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The extrinsic innervation of the abdominal organs in the female rat.

The extrinsic innervation of the abdominal organs in neonatal and adult female rats is described. Mainly an in toto acetylcholinesterase method was used; moreover, formaldehyde-induced fluorescence and acetylcholinesterase were demonstrated in sections. The major splanchnic nerve has its origin in the ninth and tenth thoracic sympathetic trunc ganglia. In the major splanchnic nerve a suprarenal ganglion is present. Sometimes the minor splanchnic nerve, arising from the tenth thoracic ganglion, joins the distal part of the suprarenal ganglion. The left and right major splanchnic nerves join the left and right celiac ganglia in the plexus. The left celiac ganglion is always bigger than the right one. The celiac plexus and the celiac inferior mesenteric plexus are joined by the intermesenteric plexus. Para-aortic nerves, originating in the caudal part of the thoracic sympathetic truncs, also join the abdominal prevertebral plexuses. The lumbar splanchnic nerves, not symmetrical in their origin, join the prevertebral plexuses and give off branches to the abdominal organs. The suprarenal glands receive bundles of nerve fibers, sometimes ganglionated, from the suprarenal ganglion. The kidneys are innervated from the celiac plexus, the upper lumbar splanchnic nerves and the intermesenteric plexus. The ovarian nerves are derived from the celiac plexus, the intermesenteric plexus and the upper lumbar splanchnic nerves. Bundles of nerve fibers run from the suprarenal ganglion in the celiac plexus in the direction of the suspensory ligament of the ovary. In many respects this description is at variance with existing literature on the autonomic innervation in the rat. These differences with the standard literature are relevant to those workers engaged in experiments on the sympathetic innervation of abdominal viscera.

Abdomen↗

[Connections between neurons of sympathetic ganglia and the myenteric nerve plexus of the mammalian colon].

By means of retrograde transport of the fluorescent marker primulin the initial part of the sympathetic innervation of the myenteric nervous plexus of the descending colon has been characterized in cats and guinea pigs. When primulin is injected into the myenteric nervous plexus, marked neurons are revealed in the caudal mesenteric ganglion, in the celiac plexus ganglia, in the sympathetic trunk ganglia. The marked nervous populations of the extramural sympathetic ganglia differ in their form, size, number of neurons and their distribution.

Animals↗

[An "atraumatic" universal needle for single-shot regional anesthesia: clinical results and a 6 year trial in over 30,000 regional anesthesias].

The so-called "atraumatic" needle was developed by modification of two essential features of the Whitacre Spinal needle. The new atraumatic needle tip is universally suitable for all single-shot techniques of regional anesthesia. This is the result of a 6-year test period with 34,950 applications of 24- and 22-Gauge needles in spinal anesthesia, diagnostic lumbar puncture, peridural anesthesia, plexus anesthesia, peripheral nerve blocks with a Teflon-coated version (unipolar electrostimulation), and lumbar sympathetic and celiac plexus blocks. Postspinal headache was observed following 0.02% of punctures for anesthetic or diagnostic purposes. Transient monosymptomatic nerve damage occurred in 1 case after axillary block (0.009%). No permanent neurological sequelae were observed due to vascular, neural, or dural lesions. In comparison, 10 cases of persistent traumatic nerve damage were reported to be caused by conventional needles during the last decade. An analysis of these cases reveals some reasons for underestimating the risk of neurological sequelae after regional anesthesia. The routine clinical use of this type of atraumatic needle revealed no disadvantages with regard to efficacy of nerve blocks or training of anesthetists. Due to the extremely low incidence of postspinal headache, this needle has been used for spinal therapy and diagnostic lumbar punctures in outpatient pain therapy for 2 years. As of this time, the overall risk of outpatient lumbar puncture cannot be estimated. Our experience should encourage further controlled studies to evaluate criteria for excluding those patients unsuited for outpatient spinal anesthesia and lumbar puncture.

Anesthesia, Conduction↗

Left subpancreatic transplexus exposure of the proximal abdominal aorta.

The authors report their experience based on the anatomical study of the celiac region and on the practice of abdominal multiorgan removal for transplantation. They particularly concentrate on the limits and the content of the celiac region of Luschka and particularly: -the position of the celiac axis in relation to the median arcuate ligament of the diaphragm, -the relations of the collateral branches of the abdominal aorta, -the place being taken by the celiac plexus and its situation in relation to the left renal v. From these elements, they describe an original transplexus surgical exposure of the origins of the celiac axis and of the superior mesenteric a. They show the importance of this approach in abdominal vascular surgery and during abdominal multiorgan removal in transplantation.

