tag:blogger.com,1999:blog-67465161998733730892024-03-13T19:20:01.637-07:00sympathectomy - controversy"Sympathectomy is a technique about which we have limited knowledge, applied to disorders about which we have little understanding." Associate Professor Robert Boas, Faculty of Pain Medicine of the Australasian College of Anaesthetists and the Royal College of Anaesthetists,
The Journal of Pain, Vol 1, No 4 (Winter), 2000: pp 258-260
Unknownnoreply@blogger.comBlogger627125tag:blogger.com,1999:blog-6746516199873373089.post-2849715425481325762016-02-14T22:57:00.002-08:002016-02-14T22:57:45.902-08:00because 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<span style="font-size: 13pt;">CARDIOVASCULAR EFFECTS OF BILATERAL ENDOSCOPIC TRANSTHORACIC SYMPATHICOTOMY AT REST AND DURING EXERCISE IN PATIENTS WITH PALMAR HYPERHIDROSIS</span><br />
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<span style="font-size: 13pt; font-weight: 700;">AUTHORS: </span><span style="font-size: 13pt;">Kazushi Takaishi, MD, Etsuo Tabo, MD, Kazuo Nakanishi, MD, Masao Soutani, MD,PhD, Kyoji Tsuno, MD, Tatsuru Arai, MD</span><span style="font-size: 13pt; font-weight: 700;">AFFILIATION: </span><span style="font-size: 13pt;">Ehime University, Shigenobu, Japan.</span><br />
<span style="font-size: 13pt; font-weight: 700;">INTRODUCTION: </span><span style="font-size: 13pt;">Palmar hyperhidrosis is characterized by an overactivity of the sympathetic fibers passing through T2 and T3 ganglia. Although endoscopic transthoracic sympathicotomy (ETS) is an effective treatment for palmar hyperhidrosis, the partial cardiac denervation that follows may cause impairment of cardiovascular function at rest and during exercise. The purpose of this study was to compare the cardiovascular response to exercise between patients with palmar hyperhidrosis and a normal control population, and to examine the effects of ETS on cardiovascular response in patients with palmar hyperhidrosis.</span><br />
<span style="font-size: 13pt; font-weight: 700;">METHODS: </span><span style="font-size: 13pt;">After institutional approval and informed consent, 16 patients with palmar hyperhidrosis undergoing bilateral T2- T4 ETS and 10 healthy volunteers were studied. First, before ETS administration, heart rate (HR), blood pressure (BP), and serum catecholamine (SC) at rest were measured in the patient group and in normal subjects. Then, changes in HR, BP and SC as a result of isometric handgrip exercise (IHE) were measured in both groups. Finally, HR and BP at rest, changes in HR and BP as a result of general exercise (GE), and changes in HR, BP and SC as a result of IHE were measured in the patient group both one day before and one day after ETS was administered.</span><span style="font-size: 13pt; font-weight: 700;">RESULTS: </span><span style="font-size: 13pt;">Although there was no significant difference in HR and BP at rest between the patient group before ETS and normal subjects, the value of serum adrenaline in the patient group (0.6 ng/ml) was significantly lower than that in normal subjects (2.6 ng/ml, p<0.01). Changes in HR, BP and SC to IHE were similar in both groups before ETS. HR and BP at rest, and changes in HR and BP as a result of GE and IHE were significantly decreased after ETS (p<0.05).</span></div>
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<span style="font-size: 13pt; font-weight: 700;">DISCUSSION: </span><span style="font-size: 13pt;">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.</span><br />
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<span style="color: #333333; font-family: メイリオ, Meiryo, verdana, 'ヒラギノ角ゴ Pro W3', 'Hiragino Kaku Gothic Pro', Osaka, 'MS Pゴシック', 'MS PGothic', sans-serif; font-size: 14px; line-height: 21px; text-indent: -21.059999465942383px;">K Takaishi, E Tabo, K Nakanishi, M Soutani, K Tsuno, T Arai:</span><br class="firstChild empty" style="color: #333333; font-family: メイリオ, Meiryo, verdana, 'ヒラギノ角ゴ Pro W3', 'Hiragino Kaku Gothic Pro', Osaka, 'MS Pゴシック', 'MS PGothic', sans-serif; font-size: 14px; line-height: 21px; text-indent: -21.059999465942383px;" /><span style="color: #333333; font-family: メイリオ, Meiryo, verdana, 'ヒラギノ角ゴ Pro W3', 'Hiragino Kaku Gothic Pro', Osaka, 'MS Pゴシック', 'MS PGothic', sans-serif; font-size: 14px; line-height: 21px; text-indent: -21.059999465942383px;">Cardiovascular effects of bilateral endoscopic transthoracic sympathicotomy at rest and during exercise in patients with palmar hyperhidrosis.</span><br class="empty" style="color: #333333; font-family: メイリオ, Meiryo, verdana, 'ヒラギノ角ゴ Pro W3', 'Hiragino Kaku Gothic Pro', Osaka, 'MS Pゴシック', 'MS PGothic', sans-serif; font-size: 14px; line-height: 21px; text-indent: -21.059999465942383px;" /><span style="color: #333333; font-family: メイリオ, Meiryo, verdana, 'ヒラギノ角ゴ Pro W3', 'Hiragino Kaku Gothic Pro', Osaka, 'MS Pゴシック', 'MS PGothic', sans-serif; font-size: 14px; line-height: 21px; text-indent: -21.059999465942383px;">International Anesthesia Research Society</span><br />
<span style="color: #333333; font-family: メイリオ, Meiryo, verdana, 'ヒラギノ角ゴ Pro W3', 'Hiragino Kaku Gothic Pro', Osaka, 'MS Pゴシック', 'MS PGothic', sans-serif; font-size: 14px; line-height: 21px; text-indent: -21.059999465942383px;">The 74th Clinical and Scientific Congress 2000</span>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6746516199873373089.post-50496762180642701102015-08-09T01:03:00.002-07:002015-08-09T01:03:38.153-07:00Sympathectomy: a neurocardiologic disorder<div style="background-color: white;">
Bilateral thoracic sympathectomies or sympathotomies are done for refractory palmar hyperhidrosis [85–87]. Iontophoresis, botulinum toxin injection, and glycopyrrolate cream are alternatives. Because sweating is mediated mainly by sympathetic cholinergic fibers, autonomic neurosurgery is usually effective; however, a variety of expected and unexpected consequences can result, including ectopic (e.g., plantar) hyperhidrosis, gustatory sweating, Horner syndrome, and decreased heart rate responses to exercise. The latter seems to be related to partial cardiac denervation [88]. Anecdotally, fatigue, altered mood, blunted emotion, and decreased ability to concentrate can develop after bilateral thoracic sympathectomies. </div>
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β-Adrenoceptor blockers are a mainstay of treatment for CPVT. An automated defibrillator may have to be implanted. Treatment for CPVT also includes left sympathectomy. Such treatment leaves open the theoretical possibilities of denervation supersensitivity of cardiac adrenoceptors and compensatory activation of the adrenomedullary hormonal system; however, plasma levels of catecholamines have not been assessed in CPVT with or without therapeutic cardiac denervation.<br />
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<span style="font-size: 15pt; font-weight: 700;">Table 1. Neurocardiologic disorders that feature abnormal catecholaminergic function</span><br />
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Disorders where abnormal catecholaminergic function is etiologic Hypofunctional states without central neurodegeneration<br />Acute, primary<br />
<span style="font-family: LucidaGrande;"></span>Neurocardiogenic syncope <span style="font-family: LucidaGrande;"></span>Spinal cord transection <span style="font-family: LucidaGrande;"></span>Acute pandysautonomia <span style="font-family: LucidaGrande;"></span>Sympathectomy<br />
Acute, secondary<br />
<span style="font-family: LucidaGrande;"></span>Drug-related (e.g., alcohol, tricyclic antidepressant, chemotherapy, opiate, barbiturates, benzodiazepines, sympatholytics, general anesthesia)<br />
<span style="font-family: LucidaGrande;"></span>Seizures<br /><span style="font-family: LucidaGrande;"></span>Guillain–Barre syndrome <span style="font-family: LucidaGrande;"></span>Alcohol</div>
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Chronic, primary</div>
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<span style="font-family: LucidaGrande;"></span>Pure autonomic failure<br /><span style="font-family: LucidaGrande;"></span>Horner's syndrome<br /><span style="font-family: LucidaGrande;"></span>Familial dysautonomia<br /><span style="font-family: LucidaGrande;"></span>Carotid sinus syncope</div>
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Adie's syndrome <span style="font-family: LucidaGrande;"></span>Dopamine-β-hydroxylase deficiency<br />
<span style="font-family: LucidaGrande;"></span>Sympathectomy<span style="font-size: 15pt; font-weight: 700;"> </span></div>
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<a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1755-5922.2010.00244.x/full">http://onlinelibrary.wiley.com/doi/10.1111/j.1755-5922.2010.00244.x/full</a></div>
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<a href="https://archive.is/UMW1w">https://archive.is/UMW1w</a></div>
Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6746516199873373089.post-37362119361652243692015-07-30T01:19:00.001-07:002015-07-30T01:19:56.582-07:00the clinical results of both surgical and neurolityc sympathectomy are uncertain<div class="p1" style="font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18.2000007629395px;">
<span class="s1" style="background-color: white;"><a href="http://sympathectomy.blogspot.com/2008/12/blood-diverted-from-muscle-to-skin.html" style="text-decoration: none;">Blood diverted from muscle to skin after sympathectomy</a></span></div>
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<span class="s2" style="background-color: white;">However, the clinical results of both surgical and neurolityc sympathectomy are uncertain. Indeed these procedures lead to a redistribution of the blood flow in the lower limbs from the muscle to the skin, with a concomitant fall of the regional resistance, mainly in undamaged vessels. The blood flow will be diverted into this part of the vascular tree, so that a "stealing" of the blood flow may occur.</span></div>
