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PubMed1985

Blood flow, sympathetic activity and pain relief following lumbar sympathetic blockade or surgical sympathectomy.

The physiological effects of local anaesthetic (bupivacaine), neurolytic (phenol) blockade and surgical ablation of the lumbar sympathetic chain were assessed in patients with peripheral vascular disease or sympathetic dystrophy. Local anaesthetic blockade in 49 patients resulted in significant decrease in pain, plantar sweating and in the vasoconstrictor ice response of the foot, as well as a significant increase in skin temperature and foot blood flow. Subsequent neurolytic blockade in 31 of these patients achieved an effective denervation as assessed by the same physiological measurements. The magnitude of changes in blood flow and sympathetic activity were similar for local anaesthetic and neurolytic blockade as well as in six patients who underwent surgical sympathectomy.

Adult↗
PubMed1991

Percutaneous lumbar sympathectomy: a comparison of radiofrequency denervation versus phenol neurolysis.

A new percutaneous approach to sympathectomy using radiofrequency denervation has seemed to offer longer duration and less incidence of postsympathetic neuralgia as compared to phenol sympathetic blocks. To compare these techniques, 17 patients underwent either phenol lumbar sympathetic blocks (n = 9) or radiofrequency denervation (n = 8). Duration of sympathetic block was followed by a sweat test and temperature measurements. Results indicate that 89% of patients in the phenol group showed signs of sympathetic blockade after 8 weeks, as compared to 12% in the radiofrequency group (P less than 0.05). Although the incidence of post sympathetic neuralgia appears to be less with radiofrequency denervation, further refinement of needle placement to ensure complete lesioning of the sympathetic chain will be required before the technique can offer advantages over current phenol techniques.

Adult↗
PubMed2003

Reversible cardiac sympathectomy by high thoracic epidural anesthesia improves regional left ventricular function in patients undergoing coronary artery bypass grafting: a randomized trial.

HYPOTHESIS: To evaluate the effects of high thoracic epidural anesthesia (TEA) on global and regional myocardial function and on perioperative coronary risk in patients undergoing coronary artery bypass grafting. DESIGN, SETTING, AND PATIENTS: Prospective and randomized clinical trial blinded for the primary outcome measure of 73 patients scheduled for coronary artery bypass grafting who had a left ventricular ejection fraction of 50% or more conducted from February 1, 2000, through August 31, 2000, at University Hospital, Münster, Germany. INTERVENTIONS: Of 73 randomized patients, 37 were control subjects (who received general anesthesia only) and 36 were in the group who received general anesthesia and high TEA. MAIN OUTCOME MEASURES: The primary outcome measure was regional left ventricular function after myocardial revascularization, assessed by transesophageal echocardiography. We further determined the plasma concentrations of cardiac troponin I and atrial and brain natriuretic peptides. Secondary outcome measures were postoperative complications recorded to 14 days and mortality recorded to 720 days. RESULTS: High TEA was effective in all patients of this group, the somatosensory block extended from T1 through T7 vertebrae. Regional left ventricular function was significantly improved (mean [SD] global wall motion index, 0.74 [0.18] vs 0.38 [0.16]; P<.05), and cardiac troponin I concentrations were reduced by 72% (mean [SD], 5.7 [1.5] vs 1.6 [0.7] ng/mL, P<.05) in patients with high TEA. Natriuretic peptide concentrations peaked during reperfusion (atrial natriuretic peptide) and 24 hours after reperfusion (brain natriuretic peptide). High TEA reduced the mean (SD) peak concentrations of atrial natriuretic peptide by 54% (211 [63] vs 98 [33] ng/mL, P =.03) and brain natriuretic peptide by 43% (189 [39] vs 108 [21] ng/mL, P =.01). One of 36 patients who received high TEA and 3 of 37 controls died. CONCLUSIONS: Reversible cardiac sympathectomy by high TEA improves regional left ventricular function and reduces postoperative ischemia after coronary artery bypass grafting. These effects of high TEA may improve the long-term outcome after myocardial revascularization.

Anesthesia, Epidural↗
PubMed1978

Muscle and subcutaneous oxygen tension. Measurements by mass spectrometry after sympathectomy.

Utilizing the mass spectrometer, tissue oxygen tension (TPO2) in the resting state was measured in the extremities of ten dogs before and after lumbar sympathectomy. Although there was considerable variation between individual dogs, significant changes in tissue oxygenation were not consistently obtained in the group as a whole, althouth femoral arterial blood flow increased in all animals. Using TPO2 changes to estimate perfusion, no significant increase in nutritive flow could be demonstrated.

