[AFTER 25 YEARS OF SURGERY OF THE SYMPATHETIC NERVE IN GYNECOLOGY].
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Autonomic Pathways↗
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Results for “Autonomous surgery”
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[Use of gangliolytics in maxillofacial surgery].
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Adult↗
[Peculiarities of endotracheal anesthesia in gynecologic surgery].
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Adolescent↗
[Study of the topographic innervation of the ANS of the human stomach. Consideration on the future of gastroduodenal surgery for ulcer].
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Autonomic Nervous System↗
["Single potential analysis of cavernous electric activity" (SPACE). Findings before and after surgical dissection of the cavernous nerves within the scope of radical prostatectomy].
Single potential analysis of cavernous electric activity (SPACE) is said to give information on the integrity of the central and peripheral parts of the autonomic nervous system insofar as it is involved in erectile function. A total of 30 patients who underwent radical prostatectomy with simultaneous severance of the cavernous nerves as treatment for locally advanced cancer were investigated by SPACE before and after the operation. The findings were compared to the those recorded on two different dates in 20 age-matched men who had not undergone surgery and in whom there was no evidence of any lesion of the autonomic nervous system. Even in this control group, few reproducible results were found. Nevertheless, with reference to the items "number of wedges" (i.e. monophasic elements with amplitudes of 25-100 microV) and "maximum amplitudes" of SPACE potentials there was a more than change correlation of the values on the two test dates, which was not found in the prostatectomy group. Although this difference between the two groups investigated was statistically significant, these findings cannot be interpreted as an effect of autonomic denervation of the cavernous bodies. This is attributed to the fact that the postoperative results in the prostatectomy group were more similar to the findings in the control group than to the preoperative measurements taken while the autonomic innervation was still intact. Therefore, our investigations lead us to conclude that routine application of SPACE as a direct check on the integrity of the autonomic nerve fibres involved in erectile dysfunction is not justified at present.
Adult↗
Autonomic dysreflexia triggered by an unstable lumbar spine in a quadriplegic patient.
A 40 year-old man with C5 complete quadriplegia, had L2-L3 pyogenic spondylitis treated with debridement and fusion of the lumbar spine with left iliac bone graft. Three months later he developed symptoms of autonomic dysreflexia, including headache, cold sweating, and hypertension whenever he was in an upright position. These symptoms resolved after lying down. Roentgenograms of the lumbar spine revealed absorption of the bone graft at the L2-L3 level. A spinal stabilization procedure was done after eight weeks of antibiotic therapy under the impression of unstable spine caused by pyogenic spondylitis. Symptoms were relieved immediately following the surgery. This report may be helpful for physicians caring for quadriplegic patients with autonomic dysreflexia induced by an unstable spine.
Adult↗
[The Giessen model of a cement-free implantable total endoprosthesis for the hip joint].
Complete endoprostheses of the bitrochanteric type were implanted in Giessen in 111 patients the average age of whom was 74 years. Computer-assisted evaluation showed that more than 70% of these patients developed autonomous mobility. The rest had not been able to walk before surgery, but could be nursed or became able to sit after the operation or were still followed up. At the end of follow-up treatment, a rate of 90% of mobile patients with or without stick is to be expected. Initially, the implantation technique is certainly more difficult to learn with this model than with other allo-endoprostheses of the hip joint. This is due to the fact that the implants are an exact replica of the pertrochanteric region, thus permitting a broad contact face to the cortical substance instead of the punctiform contact of some other models. Once learned, the technique can be applied without considerable problems. At our Department it has proved to be successful.
Aged↗
Clinical characteristics of perioperative coronary spasm: reviews of 115 case reports in Japan.
