Disorders of sweating

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GUSTATORY SWEATING AND OTHER RESPONSES AFTER CERVICO-THORACIC SYMPATHECTOMY
BLOOR Brain.1969; 92: 137-146

Sympathectomy = Autonomic peripheral neuropathy

DrRoy Freeman MBChB
^aCenter for Autonomic and Peripheral Nerve Disorders, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA

Available online 5 April 2005.

Summary

The autonomic neuropathies are a group of disorders in which the small, lightly myelinated and unmyelinated autonomic nerve fibres are selectively targeted. Autonomic features, which involve the cardiovascular, gastrointestinal, urogenital, sudomotor, and pupillomotor systems, occur in varying combination in these disorders. Diabetes is the most common cause of autonomic neuropathy in more developed countries. Autonomic neuropathies can also occur as a result of amyloid deposition, after acute infection, as part of a paraneoplastic syndrome, and after exposure to neurotoxins including therapeutic drugs.

Mia: and it can occur as a result of surgical or chemical sympathectomy.

people have a decreased quality of life after this procedure

Treatment available to patients with primary hyperhidrosis

Treatment of primary excessive sweating is split into non-surgical and surgical options.

Non-surgical include topical antiperspirants, Iontophoresis, systemic medication and medical injections.

The only viable surgical option is liposuction of armpit tissue. Sympathectomy for hyperhidrosis is not considered as a reliable treatment and recent research has shown that many people have a decreased quality of life after this procedure.

http://www.skinrevision.net.au/blog/page/2/

Sympathectomy=Autonomic Neuropathy

Sympathectomy is a surgery that involves damage to the nerves involved in body temperature regulation, sweating, bloodpressure regulation, and the regulation of many bodily functions, in the maintenance of the body's homeostasis.

Autonomic neuropathy is associated with the following:

• Alcoholic neuropathy
• Diabetic neuropathy
• Parkinson's disease
• Disorders involving sclerosis of tissues
• Surgery or injury involving the nerves
• Use of anticholinergic medications

• Swollen abdomen
• Heat intolerance, induced by exercise
• Nausea after eating
• Vomiting of undigested food
• Early satiety (feeling full after only a few bites)
• Unintentional weight loss of more than 5% of body weight
• Male impotence
• Diarrhea
• Constipation
• Dizziness that occurs when standing up
• Blood pressure changes with position
• Urinary incontinence (overflow incontinence)
• Difficulty beginning to urinate
• Feeling of incomplete bladder emptying
• Fainting
• Abnormal sweating

http://medlineplus.nlm.nih.gov/medlineplus/ency/article/000776.htm

Journal of Clinical Endocrinology & Metabolism, Vol 72,
819-823, Copyright © 1991 by Endocrine Society


Sequential cerebrospinal fluid
and plasma sampling in
humans: 24-hour melatonin
measurements in normal
subjects and after peripheral
sympathectomy

J Bruce, L Tamarkin, C Riedel, S Markey and
E Oldfield
After bilateral T1-T2 ganglionectomy, however, melatonin levels were markedly reduced, and the diurnal rhythm was abolished.

Control of intraocular blood flow

Control of intraocular blood flow.
II. Effects of sympathetic tone
John J. Weiter, Ronald A. Schachar, and J. Terry Ernest
(animal study)

March 7, 1973


Cervical sympathectomy increased ocu-
lar blood flow more than 30 per cent
(Table I). The increase in blood flow was
approximately equal in both the uveal sub-
divisions and the retina. Sympathetic
stimulation decreased ocular blood flow.
The blood flow was decreased by 56 per
cent in the ciliary body, 45 per cent in the
choroid, and 41 per cent in the retina. The
results were similar when the control vs.
experimental eye was alternated.

Eliminates the input of central signals to the pineal gland

December 1, 1971 | vol. 68 | no. 12
Melatonin Metabolism: Neural
Regulation of Pineal Serotonin:
Acetyl Coenzyme A
N-acetyltransferase Activity
David C. Klein, Joan L. Weller, and
Robert Y. Moore

These data indicate that superior cervical
sympathectomy abolishes the N-acetyl-transferase
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.

hormones

Cervical sympathectomy affects adrenocorticotropic
hormone and thyroid-stimulating hormone in rats.

Hiroshi Iwama1 , Mamoru Adachi1, Choichiro Tase1 and
Yoichi Akama1
(1) Department of Anesthesiology, Fukushima Medical College, 1
Hikarigaoka, 960-12 Fukushima, Japan
Received: 26 June 1995 Accepted: 1 March 1996

sympathectomy-induced bone resorption

A mechanism for sympathectomy-induced bone resorption in
the middle ear.
Author:Sherman, B E : Chole, R A
Citation:Otolaryngol-Head-Neck-Surg. 1995 Nov; 113(5): 569-81

Now I want to look at the correlative psychological modes of the sympathetic and parasympathetic activity. These are general qualities rather than fixed attributes.

Sympathectomy causes parasympathetic dominance. It will 'reset' your modus operandi. It will change you.

Sympathetic - Parasympathetic
Activity - Receptivity
Speed - Slowness
Tension - Relaxation
Focus - Scope
Convergent thinking - Divergent thinking
Extraversion - Introversion
Goal-oriented - Process-oriented
Agency - Presence
Direction - Elaboration

Doctors in Finland, US and Iran also offer sympathectomy to reduce anxiety, fear, stress, phobias, to reduce aggressiveness, reduce depression (sic!), reduce palpitations. The psychological changes following surgery are widely known among medical professionals, but patients are not told about them. They are told that this is a safe, minimally invasive procedure. Maybe the surgical cut they need is minimal, the procedure is certainly not minimally invasive. It will invade and violate the core of your being. It will change your body and your mind. Many people get depressed because they are not able to cope with this, like a friend who killed himself after 8 years of waiting and hoping that his condition will improve. He was 46.

"Lets just stop a minute to become aware of our own autonomic state: tongue, heart rate, peristalsis, skin – temp and moisture – warm & dry; cold&wet; relaxation/tension. Attentiveness – alert to broad awareness.."

seminar ‘The New Anatomy: Exploring the Mind in the Body’ run at Chiron February-March 2001.

It will be all altered. Sympathectomy produces a parasympathetic dominance.

AUTONOMIC NERVOUS SYSTEM

The Autonomic Nervous System:
Barometer of Emotional Intensity and Internal Conflict

A lecture given for Confer, 27th March, 2001
The material for this lecture is part of a six evening seminar ‘The New Anatomy: Exploring the Mind in the Body’ run at Chiron February-March 2001.

In standard physiology the two parts of the ANS have been perceived as functioning reciprocally: the sympathetic governing arousal, the fight or flight reaction and the parasympathetic involving relaxation, recuperation and digestion. The sympathetic nervous system is activated by any stimulus over an individual’s threshold (and the threshold can vary enormously), including feelings, and by noise, light, drugs and chemicals (e.g. caffeine).In response to the stimulus an immediate anticipatory state is generated by the release of adrenaline. This causes the heart to beat more quickly and strongly, increases blood supply to the muscles, raises blood pressure, dilates the bronchii and increases the breathing rate, raises the blood sugar level for increased energy, speeds up mental activity, increases tension in the muscles, dilates pupils and increases sweating. Non-emergency functions, such as digestion are lessened or suspended. (priming phase – short-term) Walter Cannon coined the phrase ‘fight or flight’ to describe the function of the rapid mobilisation of resources.

ANS and emotional intensity

The Autonomic Nervous System:
Barometer of Emotional Intensity and Internal Conflict

A lecture given for Confer, 27th March, 2001
The material for this lecture is part of a six evening seminar ‘The New Anatomy: Exploring the Mind in the Body’ run at Chiron February-March 2001.

The Autonomic Nervous System has two branches, the Sympathetic and the Parasympathetic, which regulate the involuntary processes of the body, the viscera, and sense organs, glands and blood vessels. In evolutionary terms it is older than the CNS and its anatomical circuitry is broadly dispersed, creating a general response, quite unlike the highly specific pathways and response of the CNS. This generalised, widely distributed structure enables it to mediate overall changes in state; it is part of the limbic system which has also been known as the mammalian or emotional brain.

