Paresthetic discomfort distinguishable from wound pain was described by 17 patients (50.0%). The most common descriptions were of ‘bloating’ (41.2%), ‘pins and needles’(35.3%), or ‘numbness’ (23.5%) in the chest wall. The paresthesia resolved in less than two months in 12 patients (70.6%), but was still felt for over 12 months in three patients (17.6%). Post-operative paresthesia and pain did not impact on patient satisfaction with the surgery, whereas compensatoryhyperhidrosis in 24 patients (70.6%) did (P=0.001). The rates and characteristics of the paresthesia following needlescopic VATS are similar to those observed after conventional VATS. Conclusions: Chest wall paresthesia affects a significant but previously overlooked proportion of patients following needlescopic VATS.
Eur J Cardiothorac Surg 2005;27:313-319
although producing no alterations in the thermal balance, does produce abnormalities in quantitative distribution of thermoregulatory sweating
JNS - Journal of Neurosurgery -: "The data demonstrate that the surgical removal of both the T-2 and the T-3 ganglia, although producing no alterations in the thermal balance, does produce abnormalities in quantitative distribution of thermoregulatory sweating in man."
the severity of post-sympathectomy (post-SE) dysfunction is unpredictable
"The aim of this study was to identify retrospectively, lumbar sympathectomy (SE) using thermography (TG) and to evaluate clinically, the severity of post-sympathectomy (post-SE) dysfunction after anterior and lateral lumbar interbody fusion procedures (ALIF, XLIF).
METHODS:
Twenty eight patients with suspected SE were referred for TG to both legs. They completed our questionnaire on severity of difficulties after SE. We evaluated the ability of physical examinations to reveal the SE in contrast to TG and compared the symptoms (warmer leg and inhibited leg sweating) of SE with questionnaire responses as subjective measure and TG as objective measure.
RESULTS:
SE was diagnosed in 0.5% after ALIF at L5/S1, in 15% after ALIF at Th12-L5 and in 4% after XLIF at T12-L5. SE severely reduced the quality of life in two cases. The ability to distinguish differences in leg temperature by palpation after SE was found in 32%. All physical examinations together were insufficient for reliably disclosing SE. Subjective symptoms of SE were often false positive and proven SE by TG was often a clinically false negative.
CONCLUSION:
This is the first study to examine post-SE dysfunction objectivelya using TG after ALIF and XLIF, and the first to evaluate clinically, the severity of the post-SE syndrome. Before surgery we cannot foresee potentially poor SE results. For this reason, injury to the sympathetic chain during surgery must be avoided. The advantage of TG for identifying SE is its non-invasiveness and reliability.
http://www.ncbi.nlm.nih.gov/pubmed/24263213"
METHODS:
Twenty eight patients with suspected SE were referred for TG to both legs. They completed our questionnaire on severity of difficulties after SE. We evaluated the ability of physical examinations to reveal the SE in contrast to TG and compared the symptoms (warmer leg and inhibited leg sweating) of SE with questionnaire responses as subjective measure and TG as objective measure.
RESULTS:
SE was diagnosed in 0.5% after ALIF at L5/S1, in 15% after ALIF at Th12-L5 and in 4% after XLIF at T12-L5. SE severely reduced the quality of life in two cases. The ability to distinguish differences in leg temperature by palpation after SE was found in 32%. All physical examinations together were insufficient for reliably disclosing SE. Subjective symptoms of SE were often false positive and proven SE by TG was often a clinically false negative.
CONCLUSION:
This is the first study to examine post-SE dysfunction objectivelya using TG after ALIF and XLIF, and the first to evaluate clinically, the severity of the post-SE syndrome. Before surgery we cannot foresee potentially poor SE results. For this reason, injury to the sympathetic chain during surgery must be avoided. The advantage of TG for identifying SE is its non-invasiveness and reliability.
http://www.ncbi.nlm.nih.gov/pubmed/24263213"
most of the existing literature is geared towards assessing only the effectiveness of the surgical sympathectomy
"Given the fact that most of the existing literature is geared towards a) assessing only the effectiveness of the surgical sympathectomy procedures, and b) publishing only studies with positive results, adverse effects and complications are not systematically reported but rather as a secondary outcome. It seems, therefore, highly likely that the complications as reported here, are truly underestimated.
The study indicates that surgical sympathectomy, irrespective of operative approach and indication, may be associated with many and potentially serious complications."
Are We Paying a High Price for Surgical Sympathectomy? A Systematic Literature Review of Late Complications
http://www.jpain.org/article/S1526-5900%2800%2944124-6/abstract
The study indicates that surgical sympathectomy, irrespective of operative approach and indication, may be associated with many and potentially serious complications."
Are We Paying a High Price for Surgical Sympathectomy? A Systematic Literature Review of Late Complications
http://www.jpain.org/article/S1526-5900%2800%2944124-6/abstract
33% of patients reported compensatory hyperhidrosis that was either 'severe' or 'incapacitating'
Endoscopic thoracic sympathectomy for primary hyperhidrosis of the...IPG487 Safety: "Compensatory hyperhidrosis was reported in 92% (416/453), 86% (1720/2000) and 74% (1265/1700) of patients in 3 case series. In 2 of these studies 33% (557/1700 and 150/453) of patients reported compensatory hyperhidrosis that was either 'severe' or 'incapacitating'."
"He knows the procedure is controversial because of the unpredictability of side-effects"
Information about surgery for sweaty hands: surgeon "knows the procedure is controversial because of the unpredictability of side-effects"
"Ferrar believes much of the controversy lies in surgeons, mainly in America, who perform the surgery on anyone who asks for it, rather than the severe end of the spectrum.
"In America there are so many that have been operated on when it hasn't been necessary, or the surgeon has given the patient false expectations, that there are support groups for people who've had complications or adverse effects. The people that come to me are almost self-selecting; they've tried everything else."
The youngest patient he has performed an endoscopic thoracic sympathectomy on was 8 years old, with most being in puberty (when the condition tends to arise). Or they are in their 20s when they are beginning relationships and jobs."
Publication info: Waikato Times [Hamilton, New Zealand] 07 Apr 2012: 22."
"Ferrar believes much of the controversy lies in surgeons, mainly in America, who perform the surgery on anyone who asks for it, rather than the severe end of the spectrum.
"In America there are so many that have been operated on when it hasn't been necessary, or the surgeon has given the patient false expectations, that there are support groups for people who've had complications or adverse effects. The people that come to me are almost self-selecting; they've tried everything else."
