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PubMed2005

Minocycline treatment attenuates microglia activation and non-angiotensin II [125I] CGP42112 binding in brainstem following nodose ganglionectomy.

We have previously shown that following unilateral nodose ganglionectomy, [125I] CGP42112 binds to a non-angiotensin II (Ang II) related binding site in rat dorsal motor nucleus of the vagus nerve, ambiguus nucleus and nucleus of the solitary tract. Furthermore, this up-regulated binding site localizes with activated microglia. Given that some tetracyclines may inhibit microglia activation in brain, we examined the effect of minocycline treatment on the binding of [125I] CGP42112 and [3H] PK11195 (an established radioligand for microglia), as well as OX-42 immunoreactivity (an immunomarker for activated microglia), following nodose ganglionectomy. Male Wistar Kyoto rats underwent unilateral nodose ganglionectomy or sham operation and were treated with saline or minocycline (50 mg/kg i.p.) 12 h before surgery and twice daily after surgery (each 50mg/kg i.p.) for 3 days. Subsequent to nodose ganglionectomy, [125I] CGP42112 binding (insensitive to PD123319 or Ang II) was increased approximately two-fold in the ipsilateral nucleus of the solitary tract and was also induced in the ipsilateral dorsal motor nucleus of the vagus nerve and ambiguus nucleus of saline-treated rats. Treatment with minocycline reduced this non-angiotensin II [125I] CGP42112 binding (40-50% reduction) in the nucleus of the solitary tract, dorsal motor nucleus of the vagus nerve and ambiguus nucleus. Analogous experiments using [3H] PK11195 also revealed up-regulated binding in the ipsilateral nucleus of the solitary tract ( approximately 205%), dorsal motor nucleus of the vagus nerve (approximately 80%) and ambiguus nucleus (approximately 210%) of saline-treated rats following nodose ganglionectomy, which was reduced by 40-100% with minocycline treatment. Immunoreactivity to OX-42 confirmed an increase in microglia activation and accumulation of macrophages in these brain stem nuclei following nodose ganglionectomy, which was also attenuated following treatment with minocycline. These data demonstrate that non-Ang II [125I] CGP42112 binding following nodose ganglionectomy is attenuated by minocycline treatment. This minocycline-induced effect was associated with reduced activation of microglia and an apparent reduction in the number of macrophages in the abovementioned nuclei. This evidence suggests that a non-Ang II [125I] CGP42112 binding site is located on, or associated with, activated microglia and macrophages, providing a useful tool with which to quantitate the neuroprotective effects of centrally acting anti-inflammatory compounds.

Animals↗
PubMed1989

Effects of superior mesenteric and coeliac ganglionectomy on peptide-producing cells of the small intestinal mucosa in the Hanford mini pig. II. Immunohistochemical study.

Superior mesenteric and coeliac ganglionectomy was performed in 5 Hanford mini pigs and cholecystokinin (CCK)-immunoreactive I-cells, neurotensin (NT)-immunoreactive N-cells, glucagon (Glu)-immunoreactive L-cells, glicentin (Glic)-immunoreactive L-cells and somatostatin (Som)-immunoreactive D-cells were quantitatively evaluated in the duodenum, the upper, middle and lower jejunum and the ileum before, 3 weeks and 6 months after ganglionectomy. Three additional animals served as controls. After ganglionectomy, I-cell numbers increase by 110% in the upper jejunum and duodenum; N-cells increase by 86% in the lower jejunum. Glu- and Glic-immunoreactive L-cells decrease slightly in the jejunum. In contrast, D-cells decrease in all sections of the small intestine by 44-76% (P less than 0.05 and P less than 0.001). All the examined entero-endocrine cells, except the D-cells in the duodenum and upper jejunum, develop hypertrophy after ganglionectomy. No changes either in number or size are found in the ganglia and neurons of the myenteric plexus. From these and the recently described increase in villus height and absorptive cells and absorptive cell enzymes after ganglionectomy (Holle, G.E. et al. Effects of superior mesenteric and coeliac ganglionectomy on the mucosa of the small intestine in the Hanford mini pig. I. Histological and enzymhistochemical study, J. Auton. Nerv. Syst., 26 (1988) 135-145), we conclude that the extrinsic nervous system takes suppressive influence on structure and probably function of the small intestinal mucosa by modifying its cellular organization.

