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PubMed2003

Scintigraphic and ultrasonographic assessment of the effect of lumbar sympathectomy upon chronic arteriosclerotic ischaemia of lower extremities.

The aim of the study was an evaluation of the effect of onesided lumbar sympathectomy in patients with peripheral vascular disease of lower extremity(ies), using perfusion scintigraphy with (99)mTc-MIBI and ultrasound Doppler blood flow-rate measurements. A secondary aim was a comparison of the diagnostic efficacy of the two techniques applied. The study was performed on 30 patients, studied prior to and early after one-sided lumbar sympathectomy. The scintigraphy yielded results indicating a statistically significant increase in perfusion of femoral and calf muscles (p < 0.001). Ultrasound investigation demonstrated significant (p < 0.001) increase of the maximal blood flow rate in the popliteal artery. Scintigraphic perfusion study yielded better agreement with the clinical evaluation than the ultrasound Doppler technique (83 v. 47 per cent, p < 0.01) and higher sensitivity in demonstration of improved blood supply (88 v. 36 per cent, p < 0.001).

Adult↗
PubMed2003

[The effects of heat stimulation and cold stress on the rats with cervical sympathectomy].

BACKGROUND: To investigate the general action of stellate ganglion block (SGB), we examined the effects of heat stimulation and cold stress on the behavior and stress hormone of the bilateral cervical sympathectomy rats as a long-term and repeated SGB model. METHODS: Wistar's male rats were divided into three groups: control (C), sham operation (S) and sympathectomy (Sx) groups. After 2 weeks, two experiments were done. One was measurement of escape response time from the heat stimulus and the other was hormone measurement. Serum adrenocorticotropic hormone (ACTH), alpha-melanocyte stimulating hormone (alpha-MSH) and beta-endorphine (beta-END) levels were measured assigning 3 groups to 2 subgroups with and without cold stress. RESULTS: Escape response time was significantly extended in the Sx group. ACTH in the Sx group was significantly higher than in other groups, but changes of ACTH by cold stress were similar in 3 groups. In the Sx group alpha-MSH was hardly changed by cold stress while alpha-MSH was significantly decreased in the S group. Changes of beta-END by cold stress were similar in the S and Sx groups. CONCLUSIONS: These results suggest that SGB works systemically through hypothalamus endocrine system and affects stress hormone differently.

Adrenocorticotropic Hormone↗
PubMed2003

Early experience with thoracoscopic sympathectomy for palmar hyperhidrosis.

Excessive craniofacial, palmar and axillary hyperhidrosis can be very distressing in young people, especially in hot climates. In this study, we are presenting our operative experience and the long-term effect of the technique of thoracospic electrocoagulation of the thoracic sympathetic chain in the treatment of this condition. We reviewed the results of 22 thoracoscopies performed on 16 patients at Asir Central Hospital in Abha, Saudi Arabia during the period from January 1999 to December 2002. The patients were 11 males and five females with a mean age of 26.9+/-5 years (range 19-35 years). Except for one patient who presented with post-traumatic, left upper limb chronic regional pain syndrome (CRPS), the rest presented with craniofacial, palmar and axillary hyperhidrosis. In the first 10 patients, sympathectomy was performed unilaterally and in the following six patients it was performed bilaterally in the same sitting. While pneumothorax occurred in three patients (19%), only one patient (6%) required chest tube insertion. During the mean follow-up period of 25.6+/-14.2 months (range 4-47 months), only one patient (6%) presented with recurrent left axillary hyperhidrosis. The patient underwent another thoracoscopy which failed due to lung adhesions and required subcutaneous electrocautery of the sweat glands. In conclusion, thoracoscopic sympathectomy is very effective (94%) in the treatment of palmar and axillary hyperhidrosis with no mortality, minimal morbidity and durable long-term effect.

Adult↗
PubMed2004

Parry-Romberg syndrome and sympathectomy--a coincidence?

