after sympathectomy the hands may become hyperkeratotic, with fissuring and scaling

Sympathectomy for palmar hyperhidrosis is effective, but has risks associated with surgery and a permanent non-sweating hand, which may become hyperkeratotic, with fissuring and scaling.

The autonomic nervous system: an introduction to basic and clinical concepts

By Otto Appenzeller, Emilio Oribe

Cilio-spinal center can extend to T5

The ciliospinal reflex (pupillary-skin reflex) consists of dilation of the ipsilateral pupil in response to pain applied to the neck, face, and upper trunk. If the right side of the neck is subjected to a painful stimulus, the right pupil dilates (increases in size 1-2mm from baseline). This reflex is absent in Horner's syndrome and lesions involving the cervical sympathetic fibers. The enhanced ciliospinal reflex in asymptomatic patients with cluster headache is due to preganglionic sympathetic mechanisms.
http://en.wikipedia.org/wiki/Ciliospinal_reflex

The cilio-spinal center is not sharply confined to TI spinal level, but may extend downwards as low as T5

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1396202/pdf/annsurg00366-0044.pdf

financial interests may unduly influence professionals’ judgments

widespread relationships with industry have created significant risks that… financial interests may unduly influence professionals’ judgments.

“conflicts of interest” threaten the integrity of research, the objectivity of education, the quality of patient care, and public trust in medicine.

Conflict of Interest in Medical Research, Education, and Practice

Released:

April 21, 2009

Type:

Consensus Report

Topics:

Biomedical and Health Research, Education

Activity:

Conflict of Interest in Medical Research, Education, and Practice

Board:

Board on Health Sciences Policy

Endoscopic sympathectomy is not minimally invasive

The term ‘‘minimally invasive surgery’’ was initially applied to coelioscopic procedures such as laparoscopic cholecystectomy and hernia repair, thoracoscopic sympathectomy, and arthroscopy, but has since been abandoned, because doing the same operation through a smaller incision is not necessarily less invasive. The term ‘‘minimally invasive parathyroidectomy’’ does not fully convey the nature of the techniques, and, as previously debated in the wider field of minimal-access surgery, carries connotations of increased safety that are not necessarily supported by the existing data [12].

Surg Clin N Am 84 (2004) 717–734

F. Fausto Palazzo, MS, FRCS(Gen),
Leigh W. Delbridge, MD, FACS*

Department of Surgery, Royal North Shore Hospital, Sydney 2065, NSW, Australia

This is how "Australia’s leading source for trustworthy medical information" describes sympathectomy

"Sympathectomy is a procedure that is used to treat neuropathic pain. It interrupts the sympathetic nervous system either temporarily or permanently."

http://www.virtualmedicalcentre.com/medical-dictionary/alpha/s

Australia’s leading source for trustworthy medical information written by health professionals. Please be aware that we do not give advice on your individual medical condition, if you want advice please see your treating physician. Virtual Medical Centre © 2002 - 2013 | Privacy Policy Last updated 8 Aug 2013

progressive hemifacial atrophy following sympathectomy for hyperhidrosis

Some authors consider the disease a variant of mor- phea because the histologic changes are identical to deep scleroderma.2 The possible etiologies include sympathetic denervation, trauma, vascular malformations, immunologic abnormality, heredi- tary disease, or infection by a slow virus.3 To our knowledge, this is the first report of a young patient with a possible association between Parry-Romberg syndrome and thoracoscopic sympathectomy.

Theoretically, thoracoscopic sympathectomy may cause 2 of the aforementioned etiologies of Parry- Romberg syndrome: sympathetic denervation and trauma. Thoracoscopic sympathectomy is a surgical technique for the treatment of palmar hyperhidrosis.

The operation ablates the upper thoracic sympa- thetic nerve ganglions responsible for nerve stimu- lation of the sweat glands of the upper limbs. The most significant complication is Horner’s syn- drome, which results from injury to the stellate sympathetic ganglion.7 In a summary of sympa- thectomies in 67 children and adolescents, compli- cations included Horner’s syndrome in 1 patient (1%) and varying degrees of compensatory sweat- ing in 30 patients (45%).8 Despite the evidence from animal studies that sympathectomy can result in facial atrophy, to our knowledge, there were no previous reports of such an association in humans.

Cutis. 2004;73:343-344, 346.

RSD due to nerve injury

According to the National Institute of Neurological Disorders and Stroke (NINDS), RSD is "a chronic pain condition that is believed to be the result of dysfunction in the central or peripheral nervous systems." According to MedicineNet, RSD involves "irritation and abnormal excitation of nervous tissue, leading to abnormal impulses along nerves that affect blood vessels and skin."

