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fatigue and amotivationality, breathing difficulties, substantially diminished physiological/chemical reaction to internal and environmental stimuli, somatosensory malfunction, aberrant physiological reaction to stress and exertion, Raynaud’s disease (albeit a possible indication for surgery), reflex hyperhidrosis, altered/erratic blood pressure and circulation, defective fight or flight response system, loss of adrenaline, eczema and other skin conditions resulting from exceptionally dry skin, rhinitis, gustatory sweating (also known as Frey's syndrome).
396:. Recurrence of the original symptoms due to nerve regeneration or nerve sprouting can occur within the first year post surgery. Nerve sprouting, or abnormal nerve growth after damage or injury to the nerves can cause other further damage. Sprouting sympathetic nerves can form connections with sensory nerves, and lead to pain conditions that are mediated by the SNS. Every time the system is activated, it is translated into pain. This sprouting and its action can lead to
334:
affected when the nerves are disabled. This problem was demonstrated by a significant number of patients who underwent sympathectomy at the same level for hand sweating, but who then presented a reduction or elimination of feet sweating, in contrast to others who were not affected in this way. No reliable operation exists for foot sweating except lumbar sympathectomy, at the opposite end of the sympathetic chain.
38:
433:
421:(or reflex hyperhidrosis) is common over the long term. The rates of severe compensatory sweating vary widely between studies, ranging from as high as 92% of patients. Of those patients that develop this side effect, about a quarter in one study said it was a major and disabling problem. 35% of people affected have to change their clothes several times a day as a result.
301:, irreparably disrupting neural messages that ordinarily would travel to many different organs, glands and muscles. It is via those nerves that the brain is able to make adjustments to the body in response to changing conditions in the environment, fluctuating emotional states, level of exercise, and other factors to maintain the body in its ideal state (see
412:
ETS has both the normal risks of surgery, such as bleeding and infection, conversion to open chest surgery, and several specific risks, including permanent and unavoidable alteration of nerve function. It is reported that a number of patients - 9 since 2010, mostly young women - have died during this
333:
Exact results of ETS are impossible to predict, because of considerable anatomic variation in nerve function from one patient to the next, and also because of variations in surgical technique. The autonomic nervous system is not anatomically exact and connections might exist which are unpredictably
325:
Sympathectomy works by disabling part of the autonomic nervous system (and thereby disrupting its signals from the brain), through surgical intervention, in the expectation of removing or alleviating the designated problem. Many non-ETS doctors have found this practice questionable chiefly because
482:
Quoting the
Swedish National Board of Health and Welfare statement: "The method can give permanent side effects that in some cases will first become obvious only after some time. One of the side effects might be increased perspiration on different places on your body. Why and how this happens is
316:
Another technique, the clamping method, also referred to as 'endoscopic sympathetic blockade' (ESB) employs titanium clamps around the nerve tissue, and was developed as an alternative to older methods in an unsuccessful attempt to make the procedure reversible. Technical reversal of the clamping
428:
Additionally, the following side effects have all been reported by patients: Chronic muscular pain, numbness and weakness of the limbs, Horner's
Syndrome, anhidrosis (inability to sweat), hyperthermia (exacerbated by anhidrosis and systemic thermoregulatory dysfunction), neuralgia, paraesthesia,
312:
There is much disagreement among ETS surgeons about the best surgical method, optimal location for nerve dissection, and the nature and extent of the consequent primary effects and side effects. When performed endoscopically as is usually the case, the surgeon penetrates the chest cavity making
526:
and retrograde ejaculation in men. Lumbar sympathectomy is still being offered as a treatment for plantar hyperhidrosis, or as a treatment for patients who have a bad outcome (extreme 'compensatory sweating') after thoracic sympathectomy for palmar hyperhidrosis or blushing; however, extensive
424:
A severe possible consequence of thoracic sympathectomy is corposcindosis (split-body syndrome), in which the patient feels that they are living in two separate bodies, because sympathetic nerve function has been divided into two distinct regions, one dead, and the other hyperactive.
391:
ETS patients are being studied using the autonomic failure protocol headed by David
Goldstein, M.D. Ph.D., senior investigator at the U.S National Institute of Neurological Disorders and Stroke. He has documented loss of thermoregulatory function, cardiac denervation, and loss of
313:
multiple incisions about the diameter of a straw between ribs. This allows the surgeon to insert the video camera (endoscope) in one hole and a surgical instrument in another. The operation is accomplished by dissecting the nerve tissue of the main sympathetic chain.
