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PubMed1987

Chemical sympathectomy reveals pre- and postsynaptic effects of neuropeptide Y (NPY) in the cardiovascular system.

Intravenous injection of neuropeptide Y (NPY) caused short-lasting dose-dependent pressor responses in anesthetized rats. NPY was equipotent with noradrenaline in producing proportional pressor effects. Chemical sympathectomy, following the administration of 100 mg/kg 6-hydroxydopamine (6-OHDA), significantly potentiated the systemic pressor effects elicited by NPY or noradrenaline. Pretreatment with 2 nmol NPY enhanced the noradrenaline-induced pressor response in control rats. NPY did not change the basal tension of isolated rat aortic strips but significantly potentiated the contractile activity induced by 16 nM noradrenaline. This effect of NPY was not observed in aortic strips from rats pretreated with 6-OHDA. The presence of pre- and postsynaptic sites of action for NPY in the cardiovascular system of the rat is discussed.

Animals↗
PubMed1983

Effects of adrenal demedullation combined with chemical sympathectomy on cold-induced responses of endocrine pancreas in rats.

Adrenal demedullation combined with chemical sympathectomy with 6-hydroxydopamine (ACS) lowered plasma glucagon and insulin levels in rats. Acute cold exposure increased plasma glucagon in both ACS and control rats, while it increased plasma insulin only in ACS rats. ACS rats responded to cold with a smaller increase in plasma glycerol and a more pronounced elevation of plasma free fatty acids.

Adrenal Medulla↗
PubMed1985

Sympathectomy enhances the substance P-mediated breakdown of the blood-aqueous barrier in response to infrared irradiation of the rabbit iris.

Rabbits were subjected to infrared irradiation of the iris 1 month after unilateral cervical sympathectomy. The resulting breakdown of the blood-aqueous barrier was greatly enhanced on the sympathectomized side. In contrast, the response to intravitreally injected substance P (SP) was the same in both eyes. The enhancement of the response to IR irradiation could be abolished by pretreatment with an SP antagonist, (D-Pro2, D-Trp7,9)-SP.

Animals↗
PubMed1984

The early effects of sympathectomy on bone blood flow.

Several laboratories, including our own, have investigated the physiology of bone blood flow by perfusion of the tibia via the nutrient artery. Any damage caused to the nerve supply by cannulation of the artery might affect the results. The possible effect of such damage was investigated by measuring blood flow to the dog tibia using a microsphere technique, before and after sympathectomy. No effect was found and the tibial nutrient artery is therefore a suitable vessel for perfusion when estimating nutrient exchange in bone.

Animals↗
PubMed1999

The long-term results of upper dorsal sympathetic ganglionectomy and endoscopic thoracic sympathectomy for palmar hyperhidrosis.

To assess and compare the long-term results of upper dorsal sympathetic ganglionectomy (UDS) and endoscopic thoracic sympathectomy (ETS), we examined 84 patients who underwent UDS and 71 patients who underwent ETS for the treatment of palmar hyperhidrosis. The period of follow-up ranged from 37 to 228 months. The immediate success rate was 100% in the UDS group and 98.6% in the ETS group. Troublesome compensatory hyperhidrosis occurred in 67.8% of the UDS patients and 84.8% of the ETS patients; however, 55% of the UDS patients and 63% of the ETS patients felt satisfied with their operation. The main reasons for dissatisfaction were recurrence and compensatory hyperhidrosis. Interestingly, simultaneous cure of plantar hyperhidrosis occurred in 28 (40%) of the UDS patients and 28 (44%) of the ETS patients with concomitant plantar hyperhidrosis. ETS required both a shorter operation time and hospital stay than UDS. Thus, we now perform ETS as the treatment of choice because of its excellent illumination and adequate magnification via a minimally invasive approach. The use of ETS as the first choice of treatment for palmar hyperhidrosis is supported not only by the immediate results, complications, and cure of plantar hyperhidrosis, but also by the long-term results. Nevertheless, compensatory hyperhidrosis was also a major complication after ETS.

Adolescent↗
PubMed1975

Absence of a circadian rhythm in crypt cell mitotic rate following chemical sympathectomy in rats.

The circadian rhythms in both consumption of food by rats and in the mitotic rate in epithelial cells lining the bases of the crypts of Lieberkühn of the proximal jejunum were studied in normal and in chemically sympathectomised rats. In normal rats both food consumption and crypt cell mitotic rat showed a distinct circadian rhythm, both parameters having a peak around 00.00 to 04.00 hours. Following chemical sympathectomy the circadian rhythm in food consumption was essentially unchanged whereas that in the crypt cell mitotic rate was abolished.

