GAP-43 mRNA and calcitonin gene-related peptide mRNA expression in sensory neurons are increased following sympathectomy

Sympathectomy has been shown to result in an increased density of fibers immunoreactive for sensory peptides in peripheral targets innervated by both sensory and sympathetic neurons, providing evidence for functional interactions between sympathetic and sensory systems. These findings provided the background for examining the hypothesis that axonal outgrowth is induced from sensory neurons following sympathectomy. We examined the expression of GAP-43 mRNA, a specific marker for axonal outgrowth, in cervical (C3, C7, C8) and thoracic (T1, T2) dorsal root ganglia (DRG) of the rat following bilateral removal of the superior cervical ganglion, to assess whether the described increases in peptidergic afferent fibers reflected axonal outgrowth. In situ hybridization was used with ³⁵S labeled riboprobes complementary to GAP-43 mRNA, and to calcitonin gene-related peptide (CGRP) mRNA, a marker for a major subset of thin-fiber sensory neurons. The density of GAP-43 mRNA nearly doubled by 18 h following sympathectomy and reached a threefold increase by 3 days. By 45 days following surgery, the GAP-43 mRNA level was still nearly twice that of normal animals. CGRP immunoreactivity was also examined: the density of fibers in the iris and cornea of sympathectomized animals was considerably greater from two weeks to 45 days following surgery, than in sham-operated controls. Concomitantly, there was a slight but significant increase in CGRP mRNA expression in T1 and C3 DRG 14 days post

http://www.refdoc.fr/Detailnotice?idarticle=15110598

numbness and dysesthesia

After a mean of 123 mo 36 patients could be re-evaluated. Eighteenpatients (50%) were free from former symptoms, while sequels were still present in 18 patients (50%).

Numbness and paresthesia are rarely reported in the literature but are present in up to 10% of patients 1 year after a thoracoscopic procedure[2,9]. It is known that numbness and dysesthesia may decrease by time, but long-term results are not known.

Early postoperative sequels are frequently found in VATS procedures, but patients with pain even after years have a nearly 50% chance to eliminate their problems. In addition, numbness and dysesthesia seem to disappear almost completely several years after the procedure.

http://www.ejcts.ch/cgi/content/full/32/3/409

postsympathectomy neuralgia is frequent

Surgical sympathectomy has a long heritage for the treatment of peripheral vascular disease and various chronic pain problems.

Despite concerns expressed as long ago as 1942 about the efficacy of surgical sympathectomy for the management of non-cancer pain, the procedure was enthusiastically pursued for the management of reflex sympathetic dystrophy or complex regional pain syndrome (CRPS), migraine, dysmenorrhea, epilepsy, chronic pancreatitis, postherpetic neuralgia of the trigeminal nerve, postdiscectomy syndrome, and phantom limb pain. However, systematic reviews have found no tangible evidence supportive of sympathectomy for the management of neuropathic pain. Furthermore, postsympathectomy neuralgia is a common complaint with a reported incidence between 15% to 50%.

Bonica's Management of Pain,

Lippincott Williams & Wilkins, 2009 - 2064 pages

Sympathectomy induces adrenergic excitability of cutaneous C-fiber nociceptors

http://www.ncbi.nlm.nih.gov/pubmed/8822575

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

pH changes in synovial fluid following perivascular sympathectomy

Proc Inst Med Chic. 1947 Nov 15;16(17):465.

http://www.ncbi.nlm.nih.gov/pubmed/18896440

The nerve endings in Schwann cells under the endothelium degenerated after sympathectomy

ep.physoc.org/content/52/1/31.full.pdf

Indeed, local sympathectomy influences specific responses in immune organs

Brain Research
Volume 888, Issue 2, 12 January 2001, Pages 227-234

The T1 and T2 segments innervate the head and neck; T2 through T6 segments, the upper extremities and thoracic viscera

Basic neurosciences with clinical applications
By Eduardo E. Benarroch, Elsevier Health Sciences, 2006

Differences in the injury/sprouting response

While increased hilar and decreased distal NA innervation in arthritic rats was strikingly similar to that of non-arthritic 6-OHDA-treated rats, there were differences in splenic compartments innervated by sympathetic nerves between these groups. In 6-OHDA-treated rats, NA nerves re-innervated splenic compartments normally innervated by sympathetic nerves. In arthritic rats, sympathetic nerves returned to normally innervated splenic compartments, but also abundantly innervated red pulp. These findings suggest that splenic sympathetic nerves undergo a disease-associated injury/sprouting response with disease development that alters the normal pattern and distribution of NA innervation. The altered sympathetic innervation pattern is likely to change NA signaling to immune cell targets, which could exert long-term regulatory influences on initiation, maintenance, and resolution of immune responses that impact disease pathology.
Brain, Behavior & Immunity; Feb2009, Vol. 23 Issue 2, p276-285, 10p

Phantom sweating occurs frequently after sympathectomy

To describe the biology of phantom sweating, a novel autonomic neuropathy symptom, based on a description of a patient with a small fiber and autonomic neuropathy. Clinical and laboratory assessments. Evidence of a generalized small fiber and autonomic neuropathy. Phantom sweating occurs frequently after sympathectomy but has not been reported previously in patients with a somatosensory or autonomic neuropathy. We suggest that this symptom is an autonomic paresthesia.
Clinical Autonomic Research; Dec2008, Vol. 18 Issue 6, p352-354, 3p,

animals that underwent late sympathectomy had significantly increased arthritis scores compared with controls

Arthritis & Rheumatism; Apr2005, Vol. 52 Issue 4, p1305-1313, 9p

marked changes in the nerves that remain

In the lung, sympahtectomy induces a marked increase in CGRP-immunoreactive nerve density around the ariways, blood vessels, and also in the vicinity of the neuroepithelial bodies of the pulmonary epithelium.

