"Lifestyle' Surgical Procedure Carries Unrecognized Risk of Complications"

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

Changes in cerebral morphology consequent to peripheral autonomic denervation

Our findings suggest that peripheral autonomic denervation is associated with grey matter loss in cortical regions encompassing areas that we have previously shown are functionally involved in generation and representation of bodily states of autonomic arousal. The nature of these changes cannot be determined from morphometric analysis alone, but we suggest that they reflect experience-dependent change consequent upon loss of afferent input to brain regions involved in representation of autonomic states.
http://dx.doi.org/doi:10.1016/S1053-8119(03)00011-9

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

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

7th International Symposium on Sympathetic Surgery 20th-22nd March 2007 Muro Alto (PE), Brazil
Clinical Autonomic Research. New York:Apr 2007. Vol. 17, Iss. 2, p. 126-44 (19 pp.)

Pity colleagues, pity for these poor patients!
Gross Michel* Institution: Private Cabinet*; Grone - Switzerland
A desperate 22-year-old man comes to consult and tells me about his idea of committing suicide. Since the age of 9, he suffers from a severe cephalic ephidrosis, with blushing face, intensifying with years, to such an extent that it became unbearable over the last year:
''It is a real Calvary''. His family GP assures him that his troubles are going to disappear as he will get older and ''ut aliquid fieri'' he prescribes sage drops and anxiolytic. As these prescriptions do not improve his situation, his GP sends him to an endocrinologist who performs many exams to exclude an hyperthyreosis, a carcinoıd tumor or a pheochromocytoma. Among the considerable number of blood exams, one appears to be out of normal ranges. The patient goes therefore to an haematologist, who does not find anything
abnormal. A neurologist, then consulted, does not suspect anything in particular, but asks however for some radiology exams, including a brain MRI, as well as a Pet-scan, to exclude an adrenal gland tumor. All these exams being normal, the patient is sent to a behaviour therapist to begin a psychotherapy. Exhausted by the
weight of these useless consultations here and there, our young patient, always seeking for the solution to his problems, decides to turn to an acupuncturist, an osteopath, a healer and a radiesthesist, in vain. He then decides to consult a dermatologist and shares with him a summary of information gathered on Internet, including information from my site. Finally, the patient was referred to me.
Aware of that, the GP warns his colleagues by sending a letter indicating that any therapeutic measure other than psychotherapy is not recommended, considering the surgical alternative as irresponsible. I did by the way, not get any call from any of my colleagues. The patient had successful surgery 2 weeks later
(sympathicotomy T2-3-4-5) This recent history redraws, once again, iatrogenic caricatural wandering to which our patients are too often subjected. It has to push us to publish our works, to inform the medical corps, relentlessly and without restraint. The information could also, throughout the public, reach our colleagues. It is at the end an interesting paradox to note that physicians, whose primary role is to relieve patients, are also the primary actors of a film where patients are maintained in a ''medical jail''.

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

Effects of endoscopic thoracic sympathectomy for primary hyperhidrosis on cardiac autonomic nervous activity.

Cruz J, Sousa J, Oliveira AG, Silva-Carvalho L.

Service of Cardiothoracic Surgery, Hospital de Santa Maria, Lisbon, Portugal. costacruzjorge@gmail.com

We found statistically significant differences (P < .05) in both time and frequency domains. Parameters that evaluate global cardiac autonomic activity (total power, SD of normal R-R intervals, SD of average normal R-R intervals) and vagal activity (rhythm corresponding to percentage of normal R-R intervals with cycle greater than 50 ms relative to previous interval, square root of mean squared differences of successive normal R-R intervals, high-frequency power, high-frequency power in normalized units) were statistically significantly increased after sympathectomy. Low-frequency power in normalized units, reflecting sympathetic activity, was statistically significantly decreased after sympathectomy. Low-/high-frequency power ratio also showed a significant decrease, indicating relative decrease in sympathetic activity and increase in vagal activity.

These results provide, for the first time to our knowledge, clear evidence of increased vagal and global cardiac autonomic activity and decreased sympathetic activity after endoscopic thoracic sympathectomy.

