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PubMed2000

[Percutaneous lumbar sympathectomy--presentation of a new trans-diskal approach].

The authors present the technique of chemical lumbar sympathectomy by an anatomically new medial transdiscal approach. On a group of 80 operations they analyze the indication criteria, complications and results of this method. They compare the percutaneous technique of severing of the sympathetic nerve with the classical surgical approach. In 41 patients where a modified transdiscal approach was used the authors did not encounter any serious complications. Using thin needles (minimum 23-G) they recommend this method as an alternative of the classical approach of Kappis.

Aged↗

PubMed2000

[Changes of autonomic functions by endoscopic upper thoracic sympathectomy on idiopathic hyperhidrosis].

Changes of autonomic functions before and after bilateral endoscopic upper thoracic sympathectomy (EUTS) were evaluated in 13 patients with idiopathic hyperhidrosis, with the sympathetic skin response, coefficient of variation of R-R intervals, mean heart rate, thermography, and non-invasive Valsalva test of the tonometry method. EUTS electronically destructs the upper thoracic sympathetic ganglions which innervate the upper extremities, and partially the heart. The decrement of mean heart rate, and persistent inhibition of the vascular contraction and hidrosis of the hands appeared after EUTS. These manifestations were effect produced by the abortion of sympathetic activity by EUTS. In 10 of the 12 cases, the baroreceptor sensitivity index II of Valsalva test which reflects the sympathetic autonomic nervous function of the heart showed normal pattern after EUTS. Four cases revealed reincrement of both the blood pressure and heart rate at the latter half phase of the second stage of the Valsalva test. The sympathetic dysfunction of the heart was limited to the decrement of mean heart rate although EUTS partially destroys sympathetic fibers innervating the heart. A long-term study is necessary to evaluate the effect of EUTS on the cardiac function.

Adolescent↗

PubMed2001

[Endoscopic transthoracic sympathectomy (ETS) with a fine 2-mm thoracoscope in palmar hyperhidrosis].

Endoscopic transthoracic sympathectomy (ETS) is an efficient, safe, minimally invasive procedure, and requires only a short period of hospitalization. We performed bilateral ETS using a thoracoscope 2 mm in diameter. We performed 120 ETS for the treatment of palmar hyperhidrosis from August 1997 to April 2000. The patient was placed in the semi-sitting position under general anesthesia, one-lung ventilation being used; the operation was performed with 2-mm two-puncture method. The sympathetic chain could be observed through parietal pleura riding on the costovertebral junctions. A 2-mm Kirschner wire was employed as an electrode, and the second and third thoracic sympathetic chains were electro cauterized. A thoracic drain was not used. The needling sites were only 2 mm in size and could be fixed without suture. For the patient, a small scar of this size means virtually no scar. The operative times were from 11 min to 81 min in bilateral ETS. Immediately and dramatic decrease in the sweat excretion in the palms was noted in all patients. The 95% patients were highly satisfied with the results. The commonest side effects were compensatory sweating. This procedure is recommended as the method of choice for the surgical treatments of palmar hyperhidrosis.

Adolescent↗

PubMed2001

Right vs left side thoracoscopic sympathectomy: effects of CO2 insufflation on haemodynamics.

BACKGROUND AND AIMS: Currently, few reports of the haemodynamic impact of intrapleural CO2 insufflation in the clinical setting are available. Therefore, we conducted the present study to compare the haemodynamic changes between right and left side thoracoscopic sympathectomy (TS) for treatment of palmar hyperhidrosis (PH) under general anaesthesia. MATERIALS AND METHODS: 20 adult patients (17 males) undergoing TS were randomly allocated to two groups (each 10); group A, right side and group B, left side TS procedures were performed under general anaesthesia with single-lumen endotracheal tube. Besides the routine monitoring of vital signs, non-invasive cardiac output monitor (NICO) was used to record the stroke volume (SV), cardiac output (CO) and cardiac index (CI). Intrapleural CO2 insufflation was used. Anaesthesia was maintained with 1 MAC sevoflurane in 50% nitrous oxide in oxygen with incremental doses of sufentanil and atracurium when required. Haemodynamic parameters were obtained every 3 min then averaged over the time of surgery at phases; I) after tracheal intubation, II) after CO2 insufflation and III) after CO2 deflation. RESULTS: The CO, CI and SV showed decreased trend in both groups during phase II compared to phase I with significant differences (P < 0.05). Comparing the CO and CI variables revealed lower values in group A compared to group B but with non-significant differences (P > 0.05). While the SV variable showed significant low value in group A compared to group B (P < 0.05). CONCLUSIONS: Compared to left side TS, direct compression by CO2 against the venae cava and right atrium and ventricle during right side TS caused reduction of the venous return and hence low CO, CI and SV.