308:
Because these nerves also regulate conditions like excessive blushing or sweating, which the procedure is designed to eliminate, the normative functions these physiological mechanisms perform will be disabled or significantly impaired by sympathectomy.
403:
In addition, patients have reported lethargy, depression, weakness, limb swelling, lack of libido, decreased physical and mental reactivity, oversensitivity to sound, light and stress and weight gain (British
Journal of Surgery 2004; 91: 264–269).
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runs to almost every organ, gland and muscle system in the body. It was surmised that these nerves play a role in how the body regulates many different body functions in response to changes in the external environment, and in emotion.
534:
Endoscopic sympathectomy itself is relatively easy to perform; however, accessing the nerve tissue in the chest cavity by conventional surgical methods was difficult, painful, and spawned several different approaches in the past. The
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The
Finnish Office for Health Care Technology Assessment concluded more than a decade ago in a 400-page systematic review that ETS is associated with an unusually high number of significant immediate and long-term adverse effects.
578:"minimally invasive" surgical techniques has decreased the recovery time from the surgery and increased its availability. Today, ETS surgery is practiced in many countries throughout the world predominantly by vascular surgeons.
215:). The intervention is controversial and illegal in some jurisdictions. Like any surgical procedure, it has risks; the endoscopic sympathetic block (ESB) procedure and those procedures that affect fewer nerves have lower risks.
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Beskrovnova NN, Makarychev VA, Kiseleva ZM, Legon'kaia, Zhuchkova NI (1984). "Morphofunctional changes in the myocardium following sympathectomy and their role in the development of sudden death from ventricular fibrillation".
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400:, a recognized after effect of sympathectomy, when the growing sympathetic nerves innervate salivary glands, leading to excessive sweating regardless of environmental temperature through olfactory or gustatory stimulation.
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T2-3 sympathectomy suppressed baroreflex control of heart rate in the patients with palmar hyperhidrosis. The baroreflex response for maintaining cardiovascular stability is suppressed in the patients who received the
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In 2003, ETS was banned in its birthplace, Sweden, due to inherent risks, and complaints by disabled patients. In 2004, Taiwanese health authorities banned the procedure on people under 20 years of age.
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still unknown. According to the research available about 25-75% of all patients can expect more or less serious perspiration on different places on their body, such as the trunk and groin area, this is
1200:
Chess-Williams RG, Grassby PF, Culling W, Penny W, Broadley KJ, Sheridan DJ (1985). "Cardiac postjunctional supersensitivity to β-agonists after chronic chemical sympathectomy with 6-hydroxydopamine".
369:. It reduces the physiological responses to strong emotions, such as fear and laughter, diminishes the body's physical reaction to both pain and pleasure, and inhibits cutaneous sensations such as
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242:(lower back). The most common area targeted in sympathectomy is the upper thoracic region, that part of the sympathetic chain lying between the first and fifth thoracic vertebrae.
543:(sawing off) of ribs. A supraclavicular (above the collar-bone) approach was developed in 1935, which was less painful than the posterior, but was more prone to damaging delicate
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285:
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Pohjavaara P, Telaranta T, Väisänen E (2003). "The role of the sympathetic nervous system in anxiety: Is it possible to relieve anxiety with endoscopic sympathetic block?".
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associated with sympathetic denervation, conventional or "open" sympathectomy was never a popular procedure, although it continued to be practiced for hyperhidrosis,
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procedure must be performed within a short time after clamping (estimated at a few days or weeks at most), and a recovery, evidence indicates, will not be complete.
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Bassenge E, Holtz J, von
Restorff W, Oversohl K (July 1973). "Effect of chemical sympathectomy on coronary flow and cardiovascular adjustment to exercise in dogs".
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procedure due to major intrathoracic bleeding and cerebral disruption. Bleeding during and following the operation may be significant in up to 5% of patients.
1432:
Moak JP, Eldadah B, Holmes C, Pechnik S, Goldstein DS (June 2005). "Partial cardiac sympathetic denervation after bilateral thoracic sympathectomy in humans".
