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PubMedDate not supplied

Effect of chemical sympathectomy on muscle blood flow.

Lumbar chemical sympathectomy using 5% phenol in glycerin alleviated intermittent claudication and improved cutaneous blood flow. This technic permits instituting physiotherapy and exercises to improve collateral circulation. The procedure was performed 56 times on 29 cases. No significant complication was observed. Muscle blood flow (MBF) was measured by 133Xe clearance, at rest and following exercise. Total blood flow (TBF) of the leg was measured by the impedance method, and increased cutaneous blood flow was confirmed by thermogram and photoplethysmogram. TBF increased significantly following exercise after sympathectomy. The ratio of MBF at rest and after exercise increased significantly in m. gastrocnemius, a white muscle, but was not significant in m. anterior tibialis, a red muscle. Chemical lumbar sympathectomy also produces preganglionic neurolysis to suppress vascular hypersensitivity after surgical ganglionectomy.

Adult↗
PubMed1979

Studies on the origin of altered thyroid hormone levels in the blood of rats during cold exposure. II. Effect of propranolol and chemical sympathectomy.

The effect of sympathetic activity on T4 and T3 levels in cold-exposed rats was investigated. Administration of the highest dose of propranolol (2 mg/100 g b.w.) twice daily during 4 days decreased T4 and T3 concentrations in plasma of rats living at 23 degrees C (T4 from 46.4 +/- 2.6 to 25.8 +/- 5.3 nmol/l and T3 from 1.08 +/- 0.6 to 0.82 +/- 0.12 nmol/l). No significant effect on T4 and T3 levels (49.0 +/- 11.6 and 1.48 +/- 0.16 n/mol, respectively) after the administration of the same dose regimen of propranolol was observed in rats exposed to cold for 4 weeks. T4 and T3 levels in rats exposed to cold for 4 weeks were not significantly altered 1 week after sympathectomy, while remaining in the cold. However, chemical sympathectomy before cold exposure delayed the cold induced T3 elevation occurring during the first week of cold exposure (controls: from 1.16 +/- 0.19 to 1.44 +/- 0.29 nmol/l; sympathectomized rats: from 1.07 +/- 0.12 to 1.17 +/- 0.22 nmol/l). After 2 weeks of cold exposure the T3 levels of controls and sympathectomized rats were not significantly different (controls: 1.45 +/- 0.12 nmol/l, sympathectomized rats: 1.38 +/- 0.15 nmol/l). No effect of sympathectomy was observed on T4 levels. These experiments show that the role of sympathetic activity in increasing T3 is not clear during cold exposure. They provide some evidence that sympathetic activity may play a role in the initiation of the process leading to increased T3 plasma levels during cold exposure.

Adaptation, Physiological↗
PubMed2006

Effects of cervical sympathectomy on vasospasm induced by meningeal haemorrhage in rabbits.

This study investigates the role of cervical sympathectomy in the prevention of acute vasospasm induced by meningeal haemorrhage in rabbits. Sixteen adult English Norfolk rabbits were divided into 2 experimental groups: bilateral cervical sympathectomy of the superior sympathetic ganglion (SSSG, n=8), and bilateral SSSG and sympathectomy of the inferior sympathetic ganglion (SISG, n=8). Other 24 animals were used as controls. Basilar artery diameter was evaluated by angiography. SSSG protected the animals against developing cerebral vasospasm; SSSG associated with SISG did not increase this effect.

Acute Disease↗
PubMed1998

Thoracoscopic sympathectomy: techniques and outcomes.

Thoracic sympathectomy is an important option in the treatment of palmar hyperhidrosis and pain disorders. Earlier surgical procedures were highly invasive with known morbidity, acceptable outcome, and established recurrence rates that were the limitations to considering surgical treatment. Thoracoscopic sympathectomy is a minimally invasive procedure that allows detailed visualization of the sympathetic ganglia and minimal postoperative morbidity; however, outcome studies of this technique have been limited. The authors treated 39 patients with 60 thoracoscopic procedures, and the outcomes in this small series were equivalent to previously established open surgical techniques; however, operative moribidity rates, hospital stay, and time of return to normal activity were substantially reduced. Complications and recurrence of symptoms were also comparable to previous reports. Overall patient satisfaction and willingness to repeat the operative procedure ranged from 66 to 96% in all patients. Patients and physicians can consider minimally invasive thoracoscopic sympathectomy procedures as an option to treat sympathetically mediated disorders because of the procedure's reduced morbidity and at least equivalent outcome rates in comparison to other treatments.

