arrhythmias are precipitated by emotional stimuli

JAMES W. JEFFERSON
Psychocardiology: Meeting place of heart and mind
Psychosomatics, Nov 1985; 26: 841 - 842.
......life-threatening, often fatal, arrhythmias are precipitated by emotional stimuli, and effective treatments such as high thoracic left sympathectomy are directed at the nervous sys-tem rather than the heart.

Mental Phenomena: brain - body - environment

But maybe a better way of talking about it would be to say that mental phenomena arise through the interaction between brain and body and the environment and -- this is what Karl Popper says -- that whole interactive thing produces an emergent, which we call mind and spirit, and so on.

Karl Pribram

Changing the pattern of afferent information generated by the cardiovascular system can significantly influence perception and emotional experience

messages from the cardiovascular system have effect on the mental processing

when the communication of afferent signals from the heart
to the brain is compromised, there is less awareness
of feeling sensations in the body.

In summary, evidence now clearly demon-
strates that afferent signals from the heart signifi -
cantly influence cortical activity. Specifically, we now
know that afferent messages from the cardiovascular
system are not only relayed to the brain stem to ex-
ert homeostatic effects on cardiovascular regulation,
but also have separate effects on aspects of higher
perceptual activity and mental processing.
Rollin McCraty, Ph.D.

It has been shown that the processing of visual informaiton is significantly changed as heart rate and carotid pressure changed

For example, the effects of cardiac afferent
input on sensory perception have been studied by
looking at how these signals affect processing in the
visual system. It has been shown that the process-
ing of visual information is significantly changed
as heart rate and carotid pressure change. These
findings provide confirmation of the Laceys’ earlier
behavioral evidence that cardiovascular activity in-
fluences sensory intake.

Rollin McCraty, Ph.D.

Sympathectomy separates the viscera from the CNS

Elmer Green, Menninger Clinic
physician and pioneer of the biofeedback approach
to treatment of disease, offered an astute summation
of this highly debated topic: “Every change in the
physiological state is accompanied by an appropri-
ate change in the mental emotional state, conscious
or unconscious, and conversely, every change in the
mental emotional state, conscious or unconscious,
is accompanied by an appropriate change in the
physiological state.”


autonomic responses vary both quantitatively and qualitatively
with the degree of emotional intensity.

Individual differences in patterns of autonomic
discharge during emotional states have also been
identified and associated with personality charac-
teristics. For instance, individuals who have been
characterized as “impulsive” personality types dis-
play rhythmic bouts of palmar sweat secretion and
increases in heart rate even at rest, while in others,
little change occurs in these physiological parameters
under similar circumstances.

Afferent feedback from bodily organs has been
shown to affect overall brain activity and to exert a
measurable influence on cognitive, perceptual, and
emotional processes.
Rollin McCraty, Ph.D.
Heart–Brain Neurodynamics
The Making of Emotions

Sympathectomy causes a parasympathetic dominance

A u t o n o m i c N e r v o u s S y s t em


Sympathetic Pathway - Accelerator
High Effort - Adrenaline

Parasympathetic Pathway - Brake
Low Effort/Relaxation - Acetylcholine

www.macquarieinstitute.com.au/pdfs/

the critical role of ascending input from the heart and body to the brain in the generation of emotions

Heart-Brain Neurodynamics ENDY Heart–Brain Neurodynamics: The Making of Emotions By Rollin McCraty, Ph.D. The Making of Emotions Heart-Brain Neurodynamics explores recent scientific advances that clarify a number of central controversies in the understanding of emotion, including the relationship between intellect and emotion. A discussion of the critical role of ascending input from the heart and body to the brain in the generation of emotions culminates in a detailed presentation of a new model of emotion in which the brain functions as a complex pattern-matching system. From this perspective it is shown that the heart is a key component of the emotional system, providing a physiological basis for the link between the heart and our emotional life.

New Electrophysiological Correlates Associated with Intentional Heart Focus. Rollin McCraty, M.A., Mike Atkinson, & William A. Tiller, Ph.D.

the heart is a key component of the emotional system

Research has also shown that the heart is a key component of the emotional system. Scientists now understand that the heart not only responds to emotion, but that the signals generated by its rhythmic activity actually play a major part in determining the quality of our emotional experience from moment to moment. As described next, these heart signals also profoundly impact perception and cognitive function by virtue of the heart’s extensive communication network with the brain. Finally, rigorous electrophysiological studies conducted at the Institute of HeartMath have even indicated that the heart appears to play a key role in intuition. Although there is much yet to be understood, it appears that the age-old associations of the heart with thought, feeling, and insight may indeed have a basis in science.
Ph.D. Rollin McCraty

measure of autonomic arousal

Psychologists may try to measure autonomic arousal to see how stressed participants feel at any time. They cannot measure autonomic arousal, so they use other measures as a proxy, for example heart rate, blood pressure, breathing rate, or galvanic skin response.

