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Though this paper was published in 2003, most of the 55 cited studies are from many years ago. This paper is devastating in two respects. First, it documents in no uncertain terms the horror suffered by ETS victims. And secondly, it proves that the ETS surgeons have known all along what they were doing.

Here are a few excerpts from the full article, followed by the abstract and references:

"Upper dorsal sympathectomy [ETS] significantly decreases pulse rates at rest and after effort."

"[ETS] blunts the blood pressure response to exercise"

"In some cases, severe bradycardia requiring permanent pacing [a pacemaker] may result from bilateral T2sympathectomy"

"Sympathectomy produces a vasodilatatory cutaneous effect"

"The [blood] circulation in the muscles . . . may even be reduced."

"[ETS] significantly decreases pulse rate and systolic blood pressure, reduces myocardial oxygen demand, increases left ventricular ejection fraction and prolongs Q-T interval."

"A certain loss of lung volume and decrease of pulmonary diffusion capacity for CO result from sympathectomy [ETS]."

"Studies . . . in normal . . . humans have shown that sympathetic blockade invariably produces intense skin vasodilation resulting in redistribution of total limb blood flow with reduction of blood flow to muscles."

"[ETS] results in elevation of skin temperature . . ."

The abstrcact reads as follows:

INVITED LECTURE

The pathophysiology of cervical and upper thoracic sympathetic surgery

M. Hashmonai1, 2 and D. Kopelman1, 3
(1) Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel
(2) P. O. Box 359, Zikhron Yaakov, 30952, Israel
(3) Dept. of Surgery B, Haemek Medical Center, Afula, Israel

Abstract. The main effect of upper thoracic sympathectomy is sudomotor. To abolish sweating of the palms, T2 ganglionectomy (often with the addition of T3) was invariably performed. To prevent axillary sweating, additional T4 ablation was recommended. Sympathectomy produces a vasodilatatory cutaneous effect. The circulation in the muscles, however, is unaltered or may even be reduced. It also appears that improved skin blood flow is on the thermoregulatory, not nutritive level. It seems that chronic surgical sympathectomy does not cause major changes in the vascular function of the forearm. Although the exact pathophysiological mechanism of blushing is still obscure, bilateral upper dorsal sympathectomy alleviates this phenomenon. T2-T3 ganglionectomy significantly decreases pulse rate and systolic blood pressure, reduces myocardial oxygen demand, increases left ventricular ejection fraction and prolongs Q-T interval. A certain loss of lung volume and decrease of pulmonary diffusion capacity for CO result from sympathectomy. Histomorphological muscle changes and neuro-histochemical and biochemical effects have also been observed.

Here are the studies referenced in the Hashmonai/Kopelman article:

1. Asking B,Svartholm E (1994) Degeneration activity:a transient effect following sympathectomy for hyperhidrosis. Eur J Surg 160(Suppl 572):41–42

2. Atlas LN (1941) The role ofthe second thoracic spinal segment in the preganglionic sympathetic innervation ofthe human hand – surgical implications. Ann Surg 114:456–461

3. Brock JA,Van Helden DF,Dosen P, Rush RA (1996) Prevention ofhigh blood pressure by reducing sympathetic innervation in the spontaneously hypertensive rat.J Auton Nerv Syst 61:97–102

4. Brothers TE,Wakefield TW,Jacobs LA, Lindenauer SM (1993) Effects oflumbar sympathectomy on canine transcutaneous oxygen tension.Surgery 113:433–437

5. Charkoudian N,Eisenach JH,Atkinson JLD,Fealey RD,Joyner MJ (2002) Effects ofchronic sympathectomy on locally mediated cutaneous vasodilation in humans.J Appl Physiol 92:685–690

6. Chung I-H,Oh C-S,Koh K-S,Kim H-J, Paik H-C,Lee D-Y (2002) Anatomic variations ofthe T2nerve root (including the nerve ofKuntz) and their implications for sympathectomy.J Thorac Cardiovasc Surg 123:498–501

7. Cloward RB (1969) Hyperhidrosis.J Neurosurg 30:545–551

8. Delaney J,Scarpino J (1973) Limb arteriovenous shunting following sympathetic denervation.Surgery 73:202–206

9. de Takats G (1974) Sympathectomy for hypertension.Am J Surg 127:521–524

10. Drott C,Claes G,Göthberg G, Paszkowski P (1994) Cardiac effects of endoscopic electrocautery ofthe upper thoracic sympathetic chain.Eur J Surg 160(Suppl 572):65–70

