Anterior Transthoracic Upper Dorsal Sympathectomy

Palumbo, Louis T.; Lulu, Donald J.

doi:10.1001/archsurg.1966.01320200087014

Cited by 23 publications

(12 citation statements)

References 2 publications

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“…The axillary approach of Atkins (1954) was designed to provide a simple anatomical approach to the sympathetic chain46. The transthoracic approach of Palumbo and Lulu (1966), although providing the best exposure, involved the morbidity and even mortality of a thoracotomy4'. The dorsal midline approach of above this point.…”

Section: Surgical Approaches For Upper Thoracic Sympathectomymentioning

confidence: 99%

Surgical management of primary hyperhidrosis

Moran

Brady

1991

Journal of British Surgery

124

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Primary hyperhidrosis, although lacking a precise definition and of unknown aetiology, disrupts professional and social life and may lead to emotional problems. A variety of treatment methods are used to control or reduce the profuse sweating which involves mainly the palms, soles and axillae. The simplest method, the application of topical agents, is usually attempted first for axillary and plantar sweating. Iontophoresis may provide relief especially in patients with plantar or palmar involvement. In severe cases operative intervention is necessary. Excision of sweat glands is successful in patients with axillary hyperhidrosis but the role of suction-assisted removal of axillary sweat glands remains to be determined. Sympathectomy remains the standard by which other treatments must be judged. For upper thoracic sympathectomy a variety of surgical approaches are used with satisfactory relief of hyperhidrosis. Complications related to the surgical approach, such as Horner's syndrome, brachial plexus injuries, pneumothorax and painful scars may occur, while following sympathectomy compensatory hyperhidrosis is usual and hyperhidrosis may recur. Plantar hyperhidrosis which may be exacerbated or ameliorated by upper thoracic sympathectomy and which fails to respond to non-operative intervention is relieved by lumbar sympathectomy.

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Section: Surgical Approaches For Upper Thoracic Sympathectomymentioning

confidence: 99%

Surgical management of primary hyperhidrosis

Moran

Brady

1991

Journal of British Surgery

124

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“…In contrast, activation of cardiac sympathetic (spinal) afferents evokes reflex excitatory cardiovascular responses (Peterson & Brown, 1971; Malliani et al 1972; Huang et al 1995 b ; Tjen‐A‐Looi et al 1998; Fu & Longhurst, 2001). Clinical evidence suggests that angina pectoris can be relieved by stellate ganglionectomy or dorsal rhizotomy, but not by cervical vagotomy, indicating that cardiac nociception is transmitted by cardiac sympathetic afferents through spinal cord pathways (Birkitt et al 1965; Palumbo & Lulu, 1965; Meller & Gebhart, 1992). Thus, dual neural innervation of sympathetic and vagal afferents relays information from the heart to the brain.…”

mentioning

confidence: 99%

Xanthine oxidase, but not neutrophils, contributes to activation of cardiac sympathetic afferents during myocardial ischaemia in cats

