Several reports also demonstrate significantly lower heart rate increases during exercise in subjects who have undergone bilateral ISS [9–12] compared to pre-surgical levels. In spite of this high occurrence, recent reviews on the usual collateral effects of thoracic sympathectomy still do not include these possible cardiac consequences [6].
Eur J Cardiothorac Surg 2001;20:1095-1100
http://ejcts.ctsnetjournals.org/cgi/content/full/20/6/1095
Sunday, January 25, 2009
Palmar Hyperhidrosis worse after Sympathectomy
We describe a patient who underwent upper thoracic sympathectomy for palmar hyperhidrosis, and whose symptoms subsequently deteriorated, becoming worse than those on initial presentation.
Clinical and Experimental Dermatology
Volume 20 Issue 3, Pages 230 - 233
Published Online: 27 Apr 2006
Accepted for publication 6 January 1995
http://www3.interscience.wiley.com/journal/119248210/abstract
THE SYMPATHETIC NERVOUS SYSTEM AS A HOMEOSTATIC MECHANISM
The responses of intact rats to cold-exposure (4°C) include vasoconstriction, piloerection, shivering, adrenocorticotrophin (ACTH) hypersecretion and increased mobilization of free fatty acids and glucose. Adrenal demedullation prevents the increased mobilization of glucose and decreases survival time. Chemical sympathectomy blocks all of the responses except ACTH hypersecretion. Such animals lose body heat rapidly and die in a few hours. Total adrenalectomy has a similar effect. The damaging actions of chemical sympathectomy are reversed by administration of catecholamines while those of total adrenalectomy are reversed by cortisone. Thus, the sympathetic nervous system appears to be essential for existence at low environmental temperature.
http://jpet.aspetjournals.org/cgi/content/abstract/157/1/103
http://jpet.aspetjournals.org/cgi/content/abstract/157/1/103
All possible side effects should be dealt with and written informed consent required
Thoracoscopic sympathicotomy by electrocautery is an irreversible procedure. Thus the indications must be meticulously considered before the final decision to operate is taken by both the surgeon and the patient. All possible side effects should be dealt with and written informed consent required.
http://www3.interscience.wiley.com/journal/106568639/abstract?CRETRY=1&SRETRY=0
http://www3.interscience.wiley.com/journal/106568639/abstract?CRETRY=1&SRETRY=0
Published Online: 2 Dec 2003
Copyright © 2002 Taylor and Francis Ltd
Sympathectomy impairs temperature homeostasis, decreases Cardiac output and myocardial work
The decrease in body temperature associated with the onset of central neuraxial block has three reported mechanism: loss of the patient's thermorgulatory capability, with impaired shivering and loss of the ablility to sense cold temperatures; sympathectomy induced peripheral vasodilation, resulting in admixing of peripheral (cool) with core (warm) blood (this mixing results in a 1C to 2C decrease in core temperature and is proporitonal to the extent of sympathetic block and patient's age, and loss of tissue heat below the level of sympathectomy due to vasodilation.
Neuraxial anesthesia decreases afterload by producing arterial vasodilation. This vasodilation however is not equivalent in all vascular beds. For instance, muscle and skin blood flow may be decreased by sympathectomy, whereas the total blood flow to the same extremity may be quadrupled. Additionally, the extent to which afterload is decreased by sympathetic denervation varies considerably from one patient to another.
The effectiveness of this reflex vasoconstriction in maintaining normotension is a function of the extent of the sympathetic block. If, for instance, sympathetic block reaches the fourth thoracic dermatome (T4) or higher, the intact upper limb vasculature may contribute only 5% of the total cardiac output. Even maximal vasoconstriction will be insuffiecient to compensate for the profound arterial vasodilation in the rest of the body.
Cardiac Function
Importantly, bradycardia during high (thoracic) levels of spinal or epidural anesthesia is due to two main factors: denervation of preganglionic cardiac accelerator fibers (T1-4) and diminished venous return to the right ventricle because of decreases in preload.
Cardiac Output
The extent of CO decrease is also a function of the degree of sympathetic denervation.
Conversely, assumption of an even slight head-up position during neuraxial anesthesia with high levels of sympathetic denervation (..) may have catastrophic consequences such as profound bradycardia, cerebral hypoperfusion and carida arrest. Reports of severe complications related to improper positioning of patients during high levels of spinal or epidural anesthesia have spanned the last six decades.
Myocardial Work
The significant decrease in myocardial work is due primarily to threee factors: Decrease in HR (heart rate), decrease in arterial/total peripheral resistance (afterload), and decrease in stroke volume of the left ventricle secondary to the decreased preload.
Supplemental Oxygen
The purpose of the supplemental oxygen is to assure that tissue oxygenation is maintained , despite decreases in CO and periperal blood low.
