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PubMed1990

Morphometric and biochemical evaluation of rat prostate and seminal vesicle following chemical sympathectomy with guanethidine.

Selective chemical sympathectomy of the internal genital organs of adult male rats was undertaken by chronic treatment with low doses of guanethidine. Biochemical and morphometric methods revealed that removal of sympathetic innervation prevents fructose secretion in the prostate and seminal vesicle, in addition to promoting reduced efficiency of delivery by the latter.

Animals↗
PubMed1990

6-OHDA sympathectomy and exercise performance in the rat.

6-hydroxydopamine (6-OHDA) was utilised for the study of the sympathetic nervous system in the resting rats and rats submitted to prolonged exercise. In order to reduce the acute physiological stress associated with an injection of 6-OHDA, beta-1 and alpha-1 adrenoceptors were blocked before the treatment leading to sympathectomy. Sympathectomised rats were divided in two groups: one sacrificed at rest, 24 hours after the treatment. The other group was sacrificed after a treadmill exercise to exhaustion. Running time to exhaustion was 36.0 +/- 4.5 min (mean +/- S.E.M.). This group ran significantly less than a control group brought to exhaustion in 73.7 +/- 10.0 min of exercise (P < 0.05). In order to make appropriate comparisons, another control group was run for 36 min. Some differences were observed between corresponding control and sympathectomized groups. At rest: 1) a lower plasma level of insulin, and 2) a higher plasma free fatty acid concentration were observed in sympathectomized rats. After 36 min of exercise: 1) a lower plasma concentration of norepinephrine, 2) no decrease of the plasma level of insulin, 3) no increase in the plasma glucagon concentration, and 4) a higher plasma glucose level were observed in sympathectomised rats when compared to control rats running for the same time. The lower plasma norepinephrine concentration in exercised sympathectomised rats suggests a lower sympathetic nervous activity in these animals than in control rats. The absence of a decrease of plasma insulin concentration and of an increase in glucagon can be attributed to this lower sympathetic activity in sympathectomised rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1975

Experimental cerebral vasospasm. Part 2: effects of vasoactive drugs and sympathectomy on early and late spasm.

The authors report the effects of vasoactive drugs and sympathectomy on experimental spasm using vertebral angiography. Papaverine and isoxsuprine injections into the vertebral artery released both early and late spasm. The antiserotonin agent, methysergide, adn the alpha adrenergic blocking agent, phentolamine, released early but not late spasm. In sympathathectomized dogs, early spasm was milder than in untreated dogs; however, late spasm was the same as in untreated dogs. The authors discuss an etiological difference between early and late spasm.

Animals↗
PubMed1996

Orientation landmarks of endoscopic transaxillary T-2 sympathectomy for palmar hyperhidrosis.

The identification of the T-2 ganglion through a narrow operative viewfield is the greatest challenge in performing endoscopic transaxillary T-2 sympathectomy, especially for a surgeon who is unfamiliar with the technique. The authors describe a simple anatomical method for identifying the T-2 ganglion during the operation, based on a study of 17 adult cadavers. First, a similar clinical procedure was performed along the anterior or middle axillary line via the second to fourth intercostal spaces to measure the aiming angles and intrathoracic depth needed. Second, the regional anatomical structures and their relationship to bilateral T-2 ganglia were delineated. It was discovered that the superior intercostal artery, a branch of the subclavian artery, was an accessible landmark. This small vessel existed in 87.5% of the cadavers studied. It consistently runs lateral to the parallel sympathetic chain at an average distance of 10 mm. Most important is that it can be easily distinguished where it runs across the inner part of the second rib. The authors emphasize that the superior intercostal artery should be a very beneficial landmark for surgical orientation.

Adolescent↗
PubMed1985

Developmental status of sympathetic innervation in relation to calcium accumulation by submandibular gland following reserpine, surgical sympathectomy or cyclocytidine.

