyperhidrosis.

"Compensatory sweating' disastrous

World J Surg. 2008 Nov;32(11):2343-56. Links

The correlation between the method of sympathetic ablation for palmar hyperhidrosis and the occurrence of compensatory hyperhidrosis: a review.

Kopelman D, Hashmonai M.

Department of Surgery B, Ha'emek Hospital, Afula, Israel.

BACKGROUND: Upper dorsal sympathectomy achieves excellent long-term results in the treatment of primary palmar hyperhidrosis. Compensatory hyperhidrosis (CHH) remains an unexplained sequel of this treatment, attaining in a small percentage of cases disastrous proportions.

The search identified 42 techniques of sympathetic ablation. However, pertinent data for the present study were reported for only 23 techniques with multiple publications found only for 10. The only statistically valid results from this review point that T2 resection and R2 transection of the chain (over the second rib) ensue in less CHH than does electrocoagulation of T2. Further comparisons were probably prevented due to the enormous disparity in the reported results, indicating lack of standardization in definitions.

Hemodynamic consequences of cervico-dorsal sympathectomy

Hemodynamic consequences of cervico-dorsal sympathectomy
Thoracic sympathectomy has usually minimal consequences if unilateral, especially on the right side. For bilateral procedures, a mean 12% reduction of heart rate was reported [5]. Around 50% of patients have bradycardia in the following minutes of a bilateral surgery with mean and diastolic blood pressure significant reduction. Since the sympathectomy will block the chronotropic response, a significant increase of the ejection volume is observed when the patient moves in the erect position from dorsal decubitus [6].

Two cardiovascular complications were reported in the literature. First, an asystolic cardiac arrest in an 18-year-old woman during the second side (left) of bilateral sympathectomy for severe hyperhidrosis, requiring resuscitation maneuvers, with no chronic sequelae [7]. The second case was reported in a 23-year-old woman in whom a bilateral T₂ sympathectomy was performed for facial hyperhidrosis. Two years later, following electrophysiologic studies confirming unopposed vagotonic stimulation, she underwent permanent pacemaker insertion for symptomatic bradycardia [8].

	6. Recommendations

Patients should be instructed of possible cardiovascular complications following this intervention.

http://icvts.ctsnetjournals.org/cgi/content/full/8/2/238

Cardiac arrest as a major complication of bilateral cervico-dorsal sympathectomy

Interact Cardiovasc Thorac Surg. 2009 Feb;8(2):238-9. Epub 2008 Nov 27.

O'Connor K, Molin F, Poirier P, Vaillancourt R.

Department of Cardiology, Institut universitaire de cardiologie et de pneumologie, Hôpital Laval, Québec, Canada. kim.oconnor.1@ulaval.ca

Severe palmar and/or axillary hyperhidrosis can be socially and psychologically very disturbing. We present a case of a patient who suffered from a 43 s asystolic cardiac arrest the night following a second contralateral thoracoscopic T(2)-T(3) sympathectomy for severe axillary and truncal hyperhidrosis. The cardiovascular effects of cervico-dorsal sympathectomy will be reviewed. Evaluation required to prevent such a serious cardiac complication will also be discussed.

PMID: 19038983 [PubMed - indexed for MEDLINE

statistically significant differences - cardiac effect

J Thorac Cardiovasc Surg. 2009 Mar;137(3):664-9. Epub 2008 Sep 24

Effects of endoscopic thoracic sympathectomy for primary hyperhidrosis on cardiac autonomic nervous activity.

Cruz J, Sousa J, Oliveira AG, Silva-Carvalho L.

Service of Cardiothoracic Surgery, Hospital de Santa Maria, Lisbon, Portugal. costacruzjorge@gmail.com

OBJECTIVE: Endoscopic thoracic sympathectomy is performed to treat primary hyperhidrosis. The second and third sympathetic thoracic ganglia excised also innervate the heart. Some studies have shown decreased heart rate but have not been conclusive regarding other cardiac effects of sympathectomy. We studied the cardiac autonomic effects of endoscopic thoracic sympathectomy in a group of patients with primary hyperhidrosis. Heart rate variability is a simple, noninvasive electrocardiographic marker reflecting the activity and balance of the sympathetic and vagal components of the autonomous nervous system. METHODS: We performed a prospective study in 38 patients with primary hyperhidrosis with 24-hour Holter recordings obtained before endoscopic thoracic sympathectomy and 6 months later. RESULTS: We found statistically significant differences (P < .05) in both time and frequency domains. Parameters that evaluate global cardiac autonomic activity (total power, SD of normal R-R intervals, SD of average normal R-R intervals) and vagal activity (rhythm corresponding to percentage of normal R-R intervals with cycle greater than 50 ms relative to previous interval, square root of mean squared differences of successive normal R-R intervals, high-frequency power, high-frequency power in normalized units) were statistically significantly increased after sympathectomy. Low-frequency power in normalized units, reflecting sympathetic activity, was statistically significantly decreased after sympathectomy. Low-/high-frequency power ratio also showed a significant decrease, indicating relative decrease in sympathetic activity and increase in vagal activity. CONCLUSION: These results provide, for the first time to our knowledge, clear evidence of increased vagal and global cardiac autonomic activity and decreased sympathetic activity after endoscopic thoracic sympathectomy.

PMID: 19258086 [PubMed - indexed for MEDLINE

40% were disappointed

We detected 8 patients (53%) complaining
about a decent to moderate recurrence of hand sweating and compensatory and gustatory sweating were observed in 9 (60%) and 5 (33%)
patients, respectively. Reported side effects related to surgery were paresthesias of the upper limb and the thoracic wall in 8 patients
(53%) and recurrent pain in the axillary region in one. At an average 12 years after surgery, 47% of patients were satisfied with the
treatment results, 40% were disappointed. Six patients (40%) affirmed they would ask for the operation if it were to be redone. Our
findings indicate that results of ETS deteriorate and compensatory sweating does not improve with time. It is mandatory to inform patients
of the potential long-term adverse effects before surgery.
􏰀 2009 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.
Interactive CardioVascular and Thoracic Surgery 8 (2009) 54–57

Sympathectomy = psychosurgery

http://encyclopedia.stateuniversity.com/pages/17971/psychosurgery.html
Cambridge Encyclopedia :: Cambridge Encyclopedia Vol. 60

Some consider use of endoscopic thoracic sympathectomy (ETS surgery) for patients with anxiety disorder to be
psychosurgery, despite it not being surgery of the brain.

"sympathectomy with little or no idea whether this is likely to produce benefit"

ANZ Journal of Surgery

Volume 45 Issue 4, Pages 425 - 434

Published Online: 21 Jan 2008

Journal compilation © 2009 Royal Australasian College of Surgeons

Proceedings of the Surgical Research Society of Australasia - SCIENTIFIC MEETING

"sympathectomy with little or no idea whether this is likely to produce benefit" - to be updated soon.