Adult↗

PubMed2001

Thoracoscopic sympathectomy for treatment of hyperhidrosis surgical experience and results of 30 cases.

The thoracoscopic sympathectomy in treatment of primary palmar and axillary hyperhidrosis was performed on 30 patients complaining of hyperhidrosis admitted to El Demerdash University Hospital and Ain Shams University Specialised Hospital and The Saudi German Hospital between March 1999 and March 2001. The indication of surgery was primary palmar hyperhidrosis in 24 cases and combined palmar and axillary hyperhidrosis in 6 cases. 25 cases were males and 5 cases were females. The mean age in our sample was 25.7 +/- 4.05 years. There were no major complications in our series and 4 cases were complicated by intercostal vessels bleeding which were successfully controlled by cauterization during surgery and no one of them necessitated neither thoracotomy nor application of intercostal tubes. The patients were followed up for one year after operation and only one case had recurrence of palmar hyperhidrosis.

Adult↗

PubMedDate not supplied

Effects of lumbar sympathectomy on thromboangiitis obliterans.

The clinical response to lumbar sympathectomy has been reported. The incidence of improvement was as follows: Coldness 52 percent, ulcer 58 percent, rest pain 64 percent, and claudication 31 percent, respectively. The blood flow in the anterior tibial muscles did not increase within 5 weeks postoperatively. There were correlations between the effects and the clinical stages, the interval from the onset to the operations, the abuse of tobacco, and the degree of reactive hyperemia, but not relation was observed between as to the site of obstruction. In the experiments, the influence of acetylcholine on blood flow increased after the operations and the duration of vasoconstriction following administration of noradrenalin became shorter. On the basis of the clinical and experimental facts, postoperative improvement seems to be due to increased blood flow to the peripheral skin and to relief of vasospasm.

Acetylcholine↗

PubMed1975

[Results of thoracoscopic sympathectomy in hyperhidrosis of the upper extremities (author's transl)].

Thoracoscopic sympathectomy bei Kux's method was undertaken on 256 occasions for the treatment of 168 patients suffering from hyperhidrosis of the upper extremities. There were no operative fatalities. Thoracotomy was required in only 2 cases, the indication being intraoperative bleeding. 2 further patients developed a tension pneumothorax postoperatively necessitating drainage. The operation was successful in all but 2 cases. Division of the sympathetic chain between T1 and T2 suffices to achieve dryness of the hands; if underarm perspiration is to equally influenced then division of the sympathetic trunk must be extended caudally to the level of T5. On follow-up examination of 104 patients 2 and 10 years after the operation, a successful result was noted in 94% of cases. Unwanted side effects were vicarious and gustatory perspiration, which arose in 39% and 56% of cases respectively, but did not affect the successful outcome of the operation.

Adult↗

PubMed1975

[Experimental Subarachnoid hemmorrhage in dogs--effect of various drugs and sympathectomy on cerebral arterial spasm (author's transl)].