PMID: 19258086 [PubMed - indexed for MEDLINE]

Changes in cerebral morphology consequent to peripheral autonomic denervation

Our findings suggest that peripheral autonomic denervation ( ETS= peripheral autonomic denervation) is associated with grey matter loss in cortical regions encompassing areas that we have previously shown are functionally involved in generation and representation of bodily states of autonomic arousal. http://www.ncbi.nlm.nih.gov/pubmed/12725766 Neuroimage. 2003 Apr;18(4):908-16. Links Critchley HD, Good CD, Ashburner J, Frackowiak RS, Mathias CJ, Dolan RJ. Wellcome Department of Imaging Neuroscience, Institute of Neurology, UCL, 12 Queen Square, London WC1N 3BG, UK. j.critchley@fil.ion.ucl.ac.uk

Bradycardia likely, compensatory sweating obligatory

Bradycardia likely, compensatory sweating obligatory

Patient?s informed consent should include and define side effects like gustatory sweating, olfactory sweating and bradycardia as likely, and compensatory sweating as obligatory.

Clinical Autonomic Research; Dec2003 Supplement 1, Vol. 13, p0, 1p

Sympathectomy on cerebral and peripheral muscular arteries

Differing influence of sympathectomy on smooth muscle cells and fibroblasts in cerebral and peripheral muscular arteries.

Source:

Autonomic Neuroscience: Basic & Clinical; Jan2006, Vol. 124 Issue 1/2, p38-48, 11p

In contrast to intact FAs, the external layers of sympathectomized FAs revealed migration of fibroblasts from the adventitia and death of SMCs. These results strongly suggest that sympathetic nerves intervene in the cytoskeletal protein remodelling through phenotypic modulation of both SMCs and MFBs during post-natal development, and in pathologies involving similar phenomena, such as atherosclerosis. [Copyright 2006 Elsevier] ( femoral (FA) and basilar (BA) arteries.)

unable to establish the etiology of 'Compensatory Sweating'

Bilateral upper thoracic sympathicolysis is followed by redistribution of body perspiration, with a clear decrease in the zones regulated by mental or emotional stimuli, and an increase in the areas regulated by environmental stimuli, though we are unable to establish the etiology of this redistribution.
Surgical Endoscopy; Nov2007, Vol. 21 Issue 11, p2030-2033, 4p, 2 charts

Impaired chronotropic response to exercise stress testing as a predictor of mortality

Chronotropic incompetence, an attenuated heart rate response to exercise, is a predictor of all-cause mortality in healthy populations. This association may be independent of exercise-induced myocardial perfusion defects.
Michael S Lauer, Gary S Francis, Peter M Okin, Fredric J Pashkow, et al. JAMA. Chicago:Feb 10, 1999. Vol. 281, Iss. 6, p. 524-9 (6 pp.)

cardiopulmonary function impairment after ETS

This article focuses on a study related to evaluating the cardiopulmonary function impairment after sympathectomy in patients with essential hyperhidrosis. The observed modifications in cardiopulmonary function after bilateral dorsal sympathectomy suggest that there is a slight effect of the intervention on the small airway, as evidenced by the presence of bronchial hyperresponsiveness in half of the studied patients and on a mild reduction in maximal hear rate.

CHEST; Oct2005, Vol. 128 Issue 4, p2702-2705, 4p

disturbances in the sympathetic regulation of the peripheral blood flow

Finger skin blood flow was measured in 80 healthy subjects, using laser Doppler imaging during basal vasodilatation at a local temperature of 40°C. The response to cooling of the contralateral hand at 15°C was studied. A vasoconstriction index was calculated in all subjects and a nomogram was constructed, taking age into consideration. Compared with these normal subjects, four patients operated on with transthoracic endoscopic sympathectomy due to hand hyperhidrosis showed clearly attenuated responses. The results indicate that the test can be used to assess disturbances in the sympathetic regulation of the peripheral blood flow.
Clinical Physiology; Mar1998, Vol. 18 Issue 2, p103-107, 5p

Reduced HRV and baroreflex sensitivity as universally applicable cardiovascular “risk factors”

Murray Esler
Elisabeth Lambert

Reduced HRV and baroreflex sensitivity as universally applicable cardiovascular “risk factors”: waiting for the bubble to burst

Clin Auton Res (2003) 13:170–172

cardiovascular response to different levels of sympathetic blockade varies widely

Individual cardiovascular response to different levels of sympathetic blockade varies widely, depending on the degree of sympathetic tone before the block.