Causes of sexual dysfunction in the male

TABLE 2. Causes of sexual dysfunction in the male classified by clinical manifestation

Orgasmic dysfunction Drugs (selective serotonin reuptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors,
substance abuse)
CNS disease (multiple sclerosis, Parkinson’s, Huntington’s chorea, lumbar sympathectomy)
Psychogenic (performance anxiety, conditioning factors, fear of impregnation, hypoactive sexual desire)

Male Sexual Function and Its Disorders: Physiology, Pathophysiology, Clinical Investigation, and Treatment
FOUAD R. KANDEEL, VIVIEN K. T. KOUSSA, AND RONALD S. SWERDLOFF
The Leslie and Susan Gonda (Goldschmied) Diabetes and Genetic Research Center, Department of
Diabetes, Endocrinology & Metabolism, City of Hope National Medical Center, Duarte, California
91010; and Department of Medicine, Harbor-UCLA Medical Center, Torrance, California 90502
Endocrine Reviews 22(3): 342–388
Copyright © 2001 by The Endocrine Society

sympathectomy as heart surgery (also)

Surgical left cardiac sympathetic denervation for long QT syndrome: effects on QT interval and heart rate

Journal	Heart and Vessels
Publisher	Springer Japan
ISSN	0910-8327 (Print) 1615-2573 (Online)
Issue	Volume 20, Number 4 / July, 2005 (1) Department of Cardiology, People’s Hospital of Peking University, Beijing, 100044, China (2) Heart Center, Tongren Hospital, Beijing, China (3) Department of Thoracic Surgery, Tongren Hospital, Beijing, China (4) School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW, 2678, Australia

complications that can be catastrophic

Lumbar sympathectomy has been employed for over 75 years for the treatment of a variety of painful and circulatory conditions in the lower extremities. Chemical sympathectomy decreased the need for open surgical sympathectomy with less morbidity and mortality but still has risks and complications that can be catastrophic. The development of precise neurolysis with radiofrequency lesioning significantly decreased the risks of sympathectomy with results comparable to chemical and surgical neuroablation. Radiofrequency sympathectomy also allows repeat procedures without the risk of distorting the original anatomy.

Percutaneous radiofrequency lumbar sympathectomy
Techniques in Regional Anesthesia and Pain Management, Volume 8, Issue 1, Pages 53-56

Severe CS for 18% of patients

It was not necessary to remove the clips in any case. In our historical series of 300 patients submit-
ted to sympathicotomy we observed an improvement of the symptoms in 99% and CS in 78%, being severe in 18%.


162-P
EFFECTIVENESS OF SYMPATHETIC BLOCK BY CLIPPING IN THE TREATMENT
OF HYPERHIDROSIS AND UNCONTROLLABLE FACIAL BLUSHING
J.J. Fibla, L. Molins, J.M. Mier, G. Vidal
Thoracic Surgery Sagrat Cor University Hospital, Barcelona, Spain
2008;7:147-200
Interact CardioVasc Thorac Surg
Abstracts: Suppl. 2 to Vol. 7 (June 2008)

Sympathectomy increased the pain threshold and made the sympathectomized rats hypesthetic.

Spine:

15 April 1996 - Volume 21 - Issue 8 - pp 925-930

Anatomy

Latanoprost has been shown to abolish sympathectomy induced iris hypopigmentation

British Journal of Ophthalmology 1999;83:1403c; doi:10.1136/bjo.83.12.1403c

Copyright © 1999 by the BMJ Publishing Group Ltd.

Br J Ophthalmol 1999;83:1403 ( December )

Surgical or chemical sympathectomy leads to suppression of adrenergic and neuropeptide Y fibers.

Clinical Anatomy of the Nose, Nasal Cavity and Paranasal Sinuses

By Johannes Lang

Translated by P. M. Stell

Edition: illustrated

Published by Thieme, 1989

Injury of peripheral nerves often results in hyperalgesia

Injury of peripheral nerves often results in hyperalgesia (an increased sensitivity to painful stimuli). This hyperalgesia is mediated in part by sympathetic neurotransmitters. We examined the effect of neuropeptide Y (NPY), specific Y1 and Y2 agonists, and an NPY antagonist on peripheral hyperalgesia in rats whose sciatic nerves had been partially transected. NPY and the Y2 agonist, N-acetyl [Leu²⁸,Leu³¹] NPY 24–36 exacerbated both mechanical and thermal hyperalgesia, while the Y1 agonist, [Leu³¹, Pro³⁴]NPY relieved thermal hyperalgesia.

School of Anatomy, University of New South Wales, Sydney, NSW 2052, Australia

Brain Research
Volume 669, Issue 2, 16 January 1995, Pages 245-254

sympathectomy can itself trigger a painful syndrome

Finally, it should be noted that neuropathic, painful states are not invariably sympathetic dependent. Clinically, 'sympathetically maintained' and 'non-sympathetically maintained' states of pain can be differentiated, based on the fact that in some patients neuropathic pain can be relieved by sympathetic blocks. Furthermore, surgical sympathectomy can itself trigger a painful syndrome in some patients.

Pain medicine: the requisites in anesthesiology

By Stephen E. Abram

Edition: illustrated

Published by Elsevier Health Sciences, 2006

Results of ETS deteriorate

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

---

Accepted for publication 6 January 1995

Clinical and Experimental Dermatology

Volume 20 Issue 3, Pages 230 - 233

Published Online: 27 Apr 2006

Sympathectomy on Neuropeptide Y

Neuropeptide Y (NPY)-immunoreactive nerve fibers were numerous around arteries and few around veins. NPY probably co-exists with noradrenaline in such fibers since chemical or surgical sympathectomy eliminated both NPY and noradrenaline from perivascular nerve fibers and since double staining demonstrated dopamine-β-hydroxylase, the enzyme that catalyzes the conversion of dopamine to noradrenaline, and NPY in the same perivascular nerve fibers.

Neuropeptide Y co-exists and co-operates with noradrenaline in perivascular nerve fibers

References and further reading may be available for this article. To view references and further reading you must purchase this article.

Regulatory Peptides
Volume 8, Issue 3, April 1984, Pages 225-235

sympathectomy severs both vasomotor and sensory fibres

Lumbar sympathectomy severs both vasomotor and sensory fibres, suggesting that relief of rest pain may be explained not only by increased cutaneous and muscle blood flow, but also by nociceptive sensory denervation.

Brendon J. Coventry* and John A. Walsh ^† *Department of Surgery, University of Adelaide, Royal Adelaide Hospital and ^† VascularSurgery Unit, Department of Surgery, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia

ANZ Journal of Surgery

Volume 73 Issue 1-2, Pages 14 - 18

Published Online: 5 Feb 2003

Journal compilation © 2009 Royal Australasian College of Surgeons

Secretions of the pituitary-adrenal cortex as controllers of emotion

Peripheral sympathectomy prevents the normal occurrence of a variety of bodily changes and hence, a fortiori, prevents sensory feedback of those changes. (p.68)

Biology and emotion

By Neil McNaughton
Edition: illustrated

Published by Cambridge University Press, 1989

more likely to develop autoimmune disorders after sympathectomy

page 71:
Lewis rats are much more likely to develop autoimmune disorders after sympathectomy (Dimitrova and Felten, 1995).
This finding suggests that if sympathetic regulation were impaired in a genetically predisposed individual, an autoimmune disease might develop.
Betrayal by the Brain: The Neurologic Basis of Chronic Fatigue Syndrome, Fibromyalgia Syndrome and Related Neural Network Disorders
by Jay A. Goldstein
published by The Haworth Medical Press, 1996

ETS prevents responses to reflex or emotional changes in the central nervous system - Is this the definition of LOBOTOMY?

