significant fall in left circumflex coronary flow was proportional to the decline in external heart work due to sympathectomy
http://www.springerlink.com/content/k2n6j4555g16x773/
sympathectomy affects the heart, sweating, and circulation
heart rate was significantly reduced at rest (14%), at sub-maximal exercise (12.3%), and at peak exercise (5.7%), together with a significant increase in oxygen pulse (11.8, 12.7, and 7.8%, respectively). The rate pressure product (RPP) was also significantly reduced following the surgical procedure at all three study stages, while all other physiological variables measured remained unchanged. It is suggested that thoracic-sympathetic denervation affects the heart, sweating, and circulation of the respective denervated region
Eur J Appl Physiol. 2008 Sep;104(1):79-86. Epub 2008 Jun 10.
Eur J Appl Physiol. 2008 Sep;104(1):79-86. Epub 2008 Jun 10.
Post-sympathectomy neuralgia is a severe complication since pain can be permanent, severe, and incapacitating
http://www.springerlink.com/content/q04711t06j164206/
"ETS has proved moderately successful in treating hyperhidrosis, although the operation does carry a high risk of complications. "
Other complications of ETS include:
http://www.knowsley.nhs.uk/health-a-to-z/h/hyperhidrosis-excessive-sweating/
- sweating on the face and neck after eating food (gustatory sweating),
- inflammation of the nose (rhinitis), and
- air becoming trapped between the layers of the lung (pneumothorax) which can cause chest pain and breathing difficulties (although this usually resolves itself without the need for treatment).
- Horner's syndrome, a condition that causes drooping of the eyelids, and
- damage to the phrenic nerve (a nerve that is used to help in breathing).
http://www.knowsley.nhs.uk/health-a-to-z/h/hyperhidrosis-excessive-sweating/
75% pneumothorax expected after sympathectomy
A small insignificant pneumothorax can be expected after ETS in about 75% of cases [15], which gets spontaneously absorbed, usually within 24 h.
Comparing T2 and T2–T3 ablation in thoracoscopic sympathectomy for palmar hyperhidrosis: a randomized control trial
A. N. Katara, J. P. Domino, W.-K. Cheah, J. B. So, C. Ning, D. Lomanto
Minimally Invasive Surgical Centre, Department of General Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074
Received: 13 October 2006/Accepted: 2 November 2006
http://medicine.nus.edu.sg/medsur/research_publications_2007.html
[15] Ojimba TA, Cameron AEP (2004) Drawbacks of endoscopic thoracic sympathectomy. Br J Surg 91: 264–269
Permanent side effects included compensatory sweating in 67.4%, gustatory sweating in 50.7% and Horner's trias in 2.5%. However, patient satisfaction declined over time, although only 1.5% recurred. This left only 66.7% satisfied, and a 26.7% partially satisfied. Compensatory and gustatory sweating were the most frequently stated reasons for dissatisfaction. Individuals operated for axillary hyperhidrosis without palmar involvement were significantly less satisfied (33.3% and 46.2%, respectively).
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1234291/
Comparing T2 and T2–T3 ablation in thoracoscopic sympathectomy for palmar hyperhidrosis: a randomized control trial
A. N. Katara, J. P. Domino, W.-K. Cheah, J. B. So, C. Ning, D. Lomanto
Minimally Invasive Surgical Centre, Department of General Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074
Received: 13 October 2006/Accepted: 2 November 2006
http://medicine.nus.edu.sg/medsur/research_publications_2007.html
[15] Ojimba TA, Cameron AEP (2004) Drawbacks of endoscopic thoracic sympathectomy. Br J Surg 91: 264–269
Permanent side effects included compensatory sweating in 67.4%, gustatory sweating in 50.7% and Horner's trias in 2.5%. However, patient satisfaction declined over time, although only 1.5% recurred. This left only 66.7% satisfied, and a 26.7% partially satisfied. Compensatory and gustatory sweating were the most frequently stated reasons for dissatisfaction. Individuals operated for axillary hyperhidrosis without palmar involvement were significantly less satisfied (33.3% and 46.2%, respectively).
