Activation of immune cells in the central nervous system leads to the release of proinflammatory factors

There is also growing evidence that inflammation in the brain (neuroinflammation) might play the primary role in the pathogenesis of a number of neurodegenerative diseases like Alzheimer's disease (AD) and Parkisons disease (PD) (Minghetti 2005). Activation of immune cells in the central nervous system leads to the release of proinflammatory factors such as IL-1, IL-2, IL-6 and TNF-a which in turn have cytotoxic effects (neurotoxicity). It has also been speculated that neuroinflammation with disturbed glutamate metabolism is the cause of the fatigue that characterizes diseases like CS (Rönnback 2004).
Study protocol 070927: Version 1.4
Oskar Ragnarsson

Cervical sympathectomy causes alveolar bone loss

Cervical sympathectomy causes alveolar bone loss

Both superior cervical ganglionectomy and oral challenge with P. gingivalis resulted in accelerated alveolar bone loss. Gingival tissues in the superior cervical ganglionectomy group showed increased expression of the cytokines interleukin-1alfa, tumor necrosis factor-alfa and interleukin-6. The density of neuropeptide Y-immunoreactive fibers was decreased following superior cervical ganglionectomy. Osteoclasts were observed in the superior cervical ganglionectomy and P. gingivalis-challenged groups. Conclusion:  Both superior cervical ganglionectomy and oral challenge with P. gingivalis induced alveolar bone loss.

http://www.ingentaconnect.com/content/mksg/per/2009/00000044/00000006/art00002

73% of patients suffered form 'gustatory sweating' and variety of phenomena

In a series of 100 bilateral upper dorsal sympathectomies performed for palmar hyperhidrosis,
gustatory sweating and other gustatory phenomena were reported by 68 of 93 patients (73%),
followed up for an average of 11/2 years. These gustatory phenomena were quite different from
physiologic gustatory sweating: a wide range of gustatory stimuli caused a variety of phenomena in
varied locations. There was a negative correlation between the incidence of these phenomena and the
occurrence of Horner's syndrome after sympathectomy. Analysis of our observations, and of clinical
and experimental work of others, leads to the conclusion that gustatory phenomena after upper
dorsal sympathectomy are the result of preganglionic sympathetic regeneration or collateral sprouting
with aberrant synapses in the superior cervical ganglion.
•
Arch Neurol. 1977;34(10):619-623.

36% intense 'compensatory sweating'

The results and complication rates have not necessarily been similar in reports worldwide. This can be explained in part due to the lack of clear-cut definitions for the indications, success, complications, side effects, and short- and long-term follow-up data of the procedures. It is well known that sympathectomy is often complicated by CH; the reported incidence rates vary greatly from 30% to 84% [15]. In our series it has been noted in 62.5% of the patients (26.5% moderate and 36% intense).

Although VATS sympathectomy is a simple and quick procedure, unusual complications such as chylothorax may occur [16]. However, lethal or potentially serious complications have also been reported [8, 17, 18], such as subclavian artery injury, damage to brachial plexus, large hemothorax, cerebral edema, neurologic sequelae, sinus bradycardia, and cardiac arrest.
Ann Thorac Surg 2003;76:886-891

significant decrease of MAP, cardiac arrythmia, cardiac arrest and hypoxemia - complications of ETS surgery

Both MAP 1 and MAP2were reduced after sympahtectomy (P < 0.05). Heart rate was reduced transiently after the sympahtectomy and returned to the baseline value. PaO2 was reduced in 10 min after each right lung ventilation (P < 0.05) and left lung ventilation (P < 0.05).

Since thoracoscopic sympathectomy can rarely cause a significant decrease of MAP, cardiac arrythmia, cardiac arrest and hypoxemia, we concluded that invasive BP monitoring should be used for early detection of those complications and immediate arterial sampling.
Department of Anesthesiology and Pain Medicine, College of medicine, Kyung Hee University, Seoul, Korea
2004; 8: 147-153

