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At least 397 records · Page 22Linked to original sources
PubMed1986

[Cushing's syndrome caused by multinodular adrenocortical dysplasia in a 3-year-old child. Association with a neurologic syndrome].

A case of multinodular pigmented adrenocortical hyperplasia occurring in a child aged 4 years is reported. The disease suggested an autonomously functioning lesion with low plasma ACTH. At surgery both adrenals presented with brown or yellow patches on the surface corresponding to multiple nodules. Unilateral adrenalectomy was followed by complete recovery and normal ACTH response to IV lysine vasopressin with a follow-up of 3 years. The patient also presented mild spastic diplegia and retarded mental development of unexplained origin.

Adrenal Cortex↗
PubMed1981

[Treatment results in radio-iodine therapy of the autonomous adenoma of the thyroid gland (author's transl)].

In order to control the results of radio-iodine therapy, the autonomous adenomas treated in our clinic from 1961 to 1975 with radioactive iodine on 105 patients have been subjected to follow-up examinations and compared with the results obtained by other authors, especially Swoboda et al. (23), who treated 185 patients with corresponding follow-ups. In both groups, efforts were aimed at achieving successful treatment via high single-dose radio-iodine therapy. The article discusses the indication, method, results and posttherapeutic care involved. Both the examined groups demonstrate good treatment results (in 95 or 98%, respectively, of our cases and of the cases treated by Swoboda et al., the autonomous adenoma was eliminated). This proves that high single-dose therapy with radioactive iodine (I131) is a successful method of treating an autonomous adenoma, thus representing a therapeutic alternative to surgery.

Adenoma↗
PubMedDate not supplied

Wittmoser's technique of thoracoscopic sympathectomy and vagotomy.

His extensive developmental and clinical work made Raimund Wittmoser a major trailblazer in endoscopic surgery from the 1950s on. His single-puncture technique for operative thoracoscopy permitted surgical interventions of peerless quality on the sympathetic and vagal nerves. His basic surgical principle was to achieve the greatest possible selectivity by a segmental approach to the sympathetic rami communicantes or the individual branches of the vagus nerve. Besides his extraordinary surgical skills, his particular achievement was the development of new instrumental and ancillary technologies for endoscopic surgery. In addition to the development of new endoscopes and imaging systems, his pressure-regulated CO2 insufflation system and low frequency cautery technique had major impact on the further development of endoscopic surgery. Finally, Wittmoser's surgical interventions in the autonomic nervous system were of outstanding quality and set standards still observed by thoracoscopic surgeons today.

Germany↗
PubMed1987

Autonomic nervous system regulation of murine immune responses as assessed by local surgical sympathetic and parasympathetic denervation.

The effect of local sympathetic denervation on immune responses of submaxillary lymph nodes (SmLN) of mice was examined in animals subjected to unilateral superior cervical ganglionectomy (SCGx). Norepinephrine (NE) content in ipsilateral SmLN decreased by 90% 7-20 days after SCGx, while bilateral SCGx resulted in a 91% decrease of SmLN NE content. SmLN of mice subjected to unilateral SCGx exhibited greater plaque-forming cell (PFC) response than the innervated contralateral SmLN, when challenged i.d. or i.p. with sheep red blood cells (SRBC) 10-20 days after surgery. In mice challenged with SRBC at an early phase of sympathetic nerve paralysis (i.e., 2 h after SCGx), PFC response was already increased in the ipsilateral SmLN whereas during the anterograde degeneration of nerve endings (6-24 h after SCGx) an impending depression of PFC number was observed. Contact hypersensitivity and allogeneic delayed-type reactions were also enhanced in the ear ipsilateral to SCGx. Primed SmLN cells of nodes located ipsilaterally to SCGx, when injected to (BALB/c x C57BL/6) F1, resulted in significantly higher spleen index than similarly treated, contralateral SmLN. In contrast, mitogenic stimulation under various experimental protocols failed to reveal significant differences between proliferation of cell populations obtained from ipsilateral and contralateral SmLN of unilaterally SCGx mice. SmLN of mice parasympathetically decentralized by unilateral sections of the chorda tympani-lingual nerve trunk showed lower PFC response than the innervated contralateral SmLN, when challenged with SRBC 8-28 days after surgery. These results suggest a regulatory function of the autonomic nervous system in immune reaction.

Animals↗
PubMedDate not supplied

[Use of remifentanil in ambulatory obstetric-gynecologic surgery. A dose-effect study].