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1234291/
Depending on the series and the duration of follow-up, the success rate of sympathectomy varies from 12% to 97%
http://www.ispub.com/journal/the-internet-journal-of-pain-symptom-control-and-palliative-care/volume-2-number-1/complex-regional-pain-syndrome-a-clinical-review.html
Sympathectomy has been discredited in this condition
Vasospastic conditions
Raynaud’s syndrome
http://surgeryonline.wordpress.com/category/arterial-disorders/
Drug warning - Karvezide, AVAPRO HCT - 'you must tell your doctor if you have had sympathectomy'
Tell your doctor if:
* you have had a sympathectomy
* you have been taking diuretics
*you have a history of allergy or asthma
www.racgp.org.au/cmi/swckarvz.pdf
* you have had a sympathectomy
* you have been taking diuretics
*you have a history of allergy or asthma
www.racgp.org.au/cmi/swckarvz.pdf
2. Before you start to take AVAPRO HCT
Tell your doctor if:- you suffer from any medical conditions especially-
- kidney problems, or have had a kidney transplant or dialysis
- heart problems
- liver problems, or have had liver problems in the past
- diabetes
- gout or have had gout in the past
- lupus erythematosus
- high or low levels of potassium or sodium or other electrolytes in your blood
- primary aldosteronism - you are strictly restricting your salt intake
- you are lactose intolerant or have had any allergies to any other medicine or any other substances, such as foods, preservatives or dyes.
- have had a sympathectomy
- you have been taking diuretics
- you have a history of allergy or asthma
Published by MIMS/myDr March 2011
UBM Medica Australia uses its best endeavours to ensure that at the time of publishing, as indicated on the publishing date for each resource (e.g. Published by MIMS/myDr January 2007), the CMI provided was complete to the best of UBM Medica Australia's knowledge.
Use of stellate ganglion block for the treatment of psychiatric and behavioral disorders
The present invention is directed to a method for the treatment of a patient suffering from psychiatric and behavioral disorders, including post partum depression, post traumatic stress disorder, compulsive smoking, attention deficit hyperactivity disorder, gambling addiction, comprising the step of administering a stellate ganglion block to the patient to alleviate the symptoms. The stellate ganglion block may be followed by a sympathectomy to provide permanent relief.
http://www.freepatentsonline.com/y2007/0135871.html
Kind Code: A1
Number of sympathectomies is on the increase in Australia - the power of medical advertising
years 2000 - 2001:
Total: 1034
years 2001-2002:
Total: 1575
years 2002 - 2003
Total: 1228
years 2003 - 2004
Total: 1193
years 2004 - 2005
Total: 1483
years 2005 - 2006
Total:1358
years 2006 - 2007
Total: 972
years 2007 - 2008
Total: 850
years 2008 - 2009
Total: 891
years 2009 - 2010
Total: 1083
source: aihw.gov.au
Total: 1034
years 2001-2002:
Total: 1575
years 2002 - 2003
Total: 1228
years 2003 - 2004
Total: 1193
years 2004 - 2005
Total: 1483
years 2005 - 2006
Total:1358
years 2006 - 2007
Total: 972
years 2007 - 2008
Total: 850
years 2008 - 2009
Total: 891
years 2009 - 2010
Total: 1083
source: aihw.gov.au
Iatrogenic harlequin syndrome resulting from sympathectomy
Postgrad Med J 2003;79:278 doi:10.1136/pmj.79.931.278
A 29 year old man with severe facial hyperhidrosis underwent an uncomplicated right thoracoscopic sympathectomy. Before operating on his left side, a starch-iodine preparation was applied to his face in order to demarcate residual sudomotor function. The preparation becomes blue on exposure to moisture, thereby representing residual sweat gland activity.
Figure 1 demonstrates that sympathetic innervation to the face is strictly unilateral, and nerve fibres do not appear to cross the midline. This is essentially an iatrogenic variation of the harlequin syndrome,2 which usually results from interruption of post-ganglionic sympathetic fibres secondary to malignant invasion.
His facial hyperhidrosis was completely treated once the contralateral sympathectomy was performed.
T3 sympathectomy leads to subclinical pupillary dysfunction with a tendency for miosis
We found statistically significant differences (P < 0.001) between the preoperative P/I ratio [0.40 mm (standard deviation, SD 0.07 mm)] and the postoperative basal ratio [0.33 (SD 0.05)] at 24 h. The P/I ratio at 24 h increased from 0.33 to 0.36 (SD 0.09), a nonsignificant increase (P = 0.45), after instillation of medicated eye drops. No differences were observed between the preoperative [0.40 (SD 0.07)] and 1-month basal values [0.38 (SD 0.07)], and instillation of apraclonidine no longer induced a hypersensitivity response.
