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PubMed1988

Dorsal sympathectomy for hyperhidrosis--the posterior paravertebral approach.

Definitive therapy for hyperhidrosis is sympathectomy. The authors have used a posterior approach to perform 36 dorsal sympathectomies for upper extremity hyperhidrosis in 18 patients (12 female, 6 male). All 18 patients suffered from excessive sweating of the upper extremity (17 palmar, 1 axillary) that caused significant psychological and occupational problems. Eleven patients (61.1%) had lower extremity involvement as well. For all 18 patients conservative medical treatment had failed. Bilateral operations were performed, via a posterior extrapleural approach, through the bed of the third rib. All 36 limbs were relieved of excess sweating. There were no deaths and only two minor wound complications. In no patient did Horner's syndrome develop. Long-term follow-up did not reveal any recurrence of hyperhidrosis. Two patients did complain of compensatory hyperhidrosis of the lower extremities. Dorsal sympathectomy was effective in all of the patients with upper extremity hyperhidrosis in this series. The posterior approach is technically simple, allows simultaneous bilateral operations, and is associated with only infrequent minor complications.

Adolescent↗
PubMed1988

Lumbar sympathectomy in the management of rectal tenesmoid pain.

Lumbar sympathectomy was performed in twelve patients whose main or sole complaint was rectal tenesmus resulting from pelvic carcinoma, and in whom psychotropic drugs had failed to control their symptom. Following bilateral chemical lumbar sympathectomy, ten patients achieved complete relief and one patient achieved partial relief. No patient achieving relief had recurrence of their tenesmoid pain. Patients were followed up for between three days and seven months. No complications were noted except temporary hypotension in one patient. It is concluded that lumbar sympathectomy is a safe and effective treatment for rectal tenesmus and may be the treatment of choice if pharmacological methods have failed to control this symptom.

Adult↗
PubMed1987

[Structure of the neurons of the sympathetic ganglia in guanethidine chemical sympathectomy].

As demonstrated the investigation of cell composition of the cranial cervical, cervico-thoracic and the 3d thoracic ganglia of the sympathetic trunk in mature Wistar rats under guanethidine chemical sympathectomy, there are intraganglionic reconstructions and changes in the value of the subpopulations of neurocytes in the preserved cell population. Ratio of the neuronal subpopulations studied with various character of changes revealed adaptive-compensatory processes, developing in the course of sympathectomy at the level of population. The ways of realization of the populational and cellular levels of compensation are considered. The wavy character of sympathectomy is thought to reflect integral behavior of the nervous cells subpopulation in the course of development of homeostatic reactions.

Animals↗
PubMed1987

[Expediency of combined lumbar sympathectomy with reconstructive-restorative operations in arteriosclerotic lesion of the aorto-femoral segment].

An examination of patients after reconstructive operations on the aorto-femoral segment in combination with lumbar sympathectomy (173 patients) and without it (75 patients) has shown sympathetcomy to promote reduction of the amount of postoperative thromboses and amputations in the early postoperative period. In the remote period the frequency of reocclusions in patients subjected to sympathectomy was higher. The authors consider that sympathectomy is responsible for progress of atherosclerosis.

Adult↗
PubMed1985

[Study of the muscular perfusion of the lower limbs using thallium 201 scintigraphy before and after lumbar sympathectomy in 13 patients].

Scintigraphy with 201-Thallium is a useful method for exploring muscle circulation in lower limbs of patients with arteritis. Comparative values with time can be obtained by studying respective isotopic activity ratios of the thigh, calf and foot. Unilateral isolated lumbar sympathectomy was performed in 13 patients for arteriopathy of the lower limbs (7 claudications, 4 isolated trophic disorders, 1 thrash-foot and 1 juvenile arteriopathy). Investigations included clinical and arteriographic explorations and functional tests (Doppler, distal pressure, digital plethysmography and 201-Thallium muscle scintigraphy) before and after operation. Pathology of the sympathetic chain was determined in each case. Short-term (2 weeks) follow up examinations gave data showing absence of correlation between the operative procedure and scintigraphy results. Muscle perfusion was improved in only 3 cases: one presented paradoxical improvement contralateral to the sympathectomy, while no change from the pre-operative values was recorded in 9 patients. The findings raise questions concerning the reproducibility of the scintigraphic method, and also confirm the pathogenic hypothesis by which lumbar sympathectomy has only a limited effect on muscle circulation.

Arteriosclerosis↗
PubMed1985

[The indications for lumbar sympathectomy as a function of clinical findings and of the results of the angiographic test].

