ISSS-ABSTRACTS
significant impairment of the heart rate to workload relationship was consistently observed following sympathectomy
The aim of the present prospective study was to confirm that a significant impairment of the heart rate to workload relationship was consistently observed following unilateral and/or bilateral (sympathectomy) surgery. Eur J Cardiothorac Surg 2001;20:1095-1100 http://ejcts.ctsnetjourna...i/content/full/20/6/1095
Psychiatrist treating patients with cardiac problems ?
"The guidelines for the block in individual cases:
Sweating of the underarms and hands - T4 or T5
Sweating of the face and blushing - T3 or T4
Blushing of the face alone - T2
Social anxiety with blushing - T2
Social anxiety without FB - T3 and T4 on the left side only
Heart racing and rhythm disorders - T3, T4, and T5 on the left side only "
Telaranta also claims that after clamping/crushing the nerve and subsequent removal of the titanium clips, the sympathetic chain will regain full function. Sadly, this is an unproven and unsubstantiated claim.
He also claims that his procedure is "more gentle". Nerve injury - no matter how acquired - remains a nerve injury with it's complications.
http://www.privatix.fi/index.shtml?&a=0&s=navig_03&l=en&d=01_details
Sweating of the underarms and hands - T4 or T5
Sweating of the face and blushing - T3 or T4
Blushing of the face alone - T2
Social anxiety with blushing - T2
Social anxiety without FB - T3 and T4 on the left side only
Heart racing and rhythm disorders - T3, T4, and T5 on the left side only "
Telaranta also claims that after clamping/crushing the nerve and subsequent removal of the titanium clips, the sympathetic chain will regain full function. Sadly, this is an unproven and unsubstantiated claim.
He also claims that his procedure is "more gentle". Nerve injury - no matter how acquired - remains a nerve injury with it's complications.
http://www.privatix.fi/index.shtml?&a=0&s=navig_03&l=en&d=01_details
so inclusive it risks mislabelling millions of healthy people as mentally ill, potentially leading to increased stigma and medication
IN RADICAL changes to the way mental health conditions are diagnosed, what was once considered an unruly child's temper tantrum could soon be labelled ''disruptive mood dysregulation disorder''.
If a widow's grief lasts longer than a fortnight then she might be diagnosed with ''major depressive disorder''. When the mother in a bitter custody battle tries to turn a child against the father, it might create ''parental alienation disorder''.
These are among new conditions proposed for the fifth edition of the psychiatrist's bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is due to be finalised next year.
They fear it is so inclusive it risks mislabelling millions of healthy people as mentally ill, potentially leading to increased stigma and medication.
Doctors in Australia are also concerned, some arguing the revised manual - which has been produced by the American Psychiatric Association since 1952 and is used globally by psychiatrists and psychologists to diagnose mental disorders - is turning unhappiness into a disease.
If a widow's grief lasts longer than a fortnight then she might be diagnosed with ''major depressive disorder''. When the mother in a bitter custody battle tries to turn a child against the father, it might create ''parental alienation disorder''.
These are among new conditions proposed for the fifth edition of the psychiatrist's bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is due to be finalised next year.
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The proposed changes have caused an international outcry. The Association for Psychological Science, the American Counselling Association, the British Psychological Society and leading psychiatrists are calling for the draft of the new edition to be subject to independent scientific review.They fear it is so inclusive it risks mislabelling millions of healthy people as mentally ill, potentially leading to increased stigma and medication.
Doctors in Australia are also concerned, some arguing the revised manual - which has been produced by the American Psychiatric Association since 1952 and is used globally by psychiatrists and psychologists to diagnose mental disorders - is turning unhappiness into a disease.
sympathectomy results in a pronounced increase of cerebrospinal fluid production
Electrical stimulation of the sympathetic nerves, which originate in the superior cervical ganglia, induces as much as 30% reduction in the net rate of cerebrospinal fluid (CSF) production, while sympathectomy results in a pronounced increase, about 30% above control, in the CSF formation. There is strong reason to believe that the choroid plexus is under the influence of a considerable sympathetic inhibitory tone under steady-state conditions.
http://ukpmc.ac.uk/abstract/MED/6276421
http://ukpmc.ac.uk/abstract/MED/6276421
"Lumbar sympathectomy/Sympathectomy and Hydrocephalus sharing one common finding"
http://en.diagnosispro.com/disease_comparison-for/lumbar-sympathectomy-versus-hydrocephalus/16143-22570.html
DiagnosisPro is a medical expert system.[1] It provides exhaustive diagnostic possibilities for 11,000 diseases and 30,000 findings.[2] It is supposed to give the most appropriate differential however this is not always the case.[3] Between Oct 2008 and Oct 2009 the site averaged 61,000 visits per month. [4]
http://en.diagnosispro.com/disease_comparison-for/lumbar-sympathectomy-versus-hydrocephalus/16143-22570.html
Hydrocephalus also known as "water in the brain," is a medical condition in which there is an abnormal accumulation of cerebrospinal fluid (CSF)
http://en.wikipedia.org/wiki/Hydrocephalus
DiagnosisPro is a medical expert system.[1] It provides exhaustive diagnostic possibilities for 11,000 diseases and 30,000 findings.[2] It is supposed to give the most appropriate differential however this is not always the case.[3] Between Oct 2008 and Oct 2009 the site averaged 61,000 visits per month. [4]
http://en.diagnosispro.com/disease_comparison-for/lumbar-sympathectomy-versus-hydrocephalus/16143-22570.html
Hydrocephalus also known as "water in the brain," is a medical condition in which there is an abnormal accumulation of cerebrospinal fluid (CSF)
http://en.wikipedia.org/wiki/Hydrocephalus
Ischemic spinal cord injury has been reported after sympathectomy
it had been marketed intensively to surgeons on the basis of ''compelling'' but misleading claims
MICHELE STEGER is one of thousands of Australians whose ordeal with failing and poisonous hip implants was described by a Senate committee this week as ''intolerable and unacceptable''.
Not only had the product failed at rate several times higher than normal, the ill-functioning metal joint had spread toxic levels of chromium and cobalt into the tissue of her hip.
The Senate community affairs references committee said it believed ''insufficient information has been provided to consumers regarding concerns with the device. This is regrettable''.
Regret understates Mrs Steger's reaction when she learned in October 2010 that a previous implant that had caused her so much grief officially had been withdrawn from use 10 months previously.
The first hint she got that her DePuy ASR implant had been recalled in December 2009 came neither from her surgeon nor even health authorities.
Not only had the product failed at rate several times higher than normal, the ill-functioning metal joint had spread toxic levels of chromium and cobalt into the tissue of her hip.
The Senate community affairs references committee said it believed ''insufficient information has been provided to consumers regarding concerns with the device. This is regrettable''.
Regret understates Mrs Steger's reaction when she learned in October 2010 that a previous implant that had caused her so much grief officially had been withdrawn from use 10 months previously.
The first hint she got that her DePuy ASR implant had been recalled in December 2009 came neither from her surgeon nor even health authorities.
isolated failure of sympathetic sudomotor activity
The main clinical features include symptoms of heat intolerance: feeling hot, flushed, dyspneic, light-headed, and weak when the ambient temperature is high or when exercising. Recent accounts of acquired idiopathic anhidrosis, however, have emphasized the heterogeneous features and sub-types of this condition.
Fitzpatrick's Dermatology In General Medicine, Seventh Edition: Two Volumes
Pub Date: NOV-07
Fitzpatrick's Dermatology In General Medicine, Seventh Edition: Two Volumes
Pub Date: NOV-07
The practice of sympathectomy for treating neuropathic pain is based on very weak evidence. Furthermore, complications of the procedure may be significant.
Cochrane Summariesbeta
Independent high-quality evidence for health care decision making
http://summaries.cochrane.org/CD002918/cervico-thoracic-or-lumbar-sympathectomy-for-neuropathic-pain
Sympathectomy useless, even detrimental
A number of surgical procedures have been developed, which, although well-intentioned, are found unfortunately by further study to prove useless, or even detrimental. It is believed at present that lumbar sympathetic ganglionectomy in the treatment of the post-thrombotic type of ulceration of the lower extremity should be placed in this category.
http://archsurg.ama-assn.org/cgi/content/summary/67/1/2
http://archsurg.ama-assn.org/cgi/content/summary/67/1/2
It has to push us to publish our works, to inform the medical corps, relentlessly and without restraint
7th International Symposium on Sympathetic Surgery 20th-22nd March 2007 Muro Alto (PE), Brazil
Clinical Autonomic Research. New York:Apr 2007. Vol. 17, Iss. 2, p. 126-44 (19 pp.)
Pity colleagues, pity for these poor patients!
