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PubMed1997

[Lumbar sympathectomy by retroperitoneal endoscopy: feasibility study].

Endoscopic surgery has been used as a new procedure to simplify different surgical processes. The goal of this study was to evaluate the benefits of endoscopic retroperitoneal surgery for lumbar sympathectomies. Between February 93 and November 95 we performed 35 lumbar sympathectomies using this technique. All patients were arteritic. The results were as follows: for 25% of the patients, conversion classical open technique was required; 6% complications (septic); 3% of the patients died. In comparing the various techniques of sympathectomy and sympatholysis, it would appear that the endoscopic technique produces fewer complications. However we believe that a learning period is necessary before this technique can be fully mastered.

Adult↗
PubMed1997

Predicting changes in the distribution of sweating following thoracoscopic sympathectomy.

BACKGROUND: Compensatory sweating is a common symptom following thoracic sympathectomy; however, the reported incidence of this complication varies greatly, and its severity has not been quantified. METHODS: In this study changes in the distribution of sweating following bilateral T2-3 thoracoscopic sympathectomy for hyperhidrosis were assessed in 42 patients. Sweat production in the palms, axillae, face, trunk and feet was assessed using a linear analogue scale. RESULTS: The operation was most successful in reducing sweat production in the palms, axillae and face (in descending order). The operation also reduced pedal sweat production in 12 of the 29 patients who suffered concomitant pedal hyperhidrosis. Compensatory truncal sweating occurred in 36 of the 42 patients; it was severe in ten, moderate in 16 and minimal in ten. CONCLUSION: Patients should be warned about compensatory sweating before thoracic sympathectomy.

Adult↗
PubMed1998

Retroperitoneal endoscopic lumbar sympathectomy with balloon dissection: experience with a cadaveric model.

The objective of this study was to determine the feasibility of retroperitoneal endoscopic lumbar sympathectomy with balloon dissection technique using a cadaveric model. Retroperitoneal endoscopic lumbar sympathectomy was performed on 10 cadavers. The procedure was combined with balloon dissection to provide easier visualization and more working space. The outcome was successful in eight cadavers. Average operating time was 40 min, and visualization was good. The only major technical problems were perforation of the peritoneum and air leak into the abdomen. It was concluded that retroperitoneal endoscopic lumbar sympathectomy with balloon dissection has the advantages of minimal invasiveness, clear visualization, and controlled blunt dissection. The use of a cadaveric model may improve the clinical learning curve.

Cadaver↗
PubMedDate not supplied

Thoracoscopic sympathectomy for vasospastic diseases.

BACKGROUND: Vasospastic disorders (acrocyanosis, Raynaud's syndrome, causalgia) can arise from different etiologic factors, but the pathogenesis is always represented by an altered mechanism of vasal motility. Upper dorsal sympathectomy has been demonstrated to be an effective treatment for these disorders by decreasing peripheral resistances. Surgical technique has shown long-lasting results, and it can now be performed by endoscopic approach. METHODS: Our experience with six cases of sympathectomy is illustrated. The indications, thoracoscopic technique, complications and long-term results are evaluated. Four women with Raynaud's syndrome and two men with causalgia were treated in this series. After an accurate preoperative evaluation, the second, third, fourth and fifth thoracic ganglia of the sympathetic chain were identified and excised. RESULTS: All patients experienced relief of symptoms with very limited pain and discomfort. They did not require further medical therapy and are relapse-free at follow-up. CONCLUSIONS: We conclude that thoracoscopic sympathectomy can be considered an effective, safe and simple treatment for selected cases of vasospastic phenomenon.

Adult↗
PubMed1996

Technical considerations in endoscopic cervicothoracic sympathectomy.

