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PubMed1990

Effect of chemical sympathectomy on cardiac hypertrophy and hemodynamics following myocardial infarction in the rat.

The effects of sympathectomy on cardiac structure and function were studied in an animal model of myocardial infarction. Ninety-six rats were double randomized to control or infarction disease state and to placebo or chemical sympathectomy (guanethidine, 30 mg/kg daily, intraperitoneal). Five weeks after anterior infarction, there was hypertrophy in placebo-treated animals in myocardial fibers remote from the infarct (9.8 +/- 1.8 microns in infarction vs 8.1 +/- 1.0 microns in control, p less than 0.05). However, myocardial hypertrophy was not present in guanethidine-treated animals (8.6 + 1.6 microns in infarction vs 8.0 + 0.6 microns in control, p = N.S.). Guanethidine treatment caused significant reductions in systolic arterial blood pressure and indices of left ventricular contractility and relaxation (p less than 0.05), but these effects were not different between infarct and control treatments (p = N.S.). Although both effects of guanethidine treatment (sympathectomy and hemodynamic) were correlated with myocardial fiber diameter by univariate analysis, only sympathectomy was significant by stepwise regression analysis (p less than 0.05). Therefore, the cardiac sympathetic nerves have important effects on the development of hypertrophy after myocardial infarction, and sympathectomy alters this process in the rat model.

Analysis of Variance↗
PubMed1987

Effects of chemical sympathectomy in neonatal and adult mice on C-1300 neuroblastoma tumor growth and catecholamine content.

The in situ C-1300 murine neuroblastoma (MNB) tumor model was used to investigate the influence of 6-hydroxydopamine (6HD)-induced sympathectomy on tumor growth and catecholamine concentration. One week (adult) and 3 weeks (neonatal) after sympathectomy, mice were implanted with 10(6) disaggregated MNB cells. The time interval between implantation of MNB cells and detection of palpable tumor (tumor onset time), transverse tumor diameter, tumor weight, tumor weight to body weight ratio, and tumor catecholamine concentration were determined. Sympathectomy following 6HD administration was confirmed by analysis of catecholamine concentrations in the heart and spleen by high-pressure liquid chromatography. Treatment of adult animals with 6HD reduced the mean heart and spleen norepinephrine (NE) concentrations to less than 20% of controls (vehicle treated). Neonatal sympathectomy decreased the average heart and spleen NE concentrations to less than 10% of comparable control mice. Whole brain NE and dopamine concentrations were not altered by treatment with 6HD in either age group. Tumor onset time following implantation of MNB cells was significantly increased in animals sympathectomized as either neonates or as adults. In contrast, MNB tumor growth rate following tumor onset was significantly inhibited in animals sympathectomized as neonates but not as adults. The catecholamine concentrations of tumors removed from control and sympathectomized mice 8 days after tumor onset were determined. Tumor NE and dopamine concentrations were increased 9.09 +/- 2.8- (SE) and 7.03 +/- 1.8-fold, respectively, in mice sympathectomized as neonates. There were no significant differences in the NE and dopamine concentrations of tumors obtained from sympathectomized and control adult mice. Pretreatment with desmethylimipramine prior to 6HD administration prevented destruction of sympathetic neurons, inhibition of tumor growth rate, and the increase in tumor catecholamine concentration observed in neonatally sympathectomized mice. These data suggest that the influence of chemical sympathectomy on MNB tumor growth and biochemical differentiation, as defined by catecholamine content, are age dependent.

Age Factors↗
PubMed1985

[Flowmeter monitoring following lumbar sympathectomy].

Lumbar sympathectomy is still a subject for debate with respect to its results and mechanism of action. Effects were assessed objectively by measuring hemodynamic parameters of blood flow. The study protocols are discussed. Muscle nutritional capillary flow was determined by clearance of radioactive Xenon. Within a period varying from 8 to 24 months. 31 to 51% of patients with arteritis show increased muscle flow after sympathectomy. Effects are analyzed as a function of site of lesion, duration of claudication and uni- or bilateral operation performed. The non-invasive electromagnetic flowmeter measures global pulsatile arterial blood flow in the upper third of the leg: improvement in pulsatile flow was noted in 86% of cases six months after sympathectomy. Finally, skin microcirculation velocity was measured by Doppler using a laser beam: improvement occurred immediately after sympathectomy for well defined clinical indications, whereas no effect was noted in arteriopathy of diabetic origin. This method can therefore clarify mechanisms of action of sympathectomy and justify its indications.

