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PubMed1978

The Grimonster symposium on the occasion of the 50th anniversary of the first lumbar sympathectomy.

Under the auspices of the Belgian Surgical Society, a small group of American and European surgeons discussed in detail the place of lumbar sympathectomy in present day surgical practice. A consensus was reached concerning the physiologic effect, anatomical variations and indications for the operation. Conclusions included the questionable value of lumbar sympathectomy for treating intermittent claudication due to aortoiliac disease alone, its possible effectiveness when obliterative arterial disease is limited to the femoral popliteal segment, and its occasional beneficial effect when performed in conjunction with some reconstructive arterial operations.

Belgium↗
PubMed1987

Sympathectomy for causalgia. Patient selection and long-term results.

Thirty-four sympathectomies were performed for causalgic pain. Overt extremity trauma was the precipitating event in only 26%. In 48%, nerve compression requiring surgical relief preceded the onset of the pain; most common lumbar disk surgery (37%). In the remainder (26%), miscellaneous vascular conditions contributed. Satisfactory immediate relief was obtained in 97% and 61% were completely relieved of pain initially. There were no deaths, 10% wound complication rate, and one instance of Horner's syndrome. Postsympathectomy neuralgia occurred in close to 40%, lasted a little over a month on the average but did not persist beyond ten weeks. In extended follow-up, only one patient failed to sustain satisfactory relief (97% of those relieved, 94% of the total) and 84% continued to enjoy the same degree of relief as they had immediately preoperatively. This frequency, degree, and duration of benefit establishes causalgic pain as one of the best indications for surgical sympathectomy.

Adolescent↗
PubMed2004

Anatomical basis for a successful upper limb sympathectomy in the thoracoscopic era.

In this clinico-anatomical study, factors potentially responsible for unsuccessful upper limb sympathectomy (ULS) by the thoracoscopic route were evaluated. This study comprised two subsets: 1) in the clinical subset, 25 patients (n = 50 sides) underwent bilateral second thoracic ganglionectomy for palmar hyperhidrosis, and factors predisposing to unsuccessful ULS were identified; and 2) in the anatomical subset, the neural connections of the first and second intercostal spaces were bilaterally dissected in 22 adult cadavers (22 right, 21 left; n = 43 sides). Alternate neural pathways (ANP) were noted in 9 of 50 sides in the 25 clinical cases (18%). In three asthenic patients (5 sides), fascia overlying the longus colli muscle mimicked the sympathetic chain. The right superior intercostal vein (SIV) was located anterior to the second thoracic ganglion in 6 of 50 sides (12%) and predisposed to troublesome bleeding in 2 of 50 cases; the SIV was posterior to the ganglion in 19 of 50 sides (38%), posing no technical problem. On the left, the SIV was noted outside the field of dissection in all but one case. A successful outcome to sympathectomy was noted in all 25 patients. A spectrum of sympathetic contributions to the first thoracic ventral ramus for the first intercostal space was noted in 37 of 43 anatomical cases (86%). These were categorized according to the arrangements of the intrathoracic ramus between the second intercostal nerve and the first thoracic ventral ramus. The cervicothoracic ganglion (37/43 cases; 86%) and an independent inferior cervical ganglion (6/43 cases; 14%) were always located above the second rib. The second thoracic ganglion was consistently located in the second intercostal space. This study demonstrates that ANPs have little clinical significance when a second thoracic ganglionectomy is undertaken. Technical failures may be avoided if the surgeon is mindful of anatomical variations at surgery.

Adult↗
PubMed2003

Chemical sympathectomy-induced changes in TH-, VIP-, and CGRP-immunoreactive fibers in the rat mandible periosteum: influence on bone resorption.

