Other potential complications include inadequate resection of the ganglia, gustatory sweating, pneumothorax, cardiac dysfunction, post-operative pain, and finally Horner’s syndrome secondary to resection of the stellate ganglion.
After severing the cervical sympathetic trunk, the cells of the cervical sympathetic ganglion undergo transneuronic degeneration
After severing the sympathetic trunk, the cells of its origin undergo complete disintegration within a year.
Spinal cord infarction occurring during thoraco-lumbar sympathectomy
J Neurol Neurosurg Psychiatry 1963;26:418-421 doi:10.1136/jnnp.26.5.418
Thursday, February 3, 2011
Neuraxial blocks typically produce variable decrease in blood pressure that might be accompanied by a decrease in heart rate and cardiac contractility. These effects are generally proportional to the degree (level) of the sympathectomy. Vasomotor tone is primarily determined by sympathetic fibres arising from T5 to L1, innervating arterial and venous smooth muscle. Blocking these nerves causes vasodilation of the venous capacitance vessels, pooling of blood, and decreased vvenous terurn to the heart; in some instances, arterial vasodilation may also decrease systemic vascular resistance. The effects of arterial vasodilation may be minimized by compensatory vasoconstriction above the level of the block. A high sympathetic block not only prevents compensatory vasoconstriction but also blocks the sympathetic cardiac accelerator fibres that arise at T1-T4.
Profound hypotension may result from vasodilation combined with bradycardia and decreased contractility. These effects are further exaggerated if venous return is further compromised by a head-up position or from the weight of a gravid uterus. Unopposed vagal tone in some persons may explain cardiac arrest with spinal anesthesia.
The sympathetic system normally maintains some tonic vasoconstriction on the vascular tree. Loss off this tone following induction of anesthesia or sympathectomy frequently contributes to perioperative hypotension.
AV conduction abnormalities are usually manifested by abnormal ventricular depolarization (bundle-branch block) prolongation of the P-R interval (first degree AV block) failure of some atrial impulses to depolarize the ventricles (second degree AV block) or AV dissociation (third degree AV block or complete heart block).
Clinical anesthesiology By G. Edward Morgan, Maged S. Mikhail, Michael J. Murray
McGraw-Hill, Edition: 3 - 2002
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.
the following medical conditions:
* kidney problems
* liver problems
* heart problems
* recent excessive vomiting or
* Systemic Lupus Erythematosus
(SLE), a disease affecting the
skin, joints and kidneys
* a salt restricted diet
* a past operation known as
If you have not told your doctor about any of the above, tell him/her before you start taking Atacand Plus 16/12.5.
Atacand Plus 16/12.5 is used to treat high blood pressure.
- Idiopathic orthostatic hypotension
- Multiple sclerosis
- Posterior fossa tumor
- Shy-Drager syndrome
- Spinal cord injury with paraplegia
- Surgical sympathectomy
- Tabes dorsales (syphillis)
- Wernicke's encephalopathy
Dizziness: Classification and Pathophysiology
The Journal of Manual and Manipulative Therapy, Vol. 12, No 4 (2004)
Wednesday, February 2, 2011
T(2)-T(3) ganglionectomy significantly decreases pulse rate and systolic blood pressure, reduces myocardial oxygen demand, increases left ventricular ejection fraction and prolongs Q-T interval. A certain loss of lung volume and decrease of pulmonary diffusion capacity for CO result from sympathectomy. Histomorphological muscle changes and neuro-histochemical and biochemical effects have also been observed.
a significant impairment of the heart rate to workload relationship was consistently observed following sympathectomy
The aim of the present prospective study was to confirm that a significant impairment of the heart rate to workload relationship was consistently observed following unilateral and/or bilateral surgery.
Eur J Cardiothorac Surg 2001;20:1095-1100
disturbed peripheral vascular and heart rate responses after sympathectomy
Even epidural blockade limited only to the thoracic dermatomes is liable to cause complete sympathectomy, including cardiac sympathetic denervation. The ensuing vasodilation and bradycardia lead to hypotension, poor tolerance of mechanical interference with the heart, and inability to respond to acute changes in intravascular volume or body position. This symptom complex is especially troublesome to manage during intrathoracic operations when avoidance of hypervolemia is emphasized.