Aorta, Abdominal↗

Greater splanchnic nerve activity in the rat.

The greater splanchnic nerve trunks in the rat, unlike in other experimental animals, do not join celiac plexus directly. These nerve trunks join small ganglia, the cardiac ganglia, on either side. The cardiac ganglia are located about 1 cm rostro-lateral to unpaired celiac ganglion. The greater splanchnic nerve activity immediately proximal to celiac ganglion is predominantly post-ganglionic in the rat. On the other hand, the activity of the greater splanchnic nerve proximal to the celiac ganglion is predominantly preganglionic in other experimental animals, (e.g., cat), In the rat, preganglionic sympathetic nerve activity is predominant in the segment of the greater splanchnic nerve proximal to the cardiac ganglion.

Animals↗

Effects of autonomic denervation on canine exocrine pancreatic secretion and blood flow.

The effect of autonomic denervation on the exocrine pancreatic secretion and blood flow was studied in a group of dogs. Pancreatic secretion was collected and analyzed for volume and bicarbonate by direct cannulation of the main papilla through a duodenotomy prior to and following truncal vagotomy and celiac plexus denervation. Pancreatic blood flow was determined by the radioisotope distribution method (141Ce). Truncal vagotomy causes a reduction in pancreatic secretion of volume and bicarbonate by 25-30%, while celiac denervation caused a reduction of 70% in the secretion. The mean baseline pancreatic blood flow was 0.5 ml/g pancreas/min. Truncal vagotomy did not cause any significant flow changes, while celiac denervation caused a significant increase in blood flow of 350% (to 1.75 ml/g/min). These results suggest that both the parasympathetic and the sympathetic system affect pancreatic secretion independently of their effect upon pancreatic blood flow.

Animals↗

[Clinical and morphological comparisons in extravasal stenosis of the celiac trunk].

The results of clinico-morphological examinations of 155 patients (of them 118 operated on) with extravasal stenosis of the celiac trunk due to the squeezing of the celiac plexus by the median arcuate ligament, cruses of the diaphragm, and neurofibrous tissue are presented. All the patients had the symptoms typical of "abdominal angina". The tissues taking part in the squeezing of the celiac trunk: the sympathetic ganglion (27 patients), nerve trunks (66 patients), and the surrounding connective tissue (48 patients) were all characterized by inflammatory and sclerotic alterations. Alterations in the form of manifestations of the peptic and duodenal ulcer were found in 18.7% of the patients and various variants of chronic gastritis in 95.4%. Morphological investigations of the liver condition (78 patients) revealed changes in this organ (increased content of lipofuscin, sclerosis, protein and fatty dystrophy, infiltration). The clinical manifestations and morphological alterations are caused by the blood flow disturbance in the celiac trunk due to its stenosis.

Abdomen↗

Innervation of the pancreas from the perspective of perineural invasion of pancreatic cancer.

INTRODUCTION: Pancreatic cancer invasion via neural routes (perineural invasion) has been studied extensively, but detailed research on the morphology of innervation of the pancreas related to perineural invasion is scarce. AIMS: To clarify the morphology of neural distribution in the human pancreas. METHODOLOGY: The pancreas and surrounding structures were dissected in 9 cadavers, the specimens were immersed in a 0.001% solution of alizarin red S in ethanol to stain the peripheral nerves, and the detailed distribution was studied to confirm the extrapancreatic and intrapancreatic plexus using a binocular microscope. RESULTS: The innervation of the uncinate process of the pancreas originated from the superior mesenteric plexus (SMPlx) along the inferior pancreaticoduodenal artery (IPDA), but did not form a wide offshoot of nerve bundles as reported. Concerning the innervation of the body and tail, it was found that the nerve fibers entered the pancreas immediately after leaving the celiac plexus, and were distributed around the pancreatic duct in a twig-like manner. CONCLUSION: It was emphasized that the nerve originating from SMPlx to the uncinate process chiefly ran along the IPDA and it was necessary to focus one's attention not only on the extrapancreatic perineural invasion but also on the intrapancreatic perineural invasion in carcinoma of the body and tail of the pancreas.

Aged↗

Laparoscopic release of celiac artery compression syndrome facilitated by laparoscopic ultrasound scanning to confirm restoration of flow.

