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At least 217 records · Page 12Linked to original sources
PubMed1997

[Long-term follow-up of female tetraplegic patients with cutaneous vesicostomy].

Tetraplegic women who underwent a cutaneous vesicostomy in our institutions were studied to evaluate long-term urinary complications and their quality of life (QOL). A total of 5 patients (C4, C5 and C6 injuries in one patient each and C7 injury in 2) were followed for 98 to 125 months (mean 107 months). Autonomic hyperreflexia disappeared after surgery in all patients. None of the patients showed deterioration of the upper urinary tract. Urinary tract infections were noted in 3 of 5 patients, but not severe. Bladder stones developed in 2 patients and a stomal stricture in 1. A questionnaire survey showed the patients to be satisfied with the operation, which had improved their QOL. These findings suggest that a cutaneous vesicostomy is an excellent surgical procedure for tetraplegic women.

Adult↗
PubMed1998

[Surgical procedure for hyperthyroidism in children and adolescents].

The high recurrence rate of hyperthyroidism after drug therapy in Graves disease and the high incidence of differentiated thyroid cancer in autonomously functioning thyroid nodules are the most common indications for surgical treatment in children and adolescents (less than 18 years old). Between April 1986 and March 1998, 101 adolescents were operated on: 24 children (23.8%) for Graves disease, 9 adolescents (8.9%) for autonomously functioning thyroid nodules. Surgery for hyperthyroidism is recommended in children and adolescents because of the low morbidity, the guarantee that this approach will successfully treat hyperthyroidism and the necessity for histological exploration.

Adolescent↗
PubMed2000

A prospective study on radical and nerve-preserving surgery for rectal cancer in the Netherlands.

INTRODUCTION: Preservation of the pelvic autonomic nerves is thought to lower bladder and sexual dysfunction after rectal cancer surgery. A prospective study was undertaken in a Dutch population to evaluate functional outcome, local recurrence and survival of a Japanese operative technique combining nerve preservation with radical tumour resection. METHODS: Forty-seven patients were operated upon by a Japanese surgeon. Voiding and sexual function were prospectively analysed using questionnaires. Two-year follow-up on urinary function was complete in 73%, and 2-year follow-up of male sexual function was complete in 77%. Median follow-up for survival and recurrence was 42 months and was complete in all patients. RESULTS: Five patients (19%) developed minor urinary incontinence in the period between 1 and 2 years of follow-up. Six patients (22%) had a persistently elevated frequency of voiding. There was no statistically significant correlation between the extent of nerve preservation and the reported minor voiding dysfunctions. None of the patients reported major incontinence of urine. Impotence was related to sacrifice of the inferior hypogastric plexus and ejaculatory dysfunction was related to sacrifice of the superior hypogastric plexus. Sexual function did not change during follow-up. Of 42 curatively-operated patients, three (7.1%) developed local recurrence. Sixty-seven per cent were overall free of recurrence. Disease-free survival was 57%. CONCLUSIONS: Preservation of the pelvic autonomic nerves minimizes bladder dysfunction after rectal cancer surgery. The preservation of the total autonomic nerve system is essential for normal sexual function in male patients. Nerve preservation does not compromise radicality in mesorectal excision. Mesorectal excision should involve identification and preservation of the pelvic autonomic nerves.

Adult↗
PubMed1987

CRH in Cushing's syndrome.

CRH-stimulation-test with 100 micrograms ovine or human corticotropin releasing hormone is useful in making the differential diagnosis of established Cushing's syndrome (N = 45). Only in 3 patients we did not find the expected result. In one patient with proven pituitary ACTH-dependent Cushing's disease there was no ACTH- and cortisol-increase after CRH-stimulation, whereas in two patients with ectopic ACTH-production due to a lung tumour there was a significant ACTH-increase after CRH-stimulation. The CRH-test was repeated 7-10 days after transsphenoidal surgery in 30 patients with Cushing's disease. Successfully operated patients exhibit no, blunted or normal ACTH responses to CRH. In patients with autonomous adrenal cortisol secretion after surgery the ACTH response to CRH can already be demonstrated when cortisol levels are still undetectable. The same could be shown for patients after long-term corticoid therapy suggesting that the cause of adrenal failure after unilateral adrenalectomy for Cushing's syndrome or long-term corticoid therapy is due to hypothalamic CRH deficiency. Acute administration of corticoids suppressed CRH-induced ACTH-secretion in normals and patients with pituitary ACTH-dependent Cushing's disease suggesting the pituitary level as target side for the acute feedback inhibition. Our results with different stimuli of the ACTH-secretion in normal controls (N = 6) with and without intravenous dexamethasone administration indicate a multihormonal control of pituitary adrenal activity.--Measurements of CRH-levels with a homologous human CRH-radioimmunoassay in patients with pituitary ACTH-dependent Cushing's disease did not help in differentiating these patients according to their possible pathophysiology (functional hypothalamic or autonomous pituitary cause of ACTH-hypersecretion).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenocorticotropic Hormone↗
PubMed2003

Software agents in surgery: an update.

