Reccurrence of symptoms in 17.6% patients!

TS Chiou

Journal of neurosurgery. Spine 2005 Feb

Overall, 88 patients (96.7%) developed compensatory hyperhidrosis, with the mean initial occurrence at 8.2 weeks. The symptoms of compensatory hyperhidrosis progressively worsened to the maximum degree within another 2 weeks after onset (mean 10.3+/-1.83 weeks). In 19 patients (21.6%), symptoms of compensatory hyperhidrosis improved spontaneously within 3 months after sympathectomy (mean 13.3 weeks). Postoperative compensatory hyperhidrosis occurred in 71.4% of patients within the 1st year. Recurrent sweating occurred in only 17.6% of patients. None of these patients required repeated operation. The earliest onset of recurrent sweating was noted at 2 weeks postoperatively by three patients, and the mean initial postoperative reccurrence was 32.7 weeks after surgery.

Skin blood flow, sympathetic vasoconstrictor reflexes and pain before and after surgical sympathectomy

Changes in vascular sensitivity to cold temperature and circulating catecholamines may be responsible for vascular abnormalities. Alternatively, RSD may be associated with an abnormal (side different) reflex pattern of sympathetic vasoconstrictor neurons due to thermoregulatory and emotional stimuli generated in the central nervous system. (3) After sympathectomy, denervation supersensitivity of blood vessels and intense vasomotion may be associated with recurrence of pain in some patients.
BARON R. ⁽¹⁾ ; MAIER C. ⁽²⁾ ;
⁽¹⁾ Klinik für Neurologie, Christian-Albrechts-Universität Kiel, 24105 Kiel, ALLEMAGNE
⁽²⁾ Klinik für Anästhesiologie, Christian-Albrechts-Universität Kiel, 24105 Kiel, ALLEMAGNE
Elsevier, Amsterdam, PAYS-BAS (1975)

Regulation of adrenal angiotensin receptor subtypes: a possible mechanism for sympathectomy-induced adrenal hypertrophy

Regulation of adrenal angiotensin receptor subtypes: a possible mechanism for sympathectomy-induced adrenal hypertrophy.
Qiu, J., Nelson, S.H., Speth, R.C., Wang, D.H. J. Hypertens. (1999)

Hyperalgesia induced in the rat by the amino-terminal octapeptide of nerve growth factor.

Hyperalgesia induced in the rat by the amino-terminal octapeptide of nerve growth factor.
Taiwo, Y.O., Levine, J.D., Burch, R.M., Woo, J.E., Mobley, W.C.
Proc. Natl. Acad. Sci. U.S.A. (1991)

Heterogeneous atrial denervation creates substrate for sustained atrial fibrillation.

Heterogeneous sympathetic atrial denervation with phenol facilitates sustained AF (atrial fibrillation).
Olgin, J.S. et al.

Baker Institute - Cardiac synthesis, processing, and coronary release of enkephalin-related peptides

Chemical sympathectomy produced an increase in total enkephalin content similar to that observed after 2-h control perfusion. This observation suggested that the normal turnover of myocardial enkephalin may depend in part on continued sympathetic influences.

⁽¹⁾ Institut Universitaire de Technologie, Université d'Auvergne, 63172 Aubière, FRANCE
⁽²⁾ Baker Medical Research Institute, Melbourne, Victoria 8008, AUSTRALIE
⁽³⁾ Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth, Texas 76107, ETATS-UNIS
⁽⁴⁾ Laboratory of Cardiovascular Science, Gerontology Research Center, National Institute on Aging, National Institutes of Health, Baltimore, Maryland 21224-6825, ETATS-UNIS
YOUNES Antoine ⁽¹⁾ ; PEPE Salvatore ⁽²⁾ ; BARRON Barbara A. ⁽³⁾ ; SPURGEON Harold A. ⁽⁴⁾ ; LAKATTA Edward G. ⁽⁴⁾ ; CAFFREY James L. ⁽³⁾ ;
American journal of physiology. Heart and circulatory physiology ISSN 0363-6135 CODEN AJPPDI

2000, vol. 48, n^o4, pp. H1989-H1998 (41 ref.)

Sympathectomy eliminates the psychogalvanic reflex

Some Observations on the Psychogalvanic Reflex

ABRAHAM VERGHESE M.D., D.P.M.¹

¹ Department of Psychiatry, Christian Medical College & Hospital, Vellore, India

Some P.G.R. studies in a female subject who had bilateral cervical sympathectomy were described. It was found that sympathectomy abolished P.G.R. and that intra-arterial infusion of acetylcholine evoked marked P.G.R. changes in the sympathectomized limb. These findings support the theory that the P.G.R. is mediated through the cholinergic fibres of the sympathetic nervous system. Submitted on May 22, 1967

Mia: Was told by a heart specialist, jokingly that the patient can gain employment as spy after sympathectomy: it eliminates fear responses, abolishes the psychogalvanic response, and there will be no sudden jump in heart rate. No problems with lie-detectors....ever.

http://bjp.rcpsych.org/cgi/content/abstract/114/510/639

Cardiovascular collapse caused by carbon dioxide insufflation during 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.

Harris, R. J.
Benveniste, G.
Pfitzner, John
Citation: Anaesthesia and Intensive Care, 2002; 30 (1):86-89
Publisher: Australian Society of Anaesthetists

Cervical sympathectomy reduces the heterogeneity of oxygen saturation in small cerebrocortical veins

Sympathectomy significantly reduced this heterogeneity in the anterior cortex through a reduction in the number of low O2 saturation veins (coefficient of variation 11.7%).

H. M. Wei, A. K. Sinha and H. R. Weiss
Department of Anesthesia, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway 08854-5635
J Cereb Blood Flow Metab. 1993 Mar;13(2):269-75

Anterior cingulate cortex: includes both the ventral and dorsal areas of the cingulate cortex, and appears to play a role in a wide variety of autonomic functions like regulation of blood pressure and heart rate, as well as rational cognitive functions, such as reward anticipation, decision-making, empathy and emotion.

Supersensitivity to substance P

The sympathetically denervated parotid gland of the rat develops a supersensitivity to substance P, and VIP injected intravenously. Further, the neuropeptide conttent (VIP and CGRP) of the parasympathetic salivary innervation tends to increase as a a consequence of sympathetic denervation. It has been reported by Harrop and Garrett that little acinar degranulation (or decrease in glandular amylase activity) occurs in the parotid gland in response to food intake in rats if subjected to unilateral sympathetic decentralization before feeding.

