(TWO NEW ILLUMINATING INSTRUMENTS FOR SURGERY OF THE THORACIC, THORACOLUMBAR AND LUMBAR SYMPATHETIC CHAINS.)
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Autonomic Nervous System↗
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Results for “Autonomous surgery”
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[Preservation of organic function in surgery for cervical cancer].
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Adenocarcinoma↗
Intercostal-celiac plexus block for abdominal surgery in the poor risk patient.
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Abdomen↗
[Restorative treatment and metabolic rehabilitation of uterine myoma patients at the transitional age following surgery].
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Adult↗
Assessment of autonomic cardiovascular changes associated with recovery from anaesthesia in children: a study using spectral analysis of blood pressure and heart rate variability.
Recovery from anaesthesia is associated with large changes in cardiovascular autonomic activity, which are poorly documented in children. This study was undertaken to investigate the cardiovascular autonomic activity in anaesthetized and recovering children, using a noninvasive approach based on spectral analysis of heart rate (HR) and blood pressure (BP) variability. Ten children (aged 5-13 years) undergoing major surgery were studied. Continuous HR and BP were recorded using a noninvasive device during deep anaesthesia and recovery. Spectral analysis was used to determine the main oscillatory components of HR and BP signals. For each power spectrum, the frequency components were identified as follows (i): the low frequency (LF) component (0.04-0.14 Hz) both parasympathetically and sympathetically mediated for HR and corresponding to vasomotor sympathetic modulation for BP; and (ii) the high frequency (HF) component (0.2-0.6 Hz) parasympathetically mediated for HR, and reflecting mechanical influence of ventilation on cardiac output for BP. In addition, the LF : HF ratio for HR, reflecting the cardiac sympathovagal balance, was calculated. Under deep anaesthesia, HR variability and BP variability were very low and mainly due to mechanical influence of intermittent positive pressure ventilation. Conversely, the recovery period was associated with a marked increase of HR and BP overall variability. Compared to anaesthesia, spectral analysis of HR and BP revealed that the LF component of BP and HR spectra increased 40-fold during recovery; the LF : HF ratio of HR was also increased during recovery (0.1 +/- 0.1 versus 1.3 +/- 1.2, P=0.008). The results of this study demonstrate that the recovery period is associated with an increase of cardiovascular sympathetic drive in children after major surgery.
Adolescent↗
Acute coronary vasospasm during thoracic spine surgery.
Cardiac ischemia is a well-known and serious complication during surgery. The authors describe a case of acute coronary vasospasm in a young patient undergoing thoracic laminectomy with biopsy of intramedullary tumor. The possible role of the autonomic nervous system in the causation of acute coronary vasospasm is discussed, and this is highlighted as an unusual cause of myocardial ischemia during thoracic spine surgery.
Acute Disease↗
Long-term survival and recurrences after total nerve-sparing surgery for rectal cancer.
BACKGROUND/AIMS: In advanced extraperitoneal rectal cancer Japanese surgeons perform the lateral pelvic nodal dissection with only partial pelvic autonomic nerves preservation; instead most Western surgeons prefer the total mesorectal excision (TME) with complete pelvic nerve sparing except for evident neoplastic nervous involvement. Long-term oncological results of the total nerve-sparing TME are reported. METHODOLOGY: From January 1992 to October 1998 71 [corrected] patients with extraperitoneal rectal carcinoma underwent TME with total nerve sparing except in two cases in which only a partial sparing was possible because of macroscopic neoplastic nervous infiltration: 54 anterior resections and 17 abdominoperineal resections were performed. Sixty-one curatively operated patients (9 stage I, 20 stage II, 29 stage III and 3 stage IV) were included. RESULTS: No postoperative death occurred. Postoperative radiochemotherapy was performed in 31 cases, radiotherapy in 9 cases and chemotherapy in 9 cases. The mean follow-up was 98.7 months. The 5-year overall and disease-free survival rates were 88.8% and 77.7%, 90% and 75.1%, 62.3% and 45% for stage I, II and III respectively. The 8-year actuarial overall and disease-free survival rates were 77.7% and 77.7%, 78.3% and 75.1%, 50.4% and 40% for stage I, II and III respectively. Local failures with or without distant metastases were 6 (9.8%). CONCLUSIONS: Total nerve-sparing surgery is not contraindicated unless grossly neoplastic involvement is present.
