ARE WE PAYING A HIGH PRICE FOR SYMPATHECTOMY? 2
Nevertheless, immediate (perioperative and postoperative) complications (primarily for the open but also
the endoscopic approach) include: fever, hematoma, transient Horner’s syndrome, bleeding, pneumotho-
rax, infection, wound pain, lymphatic leak, chylothorax, arterial injury, brachial plexus injury, etc.17. Late
complications include: permanent Horner’s syndrome, neuralgic pains, unsightly wound appearance, com-
pensatory hyperhidrosis, gustatory sweating and phantom sweating, and in the case of bilateral lumbar
sympathectomy erectile dysfunction in the male and lack of clitoral tumescence in the female18.
I S I S
SCIENTIFIC NEWSLETTER
Volume 4 Number 2
Summer Issue 2001
the endoscopic approach) include: fever, hematoma, transient Horner’s syndrome, bleeding, pneumotho-
rax, infection, wound pain, lymphatic leak, chylothorax, arterial injury, brachial plexus injury, etc.17. Late
complications include: permanent Horner’s syndrome, neuralgic pains, unsightly wound appearance, com-
pensatory hyperhidrosis, gustatory sweating and phantom sweating, and in the case of bilateral lumbar
sympathectomy erectile dysfunction in the male and lack of clitoral tumescence in the female18.
I S I S
SCIENTIFIC NEWSLETTER
Volume 4 Number 2
Summer Issue 2001
ARE WE PAYING A HIGH PRICE FOR SYMPATHECTOMY?
ARE WE PAYING A HIGH PRICE FOR
SURGICAL SYMPATHECTOMY?
Andrea Furlana,c MD, Angela Mailisa,b MD, MSc, FRCPC (PhysMed) and
Marios Papagapioua MSc
Conclusions: Surgical sympathectomy irrespective of approach is accompanied by several potentially
disabling complications.
Surgical sympathectomy is performed in thousands of patients around the world primarily for the treatment
of bothersome palmar hyperhidrosis.1-7 Much less frequent indications are: neuropathic pain syndromes
(like Reflex Sympathetic Dystrophy and Causalgia)2;8;9 , ischaemic conditions including peripheral vascular
disease and Raynaud’s phenomena2 and rarely facial blushing10, Prinzmetal’s angina11, as well as migraine,
dysmenorrhea and pancreatitis2;12
I S I S
SCIENTIFIC NEWSLETTER
Volume 4 Number 2
Summer Issue 2001
SURGICAL SYMPATHECTOMY?
Andrea Furlana,c MD, Angela Mailisa,b MD, MSc, FRCPC (PhysMed) and
Marios Papagapioua MSc
Conclusions: Surgical sympathectomy irrespective of approach is accompanied by several potentially
disabling complications.
Surgical sympathectomy is performed in thousands of patients around the world primarily for the treatment
of bothersome palmar hyperhidrosis.1-7 Much less frequent indications are: neuropathic pain syndromes
(like Reflex Sympathetic Dystrophy and Causalgia)2;8;9 , ischaemic conditions including peripheral vascular
disease and Raynaud’s phenomena2 and rarely facial blushing10, Prinzmetal’s angina11, as well as migraine,
dysmenorrhea and pancreatitis2;12
I S I S
SCIENTIFIC NEWSLETTER
Volume 4 Number 2
Summer Issue 2001
Nerves regenerate after surgery and cause the abnormal sweating - among other symptoms
Regeneration after cervicothoracic sympathectomy producing gustatory responses.
Treatment for Gustatory Sweating? Avoid food.
9 months later, within one minute of eating a sour apple, the patient developed severe sweating over the left half of the face and the left chest. The reaction was confirmed by infra-red thermography which proved that the skin temperature in the sweating region had fallen to 3 degrees C. The likely cause of localized gustatory sweating is intra-operative damage of the stellate ganglion or its preganglionic nerve connections. Treatment is limited to avoidance of the precipitating gustatory stimulus.
Dtsch Med Wochenschr. 1992 Oct 9;117(41):1556-60.
Plendl H, Paulus W, Witt TN.
Dtsch Med Wochenschr. 1992 Oct 9;117(41):1556-60.
Plendl H, Paulus W, Witt TN.
Neurologische Klinik, Klinikum Grosshadern, Universität München.
injury=sympathectomy
Blackwell Synergy - Br J Dermatol, Volume 142 Issue 1 Page 194-195 ...
Pathological gustatory sweating and flushing can develop after injury to preganglionic cervicothoracic sympathetic fibres, an unavoidable consequence of ...www.blackwell-synergy.com/
Symptoms can appear years after the surgery!
Handbook of Clinical Neurology
by P. J. Vinken, G. W. Bruyn - 1968 - NeurologyWeeks, months, or years after cervicothoracic preganglionic sympathectomy,
gustatory sweating and flushing may develop on the denervated side along with impaired thermoregulatory sweating.
