American Institute for Hyperhidrosis claims to cure anxiety and palpitations with ETS

Palpitations caused by anxiety can be significantly reduced.


Migraine occurrence and trembling of the hands may improve.

(They also claim, that Copensatory Hyperhidorsis is) "tolerable by most patients and only 5% describe it as troublesome. Some patients say it improves with time."

http://www.handsweat.com/sideeff.html


There has been no clinical evaluation of the severity of the so called CS to this day. Surgeons who perform the surgery and profit from it claim it to be close to insignificant..that even improves with time. Other sources will state 90% of severe CS, and 25% disabling CS. Surely it can not be just a question of semantics when you have a 25% chance of being disabled after an elective surgery!
Doctors are unable to support their claims about the positive outcomes of the surgery. There has been no controlled trial to support their positive advertising, and it is left solely to the discretion of the surgeon to admit or deny the incidence and severity of the side-effects.

permanent sympathetic nerve damage and hyperthermia due to sympathectomy

"Virtual sympathectomy" secondary to repeated stellate ganglion nerve blocks leading to permanent sympathetic nerve damage and hyperthermia (heat leakage)"
www.rsdrx.com/crps_and_sympathectomy.htm 

acute response to surgical denervation and abrupt release of sympathetic tone

Intraoperative predictability of successful outcome depends on monitoring of the acute response to surgical denervation and abrupt release of sympathetic tone.

Information on the long-term physiological sequelae is emerging rapidly. Preoperatively, in addition to abnormal sudomotor control, sympathetic cardiovascular regulation may be affected mildly in severe cases of hyperhidrosis. A blunted reflex bradycardia response to parasympathomimetic maneuvers such as Valsalva maneuver or cold water face immersion, as well as an increased heart rate response
to orthostatic stress, suggests a hyperfunctioning sympathetic discharge that is reversed after ETS.25,69 Because sympathetic cardiac accelerator fibers exit the spinal cord from segments T1 to T4, ETS is believed to simulate a mild physiological !-adrenergic blockade.70 This is because the heart rate at rest and during maximal exercise is lower 6 weeks postoperatively

DIAGNOSIS AND TREATMENT OF HYPERHIDROSIS,  CONCISE REVIEW FOR CLINICIANS
Mayo Clin Proc.     •     May 2005;80(5):657-666 

denervation supersensitivity of alpha receptors after 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/84/3/1025
 
 

compensatory disease may not be immediate after sympathectomy

Newer techniques include the use of clips instead of complete transsection of the nerve but reversal is not always possible as nerve destruction can be quick and compensatory disease may not be immediate.

The main complications with sympathectomy include compensatory sweating, phantom sweating, gustatory sweating, Horner syndrome, and neuralgia.

Management of Hyperhidrosis

Aamir Haider, Nowell Solish and Nicholas J. Lowe
www.sweatclinicsofcanada.com/Book.pdf

This injures all the neurons at this level of the spinal cord, some of which may die, and may predispose the patient to spinal cord reorganization and severe compensatory hyperhidrosis

Sympathectomy vs sympathotomy. Sympathectomy, with use of ganglionectomy and by definition, must sever the primary axon from the neuron in the intermediolateral cell column of the spinal cord (red) before primary or collateral synapse in the T2 ganglion. This injures all the neurons at this level of the spinal cord, some of which may die, and may predispose the patient to spinal cord reorganization and severe compensatory hyperhidrosis. Sympathotomy interrupts only axons after potential T2 ganglion synapses, a less injurious effect on the neuron, and is the least destructive procedure possible with successful treatment
of palmar hyperhidrosis.
Mayo Clin Proc 2003;78:167-172.   http://www.mayoclinic.org/medicalprofs/enlargeimage5096.html

Sensory nerves impair sympathetic reinnervation and recovery of smooth muscle function

We conclude that sensory nerves limit the extent of sympathetic reinnervation and functional recovery that can occur following neonatal sympathetic denervation.
http://www.ncbi.nlm.nih.gov/pubmed/1397180

Sympathectomy alters bone architecture

These data indicate that guanethidine-induced sympathectomy caused a negative balance of bone metabolism, leading to decreased mass by regulating deposition rather than resorption during modeling and remodeling of bone.
http://www.ncbi.nlm.nih.gov/pubmed/18449939

obliteration of the cervical sympathetic peripheral innervation impairs the capability to produce an induced febrile response.

http://www.sciencedirect.com/science/article/pii/S0165572809000575

reduction in hypothalamic dopamine after sympathectomy, which leads to an increase in serum prolactin level

At this point, it is particularly interesting to recall the earlier reports of middle ear bone remodeling in the gerbil after chemical sympathectomy by guanethidine sulfate (86) or hydroxydopamine (85). Although these neurotoxins do eliminate sympathetic activity, there are, in parallel, major central consequences. In particular, both treatments reduce hypothalamic dopamine, which leads to an increase in serum prolactin levels.
http://ajpendo.physiology.org/content/293/5/E1224.full

"Again, patients admitted with any malignancy, cholecystectomy, thyroidectomy, renal disease, cardiac disease, sympathectomy, or vascular graft were eliminated as controls."

This article reviews the evidence that neuroleptics may increase the risk of breast cancer via their effects on prolactin secretion.
Paul M. Schyve; Francine Smithline; Herbert Y. Meltzer
Neuroleptic-induced Prolactin Level Elevation and Breast Cancer: An Emerging Clinical Issue
Arch Gen Psychiatry, Nov 1978; 35: 1291 - 1301.

Body temperature is highly correlated with plasma prolactin in thermally stressed men
(78), suggesting that normal heat defense is associated with decreased central dopamine, and
intraventricular haloperidol produces a coordinated heat-defense response (79). These reports refute a
unique or essential role for central dopamine antagonism in neuroleptic malignant syndrome hyperthermia
and provide additional evidence that state-dependent factors are important mediators of dopamine
antagonist effects.
There is substantial evidence to support the hypothesis that dysregulated sympathetic nervous system hyperactivity is responsible for most, if not all, features of neuroleptic malignant syndrome. A predisposition to more extreme sympathetic nervous system activation and/or dysfunction in response to emotional or psychological stress may constitute a trait vulnerability for neuroleptic malignant syndrome, which, when coupled with state variables such as acute psychic distress or dopamine receptor antagonism, produces the clinical syndrome of neuroleptic malignant syndrome. This hypothesis provides a more comprehensive explanation for existing clinical data than do the current alternatives.