Gross Michel* Institution: Private Cabinet*; Grone - Switzerland
A desperate 22-year-old man comes to consult and tells me about his idea of committing suicide. Since the age of 9, he suffers from a severe cephalic ephidrosis, with blushing face, intensifying with years, to such an extent that it became unbearable over the last year:
''It is a real Calvary''. His family GP assures him that his troubles are going to disappear as he will get older and ''ut aliquid fieri'' he prescribes sage drops and anxiolytic. As these prescriptions do not improve his situation, his GP sends him to an endocrinologist who performs many exams to exclude an hyperthyreosis, a carcinoıd tumor or a pheochromocytoma. Among the considerable number of blood exams, one appears to be out of normal ranges. The patient goes therefore to an haematologist, who does not find anything
abnormal. A neurologist, then consulted, does not suspect anything in particular, but asks however for some radiology exams, including a brain MRI, as well as a Pet-scan, to exclude an adrenal gland tumor. All these exams being normal, the patient is sent to a behaviour therapist to begin a psychotherapy. Exhausted by the
weight of these useless consultations here and there, our young patient, always seeking for the solution to his problems, decides to turn to an acupuncturist, an osteopath, a healer and a radiesthesist, in vain. He then decides to consult a dermatologist and shares with him a summary of information gathered on Internet, including information from my site. Finally, the patient was referred to me.
Aware of that, the GP warns his colleagues by sending a letter indicating that any therapeutic measure other than psychotherapy is not recommended, considering the surgical alternative as irresponsible. I did by the way, not get any call from any of my colleagues. The patient had successful surgery 2 weeks later
(sympathicotomy T2-3-4-5) This recent history redraws, once again, iatrogenic caricatural wandering to which our patients are too often subjected. It has to push us to publish our works, to inform the medical corps, relentlessly and without restraint. The information could also, throughout the public, reach our colleagues. It is at the end an interesting paradox to note that physicians, whose primary role is to relieve patients, are also the primary actors of a film where patients are maintained in a ''medical jail''.
Clinical Autonomic Research. New York:Apr 2007. Vol. 17, Iss. 2, p. 126-44 (19 pp.)
Pity colleagues, pity for these poor patients!
Gross Michel* Institution: Private Cabinet*; Grone - Switzerland
A desperate 22-year-old man comes to consult and tells me about his idea of committing suicide. Since the age of 9, he suffers from a severe cephalic ephidrosis, with blushing face, intensifying with years, to such an extent that it became unbearable over the last year:
''It is a real Calvary''. His family GP assures him that his troubles are going to disappear as he will get older and ''ut aliquid fieri'' he prescribes sage drops and anxiolytic. As these prescriptions do not improve his situation, his GP sends him to an endocrinologist who performs many exams to exclude an hyperthyreosis, a carcinoıd tumor or a pheochromocytoma. Among the considerable number of blood exams, one appears to be out of normal ranges. The patient goes therefore to an haematologist, who does not find anything
abnormal. A neurologist, then consulted, does not suspect anything in particular, but asks however for some radiology exams, including a brain MRI, as well as a Pet-scan, to exclude an adrenal gland tumor. All these exams being normal, the patient is sent to a behaviour therapist to begin a psychotherapy. Exhausted by the
weight of these useless consultations here and there, our young patient, always seeking for the solution to his problems, decides to turn to an acupuncturist, an osteopath, a healer and a radiesthesist, in vain. He then decides to consult a dermatologist and shares with him a summary of information gathered on Internet, including information from my site. Finally, the patient was referred to me.
Aware of that, the GP warns his colleagues by sending a letter indicating that any therapeutic measure other than psychotherapy is not recommended, considering the surgical alternative as irresponsible. I did by the way, not get any call from any of my colleagues. The patient had successful surgery 2 weeks later
(sympathicotomy T2-3-4-5) This recent history redraws, once again, iatrogenic caricatural wandering to which our patients are too often subjected. It has to push us to publish our works, to inform the medical corps, relentlessly and without restraint. The information could also, throughout the public, reach our colleagues. It is at the end an interesting paradox to note that physicians, whose primary role is to relieve patients, are also the primary actors of a film where patients are maintained in a ''medical jail''.
Retrograde Changes in the Nervous System Following Unilateral Sympathectomy
In consequence of right-sided smpathectomy at the level of C5 it was found that in the sheep the cervical sympathetic trunk contains nerve fibres which proceed from cells situated in the first four segments of the thoracic part of the spinal cord and in the stellate ganglion. These fibres are about 85 per cent of all fibres of the sympathetic trunk. The remaining 15 per cent proceed from nerve cells situated nasally of the anterior cervical ganglion.
http://onlinelibrary.wiley.com/doi/10.1111/j.1439-0442.1967.tb00255.x/abstract
http://onlinelibrary.wiley.com/doi/10.1111/j.1439-0442.1967.tb00255.x/abstract
Telaranta's patient commits suicide after elective surgery for sweaty hands
One of Dr. Telaranta’s patients who had made a complaint began to experience strong reactions of anxiety which did not go away even after corrective surgery. Later the patient committed suicide.
Surgery involving the clamping of sympathetic nerve trunks to prevent excessive perspiration and blushing appears to be of questionable value.
Complications have been reported, ranging from phantom perspiration to blood clots in the brain.
The Finnish Office for Health Care Technology Assessment (FinOHTA), which is part of the National Research and Development Centre for Welfare and Health (STAKES) recently conducted a survey on the various effects of hyperhidrosis surgery at the request of the Finnish Medical Association.
Finnish surgeon Timo Telaranta has performed about 2,000 such operations at private clinics in Helsinki and Oulu in the past ten years.
The National Authority for Medicolegal Affairs has issued three warnings to Telaranta and the Provincial Government of Southern Finland has issued one.
Many doctors have serious reservations about the idea of treating complaints such as excessive perspiration, blushing, and performance anxiety by severing people’s nerves.
http://www.hs.fi/english/article/1101979734791
Surgery involving the clamping of sympathetic nerve trunks to prevent excessive perspiration and blushing appears to be of questionable value.
Complications have been reported, ranging from phantom perspiration to blood clots in the brain.
The Finnish Office for Health Care Technology Assessment (FinOHTA), which is part of the National Research and Development Centre for Welfare and Health (STAKES) recently conducted a survey on the various effects of hyperhidrosis surgery at the request of the Finnish Medical Association.
Finnish surgeon Timo Telaranta has performed about 2,000 such operations at private clinics in Helsinki and Oulu in the past ten years.
The National Authority for Medicolegal Affairs has issued three warnings to Telaranta and the Provincial Government of Southern Finland has issued one.
Many doctors have serious reservations about the idea of treating complaints such as excessive perspiration, blushing, and performance anxiety by severing people’s nerves.
http://www.hs.fi/english/article/1101979734791
Peer review and the corruption of science
Peer review is the process that decides whether your work gets published in an academic journal. It doesn't work very well any more, mainly as a result of the enormous number of papers that are being published (an estimated 1.3 million papers in 23,750 journals in 2006). There simply aren't enough competent people to do the job. The overwhelming effect of the huge (and unpaid) effort that is put into reviewing papers is to maintain a status hierarchy of journals. Any paper, however bad, can now get published in a journal that claims to be peer-reviewed.
The blame for this sad situation lies with the people who have imposed a publish-or-perish culture, namely research funders and senior people in universities. To have "written" 800 papers is regarded as something to boast about rather than being rather shameful. University PR departments encourage exaggerated claims, and hard-pressed authors go along with them.
Not long ago, Imperial College's medicine department were told that their "productivity" target for publications was to "publish three papers per annum including one in a prestigious journal with an impact factor of at least five.″ The effect of instructions like that is to reduce the quality of science and to demoralise the victims of this sort of mismanagement.
The only people who benefit from the intense pressure to publish are those in the publishing industry. Hardly a day passes without a new journal starting. My email inbox is full of invitations to publish in a weird variety of journals. They'll take just about anything. The US National Library of Medicine indexes 39 journals that deal with alternative medicine. They are all "peer-reviewed", but rarely publish anything worth reading. The peer review for a journal on homeopathy is, presumably, done largely by other believers in magic. If that were not the case, these journals would soon vanish.
But it isn't only quack journals that have failures in peer review. In June, the British Journal of General Practice published a paper, "Acupuncture for 'frequent attenders' with medically unexplained symptoms: a randomised controlled trial (CACTUS study)". It has lots of numbers, but the result is very easy to see. All you have to do is look at their Figure.
http://www.guardian.co.uk...rish-peer-review-science
The blame for this sad situation lies with the people who have imposed a publish-or-perish culture, namely research funders and senior people in universities. To have "written" 800 papers is regarded as something to boast about rather than being rather shameful. University PR departments encourage exaggerated claims, and hard-pressed authors go along with them.
Not long ago, Imperial College's medicine department were told that their "productivity" target for publications was to "publish three papers per annum including one in a prestigious journal with an impact factor of at least five.″ The effect of instructions like that is to reduce the quality of science and to demoralise the victims of this sort of mismanagement.
The only people who benefit from the intense pressure to publish are those in the publishing industry. Hardly a day passes without a new journal starting. My email inbox is full of invitations to publish in a weird variety of journals. They'll take just about anything. The US National Library of Medicine indexes 39 journals that deal with alternative medicine. They are all "peer-reviewed", but rarely publish anything worth reading. The peer review for a journal on homeopathy is, presumably, done largely by other believers in magic. If that were not the case, these journals would soon vanish.