Neural Mecahinism of Salivary Gland Secretion By John Raymond Garrett, Jörgen
Published by Karger Publishers, 1999

Parotid Degeneration secretion after sympathectomy

Volume 162, Number 1 / September, 1975

Cell and Tissue Research
Parotid glands of rat have been examined 12, 24 and 48 hours after avulsion of the cervical sympathetic ganglion and compared with the normally innervated left glands. Formaldehyde-induced fluorescence showed a relatively normal complement of adrenergic nerves at 12 hours but most of the nerves had lost their noradrenaline content by 24 hours and no fluorescent nerves were detected at 48 hours.
This loss of granules is considered to be due to sympathetic degeneration secretion caused by the release of noradrenaline from the degenerating adrenergic nerves between 12 and 24 hours after ganglionectomy. This is thought to be the first example of morphological change resulting from degeneration activation to be recorded microscopically.
http://www.springerlink.com/content/n08314p052546477/

Monckeberg Sclerosis following symathectomy

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).

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.

Goebel FD, Fuessl HS.
Diabetologia. 1983 May;24(5):347-50.

Post- sympathectomy gustatory sweating has been reported in 28% of patients

Jack Collin, consultant surgeon.
Paul Whatling, higher specialist trainee.

John Radcliffe Hospital, Oxford OX3 9DU

Postsurgery, severe compensatory sweating was experienced in 90% of patients

Video-assisted Transthoracic Sympathectomy in the Treatment of Primary Hyperhidrosis: Friend or Foe?

Main outcome measures included the incidence of dry hands, compensatory sweating, chest pain, upper-limb muscle weakness, shortness of breath, and gustatory phenomena; in addition, patient perception of the success of the surgical procedure was assessed.

Postsurgery, severe compensatory sweating was experienced in 90% of patients.

Because the occurrence of severe compensatory sweating is unpredictable, a reversible sympathectomy may be desirable.

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 10(4):226-229, August 2000.
Fredman, Brian MB BCh; Zohar, Edna MD; Shachor, Dov MD; Bendahan, Jose MD; Jedeikin, Robert BSc, MB, ChB, FFA(SA)

New Name for CS: Abnormal Sweating

What are the risks of a sympathectomy?

* Risks from anaesthesia
* Bleeding
* Infection
* Worsening of pain
* Creation of a new pain syndrome
* Abnormal sweating

1. Mailis-Gagnon A, Furlan A. Sympathectomy for neuropathic pain. The Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.: CD002918. DOI: 10.1002/14651858.CD002918.

Recurrent palmar hyperhidrosis occurs

Recurrent palmar hyperhidrosis occurs in 5.4% of cases, but can be cured by a second thoracoscopic sympathectomy. Horner's syndrome is an avoidable complication of thoracoscopic sympathectomy.

Volume 17, Issue 4, Pages 343-346 (April 1999)

The Results of Thoracoscopic Sympathetic Trunk Transection for Palmar Hyperhidrosis and Sympathetic Ganglionectomy for Axillary Hyperhidrosis

Eurpean Journal of Vascular and Endosvascular Surgery

pathologic coupling of sympathetic and afferent activity after a mechanically induced peripheral nerve lesion

Under physiological conditions there is no interaction between the sympathetic and the afferent nociceptive system; stimulation of the sympathetic trunk does not induce any activity in afferent neurons.65,79 However, under pathophysiological conditions the situation dramatically changes.80 Neurophysiological and neuroanatomical experiments in animals show that a pathologic coupling of sympathetic and afferent activity may follow a mechanically induced peripheral nerve lesion. This may take place between sympathetic fibers and regenerating or intact nociceptive C-fibers in the periphery, or between sympathetic vasoconstrictor fibers and afferent somata within the dorsal root ganglion.81 The interaction is chemically via noradrenaline from sympathetic endings and adrenoreceptors that are expressed on afferent neurons under pathophysiological conditions (Figure 4A). Accordingly, mRNA for alpha2A-adrenoceptors is up-regulated in DRG neurons after nerve lesion.82

Complex regional pain syndrome – diagnostic, mechanisms,
CNS involvement and therapy
G Wasner1 (#aff1) , J Schattschneider1 (#aff1) , A Binder1 (#aff1) and R Baron1 (#aff1)
Spinal Cord (2003) 41, 61–75. doi:10.1038/sj.sc.3101404

A partial nerve lesion is the important preceding event in CRPS II

Autonomic disturbances

A partial nerve lesion is the important preceding event in CRPS II (Reflex Regional Pain Syndrome). Therefore, it has generally been assumed that abnormalities in skin blood flow within the territory of the lesioned nerve are due to peripheral impairment of sympathetic function and sympathetic denervation. During the first weeks after transection of vasoconstrictor fibers, vasodilatation is present within the denervated area. Later the vasculature may develop increased sensitivity to circulating catecholamines, probably due to upregulation of adrenoceptors.⁶⁶ Similar observations were recently described in the chronic nerve constriction injury model in rats.^67,68 The skin on the lesioned side was abnormally warm for about the first post-operative week and then evolved to a chronically cold status. The late-stage cold skin was present despite a complete absence of fluorescence for norepinephrine. Thus, in this animal model, the skin is cold due to denervation supersensitivity of adrenoceptors rather than excessive sympathetic vasoconstrictor activity.

Further important signs of sympathetic dysfunction in CRPS are unilateral sweating abnormalities.⁷⁸ Quantitative measurements of sudomotor activity show enhanced sweat production in the disturbed limb in the acute and chronic stage of the disease in many CRPS patients.^23,26 This unilateral hyperhidrosis indicates enhanced sympathetic sudomotor activity.

In conclusion, the combination of increased sudomotor and decreased cutaneous sympathetic vasoconstrictor outflow is a well known centrally regulated thermoregulatory function to keep body core temperature constant in different environments. However, under physiological conditions all extremities are involved. Therefore, the unilateral activation of sudomotor and inhibition of cutaneous sympathetic vasoconstrictor neurons indicates a centrally located thermoregulatory dysfunction in CRPS.

Complex regional pain syndrome – diagnostic, mechanisms,
CNS involvement and therapy
G Wasner1 (#aff1) , J Schattschneider1 (#aff1) , A Binder1 (#aff1) and R Baron1 (#aff1)
Spinal Cord (2003) 41, 61–75. doi:10.1038/sj.sc.3101404

A critical analysis and long-term results

Permanent side effects included compensatory sweating in 67.4%, gustatory sweating in 50.7% and Horner's trias in 2.5%. However, patient satisfaction declined over time, although only 1.5% recurred. This left only 66.7% satisfied, and a 26.7% partially satisfied. Compensatory and gustatory sweating were the most frequently stated reasons for dissatisfaction. Individuals operated for axillary hyperhidrosis without palmar involvement were significantly less satisfied (33.3% and 46.2%, respectively).

F Herbst, E G Plas, R Függer, and A Fritsch

Department of Surgery, University of Vienna, Austria.
Ann Surg. 1994 July; 220(1): 86–90.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1234291

Sympathectomy was never evaulated for effectiveness or safety

No systematic reviews, meta-analyses, or clinical trials that evaluated the
effectiveness of endoscopic thoracic sympathectomy for treating facial
blushing were identified. However, we have identified four case series
related to the request (Drott et al. 1998, Rex et al. 1998, Telaranta 1998,
Yilmaz et al. 1996). These studies were conducted in three countries
(Sweden, Finland and the Netherlands).