1535:
Furlan AD, Mailis A, Papagapiou M (2000). "Are We Paying a High Price for
Surgical Sympathectomy? A Systematic Literature Review of Late Complications".
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Milner P, Lincoln J, Burnstock G (1998). "The neurochemical organization of the autonomic nervous system". In
Appenzeller O, Vinken PJ, Bruyn GW (eds.).
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Dimitriadou V, Aubineau P, Taxi J, Seylaz J (1988). "Ultrastructural changes in the cerebral artery wall induced by long-term sympathetic denervation".
658:
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Lai CL, Chen WJ, Liu YB, Lee YT (2001). "Bradycardia and
Permanent Pacing After Bilateral Thoracoscopic T2-Sympathectomy for Primary Hyperhidrosis".
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located bilaterally along the vertebral column (a localisation which entails a low risk of injury) responsible for various important aspects of the
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Wei HM, Sinha AK, Weiss HR (1 April 1993). "Cervical sympathectomy reduces the heterogeneity of oxygen saturation in small cerebrocortical veins".
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Miranda-Sivelo A, Bajo-Del Pozo C, Fructuoso-Castellar A (2013). "Unnecessary surgical treatment in a case of olfactory reference syndrome".
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A lumbar sympathectomy was also developed and used to treat excessive sweating of the feet and other ailments, and typically resulted in
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2003:
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1296:"Influence of Endoscopic Thoracic Sympathectomy on Baroreflex Control of Heart Rate in Patients with Palmar Hyperhidrosis"
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Other side effects are the inability to raise the heart rate sufficiently during exercise with instances requiring an
1112:"Vasomotor Responses in the Extremities of Subjects with Various Neurologic Lesions: I. Reflex Responses to Warming"
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Suzuki J, Takaku A, Kodama N, Sato S (1975). "An
Attempt to Treat Cerebrovascular 'Moyamoya' Disease in Children".
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388:. Arousal is essential to consciousness, in regulating attention and information processing, memory and emotion.
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Hashmonai M, Kopelman D (2003). "The pathophysiology of cervical and upper thoracic sympathetic surgery".
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The first sympathectomy was performed by Alexander in 1889. Thoracic sympathectomy has been indicated for
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for thoracic sympathectomy are focal hyperhidrosis (that specifically affects the hands and underarms),
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Cerfolio RJ, De Campos JR, Bryant AS, Connery CP, Miller DL, DeCamp MM, McKenna RJ, Krasna MJ (2011).
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1161:"Holter changes resulting from right-sided and bilateral infrastellate upper thoracic sympathectomy"
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The endoscopic version of thoracic sympathectomy was pioneered by Goren Claes and Christer Drott in
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Cervical sympathectomy reduces the heterogeneity of oxygen saturation in small cerebrocortical veins
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A large study of psychiatric patients treated with this surgery showed significant reductions in
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1957:[Guidelines for the prevention, diagnosis and treatment of compensatory hyperhidrosis].
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Ultrastructural changes in the cerebral artery wall induced by long-term sympathetic denervation
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611:"The Society of Thoracic Surgeons Expert Consensus for the Surgical Treatment of Hyperhidrosis"
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A custom made operating thoracoscope, used for the endoscopic thoracic sympathectomy procedure.
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Telaranta T (2003). "Psychoneurological applications of endoscopic sympathetic blocks (ESB)".
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1886:"Effects of cervical sympathectomy on vasospasm induced by meningeal haemorrhage in rabbits"
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1778:"Mönckeberg's sclerosis after sympathetic denervation in diabetic and non-diabetic subjects"
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region is destroyed. ETS is used to treat excessive sweating in certain parts of the body (
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There are reports of ETS being used to achieve cerebral revascularization for people with
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Lyra Rd, de Campos JR, Kang DW, Loureiro Md, Furian MB, Costa MG, Coelho Md (Nov 2008).
1572:"Quality of life after thoracic sympathectomy for palmar hyperhidrosis: a meta-analysis"
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262:, although this usually responds to non-surgical treatments, and sometimes people with
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Social Phobia: Aetiology, Course and Treatment with Endoscopic Sympathetic Block (ESB)
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1955:"Diretrizes para a prevenção, diagnóstico e tratamento da hiperidrose compensatória"
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Dumont P (2008). "Side Effects and Complications of Surgery for Hyperhidrosis".