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<span class="s2" style="background-color: white;">Vito A. Peduto, Giancarlo Boero, Antonio Marchi, Riccardo Tani</span></div>
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<span class="s2" style="background-color: white;">Bilateral extensive skin necrosis of the lower limbs following prolonged epidural blockade</span></div>
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<span style="background-color: white;"><span class="s2"></span><br /></span></div>
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<span class="s2" style="background-color: white;">Anaesthesia 1976; 31: 1068-75.</span></div>
Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6746516199873373089.post-25774004413078513092015-06-18T20:49:00.000-07:002015-06-18T20:49:05.341-07:00sympathectomy created imbalance of autonomic activity and functional changes of the intrathoracic organs<h3 class="post-title entry-title" itemprop="name" style="background-color: white; color: #666666; font-family: 'Trebuchet MS', Trebuchet, Verdana, sans-serif; font-size: 22px; font-stretch: normal; font-weight: normal; margin: 0.75em 0px 0px; position: relative;">
<span style="font-size: 13.1999998092651px; line-height: 1.4;">Surgical thoracic sympathectomy such as ESD (endoscopic thoracic sympathectic denervation) or heart transplantation can result in an imbalance between the sympathetic and parasympathetic activities and result in functional changes </span><span style="font-size: 13.1999998092651px; line-height: 1.4;">in the intrathoracic organs.</span></h3>
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Therefore, the procedures affecting sympathetic nerve functions, such as epidural anesthesia, ESD, and heart transplantation, may cause an imbalance between sympathetic and parasympathetic activities (1, 6, 16, 17). Recently, it has been reported that <b>ESD results in functional changes of the intrathoracic organs.</b><br /><br /><br />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.<br />Journal of Asthma, 46:276–279, 2009<br />http://informahealthcare.com/doi/abs/10.1080/02770900802660949</div>
Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6746516199873373089.post-7406117908485981882015-05-28T00:39:00.001-07:002015-05-28T00:39:05.165-07:00Middle cerebral artery blood velocity during exercise with beta-1 adrenergic and unilateral stellate ganglion blockade in humans<div class="cit" style="background-color: white; font-family: arial, helvetica, clean, sans-serif; font-size: 0.8465em; line-height: 1.45em;">
<span role="menubar"><a abstractlink="yes" alsec="jour" alterm="Acta Physiol Scand." aria-expanded="false" aria-haspopup="true" href="http://www.ncbi.nlm.nih.gov/pubmed/10971220#" role="menuitem" style="border-bottom-width: 0px; color: #660066;" title="Acta physiologica Scandinavica.">Acta Physiol Scand.</a></span> 2000 Sep;170(1):33-8.</div>
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Middle cerebral artery blood velocity during exercise with beta-1 adrenergic and unilateral stellate ganglion blockade in humans.</h1>
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<a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Ide%20K%5BAuthor%5D&cauthor=true&cauthor_uid=10971220" style="border-bottom-width: 0px; color: #660066;">Ide K</a><span style="font-size: 0.8461em; line-height: 1.6363em; position: relative; top: -0.5em; vertical-align: baseline;">1</span>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Boushel%20R%5BAuthor%5D&cauthor=true&cauthor_uid=10971220" style="border-bottom-width: 0px; color: #660066;">Boushel R</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=S%C3%B8rensen%20HM%5BAuthor%5D&cauthor=true&cauthor_uid=10971220" style="border-bottom-width: 0px; color: #660066;">Sørensen HM</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Fernandes%20A%5BAuthor%5D&cauthor=true&cauthor_uid=10971220" style="border-bottom-width: 0px; color: #660066;">Fernandes A</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Cai%20Y%5BAuthor%5D&cauthor=true&cauthor_uid=10971220" style="border-bottom-width: 0px; color: #660066;">Cai Y</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Pott%20F%5BAuthor%5D&cauthor=true&cauthor_uid=10971220" style="border-bottom-width: 0px; color: #660066;">Pott F</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Secher%20NH%5BAuthor%5D&cauthor=true&cauthor_uid=10971220" style="border-bottom-width: 0px; color: #660066;">Secher NH</a>.</div>
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<abstracttext>A reduced ability to increase cardiac output (CO) during exercise limits blood flow by vasoconstriction even in active skeletal muscle. Such a flow limitation may also take place in the brain as an increase in the transcranial Doppler determined middle cerebral artery blood velocity (MCA V(mean)) is attenuated during cycling with beta-1 adrenergic blockade and in patients with heart insufficiency. We studied whether sympathetic blockade at the level of the neck (0.1% lidocaine; 8 mL; n=8) affects the attenuated exercise - MCA V(mean following cardio-selective beta-1 adrenergic blockade (0.15 mg kg(-1) metoprolol i.v.) during cycling. Cardiac output determined by indocyanine green dye dilution, heart rate (HR), mean arterial pressure (MAP) and MCA V(mean) were obtained during moderate intensity cycling before and after pharmacological intervention. During control cycling the right and left MCA V(mean) increased to the same extent (11.4 +/- 1.9 vs. 11.1 +/- 1.9 cm s(-1)). With the pharmacological intervention the exercise CO (10 +/- 1 vs. 12 +/- 1 L min(-1); n=5), HR (115 +/- 4 vs. 134 +/- 4 beats min(-1)) and delta MCA V(mean) (8.7 +/- 2.2 vs. 11.4 +/- 1.9 cm s(-1) were reduced, and MAP was increased (100 +/- 5 vs. 86 +/- 2 mmHg; P < 0.05). However, sympathetic blockade at the level of the neck eliminated the beta-1 blockade induced attenuation in delta MCA V(mean) (10.2 +/- 2.5 cm s(-1)). These results indicate that a reduced ability to increase CO during exercise limits blood flow to a vital organ like the brain and that this flow limitation is likely to be by way of the sympathetic nervous system.</abstracttext></div>
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Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6746516199873373089.post-27908309831906715392015-05-09T19:33:00.001-07:002015-05-09T19:33:40.230-07:00Sympathectomy at the level of the T2 ganglion leads to decreased negative feedback to the hypothalamusCompensatory sweating was originally thought to be a mechanism of excessive sweating (in an anatomical region with an intact sympathetic nervous system) to maintain a constant rate of total sweat secretion.90 However, this theory was not confirmed by other studies, demonstrating that compensatory sweating represented a reflex action by an altered feedback mechanism at the level of the hypothalamus which is dependent on the level at which sympathetic denervation occurs. Sympathectomy at the level of the T2 ganglion leads to decreased negative feedback to the hypothalamus. When performing a sympathectomy at a lower level, the negative feedback to the hypothalamus is less inhibited, leading to a decrease in compensatory sweating. Chou et al.91 have proposed the term ‘reflex sweating’ to replace compensatory sweating. Other side effects described in a review article by Dumont89 are gustatory sweating, cardiac effects, phantom sweating, lung function changes, dry hands and altered taste. Besides these side effects there are significant risks of complications during and after surgery (arterial or venous vascular injury, pneumothorax, infection, Horner syndrome etc.).<br />
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JEADV 2012, 26, 1–8 Journal of the European Academy of Dermatology and VenereologyUnknownnoreply@blogger.comtag:blogger.com,1999:blog-6746516199873373089.post-83918502689951141992015-01-17T02:25:00.001-08:002015-01-17T02:25:34.156-08:00peripheral sympathectomy causes a dramatic increase in NGF levels in the denervated organs<h3 class="post-title entry-title" style="background-color: white; color: #525252; font-family: 'Trebuchet MS', Trebuchet, sans-serif; margin: 20px 0px 0px; position: relative;">
<a href="http://sympathectomy.blogspot.com.au/2008/07/increased-growth-factor-messenger-rna.html" style="color: black; font-size: 20px; font-stretch: normal; text-decoration: none;">Increased Nerve Growth Factor Messenger RNA and Protein</a></h3>
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Peripheral NGF mRNA and protein levels following<br />sympathectomy<br /><span style="color: red; font-size: 17px;"><span style="font-weight: bold;">It has been shown previously that peripheral sympathectomy</span><br /><span style="font-weight: bold;">causes a dramatic increase in NGF levels in the denervated</span><br /><span style="font-weight: bold;">organs</span></span> (Yap et al., 1984; Kanakis et al., 1985; Korsching and<br />Thoenen, 1985).<br />Increased ,&Nerve Growth Factor Messenger RNA and Protein<br />Levels in Neonatal Rat Hippocampus Following Specific Cholinergic<br />Lesions<br />Scott R. Whittemore,” Lena Liirkfors,’ Ted Ebendal,’ Vicky R. Holets, 2,a Anders Ericsson, and HBkan Persson<br />Departments of Medical Genetics and’ Zoology, Uppsala University, S-751 23 Uppsala, Sweden, and *Department of</div>
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Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6746516199873373089.post-10036940778650599132015-01-14T22:35:00.000-08:002015-01-14T22:35:25.591-08:00Compensatory sweating is not compensatory<h2 style="border: 0px none white; color: #222222; font-family: Lato, Arial, sans-serif; line-height: 1.2em; margin: 0px 0px 12px; padding: 0px; text-shadow: rgb(255, 255, 255) 1px 1px 1px; vertical-align: baseline;">