But it isn't only quack journals that have failures in peer review. In June, the British Journal of General Practice published a paper, "Acupuncture for 'frequent attenders' with medically unexplained symptoms: a randomised controlled trial (CACTUS study)". It has lots of numbers, but the result is very easy to see. All you have to do is look at their Figure.
http://www.guardian.co.uk...rish-peer-review-science
Access to medical records for patients is still unresolved
The recognised requirement for informed consent to treatment has also had a direct bearing on this new era of cooperation. [33] PIAC's report, Whose Health Records, refers to court decisions over the past ten years in Australia which have made the medical professions `more accountable and led to greater recognition of consumer rights'. PIAC cites the High Court's judgment in 1992 in Rogers v Whitaker for a doctor's obligation to `provide a consumer with sufficient information to allow them to give informed consent to treatment'. [34] Such landmark decisions have in many ways changed the doctor-patient relationship, although provision of access to medical records in private general and specialist medical practice has remained legally unresolved.
Members of the Royal Australian College of General Practitioners (RACGP) responded to this issue in a recent survey conducted by the RACGP. Their survey canvassed a range of issues including patient access to medical records. 76 per cent of respondents indicated that they agreed that legislation which presently does not allow patients to have access to their medical records should not be changed.
Medical practitioners therefore may state the principle that access to medical records and privacy of medical records is one simply of communication, education and cooperation. In practice, fears of possible litigation as well as strongly-held views on medical records being the sole property of the medical practitioner, often prevents patients gaining automatic access to their records.
The final report of the Professional Indemnity Review (PIR) also noted that doctors feared litigation. PIR pointed to doctors' fears that patients might `lose confidence in the health care system and the advice of health care professionals' if patients were more aware of the `unknowns and risks' which might be revealed in medical and health records. [43]
http://www.aph.gov.au/senate/committee/clac_ctte/completed_inquiries/1996-99/medical/report/c02.htm
Members of the Royal Australian College of General Practitioners (RACGP) responded to this issue in a recent survey conducted by the RACGP. Their survey canvassed a range of issues including patient access to medical records. 76 per cent of respondents indicated that they agreed that legislation which presently does not allow patients to have access to their medical records should not be changed.
Medical practitioners therefore may state the principle that access to medical records and privacy of medical records is one simply of communication, education and cooperation. In practice, fears of possible litigation as well as strongly-held views on medical records being the sole property of the medical practitioner, often prevents patients gaining automatic access to their records.
The final report of the Professional Indemnity Review (PIR) also noted that doctors feared litigation. PIR pointed to doctors' fears that patients might `lose confidence in the health care system and the advice of health care professionals' if patients were more aware of the `unknowns and risks' which might be revealed in medical and health records. [43]
http://www.aph.gov.au/senate/committee/clac_ctte/completed_inquiries/1996-99/medical/report/c02.htm
ONE in 15 medical practitioners registered to work in NSW has a criminal past
ONE in 15 medical practitioners registered to work in NSW has a criminal past, new figures reveal.
The first look into the criminal histories of 13,000 doctors, dentists, psychologists, nurses and pharmacists - many of whom were graduates and foreign medical professionals registering for the first time - has led to calls for further background checks.
There are 156,000 people working in NSW who have not been checked by police under the new system, which does not take into account driving infringements.
But eyebrows have been raised by the findings of the Australian Health Practitioner Regulation Agency, the national body established last year to replace a patchwork of more than 80 medical boards around Australia.
Of the 13,421 medicos checked by NSW police at the request of the agency, 936 - or 7 per cent - were found to have ''disclosable court outcomes'' such as convictions for theft, fraud and sexual offences. The figure was slightly higher than the national average of 6 per cent.
The first look into the criminal histories of 13,000 doctors, dentists, psychologists, nurses and pharmacists - many of whom were graduates and foreign medical professionals registering for the first time - has led to calls for further background checks.
There are 156,000 people working in NSW who have not been checked by police under the new system, which does not take into account driving infringements.
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The Minister for Health, Jillian Skinner, and the Australian Medical Association insist the industry is ''weeding out'' unsuitable people.But eyebrows have been raised by the findings of the Australian Health Practitioner Regulation Agency, the national body established last year to replace a patchwork of more than 80 medical boards around Australia.
Of the 13,421 medicos checked by NSW police at the request of the agency, 936 - or 7 per cent - were found to have ''disclosable court outcomes'' such as convictions for theft, fraud and sexual offences. The figure was slightly higher than the national average of 6 per cent.
Patients with sympathectomy are not suitable controls for sleep study. Why?
Exclusions:
Patients with permanent pacemaker, non-sinus cardiac arrhythmias, peripheral vasculopathy or neuropathy, severe lung disease, status postbilateral cervical or thoracic sympathectomy, finger deformity that precludes adequate sensor application, using a-adrenergic receptor blockers, or alcohol or drug abuse during the last 3 years.
The clinic sleep laboratory of the Technion Sleep Medicine Centre, Israel
http://chestjournal.chestpubs.org/content/123/3/695.long
CHEST March 2003 vol. 123 no. 3 695-703
MSAC Application no 1130, Assessment Report
Patients with permanent pacemaker, non-sinus cardiac arrhythmias, peripheral vasculopathy or neuropathy, severe lung disease, status postbilateral cervical or thoracic sympathectomy, finger deformity that precludes adequate sensor application, using a-adrenergic receptor blockers, or alcohol or drug abuse during the last 3 years.
The clinic sleep laboratory of the Technion Sleep Medicine Centre, Israel
http://chestjournal.chestpubs.org/content/123/3/695.long
CHEST March 2003 vol. 123 no. 3 695-703
MSAC Application no 1130, Assessment Report
The amount of compensatory sweating depends the amount of cell body reorganization in the spinal cord after surgery
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
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
ETS considered psychiatric surgery - says Dr Nagy
"ETS can alter many bodily functions, including sweating , heart rate , heart stroke volume , blood pressure , thyroid , baroreflex , lung volume , pupil dilation, skin temperature, goose bumps and other aspects of the autonomic nervous system . It can diminish the body's physical reaction to exercise and/or strong emotion, and thus is considered psychiatric surgery. In rare cases sexual function or digestion may be modified as well. "
http://www.lvhyperhidrosis.com/treatment.html
http://www.lvhyperhidrosis.com/treatment.html
MD admits stellate ganglion block impacts on the insular cortex of the brain and alters emotions
Dr. Lipov says, "What really intrigued me about Dr, DeWall's study was he showed Tylenol exerted this emotional effect by acting on the insular cortex of the brain. That's exactly the same area that's affected by a Stellate Ganglion Block.[4]" The specialist is also Director of Chronic Pain Research at Northwest Community Hospital in Arlington Heights.
http://www.medicalnewstoday.com/releases/227298.php
http://www.medicalnewstoday.com/releases/227298.php
if more than one child in 1000 has a febrile seizure, the vaccine is doing more harm than good
PUBLISHED research linking CSL’s influenza vaccine to high rates of fever in children was omitted from the product information for its 2010 Fluvax product, which caused serious adverse reactions in children.
The product information (PI) included data from the 2005 flu season showing that after receiving Fluvax, fever was experienced by 22.5% of children aged from 6 months to less than 3 years and 15.6% of children aged from 3 years to less than 9 years.
However, the PI omitted data from the 2006 season which showed that the rate of fever had increased considerably — to 39.5% in the younger age group and 27% in the older group. Of the 272 children who received the 2006 vaccine, one child in the older group experienced a febrile convulsion.
However, Professor Collignon said it was important to weigh the risks of the vaccine with the risks of influenza itself.
“By my calculations, if more than one child in 1000 has a febrile seizure, the vaccine is doing more harm than good”.
In 2010, Fluvax was found to be causally linked to a significantly increased rate of fevers and febrile convulsions among Australian children. One published estimate put the rate of paediatric febrile convulsions at 3.3 per 1000 doses, or more than 200 times the rate in the only other published population-based estimate. (3)
MJA InSight, 17 October 2011
The product information (PI) included data from the 2005 flu season showing that after receiving Fluvax, fever was experienced by 22.5% of children aged from 6 months to less than 3 years and 15.6% of children aged from 3 years to less than 9 years.
However, the PI omitted data from the 2006 season which showed that the rate of fever had increased considerably — to 39.5% in the younger age group and 27% in the older group. Of the 272 children who received the 2006 vaccine, one child in the older group experienced a febrile convulsion.
However, Professor Collignon said it was important to weigh the risks of the vaccine with the risks of influenza itself.
“By my calculations, if more than one child in 1000 has a febrile seizure, the vaccine is doing more harm than good”.