OBJECTIVE: To evaluate the technique and results of videoendoscopic cervicothoracic sympathectomy in patients who have reflex sympathetic dystrophy or hyperhidrosis of the upper extremity. DESIGN: Clinical case series. The cohort underwent diagnostic evaluation and surgical intervention, and had a mean postoperative follow-up of 14 months. SETTING: An urban, university-affiliated tertiary referral medical center. PATIENTS: A consecutive, referred sample. Seven of the nine patients had reflex sympathetic dystrophy and two had bilateral upper extremity hyperhidrosis. Five were women and four were men, with a mean age of 44 years. INTERVENTIONS: Ten thoracoscopic sympathectomies, encompassing the lower third of the stellate ganglion to the fourth thoracic ganglion, in nine patients. The technique is performed under general anesthesia, using three 1-cm incisions for instrument placement. Patients had bilateral hand temperature probes intraoperatively. Six of the procedures were in the left hemithorax, four in the right. MAIN OUTCOME MEASURES: Relief of the symptoms for which the patient was referred. Perfection and alteration of the technique also were measured. RESULTS: The average operating time was 91 minutes. The average length of hospital stay was 3.5 days. The mean increase in skin temperature was 2.4 degrees C. Nine of 10 patients had partial or complete relief of symptoms. One patient with severe dystrophic reflex sympathetic dystrophy has persistent symptoms. One patient had a pneumothorax for 48 hours. Horner's syndrome did not develop in any patient. CONCLUSION: Endoscopic cervicothoracic sympathectomy is an effective, minimally invasive therapy for upper extremity reflex sympathetic dystrophy and hyperhidrosis.

Adult↗
PubMed1975

Phenol sympathectomy in the treatment of intermittent claudication: a controlled clinical trail.

Twenty-five patients with intermittent claudication were randomly allocated to treatment either by injection of phenol into the lumbar sympathetic chain or by injection of local anaesthetic subcutaneously. On the day after the injection, sympathectomy, assessed by skin temperature change, was achieved in 85 per cent of the phenol group. At 1 month subjective improvement was claimed by 45 per cent of the patients in the sympathectomized group and by 64 per cent in the control group; at 3 months the figures were 25 and 45 per cent respectively. Treadmill testing at two exercise loads showed no significant difference in claudication distance or stopping time between the two groups. Calf blood pressure response following exercise was not affected by sympathectomy. There is no subjective or objective evidence that phenol sympathectomy improves intermittent claudication.

Blood Pressure↗
PubMed1992

Laser endoscopic sympathectomy for palmar hyperhidrosis.

Hyperhidrosis palmaris is a common disorder among the Orientals. Despite numerous therapeutic modalities in practice, none has proved entirely satisfactory. With the introduction of video-endoscopic surgery, we combined this system with a fiber optic Nd-YAG laser unit, electrocautery, and a laser Doppler flowmeter to design a new and promising therapeutic technique for palmar hyperhidrosis. General anesthesia with alternating one-lung ventilation is essential for a safe and smooth endoscopic sympathectomy. An operating endoscope was introduced into thoracic cavity via the second intercostal space and then attached to a CCD camera video system, which provided clear visibility of the sympathetic trunk in most cases. The proper level of the sympathetic trunk was further confirmed with the aid of vasomotor response of the palmar skin resulting from electric stimulation on the related sympathetic trunk. Finally, the confirmed target was precisely vaporized with a low power Nd-YAG laser through an endoscope. Twenty patients underwent bilateral sympathectomy, mostly on T2 and its adjacent trunk. This technique did not cause any injury to the lung or bleeding. No Horner's syndrome was produced. It provided a precise ganglionectomy on a confirmed target under clear magnified vision. Consequently, a definite and long-lasting therapeutic effect seemed warranted. It was considered to be a relative minor and safe procedure causing minimal discomfort and an almost invisible scar without producing serious complications. It also shortened the operation time and hospital stay remarkably in comparison with other open sympathectomy procedures.

Adolescent↗
PubMed1984

Ovarian sympathectomy in the guinea pig. I. Effects on follicular development during the estrous cycle.

The influence of ovarian adrenergic nerves on follicular growth during the estrous cycle in the adult guinea pig was ascertained by comparing follicular development in control and chemically sympathectomized ovaries from the same animal. Selective ovarian sympathectomy was achieved by injecting 6-hydroxydopamine into a surgically closed periovarian membranous sac (bursa) on day 2 of the cycle (day 1 = day of estrus). The contralateral surgically closed ovarian bursa was injected with solvent used for 6-hydroxydopamine. Animals were laparotomized on days 5, 10 and 14 of the cycle. Blood from the utero-ovarian vein was collected bilaterally for measurement of progesterone and androstenedione. The ovaries were processed for histologic examination, and the number of follicles in each ovary was analyzed morphometrically. Sympathectomy on day 2 caused a decrease in healthy preovulatory follicles (greater than 700 micron diameter) on day 10 of the cycle. There were no differences in ovarian weights or the total number of follicles per ovary at this time. On days 5 and 14 of the cycle, there were no differences in ovarian weights, total number of follicles per ovary or follicles in any size classification. Sympathectomy did not alter progesterone levels in the utero- ovarian vein as compared to contralateral control levels. From control ovaries, there was a significant increase in progesterone in the blood of the utero-ovarian vein on day 10 but venous levels of progesterone from sympathectomized ovaries were not significantly different at any day of the cycle. In the venous effluent from sympathectomized ovaries, androstenedione was elevated at day 5 compared to days 10 and 14.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic Fibers↗
PubMed1981