It was suggested that the sympathetic control of heart rate modified the dominating parasympathetic tone, rather than functioning as an active cardiac accelerator. In this study there was no compensation for changes in preload; therefore cardiopulmonary baroreceptors affected by changes in central volume secondary to peripheral vasodilatation or vasoconstriction might have altered arterial baroreceptor heart rate reflex as well. To minimize that influence, Goertz et al gave plasma volume expanders to equalize left ventricular preload conditions as assessed by transesophageal echocardiography". High TEA added to general anaesthesia significantly decreased the cardiac acceleration in response to decreasing blood pressure, suggesting that baroreflex-mediated heart rate response to a decrease in arterial blood pressure depends on the integrity of the sympathetic nervous system. However general anaesthesia, in addition to high levels of epidural anaesthesia, may have modified the balance between sympathetic and parasympathetic tone as well.

B T Veering, M J Cousins. Anaesthesia and Intensive Care. Edgecliff:Dec 2000. Vol. 28, Iss. 6, p. 620-35 (16 pp.)
Copyright Australian Society of Anaesthetists Dec 2000

integration of somatosensory and phasic baroreceptor information at cortical, limbic and brainstem levels

Following one's heart: cardiac rhythms gate central initiation of sympathetic reflexes.

Gray MA, Rylander K, Harrison NA, Wallin BG, Critchley HD.

Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Brighton, East Sussex BN1 9RR, United Kingdom. m.a.gray@bsms.ac.uk

Central nervous processing of environmental stimuli requires integration of sensory information with ongoing autonomic control of cardiovascular function. Rhythmic feedback of cardiac and baroreceptor activity contributes dynamically to homeostatic autonomic control. We examined how the processing of brief somatosensory stimuli is altered across the cardiac cycle to evoke differential changes in bodily state. Using functional magnetic resonance imaging of brain and noninvasive beat-to-beat cardiovascular monitoring, we show that stimuli presented before and during early cardiac systole elicited differential changes in neural activity within amygdala, anterior insula and pons, and engendered different effects on blood pressure. Stimulation delivered during early systole inhibited blood pressure increases. Individual differences in heart rate variability predicted magnitude of differential cardiac timing responses within periaqueductal gray, amygdala and insula. Our findings highlight integration of somatosensory and phasic baroreceptor information at cortical, limbic and brainstem levels, with relevance to mechanisms underlying pain control, hypertension and anxiety.

J Neurosci. 2009 Feb 11;29(6):1817-25.

Fear conditioning dependent on autonomic awareness

The degree to which perceptual awareness of threat stimuli and bodily states of arousal modulates neural activity associated with fear conditioning is unknown. We used functional magnetic neuroimaging (fMRI) to study healthy subjects and patients with peripheral autonomic denervation to examine how the expression of conditioning-related activity is modulated by stimulus awareness and autonomic arousal. In controls, enhanced amygdala activity was evident during conditioning to both "seen" (unmasked) and "unseen" (backward masked) stimuli, whereas insula activity was modulated by perceptual awareness of a threat stimulus. Absent peripheral autonomic arousal, in patients with autonomic denervation, was associated with decreased conditioning-related activity in insula and amygdala. The findings indicate that the expression of conditioning-related neural activity is modulated by both awareness and representations of bodily states of autonomic arousal.

Author/s: Critchley, Hugo D (HD); Mathias, Christopher J (CJ); Dolan, Raymond J (RJ);

Affiliation: Department of Imaging Neuroscience, 12 Queen Square, Institute of Neurology and Institute of Cognitive Neuroscience, UCL, WC1N 3BG, London, United Kingdom.

Journal: Neuron (Neuron), published in United States. (Language: eng)

Reference: 2002-Feb; vol 33 (issue 4) : pp 653-63

Changes in cerebral morphology consequent to peripheral autonomic denervation

Our findings suggest that peripheral autonomic denervation (ETS = peripheral autonomic denervation) is associated with grey matter loss in cortical regions encompassing areas that we have previously shown are functionally involved in generation and representation of bodily states of autonomic arousal.

