significant change after sympathectomy: QT dispersion was significantly reduced 1 month after surgery and the dispersion was further diminished 2 years later

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

The Change in Regional Cerebral Oxygen Saturation after Stellate Ganglion Block

The Change in Regional Cerebral Oxygen Saturation after Stellate Ganglion Block: "Korean J Pain. Jun 2010; 23(2): 142–146.
Published online May 31, 2010.



Stellate ganglion block (SGB) is known to increase blood flow to the innervations area of the stellate ganglion. Near infrared spectroscopy reflects an increased blood volume and allows continuous, non-invasive, and bedside monitoring of regional cerebral oxygen saturation (rSO2). We investigated the influence of SGB on bilateral cerebral oxygenation using a near infrared spectroscopy.



Methods

SGB was performed on 30 patients with 1% lidocaine 10 ml using a paratracheal technique at the C6 level and confirmed by the presence of Horner's syndrome. The blood pressure (BP), heart rate (HR) and rSO2 were measured before SGB and 5, 10, 15 and 20 minutes after SGB. Tympanic temperature of each ear was measured prior to SGB and 20 minutes after SGB.



Results

The increments of the rSO2 on the block side from the baseline were statistically significant at 5, 10, 15 and 20 minutes. The rSO2 on the non-block side compared with the baseline, however, decreased at 15 and 20 minutes. The difference between the block and the non-block sides was significant at 15 and 20 minutes. The BP at 10, 15 and 20 minutes was increased and the HR was increased at 10 and 15 minutes.



Conclusions

We observed an increment of the rSO2 on the block side from the baseline; however, the rSO2 on the non-block side decreased."



'via Blog this'

Inflammation in dorsal root ganglia after peripheral nerve injury: Effects of the sympathetic innervation

Following a peripheral nerve injury, a sterile inflammation develops in sympathetic and dorsal root ganglia (DRGs) with axons that project in the damaged nerve trunk. Macrophages and T-lymphocytes invade these gan- glia where they are believed to release cytokines that lead to hyperexcitability and ectopic discharge, possibly contributing to neuropathic pain. Here, we examined the role of the sympathetic innervation in the inflammation of L5 DRGs of Wistar rats following transection of the sciatic nerve, comparing the effects of specific surgical in- terventions 10–14 days prior to the nerve lesion with those of chronic administration of adrenoceptor antago- nists. Immunohistochemistry was used to define the invading immune cell populations 7 days after sciatic transection. Removal of sympathetic activity in the hind limb by transecting the preganglionic input to the rele- vant lumbar sympathetic ganglia (ipsi- or bilateral decentralization) or by ipsilateral removal of these ganglia with degeneration of postganglionic axons (denervation), caused less DRG inflammation than occurred after a sham sympathectomy. By contrast, denervation of the lymph node draining the lesion site potentiated T-cell in- flux. Systemic treatment with antagonists of α1-adrenoceptors (prazosin) or β-adrenoceptors (propranolol) led to opposite but unexpected effects on infiltration of DRGs after sciatic transection. Prazosin potentiated the influx of macrophages and CD4+ T-lymphocytes whereas propranolol tended to reduce immune cell invasion. These data are hard to reconcile with many in vitro studies in which catecholamines acting mainly via β2-adrenoceptors have inhibited the activation and proliferation of immune cells following an inflamma- tory challenge. 

Autonomic Neuroscience: Basic and Clinical 182 (2014) 108–117 

Neuroscience Research Australia, Randwick, NSW 2031, and the University of New South Wales, Sydney, NSW 2052, Australia

Functional and organic vascular wall changes after sympathectomy and partial nerve damage

Langenbecks  

Arch  

Klin  

Chir  

Ver  

Dtsch  

Z  

Chir.  

1959;;291:217-31. 

In the setting of sympathectomy, interference with any of the effectors evokes immediate, precipitous declines in blood pressure

"From the finding that removal of the sympathetic nerves did not affect blood pressure much, Cannon inferred that the sympathetic nervous system did not contribute to blood pressure in intact, undisturbed organism. In the 1980s, however, several reports showed  that sympathectomy compensatorily activates other effectors, such as the renin-angiotensin-aldosterone system, the vasopressin system, and the adrenal medulla, and compensatory activation of these effectors maintains blood pressure at approximately normal levels. In the setting of sympathectomy, interference with any of the effectors evokes immediate, precipitous declines in blood pressure. Because Cannon was so firmly convinced of the functional unity of the sympathoadrenal system, which would be activated only in emergencies, he never considered adequately the possibility that the sympathetic nervous system might indeed contribute to levels of blood pressure and other monitored variables under resting conditions." Adrenaline and the Inner World:  An Introduction to Scientific Integrative Medicine

David S. Goldstein

JHU Press, 01/04/2008 - Medical - 328 pages

sympathectomy and parasympathectomy lead to hyperfunction of the serotoninergic system and pathology

We studied the balance of activity of sympathetic, parasympathetic, and serotoninergic divisions of the autonomic nervous system in the regulation of the heart function in rabbits. High activities of the sympathetic and parasympathetic system are associated with antagonistic interactions between them. Moderation of activity of these systems could be accompanied by activation of the serotoninergic system. Physiological sympathectomy and parasympathectomy lead to hyperfunction of the serotoninergic system and pathology. 