The youngest patient he has performed an endoscopic thoracic sympathectomy on was 8 years old, with most being in puberty (when the condition tends to arise). Or they are in their 20s when they are beginning relationships and jobs."
Publication info: Waikato Times [Hamilton, New Zealand] 07 Apr 2012: 22."
Chest pain, chest hypersensitivity, arm pain, paraesthesias of the upper limb and the thoracic wall, and recurrent pain in the axillary region have all been described
"Chest pain, chest hypersensitivity, arm pain, paraesthesias of the upper limb and the thoracic wall, and recurrent pain in the axillary region have all been described. Intra-operative intrapleural analgesia using bupivacaine can help reduce postoperative pain. Using a 5 mm rather than 1cm post causes less postoperative discomfort, particularly in women with narrow intercostal spaces."
Complications in Vascular and Endovascular Surgery: How to avoid them and how to get out of trouble
Jonothan J Earnshaw, Michael Wyatt,
tfm Publishing Limited, Jan 1, 2012 - Medical - 318 pages
Complications in Vascular and Endovascular Surgery: How to avoid them and how to get out of trouble
Jonothan J Earnshaw, Michael Wyatt,
tfm Publishing Limited, Jan 1, 2012 - Medical - 318 pages
Sympathectomy is by no means a benign procedure, and sympathectomy for sweating can induce pain and allodynia
"As to sympathetic block, or sympathectomy, Seddon (1964) when writing of acute ischaemia said 'let us hope that the completely futile sympathetic block will not have been done'. Birnstingl (1982), vascular surgeon to the Royal National Orthopaedic Hospital for some years, said 'sympathetic block is useless'; sympathectomy has no place in the treatment of acute ischaemia..." (p. 308)
"Sympathectomy is by no means a benign procedure, and sympathectomy for sweating can induce pain and allodynia at the border zone which is sometimes associated with pronounced increase in sweating in that area." (p. 534) Surgical Disorders of the Peripheral Nerves by Rolfe Birch Springer, Jan 21, 2011 - Medical - 512 pages original article published in Ann R Coll Surg Engl 2002; 84:181-184"
"Sympathectomy is by no means a benign procedure, and sympathectomy for sweating can induce pain and allodynia at the border zone which is sometimes associated with pronounced increase in sweating in that area." (p. 534) Surgical Disorders of the Peripheral Nerves by Rolfe Birch Springer, Jan 21, 2011 - Medical - 512 pages original article published in Ann R Coll Surg Engl 2002; 84:181-184"
peripheral sympathectomy causes a dramatic increase in NGF levels in the denervated organs
Increased Nerve Growth Factor Messenger RNA and Protein
Peripheral NGF mRNA and protein levels following
sympathectomy
It has been shown previously that peripheral sympathectomy
causes a dramatic increase in NGF levels in the denervated
organs (Yap et al., 1984; Kanakis et al., 1985; Korsching and
Thoenen, 1985).
Increased ,&Nerve Growth Factor Messenger RNA and Protein
Levels in Neonatal Rat Hippocampus Following Specific Cholinergic
Lesions
Scott R. Whittemore,” Lena Liirkfors,’ Ted Ebendal,’ Vicky R. Holets, 2,a Anders Ericsson, and HBkan Persson
Departments of Medical Genetics and’ Zoology, Uppsala University, S-751 23 Uppsala, Sweden, and *Department of
Histology, Karolinska Institute, S-104 01 Stockholm, Sweden
sympathectomy
It has been shown previously that peripheral sympathectomy
causes a dramatic increase in NGF levels in the denervated
organs (Yap et al., 1984; Kanakis et al., 1985; Korsching and
Thoenen, 1985).
Increased ,&Nerve Growth Factor Messenger RNA and Protein
Levels in Neonatal Rat Hippocampus Following Specific Cholinergic
Lesions
Scott R. Whittemore,” Lena Liirkfors,’ Ted Ebendal,’ Vicky R. Holets, 2,a Anders Ericsson, and HBkan Persson
Departments of Medical Genetics and’ Zoology, Uppsala University, S-751 23 Uppsala, Sweden, and *Department of
Histology, Karolinska Institute, S-104 01 Stockholm, Sweden
Stratified analysis of clinical outcomes in ... [Ann Thorac Surg. 2008] - PubMed - NCBI
"Significant compensatory sweating in relation to the level(s) of sympathetic chain division occurred in T2 alone, 45%; T2 to T3, 30%; T3 to T4, 14%; T2 to T4, 38%; and more than three levels, 49%"
Ann Thorac Surg. 2008 Feb;85(2):390-3;
http://www.ncbi.nlm.nih.gov/pubmed/18222231
Ann Thorac Surg. 2008 Feb;85(2):390-3;
http://www.ncbi.nlm.nih.gov/pubmed/18222231
Surprisingly, many patients experienced mild recurrent symptoms within the first year
Sympathicotomy for isolated facial blushing:... [Ann Thorac Surg. 2012] - PubMed - NCBI: "Mild recurrence of facial blushing occurred in 30% of patients within the first year. One patient experienced Horner's syndrome. Compensatory sweating occurred in 93% of patients, gustatory sweating 36%, and dry hands in 66%; 13% of patients regretted the operation despite thorough preoperative selection and information."
Patients who undergo sympathotomy for hyperhidrosis will commonly report "clinically bothersome" compensatory hyperhidrosis.
J Thorac Cardiovasc Surg. 2014 Apr;147(4):1160-1163.e1. doi: 10.1016/j.jtcvs.2013.12.016. Epub 2014 Jan 2.
ETS is not without its critics
"ETS is not without its critics. Like any major surgical procedure, there is an operative risk, with a prominent fatality in Dublin a few years ago. Homer's syndrome can result. The most common problem is the development of 'compensatory hyperhidrosis', usually on the back. In 2003, ETS was banned in its birthplace, Sweden, due to overwhelming complaints by disabled patients."
Enabling freedom from hyperhidrosis
O'Keeffe, John. Irish Medical Times
48.12 (Apr 4, 2014): 31.
48.12 (Apr 4, 2014): 31.
"The custom of a majority is no guarantee of safety and is seldom a guide to best medical practice." in Legal Forum
"The custom of a majority is no guarantee of safety and is seldom a guide to best medical practice." in Legal Forum: "Cameron`s claim that there has been only one death attributable to synchronous bilateral thoracoscopic sympathectomy is implausible. Surgeons and anaesthetists are reticent in publicizing such events and Civil Law Reports of settled cases are an inadequate measure of the current running total. The custom of a majority is no guarantee of safety and is seldom a guide to best medical practice.