During intrathoracic procedures using one-lung ventilation, a right-to-left intrapulmonary shunt is intentionally created (in the form of the nonventilated lung). The ensuing arterial oxygen tension (PaO2) is determined by a complex interaction involving cardiac output, mixed venous oxygen tension, the status of the ventilated lung, size of the shunt, and most significantly, hypoxic pulmonary vasoconstriction (HPV).
HPV diverts pulmonary blood flow away from the shunt by vavsoconstriction in the nonventilated lung, and is the principal adaptive defense mechanism against arterial hypoxemia during one-lung ventilation. The cellular mechanism and regulation of HPV, and the possible role of the autonomic nervous system are not completely understood.
The effect of thoracic sympathectomy of HPV is even less well understood. Since potent vasodilators such as nitroprusside antagonize HPV-induced vasoconstriction and lower the arterial oxygen tension, it is reasonable to assume that HPV will become less effective with thoracic sympathectomy.
Clinical studies have produced conflicting conclusions, most probably because direct measurement of HPV is not possible in human studies, and the surrogate endpoing examined PaO2 is determined not only by HPV, but also by a host of interacting factors, some of which may be affected by the sympathectomy and can not be held constant.
Risk Factor for Neuraxial Anesthesia-Associated Bradycardia:
Block height higher than T5
| || || || |
Spinal and Epidural AnesthesiaBy Cynthia Wong
After thoracoscopic sympathectomy for hyperhidrosis, very severe discomfort and hyperhidrosis in the neighboring non-sympathectomized regions occurred with alarming frequency and intensity. (p.879)
Edition: 4 - 2008
The normal physiological response to massive atelectasis is an increase in pulmonary vascualr resistance (hypoxic pulmonary vasoconstriction) with re-routing of blood to well ventilated lung zones and consequent improvement of in PaO2. However, during endobronchial anaesthesia for thoracic sympathectomy there is an apparent failure of this compensatory mechanism. When more than 70% of the lung is atelectatic, compensation by hypoxic pulmonary vasonstriction appears to be ineffective. Furthermore, in in vitro and animal studies, inhalation anaesthetic agent have been shown to depress hypoxic pulmonary vasoconstriction.
In a study by Hartrey and colleagues, SpO2<95% style="font-weight: bold;">During carbon dioxide insufflation using endobronchial intubation, Hartrey and colleagues reported a decrease in systolic arterial pressure of >20 mm Hg in 21% of patients. Similarly, we have reported sudden hypotension and bradycardia after injudicious carbon dioxide insufflation.
In an interesting study of the delayed cardiac effects of T2-4 sympathectomy, Drott and colleagues demmonstrated significantly reduced heart rate at rest, and during both exercise and the recovery phase of the exercise.
Changes in the electrical axis and shortening of the QT interval have also been reported.
B. Fredman, D. Olsfanger, R. Jedeikin
British Journal of Anaesthesia 1997; 79: 113-119
It is well known that hypoxic pulmonary vasoconstriction(HPV) plays an important role to protect hypoxemia during the atelectasis induced by one-lung ventilation. Thoracic sympathectomy may have effects on pulmonary vasculature(HPV) and hemodynamics during one-lung anesthesia.
Mean arterial blood pressure was decreased from 81.9+/-2.89 to 73.2+/-2.49 mmHg after thoracic sympathectomy and heart rate was decreased from 104.4+/-3.12 to 88.2+/-2.31beats/min. Arterial oxygen tension was decressed from 570.5+/-17.9 to 521.4+/-23.2mmHg after position change, and decreased to 271.1+/-28.1 mmHg under one-lung ventilation, and finally decreased to 217.0+/-18.3 mmHg after thoracic sympathectomy. With the above results, we can conclude that patients for TES should be carefully observed during and after the procedure, and hypoxic pulmonary vasoconstriction may be impaired after TES.
Korean J Anesthesiol. 1993 Aug;26(4):695-699.
Pulse oximetry and repeated blood gas measurements are needed during endoscopic transthoracic sympathectomy in order to detect and treat hypoxemic events, which may jeopardize the patient's life.
