sympathectomy affects the brain: April 2011

cell body reorganization in the spinal cord after sympathectomy

The amount of compensatory sweating depends on the patient, the damage that the white rami communicans incurs, and the amount of cell body reorganization in the spinal cord after surgery.
Other potential complications include inadequate resection of the ganglia, gustatory sweating, pneumothorax, cardiac dysfunction, post-operative pain, and finally Horner’s syndrome secondary to resection of the stellate ganglion.
www.ubcmj.com/pdf/ubcmj_2_1_2010_24-29.pdf

After severing the cervical sympathetic trunk, the cells of the cervical sympathetic ganglion undergo transneuronic degeneration
After severing the sympathetic trunk, the cells of its origin undergo complete disintegration within a year.
http://onlinelibrary.wiley.com/doi/10.1111/j.1439-0442.1967.tb00255.x/abstract

Saturday, April 23, 2011

Inflammation after a spinal cord injury (SCI) is nonresolving

Inflammation after a spinal cord injury (SCI) is nonresolving, and can be characterized by quantification of lymphocytes using resolution indexes (Ri) and resolution plateaus (Rp), according to an experimental study published online March 22 in Brain Pathology.

Harald Prüss, M.D.,

http://www.mdnews.com/news/hd/2011_16/hd_651416

Friday, April 22, 2011

cervical sympathectomy works systemically through hypothalamus endocrine system

Background: To investigate the general action of stellate ganglion block (SGB), we examined the effects of heat stimulation and cold stress on the behavior and stress hormone of the bilateral cervical sympathectomy rats as a long-term and repeated SGB model. Methods: Wistar's male rats were divided into three groups: control (C), sham operation (S) and sympathectomy (Sx) groups. After 2 weeks, two experiments were done. One was measurement of escape response time from the heat stimulus and the other was hormone measurement. Serum adreno-corticotropic hormone (ACTH), .ALPHA.-melanocyte stimulating hormone (.ALPHA.-MSH) and .BETA.-endorphine (.BETA.-END) levels were measured assigning 3 groups to 2 subgroups with and without cold stress. Results: Escape response time was significantly extended in the Sx group. ACTH in the Sx group was significantly higher than in other groups, but changes of ACTH by cold stress were similar in 3 groups. In the Sx group .ALPHA.-MSH was hardly changed by cold stress while .ALPHA.-MSH was significantly decreased in the S group. Changes of .BETA.-END by cold stress were similar in the S and Sx groups. Conclusions: These results suggest that SGB works systemically through hypothalamus endocrine system and affects stress hormone differently. (author abst.)

http://sciencelinks.jp/j-east/article/200402/000020040204A0020288.php

Unilateral cervical sympathectomy resulted in a moderate and short decrease in milk secretion

the average amount of milk given by operated animals 10 days after operation being 76-3% of the initial level. Total cervical sympathectomy (the 2nd operation was performed 1 month later) caused a much greater and more prolonged decrease in milk secretion, 59.7% of the initial level being secreted during the 10 days after operation. A gradual increase in milk secretion was observed after the operation and this increase was more gradual after total sympathectomy than after partial sympathectomy. Denervation of the thyroid and parathyroids did not decrease milk secretion. Section of the pituitary stalk in 6 goats, which included complete section (2 goats), complete section with scar tissue at the site of section and considerable damage to the median eminence of the tuber einereum (1 goat) and incomplete section (3 goats) was performed. Milk ejection disappeared completely for 7-11 days in the goats with complete section and remained defective for some weeks after, but was still effective in those where the infundibular stem and part of the glandular portion of the pituitary stalk was still intact. Milk secretion was 28.9% of the initial level in the goats with complete section and 12.9% in the goat with the scar tissue whereas it was 40.5 and 55.7% in the incompletely sectioned and control operated goats. (See also D.S.A. 21 [3081].) D.E.E.

Influence of cervical sympathectomy and pituitary stalk section upon milk secretion in goats.

Authors

TVERSKOY, G. B.

Journal

Nature 1960 Vol. 186 No. 4727 pp. 782-84

ISSN

0028-0836

DOI

10.1038/186782a0

Monday, April 18, 2011

adult neurogenesis may contribute to the functioning, and phyio- and pathology of the CNS, particularly to the etiology of neurological diseases and disorders

Neuroinflammation is a process in which the brain responds to infections, diseases and injuries [1, 2]. Neuroinflammation involve two types of immune cells: lymphocytes, monocytes and macrophages of the hematopoietic system, and microglial cells of the CNS [3, 4]. Neuroinflammation disrupts the blood-brain barrier (BBB), allowing cells from the hematopoietic system to leave the blood stream and come in contact to the injury site [5]. The immune cells respond to injuries by eliminating debris and, synthesizing and releasing a host of powerful regulatory substances, like the complements, cytokines, chemokines, glutamate, interleukins, nitric oxide, reactive oxygen species and transforming growth factors [6-10]. The substances have both beneficial and harmful effects on the cellular environment, creating further damages [11] (fig. 1). Mature astrocytes are also activated following injury to the CNS [12, 13].