Arterial Occlusive Diseases↗
PubMedDate not supplied

The early use of operative lumbar sympathectomy in peripheral vascular disease.

The results of operative lumbar sympathectomy for both intermittent claudication and rest pain in 153 patients have been reviewed. Sympathectomy was performed as an initial procedure to further below the groin reconstructive surgery, should symptoms not be alleviated. Five year post-sympathectomy, 67% of the claudicant and 54% of the rest pain patients had avoided further surgery. Patient mortality from other manifestations of atherosclerosis was notably poor at five years and was significantly greater than the sympathectomy failure rate after the first year. The results in diabetics were not significantly different from those in non-diabetics. The possible value of lumbar sympathectomy in both claudication and rest pain is reviewed and discussed.

Amputation, Surgical↗
PubMed1985

[Monitoring by non-flowmeter vascular function tests following lumbar sympathectomy].

Postoperative follow up examinations were conducted using vascular functional explorations (V.F.E.) including thermometry, Doppler, irrigraphy, digital plethysmography and tread mill. Immediate and long-term effects of lumbar sympathectomy have to be distinguished: the majority of hemodynamic variations noted are not due exclusively to lumbar sympathectomy, except for the iatrogenic development of vasomotor inertia (R.H.T. indifferent or negative) and perhaps values with time of the digital flow curve. Results of V.F.E. after lumbar sympathectomy are discussed in relation to three modalities and taking into account the efficacy and extent of the sympathetic chain resection. The question is raised as to the usefulness of lumbar sympathectomy when the pretreatment V.F.E. findings show hemodynamic elements of the type that would be expected after lumbar sympathectomy.

Arterial Occlusive Diseases↗
PubMedDate not supplied

Effect of lumbar sympathectomy on the lower extremity.

1. Lumbar sympathectomy creates a state of vasodilatation equivalent to physiological vasodilatation of daily living; however, after sympathectomy, vasodilatation is permanent and irreversible. 2. This vasodilatation is characterized at rest by a preferred distribution of blood to the skin and to subcutaneous cellular tissue of the lower extremity, foot and toes. 3. This vasodilatation, although permanent, does not interfere with increased output to muscles at work. They benefit by a particular mechanism of metabolic vasodilatation (Fig. 6). 4. Lumbar sympathectomy has a beneficial effect on the collateral compensatory circulation of an obliterated large artery. This effect is induced by suppression of the peripheral resistance, and thus, by increasing the pressure gradient. 5. The vasodilatation obtained by intravenous injection of pentothal is qualitatively the same as that which follows a lumbar sympathectomy. The test with pentothal, because of this action, is an excellent method for prognosis and control of lumbar sympathectomy effects.

Angiography↗
PubMed1984

Effects of upper abdominal sympathectomy on gastric acid, serum gastrin, and catecholamines in the rat gut.

Selective upper abdominal sympathectomy increased basal acid output in rats but was without effect on stimulated acid output, serum gastrin concentration, and gastric mucosal histidine decarboxylase activity. The sympathectomy was verified by fluorescence histochemistry and determination of tissue catecholamines. A drastic reduction in tissue noradrenaline, adrenaline, and dopamine levels occurred after sympathectomy, and fluorescence microscopy showed a complete loss of adrenergic nerve fibers. Vagotomy reduced catecholamine levels in the stomach wall by 50% but did not affect the catecholamine content in the pancreas and small bowel. Surprisingly, combined vagotomy and upper abdominal sympathectomy resulted in lower catecholamine levels than sympathectomy alone in extragastric but not in gastric tissues.

Animals↗
PubMed1980

Hemodynamic effects of sympathectomy in ischemic canine hindlimbs.

