Information provided to patients regarding side-effects
Mia: The information on the different websites shows great variation in what is disclosed to patients. The full impact of the surgery is never fully explained, but there is indication that some of the surgeons allow more information to appear. The question is: how they narrate this information?! Several of the ETS surgeons list more negative side-effects but they immediately discredit the information as a hearsay, never proven and unscientific. This way they covered the bases without frightening away the patient. Keep in mind, it is an elective surgery.
So far over 70 surgeons (esp. those who are the best known in the field and published the most) have been approached with the request to put a link to this BLOG on their information sheet/website, so that patients are aware of the potential risks associated with sympathectomy and can make an INFORMED decision. So far NONE of the surgeons agreed to do so, even though the material published here is from the medical journals already published.
List of complications from a transcript: Court of Appeals of Texas,San Antonio 2008,
Vaughan v. Nielson
(The highlighted side-effects are rarely disclosed by surgeons)
Possible perforation of breast implants if present
Sensitive Pleurae (chest lining sensitivity) limiting exercise
Horners Syndrome occurrence rate 0.3%
Heat intolerance
Pneumothorax (collapsed lung)
Bleeding
Postop Neuralgia and parasthesias are uncommon
Possible hair loss
Bradycardia (slow heart rate) possibly requiring a pacemaker (SIC!)
Subcutaneous emphysema
Possible conversion to open thoracotomy
Possible recurrence of symptoms
http://209.85.173.132/search?q=cache:WSfz4lbpQ1EJ:lawandmedicine.law.miami.edu/wp-content/uploads/2008/09/vaughan_nielson.doc+%22split+body+syndrome%22&hl=en&ct=clnk&cd=3&gl=us&client=safari
Unsubstantiated statements by ETS surgeon can be misleading
"The incidence of compensatory hyperhidrosis is
proportional to
the surface
area rendered anhidrotic."
"The statement is based on my own observations. It is
original and does not refer to any other article.
You have already discovered the
original source.
It is a clinical observation. I have done no
measurements that is/yet to be subjected to
scientific study.
You can quote it as a clinical
hypothesis that I have postulated."
Jack Collin,
consultant surgeon
Oxford
Mia: the only study done (and posted on this blog)
so far, states that
Sympathectomy will INCREASE the total
amount of body sweat.
http://www.ncbi.nlm.nih.gov/pubmed/11193740
Sympathectomy - division of adrenergic, cholinergic and sensory fibres
In general sympathectomy has been used for one or more of the following purposes:
1) to eliminate tonic or engendered responses which depend upon impulses in adrenergic nerves;
2) to eliminate visceral stores or adrenergic substances which depend upon the integrity of the postganglionic sympathetic innervation;
3) to eliminate postganglionic sympathetic tissue as a locus for the synthesis, uptake, binding, release and metabolism of adrenergic substances;
4) to eliminate visceral afferent fibers which are frequently distributed in common with autonomic nerves. The extent to which the surgical procedure is adjudged successful is usually related to the anatomical extent of the denervation and the time after operation at which the result is evaluated.
It is clear that "sympathectomy" is not a selective excision of adrenergic elements only. It is well recognized that preganglionic sympathectomy involves division of cholinergic elements ad sensory fibers.
Pharmacological Reviews, 1966 Vol. 18, No. 1. Part I
1) to eliminate tonic or engendered responses which depend upon impulses in adrenergic nerves;
2) to eliminate visceral stores or adrenergic substances which depend upon the integrity of the postganglionic sympathetic innervation;
3) to eliminate postganglionic sympathetic tissue as a locus for the synthesis, uptake, binding, release and metabolism of adrenergic substances;
4) to eliminate visceral afferent fibers which are frequently distributed in common with autonomic nerves. The extent to which the surgical procedure is adjudged successful is usually related to the anatomical extent of the denervation and the time after operation at which the result is evaluated.
