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PubMed2005

Effects of bilateral T2-sympathectomy on static and dynamic heart rate responses to exercise in hyperhidrosis patients.

The static/dynamic changes of gas exchange, heart rate (HR) and blood pressure in terms of work rate (WR) and WR changes in ramp exercise were investigated by cardio-pulmonary exercise tests (CPETs) in hyperhidrosis patients before (W0), one week (W1) and four weeks (W4) after bilateral T2-sympathectomy. Accompanied by constant oxygen consumption and WR at peak exercise and similar oxygen debt in recovery, the HR significantly (p<0.05) decreased statically in all stages of CPET, but was not altered dynamically, i.e., similar slope but significantly diminished intercept in HR changes versus WR changes (70+/-6.0 vs. 82+/-19 beats/min, p<0.01), in W1 (n=11), compared to W0 (n=13). However, this surgical effect on static HR changes seemed to have disappeared in W4 (n=8), albeit at that time the static blood pressure decreased significantly during exercise. These findings suggest that bilateral T2-sympathectomy will reduce static HR without causing cardiovascular insufficiency in one week, and would then recover by one month in hyperhidrosis patients.

Adolescent↗
PubMed2006

Differing influence of sympathectomy on smooth muscle cells and fibroblasts in cerebral and peripheral muscular arteries.

In the present study, we examined the effect of sympathectomy on the distribution and the relative expression of cytoskeletal proteins used as markers of phenotypic modulation of vascular smooth muscle cells (SMCs) and myofibroblasts (MFBs) in rabbit femoral (FA) and basilar (BA) arteries. Adult rabbits were treated either with repeated 6-hydroxydopamine (6-OHDA) for sympathectomy or with vehicle for control. Cross sections taken from sympathectomized and control arteries 79 days later were immunolabelled for vimentin, desmin, alpha-smooth muscle actin (alpha-SM actin), beta-isoform of actin and h-caldesmon. The distribution of these proteins and the intensity of fluorescent labelled SMCs were examined under a confocal microscope. In the sympathectomized BA, there was no change for desmin, vimentin and h-caldesmon expression, but the expression of both alpha-SM actin and the beta-isoform was significantly higher (+19% and +30%, respectively). In the sympathectomized FA, the expression of the alpha- and beta-isoforms of actin remained unchanged, whereas those of desmin and vimentin were significantly higher (+35% and 17%, respectively) and h-caldesmon expression was lowered by 13%. In contrast to intact FAs, the external layers of sympathectomized FAs revealed migration of fibroblasts from the adventitia and death of SMCs. These results strongly suggest that sympathetic nerves intervene in the cytoskeletal protein remodelling through phenotypic modulation of both SMCs and MFBs during post-natal development, and in pathologies involving similar phenomena, such as atherosclerosis.

Animals↗
PubMed2005

Aging and sympathetic modulation of immune function in Fischer 344 rats: effects of chemical sympathectomy on primary antibody response.

In aged Fischer 344 (F334) rats, sympathetic innervation of the spleen is markedly diminished compared with young rats. To determine if this diminished noradrenergic (NA) innervation maintains a functional connection with the immune system, 3- and 17-month-old male F344 rats were treated with the NA-selective neurotoxin, 6-hydroxydopamine (6-OHDA), to ablate peripheral NA nerve fibers. In sympathectomized rats immunized with keyhole limpet hemocyanin (KLH), a T-dependent protein antigen, anti-KLH IgM, IgG, IgG1, IgG2b antibody titers were increased in young and old rats 14 days after immunization compared to vehicle controls. Furthermore, the number of IgM and IgG anti-KLH antibody-secreting spleen cells was elevated 7 and 14 days post-immunization. These effects were prevented by pretreatment with desipramine, a catecholamine uptake blocker that blocks 6-OHDA uptake and subsequent sympathectomy. Chemical sympathectomy also increased KLH-induced proliferation in vitro by spleen cells from old, but not young animals. Isoproterenol (ISO), a beta-adrenergic receptor agonist, elicited a rise in cAMP in spleen cells from NA-intact young and old rats, but the increase was attenuated in spleen cells from old rats. These results demonstrate that, although NA innervation in the F344 rat spleen is diminished with age, sympathetic signaling of the immune system remains intact. Thus, the SNS can inhibit antibody produced in response to a protein antigen in both young and old F344 rats.

