Cell body reorganization in the spinal cord after elective surgery to treat palmar sweating

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

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

After severing the cervical sympathetic trunk, the cells of the cervical sympathetic ganglion undergo transneuronic degeneration
After severing the sympathetic trunk, the cells of its origin undergo complete disintegration within a year.

http://onlinelibrary.wiley.com/doi/10.1111/j.1439-0442.1967.tb00255.x/abstract

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

Sunday, August 24, 2014

The second thoracic sympathetic ganglion was most commonly located (50%) in the second intercostal space

anatomic variations of the T2 nerve root

6 (9.1%) sides showed a single large ganglion formed by the stellate and the second thoracic sympathetic ganglia. The second thoracic sympathetic ganglion was most commonly located (50%) in the second intercostal space. Conclusion: The anatomic variations of the intrathoracic nerve of Kuntz and the second thoracic sympathetic ganglion were characterized in human cadavers.
Journal of thoracic and cardiovascular surgery Y. 2002, vol. 123, No. 3, pages 498-501 [bibl. : 14 ref.
http://www.refdoc.fr/Detailnotice?idarticle=9466218

Friday, August 22, 2014

change in sympathetic nervous system activity after thoracic sympathectomy

The photoplethysmographic (PPG) signal, which measures cardiac-induced changes in tissue blood volume by light transmission measurements, shows spontaneous fluctuations. In this study, PPG was simultaneously measured in the right and left index fingers of 16 patients undergoing thoracic sympathectomy, and, from each PPG pulse, the amplitude of the pulse (AM) and its maximum (BL) were determined. The parameter AM/BL is proportional to the cardiac-induced blood volume increase, which depends on the arterial wall compliance. AM/BL increased after the thoracic sympathectomy treatment (for male patients, from 2.60±1.49% to 4.81±1.21%), as sympathetic denervation decreases arterial tonus in skin. The very low-frequency (VLF) fluctuations of BL or AM showed high correlation (0.90±0.11 and 0.92±0.07, respectively) between the right and left hands before the thoracic sympathectomy, and a significant decrease in the right-left correlation coefficient (to 0.54±0.22 and 0.76±0.20, respectively) after the operation. The standard deviation of the BL or AM VLF fluctuations also reduced after the treatment, indicating sympathetic mediation of the VLF PPG fluctuations. The study also shows that the analysis of the PPG signal and the VLF fluctuations of the PPG parameters enable the assessment of the change in sympathetic nervous system activity after thoracic sympathectomy.

Volume 39Issue 5pp 579-583
http://link.springer.com/article/10.1007%2FBF0234514

Thursday, August 21, 2014

after sympathectomy "He becomes more quiet, less impressionable, less agitated, tremor diminishes..."

Everyone seems to agree that when sympathectomy is successful the subjective symptoms of the patient show a considerable improvement. He becomes more quiet, less impressionable, less agitated, tremor diminishes, tachycardia, however, is little influenced or not at all, and the same is true for goiter.
   In conclusion it may be said that the results obtained from sympathectomy when present are very immediate. The ocular symptoms are the ones most happily influenced by the operation; the others such as nervousness, tachycardia, and goiter are problematical.
   Remote Results.- In going over the cases operated by Jaboulay as far back as twelve and fourteen years, A. Charlier was able to find that a number of his patients had been cured completely. He was able to retrace 18 out of the 31 cases operated by Jaboulay from four to fourteen years before. Three of them were completely cured, 9 of them were so ameliorated that the subjective cure was a complete one, the objective cure, however, being incomplete; the 6 remaining cases were doubtful. All these patients experienced considerable benefit to their nervous symptoms; improved and no trophic disturbances of any sort followed as the result of sympathectomy.

Saturday, August 9, 2014

Neurogenic and non-neurogenic inflammation in the rat paw following chemical sympathectomy

Neurogenic and non-neurogenic inflammation in t... [Neuroscience. 1991] - PubMed - NCBI: "Neuroscience. 1991;45(3):761-5.
Neurogenic and non-neurogenic inflammation in the rat paw following chemical sympathectomy.
Donnerer J1, Amann R, Lembeck F.
Author information
Abstract
Rats with chemical sympathectomy, induced either at neonatal age (long-term sympathectomy) or in adult animals (short-term sympathectomy) by guanethidine or by 6-hydroxydopamine, were used to determine the contribution of sympathetic noradrenergic fibres to afferent neuron-mediated responses and to non-neurogenic inflammation in the rat. Following long-term sympathectomy with 6-hydroxydopamine there was a 66% depletion of noradrenaline in the paw skin. This was accompanied by a 20-53% increase in the levels of sensory neuropeptides in the paw skin and sciatic nerve. A hypersensitivity towards heat stimuli was observed in the tail immersion test. "




Misleading information about ETS surgery: Westside Dermatology

Excessive sweating treatments | Westside Dermatology: "A variety of surgical approaches have been used to treat severe underarm sweating, but they are usually reserved for the most extreme cases that do not respond to other treatments.Endoscopic thoracic sympathectomy involves surgical interuption of the nerves signals between the spinal column and the sweat glands in the affected area.  This procedure is conducted in an operating theatre by a specialist Thoracic surgeon or a neurosurgeon."