BACKGROUND: Remifentanil, a recently commercialised opioid, is characterised by a predictable and non cumulative effect which vanishes rapidly without determining side effects in the long term. These characteristics make remifentanil an ideal opioid in continuous infusion for the ambulatory surgery setting. Aim of this study was to assess the ideal dose of remifentanil, administered in bolus before propofol, in patients undergoing uterine curettage and assisted by mask ventilation in 100% oxygen. METHODS: Sixty patients, ASA status I-II, scheduled for uterine curettage, were divided into three study groups according to the bolus dose of remifentanil received before the induction agent: group A (n = 20) 1 microgram/kg; group B (n = 20) 2 micrograms/kg; group C (n = 20) 2 micrograms/kg. All patients were assisted by 100% oxygen ventilation with facial mask. During surgery the following were recorded: time to spontaneous ventilation (in case of post induction apnea); incidence of somatic and autonomic responses to surgical stress (treated with remifentanil in bolus). At the end of surgery the times to response to simple verbal commands, to discharge from the recovery room (by Aldrete score every 5') and to discharge from hospital (by PADSS score every 30') were registered. RESULTS: All patients presented post-induction apnea with a significantly more rapid return to spontaneous ventilation in group A. Six patients of group A responded to surgical stress while in groups B and C there was no need for supplementary boluses (p < 0.05). Five patients of group C were treated with atropine for bradycardia, in four of group C it was necessary to administer succinylcholine for thoracic rigidity. No significant differences regarding the anesthesia recovery times were observed. All patients were discharged from the recovery room after 10' from the end of surgery. Overall, the qualification for discharge from hospital was obtained at the second PADSS score control, except for one group A patient who incurred in metrorrhagia. CONCLUSIONS: The administration in bolus of remifentanil, before the inducing agent, permits short-term surgery in ambulatory surgery settings thanks to the rapid recovery of vital functions. Compared to the other doses, the 1.5 micrograms/kg dose guaranteed a good control over surgical stress without influencing the speed of awakening and without determining uncomfortable side effects.

Adult↗
PubMed1998

Influence of type of surgery on the occurrence of parasympathetic reinnervation after cardiac transplantation.

BACKGROUND: Cardiac autonomic reinnervation after human cardiac transplantation has been demonstrated frequently but to date only for sympathetic efferents. Standard surgical techniques leave many parasympathetic branches intact in the original atria and thus with less stimulus to reinnervate the donor atria. METHODS AND RESULTS: We used changes in the RR-interval power spectrum induced by sinusoidal modulation of arterial baroreceptors by neck suction at different frequencies to detect both parasympathetic and sympathetic reinnervation in 79 subjects with "standard" and 10 "bicaval" heart transplants. In 24 subjects (17 standard and 7 bicaval), the protocol was repeated 6 and 11 months after transplantation. Neck suction at 0.20 Hz produced a component at 0.20 Hz in the RR-interval spectrum not due to respiration (fixed at 0.25 Hz), which suggested parasympathetic reinnervation, in 4 of 10 bicaval but in only 2 of 79 standard transplant subjects (whose recipient atria underwent >50% resection to remove scars of previous interventions), P<.001. In only 1 (bicaval) transplant subject was parasympathetic reinnervation present 6 months after transplantation (confirmed 3 months later); in 4 subjects, it was absent at 6 months but appeared after 11 months after transplantation. Atropine (0.04 mg/kg i.v.) abolished the response to fast (0.20 Hz) and reduced that to slow stimulation, confirming the presence of parasympathetic reinnervation (4 subjects). CONCLUSIONS: Parasympathetic reinnervation depends on the surgical technique: because bicaval surgery cuts all sympathetic and parasympathetic nerves, regeneration might be stimulated similarly in both branches. Standard surgery cuts only approximately 50% of sympathetic fibers; most recipient parasympathetic axons remain intact, hence their regeneration might not be stimulated.

Atropine↗
PubMed1993

Reversibility of unawareness of hypoglycemia in patients with insulinomas.

BACKGROUND: A lack of appropriate autonomic warning symptoms before the development of neuroglycopenia occurs frequently in patients with diabetes mellitus. The pathogenesis of this phenomenon is unclear, but it is associated with intensive insulin therapy, prolonged duration of diabetes, frequent episodes of hypoglycemia, and impaired glucose counterregulation. Recently, it has been proposed that repeated episodes of hypoglycemia may themselves induce the phenomenon. METHODS: To test this hypothesis and to determine whether the phenomenon is reversible, we assessed autonomic and neuroglycopenic symptoms, counterregulatory hormonal responses, and cognitive function during stepped hypoglycemic-clamp studies in 6 patients with insulinomas before and approximately six months after curative surgery and in 14 normal subjects matched for age, weight, and sex. RESULTS: Before surgery, the patients with insulinomas had lower scores than the normal subjects for autonomic symptoms (mean [+/- SD], 3.5 +/- 0.8 vs. 9.6 +/- 4.5) and neuroglycopenic symptoms (2.8 +/- 1.5 vs. 8.9 +/- 5.3). The patients also had impaired counterregulatory hormonal responses (their plasma epinephrine, norepinephrine, glucagon, growth hormone, and cortisol responses before surgery were 187 +/- 227 pg per milliliter [1.03 +/- 1.25 nmol per liter], 223 +/- 85 pg per milliliter [1.32 +/- 0.50 nmol per liter], 86 +/- 21 ng per liter, 7.4 +/- 5.2 micrograms per liter, and 12.1 +/- 1.5 micrograms per deciliter [334 +/- 41 nmol per liter], respectively, as compared with 842 +/- 439 pg per milliliter [4.63 +/- 2.41 nmol per liter], 519 +/- 150 pg per milliliter [3.07 +/- 0.89 nmol per liter], 201 +/- 58 ng per liter, 25.3 +/- 13.7 micrograms per liter, and 26.3 +/- 1.2 micrograms per deciliter [726 +/- 33 nmol per liter] in the normal subjects) and less deterioration in cognitive function than the normal subjects during hypoglycemia (sum of z scores for seven tests of cognitive function, 1.7 +/- 1.9 vs. 8.9 +/- 3.5) (P < 0.02 for all comparisons). Surgical cure reversed all these abnormalities (P not significant for all comparisons with the normal subjects). CONCLUSIONS: Hypoglycemia itself can induce unawareness of the autonomic and neuroglycopenic symptoms of hypoglycemia and decrease the counterregulatory hormonal responses to hypoglycemia.

