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PubMed1999

Effect of sympathectomy on the expression of NMDA receptors in the spinal cord.

The expression of NMDA receptors in the intermediolateral (IML) region of the upper thoracic spinal cord, was studied in 3 week old rats. The effect of section of the cervical sympathetic nerve on neuronal cell number and receptor expression was examined up to two weeks after the operation. Age-matched sham-operated and unoperated animals were used as controls. It was shown using quantitative autoradiography with the NMDA receptor antagonist [(3)H]MK-801 (dizocilpine maleate), that there was a marked downregulation of receptors in all groups of animals, beginning at approximately 4 weeks of age. However after sympathectomy, which resulted in the death of 44% of neurones in the IML by 7 days, there was a significant increase in receptor density per neurone compared to sham-operated controls. In the control animals there was a significant increase in the Kd value of the binding between 21 and 24 days after birth indicating an increased expression of a low affinity receptor, but no such increase was seen after axotomy. The results are consistent with two populations of NMDA receptors being transiently expressed in the IML in developing animals, and the higher affinity receptor being down-regulated between 4 and 5 weeks of age. The presence of the high affinity receptor subtype may predispose neurones to die after axotomy.

Animals↗
PubMed2002

Chemical sympathectomy alters food intake and thermogenic responses to catecholamines in rats.

It has been suggested that the sympathetic nervous system contributes to the short-term control of feeding. The adrenergic innervation of some splanchnic organs seems to be especially involved in such processes, since catecholamines reduce feeding only when injected intraperitoneally or intraportally. In this work, the effects of neonatal sympathetic denervation with guanethidine (Gnt) upon food intake were assessed in adult rats. Gnt-treated male rats had lower body weight gain. The hypophagic response to intraperitoneal (ip) norepinephrine was 70% higher in Gnt-treated animals as compared to controls (P < 0.05); that of epinephrine (E) by 33% (P < 0.05) and that of isoproterenol was not significantly modified. As in normal rats, the hypophagic effect was much stronger after ip than after intramuscular (im) administration (P < 0.05). On the other hand, resting oxygen consumption (VO2) was consistently lower in denervated animals. Ip E administration did not modify VO2, while im E caused increased motor activity and VO2 (P < 0.05). In contrast to control rats, the respiratory exchange ratio in ad libitum fed Gnt rats did not decrease after Ip E administration, suggesting a lack of effect upon lipid mobilization. The lower rate of body weight gain induced by neonatal Gnt sympathectomy might be due to lower daily food intake possibly related, in part, to the sensitization of the alpha-adrenergic porto-hepatic response to endogenous catecholamines. Compared with controls, Gnt-treated rats also showed a limited thermogenic capacity not related to feeding, and a greater degree of carbohydrate oxidation, possibly due to a defect in E-induced lipolysis, which is beta-adrenergic.

Adrenergic Agonists↗
PubMed2000

Ontogeny of IgA(+) cells in lamina propria: effects of sympathectomy.

The effect of chemical sympathectomy on the ontogeny of the IgA(+) cells in the intestinal LP was examined in weanling rats. Ablation of the peripheral sympathetic nerve terminals using 6-hydroxydopamine (6-OHDA) on days 14 and 17 was associated with an increase in the number of IgA(+) and IgM(+) cells in the intestinal LP at 28, 30 and 35 days of age. Despite the precocious development of Ig-containing cells in the gut, the specific intestinal immune response to ovalbumin (OVA), induced by IP priming with OVA at 30 days of age and boosting ID 14 days later, was not altered by 6-OHDA treatment, with no difference observed in the numbers of total AOCC or IgA(+)/AOCC in the LP of treated, compared to control animals. The results presented in this study suggest that sympathetic innervation is an influential factor in the ontogeny of IgA(+) cells populating the intestinal lamina propria, although no functional significance in terms of the specific local response to a new antigen was detected using the immunisation model described here.

Animals↗
PubMed1996

Effects of immunological sympathectomy on postnatal peptide expression in the rat adrenal medulla.

Administration of monoclonal antibodies against acetylcholinesterase (AChE-mabs) to adult rats leads to a selective degeneration of the acetylcholine esterase-(AChE), choline acetyltransferase-(ChAT) and enkephalin-(ENK) positive preganglionic fibres of the splanchnic nerve innervating the adrenal gland. Here we used this approach of immunological sympathectomy, performed at postnatal day 2 (P2), in an attempt to study the development role of the preganglionic fibres in the adrenal medulla in more detail. Analysis was performed at P16 and revealed that the effect of this treatment varied considerably between animals, as judged by the number of remaining AChE-, ChAT- and ENK-positive fibres. The number and intensity especially of ENK fibres in the adrenal medulla correlated negatively with the number and staining intensity of ENK-immunoreactive chromaffin cells, suggesting a 'dose-response' relationship. Thus, the high early postnatal levels of ENK-like immunoreactivity generally persisted in chromaffin cells of adrenals with a successful immunosympathectomy, i.e. in those adrenals that lacked AChE-, ChAT- and ENK-positive nerves. In contrast, calcitonin gene-related peptide-like immunoreactivity in nerves and chromaffin cells was not affected. Large and strongly AChE-positive intra-adrenal ganglion neurones, recently termed type I ganglion neurones, were present also after AChE-mab treatment and had an apparently normal morphology. These results indicate a role for preganglionic fibres in the developmental regulation of ENK in the chromaffin cells. However, these fibres appear less important for the postnatal development of the type I ganglion neurones.

