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Results for “CELIAC PLEXUS”

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PubMed1977

[Ultrastructural organization of chromaffin paraganglia in the ganglia of the solar plexus].

Under study was the ultrastructural organization of chromaffin cells in the nodes of the solar plexus of albino rats. The chromaffin cells form accumulations--paraganglia, bent for capillaries. The chromaffin cells are of small size and have a dense glial capsule. The cytoplasms are rich in mitochondria, Golgi Complexes and vesicles containing catecholamines. The state of cytoplasmic components speaks of asynchronous secretory activity of chromaffin cells. Among catecholamine-containing vesicles three main types can be distinguished, different is size, structure of the content and localization in the perikaryon. Excretion of catecholamines in realized through cytoplasmic processes which, getting free of the glial capsule, come out directly to capillaries. The coordinating influence of the sympathetic nervous system on the endocrinous function of chromaffin paraganglia of the solar plexus is exercised by paraganglionic fibres, whose terminal portions form synaptic contacts on the chromaffin cells.

Animals↗

PubMed1989

Coeliac plexus block and cephalic spread of injectate.

Extensive cephalic spread of solution occurred in three out of seven cases studied during coeliac plexus blockade. Spread on to cardiac nerves and plexus may be a factor in hypotension following this procedure. Incremental dosage and careful screening is recommended.

Autonomic Nerve Block↗

PubMed2004

Efficacy of coeliac plexus and splanchnic nerve blockades in body and tail located pancreatic cancer pain.

Palliative treatment, pain therapy and quality of life (QOL) are very important in pancreatic cancer patients. We evaluated the pain relieving efficacy, side effects and effects on QOL of neurolytic coeliac plexus blockade (NCPB) and splanchnic nerves neurolytic blockade (SNB) in body and tail located pancreatic cancer. The study protocol was approved by the local ethics committee. Patients were randomly divided into two groups. Coeliac group; GC, N = 19 were treated with coeliac plexus blockade, whereas the patients in splanchnic group; GS, N = 20 were treated with bilateral splanchnic nerve blockade. The VAS values, opioid consumption and QOL (Patient satisfaction scale=PSS, performance status scale=PS) were evaluated prior to the procedure and at 2 weeks intervals after the procedure with the survival rates. The demographic features were found to be similar. The VAS differences (difference of every control's value with baseline value) in GS were significantly higher than the VAS differences in GC on every control meaning that VAS values in GS decreased more than the VAS values in GC. GS patients were found to decrease the opioid consumption significantly more than GC till the 6th control. GS patients had significant improvement in PS values at the first control. The mean survival rate was found to be significantly lower in GC. Two patients had severe pain during injection in GC and 5 patients had intractable diarrhoea in GC. Comparing the ease, pain relieving efficacy, QOL-effects of the methods, splanchnic nerve blocks may be an alternative to coeliac plexus blockade in patients with advanced body and tail located pancreatic cancer.

Adult↗

PubMed1983

Coeliac plexus block for pain in pancreatic cancer and chronic pancreatitis.

We have performed coeliac plexus block by standard percutaneous technique for disabling pain in 36 patients (13 with cancer and 23 with chronic pancreatitis). Eleven of the 13 cancer patients had complete pain relief initially and 7 remained pain free at the time of death. By contrast, only 12 of the 23 patients with pancreatitis had complete pain relief, 6 had partial relief and there was no effect in 5. The mean pain-free period in the chronic pancreatitis patients was only 2 months, and the longest 4 months. Benefit was least in patients with previous pancreatic surgery and repeat blocks were unhelpful. Transient postural hypotension occurred in most patients; two had nerve root pain and one developed persistent weakness and anaesthesia of the left leg, with bladder disturbance. These results warrant the continuing use of coeliac plexus block in pancreatic cancer, but rarely in chronic pancreatitis.

