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At least 253 records · Page 14Linked to original sources
PubMed2006

[Needlescopic thoracic sympathectomy for palmar hyperhidrosis].

OBJECTIVE: To evaluate the safety and efficacy of needlescopic thoracic sympathectomy for palmar hyperhidrosis. METHODS: From March 2004 to April 2005, 62 patients, including 23 men and 39 women with a mean age of 23 years (ranged from 12 to 53 years), underwent bilateral needlescopic thoracic sympathectomy. Among all the patients 8 cases had accompanied axillary hyperhidrosis. The degree of palmar sweating was moderate in 16 cases and severe in 46 cases. The sympathetic chain on the body of the second and third ribs in all patients was cauterized and divided; the chain on the fourth rib in those with axillary hyperhidrosis was also severed. Intraoperative changes in palmar temperature and blood flow were recorded. RESULTS: Sympathectomies were successful, and dry limbs were immediately achieved in all patients after surgery. There were no mortality or life-threatening complication, however 1 patient developed moderate pneumothorax which resolved soon after chest drainage. After all procedures, palmar blood perfusion increased significantly and mean palmar temperature elevated by 2.4 degrees C. The mean operative duration was 65 min, and the mean postoperative hospital stay was 1.2 days. No recurrence of palmar hyperhidrosis occurred after a mean follow-up of 6.3 months (ranged from 1 to 13 months). Compensatory sweating was found in 26 patients, but the symptoms were mostly tolerable and required no further treatment. CONCLUSION: Needlescopic thoracic sympathectomy is a safe and effective technique for palmar hyperhidrosis, which is less invasive than conventional video-assisted thoracic surgery.

Adolescent↗
PubMed1990

[Catecholamines in adrenergic nerve fibers of the lymph nodes after sympathectomy].

Using Falck method in combination with microfluorimetry, catecholamine level in adrenergic nervous fibers has been measured in the canine popliteal lymph nodes, normal and in 12 h, 7, 30, and 90 days after unilateral lumbar sympathectomy. During first 24 h after the operation the level of catecholamines is for certain increased in the nervous fibers of the lymph node of the sympathectomized extremity. In 30 days after the sympathectomy their content drops at the side of the operation and increases in the contralateral extremity. By 3 months the equilibrium of the catecholamine content is restored in the nervous fibers of the lymph nodes in the homo- and contralateral extremities at the level higher than in the control. A conclusion is made that under conditions of unilateral sympathectomy only a partial sympathectomy of the popliteal lymph node is reached. All luminiscent adrenergic nervous fibers of the sympathectomized lymph node are processes of neurons, situating in the contralateral sympathetic trunk, or neurites of cells in sacral nodes, getting their preganglionic fibers from the contralateral trunk. The changes in catecholamine concentrations mentioned are considered as a compensatory reaction, directed to maintenance of general homeostatic equilibrium under conditions, when the nervous system transfers to a new level, ensuring the partly desympathized tissue by mediators.

Adrenergic Fibers↗
PubMed1989

[The effect of chemical sympathectomy on the cell kinetics of gastric mucosa in golden hamsters].

The effects of chemical sympathectomy on the differentiation of the generative cells, superficial epithelial cells and gastrin cells of the gastric mucosa of hamster were examined by 3H-thymidine autoradiography. The labeling indices of the generative cell zone in the gastric mucosa and antral gastrin cells showed a transient significant decrease after chemical sympathectomy, and then they were gradually restore with time. After 4 weeks onward, the labeling indices of the generative cells showed a slightly low value compared with those in controls. The renewal of superficial epithelial cells and gastrin cells was examined in the hamster sympathectomized for 4 weeks. The time required for the differentiation to PAS positive superficial epithelial cells or gastrin cells had a tendency to elogate after chemical sympathectomy. These results suggest that chemical sympathectomy played an inhibitive action on the proliferation and the differentiation of gastric mucosa.

Animals↗
PubMed1977

[History of lumbar sympathectomy from its origin to the present].