Animal studies indicate that norepinephrine, a catecholamine released from sympathetic nerves, acquires the capacity to activate pain pathways after tissue or nerve injury, resulting in RSD. Another theory suggests that RSD, which follows an injury, is caused by triggering an immune response and symptoms associated with inflammation (redness, warmth, swelling). RSD is not thought to have a single cause, but rather multiple causes producing similar symptoms.

http://arthritis.about.com/od/rsd/a/rsd.htm

Limited sympathectomy does not reduce postoperative compensatory sweating

Endoscopic transthoracic for upper limb hyperhidrosis: Limited does not reduce postoperative compensatory sweating:

Sympathetic chain ganglia are responsible for delivering information to the rest of the body regarding stress situations and the fight or flight response

Sympathetic chain ganglia are responsible for delivering information to the rest of the body regarding stress situations and the fight or flight response. These sympathetic ganglia are the structures that are destroyed during a sympathectomy
http://www.ast.org/publications/Journal%20Archive/2009/9_September_2009/CE.pdf

After sympathectomy in rats there is an increase in osteoclast-mediated bone resorption as well as an increase in the number of osteoclasts on the sympathectomized side

Paper: Osteoclastic Activation In Periapical Lesions After NPY Knockout (IADR/AADR/CADR 87th General Session and Exhibition (April 1-4, 2009)): "After sympathectomy in rats there is an increase in osteoclast-mediated bone resorption as well as an increase in the number of osteoclasts on the sympathectomized side compared to the control. These findings suggest an inhibitory effect of the SNS on bone resorption via osteoclasts. Our objective was to determine if an SNS mediator, neuropeptide Y (NPY), affects osteoclastic activity after pulpal exposure."

Two-stage unilateral versus one-stage bilateral single-port sympathectomy for palmar and axillary hyperhidrosis

Compensatory sweating occurred in 25 (19%) patients of the one-stage group and in 6 (4%) of the two-stage group (P = 0.0001). No patients developed Horner’s syndrome.
CONCLUSIONS: Both two-stage unilateral and one-stage bilateral single-port video-assisted thoracoscopic sympathectomies are effective, safe and minimally invasive procedures. Two-stage unilateral sympathectomy can be performed with a lower occurrence of compensatory sweating, improving permanently the quality of life in patients with palmar and axillary hyperhidrosis. 
http://icvts.oxfordjournals.org/content/16/6/834.full.pdf+html 

sympathectomy led to significant decrements in escape and avoidance responding

PsycNET - Option to Buy: "Chemical sympathectomy and avoidance learning in the rat.
By Di Giusto, E. L.; King, M. G.
Journal of Comparative and Physiological Psychology, Vol 81(3), Dec 1972, 491-500.
Abstract
Reports results of 5 experiments with male Wistar rats (N = 108). Depletion of peripheral sympathetic noradrenaline induced by administration of 6-hydroxydopamine, ip, led to significant decrements in escape and avoidance responding when the required response was difficult, but not when it was relatively easy to acquire. Results are similar to previous findings obtained with adrenal-demedullated Ss. Findings clarify the role of the sympathetic nervous system in the motivation of behavior elicited by aversive stimulation. Implications for 2-process theory and the "Kamin effect," or "learned helplessness," are discussed. (40 ref.) (PsycINFO Database Record (c) 2012 APA, all rights reserved)"

Hyperhidrosis (excessive sweating). DermNet NZ

Hyperhidrosis (excessive sweating). DermNet NZ: "Localised hyperhidrosis may also be due to:

Stroke
Spinal damage
Peripheral damage
Surgical sympathectomy
Neuropathy
Brain tumour
Chronic anxiety disorder"

Severity of compensatory sweating after thor... [Ann Thorac Surg. 2004] - PubMed - NCBI

Severity of compensatory sweating after thor... [Ann Thorac Surg. 2004] - PubMed - NCBI: "Compensatory sweating occurred in 89% of patients and was so severe in 35% that they often had to change their clothes during the day. The frequency of compensatory sweating was not significantly different among the three groups, but severity was significantly higher after Th2-4 sympathectomy for axillary hyperhidrosis (p = 0.04). Gustatory sweating occurred in 38% of patients, and 16% of patients regretted the operation.
CONCLUSIONS:
Compensatory and gustatory sweating were remarkably frequent side effects after thoracoscopic sympathectomy for primary hyperhidrosis."

Impaired skin vasomotor reflexes have been found in patients with sympathetic dystrophies, dysautomias, post-regional sympathectomy and diabetic neuropathies

Not surprisingly, diminished vasoconstrictor responses, similar to the current findings, have been found
in patients with sympathetic dystrophies [26], dysautomias [27], post-regional sympathectomy [28] and
diabetic neuropathies [11].