Animals↗
PubMed1982

Effects of guanethidine-induced sympathectomy on morphology of the pre- and postclosure ileum of the neonatal rat.

The disappearance of the characteristic supranuclear vacuole and extensive apical canalicular system from enterocytes of the ileal villi occurs during the third postnatal week in rats. This phenomenon is associated with loss of permeability of these cells to macromolecules and is therefore termed closure. The present study was designed to analyze the influence of neonatal guanethidine (GTN)-induced sympathectomy on the morphology of the pre- and postclosure ileum of the rat. Light and electron microscopy of control and GTN-sympathectomized rats demonstrated the retention of immature, vacuolated cells on ileal villi as late as 23 days postnatally in GTN-treated rats. Villi from control rats contained only adultlike nonpermeable cells. Electron microscopy further demonstrated no structural differences in the apical canalicular system or storage vacuoles of the delayed cells in GTN rats when compared to the ileal epithelium from preclosure time periods (7 and 15 days) in both GTN-sympathectomized and control rats. Goblet cells were counted on Periodic-Acid-Schiff-stained sections of ileum from 7, 15, and 23-day GTN and control rats. The percentage of goblet cells in the total epithelial cell population of the villus was significantly higher in control versus GTN rats at all time periods. The percentage of goblet cells increased in both groups from day 7 to 15. However, closure in the control group (approximately day 18) was coincident with a steep increase in the percentage of ileal goblet cells which was not evident in the goblet-cell population of the GTN villus. This pattern of change in control versus GTN goblet-cell production was correlated with a similar pattern of variation in the number of crypt cell mitoses between the two groups over the same time period.

Aging↗
PubMed1981

Peripheral Nerve unmyelinated axons following lumbar sympathectomy.

One year after bilateral lumbar sympathectomy for Raynaud's syndrome, a young woman underwent fascicular biopsy of the sural nerve to help elucidate the cause of lower limb pain. The morphological features, density, and diameter spectrum of unmyelinated fibers were normal. The sympathetic nervous system appears to contribute few, if any, axons to the total population of unmyelinated axons in this cutaneous nerve.

Adult↗
PubMed2005

Receptor binding occurrence and plasma levels of natriuretic peptides in response to sympathectomy.

In the present investigation the relationship between the sympathetic nervous system and the endocardial levels of receptor binding sites for natriuretic peptides and the plasma content of atrial natriuretic peptide were analyzed in rats. In order to destruct the cardiac sympathetic nerve terminals, chemical sympathectomy with 6-hydroxydopamine was made in parallel with intravenous measurements of blood pressure and heart frequency. By use of immunohistochemical and enzyme-linked-immunosorbent techniques the expression of tyrosine hydroxylase-positive sympathetic nerve terminals and plasma levels of pro-atrial natriuretic peptide were determined, respectively. The occurrence of receptor binding sites for natriuretic peptides was examined by in vitro receptor autoradiography. In contrast to the marked occurrence of natriuretic peptide receptor binding sites seen in the ventricular endocardium of control rats, the sympathectomized rats exhibited a decreased number of binding sites for natriuretic peptides in the endocardium of both the right and left chambers. Interestingly, this was found in parallel with a significant decrease of systolic and diastolic blood pressure and increased plasma levels of pro-atrial natriuretic peptide in the treated group of rats. These findings, together with those in previous studies, give support to an idea that one part of the blood pressure-decreasing effects, seen in patients treated with beta-adrenergic blockade, might be through a reduction of the natriuretic clearance receptor C, then giving rise to increased levels of atrial natriuretic peptide.

Animals↗
PubMed1995

Effects of unilateral cranial sympathectomy either alone or with sensory nerve sectioning on pedicle growth in red deer (Cervus elaphus).

In a previous study (Li et al. [1993], J. Exp. Zool., 267:188-197) sensory nerve sectioning had no effect on the timing of pedicle growth. The aim of the present study was to determine whether sensory nerve sectioning in conjunction with sympathectomy would influence pedicle growth. Twelve intact male red deer calves were allocated to treatment before any pedicle growth as follows: 1) unilateral sensory nerve removal (USX, n = 5), 2) unilateral superior cervical ganglionectomy (SGX, n = 4), or 3) both USX and SGX (SG/USX, n = 3). The calves were observed weekly. In all cases the untreated side was the control. Pedicle initiation was measured with a pedicle detector and after initiation, growth was measured with a ruler. When the treated pedicles reached a length of 60 mm the calves were killed and tissues from the pedicle were examined immunohistochemically for nerves. No large bundles of nerves were observed in the treated pedicle although a few fine fibres were present. All calves grew pedicles. There were no significant differences in the timing of pedicle initiation either within treatment or between treatments. All denervated pedicles grew faster than controls and were consequently higher at examination. The fact that pedicle growth took place despite reduced innervation indicates that a continuous neural connection is not a pre-requisite for normal pedicle growth.