Neuraxial anesthesia decreases afterload by producing arterial vasodilation. This vasodilation however is not equivalent in all vascular beds. For instance, muscle and skin blood flow may be decreased by sympathectomy, whereas the total blood flow to the same extremity may be quadrupled. Additionally, the extent to which afterload is decreased by sympathetic denervation varies considerably from one patient to another.
The effectiveness of this reflex vasoconstriction in maintaining normotension is a function of the extent of the sympathetic block. If, for instance, sympathetic block reaches the fourth thoracic dermatome (T4) or higher, the intact upper limb vasculature may contribute only 5% of the total cardiac output. Even maximal vasoconstriction will be insuffiecient to compensate for the profound arterial vasodilation in the rest of the body.
Cardiac Function
Importantly, bradycardia during high (thoracic) levels of spinal or epidural anesthesia is due to two main factors: denervation of preganglionic cardiac accelerator fibers (T1-4) and diminished venous return to the right ventricle because of decreases in preload.
Cardiac Output
The extent of CO decrease is also a function of the degree of sympathetic denervation.
Conversely, assumption of an even slight head-up position during neuraxial anesthesia with high levels of sympathetic denervation (..) may have catastrophic consequences such as profound bradycardia, cerebral hypoperfusion and carida arrest. Reports of severe complications related to improper positioning of patients during high levels of spinal or epidural anesthesia have spanned the last six decades.
Myocardial Work
The significant decrease in myocardial work is due primarily to threee factors: Decrease in HR (heart rate), decrease in arterial/total peripheral resistance (afterload), and decrease in stroke volume of the left ventricle secondary to the decreased preload.
Supplemental Oxygen
The purpose of the supplemental oxygen is to assure that tissue oxygenation is maintained , despite decreases in CO and periperal blood low.
Complications in Anesthesiology
By Emilio B. Lobato, Nikolaus Gravenstein, Robert R. Kirby
Contributor Emilio B. Lobato, Nikolaus Gravenstein, Robert R. Kirby
Edition: 3, illustrated
Published by Lippincott Williams & Wilkins, 2007
ISBN 0781782635, 9780781782630
Shivering - a normal response during fever is eliminated by sympathectomy
During fever pyrogen is released from leucocytes and this agent causes the disturbed thermoregualtion (Atkins, 1960). For this response to occur, an intact efferent sympathetic system is required because fever can be markedly reduced by bilateral sympathectomy in the cat (Pinkston, 1935). In man, pyrogen seems to act above the level of the 5th cervical spinal cord segment; for a patient with a lesion at that level the intravennours administration of pyrogen produced shivering in normally innervated muscles only and no alteration in hand blood flow was seen (Cooper at al., 1964)
The Autonomic Nervous System: An Introduction to Basic and Clinical Concepts
By Otto Appenzeller, Emilio Oribe
Edition: 5, illustrated
Published by Elsevier Health Sciences, 1997
ISBN 0444827617, 9780444827616
Gustatory sweating occurred in 38% of patients, and 16% of patients regretted the operation
Follow-up by questionnaire was possible in 94% of patients after a median of 26 months. Compensatory sweating occurred in 89% of patients and was so severe in 35% that they often had to change their clothes during the day. The frequency of compensatory sweating was not significantly different among the three groups, but severity was significantly higher after Th2-4 sympathectomy for axillary hyperhidrosis (p = 0.04). Gustatory sweating occurred in 38% of patients, and 16% of patients regretted the operation.
http://ats.ctsnetjournals.org/cgi/content/abstract/78/2/427
Ann Thorac Surg 2004;78:427-431
© 2004 The Society of Thoracic Surgeons
http://ats.ctsnetjournals.org/cgi/content/abstract/78/2/427
Ann Thorac Surg 2004;78:427-431
© 2004 The Society of Thoracic Surgeons
Sympathectomy only as a last resort?
Endoscopic thoracic sympathectomy is still practiced here but its use is decreasing and it's really only advocated as the last resort for palmar [hand] hyperhidrosis or facial blushing, and it's only rarely used for axillary [underarm] hyperhidrosis.
Dr Goodman, Melbourne, Australia
http://www.sweathelp.org/english/CMN_Article.asp?ArticleCode=64750038&EditionCode=77446114
0 comments Dr Goodman, Melbourne, Australia
http://www.sweathelp.org/english/CMN_Article.asp?ArticleCode=64750038&EditionCode=77446114
Friday, January 23, 2009
Sympathetic vasodilatation in human limbs
During the 1950s and early 1960s a variety of experiments were conducted, expanding on these original observations. Many of these studies were conducted by
Professor Barcroft's protégés (Roddie, 1977; Roddie & Shepherd, 1998). In these studies (Fig. 3), conducted before rigorous human studies review boards, severe
mental or emotional stress evoked physiological changes similar to the 'defence reaction' and caused forearm blood flow to rise by up to 10-fold (for a discussion
of the mental stress used see Roddie, 1977). The forearm vasodilatation was absent after surgical sympathectomy, and in most subjects a portion of the
vasodilatation could be blunted by atropine (Fig. 3).