Adult↗
[Approach to a differentiated recurrence prevention following struma surgery].
Changes of the pituitary-thyroid axis were studied in 70 patients (45 with euthyroid goiters, 25 with autonomous adenomas) preoperatively; over a 6-week postoperative interval without thyroid-hormone treatment; under T4 therapy increased stepwise and maintained for 1 year; and over a period of 12 weeks after its withdrawal. The postoperative thyrotropic function obviously depends on the preoperative condition and thereby on the quality of the remaining tissue as well as on the extent of the operation and thus the amount of remaining tissue. The frequency of a "prehypothyroid" status in the early postoperative course is high (77%) after bilateral resection for euthyroid goiter, but decreased 1 year after the operation (47%). After unilateral resection for euthyroid goiters and after bilateral and unilateral resection or enucleation for autonomous adenomas, the remaining tissue is for the most part sufficient to avoid increased pituitary stimulation. Prophylaxis of recurrent goiter with thyroid hormones could be prescribed individually on the basis of the postoperative function of the pituitary-thyroid axis.
Adenoma↗
[Neurovascular implications in total meso-rectal excisions. A prospective study of sexual function after surgery for rectal cancer].
Total mesorectal excision (TME), well established in the modern curative surgery of rectal cancer, needs further investigation, especially with regards to the preservation technic of the autonomous abdominopelvic innervation currently used to prevent or reduce the urogenital sequelae. The Authors offer a perspective study over the recovery of sexual activity in a homogeneous group of 32 male patients submitted, because of cancer, to restorative proctectomy, with anatomical preparation of the hypogastric and sacral plexus. The criteria for eligibility were the followings: male under 70 years of age, excision of the primary rectal cancer with coloanal or colo-rectal anastomosis performed at less than 5 cm from the anal verge, staging not more than T3N2M0, without previous RT or other pelvic operations and without protective enterostomy, nor local or systemic recurrences during the follow up period. The functional results obtained on the basis of a questionnaire, filled in quarterly by the patients as well as their partners for at least a year, three months after the operation were: lack of sexual disorders in 37.5%, reduction of the sexual activity (partial erection, lack of ejaculation, anorgasmy) in the 34.4%, and no sexual activity in 28.1% of the patients. After 6 months the total lack of sexual activity was observed in only 15.6% of the patients, whereas after a year 65.6% of the patients showed a normal level of sexual activity. The Authors explain the preparatory technic to approach the mesorectum sparing the autonomous nerves and discuss the two fundamental surgical-anatomical aspects of the nerve-sparing technic still not sufficiently clarified as far as the behaviour of the pelvic visceral fascia and the course of the medial-rectal artery are concerned. The results obtained even considering the limitation in the evaluation and standardization of the genito-sexual disorders, show the need to extend and deepen the study relative to the nerve-sparing technics in rectal cancer surgery.
Adult↗
Effects of extradural analgesia and vagal blockade on the metabolic and endocrine response to upper abdominal surgery.
The effect of thoracic extradural analgesia and vagal blockade on the metabolic and endocrine responses to cholecystectomy was investigated. In comparison with a control group of patients, extradural analgesia and vagal blockade abolished the glycaemic response but had no effect on the increase in plasma cortisol. Circulating insulin values were significantly decreased in the extradural group of patients, confirming the importance of autonomic innervation in maintaining basal insulin output. there is, at present, no satisfactory local analgesic technique for controlling the endocrine response to upper abdominal surgery.
Anesthesia, Epidural↗
[The effect of early visual deprivation on the formation of a control system for brain states in early human ontogeny].