perioperative alterations in hemodynamic changes

Our purpose was to examine perioperative alterations in hemodynamic changes with head-up tilt (HUT) in patients undergoing endoscopic thoracic sympathectomy (ETS).
Methods. The subjects were 11 patients with essential hyperhidrosis scheduled to undergo ETS (ETS group) and 9 age-matched volunteers undergoing minor surgery (control group). HUT was performed (40°; 5 min) before and after the surgery, under nitrous oxide anesthesia. Orthostatic hypertension and hypotension in response to HUT were defined as changes of 10% or greater in systolic blood pressure.
Results. The increase in heart rate in response to HUT was significantly reduced after surgery in the ETS group (from 34 ± 18 to 14 ± 11 beats·min−1; P < 0.001), but not in the control group (from 23 ± 18 to 22 ± 12 beats·min−1; P = 0.911). Orthostatic hypertension disappeared completely after ETS (from 5 of 11 to none of 11 patients; P = 0.035), whereas the prevalence of orthostatic hypotension increased significantly after ETS (from 3 of 11 to 9 of 11 patients; P = 0.030). In the control group, the prevalence of neither orthostatic hypertension nor orthostatic hypotension changed after surgery.

	Journal of Anesthesia
ISSN	0913-8668 (Print) 1438-8359 (Online)
Issue	Volume 16, Number 1 / February, 2002

controversial subject

The treatment of facial blushing and or facial sweating is a controversial subject. The uncontrolled and embarrassing situation of facial sweating and blushing was thought to be easily treated with ETS. This came about when ETS was done for patients with sweaty hands. Among those patients who also suffered from facial blushing and/or facial sweating the results were also successful at reducing facial blushing and/or sweating. However over the years two observations were made when this operation was applied only for patients with facial blushing and or facial sweating. Percentage wise these patients developed a higher rate of severe compensatory sweating. Also these patients experienced a higher degree of dissatisfaction due to the side effects. Side effects such as facial flushed feelings, loss of stamina, facial skin sensitivity, increased amount of fatigue and others led Dr. Reisfeld to the decision not to perform ETS when only facial blushing or facial sweating were involved. The clinical experience that was accumulated over the last several years is what has allowed Dr. Reisfeld to reach this assessment. More time is needed to reach a definite conclusion with regard to the most appropriate procedure for patients who suffer from only facial blushing and/or facial sweating.
http://www.sweaty-palms.com/blushing.html

haemodynamic instability during surgery

Rapid and excessive carbon dioxide insufflation into the closed chest cavity may create a tension pneumopthorax, displace the mediastinum, and compress the lungs and great vessels with consequent haemodynamic instability. During carbon dioxide insufflation using endobronchial intubation, Hartrey and colleagues reported a decrease in systolic arterial pressure of > 20 mm Hg in 21% of patients. Similarly, we have reported sudden hypotension and bradycardia after injudicious carbon dioxide insufflation.

In common with other surgical procedures, routine monitoring during thorascopic sympathectomy should include ECG, pulse oximetry and capnography. However, during thorascopic surgery, SpO2 and end-tidal carbon dioxide have the additional function of monitoring the surgical technique.
BJA 1997;79: 113-119

collateral effects of thoracic sympathectomy not disclosed to patients

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

Compensatory sweating occurred in 87% of the patients - serious in 36% and incapacitating in 6%

Compensatory sweating occurred in 87% of the patients - serious in 36% and incapacitating in 6%

Ann Thorac Surg. 2004 Nov;78(5):1801-7.

The rates of compensatory sweating and gustatory sweating were 93.5% and 49.4%, respectively

Surgical Endoscopy
Volume 23, Number 7 / July, 2009

Patients decide in what form the surgery should be performed!

The 25 patients with palmar hyperhidrosis who insisted on receiving ETS of T4 experienced no compensatory hyperhidrosis. Of the 54 patients with facial blushing who received ESB of T2, 23 experienced compensatory hyperhidrosis.
http://www.springerlink.com/content/j6k17332rhqjv663/

90 % of patients experienced severe compensatory sweating

Postsurgery, severe compensatory sweating was experienced in 90% of patients (P < 0.0001). The sites of
compensatory sweating were the back (75%), abdomen (51%), feet (23%), groin and thigh (13%), chest (13%), andaxillae (8%). Transient whole-body sweating for no apparent reason was experienced in 30% of patients.

Thirty-seven patients (11%) regretted having undergone the surgical procedure.

Main outcome measures included the incidence of dry hands, compensatory sweating, chest pain, upper-limb muscle weakness, shortness of breath, and gustatory phenomena;

Surg Laparosc Endosc Percutan Tech. 2000 Aug;10(4):226-9.