All the sympathetic ganglia that send postganglionic nerve fibres to structures in the head, neck and upper limb receive preganglionic fibres from the central nervous system only through the white rami communicates of the upper thoracic ventral rami. These preganglionic fibres ascend in the trunk and reach its ganglia directly and outlying ganglia through branches of the trunk. Thus destruction of the trunk at the root of the neck, whether as a result of a surgery (cervical sympathectomy) or of some pathological condition,isolates all these sympathetic ganglion cells from the central nervous system and prevents them from responding to reflex or emotional changes in the central nervous system.
Cunningham's Manual of Practical Anatomy: Volume III: Head, Neck and Brain (Oxford Medical Publications)
G. J. Romanes
Paperback - Nov 20, 1986

No correlation between the denervated area and severity of 'compensatory' sweating

There was no correlation between the degree of alteration in total body perspiration and the development of CH. Performing thoracoscopic T2-T3 sympathectomy for PPH affects the total body sweating response to heat; however, the development of CH does not correlate with this alteration. (author abst.)

http://sciencelinks.jp/j-east/article/200108/000020010801A0160337.php

Journal Title; Surg Today

Journal Code:Z0754A

ISSN:0941-1291

VOL.30;NO.12;PAGE.1089-1092(2000)

Mia: proof that 'compensatory' sweating is NOT compensatory

Devervation sensitivity and Sympathectomy

Somatic effectors are dependent on their innervation to maintain structural and functional integrity. Whenn denervated, they eventually atrophy. This is the fate of the denervated voluntary muscles as noted in a lower motor neuron paralysis. Autonomic effectors are not wholly dependent on their innervation. Denervated involuntary muscles, cardiac muscle and glands continue to function. For example, the transplanted heart might function reasonably well. However, when deprived of autonomic nervous system influences, these effectors are abnormal in that they do not respond as effectively as they should to satisfy the changing demands of the organism.
When an effector is deprived of it's innervation, it may become extremely sensitive to chemical mediators (neurotransmitters). For example, the rate of beat of the totally denervated heart will increase if the heart is exposed to just 1 part of epinephrine in 1400 million.

Denervation supersensitivity is noticeable in clinical situation following sympathectomy. (p.367)

The human nervous system: structure and function

By Charles Robert Noback, Norman L. Strominger, Robert J. Demarest, David A. Ruggiero

Edition: 6, illustrated

Published by Humana Press, 2005

ISBN 1588290409, 9781588290403

The haemodynamic effect of thoracoscopic cardiac sympathectomy

The response of the heart to stress is much attenuated by upper thoracic sympathectomy.

A patient with angina pectoris who had been successfully treated by thoracoscopic cardiac sympathectomy was scheduled to have scalp debridement under general anaesthesia for a scald burn. There were haemodynamic changes during and after the operation including anaesthetic induction, endotracheal intubation, maintenance, and early recovery period. The sympathetic denervated heart showed little chronotropic response to anaesthetic and surgical stimulation. On the contrary, the parasympathetic response was predominant. An episode of severe bradycardia occurred during endotracheal suctioning prior to extubation. The haemodynamic response to cardiac sympathetic denervation corresponded to the efferent effect of beta-receptor blockade

European Journal of Surgery

See Also:

• British Journal of Surgery

Volume 164 Issue S1, Pages 37 - 38

Published Online: 2 Dec 2003

This is how language is used to distort, misrepresent and manipulate:

"The operation involves snipping some nerves that cause blushing. It involves 2 tiny incisions in the arm-pit through which they gain access to the nerves. The whole thing takes less than 1 hour and it requires one nights stay in the hospital. It is relatively straight-forward in the hands of people who do it regularly and the people in Karolinska are experts."

http://www.irishhealth.com/article.html?id=4396

Telaranta reveals what is wrong with the surgery:

The first aim in correctional surgery is to restore normal neuronal pathways in the sympathetic chain. This can be accomplished by:

1. Excision of the scar and a neurolysis around the healthy nerve ends. This often gives immediate relief in the compensatory hyperhidrosis by stopping the neuropathic feedback hypersensitivity. If pain has been included in the side effects, it is usually right away diminished after the neurolysis.

2. Adding fresh nerve stimuli to the midbrain structures. To accomplish this we transpose the living intercostal nerve to the stellate (T1) ganglion.
This procedure adds to the possibility of thermoregulatory feedback between the lower sympathetic chain and the midbrain ganglia. Also the energy level may be restored, if damaged in the first surgery. This result is often immediate.

http://www.privatix.fi/index.shtml?&a=0&s=navig_03&l=en&d=02_reversal

Mia: Telaranta in his summary describing what he can improve on with his 'reversal of ETS'. First he has to admit what goes wrong with Sympathectomy in the first place. None of these effects (side-effects) is included on any of the patient information brochures, and patients are lead to believe that the surgery will only affect their skin sweating - in a good way. In his text we find admission that it also affects midbrain and it's function. As far as I tell from the extensive research I have undertaken, none of the surgeons offering this simple, 'almost miraculous' surgery ever mentioned ETS (Sympathectomy) affecting brain function.

There should be no surprise why are there so many websites and forums dedicated to the patients outrage, grief and support, as the medical community refuses to acknowledge these side-effects - unless there is some incentive, as there is in this case. The high number of patients seeking reversal surgeries is should provide and indication of the problem.

19% of patients suing Telaranta?!

29 % benefited greatly from the procedure and 81 % had at least useful recovery with a marked relief in the reflex sweating. Only 19 % denied all benefit, but none of these claimed any worsening of the situation. Even these patients may have had some benefit, but because of the pending lawsuits and compensation requests it is understandable, that willingness to evaluate positively the end result is not at the highest level.

REFINED REVERSAL SURGERY OF ETS
updated 1.9.2008

Timo Telaranta, MD, PhD, Ass. Prof. of Clinical Surgery, Rome, Italy

http://www.privatix.fi/index.shtml?&a=0&s=navig_03&l=en&d=05_results

Sympathectomy causes changes in the noradrenergic-dopaminergic feed-back systems

The results of motor improvement may be due to changes in the noradrenergic-dopaminergic feed-back systems. It is also possible that the autonomic nervous system plays a role in the Parkinson's disease which is still poorly understood.


Relief of extrapyramidal symptoms
by sympathetic block
2003-05-17
http://www.privatix.fi/index.shtml?&a=0&s=navig_03&l=en&d=extrapyramidal

Hyperglycemic responses attenuated by sympathectomy

Hyperglycemic responses to CDP-choline, choline, cytidine monophosphate and cytidine were not affected by chemical sympathectomy, but were prevented by bilateral adrenalectomy. Phosphocholine-induced hyperglycemia was attenuated by bilateral adrenalectomy or by chemical sympathectomy. These data show that CDP-choline and its metabolites induce hyperglycemia which is mediated by activation of ganglionic nicotinic receptors and stimulation of catecholamine release that subsequently activates 2-adrenoceptors.
Archives Of Physiology And Biochemistry, Volume 113, Issue 4 & 5 October 2007 , pages 186 - 201 First Published on: 03 October 2007

Reactions to drugs after sympathectomy

Antihypertensive effects of thiazide diuretics may be enhanced in patients with a sympathectomy.
p.262

Handbook of Drug Interactions: A Clinical and Forensic Guide

By Ashraf Mozayani

Edition: illustrated

Published by Humana Press, 2004

ISBN 1588292118, 9781588292117

663 pages

Causes of male infertility

Sympatholytic drugs or sympathectomy - p. 662

Endocrinology & metabolism

By Philip Felig, Lawrence A. Frohman

Edition: 4, illustrated

Published by McGraw-Hill Professional, 2001

ISBN 0070220018, 9780070220010

1562 pages

Bilateral thoracoscopic cervical sympathectomy for the treatment of recurrent polymorphic ventricular tachycardia

Congenital long QT syndrome (LQTS) is a disorder of prolonged cardiac repolarisation, manifest by a prolonged QT interval and characterised by recurrent presyncope/syncope, polymorphic ventricular tachycardia (PMVT), or sudden cardiac death.
She was ultimately treated successfully with bilateral thoracoscopic cervicothoracic sympathectomies. This is the first reported bilateral thoracoscopic treatment of a patient with LQTS and symptomatic life threatening ventricular tachyarrhythmias refractory to current pharmacological and pacing techniques.
Heart 2005;91:15-17
© 2005 by BMJ Publishing Group & British Cardiac Society

ETS reduces anxiety. Is it a psychosurgery?