Applying Regression and Correlation: A Guide for Students and Researchers

By Jeremy Miles, Mark Shevlin

Published 2001 SAGE

Regression analysis

272 pages

ISBN:0761962301

Changes in the level of activity of the peripheral autonomic nervous system often mirror arousal changes in the central nervous system

Arousal is both a behavioral and psychological construct. An aroused organism is alert. It is prepared to process incoming stimuli. An unaroused organism is comatose. It is not prepared to process stimuli and is unaware of of stimuli. Psychologically, arousal also refers to the excitatory state or the propensity of neurons to discharge when appropriately activated (neuronal preparation).
Changes in the level of activity of the peripheral autonomic nervous system often mirror arousal changes in the central nervous system.

The ability to sustain attention is termed vigilance. Arousal and vigilance are closely linked so that when arousal wanes, vigilance diminishes and vice versa.
By Richard J. Davidson, Kenneth Hugdahl
Published 1995
MIT Press

Cerebral dominance

735 pages

ISBN:0262540797

Arousal - behavior and performance

Research suggests that the interaction between increased arousal and accompanying psychological mood have a combined effect upon behavior and performance (Edwards & Hardy, 1996; Hardy, 1996b; Hardy & Parfitt, 1991; Janelle, Singer, & Williams, 1999; Thelwell & Maynard, 1998; Woodman, Albinson, & Hardy, 1997).

by D. Gant Ward , Richard H. Cox

Heart rate - Increases or decreases as arousal increases or decreases

Drive Theory essentially predicts that performance increases in a linear fashion as arousal increases. More precisely, drive theory predicts that performance is a function of the interaction between habit and drive (arousal).

Commonly used measures of AROUSAL
Brain activity - Changes are thought to reflect changes in arousal; alpha activity is thought to reflext low arousal (relaxation), whereas beta activity is thought to reflect higher levels of arousal

Heart rate - Increases or decreases as arousal increases or decreases

Cortisol - A stress hormone released during an encounter with a stressor or challenge (physical or psychological)

Introduction to Exercise Science - By Stanley P. Brown

Published 2000 - Medical - page 321
Lippincott Williams
& Wilkins

one of the components of anxiety as a dispositional characteristic was "drive"

Anxiety was a pivotal concept in psychodynamic theories. In my dissertation, supervised by Spence and conducted in his laboratory, I elected to investigate whether one of the components of anxiety as a dispositional characteristic was "drive" (the energetic component of the Hullian motivational complex). Quite simply, I investigated, whether chronically anxious individuals would classically condition more rapidly than less anxious individuals. As it turned out, they did (Taylor, 1951)

Models of Achievement: Reflections of Eminent Women in Psychology

By Agnes N. O'Connell, Nancy Felipe Russo
Published 1988
Lawrence Erlbaum
Associates

pneumothorax, leading rapidly to hypotension, electromechanical dissociation and asystole

Small pneumothorax, leading rapidly to hypotension, electromechanical dissociation and asystole during thorascopic sympathectomy. Patient resuscitated successfully.

Adverse events in anaesthetic practice: qualitative study of definition, discussion and reporting
A.F. Smith, D. Goodwin, M. Mort and C. Pope
British Jounal of Anaesthesia 96 (6): 715-21 (2006)

SNS dysregulation is a critical component of the immune system dysregulation

D. Lorton, C. Lubahn and D. Bellinger

Abstract:

Evidence that the SNS can enhance or suppress inflammation and immune function, that SNS dysregulation is a critical component of the immune system dysregulation which drives RA pathology, and that the SNS may be targeted in RA to restore immune system homeostasis and prevent disease pathology, will be presented.
Handbook of Neurochemistry and Molecular Neurobiology
Neuroimmunology
Abel Lajtha, Armen Galoyan and Hugo O. Besedovsky

high and low blood pressure has simultaneously influenced the behavior

Data are consistent with the hypothesis that strains selectively bred for some behavioral feature may also differ in central arousal, which will interact with task difficulty to determine performance differences. Data also indicate that selective breeding for high and low blood pressure has simultaneously influenced the behavioral properties of these 2 strains. (31 ref) (PsycINFO Database Record (c) 2007 APA)

Two-way shuttle box and lever-press avoidance in the spontaneously hypertensive and normotensive rat.

