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At least 1,063 records · Page 59Linked to original sources
PubMed1995

[Video thoracoscopic sympathectomy].

Twenty operations of video thoracoscopic sympathectomy (VTS) were performed on 17 patients in 1992-1994. The indications for the operation are Raynaud's disease and some obliterating occlusions of the upper limb arteries in which a reconstructive operation is not possible. The VTS operation is technically simple and atraumatic. Its effectiveness is determined by the disappearance of pain, warmer hands, and the results of histological study. The authors experience has shown that VTS does not need special instruments. At the same time, they believe that cooperation with specialists in thoracic and vascular surgery is very important and obligatory in development of complications.

Adolescent↗
PubMed1995

[Thoracoscopy in upper thoracic sympathectomy].

The authors describe their experience with the endoscopic technique of upper thoracic sympathectomy. They evaluate it as an easily performed and safe method which gives great comfort to the patient as well as excellent functional and cosmetic results and involves a minimal burden and ensures rapid convalescence. It enables the surgeon to obtain a perfect orientation in the surgical field as well as safe and perfect preparation of the thoracic portion of the sympathetic nerve. The low cost is also important.

Ganglia, Sympathetic↗
PubMed1994

Anaesthetic implications for transthoracic endoscopic sympathectomy.

Transthoracic endoscopic sympathectomy is now considered the treatment of choice for patients with upper limb hyperhidrosis requiring sympathetic ablation. This procedure requires the use of an endobronchial double lumen tube and subsequent one-lung anaesthesia, a technique that is associated with a number of potential problems. Full patient monitoring is thus required and includes pulse, ECG, non-invasive blood pressure measurement, pulse oximetry, end-tidal carbon dioxide concentration and peak inspiratory airway pressure. We reviewed our anaesthetic technique and peri-operative complications in 26 patients, to assess patient safety. In our study hypoxaemia occurred commonly but was transient in all bar one case where re-expansion of the lung was required. Hypotension occurred at two stages of the procedure, but active intervention was not required, and two patients required underwater drainage of the pleural cavity for treatment of pneumothorax. With skilled anaesthetic personnel and adequate monitoring this procedure may be carried out safely.

Adolescent↗
PubMed1994

Degeneration activity: a transient effect following sympathectomy for hyperhidrosis.

The degeneration activity of effector organs is due to a period of transmitter release from degenerating sympathetic post-ganglionic nerve endings. This is the theoretical explanation for a period of sweating some days following sympathectomy for hyperhidrosis seen in some patients operated on with the thoracoscopic technique in Jönköping, Sweden. The reasons for degeneration activity, well documented in animal experiments, are discussed in this paper.

Adolescent↗
PubMed1994

The history of cervicothoracic sympathectomy.

As early as in 1889 surgery on the cervical sympathetic nervous system was performed. During the following decades this operation was tried for a variety of diseases. In the early 1920s it was clarified that patients with hyperhidrosis, vasospastic conditions, and angina pectoris would benefit from stellectomy. It was, however, soon discovered that removal of the upper thoracic ganglia was required in order to obtain complete sympathetic denervation of the upper extremity. Several open surgical techniques for upper thoracic sympathectomy were described. During the 1940s a few pioneers started to excise sympathetic ganglia by thoracoscopy which had originally been described as a diagnostic tool by Jacobaeus in 1910. The endoscopic approach, amply documented by Kux in 1954, did not, however, gain widespread popularity until the 1980s. Like the general upsurge of interest in endoscopic surgery, thoracoscopic ablation of the upper thoracic sympathetic ganglia is now rapidly being adopted by surgeons.

Ganglia, Sympathetic↗
PubMed1995

[Effects of medical vagotomy and sympathectomy on gastric mucosal prostaglandins in water immersion restrain rats].

Ulcer index (UI), gastric submucosal blood flow (SMBF), gastric fundic mucosal content of 5 prostaglandins (PGE2, TXB2, PGF2 alpha, PGD2, 6-keto-PGF1 alpha) were measured in water immersion restrain rats under medical vagotomy (MV) or medical sympathectomy (MSp). UI decreased under MV and MSp with 6 hours stress. SMBF decreased less under MV and MSp than control rats. PGE2 of control rats decreased under stress, but increased under MV and MSp. It is resulted that MV and MSp effect PGE2 to increase, inhibition of SMBF decreasing because of increasing PGE2 were recognised and there for stress ulcer were inhibited.

