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PubMed1996

Endoscopic sympathectomy treatment for craniofacial hyperhidrosis.

OBJECTIVE: To present endoscopic T-2 sympathectomy as a minimally invasive therapy for craniofacial hyperhidrosis (CH). DESIGN: Follow-up study of 30 patients with CH treated by the new method in a 4-year period. The duration of follow-up was from 8 to 44 months (mean, 15 months). SETTING: University hospital. PATIENTS: Thirty consecutive patients with CH (18 men, 12 women) treated by the new method. All patients were essentially in good health except that they suffered from distressing CH to the extent that their daily activities were often disturbed. Their ages ranged from 7 to 63 years (mean age, 42.8 years). INTERVENTION: Endoscopic sympathectomy on both sides was carried out in a 1-stage operation for all patients. MAIN OUTCOME MEASURES: The patients were interviewed 1 week and then 3 months after surgery and then followed up by telephone interview about the alleviation or recurrence of CH and complications. RESULTS: All of the treated patients obtained a satisfactory alleviation of CH. One case was complicated by a mild and transient ptosis of the left eye. No recurrence of CH was noticed during the follow-up period. CONCLUSIONS: This therapeutic procedure is minimally invasive and effective. It causes minimal discomfort and was associated with no major complications in this series. The patients require only an overnight hospital stay and the operation scars are small. Endoscopic sympathectomy has proven to be an effective method in treating patients with distressing CH.

Adolescent↗
PubMed2004

Drawbacks of endoscopic thoracic sympathectomy.

BACKGROUND: Endoscopic thoracic sympathectomy (ETS) has come into widespread use for palmar hyperhidrosis and other complaints of the upper limb and of the head and neck, but there are concerns about its safety. This review highlights the operative complications and long-term side-effects that may occur. METHODS: A Medline search was carried out using the terms 'thoracoscopic sympathectomy', 'endoscopic thoracic sympathectomy' and 'complications'. References from identified articles were handsearched for further relevant articles. The senior author's experience and personal communications were also taken into account. RESULTS AND CONCLUSION: No death following ETS has ever been reported in the literature, but nine anecdotal fatalities are known, five resulting from major intrathoracic bleeding and three from anaesthetic mishap. Significant intrathoracic bleeding may occur in up to 5 per cent of patients but only a minority require thoracotomy; pneumothorax occurs in 2 per cent of patients and two instances of brain damage are known. In the longer term compensatory hyperhidrosis is extremely common and 1-2 per cent of patients regret having had surgery because of its severity. Horner's syndrome, on the other hand, is rare. Improvements in instrumentation, adequate training and careful patient selection may help reduce the drawbacks of ETS.

Humans↗
PubMed1986

Molecular adaptations in catecholamine biosynthesis induced by cold stress and sympathectomy.

Chronic cold stress and chemical sympathectomy are known to increase the synthesis and release of catecholamines in the adrenal medulla. Chromaffin cells adapt to altered functional requirements by increasing the synthesis of tyrosine hydroxylase (TH), the rate-limiting enzyme in catecholamine biosynthesis. In this study, we investigated the molecular genetic mechanisms underlying these changes in enzyme activity. Estimates of TH mRNA levels were obtained by RNA dot-blot analysis with a cloned TH cDNA hybridization probe. Exposure to cold produced a 4.3-fold increase in the relative abundance of adrenomedullary TH mRNA. Increases in TH mRNA levels (90%) also were observed in the brainstem of cold-stressed animals. The relative amount of TH synthesized in vitro in a rabbit reticulocyte cell-free system, programmed with adrenal poly(A)+RNA, increased 4.3 times in cold-stressed rats. Alteration in TH mRNA abundance appears to be specific, as we observed no significant difference in the levels of total RNA or poly(A)+RNA in this tissue. In addition, the relative abundance of adrenomedullary TH mRNA increased by 60% 4 days after systemic administration of the neurotoxin 6-hydroxydopamine. This increase was transient and disappeared 2 weeks after the lesion. Changes in TH mRNA levels after cold stress or sympathectomy were eliminated by denervation of the adrenal gland. These results indicate that alterations in the relative abundance of TH mRNA mediate changes in TH activity induced by chronic stress or sympathectomy, and that these changes require an intact sympathetic input.

Adrenal Medulla↗
PubMed1994

Short communication: distal adrenergic innervation remains normal after perivascular sympathectomy.