Drawbacks of thoracoscopic sympathectomy | The BMJ

Drawbacks of thoracoscopic sympathectomy | The BMJ: "BMJ 2005; 330 doi: http://dx.doi.org/10.1136/bmj.330.7500.1127 (Published 12 May 2005)
Cite this as: BMJ 2005;330:1127
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Drawbacks of thoracoscopic sympathectomy

Side effects after thoracoscopic sympathectomy have been discussed
widely in Taiwan society in the past few months. Lots of people in Taiwan
suffer from hyperhidrosis palmaris. Thoracoscopic sympathectomy is covered
by our National Health Insurance, and yet patient billing for this
operation does not exceed US$ 60. This is why this operation is so popular
here (1). However, patients with serious compensatory sweating must change
clothes several times a day (some complain they change as often as 10
times a day), resulting in a serious impact on work and social
interaction. Patients suffering from such serious side effects in Taiwan
have formed a support group based on an Internet discussion forum to
request the government to take this problem seriously
(http://home.pchome.com.tw/family/vivi12175/). Since October 2004, The
Department of Health Executive, Yuan, Taiwan, has prohibited surgeons from
performing this operation on patients under 20 years of age. To our
knowledge, this type of Internet-based support group also exists in
England (http://www.noetsuk.com/), Sweden
(http://home.swipnet.se/sympatiska/index3.htm), Australia (http://www.ets-
sideeffects.netfirms.com/), Spain
(http://www.terra.es/personal8/hiperhidrosis/principal.htm) and Japan
(http://www.geocities.jp/etscontroversialop/index.html). Thoracoscopic
sympathectomy is a relatively safe and simple procedure, however, the side
effects are potentially devastating. All surgeons who do the operation and
individuals preparing to undergo this treatment should know this well.
1.Lin TS, Wang NP, Huang LC. Pitfalls and complication avoidance
associated with transthoracic endoscopic sympathectomy for primary
hyperhidrosis (analysis of 2200 cases). Int J Surg Investig 2001; 2: 377-
85."



'via Blog this'

An absence of afferent feedback concerning autonomically generated bodily states was associated with subtle impairments of emotional responses

nature neuroscience • volume 4 no 2 • february 2001 

Neuroanatomical basis for first- and second-order representations of bodily states
H. D. Critchley1,2, C. J. Mathias2,3 and R. J. Dolan1

Thursday, August 7, 2014

“In no other area than Sympathetic Surgery, disagreement, conflicting opinion, different definitions and misleading interpretations of the data exist"

8th ISSS Symposium New York, 2009: 

“In no other area than Sympathetic Surgery, disagreement, conflicting opinion, different definitions and misleading interpretations of the data exist. Mainly regarding surgical indications, the level and extent of the procedure and results evaluation”.

ATS Expert Consensus for the Surgical Treatment of Hyperhidrosis powerpoint presentation  – October 6, 2012, XVI Congreso Boliviana de Cirugia Cardiaca, Toracica y Vascular, Santa Cruz de la Sierra, Bolivia.


or:

The Effects of Thoracic Sympathotomy on Heart Rate Variability in Patients with Palmar Hyperhidrosis

Compared with preoperative variables, there was a significant increase in the number of adjacent normal R wave to R wave (R- R) intervals that differed by more than 50 ms, as percent of the total number of normal RR intervals (pNN50); root mean square difference, the square root of the mean of the sum of squared differences between adjacent normal RR intervals over the entire 24-hour recording; standard deviation of the average normal RR in- terval for all 5-minute segments of a 24-hour recording (SDANN) after thoracic sympathotomy. Low frequencies (LF, 0.04 to 0.15 Hz) decreased significantly.
Yonsei Med J 53(6):1081-1084, 2012

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481380/pdf/ymj-53-1081.pdf 

"synaptic reorganization in the sympathetic chain or spinal cord after sympathotomy" - MAYO Clinic

"synaptic reorganization in the sympathetic chain or spinal cord after sympathotomy" - MAYO Clinic
http://www.mayoclinic.org/documents/mc5520-06pdf/DOC-20077566"


Wednesday, August 6, 2014

Patients with surgical sympathectomies have low plasma levels of DA and NE [49], whereas EPI:NE ratios are increased

Patients with surgical sympathectomies have low plasma levels of DA and NE [49], whereas EPI:NE ratios are increased (unpublished observations), suggesting decreased sympathetically mediated exocytosis and compensatory adrenomedullary activation.

Catecholamines 101 David S. Goldstein
Clin Auton Res (2010) 20:331–352

Tuesday, August 5, 2014

The most common complication is post-sympathectomy neuralgia

"The most common complication is post-sympathectomy neuralgia"



Neural Blockade in Clinical Anesthesia and Management of Pain By Michael J. Cousins,



 "The most common complication is post-sympathectomy neuralgia.... The reported incidence has varied widely between studies, from around 30% to 50%. Whether the sympathectomy is achived by open surgical resection or percutaneous techniques does not seem to influence the incidence."



Vascular Surgery: Principles and Practice by Robert W. Hobson, Samuel E. Wilson, Frank J. Veith - 2004 - Medical - 1600 pages



Postsympathectomy neuralgia is a constant and annoying feature of sympathectomy, and the patient should be forewarned."