<span style="font-size: x-small;">Does compensatory sweating only happen to <a class="zem_slink" href="http://en.wikipedia.org/wiki/Hyperhidrosis" rel="wikipedia" target="_blank" title="Hyperhidrosis">hyperhidrosis</a> patients who underwent <a class="zem_slink" href="http://en.wikipedia.org/wiki/Endoscopic_thoracic_sympathectomy" rel="wikipedia" target="_blank" title="Endoscopic thoracic sympathectomy">ETS</a>?</span></h2>
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The exact reason for compensatory sweating is yet to be determined. There are some physiological explanations for that but none are yet completely proven. The reason for this statement is that compensatory sweating happens in a mild, moderate or a higher level of sweating. The fact that not everyone responds in the same way to the hyperhidrosis operation points to the unknown nature of this problem. More than that patients who underwent thoracic sympathectomy for reasons OTHER than hyperhidrosis also develop compensatory sweating in different intensities. This last statement shows that compensatory sweating happens to both hyperhidrosis patients and non-hyperhidrosis patients who have undergone the surgery.</div>
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<span style="color: #444444; font-family: Open Sans, Arial, sans-serif;"><span style="font-size: 13px; line-height: 26px;">https://archive.today/FKekr#selection-623.0-627.716</span></span></div>
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Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6746516199873373089.post-89163913696177864592015-01-13T05:13:00.001-08:002015-01-13T05:13:02.787-08:00Sympathectomy reduces emotional, stress-induced sweating indicating that it affects the stress-response<div>
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<span style="line-height: 20px;"><span style="font-family: serif;">"...for reasons that are not obvious, many patients with facial hyperhidrosis and hyperhidrosis of the feet will benefit from upper thoracic sympathectomy. " </span></span><br />
<span style="line-height: 20px;"><span style="font-family: serif;"><br /></span></span>
<span style="line-height: 20px;"><span style="font-family: serif;">(The Journal of Pain, Vol 1, No 4 (Winter), 2000: pp 261-264)</span></span><br />
<span style="line-height: 20px;"><span style="font-family: serif;"><br /></span></span>
<span style="line-height: 20px;"><span style="font-family: serif;">"Bilateral upper thoracic sympathicolysis is followed by redistribution of body perspiration, with a clear decrease in the zones regulated by mental or emotional stimuli, and an increase in the areas regulated by environmental stimuli, though we are unable to establish the etiology of this redistribution." </span></span><br />
<span style="line-height: 20px;"><span style="font-family: serif;"><br /></span></span>
<span style="line-height: 20px;"><span style="font-family: serif;">(Surg Endosc. 2007 Nov;21(11):2030-3. Epub 2007 Mar 13.) </span></span><br />
<span style="line-height: 20px;"><span style="font-family: serif;"><br /></span></span>
<span style="line-height: 20px;"><span style="font-family: serif;"><br /></span></span>
<span style="line-height: 20px;"><span style="font-family: serif;">"Palmar hyperhidrosis of clinical severity is a hallmark physical sign of many anxiety disorders, including generalized anxiety disorder, panic disorder, posttraumatic stress disorder, and especially social phobia.4 These are increasingly well understood and highly treatable neurobiological conditions. They are mod- erately heritable hard-wired fear responses,5 and are linked to amygdalar and locus coeruleus hyper-reactivity during psycho- social stress.6,7 <a class="zem_slink" href="http://en.wikipedia.org/wiki/Anxiety_disorder" rel="wikipedia" target="_blank" title="Anxiety disorder">Anxiety disorders</a> are known to be much more common among women. This is consistent with the finding of Krogstad et al. that among controls sweating was reported more often by men, while among the hyperhidrosis group sweating was reported more often among women."</span></span><br />
<span style="line-height: 20px;"><span style="font-family: serif;"><br /></span></span>
<span style="line-height: 20px;"><span style="font-family: serif;">"A surgical treatment for anxiety-triggered palmar hyperhidrosis is not unlike treating tearfulness in major depression by severing the nerves to the lacrimal glands. We have recently made a similar argument advocating a psychopharmacological, rather then a surgi- cal, first-line treatment for blushing.9" </span></span><br />
<span style="line-height: 20px;"><span style="font-family: serif;">(Journal Compilation - 2006 British Association of Dermatologists - <a class="zem_slink" href="http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2133" rel="homepage" target="_blank" title="British Journal of Dermatology">British Journal of Dermatology</a> 2006, </span></span><span style="font-family: AdvPSJOANNA; font-size: 9pt;">DOI: 10.1111/j.1365-2133.2006.07547.x</span><span style="font-family: serif; line-height: 20px;">)</span></div>
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Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6746516199873373089.post-58714537919236303222015-01-02T17:52:00.001-08:002015-01-02T18:59:16.074-08:00Peripheral, autonomic regulation of locus coeruleus noradrenergic neurons in brain: putative implications for psychiatry and psychopharmacology<span style="background-color: white; color: #525252; font-family: 'Trebuchet MS', Trebuchet, sans-serif; font-size: 13px; line-height: 18px;">the new data seem to allow a better understanding of how autonomic vulnerability or visceral dysfunction may precipitate or aggravate mental symptoms and disorder.</span><br />
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<div class="AuthorGroup" style="background-color: white; color: #525252; font-family: 'Trebuchet MS', Trebuchet, sans-serif; font-size: 13px; line-height: 18px;">
T. H. Svensson<sup>1</sup></div>
<table style="background-color: white; color: #525252; font-family: 'Trebuchet MS', Trebuchet, sans-serif; font-size: 13px; line-height: 18px;"><tbody>
<tr valign="top"><td><span class="Affiliation"><a href="https://www.blogger.com/blogger.g?blogID=1660264747210613513" name="Aff1" style="color: #bf705c; text-decoration: none;"></a>(1)</span></td><td><span class="Affiliation">Department of Pharmacology, Karolinska Institute, Box 60 400, S-104 01 Stockholm, Sweden</span></td></tr>
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<strong style="background-color: white; color: #525252; font-family: 'Trebuchet MS', Trebuchet, sans-serif; font-size: 13px; line-height: 18px;">Received: </strong><span style="background-color: white; color: #525252; font-family: 'Trebuchet MS', Trebuchet, sans-serif; font-size: 13px; line-height: 18px;">20 June 1986 </span><strong style="background-color: white; color: #525252; font-family: 'Trebuchet MS', Trebuchet, sans-serif; font-size: 13px; line-height: 18px;">Revised: </strong><span style="background-color: white; color: #525252; font-family: 'Trebuchet MS', Trebuchet, sans-serif; font-size: 13px; line-height: 18px;">25 November 1986</span><br />
<a href="http://www.springerlink.com/content/100390/?p=11c1d4fc1fbd4416a3d3c0a3de284c47&pi=0" style="background-color: white; color: #8b7b06; font-family: 'Trebuchet MS', Trebuchet, sans-serif; font-size: 13px; line-height: 18px; text-decoration: none;">Psychopharmacology</a><br />
<br style="background-color: #fff4f4; color: #545454; font-family: Georgia, Utopia, 'Palatino Linotype', Palatino, serif; font-size: 13px; line-height: 18px;" />
<span style="background-color: #fff4f4; color: #545454; font-family: Georgia, Utopia, 'Palatino Linotype', Palatino, serif; font-size: 13px; line-height: 18px;">"</span><span style="background-color: white; color: #3e3d40; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px;">Locus coeruleus (LC) is located in the ventrallateral side of the fourth ventricle in the pontine, most of which are noradrenergic neurons projecting to the cortex, cingulate cortex, amygdala nucleus, thalamus, hypothalamus, olfactory tubercles, hippocampus, cerebellum, and spinal cord (</span><a href="http://journal.frontiersin.org/Journal/10.3389/fnmol.2012.00029/full#B40" style="background-color: white; color: #707173; cursor: pointer; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px; outline: 0px !important; text-decoration: none;">Swanson and Hartman, 1975</a><span style="background-color: white; color: #3e3d40; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px;">). Norepinephrine (NE) released from the nerve terminal of LC neurons contributes to about 70% of the total extracellular NE in primates brain (</span><a href="http://journal.frontiersin.org/Journal/10.3389/fnmol.2012.00029/full#B38" style="background-color: white; color: #707173; cursor: pointer; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px; outline: 0px !important; text-decoration: none;">Svensson, 1987</a><span style="background-color: white; color: #3e3d40; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px;">). It plays important roles not only in arousal, attention, emotion control, and stress (reviewed in </span><a href="http://journal.frontiersin.org/Journal/10.3389/fnmol.2012.00029/full#B1" style="background-color: white; color: #707173; cursor: pointer; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px; outline: 0px !important; text-decoration: none;">Aston-Jones and Cohen, 2005</a><span style="background-color: white; color: #3e3d40; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px;">; </span><a href="http://journal.frontiersin.org/Journal/10.3389/fnmol.2012.00029/full#B4" style="background-color: white; color: #707173; cursor: pointer; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px; outline: 0px !important; text-decoration: none;">Berridge and Waterhouse, 2003</a><span style="background-color: white; color: #3e3d40; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px;">; </span><a href="http://journal.frontiersin.org/Journal/10.3389/fnmol.2012.00029/full#B6" style="background-color: white; color: #707173; cursor: