J.Jpn. Surg. Soc.. 62(3): 314-339, 1961

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FUNCTIONS OF THE SKIN AFTER SYMPATHECTOMY

Various studies on the functions of the skin including perspiration and temperature regulation were performed in 51 patients who had received thoracolumbar sympathectomy from Th 6 to L 2 for essential hypertension and in 6 patients who had had lumbar sympathectomy or stellate ganglionectomy for Buerger's disease, and the following results were obtained.
1) Perspiration
There have been various theories on pilocarpine sweating after sympathetic ganglionectomy. Some state the disappearance of pilocarpine sweating after sympthectomy while others report excessive sweating. On the other hand, as to thermoregulatory sweating, most authors agree on the disappearance of sweating after sympathectomy.
According to my experiments on our patients, thermoregulatory sweating disappeared completely immediately after sympathectomy while pilocarpine sweating gradually decreased following a transient increase. The similar results were obtained from the local sweating test by means of intradermal injection of pilocarpine or adrenaline.
Histological studies on the sweat gland of the individuals, who had undergone sympathectomy one month before and demonstrated disappearance of the both thermoregulatory and pilocarpine sweating, revealed that the sweat gland in the sympathectomized area remained perfectly normal or in the preoperative condition. The sweat gland of the individuals who had received sympathectomy 3-4 years ago was markedly atrophied and surrounded with hard fibrous connective tissue, and the capillary blood flow around the gland was almost stopped.
The amount of polysaccharides, alkaline aminoacids, sulfur-bearing aminoacids, carbonic anhydrase and phospho-monoesterase in the cells of the sweat gland was examined. There was no histochemical difference between the sweat glands before and one-month after sympathectomy. In the sweat gland 3-4 years after sympathectomy, no marked abnormal change was observed except increased alkaline aminoacids in the nucleus.
Accordingly, it was elucidated that the differences in the opinions of the author on the function of sweat gland after sympathectomy were due to the differences in the time of observation after sympathectomy. Also, it was suggested that pirocarpine did not stimulate the sweat cell directly but indirectly through the secretory nervous fibers, from the fact that the swest cell remained normal even when pirocarpine sweating ceased. It was surmized that the secretory nervous fibers derived from the both sympathetic and parasympathetic nervous systems, and that the excitation of the both nervous system caused perspiration. Intensive acceleration of sweating was confirmed to be due to increased capillary blood flow in the capillary nets around the sweat gland as well as the excitation of the sweat gland itself.
2) Electrical skin resistance
Although electrical skin resistance is said not show directly the degree of perspiration because of many factors which affect the resistance, the values of electrical skin resistance and the changes in perspiration after sympathectomy were in perfect accordance. Therefore, the other factors which affect the resistance may be negligible in this case.
3) Skin temperature
The skin temperature started to rise immediately after the resection of the sympathetic nerve which innervates the area . This phenomenon, which agrees with the reports of other investigators, was confirmed from the stand-point of inductive statistics. In spite that the increase in the skin blood flow after sympathectomy is said to be transient, the elevation in skin temperature lasted for a considerable length of time. One of the reasons for this discrepancy may be the cessation of perspiration in the area.
4) Sebaceous glands
The sebaceous gland was not affected with sympathectomy, both histologically and histochemically. The functions and structures of the sebaceous glands are considered to be under the influences of the endocrine systen rather than the autonomic nervous system.
5) Pilorum muscles
The actions of pilorum muscles were studied by the observations on local goose flesh and piloerection wave. Resection of the sympathetic nerve caused the disappearance of piloerection wave of the innervated area. On the other hand, local goose flesh was more frequently observed in the area than in other regions. However, the local goose fleseh gradually disappeared with the elapse of 2 weeks to one month. Therefore, it was supposed that a temporary excitation of the sympathetic nerve endings, which first caused the local goose flesh, gradually subsided with the progress of degeneration of the resected sympathetic nervous fibers. Piloerection waves were considered to be influenced fairly directly by the sympathetic nervous function.
6) Dermographism
Dermographism was not affected with sympathectomy.
7) Color of the skin
The color of the skin was not influenced with sympathectomy either.
8) Skin test with thermal irritation
Skin test with thermal irritation did not show abnormality after sympathectomy.
9) QRZ
The QRZ reaction on the operated side was transiently accentuated slightly, which may be due to an increase in the skin blood flow.
10) Tuberculin skin test
Tuberculin reaction of the skin on the sympathectomized side was slightly less marked than on the other side. This is supposed to be due to hyperfunction of the reticuloendothelial system on the operated side.
11) Cutaneous sensations
The tactile, pain, temperature and spatial sensations were examined. Except temperature sensation, other cutaneous sensations were not affected with sympathectomy. It is likely that the changes in temperature sensation have a considerable correlation with skin temperature.
(Author's abstract)

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