The author first recalls the origins of the words "sympathetic" and "neurovegetative system" and then outlines the beginnings of surgery on the autonomic nervous system in general. This started with the section of the rami communicantes introduced by the Australians Royle and Hunter in surgery of the muscle tone. Then nearly at the same time in 1924. Adson in USA and J. Diez in Argentina resected the lumbar sympathetic chains; the latter mainly for treatment of thromboangeitis obliterans. From 1924 on, lumbar sympathectomy met with rapid success as shown at the Cairo Congress of 1935. Physiologic and pathologic effects of lumbar sympathectomy are analysed and the usual techniques are reviewed. The author then lists the specific postoperative complications, including the pain symdroms and the functional sexual disorders in males. Finally the principal indications where lumbar sympathectomy proved useful are named. Chronic obliterative arteriopathies are the first. For these lumbar sympathectomy still holds a palliative, supportive or absolute role. A scheme illustrates its beneficial actions.

Arterial Occlusive Diseases↗
PubMedDate not supplied

Lumbar sympathectomy and distal arteriovenous fistula as adjuncts to prevent arterial rethrombosis after thrombectomy: experimental study in dogs.

The role of lumbar sympathectomy and distal arteriovenous fistula (AVF) in preventing rethrombosis of femoral arteries with intimal injury and poor run-off was studied in 21 dogs. Femoral artery thrombosis was induced by endothelial lesion in all animals (phase 1) and 24 hours later the arterial flow was restored by thrombectomy. The dogs were then randomly allocated into 3 experimental groups: control, sympathectomy, and AVF (phase 2). Critical stenosis of the popliteal artery was then created by a partially occluding ligature in all animals in order to simulate poor run-off. After 24 hours the femoral arteries were studied for the presence of rethrombosis (phase 3). At the end of phase 2 and during phase 3, femoral pressure and flow, fluorescein circulation time and paw temperature were measured, and arteriography was done. Arterial rethrombosis was significantly prevented in the AVF group (6/7) when compared to the control group (2/7) or the sympathectomy group (1/7). These data suggest an effective action of an adjuvant AVF, but not of sympathectomy in preventing rethrombosis after thrombectomy in arteries with poor run-off.

Animals↗
PubMed1988

[Characteristics of the secretory activity of the respiratory cells of mouse lungs after partial chemical sympathectomy].

Partial "sympathectomy" in the neonatal BALB mice was achieved by the treatment with guanethidine. The number of neurons in the stellate ganglion decreased to 20% of the control values and remained constant throughout the subsequent period of 1 month. Partial "chemical sympathectomy" did not affect the postnatal growth and development of the lungs. Partial "chemical sympathectomy" significantly increased the number of secreting cells in bronchiolar and alveolar regions. Secretory activity of the alveolocyte population, type two, synthetizing and secreting surfactant also increased. It has been concluded that the partial "chemical sympathectomy" stimulated the alveolar surfactant secretion.

Animals↗
PubMed1987

The effect of sympathectomy on blood flow in bone. Regional distribution and effect over time.

Considerable interest has developed in the role of the autonomic nervous system and its effect on blood flow in bone. Theories pertaining to the long-term physiological effect of sympathectomy on blood flow in bone have been controversial. This study employed the radioactive tracer-microsphere technique to investigate the influence of sympathectomy on regional blood flow in bone over time in dogs. Blood flow was measured in fifteen adult dogs, weighing eighteen to twenty kilograms, at one hour, one day, and one, two, three, four, and six weeks after a transperitoneal sympathectomy from the first to the sixth lumbar level. Absolute control flow values were consistent with those that have been reported previously and had lower standard errors. Blood flow in bone in the femoral regions increased by 24.0 to 41.0 per cent. Greater elevations, of 37.0 to 59.0 per cent, were noted in the tibial sections. The largest increases (58.0 to 67.0 per cent) were seen in the metatarsals and proximal phalanges. All elevated values for blood flow returned to control values by six weeks. The data support the hypothesis that surgical sympathectomy exerts a significant yet transient effect on blood flow in bone. Furthermore, the greater increase distally is the first physiological evidence to support previous anatomical work that concluded that the major site of sympathetic tone lies distally in the lower extremity of the dog.