Following transection of the preganglionic autonomic nerves or in spinal cord injury, there are marked changes in the nerves that remain. Such changes can be manifested not only as nerve growth and changes in neurotransmitter expression, but remarkably, in reorganization of nerve pathways and their function.

Since sprouting is a common response of the nerves that remain following nerve injury, the close association of the different divisions of the autonomic nervous system in the pelvic region opens up the possibility for new connections to form new pathways. Spinal cord injury can unmask spinal reflexes that are normally inhibited by input from higher centers in the brain.

Handbook of the autonomic nervous system in health and disease

By Liana Bolis, J. Licinio, Stefano Govoni
Informa Health Care, 2003 - Medical - 677 pages

sympathectomy per se may sensitize peripheral nociceptors and lead to neuralgia

Interestingly, while is used for the treatment of some chronic pain conditions, sympathectomy per se may sensitize peripheral nociceptors to circulating norephinephrine, and this sensitization may lead to post-sympathectomy neuralgia. (p.287)

Peripheral Receptor Targets for Analgesia: Novel Approaches to Pain Management

By Brian E. Cairns
John Wiley and Sons, 2009 - Medical

Cutaneous innervation in man before and after lumbar sympathectomy: Evidence for interruption of both sensory and vasomotor nerve fibres

Coventry, Brendon John Walsh, J. A.
Citation:	ANZ Journal of Surgery, 2003; 73 (1-2):14-18
Publisher:	Blackwell Science Asia
Issue Date:	2003

Sympathicotomy affects cutaneous blood flow, temperature, and sympathicus-mediated reflexes

Complex autonomic reflexes are also affected. The patient should be completely informed before surgery of the side effects elicited by TES.

http://www.ncbi.nlm.nih.gov/pubmed/18540897

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

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

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

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

Autonomic neuropathy simulating the effects of sympathectomy

Odel, H. M., Roth, G. M., and Keating, F. R., Jr. (1955). Autonomic neuropathy simulating the effects of sympathectomy as a complication of diabetes mellitus. Diabetes, 4, 92-98.

Surgery for hyperhidrosis abolished 6-sulphatoxymelatonin excretion

The amount of 6-sulphatoxymelatonin, the chief metabolite of melatonin, in the urine was measured in nine patients, who were subjected to bilateral sympathectomy at the second thoracic ganglionic level for treatment of hyperhidrosis of the palms.
All patients showed before surgery a normal 6-sulphatoxymelatonin excretion with a peak in the excretion during the night time. After the sympathectomy, the high night time excretion was clearly abolished in five patients but remained high in four patients. This indicates that the segmental locations of the preganglionic sympathetic perikarya in the spinal cord, stimulating the melatonin secretion in the pineal gland in humans, vary between individuals. An increase in daytime melatonin excretion was observed in the patients responding to the sympathectomy with an abolished 6-sulphatoxymelatonin rhythm. This increase could indicate that the final sympathetic neurons innervating the pineal gland might have a both stimulatory and inhibitory function.
Molecular and Cellular Endocrinology
Volume 252, Issues 1-2, 27 June 2006, Pages 40-45

Sudomotor dysfunction in autoimmune autonomic ganglionopathy

http://www.ncbi.nlm.nih.gov/pubmed/19884578

Other alternative more selective methods, rather than cutting the main trunk should be studied

Compensatory sweating remains the most common, and most disabling complication of video-assisted thoracoscopic sympathectomy. Other alternative more selective methods, rather than cutting the main trunk should be studied thoroughly to assess their efficacy in reducing the complication of compensatory sweating.
http://www.ncbi.nlm.nih.gov/pubmed/18521466

Evidence: sympathectomy created imbalance of autonomic activity and functional changes of the intrathoracic organs

Surgical thoracic sympathectomy such as ESD or heart transplantation can result in an imbalance between the sympathetic and parasympathetic activities and result in functional changes
in the intrathoracic organs.
Therefore, the procedures affecting sympathetic nerve functions, such as epidural anesthesia, ESD, and heart transplantation, may cause an imbalance between sympathetic and parasympa-
thetic activities (1, 6, 16, 17). Recently, it has been reported that ESD results in functional changes of the intrathoracic organs.


In conclusion, our study demonstrated that ESD adversely affected lung function early after surgery and the BHR was affected by an imbalance of autonomic activity created by bilateral ESD in patients with primary focal hyperhidrosis.
Journal of Asthma, 46:276–279, 2009

Evidence: sympathectomy created imbalance of autonomic activity and functional changes of the intrathoracic organs

Surgical thoracic sympathectomy such as ESD or heart transplantation can result in an imbalance between the sympathetic and parasympathetic activities and result in functional changes
in the intrathoracic organs.
Therefore, the procedures affecting sympathetic nerve functions, such as epidural anesthesia, ESD, and heart transplantation, may cause an imbalance between sympathetic and parasympa-
thetic activities (1, 6, 16, 17). Recently, it has been reported that ESD results in functional changes of the intrathoracic organs.


