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PubMed2001

[Thoracoscopic thoracic sympathectomy--personal experience].

The authors present a group of 48 thoracoscopic thoracic sympathectomies they performed in 35 patients between November 1997 and March 2000. A favourable effect was recorded in all operated patients where the defect healed or the blood supply of the upper extremities improved. Twice thoracoscopic resympathectomy was performed in a patient 15 years after classical upper thoracic sympathectomy [2] from the supraclavicular space. Twice a relapse was recorded one year after the operation. The complaints are substantially smaller than before operation. The authors emphasize the advantages of thoracoscopic thoracic sympathectomy which is associated with a minimal risk of complications.

Adult↗
PubMed2001

Upper dorsal thoracoscopic sympathectomy for palmar hyperhidrosis. The use of harmonic scalpel versus diathermy.

BACKGROUND: Upper dorsal thoracoscopic sympathectomy, the treatment of choice for primary palmar hyperhidrosis, is not devoid of long-term complications, like Horner's syndrome and postoperative neuralgia. It has been postulated that propagation of heat induced by diathermy may be responsible for some of these sequelae. To assess this hypothesis, a study was undertaken to evaluate the use of harmonic scalpel, which does not dissipate heat. METHOD: Sixteen patients with primary palmar hyperhidrosis underwent upper dorsal thoracoscopic sympathectomy using the harmonic scalpel on one side and diathermy on the other. Follow-up was made two years postoperatively. RESULTS: The length of the procedure with each instrument was similar. There was no localization of postoperative pain, which could be attributed to either device. No Horner's syndrome or postoperative neuralgia occurred. CONCLUSION: The present study proved the safe use of harmonic scalpel for upper dorsal thoracoscopic sympathectomy, but did not detect any important advantage of either instrument over diathermy.

Adolescent↗
PubMed2002

[Tele-surgery of thoracic sympathectomy].

Experience of surgical treatment of Raynaud's disease with application of thoracoscopic sympathectomy (TSSE) method using telesurgical technique was analyzed. Operative intervention was performed in 17 patients. Stable positive result was observed in all the patients for the period of 2 years and more. Regarding the intervention traumaticity, efficacy of treatment in immediate and late postoperative period, the patients quality of life, the duration of stay in hospital and the value of treatment, the TSSE results, performed with telesurgical technique application, were significantly better than the results of thoracotomic sympathectomy. Peculiarities of anesthesiologic support and predominance of application of monopulmonary artificial ventilation of lungs during performance of thoracic sympathectomy were noted.

Humans↗
PubMed2002

[Effect of sympathectomy on the heart pump function in rats during postnatal ontogenesis].

The influence of guanetidine sympathectomy (30 mg/kg) on the heart pump function in rats during 3 weeks in postnatal ontogenesis has been investigated. Sympathectomy restrains age-dependent establishment of stroke volume, cardiac output and heart rate. The adaptation effects of regular physical training do not develop in the animals with sympathectomy, i.e. heart rate does not decrease and stroke volume does not increase. The initial stage of adaptation of the sympathectomized animals to physical training is accompanied by decrease in stroke volume and remarkable increase in heart rate which indicates the reduction of contractile activity in the myocardium.

Aging↗
PubMed1992

[Thoracic sympathectomy in the treatment of chronic ischemia of upper extremities and excessive sweating of the palms].

The results are presented of treatment of 65 patients with chronic peripheral ischaemia of upper extremities and excessive sweating of the palms, in whom 78 thoracic sympathectomies were done by the Smitwick method in the years 1972-1989. The cause of ischaemia in 45 patients were organic changes (TO, AO), in 18 cases--functional changes (Raynaud syndrome), and in two patients--excessive sweating of the palms. Patients with trophic changes were 72% of those surgically treated. Long-term follow-up (8.5 years on the average) demonstrated a significant improvement in the group of organic changes in 84% of the surgically treated cases, in the group of functional changes in 83.2% of cases, and in excessive sweating of the palms in 100% of cases. In five patients contralateral effect of thoracic sympathectomy was observed. The authors discussed the extent of sympathetic trunk removal. They think that thoracic sympathectomy is a procedure of choice in cases of peripheral ischaemic changes in upper extremities not responding to conservative treatment.

Adolescent↗
PubMed2002

Thoracoscopic sympathectomy for primary palmar hyperhydrosis: the Penang Hospital experience.

