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At least 37 records · Page 2Linked to original sources
PubMed1992

[Nerve-sparing cystectomy and ileal bladder substitution].

Nerve-sparing techniques and bladder substitution following radical cystectomy allow today to obviate functional sequelae once registered in this type of surgery. Intraoperative identification of the pelvic plexus, which provides autonomic innervation to the corpora cavernosa, is necessary to preserve sexual function. Ileal orthotopic bladder substitution with preservation of the distal urethral sphincter assures a micturition per urethram and the urinary continence. The Authors report their experience with the Studer and Zingg procedure (ileal orthotopic bladder reservoir) performed in 26 cases. Results, technique, complications, and long-term evaluation are stressed.

Aged↗
PubMed1992

Pre- and postoperative glucose levels for eliciting hypoglycaemic responses in a patient with insulinoma.

Counterregulatory hormones and hypoglycaemic symptoms were studied during a gradual decline in plasma glucose in a 66-year-old man before and 9 weeks after removal of an insulin-producing tumour. Before surgery the adrenaline started to respond first at plasma glucose 2.8 mmol l-1. He reported no autonomic symptoms although plasma glucose fell to 2.3 mmol l-1 with a corresponding adrenaline rise to 4.64 nmol l-1. After surgery adrenaline responded at a plasma glucose of 3.7 mmol l-1 and he started to sweat and tremble at a plasma glucose of 3.1 mmol l-1 (corresponding adrenaline 2.63 nmol l-1). The lack of autonomic symptoms preoperatively may indicate adrenaline insensitivity, possibly as a result of repeated hypoglycaemia.

Aged↗
PubMed1992

The treatment of chronic extremity pain in failed lumbar surgery. The role of lumbar sympathectomy.

Persistent lower extremity pain after unsuccessful lumbar surgery continues to be a disabling condition. The results of deafferentation procedures for radiculopathy have been disappointing. Hence, the prospect of isolating a potentially reversible component of extremity pain is quite attractive. Given the frequency with which vasomotor complaints occur in this setting, the occurrence of autonomic dysfunction seems quite plausible. Autonomic dysfunction was investigated in 17 patients who had undergone previous lumbar surgery and had chronic limb pain. Patients underwent a preblockade thermogram, sympathetic blockade, and postblockade thermograms. All patients reported substantial relief after blockade, and all underwent retroperitoneal sympathectomy. All patients were followed for at least 2 years. The clinical results were disappointing, with only one patient reporting substantial relief. Although the results of thermography initially seemed to correlate with clinical outcome, further follow-up failed to yield any correlation. Additionally, no specific combination of response to blockade or thermogram was predictive of the clinical success after sympathectomy. Now, lumbar sympathectomy is not recommended in the setting of chronic radiculopathy and persistent extremity pain.

Female↗
PubMed1975

Impaired cardiovascular responsiveness in liver disease.

Cardiovascular responsiveness to reflex impaired in patients with cirrhosis compared with control subjects. Peripheral vascular responses to exogenous noradrenaline were also impaired in cirrhotic patients, but peripheral vascular responses to infused adrenaline and to angiotensin II were similar in both groups. Impaired cardiovascular reactivity in patients with chronic liver disease could predispose them to circulatory failure after haemorrhage or surgery and should be considered when prescribing drugs which affect autonomic activity.

Angiotensin II↗
PubMed1979

Respiratory influence on heart rate in diabetes mellitus.

To find a simple and accurate test of autonomic nervous dysfunction in diabetes mellitus, 41 insulin-dependent diabetics and 25 controls were investigated. The diabetics, none of whom had symptoms of autonomic dysfunction, were tested for retinopathy and sensory neuropathy. Each subject also performed maximal deep-breathing procedures while undergoing electrocardiographic recording: in normal subjects the intervals are shortened during inspiration and prolonged during expiration, and a difference in the heart rate between inspiration and expiration of 10% or less seems to indicate autonomic dysfunction. This difference was calculated as an E:I ratio of the mean of the longest R-R interval during maximal expiration to the mean of the shortest during maximal inspiration. Ten of the 18 patients found to have sensory neuropathy had abnormal E:I ratios, and among those with absent ankle reflexes the proportion was even higher (9 out of 11). The E:I ratio also seemed to be as accurate as traditional tests for autonomic dysfunction and easier to perform. Diabetics with autonomic dysfunction have an increased risk of acute cardiorespiratory death during and after surgery, and maximal deep breathing and calculation of the E:I ratio may be a useful test to perform on diabetics at risk.

