The amount of compensatory sweating depends on the patient, the damage that the white rami communicans incurs, and the amount of cell body reorganization in the spinal cord after surgery.
Other potential complications include inadequate resection of the ganglia, gustatory sweating, pneumothorax, cardiac dysfunction, post-operative pain, and finally Horner’s syndrome secondary to resection of the stellate ganglion.
www.ubcmj.com/pdf/ubcmj_2_1_2010_24-29.pdf

After severing the cervical sympathetic trunk, the cells of the cervical sympathetic ganglion undergo transneuronic degeneration
After severing the sympathetic trunk, the cells of its origin undergo complete disintegration within a year.
http://onlinelibrary.wiley.com/doi/10.1111/j.1439-0442.1967.tb00255.x/abstract

Thursday, March 26, 2009

Secretions of the pituitary-adrenal cortex as controllers of emotion

Peripheral sympathectomy prevents the normal occurrence of a variety of bodily changes and hence, a fortiori, prevents sensory feedback of those changes. (p.68)

Biology and emotion

By Neil McNaughton
Edition: illustrated

Published by Cambridge University Press, 1989

more likely to develop autoimmune disorders after sympathectomy

page 71:
Lewis rats are much more likely to develop autoimmune disorders after sympathectomy (Dimitrova and Felten, 1995).
This finding suggests that if sympathetic regulation were impaired in a genetically predisposed individual, an autoimmune disease might develop.
Betrayal by the Brain: The Neurologic Basis of Chronic Fatigue Syndrome, Fibromyalgia Syndrome and Related Neural Network Disorders
by Jay A. Goldstein
published by The Haworth Medical Press, 1996

ETS prevents responses to reflex or emotional changes in the central nervous system - Is this the definition of LOBOTOMY?

All the sympathetic ganglia that send postganglionic nerve fibres to structures in the head, neck and upper limb receive preganglionic fibres from the central nervous system only through the white rami communicates of the upper thoracic ventral rami. These preganglionic fibres ascend in the trunk and reach its ganglia directly and outlying ganglia through branches of the trunk. Thus destruction of the trunk at the root of the neck, whether as a result of a surgery (cervical sympathectomy) or of some pathological condition,isolates all these sympathetic ganglion cells from the central nervous system and prevents them from responding to reflex or emotional changes in the central nervous system.
Cunningham's Manual of Practical Anatomy: Volume III: Head, Neck and Brain (Oxford Medical Publications)
G. J. Romanes
Paperback - Nov 20, 1986

No correlation between the denervated area and severity of 'compensatory' sweating

There was no correlation between the degree of alteration in total body perspiration and the development of CH. Performing thoracoscopic T2-T3 sympathectomy for PPH affects the total body sweating response to heat; however, the development of CH does not correlate with this alteration. (author abst.)

http://sciencelinks.jp/j-east/article/200108/000020010801A0160337.php

Journal Title; Surg Today

Journal Code:Z0754A

ISSN:0941-1291

VOL.30;NO.12;PAGE.1089-1092(2000)

Mia: proof that 'compensatory' sweating is NOT compensatory

Devervation sensitivity and Sympathectomy

Somatic effectors are dependent on their innervation to maintain structural and functional integrity. Whenn denervated, they eventually atrophy. This is the fate of the denervated voluntary muscles as noted in a lower motor neuron paralysis. Autonomic effectors are not wholly dependent on their innervation. Denervated involuntary muscles, cardiac muscle and glands continue to function. For example, the transplanted heart might function reasonably well. However, when deprived of autonomic nervous system influences, these effectors are abnormal in that they do not respond as effectively as they should to satisfy the changing demands of the organism.
When an effector is deprived of it's innervation, it may become extremely sensitive to chemical mediators (neurotransmitters). For example, the rate of beat of the totally denervated heart will increase if the heart is exposed to just 1 part of epinephrine in 1400 million.

Denervation supersensitivity is noticeable in clinical situation following sympathectomy. (p.367)

The human nervous system: structure and function

By Charles Robert Noback, Norman L. Strominger, Robert J. Demarest, David A. Ruggiero

Edition: 6, illustrated

Published by Humana Press, 2005

ISBN 1588290409, 9781588290403

The haemodynamic effect of thoracoscopic cardiac sympathectomy

The response of the heart to stress is much attenuated by upper thoracic sympathectomy.

A patient with angina pectoris who had been successfully treated by thoracoscopic cardiac sympathectomy was scheduled to have scalp debridement under general anaesthesia for a scald burn. There were haemodynamic changes during and after the operation including anaesthetic induction, endotracheal intubation, maintenance, and early recovery period. 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

European Journal of Surgery

See Also:

British Journal of Surgery

Volume 164 Issue S1, Pages 37 - 38

Published Online: 2 Dec 2003

This is how language is used to distort, misrepresent and manipulate:

"The operation involves snipping some nerves that cause blushing. It involves 2 tiny incisions in the arm-pit through which they gain access to the nerves. The whole thing takes less than 1 hour and it requires one nights stay in the hospital. It is relatively straight-forward in the hands of people who do it regularly and the people in Karolinska are experts."

http://www.irishhealth.com/article.html?id=4396

Telaranta reveals what is wrong with the surgery:

The first aim in correctional surgery is to restore normal neuronal pathways in the sympathetic chain. This can be accomplished by:

1. Excision of the scar and a neurolysis around the healthy nerve ends. This often gives immediate relief in the compensatory hyperhidrosis by stopping the neuropathic feedback hypersensitivity. If pain has been included in the side effects, it is usually right away diminished after the neurolysis.