Along these lines, recent observations in animals indicate that chronic sympathectomy eliminates endothelial NO synthase expression
in sympathectomised blood vessels (Aliev et al. 1996). This suggests that normal NO-mediated responses to local and circulating factors would be present
following acute sympathectomy with local anaesthetics or drugs injected into the brachial artery, but that these responses would be absent in the months and
years following surgical sympathectomy.
Individual records from two subjects during periods of severe mental stress. A, in a patient with a unilateral cervical sympathectomy, mental stress
(hatched bar) evoked profound increases in forearm blood flow in the normal arm. These increases in forearm blood flow were absent in the sympathectomised forearm. B, a second subject was studied with normal innervation to both upper extremities. Atropine given selectively to one
forearm blunted but did not eliminate the vasodilator responses to severe mental stress. Adapted from Blair et al. (1959).
http://jp.physoc.org/cgi/content/full/526/3/471
Professor Barcroft's protégés (Roddie, 1977; Roddie & Shepherd, 1998). In these studies (Fig. 3), conducted before rigorous human studies review boards, severe
mental or emotional stress evoked physiological changes similar to the 'defence reaction' and caused forearm blood flow to rise by up to 10-fold (for a discussion
of the mental stress used see Roddie, 1977). The forearm vasodilatation was absent after surgical sympathectomy, and in most subjects a portion of the
vasodilatation could be blunted by atropine (Fig. 3).
Along these lines, recent observations in animals indicate that chronic sympathectomy eliminates endothelial NO synthase expression
in sympathectomised blood vessels (Aliev et al. 1996). This suggests that normal NO-mediated responses to local and circulating factors would be present
following acute sympathectomy with local anaesthetics or drugs injected into the brachial artery, but that these responses would be absent in the months and
years following surgical sympathectomy.
Individual records from two subjects during periods of severe mental stress. A, in a patient with a unilateral cervical sympathectomy, mental stress
(hatched bar) evoked profound increases in forearm blood flow in the normal arm. These increases in forearm blood flow were absent in the sympathectomised forearm. B, a second subject was studied with normal innervation to both upper extremities. Atropine given selectively to one
forearm blunted but did not eliminate the vasodilator responses to severe mental stress. Adapted from Blair et al. (1959).
http://jp.physoc.org/cgi/content/full/526/3/471
Alterations of the Three-Phase Bone Scan After Sympathectomy
The data demonstrated that alterations in TPBS after sympathectomy are identical to those reported in early RSD and these alterations bear no relationship to the success of sympathectomy regarding pain relief. The mechanisms underlying alterations of TPBS as well as the potential mechanisms of sympathectomy failures are discussed.
Clinical Journal of Pain. 10(2):146-155, June 1994
Clinical Journal of Pain. 10(2):146-155, June 1994
sympathectomy is based on poor quality evidence, uncontrolled studies and personal experience
The practice of surgical and chemical sympathectomy is based on poor quality evidence, uncontrolled studies and personal experience. Furthermore, complications of the procedure may be significant, in terms of both worsening the pain or producing a new pain syndrome; and abnormal forms of sweating (compensatory hyperhidrosis and pathological gustatory sweating). Therefore, more clinical trials of sympathectomy are required to establish the overall effectiveness and potential risks of this procedure.
Cochrane Database Syst Rev. 2003;(2):CD002918.
Cochrane Database Syst Rev. 2003;(2):CD002918.
Painful sweating after nerve sprouting
The authors propose that after destruction of cutaneous nerves, aberrant regenerant sprouting innervates sweat glands, producing gustatory sweating as in auriculotemporal syndrome (Frey syndrome), and innervates nociceptors, producing pain.
http://www.neurology.org/cgi/content/abstract/63/8/1471
http://www.neurology.org/cgi/content/abstract/63/8/1471
Sexual function after bilateral lumbar sympathectomy
In patients who had only bilateral sympathectomy, these complications occurred in 24% and mainly consisted of ejaculation disturbances. Only three patients became impotent, each having had aortic surgery.
http://www.ncbi.nlm.nih.gov/pubmed/7364866
http://www.ncbi.nlm.nih.gov/pubmed/7364866
Sympathectomy as a cure for psychiatric mischief...
Of those I havemet, however, some have been supposed to be subject to deep psychiatric
mischief, none has benefited from psychiatric treatment, and all have been
cured by sympathectomy. Furthermore it must be noted as a matter of
special interest that the cure is permanent, and the trouble does not recur
even in patients who show evidence of some return of sympathetic function.
SOME UNSOLVED PROBLEMS IN THE SURGERY OF THE
SYMPATHETIC NERVOUS SYSTEM
Bradshaw Lecture delivered at the Royal College of Surgeons of England
on 11th June, 1953
by
Professor Sir James Paterson Ross, K.C.V.O., F.R.C.S.
