decreased brain metabolism, rather than an increased intracranial pressure, is the cause of decreased cerebral blood flow after superior cervical sympathetic ganglionectomy

"The reduced brain metabolism and consequently reduced cerebral perfusion in the late 

postsympathectomy period could account for reduction in CSF production (Bering3)."

"In support of the above statement we mention that on the late postsympathectomy (11 to 24 months) group of dogs besides the lowered CBF 

(31.36 ml/100 gm brain weight/minute) and MCP (79.3 mm NS) also a lowered MVP (46.5 mm NS) was found. These data indicate that cervicalsympathectomy has a profound and intricate effect on the dynamics of cerebrovascular fluids and probably, in the background of all observedphenomena, a decreased cerebral metabolism as a sympathectomy effect is the underlying cause. Correspondingly the cerebral metabolic rate ofoxygen (CMR O2) decreased to 2.94 and 2.43 ml of O2/IOO gm brain weight/ minute in the sympathectomized groups." 

"Decreased brain metabolism, rather than an increased intracranial pressure, is the cause of decreased cerebral blood flow after superior 

cervical sympathetic ganglionectomy."

http://archsurg.ama-assn.org/cgi/content/summary/90/3/418

CERVICAL SYMPATHECTOMY AND CEREBROSPINAL FLUID PRESSURE: THEIR RELATIONSHIP TO BRAIN METABOLISM

http://www.ncbi.nlm.nih.gov/pubmed/14247422

Surgical Denervation of Ocular Sympathetic Afferents Decreases Local Transforming Growth Factor-β and Abolishes Immune Privilege

Mounting evidence points to a role for the sympathetic nervous system in suppressing inflammation. This role might be of specific relevance for immune privilege in the eye, where, sporadically, patients with denervated sympathetic fibers develop chronic inflammation.

Our results show that in the absence of functional sympathetic fibers, the eye loses its ability to prevent either the immune rejection of intraocular allogeneic tumor cells or the suppression of delayed type hypersensitivity responses against soluble antigens injected in the anterior chamber. This loss of immune privilege is accompanied by a decrease in the concentration of transforming growth factor-β in the aqueous humor. These results suggest that immune privilege is lost in the absence of a functional sympathetic innervation of the eye, allowing intraocular immune responses to become exaggerated. We conclude that ocular sympathetic nerves are critical for the generation and maintenance of immune privilege in the eye through the facilitation of local transforming growth factor-β production.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2731140/

Chemical sympathectomy leads to lowering of aqueous humor production

GRAEFE'S ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY

Volume 200, Number 3, 223-226, DOI: 10.1007/BF01028537

Cervical sympathectomy causes photoreceptor-specific cell death in the rat retina

Changes in the regulation of the vasculature of the eye may be related to some age-related ocular diseases. We have previously shown that loss of sympathetic innervation, as can normally occur with age, resulted in substantial vascular growth of the choroid. The current study was designed to determine whether changes induced by sympathetic denervation causes significant loss of photoreceptors and increased glial cell reactivity in the retina. Sympathetic denervation was performed followed by immunohistochemistry, TUNEL staining, and protein expression analysis to investigate photoreceptor loss. There was a significant reduction (30%) in photoreceptor numbers in the sympathectomized eye. This loss was due to apoptosis, as there was over a doubling in apoptotic cell numbers after sympathectomy. This loss of photoreceptors in the sympathectomized eye resulted in a significantly reduced width of the outer nuclear layer of the retina when compared to the contralateral eye. Increased glial fibrillary acidic protein (GFAP) staining was also noted after sympathectomy in the ganglion cell layer with streaking toward the bipolar cell layer. These results suggest that loss of sympathetic innervation may cause significant changes to the physiology of the choroid.

Autonomic Neuroscience
Volume 120, Issues 1-2, 15 June 2005, Pages 46-51 

morphological changes in the retina noted after sympathectomy

Results: Mice treated with PDGF inhibitor AG 1296 showed an inhibition of corneal neovascularization and a reduction of pericytes in the new formed vessels compared to untreated animals. 