Jack Collin,
Consultant Surgeon
Oxford
http://www.bmj.com/content/320/7244/1221?tab=responses"
Jack Collin,
Consultant Surgeon
Oxford
http://www.bmj.com/content/320/7244/1221?tab=responses"
Peripheral neuropathy gives reduced sensation and sweat ability of the arms and legs but can lead to compensatory sweating of the trunk and head.
Google Translate:
http://www.svettmottagningen.se/information-till-sjukvarden/hyperhidros
Peripheral neuropathy gives reduced sensation and sweat ability of the arms and legs but can lead to compensatory sweating of the trunk and head.
Horner's syndrome due sympatikusskada means, for example Anhidrosis on one half of the face which can then be followed by compensatory hyperhidrosis on the other side. Harlequin syndrome is another name in the same condition in which instead focuses on the color difference where the sympatikusskadade page turns white and the other side is red with exertion. The look can then recall a home to Harelquin.
Freys'syndrom arise after salivary gland surgery faulty growing parasympathetic salivary fibers innervate the sweat glands in the cheek. This means that when the patient eats or even just thinking about food so producing a profuse perspiration from his cheek
Sympathectomy was common in the 90s in Sweden. At indications palmar and axillary hyperhidrosis, redness, or social phobia, burned the thoracic sympathetic ganglia endoscopically. Compensatory hyperhidrosis developed below the nipples of a large number of patients 1-6 months after sympatektomin.
http://www.svettmottagningen.se/information-till-sjukvarden/hyperhidros
This is the first study to examine post-SE (post-sympathectomy) dysfunction objectively
This is the first study to examine post-SE dysfunction objectively using TG after ALIF and XLIF, and the first to evaluate clinically, the severity of the post-SE syndrome. Before surgery we cannot foresee potentially poor SE results. For this reason, injury to the sympathetic chain during surgery must be avoided. The advantage of TG for identifying SE is its non-invasiveness and reliability.
The aim of this study was to identify retrospectively, lumbar sympathectomy (SE) using thermography (TG) and to evaluate clinically, the severity of post-sympathectomy (post-SE) dysfunction after anterior and lateral lumbar interbody fusion procedures (ALIF, XLIF).
http://www.ncbi.nlm.nih.gov/pubmed/24263213
The aim of this study was to identify retrospectively, lumbar sympathectomy (SE) using thermography (TG) and to evaluate clinically, the severity of post-sympathectomy (post-SE) dysfunction after anterior and lateral lumbar interbody fusion procedures (ALIF, XLIF).
http://www.ncbi.nlm.nih.gov/pubmed/24263213
Sympathectomy a psychosurgery?
Financial Review - News Store: "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.""
'via Blog this'
'via Blog this'
Dr. Telaranta treating fear, stuttering, stage fright, blushing with sympathectomy. Is ETS a psychosurgery?
Dr. Telaranta | Blog by Dr. Telaranta: "As a treatment, sympathetic blocking could be effective. Fortunately one can test whether it’ll have an effect, to a pretty high level of certainty, by first administering a temporary block t. Sympathetic block is usually effective in reducing all types of fear, why not also in reducing the fear of stuttering.
Sympathetic block typically has the highest likelihood of effective results on both schizophrenia and tremor when fear or anxiety plays a significant part in the onset of symptoms. It is also very effective in treating social phobia, stage fright and blushing. A stage fright-like fear of public presentations is likely common amongst those who stutter."
http://www.sympatix.fi/blog/?lang=en_
Sympathetic block typically has the highest likelihood of effective results on both schizophrenia and tremor when fear or anxiety plays a significant part in the onset of symptoms. It is also very effective in treating social phobia, stage fright and blushing. A stage fright-like fear of public presentations is likely common amongst those who stutter."
http://www.sympatix.fi/blog/?lang=en_
sympathectomy, by chemical or surgical means, is based on such anecdotal observation and small case studies which have failed to stand up to scientific scrutiny
Clinical trials do exist and their inability to demonstrate effectiveness suggests an obvious conclusion: the argument for sympathectomy, by chemical or surgical means, is based on such anecdotal observation and small case studies which have failed to stand up to scientific scrutiny. To date there are no reproducible, blinded, randomized studies utilizing control populations which have demonstrated a benefit to sympathetic blockade in CRPS.
DISABILITY MEDICINE, The Official Periodical of the American Board of Independent Examiners,
Vol. 5 No. 3-4 July - December 2005
www.abime.org/documents/
DISABILITY MEDICINE, The Official Periodical of the American Board of Independent Examiners,
Vol. 5 No. 3-4 July - December 2005
www.abime.org/documents/
Following a peripheral nerve injury, a sterile inflammation develops in sympathetic and dorsal root ganglia
Following a peripheral nerve injury, a sterile inflammation develops in sympathetic and dorsal root ganglia (DRGs) with axons that project in the damaged nerve trunk. Macrophages and T-lymphocytes invade these ganglia where they are believed to release cytokines that lead to hyperexcitability and ectopic discharge, possibly contributing to neuropathic pain. Here, we examined the role of the sympathetic innervation in the inflammation of L5 DRGs of Wistar rats following transection of the sciatic nerve, comparing the effects of specific surgical interventions 10-14days prior to the nerve lesion with those of chronic administration of adrenoceptor antagonists. Immunohistochemistry was used to define the invading immune cell populations 7days after sciatic transection. Removal of sympathetic activity in the hind limb by transecting the preganglionic input to the relevant lumbar sympathetic ganglia (ipsi- or bilateral decentralization) or by ipsilateral removal of these ganglia with degeneration of postganglionic axons (denervation), caused less DRG inflammation than occurred after a sham sympathectomy. By contrast, denervation of the lymph node draining the lesion site potentiated T-cell influx. Systemic treatment with antagonists of α1-adrenoceptors (prazosin) or β-adrenoceptors (propranolol) led to opposite but unexpected effects on infiltration of DRGs after sciatic transection. Prazosin potentiated the influx of macrophages and CD4+ T-lymphocytes whereas propranolol tended to reduce immune cell invasion. These data are hard to reconcile with many in vitro studies in which catecholamines acting mainly via β2-adrenoceptors have inhibited the activation and proliferation of immune cells following an inflammatory challenge.