Sutterer, James R.; Perry, John; de Vito, William

http://psycnet.apa.org/index.cfm?fa=main.doiLanding&uid=1981-07293-001

Use of stellate ganglion block for the treatment of psychiatric and behavioral disorders

The present invention is directed to a method for the treatment of a patient suffering from psychiatric and behavioral disorders, including post partum depression, post traumatic stress disorder, compulsive smoking, attention deficit hyperactivity disorder, gambling addiction, comprising the step of administering a stellate ganglion block to the patient to alleviate the symptoms. The stellate ganglion block may be followed by a sympathectomy to provide permanent relief.

United States Patent 20070135871

Kind Code: A1

http://www.freepatentsonline.com/y2007/0135871.html

surgically induced autonomic failure

2004 - David S. Goldstein MD, Ph.D., senior clinical investigator for the National Institute of Neurological Disorders and Stroke calls sympathectomy "surgically induced autonomic failure".

Arousal - drive and feedback

Emotion is persistently regarded as energizing and organizing...

One virtue of identifying arousal with drive is that it relates differing views (as well as bringing into the focus of attention data that may otherwise be neglected).

The feedback from cortical functioning makes intelligible Mowrer's equating anxiety aroused by threat of pain, and anxiety aroused in some way by cognitive processes related to the ideas of self. Solomon and Wynne's results with sympathectomy are also relevant, since we must not neglect the arousal effect of interoceptor activity; and so is clinical anxiety due to metabolic and nutritional disorders, as well as that of some conflict of cognitive processes.
Obviously these are not explanation that are being discussed, but possible lines of future research; and there is one problem in particular that I would urge should not be forgotten. This is the cortical feedback to the arousal system, in psysiological terms: or in psychological terms, the immediate drive value of cognitive processes, without intermediary. This is psychologically demonstrable, and has been demonstrated repeatedly.

DRIVES AND THE C.N.S. (CONCEPTUAL NERVOUS SYSTEM)[1]

D. O. Hebb (1955)

First published in Psychological Review, 62, 243-254.

15.2% drop in ejection fraction

The study was approved by the local ethics committee, and in agreement with the Helsinki II declaration written informed consent was obtained in each case. Healthy (ASA I) patients scheduled for thoracoscopic sympathectomy for flushing syndrome were asked to participate in the study, and all patients were evaluated for presence of cardiac disease prior to anaesthesia.

Fourteen participants (12 f; 2 m) with a median age of 32.5 (range: 26–70) yr were successively enrolled in the study. All participants were unmedicated and had no history of previous cardiac illness. Preoperative cardiac risk assessment, including ECG and chest X-ray, revealed no evidence of manifest cardiac disease.
Transthoracic TDE image acquisition and subsequent analysis was possible in all participants. Full TTS from apical four- and two-chamber views was not possible in four of 14 individuals, mainly due to poor signal/noise ratio in apical segments.
Propofol anaesthesia induction resulted in significant attenuation in blood pressure but no change in HR was observed (Table 1). TDE variables (PSV, TTD, and TTS) declined significantly, whereas TTP was unchanged (Table 1).

Limitations of the current study: As the primary objective was to evaluate LV function by measuring myocardial velocities, no LV area calculations were performed. TTS was attempted in order to form the basis for comparison with currently used methods. As noted, TTS was not possible in some patients; however, the results from 10 patients were conclusive (15.2% drop in ejection fraction) (P = 0.009). Similarly, as the study population consisted of healthy patients undergoing short-duration minor surgery no invasive pressures were coupled with TDE.

Propofol reduces tissue-Doppler markers of left ventricle function: a transthoracic echocardiographic study

J. R. Larsen^1,2,*, P. Torp¹, K. Norrild¹ and E. Sloth¹

¹ Department of Anaesthesiology and Intensive Care
² Department of Experimental and Clinical Research, Skejby Sygehus, Aarhus University Hospital, DK-8200 Aarhus N, Denmark

http://bja.oxfordjournals.org/cgi/content/full/98/2/183

Symptoms became worse after bilateral sympathectomy

In an attempt to control his hypertension, bilateral syrnpathectomy was performed in 1968. Following this procedure, the patient's hypertension improved, but his symptoms exacerbated. His lassitude and dyspnea on exertion increased and, in addition, he had frequent episodes of angina pectoris. He also complained of severe palpitations and dizziness during physical activity. It is noteworthy that following the initial episode of chest pain in 1984, the patient had been free of any form of chest discomfort until after the sympathectomy.