BACKGROUND: Primary palmar hyperhidrosis is a functionally and socially disabling condition. The choice of treatment is controversial. OBJECTIVE: To examine the clinical presentation of primary palmar hyperhidrosis and the results of treatment with thoracoscopic sympathectomy in a local setting. MATERIALS AND METHODS: A retrospective study of 7 patients involving 10 sympathectomies between October 1997 and October 2000 was undertaken. RESULTS: The duration of anaesthesia ranged from 55 to 130 minutes with the majority being 1 hour. The immediate results were good, with all operated limbs dry soon after operation. There was no mortality or serious morbidity in this study. All were satisfied with the results of surgery. CONCLUSIONS: Primary palmar hyperhidrosis is not uncommon but rather underdiagnosed. Thoracoscopic sympathectomy is an effective treatment with minimal complications.

Adolescent↗
PubMedDate not supplied

Retroperitoneoscopic lumbar sympathectomy for buerger's disease: a novel technique.

BACKGROUND: The conventional lumbar sympathectomy procedure through the extraperitoneal route requires a muscle cutting-splitting incision, which leads to significant postoperative pain and prolonged convalescence. With increasing experience in retroperitoneoscopic procedures, we did a pilot study to explore the role of retroperitoneoscopy in lumbar sympathectomy. We describe herein our technique used for the surgery. METHODS: The patient was placed in a lateral position. A 15-mm incision was made just below the 12th rib, and retroperitoneal space was created using blunt finger dissection. A custom-made, large balloon was inserted and inflated with the equivalent of 750 mL to 1000 mL of saline. The second 10-mm port was placed in line with the first port above the iliac crest. The third and fourth 5-mm ports were placed anterior to the first 2 ports. Peritoneum was retracted anteriorly. The medial border of the psoas muscle was used as a landmark and a chain identified immediately medial to it. Lumbar vessels were ligated on the right side. The first to fourth lumbar sympathetic ganglia were removed with the intervening chain. The port sites were closed without a drain. RESULTS: We attempted and successfully completed this procedure in 8 patients; 6 on the left side and 2 on the right side. The average operating time was 38 minutes. The mean hospital stay was 1.5 days. All patients had symptomatic pain relief and clinical improvement. CONCLUSIONS: Retroperitoneoscopic lumbar sympathectomy is a safe and effective procedure. It has a short convalescent time and minimal morbidity; hence, it is a viable alternative for the open procedure.

Adult↗
PubMed2004

[Lumbar sympathectomy in treatment of obliterating diseases of lower limbs: state of the art].

The article deals with analysing examination and surgical treatment of 80 patients with predominant lesions to the distal arterial bed of the lower extremities, who were operated on at the RRSC from 1996 to 2003 with various degree on the background of chronic obliterating diseases of lower limbs arteries. All the patients were subdivided into two groups according to the outcomes of the epidural block: Group I -- with positive outcomes consisted of 36 (45 %) patients, and Group II -- with a negative outcome -- included 44 (55 %) patients. The patients from the both groups underwent the following operations: lumbar sympathectomy combined with direct and indirect methods of revascularisation, as well as lumbar sympathectomy as an independent therapeutic method. To solve the problem concerning feasibility of either done, or concomitant lumbar sympathectomy, we devised assessment of microcirculation state (alterations in volumetric blood flow indices in epidural block in relation to the indices at rest, as well as in the immediate or remote postoperative period) and peripheral haemocirculation (dynamics of the onkle brachial index values on the background of epidural block test, nitroglycerine test in relation to the ARI at rest both in the short-, and long-term postoperative period) by data of scintigraphy and dopplerography of the lower limbs.

Arteriosclerosis↗
PubMed2005

[Thoracoscopic sympathectomy in the treatment of palmar hyperhidrosis and facial blushing].

BACKGROUND: Severe palmar hyperhidrosis and facial blushing are conditions connected with considerable psychosocial burden. Conservative treatment is often of limited value. Several reports have demonstrated high success rates in thoracoscopic sympathectomy. Treatment results from Norwegian centres have not previously been published. MATERIAL AND METHODS: The long term effects of thoracoscopic sympathectomy performed between 1998 and 2002 at Aker University Hospital were evaluated by questionnaire, using VAS scores (visual analogue scales) obtained from 72 out of 76 operated patients. RESULTS: In palmar hyperhidrosis, a reduction in VAS score above 3 was reported in 27 of 28 patients (from mean 9.5 +/- 0.2 to 0.8 + 0.4). In facial blushing, 39 of 44 patients reported a reduction in VAS score above 3 (from mean 8.9 +/- 0.3 to 2.5 +/- 0.4). The overall satisfaction rate was 90 %. A majority of patients (86 %) experienced variable but lasting compensatory general hyperhidrosis. However, only a few patients found this condition disabling to the extent that it caused regret (3 patients) or dissatisfaction (4 patients). CONCLUSION: Thoracoscopic sympathectomy markedly reduces palmar hyperhidrosis and facial blushing, but the indication should be strong and the information thorough because of compensatory hyperhidrosis.