A 43-year-old woman presented with symptomatic mesenteric ischemia caused by median arcuate ligament compression of her celiac artery. Magnetic resonance angiography clearly demonstrated stenosis of the proximal celiac artery. She underwent laparoscopic decompression by division of the ligament and excision of the celiac plexus. Laparoscopic Doppler ultrasound scanning demonstrated markedly improved flow in the artery. She was discharged in 15 hours and reported complete resolution of her symptoms at the 3-month postoperative visit. Laparoscopy provides a less invasive but equally effective method for decompressing the celiac artery as well as assessing adequacy of flow after its release.

Adult↗

The origin of the extrinsic adrenergic innervation to the rat ovary.

Cutting the suspensory ligament reduced the ovarian content of norepinephrine (NE) to less than half that of controls and only a few blood vessels had perivascular fibers and an occasional nerve remained in the interstitial gland. Cutting the ovarian plexus had a less drastic, but similar effect on the ovarian content of NE and on the pattern of ovarian adrenergic nerves. Cutting both the suspensory ligament and ovarian plexus eliminated visualization of ovarian adrenergic nerves, but some ovarian NE was still measurable. Fluorescence and electron microscopic studies of the suspensory ligament revealed a large adrenergic nerve embedded in smooth muscle of the ligament. The nerve was also acetylcholinesterase-positive. Cutting the celiac plexus or incising a small nerve lateral to the plexus and medial to the origin of the suspensory ligament, had the same effect on the ovarian adrenergic nerves as cutting the suspensory ligament. It is concluded that the extrinsic adrenergic nerves to the rat ovary reach the organ by two routes: one via the nerve in the suspensory ligament (superior ovarian nerve), and one via the traditionally described ovarian plexus along the ovarian artery.

Acetylcholinesterase↗

[Neural apparatus of the wall of the ductus deferens in the dog].

While studying the innervation sources of the deferent duct in 10 dogs, 2-3 nerves have been revealed that take their origin at the pelvic neural plexus and approach the duct together with the blood vessels at the pelvic neural plexus and approach the duct together with the blood vessels at the place where it crosses the ureter ("the vascular-neural hilus"). In the experiment performed in 65 dogs the nature of these sources has been revealed. The motor innervation is presented by the nodes of the celiac plexus, of the lumbar and sacral parts of the sympathetic trunk, of the subceliac, gonadal and splanchic pelvic nerves, and the sensitive innervation is multisegmental and is performed by the intravertebral nodes L2-S3. Quantitative investigation of the degenerated neural fibers in the dog deferent duct wall demonstrates that the innervation sources mentioned above participate te a various degree along the course of the organ. In the "hilus" the nerves of the dog deferent duct are divided into the proximal nad distal groups. The proximal group runs towards the prostate and forms a plexus with large loops connected with the neural plexuses of the urinary bladder, the ureter and the prostate. It has small neural nodes. The distally directed nerves run, together with the blood vessels, in the deferent duct towards the epididymis. In the deferent duct wall, adventitila, muscular and mucous neural plexus are found, the cholinergic component prevailing the adrenergic one. The plexuses are somewhat better developed at the beginning of the deferent duct and they are especially pronounced in the ampule. The receptors of the organ's wall are simple, poorly branching.

Adrenergic Fibers↗

Splanchnic neural regulation of somatostatin secretion in the isolated perfused human pancreas.