Limited preview - books.google.com/books?isbn=0444828133... GS - Autonomic Disorder
Gustatory sweating is an autonomic disorder that fre-. quently occurs after parotid. gland. surgery.
Anhidrosis = Hyperthermia
| | Semin Neurol 2003; 23: 399-406 DOI: 10.1055/s-2004-817724 |
 | |
| Disorders of Sweating | |
| William P. Cheshire1, Roy Freeman2 | |
| 1Department of Neurology, Mayo Clinic, Jacksonville, Florida 2Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts | |
ABSTRACT
The clinical spectrum of sweating disorders includes sudomotor excess and deficiency. Hyperhidrosis is characterized by sweating beyond that required to maintain a constant internal body temperature. Hypohidrosis and anhidrosis are distinguished by a reduced or absent ability to generate sweat for the purpose of evaporative heat dissipation. Whereas hyperhidrosis is usually benign, anhidrosis may predispose to hyperthermia.Gustatory Sweating - damage to the autonomic nervous system
Spectrum of gustatory sweating, with especial
reference to its presence in diabetics with
autonomic neuropathy
Michael M. Bronshvag,4
Certain otherwise normal individ-
uals may have an idiosyncratic response to
one or several foods, and the mechanism of
this sensitivity is not known . It may also be
seen after parotid surgery (auriculotemporal
syndrome) (4), cervical sympathectomy
(usually bilateral) (1) and in diabetic neu-
ropathy (2). The common denominator in
these conditions seems to be damage to the
autonomic nervous system.
Less easy to understand is the syndrome
after cervical sympathectomy (usually bilat-
eral) (1). As with the auniculotemporal syn-
drome, the onset occurs weeks to months
after the surgery and apparently does not
correlate with relapse of the surgical condi-
tion. Although anesthetic block or excision
of the stellate ganglion abolishes the gusta-
tory sweating response in “normal” pa-
tients, it does not have a similar effect in
postsympathectomy gustatory sweating.
Sweating is more profuse if there is no
ipsilateral Homer’s syndrome . The distni-
bution of sweating is the face and almost
always the arm, corresponding to the distni-
bution of innervation from the cervical sym-
pathetic ganglia. Although sensitivity to cm-
culating acetylcholine has been postulated
as the mechanism of production of sweating,
injection of cholinergic substances or acetyl-
choline does not reproduce the syndrome,
and ganglionic blocking agents can interrupt
the syndrome, suggesting that the response
is neural rather than humoral. It is now felt
that sprouting of cholinergic fibers into the
area of the surgical lesion is the cause.
Whether the sprouting axons arise from the
thoracic sympathetic ganglia and meander
past the surgical site, or whether they arise
from the vagus nerve is not established.
Diabetic patients with autonomic neurop-
athy may present with a similar syndrome
(2). The similarity of the syndrome in dia-
betes to that occurring in postsurgical pa-
tients makes it most reasonable to assume
that a lesion has occurred in the autonomic
nervous system with subsequent sprouting
between healthy cholinergic axons and dis-
eased ones. A careful study of diabetic
patients manifesting this phenomenon re-
vealed widespread deficits in the sympa-
thetic and parasympathetic nervous systems .
This suggests that
abnormal sprouting and unusual relation-
ships of unmyelinated fibers to Schwann
cells may be the anatomic bases for painful
diabetic neuropathy . In view of this histo-
logical evidence , it seems reasonable to sug-
gest that the mechanism for gustatory sweat-
ing in diabetic patients with autonomic neu-
ropathy is also axonal degeneration with
abnormal sprouting from continguous ax-
ons. Since in gustatory sweating it is pre-
sumed that the stimulus to the sweat glands
originates in the dorsal motor nucleus of
the medulla, and is diverted to sympathetic
cholinergic axons destined for the face and
perhaps the arm, it is likewise plausible that
adrenergic vasomotor impulses from the
cervical sympathetic chain cause the other
less constant parts of these syndromes such
as goose flesh, vasoconstniction, paraesthes-
ias and flushing.
TheAmericanJournalClinicalNutrition31:FEBRUARY 1978, pp. 307-309. Printed in U.S.A.
reference to its presence in diabetics with
autonomic neuropathy
Michael M. Bronshvag,4
Certain otherwise normal individ-
uals may have an idiosyncratic response to
one or several foods, and the mechanism of
this sensitivity is not known . It may also be
seen after parotid surgery (auriculotemporal
syndrome) (4), cervical sympathectomy
(usually bilateral) (1) and in diabetic neu-
ropathy (2). The common denominator in
these conditions seems to be damage to the
autonomic nervous system.