Aged↗

PubMed1992

Clinicopathological study on neural invasion to the extrapancreatic nerve plexus in pancreatic cancer.

Thirty-four cases that underwent resection of cancer of the pancreatic head were examined clinicopathologically to elucidate neural invasion of cancer of the pancreatic head into the extrapancreatic nerve plexus. Invasion of cancer into the retropancreatic tissue (rpe) was seen in 29 (86 per cent) of the 34 cases and neural invasion of the extra-pancreatic nerve plexus in 21 (72 per cent) of the 29 rpe cases. The incidence of invasion of the IInd portion of the nerve plexus of the pancreatic head was high (14 = 67 per cent). The degree of neural invasion tended to increase with the extent of lymph vessel invasion. Observation of serial sections revealed continuity of the neural invasion into the nerve plexus. From these findings we conclude that neural invasion of the extrapancreatic nerve plexus is mainly the result of continuous spread, and that en bloc resection of the retropancreatic tissue involving the nerve plexus and fat tissue is necessary in the surgical treatment of cancer of the pancreatic head.

Carcinoma, Intraductal, Noninfiltrating↗

PubMed1975

[Diagnosis and operative treatment of coelic-artery compression].

Stenosis of the coeliac artery by compression occurs predominantly in youngish patients and three times more frequently in women than men. It gives rise to abdominal symptoms, due to chronic disturbance of intestinal arterial supply. In eight patients, operated on for this condition, the characteristic symptoms were of abdominal pain, epigastric vascular sounds, loss of weight, nausea and vomiting. Diagnosis could only be made by angiography of the coeliac and (or) mesenteric arteries, and lateral aortography. Analysis of 240 cases reported in the literature indicates that the condition is caused by compression of the coeliac artery by the medial arcuate ligament of the diaphragm, and only in a few instances by nerve tissue of the mesenteric ganglion of the coeliac plexus. Operative treatment (decompression of the artery) removes symptoms in 83% of cases.

Adult↗

PubMed1991

Surgery offers the best palliation for carcinoma of the pancreas.

This debate discusses the palliative management of pancreatic cancer. The arguments in favour of surgical palliation are that this approach allows all symptoms to be treated or prevented, the diagnosis can be confirmed histologically and a final assessment of resectability can be made. The arguments against the use of surgery are that survival is short and that effective alternative therapies are available: endoscopic intubation, percutaneous coeliac plexus block and pancreatic enzyme supplements. The most appropriate policy, however, is to tailor the management plan to suit the individual patient.

Aged↗

PubMed1990

[Embryonal development and the structure of the intermesenteric plexus in humans and various mammals].

The intermesenteric plexus is an independent formation, it is connected with other plexuses in the abdominal and pelvic cavities and participates in innervation of organs. In the species investigated (mole, rat, cat, dog, man) connections between the intermesenteric and other vegetative plexuses in the abdominal and pelvic cavities vary according to their amount and complexity, they are most abundant and complex in man. In the latter the plexus is also mostly rich in neuro-fibrillar and neuro-cellular elements. In the intermesenteric plexus of the man and the animals studied there is a rather big part of vegetative ganglia, which can be considered as peripheral centers of the internal abdominal organs innervation.

Animals↗

PubMed1983

[Activity of the neurons of the abdominal-aortic plexus in the guinea pig during preservation of its connections with the large intestine].

With intracellular recording, peripheral inputs from the mechanoreceptor C--afferents of the colon which signal the motor status of its isolated oral and aboral segments were shown to converge on neurons of the abdominal aortic plexus of the guinea pig. A proportion (19.8%) of synapthcally activated neurons of this plexus send axons to the periphery within mesenteric nerves, thus forming the efferent link of an extracentral intestio--intestinal reflex.

Action Potentials↗

PubMed1985

Coeliac plexus block versus pancreaticogastrostomy for pain in chronic pancreatitis. A controlled randomized trial.