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Sympathectomy physically destroys relevant nerves anywhere in either of the two
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Technical Advances in Mediastinal Surgery, An Issue of Thoracic Surgery Clinics
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1071:"Is previous thoracic sympathectomy a risk factor for exertional heat stroke?"
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Sympathectomy developed in the mid-19th century, when it was learned that the
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Redisch W, Tangco FT, Wertheimer L, Lewis AJ, Steele JM, Andrews D (1957).
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Verghese A (May 1968). "Some observations on the psychogalvanic reflex".
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230:(PNS). Each nerve trunk is broadly divided into three regions: cervical (
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Abraham P, Berthelot J, Victor J, Saumet JL, Picquet J, Enon B (2002).
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703:"Hyperhidrosis and bromhidrosis: a guide to assessment and management"
559:, and various psychiatric disorders. With the brief popularization of
511:(excessive sweating) since 1920, when Kotzareff showed it would cause
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Sympathetic denervation is one of the causes of Mönckeberg's sclerosis
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211:. By far the most common complaint treated with ETS is sweaty palms (
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Thoracic sympathectomy will change many bodily functions, including
807:"Thoracoscopic procedures for intrathoracic and pulmonary diseases"
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Morphofunctional changes in the myocardium following sympathectomy.
2104:
2019:
Hashmonai M, Kopelman D (2003). "History of sympathetic surgery".
944:"Treatment of social phobia by endoscopic thoracic sympathicotomy"
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377:
231:
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1936:"Effectiveness and safety of endoscopic thoracic sympathectomy"
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Khan IA (2002). "Long QT syndrome: Diagnosis and management".
31:
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Sihoe AD, Liu RW, Lee AK, Lam CW, Cheng LC (September 2007).
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Kawamata YT, Homma E, Kawamata T, Omote K, Namiki A (2001).
361:, pupil dilation, skin temperature and other aspects of the
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in the 1940s, sympathectomy fell out of favor as a form of
551:. Because of these difficulties, and because of disabling
1411:(Thesis). University of Oulu, Department of Psychiatry.
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A thermal image of an ETS patient 2 years after surgery.
273:, and to treat headaches, hyperactive bronchial tubes,
1034:. Cambridge, UK: Cambridge University Press. p.
187:) is a surgical procedure in which a portion of the
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Surgical removal of sympathetic nerves in the thorax
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62:. Unsourced material may be challenged and removed.
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447:Sympathectomy eliminates the psychogalvanic reflex
1474:"Drawbacks of endoscopic thoracic sympathectomy"
676:. In Dickman CA, Rosenthal DJ, Perin NI (eds.).
475:being reported as a consequence of the surgery.
277:, social phobia, anxiety, and other conditions.
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1202:Naunyn-Schmiedeberg's Archives of Pharmacology
266:present to surgeons requesting sympathectomy.
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2058:British Journal of Surgery 2004; 91: 264–269
539:approach was developed in 1908, and required
417:(collapsed lung) can occur (2% of patients).
8:
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1940:Health Technology Assessment (HTA) Database
1884:Faleiros AT, Maffei FH, Resende LA (2006).
1576:General Thoracic and Cardiovascular Surgery
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1325:. : Elsevier Science Publishers. pp.
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1998:. Elsevier Health Sciences. p. 329.
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440:Other long-term adverse effects include:
122:Learn how and when to remove this message
1820:Vestnik Akademii Meditsinskikh Nauk SSSR
1392:Teleranta, Pohjavaara, et al. 2003, 2004
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1942:. Centre for Reviews and Dissemination.
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18:Endoscopic transthoracic sympathicotomy
574:in the late 1980s. The development of
321:Physical, mental and emotional effects
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1843:Pacing and Clinical Electrophysiology
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672:Papadopoulos SM, Dickman CA (1999).
657:. September 24, 2014. Archived from
515:(total inability to sweat) from the
297:in the upper thoracic region of the
293:ETS involves dissection of the main
60:adding citations to reliable sources
2091:Tests and procedures involving the
651:"Endoscopic thoracic sympathectomy"
330:, yet anatomically typical nerves.