Additionally, there have been a few reports of EM patients benefitting from sympathectomy or neurolitic
irreversible blocks of the lumbar sympathetic ganglia [22,23], while others have found the symptoms of EM to be aggravated by such treatment [24,25], possibly as a result of denervation supersensitivity.
Clinical Science (1999) 96, 507ñ512 (Printed in Great Britain)
Roberta C. LITTLEFORD, Faisel KHAN and Jill J. F. BELCH
University Department of Medicine, Section of Vascular Medicine and Biology, Ninewells Hospital and Medical School,
Dundee DD1 9SY, Scotland, U.K.

Sympathectomy interrupts neural messages that ordinarily would travel to many different organs, glands and muscles

Sympathectomy involves dissection of the main sympathetic trunk in the upper thoracic region thus interrupting neural messages that ordinarily would travel to many different organs, glands and muscles. It involves division of adrenergic, cholinergic and sensory fibers which elaborate adrenergic substances during the process of regulating visceral function.
Journal of Applied Sciences Research, 6(6): 659-664, 2010

Vascular sympathetic denervation can lead to degeneration of the smooth muscle of arteries leading to medial arterial calcification and stiffening of the arteries

Sympathetic denervation of the peripheral arterial system may occur quite early in the evolution of neuropathy and has major effects on blood flow and vascular responses and causes structural changes in the arterial wall (Edmonds 2004). Vascular sympathetic denervation can lead to degeneration of the smooth muscle of arteries leading to medial arterial calcification and stiffening of the arteries. This calcification may assume the histological characteristics of bone.

   Unilateral lumbar sympathectomy in humans, both in diabetics and non-diabetics, has been show to result in medial wall calcification on the ipsilateral side (Goebel and Fuessl 1983). Unilateral sympathectomy in animals leads to excess deposition of cholesterol on the operated side and the occurrence of cholesterol sclerosis in the rabbit's aorta was accelerated by removal of the coeliac ganglion (Harrison 1938). Furthermore, in animal models, denervation of smooth muscle leads to striking pathological changes, including atrophy of muscle fibres with foci of degeneration (Kerper and Collier 1926). Arterial calcification in initiated within senescent atrophic smooth muscle (Morgan 1980).

   Medial arterial calcification in the Pima Indians is significantly associated with an increased prevalence of cardiovascular mortality (Everhart et al 1988). Medial calcification may be important factor in development of peripheral vascular disease, which in diabetes shows a predilection for the distal arteries below the knee and is unexplained. Chantelau reported an association of below knee atherosclerosis to medial arterial calcification (Chantelau et al. 1995).

p. 653

Autonomic Failure: A Textbook of Clinical Disorders of the Autonomic Nervous System[Hardcover]

Christopher J. Mathias (Author), Roger Bannister (Author)

• Publisher: Oxford University Press, USA; 5 edition (July 24, 2013)
• Language: English
• ISBN-10: 0198566344
• ISBN-13: 978-0198566342

"Patients report that they feel less anxious in stressful situations. Stage fright is reduced. The results are usually permanent."

http://neuro.templehealth.org/content/ETShyperhidrosis.htm

Sympathectomy, (ETS, VATS, ESB and many other names for the same procedure) affects emotional responses, fear responses, arousal, etc. It changes a person's  ability to feel and respond to emotions. It changes drive, attention, mobilisation.
Patients sign up for a surgery to treat sweaty hands, and not 'adjustments' to their emotions and personality.

sympathectomy leads to fluctuation of vasoconstriction alternated with vasodilation in an unstable fashion

"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)"

Chronic Pain: 

Reflex Sympathetic Dystrophy : Prevention and Management

Hooshang Hooshmand

CRC PressINC, 1993 - Medical - 202 pages

we stopped performing sympathectomies in 1994, since we were alarmed by the complication and failure rate

Physical  medicine
Russell,  Alan  L.  Patient  Care 13.2  (Feb  2002):  19. 

Seven cases of enlargement of the breast following sympathectomy for hyperhidrosis

The  phenomenon  of  hyperhidrosis  is  a  pathological  state  caused  by  unknown  stimulus  of  the  sympathetic  nervous  system.  When  a  variety  of  conservative  treatments have  failed,  surgery  which  involves  the  removal  of  some  ganglia  of  the  cervical  sympathetic  chain,  is  the  treatment  of  choice.  In  the  last  four  years  we  operated  on 253  patients  for  palmar  hyperhidrosis  using  the  transaxillary  approach  only. Recently,  a  new  side  effect  of  surgery  has  come  to  our  attention.  This  phenomenon  is enlargement  of  the  breast  on  the  operated  side.  Our  series  show  seven  cases  (2.4%)  of  women  operated  for  palmar  hyperhidrosis  who  manifested  this phenomenon,  two  of  them  bilaterally.  The  enlargement  of  the  breast  was  found  usually  by  the  second  follow-­up  visit  after  operation  when,  in  most  cases,  the  patient mentioned  it.Examination  of  the  breast  revealed  enlargement  of  a  few  centimeters  which  in  several  patients  required  a  change  to  a  larger  brassiere  size.  In  both  of our  patients  who  underwent  bilateral  surgery,  the  breasts  enlarged  until  they  were  equal  in  size.  The  women  then  did  not  complain  further.  