Adult↗
PubMed1978

Preliminary investigation into a new method of assessing the quality of anaesthesia: the cardiovascular response to a measured noxious stimulus.

It is suggested that the autonomic response to noxious stimulation may be measured during anaesthesia. The response may be marked despite considerable depression of cortical activity as measured by the cerebral function monitor. Preliminary results suggest that large doses of narcotic analgesics reduce the autonomic response to noxious stimulation and this may be used as a test to compare the potency and duration of action of narcotic drugs during anaesthesia. It is possible that the measurement of beat-to-beat variation in heart rate may be used to monitor autonomic nervous system activity and, indirectly, the degree of stress during surgery, provided that the efferent limb of the reflex arc remains intact. With the aid of the cerebral function monitor and with an index of reflex response to noxious stimulation it should be possible to monitor the effect of anaesthesia on the central nervous system more precisely.

Alfaxalone Alfadolone Mixture↗
PubMed1991

Prevention of renal osteodystrophy.

Prevention of bone disease associated with impairment of the renal function is desirable. Attempts at such prevention inevitably also embrace prevention of the extraosseous consequences of autonomous hyperparathyroidism, such as the effects of hypercalcaemia, need for parathyroid surgery, and, perhaps, toxic effects of the parathyroid hormone. Strategies for prevention in early, moderate, and end-stage renal failure are reviewed and discussed with particular reference to dietary phosphorus restriction, use of gut phosphorus binders, control of acidosis, calcium supplementation, use of oral and intravenous calcitriol, and use of synthetic analogues of 1,25-dihydroxyvitamin D3. The onset of severe renal osteodystrophy can be delayed. Early attempts at prevention are logical, but we do not know whether these will reduce the need for parathyroid surgery or will make patients feel better or live longer. The costs of prophylaxis--both financial and in terms of incidence and severity of complications--remain to be defined. An individual approach to each patient with renal impairment seems at present appropriate.

Aluminum↗
PubMed1976

[Sphincter surgery. Etiology and therapy of the anal fissure (author's transl)].

Anal fissures belong to the autonomic diseases. A raised sympathicotonus (spasm dystrophy) is responsible for the origin, the poor healing tendency and the burning pain. This excessive effect of the sympathetic leads first to functional and later to organic disorders of the sphincter in the form of an achalasia. The empirically developed methods of operation have intervention in the autonomic nervous system in common, and only differ in the extent of this "invasion of the autonomic". Functional changes must be treated with local anesthetics or by stretching the sphincter, organic changes by sphincterotomy.

Adolescent↗
PubMed1976

[General anesthesia in major cancer surgery of the upper respiratory and digestive tracts. Significance of a fentanyl-thiamine combination].

Synaptanalgesia uses a polysynaptic inhibitor: thiamine and a powerful analgesic drug with or without nitrous oxide. This type of vigil or sub-vigil anesthesia used in major cancer surgery of the upper digestive tract and the airway, permits one to obtain: -efficacious protection of the autonomic nervous system, in spite of manipulations of highly reflexogenic areas, -a marked reduction in bleeding. The technique used is derived from that of other authors: DE CASTRO, MUNDELEER, VALENI, MAZZONI, GASPARETTO, adapting it to this type of surgery and attempting to simplify it.

Adult↗
PubMed1978

[Approach to a differentiated recurrence prevention following struma surgery].

Changes of the pituitary-thyroid axis were studied in 70 patients (45 with euthyroid goiters, 25 with autonomous adenomas) preoperatively; over a 6-week postoperative interval without thyroid-hormone treatment; under T4 therapy increased stepwise and maintained for 1 year; and over a period of 12 weeks after its withdrawal. The postoperative thyrotropic function obviously depends on the preoperative condition and thereby on the quality of the remaining tissue as well as on the extent of the operation and thus the amount of remaining tissue. The frequency of a "prehypothyroid" status in the early postoperative course is high (77%) after bilateral resection for euthyroid goiter, but decreased 1 year after the operation (47%). After unilateral resection for euthyroid goiters and after bilateral and unilateral resection or enucleation for autonomous adenomas, the remaining tissue is for the most part sufficient to avoid increased pituitary stimulation. Prophylaxis of recurrent goiter with thyroid hormones could be prescribed individually on the basis of the postoperative function of the pituitary-thyroid axis.