One week after unilateral distal superficial femoral artery ligation, 15 anesthetized dogs were studied before and after bilateral lumbar sympathectomy. Total hindlimb capillary (THC) flow and arteriovenous anastomotic (AVA) flow were determined by microsphere arteriovenous (A-V) shunt measurement combined with electromagnetic femoral artery blood flow measurement. Muscle capillary blood flow (MBF) was measured by xenon133 clearance. Baseline femoral blood flow in ischemic (I) hindlimbs was only 53% of contralateral control (C) hindlimbs (I = 56, C = 105 ml/min, P less than 0.01). Ischemia was manifest in I limbs by reduced O2 consumption (I = 1.68, C = 2.53 ml of O2/min, P less than 0.01). After sympathectomy, total blood flow increased significantly in I limbs, but no improvement in O2 consumption occurred. This was due to increased A-V shunting, with increased AVA flow (from 3 to 20 ml/min. P less than 0.01) but unchanged THC flow. Neither resting nor reactive hyperemic MBF improved after sympathectomy. Control limbs showed similarly increased AVA flow, but decreased O2 consumption, suggesting a detrimental effect of sympathectomy. The major hemodynamic consequence of sympathectomy in ischemic canine hindlimbs was increased nonnutritive A-V shunting, with no improvement in total capillary flow.

Animals↗
PubMed1994

Sympathectomy: quo vadis?

This paper reviews the evolution of sympathectomy in the management of vascular disease, hyperhidrosis and reflex sympathetic dystrophy over the past 26 years. The average general surgery resident has never been exposed to the procedure. The author feels that sympathectomy should be part of the armamentarium of vascular surgeons. An understanding of physiologic screening tests is necessary for the proper selection of patients who may benefit from sympathectomy. There has been a progressive decline in the number of publications on sympathectomy during this period. While the procedure is less commonly performed for vascular disease, sympathectomy remains a useful treatment for uncontrolled hyperhidrosis and for reflex sympathetic dystrophy.

Humans↗
PubMed1994

[Experience of anesthesia during transthoracic endoscopic sympathectomy for palmar hyperhidrosis: comparison between double-lumen endobronchial tube ventilation and laryngeal mask ventilation].

In the past year we had 36 patients operated for transthoracic endoscopic sympathectomy to treat palmar hyperhidrosis. The first group composed of 17 patients receiving anesthesia with double-lumen endobronchial-tube ventilation from July-92 to April-93, and the second group composed of 19 patients receiving anesthesia with laryngeal mask ventilation from April-93 to August-93. During right lung collapse for sympathectomy, the first group patients' SaO2 (oxygen saturation) decreased from 99.65 +/- 0.62 mmHg (pre-operation) to 95.12 +/- 5.48 mmHg (at cauterization), 95.24 +/- 5.41 mmHg (5 minutes after cauterization) and resumed 99.53 +/- 0.62 mmHg after the procedure completed. During left lung collapse for left side sympathectomy, the same group patients' SaO2 decreased from 99.59 +/- 0.62 mmHg to 97.35 +/- 3.06 mmHg, 97.82 +/- 2.53 mmHg and resumed 99.65 +/- 0.49 mmHg respectively. The second group using laryngeal mask ventilation had SaO2 changes during right side sympathectomy from 99.68 +/- 0.58 mmHg (pre-cauterization) to 99.74 +/- 0.45 mmHg (when cauterization), 99.79 +/- 0.42 mmHg (5 minutes after cauterization) and resumed 99.84 +/- 0.37 mmHg after the procedure completed. During left side sympathectomy the second group patients' SaO2 changed from 99.84 +/- 0.39 mmHg to 99.42 +/- 1.50 mmHg, 99.47 +/- 1.46 mmHg and resumed 99.74 +/- 0.59 mmHg respectively. After 2-Way ANOVA with repeated measures of the SaO2 value, we could see that no matter what side operation, there were differences existed between these two groups (< 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Cervicothoracic sympathectomy for Raynaud's syndrome.

Raynaud's syndrome is a clinical entity characterized by episodic vascular spasm and digital ischemia occurring in response to cold or emotional stimuli. Most patients with Raynaud's syndrome are successfully managed with medical therapy. Surgical sympathectomy is rarely performed and its use remains controversial. Of 3,219 patients seen with the diagnosis of Raynaud's disease, phenomenon or syndrome over the last 10 years at Mayo Clinic, 20 cervical or thoracic sympathectomies were performed in 14 (0.4%) patients. Of all patients who underwent cervico thoracic sympathectomy (68) for various reasons during the same time period, 20.5% (14/68) were performed for Raynaud's syndrome. Surgical sympathectomy was reserved for those rare patients with persistent, severe symptoms (pain, ulcer) despite intensive medical treatment. Surgical therapy was also used for those few patients with occupations involving exposure to cold and disabling, refractory symptoms in hopes of allowing them to return to work. Transaxillary (12 limbs) or supraclavicular (8 limbs) exposure and resection of the sympathetic chain with T1-T4 ganglions was usually performed. Initial resolution or improvement of symptoms was achieved in 19/20 (95%) of limbs. Both patients with digital ulceration healed. Although improved in some, persistent or recurrent symptoms were present in all patients after six months postoperatively. Increased sensitivity of digital vessels to circulating catecholamines, nerve fiber regeneration or incomplete sympathectomy have been postulated to lead to recurrence. Five patients developed Horner's syndrome postoperatively. A portion of the stellate ganglion was intentionally resected in 3 of the 5 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Limiting the anatomic extent of upper thoracic sympathectomy for primary palmar hyperhidrosis.