Adrenergic beta-Agonists↗
PubMed2007

A randomized trial of T3-T4 versus T4 sympathectomy for isolated axillary hyperhidrosis.

INTRODUCTION: Video-assisted thoracic sympathectomy (VATS) is one minimally invasive definitive treatment for axillary hyperhidrosis. Different techniques exist for controlling axillary sudoresis, but they are temporary and have high cost. This study was conducted to compare the initial results from sympathectomy using two distinct levels for treating axillary sudoresis: T3-T4 vs T4. METHODS: Sixty-two patients with axillary hyperhidrosis were prospectively randomized for denervation of T3-T4 or T4 alone. All patients were examined preoperatively and were followed-up at 1 and 6 months postoperatively. Evaluated were the axillary hyperhidrosis treatment, the presence, location, and severity of compensatory hyperhidrosis, and the quality of life. RESULTS: All the patients said that their axillary hyperhidrosis was successfully treated by the surgery after 6 months. There was no treatment failure. Compensatory hyperhidrosis was present in 29 patients (90.6%) of the T3-T4 group and in 17 T4 patients (56.7%) after 1 month. After 6 months, all the T3-T4 patients presented some degree of compensatory hyperhidrosis vs 13 T4 patients (43.3%). The severity of the compensatory hyperhidrosis was also lower in the T4 patients (P < . 01). The quality of life was poor in both groups before the surgery, and was equally improved in both groups after 1 and 6 months of follow-up. There were no deaths or significant postoperative complications nor a need for conversion to thoracotomy. CONCLUSION: Both techniques are effective for treating axillary hyperhidrosis, but the T4 group presented milder compensatory hyperhidrosis and had a greater satisfaction rate.

Adult↗
PubMed2006

Sympathectomy-like effects of brachial plexus block in arteriovenous access surgery.

We used color Doppler ultrasonography to prospectively study the effects of supraclavicular brachial plexus block (BPB) on blood flow and vein diameter in patients undergoing arteriovenous access surgery. BPB might produce a sympathectomy-like effect that could have a role in improving patencty. Thirty-one consecutive patients who underwent arteriovenous access surgery with BPB were studied prospectively, in addition to 5 patients with BPB having other operations and 5 patients undergoing general anesthesia for elective surgery. Vessel diameter and pulsatility index (PI) were among the parameters measured. Mean PI decreased from 6.18 +/- 1.67 before the block to 3.92 +/- 1.75 at 10 min after initiation of the block (p = 0.001). Basilic vein diameter increased from 6.28 +/- 0.86 mm (range 4.85 to 7.30) before the block to 7.83 +/- 1.52 mm (range 5.80 to 12.14) 10 min after the block (p = 0.03). In the general anesthesia control group the PI decreased, but returned to preanesthetic levels immediately after the patients reached the recovery room. In the nonaccess BPB group the PI remained low after the block for at least 5 h. Brachial plexus block causes significant venous dilation and a significant decrease in the pulsatility index. This appears to be due to a beneficial sympathectomy-like effect of the block that might prevent early failure and improve patency in vascular access surgery.

Anesthesia, General↗
PubMed2001

Thoracoscopic sympathectomy for palmar hyperhidrosis.

Palmar hyperhidrosis (i.e., excessive sweating of the palms) usually appears at puberty and causes psychological, social, educational, and occupational problems for people who suffer from it. Although many treatments have been used, the only treatment that permanently eradicates the condition is sympathectomy. The advent of thoracoscopic surgery has allowed surgeons to perform sympathectomy as an outpatient procedure that is safe and effective and produces life-changing results for patients.

Adult↗
PubMed2001

Early complications of thoracic endoscopic sympathectomy: a prospective study of 940 procedures.