Retina from sympathectomized eyes receiving saline treatment had significantly  reduced PEDF mRNA and protein expression relative to the contralateral eye receiving saline treatment. These results are similar to previous work and indicate that injection alone did not alter the results. Intravitreal PEDF administration to sympathectomized eyes returned both mRNA and protein levels to those of the contralateral eye. PEDF administration also normalized retinal morphometry to prevent the sympathectomy-induced increases 

in capillary density of the outer plexiform layers, as well as the ganglion cell layer. 

Conclusions: These results suggest that one injection of PEDF can restore protein and mRNA 

levels to those noted in an untreated animal. Furthermore, these results also indicate that 

one injection of PEDF can reverse the morphological changes noted after sympathectomy 

in the retina. 

CR:  J.J. Steinle,  B.L. Lashbrook,

files.abstractsonline.com/SUPT/25/1421/SessionPDF/119.pdf

Secondary Effects of Sympathectomy - Disturbance of Sexual Function

If a portion of the autonomic nervous system is removed to modify a specific disease process, unrelated physiologic mechanisms will also be affected. The degree to which these other mechanisms may be affected often governs the selection of operative procedures. The results produced by interfering with mechanisms other than those for which the operation is performed might be designated as side-effects or secondary effects. . . .

N Engl J Med 1951; 245:121-130July 26, 1951

http://www.nejm.org/doi/full/10.1056/NEJM195107262450401

We disagree that surgery and botulinum toxin are treatments of choice in severe cases of hyperhidrosis

The truth is exactly the opposite. Surgery is only rarely necessary, and the editorial quite properly warns of numerous surgical pitfalls, which include recurrence of hyperhidrosis, almost certain impotence, compensatory sweating, permanent neurological damage from anoxia, and death (their words). Botulinum toxin, which they recommend for axillary or plantar hyperhidrosis, requires 12 injections per axilla and 24-36 injections per foot. Even this horrendous procedure gives only 11 months' relief, and antibody formation may reduce long term efficiency.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118569/

Iontophoresis should be tried before other treatments

Iontophoresis is easy to perform, effective in about 90% of patients in two studies with 54 and 30 participants, free of hazardous side effects, and well accepted by almost all patients.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118569/

the Kuntz nerve played no part in the success or failure of ETS surgery

If you research the topic of ETS, you will come across various claims and counter-claims
about the importance or otherwise of the Kuntz nerve. The Kuntz nerve is a small nerve
fibre sometimes seen on the second rib not far from the main sympathetic chain. Its
function is not known in humans. Some web-sites on ETS claim success rates of up to
100% for facial blushing because they search for and destroy the Kuntz nerve(s). These
same people also claim to be able to correct failed ETS operations by reoperating and
destroying the Kuntz nerve.
At the meeting of the International Society for Sympathetic Surgery in Germany, May
2003, attended by a majority of the world’s experts in ETS surgery (including us), all but
one of the surgeons present were of the opinion that the Kuntz nerve played no part in the
success or failure of ETS surgery for facial blushing. We share this majority opinion.
www.lapsurgeryaustralia.com.au

Fake websites in the service of the ETS industry - who protects the patients?

Mia:
Many surgeons compete with each other for the attention of the 'costumer' in the saturated market of the www. Adaptations to a business model raises ethical questions that should have been explored long ago and should have raised the ire of the medical community. The occasional whimper of discord is silenced by the cacophony of (ignorant) enthusiasm. Not quite the scientific behavior one would expect.

How does the entrepreneurial aspect of medicine impact on the information patients are given? In the area of elective procedures, is it in the interest of the service provider to provide full disclosure? Does self-interest influence and modify how the information is conveyed? How information morphs into little facts and more emoting, to appeal to the irrational in all of us, to seduce us.

Fake websites that pretend to be independent,  informative, with the sole raison d'etre to praise the surgeon's skill, expertise and experience, - and to hook the patient into reading more on the surgeons' website, with many obvious links to the surgeon on every page.
Why are predatory practices of medical professionals tolerated?