PURPOSE: Factors affecting perioperative development of coronary spasm have not been elucidated. A number of case reports describing perioperative coronary spasm have appeared in Japanese anesthesia journals, mostly published in Japanese. The purpose of this study was to investigate the contributing factors affecting perioperative coronary artery spasm by reviewing the published articles. METHODS: Reports were identified by using Medline database (1968-1998) or by manually searching nonindexed Japanese journals. The clinical characteristics of perioperative coronary spasm were analyzed in 115 patients who developed coronary artery spasm during the perioperative period. RESULTS: The mean age of the patients was 64 +/- 9 years (range, 36 to 87 years). There were 97 men (84%) and 18 women (16%). Preoperative risk factors included hypertension (27%), angina pectoris (27%), cigarette smoking (13%), and diabetes mellitus (11%). The attack was related to inadequate depth of general anesthesia (23%), use of vasopressors (22%), vagal reflex (19%), administration of drugs other than vasopressors (17%), and epidural block (15%). About 85% of patients showed no ischemic abnormality on the preoperative electrocardiogram, whereas 56% had significant coronary stenosis on postoperative coronary arteriography. Coronary spasm tended to occur in patients under inhalation anesthesia combined with epidural block. Nitrates alleviated the episode in the majority of cases, whereas defibrillation and cardiac massage were required in 19% of patients. No deaths were reported. CONCLUSION: Perioperative coronary spasm is prevalent in elderly male patients with coronary risk factors who undergo abdominal or thoracic surgery under inhalational anesthesia combined with epidural anesthesia. Instability of the autonomic nervous system and/or vascular hyperreactivity may be the underlying pathogenic mechanisms of perioperative coronary spasm.
Journal Article↗
[New concepts for staging and therapy of cervix cancer by endoscopic surgery].
Non-invasive staging of cervical cancer according to FIGO is out-dated. In contrast to clinical staging exact histopathologic evaluation of tumor extension and tumor biology can be achieved via laparoscopic evaluation. Invasive endoscopic staging is advantageous and should be integrated into the diagnostic armamentarium of gynecologic oncologists and radiotherapists. Through magnification and blood-less surgery minute anatomical structures can be identified laparoscopically. Thus, fibers of autonomic nerves can be visualized and parasympathetic fibres can be preserved. Conservation of these neural structures leads to significant reduction of postoperative morbidity of bladder and rectum. The concept of the sentinel lymph node is also valid for the uterine cervix. Selected biopsy of the sentinel node and identification of single tumor cells leads potentially to higher oncologic safety and may reduce morbidity associated with radical lymphadenectomy. In early stage cervical cancer fertility may be preserved by radical trachelectomy which is combined with laparoscopic parametric and pelvic lymphadenectomy. Following radical trachelectomy a pregnancy rate of 40% is achieved, the recurrence rate following conventional radical hysterectomy is identical.
Cervix Uteri↗
Management of hyper & hypo thyroid conditions.
In hyperthyroidism, the primary objective of therapy is to reduce secretion of thyroid hormone, which can be accomplished in various ways. The stimulus to hypersecretion can be removed in some causes of hyperthyroidism; in others, hormone synthesis and release can be inhibited by drugs such as thioamides, adrenergic blocking agents, or possibly lithium or glucocorticoids. Radioactive iodine is indicated for primary therapy of uncomplicated hyperthyroidism due to Graves' disease in persons over 30 years of age (myxedema may be a complication) and for treatment of autonomous thyroid adenoma in patients who are not suitable candidates for surgery. Surgical ablation is preferred for some causes of hyperthyroidism but may induce postoperative hypothyroidism. Hypothyroidism due to thyroid failure usually presents few therapeutic difficulties and can be managed simply by long-term hormone replacement. Before hormone replacement is prescribed for secondary or tertiary hypothyroidism, the other pituitary functions should be assessed.
Adult↗
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↗
The effect of posterior sagittal anorectoplasty and its variants on lower urinary tract function in children with anorectal malformations.
The effect of posterior sagittal anorectoplasty (PSARP) and its variants on lower urinary tract function was investigated urodynamically in 32 patients with anorectal malformations. In 27 patients urodynamic evaluation was performed before and after surgery and in 4 it was done postoperatively only. One child was clinically assessed with no postoperative urodynamic study. Minor postoperative changes in the specific preoperative urodynamic pattern were observed in 4 cases but the changes did not seem to be related to surgery. In 3 boys with rectourethral fistulas detrusor failure consistent with autonomic denervation was noted postoperatively. Standard posterior sagittal anorectoplasty was performed in 1 of the 3 boys and posterior sagittal anorectoplasty combined with additional transabdominal procedures was done in the other 2. In general our findings suggest that posterior sagittal anorectoplasty and its variants do not affect lower urinary tract function unless these surgical techniques are combined with major transabdominal procedures and extensive retrovesical dissection.