Bulletin of Experimental Biology and Medicine, Vol. 140, No. 5, 2005 PHYSIOLOGY

"patient information must include the long-term substantial risk for severe CS and regret of the procedure"

http://www.ncbi.nlm.nih.gov/pubmed/22191130

lowering of heart rate and blood pressure, decreased responsiveness of the cardiocirculatory system to emotional stimuli after sympathectomy

"lowering of heart rate and blood pressure, decreased responsiveness of the cardiocirculatory system to emotional stimuli: it is an effect that is especially noticeable in patients operated on for erythrophobia and less evident in those operated for hyperhidrosis. It is almost always a welcome phenomenon, which contributes considerably to the feeling of tranquility and serenity that generally supersedes anxiety. Excessive reduction in blood pressure or heart rate may lead to a state of weakness and fatigue that may require removal of the clips in approx. 2%. This rare state of asthenia contrasts with the increased energy and vigor that most patients experience when they feel freed from overwhelming anxiety."    

"The neurovegetative nervous system is, however, very dynamic and tends to adapt continuously during lifetime to all environmental or organic changes and conditions. Therefore, it reacts very individually when a reflex circuit has been blocked. The resulting side effects cannot be predicted in detail, and though they in most patients are relatively mild or even absent, there is a small group of patients developing heavy side effects. Therefore, surgery should only be considered in carefully selected cases in whom non-invasive treatment has failed and in whom the detrimental consequences of erythrophobia regarding the psychosocial situation and the quality of life is such to justify more adverse side effects. It should also always be kept in mind that therapy can be ineffective and that, in the long term, 10-15% of patients do not consider themselves satisfied with the result of surgery. In any case, the author prefers the use of a potentially reversible surgical technique (ESB), instead of destructive techniques (cutting, coagulation, removal of ganglia)."  

http://www.chir.it/en_erythrophobia.php

facial anhidrosis and disturbed cardiovascular responses to temperature after sympathectomy for hand sweating

"Although thoracic sympathectomy is commonly used to reduce upper limb sweating, it may also lead to facial anhidrosis and disturbed cardiovascular responses to temperature. The resultant effect on overall body heat loss has not been documented. We present a case of a young patient with previous thoracic sympathectomy who suffered severe heat stroke after heavy exercise. 
http://ats.ctsnetjournals.org/cgi/content/full/84/3/1025

significant associations between heart rate and regional cerebral blood flow

Neurosci Biobehav Rev. 2012 Feb;36(2):747-56. doi: 10.1016/j.neubiorev.2011.11.009. Epub 2011 Dec 8.

A meta-analysis of heart rate variability and neuroimaging studies: implications for heart rate variability as a marker of stress and health.

The intimate connection between the brain and the heart was enunciated by Claude Bernard over 150 years ago. In our neurovisceral integration model we have tried to build on this pioneering work. In the present paper we further elaborate our model and update it with recent results. Specifically, we performed a meta-analysis of recent neuroimaging studies on the relationship between heart rate variability and regional cerebral blood flow. We identified a number of regions, including the amygdala and ventromedial prefrontal cortex, in which significant associations across studies were found. We further propose that the default response to uncertainty is the threat response and may be related to the well known negativity bias. Heart rate variability may provide an index of how strongly 'top-down' appraisals, mediated by cortical-subcortical pathways, shape brainstem activity and autonomic responses in the body. If the default response to uncertainty is the threat response, as we propose here, contextual information represented in 'appraisal' systems may be necessary to overcome this bias during daily life. Thus, HRV may serve as a proxy for 'vertical integration' of the brain mechanisms that guide flexible control over behavior with peripheral physiology, and as such provides an important window into understanding stress and health.

http://www.ncbi.nlm.nih.gov/pubmed/22178086

sympathectomy "not as minor a procedure as usually asserted"

Although morbidity was low, significant complications of TES (Thoracic endoscopic sympathectomy) occurred. Patients should be clearly warned that TES is not as minor a procedure as usually asserted. Complications as well as adverse effects should be considered when discussing this surgical indication.
Ann Thorac Surg 71(4):1116-9 (2001)

"Sympathectomy can enhance or suppress antibody production"

Neuropsychiatry - Google Books:

The mechanisms by which sympathectomy leads to increased local bone loss is unknown.

In vivo effects of surgical sympathectomy on intra... [Am J Otol. 1996] - PubMed - NCBI: "Am J Otol. 1996 Mar;17(2):343-6.
In vivo effects of surgical sympathectomy on intramembranous bone resorption.
Sherman BE1, Chole RA.
Author information
1Department of Otolaryngology--Head and Neck Surgery, School of Medicine, University of California, Davis, USA.
Abstract
Bone modeling and remodeling are highly regulated processes in the mammalian skeleton. The exact mechanism by which bone can be modeled at a local site with little or no effect at adjacent anatomic sites is unknown. Disruption of the control of modeling within the temporal bone may lead to various bone disease such as otosclerosis, osteogenesis imperfecta, Paget's disease of bone, fibrous dysplasia, or the erosion of bone associated with chronic otitis media. One possible mechanism for such delicate control may be related to the ubiquitous and rich sympathetic innervation of all periosteal surfaces. Previous studies have indicated that regional sympathectomy leads to qualitative alterations in localized bone modeling and remodeling. In this study, unilateral cervical sympathectomy resulted in significant increases in osteoclast surface and osteoclast number within the ipsilateral bulla of experimental animals. The mechanisms by which sympathectomy leads to increased local bone loss is unknown. Potential mechanisms include disinhibition of resorption, secondary to the elimination of periosteal sympathetics, as well as indirect vascular effects."