Acetylcholinesterase↗
PubMed1998

Sympathectomy does not affect the early ectopic discharge from myelinated fibres in ferret inferior alveolar nerve neuromas.

Ectopic neural activity from damaged axons is thought to contribute to the development of sensory disorders following nerve injury. Here we have studied the role of sympathetic fibres in the generation or potentiation of this abnormal activity by determining the effect of predegenerating these fibres. Twelve adult ferrets were used in the study and six of them underwent sympathectomy by removal of the left superior cervical ganglion. Electrophysiological recordings were made from myelinated axons in fine filaments dissected from the inferior alveolar nerve, 3 days after it had been ligated further distally, and the level of spontaneous activity and mechanical sensitivity was determined. There was no significant difference between the level or characteristics of spontaneous activity, or the level of mechanical sensitivity, in the two groups of animals. We conclude that, in this animal model, the absence of sympathetic nerve fibres does not affect the development or characteristics of ectopic neural activity in the early period following nerve injury.

Animals↗
PubMed2000

Long-term superior cervical sympathectomy induces mast cell hyperplasia and increases histamine and serotonin content in the rat dura mater.

Nerve fibres and mast cells are often described in close morphological and functional interactions in various organs such as the dura mater. The respective roles of mast cell activation and sympathetic impairment in cluster headache and migraine attacks have been repeatedly suggested. We have thus investigated the long-term effects of sympathectomy on mast cell morphology and content in the rat dura mater. Fifteen to 60 days after either sham, unilateral or bilateral superior cervical ganglionectomy, dura were removed for either histochemical or biochemical analysis. In the first case, they were fixed and mast cell heparin was stained by fluorescein isothiocyanate-conjugated avidin. Microscopic examination was followed by digital acquisitions using a tomographic process to assess mast cell density in the whole depth of the dura mater. Unilateral ganglionectomy induced a progressive and significant increase in mast cell density 15-60 days post-surgery in contralateral hemi-dura and 30 days post-surgery in ipsilateral hemi-dura. This increase was significant in both dura 60 days after bilateral ganglionectomy. Following perfusion with saline, we also examined the content of histamine and serotonin, pre-formed amines stored in mast cell granules. Biochemical analysis of dura serotonin and histamine content using high-pressure liquid chromatography and radioenzymatic assays, respectively, revealed under all conditions a serotonin tissue concentration lower than that of histamine. After sham ganglionectomy, the dura serotonin content increased from 15 to 60 days post-surgery, whereas the histamine content remained stable over the same period. After unilateral ganglionectomy, the histamine content increased progressively and significantly 30-60 days post-surgery in both hemi-dura, whereas the serotonin content became significantly different from that of sham only 60 days post-surgery in the ipsilateral dura. After bilateral ganglionectomy, the histamine level significantly increased in both hemi-dura 15-60 days post-surgery, whereas the serotonin level had significantly increased at 60 days post-surgery. These results clearly demonstrate, for the first time, a long-term trophic effect of sympathetic nerve degeneration on mast cells in the dura mater. Since mast cell activation has been described previously on the painful side of cluster headache patients during attack periods, we propose that the sympathetic impairment reported in these patients could be prominent, directly or indirectly inducing mast cell hyperplasia and changes in amine contents in the tissue concerned.

Animals↗
PubMed2002

Similar half-octave TTS protection of the cochlea by xylazine/ketamine or sympathectomy.

Cochlear efferents, sympathetic control and stress conditions have been shown to influence sound-induced hearing loss. These factors are also known to be modified by sedation/anesthesia. We tested here the effect of sedation/anesthesia on temporary threshold shift (TTS) compared to that in the same awake animals. The effect of sympathectomy was also tested. We employed awake guinea pigs with a chronically implanted electrode on the round window of each of the cochleae. Each ear was tested for its sensitivity to TTS induced by a 1 min or a 10 min exposure to an 8 kHz pure tone at 96 dB sound pressure level. After an intramuscular injection of xylazine or ketamine together with xylazine, TTS at half-octave frequencies was reduced compared to that in awake animals. The second half-octave frequencies were less affected. This specific pattern of protection was also observed here after surgical ablation of a superior cervical ganglion. The data lead to the speculation that protection from TTS under sedation/anesthesia might be due to diminished sympathetic influence. Xylazine is a pre-synaptic alpha2-adrenoreceptor agonist which blocks noradrenaline release from the sympathetic system. Ketamine is a N-methyl-D-aspartic acid receptor antagonist which could reduce glutamate excitotoxicity as well as reduce sympathetic activity.