Late effects of early visual deprivation on state control in sleep were studied in 23 infants with bilateral congenital cataract before and after surgery (usually, on the 6th month of life). In the course of three years 67 observations were performed. Laboratory assessments included videotaping infant sleep behaviour, recording EEG, EOG, ECG, galvanic skin response. It was shown that the early visual deprivation led to general changes in the basic mechanisms underlying state control in infancy. The sleep stages (active and quiet sleep), their duration and physiological autonomic and central characteristics were modified as compared to the age norm over a protracted period after surgery, when the visual experience became available for the infant. This type of sleep cycle can be identified as "partially perinatal sleep pattern". Revealed peculiarities of sleep cycle organization were suggested to reflect the higher level of activation in the neural arousal systems owing to the deficit of environmental stimulation during the critical stage (2-4 months) of brain development.
Brain↗
Intractable angina pectoris: management with dorsal column stimulation.
This case report gives the first published description of the use of dorsal column stimulation in the management of a patient with intractable angina pectoris that was unresponsive to maximal medical therapy, who was unsuitable for coronary artery revascularization surgery.
Angina Pectoris↗
William Cheselden: anatomist, surgeon, and medical illustrator.
William Cheselden was Great Britain's foremost surgeon/scientist in the first half of the 18th century. Cheselden directly challenged the Company of Barber-Surgeons' exclusive right to control dissection in London by being the first to conduct a regular series of anatomy lectures and demonstrations outside of the Company's Hall. He incorporated his lecture syllabus into a handbook of anatomy, The Anatomy of the Humane Body, which was used by students for nearly 100 years. Cheselden also wrote the text and drew the illustrations for a majestic atlas of comparative osteology, the Osteographia, or the Anatomy of the Bones. Cheselden used his superior knowledge of anatomy to reduce the morbidity and mortality associated with perineal lithotomy, one of the few operations possible in his era. Sagacious and pragmatic, Cheselden recognized that the enlightened practice of surgery beginning to take root in 18th-century London could flourish only under an autonomous body of surgeons. Cheselden used his personal funds and political skills to urge Parliament to pass legislation for the dissolution of the combined Company of Barber-Surgeons and the establishment of separate and distinct Surgeons' and Barbers' Companies. After disjoinder of the two groups on May 2, 1745, Cheselden served as one of the Wardens of the new Company of Surgeons--a predecessor of the Royal College of Surgeons of England. In 1746, Cheselden, who helped design the first Surgeons' Hall, served as the Company's Master.
Anatomy↗
Diabetic autonomic neuropathy: abnormal cardiovascular reactions under general anesthesia.
The influence of diabetic autonomic neuropathy upon the behavior of the circulatory system was investigated in 56 patients who had undergone ophthalmological surgery. A standardized test combination (variability in heart rate during deep breathing. Valsalva ratio, 30:15 ratio, change in blood pressure from lying to standing, sustained handgrip test) was used to study the patients' cardiovascular reflectory reactions. The patients were then divided into the following groups: Group I, non-diabetics. Group II, diabetics without autonomic neuropathy. Group III, diabetics with autonomic neuropathy. The anesthetic (induction by barbiturates and conduction by inhalation agents) and the surgical procedure (pars plana vitrectomy) were standardized and always identical. During anesthesia patients in group III experienced hypotensive reactions (systolic blood pressure below 90 mm Hg) significantly more often (72.2%) than patients in group I (25%). In order to achieve stability in blood pressure the patients of group III had to be given vasoactive drugs much more often (77.8%) than the patients of group I (12.5%) and those of group II (35.7%). We found a significant correlation between the degree of autonomic dysfunction and the largest drop in blood pressure under narcosis (r = -0.60, P less than 0.001). However, marked variability in heart rate and cardiac rhythm disorders during anesthesia were seen only in patients of groups I and II. These results prove the atypical hemodynamic behavior and especially the extreme instability in blood pressure in diabetic autonomic neuropathy under general anesthesia. Therefore we consider it to be very helpful to check the cardiovascular reflectory status of diabetics preoperatively.