Animals↗
PubMedDate not supplied

CT-guided lumbar sympathectomy: results and analysis of factors influencing the outcome.

PURPOSE: To prospectively analyze the effectiveness of computed tomography-guided percutaneous lumbar sympathectomy (CTLS) in patients with peripheral arterial occlusive disease in relation to angiographic findings and vascular risk factors. METHODS: Eighty-three patients were treated by CTLS. After clinical evaluation of the risk profile and diagnostic intraarterial digital subtraction arteriography, 14 patients underwent unilateral, and 69 bilateral one-level treatment. Follow-up studies took place on the day following the intervention, after 3 weeks, and after 3 months. RESULTS: A total of 152 interventions were performed in 83 patients. After 3 months, clinical examination of 54 patients (5 patients had died, 24 were lost to follow-up) revealed improvement in 46% (25/54), no change in 39% (21/54), and worsening (amputation) in 15% (8/54). There was no significant statistical correlation among any of the analyzed factors (diabetes mellitus, arterial hypertension, smoking, hyperlipidemia, obesity, hyperuricemia, number of risk factors, ankle-arm index, and angiography score) and the outcome after CTLS. Three major complications occurred: one diabetic patient developed a retroperitoneal abscess 2 weeks after CTLS, and in two other patients ureteral strictures were detected 3 months and 2 years after CTLS, respectively. CONCLUSION: As no predictive criteria for clinical improvement in an individual patient could be identified, CTLS, as a safe procedure, should be employed on a large scale in patients who are unsuitable for treatment by angioplasty or revascularization.

Adult↗
PubMed2002

Thoracoscopic sympathectomy using ultrasonic coagulating shears: a technical improvement in the treatment of palmar hyperhidrosis.

Thoracoscopic sympathectomy has emerged in recent years as the treatment of choice for primary palmar hyperhidrosis when medical treatment fails. Postoperative complications have been reported in large series, however, including neurologic problems such as temporary or definitive Horner syndrome and peripheral nerve injuries. The authors report the use of ultrasonic coagulating scissors instead of electrocautery for the dissection and removal of a segment of sympathetic chain in an 11-year-old girl. A bilateral procedure was performed sequentially through three 5-mm axillary trocars on each side. The use of ultrasonic shears eliminates the risk of distal nerve injury induced by the spread of electric current and could possibly reduce the incidence of the above-mentioned complications.

Child↗
PubMed2003

Sympathectomy causes increased root resorption after orthodontic tooth movement in rats: immunohistochemical study.

Accumulating evidence suggests that the sympathetic nervous system modulates inflammatory responses and bone remodeling. We have studied the effects of sympathectomy and orthodontic tooth movement (OTM) on root resorption, immunocompetent cell recruitment, neuropeptide, neurokinin-1 receptor (NK1-R), and interleukin 6 (IL-6) expression. Experimental rats (n=8) had the right superior cervical ganglion surgically removed, whereas control rats (n=6) underwent sham surgery. Three days later, all rats had the right maxillary first molar moved mesially by an orthodontic appliance. The rats were perfused 13 days later, and the right maxillae were processed for immunohistochemistry by using primary antibodies directed against ED1 antigen, CD43, substance P (SP), NK1-R, neuropeptide Y (NPY), and IL-6. Following OTM, sympathectomized (SCGx) rats had significantly more root resorption (P<0.01) and SP-immunoreactive (IR) fibers (P=0.01) in the compressed periodontal ligament (PDL) compared with control rats. There was a significant decrease in recruitment of CD43+ cells in the pulp after OTM in SCGx rats compared with control rats (P=0.02). An upregulation of NK1-R immunoreactivity was observed surrounding the hyalinized tissue, and an increase in the number of NK1-R IR cells and density of SP-IR fibers was present in first molar pulp of all rats. NPY-IR fibers were absent in the compressed PDL of SCGx and control rats. Thus, OTM induces remodeling not only around the periodontal tissues, but also in the dental pulp. The sympathetic nerves have an inhibitory effect on hard tissue resorption and a stimulatory effect on CD43+ cell recruitment after OTM.

Animals↗
PubMed2004

Results of thoracoscopic sympathectomy for the treatment of axillary and palmar hyperhidrosis with respect to compensatory hyperhidrosis and dry hands.