...– we now know that it is dynamically related to many other parts of the brain especially the orbitofrontal cortex. Autonomic also means self-regulating and this is a key principle of all body systems, which depend of constant feedback in order to maintain homeostasis. There are multiple feedback loops in the body which continually send and receive information about what’s going on and the ANS is part of this wider complex.

The FINOHTA REPORT

"Endoscopic thoracic sympathectomy is associated with significant immediate and long-term adverse effects. This is alarming especially since the operation is performed to alleviate a relatively harmless condition. Many patients also suffer from compensatory hyperhidrosis after ETS. Due to wide variation in the reporting of adverse effects, it is
probable that these have been underreported most of the time. "

SYMPATHECTOMY ON THE FOX NEWS

http://www.livevideo.com/video/DA86D572A6634B558B52B5B5AF79DE42/ets-fox-news-sympathectomy-sid.aspx

SAMPLE OF THE SALES PITCH - THIS IS HOW IT'S DONE

Surgical sympathectomy is the gold standard of treatment for this disease, by which all other treatments must be judged. Upper thoracic sympathectomy has been performed for many years as therapy for hyperhydrosis and several other diseases. There are various surgical approaches available. Prior to the advent of endoscopic transthoracic sympathectomy (ETS), these approaches involved either painful back or neck incisions with possible risk of brachial plexus, or phrenic nerve injury, or Horners syndrome. The introduction of ETS for excessive hand and facial sweating has revolutionized the treatment of this disease. The success rate is in excess of 98%, with very few side effects or serious complications.
Endoscopic sympathectomy is a highly-effective treatment for patients with palmar or facial hyperhydrosis. ETS allows simultaneous treatment of both sides with a very low risk of complications. Attention to surgical detail is important to achieve excellent long-term results. We continue to lead the New York metropolitan area in minimally invasive thoracoscopic procedures, and especially ETS.

THE SYMPATHECTOMY FAILURE

1. Sympathectomy is analogous to the act of killing the messenger. The sympathetic nervous system has the critical job of properly controlling and preserving the circulation in different parts of the body, especially in the extremities. By paralyzing the system, the extremity will be more apt to have disturbance of circulation and is left unprotected from fluctuation in circulation.

Sympathectomy is similar to permanently removing the central heat and air-conditioning system and never replacing it because of malfunction.

Sympathectomy permanently damages the temperature regulatory system. The reason sympathectomy does not cause side effects other than ineffective control of pain as well as impotence and orthostatic hypotension is because it is invariably partial and incomplete.H. Hooshmand, M.D.: Chronic Pain

View Larger Image

9780849386671

Chronic Pain: Reflex Sympathetic Dystrophy Prevention and Management

Hooshang Hooshmand

ISBN 10: 0849386675 / 0-8493-8667-5 
ISBN 13: 9780849386671
Publisher: CRC Pr I Llc
Publication Date: 1993
Binding: Hardcover

Melbourne Surgeon's definition of a very safe procedure

"Thoracoscopic cervical sympathectomy is considered a very safe procedure, with very few problems other than the transient pain mentioned above. Nonetheless, you should know that there is a very small risk - not more than 1 chance in 2000 - that you may experience numbness or weakness in the hand from other nerve damage. A droopy eyelid and small pupil can also occur as a result of the procedure affecting the nerve supply to the eyelid (1%). Excessive sweating of the lower body will occur and this is known as compensatory sweating and can be quite marked. A stuffy nose may result and this change can be permanent requiring nasal spray for life. The face will feel dry after thoracoscopic cervical sympathectomy and this may be annoying. Failure to improve your condition or failure to remove the part of the nerve can occur and this is called a therapeutic failure and is therefore also a risk. Risk to life is < 0.01%."

Not being able to sweat and cool of through the head is more than annoying. 40% of the body heat is released through the top of the head. This will be eliminated. The will be no sweating from the head, neck and shoulders.
The the skin's natural cleaning mechanism, sweating will be eliminated. The skin will become dehydrated, clogged up and more prone to acne. Sympathectomy also lowers the denervated skin's immune responses, it will be more prone to infections. Sympathectomy alters the skin's healing process. People undergoing the opearation will have scar tissue after the operation and from future cutaneous trauma.
Sympathetic denervation impairs epidermal healing in cutaneous wounds
LINCOLN R. KIM, BSCaI KEITH WHELPDALE, MSCb; MA TEUSZ ZUROWSKI, MSCb; BRUCE POMERANZ, MD, PhD°, b

INTRAOCULAR PRESSURE AND DENERVATION

Br J Ophthalmol. 1983 May; 67(5): 297-301.

Ocular sympathetic denervation associated with ocular hypertension: a case report.

D J Brazier

The exact function of the sympathetic nervous system in the regulation of intraocular pressure remains unclear. Many observers have noted reduced intraocular pressure in eyes whose sympathetic supply has been interrupted. A case of ocular sympathetic denervation associated with ocular hypertension is reported. Reports on the relationship between intraocular pressure and sympathetic denervation are reviewed and their relevance to this case discussed.

MANY PATIENTS COMPLAIN ABOUT VISUAL DISTURBANCES, BLURRY VISION AFTER THE SURGERY. THERE IS THE CASE OF ORTHOSTATIC HYPOTENSION CAUSED BY THE SURGERY BY DISABLING REGULATION OF THE BLOODPRESSURE, SO THAT BLOOD POOLS INTO THE LEGS WHEN PATIENTS STAND UP. THIS CAN CAUSE BLURRY VISION. THE SYMPATHETIC NERVES ALSO INNERVATE THE SMOOTH MUSCLE THAT IS INVOLVED IN EYEMOVEMENTS. AND NOW THIS ARTICLE TALKING ABOUT THE CONNECTION BETWEEN INNERVATION AND INTRAOCULAR PRESSURE.
IT IS A WELL-DOCUMENTED FACT THAT THE OPERATION CAN CAUSE HORNER SYNDROME, CAUSING A DROOPY EYELID AND AFFECTING THE PUPILS.

b. Cervical sympathectomy causes photoreceptor-specific cell death in the
rat retina
Jena J. Steinle , , Naarah L. Lindsay and Bethany L. Lashbrook


There was a significant reduction (30%) in photoreceptor numbers in the sympathectomized eye. This loss was due to apoptosis, as there was over a doubling in apoptotic cell numbers after sympathectomy. This loss of photoreceptors in the sympathectomized eye resulted in a significantly reduced width of the outer nuclear layer of the retina when compared to the contralateral eye. Increased glial fibrillary acidic protein (GFAP) staining was also noted after sympathectomy in the ganglion cell layer with streaking toward the bipolar cell layer. These results suggest that loss of sympathetic innervation may cause significant changes to the physiology of the choroid.
Journal of Medical Colleges of PLA

AUTOIMMUNE DISEASE AND INNERVATION

Brain Behav Immun. 2007 May 19; : 17517488
Autoimmune disease and innervation.

Rainer H Straub

In the decades before 1987, most of the research devoted to neuronal innervation was carried
out in primary and secondary lymphoid organs at very different locations. This was an important period in order to understand hard-wiring of immune organs in physiology. Between 1988 and 1997, with the appearance of specific antibodies against neuronal markers, innervation was studied in inflamed tissue of patients and of animals with autoimmune diseases. This period clearly revealed that nerve fibers of, both, the sympathetic and sensory nervous system are altered, but only small amounts of tissue have been investigated by qualitative but not quantitative techniques. Between 1998 and 2007, with the understanding that sympathetic and sensory neurotransmitters might play opposite roles in inflammation, nerve fibers of the different nervous systems have been studied in parallel using quantitative techniques. These studies have been carried out in a large number of patients with long-standing autoimmune diseases. It turned out that sympathetic nerve fibers are lost in chronically inflamed tissue, while substance P-positive nerve fibers sprout into the inflamed area. This might be important because high concentrations of sympathetic neurotransmitters are antiinflammatory whereas substance P has a proinflammatory role. The first challenge for future research is the determination of innervation in the early human autoimmune disease. The second challenge is the identification of reasons for the differential loss of sympathetic in relation to sensory nerve fibers. It might well be that nerve repellent factors specific for the sympathetic nerve fiber might play an important role for the observed differential loss. Whether, or not, a therapy can be based on these findings remains to be established.
[Pubmed] [Scholar] [EndNote] [BibTex] [Doi]

THIS IS WHAT THERMOREGULATORY DYSFUNCTION LOOKS LIKE

CONSIDERABLE HYPERTHERMIA THROUGHOUT THE FACE AND NECK, WHICH IS CONSISTENT WITH AUTONOMIC DYSFUNCTION.
A SURGICALLY INDUCED AUTONOMIC DYSFUNCTION, THAT IS CONSISTENT WITH T2 SYMPATHECTOMY.
A SIGNIFICANT PATERN OF HYPOTHERMIA EXTENDING FROM THE RIGHT ARM INTO THE RIGHT AXILLA, THIS ALSO CORRELATES WITH THERMOREGULATORY DYSFUNCTION.

