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January 13, 1940


JAMA. 1940;114(2):178. doi:10.1001/jama.1940.02810020082023

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To the Editor:—  In The Journal, October 28, Dr. Rupert B. Raney advances the theory that preganglionic sympathectomy should be performed for relief of attacks of angina pectoris. In the description of his technic and in figure 4 the author indicates that all the rami communicantes entering or leaving the ganglions are severed. As it is impossible to distinguish preganglionic (white) from postganglionic (gray) rami by gross examination, it would seem that the author is actually completely severing the postganglionic as well as the preganglionic fibers.It has been the practice of those who perform the operation of preganglionic resection to excise the intercostal nerve as it leaves the intervertebral foramen, thus insuring as far as possible ablation of the preganglionic fibers, leaving the ganglion and its emerging postganglionic fibers intact.In his summary Raney says:The operation is based on the assumption that in angina pectoris the sympathetic action

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