The four case series were not critically appraised because they are prone
to bias and have significant methodological problems. These studies
represent level IV evidence according to the NHMRC criteria and one
should not draw firm conclusions from their findings.

To date, the benefits or side effects associated with endoscopic thoracic
sympathectomy for treating facial blushing have not been properly
evaluated and reported.

Centre for Clinical Effectiveness

Omar Ahmed PhD,
Monash University, 2001

retarded adaptation of hemodynamics to a sudden start of exercise following sympathectomy

E. Bassenge¹, J. Holtz¹, W. v. Restorff¹ and K. Oversohl¹

(1)	Physiologisches Institut der Ludwig-Maximilian-Universität München, Germany

Received: 18 April 1973

The exercise capacity and the increase of coronary and systemic hemodynamics under treadmill exercise were studied in 5 dogs, chemically sympathectomized with 6-hydroxy-dopamine.

Completeness of adrenergic denervation was verified by stimulation of the right stellate ganglion, by intravenous administration of tyramine, and by demonstration of supersensitivity to exogenous norepinephrine.

These dogs demonstrated a retarded adaptation of hemodynamics to a sudden start of exercise. A fall in mean arterial pressure below 45 mmHg within 10 to 15 sec lead to collapse. After a recovery period of 60–90 sec, moderate treadmill exercise could be continued; steady state attainment of hemodynamic parameters was considerably delayed.

Mean arterial pressure and total peripheral resistance were significantly reduced at rest and during steady state of exercise as compared to controls prior to sympathectomy identical .

The significant fall in left circumflex coronary flow was proportional to the decline in external heart work due to sympathectomy both at rest and under exercise.

Effect of chemical sympathectomy on coronary flow and cardiovascular adjustment to exercise in dogs

http://www.springerlink.com/content/k2n6j4555g16x773/

	Pflügers Archiv European Journal of Physiology
	Springer Berlin / Heidelberg

Relationship between sympathovagal tone and personality traits

E. Schweiger, W. Wittling^, , S. Genzel and A. Block

Department of Physiological and Clinical Psychology, Catholic University of Eichstaett, D-85071, Eichstaett, Germany

Received 27 August 1997.

Available online 15 September 1998.

Results of two-factor ANOVAs revealed substantial differences in personality characteristics depending on the level of sympathetic and parasympathetic tone respectively.
Correlational analysis showed remarkable relationships between sympathetic tone and some prominent personality traits. By introducing one of these personality traits (anxiety) as a covariate into two-factor ANCOVAs the originally obtained results were markedly altered.

PERSONALITY, AFFECT, AND CARDIOVASCULAR RESPONSE

Symposium 10

PERSONALITY, AFFECT, AND CARDIOVASCULAR RESPONSE: EVIDENCE FOR MOTIVATIONAL GAINS AND DEFICITS

Copyright Copyright © 2007 Society for Psychophysiological Research

Headache Following Cervical Sympathectomy - Harvard Medical School

Headache Following Cervical Sympathectomy and Results of a Blood Flow Study in the Cat

Egilius L. H. Spierings, MD, PhD

Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.

Address all correspondence to Dr. Egilius L. H. Spierings, 25 Walnut Street, Suite 102, Wellesley Hills, MA 02481-2106.

Background.—A patient developed severe, continuous, unilateral headache that was "vascular" in nature, following cervical sympathectomy.

Objective.—To determine the changes in cranial blood flow in the cat following lesioning and stimulation of the cervical sympathetic nerve.

Method.—Carotid blood flow was determined by electromagnetic flowmetry and its tissue distribution by intra-arterial injection of 15-μm radioactive microspheres.

Results.—Following sympathetic lesioning, an increase in carotid blood flow was observed and reversed with stimulation. The distribution of carotid blood flow changed for the brain only, maintaining relatively constant tissue perfusion.

Conclusion.—An increase in cerebral blood flow could not have accounted for the sympathectomy-induced headache. Dilation of major cerebral arteries and cranial noncerebral vasodilation probably constitutes its mechanism.

Accepted for publication October 6, 2002

Cervical sympathectomy reduces the heterogeneity of oxygen saturation in small cerebrocortical veins

H. M. Wei, A. K. Sinha and H. R. Weiss

Department of Anesthesia, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway 08854-5635.

This study evaluated the hypothesis that the peripheral sympathetic nervous system is one of the factors increasing the heterogeneity of venous O2 saturation in selective brain regions. Regional cerebral blood flow and O2 saturation were determined in the anterior cortex, posterior cortex, and medulla of either sham-operated or bilaterally sympathectomized Long-Evans rats. Cerebral venous O2 saturations, indicating the balance between local O2 supply and consumption, were found to be significantly more heterogeneous in the sham-operated group. In the anterior cortex, the coefficient of variation [100(SD/mean)] for the sham-operated animals was 22.4%. Sympathectomy significantly reduced this heterogeneity in the anterior cortex through a reduction in the number of low O2 saturation veins (coefficient of variation 11.7%). Blood flow and O2 consumption in the anterior cortex were not different between groups. The effects of sympathectomy in the posterior cortex were similar to those in the anterior cortex. However, sympathectomy did not alter any measured variables in the medulla. Thus, bilateral superior cervical ganglionectomy reduced the heterogeneity of cerebrocortical venous O2 saturation by reducing the number of low O2 saturation veins in the rostral part of the brain.
Journal of Applied Physiology, Vol 74, Issue 4 1911-1915, Copyright © 1993 by American Physiological Society
http://jap.physiology.org/cgi/content/abstract/74/4/1911

Sympathectomy - basal ganglia - functions

In the brain (part of the central nervous system), the "basal ganglia" is a group of nuclei interconnected with the cerebral cortex, thalamus and brainstem, associated with a variety of functions: motor control, cognition, emotions and learning.

The Unbalanced Autonomic Nervous System Causes the Symptoms of the Metabolic Syndrome

The metabolic syndrome consists of visceral obesity, hyperglycemia, hyperinsulinemia, dyslipidemia, and cardiovascular diseases. A common pathophysiological denominator underlying these epidemiological correlations has not been identified. However, the autonomic nervous system was shown to play a role in the metabolic syndrome. Recently, a prospective cohort study in 8,000 patients from 1987-1998 revealed a high relative risk to develop type 2 diabetes if autonomic dysfunction is present in healthy subjects independent from other risk factors, such as body weight.^[42]

Diabetes. 2003;52(11):2652-2656. ©2003 American Diabetes Association, Inc.

sympathectomy can relieve symptoms of angina

Surgical sympathectomy can relieve symptoms of angina in patients with refractory angina. However, in these high-risk patients this thoracic surgery may result in significant morbidity and mortality rates.

