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PubMed2001

Modulation of visceral nociceptive responses of rat spinal dorsal horn neurons by sympathectomy.

We determined whether sympathectomy modulates visceral nociception under physiological or inflammatory conditions. Recordings of sacral spinal dorsal horn neurons with sustained responses were performed in pentobarbitone-anesthetized rats. Graded colorectal distension (CRD, 20-100 mmHg) was used as a visceral nociceptive stimulus. Inflammation was induced by intracolonic instillation of turpentine (25%). Sympathectomy was produced by administering 6-hydroxydopamine. Inflammation produced an increase in the CRD-evoked responses. The CRD-evoked responses were attenuated following sympathectomy both under control and inflammatory conditions. These changes in the CRD-evoked responses were associated with corresponding changes in spontaneous discharge rate. The convergent input evoked by noxious pinch of the skin was not changed by any of the experimental conditions. The results indicate that sympathectomy attenuates visceral nociceptive responses and spontaneous activity of sacral spinal cord neurons, without effect on convergent cutaneous inputs, both under physiological and inflammatory conditions.

Animals↗
PubMed2001

Chemical sympathectomy for neuropathic pain: does it work? Case report and systematic literature review.

OBJECTIVE: To determine if chemical sympathectomy successfully reduces limb neuropathic pain. DESIGN: Systematic literature review of the effectiveness of phenol or alcohol sympathectomy for extremity neuropathic pain. PATIENT: A 29-year-old female with complex regional pain syndrome of both lower extremities after back surgery who was submitted to bilateral lumbar chemical sympathectomy. SEARCH STRATEGY: The Cochrane Database of Systematic Reviews, the Cochrane Controlled Trials Register, Medline, and EMBASE were systematically searched. OUTCOME MEASURES: (1) For the patient in question: spontaneous pain, allodynia, pinprick hyperalgesia, pressure evoked pain; (2) For the literature review: meaningful versus nonmeaningful pain relief based on degree and duration (>2 weeks) of pain relief. RESULTS: (1) The case reported experienced partial temporary relief of pain primarily related to selective modulation of allodynia, but not deep pain or pinprick hyperalgesia; (2) 44% of 66 patients in 13 studies that met the authors' inclusion criteria experienced meaningful pain relief. Whereas 19% experienced no meaningful relief, for the remaining 37% of the patients no conclusions regarding duration and degree of relief could be drawn due to poor reporting of outcomes. CONCLUSIONS: Based on the case reported and systematic literature review, chemical sympathectomy seems to have at best a temporary effect, limited to cutaneous allodynia. Despite the popularity of chemical sympatholysis, only few patients and poorly defined outcomes are reported in the literature, substantiating the need for well-designed studies on the effectiveness of the procedure.

Adult↗
PubMed1998

Effect of neonatal sympathectomy on the development of structural vascular changes in angiotensin II-treated rats.

BACKGROUND: In a previous study, we found that neonatal sympathectomy prevented the development of angiotensin II (ANG II)-induced hypertension but not the development of structural changes in small mesenteric arteries. OBJECTIVES: To investigate further the dissociation between hypertension and structural vascular changes in sympathectomized ANG II-treated rats by extending morphometric measurements to include all segments of the mesenteric arterial tree. METHODS: Neonatally sympathectomized and sham-sympathectomized male Sprague-Dawley rats, aged 34 months, were administered 200 ng/kg per min ANG II subcutaneously for 4 weeks. Sham-operated sympathectomized and sham-sympathectomized rats were controls. At the end of the treatment period the mesenteric circulation of rats was perfusion-fixed for morphometric measurements. RESULTS: Tail systolic blood pressure in ANG II-treated sham-sympathectomized rats increased by 47 mmHg (P < 0.001); the increase of systolic blood pressure (11 mmHg) in ANG II-treated sympathectomized rats did not attain statistical significance. Sympathectomy alone increased the lumen and reduced the wall : lumen ratio of first- and second-order branches of the superior mesenteric artery (hypotrophic outward remodeling). ANG II treatment increased the dimensions, wall thickness, and wall area of first- and second-order arteries (hypertrophic outward remodeling) and the wall : lumen ratio of small resistance arteries in sham-sympathectomized rats. Neonatal sympathectomy attenuated the development of structural changes in large arteries but had no effect on the development of structural changes in small arteries of ANG II-treated rats. CONCLUSION: Hypertension and sympathetic innervation appear to be contributing to the development of structural changes in large arteries of ANG II-treated rats because sympathectomy attenuated these changes. Structural changes in small arteries, on the other hand, appear to be due to a direct trophic effect of ANG II.