2. Adding fresh nerve stimuli to the midbrain structures. To accomplish this we transpose the living intercostal nerve to the stellate (T1) ganglion.
This procedure adds to the possibility of thermoregulatory feedback between the lower sympathetic chain and the midbrain ganglia. Also the energy level may be restored, if damaged in the first surgery. This result is often immediate.

http://www.privatix.fi/index.shtml?&a=0&s=navig_03&l=en&d=02_reversal

Mia: Telaranta in his summary describing what he can improve on with his 'reversal of ETS'. First he has to admit what goes wrong with Sympathectomy in the first place. None of these effects (side-effects) is included on any of the patient information brochures, and patients are lead to believe that the surgery will only affect their skin sweating - in a good way. In his text we find admission that it also affects midbrain and it's function. As far as I tell from the extensive research I have undertaken, none of the surgeons offering this simple, 'almost miraculous' surgery ever mentioned ETS (Sympathectomy) affecting brain function.

There should be no surprise why are there so many websites and forums dedicated to the patients outrage, grief and support, as the medical community refuses to acknowledge these side-effects - unless there is some incentive, as there is in this case. The high number of patients seeking reversal surgeries is should provide and indication of the problem.

19% of patients suing Telaranta?!

29 % benefited greatly from the procedure and 81 % had at least useful recovery with a marked relief in the reflex sweating. Only 19 % denied all benefit, but none of these claimed any worsening of the situation. Even these patients may have had some benefit, but because of the pending lawsuits and compensation requests it is understandable, that willingness to evaluate positively the end result is not at the highest level.

REFINED REVERSAL SURGERY OF ETS
updated 1.9.2008

Timo Telaranta, MD, PhD, Ass. Prof. of Clinical Surgery, Rome, Italy

http://www.privatix.fi/index.shtml?&a=0&s=navig_03&l=en&d=05_results

Sympathectomy causes changes in the noradrenergic-dopaminergic feed-back systems

The results of motor improvement may be due to changes in the noradrenergic-dopaminergic feed-back systems. It is also possible that the autonomic nervous system plays a role in the Parkinson's disease which is still poorly understood.

Relief of extrapyramidal symptoms
by sympathetic block
2003-05-17
http://www.privatix.fi/index.shtml?&a=0&s=navig_03&l=en&d=extrapyramidal

Hyperglycemic responses attenuated by sympathectomy

Hyperglycemic responses to CDP-choline, choline, cytidine monophosphate and cytidine were not affected by chemical sympathectomy, but were prevented by bilateral adrenalectomy. Phosphocholine-induced hyperglycemia was attenuated by bilateral adrenalectomy or by chemical sympathectomy. These data show that CDP-choline and its metabolites induce hyperglycemia which is mediated by activation of ganglionic nicotinic receptors and stimulation of catecholamine release that subsequently activates 2-adrenoceptors.
Archives Of Physiology And Biochemistry, Volume 113, Issue 4 & 5 October 2007 , pages 186 - 201 First Published on: 03 October 2007

Reactions to drugs after sympathectomy

Antihypertensive effects of thiazide diuretics may be enhanced in patients with a sympathectomy.
p.262

Handbook of Drug Interactions: A Clinical and Forensic Guide

By Ashraf Mozayani

Edition: illustrated

Published by Humana Press, 2004

ISBN 1588292118, 9781588292117

663 pages

Causes of male infertility

Sympatholytic drugs or sympathectomy - p. 662

Endocrinology & metabolism

By Philip Felig, Lawrence A. Frohman

Edition: 4, illustrated

Published by McGraw-Hill Professional, 2001

ISBN 0070220018, 9780070220010

1562 pages

Bilateral thoracoscopic cervical sympathectomy for the treatment of recurrent polymorphic ventricular tachycardia

Congenital long QT syndrome (LQTS) is a disorder of prolongedcardiac repolarisation, manifest by a prolonged QT intervaland characterised by recurrent presyncope/syncope, polymorphicventricular tachycardia (PMVT), or sudden cardiac death.
She was ultimately treated successfullywith bilateral thoracoscopic cervicothoracic sympathectomies.This is the first reported bilateral thoracoscopic treatmentof a patient with LQTS and symptomatic life threatening ventriculartachyarrhythmias refractory to current pharmacological and pacingtechniques.
Heart 2005;91:15-17
© 2005 by BMJ Publishing Group & British Cardiac Society

ETS reduces anxiety. Is it a psychosurgery?

The results of STAI showed significant improvement inthe levels of anxiety after surgery compared with the preoperativelevels and with established norms (p <>Conclusions:Patients with primary hyperhidrosis that undergo EBTS presenteda decrease in the level of anxiety and associated symptoms.

Eur J Cardiothorac Surg 2006;30:228-231
© 2006 Elsevier Science NL

sympathectomy suppressed baroreflex control of heart rate

Our results indicated that T2-3 sympathectomy suppressed baroreflex control of heart rate in both pressor and depressor tests
in the patients with palmar hyperhidrosis. We should note that baroreflex response for maintaining cardiovascular stability is suppressed in the patients who received the ETS.
Anesthesiology 2001; 95:A160

Is this and admission that ETS causes reduced exercise tolerance?!

So far Dr. Reisfeld has performed approximately 35 clamp removal procedures. The results are not 100% but about 50% of those cases showed improvements in their clinical condition which translated into reduction of compensatory sweating, better exercise tolerance, re-appearance of sweat in the hands and upper body, etc. Obviously more time is needed to come to any definite conclusions and also we will need more cases so statistical analysis can be made.
http://www.sweaty-palms.com/detailsofsurgery.html

Depression of Endothelial Nitric Oxide Synthase but Increased Expression of Endothelin-1 Immunoreactivity in Rat Thoracic Aortic Endothelium Associated With Long-term, but Not Short-term, Sympathectomy

Gjumrakch Aliev, Vera Ralevic, Geoffrey Burnstock
(Circulation Research. 1996;79:317-323.)
© 1996 American Heart Association, Inc.