Adult mongrel dogs were used. The posterior communicating artery was punctured with a fine needle and subarachnoid hemorrhage was produced, which simulated aneurysmal rupture in human. The cerebral basal arteries were constricted remarkably after the puncture. However this vasospasm disappeared in about 60-120 minutes. After this restoration, the vessels began to be constricted again and reduced their diameter in greater degree with lapse of time. Effect of various drugs and sympathectomy on the experimental spasm induced by this method were studied utilizing the magnified vertebral angiography. The drugs used were papverine, isoxuprine, methysergide, phentolamine and propranolol. One of these drugs was given to each dog into the vertebral artery 15 minutes after the puncture of the artery for study of the early spasm, and the same procedure was carried out 24 hours after the late spasm. Vertebral arteriograms were taken immediately after and at 5, 10 and 30 minutes after injection of the drug. Diameter changes of the cerebral basal arteries were measured on the film. Smooth muscle relaxtants, papaverine and isoxsuprine, were effective on relieving the early and the late spasm. An antiserotonin agent, methysergide, relieved slightly the early spasm, but it had no effect on the late spasm. Phentolamine, that is an adrenergic blocking agent, relieved the early spam remarkably, but it was less effective on the late spam. A beta adrenergic blocking agent, propranolol, was effective on relieving neither the early nor the late spasm. Two weeks after the removal of the bilateral upper cervical ganglia, subarachnoid hemorrhage was produced by the smae method as mentioned above in four dogs. Arteriograms taken 24 hours after puncture of the posterior communicating artery in these dogs showed vasoconstriction as same as in the non-sympathectomized dogs. From these experimental results, it was suggested that an etiological difference in the early and the late spasm may exist, and that the occurence of the late spasm may not be influenced by the sympathetic system.

Animals↗

PubMedDate not supplied

Phagocytic response in rats following chemical sympathectomy with 6-hydroxydopamine.

Wistar rats were injected i.p. at 2, 4 and 7 days after birth with 6-OHDA (50 mg/kg). At maturity the phagocytic response of neutrophils was elicited by Escherichia coli (EC) lipopolysaccharide (LPS). Before and at 3 and 24 hours after the injection of LPS (1 mg/kg i.v.) the leucocyte (L) and neutrophil (N) counts and the phagocytic activity of N in blood against EC have been tested. In controls (6 female and 7 male rats) the number of N increases significantly after 3 h. The L and N responses were similar in controls and in treated (SyX) animals. In controls the percentage of phagocytic active N(PA) and the number of bacteria incorporated by 100 n(IB) shows significant rises at 3 h. In the SyX groups (7 females and 7 males) PA does not increase; the IB decreases significantly in females at 3 and 24 h. In conclusion chemical sympathectomy depresses the PR to LPS in rats; this suggests a stimulatory action of the sympathetic system on the phagocytic immune reaction. An immunological sexual dimorphism exists.

Animals↗

PubMed1992

[Lumbar sympathectomy for arteritis. A reliable and (almost) seventy year-old technique].

The old procedure of lumbar sympathectomy has long been the only chance of avoiding amputation for arteritic patients. Its field of application has shifted as reconstructive surgery and medical therapy made progress, and it is no longer the only solution and has more precise indications. Proper evaluation of its chances of success according to the individual situations allows establishing its potential and limitations. This simple procedure, entailing no risk for the future, deserves remaining among the available means for the treatment of arteritis, despite its age.

Arteritis↗

PubMedDate not supplied

[The past, present and future of lumbar sympathectomy].

The ischemic extremities treatment in a precarious phase has been standardized in the two last decades with a significance extremities savement. But the ischemia of the interdigital vessels and at the microcirculation is still a defiance. We expose the hiperemiant surgery past. We describe the experience of four years in Centre Hospitalari-Unitat Coronaria, Manresa, with 21 lumbar sympathetic ablation in patients without distal pulse, ankle/arm index by Doppler effect between 0 and 0.6 and angiographies without distal bed images, with 13 successes, 2 exitus by M.A.I., 3 amputations and a lung edema. We finish with a futuristic vision that suggest alternatives for the usage of the lumbar sympathectomy according to the medical advances in the coming time for available the ischemic extremities.

Aged↗

PubMed2003

[Reconstructive surgery on the femoro-popliteal segment in combination with lumbar sympathectomy].