Enlargement  of  the  Breast-­-­A  New  Side  Effect  of  Transaxillary  Cervical  Sympathectomy:  Case  Report Kott,  Itamar;;  Hauptman,  Eli;;  Zelkovsky,  Avigdor;;  Reiss,  Raphael.  Vascular  and  Endovascular  Surgery 20.1  (Jan  1986):  50-­54. 

Several reports have dealt with the alteration of antibody responses of spleen and lymph nodes following sympathectomy

http://www.ncbi.nlm.nih.gov/pubmed/8528891

Sympathectomy significantly alters vascular responses

Vascular responses to warming were studied in hemiplegic patients and after sympathectomy, using venous occlusion plethysmography of foot and leg. Comparisons were made with corresponding age groups. The pattern of response was essentially unchanged in hemiplegic patients, but was altered substantially where sympathetic pathways had been interrupted.

Vasomotor Responses in the Extremities of Subjects with Various Neurologic Lesions

I. Reflex Responses to Warming

1. WALTER REDISCH, M.D.; 
2. FRANCISCO T. TANGCO, M.D.; 
3. LOTHAR WERTHEIMER, M.D.;
4. ARTHUR J. LEWIS, M.D.; 
5. J. MURRAY STEELE, M.D.; 
6. Dorothy Andrews, B.A.,

http://circ.ahajournals.org/content/15/4/518.abstract

Sympathectomy involves division of adrenergic, cholinergic and sensory fibers which elaborate adrenergic substances during the process of regulating visceral function

G. SURGICAL SYMPATHECTOMY AND ADRENERGIC FUNCTIONPharmacol Rev March 1966 18:611-618;

Sympathectomy (ETS or ESB) can alleviate social phobia, and common fears such as fear of flying, heights, open spaces, or the darkness

Is sympathectomy the new lobotomy?

"ESB may also alleviate social phobia and common fears such as fear of flying, heights, open spaces, or the darkness. In addition, it can be used to decrease trembling of the body, hands, and voice, even stuttering. It may help in alcoholism or drug withdrawal, because these are often linked with social anxiety. 
Sympathetic block is a gentle and exact endoscopic procedure. It is performed as day surgery under light anesthesia."

http://www.sympatix.fi/?lang=en

absence of myelinated and amyelinated fibers following clip removal suggests that sympathectomy - by the clipping method - is irreversible

Ten days after clipping, all sympathetic chains displayed evident Wallerian degeneration. Twenty days after clipping, Wallerian degeneration of myelinated fibers was more widespread and also more striking. Thirty days after clipping, a very marked macrophagic reaction was visible, with multiple signs of phagocytosis of myelin debris. By 30 days post operation and 20 days after clip removal, a few residual myelin and amyelinated fibers were visible. These findings suggest that axon regeneration is not possible. CONCLUSIONS There are Wallerian degeneration and axon loss 10 days after clipping. The almost total absence of myelinated and amyelinated fibers following clip removal suggests that there was no nerve regeneration, and that therefore clipping cannot be considered a reversible technique.

Surg Endosc. 2012 May ;26 (5):1258-63  22083329 

Intense pain following sympathectomy, reduced inspiratory capacity

Intrapleural analgesia after endoscopic thoracic sympathectomy.

Patrícia Gomes da Silva, Daniele Cristina Cataneo, Fernanda Leite, Erica Nishida Hasimoto, Guilherme Antonio Moreira de Barros

Postgraduate Program in Anesthesiology, Botucatu School of Medicine, UNESP, Bauru, SP, Brazil.