Clinical Investigations

American Heart Journal. 133(6):648-655, June 1997.
Gramling-Babb, Patricia MD; Miller, Michael J. MD; Reeves, Scott T. MD; Roy, Raymond C. MD; Zile, Michael R. MD
http://pt.wkhealth.com/pt/re/amhj/abstract.00000406-199706000-00007.htm;jsessionid=L6WWlJ0hBkQfdvQ9pgYwy1mHSyrL4pcGKTw5PvNGJSgDFD1j8L3V!1270838445!181195628!8091!-1

disturbed peripheral vascular and heart rate responses

Thoracic sympathectomy can result in reduced sweating and disturbed peripheral vascular and heart rate responses. Patients should be warned that these mechanisms may play a role in the development of exertional heat stroke.

Is Previous Thoracic Sympathectomy a Risk Factor for Exertional Heat Stroke?
http://www.ncbi.nlm.nih.gov/pubmed/17720429

Abnormal stress responses in patients with diseases affecting the sympathetic nervous system

Patients who lack baroreceptors have exaggerated blood pressure responses to stress. They have episodes of hypertension and hypotension that cause headaches and dizziness.

Patients with diseases of the sympathetic nervous system illustrate that everyday occurrences such as a change in posture or ambient temperature are stresses requiring a marked change in sympathetic nervous activity. Both physical and psychological stresses elicit large initial sympathetic neuronal responses that are subsequently damped by feedback inhibition from structures such as the baroreceptors. Damage to part of these feedback loops leads to exaggerated pressor responses to stress.
Ziegler MG, Ruiz-Ramon P, Shapiro MH.

University of California, San Diego.

Psychosom Med. 1993 Jul-Aug;55(4):339-46.

complex alterations of vascular reactivity

Enhanced vascular reactivity in the sympathectomized rat: studies in vivo and in small isolated resistance arteries.

Conclusions: In conclusion, we showed that sympathectomy produces complex alterations of vascular reactivity both in vivo and in isolated vessels, which shift the balance of the sensitivity of the vessel between vasoconstrictor and vasodilating agents towards an increased constriction. These results are unlikely to simply reflect denervation supersensitivity; their underlying receptor, post-receptor and/or contractile mechanisms are yet to be identified.

Journal of Hypertension. 18(8):1041-1049, August 2000.
Rizzoni, Damiano 1; Perlini, Stefano 2,3; Mircoli, Luca 2; Porteri, Enzo 1; Franzelli, Cristina 2; Castellano, Maurizio 1; Rosei, Enrico Agabiti 1; Ferrari, Alberto U. 2,4

Abnormal pain following nerve sprouting

Collectively, our findings indicate that as a result of autonomic sprouting due to CCI of the MN, remaining intact nociceptive fibres may potentially develop sensitivity to sympathetic and parasympathetic stimulation, which may have a role in the generation of abnormal pain following nerve injury.

---

Received 22 October 2004, revised 17 February 2005, accepted 23 February 2005

C. Grelik ¹ , G. J. Bennett ^3,4,5 and A. Ribeiro-da-Silva ^1,2,5

¹ Department of Pharmacology & Therapeutics, McGill University, 3655 Prom. Sir-William-Osler, Montreal, Quebec, Canada H3G 1Y6
² Department of Anatomy and Cell Biology,
³ Department of Anesthesia,
⁴ Faculty of Dentistry, and
⁵ McGill Centre for Research on Pain, McGill University, Montreal, Quebec, Canada

Summary from the University of Cambridge

ANDBN, MAGNUSSON and ROSENGREN (1965)
have demonstrated a complete loss of DOPA decarboxylase activity of iris, spleen
and submaxillary gland after surgical sympathectomy, and a complete loss of tyrosine
hydroxylase activity of heart, submaxillary gland and kidney has been found after
surgical sympathectomy (POOL, COVELL, LEVITT, GIBB and BRAUNWALD, 1967;
SEDVALL and KOPIN, 1967; NAGATSU, RUST and DE QUATTRO, 1969). Although the
time course of the fall in DOPA decarboxylase and tyrosine hydroxylase activities
of operated vasa was not investigated, a preliminary experiment showed that all
DOPA decarboxylase activity was absent one day after denervation. Thus, it seems
likely that these two enzymes which are involved in the biosynthesis of NA have
a cellular localization within the sympathetic nerves of the vas deferens.
NORADRENALINE METABOLIZING ENZYMES IN
NORMAL AND SYMPATHETICALLY DENERVATED
VAS DEFERENS
B. JARROTTI and L. L. IVERSEN
Department of Pharmacology, University of Cambridge, Cambridge, England
(Received 5 May 1970. Accepted 21 May 1970)

Sympathectomy causes diminished capacity for physical sensation

Results: In the hot-plate analgesia test, sympathectomized rats increased their hot-plate latency time compared with that of sham-operated rats. Density of calcitonin gene-related peptide immunoreactive fibers in sympathectomy side of the lumbar dura mater decreased to 45.5% compared with the contralateral side. The number and size of calcitonin gene-related peptide immunoreactive cells in dorsal root ganglia showed no difference between sympathectomized and contralateral side.

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

An Anatomic Study of Neuropeptide Immunoreactivities in the Lumbar Dura Mater After Lumbar Sympathectomy.

Spine. 21(8):925-930, April 15, 1996.
Sekiguchi, Yasufumi MD *+; Konnai, Yasunobu MD *+; Kikuchi, Shinichi MD, PhD *; Sugiura, Yasuo MD, PhD +

Long-term superior cervical sympathectomy induces mast cell hyperplasia and increases histamine and serotonin content

Nerve fibres and mast cells are often described in close morphological and functional interactions in various organs such as the dura mater. The respective roles of mast cell activation and sympathetic impairment in cluster headache and migraine attacks have been repeatedly suggested. We have thus investigated the long-term effects of sympathectomy on mast cell morphology and content in the rat dura mater.
After unilateral ganglionectomy, the histamine content increased progressively and significantly 30–60 days post-surgery in both hemi-dura, whereas the serotonin content became significantly different from that of sham only 60 days post-surgery in the ipsilateral dura. After bilateral ganglionectomy, the histamine level significantly increased in both hemi-dura 15–60 days post-surgery, whereas the serotonin level had significantly increased at 60 days post-surgery.

These results clearly demonstrate, for the first time, a long-term trophic effect of sympathetic nerve degeneration on mast cells in the dura mater.

A. Bergerot^*, A. -M. Reynier-Rebuffel^†, J. Callebert^‡ and P. Aubineau

Copyright © 1999 IBRO. Published by Elsevier Science Ltd.

Mast cell hyperplasia: role of cytokines.

Bischoff SC, Sellge G.