Long-term results of 660 reconstructive surgeries on the arteries of the femoro-popliteal segment performed from 1975 to 2002 are analyzed. Two hundred and twenty-eight (34.5%) of them were combined with lumbar sympathectomy (LSE) on the affected side. It was demonstrated that LSE influences outcomes of reconstructions on the femoro-popliteal segment. This influence depends on a primary degree of leg ischemia. At the stage of intermittent claudication LSE permits to improve patency of the femoro-popliteal segment, salvage of the leg, to decrease the rate of postoperative complications due to reduction of thrombosis and purulation rates. The rate of cardiovascular complications increases. In critical limb ischemia effect of LSE is opposite. It increases the rate of repeated occlusions and amputations compared with reconstructive surgeries without LSE. The rate of postoperative complications also increased due to thrombosis and cardiovascular complications. It is concluded that LSE is the factor improving outcomes of reconstructive surgery on the femoro-popliteal segment, but it must be used differentially. It is necessary to perform LSE during all reconstructive surgeries in patients with intermittent claudication and without serious cardiovascular diseases. In critical limb ischemia and serious concomitant cardiovascular diseases LSE must be avoided.

Femoral Artery↗

PubMed2003

[Video-assisted thoracoscopic left sympathectomy for the treatment of congenital long QT syndrome].

OBJECTIVE: To assess the feasibility, safety and effectiveness of video-assisted thoracoscopic sympathectomy (VATS) for the treatment of congenital long QT syndrome. METHODS: Under general anaesthesia, pleural cavity was entered via two or three small incisions in the left intercostal space. The left thoracic sympathetic chain was identified and resected from T2 approximately T5. The lower one at the third of the left stellate ganglion was also resected. RESULTS: VATS resulted in a significant shortening in corrected QT intervals in three patients. The average QT interval of the four patients was 537.5 ms before VATS and 512.5 ms after VATS. The heart rate of the patients remained unchanged. There were no major peri-operative complications apart from mild ptosis of the left upper eyelid in one patient who recovered in the following days. The syndrome recurred in one patient in syncopal events in four months after VATS. CONCLUSION: VATS is a safe as well as an effective technique for the treatment of congenital long QT syndromes.

Adult↗

PubMed2003

[Experience in treatment of Raynaud's syndrome by chemical thoracic sympathectomy].

OBJECTIVE: To summarize the experience in treatment of Raynaud's syndrome with chemical thoracic sympathectomy (CTS) guided by X ray. METHODS: From March 2001 to December 2002,35 cases (66 limbs) of Raynaud's syndrome were treated by CTS. Guided by X ray, a needle was punctured through the back skin to the second or third thoracic sympathetic ganglion beside the thoracic vertebrae and 2 ml of 5% phenol was injected. RESULTS: The first CTS treatment produced an excellent effect on 32 limbs, good effect on 12 limbs, and no effect on 22 limbs with an effective rate of 66.7% (44/66). The same treatment was performed on the limbs without effect 1 - 2 days after the first treatment and produce excellent effect on 2 limbs, good effect on 6 limbs, and no effect on 14 limbs with an effective rate of 36.4% (8/22). The efficiency rate of the first hospitalization was 78.8%. The effective rate of treating primary Raynaud's disease by CTS was 88.5% and that of treating secondary one was 42.8%. 85% of the patients were followed up for 9 months on average with an efficiency rate of 61%. CONCLUSION: CTS is mini-invasive, cheap, easy to popularize, and a relatively ideal choice in treatment of Raynaud's syndrome. Complications can be minimum only if the operation is performed carefully.

Adult↗

PubMed2003

[Effects of sympathectomy on the blood pressure of young Wistar rats fed with high-sucrose diet].

