Abolition of sympathetic skin responses following endoscopic thoracic sympathectomy

The recording of sympathetic skin responses (SSRs) is a simple, electrophysiological method to assess sympathetic nerve function. Within the last 10 years, SSRs have mainly been applied to delineate peripheral and central nervous system diseases, although the sympathetic nature of these responses was not fully documented, e.g., by a study of sympathectomy. We therefore recorded SSRs before and after 30 cases of endoscopic thoracic sympathectomy. The main indication was palmar hyperhidrosis, in which we found two types of SSR abnormalities. Most patients exhibited normal SSR waveforms but with increased amplitudes. The other patients exhibited abnormal SSRs which did not occur as single responses but as several consecutive waves.

Muscle & Nerve

Volume 19 Issue 5, Pages 581 - 586

Published Online: 7 Dec 1998

cervical sympathectomy resulted in a rapid degeneration in some of the cells in the sinuatrial and atrioventricular nodes

This study describes the ultrastructural changes in the sinuatrial and atrioventricular nodes of the heart of the monkey (Macaca fascicularis) after right cervical sympathectomy. Obvious changes in the nodal cells were seen one day after operation. Numerous glycogen particles grouped together to form electron-dense patches containing vacuoles in the cytoplasm. At three days after operation, intracellular organelles exhibited fragmentation and dissolution. By five and seven days after operation, the affected cells were vacuolated and some were swollen and appeared to have degenerated. Simultaneously, there was massive infiltration of macrophages were present nodal tissues. Axon profiles and terminals showing various degrees of degeneration were present in the vicinity of the nodal cells throughout the period of study.

J Anat. 1984 October; 139(Pt 3): 449–461.

Electrophysiology - effect on the heart

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.

Cardiovascular Research 1982 16(9):524-529; doi:10.1093/cvr/16.9.524

Infra-stellate upper thoracic sympathectomy results in a relative bradycardia during exercise, irrespective of the operated side

Patients should be informed of the exercise bradycardia resulting from ISS.

Eur J Cardiothorac Surg 2001;20:1095-1100

Sympathectomy induces adrenergic excitability of cutaneous C-fiber nociceptors

Journal of Neurophysiology, Vol 75, Issue 1 514-517, Copyright © 1996 by APS

The induction of adrenergic excitability in CPMs by sympathectomy is suggested to be a counterpart to postsympathectomy neuralgia in human beings and a possible part of the mechanism leading to sympathetically related pain states.

The results provide new evidence about the change in atrial natriuretic peptide levels that occurs when sympathetic innervation is altered.

PMID: 9799658 [PubMed - indexed for MEDLINE]

J Mol Cell Cardiol. 1998 Oct;30(10):2047-57.

Neuroma following nerve injury/surgery

When a nerve is cut, the piece of nerve that is beyond the cut point eventually dies, however, its Schwann cells, the cells that encircle the nerve fibers remain for a much longer time. These Schwann cells secrete a chemical messenger known as nerve growth factor that tells the cut end of nerve where to grow back. So the cut end of nerve will send out multiple sprouts in the direction of the nerve growth factor, however, these sprouts do not go out in an orderly manner, instead they grow out in all directions and eventually cluster and form a knot of nerve fibers. This eventually leads to the formation of a TRUE neuroma or a END BULB or STUMP neuroma.

www.tarsaltunnelcenter.com/assets/recurrent.shtml

Risks during Thoracic Sympathectomy - Surgery not as safe as reported

Even epidural blockade limited only to the thoracic dermatomes is liable to cause complete sympathectomy, including cardiac sympathetic denervation. The ensuing vasodilation and bradycardia lead to hypotension, poor tolerance of mechanical interference with the heart, and inability to respond to acute changes in intravascular volume or body position. This symptom complex is especially troublesome to manage during intrathoracic operations when avoidance of hypervolemia is emphasized.
Thoracic sympathectomy has two other potenital consequences: effect on bronchomotor tone and effect on oxygenation.

During intrathoracic procedures using one-lung ventilation, a right-to-left intrapulmonary shunt is intentionally created (in the form of the nonventilated lung). The ensuing arterial oxygen tension (PaO2) is determined by a complex interaction involving cardiac output, mixed venous oxygen tension, the status of the ventilated lung, size of the shunt, and most significantly, hypoxic pulmonary vasoconstriction (HPV).
HPV diverts pulmonary blood flow away from the shunt by vavsoconstriction in the nonventilated lung, and is the principal adaptive defense mechanism against arterial hypoxemia during one-lung ventilation. The cellular mechanism and regulation of HPV, and the possible role of the autonomic nervous system are not completely understood.
The effect of thoracic sympathectomy of HPV is even less well understood. Since potent vasodilators such as nitroprusside antagonize HPV-induced vasoconstriction and lower the arterial oxygen tension, it is reasonable to assume that HPVwill become less effective with thoracic sympathectomy.
Clinical studies have produced conflicting conclusions, most probably because direct measurement of HPV is not possible in human studies, and the surrogate endpoing examined PaO2 is determined not only by HPV, but also by a host of interacting factors, some of which may be affected by the sympathectomy and can not be held constant.

Risk Factor for Neuraxial Anesthesia-Associated Bradycardia:
Block height higher than T5
Younger age

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Spinal and Epidural Anesthesia By Cynthia Wong

Publication Date: 2007-01-01 Publisher: MCGRAW-HILL EDUCATION - EUROPE Country of origin: UNITED STATES

Alteration in Cerebral Blood Flow after sympathectomy

Jeng and associates observed an increase in cerebral blood flow after T2 sympathectomy, and they suggested the possibility of using such a surgical approach to improve cerebral blood flow in patients with cerebral vascular insufficiency.

Youmans Neurological Surgery, 5th Edition
Publisher: Saunders
Publication Date: 2003-10-10

The angina-relieving effects of sympathetic blockade

In the 1930's it was recognised by neurosurgeons performing destructive sympathectomies for angina pectoris that local anaesthetic infiltration around the stellate ganglion often resulted in pain relief outlasting the duration of action of the local anaesthetic drug^13. This observation has been more recently confirmed¹⁴, and is currently (June 1999) the subject of a large scale randomised double-blind placebo-controlled trial funded by the British Heart Foundation.