Animals↗
PubMed2004

Non-angiotensin II [(125)I] CGP42112 binding is a sensitive marker of neuronal injury in brainstem following unilateral nodose ganglionectomy: comparison with markers for activated microglia.

Previously we reported that a non-angiotensin II [(125)I] CGP42112 binding site is up-regulated in rat brainstem nuclei as a result of unilateral nodose ganglionectomy. In the present study, we compared non-angiotensin II [(125)I] CGP42112 binding with microglia/macrophage activation following nodose ganglionectomy, using both in vitro autoradiography and immunohistochemistry. Specific [(125)I] CGP42112 binding was observed in the nucleus of the solitary tract (NTS) and revealed an AT(2) receptor component as well as a non-angiotensin II receptor component. Subsequent to unilateral nodose ganglionectomy, [(125)I] CGP42112 binding in the ipsilateral NTS was increased approximately two-fold and was also induced in the ipsilateral dorsal motor nucleus (DMX) and the nucleus ambiguus (n.amb). This non-angiotensin II [(125)I] CGP42112 binding site was displaced by CGP42112 but not other ligands. Increased [(3)H] PK11195 binding (a known marker of reactive gliosis) was also observed in the same brainstem nuclei as non-angiotensin II [(125)I] CGP42112 binding after nodose ganglionectomy. The similarity in binding patterns between [(125)I] CGP42112 and [(3)H] PK11195 was shown to be primarily due to retrograde degeneration in the ipsilateral NTS, DMX and n.amb, as both radioligands were localized to similar cellular targets within the interstial space and over cellular debris. Immunohistochemical data confirmed reactive gliosis within the ipsilateral NTS, DMX and n.amb, following nodose ganglionectomy, which was predominantly characterized by an increase in OX-42 immunoreactivity (a marker for activated microglia/macrophages), with only a small increase in glial fibrillary acidic protein immunoreactivity (a marker of astrogliosis) detected. These data demonstrate for the first time that non-angiotensin II [(125)I] CGP42112 binding is associated with activated microglia, as well as macrophages, following unilateral nodose ganglionectomy. Furthermore, these studies also demonstrate the potential use of non-angiotensin II [(125)I] CGP42112 binding as a marker for quantitating inflammatory events which occur as a result of damage to the CNS.

Angiotensin II↗
PubMed1996

Effect of celiac ganglionectomy on tachykinin innervation, receptor distribution and intestinal responses in the rat.

Substance P (SP) is an important neurotransmitter in the control of intestinal motility and is found in both the enteric and sympathetic nervous systems. This study examined the effect of celiac ganglionectomy on (1) mechanical properties of the circular muscles of the duodenum, ileum and proximal colon, (2) circular muscle responses to SP and neurokinin A. (3) distribution of substance P-like immunoreactive nerves, and (4) the distribution of neurokinin 1 and neurokinin 2 receptors. Celiac ganglionectomy resulted in an effective sympathectomy as evidenced by a marked decrease in norepinephrine content and tyrosine hydroxylase staining in the duodenum, ileum and proximal colon. The in vitro length/tension characteristics of the circular muscle of the duodenum, ileum and colon were unchanged after ganglionectomy. In all regions of the gut studied, substance P and neurokinin A caused dose-dependent contractions that were unaltered by celiac ganglionectomy. Immunohistochemistry revealed moderate substance P-like immunoreactive fibers in the myenteric plexus, submucosal plexus and circular muscle of the ileum, while in the colon, substance P-like immunoreactivity was intense in the myenteric plexus, and moderate in the circular muscle. In vitro autoradiography showed minimal binding of SP (NK1 receptor) or neurokinin A (NK2 receptor) in the ileum and significantly greater binding in the circular muscle layer of the colon. Celiac ganglionectomy did not affect substance P-like immunoreactivity, or NK1 or NK2 receptor binding. A greater contractile response to neurokinins was seen in the colon than in the duodenum or ileum, which paralleled the receptor density. The studies demonstrate that surgical celiac ganglionectomy, unlike chemical sympathectomy, does not affect the substance P innervation, receptor density or physiological responses of the intestine. The greater contractile response of the colon than the ileum parallels the greater receptor density rather than the peptide content as determined by immunhistochemistry.

