Thoracolumbar sympathectomy in hypertension.

The average survival time of patients in the malignant phase of hypertension is short-eight months according to Keith et al. (1928). There have been many reports of the effects of bilateral thoracolumbar sympathectomy on the mortality rate in. this disease. Woods and Peet (1941) recorded a survival rate of 33 per cent five years after operation and Peet and Isberg (1946) a rate of 19 per cent after five to eleven years. Evelyn et al. (1949) noted that in twelve of their patients papilloedema disappeared but there was no significant fall in blood pressure. In England, Morrissey et al. (1953) have had encouraging results in the treatment of severe hypertension, but Pickering (1955) recorded an adequate fall in blood pressure in only 18 per cent of 142 patients two years after operation. Bilateral thoracolumbar sympathectomy is a major surgical procedure and may be followed by troublesome complications such as causalgia and postural hypotension. Many centres have, therefore, abandoned the operation in favour of "medical sympathectomy" by ganglion-blocking drugs. Unfortunately, not all the patients suffering from severe diastolic hypertension respond adequately to these drugs. The recently introduced mecamylamine is said to be more effective than the other ganglion-blocking agents, but it has a potent vagal blocking effect. In view of the difficulty in connection with ganglion-blocking drugs, it was thought that a review of the results of thoracolumbar sympathectomy in this hospital would be of value. Before operation all patients had undergone a full clinical examination, followed by examination of the urine, specific gravity range test, blood urea estimation, intravenous pyelogram, and by cardioscopy, electrocardiogram, and a sedation test. A few had slight albuminuria, but none had significant impairment of renal function or evidence of cardiac failure. Only one was over the age of 50. The positive indications were a persistent diastolic blood pressure above 130 mm. Hg or intractable headaches and rapid deterioration of vision. The headaches were intense in 27 of the 31 patients.