Department of Gastroenterology, Hepatology and Endocrinology, Medical School of Hannover, Germany

Mast cell hyperplasia is found in different pathologies such as chronic inflammatory processes, fibrotic disorders, wound healing or neoplastic tissue transformation. The functional significance of the accumulation of mast cells in these processes is largely unknown. It is now established that bone marrow-derived mast cell progenitors circulate in peripheral blood and subsequently migrate into the tissue where they undergo final maturation under the influence of local microenvironmental factors. Cytokines are of particular importance for mast cell recruitment, development, and function. Stem cell factor (SCF) is a unique mast cell growth factor, since mast cells disappear completely in the absence of SCF. However, several other cytokines such as IL-3 and IL-4 have been shown to influence mast cell proliferation and function also. This review focuses on the role of cytokines in the regulation of mast cell hyperplasia. Copyright 2002 S. Karger AG, Basel

Int Arch Allergy Immunol. 2002 Feb;127(2):118-22.

Sympathectomy increases chronic DSS colitis

Sympathectomy reduced acute DSS colitis but increased chronic DSS colitis. Sympathectomy also increased chronic colitis in Il10–/– mice.

Anti-inflammatory role of sympathetic nerves in chronic intestinal inflammation

R H Straub¹, F Grum¹, U Strauch¹, S Capellino¹, F Bataille², A Bleich³, W Falk¹, J Schölmerich¹, F Obermeier¹

¹ Laboratory of Neuroendocrino-Immunology, Department of Internal Medicine I, University Hospital Regensburg, Germany
² Department of Pathology, University of Regensburg, Regensburg, Germany
³ Institute for Laboratory Animal Science and Central Animal Facility, Hannover Medical School, Hannover, Germany

Published Online First: 28 February 2008. doi:10.1136/gut.2007.125401
Gut 2008;57:911-921
Copyright © 2008 BMJ Publishing Group Ltd & British Society of Gastroenterology

destroying the sympathetic nerves and their ability to transmit impulses

Surgery (Endoscopic thoracic sympathectomy or ETS): Select sympathetic nerves or nerve ganglia in the chest are either cut or burned (completely destroying their ability to transmit impulses), or clamped (theoretically allowing for the reversal of the procedure). The procedure often causes anhidrosis from the mid-chest upwards, a disturbing condition. Major drawbacks to the procedure include thermo regulatory dysfunction (Goldstein, 2005), lowered fear and alertness and the overwhelming incidence of compensatory Hyperhydrosis. Some people find this sweating to be tolerable while others find the compensatory Hyperhydrosis to be worse than the initial condition. It has also been established that there is a low (less than 1%) chance of Horner's syndrome. Other risks common to minimally-invasive chest surgery, though rare, do exist. Patients have also been shown to experience a cardiac sympathetic denervation, which results in a 10% lowered heartbeat during both rest and exercise. ETS was thought to be helpful in treating facial blushing and facial sweating. According to Dr. Reisfeld,the only indication for ETS at present is excessive and severe palmar Hyperhydrosis (excessive hand sweating). Statistics have shown that when treated for facial blushing and/or excessive facial sweating, the failure rate of ETS for those two clinical presentations is higher and patients are more prone to side effects.
http://immersivemedical.com/hyperhydrosis_fr_2.html

Changes in Electrophysiology following sympathectomy

Chemical sympathectomy was obtained following intravenous injection of 50 mg·kg^–1 of 6-hydroxydopamine. Sympathectomised dogs presented significant increases in: basic sinus period, sino-atrial conduction time (SACT), AH and HV intervals of the His bundle electrogram, atrial functional (AFRP) and effective (AERP) refractory periods, atrio-ventricular node functional (AVNFRP) and effective (AVNERP) refractory periods, ventricular functional (VFRP) and effective (EVRP) refractory periods and atrial (AMAP) and ventricular (VMAP) monophasic action potential durations. Corrected sinus recovery time (CSRT) was not affected by chemical sympathectomy. Neither was the atrial ERP/MAP duration ratio. This new form of sympathectomy affects all the levels of the cardiac conduction system. Such results are in accordance with those obtained with surgical sympathectomy or the use of beta-blocking agents.

DIANE GODIN^*, CLAUDE GUIMOND, RÉGINALD A NADEAU and A ROBERT LEBLANC

From the Department of Physiology, Faculty of Medicine, Université de Montréal and Centre de recherche, Hôpital du Sacré-Coeur, Montréal, Canada

Cardiovascular Research 1982 16(9):524-529; doi:10.1093/cvr/16.9.524
© 1982 by European Society of Cardiology

Sympathectomy frequently causes perioperative hypotension

Vasomotor output is modified by inputs from throughout the central nervous system, including the hypothalamus, cerebral cortex, and the other areas in the brain stem. Areas in the posterolateral medulla receive input from both the vagal and the glossopharyngeal nerves and play an important role in mediating a variety of circulatory reflexes. The sympathetic system normally maintains some tonic vasoconstriction on the vascular tree. Loss of this tone following induction of anesthesia or sympathectomy frequently contributes to perioperative hypotension.

Clinical Anesthesiology

By G. Edward Morgan, Maged S. Mikhail, Michael J. Murray

Published by McGraw-Hill Professional, 2005

ISBN 0071423583, 9780071423588

hypoxic response after sympathectomy

Blockade of the sympathetic nervous system with {alpha} ... (9) reported a reduction in the hypoxic response of the lung after sympathectomy. ...
www.anesthesia-analgesia.org/cgi/content/full/88/3/494

by I Garutti - 1999

autoregulatory breakthrough is eliminated when the arterial baroreflex is interrupted

The effects of sympathetic section blockade are greater during systemic hypercapnia than during normocapnia: a decrease in cerebrovascular resistance has been demonstrated in cats and rabbits after bilateral sympathectomy when PaCO2 was below 62-67 mmHg.
Blockade of sympathetic activity causes a significant further increase in CBF during hypoxia.

..sympathetic activation exerts a significant protective action on CBF and blood-brain barrier (BBB) permeability (Bill and Lander 1976) an effect which is also seen in the presence of moderate increase increases in BP, where autoregulation maintains CBF almost constant.

The vasodilation which characterizes autoregulatory breakthrough is eliminated when the arterial baroreflex is interrupted (Talman et al. 1994), which suggests that it is an active process. It is possible that the breakthrough depends on release of nitric oxide or a NO donor associated with the removal of the sympathetic innervation of cerebral vessels (Talman and Dragon 1995).