Animals↗
PubMed1989

Pancreatic exocrine responses to secretin, 2-deoxyglucose, a meal, and ethanol after coeliac ganglionectomy in the conscious dog.

The effects of coeliac ganglionectomy on pancreatic exocrine responses to graded doses of secretin, intravenous 2-deoxyglucose 100 mg/kg, ethanol 0.56 g/kg, and 1 g/kg, and to a meat meal were studied in conscious dogs (weight 11 to 27 kg). Five animals underwent coeliac ganglionectomy and up to seven control animals were studied. Coeliac ganglionectomy increased four-fold the pancreatic fluid response to secretin. The early part of the fluid response to 2-deoxyglucose was reduced, but there was no effect on the protein response to 2-deoxyglucose. In controls, ethanol 0.56 g/kg stimulated pancreatic secretion, to nearly double the basal level, but after coeliac ganglionectomy this dose of ethanol inhibited secretion to one third of basal values. There was no effect of coeliac ganglionectomy on pancreatic response to ethanol 1 g/kg. After coeliac ganglionectomy the early response to a meal was increased by 100% for fluid output and by 50% for protein secretion, but from 10 minutes to two hours after the meal there was no effect on pancreatic response. These data shed further light on the mode of action of ethanol on pancreatic secretion, and they indicate that therapeutic coeliac ganglia ablation in man is unlikely to be detrimental to physiological pancreatic secretion.

Animals↗
PubMed1979

Effects of celiac and superior mesenteric ganglionectomy on interdigestive myoelectric complex in dogs.

The interdigestive myoelectrical activity of the stomach and small bowel has been studied before and after celiac and superior mesenteric ganglionectomy in four healthy, well-trained conscious dogs. The interdigestive myoelectric complex was present before and after the gangliomectomy in all dogs, but variability in the duration of its cycles was increased by ganglionectomy. The percentage of time that action potential activity was present during the interdigestive period in the stomach and orad half of the small bowel was also increased in all animals after the ganglionectomy. The duration of phase III, the activity front, was unaltered by the operation, but the timing of the other phases became more variable after ganglionectomy. The time required for migration of the complex from duodenum to terminal ileum was more variable after ganglionectomy in the three animals in which it could be measured, and in two of them the migration time was shorter. An abnormal electrical pattern occurred in all animals after ganglionectomy. Its duration ranged from 0.5--5 min. Electrically, it appeared to represent an elongated, nonmigrating activity front.

Action Potentials↗
PubMed1991

Patterns of reinnervation of denervated cerebral arteries by sympathetic nerve fibers after unilateral ganglionectomy in rats.

