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
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
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