Perivascular sympathectomy, which has been used for vasospastic disorders of the hands, was examined in experimental models. Perivascular sympathectomy was performed on the central ear vessels and forepaw metacarpal vessels of the rabbit and on the common digital vessels in the monkey. The effects on adrenergic nerves were studied using a glyoxylic acid-induced fluorescence method. Adrenergic nerves were removed only at the site of the perivascular sympathectomy and the distal adrenergic innervation appeared normal. Because the distal sympathetic nerves appeared normal after the operation, it should rather be called adventitectomy and we feel its clinical effects should be reevaluated.

Animals↗
PubMed1998

Central nervous system activation following peripheral chemical sympathectomy: implications for neural-immune interactions.

Many studies have demonstrated that ablation of the sympathetic nervous system (SNS) alters subsequent immune responses. Researchers have presumed that the altered immune responses are predominantly the result of the peripheral phenomenon of denervation. We, however, hypothesized that chemical sympathectomy will signal and activate the central nervous system (CNS). Activation of the CNS was determined by immunocytochemical visualization of Fos protein in brains from male C57BL/6 mice at 8, 24, and 48 h following denervation. A dramatic induction of Fos protein was found in the paraventricular nucleus (PVN) of the hypothalamus and other specific brain regions at 8 and 24 h compared to vehicle control mice. Dual-antigen labeling demonstrates that corticotrophin releasing factor (CRF)-containing neurons in the PVN are activated by chemical sympathectomy; however, neurons containing neurotransmitters which may modulate CRF neurons, such as vasopressin, tyrosine hydroxylase, and adrenocorticotropin, do not coexpress Fos. Our findings suggest an involvement of the CNS in sympathectomy-induced alterations of immunity.

Adrenocorticotropic Hormone↗
PubMed2002

Increased ocular blood vessel numbers and sizes following chronic sympathectomy in rat.

Disease states characterized by ocular vascular pathology are often associated with impaired sympathetic function. This study examined the effect of sympathetic denervation on ocular vasculature of the adult rat. Uveal perfusion and choroidal and retinal blood vessel sizes and numbers were assessed in rats with intact innervation and after short- (2 days) or long-term (6 weeks) sympathetic denervation induced by ipsilateral superior cervical ganglion excision. In rats with intact innervation and after short-term sympathectomy, blood flow in both eyes was comparable. However, after long-term sympathectomy, blood flow was four-fold greater in the denervated than in the innervated eye, but was unaltered in lacrimal gland, cerebral cortex, and masseter muscle. Choroid surface area was not affected by long-term sympathectomy, but choroidal thickness was increased and choroidal cross-sectional area occupied by vascular lumina was greater. Arteriolar number per unit cross-sectional area of choroid was not altered although arteriolar diameters were enlarged. Choroidal venules were larger and more abundant. Choroidal capillary numbers were unchanged, but retinal capillaries of the outer plexiform layer were increased. To determine if these changes result from loss of sympathetic activity, sympathetic preganglionic innervation was excised chronically. This produced significant increases in choroidal thickness and vascular luminal area, and in numbers of arterioles, small venules, and capillaries in the outer plexiform layer. These findings show that sympathetic innervation is critical in regulating choroidal and retinal vascularity, and that chronic loss of sympathetic activity may contribute to abnormal vascular proliferation in diseases such as age-related macular degeneration and diabetic retinopathy.

Animals↗
PubMed2001

The effect of unilateral sympathectomy and cavity preparation on peptidergic nerves and immune cells in rat dental pulp.

Recent evidence suggests interactions between primary afferent nociceptors and postganglionic sympathetic efferents in the pathogenesis of inflammation. The effect of unilateral removal of the superior cervical ganglion on the innervation pattern of nerve fibers immunoreactive (IR) to calcitonin gene-related peptide (CGRP), substance P (SP), and neuropeptide Y (NPY), as well as the occurrence of immune cells in the injured and uninjured rat molar pulp, was investigated. Light microscopic immunocytochemistry demonstrated that the molar pulps contralateral to the sympathectomy contained a NPY-IR nerve fiber network more dense and heavily stained than unoperated control rats. The NPY-IR fibers showed, however, no sprouting after deep cavity preparation. There was no compensatory increase in CGRP- and SP-IR nerve fibers in the dental pulp after unilateral sympathectomy, although a significant increase in cells IR to CGRP and SP was found in the ipsilateral trigeminal ganglion. Unilateral sympathectomy induced a significant increase in immune cell density both in the inflamed and in the uninflamed dental pulp bilaterally. Our results demonstrate, for the first time, a trophic effect of the sympathetic nerves on immune cells in the dental pulp, indicating that an imbalance of sympathetic nerves may induce inflammation and pain in teeth.