http://www.ncbi.nlm.nih.gov/pubmed/22044979
CONCLUSIONS:
T3 sympathectomy leads to subclinical pupillary dysfunction with a tendency for miosis, even though this impairment is not generally evident on standard physical examination or reported by patients. This subclinical dysfunction may be caused by injury to an undefined group of presympathetic nerve cell axons in caudocranial direction that communicate with the cervical sympathetic ganglia and whose function is mydriatic pupillary innervation.http://www.ncbi.nlm.nih.gov/pubmed/22044979
medical students need to realise how vulnerable they are to being seduced by the special privileges of their profession
More than 7% of all German physicians became members of the Nazi SS during World War II, compared with less than 1% of the general population. In so doing, these doctors willingly participated in genocide, something that should have been antithetical to the values of their chosen profession. The participation of physicians in torture and murder both before and after World War II is a disturbing legacy seldom discussed in medical school, and underrecognised in contemporary medicine. Is there something inherent in being a physician that promotes a transition from healer to murderer? With this historical background in mind, the author, a medical student, defines and reflects upon moral vulnerabilities still endemic to contemporary medical culture.
http://jme.bmj.com/content/early/2012/05/02/medethics-2011-100372.abstract
Alessandra Colaianni, of Johns Hopkins Medical School, asks the unsettling question: "Is there something inherent in being a physician that promotes a transition from healer to murderer?" Some recent situations in the United States suggest that this is possible: allegations of euthanasia in the wake of Hurricane Katrina, torture of Guantanamo detainees, and the participation of doctors in capital punishment. Colaianni suggests that there are illuminating parallels between medical training and the work of doctors in Auschwitz.
Socialisation and hierarchy: doctors are pressured to conform to group norms, often with techniques like "Sleep deprivation, heightened stress levels and fear of failure". Ambition: just as Nazi doctors participated in the T4 euthanasia program to advance their careers, today's doctors are pressured to succeed even at the risk of losing their integrity. Doctors have a "licence to sin" which can easily be perverted: some "actions are allowed when they are performed by physicians, but are the stuff of horror films and criminal cases when non-licensed personnel attempt them."
Detachment was also a characteristic of Nazi doctors. They could select prisoners by day and dine with their colleagues by night: "the medical profession requires unflappability in the face of things that others would consider disgusting, horrific, or otherwise overwhelming".
Colaianni concludes that medical students need to realise how vulnerable they are to being seduced by the special privileges of their profession. "It is for this reason that a solid grounding in principles of ethics, individualism and human rights is so crucial for physicians and others in positions of power or trust."
http://www.bioedge.org/index.php/bioethics/bioethics_article/10042
http://jme.bmj.com/content/early/2012/05/02/medethics-2011-100372.abstract
Alessandra Colaianni, of Johns Hopkins Medical School, asks the unsettling question: "Is there something inherent in being a physician that promotes a transition from healer to murderer?" Some recent situations in the United States suggest that this is possible: allegations of euthanasia in the wake of Hurricane Katrina, torture of Guantanamo detainees, and the participation of doctors in capital punishment. Colaianni suggests that there are illuminating parallels between medical training and the work of doctors in Auschwitz.
Socialisation and hierarchy: doctors are pressured to conform to group norms, often with techniques like "Sleep deprivation, heightened stress levels and fear of failure". Ambition: just as Nazi doctors participated in the T4 euthanasia program to advance their careers, today's doctors are pressured to succeed even at the risk of losing their integrity. Doctors have a "licence to sin" which can easily be perverted: some "actions are allowed when they are performed by physicians, but are the stuff of horror films and criminal cases when non-licensed personnel attempt them."
Detachment was also a characteristic of Nazi doctors. They could select prisoners by day and dine with their colleagues by night: "the medical profession requires unflappability in the face of things that others would consider disgusting, horrific, or otherwise overwhelming".
Colaianni concludes that medical students need to realise how vulnerable they are to being seduced by the special privileges of their profession. "It is for this reason that a solid grounding in principles of ethics, individualism and human rights is so crucial for physicians and others in positions of power or trust."
http://www.bioedge.org/index.php/bioethics/bioethics_article/10042
nerves that sent blood-pressure-raising flight-or-fight signals to the brain were cut
page 187:
It was a grueling operation called sympathectomy, in which the nerves that sent blood-pressure-raising flight-or-fight signals to the brain were cut...The nerve cutting scrambled signals to her circulatory system. She was cold on one side of her body and warm on the other.
It was a grueling operation called sympathectomy, in which the nerves that sent blood-pressure-raising flight-or-fight signals to the brain were cut...The nerve cutting scrambled signals to her circulatory system. She was cold on one side of her body and warm on the other.
The Happy Bottom Riding Club: The Life and Times of Pancho Barnes (Paperback)
by Lauren Kessler (Author)
The second thoracic sympathetic ganglion was most commonly located (50%) in the second intercostal space
Presence of the stellate ganglion was noted in 56 (84.8%) sides, and 6 (9.1%) sides showed a single large ganglion formed by the stellate and the second thoracic sympathetic ganglia. The second thoracic sympathetic ganglion was most commonly located (50%) in the second intercostal space. CONCLUSION: The anatomic variations of the intrathoracic nerve of Kuntz and the second thoracic
sympathetic ganglion were characterized in human cadavers.
