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VASOMOTOR TONUS OF THE DENERVATED ARTERY: CONTROL OF SYMPATHECTOMIZED BLOOD VESSELS BY SYMPATHOMIMETIC HORMONES AND ITS RELATION TO THE SURGICAL TREATMENT OF PATIENTS WITH RAYNAUD'S DISEASE

VASOMOTOR TONUS OF THE DENERVATED ARTERY: CONTROL OF SYMPATHECTOMIZED BLOOD VESSELS BY... Abstract THE PROBLEM OF RELEASING VASOCONSTRICTOR TONE BY SYMPATHECTOMY Since the first attempts to relieve vasospasm in Raynaud's disease by sympathetic ramisection the results of the operation have been so variable that numerous modifications have been proposed in the technic of arterial denervation. Ganglionectomy has been found much more effective than ramisectomy because it is easier to make certain of resecting the nodal ganglia than to be sure of cutting all their delicate rami communicantes; also, because regeneration of the vasoconstrictor fibers is far less likely after this more radical but harmless procedure. Resection of the second and third lumbar ganglia is now established as a certain method for restoring an adequate circulation in favorable early cases of Raynaud's disease of the lower extremity. Twelve patients so treated at the Massachusetts General Hospital, after satisfactory response to procaine block, have all maintained an excellent circulation in the feet, with freedom from References 1. Kuntz, A.: Distribution of the Sympathetic Rami to the Brachial Plexus: Its Relation to Sympathectomy Affecting the Upper Extremity , Arch. Surg. 15: 871 ( (Dec.) ) 1927.Crossref 2. Adson, A. W., and Brown, G. E.: The Treatment of Raynaud's Disease by Resection of the Upper Thoracic and Lumbar Sympathetic Ganglia and Trunks , Surg., Gynec. & Obst. 48:577, 1929. 3. Lewis, T.: Experiments Relating to the Peripheral Mechanism Involved in Spasmodic Arrest of the Circulation in the Fingers; A Variety of Raynaud's Disease , Heart 15:7, 1929. 4. Lewis, T., and Pickering, G. W.: Observations upon Maladies in Which the Blood Supply to Digits Ceases Intermittently or Permanently, and upon Bilateral Gangrene of Digits; Observations Relevant to So-Called "Raynaud's Disease," Clin. Sc. 1:327, 1934. 5. personal communication from Sir Thomas Lewis. 6. White, J. C.: The Autonomic Nervous System , New York, The Macmillan Company, 1935. 7. Ross, J. P.: The Results of Sympathectomy: An Analysis of the Cases Reported by Fellows of the Association of Surgeons , Brit. J. Surg. 23:433, 1935. 8. Before operation the surface temperature often fell as low as from 68 to 66 F. in a room at 70 F. This cooling below the temperature of the room, which is due to abnormal sweating and evaporation, is eliminated by sympathectomy and the resultant sudomotor paralysis. 9. Gask, G. E.: The Surgery of the Sympathetic Nervous System , Brit J. Surg. 21:113, 1933. 10. Adson, A. W.: Indications for Operation on the Sympathetic Nervous System , J. A. M. A. 106:360 ( (Feb. 1) ) 1936. 11. Elliott, T. R.: The Action of Adrenaline , J. Physiol. 32:401, 1905. 12. Meltzer, S. J., and Meltzer, C.: The Share of the Central Vasomotor Innervation in the Vasoconstriction Caused by Intravenous Injection of Suprarenal Extract , Am. J. Physiol. 9:147, 1903. 13. Meltzer, S. J., and Auer, C. M.: Studies on the "Paradoxical" Pupil-Dilatation Caused by Adrenalin: I. The Effect of Subcutaneous Injections and Instillations of Adrenalin upon the Pupils of Rabbits , Am. J. Physiol. 11:28, 1904. 14. Hartman, F. A.; McCordock, H. A., and Loder, M. M.: Conditions Determining Adrenal Secretion , Am. J. Physiol. 64:1, 1923. 