abnormal heart rate recovery predicts death

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

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

"Lifestyle' Surgical Procedure Carries Unrecognized Risk of Complications"

(news release, Hoboken, NJ: John Wiley & Sons, Inc, British Journal of Surgery, Feb 5, 2004)

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.
http://dx.doi.org/doi:10.1016/S1053-8119(03)00011-9

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

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

Bradycardia likely, compensatory sweating obligatory

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

Unforeseeable and unacceptable complications

Thorac Surg Clin. 2008 May;18(2):193-207.Links

Side effects and complications of surgery for hyperhidrosis.

Dumont P.

Most of the difficulties associated with hyperhidrosis surgery are due to unavoidable side effects and unforeseeable and unacceptable complications. Careful patient selection is important before surgery so surgeons can avoid some of these pitfalls.

Patients should also be fully informed of all potential side effects and complications before surgical treatment.

the lack of uniform outcome measures makes these data difficult to interpret

The great majority of the currently available evidence supporting sympathectomy for primary hyperhidrosis is observational, coming from a variety of prospective and restrospective clinical series as well as comparative studies.

Thorac Surg Clin. 2008 May;18(2):209-16.Links

Evidence-based review of the surgical management of hyperhidrosis.

"Compensatory sweating' disastrous

World J Surg. 2008 Nov;32(11):2343-56. Links

The correlation between the method of sympathetic ablation for palmar hyperhidrosis and the occurrence of compensatory hyperhidrosis: a review.

Kopelman D, Hashmonai M.

Department of Surgery B, Ha'emek Hospital, Afula, Israel.

BACKGROUND: Upper dorsal sympathectomy achieves excellent long-term results in the treatment of primary palmar hyperhidrosis. Compensatory hyperhidrosis (CHH) remains an unexplained sequel of this treatment, attaining in a small percentage of cases disastrous proportions.

The search identified 42 techniques of sympathetic ablation. However, pertinent data for the present study were reported for only 23 techniques with multiple publications found only for 10. The only statistically valid results from this review point that T2 resection and R2 transection of the chain (over the second rib) ensue in less CHH than does electrocoagulation of T2. Further comparisons were probably prevented due to the enormous disparity in the reported results, indicating lack of standardization in definitions.

Hemodynamic consequences of cervico-dorsal sympathectomy

Hemodynamic consequences of cervico-dorsal sympathectomy
Thoracic sympathectomy has usually minimal consequences if unilateral, especially on the right side. For bilateral procedures, a mean 12% reduction of heart rate was reported [5]. Around 50% of patients have bradycardia in the following minutes of a bilateral surgery with mean and diastolic blood pressure significant reduction. Since the sympathectomy will block the chronotropic response, a significant increase of the ejection volume is observed when the patient moves in the erect position from dorsal decubitus [6].

Two cardiovascular complications were reported in the literature. First, an asystolic cardiac arrest in an 18-year-old woman during the second side (left) of bilateral sympathectomy for severe hyperhidrosis, requiring resuscitation maneuvers, with no chronic sequelae [7]. The second case was reported in a 23-year-old woman in whom a bilateral T₂ sympathectomy was performed for facial hyperhidrosis. Two years later, following electrophysiologic studies confirming unopposed vagotonic stimulation, she underwent permanent pacemaker insertion for symptomatic bradycardia [8].

	6. Recommendations

Patients should be instructed of possible cardiovascular complications following this intervention.
http://icvts.ctsnetjournals.org/cgi/content/full/8/2/238

Cardiac arrest as a major complication of bilateral cervico-dorsal sympathectomy

Interact Cardiovasc Thorac Surg. 2009 Feb;8(2):238-9. Epub 2008 Nov 27.

O'Connor K, Molin F, Poirier P, Vaillancourt R.

Department of Cardiology, Institut universitaire de cardiologie et de pneumologie, Hôpital Laval, Québec, Canada. kim.oconnor.1@ulaval.ca

Severe palmar and/or axillary hyperhidrosis can be socially and psychologically very disturbing. We present a case of a patient who suffered from a 43 s asystolic cardiac arrest the night following a second contralateral thoracoscopic T(2)-T(3) sympathectomy for severe axillary and truncal hyperhidrosis. The cardiovascular effects of cervico-dorsal sympathectomy will be reviewed. Evaluation required to prevent such a serious cardiac complication will also be discussed.

PMID: 19038983 [PubMed - indexed for MEDLINE

statistically significant differences - cardiac effect

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

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

OBJECTIVE: Endoscopic thoracic sympathectomy is performed to treat primary hyperhidrosis. The second and third sympathetic thoracic ganglia excised also innervate the heart. Some studies have shown decreased heart rate but have not been conclusive regarding other cardiac effects of sympathectomy. We studied the cardiac autonomic effects of endoscopic thoracic sympathectomy in a group of patients with primary hyperhidrosis. Heart rate variability is a simple, noninvasive electrocardiographic marker reflecting the activity and balance of the sympathetic and vagal components of the autonomous nervous system. METHODS: We performed a prospective study in 38 patients with primary hyperhidrosis with 24-hour Holter recordings obtained before endoscopic thoracic sympathectomy and 6 months later. RESULTS: 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. CONCLUSION: 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

40% were disappointed

We detected 8 patients (53%) complaining
about a decent to moderate recurrence of hand sweating and compensatory and gustatory sweating were observed in 9 (60%) and 5 (33%)
patients, respectively. Reported side effects related to surgery were paresthesias of the upper limb and the thoracic wall in 8 patients
(53%) and recurrent pain in the axillary region in one. At an average 12 years after surgery, 47% of patients were satisfied with the
treatment results, 40% were disappointed. Six patients (40%) affirmed they would ask for the operation if it were to be redone. Our
findings indicate that results of ETS deteriorate and compensatory sweating does not improve with time. It is mandatory to inform patients
of the potential long-term adverse effects before surgery.
�� 2009 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.
Interactive CardioVascular and Thoracic Surgery 8 (2009) 54–57

Sympathectomy = psychosurgery

http://encyclopedia.stateuniversity.com/pages/17971/psychosurgery.html
Cambridge Encyclopedia :: Cambridge Encyclopedia Vol. 60

Some consider use of endoscopic thoracic sympathectomy (ETS surgery) for patients with anxiety disorder to be
psychosurgery, despite it not being surgery of the brain.