BACKGROUND: We examined the results of thoracoscopic sympathectomy (TS) for palmar and axillary hyperhidrosis with respect to operative method, symptom control, patient satisfaction and complications. METHODS: We performed a retrospective review of patient records with mail and telephone questionnaire follow-up of 55 patients (15 men) with a median age of 26 years (range, 15-52) who underwent TS between February 1994 and December 2001. RESULTS: There were no differences in complication rates between those having bilateral TS (n = 23) and those having unilateral procedures (n = 20) with a median follow-up of 21 months (range, 2-94). Forty-three patients returned questionnaires (response rate, 78%). Forty patients (93%) were satisfied with the results. Thirty-four patients (79%) noted compensatory hyperhidrosis and 22 (51%) excessively dry hands. CONCLUSION: Despite high rates of compensatory sweating, the majority of patients are very satisfied with the results. The high rate of excessively dry hands is a previously unreported finding and important to discuss when obtaining consent.

Adolescent↗
PubMed2003

Indications for endoscopic thoracic sympathectomy.

The thoracoscopic approach to the sympathetic chain has diminished the trauma of previous open sympathectomy. The minimal trauma has opened the way to manipulate the chain for several conditions. Hand sweat is the most common indication resulting in patient satisfaction 2-13 years after surgery in more than 90%. High satisfaction was also obtained in patients with angina pectoris and a very disabling condition, facial blushing (85 %). Somewhat poorer results were obtained in patients with facial and axillary sweating. In patients with Mb Raynaud-all had recurrences within a year. Since severe side effects, especially compensatory sweating, may occur, the ETS procedure should be reserved only for patients with severe problems where other treatments have failed.

Angina Pectoris↗
PubMed2003

Results of endoscopic thoracic sympathectomy (ETS) on hyperhidrosis, facial blushing, angina pectoris, vascular disorders and pain syndromes of the hand and arm.

Endoscopic thoracic sympathectomy (ETS) has gained increasing popularity due to its minimally invasive character. Despite the simplicity of the procedure, non-surgical options should always be considered as the first line of treatment. The complication risk of ETS is low but side effects, primarily compensatory sweating (CS) of mainly the trunk, may be severe enough to cause regret of the procedure. The risk/benefit ratio should always be discussed with the patient. Severe palmar hyperhidrosis and facial blushing respond very well to ETS with a high patient satisfaction rate. Facial hyperhidrosis is effectively treated with ETS, but is associated with a high risk for severe CS. Axillary hyperhidrosis is best treated by means other than ETS. The use of ETS for pain syndromes, vascular insufficiency and angina pectoris is not well supported by scientific evidence, making careful patient selection mandatory.

Angina Pectoris↗
PubMed2003

Specific complications and mortality of endoscopic thoracic sympathectomy.

Endoscopic Thoracic Sympathectomy (ETS) has gained an increasing popularity due to its minimal invasive character. Despite the simplicity of the procedure, non-surgical options should always be considered as the first line of treatment. The complication risk of ETS is low but side effects, primarily compensatory sweating (CS) of mainly the trunk may be severe enough to cause regret of the procedure. The risk/benefit ratio should always be discussed with the patient. Severe palmar hyperhidrosis and facial blushing respond very well to ETS with a high patient satisfaction rate. Facial hyperhidrosis is effectively treated with ETS but is associated with a high risk for severe CS. Axillary hyperhidrosis is best treated by other means than ETS. The use of ETS for pain syndromes, vascular insufficiency and angina pectoris is not well supported by scientific evidence, making mandatory careful patient selection.

Humans↗
PubMed2003

Microinvasive resectional sympathectomy using the harmonic scalpel. A more effective procedure with fewer side effects for treating essential hyperhidrosis of the hands, face or axillae.

Compensatory sweating remains one of the most unpredictable and debilitating complications of sympathectomy for hyperhidrosis. There appears to be a significant difference in compensatory sweating rates seen between the different techniques utilized to treat hyperhidrosis. Resectional techniques have historically resulted in excellent symptom relief with relatively low levels of severe post-op compensatory sweating. The advent of video-assisted approaches to the treatment of hyperhidrosis has led to other procedures including ablation/cautery, cutting and clipping of the nerve all of which report compensatory sweating rates between 70 and 100%. We have developed a minimally invasive video-assisted approach to sympathetic nerve resection. We studied 486 patients with severe essential hyperhidrosis affecting the hands, feet, axillae and face in variable combinations, who underwent bilateral resection of T2 and T3 for hand, facial or head sweating. 100% relief of sweating was noted in all cases. For axillary sweating the addition of T4 resection has resulted in complete relief of axillary hyperhidrosis symptoms. In this patient population our overall compensatory sweating rate has been approximately 18% with significant compensatory sweating occurring in less than 2% of patients.