http://ajp.psychiatryonline.org/cgi/content/full/156/2/169

dural blood flow decreased significantly in the cervical sympathectomy group

Migraine may affect the autonomic nervous system, but the mechanisms remain unclear. The sympathetic and parasympathetic nervous systems may play different roles in the attack. To explore the effect of blocking the cervical sympathetic nerve on vasodilation of the meningeal vessels, jugular vein calcitonin gene-related peptide (CGRP) and meningeal blood flow changes were measured before and after transection of the cervical sympathetic nerve by electrically stimulating the trigeminal ganglion in Sprague–Dawley (SD) rats. We found that CGRP level and meningeal blood flow increased in both the sham-operated and sympathectomized groups (p<0.05). Compared with the sham-operated group, dural blood flow decreased significantly in the cervical sympathectomy group, but CGRP level was not significantly different between these two groups. The cervical sympathetic nerve may play an important role in the process of neurogenic dural vasodilation in rats; this effect is not entirely dependent on CGRP level.
http://www.autonomicneuroscience.com/article/S1566-0702%2811%2900026-9/abstract

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

Extreme caution is called for when considering surgical sympathectomy

Surgical sympathectomy is carried out on the basis of poor quality evidence, studies without
control groups, and personal experience. Though it would appear logical (and has been
suggested) that surgical sympathectomy is indicated primarily for patients with confirmed
'sympathetic-dependent pain, other authors take the view that the treatment results are
not correlated to this. Eighteen percent of patients undergoing sympathectomy for
neuropathic pain experience compensatory hyperhidrosis and 25% experience neuropathic
complications.
Extreme caution is called for when considering surgical sympathectomy for pain control in
CRPS-I. The procedure should be conducted in the context of a trial in order to ascertain
the efficacy and potential risks.
Guideline
INITIATIVE:
Netherlands Society of Rehabilitation Specialists
Netherlands Society of Anaesthesiologists

WITH THE SUPPORT OF:
Institute for Healthcare Improvement CBO
www.cbo.nl/Downloads/341/rl_crps_eng_07.pdf

Decreased tanning response after video-assisted thoracoscopic sympathectomy

http://www.ncbi.nlm.nih.gov/pubmed/18794484

Skin depigmentation: could it be a complication caused by thoracic sympathectomy?

 http://www.ncbi.nlm.nih.gov/pubmed/19766777

lumbar sympathectomy results in loss of ejaculation

Sympathectomy for the long term management of such patients has been carried out (Abel et al., 1974) and success reported. Loss of ejaculation does follow sympathectomy but his is a minor problem in patients who have an already destroyed sacral cord. (p. 410)

During fever pyrogen is released from leucocytes and his agent causes the disturbed thermoregulation (Atkinson, 1960). For his response to occur, an intact efferent sympathetic system is requred because fever can be markedly reduced by bilateral sympathectomy in he cat (Pinkston, 1935). (p.193)
The autonomic nervous system: an introduction to basic and clinical concepts By Otto Appenzeller, Emilio Oribe, Elsevier Health Sciences, 1997 - Medical

significant change after sympathectomy: reduced sympathetic and increased vagal tone

The HRV analysis showed a significant change of indices reflecting sympatho-vagal balance indicating significantly reduced sympathetic (LF) and increased vagal (HF, rMSSD) tone. These changes still persisted after 2 years. Global HRV increased over time with significant elevation of SDANN after 2 years. QT dispersion was significantly reduced 1 month after surgery and the dispersion was further diminished 2 years later.
http://www.sciencedirect.com/science/article/pii/S0167527399001011

Sympathectomy leads to a decrease in noradrenaline levels in the cerebral cortex

Chemical Sympathectomy leads to a decrease in noradrenaline levels measured in the cerebral cortex. (Onesti at al. 1989)

brain levels of norepinephrine were reduced significantly

EFFECT OF 6-HYDROXYDOPAMINE ON BRAIN NOREPINEPHRINE AND DOPAMINE: EVIDENCE FOR SELECTIVE DEGENERATION OF CATECHOLAMINE NEURONS

George R. Breese ¹ and Dennis Traylor ¹

¹ Departments of Psychiatry and Pharmacology and the Child Development Institute, University of North Carolina School of Medicine, Chapel Hill, North Carolina

After the intracisternal administration of 6-hydroxydopamine, brain levels of norepinephrine were reduced significantly with or without pargyline pretreatment. Depletion of dopamine in the central nervous system was found to be enhanced markedly by pargyline administration at higher dose levels of 6-hydroxydopamine. Brain serotonin concentrations were not altered. The effects of 6-hydroxydopamine were long-lasting with the depletion of brain amines persisting at 78 days. After norepinephrine-H³ intracisternally to animals treated with 6-hydroxydopamine, labeled norepinephrine uptake was diminished with a corresponding reduction of deaminated catechols and a marked increased in methylated amines. Tyrosine hydroxylase activity was found to be reduced in brainstem, caudate nucleus and whole brain in 6-hydroxydopamine-treated animals. Conversion of tyrosine-H³ to labeled norepinephrine and dopamine was also markedly diminished. The results support the view that 6-hydroxydopamine produces a "central sympathectomy" when introduced into cerebrospinal fluid.

Journal of Pharmacology And Experimental Therapeutics, Vol. 174, Issue 3, 413-420, 1970
Copyright © 1970 by American Society for Pharmacology and Experimental Therapeutics

sympathectomy impairing adrenergic transmission

The chronic bilateral cervical superior sympathectomy could provoke norepinephrine depletion in the small granular vesicles of the sympathetic terminals, impairing adrenergic transmission; this would then eliminate the constrictor sympathetic effect¹³. Our study is in agreement with published data where pharmacological or anatomical exclusion of the sympathetic activity prevented vasospasm²⁴.