Tjen‐A‐Looi

Longhurst

2002

The Journal of Physiology

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Activation of cardiac sympathetic afferents during myocardial ischaemia causes angina and induces important cardiovascular reflex responses. Reactive oxygen species (ROS) are important chemical stimuli of cardiac afferents during and after ischaemia. Iron‐catalysed Fenton chemistry constitutes one mechanism of production of hydroxyl radicals. Another potential source of these species is xanthine oxidase‐catalysed oxidation of purines. Polymorphonuclear leukocytes (PMNs) also contribute to the production of ROS in some conditions. The present study tested the hypothesis that both xanthine oxidase‐catalysed oxidation of purines and neutrophils provide a source of ROS sufficient to activate cardiac afferents during ischaemia. We recorded single‐unit activity of cardiac afferents innervating the ventricles recorded from the left thoracic sympathetic chain (T1‐5) of anaesthetized cats to identify the afferents' responses to ischaemia. The role of xanthine oxidase in activation of these afferents was determined by infusion of oxypurinol (10 mg kg−1, I.V.), an inhibitor of xanthine oxidase. The importance of neutrophils as a potential source of ROS in the activation of cardiac afferents during ischaemia was assessed by the infusion of a polyclonal antibody (3 mg ml−1 kg−1, I.V.) raised in rabbits immunized with cat PMNs. This antibody decreased the number of circulating PMNs and, to a smaller extent, platelets. Since previous data suggest that platelets release serotonin (5‐HT), which activates cardiac afferents through a serotonin receptor (subtype 3,5‐HT3 receptor) mechanism, before treatment with the antibody in another group, we blocked 5‐HT3 receptors on sensory nerve endings with tropisetron (300 μg kg−1, I.V.). We observed that oxypurinol significantly decreased the activity of cardiac afferents during myocardial ischaemia from 1.5 ± 0.4 to 0.8 ± 0.4 impulses s−1. Similarly, the polyclonal antibody significantly reduced the discharge frequency of ischaemically sensitive cardiac afferents from 2.5 ± 0.7 to 1.1 ± 0.4 impulses s−1. However, pre‐blockade of 5‐HT3 receptors eliminated the influence of the antibody on discharge activity of the afferents during ischaemia. This study demonstrates that ROS generated from the oxidation of purines contribute to the stimulation of ischaemically sensitive cardiac sympathetic afferents, whereas PMNs do not play a major role in this process.

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“…Other indications include sympathetic disorders such as splanchnic pain associated with pancreatitis (T4–T6), causalgia, reflex sympathetic dystrophy, and post-traumatic pain syndrome. 4,5,11,12 After TDS, 80% to 90% of patients with peripheral vascular disease have early relief of symptoms, and most of them (78%) remain significantly better even many years after surgery. 4,5,13–15 Surprisingly, even larger series reporting TDS have not included patients with Buerger disease, perhaps because of its low prevalence in Western countries.…”

Section: Discussionmentioning

confidence: 99%

“…4,5,11,12 After TDS, 80% to 90% of patients with peripheral vascular disease have early relief of symptoms, and most of them (78%) remain significantly better even many years after surgery. 4,5,13–15 Surprisingly, even larger series reporting TDS have not included patients with Buerger disease, perhaps because of its low prevalence in Western countries. 1 Increased magnification with the thoracoscopic approach permits better visualization and identification of collateral branches and preganglionic fibers, thus ensuring complete excision with good results.…”

Section: Discussionmentioning

confidence: 99%

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Thoracoscopic Dorsal Sympathectomy for Upper Limb Buerger's Disease

Kothari

Sharma

et al. 2014

JSLS

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Background and Objectives:Thromboangiitis obliterans is a common peripheral vascular disease in India. This study was conducted to assess the efficacy of thoracoscopic dorsal sympathectomy as a treatment for Buerger disease of the upper extremities.Methods:Thirty thoracoscopic dorsal sympathectomies (17 left- and 13 right-sided) were performed in a tertiary medical center in 5 women and 20 men (mean age, 41 years) between July 2010 and February 2013.Results:The mean operative time was 30 minutes, and the mean hospital stay was 52 hours. There were no complications. All patients had improvement in pain and were relapse-free after a mean follow-up period of 11.63 months.Discussion:Thoracoscopic dorsal sympathectomy reduces pain significantly by reducing peripheral resistance and promoting collateral development. The increased magnification of the thoracoscopic approach permits better visualization, ensuring complete excision and therefore good results. Thoracoscopic dorsal sympathectomy for Buerger disease of the upper limb is a safe and effective treatment.

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Anterior Transthoracic Upper Dorsal Sympathectomy

Cited by 23 publications

References 2 publications

Surgical management of primary hyperhidrosis

Surgical management of primary hyperhidrosis

Xanthine oxidase, but not neutrophils, contributes to activation of cardiac sympathetic afferents during myocardial ischaemia in cats

Thoracoscopic Dorsal Sympathectomy for Upper Limb Buerger's Disease

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