Journal Article↗
PubMed2000

Presynaptic muscarinic facilitation of parasympathetic neurotransmission after sympathectomy in the rat choroid.

The effect of sympathectomy on parasympathetic regulation of ocular perfusion was investigated. Uveal blood flow through the vortex veins was measured by laser Doppler flowmetry during electrical stimulation of the superior salivatory nucleus, which activates ocular parasympathetic nerves, in adult rats with intact innervation and 2 days or 6 weeks after excision of the ipsilateral superior cervical ganglion. In all groups, parasympathetic stimulation produced comparable increases in flux, which were abolished by the selective neuronal nitric-oxide synthetase inhibitor, 1-(2-trifluoromethylphenyl) imidazole. Atropine had no effect in control and acutely sympathectomized rats but abolished the flux increase in four of six chronically sympathectomized animals, and 1-(2-trifluoromethylphenyl) imidazole eliminated the residual response. The muscarinic receptor agonist bethanechol did not affect basal flow in control or sympathectomized rats. However, bethanechol enhanced parasympathetically mediated vasodilation, but only in rats studied at 6 weeks after sympathectomy, a finding consistent with the appearance of muscarinic prejunctional facilitation of nitrergic transmission. In chronically sympathectomized rats, the M(2) and M(4) receptor antagonists methoctramine and tropicamide did not affect choroidal flow during parasympathetic activation. However, pirenzepine increased flux, implying the presence of M(1) inhibitory autoreceptors on these nerves. Parasympathetically mediated increased flux was partially blocked by the M(3) antagonist 4-diphenylacetoxy-N-methylpiperdine, and the remaining vasodilation was blocked by atropine. We conclude that parasympathetic prejunctional facilitatory M(3) and probably M(5) receptors adopt a crucial role after chronic sympathectomy in maintaining nitrergic vasodilatory ocular neurotransmission in the face of down-regulated nitric oxide transmitter mechanisms.

Animals↗
PubMed1999

Thoracoscopic sympathectomy: indications and complications.

In 1942,Hughes performed the first thoracoscopic removal of sympathetic ganglia. Two years later Goetz and Marr reported on cases that had undergone thoracoscopic sympathectomy. In the 1950s, Kux performed more than 1,400 thoracoscopic sympathectomies and vagotomies. Interest in thoracoscopic sympathectomy increased in the 1980s and now it is the treatment of choice for severe axillary and palmar hyperhidrosis.

Journal Article↗
PubMed1992

Thoracoscopic transthoracic dorsal sympathectomy.

The authors report on the three patients who underwent thoracoscopic transthoracic dorsal sympathectomies by the techniques of minimal-access surgery learned from laparoscopic cholecystectomy. All three had histologic confirmation of removal of the sympathetic chain and have had an encouraging early postoperative result. The authors believe that thoracoscopic transthoracic dorsal sympathectomy can be accurately and safely performed and will become the method of choice for dorsal sympathectomy.

Adult↗
PubMed1978

Phenol sympathectomy for vascular occlusive disease.

Surgical lumbar sympathectomy is often performed as a last resort in treating peripheral vascular occlusive disease. However, the variable success rate and the morbidity of this procedure prompted us to examine phenol sympathectomy and to elucidate the factors which can be used to predict success with the procedure. During the past three years, 127 phenol sympathectomies have been performed for peripheral vascular disease using a standard technique. The technique has proved simple and harmless. The results of a prospective study of 52 patients indicate that it is possible to predict the chance of success after this procedure by using a combination of clinical criteria and systolic pressure measurements at the ankle. A good response is anticipated in patients with rest pain or night pain if the systolic pressure at the ankle is greater than 35 millimeters of mercury. Patients with gangrene of the digits responded if the pressure at the ankle was greater than 60 millimeters of mercury.

Arterial Occlusive Diseases↗
PubMed1995

Anti-dopamine beta-hydroxylase immunotoxin-induced sympathectomy in adult rats.