Antônio Tadeu de Souza Faleiros^I; Francisco Humberto de Abreu Maffei^II; Luiz Antonio de Lima Resende^III

^IServices of Neurosurgery, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, SP, Brazil
^IIVascular Surgery, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, SP, Brazil
^IIINeurology, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, SP, Brazil

marked changes in brain NE following sympathectomy

Biochemical and functional evaluation of the sympathectomy produced by the administration of guanethidine to newborn rats

EM Johnson , E Cantor and JR Douglas

The administration of guanethidine to newborn rats has been shown by morphological criteria to destroy sympathetic neurons. Newborn rats were injected with guanethidine (50-100 mg/kg/day for 20 days). Upon maturation (at 10 weeks old), the degree of destruction of the sympathetic nervous system (sympathectomy) was assessed. Marked decreases (80-98%) in the norepinephrine concentration in several tissues (heart, spleen, intestine, mesentery, kidney, uterus, vas deferens) were observed in the guanethidine-treated rats when compared to saline-treated controls. No changes were observed in the epinephrine concentration in the adrenals or in the norepinephrine levels in whole brain. Analysis of brain areas showed no change in the norepinephrine levels in brain stem and cerebrum and a small (18%) decrease in the cerebellum. Stimulation of the sympathetic vasomotor outflow in the pithed rat preparation produced almost no response in guanethidine- treated animals. Periarterial nerve stimulation of the isolated perfused kidney preparation also produced essentially no response in guanethidine-treated animals. Isolated intestinal preparations from guanethidine-treated animals responded to nerve stimulation with contractions rather than relaxation as seen in preparations from control animals. Isolated vas deferens preparations responded normally to nerve stimulation despite a 95% decrease in tissue norepinephrine concentration. These data indicate that administration of guanethidine to newborn rats produces a more complete peripheral sympathectomy, especially of the vasculature, than immunosympathectomy or neonatal administration of 6-hydroxydopamine and does so with no significant effect on central noradrenergic neurons.

Volume 193, Issue 2, pp. 503-512, 05/01/1975
Copyright © 1975 by American Society for Pharmacology and Experimental Therapeutics

the adrenergic system in regulation of the metabolism of the retina

Stefan M. Pojda¹ and Ryszard Brus²

(1)	Department of Ophthalmology, Silesian Academy of Medicine, Francuska str. 20/24, 40-027 Katowice, Poland

(2)	Department of Pharmacology, Silesian Academy of Medicine, Zabrze 8, Poland

Received: 16 April 1976

Summary Male Wistar rats were injected intraventricularly with two doses of 250 mcg of 6-hydroxydopamine (6-OHDA) in two consecutive days. Two weeks later the oxygen uptake, anaerobic glycolysis and lactic acid dehydrogenase (LDH) activity in the retina were determined. The decrease of oxygen uptake (–28 %), anaerobic glycolysis (–31 %) and LDH activity (–12 %) in rats treated with 6-OHDA in comparison to control animals was found. The possible role of the adrenergic system in regulation of the metabolism of the retina is discussed.

Heightened emotions cause experiences to crystallize into lasting and vivid memories

Emotional memory.(NEUROSCIENCE)(effect of Norepinephrine to memory)(Brief article)

From:

Science News

Date:

October 20, 2007

Author:

Barry, P.

| Copyright information COPYRIGHT 2007 Science Service, Inc. This material is published under license from the publisher through the Gale Group, Farmington Hills, Michigan. All inquiries regarding rights should be directed to the Gale Group.

Where were you on Sept. 11, 20017 Or when the shuttle Challenger exploded in 19867 Heightened emotions cause experiences to crystallize into lasting and vivid memories. This boost in memory formation is due in part to the stress hormone norepinephrine, but scientists haven't understood how the hormone causes this effect.

Now researchers have uncovered molecular changes triggered by norepinephrine that help nerve cells form new memories.

A team led by Roberto Malinow of Cold Spring Harbor Laboratory in New York traced the hormone's effects to a receptor molecule called glutamate receptor 1 (G1uR1) on the surfaces of nerve cells. Through G1uR1 and similar receptors, ... http://www.highbeam.com/doc/1G1-170372501.html

brain norepinephrine turnover, and memory and the need for Power

David C. McClelland¹ , J. Anderson Maddocks¹ and Dan P. McAdams^{1, 2}

(1)	Department of Psychology and Social Relations, Harvard University, 33 Kirkland Street, 02138 Cambridge, Massachusetts

(2)	Present address: Loyola University of Chicago, USA

Abstract Subjects were classified according to whether they were high or low in the need for Power and high or low in gain in 3-methoxy-4-hydroxyphenylglycol (MHPG), a putative index of brain norepinephrine (NE) turnover, after engaging in some tasks that involved memory for story content. Subjects who were high inn Power and in the index of brain NE turnover showed better recall of power-related facts than subjects low on both these characteristics, confirming an earlier finding, which suggests that the need for Power is subserved by a noradrenergic reward system in the brain.

The need for power, brain norepinephrine turnover, and memory

Journal	Motivation and Emotion
Publisher	Springer Netherlands
ISSN	0146-7239 (Print) 1573-6644 (Online)
Issue	Volume 9, Number 1 / March, 1985
DOI	10.1007/BF00991546
Pages	1-10
Subject Collection	Behavioral Science
SpringerLink Date	Monday, January 10, 2005

Norepinephrine

Doze said the adrenergic system — one of the essential neurochemical systems in the brain — synthesizes and controls the release of the neurotransmitter norepinephrine (also known as noradrenalin).

Norepinephrine works in both the central and peripheral nervous systems. It’s responsible for many critical functions, but in this context, its key functions in the central nervous system include sleep, emotions, learning, and memory.

Probing the deepest levels of brain chemistry to uncover clues to memory loss

By Juan Miguel Pedraza

A neurotransmitter involved in emotional arousal enhances learning

A neurotransmitter involved in emotional arousal enhances learning by phosphorylating glutamate receptors.

Do you remember the song that was playing during your first kiss? Both positive and negative emotions influence learning and memory but researchers have not determined the mechanism. Now Hu et al. report that the neurotransmitter norepinephrine regulates glutamate receptor trafficking in a recent article in Cell.

Axon terminals containing norepinephrine synapse in the hippocampus and amygdala, which are important in emotional memory. In the hippocampus, norepinephrine reduces the threshold for long-term potentiation (LTP), which is thought to be a substrate of memory. Norepinephrine acts at -adrenergic receptors, where it activates cAMP-dependent protein kinase (PKA) and calcium/calmodulin-dependent protein kinase II (CaMKII). These kinases phosphorylate serines 845 and 831, respectively, in the AMPA glutamate receptor type 1 (GluR1). The authors proposed that norepinephrine regulates learning by phosphorylating AMPA receptors.

Hu, H. et al. Emotion enhances learning via norepinephrine regulation of AMPA-receptor trafficking. Cell 131, 160–173 (2007). | Article | PubMed |

Emotional intelligence

Neuroscience Gateway (October 2007) | doi:10.1038/aba1787

The excitatory actions of epinephrine were not observed

The excitatory actions of epinephrine were not observed in groups given an identical dose of the hormone after peripheral β-adrenergic receptor blockade with sotalol. These findings demonstrate that neural discharge in vagal afferent fibers is increased by elevations in peripheral concentrations of epinephrine and the significance of these findings in understanding how epinephrine modulates brain limbic structures to encode and store new information into memory is discussed.