In 70 % compensatory sweating severe, recurrence rates were 15% and 19% at 1 and 2 years after surgery

In T2 and T3 resection, all patients experienced Compensatory Sweating and over 70% of the patients felt it was severe. Even in T2 resection, 90% of patients experienced CS and in 50% of these it was severe. High rates of CS are reported in Asian countries with hot and humid climates.

In T2 resection, recurrence rates were 15% and 19% at 1 and 2 years after surgery.It was not rare for a patient to experience recurrence more than 3 years after surgery.
Motoki Yano, MD, PhD and Yoshitaka Fujii, MD, PhD

Volume 138, Issue 1, Pages 40-45 (July 2005)

The results of endoscopic sympathectomy deteriorate progressively from the immediate outcome

British Journal of Surgery ISSN 0007-1323

1999, vol. 86, no1, pp. 45-47 (12 ref.)

a strong association of autonomic dysfunction and impaired cerebral autoregulation

Furthermore, we found a strong association of autonomic dysfunction and impaired autoregulation indicated by a correlation between the LF/HF ratio and Sx (p < 0.001).

Drug and Alcohol Dependence

Volume 110, Issue 3, 1 August 2010, Pages 240-246

After sympathectomy for hyperhidrosis, very severe discomfort and hyperhidrosis occurred with alarming frequency and intensity

"After thoracoscopic sympathectomy for hyperhidrosis, very severe discomfort and hyperhidrosis in the neighboring non-sympathectomized regions occurred with alarming frequency and intensity."
(p.879)

Cousins and Bridenbaugh's Neural Blockade in Clinical Anesthesia and Pain Medicine by Michael J Cousins, Phillip O Bridenbaugh, Daniel B Carr, and Terese T Horlocker
Wolters Kluwer Health
Edition: 4 - 2008

Sympathectomy is one of the causes or Orthostatic Hypotension

Causes of Orthostatic Hypotension

Peripheral

Amyloidosis

Diabetic, alcoholic, or nutritional neuropathy

Familial dysautonomia (Riley-Day syndrome)

Guillain-Barré syndrome

Paraneoplastic syndromes

Pure autonomic failure (formerly called idiopathic orthostatic hypotension)

Surgical sympathectomy

http://www.merckmanuals.com/professional/sec07/ch069/ch069d.html

cervical ganglionectomy produces a significant reduction in the noradrenergic innervation of ip- silateral extraparenchymal arteries

Immediately following experimentation the cerebral vessels were examined
for the presence of noradrenergic fibers. The results of the study demonstrate that:
(1) superior cervical ganglionectomy produces a significant reduction in the noradrenergic innervation of ipsilateral extraparenchymal arteries;
(2) the peripheral sympathetic nervous system contributes to overall cerebral vascular resistance primarily by affecting resistance in extraparenchymal arteries; and
(3) as a result, it determines the contribution of the extraparenchymal arteries tooverall cerebral blood flow autoregulation.
1975;6;284-292 Stroke

interrupting sympathetic efferent fibers innervating the heart and baroreflex

The results suggest that cardiac sympathectomy induced by epidural anesthesia can suppress partially baroreceptor function by interrupting sympathetic efferent fibers innervating the heart during high levels of epidural anesthesia, but that lumbar sympathectomy during epidural anesthesia is unlikely to affect baroreceptor activity.
Baroreflex control of heart rate during cardiac sympathectomy by epidural anesthesia in lightly anesthetized humans.

Dohi S, Tsuchida H, Mayumi T
Anesth Analg 1983; 62:815-20.

Baroreflex sensitivity, measured as cardiac acceleration in response to nitroglycerin, was significantly lower (p < style="font-weight: bold;">The results suggest that baroreflex-mediated response to decreases in arterial pressure is dependent on the integrity of the sympathetic nervous system.

Baroreflex control of heart rate during high thoracic epidural anaesthesia. A randomised clinical trial on anaesthetised humans.
Goertz A, Heinrich H, Seeling W
Anaesthesia 1992; 47:984-7.