Autoradiographic assessment of 3H-proline uptake by osteoblasts following guanethidine-induced sympathectomy in the rat.

Sympathectomy was carried out in rats by injections of guanethidine-sulfate from birth to 14 days of age. At 45 days of age, the activity of osteoblastic cells was monitored by 3H-proline autoradiography. Effectiveness of sympathectomy was verified by light-microscopic examination of superior cervical and celiac ganglia. Grain counts over periosteal osteoblasts of the femoral diaphysis and osteoblasts mesial to the first molar in the mandible demonstrated a significant reduced uptake of 3H-proline in the sympathectomized rats. The data provide direct evidence of sympathetic influence on osteoblastic activity and suggest that sympathectomy may result in the loss of a trophic influence which is important in the regulation of osteogenesis.

Animals↗
PubMed1980

Pattern of crypt cell proliferation in the pre- and post-closure ileum of the neonatal rat: effects of sympathectomy.

The present experiments were designed to investigate ileal crypt cell division before and after neonatal closure to macromolecular absorption by measurements of mitotic index, labelling index, colchicine-induced estimation of mitotic rate (mitoses/cell/hour) and crypt depth and villus height on postnatal days 15--23. In addition, the effects of the sympathetic nervous system on crypt cell proliferation were analyzed by guanethidine-induced sympathectomy. Guanethidine treatment resulted in at least a 70% reduction in superior cervical and coeliac perikarya at 15 days after birth. All cell proliferative indices demonstrated a rather constant rate of cell division in the ileal epithelium between 15 and 17 days after birth with a sudden burst of mitotic activity on day 18. The mitotic rate of control rats increased from day 18 to 23 with 3-week-old rat demonstrating a faster rate of ileal crypt cell proliferation than adult rats. The ileal crypt depth more than doubled between 15 and 23 days while the height of the villus column increased slowly but steadily (36%) during the period of this study. Cell division is inhibited by guanethidine-induced sympathectomy although there is still an acceleration of mitosis in the post-closure period. The relationship of sympathectomy and ileal crypt cell proliferation is discussed and compared to hormonal effects on closure and related developmental events.

Animals↗
PubMed1976

Ultrastructrual effects of chemical sympathectomy on brown adipose tissue.

Adult rats maintained at 20-22 degrees C, were exposed to 4 degrees C for 30-60 min and injected with 50 or 100 mg/kg 6-hydroxydopamine (6-OHDA) in an attempt to achieve a similar degree of chemical sympathectomy of nerves terminating among the adipocytes and the smooth muscle cells of the blood vessels in the interscapular brown adipose tissue (BAT). After 1, 4 or 10 days the pads of BAT were removed and small sections from each pad prepared for electron microscopy; the remaining tissue was used for noradrenaline (NA) analysis for fluorescence histochemistry. Ultrastructural observations showed that 24 h after the 6-OHDA injection virtually all noradrenergic nerve terminals were distorted and contained aggregates of degenerated cell organelles. The destruction could be correlated with a disappearance of fluorescent varicosities and a reduction of measurable NA to 8-12% of the control value. There was no differential toxic effect of 6-OHDA on the terminals among the adipocytes compared to those associated with blood vessels. Thus, treatment with 6-OHDA is more effective than previous attempts using immunological or surgical methods to produce sympathectomy, because both of the latter methods only eliminate the innervation of the blood vessels and spare the nerve terminals of the adipocytes. 4 days after 6-OHDA injection there was no improvement in the morphology of the terminals but after 10 days there was an increase in the number of terminals and axons with a normal appearance and this was paralleled by an increase in extractable NA to 50% of the control value. Because of the relatively rapid recovery of NA content and reappearance of terminals of normal appearance within 10 days after 6-OHDA injection, these animals should be injected weekly when a more permanent sympathectomy of adipocytes and blood vessels is desired.