Neuroimage. 2003 Apr;18(4):908-16. Links

Critchley HD, Good CD, Ashburner J, Frackowiak RS, Mathias CJ, Dolan RJ.

Wellcome Department of Imaging Neuroscience, Institute of Neurology, UCL, 12 Queen Square, London WC1N 3BG, UK. j.critchley@fil.ion.ucl.ac.uk

Unforeseeable and unacceptable complications

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

Side effects and complications of surgery for hyperhidrosis.

Dumont P.

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

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

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

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

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

Evidence-based review of the surgical management of hyperhidrosis.

"Compensatory sweating' disastrous

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

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

Kopelman D, Hashmonai M.

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

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

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

Hemodynamic consequences of cervico-dorsal sympathectomy

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

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

	6. Recommendations

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

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

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

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

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

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

PMID: 19038983 [PubMed - indexed for MEDLINE

statistically significant differences - cardiac effect

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

Effects of endoscopic thoracic sympathectomy for primary hyperhidrosis on cardiac autonomic nervous activity.

Cruz J, Sousa J, Oliveira AG, Silva-Carvalho L.

Service of Cardiothoracic Surgery, Hospital de Santa Maria, Lisbon, Portugal. costacruzjorge@gmail.com

OBJECTIVE: Endoscopic thoracic sympathectomy is performed to treat primary hyperhidrosis. The second and third sympathetic thoracic ganglia excised also innervate the heart. Some studies have shown decreased heart rate but have not been conclusive regarding other cardiac effects of sympathectomy. We studied the cardiac autonomic effects of endoscopic thoracic sympathectomy in a group of patients with primary hyperhidrosis. Heart rate variability is a simple, noninvasive electrocardiographic marker reflecting the activity and balance of the sympathetic and vagal components of the autonomous nervous system. METHODS: We performed a prospective study in 38 patients with primary hyperhidrosis with 24-hour Holter recordings obtained before endoscopic thoracic sympathectomy and 6 months later. RESULTS: We found statistically significant differences (P < .05) in both time and frequency domains. Parameters that evaluate global cardiac autonomic activity (total power, SD of normal R-R intervals, SD of average normal R-R intervals) and vagal activity (rhythm corresponding to percentage of normal R-R intervals with cycle greater than 50 ms relative to previous interval, square root of mean squared differences of successive normal R-R intervals, high-frequency power, high-frequency power in normalized units) were statistically significantly increased after sympathectomy. Low-frequency power in normalized units, reflecting sympathetic activity, was statistically significantly decreased after sympathectomy. Low-/high-frequency power ratio also showed a significant decrease, indicating relative decrease in sympathetic activity and increase in vagal activity. CONCLUSION: These results provide, for the first time to our knowledge, clear evidence of increased vagal and global cardiac autonomic activity and decreased sympathetic activity after endoscopic thoracic sympathectomy.

PMID: 19258086 [PubMed - indexed for MEDLINE

40% were disappointed

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

Sympathectomy = psychosurgery

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

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

unforeseeable and unacceptable complications

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

Side effects and complications of surgery for hyperhidrosis.

Dumont P.

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

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

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

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

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

Evidence-based review of the surgical management of hyperhidrosis.

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

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

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

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

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

PMID: 19038983 [PubMed - indexed for MEDLINE

statistically significant differences - cardiac effect

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

Effects of endoscopic thoracic sympathectomy for primary hyperhidrosis on cardiac autonomic nervous activity.

Cruz J, Sousa J, Oliveira AG, Silva-Carvalho L.