Other causes of autonomic dysfunction: sympathectomy

Patients with progressive autonomic dysfunction (including diabetes) have little or no increase in plasma noradrenaline and this correlates with their orthostatic intolerance (Bannister, Sever and Gross, 1977). In patients with pure autonomic failure, basal levels of noradrenaline are lower than in normal subjects (Polinsky, 1988). Similar low values are observed in patients with sympathectomy and in patients with tetraplegia. (p.51)

The finger wrinkling response is abolished by upper thoracic sympathectomy. The test is also abnormal in some patients with diabetic autonomic dysfunction, the Guillan-Barre syndrome and other peripheral sympathetic dysfunction in limbs. (p.46)

Other causes of autonomic dysfunction without neurological signs include medications, acute autonomic failure, endocrine disease, surgical sympathectomy . (p.100)

Anhidrosis is the usual effect of destruction of sympathetic supply to the face. However about 35% of patients with sympathetic devervation of the face, acessory fibres (reaching the face through the trigeminal system) become hyperactive and hyperhidrosis occurs, occasionally causing the interesting phenomenon of alternating hyperhidrosis and Horner's Syndrome (Ottomo and Heimburger, 1980). (p.159)

Disorders of the Autonomic Nervous System

By David Robertson, Italo Biaggioni

Edition: illustrated

Published by Informa Health Care, 1995

ISBN 3718651467, 9783718651467

bradycardia and other cardiac complications are common side effects?

The most common side effects of sympathectomy are compensatory sweating, gustatory sweating and cardiac changes including decreasing heart rate, systolic-diastolic and mean arterial pressure. The mechanism of bradycardia and other cardiac complications that develop after thoracic sympathectomy are still unclear.

http://tipbilimleri.turkiyeklinikleri.com/abstract_54802.html

"It is a lie that sympatholysis may specifically cure patients

with unqulified "reflex sympathetic dystrophy". This was already stated by the father of sympathectomy, Rene Leriche, more than half a century ago.
...it is not an error. but a lie. While conceptual errors are not only forgivable, but natural to inexact medical science, lies, particularly when entrepreneurially inspired are condemnable and call for a peer intervention.

J. Neurology (1999) 246: 875-879

Lack of disclosure to ETS patients is unethical and would be criminal in a just society

It is the doctor's moral and ethical duty to provide you with full and honest disclosure of the facts prior to surgery. The whole doctrine of informed consent is to prevent patients from having to realize they made a mistake in hindsight. You shouldn't have had to find out from a former patient's wife that the surgery would cause drenching sweating on your back. It was Garza's job to do that. He completely lied to you regarding the supposed reversibility. Anyone who goes through medical school knows that can't crush a nerve with a metal clamp, remove it later and have the nerve return to normal functioning.

Although it is not possible to predict exactly what will occur in each individual case, there is nearly 100 years of published scientific and medical research available on the effects of sympathectomy. That research paints a very different picture of the effects of this surgery than the one presented to patients considering this surgery. That's the issue. Generally, they lie and tell patients that CS is inconsequential in all but a tiny fraction of cases and simply fail to disclose a huge number of verified adverse effects of the surgery. They take advantage of the patient's ignorance on medical matter. It's unethical and would be criminal in a just society.

In short, you do have a way of knowing what will likely occur as a result of the surgery before you have it done. All the information necessary to make an informed decision exists. It's just not getting to patients.

http://etsandreversals.yuku.com/reply/22927/Would-you-do-it-again#reply-22927

Surgical sympathectomy listed as neurologic disorder

Other neurologic disorders
- Idiopathic orthostatic hypotension
- Multiple sclerosis
- Parkinsonism
- Posterior fossa tumor
- Shy-Drager syndrome
- Spinal cord injury with paraplegia
- Surgical sympathectomy
- Syringomyelia
- Syringobulbia
- Tabes dorsales (syphillis)
- Wernicke's encephalopathy
Dizziness: Classification and Pathophysiology
The Journal of Manual and Manipulative Therapy, Vol. 12, No 4 (2004)

Sympathectomy induces adrenergic excitability of cutaneous C-fiber nociceptors

1: J Neurophysiol. 1996 Jan;75(1):514-7.