In 2010, Fluvax was found to be causally linked to a significantly increased rate of fevers and febrile convulsions among Australian children. One published estimate put the rate of paediatric febrile convulsions at 3.3 per 1000 doses, or more than 200 times the rate in the only other published population-based estimate. (3)
MJA InSight, 17 October 2011
CLINICAL practice guidelines are vulnerable to bias
CLINICAL practice guidelines are vulnerable to bias, with only 15% of NHMRC guidelines from Australia’s most prolific guideline developers including a declaration of conflicts of interest, new research has found.
Although a conflict of interest (COI) statement has long been required from authors of research papers, it is often lacking for developers of clinical practice guidelines, despite the influence of guidelines on clinical care.
The research, in the latest issue of the MJA, looked at more than 200 clinical guidelines that were listed on the NHMRC website. Its authors concluded that the NHMRC needed to “urgently promote a more ethically sound development process for guidelines”.
“Our review of the country’s most prolific guideline developers shows that only 15% of guidelines have COI statements”, they said.
“This raises questions about whether medical bodies are affected by unrecognised, and thus unaddressed, extraneous interests, and may erode the trust the community has in the profession to speak authoritatively about health problems.”
MJA InSight, 17 October 2011
Although a conflict of interest (COI) statement has long been required from authors of research papers, it is often lacking for developers of clinical practice guidelines, despite the influence of guidelines on clinical care.
The research, in the latest issue of the MJA, looked at more than 200 clinical guidelines that were listed on the NHMRC website. Its authors concluded that the NHMRC needed to “urgently promote a more ethically sound development process for guidelines”.
“Our review of the country’s most prolific guideline developers shows that only 15% of guidelines have COI statements”, they said.
“This raises questions about whether medical bodies are affected by unrecognised, and thus unaddressed, extraneous interests, and may erode the trust the community has in the profession to speak authoritatively about health problems.”
MJA InSight, 17 October 2011
Deceit and fraud in medical research
Deceit and fraud in medical research is a serious problem for the credibility of published literature. Although estimating its prevalence is difficult, reported incidences are alarming. The spectrum of the problem ranges from what may seem as rather innocuous gift authorship to wholesale fabrication of data. Potential factors which may have promoted fraud and deceit include financial gain, personal fame, the competitive scientific environment and scientific hubris. Fraud and deceit are difficult to detect and are generally brought to the fore by whistleblowers.
International Journal of Surgery
Volume 4, Issue 2, 2006, Pages 122-126
Usman Jaffer, and Alan E.P. Cameron
International Journal of Surgery
Volume 4, Issue 2, 2006, Pages 122-126
Usman Jaffer, and Alan E.P. Cameron
ETS story
Physicians are required to gain informed consent prior to administering a treatment. Informed consent is gained by providing patients with a full accounting of the risks of the treatment as documented in peer-reviewed, published medical/scientific literature.
Your scenario of surgeons being flummoxed by unhappy patients complaining after surgery doesn't hold water. The rules of professional medical ethics require that the treating physician be well versed in the published literature on the treatments he delivers.
There is a mountain of published research (spanning nearly a century) documenting the adverse effects of sympathectomy. There are numerous studies, for example, showing very high rates of severe side effects and studies showing that satisfaction diminishes substantially over the long term.
It is a doctors job to know this stuff and it is their ethical duty to disclose that information to patients.
So, I see the blame thing as pretty cut and dry. Surgeons perfoming sympathectomies routinely withhold information vital to informed consent. Anyone who does objective comparison between what is documented in medical/scientific literature and what is typically disclosed to prospective ETS patients has no choice but reach this conclusion.
And, to make matters worse, many surgeons use testimonials from a hand-selected group of their happiest patients to advocate the surgery. That practice is considered unethical by all medical professional organizations.
http://etsandreversals.yuku.com/reply/22927/Would-you-do-it-again#reply-22927
The functional name for the this surgery is "sympathetic denervation". It's not some super-advanced, modern cure based on recent discoveries in neurophysiology. It's a primitive, destructive procedure. It's a method used on animals for research. It's brute force method...destroy the pathways to the sweat glands over a large region. Unfortunately, it destroys pathways to and from many other organs including the heart and lungs and causes a large number of neuropathological dysfunction. That hasn't changed in the last ten years. It will not and cannot change in the next 1000 years because it will still be a nerve injury 1000 years from now. I'm not making this up. It's a simple fact. Don't let some doctor take advantage of your ignorance
http://etsandreversals.yuku.com/topic/4919/Should-i-have-ETS-surgery#.Tok-TE8YAyk
Your scenario of surgeons being flummoxed by unhappy patients complaining after surgery doesn't hold water. The rules of professional medical ethics require that the treating physician be well versed in the published literature on the treatments he delivers.
There is a mountain of published research (spanning nearly a century) documenting the adverse effects of sympathectomy. There are numerous studies, for example, showing very high rates of severe side effects and studies showing that satisfaction diminishes substantially over the long term.
It is a doctors job to know this stuff and it is their ethical duty to disclose that information to patients.
So, I see the blame thing as pretty cut and dry. Surgeons perfoming sympathectomies routinely withhold information vital to informed consent. Anyone who does objective comparison between what is documented in medical/scientific literature and what is typically disclosed to prospective ETS patients has no choice but reach this conclusion.
And, to make matters worse, many surgeons use testimonials from a hand-selected group of their happiest patients to advocate the surgery. That practice is considered unethical by all medical professional organizations.
http://etsandreversals.yuku.com/reply/22927/Would-you-do-it-again#reply-22927
'Improved sympathectomy' - is it an oxymoron?
"also it seems like the more bad and negative affects were from 10 to 12 years ago when they had just started performing the surgery.. they must have improved it a lot by now.?"This procedure has been performed since the 1920's. Yes, the 1920's. In the 1980's they started to do it using "keyhole" surgery which means they don't have to make a big incision. But, the surgery is no different than what they've been doing for the last 70+ years. It's a nerve injury. You can't "improve" they way you inflict a nerve injury. You can't injure the nerve in some "special" way such that the injury suddenly has a different effect on the body.
The functional name for the this surgery is "sympathetic denervation". It's not some super-advanced, modern cure based on recent discoveries in neurophysiology. It's a primitive, destructive procedure. It's a method used on animals for research. It's brute force method...destroy the pathways to the sweat glands over a large region. Unfortunately, it destroys pathways to and from many other organs including the heart and lungs and causes a large number of neuropathological dysfunction. That hasn't changed in the last ten years. It will not and cannot change in the next 1000 years because it will still be a nerve injury 1000 years from now. I'm not making this up. It's a simple fact. Don't let some doctor take advantage of your ignorance
http://etsandreversals.yuku.com/topic/4919/Should-i-have-ETS-surgery#.Tok-TE8YAyk
sympathectomy will block the chronotropic response
Around 50% of patients have bradycardia in the following minutes of a bilateral surgery with mean and diastolic blood pressure significant reduction. Since the sympathectomy will block the chronotropic response, a significant increase of the ejection volume is observed when the patient moves in the erect position from dorsal decubitus [6]. Two cardiovascular complications were reported in the literature. First, an asystolic cardiac arrest in an 18-year-old woman during the second side (left) of bilateral sympathectomy for severe hyperhidrosis, requiring resuscitation maneuvers, with no chronic sequelae [7]. The second case was reported in a 23-year-old woman in whom a bilateral T2 sympathectomy was performed for facial hyperhidrosis. Two years later, following electrophysiologic studies confirming unopposed vagotonic stimulation, she underwent permanent pacemaker insertion for symptomatic bradycardia [8].
http://icvts.ctsnetjournals.org/cgi/content/full/8/2/238
http://icvts.ctsnetjournals.org/cgi/content/full/8/2/238
many claims in Australia do not result in payments to plaintiffs
However, as with the US research, many claims in Australia do not result in payments to plaintiffs. This fact often comes as a surprise to medical practitioners as it is not well publicised.
It is not a simple matter for a plaintiff to succeed in a claim for compensation based in medical negligence. And it certainly is an expensive exercise especially when there can be no guarantee of success.
For doctors involved in a claim that is successfully defended there is usually no direct financial cost.
Ms Cheryl McDonald is claims department manager with MIGA (Medical Insurance Group Australia).
It is not a simple matter for a plaintiff to succeed in a claim for compensation based in medical negligence. And it certainly is an expensive exercise especially when there can be no guarantee of success.
For doctors involved in a claim that is successfully defended there is usually no direct financial cost.
Ms Cheryl McDonald is claims department manager with MIGA (Medical Insurance Group Australia).
MJA InSight, Issue 38 - 10 Oct, 2011
HAZARDS ASSOCIATED WITH CERVICO-THORACIC SYMPATHECTOMY
The need for a realistic appraisal of the potentialities for harm in Cervico-Thoracic sympathectomy is apparent on anatomic grounds alone (Orkin et al. ] 950). Fatalities occur from time to time, but only a few reports of such fatalities find their way into the literature (Adriani et al. 1952). Reported complications associated with Ccrvico-Thoracic sympathectomy, which is, in effect a permanent Stellate
Ganglion block (Moore 1954), include pneumothorax, Horner's syndrome, phrenic and recurrent laryngeal nerve damage, infection from oesophageal puncture, cardiac arrhythmias (Tochinai 1974), and very infrequently cardiac arrest (Moore 1954).