Angiotensin II↗
PubMed1997

Complications in patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy.

OBJECTIVE: To assess the complications in a group of patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy. The extraordinarily high incidence of postoperative compensatory hyperhidrosis in our series is stressed and explained. METHODS: The retrospective study included chart reviews and outpatient assessments. Seventy-two patients underwent T2 or T2-T3 endoscopic sympathectomy for primary palmar hyperhidrosis. Patients' hyperhidrosis severity, precipitating factors, postoperative complications, surgical results, and satisfaction were assessed. Severity of palmar hyperhidrosis and compensatory hyperhidrosis was classified by two grading scales. RESULTS: The success rate of sympathectomy was 93%. All patients except one suffered from compensatory sweating, which was the main cause of patients' dissatisfaction postoperatively. Seventeen percent of the patients (12 of 72 patients) experienced new symptoms of gustatory sweating (facial sweating associated with eating). Twenty-one patients experienced other complications, including pneumothorax, Horner's syndrome, nasal obstruction, and intercostal neuralgia. CONCLUSION: Transthoracic endoscopic sympathectomy is an effective and simple modality to treat palmar hyperhidrosis. However, all patients need to be warned of the common complications, particularly compensatory hyperhidrosis, before surgery.

Adult↗
PubMed2000

Uniportal endoscopic superior thoracic sympathectomy.

OBJECTIVE: A retrospective study presenting our experience with upper thoracic endoscopic sympathectomy in patients with primary palmar hyperhidrosis. METHODS: One hundred patients (46 women and 54 men) underwent bilateral uniportal endoscopic thoracic sympathectomy since January 1, 1995. Age distribution ranged from 12 to 54 years (mean, 23.4 yr). RESULTS: Sympathectomy on both sides was accomplished within 30 minutes in a single stage. Ninety-six patients (96%) had an uneventful postoperative course and were discharged the following day. Four patients with residual hemothorax required intercostal drainage and were discharged on the third postoperative day. Ninety-six patients were completely satisfied with immediate and permanent relief of palmar perspiration. Compensatory hyperhidrosis was the major complication, which was usually mild and tolerable after reassurance. In only eight patients (8%) was the compensatory hyperhidrosis considered bothersome, requiring treatment with aluminum chloride in ethanol solution at 25%. There was no mortality. Recurrence of palmar hyperhidrosis has been noticed in five patients (5%) during the follow-up period (range, 2-56 mo; mean, 12 mo). At the time of reoperation, a remaining branch of the sympathetic chain could be observed and coagulated. CONCLUSION: We consider thoracoscopic sympathectomy to be a simple, safe, and effective method for treating palmar hyperhidrosis. It is an effective method for treating patients with palmar hyperhidrosis, with a shorter operation time, fewer hospital days, and a better cosmetic result, as compared with the open approaches.

Adaptation, Physiological↗
PubMed2002

Long-term assessment of percutaneous stereotactic thermocoagulation of upper thoracic ganglionectomy and sympathectomy for palmar and craniofacial hyperhidrosisin 1742 cases.