Intoxications of the Nervous System

By Pierre J. Vinken, F. A. de Wolff, George W. Bruyn, Otto Appenzeller, Harold L. Klawans

Published by Elsevier Health Sciences, 1999

ISBN 0444828133, 9780444828132

Effects of Sympathetic Nervous System activation

Our previous work indicates that myocardial ischemia could be the mechanism responsible for the left ventricular (LV) dysfunction that frequently develops after massive sympathetic nervous system (SNS) activation. In this study, coronary blood flow (CBF) and myocardial ATP, creatine phosphate, and lactate concentrations were measured after massively activating the SNS of anesthetized rabbits with an intracisternal injection of veratrine. CBF was measured at time 0 (baseline), and at 2, 10, and 20 min after SNS activation in one group, and at 0, 45, 90, and 150 min in a second group. Myocardial ATP, creatine phosphate, and lactate were measured at 0, 2, 10, 20, 90, and 150 min in separate groups of rabbits. SNS activation caused LV dysfunction in 60% of the rabbits. SNS-related increases in CBF kept pace with the increases in myocardial energy demand as determined from the systolic pressure-heart rate product. The subendocardial-to-subepicardial blood flow ratio did not change significantly. Myocardial creatine phosphate concentration was depressed 2 min after SNS activation and remained depressed for at least 20 min. ATP fell continuously and was significantly lower than baseline by 20 min. Tissue lactate concentration was elevated at this time.
Jennifer M. Smith and Charles F. Pilati^,1

Department of Physiology, Northeastern Ohio University College of Medicine, Rootstown, Ohio 44272

Experimental Biology and Medicine 227:125-132 (2002)
© 2002 Society for Experimental Biology and Medicine

---

Orthostatic hypotension following sympathectomy can lead to syncope

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.

9. Will the capillary pressure increase or decrease in the following situations?

1. Arteriolar vasodilation: increase

2. Venodilation: decrease (however, Dr. Gray points out that capillary beds of lower extremities will experience an increase in pressure due to back pressure exerted by the column of blood in the dilated veins!)

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

Marked MAP instability following sympathectomy

In this study, conscious freely behaving rats with functional sympathetic denervation of the vessels, as evidenced by the disappearance of pressor responses to tyramine, did not show any change in the mean level of blood pressure but had a striking increase in the spontaneous MAP (mean arterial pressure) variability as compared with intact rats. This exaggerated blood pressure lability was associated with an increase in the variability of mesentric conductance with no change in that of the hindquarters vascular bed, which is the sum of vascular conductances of all regional hemodynamic changes after sympathectomy and suggest that the sympathetic nervous system may play an important role in reducing short-term hemodynamic variability.
In conclusion, the results of the present study suggest a major role for the sympathetic nervous system in the regulation of regional circulations, the loss of which in sympathectomized rats results in a marked instability of MAP. The vasodilator component of MAP lability after sympathectomy does not appear to depend on an episodic release of NO synthesized by the L-arginine pathway.

Genetic Hypertension, by Jean Sassard

Under the patronage of: Ministère de la recherche et de la technologie, Ministère délégué à la santé, INSERM, CNRS (Départment des sciences de la vie), Conseil général du Rhône, Mairie de Lyon, Chambre de commerce et d'industrie de Lyon
Genetic Hypertension: Proceedings of the 7th International Symposium on SHR and Related Studies Held in Lyon (France), Ecole Normale Supérieure, October 28-30, 1991 = Hypertension Génétique

Sympathectomy for the treatment of Tachycardia

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

A J Turley, J Thambyrajah, A A Harcombe

Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, UK

She was ultimately treated successfully with bilateral thoracoscopic cervicothoracic sympathectomies. This is the first reported bilateral thoracoscopic treatment of a patient with LQTS and symptomatic life threatening ventricular tachyarrhythmias refractory to current pharmacological and pacing techniques.

Heart 2005;91:15-17
© 2005 by BMJ Publishing Group & British Cardiac Society

Fertility following sympathectomy

Both chemically and surgically induced sympathectomy increased the weight of the epididymis and seminal vesicles/coagulating glands as well as the number and the transit time of cauda epididymal sperm. Neither serum testosterone levels nor LH was affected by treatment with guanethidine. Using natural mating, no litters were produced by guanethidine-treated rats. Chemically denervated rats failed to produce copulatory plugs or ejaculate into the uterus. However, distal cauda epididymal sperm from chemically or surgically denervated rats displayed normal fertilization ability (80%) using in utero inseminations.
Biology of Reproduction 59, 897-904 (1998)
©Copyright 1998 Society for the Study of Reproduction, Inc.

Fertility of Rat Epididymal Sperm after Chemically and Surgically Induced Sympathectomy¹

Wilma De G. Kempinas^2,a, Juan D. Suarez^b, Naomi L. Roberts^b, Lillian F. Strader^b, Janet Ferrell^b, Jerome M. Goldman^b, Michael G. Narotsky^b, Sally D. Perreault^b, Donald P. Evenson^c, Deborah D. Ricker^d, , and Gary R. Klinefelter^b

Norepinephrine loss produces motor deficits

Norepinephrine loss produces more profound motor deficits than MPTP treatment in mice

1. K. S. Rommelfanger*,
2. G. L. Edwards†,
3. K. G. Freeman†,
4. L. C. Liles*,
5. G. W. Miller‡, and
6. D. Weinshenker*,§


Departments of *Human Genetics and
‡Environmental and Occupational Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322; and
†Department of Physiology and Pharmacology, College of Veterinary Medicine, University of Georgia, Athens, GA 30602
Edited by Richard D. Palmiter, University of Washington School of Medicine, Seattle, WA, and approved June 25, 2007 (received for review March 27, 2007)

Effect of adrenalectomy or sympathectomy on spinal cord blood flow

We conclude that adrenalectomy near-totally ablates the hypothermia-associated increase in RSCBF (regional spinal cord blood flow) measured in intact rats and that abdominal sympathectomy totally ablates it. This evidence complements morphological evidence for adrenergic innervation of the spinal cord vasculature.

Heart and Circulatory Physiology, Vol 260, Issue 3 827-H831, Copyright © 1991 by American Physiological Society

A. Iwai, W. W. Monafo and S. G. Eliasson
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110.

http://ajpheart.physiology.org/cgi/content/abstract/260/3/H827

Morphofunctional changes in the myocardium following sympathectomy

Vestn Akad Med Nauk SSSR. 1984;(2):80-5.
Related Articles, Links

[Morphofunctional changes in the myocardium following sympathectomy and their role in the development of sudden death from ventricular fibrillation]

[Article in Russian]

Beskrovnova NN, Makarychev VA, Kiseleva ZM, Legon'kaia , Zhuchkova NI.

Publication Types:

* English Abstract

Postoperative complications are frequent after sympathectomy

[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]
[My paper] L Räf

Lakartidningen. 2001 Apr 11;98 (15):1764-5 11374001 (P,S,E,B)

inhalation of carbon dioxide

Minerva Med. 1958 Feb 14;49(13):514-6.Links
[Behavior of liquoral pressure after inhalation of carbon dioxide, as evaluative test of cerebral circulation with particular regard to treatment by sympathetic block in focal vascular cerebropathies.]
[Article in Italian]

POLETTI T, CAMERON-CURRY V, SGARBI M.

