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PubMed1997

Decreased neuronal nitric oxide synthase-immunoreactivity and NADPH-diaphorase activity in rat pterygopalatine ganglion parasympathetic neurons and cerebrovascular innervation following long-term sympathectomy.

Neural control of tissue perfusion is mediated predominantly by sympathetic vasoconstrictor and, in some tissues, parasympathetic vasodilator systems. The objective of this study was to determine if changes occur within parasympathetic vasodilator neurons supplying cranial vessels after sympathectomy. Cranial sympathetic innervation was excised unilaterally, and 6 weeks later pterygopalatine ganglion neurons were evaluated for expression of neuronal nitric oxide synthase immunoreactivity (NOS-ir) and NADPH-diaphorase activity. Relative to the unoperated side, the number of parasympathetic neurons staining densely either for NOS or for NADPH-diaphorase decreased by 37% and 47%, respectively, whereas unstained somata increased by 51% and 48%. Internal carotid artery NOS-ir innervation density was reduced by 35%. These findings are consistent with a down-regulation of nitrergic properties in some cranial parasympathetic neurons after sympathectomy.

Animals↗
PubMed1997

Effects of sympathectomy on endothelin-1 and histamine responses of rabbit carotid artery.

1. The effects of chronic sympathectomy on contractile responses of rabbit common carotid artery was studied in vitro. 2. Endothelin-1 (ET-1), histamine, KC1 and papaverine concentration-response curves of sympathectomized and sham-operated (control) vessels were recorded and analyzed. Effects of endothelium removal also were investigated. 3. The contractions elicited by ET-1 and histamine in sympathectomized preparations did not change when compared with controls. Papaverine, which produces endothelium-independent relaxation, and KC1, which produces endothelium-independent contraction, did not differ from controls. No significant difference was observed between the contractile responses of sympathectomized vessels and those of control vessels to ET-1 and histamine after the removal of endothelium. 4. These results indicate that chronic sympathectomy did not affect the sensitivity to exogenous ET-1 and histamine of the vascular smooth muscle.

Animals↗
PubMed2002

The influence of chemical sympathectomy on pain responsivity and alpha 2-adrenergic antinociception in neuropathic animals.

We studied the effect of chemical sympathectomy by 6-hydroxydopamine (6-OHDA) on pain behavior and alpha(2)-adrenergic antinociception in rats with a spinal nerve ligation-induced neuropathy. For assessment of alpha(2)-adrenergic antinociception, the rats were treated systemically with two alpha(2)-adrenoceptor agonists, one of which only poorly (MPV-2426) and the other very well (dexmedetomidine) penetrates the blood-brain barrier. Moreover, the effect of MPV-2426 on spontaneous activity of dorsal root nerve fibers proximal to the nerve injury was determined. Systemic treatment with 6-OHDA produced a marked decrease in immunocytochemical labeling of sympathetic nerve fibers in the skin but it produced no marked change in basal pain sensitivity to mechanical stimulation either in neuropathic or sham-operated animals. Systemic administration of MPV-2426 and dexmedetomidine produced a dose-dependent tactile antiallodynic effect in neuropathic animals. Intraplantar injection of MPV-2426 had an identical antiallodynic effect independent of whether it was injected into the neuropathic or contralateral hindpaw. In a test of mechanical nociception and hyperalgesia, dexmedetomidine markedly attenuated pain responses in all experimental groups, whereas MPV-2426 had a weak but significant pain attenuating effect only in neuropathic animals. In the tail flick test, both alpha(2)-adrenoceptor agonists had a significant antinociceptive effect. The pain attenuating effect of MPV-2426 was enhanced by pretreatment with 6-OHDA, except in a test of tactile allodynia. MPV-2426-induced modulation of spontaneous activity was not a general property of dorsal root fibers proximal to the injury. The results indicate that a chemical destruction of sympathetic postganglionic nerve fibers innervating the skin does not markedly influence cutaneous pain sensitivity nor is it critical for the alpha(2)-adrenoceptor agonist-induced attenuation of pain behavior in neuropathic or non-neuropathic animals. Chemical sympathectomy, independent of neuropathy, enhanced the pain attenuating effect by MPV-2426, probably due to a peripheral action, whereas in non-sympathectomized control and neuropathic animals peripheral mechanisms have only a minor, if any, role in the alpha(2)-adrenoceptor agonist-induced antinociception.