Journal of Cardiothoracic and Vascular Anesthesia
Volume 10, Issue 2, February 1996, Pages 207-209
Youmans Neurological Surgery, 5th Edition
Publication Date: 2003-10-10
After sympathectomy, RSCBF (regional spinal cord blood flow) was unchanged during hypothermia. In the cauda equina, flow fell in all hypothermic rats. The hypothermia-associated increases in RSCBF were not related to changes in mean arterial blood pressure. We conclude that adrenalectomy near-totally ablates the hypothermia-associated increase in RSCBF measured in intact rats and that abdominal sympathectomy totally ablates it. This evidence complements morphological evidence for adrenergic innervation of the spinal cord vasculature.Am J Physiol. 1991 Mar;260(3 Pt 2):H827-31.
Ultrastructural changes in the nerves innervating the cerebral artery after sympathectomy
Postsympathectomy limb pain, postsympathectomy parotid pain, and Raeder's paratrigeminal syndrome are pain states associated with the loss of sympathetic fibres and in particular with postganglionic sympathetic lesions. There is a characteristic interval of about 10 days between surgical sympathectomy and onset of pain. It is proposed that this pain in man is correlated with the delayed rise in sensory neuropeptides seen in rodents after sympathectomy. These chemical changes probably reflect the sprouting of sensory fibres and may result from the greater availability of nerve growth factor after sympathectomy. The balance between the sensory and sympathetic innervations of a
peripheral organ may be determined by competition for a limited supply of nerve growth factor.
Lancet. 1985 Nov 23;2(8465):1158-60.
J Comp Physiol Psychol 1976; 90:303-16.
normal forearm vasodilator response to mental stress was absent months or years after surgical sympathectomy
Additional indirect evidence on this topic in humans comes from a study conducted in the 1950s (3). In this study, the normal forearm vasodilator response to mental stress was absent months or years after surgical sympathectomy.
J Appl PhysiolVol. 92, Issue 5, 2019-2025, May 2002
sympathectomy can impair the autonomic nervous system’s increase of the heart rate in response to exercise
it has been shown that thoracic sympathectomy can impair the autonomic nervous system’s increase of the heart rate in response to exercise . Although absolute tachycardia is not eliminated, given the endocrine and paracrine stimuli during exercise, the maximum heart rate reached during exercise has been shown to be significantly reduced after sympathectomy. Thus for a given workload during exercise, there will be a relative bradycardia. This may possibly affect the circulatory system’s ability to convey heat from the body core to the extremities for heat loss.
thoracic sympathectomy has been demonstrated to abolish or alter sympathetic vasoconstrictive responses in the skin, and this may contribute to abnormal peripheral vascular responses to temperature . Paradoxically it has been suggested that in some cases there may be abnormal vasoconstriction rather than the expected vasodilatation after sympathectomy . It is not impossible that such atypical peripheral vascular responses to rising body temperature may have contributed to impaired heat loss during exercise or to an inappropriate response to shock on the development of the heat stroke.
the abolition of sweating from the upper body as well as the axillae and both upper limbs may have significantly reduced the capacity of the patient to lose heat through sweating during exercise. Anhidrosis in the head and neck after sympathectomy affects a proportion of patients, but is often neglected in most reports of post-sympathectomy complications . The loss of head and neck sweating in this patient may have further impaired overall heat loss. However we would also note that the degree of heat loss impairment after sympathectomy has never been quantified, and its effect on body temperature during exercise remains to be established.
"Although thoracic sympathectomy is commonly used to reduce upper limb sweating, it may also lead to facial anhidrosis and disturbed cardiovascular responses to temperature. The resultant effect on overall body heat loss has not been documented. We present a case of a young patient with previous thoracic sympathectomy who suffered severe heat stroke after heavy exercise.
An already impaired cardiovascular system is recognized to be a significant risk factor for development of heat stroke. In the post-sympathectomy patient, the abnormal sympathetic skin response may lead to peripheral vascular failure or the reduced cardiac chronotropic response may impair the body’s capacity to compensate for shock. These may have contributed to the rapid development of shock and severe multiple organ dysfunction syndrome in this patient.