MORE ON BRAIN COOLING

“The efficiency of SBC (Selective Brain Cooling) is increased by evaporation of sweat on the head and by ventilation through the nose.” (Nagasaka et al. 1998)

“A necessary condition for SBC is a high heat loss capacity from the head itself, without such a heat loss SBC is not possible.” (Cabanac 1993)

“Because the human head sweats more than the rest of the body, heat loss from the head skin could amount to 125-175 Watts under conditions of moderate hyperthermia.” (http://www.editthis.info/corposcindosis/Changes_to_Systemic_Function%2C_part_1Cabanac 1993)

SELECTIVE BRAIN COOLING...IF THERE IS NO SWEATING FROM THE FACE...?

Selective Brain Cooling

Besides the general “heat intolerance”, ETS patients have anecdotally reported what they consider to be a “hot brain” syndrome. In particular, Taiwanese ETS patient and robotics engineer “Hpymaker” has made frequent references in the oral history to this hot brain phenomenon. Songboy1234 has also reported a very disturbing sensation like a fever that occurs when exercise is attempted.

Is there any scientific reason to suppose that ETS surgery could interfere with brain cooling, separate from the general thermoregulatory difficulties already shown? This would depend upon whether the normal human has any mechanism to selectively cool the brain; and if so, whether that mechanism is damaged by sympathectomy. The answers are yes we do; and yes it is.

Studies from decades ago began to confirm Selective Brain Cooling. “Cooling of the head skin . . .produces a significant improvement in the performance of heat-stressed humans.” (Kenney, see Williams & Shitzer, 1974).

The ability to selectively cool the brain during hyperthermia (overheating) has long been an accepted fact in many mammals, such as dogs. Dogs have a network of blood vessels in the head called the “carotid rete” which allows heat exchange between warm blood in arteries and cooler blood in veins. The excess heat escapes through the mouth during panting. Humans do not have a carotid rete, so for some time the notion of selective brain cooling in humans was controversial.

However, it has been shown that at 65.8˚ F (18.8˚ C) ambient temperature the deep trunk temperature of a marathon runner may rise to 107.4˚ F (41.9˚ C) with no clinical sign of heat illness (Cabanac et al. 1979; see Maron, Wagner & Horvath, 1977). Michel Cabanac at the Department of Physiology, Laval University, Quebec has been studying Selective Brain Cooling in Humans since the 1970’s, and has evidently discovered the mechanism by which humans accomplish this.

It turns out that certain veins in the face, such as the ophthalmic veins, will actually reverse the direction of blood flow when the body begins to overheat. The blood in these veins is cooled by evaporation of facial sweat, then flows backwards into the sinus and intercranuim area, cooling the carotid artery and the brain.

“The selective influence of facial fanning on human brain temperature can be attributed, therefore, to cool venous blood perfusing the cavernous sinus and possibly cooling the blood of the internal carotid artery.” (Cabanac et al. 1979)

A group of Japanese physiologists at Kanazawa University have been confirming and expanding upon Cabanac’s findings. Their studies subject people to heat stress and exercise, and measure variables such as skin temperature, core temperature, forehead sweating, and blood flow in the ophthalmic vein. They found “that there are elements within the brain that control the mechanisms for switching the direction of venous flow through the emissary veins to keep the brain cool during hyperthermia.” (Hirashita et al. 1992)

Given that this direction-reversing mechanism requires vascular control in the face, we already have strong reason to suspect that ETS would disturb if not destroy selective brain cooling. Is head sweating also important to this process?

“The efficiency of SBC (Selective Brain Cooling) is increased by evaporation of sweat on the head and by ventilation through the nose.” (Nagasaka et al. 1998)
http://www.editthis.info/corposcindosis/Changes_to_Systemic_Function%2C_part_1

ETS SURGEON ADMITS OPERATION CAUSES HEAT INTOLERANCE

Nielson Website

Additional confirmation of thermoregulatory difficulties comes from ETS surgeon David Nielson, whose advertising website has, since 2003, listed “heat intolerance” among the “side effects” produced by the surgery.
http://www.hyperhidrosis-usa.com/sideeffects.html

ANHIDROSIS AFTER SYMPATHETOMY

Prediction: Thoracic sympathectomy will cause anhidrosis in the denerved area.

Empirical Status: Confirmed.

Anhidrosis

Sweat glands are controlled almost entirely via the sympathetic nervous system, and do not have parasympathetic innervation at all. Unlike most other sympathetic nerve terminals, the receptors in sweat glands are activated by acetylcholine, not norepinephrine. It is possible that sweat glands can be activated locally to a small degree by catecholamines in the blood, but for practical purposes sympathectomy renders sweat glands permanently non-functional in the denerved area. This dysfunction is called "anhidrosis".

Anhidrosis is considered dangerous, as we learn from the WebMD dictionary:

Anhidrosis: Not sweating. From the Greek an- meaning a lack of + hidros meaning sweat = lack of sweat. The inability to sweat may seem a blessing but it is not, since to sweat is to be able to stay cool. Anhidrosis creates a dangerous inability to tolerate heat. (WebMD dictionary)

In one clinical trial, ETS patients subjectively described the sensation of anhidrosis as “disturbing”.

“Patients undergoing T2-T4 resection often experience anhidrosis from the nipple line upwards which has been disturbing for several individuals.” (Fischel et al. 2003)


http://www.editthis.info/corposcindosis/Changes_to_Individual_Effectors,_part_2

TREATMENT NEEDED AFTER THE TREATMENT ENDED UP NOT BEING A TREATMENT ...

COMMUNICATIONS AND BRIEF REPORTS

Treatment of Unilateral Compensatory Sweating after Endoscopical Thoracic Sympathectomy for General Hyperhidrosis with Botulinum Toxin A

• FALK GEORGES BECHARA, MD ^{* *} Department of Dermatology and Allergology, Ruhr-University Bochum, Bochum, Germany; ,
• MICHAEL SAND, MD ^{* *} Department of Dermatology and Allergology, Ruhr-University Bochum, Bochum, Germany; ,
• GEORG MOUSSA, MD ^{* *} Department of Dermatology and Allergology, Ruhr-University Bochum, Bochum, Germany; ,
• DANIEL SAND, BS ^{† †} Department of Physiological Science, University of California Los Angeles (UCLA), Los Angeles, California; ,
• PETER ALTMEYER, MD ^{* *} Department of Dermatology and Allergology, Ruhr-University Bochum, Bochum, Germany; ,
• KLAUS HOFFMANN, MD ^{* *} Department of Dermatology and Allergology, Ruhr-University Bochum, Bochum, Germany; and
• JOHANNES SCHMIDT, MD ^{‡ ‡} Department of Visceral Surgery, Lutherhaus Essen, University of Witten-Herdecke, Essen, Germany

• ^* Department of Dermatology and Allergology, Ruhr-University Bochum, Bochum, Germany; ^† Department of Physiological Science, University of California Los Angeles (UCLA), Los Angeles, California; ^‡ Department of Visceral Surgery, Lutherhaus Essen, University of Witten-Herdecke, Essen, Germany

BODY WEIGHT

Chemical Sympathectomy Alters Regulation of Body Weight
During Prolonged ICV Leptin Infusion

Robert L. Dobbins1, Lidia S. Szczepaniak1, Weiguo Zhang1 and J. Denis McGarry1,2

ABOUT LIPOLYSIS FOLLOWING SYMPATHECTOMY

Hormones in Muscular Activity

by Atko Viru - 1985 - Medical
121 ± 13 min).44 Consequently, following chemical sympathectomy the adrenal medulla is unable to ensure adequate lipolysis. ...
Limited preview - books.google.com/books?isbn=0849354943...