Ninety-four consecutive patients undergoing bilateral sympathectomy of the upper part of the thorax for primary palmar hyperhidrosis were reviewed. The supraclavicular operative approach was used and a limited sympathectomy was performed from below T1 to above T3, denervating the palm only. Follow-up evaluation was complete in 86 patients at a median period of 31 months. All patients had complete and permanent relief of palmar hyperhidrosis. However, 19 had compensatory hyperhidrosis and this was the common cause of patient dissatisfaction. Although axillary denervation was not performed, axillary sweating was a problem postoperatively in only two patients. Significant morbidity was minimal; the only permanent disability was in one patient with Horner's syndrome. Upper thoracic sympathectomy is a safe and effective method of treatment for primary palmar hyperhidrosis. The low incidence of compensatory sweating may be explained by the limited extent of the sympathectomy. Axillary sweating is rarely a significant postoperative problem, and extensive sympathectomy to include axillary denervation is unnecessary and should be avoided to minimize compensatory hyperhidrosis.

Adolescent↗
PubMed1995

[Upper thoracic sympathectomy by thoracoscopic approach. A method of choice for the treatment of palmar hyperhidrosis].

Palmar hyperhidrosis is excessive sweating beyond physiological needs in the palm without recognized etiology. Although a benign disease, it is annoying to most patients. Currently the best treatment for this condition is upper thoracic sympathectomy via many different approaches. The video-thoracoscopic approach has been recommended a a minimally invasive procedure. We report our 1-year experience with transaxillary endoscopic sympathectomy in 99 patients with palmar hyperhidrosis. Standard video-laparoscopy was used via a transaxillary approach to perform sympathectomy. The mean operating time of this operation was 12 minutes and mean hospital stay was 32 hours. The results in terms of warm and dry hands were excellent. Only one case of transitory Horner syndrome was noted. Transaxillary thoracoscopic sympathectomy for palmar hyperhidrosis is a relatively simple and effective procedure which can be performed with standard laparoscopic instruments. The advantages are, short recovery time and hospital stay along with excellent functional and cosmetic results. We are convinced that thoracoscopic sympathectomy is the procedure of choice for the treatment of palmar hyperhidrosis.

Adolescent↗
PubMedDate not supplied

Should chemical sympathectomy precede below knee amputation?

Lumbar sympathectomy has a controversial place in the management of severe limb ischemia for limb preservation. In a consecutive clinical series laser Doppler (LD) blood flow was measured at the distal limit of an anterior below knee skin flap in 21 patients. Amputation level was selected by clinical judgement. Mean LD value in 15 patients who had primary BK healing was 42V (range 20-85) compared to 11V (9-20) in six patients who proceeded to AK amputation (p < 0.001) establishing 20V as a critical value for BK healing. To examine the effect of chemical sympathectomy 21 further patients with severe ischemia had LD measurements at the same BK site before and one week after chemical sympathectomy. LD values rose significantly from 26V (10-75) to 50V (10-100), (p < 0.001). In particular seven patients had initial LD levels below 20V and in five chemical sympathectomy produced elevation to levels commensurate with BK healing. We conclude that chemical sympathectomy can improve below knee skin blood flow and may enhance primary wound healing.

Aged↗
PubMed1976

Chemical sympathectomy and two-way escape and avoidance learning in the rat.