Animals↗
PubMed1995

Alterations in cytokine and antibody production following chemical sympathectomy in two strains of mice.

It is becoming clear that immune responses are subject to modulation by the sympathetic nervous system. We examined the effect of chemical sympathectomy (to ablate peripheral sympathetic nerve fibers) on cytokine and Ab production in two strains of mice that are known to differ in their response to a variety of pathogens and in the dominant types of cytokines produced. C57Bl/6J mice produce a strong cell-mediated response, characterized by production of IL-2 and IFN-gamma, whereas BALB/cJ have a dominant humoral response, with production of IL-4 and IL-10. Animals were denervated by injection with 6-hydroxydopamine and immunized with keyhole limpet hemocyanin, and spleens were removed at various times after immunization. Denervation significantly increased the keyhole-limpet-hemocyanin-stimulated in vitro proliferation and IL-2 and IL-4 production by splenocytes from both strains. The increases were prevented by pretreatment with desipramine, which blocks the uptake of 6-hydroxydopamine into the nerve fibers and subsequent nerve fiber destruction. Serum titers of IgM, IgG, IgG1, and IgG2a were also enhanced in the C57Bl/6J strain; BALB/cJ mice had a small increase in IgG1 only. These results suggest that one function of splenic innervation and transmitter release may be to modulate T helper cytokines, thereby partially regulating immune effector function. Our evidence is consistent with a model of immune regulation in which removal of sympathetic nervous system input enhances at least some parameters of immune responses.

Animals↗
PubMed1995

Use of a single lumen endotracheal tube and continuous CO2 insufflation in transthoracic endoscopic sympathectomy.

BACKGROUND: Transthoracic endoscopic sympathectomy (TES) is an accepted standard surgical treatment for palmar hyperhidrosis. For anesthetic management, a double lumen endobronchial tube is usually used to deflate the lung on the operative side. Recently we have applied continuous insufflation of carbon dioxide (CO2) into the pleural cavity to merely compress one lung while ventilating both lungs with a conventional single lumen endotracheal tube. METHODS: We have studied 45 patients (ASA I and II) who underwent bilateral TES, Thirty-three were ventilated by single lumen tube and the other 12 by double lumen endobronchial tube with one lung ventilation. In both groups I and II, CO2 was insufflated slowly through the scope to a intrapleural pressure of 20 cm H2O. Both lungs were ventilated with peak pressure of less than 20 cmH2O at tidal volume of 5-12 ml/kg at 10-16 beats/min. RESULTS: In these patients, no CO2 retention was noted. Oxygenation and cardiovascular stability were maintained and there were no complications. In the double lumen series, we found that oxygen saturation was less uniform and less stable than those in the single lumen series. CONCLUSIONS: It is concluded that the use of single lumen endotracheal tube with continuous insufflation of CO2 in TES is easy, simple and safe.

Adolescent↗
PubMed1994

One lung ventilation in endoscopic transthoracic sympathectomy.

Endoscopic transthoracic sympathectomy currently requires one lung anaesthesia to facilitate access to the thoracic sympathetic chain. This may cause reduced perioperative arterial oxygen saturation. We describe a series of patients in which the collapsed lung is kept partially inflated using continuous positive airway pressure (CPAP) with 100% oxygen. This modification of anaesthetic technique enabled a normal arterial oxygen saturation to be maintained thus preventing operative delays whilst the lung was reinflated to restore adequate oxygen saturation.

Humans↗
PubMed1975

Anesthetic hazards for patients who have undergone bilateral thoracolumbar sympathectomy.

Abrupt and serious circulatory changes may take place during and after operations under general anesthesia in patients who have had extensive thoracolumbar sympathectomy performed previously. These changes should be anticipated and treated promptly and vigorously, if prevention is not possible. Experiences with 23 such cases are presented.