'via Blog this'

medical procedures are misrepresented in the media

"If your patients rely on the mainstream media for medical advice, they may well think that cancer has been cured many times over, and have other inflated views about the benefits of new treatments and tests.

AND they probably would be shocked to learn about the potential downsides of many medical interventions, let alone costs.

That’s the conclusion of a comprehensive analysis of almost 2000 medical news items published in the US by print, online and television outlets between 2006 and 2013.

It was undertaken by the media watchdog Health News Review, and recently published in JAMA Internal Medicine (5 May, 2014). Most stories were judged unsatisfactory in how they covered the costs, benefits, harms and quality of the evidence supporting the new treatment or test, and how it was compared to alternatives.

“Drugs, medical devices, and other interventions were usually portrayed positively; potential harms were minimised and costs were ignored,” wrote the founder of Health News Review, Gary Schwitzer."

Melissa Sweet, Medical Observer, 24th Jun 2014

Chest wall paresthesia affects a significant but previously overlooked proportion of patients following sympathectomy

Paresthetic discomfort distinguishable from wound pain was described by 17 patients (50.0%). The most common descriptions were of ‘bloating’ (41.2%), ‘pins and needles’(35.3%), or ‘numbness’ (23.5%) in the chest wall. The paresthesia resolved in less than two months in 12 patients (70.6%), but was still felt for over 12 months in three patients (17.6%). Post-operative paresthesia and pain did not impact on patient satisfaction with the surgery, whereas compensatoryhyperhidrosis in 24 patients (70.6%) did (P=0.001). The rates and characteristics of the paresthesia following needlescopic VATS are similar to those observed after conventional VATS. Conclusions: Chest wall paresthesia affects a significant but previously overlooked proportion of patients following needlescopic VATS.



Eur J Cardiothorac Surg 2005;27:313-319

The physiology of the sympathetic innervation of the limbs according to the ganglia and their location in correspondence with the ribs is highly variable

The Surgical Treatment of Hyperhidrosis - The Annals of Thoracic Surgery: "The physiology of the sympathetic innervation of the limbs according to the ganglia and their location in correspondence with the ribs is highly variable. Surgery performed by rib count is not anatomical, and rib count is often erroneous: according to Chou and colleagues [3], the estimated rib level was wrong in 5 of 114 patients. "



'via Blog this'

although producing no alterations in the thermal balance, does produce abnormalities in quantitative distribution of thermoregulatory sweating

JNS - Journal of Neurosurgery -: "The data demonstrate that the surgical removal of both the T-2 and the T-3 ganglia, although producing no alterations in the thermal balance, does produce abnormalities in quantitative distribution of thermoregulatory sweating in man."

the severity of post-sympathectomy (post-SE) dysfunction is unpredictable

"The aim of this study was to identify retrospectively, lumbar sympathectomy (SE) using thermography (TG) and to evaluate clinically, the severity of post-sympathectomy (post-SE) dysfunction after anterior and lateral lumbar interbody fusion procedures (ALIF, XLIF).
METHODS:
Twenty eight patients with suspected SE were referred for TG to both legs. They completed our questionnaire on severity of difficulties after SE. We evaluated the ability of physical examinations to reveal the SE in contrast to TG and compared the symptoms (warmer leg and inhibited leg sweating) of SE with questionnaire responses as subjective measure and TG as objective measure.
RESULTS:
SE was diagnosed in 0.5% after ALIF at L5/S1, in 15% after ALIF at Th12-L5 and in 4% after XLIF at T12-L5. SE severely reduced the quality of life in two cases. The ability to distinguish differences in leg temperature by palpation after SE was found in 32%. All physical examinations together were insufficient for reliably disclosing SE. Subjective symptoms of SE were often false positive and proven SE by TG was often a clinically false negative.
CONCLUSION:
This is the first study to examine post-SE dysfunction objectivelya using TG after ALIF and XLIF, and the first to evaluate clinically, the severity of the post-SE syndrome. Before surgery we cannot foresee potentially poor SE results. For this reason, injury to the sympathetic chain during surgery must be avoided. The advantage of TG for identifying SE is its non-invasiveness and reliability.
http://www.ncbi.nlm.nih.gov/pubmed/24263213"

most of the existing literature is geared towards assessing only the effectiveness of the surgical sympathectomy

"Given the fact that most of the existing literature is geared towards a) assessing only the effectiveness of the surgical sympathectomy procedures, and b) publishing only studies with positive results, adverse effects and complications are not systematically reported but rather as a secondary outcome. It seems, therefore, highly likely that the complications as reported here, are truly underestimated.



The study indicates that surgical sympathectomy, irrespective of operative approach and indication, may be associated with many and potentially serious complications."  



Are We Paying a High Price for Surgical Sympathectomy? A Systematic Literature Review of Late Complications

http://www.jpain.org/article/S1526-5900%2800%2944124-6/abstract

33% of patients reported compensatory hyperhidrosis that was either 'severe' or 'incapacitating'

Endoscopic thoracic sympathectomy for primary hyperhidrosis of the...IPG487 Safety: "Compensatory hyperhidrosis was reported in 92% (416/453), 86% (1720/2000) and 74% (1265/1700) of patients in 3 case series. In 2 of these studies 33% (557/1700 and 150/453) of patients reported compensatory hyperhidrosis that was either 'severe' or 'incapacitating'."