Adrenergic alpha-2 Receptor Agonists↗
PubMed1980

Digital artery sympathectomy.

A very distal sympathectomy at the level of the origin of the proper digital arteries has been devised. Four men and four women have been operated on for digital vascular insufficiency due to frostbite, crush injuries, scleroderma, and Raynaud's disease. The operation is done through a palmar approach and the adventitia removed, over a length of 3 to 4 mm, from the proper digital arteries distal to the junction of the distal perforating artery with the common digital artery. Three frostbite victims have done well; their ulcers have healed, pain symptoms have improved, and a skin temperature rise of 1.5 degrees to 2.5 degrees F has persisted over a 17-year follow-up. Two crushed fingers have shown some, but not impressive, permanent symptomatic improvement. Three women had four operations for Raynaud-type disease. Two of the women, 40 and 41 years of age, showed a permanent skin temperature rise of only 2 degrees and 1 degree F, respectively. They showed significant, but not total, pain relief. The third woman, 22 years of age, had atrophic, curled index and thumb nails. After sympathectomy, the nails grew normally, there was significant pain relief, and the patient showed a permanent 3 degrees F rise in skin temperature.

Adult↗
PubMed1986

Thermal changes in a rabbit ear model after sympathectomy.

The long-term cutaneous thermal changes and the degree of sympathetic reinnervation of the vessels after a distal sympathectomy in an experimental model are reported. Under general anesthesia, a distal sympathectomy was performed at the proximal portion of the central artery of a rabbit ear. The contralateral ear served as a control. A dual-channel digital thermometer was used to record periodic cutaneous temperatures in identical positions on the distal third of the ears. Sympathetic reinnervation was assessed with catecholamine histofluorescence in the dead animals. A mean difference in temperature of 1.2 degrees C (P less than 0.01) was recorded 12 months after surgery. All of the sympathectomized ears maintained higher temperatures than their contralateral controls. Arterial sympathetic reinnervation 3 months after surgery was sparse and inconsistent. No increased reinnervation was noted at 12 months.

Animals↗
PubMed1996

Upper dorsal thoracoscopic sympathectomy for palmar hyperhidrosis: improved intermediate-term results.

PURPOSE: The purpose of this study was to examine the immediate and mid-term results of thoracoscopic upper dorsal (T2-T3) sympathectomy for primary palmar hyperhidrosis. METHODS: From June 1993 to October 1994 we performed 106 sympathectomies on 53 patients with palmar hyperhidrosis. Thirty-four female patients and 19 male patients ranging in age from 15 to 44 years, (mean 23.1 years) were studied. Both sides were operated during the same surgical procedure. The T2-T3 ganglia were resected by electrocuting with a hook and were removed for histologic examination. Follow-up for a mean of 19.25 months was obtained on 52 patients (104 operated limbs). RESULTS: All limbs were completely dry at the end of the procedure, and hyperhidrosis did not recur during the whole follow-up period. Short-term postoperative complications (mainly atelectasis, pneumonia, pneumothorax, and hemothorax) occurred in six (11.3%) patients. Long-term sequelae were observed in 43 (81.1%) patients and included Horner's syndrome (9 patients, 17.3%, one side only in each patient), neuralgia (7 patients, 13.5%), and compensatory hyperhidrosis (35 patients, 67.3%). These sequelae were not permanent in all cases, and the degree of severity was variable. Six (11.5%) patients, three of whom regretted being operated, were dissatisfied with their results: one because of Horner's syndrome, one because of persisting neuralgia, and four because of compensatory sweating. CONCLUSIONS: Despite the large number of postoperative long-term sequelae, 88.5% of patients expressed subjective satisfaction from the procedure. Obtaining 100% of dry hands on mid-term follow-up makes this approach rewarding.

