Cell body reorganization in the spinal cord after surgery to trea sweaty palms and blushing

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

Spinal cord infarction occurring during thoraco-lumbar sympathectomy
J Neurol Neurosurg Psychiatry 1963;26:418-421 doi:10.1136/jnnp.26.5.418

Thursday, December 26, 2013

Decreased HRV is predictive of adverse cardiovascular outcomes in a variety of disease states

Water immersion-induced skin wrinkling (WISW) is dependent on intact peripheral sympathetic function. WISW was hypothesized to reflect autonomic function in subjects with- out peripheral neuropathy. We prospectively studied 70 healthy subjects (aged 31 88 years, 63% females) without cardiovascular risk factors or neurological disease. All sub- jects underwent short-term heart rate variability (HRV) stud- ies. Time and frequency domain variables were derived in- cluding the HRV index. WISW was graded using a previously validated scale of 1–4 of which 18.6% of subjects exhibited grade 1 (minimal) WISW and 35.7% had grade 2 WISW. On multivariate analysis using the HRV index, WISW was inde- pendently related to height and the HRV index. We conclude that WISW is related to central autonomic function.


Although the mechanism is not fully understood, WISW is felt to be caused by passive diffusion of water across the stratum corneum into the sweat ducts, which in turn alters electrolyte balance, decreases membrane stabilization, increases sympathetic neural firing and stimulates vasoconstriction [1–3, 8].WISW is decreased in diabetic patients and in patients after cervical sympathectomy [4, 9].
Heart rate variability (HRV) is the beat-to-beat variation in cardiac cycle length due to autonomic influence on the sinus node. Decreased HRV is predictive of adverse cardiovascular outcomes in a variety of disease states[5]. The influence of the central nervous system activity on autonomic function suggests that HRV may be a useful prognostic indicator in patients with cerebrovascular events [6].


Cardiology 2010;116:247–250 DOI: 10.1159/000316043
Received: May 10, 2010
Accepted after revision: May 28, 2010 Published online: August 18, 2010

Tuesday, December 17, 2013

reduced high-frequency power after sympathetic blockade

Alternatively, reduced high-frequency power after sympathetic blockade may also be explained by diminished “accentuated antagonism,” a phenomenon described more than three decades ago (4). Heart rate response to vagal nerve stimulation is accentuated when sympathetic tone is elevated, and vice versa. Thus, cardiac sympathetic withdrawal by high spinal or epidural blockade may have resulted in diminished beat-to-beat fluctuations of R-R intervals without alteration of actual vagal nerve activity. To draw a definitive conclusion regarding the mechanism, determinations of central vagal/sympathetic outflow would be mandatory by an animal experiment.
http://www.anesthesia-analgesia.org/content/100/4/1216.2.full
  1. 1.↵ 
    Tanaka M, Goyagi T, Kimura T, Nishikawa T. The effects of cervical and lumbar 
    epidural anesthesia on heart rate variability and spontaneous sequence baroreflex
    sensitivity. Anesth Analg 2004;99:924–9.

  2. 2.↵ 
    Introna R, Yodlowski E, Pruett J, et al. Sympathovagal effects of spinal anaesthesia 
    assessed by heart rate variability analysis. Anesth Analg 1995;80:315–21.
  3. 3.↵ 
    Malliani A, Pagani M, Lombardi F, et al. Cardiovascular regulation explored in the 
    frequency domain. Circulation 1991;84:482–92.

  4. 4.↵ 
    Levy MN. Sympathetic-parasympathetic interactions in the heart. 
    Circ Res1971;29:437–45.

Thursday, December 12, 2013

significant change after sympathectomy: reduced sympathetic and increased vagal tone

The HRV analysis showed a significant change of indices reflecting sympatho-vagal balance indicating significantly reduced sympathetic (LF) and increased vagal (HF, rMSSD) tone. These changes still persisted after 2 years. Global HRV increased over time with significant elevation of SDANN after 2 years. QT dispersion was significantly reduced 1 month after surgery and the dispersion was further diminished 2 years later.
http://www.sciencedirect.com/science/article/pii/S0167527399001011
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