Adenoma↗
PubMed1991

The cervical sympathetic nerves in surgery of the neck.

The otolaryngologist-head and neck surgeon is aware that the cervical sympathetic nerves lie behind the carotid artery and should be avoided during neck surgery. To render this sketchy dictum more tangible, relevant anatomy and physiology of the autonomic supply to the head and neck is reviewed, as are aspects of site-of-lesion testing, with respect to Horner's syndrome. Examples of neck operations during which the cervical sympathetic chain--from the base of skull to the root of the neck--may be injured are illustrated.

Autonomic Nervous System↗
PubMed1992

Rhinorrhea after neurotologic surgery.

Rhinorrhea after neurotologic surgery may be indicative of a cerebrospinal fluid (CSF) leak or may be secondary to autonomic dysfunction as a result of injury to preganglionic parasympathetic fibers. Differentiation between these two conditions is essential because undetected CSF rhinorrhea may lead to meningitis and death.

Autonomic Nervous System Diseases↗
PubMed1977

Coeliac plexus block with alcohol for relief of upper abdominal pain due to cancer.

One hundred cases of coeliac plexus block in which absolute alcohol was used as a sclerosing agent, performed over a period of 10 years between 1963 and 1973, are analysed. A success rate of 91% in relieving the pain of advanced intra-abdominal malignant disease is claimed and reasons for failures are advanced. The technique described is relatively simple and a 3-day hospital stay is all that is required. It is recommended that this procedure be carried out before the invalid is subjected to repeated injections of narcotic drugs or any form of surgery for pain relief.

Abdominal Neoplasms↗
PubMed1979

Shy-Drager syndrome. A review and a description of the anaesthetic management.

Autonomic failure in patients with the Shy-Drager syndrome may produce cardiovascular instability during anaesthesia and surgery. The syndrome is reviewed and the anaesthetic management of a case is described. The choice between general and regional anaesthesia seems to be less important than adequate cardiovascular monitoring and the maintenance of blood pressure with intravenous fluids. Sympathomimetic drugs, if used at all, should be administered in very dilute solutions to avoid hypertension from denervation hypersensitivity. In the postoperative period, symptoms from orthostatic hypotension may be severe and their control requires prolonged postural training, by elevation of the head of the bed, and therapy with 9-alpha-fludrocortisone.

Anesthesia, General↗
PubMed1978

Autonomic receptor functions of the human ureter: an in vitro study.

The autonomic receptor functions of ureteral smooth muscle were studied in vitro on strips of human ureter obtained at surgery. A dose-dependent, reproducible, contraction response to 5-hydroxytryptamine (Serotonin, 5-HT) was demonstrated. This response could be blocked by methysergide. Responses to acetylcholine and to drugs stimulating adrenergic receptor functions were also found, but they were weak and inconsistent. This suggests that contraction of ureteral smooth muscle is mediated through receptors which are sensitive to 5-hydroxytryptamine.

Acetylcholine↗
PubMed1992

[Biological and developmental aspects of macronodular adrenal hyperplasia in Cushing's disease].

The pathophysiology of macronodular adrenocortical hyperplasia (MNH) associated with Cushing's diseases remains debatable. Some authors have claimed that MNH represents an autonomous condition that has to be treated by surgical adrenalectomy while others advocate the use of pituitary surgery. We have compared the biochemical features, before and after pituitary surgery, between 7 cases of MHN and 22 cases of diffuse hyperplasia (DH) associated with Cushing's disease. In addition, the diameter of the adrenal nodules after surgery was evaluated in 6 cases. The mean ACTH level in MNH and DH subjects was similar. Dexamethasone suppressibility and the stimulatory effect of metyrapone on ACTH secretion were less in MNH than in DH subjects, suggesting a greater degree of adrenal autonomy in the former. The cortisol responses to metyrapone and CRF tests suggested an increased responsiveness of the adrenals to endogenous ACTH in the MNH group. Only one MNH patient had biochemical features suggesting a primary adrenal disease. The use of a sensitive ACTH assay and the results of inferior petrosal sinus sampling identified the ACTH-dependency of the disease. A short to medium term remission of the disease was obtained in all cases of MNH and in 87% of cases of DH after surgery. The diameter of the adrenal nodules significantly decreased in only 43% of cases. Our results suggest that the adrenal autonomy in MNH is incomplete and that, despite the persistence of the adrenocortical nodules, the disease can be cured with pituitary microsurgery in most cases.

Adrenal Glands↗