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PubMed1986

[Sympathectomy of the digital arteries in acro-syndromes].

Digital sympathectomy as proposed by Flatt and al. was performed on 12 Raynaud's diseases, 6 distal arteriopathy and 4 post-trauma ischemic syndrome. Operation was performed under tourniquet. The approach depends on the number of digits involved (Brünner at the proximal part of P1, transversal in the distal palmar crease, zigzag incision at the level of each intermetacarpal space). Under microscope, adventisectomy is started on a lateral side of the artery followed by the posterior side on at least 1 cm, using the adventitia avoid all direct manipulation of the vessels. Closing skin on an aspirative drainage and simple non compressive drainage is maintaining 4 days. Index pressure and arterial blood flow are measured. Results are bad for post-trauma ischemic syndrome and arteritis but encouraging in Raynaud's disease (7 patients asked for the same operation on the opposite side).

Adult↗
PubMed1985

[Systemic hemodynamic changes during the development of DOCA-salt hypertension. The effect of neonatal sympathectomy].

The elevation of the cardiac index was discovered at the initial stage of DOCA-salt hypertension in rats. The blood pressure rise at the stage of stable hypertension was caused by an increase in the total peripheral vascular resistance. Neonatal sympathectomy prevented the development of DOCA-salt hypertension and elevation of the cardiac index revealed in control sympathectomized rats.

Animals↗
PubMed1985

[Predictive value of the reactive hyperemia test as an indicator for lumbar sympathectomy].

Seventy-five patients had a lumbar sympathectomy for chronic arteritis of the lower limbs. This study was done to assess the predictive value of Hillestad's test (potential of vasodilatation) and that of the deep breath test (sympathic stimulation), realised by digital strain gauge plethysmography. Were considered a success the patients with claudication who doubled their walking distance and those with rest pain or gangrene who suffered no more or healed. Globally speaking, 49% were a success. A positive response to Hillestad's test was followed by an 83% overall success rate. For claudicants with femoropopliteal lesions the predictive success rate was 95% with a positive Hillestad's test, against 60% globally; for patients with rest pain or gangrene or with distal lesions the success probability was around 60% if Hillestad's test was positive. A negative response to Hillestad's test was always followed by a failure in diabetics. A better predictability ought to be obtained with the adjunction of a deep breath test.

Adult↗
PubMedDate not supplied

The anatomy of the lumbar sympathetic trunks in man (with special reference to the question of regeneration after sympathectomy).

Although possible to decentralize the sympathetic outflow to the leg, below the knee, by resecting only the third lumbar sympathetic ganglion, the likelihood of restoration of normal vasoconstrictor activity warrants a more extensive resection to include at least the second and third lumbar ganglia, and preferably the second, third, and fourth lumbar ganglia. When cross-over fibers are suspected or demonstrated following unilateral sympathectomy, the denervation should include the fourth and fifth lumbar ganglia. The first lumbar ganglion should be spared at least unilaterally if interference with reproductive function is to be avoided.

Arterial Occlusive Diseases↗
PubMed1979

[The value of thoracoscopic sympathectomy in the treatment of Raynaud's syndrome].

On the basis of a follow-up period lasting at least 6 years concerning 23 patients, in whom on account of a Raynaud-syndrome a thoracoscopic sympathicotomy in the region Th 2-5 was carried out in most cases bilaterally in two sessions, in comparison with the sympathicectomy performed in major surgery can be established:no mortality, no serious complications, duration of stay in hospital 5-7 days, no absolute healing. In a follow-up period of the same length in an approach of major surgery absolute healings are possible, but only in 35%. This gain is loaded by a longer stay in hospital of at least 10 days and a mortality of 4.3% as well as by a complication rate of 6-41%, to which in 8-13% of the cases a Horner-syndrome comes. Therefore, before an approach in major surgery a thoracoscopic intervention is to be tried. The thoracoscopic operators should strive for a sympathectomy with destroy of the ganglia Th 2 and 3 instead for a sympathicotomy.

Humans↗
PubMed1979

Ocular manifestations after upper dorsal sympathectomy.

Fifty patients underwent ophthalmologic examination before and after bilateral upper dorsal sympathectomy performed for palmar hyperhidrosis. Postoperative examination was done during the first week, at 3 to 4 weeks and at 6 to 12 months after the operation. Immediately after surgery there were 18 patients with ptosis (6 severe) and 23 with miosis (12 severe). There were 19 patients with excessive lacrimation and some degree of congestion of conjunctival blood vessels was present in almost all patients. Uniocular decrease in tears was present in 2 patients. Most of these manifestations decreased with passage of time. At one year there remained only 3 patients with severe ptosis and 4 with severe miosis. The results suggest that the classical anatomic explanation of Horner's syndrome may require some modification.

Adult↗
PubMed1979

[Indications and results of dorsal sympathectomy in vascular syndromes of the upper limb (author's transl)].