J Thorac Cardiovasc Surg 2002 Mar;123(3):498-501
Chung IH, Oh CS, Koh KS, Kim HJ, Paik HC, Lee DY.
Long-term sympathectomy induces sensory and parasympathetic fibres sprouting, and mast cell activation in the rat dura mater
http://discovery.ucl.ac.uk/1330488/
There are similarities between the delayed onset of the human pain state and the delayed rise in sensory peptides after sympathectomy
The effect of sympathectomy on the calcitonin gene-related peptide (CGRP) level in the rat primary trigeminal sensory neurone was investigated. Six weeks after bilateral removal of the superior cervical ganglion there was a 70% rise in the CGRP content of the iris and the pial arteries, a 34% rise in the concentration in the trigeminal ganglion but no change in the brainstem. The CGRP rise in both end organs suggests that this phenomenon may be common to all peripheral organs receiving combined sensory and sympathetic innervations. The lack of any rise in the brainstem CGRP content raises the possibility that this process spares central terminations. In contrast, the level of neuropeptide Y, a peptide mainly contained in sympathetic terminals, fell to 35% of control values in the iris and pial arteries whilst the trigeminal ganglion and brainstem concentrations remained unchanged. The possible relevance of these observations to the clinical syndrome of postsympathectomy pain (sympathalgia) is discussed. There are similarities between the delayed onset of the human pain state and the delayed rise in sensory peptides after sympathectomy.
http://www.ncbi.nlm.nih.gov/pubmed/3877546
http://www.ncbi.nlm.nih.gov/pubmed/3877546
Digital infrared thermal image after T2 sympathicotomy or T3 ramicotomy
(A) Clear cut change of skin temperature after a T2 sympathicotomy. (B) An even distribution of skin temperature after ramicotomy.
Gossot and colleagues [8] analyzed a group of T2, T3, T4 sympathectomy patients in comparison with a group of patients undergoing a T2, T3, T4 ramicotomy and they reported no statistical difference regarding the incidence of CS between the two groups studied (72.2% and 70.9%). However in terms of the severity of CS (embarrassing, disabling) causing inconveniences to daily life, they reported 27% and 13% incidences in these two groups, respectively. These findings suggest that by preserving the sympathetic trunk, it was possible to reduce the severity of CS.
The preganglionic fibers of the sympathetic nerve to the arm originate mostly from the spinal segments T3–T6 and the postganglionic fibers of the sympathetic nerve to the arm originate from T2 and, to a lesser extent, the T3 ganglia [9]. This implies that the division of preganglionic fibers (rami communicantes) reduces the extent of denervation of the sympathetic nerve as compared with the division of postganglionic fibers (sympathetic trunk) in the treatment of palmar hyperhidrosis. Sympathectomy or sympathicotomy is one of the procedures used to divide the sympathetic trunk. Sympathicotomy distinctively changes sympathetic nerve distribution in comparison with a ramicotomy. Figure 4A illustrates the clear-cut changes of skin temperature after a T2 sympathicotomy. However the overall sympathetic nerve distribution to the body is not markedly changed after a T3 ramicotomy because a T3 ramicotomy is a procedure that is used to divide one of the preganglionic fibers and to preserve the sympathetic trunk. Figure 4B illustrates an even distribution of skin temperature after T3 ramicotomy.
http://ats.ctsnetjournals.org/cgi/content/full/78/3/1052#FIG4
Drionic effectively "...reduced sweating for up to 6 weeks..."
Clinical Studies
The following comments are from clinical studies which demonstrated the safety and effectiveness of Drionic:
- Efficacy of the Drionic unit in the treatment of hyperhidrosis. J Am Acad Dermatol 1987;16:828-832. "...the Drionic unit appears to have a definite place in the treatment of hyperhidrosis." Daniel L. Akins, M.D. John L. Meisenheimer, M.D. Richard L. Dobson, M.D., Professor & Chairman, Dept. of Dermatology From the Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina
- A new device in the treatment of hyperhidrosis by iontophoresis. Cutis 1982;29:82-89. Drionic effectively "...reduced sweating for up to 6 weeks..." Further, the study concluded that "Because of its design, it has great potential for home use." CPT John L. Peterson, M.D. MAJ Sandra I. Read, M.D. COL Orlando G. Rodman, M.D. Chief, Dermatology Service From the Dermatology Service, Dept. of Medicine, Walter Reed Army Medical Center, Washington, DC
- Tap water iontophoresis in the treatment of hyperhidrosis. Int J Dermatol 26;1987:194-197. "Tap water iontophoresis is a recognized method of reducing sweat in various parts of the body. The Drionic device is a battery-operated method of inducing tap water iontophoresis. This simple device may be used at home and is effective in reducing hyperhidrosis for as long as 6 weeks." Mervyn L. Elgart, M.D., Professor & Chairman, Dept. of Dermatology Glenn Fuchs, M.D. From the Department of Dermatology, George Washington Univ. Medical Center, Washington, DC.