In conclusion, our study demonstrated that ESD adversely affected lung function early after surgery and the BHR was affected by an imbalance of autonomic activity created by bilateral ESD in patients with primary focal hyperhidrosis.
Journal of Asthma, 46:276–279, 2009

sympathectomy significantly increased the ratio of patients exhibiting a positive response to methacholine

Of 46 patients who had a negative result for methacholine challenge preoperatively, 12 (26%) became positive after surgery. In terms of the level of sympathectomy, T3 sympathectomy significantly increased the ratio of patients exhibiting a positive response to methacholine (from 19% to 34%, respectively) (p < 0.005).
Conclusions. Thoracic sympathectomy can adversely affect lung function early after surgery, although the clinical significance is uncertain. It may also exert an influence on the development of bronchial hyperresponsiveness, especially when performed at the T3 level.
Journal of Asthma, 46:276–279, 2009

TNF at a site of immunological injury may lead to chronic activation of innate immune cells and to chronic inflammatory responses

There is now good evidence to demonstrate that aberrations in tumour necrosis factor (TNF) production in vivo may be either pathogenic or protective and several plausible mechanisms may explain these contrasting activities. According to the classic pro-inflammatory scenario, failure to regulate the production of TNF at a site of immunological injury may lead to chronic activation of innate immune cells and to chronic inflammatory responses, which may consequently lead to organ specific inflammatory pathology and tissue damage.
http://www.ncbi.nlm.nih.gov/pubmed/10577971

Alterations in cytokine and antibody production following chemical sympathectomy

It is becoming clear that immune responses are subject to modulation by thesympathetic nervous system. We examined the effect of chemicalsympathectomy (to ablate peripheral sympathetic nerve fibers) on cytokine and Ab production in two strains of mice that are known to differ in their response to a variety of pathogens and in the dominant types of cytokines produced. C57Bl/6J mice produce a strong cell- mediated response, characterized by production of IL-2 and IFN-gamma, whereas BALB/cJ have a dominant humoral response, with production of IL- 4 and IL-10. Animals were denervated by injection with 6- hydroxydopamine and immunized with keyhole limpet hemocyanin, and spleens were removed at various times after immunization. Denervation significantly increased the keyhole-limpet-hemocyanin-stimulated in vitro proliferation and IL-2 and IL-4 production by splenocytes from both strains.
http://www.jimmunol.org/cgi/content/abstract/155/10/4613

cytokines mediate and control immune and inflammatory responses

Under certain conditions, however, stress hormones may actually facilitate inflammation through induction of interleukin (IL)-1, IL-6, IL-8, IL-18, tumor necrosis factor-alpha and C-reactive protein production and through activation of the corticotropin-releasing hormone/substance P-histamine axis. Thus, a dysfunctional neuroendocrine-immune interface associated with abnormalities of the 'systemic anti-inflammatory feedback' and/or 'hyperactivity' of the local pro-inflammatory factors may play a role in the pathogenesis of atopic/allergic and autoimmune diseases, obesity, depression, and atherosclerosis. These abnormalities and the failure of the adaptive systems to resolve inflammation affect the well-being of the individual, including behavioral parameters, quality of life and sleep, as well as indices of metabolic and cardiovascular health.
http://www.ncbi.nlm.nih.gov/pubmed/16166805

Sympathectomy induces adrenergic excitability of cutaneous C-fiber nociceptors

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

nerve damage causes an inflammatory response

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

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

82.9% Were Disturbed Because CS Was More Than Expected

However, compensatory sweating (CS) developed in 97.1% of the patients, and 82.9% answered that they were disturbed because it was more than they had expected. This result makes us realize further the importance of preoperative informed consent for CS. The problem of palmar hyperhidrosis is very serious for patients, and hence it is important to give treatment with a thorough understanding of the effectiveness and problems of ETS for palmar hyperhidrosis according to the analytical results of this questionnaire.
http://ci.nii.ac.jp/naid/110006980508/en

An Ultrastructural Study - effects of Preganglionic Sympathectomy

The ultrastructure of satellite cells of the rat superior cervical ganglion was studied following preganglionic sympathectomy. Several distinct morphological alterations were observed: (a) enlargement of the intercellular space between the ganglion cells and the satellite cells, (b) dilation of the granular endoplasmic reticulum and loss of attached ribosomes, and (c) swelling of the mitochondria with disorganization of the cristae mitochondriales. The presence of degenerating nerve fibers and synaptic boutons was also noted.

Journal of Neural Transmission 38, 43--57 (1976)

lesser (sic!) imbalance of the autonomic nervous system

Ramicotomy is a surgical procedure, with less adverse effects than conventional sympathectomy, however, it was abandoned due to the high recurrence rate.

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.

lead to hyperfunction of the serotoninergic system and pathology

We studied the balance of activity of sympathetic, parasympathetic, and serotoninergic divisions of the autonomic nervous system in the regulation of the heart function in rabbits. High activities of the sympathetic and parasympathetic system are associated with antagonistic interactions between them. Moderation of activity of these systems could be accompanied by activation of the serotoninergic system. Physiological sympathectomy and parasympathectomy lead to hyperfunction of the serotoninergic system and pathology.