PMID: 13516803 [PubMed - OLDMEDLINE]

Cerebral accidents of vascular origin and cervical sympathectomy

Progr Med (Paris). 1955 Feb 10;83(3):43-7.Links
[Cerebral accidents of vascular origin and cervical sympathectomy.]
[Article in French]

CHAVANY JA, DJINDJIAN R, HAGEN-MULLER D.

Role of sympathectomy in the treatment of cerebrovascular occlusion

J Albert Einstein Med Cent (Phila). 1960 Jan;8:31-8.Links
Role of sympathectomy in the treatment of cerebrovascular occlusion.
SHENKIN HA, FINNESON BE.

Resection of the cervical sympathetic nerve in cerebrovascular diseases

Progr Med (Napoli). 1957 May 31;13(10):289-94.Links
[Resection of the cervical sympathetic nerve in cerebrovascular diseases.]
[Article in Italian]

POLETTI T, SGARBI M, CAMERON-CURRY

http://www.ncbi.nlm.nih.gov/pubmed/13453570?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=5&log$=relatedarticles&logdbfrom=pubmed

Acceptance by the medical community is not a substitute for rigorous testing

http://www.healthyplace.com/Communities/Depression/ect/news/newyork/krausstest.asp

A large proportion of psychiatrists claims ECT to be SAFE and EFFECTIVE. This is not the only parallel you can find between surgeons talking about ETS and psychiatrists talking about ECT.

TESTIMONY OF JOHN M. FRIEDBERG, M.D., NEUROLOGIST, BEFORE THE MENTAL HEALTH COMMITTEE OF THE NEW YORK STATE ASSEMBLY

MARTIN LUSTER PRESIDING

NYC, May 18, 2001

http://www.healthyplace.com/Communities/Depression/ect/news/newyork/friedbergtest.asp

From the ETS Discussion Forum

ETS surgeons should be measuring heart function, bronco-motor tone, thermoregulation, blood vessel constriction, and thyroid. They should be doing bone scans and exercise tests. They should measure changes in catecholomine levels. At least they should measure sweating. All of this is affected by ETS, and they simply dont want to know. Sorry, but the vast majority of ETS papers are not science. Dr. Goldstein at NIH is doing some good work, and showing some very disturbing results. All in all, ETS is still highly experimental, under-studied, and patients should be warned accordingly.

http://etsandreversals.yuku.com/reply/1861#reply-1861

Cervical sympathectomy in the treatment of cerebral vascular disorders

Lahey Clin Bull. 1953 Jul;8(5):142-8.Links
Cervical sympathectomy in the treatment of cerebral vascular disorders.
POPPEN JL, FAGER CA Jr.

PMID: 13070547 [PubMed - indexed for MEDLINE]

sympathectomy for palmar hyperhidrosis: effects on pulmonary function

In order to investigate the effect of sympathectomy, pulmonary function was compared before and four weeks after operation in 20 patients. Forced vital capacity (FVC) (-2.3%), forced expiratory volume in one second (FEV1) (-6.1%), and FEV1/FVC (-4.6%) were all slightly but significantly decreased four weeks after thoracoscopic sympathectomy. Also the instantaneous forced expiratory flow at 75%, 50% and 25% of the FVC (V_max 25, V_max 50, V_max75) in flow-volume curves were decreased (-1.6%, 8.4%, and -20% respectively). Therefore, thoracoscopic sympathectomy minimises pulmonary restrictive effects but allows subclinical small airway obstructive effects to become more evident.

TSENG Ming-Yuan ⁽¹⁾ ; TSENG Jen-Ho ⁽¹⁾ ;
⁽¹⁾ Division of Neurosurgery, Department of Surgery, Medical School and Hospital, National Taiwan University, 7 Chung-Shan South Road, Taipei, TAIWAN, PROVINCE DE CHINE
Journal of clinical neuroscience ISSN 0967-5868
2001, vol. 8, n^o6, pp. 539-541 (29 ref.)

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

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

Unilateral cerebral infarcts were produced in the rat by ligation of one common carotid artery and subsequent exposure to carbon monoxide. The incidence and extension of brain infarcts was increased in animals with additional ipsilateral cervical preganglionic sympathectomy. Sympathectomy did not affect markedly the respiration and systemic circulation. The effect of sympathectomy was attributed to a cutaneous vasodilation, leading to an extracranial steal phenomenon.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1027532

Elevated levels of TH in major depression and after sympathectomy

Zhu MY, Klimek V, Dilley GE, Haycock JW, Stockmeier C, Overholser JC, Meltzer HY, Ordway GA.
Elevated levels of tyrosine hydroxylase in the locus coeruleus in major depression.
Biol Psychiatry. 1999 Nov 1;46(9):1275-86.

CONCLUSIONS: Elevated expression of TH in the LC in major depression implies a premortem overactivity of these neurons, or a deficiency of the cognate transmitter, norepinephrine."

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.

Sympathectomy resulted in reduced antibody responses to T-dependent antigens

It has been exhaustively demonstrated that the regions in which lymphocytes T cells reside, and through which they recirculate, receive direct sympathetic neural input. Therefore, the immune system can be considered “hard-wired” to the brain. Chemical sympathectomy of adult mice resulted in reduced antibody responses to T-dependent antigens.

VOL. 31, NOS. 5 & 6, 2000 JOURNAL OF MEDICINE

JOURNAL OF MEDICINE, 2000

ENHANCEMENT OF NORADRENERGIC NEURAL TRANSMISSION: AN EFFECTIVE THERAPY OF

MYASTHENIA GRAVIS
Fuad. Lechin^1,2, Bertha van der Dijs^1,2, Betty Pardey-Maldonado¹,

Eduardo Jahn¹, Vladimir Jimenez¹, Beatriz Orozco¹,Scarlet Baez² and Marcel E. Lechin³

The abrupt increase and decrease in BP observed at the time when the lighting conditions are changed are eliminated by chemical sympathectomy

The disruption of the baroreflex selectively eliminates the circadian rhythm of BP, and the circadian rhythms of BP and HR are modulated by the autonomic nervous system in rats. The circadian rhythms of BP and HR are regulated by different mechanisms involving the autonomic nervous system.

Chemical sympathectomy with guanethidine may activate the influence of the parasympathetic
nervous system on the heart. The possible reasons for the decrease of MBP during the dark period seem to be the elimination of the sympathetic nervous system or the activation of the
parasympathetic nervous system, or both. Because the SBP and PP in sympathectomized rats during the dark period were suppressed, the decrease of stroke volume, which is reflected in SBP or PP, may be responsible for the decrease of MBP during the dark period. It seems definitive,
therefore, that the autonomic nervous system, particularly the sympathetic nervous system, is
important for the manifestation of 24-hour rhythms of BP and HR in rats.