Cardiac function after sympathectomy

These findings suggest that cardiac muscle cells require thyroxin for normal growth and enzyme development. Also, Sx (Sympathectomy) may impair cardiac functional capacity by altering Ca2+ activity of actomyosin ATPase.
Am J Physiol Cell Physiol 236: C30-C34, 1979;
0363-6143/79 $5.00

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sympathectomy interrupts neural messages to many different organs, glands and muscles

Acquired cardiovascular disease following Sympathectomy

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.

The Journal of Thoracic and Cardiovascular Surgery
Volume 137, Issue 3, March 2009, Pages 664-669

decreased conditioning-related activity in insula and amygdala after autonomic denervation

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.

http://www.ncbi.nlm.nih.gov/pubmed/11856537

Surgical and chemical sympathectomy can alter cellular proliferation

Surgical denervation and chemical sympathectomy can alter cellular proliferation, B- and T-cell responsiveness and lymphocyte migration in lymphoid organs [17].

In vitro studies have shown that neuropeptides can have numerous effects, either inhibiting or stimulating the proliferation, differentiation and functions of immune cells [19]* Development of systemic lupus erythematosus in mice is associated with alteration of neuropeptide concentrations in inﬂamed kidneys and immunoregulatory organs

Neuroscience Letters 248 (1998) 97– 100

Cell body reorganization in the spinal cord after elective surgery to treat sweaty palms

The amount of compensatory sweating depends on the patient, the damage that the white rami communicans incurs, and the amount of cell body reorganization in the spinal cord after surgery.

Other potential complications include inadequate resection of the ganglia, gustatory sweating, pneumothorax, cardiac dysfunction, post-operative pain, and finally Horner’s syndrome secondary to resection of the stellate ganglion.
www.ubcmj.com/pdf/ubcmj_2_1_2010_24-29.pdf

After severing the cervical sympathetic trunk, the cells of the cervical sympathetic ganglion undergo transneuronic degeneration
After severing the sympathetic trunk, the cells of its origin undergo complete disintegration within a year.
http://onlinelibrary.wiley.com/doi/10.1111/j.1439-0442.1967.tb00255.x/abstract

Spinal cord infarction occurring during thoraco-lumbar sympathectomy
J Neurol Neurosurg Psychiatry 1963;26:418-421 doi:10.1136/jnnp.26.5.418

Retrograde Changes in the Nervous System Following Unilateral Sympathectomy

In consequence of right-sided smpathectomy at the level of C5 it was found that in the sheep the cervical sympathetic trunk contains nerve fibres which proceed from cells situated in the first four segments of the thoracic part of the spinal cord and in the stellate ganglion. These fibres are about 85 per cent of all fibres of the sympathetic trunk.
http://onlinelibrary.wiley.com/doi/10.1111/j.1439-0442.1967.tb00255.x/abstract

Segmental myoclonus was associated with thoracic sympathectomy

Spinal myoclonus was associated with laminectomy, remote effect of cancer, spinal cord injury, post-operative pseudomeningocele, laparotomy, thoracic sympathectomy, poliomyelitis, herpes myelitis, lumbosacral radiculopathy, spinal extradural block, and myelopathy due to demyelination, electrical injury, acquired immunodeficiency syndrome, and cervical spondylosis.

http://www.ncbi.nlm.nih.gov/pubmed/3753263

Spinal myoclonus is typically associated with a localized area of damaged tissue (focal lesion). The injured area may include direct damage of the spinal cord or may cause abnormal changes in the function of the spinal cord.

http://www.wemove.org/myo/myo_pc.html

Spinal myoclonus following a peripheral nerve injury: a case report

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2526081/

cross-inhibitory control of various afferent in the spinal cord

In conclusion, our results suggest that cross-inhibitory control by various afferents in the spinal cord may exist in the feet as well as in the contralateral hand. The release of cross-inhibitory control by T3 sympathicotomy results in vasoconstriction and a decrease of skin temperature on the contralateral hand and the feet.

The basic neuronal network for this reciprocal organization is probably located in the spinal level (15). Therefore, the reduction in the contralateral skin temperature may be explained by cross-inhibitory control of various afferent in the spinal cord.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2722005/

Contralateral temperature changes of the finger surface during video endoscopic sympathectomy for palmar hyperhidrosis
http://www.ncbi.nlm.nih.gov/pubmed/8832515

Spinal Ischemic Stroke from complications of abdominal surgery, esp. sympathectomy

Viktor’s Notes℠ for the Neurosurgery Resident
Please visit website at www.NeurosurgeryResident.net
Updated: April 17, 2010

painful vasospastic condition in the right arm following surgical sympathectomy on the left side

decline in external heart work due to sympathectomy both at rest and under exercise

Hemodynamic changes in vertebral and carotid arteries were observed after sympathicotomy for PH

ATELECTASIS IS A COMMON PULMONARY COMPLICATION FOLLOWING THORACIC AND UPPER ABDOMINAL PROCEDURES

General anesthesia and surgical manipulation lead to atelectasis by causing diaphragmatic dysfunction and diminished surfactant activity. The atelectasis is typically basilar and segmental in distribution. After induction of anesthesia, atelectasis increases from 1 to 11% of total lung volume. End-expiratory lung volume is also found to be decreased.

Postoperative atelectasis is extremely common. Lobar atelectasis is also common. The incidence and prevalence of this disorder are not well documented.

http://emedicine.medscape.com/article/296468-overview#a0104

Atelectasis occurs regularly after induction of general anesthesia, persists postoperatively, and may contribute to significant postoperative morbidity and additional health care costs. Laparoscopic surgery has been reported to be associated with an increased incidence of postoperative atelectasis.