Animals↗
PubMed1991

Endoscopic thoracic sympathectomy: evaluation of pulsatile laser, non-pulsatile laser, and radiofrequency-generated thermocoagulation.

We describe a modified technique for percutaneous denervation of the thoracic sympathetic chain by laser to treat selected cases of sympathetic causalgia of the upper extremities. The technique involves transpleural ablation with laser under thoracoscopic guidance through the second or third intercostal space-anterior axillary line. We also compare four different modalities of endoscopic denervation: A xenon chloride excimer laser (308 nm, 35 mJ/pulse, 20 pulses/sec, 2.2 mm catheter tip), CO2 laser (14 W, CW, 2 mm spot size), Nd:YAG laser (88 W, CW, 3 mm spot size), and radiofrequency-generated thermocoagulation (3 W, CW, 2.1 mm catheter tip) by performing bilateral thoracic sympathectomy on 12 mongrel dogs (three dogs each). Criteria analyzed included duration of exposure, power density, total energy output, laser penetration and spread, gross morphology, and scanning electron microscopy (SEM) of the destroyed neural tissue. Total ablation of the inferior segment of the stellate ganglion and the T1-T2 nerve roots by excimer laser required 83 +/1 1 Joules over an exposure period of 118 seconds. Ablation by CO2 and Nd:YAG laser required 153 +/- 13 Joules and 554 +/- 47 Joules delivered over 11 and 6 seconds respectively. In contrast, ablation of the same volume of nerve tissue by RF required 810 +/- 50 Joules over 270 seconds. SEM evaluation revealed that excimer and CO2 laser lesions were narrower in configuration compared to RF and Nd:YAG lesions which showed more lateral spread. The actual depth of penetration per 1 second exposure was similar for Excimer and CO2 (1.5 mm) and RF (1.3 mm), but deeper for Nd:YAG (3 mm).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1997

Acetylcholinesterase monoclonal antibody-induced sympathectomy: effects on immune status and acute morphine-induced immunomodulation.

The present study examined the role of the sympathetic nervous system (SNS) in immunomodulation by using the acetylcholinesterase monoclonal antibody (AChE mAb)-induced sympathectomy model. As part of this investigation, the effects of AChE mAb treatment on the immune alterations produced by acute morphine treatment also were explored. Experimental rats received tail vein injections of murine monoclonal IgG2b antibodies against rat brain acetylcholinesterase, which produce a destruction of cholinergic, sympathetic preganglionic neurons and a resultant decrease in sympathetic activity. Control rats received tail vein injections of murine IgG antibodies, which do not affect sympathetic preganglionic neurons or sympathetic activity. One week after antibody treatment, rats received a subcutaneous injection of 15 mg/kg morphine or the saline vehicle. One hour after the morphine or saline injections, rats were sacrificed and immune assays were conducted. AChE mAb treatment increased the mitogen-stimulated proliferation of splenic T cells and interleukin-2 (IL-2) production by stimulated splenocytes, indicating that these immune measures are sensitive to the AChE mAb-induced alteration in sympathetic function. Treatment with AChE mAb did not alter the mitogen-stimulated proliferation of splenic B cells or blood T cells, splenic natural killer (NK) cell activity, or the production of interferon-gamma (IFN-gamma) by stimulated splenocytes, indicating that these immune measures are relatively insensitive to the AChE mAb-induced alteration in sympathetic activity. The AChE mAb-induced alteration in sympathetic activity did not affect the suppressive effects of acute morphine treatment on the mitogen-stimulated proliferative response of splenic T and B cells and blood T cells, splenic NK cell activity, and the production of IFN-gamma and IL-2 by stimulated splenocytes.

Acetylcholinesterase↗
PubMed1998

Sympathectomy-induced immune changes are not abrogated by the glucocorticoid receptor blocker RU-486.