pointer; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px; outline: 0px !important; text-decoration: none;">Bouret and Sara, 2005</a><span style="background-color: white; color: #3e3d40; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px;">; </span><a href="http://journal.frontiersin.org/Journal/10.3389/fnmol.2012.00029/full#B30" style="background-color: white; color: #707173; cursor: pointer; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px; outline: 0px !important; text-decoration: none;">Nieuwenhuis et al., 2005</a><span style="background-color: white; color: #3e3d40; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px;">; </span><a href="http://journal.frontiersin.org/Journal/10.3389/fnmol.2012.00029/full#B35" style="background-color: white; color: #707173; cursor: pointer; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px; outline: 0px !important; text-decoration: none;">Sara and Devauges, 1989</a><span style="background-color: white; color: #3e3d40; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px;">; </span><a href="http://journal.frontiersin.org/Journal/10.3389/fnmol.2012.00029/full#B41" style="background-color: white; color: #707173; cursor: pointer; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px; outline: 0px !important; text-decoration: none;">Valentino and Van Bockstaele, 2008</a><span style="background-color: white; color: #3e3d40; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px;">), but also in sensory information processing (</span><a href="http://journal.frontiersin.org/Journal/10.3389/fnmol.2012.00029/full#B38" style="background-color: white; color: #707173; cursor: pointer; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px; outline: 0px !important; text-decoration: none;">Svensson, 1987</a><span style="background-color: white; color: #3e3d40; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px;">). LC directly modulates the somatosensory information from the peripheral system. Under the stress condition, LC could completely inhibit the input from painful stimuli through the descending projection to the spinal cord (</span><a href="http://journal.frontiersin.org/Journal/10.3389/fnmol.2012.00029/full#B37" style="background-color: white; color: #707173; cursor: pointer; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px; outline: 0px !important; text-decoration: none;">Stahl and Briley, 2004</a><span style="background-color: white; color: #3e3d40; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px;">). Dys-regulations of LC neurotransmission have been suggested to be involved in physical painful symptoms, attention deficit hyperactivity disorder (ADHD), sleep/arousal disorder, post-traumatic stress disorder, depression, schizophrenia, and Parkinson's disease (reviewed in </span><a href="http://journal.frontiersin.org/Journal/10.3389/fnmol.2012.00029/full#B4" style="background-color: white; color: #707173; cursor: pointer; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px; outline: 0px !important; text-decoration: none;">Berridge and Waterhouse, 2003</a><span style="background-color: white; color: #3e3d40; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px;">; </span><a href="http://journal.frontiersin.org/Journal/10.3389/fnmol.2012.00029/full#B23" style="background-color: white; color: #707173; cursor: pointer; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px; outline: 0px !important; text-decoration: none;">Grimbergen et al., 2009</a><span style="background-color: white; color: #3e3d40; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px;">; </span><a href="http://journal.frontiersin.org/Journal/10.3389/fnmol.2012.00029/full#B29" style="background-color: white; color: #707173; cursor: pointer; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px; outline: 0px !important; text-decoration: none;">Mehler and Purpura, 2009</a><span style="background-color: white; color: #3e3d40; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px;">).</span><span style="background-color: white; color: #3e3d40; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 16px; line-height: 22px;">"</span><br />
<a href="http://journal.frontiersin.org/Journal/10.3389/fnmol.2012.00029/full" style="background-color: #fff4f4; color: #bf705c; font-family: Georgia, Utopia, 'Palatino Linotype', Palatino, serif; font-size: 13px; line-height: 18px; text-decoration: none;">http://journal.frontiersin.org/Journal/10.3389/fnmol.2012.00029/full</a>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6746516199873373089.post-23918036733881561832014-12-30T02:12:00.002-08:002014-12-30T02:12:43.127-08:00 direct injury to the anatomic structure of the autonomic nervous system in the thoracic cavity, and postthoracotomy pain may contribute independently or in association with each other to the development of these arrhythmias<div class="cit" style="background-color: white; font-family: arial, helvetica, clean, sans-serif; font-size: 0.8465em; line-height: 1.45em;">
<span role="menubar"><a abstractlink="yes" alsec="jour" alterm="Anesthesiol Res Pract." aria-expanded="false" aria-haspopup="true" href="http://www.ncbi.nlm.nih.gov/pubmed/24235971#" role="menuitem" style="border-bottom-width: 0px; color: #660066;" title="Anesthesiology research and practice.">Anesthesiol Res Pract.</a></span> 2013;2013:413985. doi: 10.1155/2013/413985. Epub 2013 Oct 23.</div>
<h1 style="background-color: white; font-family: arial, helvetica, clean, sans-serif; font-size: 1.231em; line-height: 1.125em; margin: 0.375em 0px;">
Supraventricular arrhythmias after thoracotomy: is there a role for autonomic imbalance?</h1>
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<a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Vretzakis%20G%5BAuthor%5D&cauthor=true&cauthor_uid=24235971" style="border-bottom-width: 0px; color: #660066;">Vretzakis G</a><span style="font-size: 0.8461em; line-height: 1.6363em; position: relative; top: -0.5em; vertical-align: baseline;">1</span>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Simeoforidou%20M%5BAuthor%5D&cauthor=true&cauthor_uid=24235971" style="border-bottom-width: 0px; color: #660066;">Simeoforidou M</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Stamoulis%20K%5BAuthor%5D&cauthor=true&cauthor_uid=24235971" style="border-bottom-width: 0px; color: #660066;">Stamoulis K</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Bareka%20M%5BAuthor%5D&cauthor=true&cauthor_uid=24235971" style="border-bottom-width: 0px; color: #660066;">Bareka M</a>.</div>
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Abstract</h3>
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<abstracttext><span style="background-color: white;">Supraventricular arrhythmias are common rhythm disturbances following pulmonary surgery. The overall incidence varies between 3.2% and 30% in the literature, while atrial fibrillation is the most common form. These arrhythmias usually have an uneventful clinical course and revert to normal sinus rhythm, usually before patent's discharge from hospital. Their importance lies in the immediate hemodynamic consequences, the potential for systemic embolization and the consequent long-term need for prophylactic drug administration, and the increased cost of hospitalization. Their incidence is probably related to the magnitude of the performed operative procedure, occurring more frequently after pneumonectomy than after lobectomy. Investigators believe that surgical factors (irritation of the atria per se or on the ground of chronic inflammation of aged atria), </span><span style="background-color: yellow;">direct injury to the anatomic structure of the autonomic nervous system in the thoracic cavity, and postthoracotomy pain may contribute independently or in association with each other to the development of these arrhythmias.</span><span style="background-color: white;"> This review discusses currently available information about the potential mechanisms and risk factors for these rhythm disturbances. </span><span style="background-color: white;">The discussion is in particular focused on the role of postoperative pain and its relation to the autonomic imbalance, in an attempt to avoid or minimize discomfort with proper analgesia utilisation.</span></abstracttext><br />
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<abstracttext><a href="http://www.ncbi.nlm.nih.gov/pubmed/24235971">http://www.ncbi.nlm.nih.gov/pubmed/24235971</a></abstracttext></div>
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Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6746516199873373089.post-35717721620667277612014-12-28T18:01:00.002-08:002014-12-28T18:01:13.412-08:00"Since changes in old age show some similarities with those following chronic sympathectomy"<span style="font-size: x-small;">"For the tracheobronchial tree. surgical (sympathectomy) and chemical (with 6-hydroxydopamine or reserpine) interventions lead to histological disappearance of the NA and NPY." (p.435)</span><br />
<span style="font-size: x-small;"><br /></span>
<span style="font-size: x-small;">" Prejunctional supersensitivity to norepinephrine after sympathectomy or cocaine treatment." (p. 410)</span><br />
<span style="font-size: x-small;"><br /></span>
<span style="font-size: x-small;">"Following chronic sympathectomy, substance P expression in presumptive sensory nerves....and NPY-expression in parasympathetic nerves ...to autonomically innervated tissues have both been shown to increase... Experiments using NGF and anti-NGF antibodies (Kessler et al., 1983) have suggested that competition between sympathetic and sensory fibers for target-derived growth factors could explain these apparently compensatory interactions,..." (p. 33)</span><br />
<span style="font-size: x-small;"><br /></span>