Adipose Tissue, Brown↗
PubMed1994

Joint inflammation is reduced by dorsal rhizotomy and not by sympathectomy or spinal cord transection.

OBJECTIVES: To investigate the role of primary afferents, sympathetic postganglionic efferents and descending systems on the central control of peripheral inflammation. METHODS: Acute inflammation was induced by intra-articular injection of kaolin and carrageenan into the knee joint cavity of the rat. Before the induction of the arthritis, a unilateral dorsal rhizotomy, a chemical (phentolamine) and/or surgical sympathectomy, or a spinal transection was performed. Joint inflammation (joint circumference and thermographic readings) and behavioural signs were assessed. RESULTS: Only arthritic animals with a dorsal rhizotomy showed a significant reduction of the inflammatory response compared with control arthritic animals. No significant differences in the inflammatory response occurred following sympathectomy or spinal transection. The animals who received sympathectomy showed similar behavioural manifestations to the arthritic animals. CONCLUSIONS: The central terminals of primary afferents are important in the development of acute joint inflammation since dorsal rhizotomy attenuated the inflammatory response in the knee joint. The sympathetic nervous system is not involved in the acute inflammatory phase of this arthritis model. The central processes controlling acute inflammation involve a local spinal circuit since spinal cord transection at T9 has no effect on the inflammation.

Acute Disease↗
PubMed1977

Increased circulating plasma catecholamines and plasma renin activity in dogs after chemical sympathectomy with 6-hydroxydopamine.

Circulating plasma catecholamines, plasma renin activity, and other variables were measured in unanesthetized dogs before and after chemical sympathectomy with 6-hydroxydopamine (6-OHDA, 50 mg/kg). Chemical sympathectomy resulted in an immediate fall in mean arterial blood pressure and a delayed reduction in heart rate. Significant increases in plasma glucose and lactate concentrations, circulating plasma catecholamines, and plasma renin activity were found 24 h after 6-OHDA treatment. Circulating catecholamine levels decreased rapidly as time elapsed after sympathectomy and were half the initial values after 2 weeks. Plasma renin activity remained elevated during the 1st week after 6-OHDA treatment and returned to control levels during the 2nd week. Significant correlations were found between circulating catecholamines and heart rate mean arterial pressure, and plasma glucose and lactate concentrations. A significant correlation was also found between plasma renin activity and the mean arterial blood pressure. These results confirm that the adrenal medulla increases its catecholamine secretion rate into the circulation to compensate for the loss of adrenergic innervation after 6-OHDA treatment. They also indicate that the renin-angiotensin system represents another important compensatory mechanism for circulatory homeostasis in sympathectomized animals.

Animals↗
PubMed1978

Differential impairment of thermogenesis in the pigeon after chemical sympathectomy.

A dose-controlled chemical sympathectomy with 6-hydroxydopamine (6-OHDA) did not disrupt thermostasis in the pigeon at +38 degrees C. At +6 degrees C, thermogenesis was impaired, but the lower body temperature and oxygen consumption were stable and vasoconstriction was normal. The stability may partly be explained by a massive release of adrenaline from the adrenals (50% in 20 min). Despite a deficit in heat production both after sympathectomy and after acute 6-OHDA, no change in muscle electrical activity was observed. Plasma free fatty acid (FFA) concentration was significantly elevated after sympathectomy, but no changes occurred in blood glucose or plasma lactate levels. The results indicate a major compensatory role for the adrenals in avian thermogenesis. They also suggest a sympathetically mediated auxiliary thermogenic mechanism independent of muscle electrical activity and coupled to FFA metabolism.

Adrenal Glands↗
PubMed1980

Reduced coronary collateral resistances after chronic ventricular sympathectomy.