Gustatory sweating 56 %, recurrence rate 38% after Sympathectomy

Gustatory sweating in the neck was reported by nine patients (56%), which usually occurred in response to
hot or spicey foods.
The symptoms are not troublesome for most patients, but in severe cases furhter surgery might be required.
Six patients (38%/) also had mild recurrent sweating of the hands, especially in response to either extreme heat,
anxiety or food.
A return of sweating in the hands is common occurrence in patients followed up for sufficient length of time.

Annals of the Royal College of Surgeons of England (1989) vol. 7.1

Results support our hypothesis that blockade of the sympathetic nervous system substantially degrades ligament

2004, vol. 96, n^o2, pp. 711-718 [8 page(s) (article)] (44 ref.)

Supersensitivity to noradrenaline and chronic neuropathic pain conditions

Supersensitivity to noradrenaline contributes to certain vascular disorders (e.g., hypertension) and chronic neuropathic pain conditions (e.g., complex regional pain syndrome). We aimed to develop a procedure for inducing adrenergic supersensitivity that could be used to investigate the role of catecholamines in these clinical conditions.
These observations indicate that prolonged depletion of adrenergic stores by guanethidine induces adrenergic supersensitivity in cutaneous vessels, and that adrenergic supersensitivity enhances thermal hyperalgesia in the presence of noradrenaline.
Autonomic Neuroscience
Volume 88, Issues 1-2, 12 April 2001, Pages 86-93

Darren M. Lipnicki and Peter D. Drummond^,

School of Psychology, Murdoch University, Murdoch, Western Australia 6150, Australia

increased blood flow after sympathectomy is due to increased nonnutritive AVA flow

In the acute canine model, increased blood flow after sympathectomy is due to increased nonnutritive arteriovenous anastomoses (AVA) flow, with no change in total hindlimb capillary flow, both at rest and during reactive hyperemia.

Surgery. 1977 Jul;82(1):82-9.

sympathectomy on cerebral blood flow

CBF increased significantly after the elevation of systemic blood pressure compared with that in the control group, and cerebral autoregulation was impaired. After a 1-hour study, the specific gravity of the cerebral tissue in the treated group significantly decreased; electron microscopic studies at that time revealed brain edema. It is suggested that depletion of brain noradrenaline levels causes a disturbance in cerebral microvascular tone and renders the cerebral blood vessels more vulnerable to hypertension.
J Neurosurg. 1991 Dec;75(6):906-10.

sympathectomy leading to an extracranial steal phenomenon.

The incidence and extension of brain infarcts was increased in animals with additional ipsilateral cervical preganglionic sympathectomy. Sympathectomy did not affect markedly the respiration and systemic circulation. The effect of sympathectomy was attributed to a cutaneous vasodilation, leading to an extracranial steal phenomenon.
J Neurol Neurosurg Psychiatry. 1983 August; 46(8): 768–773.

ventilation technique may prevent hypoxemia during endoscopic sympathectomy

The near-sitting position, a single-lumen tube, and a continuous two-lung ventilation technique is simple and may prevent hypoxemia during endoscopic transthoracic sympathectomy.
Journal of Cardiothoracic and Vascular Anesthesia
Volume 10, Issue 2, February 1996, Pages 210-212

chronic sympathectomy on muscle fibre composition

It is concluded that sympathectomy induces several biochemical changes in skeletal muscle which constitute a change and increase in fast myosin light chain synthesis and a corresponding fibre type transformation.
Received 24 August 1987; accepted 26 October 1987

Clinical Physiology and Functional Imaging

"We have previously reported functional and histological studies in five beagle dogs with unilateral lumbar sympathectomy. Three months later, fatiguability in the gracilis muscles was increased on the denervated sides, and this was associated with an increase in the relative distribution of FT fibres. Biochemical studies now show that these changes were associated with an increase in cytosolic protein without change in DNA content; this is consistent with an increase in cell size. There was a reduction in the proportion of slow myosin light chain isoforms from 50 +/- 7 to 34 +/- 6%. Noradrenaline levels were increased on the denervated sides but this may reflect greater vascularity. Calcium content did not correlate with fibre type but there was a positive relation with both noradrenaline content (r = 0.73; P less than 0.05) and DNA content (r = 0.84; P less than 0.05). It is concluded that sympathectomy induces several biochemical changes in skeletal muscle which constitute a change and increase in fast myosin light chain synthesis and a corresponding fibre type transformation."