PURPOSE To compare analgesia traditionally used for thoracic sympathectomy to intrapleural ropivacaine injection in two different doses. METHODS Twenty-four patients were divided into three similar groups, and all of them received intravenous dipyrone. Group A received intravenous tramadol and intrapleural injection of saline solution. Group B received intrapleural injection of 0.33% ropivacaine, and Group C 0.5% ropivacaine. The following aspects were analyzed: inspiratory capacity, respiratory rate and pain. Pain was evaluated in the immediate postoperative period by means of the visual analog scale and over a one-week period. RESULTS In Groups A and B, reduced inspiratory capacity was observed in the postoperative period. In the first postoperative 12 hours, only 12.5% of the patients in Groups B and C showed intense pain as compared to 25% in Group A. In the subsequent week, only one patient in Group A showed mild pain while the remainder reported intense pain. In Group B, half of the patients showed intense pain, and in Group C, only one presented intense pain. CONCLUSION Intrapleural analgesia with ropivacaine resulted in less pain in the late postoperative period with better analgesic outcomes in higher doses, providing a better ventilatory pattern.

http://lib.bioinfo.pl/meid:154350/pmid

On a metabolic basis, 'autosympathectomy' influences neural and muscle structures and leads also to peripheral vasodilatation

Radiology of Peripheral Vascular Diseases: With 198 Tables

 edited by Eberhard Zeitler, Ernst Ammann

Springer, 2000 - Medical - 712 pages

Brachial plexopathy is another well recognised but not much publicised side-effect of sympathectomy

Brachial plexus dysfunction (brachial plexopathy) is a form of peripheral neuropathy. It occurs when there is damage to the brachial plexus, an area on each side of the neck where nerve roots from the spinal cord split into each arm's nerves.

Damage to the brachial plexus is usually related to direct injury to the nerve, stretching injuries (including birth trauma), pressure from tumors in the area (especially from lung tumors), or damage that results from radiation therapy.

Brachial plexus dysfunction may also be associated with:

• Birth defects that put pressure on the neck area
• Exposure to toxins, chemicals, or drugs
• General anesthesia, used during surgery
• Inflammatory conditions, such as those due to a virus or immune system problem

In some cases, no cause can be identified.

Symptoms

• Numbness of the shoulder, arm, or hand
• Shoulder pain
• Tingling, burning, pain, or abnormal sensations (location depends on the area injured)
• Weakness of the shoulder, arm, hand, or wrist

http://www.nlm.nih.gov/medlineplus/ency/article/001418.htm

cardiovascular effects, tremulousness and sweating produced by thyroid hormones can be reduced or abolished by sympathectomy

Although, plasma catecholamine levels are normal in hyperthyroidism, the cardiovascular effects, tremulousness and sweating produced by thyroid hormones can be reduced or abolished by sympathectomy. (p. 133)

Introduction To Endocrinology

ENDOCRINOLOGY CHANDRA S. NEGI

PHI Learning Pvt. Ltd., 2009 - Endocrinology - 455 pages

Trouble in the Gap: A Bioethical and Sociological Analysis of Informed Consent for High-Risk Medical Procedures - Springer

Trouble in the Gap: A Bioethical and Sociological Analysis of Informed Consent for High-Risk Medical Procedures - Springer: "we argue that “informed” consent is a process that is usually incomplete, despite trappings and assumptions that help to create the illusion of completeness."

after sympathectomy the extremity will be more apt to have disturbance of circulation and is left unprotected from fluctuation in circulation

1. Sympathectomy is analogous to the act of killing the messenger. The sympathetic nervous system has the critical job of properly controlling and preserving the circulation in different parts of the body, especially in the extremities. By paralyzing the system, the extremity will be more apt to have disturbance of circulation and is left unprotected from fluctuation in circulation.

Sympathectomy is similar to permanently removing the central heat and air-conditioning system and never replacing it because of malfunction.

Sympathectomy permanently damages the temperature regulatory system. The reason sympathectomy does not cause side effects other than ineffective control of pain as well as impotence and orthostatic hypotension is because it is invariably partial and incomplete.H. Hooshmand, M.D.: Chronic Pain

View Larger Image

9780849386671

Chronic Pain: Reflex Sympathetic Dystrophy Prevention and Management

Hooshang Hooshmand

ISBN 10: 0849386675 / 0-8493-8667-5 

ISBN 13: 9780849386671

Publisher: CRC Pr I Llc

Publication Date: 1993

Binding: Hardcover

Register all trials, report all results – it's long overdue

Register all trials, report all results – it's long overdue: "If researchers go to the effort of getting funds, recruiting patients, and following them up, you would think that they would be keen to publish the results. So it’s surprising that our best estimates show around half of all completed clinical trials have never been published in academic journals. And the half we have is biased towards trials with positive results."

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Patients complain of emotional blunting following sympathectomy for sweaty hands

Hohmann, G.W. : The effect of dysfunction of the autonomic nervous system on experienced feelings and emotions

Paper read at Conference on Emotions and Feelings at New School for Social Research, New York, Oct 1962.