Removal of sympathetic noradrenergic input to the immune system by injection of 6-hydroxydopamine (6-OHDA) triggers increases in antigen-specific in vitro splenocyte proliferation and cytokine production in BALB/cJ and C57B1/6J mice. This examines the possible role of glucocorticoids in these previously reported changes. In both strains, chemical sympathectomy triggers an elevation of glucocorticoid levels immediately following injection of 6-OHDA, returning to normal within one to two days. In the BALB/cJ strain, glucocorticoid elevation is seen only after the initial 6-OHDA injection; levels in chronically denervated animals are not different from controls. In the C57B1/6J strain, the increase is seen even with chronically denervated animals. Prior implantation of mice with pellets containing the glucocorticoid receptor antagonist RU-486 does not abrogate denervation-induced increases in cytokine production or proliferation in either strain. In addition to the previously reported increased interleukin (IL)-2 and IL-4 production, there is an increase in IFN-gamma production in the C57B1/6J strain following either acute or chronic denervation. The persistence of denervation-induced changes even when the effect of corticosterone is blocked with RU-486 or diminished with chronic denervation indicates that the changes are driven mainly by a glucocorticoid-independent mechanism.

Animals↗
PubMed1995

Endoscopic extraperitoneal lumbar sympathectomy.

From June 24, 1993, until November 9, 1993, eight sympathectomies were performed by extraperitoneal endoscopy for treatment of Sudeck atrophy. Seventy-five percent of the patients were satisfied with the result of the intervention. A follow-up after 4 months shows that four patients are free of pain. Two are satisfied, but some pain remains. In two cases, the intensity of the pain remains unchanged but the character of the pain has changed. This new technique is safe and offers the well-known advantages of minimal invasive surgery. Moreover, this endoscopic approach opens perspectives for the exploration of the entire retroperitoneum.

Adult↗
PubMed1988

Co-existence and origin of peptidergic and adrenergic nerves in the guinea pig uterus. Retrograde tracing and immunocytochemistry, effects of chemical sympathectomy, capsaicin treatment and pregnancy.

The occurrence and distribution of peptidergic nerves in the guinea pig uterus was studied by means of immunocytochemistry using numerous neuropeptide anti-sera. Neuropeptide Y (NPY)-immunoreactive (IR) nerves were the most abundant, whereas substance P (SP)-, calcitonin gene-related peptide (CGRP)-, and neurokinin A (NKA)-IR nerves were less frequent, and peptide histidine isoleucine (PHI)-IR nerves were the most sparse. Chemical sympathectomy by means of 6-hydroxydopamine, and capsaicin treatment revealed the division of the peptidergic nerves into three separate populations: (1) NPY-IR nerves, which co-existed with adrenergic nerves, (2) SP-, CGRP- and NKA-IR nerves, which mutually co-existed, and (3) PHI-IR nerves. Parallel-running adrenergic/NPY-IR and SP-IR nerves could be found with very similar although not completely identical morphological appearance. Paracervical ganglia contained neurotensin- and dynorphin A-IR cells bodies in addition to cell bodies with immunoreactivities similar to those in prevertebral ganglia. Combined retrograde tracing with True blue and immunocytochemistry showed that the adrenergic and NPY-IR uterine nerves originate in paracervical and prevertebral ganglia. In the prevertebral ganglia the cellular origin was the same for adrenergic and NPY-IR nerves. In contrast, SP-, CGRP-, and NKA-IR nerves originated in dorsal root ganglia. At full-term pregnancy all the neuropeptide immunoreactivities had vanished, probably reflecting a fetus-induced general nerve degeneration.

Adrenergic Fibers↗
PubMed1977

Effect of neonatal sympathectomy on the postnatal differentiation of the submandibular gland of the rat.

Right superior cervical sympathectomy was performed in one-day old rats. This operation had a small but definite effect on the postnatal development of the submandibular gland. The gland on the sympathectomized side weighed less and contained smaller amounts of DNA, RNA and protein than the contralateral intact gland. The postnatal development of acinar cells and granular convoluted ductal cells was retarded in the sympathectomized gland. The acinar cells which differentiated after the ganglionectomy were smaller than those in the contralateral intact gland and were filled with secretory granules but devoid of basal basophilia. The rate of cellular proliferation in the sympathectomized gland was, however, similar to that intact gland at various ages studied.

Animals↗
PubMed1992

Alpha-adrenoceptor function before and after chemical sympathectomy in human and feline detrusor muscles.

Isolated bladder segments from man and cat were treated with 6-hydroxydopamine (6-OHDA) in vitro. Chemical sympathectomy was evaluated with fluorescence microscopy and found to be very similar to the effect of 6-OHDA administered in vivo to cats. Isometric smooth muscle contractile responses were induced by field stimulation (FS). The amplitude of the responses increased after denervation. The effects of alpha-adrenoceptor agonists and antagonists on the FS-induced contractile responses were compared before and after treatment with 6-OHDA. The reduction in the contractile responses after the addition of noradrenaline to the feline bladder strips was more pronounced after treatment. Phentolamine induced an increase in contractile responses before treatment, an effect not seen afterwards in human bladder strips but which persisted in feline bladder strips. Selective alpha-adrenoceptor agonists did not alter the contractile responses in denervated strips. It is suggested that the function of the alpha-adrenoceptors in the detrusor is to inhibit neuronally mediated contractile responses of smooth muscle.