It is clear that "sympathectomy" is not a selective excision of adrenergic elements only. It is well recognized that preganglionic sympathectomy involves division of cholinergic elements ad sensory fibers.
Pharmacological Reviews, 1966 Vol. 18, No. 1. Part I
Bilateral surgical sympathectomy provides a valuable tool for future investigations of the cellular basis of supersensitivity in the myocardium.
K Goto, PA Longhurst, LA Cassis, RJ Head, DA Taylor, PJ Rice and WW Fleming
Volume 234, Issue 1, pp. 280-287, 07/01/1985
Volume 234, Issue 1, pp. 280-287, 07/01/1985
Copyright © 1985 by American Society for Pharmacology and Experimental Therapeutics
Autonomic dysreflexia
Autonomic dysreflexia is a potentially life-threatening complication in these patients. This disorder represents an autonomic response, which is primarily sympathetic, to specific visceral stimuli in patients with spinal cord injury above the level of T6. An incomplete compensatory parasympathetic outflow will occur above the level of injury. This phenomena is more common in patients with cervical injuries, and common triggers include bowel and bladder distention. Symptoms may involve piloerection, diaphoresis, pounding headache, flushing above the level of the injury, and may be associated with sudden and severe hypertension accompanied by reflex bradycardia. Although bradycardia is most common, tachycardia and arrhythmias may be present. Hypertension may be of varying severity from causing a mild headache to a seixure or life-threatening cerebral hemorrhage.
Published by Humana Press, 2000
Voiding Dysfunction
By Rodney A. AppellPublished by Humana Press, 2000
Hypotension
Orthostatic hypotension is commonly associated with prolonged bed rest (24 hours or longer). It may also result from sympathectomy, which disrupts normal vasoconstrictive mechanisms.
Orthostatic hypotension [Postural hypotension]: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
reduction of catecholamines by more than 90%
Sympathectomy has been used to study the role of the sympathetic nervous system in the control of gastric acid secretion. Conflicting results may reflect differences in the sympathectomy procedures used. In a previous study we showed a reduction of catecholamines by more than 90% in the gut wall of the rat after surgical upper abdominal sympathectomy.
Total denervation, including combined surgical and chemical sympathectomy plus vagotomy, did not reduce noradrenaline levels more than surgical sympathectomy alone, suggesting that the proportion of adrenergic fibers that derive from the vagus is quantitatively insignificant but that the vagus exerts a local control of the sympathetic stores of gastric catecholamines. Thus, surgical upper abdominal sympathectomy is the method of choice in studies of the role of the sympathetic nervous system in regulating gastric functions. Adrenaline and dopamine levels were much lower than the noradrenaline levels but showed roughly the same trends of changes after the denervations (except that chemical sympathectomy did not affect dopamine).
Scandinavian Journal of Gastroenterology, Volume 20, Issue 10 December 1985 , pages 1276 - 1280
H. Graffner a; M. Ekelund a; R. H
kanson a; E. Rosengren a
Total denervation, including combined surgical and chemical sympathectomy plus vagotomy, did not reduce noradrenaline levels more than surgical sympathectomy alone, suggesting that the proportion of adrenergic fibers that derive from the vagus is quantitatively insignificant but that the vagus exerts a local control of the sympathetic stores of gastric catecholamines. Thus, surgical upper abdominal sympathectomy is the method of choice in studies of the role of the sympathetic nervous system in regulating gastric functions. Adrenaline and dopamine levels were much lower than the noradrenaline levels but showed roughly the same trends of changes after the denervations (except that chemical sympathectomy did not affect dopamine).