Vice-President, Royal College of Surgeons of England
The haemodynamic effect of thoracoscopic cardiac sympathectomy
The sympathetic denervated heart showed little chronotropic response to anaesthetic and surgical stimulation. On the contrary, the parasympathetic response was predominant. An episode of severe bradycardia occurred during endotracheal suctioning prior to extubation. The haemodynamic response to cardiac sympathetic denervation corresponded to the efferent effect of beta-receptor blockade.
Copyright © 1998 Taylor and Francis Ltd.
http://www3.interscience.wiley.com/journal/106568649/abstract
Copyright © 1998 Taylor and Francis Ltd.
http://www3.interscience.wiley.com/journal/106568649/abstract
Sunday, January 18, 2009
Dangerous complications of sympathectomy reported
Endoscopic thoracic sympathectomy (ETS), a procedure used to correct palmar hyperhidrosis, facial sweating and blushing, can be accompanied by dangerous complications, according to a Feb 5, 2004, news release from John Wiley & Sons, Inc, publisher of the British Journal of surgery.
Complications of procedure to correct sweating reported. | Goliath Business News
"Lifestyle' Surgical Procedure Carries Unrecognized Risk of Complications" (news release, Hoboken, NJ: John Wiley &
Sons, Inc, British Journal of Surgery, Feb 5, 2004)
"Lifestyle' Surgical Procedure Carries Unrecognized Risk of Complications" (news release, Hoboken, NJ: John Wiley &
Sons, Inc, British Journal of Surgery, Feb 5, 2004)
Left, but not right, one-lung ventilation causes hypoxemia during endoscopic transthoracic sympathectomy
Endoscopic transthoracic sympathectomy was
performed under general anesthesia, using a double-lumen endobronchial
tube, after induction of artificial pneumothorax plus insufflation of CO2 into
the operated chest. Via radial artery cannulae, one to three arterial blood
gas samples were taken during two-lung ventilation before surgery, at each
one-lung ventilation, in most cases during the period of two-lung ventilation
when switching between the operated sides, and after surgery.
Left-lung ventilation and right-chest operation caused profound decrease of arterial oxygen partial
pressure (PaO2), compared with two-lung ventilation.
J Cardiothorac Vasc Anesth. 1996 Feb;10(2):207-9.
performed under general anesthesia, using a double-lumen endobronchial
tube, after induction of artificial pneumothorax plus insufflation of CO2 into
the operated chest. Via radial artery cannulae, one to three arterial blood
gas samples were taken during two-lung ventilation before surgery, at each
one-lung ventilation, in most cases during the period of two-lung ventilation
when switching between the operated sides, and after surgery.
Left-lung ventilation and right-chest operation caused profound decrease of arterial oxygen partial
pressure (PaO2), compared with two-lung ventilation.
J Cardiothorac Vasc Anesth. 1996 Feb;10(2):207-9.
early lymphocytosis was absent in sympathectomized subjects
Peripheral white and red blood cell changes were studied in response to acute insulin-induced hypoglycaemia in six normal, six splenectomized and five sympathectomized (tetraplegic) subjects. The normal subjects were restudied during beta (propranolol) and beta-selective (metroprolol) adrenergic blockade.
In the normal subjects a lymphocytosis immediately followed the acute hypoglycaemic reaction (R) with a neutrophilia 2 h later. The early lymphocytosis was absent in sympathectomized subjects and reduced under beta blockade in normal subjects, indicating mediation via an adrenergic mechanism.
Haemoglobyn, packed cell volume and total erythrocyte count rose maximally at R in all groups except the sympathectomized subjects in vhom all parameters declined progressively from basal values.
Peripheral blood cell changes in response to acute hypoglycaemia in man
European Journal of Clinical Investigation, Volume 13 Issue 1, Pages 33-39, 1982
Arterial Hypercapnia is enhanced after cervical sympathectomy
The Cardiovascular System: A Critical, Comprehensive Presentation of Physiological Knowledge and Concepts
by Robert M. Berne, Nicholas Sperelakis, Stephen R. Geiger,
Published by American Physiological Society, 1979
NA plasma levels are significantly decreased after sympathectomy for HH
Preoperative NA and A plasma levels were all within the normal limits used in our laboratory. After TS, mean NA plasma levels are significantly decreased...
We conclude that sympathetic overactivity in EH is limited to the upper dorsal sympathetic ganglia and that some of the cardiovascular and pulmonary effects that are observed after TS may be associated with the decrease in NA.
Eur J Clin Invest. 1997 Mar;27(3):202-5
We conclude that sympathetic overactivity in EH is limited to the upper dorsal sympathetic ganglia and that some of the cardiovascular and pulmonary effects that are observed after TS may be associated with the decrease in NA.