15. Cannon, W. B.; Lewis, J. T., and Britton, S. W.: Studies on the Conditions of Activity in Endocrine Glands: XVII. A Lasting Preparation of the Denervated Heart for Detecting Internal Secretion, with Evidence for Accessory Accelerator Fibers from the Thoracic Sympathetic Chain , Am. J. Physiol. 77:326, 1926. 16. Freeman, N. E.; Smithwick, R. H., and White, J. C.: Adrenal Secretion in Man: The Reactions of the Blood Vessels of the Human Extremity, Sensitized by Sympathectomy, to Adrenaline and to Adrenal Secretion Resulting from Insulin Hypogycemia , Am. J. Physiol. 107:529, 1934. 17. Smithwick, R. H.; Freeman, N. E., and White, J. C.: Effect of Epinephrine on the Sympathectomized Human Extremity: An Additional Cause of Failure of Operations for Raynaud's Disease , Arch. Surg. 29:759 ( (Nov.) ) 1934. 18. Feldberg, W.: The Peripheral Innervation of the Vessels of the External Ear of the Rabbit , J. Physiol. 61:518, 1926. 19. Grant, R. T.; Bland, E. F., and Camp, P. D.: Observations on the Vessels and Nerves of the Rabbit's Ear with Special Reference to the Reaction to Cold , Heart 16:69, 1932. 20. In our rabbits measurements of the external diameter of the main auricular artery at the middle of the ear gave uniform average readings, viz.: maximal constriction, 0.2 mm.; maximal dilatation, from 1.2 to 1.5 mm. in the larger animals; average with animal at rest comfortably warm, from 0.8 to 0.6 mm. 21. Grant and others,18 p. 91. 22. Langley, J. N.: On the Origin from the Spinal Cord of the Cervical and Upper Thoracic Sympathetic Fibers, with Some Observations on White and Grey Rami Communicantes , Phil. Tr. Roy. Soc., London, s.B 183:85, 1892. 23. Coller, F. A., and Maddock, W. G.: The Function of Peripheral Vasoconstriction , Ann. Surg. 100:983, 1934. 24. Fulton, J. F., and Keller, A. D.: Observations on the Response of the Same Chimpanzee to Dial, Amytal and Nembutal, Used as Surgical Anaesthetics. Surg., Gynec. & Obst. 54:764, 1932. 25. Rosenblueth, A., and Cannon, W. B.: Studies on Conditions of Activity in Endocrine Organs: XXVIII. Some Effects of Sympathin on the Nictitating Membrane , Am. J. Physiol. 99:398, 1932. 26. Cannon, W. B.: Chemical Mediators of Autonomic Nerve Impulses , Science 78:43, 1933.Crossref 27. Hampel, C. W.: Effect of Denervation on the Sensitivity to Adrenine of the Smooth Muscle in the Nictitating Membrane of the Cat , Am. J. Physiol. 111: 611, 1935. 28. Grant, R. T.: Further Observations on the Vessels and Nerves of the Rabbit's Ear, with Special Reference to the Effects of Denervation , Clin. Sc. 2: 1, 1935. 29. Cannon, W. B.: The Wisdom of the Body , New York, W. W. Norton & Company, Inc., 1932. 30. Newton, H. F.; Zwemer, R. L., and Cannon, W. B.: Studies on the Conditions of Activity in Endocrine Organs: XXV. The Mystery of Emotional Acceleration of the Denervated Heart After Exclusion of Known Humoral Accelerators , Am. J. Physiol. 96:377, 1931. 31. Whitelaw, G. P., and Snyder, J. C.: The Physiological Production of Sympathin in the Liver , Am. J. Physiol. 110:247, 1934. 32. Cannon, W. B., and Rosenblueth, A.: Studies on Conditions of Activity in Endocrine Organs: XXIX. Sympathin E and Sympathin I , Am. J. Physiol. 104: 557, 1933. 33. Langley, J. N.: The Sympathetic and Other Related Systems of Nerves , in Schäfer, E. A.: Textbook of Physiology , New York, The Macmillan Company, 1900, vol. 2, p. 616. 34. Smithwick, R. H.: Modified Dorsal Sympathectomy for Vascular Spasm (Raynaud's Disease) of the Upper Extremity , Ann. Surg. 104:339, 1936.Crossref 35. Telford, E. D.: The Technic of Sympathectomy , Brit. J. Surg. 23:448, 1935.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology & Psychiatry American Medical Association