Scandinavian Journal of Gastroenterology, Volume 20, Issue 10 December 1985 , pages 1276 - 1280
H. Graffner a; M. Ekelund a; R. H
kanson a; E. Rosengren a | Affiliation: | a Depts. of Surgery and Pharmacology, University of Lund, Lund, Sweden |
Serum Dopamine-β -Hydroxylase: Decrease after Chemical Sympathectomy
Dopamine-β -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-β -hydroxylase activity.
| Weinshilboum, Richard; Axelrod, Julius | ||
| Publication: | Science, Volume 173, Issue 4000, pp. 931-934 | |
| Publication Date: | 09/1971 | |
| Origin: | JSTOR |
Absence of the localized Schwartzman reaction
This investigation was undertaken to determine whether the presence of catechol amines was necessary for endotoxin to be operative in the production of a localized Schwartzman reaction. Seven rabbits were pretreated with 6–OH dopamine to produce a generalized chemical sympathectomy. An attempt was made to induce a localized Schwartzman reaction in these rabbits as well as in a control group. The rabbits in the experimental group did not develop the classical localized Schwartzman reaction, while those in the control group developed the localized Schwartzman reaction both clinically and histologically.
L. Shapiro1 , P. Cuevas 1 , R. E. Stallard 1 , M. P. Ruben 1 1 Clinical Research Center, Boston University Medical Center, School of Graduate Dentistry, Boston, Massachusetts, USA.
L. Shapiro
Journal of Periodontal Research, Volume 9 Issue 4, Pages 207 - 210
Published Online: 30 Jun 2006
Sympathectomy decreased NE and DA concentrations of muscles to approximately 10% of control values
We studied the effect of unilateral sympathectomy on rat quadriceps and gastrocnemius muscle concentrations of endogenous dihydroxyphenylalanine (DOPA), dopamine (DA), and norepinephrine (NE) and assessed the relationships between these catecholamines in several rat tissues. Catecholamines were measured by reverse-phase high-performance liquid chromatography with electrochemical detection. Sympathectomy decreased NE and DA concentrations of muscles to approximately 10% of control values, whereas the DOPA concentration tended to increase. Relatively high concentrations of DOPA were found in the gastrointestinal tract, kidney, and spleen. No correlations were obtained between the tissue concentration of DOPA and NE. A DA-to-NE ratio approximately 1% was observed in liver, muscle, pancreas, spleen, and heart, whereas we found exponentially increasing DA values with increasing NE concentration in tissues obtained from stomach, small and large intestine, kidney, and lung. In conclusion, endogenous DOPA in muscle tissue is not located in sympathetic nerve terminals but probably in muscle cells. DA concentrations in the gastrointestinal tract and in the kidneys were greater than could be ascribed to its role as a precursor in the biosynthesis of NE.
E. Eldrup, E. A. Richter and N. J. Christensen
Department of Internal Medicine and Endocrinology, Herlev University Hospital, Denmark.
Am J Physiol Endocrinol Metab 256: E284-E287, 1989;
sympathectomy abolished the differences in body fat accumulation
There is evidence to suggest that obese individuals,
and those predisposed to obesity, may have a defective
thermogenic response to meal ingestion when compared
with lean individuals (Raben et al. 1994; Napoli &
Horton, 1996; Matsumoto et al. 2001). De Jonge & Bray
(1997) concluded that DIT was lower in obesity, an out-
come demonstrated in twenty-two of twenty-nine studies
The role of the sympathetic nervous system may be
important to the results documented here (Fagius &
Berne, 1994). There is evidence for a reduced sympathetic
nervous system activity in the aetiology of obesity in ani-
mals and man (Bray, 1990; Matsumoto et al. 2001).
While all macronutrients stimulate the sympathetic nervous
system (Fagius & Berne, 1994), the type of dietary fat has
important influences as well (Young & Walgren, 1994).
Takeuchi et al. (1995) and Matsuo et al. (1995) have
demonstrated a lower sympathetic activity and low DIT,
but a higher carcass fat content in rats fed beef tallow
(saturated fat) as compared with safflower oil (unsaturated
fat). Importantly, sympathectomy abolished the differences
in body fat accumulation and DIT between the two dietary
fat groups.