Bulletin of Experimental Biology and Medicine, Vol. 140, No. 5, 2005 PHYSIOLOGY

Sympathectomy = autonomic neuropathy

A number of papers have been published which
stressed [22-24] the high failure rate of sympathecto-
my operations in diabetics. We believe that the failure
of the operation is due to the fact that diabetic auto-
nomic neuropathy has already sympathectomized the
patient. The results of the present study are compati-
ble with this idea. It is also of interest that the histolog-
ical abnormalities found in the present study are simi-
lar to those described in the bladder [15], in the corpo-
ra cavernosa [16] and in the myocardium [17], all of
which are typical sites of diabetic autonomic neuro-
pathy. Thus, autonomic neuropathy is a very com-
mon feature in diabetes and an important back-
ground to the development of other complications.
For example, although the chronic dryness of the skin
is rarely troublesome for the patient, it may lead to
skin shrinkage and cracking which may, in turn, pre-
dispose to infection.

Diabetologia, Volume 22, Number 2 / February, 1982

Effect of sympathetic denervation on the rate of protein synthesis in rat skeletal muscle

Soleus isolated after 2 and 4 days of chemical sympathectomy or after 3 days of lumbar denervation showed a 17–20% statistically significant decrease in in vitro rates of protein synthesis.
American Journal of Physiology: Endocrinology & Metabolism; Apr2004, Vol. 49 Issue 4, pE642-E647, 6p

Immunoglobulin producing cells in the rat dental pulp after unilateral sympathectomy.

Sympathectomy results in recruitment of cells expressing κ and λ light chains into the dental pulp (P=0.005). Electron microscopy revealed these cells to be mainly plasma cells and Mott cells. We conclude that neural imbalance caused by unilateral sympathectomy recruits immunoglobulin producing cells in the dental pulp. Our results are in agreement with a model of immune regulation in which the sympathetic nervous system exerts a tonic regulatory effect over lymphocyte proliferation and migration. [Copyright &y& Elsevier]
Neuroscience; Jan2006, Vol. 136 Issue 2, p571-577, 7p

Anti-inflammatory role of sympathetic nerves in chronic intestinal inflammation

Sympathectomy reduced acute DSS colitis but increased chronic DSS colitis.Sympathectomy also increased chronic colitis in II10^-/- mice. Conclusions: This study demonstrated a loss of sympathetic and an increase of SP⁺ nerve fibres in Crohn's disease. SEMA3C, a sympathetic nerve repellent factor, is highly expressed in the epithelium of Crohn's disease patients. In chronic experimental colitis, the sympathetic nervous system confers an anti-inflammatory influence. Thus, the loss of sympathetic nerve fibres in the chronic phase of the disease is most probably a pro-inflammatory signal, which might be related to repulsion of these fibres by SEMA3C and other repellents.
Straub, R. H.¹ rainer.straub@klinik.uni-regensburg.de
Gut; Jul2008, Vol. 57 Issue 7, p911-921,

Similar pathological effects of sympathectomy and hypercholesterolemia on arterial smooth muscle cells and fibroblasts

(FA) but not the basilar (BA) artery from non-pathological rabbits manifests migration of adventitial fibroblasts (FBs) into the media and loss of medial smooth muscle cells (SMCs). The aim of the present study was to verify whether similar behaviour of arteries occurred in the pathological context of atherosclerosis. Thus, similar experiments were conducted on hypercholesterolemic rabbits, which were chemically sympathectomized with 6-hydroxydopamine (n=4) or treated with vehicle for control (n=5).

Both intact and sympathectomized BA and FA developed atherosclerotic plaques, but the thickening of the intima was more advanced in sympathectomized animals, as judged by increased plaque frequency and by the phenotypic modulation of SMCs in the intima. Our results show that in the media of FAs hypercholesterolemia induces changes similar to those observed in sympathectomized rabbits in non-pathological conditions, i.e., migration of adventitial FBs to the media and loss of medial SMCs. These latter changes, which can be ascribed to pathological events, were accentuated aftersympathectomy in the hypercholesterolemic rabbits. The present study reveals that pathological events, including migration and phenotypic modulation of vascular FBs and loss of SMCs, may be under the influence of sympathetic nerves.

Acta Histochemica; Jul2008, Vol. 110 Issue 4, p302-313, 12p

About 40% of ETS2 groups and 25% of ETS3 group patients were unsatisfied with their operation

(Surgery 2008;143:784-9.)

Thoracoscopic Sympathectomy at the T2 or T3 Level Facilitates Bradykinin-Induced Protein Extravasation in Human Forearm Skin

The endogenous peptide bradykinin (BK) is an inflammatory mediator that induces nociceptor activation and sensitization as well as protein extravasation and vasodilation.