Monckeberg's sclerosis after sympathetic denervation

Goebel FD, Fuessl HS.
Medial arterial calcification is frequently seen in diabetic patients with severe diabetic
neuropathy. Sixty patients (19 diabetic and 41 non-diabetic) were examined
radiologically for typical Monckeberg's sclerosis of feet arteries 6-8 years after uni- or
bilateral lumbar sympathectomy. Fifty-five out of 60 patients (92%) revealed medial
calcification. This calcification was observed in both feet of 93% of patients, who had
undergone bilateral operation. After unilateral sympathectomy the incidence of calcified
arteries on the side of operation was significantly higher than that on the contralateral
side (88% versus 18%, p less than 0.01). Although diabetic patients showed longer
stretches of calcification than non-diabetic subjects, the difference was not significant in
terms of incidence and length. Of 20 patients who had no evidence of calcinosis
pre-operatively, 11 developed medial calcification after unilateral operation exclusively
on the side of sympathectomy. In seven patients calcinosis was detected in both feet after
bilateral operation. In conclusion, sympathetic denervation is one of the causes of
Monckeberg's sclerosis regardless of diabetes mellitus.

Reduced baroreflex sensitivity is associated with increased vascular calcification and arterial stiffness

Reduced baroreflex sensitivity is associated with increased vascular calcification and arterial stiffness

Introduction. Vascular calcification is a critical determinant of cardiovascular morbidity and mortality in chronic haemodialysis (HD) patients. The pathophysiology underlying this observation remains obscure. Baroreceptor sensitivity (BRS) is important in the maintenance of an appropriate cardiovascular status both at rest and under the physiological stress of HD. BRS is determined by both the mechanical properties of the vascular wall, mediating the transfer of transmural pressure, and afferent and efferent autonomic function. We aimed to study the association between arterial structure, function and BRS in chronic HD patients.

Conclusion. The reduction in BRS and the resulting aberrant blood pressure response to the physiological stress and volume changes of HD may be important in the further understanding of the pathophysiology of the increased mortality in HD patients with vascular calcification.

Lindsay J. Chesterton1, Mhairi K. Sigrist1, Terence Bennett2, Maarten W. Taal1 and Christopher W. McIntyre

In a person who had a sympathectomy, the sympathetic component of the baroreceptor mechanism is absent

The baroreceptor reflex is only a short-term regulator of blood pressure because the receptors adapt by raising the threshold and lowering discharge rate.
8. Describe the reflex compensations when someone suddenly stands up from a supine position. What would happen in a patient who just had a sympathectomy?

Sudden standing causes pooling of blood in the leg veins. This results in decreased venous return to the heart, which leads to decreased cardiac output (Frank-Starling mechanism), which leads to decreased MAP. This decrease in MAP is detected by the carotid sinus baroreceptors, which relay a message to the medullary cardiovascular control center, which increases sympathetic outflow and decreases parasympathetic outflow, this causes:

* An increase in HR and myocardial contractility, tending to restore cardiac output.
* Vasoconstriction in skeletal musculature, skin, kidneys and gut, reducing blood flow to these organs and increasing TPR.
* Venoconstriction decreasing capacitance and increasing venous return

A patient with a sympathectomy would experience what's referred to as orthostatic hypotension (which might lead to syncope). Orthostatic hypotension is a decrease in arterial pressure when going from supine to a standing position. A person with a normal baroreceptor mechanism will try to restore MAP. In a person who had a sympathectomy, the sympathetic component of the baroreceptor mechanism is absent.

Heart Physiology II

M.A.S.T.E.R. Learning Program, UC Davis School of Medicine
Date Revised: Jan 16, 2002
Revised by: Gordon Li and Carolyn Nguyen

reflex vasoconstriction induced by mild central hypovolemia includes a significant reduction of jejunal mucosal perfusion in supine resting humans

J Auton Nerv Syst. 1998 Feb 5;68(3):157-63.

Baroreceptor-mediated reduction of jejunal mucosal perfusion, evaluated with endoluminal laser Doppler flowmetry in conscious humans.

Thorén A1, Ricksten SE, Lundin S, Gazelius B, Elam M.

Author information

Abstract

Reduction of central blood volume elicits a peripheral vasoconstrictor reflex in various tissues including skin, skeletal muscle and the hepatomesenteric region. The aim of the present study was to investigate whether this reaction includes a decreased perfusion of the jejunal mucosa in man. Laser Doppler flowmetry (LDF) was used to monitor jejunal mucosal and skin perfusion simultaneously in eleven healthy volunteers. LDF recordings were performed during quiescent (phase 1) periods of the migrating motor complex. Seven subjects demonstrated cycling changes of jejunal mucosal perfusion (vasomotion). The average minimum jejunal flux value was 72 +/- 6 perfusion units. The average intraindividual coefficient of variation was 18 +/- 2%. Lower body negative pressure (LBNP) was used to elicit controlled reductions of central blood volume. LBNP of 10 mm Hg induced a 12 +/- 4% (P < 0.05) decrease in jejunal perfusion and a 43 +/- 11 (P < 0.001) decrease in cutaneous perfusion. Corresponding responses to LBNP of 20 mm Hg were 17 +/- 5% (P < 0.01) and 37 +/- 10% (P < 0.01) reductions in jejunal mucosal and skin perfusion, respectively. Cardiac index was significantly reduced by the LBNP procedure, whereas heart rate remained unchanged and blood pressure changes were minor and inconsistent. These findings indicate that the reflex vasoconstriction induced by mild central hypovolemia includes a significant reduction of jejunal mucosal perfusion in supine resting humans. This reflex may provide one mechanism for the intestinal ischemia often occurring in critically ill patients.

Predicting CS?

The mechanism of the so-called Compensatory Sweating is still unclear, and there are no ways to predict who will bit hit harder.
Some surgeons tell their patients that it happens mostly to men, who are overweight and had a heavy sweating prior to surgery.
This has never been proven, and my experience with people who underwent the surgery and have the debilitating CS does not indicate any group that would be more likely to be affected.
Also: these statistics are unreliable. There has been no independent study the examine the severity or extent of the CS. Many questions are not asked, so that they will not tarnish the results. These statistics are collected and questions formulated by the surgeons who offer the surgery. It would be reasonable to assume that they will look for a confirmation of the effectiveness of the operation....otherwise they would not do the surgery....

15% regretted the operation.

Evaluation of compensatory sweating after bilateral thoracoscopic sympathectomy for palmar hyperhidrosis.

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.

The study is a retrospective review of 60 patients undergoing bilateral T2-T3 thoracoscopic sympathectomy for palmar hyperhidrosis in our department between 1997 and 2003. The study was based on a telephone questionnaire and medical chart review. Forty patients (67%) replied to the questionnaire and were included in the study. Postoperative complications, therapeutic results, patient satisfaction, and the severity of compensatory sweating (CS) were assessed. In all patients both palms were dry at the end of surgery. Postoperative complications included permanent unilateral Horner syndrome, wound infection, and residual pneumothorax resolving after thoracal drainage, in one patient each. 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.

Sympathectomy potentiates the vasoconstrictor response to nitric oxide synthase

Nitric oxide exerts its cardiovascular actions at least in part by modulation of the sympathetic vasoconstrictor tone. There is increasing evidence that nitric oxide inhibits central neural sympathetic outflow, and preliminary evidence suggests that it may also modulate peripheral sympathetic vasoconstrictor tone.

METHODS:

To test this latter concept, in six subjects having undergone thoracic sympathectomy for hyperhydrosis, we compared the vascular responses to systemic L-NMMA infusion (1 mg/kg/min over 10 min) in the innervated and the denervated limb. We also studied vascular responses to the infusion of the non-nitric-oxide-dependent vasoconstrictor phenylephrine.