- Efficacy of the Drionic unit in the treatment of hyperhidrosis. JAm Acad Dermatol 16:828-832, Apr. 1987. Elgart ML, Fuchs G: Tap water iontophoresis in the treatment of hyperhidrosis. Int J Dermatol 26: 194-197, Apr. 1987. (old model)
Informing the patient of the seriousness of the consequences before this operation is absolutely necessary
http://ats.ctsnetjournals.org/cgi/content/full/80/3/1160-a
the surgical 'cure' for hyperhidrosis can make the condition worse
First, we object to the classification of excessive sweating and facial
blushing as diseases. While it is true that these conditions can be very
embarrassing, causing the afflicted to dislike or avoid social
situations, and this can indeed have a negative impact on the quality of
life, from a physiological point of view they are entirely harmless. We
believe that the recent “official” classification of these conditions
as diseases is borne not of medical accuracy, but rather out of a desire
to legitimize and justify the surgery in the eyes of both prospective
patients and their insurance carriers.
Second, and more importantly, we object to the procedure itself. Interrupting the sympathetic chain in the thoracic region (by whatever means) is proven to cause a litany of permanent physical and mental disabilities, including anhidrosis, lowered heart function, lowered mental function, diminished lung volume, loss of baroreflex, paralyzed blood vessels, dysfunctional thermoregulation, chronic pain, paresthesia, lowered alertness, decreased exercise capacity, lowered response to fear, thrills, and other strong emotions. Thousands of unsuspecting patients are having psychiatric surgery without consent, forever robbed of their strongest feelings.
And, infamously, ETS surgery can cause uncontrollable, clothes-drenching sweating from the nipple-line down. In other words, the “cure” for hyperhidrosis can actually cause WORSE hyperhidrosis. Some cure.
http://forums.randi.org/archive/index.php/t-77170.html
Second, and more importantly, we object to the procedure itself. Interrupting the sympathetic chain in the thoracic region (by whatever means) is proven to cause a litany of permanent physical and mental disabilities, including anhidrosis, lowered heart function, lowered mental function, diminished lung volume, loss of baroreflex, paralyzed blood vessels, dysfunctional thermoregulation, chronic pain, paresthesia, lowered alertness, decreased exercise capacity, lowered response to fear, thrills, and other strong emotions. Thousands of unsuspecting patients are having psychiatric surgery without consent, forever robbed of their strongest feelings.
And, infamously, ETS surgery can cause uncontrollable, clothes-drenching sweating from the nipple-line down. In other words, the “cure” for hyperhidrosis can actually cause WORSE hyperhidrosis. Some cure.
http://forums.randi.org/archive/index.php/t-77170.html
pathological pain, such as occurs in response to peripheral nerve injury
http://www.ncbi.nlm.nih.gov/pubmed/17706291
most surgeons do not have a clear understanding of their short-term outcomes for the majority of procedures they perform
The public would probably be surprised to know that most surgeons do not have a clear understanding of their short-term outcomes for the majority of procedures they perform.
Of even greater concern is the lack of data on long-term outcomes associated with surgical interventions.
Many surgeons argue that they are too busy and do not have the time and resources to conduct this sort of follow-up. This is not entirely without foundation, but it does seem difficult to defend a stance that says “I will continue to work feverishly at the operations I do but not assess how successful my results are”.
Of even greater concern is the lack of data on long-term outcomes associated with surgical interventions.
Many surgeons argue that they are too busy and do not have the time and resources to conduct this sort of follow-up. This is not entirely without foundation, but it does seem difficult to defend a stance that says “I will continue to work feverishly at the operations I do but not assess how successful my results are”.
Guy Maddern (ASERNIP-s): No excuse for poor surgical outcomes
MJA INSIGHT, 8 August 2011
Disorders of sweating - Iatrogenic causes: Surgical sympathectomy/sympathotomy
(p. 558)
Primer on the Autonomic Nervous System
edited by David Robertson, Italo Biaggioni, Geoffrey Burnstock, Phillip A. Low, Julian F.R. Paton
CS is referred to as perilesional hyperhidrosis - the shifting narrative
Perilesional/Compensatory Hyperhidrosis
Central and/or peripheral denervation of large numbers of sweat glands produces increased sweat output in innervated glands, maximal in contiguous dermatomal regions, occurs in PAF, Ross syndrome, SCI and post-surgical sympathectomy. (p.555)Primer on the Autonomic Nervous System
Sympathectomy, ganglionopathies and myelopathies produce such pattern
Segmental Anhidrosis
This pattern occurs when a large, contiguous body area of sweat loss with sharply demarcated borders conforming to sympathetic or somatic dermatomes are present.