OBJECTIVE: We sought to determine the long-term outcome of percutaneous stereotactic thermocoagulation for upper thoracic ganglionectomy and sympathectomy in patients with palmar and craniofacial hyperhidrosis with the use of a three-dimensional system of coordinates for the location of the T2 and T3 ganglia on the basis of the findings in a cadaveric study. METHODS: From November 1986 to May 1998, upper thoracic ganglionectomy and sympathectomy with the use of percutaneous stereotactic thermocoagulation were performed in 1688 patients with palmar hyperhidrosis and 54 patients with craniofacial hyperhidrosis as outpatient surgical procedures based on a three-dimensional coordinate system for determining the location of the thermocoagulation point, which was developed by the authors in a cadaveric study. The technique requires only local anesthesia. RESULTS: After initial thermocoagulation, sweating stopped in 3465 (99.5%) of 3484 sides. Hyperhidrosis recurred within 2 to 59 months of treatment in 268 procedures. All patients in whom hyperhidrosis recurred were retreated successfully, resulting in a final success rate of 99.9%. Complications of treatment included pneumothorax in seven procedures (0.2%) and partial Horner's syndrome in five procedures (0.15%). Decreased plantar sweating was noted during follow-up in 92% of patients. CONCLUSION: The results of this study indicate that upper thoracic ganglionectomy and sympathectomy performed with the use of percutaneous thermocoagulation are a very effective treatment for palmar and craniofacial hyperhidrosis that provides excellent immediate and long-term results as well as a low complication rate. The method is also effective as a retreatment for recurrences. Our data also suggest that performing ganglionectomy and sympathectomy in both T2 and T3 is unnecessary, because the procedure had equal long-term effectiveness when performed in T2 alone.

Adolescent↗
PubMed1982

The effect of renal sympathectomy on blood pressure and plasma renin activity in spontaneously hypertensive and normotensive rats.

Renal denervation delays the development of hypertension in spontaneously hypertensive (SH) rats. The influence of bilateral surgical renal sympathectomy, verified by fluorescence microscopy, on blood pressure and plasma renin activity in SH and normotensive rats (170-180 g before the sympathectomy) was studied. Neither in SH nor in normotensive rats, did the preoperative systolic blood pressure in the renal-sympathectomized group differ from that in the sham-operated controls. After the sympathectomy, blood pressure in the SH rats increased in 4 weeks only insignificantly, from 160 +/- 3 to 172 +/- 6 mmHg, while that in the sham-operated SH rats rose from 163 +/- 5 to 191 +/- 5 mmHg. In normotensive rats, blood pressures in both the renal-sympathectomized and sham-operated groups remained at the pre-operative levels. Thirty days after the operations, plasma renin activity or plasma kininogen in the renal-sympathectomized group did not differ from that in the sham-operated one either in SH or in normotensive rats. The results suggest that the delay in hypertension development produced by renal sympathectomy in SH rats is not mediated by a reduction in renin secretion.

Adrenergic Fibers↗
PubMed1987

Effects of sympathectomy on heart size and function in aortic-constricted rats.

Effects of chemical sympathectomy with 6-hydroxydopamine on left ventricular mass, norepinephrine content, and performance in aortic-constricted and sham-constricted rats were examined. Sympathectomy did not affect mean arterial pressure but it led to lower final body weights in aortic-constricted rats. Of the hypertensive aortic-constricted rats, those that had also been sympathectomized showed greater increases in left ventricular weight-to-body weight, right ventricular weight-to-body weight, and lung weight-to-body weight ratios. Left ventricular norepinephrine content was depressed by either sympathectomy or aortic constriction and was severely depleted by their combination. Sympathectomy had no effect on maximal cardiac output or left ventricular stroke work during rapid saline infusion. In aortic-constricted rats, however, it lowered heart rate during the infusion and increased left ventricular end-diastolic pressure at peak stroke work. 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.

Animals↗
PubMed1984

Dietary obesity and neonatal sympathectomy. I. Effects on body composition and brown adipose.

The effect of neonatal sympathectomy with guanethidine (50 mg/kg for 3 wk) on the development of diet-induced obesity (DIO) was assessed by raising guanethidine-(G) or saline-treated (S) Sprague-Dawley rats in small litters (4-5 pups/dam) and feeding a high-calorie diet from weaning (n = 29-30) or by raising similarly treated rats in normal litters (10 pups/dam) and feeding chow from weaning (n = 29-30). Sympathectomy depleted norepinephrine (NE) levels 65-98% in all organs except the adrenals and brain but had no statistically significant effect on weight gain, food intake, food efficiency, body composition, plasma glycerol, insulin, or glucose, or on basal rectal temperatures in either diet group; there was a tendency toward increased adiposity in sympathectomized rats. Despite 95-98% depletion of NE in interscapular brown adipose tissue (IBAT), sympathectomy affected only the percentage of multilocular cells that was decreased 46-69%. Rats from small litters in both treatment groups (S and G) became obese without increased food intake (increased food efficiency), had heavier IBAT pads with bigger cells and more lipid, and were also hyperlipidemic, hyperinsulinemic, and hyperglycemic compared with controls. Therefore neonatal sympathectomy was not as significant in the subsequent development of DIO as were diet and litter size.