Chronic inflammation during depressive episodes could predispose depressive patients to neurodegenerative diseases, later in life [29].
http://www.medsci.org/v05p0127.htm

Tuesday, April 12, 2011

The cerebral vessels became hypersensitive to epinephrine after cervical sympathectomy

The cerebral vessels became hypersensitive to epinephrine after cervical sympathectomy.
HERTZMAN, A. B., AND DILLON, J. B.
Annual Review of Physiology
Vol. 4: 187-214 (Volume publication date March 1942)

Changes in the cerebral capillary bed following cervical sympathectomy

Arch. Neurol. and Psychiat., 1929, 21, 1102.Tracy J. PutnamThe Cerebral Circulation: Some New Points in its Anatomy, Physiology and Pathology
J Neurol Psychopathol, Jan 1937; s1-17: 193 - 212.

Tuesday, April 5, 2011

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

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

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

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

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

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

cervical sympathetic ganglionectomy."

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

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autonomic vulnerability or visceral dysfunction may precipitate or aggravate mental symptoms

dynamic cerebral autoregulation is altered by ganglion blockade

After ganglion blockade, systolic and pulse pressure decreased significantly by 13% and 26%, respectively. CBF velocity decreased by 6% (P <0.05). In the very low frequency range (0.02 to 0.07 Hz), mean blood pressure variability decreased significantly (by 82%), while CBF velocity variability persisted. Thus, transfer function gain increased by 81%. In addition, the phase lead of CBF velocity to arterial pressure diminished. These changes in transfer function gain and phase persisted despite restoration of arterial pressure by infusion of phenylephrine and normalization of mean blood pressure variability by oscillatory lower body negative pressure.

Conclusions-: These data suggest that dynamic cerebral autoregulation is altered by ganglion blockade. We speculate that autonomic neural control of the cerebral circulation is tonically active and likely plays a significant role in the regulation of beat-to-beat CBF in humans.

Circulation. 106(14):1814-1820, October 1, 2002.

second thoracic sympathetic ganglion was most commonly located (50%) in the second intercostal space

anatomic variations of the T2 nerve root

6 (9.1%) sides showed a single large ganglion formed by the stellate and the second thoracic sympathetic ganglia. The second thoracic sympathetic ganglion was most commonly located (50%) in the second intercostal space. Conclusion: The anatomic variations of the intrathoracic nerve of Kuntz and the second thoracic sympathetic ganglion were characterized in human cadavers. Journal of thoracic and cardiovascular surgery Y. 2002, vol. 123, No. 3, pages 498-501 [bibl. : 14 ref. http://www.refdoc.fr/Detailnotice?idarticle=9466218

decreased conditioning-related activity in insula and amygdala after autonomic denervation

The degree to which perceptual awareness of threat stimuli and bodily states of arousal modulates neural activity associated with fear conditioning is unknown. We used functional magnetic neuroimaging (fMRI) to study healthy subjects and patients with peripheral autonomic denervation to examine how the expression of conditioning-related activity is modulated by stimulus awareness and autonomic arousal. In controls, enhanced amygdala activity was evident during conditioning to both "seen" (unmasked) and "unseen" (backward masked) stimuli, whereas insula activity was modulated by perceptual awareness of a threat stimulus. Absent peripheral autonomic arousal, in patients with autonomic denervation, was associated with decreased conditioning-related activity in insula and amygdala. The findings indicate that the expression of conditioning-related neural activity is modulated by both awareness and representations of bodily states of autonomic arousal.

http://www.ncbi.nlm.nih.gov/pubmed/11856537

Segmental myoclonus was associated with thoracic sympathectomy

Spinal myoclonus was associated with laminectomy, remote effect of cancer, spinal cord injury, post-operative pseudomeningocele, laparotomy, thoracic sympathectomy, poliomyelitis, herpes myelitis, lumbosacral radiculopathy, spinal extradural block, and myelopathy due to demyelination, electrical injury, acquired immunodeficiency syndrome, and cervical spondylosis.