The pathogenesis of angina and myocardial infarction pain involves the activation of the afferent sympathetic pathway. A frequent and important consequence of pain (especially when severe) is the `flight or fight' response through activation of sympathetic efferents. The clinical image of the patient with an acute myocardial infarction (cold, clammy, sweaty, anxious, tachycardic) is secondary to this adrenergic activation. Therefore, angina might be regarded as the sensory component of a positive feedback loop, which cannot under these circumstances be conceived as resulting in benefit, and which may be considered to be a maladaption.

The angina-relieving effects of sympathetic blockade might be due to interference with this maladaptive feedback loop, in a similar manner to the way in which adenosine interrupts a re-entrant tachycardia. If such a loop exists, it may partly explain chronic refractory angina and the fact that temporary interruption of this pathway has a prolonged effect on pain¹⁴. Beneficial amelioration of angina can be achieved with repeated blocks¹⁴. There does not appear to be any predictability in the length of time a patient remains pain-free after successive blocks.

http://www.angina.org/source/pro/symp_block.htm

Behavioral changes after sympathectomy

Six experiments are reported on the effects of 2,4,5-trihydroxyphenylethyl-amine (6-hydroxydopamine) on two-way escape and avoidance learning. Rats were tested on either escape or avoidance learning at 80 days of age after chemical sympathectomy at birth or 40 or 80 days of age. Neonatal and chronic sympathectomy (at 40 days), but not acute sympathectomy (at 80 days), resulted in depressed escape learning. Avoidance learning was affected by neonatal sympathectomy and partially by acute sympathectomy. The results have implications for the role of the autonomic nervous system in escape-avoidance learning.
J Comp Physiol Psychol 1976; 90:303-16.

Glycogen accumulation in Reissner's membrane following chemical sympathectomy

Acta Otolaryngol. 1978 Nov-Dec;86(5-6):314-30.
PMID: 213930 [PubMed - indexed for MEDLINE]

Role of the ANS in cerebral circulation

It is proposed that the autonomic innervation of brain vessels participates in the control not only of the cerebral circulation but also of associated intracranial pressure phenomena.
Blood Vessels 1974;11:2-31

Sympathectomy alters cranial nerves and cerebral blood flow

Moya-Moya Syndrome

Moya Moya syndrome is a vasculopathy of the cranial arteries, usually the carotids, leading to progressive intracranial occlusion with distal collateral vessels. This is a very frequent cause of pediatric stroke in India(10,11). Children usually present with an acute focal deficit such as hemiplegia, whereas in later years sub-arachnoid hemorrhage is a common presenta-tion. Due to bilateral carotid involvement sometimes alternating hemiplegia is seen. The outcome varies widely without treatment. Moya Moya disease is usually idiopathic, although same radiographic pattern is seen in some patients with sickle cell disease, neuro-fibromatosis, postcranial irradiation and in various other conditions(15). There is no proven treatment of Moya Moya disease. Medical management involves use of aspirin but needs further testing. Surgical treatment involves cervical sympathectomy, intracranial graft of omentum or temporalis muscle and bypass of superficial temporal artery to the middle cerebral artery(34).

http://indianpediatrics.net/feb2000/personal.htm

sympathectomy greatly reduces ventilation

In conscious animals, cervical sympathectomy greatly reduces ventilation in normoxia and slightly affects ventilatory responses to hypoxia and hypercapnia, also suggesting an important role for these nerves in the control of breathing.
Eur Respir J 1998; 12: 177–184

reduces the amount of adrenaline

Cervical sympathectomy
A form of surgery that is useful for some people with LQTS. It reduces the amount of adrenaline and its by-products produced and delivered to the heart by certain nerves (the left cervical ganglia). It involves operating on the left neck and removing or blocking these nerves

http://www.sads.org.uk/technical_terms.htm

sympathectomy totally ablates regional spinal cord blood flow

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

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

Transverse myelitis

Transverse myelitis is a neurological disorder caused by an inflammatory process of the grey and white matter of the spinal cord, and can cause axonal demyelination.
In some cases, the disease is presumed to be caused by viral infections or vaccinations and has also been associated with spinal cord injuries, immune reactions, schistosomiasis and insufficient blood flow through spinal cord vessels. Acute myelitis accounts for 4 to 5 percent of all cases of neuroborreliosis.^[1] Symptoms include weakness and numbness of the limbs as well as motor, sensory, and sphincter deficits. Severe backpain may occur in some patients at the onset of the disease.

http://en.wikipedia.org/wiki/Transverse_myelitis

Parallels with Lobotomy

Finally, one should beware the tendency to rely on an individual piece of anecdotal evidence (or even a handful of such examples) when assessing whether a treatment "works." Lobotomy was a mutilating and irreversible operation that possessed little or no scientific warrant, and was used in remarkably careless ways on patients who either had no say in the matter, or who were gulled by ruthless enthusiasts like Walter Freeman, who fed them grossly inaccurate information about what was being done to them. Many operations were done on people whose problems were relatively minor and transient, and these less disturbed individuals undoubtedly provided the majority of Freeman's successes.
by Andrew Scull

Answered by Barak Goodman:
The quantitative analysis of lobotomy was meager. The obstacles to a good study of lobotomy were numerous: the patients were often abandoned in mental hospitals and therefore hard to access; controlled studies were of course impossible; and no two patients got the same operation (Freeman's operation was truly "a stab in the dark"). The stigma attached to the operation made it a less than desirable area of research and study. Perhaps the most thorough analysis was done by Freeman himself, who kept in touch with hundreds of his patients and tried to assemble data to support lobotomy's efficacy. I think we have to regard that data as suspect.

Occasionally, after the fact, lawsuits are launched attempting to secure damages for the victims. This occurred in Canada, for instance, after the death of Ewen Cameron, former president of the American, Canadian, and World Psychiatric Associations, and a member of the Nuremberg medical tribunal which had investigated Nazi doctors. Cameron, practicing at McGill University, had experimented with "depatterning" and "psychic driving," extraordinary experiments where, inter alia, he wiped out patients' memories with repeated electroshocks designed to reduce those subjected to them to the status of helpless, incontinent "infants," whose psyches he then purported to rebuild. Cameron at his death was a highly respected figure in his profession. Only after it emerged that much of this work had been secretly supported by the CIA were lawsuits brought, some of which were successful in securing monetary damages for his victims and/or their families. Whether money could ever adequately compensate for what has been done, for suicides and ruined lives, is very doubtful, as I'm sure you would agree. But the legal acknowledgement of the depth of the wrong that has been wrought is, of course, worth something.