VASOMOTOR TONUS OF THE DENERVATED ARTERY: CONTROL OF SYMPATHECTOMIZED BLOOD VESSELS BY SYMPATHOMIMETIC HORMONES AND ITS RELATION TO THE SURGICAL TREATMENT OF PATIENTS WITH RAYNAUD'S DISEASE

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American Medical Association
Copyright
Copyright © 1936 American Medical Association. All Rights Reserved.
ISSN
0096-6754
DOI
10.1001/archneurpsyc.1936.02260120098007
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Abstract

Abstract THE PROBLEM OF RELEASING VASOCONSTRICTOR TONE BY SYMPATHECTOMY Since the first attempts to relieve vasospasm in Raynaud's disease by sympathetic ramisection the results of the operation have been so variable that numerous modifications have been proposed in the technic of arterial denervation. Ganglionectomy has been found much more effective than ramisectomy because it is easier to make certain of resecting the nodal ganglia than to be sure of cutting all their delicate rami communicantes; also, because regeneration of the vasoconstrictor fibers is far less likely after this more radical but harmless procedure. Resection of the second and third lumbar ganglia is now established as a certain method for restoring an adequate circulation in favorable early cases of Raynaud's disease of the lower extremity. Twelve patients so treated at the Massachusetts General Hospital, after satisfactory response to procaine block, have all maintained an excellent circulation in the feet, with freedom from References 1. Kuntz, A.: Distribution of the Sympathetic Rami to the Brachial Plexus: Its Relation to Sympathectomy Affecting the Upper Extremity , Arch. Surg. 15: 871 ( (Dec.) ) 1927.Crossref 2. Adson, A. W., and Brown, G. E.: The Treatment of Raynaud's Disease by Resection of the Upper Thoracic and Lumbar Sympathetic Ganglia and Trunks , Surg., Gynec. & Obst. 48:577, 1929. 3. Lewis, T.: Experiments Relating to the Peripheral Mechanism Involved in Spasmodic Arrest of the Circulation in the Fingers; A Variety of Raynaud's Disease , Heart 15:7, 1929. 4. Lewis, T., and Pickering, G. W.: Observations upon Maladies in Which the Blood Supply to Digits Ceases Intermittently or Permanently, and upon Bilateral Gangrene of Digits; Observations Relevant to So-Called "Raynaud's Disease," Clin. Sc. 1:327, 1934. 5. personal communication from Sir Thomas Lewis. 6. White, J. C.: The Autonomic Nervous System , New York, The Macmillan Company, 1935. 7. Ross, J. P.: The Results of Sympathectomy: An Analysis of the Cases Reported by Fellows of the Association of Surgeons , Brit. J. Surg. 23:433, 1935. 8. Before operation the surface temperature often fell as low as from 68 to 66 F. in a room at 70 F. This cooling below the temperature of the room, which is due to abnormal sweating and evaporation, is eliminated by sympathectomy and the resultant sudomotor paralysis. 9. Gask, G. E.: The Surgery of the Sympathetic Nervous System , Brit J. Surg. 21:113, 1933. 10. Adson, A. W.: Indications for Operation on the Sympathetic Nervous System , J. A. M. A. 106:360 ( (Feb. 1) ) 1936. 11. Elliott, T. R.: The Action of Adrenaline , J. Physiol. 32:401, 1905. 12. Meltzer, S. J., and Meltzer, C.: The Share of the Central Vasomotor Innervation in the Vasoconstriction Caused by Intravenous Injection of Suprarenal Extract , Am. J. Physiol. 9:147, 1903. 13. Meltzer, S. J., and Auer, C. M.: Studies on the "Paradoxical" Pupil-Dilatation Caused by Adrenalin: I. The Effect of Subcutaneous Injections and Instillations of Adrenalin upon the Pupils of Rabbits , Am. J. Physiol. 11:28, 1904. 14. Hartman, F. A.; McCordock, H. A., and Loder, M. M.: Conditions Determining Adrenal Secretion , Am. J. Physiol. 64:1, 1923. 