Animals↗
PubMed1986

Effect of chemical sympathectomy on renal hydroelectrolytic handling in dogs with chronic caval constriction.

The effect of renal selective chemical sympathectomy by intrarenal infusion of 6-hydroxydopamine (6-OHDA, 5 mg/kg body weight) on the renal excretion of water and electrolytes was studied in 7 dogs in whom a syndrome of sodium and water retention and ascites formation was induced by partial constriction of thoracic inferior vena cava. Propranolol (1 mg) and phentolamine (3 mg) were also injected to obviate acute systemic hemodynamic changes. Sympathectomy was performed once in 4 dogs and three times in 3 dogs. Sympathectomy induced an abrupt and transient increase in urinary flow (from 170 +/- 30 to 890 +/- 60 ml/24 h) and sodium excretion (from 4.5 +/- 1.5 to 178 +/- 21 mEq/24 h). This was accompanied by an important fall in plasma renin activity (from 2.2 +/- 0.2 to 0.5 +/- 0.1 ng angiotensin I/ml/h) and aldosterone, and disappearance of ascites. It is concluded that chemical sympathectomy, by increasing renal sodium and water excretion, mobilizes the ascites induced by chronic caval constriction, a fact that highlights the role of the renal sympathetic system in the pathogenesis of sodium and water retention by the kidney.

Aldosterone↗
PubMed1986

Radionuclide angiography in the assessment of lumbar sympathectomy.

Nuclear angiography was used in the assessment of the effects of lumbar sympathectomy in 16 patients. Computed nuclear angiographic study was performed before and after sympathectomy. 7 patients had a good clinical course and 9 had a poor prognosis. Visual observation and computed analysis gave almost equal information. Shortening of arrival time (ATdecrease) and increase in input rate ratio (IRratio) were the most suitable parameters in computed analysis. A good clinical course was probable if ATdecrease was greater than or equal to 5 s and IRratio greater than or equal to 1.3. Smaller values predicted poor prognosis. Preoperative Doppler ankle/arm systolic blood pressure index (API) greater than or equal to 0.50 predicted good and less than or equal to 0.50 poor clinical response. Postoperative API provided no additional information and was not able to measure the effects of sympathectomy. Radionuclide angiography was found to be a safe, noninvasive reliable method in the evaluation of peripheral circulation in the follow-up of sympathectomy.

Adult↗
PubMed1987

Recurrent sympathetic dystrophy: successful treatment by contralateral sympathectomy.

Reflex sympathetic dystrophy comprises a group of disorders characterized by disabling pain and vasomotor disturbances. Sympathectomy has become a mainstay of therapy. Recurrent symptoms following sympathectomy have been attributed to incorrect diagnosis, delayed treatment, or secondary gains. This report concerns a case of lower-extremity reflex sympathetic dystrophy that recurred following an initially curative sympathectomy and that responded to treatment with contralateral sympathectomy. We suggest that these recurrent symptoms may be due to reinnervation from the contralateral lumbar sympathetic chain.

Adult↗
PubMed1987

Cardiovascular, metabolic and endocrine effects of chemical sympathectomy and of adrenal demedullation in fetal sheep.