Intelligent and, thus, autonomously reacting software programs are capable of handling a lot of different tasks as has been realized in economics and network administration. The same so-called software agents can be used for a variety of organizational tasks in medicine. Some software agents already manage an individual patient's health care record from documentation to ambulant or stationary admission, surgical planning, and many other tasks which currently consume more than half of a physician's daily working time. Hence, not only a large potential of time, but also of economical savings result to the physicians' new disposition.

General Surgery↗
PubMed1995

Power spectral analysis of systemic arterial pressure signals during open heart surgery.

BACKGROUND: The close relationship between the balance of sympathetic and parasympathetic tones and the results of power spectral analysis (PSA) of systemic arterial pressure (SAP) has been suggested recently. The purpose of this study was to further describe the changes of balance between the two autonomic nervous components during open heart surgery for coronary arterial disease (CAD) or valvular heart disease (VHD) with the PSA technique of SAP. METHODS: By relaying the SAP signals to a personal computer utilizing a power spectral analysis algorithm, radial arterial pressure signals of 27 patients (11 with CAD for coronary artrial bypass graft, as CAD groups; 16 with VHD, as VHD group, including 8 for aortic valve replacement and 8 for mitral valve replacement) during open heart surgery were monitored in a continuous, on-line and real-time manner. On-line power spectral analysis was performed according to the five different stages of the operation. RESULTS: Power density tended to increase in the high frequency (HF) band during the ventilator-supported stages of the open heart procedures, i.e., the pre-cardiopulmonary bypass (CPB) and the off-CPB periods. The power density in other frequency bands during the whole course of general anesthesia otherwise decreased significantly, with the lowest values occurring during CPB. The power density in very low frequency (VLF) band was much higher than in other bands during CPB, and became the major component of total power density in this period. CONCLUSIONS: The balance between sympathetic and parasympathetic components of autonomic nervous system changes rapidly during open heart surgery and needs careful monitoring. By utilizing PSA of SAP, mathematical error might be an obstacle of using LF:HF ratio as an index of autonomic balance during the CPB period when the HF density approaches zero.

Aged↗
PubMed2000

Laparoscopic total mesorectal excision with autonomic nerve preservation.

Laparoscopy has greatly influenced abdominal surgery. We hypothesize that the benefits of minimally invasive surgery are applicable to rectal cancer. A cadaver model of laparoscopic rectal resection with total mesorectal excision (TME) and autonomic nerve preservation was utilized to explore this hypothesis. The principles of TME were followed, including high vascular ligation, sharp mesorectal dissection, and identification and preservation of the autonomic pelvic nerves. After proving feasibility in the cadaver model, a clinical study was performed on patients with mid to low rectal cancers. We observed acceptable morbidity with this minimally invasive technique of rectal resection and TME. We conclude that there is growing evidence that laparoscopic methods can be applied to patients with rectal cancer.

Adenocarcinoma↗
PubMed2002

Autonomic nerve preserving total mesorectal excision.

The main objectives of surgery for rectal cancer are cure and the prevention of local or pelvic recurrence. Preservation of pelvic autonomic functions are important associated goals that have influenced the design of the operation. These changes began with modifications to the art of lateral pelvic lymphadenectomy, and with the introduction of sharp pelvic dissection along anatomical pelvic fascial planes for rectal cancer in the mid-1970s. These changes evolved to include deliberate autonomic nerve preservation as a part of the operation that was ultimately reported as TME with ANP [1]. While it is a small nuance. dissection was generally directed to the widest possible pelvic margin--medial to the autonomic nerves, as opposed to just peripheral to the mesorectum. Both sexual and urinary functions are complex. and patients undergoing surgery for rectal cancer may have differing baseline levels of function. Pre-existing benign prostatic hypertrophy or stress incontinence are common physical conditions. Patients bring personal or cultural attitudes to the subject of sexual function with advancing years. in a population with a median age in the mid-sixties. Other health issues such as coronary artery or peripheral vascular atherosclerotic disease, diabetes mellitus. smoking or alcohol intake, or the use of medications to treat these conditions, may influence sexual function. Radiation therapy, frequently used in conjunction with chemotherapy in the treatment of rectal cancer, may be associated with its own incidence of impotence caused via a different mechanism. While radiation may affect the vasa nervosa of the autonomic nerves, leading to fibrosis and dysfunction. radiation therapy may also be associated with smooth muscle fibrosis, causing vasculogenic impotence due to penile outflow dysfunction in the corpora cavernosa. The causes of impotence after surgery alone or after surgery. radiation, and chemotherapy for rectal cancer are complex, and not all answers to the problem reside in autonomic nerve-preservation. Attention to all of the potential causes of impotence and of urinary dysfunction will require continued longitudinal research by clinical investigators from multiple disciplines.

Autonomic Nervous System↗
PubMed2004

Cerebral autoregulation improves in epilepsy patients after temporal lobe surgery.