The authors report 50 cases of dorsal sympathectomy followed up on the cardiovascular surgery unit of the Amiens University Hospital over a period of six years. The authors then formulate a number of reflexions concerning the clinical findings, the therapeutic indications, and the way of assessing the results of this operation in vascular syndromes of the upper limb. This is a plea in favour of this operation as, in most cases, no other treatment is comparable.

Adolescent↗
PubMed1979

Antiarrhythmic effect of cardiac sympathectomy.

The authors studied the effect of sympathetic denervation of the heart (removal of the stellate ganglion together with the sympathetic trunk up to the level of the 5th thoracic ganglion) on the ventricular fibrillation threshold (VFT) in dog. The acute experiments were performed under general anaesthesia with pentobarbital. Unilateral left sympathetic denervation raised the VFT to 144% of the initial value (14 measurements) and unilateral right sympathectomy to 214% (9 measurements). Immediately after bilateral denervation the VFT increased to 242% (23 observations). Atropine blockade of the vagus nerve (0.1 mg/kg b.w.) displayed no effect on the VFT increase. The observed increase in VFT corresponded with the finding that bilateral sympathetic denervation of the heart protected the dogs from spontaneous ventricular fibrillation after ligating the intraventricular branch of the left coronary artery. The authors compared their own results with those reported in the literature and discuss the possible clinical use of sympathetic denervation of the heart in the treatment of tachyarrhythmia.

Animals↗
PubMedDate not supplied

[Observations on 235 isolated lumbar sympathectomies performed in atherosclerotic obliterating arteriopathies].

A group of 235 patients is presented in whom lumbal sympatthectomies were performed over a period of 10 years in the III-rg Surgical Clinic from Jassy, and in the County Hospital from Focşani. A review is also presented, of the controversial opinion expressed in the literature in connection with the efficiency of this type of intervention. The immediate postoperative results were good in 91.9% of all cases and after 10 years the results were good and moderate in 72.2% of all subjects. The disappearance of paresthesia, the maintenance of a warm leg, with a well-outlined subcutaneous venous network, as well as the increased intervals between claudication bouts, make the isolated lumbal sympathectomy an excellent palleative intervention in patients with arteriosclerotic obliterating arteriopathies.

Arteriosclerosis Obliterans↗
PubMedDate not supplied

[Severe arterial hypertension due to chronic constitutional hyperadrenalism. Splanchnic sympathectomy and left adrenal medulla sclerosis with 40 percent sodium salicylate (result after 3 years--genetic chemosurgery)].

The case is presented of a male patient hospitalized for severe arterial hypertension determined by chronic constitutional hyperadrenalism. Splanchnic-sympathectomy was performed, associated to medullar sclerosis of the left adrenal with 40% sodium salicylate (genetic chemical surgery). The results after 3 years were good, both clinically and paraclinically. The constitutional background was normo-hypoadrenergic and the ecologic balance of the patient became normal after surgery.

Adrenal Medulla↗
PubMed1984

Gastric function before and after gastric sympathectomy and subsequent truncal vagotomy.

A surgical technique for selective gastric sympathectomy (SGS) has been developed by total devascularization of the dog stomach with immediate revascularization via the divided and reanastomosed splenic artery and vein. Splenectomy is also performed to divert the entire splenic blood-flow to the stomach. Several months later biopsy of vessels from the gastric wall shows that all catecholamine staining is lost. Blood-flow studies using the aminopyrine clearance method show that a significant decrease in blood-flow occurs, particularly during maximal acid secretion. The effects of SGS on the gastric acid responses of 5 dogs were: (1) increased responsiveness to histamine with a left shift of the dose-response curve (D50 = 35 +/- 5 before, and 17 +/- 4 micrograms kg-1 hr-1 after; p less than 0.05); (2) increased response to insulin hypoglycemia (peak 15 min output = 3.5 +/- 0.9 before, and 5.5 +/- 0.9 mMol after; p less than 0.05); but (3) a reduction of acid response to meal (peak 15 min output = 7.1 +/- 0.9 before, 3.7 +/- 1 after; p less than 0.05). Propranolol, on the other hand, had no effect on the response to meal before SGS but enhanced it after SGS restoring the response to pre-SGS levels. Subsequent vagotomy abolished acid response to insulin but did not alter the post-SGS response to a meal. We conclude that the sympathetics exert a beta-adrenergic inhibitory influence on gastric acid response to insulin and histamine but not to food. Following SGS, the enhancing effect of propranolol probably implies supersensitivity of the stomach to circulating catecholamines.

Animals↗
PubMed1983

Hierarchy of blood pressure control mechanisms after spinal sympathectomy.

