"Sympathectomy is a technique about which we have limited knowledge, applied to disorders about which we have little understanding." Associate Professor Robert Boas, Faculty of Pain Medicine of the Australasian College of Anaesthetists and the Royal College of Anaesthetists The Journal of Pain, Vol 1, No 4 (Winter), 2000: pp 258-260
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
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
Friday, April 15, 2011
Wednesday, April 6, 2011
Nerve regeneration commonly occurs following both surgical or chemical ablation
This systematic review found only one small study (20 participants) of good methodological quality, which reported no significant difference between surgical and chemical sympathectomy for relieving neuropathic pain. Potentially serious complications of sympathectomy are well documented in the literature, and one (neuralgia) occurred in this study.
The practice of sympathectomy for treating neuropathic pain is based on very weak evidence. Furthermore, complications of the procedure may be significant.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0011684/
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2011 Issue 3, Copyright © 2011 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available inThe Cochrane Library (ISSN 1464-780X).
Tuesday, April 5, 2011
Decreased brain metabolism, rather than an increased intracranial pressure, is the cause of decreased cerebral blood flow after superior cervical sympathetic ganglionectomy
"The reduced brain metabolism and consequently reduced cerebral perfusion in the late
postsympathectomy period could account for reduction in CSF production (Bering3)."
"In support of the above statement we mention that on the late postsympathectomy (11 to 24 months) group of dogs besides the lowered CBF
(31.36 ml/100 gm brain weight/minute) and MCP (79.3 mm NS) also a lowered MVP (46.5 mm NS) was found. These data indicate that cervicalsympathectomy has a profound and intricate effect on the dynamics of cerebrovascular fluids and probably, in the background of all observedphenomena, a decreased cerebral metabolism as a sympathectomy effect is the underlying cause. Correspondingly the cerebral metabolic rate ofoxygen (CMR O2) decreased to 2.94 and 2.43 ml of O2/IOO gm brain weight/ minute in the sympathectomized groups."
"Decreased brain metabolism, rather than an increased intracranial pressure, is the cause of decreased cerebral blood flow after superior cervical sympathetic ganglionectomy."
http://archsurg.ama-assn.org/cgi/content/summary/90/3/418
After the sympathectomy, the high night time excretion was clearly abolished
The amount of 6-sulphatoxymelatonin, the chief metabolite of melatonin, in the urine was measured in nine patients, who were subjected to bilateral sympathectomy at the second thoracic ganglionic level for treatment of hyperhidrosis of the palms. All patients showed before surgery a normal 6-sulphatoxymelatonin excretion with a peak in the excretion
during the night time. After the sympathectomy, the high night time excretion was clearly abolished in five patients but remained high in four patients...
http://www.ncbi.nlm.nih.gov/pubmed/16647807
during the night time. After the sympathectomy, the high night time excretion was clearly abolished in five patients but remained high in four patients...
http://www.ncbi.nlm.nih.gov/pubmed/16647807
Monday, April 4, 2011
denervation on protein synthesis and degradation in adult rat diaphragm muscle
Previous studies showed that unilateral denervation (DNV) of the rat diaphragm muscle (DIAm) results in loss of myosin heavy chain protein by 1 day after DNV. We hypothesize that DNV decreases net protein balance as a result of activation of the ubiquitin-proteasome pathway. In DIAm strips, protein synthesis was measured by incorporation of 3H-Tyr, and protein degradation was measured by Tyr release at 1, 3, 5, 7, and 14 days after DNV. Total protein ubiquitination, caspase-3 expression/activity, and actin fragmentation were analyzed by Western analysis. We found that, at 3 days after DNV, protein synthesis increased by 77% relative to sham controls. Protein synthesis remained elevated at 5 (85%), 7 (53%), and 14 days (123%) after DNV. At 5 days after DNV, protein degradation increased by 43% relative to sham controls and remained elevated at 7 (49%) and 14 days (74%) after DNV. Thus, by 5 days after DNV, net protein balance decreased by 43% compared with sham controls and was decreased compared with sham at 7 (49%) and 14 days (72%) after DNV. Protein ubiquitination increased at 5 days after DNV and remained elevated.
http://jap.physiology.org/content/107/2/438.full
fall in the resting membrane potential (RMP) that was identical to the effect of surgical denervation
ACh blockade using a-BuTx produced a fall in the resting membrane potential (RMP) that was identical to the effect of surgical denervation with respect to the time of onset, rate of development, and extent of change. Blockade of nerve impulses using TTX produced a similar but partial change in the RMP that began later and progressed more slowly than that of denervation.