"He knows the procedure is controversial because of the unpredictability of side-effects"

Information about surgery for sweaty hands: surgeon "knows the procedure is controversial because of the unpredictability of side-effects"



"Ferrar believes much of the controversy lies in surgeons, mainly in America, who perform the surgery on anyone who asks for it, rather than the severe end of the spectrum.
"In America there are so many that have been operated on when it hasn't been necessary, or the surgeon has given the patient false expectations, that there are support groups for people who've had complications or adverse effects. The people that come to me are almost self-selecting; they've tried everything else."
The youngest patient he has performed an endoscopic thoracic sympathectomy on was 8 years old, with most being in puberty (when the condition tends to arise). Or they are in their 20s when they are beginning relationships and jobs."



Publication info: Waikato Times [Hamilton, New Zealand] 07 Apr 2012: 22."

Chest pain, chest hypersensitivity, arm pain, paraesthesias of the upper limb and the thoracic wall, and recurrent pain in the axillary region have all been described

"Chest pain, chest hypersensitivity, arm pain, paraesthesias of the upper limb and the thoracic wall, and recurrent pain in the axillary region have all been described. Intra-operative intrapleural analgesia using bupivacaine can help reduce postoperative pain. Using a 5 mm rather than 1cm post causes less postoperative discomfort, particularly in women with narrow intercostal spaces.

Complications in Vascular and Endovascular Surgery: How to avoid them and how to get out of trouble


Jonothan J Earnshaw, Michael Wyatt,

tfm Publishing Limited, Jan 1, 2012 - Medical - 318 pages"

Sympathectomy is by no means a benign procedure, and sympathectomy for sweating can induce pain and allodynia

"Sympathectomy is by no means a benign procedure, and sympathectomy for sweating can induce pain and allodynia at the border zone which is sometimes associated with pronounced increase in sweating in that area." (p. 534) Surgical Disorders of the Peripheral Nerves by   Rolfe Birch Springer, Jan 21, 2011 - Medical - 512 pages original article published in Ann R Coll Surg Engl 2002; 84:181-184"

the autonomic nervous system varies in a unique, autonomous manner, and it is therefore difficult to assess changes in patients in a uniform manner

There are several reasons that stellate ganglion block affects the cardiovascular system. Stellate ganglion block will initially affect both the sympathetic and parasympathetic nervous systems based on the degree of block. The intensity of right stellate ganglion blockage of the sympathetic and parasympathetic nervous system will result in heart rate changes and altered activity of the sympathetic and parasympathetic nervous system. Efferent sympathetic innervation from the right stellate ganglion is primarily distributed over the sinus node of the heart, and the influence of the autonomic nervous system and left stellate ganglion block should be assessed. Further, results will be affected by the health status of participants.

Although efferent sympathetic nerves from the stellate ganglion are primarily distributed over the heart, efferent sympathetic fibers from the 2nd to 5th thoracic ganglia affect the heart as well. Accordingly, the autonomic nervous system of the heart is not completely dependent on the stellate ganglia. The influence of the autonomic nervous system cannot be excluded as well. It is worth noting that the mepivacaine in the present study was a lower dosage than those used in other studies. Finally, the autonomic nervous system varies in a unique, autonomous manner, and it is therefore difficult to assess changes in patients in a uniform manner or just through the application of one or two indicators. Future studies should examine diverse methods for the assessment of autonomic nervous system function.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872892/

peripheral sympathectomy causes a dramatic increase in NGF levels in the denervated organs

Increased Nerve Growth Factor Messenger RNA and Protein

Peripheral NGF mRNA and protein levels following
sympathectomy
It has been shown previously that peripheral sympathectomy
causes a dramatic increase in NGF levels in the denervated
organs (Yap et al., 1984; Kanakis et al., 1985; Korsching and
Thoenen, 1985).
Increased ,&Nerve Growth Factor Messenger RNA and Protein
Levels in Neonatal Rat Hippocampus Following Specific Cholinergic
Lesions
Scott R. Whittemore,” Lena Liirkfors,’ Ted Ebendal,’ Vicky R. Holets, 2,a Anders Ericsson, and HBkan Persson
Departments of Medical Genetics and’ Zoology, Uppsala University, S-751 23 Uppsala, Sweden, and *Department of
Histology, Karolinska Institute, S-104 01 Stockholm, Sweden

Stratified analysis of clinical outcomes in ... [Ann Thorac Surg. 2008] - PubMed - NCBI

"Significant compensatory sweating in relation to the level(s) of sympathetic chain division occurred in T2 alone, 45%; T2 to T3, 30%; T3 to T4, 14%; T2 to T4, 38%; and more than three levels, 49%"



Ann Thorac Surg. 2008 Feb;85(2):390-3;

http://www.ncbi.nlm.nih.gov/pubmed/18222231

Patients who undergo sympathotomy for hyperhidrosis will commonly report "clinically bothersome" compensatory hyperhidrosis.

J Thorac Cardiovasc Surg. 2014 Apr;147(4):1160-1163.e1. doi: 10.1016/j.jtcvs.2013.12.016. Epub 2014 Jan 2.

ETS is not without its critics

"ETS is not without its critics. Like any major surgical procedure, there is an operative risk, with a prominent fatality in Dublin a few years ago. Homer's syndrome can result. The most common problem is the development of 'compensatory hyperhidrosis', usually on the back. In 2003, ETS was banned in its birthplace, Sweden, due to overwhelming complaints by disabled patients."

Enabling freedom from hyperhidrosis

O'Keeffe, John. Irish Medical Times48.12 (Apr 4, 2014): 31.