BACKGROUND: Thoracic endoscopic sympathectomy (TES) has become the surgical technique of choice for treating intractable palmar hyperhidrosis and is usually considered as a simple and safe procedure. To evaluate the complication rate of TES, we conducted a prospective study of peri- and postoperative complications. METHODS: From 1995 to 1999, 467 consecutive patients were operated on for upper limb hyperhidrosis. There were 164 men and 303 women, ranging in age from 15 to 59 years (mean 31 years). In all but 5 cases, the procedure was bilateral. Eleven patients underwent a reoperation for failure; thus the total number of sympathectomies was 940. The procedure was performed in two stages in 182 patients and in one stage in 267 patients. All patients were seen 1 month after the operation. RESULTS: There was no mortality. The mean postoperative hospital stay was 2.3 days in the group of patients who were operated on in two stages and 1.1 day in patients who were operated on in one stage. There were three major complications: one tear of the right subclavian artery and two chylothoraces. There were 25 cases (5.3%) of bleeding (300 to 600 mL) during dissection of the sympathetic trunk due to injury to an intercostal vein; in all cases it was controlled thoracoscopically. There were 12 pneumothoraces (1.3%) after removal of chest tubes. All of these were unilateral. Four required chest drainage for a period of less than 24 hours. One patient had a mild pleural effusion. Four patients had a unilateral partial Horner Syndrome (0.4%) that disappeared within 3 months in 2 patients. The other 2 patients were lost to follow-up. One patient complained of rhinitis. CONCLUSIONS: Although morbidity was low, significant complications of TES occurred. Patients should be clearly warned that TES is not as minor a procedure as usually asserted. Complications as well as adverse effects should be considered when discussing this surgical indication.

Adolescent↗
PubMed1986

Prevention of myocardial injury during brain death by total cardiac sympathectomy in the Chacma baboon.

In a previous study, structural myocardial damage was found to occur in 60% of baboons after brain death had been induced by a rapid increase in intracranial pressure. In the present study, we attempt to clarify the causative mechanisms involved in the development of such injury. Three groups of baboons were subjected to brain death: group A, the control; group B, those with previous surgical or pharmacological cardiac sympathectomy or cardiac denervation; and group C, those with bilateral vagotomy, incomplete sympathectomy, or bilateral adrenalectomy. Electrocardiographic and hemodynamic responses to brain death were greatly modified in group B baboons compared with responses in groups A and C. Groups A and C showed a high incidence of myocardial necrosis, whereas no myocyte damage was seen in the hearts of group B baboons. The histological appearance of innervated hearts following brain death (groups A and C) may closely resemble that seen during an acute rejection episode following cardiac transplantation. We suggest that myocardial damage occurring during the process of dying may be related to endogenous catecholamine release (possibly resulting in increased calcium uptake by the myocardial cells), inducing various forms of myocyte necrosis. This may result in early failure in a donor heart following cardiac transplantation.

Animals↗
PubMed1999

Outpatient thoracoscopic limited sympathectomy for hyperhidrosis palmaris.

Thoracoscopic sympathectomy is considered the most effective treatment for hyperhidrosis palmaris. We have treated 1,043 cases of this disease by this method. We have developed an outpatient technique of thoracoscopic sympathectomy using electrocautery. This procedure has been used in 47 patients with hyperhidrosis palmaris. The early results have been favorable. We describe this fast, safe, economic, and effective method for the treatment of hyperhidrosis palmaris.

Adolescent↗
PubMed2000

Needle thoracic sympathectomy for essential hyperhidrosis: intermediate-term follow-up.

BACKGROUND: Essential hyperhidrosis is a condition with excessive sweating localized to certain part of the body. A definitive cure can be obtained by upper thoracic sympathectomy. METHOD: Between June and October 1997, 117 patients with essential hyperhidrosis underwent needle thoracoscopic sympathectomy. Of the 94 patients, 42 were men and 52 women. Their ages ranged from 14 to 63 years, with a mean age of 23 years. RESULTS: There were no mortality or life-threatening complications. Symptomatic improvement was found in 95.7%. Compensatory hyperhidrosis was found in 71.2% of the patients, but in these compensatory hyperhidrosis were mostly tolerable. CONCLUSIONS: This therapeutic procedure is minimally invasive and very effective. Further development of the new device and surgical technique are expected to follow.

Adolescent↗
PubMed2003

Unilateral brachial plexus injury as a complication of thoracoscopic sympathectomy for hyperhidrosis: a case report.