Adult↗
[Recent advances in colorectal cancer surgery].
Recent advances in colorectal cancer surgery have been made in improving the cure rate after surgery, the preservation of postoperative function, and the development of minimally invasive procedures. Indication for wide lymph node dissection in rectal cancer surgery is now limited to a smaller number of cases. Functional outcome is being improved thanks to the introduction of autonomic nerve preserving operations as well as the increasing number of sphincter preserving operations. Laparoscopic colectomy for cancer has been practiced for 7-8 years, and the advantages and disadvantages of this procedure are being clarified. Transanal endoscopic microsurgery (TEM) is a minimally invasive surgery for rectal tumors in early stages. The procedure is now overtaking the posterior surgical approach, which is used less and less in recent years. Future goals in colorectal cancer surgery are further improvements in the cure rate and the functional results. Minimally invasive surgery may become the established procedure after a careful assessment of its cure rate compared to the open surgical procedure.
Colorectal Neoplasms↗
Intraoperative guidance of pre-planned bone deformations with a surface scanning system.
Computer- and robot-based systems to support interventions become more and more important in modem surgery. In general these systems provide methods to plan an intervention pre-operatively and to execute it with support from a autonomous robot-system. Due to the principle restriction of a robot to comparatively simple work steps, there are some complex work steps which the surgeon may plan but which he/she has to execute manually. In craniofacial surgery osteotomised bone segments are deformed by hand to a shape given by the planning system. We support the execution of pre-planned deformation by comparison of the actual shape of an object with the target shape. The actual shape is obtained intra-operatively with a surface scanning device, the deviation from the target shape are visualised by projecting colour-coded error values directly on the object to be deformed. The surgeon uses these projections to adjust further deformation steps. The system is therefore able to validate the correct execution of planned deformations, especially of bony structures.
Computer Simulation↗
[Micturition disorder as a sequela of sacral autonomic diabetic neuropathy].
Diabetic neuropathy may manifest itself also in the autonomous nervous system and thus lead to a functional disorder of the urinary bladder. Urodynamic studies carried out in 11 diabetic patients with unclear bladder dysfunction allowed 2 forms of bladder anomalies to be identified: 1. detrusor hyperreflexia, 2. hyporeflexia and areflexia of the detrusor. Whereas hyperreflexia is clinically characterised by signs of motor urgency, hyporeflexia is mainly identifiable by residual urine formation and recurrent infections of the urinary tract. Therapy depends on the type of dysfunction and consists of physiotherapeutic measures, drug therapy and occasionally surgery.
Aged↗
[General anesthesia using diprivan in patients with lesions of the locomotor system in a day hospital].
The study is aimed at investigating the possibility of using diprivan in total anesthesia of patients with consequences of infantile cerebral paralysis (ICP) during orthopedic surgery in an outpatient setting. The study was carried out at the Institute of Clinical Rehabilitology in the town of Tula. Ninety-two patients aged 4 to 15 years were examined. Hemodynamics was assessed by tetrapolar thoracic rheography after Kubecik. The patients were divided into 3 groups with disorders of static kinetic functions of different severity: I) walk-in patients, 29.3%; II) patients walking with difficulty, 59.7; III) patients incapable to walk by themselves, 9.2%. The autonomic status was studied using clino-orthostatic tests and cardiointervalography. Characteristic changes of the hemodynamics under conditions of narcosis and surgery were revealed in the patients with locomotor disorders of different severity. Diprivan can be used as the basic hypnotic component of anesthesia in orthopedic operations in patients with ICP consequences with locomotor disorders of different severity. It meets the requirements to the adequacy of anesthesiological protection in an outpatient setting. Assessment of the autonomic status in patients with ICP consequences permits a differentiated approach to total anesthesia with diprivan. Premedication with ketamine prevents the hypotensive effect of diprivan and ensures hemodynamic stability in the course of anesthesia and surgery.
Adolescent↗