The following is a case report of a healthy 18-year-old woman who had bilateral Cervico-Thoracic sympathectomy done in two stages for severe hyperhidrosis in the palms of her hands.
Two episodes of asystolic arrest occurred during the 2nd stage left Cervico-Thoracic sympathectomy.
The
cause of hyperhidrosis apparently originates
from some poorly understood stimulation of the
sympathetic nervous system (Cloward 1969),
and in sensitive patients this may possibly lead
to excessive vagal stimulation to counteract it,
as illustrated by the bradycardia and asystolic
reaction to the sudden removal of the
sympathetic control, and by the high doses of
sympathomimetic drugs necessary to
recommence cardiac activity. Anatomically the
heart is innervated by the cardiac plexus which
consists of the cardiac nerves derived from the
cervical and upper thoracic ganglia of the
sympathetic trunk and branches of the vagus.
The pacemaker of the heart, the sino-atrial
node, is innervated by both the parasympathetic
and sympathetic nerves (King and Coakley
1958). The ventricular muscle of the heart is
supplied solely by the sympathetic nerves, and
the larger branches of the coronary arteries are
also predominantly innervated by sympathetics
(Woollard 1926). These factors may also have a
bearing on the hazard of a bilateral cervico-
thoracic sympathectomy, which leaves the heart
solely under vagal control. Usually, following
denervation, the heart will initiate its own
impulse, without recourse to external agencies,
but there may be a place for transvenous
electrode cardiac pacing, if spontaneous initiation
of impulse is delayed, or bradycardia is severe.
Anaesthesia and Intensive Care, Vol. V, No. 1, February, 1977
R. F. Y. ZEE
Royal Perth Hospital, Perth
Ganglion block (Moore 1954), include pneumothorax, Horner's syndrome, phrenic and recurrent laryngeal nerve damage, infection from oesophageal puncture, cardiac arrhythmias (Tochinai 1974), and very infrequently cardiac arrest (Moore 1954).
The following is a case report of a healthy 18-year-old woman who had bilateral Cervico-Thoracic sympathectomy done in two stages for severe hyperhidrosis in the palms of her hands.
Two episodes of asystolic arrest occurred during the 2nd stage left Cervico-Thoracic sympathectomy.
The
cause of hyperhidrosis apparently originates
from some poorly understood stimulation of the
sympathetic nervous system (Cloward 1969),
and in sensitive patients this may possibly lead
to excessive vagal stimulation to counteract it,
as illustrated by the bradycardia and asystolic
reaction to the sudden removal of the
sympathetic control, and by the high doses of
sympathomimetic drugs necessary to
recommence cardiac activity. Anatomically the
heart is innervated by the cardiac plexus which
consists of the cardiac nerves derived from the
cervical and upper thoracic ganglia of the
sympathetic trunk and branches of the vagus.
The pacemaker of the heart, the sino-atrial
node, is innervated by both the parasympathetic
and sympathetic nerves (King and Coakley
1958). The ventricular muscle of the heart is
supplied solely by the sympathetic nerves, and
the larger branches of the coronary arteries are
also predominantly innervated by sympathetics
(Woollard 1926). These factors may also have a
bearing on the hazard of a bilateral cervico-
thoracic sympathectomy, which leaves the heart
solely under vagal control. Usually, following
denervation, the heart will initiate its own
impulse, without recourse to external agencies,
but there may be a place for transvenous
electrode cardiac pacing, if spontaneous initiation
of impulse is delayed, or bradycardia is severe.
Anaesthesia and Intensive Care, Vol. V, No. 1, February, 1977
R. F. Y. ZEE
Royal Perth Hospital, Perth
'Improved sympathectomy' - is it an oxymoron?
"also it seems like the more bad and negative affects were from 10 to 12 years ago when they had just started performing the surgery.. they must have inproved it alot by now.?"I'd like to echo what some others have said just so you are completely clear on this issue. This procedure has been performed since the 1920's. Yes, the 1920's. In the 1980's they started to do it using "keyhole" surgery which means they don't have to make a big incision. But, the surgery is no different than what they've been doing for the last 70+ years. It's a nerve injury. You can't "improve" they way you inflict a nerve injury. You can't injure the nerve in some "special" way such that the injury suddenly has a different effect on the body.
The functional name for the this surgery is "sympathetic denervation". It's not some super-advanced, modern cure based on recent discoveries in neurophysiology. It's a primitive, destructive procedure. It's a method used on animals for research. It's brute force method...destroy the pathways to the sweat glands over a large region. Unfortunately, it destroys pathways to and from many other organs including the heart and lungs and causes a large number of neuropathological dysfunction. That hasn't changed in the last ten years. It will not and cannot change in the next 1000 years because it will still be a nerve injury 1000 years from now. I'm not making this up. It's a simple fact. Don't let some doctor take advantage of your ignorance
http://etsandreversals.yuku.com/topic/4919/Should-i-have-ETS-surgery#.Tok-TE8YAyk
There is no evidence whatsoever that the sympathetic ganglia have any regulatory function on sweating
There is no "signal that tells the body to sweat excessively". The nervous system doesn't work like that. Worse, it implies that there is some separate signal that tells the body to sweat "normally" which, again, is implied to be unaffected by the surgery. It's nonsense and an affront to all that is known about neuroanatomy and neurophysiology.
Of all the lies and distortions, this is the one that pisses me off the most. Not only is it demonstrably false, it is criminally misleading in terms of what it leads the patient to expect. There no evidence whatsoever that the sympathetic ganglia have any regulatory function. Regulation if sympathetic activity occurs in the brain, not the sympathetic ganglia.
Why the hell don't they call it what it is?: sympathetic denervation surgery (which is a fancy name for a particular type of nerve injury). It eliminates excessive sweating by eliminating the ability to sweat at all (anhidrosis) over a large area. It achieves this end in the most brutal way possible: by permanently destroying the neural pathways. Any statement or implication that sympathectomy reduces sweating to normal levels or improves the regulation of sweating in any way is a boldfaced lie.
http://etsandreversals.yuku.com/topic/4918/Lies-from-your-government
Of all the lies and distortions, this is the one that pisses me off the most. Not only is it demonstrably false, it is criminally misleading in terms of what it leads the patient to expect. There no evidence whatsoever that the sympathetic ganglia have any regulatory function. Regulation if sympathetic activity occurs in the brain, not the sympathetic ganglia.
Why the hell don't they call it what it is?: sympathetic denervation surgery (which is a fancy name for a particular type of nerve injury). It eliminates excessive sweating by eliminating the ability to sweat at all (anhidrosis) over a large area. It achieves this end in the most brutal way possible: by permanently destroying the neural pathways. Any statement or implication that sympathectomy reduces sweating to normal levels or improves the regulation of sweating in any way is a boldfaced lie.
http://etsandreversals.yuku.com/topic/4918/Lies-from-your-government
Concerns about surgical risks not properly explained appear to be the heartland of contemporary disputes between patients and doctors
Concerns about surgical risks not properly explained appear to be the heartland of contemporary disputes between patients and doctors over consent, at least in Australia.
2 Derivation of study sample
http://www.mja.com.au/public/issues/195_06_190911/gog10379_fm.html
“Invidious” task of obtaining consent
IN more than 70% of claims and complaints about informed consent the main allegation was that the doctor failed to mention or properly explain the risk of complications, new research shows.
The MJA study of 481 cases of alleged failures in the informed consent process found 57% were against surgeons and 92% involved surgical procedures. About one in six cases involved cosmetic procedures and the rate of complaints against plastic surgeons was significantly higher than that against any other specialists. (1)
“You are not expected to warn of absolutely every single complication but you have got to warn of material risks, which are that if a reasonable person in the patient’s position, if warned of the risk, would be likely to attach significance to it”, Ms McDonald said.
It was even more important with elective cosmetic surgery to ensure that the consent and the patient’s expectations of the procedure were realistic, she said.
Dr John Buntine, president of the Australian Association of Surgeons, in a letter to the MJA relating to previous research on patient complaints, said he believed that a common stimulus for complaints was a perception that the doctor was overconfident, perhaps arrogant, and had little personal interest in the patient’s welfare. (2)
“Good manners, kindness, demonstrations of personal interest and concern, and a degree of humility all discourage complaints”, he said.
- Cathy Saunders, MJA InSight, 19 September 2011
The MJA study of 481 cases of alleged failures in the informed consent process found 57% were against surgeons and 92% involved surgical procedures. About one in six cases involved cosmetic procedures and the rate of complaints against plastic surgeons was significantly higher than that against any other specialists. (1)
“You are not expected to warn of absolutely every single complication but you have got to warn of material risks, which are that if a reasonable person in the patient’s position, if warned of the risk, would be likely to attach significance to it”, Ms McDonald said.
It was even more important with elective cosmetic surgery to ensure that the consent and the patient’s expectations of the procedure were realistic, she said.