nerve damage causes an inflammatory response

Damage to peripheral nerves often results in pain and hyperalgesia. We suggest that nerve damage causes an inflammatory response in which cells associated with the nerve release inflammatory mediators such as
eicosanoids; these mediators may contribute to the hyperalgesia which results from nerve injury. The cell types most likely to be responsible include macrophages and postganglionic sympathetic neurones.
http://www.springerlink.com/content/pjh3832058475340/
D. J. Tracey1 J. S. Walker1
School of Anatomy, University of New South Wales, 2052 Sydney, NSW, Australia

The brain and the immune system are the two major adaptive systems of the body. During an immune response the brain and the immune system “talk to each other” and this process is essential for maintaining homeostasis. Two major pathway systems are involved in this cross-talk: the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS). This overview focuses on the role of SNS in neuroimmune interactions, an area that has received much less attention than the role of HPA axis. Evidence accumulated over the last 20 years suggests that norepinephrine (NE) fulfills the criteria for neurotransmitter/neuromodulator in lymphoid organs.
http://pharmrev.aspetjournals.org/content/52/4/595.abstract

82.9% Were Disturbed Because CS Was More Than Expected

Endoscopic thoracic sympathectomy (ETS) for palmar hyperhidrosis was performed using a 3-mm small endoscope at our hospital, and we conducted a questionnaire for the purpose of studying the conditions and satisfaction after surgery. The subjects were comprised of 50 patients, of which 35 patients (75%) answered the survey. The average age of the respondents was 27 years old (range: 12?62 years old) including 13 males and 22 females and the average postoperative observation period was 33 months (1?114 months). The results showed the good effects of surgery in all of the patients for palmar sweating while patient satisfaction was 79.4 points, which concluded that ETS was sufficiently accepted as treatment for palmar hyperhidrosis. However, compensatory sweating (CS) developed in 97.1% of the patients, and 82.9% answered that they were disturbed because it was more than they had expected. This result makes us realize further the importance of preoperative informed consent for CS. The problem of palmar hyperhidrosis is very serious for patients, and hence it is important to give treatment with a thorough understanding of the effectiveness and problems of ETS for palmar hyperhidrosis according to the analytical results of this questionnaire.

http://ci.nii.ac.jp/naid/110006980508/en

Safety and Ethics in Healthcare

"...professionals may adopt unreasonable practices. Practices may develop in professions, particularly as to disclosure, not because they serve the interests of the clients, but because they protect the interests or convenience of members of the profession. The court has an obligation to scrutinize professional practices to ensure that they accord with the standard of reasonableness imposed by the law."

Incresingly, the question is not whether the defendant's conduct conforms with the practices of the profession, but whether it conforms with standards of reasonableness. (p. 150)

"The right of patients self-determination is well entrenched both in law and in ethical codes. Respect for patient autonomy now occupies centre stage in medical ethics. In considering patient autonomy one needs to think about truth telling, confidentiality, privacy, disclosure of information and consent. Each is important and all have important implications for healthcare professionals." (p. 167)

Safety and Ethics in Healthcare: A Guide to Getting it Right, By Bill Runciman, Alan Merry

Published by Ashgate Publishing, Ltd., 2007

Effect of cervical sympathectomy and circulatory hypoxia on time course of prostaglandin concentration in brain tissues

http://www.springerlink.c...ontent/j705306763158841/

Some workers suggest a possible "transmembrane" role of PG in the nervous system.

If the increase in the PG level during ischemia is regarded as a protective reaction, it must be admitted that no increase took place 1 day after CSE (cervical sympathectomy) and it was considerably weakened 7-40 days after CSE.

The effect of cerebral ischemia was virtually indistinguishable from the action of CSE itself.

