Sympathectomy for XXXX .

@entity75 @entity167 @entity8810 @entity6865 @entity3971 @entity1119 @entity6866 @entity158 @entity9
BACKGROUND: @entity9 is defined as @entity158 initiated or caused by a @entity75 or dysfunction in the nervous system. Some examples of this condition are phantom limb @entity158 , @entity158 and complex regional @entity158 (reflex sympathetic dystrophy) and type II ( @entity6866 ). Treatment options include drugs, physical treatments, surgery and psychological interventions. The concept that many @entity9 , particularly @entity6865 and @entity6866 are "sympathetically maintained @entity158 " has historically led to attempts to temporarily or permanently interrupt the sympathetic nervous system. Chemical sympathectomies use @entity167 or @entity3971 injections to destroy the sympathetic chain, but this effect is temporary until regeneration of the sympathetic chain occurs. Surgical ablation can be performed by open removal or electrocoagulation of the sympathetic chain, or minimally invasive procedures using stereotactic thermal or laser interruption. OBJECTIVES: The review aimed to assess the effects of both chemical and surgical sympathectomy for @entity9 . Secondary objectives were to compare the effects of sympathectomy with no treatment, placebo or conventional treatment, and to evaluate whether the technique of sympathectomy influences the outcomes of the procedure. SEARCH STRATEGY: We searched MEDLINE and EMBASE up to February 2003 and the latest issue of the Cochrane Library (Issue 1, 2003). We screened references in the retrieved articles, literature reviews and book chapters. We also contacted experts in the field of @entity9 . SELECTION CRITERIA: Clinical trials and observational studies assessing the effects of sympathectomy (surgical or chemical) for @entity9 of both central or peripheral origin were included. DATA COLLECTION AND ANALYSIS: Two reviewers applied the selection criteria to titles and abstracts. Full articles of potentially eligible trials were obtained and the same reviewers applied the inclusion criteria to the studies. The methodological quality of the studies was evaluated. The studies were also evaluated for clinical relevance according to a classification developed by our group. Statistical pooling was not possible due to heterogeneity of data; instead a narrative description of each included study was performed. MAIN RESULTS: We included four studies. One randomized trial comparing radiofrequency sympatholysis with @entity3971 sympathectomy was rated as low methodological quality and it showed that radiofrequency sympatholysis does not offer advantage over @entity3971 techniques. However, a modified technique produced sympatholysis comparable to that produced by 6% @entity3971 , with less incidence of @entity9 . REVIEWER'S CONCLUSIONS: The practice of surgical and chemical sympathectomy is based on poor quality evidence, uncontrolled studies and personal experience. Furthermore, complications of the procedure may be significant, in terms of both worsening the @entity158 or producing a new @entity158 ; and abnormal forms of sweating (compensatory @entity1119 and pathological @entity8810 ). Therefore, more clinical trials of sympathectomy are required to establish the overall effectiveness and potential risks of this procedure.