Adolescent↗
PubMed1991

[Segmental arterial sympathectomies at the level of the fingers].

The authors relate their experience of thirty digital artery sympathectomies in twenty-four fingers. Ten men and two women were operated: six crush injuries to fingers, three Raynaud's disease and two Buerger disease and one scleroderma. All presented digital vascular insufficiency. The pre-operative arteriogram always revealed more extensive thrombosis than suspected by the clinical symptoms. In this way we performed a segmental arterial sympathectomy depending on the site of the thrombosed artery. The follow-up was five years. The immediate postoperative results were excellent. Five years later the results depended on the nature of the initial disease.

Angiography↗
PubMed1988

Neuralgia following lumbar sympathectomy.

Between March and October 1986, 33 consecutive patients underwent unilateral lumbar sympathectomy in the Thoracic and Cardiovascular Surgical Unit of the Catholic University in Louvain, Belgium. Ten patients experienced postsympathectomy neuralgia. After a single epidural injection of fentanyl, 50 micrograms, and methylprednisolone 80 mg, pain disappeared completely in six patients. Neuralgia recurred in four patients requiring repeat epidural injection with relief of residual symptoms. Epidural infiltration is a reliable treatment for neuralgia after lumbar sympathectomy.

Drug Therapy, Combination↗
PubMed1992

Postural changes in femoral artery blood flow in normal subjects, patients with peripheral vascular occlusive disease and patients undergoing lumbar sympathectomy, measured by duplex ultrasound flowmetry.

Regulatory peripheral vasoconstriction occurs in response to lower limb dependency. In mildly ischaemic limbs these responses are retained but are lost in patients with rest pain. Previously used methods have inherent difficulties when applied during postural change. We studied orthostatic responses in 12 normal subjects (aged 22-74 years, median 52 years) and 16 patients (aged 21-83 years, median 48 years) with mild and severe peripheral vascular disease using a duplex ultrasound flowmeter. In the normal subjects the 60-s mean common femoral artery volume flow values (ml min-1 +/- S.D.) were 77 +/- 83; -78 +/- 116; -190 +/- 136 for elevation, dependency and standing respectively. For claudicants (n = 7) the values were 18 +/- 37; -112 +/- 123; -216 +/- 103, respectively. In rest pain patients (n = 9) the responses were reversed, being -252 +/- 124; 131 +/- 89 and 184 +/- 85. Significant differences were apparent between elevation, dependency and standing flows, in each of the three groups (all p less than 0.0001). The rest pain group displayed characteristically different responses compared with both normal subjects and claudicants, for each postural change (p less than 0.0001 in all cases). Investigation of the dependency response was undertaken in eight further patients with rest pain before and after lumbar chemical sympathectomy and a characteristic pre-sympathectomy response predicted the clinical outcome.

Aged↗
PubMed1994

Transthoracic endoscopic sympathectomy for hyperhidrosis and Raynaud's phenomenon.

Over an 80 month period, 53 transthoracic endoscopic sympathectomies were performed in 34 patients. The indications for surgery were palmar hyperhidrosis in 20 procedures (38%), palmar and axillary hyperhidrosis in eight procedures (15%), Raynaud's phenomenon in 23 procedures (43%), and combined palmar hyperhidrosis and Raynaud's phenomenon in two procedures (4%). Follow-up data, obtained by a self-assessment postal questionnaire, was available for 47 procedures in 30 patients (91%). Fourteen out of 15 procedures (93%) performed for palmar hyperhidrosis, all eight procedures (100%) for palmar and axillary hyperhidrosis and 14 out of 22 procedures (64%) performed for Raynaud's phenomenon produced an immediate improvement in symptoms. These improvements were sustained in 13 procedures (87%) performed for palmar hyperhidrosis, all procedures performed for palmar and axillary hyperhidrosis (100%) but only 10 procedures (45%) performed for Raynaud's phenomenon at a median follow-up of 16, 34 and 44.5 months respectively. There were no deaths nor postoperative Horner's syndrome in these patients. The only minor complications were two small pneumothoraces. Compensatory sweating was observed after 24 procedures (51%). These results confirm that transthoracic endoscopic sympathectomy is a simple, safe and effective procedure. In patients with hyperhidrosis, the results are excellent and prolonged; in patients with Raynaud's phenomenon, immediate improvement can be achieved but the symptoms may return with time.