Andrew Scull

My father was aiming to disconnect the thalamus from the frontal cortex

The positive(sic!) consequences of cutting between thalamus and frontal cortex were loss of fear and anxiety. The negative consequences of cutting were loss of social inhibition (loss of guilt, shame, fear of disapproval) and loss of the ability to think ahead (no ambition, eating to excess, inability to read the minds of others).

" People who start taking Prozac, Miltown, or other tranquilizers no longer suffer anxiety and fear of the future, but they lose ambition, libido, and the capacity for deep feelings. That is the cost of treatment. Neither surgery nor drugs cure the mental illness. They only relieve the suffering, and the cost is high.

Most patients who are not suffering too much prefer to continue to suffer than to accept the loss. Other patients suffer so intensely that they kill themselves rather than continue living.

Walter Freeman III

http://www.pbs.org/wgbh/amex/lobotomist/forum/day2.html

Lobotomy lauded as a successful surgery. History repeating itself?

Now while there certainly were doctors and surgeons who worried about doing this surgery, and approached it very cautiously, nearly all of those who initially tried it reported good results, and published their findings in medical journals. Indeed, in 1943, a researcher tallied up the results of 618 lobotomies performed at 18 different sites in the United States and Canada, and concluded that 518 patients were "improved" or "recovered," and that only eight had been made worse by the surgery. The researcher concluded: "We have known for a long time that man may get on with one lung or one kidney, or part of the liver. Perhaps he may get on, and somewhat differently, with fewer frontal fiber tracts in the brain."

The surgery did what scientists said it did; the question is why did they judge this to be a good thing for those said to be mentally ill? It was that evaluation process that provided a context for Freeman and others to do the surgery.

So, could something like this happen today? Could psychiatry -- or some other branch of medicine -- adopt a form of care that we would later come to see as harmful? The history of medicine certainly warns us that doctors can be deluded about the merits of their therapies, and today that whole decision-making process is greatly influenced by pharmaceutical companies' money, which only increases the possibility of medicine going astray. The lobotomy story really should remind us of that possibility.

Robert Whitaker

http://www.pbs.org/wgbh/amex/lobotomist/forum/day1.html

Orthodeoxia

Orthodeoxia-an uncommon presentation following bilateral thoracic sympathectomy
P V van Heerden, P D Cameron, A Karanovic, M A Goodman. Anaesthesia and Intensive Care. Edgecliff:Oct 2003. Vol. 31, Iss. 5, p. 581-3

Abstract (Summary)

We present a case of orthodeoxia (postural hypoxaemia) which resulted from a combination of lung collapse/consolidation and blunted hypoxic pulmonary vasoconstriction due to partial interruption of the sympathetic nerve supply to the lung by bilateral thoracic sympathectomy.

Less common associations with orthodeoxia are atypical pneumonia3, trauma8, organophosphate poisoning10 and progressive autonomic failure12.

The surgical procedure, which interrupted both sympathetic trunks, probably resulted in "sympathectomy" of the lung with consequent vasoplegia of the pulmonary circulation and blunting of the HPV response.

The combination of areas of reduced ventilation in the lung, together with blunted HPV, resulted in profound oxygen desaturation in our patient when she sat up in bed.

As antibiotics and chest physiotherapy improved the collapse/consolidation of the lungs, the patient became less dependent on artificial means of maintaining pulmonary vascular tone, so that the noradrenaline and then the almitrine could be weaned without incident. Presumably there will be some return of sympathetic tone to the pulmonary circulation with time.

It was not the intention of the authors to describe all the physiological consequences of thoracotomy or thoracoscopy, with or without one-lung ventilation, in this short communication. Clearly these procedures on their own can have significant effects on lung physiology, quite apart from the unique confluence of factors producing orthodeoxia in the patient presented in this case report.

Copyright Australian Society of Anaesthetists Oct 2003

Strong parallels with Lobotomy - What has changed?

One of the most horrifying medical treatments of the 20th century was carried out not clandestinely, but with the approval of the medical establishment, the media and the public. Known as the transorbital or "ice pick" lobotomy, the crude and destructive brain-scrambling operation performed on thousands of psychiatric patients between the 1930s and 1960s was touted as a cure for mental illness.

Freeman's operation reflected the neurologist's peculiar combination of zealotry, talent, hubris and, as one of his trainees noted, craziness.

Undaunted by his failures, Freeman's pitch that lobotomy cured mental illness was seized on by the press -- the Washington Star called it among "the greatest innovations of this generation," and the New York Times pronounced it "history-making." Many doctors embraced it as a 10-minute operation that promised to empty mental hospitals and return patients to their families. Opponents, mostly psychiatrists who practiced Freudian talk therapy, didn't matter much: In those days public criticism of a doctor by his peers was regarded as unethical.

The story of how Freeman sold his procedure to credulous colleagues, assiduously courted the press and convinced desperate families that sticking an ice pick through a patient's upper eye sockets and twirling it like a swizzle stick through brain matter would cure psychosis, depression or troublesome behavior is the ultimate in cautionary medical tales.

The issue at the heart of this powerful and unsettling film is not, as one writer puts it, "how a man could go off the rails, but how science could go off the rails."

'Lobotomist' Serves as a Warning

Documentary Shows Damage Done When Medicine Goes Awry

By Sandra G. Boodman

Washington Post Staff Writer
Tuesday, January 15, 2008; Page HE01

Changes in cerebral capillary bed

Changes in the cerebral capillary bed following cervical sympathectomy,' Arch. Neurol. and Psychiat., 1929, 21, 1102.
Tracy J. Putnam
The Cerebral Circulation: Some New Points in its Anatomy, Physiology and Pathology
J Neurol Psychopathol, Jan 1937; s1-17: 193 - 212.

Permeability and Sympathetic Nervous System

In dogs, cats, and rabbits sympathectomy reduces the penetration of dye from the blood through the synovial membrane of the knee joint.
J Neurol Psychiatry, Apr 1941; 4: 147 - 162.