Indications for lumbar sympathectomy are presented as a function of the clinical findings and results of angiography, voluntarily ignoring data from non-invasive vascular function tests, in an attempt to answer two questions. Firstly, can the decision to perform lumbar sympathectomy depend on clinical findings only in 1983? Secondly, is angiography essential in all cases before sympathectomy? The positive response to both questions is based on a study of approximately 2,300 case reports.

Angiography↗
PubMed1979

The effect of sympathectomy on the urethral pressure profile in the experimental animal.

The effect of sympathectomy and various pharmacologic agents on the dog urethral pressure profile (UPP) was assessed. Succinylcholine was used to subtract the effect of the external urethral sphincter from the total UPP. In the presence of succinylcholine effect, sympathectomy caused a decrease in the UPP in 12 of 13 experiments. In addition, an attempt was made to elicit a denervation sensitivity response to phenylephrine after sympathectomy; none could be shown. Measurements were made of UPP's after administration of both succinylcholine and phenylephrine. Seven of the 13 dogs showed a significant decrease in UPP after succinylcholine administration. Nine of 12 dogs showed a marked increase in UPP after phenylephrine was given.

Animals↗
PubMedDate not supplied

Effect of lumbar sympathectomy on the muscles.

With the physiological data concerning microcirculation and sympathetic control, the author foresees the effects that one must obtain with lumbar sympathectomy. The improvements of cutaneous circulation are usually well known while those of muscular circulation are more debated. To prove it, the author has studied the muscular flow after sympathectomy using Xenon radioactive method and the non invasive electromagnetic flowmetry method. Despite the background of a short experience in this matter, the results seems to point out a beneficial effect of lumbar sympathectomy in muscular circulation at rest and exercise, in patients having obstructive arteriopathies of the lower extremities.

Adrenergic Fibers↗
PubMed1977

[Complications of lumbar sympathectomy. Retrospective study of 791 patients].

The purpose of this paper is to define the nature and the frequency of post-lumbar sympathectomy complications and to reappreciate their importance in the evaluation of operative indication. The non specific miscellaneous complications are no more frequent than after any other lombotomy. The specific complications occur in less than 10%; they are almost always transient. Prolonged paralytic ileus is related to post-operative hematoma in retroperitoneal space. Ejaculation disturbances are produced either by bilateral resection of one of the two first lumbar ganglian or by section of the intermesenteric plexus, the presacral nerves or the hypogastric nerves during associated dissection of the aortic bifurcaiton. Late neuralgia is probably induced by retroperitoneal hematoma; its size increases gradually during the postoperative period by transference of tissue fluids. In conclusion, the morbidity and the morbidity rates of lumbar sympathectomy are remarkably low; these are not arguments against the lumbar sympathectomy.

Adult↗
PubMed1984

Effects of chemical sympathectomy on insulin receptors and insulin action in isolated rat adipocytes.

Insulin receptors and effects of insulin on lipolysis, lipogenesis and glucose transport were investigated in fat cells obtained from rats chemically sympathectomized with 6-hydroxydopamine. Four days after a single injection of 6-hydroxydopamine (50 mg/kg), the norepinephrine content of the epididymal adipose tissue was reduced by 97.5%. The number of high-affinity insulin binding sites was increased moderately (16%). In parallel, the sensitivity to insulin of the isoprenaline-stimulated lipolysis was increased as judged from insulin concentrations yielding half-maximal inhibition which were lower (40%) in the treated group. Glucose metabolism, however, was inhibited by chemical sympathectomy: the glucose transport rate was significantly reduced and fatty acid synthesis was nearly totally abolished. Insulin was still effective in stimulating both parameters but failed to restore normal levels. The results suggest that the sympathetic innervation of adipose tissue may exert an inhibitory effect on the number of high-affinity insulin receptors as well as on the sensitivity of the lipolysis to insulin, as both parameters were increased by sympathectomy. To explain the inhibitory effect of 6-hydroxydopamine treatment on glucose transport and fatty acid synthesis, a possible trophic effect of the sympathetic innervation is discussed as well as indirect mechanism counteracting the effects of the chemical sympathectomy.

Adipose Tissue↗
PubMed1984

Current status of thoracic dorsal sympathectomy.