He had multiple organ dysfunction syndrome develop, with severe renal and hepatic failure, grade II hepatic encephalopathy, and disseminated intravascular coagulation. He responded remarkably well to aggressive supportive measures including forced alkaline diuresis, and he was eventually discharged home after 1 month. The patient was previously a healthy, physically fit, nonsmoker. He worked as a body building trainer and led an active, sporty lifestyle. The only significant medical history was that he had received thoracic sympathectomy for axillary hyperhidrosis 4 years ago at another hospital.
PMID: 213930 [PubMed - indexed for MEDLINE]
Blood Vessels 1974;11:2-31
Eur Respir J 1998; 12: 177–184
Goodman. Anaesthesia and Intensive Care. Edgecliff:Oct 2003. Vol. 31, Iss. 5, p. 581-3
A form of surgery that is useful for some people with LQTS. It reduces the amount of adrenaline and its by-products produced and delivered to the heart by certain nerves (the left cervical ganglia). It involves operating on the left neck and removing or blocking these nerves
Transverse myelitisTransverse myelitis is a neurological disorder caused by an inflammatory process of the grey and white matter of the spinal cord, and can cause axonal demyelination.
In some cases, the disease is presumed to be caused by viral infections or vaccinations and has also been associated with spinal cord injuries, immune reactions, schistosomiasis and insufficient blood flow through spinal cord vessels. Acute myelitis accounts for 4 to 5 percent of all cases of neuroborreliosis. Symptoms include weakness and numbness of the limbs as well as motor, sensory, and sphincter deficits. Severe backpain may occur in some patients at the onset of the disease.
One patient with documented transection of the cord above T5 behaved like subjects after surgical sympathectomy
Increase in blood flow is generally followed by a rise in skin temperature but decrease in blood flow in response to the Gibbon-Landis procedure after sympathectomy is not necessarily accompanied by a fall in surface temperature. This poor correlation between skin temperature and blood flow confirms the previous report of Hoobler and co-workers and helps define the limits of usefulness of measurements
of skin temperature as an index of blood flow to the extremity.
The vasomotor responses to the Gibbon-Landis procedure (reflex response to warming) were studied in hemiplegic patients, subjects with "high transection" of the cord, and in sympathectomized patients.
One patient with documented transection of the cord above T5 behaved like subjects after surgical sympathectomy.
Of 11 sympathectomized limbs tested for vasodilatation in response to the Gibbon-Landis procedure, 4
showed no response, while 7 responded with decrease in blood flow (vasoconstriction).
Vasomotor Responses in the Extremities of Subjects with Various Neurologic Lesions
I. Reflex Responses to Warming
By WALTER REDISCH, M.D., FRANCISCO T. TANGCO, M.D., LOTHAR WERTHEIMER, M.D.,
ARTHUR J. LEWIS, M.D., J. MURRAY STEELE, M.D.
Alterations in skin microcirculation induced by brachial plexus block can be evaluated by wavelet transform of the laser Doppler flowmetry signal. Brachial plexus block reduces the oscillatory components within the 0.0095- to 0.021- and 0.021- to 0.052-Hz intervals of the perfusion signal. These alterations are related to inhibition of sympathetic activity and a possible impairment of endothelial function.
Endothelial dysfunction, or the loss of proper endothelial function, is a hallmark for vascular diseases, and often leads to atherosclerosis.
Careful observations showed that the forearm sweating responded diversely to various mental stimuli, unlike the palmar sweating whose response was always an increase. Mental arithmetic, mental testing and physical exercise caused an immediate increase in the palmar sweating but often elicited a transient decrease in the forearm sweating, whereas pain, noise, and emotional stimuli consistently provoked an increase of sweating on the forearm as well as on the palm. These observations suggest that the activities of higher centers, presumably involving neocortex and limbic cortex, exert various influences on the central mechanisms of palmar and generalized sweating.
Jpn J Physiol. 1975;25(4):525-36.