Less easy to understand is the syndrome
after cervical sympathectomy (usually bilat-
eral) (1). As with the auniculotemporal syn-
drome, the onset occurs weeks to months
after the surgery and apparently does not
correlate with relapse of the surgical condi-
tion. Although anesthetic block or excision
of the stellate ganglion abolishes the gusta-
tory sweating response in “normal” pa-
tients, it does not have a similar effect in
postsympathectomy gustatory sweating.
Sweating is more profuse if there is no
ipsilateral Homer’s syndrome . The distni-
bution of sweating is the face and almost
always the arm, corresponding to the distni-
bution of innervation from the cervical sym-
pathetic ganglia. Although sensitivity to cm-
culating acetylcholine has been postulated
as the mechanism of production of sweating,
injection of cholinergic substances or acetyl-
choline does not reproduce the syndrome,
and ganglionic blocking agents can interrupt
the syndrome, suggesting that the response
is neural rather than humoral. It is now felt
that sprouting of cholinergic fibers into the
area of the surgical lesion is the cause.
Whether the sprouting axons arise from the
thoracic sympathetic ganglia and meander
past the surgical site, or whether they arise
from the vagus nerve is not established.
Diabetic patients with autonomic neurop-
athy may present with a similar syndrome
(2). The similarity of the syndrome in dia-
betes to that occurring in postsurgical pa-
tients makes it most reasonable to assume
that a lesion has occurred in the autonomic
nervous system with subsequent sprouting
between healthy cholinergic axons and dis-
eased ones. A careful study of diabetic
patients manifesting this phenomenon re-
vealed widespread deficits in the sympa-
thetic and parasympathetic nervous systems .
This suggests that
abnormal sprouting and unusual relation-
ships of unmyelinated fibers to Schwann
cells may be the anatomic bases for painful
diabetic neuropathy . In view of this histo-
logical evidence , it seems reasonable to sug-
gest that the mechanism for gustatory sweat-
ing in diabetic patients with autonomic neu-
ropathy is also axonal degeneration with
abnormal sprouting from continguous ax-
ons. Since in gustatory sweating it is pre-
sumed that the stimulus to the sweat glands
originates in the dorsal motor nucleus of
the medulla, and is diverted to sympathetic
cholinergic axons destined for the face and
perhaps the arm, it is likewise plausible that
adrenergic vasomotor impulses from the
cervical sympathetic chain cause the other
less constant parts of these syndromes such
as goose flesh, vasoconstniction, paraesthes-
ias and flushing.
TheAmericanJournalClinicalNutrition31:FEBRUARY 1978, pp. 307-309. Printed in U.S.A.
Disorders of sweating
PDF
GUSTATORY SWEATING AND OTHER RESPONSES AFTER CERVICO-THORACIC SYMPATHECTOMY
BLOOR Brain.1969; 92: 137-146
GUSTATORY SWEATING AND OTHER RESPONSES AFTER CERVICO-THORACIC SYMPATHECTOMY
BLOOR Brain.1969; 92: 137-146
Sympathectomy = Autonomic peripheral neuropathy
DrRoy Freeman MBChB
aCenter for Autonomic and Peripheral Nerve Disorders, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
Available online 5 April 2005.
Summary
The autonomic neuropathies are a group of disorders in which the small, lightly myelinated and unmyelinated autonomic nerve fibres are selectively targeted. Autonomic features, which involve the cardiovascular, gastrointestinal, urogenital, sudomotor, and pupillomotor systems, occur in varying combination in these disorders. Diabetes is the most common cause of autonomic neuropathy in more developed countries. Autonomic neuropathies can also occur as a result of amyloid deposition, after acute infection, as part of a paraneoplastic syndrome, and after exposure to neurotoxins including therapeutic drugs.
Mia: and it can occur as a result of surgical or chemical sympathectomy.
THE LANGUAGE SURGEONS USE
People who have no interest (financial, that is) will give you a different picture about this procedure. I will post some more from the sales pitch texts, so that you can see the difference and the language these surgeons use, often inserting words such as: tiny, excellent, sympathectomy is the gold standard of treatment, highly effective, minimally invasive, minimal, etc.
You do not have to be a linguist to see that the careful word selection (why would a scientist say something like 'tiny cut'...) is used to seduce the unsuspecting patient.
Here is someone who doe not perform the surgery:
"A procedure called a sympathectomy is your drastic last resort," according to Dr Alan Watson, a consultant dermatologist. This operation involves chest surgery to destroy the nerves which produce the sweating, but there can be serious complications."
You do not have to be a linguist to see that the careful word selection (why would a scientist say something like 'tiny cut'...) is used to seduce the unsuspecting patient.
Here is someone who doe not perform the surgery:
"A procedure called a sympathectomy is your drastic last resort," according to Dr Alan Watson, a consultant dermatologist. This operation involves chest surgery to destroy the nerves which produce the sweating, but there can be serious complications."