Anal Canal↗
Results in the operative treatment of elderly patients with spinal meningiomas.
STUDY DESIGN: Thirty consecutive patients over 70 years of age who were operated on for spinal meningiomas are presented to assess surgical criteria and postoperative outcome. OBJECTIVES: To assess the outcome of surgically treated spinal meningiomas in patients in their eighth or ninth decade of life and to analyze the possible role of some prognostic factors. SUMMARY OF BACKGROUND DATA: The ageing of the population in the industrial nations has led to increased findings of benign spinal tumors, namely meningiomas, in the elderly. These slow-growing tumors may prevent these patients from leading an autonomous life. Little is known about the outcome of spinal meningioma surgery in patients of 70 years or older because the number of these patients, although increasing, is still small. METHODS: Thirty consecutive patients over 70 years of age (mean age, 77.1 years) were operated on for spinal meningiomas between 1986 and 2001. The preoperative neurologic status of the patients was graded with the Solero score, and the general health conditions were staged according to the American Society of Anesthesiology classification. Total tumor removal was achieved in 27 patients. The follow-up period ranged from 17 to 173 months (mean, 62.7 months). RESULTS: There was no operative mortality, and morbidity was not significant. Although not significant, neurologic outcome was better in patients with a low preoperative Solero score than those with a high one (P = 0.06). Clinical outcome was not influenced by the duration of symptoms before surgery or preoperative American Society of Anesthesiology classification. No recurrence was observed during the follow-up period. CONCLUSIONS: Neurologic outcome following surgery was favorable in the vast majority of patients, with no mortality or significant morbidity. Surgery is the only treatment in elderly patients with symptomatic spinal meningiomas, even those with a poor preoperative neurologic condition, whenever there is an acceptable risk from an anesthesiological point of view.
Aged↗
[Impact of serum thyroglobulin concentration in the diagnosis of benign and malignant thyroid diseases].
UNLABELLED: AIM of this study is to evaluate new and controversially discussed indications for determining the thyroglobulin (Tg) level in different thyroid diseases to support routine diagnostics. METHODS: The following groups were included: 250 healthy subjects without goiter, 50 persons with diffuse goiter, 161 patients with multinodular goiter devoid of functional disorder (108 of them underwent surgery, in 17 cases carcinomas were detected), 60 hyperthyroid patients with autonomously functioning nodular goiter, 150 patients with Hashimoto's thyroiditis and 30 hyperthyroid patients with Graves' disease. RESULTS: The upper limit of the normal range of the Tg level was calculated as 30 ng Tg/ml. The evaluation of the collective with diffuse goiter showed that the figure of the Tg level can be expected in a similar magnitude as the thyroid volume in milliliters. Nodular tissue led to far higher Tg values then presumed when considering the respective thyroid volume, with a rather high variance. A formula for a rough prediction of the Tg levels in nodular goiters is described. In ten out of 17 cases with thyroid carcinoma, the Tg was lower than estimated with thyroid and nodular volumes, but two patients showed a Tg exceeding 1000 ng/ml. The collective with functional autonomy had a significantly higher average Tg level than a matched euthyroid group being under suppressive levothyroxine substitution. However, due to the high variance of the Tg values, the autonomy could not consistently be predicted with the Tg level in individual cases. The patients with Hashimoto's thyroiditis showed slightly decreased Tg levels. In Graves' disease, a significantly higher average Tg level was observed compared with a matched group with diffuse goiter, but 47% of all Tg values were still in the normal range (< 30 ng/ml). CONCLUSION: Elevated Tg levels indicate a high probability of thyroid diseases, such as malignancy, autonomy or Graves' disease. However, as low Tg concentrations cannot exclude the respective disorder, a routine Tg determination seems not to be justified in benign thyroid diseases.
Biomarkers↗
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↗
[The clinical neuropsychological aspects in the surgical treatment of arteriovenous malformations of the gyrus cinguli].