Epinephrine administration increases neural impulses propagated along the vagus nerve: Role of peripheral β-adrenergic receptors

T. Miyashita and C.L. Williams

^aDepartment of Neurosciences, University of New Mexico, Albuquerque, NM 87131, USA

^bDepartment of Psychology, The University of Virginia, Charlottesville, VA 22904, USA

Received 9 June 2005;

revised 17 August 2005;

accepted 29 August 2005.

Available online 17 October 2005.

arousal related hormone affects memory processing

A significant number of animal and human studies demonstrate that memories for new experiences are encoded more effectively under environmental or laboratory conditions which elevate peripheral concentrations of the hormone epinephrine and in turn, induce emotional arousal. Although this phenomenon has been replicated across several learning paradigms, understanding of how this arousal related hormone affects memory processing remains obscure because epinephrine does not freely enter into the central circulation to produce any direct effects on the brain. This study examined whether epinephrine’s actions on the CNS may be mediated by the initial activation of peripheral vagal fibers that project to the brain.

Epinephrine administration increases neural impulses propagated along the vagus nerve: Role of peripheral β-adrenergic receptors

T. Miyashita^a and C.L. Williams^b,

^aDepartment of Neurosciences, University of New Mexico, Albuquerque, NM 87131, USA

^bDepartment of Psychology, The University of Virginia, Charlottesville, VA 22904, USA

Received 9 June 2005;

revised 17 August 2005;

accepted 29 August 2005.

Available online 17 October 2005.

The role of norepinephrine in spatial reference and spatial working memory

The role of norepinephrine in spatial reference and spatial working memory

The adrenergic system (utilizing norepinephrine, NE, as a neurotransmitter) is implicated in hippocampus-based learning and memory, in addition to its well known peripheral actions mediated by the sympathetic nervous system.
Michael J. Gertner, University of Pennsylvania
Steven A. Thomas, University of Pennsylvania
http://repository.upenn.edu/curej/18/

Norepinephrine Important In Retrieving Memories

Norepinephrine Important In Retrieving Memories

Source: U. Of Pennsylvania Medical Center
Date: 2 April 2004

In addition, beta-blockers, which are used to treat heart failure and hypertension (among other ailments) block the same norepinephrine receptors important for memory retrieval. Therefore, when treating heart disease, the use of beta blockers that do not cross into the brain may help to avoid memory-related side effects, suggest the researchers.

The findings of this research appear in the April 2 issue of Cell.

Causes of Orthostatic Hypotension

Causes of Orthostatic Hypotension:

Neurologic (involving autonomic dysfunction) -
Surgical sympathectomy

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

NE levels and Posttraumatic Stress Disorder

CSF Norepinephrine Concentrations in Posttraumatic Stress Disorder
Thomas D. Geracioti, Jr., M.D.
Dewleen G. Baker, M.D.
Nosakhare N. Ekhator, M.S.
Scott A. West, M.D.
Kelly K. Hill, M.D.
Ann B. Bruce, M.D.
Dennis Schmidt, Ph.D.
Barbara Rounds-Kugler, R.N.
Rachel Yehuda, Ph.D.
Paul E. Keck, Jr., M.D.
John W. Kasckow, M.D., Ph.D.
Objective: Despite evidence of hyperresponsive peripheral and central nervous system (CNS) noradrenergic activity in posttraumatic stress disorder (PTSD), direct measures of CNS norepinephrine in PTSD have been lacking. The goal of this study was to determine serial CSF norepinephrine levels in patients with PTSD.
Method: CSF samples were obtained serially over a 6-hour period in 11 male combat veterans with chronic PTSD and eight healthy men through an indwelling subarachnoid catheter. Thus the authors were able to determine hourly CSF norepinephrine concentrations under base-
line (unstressed) conditions. Severity of the patients’ PTSD symptoms was assessed with the Clinician-Administered PTSD Scale.
Results: CSF norepinephrine concentrations were significantly higher in the men
with PTSD than in the healthy men. Moreover, CSF norepinephrine levels strongly and
positively correlated with the severity of PTSD symptoms. Plasma norepinephrine concentrations showed no significant relationship with the severity of PTSD symptoms.
Conclusions: These findings reveal the presence of greater CNS noradrenergic activity under baseline conditions in patients with chronic PTSD than in healthy subjects and directly link this pathophysiologic observation with the severity of the clinical posttraumatic stress syndrome.
(Am J Psychiatry 2001; 158:1227–1230)

Alterations in T and B cell proliferation and differentiation in vitro following chemical sympathectomy

Madden, K.S., Moynihan, J.A., Brenner, G.J., Felten, S.Y., Felten, D.L. and Livnat, S. (1994b).:Sympathetic nervous system modulation of the immune system. III. Alterations in T and B cell proliferation and differentiation in vitro following chemical sympathectomy. J. Neuroimmunol. 49: 77-87.

reduced antibody responses to T-dependent antigens

It has been exhaustively demonstrated that the regions in which lymphocytes T cells reside, and through which they recirculate, receive direct sympathetic neural input. Therefore, the immune system can be considered “hard-wired” to the brain. Chemical sympathectomy of adult mice resulted in reduced antibody responses to T-dependent antigens. The interaction between sympathetic NA nerve fibers and cells of the immune system has been shown through the distribution of tyrosine hydrolase (TH⁺) nerve fibers among lymphocytes and macrophages in lymphoid organs, the expression of adrenoceptors on cells of the immune system, and the immunomodulatory effects of NA. In old rats, a conspicuous decline in NA innervation and NA contents is observed in the splenic white pulp as well as in the cell bodies in superior celiac-mesenteric ganglia that provide preganglionic sympathetic innervation to the spleen (Arnason, 1993; Carlson, Fox et al., 1997; Madden. Felten et al., 1994a; Roszman and Carlson, 1991). Paralleling these alterations in sympathetic NA neuronal activity is an age-related loss of T cell mediated immune responses, including reduced T cell proliferation and IL-2 production by antigen- and mitogen-stimulated lymphocytes. Treatment of these rats with drugs inducing noradrenergic regeneration and re-innervation reverted the rats’ immune abnormalities (Tang, Shankar et al., 1999; Thyaga-Rajan, Madden et al., 1999). Noradrenergic innervation of the spleen is responsible for a significant increase of gamma-interferon, IL-2 and tumor necrosis factor alpha, the three Th-1 cytokines, and a lowering of IL-4, IL-5 and IL-10 (TH-2 cytokines) production (Carlson, Fox et al., 1997; Madden, Moynihan et al., 1994b; Spengler, Allen et al., 1990). Other evidence showed that elevated plasma NA concentrations increased the level of Th-1 cytokines (Kappel, Poulsen et al., 1998; Ross, Williams et al., 1987). These and other findings demonstrate that the noradrenergic innervation of bone marrow is functionally dynamic and is responsive to central activation. Furthermore, these results lend credence to the premise that neural mechanisms participate in regulating lymphopoietic cellular events.