Auton Neurosci. 2013 Dec 23.
http://www.ncbi.nlm.nih.gov/pubmed/24418114
Auton Neurosci. 2013 Dec 23.
http://www.ncbi.nlm.nih.gov/pubmed/24418114
Surgical sympathectomy is rarely performed and its use remains controversial
Although improved in some, persistent or recurrent symptoms were present in all patients after six months postoperatively. Increased sensitivity of digital vessels to circulating catecholamines, nerve fiber regeneration or incomplete sympathectomy have been postulated to lead to recurrence. Five patients developed Horner's syndrome postoperatively. A portion of the stellate ganglion was intentionally resected in 3 of the 5 patients.
http://www.ncbi.nlm.nih.gov/pubmed/8370999
http://www.ncbi.nlm.nih.gov/pubmed/8370999
prolongation of the isometric (tension) period (TP) of the left ventricle occurred in the majority (72 per cent) of all cases after sympathectomy
The prolongation of the isometric (tension) period (TP) of the left ventricle which occurred in the majority (72 per cent) of all cases after unilateral or bilateral transthoracic sympathectomy (without or with unilateral or bilateral transthoracic splanchnicotomy) indicates a diminution of inotropic cardiac action. It can be assumed to correspond to the cholinergic (vagal) preponderance which results from a partial or complete sympathetic denervation of the heart. Reduction of the pulse pressure oc-
curred in 56 per cent of the cases, probably due to the same mechanism.
www.chestjournal.org/content/38/4/423.full.pdfby W RAAB - 1960
www.chestjournal.org/content/38/4/423.full.pdfby W RAAB - 1960
change in sympathetic nervous system activity after thoracic sympathectomy
The photoplethysmographic (PPG) signal, which measures cardiac-induced changes in tissue blood volume by light transmission measurements, shows spontaneous fluctuations. In this study, PPG was simultaneously measured in the right and left index fingers of 16 patients undergoing thoracic sympathectomy, and, from each PPG pulse, the amplitude of the pulse (AM) and its maximum (BL) were determined. The parameter AM/BL is proportional to the cardiac-induced blood volume increase, which depends on the arterial wall compliance. AM/BL increased after the thoracic sympathectomy treatment (for male patients, from 2.60±1.49% to 4.81±1.21%), as sympathetic denervation decreases arterial tonus in skin. The very low-frequency (VLF) fluctuations of BL or AM showed high correlation (0.90±0.11 and 0.92±0.07, respectively) between the right and left hands before the thoracic sympathectomy, and a significant decrease in the right-left correlation coefficient (to 0.54±0.22 and 0.76±0.20, respectively) after the operation. The standard deviation of the BL or AM VLF fluctuations also reduced after the treatment, indicating sympathetic mediation of the VLF PPG fluctuations. The study also shows that the analysis of the PPG signal and the VLF fluctuations of the PPG parameters enable the assessment of the change in sympathetic nervous system activity after thoracic sympathectomy.
2001, Volume 39, Issue 5, pp 579-583
http://link.springer.com/article/10.1007%2FBF02345149
2001, Volume 39, Issue 5, pp 579-583
http://link.springer.com/article/10.1007%2FBF02345149
The graph shows an overall shorter survival rate of sympathectomised rats
Results
Graph 1 shows the survival rate in both sympathectomised and non sympathectomised rats after the administration of YA cells. The graph shows an overall shorter survival rate of sympathectomised rats. In both groups there is a steep decrease in survival after 15 days, causing the median survival rate (18 days) of both groups to overlap. On the other hand the net survival rate is increased in non sympathectomised rates by 6 days
References:
1. Ewa Chelmicka – Szorc, Barry G. W. Arnason. Effect of 6-Hydroxydopamine on Tumor Growth. CANCER RESEARCH 1976, 36, 2382-2384.
2. Boris Mravec, Neurobiológia chorôb periférnych tkanív, Bratislava, SAP 2008, 220 s., ISBN 978-80-8095-030-9
3. Raju B, Haug SR, Ibrahim SO, Heyeraas KJ. Sympathectomy decreases size and invasiveness of tongue cancer in rats. Neuroscience. 2007;149(3):715-25.
4. Mravec B ,Gidron Y,Hulin I. Neurobiology of cancer: Interactions between nervous, endocrine
and immune systems as a base for monitoring and modulating the tumorigenesis by the brain. Seminars in Cancer Biology 18 (2008) 150–163.
5. Paul G. Green,Wilfrid Janig, Jon D. Levinel. Negative Feedback Neuroendocrine Control of Inflammatory Response in the Rat is Dependent on the Sympathetic Postganglionic Neuron. The Journal of Neuroscience, 1997, 17(8):3234 –3238
6. Aparna A. Bhanushali , R. Raghunathan , Rajiv D. Kalraiya , Narendra G. Mehta. Cancer-related anemia in a rat model: α2-macroglobulin from Yoshida sarcoma shortens erythrocyte survival. European Journal of Haematology 2002. 68(1),42 - 48
The effect of sympathectomy on the growth of intraperitoneally administered Yoshida ascitic cells in rats
El-Hassoun Olia, Coauthors: Zuzana Valašková, Ivan Hulín
Supervisor: Boris Mravec
Institute of Pathophysiology, LF UK Bratislava
http://svoc.fmed.uniba.sk/abstrakty/48/36.html
Long-term sympathectomy induces sensory and parasympathetic fibres sprouting, and mast cell activation in the rat dura mater
Bergerot, A; Aubineau, P; (1998) Long-term sympathectomy induces sensory and parasympathetic fibres sprouting, and mast cell activation in the rat dura mater. EUR J NEUROSCI , 10 79 - 79.
http://discovery.ucl.ac.uk/1330488/
http://discovery.ucl.ac.uk/1330488/
Lewis rats are much more likely to develop autoimmune disorders after sympathectomy
Lewis rats are much more likely to develop autoimmune disorders after sympathectomy
(Dimitrova and Felten, 1995). This finding suggests that if sympathetic regulation were impaired in a
genetically predisposed individual, an autoimmune disease might develop.
Betrayal by the Brain: The Neurologic Basis of Chronic Fatigue Syndrome, Fibromyalgia Syndrome and Related Neural Network Disorders
by Jay A. Goldstein
published by The Haworth Medical Press, 1996
(Dimitrova and Felten, 1995). This finding suggests that if sympathetic regulation were impaired in a
genetically predisposed individual, an autoimmune disease might develop.