Adipose Tissue↗
PubMed2006

Sympathectomy causes aggravated lesions and dedifferentiation in large rabbit atherosclerotic arteries without involving nitric oxide.

Previously [Histochem J 1997;29:279-286], we found that sympathectomy induced neointima formation in ear but not cerebral arteries of genetically hyperlipidemic rabbits. To clarify the influence of sympathetic nerves in atherosclerosis, and whether their influence involves vascular NO activity, we studied groups of normocholesterolemic intact (NI) and sympathectomized (NS), and hypercholesterolemic intact (HI) and sympathectomized (HS) rabbits (diet/6-hydroxydopamine for 79 days). Segments of basilar (BA) and femoral (FA) arteries were studied histochemically, to evaluate differentiation (anti-desmin, anti-vimentin, anti-h-caldesmon, and nuclear dye), by confocal microscopy, and by in vitro myography. In BAs, staining of NI and NS groups was similar. In hypercholesterolemic groups, a small neointima developed, more frequently in HS segments where smooth muscle cells (SMCs) positive for all antibodies appeared to be migrating into the neointima. In FAs, SMCs stained for the three antibodies in the NI group, but we observed desmin- and h-caldesmon-negative, vimentin-positive cells in some external medial layers of the NS, HI and HS groups, identical to adventitial fibroblasts. Large neointimas of the HS group contained vimentin-positive and largely desmin- and h-caldesmon-negative cells. Relaxation of BA or FA segments to acetylcholine was not decreased by sympathectomy. Sympathectomy increased the contraction of resting FAs to nitro-L-arginine (p = 0.0379). Thus, sympathectomy aggravates the tendency for FA SMCs to migrate and dedifferentiate, increasing atherosclerotic lesions, without decreasing NO activity, but has only minor effects on BAs.

Acetylcholine↗
PubMed1984

Efficacy of left cardiac sympathectomy in the treatment of patients with the long QT syndrome.

Ten patients with the long QT syndrome and recurrent syncope and/or cardiac arrest caused by ventricular arrhythmias underwent left stellate (one patient) or left cervicothoracic sympathectomy (nine patients) after failing to respond to high-dose beta-blocker therapy. The syndrome was familial in four and idiopathic in six. All patients had a prolonged resting QT interval (548 +/- 51 msec, mean +/- SD) and corrected QT interval (QTc) (556 +/- 43 msec). After sympathectomy the mean QTc shortened significantly from 556 +/- 43 to 508 +/- 65 msec (p less than .05) but the QTc remained abnormal in all but one patient. Over a mean follow-up period of 38.6 +/- 19 months, eight patients developed recurrent symptoms that included cardiac arrest in three (one fatal, two nonfatal), syncope in four, and presyncope in six. The addition of beta-blockers was ineffective in suppressing the recurrent symptoms. The control of symptoms required more extensive sympathectomy (three patients), chronic atrial pacing (three patients), and implantation of an automatic internal defibrillator (one patient). Only one patient has remained asymptomatic without drug or pacemaker therapy. In conclusion, left cervicothoracic sympathectomy proved inadequate for long-term control of symptoms in most patients with the long QT syndrome. These patients usually required concomitant drugs, more extensive surgery, or long-term cardiac pacing for symptomatic relief.

Adolescent↗
PubMed1996

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.