The expression of neurotransmitter receptors by bone cells supports the concept that the nervous system is a regulator of bone metabolism. The discrimination of the respective roles of the sensory and sympathetic nervous systems requires evidence of topographic relationships between the corresponding fibers and the cells involved in bone turnover, in vivo. In this study, the influence of the sympathetic system on bone resorption was assessed by using a synchronized model of cortical resorption along the mandible. The sympathetic system was destroyed by daily injections of guanethidine (40 mg/kg) for 25 days; a resorption wave was induced on day 21. The distribution of periosteal tyrosine-hydroxylase (TH)-, vasoactive intestinal polypeptide (VIP)-, and calcitonin gene-related peptide (CGRP)-immunoreactive (IR) fibers was studied by compartmentalizing the periosteum. Most fibers were located in the distal, non-osteogenic compartment. TH-IR fibers were located perivascularly, VIP-IR fibers were gathered at the boundary with the osteogenic compartment, and CGRP-IR fibers were scattered. Sympathectomy decreased the number of TH- and VIP-IR fibers and increased the number of CGRP-IR fibers, without changing their topography. After the injection of Fast blue, a retrograde fluorescent marker, over the periosteum, fluorescent neuronal cell bodies were found in the superior cervical ganglion (SCG). Many neurons were TH-IR and very few were VIP-IR. Sympathectomy decreased the numbers of fluorescent and TH-IR cell bodies. It also decreased the number of preosteoclasts and osteoclasts, which had a drastic effect on the cortical bone surface, as assessed by scanning electron microscopy. These data indicate that VIP-IR fibers have a strategic position close to the most peripheral and less differentiated, osteogenic cells, pointing to a functional relationship. As poorly differentiated osteogenic cells support preosteoclast differentiation, VIP-IR fibers may be involved in this process, as suggested by the smaller number of preosteoclasts in sympathectomized rats. Although VIP is predominantly a parasympathetic mediator, it seemed to be conveyed by sympathetic fibers, as shown by the marked effect of guanethidine treatment. Nevertheless, these fibers did not originate from the SCG, contrary to TH-IR fibers.

Adrenergic Fibers↗
PubMed2004

Expression of brain natriuretic peptide in the rat heart studies during heart growth and in relation to sympathectomy.

Brain natriuretic peptide (BNP) might be of importance during heart development and is described to be increasingly expressed in congestive heart failure and to affect the progress of this condition. However, details in the normal expression of BNP are still unclear in various parts of the adult and growing heart, including the conduction system. In this study, we investigated the expression of BNP in relation to that of atrial natriuretic peptide (ANP) in the growing as well as in the adult rat heart. The effects of chemical sympathectomy in adult rats were also examined. Contrary to previous BNP immunohistochemical studies, the BNP antiserum was preabsorbed with an excess of ANP before staining to abolish the crossreactivity with ANP. There was a pronounced BNP immunoreaction in the auricles, the trabeculated ventricular walls, and the peripheral parts of the conduction system at 0-1 days postnatally. The degree of immunoreaction gradually decreased with increasing age. A similar developmental pattern was seen concerning ANP expression, but the magnitude of the latter clearly exceeded that for BNP. Immunoreaction for BNP was never detected in the atrioventricular (AV) node and AV bundle at any stage. In contrast to the situation for ANP previously observed, no obvious changes in BNP immunoreaction patterns were observed in response to sympathectomy. This is the first study to thoroughly demonstrate the expression of BNP in the various regions of the rat heart during growth and in the normal and sympathectomized adult stage. The observations are related to possible functions of natriuretic peptides in the growing and adult heart.

Animals↗
PubMed2002

Chemical sympathectomy has no effect on the severity of murine AIDS: murine AIDS alone depletes norepinephrine levels in infected spleen.

Numerous studies have shown that alterations in sympathetic nervous system (SNS) function produced by beta-adrenergic receptor blockade or chemical sympathectomy can produce changes in T and B lymphocyte function and both innate and acquired immune responses. However, fewer studies have investigated changes in immune response following SNS alterations in animal models of disease. We tested whether blocking SNS activity using 6-OHDA or the beta-receptor antagonist nadolol alters the typical pattern in production of T helper 1 (Th1) and Th2 cytokines seen in cultures of spleen cells from C57BL/6 mice infected with murine AIDS (MAIDS). We found that neither method of sympathetic blockade affected cytokine response to MAIDS. We also found that the norepinephrine concentration and content of the spleen were reduced dramatically by the MAIDS infection itself at 3 and 6 weeks after LP-BM5 inoculation. This finding has not been previously reported in mice with MAIDS and suggests that the viral infection itself produces a functional sympathectomy in the spleen, a target of that infection.

Adrenergic beta-Antagonists↗
PubMed2001

Effect of peripheral nerve lesion and lumbar sympathectomy on peptide regulation in dorsal root ganglia in the NGF-overexpressing mouse.