Unilateral brachial plexus injury is a rare complication of thoracoscopic sympathectomy, which is generally considered to be a simple and safe procedure. We report on a 26-year-old man who developed weakness and numbness of the right arm after thoracoscopic sympathectomy for hyperhidrosis. Electromyographic study revealed evidence of denervation in the upper trunk of the right brachial plexus. A nerve conduction study on the right axillary nerve revealed a reduced compound muscle action potential amplitude at the right deltoid muscle. We suggest that this complication was caused by stretch and/or compression when the arm was hyperabducted during the operation. The outcome was excellent, with almost complete recovery 3 months later. The complication can be prevented by minimizing operation time and avoiding hyperabduction of the arm. The prognosis for postoperative brachial plexopathy is usually good with conservative management.

Adult↗
PubMed1999

Sympathectomy inhibits the vasoactive effects of nicotine in conscious rats.

OBJECTIVE: The mechanisms underlying the pressor response to nicotine are incompletely understood. Although sympatho-adrenergic activation plays a major role, the relative contribution of adrenal vs. neurally released catecholamines and the possible role of non-adrenergic factors (e.g. vasopressin release) is not established. METHODS: We examined the cardiovascular responses to graded i.v. injections of nicotine (1 to 100 micrograms kg-1) in conscious Wistar-Kyoto rats under control conditions and (i) after chemical sympathectomy by 6-hydroxydopamine, which destroys sympathetic endings but spares the adrenal medulla; (ii) after an alpha-adrenergic blockade by phenoxybenzamine; (iii) after a V1 vasopressin receptor blockade by a specific antagonist. RESULTS: In control rats, nicotine caused a dose-dependent tachycardiac and pressor response. Both responses were abolished by sympathectomy, whereas the alpha-blockade left the tachycardiac response unaffected but inhibited the pressor response: the V1 vasopressin receptor blockade had no effect on either the tachycardiac or pressor response. CONCLUSIONS: We conclude that in the conscious rat; (1) the pressor response to nicotine mainly depends on peripheral alpha-adrenergically-mediated vasoconstriction; (2) the vasomotor effect is caused by neural rather than adrenomedullary catecholamine release; (3) the nicotine-induced increase in heart rate (and presumably cardiac output) is per se unable to raise blood pressure, and (4) the nicotine-induced release of vasopressin plays no significant role in the pressor response.

Adrenergic alpha-Antagonists↗
PubMed1999

Sympathectomy potentiates the vasoconstrictor response to nitric oxide synthase inhibition in humans.

OBJECTIVE: Nitric oxide exerts its cardiovascular actions at least in part by modulation of the sympathetic vasoconstrictor tone. There is increasing evidence that nitric oxide inhibits central neural sympathetic outflow, and preliminary evidence suggests that it may also modulate peripheral sympathetic vasoconstrictor tone. METHODS: To test this latter concept, in six subjects having undergone thoracic sympathectomy for hyperhydrosis, we compared the vascular responses to systemic L-NMMA infusion (1 mg/kg/min over 10 min) in the innervated and the denervated limb. We also studied vascular responses to the infusion of the non-nitric-oxide-dependent vasoconstrictor phenylephrine. RESULTS: L-NMMA infusion evoked a roughly 3-fold larger increase in vascular resistance in the denervated forearm than in the innervated calf. In the denervated forearm, vascular resistance increased by 58 +/- 10 percent (mean +/- SE), whereas in the innervated calf it increased only by 21 +/- 6 percent (P < 0.01, forearm vs. calf). This augmented vasoconstrictor response was specific for L-NMMA, and not related to augmented non-specific vasoconstrictor responsiveness secondary to sympathectomy, because phenylephrine infusion increased vascular resistance similarly in the denervated forearm and the innervated calf (by 24 +/- 7, and 29 +/- 8 percent, respectively). The augmented vasoconstrictor response was related specifically to denervation, because in control subjects, the vasoconstrictor responses to L-NMMA were comparable in the forearm and the calf. CONCLUSIONS: These findings indicate that in the absence of sympathetic innervation, the vasoconstrictor responses to nitric oxide synthase inhibition are augmented.