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,*^† Nicola Meyer, MD, ^† Andreas Bickel, MD, ^† Christoph H.Schick, MD, ^‡§ Sophie Krüger, MD, ^§ Martin Schmelz, MD, ^¶ and Frank Birklein,MD**

Pain Medicine

Published Online: 1 Mar 2010

© 2010 American Academy of Pain Medicine

Chest wall paresthesia affects a significant but previously overlooked proportion of patients

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, but has minimal impact on post-operative satisfaction. Needlescopic VATS offers no apparent advantage over conventional VATS with regard to paresthesia.

http://www.ncbi.nlm.nih.gov/pubmed/15691688?dopt=Abstract

more likely to develop autoimmune disorders after sympathectomy

page 71:
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

No increase in muscle blood flow following sympathectomy

Recent evidence suggests that this increase in total blood flow represents, in the main, arteriovenous shunting with little, if any, effect on the nutritive blood flow at the tissue level. Studies aimed at investigating the effect of lumbar sympathectomy on regional tissue circulation have utilized the local clearance of radioactive isotopes. No significant change in the clearance of these substances in muscle have been noted following lumbar sympathectomy in man. However, the data on skin clearance remains conflicting.
Vascular and Endovascular Surgery, Vol. 6, No. 5, 227-238 (1972)
http://ves.sagepub.com/cgi/pdf_extract/6/5/227

sympathectomy causes qualitative alterations in bone modeling and remodeling

The results further support that a regional sympathectomy causes qualitative alterations in bone modeling and remodeling, leading to bone resorption.
J Auton Nerv Syst. 2000 Jan 14;78(2-3):113-6.

Carbon dioxide absorption into the blood during thoracoscopic surgery

Respiratory function and pulmonary gas exchange are affected in thoracoscopic procedures where a pneumothorax is introduced using CO2. Carbon dioxide absorption into the blood during thoracoscopic surgery using intrathoracic carbon dioxide insufflation may lead to respiratory acidosis, increased ventilation requirements, and possible serious cardiovascular compromise.
http://www.koreamed.org/SearchBasic.php?RID=173908&DT=1

lactic acidosis, complication of thoracoscopic sympathectomy

We report a case of severe lactic acidosis in a patient undergoing thoracoscopicsympathectomy under general anesthesia who received repeated albuterol.
Lactic acidosis can occur in two different clinically distinguishable categories. The first (type A) occurs when oxygen delivery to the tissues is compromised. The second (type B) occurs when either lactate production is increased or lactate removal is decreased without obvious oxygen delivery problems. ^7,8
β-2 Receptor activation produces excess glycogenolysis and lipolysis. ¹⁰Increased glycogenolysis eventually leads to increased concentrations of pyruvate. Pyruvate is converted to acetyl CoA, which enters the citric acid cycle. If pyruvate does not enter this aerobic pathway, it is converted to lactate instead, thereby potentially causing lactic acidosis.
journals.lww.com › Home › August 2003 - Volume 99 - Issue 2

sympathectomy further increases muscle protein degradation of acutely diabetic rats

Muscle & Nerve

Volume 38 Issue 2, Pages 1027 - 1035

Permanent pain following sympathectomy

The mean inpatient pain scores were significantly higher in the biportal group (1.2±0.6) than that in the uniportal group (0.8±0.5, P=0.025). For the first three weeks after operation, four out of 20 (20%) patients in the uniportal group constantly suffered from mild or moderate residual pain while eight out of 25 (32%) cases in the biportal group (P=0.366). Among them, two cases in the uniportal group and five cases in the biportal group need to take analgesics.
Chinese Medical Journal, 2009, Vol. 122 No. 13 :

three-phase bone scan (TPBS) after sympathectomy are identical to those reported in early RSD

Three-phase bone scan (TPBS) after sympathectomy are identical to those reported in early RSD and these alterations bear no relationship to the success of sympathectomy regarding pain relief. The mechanisms underlying alterations of TPBS as well as the potential mechanisms of sympathectomy failures are discussed.
The Clinical Journal of Pain: June 1994 - Volume 10 - Issue 2

marked dysaesthesia over the front of the chest and in the axilla

Thirty-five patients were followed up after an average of 7.8 years (range 2-17 years). In one patient unilateral reoperation was carried out four months after the first operation. Since the first operation 34 patients had suffered from neither palmar nor axillary sweating. However 20 had permanent compensatory hyperhidrosis, and 15 suffered from gustatory facial sweating, which had usually started within six months of operation. Four, in whom two spinal thoracic nerves had also been resected, reported marked dysaesthesia over the front of the chest and in the axilla, lasting for several years.
http://www.ncbi.nlm.nih.gov/pubmed/1114879

The results of endoscopic sympathectomy deteriorate progressively from the immediate outcome

The results of endoscopic sympathectomy deteriorate progressively from the immediate outcome.

British Journal of Surgery

Volume 86 Issue 1, Pages 45 - 47

Published Online: 2 Jan 2003

phantom sweating - autonomic neuropathy symptom

Phantom sweating is a sensation in which the patient feels that sweat is about to burst out of skin pores, but in which sweating never actually occurs. In a series of 100 patients undergoing bilateral upper dorsal sympathectomy for palmar hyperihidrosis, 82 patients were specifically questioned and 48 (59%) reported phantom sweating. Phantom sweating started soon after the operation, was triggered by the same stimuli that caused hyperhidrosis preoperatively, lasted for a few seconds, and tended to diminish with time. In an average follow-up of 18 months, the phenomenon disappeared in 11 patients (23%). Phantom sweating is probably a symptom of residual sympathetic activity.
http://www.ncbi.nlm.nih.gov/pubmed/911065
Angiology. 1977 Nov;28(11):799-802.