M. J. Soares*, S. J. Cummings, J. C. L. Mamo, M. Kenrickand L. S. Piers1
Department of Nutrition, Dietetics and Food Science, School of Public Health, Curtin University of Technology,
Department of Human Movement and Exercise Science, University of Western Australia,
British Journal of Nutrition (2004), 91, 245–252
and those predisposed to obesity, may have a defective
thermogenic response to meal ingestion when compared
with lean individuals (Raben et al. 1994; Napoli &
Horton, 1996; Matsumoto et al. 2001). De Jonge & Bray
(1997) concluded that DIT was lower in obesity, an out-
come demonstrated in twenty-two of twenty-nine studies
The role of the sympathetic nervous system may be
important to the results documented here (Fagius &
Berne, 1994). There is evidence for a reduced sympathetic
nervous system activity in the aetiology of obesity in ani-
mals and man (Bray, 1990; Matsumoto et al. 2001).
While all macronutrients stimulate the sympathetic nervous
system (Fagius & Berne, 1994), the type of dietary fat has
important influences as well (Young & Walgren, 1994).
Takeuchi et al. (1995) and Matsuo et al. (1995) have
demonstrated a lower sympathetic activity and low DIT,
but a higher carcass fat content in rats fed beef tallow
(saturated fat) as compared with safflower oil (unsaturated
fat). Importantly, sympathectomy abolished the differences
in body fat accumulation and DIT between the two dietary
fat groups.
M. J. Soares*, S. J. Cummings, J. C. L. Mamo, M. Kenrickand L. S. Piers1
Department of Nutrition, Dietetics and Food Science, School of Public Health, Curtin University of Technology,
Department of Human Movement and Exercise Science, University of Western Australia,
British Journal of Nutrition (2004), 91, 245–252
Influence of vagatomy and sympathectomy on thermogenesis
P. L. Andrews, N. J. Rothwell and M. J. Stock
Infusion of rats with insulin (8 U/day via implanted minipump) for 7 days caused a 22% rise in resting oxygen consumption, which was inhibited by acute injection of the beta-adrenergic antagonist propranolol. Insulin treatment produced significant increases in brown fat mass, protein content, and total thermogenic activity (assessed from binding of guanosine diphosphate to isolated brown fat mitochondria), but these responses were inhibited by prior surgical sympathectomy of the tissue. Animals subjected to subdiaphragmatic vagotomy gained more weight than pair-fed, sham-operated controls and showed reductions in total energy expenditure, the acute thermogenic response to a meal and brown adipose tissue activity. Daily injections of insulin (1 U/day) prevented all of these effects of vagotomy. These data demonstrate that the changes in brown fat activity induced by exogenous insulin are mediated by the sympathetic nervous system and that the depressed thermogenesis and brown fat activity associated with vagotomy appear to be due to a relative insulin deficiency and can be reversed by treatment with the hormone.
Am J Physiol Endocrinol Metab 249: E239-E243, 1985; Brown adipose tissue - thermogenesis
The sympathetic nervous system (SNS) plays a critical role in the regulation of mammalian thermogenic responses to cold exposure and dietary intake. Catecholamine-stimulated thermogenesis is mediated by the beta-adrenergic receptor. In the rat brown adipose tissue is the major site of metabolic heat production in response to both cold (nonshivering thermogenesis) and diet (diet-induced thermogenesis). Measurements of norepinephrine turnover rate in interscapular brown adipose tissue of the rat demonstrate increased sympathetic activity in response to both cold exposure and overfeeding. In adult humans, a physiologically significant role for brown adipose tissue has not been established but cannot be excluded.
http://www.ncbi.nlm.nih.gov/pubmed/6380306?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=4&log$=relatedreviews&logdbfrom=pubmed
Landsberg L, Saville ME, Young JB.
Am J Physiol. 1984 Aug;247(2 Pt 1):E181-9.
http://www.ncbi.nlm.nih.gov/pubmed/6380306?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=4&log$=relatedreviews&logdbfrom=pubmed
Landsberg L, Saville ME, Young JB.