Animals↗
PubMed1985

Degeneration patterns of postganglionic fibers following sympathectomy.

In cats the time course of degeneration following lumbal sympathectomy was studied in the ramus communicans griseus (rcg) and in the nerves to the triceps surae muscle using light and electron microscopic methods. The left lumbar sympathetic trunk including its rami communicantes was removed from L2 to S1 using a lateral approach. The animals were sacrificed between 2 and 48 days after the sympathectomy. Tissue samples were taken (a) one cm proximal to the entrance of the rcg into the spinal nerve, and (b) one cm proximal to the entrance of the nerve into the muscle belly. In the rcg signs of degeneration can already be recognized in the myelinated as well as in the unmyelinated axons 48 h after sympathectomy. The degenerative processes in the axons reach their peak activity at about 4 days p.o. They end a week later. Signs of the reactions of the Schwann cells and of the endoneural cells can first be seen 2 days p.o. They are most pronounced around the 8th day p.o., and last at least up to the third week. Thereafter the cicatrization processes settled to a rather steady state (total observation period 7 weeks). In the muscle nerves the first signs of an axonal degeneration of the sympathetic fibers can be recognized 4 days after surgery. The signs of axonal degeneration are most striking about 8 days p.o. They have more or less disappeared another week later. The reactions of the Schwann cells also start on the fourth day but outlast the degenerative processes by some 8 days. Thus the degenerative and reactive processes in the rcg precede those in the muscle nerves by 2 days early after surgery and by 6 days 3 weeks later. Seven weeks after surgery, fragments of folded basement lamella and Remak bundles with condensed cytoplasm and numerous flat processes are persisting signs of the degeneration. In addition to the differences in time course between the proximal and the distal site of observation, it was also noted that both the axonal degeneration and the reactions of the Schwann cells are more pronounced in the rcg than in the muscle nerve. For example there was abundant mitotic activity in the central endoneural and Schwann cells whereas we could not detect such activity in the periphery.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1995

Pineal 'synaptic' ribbon numbers and melatonin synthesis of rat are resistant to guanethidine sympathectomy.

Chemical sympathectomy is widely used to study the impact of the noradrenergic system on neuronal and neuroendocrine circuits. We tested the effects of intraperitoneal injections of guanethidine, an adrenergic neuron blocking agent, on selected functional parameters of the rat pineal gland which are known to be under sympathetic influence. The reliability of the method was demonstrated by the clear enophthalmus developed by experimental animals. However, neither the numbers of 'synaptic' ribbons nor melatonin synthesis differed between treated and control rats, both parameters exhibiting the nocturnal increase seen in intact animals. These results are in striking contrast to those obtained upon chemical sympathectomy with 6-hydroxydopamine or surgical superior cervical ganglionectomy. We conclude that guanethidine is not capable of sufficiently removing noradrenergic influence from the rat pineal gland, and that this substance is thus inferior to other experimental methods of sympathectomy.

Animals↗
PubMed2006

A 7-year experience with thoracoscopic sympathectomy for critical upper limb ischemia.

BACKGROUND: Severely symptomatic arterial insufficiency of an upper limb not suitable for revascularization is a difficult condition to manage. Thoracoscopic sympathectomy (TS) can be an effective procedure in this setting. METHODS: Our experience with 18 consecutive thoracoscopic sympathectomy (TS) procedures over a period of 7 years has been reviewed. Indications, operative technique, complications, and outcome of surgery are analyzed. RESULTS: We performed 18 TS procedures on 17 patients during this period. There were no deaths. One patient had intraoperative hemorrhage necessitating conversion to open thoracotomy. Mean postoperative hospital stay was 2.3 days. Follow-up ranged from 6 to 72 months. All patients demonstrated clinical benefit from the procedure. CONCLUSIONS: Thoracoscopic sympathectomy is a useful option in patients with severely symptomatic hand and digital ischemia from occlusive small arterial disease like thromboangitis obliterans.

Adult↗
PubMed2002

Effects of chemical sympathectomy by means of 6-hydroxydopamine on insulin secretion and islet morphology in alloxan-diabetic mice.

