0
Letters |

Treatment for the Disuse Phenomenon-Reply

Victor G. deWolfe, MD
JAMA. 1964;187(12):962. doi:10.1001/jama.1964.03060250079029.
Text Size: A A A
Published online

ABSTRACT

While I agree that sympathectomy should be reserved for those patients who fail to respond to an adequate program of intensive physical therapy and lumbar sympathetic blocks, as was the case in all of our patients who underwent sympathectomy, I cannot agree that orthostatic hypotension constitutes a significant complication of lumbar sympathectomy. Over a thousand lumbar sympathectomies have been done in this institution for peripheral vascular disorders, many of them in older patients with severe arteriosclerosis obliterans with hypertension, and I cannot recall a single case of significant orthostatic hypotension. I do not believe that the limited type of sympathectomy which is done to produce peripheral vasodilatation, consisting of unilateral removal of the third, fourth, and fifth or fourth and fifth lumbar ganglia, produces orthostatic hypotension, except perhaps in rare instances. On the other hand, extensive sympathectomy, such as the bilateral dorsolumbar sympathectomy advocated by Smithwick for hypertension, does indeed

Topics

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Jobs
brightcove.createExperiences();