Betrayal by the Brain: The Neurologic Basis of Chronic Fatigue Syndrome, Fibromyalgia Syndrome and Related Neural Network Disorders
by Jay A. Goldstein
published by The Haworth Medical Press, 1996
significant change after sympathectomy: reduced sympathetic and increased vagal tone
The HRV analysis showed a significant change of indices reflecting sympatho-vagal balance indicating significantly reduced sympathetic (LF) and increased vagal (HF, rMSSD) tone. These changes still persisted after 2 years. Global HRV increased over time with significant elevation of SDANN after 2 years. QT dispersion was significantly reduced 1 month after surgery and the dispersion was further diminished 2 years later.
http://www.sciencedirect.com/science/article/pii/S0167527399001011
http://www.sciencedirect.com/science/article/pii/S0167527399001011
"sympathectomy is a form of sensory neurectomy" (p.1500)
Bonica's Management of Pain
Scott Fishman, Jane Ballantyne, James P. Rathmell
|
sympathectomized arteries become more susceptible to lipid accumulation
Combined effect of cholesterol feeding and sympathectomy on the lipid content in rabbit aortas
Volume 37, Issue 4, December 1980, Pages 521–528
Decreased HRV is predictive of adverse cardiovascular outcomes in a variety of disease states
Water immersion-induced skin wrinkling (WISW) is dependent on intact peripheral sympathetic function. WISW was hypothesized to reflect autonomic function in subjects with- out peripheral neuropathy. We prospectively studied 70 healthy subjects (aged 31 88 years, 63% females) without cardiovascular risk factors or neurological disease. All sub- jects underwent short-term heart rate variability (HRV) stud- ies. Time and frequency domain variables were derived in- cluding the HRV index. WISW was graded using a previously validated scale of 1–4 of which 18.6% of subjects exhibited grade 1 (minimal) WISW and 35.7% had grade 2 WISW. On multivariate analysis using the HRV index, WISW was inde- pendently related to height and the HRV index. We conclude that WISW is related to central autonomic function.
Accepted after revision: May 28, 2010 Published online: August 18, 2010
Although the mechanism is not fully understood, WISW is felt to be caused by passive diffusion of water across the stratum corneum into the sweat ducts, which in turn alters electrolyte balance, decreases membrane stabilization, increases sympathetic neural firing and stimulates vasoconstriction [1–3, 8].WISW is decreased in diabetic patients and in patients after cervical sympathectomy [4, 9].
Heart rate variability (HRV) is the beat-to-beat variation in cardiac cycle length due to autonomic influence on the sinus node. Decreased HRV is predictive of adverse cardiovascular outcomes in a variety of disease states[5]. The influence of the central nervous system activity on autonomic function suggests that HRV may be a useful prognostic indicator in patients with cerebrovascular events [6].
Cardiology 2010;116:247–250 DOI: 10.1159/000316043
Received: May 10, 2010
In the Search for the Treatment of Compensatory Sweating
Removal of the clips from the sympathetic trunk does not provide resolution of compensatory sweating in 1 year of observation. T6-9 block does not provide remedy for compensatory hyperhidrosis. Regional abdomino-lumbar iontophoresis seems to be very promising, but further research and followup are mandatory.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3458267/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3458267/
Is sympathectomy (ETS) safe and effective?
Well, it depends on who you ask.
We already know what the surgeons who offer the surgery have to say about it, as most of us was conned into having the surgery. We also know what these surgeons have to say about non-surgical options (ineffective, tedious, time-consuming, expensive, not permanent, resulting in disabling side-effects, very painful, useless - on one website patients are told that application of BOTOX requires general anaesthesia, just to scare them off that one... : http://archive.is/lSWd0 ). The question is answered very differently when you ask a medical professional who offers these non-surgical treatment options. Their advice and their version of FACTS always depends on the treatment and technique they have on offer.
A very simple exercise: print out the texts from few of these websites and offer it to someone to read. Then let them guess what they think which treatment the medical professional is siding with, that is: which treatment is being offered and advertised by them.
Here is a sample. You will most certainly detect that this medical professional is NOT offering ETS, as he selected different FACTS about the procedure and it's results.
and because you can never be safe enough, here is the archived version:
from:
Natural bodily functioning does not include “purely autonomic” or “purely somatic” responses, just as it does not include ‘purely sympathetic” or “purely parasympathetic” responses
Langley initially expected to find afferent cell bodies in autonomic ganglia, with projections to other ganglia. He believed that activation of these “autonomic afferents” should lead to purely autonomic responses. However Langley’s own careful work demonstrated that there were no such neurons.
The fundamentally important point is that integrative processes responsible for the organization of visceral function occur principally within the central nervous system (brain and/or spinal cord). Both somatic and visceral afferents result in complex, brain mediated, responses that include somatic and visceral function. Autonomic motor activity can be generated by both somatic and visceral inputs to the CNS, and visceral inputs to the CNS initiate responses that are both somatic and autonomic. Natural bodily functioning does not include “purely autonomic” or “purely somatic” responses, just as it does not include ‘purely sympathetic” or “purely parasympathetic” responses.
Bill Blessing and Ian Gibbins (2008), Scholarpedia, 3(7):2787.
revision #46085 [link to/cite this article]
Curator: Dr. Bill Blessing, Centre for Neuroscience, Flinders University, Adelaide, AUSTRALIA
there are three main conditions which could impair the autonomy of a patient's medical decision: insufficient information, irrational beliefs/desires, and influence of different framing effects
http://onlinelibrary.wiley.com/doi/10.1111/j.1467-8519.2012.01973.x/abstract
Postsympathectomy pain of such severity that parenteral narcotics afforded no relief
Fifty-six consecutive patients who subsequently underwent ninety-six lumbar sympathectomies were studied prospectively with regard to the development of postoperative pain. Pain after operation was observed in thirty-four extremities by twenty-five of the patients (35 per cent). It began abruptly an average of twelve days after operation and was often accentuated nocturnally. The pain was almost always described as a deep, dull ache and persisted two to three weeks before spontaneously remitting. Postsympathectomy pain of such severity that parenteral narcotics afforded no relief developed in two of these fifty-six patients and in nine additional patients. Treatment with carbamazepine produced dramatic reduction in the intensity of pain in seven of these nine patients within twenty-four hours after the institution of therapy. Two patients were given intravenous diphenylhydantoin and both experienced immediate relief of pain. The mechanisms of the syndrome and of the action of these drugs are uncertain.
Systemic therapy with glycopyrrolate or clonidine can be effective for HH. Nearly two-thirds responded to therapy, and less than a quarter had treatment-limiting adverse effects, all of which were self-limited and nonserious
J Am Acad Dermatol. 2012 Mar;66(3):387-92. doi: 10.1016/j.jaad.2011.01.023. Epub 2011 Aug 4.
http://www.ncbi.nlm.nih.gov/pubmed/21820204
A randomized placebo-controlled trial of oxybutynin for the initial treatment of palmar and axillary hyperhidrosis
Palmar and axillary hyperhidrosis improved in >70% of the patients, and 47.8% of those presented great improvement. Plantar hyperhidrosis improved in >90% of the patients. Most patients (65.2%) showed improvements in their quality of life. The side effects were minor, with dry mouth being the most frequent (47.8%).