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71:"Endoscopic thoracic sympathectomy"
749:10.1016/j.genhosppsych.2013.06.014
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2156:Endoscopic thoracic sympathectomy
1700:The British Journal of Psychiatry
222:, which are long chains of nerve
181:Endoscopic thoracic sympathectomy
137:Endoscopic thoracic sympathectomy
1959:Jornal Brasileiro de Pneumologia
1855:10.1046/j.1460-9592.2001.00524.x
1088:10.1016/j.athoracsur.2007.04.066
824:10.1046/j.1440-1843.1999.00146.x
628:10.1016/j.athoracsur.2011.01.105
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1972:10.1590/s1806-37132008001100013
1903:10.1590/S0004-282X2006000400006
47:needs additional citations for
2191:Magnetic resonance neurography
1639:10.1016/j.thorsurg.2008.01.007
1472:Ojimba TA, Cameron AE (2004).
1165:The Annals of Thoracic Surgery
1075:The Annals of Thoracic Surgery
674:"Thoracoscopic Sympatheectomy"
615:The Annals of Thoracic Surgery
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1890:Arquivos de Neuro-Psiquiatria
1743:Journal of Applied Physiology
1178:10.1016/S0003-4975(02)04080-8
701:Perera E, Sinclair R (2013).
2232:Thoracic surgical procedures
2179:Repetitive nerve stimulation
1776:Goebel FD, Füessl H (1983).
1755:10.1152/jappl.1993.74.4.1911
1321:The autonomic nervous system
985:Nordic Journal of Psychiatry
264:olfactory reference syndrome
209:reflex sympathetic dystrophy
2021:Clinical Autonomic Research
1570:Wei Y, Xu ZQ, Li H (2020).
1446:10.1016/j.hrthm.2005.03.003
1250:Clinical Autonomic Research
948:European Journal of Surgery
848:Clinical Autonomic Research
737:General Hospital Psychiatry
710:Australian Family Physician
680:. Theime. pp. 143–60.
678:Thoracoscopic Spine Surgery
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2138:Sympathetic nervous system
1588:10.1007/s11748-020-01376-5
1478:British Journal of Surgery
890:"London Arrhythmia Centre"
419:Compensatory hyperhidrosis
326:its purpose is to destroy
299:sympathetic nervous system
2093:peripheral nervous system
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860:10.1007/s10286-003-1107-1
854:: I20–1, discussion I21.
228:peripheral nervous system
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2227:Neurosurgical procedures
1627:Thoracic Surgery Clinics
805:Sung SW, Kim JS (1999).
501:autonomic nervous system
367:fight-or-flight response
363:autonomic nervous system
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1549:10.1054/jpai.2000.19408
1129:10.1161/01.cir.15.4.518
921:10.1067/mhj.2002.120295
894:www.hcahealthcare.co.uk
460:Exertional heat stroke.
328:functionally disordered
2174:Nerve conduction study
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772:Pediatric Neurosurgery
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1026:McNaughton N (1989).
485:Compensatory sweating
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1537:The Journal of Pain
1030:Biology and emotion
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588:Harlequin syndrome
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1961:(in Portuguese).
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2006:
1993:
1992:
1988:
1952:
1951:
1947:
1934:
1933:
1929:
1883:
1882:
1878:
1840:
1839:
1835:
1816:
1815:
1811:
1775:
1774:
1770:
1740:
1739:
1735:
1706:(510): 639–42.
1697:
1696:
1692:
1662:
1661:
1654:
1624:
1623:
1619:
1569:
1568:
1564:
1534:
1533:
1529:
1522:"Find guidance"
1520:
1519:
1515:
1471:
1470:
1461:
1431:
1430:
1426:
1419:
1408:
1401:
1400:
1396:
1391:
1387:
1352:Pflügers Archiv
1349:
1348:
1344:
1337:
1316:
1315:
1311:
1293:
1292:
1285:
1247:
1246:
1237:
1199:
1198:
1194:
1158:
1157:
1153:
1109:
1108:
1104:
1068:
1067:
1056:
1046:
1025:
1024:
1020:
982:
981:
977:
941:
940:
936:
906:
905:
901:
888:
887:
883:
845:
844:
840:
804:
803:
799:
769:
768:
764:
743:(6): 683.e3–4.