The results of STAI showed significant improvement in the levels of anxiety after surgery compared with the preoperative levels and with established norms (p <>Conclusions: Patients with primary hyperhidrosis that undergo EBTS presented a decrease in the level of anxiety and associated symptoms.

Eur J Cardiothorac Surg 2006;30:228-231
© 2006 Elsevier Science NL

sympathectomy suppressed baroreflex control of heart rate

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


Is this and admission that ETS causes reduced exercise tolerance?!

So far Dr. Reisfeld has performed approximately 35 clamp removal procedures. The results are not 100% but about 50% of those cases showed improvements in their clinical condition which translated into reduction of compensatory sweating, better exercise tolerance, re-appearance of sweat in the hands and upper body, etc. Obviously more time is needed to come to any definite conclusions and also we will need more cases so statistical analysis can be made.
http://www.sweaty-palms.com/detailsofsurgery.html

Depression of Endothelial Nitric Oxide Synthase but Increased Expression of Endothelin-1 Immunoreactivity in Rat Thoracic Aortic Endothelium Associated With Long-term, but Not Short-term, Sympathectomy

Gjumrakch Aliev, Vera Ralevic, Geoffrey Burnstock
(Circulation Research. 1996;79:317-323.)
© 1996 American Heart Association, Inc.

Cardiac function after sympathectomy

These findings suggest that cardiac muscle cells require thyroxin for normal growth and enzyme development. Also, Sx (Sympathectomy) may impair cardiac functional capacity by altering Ca2+ activity of actomyosin ATPase.
Am J Physiol Cell Physiol 236: C30-C34, 1979;
0363-6143/79 $5.00

From a website set up by one of the ETS patients

A team of researchers at the National Institute of Neurological Disorders and Stroke (NINDS) considers sympathectomy to be a neurocardiologic disorder. Led by senior investigator David Goldstein, M.D. Ph.D., they have thusfar studied at least four sympathectomy patients, and have shown that the surgery causes what Goldstein terms "surgically induced autonomic failure".

I participated in the study in November, 2004. For five days I underwent a battery of tests, including PET scans, drug tests, sweat tests, a tilt-table test, EKG, and a lumbar puncture (spinal tap). Conclusions:

1. Partial cardiac denervation as a result of bilateral thoracic sympathectomies.

2. Complete absence of blood vessel constriction in the arms, as expected in thoracic sympathectomy.

3. Complete loss of sympathetic innervation to the thyroid.

4. Abnormal catecholamine levels in the spinal fluid.

Bear in mind that these researchers are only looking at a few of the many aspects of ETS dysfunction.

http://www.truthaboutets.com/Pages/NIH.html

Cardiac arrest as a major complication of bilateral cervico-dorsal sympathectomy

We present a case of a patient who suffered from a 43 s asystolic cardiac arrest the night following a second contralateral thoracoscopic T₂–T₃ sympathectomy for severe axillary and truncal hyperhidrosis. The cardiovascular effects of cervico-dorsal sympathectomy will be reviewed. Evaluation required to prevent such a serious cardiac complication will also be discussed.

Interact CardioVasc Thorac Surg 2009;8:238-239. doi:10.1510/icvts.2008.188011
© 2009 European Association of Cardio-Thoracic Surgery

http://icvts.ctsnetjournals.org/cgi/content/abstract/8/2/238

Melatonin metabolism

There is a diurnal rhythm in the activity of serotonin N-acetyltransferase in the rat pineal gland. In the normal rat, the nocturnal enzyme activities are 15-to 30-fold greater than are daytime activities. This rhythm is abolished by decentralization or removal of the superior cervical ganglia, procedures that interrupt the only source of central neural input to the pineal gland. This effect of superior cervical sympathectomy on the N-acetyltransferase rhythm cannot be attributed to changes occurring in the denervated pineal parenchymal cells. When chronically denervated glands are placed in organ culture with norepinephrine, the neurotransmitter normally located in sympathetic terminals in the gland, N-acetyltransferase activity increases 10- to 20-fold. These data indicate that superior cervical sympathectomy abolishes the N-acetyltransferase rhythm by elimination of the input of central signals to the gland. These signals appear to regulate the N-acetyltransferase rhythm in the normal rat by regulation of the release of norepinephrine from the sympathetic terminals within the pineal gland.

by: DC Klein, JL Weller, RY Moore

Proceedings of the National Academy of Sciences of the United States of America, Vol. 68, No. 12. (December 1971), pp. 3107-3110.

Melatonin, serotonin

Cervical sympathetic nerves may affect blood adrenocorticotropic hormone (ACTH), cortisol (CS), melatonin or serotonin levels. We examined whether stellate ganglion block (SGB), which inhibits this nerve conduction, affects these substances.

During surgery, melatonin circadian rhythm and serotonin levels did not change, but melatonin increased only at night and serotonin decreased after surgery. These findings suggested that some stress stimuli are conducted via cervical sympathetic nerves to the hypothalamus, which is reduced by SGB, and to the pineal gland at night, which causes increased melatonin and decreased serotonin levels.

Authors: Iwama, Hiroshi; Son, Syoraku; Watanabe, Kazuhiro

Source: The Pain Clinic, Volume 13, Number 3, 2001 , pp. 233-244(12)

Publisher: Maney Publishing

Melatonin production abolished after sympathectomy

The amount of 6-sulphatoxymelatonin, the chief metabolite of melatonin, in the urine was measured in nine patients, who were subjected to
bilateral sympathectomy at the second thoracic ganglionic level for treatment of hyperhidrosis of the palms. All patients showed before surgery had a normal 6-sulphatoxymelatonin excretion with a peak in the excretion during the night time. After the sympathectomy, the high night time excretion
was clearly abolished in five patients but remained high in four patients. This indicates that the segmental locations of the preganglionic sympathetic perikarya in the spinal cord, stimulating the melatonin secretion in the pineal gland in humans, vary between individuals.
© 2006 Elsevier Ireland Ltd. All rights reserved.
Molecular and Cellular Endocrinology 252 (2006) 40–45


Melatonin
Melatonin is an important immunomodulator and is the principal means by which tissues are synchronized
to the daily cycle of light exposure and physical actity. Cortisol, on the other hand, is critical for
maintaining energy homeostasis and modulating immune function. Melatonin and cortisol tend to run opposite
to each other. That is, cortisol approaches its low point at bedtime, whereas melatonin reaches its peak a few
hours aft corti bottoms out (see Figure 1 below). Deviations from the normal patterns for these hormones can
have significant implications for overall health and future risk of cancer. In fact, research shows that low
melatonin and high cortisol are independently associated with some of the same health conditions.
Consequently, the balance between these two hormones is important to overall good healt. The melatonin-
cortisol index (MCI)s an innovative way of examining the balance between these two vital hormones. The MCI may be used to assess cancer risk and immune function, and may also aid in the assessment of depression, heart disease, osteoporosis and weight management issues.
Melatonin | Rocky Mountain Analytical Lab
http://www.rmalab.com/index.php?id=61

anaesthetic management of hypoxaemia during transthoracic endoscopic sympathectomy.

