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At least 415 records · Page 23Linked to original sources
PubMed1998

The role of endosonography in the diagnosis and management of pancreatic cancer.

Among the various diagnostic tests that may be used to detect and stage pancreatic cancer, endoscopic ultrasound (EUS) is among the most promising. It is a highly sensitive test for detecting pancreatic tumors and for detecting the invasion of these tumors into the portal venous system or loco-regional lymph nodes. With the development of EUS-guided fine-needle puncture, tissue diagnosis of imaged lesions is now possible. This latest advance has improved the specificity and overall accuracy of EUS and also allows for the development of therapeutic applications, such as celiac plexus neurolysis. In this article we review the materials, methods, and clinical applications of EUS for the evaluation of pancreatic cancer.

Endosonography↗
PubMed1996

Interaction between parasympathetic and sympathetic nerves in prevertebral ganglia: morphological evidence for vagal efferent innervation of ganglion cells in the rat.

Vagal efferent preganglionic neurons were anterogradely labeled by injecting either DiI or DiA, fluorescent lipophilic carbocyanine dyes, into the dorsal motor nucleus of the vagus of the rat. All neurons of the peripheral nervous system (outside the blood-brain barrier) were then fluorescently counterstained in vivo by injecting Fluorogold (Fluorochrome, Inc., Englewood, CO) intraperitoneally. The upper abdominal prevertebral ganglia, including the numerous microganglia associated with the periarterial plexuses of the celiac and superior mesenteric arteries, were identified and dissected in formalin-fixed tissue under ultraviolet light and stereomicroscopic guidance. In 14 of 15 animals analyzed (93%), labeled vagal efferent fibers were found to penetrate into both the left and right celiac ganglia and the superior mesenteric ganglion, as well as into some of the associated microganglia. These projections formed varicose terminal-like structures, highly suggestive of synaptic contacts surrounding individual ganglion cells. In about half the animals, such vagal innervation was also seen in the left and right suprarenal ganglia. The specificity of vagal efferent labeling was confirmed by control experiments, which included injections in vagotomized animals and direct selective labeling of vagal afferents from the nodose ganglia. It is concluded that vagal efferent preganglionics innervate principal ganglion cells of prevertebral ganglia. These vagal contacts may either directly modulate the postganglionic outflow or else gate some or all of the potential modulatory inputs to these postganglionic neurons, thus allowing the vagal system to exert a more selective influence on sympathetic outflow. Finally, the use of laser scanning confocal microscopy and the in toto Fluorogold staining method for investigations of the peripheral nervous system are discussed.

Animals↗
PubMed1983

Pancreatic intraductal pressure: II. Effects of autonomic denervation.

The effects of autonomic denervation, local anaesthesia, and electrical stimulation on pancreatic intraductal pressure were studied in a group of dogs. Pressure studies were performed via a catheter placed in the distal pancreatic duct and by a transsphincteric route. Periampullary application of lidocain produced a decrease in the distal pancreatic duct pressure. Bilateral vagal section resulted in a significant pressure decrease while celiac ganglion plexus denervation produced additional pressure decreases. Electrical stimulation of the ampullary region resulted in a significant pressure increase. With transsphincteric pressure studies, bilateral vagotomy did not produce a significant pressure change, while celiac plexus denervation and pancreatic duct perfusion with lidocainin resulted in a moderate decrease in pressure. Electrical stimulation of the completely denervated perampullary region resulted in a significant pressure increase. These results suggest that the autonomic nervous system may affect the pancreatic ductal pressure, via its action on the sphincter mechanism of the main papilla, as well as on the ductal system. Local duodenopancreatic reflexes may play an additional role in controlling pancreatic duct pressure.

Animals↗
PubMed2005

Combined neurolytic block of celiac, inferior mesenteric, and superior hypogastric plexuses for incapacitating abdominal and/or pelvic cancer pain.

Thirty-five patients with extensive abdominal or pelvic cancer who suffered uncontrolled, diffuse, extensive, and incapacitating pain were treated with a combination of neurolytic celiac plexus block (CPB), inferior mesenteric plexus block (IMPB), and superior hypogastric plexus block (SHGPB). The combination of neurolytic CPB, IMPB, and SHGPB was performed with alcohol, mainly using a transintervetebral disc approach. The combination neurolysis produced effective immediate pain relief in all the patients (visual analog scale (VAS), reduced from 8.8 +/- 0.2 to 0). This pain relief persisted during the first 3 months (VAS, 2.3 +/- 0.5) or until death. Morphine consumption was significantly decreased for the first 1 month (from 96 +/- 29 mg to 31 +/- 10 mg per day) after the neurolysis and thereafter continued to be lower than before the surgery, though not significantly so. No serious complications were observed to have been caused by the neurolytic procedure on the three sympathetic plexuses. Our preliminary clinical results suggest that the combination of neurolytic CPB, IMPB, and SHGPB improves the quality of life of patients who have incapacitating cancer pain, by reducing both the intensity of the pain and their opioid consumption, without serious complications. This combination procedure may provide a new therapeutic option for pain relief in patients with advanced cancer.

Abdominal Neoplasms↗
PubMed1991

[Effects of stimulation of arcuate nucleus on intragastric pressure and peripheral pathway analysis in rats].

The effect of electrical stimulation of arcuate nucleus (ARC) on intragastric pressure (IGP) was examined on 68 Wistar rats anaesthetized with urethan. The results were as follows: (1) Stimulation of ARC could induce an obvious decrease of IGP. (2) This effect was not blocked by atropine but partially by vagotomy. (3) Extirpation of celiac neural plexus or intramuscular injection of phentolamine could obviously reduce the suppression of IGP induced by ARC stimulation, but intramuscular injection of propranolol had no such effect. (4) After vagotomy plus extirpation of celiac neural plexus, IGP could still be made a decrease by stimulating ARC. In view of the present investigation, it is suggested that (1) Both sympathetic nerve and vagus are involved in the reduction of IGP induced by ARC stimulation, the former and the latter routes being respectively mediated by alpha-adrenoceptor and non-cholinergic, non-adrenergic fibres. (2) Humoral factors may be also involved in this effect of ARC stimulation.

Animals↗