VOL. 31, NOS. 5 & 6, 2000 JOURNAL OF MEDICINE

JOURNAL OF MEDICINE

Copyright © 2000 by

PJD Publications Limited

The hepatic sympathetic nerve

Mortality in sympathectomised mice was significantly higher than that in sham operated mice following administration of Jo-2. This result was also supported by apoptosis data in which sympathectomised livers exhibited a significant elevation in the number of apoptotic hepatocytes and caspase-3 activity after Jo-2 treatment compared with sham operated livers. Moreover, pretreatment with norepinephrine dose dependently inhibited the hepatic sympathectomy induced increase in mortality after Jo-2 injection. Antiapoptotic protein levels of FLICE inhibitory protein, Bcl-xL, and Bcl-2 in the liver were significantly lower in sympathectomised mice at one and two hours following Jo-2 treatment than in sham operated animals. In addition, interleukin 6 supplementation dose dependently suppressed the hepatic sympathectomy induced increase in mortality after Jo-2 treatment.

The hepatic sympathetic nerve plays a critical role in preventing Fas induced liver injury in mice

Y Chida¹, N Sudo¹, A Takaki², C Kubo¹

¹ Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
² Department of Integrative Physiology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan

Dr Y Chida
Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan

The sympathoadrenal system is one of the major pathways mediating physiological responses in the organism

The sympathoadrenal system is one of the major pathways mediating physiological responses in the organism. The sympathoadrenal system plays an important role in the regulation of blood pressure, glucose, sodium and other key physiological and metabolic processes. In many disease states, the sympathoadrenal system is affected and by corrective physiological responses the sympathoadrenal system preserves homeostasis. Many therapeutic agents are either adrenergic activators or inhibitors. Therefore, measurements of the components of the sympathoadrenal system and the activity of the sympathoadrenal system have been of major interest for decades.
Levels of plasma (p-) noradrenaline (NA), the sympathetic neurotransmitter, have been used to indicate activity of the neuronal sympathoadrenal component, while adrenaline (Adr) levels indicate activity of the hormonal adrenomedullary component of the sympathoadrenal system (Christensen 1991, Goldstein 1995, Christensen & Norsk 2000).

Based upon the absence of an arterio-venous increase in p-DOPA concentration in sympathectomized limbs and a decrease in p-DOPA after inhibition of tyrosine hydroxylase (TH) in dogs, it was concluded that DOPA can pass across sympathetic neuronal membranes to reach the general circulation and furthermore, that p-DOPA may be related to regional rate of tyrosine hydroxylation (Goldstein et al 1987a). P-DOPA only demonstrated minimal changes during stimuli that produced significant changes in p-NA. Due to partly parallel changes of p-NA and p-DOPA, however, it was believed that p-DOPA reflect the rate of catecholamine synthesis and that p-DOPA was a simple and direct index of TH activity in vivo (Eisenhofer et al 1988, Goldstein & Eisenhofer 1988, Garty et al 1989b). It was inferred that p-DOPA levels may be an index of sympathetic activity.

Department of Internal Medicine and Endocrinology, Herlev University Hospital, Herlev.

Correspondence: Ebbe Eldrup, Bolbrovænge 29, DK-2960 Rungsted Kyst.

Official opponents: Jens H. Henriksen, professor, MD, and Jan Abrahamsen, MD.

Dan Med Bull 2004;51:34-62.

Sympathectomy - treatment for Long QT Syndrome

The long-term treatment is aimed at reducing the QT-interval duration and preventing the torsades and sudden death and includes use of oral [beta]-adrenergic blockers, implantation of permanent pacemaker/cardioverter-defibrillator, and left thoracic
sympathectomy.

American Heart Journal. 143(1):7-14, January 2002.
Khan, Ijaz A. MD, FACP, FACC

Sympathetic blocks can also alter the function of organs that have a sympathetic control component

Sympathetic blocks can also alter the function of organs that have a sympathetic control component...
However, surgical sympathectomy may result in a compensatory hyperhidrosis: a condition characterized by abnormally profuse sweating in a location remote form the sympathectomy. Other complications can also occur, including paresis, paralysis, and bowel or bladder dysfunction. Neurolytic procedures typically can only be considered if all other measures have failed.

http://www.wipo.int/pctdb/en/wo.jsp?IA=WO2005072433&wo=2005072433&DISPLAY=DESC

Patients usually develop Horner's syndrome and Guttman's sign, stuffy nose

Salahadin Abdi, MD, PhD, Yili Zhou, MD, PhD, NileshPatel, MD, Bhupinder Saini, MD, and John Nelson, MD
A New and Easy Technique to Block the Stellate Ganglion

Patients usually develop Horner's syndrome and Guttman's sign, stuffy nose and increased temperature on the ipsilateral side of the block (face and upper extremity) within 5 minutes after the procedure.

Pain Physician Vol. 7, No. 3, 2004

Stuffy nose and orthostatic hypotension following sympathectomy

3. Dibenzyline (Smith, Kline & French Labs.): - is a congener of dibenamine in the p-alkylamine family. It is capable of producing a chemical sympathectomy by oral administration. The drug was started usually with two capsules of 10 mg. each on the first day and was daily increased by 20 mg. till the effect of adrenergic blockade viz. stuffy nose and slight orthostatic hypotension appeared, after which the patient was maintained on that very dosage for the rest of the period he was under observation. Medication should begin at a low level as some individuals show postural changes with as little as 20 mgs. of dibenzyline.