The history of this patient seems particularly noteworthy in that his symptoms became worse after bilateral sympathectomy and subsequent improvement in the control of his hypertension. When the blood pressure became lower, the dyspnea on exertion worsened, angina pectoris appeared and dizziness on physical activity was noted for the first time.
DOI 10.1378/chest.57.1.87 1970;57;87-90
Chest
Eduardo Moreyra, Pieter Knibbe and Albert N. Brest
Hypertension and Muscular Subaortic Stenosis

Cardiac hypertrophy accelerated by left cervical sympathectomy in spontaneously hypertensive rats

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

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

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

Cardiac hypertrophy in spontaneously hypertensive rats was accelerated by denervation of the left cervical sympathetic ganglia. Supersensitivity due to denervation may also exist in cardiac muscles.

This work was supported by a grant of the Ministry of Education for 1980.
http://www.springerlink.com/content/k584578m848n8838/

sympathectomy - protection against noise-induced hearing loss

Strategies to enhance CBF for protection against noise

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

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

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

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

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

The present results suggest that cervical sympathectomy in the rat increases ACTH secretion and decreases TSH secretion in the pituitary. These effects seem to be due to a mildly increased secretion of melatonin in the pineal body that probably in turn increases corticotropin-releasing factor (CRF) secretion and decreases thyrotropin-releasing hormone (TRH) secretion in the hypothalamus. Extrapolation of these findings to humans suggests that long-term and repeated stellate ganglion block would affect the pituitary secretions of ACTH and TSH. (adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH)
J Anesth (1996) 10:181-184
Cervical sympathectomy affects adrenocorticotropic hormone
and thyroid-stimulating hormone in rats
Hiroshi Iwama, Mamoru Adachi, Choichiro Tase, and Yoichi Akama
Department of Anesthesiology, Fukushima Medical College, 1 Hikarigaoka, Fukushima 960-12, Japan

Selective lung ventilation during thoracoscopy: effects of insufflation on hemodynamics

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

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

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

complications of CO2 insufflation

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

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

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

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

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

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

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

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

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

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

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

Sympathectomy is effective treatment of Long QT Syndrome

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

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

Disorders associated with autonomic insufficiency

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

Decrease in peripheral vascular resistance

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

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

Orthostatic hypotension - Sequelae of surgical sympathectomy

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

Nervous system dysfunction - Syncope

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

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

Sympathectomy incompatible with life

Danielopolu later declared cervicothoracic sympathectomy to be disastrous, from the therapeutic point of view, and concluded that removal of the stellate ganglion for angina was incompatible with life.
Landmarks in Cardiac Surgery
By Stephen Westaby, Cecil Bosher

Published 1998
Informa Health Care
Heart
683 pages
ISBN:1899066543

Complications in Cardiothoracic Surgery: Avoidance and Treatment

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

Neurophysiological Basis of Cerebral Blood Flow

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

Effects of cervical sympathectomy on secondary vasodilation

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

THE EFFECT OF SYMPATHECTOMY ON THE FATTY DEPOSIT IN CONNECTIVE TISSUE

A. B. L. Beznák 1 and Z. Hasch 1

1 The Institute of Experimental Pathology, University of Budapest

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

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

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

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

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

Serum dopamine- -hydroxylase: decrease after chemical sympathectomy.

R Weinshilboum
J Axelrod

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

Sympathectomy and the immue system

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

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

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

Cerebral venous blood oxygen content and brain blood flow

Cerebral venous blood oxygen content and brain blood flow

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

Cerebral oxygen consumption

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

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

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

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

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

altering Ca2+ activity of actomyosin ATPase

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

Effects of thyroid deficiency and sympathectomy on cardiac enzymes

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

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

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

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

Norephineprine - Emotion - Memory

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

Beta-blockers impair working memory

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

beta blockers which block adrenaline can affect memory

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

recurrence rate 15% and 19%

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

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

unable to establish the etiology of redistribution of perspiration

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

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

diarrhea associated with disordered motility

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

Sympathectomy, whether chemical or surgical, leads to diarrhea

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

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

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

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

Modulation of drug effects by regional sympathetic denervation and supersensitivity