Anesth Analg 2009; 109:1511-1516

RESPONSE TO SYMPATHETIC BLOCKADE DEPENDS ON THE DEGREE OF SYMPATHETIC TONE BEFORE THE BLOCK

Denervation of preganglionic cardiac accelerator fibres leaving the cord at T1-T5 results in minimal vasodilatory consequences. Changes however in heart rate, left ventricular function and myocardial oxygen demand may occur due to high thoracic epidural blockade and are discussed below.

The major determinant of heart rate is the balance between sympathetic and parasympathetic systems with the latter predominating. A high thoracic epidural anaesthesia (TEA) covering the cardiac segments (T1-T4) produces small but significant reductions in heart rate4-8. During cardiac sympathetic denervation, parasympathetic cardiovascular responses, including those involved in baroreflexes, may dominate.

Individual cardiovascular response to different levels of sympathetic blockade varies widely, depending on the degree of sympathetic tone before the block.
Anaesth Intensive Care 2000; 28: 620-635
B. T. VEERING*, M. J. COUSINS†
Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands and Department of Anaesthesia and
Pain Management, University of Sydney, Royal North Shore Hospital, Sydney, New South Wales

limited sympathectomy does not reduce postoperative compensatory sweating

On univariate and multivariate analysis, the extent of denervation was not associated with the occurrence or the severity of compensatory sweating.

Compensatory sweating and temporary relief/recurrence were equally considered to be the main causes of dissatisfaction. CONCLUSION: Compensatory sweating was the most common long-term complication of thoracodorsal sympathectomy for primary hyperhidrosis. Its incidence and severity were not associated with the extent of sympathectomy.

http://www.ncbi.nlm.nih.gov/pubmed/12514588

cervical sympathectomy is a psychosurgery

Effects of upper abdominal sympathectomy on gastric acid, serum gastrin, and catecholamines

Selective upper abdominal sympathectomy increased basal acid output in rats but was without effect on stimulated acid output, serum gastrin concentration, and gastric mucosal histidine decarboxylase activity. The sympathectomy was verified by fluorescence histochemistry and determination of tissue catecholamines. A drastic reduction in tissue noradrenaline, adrenaline, and dopamine levels occurred after sympathectomy, and fluorescence microscopy showed a complete loss of adrenergic nerve fibers. Vagotomy reduced catecholamine levels in the stomach wall by 50% but did not affect the catecholamine content in the pancreas and small bowel. Surprisingly, combined vagotomy and upper abdominal sympathectomy resulted in lower catecholamine levels than sympathectomy alone in extragastric but not in gastric tissues.

http://www.ncbi.nlm.nih.gov/pubmed/6515311

our ignorance of the mechanisms of primary hyperhidrosis and of the effect of sympathetic ablation

Muliptle organ failure as a consequence of elective sympathectomy

In the post-sympathectomy patient, the abnormalsympathetic skin response may lead to peripheral vascular failureor the reduced cardiac chronotropic response may impair thebody’s capacity to compensate for shock. These may havecontributed to the rapid development of shock and severe multipleorgan dysfunction syndrome in this patient.
He had multiple organ dysfunction syndrome develop, with severerenal and hepatic failure, grade II hepatic encephalopathy,and disseminated intravascular coagulation. He responded remarkablywell to aggressive supportive measures including forced alkalinediuresis, and he was eventually discharged home after 1 month. The patient was previously a healthy, physically fit, nonsmoker.He worked as a body building trainer and led an active, sportylifestyle. The only significant medical history was that hehad received thoracic sympathectomy for axillary hyperhidrosis4 years ago at another hospital.

http://ats.ctsnetjournals.org/cgi/content/full/84/3/1025

the muscles that are supplied by these nerves shorten and tighten

This now well-established but generally under-appreciated principle of physiology is aptly known as 'Cannon's Law of Denervation Supersensitivity'. It describes the wide ranging effects of the complete loss of nerve inputs to a variety of bodily structures under experimental conditions. One of the many responses to nerves that are sick or dysfunctional (now termed Disuse Supersensitivity) is that the muscles that are supplied by these nerves shorten and tighten (due to the supersensitivity of both the muscle's specialized stretch receptors and motor nerve-muscle junctions), resulting not only in muscle spasm and stiffness which limit flexibility, but a whole sequence of pain compounding reactions. The two earliest are that localized taut bands of muscle fibers begin to compress the small specialized pain sensing (and now extra-sensitive) nerve fibers within the muscle (known as myofascial tender or trigger points) causing type 1 pain, and the compressed muscles do not allow proper blood flow in, or waste products to be removed. This leads to a build up of lactic acid, which further enhances the perception of pain through type 2 pain mechanisms. Continued and prolonged muscle shortening or contracture gradually leads to increased mechanical tension on the muscle's tendonous attachments to bone, causing all of the various tendonitis (types 1 & 2 pain) syndromes throughout the body. The end result is a truly vicious snowballing cycle of pain, with the muscle shortening further increasing pressure on the nerves.

www.northwestims.com/faq-4.html

Cannon's law of denervation tells us that if a post-ganglionic neurone has it's pre-ganglionic input removed, then it will become super-sensitive to the normal neurotransmitters that mediate that pre-ganglionic input. There is a variety of reasons for this, including up-regulation of receptors for the neurotransmitter(s), post-receptor effects, and impaired removal of neurotransmitters from the synapse

www.anaesthetist.com/anaes/patient/ans/

Most authors do not describe clinically significant capsular adhesions as a predominant finding in the chronic phase of this condition. Instead, pathologic data confirm an active process of hyperplastic fibroplasia and excessive type III collagen secretion that lead to soft-tissue contractures of the aforementioned structures (ie, the coracohumeral ligament, soft tissues of rotator interval, the subscapularis muscle, the subacromial bursae). However, these findings were observed in surgical patients who had severe and late-phase disease and cannot be applied to early phases of the disease.