In order to clarify the manner in which previously denervated cerebral arteries become reinnervated after unilateral excision of the superior cervical ganglion (SCG), we observed directly the reinnervating sympathetic nerve fibers originating in the contralateral SCG by using anterograde labeling with wheat germ aggulutinin-horseradish peroxidase in rats. The nerve fibers sprouted from the nerve fibers in the contralateral anterior cerebral artery and reinnervated the arterial wall of the anterior cerebral artery of the denervated side as early as one week after ganglionectomy. In addition to this sprouting route, three other reinnervating nerve fiber routes were observed in the circle of Willis of the denervated side two weeks after ganglionectomy: the proximal portion of the internal carotid artery, the route passing between bilateral ethmodial arteries, and the posterior communicating artery. Eight weeks after ganglionectomy, these reinnervating nerve fibers formed a fairly dense plexus in a circular pattern in the circle of Willis. However, the reinnervation could not be observed in the arterial branches derived from the circle of Willis (middle cerebral artery and posterior cerebral artery) even 16 weeks after ganglionectomy. The present results clearly demonstrated the time course, distribution pattern and limitation of the reinnervation from the contralateral SCG following unilateral ganglionectomy. The fact that reinnervation could be observed only in the main cerebral arteries of the circle of Willis, in which the nerve plexus appeared to have a circular pattern, suggests a difference between the qualities of sympathetic innervation controlling the cerebral circulation in these arteries and the other arterial branches related to these differences in reinnervation capacity.

Animals↗
PubMed1994

Superior cervical ganglionectomy suppresses circadian corticotropic rhythms in male rats in the short term (5 days) and long term (10 days).

Superior cervical ganglionectomy (SCGx) has drastic effects on numerous hormonal circadian rhythms and particularly on pineal melatonin secretion. We investigated the hormonal consequences of ablation of the superior cervical ganglion on the corticotropic circadian rhythms in the male rat. Plasma were obtained by sampling blood every 4 h, using a chronic carotid cannula. Adreno-corticotropin hormone (ACTH) was assayed by radioimmunoassay (RIA) and corticosterone (B) by radiocompetition. Urinary 6-sulphatoxymelatonin (aMT6s), considered as an index of the pineal gland activity, was assayed by specific RIA: a decrease in the aMT6s concentration after ganglionectomy was taken as proof of adequate surgical operation. Control animals showed classical circadian rhythms for ACTH and B with basal values during the light phase and circadian peaks around the light/dark interface. Five and ten days after ganglionectomy, the circadian rhythms of ACTH and B were suppressed. In addition, the mean ACTH concentrations increased significantly 10 days after ganglionectomy compared to those in sham-operated rats and 5 days post-operation group. The mean plasma corticosterone levels were similar in those three groups of animals. This is the first study demonstrating the suppressive effect of superior cervical ganglionectomy on the circadian corticotropic hormonal cycle.

Adrenocorticotropic Hormone↗
PubMed1989

Effects of superior mesenteric and coeliac ganglionectomy on the small intestinal mucosa in the Hanford mini pig. I. Histological and enzyme-histochemical study.

The effects of total superior mesenteric and coeliac ganglionectomy on the thickness of the mucosa, the cell composition of the epithelium and the enzyme activity of the absorptive cells was studied in 10 Hanford mini pigs 3 weeks and 6 months after ganglionectomy. The mucosal thickness increased after ganglionectomy by 10-33% (P less than 0.02) mainly due to increase in the villus height. Differential cell counts showed a postganglionectomy decrease in percentage of goblet cells of 20-40%. Absorptive cell counts increased significantly (P less than 0.05). Enterochromaffin cells (stained with the Masson-Fontana method) and 5-hydroxytryptamine (5-HT)-immunoreactive cells did not change significantly in the small intestine. The activity of L-leucine-amino-peptidase, non-specific alkaline phosphatase, adenosintriphosphatase, non-specific acid phosphatase, non-specific esterase and succinate dehydrogenase, as assessed by absorption photometry, increased by 2-18% (P less than 0.01) after ganglionectomy. Total ganglionectomy thus results in a rise in villus height and in an increase in the number of absorptive cells which, by their enzymatic activity, appear to be fully mature.

Animals↗
PubMed1996

Acute effects of unilateral pelvic ganglionectomy on urinary bladder function in vivo in the male rat.