Adaptation, Physiological↗
PubMed2003

Variations in dynamic lung compliance during endoscopic thoracic sympathectomy with CO2 insufflation.

Endoscopic thoracic sympathectomy (ETS) is the preferred surgery for treatment of intractable palmar hyperhidrosis (PH). General anesthesia with onelung collapsed ventilation (OLCV) using single-lumen tracheal tube (SLT), is our preferred anesthetic technique for ETS. Intrapleural CO(2) insufflation (capnothorax) was used to ensure lung collapse. The current study examined the effects of capnothorax on dynamic lung compliance (DLC) of the ventilated lung during ETS. After obtaining written informed consent, 10 adult male patients ASA I&II undergoing ETS were studied. Their average age and weight were 25 +/- 7 yr and 67 +/- 8 kg. General anesthesia with SLT and OLCV technique was used. Capnothorax with intrapleural pressure (IPP) of 10 mmHg was initially used, then it was reduced and maintained at 5 mmHg throughout the operation. Anesthesia delivery unit (Datex Ohmeda type A_Elec, Promma, Sweden) was used where airway pressures and DLC were displayed during OLCV. A computer program (SPSS 9.0 for Windows; SPSS Inc., Chicago, IL) was used for statistical analysis of the data obtained. One way analysis of variance (ANOVA) was used for analysis of data before, during and after OLCV. P<0.05 was considered significant. The mean values of the DLC were 52 +/- 6, 30 +/- 3, 39 +/- 5 and 53 +/- 9 ml/cmH(2)O before, during (at 10 and 5 mmHg IPP) and after OLCV respectively with significant differences before and at 10 and 5mmHg IPP. In conclusions, during OLCV and capnothorax for ETS, DLC tends to decrease with increasing of intrapleural CO(2) insufflation pressure. However, in short procedures it has no deleterious postoperative effect. To the best of our knowledge this is the first study performed to investigate DLC changes during OLCV with capnothorax.

Adult↗
PubMed2004

Successful thoracoscopic sympathectomy for primary erythromelalgia in the upper extremities.

Erythromelalgia is known as a rare syndrome of unknown etiology, characterized by redness with burning pain, edema associated with increased skin temperature in the upper and/or lower extremities. Various treatments such as drug therapies and sympathetic blockade were reported. We report two cases including a 57-year-old woman and a 64-year-old woman, showing the successful clinical outcome by bilateral thoracoscopic sympathectomy.

Erythromelalgia↗
PubMed2005

Intraoperative prediction of compensatory sweating for thoracic sympathectomy.

OBJECTIVE: Postoperative compensatory sweating (PCS) is an important problem impacting on quality of life for patients after endoscopic thoracic sympathectomy (ETS). The present study investigated whether intraoperative palmar temperature and blood flow are useful for assessing PCS after ETS. METHODS: Retrospectively, results were evaluated for ETS in 27 consecutive patients with primary palmar hyperhidrosis between 1996 and 2002. For all patients, bilateral nerve conduction to the palms was interrupted. The relationship between the range of PCS and intraoperative changes in palmar temperature and blood flow was investigated. RESULTS: PCS developed in all cases. After completion of ETS, mean blood flow and temperature increased respectively. Significant correlations were found between the range of PCS and increases in palmar temperature (p<0.05) and blood flow (p<0.05). CONCLUSION: Intraoperative monitoring of increases in palmar temperature and blood flow may be useful in patients with primary hyperhidrosis, to predict the range of PCS after ETS.

Adolescent↗
PubMed1977

The effect of systolic hypertension on rhesus monkey eyes after ocular sympathectomy.

Systolic hypertension was induced in rhesus monkeys by obstructing the thoracic aorta and by ocular sympathectomy obtained with the retrobulbar injection of 6-hydroxydopamine. During the late phase of fluorescein angiography, fluorescein leaked from the choroidal circulation into the retina. The retinal vessels did not leak fluorescein. The effect was not permanent since fluorescein did not leak into the retina after the blood pressure returned to normal.

Animals↗