Journal of Vascular Surgery, Volume 55, Issue 6, June 2012, Pages 1696-1700
Long-term efficiency? 40% affirmed they would ask for the operation if it were to be redone, 53% recurrence
At an average 12 years after surgery, 47% of patients were satisfied with the treatment results, 40% were disappointed.
53% complaining about a decent to moderate recurrence of hand sweating and compensatory and gustatory sweating were observed in 9 (60%) and 5 (33%) patients, respectively.
Interact CardioVasc Thorac Surg (2009) 8 (1): 54-57.
53% complaining about a decent to moderate recurrence of hand sweating and compensatory and gustatory sweating were observed in 9 (60%) and 5 (33%) patients, respectively.
Only 56% would recommend thoracoscopic sympathectomy to others with hyperhydrosis
http://www.ncbi.nlm.nih.gov/pubmed/21539945
"return of sweating in the hands is common occurrence in patients followed up for sufficient length of time "
Annals of the Royal College of Surgeons of England (1989) vol. 7.1
Neuralgia due to sympathectomy
Depending on the skill of the surgeon and difficulty encountered performing various intraoperative maneuvers, the incidence of complications following sympathectomy should be the same as that following any other extraperitoneal or extrapleural operation. However, a frequent complication following sympathectomy, and one which is apparently unrelated to operative technique, is that of postsympathectomy neuralgia.
This neuralgia is characterized by aching thigh pain after lumbar sympathectomy or aching shoulder and arm pain after cervical sympathectomy. The pain is intense in severity, sudden in onset and disappearance, and not related to any major neurologic manifestations.
Recently we have reviewed the files of the Vascular Surgical Service at the West Roxbury Veteran's Hospital and the literature on this condition. This report is a presentation of our findings.
Incidence Pain following sympathectomy has been described as "an all too common complaint."8 Reports have varied in incidence from 2.1% to "practically every case."
http://archsurg.jamanetwork.com/article.aspx?articleid=560162
Autonomic neuropathy in the skin following sympathectomy
In diabetics with the anhidrotic syndrome, autonomic nerve fibres were studied in skin biopsies using argentic techniques and light microscopy. The Minor test was used to differentiate normal from anhidrotic skin areas. In the anhidrotic areas, histology of the nerve fibres showed beading, spindle-shaped thickening and fragmentation adjacent to the sweat glands. These changes were similar to those observed in two patients who had previously undergone lumbar sympathectomy. No abnormalities of the sympathetic nerve endings could be found in biopsies taken from normal areas of the forearm of the same patients. We conclude that the diabetic anhidrotic syndrome, a form of diabetic autonomic neuropathy, is due to a lesion of the sympathetic nerve supply to the skin.
I. Faerman1, E. Faccio3, I. Calb2, J. Razumny1, N. Franco2, A. Dominguez2 and H. A. Podestá1
Endoscopic sympathectomy is not minimally invasive
The term ‘‘minimally invasive surgery’’ was initially applied to coelioscopic procedures such as laparoscopic cholecystectomy and hernia repair, thoracoscopic sympathectomy, and arthroscopy, but has since been abandoned, because doing the same operation through a smaller incision is not necessarily less invasive. The term ‘‘minimally invasive parathyroidectomy’’ does not fully convey the nature of the techniques, and, as previously debated in the wider field of minimal-access surgery, carries connotations of increased safety that are not necessarily supported by the existing data [12].
Surg Clin N Am 84 (2004) 717–734
F. Fausto Palazzo, MS, FRCS(Gen),
Leigh W. Delbridge, MD, FACS*
Department of Surgery, Royal North Shore Hospital, Sydney 2065, NSW, Australia
Leigh W. Delbridge, MD, FACS*
Department of Surgery, Royal North Shore Hospital, Sydney 2065, NSW, Australia
Endoscopic thoracic sympathectomy remains a fairly controversial procedure
Studies by ETS surgeons have claimed an initial satisfaction rate around 85-95% with at least 2%-19% regretting the surgery and up to 51% of the patients complaining about decreased quality of life. However, at least one study shows a satisfaction rate as low as 28.6.
Most patients report various adverse reactions as a result of the surgery. And, whilst the results of endoscopic thoracic sympathectomy might appear moderately successful in treating hyperhidrosis, there is a high risk of complications.
Along with the normal side effects of surgery, such as pain, bleeding and bruising, the most frequent post surgical complication is ‘compensatory hyperhidrosis’ – where excessive sweating in seen another part of the body as a result, most commonly the lower back or upper thighs.
There is also the potential surgical complication of a pneumothorax, where air becomes trapped between the lung and the internal chest wall, making breathing difficult and painful. Whilst this can be a life-threatening condition, if not too large it generally resolves over time with out further surgical intervention.
Other fairly common complications of endoscopic thoracic sympathectomy include:
Rhinitis - inflammation of the nose and
Gustatory sweating - sweating on the face and neck after eating food,
Rarer complications of endoscopic thoracic sympathectomy as a result of nerve damage include:
Damage to the phrentic nerve. – Phrentic nerve damage can lead to long term shortness of breath, repair of the nerve during the surgery is also possible in some cases..
Horner’s syndrome, - a condition that causes drooping of the eyelids.
Endoscopic thoracic sympathectomy remains a fairly controversial procedure; with advocates claiming high success rates and minimal complications when performed correctly, whilst opponents report huge variation in post operation satisfaction levels and poor consistency in the surgical procedure as a result of anatomical variations in the sympathetic nerve network between patients and personal preferences between doctors.
http://www.lasertreatmentclinics.co.uk/Hyperhidrosis_Endoscopic_Sympathectomy/
This is how "Australia’s leading source for trustworthy medical information" describes sympathectomy
| "Sympathectomy is a procedure that is used to treat neuropathic pain. It interrupts the sympathetic nervous system either temporarily or permanently." |
Australia’s leading source for trustworthy medical information written by health professionals.
Please be aware that we do not give advice on your individual medical condition,
if you want advice please see your treating physician.
Virtual Medical Centre © 2002 - 2013 | Privacy Policy Last updated 8 Aug 2013
|
progressive hemifacial atrophy following sympathectomy for hyperhidrosis
Some authors consider the disease a variant of mor- phea because the histologic changes are identical to deep scleroderma.2 The possible etiologies include sympathetic denervation, trauma, vascular malformations, immunologic abnormality, heredi- tary disease, or infection by a slow virus.3 To our knowledge, this is the first report of a young patient with a possible association between Parry-Romberg syndrome and thoracoscopic sympathectomy.