Sympathectomy (Sx) of the submandibular gland was induced at various postnatal ages by ip administration of a single dose of reserpine or by unilateral excision of a superior cervical ganglion. If animals were 12 days old or less at the time of drug administration, [Ca] of the submandibular gland was not measurably increased 24 hr later; if rats were 14 days of age or older, [Ca] of the gland 24 hr after reserpine injection was nearly double that of untreated controls. Two days after surgical Sx, [Ca] of the denervated submandibular gland was unchanged from that of the innervated member of a pair if animals were less than 14 days of age at the time of denervation; [Ca] was twice that of glands of control rats if animals were older than 14 days of age when the denervation was performed. The anti-tumor agent, cyclocytidine (CC), given daily for 3 days in an ip dose of 500 mg/kg, also caused a two- to threefold increase in [Ca] of the submandibular gland when rats were more than 12 days of age at the time of the initial injection of the drug, but in rats younger than this age, CC caused no change in the [Ca] of the submandibular gland. Present data show that there are age-related differences in the ability of the submandibular gland to accumulate calcium following sympathetic denervation or treatment with a norepinephrine-releasing drug. These differences may be attributed either to incomplete development of calcium transport mechanisms, or incomplete development of the sympathetic innervation before 14 days of age.

Age Factors↗
PubMed2003

Sympathotomy instead of sympathectomy for palmar hyperhidrosis: minimizing postoperative compensatory hyperhidrosis.

OBJECTIVE: To determine whether anatomical modification of sympathectomy diminishes severe postoperative compensatory hyperhidrosis. PATIENTS AND METHODS: From January 1, 2000, to June 1, 2001, we prospectively studied 10 consecutive patients with primary palmar hyperhidrosis, aged 14 to 42 years. Medical therapy had failed in all patients. A preoperative and postoperative evaluation and thermoregulatory sweat testing were conducted in all patients. All patients underwent sympathotomy (bilateral simple disconnection) of the second thoracic ganglion input into the brachial plexus, and no sympathetic ganglia were violated. RESULTS: In the 10 patients, all 20 upper extremities improved postoperatively: 11 (55%) had near-complete cessation of palmar sweating, 8 (40%) had marked reduction in sweating, and 1 (5%) had delayed onset but full sweating at the end of the thermoregulatory sweat test. No intraoperative complications of hemopneumothorax or Horner syndrome occurred. Importantly, there were no moderate or severe postoperative hyperhidrosis complications. CONCLUSION: Sympathotomy to disconnect T2 ganglion input into the brachial plexus produces excellent results in the treatment of primary palmar hyperhidrosis and may lower the severity of postoperative compensatory hyperhidrosis complications. Long-term durability of the procedure requires further follow-up.

Adolescent↗
PubMed1976

[Surgical indications and results of thoracic sympathectomy].

Between the 1st of July 1971 and the 31st of December 1974, among 1,459 operations on vascular surgery, we carried out 77 thoracic sympathectomies in 46 patients. In most patients there was an oblitering angiopathie of digital type, stage II to IV, confirmed by angiography. Two patients had mixed type obstructions, two others had hyperhidrosis, one patient suffered from cleroderma, another had a thoracic outlet syndrome with digital arterial obstruction. In all cases, the transaxillary approach was that which caused the least complications and which permitted satisfactory exposure of the sympathetic nerve. The cosmetic results were good. The second and third thoracic ganglia were resected and the planes of cleavage marked with silver clips. In advanced stage III and stage IV, we noted 92 p. 100 improvements i.e. return to stages I or II. The operative mortality was nil. The most serious complication was a case of hemothorax which required later pulmonary decortication. We noted in two cases, a Horner's syndrome.

Adult↗
PubMedDate not supplied

[Nature of changes in the activity of certain enzymes of energy metabolism in the liver after partial sympathectomy].