Parry-Romberg syndrome is a clinical entity consisting of progressive hemifacial atrophy appearing at a young age. Animal studies indicate that sympathectomy can produce hemifacial atrophy. To our knowledge, this is the first report of a patient with a possible association between Parry-Romberg syndrome and thoracoscopic sympathectomy.

Adolescent↗
PubMed2004

[A new method of performance of thoracic sympathectomy, based on the analysis of peculiarities of anatomical architecture of cervicothoracic sympathetic stem].

Peculiarities of anatomic structure (disposition, form, size) of stellate ganglion, II and III thoracic sympathetic ganglions together with their branches were suggested. There were established their morphological differences. Peculiarities of anatomical structure of the "lateral branch" II sympathetic ganglions were studied, its role in occurrence of the disease recurrence after performance of the thoracic sympathectomy performance was proved. Basing on the results achieved the method of thoracoscopic sympathectomy performance for Raynaud's phenomenon was elaborated.

Humans↗
PubMed2005

[Reparative regeneration of nerve fibers after sympathectomy: an experimental study].

The results of sympathectomies depend on the degree of regeneration of the sympathetic nerve trunk: the quicker the onset of regeneration the less remarkable the effect of operation. The aim of our experimental study WPS to examine the rate of regeneration of sympathetic nerve fibers softer different sympathectomy techniques (resection, electrocoagulation and cryodestruction of the part of the sympathetic nerve trunk) following 6 and 12 months. Nine random-bred rabbits were used (Central Research Laboratory, Urals State Medical Academy) to examine the rate of regeneration of the sympathetic nerve trunk contained by the vascular-nervous bundle of rabbit ear. Altogether 18 nerve sympathetic trunks were examined. The rate of regeneration was measured by morphometry. While examining the processes of reparative regeneration of the nerve fibers after resection, electrocoagulation and cryodestruction, account was taken of the changes in their quantity, diameter and degree of myelinization over time. The study of the morphologic picture during comparative analysis of regeneration made on different models of nerve derangement has demonstrated that after resection and electrocoagulation of the sympathetic trunk the process of regeneration proceeds most slowly. On cryogenic injury to the nervous tissue when only nerve fibers are damaged and connective tissue membranes preserve their anatomic integrity, there are created most favourable conditions for regeneration. Toward 12 months after cryodestruction the bundles of nerve fibers acquire an identical diameter, with predominance of the population of thick nerve fibers, and appear mature enough. After electrocoagulation the fibers contained by the bundles are different in diameter, with the predominance of medium-diameter fibers whereas the thick nerve fibers are not many. After resection the thick nerve fibers are lacking whereas the medium-diameter bundles contain myelinated nerve fibers, with the maintenance of the selective decay of the myelin membrane.

Animals↗
PubMed1992

Effect of perivascular sympathectomy on distal blood flow in the rabbit forepaw. A dynamic isotope experiment with Tc99m.

Perivascular sympathectomy, used for treating patients suffering from vasospastic disorders of the hand, is believed to cause an increase in the distal blood flow. Its effects were examined here by performing the operation on the metacarpal arteries of the left forepaw of ten New Zealand White rabbits, the right forepaw serving as a control. Blood flow was measured by Tc99m radionuclide angiography five days before the operation and three days and two and a half weeks after it. There was no statistically significant postoperative increase in blood flow in the distal parts, so that it may be concluded that at least in this experimental model, the distal sympathectomy did not have any such effect.

Animals↗
PubMed2006

[Method of laser Doppler-flowmetry in the assessment of efficiency of sympathectomy in patients with upper extremity ischemia].

Changes to microcirculation were analyzed in 61 patients after 76 upper-chest sympathectomies. Rheovasography, transcutaneous determination of partial oxygen pressure in the tissues, laser Doppler-flowmetry were performed to evaluate the microcirculation. The data obtained give evidence of a significantly better microcirculation after the upper-chest sympathectomy.

Adult↗
PubMed2006

Retroperitoneoscopic lumbar sympathectomy for nonreconstructable arterial occlusive disease.