<span style="font-size: x-small;">"Since changes in old age show some similarities with those following chronic sympathectomy, it is tempting to consider whether alterations in one group of nerves in tissues with multiple innervations trigger reciprocal changes in other populations of nerves, perhaps through the mechanism of competition for common, target-produced growth factors. The nature of these changes is such that they could be nonadaptive and even destabilizing of cardiovascular homeostasis. (p. 34) </span><br />
<span style="font-size: x-small;"><br /></span>
<span style="font-size: x-small;">Impairment of sympathetic and neural function has been claimed in cholesterol-fed animals (Panek et al., 1985). It has also been suggested that surgical sympathectomy may be useful in controlling atherosclerosis in certain arterial beds (Lichter et al., 1987). Defective cholinergic arteriolar vasodilation has been claimed in atherosclerotic rabbits (Yamamoto et al., 1988) and, in our laboratory, we have recently shown impairment of response to perivascular nerves supplying the mesenteric, hepatic, and ear arteries of Watanabe heritable hyperlipidemic rabbits (Burnstock et al., 1991). </span><br />
<span style="font-size: x-small;"> Loss of adrenergic innervation has been reported in alcoholism (Low et al., 1975), amyloidosis (Rubenstein et al., 1983), orthostatic hypotension (Bannister et al., 1981), and subarachnoid haemorrhage (Hara and Kobayashi, 1988). Recent evidence shows that there is also a loss of noradrenergic innervation of blood vessels supplying malignant, as compared to benign, human intracranial tumours (Crockard et al., 1987). (p. 14) </span><br />
<h1 class="booktitle" style="background-color: white; color: #333333; font-family: Arial, sans-serif; line-height: 18px; margin-bottom: 21px; margin-top: 0px;">
<span class="fn" style="font-size: 23px;"><span dir="ltr">Vascular Innervation and Receptor Mechanisms</span></span>: <span class="subtitle" style="font-size: 16px; font-weight: normal;"><span dir="ltr">New Perspectives</span></span><span class="ebook-msg" style="font-size: 16px; font-weight: normal;"> </span></h1>
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<span dir="ltr">Rolf Uddman</span></div>
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<span dir="ltr">Academic Press</span>, <span dir="ltr">2 Dec 2012</span> - <a class="secondary" href="https://www.google.com.au/search?tbo=p&tbm=bks&q=subject:%22Medical%22&source=gbs_ge_summary_r&cad=0" style="color: #6611cc; text-decoration: none;"><span dir="ltr">Medical</span></a> - <span dir="ltr">498 pages</span></div>
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Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6746516199873373089.post-64575485799815966652014-12-27T01:30:00.002-08:002014-12-27T01:30:48.232-08:00sympathectomy leads to fluctuation of vasoconstriction alternated with vasodilation in an unstable fashion. Following sympathectomy the involved extremity shows regional hyper - and hypothermia<span style="background-color: #fff4f4; color: #545454; font-family: Georgia, Utopia, 'Palatino Linotype', Palatino, serif; font-size: 13px; line-height: 1.4;">"</span><span style="background-color: white; color: #000066; font-family: Verdana, Arial, Helvetica; font-size: xx-small; text-align: justify;">To quote Nashold, referring to sympathectomy, "Ill- advised surgery may tend to magnify the entire symptom complex"(38). Sympathectomy is aimed at achieving vasodilation. The neurovascular instability (vacillation and instability of vasoconstrictive function), leads to fluctuation of vasoconstriction alternated with vasodilation in an unstable fashion (39). Following sympathectomy the involved extremity shows regional hyper - and hypothermia in contrast, the blood flow and skin temperature on the non- sympathectomized side are significantly lower after exposure to a cold environment (39). This phenomenon may explain the reason for spread of CRPS. In the first four weeks after sympathectomy, the Laser Doppler flow study shows an increased of blood flow and hyperthermia in the extremity (40). Then, after four weeks, the skin temperature and vascular perfusion slowly decrease and a high amplitude vasomotor constriction develops reversing any beneficial effect of surgery (39). According to Bonica , "about a dozen patients with reflex sympathetic dystrophy (RSD) in whom I have carried out preoperative diagnostic sympathetic block with complete pain relief, sympathectomy produced either partial or no relief (40)"</span><br /><div class="post-body entry-content" id="post-body-7052210266204892291" itemprop="description articleBody" style="background-color: #fff4f4; color: #545454; font-family: Georgia, Utopia, 'Palatino Linotype', Palatino, serif; font-size: 13px; line-height: 1.4; position: relative; width: 570px;">
<br /><div class="booktitle" style="background-color: white; color: #333333; font-family: Arial, sans-serif; margin-bottom: 21px;">
<h1 style="display: inline; font-size: 23px; font-weight: normal; margin: 0px; position: relative;">
<span class="fn"><span dir="ltr">Chronic Pain</span></span>: </h1>
<span class="subtitle" style="font-size: 16px;"><span dir="ltr">Reflex Sympathetic Dystrophy : Prevention and Management</span></span></div>
<div class="bookcover" style="background-color: white; color: #333333; float: left; font-family: Arial, sans-serif; margin-right: 12px;">
<img alt="Front Cover" border="1" id="summary-frontcover" src="http://bks3.books.google.com.au/books?id=-j8n1Z_JxqUC&printsec=frontcover&img=1&zoom=1&imgtk=AFLRE736zqrwzsNLOa1GtqquQMNb-pDjH98MG7jzF8fPtgtew8u2db6EKEzmc082qexiGJPItRVbOARxI0rsWAJKaI1yRtEZNM57s-P2eKqNFsOeoacPsKUOdoEM5Hsk7GAufo5VXI9r" style="-webkit-box-shadow: rgba(0, 0, 0, 0.0980392) 1px 1px 5px; border: 1px solid rgb(241, 241, 241); box-shadow: rgba(0, 0, 0, 0.0980392) 1px 1px 5px; padding: 1px;" title="Front Cover" width="128" /></div>
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<iframe allowtransparency="true" data-gapiattached="true" frameborder="0" hspace="0" id="I0_1373185614103" marginheight="0" marginwidth="0" name="I0_1373185614103" scrolling="no" src="https://plusone.google.com/u/0/_/+1/fastbutton?size=small&count=true&source=google%3ABOOKS&hl=en&origin=http%3A%2F%2Fbooks.google.com.au&url=http%3A%2F%2Fbooks.google.com.au%2Fbooks%2Fabout%2FChronic_Pain.html%3Fid%3D-j8n1Z_JxqUC&gsrc=1p&jsh=m%3B%2F_%2Fscs%2Fabc-static%2F_%2Fjs%2Fk%3Dgapi.gapi.en.aBqw11eoBzM.O%2Fm%3D__features__%2Fam%3DEA%2Frt%3Dj%2Fd%3D1%2Frs%3DAItRSTMkiisOVRW5P7l3Ig59NtxV0JdMMA#_methods=onPlusOne%2C_ready%2C_close%2C_open%2C_resizeMe%2C_renderstart%2Concircled&id=I0_1373185614103&parent=http%3A%2F%2Fbooks.google.com.au&pfname=%2F-j8n1Z_JxqUC&rpctoken=73431359" style="border-style: none; height: 15px; left: 0px; margin: 0px; position: static; top: 0px; visibility: visible; width: 70px;" tabindex="0" title="+1" vspace="0" width="100%"></iframe></div>
<span id="gb-atb-plusone-container" style="display: block; height: 17px; margin-bottom: 1px;"></span><span dir="ltr" style="color: #6611cc;"><a class="secondary" href="http://www.google.com.au/search?tbo=p&tbm=bks&q=inauthor:%22Hooshang+Hooshmand%22" style="color: #6611cc; text-decoration: none;">Hooshang Hooshmand</a></span></div>
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<span class="gb-my-library-book-plusone-container"></span></div>
<div style="margin: 0.2em 0px;">
<span dir="ltr">CRC PressINC</span>, 1993 - <a class="secondary" href="http://www.google.com.au/search?tbo=p&tbm=bks&q=subject:%22Medical%22&source=gbs_ge_summary_r&cad=0" style="color: #6611cc; text-decoration: none;"><span dir="ltr">Medical</span></a> - <span dir="ltr">202 pages</span></div>
</div>
</div>
<br />Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6746516199873373089.post-88436035782763257112014-12-25T01:48:00.001-08:002014-12-25T01:48:19.818-08:00Despite the simplicity and rapidity of the procedure, some patients experience intense, in some cases persistent, postoperative pain<a href="http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132008000300003&lng=en&nrm=iso&tlng=en">Jornal Brasileiro de Pneumologia - The incidence of residual pneumothorax after video-assisted sympathectomy with and without pleural drainage and its effect on postoperative pain</a>:<br />
<br />
"Anteroposterior chest X-ray in the orthostatic position, while inhaling, was absolutely normal in 18 patients (32.1%), and residual pneumothorax was detected in 17 patients (30.4%). When the patients were separated into two groups (those who had received drainage and those who had not), 25.9% (7 patients) and 34.4% (10 patients), respectively, presented residual pneumothorax, with no difference between the two groups (p = 0.48) (Figure 1).<br />
<br />
The additional alterations were laminar atelectasis and emphysema of the subcutaneous cellular tissue.<br />
<br />
Chest X-rays in the orthostatic position, while exhaling, revealed residual pneumothorax in 39.3% (22 patients) and was absolutely normal in 25% (14 patients). On the same X-rays, when patients were analyzed separately, residual pneumothorax was seen in 33.3% of the patients who had received drainage (9 patients) and in 44.8% (13 patients) of those who had not, with no difference between the two groups (p = 0.37) (Figure 1).<br />
<br />
The low-dose computed tomography scans of the chest detected residual pneumothorax in 76.8% (43 patients). In the patients submitted to postoperative drainage, this rate was 70.3% (19 patients), compared with 82.7% (24 patients) in those without pleural drainage, with no difference between the two groups (p = 0.27) (Figure 1). Therefore, the overall rate of occult pneumothorax (only visible through tomography), revealed on anteroposterior X-rays was 35.7% (20 patients): 48.2% while patients were inhaling and 41.1% while patients were exhaling. The VAS score in the PACU ranged from 0 to 10, with a mean of 2.16 ± 0.35.<br />
<br />