Theoretically, thoracoscopic sympathectomy may cause 2 of the aforementioned etiologies of Parry- Romberg syndrome: sympathetic denervation and trauma. Thoracoscopic sympathectomy is a surgical technique for the treatment of palmar hyperhidrosis.
The operation ablates the upper thoracic sympa- thetic nerve ganglions responsible for nerve stimu- lation of the sweat glands of the upper limbs. The most significant complication is Horner’s syn- drome, which results from injury to the stellate sympathetic ganglion.7 In a summary of sympa- thectomies in 67 children and adolescents, compli- cations included Horner’s syndrome in 1 patient (1%) and varying degrees of compensatory sweat- ing in 30 patients (45%).8 Despite the evidence from animal studies that sympathectomy can result in facial atrophy, to our knowledge, there were no previous reports of such an association in humans.
Cutis. 2004;73:343-344, 346.
RSD due to nerve injury
According to the National Institute of Neurological Disorders and Stroke (NINDS), RSD is "a chronic pain condition that is believed to be the result of dysfunction in the central or peripheral nervous systems." According to MedicineNet, RSD involves "irritation and abnormal excitation of nervous tissue, leading to abnormal impulses along nerves that affect blood vessels and skin."
Animal studies indicate that norepinephrine, a catecholamine released from sympathetic nerves, acquires the capacity to activate pain pathways after tissue or nerve injury, resulting in RSD. Another theory suggests that RSD, which follows an injury, is caused by triggering an immune response and symptoms associated with inflammation (redness, warmth, swelling). RSD is not thought to have a single cause, but rather multiple causes producing similar symptoms.
http://arthritis.about.com/od/rsd/a/rsd.htm
PLOS Medicine: Why Most Published Research Findings Are False
PLOS Medicine: Why Most Published Research Findings Are False: "There is increasing concern that most current published research findings are false. The probability that a research claim is true may depend on study power and bias, the number of other studies on the same question, and, importantly, the ratio of true to no relationships among the relationships probed in each scientific field. In this framework, a research finding is less likely to be true when the studies conducted in a field are smaller; when effect sizes are smaller; when there is a greater number and lesser preselection of tested relationships; where there is greater flexibility in designs, definitions, outcomes, and analytical modes; when there is greater financial and other interest and prejudice; and when more teams are involved in a scientific field in chase of statistical significance. Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias. In this essay, I discuss the implications of these problems for the conduct and interpretation of research."
After sympathectomy in rats there is an increase in osteoclast-mediated bone resorption as well as an increase in the number of osteoclasts on the sympathectomized side
Paper: Osteoclastic Activation In Periapical Lesions After NPY Knockout (IADR/AADR/CADR 87th General Session and Exhibition (April 1-4, 2009)): "After sympathectomy in rats there is an increase in osteoclast-mediated bone resorption as well as an increase in the number of osteoclasts on the sympathectomized side compared to the control. These findings suggest an inhibitory effect of the SNS on bone resorption via osteoclasts. Our objective was to determine if an SNS mediator, neuropeptide Y (NPY), affects osteoclastic activity after pulpal exposure."
Two-stage unilateral versus one-stage bilateral single-port sympathectomy for palmar and axillary hyperhidrosis
Compensatory sweating occurred in 25 (19%) patients of the one-stage group and in 6 (4%) of the two-stage group (P = 0.0001). No patients developed Horner’s syndrome.
CONCLUSIONS: Both two-stage unilateral and one-stage bilateral single-port video-assisted thoracoscopic sympathectomies are effective, safe and minimally invasive procedures. Two-stage unilateral sympathectomy can be performed with a lower occurrence of compensatory sweating, improving permanently the quality of life in patients with palmar and axillary hyperhidrosis.
http://icvts.oxfordjournals.org/content/16/6/834.full.pdf+html
CONCLUSIONS: Both two-stage unilateral and one-stage bilateral single-port video-assisted thoracoscopic sympathectomies are effective, safe and minimally invasive procedures. Two-stage unilateral sympathectomy can be performed with a lower occurrence of compensatory sweating, improving permanently the quality of life in patients with palmar and axillary hyperhidrosis.
http://icvts.oxfordjournals.org/content/16/6/834.full.pdf+html
sympathectomy and avoidance learning
PsycNET - Option to Buy: "Chemical sympathectomy and avoidance learning in the rat.
By Di Giusto, E. L.; King, M. G.
Journal of Comparative and Physiological Psychology, Vol 81(3), Dec 1972, 491-500.
Abstract
Reports results of 5 experiments with male Wistar rats (N = 108). Depletion of peripheral sympathetic noradrenaline induced by administration of 6-hydroxydopamine, ip, led to significant decrements in escape and avoidance responding when the required response was difficult, but not when it was relatively easy to acquire. Results are similar to previous findings obtained with adrenal-demedullated Ss. Findings clarify the role of the sympathetic nervous system in the motivation of behavior elicited by aversive stimulation. Implications for 2-process theory and the "Kamin effect," or "learned helplessness," are discussed. (40 ref.) (PsycINFO Database Record (c) 2012 APA, all rights reserved)"
By Di Giusto, E. L.; King, M. G.
Journal of Comparative and Physiological Psychology, Vol 81(3), Dec 1972, 491-500.
Abstract
Reports results of 5 experiments with male Wistar rats (N = 108). Depletion of peripheral sympathetic noradrenaline induced by administration of 6-hydroxydopamine, ip, led to significant decrements in escape and avoidance responding when the required response was difficult, but not when it was relatively easy to acquire. Results are similar to previous findings obtained with adrenal-demedullated Ss. Findings clarify the role of the sympathetic nervous system in the motivation of behavior elicited by aversive stimulation. Implications for 2-process theory and the "Kamin effect," or "learned helplessness," are discussed. (40 ref.) (PsycINFO Database Record (c) 2012 APA, all rights reserved)"
Blushing and Facial Blushing Causes, Treatment, Diagnosis
Blushing and Facial Blushing Causes, Treatment, Diagnosis: "The treatment of facial blushing and or facial sweating is a controversial subject. The uncontrolled and embarrassing situation of facial sweating and blushing was thought to be easily treated with ETS. This came about when ETS was done patients with sweaty hands. Among those patients who also suffered from facial blushing and/or facial sweating the results were also successful at reducing facial blushing and/or sweating. However over the years two observations were made when this operation was applied only patients with facial blushing and or facial sweating. Percentage wise these patients developed a higher rate of severe compensatory sweating. Also these patients experienced a higher degree of dissatisfaction due to the side effects. Side effects such as facial flushed feelings, loss of stamina, facial skin sensitivity, increased amount of fatigue and others led Dr. Reisfeld to the decision not to perm ETS when only facial blushing or facial sweating were involved. The clinical experience that was accumulated over the last several years is what has allowed Dr. Reisfeld to reach this assessment."