Sympathectomy causes wall thinning, elongation, convolution, and aneurysm formation

Sympathectomy causes basilar artery enlargment, which is beneficial for maintaining cerebral blood flow; however, it also causes wall thinning, elongation, convolution, and aneurysm formation, which may be hazardous in stenoocclusive carotid artery disease. Sympathectomy can prevent new vessel formation and hyperthyrophic changes at the posterior circulation. Neovascularisation is not detected adequately in sympathectomised animals.



Acta Neurochirurgica156.5 (May 2014): 963-9.

"The custom of a majority is no guarantee of safety and is seldom a guide to best medical practice." in Legal Forum

Cameron`s claim that there has been only one death attributable to synchronous bilateral thoracoscopic sympathectomy is implausible. Surgeons and anaesthetists are reticent in publicizing such events and Civil Law Reports of settled cases are an inadequate measure of the current running total. The custom of a majority is no guarantee of safety and is seldom a guide to best medical practice.
Jack Collin,
Consultant Surgeon
Oxford
http://www.bmj.com/content/320/7244/1221?tab=responses

Peripheral neuropathy gives reduced sensation and sweat ability of the arms and legs but can lead to compensatory sweating of the trunk and head

Google Translate:

Peripheral neuropathy gives reduced sensation and sweat ability of the arms and legs but can lead to compensatory sweating of the trunk and head.

Horner's syndrome due sympatikusskada means, for example Anhidrosis on one half of the face which can then be followed by compensatory hyperhidrosis on the other side. Harlequin syndrome is another name in the same condition in which instead focuses on the color difference where the sympatikusskadade page turns white and the other side is red with exertion. The look can then recall a home to Harelquin.

Freys'syndrom arise after salivary gland surgery faulty growing parasympathetic salivary fibers innervate the sweat glands in the cheek. This means that when the patient eats or even just thinking about food so producing a profuse perspiration from his cheek

Sympathectomy was common in the 90s in Sweden. At indications palmar and axillary hyperhidrosis, redness, or social phobia, burned the thoracic sympathetic ganglia endoscopically. Compensatory hyperhidrosis developed below the nipples of a large number of patients 1-6 months after sympatektomin.

the sympathetic fibers passing through the T2-3 ganglia play an important role in the elaboration or modulation of autonomic function elsewhere

The data indicate that the sympathetic fibers passing through the T2-3 ganglia play an important role in the elaboration or modulation of autonomic function elsewhere.

Journal of the Autonomic Nervous System
Volume 8, Issue 1, May 1983, Pages 33-43

This is the first study to examine post-SE (post-sympathectomy) dysfunction objectively

This is the first study to examine post-SE dysfunction objectivelya using TG after ALIF and XLIF, and the first to evaluate clinically, the severity of the post-SE syndrome. Before surgery we cannot foresee potentially poor SE results. For this reason, injury to the sympathetic chain during surgery must be avoided. The advantage of TG for identifying SE is its non-invasiveness and reliability.

The aim of this study was to identify retrospectively, lumbar sympathectomy (SE) using thermography (TG) and to evaluate clinically, the severity of post-sympathectomy (post-SE) dysfunction after anterior and lateral lumbar interbody fusion procedures (ALIF, XLIF).
http://www.ncbi.nlm.nih.gov/pubmed/24263213

sympathectomy is associated with increased pulmonary metastases

Brenner, GJ, Felten, SY, Felten, DL, Cohen, N and Moynihan, JA. Chemical sympathectomy is associated with increased pulmonary metastases. Journal of Neuroimmunology 1992;;37:191-202.

Sympathectomy (ETS) a psychosurgery?

Financial Review - News Store: "It's not unusual to hear people who have undergone sympathectomies describe themselves as feeling emotionally "colder" than before. Among psychologists and neurologists alike there is concern, but no evidence, that the procedure limits alertness and arousal as well as fear, and might affect memory, empathy and mental performance. Professor Ronald Rapee, the director of the Centre of Emotional Health at Sydney's Macquarie University, says he's counselled several people who complain of feeling "robot-like" in the long-term wake of the operation. "They're happy they no longer blush, but they miss the highs and lows they used to feel.""



'via Blog this'

Dr. Telaranta treating fear, stuttering, stage fright, blushing with sympathectomy. Is ETS a psychosurgery?

Dr. Telaranta | Blog by Dr. Telaranta: "As a treatment, sympathetic blocking could be effective. Fortunately one can test whether it’ll have an effect, to a pretty high level of certainty, by first administering a temporary block t. Sympathetic block is usually effective in reducing all types of fear, why not also in reducing the fear of stuttering.

Sympathetic block typically has the highest likelihood of effective results on both schizophrenia and tremor when fear or anxiety plays a significant part in the onset of symptoms. It is also very effective in treating social phobia, stage fright and blushing. A stage fright-like fear of public presentations is likely common amongst those who stutter."



http://www.sympatix.fi/blog/?lang=en_

Link between skin innervation and neuropathic pain

Nerve conduction studies for large-diameter motor and sensory nerves were normal. This report documents a pure small-fibre sensory neuropathy after prolonged use of linezolid, and the relationship between skin innervation and corresponding neuropathic pain.

Journal of Neurology, Neurosurgery, and Psychiatry 2008;79:97-99

Patients should be clearly warned that TES is not as minor a procedure as usually asserted - The Annals of Thoracic Surgery, 2001

Early complications of thoracic endoscopic sympathectomy: a prospective study of 940 procedures: "Although morbidity was low, significant complications of TES occurred.