Service of Cardiothoracic Surgery, Hospital de Santa Maria, Lisbon, Portugal. costacruzjorge@gmail.com

OBJECTIVE: Endoscopic thoracic sympathectomy is performed to treat primary hyperhidrosis. The second and third sympathetic thoracic ganglia excised also innervate the heart. Some studies have shown decreased heart rate but have not been conclusive regarding other cardiac effects of sympathectomy. We studied the cardiac autonomic effects of endoscopic thoracic sympathectomy in a group of patients with primary hyperhidrosis. Heart rate variability is a simple, noninvasive electrocardiographic marker reflecting the activity and balance of the sympathetic and vagal components of the autonomous nervous system. METHODS: We performed a prospective study in 38 patients with primary hyperhidrosis with 24-hour Holter recordings obtained before endoscopic thoracic sympathectomy and 6 months later. RESULTS: We found statistically significant differences (P < .05) in both time and frequency domains. Parameters that evaluate global cardiac autonomic activity (total power, SD of normal R-R intervals, SD of average normal R-R intervals) and vagal activity (rhythm corresponding to percentage of normal R-R intervals with cycle greater than 50 ms relative to previous interval, square root of mean squared differences of successive normal R-R intervals, high-frequency power, high-frequency power in normalized units) were statistically significantly increased after sympathectomy. Low-frequency power in normalized units, reflecting sympathetic activity, was statistically significantly decreased after sympathectomy. Low-/high-frequency power ratio also showed a significant decrease, indicating relative decrease in sympathetic activity and increase in vagal activity. CONCLUSION: These results provide, for the first time to our knowledge, clear evidence of increased vagal and global cardiac autonomic activity and decreased sympathetic activity after endoscopic thoracic sympathectomy.

PMID: 19258086 [PubMed - indexed for MEDLINE

Sympathectomy = psychosurgery

http://encyclopedia.stateuniversity.com/pages/17971/psychosurgery.html

Cambridge Encyclopedia :: Cambridge Encyclopedia Vol. 60

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

sympathectomy affords no relief

Risk-Benefit Ratio for Surgical Sympathectomy: Dilemmas in Clinical Decision Making

The Journal of Pain
Volume 1, Issue 4, December 2000, Pages 261-264

References and further reading may be available for this article. To view references and further reading you must purchase this article.

Srinivasa N. Raja and James N. Campbell

assessing whether the risk-benefit ratio is favor- able to the patient, physician, and society. .... ers, sympathectomy affords no relief, and in still ... might not produce the intended results. There ... pathectomy likely arise from misdiagnosis. ... little likelihood of a favorable response to sym- pathectomy. ...

Mia: to be updated

"sympathectomy with little or no idea whether this is likely to produce benefit"

ANZ Journal of Surgery

Volume 45 Issue 4, Pages 425 - 434

Published Online: 21 Jan 2008

Journal compilation © 2009 Royal Australasian College of Surgeons

Proceedings of the Surgical Research Society of Australasia - SCIENTIFIC MEETING

"sympathectomy with little or no idea whether this is likely to produce benefit" - to be updated soon.

Severe CS in 18%

It was not necessary to remove the clips in any case. In our historical series of 300 patients submit-
ted to sympathicotomy we observed an improvement of the symptoms in 99% and CS in 78%, being severe in 18%.


162-P
EFFECTIVENESS OF SYMPATHETIC BLOCK BY CLIPPING IN THE TREATMENT
OF HYPERHIDROSIS AND UNCONTROLLABLE FACIAL BLUSHING
J.J. Fibla, L. Molins, J.M. Mier, G. Vidal
Thoracic Surgery Sagrat Cor University Hospital, Barcelona, Spain
2008;7:147-200
Interact CardioVasc Thorac Surg
Abstracts: Suppl. 2 to Vol. 7 (June 2008)

Sympathectomy increased the pain threshold and made the sympathectomized rats hypesthetic.

Spine:

15 April 1996 - Volume 21 - Issue 8 - pp 925-930

Anatomy

Latanoprost has been shown to abolish sympathectomy induced iris hypopigmentation

British Journal of Ophthalmology 1999;83:1403c; doi:10.1136/bjo.83.12.1403c

Copyright © 1999 by the BMJ Publishing Group Ltd.

Br J Ophthalmol 1999;83:1403 ( December )

Surgical or chemical sympathectomy leads to suppression of adrenergic and neuropeptide Y fibers.