Eur J Clin Invest. 1997 Mar;27(3):202-5
Changes in cardiocirculatory autonomic function after thoracoscopic upper dorsal sympathicolysis for essential hyperhidrosis
Thoracoscopic D2-D3 sympathicolysis corrects this hyperfunction and has a partial beta-blocker-like activity, which results in a decrease in heart rate at rest and during maximal exercise, and in the diastolic blood pressure response to the handgrip test. Further studies are needed to assess the long-term consequences of this procedure.
J Auton Nerv Syst. 1996 Sep 12;60(3):115-20
J Auton Nerv Syst. 1996 Sep 12;60(3):115-20
Sympathectomy equated with autonomic neuropathy
"The effect of neuropathy on healing of the medial collateral ligament was studied in rats that
had undergone surgical sympathectomy (autonomic neuropathy) or femoral nerve transaction (sensory neuropathy)40. There
were significant decreases in various neuropeptides, such as substance P, calcitonin gene-related peptide, and vasoactive
intestinal peptide, in the denervated tissues. Impaired healing, demonstrated by significant decreases in failure force of the
healing ligaments, was seen in both groups of rats."
http://www.ejbjs.org/cgi/content/full/90/8/1800
had undergone surgical sympathectomy (autonomic neuropathy) or femoral nerve transaction (sensory neuropathy)40. There
were significant decreases in various neuropeptides, such as substance P, calcitonin gene-related peptide, and vasoactive
intestinal peptide, in the denervated tissues. Impaired healing, demonstrated by significant decreases in failure force of the
healing ligaments, was seen in both groups of rats."
http://www.ejbjs.org/cgi/content/full/90/8/1800
The incidence of postsympathectomy compensatory hyperhidrosis
The incidence of postsympathectomy compensatory hyperhidrosis (PCH) varies with patient's geographic location, working environment, humidity, temperature, and the season when it is surveyed, so that the reported incidence varies greatly from 30 to 85% .
a Division of Neurosurgery, National Taiwan University Hospital, No. 7 Chung-Shan S. Rd, Taipei, Taiwan
Saturday, January 3, 2009
Disabling Orthostatic Hypotension Caused by Sympathectomies for Hyperhidrosis
Syncope Cases
Published Online: 16 Nov 2007
Editor(s): Roberto Garc�a-Civera, Gonzalo Bar�n-Esquivias, Jean-Jacques Blanc, Michele Brignole, Angel Moya i Mitjans, Ricardo Ruiz-Granell, Wouter Wieling
Print ISBN: 9781405151092 Online ISBN: 9780470995013
Copyright © 2006 by Blackwell Publishing
http://www3.interscience.wiley.com/cgi-bin/summary/116842153/SUMMARY
A mismatch between intravascular volume and the required cardiac output on standing up is the most common cause of orthostatic hypotension. In a small minority of cases, however, orthostatic hypotension is not caused by volume depletion, but by impairment of the autonomic reflexes required to maintain blood pressure in the upright position. This disorder is known as autonomic failure.
In patients with autonomic failure, orthostatic hypotension is caused by an impaired capacity of sympathetic nerves to increase vascular resistance. Downward pooling of venous blood and a consequent reduction in stroke volume and cardiac output lead to the orthostatic fall in arterial pressure.
Adrenal Insufficiency after sympathectomy
A Study of Adrenal Insufficiency After Treatment of Hypertension by Bilateral Sympathectomy Plus Unilateral Adrenalectomy
Chapter Author: P. Etienne-Martin
http://www3.interscience.wiley.com/cgi-bin/summary/119228241/SUMMARY
Copyright © 1954 Ciba Foundation
Structural changes of arteries after sympathectomy
The findings indicate that in renal hypertensive rats structural changes of both large arteries and veins may develop in the absence of an intact sympathoadrenergic system.
Am J Physiol Heart Circ Physiol 241: H449-H454, 1981;
Effect of sympathectomy on arterial and venous changes in renal hypertensive rats
G. SimonAm J Physiol Heart Circ Physiol 241: H449-H454, 1981;
PET Imaging of Oxidative Metabolism Abnormalities in Sympathetically Denervated Myocardium
The average percentage of the left ventricle denervated in the group I animals was 13.1% ±7.3%.
Significant reductions in oxidative metabolism were observed in the sympathectomized tissue both at 2 and 8 wk after surgery (22% and 15% reductions, respectively).
Gary D. Hutchins, Timothy Chen, Kathy A. Carlson, Richard L. Fain, Wendy Winkle, Triad Vavrek, Bruce H. Mock
and Douglas P. Zipes
J NucÃ-Med 1999; 40:846-853
Significant reductions in oxidative metabolism were observed in the sympathectomized tissue both at 2 and 8 wk after surgery (22% and 15% reductions, respectively).