Cervical sympathectomy causes alveolar bone loss

Both superior cervical ganglionectomy and oral challenge with P. gingivalisresulted in accelerated alveolar bone loss. Gingival tissues in the superior cervical ganglionectomy group showed increased expression of the cytokines interleukin-1alfa, tumor necrosis factor-alfa and interleukin-6. The density of neuropeptide Y-immunoreactive fibers was decreased following superior cervical ganglionectomy. Osteoclasts were observed in the superior cervical ganglionectomy and P. gingivalis-challenged groups. Conclusion:  Both superior cervical ganglionectomy and oral challenge with P. gingivalis induced alveolar bone loss.

http://www.ingentaconnect.com/content/mksg/per/2009/00000044/00000006/art00002

73% of patients suffered form 'gustatory sweating' and variety of phenomena

In a series of 100 bilateral upper dorsal sympathectomies performed for palmar hyperhidrosis,
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.

subclavian artery injury, damage to brachial plexus, large hemothorax, cerebral edema, neurologic sequelae, sinus bradycardia, and cardiac arrest

The results and complication rates have not necessarily been similar in reports worldwide. This can be explained in part due to the lack of clear-cut definitions for the indications, success, complications, side effects, and short- and long-term follow-up data of the procedures. It is well known that sympathectomy is often complicated by CH; the reported incidence rates vary greatly from 30% to 84% [15]. In our series it has been noted in 62.5% of the patients (26.5% moderate and 36% intense).

Although VATS sympathectomy is a simple and quick procedure, unusual complications such as chylothorax may occur [16]. 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

Compensatory sweating occurred in 87% of the patients - serious in 36% and incapacitating in 6%

Ann Thorac Surg. 2004 Nov;78(5):1801-7.

The rates of compensatory sweating and gustatory sweating were 93.5% and 49.4%, respectively

Surgical Endoscopy
Volume 23, Number 7 / July, 2009

90 % of patients experienced severe compensatory sweating

Surg Laparosc Endosc Percutan Tech. 2000 Aug;10(4):226-9.

sympathectomy induces several biochemical changes in skeletal muscle

It is concluded that sympathectomy induces several biochemical changes in skeletal muscle which constitute a change and increase in fast myosin light chain synthesis and a corresponding fibre type transformation."

Journal: Clinical physiology (Oxford, England) (Clin Physiol), published in ENGLAND.

Reference: 1988-Apr; vol 8 (issue 2) : pp 181-91

Dysregulation of the autonomic nervous system can be a link between visceral adiposity and insulin resistance.

Obes Res. 2005 Apr;13(4):717-28.

Lindmark S, Lönn L, Wiklund U, Tufvesson M, Olsson T, Eriksson JW. Department of Medicine, Umeå University Hospital, S-901 85 Umeå, Sweden. stina.lindmark@medicin.umu.se

sympathectomy tended to accelerate the sclerodermatous and trophic ulcerative processes

by RJ Calvert - 1955

alterations in the relative abundance of TH mRNA mediate changes in TH activity induced by chronic stress or sympathectomy

These results indicate that alterations in the relative abundance of TH mRNA mediate changes in TH activity induced by chronic stress or sympathectomy, and that these changes require an intact sympathetic input.

Journal of Neuroscience Research

Volume 16 Issue 1, Pages 13 - 24

Published Online: 11 Oct 2004

peripheral sympathetic denervation may modulate immune function via activation of the hypothalamic-pituitary-adrenal (HPA) axis

Together, these findings suggest that peripheral sympathetic denervation may modulate immune function via activation of the hypothalamic-pituitary-adrenal (HPA) axis.

Ann N Y Acad Sci. 2000;917:923-34.

Increasing evidence suggests that the detrimental effects of glucocorticoid (GC) hypersecretion occur by activation of the hypothalamic-pituitary-adrenal (HPA) axis in several human pathologies, including obesity, Alzheimer's disease, AIDS dementia, and depression. The different patterns of response by the HPA axis during chronic activation are an important consideration in selecting an animal model to assess HPA axis function in a particular disorder.

Detrimental effects of chronic hypothalamic-pituitary-adrenal axis activation. From obesity to memory deficits
Raber J Mol Neurobiol 1998 Aug; 18(1): 1-22

83% of patients reported severe 'compensatory sweating'

Fully 83% of patients who underwent T2 sympathectomy reported severe compensatory sweating one year after surgery and the majority of those reported they regretted the decision to have the surgery.
Heather Ennis. Medical Post. Toronto: Feb 15, 2005. Vol. 41, Iss. 7; pg. 17, 2 pgs

sympathectomy increased the bacterial tissue burden

sympathectomy increased the bacterial tissue burden, which was caused by a reduction in corticosterone tonus, and decreased both interleukin-4 secretion from peritoneal cells and the influx of lymphocytes into the peritoneal cavity. In both models, the peritoneal wall was the critical border for systemic infection. These results show the dual role of the sympathetic nervous system in sepsis. It can be favorable or unfavorable, depending on the innate immune effector mechanisms necessary to overcome infection.
The Journal of Infectious Diseases. Chicago: Aug 15, 2005. Vol. 192, Iss. 4;pg. 560, 13 pgs

Laparoscopic surgery is associated with an increased incidence of postoperative atelectasis

Atelectasis occurs regularly after induction of general anesthesia, persists postoperatively, and may contribute to significant postoperative morbidity and additional health care costs. Laparoscopic surgery has been reported to be associated with an increased incidence of postoperative atelectasis.
Anesth Analg 2009; 109:1511-1516
© 2009 International Anesthesia Research Society