Clinical Anatomy of the Nose, Nasal Cavity and Paranasal Sinuses

By Johannes Lang

Translated by P. M. Stell

Edition: illustrated

Published by Thieme, 1989

Injury of peripheral nerves often results in hyperalgesia

Injury of peripheral nerves often results in hyperalgesia (an increased sensitivity to painful stimuli). This hyperalgesia is mediated in part by sympathetic neurotransmitters. We examined the effect of neuropeptide Y (NPY), specific Y1 and Y2 agonists, and an NPY antagonist on peripheral hyperalgesia in rats whose sciatic nerves had been partially transected. NPY and the Y2 agonist, N-acetyl [Leu²⁸,Leu³¹] NPY 24–36 exacerbated both mechanical and thermal hyperalgesia, while the Y1 agonist, [Leu³¹, Pro³⁴]NPY relieved thermal hyperalgesia.

School of Anatomy, University of New South Wales, Sydney, NSW 2052, Australia

Brain Research
Volume 669, Issue 2, 16 January 1995, Pages 245-254

sympathectomy can itself trigger a painful syndrome

Finally, it should be noted that neuropathic, painful states are not invariably sympathetic dependent. Clinically, 'sympathetically maintained' and 'non-sympathetically maintained' states of pain can be differentiated, based on the fact that in some patients neuropathic pain can be relieved by sympathetic blocks. Furthermore, surgical sympathectomy can itself trigger a painful syndrome in some patients.

Pain medicine: the requisites in anesthesiology

By Stephen E. Abram

Edition: illustrated

Published by Elsevier Health Sciences, 2006

Deterioration of the effects of ETS

We describe a patient who underwent upper thoracic sympathectomy for palmar hyperhidrosis, and whose symptoms subsequently deteriorated, becoming worse than those on initial presentation.

---

Accepted for publication 6 January 1995

Clinical and Experimental Dermatology

Volume 20 Issue 3, Pages 230 - 233

Published Online: 27 Apr 2006

Sympathectomy Causes Aggravated Lesions and Dedifferentiation

Previously [Histochem J 1997;29:279-286], we found that sympathectomy induced neointima formation in ear but not cerebral arteries of genetically hyperlipidemic rabbits.
Sympathectomy Causes Aggravated Lesions and Dedifferentiation in Large Rabbit Atherosclerotic Arteries without Involving Nitric Oxide

J Vasc Res 2006;43:289-305 (DOI: 10.1159/000093010)

sympathectomy severs both vasomotor and sensory fibres

Lumbar sympathectomy severs both vasomotor and sensory fibres, suggesting that relief of rest pain may be explained not only by increased cutaneous and muscle blood flow, but also by nociceptive sensory denervation.

Brendon J. Coventry* and John A. Walsh ^†

*Department of Surgery, University of Adelaide, Royal Adelaide Hospital and ^† VascularSurgery Unit, Department of Surgery, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia

ANZ Journal of Surgery

Volume 73 Issue 1-2, Pages 14 - 18

Published Online: 5 Feb 2003

Journal compilation © 2009 Royal Australasian College of Surgeons

neuropeptide Y-like immunoreactive nerves in the dura mater after sympathectomy

These results suggest that as a consequence of long-term sympathectomy with guanethidine, compensatory changes occur, involving an increase in the expression of neuropeptide Y-like immunoreactivity in non-sympathetic axons in cerebrovascular nerves and iris of the rat. In contrast, the neuropeptide Y-like immunoreactive nerves in the dura mater appear to be entirely sympathetic, since none were present after short-term sympathectomy and none appeared after long-term sympathectomy.

Neuroscience. 1990;34(2):369-78.
PMID: 2333147 [PubMed - indexed for MEDLINE

sympathectomy enhances the severity of EAE

It is now well established that the immune system and the nervous system are connected bidirectionally ( 8, 9, 10 ). Although much remains to be investigated, several lines of evidence suggest that the sympathetic nervous system (SNS) provides a major pathway for neuroimmune interactions. Indeed, a role for catecholamines such as norepinephrine and epinephrine in SNS-mediated immunoregulation has been implicated in various conditions ( 11, 12, 13, 14, 15 ). Regarding the modulation of autoimmunity, it was previously demonstrated that depletion of SNS transmitters by chemical sympathectomy enhances the severity of EAE ( 11, 12 ). Because -adrenoceptor agonists protect against EAE ( 13 ) and catecholamines modulate several immunological functions critical to the pathogenesis of EAE ( 14 ), the enhancement of EAE by chemical sympathectomy has largely been attributed to the depletion of catecholamines. However, although neuropeptide Y (NPY) is also released from SNS terminals innervating lymphatic tissues ( 16, 17 ), no previous studies have explored the possibility that depletion of other SNS transmitters such as NPY may contribute to these findings.