Partial sympathectomy of rat liver, carried out by bilateral section of celiac nerves, caused a distinct increase in the activity of hexokinase and glucose-6-phosphate dehydrogenase and (less distinctly) of 6-phosphogluconate dehydrogenase and lactate dehydrogenase in liver tissue. The alterations in glucokinase activity were not statistically significant. Noradrenaline disappeared completely from rat liver after the celiac nerves section. Activities of the above-mentioned enzymes were altered to the same degree in sympathectomized liver of adrenalectomized animals. The increase in the hexokinase and glucose-6-phosphate dehydrogenase activity was prevented by administration of actinomycin D immediately after the section of celiac nerves. The data obtained suggest that after section of liver celiac nerves the alterations in the enzymatic activities are determined by the increase of their biosynthesis and occur as a result of impairment of liver sympathetic innervation.

Adrenalectomy↗
PubMed1999

[Intraoperative assessment by laser-Doppler skin blood flowmetry of the efficacy of endoscopic thoracic sympathectomy].

We have investigated whether laser-Doppler (L-D) skin blood flowmetry on the finger could be useful for an intraoperative assessment of the efficacy of endoscopic thoracic sympathectomy (ETS) under general anesthesia. Subjects were 5 young adults receiving ETS for palmar hyperhidrosis. ETS was performed with the patients in the semi-sitting position under one lung ventilation. A pair of LDF probes were placed on the palmar side of the both second fingers. Palmar hyperhidrosis disappeared after ETS in all cases, but compensatory hyperhidrosis developed in the back of the body and the thigh. After completion of ETS on one side, the L-D skin blood flow increased to 267.6 +/- 211.1% on the side of ETS, and it increased in 2 other cases and decreased on the contrary in 3 cases on the other side. After ETS on both sides the L-D skin blood flow increased to 265.0 +/- 185.9% on the side of initial ETS and to 211.4 +/- 172.8% on the side of subsequent ETS. The initial EST induced reflex vasoconstriction on the finger of both sides and also on the toe. Spontaneous fluctuation and reflex vasoconstriction of the skin blood flow were still observed, although the periodicity of spontaneous fluctuation between the right and the left finger was lost in some of the cases. An increase in L-D skin blood flow on the side of ongoing ETS is useful for intraoperative assessment of ETS.

Adult↗
PubMed1999

Lumbar epidural sympathectomy for frostbite injuries of the feet.

Fourteen patients with pain and paresthesias secondary to frostbite injury were treated with lumbar sympathetic blockade. The majority of patients had an excellent response to 48 hours of continuous epidural blockade with no recurrence of symptoms after blockade. Those patients who had a limited response to epidural blockade responded well to surgical lumbar sympathectomy. Lumbar sympathetic blockade is a safe and effective technique for treating the symptoms associated with frostbite injury.

Adult↗
PubMedDate not supplied

Thoracoscopic (upper thoracic) sympathectomy for primary palmar hyperhidrosis in children.

Primary palmar hyperhidrosis is a disabling disorder that starts in childhood and causes physical and psychological inconvenience. Conservative treatment is not effective in severe cases. Thoracoscopic sympathectomy is the treatment of choice. It is a safe minimally invasive procedure with good results. There are few reports in the UK regarding surgical treatment in children. Post-operative compensatory hyperhidrosis of the trunk and thighs occurs in up to 50% of cases. We report on three cases involving six procedures.

Child↗
PubMed2000

[Ineffective and recurrent cases of thoracoscopic sympathectomy for hyperhidrosis and intractable pain].

We reported the cases of thoracoscopic sympathectomy, that is, six cases of hyperhidrosis, three of post herpetic neuralgia, and four of reflex sympathetic dystrophy, including recurrent or incompletely resected or ineffective ones. Recently this procedure for hyperhidrosis had been performed frequently because of its effectiveness, less pain, early discharge and cosmetic aspect. For an ineffective case of hyperhidrosis abdominal respiration which emphasized the exhalation and using an upper abdomen decreased the sweating. The balance of autonomic nerve system, toward parasympathetic dominant, was thought to be improved by conscious respiration. The decrease of sweating right after the operation in a case of incomplete resection indicated that intraoperative maneuver could restrict the sympathetic nerve. This procedure for a pain control could be less effective than that for hyperhidrosis, so an adequate preoperative informed consent was thought to be necessary.