Anti-dopamine beta-hydroxylase immunotoxin (DHIT) is an antibody-targeted noradrenergic lesioning tool comprised of a monoclonal antibody against the noradrenergic enzyme, dopamine beta-hydroxylase, conjugated to saporin, a ribosome-inactivating protein. Noradrenergic-neuron specificity and completeness and functionality of sympathectomy were assessed. Adult, male Sprague-Dawley rats were given 28.5, 85.7, 142 or 285 micrograms/kg DHIT i.v. Three days after injection, a 6% to 73% decrease in the neurons was found in the superior cervical ganglia of the animals. No loss of sensory, nodose and dorsal root ganglia, neurons was observed at the highest dose of DHIT. In contrast, the immunotoxin, 192-saporin (142 micrograms/kg), lesioned all three ganglia. To assess the sympathectomy, 2 wk after treatment (285 micrograms/kg), rats were anesthetized with urethane (1 g/kg) and cannulated in the femoral artery and vein. DHIT-treated animals' basal systolic blood pressure and heart rate were significantly lower than controls. Basal plasma norepinephrine levels were 41% lower in DHIT-treated animals than controls. Tyramine-stimulated release of norepinephrine in DHIT-treated rats was 27% of controls. Plasma epinephrine levels of DHIT animals were not reduced. DHIT-treated animals exhibited a 2-fold hypersensitivity to the alpha-adrenergic agonist phenylephrine. We conclude that DHIT selectively delivered saporin to noradrenergic neurons resulting in destruction of these neurons. Anti-dopamine beta-hydroxylase immunotoxin administration produces a rapid, irreversible sympathectomy.

Adrenergic Agents↗
PubMed1994

Video-assisted thoracoscopic T2 sympathectomy for hyperhidrosis palmaris.

BACKGROUND: Hyperhidrosis palmaris is a functionally and socially disabling problem. Thoracic sympathectomy of the T2 ganglion has proved to be the time-honored treatment modality. STUDY DESIGN: The results of this study demonstrate the effectiveness of video-assisted thoracoscope for treatment of hyperhidrosis palmaris. The possibility to apply different anesthetic techniques and to measure surface temperature change of the hand were documented as well. RESULTS: Eighty consecutive cases (159 procedures) of essential hyperhidrosis palmaris were treated by video-assisted thoracoscopic T2 sympathectomy between January 1991 and December 1992. The surgical results were classified as excellent (much improved, very dry) in 88.1 percent, good (improved, minimal wet) in 9.4 percent, and fair (slightly improved, still wet) in 2.5 percent of the patients. The postoperative complications included one prolonged air leakage, one hemothorax, two wound infections, and 15 cases of facial anhidrosis. There were no recurrent cases (mean follow-up, 14.5 months). Fifty-six patients had concomitant hyperhidrosis pedum. Interestingly enough, through unknown mechanism, 64.3 percent of the patients with concomitant hyperhidrosis pedum were cured after this procedure. CONCLUSIONS: Video-assisted thoracoscopy provides magnified surgical fields, which make thoracoscopic sympathectomy for hyperhidrosis palmaris an effective, safe, easy to use, and time-saving procedure. This technique is also excellent for teaching purposes and allows the assistant to participate in the operation.

Adolescent↗
PubMed1976

Functional evaluation of 6-hydroxydopamine-induced sympathectomy in the liver of the cat.

Intraportal injection of 6-hydroxydopamine (25 mg/kg) results in nearly complete functional sympathectomy in the cat liver 1 week after the injection. Functional sympathectomy was verified by comparing the changes in liver blood volume (measured in vivo in a plethysmograph) resulting from direct stimulation of the hepatic nerves in control and pretreated animals. Pretreatment prevented the large reductions in hepatic blood volume normally seen with nerve stimulation while the response to infused noradrenaline was not reduced. Lack of morphological changes in right atrial nerve endings and an unaltered pressor response to bilateral carotid arterial occlusion indicate that sympathectomy at sites other than the liver did not occur.

Animals↗
PubMed1988

Organization of the guinea-pig uterine innervation. Distribution of immunoreactivities for different neuronal markers. Effects of chemical- and pregnancy-induced sympathectomy.