From the chromosomal, cytochemical, and histologic points of view, the soft-tissue contractures are identical to those seen in a Dupuytren contracture of the hand. These contractures result in the classic progressive loss of ROM of the glenohumeral joint, which affects external rotation and abduction, then flexion, adduction, and extension (in descending order of severity). Despite these histopathologic similarities, the favorable and regressive outcome of adhesive capsulitis differs from the unfavorable and progressive outcome of Dupuytren disease.

http://emedicine.medscape.com/article/326828-overview#a0104

The courts have become the sole policing body for the medical profession

Major lawsuits, with the major judgments that go with them, may not completely keep negligent physicians from practicing, but they are the one way that currently exists to deter these individuals from practicing their inept brand of medicine. "

Over the years, we have given a lot of thought to why the medical profession adheres to this code of silence. What is it about this profession that causes it to protect its own at the expense of the public?"

Harvey F. Wachsman: Lethal Medicine

Publisher: Henry Holt & Co

All patients except one suffered from compensatory sweating

Complications in patients with palmar hyperhidrosis treated with transthoracic endoscopicsympathectomy.

Neurosurgery. 1997 Jul ;41 (1):110-3; discussion 113-5 9218302

OBJECTIVE: To assess the complications in a group of patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy. The extraordinarily high incidence of postoperative compensatory hyperhidrosis in our series is stressed and explained. METHODS: The retrospective study included chart reviews and outpatient assessments. Seventy-two patients underwent T2 or T2-T3 endoscopic sympathectomy for primary palmar hyperhidrosis. Patients' hyperhidrosis severity, precipitating factors, postoperative complications, surgical results, and satisfaction were assessed. Severity of palmar hyperhidrosis and compensatory hyperhidrosis was classified by two grading scales. RESULTS: The success rate ofsympathectomy was 93%. All patients except one suffered from compensatory sweating,which was the main cause of patients' dissatisfaction postoperatively. Seventeen percent of the patients (12 of 72 patients) experienced new symptoms of gustatory sweating (facial sweating associated with eating). Twenty-one patients experienced other complications, including pneumothorax, Horner's syndrome,nasal obstruction, and intercostal neuralgia.

'Emotional' sweating regulated by neocortex and limbic cortex

Careful observations showed that the forearm sweating responded diversely to various mental stimuli, unlike the palmar sweating whose response was always an increase. Mental arithmetic, mental testing and physical exercise caused an immediate increase in the palmar sweating but often elicited a transient decrease in the forearm sweating, whereas pain, noise, and emotional stimuli consistently provoked an increase of sweating on the forearm as well as on the palm. These observations suggest that the activities of higher centers, presumably involving neocortex and limbic cortex, exert various influences on the central mechanisms of palmar and generalized sweating.
Jpn J Physiol. 1975;25(4):525-36.
http://www.ncbi.nlm.nih.gov/pubmed/1206808

Very severe discomfort following sympathectomy with alarming frequency and intensity

a reduction of the muscular tone and to a secondary neurovascular disorder after sympathectomy

Neuroma following nerve injury/surgery

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

www.tarsaltunnelcenter.com/assets/recurrent.shtml

hyperhidrosis is not related with social phobia or personality disorder

The total reward dependence and persistence scores were significantly higher in hyperhidrosis patients. The fear of uncertainty in the harm avoidance scale was found to be significantly greater in hyperhidrosis patients. Regarding character dimensions, the total score in each of the subscales self-directedness, cooperativeness and self-transcendence was found to be higher in hyperhidrosis patients. Conclusion: The higher scores of all subscales of character dimensions in hyperhidrosis patients suggest that hyperhidrosis is not related with social phobia or personality disorder.

http://www.online.karger.com/ProdukteDB/produkte.asp?Aktion=ShowFulltext&ArtikelNr=99589&Ausgabe=232867&ProduktNr=224164

Use of stellate ganglion block for the treatment of psychiatric and behavioral disorders

The present invention is directed to a method for the treatment of a patient suffering from psychiatric and behavioral disorders, including post partum depression, post traumatic stress disorder, compulsive smoking, attention deficit hyperactivity disorder, gambling addiction, comprising the step of administering a stellate ganglion block to the patient to alleviate the symptoms. The stellate ganglion block may be followed by a sympathectomy to provide permanent relief.

United States Patent 20070135871

Kind Code: A1

http://www.freepatentsonline.com/y2007/0135871.html

slowing of the heart rate usually occurs on the second to fourth day after sympathectomy

The rate fell to a level between 40 and 6o per minute, the maximal slowing usually occurring on the second to fourth day after operation. Consistent slowing of the rate was not observed after a unilateral thoracic sympathectomy of either side. While there was some recovery from the maximum bradycardia with the passage of time in most patients, relatively slow resting cardiac rates and failure of tachycardia to develop with postural hypotension or exercise persisted in all patients.