The daily variations in MBP in intact rats, in which an abrupt rise was seen when the light was
turned off and a sharp fall in MBP was seen when the light was turned on, were not observed in sympathectomized rats. These results suggest that a change in autonomic nervous tone, the majority being the sympathetic nervous tone, is required for the abrupt changes in BP at the time when the lighting is altered. In humans, BP often rises abruptly around the time of awakening.1 If this early morning surge in BP were due to the same mechanisms as in rats, a change in autonomic nervous tone would be important for the formation of this morning surge in humans. In fact, -sympathetic vasoconstrictor activity is reportedly related to this early morning surge.
Furthermore, the autonomic nervous system may play some role in the high correlation between the HR and locomotor activity, because the slope of the regression line was decreased in sympathectomized rats. The correlation between the MBP (mean blood pressure) and locomotor activity was disrupted by both SAD and chemical sympathectomy.

The abrupt increase and decrease in BP observed at the time when the lighting conditions are changed are eliminated by chemical sympathectomy.

(Circulation. 1997;96:1667-1674.)
© 1997 American Heart Association, Inc.
Mitsutaka Makino, MD; Hiroshi Hayashi, MD;
Hiroto Takezawa, MD; Makoto Hirai, MD;
Hidehiko Saito, MD; ; Shizufumi Ebihara, PhD

Hemodynamic changes after sympathectomy and the number od sympathetic segments operated

After ETS, heart rate, systolic, diastolic, and mean blood pressures, rate-pressure product, and NOR decreased,whereas left ventricular end-systolic volume index, cardiac index, and ejection fraction did not change in the 2 groups.Among percent changes in all hemodynamic parameters and NOR occurring after ETS, only the percent decrease in systolic blood pressure in group Th2–4 was larger than that in group Th2–3 (–15 ± 12 % vs.–4±8%, respectively, p <>

Yukio Nakamura¹, Shin-ichiro Muramoto¹, Rira Kato¹, Takahiro Saeki¹, Manabu Fujimoto¹, Hiroshi Kida¹ and Yasushi Matsumoto²

(1)	Dept. of Cardiology, Kanazawa National Hospital, 1-1 Shimoishibiki-machi, Kanazawa, Ishikawa, 920–8650, Japan

(2)	Dept. of Cardiovascular Surgery, Kanazawa National Hospital, Kanazawa, Ishikawa, Japan

Sympathectomy as a treatment for Social Phobia

Pohjavaara P, Telaranta T, Väisänen E.

Tampere City Mental Health Care Centre, Finland. paipoh@koti.soon.fi

Social phobia is a neglected disorder, which can cause very debilitating consequences in patients' lives. The patients tend to isolate and suffer from comorbid disorders such as depression, other anxiety disorders, and drug and alcohol abuse. Traditional treatment methods such as medication and psychotherapy do not help everyone. A prospective, uncontrolled follow-up study with 169 social phobic patients was performed by uni- or bilateral endoscopic sympathetic block of the upper thoracic ganglia.

Endoscopic sympathetic block is recommended as the treatment of choice in severe, conservative therapy resistant social phobia.
Ann Chir Gynaecol. 2001;90(3):177-84.

Psychoneurological applications of endoscopic sympathetic blocks

Telaranta T.

University of Oulu, Oulu, Finland. timo.telaranta@privatix.fi

In addition to more widely and longer known indications of ETS, various neurological disorders and psychologically stressful situations in their worst expressions might be alleviated by the reversible ESB procedure. The patients with social phobia, especially those who have also blushing and/or stage fright type of heart racing, benefit from the ESB. The disturbances of the sympathetic nervous system, e. g. in Parkinson's disease and multiple system atrophy might be alleviated with sympathetic block, especially the extrapyramidal symptoms in these diseases. In migraine, sympathetic surgery has been noted to give some help. The unilateral left-sided block has been effective in long QT-syndrome type arrhythmias. In schizophrenia, the phobic, paranoic or confusional reactions have been tentatively treated by the sympathetic block.

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=14673667&dopt=AbstractPlus

Vasodilator response to mental stress absent after sympathectomy

The idea that there might be sympathetic vasodilator nerves to skeletal muscle is an old concept that fits with the archaic `fight or flight' model of the sympathetic nervous system. Clear evidence for vasodilator nerves to skeletal muscle began to emerge in animals during the 1930s, when stimulation of selected brainstem areas was shown to evoke hypertension, tachycardia and skeletal muscle vasodilation (i.e. the `defense reaction'). By the 1940s and 1950s this idea was well established and it was shown in animals that the sympathetic dilator nerves to muscles were cholinergic. During this time, circumstantial evidence began to suggest the existence of sympathetic cholinergic vasodilator fibres in human skeletal muscle. In this context, the well- known forearm vasodilator response to mental stress was shown to be atropine-sensitive, and absent after surgical sympathectomy.

Sympathetic vasodilation in human muscle

Authors: Joyner, M. J.¹; Dietz, N. M.¹

Source: Acta Physiologica, Volume 177, Number 3, March 2003 , pp. 329-336(8)

Publisher: Blackwell Publishing

Tyrosine hydroxylase, DOPA and catecholamines

Tyrosine hydroxylase (TH) mRNA and activity and concentrations of 3,4-dihydroxyphenylalanine (DOPA) and catecholamines were examined as markers of sympathetic innervation and catecholamine synthesis in peripheral tissues of sympathectomized and intact rats. Chemical sympathectomy with 6-hydroxydopamine (6-OHDA) markedly decreased norepinephrine and to a generally lesser extent TH activities and dopamine in most peripheral tissues (stomach, lung, testis, duodenum, pancreas, salivary gland, spleen, heart, kidney, thymus). Superior cervical ganglia, adrenals and descending aorta were unaffected and vas deferens showed a large 92% decrease in norepinephrine, but only a small 38% decrease in TH activity after 6-OHDA.
Differential Effects of Chemical Sympathectomy on Expression and Activity of Tyrosine Hydroxylase and Levels of Catecholamines and DOPA in Peripheral Tissues of Rats
Journal Neurochemical Research
Publisher Springer Netherlands Issue Volume 24, Number 1 / January, 1999

sympathectomy prevents them from responding to reflex or emotional changes in the central nervous system - psychosurgery

All the sympathetic ganglia that send postganglionic nerve fibres to structures in the head, neck and upper limb receive preganglionic fibres from the central nervous system only through the white rami communicates of the upper thoracic ventral rami. These preganglionic fibres ascend in the trunk and reach its ganglia directly and outlying ganglia through branches of the trunk. Thus destruction of the trunk at the root of the neck, whether as a result of a surgery (cervical sympathecotmy) or of some pathological condition, isolates all these sympathetic ganglion cells from the central nervous system and prevents them from responding to reflex or emotional changes in the central nervous system.
Cunningham's Manual of Practical Anatomy: Volume III: Head, Neck and Brain (Oxford Medical Publications)
G. J. Romanes
Paperback - Nov 20, 1986, page 87