OBJECTIVE: The somatostatin-secreting delta cells in the islets of Langerhans appear to be regulated by neural mechanisms that have not been defined clearly. In this study, the celiac neural bundle of the human pancreas was electrically stimulated in the presence and absence of selective neural antagonists. SUMMARY BACKGROUND DATA: The authors previously reported on studies of the splanchnic neural regulation of insulin, glucagon, and pancreatic polypeptide secretion. In these studies, alpha-adrenergic fibers appeared to have a predominant effect, strongly inhibiting the secretion of insulin, glucagon, and pancreatic polypeptide secretion. Cholinergic fibers appeared to stimulate strongly, although beta-adrenergic fibers weakly stimulated, the secretion of these hormones. Investigations of neural regulatory mechanisms governing human somatostatin release in vitro have not been previously reported. METHODS: Pancreata were obtained from eight cadaveric organ donors. The isolated perfused human pancreas technique was used to assess the regulation of somatostatin secretion by the various neural fibers contained within the celiac plexus. The secretory response of somatostatin was examined in the presence of 16.7 mmol/L glucose, with and without neural stimulation, and specific neural antagonists. RESULTS: The basal somatostatin secretion was 88 +/- 26 fmol/g/min and increased 131 +/- 23% (n = 8, p < 0.01) in response to 16.7 mmol/L glucose. The augmentation seen with glucose was inhibited 66 +/- 22% (n = 8, p < 0.05) during celiac neural bundle stimulation. Alpha-adrenergic blockade resulted in a 90 +/- 30% (n = 6, p < 0.01) augmentation of somatostatin release. Beta-adrenergic blockade caused a 13 +/- 2% (n = 6, p < 0.05) suppression of somatostatin release. Complete adrenergic blockade resulted in a 25 +/- 23% (n = 5, p = not significant) inhibition of somatostatin release. Cholinergic blockade resulted in a 40 +/- 10% (n = 6, p < 0.02) suppression of somatostatin release. CONCLUSIONS: The predominant effect of celiac neural bundle stimulation was inhibition of somatostatin secretion through an alpha-adrenergic effect. Beta-adrenergic fibers stimulate somatostatin secretion; cholinergic fibers have a negligible effect on somatostatin secretion. These data suggest that the splanchnic innervation of the pancreas has a potent regulatory role in somatostatin release in this in vitro human model.

Adolescent↗

[Morphologic and histochemical organization of the pericardial nervous apparatus of vertebrates and humans].

It has been stated that the neuronal apparatus of the vertebrate and human pericardium is represented by plexus of myelinated and amyelinated fibers, nerve cells and receptors. The plexus contain both cholinergic and adrenergic neuronal structures. Pericardial neuronal apparatus in the vertebrates and in man reaches its highes development. In the course of human ontogenesis, free diffuse receptors reveal themselves beginning from the 4th month, and more complex incapsulated ones--from the 5th month of the intrauterine development. Neuronal plexus of the fetal pericardium is formed by the 28th week. Cholinergic neuronal elements in the pericardium begin to reveal themselves at the 13th week, and adrenergic ones--at the 14th week of the intrauterine development. The main source of the afferent and vegetative innervation in the pericardium are inferior and superior thoracic cerebrospinal nodes, vagus nerves and branches from the nodes of the sympathetic trunk. Neuronal fibers composing diaphragmal and parasternal nerves and those of celiac plexus reach the pericardium, too.

Amphibians↗

Synaptic organization of amphibian sympathetic ganglia.

The synaptic organization of the amphibian sympathetic ganglia was studied, especially in the last two abdominal paravertebral ganglia of the frog. These ganglia appear to form a monosynaptic relay, not containing interneurons. They consist of two systems working in parallel: the principal neurons, by far the most numerous, and a small number of chromaffin (i.e., SIF) cells, usually arranged in clusters. Each principal neuron is innervated by a preganglionic branch forming a set of cholinergic synapses which exhibit classical ultrastructure. The only peculiarity is the presence of a subsynaptic apparatus in a variable percentage of synaptic complexes. Electrophysiological studies have demonstrated that synaptic transmission is due to ACh release and involves several postsynaptic potentials. Moreover, the principal neurons are of two types, B and C, whose preganglionic axons and their own axons have different conduction velocities. C neurons tend to be small in diameter, and B neurons are larger, but the size distribution of the two populations overlaps. More recently, it was demonstrated that these two neuronal systems have different immunocytochemical features. The C preganglionic fibers contain an LHRH-like peptide, which is responsible for late synaptic events. The B preganglionic fibers contain CGRP, whose role has not yet been established. The principal neurons all contain adrenaline, but neuropeptide Y is also present in C neurons and could be a second transmitter at peripheral junctions. SP-containing fibers also pass through the ganglia, but give rise to intraganglionic synapses only rarely, except in the celiac plexus. Galanin can coexist with neuropeptide Y in certain C neurons. Numerous principal neurons are immunoreactive for VIP. Chromaffin cells contain noradrenaline and metenkephalin, and some contain SP or LHRH; they are endocrine cells controlled by preganglionic fibers and can have a modulatory effect on principal neurons endowed with appropriate receptors. The accessibility of frog abdominal ganglia and the anatomical separation of B and C preganglionic fiber pathways provide interesting systems in which to carry out experimentation on the stability and specificity of synaptic contacts. After postganglionic axotomy, the majority of synapses disappear by disruption of synaptic contacts. There is a certain discrepancy between the recovery of synaptic transmission and the reappearance of morphologically identifiable synapses, suggesting that a certain amount of transmission is possible at contacts devoid of synaptic complexes. The selective deafferentation of B or C neurons showed that the subsynaptic apparati are mainly found at B neuron synapses. The course of reinnervation following selective deafferentation reveals the existence of different specificities at B and C synapses: C neurons are easily reinnervated by B preganglionic fibers, whereas C fibers appear fairly ineffective at reinnervating B neurons, even after a long interval. Attempts were made to reinnervate ganglionic neurons with somatic motor nerve fibers. Reinnervation was achieved only rarely, and it is concluded that the ganglionic synapses in the frog have a higher specificity and lower plasticity than in mammals.