Observations during lobotomy applied to patients for treatment of palmar sweating

J. Neurol. Neurosurg. Psychiatry, Aug 1954; 17: 196 - 203.
......similar serial observa- tions on patients undergoing other intracranial operations. One patient undergoing a two-stage lumbar sympathectomy for hypertension was studied in detail. Following both operations she failed to show any marked rise in skin resistance......

Alick Elithorn, Malcolm F. Piercy, and Margaret A. Crosskey
A PERSISTING CHANGE IN PALMAR SWEATING FOLLOWING PREFRONTAL LEUCOTOMY

Increased sensitivity to insulin following sympathectomy

the increased insulin tolerance seen in patients during the immediate post-operative period after lumbo-dorsal sympathectomy is followed by a secondary stage of increased sensitivity to the drug.

E. Marley ALTERED RESPONSE TO SMALL DOSES OF INSULIN ASSOCIATED WITH ELECTROPLEXY AND HYPOGLYCAEMIC THERAPIES J. Neurol. Neurosurg. Psychiatry, Feb 1956; 19: 57 - 61.

Sprouting following sympathectomy- recurrence of symptoms

They showed that recovery of function after partial sympathectomy in cats depends, not on hypersensitivity, but on collateral sprouting of the surviving sympathetic fibres.
G. F. M. Russell

J. Neurol. Neurosurg. Psychiatry, Nov 1958; 21: 290 - 296.

Auto-regulation after sympathectomy

sympathectomy changes the position of upper and lower limits of auto- regulation but not the basic ability to autoregulate per se (Fitch)

J. D. Pickard, D. P. J. Boisvert, D. I. Graham, and W. Fitch Late effects of subarachnoid haemorrhage on the response of the primate cerebral circulation to drug-induced changes in arterial blood pressure J. Neurol. Neurosurg. Psychiatry, Oct 1979; 42: 899 - 903.

Oedema associated with the interruption of preganglionic sympathetic tract

J. Neurol. Neurosurg. Psychiatry, Mar 1992; 55: 232 - 233.
......with Raynaud's disease or causalgia after acute interruption of post-ganglionic sympathetic fibres such as a wide-spread sympathectomy. Complete sympathetic block dilates vein and capillary and increases peripheral pooling, which raises hydrostatic pressure.....

Dilation of major cerebral arteries and cranial noncerebral vasodilation following sympathectomy

Headache Following Cervical Sympathectomy
Headache. 43(4):410-414, April 2003.
Spierings, Egilius L. H. MD, PhD

Abstract:
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-[mu]m 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.

pituitary secretions of ACTH and TSH after sympathectomy

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

Journal	Journal of Anesthesia
Publisher	Springer Japan
ISSN	0913-8668 (Print) 1438-8359 (Online)
Issue	Volume 10, Number 3 / September, 1996

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 longterm and repeated stellate ganglion block would affect the pituitary secretions of ACTH and TSH.

remarkable changes in the nerves that remain

Chemical denervation and selected ganglionectomy studies have shown that loss of sympathetic or sensory innervation induces remarkable changes in the nerves that remain.

Sympathectomy. Unilateral removal of the SCG results in the reinnervation of the denervated cerebral vessel by sprouting nerves from the contralateral ganglion (Kahrstrom et al. 1986). Following chronic guanethidine sympathectomy there is a complete depletion of sympathetic cotransmitters NA and NPY from the dura mater but an increase in the expression of NPY in non-sympathetic axons (lacking small dense-cored vesicles) supplying cerebral vessels and the iris (Mione at al. 1990). The source of increased cerebrovasular NPY is thought to be preexisting parasympathetic cranial ganglia which normally express both NPY and VIP (Gibbins and Morris 1998).
Indeed, sympathectomy-induced DBH-immunoreactivity in the sphenopalatine (parasympathetic) ganglion occurs at the same time as a loss of VIP-immunoreactivity (Fan and Smith 1993). In the cerebral and uterine artery, loss of sympathetic nerves also leads to increased DBH-immunoreactivity in non-sympathetic nerves that lack TH and NA (Morris et al. 1991).

The loss of sympathtetic neurones and nerve fibres is also accompanied by striking increases in sensory innervation. This has been attributed to increased availability to NGF (as there are no sympathetic nerves with which to compete for uptake) which promotes the growth of sensory nerves (Kessler et al. 1983)

In the lung, sympathectomy induced a marked increase in CGRP-immunoreactive nerve density around the airways, and blood vessels.

The Autonomic Nervous System. Part I. Normal Functions by O. Appenzeller (Hardcover - Dec 1, 1999)

Category: Neurology & Clinical Neurophysiology

Publication Date: 1999-12-16 Publisher: Elsevier - Health Sciences Div

Ultrastructural changes in the pineal gland

H. J. Romijn¹

(1)	Present address: Department of Electron Microscopy, Netherlands Central Institute for Brain Research, Amsterdam, The Netherlands

Received: 3 March 1975

Summary The ultrastructure of the rabbit pineal gland was investigated after sympathectomy (extirpation or decentralization of the superior cervical ganglia), parasympathectomy, continuous illumination and continuous darkness. The similarity of the ultrastructural changes in the light pinealocytes occurring after sympathectomy and after continuous illumination was striking. It is supposed that these changes have a common cause,viz. the lack of free noradrenaline, the pinealotropic neurotransmitter.

The smooth endoplasmic reticulum present in the terminals of the offshoots of the light pinealocytes is possibly involved in pineal indoleamine synthesis.

Journal of Neural Transmission
SpringerLink DateTuesday, March 29, 2005

Denervated heart does not respons as effectively as it should

Somatic effectors are dependent on their innervation to maintain structural and functional integrity. When denervated, they eventually atrophy. This is the fate of denervated voluntary muscles as noted in a lower motor neuron paralysis.
Denervated involuntary muscles, cardiac muscle, and glands continue to function. For example, the transplanted heart may function reasonably well. However, when deprived of autonomic nervous system influences, these effectors are abnormal in that they do not respond as effectively as they should to satisfy the changind demands of the organism.

The Human Nervous System

Structure and Function

Noback, C.R.; Ruggiero, D.A.; Demarest, R.J.; Strominger, N.L. (Eds.)