Hyperhidrosis (excessive sweating). DermNet NZ
Hyperhidrosis (excessive sweating). DermNet NZ: "Localised hyperhidrosis may also be due to:
Stroke
Spinal damage
Peripheral damage
Surgical sympathectomy
Neuropathy
Brain tumour
Chronic anxiety disorder"
Stroke
Spinal damage
Peripheral damage
Surgical sympathectomy
Neuropathy
Brain tumour
Chronic anxiety disorder"
Right sympathectomy was associated with a 372% increase in PI (p < 0.0001), and left sympathectomy with a 316% increase in PI
Oximetry-derived perfusion index for intraop... [Ann Thorac Surg. 2005] - PubMed - NCBI: "Baseline oximetric waveforms were adequate in all subjects. Right was associated with a 372% increase in PI (p < 0.0001), and left with a 316% increase in PI (p < 0.029). This occurred as early as 1 minute after transection of the sympathetic chain. The PI in the reference probes as well as the hemodynamics remained constant."
Severity of compensatory sweating after thor... [Ann Thorac Surg. 2004] - PubMed - NCBI
Severity of compensatory sweating after thor... [Ann Thorac Surg. 2004] - PubMed - NCBI: "Compensatory sweating occurred in 89% of patients and was so severe in 35% that they often had to change their clothes during the day. The frequency of compensatory sweating was not significantly different among the three groups, but severity was significantly higher after Th2-4 sympathectomy for axillary hyperhidrosis (p = 0.04). Gustatory sweating occurred in 38% of patients, and 16% of patients regretted the operation.
CONCLUSIONS:
Compensatory and gustatory sweating were remarkably frequent side effects after thoracoscopic sympathectomy for primary hyperhidrosis."
CONCLUSIONS:
Compensatory and gustatory sweating were remarkably frequent side effects after thoracoscopic sympathectomy for primary hyperhidrosis."
Impaired skin vasomotor reflexes have been found in patients with sympathetic dystrophies, dysautomias, post-regional sympathectomy and diabetic neuropathies
Not surprisingly, diminished vasoconstrictor responses, similar to the current findings, have been found
in patients with sympathetic dystrophies [26], dysautomias [27], post-regional sympathectomy [28] and
diabetic neuropathies [11].
Additionally, there have been a few reports of EM patients benefitting from sympathectomy or neurolitic
irreversible blocks of the lumbar sympathetic ganglia [22,23], while others have found the symptoms of EM to be aggravated by such treatment [24,25], possibly as a result of denervation supersensitivity.
Clinical Science (1999) 96, 507ñ512 (Printed in Great Britain)
Roberta C. LITTLEFORD, Faisel KHAN and Jill J. F. BELCH
University Department of Medicine, Section of Vascular Medicine and Biology, Ninewells Hospital and Medical School,
Dundee DD1 9SY, Scotland, U.K.
in patients with sympathetic dystrophies [26], dysautomias [27], post-regional sympathectomy [28] and
diabetic neuropathies [11].
Additionally, there have been a few reports of EM patients benefitting from sympathectomy or neurolitic
irreversible blocks of the lumbar sympathetic ganglia [22,23], while others have found the symptoms of EM to be aggravated by such treatment [24,25], possibly as a result of denervation supersensitivity.
Clinical Science (1999) 96, 507ñ512 (Printed in Great Britain)
Roberta C. LITTLEFORD, Faisel KHAN and Jill J. F. BELCH
University Department of Medicine, Section of Vascular Medicine and Biology, Ninewells Hospital and Medical School,
Dundee DD1 9SY, Scotland, U.K.
sympathectomy interrupts neural messages that ordinarily would travel to many different organs, glands and muscles
Sympathectomy involves dissection of the main sympathetic trunk in the upper thoracic region thus interrupting neural messages that ordinarily would travel to many different organs, glands and muscles. It involves division of adrenergic, cholinergic and sensory fibers which elaborate adrenergic substances during the process of regulating visceral function.
Journal of Applied Sciences Research, 6(6): 659-664, 2010
Journal of Applied Sciences Research, 6(6): 659-664, 2010
Vascular sympathetic denervation can lead to degeneration of the smooth muscle of arteries leading to medial arterial calcification and stiffening of the arteries
Sympathetic denervation of the peripheral arterial system may occur quite early in the evolution of neuropathy and has major effects on blood flow and vascular responses and causes structural changes in the arterial wall (Edmonds 2004). Vascular sympathetic denervation can lead to degeneration of the smooth muscle of arteries leading to medial arterial calcification and stiffening of the arteries. This calcification may assume the histological characteristics of bone.
Unilateral lumbar sympathectomy in humans, both in diabetics and non-diabetics, has been show to result in medial wall calcification on the ipsilateral side (Goebel and Fuessl 1983). Unilateral sympathectomy in animals leads to excess deposition of cholesterol on the operated side and the occurrence of cholesterol sclerosis in the rabbit's aorta was accelerated by removal of the coeliac ganglion (Harrison 1938). Furthermore, in animal models, denervation of smooth muscle leads to striking pathological changes, including atrophy of muscle fibres with foci of degeneration (Kerper and Collier 1926). Arterial calcification in initiated within senescent atrophic smooth muscle (Morgan 1980).
Medial arterial calcification in the Pima Indians is significantly associated with an increased prevalence of cardiovascular mortality (Everhart et al 1988). Medial calcification may be important factor in development of peripheral vascular disease, which in diabetes shows a predilection for the distal arteries below the knee and is unexplained. Chantelau reported an association of below knee atherosclerosis to medial arterial calcification (Chantelau et al. 1995).
p. 653
Autonomic Failure: A Textbook of Clinical Disorders of the Autonomic Nervous System[Hardcover]
Christopher J. Mathias (Author), Roger Bannister (Author)- Publisher: Oxford University Press, USA; 5 edition (July 24, 2013)
- Language: English
- ISBN-10: 0198566344
- ISBN-13: 978-0198566342
Subscribe to:
Posts (Atom)