Seventeen patients with chronic pancreatitis and dilated pancreatic ducts were randomly allocated to coeliac plexus block or pancreaticogastrostomy. The number of patients with pain relief after coeliac plexus block and pancreaticogastrostomy did not differ at discharge. Pain score and use of analgesics before coeliac plexus block and 6 months later were unaffected but were significantly less after pancreaticogastrostomy. Operation decreased pancreatic tissue pressure significantly. This pressure decrease is believed to explain pain relief.

Adult↗

PubMed2006

Distribution of lymphatic vessels in the neural plexuses surrounding the superior mesenteric artery.

OBJECTIVES: To investigate whether lymphatic vessels exist in the neural plexuses surrounding the superior mesenteric artery (SMA) and the ultrastructural relationship between neural plexuses and lymphatic vessels. METHODS: A total of 970 serial sections including the structure surrounding the SMA were obtained from 9 cadavers. They were subjected to conventional hematoxylin/eosin staining and immunostaining for the lymphatic marker D2-40. Epithelial membrane antigen and S100 were also immunostained to identify the perineurium and nerve bundles, respectively. RESULTS: Thin-walled, erythrocyte-free vessels staining with lymphatic markers (D2-40) were found in the neural plexuses surrounding the SMA along a full circumference. There seemed to be a distribution correlation between lymphatic vessels and neural plexuses. Lymphatic vessels were not identified within the nerve bundles. The plexuses contained no lymph nodes in any sections. CONCLUSIONS: To our knowledge we report the immunohistochemical visualization of lymphatic vessels in peri-SMA neural plexuses for the first time. Therefore, particular attention should be paid to the lymphatic vessels within neural plexuses as a possible route of invasion and the source of pancreatic cancer recurrence.

Aged↗

PubMed1992

Continuous coeliac plexus blockade plus intermittent wound infiltration with bupivacaine following upper abdominal surgery: a double-blind randomised study.

In this double-blind trial, we observed the effect of intermittent wound infiltration with local anaesthetic plus continuous coeliac plexus blockade on postoperative pain relief, pulmonary function, the neuroendocrine and acute phase protein response following upper abdominal surgery. In Group A (n = 10) patients received bupivacaine intermittently into the wound and continuously into the coeliac plexus following an initial bolus. A total of 862.5 mg of bupivacaine was used over 12 h with no observed toxicity. Group B (n = 10) received equal volumes of saline. Although pain relief was poor in both groups, the bupivacaine group used less morphine postoperatively and had lower pain scores than the saline group 4 h after operation (P less than 0.05). Pulmonary function was significantly reduced in both groups with no statistical difference between the two. Significant reductions in serum glucose and cortisol were achieved (P less than 0.05), suggesting that afferent neural blockade was partially effective in attenuating the neuroendocrine response. However, the postoperative rise in interleukin-6 was not affected by this technique. It is concluded that total afferent neural blockade cannot be achieved with peripheral wound and coeliac plexus administration of relatively large doses of local anaesthetic during upper abdominal surgery.

Abdomen↗

PubMed1999

Release of nitric oxide within the coeliac plexus is involved in the organization of a gastroduodenal inhibitory reflex in the rabbit.