Some individuals (up to 90%) may experience another type of sweating that is increased while eating or smelling certain foods (gustatory sweating) (Hornberger).Source: Medical Disability AdvisorPublish Post
Because of their size and location, injuries to the sympathetic ganglia or chain is rarely indicated or performed. Receptor hypersensitivity is a common problem after significant sympathetic injury, including clammy hands, erythema, and allodynia. When sympathetic nerves regenerate, they may establish aberrant connections to sensory receptors, muscles, or other sympathetics receptors; this may lead to an over-response or abnormal response. This article has been reviewed by the NeuroWiki Editorial Board
because bilateral ETS causes the suppression of cardiovascular response to exercise, patients need to be observed during high-level exercise
HR and BP at rest and cardiovascular response to exercise were similar in patients with palmar hyperhidrosis before ETS and in the normal control population. Therefore, we consider that patients with palmar hyperhidrosis have no overactivity of the sympathetic nerve. However, because bilateral ETS causes the suppression of cardiovascular response to exercise, patients that has been treated with ETS need to be observed during high-level exercise.
Your scenario of surgeons being flummoxed by unhappy patients complaining after surgery doesn't hold water. The rules of professional medical ethics require that the treating physician be well versed in the published literature on the treatments he delivers.
There is a mountain of published research (spanning nearly a century) documenting the adverse effects of sympathectomy. There are numerous studies, for example, showing very high rates of severe side effects and studies showing that satisfaction diminishes substantially over the long term.
It is a doctors job to know this stuff and it is their ethical duty to disclose that information to patients.
So, I see the blame thing as pretty cut and dry. Surgeons perfoming sympathectomies routinely withhold information vital to informed consent. Anyone who does objective comparison between what is documented in medical/scientific literature and what is typically disclosed to prospective ETS patients has no choice but reach this conclusion.
And, to make matters worse, many surgeons use testimonials from a hand-selected group of their happiest patients to advocate the surgery. That practice is considered unethical by all medical professional organizations.
Tuesday, February 1, 2011
International Hyperhidrosis Society
Patients with a T2 lesion were significantly more likely to have severe compensatory sweating than those with other levels
Ann Thorac Surg 2006;81:1227-1233
Significant compensatory sweating in relation to the level(s) of sympathetic chain division occurred in T2 alone, 45%
Ann Thorac Surg 2008;85:390-394. doi:10.1016/j.athoracsur.2007.08.001
Thoracoscopic Sympathectomy at the T2 or T3 Level Facilitates Bradykinin-Induced Protein Extravasation in Human Forearm Skin
Conclusions. Forearm skin perfusion is increased after ETSC on the T2 or T3 level indicating decreased sympathetic activity while BK-induced protein extravasation was increased. These results show that preganglionic sympathectomy does not diminish bradykinin-induced protein extravasation as found for postganglionic sympathectomy in rats.
Stefan Leis, MD,*
Published Online: 1 Mar 2010
© 2010 American Academy of Pain Medicine
Monday, January 31, 2011
American Journal of Clinical Dermatology; 2003, Vol. 4 Issue 10, p681-697, 17p
With the purpose of using a less aggressive surgical approach and lesser imbalance of the autonomic nervous system, the ramicotomy was proposed.
Ramicotomy allows complete section of all rami communicantes of the sympathetic ganglia. The histological regeneration might be greater than the recurrence rates of clinical symptoms seen in a human being due to non-functional regenerations.
Interact CardioVasc Thorac Surg 2009;9:411-415.
"Referring an anxious patient with palmar hyperhidrosis to surgery without first completing a proper trial of psychotropic medication may constitute malpractice especially if the patient experiences some of the more severe surgical complications which can occur during sympathectomy" (Bracha et al. 2006 emphasis added)
Additional confirmation of thermoregulatory difficulties comes from ETS surgeon David Nielson, whose advertising website has, since 2003, listed “heat intolerance” among the “side effects” produced by the surgery. Nielson website
The empirical confirmation for the thermoregulatory problems comes from an as yet unpublished study by David Goldstein at National Institutes of Health. In addition to his published neurocardiology findings about ETS patients, Goldstein has begun thermoregulatory investigations.