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

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

Sympathetic surgery in cerebral vascular disorders

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

Increased blood flow reduces perfusion of the small blood vessels

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

decreased nasal patency and increased nasal airflow resistance

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

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

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

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

Selective brain cooling, decrease is nasal airway patency

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

...hypothalamic temperture during all procedures. Respiratory rate was also depressed by the sympathectomy, apparently mainly as a result of a decrease in nasal airway patency...
Pflügers Archiv European Journal of Physiology, Volume 417, Number 4 / December, 1990

Pineal gland

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

Cervical sympathectomy affects ...testosterone in male rats

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

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

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

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

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

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

Denervation of the eye

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

adrenocorticotropic hormone

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

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

The connection between psyche and sympathetic nervous system

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

Tampere, Finland

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

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

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

Sympathectomy in the treatment of addiction

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

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

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

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

abolition of reflex secretion of adrenaline

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

diminution of the myocardial concentration of epinephrine

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

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

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


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

ETS attenuates autonomic circulatory response

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

SpringerLink Date Friday, February 01, 2002

Ventricular Ectopic Rhythms and Ventricular Fibrillation following Sympathectomy

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

disabilities or inconveniences

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

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

marked athropy of the extremity, etc

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

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

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

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

Accepted 19 August 1997.
Available online 17 August 1998.

Role of catecholamines in Depression, Parkinson's and Hypertension

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

Julius Axelrod
NOBEL - LECTURE 1970


.

Adrenal Tyrosine Hydroxylase: Compensatory Increase in Activity after Chemical Sympathectomy

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

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

Destruction of peripheral sympathetic nerve endings with 6-hydroxydopamine causes a disappearance of cardiac tyrosine hydroxylase, accompanied by a twofold increase in adrenal tyrosine hydroxylase and a small increase in phenyl-ethanolanine-N-methyl transferase.
Science 31 January 1969:
Vol. 163. no. 3866, pp. 468 - 469

Postoperative complications are frequent after ETS

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

Räf L.

Patientskadenämnden och Landstingens Omsesidiga Försäkringsbolag, Stockholm.

sympathectomy, preventing noradrenaline release

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

ANTIARRHYTHMICS
© Charles Gomersall July 1999

BP reduction

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


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

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

Sympathetic regulation of the cerebral circulation by the carotid chemoreceptor reflex

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

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

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

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

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

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

Changes of Catecholamines

1. The contents of norepinephrine, epinephrine, dopamine, and dopa of the heart were determined fluorimetrically in 24 dogs from 1 to 50 days following bilateral cervical sympathectomy. The results were compared with those obtained from intact dogs in the previous studies. 2. After bilateral cervical sympathectomy, the norepinephrine content show a rapid decrease from 4 days to 7 days and a slow decrease within the following 14 days. No tendency of recovery was apparent in the heart for 50 days following the operation, the norepinephrine content remaining almost at an equal level. The same operative procedure, however, had no significant effect on the concentrations of dopamine and dopa 3. It was postulated that norepinephrine could not be synthesized and/or accumulated in the heart following bilateral cervical sympathectomy, but that cardiac muscle might synthesize dopamine for itself.
Japanese circulation journal
Vol.29, No.1(19650120) pp. 11-15
KIMATA SHIN-ICHI 1
1The Third Department of Internal Medicine, Faculty of Medicine, University of Tokyo

sympathectomy – its effect in the treatment of refractory angina pectoris

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

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

Dopamine

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

Autonomic Pharmacology
By Kenneth J. Broadley
Published 1996
CRC PRESS

Sympathectomy alters acetylcholinesterase expression

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

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

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

Serum Dopamine-beta-Hydroxylase: Decrease after Chemical Sympathectomy

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

NE synthesis was abolished by chronic sympathectomy

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

Copyright © 1993 S. Karger AG, Basel

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

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

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

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

Sympathectomy also reduced the percent of DA (Dopamine)

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


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

Dopamine-beta-Hydroxylase: Decrease after Chemical Sympathectomy

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

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

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

structural damage to the peripheral arteries

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

Richard M. Stess
Marilyn J. Waller

Hemodynamic responses were abolished after bilateral sympathectomy

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


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

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

ipsilateral ptosis, miosis, facial anhydrosis, vasomotor rhinitis

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

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

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

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

Sympathectomy in the treatment of Tinnitus

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

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

Sympathectomy for moyamoya disease

The history of neurosurgical procedures for moyamoya disease

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

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

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

Alteration of antioxidant status following sympathectomy

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

PROTECTION OF CEREBRAL VESSELS BY SYMPATHETIC NERVES

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

Intracerebral gas partial pressure changes under vasoactive drugs

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