Year : 1954 | Volume : 2 | Issue : 2 | Page : 33-44

Adrenergic blocking agents in glaucoma

Srivastava SP
Department of Ophthalmology, Medical College, Agra, India

only to be performed in etreme cases

In conclusion, it must be stated that due to the potential complications and the invasiveness of the procedure, sympathectomies are only to be performed in extreme cases after extensive discussions with the patient.
http://www.jle.com/fr/revues/medecine/ejd/e-docs/00/01/87/A0/article.md

Version imprimable

Current therapeutic strategies for hyperhidrosis: a review

European Journal of Dermatology. Volume 12, Numéro 3, 219-23, May - June 2002, Revues

Auteur(s) : Barbara TOGEL, Bärbel GREVE, Christian RAULIN, University Dermatological Clinic, D-69115, Heidelberg, Germany..

sweating is preserved and becomes exaggerated in some instances

FACIAL FLUSHING AND SWEATING MEDIATED BY THE SYMPATHETIC NERVOUS SYSTEM

PETER D. DRUMMOND and JAMES W. LANCE

Department of Neurology,Prince Henry Hospital Sydney, New South Wales, Australia

It is concluded that the cervical sympathetic outflow is the main pathway for thermoregulatory flushing and emotional blushing and that diminution or absence of such vasodilator reactions is a usual component of Homer's syndrome unless the responsible lesion is confined to the first thoracic root. Gustatory vasodilatation and sweating is preserved and becomes exaggerated in some instances.

Received March 4, 1986. Revised July 22, 1986. Accepted August 5, 1986.

ETS for blushing?!

Endoscopic thoracic sympathectomy for
treating facial blushing

Omar Ahmed PhD
Centre for Clinical Effectiveness
Monash Medical Centre

21 February 2001

• No systematic reviews, meta-analyses, or clinical trials that evaluated the
effectiveness of endoscopic thoracic sympathectomy for treating facial
blushing were identified. However, we have identified four case series
related to the request.
• 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. (Mia: there has been no evaluation since this report was completed in 2001, and the surgery is being performed without clinical evidence regarding safety and effectiveness! In Australia, it is listed on MBS, nobody is able to explain on the basis of what or which finding has it been included.)

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

As requested by CCE, a disclaimer attached to this quotation:
Please note that this review was done in 2001 and is now 7years old. The findings are unlikely to be consistent with current information and I would hesitate to recommend it as a source of useful information. This review has been archived and is covered by the disclaimer below on the CCE website archive.

increase in plasma norepinephrine (NE), is a salient feature in congestive heart failure

http://content.onlinejacc.org/cgi/content/full/42/3/549

http://content.onlinejacc.org/cgi/content/full/42/3/549 Activation of the sympathetic nervous system, manifested by an increase in plasma norepinephrine (NE), is a salient feature in congestive heart failure. J Am Coll Cardiol, 2003; 42:549-551, doi:10.1016/S0735-1097(03)00643-0 © 2003 by the American College of Cardiology Foundation Chang-seng Liang, MD, PhD, FACC*,* * Department of Medicine (Cardiology Unit), University of Rochester Medical Center, Rochester, New York, USA

High plasma norepinephrine and depression!

Copyright © 1999 Society of Biological Psychiatry. Published by Elsevier Science Inc.

Plasma norepinephrine and prediction of outcome in major depressive disorder

Timothy G. Johnston^a, Christopher B. Kelly^{, a}, Michael R. Stevenson^b and Stephen J. Cooper^a
a Department of Mental Health, Whitla Medical Building, The Queen’s University of Belfast, Belfast, UK (TGJ, CBK, SJC)
^b Department of Medical Statistics, Mulhouse Building, The Queen’s Unversity of Belfast, Belfast, UK (MRS)
Received 1 February 1999; revised 17 May 1999; accepted 21 May 1999. Available online 30 November 1999.

Background: Several epidemiologic and clinical factors have been shown to predict long term outcome in major depressive disorder (MDD). The value of biological predictors has not been extensively studied. This study examined whether plasma norepinephrine may be useful in predicting outcome in MDD.

Methods: Forty patients were followed up 8 years after an index major depressive episode. Three outcome variables were assessed: time to first recurrence (the primary outcome measure), the Lee and Murray criteria and the Depression Outcome Scale (DOS). The results were examined against plasma norepinephrine value, at the index episode, using survival analysis and linear regression.

Results: High plasma norepinephrine at the index episode was positively and significantly associated with time to first recurrence for patients with nonpsychotic MDD (n = 31, χ² = 8.38, on 1 df, p < .01). Similarly, plasma norepinephrine was significantly associated with good global outcome, both using Lee and Murray criteria (n = 34, adjusted R² = .24, p < .01) and DOS criteria (n = 31, adjusted R² = .17, p < .01) for this group of patients. In contrast, plasma norepinephrine was not significantly related to outcome for MDD with psychotic features.

Conclusions: Plasma norepinephrine at index episode seems to be a predictor of outcome in MDD.

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T4S-3Y0RJKC-F&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=a88b42c007e4dcb51054a00cf6662e2d

morphological change resulting from degeneration activation

J. R. Garrett^{1, 2} and A. Thulin^{1, 2}

(1)	Department of Oral Pathology, King's College Hospital Dental School, London, England

(2)	Institute of Physiology, University of Lund, Lund, Sweden

(3)	King's College Hospital Dental School, SE5 8RX London, England

Received: 20 May 1975

Summary Parotid glands of rat have been examined 12, 24 and 48 hours after avulsion of the cervical sympathetic ganglion and compared with the normally innervated left glands. Formaldehyde-induced fluorescence showed a relatively normal complement of adrenergic nerves at 12 hours but most of the nerves had lost their noradrenaline content by 24 hours and no fluorescent nerves were detected at 48 hours. Ultrastructural degenerative changes in axons were rare at 12 hours, common at 24 hours, and the degenerating axons appeared to have disappeared by 48 hours. The glands looked whitish and pale and similar to the controls at 12 and 48 hours but were pinkish and oedematous on the sympathectomised side at 24 hours. Correspondingly the acini were loaded with secretory granules at 12 and 48 hours but were extensively depleted of granules at 24 hours. This loss of granules is considered to be due to sympathetic degeneration secretion caused by the release of noradrenaline from the degenerating adrenergic nerves between 12 and 24 hours after ganglionectomy. This is thought to be the first example of morphological change resulting from degeneration activation to be recorded microscopically.

http://www.springerlink.com/content/n08314p052546477/

Sympathetic Hyperactivity in Chronic Renal Failure: A Wake-up Call

Sympathetic Hyperactivity in Chronic Renal Failure: A Wake-up Call

Hein A. Koomans, Peter J. Blankestijn and Jaap A. Joles

Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands

Correspondence to Dr. Hein A. Koomans, Department of Nephrology and Hypertension, University Medical Center Utrecht, Room F03.223, P.O. Box 85500, 3508 GA Utrecht, The Netherlands. Phone: 31-30-2507329; Fax: 31-30-2543492; E-mail: H.A.Koomans@azu.nl

ABSTRACT. Sympathetic hyperactivity plays an important and distinct role in hypertension associated with chronic renal failure (CRF). Renal ischemia, elevated angiotensin II, and suppressed brain nitric oxide (NO) all stimulate sympathetic activity. Evidence is accumulating for a role of sympathetic hyperactivity in renal and cardiac damage in patients with CRF.