1. The coeliac plexus can organize a gastroduodenal inhibitory reflex without action potentials. The involvement of the nitric oxide-cGMP pathway in this reflex was investigated in the rabbit on an in vitro preparation of the coeliac plexus connected to the stomach and duodenum. Intraluminal duodenal pressures were measured with water-filled balloons. Gastric distension inhibited duodenal motility, thus characterizing a gastroduodenal inhibitory reflex organized by the coeliac plexus. 2. L-Arginine, superfused at the coeliac plexus level, enhanced this reflex, whereas Nomega-nitro-L-arginine (L-NOARG) or 2-(4-carboxyphenyl)-4,4,5,5 tetramethylimidazoline-1-oxyl-3-oxide (carboxy PTIO) reduced or abolished it. Moreover, diethylamine/nitric oxide complex superfused at the coeliac plexus level inhibited duodenal motility in the absence of gastric distension. 3. The effects of nitric oxide were mediated through the activation of guanylyl cyclase, as 1H-[1,2,4] oxadiazolo [4,3-a] quinoxalin-1-one (ODQ) reduced or abolished the gastroduodenal inhibitory reflex, whereas zaprinast enhanced it. Moreover, 8-bromo-cGMP and cGMP, superfused at the coeliac plexus level, inhibited duodenal motility in the absence of gastric distension. 4. On the other hand, when perfused at the visceral level, L-NOARG, propranolol plus phentolamine, and guanethidine did not affect the reflex. Thus, neither nitric oxide nor noradrenaline could be the transmitters released at the muscular level to induce this reflex. 5. Our study demonstrates that the gastroduodenal inhibitory reflex, which is organized by the coeliac plexus without action potentials, is induced by the release within the plexus of nitric oxide acting on the cGMP pathway. These results provide new insights into the control of digestive motility by the prevertebral ganglia.

Action Potentials↗

PubMed1994

Neural invasion and nodal involvement in distal bile duct cancer.

Nodal status and neural plexus invasion are important prognostic factors in pancreaticobiliary cancer. The relationship between neural invasion and nodal involvement is evaluated, and its significance for therapy discussed. During the last 20 years, 29 patients with distal bile duct cancer underwent pancreaticoduodenectomy at our institute. An accurate evaluation of the relationship between nodal involvement and plexus invasion was done by histological examination. Twenty of the 29 patients had nodal involvement (68.9%) including 11 patients (37.9%) with nodal involvement of the third group of lymph node (n3). None of these 11 patients had tumors confined to the bile duct wall (panc0 disease). Eight patients (27.6%) had plexus invasion. None of these patients had panc0 disease. The most frequent site of extrapancreatic plexus invasion was the first portion of the plexus pancreaticus capitalis. Nodal dissection around the superior mesenteric artery, and plexus dissection in the hepatoduodenal ligament, around the hepatic artery, and at the first portion of plexus pancreaticus capitalis is necessary in the treatment of distal bile duct cancer, except in patients with no evidence of pancreatic invasion.

Adult↗

PubMed1991

Paraplegia following coeliac plexus block.

A case is described in which a coeliac plexus block with alcohol 48%, performed under X ray control, resulted in paraplegia. Ischaemia of the spinal cord, due to damage to the arterial blood supply, was thought to be the cause.

Aged↗

PubMed1990

Nerve block in pancreatic pain.

Pain from pancreatic cancer is, in most cases, both severe and debilitating. Large doses of morphine are sometimes not tolerated or accepted by the patient, and are often ineffective. It has been claimed that "coeliac plexus block is the simplest, most effective and least hazardous" means of palliation (49, 59); we think that this is true, and that coeliac plexus block should be considered more often than it is today, and at an earlier stage. Only in rare cases should pain from pancreatitis be treated with a nerve block.

Abdominal Pain↗

PubMed1995

Coeliac plexus block for patients with cancer pain.

1. Neurolytic coeliac blockade is an extremely effective palliative treatment for cancer of the upper abdominal viscera. 2. A successful block can be expected in over 80 per cent of patients in expert hands. 3. Coeliac plexus blockade frequently allows patients to reduce their analgesic consumption, with a consequent reduction in drug-induced side-effects. 4. Knowledge of potential side-effects and complications minimises their impact on the patient.

Autonomic Nerve Block↗

PubMed1989

Paraplegia after coeliac plexus block.

A case is described in which paraplegia followed a coeliac plexus block performed using 90% alcohol under X ray screening. The likely cause was an ischaemic injury to the cord secondary to damage to the artery of Adamkiewicz. This rare complication seems difficult to avoid.

Autonomic Nerve Block↗