Animals↗

Pain management in patients with pancreatic carcinoma.

Pancreatic cancer has a very poor prognosis and is often associated with severe pain. A variety of pain syndromes and pain pathophysiologies can be identified. Information about the analgesic efficacy of available oncological treatments is very limited, but the available data suggest that pharmacological and non-pharmacological approaches can be effective in the majority of cases. Guidelines have been developed for drug administration that emphasize indications, selection of routes, optimal dosing, and side effect treatment. Celiac plexus block can be considered for a subgroup of patients who fail to benefit from drug therapy. Optimally, pain management should be provided within a broader model of palliative care, which can address the many problems associated with this challenging disease.

Humans↗

Pain management of the oncologic patient.

After the first 5 years of life, cancer is one of the three most common causes of death. Most investigations of cancer pain have shown that 50-70% of patients suffer needlessly. Pain may be due to the tumor or a co-existant benign pain syndrome. Methods of pain management include: 1) neurolytic blockade: stellate ganglion block, celiac plexus block, lumbar sympathetic block, epidural phenol, subarachnoid neurolysis; and 2) non-pharmacologic methods: radiofrequency thermocoagulation lumbar sympathectomy, transcutaneous nerve stimulation (TENS), dorsal column stimulation (DCS). In summary, we utilize every possible combination of therapeutic modalities for cancer pain management. With so many safe procedures available, we encourage the primary physician to refer patients early in their disease process. Neurolytic procedures should be performed prior to initiation of high dose narcotic therapy, radiation, chemotherapy, and surgery when possible.

Analgesia, Epidural↗

Gastrointestinal invasion by herpes simplex virus type 1 inoculated cutaneously into the immunosuppressed mice.

The pathogenesis of infection in mice with herpes simplex virus type 1 (HSV-1) strain 7401H was studied. Mice immunosuppressed by intraperitoneal injection of cyclophosphamide were inoculated cutaneously into the flank with the virus and developed severe zosteriform skin lesions. All of them died within 2 weeks after the infection, while most of the normal mice survived the viral infection with healing of the lesions. In the gastrointestinal tract of the immunosuppressed mice, macroscopic abnormalities were frequently observed, and infectious viruses were detected on days 7 to 9. The viruses were also detectable in the dorsal root ganglia and the spinal cord of thoracolumbar area on days 5 to 7, and in the celiac plexus on day 7. However, no viruses were detected in the blood. Immunohistological examination of the gastrointestinal tract revealed that the viral antigens were localized in Auerbach's myenteric plexus. These results suggest that HSV-1 inoculated into the flank skin invaded the gastrointestinal tract via the nervous system, which gastrointestinal involvement might possibly have caused the death of the mice.

Animals↗

Chronic pancreatitis: results of operations for relief of pain.

Pancreaticojejunostomy is the method of choice for surgical treatment of pain in chronic pancreatitis in the case of ductal dilation. The operative risk is small and all remaining glandular tissue preserved. At 5 years postoperatively, about two-thirds of the patients still experience pain relief. In the absence of dilated ducts, the surgical options are somewhat more controversial. Parenchyma-saving alternatives such as nerve-cutting procedures have not met expectations. Instead, percutaneous blockage of the celiac plexus using alcohol and phenol have been more commonly used for short-term pain relief. The relatively great number of different resective procedures probably reflects the dissatisfaction with the effect of each one of them. Neither left resection nor total pancreatectomy is, today, an attractive alternative due to the relatively high mortality and morbidity (short- and long-term) risks, especially when evaluated against the backdrop of the limited pain reduction in many patients. The Whipple procedure is still the best alternative, although it should be used with critical selection by both the patient and the surgeon. As for the new operations presented during the 1980's, it is too early to foresee their possible future role. We feel, however, that we still have to await the operation which fulfills the criteria of an ideal operation for pain in chronic pancreatitis.

Chronic Disease↗