Carotid distensibility, baroreflex sensitivity, and orthostatic stress

J Appl Physiol 99: 64-70, 2005. First published February 24, 2005; doi:10.1152/japplphysiol.01248.2004
8750-7587/05 $8.00

Carotid distensibility, baroreflex sensitivity, and orthostatic stress

Craig D. Steinback,¹ Deborah D. O’Leary,² Jason Bakker,¹ Angela D. Cechetto,¹ Hanif M. Ladak,^3,4,6 and J. Kevin Shoemaker^1,5

¹Neurovascular Research Laboratory, School of Kinesiology, University of Western Ontario, London, Ontario; ²Department of Community Health Sciences, Brock University, St. Catharines, Ontario; Departments of ³Medical Biophysics, ⁴Electrical & Computer Engineering, and ⁵Physiology and Pharmacology, University of Western Ontario, London, Ontario; and ⁶Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada

Submitted 5 November 2004 ; accepted in final form 22 February 2005

In this study, we tested the hypothesis that carotid arteries undergo rapid changes in distensibility on moving from the supine to head-up tilt (HUT) postures and, subsequently, that this change in carotid distensibility (cDa) might be associated with concurrent reductions in cardiovagal baroreflex sensitivity (BRS). Thus the effect of posture on carotid vascular mechanics and cardiovagal BRS with consideration for altered central hemodynamics (i.e., stroke volume; Doppler ultrasound) was examined. Carotid pulse pressure (cPP; Millar transducer) and contralateral B-mode ultrasound images were assessed at the carotid artery during supine and 60° HUT postures. From these measures, cDa was calculated at 5-mmHg pressure increments experienced during the cardiac cycle (n = 6). cPP (n = 9) was not different in the two postures. A smaller stroke volume being ejected into a smaller carotid artery in HUT explained the maintenance of cPP in HUT. Also, compared with supine, cDa was reset to a lower level in HUT (main effect of posture; P <> BRS (sequence method) was diminished in HUT vs. supine (P < 0.05). A positive correlation was observed between the tilt-induced changes in maximal cDa (in early systole) and cardiovagal BRS (r² = 0.75; P <> between changes in cPP, systolic vessel dimensions, or average cDa and the corresponding change in BRS. The present results indicate that HUT elicits rapid changes in carotid artery mechanics and further suggest that reductions in the maximal cDa measured in early systole contribute to reduced cardiovagal BRS with HUT.

Patients with a history of sympathectomy were also excluded.

J Korean Acad Rehabil Med. 2000 Apr;24(2):193-199. Korean.

Comparison of Catecholamine Levels in Hemiplegic Patients with and without Reflex Sympathetic Dystrophy.

Kim EG, Kim YG, Byun SJ, Kim HS, Ahn KH.

Department of Rehabilitation Medicine, Kyung Hee University College of Medicine.
Department of Rehabilitation Medicine, Joongmoon College of Medicine.
Department of Neurology, Kyung Hee University College of Medicine.

OBJECTIVE: To determine whether the cause of sympathetic dysfunction is due to increased regional sympathetic outflow or receptor supersensitivity to circulating catecholamines in the pathogenesis of reflex sympathetic dystrophy in hemiplegia. METHOD: Ten hemiplegic patients with reflex sympathetic dystrophy were instructed to refrain from smoking or using caffeine and alcohol, and medications that influence catecholamine metabolism were witheld for 24 hours before blood sampling. Patients with cardiovascular disease, diabetes or abnormal liver and renal function tests were excluded from the study. Patients with a history of sympathectomy were also excluded.

Serum Dopamine-beta-Hydroxylase: Decrease after Chemical Sympathectomy

Serum Dopamine-beta-Hydroxylase: Decrease after Chemical Sympathectomy

Weinshilboum and Axelrod
Science 3 September 1971: 931-934
DOI: 10.1126/science.173.4000.931

Partial cardiac sympathetic denervation after bilateral thoracic sympathectomy in humans

Partial cardiac sympathetic denervation after bilateral thoracic sympathectomy in humans

Jeffrey P. Moak MD^a, Basil Eldadah MD, PhD^b, Courtney Holmes CMT^b, Sandra Pechnik RN^b and David S. Goldstein MD, PhD^b
aChildren’s National Medical Center, Washington, DC
^bClinical Neurocardiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
Received 6 January 2005; accepted 1 March 2005. Available online 25 May 2005.http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B7GW9-4G7WHD3-6&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=fd8be4ed02dd6654028265ed316ed13f

Severe bronchospasm after sympathectomy

Does bilateral thoracic sympathectomy predispose to reflex bronchospasm following tracheal intubation?

Ahed Zeidan, MD^*, Nazih Nahle, MD^* and Anis Baraka, MD FRCA

^* Sahel General Hospital,
American University of Beirut Medical Center, Beirut, Lebanon,

To the Editor:

Thoracic endoscopic sympathectomy has become the technique of choice for treating intractable essential hyperhidrosis.¹ We report severe bronchospasm following tracheal intubation in a patient with a previous history of bilateral thoracic sympathectomy.

Canadian Journal of Anesthesia 52:997-998 (2005)
© Canadian Anesthesiologists' Society, 2005

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High Plasma Norephrine - future RENAL injury

HIGH PLASMA NOREPINEPHRINE LEVELS DETERMINED BY .BETA.2-ADRENOCEPTOR POLYMORPHISMS PREDICT THE FUTURE RENAL INJURY IN NONOBESE, NORMOTENSIVE SUBJECTS

Title;HIGH PLASMA NOREPINEPHRINE LEVELS DETERMINED BY .BETA.2-ADRENOCEPTOR POLYMORPHISMS PREDICT THE FUTURE RENAL INJURY IN NONOBESE, NORMOTENSIVE SUBJECTS

Author;MASUO KAZUKO(Baker Heart Res. Inst., Aus) MASUO KAZUKO(Osaka Univ. Graduate School Of Medicine, Jpn) KATSUYA TOMOHIRO(Osaka Univ. Graduate School Of Medicine, Jpn) KAWAGUCHI HIDEKI(Ucla, Usa) RAKUGI HIROMI(Osaka Univ. Graduate School Of Medicine, Jpn) OGIHARA TOSHIO(Osaka Univ. Graduate School Of Medicine, Jpn) TUCK MICHAEL L.(Ucla, Usa)

Journal Title;Abstr 21st Sci Meet Int Soc Hypertens 2006

Journal Code:K20060131

Pain - increased expression of human alpha -adrenergic receptors after loss of sympathetic activity.