Sympathectomy, ganglionopathies and myelopathies produces such pattern. When borders are not well defined and anhidrosis not contiguous, a regional pattern is said to exist. Both postganglionic and preganglionic lesions may produce these distributions. (p.557)
This pattern occurs when a large, contiguous body area of sweat loss with sharply demarcated borders conforming to sympathetic or somatic dermatomes are present.
Sympathectomy, ganglionopathies and myelopathies produces such pattern. When borders are not well defined and anhidrosis not contiguous, a regional pattern is said to exist. Both postganglionic and preganglionic lesions may produce these distributions. (p.557)
Primer on the Autonomic Nervous System
edited by David Robertson, Italo Biaggioni, Geoffrey Burnstock, Phillip A. Low, Julian F.R. Paton
sympathectomy cannot by direct effect on the muscle vessels either abolish or lessen claudication
http://pmj.bmj.com/content/29/335/459
Sympathectomy useless, even detrimental
A number of surgical procedures have been developed, which, although well-intentioned, are found unfortunately by further study to prove useless, or even detrimental. It is believed at present that lumbar sympathetic ganglionectomy in the treatment of the post-thrombotic type of ulceration of the lower extremity should be placed in this category.
http://archsurg.ama-assn.org/cgi/content/summary/67/1/2
http://archsurg.ama-assn.org/cgi/content/summary/67/1/2
reductions in heart rate variability are a predictor of sudden cardiac death, even in individuals without a prior history of cardiovascular disease
Research indicates that a highly variable heart rate increases your capacity to respond and adapt to life’s challenges.
In a sense, it makes your cardiovascular system more flexible. If you’re less able to switch to the rest system, you’re more likely to feel stressed because your body is indicating that there’s danger in the environment – even if there isn’t.
Research has shown that reductions in heart rate variability are a predictor of sudden cardiac death, even in individuals without a prior history of cardiovascular disease.
http://theconversation.edu.au/depression-can-break-your-heart-literally-1102
In a sense, it makes your cardiovascular system more flexible. If you’re less able to switch to the rest system, you’re more likely to feel stressed because your body is indicating that there’s danger in the environment – even if there isn’t.
Research has shown that reductions in heart rate variability are a predictor of sudden cardiac death, even in individuals without a prior history of cardiovascular disease.
http://theconversation.edu.au/depression-can-break-your-heart-literally-1102
the medical profession is so trusted that its activities are rarely questioned
By Paul Komesaroff, Monash University; Ian Kerridge, University of Sydney, and Wendy Lipworth, University of New South Wales
https://theconversation.edu.au/big-debts-in-small-packages-the-dangers-of-pens-and-post-it-notes-4949
https://theconversation.edu.au/big-debts-in-small-packages-the-dangers-of-pens-and-post-it-notes-4949
compensatory sweating was perceived in 56% of the adults and all of the children, or CS was lower in children - illustrations of typical contradictions about effects of ETS
compensatory sweating was perceived in 56% of the adults and all of the children. With the compensatory sweating, the effect on the life was severe in children and the patient's satisfaction was 50-60%, showing a large difference from the satisfaction of the adult patients at nearly 100%. As for other complications, neuralgia was recognized in 9% of the adults, but not in the children, and the crisis of perceptual disorder, hemorrhage and Horner's syndrome did not occur in both the adults and children. The compensatory sweating in the child patients was more remarkable than in the adult patients and the postoperative satisfaction was low, and it seems better to perform thoracoscopic sympathic blockade after the adolescence.
http://sciencelinks.jp/j-east/article/200513/000020051305A0251361.php
Do children tolerate thoracoscopic sympathectomy better than adults? CS appeared within 6 months postoperatively in 81.8% of all the patients but significantly less in children
(69.8%) compared to the others (88.5%; P < 0.001). CS increased with time in 12% of the participants, but decreased in 20.8% of the children versus 10.5% of the others (P = 0.034), usually within the first two postoperative years. The severity of the CS was also lower in children: it was absent or mild in 54.3% of the children versus 38.0% of the others, and moderate or severe in 45.7 versus 62%, respectively (P = 0.004). Fifty-one percent of the participants claimed that their quality of life decreased moderately or severely as a result of CS, but only one-third of them (7.9% children vs. 22.4% others, P = 0.001) would not have undergone the operation in retrospect.