RESULTS:

L-NMMA infusion evoked a roughly 3-fold larger increase in vascular resistance in the denervated forearm than in the innervated calf. In the denervated forearm, vascular resistance increased by 58 +/- 10 percent (mean +/- SE), whereas in the innervated calf it increased only by 21 +/- 6 percent (P < 0.01, forearm vs. calf). This augmented vasoconstrictor response was specific for L-NMMA, and not related to augmented non-specific vasoconstrictor responsiveness secondary to sympathectomy, because phenylephrine infusion increased vascular resistance similarly in the denervated forearm and the innervated calf (by 24 +/- 7, and 29 +/- 8 percent, respectively). The augmented vasoconstrictor response was related specifically to denervation, because in control subjects, the vasoconstrictor responses to L-NMMA were comparable in the forearm and the calf.

CONCLUSIONS:

These findings indicate that in the absence of sympathetic innervation, the vasoconstrictor responses to nitric oxide synthase inhibition are augmented.

http://www.ncbi.nlm.nih.gov/pubmed/10690345

Melatonin changes after sympathectomy

Bruce J, Tamarkin L, Riedel C, Markey S, Oldfield E.

Sequential cerebrospinal fluid and plasma sampling in
humans: 24-hour melatonin measurements in normal
subjects and after peripheral sympathectomy. English.
72. 1991:819-23.


Brismar K, Mogensen L, Wetterberg L.
Depressed
melatonin secretion in patients with nightmares due to
beta-adrenoceptor blocking drugs. English. 221.
1987:155-8.

Evidence suggests a link between endogenous melatonin and the sleep cycle
• There is evidence of a link between endogenous melatonin and the temperature rhythm.

Melatonin deficiency causes SOMNOLENCE

nerve blocks as a treatment for Herpes Zoster...

Management of herpes zoster (shingles) and postherpetic neuralgia

Robert W Johnson‌, Tessa L Whitton‌

Pain Management Clinic, Level 4, Bristol Royal Infirmary, Bristol, BS2 8HW, UK.

The Cancer Patient with Chronic Pain Due To Herpes Zoster

... were mild and tolerable and consisted primarily of somnolence and dizziness. ... Peripheral neurectomy, cordotomy, dorsal rhizotomy, sympathectomy, ...
www.current-reports.com/article.cfm?PubID=PA04-6-1-01&Type=Article&KeyWords= -

Insulin hypersensitivity produced by sympathectomy

Insulin
hypersensitivity has been undeniably
produced by hypophysectomy, by ad-
renalectomy, by sympathectomy, by
spinal cord lesions, and by hypothalam-
ic lesions.

THE HYPOTHALAMUS: A REVIEW OF THE
EXPERIMENTAL DATA
W. R. Ingram

treatment of choice??!!

"Surgery - Endoscopic Sympathectomy, Treatment of Choice for Severe Hyperhidrosis. Interruption of nerve impulses to sweat glands of the palms, face, axillae (armpits) by cutting or electrocautery is called "Thoracic Sympathectomy". The ganglia (nerve junctions) which lead to the sweat glands of the palms, axillae, scalp and face are accessible through the chest (thoracic cavity) because they travel along the side of the spine of the back. Using a Micro Single Incision endoscopic technique, easy access to this area requires only a single 1/12th inch incision per side. In the past, a rib was removed or a large painful incision was required between two ribs to provide access to this area. Some surgeons today make three to four small incisions when performing endoscopic thoracic sympathectomy. Dr N. has applied state-of-the-art technology to his endoscopic technique and he only makes a 1/12th inch incision per side."
(internet ad for a surgeon from the US)

My comment: That is brilliant achievement! However the operation, no matter how many holes it requires, it will have the same effects on the patient.
Surely the definition of the surgery needs some rephrasing?! The operation disrupts more than the impulses to the sweat glands. It disrupts signaling between the body and the brain, partial autonomic dysfunction, disables thermoregulation, causes revascularization of the brain, reduces heart rate and blood pressure, abolishes homeostasis...a long list really.
All these effects have been proven.

As with other tissues and organs, hypoxia, such as at high altitude, causes an increase in blood flow to bone, as does hypercapnia and sympathectomy.

www.itdynamicsphil.com/pdf/orthopedics-for-mt.pdf

DENERVATION SUPERSENSITIVITY

what follows Sympathectomy..
coming soon.....

The antihypertensive effects of the drug may be enhanced in the post-sympathectomy patient.

Diovan HCT Tablets

also:

http://www.rxlist.com/lozol-drug/side-effects-interactions.htm
http://www.drugs.com/pro/hydrochlorothiazide.html
http://www.drugs.com/ppa/atenolol-chlorthalidone.html
http://www.drugs.com/pro/renese.html

Drug and SYMPATHECTOMY interaction

Tell your doctor if you have any of
the following medical conditions:
* kidney problems
* liver problems
* heart problems
* diabetes
* recent excessive vomiting or
diarrhoea
* Systemic Lupus Erythematosus
(SLE), a disease affecting the
skin, joints and kidneys
* a salt restricted diet
* a past operation known as
sympathectomy
If you have not told your doctor
about any of the above, tell
him/her before you start taking
Atacand Plus 16/12.5.

What Atacand Plus
16/12.5 is for
Atacand Plus 16/12.5 is used to treat
high blood pressure.

Causes of SYNCOPE

neurological, mechanical or both:
sympathectomy


http://www.wrongdiagnosis.com/symptoms/coma/book-causes-6a.htm

HOW SYMPATHECTOMY CAUSES PAIN

During surgery, for ex-
ample, accidental sympathectomy
can occur, leading to neuroma development and a predictable se-
quence of events: “internal” stimu-
lation of afferent or somatosensory
neurons, generation of efferent
nerve impulses, and the subse-
quent sensation of neurologic pain.
JAMES F. CARTER, MD, and DAVID E. SOPER, MD

The surgery

side effects and complications
Because of the proximity to the cervical spinal canal, accidental
RF lesioning of the neuraxial structures at this level can result
in significant neurologic dysfunction, including quadriparesis.
Unintentional lesioning of the phrenic nerve can result in dia-
phragmatic paralysis and respiratory insufficiency. Inadvertent
lesioning of the recurrent laryngeal nerve can result in pro-
longed or permanent hoarseness. A permanent Horner syn-
drome can occur if the superior cervical sympathetic ganglion
is damaged during the procedure. Pneumothorax is a distinct
possibility, especially on the right side and with lesioning at the
T1 level. The incidence of all the above complications can be
decreased with careful use of trial stimulation and fluoroscopic
guidance. The anatomic region in this area is highly vascular,
increasing the risk for local and systemic anesthetic toxicity as
well as hematoma formation.

effects of thiazides may be enhanced in the post-sympathectomy patient

Ziac side effects (Bisoprolol and Hydrochlorothiazide) and drug ...

Somnolence, 0.7, 1.1, 0.7, 0.9. Loss of libido, 1.2, 0.4, 1.2, 0.4 .... effects of thiazides may be enhanced in the post-sympathectomy patient. ...
www.rxlist.com/cgi/generic/bishctz_ad.htm - 62k

Hypotension following Sympathectomy

fatigue and somnolence.

Sympathectomy for sympathetically mediated pain

Surgical sympathectomy, spinal cord stimulation, and central
neuraxial blockade have all been reported to be useful, but not rigorously tested. When superficial tactile
allodynia is a prominent feature of the patient’s presentation, this author has found that a diagnostic
lumbar paravertebral sympathetic block can be useful in assessing the degree of sympathetically mediated
pain. When sympathetically mediated pain is a prominent feature, as evidenced by over 50% pain reduction
with the sympathetic block, a percutaneous radiofrequency rhizotomy of the sympathetic chain can follow
for a more long-lasting effect.

By Timothy L. Sternberg, DMD, MD
Director, Center for Pain Management
University of Florida/Shands Jacksonville

epidural catheter - three years after a sympathectomy

epidural abscess in a patient with dorsal hyperhidrosis .