Recent pharmacological studies have shown that perivascular nerves can influence the development and function of vascular endothelial cells (ECs). However, morphological studies have not yet been carried out to investigate whether these functional changes are associated with changes in vasoactive substances in ECs. We used postembedding electron microscopy (EM) triple gold-labeling immunocytochemistry to study the effects of short-term sympathectomy (3 days after 6-hydroxydopamine [6-OHDA] treatment) and long-term sympathectomy (guanethidine and 8 days after 6-OHDA) on the distribution of vasoactive substances in ECs of the rat thoracic aorta. The post-embedding immunocytochemistry, which can detect levels of label in individual cells, showed that there was a significant decrease in endothelial NO synthase (NOS3)-labeled, serotonin (5-HT)-labeled, and substance P (SP)-labeled, but a significant increase in endothelin-1 (ET-1)-labeled, gold particles in ECs after long-term, but not after short-term (3-day), sympathectomy. In conclusion, our results show that long-term sympathectomy causes an increase in ET-1 and decrease in NOS3, 5-HT, and SP immunoreactivity in ECs of the thoracic aorta. Our data also indicate that postembedding EM triple gold-labeling immunocytochemistry is a valuable technique for quantitative studies of the content of vasoactive substances in ECs.

Animals↗
PubMed1987

Effect of lumbar sympathectomy on muscle blood flow: distribution of perfusion measured by hydrogen clearance in skeletal muscle.

Measurements of local tissue blood flow using a technique of hydrogen clearance were used to examine the effect of lumbar sympathectomy on skeletal muscle blood flow. Polarographic recordings on 25 hydrogen desaturations were obtained with platinized platinum electrodes. Lumbar sympathectomies were done on five canines leaving the contralateral limb as a control. The hydrogen clearance data were modeled with biexponential curves: the initial rapid component and the second slow component yielded a weighted average perfusion through tissue. Average volumetric blood flow in the control limb was 6.08 +/- 0.45 ml/min/100 g tissue while the sympathectomized limb averaged 9.54 +/- 0.61 ml/min/100 g tissue (p less than 0.005). Average blood flow increases ranged from 33 to 83 percent in the sympathectomized limb over the control limb. This significant increase in muscle blood flow following lumbar sympathectomy, if of prolonged duration, may be cause for re-evaluation of the role of sympathectomy in the management of arteriosclerotic occlusive disease.

Animals↗
PubMed1978

The immediate effect of lumbar sympathectomy on arterial blood flow measured by electromagnetic flowmetry.

The immediate effect of lumbar sympathectomy on arterial blood flow was studied in 51 patients with peripheral arterial disease by means of electromagnetic flowmetry. Concomitant arterial reconstruction was performed in 37 cases. The measurement was made on the reconstructed segment or on the bypass graft, and on the femoral artery when sympathectomy alone was performed. The flow increase varied considerably from case to case and was rather unpredictable. There was no significant correlation between the effect of sympathectomy and peripheral arterial disease or the condition of the outflow tract. Thus, on the basis of these measurements, it is difficult to determine the significance of lumbar sympathectomy as a method of increasing blood flow.

Adult↗
PubMed2001

[Minimally-invasive endoscopic transthoracic sympathectomy of the upper limbs. A new method].

OBJECTIVE: Indications for endoscopic transthoracic upper dorsal sympathectomy are axillary and palmar hyperhidrosis, upper extremities ischemia (due to, e.g., Raynaud s disease), and upper extremities causalgia. METHODS: At present, this methodology relies on (at least) double trocar insertion (per side) and/or carbon dioxide insufflation. Thus, although this approach, compared with the traditional open sympathectomy techniques, it guarantees the smallest number of postoperative complications, it still determines a certain amount of postoperative discomfort as well as a risk of complications related to carbon dioxide insufflation, as intraoperative profound bradycardia and hypotension due to mediastinal shift, and postoperative subcutaneous emphysema. From December 1995, we are using a minimally-invasive endoscopic transthoracic sympathectomy technique, performed by a single-entry specifically modified thoracoscope and without the need for carbon dioxide insufflation, with the aim to reduce the drawbacks associated with the above-mentioned currently adopted endoscopic techniques. After general anesthesia with double-lumen endotracheal tube, with the patient placed in a half-sitting position with both arms abduced to 90 degrees, a 1 cm incision is performed, along the midclavear line (in male patients) or the anterior axillary line (in female patients), in the second or third intercostal space. RESULTS: The effects of sympathectomy are immediate, and the patients wake up with warm and dry hands and axillae. CONCLUSIONS: In personal opinion, this single-entry technique, compared with other reported approaches, should minimize any damage to the intercostal neurovascular bundle, while avoiding the complications connected with carbon dioxide insufflation.