Regarding characteristics, 44.6% of the patients reported chest pain upon breathing and 32.1% reported retrosternal pain. The same evaluation performed in the infirmary, during the immediate postoperative period, ranged from 0 to 10, with a mean of 3.75 ± 0.30, being 69.6% of chest pain upon breathing and 78.6% of retrosternal pain. On postoperative day 7, according to VAS, pain ranged from 0 to 10, with a mean of 2.05 ± 0.31; regarding characteristics, it was continuous in 32.1% of the cases, and retrosternal in 26.8%. On postoperative day 28, pain ranged from 0 to 3, with a mean of 0.17 ± 0.08, 7.1% of mechanical rhythm and 5.4% upper posterior."<br />
<br />
<h2 style="background-color: white; color: navy; font-family: verdana, arial; font-size: 19px; font-weight: normal; margin: 0px;">
<a href="http://www.scielo.br/scielo.php?script=sci_serial&pid=1806-3713&lng=en&nrm=iso">Jornal Brasileiro de Pneumologia</a></h2>
<h2 id="printISSN" style="background-color: white; color: navy; font-family: verdana, arial; font-size: 12px; font-weight: normal; margin: 0px;">
<span style="color: #0000a0;"><em>Print version</em> ISSN </span>1806-3713</h2>
<h3 style="background-color: white; color: maroon; font-family: times; font-size: 15px;">
J. bras. pneumol. vol.34 no.3 São Paulo Mar. 2008</h3>
<br />
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132008000300003&lng=en&nrm=iso&tlng=enUnknownnoreply@blogger.comtag:blogger.com,1999:blog-6746516199873373089.post-16289050828571966822014-12-24T23:49:00.001-08:002014-12-24T23:49:20.485-08:00Our data confirmed that sympathectomy in patients with EPH results in a disturbance of bronchomotor tone and cardiac functionOur study was composed of patients affected by EH, and<br />
<br />
thus having a dysfunction of sympathetic activity. The<br />
<br />
observed respiratory and clinical effects would probably not<br />
<br />
be observed in healthy individuals.<br />
<br />
(ii) The cardio-respiratory effects were observed 6 months after<br />
<br />
operation. However, a longer postoperative period would<br />
<br />
be required to determine if they are long-term effects.<br />
<br />
(iii) The number of patients was too limited, thus our results<br />
<br />
should be corroborated by larger studies.<br />
<br />
CONCLUSION<br />
<br />
Our data confirmed that sympathectomy in patients with<br />
<br />
EPH results in a disturbance of bronchomotor tone and<br />
<br />
cardiac function.<br />
<br />
<ol style="border: none; font-family: 'Lucida Grande', 'Lucida Sans Unicode', Tahoma, Verdana, Arial, Helvetica, sans-serif; font-size: 11px; line-height: 11.1999998092651px; list-style: none; margin: 0px 4px 0px 0px; outline-style: none; padding: 3px 0px; vertical-align: baseline;">
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<cite style="border: 0px; display: block; font-family: inherit; font-size: inherit; font-style: normal; line-height: inherit; margin: 3px 0px 5px; outline-style: none; padding: 0px; text-align: inherit; vertical-align: baseline;"></cite><br />
<br />
<div style="text-align: left;">
<abbr class="slug-jnl-abbrev" style="border: 0px; font-family: inherit; font-size: inherit; font-style: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline-style: none; padding: 0px; text-align: inherit; vertical-align: baseline;" title="European Journal of Cardio-Thoracic Surgery">Eur J Cardiothorac Surg</abbr><span class="slug-pub-date" itemprop="datePublished" style="border: 0px; font-family: inherit; font-size: inherit; font-style: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline-style: none; padding: 0px; text-align: inherit; vertical-align: baseline;"> (2012)</span></div>
<span class="slug-doi-wrapper" style="border: 0px; display: block; font-family: inherit; font-size: inherit; font-style: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline-style: none; padding: 0px; text-align: left; vertical-align: baseline;">doi: <span class="slug-doi" style="border: 0px; font-family: inherit; font-size: inherit; font-style: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline-style: none; padding: 0px; text-align: inherit; vertical-align: baseline;" title="10.1093/ejcts/ezs071">10.1093/ejcts/ezs071</span></span></div>
</li>
</ol>
Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6746516199873373089.post-36281094109040561242014-12-22T22:12:00.002-08:002014-12-22T22:12:31.994-08:00Acute pain following needlescope-VATS (nVATS) sympathectomy for palmar hyperhidrosis"...recently Sihoe et al. [10] have reported that pre-emptive wound infiltration with a local anaesthetic reduces the postoperative wound pain following needlescope-VATS (nVATS) sympathectomy for palmar hyperhidrosis. The concept of pre-emptive analgesia has gained popularity following<br />
experimental work, demonstrating that early control of pain can alter its subsequent evolution as well as the recognition that nociception produces important physiological responses, even in adequately anaesthetised individuals, and the understanding that for many individuals the minimisation of pain can improve clinical outcomes [11].<br />
The pre-emptive analgesia is based on the intuitive idea that if pain is treated before the injury occurs, the nociceptive system will perceive less pain than if analgesia is given after the injury has already occurred. The preoperative administration of analgesic will modify the afferent nociceptive barrage from the site of injury, thus preventing the development of central sensitisation and hyperalgesia [12].<br />
Thus, we have focussed on this argument in the aim of the present study, which is to determine whether pre-emptive local analgesia (PLA) has an effect to reduce acute postoperative pain following standard-VATS (s-VATS) sympathectomy, in view of n-VATS being considered less painful<br />
than the s-VATS procedure [4,5]."<br />
<br />
<a href="http://ejcts.oxfordjournals.org/content/37/3/588.full.pdf+html">http://ejcts.oxfordjournals.org/content/37/3/588.full.pdf+html</a><br />
European Journal of Cardio-thoracic Surgery 37 (2010) 588—593<br />
Pre-emptive local analgesia in video-assisted thoracic surgery sympathectomy<br />
<br />
Alfonso Fiorelli, Giovanni Vicidomini, Paolo Laperuta, Luigi Busiello,<br />
Anna Perrone, Filomena Napolitano, Gaetana Messina, Mario Santini*<br />
Thoracic Surgery Unit, Second University of Naples, Naples, Italy<br />
Received 28 March 2009; received in revised form 21 July 2009; accepted 31 July 2009; Available online 12 September 2009Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6746516199873373089.post-9528702522090361002014-12-22T10:43:00.000-08:002014-12-22T10:43:07.270-08:00sympathicotomy may cause a temporary impairment of the caudal-to-rostral hierarchy of thermoregulatory control and changes in microcirculationPatients with palmar hyperhidrosis have been reported to have a much<br />
more complex dysfunction of autonomic nervous system, involving compensatory high parasympathetic activity as well as sympathetic overactivity (13, 14), suggesting that sympathicotomy initially induces a sympathovagal imbalance with a parasympathetic predominance, and that this is restored on a long-term basis (14). Therefore, thoracic sympathicotomy may cause a temporary impairment of the caudal-to-rostral hierarchy of thermoregulatory control and changes in microcirculation.<br />
<br />
The reduction of finger skin temperature on the non-denervated side may be due to either a decrease in the cross-<br />
inhibitory effect or the abnormal control of the inhibitory fibers by the sudomotor center (6).<br />
Vasoconstrictor neurons have been found to be largely under the inhibitory control of various afferent<br />
input systems from the body surface, whereas sudomotor neurons are predominantly under excitatory<br />
control (15). The basic neuronal network for this reciprocal organization is probably located in the spinal level (15). Therefore, the reduction in the contralateral skin temperature may be explained by cross-inhibitory control of various afferent in the spinal cord.<br />
In particular, our study showed that, following bilateral T3 sympathicotomy, the skin temperatures on<br />
the hands increased whereas the skin temperatures on the feet decreased. These findings suggest a<br />
cross-inhibitory control between the upper and lower extremities. However, the pattern of skin<br />
temperature reduction on the feet differed from that on the contralateral hand. The skin temperature on<br />
the feet did not decrease after right T3 sympathicotomy but decreased significantly after bilateral T3<br />
sympathicotomy.<br />
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2722005/Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6746516199873373089.post-85094113556588553152014-12-13T02:29:00.001-08:002014-12-13T02:29:38.995-08:00functional abnormality detected in the small airway of patients who underwent bilateral dorsal sympathectomy to treat primary hyperhidrosis is still present 3 years after surgery<div style="background-color: white; font-family: Arial, Verdana, Helvetica, sans-serif; font-size: 13px; margin-left: 10px;">
The main observation of our study was that the functional abnormality detected in the small airway of patients who underwent bilateral dorsal sympathectomy to treat primary hyperhidrosis is still present 3 years after surgery, although the patients remain clinically asymptomatic.</div>
<div style="background-color: white; font-family: Arial, Verdana, Helvetica, sans-serif; font-size: 13px; margin-left: 10px;">
Studies to date evaluate alterations in lung function at 1, 3, and 6 months after sympathectomy. Only 1 recent study provides data 1 year after surgery. Ponce González et al<sup>10</sup> studied a group of 37 patients who underwent forced spirometry before surgery, and at 3 months and 1 year after surgery. They observed a decrease in FVC, FEV<sub>1</sub>, and FEF<sub>25%-75%</sub> at 3 months, although FVC returned to baseline values at 12 months, whereas FEV<sub>1</sub> and FEF<sub>25%-75%</sub> remained significantly low (-2.8% and -11.2%, respectively). These findings are consistent with ours, and corroborate the persistence of minimal bronchial obstruction 3 years after surgery. This appears to be associated with the influence of the sympathetic nervous system on bronchomotor tone.</div>