Mean and maximal micturition volumes following a standardized water intake were determined before and up to three days after unilateral pelvic ganglionectomy or sham operation in adult male rats. Sham operation did not change the volumes. Unilateral ganglionectomy on the other hand decreased significantly both mean and maximal micturition volumes (and thus increased micturition frequency). The effect was most pronounced 1 day after ganglionectomy, but was still significant after 3 days. Cystometrograms were recorded without and with atropine (1 mg/kg) before operation and 1, 2 or 3 days after sham-operation or ganglionectomy. Micturition pressure decreased to about 50% 1 day after ganglionectomy and remained at this level. Atropine decreased micturition pressure in the controls to about 55% of the initial. The atropine resistant pressure response in the ganglionectomized rats amounted to 90% after 1 day, and was still above 70% after 3 days. The sham-operated controls had no residual urine without or with atropine. The unilaterally ganglionectomized animals had no residual urine in the absence of atropine, but after administration of the drug the animals rapidly developed a significant residual urine.

Animals↗
PubMed1998

Microsurgical C-2 ganglionectomy for chronic intractable occipital pain.

OBJECT: The authors evaluated the effectiveness of microsurgical C-2 ganglionectomy in 39 patients with medically refractory chronic occipital pain. In this procedure the neurons transmitting sensory inputs from the occiput are removed and, unlike peripheral nerve ablation, axonal regeneration is not possible. METHODS: The patients in this series had symptoms for 1 to 43 years. In 22 patients the occipital pain was caused by trauma; in 17 patients the pain was spontaneous. Pain relief failed in 17 patients who had undergone a previous occipital neurectomy or C-2 rhizolysis. Twenty-three patients experienced pain that was described as shocklike, electric, shooting, jabbing, stabbing, sharp, or exploding (Group I). Eight patients described their pain as dull, pounding, aching, throbbing, or pressurelike (Group II). The patients underwent unilateral or bilateral C-2 open microsurgical ganglionectomies. The postoperative follow-up period ranged from 19 to 48 months. Nineteen patients experienced an excellent result (> 90% reduction in pain). Pain caused by trauma or that described using Group I terms responded best to ganglionectomy (80% good or excellent response). In contrast, the majority of the patients with nontraumatic pain or those described using Group II descriptors did not achieve favorable results. CONCLUSIONS: The authors conclude that: 1) patients who suffer from chronic occipital pain after having sustained injury obtain worthwhile benefit from microsurgical C-2 ganglionectomy; 2) patients suffering from migraine, tension, and vascular headaches involving the occipital area are most often not helped by this operation; and 3) terms such as "shock," "electric," "shooting," "jabbing," and "sharp" used to describe occipital pain predict a favorable pain outcome following a C-2 ganglionectomy.

Adult↗
PubMed1987

The effect of unilateral dorsal root ganglionectomies or ventral rhizotomies on alpha 2-adrenoceptor binding to, and the substance P, enkephalin, and neurotensin content of, the cat lumbar spinal cord.

The density of alpha 2-adrenoceptor binding sites and the content of substance P, enkephalins, and neurotensin were determined in quadrants of the lumbar spinal enlargement of control cats and of cats upon which either unilateral dorsal root ganglionectomies or unilateral ventral rhizotomies had been performed. The performance of unilateral dorsal root ganglionectomies resulted in a significant decrease (45-55%) of substance P content in the ipsilateral dorsal horn 7 and 21 days postoperatively. The concentration of alpha 2-adrenoceptor binding sites ([3H]rauwolscine Bmax) in the ipsilateral dorsal horn was consistently and significantly decreased at these same postganglionectomy times (20% reduced relative to the contralateral dorsal horn). Enkephalin content 7 and 21 days after ganglionectomies was not significantly different from control, whereas the neurotensin content of the ipsilateral dorsal horn was significantly increased in the 21-day survival cats. The performance of unilateral ventral rhizotomies did not produce any statistically significant changes in the density of alpha 2-adrenoceptor binding sites or in the substance P or enkephalin content of any spinal quadrant. The neurotensin content of both the ipsilateral dorsal and ipsilateral ventral quadrants of the ventral rhizotomized cats was significantly increased. The significant decrease of alpha 2-adrenoceptor binding site concentration in the ipsilateral dorsal horn after unilateral dorsal root ganglionectomies suggests that approximately 20% of the alpha 2-adrenoceptors present within the cat lumbar spinal dorsal gray are located on the axons or terminals of primary sensory afferents. Consistent with this interpretation of the ganglionectomy results, we found significant levels of saturable [3H]rauwolscine binding to homogenates of the cat L4-Sl spinal dorsal root ganglia. Because alpha 2-adrenoceptor binding sites in the ipsilateral ventral lumbar spinal gray were not significantly reduced after unilateral ventral rhizotomies, our results provide no evidence for the location of alpha 2-adrenoceptor on lumbar spinal motoneurons.