Adolescent↗
PubMed2000

Case study to illustrate a multidisciplinary approach to a case of critical limb ischaemia and the role of chemical lumbar sympathectomy.

This case study illustrates the role of the Podiatrist in the primary health care team and how a multidisciplinary approach to treatment promotes successful diagnosis and treatment regimes. It also outlines the role for chemical lumbar sympathectomies in treating critical lower limb ischaemia, a procedure regarded as having been superseded by more effective treatments but which proved to be the treatment of choice in this case. The subject of this case study presented at a community podiatry clinic exhibiting the signs of acute ischaemia, together with two recently developed ulcers on her right foot. After further vascular investigations, including angiograms and doppler studies, a blockage in the popliteal artery was revealed. Due to anatomically slender arteries, angioplasty and by-pass surgery were contra indicated. A chemical lumbar sympathectomy was performed in an attempt to increase blood flow to the tissues and to reduce the extreme pain being experienced by the patient. This proved successful, allowing the lesions to heal and also the collateral circulation to develop, resulting in a re-vascularized, viable foot.

Female↗
PubMed1996

Total intravenous anesthesia and high-frequency jet ventilation during transthoracic endoscopic sympathectomy for treatment of essential hyperhidrosis palmaris: a new approach.

OBJECTIVE: To evaluate the effects of high-frequency jet ventilation (HFJV) applied to both lungs on hemodynamic parameters, oxygenation, and operating conditions during bilateral videothoracoscopic sympathectomy. DESIGN: A prospective, unblinded study. SETTING: An ambulatory surgical unit at a university medical center. PARTICIPANTS: 30 patients (11 men, 19 women), ASA status 1. INTERVENTION: Bilateral videothoracoscopic sympathectomies were performed using total intravenous anesthesia with propofol, alfentanil, and atracurium, and the patients were ventilated with an oxygen-air mixture using HFJV delivered to both lungs with a Hi-Lo Jet tracheal tube (Mallinckrodt). MEASUREMENTS AND MAIN RESULTS: Mean total anesthesia time was 55 +/- 13 minutes. Hemodynamic parameters remained stable during surgery, although ablation of the sympathetic ganglia induced three incidences of bradycardia (10% of the patients), which were responsive to atropine. Four patients developed oxygen desaturation (Sa O2 < 90%) after the creation of the pneumothorax. Surgical conditions were considered excellent by the surgeons. Concerning postoperative complications, a temporary Horner's syndrome was observed in one patient. Another patient had a mild residual pneumothorax on the first postoperative day that resolved without insertion of a chest tube. CONCLUSIONS: It was concluded that HFJV applied to both lungs is an easy and safe anesthetic technique that provides excellent surgical conditions and causes a minor incidence of morbidity.

Adolescent↗
PubMed1996

Near-sitting position and two-lung ventilation for endoscopic transthoracic sympathectomy.

OBJECTIVE: To control for hypoxemia during endoscopic transthoracic sympathectomy, usually by using double-lumen tube and one-lung ventilation, a different anesthetic technique was adopted. DESIGN: A prospective clinical study. SETTING: A university-affiliated medical center. PARTICIPANTS: Twenty-one adult patients (10 male and 11 female) between 15 and 44 years of age (mean, 22 years), ASA (American Society of Anesthesiologists) physical status I and II, participated in the study. INTERVENTIONS: Under general anesthesia, a single-lumen endotracheal tube was inserted. The radial artery was cannulated for blood pressure monitoring and blood gas sampling. Patients were gradually raised from a supine position to 60 to 70 degrees from the horizontal plane. Mean fractional inspiratory O2 ratio was 0.4 +/- 0.02 (mixture of O2 and air) throughout the operation. Blood gas samples were taken during two-lung ventilation before surgery, at each one-chest operation, and when switching between the operated chest sides. An artificial pneumothorax was established by insufflation of CO2, the sympathetic chain coagulated, the pneumothorax released, and the lung reinflated. MEASUREMENTS AND MAIN RESULTS: Comparisons were performed using one-way analysis of variance and the Bonferroni post-test. Arterial O2 partial pressure at right- and left-chest operation were 209 +/- 83 and 189 +/- 63 mmHg, respectively, compared with 227 +/- 43 and 241 +/- 69 mmHg on two-lung ventilation before and during surgery, respectively. O2 saturation, arterial CO2 partial pressure, bicarbonate, base excess, peak inspiratory pressure, and hemodynamic parameters (in most patients) did not change throughout the operation. CONCLUSIONS: The near-sitting position, a single-lumen tube, and a continuous two-lung ventilation technique is simple and may prevent hypoxemia during endoscopic transthoracic sympathectomy.