Adolescent↗
PubMed2000

Endoscopic thoracic sympathectomy for treatment of essential hyperhidrosis syndrome: experience with 650 patients.

Patients with essential hyperhidrosis (EH) syndrome may experience subjective suffering and social/occupational challenges. We examined the safety and efficacy of minimally invasive endoscopic surgery for treating EH. Single bilateral incisions, followed by endoscopic thoracic sympathectomy (ETS)-mediated bilateral ablation of the T2 sympathetic ganglia, were used to treat 650 patients with a primary diagnosis of palmar (90%) or facial hyperhidrosis (10%). Palmar and facial hyperhidrosis were resolved in 584 of 585 (>99%) and 62 of 65 (95%) patients, respectively. Surgery required less than 1 hour, and no patient experienced a life-threatening adverse event. Compensatory sweating was observed in 83% of patients and was considered mild or moderate in approximately 67% of those patients. Innovations in ETS have resulted in minimally invasive, highly efficient, safe treatment of EH. Surgery is minimally intrusive to patients, who were usually discharged within 2 hours after surgery and able to resume normal activities within 1 week.

Adolescent↗
PubMed2000

[Ischemic disease of the lower extremity and lumbar sympathectomy].

We consider lumbar sympathectomy (LSE) to be the last attempt to improve the condition of the limb. Though being aware of inconsistent opinions on LSE, we are not opponents of this method, particularly if it is carried out in a selected group of patients, that is in case of: 1) treatment of frostbites, 2) treatment of patients at an early stage of advanced ischemia whose main symptom is moderate night pain at rest, 3) desiccation of chronically moist ulcerations between the toes, 4) treatment of patients with reflex symptomatic dystrophy (causalgia), 5) Buerger's disease.

Female↗
PubMed2000

Thoracoscopic sympathectomy.

The objective was to evaluate the safety and effectiveness of endoscopic thoracic sympathectomy (ETS) for treatment of a variety of sympathetic disorders, including hyperhidrosis, splanchnic pain, reflex sympathetic dystrophy, and Raynaud upper extremity ischemia. Sixty-three ETS procedures were performed in 34 patients at the University of Maryland Medical System between March 1992 and August 1999 (14 male patients, 20 female patients; mean age 22 years). The indications for surgery were hyperhidrosis in 26 patients, upper extremity ischemia in 3 patients, splanchnic pain and reflex sympathetic dystrophy in 2 patients each, and facial blushing in 1 patient. Preoperative symptoms resolved completely or improved significantly in 97.1% (33/34) of patients. One patient with left reflex sympathetic dystrophy had symptoms that recurred shortly after surgery. There were no major complications; one patient with hyperhidrosis reported significant compensatory hyperhidrosis. These findings suggest that ETS is a safe and effective procedure for treatment of a variety of sympathetic disorders. Its application for hyperhidrosis is very effective, and its treatment of splanchnic pain, reflex sympathetic dystrophy, and Raynaud syndrome are rewarding. With increasing experience, ETS should become established in the repertoire of the thoracic surgeon.

Abdominal Pain↗
PubMed1976

Current status of lumbar sympathectomy.

A review of a recent series of lumbar sympathectomies would appear to support the continued use of the procedure in the treatment of selected patients with localized pre-gangrenous lesions or superficial ischemic ulcerations in whom arterial reconstructive operation is not feasible. A conclusion regarding the use of the procedure in conjunction with bypass grafting or thromboendarterectomy cannot be made. Indications for the treatment of nonatherosclerotic disease are briefly mentioned. Nevertheless, the morbidity and mortality from the operation itself is significant and suggests that its use as a temporizing measure in highly doubtful cases is not warranted.

Animals↗