This article summarizes over 20 years of experience (1962 to 1982) with cervical sympathectomy (thoracic dorsal sympathectomy) in 46 patients undergoing 68 sympathectomies. All operations were performed through an anterior supraclavicular approach. Indications for surgery were intractable Raynaud's disease (26 patients), atherosclerotic obliterative arterial disease (five), causalgia (five), posttraumatic sympathetic dystrophy (seven), collagen vascular disorders (eight), hyperhidrosis (12), occupational-related digital thrombosis (four), and thrombosis secondary to intra-arterial injection (one). The incidence of complications and side effects, both temporary and permanent, including Horner's syndrome, is reviewed in detail. Particular reference is made to the various surgical techniques of managing the stellate ganglion; four patients had two-third to three-fourth resection of the stellate ganglion down to and including the T-3 thoracic ganglion, two had preservation of the stellate ganglion and resection of the T-2 through T-4 ganglia, seven had excision of the entire stellate ganglion down to and including the T-4 ganglion, seven had resection of the lower third of the stellate ganglion down to and including the T-4 ganglion, and 48 had removal of the lower half of the stellate ganglion down to and including the T-3 ganglion. The study reviews the literature germane to anatomic considerations and suggests revisions in current texts and atlases. By retrospective analysis of the records and a follow-up questionnaire, which provided an 86% follow-up (average 8.4 years), the paper points to the distinctive clinical characteristics of the different groups within the population undergoing the operation and provides guidelines for patient selection and conclusions on the place for this operation in the management of vascular diseases involving the upper extremity.

Adult↗
PubMed1981

[Functional and structural behavior of the cardiovascular system of normotonic and spontaneously hypertensive rats following chemical sympathectomy and angiotensin administration].

The non-cleared influences of the sympathetic nervous system [sN] on structural reactions of SHR and on the direct cardiac effects of AII and the structural vascular behavior were investigated. In 67 spontaneously hypertensive rats (Okamoto-Aoki) and 55 normotonic Wistar rats (NR) the blood pressure behaviour, the structural vascular and organ reactions and the noradrenaline (NA) content of the myocardium were examined with an intact sympathetic nervous system as well as after its almost complete elimination by chemical sympathectomy with 6-hydroxy-dopamine (6-OH-DA). Moreover, the functional and structural responsiveness of the arterial vessels of sympathectomized animals to angiotensin II administrations was investigated. 6-OH-DA in the dosage applied, induces during its time of action in NR a smaller, in SHR a larger decrease of blood pressure and, presumably induced by intense NA-depletion of the myocardium, myocardial alterations. Despite extensive AII-induced alterations of the already early hypertrophically-hyperplastically changed vascular wall, the structural and functional responsiveness of the arterial vascular system was maintained even after sympathectomy, and the sensitivity of the SHR to AII remained. For maintaining hypertension, the cooperation of structural and functional influences is necessary, as is indicated by the reduction of blood pressure in sympathectomized SHR and its regular return to the daily initial values of normotonic animals under additional AII administration. Besides the vascular alterations contributing to the exacerbation of the hypertension, here the sNS is of essential importance. For obtaining a total pressure effect of AII the sNS obviously has not necessarily to be intact, though its activity state can influence the responsiveness of the arterial vascular system to AII. The reduction of the sympathicotonus by sympathectomy seems to have a protective effect on the development of AII-induced structural vascular alterations; in contrast to the myocardium in SHR, in which it induces an exacerbation and an increase in the AII-induced myocardial alteration. These findings obtained from rats are supposed to be important also for the essential hypertension in man. By maintaining the functional responsiveness of the arterial vascular system, antihypertensives which react with the different parts of the sNS cab become effective while structural alterations of the vascular wall can be influenced, too. The possibility of the simultaneous development of myocardial alterations should be taken into special consideration.

Angiotensin II↗
PubMed1978

Major amputation following vascular reconstructive procedures (including sympathectomy).

To study the effects of vascular reconstruction or sympathectomy, or both, on the level of amputation, the number of revision procedures performed and the mortality following amputation, the authors reviewed the records of 504 patients from three Toronto teaching hospitals who had one or both limbs removed at or above the below-knee level. It appears that (a) previous vascular surgery or sympathectomy, or both, actually increases the number of patients in whom a below-knee amputation is successful, (b) the number of revision procedures necessary is increased after failed vascular surgery or sympathectomy, or both and (c) revision procedures following amputation do not affect the mortality from lower limb amputation.

Amputation, Surgical↗
PubMed1981

Effect of surgical lumbar sympathectomy on innervation of arterioles in the lower limb of patients with diabetes.

The innervation of lower limb epineurial arterioles, specimens of which were obtained from six patients in the sympathectomy and from six patients in the nonsympathectomy diabetic groups at amputation for ischemic peripheral vascular disease, was compared by quantitative ultrastructural methods. Results demonstrated no statistically significant difference in the number of vasomotor axons present, the average axon to smooth muscle cell distance or the axon distribution pattern in the adventitia between the two diabetic groups of patients. A previous investigation has established that innervation of these arterioles is significantly reduced in patients with diabetes having end-stage ischemia of the lower limb when compared with similar patients without diabetes. The present results demonstrate that surgical lumbar sympathectomy does not significantly further reduce the already severely diminished number of vasomotor nerves in some diabetic arterioles. This observation offers a possible explanation for the poorer success rate of those with diabetes compared with those without diabetes in avoiding amputation of the limb after lumbar sympathectomy.