Gary D. Hutchins, Timothy Chen, Kathy A. Carlson, Richard L. Fain, Wendy Winkle, Triad Vavrek, Bruce H. Mock
and Douglas P. Zipes
J NucÃ-Med 1999; 40:846-853
Friday, January 2, 2009
Drawbacks of sympathectomy
Radiofrequency neurolysis (RFN) is becoming a popular method of sympathectomy among pain specialists. The advantages of RFN over chemical and surgical sympathectomy are decrease incidence of neuritis, avoidance of tinitus, blindness and urethral stricture that can occur with chemical sympathectomy, amelioration of anesthetic and surgical risks and early ambulation of the patient. The reasons for the failure of sympathectomy are incomplete sympathectomy, extensive interconnection of chains of sympathectomy ganglia cause rerouting of sympathetic impulse after removal of short chain of ganglia, and hypersensitization of adenoreceptors in the sympathectomized area.
Meraj Siddiqui, Shazia Siddiqui, J. Sue Ranasinghe & Fred Furgang: Complex Regional Pain Syndrome: A Clinical Review: Pain, Symptom Control and Palliative Care. 2001; Volume 2, Number 1.
http://www.ispub.com/ostia/index.php?xmlPrinter=true&xmlFilePath=journals/ijpsp/vol2n1/cps.xml
Meraj Siddiqui, Shazia Siddiqui, J. Sue Ranasinghe & Fred Furgang: Complex Regional Pain Syndrome: A Clinical Review: Pain, Symptom Control and Palliative Care. 2001; Volume 2, Number 1.
http://www.ispub.com/ostia/index.php?xmlPrinter=true&xmlFilePath=journals/ijpsp/vol2n1/cps.xml
cardiovascular adjustment to exercise and sympathectomy
Mean arterial pressure and total peripheral resistance were significantly reduced at rest and during steady state of exercise as compared to controls prior to sympathectomy identical vO2, whereas CO remained unchanged.
The significant fall in left circumflex coronary flow was proportional to the decline in external heart work due to sympathectomy both at rest and under exercise.
http://www.springerlink.com/content/k2n6j4555g16x773/
http://www.springerlink.com/content/k2n6j4555g16x773/
Coronary blood flow reduced by 50% after sympathectomy
However, at each level of exercise, mean coronary flow in sympathectomized ventricles was reduced by about 50% compared to control values. The slopes of coronary flow on pressure-rate product and tension-time index were also reduced. No difference in left ventricular oxygen extraction between control and sympathectomized hearts were observed. Thus, chronic ventricular sympathectomy altered the relationships between coronary flow and oxygen consumption, on the one hand, and ventricular oxygen-dependent performance and whole-body exercise level, on the other hand.
Med Sci Sports Exerc. 1988 Apr;20(2):126-35.
http://www.ncbi.nlm.nih.gov/pubmed/3367747
Med Sci Sports Exerc. 1988 Apr;20(2):126-35.
http://www.ncbi.nlm.nih.gov/pubmed/3367747
Sympathectomy impaired the PTH (parathyroid hormone) response to hypocalcaemia
Clinical Physiology and Functional Imaging
Volume 10 Issue 1, Pages 37 - 53Published Online: 28 Jun 2008
surgical sympathectomy is known to induce resorption within mandibular and auditory bulla bone
Bone destruction causes hearing loss in various middle ear disorders. The mechanisms of such pathological remodeling are unknown.
Unilateral surgical sympathectomy is known to induce resorption within mandibular and auditory bulla bone. Explanation of the cause of this effect, however, may be confounded by hemodynamic changes induced by hemicranial sympathectomy and by uncertainty as to the neuroanatomical origins of sympathetic fibers.
Ann Otol Rhinol Laryngol. 1999 Nov;108(11 Pt 1):1078-87.
http://www.ncbi.nlm.nih.gov/pubmed/10579236
Unilateral surgical sympathectomy is known to induce resorption within mandibular and auditory bulla bone. Explanation of the cause of this effect, however, may be confounded by hemodynamic changes induced by hemicranial sympathectomy and by uncertainty as to the neuroanatomical origins of sympathetic fibers.
Ann Otol Rhinol Laryngol. 1999 Nov;108(11 Pt 1):1078-87.
http://www.ncbi.nlm.nih.gov/pubmed/10579236
Changes in Parathyroid Hormone and Calcium Levels
Changes in Parathyroid Hormone and Calcium Levels after Superior Cervical Ganglionectomy of Rats
23-26 h after SCGx there is a significant impairment of homeostatic iPTH responses to low Ca levels which can be overcome by suitable Ca stimulus; (3) circulating catecholamines may affect denervated parathyroid cells, as revealed by the changes in serum iPTH and Ca elicited by
- and 
-adrenoceptor-blocker treatment of SCGx rats.