Sherrington, C.S.: Experiments on the value of vascular and visceral factors for the genesis of emotion 

Proc. Roy.Soc., 1900, 66, 390-403

Wenger, M.A.: Emotion as visceral action: an extension of Lange's theory. In Reymert, M.L., Feelings and emotions: the Moosehart ymposium, New York: McGraw-Hill, 1950. Pp.3-10.

Wynne, L.C., and Solomon, R.L.: Traumatic avoidance learning: acquisition and extinction in dogs deprived of normal peripheral autonomic function. 

Genet. psychol. Monogr., 1955, 52, 241-84

Landis, C., and Hunt, W. A. Adrenalin and emotion. 

Psychol. Rev., 1932, 39, 467-85.

Schachter, S., and Wheeler, L.: Epinephrine, chlorpromazine, and amusement. 

J. of abnorm. soc. Psychol., 1962, 65, 121-28.

Complications of endoscopic sympathectomy - hypoxia, hypotension, haemothorax, pneumothorax

"there are some potentially serious anaesthetic sequelae. Despite the use of various analgesic techniques, including intrapleural bupivacaine and systemic opioids, postoperative chest pain is a common and distress- ing feature, with a duration of 12 hours or more.
In a recent prospective study of 58 patients undergoing this procedure, Jedeikin et al reported hypoxia (with an arterial oxygen saturation of 70%) and hypotension (with decrease in arterial pressure to < 50mmHg) as uncommon but important complications.
'These events maybe the result of compression of the mediastinum and major vessels by carbondioxide insufflation. In addition, during bilateral procedures, lesser degrees of hypoxia were common place with deflation of the lung on the second side, despite apparently adequate reinflation of the first lung. 15% of patients had pneumothorax and 7% required underwater drainage for haemothorax or pneumothorax."

A C QUINN R E EDWARDS PJNEWMAN W J FAWCETT
BMJ VOLUME 306 26JUNE1993 

chemical and surgical sympathectomy have shown that mechanism of the SNS regulation of T and B cell function are very complicated

In vitro and in vivo studies involving chemical and surgical sympathectomy have shown that mechanism of the SNS regulation of T and B cell function are very complicated.

Moreover, immune cells not only influence the CNS centers that regulate the autonomic output, but also regulate more directly the activity of the sympathetic nerves in the lymphoid organs and inflammatory sites or in the sympathetic ganglia.

Cytokines and the Brain

Christopher Phelps, E. Elena Andreevna Korneva

Elsevier, 2008 - 575 pages

It has been shown in animals that sympathectomy of one side of the body leads to an increase in the development of tumors on the denervated side

Coujard R, Heitz F. Cancerologic: Production de tumeurs malignes consecutives a des lesions des fibres sympathiques du nerf sciatique chez le Cobaye. C R Acad Sci 1957; 244: 409-411. 

Besedovsky H, DelRey A, Sorkin E, DaPrada M, Keller H. Immunoregulation mediated by the sympathetic nervous system. Cellular Immun 1979; 48:346-355. 

Stein-Werblowsky R. The sympathetic nervous system and cancer. Exper Neuro 1974; 42:97-100. 

Delrey A, Besedovsky H, Sorkin E, DaPrada M, Arrenbrecht S. Immunoregulation mediated by the sympathetic nervous system, II. Mol Immunol 1981; 63:329-334.

in the absence of autonomic arousal, behavior that appears emotional will not be experienced as emotional

"In the presence of a barking dog, for example, the sympathectomized cats manifested almost all of the signs of feline rage. Finally, Cannon notes the report of Dana (1921) that a patient with a spinal-cord lesion and almost totally without visceral sensation still manifested emotionality.
For either the Jamesian or the present formulation such data are crucial, since both views demand visceral arousal as a necessary condition for emotional arousal. When faced with this evidence, James's defenders (e.g., Wenger, 1950; Mandler, 1962) have consistently made the point that the apparently emotional behavior manifested by sympathectomizied animals and men is well-learned behavior, acquired long before sympathectomy. There is a dual implication in this position: first, that sympathetic arousal facilitates the acquisition of emotional behavior, and second, that sympathectomized subjects act but do not feel emotional. There is a small but growing evidence supporting these contentions. Wynne and Solomon (1955) have demonstrated that sympathectomized dogs acquire an avoidance response considerably more slowly than control dogs. Further, on extinction trials most of their 13 sympathectomized animals extinguished quickly, whereas not a single one of the 30 control dogs gave any indication of extinction over 200 trials. Of particular interest are two dogs who were sympathectomized after they had acquired the avoidance response. On extinction trials these two animals behaved precisely like the control dogs - giving no indication of extinction. Thus, when deprived of visceral innervation, animals are quite slow in acquiring emotionally-linked avoidance responses and in general, quick to extinguish such responses." (p. 163)