Animals↗
PubMed2004

Alteration in cardiovascular function and body surface temperature during percutaneous stereotactic upper thoracic ganglionectomy and sympathectomy in palmar hyperhidrotic patients.

We assessed changes in cardiovascular function, specifically arterial blood pressure and heart rate in 6 palmar hyperhidrotic patients before, during, and after T2 and T3 ganglionectomy and sympathectomy. We also assessed changes in skin temperature, specifically at the forehead, axilla, thumb, loin, and sole of the foot (all bilaterally) in 10 palmar hyperhidrotic patients before, during, and after T2 ganglionectomy and sympathectomy. In both methods, ganglionectomy and sympathectomy were done by percutaneous stereotactic thermocoagulation, under local anesthesia, at room temperature 21.4 +/- 0.6 degrees C. During the procedure we found a significant acute decrease in systolic and pulse pressures, from 153 +/- 10 to 127 +/- 9 and from 80 +/- 7 to 56 +/- 4mmHg respectively, and a lesser decrease in diastolic pressure; heart rate showed no statistically significant changes. We also noted a marked increase in thumb temperature, from 21.2 +/- 0.6 to 36.0 +/- 0.1 degrees C, with a mean increase of 14.8 degrees C, at a room temperature 21.4 +/- 0.6 degrees C, after complete bilateral T2 ganglionectomy and sympathectomy. Skin temperature at the forehead, axilla, loin, and sole of the foot, all measured bilaterally, showed no significant increase, although there was a decrease in sweating in both forehead and axillary regions. The decrease in systolic and pulse pressures observed during the thermocoagulation procedure were temporary effects. The increase in thumb temperature, however, appears to be a permanent effect for palmar hyperhidrotic patients. Finally, the data indicate that the sympathetic innervation of the blood vessel in the periphery presents a segmental organization.

Anesthesia, Local↗
PubMed2003

Localization of AT(2) receptors in the nucleus of the solitary tract of spontaneously hypertensive and Wistar Kyoto rats using [125I] CGP42112: upregulation of a non-angiotensin II binding site following unilateral nodose ganglionectomy.

We have examined the binding distribution of a selective AT(2) receptor ligand [125I] CGP42112 in the brain of adult Wistar-Kyoto (WKY) and spontaneously hypertensive rats (SHR). AT(2) receptor localization was also examined in the rat brainstem following unilateral nodose ganglionectomy. Specific [125I] CGP42112 binding was observed in discrete brain regions from both rat strains, including the nucleus of the solitary tract (NTS), and did not differ between WKY and SHR. [125I] CGP42112 binding in the NTS revealed an AT(2) receptor component that was displaceable by PD 123319 and Ang II (50-58%), as well as a non-angiotensin II receptor component (42-49%). Following unilateral nodose ganglionectomy, [125I] CGP42112 binding density on the denervated side of the NTS was increased approximately two-fold in both WKY and SHR. This increased [125I] CGP42112 binding density in the ipsilateral NTS was comprised of a greater non-angiotensin II component than that observed in the sham groups, since only approximately 30% was displaced by PD123319 and angiotensin II. Furthermore, [125I] CGP42112 also revealed high binding density on the denervated side in the dorsal motor nucleus and the nucleus ambiguus in both WKY and SHR. AT(2) receptor immunoreactivity was also visualised in the NTS of sham operated rats, but was not observed in the dorsal motor nucleus or the nucleus ambiguus, nor was it up-regulated following nodose ganglionectomy. These results demonstrate, for the first time, an AT(2) receptor binding site in the NTS, as well as a non-angiotensin II [125I] CGP42112 binding site. These studies also demonstrate that nodose ganglionectomy represents a useful model in which to study a non-angiotensin II [125I] CGP42112 binding site that is up-regulated following degeneration of afferent vagal nerves.