Journal: Clinical physiology (Oxford, England) (Clin Physiol), published in ENGLAND.

Reference: 1988-Apr; vol 8 (issue 2) : pp 181-91

Dates: Created 1988/06/08; Completed 1988/06/08; Revised 2004/11/17;

PMID: 3359751, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: )

Sympathectomy--how much side-effects are acceptable?

Lakartidningen 2001 Oct 10;98(41):4494-5

[Article in Swedish]

Berglund F, Berglund E.

Publication Types:

Letter

PMID: 11699265 [PubMed - indexed for MEDLINE]

Cardiac Arrest during Endoscopic Thoracic Sympathicotomy with One Lung Ventilation

Korean J Anesthesiol. 2007 Apr;52(4):479-483. Published online 2007 April 30. doi: 10.4097/kjae.2007.52.4.479.

Cardiac Arrest during Endoscopic Thoracic Sympathicotomy with One Lung Ventilation under General Anesthesia - Two cases report -
Sang Woo Jung, M.D., Sung Wook Park, M.D.,* and Moo Il Kwon, M.D.*
Department of Anesthesiology and Pain Medicine, Seoul Sacred Heart Hospital, Seoul, Korea.
*Department of Anesthesiology and Pain Medicine, College of Medicine, Kyung Hee University, Seoul, Korea.
Corresponding author (Email: kwonmooil@yahoo.co.kr )
Received November 10, 2006.

Effect of Endoscopic Transthoracic Sympathicotomy on Heart Rate Variability

Endoscopic transthoracic sympathicotomy is a recently developed technique to reduce pain and ischemia in patients with severe angina pectoris.
ETS caused a shift of sympathovagal balance toward parasympathetic tone.
The American Journal of Cardiology
Volume 79, Issue 11, 1 June 1997, Pages 1447-1452

Does the autonomic nervous system play a role in the development of insulin resistance?

vAn altered balance of the parasympathetic and sympathetic nervous activity, mainly explained by an attenuated parasympathetic activity, might contribute to the development of insulin resistance and Type 2 diabetes.
Diabet Med. 2003 May;20(5):399-405.

Dysregulation of the autonomic nervous system can be a link between visceral adiposity and insulin resistance.

Obes Res. 2005 Apr;13(4):717-28.

Lindmark S, Lönn L, Wiklund U, Tufvesson M, Olsson T, Eriksson JW.

Department of Medicine, Umeå University Hospital, S-901 85 Umeå, Sweden. stina.lindmark@medicin.umu.se

Limited sympathectomy does not reduce postoperative compensatory sweating

Journal of Vascular Surgery
Volume 37, Issue 1, January 2003, Pages 124-128

Causes of Orthostatic Hypotension:

Neurologic (involving autonomic dysfunction) -

Central

Multiple system atrophy (previously Shy-Drager syndrome)

Parkinson's disease

Strokes (multiple)

Spinal cord

Tabes dorsalis

Transverse myelitis

Tumors

Peripheral

Amyloidosis

Diabetic, alcoholic, or nutritional neuropathy

Familial dysautonomia (Riley-Day syndrome)

Guillain-Barré syndrome

Paraneoplastic syndromes

Pure autonomic failure (formerly called idiopathic orthostatic hypotension)

Surgical sympathectomy

http://www.merck.com/mmpe/sec07/ch069/ch069d.html

Pulmonary functional abnormalities after upper dorsal sympathectomy

http://chestjournal.chestpubs.org/content/77/5/651.abstract

NIH Clinical Studies book includes Sympahtectomy among Neurocardiologic disorders

Perhaps everyone considering ETS surgery should see this: the National Institute of Health (NIH) Clinical Studies book, where sympathectomy is listed as a "Neurocardiologic Disorder", right along side Parkinson's Disease, etc.

http://www.truthaboutets.com/Pages/NIH.html

I think it is fair to assume that of the thousands of people who have undergone sympathectomy for excessive sweating or facial blushing, few if any of them understood they were consigning themselves to a permanent autonomic system disorder.