Dr John Buntine, president of the Australian Association of Surgeons, in a letter to the MJA relating to previous research on patient complaints, said he believed that a common stimulus for complaints was a perception that the doctor was overconfident, perhaps arrogant, and had little personal interest in the patient’s welfare. (2)
“Good manners, kindness, demonstrations of personal interest and concern, and a degree of humility all discourage complaints”, he said.
- Cathy Saunders, MJA InSight, 19 September 2011
THE vast majority of doctors who face a medical indemnity claim will not end up in court
THE vast majority of doctors who face a medical indemnity claim will not end up in court, new data on claims from 2008–09 show.
The figures on public and private sector medical indemnity claims show that only 6% of claims were finalised through a court decision, while 29% were settled through negotiation with the claimant and 65% were discontinued. (1)
Dr Sara Bird, manager of medicolegal and advisory services at MDA National, said the reported low rate of claims going to court was consistent with experience at MDA National.
MJA InSight,
http://www.mjainsight.com.au/view?post=few-indemnity-claims-go-to-court&post_id=6427&cat=news-and-research
The figures on public and private sector medical indemnity claims show that only 6% of claims were finalised through a court decision, while 29% were settled through negotiation with the claimant and 65% were discontinued. (1)
Dr Sara Bird, manager of medicolegal and advisory services at MDA National, said the reported low rate of claims going to court was consistent with experience at MDA National.
MJA InSight,
http://www.mjainsight.com.au/view?post=few-indemnity-claims-go-to-court&post_id=6427&cat=news-and-research
So numerous are the possible variations that the outcome of a sympathectomy is unpredictable
The sympathetic pathways to the heart are extremely variable in their topography, and the diversity of arrangements encountered accounts for the morphological contradictions in the literature. So numerous are the possible variations that the outcome of a sympathectomy is unpredictable. Where denervation is incomplete, collateral sprouting and regeneration of nerves could even lead to hyperstimulation via the sympathetic pathways.
http://onlinelibrary.wiley.com/doi/10.1002/aja.1001240203/abstract
http://onlinelibrary.wiley.com/doi/10.1002/aja.1001240203/abstract
After severing the cervical sympathetic trunk, the cells of the cervical sympathetic ganglion undergo transneuronic degeneration
In consequence of right-sided smpathectomy at the level of C5 it was found that in the sheep the cervical sympathetic trunk contains nerve fibres which proceed from cells situated in the first four segments of the thoracic part of the spinal cord and in the stellate ganglion. These fibres are about 85 per cent of all fibres of the sympathetic trunk. The remaining 15 per cent proceed from nerve cells situated nasally of the anterior cervical ganglion.
The spinal cord. Changes found in the segment Th1 – Th4 in sheep III and IV closely resembled those
seen in the stellate ganglion (Figures 6, 7).
2. After severing the sympathetic trunk, the cells of its origin undergo complete disintegration within
a year.
3. After severing the cervical sympathetic trunk, the cells of the cervical sympathetic ganglion
undergo transneuronic degeneration.
http://onlinelibrary.wiley.com/doi/10.1111/j.1439-0442.1967.tb00255.x/abstract
The spinal cord. Changes found in the segment Th1 – Th4 in sheep III and IV closely resembled those
seen in the stellate ganglion (Figures 6, 7).
2. After severing the sympathetic trunk, the cells of its origin undergo complete disintegration within
a year.
3. After severing the cervical sympathetic trunk, the cells of the cervical sympathetic ganglion
undergo transneuronic degeneration.
http://onlinelibrary.wiley.com/doi/10.1111/j.1439-0442.1967.tb00255.x/abstract
Predatory practices, misrepresentation is the standard by ETS surgeons
"30-45 Minute Procedure; Close to 100% Success Rate; Hundreds of Thousands of Procedures Performed; Experienced ETS Surgeons Around the World"
http://www.hyperhidrosis.com/
http://www.hyperhidrosis.com/
sympathectomy created imbalance of autonomic activity and functional changes of the intrathoracic organs
Surgical thoracic sympathectomy such as ESD (endoscopic thoracic sympathectic denervation) or heart transplantation can result in an imbalance between the sympathetic and parasympathetic activities and result in functional changes in the intrathoracic organs.
Therefore, the procedures affecting sympathetic nerve functions, such as epidural anesthesia, ESD, and heart transplantation, may cause an imbalance between sympathetic and parasympathetic activities (1, 6, 16, 17). Recently, it has been reported that ESD results in functional changes of the intrathoracic organs.
In conclusion, our study demonstrated that ESD adversely affected lung function early after surgery and the BHR was affected by an imbalance of autonomic activity created by bilateral ESD in patients with primary focal hyperhidrosis.
Journal of Asthma, 46:276–279, 2009
http://informahealthcare.com/doi/abs/10.1080/02770900802660949
Therefore, the procedures affecting sympathetic nerve functions, such as epidural anesthesia, ESD, and heart transplantation, may cause an imbalance between sympathetic and parasympathetic activities (1, 6, 16, 17). Recently, it has been reported that ESD results in functional changes of the intrathoracic organs.
In conclusion, our study demonstrated that ESD adversely affected lung function early after surgery and the BHR was affected by an imbalance of autonomic activity created by bilateral ESD in patients with primary focal hyperhidrosis.
Journal of Asthma, 46:276–279, 2009
http://informahealthcare.com/doi/abs/10.1080/02770900802660949
Low HRV is a risk factor for pathophysiology and psychopathology
The intimate connection between the brain and the heart was enunciated by Claude Bernard over 150 years ago. In our neurovisceral integration model we have tried to build on this pioneering work. In the present paper we further elaborate our model. Specifically we review recent neuroanatomical studies that implicate inhibitory GABAergic pathways from the prefrontal cortex to the amygdala and additional inhibitory pathways between the amygdala and the sympathetic and parasympathetic medullary output neurons that modulate heart rate and thus heart rate variability. We propose that the default response to uncertainty is the threat response and may be related to the well known negativity bias. We next review the evidence on the role of vagally mediated heart rate variability (HRV) in the regulation of physiological, affective, and cognitive processes. Low HRV is a risk factor for pathophysiology and psychopathology. Finally we review recent work on the genetics of HRV and suggest that low HRV may be an endophenotype for a broad range of dysfunctions.
http://www.ncbi.nlm.nih.gov/pubmed/18771686
http://www.ncbi.nlm.nih.gov/pubmed/18771686
ganglion block for unbalanced sympathetic nervous system disorders
Stellate ganglion blocks (SGB) are widely used for pain relief in outpatient clinics due to its many therapeutic indications and easy maneuvering. It is used locally over stellate ganglion territory disorders in the craniocervical (head and neck) or upper limbs and systemically for angina pectoris, psychosomatic disorders, hormonal disorders, or unbalanced sympathetic nervous system disorders [1].
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872892/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872892/
Presentations at the 4th International Symposium on Sympathetic Surgery
http://www.angelfire.com/ab/ets/201.htm#_Hlt521158972
Surgical sympathectomy is the gold standard of treatment for this disease, by which all other treatments must be judged
http://www.fortishospitals.com/heart-care/treatments-and-procedures/vats-sympathetectomy.html
For blood pressure control in certain acute hypotensive states (e.g., pheochromocytomectomy, sympathectomy...
Norepinephrine (Levophed ®) -
For blood pressure control in certain acute hypotensive states (e.g., pheochromocytomectomy, sympathectomy, poliomyelitis, spinal anesthesia, myocardial infarction, septicemia, blood transfusion, and drug reactions).
http://www.globalrph.com/norepinephrine_dilution.htm
For blood pressure control in certain acute hypotensive states (e.g., pheochromocytomectomy, sympathectomy, poliomyelitis, spinal anesthesia, myocardial infarction, septicemia, blood transfusion, and drug reactions).
http://www.globalrph.com/norepinephrine_dilution.htm
Unilateral sympathectomy leads to decreases in ventral prostate weight
http://www.biolreprod.org/content/51/1/99
painful vasospastic condition in the right arm following surgical sympathectomy on the left side
Spinal dorsal column stimulation has been used in the treatment of a patient with a painful vasospastic condition in the right arm following surgical sympathectomy on the left side. After sympathectomy the left arm became constantly dry and warm and consistently lacked skin vasomotor (laser Doppler flowmetry) responses to arousing stimuli, indicating a complete loss of sympathetic vasomotor innervation.
http://www.springerlink.com/content/n823388l26q330m3/
http://www.springerlink.com/content/n823388l26q330m3/
Several autonomic reflexes were dramatically affected after sympathectomy for hyperhidrosis
major effects on local blood flow and temperature are elicited by TES. Complex autonomic reflexes are also affected. The patient should be completely informed before surgery of the side effects elicited by transthoracic endoscopic sympathicotomy (TES).
http://www.ncbi.nlm.nih.gov/pubmed/18540897
Acta Neurol Scand. 2008 Dec;118(6):402-6.
http://www.ncbi.nlm.nih.gov/pubmed/18540897
Acta Neurol Scand. 2008 Dec;118(6):402-6.