Skoog's12 work has shown that there are marked differences in the number and precise location of the accessory ganglion cells in the cervical region in different patients and on the two sides in the same patient.
Annals of Surgery, 1949 October, Volume 130 Number 4

Receptor hypersensitivity is a common problem

Because of their size and location, injuries to the sympathetic ganglia or chain is rarely indicated or performed. Receptor hypersensitivity is a common problem after significant sympathetic injury, including clammy hands, erythema, and allodynia. When sympathetic nerves regenerate, they may establish aberrant connections to sensory receptors, muscles, or other sympathetics receptors; this may lead to an over-response or abnormal response.
http://wiki.cns.org/wiki/index.php/Injury,_Sympathetic_Nerve

he could not be thrilled in the sympathectomized half of his body

Sweet* has reported the case of a very intelligent patient, the dean of a graduate school, who after a unilateral sympathectomy to treat his upper limb hyperhidrosis, found that his previous and customary sensation of shivering while listening to a stirring passage of music occurred in only one side and he could not be thrilled in the sympathectomized half of his body. These cases were interesting because emotions are usually experienced in a rather diffuse and bilateral fashion unless innervation has been specifically interrupted. (p.134.)
Jose M.R. Delgado, M.D.
Physical control of the mind,
Harper Torchbooks, Harper & Row Publishers, 1971

*Sweet, W.H. Participant in "Brain Stimulation in Behaving Subjects". Neurosciences Research Program Workshop. Dec. 1966

Permanent thermoregulatory dysfunction after ETS

What you see here is not a result of the surgery gone wrong, this is the inevitable consequence of cutting/clamping the sympathetic chain, independently of skill of the surgeon, experience of the surgeon, T2, or T3, T4, or method used. Once the communication is disrupted, (and it happens with the clamping as well), it will disable the body's thermoregulation and will cause malfunctioning of the sympathetic nervous system. This damage is permanent and irreversible. There has been no controlled clinical trial into the effects of this surgery on humans or its safety, but it is still used for many conditions: angina pectoris, to lower blood pressure, to treat migraine, to reduce pain in cancer patients, to reduce immuneresponses after skin transplant, to treat various cancers in the oral cavity, and among many: to treat anxiety disorders, schizophrenia, and phobias. Every drug introduced into the market has to go through rigorous testing procedures before approval. This does not apply to surgeries. It is left to the surgeons to decide whether they offer sympathectomy or not. It is not based on scientific evidence and research but 'opinion' and business plan. Patients are rarely followed up and if they are, the questions asked are limited. Patient complaints about unexpected symptoms are dismissed as imagined - until you speak to someone who has an understanding of the ANS.

denervation supersensitivity of alpha recepors following sympathectomy

There is, however, considerable risk of developing a post-sympathectomy pain syndrome that may be the result of a denervation supersensitivity of alpha receptors.
www.mc.vanderbilt.edu/.../Complex%20Regional%20Pain%20Syndrome-1...

Paradoxically it has been suggested that in some cases there may be abnormal vasoconstriction rather than the expected vasodilatation after sympathectomy.
ats.ctsnetjournals.org/cgi/content/full/84

complex alterations of vascular reactivity

In conclusion, we showed that sympathectomy produces complex alterations of vascular reactivity both in vivo and in isolated vessels, which shift the balance of the sensitivity of the vessel between vasoconstrictor and vasodilating agents towards an increased constriction. These results are unlikely to simply reflect denervation supersensitivity; their underlying receptor, post-receptor and/or contractile mechanisms are yet to be identified. Journal of Hypertension. 18(8):1041-1049, August 2000.

Haematological changes during stress abolished by sympathectomy

http://www3.interscience.wiley.com/journal/120731423/abstract

Receptor hypersensitivity is a common problem

causes of autonomic dysfunction - sympathectomy

The finger wrinkling response is abolished by upper thoracic sympathectomy. The test is also abnormal in some patients with diabetic autonomic dysfunction, the Guillan-Barre syndrome and other peripheral sympathetic dysfunction in limbs. (p.46)

Other causes of autonomic dysfunction without neurological signs include medications, acute autonomic failure, endocrine disease, surgical sympathectomy . (p.100)

Disorders of the Autonomic Nervous System

By David Robertson, Italo Biaggioni

Edition: illustrated

Published by Informa Health Care, 1995

ISBN 3718651467, 9783718651467

A depression in the heart rate and decrease in response to stress is expected

decreased conditioning-related activity in insula and amygdala after autonomic denervation

http://www.ncbi.nlm.nih.gov/pubmed/11856537

the primary event of gustatory sweating is a degeneration of the cervical sympathetic neurons

The development of gustatory sweating after cervical sympathectomy can only be explained if one is to admit that the primary event of gustatory sweating is a degeneration of the cervical sympathetic neurons. The initial event is the loss of postganglionic sympathetic neurons and the resulting denervation of the corresponding facial sweat glands. Regeneration of parasympathetic fibers, within the degenerating sympathetic neurilemmal sheets, is a secondary event although it accounts for the observed symptoms.

Salivary gland disorders

Eugene N. Myers, Robert L. Ferris

Springer, 2007 - Medical - 517 pages

International systematic reviews of ETS surgery warn of insuffiecient evidence on ETS

Australian Review of ETS surgery

"A lack of high quality randomised trial evidence on ETS means that it is difficult to make a judgment on the safety and effectiveness of this technique. There is potentially a number of safety issues associated with this procedure. ASERNIP-s suggests that a full systematic review including all available comparative and case series information, together with clinical inpuut, should be undertaken to provide up-to-date and comprehensive assessment of the safety and effectiveness of ETS." (ASERNIP-s Report No. 71, August 2009)

Australian Review of ETS surgery - 2001

The four case series were not critically appraised because they are prone to bias and have significant methodological problems. These studies represent level IV evidence according to the NHMRC criteria and one should not draw firm conclusions from their findings.

To date, the benefits or side effects associated with endoscopic thoracic sympathectomy for treating facial blushing have not been properly evaluated and reported.

Further research using a well-designed controlled trial is warranted to assess the efficacy of endoscopic thoracic sympathectomy for treating facial blushing.