2007, 416 p. 178 illus., Softcover

ISBN: 978-1-58829-040-3

Mia: Please note, that with heart transplants both, sympathetic and parasympathetic influences are disrupted , so while there is denervation, there is no obvious imbalance between these. In sympathectomy, only the sympathetic nerves are cut, and the parasympathetic influence is predominant, whic will result in slowing of the heart.

Reduced Heart Rate Variability and Increased C-reacitve protein - predicts death and myocardial infarction

Increased C-reactive protein (CRP) and reduced heart rate variability (HRV) both indicate poor prognosis. An inverse association between HRV and CRP has been reported, suggesting an interaction between inflammatory and autonomic systems. However, the prognostic impact of this interaction has not been studied. We thus investigated the prognostic impact of CRP, HRV and their combinations.

Conclusions: The combination of CRP and HRV or heart rate (HR) predicts death and myocardial infarction with synergism, indicating interaction between inflammatory and autonomic systems with a prognostic significance.

Journal of Internal Medicine. 260(4):377-387, October 2006.
SAJADIEH, A. 1; NIELSEN, O. W. 1; RASMUSSEN, V. 2; HEIN, H. O. 3; HANSEN, J. F. 1

Sympathectomy is known to alter immunity

Chemical Sympathectomy, as well as manipulation of the autonomic nervous system, is known to alter lymphocyte dependent immunity.
The stress induced by autonomic dysregulation after SCI, and especially by episodes of autonomic dysreflexia, may well be an important cause of immune suppression in this group.

Neurologic events are known to affect immunologic function indirectly, through the pituitary adrenal axis, and through endocrine and neuropeptide regulation. Stress induces the release of adrenocorticotrophic hormone from the pituitary. This induces the release of immuno-suppressive glucocorticoids. In addition, the adrenal medulla releases catecholamines that alter leukocyte migration and lymphocyte responsiveness. Other hormones, including insulin, thyroxin, growth hormones, samostatin, and the sex hormones modulate T- and B-cell functions in complex ways. A number of abnormalities in endocrine function accompany SCI. Abnormal endocrine physiology involving sex hormones, aldosterone, catecholamines, and methylhydroxymandelic acid have been described.
Spinal Cord Medicine: Principles and Practice Spinal Cord Medicine: Principles and practiceby Vernon W. Lin, Diana D. Cardenas, Nancy C., MD Cutter,
Published by Demos Medical Publishing, LLC. 2002

efficacy ranging from 13% to 80% ?

Lumbar sympathetic blockade is indicated for diagnosis, prognosis, and therapy of painful and other conditions presumably associated with sympathetic nervous system dysfunction. Anatomy of the lumbar sympathetic chain and the rationale for the block are essential to know before performing the block. Different techniques have been described for the lumbar sympathetic blockade, with efficacy ranging from 13% to 80%, which varies according to the initial patient pathology. Genito-femoral neuralgia occurs in about 5% of patients after neurolytic block. Other potential complications are infection, hematomas, and somatic nerve damage. Copyright © 2001 by W.B. Saunders Company

Techniques in Regional Anesthesia and Pain Management, Volume 5, Issue 3, Pages 99-101
N.Mekhail, O.Malak

cervical sympathectomy resulted in a rapid degeneration in some of the cells in the sinuatrial and atrioventricular nodes

J Anat. 1984 October; 139(Pt 3): 449–461.

PMCID: PMC1165060

Copyright notice

An ultrastructural study of the effects of right cervical sympathectomy on the sinuatrial and atrioventricular nodes in the heart of the monkey (Macaca fascicularis).

S S Tay, W C Wong, and E A Ling

This study describes the ultrastructural changes in the sinuatrial and atrioventricular nodes of the heart of the monkey (Macaca fascicularis) after right cervical sympathectomy. Obvious changes in the nodal cells were seen one day after operation. Numerous glycogen particles grouped together to form electron-dense patches containing vacuoles in the cytoplasm. At three days after operation, intracellular organelles exhibited fragmentation and dissolution. By five and seven days after operation, the affected cells were vacuolated and some were swollen and appeared to have degenerated. Simultaneously, there was massive infiltration of macrophages were present nodal tissues. Axon profiles and terminals showing various degrees of degeneration were present in the vicinity of the nodal cells throughout the period of study. It is concluded that right cervical sympathectomy resulted in a rapid degeneration in some of the cells in the sinuatrial and atrioventricular nodes.

Cervical sympathectomy causes photoreceptor-specific cell death in the rat retina

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

Autonomic Neuroscience, Volume 120, Issue 1, Pages 46-51
J. Steinle, N. Lindsay, B. Lashbrook

Interview with Dr Telaranta

Do you find ETS patients less satisfied with their decision over time due
to CS or other factors & have there been adequate studies on the long term
effects of ETS on cardiac, skin function, etc..?

-My opinion is, that during time the past slowly gets into oblivion, the patients don’t remember any more the original situation. Also, I believe that the first hype of enthusiasm goes away with the central nervous system getting used to the new situation. It may even be that the initial effect on the thalamic structures is some kind of euphoric hybris due to the sudden increase of the serotonine-like overflow.

http://www.angelfire.com/journal2/sadhelp/Interview1.htm

Science 3 September 1971: Vol. 173. no. 4000, pp. 931 - 934 DOI: 10.1126/science.173.4000.931

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Serum Dopamine--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-- 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--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--hydroxylase activity arises from sympathetic nerve terminals.

abnormal heart rate recovery predicts death

5234 adults without evidence of cardiovascular disease who were enrolled in the Lipid Research Clinics Prevalence Study.

Measurements: Heart rate recovery was defined as the change from peak heart rate to that measured 2 minutes later (heart rate recovery was defined as 42 beats/min).

Results: During 12 years of follow-up, 312 participants died. Abnormal heart rate recovery predicted death (relative risk, 2.58 [CI, 2.06 to 3.20]). After adjustment for standard risk factors, fitness, and resting and exercise heart rates, abnormal heart rate recovery remained predictive (adjusted relative risk, 1.55 [CI, 1.22 to 1.98]) (P <>

Conclusion: Even after submaximal exercise, abnormal heart rate recovery predicts death.