To present our experience and evaluate intraoperative arterial oxygen desaturation during anaesthesia for transthoracic endoscopic sympathectomy (TES). DESIGN: Prospective open study.
SETTING: University Hospital in Israel.
SUBJECTS: Consecutive series of patients (n = 210), suffering from upper limb hyperhidrosis, anaesthetised for TES.
MAIN OUTCOME MEASURES: Peripheral oxygen saturation (SpO2), haemodynamic status, complications, postoperative pain (n = 210) and arterial blood gases (n = 10).
RESULTS: 407 TES; 195 bilateral, 17 unilateral. Surgical time range 20-75 minutes. SpO2 decreased below 98% in 58 patients. Sudden hypotension and bradycardia in two patients. The mean PaO2 was significantly (p = 0.03) decreased during two-lung ventilation (TLV), after reinflation of the right lung, compared with TLV after endobronchial intubation. There was no significant difference in mean PaO2 during one-lung ventilation of both lungs. Lowest PaO2 observed during one-lung ventilation was less than 13.3 kPa in three sympathectomies. Postoperative pain, severe on awakening and mainly retrosternal, was relieved with i.v. opiates. CONCLUSION: Controlled ventilation with 100% inspired O2, SpO2 monitoring and one to two gentle manual ventilations when it decreases is the cornerstone of the management of hypoxaemia, a potentially serious complication of TES.
Eur J Surg Suppl. 1994;(572):23-5
PMID: 7524777 [PubMed - indexed for MEDLINE]

Risk of road traffic accidents associated with the prescription of drugs

Engeland A, Skurtveit S, Mørland J.

Norwegian Institute of Public Health, University of Bergen, Norway. anders.engeland@isf.uib.no

The risk was markedly increased in users of natural opium alkaloids (2.0; 1.7-2.4), benzodiazepine tranquillizers (2.9; 2.5-3.5), and benzodiazepine hypnotics (3.3; 2.1-4.7). Somewhat increased or unchanged SIRs were found for nonsteroidal antiiflammatory drugs (1.5; 1.3-1.9), selective beta-2-adrenoreceptor agonists (i.e., antiasthmatics, 1.5; 1.0-2.1), calcium receptor antagonists (0.9; 0.5-1.5), and penicillin (1.1; 0.8-1.5). CONCLUSIONS: The increased risk of being involved in a road accident as driver while receiving prescribed opiates and benzodiazepines supported the results from other studies.

1: Ann Epidemiol. 2007 Aug;17(8):597-602. Epub 2007 Jun 18.
http://www.ncbi.nlm.nih.gov/pubmed/17574863

PMID: 17574863 [PubMed - indexed for MEDLINE]

Beta blockers as psychotropic drugs
Encephale. 1976;2(1):85-101.

CNS-related (side-)effects of beta-blockers with special reference to mechanisms of action
beta-Adrenoreceptor antagonists are liable to produce behavioural side-effects such as drowsiness, fatigue, lethargy, sleep disorders, nightmares, depressive moods, and hallucinations. These undesirable actions indicate that beta-blockers affect not only peripheral autonomic activity but also some central nervous mechanisms. In experimental animals beta-blockers have been found to reduce spontaneous motor activity, to counteract isolation-, lesion-, stimulation- and amphetamine-induced hyperactivity, and to produce slow-wave and paradoxical sleep disturbances. Furthermore, central effects such as tranquilizing influences are used for the treatment of conditions such as anxiety.
Peripherally mediated actions whereby beta-blockers induce changes in the autonomic activity in the periphery, which are relayed to the CNS to induce changes in activity of a variety of central systems.
1: Eur J Clin Pharmacol. 1985;28 Suppl:55-63
PMID: 2865151 [PubMed - indexed for MEDLINE]

Effect of betablockers on autonomic activation

Psychologist Alain Brunet of McGill University in Montreal (Canada) is looking for ways to make those improvements happen, through the use of an old-fashioned 'beta-blocker' drug called Propranolol. Primarily intended as heart medicine, beta blocker drugs like Propranolol have long been used "off label" to treat anxiety patients because they block or lessen "peripheral autonomic activation" (e.g., symptoms of anxiety occurring in the periphery of the body such as might be noticeable in the limbs e.g., clammy skin, sweating, shaking, etc.). A socially phobic patient who normally would freak out during a speech can take Propranolol and not notice their palms getting sweaty, etc. Because they are not distracted by arousal symptoms that do not occur (or occur with less force), they are better able to remain focused on their speaking task and to execute it without incident.

Propranolol may have another useful effect as well - in that it may suppress the long term storage of emotional memories. A Psychiatrist at Harvard, Dr. Roger Pitman, has shown that trauma patients treated with Propranolol immediately after traumas (accidents, rapes) show somewhat fewer PTSD-like symptoms than patients who did not receive Propranolol. The explanation for this is that Propranolol interferes with the formation of the strong emotional memories that might otherwise crystallize into true trauma memories.

The articles I've read about the Brunet and Pitman research suggest these researchers are thinking that the mechanism for the Propranolol effect lays in its ability to block the storage or re-storage of trauma memories. However, another explanation is also possible. It might be enough that the drug simply blunts the SNS arousal and activation that would normally occur when trauma memories are discussed.
Treating PTSD with Beta-Blockers
Posted by Mark Dombeck, Ph.D. on Tue, Apr 18th 2006

Reader's response to article: After reading your article I was greatly dismayed to note that you would class the memory suppression induced by beta blockers as beneficial. These drugs do not only 'supress' memory, they remove the emotional attatchment of memories both long and short term. They are also not selective about which memories will be be stripped of thier emotive content and can desensitise futher emotive responses, i.e. to graphic or disturbing imagery. Do you value the memory of your wife on your wedding day? The pivotal experiences through which you establish meaning in your life? Would you, for all your triumphs over adversity, through difficulties which have hindered you in some ways yet enriched your life in others think it worth it for them to be rendered obselete in a matter of hours? Is it a good thing to veiw images of injured and dying people and feel nothing? "If you disrupt those memories, remove continuity, what you have is an erosion of personhood." This was said by Dr. William B. Hurlbut, a consulting professor in biology at Stanford University and a member of the President's Council on Bioethics, I am deeply comforted that someone has the broad mindedness to consider the humanistic and ethical side of issues pertaining to the use of these drugs in an unbiased manner. I find the research alluded to in your article disturbing due to the casual nature in which it is expressed. An overdose or a mis-diagnoses due to oversensitivity to a beta-blocker such as propranolol can shatter somebodies life, or more to the point shatter somebody, leaving them with serious mental health difficulties and a complete inability to cope with the altered state in which they may find themselves.
http://www.mentalhelp.net/poc/view_doc.php?type=weblog&id=51&wlid=6&cn=1

lowering of heart can result in:

In a meta-analysis, lowering of heart rate was associated with increases in cardiac mortality, risk for nonfatal MI (Myocardial Infarction), and heart failure.