11. Drott C,Claes G,Olsson-Rex L,Dalman P,Fahlen T,Gothberg G (1998) Successful treatment offascial blushing by endoscopic transthoracic sympathicotomy.Br J Dermatol 138: 639–643

12. Ehrlich Jr E,Alexander WF (1951) Surgical implications ofupper thoracic independent sympathetic pathways. Arch Surg 62:609–614 13. Eisenach JH,Clark ES,Charkoudian N, Dinenno FA,Atkinson JLD,Fealey RD, Dietz NM,Joyner MJ (2002) Effects of chronic sympathectomy on vascular function in the human forearm.J Appl Physiol 92:2019–2025

14. Gaskell WH (1879) Further researches on the vasomotor nerves ofordinary muscles.J Physiol 1:262–302

15. Goetz RH,Marr JAS (1944) The importance ofthe second thoracic ganglion for the sympathetic supply ofthe upper extremities,with a description of two new approaches for its removal. Clin Proc 3:102–114

16. Greenhalgh RM,Rosengarten DS,Martin P (1971) Role ofsympathectomy for hyperhidrosis.Br Med J 1:332–334

17. Hashmonai M,Kopelman D,Klein O, Schein M (1992) Upper thoracic sympathectomy for primary palmar hyperhidrosis:long-term follow-up.Br J Surg 79:268–271

18. Hyndman OR,Wolkin J (1942) Sympathectomy ofthe upper extremity.Evidence that only the second dorsal ganglion need be removed for complete sympathectomy.Arch Surg 45:145–155

19. Jonnesco T (1920) Angine de poitrine guérie par la résection du sympathique cervicothoracique.Bull Acad Med Paris 84:93–102

20. Kao M-C,Tsai J-C,Lai D-M,Hsiao Y-Y, Lee Y-S,Chiu M-J (1994) Autonomic activity in hyperhidrosis patients before,during,and after endoscopic laser sympathectomy.Neurosurgery 34: 262–268

21. Kardos A,Taylor DJ,Thompson C, Styles P,Hands L,Collin J,Casadei B (2000) Sympathetic denervation ofthe upper limb improves forearm exercise performance and skeletal muscle bioenergetics.Circulation 101: 2716–2720

22. Kuntz A (1927) Distribution ofthe sympathetic rami to the brachial plexus:its relation to sympathectomy affecting the upper extremity.Arch Surg 15:871–877

23. Kurchin A,Zweig A,Adar R,Mozes M (1977) Upper dorsal sympathectomy for palmar primary hyperhidrosis by the supraclavicular approach.World J Surg 1:667–674

24. Laederach-Hofmann K,Mussgay L, Büchel B,Wilder P,Rüddel H (2002) Patients with erythrophobia (fear of blushing) show abnormal autonomic regulation in mental stress conditions. Psychosom Med 64:358–365

25. Lai C-L,Chen W-J,Liu Y-B,Lee Y-T (2001) Bradycardia and permanent pacing after bilateral thoracoscopic T2sympathectomy for primary hyperhidrosis.PACE 24(Pt.I):524–525

26. Lemmens HAJ (1982) Thoracic resympathectomy.Int Angiol 1:147–148

27. Lemmens HAJ (1982) Importance of the second thoracic segment for the sympathetic denervation ofthe hand. Vasc Surg 16:23–26

28. Marinescu V,Pausescu E,Pavelescu I, Fagarasanu D (1968) Functional and structural changes ofthe arterial wall after sympathectomy.J Cardiovasc Surg 9:54–63

29. May AG,De Weeze JA,Rob CG (1963) Effect ofsympathectomy on blood flow in arterial stenosis.Ann Surg 158:182–188

30. Molho M,Shemesh E,Gordon D,Adar R (1980) Pulmonar functional abnormalities after upper dorsal sympathectomy.A comparison between the supraclavicular and transaxillary approaches.Chest 77:651–655

31. Moran KT,Brady MP (1991) Surgical management ofprimary hyperhidrosis.Br J Surg 78:279–283

32. Nakamura Y,Fujimoto M,Nagata Y, Shiraishi K-I,Yoshizawa H,Kida H, Matsumoto Y (2002) Effects ofendoscopic transthoracic sympathicotomy on hemodynamic and neurohumoral responses to exercise in humans.Circ J 66:357–361

33. Naumann M,Hamm H (2002) Treatment ofaxillary hyperhidrosis.Br J Surg 89:259–261

34. Noppen M,Dendale P,Hagers Y,Herregodts P,Vincken W,D’Haens J (1996) Changes in cardiocirculatory autonomic function after thoracoscopic upper dorsal sympathicolysis for essential hyperhidrosis.J Autonom Nerv Syst 60:115–120