Adrenergic alpha-Agonists↗
PubMed1981

Chemical sympathectomy abolishes the increase in blood pressure of linoleic acid deficient fed rats induced by salt loading.

In previous experiments an altered PG biosynthesis as well as an increase in blood pressure, heart rate and plasma epinephrine could be found after a linoleic acid deficient diet compared with a linoleic acid rich diet in rats with a high salt intake. We injected rats with 200 micrograms 6-hydroxydopamine into the right and left cerebral ventricles 17 days before a four-week linoleic acid deficient diet (0.5 J% linoleic acid) and salt loading (1.5% NaCl). In these rats the elevation of blood pressure and plasma epinephrine compared with linoleic acid rich fed rats (13.3 J+ linoleic acid) was abolished and heart rate was reduced. PG biosynthesis in aorta and kidney medulla homogenate (PGE and PGF) and stomach fundus homogenate (6-Keto-PGF1 alpha) was not influenced by chemical sympathectomy, neither were the food and fluid intakes. We conclude that an enhanced adrenergic activity (via alterations in PG metabolism?) is involved in the blood pressure increase after a linoleic acid deficient diet under high salt intake.

Animals↗
PubMed1988

Prepontine knife cut-induced hyperthermia in the rat. Effect of chemical sympathectomy and surgical denervation of brown adipose tissue.

The effect of brown adipose tissue (BAT) denervation on the prepontine knife cut-induced hyperthermia was studied. The knife cut has earlier been shown to induce a steady state hyperthermia of 3 to 4 degrees C, as a result of marked activation of the BAT. Before the lesion, the interscapular BAT (IBAT) temperature was lower than the colonic temperature, but the temperature gradient reversed a few minutes after the lesion and the fractional blood flow increased 12-fold. Bilateral sectioning of the 5 nerves supplying IBAT did not modify either the magnitude or the kinetics of the IBAT hyperthermic response. The IBAT fractional blood flow, which was 15 times higher in denervated than in intact tissue before the lesion, scarcely increased following the lesion despite the sharp increase in the tissue's metabolic activity. Chemical sympathectomy with 6-hydroxydopamine suppressed the hyperthermic response. Propranolol or hexamethonium injected i.v. during the steady state hyperthermia resulted in a rapid drop in IBAT temperature and in a reversal of the gradient between IBAT and colonic temperature both in denervated and in intact IBAT. Injection of desipramine, an inhibitor of noradrenaline reuptake, resulted in itself in an increase of temperature in both intact and denervated tissue, which is circumstantial evidence for the presence of a functional residual innervation in the latter.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue, Brown↗
PubMed1983

Intratubular and peritubular capillary hydrostatic and oncotic pressures after chronic renal sympathectomy in the anaesthetized rat.

The possible role of peritubular capillary physical forces in the diuretic-natriuretic effects of chronic renal denervation was investigated in Inactin-anaesthetized nondiuretic control (C) and unilaterally denervated (D) rats. Micropuncture techniques were combined with measurement of intratubular and peritubular capillary hydrostatic pressures and afferent and efferent arteriolar plasma oncotic pressures were determined, as well. Compared to data of C rats and of innervated kidneys, marked denervation diuresis and natriuresis were seen without changes in GFR. Both late proximal and early distal (F/P)In values were significantly lower in D kidneys with similar SNGFR. Afferent (pia) and efferent (pi e) arteriolar oncotic pressures were unchanged by denervation (C-pi a = 23.3 +/- 0.79, pi e = 29.9 +/- 0.87 mm Hg; D-pi a = 23.2 +/- 0.94, pi e = 29.8 +/- 1.04 mm Hg). Proximal intratubular hydrostatic pressure was moderately but significantly higher in D kidneys (C = 11.9 +/- 0.5, D = 13.7 +/- 0.3 mm Hg, P less than 0.01), while peritubular capillary pressures were: efferent arteriole (C = 13.9 +/- 0.5, D = 13.4 +/- 0.6 mm Hg, NS). It is concluded that the tubular effects of chronic renal sympathectomy are not dependent on changes in Starling forces of the peritubular environment.

Animals↗