Adrenergic alpha-Agonists↗
PubMed2001

Video-assisted thoracoscopic sympathectomy-splanchnicectomy for pancreatic cancer pain.

Patients with unresectable pancreatic cancer often suffer severe pain. Various techniques are available for pain control. We present a patient with pancreatic cancer who underwent unilateral video-assisted thoracoscopic sympathectomy-splanchnicectomy and had complete pain relief. This minimally invasive procedure offers promise in carefully selected patients with severe pain from pancreatic cancer and other conditions which are not amenable to conventional interventions.

Adenocarcinoma↗
PubMed2004

Prostaglandin E1 versus lumbar sympathectomy in the treatment of peripheral arterial occlusive disease: randomised study of 86 patients.

BACKGROUND AND AIM: The aim of this study was to compare the effects of a pharmacological and a surgical vasodilatatory therapy in the treatment of chronic arterial diseases of the lower limbs. METHODS AND RESULTS: After giving their informed consent, 40 patients were randomised to receive a slow (approximately 2-hour) infusion of 40 microg of prostaglandin E1 twice daily for 28 days (group A), and 46 were randomised to undergo lumbar sympathectomy, including the second and third ganglion. Twenty-four (60%) of the patients in group A experienced complete remission, seven (17.5%) were partial responders, and nine (22.5%) failed to respond. Of the 46 patients in group B, 29 (63%) experienced complete remission, seven (15.2%) were partial responders, and 10 (21.7%) failed to respond. CONCLUSIONS: Broadly similar results were obtained with the two types of treatment, both of which are indicated mainly in Fontaine stages IIB and III (non-advanced), particularly when revascularising therapy is impossible or excessively risky. The two strategies can be advantageously combined with direct revascularisation surgery and may therefore constitute a first-line approach favouring subsequent therapy.

Aged↗
PubMed1993

Morphometric evaluation of the rat testis, epididymis and vas deferens following chemical sympathectomy with guanethidine.

Selective chemical sympathectomy of the internal sex organs of adult male rats was undertaken by long term administration of low doses of guanethidine. The spermatogenic activity of the testis was unaffected by treatment. Examination of the vas deferens using morphometric methods revealed a marked increase in luminal area in contrast to a decrease in muscle layer area and in epithelial height. This is morphological evidence of sperm accumulation caused by a disorder in ductal contractile activity. No structural changes were observed in the epididymis. However, the concentration of spermatozoa in the sperm suspension stored in the cauda epididymidis was significantly increased in denervated rats. This result is discussed in terms of a sympathetic control of resorption mechanisms in the epididymis.

Animals↗
PubMed2003

Pelviureteric junction disruption as a complication of chemical lumbar sympathectomy.

Chemical lumbar sympathectomy is a commonly performed procedure in vascular surgery and pain management. This case report discusses the management of a patient who suffered pelviureteric junction disruption following phenol injection for ischaemic leg pain despite radiological evidence of correct placement. The authors suspect this is an underreported complication, which could be relevant in obtaining informed consent.

Humans↗
PubMed1998

Lumbar sympathectomy performed by means of videoscopy.

Sympathetic denervation has fallen into disfavour for operations. Dorso-perivertebral, paravertebral or retroperitoneal approaches are only of historic importance. The oblique retroperitoneal approach is popular because it provides good visibility, at the expense of a long skin incision. A videoscopic procedure has now been developed for lumbar sympathectomy. A transverse skin incision of 3-4 cm is made in the hypochondrium, lateral to the rectus sheath. The abdominal muscles are split along their fibres. The transversalis fascia is opened and the peritoneum is carefully peeled back. A trocar is then introduced laterally from the skin incision, and under visual control the sympathetic trunk is exposed. After identifying the ganglia, L2 and L3 are coagulated together with the part of the sympathetic trunk that joins them. The suction drainage is not required nor are balloons to develop the operation field, which is not insufflated. Patients undergo rehabilitation much more easily because of reduced wound pain and they leave hospital quickly. The method only requires basic videoscopy instruments.

Endoscopy↗
PubMed1997

Bilateral thoracoscopy for sympathectomy in the treatment of hyperhidrosis.

Thoracoscopic sympathectomy has been established as the least invasive technique with high success rates for treatment of palmary hyperhidrosis [1,4,5]. In our procedure both sides are treated during the same operation. A bilateral thoracoscopy was performed in 20 patients for incapacitating hyperhidrosis. Immediate complications at operation were minimal. All patients reported satisfaction with the procedure in spite of compensatory sweating. The short hospital stay has significant financial benefits and these are increased if both sides are treated at the same time. This procedure is more aggressive than the single side procedure but the morbidity is not increased.