"A line of thought stimulated by the Wynne and Solomon (1955) and the Hohmann (1962) studies may indeed be the answer to Cannon's observations that there can be emotional behavior without visceral activity. From the evidence of these studies, it would appear, first, that autonomic arousal greatly facilitates the acquisition of emotional behavior but it is not necessary for its maintenance if the behavior is acquired prior to sympathectomy; and second, that in the absence of autonomic arousal, behavior that appears emotional will not be experienced as emotional." (p. 167)

Psychobiological Approaches to Social Behavior

P. Herbert Leiderman, David Shapiro, Harvard Medical School. Dept. of Psychiatry, United States. Office of Naval Research - 1964 - 203 pages

Recurrent hyperhidrosis is another potential side effect from hyperhidrosis surgery

The Society of Thoracic Surgeons Expert Consensus for the Surgical Treatment of Hyperhidrosis -- Cerfolio et al. 91 (5): 1642 -- The Annals of Thoracic Surgery: "Recurrent hyperhidrosis is another potential side effect from hyperhidrosis surgery. Incidence rates vary considerably and have been described as 0% to 65%"

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The Society of Thoracic Surgeons Expert Consensus for the Surgical Treatment of Hyperhidrosis -- Cerfolio et al. 91 (5): 1642 -- The Annals of Thoracic Surgery

The Society of Thoracic Surgeons Expert Consensus for the Surgical Treatment of Hyperhidrosis -- Cerfolio et al. 91 (5): 1642 -- The Annals of Thoracic Surgery: "Because the goal of this procedure is to improve quality of life, complications should be minimal and essentially eliminated. The primary side effects of hyperhidrosis surgery include CH, bradycardia, and Horner's syndrome. It is important for patients to be aware, however, of all of the possible complications that can occur. In general, "the higher the level of blockade on the chain, the higher is the expected regret rate" [26]."

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Thoracoscopic Sympathectomy for Isolated Facial Blushing -- Licht et al. 81 (5): 1863 -- The Annals of Thoracic Surgery

Thoracoscopic Sympathectomy for Isolated Facial Blushing -- Licht et al. 81 (5): 1863 -- The Annals of Thoracic Surgery: "Criticism has been raised about surgical treatment for facial blushing because there is very little evidence that the patients most likely to pursue surgical treatment for facial blushing actually blush more readily and intensely than other people [21]. It has been pointed out that facial blood flow during acute embarrassment seems to be unrelated to ratings of the self-reported frequency of blushing [22]. On the other hand, self-consciousness and fear of blushing correlate well with subjective estimates of blushing frequency and intensity [22]. It has therefore been suggested that if the source of the patient's problem is anxiety about blushing rather than blushing per se, anxiety would be a more appropriate target for treatment than permanently eliminating the normal regulation of facial blood flow and sweating [21]."

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The vasodilating effect of spinal dorsal column stimulation is mediated by sympathetic nerves - Springer

The vasodilating effect of spinal dorsal column stimulation is mediated by sympathetic nerves - Springer: "Immediately after sympathectomy, the contralateral right arm became increasingly cold and cyanotic and the patient complained of chronic painful coldness and severe cold-intolerance in the right arm. Attempts to pharmacologically vasodilate the arm with felodipine did not affect the local vasoconstriction and pain. Dorsal column stimulation (associated with symmetrical paraesthesia in both arms) induced an immediate and marked (ten-fold) increase in skin blood flow in the right arm (and in the leg), whereas skin blood flow in the left arm remained unaffected. The lack of vasomotor response in the left arm was not due to maximal vasodilatation at rest, since skin blood flow in the left arm showed a normal capacity for axon reflex vasodilatation following antidromic activation of sensory afferents. The results suggest that the marked vasodilatation induced by dorsal column stimulation is mediated by sympathetic vasomotor fibres, via modulation of central neuronal circuits involved in the regulation of skin sympathetic discharge."

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Medical Board Disciplines ETS surgeon Dr Nielson

Nielson,  David  Hugh,  M.D.,  Lic.  #K0962,  San  Antonio  TX
On  February  5,  2010,  the  Board  and  Dr.  Nielson  entered  into  an  agreed  order  requiring  Dr. Nielson  to  complete  15  hours  of  CME  in  medical  record-­keeping,  risk  management  and  ethics within  one  year;;  and  pay  an  administrative  penalty  of  $4,000  within  60  days.  The  action  was based  on  the  Board’s  finding  that  Dr.  Nielson  failed  to  keep  adequate  medical  records,  failed to  use  proper  diligence  in  his  professional  practice,  and  failed  to  adequately  supervise  the activities  of  those  acting  under  his  supervision.  The  Board  found  that  digital  photos  that  were part  of  patient  records  were  inadvertently  deleted  and  that  Dr.  Nielson  authorized  a  person  to represent  his  clinic  and  that  person  misrepresented  risks  and  procedures  for  Dr.  Nielson’s treatment  of  rosacea. 
http://www.tmb.state.tx.us/news/press/2010/021710.php

BioEdge: Leveson Inquiry recommends reform of science reporting

BioEdge: Leveson Inquiry recommends reform of science reporting: "Remember patients: don't call something a "cure" that is not a cure."