Centre for Clinical Effectiveness - Monash

Swedish Review

Finnish Review

UK Review of ETS surgery

We did not identify any controlled trials or cohort studies. The
evidence about effectiveness, based on three case series, was
therefore very limited. The main weakness of these studies was their lack of a comparison group and their resulting inability to exclude a placebo response to surgery. In addition, the methods of assessing outcome were poorly described and not validated, and the range of outcomes assessed was limited. The studies provided very limited evidence that sympathectomy improves blushing. Side effects were common.
London: Bazian Ltd (Editors), Wessex Institute for Health Research and Development, University of Southampton 2003: 11

Wiley & Sons, Inc, news release - 2004

"Lifestyle" surgical procedure carries unrecognized risk of complications.”
Hoboken, NJ: John Wiley & Sons, Inc, British Journal of Surgery, Feb 5, 2004

"Sympathectomy is a technique about which we have limited knowledge, applied to disorders about which we have little understanding." Harald Breivik Professor og avdelingsoverlege Anestesiavdelingen, Rikshospitalet http://www.pfizer.no/templates/Page____886.aspx

The aim of the present prospective study was to confirm that a significant impairment of the heart rate to workload relationship was consistently observed following unilateral and/or bilateral (sympathectomy) surgery. Eur J Cardiothorac Surg 2001;20:1095-1100 http://ejcts.ctsnetjourna...i/content/full/20/6/1095

The authors found that the incidence of hypotension was a function of the level of sympathetic denervation, occurring in 60% of patients with a T7 sympathectomy, and in 100% of patient with a T4 or higher level of sympathectomy.
(p 226)

"Inappropriate" bradycardia (i.e. "normal" HR in face of ↓MAP with sensory level T3-T4)
Peripheral vasodilation should evoke an ↑ HR. But ↓ venous return → ↑vagal tone, so HR remains at preblock rate but is "inappropriately" slow.

Central neuraxial anesthesia-induced sympathectomy leads to peripheral vasodilation, reduced preload, and subsequently decreased cardiac output. The incidence and extent of hypotension depends on the height of the block, the patient's position, and whether appropriate measures were instituted prophylactically to minimize hypotension.

After thoracoscopic sympathectomy for hyperhidrosis, very severe discomfort and hyperhidrosis in the neighboring non-sympathectomized regions occurred with alarming frequency and intensity.
(p.879)

Cousins and Bridenbaugh's Neural Blockade in Clinical Anesthesia and Pain Medicine by Michael J Cousins, Phillip O Bridenbaugh, Daniel B Carr, and Terese T Horlocker

Wolters Kluwer Health
Edition: 4 - 2008

Clinical Anesthesiology By G. Edward Morgan, Maged S. Mikhail, Michael J. Murray
McGraw-Hill, Edition: 3, 2002

“cervical sympathectomy isolates all these sympathetic ganglion cells from the central nervous system and prevents them from responding to reflex or emotional changes in the central nervous system." Cunningham's Manual of Practical Anatomy: Volume III: Head, Neck and Brain, 1986

ETS is a surgical procedure for hand sweating and blushing. This is achieved by cutting the sympathetic chain, resulting in autonomic dysfunction and the inability to sweat on the upper body. But it does more than that.
“cervical sympathectomy isolates all these sympathetic ganglion cells from the central nervous system and prevents them from responding to reflex or emotional changes in the central nervous system."
Cunningham's Manual of Practical Anatomy: Volume lll: Head, Neck and Brain, 1986

disturbed peripheral vascular and heart rate responses after sympathectomy

Denervation supersensitivity leads to Raynaud's Disease

$Denervation supersensitivity leads to Raynaud\$
Cannon and his colleagues showed in the 1930s that section and subsequent degeneration of the sympathetic nerves led to a marked supersensitivity of the sturcture to exogenous catecholamines. The increase in sensitivity ranged from 10-to 100-fold in different tissues, such as the spleen on section of the splenic nerves, or the nictitating membrane on section of the postganglionic cervical sympathetic nerve or the heart on removal of the stellate ganglion. In smooth muscle the increase in sensitivity is mostly explained by the associated loss of neuronal re-uptake of noradrenaline, with only a lesser role for the increase in receptor numbers. Mechanisms of Drug Action on the Nervous System by Ronald W. Ryall, Cambridge University Press, 1989

Changes in Electrophysiology following sympathectomy

Sympathectomised dogs presented significant increases in: basic sinus period, sino-atrial conduction time (SACT), AH and HV intervals of the His bundle electrogram, atrial functional (AFRP) and effective (AERP) refractory periods, atrio-ventricular node functional (AVNFRP) and effective (AVNERP) refractory periods, ventricular functional (VFRP) and effective (EVRP) refractory periods and atrial (AMAP) and ventricular (VMAP) monophasic action potential durations. Corrected sinus recovery time (CSRT) was not affected by chemical sympathectomy. Neither was the atrial ERP/MAP duration ratio. This new form of sympathectomy affects all the levels of the cardiac conduction system. Such results are in accordance with those obtained with surgical sympathectomy or the use of beta-blocking agents.