Previous work has suggested that chronic ventricular sympathectomy causes a reduction in coronary collateral resistances. In the present experiments an isolated dog heart procedure was used to directly measure directional collateral resistances in 12 acutely denervated controls and 8 hearts that had undergone ventricular sympathectomy 2 wk earlier. In the procedure, the major coronary arteries were perfused separately but simultaneously during maximum vasodilation, and collateral resistances supplying the vascular beds of the arteries were determined by the double retrograde flow method. In the sympathectomized hearts, all collateral resistances were 47--65% less than in the controls (P less than 0.05). Also, in all hearts, minimum antegrade coronary resistances were determined from pressure-flow relationships in the major coronary arteries. Minimum coronary resistances in the 2 groups were not significantly different (P greater than 0.05). These results indicate that 2 wk of ventricular sympathectomy indeed causes a reduction in coronary collateral resistances, but has no effect on coronary resistances.

Animals↗
PubMed1980

Evaluation of long-term chemical sympathectomy in adult rabbits.

Administration of 6-hydroxydopamine (6-OHDA) will produce long-term sympathectomy in newborn animals. This investigation was designed to determine whether or not a long-term sympathectomy can be achieved by repeated administration of 6-OHDA in adult rabbits. Chronic treatment with 6-OHDA lowered blood pressure on average of 9 mmHg; the carotid sinus reflex was depressed, in contrast to the pressure response to intravenously administered epinephrine, which was doubled. In a constant-flow hindlimb preparation, the response to norepinephrine (NE) in 6-OHDA-treated rats was 50% larger and lasted 3 times longer. NE uptake in vitro, which is proportional to the number of adrenergic nerve endings, was found to be diminished by 80-85% in aortas from 6-OHDA-treated animals, and the dose-response curve for NE was slightly shifted to the left. The number of ganglionic cells in the superior cervical ganglia in treated animals was decreased by 80%. In conclusion, results from 6-OHDA-treated adult animals were entirely consistent with the effects of long-term sympathectomy.

Animals↗
PubMed1981

Cardiac catecholamine stores after cardiac sympathectomy, 6-OHDA, and cardiac denervation.

Sympathetic nerves are known to reach the heart via classical vagal pathways. Bilateral cervicothoracic sympathectomy (CS) might be expected therefore to leave significant amounts of releasable catecholamines in the myocardium if the vagi are left intact. Cardiac responses to tyramine (500 micrograms intracoronary) were compared in animals with CS, extrinsic cardiac denervation (CD), and chemical sympathectomy with 6-hydroxydopamine (6-OHDA). Dogs were placed on cardiopulmonary bypass and isovolumic pressures were recorded from the heart. In control animals, tyramine caused profound increases in rate (58%) and isovolumic pressures (86-170%). Ten CS animals demonstrated responses indistinguishable from control animals. Four CD and four 6-OHDA animals showed no response to tyramine. Cervical vagal stimulation after atropine in the CS animals produced tachycardia. Histofluorescent studies demonstrated the presence of significant numbers of cardiac adrenergic fibers in this group. The normal tyramine responsiveness of the CS animals was attributed to 1) significant numbers of vagal adrenergic fibers remaining in the heart after cervicothoracic sympathectomy, and 2) denervation supersensitivity, rendering the heart very responsive to the catecholamine that remains.

Animals↗
PubMed1979

Pulmonary hypoxic vasoconstriction: not affected by chemical sympathectomy.

The influence of chemical sympathectomy with 6-hydroxydopamine (6-OHDA) on regional alveolar hypoxic vasconstriction and on global hypoxic pulmonary vasoconstriction was investigated. In eight dogs a double-lumened endotracheal tube allowed ventilation of one lung with nitrogen as an alveolar hypoxic challenge while ventilation of the other lung with 100% O2 maintained adequate systemic oxygenation. Distribution of perfusion to the two lungs was determined with 133Xe and external counters. Mean perfusion to the test lung was 50.9 +/- 4.9% of total lung perfusion on room air and decreased by 32.4% (P smaller than 0.01) during alveolar hypoxia. Following 6-OHDA the test lung continued to reduce perfusion during alveolar hypoxia by 27.3%. In five dogs global hypoxia induced a 106% increase in pulmonary vascular resistance (PVR) prior to 6-OHDA and a 90% increase in PVR after 6-OHDA. After 6-OHDA no rise in PRV or systemic blood pressure occurred in response to tyramine, confirming effective sympathectomy by the 6-OHDA. Thus, sympathectomy with 6-OHDA failed to substantially block regional alveolar hypoxic vasoconstriction or global hypoxic pulmonary vasconstriction.

Animals↗