AIM: The aim of this study was to present our experience with video-assisted lumbar sympathectomy for non-reconstructive arterial occlusive disease in a series of 23 consecutive patients whose predominant symptoms were unilateral rest pain, limited skin ulcerations or gangrene of the toes. METHODS: All the procedures were performed with retroperitoneal approach, dorsal position of the patient and simple digital dissection of the retroperitoneal space. RESULTS: The operations were successfully performed in all patients except for 2, who immediately underwent open conversion. A urinoma caused by ureteral lesion was the only severe complication in this series. The mean operative time of the procedure was 55 min and the hospital stay was 2 or 3 days. No parenteral analgesics were administered postoperatively. At 1 month from operation, 20 patients out of 23 had significant relief of rest pain and improvement of ischemic lesions. After a median follow-up of 36 months, 2 patients had died, 4 underwent some type of distal amputation, 1 had recurrent rest pain and the other 16 reported persistent improvement of pain or dystrophic changes. CONCLUSIONS: Retro-peritoneoscopic technique appears the modern and less invasive version of the lumbar surgical sympathectomy.

Aged↗
PubMedDate not supplied

Intraarterial perfusion of prostaglandin E1 after lumbar sympathectomy or reconstruction on femoropopliteal segment.

Out of 100 patients treated by intraarterial perfusion of prostaglandin E1 we selected 36 cases who have been treated after a lumbar sympathectomy or reconstruction on the femoro-popliteal segment. The patients were in the III and IV stage of occlusive diseases by Fontain. All patients were divided into four groups: (a) prostaglandin E1 after a lumbar sympathectomy (20); (b) prostaglandin E1 after failed femoro-popliteal bypass (8); (c) prostaglandin E1 with patent femoro-popliteal bypass and distal progression of the occlusive disease (3); (d) prostaglandin E1 with previously femoro-popliteal reconstruction and poor run off (5). After intraoperative introduction of a catheter into the superficial femoral artery, profunda femoral artery (a, b), a patent graft (c) or just implanted graft (d), a continuous intraarterial perfusion of prostaglandin E1 was applied, in doses 10 nanograms/kg body weight/minute, in total doses 3000 nanograms. The perfusion time was 48-72 h. The patients were controlled immediately after treatment as well as 1, 3, 6 and 12 months after. Our early and late results of the intraarterial perfusion of prostaglandin E1 proved as a very successful limb salvage procedure.

Alprostadil↗
PubMed1991

[Chemical lumbar sympathectomy].

After an account of historical facts the authors describe the technique of chemical lumbar sympathectomy. A 7.5% phenol solution in glycerol was used (7.5 ml). At the Surgical Clinic of the Institute for Postgraduate Medical Training of the Regional Hospital with Policlinic in Ostrava chemical lumbar sympathectomy was performed in 22 patients. No complications were observed during operation and during the postoperative period and in all patients the effect was favourable.

Humans↗
PubMed1991

[Proliferative reaction of the epithelium of gastric glands to vagotomy and sympathectomy].

By means of autoradiography and metaphase arrest technique 24-hour rhythms and intensity of proliferative processes in the epithelium of gastric glands were studied, as well as morphometric status of these structures after vagotomy and drug sympathectomy in the rat. In both cases the reaction of glandular epithelium appeared with the increase of mitotic activity and the decrease of cell synchronization before the entry into DNA--synthesis and mitosis. The number of epithelial cells in gastric glands became reduced, but after vagotomy, unlike sympathectomy, mainly because of the lack of chief cells. Thus, the trophic control upon the dynamic structure of gastric glands may have different mechanisms of realization for parasympathetic and sympathetic nervous system, probably, through the influence on cell proliferation or differentiation.

Animals↗
PubMed1991

[Characteristics of blood distribution in the tissues of the lower extremities after lumbar sympathectomy].

By means of a polarographic method, the peculiarities of blood distribution in the tissues of the lower extremities in 34 patients with obliterative atherosclerosis and in 29--with obliterative endarteritis after sympathectomy were studied. In successful intervention, the prognostically significant increase in oxygen tension in the muscles at the level of crura and feet was noted. It is suggested to use this test under conditions of medicinal ganglionectomy with the aim of prognostication of the effectiveness of the forthcoming lumbar sympathectomy.