Anesthesia, General↗
PubMed1994

Effects of adrenalectomy and chemical sympathectomy on pressor and tachycardic responses to diphenyleneiodonium.

We have reported that diphenyleneiodonium (DPI), a flavoprotein inhibitor, caused pressor and tachycardic responses by indirectly activating the sympathetic nervous system. In this study, bilateral adrenalectomy and chemical sympathectomy by 6-hydroxydopamine (6-OH-DA) were used to examine the contributions of the adrenal medullae and sympathetic nerve terminals to the pressor and tachycardic responses to DPI in pentobarbital-anesthetized rats. Intravenous bolus injections of DPI (0.05-1.6 mg/kg) caused dose-dependent increases in mean arterial pressure and HR. Neither bilateral adrenalectomy nor pretreatment (26 hr earlier) with 6-OH-DA (100 mg/kg, i.p.) significantly affected the dose-MAP curve of DPI, although 6-OH-DA but not adrenalectomy slightly and significantly shifted the dose-HR curve to the right without affecting the maximum. The combination of bilateral adrenalectomy and 6-OH-DA reduced the maximum mean arterial pressure and HR responses to DPI by 71% and 35%, respectively. Intravenous bolus injection of DPI (1.6 mg/kg) caused increases in plasma norepinephrine, epinephrine and dopamine of more than 2, 2 and 0.1 ng/ml, respectively. Although bilateral adrenalectomy reduced the DPI-induced increases of norepinephrine, epinephrine and dopamine by 85%, 100% and 93%, and 6-OH-DA reduced these increases by 67%, 48% and 61%, respectively, the combination of adrenalectomy and 6-OH-DA abolished the increases in catecholamines. These results show that sympathetic nerve terminals and sympathoadrenals play overlapping roles in the pressor and tachycardic responses to DPI, with the adrenal medullae as the primary source of plasma catecholamines released by DPI.

Adrenal Medulla↗
PubMed1994

Experience of anesthesia for transthoracic endoscopic sympathectomy in palmar hyperhidrosis--110 cases.

Transthoracic endoscopic sympathectomy (TES) is an effective treatment for palmar hyperhidrosis. We review our experience and discuss the anesthetic technique and perioperative complications encountered in 110 patients undergoing TES for palmar hyperhidrosis. All patients were monitored with EKG, NIBP and pulse oximetry (SPO2) during the operation. The trachea was intubated with a single lumen endotracheal tube and ventilation was controlled manually. 100% inspired oxygen was necessary during TES to avoid hypoxia. One patient developed sudden cardiac arrest during electrocauterization of the left sympathetic chain and two patients required underwater drainage for hemothorax. Minimal pneumothorax was diagnosed in 4 patients and all cases resolved spontaneously without active treatment.

Adolescent↗
PubMed1993

Augmented coronary blood flow response to intracoronary norepinephrine after ventricular sympathectomy.

BACKGROUND: Ventricular sympathetic denervation may occur as a result of myocardial infarction or heart transplantation. The present study examined the time-dependent effects of surgical ventricular sympathectomy on coronary flow and myocardial contractile responses to intracoronary norepinephrine administration in conscious dogs. METHODS: Adult mongrel dogs (18-26 kg), were either ventricular sympathectomized or served as a sham-operated control. Animals were studied 2, 4, and 8 weeks after surgery. Measurements of left ventricular systolic pressure (LVSP), maximum rate of left ventricular pressure generation (dP/dtmax), maximum negative rate of segmental shortening (-dL/dtmax), heart rate, and mean circumflex flow velocity (CFV) were obtained before and after bolus administration of norepinephrine into the circumflex artery in doses ranging from 0.01 to 0.50 microgram. RESULTS: Intracoronary norepinephrine administration caused significant increases in LVSP, dP/dtmax, -dL/dtmax, heart rate, and CFV. After reaching a peak or maximum response, these variables returned to their respective preinjection values, except for CFV, which exhibited a biphasic response. CFV continued to decline below control levels, indicating a vasoconstrictor response to norepinephrine, before returning back to preinjection levels. With the 0.5-microgram dose of intracoronary norepinephrine, the percent increases in CFV were 124% +/- 25% and 105% +/- 15% (P < 0.05) at 2 and 4 weeks respectively, compared with the sham-operated controls, which only increased 56% +/- 15%. The response to the 0.5-microgram dose of norepinephrine at 8 weeks (61% +/- 6%) was not significantly different from control. Elevated myocardial contractile responses in the sympathectomized hearts were also evident at 2 and 4 weeks, but not at 8 weeks. The vasoconstrictor response to norepinephrine administration was not significantly different between sympathectomized and sham-operated hearts. Finally, there was no difference in the change in LVSP, dP/dtmax, or heart rate between any of the groups at any of the doses. CONCLUSIONS: These results suggest that a supersensitivity to the coronary functional hyperemic response after intracoronary norepinephrine is present in ventricular sympathectomized hearts, but a coronary constrictor supersensitivity does not exist.