Adult↗
PubMed1999

Sympathectomy prevents fructose-induced hyperinsulinemia and hypertension.

The fructose-induced hypertensive rat is a widely used model to study the inter-relationship between hyperinsulinemia, insulin resistance and high blood pressure. Evidence suggests that hyperinsulinemia and insulin resistance may be pathogenic in the development of high blood pressure in this model. To determine the contribution of the sympathetic nervous system towards fructose-induced hypertension, the present study examined the effects of chemical sympathectomy (adrenal medullectomy, followed by weekly 6-hydroxydopamine injections) on plasma insulin levels and systolic blood pressure in control and fructose-induced hypertensive rats. Sympathectomy abrogated the development of both hyperinsulinemia and hypertension in fructose hypertensive rats without affecting these parameters in control rats. These data uncover, for the first time, the primacy of the sympathetic nervous system as a mediator of both elevated plasma insulin levels and high blood pressure in rats fed a high fructose diet.

Animals↗
PubMedDate not supplied

Activity-wheel running blunts suppression of splenic natural killer cell cytotoxicity after sympathectomy and footshock.

We used chemical sympathectomy by 6-hydroxydopamine (6-OHDA) to examine whether adaptation by the sympathetic nervous system (SNS) is a plausible explanation for our prior finding that activity-wheel running blunts the suppression of splenic natural killer cell cytotoxicity after footshock. Male Fischer rats were assigned to treatments using a group (activity wheel vs. sedentary)x treatment (6-OHDA vs. saline)x condition (footshock vs. no shock) design. After 5-6 weeks, rats were injected i.p. with saline or with 40, 80, and 80 mg/kg 6-OHDA on pre experimental days -5, -3, and -1. Half the rats received 6 min of random footshock during a 40-min period. Cytotoxicity was determined by standard 4-h 51Cr release assay. Sympathectomy reduced splenic [NE] by 72%. After 6-OHDA injection and footshock, percent lysis was 33% lower in sedentary rats compared with activity-wheel runners and home-cage controls, p=0.048. The results suggest that activity-wheel running leads to adaptations that offset an altered SNS modulation of splenic NK cell cytotoxicity in response to footshock.

Animals↗
PubMed1985

Selection of patients for lumbar sympathectomy.

We successfully predicted that patients presenting with critical ischemia of a limb and Doppler ratios greater than or equal to 0.3 would benefit from lumbar sympathectomy alone. However, we found that the procedure failed in 14 per cent of limbs whose ratios were greater than or equal to 0.3. In retrospect, all these patients were found to have deep infection. Had we known this fact prospectively, our predictions for success would have been close to 100 per cent. We were less than 50 per cent successful in predicting failure of the procedure, but the number of patients in this group is too small to draw reliable conclusions. We believe that patients with arm-ankle Doppler ratios greater than or equal to 0.3 whose manifestations of ischemia are limited to the skin will have a greater than 95 per cent chance of receiving a good result from lumbar sympathectomy alone and that this result will be maintained for many years.

Aged↗
PubMed1999

Sympathectomy abrogates immunodeficiency associated with protein-energy malnutrition.

The role of the sympathetic nervous system in the immune deficiency developed in protein-energy malnutrition (PEM) was investigated by assessing the effects of sympathectomy on the intestinal immune response of rats subject to prenatal or postnatal malnutrition. Chemical sympathectomy increased the number of IgA+ cells migrating into the intestinal lamina propria of control animals, but this effect was abrogated in rats malnourished during their perinatal stage. The method by which perinatal malnutrition was achieved influenced the magnitude of the effect on serum IgA levels with malnutrition during lactation having a more pronounced depressive effect on IgA than malnutrition during gestation. In experiments in which animals were intestinally immunised with ovalbumin (OVA) the mucosal immune response was reduced in non-sympathectomised malnourished (MN) animals and a lower level of anti-OVA IgA was detected in serum. However, in sympathectomised animals, there was no difference between MN animals and controls in the intestinal and humoral immune responses. The preliminary evidence presented in this paper strongly supports a role for the noradrenergic neurotransmitter system in the immunodeficiency developed during PEM.

Animals↗