4 April 2000 | Volume 132 Issue 7 | Pages 552-555

The thermoregulatory control of human skin blood flow is vital to the maintenance of normal body temperatures

The thermoregulatory control of human skin blood flow is vital to the maintenance of normal body temperatures during challenges to thermal homeostasis. Sympathetic neural control of skin blood flow includes the noradrenergic vasoconstrictor system and a sympathetic active vasodilator system, the latter of which is responsible for 80% to 90% of the substantial cutaneous vasodilation that occurs with whole body heat stress.
Raynaud phenomenon and erythromelalgia represent cutaneous microvascular disorders
whose pathophysiology appears to relate to disorders of local and/or reflex
thermoregulatory control of the skin circulation.
© 2003 Mayo Foundation for Medical Education and Research

Cerebral Blood Flow after Sympathectomy

After sympathectomy, CBF (Cerebral Blood Flow) increases (26.5% +-3.6%) and CVR (Cerebral Vascular Resistance) decreases (-21.8% +-2.1%) during REM were less (p <0.05).

Hematology Week. Atlanta: Dec 29, 2008. pg. 430

The intracerebral vessels constrict in response to cervical sympathetic stimulation and dilate when these fibres are interrupted

• BJA: British Journal of Anaesthesia
• Volume 95, Number 5
• Pp. 669-673, 2005

Changes in cerebral morphology consequent to peripheral autonomic denervation

Our findings suggest that peripheral autonomic denervation is associated with grey matter loss in cortical regions encompassing areas that we have previously shown are functionally involved in generation and representation of bodily states of autonomic arousal. The nature of these changes cannot be determined from morphometric analysis alone, but we suggest that they reflect experience-dependent change consequent upon loss of afferent input to brain regions involved in representation of autonomic states.
Critchley, H.D. and Good, C.D. and Ashburner, J. and Frackowiak, R.S. and Mathias, C.J. and Dolan, R.J. (2003) Changes in cerebral morphology consequent to peripheral autonomic denervation. NeuroImage, 18 (4). pp.908 - 916. ISSN 10538119

blockade of the sympathetic nervous system substantially degrades ligament

THE PERIPHERAL NERVOUS SYSTEM (PNS) has three primary functions: 1) relaying sensorimotor information to and from the central nervous system; 2) controlling local blood flow; and 3) influencing inflammatory, proliferative, and reparative processes in injured tissue. In the PNS, neurogenic factors, such as neuropeptides and neurotransmitters, are chemical agents that mediate these functions (35). These factors can influence PNS-related actions by modulating immune cell responses, cytokine response, and local blood flow (5, 35). Although neurogenic factors are released from stimulated nerve endings, their actions are not restricted to the point of stimulation (10). For example, the autonomic neuropeptides vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY) can have angiogenic, vasoregulatory, and cell proliferative actions hours to days after release from nerve endings (35, 44). In addition, Ackermann et al. (1) recently reported a role for peripheral neuropeptides in healing of tendon tissue. The above observations make it likely that these neurogenic factors play an important role in tissue homeostasis.

Clinically, chemical inhibition of the PNS is used to manage joint pain. Chemical blockade of the sympathetic nervous system is often accomplished through the administration of guanethidine. Guanethidine blocks the release and subsequent reuptake of norepinephrine (NE) (a major sympathetic neurotransmitter) in patients with osteoarthritis, rheumatoid arthritis, and reflex sympathetic dystrophy (12, 13, 24, 38, 40). This treatment, while effective in relieving pain, may have undesirable effects on connective tissues, because it alters the normal concentration of neurogenic factors.

Growing anatomic and physiological evidence suggest that the PNS is important to ligament and joint homeostasis.
Denervation of peripheral nerves leads to decreased healing of the MCL and promotes the onset of osteoarthritis (22, 34). Partial injury to the MCL can lead to increases in vascular volume, a factor that is largely controlled by ligament innervation (7). During periods of chronic overuse or disuse, homeostatic changes can be detrimental to the structural integrity of ligaments. Although the above evidence suggests that peripheral nerves play an essential role in ligament homeostasis, few studies exist that directly investigate this role.

J Appl Physiol 96: 711-718, 2004

Muscle Nerve. 1996 May;19(5):581-6.Links

Abolition of sympathetic skin responses following endoscopic thoracic sympathectomy.

Lefaucheur JP, Fitoussi M, Becquemin JP.

Department of Physiology, Henri Mondor Hospital, Creteil, France.

Sympathectomy eliminates the psychogalvanic reflex

Anaesth Intensive Care. 1979 Nov;7(4):353-7.Links

Assessment of sympathectomy--the skin potential response.

Cronin KD, Kirsner RL.

Objective assessment of the results of surgical sympathectomy and sympathetic block (both temporary and permanent) are not widely practised. This article comments briefly on the available methods, and describes the use of the abolition of the skin potential response (formerly known as the psychogalvanic reflex) to assess the abolition of sympathetic function. This method of assessment has proved useful in clinical practice.

PMID: 525760 [PubMed - indexed for MEDLINE]

Sympathectomy listed as Neurologic disorder

Other neurologic disorders

• Idiopathic orthostatic hypotension

• Multiple sclerosis

• Parkinsonism

• Posterior fossa tumor
• Shy-Drager syndrome
• Spinal cord injury with paraplegia
• Surgical sympathectomy
• Syringomyelia
• Syringobulbia
• Tabes dorsales (syphilis)
• Wernicke's encephalopathy

Dizziness in Orthopaedic Physical Therapy Practice: Classification
and Pathophysiology
Peter Huijbregts, PT, MSc, MHSc, DPT, OCS, MTC, FAAOMPT, FCAMT
Paul Vidal, PT, MHSc, DPT, OCS, MTC
The Journal of Manual & Manipulative Therapy
Vol. 12 No. 4 (2004), 199 - 214

Fifty-one percent of the participants claimed that their quality of life decreased

Quote: "Fifty-one percent of the participants claimed that their quality of life decreased moderately or severely as a result of CS, but only one-third of them (7.9% children vs. 22.4% others, P = 0.001) would not have undergone the operation in retrospect." *


Comment from CSMESS: Half of patients felt their quality of life was lowered by the surgery! Half! One out of three patients regretted the surgery!! Worse yet, they try to make that out to be a surprisingly low percentage by stating the statistic as "only one-third".