Adolescent↗
PubMed1991

[Indications for performing lumbar sympathectomy].

The results of treatment of 123 patients with obliterative diseases of the lower extremities, who underwent lumbar sympathectomy, and 115, who underwent the conservative therapy, were studied. The best result of sympathectomy was noted in patients with the impairement in the major blood flow and microcirculation without trophic disorders. In trophic disorders, sympathectomy contributed to reduction of a level of amputation.

Adult↗
PubMed1990

Bilateral simultaneous transaxillary sympathectomy in treatment of palmar hyperhidrosis: report of 60 cases.

Bilateral simultaneous transaxillary sympathectomies (BSTS) were established in order to achieve a one-stage transaxillary sympathectomy in the treatment of palmar hyperhidrosis. The features of the BSTS were the patient's supine operative position, parapectoral incision, and bilateral simultaneous procedures. BSTS were safely performed on 60 patients during a 5-year period. No serious complications or recurrences were encountered. The clinical results suggest that BSTS is the technique of choice for one-stage transaxillary sympathectomy in the treatment of palmar hyperhidrosis.

Adolescent↗
PubMedDate not supplied

Clinical parameters for predicting response to lumbar sympathectomy in patients with severe lower limb ischemia.

A prospective study of 85 lumbar sympathectomies for inoperable peripheral vascular disease was conducted to analyze the correlation between lumbar sympathectomy, ankle/arm index (AAI), popliteal-brachial index (PBI), and the clinical presentation; and to study if predicted clinical criteria, single or combined, could be defined for selection of patients who might benefit from lumbar sympathectomy. Good results were obtained if at six months after surgery pain at rest was absent, ischemic ulcers had healed, and there were no major amputations. Seventy-seven percent of all limbs with a preoperative AAI greater than or equal to 0.3 had a good outcome in contrast to 94% failure for index less than 0.3 (p = .000000477). Sixty-nine percent of all limbs with PBI greater than or equal to 0.7 had a good outcome vs. 52% if index less than 0.7 (p = 0.199). Patients with rest pain, simple leg ulcers, and toe gangrene had a good outcome if the AAI greater than or equal to 0.3 and if the postoperative AAI increased by greater than or equal to 0.1. The PBI and diabetic status had no prognostic value.

Adult↗
PubMed1990

[Thoracic sympathectomy by thoracoscopy. Apropos of 15 cases].

UNLABELLED: Thoracic sympathectomy is achieved using the trans-axillary route during the course of a thoracotomy. The indications are Raynaud's phenomenon, digital arteriopathy, and hyperhidrosis. Alongside the surgical approach in theory it is possible to use a thoracoscopic approach for a thoracic sympathectomy, to achieve a physico-chemical destruction, we have studied this possibility using this technique. MATERIAL AND METHODS: Thoracoscopy is achieved under local anaesthetic after creating a pneumothorax. The approach is through the 2nd intercostal space in the mid-clavicular line. Anaesthesia of the 2nd sympathetic ganglion is achieved, the ganglion is destroyed by injection of 8 c.c's of Phenol. 15 patients were treated (15 to 7). The presented with palmar hyperhidrosis (7), digital arteriopathy (6) or Raynaud's syndrome (2). RESULTS: The first 5 patients were failures which led to a more precise technique. Overall we observed 8 favourable results. If we exclude the first 5 cases we achieved 8 favourable results and 2 failures. The approach to the 2nd sympathetic ganglion using the thoracoscope is not always possible: the vision may be obscured. When it is possible phenolization may yield excellent results comparable to those of surgical sympathectomy. CONCLUSION: Palmar hyperhidrosis for which we have obtained the best results seems to us to be an extra indication of this technique which enables a cure at the price of a relatively simple procedure and a brief period of hospital stay.

Adolescent↗
PubMed1989

[The influence of truncal vagotomy or surgical sympathectomy on the pancreatic trophic effect of trypsin inhibitor upon normal rats and major pancreatectomized rats].

The influences of truncal vagotomy or surgical sympathectomy on the pancreatic trophic effect of oral administration of synthetic trypsin inhibitor (FOY-305) were examined upon normal rats and 85% major pancreatectomized rats. On normal rats, oral administration of trypsin inhibitor increased pancreatic weight, DNA content RNA content, protein content, pancreatic weight/DNA, RNA/DNA and protein/DNA. This pancreatic trophic effect seemed to be consisted of hyperplasia and hypertrophy of pancreatic acinar cell. Under truncal vagotomy or surgical sympathectomy, this trophic effect was not diminished. On major pancreatectomized rats, oral administration of trypsin inhibitor also caused pancreatic trophic action, consisted of hyperplasia mainly. And truncal vagotomy or surgical sympathectomy did not decrease this action. These results suggested that oral administration of trypsin inhibitor might be a beneficial method for functional recovery of remnant pancreas after major pancreatectomy even under the denervated state.