The patients are fitted with what Goldstein jokingly calls a “superhero vest”. Water is pumped into the vest, and the temperature of the water can be controlled very accurately. A thermometer probe is placed in the ear to monitor how well the patient is maintaining core body temperature against both the cold and hot water in the vest.
Goldstein has written as his interpretation of one test:"The change in core temperature of about 0.4ºC during manipulation of skin temperature would be consistent with decreased ability to maintain core temperature in response to changes in environmental temperature."
"There was evidence for a decreased ability to maintain core temperature in response to changes in environmental temperature. Taken together, there was evidence for multiple direct and indirect effects of bilateral thoracic sympathectomy that would be expected to interfere with the ability to maintain homeostasis in response to a variety of stressors."
“The efficiency of SBC (Selective Brain Cooling) is increased by evaporation of sweat on the head and by ventilation through the nose.” (Nagasaka et al. 1998)
“A necessary condition for SBC is a high heat loss capacity from the head itself, without such a heat loss SBC is not possible.” (Cabanac 1993)
“Because the human head sweats more than the rest of the body, heat loss from the head skin could amount to 125-175 Watts under conditions of moderate hyperthermia.” (Cabanac 1993)
First, it is impossible to isolate the “sweat gland nerves” because such nerves do not exist. Nerves leading to the sweat glands are all bundled together with nerves leading to many other effectors, such as the heart, the lungs, blood vessels, thyroid, bone, bone marrow, arrector pili, adipose tissue, senory nerves, etc. (the “bundling” problem).
Second, even if we wanted to stop nerve function to all sorts of effectors, it is impossible to treat “just the hands”. Each individual sympathetic ganglion serves a much larger region than that. It is generally true that ganglia higher up along the sympathetic chain innervate structures higher up in the body, but there is no possible way to isolate that portion that serves just “the hands” (the “overlap” problem).
Third, there can be significant individual differences in innervation from patient to patient, which are not discernable to the surgeon (the “individuality” problem).Hence the results of thoracic sympathectomy remain somewhat unpredictable, and denervation is always far more extensive than desired.
Surgeons have made various claims about achieving high degrees of specificity with their own brands of ETS surgery. For example, Timo Telaranta and Chien Lin devised the Lin-Telaranta classification system:
- Sweating of the hands - T4
- Sweating and Facial Blushing - T3
- Blushing of the face alone - T2
- Social anxiety with Facial Blushing - T2
- Social anxiety without Facial Blushing - T3 and T4 on the left side only
- Heart racing and rhythm disorders - T3, T4, and T5 on the left side only (Lin et al. 2001)
Other surgeons have made different, yet no less specific, claims. Many examples have emerged of surgeon advertising websites which state or imply that ETS can target sweat glands exclusively, or can target the hands to the exclusion of other body regions.
However, empirical support for any such degree of specificity is mostly absent, and contradictory data is present. For instance, a study in France showed a lowered cardiac response to exercise after ETS, even if they only operated on one side, and it didn’t matter which side it was. The authors said this was consistent with the “random distribution” of cardiac fibers noted in anatomical studies. (See Abraham et al. 2002). Yet Goldstein and colleagues at NIH produced a graph which appears to indicate that unilateral sympathectomy does not produce the same amount of denervation as does bilateral.
An early study demonstrated a “bottleneck” effect at T2. The authors presented evidence that denervation of the top 1/3 of the body was complete, whether the surgeons took just T2, or T2-T3, or T2-T4. (see Hyndman et al. 1942)
Ann Thorac Surg 2001;71:1116-1119
© 2001 The Society of Thoracic Surgeons
Ann Chir Gynaecol. 2001;90(3):195-9.
Ramicotomy allows complete section of all rami communicantes of the sympathetic ganglia. The histological regeneration might be greater than the recurrence rates of clinical symptoms seen in a human being due to non-functional regenerations.
Interact CardioVasc Thorac Surg 2009;9:411-415. doi:10.1510/icvts.2009.202150
Although VATS sympathectomy is a simple and quick procedure, unusual complications such as chylothorax may occur . However, lethal or potentially serious complications have also been reported [8, 17, 18], such as subclavian artery injury, damage to brachial plexus, large hemothorax, cerebral edema, neurologic sequelae, sinus bradycardia, and cardiac arrest.