Patients should be clearly warned that TES is not as minor a procedure as usually asserted. Complications as well as adverse effects should be considered when discussing this surgical indication."



http://www.sciencedirect.com/science/article/pii/S0003497501024225

The Annals of Thoracic Surgery

Volume 71, Issue 4, April 2001, Pages 1116–1119

Limited sympathectomy does not reduce postoperative compensatory sweating

Endoscopic transthoracic sympathectomy for upper limb hyperhidrosis: Limited sympathectomy does not reduce postoperative compensatory sweating:

http://www.jvascsurg.org/article/S0741-5214(02)75164-1/abstract

"We quickly discovered that lay people often lack the (medical) knowledge to make well-considered judgements"

Jane McCredie: Wishing on risks

MjaInsight Monday, 11 November, 2013

https://www.mja.com.au

Moreover, GPs and plastic surgeons can both be approached directly by patients in The Netherlands. The physicians studied raised many arguments that were expected: they used patient autonomy, risks and benefits, normality and justice to limit wish-fulfilling medicine. In addition, arguments new to this debate were uncovered, which were frequently used to justify compliance with a patient's request. Such arguments seem familiar from conventional medicine, including empathy, the patient–doctor relationship and reassurance. Moreover, certain arguments that play a significant role in the literature on wish-fulfilling medicine and enhancement were not mentioned, such as concepts of disease and the enhancement–treatment dichotomy and ‘suspect norms’.

"We quickly discovered that lay people often lack the (medical) knowledge to make well-considered judgements"

http://jme.bmj.com/content/38/6/327.abstract?sid=c56f1dc3-84aa-4151-bf65-e9fb96268b59

The sympathetic system is responsible for the physiological responses to emotional states

The common epithet of “fight or flight” is being enlarged to be “fight, flight, or fright” or even “fight, flight, fright, or freeze.” Cannon’s original contribution was a catchy phrase to express some of what the nervous system does in response to a threat, but it is incomplete. The sympathetic system is responsible for the physiological responses to emotional states. The name “sympathetic” can be said to mean that (sym- = “together”; -pathos = “pain,” “suffering,” or “emotion”).
http://cnx.org/content/m46582/latest/?collection=col11496/latest

Following a peripheral nerve injury, a sterile inflammation develops in sympathetic and dorsal root ganglia

Following a peripheral nerve injury, a sterile inflammation develops in sympathetic and dorsal root ganglia (DRGs) with axons that project in the damaged nerve trunk. Macrophages and T-lymphocytes invade these ganglia where they are believed to release cytokines that lead to hyperexcitability and ectopic discharge, possibly contributing to neuropathic pain. Here, we examined the role of the sympathetic innervation in the inflammation of L5 DRGs of Wistar rats following transection of the sciatic nerve, comparing the effects of specific surgical interventions 10-14days prior to the nerve lesion with those of chronic administration of adrenoceptor antagonists. Immunohistochemistry was used to define the invading immune cell populations 7days after sciatic transection. Removal of sympathetic activity in the hind limb by transecting the preganglionic input to the relevant lumbar sympathetic ganglia (ipsi- or bilateral decentralization) or by ipsilateral removal of these ganglia with degeneration of postganglionic axons (denervation), caused less DRG inflammation than occurred after a sham sympathectomy. By contrast, denervation of the lymph node draining the lesion site potentiated T-cell influx. Systemic treatment with antagonists of α1-adrenoceptors (prazosin) or β-adrenoceptors (propranolol) led to opposite but unexpected effects on infiltration of DRGs after sciatic transection. Prazosin potentiated the influx of macrophages and CD4+ T-lymphocytes whereas propranolol tended to reduce immune cell invasion. These data are hard to reconcile with many in vitro studies in which catecholamines acting mainly via β2-adrenoceptors have inhibited the activation and proliferation of immune cells following an inflammatory challenge.
Auton Neurosci. 2013 Dec 23.
http://www.ncbi.nlm.nih.gov/pubmed/24418114

Immune cell involvement in dorsal root ganglia and spinal cord after chronic constriction or transection of the rat sciatic nerve.

Hu P, Bembrick AL, Keay KA, McLachlan EM.

Chronic constriction injury (CCI) of the sciatic nerve in rodents produces mechanical and thermal hyperalgesia and is a common model of neuropathic pain. Here we compare the inflammatory responses in L4/5 dorsal root ganglia (DRGs) and spinal segments after CCI with those after transection and ligation at the same site. Expression of ATF3 after one week implied that 75% of sensory and 100% of motor neurones had been axotomized after CCI. Macrophage invasion of DRGs and microglial and astrocytic activation in the spinal cord were qualitatively similar but quantitatively distinct between the lesions. The macrophage and glial reactions around neurone somata in DRGs and ventral horn were slightly greater after transection than CCI while, in the dorsal horn, microglial activation (using markers OX-42(for CD11b) and ED1(for CD68)) was greater after CCI. In DRGs, macrophages positive for OX-42(CD11b), CD4, MHC II and ED1(CD68) more frequently formed perineuronal rings beneath the glial sheath of ATF3+ medium to large neurone somata after CCI. There were more invading MHC II+ macrophages lacking OX-42(CD11b)/CD4/ED1(CD68) after transection. MHC I was expressed in DRGs and in spinal sciatic territories to a similar extent after both lesions. CD8+ T-lymphocytes aggregated to a greater extent both in DRGs and the dorsal horn after CCI, but in the ventral horn after transection. This occurred mainly by migration, additional T-cells being recruited only after CCI. Some of these were probably CD4+. It appears that inflammation of the peripheral nerve trunk after CCI triggers an adaptive immune response not seen after axotomy.