http://www.ncbi.nlm.nih.gov/pubmed/17999068
http://sciencelinks.jp/j-east/article/200513/000020051305A0251361.php
Do children tolerate thoracoscopic sympathectomy better than adults? CS appeared within 6 months postoperatively in 81.8% of all the patients but significantly less in children
(69.8%) compared to the others (88.5%; P < 0.001). CS increased with time in 12% of the participants, but decreased in 20.8% of the children versus 10.5% of the others (P = 0.034), usually within the first two postoperative years. The severity of the CS was also lower in children: it was absent or mild in 54.3% of the children versus 38.0% of the others, and moderate or severe in 45.7 versus 62%, respectively (P = 0.004). Fifty-one percent of the participants claimed that their quality of life decreased moderately or severely as a result of CS, but only one-third of them (7.9% children vs. 22.4% others, P = 0.001) would not have undergone the operation in retrospect.
http://www.ncbi.nlm.nih.gov/pubmed/17999068
hypoaesthesia in the bilateral axillar region after endoscopic thoracic sympathectomy for palmar hyperhidrosis
http://sciencelinks.jp/j-east/article/199920/000019992099A0655152.php
Heart Rate Variability before and after the Endoscopic Transthoracic Sympathectomy in Hyperhidrosis
The etiology of primary hyperhidrosis has been speculated as "unknown" hyperactivity of the sympathetic nervous system. In our clinic, we performed endoscopic transthoracic sympathectomy(ETS) for the treatment of hyperhidrosis. In this study, we studied the cardiac autonomic nervous function using heart rate variability(HRV) before and after ETS in 70 patients with hyperhidrosis, and compared with normal control. Before ETS, high frequency(HF) power was lower in hyperhidrosis than control group, however, there was no significant difference in LF/HF. After ETS, LF/HF decreased by 31%, and lower than control. No Severe cpomplications were occurred by ETS. In conclusion, on the cardiac autonomic nervous tone, hyperhidrosis patients had the relative dominance of the sympathetic nervous tone by suppression of the parasympathetic nervous tone. After ETS, the sympathetic nervous tone was suppressed. Clinical symptoms in hyperhidrosis patients were impoved by ETS. Although ETS affected the cardiac autonomic nervous tone, it was useful and safety method for hyperhidrosis.
http://sciencelinks.jp/j-east/article/200002/000020000299A0930354.php
http://sciencelinks.jp/j-east/article/200002/000020000299A0930354.php
Persistent blushing as a side-effect of the surgery for blushing...
http://www.hyperhidrosis-usa.com/facial_blushing.html
It’s not unusual to hear people who have undergone sympathectomies describe themselves as feeling emotionally “colder” than before
It’s not unusual to hear people who have undergone sympathectomies describe themselves as feeling emotionally “colder” than before. Among psychologists and neurologists alike there is concern, but no evidence, that the procedure limits alertness and arousal as well as fear, and might affect memory, empathy and mental performance. Professor Ronald Rapee, the director of the Centre of Emotional Health at Sydney’s Macquarie University, says he’s counselled several people who complain of feeling “robot-like” in the long-term wake of the operation. “They’re happy they no longer blush, but they miss the highs and lows they used to feel.”
(John van Tiggelen, Good Weekend Magazine, The Age and the Sydney Morning Herald, 10th March 2012)
Full test of he article available here:
http://etsandreversals.yuku.com/topic/5083/Article-about-the-surgery-in-the-mainstream-media-RED-ALERT#.T2KiyiNLU1g
(John van Tiggelen, Good Weekend Magazine, The Age and the Sydney Morning Herald, 10th March 2012)
Full test of he article available here:
http://etsandreversals.yuku.com/topic/5083/Article-about-the-surgery-in-the-mainstream-media-RED-ALERT#.T2KiyiNLU1g
our advice to patients must reflect the true potential outcomes
Dear Editor,
http://www.medicalhub.com.au/wa-news/letters/3217-palmar-hyperhidrosis-revisited
I refer to the article on palmar hyperhidrosis by Dr Sanjay Sharma (Managing palmar hyperhidrosis, March). I feel that the adverse effects [of thoracoscopic sympathectomy] are understated by my colleague. For example, compensatory hyperhidrosis is common, and can be disabling, leading to regret about the procedure in some patients (up to 51% in one review). Reversal of the procedure is difficult and requires sural nerve transplant if the sympathetic chain is removed.
The procedure can be effective and worthwhile, but our advice to patients must reflect the true potential outcomes.