Activation of sympathetic nerves increases circulating glucose and inhibits insulin release from the islet beta-cells, which might contribute to stress-related diabetes. Accordingly, we have shown previously that blockade of parasympathetic activity aggravates diabetes in alloxan-treated mice, suggesting that unopposed sympathetic activity impairs diabetes. In this study, we tested whether elimination of sympathetic nerve activity by chemical sympathectomy with 6-hydroxydopamine (6-OHDA; 60 mg/kg) ameliorates the diabetogenic effects of alloxan (50 mg/kg) in NMRI mice. Mice given alloxan alone developed manifest diabetes after 2 days, as indicated by hyperglycemia. The diabetes persisted throughout the 35-day study period. Pretreatment with 6-OHDA did not, however, affect the glucose levels or the low, 2-min in vivo insulin response to glucose (1 g/kg) after alloxan. In situ hybridization at day 35 revealed a significantly reduced grain area of insulin-mRNA in the alloxan-treated animals, which was not affected by 6-OHDA, and an altered islet architecture, with accumulation of glucagon cells in the central portion. Also 6-OHDA alone reduced the insulin mRNA area, but this was accompanied by an increase in the total islet area. We conclude that, in contrast to cholinergic inhibition, sympathectomy does not perturb the development of chemically induced diabetes in mice. Alone, however, sympathectomy reduces insulin gene expression and induces increased islet size, suggesting that sympathetic nerves are of importance for long-term islet function.

Animals↗
PubMed2006

Retroperitoneoscopic lumbar sympathectomy for the treatment of plantar hyperhidrosis: technique and preliminary findings.

BACKGROUND: Patients with plantar hyperhidrosis suffer physically and mentally from a disease that often cannot be treated sufficiently using conservative measures. This article reports the authors' experience with endoscopic lumbar sympathectomies for patients with plantar hyperhidrosis. METHODS: Bilateral lumbar sympathectomy was performed for eight patients (3 women and 5 men). A retroperitoneoscopic surgical technique was used, during which the lower lumbar sympathetic trunk was resected after radiologic localization of the lumbar spine, with care taken to protect the cranial lumbar ganglia. RESULTS: All 16 sympathectomies were conducted retroperitoneoscopically, with no intra- or postoperative complications. In all cases, pedal sweat secretion was completely suspended postoperatively. After a 3- to 8-month follow-up period, the anhidrosis persisted in all cases (100%). None of the patients experienced sexual dysfunction. Five patients (62%) reportedly experienced minor compensatory sweating of the torso, and four patients (50%) had postsympathectomy neuralgia. Seven of eight patients were very happy with the postoperative results and would agree to a repeat of the intervention any time. CONCLUSIONS: Retroperitoneoscopic resection of the lower lumbar sympathetic trunk is a safe and effective procedure for obtaining suspension of excessive sweat secretion in patients with plantar hyperhidrosis that cannot be treated with conservative methods.

Adaptation, Physiological↗
PubMed1999

Thoracoscopic cervicodorsal sympathectomy with diathermy.

This study reports our experience of using thoracoscopic cervicodorsal sympathectomy with diathermy. From December 1994 to September 1998, we performed 53 thoracoscopic sympathectomies in 35 patients. There were 15 men and 20 women, ages 18 to 61 years. Ten surgeries were performed on the right side, 7 were the left, and 18 were bilateral. Indications for surgery were causalgia/reflex sympathetic dystrophy in 8 patients, Raynaud's/vasculitis in 6, intractable Raynaud's disease in 4, and hyperhydrosis in 17 (bilateral procedure). Operating time ranged from 10 to 50 min for unilateral procedures and from 45 to 80 min for bilateral procedures. Patients stayed in the hospital 1 to 4 days. From favorable immediate and follow-up results we conclude that thoracoscopic cervicodorsal sympathectomy using diathermy is feasible, safe, and effective.

Adolescent↗
PubMed2006

Sympathectomy for hyperhidrosis: should we place the clamps at T2-T3 or T3-T4?