We have investigated the relative importance of angiotensin and vasopressin in the regulation of arterial pressure following permanent interruption of supraspinal sympathetic influences. To accomplish this aim, the spinal cord of 12 dogs was transected just above the intervertebral foramen of C-6; several days later, we gave first a potent blocker of the vasculotropic actions of vasopressin and 40 min later captopril. The same experiment was performed in other dogs with the drug order reversed. Mean arterial pressure and heart rate were recorded continuously and blood samples were taken to measure plasma renin activity and plasma catecholamines. All studies were carried out at three levels of hydration: normal, after 36 h water deprivation and following an overnight infusion of 0.9% saline. Conscious dogs with complete surgical sympathectomy by spinal cord section had normal mean arterial pressure, heart rate and plasma renin activity but undetectable levels of catecholamines. Captopril produced significant falls in mean arterial pressure that were greatest in water deprivation and least in volume loading, whether the drug was given before or after treatment with the vasopressin antagonist. On the other hand, the vasopressin antagonist modified mean arterial pressure only in the water deprived state. In spinal dogs the renin angiotensin system assumes a primary role in maintaining normal mean arterial pressure at various extremes of body fluid volumes. Vasopressin plays a role only after removal of the two dominant systems.

Animals↗
PubMed1984

Hypertension after brainstem (A1) lesions in normal rats and in rats with adrenalectomy, sympathectomy or diabetes insipidus.

Lesions of the ventrolateral medulla coinciding with the A1 noradrenaline cell group, in either the rabbit or the rat, cause hypertension and bradycardia accompanied by 50-fold increases in plasma vasopressin and adrenaline and a two-to-four-fold increase in plasma noradrenaline. Following adrenalectomy in normal rats, the A1 hypertension and bradycardia were unchanged. In Brattleboro rats with diabetes insipidus, A1 hypertension was not altered but the bradycardia was reduced by 40%. In Brattleboro rats subjected to adrenalectomy, the hypertension was reduced by 50%. In normal rats, chemical sympathectomy with intravenous 6-hydroxydopamine (6OHDA) reduced the hypertension by about 50%, and when combined with adrenalectomy it abolished the hypertension altogether. In Brattleboro rats, 6OHDA reduced the hypertension after A1 lesions by about 40%. We suggest that A1 hypertension is predominantly mediated through increased activity of sympathetic vasoconstrictor nerves, and that circulating adrenaline and vasopressin only make a minor contribution to the increase in pressure.

Adrenal Glands↗
PubMed1984

How to achieve total gastric sympathectomy.

Experimental examinations on acute, stress induced gastric ulcers have shown the outstanding role of the sympathetic innervation in the pathogenesis of this ischemic disease. As reduction of sympathetic tonus resulted in a significant prophylaxis against "stress ulcers", further experimental work was done to achieve total but selective gastric sympathectomy. In a histomorphological study in dogs (Method: Hillarp and Falck in the modification of Heene ) the effects of three different surgical procedures on gastric sympathetic denervation were investigated: 1. Selective proximal vagotomy (= SPV, 8 dogs) 2. SPV and periarterial denervation of the main gastric arteries with severance of the gastrolineal ligament (= PASD , 8 dogs) 3. PASD alone (7 dogs) Selective proximal vagotomy resulted in a sympathetic denervation of major parts of the right site of the fundus and corpus. Following selective proximal vagotomy with periarterial denervation ( PASD ) there was a complete sympathetic denervation of the entire stomach. Only a minimal area of resting sympathetic innervation was observed on the esophago-cardial border when periarterial denervation ( PASD ) was performed alone.

Animals↗
PubMed1983

[Endobronchial ventilation in transthoracic endoscopic sympathectomy].

Thoracic endoscopic sympathectomy (TES) is a short surgical procedure used for the treatment of axillary and palmar hyperhydrosis. It involves creation of tension pneumothorax, lateral and head-up position and necessitates minimal lung excursions during breathing, so that a special anaesthetic technique is required. In six otherwise healthy patients an endobronchial double lumen tube was used for one-lung ventilation with intravenous anaesthesia and muscular relaxation, and circulatory response, FE CO2 and blood gases were monitored in order to compare this anaesthetic technique to conventional endotracheal intubation in previous patients. Some difficulties with inserting and securing the double lumen tube were encountered, but were far outweighed by the advantages of stable circulation, physiological blood gas values and easy access to a calm surgical field.

Adult↗
PubMed1983

[Effect of periarterial sympathectomy and decompensation of the celiac trunk on gastric secretion in the abdominal pain syndrome].

The gastric secretion was investigated after periarterial sympathectomy and decompression of the celiac trunk in 50 patients. It was shown that basal and stimulated secretion was persistently increased in cases with intact structure of the celiac plexus, while in cases with degenerative changes with fibrosis of the ganglia and conductors the gastric secretion was not found to significantly change. The data obtained should be taken into consideration when operating upon the celiac artery and celiac plexus.

Abdomen↗
PubMed1984

[A predictive thermographic test of the effect of lumbar sympathectomy].

The benefit of lumbar sympathectomy in the treatment of arteriopathy of the lower limb has been widely proved. To predict objectively its efficiency we developed a simple pharmacologic test under thermographic control. 1 mg of Reserpine is injected in a femoral artery, a digitalized thermography enables to follow the chronological evolution of temperatures of the lower limbs. Thirty patients were investigated, 27 responded positively. The mean increase in temperature of the injected limb reached 1.62 degrees C beginning 2 h 46 after the injection of Reserpine.

Aged↗