The hypothesis proposes the increased presence of -adrenergic receptors in primary afferent neurons to result from an altered gene expression triggered by cytokines/growth factors produced by disconnection of peripheral nerve fibers from their cell bodies. These additional adrenergic receptors are suggested to make nociceptors and other primary afferent neurons excitable by local or circulating norepinephrine and epinephrine. For central pathways, the adrenergic excitation would be equivalent to that produced by noxious events and would consequently evoke pain. In support, evidence is cited for a form of denervation supersensitivity in causalgia and for increased expression of human -adrenergic receptors after loss of sympathetic activity.

Edward R. Perl^*

Department of Cell and Molecular Physiology, CB 7545, University of North Carolina, Chapel Hill, NC 27599

http://www.pnas.org/cgi/content/abstract/96/14/7664

Sympathectomy induces adrenergic excitability of cutaneous C-fiber nociceptors

Sympathectomy induces adrenergic excitability of cutaneous C-fiber nociceptors

D. F. Bossut, V. K. Shea and E. R. Perl
Department of Physiology, University of North Carolina at Chapel Hill 27599-7545, USA.

http://jn.physiology.org/cgi/content/abstract/75/1/514

J Neurophysiol 75: 514-517, 1996;
0022-3077/96 $5.0

Journal of Neurophysiology, Vol 75, Issue 1 514-517, Copyright © 1996 by APS

Sympathectomy IS the DAMAGE to the sympathetic nervous system, that will cause the pain.

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Similarities between RSD patients and post-sympathtectomy patients

Quantitative Evaluation of Sympathetic Nervous System Dysfunction in Patients with Reflex Sympathetic Dystrophy

J. IDE, M. YAMAGA, T. KITAMURA and K. TAKAGI

From the Department of Orthopaedic Surgery, Kumamoto University School of Medicine, Kumamoto, Japan

Correspondence: J. Ide MD, Department of Orthopaedic Surgery, Kumamoto University School of Medicine 1–1–1 Honjo, Kumamoto 860, Japan.

We observed an increased blood flow but an unchanged vasoconstrictor response in the affected hand in stage 1 of the disorder, but in stage 2 there was a decreased blood flow and a stronger vasoconstriction following an inspiratory gasp. These results suggest that in RSD patients the sympathetic nervous system function is altered and is different in the various stages.

fiber degeneration following Sympathectomy

Petras JM, Cummings JF. Autonomic neurons in the spinal cord
of the rhesus monkey: a correlation of the findings of cytoarchi-
tectonics and sympathectomy with fiber degeneration following
dorsal rhizotomy. J Comp Neurol 1972;146:189 –218.

Sweating = supersensitivity to neurotransmitters and not sympathetic overactivity

These findings do not support the widely held view that autonomic disturbances in reflex sympathetic dystrophy are due to sympathetic overactivity. Rather, they suggest that sweating and changes in peripheral blood flow result from supersensitivity to sympathetic neurotransmitters. After injury, supersensitivity to noradrenaline may also contribute to spontaneous pain and allodynia by disrupting efferent sympathetic modulation of sensation. This would explain why pain and allodynia are relieved by sympathetic blockade, and why noradrenaline rekindles pain in sympathectomized skin.

REFLEX SYMPATHETIC DYSTROPHY: THE SIGNIFICANCE OF DIFFERING PLASMA CATECHOLAMINE CONCENTRATIONS IN AFFECTED AND UNAFFECTED LIMBS

PETER D. DRUMMOND^1,, PHILIP M. FINCH² and GEORGE A. SMYTHE³
http://brain.oxfordjournals.org/cgi/content/abstract/114/5/2025
Brain, Vol. 114, No. 5, 2025-2036, 1991
© 1991 Guarantors of Brain

unavoidable consequence of sympathectomy

Pathological gustatory sweating and flushing can develop after injury to preganglionic cervico-thoracic sympathetic fibres, an unavoidable consequence of resecting that part of the sympathetic chain. The mechanism of this abnormal response is uncertain; conceivably, though, regeneration of injured salivatory fibres or collateral sprouting from nearby intact fibres creates aberrant connections between salivatory fibres and denervated vasomotor and sudomotor neurons in the superior cervical ganglion.(7) Commands to salivate would then be translated into commands to sweat and flush in the distribution of sympathetic denervation. Cross-innervation lower down in the stellate ganglion can also produce unusual and potentially distressing autonomic disturbances in the sympathetically-denervated arm (e.g., piloerection while eating).(8)
Drummond PD. A caution about surgical treatment for facial blushing. British Journal of Dermatology 2000; volume 142: pages 194-195.

Rhinitis - relative nasal sympathetic hyposensitivity

The exact pathophysiology of intrinsic rhinitis is not fully understood. The generally held belief is that it is due to an imbalance between the outflow of the nasal sympathetic and parasympathetic nervous systems, perhaps due to excessive parasympathetic or reduced sympathetic activity. In this study the nasal airway response to a predominantly sympathetic stimulus, isometric exercise, was studied in 19 patients with intrinsic rhinitis and compared with 16 normal patients.
The study shows that there is an abnormal response to isometric exercise in intrinsic rhinitis, perhaps due to relative nasal sympathetic hyposensitivity.

The nasal response to isometric exercise in non-eosinophilic intrinsic rhinitis

• A. D. WILDE¹¹Department of Otolaryngology, Royal Liverpool University Hospital, Liverpool, UK, ²²Mr A. Wilde, Department of Otolaryngology, Royal Liverpool University Hospital, Prescott Street, Liverpool, L69 3BX, UK.,
• J. A. COOK¹¹Department of Otolaryngology, Royal Liverpool University Hospital, Liverpool, UK and
• A. S. JONES¹¹Department of Otolaryngology, Royal Liverpool University Hospital, Liverpool, UK

• ¹Department of Otolaryngology, Royal Liverpool University Hospital, Liverpool, UK

²Mr A. Wilde, Department of Otolaryngology, Royal Liverpool University Hospital, Prescott Street, Liverpool, L69 3BX, UK.

Clinical Otolaryngology

Volume 21 Issue 1 Page 84-86, February 1996

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2273.1996.tb01031.x?journalCode=coa