Similarly, the increase of extrajunctional ACh receptors following cY-BuTx-induced blockade of
ACh transmission was identical to that of surgical denervation. By contrast, the effect of nerve
impulse block using TTX was less pronounced at equivalent time points.
Our findings indicate that specific pharmacological blockade of ACh transmission produces
changes in the RMP and extrajunctional ACh receptors of skeletal muscle that are quantitatively equivalent to those of denervation. This suggests that ACh transmission itself mediates the nerve’s trophic regulation of these muscle properties.
The Journal of Neuroscience, Vol. 2, No. 2, pp. 232-243 . February 1982
The denervation effect of smooth muscles in this instance is related to the delayed response of the smooth muscle
The denervation effect of smooth muscles in this instance is related to the delayed response of the smooth muscles and not the effect of denervation.The result, however, is the same and the four components of denervation (super-duration/delayed response, hyper-excitability, increased susceptibility and super-reactivity) are mimicked exactly by inelastic and inflexible smooth muscles.
Autonomic nervous system: The autonomic nervous system of most fibromyalgia patients is imbalance with predominate excessive sympathetic outflows. The term dysautonomia is often used to describe these patients' S / S related to the ANS. There are significant problems related to smooth muscle dysfunctions (see effect of relaxin on smooth muscles) and the control of these organs as alluded to in the beginning of this discussion. This has to do with imbalance of the relatively increased sympathetic or decreased parasympathetic tone of the ANS. The inability of the ANS to maintain a homeostatic level of control on the smooth muscles and sphincters of many of the inner organs results in the under/ over performance of these organs.
http://www.encognitive.com/node/12690
Autonomic nervous system: The autonomic nervous system of most fibromyalgia patients is imbalance with predominate excessive sympathetic outflows. The term dysautonomia is often used to describe these patients' S / S related to the ANS. There are significant problems related to smooth muscle dysfunctions (see effect of relaxin on smooth muscles) and the control of these organs as alluded to in the beginning of this discussion. This has to do with imbalance of the relatively increased sympathetic or decreased parasympathetic tone of the ANS. The inability of the ANS to maintain a homeostatic level of control on the smooth muscles and sphincters of many of the inner organs results in the under/ over performance of these organs.
http://www.encognitive.com/node/12690
Thursday, March 31, 2011
surgical sympathectomy produces most of the retinal changes noted in the retina of an STZ-treated rat in a non-diabetic rat
Sympathectomy significantly increases gene and protein expression of iNOS, as well as levels of PGE2 and protein expression of PGE2-EP2 receptor subtype. Isoproterenol treatment for 6 h to human retinal endothelial cells grown in high glucose medium reduced iNOS protein expression, but had no effect on PGE2 levels or PGE2 receptor protein expression. iNOS expression was attenutated by stimulation with xamoterol, while BRL37344 had no effect, suggesting that the iNOS effects are mediated by beta1-adrenergic receptors. These results suggest that loss of sympathetic activity, as occurs in diabetes, results in an upregulation of iNOS and PGE2-EP2 receptor protein expression, as well as PGE2 levels. Isoproterenol stimulation of human retinal endothelial cells cultured in a hyperglycemic environment decreased iNOS expression with no change in PGE2 levels, suggesting that only iNOS expression is modulated by sympathetic neurotransmission in endothelial cells. Overall, these results further the idea that alterations in sympathetic neurotransmission may result in many of the changes noted in the retina of the STZ-treated rat.
http://www.ncbi.nlm.nih.gov/pubmed/17067575
http://www.ncbi.nlm.nih.gov/pubmed/17067575
Sympathectomy leading to an extracranial steal phenomenon
J Igloffstein and R Laas
J Neurol Neurosurg Psychiatry. 1983 August; 46(8): 768–773.
Unilateral cerebral infarcts were produced in the rat by ligation of one common carotid artery and subsequent exposure to carbon monoxide. 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.http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1027532
J Neurol Neurosurg Psychiatry. 1983 August; 46(8): 768–773.
Unilateral cerebral infarcts were produced in the rat by ligation of one common carotid artery and subsequent exposure to carbon monoxide. 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.http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1027532
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