Angiotensin II↗
PubMed1999

The results of thoracoscopic sympathetic trunk transection for palmar hyperhidrosis and sympathetic ganglionectomy for axillary hyperhidrosis.

OBJECTIVES: To review our total experience of thoracoscopic sympathetic trunk transection for the treatment of palmar hyperhidrosis and second and third thoracic sympathetic ganglionectomy for axillary hyperhidrosis. DESIGN: Longitudinal cohort study following up consecutive patients for 0.3 to 5.5 years. SUBJECTS: Fifty-four consecutive patients undergoing thoracoscopic sympathectomy for hyperhidrosis. METHODS: Prospective evaluation of immediate technical success, complications, late recurrence of hyperhidrosis and patient acceptability. RESULTS: 100% initial cure for palmar hyperhidrosis, 91% of sympathetic ganglionectomies for axillary hyperhidrosis were technically successful and initially curative. Compensatory sweating 44% patients, most severe after bilateral sympathetic ganglionectomy. Complications occurred in 14% patients, all resolving without further intervention. There were no cases of Horner's syndrome. 13% patients reported a return of some palmar sweating. 5.4% patients developed recurrent palmar hyperhidrosis at 6, 15 and 21 months postoperatively. CONCLUSION: Transection of the sympathetic trunk between the first and second thoracic sympathetic ganglia initially cures 100% of patients treated primarily for palmar hyperhidrosis. Technically successful 2nd and 3rd thoracic sympathetic ganglionectomy initially cures 100% of patients with axillary hyperhidrosis. Compensatory sweating is common after bilateral sympathectomy. Recurrent palmar hyperhidrosis occurs in 5.4% of cases, but can be cured by a second thoracoscopic sympathectomy. Horner's syndrome is an avoidable complication of thoracoscopic sympathectomy.

Adolescent↗
PubMed1996

Does ganglionectomy destabilize the wrist over the long-term?

Previous publications have described persistent postganglionectomy symptomatology. One report demonstrated scapholunate instability in a small number of patients. We specifically examined our ganglionectomy patients for wrist instability. Ninety-one consecutive cases of wrist ganglionectomy performed from 1987 through 1993 by the senior author (FMW) were studied. Most patients were contacted by telephone and questioned with a standardized interview format. Postoperative course, job changes and occupational restrictions, and patient satisfaction were queried. Range of motion, grip strength, scaphoid mobility, and radiographs were studied to characterize scapholunate static and dynamic relationships. Seventy-one percent (N = 61) of the operated patients were interviewed at an average postoperative interval of 44 months. Twenty-five percent (N = 21) had wrist symptoms. There was no late ganglion recurrence. Twenty of the 21 symptomatic patients (95%) had normal ranges of motion and no carpal instability. Grip strengths averaged 12% below normal in 45% of the dominant operated hands. Radiographs demonstrated no scapholunate dissociation or dynamic instability patterns. Wrist ganglionectomy does not destabilize the wrist, particularly the scapholunate joint. Thorough and meticulous extirpation of the ganglion is warranted. Additional minor problems, both as consequences of the operation and as unrelated concomitants, do occur and deserve attention. Hand surgeons assume cure of the problematic wrist because of the patient's failure to report tolerable problematic sequelae. A late revisit may reveal (1) treatable problems emanating from the dynamic forces contributing to original ganglion formation; (2) additional, unanticipated, treatable conditions resulting and not resulting from the ganglionectomy itself; and (3) ganglion recurrence.