stellate ganglion block in the treatment of panic/anxiety symptoms
Both patients experienced immediate, significant and durable relief as measured by the PCL (score minimum 17, maximum 85). In both instances, the pre-treatment score suggested a PTSD diagnosis whereas the post-treatment scores did not. One patient requested repeat treatment after 3 months, and the post-treatment score remained below the PTSD cutoff after 7 additional months of follow-up. Both patients discontinued all antidepressant and antipsychotic medications while maintaining their improved PCL score.
http://www.ncbi.nlm.nih.gov/pubmed/20412504
CONCLUSION:
Selective blockade of the right stellate ganglion at C6 level is a safe and minimally invasive procedure that may provide durable relief from PTSD symptoms, allowing the safe discontinuation of psychiatric medications.http://www.ncbi.nlm.nih.gov/pubmed/20412504
Stellate ganglion block "reboots" the insular cortex
The following is a summary from our publications in Lancet Oncology and Medical Hypothesis
 | The picture demonstrates the connections from the stellate ganglion to other neural structures. This was demonstrated using retro rabies virus techniques and functional MRI. Both are objective data demonstrating the effect on the insula by the stellate ganglion. Stellate ganglion block effectively "reboots" the insular cortex, allowing for a reduction in hot flashes |
| The stellate ganglion refers to the ganglion formed by the fusion of the inferior cervical and the first thoracic ganglion as they meet anterior to the vertebral body of C7. It is present in 80% of subjects. It usually lies on or above the neck of the first rib. http://dardipainclinic.com/stellate_ganglion_block.php |
Patients need to be able to value and trust the knowledge and judgement of doctors
http://ama.com.au/node/6569
To date, sufficient importance has not been placed on the long term effects that could cause dorsal sympathectomy
A scientific society has been created for surgery of the sympathetic nervous system, the International Society of Sympathetic Surgery (ISSS); and in the most recent thoracic surgery and related specialities congresses it fills up a considerable percentage of the programme.
On the other hand, this surgery, especially for hyperhidrosis and facial reddening, is the one that on a percentage basis generates more demands and complaints from the patients, even with medico-legal connotations.7 Despite that the majority of the patients show a very high degree of satisfaction, the presence of a patient operated for hyperhidrosis with important compensatory sweating that repeatedly manifest their dissatisfaction to the surgeon is a very annoying situation with an intractable solution. There are even forums on the Internet that constantly manifest their discomfort with this type of surgery in a violent and insulting tone, for example, the World Against Sympathectomy Website.
In summary, we are faced with a new disorder that is being attended massively in our hospitals and needs a moment of contemplation. What are we doing? Are we doing it properly? What are the future implications in these patients of dorsal sympathetic denervation? For the first 2 questions, we could find the answer in the new clinical guidelines and scientific society norms and with the publication of linger series, randomised systematic studies, reviews and meta-analyses. However, it is perhaps the latter of these that implies greater consideration. To date, sufficient importance has not been placed on the long term effects that could cause dorsal sympathectomy, and the effects on lung function, heart function, skin colouring and psychological state are being studies, among others;10 the most important being the first 2. secondary consequences of the operation.
The consequences of sympathetic denervation after a dorsal sympathectomy on lung function have been studied on several occasions11 and reductions in forced vital capacity, forced expiratory flow in the first second and maximum mesoexpiratory flow have been found, but with no clinical significance. It therefore seems that, despite sympathetic innervation being scarce, it directly influences motor tone, especially of the fine respiratory tracts, which cause a light obstructive pattern after the operation and favours bronchial hyperreactivity.12 It is of great interest to know the results of the research being carried out to recognise the long term effects.
Something similar occurs with heart function, the sympathectomy in the short term causes bradycardia due to a lack of sympathetic stimulation to the heart. Several cases of myocardial infarction13 and
chronotropic heart failure requiring the insertion of a pacemaker14 have been reported. In the long term, dorsal sympathetic interruption causes an effect similar to beta blockers on the heart, and produced a decrease in average heart rate, but with no significant changes in the electrocardiogram (normal Q-T).15 It may be good to know through long term prospective studies which effects it truly has on heart function and what it could mean for the daily lives of the operated patients. For the time being, those individuals who practice aerobic sports (for example, long distance runners and cyclists)
should be informed that with sympathectomy their heart rate may be reduced in situations of maximum effort and lower their performance.16
M. Congregado / Arch Bronconeumol. 2010;46(1):1-2
On the other hand, this surgery, especially for hyperhidrosis and facial reddening, is the one that on a percentage basis generates more demands and complaints from the patients, even with medico-legal connotations.7 Despite that the majority of the patients show a very high degree of satisfaction, the presence of a patient operated for hyperhidrosis with important compensatory sweating that repeatedly manifest their dissatisfaction to the surgeon is a very annoying situation with an intractable solution. There are even forums on the Internet that constantly manifest their discomfort with this type of surgery in a violent and insulting tone, for example, the World Against Sympathectomy Website.
In summary, we are faced with a new disorder that is being attended massively in our hospitals and needs a moment of contemplation. What are we doing? Are we doing it properly? What are the future implications in these patients of dorsal sympathetic denervation? For the first 2 questions, we could find the answer in the new clinical guidelines and scientific society norms and with the publication of linger series, randomised systematic studies, reviews and meta-analyses. However, it is perhaps the latter of these that implies greater consideration. To date, sufficient importance has not been placed on the long term effects that could cause dorsal sympathectomy, and the effects on lung function, heart function, skin colouring and psychological state are being studies, among others;10 the most important being the first 2. secondary consequences of the operation.
The consequences of sympathetic denervation after a dorsal sympathectomy on lung function have been studied on several occasions11 and reductions in forced vital capacity, forced expiratory flow in the first second and maximum mesoexpiratory flow have been found, but with no clinical significance. It therefore seems that, despite sympathetic innervation being scarce, it directly influences motor tone, especially of the fine respiratory tracts, which cause a light obstructive pattern after the operation and favours bronchial hyperreactivity.12 It is of great interest to know the results of the research being carried out to recognise the long term effects.
Something similar occurs with heart function, the sympathectomy in the short term causes bradycardia due to a lack of sympathetic stimulation to the heart. Several cases of myocardial infarction13 and
chronotropic heart failure requiring the insertion of a pacemaker14 have been reported. In the long term, dorsal sympathetic interruption causes an effect similar to beta blockers on the heart, and produced a decrease in average heart rate, but with no significant changes in the electrocardiogram (normal Q-T).15 It may be good to know through long term prospective studies which effects it truly has on heart function and what it could mean for the daily lives of the operated patients. For the time being, those individuals who practice aerobic sports (for example, long distance runners and cyclists)
should be informed that with sympathectomy their heart rate may be reduced in situations of maximum effort and lower their performance.16
M. Congregado / Arch Bronconeumol. 2010;46(1):1-2
ETS story
I had ETS surgery (cutting of T2) about 10 years ago for facial HH. The surgery worked very well and I had virtually no immediate complications from the surgery (infection, nerve damage, etc). I now experience severe CS on my trunk (worse on my back) that is pretty debilitating. At this point I'm considering reversal surgery (and am very open to any insight).
I had the surgery done in San Francisco, CA by a now-retired thoracic surgeon (I live in the Portland, OR area). He did mention CS as a possible side effect but didn't present it as a huge risk. To be fair, I was so desperate that I probably wouldn't have listened anyway. That's why it is incumbent on doctors to save us from ourselves. Any surgeon that performs invasive, irreversible surgery to treat conditions where patients are despondent and vulnerable should overemphaasize the risks and minimize the possible benefits (under-promise and over-deliver).
The surgery was uneventful and recovery was quick and I had no immediate complications. In terms of efficacy, the surgery was tremendously successful. My facial HH was immediately and completely resolved, as was my hand-sweating (which wasn't a huge problem, but they are 100% dry now). I still experience gustatory sweating occasionally with very rich or spicy foods but it's not a problem at all. I also still experience blushing but I believe it may be better than it was.
That's the good part. Like many others, I now have severe CS on my trunk (worse on my back). I don't have any of the other dry scalp or pain syndromes that others have though, so maybe I'm one of the lucky ones.
Interestingly, having no moisture on your hands does cause some problems. It's hard to count out money (seriously) or pick things up and it's almost impossible to deal cards (and I used to be a BJ dealer in Las Vegas in college!). It's also hard to play basketball as you really need a little moisture on your hands to properly grip and put spin on the ball.
I've tried hyoscyamine and Robinul and find that Robinul seems to work better but really only reduces the CS about 20-30% most of the time. Often, it doesn't matter what I take.
http://www.no-ets.com/forums/viewtopic.php?p=1489&sid=6ff9da7866e646365a7b8ba9bfcbd845
I had the surgery done in San Francisco, CA by a now-retired thoracic surgeon (I live in the Portland, OR area). He did mention CS as a possible side effect but didn't present it as a huge risk. To be fair, I was so desperate that I probably wouldn't have listened anyway. That's why it is incumbent on doctors to save us from ourselves. Any surgeon that performs invasive, irreversible surgery to treat conditions where patients are despondent and vulnerable should overemphaasize the risks and minimize the possible benefits (under-promise and over-deliver).