Animals↗
PubMed1977

The effect of neonatal sympathectomy on the response of the rat submandibular gland to isoproterenol.

The right superior cervical ganglion was removed from 1-day-old rat pups. For four consecutive days (22-26 days of age), the rats were injected twice daily with isoproterenol-HCl (IPR) at a dose of 2.0 mg/100 g.b.w. and killed on the 27th day of age. Control animals were injected with the solvent, 0.1% Na2S2O5, according to the same protocol. In both control and IPR-treated rats, fluorescence microscopic examination of glands prepared by the Falck-Hillarp method showed a total absence of adrenergic nerve fibers on the side of sympathectomy, and a normal innervation on the unoperated side, while light microscopic examination of Epon-embedded glands revealed no differences in structure between the noninnervated and intact glands. However, after IPR treatment the noninnervated glands consistently showed greater absolute and relative weight, and total DNA, RNA and protein than the corresponding intact gland from the same animal. It is suggested that this greater hyperplastic and hypertrophic response in the noninnervated gland represents a postjunctional supersensitivity of acinar cells to the beta agonistic action of IPR.

Animals↗
PubMedDate not supplied

Selective inhibition of endothelium-dependent relaxation by sympathectomy in rabbit carotid artery rings in vitro.

The influence of cervical and periarterial sympathectomy on endothelium-dependent relaxation of the rabbit common carotid artery was studied in vitro. Noradrenaline, serotonin, acetylcholine and papaverine concentration-response curves of sympathectomized and control rabbit common carotid artery rings were recorded and analyzed and effects of endothelium removal were investigated. Endothelium-dependent relaxation was selectively and significantly inhibited in 3 weeks postsympathectomy arterial preparations. Alterations in acetylcholine receptors of endothelial cells, decrease in endothelium-derived relaxing factor synthesis, or desensitization of medial muscular cells to endothelium-derived relaxing factor are hypothetical causes of this phenomenon.

Acetylcholine↗
PubMed1977

[Influence of lumbar sympathectomy on the proportion of amputation (author's transl)].

One hundred and eighty-three lower limbs with arterial occlusion and stade II chronic ischemia were followed for 5 years. Two groups, comparable as to age, sex number and location of lesions were formed by prospective randomization. Ninety limbs were treated by lumbar sympathectomy and 93 were not operated. After 5 years there is no difference between the 2 groups as to mortality, cardiovascular morbidity, claudication or minor or major amputations.

Amputation, Surgical↗
PubMed1977

[Interest of the local regional anesthesia in lumbar sympathectomy (author's transl)].

Authors report 163 cases of lumbar sympathectomy they did under local anesthesia from 1968 to 1975. All were older--and poor risk patients. Approach was always lumbar with resection of distal part of the 12th rib. If good care is taken to do anesthesia infiltration of the five lower intercostal nerves and of the 1st and 2nd posterior lumbar nerves, anesthesia is quite good, and surgery easy and painless. The main advantages are:--easy excision of the first lumbar sympathetic node through this lumbar approach;--low lethality as far as authors consider almost no contra-indications;--very fast recovery of bowel movements;--immediate oral feeding which is important for diabetic patients;--no tracheal, bronchial or lung postoperative infestation or trouble. Patients have never had any trouble (convulsions) from lignocaine since gardenal is given in pre-anesthesia.

Aged↗