Adolescent↗
PubMed2001

Transthoracic endoscopic T-2, 3 sympathectomy for facial hyperhidrosis.

Twenty-five patients (20 men and 5 women) with the chief complaint of facial hyperhidrosis were treated by transthoracic endoscopic T-2, 3 sympathectomy. All patients were essentially in good health except the embarrassment of facial sweating. Fifteen of them also suffered from distressing palmar hyperhidrosis. The ages ranged from 18 to 40 years (mean age 25 years). All of them except two obtained a satisfactory improvement of facial hyperhidrosis after 3 months to 2 years of follow-up. One man demonstrated very mild ptosis in the right eye. Pre- and postoperative sympathetic skin response (SSR) revealed the absence rate from 20% to 72% with electrical stimulation (p < 0.05). This study shows that T-2, 3 sympathectomy is a choice of treatment for facial hyperhidrosis and sympathetic supply to the face may at least partly be from T-2, 3 level.

Adolescent↗
PubMed1999

Differential effects of chemical sympathectomy on expression and activity of tyrosine hydroxylase and levels of catecholamines and DOPA in peripheral tissues of rats.

Tyrosine hydroxylase (TH) mRNA and activity and concentrations of 3,4-dihydroxyphenylalanine (DOPA) and catecholamines were examined as markers of sympathetic innervation and catecholamine synthesis in peripheral tissues of sympathectomized and intact rats. Chemical sympathectomy with 6-hydroxydopamine (6-OHDA) markedly decreased norepinephrine and to a generally lesser extent TH activities and dopamine in most peripheral tissues (stomach, lung, testis, duodenum, pancreas, salivary gland, spleen, heart, kidney, thymus). Superior cervical ganglia, adrenals and descending aorta were unaffected and vas deferens showed a large 92% decrease in norepinephrine, but only a small 38% decrease in TH activity after 6-OHDA. Presence of chromaffin cells or neuronal cell bodies in these latter tissues, indicated by consistent expression of TH mRNA, explained the relative resistance of these tissues to 6-OHDA. Stomach also showed consistent expression of TH mRNA before, but not after 6-OHDA, suggesting that catecholamine synthesizing cells in gastric tissue are sensitive to the toxic effects of 6-OHDA. Tissue concentrations of DOPA were mainly unaffected by 6-OHDA, indicating that much of the DOPA in peripheral tissues is synthesized independently of local TH or sympathetic innervation. The differential effects of chemical sympathectomy on tissue catecholamines, DOPA, TH mRNA and TH activity demonstrate that these variables are not simple markers of sympathetic innervation or catecholamine synthesis. Other factors, including presence of neuronal cell bodies, parenchymal chromaffin cells, non-neuronal sites of catecholamine synthesis and alternative sources of tissue DOPA, must also be considered when tissue catecholamines, DOPA and TH are examined as markers of sympathetic innervation and local catecholamine synthesis.

Animals↗
PubMed1990

Differential effects of electrical stimulation of the dorsal raphe nucleus and of cervical sympathectomy on serotonin and noradrenaline concentrations in major cerebral arteries and pial vessels in the rat.

