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PubMedDate not supplied

Pelvic anatomy for colorectal surgeons.

INTRODUCTION: recent advances in rectal surgery include total mesorectal excision and preservation of the autonomic pelvic nerves, so that colorectal surgeons have to get some information on the embryology of the rectum, on the complex anatomy of the pelvic floor and on the distribution of lymphatic nodes. Embryology includes the formation of the hindgut during the first month of the embryo and the subsequent formation of the rectum and anal canal. The mesorectum contains the blood vessels and the lymphatic nodes. To totally excise the mesorectum, the surgeon should follow the "holy plane" described by Heald, between the perirectal fascia and the pelvic fascia. Doing this, the surgeon has the best chance to preserve the autonomic pelvic nerves that comprise the superior hypogastric plexus, the right and left hypogastric nerves and the right and left inferior hypogastric plexuses.

Colon↗

PubMed1979

Reduced vibratory perception and corneal sensitivity and metabolic disturbances following intestinal bypass surgery.

Decreased corneal sensitivity and vibratory perception suggesting a diagnosis of polyneuropathy were demonstrated in some of 26 patients who had undergone intestinal bypass surgery. Psychological tests revealed signs of disturbance of the autonomic nervous system. A deficiency of 25-hydroxyvitamin D was demonstrated, clearly related to the frequency of stools and to the weight loss. This deficiency might play a role in the pathogenesis of the polyneuropathy.

Adolescent↗

PubMed2006

Biological effect of far-infrared therapy on increasing skin microcirculation in rats.

BACKGROUND/PURPOSE: Insufficient microcirculation of skin leads to acute and chronic tissue ischemia in cases of trauma, reconstructive surgery, diabetes mellitus and peripheral arterial occlusive disease. The autonomic nervous system and nitric oxide (NO) play important roles in maintaining blood perfusion of the skin. Far-infrared (FIR) therapy provides low energy of light emitted from an artificial radiator and has been used to treat many vascular-related disorders. Nevertheless, the mechanisms through which FIR works remain unclear. The present study aims to test the hypothesis that the effect of FIR is through increasing skin microcirculation by a mechanism other than its thermal effect. METHODS: Sixty rats were used in the present study. A WS TY301 FIR emitter was placed 20 cm above the rats. Skin temperature and blood flow were continuously measured by a K-type thermocouple. Under laboratory control, the abdominal skin temperature steadily increased from 38-39 degrees C, and was kept at constant temperature. Skin microcirculation was measured with a continuous laser Doppler flowmeter. RESULTS: There was no significant change of skin blood flow during FIR treatment. Skin blood flow increased significantly soon after the removal of the FIR emitter. The stimulating effect on skin blood flow was more significant in the rats treated with FIR for 45 min and could be sustained as long as 60 min. These findings suggested a non-thermic biological effect of FIR on skin microcirculation. The promotive effect of FIR on increasing skin blood flow was not influenced by pretreatment of APP (atropine, propranolol and phentolamine), but was suppressed by pretreatment with NG-nitro-L-arginine methyl ester (an endothelial nitric oxide synthase inhibitor). CONCLUSION: In conclusion, FIR therapy exerts a NO-related biological effect to increase skin microcirculation in rats. This might bring into perspective the clinical application of FIR to treat ischemic disease by augmenting L-arginine/NO pathway.

Animals↗

PubMed2001

Lin-Telaranta classification: the importance of different procedures for different indications in sympathetic surgery.

BACKGROUND AND AIMS: The second sympathetic thoracic ganglion has long been regarded as the most important structure in all sympathetic procedures for any indication, be it hand sweating, blushing, or social phobia. Earlier, we had found an interesting new basis for the selection of more specific methods in individual disorders. The aim of the present study was to either confirm the old theory or to bring forward a more appropriate theory for sympathetic surgery to be used as a classified method. MATERIAL AND METHODS: Altogether 193 patients were treated in Taiwan and 55 in Finland according to the new selective principle. Endoscopic sympathetic block of the second thoracic ganglion (ESB 2) was used as a method for conflicted type of social phobia or blushing for 25 patients. ESB 3 was used for facial sweating and blushing for 55 patients. ESB 4 was used for hand and axillary sweating for 168 patients. Reflex sweating was taken as the most important sign of unsuccessful surgery. RESULTS: All patients benefited of the procedure in their presenting symptoms. Four of 25 cases in ESB 2 -group and three of 55 cases in ESB 3 -group had unacceptable reflex sweating. No patient with reflex sweating was found in ESB 4 -group. These results confirm our previous findings, that sympathetic nerves innervate the human body in similar dermatome fashion as the peripheral nervous system. According to this, we organized the various sympathetic disorders into three main categories: those restricted within the head, like conflicted type social phobia and conflicted type blushing, to Group 1; those on the head and face, like sweating with or without blushing, to Group 2; and those in the hands and underarms to Group 3. The principle of different surgical procedures for different disorders of the sympathetic system are proposed: ESB 2 for Group 1, ESB 3 for Group 2, and ESB 4 for Group 3 disorders. CONCLUSIONS: We call this new classification "Lin-Telaranta classification". Not only the incidence of complication rates is lowered but also the side effects can be predicted by the Lin-Telaranta classification in sympathetic surgery.