PURPOSE: To report the management of a patient who developed a lumbar epidural abscess when an epidural catheter was placed three years after a thoracic sympathectomy. The possible contribution of hyperhidrosis is discussed. CLINICAL FEATURES: A 62-yr-old male had compensatory hyperhidrosis in his back after thoracic sympathectomy. The patient, who suffered from thromboangeitis obliterans, underwent lumbar (L2-3) epidural catheterization in order to improve arterial circulation and ameliorate resting pain in his left leg. On the third day after catheterization, the patient complained of a dull pain in his back. Emergency magnetic resonance imaging revealed a 12-mm abscess in the epidural space. On the tenth day after catheterization, laminotomy at the 3-4 lumbar vertebrae and local drainage were performed. A 14-mm abscess was removed from the epidural space. The patient was discharged on day 21 after catheterization without any disability. CONCLUSION: Special precautions against infection may be necessary in patients with hyperhidrosis in the area where continuous epidural catheterization is attempted

Brain before surgery

There may be additional mechanisms involved in primary hyperhidrosis. An EEG and PET scan study of
patients with palmoplantar hyperhidrosis showed increased sharp wave bursts during hyperventilation and
hyperperfusion of the frontal cortex.[119]

International Hyperhidrosis Society

Compensatory Sweating will run and ruin your life

Compensatory Sweating

Compensatory sweating is excessive sweating that may occur on the back, chest, abdomen, legs, face, and buttocks as a side effect of ETS surgery. This side effect is grave because it can be equally or even more extreme than the original sweating problem.

In a study involving 121 patients at the Medical City Hospital of Dallas, Texas, compensatory sweating occurred in more than 80% of the patients undergoing ETS. Similarly, in a Danish study conducted at the Aarhus University Hospital, 90% of the patients undergoing ETS for underarm sweating, reported compensatory sweating, half of whom were forced to change their clothes during the day because of it. http://www.sweathelp.org/English/PFF_Treatment_Surgery.asp

SERIOUS, DISABLING SIDE EFFECTS, HEAVILY ADVERTISED...

isn't there a contradiction here??? just think about it!

Serious negative side effects of sympathectomy

"Surgery

After all other treatments have been tried, adjusted for individual circumstances, and still found to be ineffective, surgical treatment for excessive sweating may be an option considered by your physician. There are a number of different types of surgery that are sometimes used to treat hyperhidrosis. These include local surgical procedures that remove the sweat glands and endoscopic thoracic sympathectomy (ETS). ETS, in particular, is considered a last resort because it frequently causes serious, irreversible compensatory sweating. And in fact, most physicians do not recommend ETS surgery because of the serious negative side effects of the procedure."
http://www.sweathelp.org/English/PFF_Treatment_Surgery.asp

Severe side-effects, permanent damage

"Due to side effects, oral medications are not recommended as a long-term solution. Similarly, surgical options, although heavily advertised, are reserved for only certain severe cases of hyperhidrosis that have not responded to any of the other treatment options. Before considering surgical treatment, physicians and their patients must fully consider and discuss the very real risks of permanent damage and severe side effects."
http://www.sweathelp.org/English/PFF_Treatment_Overview.asp

Last resort surgery? What does that mean??

"Dr. Goodman: Mainly dermatologists and cosmetic physicians provide treatments for excessive sweating here. Treatments available include heavy-duty antiperspirants, botulinum toxin injections, and iontophoresis. We provide iontophoresis treatments here at the Skin and Cancer Foundation of Victoria and it's available at certain other hospital centers, but it's not available in private practice like it is in the United States, and usually the iontophoresis units being used have been built by hospitals' own engineering departments. Occasionally, though, the R.A. Fischer galvanic units may also be used. Endoscopic thoracic sympathectomy is still practiced here but its use is decreasing and it's really only advocated as the last resort for palmar [hand] hyperhidrosis or facial blushing, and it's only rarely used for axillary [underarm] hyperhidrosis. "

http://www.sweathelp.org/English/CMN_Article.asp?ArticleCode=64750038

SYMPATHECTOMY REDUCES FEAR

and this is not good news. Fear is still one of our survival tools, we need fear to assess situations, to avoid dangerous situations and not take unnecessary risks. Fear is also one of the emotions on the palette of the complex human emotions. If it is not paralyzing, irrational fear, why would you want to reduce the scale of emotions you can experience. Not only that, but fear is very closely linked to motivation. Why would you want to switch that 'engine' off?

"Experiements in animals demonstrate that sympathectomy may retard averse conditioning. (DiGusto and King, 1972), most likely because sympathectomy reduces fear."
Clinical Neuropsychology 2003

ANOTHER WEBSITE!!!

http://www.truthaboutets.com/sideeffects.html

Serotonin? !

Is it connected to depression??? Is there a possibility that the patients complain about depression after surgery not just because they are ... wankers???

sympathectomy abolishes the circadian rhythm

Melatonin Metabolism: Neural Regulation of Pineal Serotonin ...

These data indicate that superior cervical sympathectomy abolishes the ... Indole metabolism in the pineal gland: a circadian rhythm in N-acetyltransferase. ...
www.pubmedcentral.nih.gov/articlerender.fcgi?artid=389600

Chemical Sympathectomy Alters Cytotoxic T Lymphocyte Responses

google. learn.

PROFOUND CHANGES IN CATECHOLAMINE CONTENT FOLLOWING SYMPATHECTOMY

These results indicate that
alterations in the relative abundance of TH mRNA mediate changes in TH activity induced by
chronic stress or sympathectomy, and that these changes require an intact sympathetic input.

Molecular adaptations in catecholamine biosynthesis induced
by cold stress and sympathectomy
M.K. Stachowiak 1, S.J. Fluharty 2, E.M. Stricker 2, M.J. Zigmond 3, B.B. Kaplan, Ph.D. 1 *
1
Department of Psychiatry, Center for Neuroscience, University of Pittsburgh, Pittsburgh,
Pennsylvania
2
Department of Psychology, Center for Neuroscience, University of Pittsburgh, Pittsburgh,
Pennsylvania
3
Department of Biological Sciences, Center for Neuroscience, University of Pittsburgh, Pittsburgh,
Pennsylvania





Epinephrine Produces a -Adrenergic
Receptor-Mediated Mechanical Hyperalgesia and
In Vitro Sensitization of Rat Nociceptors
Sachia G. Khasar, Gordon McCarter, and Jon D. Levine
Departments of Medicine and Oral and Maxillofacial Surgery, Division of
Neuroscience and Biomedical Sciences Program, National Institutes of Health
Pain Center (UCSF), University of California, San Francisco, California
94143-0440

SYMPATHECTOMY AND THE SUBMANDIBULAR GLAND

SYMPATHECTOMY CAUSES DEGENERATION OF THE SUBMANDIBULAR GLAND.

RIGOROUS TESTING FOR DRUGS, WHAT ABOUT SURGERIES???

I KNOW I AM REPEATING MYSELF AND YOU HAVE FOUND THIS QUESTION ALREADY SOMEWHERE ELSE, BUT I BELIEVE IT DESERVES ANOTHER TITLE, AND REMINDER.
HOW IS IS POSSIBLE THAT DRUGS HAVE TO GO THROUGH RIGOROUS TESTING BUT THE SAME DOES NOT APPLY TO IRREVERSIBLE NERVE SURGERIES??? WAIT A MINUTE! THIS IS THE TESTING!!!
I WISH SOMEBODY WOULD COLLECT THE RELEVANT DATA FOLLOWING SURGERY.
ANYBODY?!
AND: IF THIS IS THE TESTING, THEN THE PATIENT HAS TO BE INFORMED! IT IS CALLED INFORMED CONSENT.
HOW MANY RULES AND LAWS HAVE BEEN BROKEN HERE?!

WHAT ABOUT KUNTZ NERVE

Some surgeons generously throw in an additional nerve transection/ablation of the Nerve of Kuntz. It is interesting as there has been no study to investigate to exact function/role of this nerve or the effect of cutting this additional nerve in the short term and long term.
Another reason to call this a highly controversial and without doubt experimental surgery.