Ann Thorac Surg 2003;76:886-891
gustatory sweating and other gustatory phenomena were reported by 68 of 93 patients (73%),
followed up for an average of 11/2 years. These gustatory phenomena were quite different from
physiologic gustatory sweating: a wide range of gustatory stimuli caused a variety of phenomena in varied locations. There was a negative correlation between the incidence of these phenomena and the occurrence of Horner's syndrome after sympathectomy. Analysis of our observations, and of clinical and experimental work of others, leads to the conclusion that gustatory phenomena after upper dorsal sympathectomy are the result of preganglionic sympathetic regeneration or collateral sprouting with aberrant synapses in the superior cervical ganglion.
Arch Neurol. 1977;34(10):619-623.
This article reviews the evidence that neuroleptics may increase the risk of breast cancer via their effects on prolactin secretion.
Paul M. Schyve; Francine Smithline; Herbert Y. Meltzer
Neuroleptic-induced Prolactin Level Elevation and Breast Cancer: An Emerging Clinical Issue
Arch Gen Psychiatry, Nov 1978; 35: 1291 - 1301.
Fifteen patients (16 per cent) developed recurrent sweating, but none required reoperation.
Twelve patients (13 per cent) were dissatisfied with the operative results, mainly owing to compensatory hyperhidrosis, which occurred in 88 patients (97 per cent) within the first year.
The results of endoscopic sympathectomy deteriorate progressively from the immediate outcome.
Published Online: 2 Jan 2003
Clin Auton Res. 2003 Dec;13 Suppl 1:I20-1; discussion I21.
Other therapies included sympathectomy, severing the nerves to blood vessels (a surgery with a great risk of complication!)
Extensive surgery or burning causes nerve scaring, which may behave like epilepsy of the autonomous nervous system
PMID: 10971220 [PubMed - indexed for MEDLINE]
1. Acta Physiol Scand. 2000 Sep;170(1):33-8.
European Journal of Cardio-Thoracic Surgery, Volume 36, Issue 2, August 2009, Pages 360-363
- Endoscopic thoracic sympathectomy (ETS) involves division of the thoracic sympathetic chain between T2 and T4.
- The main indication for ETS is the treatment of palmar hyperhidrosis.
- The most common method of anaesthesia for ETS uses intermittent positive pressure ventilation via a standard tracheal tube.
- Perioperative risks are low, but complications can be devastating.
We describe a patient who underwent upper thoracic sympathectomy for palmar hyperhidrosis, and whose symptoms subsequently deteriorated, becoming worse than those on initial presentation.
We found statistically significant differences (P < .05) in both time and frequency domains. Parameters that evaluate global cardiac autonomic activity (total power, SD of normal R-R intervals, SD of average normal R-R intervals) and vagal activity (rhythm corresponding to percentage of normal R-R intervals with cycle greater than 50 ms relative to previous interval, square root of mean squared differences of successive normal R-R intervals, high-frequency power, high-frequency power in normalized units) were statistically significantly increased after sympathectomy. Low-frequency power in normalized units, reflecting sympathetic activity, was statistically significantly decreased after sympathectomy. Low-/high-frequency power ratio also showed a significant decrease, indicating relative decrease in sympathetic activity and increase in vagal activity.
The Journal of Thoracic and Cardiovascular Surgery
Volume 137, Issue 3, March 2009, Pages 664-669
Eur J Cardiothorac Surg 2001;20:1095-1100
Anesth Analg 2009; 109:1511-1516
© 2009 International Anesthesia Research Society
Source: British Journal of Surgery, Volume 84, Number 12, December 1997 , pp. 1702-1704(3)
Publisher: John Wiley & Sons, Ltd.