"Only"?? Are you kidding me? Since when is having one third of your patients end up worse off after a permanent, destructive nerve surgery considered a surprisingly good result?

How can a surgery for a benign condition -- a surgery performed for the sole purpose of increasing quality of life -- be considered justified when over half of the patients end up with lower quality of life?

And then on top of it all, they recommend ETS for children -- creatures whose minds and bodies have not fully developed -- based on the answers these children give to questions posed by adult authority figures? Doctors, no less.

I guess I should be happy they published these numbers. I believe that they are representative of reality in terms of the percentage of people who end up with lower quality of life from ETS. It's a far cry from the "5% get bad side effects" crap that most prospective patients are told in order to get them to have the surgery. Still, it is unfathomable to me that an article citing a lowering of quality of life for half the patients and a third regretting the surgery can be spun positively. (http://etsandreversals.yuku.com/directory)

*Pediatr Surg Int. 2007 Nov 13 [Epub ahead of print] Links
Do children tolerate thoracoscopic sympathectomy better than adults?Steiner Z, Cohen Z, Kleiner O, Matar I, Mogilner J.
Department of Pediatric Surgery, Hillel Yaffe Medical Center, P. O. Box 169, Hadera, 38100, Israel, steiner@hy.health.gov.il.

Effects of stellate ganglion block on cerebral haemodynamics as assessed by transcranial Doppler ultrasonography

M. M. Gupta¹, P. K. Bithal^1,*, H. H. Dash¹, A. Chaturvedi¹ and R. P. Mahajan²

¹ Department of Neuroanaesthesiology, All India Institute of Medical Sciences (A.I.I.M.S.), New Delhi, India. ² University Department of Anaesthesia and Intensive Care, Queen's Medical Centre, Nottingham, UK

^* Corresponding author. E-mail: pkbithal@hotmail.com

Accepted for publication July 11, 2005.

Relationship of cerebral bloodflow and metabolism to neurological symptoms

Reduced cerebral vascular tone

This is manifested by the following rheoencephalographic findings: steep rise of the anacrotic section of the curve, high amplitude, sharp peak, overt incisure with low localization (in the lower third of the curve or very close to the baseline), prominent post-incisure wave. These rheoencephalographic changes may be observed after inhalation of 5 to 7% CO2 or cervical sympathectomy (Jenkner, 1962), resulting in dilation of the cerebral vessels. Analogous deviations may be induced by vasodilative drugs.
UnderThese signs of reduced cerebral vascular tone may be observed alsi in a variety of pathologic conditions associated with cerebral hyperemia, such as contusion of the brain (Jenkner, 1962), following electroshock (Lifshitz. 1963) and others.

Cerebral blood flow: Relationship of cerebral bloodflow and metabolism to neurological symptoms

By John Stirling Meyer, J. P. Schadé

Contributor John Stirling Meyer

Edition: illustrated

Published by Elsevier, 1972

It has to push us to publish our works, to inform the medical corps, relentlessly and without restraint

7th International Symposium on Sympathetic Surgery 20th-22nd March 2007 Muro Alto (PE), Brazil
Clinical Autonomic Research. New York:Apr 2007. Vol. 17, Iss. 2, p. 126-44 (19 pp.)

Pity colleagues, pity for these poor patients!
Gross Michel* Institution: Private Cabinet*; Grone - Switzerland
A desperate 22-year-old man comes to consult and tells me about his idea of committing suicide. Since the age of 9, he suffers from a severe cephalic ephidrosis, with blushing face, intensifying with years, to such an extent that it became unbearable over the last year:
''It is a real Calvary''. His family GP assures him that his troubles are going to disappear as he will get older and ''ut aliquid fieri'' he prescribes sage drops and anxiolytic. As these prescriptions do not improve his situation, his GP sends him to an endocrinologist who performs many exams to exclude an hyperthyreosis, a carcinoıd tumor or a pheochromocytoma. Among the considerable number of blood exams, one appears to be out of normal ranges. The patient goes therefore to an haematologist, who does not find anything
abnormal. A neurologist, then consulted, does not suspect anything in particular, but asks however for some radiology exams, including a brain MRI, as well as a Pet-scan, to exclude an adrenal gland tumor. All these exams being normal, the patient is sent to a behaviour therapist to begin a psychotherapy. Exhausted by the
weight of these useless consultations here and there, our young patient, always seeking for the solution to his problems, decides to turn to an acupuncturist, an osteopath, a healer and a radiesthesist, in vain. He then decides to consult a dermatologist and shares with him a summary of information gathered on Internet, including information from my site. Finally, the patient was referred to me.
Aware of that, the GP warns his colleagues by sending a letter indicating that any therapeutic measure other than psychotherapy is not recommended, considering the surgical alternative as irresponsible. I did by the way, not get any call from any of my colleagues. The patient had successful surgery 2 weeks later
(sympathicotomy T2-3-4-5) This recent history redraws, once again, iatrogenic caricatural wandering to which our patients are too often subjected. It has to push us to publish our works, to inform the medical corps, relentlessly and without restraint. The information could also, throughout the public, reach our colleagues. It is at the end an interesting paradox to note that physicians, whose primary role is to relieve patients, are also the primary actors of a film where patients are maintained in a ''medical jail''.

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

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

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

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

We found statistically significant differences (P < .05) in both time and frequency domains. Parameters that evaluate global cardiac autonomic activity (total power, SD of normal R-R intervals, SD of average normal R-R intervals) and vagal activity (rhythm corresponding to percentage of normal R-R intervals with cycle greater than 50 ms relative to previous interval, square root of mean squared differences of successive normal R-R intervals, high-frequency power, high-frequency power in normalized units) were statistically significantly increased after sympathectomy. Low-frequency power in normalized units, reflecting sympathetic activity, was statistically significantly decreased after sympathectomy. Low-/high-frequency power ratio also showed a significant decrease, indicating relative decrease in sympathetic activity and increase in vagal activity.

These results provide, for the first time to our knowledge, clear evidence of increased vagal and global cardiac autonomic activity and decreased sympathetic activity after endoscopic thoracic sympathectomy.