http://www.ncbi.nlm.nih.gov/pubmed/3753263

Spinal myoclonus is typically associated with a localized area of damaged tissue (focal lesion). The injured area may include direct damage of the spinal cord or may cause abnormal changes in the function of the spinal cord.

http://www.wemove.org/myo/myo_pc.html

Spinal myoclonus following a peripheral nerve injury: a case report

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2526081/

decrease in CBF induced by sympathectomy cannot be attributed to hypersensitivity

Thus the decrease in CBF induced by chronic sympathectomy cannot be attributed to the development of hypersensitivity to catecholamines. This decrease remained stable whatever the value of resting flow and was maintained under anesthesia. It is concluded that, as in the peripheral circulation, chronic sympathectomy affects the equilibrium of the vascular smooth muscle fibers, but that circulating amines play no compensatory role in the cerebral circulation because of the blood-brain barrier.

http://www.sciencedirect.com/science/article/pii/0006899385902434

After the sympathectomy, the high night time excretion of melatonin was abolished

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...
http://www.ncbi.nlm.nih.gov/pubmed/16647807

LIMITED SYMPATHECTOMY DOES NOT REDUCE SEVERITY OF SIDE-EFFECTS

On univariate and multivariate analysis, the extent of denervation was not associated with the occurrence or the severity of compensatory sweating.

Compensatory sweating and temporary relief/recurrence were equally considered to be the main causes of dissatisfaction. CONCLUSION: Compensatory sweating was the most common long-term complication of thoracodorsal sympathectomy for primary hyperhidrosis. Its incidence and severity were not associated with the extent of sympathectomy.

http://www.ncbi.nlm.nih.gov/pubmed/12514588

Muliptle organ failure as a consequence of elective sympathectomy

In the post-sympathectomy patient, the abnormalsympathetic skin response may lead to peripheral vascular failureor the reduced cardiac chronotropic response may impair thebody’s capacity to compensate for shock. These may havecontributed to the rapid development of shock and severe multipleorgan dysfunction syndrome in this patient.
He had multiple organ dysfunction syndrome develop, with severerenal and hepatic failure, grade II hepatic encephalopathy,and disseminated intravascular coagulation. He responded remarkablywell to aggressive supportive measures including forced alkalinediuresis, and he was eventually discharged home after 1 month. The patient was previously a healthy, physically fit, nonsmoker.He worked as a body building trainer and led an active, sportylifestyle. The only significant medical history was that hehad received thoracic sympathectomy for axillary hyperhidrosis4 years ago at another hospital.

http://ats.ctsnetjournals.org/cgi/content/full/84/3/1025

Cell body reorganization in the spinal cord after elective surgery to treat sweaty palms

slowing of the heart rate usually occurs on the second to fourth day after sympathectomy

The rate fell to a level between 40 and 6o per minute, the maximal slowing usually occurring on the second to fourth day after operation. Consistent slowing of the rate was not observed after a unilateral thoracic sympathectomy of either side. While there was some recovery from the maximum bradycardia with the passage of time in most patients, relatively slow resting cardiac rates and failure of tachycardia to develop with postural hypotension or exercise persisted in all patients.

Skoog's12 work has shown that there are marked differences in the number and precise location of the accessory ganglion cells in the cervical region in different patients and on the two sides in the same patient.
Annals of Surgery, 1949 October, Volume 130 Number 4

'Emotional' sweating regulated by neocortex and limbic cortex

Careful observations showed that the forearm sweating responded diversely to various mental stimuli, unlike the palmar sweating whose response was always an increase. Mental arithmetic, mental testing and physical exercise caused an immediate increase in the palmar sweating but often elicited a transient decrease in the forearm sweating, whereas pain, noise, and emotional stimuli consistently provoked an increase of sweating on the forearm as well as on the palm. These observations suggest that the activities of higher centers, presumably involving neocortex and limbic cortex, exert various influences on the central mechanisms of palmar and generalized sweating.
Jpn J Physiol. 1975;25(4):525-36.
http://www.ncbi.nlm.nih.gov/pubmed/1206808

The sympathetic nervous system is responsible for the physiological responses to emotional states

The common epithet of “fight or flight” is being enlarged to be “fight, flight, or fright” or even “fight, flight, fright, or freeze.” Cannon’s original contribution was a catchy phrase to express some of what the nervous system does in response to a threat, but it is incomplete. The sympathetic system is responsible for the physiological responses to emotional states. The name “sympathetic” can be said to mean that (sym- = “together”; -pathos = “pain,” “suffering,” or “emotion”). http://cnx.org/content/m46582/latest/?collection=col11496/latest