Endoscopic thoracic sympathectomy is routinely used to treat severe hyperhidrosis. It is usually performed at the T2-T3 level of the nerve, but may produce less severe compensatory hidrosis if performed at a lower level. This study evaluates the outcome of 1,274 patients who underwent endoscopic thoracic sympathectomy for plamar, plantar, axillary or facial hyperhidrosis/blushing. Half of the patients were clamped at the T2-T3 level and half were clamped at the T3-T4 level. Postsurgical symptoms and side effects were assessed by interview. All of patients with palmar hyperhidrosis were cured or improved. Patients with plantar and axillary hyperhidrosis were more likely to be improved at T3-T4 level clamping. Patients with facial hyperhidrosis were more likely to be cured at T2-T3 level, but did show improvement at the T3-T4 level. Overall satisfaction was higher in the T3-T4 group. Some degree of mild compensatory sweating occurred in all patients. However, severe compensatory sweating was more common in the T2-T3 group. Around 2% of patients requested a reversal of their surgery. Endoscopic thoracic sympathectomy is a safe and effective treatment for hyperhidrosis. Clamping at the T3-T4 level has a more successful outcome. In particular, it appears to reduce the incidence of severe compensatory hidrosis.

Adolescent↗
PubMed1985

Chemical lumbar sympathectomy for ischemic rest pain. A randomized, prospective controlled clinical trial.

The results of a randomized, controlled, prospective double-blind trial of phenol chemical sympathectomy against placebo bupivacaine injection in 41 limbs (24 treatment and 17 control) have been presented. Ablation of the skin potential response was used as an indication of successful sympathectomy. Rest pain was relieved in 83.5 percent of patients at 1 week with a placebo response of 23.5 percent (chi-square test, p less than 0.002). Sixty-six percent of patients remained free from rest pain at 6 months (chi-square test, p less than 0.02). The ankle-brachial systolic pressure index and resting and peak (reactive hyperemic) blood flows were measured in the foot; there was no demonstrable improvement in these hemodynamic factors. Chemical sympathectomy in these circumstances is probably acting as a pain-relieving injection but nevertheless produces useful remission of rest pain in these inoperable but otherwise relatively stable patients. It can also be employed while relevant investigations are carried out before direct arterial surgery.

Aged↗
PubMed1990

The early effects of surgical sympathectomy on bone resorption in the rat incisor socket.

Earlier studies have shown that one week after sympathectomy in the rat, both bone apposition and resorption are significantly altered. Resorption in the incisor socket was now examined 1, 3 and 5 days after surgical sympathectomy. Morphometric analyses indicated that the total resorbing surface, active resorbing surface and number of osteoclasts per socket were increased one day after sympathectomy; the area and length of the bone surface of the socket were not significantly altered. Sympathetic denervation thus affects bone resorption within the first few hours after surgery.

Alveolar Process↗
PubMed1985

Effects of chemical sympathectomy with 6-hydroxydopamine on cardiac output and its distribution in the rat.

Cardiac output and its regional distribution were determined with radioactive microspheres in pentobarbitone anaesthetised rats 16 h and 5 days after sympathectomy with 6-hydroxydopamine (150 mg/kg i.p. over 24 h). Distribution was not different at either time in sympathectomised animals compared to controls given i.p. saline/ascorbic acid. Cardiac output was 12% greater 16 h after sympathectomy than in the controls but heart rate and blood pressure were 20% lower. Stroke volume was 43% greater in animals given 6-hydroxydopamine and total peripheral resistance 29% lower than in sham-sympathectomised rats. Five days after sympathectomy, blood pressure and heart rate were still lower in sympathectomised rats, but cardiac output and total peripheral resistance were not significantly different from control. It is concluded that basal sympathetic tone does not determine the distribution of cardiac output at rest and that its primary effect on the heart is to maintain heart rate rather than contractility.

Animals↗
PubMed1983

Effect of guanethidine sympathectomy on intake and body weight of intact and LHA-lesioned rats.

The present study investigated the role of direct sympathetic nervous system innervation of the viscera in the reduced body weight levels maintained by animals bearing lesions of the lateral hypothalamic area (LHA). Adult, male rats with, and without, electrolytic lesions of the (LHA) were treated with guanethidine sulphate (25 mg/kg IP daily for 6 weeks) to produce destruction of the peripheral sympathetic nervous system. LHA-lesioned rats displayed the expected reduced body weight compared to intact rats. Sympathectomy in lesioned rats resulted in an identical pattern of effects to that seen in intact rats. Transitory reductions in intake were effected and weight was significantly depressed by one week of guanethidine treatment. However, weight had recovered to control levels in both intact and lesioned drug-treated groups by the end of the experiment. The reduced body weight level maintained by LHA-lesioned rats was not altered by guanethidine sympathectomy. The major conclusions are (1) the reduced body weights maintained following LHA lesions are not dependent upon an intact sympathetic nervous innervation of visceral organs, and (2) peripheral sympathectomy in intact adult rats has no chronic effects on either body weight or food and water intake.

Animals↗