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[Treatment of Prinzmetal's angina with normal coronary vessels by thoracic sympathectomy].

Two cases of Prinzmetal angina with normal coronary arteries are reported: coronary spasm was demonstrated in the left anterior descending artery in the first, and in the right coronary artery in the second case. Invalidating angina persisted despite maximal medical treatment with nitrite derivatives, nifedipine, verapamil and amiodarone. Homolateral thoracic sympathectomy led to long term remission of symptoms in one case and a short remission in the other, who then had to undergo complete denervation by plexectomy. Two hours after reoperation a refractory spasm of the right coronary artery led to the death of the patient. The possible causes of refractory coronary spasm and possible therapeutic approaches are discussed with reference to these cases.

Adult↗

Upper dorsal sympathectomy for palmar hyperhidrosis.

The treatment results in 133 patients who underwent bilateral upper dorsal sympathectomy (BUDS) for palmar hyperhidrosis (HH) are reported. Group 1 (67 patients) was followed for 5 to 10 yr (mean 7) and Group 2 (66 patients) was followed for 1 to 4 yr (mean 2). Early results and complications, early and late sequelae, late recurrence and patient satisfaction with the results of the operation were analyzed. The immediate success rate was 98%, and late recurrence of HH was noted in 5.3% of the patients. The incidence of technical complications was lower in Group 2 than in Group 1, otherwise both groups were similar. Persistent, severe Horner's syndrome was present in only one patient at late follow-up. Troublesome compensatory HH persisted in one-third of the patients. Overall patient satisfaction was good, and only 10 patients regretted having undergone the operation. BUDS appears to be the best solution for severe palmar HH in properly selected patients.

Adult↗

[Velocimetry and sympathectomy].

In a previous work, the writers have described the influence of vasomotoricity on the shape of the ultrasonic velocimetric curves (Doppler). A vasodilatation induced by an anaesthesia of the sympathetic chain or by a general anaesthesia by penthotal produces a raising of the whole curve above the basic line. The writers have studied in the present work the shape of the velocimetric curves after a lumbar sympathectomy and have compared them with the variations of the cutaneous thermometry and with the clinical results. A correlation has been found in 86.3% of the 124 studied limbs. The study shows that the raising of the curve due to the phenomenon of vasodilatation appears only at the extremity of the limb. The profile of the curve remains unchanged at the root. A velocimetric curve above the basic line may occur apart from any vasomotoric modification. In this case it is the sign of an up-stream obliteration combined with a drop of the index of perfusion (less than the unit).

Arm↗

Effects of chemical sympathectomy on the increases in plasma catecholamines and dopamine-beta-hydroxylase induced by forced immobilization and insulin-induced hypoglycemia: origin and fate of plasma dopamine-beta-hydroxylase.

The effect of acute stresses on plasma norepinephrine, epinephrine and dopamine-beta-hydroxylase (DBH) were evaluated in control and 6-hydroxydopamine-treated, awake cannulated guinea pigs. Forced immobolization for 1 hr caused a 3- and 5-fold increase in plasma DBH and norepinephrine, respectively. Pretreatment with 6-hydroxydopamine (23 mg/kg b.wt.i.a., 72 and 48 hr before stress) reduced by 70% the increase in plasma DBH and totally prevented the rise in plasma catecholamines evoked by the restraining stress. Injection of insulin (5 U/kg b.wt.i.a.) induced a 60% decrease in blood glucose, a 1-fold increase in plasma DBH and a selective 4-fold increase in plasma epinephrine; these effects were not modified by chemical sympathectomy. Our results indicate that forced immobilization and hypoglycemia produce a preferential activation of the sympathetic postganglionic nerves and of the adrenal medulla, respectively, and that in guinea pigs both stresses increase plasma DBH. The kinetics of disappearance of plasma DBH were studied after subjecting the guinea pigs for 1 hr to forced immobilization. Although 7 of 12 animals showed a biphasic rate of fall of plasma DBH, in each case there was a rapid initial fall possibly due to the "distribution" of the enzyme with a T1/2 of 1.65 hr. Similar findings were observed in 6-hydroxydopamine-treated guinea pigs. These results suggest that the distribution of DBH is the most important process in reducing the augmented plasma DBH levels elicited by a short-term stress and that this process is not dependent on the integrity of the sympathetic nerves nor on the adrenal or sympathetic origin of the enzyme. This study supports the view that the ratio, content of releasable DBH present in sympathetic nerves and adrenal glands/total circulating pool of DBH, is the factor that determines whether an increase in plasma DBH would occur in animals exposed to an acute stress.

