Sympathectomy of the Upper Extremity

Hyndman, Olan R.

doi:10.1001/archsurg.1942.01220010148011

Cited by 37 publications

(1 citation statement)

References 18 publications

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“…This result is in' keeping with those previously mentioned (57). Removal of only the second dorsal sympathetic ganglion is stated to result in as complete sympathectomy, in so far as central connections are concerned, as does the removal of the inferior cervical and upper two dorsal ganglia (58).…”

Section: Efferent Pathwayssupporting

confidence: 85%

Visceral Functions of the Nervous System

McSwiney¹

1944

Annu. Rev. Physiol.

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It is interesting to recall that some forty years ago Sherrington (1) included a description of spinal visceral reflexes in a chapter on "The Spinal Cord" which he contributed to Schafer's Text Book of Physiology. In the course of the article he drew attention to the fact that after destruction of the higher nerve centres, e.g. brain, the competence remaining to the spinal centres is found great�st for visceral reactions. From this point of view the visceral reflexes present the most per fect reactions of the spinal animal. The bulbo-spinal animal, receiving as it does the afferent impulses of the vagus as well as of the thoracic and sacral nerves, may indeed be considered as regards visceral function a fairly perfect animal. The purely spinal animal does, however, exhibit some amount of damage to the nervous regulation of its viscera; this is chiefly of the nature of "shock" and temporary.Magoun (2) rightly points out that "the full role of the auto nomic syst�m in the integration of bodily processes is only exerted through the action of essential supranuclear centres in the medulla, hypothalamus, and cerebral cortex." It should be emphasized, however, that the vis � era, though dependent on the nervous sys tem for the integration of reactions and necessary adjustments, are capable of independent function after section of the extrinsic nerves.It is intended to include in this chapter studies on the represen tation of the sympathetic and parasympathetic systems in the cerebral cortex, hypothalamus, medulla, and the s pinal cord, to gether with investigations on the autonomic nerves in their more general aspects. Papers concerned with the problem of visceral sensation, including referred pain, will also be discussed, and refer ence will be made to the viscerosomatic and somaticovisceral re flexes which seem logically to belong to this section. CENTRES Cerebral cortex.-Few papers describing the influence of the cortex on the discharge of impulses by way of the autonomic nerv ous system have appeared during the year.365 Annu. Rev. Physiol. 1944.6:365-390. Downloaded from www.annualreviews.org Access provided by University of Bath on 02/04/15. For personal use only. Quick links to online content Further ANNUAL REVIEWS

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Section: Efferent Pathwayssupporting

confidence: 85%

Visceral Functions of the Nervous System

McSwiney¹

1944

Annu. Rev. Physiol.

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Studies on Sweat Secretion in Man

Netsky¹

1948

Arch NeurPsych

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PREVIOUS studies of the Smithwick type of preganglionic thoracic sympathectomy have shown an area of anhidrosis on the ipsilateral side of the face, arm and upper portion of the trunk. The loss of sweating has been pictured as complete. The anhidrosis has usually been determined by the method of electrical skin resistance or by colorimetric methods, such as the starch-iodine test. These methods give similar results.1 In the course of studies with two newer methods, it has been found that the loss of sweating following such an operation is not complete. These methods allow visualization of the function of small numbers of sweat glands and have uniformly shown activity of a small percentage of glands in sympathectomized areas. Evidence is presented that these glands are innervated by preganglionic fibers which arise in the first thoracic root. METHODSFor purposes of comparison, both the skin resistance method of Richter2 and the starch-iodine3 or chinizarin (quinizarin; 1,4-dihydroxy-anthraquinone) 4 method were used. The results reported here are based chiefly on two newer methods. These may be called the fannie acid method and the prism method. The first method has already been described by Silverman and Powell.5 The Arthur Weil Fellow in Neuropathology.

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Upper thoracic sympathectomy for primary palmar hyperhidrosis: long-term follow-up

Hashmonai

Kopelman

Kein

et al. 1992

Journal of British Surgery

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Primary palmar hyperhidrosis is a functionally and socially disabling condition. Upper thoracic sympathectomy is the best curative treatment. Several surgical approaches have been suggested and, recently, less invasive techniques have been communicated. To evaluate which method is the best, the short- and particularly the long-term results must be compared. A series is presented of 170 upper thoracic sympathectomies by the supraclavicular approach performed on 85 patients with palmar hyperhidrosis. Follow-up for a mean of 8.3 years was obtained on 124 operated limbs. The immediate failure rate for relief from hyperhidrosis was 2.4 per cent and hyperhidrosis recurred in another 4.1 per cent of limbs after a period of between 2 and 18 months. Thirteen per cent of patients were dissatisfied with the results of operation, one because of persisting vasomotor rhinitis, two because of Horner's syndrome and five because of persisting or recurrent hyperhidrosis. Satisfactory results in approximately 87 per cent of cases make the operation rewarding. This outcome should be compared with the long-term results of other methods, such as percutaneous phenol injection and the transthoracoscopic approach, when such data are compiled and published.

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Sympathectomy of the Upper Extremity

Cited by 37 publications

References 18 publications

Visceral Functions of the Nervous System

Visceral Functions of the Nervous System

Studies on Sweat Secretion in Man

Upper thoracic sympathectomy for primary palmar hyperhidrosis: long-term follow-up

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