Adolescent↗
PubMedDate not supplied

Hallux amputation in combination with a lumbar sympathectomy for treatment of a non-healing ulceration in a patient with Buerger's disease.

Buerger's disease is a distal vascular occlusive disease primarily affecting those with a history of tobacco use. Treatment of digital pathology can be quite difficult as a result. This paper discusses a patient who developed an ulceration of the left hallux that did not respond to local wound care and antibiosis. A lumbar sympathectomy was performed in conjunction with a hallux amputation to promote distal vasodilation and enhance the patient's ability to heal.

Amputation, Surgical↗
PubMed2001

Posterior approach for the simultaneous, bilateral thoracoscopic sympathectomy.

If there is an indication for sympathectomy in the case of severe hyperhidrosis or rubeosis, in our opinion the posterior approach is preferable because of the advantages in surgical technique and anesthesia. Bilateral treatment can be accomplished in a single admission, with all the concomitant advantages.

Adolescent↗
PubMed2003

Evaluation of the impact of transthoracic endoscopic sympathectomy on patients with palmar hyperhydrosis.

OBJECTIVES: We assessed the impact of transthoracic endoscopic sympathectomy (TES) on the quality of life of patients with palmar hyperhydrosis. DESIGN: A retrospective questionnaire based study. METHODS: Patients undergoing TES at our institution between 1997 and 2002 received a SF-36 quality of life postal questionnaire. The pre- and post-operative symptoms were assessed. Statistical analysis was by means of the Student's t test. RESULTS: Ninety-four TES were carried out in 62 patients. Forty-one cases were female. The age range was 17-64 years. The mean follow-up period was 38.46 months. Mean hospital stay was 3 days. Compensatory hyperhydrosis was reported in 29 cases and only considered severe in four cases (9.7%). Forty-one patients replied to the questionnaire (66%). The overall quality of life (as assessed by the SF-36 form) was unanimously improved (p<0.0009) and demonstrated significant improvements in social functioning (p<0.0002), physical role limitations (p<0.0007), emotional well-being (p<0.0007) and overall energy levels (p<0.05). CONCLUSION: TES resulted in significant improvements inpatient's overall quality of life, social and emotional functioning. The procedure is associated with minimal morbidity and only a short inpatient stay is required. Patients should be cautioned on the possibility of compensatory hyperhydrosis which may occur in a small number of cases.

Adolescent↗
PubMed2004

[Video-assisted thoracoscopic sympathectomy for the treatment of facial flushing: ultrasonic scalpel versus diathermy].

OBJECTIVE: To evaluate the advantages of the ultrasonic scalpel compared to electrocoagulation in patients undergoing video-assisted thoracoscopic sympatholysis or sympathectomy for uncontrolled facial blushing. METHODS: Two hundred bilateral video-assisted thoracoscopic procedures to interrupt transmission in the thoracic sympathetic nerve were performed in 100 patients with incapacitating facial blushing. In 2 cases, the video-assisted approach was chosen because of pleural symphysis. The mean age of patients was 34 years (range: 15 to 67). The sympathetic chain was interrupted from the lower portion of the first thoracic ganglion through the third. RESULTS: All patients were discharged within 24 hours with the exception of one on whom an emergency thoracotomy had been performed. No complications were reported in the group in which a harmonic scalpel was used. One case of temporary Horner syndrome (4 months) and 3 cases of persistent chest pain (more than 2 weeks) were reported in the diathermy group. There were 9 cases of partial and asymptomatic pneumothorax that resolved without treatment or prolonged hospital stays. CONCLUSION: Dissection of the sympathetic nerve is accomplished more reliably and with better visualization with the ultrasonic scalpel. Peripheral lesions in lung parenchyma and adjacent tissues (intercostal vessels and nerves) are avoided, as is Horner syndrome, which can be caused by dispersion of heat. Use of the ultrasonic scalpel would also lead to a lower incidence of postoperative neuralgia.

Adolescent↗
PubMed1998

Finger skin blood flow in response to indirect cooling in normal subjects and in patients before and after sympathectomy.

Finger skin blood flow was measured in 80 healthy subjects, using laser Doppler imaging during basal vasodilatation at a local temperature of 40 degrees C. The response to cooling of the contralateral hand at 15 degrees C was studied. A vasoconstriction index was calculated in all subjects and a nomogram was constructed, taking age into consideration. Compared with these normal subjects, four patients operated on with transthoracic endoscopic sympathectomy due to hand hyperhidrosis showed clearly attenuated responses. The results indicate that the test can be used to assess disturbances in the sympathetic regulation of the peripheral blood flow.

Adult↗