Dr Ian Gilfillan, Cardiothoracic Surgeon http://www.medicalhub.com.au/wa-news/letters/3217-palmar-hyperhidrosis-revisited
post-sympathectomy neuralgia is frequent
Surgical sympathectomy has a long heritage for the treatment of peripheral vascular disease and various chronic pain problems.
Despite concerns expressed as long ago as 1942 about the efficacy of surgical sympathectomy for the management of non-cancer pain, the procedure was enthusiastically pursued for the management of reflex sympathetic dystrophy or complex regional pain syndrome (CRPS), migraine, dysmenorrhea, epilepsy, chronic pancreatitis, postherpetic neuralgia of the trigeminal nerve, postdiscectomy syndrome, and phantom limb pain. However, systematic reviews have found no tangible evidence supportive of sympathectomy for the management of neuropathic pain. Furthermore, postsympathectomy neuralgia is a common complaint with a reported incidence between 15% to 50%.
As surgery is often mentioned as a cause of CRPS, it is somewhat illogical to consider surgery as an effective treatment. Nonetheless, surgical sympathectomy has a long anecdotal history in the treatment of RSD, and more recently endoscopic and radiofrequency sympathectomy has been tried.
Bonica's Management of Pain,
Lippincott Williams & Wilkins, 2009 - 2064 pages
impairment of the CBF autoregulation after unilateral cervical sympathectomy
Although these findings argued against a neurogenic mechanism, James at al. (1969) reported impairment of autoregulation after unilateral cervical sympathectomy in the babbon. Gotoh et al. (1971/1972) observed impairment of autoregulation in patients with the Shy-Drager syndrome.
It was concluded that the autonomic nervous system plays an important role in the mechanism of autoregulation of CBF and that his mechanism is independent of the chemical control of the cerebral vessels. This was confirmed by direct observation of the pial vessels in cats, where separate sites of action in the vascular tree for autoregulation and chemical control were demonstrated; the autoregulatory reaction was located in pial arteries with a diameter larger than 50 μ, and the reaction to carbon dioxide in pial arteries of smaller diameter (Gotoh et al. 1975).
They concluded that the arteries operating in autoregulation were the larger ones with the dense innervation, while the smaller arteries with sparse innervation were involved in chemical control.
Coronna and Plum (1973) demonstrated the absence of CBF autoregulation in a patient with a Shy-Drager syndrome who had a postganglionic denervation.
It was concluded that the autonomic nervous system plays an important role in the mechanism of autoregulation of CBF and that his mechanism is independent of the chemical control of the cerebral vessels. This was confirmed by direct observation of the pial vessels in cats, where separate sites of action in the vascular tree for autoregulation and chemical control were demonstrated; the autoregulatory reaction was located in pial arteries with a diameter larger than 50 μ, and the reaction to carbon dioxide in pial arteries of smaller diameter (Gotoh et al. 1975).
They concluded that the arteries operating in autoregulation were the larger ones with the dense innervation, while the smaller arteries with sparse innervation were involved in chemical control.
Coronna and Plum (1973) demonstrated the absence of CBF autoregulation in a patient with a Shy-Drager syndrome who had a postganglionic denervation.
Gotoh et al (1979) subsequently showed that autoregulation in patients with this syndrome was impaired irrespective of the localization of the damage to the cervical sympathetic nervous system (preganglionic, central, postganglionic) as judged by the eye instillation test.
Handbook of Clinical Neurology,
Vascular Diseases, Part I by P. J. Vinken, G. W. Bruyn, H. L. Klawans, and J. F. Toole
CAUSES AND MANAGEMENT OF ORTHODEOXIA - The Australian Short Course on Intensive Care Medicine, 2005
DEFINE AND LIST THE CAUSES AND MANAGEMENT OF PLATYPNOEA AND
ORTHODEOXIA
p. 79:
Autonomic
o Parkinson disease (Hussain 2004)
o Bilateral thoracic sympathectomy (van Heerdon 2004)
Published in 2005 by
The Australasian Academy of Critical Care Medicine
“Ulimaroa”
630 St Kilda Rd, Melbourne,
Victoria 3004
ISSN 1327-4759
ORTHODEOXIA
p. 79:
Autonomic
o Parkinson disease (Hussain 2004)
o Bilateral thoracic sympathectomy (van Heerdon 2004)
Published in 2005 by
The Australasian Academy of Critical Care Medicine
“Ulimaroa”
630 St Kilda Rd, Melbourne,
Victoria 3004
ISSN 1327-4759
Occurrence and multiple recurrence of severe vasospasm of the upper extremity following thorascopic sympathectomy for hyperhidrosis
http://www.ncbi.nlm.nih.gov/pubmed/21130009
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