The surgery was uneventful and recovery was quick and I had no immediate complications. In terms of efficacy, the surgery was tremendously successful. My facial HH was immediately and completely resolved, as was my hand-sweating (which wasn't a huge problem, but they are 100% dry now). I still experience gustatory sweating occasionally with very rich or spicy foods but it's not a problem at all. I also still experience blushing but I believe it may be better than it was.
That's the good part. Like many others, I now have severe CS on my trunk (worse on my back). I don't have any of the other dry scalp or pain syndromes that others have though, so maybe I'm one of the lucky ones.
Interestingly, having no moisture on your hands does cause some problems. It's hard to count out money (seriously) or pick things up and it's almost impossible to deal cards (and I used to be a BJ dealer in Las Vegas in college!). It's also hard to play basketball as you really need a little moisture on your hands to properly grip and put spin on the ball.
I've tried hyoscyamine and Robinul and find that Robinul seems to work better but really only reduces the CS about 20-30% most of the time. Often, it doesn't matter what I take.
http://www.no-ets.com/forums/viewtopic.php?p=1489&sid=6ff9da7866e646365a7b8ba9bfcbd845
Surgical Sympathectomy should be first line treatment according to 'Center for the Cure of Sweaty Palms™' surgeon
Given the clear superiority of BTS (bilateral thoracoscopic sympathectomy) for severe palmoplantar hyperhidrosis, deliberately using medical treatments that are known with near certainty to be eneffective and at times considerably noxious simply as a requisite to surgery may not be in the best interest of such patients, nor is such an approach ultimately cost-effective. There is no evidence that surgical intervention should be considered a "last resort" for this form of hyperhidrosis. BTS can safely and confidently be recommended as first-line treatment for the typical, severe form of palmoplantar hyperhidrosis.
(no conflict of interest has been declared by the authors)
Fritz J. Baumgartner
, a, 
, Shana Bertina and Jiri Konecnya
Annals of Vascular Surgery
Volume 23, Issue 1, January-February 2009, Pages 1-7
http://www.sciencedirect.com/science/article/pii/S0890509608001854
(no conflict of interest has been declared by the authors)
Fritz J. Baumgartner
, a, , Shana Bertina and Jiri KonecnyaAnnals of Vascular Surgery
Volume 23, Issue 1, January-February 2009, Pages 1-7
http://www.sciencedirect.com/science/article/pii/S0890509608001854
fraudulent or unethical medical research represents an unacceptable breach of trust for clinicians, health policymakers and the general public
http://www.mja.com.au/public/issues/194_12_200611/myb10505_fm.html
medical professionals have a feeling of invincibility
Medical practitioners are surprised when their performance is called into question. Many have a feeling of invincibility based on a lifetime of accumulated educational and professional successes.
The public add to this assumption by placing complete faith in their selected practitioner — until some misadventure occurs. Then the blame game starts.
When defending a claim, it is unreasonable to expect defence counsel to be cognisant of international medical literature concerning the condition in dispute. The defendant doctor should make it their job to amass expert opinion so lawyers can filter and present appropriately.
MJA INSIGHT Aug. 1. 2011
The public add to this assumption by placing complete faith in their selected practitioner — until some misadventure occurs. Then the blame game starts.
When defending a claim, it is unreasonable to expect defence counsel to be cognisant of international medical literature concerning the condition in dispute. The defendant doctor should make it their job to amass expert opinion so lawyers can filter and present appropriately.
MJA INSIGHT Aug. 1. 2011
most surgeons do not have a clear understanding of their short-term outcomes for the majority of procedures
The public would probably be surprised to know that most surgeons do not have a clear understanding of their short-term outcomes for the majority of procedures they perform.
Of even greater concern is the lack of data on long-term outcomes associated with surgical interventions.
Many surgeons argue that they are too busy and do not have the time and resources to conduct this sort of follow-up. This is not entirely without foundation, but it does seem difficult to defend a stance that says “I will continue to work feverishly at the operations I do but not assess how successful my results are”.
Of even greater concern is the lack of data on long-term outcomes associated with surgical interventions.
Many surgeons argue that they are too busy and do not have the time and resources to conduct this sort of follow-up. This is not entirely without foundation, but it does seem difficult to defend a stance that says “I will continue to work feverishly at the operations I do but not assess how successful my results are”.
Guy Maddern: No excuse for poor surgical outcomes
MJA INSIGHT, 8 August 2011
lumbar sympathectomy results in loss of ejaculation
Sympathectomy for the long term management of such patients has been carried out (Abel et al., 1974) and success reported. Loss of ejaculation does follow sympathectomy but his is a minor problem in patients who have an already destroyed sacral cord. (p. 410)
During fever pyrogen is released from leucocytes and his agent causes the disturbed thermoregulation (Atkinson, 1960). For his response to occur, an intact efferent sympathetic system is requred because fever can be markedly reduced by bilateral sympathectomy in he cat (Pinkston, 1935). (p.193)
The autonomic nervous system: an introduction to basic and clinical concepts By Otto Appenzeller, Emilio Oribe, Elsevier Health Sciences, 1997 - Medical
During fever pyrogen is released from leucocytes and his agent causes the disturbed thermoregulation (Atkinson, 1960). For his response to occur, an intact efferent sympathetic system is requred because fever can be markedly reduced by bilateral sympathectomy in he cat (Pinkston, 1935). (p.193)
The autonomic nervous system: an introduction to basic and clinical concepts By Otto Appenzeller, Emilio Oribe, Elsevier Health Sciences, 1997 - Medical
Intentional misrepresentation of the elective surgical procedure is common practice
"Sweating is one form of regulating the body's temperature. If the operation prevents sweating in one area, it is possible that patients will notice a greater amount of sweating elsewhere in their body in order to compensate. This is called "compensatory sweating" and can occur on the face, abdomen, back, buttocks, thighs, or feet. While this is a mild nuisance for most patients, occasionally (5-10% of the time) it can be severe and interfere with the patient's lifestyle. If it occurs, it usually improves within 6 months."
http://thoracic.surgery.virginia.edu/general-thoracic/general-thoracic-conditions-treatment/hyperhidrosis/
Mia: None of the 'facts' listed in the above text can be supported by scientific evidence. The information illustrates the myths spread on the internet by those who have a financial interest in offering ETS, - an interest that overrides the medical and ethical obligations of the medical profession.
The so called "compensatory sweating" is NOT compensatory, and the only study looking into this concluded that patients did sweat more after ETS.
If this side-effect of the elective surgery (intentional neurological injury/lesion) would be "compensatory" in order to maintain thermoregulation, it would be observed after botox or ionthoporesis treatment as well. Hyperhidrosis (reflex hyperhidrosis) is an usual finding in people after spinal cord injuries (especially above T6) and in diabetics due to damage to the SNS. It is a pathological response to injury.
No evidence can support - and there is clear contrary evidence - that if this compensatory sweating would occur, it would diminish in 6 months. It is all part of the intentional misrepresentation of elective surgeries to make them appear more appealing and safer than they are.
http://thoracic.surgery.virginia.edu/general-thoracic/general-thoracic-conditions-treatment/hyperhidrosis/
Mia: None of the 'facts' listed in the above text can be supported by scientific evidence. The information illustrates the myths spread on the internet by those who have a financial interest in offering ETS, - an interest that overrides the medical and ethical obligations of the medical profession.
The so called "compensatory sweating" is NOT compensatory, and the only study looking into this concluded that patients did sweat more after ETS.
If this side-effect of the elective surgery (intentional neurological injury/lesion) would be "compensatory" in order to maintain thermoregulation, it would be observed after botox or ionthoporesis treatment as well. Hyperhidrosis (reflex hyperhidrosis) is an usual finding in people after spinal cord injuries (especially above T6) and in diabetics due to damage to the SNS. It is a pathological response to injury.
No evidence can support - and there is clear contrary evidence - that if this compensatory sweating would occur, it would diminish in 6 months. It is all part of the intentional misrepresentation of elective surgeries to make them appear more appealing and safer than they are.
'Singing praises for ETS' and other predatory practices
I had ETS and am cured!!!!!!!
It's the best thing ever!!!!!!!
Forget about Botox, Dryonics, topicals, etc. Go right to surgery
http://singingpraisesforets.blogspot.com/
Following a complaint in May 2012, the surgeon - author (HyperhidrosisDoc) of the blog edited the text to:
"When Botox, Dryonics, topicals, etc. fail,
Go right to surgery"
It's the best thing ever!!!!!!!
Forget about Botox, Dryonics, topicals, etc. Go right to surgery
http://singingpraisesforets.blogspot.com/
Following a complaint in May 2012, the surgeon - author (HyperhidrosisDoc) of the blog edited the text to:
"When Botox, Dryonics, topicals, etc. fail,
Go right to surgery"
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