Autonomic Nervous System Diseases↗

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↗

PubMed1980

[Granulomatous tumors of a pseudo-Hodgkin type of the thymus gland (thymus gland lymphogranulosarcomas)].

The group of thymic lymphogranulosarcomas are losing their pathologic individuality as autonomous thymic tumors with particular histological and special evolutive characters. Experience shows that a good number of alleged "pseudo-hodgkinian thymomas" have evoluted in the hodgkinian mode. From a total of 56 apparently autonomous thymic tumors operated on in the Department of Surgery A at this hospital, 9 thymic lymphogranulosarcomas have been identified. Our observations confirm that "pseudo-hodgkinian" tumors of the thymic lodge are rather Hodgkin's disease or a primitive-ganglion Hodgkin's disease localized in the thymic lodge. In practice, the discovery of granulomatous tissue in a thymic lodge tumor, even in the absence of typical Sternberg cells, requires a search for other localizations to determine the evolutive stage of the disease. Experience shows that partial or total surgical excision, followed by combined chemotherapy, exploratory laparotomy and radiotherapy, offer the best chances of long term survival at present.

Adult↗

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↗

PubMed1990

[Large bowel cancer: prognostic factors, surgical treatments and their results].

Although the classification proposed by Dukes has been repeatedly modified, causing unnecessary confusion, his original concept remains unrefuted; cancer penetration through the bowel wall and lymph node metastasis are two major prognostic factors, of which nodal metastasis represents a more advanced stage. However, the results of our exhaustive computer analyses did not support this concept, and better classifications may be developed using our computer algorithm, enabling us to refine the indication for extensive surgery or limited resection. There are two trends of surgical treatment in Japan. One is an attempt to extend the area of resection including the paraaortic and parailiac nodes, and also iliac vessels. Patients treated by this method show a higher survival rate if compared with historical controls in Japan. However, extensive surgery of the rectum is associated with poor quality of life with bladder and anal dysfunctions as well as sexual impotence. The other trend is to limit the extent of resection and minimize the functional defect. The organs thus saved include the sphincter and autonomic nerves. The results are almost comparable with those of more radical surgery. With aggressive re-resection of recurrent tumors in the liver, lungs, lymph nodes and local areas, the number of long-term survivors is now increasing who would otherwise have died.

Colorectal Neoplasms↗

PubMed1994

Unilateral mydriasis after induction of anaesthesia.

Unilateral mydriasis is a disturbing finding during anaesthesia and may indicate serious neurological injury. In addition, the assessment of abnormal neurological findings is limited during general anaesthesia, and therefore requires special consideration. I report finding a dilated right pupil (7 mm, nonreactive to light) after bronchoscopic tracheal intubation and induction of general anaesthesia in a frail, 74-yr-old woman with cervical subluxations and spinal cord impingement. The possible aetiology of the unilateral mydriasis includes the effects of anaesthetic agents, stellate ganglion block, impaired venous return from the head and neck, acute intracranial mass lesion or an haemorrhagic event, direct eye trauma, pre-existing medical or surgical conditions, and inadvertent direct deposition of alpha-adrenergic or anticholinergic agents in the eye. Consideration of these factors, the autonomic innervation of the eye, and an intraoperative "wake-up" test allowed satisfactory neurological assessment in this patient and surgery to proceed. Unilateral mydriasis, while unusual, may be seen during general anaesthesia and requires thorough knowledge of autonomic nerve pathways and pharmacology of the eye for correct diagnosis. In this case, mydriasis was considered to result from phenylephrine/lidocaine spray which was used to provide topical anaesthesia to the airway.

Aged↗

PubMed1993

Autonomic dysreflexia after brainstem tumor resection. A case report.

Autonomic dysreflexia is a poorly understood entity, typically occurring in the spinal cord-injured patient, with paroxysmal hypertension, bradycardia, severe throbbing headache, anxiety and sweating above the level of the lesion. An 18-year-old man underwent removal of a hemangioblastoma from the inferior portion of the fourth ventricle, a region known as the area postrema. Postoperatively he exhibited signs of autonomic failure. He later developed recurrent paroxysmal episodes of abdominal pain, hypertension, skin flushing and headaches. He subsequently was found to have a gastric ulcer. Symptoms and signs significantly improved with its treatment. We postulate that diminished sympathetic outflow occurred as a result of the surgery, creating a situation similar to the spinal cord-injured patient. Autonomic dysreflexia was elicited as a consequence of the noxious input of the gastric ulcer. In other cases of brainstem tumor resection, unrecognized episodes of autonomic dysreflexia may occur. This case also indicates that sympathetic supraspinal control is located at the level of the medulla or higher.

Adolescent↗

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↗

PubMed1958