The levels of noradrenaline (NA), serotonin (5-HT), and 5-hydroxyindoleacetic acid were measured by HPLC and compared between the large arteries of the circle of Willis and the small pial vessels in the rat, following either electrical stimulation of the dorsal raphe nucleus or bilateral superior cervical ganglionectomy. With electrical stimulation, the 5-HT concentrations were reduced (-48%) in the small pial vessels, but were unchanged in the major cerebral arteries. NA concentrations were dramatically reduced following cervical sympathectomy in the large arteries (-77%), though the reduction was less pronounced (-34%) in the small vessels. Sympathectomy caused a significant decrease in the 5-HT concentration of the major cerebral arteries (-33%), but was without effect on the 5-HT levels of the small pial vessels. These results show that an appreciable fraction of the perivascular 5-HT measured in the small pial and the large cerebral arteries originates from different sources.

Animals↗
PubMed1978

Study of chemical sympathectomy in endotoxin-induced lethality and fibrin depostion.

Shock and the generalized Shwartzman reaction are well known features of endotoxin which have been shown to involve the sympathetic nervous system. The mechanism of sympathetic nervous system involvement with endotoxin injection was studied in rabbits chemically sympathectomized with 6-hydroxydopamine. Endotoxin, in doses producing a spectrum of morbidity and mortality in normal rabbits, was administered i.v. to chemically sympathectomized, normal, and unilateral renal surgically sympathectomized animals. Chemical sympathectomy produced a significant depletion of tissue norepinephrine which, in endotoxin recipient animals, was associated with a significantly lower mortality rate and greatly decreased fibrin deposition in the lungs and kidneys, despite intravascular coagulation. Unilateral renal sympathectomy afforded protection to the ipsilateral kidney, but data on mortality and systemic fibrin deposition were similar to those reported for normal rabbits given endotoxin. Six-hydroxydopamine prevents significant tissue injury secondary to endotoxin in this experimental model. In addition, the data provide direct evidence that an intact reactive sympathetic nervous system is essential for development of lethal toxicity and generalized Shwartzman reaction due to endotoxin.

Animals↗
PubMed2004

Sympathectomy reveals alpha 1A- and alpha 1D-adrenoceptor components to contractions to noradrenaline in rat vas deferens.

We have previously demonstrated that contractions of rat vas deferens to exogenous noradrenaline involve predominantly alpha(1A)-adrenoceptors, but that contractions to endogenous noradrenaline involve predominantly alpha(1D)-adrenoceptors. In this study, we have examined the effects of sympathectomy on the subtypes of alpha(1)-adrenoceptor in rat vas deferens in radioligand binding and functional studies. In vehicle-treated tissues, antagonist displacement of [(3)H]prazosin binding to alpha(1)-adrenoceptors was consistent with a single population of alpha(1)-adrenoceptors. Binding affinities for a range of alpha(1)-adrenoceptor antagonists were expressed as pK(i) values and correlated with known affinities for alpha(1)-adrenoceptor subtypes. The correlation was significant only with alpha(1A)-adrenoceptors. In tissues from rats sympathectomised with 6-hydroxy-dopamine (2 x 100 mg kg(-1) i.p.), binding affinity for the alpha(1D)-adrenoceptor antagonist BMY 7378 fitted best with a two-site model. In functional studies, the potency of noradrenaline at producing total (phasic plus tonic) but not tonic contractions was increased in tissues from sympathectomised rats. Results obtained from sympathectomised rats suggest that phasic contractions are mainly alpha(1D)-adrenoceptor mediated, whereas tonic contractions are mainly alpha(1A)-adrenoceptor mediated, based on the effects of BMY 7378 and the alpha(1A)-adrenoceptor antagonist RS 100329. It is concluded that the predominant alpha(1)-adrenoceptor in vehicle-treated rat vas deferens is the alpha(1A)-adrenoceptor, both in terms of ligand binding and contractions to exogenous agonists. The alpha(1D)-adrenoceptor is only detectable by ligand binding following chemical sympathectomy, but is involved in noradrenaline-evoked contractions, particularly phasic contractions, of rat vas deferens.

Adrenergic alpha-1 Receptor Antagonists↗