734:
733:
729:
705:
700:
699:
695:
688:
671:
670:
666:
649:
648:
644:
608:
607:
600:
596:
584:
497:
410:
398:Frey's syndrome
323:
283:
248:
174:
159:
128:
117:
111:
108:
65:
63:
53:
41:
28:
23:
22:
15:
12:
11:
5:
2245:
2243:
2235:
2234:
2229:
2224:
2214:
2213:
2207:
2206:
2204:
2203:
2198:
2193:
2188:
2183:
2182:
2181:
2170:
2168:
2164:
2163:
2161:
2160:
2159:
2158:
2148:
2146:Ganglionectomy
2142:
2140:
2134:
2133:
2131:
2130:
2125:
2120:
2115:
2109:
2107:
2097:
2096:
2090:
2088:
2087:
2080:
2073:
2065:
2055:
2054:
2011:
2004:
1986:
1965:(11): 967–77.
1945:
1927:
1876:
1833:
1809:
1768:
1733:
1690:
1652:
1633:(2): 193–207.
1617:
1582:(8): 746–753.
1562:
1527:
1513:
1459:
1424:
1417:
1394:
1385:
1342:
1335:
1309:
1300:Anesthesiology
1283:
1235:
1192:
1171:(6): 2076–81.
1151:
1102:
1054:
1044:
1018:
975:
954:(580): 27–32.
934:
899:
881:
838:
797:
778:(4): 193–206.
762:
727:
693:
686:
664:
661:on 2022-01-27.
642:
597:
595:
592:
591:
590:
583:
580:
519:line upwards.
496:
493:
465:
464:
461:
458:
454:
451:
448:
445:
409:
406:
322:
319:
282:
279:
247:
244:
176:
175:
168:
165:
164:
157:
151:
150:
145:
139:
138:
130:
129:
112:September 2022
44:
42:
35:
26:
24:
14:
13:
10:
9:
6:
4:
3:
2:
2244:
2233:
2230:
2228:
2225:
2223:
2220:
2219:
2217:
2202:
2199:
2197:
2194:
2192:
2189:
2187:
2184:
2180:
2177:
2176:
2175:
2172:
2171:
2169:
2165:
2157:
2154:
2153:
2152:
2151:Sympathectomy
2149:
2147:
2144:
2143:
2141:
2139:
2135:
2129:
2126:
2124:
2121:
2119:
2116:
2114:
2111:
2110:
2108:
2106:
2102:
2098:
2094:
2086:
2081:
2079:
2074:
2072:
2067:
2066:
2063:
2059:
2050:
2046:
2042:
2038:
2034:
2030:
2026:
2022:
2015:
2012:
2007:
2005:9781455700721
2001:
1997:
1990:
1987:
1982:
1978:
1973:
1968:
1964:
1960:
1956:
1949:
1946:
1941:
1937:
1931:
1928:
1923:
1919:
1914:
1909:
1904:
1899:
1896:(3a): 572–4.
1895:
1891:
1887:
1880:
1877:
1872:
1868:
1864:
1860:
1856:
1852:
1848:
1844:
1837:
1834:
1829:
1825:
1821:
1813:
1810:
1805:
1801:
1796:
1791:
1788:(5): 347–50.
1787:
1783:
1779:
1772:
1769:
1764:
1760:
1756:
1752:
1749:(4): 1911–5.
1748:
1744:
1737:
1734:
1729:
1725:
1721:
1717:
1713:
1709:
1705:
1701:
1694:
1691:
1686:
1682:
1678:
1674:
1671:(3): 122–43.
1670:
1666:
1665:Blood Vessels
1659:
1657:
1653:
1648:
1644:
1640:
1636:
1632:
1628:
1621:
1618:
1613:
1609:
1605:
1601:
1597:
1593:
1589:
1585:
1581:
1577:
1573:
1566:
1563:
1558:
1554:
1550:
1546:
1543:(4): 245–57.
1542:
1538:
1531:
1528:
1523:
1517:
1514:
1509:
1505:
1501:
1497:
1492:
1487:
1483:
1479:
1475:
1468:
1466:
1464:
1460:
1455:
1451:
1447:
1443:
1439:
1435:
1428:
1425:
1420:
1414:
1407:
1406:
1398:
1395:
1389:
1386:
1381:
1377:
1373:
1369:
1365:
1361:
1358:(4): 285–96.