OBJECTIVE: Diet is an important factor influencing blood pressure and, increases in dietary carbohydrate intake can raise blood pressure in adult rats. A previous study showed that the blood pressure of the rats fed with high-carbohydrate was 5-20 mmHg higher than that of control rats. While the mechanism involved is not clear. This study aimed to investigate the effects of high-sucrose intake on blood pressure of young Wistar rats and the role that sympathetic nerve system in the process. METHODS: Male neonatal Wistar rats were performed sympathectomy operation with 6-hydroxydopamine (6-OHDA) and then divided into four groups: (1) 0.1% VitC saline-common diet group (VN), (2) 0.1% VitC saline-high sucrose (VS), (3) 6-OHDA-common diet group (OHN) and (4) 6-OHDA-high sucrose (OHS) after three week. The data on the body weight (BW), systolic blood pressure (SBP) and heart rate (HR) were recorded. Then the level of blood glucose, serum insulin and angiotensin II (AngII) were measured and the functional studies of the thoracic aorta was performed. RESULTS: The VS group exhibited higher SBP than the OHS group from the 6th week (113.7 +/- 4.2 mmHg vs. 104.0 +/- 5.8 mmHg, P < 0.01) and the VN group from the 7th week (117.6 +/- 6.3 mmHg vs. 109.6 +/- 4.6 mmHg, P < 0.01), while the SBP of the VN group was similar to those of the OHN group and the OHS group (P > 0.05). No significant differences in blood glucose, serum insulin and insulin sensitive index (ISI) were found among the four groups. The thoracic aorta segments of the VS group had higher contractive response to AngII (P < 0.01) and NE (P < 0.05) than the VN group, but the relaxations to acetylcholine (ACh) and nitroglycerine (NTG) showed no difference among the four groups (P > 0.05). CONCLUSION: The high-sucrose diet might elevate the blood pressure in young Wistar rats and the sympathetic system may play an important role in this process.

Angiotensin II↗

PubMedDate not supplied

[Transperitoneal laparoscopic right sympathectomy].

Laparoscopic lumbar transperitoneal sympathectomy represents the miniinvasive approach of laterocolic procedure Adson-Diez. It is suitable to laparoscopic surgery, has a good reproducibility and it is more advantageous than total retroperitoneal approach because of a larger working space.

Humans↗

PubMedDate not supplied

Thoracoscopic sympathectomy for upper limb ischemic disease.

We treated in 2001 in our clinic two patients with upper limb ischemic disease. Both patients had chronic pain and cyanosis of the fingers, with trophic disorders and partial amputations of distal phalanges. They were previously submitted to medical treatment with no result. We present the technique used, resectional thoracoscopic sympathectomy including T2 and T3 ganglia. First of the patients was operated on bilaterally in two successive operations, the second one only on the right side. There was an uneventful postoperative evolution with good immediate and short term results.

Arm↗

PubMed1992

Foetal circulatory responses to arrest of uterine blood flow in sheep: effects of chemical sympathectomy.

Acute foetal asphyxia, caused by arrest of uterine blood flow, increases both sympathetic activity and peripheral vascular resistance and decreases blood flow to peripheral organs (Jensen et al., J. Dev. Physiol., 9, 543-559). The rapidity and uniformity of this peripheral vasoconstriction suggest that the sympatho-neuronal system may reflexly cause these initial blood flow changes during acute asphyxia. To test this hypothesis, we studied 5 intact and 6 chemically sympathectomized (6-hydroxy-dopamine, 46.1 +/- 6 mg/kg foetal weight) chronically prepared normoxaemic foetal sheep in utero at 0.9 of gestation. Organ blood flows (microsphere method), plasma concentrations of catecholamines, vasopressin, and angiotensin II, acid-base balance and blood gases were measured before, during and after arrest of uterine blood flow for 2 min, i.e., at 0, 1, 2, 3, 4 & 30 min. In intact foetuses there was a progressive increase in arterial blood pressure and a rapid circulatory centralization in favour of the brain stem and heart and at the expense of most of the peripheral organs. The changes in peripheral blood flow during and after asphyxia were well reflected by those in the skin and scalp. In chemically sympathectomized foetuses, arterial blood pressure fell transiently at 1 min of asphyxia and cardiac output was redistributed towards the carcass and intestinal organs at the expense of the heart, spinal medulla, and placenta. We conclude that in foetal sheep at 0.9 of gestation, the short-term adaptation to arrest of uterine blood flow is a rapid and profound peripheral vasoconstriction to effect an increase in arterial blood pressure. This initial response during circulatory centralization, which is necessary to increase or maintain blood flow to the heart, brain stem, and placenta, is blunted by sympathectomy. Thus, the foetal sympatho-neuronal system is important for short-term adaptation to and intact survival of asphyxia.

Adaptation, Physiological↗