Am J Physiol. 1984 Aug;247(2 Pt 1):E181-9.
sympathectomy induces a disappearance of diurnal fluctuation in the sensitivity to injected noradrenaline
In sympathectomized animals a depletion of noradrenaline from interscapular brown adipose tissue and the heart was observed. Besides, a change in adrenaline/noradrenaline ratio was found in the adrenals.
Petrović VM, Maksimović K, Davidović V.
Arch Int Physiol Biochim. 1980 Aug;88(3):273-6.
http://www.ncbi.nlm.nih.gov/pubmed/6159854
Petrović VM, Maksimović K, Davidović V.
Arch Int Physiol Biochim. 1980 Aug;88(3):273-6.
http://www.ncbi.nlm.nih.gov/pubmed/6159854
Surgical aspects of chronic post-thoracotomy pain
Chronic post-thoracotomy pain is a continuous dysaesthetic burning and aching in the general area of the incision that persists at least 2 months after thoracotomy. It occurs in approximately 50% of patients after thoracotomy and is usually mild or moderate. However, in 5% the pain is severe and disabling. No one technique of thoracotomy has been shown to reduce the incidence of chronic postthoracotomy pain. The most likely cause is intercostal nerve damage, although the precise mechanism for this is not known. Future work needs to examine surgical technique in detail. Until then, patients need to be adequately warned of this sequela of thoracotomy.
Mark L. Rogers, John P. Duffy
Mark L. Rogers, John P. Duffy
Department of Cardiothoracic Surgery, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK
Received 16 May 2000;
Autonomic neuropathy in the skin following sympathectomy
In diabetics with the anhidrotic syndrome, autonomic nerve fibres were studied in skin biopsies using argentic techniques and light microscopy. The Minor test was used to differentiate normal from anhidrotic skin areas. In the anhidrotic areas, histology of the nerve fibres showed beading, spindle-shaped thickening and fragmentation adjacent to the sweat glands. These changes were similar to those observed in two patients who had previously undergone lumbar sympathectomy. No abnormalities of the sympathetic nerve endings could be found in biopsies taken from normal areas of the forearm of the same patients. We conclude that the diabetic anhidrotic syndrome, a form of diabetic autonomic neuropathy, is due to a lesion of the sympathetic nerve supply to the skin.
I. Faerman1, E. Faccio3, I. Calb2, J. Razumny1, N. Franco2, A. Dominguez2 and H. A. Podestá1
Diabetologia
Volume 22, Number 2 / February, 1982
I. Faerman1, E. Faccio3, I. Calb2, J. Razumny1, N. Franco2, A. Dominguez2 and H. A. Podestá1
Diabetologia
Volume 22, Number 2 / February, 1982
relevant to the pathogenesis of human dysautonomias
Systemic injection of monoclonal antibodies to neural acetylcholinesterase in adult rats caused a syndrome with permanent, complement-mediated destruction of presynaptic fibers in sympathetic ganglia and adrenal medulla. Ptosis, hypotension, bradycardia, and postural syncope ensued. In sympathetic ganglia, acetylcholinesterase activity disappeared from neuropil but not from nerve cell bodies. Choline acetyltransferase activity and ultrastructurally defined synapses were also lost. Electrical stimulation of presynaptic fibers to the superior cervical ganglion ceased to evoke end-organ responses.
This model of selective cholinergic autoimmunity represents another tool for autonomic physiology and may be relevant to the pathogenesis of human dysautonomias.
S Brimijoin and V A Lennon
This model of selective cholinergic autoimmunity represents another tool for autonomic physiology and may be relevant to the pathogenesis of human dysautonomias.
S Brimijoin and V A Lennon
Department of Pharmacology, Mayo Clinic, Rochester, MN 55905.
Proc Natl Acad Sci U S A. 1990 December; 87(24): 9630–9634. 