Animals↗
PubMed1989

Monoamine oxidase (MAO) in pancreatic islets of the mouse: some characteristics and the effect of chemical sympathectomy.

We have previously observed that chemical sympathectomy in the guinea pig induced an increase in the intensity of serotonin fluorescence in the insulin cells of the pancreatic islets. In the present study we have studied some basal characteristics of mouse islet monoamine oxidase (MAO) and the effect of chemical sympathectomy induced by 6-hydroxydopamine on the activity of this enzyme. Estimated Km-values for MAO activity with different substrates were as follows: serotonin (5-HT; 2 x 10(-4) M), dopamine (DA; 4 x 10(-4) M), and 2-phenylethylamine (PEA; 4 x 10(-6) M). The highest specific activity was displayed with PEA and DA as substrates, whereas it was about 10 times lower with 5-HT as substrate. Two days after the destruction of islet adrenergic nerves by 6-hydroxydopamine we observed a decrease of approximately 30% of the MAO activity with serotonin as substrate and after seven days the MAO activity with PEA as substrate had decreased by 18%. By contrast the MAO activity with DA as substrate was slightly increased (+ 12%) at two days after sympathectomy. There is a need for a further characterization of islet MAO activity(ies) and for further studies on its putative role in insulin secretory processes through its regulation of the islet monoamine stores.

Animals↗
PubMed1989

[Compensatory-adaptive modifications of the C-cell apparatus of the thyroid in normal rats of various ages and in partial sympathectomy].

Population of the thyroid C-cells, normal and at sympathectomy has been analyzed in 75 white male rats at the age of 1, 3 and 6 months by means of electron microscopical, morphometrical and radioimmunological methods. Partial sympathectomy has been performed using subcutaneous injection of guanethidine (15 mg/kg of body mass) during 14 days after birth. During the period from 1 up to 6 months of life in intact rats a decrease in C-cells functional activity is observed. Under conditions of sympathectomy in 30-day-old animals decreasing extrusion processes of the secretory material are observed. During successive periods of life (3 and 6 months) mechanisms of paracrinic evacuation of hormonal products enhance considerably, nuclear volume of the cells and number of C-cells in the field of vision increase. Their hyperplastic alterations in the sympathectomized thyroid gland are more pronounced in 3-month-old animals.

Adaptation, Physiological↗
PubMed1987

[Delayed development of hypertension and increased aortic relaxation in spontaneously hypertensive rats after neonatal sympathectomy].

The effect of neonatal sympathectomy on vasodilator responses to acetylcholine (ACh) and cAMP has been studied in aortic rings of spontaneously hypertensive rats (SHR) and normotensive animals. The relaxation of intact SHR aorta in response to ACh and cAMP was 20-35% lower than that of normotensive rats. Sympathectomy in normotensive rats did not affect the level of blood pressure and aorta reactivity to Ach. In SHR, sympathectomy caused a decrease in blood pressure, while relaxation in response to ACh and cAMP increased, as compared to intact SHR, but remained lower than in normotensive rats. The data obtained suggest that the decrease in arterial pressure of sympathectomized SHR is a result not only of the reduction in sympathetic effects but also of the increase in smooth muscle relaxation.

Acetylcholine↗
PubMedDate not supplied

Lumbar sympathectomy for severe lower limb ischaemia: results and analysis of factors influencing the outcome.

Sixty consecutive patients (66 legs) underwent surgical lumbar sympathectomy as the only therapy for severe lower limb ischaemia (pain at rest and/or frank gangrene) caused by arteriosclerosis in the period 1977 to 1982. After six months results were good, as defined by absence of pain at rest, healing of ischaemic lesions and no major amputation, in 48% of limbs and bad in all other limbs. Patients with rest pain only fared much better than those with gangrene: after six months a major amputation had to be performed in 14% and 45% respectively. The presence or absence of diabetes mellitus and palpable pulsations at knee level and the angiographic patterns were of no help in the prediction of the results of lumbar sympathectomy. Doppler ankle/arm indices did have predictive value, since in all limbs with Doppler indices lower than 0.30 a major amputation had to be performed. Lumbar sympathectomy still remains a useful procedure in the treatment of selected patients with severe lower limb ischaemia in which reconstructive surgery is not feasible. But it is only advocated in the presence of ankle/arm indices above 0.30 and in the absence of gangrenous lesions.

Ankle↗