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catecholamine released from sympathetic nerves, acquires the capacity to activate pain pathways after tissue or nerve injury

What Is Reflex Sympathetic Dystrophy Syndrome or RSD?: "According to the National Institute of Neurological Disorders and Stroke (NINDS), RSD is "a chronic pain condition that is believed to be the result of dysfunction in the central or peripheral nervous systems." According to MedicineNet, RSD involves "irritation and abnormal excitation of nervous tissue, leading to abnormal impulses along nerves that affect blood vessels and skin."

Animal studies indicate that norepinephrine, a catecholamine released from sympathetic nerves, acquires the capacity to activate pain pathways after tissue or nerve injury, resulting in RSD. Another theory suggests that RSD, which follows an injury, is caused by triggering an immune response and symptoms associated with inflammation"

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Transection below T8-T10 is not accompanied by reflex sweating

Reflex sweating in patients with spina... [Arch Phys Med Rehabil. 1977] - PubMed - NCBI: "Sweat glands derive their innervation from the sympathetic nervous system. The spinal sympathetic structures that are located in the intermediolateral areas extend from T1-L2 segments and are under the control of hypothalamic centers. Cord transection abolishes the supraspinal control of sudorimotor function. Since sympathetic innervation does not follow a clear segmental distribution, normal sweating may be preserved at a higher or lower level than skin sensation. Nonthermoregulatory reflex sweating is an indication of unchecked spinal cord facilitation and is precipitated by afferent stimuli from bladder, rectum, and various other sources. It is usually a manifestation of mass reflex or autonomic crisis and occurs particularly in cervical or high thoracic lesions. Transection below T8-T10 is not accompanied by reflex sweating. The phenomenon of thermal relfex sweating is controversial. Although some aspects of nonthermoregulatory reflex sweating are still unclear, proper immediate and continuing preventive management will reduce the incidence of this and other autonomic manifestations. "

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Hemodynamic changes in vertebral and carotid arteries were observed after sympathicotomy

T3 sympathicotomy segment was the most frequent transection done (95.83%), as only ablation (25%) or in association with T4 (62.50%) 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.
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.
http://www.ncbi.nlm.nih.gov/pubmed/16186983 

Gustatory sweating and other responses after sympathectomy

Gustatory sweating on the head, neck and arms, often occurs after cervico-thoracic sympathectomy. Haxton (1948) reported an incidence of 36 percent, the same as in the present series. It was thought that some information about regeneration in the cervical sympathetic might be revealed by investigation of this surgical curiosity.

Although sweating is the common gustatory response after cervical sympathectomy, other changes are experienced. Haxton (1948) described associated paresthesia and flushing, gooseflesh may occur (Herxheimer, 1958) and vaso-constriction is reported in this paper. These occur together or separately and occasionally sweating might be absent. The subject has been confused by comparison with post-parotidectomy gustatory sweating which has a different mechanism (Glaister et al.,1958; Bloor, 1958).

Sweating is produced by cholinergic sympathetic fibres. In normal individuals both vasocontriction and gooseflesh are adrenergic. This also holds in gustatory responses.  Figure 2 shows blocking of sweating by atropine, whilst gooseflesh continues unchanged.
   The tingling sensations were described as being unlike normal sensation, and likened to plucking out of hair. In one patient in was so unpleasant that she refused to take a test stimulus. Flushing usually occurs on the upper chest and neck, and is an erythema with sharp demarcation, not associated with a rise in skin temperature.
   Of the patients, 29 were found to have gustatory responses, and 24 were studied in detail. Of 22 patients with sweating who could be studied, 11 had gooseflesh, 10 tingling, 6 flushing, and 4 vasoconstriction. Four patients, however, had no sweating and their gustator responses consisted of gooseflesh and tingling in one, tingling alone, and flushing in two. None of these four showed vasoconstriction.
   The stimulus for testing used was usually Worcester sauce, but specificity of the response was sometimes great, and one patient reacted only to boiled sweets made by one particular firm.

http://brain.oxfordjournals.org/content/92/1/137.extract   &
http://ang.sagepub.com/content/17/3/143.extract