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Treatment for the Disuse Phenomenon-Reply

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


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