The results further support that a regional sympathectomy causes qualitative alterations in bone modeling and remodeling, leading to bone resorption

Journal of the Autonomic Nervous System
Volume 78, Issues 2-3, 14 January 2000, Pages 113-116

Sympathectomy-induced alterations of immunity

Many studies have demonstrated that ablation of the sympathetic nervous system (SNS) alters subsequent immune responses. Researchers have presumed that the altered immune responses are predominantly the result of the peripheral phenomenon of denervation.
Activation of the CNS was determined by immunocytochemical visualization of Fos protein in brains from male C57BL/6 mice at 8, 24, and 48 h following denervation. A dramatic induction of Fos protein was found in the paraventricular nucleus (PVN) of the hypothalamus and other specific brain regions at 8 and 24 h compared to vehicle control mice. Dual-antigen labeling demonstrates that corticotrophin releasing factor (CRF)-containing neurons in the PVN are activated by chemical sympathectomy; however, neurons containing neurotransmitters which may modulate CRF neurons, such as vasopressin, tyrosine hydroxylase, and adrenocorticotropin, do not coexpress Fos. Our findings suggest an involvement of the CNS in sympathectomy-induced alterations of immunity.
Tracy A. Callahan, Jan A. Moynihan and Diane T. Piekut
Brain, Behavior, and Immunity
Volume 12, Issue 3, September 1998, Pages 230-241

sympathectomy can itself trigger a painful syndrome

Furthermore, surgical sympathectomy can itself trigger a painful syndrome in some patients.

Pain Medicine: the requisites in anesthesiology

By Stephen E. Abram

Elsevier Health Sciences, 2006

Injury of peripheral nerves often results in hyperalgesia

School of Anatomy, University of NSW, Sydney

Brain Research

Volume 669, Issue 2, 16v January 1995, Pages 245-254

Surgical or chemical sympathectomy leads to suppression of adrenergic and neuropeptide Y fibers

Clinical Anatomy of the NOse, Nasal Cavity and Paranasal Sinuses

By Johannes Land

Published by Thieme, 1989

disturbances in the sympathetic regulation of the peripheral blood flow

Compared with these normal subjects, four patients operated on with transthoracic endoscopic sympathectomy due to hand hyperhidrosis showed clearly attenuated responses.

The results indicate that the test can be used to assess disturbances in the sympathetic regulation of the peripheral blood flow.

Clinical Physiology; Mar 1998, Vol.18 Issue 2, p103-107, 5p

blockade of the sympathetic nervous system substantially degrades ligament

J Appl Physiol 96: 711-718, 2004

Neuroma following nerve injury/surgery

When a nerve is cut, the piece of nerve that is beyond the cut point eventually dies, however, its Schwann cells, the cells that encircle the nerve fibers remain for a much longer time. These Schwann cells secrete a chemical messenger known as nerve growth factor that tells the cut end of nerve where to grow back. So the cut end of nerve will send out multiple sprouts in the direction of the nerve growth factor, however, these sprouts do not go out in an orderly manner, instead they grow out in all directions and eventually cluster and form a knot of nerve fibers. This eventually leads to the formation of a TRUE neuroma or a END BULB or STUMP neuroma.

www.tarsaltunnelcenter.com/assets/recurrent.shtml

Sympathectomy induces adrenergic excitability of cutaneous C-fiber nociceptors

Journal of Neurophysiology, Vol 75, Issue 1 514-517, Copyright © 1996 by APS

The induction of adrenergic excitability in CPMs by sympathectomy is suggested to be a counterpart to postsympathectomy neuralgia in human beings and a possible part of the mechanism leading to sympathetically related pain states.

plasma levels of natriuretic peptides in response to sympathectomy

The occurrence of receptor binding sites for natriuretic peptides was examined by in vitro receptor autoradiography. In contrast to the marked occurrence of natriuretic peptide receptor binding sites seen in the ventricular endocardium of control rats, the sympathectomized rats exhibited a decreased number of binding sites for natriuretic peptides in the endocardium of both the right and left chambers. Interestingly, this was found in parallel with a significant decrease of systolic and diastolic blood pressure and increased plasma levels of pro-atrial natriuretic peptide in the treated group of rats. These findings, together with those in previous studies, give support to an idea that one part of the blood pressure-decreasing effects, seen in patients treated with β-adrenergic blockade, might be through a reduction of the natriuretic clearance receptor C, then giving rise to increased levels of atrial natriuretic peptide.

http://cat.inist.fr/?aModele=afficheN&cpsidt=17030448

Neurogenic and non-neurogenic inflammation in the rat paw following chemical sympathectomy

http://www.ncbi.nlm.nih.gov/pubmed/1723182?dopt=Abstract

Neuroscience. 1991;45(3):761-5.
Neonatal guanethidine sympathectomy caused an 86% depletion of noradrenaline in the paw skin and neurogenic plasma protein extravasation upon antidromic nerve stimulation was impaired. Sensory neuropeptides were unchanged in the skin after neonatal guanethidine and only calcitonin gene-related peptide content was increased in the spinal cord and sciatic nerves. The other observations (i.e. the sensitivity towards heat stimuli, the neurogenic mustard oil inflammation and the non-neurogenic carrageenan oedema) were similar to those observed after neonatal 6-hydroxydopamine treatment.