Daniel P. Cardinali, Marta G. Ladizesky
Vol. 40, No. 4, 1985
23-26 h after SCGx there is a significant impairment of homeostatic iPTH responses to low Ca levels which can be overcome by suitable Ca stimulus; (3) circulating catecholamines may affect denervated parathyroid cells, as revealed by the changes in serum iPTH and Ca elicited by
- and -adrenoceptor-blocker treatment of SCGx rats.Daniel P. Cardinali, Marta G. Ladizesky
Vol. 40, No. 4, 1985
Amygdala and aversive conditioning
Lesioned rats and controls were again tested for aversive conditioning to explicit and contextual cues. Rats with cell body lesions of the hippocampus showed normal suppression of drinking in the presence of the conditioned stimulus, but were severely impaired in choosing the safe environment based on contextual cues alone. These results suggest a double dissociation of the effects of amygdala and hippocampal damage on fear conditioning to explicit and contextual cues.
Department of Experimental Psychology, University of Cambridge, U.K.
Sympathectomy resulted in 2- to 5-fold increases in NGF protein levels in heart atrium and ventricle
Peripheral sympathectomy carried out in the adult rat resulted in 2- to 5-fold increases in NGF protein levels in heart atrium and ventricle, as well as submandibular gland, with no concomitant increase in NGF mRNA.
Sympathectomy Attenuates the Maintenance but Not Initiation of L-NAME– Induced Hypertension
We measured intra-arterial pressure in conscious, unrestrained rats with and without guanethidine-induced sympathectomy during varying durations of intravenous N-nitro-L-arginine methyl ester (L-NAME). The major new finding is that sympathectomy had no effect on the hypertensive response to bolus injections of L-NAME but in the same rats it produced a greater than 50% attenuation in the hypertension seen after 6 days of continuous L-NAME (change in mean arterial pressure, 23±4 versus 55±4 mm Hg,
P<.01, sympathectomy versus control). Using 8-hour infusions of L-NAME, we found that 60 minutes was the minimum time required for detecting a sympathectomy-sensitive component of L-NAME–induced hypertension. Furthermore, we demonstrate that the magnitude of this component increases further between 8 hours to 6 days of continuous L-NAME: it accounted for only 18% of the total hypertensive response at 8 hours but 61% after 6 days. From these experiments, we conclude that the importance of the sympathetic system in the pathogenesis of L-NAME–induced hypertension accrues slowly over hours and days, and thus its importance can be overlooked by focusing on the initial phase of the hypertension. (Hypertension. 1997;30[part 1]:64-70.) Sander, Mikael; Hansen, Jim; Victor, Ronald G.
P<.01, sympathectomy versus control). Using 8-hour infusions of L-NAME, we found that 60 minutes was the minimum time required for detecting a sympathectomy-sensitive component of L-NAME–induced hypertension. Furthermore, we demonstrate that the magnitude of this component increases further between 8 hours to 6 days of continuous L-NAME: it accounted for only 18% of the total hypertensive response at 8 hours but 61% after 6 days. From these experiments, we conclude that the importance of the sympathetic system in the pathogenesis of L-NAME–induced hypertension accrues slowly over hours and days, and thus its importance can be overlooked by focusing on the initial phase of the hypertension. (Hypertension. 1997;30[part 1]:64-70.) Sander, Mikael; Hansen, Jim; Victor, Ronald G.
Anti-inflammatory role of the sympathetic nerves
In all layers, Crohn’s disease patients demonstrated a loss of sympathetic nerve fibres. Sprouting of SP+ nerve fibres was particularly observed in the mucosa and muscular layer in Crohn’s disease.
http://gut.bmj.com/cgi/content/abstract/57/7/911
http://gut.bmj.com/cgi/content/abstract/57/7/911
In a person who had a sympathectomy, the sympathetic component of the baroreceptor mechanism is absent.
A patient with a sympathectomy would experience what's referred to as orthostatic hypotension (which might lead to syncope). Orthostatic hypotension is a decrease in arterial pressure when going from supine to a standing position. A person with a normal baroreceptor mechanism will try to restore MAP. In a person who had a sympathectomy, the sympathetic component of the baroreceptor mechanism is absent.
M.A.S.T.E.R. Learning Program, UC Davis School of Medicine
Date Revised: Jan 16, 2002
Revised by: Gordon Li and Carolyn Nguyen
M.A.S.T.E.R. Learning Program, UC Davis School of Medicine
Date Revised: Jan 16, 2002
Revised by: Gordon Li and Carolyn Nguyen
Sympathectomy causes ejaculatory dysfunction
We conclude that sympathectomy delays the transit of sperm through the cauda epididymidis and produces ejaculatory dysfunction but does not compromise sperm quality in the distal cauda epididymidis.