PMID: 19258086 [PubMed - indexed for MEDLINE]

Changes in cerebral morphology consequent to peripheral autonomic denervation

Our findings suggest that peripheral autonomic denervation ( ETS= peripheral autonomic denervation) is associated with grey matter loss in cortical regions encompassing areas that we have previously shown are functionally involved in generation and representation of bodily states of autonomic arousal. http://www.ncbi.nlm.nih.gov/pubmed/12725766 Neuroimage. 2003 Apr;18(4):908-16. Links Critchley HD, Good CD, Ashburner J, Frackowiak RS, Mathias CJ, Dolan RJ. Wellcome Department of Imaging Neuroscience, Institute of Neurology, UCL, 12 Queen Square, London WC1N 3BG, UK. j.critchley@fil.ion.ucl.ac.uk

Emotion - Autonomic activation - Feedback

Background: Following emotional stimuli, changes in heart rate,
blood pressure and sudomotor activity, which are associated with
changes in regional cerebral activity, feedback to influence the
expression of emotional feelings. In spinal cord injury (SCI), the
efferent generation of sympathetic responses and afferent sensory
feedback of visceral state is impaired, and the integration of bodily
arousal and emotion is altered.


During conditioning-related brain
activity SCI patients, compared to controls, showed attenuation of
subgenual cingulate, ventromedial prefrontal and posterior cingu-
late cortex activity and enhancement of dorsal anterior cingulate,
periaqueductal grey matter and superior temporal gyrus activity.
Conclusion. Our findings suggest impairment in emotion-related
generation of autonomic bodily responses and abnormalities in
brain regions associated with emotional control in patients with
SCI. These early findings warrant further development to support
prevention of emotional dysfunction in SCI.

Clin Auton Res (2007) 17:264–327

Bradycardia likely, compensatory sweating obligatory

Patient?s informed consent should include and define side effects like gustatory sweating, olfactory sweating and bradycardia as likely, and compensatory sweating as obligatory.

Clinical Autonomic Research; Dec2003 Supplement 1, Vol. 13, p0, 1p

Sympathectomy on cerebral and peripheral muscular arteries

Differing influence of sympathectomy on smooth muscle cells and fibroblasts in cerebral and peripheral muscular arteries.

Source:

Autonomic Neuroscience: Basic & Clinical; Jan2006, Vol. 124 Issue 1/2, p38-48, 11p

In contrast to intact FAs, the external layers of sympathectomized FAs revealed migration of fibroblasts from the adventitia and death of SMCs. These results strongly suggest that sympathetic nerves intervene in the cytoskeletal protein remodelling through phenotypic modulation of both SMCs and MFBs during post-natal development, and in pathologies involving similar phenomena, such as atherosclerosis. [Copyright 2006 Elsevier] ( femoral (FA) and basilar (BA) arteries.)

unable to establish the etiology of 'Compensatory Sweating'

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.
Surgical Endoscopy; Nov2007, Vol. 21 Issue 11, p2030-2033, 4p, 2 charts

Impaired chronotropic response to exercise stress testing as a predictor of mortality

Chronotropic incompetence, an attenuated heart rate response to exercise, is a predictor of all-cause mortality in healthy populations. This association may be independent of exercise-induced myocardial perfusion defects.
Michael S Lauer, Gary S Francis, Peter M Okin, Fredric J Pashkow, et al. JAMA. Chicago:Feb 10, 1999. Vol. 281, Iss. 6, p. 524-9 (6 pp.)

cardiopulmonary function impairment after ETS

This article focuses on a study related to evaluating the cardiopulmonary function impairment after sympathectomy in patients with essential hyperhidrosis. The observed modifications in cardiopulmonary function after bilateral dorsal sympathectomy suggest that there is a slight effect of the intervention on the small airway, as evidenced by the presence of bronchial hyperresponsiveness in half of the studied patients and on a mild reduction in maximal hear rate.

CHEST; Oct2005, Vol. 128 Issue 4, p2702-2705, 4p

disturbances in the sympathetic regulation of the peripheral blood flow

Finger skin blood flow was measured in 80 healthy subjects, using laser Doppler imaging during basal vasodilatation at a local temperature of 40°C. The response to cooling of the contralateral hand at 15°C was studied. A vasoconstriction index was calculated in all subjects and a nomogram was constructed, taking age into consideration. Compared with these normal subjects, four patients operated on with transthoracic endoscopic sympathectomy due to hand hyperhidrosis showed clearly attenuated responses. The results indicate that the test can be used to assess disturbances in the sympathetic regulation of the peripheral blood flow.
Clinical Physiology; Mar1998, Vol. 18 Issue 2, p103-107, 5p

Reduced HRV and baroreflex sensitivity as universally applicable cardiovascular “risk factors”

Murray Esler
Elisabeth Lambert

Reduced HRV and baroreflex sensitivity as universally applicable cardiovascular “risk factors”: waiting for the bubble to burst

Clin Auton Res (2003) 13:170–172

cardiovascular response to different levels of sympathetic blockade varies widely

Individual cardiovascular response to different levels of sympathetic blockade varies widely, depending on the degree of sympathetic tone before the block.

It was suggested that the sympathetic control of heart rate modified the dominating parasympathetic tone, rather than functioning as an active cardiac accelerator. In this study there was no compensation for changes in preload; therefore cardiopulmonary baroreceptors affected by changes in central volume secondary to peripheral vasodilatation or vasoconstriction might have altered arterial baroreceptor heart rate reflex as well. To minimize that influence, Goertz et al gave plasma volume expanders to equalize left ventricular preload conditions as assessed by transesophageal echocardiography". High TEA added to general anaesthesia significantly decreased the cardiac acceleration in response to decreasing blood pressure, suggesting that baroreflex-mediated heart rate response to a decrease in arterial blood pressure depends on the integrity of the sympathetic nervous system. However general anaesthesia, in addition to high levels of epidural anaesthesia, may have modified the balance between sympathetic and parasympathetic tone as well.

B T Veering, M J Cousins. Anaesthesia and Intensive Care. Edgecliff:Dec 2000. Vol. 28, Iss. 6, p. 620-35 (16 pp.)
Copyright Australian Society of Anaesthetists Dec 2000

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

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

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

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

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

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

Fear conditioning dependent on autonomic awareness

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

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

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

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

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

Changes in cerebral morphology consequent to peripheral autonomic denervation

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

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

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

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