15. Cannon, W. B.; Lewis, J. T., and Britton, S. W.: Studies on the Conditions of Activity in Endocrine Glands: XVII. A Lasting Preparation of the Denervated Heart for Detecting Internal Secretion, with Evidence for Accessory Accelerator Fibers from the Thoracic Sympathetic Chain , Am. J. Physiol. 77:326, 1926. 16. Freeman, N. E.; Smithwick, R. H., and White, J. C.: Adrenal Secretion in Man: The Reactions of the Blood Vessels of the Human Extremity, Sensitized by Sympathectomy, to Adrenaline and to Adrenal Secretion Resulting from Insulin Hypogycemia , Am. J. Physiol. 107:529, 1934. 17. Smithwick, R. H.; Freeman, N. E., and White, J. C.: Effect of Epinephrine on the Sympathectomized Human Extremity: An Additional Cause of Failure of Operations for Raynaud's Disease , Arch. Surg. 29:759 ( (Nov.) ) 1934. 18. Feldberg, W.: The Peripheral Innervation of the Vessels of the External Ear of the Rabbit , J. Physiol. 61:518, 1926. 19. Grant, R. T.; Bland, E. F., and Camp, P. D.: Observations on the Vessels and Nerves of the Rabbit's Ear with Special Reference to the Reaction to Cold , Heart 16:69, 1932. 20. In our rabbits measurements of the external diameter of the main auricular artery at the middle of the ear gave uniform average readings, viz.: maximal constriction, 0.2 mm.; maximal dilatation, from 1.2 to 1.5 mm. in the larger animals; average with animal at rest comfortably warm, from 0.8 to 0.6 mm. 21. Grant and others,18 p. 91. 22. Langley, J. N.: On the Origin from the Spinal Cord of the Cervical and Upper Thoracic Sympathetic Fibers, with Some Observations on White and Grey Rami Communicantes , Phil. Tr. Roy. Soc., London, s.B 183:85, 1892. 23. Coller, F. A., and Maddock, W. G.: The Function of Peripheral Vasoconstriction , Ann. Surg. 100:983, 1934. 24. Fulton, J. F., and Keller, A. D.: Observations on the Response of the Same Chimpanzee to Dial, Amytal and Nembutal, Used as Surgical Anaesthetics. Surg., Gynec. & Obst. 54:764, 1932. 25. Rosenblueth, A., and Cannon, W. B.: Studies on Conditions of Activity in Endocrine Organs: XXVIII. Some Effects of Sympathin on the Nictitating Membrane , Am. J. Physiol. 99:398, 1932. 26. Cannon, W. B.: Chemical Mediators of Autonomic Nerve Impulses , Science 78:43, 1933.Crossref 27. Hampel, C. W.: Effect of Denervation on the Sensitivity to Adrenine of the Smooth Muscle in the Nictitating Membrane of the Cat , Am. J. Physiol. 111: 611, 1935. 28. Grant, R. T.: Further Observations on the Vessels and Nerves of the Rabbit's Ear, with Special Reference to the Effects of Denervation , Clin. Sc. 2: 1, 1935. 29. Cannon, W. B.: The Wisdom of the Body , New York, W. W. Norton & Company, Inc., 1932. 30. Newton, H. F.; Zwemer, R. L., and Cannon, W. B.: Studies on the Conditions of Activity in Endocrine Organs: XXV. The Mystery of Emotional Acceleration of the Denervated Heart After Exclusion of Known Humoral Accelerators , Am. J. Physiol. 96:377, 1931. 31. Whitelaw, G. P., and Snyder, J. C.: The Physiological Production of Sympathin in the Liver , Am. J. Physiol. 110:247, 1934. 32. Cannon, W. B., and Rosenblueth, A.: Studies on Conditions of Activity in Endocrine Organs: XXIX. Sympathin E and Sympathin I , Am. J. Physiol. 104: 557, 1933. 33. Langley, J. N.: The Sympathetic and Other Related Systems of Nerves , in Schäfer, E. A.: Textbook of Physiology , New York, The Macmillan Company, 1900, vol. 2, p. 616. 34. Smithwick, R. H.: Modified Dorsal Sympathectomy for Vascular Spasm (Raynaud's Disease) of the Upper Extremity , Ann. Surg. 104:339, 1936.Crossref 35. Telford, E. D.: The Technic of Sympathectomy , Brit. J. Surg. 23:448, 1935.Crossref

Journal

Archives of Neurology & PsychiatryAmerican Medical Association

Published: Dec 1, 1936

References