Brain Behav Immun. 2007 Jul;21(5):599-616. Epub 2006 Dec 21.

http://www.ncbi.nlm.nih.gov/pubmed/17187959

Surgical sympathectomy is rarely performed and its use remains controversial

Although improved in some, persistent or recurrent symptoms were present in all patients after six months postoperatively. Increased sensitivity of digital vessels to circulating catecholamines, nerve fiber regeneration or incomplete sympathectomy have been postulated to lead to recurrence. Five patients developed Horner's syndrome postoperatively. A portion of the stellate ganglion was intentionally resected in 3 of the 5 patients.
http://www.ncbi.nlm.nih.gov/pubmed/8370999

Use with caution. The effects of this medicine may be increased after sympathectomy

Sympathectomy (a surgical procedure where certain nerves are removed)—Use with caution. The effects of this medicine may be increased.

http://www.mayoclinic.org/drugs-supplements/bisoprolol-and-hydrochlorothiazide-oral-route/before-using/DRG-20071051

Bisoprolol And Hydrochlorothiazide (Oral Route) - Drugs and Supplements - Mayo Clinic

www.mayoclinic.org

In deciding to use a medicine, the risks of taking the medicine must be weighed 

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

http://www.mayoclinic.org/documents/mc5520-06pdf/DOC-20077566

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.

Medical and Biological Engineering and Computing

2001, Volume 39, Issue 5, pp 579-583
http://link.springer.com/article/10.1007%2FBF02345149

The graph shows an overall shorter survival rate of sympathectomised rats

The effect of sympathectomy on the growth of intraperitoneally administered Yoshida ascitic cells in rats

El-Hassoun Olia, Coauthors: Zuzana Valašková, Ivan Hulín

Supervisor: Boris Mravec

Institute of Pathophysiology, LF UK Bratislava

http://svoc.fmed.uniba.sk/abstrakty/48/36.html

Long-term sympathectomy induces sensory and parasympathetic fibres sprouting, and mast cell activation in the rat dura mater

Bergerot, A; Aubineau, P; (1998) Long-term sympathectomy induces sensory and parasympathetic fibres sprouting, and mast cell activation in the rat dura mater. EUR J NEUROSCI , 10 79 - 79. 

http://discovery.ucl.ac.uk/1330488/

Lewis rats are much more likely to develop autoimmune disorders after sympathectomy

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

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 is a form of sensory neurectomy" (p.1500)

Bonica's Management of Pain Scott Fishman, Jane Ballantyne, James P. Rathmell Lippincott Williams & Wilkins, 2010 - Medical - 1661 pages

sympathectomized arteries become more susceptible to lipid accumulation

Combined effect of cholesterol feeding and sympathectomy on the lipid content in rabbit aortas

Atherosclerosis

Volume 37, Issue 4, December 1980, Pages 521–528

Decreased HRV is predictive of adverse cardiovascular outcomes in a variety of disease states

Water immersion-induced skin wrinkling (WISW) is dependent on intact peripheral sympathetic function. WISW was hypothesized to reflect autonomic function in subjects with- out peripheral neuropathy. We prospectively studied 70 healthy subjects (aged 31 88 years, 63% females) without cardiovascular risk factors or neurological disease. All sub- jects underwent short-term heart rate variability (HRV) stud- ies. Time and frequency domain variables were derived in- cluding the HRV index. WISW was graded using a previously validated scale of 1–4 of which 18.6% of subjects exhibited grade 1 (minimal) WISW and 35.7% had grade 2 WISW. On multivariate analysis using the HRV index, WISW was inde- pendently related to height and the HRV index. We conclude that WISW is related to central autonomic function.

Although the mechanism is not fully understood, WISW is felt to be caused by passive diffusion of water across the stratum corneum into the sweat ducts, which in turn alters electrolyte balance, decreases membrane stabilization, increases sympathetic neural firing and stimulates vasoconstriction [1–3, 8].WISW is decreased in diabetic patients and in patients after cervical sympathectomy [4, 9].

Heart rate variability (HRV) is the beat-to-beat variation in cardiac cycle length due to autonomic influence on the sinus node. Decreased HRV is predictive of adverse cardiovascular outcomes in a variety of disease states[5]. The influence of the central nervous system activity on autonomic function suggests that HRV may be a useful prognostic indicator in patients with cerebrovascular events [6].

Cardiology 2010;116:247–250 DOI: 10.1159/000316043

Received: May 10, 2010

Accepted after revision: May 28, 2010 Published online: August 18, 2010

Removal of the clips from the sympathetic trunk does not provide resolution of compensatory sweating

Removal of the clips from the sympathetic trunk does not provide resolution of compensatory sweating in 1 year of observation. T6-9 block does not provide remedy for compensatory hyperhidrosis. Regional abdomino-lumbar iontophoresis seems to be very promising, but further research and followup are mandatory.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3458267/

Natural bodily functioning does not include “purely autonomic” or “purely somatic” responses, just as it does not include ‘purely sympathetic” or “purely parasympathetic” responses

Langley initially expected to find afferent cell bodies in autonomic ganglia, with projections to other ganglia. He believed that activation of these “autonomic afferents” should lead to purely autonomic responses. However Langley’s own careful work demonstrated that there were no such neurons.