A procedure in fetal sheep for causing peripheral sympathectomy by regular intravascular guanethidine sulphate administration and for causing adrenal demedullation by intragland injection of acid formalin is reported. Demedullation substantially removed adrenaline from the fetal circulation, but has a small effect only on noradrenaline. Plasma noradrenaline levels were depressed by 50% when demedullated fetuses were also subject to peripheral sympathectomy by guanethidine sulphate treatment. This provides some evidence that the paraganglia in the sheep fetus contributes to resting plasma catecholamines. Furthermore the ability of adrenal demedullation to increase markedly this pool of extra-adrenal chromaffin tissue indicates that in the fetus adrenal activity regulates the growth of these para-aortic bodies. In response to sympathectomy plasma vasopressin concentrations rose substantially, whilst adrenal demedullation caused a small rise. Demedullation and sympathectomy depressed fetal plasma glucose and elevated plasma cortisol. In both sympathectomised and adrenal demedullated fetuses resting heart rate and blood pressure was not depressed. However in those with a depleted peripheral nervous system periods of cardiovascular instability were apparent after 2-3 days of treatment with guanethidine sulphate. Hence there were regular episodes where fetal blood pressure and heart rate fell sharply followed 60-90s later by very large increases in blood pressure sustained for up to 10 min and associated with substantial production of plasma vasopressin and catecholamines. These results show that fine cardiovascular control in the fetus requires an intact sympathetic system as the endocrine system is too slow responding to effectively maintain reflex vascular control.

Adrenal Medulla↗
PubMed1987

Extensive or partial microsurgical sympathectomy of the arm by supraclavicular route for primary or secondary Raynaud symptoms.

Surgery was performed in patients with Raynaud's disease (primary Raynaud symptoms) or with Raynaud symptoms as part of the cervical rib/scalenus-anticus syndrome (secondary Raynaud symptoms). In 13 arms with primary, and six with secondary Raynaud symptoms with trophic changes, the aim was extensive sympathectomy. Good results, without Horner's syndrome, were obtained with extensive postganglionic sympathectomy. When the grey ramus T1 could not be identified, T2 ganglionectomy and extirpation of the grey rami C7 and C8 were performed with the same result. Extirpation of the grey ramus C6 was not mandatory for a good result. Extirpation of unidentified T1 rami resulted in permanent Horner's syndrome in two of four patients. Cases of secondary Raynaud symptoms without trophic changes were divided into two equal groups, each of 18 arms. Combined neurovascular decompression and partial sympathectomy were performed in one group, and neurovascular decompression only in the other. Partial sympathectomy seemed to improve the results.

Adult↗
PubMed1986

[Current state of sympathectomy in peripheral reconstructive surgery].

The Authors present the results got regarding operations of sympathectomy together with operations of distal by-pass at the Institute of Surgical Pathology of the University of Verona from 1979 to 1983. Among the 106 cases, in 58 (55%) sympathectomy was performed with a aorto-bifemoral or iliac-femoral by-pass at the same time, in 48 (45%) pas performed with more distal by-pass. At follow-up in the 72% of the cases a clinical improvement as been noticed, in the 14.5% of the cases a steady result as been found, and in the 12.6% of the cases an aggravation of the situation. Furthermore the clinical stage of the disease (according to Fountain) as been compared with the operation. The Authors concluded that the sympathectomy carried out together with other vascular surgical operations is still a good procedure if the patients are within 70 years of age, no diabetics and pith a sufficient perfusion pressure of the ankle. Moreover, paradoxically, the sympathectomy is much more useful on stage II or III than on stage IV.

Aorta, Abdominal↗
PubMedDate not supplied

Evaluation of effectiveness of lumbar sympathectomy by non invasive diagnostic techniques.

Out of a total of more than 1,200 patients in whom lumbar sympathectomy was carried out, two groups of 96 and 50 consecutive and non selected patients were evaluated before and after the operation by non invasive physiologic tests (digital plethysmography, post-occlusive reactive hyperemia, segmental blood pressure at rest and after exercise, Strandness test). Results were compared with angiography and clinical data. The statistical study of results corroborates the following points. 1. Lumbar sympathectomy is essentially effective in atherosclerotic arterial disease, but much less so in diabetic patients and in cases of widespread disease. 2. Patients with obstructive disease of the femoral artery had more improvement (t = 4.25) than patients with obstruction of peripheral arteries (t = 2.4). 3. Walking time was significantly improved after sympathectomy (p = 0.02). 4. Only one parameter, rheographic quotient Rq was statistically improved (p = 0.01). 5. The post occlusive reactive hyperemia test is a good method to predict the results of lumbar sympathectomy (correlation r = 0.22). We feel that this operation is indicated in cases of: isolated obstruction of the femoral artery with claudication superior to 200 meters, reconstruction with an associated obstruction of the superficial femoral artery.