— Mark S. Link, MD

Published in Journal Watch Cardiology December 10, 2008




A review of 22 studies published in the medical journal The Lancet in January may suggest another reason to be wary of beta-blockers for high blood pressure. The review concluded that diuretics and beta-blocker treatments may increase the chances of developing type 2 diabetes.
http://www.news-medical.net/?id=22051

Dual innervation of the cerebral arteries

There has been considerable controversy concerning the motor innervation of cerebral arteries. Bayliss et aL (1) and Hill and MacLeod (2) reported no evidence of any vascular response suggesting the existence of vasomotor nerves supplying the vessels of the brain. Dumke and Schmidt (3) also found
little effect of sympathetic stimulation on cerebral blood flow, as did Carlyle and Grayson (4), who concluded that non-nervous autoregulation is the most important factor in the control of cerebral blood flow. The view of these authors (1-4) and others that vasomotor nerves are of minor importance in the
regulation of cerebral blood flow has been supported in recent reviews (5-7), but these conclusions have been recently challenged by James et al. (8), who implicated vasomotor nerves in the responses of cerebral vessels to changes in blood CO2 levels. Earlier than this, Hiirthle (9) and Forbes and Cobb (10) had observed clear responses of cerebral arteries to motor nerve stimulation. Forbes and Cobb observed a constriction of cerebral arteries in response to sympathetic stimulation and a
dilatation, which was blocked by atropine, in response to parasympathetic stimulation.
Meyer et al (11), using a preparation similar to that of Dumke and Schmidt (3), recently
observed a 22 to 30% reduction in internal carotid blood flow when the cervical sympathetic nerve was stimulated.

This work has clearly shown a dual
adrenergic and nonadrenergic innervation of
the anterior cerebral arteries of the rat. Two
types of nerve fiber can be distinguished by
their vesicle inclusions in tissue fixed in
permanganate or, after treatment with 6-
OHDA, in osmium or glutaraldehyde. The
first type contained many small granular
vesicles and degenerated after cervical sympa-
thectomy. Fluorescent, noradrenaline-contain-
ing fibers were detected around the cerebral
arteries; after sympathectomy, these fibers also
degenerated. This suggests that the axons
containing small granular vesicles are adrener-
gic.

Copyright © 1970 American Heart Association. All rights reserved. Print ISSN: 0009-7330. Online ISSN:
TX 72514
Circulation Research is published by the American Heart Association. 7272 Greenville Avenue, Dallas, 1970;26;635-646
Circ. Res.T. IWAYAMA, J. B. FURNESS and G. BURNSTOCK
From the Department of Zoology, University of
Melbourne, Parkville 3052, Victoria, Australia.

This investigation was supported by grants from the
National Heart Foundation of Australia and the
Australian Research Grants Committee.
Dr. Iwayama's permanent address is Department of
Anatomy, Faculty of Medicine, Kyushu University,
Fukuoka, Japan.
Received January 5, 1970. Accepted for publication
March 9, 1970.

Catecholamine influences and sympathetic neural modulation of immune responsiveness

K S Madden, V M Sanders, D L Felten
Department of Neurobiology and Anatomy, University of Rochester School of Medicine and Dentistry, New York 14642, USA.
Primary and secondary lymphoid organs are innervated extensively by noradrenergic sympathetic nerve fibers. Lymphocytes, macrophages, and other cells of the immune system bear functional adrenoreceptors. Norepinephrine fulfills criteria for neurotransmission with cells of the immune system as targets. In vitro, adrenergic agonists can modulate all aspects of an immune response (initiative, proliferative, and effector phases), altering such functions as cytokine production, lymphocyte proliferation, and antibody secretion. In vivo, chemical sympathectomy suppresses cell-mediated (T helper-1) responses, and may enhance antibody (T helper-2) responses. Noradrenergic innervation of spleen and lymph nodes is diminished progressively during aging, a time when cell-mediated immune function also is suppressed. In animal models of autoimmune disease, sympathetic innervation is reduced prior to onset of disease symptoms, and chemical sympathectomy can exacerbate disease severity. These findings illustrate the importance of the sympathetic nervous system in modulating immune function under normal and disease states.

the third ventricular floor of the rat following cervical sympathectomy

Various investigators have shown that unilateral ganglionectomy or transection
of the internal and external carotid nerves leads to a regenerative response in
the ipsilateral superior cervical ganglion and to uninjured mature sympathetic
neurons sprouting into bilaterally innervated shared target organs. In this study
changes in the supraependymal neuronal network following unilateral and bi-
lateral cervical sympathectomy on the infundibular floor of the third ventricle
were studied by scanning electron microscopy in comparison with normal and
sham-operated control animals. After unilateral cervical sympathectomy there
was a great increase in the number of varicose nerve fibres on the infundibular
floor as compared to the normal and sham-operated control animals. Not only
was there an increase in the number of nerve fibres, but also their varicosities
were substantially larger than those normally present on the ependymal surface.
This study indicates the possible sympathetic projections from the superior cer-
vical ganglia to the ependymal surface of the third cerebral ventricle.

Folia Morphol.
Vol. 66, No. 2, pp. 94–99
Copyright © 2007 Via Medica
ISSN 0015–5659
www.fm.viamedica.

Adrenergic sympathectomy ablates unmyelinated fibers in the rat 'preganglionic' cervical sympathetic trunk

Classical anatomical depictions of the cervical sympathetic trunk label it as a cholinergic preganglionic structure. We studied the cervical sympathetic trunk of the rat following daily injection for 5 weeks of guanethidine monosulphate, a regimen known to selectively destroy adrenergic neurons outside of the blood-brain barrier leaving cholinergic systems and preganglionic structures intact. The drug-treated animals were compared with a group of physiologic saline-injected animals. In the drug-treated animals, there was an approximately 40% reduction in the numbers of unmyelinated fibers per unit area compared to controls. The finding of swollen and degenerative appearing unmyelinated fibers at 7 days of drug treatment confirmed that the fiber loss resulted from active axonal degeneration. The pattern of unmyelinated fiber loss was expressed as a reduction of fibers per Schwann cell-basement membrane profile with an appearance of 'empty profiles', and a conversion of large profiles (with large numbers of fibers per profile) to smaller size categories. There were no differences in axon diameters, fascicular areas, and numbers of microvessels between the groups. Microvessels were dilated in the drug-treated animals. These findings suggest that a large component of the cervical sympathetic chain in the rat consists of postganglionic adrenergic fibers which appear to intermingle with preganglionic cholinergic axons coursing through the chain.
Brain Res. 1989 Oct 2;498(2):221-8.

http://www.ncbi.nlm.nih.gov/pubmed/2790480?dopt=Abstract

Parasympathetic varicosity proliferation after sympathectomy

Parasympathetic innervation to eyelid smooth muscle inhibits sympathetic neurotransmission pre-junctionally without appreciable direct post-junctional effects. However, 5 weeks after sympathectomy, parasympathetic stimulation elicits substantial cholinergically mediated contractions. This study examined ultrastructural changes accompanying the conversion to parasympathetic excitation. In intact muscles, 64±9 nerve varicosities were encountered per 104 μm2. Most were close to muscle cells and not fully enclosed by supporting cells. Axo–axonal synapses were observed occasionally. Two days following sympathectomy, varicosity numbers were reduced by 97% and, relative to controls, remaining varicosities were farther from muscle cells and more frequently fully enclosed by supporting cells, but contained greater numbers of small spherical and large dense vesicles. By 6 weeks post-sympathectomy, numbers of varicosities per unit muscle volume increased to 14% of controls. These varicosities differed from those at 2 days in being closer to smooth muscle cells, less frequently enclosed, and having fewer small vesicles. These findings indicate that intact eyelid smooth muscle varicosities are predominantly sympathetic, but a small number of parasympathetic varicosities are present, some of which may form pre-junctional synapses with sympathetic nerves. Between 2 days and 6 weeks post-sympathectomy, varicosities increased in number and established appositions with smooth muscle cells. This suggests that parasympathetic nerves are capable of re-innervating an atypical smooth muscle target after sympathectomy, and that parasympathetic synaptogenesis is likely to contribute to conversion from pre-junctional inhibition to post-junctional excitation after sympathectomy.
Brain Research
Volume 786, Issues 1-2, 9 March 1998, Pages 171-180