Patients with temporal lobe epilepsy (TLE) often show increased cardiovascular sympathetic modulation during the interictal period, that decreases after epilepsy surgery. In this study, we evaluated whether temporal lobectomy changes autonomic modulation of cerebral blood flow velocity (CBFV) and cerebral autoregulation. We studied 16 TLE patients 3-4 months before and after surgery. We monitored heart rate (HR), blood pressure (BP), respiration, transcutaneous oxygen saturation (sat-O(2)), end-expiratory carbon dioxide partial pressure (pCO(2)) and middle cerebral artery CBFV. Spectral analysis was used to determine sympathetic and parasympathetic modulation of HR, BP and CBFV as powers of signal oscillations in the low frequency (LF) ranges from 0.04-0.15Hz (LF-power) and in the high frequency ranges from (HF) 0.15-0.5Hz (HF-power). LF-transfer function gain and phase shift between BP and CBFV were calculated as parameters of cerebral autoregulation. After surgery, HR, BP(mean), CBFV(mean), respiration, sat-O(2), pCO(2) and HF powers remained unchanged. LF-powers of HR, BP, CBFV and LF-transfer function gain had decreased while the phase angle had increased (p<0.05). The reduction of LF powers and LF-gain and the higher phase angle showed reduced sympathetic modulation and improved cerebral autoregulation. The enhanced cerebrovascular stability after surgery may improve autonomic balance in epilepsy patients.

Adult↗
PubMed1998

Radical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery and its results: the impact of lateral lymph node dissection.

Lateral lymph node metastases occur in 9% of rectal cancer patients. For cancers localized in the lower rectum below peritoneal reflection, the frequency increases to 13% of all cases and to 25.5% in those of Dukes' stage C. The most important technique in colorectal surgery for decreasing local failure in the pelvis is lateral lymph node dissection. Today, however, it is also regarded as crucial that with perfect lymph node dissection of the lateral area outside of the pelvic plexus, the postoperative functions of urination and sexual ability are preserved. Since 1988 we have performed autonomic nerve-preserving curative resection (ANP) with lateral dissection in most patients with advanced lower rectal cancer. The mean 5-year survival rate of patients with lateral lymph node metastasis from the lower rectum was 37.5%, improving from 32.1% to 43.4% during this period. In cases of ANP with lateral dissection the local recurrence rate was 4.8% overall and 7.4% in the Dukes' C group. Postoperative urinary function has been good or fair in all ANP patients. Sexual function remained problematic, especially regarding male ejaculation. We describe our method for preserving the autonomic nervous system in the pelvis and for achieving complete dissection in the lateral area.

Autonomic Nervous System↗
PubMed2003

Unusual cause of partially reversible severe cardiovascular autonomic failure.

We report an unusual case of partially reversible severe cardiovascular autonomic system failure in a patient with double primary malignancies. The patient presented with severe orthostatic hypotension preceding the detection of lymphoma and lung cancer. The patient had autonomic failure on presentation. One year after surgery and chemotherapy, there was a gradual improvement in both symptoms and autonomic function simultaneously. We conclude that paraneoplastic severe autonomic failure can be reversible.

Autonomic Nervous System↗
PubMed1991

Fine needle aspiration biopsy of thyroid nodules.

Between April 1982 and December 1988, we performed 611 fine needle aspiration (FNA) biopsies in 502 patients with solitary thyroid nodules. The biopsy results were classified as follows: unsatisfactory, 19%; benign, 53%; suspicious, 23%; and malignant, 5%. Malignant lesions were found at surgery in 24 of 25 patients with malignant cytology and 31 of 68 patients with suspicious cytology. Autonomous nodules, obviating the need for surgery, were detected in 5 of 36 (14%) patients with cytology suspicious for follicular neoplasm. We conclude that FNA biopsy of the thyroid nodule is a safe and accurate diagnostic test. Thyroid scintigraphy remains useful in patients with cytologic results suspicious for follicular neoplasm. A cost-effective strategy for managing thyroid nodules is presented.

Adenocarcinoma↗
PubMed1988

Studies of the neurogenic bladder.

A series of 36 patients with specific neurological lesions affecting those parts of the nervous system thought to be involved in the control of bladder function have been studied by urodynamic, electromyographic and neurohistochemical means and the results compared with those obtained in 20 control subjects. In patients with pelvic nerve injury urethral sphincter electromyography (EMG) revealed abnormal motor units and the density of bladder innervation was significantly reduced (P less than 0.01). By contrast, in patients with distal autonomic neuropathy the innervation of the striated muscle of the urethra was unaffected and although there was an almost total loss of nerves from the bladder muscularis, the subepithelial plexus of nerves was preserved. In patients with progressive autonomic failure and multiple system atrophy, the bladder neck was incompetent in every case and the striated muscle of the urethra was affected by a process of denervation and re-innervation. These findings serve to distinguish patients with autonomic failure from those with idiopathic Parkinson's disease and influence the selection of patients for transurethral surgery.

Autonomic Nervous System Diseases↗