<div style="background-color: white; font-family: Arial, Verdana, Helvetica, sans-serif; font-size: 13px; margin-left: 10px;">
As previously mentioned, the airway is innervated mainly by the parasympathetic nervous system. Sympathetic innervation, although scant, indirectly affects motor tone and could have caused the mild residual obstructive pattern after surgery. Despite the doubtful role of the sympathetic nervous system in the lung, a series of physiologic studies show the effect of sympathetic nervous activity after bilateral dorsal sympathectomy.<sup>11,12</sup> The first was by Noppen and Vincken<sup>4</sup>, who compared the results of lung function studies (spirometry, diffusion, and lung volumes using plethysmography) in 7 patients before dorsal sympathectomy performed using VATS, at 6 weeks, and at 6 months (previous studies had been performed using invasive techniques [thoracotomy]). A statistically significant decrease was observed in FEV<sub>1</sub>, FEF<sub>25%-75%</sub>, and total lung capacity 6 weeks after surgery. At 6 months, the authors again evaluated the 35 patients and found that total lung capacity had returned to normal values, whereas FEF<sub>25%-75%</sub> remained low. They attributed the permanent decrease in FEF<sub>25%-75%</sub> to the sympathetic denervation produced by surgery, and stressed that, in patients with primary hyperhidrosis, bronchomotor tone is influenced by the sympathetic nervous system. This contrasts with the common opinion that motor tone in the airway is not affected by this system. Both the study by Ponce González et al,<sup>10</sup> who evaluated their patients at 1 year, and our study, in which we evaluated patients at 3 years, show that persistence of the decrease in FEF<sub>25%-75%</sub> over time is related more to sympatholysis of the ganglia than to VATS.</div>
<span style="background-color: white; font-family: Arial, Verdana, Helvetica, sans-serif; font-size: 13px;"><br /></span>
<span style="background-color: white; font-size: 13px;"><span style="font-family: Arial, Verdana, Helvetica, sans-serif;"><a href="http://www.archbronconeumol.org/en/bilateral-dorsal-sympathectomy-for-the/articulo/13147806/">http://www.archbronconeumol.org/en/bilateral-dorsal-sympathectomy-for-the/articulo/13147806/</a></span></span>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6746516199873373089.post-72582580472420432012014-12-03T16:52:00.001-08:002014-12-03T16:52:35.509-08:00Evidence based medicine is broken | The BMJ"How many people care that the research pond is polluted,5 with fraud, sham diagnosis, short term data, poor regulation, surrogate ends, questionnaires that can’t be validated, and statistically significant but clinically irrelevant outcomes? Medical experts who should be providing oversight are on the take. Even the National Institute for Health and Care Excellence and the Cochrane Collaboration do not exclude authors with conflicts of interest, who therefore have predetermined agendas.6 7 The current incarnation of EBM is corrupted, let down by academics and regulators alike.8"<br /><br />
<br /><br />
<a href="http://www.bmj.com/content/348/bmj.g22">http://www.bmj.com/content/348/bmj.g22</a>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6746516199873373089.post-13916791166810123482014-12-02T15:55:00.002-08:002014-12-02T15:55:39.077-08:00"sympathectomy, although having varying results, does seem to increase the severity of autoimmune disorders"<h3 class="post-title entry-title" style="background-color: white; color: #525252; font-family: 'Trebuchet MS', Trebuchet, sans-serif; margin: 20px 0px 0px; position: relative;">
<a href="http://sympathectomy.blogspot.com.au/2009/07/allostasis-state-of-imbalance.html" style="color: black; font-stretch: normal; text-decoration: none;"><span style="font-size: x-small;">Allostasis - a state of imbalance responsible for Autoimmune disorders</span></a></h3>
<div class="post-header" style="background-color: white; color: #525252; font-family: 'Trebuchet MS', Trebuchet, sans-serif; font-size: 13px; line-height: 1.6; margin: 0px 0px 1em;">
<div class="post-header-line-1">
</div>
</div>
<div class="post-body entry-content" style="background-color: white; color: #525252; font-family: 'Trebuchet MS', Trebuchet, sans-serif; line-height: 18.2000007629395px; position: relative; width: 500px;">
<span style="font-size: 13px;">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)</span><br /><span style="font-size: 13px;">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.</span><br /><br /><span style="font-size: 13px;">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)</span><br /><br /><span style="font-size: 13px;">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)</span><br /><br /><span style="font-size: 13px;">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)</span><br /><div id="titlebar" style="white-space: nowrap;">
<h1 class="title" dir="ltr" style="margin: 0px; position: relative;">
<span style="font-size: x-small;">Allostasis, homeostasis and the costs of physiological adaptation</span></h1>
<span style="font-size: x-small;"><span class="addmd">By Jay Schulkin</span><a dir="ltr" href="http://www.cambridge.org/0521811414" style="color: #8b7b06; text-decoration: none; white-space: normal;">Cambridge University Press</a>, 2004</span></div>
<br /><br /><div style="font-size: 13px;">
<b>Allostasis</b> is the process of achieving stability, or <a href="http://en.wikipedia.org/wiki/Homeostasis" style="color: #8b7b06; text-decoration: none;" title="Homeostasis">homeostasis</a>, through physiological or behavioral change. This can be carried out by means of alteration in <a href="http://en.wikipedia.org/wiki/Hypothalamic-pituitary-adrenal_axis" style="color: #8b7b06; text-decoration: none;" title="Hypothalamic-pituitary-adrenal axis">HPA axis</a>hormones, the <a href="http://en.wikipedia.org/wiki/Autonomic_nervous_system" style="color: #8b7b06; text-decoration: none;" title="Autonomic nervous system">autonomic nervous system</a>, <a href="http://en.wikipedia.org/wiki/Cytokine" style="color: #8b7b06; text-decoration: none;" title="Cytokine">cytokines</a>, or a number of other systems, and is generally adaptive in the short term <sup class="reference" id="cite_ref-0"><a href="http://en.wikipedia.org/wiki/Allostasis#cite_note-0" style="color: #8b7b06; text-decoration: none;">[1]</a></sup></div>
</div>
Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6746516199873373089.post-27909610226311060622014-11-30T17:13:00.001-08:002014-11-30T17:13:08.279-08:00"Similar low values are observed in patients with sympathectomy and in patients with tetraplegia""Patients with progressive autonomic dysfunction (including diabetes) have little or no increase in plasma noradrenaline and this correlates with their orthostatic intolerance (Bannister, Sever and Gross, 1977). In patients with pure autonomic failure, basal levels of noradrenaline are lower than in normal subjects (Polinsky, 1988). Similar low values are observed in patients with sympathectomy and in patients with tetraplegia. (p.51)<br />
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The finger wrinkling response is abolished by upper thoracic sympathectomy. The test is also abnormal in some patients with diabetic autonomic dysfunction, the Guillan-Barre syndrome and other peripheral sympathetic dysfunction in limbs. (p.46)<br />
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Other causes of autonomic dysfunction without neurological signs include medications, acute autonomic failure, endocrine disease, surgical sympathectomy . (p.100)<br />
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Anhidrosis is the usual effect of destruction of sympathetic supply to the face. However about 35% of patients with sympathetic devervation of the face, acessory fibres (reaching the face through the trigeminal system) become hyperactive and hyperhidrosis occurs, occasionally causing the interesting phenomenon of alternating hyperhidrosis and Horner's Syndrome (Ottomo and Heimburger, 1980). (p.159)<br /><br />
<br /><br />
Disorders of the Autonomic Nervous System<br />
By David Robertson, Italo Biaggioni<br />
Edition: illustrated<br />
Published by Informa Health Care, 1995<br />
ISBN 3718651467, 9783718651467"<br /><br />
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<a href="https://chrome.google.com/webstore/detail/pengoopmcjnbflcjbmoeodbmoflcgjlk" style="font-size: 13px;">'via Blog this'</a>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6746516199873373089.post-37760415605267583082014-11-29T16:39:00.001-08:002014-11-29T16:39:01.053-08:00"Sympathectomy is a destructive procedure that interrupts the sympathetic nervous system<a href="http://summaries.cochrane.org/CD002918/SYMPT_cervico-thoracic-or-lumbar-sympathectomy-for-neuropathic-pain">Cervico-thoracic or lumbar sympathectomy for neuropathic pain | Cochrane Summaries</a>: "Sympathectomy is a destructive procedure that interrupts the sympathetic nervous system. Chemical sympathectomies use alcohol or phenol injections to destroy sympathetic nervous tissue (the so-called "sympathetic chain" of nerve ganglia). Surgical ablation can be performed by open removal or electrocoagulation (destruction of tissue with high-frequency electrical current) of the sympathetic chain, or by minimally invasive procedures using thermal or laser interruption. Nerve regeneration commonly occurs following both surgical or chemical ablation, but may take longer with surgical ablation.<br />
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This systematic review found only one small study (20 participants) of good methodological quality, which reported no significant difference between surgical and chemical sympathectomy for relieving neuropathic pain. Potentially serious complications of sympathectomy are well documented in the literature, and one (neuralgia) occurred in this study.<br />
<br />