Animals↗

Postjunctional supersensitivity in young rat heart produced by immunological and chemical sympathectomy.

Postnatal changes in sensitivity to norepinephrine (NE) were studied in normal and sympathectomized rat hearts. The sensitivity of left atria to NE was highest at birth, after which it declined, reaching the adult level by 2 weeks of age. Developmental changes in NE sensitivity of the left atria seemed to be related to the density of sympathetic innervation, and the high sensitivity at birth was most likely due to the lack or immaturity of the uptake function of the nerve endings. In contrast to the atria, right ventricular papillary muscle did not change in NE sensitivity with age. Immunological and chemical sympathectomy was performed by repetitive administration of antiserum to nerve growth factor and 6-hydroxydopamine, respectively. Both atria and papillary muscles from immunologically and chemically sympathectomized rats were supersensitive to NE at all ages tested. Inasmuch as the supersensitivity to NE was most marked at the 4th week of age, atria of this age were used for the study on the mechanisms of supersensitivity. Left atria from sympathectomized 4-week-old animals were also supersensitive to isoproterenol and phenylephrine. Because isoproterenol and phenylephrine are not taken up into sympathetic nerve endings, it was concluded that the postjunctional mechanisms were involved in the genesis of the denervation supersensitivity of left atria.

Animals↗

[Late results of thoracic sympathectomy in various diseases].

The late results of 171 thoracal sympathectomies performed on 142 patients in the 20-year period 1952 to 1971 are described. Favourable results were achieved in Raynaud's disease, obliterating endarteritis and other occlusive vascular diseases, and also in hyperhidrosis.

Endarteritis↗

[Dynamics of the change in the prostaglandin content of brain tissue in upper cervical sympathectomy and circulatory hypoxia].

A study was made of the effect of cervical sympathectomy (SE) on the time course in the content of prostaglandins (PG) (E + A) and F2 alpha under normoxia and circulatory hypoxia. The sympathectomized rats manifested a biphasic change in the content of PG (E + A). The content of PG (E + A) rose by days 1 and 7. It returned to normal by day 14 and increased again by day 40 after SE. The content of PG F2 alpha drastically increased 7 days after SE and then returned to normal. Brain ischemia induced by bilateral ligation of the common carotid arteries led to an increase in the content of PG (E + A) and in that of PGF2 alpha, in particular. Preliminary SE resulted in the absence of differences in the content of PG (E + A) caused by brain ischemia. It is assumed that PGF2 is largely implicated in the regulation of the tone of the bran vessels and in the regulation of metabolism during ischemia with disordered sympathetic control.

Adaptation, Physiological↗

[Cytofluorimetric study of the small, intensely fluorescent cells of the rat atria in pharmacological sympathectomy].

The fluorescence intensity of small intensely fluorescent (SIF) cells of rat atria was measured by the modified Falck method in health and chronic guanethidine administration. The normal value of fluorescence of single SIF cells was lower than that of clustered SIF cells. However, similar deviations were observed for both the types of SIF cells under chemical sympathectomy. The mean value of fluorescence decreased during 6-9 weeks of the experiment and increased during the next 3 weeks. The most pronounced reaction was exhibited by SIF cells in the superior vena cava and interatrial septum.

Animals↗

Quantitative changes in the numbers of dense-core vesicles and 'synaptic' ribbons in pinealocytes of the Djungarian hamster (Phodopus sungorus) following sympathectomy.

The dense-core vesicles and 'synaptic' ribbons were counted in Djungarian hamster pinealocytes after superior cervical ganglionectomy. Sympathectomy caused a decrease in the number of dense-core vesicles in pinealocytes, suggesting diminished secretory activity of these cells. An increase in the number of 'synaptic' ribbons after superior cervical ganglionectomy supports the hypothesis that adrenergic innervation of the pineal gland influences the level of 'synaptic' ribbon formation.

Animals↗

[Effect of sympathectomy on responses of pial arteries during acute deficiency of cerebral blood supply].

The dilatatory responses of small pial arteries including their active segments (sphincters at off-shoots, precortical arteries), to blood supply deficiency in the cerebral cortex were compared in control and sympathectomized rabbits. The sympathectomy resulted in complete disappearance of histochemically detected adrenergic and a considerable decrease of cholinergic nerve fibers in the pial arterial walls. The vasodilatation was much less obvious in sympathectomized than in control animals. This was associated with (and probably caused by) a considerable rise in histochemically detected serotonin activity of the pial arteries walls. After recovery of blood supply to the brain the constriction of the pial arterial active segments restricting the excessive cerebral blood flow, was significantly reduced due, probably, to the sympathetic deprivation. Therefore, the sympathetic control plays an important part in pial arterial responses regulating the adequate blood supply of the cerebral cortex.