The structural organization of the guinea-pig uterine innervation was investigated by an immunofluorescence method using neurofibrillary protein (NF) and neuron-specific enolase (NSE) as general neuronal markers. NF- and NSE-immunoreactive nerve trunks and non-varicose nerves formed continuous networks similar to nerves with analogue morphology and with immunoreactivities for tyrosine hydroxylase (TH; adrenergic nerves) and neuropeptide Y (NPY). NF- and NSE-immunoreactive non-varicose nerves occurred in the myometrium and along vessels, where TH- and NPY-immunoreactive varicose nerves were also comparatively frequent. After chemical sympathectomy all TH- and NPY-immunoreactive varicose nerves and most NF- and NSE-immunoreactive non-varicose nerves disappeared, suggesting colocalization of TH, NPY, NF and NSE immunoreactivities. During pregnancy all NF-, NSE-, TH- and NPY-immunoreactive nerve structures disappeared in the foetus-bearing uterine horns whereas in the cervix and non-foetus-bearing uterine horns only the myometrial TH- and NPY-immunoreactive varicose nerves disappeared. After parturition there was a complete structural restoration of all types of immunoreactive nerves in previously non-foetus-related tissue. The reinnervation of this tissue followed a similar time-course to that after chemical sympathectomy. In contrast, the reinnervation of previously foetus-related tissue was much slower and incomplete. In conclusion, the whole autonomic uterine innervation undergoes overt structural changes during pregnancy and these changes are related to the foetus-bearing regions.

Adrenergic Fibers↗
PubMed1996

Lumbar sympathectomy for causalgia secondary to lumbar laminectomy.

BACKGROUND: This study reviews 12 patients (15 limbs) who underwent lumbar sympathectomies (LS) (after a series of chemical sympathetic blocks) for causalgia following a lumbar laminectomy (LL). To our knowledge, using LS to treat causalgia after LL has only been reported once before in the English literature. PATIENTS AND METHODS: Patients were classified (Drucker) as Stage I, II, or III. Sympathetic block results were graded as excellent, fair, or poor. Early and late responses to LS were classified as complete relief, partial relief (patient satisfied or unsatisfied), or no relief. RESULTS: The mean duration between LL and the first sympathetic block was 8.4 months, with a mean of 9.5 months to LS. There were no operative deaths; however, 13% of limbs (2/15) had transient postoperative sympathetic neuralgia. Eighty percent (12 limbs) had an early satisfactory outcome after LS, and 73% (11 limbs) had a late satisfactory outcome. Stage II patients were more likely to have satisfactory early and late outcomes (92% and 85%) than Stage III patients (0%, P<0.01). Limbs with an excellent response to sympathetic block were more likely to have satisfactory early and late surgical outcomes (11/11, 100%). The time among LL and sympathetic block and L was shorter in patients who had satisfactory early and late surgical outcomes (P<0.0001). A multivariate analysis demonstrated that the most important independent factor in determining early and late outcomes of sympathectomy was the time between LL and LS (P=0.01). CONCLUSIONS: LS for causalgia following LL should be confined to Stage II patients who have had an excellent response to sympathetic block.

Adult↗
PubMed1995

Site-specific effects of sympathectomy on the adrenergic control of lipolysis in hamster fat cells.

Regional variations in the response of adipose tissue to lipolytic stimuli have been suggested to be involved in the development of visceral adiposity-related morbidity and mortality. Moreover, studies in humans and in laboratory rodents such as hamsters have shown that the response of adipocytes to catecholamines depends on their anatomical origin. The aim of the present study was to investigate the relative involvement of the adrenal medulla and of the sympathetic nervous system on regional differences in the adrenergic control of lipolysis in isolated adipocytes from inguinal and epididymal adipose tissues. For this purpose, we carried out adrenal demedullation or chemical sympathectomy in hamsters. The results confirmed that epididymal adipocytes were significantly more responsive to to a beta-adrenergic stimulation than inguinal adipocytes (p < or = 0.05). This site specificity could originate at a step distal to receptors since tissues exhibited a similar number of binding sites for [125I]cyanopindolol. No significant regional differences were observed in the alpha2-adrenergic antilipolytic response, with the exception of the clonidine EC50. A 14-day sympathectomy significantly increased the beta-adrenergic lipolytic response only in inguinal adipocytes (p < or = 0.05), and increased the alpha2-adrenergic response only in epididymal adipocytes (p < or = 0.05). On the other hand, adrenal demedullation had no effect on both adrenergic pathways. These results suggest that the sympathetic tone of adipose tissues could be involved in the alpha2- and beta-adrenergic site-specific response in hamster fat cells. The 33% increase of the beta-response in inguinal fat cells and the 38% increase of the alpha2-response in epididymal fat cells also suggest that the sympathetic pathway favors the lipolytic activation of the epididymal adipose tissue.