The practice of sympathectomy for treating neuropathic pain is based on very weak evidence. Furthermore, complications of the procedure may be significant."<br /><br />
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<a href="https://chrome.google.com/webstore/detail/pengoopmcjnbflcjbmoeodbmoflcgjlk" style="font-size: 13px;">'via Blog this'</a>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6746516199873373089.post-67929117188024285542014-11-25T15:37:00.002-08:002014-11-25T15:37:40.299-08:00Stellate ganglion block alleviates anxiety, depression<div class="BodyCxSpFirst" style="background-color: white; box-sizing: border-box; color: #333333; font-family: Arial, Helvetica, sans-serif; font-size: 15px; line-height: 20px; margin-bottom: 18px; position: relative; top: -2px;">
Among veterans with post-traumatic stress disorder, treatment with a single stellate ganglion block could help alleviate anxiety, depression and psychological pain rapidly and for long-term use, according to results presented at the American Society for Anesthesiologists Annual Meeting.</div>
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See Also</h5>
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<li style="box-sizing: border-box; margin: 0px 0px 5px; padding: 0px;"><a href="http://www.healio.com/psychiatry/ptsd/news/online/%7B64739e56-e580-4bb8-a714-99d200337a5c%7D/experts-propose-nerve-blocks-to-treat-ptsd" style="background: transparent; box-sizing: border-box; color: #0355c2; font-size: 11px; text-decoration: none;">Experts propose nerve blocks to treat PTSD</a></li>
<li style="box-sizing: border-box; margin: 0px 0px 5px; padding: 0px;"><a href="http://www.healio.com/psychiatry/ptsd/news/online/%7B4e137bbf-4bc0-4c31-b6b2-77e83e9b09d9%7D/dsm-5-ptsd-screening-may-miss-previously-diagnosed-soldiers" style="background: transparent; box-sizing: border-box; color: #0355c2; font-size: 11px; text-decoration: none;">DSM-5 PTSD screening may miss previously diagnosed ...</a></li>
<li style="box-sizing: border-box; margin: 0px 0px 5px; padding: 0px;"><a href="http://www.healio.com/psychiatry/ptsd/news/online/%7Bf6405a66-a5bd-449e-8a4d-94b0943fd87d%7D/amygdala-activation-could-predict-ptsd-susceptibility" style="background: transparent; box-sizing: border-box; color: #0355c2; font-size: 11px; text-decoration: none;">Amygdala activation could predict PTSD susceptibility ...</a></li>
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Researchers performed a single right-sided stellate ganglion block (SGB) using 7 mL of 2% lidocaine and 0.25% bupivacaine under fluoroscopic guidance on 12 veterans with military-related, chronic extreme post-traumatic stress disorder (PTSD) with hyperarousal symptoms. At baseline, 1 week, 1 month, 3 months and 6 months post-block, PTSD symptoms were assessed using the Clinician Administered PTSD Scale (CAPS) score and the Post-traumatic Stress Self Report (PSS-SR) scale. Depressive symptoms were assessed with the Beck Depression Inventory version 2. Anxiety related symptoms with a generalized anxiety scale score and the State-Trait Anxiety Index and psychological pain with the Mee-Bunney scale.</div>
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Study results showed the block was greatly effective in 75% of participants, with a positive effects taking effect often within minutes of SGB. At week 1, there was significant reduction of both CAPS and PSS-SR and researchers found CAPS approached normal-to-mild PTSD levels by 1 month. Anxiety, depression and psychological pain scores also were significantly reduced by the block, according to study results. Overall, positive effects remained evident at 3 months, but were generally gone by 6 months.</div>
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<strong style="box-sizing: border-box;">Reference:</strong></div>
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Alkire MT. A1046. Presented at: American Society for Anesthesiologists Annual Meeting; <span style="box-sizing: border-box;"> </span>Oct. 11-15, 2014; New Orleans.</div>
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<span style="color: #333333; font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 15px; line-height: 20px;"><a href="http://www.healio.com/psychiatry/ptsd/news/online/%7B14e0a858-100a-43b1-a0e0-47c6376cb885%7D/stellate-ganglion-block-alleviates-anxiety-depression-for-veterans-with-ptsd">http://www.healio.com/psychiatry/ptsd/news/online/%7B14e0a858-100a-43b1-a0e0-47c6376cb885%7D/stellate-ganglion-block-alleviates-anxiety-depression-for-veterans-with-ptsd</a></span></span></div>
Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6746516199873373089.post-89235547628802949872014-11-22T17:35:00.001-08:002014-11-22T17:35:01.237-08:00Hemodynamic changes in vertebral and carotid arteries were observed after sympathicotomy for hyperhidrosis<span style="background-color: white; color: #141823; font-family: Helvetica, Arial, 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 14px; line-height: 20px;">T3 sympathicotomy segment was the most frequent transection done (95.83%), as only ablation (25%) or in association with T4 (62.50%)</span><span class="text_exposed_show" style="background-color: white; color: #141823; display: inline; font-family: Helvetica, Arial, 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 14px; line-height: 20px;"> or with T2 (8.33%). It was observed increase in RI and PI of the common carotid artery (p < 0.05). The DPV of internal carotid artery decreased in both sides (p < 0.05). The SPV and the DPV of the right and left vertebral arteries also increased (p < 0.05). Asymmetric findings were observed so that, arteries of the right side were the most frequently affected.<br />CONCLUSIONS: Hemodynamic changes in vertebral and carotid arteries were observed after sympathicotomy for PH. SPV was the most often altered parameter, mostly in the right side arteries, meaning significant asymmetric changes in carotid and vertebral vessels. Therefore, the research findings deserve further investigations to observe if they have clinical inferences.<br /><a href="http://www.ncbi.nlm.nih.gov/pubmed/16186983" rel="nofollow nofollow" style="color: #3b5998; cursor: pointer; text-decoration: none;" target="_blank">http://www.ncbi.nlm.nih.gov/pubmed/16186983</a></span>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-6746516199873373089.post-41090237801788569992014-11-19T22:21:00.002-08:002014-11-19T22:21:12.509-08:0024-hour melatonin measurements in normal subjects and after peripheral sympathectomy<div class="cit" style="background-color: white; font-family: arial, helvetica, clean, sans-serif; font-size: 0.8465em; line-height: 1.45em;">
<span role="menubar"><a abstractlink="yes" alsec="jour" alterm="J Clin Endocrinol Metab." aria-expanded="false" aria-haspopup="true" href="http://www.ncbi.nlm.nih.gov/pubmed/2005207#" role="menuitem" style="border-bottom-width: 0px; color: #660066;" title="The Journal of clinical endocrinology and metabolism.">J Clin Endocrinol Metab.</a></span> 1991 Apr;72(4):819-23.</div>
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Sequential cerebrospinal fluid and plasma sampling in humans: 24-hour melatonin measurements in normal subjects and after peripheral sympathectomy.</h1>
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<a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Bruce%20J%5BAuthor%5D&cauthor=true&cauthor_uid=2005207" style="border-bottom-width: 0px; color: #660066;">Bruce J</a><span style="font-size: 0.8461em; line-height: 1.6363em; position: relative; top: -0.5em; vertical-align: baseline;">1</span>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Tamarkin%20L%5BAuthor%5D&cauthor=true&cauthor_uid=2005207" style="border-bottom-width: 0px; color: #660066;">Tamarkin L</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Riedel%20C%5BAuthor%5D&cauthor=true&cauthor_uid=2005207" style="border-bottom-width: 0px; color: #660066;">Riedel C</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Markey%20S%5BAuthor%5D&cauthor=true&cauthor_uid=2005207" style="border-bottom-width: 0px; color: #660066;">Markey S</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Oldfield%20E%5BAuthor%5D&cauthor=true&cauthor_uid=2005207" style="border-bottom-width: 0px; color: #660066;">Oldfield E</a>.</div>
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Abstract</h3>
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<abstracttext>Simultaneous measurements of plasma and cerebrospinal fluid (CSF) melatonin and urinary excretion of 6-hydroxymelatonin were performed in four normal volunteers and one patient before and after upper thoracic sympathectomy for the control of essential hyperhidrosis. For normal individuals, hourly 24-h melatonin concentrations in plasma and CSF exhibited similar profiles, with low levels during the day and high levels at night. Peak plasma levels varied from 122-660 pmol/L, and the peak CSF levels from 94-355 pmol/L. The onset of the nocturnal increase in melatonin did not occur at the same time for each individual. Urinary 6-hydroxymelatonin levels also exhibited a daily rhythm, with peak excretion at night. The individual with the lowest nocturnal levels of circulating melatonin also had the lowest excretion of 6-hydroxymelatonin. In the patient with hyperhidrosis, a prominent melatonin rhythm was observed preoperatively in the CSF and plasma. After bilateral T1-T2 ganglionectomy, however, melatonin levels were markedly reduced, and the diurnal rhythm was abolished. These results provide direct evidence in humans for a diurnal melatonin rhythm in CSF and plasma as well as regulation of this rhythm by sympathetic innervation.</abstracttext></div>
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<abstracttext style="line-height: 17.9998016357422px;"><span style="font-family: arial, helvetica, clean, sans-serif; font-size: x-small;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/2005207">http://www.ncbi.nlm.nih.gov/pubmed/2005207</a></span></abstracttext></div>
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