1357:
1353:
1346:
1343:
1338:
1336:0-444-82812-5
1332:
1328:
1323:
1322:
1313:
1310:
1305:
1301:
1297:
1290:
1288:
1284:
1279:
1275:
1271:
1267:
1263:
1259:
1255:
1251:
1244:
1242:
1240:
1236:
1231:
1227:
1223:
1219:
1215:
1211:
1207:
1203:
1196:
1193:
1188:
1184:
1179:
1174:
1170:
1166:
1162:
1155:
1152:
1147:
1143:
1139:
1135:
1130:
1125:
1122:(4): 518–24.
1121:
1117:
1113:
1106:
1103:
1098:
1094:
1089:
1084:
1081:(3): 1025–7.
1080:
1076:
1072:
1065:
1063:
1061:
1059:
1055:
1051:
1047:
1045:0-521-31938-2
1041:
1037:
1032:
1031:
1022:
1019:
1014:
1010:
1006:
1002:
998:
994:
990:
986:
979:
976:
971:
967:
962:
957:
953:
949:
945:
938:
935:
930:
926:
922:
918:
914:
910:
903:
900:
895:
891:
885:
882:
877:
873:
869:
865:
861:
857:
853:
849:
842:
839:
834:
830:
825:
820:
816:
812:
808:
801:
798:
793:
789:
785:
781:
777:
773:
766:
763:
758:
754:
750:
746:
742:
738:
731:
728:
723:
719:
715:
711:
704:
697:
694:
689:
683:
679:
675:
668:
665:
660:
656:
652:
646:
643:
638:
634:
629:
624:
621:(5): 1642–8.
620:
616:
612:
605:
603:
599:
593:
589:
586:
585:
581:
579:
577:
573:
568:
566:
565:psychosurgery
562:
558:
554:
550:
549:blood vessels
546:
542:
538:
532:
530:
525:
520:
518:
514:
510:
509:hyperhidrosis
505:
502:
494:
492:
488:
486:
480:
476:
474:
470:
462:
459:
455:
452:
449:
446:
443:
442:
441:
434:
430:
426:
422:
420:
416:
407:
405:
401:
399:
395:
389:
387:
383:
379:
374:
372:
368:
364:
360:
356:
352:
348:
347:stroke volume
344:
340:
335:
331:
329:
320:
318:
314:
310:
306:
304:
300:
296:
287:
280:
278:
276:
272:
267:
265:
261:
257:
253:
245:
243:
241:
238:(chest), and
237:
233:
229:
225:
221:
216:
214:
210:
206:
202:
198:
194:
191:trunk in the
190:
186:
182:
172:
162:
158:
156:
152:
149:
146:
144:
140:
135:
126:
123:
115:
104:
101:
97:
94:
90:
87:
83:
80:
76:
73: –
72:
68:
67:Find sources:
61:
57:
51:
50:
45:This article
43:
39:
34:
33:
30:
19:
2196:Nerve biopsy
2155:
2057:
2024:
2020:
2014:
1995:
1989:
1962:
1958:
1948:
1939:
1930:
1893:
1889:
1879:
1849:(4): 524–5.
1846:
1842:
1836:
1819:
1812:
1785:
1782:Diabetologia
1781:
1771:
1746:
1742:
1736:
1703:
1699:
1693:
1668:
1664:
1630:
1626:
1620:
1579:
1575:
1565:
1540:
1536:
1530:
1516:
1484:(3): 264–9.
1481:
1477:
1440:(6): 602–9.
1437:
1434:Heart Rhythm
1433:
1427:
1404:
1397:
1388:
1355:
1351:
1345:
1320:
1312:
1303:
1299:
1253:
1249:
1208:(2): 162–6.
1205:
1201:
1195:
1168:
1164:
1154:
1119:
1115:
1105:
1078:
1074:
1049:
1029:
1021:
991:(1): 55–60.
988:
984:
978:
951:
947:
937:
912:
908:
902:
893:
884:
851:
847:
841:
817:(1): 19–29.
814:
810:
800:
775:
771:
765:
740:
736:
730:
716:(5): 266–9.