Arm↗
PubMed2004

Multiyear experience in endoscopic thoracic sympathectomy.

The results of endoscopic thoracic sympathectomy performed for 787 patients during a 30-year period are presented. Six hundred seventy three patients were operated on for upper limb arterial occlusion of distal and diffuse type, Raynaud's disease or syndrome, 7 patients - for causalgic pain in upper limbs and Sudeck's syndrome, 85 - for hyperhidrosis. Twelve patients underwent lower thoracic sympathectomy for painful chronic pancreatitis, 4 - total destruction of thoracic sympathetic trunk due to pernicious hypertension of unknown origin, and 6 - endoscopic thoracic sympathectomy for acute thrombosis of upper limb arteries with distal circulation impairment. Immediate positive effect of interventions was detected in all cases except for acute arterial thrombosis. One patient died postoperatively due to arrhythmia-related cardiac arrest. Postoperative complications - lung border damage and intercostal vascular hemorrhage - were detected in 0.2% of cases. Increased air effusion from pleural cavity and intercostal neuralgia were observed postoperatively in some cases but did not require any special management. Long-term outcomes were followed up for period of 5-10 years, 72.7% of monitored patients had stable positive outcomes. Our experience has demonstrated that endoscopic thoracic sympathectomy is a safe, minimally invasive and effective intervention for upper limb chronic arterial insufficiency of distal and diffuse type or for hyperhidrosis.

Adolescent↗
PubMed2004

[Assessment of thoracic sympathectomy by transpleural posterolateral and thoracoscopic approach in surgical treatment of Raynaud's syndrome].

Operative treatment of patients with Raynaud's Syndrome is rarely used, and is recommended by most authors only in the case of disthrophic changes or so advanced symptoms, which disturb normal social and daily life. Recently, thoracoscopic sympathectomy is applied more frequently. The aim of this study was to assess the usefulness of thoracoscopic sympathectomy by the presentation of early and long-term outcome of 43 thoracic and eight lumbar sympathectomies performed in 41 patients with Raynaud's Syndrome. Transpleural posterio-lateral thoracotomy was performed 29 times in 27 patients, whereas thoracoscopic sympatectomy 14 times in 8 patients. Surgical techniques, early and long-term results were discussed. Based on early and long-term outcome, there were no significant differences between applied surgical techniques. Moreover, thoracoscopic sympathectomy was safe in the aspect of a short duration as well as good therapeutic and cosmetic effect of the procedure. It should be applied instead of others, so far used methods, with the exception of patients with massive pleural adhesions, which need thoracotomy.

Adult↗
PubMed2005

[Craniofacial hyperhidrosis treated by video-assisted thoracoscopic sympathectomy].

OBJECTIVE: To investigate the feasibility, safety and prospect application value of video-assisted thoracoscopic sympathectomy utilized in the treatment of craniofacial hyperhidrosis. METHODS: Eighteen patients with craniofacial hyperhidrosis underwent sympathectomy from January 2003 to December 2004, including 10 cases combined with palmar hyperhidrosis. There were 17 males and 1 females with a mean age of 36.5 years (ranges, 25-42). Sympathetic chain was transected just below the stellate ganglion in pure craniofacial hyperhidrosis. Additional T(3) sympathectomy was performed in those patients combined with palmar hyperhidrosis. RESULTS: There were no surgical complication or surgical mortality cases. Seventeen patients achieved improvement of craniofacial hyperhidrosis without recurrent symptoms, but one had partial remission due to thoracic adhesion and false location of the ganglions. The effective rate was 97% (35/36). No recurrent symptoms occurred after a mean of 8.3 months of follow-up. No relapse occurred. Fifteen patients (83%) developed compensatory sweating of the trunk and lower limbs. Six patients (33%) presented palmar dry (severe hypohidrosis) and they all can tolerate the condition. All patients were satisfied with the outcomes of their operations. CONCLUSION: The initial results show that thoracoscopic sympathectomy is a safe and effective method for the treatment of craniofacial hyperhidrosis.

Adult↗