Adrenergic Fibers↗

Thoracic sympathectomy. Review of indications, results and surgical techniques.

87 patients operated upon for 125 thoracic sympathectomies with different surgical techniques (supraclavicular, axillar and posterior approach) were studied. Authors noticed clear differences in results according to the sex of the patient and basic disease. Some observations about advantages and disadvantages of the different surgical techniques are also reported. According to the results, Authors suggest a particular therapeutical behaviour.

Female↗

[Sympathectomy and bone circulation (animal experiments) (author's transl)].

Lumbar sympathectomy doubles the blood flow of the tibia. This positive effect does not correlate with fracture healing: fracture hyperaemia will last longer, formation of new bone and bone resorption will be more intensive and is combined with trophic alterations. These symptoms characterize the clinical picture.

Animals↗

Chemical lumbar sympathectomy with radiological assessment.

Forty cases of chemical lumbar sympathectomy are presented. A 7.5% solution of phenol in meglumine iothianate was injected under local anaesthesia and abdominal radiography performed. Skin temperature changes in the legs were compared with the radiological appearances and clinical results. Six injections were performed on cadavers before autopsy using a solution of methylene blue and meglumine iothianate in order to correlate the radiological appearance with the exact site of the injection. In 36 patients 32 injections were correctly sited at the first attempt. The 4 patients in whom technical failure occurred were successfully reinjected at the second attempt. Four correctly sited injections failed to produce a response and were not repeated.

Aged↗

[Mooren's ulcer treated by cervical sympathectomy: a possible new therapy (author's transl)].

The authors report a very serious case of Mooren's ulcer, which did not show any improvement with local and general treatment. This case which showed a Raynaud's phenomenon was completely cured after ablation of superior cervical ganglion and bilateral peri-carotid sympathectomy. In the authors opinion, in accordance with many instances in the literature, Mooren's ulcer has initially a sympathetic origin. Furthermore, in these cases of Mooren's ulcer in which an etiologic agent has been demonstrated, the authors believe that this agent is superimposed, and can, cause a sympathetic angiospasm, which often makes useless the various medical or surgical treatments experienced to date.

Corneal Ulcer↗

[Effect of periarterial sympathectomy of the celiac trunk and its branches on the motor function of the stomach].

The motor function of the stomach was investigated in 45 patients who were subjected to periarterial sympathectomy of the celiac trunk and its branches for the abdominal pain syndrome. Changes in the motility were studied in near and late terms after operation (1-2 years). The elevated tonus of the stomach was found to be even in the initial hypokinesis and of spastic character in the initially normal tonus. The increased peristaltic activity was noted in late terms. The changes of the gastric motility were responsible for the outcomes of operations.

Abdomen↗

Lumbar sympathectomy in the treatment of severe lower limb ischaemia in old people.

One hundred and twenty lumbar sympathectomies were performed in 110 old people (over 65 years of age) as the treatment for severe lower limb ischaemia. Only one quarter of the patients benefited from the operation. In nearly half the cases the limb was ultimately amputated. The operative mortality was 7%, with pneumonia the most common cause of death. Age and mild diabetes mellitus had no effect on the result of treatment. Diabetics on insulin, however, derived no benefit from the operation. the degree of severity of the ischaemia, and the location of the arterial occlusion affected the result of treatment.

Age Factors↗

[Choice of anaesthesia technique in thoracic endoscopic sympathectomy (author's transl)].

Thoracic endoscopic sympathectomy (TES) is a short surgical procedure used for the treatment of palmar and axillary hyperhidrosis. It involves pneumothorax, the lateral and head up position, and necessitates minimal chest excursions during breathing, so that a special type of anaesthesia is required. In 13 patients two different methods were compared and blood gas analysis as well as circulatory parameters were studied. We therefore propose an anaesthetic method using controlled mechanical ventilation; relaxation; intravenous anaesthesia; at least 1 1 fluid replacement; and careful monitoring.

Adolescent↗

Clinical results of lumbar sympathectomy.

Lumbar sympathectomy appears to be effect in relieving rest pain, particularly when the ankle: brachial systolic pressure ratio (ABR) is relatively high, i.e., greater than 0.35. The ABR seems to have less predictive value when advanced skin changes are present, and in such cases the extent of ischemic necrosis is probably the major determinant of outcome. A low, or even unrecordable ABR, does not remove all hope of a successful outcome. However, it makes success less likely and can be used as a guide in determining the risk: benefit ratio for individual patients.

Adult↗