The fundamentally important point is that integrative processes responsible for the organization of visceral function occur principally within the central nervous system (brain and/or spinal cord). Both somatic and visceral afferents result in complex, brain mediated, responses that include somatic and visceral function. Autonomic motor activity can be generated by both somatic and visceral inputs to the CNS, and visceral inputs to the CNS initiate responses that are both somatic and autonomic. Natural bodily functioning does not include “purely autonomic” or “purely somatic” responses, just as it does not include ‘purely sympathetic” or “purely parasympathetic” responses.

Bill Blessing and Ian Gibbins (2008), Scholarpedia, 3(7):2787.

revision #46085 [link to/cite this article]

Curator: Dr. Bill Blessing, Centre for Neuroscience, Flinders University, Adelaide, AUSTRALIA

there are three main conditions which could impair the autonomy of a patient's medical decision: insufficient information, irrational beliefs/desires, and influence of different framing effects

http://onlinelibrary.wiley.com/doi/10.1111/j.1467-8519.2012.01973.x/abstract

electric stimulation of the sympathetic cord in the upper thoracic level on the middle cerebral artery blood flow velocity

The effect of electric stimulation of the sympathetic cord in the upper thoracic level on the middle cerebral artery blood flow velocity (V(MCA)) in humans was examined using transcranial Doppler sonography monitoring during surgery for palmar hyperhidrosis. Sympathetic stimulation resulted in marked and rapid increases Of V(MCA). The responses were preceded by prompt increases of mean arterial blood pressure (MABP) and heart rate (HR). Division of the sympathetic cord cranially or caudally to the stimulation site partially reduced the V(MCA), MABP and HR responses. Both these operations reduced sympathetic pathways to the heart as reflected by a decrease in HR and MABP. The integrity of the sympathetic pathway from the stimulation site through the superior cervical ganglion and the carotid plexus was not a prerequisite for a V(MCA) response. Our data suggest that the V(MCA) increase mainly results from stimulation of the heart and the cardiovascular system, resulting in marked increases of blood pressure and heart rate.

CEREBROVASCULAR DISEASES Volume: 2 Issue: 6 Pages: 359-364 Published: NOV-DEC 1992

Postsympathectomy pain of such severity that parenteral narcotics afforded no relief

Fifty-six consecutive patients who subsequently underwent ninety-six lumbar sympathectomies were studied prospectively with regard to the development of postoperative pain. Pain after operation was observed in thirty-four extremities by twenty-five of the patients (35 per cent). It began abruptly an average of twelve days after operation and was often accentuated nocturnally. The pain was almost always described as a deep, dull ache and persisted two to three weeks before spontaneously remitting. Postsympathectomy pain of such severity that parenteral narcotics afforded no relief developed in two of these fifty-six patients and in nine additional patients. Treatment with carbamazepine produced dramatic reduction in the intensity of pain in seven of these nine patients within twenty-four hours after the institution of therapy. Two patients were given intravenous diphenylhydantoin and both experienced immediate relief of pain. The mechanisms of the syndrome and of the action of these drugs are uncertain.

http://www.sciencedirect.com/science/article/pii/0002961074902384

Systemic therapy with glycopyrrolate or clonidine can be effective for HH. Nearly two-thirds responded to therapy, and less than a quarter had treatment-limiting adverse effects, all of which were self-limited and nonserious

J Am Acad Dermatol. 2012 Mar;66(3):387-92. doi: 10.1016/j.jaad.2011.01.023. Epub 2011 Aug 4.
http://www.ncbi.nlm.nih.gov/pubmed/21820204

A randomized placebo-controlled trial of oxybutynin for the initial treatment of palmar and axillary hyperhidrosis

Palmar and axillary hyperhidrosis improved in >70% of the patients, and 47.8% of those presented great improvement. Plantar hyperhidrosis improved in >90% of the patients. Most patients (65.2%) showed improvements in their quality of life. The side effects were minor, with dry mouth being the most frequent (47.8%).

Journal of Vascular Surgery, Volume 55, Issue 6, June 2012, Pages 1696-1700

Long-term efficiency? 40% affirmed they would ask for the operation if it were to be redone, 53% recurrence

At an average 12 years after surgery, 47% of patients were satisfied with the treatment results, 40% were disappointed. 
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. 
Interact CardioVasc Thorac Surg(2009) 8 (1): 54-57.

Only 56% would recommend sympathectomy to others with hyperhydrosis

http://www.ncbi.nlm.nih.gov/pubmed/21539945

post-sympathectomy hyperalgesia

Behavioral test of tolerance for aversive mechanical stimuli in sympathectomized cats.

C Van Petten

, 

W J Roberts

 and 

D L Rhodes

Cats were studied behaviorally to determine their suitability as an animal model for the post-sympathectomy hyperalgesia reported to occur in humans. For this study a device and methodology were developed which allow humane testing of tolerance for intense mechanical stimulation of the hindlegs. Behavioral tolerance was measured quantitatively before and after unilateral sympathectomy. The results from this preliminary study of 6 cats are remarkably similar to those reported for humans; 1 of the 6 cats showed a decreased tolerance on the sympathectomized side which was delayed in onset and of limited duration. The new methodology appears to provide relatively stable, quantitative measures of tolerance for aversive stimulation, and the cat shows promise as an animal model for post-sympathectomy hyperalgesia.

Pain. 1983; 15(2)