Galanin is a peptide normally expressed at low levels both in sensory and in sympathetic neurons. It is strongly upregulated after peripheral nerve lesions, and it has been proposed that nerve growth factor (NGF) plays a role in this regulation. In the present study the effect of both sciatic nerve transection and lumbar sympathectomy on galanin in lumbar dorsal root ganglia (DRGs) was examined in mice overexpressing NGF (NGFOE) in the skin under the keratin promoter. The superior cervical ganglia (SCG) were also studied. In the DRG pericellular baskets containing tyrosine hydroxylase- (TH) and galanin-like immunoreactivity (LI) were found, mostly in the same fibers. Galanin-positive baskets were also found in the trigeminal ganglia. However, only single neuropeptide Y (NPY)-positive baskets were observed within the DRGs. No marked difference in number of galanin-positive neurons was seen between wild-type and NGFOE mice. After sciatic nerve transection galanin was upregulated in DRG neurons to about the same extent in NGFOE mice as in wild-type mice. Galanin-, but not TH-LIs decreased in the pericellular baskets. After lumbar sympathectomy both galanin- and TH-immunoreactive baskets disappeared, suggesting a sympathetic origin. In the SCG the very low galanin mRNA levels were strongly increased after lesion of the carotid nerves, both in wild-type and in NGFOE mice. However, whereas NPY mRNA levels decreased in the SCG after axotomy in the wild-type mice, there was a distinct increase in the NGFOE mice. Our results show that high NGF levels in skin induce formation of pericellular baskets in DRGs expressing galanin- and TH-LI and that galanin in these baskets is strongly influenced by peripheral axotomy. However, overexpression of NGF did not markedly influence galanin expression in DRG neurons, neither normally nor after nerve lesions. Finally, expression of NPY in sympathetic ganglia is differently regulated in NGFOE compared to wild-type mice.

Animals↗
PubMed1995

Inferior brachial plexus injury during thoracoscopic sympathectomy.

A case of inferior brachial plexus injury during thoracoscopic sympathectomy is presented. As this complication occurred during the first operation of the kind in our department in 1991, it is believed that it can be prevented now by supervision of thoracoscopic sympathectomy by experienced surgeons.

Adult↗
PubMed1984

Ovarian sympathectomy in the guinea pig. II. Effects on follicular development during the prepubertal period and following exogenous gonadotropin stimulation.

The role of ovarian adrenergic nerves in follicular growth was studied in prepubertal guinea pigs by determining the effect of sympathectomy on follicle populations and follicular development following exogenous gonadotropin administration. Selective unilateral ovarian sympathectomy was achieved by injecting 6-hydroxydopamine into a surgically closed periovarian bursa on day 20 postpartum. The contralateral surgically closed ovarian bursa was injected with the vehicle used for 6-hydroxydopamine. On day 25, animals were injected with pregnant mare serum or saline followed by human chorionic gonadotropin or saline 48 h later. All animals were laparotomized on day 28 and blood from utero-ovarian veins was collected bilaterally for androstenedione determination. Ovaries were processed for morphometric analysis of follicles. The sympathectomized ovary in saline-injected animals had a significant decrease in preantral follicles (characterized by less than or equal to 2 layers of granulosa cells without antrum formation), an increase in 310-500 micron diameter atretic follicles and an increase in follicles greater than or equal to 700 micron compared to the contralateral control ovary. There were no differences in androstenedione levels from the two sides, ovarian weights or the total number of follicles per ovary. Neither ovary had corpora lutea. The sympathectomized ovary in animals injected with gonadotropins was not different from the contralateral ovary in any of the parameters measured. Both control and sympathectomized ovaries had newly formed corpora lutea in response to the exogenous gonadotropins. These results suggest that ovarian adrenergic nerves normally participate in follicular development in the prepubertal guinea pig. However, exogenous gonadotropins may override neural influences on the prepubertal ovary.

Androstenedione↗
PubMed1987

S-100-immunoreactive nerves in the guinea-pig uterus with reference to ultrastructural correlations: effects of chemical sympathectomy and pregnancy.

In the guinea-pig uterus, by use of an indirect immunofluorescence method, S-100 immunoreactivity was found to be restricted to nerves that corresponded in number, distribution and type to adrenergic axons and pre-terminals. With advancing pregnancy S-100 immunoreactivity completely disappeared in uterine tissue adjacent to a fetus, in parallel with an ultrastructural degeneration of the adrenergic innervation. In the cervix and the uterine horn devoid of a fetus, however, the number and distribution of S-100-immunoreactive nerves was seemingly unchanged and no ultrastructural changes were found in adrenergic nerves. In contrast, chemical sympathectomy produced by 6-hydroxydopamine did not change S-100 immunoreactivity of uterine nerves. These findings suggest that there are differences in the denervation effected by chemical and by pregnancy-induced sympathectomy. The latter probably represents a special type of adrenergic denervation by inducing a degeneration of Schwann cells in addition to destruction of neuronal structures. This may explain the differences in the speed of regeneration of uterine adrenergic nerves following the two types of denervation.