Six experiments are reported on the effects of 2,4,5-trihydroxyphenylethyl-amine (6-hydroxydopamine) on two-way escape and avoidance learning. Rats were tested on either escape or avoidance learning at 80 days of age after chemical sympathectomy at birth or 40 or 80 days of age. Neonatal and chronic sympathectomy (at 40 days), but not acute sympathectomy (at 80 days), resulted in depressed escape learning. Avoidance learning was affected by neonatal sympathectomy and partially by acute sympathectomy. The results have implications for the role of the autonomic nervous system in escape-avoidance learning.

Age Factors↗
PubMed1979

Unique resistance to guanethidine-induced chemical sympathectomy of spontaneously hypertensive rats: a resistance overcome by treatment with antibody to nerve growth factor.

The chronic administration of high doses of guanethidine to rats produces complete destruction of the peripheral sympathetic nervous system. In a study of the effect of guanethidine-induced sympathectomy on the development of hypertension is spontaneous hypertensive rats (SHR, Okomoto strain), only a partial sympathectomy could be produced as assessed by biochemical parameters (tyrosine hydroxylase activity in ganglia and tissue norepinephrine concentrations) and by evaluation of response to stimulation of vasomotor outflow in pithed rat preparations. Other strains of rats (Sprague-Dawley, American Wistar, Kyoto Wistar) were uniformly sensitive to guanethidine sympathectomy. The resistance to guanethidine was not due to a lower accumulation of guanethidine in the neurons of SHR. Addition to the guanethidine treatment of low doses of antibody to nerve growth factor (NGF), which itself produced only a modest sympathectomy, resulted in an almost complete sympathectomy. SHR did not become hypertensive when sympathectomized by combined guanethidine-anti NGF. These results show that the sympathetic neurons of SHR differ from those of other strains with respect to sensitivity to guanethidine cytotoxicity and suggest the possibility of a role for NGF in that altered responsiveness.

Animals↗
PubMed1983

Calcium concentration of salivary glands and saliva after chemical or surgical sympathectomy.

Calcium concentration of the submaxillary (SM) gland of adult rat was increased to 2-3 times control levels 24 h after a single high dose of reserpine (RES) (5 mg/kg body weight), 6-hydroxydopamine (6-OHDA) (20 mg/kg body weight), or surgical removal of a superior cervical ganglion (Sx). The increase could also be induced within 24 h after a single injection of lower doses of RES (0.05, 0.5 mg/kg body weight). Increase in calcium concentration in the parotid (PA) was not found under any of the above conditions, but did occur transiently at times within 24 h. The increase in glandular calcium concentration was found to be temporally related to depletion of norepinephrine (NE). The time frame for initiation of calcium changes was not the same for chemical and surgical sympathectomy (Sx). Increase in calcium concentration occurred after onset of sympathectomy-induced degeneration secretion; the onset varied with the kind of sympathectomy, and was seen 1 h after drug administration with either RES or 6-OHDA, but not until about 13 h after surgical Sx. Similarly, NE was markedly depleted, but later with surgical than with chemical Sx. Furthermore, with both kinds of sympathectomy, depletion of NE occurred earlier with PA than with SM, since normal basal levels of NE of SM are 3 times as great (3400 ng/g wet weight), compared with PA levels (1300 ng/g wet weight). The fact that NED was the neurotransmitter eliciting the degeneration secretion was confirmed physiologically by examination of the composition of this secretion.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Effects of sympathectomy on a rat model of peripheral neuropathy.

The aim of this study was to determine the effects of sympathectomy on our previously developed animal model for neuropathic pain. The neuropathy was produced by a unilateral tight ligation of the L5 and L6 spinal nerves in 81 rats, all of which showed a marked increase in frequency of paw lifting in response to innocuous mechanical stimuli and a shortened latency of paw withdrawal in response to noxious radiant heat stimuli on the affected limb. We interpreted these as behavioral signs of mechanical allodynia and heat hyperalgesia. Surgical sympathectomy was performed by removing the sympathetic chain bilaterally from the L2 to L6 levels at 1 week prior to and 1, 3 and 5 weeks after nerve injury. In addition, the effect of sympathetic block was tested by systemically injecting guanethidine or phentolamine. Surgical sympathectomy relieved the signs of both mechanical allodynia and heat hyperalgesia. The effect of sympathectomy for mechanical allodynia is estimated to be almost fully expressed within 30 min after the operation. Sympathetic block by chemical agents reversibly relieved the mechanical allodynia. These data suggest that the rats in our model exhibit behavioral signs of neuropathic pain that are sympathetically maintained.

Animals↗