Female↗
PubMed2002

Long-term assessment of percutaneous stereotactic thermocoagulation of upper thoracic ganglionectomy and sympathectomy for palmar and craniofacial hyperhidrosisin 1742 cases.

OBJECTIVE: We sought to determine the long-term outcome of percutaneous stereotactic thermocoagulation for upper thoracic ganglionectomy and sympathectomy in patients with palmar and craniofacial hyperhidrosis with the use of a three-dimensional system of coordinates for the location of the T2 and T3 ganglia on the basis of the findings in a cadaveric study. METHODS: From November 1986 to May 1998, upper thoracic ganglionectomy and sympathectomy with the use of percutaneous stereotactic thermocoagulation were performed in 1688 patients with palmar hyperhidrosis and 54 patients with craniofacial hyperhidrosis as outpatient surgical procedures based on a three-dimensional coordinate system for determining the location of the thermocoagulation point, which was developed by the authors in a cadaveric study. The technique requires only local anesthesia. RESULTS: After initial thermocoagulation, sweating stopped in 3465 (99.5%) of 3484 sides. Hyperhidrosis recurred within 2 to 59 months of treatment in 268 procedures. All patients in whom hyperhidrosis recurred were retreated successfully, resulting in a final success rate of 99.9%. Complications of treatment included pneumothorax in seven procedures (0.2%) and partial Horner's syndrome in five procedures (0.15%). Decreased plantar sweating was noted during follow-up in 92% of patients. CONCLUSION: The results of this study indicate that upper thoracic ganglionectomy and sympathectomy performed with the use of percutaneous thermocoagulation are a very effective treatment for palmar and craniofacial hyperhidrosis that provides excellent immediate and long-term results as well as a low complication rate. The method is also effective as a retreatment for recurrences. Our data also suggest that performing ganglionectomy and sympathectomy in both T2 and T3 is unnecessary, because the procedure had equal long-term effectiveness when performed in T2 alone.

Adolescent↗
PubMed1991

Dorsal root ganglionectomy for failed back surgery syndrome: a 5-year follow-up study.

Dorsal root ganglionectomy has been suggested as a method for the treatment of chronic intractable radicular pain, with theoretical advantages over dorsal rhizotomy, which does not interrupt ventral root afferents. The indications for these procedures in patients with persistent pain following lumbosacral spine surgery are not well established. Long-term results have been reported infrequently, and no published series has a mean follow-up period of more than 30 months. The authors have reviewed their experience with a series of 13 patients with failed back surgery syndrome, in whom dorsal root ganglionectomy was performed. Patients were selected on the basis of clinical presentation and diagnostic root blocks suggesting a monoradicular pain syndrome. Follow-up data were obtained at a mean of 5.5 years following dorsal root ganglionectomy. Follow-up interviews to assess outcome were conducted by a disinterested third party. Treatment "success" (at least 50% sustained relief of pain and patient satisfaction with the result) was recorded in two patients at 2 years after surgery and in none at 5.5 years. Equivocal success (at least 50% relief, without clearcut patient satisfaction) was recorded in one patient at 2 and at 5.5 years postoperatively. Improvements in activities of daily living were recorded in a minority of patients. Loss of sensory and motor function was reported frequently by patients. A minority of patients had reduced or eliminated analgesic intake. These results suggest that dorsal root ganglionectomy has a limited role in the management of failed back surgery syndrome, and that methods to select patients to receive this procedure should be refined or alternative approaches should be considered.

Activities of Daily Living↗