Animals↗
PubMed1977

Effect of preganglionic sympathectomy on the cholinesterase activity in the superior cervical ganglia of rats and hamsters.

By employing biochemical assay and histochemical enzyme techniques the effect of preganglionic sympathectomy on the cholinesterase (ChE) activity in the superior cervical ganglia of rats and hamsters was investigated. Biochemical assays indicate that the ChE activity in the superior cervical ganglia of adult rats and hamsters is 57.19 and 28.63 respectively (expressed in micron moles acetylcholine hydrolyzed per min per g of tissue); two weeks after preganglionic denervation, about 50% and 60% of ChE activity are lost respectively. Histochemical enzyme examination reveals that in the rat superior cervical ganglion, the majority of the neurons are adrenergic with weak to moderate acetylcholinesterase (ACHhE) reaction and the minority of the neurons are cholinergic with strong AChE activity, while only one type of adrenergic neurons exhibits a weak AChE activity in the hamster superior cervical ganglion. The AChE activity is localized in the perinuclear area, in the cisternae of the rough surfaced endoplasmic reticulum, in the Golgi complex and on the plasma membrane of the hamster's neurons; it is mainly locolized in the cisternae of the rough surfaced endoplasmic reticulum of the rat's neurons. AChE reaction product is also detected on the aeolemmal membranes of the preganglionic nerve fibers in the sympathetic ganglia of rats and hamsters. After preganglionic sympathectomy, the AChE activity in the adrenergic neurons and in the preganglionic unmyelinated nerve fibers is markedly reduced, whereas the cholinergic neurons and preganglionic myelinated nerve fibers remain unchanged. On the basis of these results two conclusions have been reached: (1) The fact that strong AChE activity localized in the cholinergic neurons and preganglionic myelinated fibers is not influenced by denervation, suggests that these structures are able to produce AChE. (2) The reduction of AChE activity in the rat and hamster superior cervical ganglia two weeks after preganglionic denervation, observed by histochemical examination, can be correlated with a concomitant measurable reduction determined by biochemical assays.

Acetylcholinesterase↗
PubMed1990

Selective brain cooling after bilateral superior cervical sympathectomy in sheep (Ovis aries).

We have investigated the role of the sympathetic innervation of the vasculature of the head in the control of selective brain cooling of sheep, during exposure to high and low ambient temperatures and during endotoxin-induced fever. Bilateral removal of the superior cervical ganglia resulted in a significant reduction of hypothalamic temperature during all procedures. Respiratory rate was also depressed by the sympathectomy, apparently mainly as a result of a decrease in nasal airway patency. Rectal temperature changes after sympathectomy were dependent on the experimental conditions, and the rectal - hypothalamic temperature difference was enhanced during heat exposure and fever. Our results support the contention that sympathetically mediated changes in nasal blood flow and in venous return from the nasal cavity, via the angularis oculi and facial veins, may be involved in the control of selective brain cooling in sheep.

Animals↗
PubMed1979

The influence of acute and chronic cervical sympathectomy on the ocular hypotensive effect of clonidine.

The influence of clonidine on intraocular pressure was studied in chloralose-anesthetized cats. The cats were subjected to unilateral cervical sympathectomy, either acute or chronic. The drug was injected either intravenously or into the left vertebral artery. With the aim of investigating the role of the sympathetic nervous system in the central IOP-lowering effect of clonidine, the fall in IOP induced by the drug in these preparations was compared to the decrease in ocular pressure caused by clonidine in intact cats. An enhanced depressor effect in both eyes of unilaterally sympathectomized cats became evident after the intravenous injection of clonidine. In contrast, the effect of central administration was similar or even smaller than in intact cats. We conclude that the central IOP-lowering effect of clonidine is diminished after cervical sympathectomy, indicating that the peripheral sympathetic nervous system is the efferent pathway of this centrally initiated effect.

Animals↗
PubMed1994

Assessment of chemical lumbar sympathectomy in critical limb ischaemia using thermal imaging.

Objective assessment of chemical lumbar sympathectomy (CLS) is lacking. Its success is usually judged in terms of the patient's clinical improvement. We have thermographically measured the immediate temperature changes of the lower limb following CLS using a thermal imager (SAN-EI Thermotracer 6T61). Seven patients with critical limb ischaemia and one patient with Raynaud's phenomenon underwent unilateral ablation of the lumbar sympathetic chain using 5% phenol. Four patients were diabetic, two of whom had undergone previous sympathectomy on the same side. Within fifteen minutes of injection, all patients showed a rise in skin temperature in parts of the sock distribution of between 0.8 degrees C and 8.5 degrees C. We conclude that the haemodynamic effects of CLS are immediate and can be objectively measured with thermal imaging.