DIANE GODIN*, CLAUDE GUIMOND{dagger}, RÉGINALD A NADEAU{ddagger} and A ROBERT LEBLANC§

Cardiovascular Research 1982 16(9):524-529;
© 1982 by European Society of Cardiology

Cardiovascular collapse caused by carbon dioxide insufflation during sympathectomy

Carbon dioxide insufflation into the pleural space during one-lung anaesthesia for thoracoscopic surgery is used in some centres to improve surgical access, even though this practice has been associated with well-described cardiovascular compromise. The present report is of a 35-year-old woman undergoing thoracoscopic left dorsal sympathectomy for hyperhidrosis. During one-lung anaesthesia the insufflation of carbon dioxide into the non-ventilated hemithorax for approximately 60 seconds, using a pressure-limited gas inflow, was accompanied by profound bradycardia and hypotension that resolved promptly with the release of the gas.
Australian Society of Anaesthetists 2002

Sympathetic regulation of the cerebral circulation by the carotid chemoreceptor reflex

After bilateral cervical sympathectomy (n = 9), carotid chemoreceptor reflex stimulation induced significantly different (P less than 0.01) effects on cerebral blood flow, which rose by 42 +/- 8%, and cerebral vascular resistance, which did not change.
In "sham" dogs, the repeat response to carotid chemoreceptor stimulation also induced significantly different effects from those in dogs with sympathectomy. Thus, in the conscious dog, stimulation of the carotid chemoreceptor reflex elicits significant sympathetically mediated vasoconstriction in cerebral vessels.
Am J Physiol Heart Circ Physiol 238: H594-H598, 1980;

Effect of adrenalectomy or sympathectomy on spinal cord blood flow

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

Heart and Circulatory Physiology, Vol 260, Issue 3 827-H831, Copyright © 1991 by American Physiological Society

A. Iwai, W. W. Monafo and S. G. Eliasson
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110.

Sympathectomy induced adrenal hypertropy

Journal of Hypertension. 17(7):933-940, July 1999.
Qiua, Jingxin 1; Nelsona, Sharon H. 1; Spethb, Robert C. 2; Wanga, Donna H. 1,3

Objective: Previous studies indicate that the adrenal gland plays a compensatory role in the maintenance of blood pressure in chemically sympathectomized rats. However, the mechanisms responsible for compensatory adrenal responses are poorly understood. This study examined the regulation of adrenal growth and type 1A, 1B, and type 2 angiotensin II (Ang II) receptor (AT1A, AT1B and AT2) expression in the adrenal gland induced by sympathectomy.

Denervation supersensitivity leads to Raynaud's Disease

Changes in Electrophysiology following sympathectomy

Cardiovascular collapse caused by carbon dioxide insufflation during sympathectomy

Sympathetic regulation of the cerebral circulation by the carotid chemoreceptor reflex

Effect of adrenalectomy or sympathectomy on spinal cord blood flow

Sympathectomy induced adrenal hypertropy

Journal of Hypertension. 17(7):933-940, July 1999.
Qiua, Jingxin 1; Nelsona, Sharon H. 1; Spethb, Robert C. 2; Wanga, Donna H. 1,3

Sympathectomy supressed baroreflex control of heart rate

Loss of Baroreflex = aberrant blood pressure

Sympathectomy can be considered a psychiatric surgery

Circadian Rhythm eliminated by Sympathectomy

The abrupt increase and decrease in BP observed at the time when the lighting conditions are changed are eliminated by chemical sympathectomy

The disruption of the baroreflex selectively eliminatesthe circadian rhythm of BP, and the circadian rhythms of BP andHR are modulated by the autonomic nervous system in rats. The circadianrhythms of BP and HR are regulated by different mechanisms involvingthe autonomic nervous system.
(Circulation. 1997;96:1667-1674.)
© 1997 American Heart Association, Inc.

retarded adaptation of hemodynamics to a sudden start of exercise following sympathectomy

The exercise capacity and the increase of coronary and systemic hemodynamics under treadmill exercise were studied in 5 dogs, chemically sympathectomized with 6-hydroxy-dopamine.

Completeness of adrenergic denervation was verified by stimulation of the right stellate ganglion, by intravenous administration of tyramine, and by demonstration of supersensitivity to exogenous norepinephrine.

These dogs demonstrated a retarded adaptation of hemodynamics to a sudden start of exercise. A fall in mean arterial pressure below 45 mmHg within 10 to 15 sec lead to collapse.
steady state attainment of hemodynamic parameters was considerably delayed.

E. Bassenge¹, J. Holtz¹, W. v. Restorff¹ and K. Oversohl¹

Received: 18 April 1973

Things you might want to know about ETS:

What is ETS or Sympathectomy?

If you do a quick search on google because you want to find a solution for your sweaty palms, or do not want to blush every time someone looks at you, you will be flooded by all the information from the surgeons offering this procedure. If you only read these and do not have a medical background, you might fall for their statements and think to yourself: well, isn't medical science wonderful?!
You make your booking with one of the surgeons who will charm you and soon you are being wheeled in for the surgery with the promise from the surgeon, that it will change your life. You don't even know how true that is, until you wake up.
Here you will find the other side of the sales pitch and some answers to just how your life will never be the same.

Thermoregulatory Disfunction - Severe CS as the result of the elective surgery.

Note the sharp divisive line on chest: top anhidrosis, the body is unable to sweat and dissipate heat through shoulders, arms and head. 40% of heat is released from top of the head. This function of the thermoregulation is disabled for patients undergoing the selective surgery. Below the level of the T2 cut - Pathological sweating that requires complete change of clothes several times during the day. CS is not just thermoregulatory. It can be triggered by stress, in cold/winter conditions. All this as a result of an elective cosmetic surgery. The result is necessary consequence of disrupting the sympathetic chain and is independent of expertise or experience of the surgeon performing the procedure. Post ETS sweating can not be predicted. Sweating patterns prior to surgery are no relevant. There is no difference in gender or weight when it comes to CS. Some websites promoting the procedure will claim that CS diminished over time. The mechanism of CS is not understood and has not been investigated. In some cases it can take years to develop. Patients who are happy with the initial result of the surgery might deteriorate with the outcome and side-effects becoming worse.

ETS Surgery