Cervical sympathectomy inhibits axonal transport of gonadotropin-releasing hormone

To examine the effects of cervical sympathectomy on the transport of gonadotropin-releasing hormone (GnRH) between the hypothalamic neurons and the median eminence, 16 male rats were assigned into four groups: control (C), light (L), light-sympathectomy (LS), and light-colchicine (LC).

Considering the action of colchicine, which inhibits axonal transport, it is suggested that cervical sympathectomy also inhibits axonal transports of GnRH between the GnRH neurons and the median eminence during continuous exposure to light.
Journal of Anesthesia
Volume 10, Number 3 / September, 1996

acinar degranulation following sympathectomy

Chronic bilateral postganglionic sympathectomy (4-6 weeks duration) caused a drastic reduction in the capacity of the gland to secrete saliva in response to parasympathetic stimulation, reaching only one-third of that from normal animals. The initial output of amylase was greater than in normal animals but the total output was similar. The control unstimulated sympathectomized glands appeared similar morphologically to normal resting glands. However, on the parasympathetically stimulated side, besides the usual amount of acinar degranulation, there was also a conspicuous development of acinar vacuolation, not seen in the other groups of animals.
J. Physiol. November 15, 2008 586:5537-5547

Structural changes associated with parotid "degeneration secretion" after post-ganglionic sympathectomy

This loss of granules is considered to be due to sympathetic "degeneration secretion" caused by the release of noradrenaline from the degenerating adrenergic nerves between 12 and 24 hours after ganglionectomy. This is thought to be the first example of morphological change resulting from "degeneration activation" to be recorded microscopically.
Cell Tissue Res. 1975 Sep 16;162(1):1-12.

PMID: 1175216 [PubMed - indexed for MEDLINE]

Following sympathectomy the basal t-PA activity in plasma was 70% less than controls

Following sympathectomy: (i) the basal t-PA activity in plasma was 70% less than controls (2.92 ± 1.96 versus 9.33 ± 1.72 IU/ml;P ≤ 0.001); (ii) the acute release from isolated vessels induced by bradykinin or phenylephrine was comparably reduced; and (iii) the greatest reductions occurred in densely innervated small vessel explants. The results provide new support for an autonomic regulation of neural t-PA release into the vessel wall matrix and blood of densely innervated thin-walled microvessels.

Blood Coagulation & Fibrinolysis:

September 2002 - Volume 13 - Issue 6 - pp 471-481

Sympathetic nervous system control of anti-influenza CD8+ T cell responses

Adoptive transfer experiments indicate that enhanced CD8⁺ responses do not result from permanent alterations in CD8⁺ T cell function in sympathectomized mice. Rather, additional findings suggest that the sympathetic nervous system tempers the capacity of antigen-presenting cells to activate naïve CD8⁺ T cells. We also show that antiviral CD8⁺ T cell responses are enhanced by administration of a β₂ (but not β₁ or α) adrenergic antagonist. These findings demonstrate a critical role for the sympathetic nervous system in limiting CD8⁺T cell responses and indicate that CD8⁺ T cell responses may be altered in patients using β-blockers, one of the most widely prescribed classes of drugs.
PNAS March 31, 2009 vol. 106 no. 13

Allostasis - a state of imbalance responsible for Autoimmune disorders

In general, enhancing the sympathetic tone decreases both T0-cell and NK cell functions but not the proliferation of splenic B cells (Dowdell and Whitacre, 2000). In contrast, chemical sympathectomy, although having varying results, does seem to increase the severity of autoimmune disorders (Dowdell and Whitacre, 2000)
As far as metabolism, catecholamines promote mobilization of fuel stores at time of stress and act synergistically with glucocorticoids to increased glycogenolysis, gluconeogenesis, and lipolysis but exert opposing effects of protein catabolism, as noted earlier. One important aspect is regulation of body temperature (Goldsttein and Eisenhofer, 2000) Epinephrine levels are also positively related to serum levels of HDL cholesterol and negatively related to triglycerines. However, perturbing the balance of activity of various mediators or metabolism and body weight regulation can lead to well-known metabolic disorders such as type 2 diabetes and obesity.

At the same time, increased sympathetic activitation and nerephinephrine release is elevated in hypertensive individuals and also higher levels of insulin, and there are indications that insulin further increases sympathetic activity in a vicious cycle (Arauz-Pacheco et al.,1996)

As a result of either local production, cytokines often enter the the circultion and can be detected in plasma samples. Sleep deprivation and psychological stress, such as public speaking, are reported to elevate inflammatory cytokine level in blood (Altemus et al., 2001) Circulting levels of a number of inflammatory cytokines are elevated in relation to viral and other infections and contirbute to the feeling of being sick, as well as sleepiness, wiht both direct and indirect effects on the central nervous system (Arkins et al., 2000; Obal and Kueger, 2000)

Inflammatory autoimmune diseases, such as multiple sclerosis, rheumatoid arthritis, and type 1 diabetes, reflect an allostatic state that consists of at least three principal causes: genetic risk factors, (...) factors that contribute to the development of tolerance of self-antigens (...) and the hormonal mikieu that regulates adaptive immunes responses (Dowdell and Whitacre, 2000)

Allostasis, homeostasis and the costs of physiological adaptation

By Jay Schulkin
Cambridge University Press, 2004