SYMPATHECTOMY INDUCES ADRENERGIC EXCITABILITY

Sympathectomy induces adrenergic excitability of cutaneous C-fiber nociceptors
DF Bossut, VK Shea, ER Perl
Department of Physiology, University of North Carolina at Chapel Hill,

Your doctor at the consultation might tell you that there is a tiny chance that something will go wrong during the surgery, and due to damage of the nerves and/or arteries you might experience pain. However this pain might be or become extreme.
Now, the fact is that you do not need extra damage to any other nerves during surgery. The surgery itself is the damage that will induce this pain.
And it has nothing to do with having the surgery performed by an experienced surgeon. NO difference. They all do the same: disrupt, damage, cut, burn or clamp the sympathetic chain.

The immuno-modulating effect of sympathectomy

coming soon...

EFFECT OF SYMPATHECTOMY ON BONE-RESORPTION

coming soon

CANNON'S LAW

ABOUT DENERVATION SUPERSENSITIVITY:
coming soon.

DOCUMENTARY ABOUT SYMPATHECTOMY

IF YOU ARE HERE IN AUSTRALIA AND ARE ONE OF THOSE WHO HAVE HAD THE SURGERY, AND HAVE EXPERIENCED MANY MEDICAL CONDITIONS AND ILLNESSES YOU DID NOT HAVE BEFORE, ARE STRUGGLING TO MANAGE THE 'COMPENSATORY SWEATING', THE REDUCED HEART RATE, DIZZINESS, COGNITIVE DIFFICULTIES, FATIGUE AND DEPRESSION, I AM INTERESTED IN YOUR STORY, AND WOULD LOVE TO HEAR FROM YOU.
THIS IS A STORY THAT NEEDS TO BE TOLD, THERE IS NO NEED TO BE SHY OR EMBARRASSED ABOUT IT. SILENCE ONLY PERPETUATES THE IGNORANCE AND THE CRIME.
THE OPERATION WILL CHANGE YOU! IT IS A CHANGE YOU HAVE NO CONTROL OVER AND YOU HAVE NOT CHOSEN. THAT IS THE VIOLATION OF YOU AS A HUMAN BEING. LOOSING YOUR SELF, YOUR SENSE OF SELF IS THE WORST KIND OF CRIME ONE CAN COMMIT AGAINST YOU.

THE PATHOPHYSIOLOGY OF SYMPATHECTOMY

M.Hashmonai
D.Kopelman

The pathophysiology of cervical
and upper thoracic sympathetic surgery
The main effect of upper thoracic sympathectomy is su-
domotor.To abolish sweating ofthe
palms,T2ganglionectomy
with the addition ofT3) was invari-
ably performed.To prevent axillary
sweating,additional T4ablation
was recommended.Sympathec-
tomy produces a vasodilatatory cu-
taneous effect.The circulation in
the muscles,however,is unaltered
or may even be reduced.It also ap-
pears that improved skin blood
flow is on the thermoregulatory,
not nutritive level.It seems that
chronic surgical sympathectomy
does not cause major changes in
the vascular function ofthe fore-
arm.Although the exact patho-
physiological mechanism ofblush-
ing is still obscure,bilateral upper
dorsal sympathectomy alleviates
this phenomenon.T2-T3gan-
glionectomy significantly decreases
pulse rate and systolic blood pres-
sure,reduces myocardial oxygen
demand,increases left ventricular
ejection fraction and prolongs Q-T
interval.A certain loss oflung vol-
ume and decrease ofpulmonary
diffusion capacity for CO result
from sympathectomy.Histomor-
phological muscle changes and
neuro-histochemical and biochem-
ical effects have also been ob-
served.
Key words sympathectomy ·
sudomotor effect · circulatory
effect · cardiac effect ·
thermoregulation

SYMPATHECTOMY=BETABLOCKER

Cardiovascular changes after bilateral upper dorsal sympathectomy. Short- and
long-term effects.
Papa MZ, Bass A, Schneiderman J, Drori Y, Tucker E, Adar R.
The effect of bilateral upper dorsal sympathectomy (UDS) on cardiac function was investigated in two groups of young healthy
patients who underwent bilateral excision of T2 and T3 ganglia for palmar hyperhidrosis. In ten patients echocardiography of
left ventricular function (LVF) was performed before operation and 2 weeks after operation. Electrocardiograms (ECG) were
done before operation, during operation immediately after sectioning each sympathetic chain, and at 2 weeks after operation.
The mean pulse rate decreased significantly in patients after they underwent bilateral UDS. There were no clinical arrhythmias
or changes in LVF in any patient. Submaximal exercise testing and ECG tracings done at rest and after effort were obtained for
29 patients before undergoing bilateral UDS, 30 days after operation, and 1-3 more times within a 2-year postoperative period.
Pulse rates taken at rest and after effort were significantly lower than those taken after operation, and the blood pressure
response to exercise was blunted. ECG tracings showed a significant change in the electrical frontal plane axis and shortening of
the QTc interval. These changes were evident 30 days after operation and persisted for 2 years. In conclusion, bilateral UDS has
no overt arrhythmogenic effect in the young, healthy heart and its beta-blocker-like effect persists for at least 2 years.

SYMPATHECTOMY FOR BLUSHING- MOST SEVERE SIDE-EFFECTS

As a standard procedure surgeons operate the patients by cutting or clamping the sympathetic chain at T2.
In the last 10 years there are more and more articles and presentations at conferences discouraging against this operation, as it is known to cause the most severe side-effects.

CEREBRAL DAMAGE

DISEASES OF THE CARDIOVASCULAR SYSTEM (SURGICAL) 1

the dangers of cerebral damage which may follow the use of the carotid or ..... years after sympathectomy was 41, whereas five years after sympathectomy ... arjournals.annualreviews.org/doi/abs/10.1146/annurev.me.01.020150.000455 - Similar pages - Note this

Complications of Mediastinal Surgery

of the subclavian vein without revascularization may lead to transient upper ... The development of cerebral edema after thoracoscopic. sympathectomy is ...
doi.wiley.com/10.1002/9780470988367.ch14

CEREBRAL REVASCULARIZATION - SYMPATHECTOMY

Journal of Vascular Surgery : THE SECOND DECADE: 1957-1966 ...

Interest in cerebrovascular revascularization began with the presentation on .... Aortic Blood Flow Following Lower Aortic Resection and Sympathectomy. ...

linkinghub.elsevier.com/retrieve/pii/S0741521496702136

MIA: THERE IS NO QUESTION ABOUT IT, SYMPATHECTOMY WILL HAVE AN EFFECT OF CEREBRAL BLOOD FLOW. IT WILL REDUCE IT INITIALLY AND FORCE THE BODY TO GROW NEW VESSELS IN ORDER TO SUPPLY THE SUFFICIENT BLOOD/OXYGEN TO THE BRAIN. HOWEVER THIS REORGANIZATION WILL HAVE AN EFFECT ON THE BRAIN'S FUNCTIONING, AND CAN HAVE ADVERSE EFFECTS ON COGNITIVE FUNCTIONING BY TURNING OFF SOME CELLS THAT ARE STARVED OF OXYGEN, JUST LIKE IT HAPPENS WHEN ONE HAS A STROKE. IT CAN ALSO LEAD TO CHANGES IN PERSONALITY.
MY RESEARCH INDICATES THAT IT IS THE FRONTAL CORTEX THAT IS AFFECTED MOST AND THE FUNCTIONS ASSOCIATED WITH IT. IT ALSO INVOLVES CHANGES IN THE AMYGDALA, DUE TO THE DENERVATION OF THIS REGION OF THE BRAIN, KNOWN TO RECEIVE IT'S INNERVATION FROM THE UPPER CERVICAL GANGLION ONLY. SAME APPLIES TO THE PITUITARY GLAND. YOU MIGHT WANT TO LOOK UP THE FUNCTION OF THESE. IT IS QUITE REVEALING. ALSO THERE ARE STUDIES ON THESE REGIONS OF THE BRAIN FOLLOWING SYMPATHECTOMY.

VISCERAL AND CEREBRAL INVOLVEMENT FOLLOWING SYMPATHECTOMY: DEATH AFTER SURGERY

Vascularisation of Ischemic Limbs in Severe Occlusive Arterial ...