It can be tentatively suggested that PGF plays the main role in the regulation of tone of the vascular wall and in the regulation of metabolism under conditions of ischemia when the sympathetic regulation is disturbed.

sympathectomy-induced alterations of immunity

Many studies have demonstrated that ablation of the sympathetic nervous system (SNS) alters subsequent immune responses. Researchers have presumed that the altered immune responses are predominantly the result of the peripheral phenomenon of denervation. We, however, hypothesized that chemical sympathectomy will signal and activate the central nervous

system (CNS). Activation of the CNS was determined by immunocytochemical visualization of Fos protein in brains from male C57BL/6 mice at 8, 24, and 48 h following denervation. A dramatic induction of Fos protein was found in the paraventricular nucleus (PVN) of

the hypothalamus and other specific brain regions at 8 and 24 h compared

to vehicle control mice. Dual-antigen labeling demonstrates that corticotrophin releasing factor (CRF)-containing neurons in the PVN are activated by chemical sympathectomy; however, neurons containing neurotransmitters which may modulate CRF neurons, such as vasopressin,

tyrosine hydroxylase, and adrenocorticotropin, do not coexpress Fos. Our findings suggest an involvement of the CNS in sympathectomy-induced alterations of immunity.

Central Nervous System Activation following PeripheralChemical Sympathectomy: Implications for Neural–Immune Interactions

Brain, Behavior, and Immunity

Volume 12, Issue 3, September 1998, Pages 230-241

Effects of Sympathectomy on Muscle

We have previously reported functional and histological studies in five beagle dogs with unilateral lumbar sympathectomy. Three months later, fatiguability in the gracilis muscles was increased on the denervated sides, and this was associated with an increase in the relative distribution of FT fibres. Biochemical studies now show that these changes were associated with an increase in cytosolic protein without change in DNA content; this is consistent with
an increase in cell size. There was a reduction in the proportion of slow myosin light chain isoforms from 50 ± 7 to 34 ± 6%. Noradrenaline levels were increased on the denervated sides but this may reflect greater vascularity. Calcium content did not correlate with fibre type but there was a positive relation with both noradrenaline content (r= 0·73;
P<0·05) and DNA content (r= 0·84; P<0·05). It is concluded that sympathectomy induces several biochemical changes in skeletal muscle which constitute a change and increase in fast myosin light chain synthesis and a corresponding fibre type transformation.

Clinical Physiology (Oxford, England) 1988 Apr; vol 8 (issue 2): pp 181-91

2.
The objective of this paper was to study the effect of sympathetic innervation on morphological and histochemical aspects of skeletal muscle tissue. Rabbit masseter muscle was studied using histochemical and immunohistochemical methods for periods of up to 18 months post-sympathectomy. The morphological and enzymatic characteristics of control masseter muscles were similar on both the left and right sides. The main features were muscle fibres with a mosaic pattern and a predominance of type IIa fibres, followed by type I. Type IIb fibres showed very low frequency. Sympathectomized animals showed varying degrees of metabolic and morphological alterations, especially 18 months after sympathectomy. The first five groups showed a higher frequency of type I fibres, whilst the oldest group showed a higher frequency of type IIb fibres. In the oldest group, a significant variation in fibre diameter was observed. Many fibres showed small diameter, atrophy, hypertrophy, splitting, and necrosis. Areas with fibrosis were observed. Thus cervical sympathectomy induced morphological alterations in the masseter muscles. These alterations were, in part, similar to both denervation and myopathy.

International Journal of Experimental Pathology
Volume 82, Issue 2, pages 123–128, April 2001

decrease of hyperhidrosis in the zones regulated by mental or emotional stimuli

Redistribution of perspiration as reported by the patients comprised significant reductions in palmar and axillary hyperhidrosis, and an increase in the zone of the trunk and popliteal region. The incidence of plantar anhydrosis and plantar hypohidrosis was 30.3% and 20.7%, respectively (p < 0.001). Conclusions: EBTS is followed by redistribution of body perspiration, with, and important, plantar anhydrosis and hypohidrosis. Although EBTS is the standard treatment for palmar primary hyperhidrosis, we must continue studying baseline sympathetic activity in patients affected by primary hyperhidrosis and the neuroanatomy of the sympathetic system to understand the redistribution of sweating and decrease of hyperhidrosis in the zones regulated by mental or emotional stimuli.
European Journal of Cardio-Thoracic Surgery, Volume 36, Issue 2, August 2009, Pages 360-363