Adipocytes↗
PubMed1954

Lumbar sympathectomy by electrocoagulation; its use in the management of certain vascular and visceral disorders.

Although normally the sympathetic nerves aid vascular dilatation during effort, in certain diseases of the vascular system they have a reverse effect. Abolition of sympathetic vasoconstrictive impulses by sympathectomy is the most effective treatment in some chronic peripheral vascular conditions. The authors have used electrocoagulation for a number of years and found it quick, effective and more likely to prevent regeneration of the affected nerves. Improvement was obtained by sympathectomy in arteriosclerotic vascular insufficiency, thromboangiitis obliterans, Raynaud's disease, reflex sympathetic dystrophy following thrombophlebitis or trauma, scleroderma, spinal sympathetic dystrophy and acquired megacolon. A case of causalgia was aggravated by the operation. Abstention from the use of tobacco appears to be sufficient for control of symptoms in many cases. Since vasospasm is manifested in many conditions long before a thrombotic catastrophe occurs, not only relief of symptoms but prevention of irreversible changes may be achieved by early operation.

Causalgia↗
PubMed1954

Lumbar sympathectomy in older patients.

Of 43 older patients (aged 65 to 83 years) with arteriosclerosis obliterans treated by lumbar sympathectomy for one or both limbs, 19 had excellent result, 13 had fair result and four had poor result. One died postoperatively and six later. Results were better than prognosticated from response to sympathetic block. Thirty-four patients considered the operation worth while and twelve, after unilateral sympathectomy, requested operation for the other limb also. Twenty-four after operation could walk farther without claudication.

Arteriosclerosis↗
PubMed1984

Effects of various vagotomies and sympathectomies on gastric secretory functions in the non-stressed and by immobilization stressed rat.

Hanisch E, Schwille PO. Effects of various vagotomies and sympathectomies on gastric secretory function in the non-stressed and by immobilization stressed rat. Scand J Gastroenterol 1984, 19, Suppl 89, 99-104 The aim of the present study was to study several gastrointestinal parameters (acid, pepsin secretion, ulcer index, gastrin, somatostatin, glucagon) following various forms of sympathectomies in comparison with vagotomies under two different states of sympatho-adrenal activation in male gastric fistula rats. It is concluded that acid and pepsin appear regulated by the autonomous nervous system, even in the basal state. Gastric ulcer formation/prevention depends on gastric sympathetic innervation and on the state of activation of the adrenal medulla. Basal gastrin, somatostatin, glucagon may be modified by both limbs of the autonomous nervous system.

Animals↗
PubMed1983

Evaluation of combined adrenal demedullation and chronic guanethidine treatment as a sympathectomy procedure for metabolic studies.

The usefulness of a combination of adrenal demedullation and treatment with guanethidine (25 mg kg-1 day-1, i.p. for 14 days) as a sympathectomy procedure for metabolic studies was investigated in the rat. The procedure reduced markedly or abolished pressor and positive chronotropic responses to tyramine, nicotine or electrical stimulation of the sympathetic spinal outflow. Hyperglycaemic responses to nicotine or spinal sympathetic stimulation were abolished. Nicotine infusion in intact animals reduced glucose-induced hyperinsulinaemia. On the other hand nicotine infusion in sympathectomized animals produced a marked elevation in glucose-induced hyperinsulinaemia relative to that seen in intact animals. The early hyperinsulinaemic response to glucose infusion during sympathetic stimulation was markedly greater in sympathectomized rats compared with that seen in intact rats. The sympathectomy procedure did not modify the glycaemic responses to adrenaline or insulin or glucose-induced hyperinsulinaemia.

Adrenal Medulla↗