Adult↗
PubMed1998

Cytopathological findings from fine-needle aspiration biopsy are accurate predictors of thyroid pathology in patients with functioning thyroid nodules.

The cytopathological findings after fine-needle aspiration biopsy (FNAB) of functioning solitary thyroid nodules (FSTN) are not well defined. This is an important issue, once this procedure is the first step in nodule evaluation. This study evaluated FNAB findings and correlated these findings with histopathology in patients subjected to thyroidectomy. Eleven clinically euthyroid female patients (age range: 19 to 47 years) with FSTN, satisfactory specimens from FNAB and negative antithyroid antibodies were studied. Seven patients had autonomous nodules. The cytopathological findings were of follicular pattern suggestive of neoplasia in one case where the histopathological examination confirmed a follicular adenoma. In all other 6 autonomous cases, the smears were suggestive of colloid goiter and they had surgery due to compressive symptoms (n=4) or subclinical hyperthyroidism (n=2). The histopathological results confirmed colloid goiter in all except one who presented a follicular adenoma. Four patients had functioning thyroid nodules that suppressed their 1311 uptake after receiving T3. The cytopathological findings were considered malignant in one case surgically confirmed to be a papillary carcinoma. In all other 3 non-autonomous cases, the smears were suggestive of colloid goiter and they had surgery due to compressive symptoms (n=1), aesthetic reasons (n=11) or increase in nodule volume (n=1). The histopathological results confirmed colloid goiter. In conclusion, FNAB was an accurate predictor of thyroid pathology in FSTN without false-positive results in the present study.

Adenoma↗
PubMed2000

Cardiac responses associated with affective processing of unpleasant film stimuli.

The autonomic basis of cardiac reactions to unpleasant film stimuli was investigated. Film clips depicting major surgery, threats of violence, and neutral material were presented to 46 subjects. Self-report measures of emotion were obtained, as well as heart rate, respiration rate, respiratory sinus arrhythmia, T-wave amplitude and skin conductance level. Resting vagal tone was estimated in a paced breathing task prior to film viewing. Spontaneous blink rate was also taken as a measure of visual engagement during film viewing. Coherent increases in sympathetic activation accompanied the film containing violent threats, whereas the surgery film yielded greater electrodermal activation, as well as heart rate deceleration and T-wave increase. These data support the hypothesis of differential autonomic response patterns to specifically unpleasant material. As compared with threat and neutral films, greater blink rate inhibition was observed during the surgery film. Individual differences in parasympathetic cardiac control measured at rest were able to discriminate cardiac response patterns during film viewing.

Adult↗
PubMed1994

Effects of music on cardiovascular reactivity among surgeons.

OBJECTIVE: To determine the effects of surgeon-selected and experimenter-selected music on performance and autonomic responses of surgeons during a standard laboratory psychological stressor. DESIGN: Within-subjects laboratory experiment. SETTING: Hospital psychophysiology laboratory. PARTICIPANTS: A total of 50 male surgeons aged 31 to 61 years, who reported that they typically listen to music during surgery, volunteered for the study. MAIN OUTCOME MEASUREMENTS: Cardiac responses, hemodynamic measures, electrodermal autonomic responses, task speed, and accuracy. RESULTS: Autonomic reactivity for all physiological measures was significantly less in the surgeon-selected music condition than in the experimenter-selected music condition, which in turn was significantly less than in the no-music control condition. Likewise, speed and accuracy of task performance were significantly better in the surgeon-selected music condition than in the experimenter-selected music condition, which was also significantly better than the no-music control condition. CONCLUSION: Surgeon-selected music was associated with reduced autonomic reactivity and improved performance of a stressful nonsurgical laboratory task in study participants.

Adult↗