Aged↗
PubMed1975

The ultrastructure of the rabbit pineal gland after sympathectomy, parasympathectomy, continuous illumination, and continuous darkness.

The ultrastructure of the rabbit pineal gland was investigated after sympathectomy (extirpation of decentralization of the superior cervical ganglia), parasympathectomy, continuous illumination and continuous darkness. The similarity of the ultrastructural changes in the light pinealocytes occuring after sympathectomy and after continuous illumination was striking. It is supposed that these changes have a common cause, viz. the lack of free noradrenaline, the pinealotropic neurotransmitter. The smooth endoplasmic reticulum present in the terminals of the offshoots of the light pinealocytes is possibly involved in pineal indoleamine synthesis.

Animals↗
PubMed1979

Pathogenesis of duodenal ulceration produced by cysteamine or propionitrile: influence of vagotomy, sympathectomy, histamine depletion, H-2 receptor antagonists and hormones.

Insight into the pathogenesis and etiology of experimental duodenal ulceration was sought by studying the modulation of this disease in rats by selective vagotomy, chemical sympathectomy, histamine depletion, histamine H-2 receptor antagonists (eg, metiamide, cimetidine), or endocrine ablations. Gastric secretion was examined in intact and pylorus-ligated animals. The formation of duodenal ulcers induced by the administration of propionitrile or cysteamine was abolished by vagotomy, decreased by sympathectomy, histamine depletion, histamine H-2 receptor antagonists, hypophysectomy, thyroidectomy, or adrenalectomy. Cimetidine and metiamide exerted a dose-dependent antiulcer effect, but metiamide enhanced the mortality of rats given propionitrile or cysteamine. The non-ulcerogen derivative of cysteamine, ethanolamine, did not increase mortality when given in combination with metiamide. The gastric hyperacidity elicited by cysteamine was reduced by metiamide or vagotomy, the latter being more effective in this respect. Thus, the chemically induced duodenal ulcer in rats resembles the human peptic ulcer disease in sensitivity to therapeutic modalities and may serve as an appropriate model to study the role of neural, hormonal, and other factors in the etiology and pathogenesis of this disorder.

Adrenalectomy↗
PubMed1992

Transthoracic endoscopy for upper thoracic chemical sympathectomy.

Beginning in April 1989, we have performed eight upper thoracic chemical sympathectomies by transthoracic endoscopy. The indications were occlusive arterial disease in four patients and Raynaud's syndrome and palmar hyperhidrosis in two patients each. Transthoracic endoscopy was performed under general anesthesia, through the third costal interspace on the anterior mid-clavicular line. Five ml of phenol were injected into the parietal pleura covering the three proximal thoracic ganglia. The duration of thoracic drainage was 24 hours. The postoperative course was uneventful except for one case of subcutaneous emphysema and transient Horner's syndrome in three instances. There were no initial failures. Because of its simplicity and the short hospitalization period, chemical sympathectomy by transthoracic endoscopy constitutes a valuable alternative to conventional surgery. This technique is, however, limited in the case of antecedent pleuropulmonary disorders.

Adult↗
PubMedDate not supplied

Reduced resistances of septal artery collateral channels after cardiac sympathectomy.

We have shown that chronic cardiac sympathectomy reduces coronary collateral resistances. The present experiments in isolated dog hearts delineated the role of intramyocardial collateral channels from the septal (SEP) to the circumflex (CIRC), left anterior descending (LAD), and right (RT) coronary arteries in this phenomenon. In 11 controls and 8 2-wk sympathectomized hearts, a retrograde flow technique was used to determine collateral resistances between the epicardial arteries (CIRC, LAD, RT). Collateral resistances between the CIRC and LAD and between the LAD and RT were 42-68% less in sympathectomized hearts (P less than 0.05). Collateral resistances from the SEP to each epicardial artery were determined from retrograde flows simultaneously collected on each epicardial artery when the SEP was the only vessel perfused. Collateral resistances from the SEP to the CIRC and LAD were 51-59% less in the sympathectomized hearts (P less than 0.05). Thus, intramyocardial channels from the SEP to the left coronary arteries show reduced resistances after sympathectomy and can provide a substantial portion of the increased collateral flow to these vessels.

Animals↗