Biology of Reproduction 59, 897-904 (1998)
http://www.biolreprod.org/cgi/content/full/59/4/897
Biology of Reproduction 59, 897-904 (1998)
http://www.biolreprod.org/cgi/content/full/59/4/897
Sympathectomy reduces catecholamines
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.Scand J Gastroenterol. 1985 Dec;20(10):1276-80.
http://www.ncbi.nlm.nih.gov/pubmed/4095497
Thursday, January 1, 2009
Informed consent - sympathectomy
Physicians are required to gain informed consent prior to administering a treatment. Informed consent is gained by providing patients with a full accounting of the risks of the treatment as documented in peer-reviewed, published medical/scientific literature.
Your scenario of surgeons being flummoxed by unhappy patients complaining after surgery doesn't hold water. The rules of professional medical ethics require that the treating physician be well versed in the published literature on the treatments he delivers.
There is a mountain of published research (spanning nearly a century) documenting the adverse effects of sympathectomy. There are numerous studies, for example, showing very high rates of severe side effects and studies showing that satisfaction diminishes substantially over the long term.
It is a doctors job to know this stuff and it is their ethical duty to disclose that information to patients.
So, I see the blame thing as pretty cut and dry. Surgeons perfoming sympathectomies routinely withhold information vital to informed consent. Anyone who does objective comparison between what is documented in medical/scientific literature and what is typically disclosed to prospective ETS patients has no choice but reach this conclusion.
And, to make matters worse, many surgeons use testimonials from a hand-selected group of their happiest patients to advocate the surgery. That practice is considered unethical by all medical professional organizations.
http://etsandreversals.yuku.com/reply/22927/Would-you-do-it-again#reply-22927
The functional name for the this surgery is "sympathetic denervation". It's not some super-advanced, modern cure based on recent discoveries in neurophysiology. It's a primitive, destructive procedure. It's a method used on animals for research. It's brute force method...destroy the pathways to the sweat glands over a large region. Unfortunately, it destroys pathways to and from many other organs including the heart and lungs and causes a large number of neuropathological dysfunction. That hasn't changed in the last ten years. It will not and cannot change in the next 1000 years because it will still be a nerve injury 1000 years from now. I'm not making this up. It's a simple fact. Don't let some doctor take advantage of your ignorance
http://etsandreversals.yuku.com/topic/4919/Should-i-have-ETS-surgery#.Tok-TE8YAyk
Performance and availability of ETS surgery is not a failure of science (and medicine as inexact science), it is the moral failure of the profession that places entrepreneurial interest above safety and above scientific evidence on the part of the ETS industry, and deep disinterest (and self-interest) of the rest of the medical profession.
Your scenario of surgeons being flummoxed by unhappy patients complaining after surgery doesn't hold water. The rules of professional medical ethics require that the treating physician be well versed in the published literature on the treatments he delivers.
There is a mountain of published research (spanning nearly a century) documenting the adverse effects of sympathectomy. There are numerous studies, for example, showing very high rates of severe side effects and studies showing that satisfaction diminishes substantially over the long term.
It is a doctors job to know this stuff and it is their ethical duty to disclose that information to patients.
So, I see the blame thing as pretty cut and dry. Surgeons perfoming sympathectomies routinely withhold information vital to informed consent. Anyone who does objective comparison between what is documented in medical/scientific literature and what is typically disclosed to prospective ETS patients has no choice but reach this conclusion.
And, to make matters worse, many surgeons use testimonials from a hand-selected group of their happiest patients to advocate the surgery. That practice is considered unethical by all medical professional organizations.
http://etsandreversals.yuku.com/reply/22927/Would-you-do-it-again#reply-22927
'Improved sympathectomy' - is it an oxymoron?
"also it seems like the more bad and negative affects were from 10 to 12 years ago when they had just started performing the surgery.. they must have improved it a lot by now.?"This procedure has been performed since the 1920's. Yes, the 1920's. In the 1980's they started to do it using "keyhole" surgery which means they don't have to make a big incision. But, the surgery is no different than what they've been doing for the last 70+ years. It's a nerve injury. You can't "improve" the way you inflict a nerve injury. You can't injure the nerve in some "special" way such that the injury suddenly has a different effect on the body.
The functional name for the this surgery is "sympathetic denervation". It's not some super-advanced, modern cure based on recent discoveries in neurophysiology. It's a primitive, destructive procedure. It's a method used on animals for research. It's brute force method...destroy the pathways to the sweat glands over a large region. Unfortunately, it destroys pathways to and from many other organs including the heart and lungs and causes a large number of neuropathological dysfunction. That hasn't changed in the last ten years. It will not and cannot change in the next 1000 years because it will still be a nerve injury 1000 years from now. I'm not making this up. It's a simple fact. Don't let some doctor take advantage of your ignorance
http://etsandreversals.yuku.com/topic/4919/Should-i-have-ETS-surgery#.Tok-TE8YAyk
Performance and availability of ETS surgery is not a failure of science (and medicine as inexact science), it is the moral failure of the profession that places entrepreneurial interest above safety and above scientific evidence on the part of the ETS industry, and deep disinterest (and self-interest) of the rest of the medical profession.
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