Medical Devices & Surgical Technology Week. Atlanta: Sep 6, 2009. pg. 203
Heather Ennis. Medical Post. Toronto: Feb 15, 2005. Vol. 41, Iss. 7; pg. 17, 2 pgs
mechanisms. The first of these mechanisms is denervation hypersensitivity of the
surgically injured distal sympathetic stump. This could explain why CH may appear
soon after sympathectomy, but is not found in patients who undergo local excision of
axillary sweat glands or undergo local treatment. Another mechanism is regeneration
of preganglionic fibers or collateral sprouting of sympathetic fibers from the proximalstump of the sympathetic trunk. This could explain the long-termexistence
Ann Thorac Surg 2001;72:667-668
autonomic neuropathy in which the sympathetic nerve function has been divided into two distinct regions
A severe form of CS is the split-body syndrome, corposcindosis, which is deﬁned as an
autonomic neuropathy in which the sympathetic nerve function has been divided into two distinct regions, one dead and the other hyperactive. In these cases, the patient feels like he or she is living in two separate bodies.
The rates of CS in some series from the past 10 years are summarized in Table 4, with rates of mild CS varying from 14% to 90% and severe CS from 1.2% to 30.9%.
Some investigators only report on patients who have severe CS because they believe that almost all patients develop mild CS after sympathectomy.
Pascal DUMONT Thorac Surg Clin 18 (2008) 193–207
26.3% or one quarter of patients with compensatory hyperhidro- sis considered the complication major and disabling
Irrespective of approach, two or more levels of denervation and removal of the stellate ganglion produced noticeably higher incidence. Finally, the incidence of this complication seemed to be 3 times higher when the surgery was performed for primary hyperhidrosis than neuropathic pain.
The weighted mean incidence of gustatory sweating after upper extremity surgical sympathectomy was 32.3% (range 0-79) (information retrieved from 44 papers and 5,142 patients)
The phenomenon appeared on average 5 months after surgery. The weighted means appeared substantially greater when the open approach was used, two or more levels were denervated, the chain was electrocoagulated but left in situ and primary hyperhidrosis was the indication for the intervention.
The weighted mean incidence of phantom sweating was 38.6 %
The weighted mean incidence of neuropathic pain complications was 11.9% .
I S I S
Volume 4 Number 2
Summer Issue 2001
Botulinum toxin treatment for a compensatory hyperhidrosis subsequent to an upper thoracic sympathectomy
Compensatory hyperhidrosis is the commonest complication of sympathectomy, but there's no known effective treatment.
METHODS: Botulinum toxin type A was used successfully to treat a 68-year-old male with a 5-year history of compensatory hyperhidrosis of the anterior chest following thoracic sympathectomy for palmar hyperhidrosis.
J Dermatolog Treat. 2002 Jun;13(2):91-3.
Mia: Control of the palmar HH is considerably easier (cheaper, and smaller surface area) than the are of the chest. The so called "compensatory sweating" can also occur on the entire lower body and limbs. To use surgery as a first line treatment and then having to inject Botox to treat the side-effects od an elective procedure is close to medical negligence.
Sunday, January 30, 2011
Australian Review of ETS surgery, 2009 "A lack of high quality randomised trial evidence on ETS means that it is difficult to make a judgment on the safety and effectiveness of this technique. There is potentially a number of safety issues associated with this procedure. ASERNIP-s suggests that a full systematic review including all available comparative and case series information, together with clinical inpuut, should be undertaken to provide up-to-date and comprehensive assessment of the safety and effectiveness of ETS." (ASERNIP-s Report No. 71, August 2009)
Australian Review of ETS surgery - 2001The four case series were not critically appraised because they are prone to bias and have significant methodological problems. These studies represent level IV evidence according to the NHMRC criteria and one should not draw firm conclusions from their findings.
To date, the benefits or side effects associated with endoscopic thoracic sympathectomy for treating facial blushing have not been properly evaluated and reported.
Further research using a well-designed controlled trial is warranted to assess the efficacy of endoscopic thoracic sympathectomy for treating facial blushing.
Centre for Clinical Effectiveness - Monash
Swedish ReviewThe findings by SBU Alert show that poor* evidence is available about ETS as regards side effects, risks, and short-term effects. There is no* scientific evidence demonstrating the long-term results of the method or its cost effectiveness in relation to other methods.
(Swedish Council on Technology Assessment in Health Care (SBU), the Medical Products Agency, the National Board of Health and Welfare, and the Federation of Swedish County Councils.
Published: 1999-08-30 Revised: 2002-09-30