Ultrastructural changes in the nerves innervating the cerebral artery after sympathectomy

The ultrastructure of the innervation of the anterior cerebral artery of the rat was studied in control animals and in animals after superior cervical ganglionectomy.
Fluorescence histochemistry shows a periarterial network of intensely fluorescent fibers which are divided into two groups, adventitial and periadventitial. The fluorescence begins to decrease 26 hours after, and completely disappears about 32 hours after, ganglionectomy.
Fine structural changes are first observed 18 hours after ganglionectomy, when the axoplasm of degenerating axons becomes electron dense. This density gradually increases up to about 32 hours. By 32 hours most axons with disintegrating axolemmas become inclusion bodies of the Schwann cells. At this stage, synaptic vesicles can still be distinguished as less dense areas, but the membrane structures of synaptic vesicles and mitochondria are difficult to recognize. The degenerating axons are gradually absorbed and by 38 hours dense, residual bodies are observed in the Schwann cells. Generally speaking, the degeneration occurs first in the adventitial fibers and then in the periadventitial fibers. The transient appearance of small, granular vesicles is noticed in axon terminals about 18 hours after denervation, although very few small, granular vesicles are seen in control tissue or at later stages of degeneration.
Cell and Tissue Research
Publisher Springer Berlin / Heidelberg
ISSN 0302-766X (Print) 1432-0878 (Online)
Issue Volume 109, Number 4 / December, 1970

Sypathetic nervous system (SNS) modulation of immunity

Sypathetic nervous system (SNS) modulation of immunity. The role of the sympathetic nervous system in regulation of immunity is examined in mice that are chemically-denervated by injection of the neurotoxin 6-hydroxydopamine (6-OHDA). This results in a strain-dependant elevation of Th1 and Th2 cytokines and antibody titers. Denervation also results in a robust, but transient, expression of central Fos protein and corticotrophin releasing hormone, as well as an elevation in corticosterone levels in denervated mice. The interrelationships of this HPA axis activation, loss of peripheral sympathetics, and altered immune function is being explored.

Jan A. Moynihan
Associate Professor of Psychiatry, Microbiology and Immunology and of Oncology

Rice PA, Boehm GW, Moynihan JA, Bellinger DL, Stevens SY. Chemical sympathectomy alters numbers of splenic and peritoneal leukocytes. Brain Behav Immun. 16:62-73, 2002.

Rice PA, Boehm GW, Moynihan JA, Bellinger DL, Stevens SY. Chemical sympathectomy increases the innate immune response and decreases the specific immune response in the spleen to infection with Listeria monocytogenes. J Neuroimmunol 114:19-27, 2001.

Safety and Ethics in Healthcare

"...professionals may adopt unreasonable practices. Practices may develop in professions, particularly as to disclosure, not because they serve the interests of the clients, but because they protect the interests or convenience of members of the profession. The court has an obligation to scrutinize professional practices to ensure that they accord with the standard of reasonableness imposed by the law."
Incresingly, the question is not whether the defendant's conduct conforms with the practices of the profession, but whether it conforms with standards of reasonableness. (p. 150)

The right of patients self-determination is well entrenched both in law and in ethical codes. Respect for patient autonomy now occupies centre stage in medical ethics. In considerin patient autonomy one needs to think about truth telling, confidentiality, privacy, disclosure of information and consent. Each is important and all have important implications for healthcare professionals. (p. 167)

Safety and Ethics in Healthcare: A Guide to Getting it Right

By Bill Runciman, Alan Merry

Published by Ashgate Publishing, Ltd., 2007

ISBN 0754644375, 9780754644378

Some secondary effects of sympathectomy; with particular reference to disturbance of sexual function

N Engl J Med. 1951 Jul 26;245(4):121-30.
WHITELAW GP, SMITHWICK RH.

PMID: 14853048 [PubMed - indexed for MEDLINE]

causes of autonomic dysfunction - sympathectomy

Patients with progressive autonomic dysfunction (including diabetes) have little or no increase in plasma noradrenaline and this correlates with their orthostatic intolerance (Bannister, Sever and Gross, 1977). In patients with pure autonomic failure, basal levels of noradrenaline are lower than in normal subjects (Polinsky, 1988). Similar low values are observed in patients with sympathectomy and in patients with tetraplegia. (p.51)

The finger wrinkling response is abolished by upper thoracic sympathectomy. The test is also abnormal in some patients with diabetic autonomic dysfunction, the Guillan-Barre syndrome and other peripheral sympathetic dysfunction in limbs. (p.46)

Other causes of autonomic dysfunction without neurological signs include medications, acute autonomic failure, endocrine disease, surgical sympathectomy . (p.100)

Anhidrosis is the usual effect of destruction of sympathetic supply to the face. However about 35% of patients with sympathetic devervation of the face, acessory fibres (reaching the face through the trigeminal system) become hyperactive and hyperhidrosis occurs, occasionally causing the interesting phenomenon of alternating hyperhidrosis and Horner's Syndrome (Ottomo and Heimburger, 1980). (p.159)

Disorders of the Autonomic Nervous System

By David Robertson, Italo Biaggioni

Edition: illustrated

Published by Informa Health Care, 1995

ISBN 3718651467, 9783718651467

Hyperhidrosis is more than sympathetic overactivity

Our overall findings suggest that essential hyperhidrosis is a complex autonomic dysfunction rather than sympathetic overactivity, and parasympathetic system seems to be involved in pathogenesis of this disorder.

Annals of Noninvasive Electrocardiology

Volume 10 Issue 1, Pages 1 - 6

Published Online: 13 Jan 2005

Journal compilation © 2009 Wiley Periodicals, Inc.

interrupting sympathetic efferent fibers innervating the heart and baroreflex

The results suggest that cardiac sympathectomy induced by epidural anesthesia can suppress partially baroreceptor function by interrupting sympathetic efferent fibers innervating the heart during high levels of epidural anesthesia, but that lumbar sympathectomy during epidural anesthesia is unlikely to affect baroreceptor activity.
Baroreflex control of heart rate during cardiac sympathectomy by epidural anesthesia in lightly anesthetized humans.

Dohi S, Tsuchida H, Mayumi T
Anesth Analg 1983; 62:815-20.

Baroreflex sensitivity, measured as cardiac acceleration in response to nitroglycerin, was significantly lower (p < 0.01) in groups 1 and 2 (1.8 and 1.5 ms.mmHg-1 respectively) compared with group 3 (3.5 ms.mmHg-1) with no differences between the two bupivacaine concentrations. The results suggest that baroreflex-mediated response to decreases in arterial pressure is dependent on the integrity of the sympathetic nervous system.