713:
709:
696:
677:
667:
659:the original
654:
645:
618:
614:
569:
533:
521:
506:
498:
489:
484:
481:
477:
466:
439:
427:
423:
415:Pneumothorax
411:
402:
390:
375:
336:
332:
324:
315:
311:
307:
292:
268:
260:bromhidrosis
249:
217:
184:
180:
179:
118:
109:
99:
92:
85:
78:
66:
54:Please help
49:verification
46:
29:
2113:Nerve block
1913:11449/12367
1822:(2): 80–5.
1116:Circulation
915:(1): 7–14.
811:Respirology
655:India Today
529:hypotension
473:bradycardia
371:goose bumps
359:lung volume
303:homeostasis
252:indications
246:Indications
155:MedlinePlus
2216:Categories
2128:Neurectomy
594:References
576:endoscopic
513:anhidrosis
355:baroreflex
343:heart rate
199:), facial
82:newspapers
2222:Endoscopy
1612:218562024
1596:1863-6705
1256:: I40–4.
541:resection
537:posterior
524:impotence
382:alertness
2118:Vagotomy
2049:21176791
2041:14673664
2027:: I6–9.
1981:19099105
1922:17119793
1871:13586588
1863:11341096
1728:37969867
1647:18557592
1604:32390086
1557:14622605
1508:15189710
1500:14991624
1454:15922266
1380:20076364
1278:21326458
1270:14673672
1187:12643398
1138:13414070
1097:17720429
1013:28944767
1005:12745792
929:11773906
876:45719036
868:14673667
833:10339727
757:23992627
722:23781522
637:21524489
582:See also
561:lobotomy
553:sequelae
345:, heart
339:sweating
236:thoracic
201:flushing
193:thoracic
143:ICD-9-CM
2123:Axotomy
2101:Cranial
1828:6711115
1804:6873514
1763:8514710
1720:5654139
1685:3359052
1372:4798744
1306:: A160.
1230:5855368
1222:2861571
1146:5969475
970:9641382
792:1183260
495:History
386:arousal
351:thyroid
224:ganglia
96:scholar
2047:
2039:
2002:
1979:
1920:
1869:
1861:
1826:
1802:
1761:
1726:
1718:
1683:
1645:
1610:
1602:
1594:
1555:
1506:
1498:
1452:
1415:
1378:
1370:
1333:
1276:
1268:
1228:
1220:
1185:
1144:
1136:
1095:
1042:
1011:
1003:
968:
927:
874:
866:
831:
790:
755:
720:
684:
635:
572:Sweden
545:nerves
517:nipple
240:lumbar
161:007291
98:
91:
84:
77:
69:
2167:Tests
2045:S2CID
1867:S2CID
1724:S2CID
1608:S2CID
1504:S2CID
1409:(PDF)
1376:S2CID
1274:S2CID
1226:S2CID
1142:S2CID
1009:S2CID
872:S2CID
706:(PDF)
408:Risks
169:[
103:JSTOR
89:books
2103:and
2037:PMID
2000:ISBN
1977:PMID
1918:PMID
1859:PMID
1824:PMID
1800:PMID
1759:PMID
1716:PMID
1681:PMID
1643:PMID
1600:PMID
1592:ISSN
1553:PMID
1496:PMID
1450:PMID
1413:ISBN
1368:PMID
1331:ISBN
1266:PMID
1218:PMID
1183:PMID
1134:PMID
1093:PMID
1040:ISBN
1001:PMID
966:PMID
925:PMID
864:PMID
829:PMID
788:PMID
753:PMID
718:PMID
682:ISBN
633:PMID
547:and
457:ETS.
384:and
378:fear
232:neck
207:and
148:05.2
75:news
2029:doi
1967:doi
1908:hdl
1898:doi
1851:doi
1790:doi
1751:doi
1708:doi
1704:114
1673:doi
1635:doi
1584:doi
1545:doi
1486:doi
1442:doi
1360:doi
1356:341
1327:110
1258:doi
1210:doi
1206:329
1173:doi
1124:doi
1083:doi
993:doi
956:doi
952:164
917:doi
913:143
856:doi
819:doi
780:doi
745:doi
623:doi
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305:).
234:),
185:ETS
58:by
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2043:.
2035:.
2025:13
2023:.
1975:.
1963:34
1938:.
1916:.
1906:.
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1892:.
1888:.
1865:.
1857:.
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1784:.
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1983:.
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1924:.
1910::
1900::
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20:)
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