Arteries↗
PubMed1980

Predicting the success of a sympathectomy: a prospective study using discriminant function and multiple regression analysis.

A prospective study of 72 limbs treated with phenol sympatholysis for inoperable peripheral arterial occlusive disease was carried out in order to determine which factor or combination of factors could most accurately be used to predict the success or the failure of the sympathetic interruption. Seven variables were recorded prior to phenol sympatholysis and the patients were followed up to 3 years in order to determine the degree of success or failure of the sympathectomy. The results of discriminant function analysis of these data showed that the most important variables in predicting the outcome were (1) the level of ankle systolic pressure, (2) the presence or absence of a neuropathy, and (3) the extent of the ischemic damage. The correct outcome was predicted in 87% of the cases. Using these three variables, multiple regression analysis was performed to construct a table showing the percentage chance of a successful outcome from a sympathectomy. The results show that a phenol sympathectomy is likely to be successful in the management of a patient with peripheral arterial occlusive disease if there is no evidence of a somatic (and hence autonomic) neuropathy, if the ankle systolic pressure is above 30 mm Hg, and if the tissue damage is not too extensive (i.e., only rest pain, night pain, or digital gangrene is present).

Arterial Occlusive Diseases↗
PubMed1995

Intravenous tenoxicam reduces dose and side effects of PCA morphine in patients after thoracic endoscopic sympathectomy.

BACKGROUND: Among surgical modalities for treatment of palmar hyperhidrosis, endoscopic sympathectomy is the most popular choice in recent years. After surgery, the major complaint was anterior chest pain. This study was conducted to evaluate the analgesic efficacy and side effects of tenoxicam (a thienothiazine derivative) in combination with patient-controlled analgesia (PCA) using morphine in patients who received thoracic endoscopic sympathectomy. METHODS: Forty-one ASA class I patients who underwent endoscopic sympathectomy (T2 and T3 ganglia) were randomly divided into two groups. Operation was conducted under general anesthesia with single lumen endotracheal intubation. No narcotic was given during the operation except for fentanyl (3 micrograms/kg) during induction. After surgery, patients in group I received PCA morphine only and patients in group II received PCA morphine plus tenoxicam (20 mg, i.v.) immediately for pain relief. In addition, rescue analgesia with intramuscular meperidine (1 mg/kg) was available to each patient every 4 h prn. The intensity of pain was assessed with VAS pain score every 4 h for 24 h. The frequency of demand and doses of delivered PCA morphine were recorded. RESULTS: Results showed no statistically significant difference between groups in respect of age, body height, body weight and pain scores. However, based upon similar qualitative pain relief, patients in group II revealed less demand for analgesic, less doses of morphine requirement and less side effects. CONCLUSIONS: Tenoxicam may be an effective adjuvant to PCA morphine for postoperative pain control. This combination reduces the total consumption of PCA morphine with less side effects.

Adult↗
PubMed1976

[Objective results of lumbar sympathectomy. Statistical study, based on vascular function tests].

A series of 100 unselected patients who had undergone low lumbar sympathectomy were studied using vascular function tests (digital plethysmography, hyperaemia test, rheography, measurement of segmental pressures and dynamic tests, walking tolerance on a conveyor belt, Strandness test). Statistical study of the results obtained showed that, above all, isolated lesions of atherosclerotic origin gave excellent results. Increase in walking tolerance and circulatory flow (rheographic quotient) were the only statistically valid parameters. Prediction of the effects of lumbar sympathectomy by Hillestad's hyperaemia test was confirmed. There were many failures amongst the other cases (diffuse lesions, leg artery involvement, diabetic type lesions). Lumbar sympathectomy is hence justified only in the presence of femoral lesions and in association with reconstructive aorto-iliac surgery in all cases when the distal bed consists of the deep femoral only.

Aged↗
PubMed1995

Retroperitoneal endoscopic lumbar sympathectomy: laboratory and clinical experience.

Retroperitoneal endoscopic lumbar sympathectomy was performed in four pigs in the prone or lateral position to study the feasibility of these new approaches. Positioning, port placement and the dissection technique are described in detail. In nine patients retroperitoneal endoscopic lumbar sympathectomy, using the lateral position technique, was performed. The importance of port placement and dissection techniques for visualisation of the sympathetic chain are emphasised. The endoscopic retroperitoneal approach enables the sympathetic chain to be accurately localised whilst enhanced endoscopic vision aids dissection. Retroperitoneal endoscopic lumbar sympathectomy is a feasible technique offering patients the benefits of the minimally invasive approach.

Animals↗