Adult↗
PubMed1990

[Role of renin-angiotensin system and vasopressin in the control of blood pressure in genetically hypertensive rats after sympathectomy].

Early chronic sympathectomy does not normalize blood pressure (BP) in genetically hypertensive rats of the Lyon strain (LH). The purpose of this study was to examine the role of the renin angiotensin system (RAS) and vasopressin in the residual hypertension exhibited by LH sympathectomized rats. Chronic sympathectomy was achieved by treating male LH and control normotensive LN rats with guanethidine sulfate between 1 and 13 weeks of age (60 mg/kg daily from day 7 after birth to day 25, 30 mg/kg daily from day 26 to day 70 and 30 mg/kg every other day from day 71 to day 90). At 14 weeks of age, catheters were inserted into the lower abdominal aorta and inferior vena cava via the left femoral artery and vein. After 2 days of recovery, BP was continuously recorded in the conscious freely moving animals during 3 consecutive 1-hour periods: before and after administration of either an angiotensin converting enzyme inhibitor (perindopril 2 mg/kg i.v.) or a selective vascular vasopressin antagonist [beta-mercapto- beta,beta-cyclopentamethylenepropionyl1, O-Me-Tyr2, Arg8-vasopressin, AVPX 10 micrograms/kg i.v.) and finally after conjoint administration of both drugs. At the end of each period, the efficacy of blockade was verified by the disappearance of pressor responses to respective agonists (angiotensin I 150 ng/kg i.v., Arg8-vasopressin 10 ng/kg i.v.). Chronic treatment with guanethidine resulted in the disappearance of pressor responses to tyramine (250 micrograms/kg i.v.) indicating complete functional denervation of the vessels. Under basal conditions, the 1-hour average value of mean BP (MBP) was higher in LH than in LN sympathectomized rats (134 +/- 3 vs 104 +/- 2 mmHg, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

[Pain after sympathectomy].

Surgical sympathectomies and chemical sympatholyses bring about a true sympathetic deafferentation. This leads to central retrograde degenerescence reactions of the pre-ganglionic neurons, to a reduction of the muscular tone and to a secondary neurovascular disorder at the edge of the sympathetic denervation zone. In a limited number of cases, a radiculalgia-like functional painful syndrome may develop. There are variations in the degree of seriousness and evolution, but the outcome is always spontaneously favourable. Forty seven cases of radiculalgias are reported; the onset is sudden, most often at night, and the untoward effects gradually wear off with the recovery of some degree of peripheral vasomotor tone. Although classical antalgic therapies do not seem to affect the spontaneous evolution of this syndrome, the use of membrane stabilizers such as nifedipine does however induce an immediate functional improvement of the neurovascular disorders. This leads to a dramatic sedation of the pain, provided calcium inhibitors were not administered prior to the sympathectomy.

Aged↗
PubMed1990

[Our experience of lumbar chemical sympathectomy in arterial occlusive diseases of the lower limbs].

One hundred and sixty two phenol chemical sympathectomy were achieved from 1982 to 1987. After one month and one year, 92 patients get a lasting improvement. The benefit is better for rest pain relief than for intermittent claudication and skin lesions of legs. Diabetic ischaemic disease increased risk of failure of sympathetic block. Results of chemical sympathectomy are similar to the surgical procedure and the incidence of complications is lower. It is concluded that the neurolytic block will be a satisfying experience in patients with obliterative arterial disease not suitable for vascular surgery.

Adult↗
PubMed1990

Orthostatic hypotension caused by sympathectomies performed for hyperhidrosis.

We studied sympathetic cardiovascular control in a patient after sympathectomies and found severe hypoadrenergic orthostatic hypotension before and after, but not during upright exercise. This report is the first to correlate in man anatomical sympathetic lesions with autonomic function test results and to document that in a sequence of sympathectomies orthostatic hypotension does not develop until the major part of splanchnic sympathetic outflow is destroyed.

Adult↗