Using this model, we have been able to show a approximately 35% decrease in substance P (SP) binding in the intermediolateral cell column-suggesting that sympathetic preganglionic neurons possess substance P receptors. Guanethidine-induced destruction of sympathetic postganglionic neurons in neonatal rats leads to transneuronal degeneration of the sympathetic preganglionic neurons. Damage to part of these feedback loops leads to exaggerated pressor responses to stress. Both physical and psychological stresses elicit large initial sympathetic neuronal responses that are subsequently damped by feedback inhibition from structures such as the baroreceptors. Patients with diseases of the sympathetic nervous system illustrate that everyday occurrences such as a change in posture or ambient temperature are stresses requiring a marked change in sympathetic nervous activity. The continual stress of heart failure diminishes their ability to respond to further stresses such as standing upright or exercising. Patients with heart failure deplete sympathetic neuronal norepinephrine stores. They are often unable to tolerate heat, exercise, or fluid deprivation. They have postural hypotension and diminished blood pressure responses to stress. Diabetics and uremics often develop a peripheral sympathetic neuropathy. They have episodes of hypertension and hypotension that cause headaches and dizziness. Patients who lack baroreceptors have exaggerated blood pressure responses to stress. Radiotherapy to the neck can destroy the arterial baroreceptors that monitor blood pressure fluctuations. These patients lack cerebral control of spinal sympathetic reflexes. This syndrome causes episodic hypertension in quadriplegic patients from excess sympathetic activity reflexly activated by bowel or bladder distention. Transection of the cervical spinal cord leads to autonomic dysreflexia. This paper discusses insight from a number of such diseases. The 74th Clinical and Scientific Congress 2000ĭiseases that cause malfunction of the sympathetic nervous system provide insight into how the sympathetic nerves normally modulate responses to stress. International Anesthesia Research Society K Takaishi, E Tabo, K Nakanishi, M Soutani, K Tsuno, T Arai:Ĭardiovascular effects of bilateral endoscopic transthoracic sympathicotomy at rest and during exercise in patients with palmar hyperhidrosis. However, because bilateral ETS causes the suppression of cardiovascular response to exercise, patients that has been treated with ETS need to be observed during high-level exercise. Therefore, we consider that patients with palmar hyperhidrosis have no overactivity of the sympathetic nerve. RESULTS: Although there was no significant difference in HR and BP at rest between the patient group before ETS and normal subjects, the value of serum adrenaline in the patient group (0.6 ng/ml) was significantly lower than that in normal subjects (2.6 ng/ml, p DISCUSSION: HR and BP at rest and cardiovascular response to exercise were similar in patients with palmar hyperhidrosis before ETS and in the normal control population. Finally, HR and BP at rest, changes in HR and BP as a result of general exercise (GE), and changes in HR, BP and SC as a result of IHE were measured in the patient group both one day before and one day after ETS was administered. Then, changes in HR, BP and SC as a result of isometric handgrip exercise (IHE) were measured in both groups. First, before ETS administration, heart rate (HR), blood pressure (BP), and serum catecholamine (SC) at rest were measured in the patient group and in normal subjects. METHODS: After institutional approval and informed consent, 16 patients with palmar hyperhidrosis undergoing bilateral T2- T4 ETS and 10 healthy volunteers were studied. The purpose of this study was to compare the cardiovascular response to exercise between patients with palmar hyperhidrosis and a normal control population, and to examine the effects of ETS on cardiovascular response in patients with palmar hyperhidrosis. Although endoscopic transthoracic sympathicotomy (ETS) is an effective treatment for palmar hyperhidrosis, the partial cardiac denervation that follows may cause impairment of cardiovascular function at rest and during exercise. INTRODUCTION: Palmar hyperhidrosis is characterized by an overactivity of the sympathetic fibers passing through T2 and T3 ganglia. AUTHORS: Kazushi Takaishi, MD, Etsuo Tabo, MD, Kazuo Nakanishi, MD, Masao Soutani, MD,PhD, Kyoji Tsuno, MD, Tatsuru Arai, MD AFFILIATION: Ehime University, Shigenobu, Japan.
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