Prior studies have revealed that the sympathetic nervous system regulates the clinical and pathological manifestations of experimental autoimmune encephalomyelitis (EAE), an autoimmune disease model mediated by Th1 T cells. Although the regulatory role of catecholamines has been indicated in the previous works, it remained possible that other sympathetic neurotransmitters like neuropeptide Y (NPY) may also be involved in the regulation of EAE.

In conclusion, this study demonstrates for the first time to our knowledge that NPY has an immunomodulatory activity that suppresses signs of EAE. Given that the levels of NPY in the CSF are reduced in patients with MS ( 34, 35 ), it is tempting to speculate that NPY may also play a critical role in preventing the development of MS. With the availability of novel and highly selective agonists and their ability to mimic the effects of NPY in a highly specific manner, we propose that targeting NPY receptors may be a promising new therapeutic approach to autoimmune disorders.

Department of Immunology, National Institute of Neuroscience, NCNP, Ogawahigashi, Kodaira, Tokyo, Japan; Department of Biochemistry, University of Leipzig, Leipzig, Germany; and Department of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany

Effects of sympathectomy on heart size and function

This evidence suggests that elimination of the adrenergic nervous system's chronotropic influence promotes greater left ventricular filling, and the resultant increase in preload may importantly contribute to the stimulation of cardiac hypertrophy.

Am J Physiol Heart Circ Physiol 252: H442-H447, 1987;

Effects of chemical sympathectomy on insulin receptors and insulin action

Glucose metabolism, however, was inhibited by chemical sympathectomy: the glucose transport rate was significantly reduced and fatty acid synthesis was nearly totally abolished. Insulin was still effective in stimulating both parameters but failed to restore normal levels. The results suggest that the sympathetic innervation of adipose tissue may exert an inhibitory effect on the number of high-affinity insulin receptors as well as on the sensitivity of the lipolysis to insulin, as both parameters were increased by sympathectomy.

Volume 229, Issue 3, pp. 839-844, 06/01/1984
Copyright © 1984 by American Society for Pharmacology and Experimental Therapeutics

altering Ca2+ activity of actomyosin ATPase

Also, Sx (surgical sympathectomy) may impair cardiac functional capacity by altering Ca2+ activity of actomyosin ATPase.

Am J Physiol. 1979 Jan;236(1):C30-4.

PMID: 219702 [PubMed - indexed for MEDLINE]

Effect of chemical sympathectomy on serum levels of thyroid hormones and the biochemical profile

The cloacal temperature (T_c) and both the thyroid hormones showed a drastic decrease while the T₃/T₄ ratio was augmented as a result of sympathectomy.

Thus, the influence of SNS appears to be crucial in the maintenance of serum thyroid hormones and body temperature, as well as metabolic activities of hepatic cells.

R. Parikh^{, a,} and B. Pilo^b

^a School of Environmental and Information Sciences, Charles Sturt University, Albury, NSW 2640, Australia

^b Division of Neuroendocrinology, Department of Zoology, M.S. University of Baroda, Baroda 390 002, India

Journal of the Autonomic Nervous System
Volume 53, Issues 2-3, 25 June 1995, Pages 87-94

Secretions of the pituitary-adrenal cortex as controllers of emotion

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 prolonged cardiac repolarisation, manifest by a prolonged QT interval and characterised by recurrent presyncope/syncope, polymorphic ventricular tachycardia (PMVT), or sudden cardiac death.
She was ultimately treated successfully with bilateral thoracoscopic cervicothoracic sympathectomies. This is the first reported bilateral thoracoscopic treatment of a patient with LQTS and symptomatic life threatening ventricular tachyarrhythmias refractory to current pharmacological and pacing techniques.
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 in the levels of anxiety after surgery compared with the preoperative levels and with established norms (p <>Conclusions: Patients with primary hyperhidrosis that undergo EBTS presented a 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