35. Noppen M,Sevens C,Gerlo E,Vincken W (1997) Plasma catecholamine concentrations in essential hyperhidrosis and effects ofthoracoscopic D2-D3 sympathicolysis.Eur J Clin Invest 27:202–205

36. Noppen MMP,Vincken WG (1997) Partial pulmonary sympathetic denervation by thoracoscopic D2-D3sympathicolysis for essential hyperhidrosis: effect on the pulmonary diffusion capacity.Resp Med 91:537–545

37. O’Riordain DS,Maher M,Waldron DJ, O’Donovan B,Brady MP (1993) Limiting the anatomic extent ofupper thoracic sympathectomy for primary palmar hyperhidrosis.Surg Gynecol Obstet 176:151–154

38. Pai-Silva MD,Ueda AK,Resende LAL, Pai VD,Alves A,Faleiros ATS,Rodrigues ADC (2001) Morphological aspects ofrabbit masseter muscle after cervical sympathectomy.Int J Exp Path 82:123–128

39. Papa MZ,Bass A,Schneiderman J, Drori Y,Tucker E,Adar R (1986) Cardiovascular changes after bilateral upper dorsal sympathectomy.Shortand long-term effects.Ann Surg 204: 715–718

40. Rutherford RB,Valenta J (1971) Extremity flow and distribution:the effects ofarterial occlusion,sympathectomy,and exercise.Surgery 69:332–344

41. Ruocco I,Cuello AC,Shigemoto R, Ribeiro-da-Silva A (2001) Sympathectomy leads to transient substance Pimmunoreactive sensory fibre plasticity in the rat skin.Neuroscience 108: 157–166

42. Sato K,Kang WH,Saga K,Sato KT (1989) Biology ofsweat glands and their disorders:I.Normal sweat gland function.Am Acad Dermatol 20: 537–562

43. Shich CJ,Wang WC (1978) Thoracic sympathectomy for palmar hyperhidrosis.Report of457 cases.Surg Neurol 10:291–296

44. Smith PG,Warn JD,Steinle JJ,KrizsanAgbas D,Hasan W (2002) Modulation ofparasympathetic neuron phenotype and function by sympathetic innervation.Auton Neurosci Bas Clin 96: 33–42

45. Soffer EE,Schneiderman J,Schwartz I, Halpern Z,Adar R,Weissberg D,BarMeir S (1988) Effects ofupper dorsal sympathectomy on esophageal motility in humans.Dig Dis Sci 33:157–160

46. Tygesen H,Wettervik C,Claes G,Drott C,Emanuelsson H,Solem J,Lomsky M, Radberg G,Wennerblom B (1999) Long-term effect of endoscopic transthoracic sympathicotomy on heart rate variability and QT dispersion in severe angina pectoris.Int J Cardiol 70:283–292

47. van Dielen FMH,Kurvers HAJM, Dammers R,oude Egbrink MGA,Slaaf DW,Tordoir JHM,Kitslaar PJEHM (1998) Effects ofsurgical sympathectomy on skin blood flow in a rat model ofchronic limb ischemia.World J Surg 22:807–811

48. van Rhede van der Kloot EJH,Jörning PJG (1990) Resympathectomy ofthe upper extremity.Br J Surg 77: 1043–1045

49. Weissenhofer W,Schenk Jr WG (1973) Effect ofsympathectomy on blood flow through stenotic vessels during exercise:an experimental study in a canine model.Surgery 74:734–738

50. Whiteley MS,Ray-Chaudhuri SB,Galland RB (1996) Abnormal suntanning following transthoracic endoscopic sympathectomy.Br J Surg 83:1782

51. Wittmoser R (1985) Treatment of sweating and blushing by endoscopic surgery.Acta Neurochir 74:153–154

52. Wong CW (1997) Stimulation ofleft stellate ganglion prolongs Q-T interval in patients with palmar hyperhidrosis. Am J Physiol 273(Heart Circ Physiol 42):H1696–H1698

53. Wong CW (1997) The second thoracic sympathetic ganglion determines palm skin temperature in patients with essential palmar hyperhidrosis.J Auton Nerv Syst 67:121–124

54. Wong CW,Wang CH (1999) Left stellate stimulation increases left ventricular ejection fraction in patients with essential palmar hyperhidrosis.J Auton Nerv Syst 78:64–67

55. Wright CJ,Cousins MJ (1972) Blood flow distribution in the human leg following epidural sympathetic blockade. Arch Surg 105:334–337