The prevalence of migraine and Raynaud's phenomenon in Japanese patients with vasospastic angina (group I) were compared with those in 2 control groups: one with effort angina (group II) and the other group without known ischemic heart disease (group III). There were no significant differences among the 3 groups with respect to age and sex. The prevalence of migraine in group I was 23 of 100, as compared with 4 of 100 in group II (p<0.01) and 11 of 100 in group III (p<0.05). The prevalence of Raynaud's phenomenon in group I was 9 of 100, as compared with 3 of 100 in group II and 4 of 100 in group III. Thus, in Japan, the prevalence of migraine in patients with vasospastic angina was higher than those in the 2 control groups, whereas the prevalence of Raynaud's phenomenon did not differ significantly among the 3 groups. The prevalence of Raynaud's phenomenon in Japanese patients with vasospastic angina was different from that reported from North America, although the prevalence of migraine was the same. This may be partially explained by racial differences.

ndoscopic transthoracic sympathicotomy (ETS) is a safe and effective procedure that is used for the treatment of palmar hyperhidrosis. 1,2 The upper third or fourth thoracic, stellate, and cervical sympathetic ganglia receive the preganglionic fibers from the upper 4 thoracic segments of the spinal cord and direct the postganglionic fibers to the heart, upper extremities and cranial vessels. 3 Therefore, ETS results in blockade of efferent sympathetic nerves that innervate the heart and upper extremities.Natriuretic peptides are secreted into the systemic circulation in response to numerous factors, including increased atrial and/or ventricular wall tension, tachycardia, exercise, endothelin, arginine vasopressin and catecholamines. 4 An interaction between the sympathetic nervous system and the natriuretic peptide system has been suggested by experimental studies that demonstrated suppression of cardiac atrial natriuretic peptide (ANP) release in response to -adrenergic stimulation. 5,6 This is corroborated by other studies that demonstrated augmentation of cardiac natriuretic peptides by pharmacological -receptor blockade in humans. [7][8][9] However, the precise effect of the sympathetic nervous system on the natriuretic peptide system remains unclear.Therefore, we examined the effect of ETS of the second Circulation Journal Vol.69, September 2005and third thoracic sympathetic ganglia (Th2-3) on cardiac function and plasma ANP and brain natriuretic peptide (BNP) concentrations in patients with primary palmar hyperhidrosis to characterize the role of the sympathetic nervous system in the regulation of plasma natriuretic peptides. Methods Patient SelectionThirty-seven patients (19 males, 18 females, mean age 29±10 years; mean ± SD) underwent ETS for treatment of primary palmar hyperhidrosis. None had a history of cardiac disease nor were they receiving any drugs that could directly or indirectly modulate the autonomic nervous system. Written informed consent was obtained from all patients before enrollment. Study protocols were approved by the institutional committee on human research. ETSThe operative technique, which has previously been described in detail, 8,10 has been used in more than 600 patients with palmar hyperhidrosis at the Kanazawa Medical Center since 1993. Briefly, patients were intubated with an endotracheal tube under general anesthesia and placed in a semireclining position with both arms in abduction. The pleural cavity was accessed via a Surgineedle in the axillary fossa, and approximately 2 L of carbon dioxide was insufflated into the pleural cavity. A modified urological electroresectoscope was introduced via the same incision in the axillary fossa to visualize the upper thoracic cavity. The sympathetic chain was identified in the immediate vicinity of the cost- Effect of Endoscopic Transthoracic Sympathicotomy on Plasma Natriuretic Peptide Concentrations in HumansYukio Nakamura, MD; Hisashi Yoshizawa, MD; Motoaki Hirasawa, MD;Hiroshi Kida, MD; Yasushi Matsumoto, MD*; Takeshi Ueyama, MD* ...