Clinical and neuropsychological studies of the outcomes of surgical treatment in patients with arteriovenous malformations (AVM) of the gyrus cinguli were conducted. Preoperative examination revealed predominantly memory disorders in 38 cases. Of them 5 cases had amnestic disturbances similar to those of the Korsakoff syndrome. Autonomic and epileptic seizures were not common. Thirty eight patients underwent surgery. Memory deterioration was recorded in 23 cases postoperatively. Three patients developed a "new" Korsakoff syndrome. The rate of deterioration of memory disorders showed a clear correlation with the extent of gyrus cinguli destruction and degree of corpus callosum integration to AVM nidus. The qualitative analysis of amnestic syndromes demonstrated that the majority of patients developed pre- and postoperative disorders of trace selectivity, the insight incontinence of the story essence accompanied by diminished critical attitude towards their condition. This pattern of defects was similar to the clinical features of the amnestic syndrome in patients with frontal lobe lesions. Combined damage of frontal lobes and their connections (with gyrus cinguli in this case) is of great importance in the formation of a clinical picture in man. The findings should be taken into consideration when surgical policy is to be analyzed.
Adolescent↗
Acute opioid tolerance: intraoperative remifentanil increases postoperative pain and morphine requirement.
BACKGROUND: Rapid development of acute opioid tolerance is well established in animals and is more likely to occur with large doses of short-acting drugs. The authors therefore tested the hypothesis that intraoperative remifentanil administration results in acute opioid tolerance that is manifested by increased postoperative pain and opioid requirement. METHODS: Fifty adult patients undergoing major abdominal surgery were randomly assigned to two anesthetic regimens: (1) desflurane was kept constant at 0.5 minimum alveolar concentrations and a remifentanil infusion was titrated to autonomic responses (remifentanil group); or (2) remifentanil at 0.1 microg. kg-1. min-1 and desflurane titrated to autonomic responses (desflurane group). All patients were given a bolus of 0.15 mg/kg morphine 40 min before the end of surgery. Morphine was initially titrated to need by postanesthesia care nurses blinded to group assignment. Subsequently, patients-who were also blinded to group assignment-controlled their own morphine administration. Pain scores and morphine consumption were recorded for 24 postoperative h. RESULTS: The mean remifentanil infusion rate was 0.3 +/- 0.2 microg. kg-1. min-1 in the remifentanil group, which was significantly greater than in the desflurane group. Intraoperative hemodynamic responses were similar in each group. Postoperative pain scores were significantly greater in the remifentanil group. These patients required morphine significantly earlier than those in the desflurane group and needed nearly twice as much morphine in the first 24 postoperative h: 59 mg (25-75% interquartile range, 43-71) versus 32 mg (25-75% interquartile range, 19-59; P < 0.01). CONCLUSIONS: Relatively large-dose intraoperative remifentanil increased postoperative pain and morphine consumption. These data suggest that remifentanil causes acute opioid tolerance and hyperalgesia.
Analgesia, Patient-Controlled↗
Adrenal medullary transplants as a treatment for advanced Parkinson's disease.
Open autologous adrenal medullary to caudate nucleus transplantation was performed in 12 patients with advanced Parkinson's disease (PD). Ten of these patients had diurnal response fluctuations including "wearing off" and "on/off" phenomena. All of the patients were no longer satisfactorily responding to levodopa/carbidopa and dopamine agonists. The mean age of the patients was 55.1 years (range 37-65 yrs); mean duration of PD was 11.7 years (range 4-40 yrs); mean stage "on" was 3.3 (range 2-4); mean stage "off" was 4.8 (range 4-5). Mean duration of follow up from surgery was 10.4 months (range 2-17 months). Three patients improved dramatically with major changes in their lifestyle. The course of improvement in these 3 patients was different in each, implying that different mechanisms were responsible for the improvement. One of the patients died unexpectedly. In this patient, there were no surviving adrenal cells. Three patients improved moderately. Patients reported that they were "on" longer and had to take medication less often and were less dependent on individual doses of levodopa/carbidopa. The improvement has been sustained in two patients. However, in one of these patients there had to be frequent changes in scheduling to maintain the improvement. Two patients after technically successful implants did not improve. One of these patients subsequently died. In this patient there were a few surviving adrenal medullary cells. Four patients suffered major complications. One patient had a cerebral infarction and two had cerebral hemorrhages. One of these patients has shown a good recovery. One patient with autonomic insufficiency had a cardiac arrest with cerebral anoxia one week after surgery. This patient has shown a partial recovery.(ABSTRACT TRUNCATED AT 250 WORDS)
Adrenal Medulla↗