J.Jpn. Surg. Soc.. 63(1): 74-103, 1962

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Original article

STUDIES ON THE INFLUENCE UPON THE ADRENAL COREX AFTER THE THORACO-LUMBAR SYMPATHECTOTMY

The clinical and histo-pathological studies on the influence upon the adrenal cortex including the changes in the anterior lobe of the pituitary gland after completing the extensive thoraco-lumbar sympathectomy (Th6-L2) with splanchnicectomy (major and minor) as a treatment for essential hypertension was carried out.
1) The changes on the count for circulating eosinophilic leukocytes in postoperative stage in the unilateral thoraco-lumbar sympathectomy showed almost same result in that of ordinary laparotomy. However, the changes in case of bilateral thoraco-lumbar sympathectomy the period of depression was markedly shorter than that of the unilateral case. And in the early postoperative stage the count showed steap increase beyond the preoperative level.
2) The Thorn's test which was normal in the preoperative period turned to be insufficient after the bilateral thoraco-lumber sympathectomy in predominat cases.
3) The changes in differential count in peripheral blood smear revealed marked shortening of peripd of dopression of lymphocytes and eosinophiles after the bilateral thoraco-lumbar sympathectomy. Meanwhile those in unilateral thoraco-lumbar sympathectomy showed no significant changes compared to the countrols.
4) The histo-pathological changes in the adrenal cortex in sympathectomized dogs showed increase, accumulation and enlargement of sudanophilic droplets between the period of two to six months after the operation. In a human autopsy case, same findings were found in the adrenal cortex.
5) Suggestion has been made that although partial section of the aplanchnic major nerve alone or other associated sympathetics would cause no histo-pathological changes in the adrenal cortex, stimulation on the splanchnic major nerve induced the histo-pathological changes in the same organ.
6) The histo-pathological changes in the anterior lobe of the pituitary gland showed decrease of acidophiles, increase or decrease of basophiles, increase of chromophobes, cellular atrophy, disassociation of the cells.
In summary, it is suggested that hypofunction of hormonal excretion of the adrenal cortex was resulted after the extensive thoraco-lumbar sympathectomy. In addition, it was disclosed that even thoraco-lumbar sympathectomy induced the histo-pathological changes in the anterior lobe of the pituitary gland.
(author's abstract)

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