Baroreflex control of heart rate during high thoracic epidural anaesthesia. A randomised clinical trial on anaesthetised humans.
Goertz A, Heinrich H, Seeling W
Anaesthesia 1992; 47:984-7.

How sympathetic tone maintains or alters arterial pressure

After chronic sympathectomy or sinoaortic denervation (SAD), arterial pressure (AP) becomes extremely unstable, especially because of movement-related depressor episodes. The simultaneous measurement of AP and regional blood flows in sympathectomized and SAD rats indicates that these depressor episodes are accompanied by strong regional vasodilations, possibly involving an autoregulatory component.

It is concluded that both stability and normal variability of AP critically depend on the baroreflex control of the sympathetic vascular tone.
Fundam Clin Pharmacol. 1995;9(4):343-9. PMID: 8566933 [PubMed - indexed for MEDLINE]

Endoscopic thoracic sympathectomy suppressed the baroreflex control of heart rate during pressor and depressor tests in patients with palmar or axillary hyperhidrosis.
We conclude that baroreflex responses are suppressed in patients who receive ETS.

Anesth Analg. 2004 Jan;98(1):37-9, table of contents.

PMID: 14693579 [PubMed - indexed for MEDLINE]

Autonomic neuropathy simulating the effects of sympathectomy

Autonomic neuropathy simulating the effects of sympathectomy as a complication of diabetes mellitus. Diabetes 1955;4:92-97.
Odel HM, Roth GM, Keating FR,

Dysautonomias: Clinical Disorders of the Autonomic Nervous System

The term dysautonomia refers to a change in autonomic nervous system function that adversely affects health. The changes range from transient, occasional episodes of neurally mediated hypotension to progressive neurodegenerative diseases; from disorders in which altered autonomic function plays a primary pathophysiologic role to disorders in which it worsens an independent pathologic state; and from mechanistically straightforward to mysterious and controversial entities. In chronic autonomic failure (pure autonomic failure, multiple system atrophy, or autonomic failure in Parkinson disease), orthostatic hypotension reflects sympathetic neurocirculatory failure from sympathetic denervation or deranged reflexive regulation of sympathetic outflows. Chronic orthostatic intolerance associated with postural tachycardia can arise from cardiac sympathetic activation after "patchy" autonomic impairment or blood volume depletion or, as highlighted in this discussion, from a primary abnormality that augments delivery of the sympathetic neurotransmitter norepinephrine to its receptors in the heart. Increased sympathetic nerve traffic to the heart and kidneys seems to occur as essential hypertension develops. Acute panic can evoke coronary spasm that is associated with sympathoneural and adrenomedullary excitation. In congestive heart failure, compensatory cardiac sympathetic activation may chronically worsen myocardial function, which rationalizes treatment with ß-adrenoceptor blockers. A high frequency of positive results on tilt-table testing has confirmed an association between the chronic fatigue syndrome and orthostatic intolerance; however, treatment with the salt-retaining steroid fludrocortisone, which is usually beneficial in primary chronic autonomic failure, does not seem to be beneficial in the chronic fatigue syndrome. Dysautonomias are an important subject in clinical neurocardiology.
David S. Goldstein, MD, PhDModerator:; David Robertson, MDDiscussants:; Murray Esler, MD; Stephen E. Straus, MD; and Graeme Eisenhofer, PhD

5 November 2002 | Volume 137 Issue 9 | Pages 753-763

NIH CONFERENCE

PMID: 12416949 [PubMed - indexed for MEDLINE]

Exaggerated responses to drugs

Exaggerated responses to drugs following nervous system lesions were described in the medical literature more than a century ago. Although the phenomenon of supersensitivity is still not completely understood, studies in experimental animals have clarified the distinction between denervation and decentralization (for review see Trendelenberg, 1963). These characteristic pharmacologic abnormalities form the basis for distinguishing pre-, and post-ganglionic noradrenergic involvement.
Chronic postgangliionic denervation increases the pressor response to NA, while the effects of indirect symphatomimetics are reduced. Decentralization causes more modest changes in the blood pressure response and is not associated with loss of neuronal NA stores; the increase in pressor sensitivity is non-specific.

Disorders of the Autonomic Nervous System

By David Robertson, Italo Biaggioni

Published by Informa Health Care, 1995

ISBN 3718651467, 9783718651467

Peripheral SNS and Cerebral Blood Flow

Immediately following experimentation the cerebral vessels were examined
for the presence of noradrenergic fibers. The results of the study demonstrate that: (1) superior
cervical ganglionectomy produces a significant reduction in the noradrenergic innervation of ip-
silateral extraparenchymal arteries; (2) the peripheral sympathetic nervous system contributes
to overall cerebral vascular resistance primarily by affecting resistance in extraparenchymal
arteries; and (3) as a result, it determines the contribution of the extraparenchymal arteries tooverall cerebral blood flow autoregulation.
1975;6;284-292 Stroke

Regulation of peripheral inflammation

It is clear that the spinal adenosine effect requires intact somatic connectivity. Information on pain and inflammation in the periphery is transmitted to the nervous system, where increased spinal adenosine levels can suppress peripheral inflammation.
Experimental Neurology
Volume 184, Issue 1, November 2003, Pages 162-168

Thoracoscopy performed under sedation-assisted local anesthesia is associated with significant hypoventilation

Thoracoscopy performed under sedation-assisted local anesthesia is associated with significant hypoventilation. Combined measurement of Spo₂ and Pcco₂ during thoracoscopy is a novel approach in the monitoring of ventilation, enhancing patient safety, and might allow to guide the administration of sedation in a better way.

Mean baseline Pcco₂ measurement was 39.1 ± 7.2 mm Hg (± SD) [range, 27.5 to 50.5 mm Hg], and peak measurement during the procedure was 52.3 ± 10.3 mm Hg (range, 37.2 to 77 mm Hg) [p < class="sc">co₂ measurement from baseline were 13.0 mm Hg and 13.2 ± 5.3 mm Hg (range, 5.5 to 27.8 mm Hg), respectively. Mean fall in Spo₂ during the procedure was 4.6 ± 3.2% (range, 1 to 14%).

(The Paratrend 7 monitoring system (PT7), which was used in our study, is a widely validated and accepted method of continuous intraarterial blood gas measurement with good accuracy and performance. Apart from our own results in patients undergoing thoracoscopic interventions with one-lung ventilation (2), this device has been validated in an experimental study (3). In the intensive care unit (4), and during cardiac surgery (5). Furthermore, this device was used by two other groups, and their results have also been published (6,7). Nevertheless, in our study, we provided ample data on the good agreement of PT7 data with laboratory blood gas analyses. In fact, whenever a laboratory blood gas analysis was performed, PT7 values were recorded simultaneously and used for bias/precision analysis. We found an overall limit of agreement for bias/precision of -3.4/15.9 mm Hg in the clinically most important range of PaO₂ values <100> a PaO₂ value of 65 mm Hg obtained by PT7 could be as low as 45.7 mm Hg or as high as 77.5 mm Hg. However, both values clearly indicate hypoxemia under an inspired oxygen fraction of 1.0 and, thus, represent a critical medical condition.)

Detection of Hypoventilation During Thoracoscopy^*

Combined Cutaneous Carbon Dioxide Tension and Oximetry Monitoring With a New Digital Sensor

1. Prashant N. Chhajed, MD, FCCP,
2. Bruno Kaegi,
3. Rajeevan Rajasekaran, and
4. Michael Tamm, MD

CHEST February 2005 vol. 127 no. 2 585-588