Recurrent sweating occurred in 17.6% of patients

The overall mean patient satisfaction rate was 78%, with a median 80% improvement on a visual analog scale from 0% (poor) to 100% (excellent). Overall, 88 patients (96.7%) developed compensatory hyperhidrosis, with the mean initial occurrence at 8.2 weeks. The symptoms of compensatory hyperhidrosis progressively worsened to the maximum degree within another 2 weeks after onset (mean 10.3 ± 1.83 weeks). In 19 patients (21.6%), symptoms of compensatory hyperhidrosis improved spontaneously within 3 months after sympathectomy (mean 13.3 weeks). Postoperative compensatory hyperhidrosis occurred in 71.4% of patients within the 1st year. Recurrent sweating occurred in only 17.6% of patients. None of these patients required repeated operation. The earliest onset of recurrent sweating was noted at 2 weeks postoperatively by three patients, and the mean initial postoperative reccurrence was 32.7 weeks after surgery.
http://thejns.org/doi/abs/10.3171/spi.2005.2.2.0151

Young woman dies after a 'routine' operation

A 'fit and healthy' young woman was left brain dead after a pioneering operation to reduce her excessive sweating went catastrophically wrong, a medical panel has heard.

Louise Field, 27, suffered severe brain damage when doctors accidentally punctured her lung and pumped gas into her stomach, the General Medical Council heard. She died two days later.

Mr Ormiston accidentally punctured her lung during the procedure, causing her oxygen levels to dip fatally. Dr Yanny allegedly failed to tackle the situation properly as the GMC hearing was told he “knew, or ought to have known” that brain damage was inevitable as he pumped Louise full of drugs to try to reverse the condition.

When the young Midland woman was rushed to another hospital, it was claimed Dr Yanny gave no indication she might have neurological problems – likely to have been caused due to a lack of oxygen.

He was also accused of failing to inform the specialist registrar at Hemel Hempstead General Hospital about drugs given, or even provide a simple anaesthetic chart.

Mr Ormiston admitted making inaccurate records after the operation and was slammed by the GMC panel for “significant departures from good medical practice”.

But he was still cleared of serious misconduct and it was decided that his fitness to practise was not impaired.

Dr Yanny managed to keep his job after offering a series of “undertakings”.

http://www.sundaymercury.net/news/midlands-news/2010/06/20/newport-parents-speak-about-tragic-loss-of-beautiful-daughter-66331-26685674/2/

results of ETS deteriorate and compensatory sweating does not improve with time

Our findings indicate that results of ETS deteriorate and compensatory sweating does not improve with time. It is mandatory to inform patients of the potential long-term adverse effects before surgery.
10-YEAR FOLLOW-UP OF ENDOSCOPIC THORACIC SYMPATHECTOMY
G. Somuncuoglu, T. Walles, V. Steger, S. Veit, G. Friedel
Schillerhoehe Hospital, Gerlingen, Germany
2008;7:147-200 Interact CardioVasc Thorac Surg

hand, which may become hyperkeratotic, with fissuring and scaling

Sympathectomy for palmar hyperhidrosis is effective, but has risks associated with surgery and a permanent non-sweating hand, which may become hyperkeratotic, with fissuring and scaling.

The autonomic nervous system: an introduction to basic and clinical concepts

By Otto Appenzeller, Emilio Oribe

Post-sympathectomy neuralgia: hypotheses on peripheral and central neuronal mechanisms

Post-sympathectomy neuralgia is proposed here to be a complex neuropathic and central deafferentation/reafferentation syndrome dependent on: (a) the transection, during sympathectomy, of paraspinal somatic and visceral afferent axons within the sympathetic trunk; (b) the subsequent cell death of many of the axotomized afferent neurons, resulting in central deafferentation; and (c) the persistent sensitization of spinal nociceptive neurons by painful conditions present prior to sympathectomy. Viscerosomatic convergence, collateral sprouting of afferents, and mechanisms associated with sympathetically maintained pain are all proposed to be important to the development of the syndrome.

Author Keywords: Deafferentation; Central sensitization; Viscero-somatic convergence; Ectopic discharge; Sympathetically maintained pain

Pain
Volume 64, Issue 1, January 1996, Pages 1-9

Ectopic discharge in injured nerves: comparison of trigeminal and somatic afferent

Brain Research
Volume 579, Issue 1, 1 May 1992, Pages 148-151