Aged↗
PubMed1977

Lumbar sympathectomy.

The three points discussed in this paper are: 1. Improvement in walking distance. 2. Post-sympathectomy neuralgia. 3. Post-sympathectomy ejaculatory problems. The experience in the paper was derived from 2,450 operations of lumbar sympathectomy carried out between the years of 1947 and 1972. The claudicant patients were divided into 3 main groups. Those who were not treated by any form of surgery, those who could walk for 200 yards before claudication and those who could walk less than 100 yards before claudication, the latter two groups having been treated by lumbar sympathectomy. The results show a considerable difference in the two groups treated and compare favourably with the untreated cases.

Arterial Occlusive Diseases↗
PubMedDate not supplied

Phenol lumbar sympathectomy in severe arterial disease of the lower limbs: a hemodynamic study.

The indications, results and evaluation methods of lumbar sympathectomy are very controversial. The authors present their experience and results with phenol lumbar sympathectomy (PLS). PLS (Reid's technique) was carried out in 25 patients with severe peripheral arterial disease. Sympathetic tone abolition was achieved in 72% of the patients, with a beneficial clinical effect in 60%. In this group, the following measurements were made, before sympathectomy, and 24 hours, one week and one month after it: Doppler ankle-pressure, ankle-arm pressure index and calf and foot arterial flow measured with an impedance plethysmograph (IPG), at rest and after controlled exercise. The IPG-measured arterial flow in the resting foot was the only parameter to show a significant increase following PLS (p less than 0.05). Although the IPG calf flow, ankle-pressure and ankle-arm index showed increases, these were not significant. Lumbar sympathectomy by phenol injection is as effective as by surgery. Its beneficial effect is believed to be due to an increase in the resting flow in the foot.

Adult↗
PubMedDate not supplied

Criteria for prognostic evaluation of the results of lumbar sympathectomy: clinical, haemodynamic and angiographic findings.

Lumbar sympathectomy still has an important role in the surgical treatment of occlusive peripheral arterial diseases of the lower limbs located below the inguinal ligament, when the presence of peripheral lesions makes revascularization difficult. A consecutive series of 143 patients who underwent lumbar sympathectomy was considered, and the clinical, angiographic and haemodynamic findings evaluated. Haemodynamic studies on these patients showed a relation between the clinical improvement and the pressure index, measured at the ankle before lumbar sympathectomy. The patients with pressure index values above 0.5 had a symptomatic improvement whereas the patients with a pressure index below 0.3 gave less good results. It is therefore believed that lumbar sympathectomy showed not be considered a second operative choice but an elective operation, especially in patients affected by lesion of the superficial femoral artery, the popliteal artery and its branches, with pressure indices above 0.5 where revascularization is not possible.

Adult↗
PubMedDate not supplied

Sexual function after bilateral lumbar sympathectomy and aorto-iliac by-pass surgery.

Sexual function has been assessed in 44 patients under 60 years old after bilateral lumbar sympathectomy. 21 had lumbar sympathectomy alone, but in 23 it was combined with by-pass aorto-iliac surgery. Half these patients produced seminal fluid for analysis and spermatozoa were present in all. In those patients who also had aorto-iliac surgery, sexual function was impairedin 40%, ejaculation and erection difficulties occurring in the same proportion. In patients who had only bilateral sympathectomy, these complications occurred in 24% and mainly consisted of ejaculation disturbances. Only three patients became impotent, each having had aortic surgery. Serious sexual complications caused by lumbar sympathectomy alone seem relatively rare and should only preclude its use in young men wishing to reproduce.

Aorta, Abdominal↗