Eight of the 12 patients underwent sympathectomy. One patient, considered to have visceral and cerebral involvement, died. PMID: 3798265, UI: 87094501 ...
bharat_kelkar.tripod.com/sixb.htm - 117k

SYMPATHECTOMY FOR CEREBRAL REVASCULARIZATION

Neurosurg Focus 20(6):E7, 2006
The history of neurosurgical procedures for moyamoya
disease
CASSIUSV. C. REIS, M.D., SAMSAFAVI-ABBASI, M.D., PH.D., JOSEPHM. ZABRAMSKI, M.D.,
SEBASTIÃON. S. GUSMÃO, M.D., PH.D., ROBERTF. SPETZLER, M.D.,
ANDMARKC. PREUL, M.D.
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical
Center, Phoenix, Arizona; and Federal University of Minas Gerais, Belo Horizonte, Brazil
Almost 50 years of research on moyamoya disease (1957–2006) has led to the development of a variety of surgical
and medical options for its management in affected patients. Some of these options have been abandoned, others have
served as the basis for the development of better procedures, and many are still in use today. Investigators studying
moyamoya disease during this period have concluded that the best treatment is planned after studying each patient’s presenting symptoms and angiographic pattern.
The surgical procedures proposed for the treatment of moyamoya disease can be classified into three categories: direct arterial bypasses, indirect arterial bypasses, and other methods. Direct bypass methods that have been proposed are vein grafts and extracranial–intracranial anastomosis (superficial temporal artery–middle cerebral artery [STA–
MCA] anastomosis and occipital artery–MCA anastomosis). Indirect techniques that have been proposed are the following: 1) encephaloduroarteriosynangiosis; 2) encephalomyosynangiosis; 3) encephalomyoarteriosynangiosis; 4) multiple cranial bur holes; and 5) transplantation of omentum. Other options such as cervical carotid sympathectomy and superior cervical ganglionectomy have also been proposed. In this paper the authors describe the history of the development of surgical techniques for treating moyamoya disease.

AMPUTATION RATE HIGHER AFTER SYMPATHECTOMY WAS HIGHER IN FEMALES

Has the clinical definition of thromboangiitis obliterans changed ...

Amputation rate after sympathectomy was higher in females: 36% vs 22%. A revascularization procedure was performed in 15 (0.6%) ...
www.springerlink.com/index/U20N650672742U24.pdf

Changes in hemodynamics of the carotid and middle cerebral arteries following sympathectomy

http://stroke.ahajournals.org/cgi/content/full/33/5/1180

CEREBRAL ISCHEMIA FOLLOWING SYMPATHECTOMY

Thoracoscopic sympathectomy for symptomatic arterial obstruction ...

Two patients died during follow-up: 1 of myocardial infarction and 1 of cerebral ischemia, 24 and 32 months, respectively, after the operation. ...

ats.ctsnetjournals.org/cgi/content/full/74/3/885

International Journal of Cardiology : One of the most frequent ...

Nineteen of 344 (11.9%) patients died during follow-up due to cerebral ... After sympathectomy, in postoperative term, the retroperitoneal hematoma occurred ...
linkinghub.elsevier.com/retrieve/pii/S0167527306000854

ADVERSE EFFECT ON KIDNEY

Role of sympathetic neurons in biochemical and functional ...

These results indicate that neonatal sympathectomy has an adverse effect on the biochemical and functional development of the kidney. ...
jpet.aspetjournals.org/cgi/content/abstract/246/2/427 -

Acta Psychiatr Neurol. 1949;24(3-4):473-9.

Related Articles, Links

Kidney function in essential hypertension before and after sympathectomy a.m. Peet.

HILDEN T.

PMID: 15396150 [PubMed - indexed for MEDLINE]

SKIN AND SYMPATHECTOMY

Sympathectomy Protects Denervated Skin from Graft-Versus-Host Disease
Mohamed A. Kharfan-Dabaja MDa, Claudio Anasetti MDa and James L.M. Ferrara MDb
a
Division of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute and University of South
Florida, Tampa, Florida
b
Departments of Pediatrics and Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
Available online 20 February 2007.

Translated: this means that sympathectomy reduces the skin immune responses. Not a good thing. There are some surgeons - who offer sympathectomy - who promise that it will aslo cure acne!!!! Quite the contrary. Your skin will have less resilience and more prone to infections as it will have a downregulated immue reponse. Just another 'euphemism' from the doctors, that is totally unsubstantiated and fraudulent.

MSAC ON SYMPATHECTOMY

The Medicare Benefits Schedule (MBS) has evolved over time in response to changes in medical practice. Medicare benefits are payable in respect of a medical service listed in the MBS where that service is:

• provided by a medical practitioner, and
• a clinically relevant service (generally accepted in the medical profession as being necessary for the appropriate treatment of the patient).

Medicare item 35003 relates to the performance of cervical or upper thoracic sympathectomy by any surgical approach (irrespective of whether it is conducted by open exposure or endoscopically). Sympathectomy has been listed on the MBS for over three decades, and permitted by any surgical approach since 1991.

The Medical Services Advisory Committee (MSAC) was established in 1998 to advise the Minister for Health and Ageing on the strength of evidence pertaining to new and emerging medical technologies and procedures in relation to their safety, effectiveness and cost-effectiveness and under what circumstances public funding should be supported. MSAC has never considered this procedure, as it was listed on the MBS prior to MSAC's formation, and is therefore not a 'new and emerging medical technology'.

The Government relies on the advice of the medical profession in relation to the clinical relevance of procedures already listed on the MBS. If the Royal Australasian College of Surgeons were to formally advise the Government that it no longer regards this procedure as being clinically relevant, the Government would take appropriate action in relation to the MBS.

Symathectomy - controversial procedure

THE ROYAL COLLEGE OF AUSTRALASIAN SURGEONS DECLARES THAT ENDOSCOPIC THORACIC SYMPATHECTOMY IS A CONTROVERSIAL PROCEDURE, WITH NO INDEPENDENT STUDIES TO SUPPORT THE SAFETY OR EFFECTIVENESS OF THE SURGERY.

Insurance companies do not insure surgeons for sympathectomy

Yes, hard to believe but surgeons have to be forced in this way to discontinue performing the operation as it cost insurance companies too much money. These cases are settled before it has a chance to go to court and have some publicity. The people who decide to take the payments have to do so in exchange of a gag order. They can never speak about the operation. Not to anybody, anywhere, in any form. This kind of silencing and secrecy is perpetuating the surgeons ability to sell and perform the surgery on the unsuspecting and misinformed patient.
At least there is some change in Australia, but not all insurance companies have the same policy.
In the meantime many people fall victim to the euphemism and ignorance of the surgeons and end up having a procedure that was a predecessor of lobotomy.
It is the medical scandal of this century!!!!
I never thought that the insurance companies will play the role of protecting the patient from potentially harmful procedures. Isn't that the of the medical profession and government agencies overseeing medical procedures. Somebody failing the patients here!

Sympathectomy (coverage will not be provided for this procedure)
www.avant.org.au/public/pdf/Standard_Policy_Application_Form.pdf -

Monckeberg's sclerosis after sympathectomy

Monckeberg's sclerosis after sympathetic denervation in diabetic and non-diabetic
subjects.
Goebel FD, Fuessl HS.
Medial arterial calcification is frequently seen in diabetic patients with severe diabetic
neuropathy. Sixty patients (19 diabetic and 41 non-diabetic) were examined
radiologically for typical Monckeberg's sclerosis of feet arteries 6-8 years after uni- or
bilateral lumbar sympathectomy. Fifty-five out of 60 patients (92%) revealed medial
calcification. This calcification was observed in both feet of 93% of patients, who had
undergone bilateral operation. After unilateral sympathectomy the incidence of calcified
arteries on the side of operation was significantly higher than that on the contralateral
side (88% versus 18%, p less than 0.01). Although diabetic patients showed longer
stretches of calcification than non-diabetic subjects, the difference was not significant in
terms of incidence and length. Of 20 patients who had no evidence of calcinosis
pre-operatively, 11 developed medial calcification after unilateral operation exclusively
on the side of sympathectomy. In seven patients calcinosis was detected in both feet after
bilateral operation. In conclusion, sympathetic denervation is one of the causes of Monckeberg's sclerosis regardless of diabetes mellitus.
: Diabetologia. 1983 May;24(5):347-50.