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At least 73 records · Page 4Linked to original sources
PubMed2000

[The indications for autonomic nerve-sparing surgery in rectal cancer patients].

Although extended lymph node dissection was developed to improve the therapeutic result in advanced rectal cancer in the 1970s, postoperative dysfunction remained problematic. Informed consent of cancer is generalized at present. The balance between complete cure and functional preservation is important. Therefore the autonomic nerve-sparing surgical technique for rectal cancer was introduce din the 1980s. The success of nerve-sparing surgery depends on a thorough knowledge of pelvic anatomy, especially the anatomic relationship between the pelvic plexus and internal intestinal vessels. Further investigation is required to clarify the indications for autonomic nerve-sparing surgery in rectal cancer patients.

Autonomic Nervous System↗
PubMed2003

Current status of autonomic nerve-preserving surgery for mid and lower rectal cancers: Japanese experience with lateral node dissection.

Surgical practices for treatment of rectal cancer in Japan have changed from extended dissection along perivascular or parietal plane to pelvic autonomic nerve-preserving procedures without compromising radicality of surgical resection. Previous surgical results suggested the significant advantages of extended surgery in survival and local recurrence rate of Dukes B and C patients. More than 15 percent of patients with cancer in the lower rectum have extramesorectal spread to lateral pelvic nodes that can be removed by lateral dissection for local control and cure. Initially the total nerve-preserving procedure has been introduced for a complete preservation of para-aortic and intrapelvic nervous system in patients with early-stage cancer not requiring para-aortic and lateral lymph-node dissection. However, the concept of aggressive surgery for advanced rectal cancer has led to various types of pelvic autonomic nerve-preserving procedures, in which extended lymph-node dissection plus nerve-preserving technique with resection of one or more autonomic nervous segments has been performed. During two decades, total pelvic autonomic nerve-preserving procedure with lateral lymph-node dissection has been used increasingly for Dukes C lesion without increased local recurrence. The overall status of pelvic autonomic nerve-preserving procedures according to clinical experiences in Japan is reviewed in the context of cadaveric anatomic findings, Japanese vs. Western techniques and concepts, and our own clinical data.

Autonomic Nervous System↗
PubMed2003

Autonomic dysreflexia: a plastic surgery primer.

Plastic surgeons are integral to the management team for patients with spinal cord injuries, with responsibilities including pressure sore management and upper extremity reconstruction. Injury to the spinal cord profoundly disrupts the body's ability to maintain homeostasis. In particular, the autonomic system can become unregulated, resulting in a massive sympathetic discharge called autonomic dysreflexia. Autonomic dysreflexia occurs in the majority of patients with injuries above the sixth thoracic vertebra and causes sudden, severe hypertension. If left untreated, autonomic dysreflexia can result in stroke or death. Because this syndrome causes morbidity and mortality, it is crucial for plastic surgeons to be able to recognize and treat autonomic dysreflexia. This article reviews the etiology, symptoms, and treatment of this syndrome.

Adult↗
PubMed2003

Nasal polyposis: microsurgical ethmoidectomy and interruption of autonomic innervation vs conventional surgery.

Nasal polyposis is an invalidating disease which develops through chronic inflammation which leads to tissue oedema and eventually polyps. Treatment is aimed at eliminating polyps, resolving rhinitis symptoms, re-establishing nasal breathing and olfaction and preventing recurrence. The pathogenesis can be explained, in part, by degranulation of mast cells and release of mediators attracting eosinophils which, in turn, can cause tissue damage and oedema. Neurovascular reflexes and factors related to the complex anatomy of ethmoidal labyrinth may be responsible for the onset and persistence of oedema. This would offer a rationale to treatments modifying ethmoid anatomy and blocking neurovascular reflexes in the management of nasal polyposis. The advent of microsurgery and of diagnostic and operative endoscopy has led, over the last twenty years, to earlier detection and to less traumatic and more precise surgical treatment of nasal polyps. With these techniques resection of parasympathetic innervation is also possible, which is in keeping with the proposed rationale and cannot be easily achieved by conventional surgery. To evaluate the impact of this resection on the management of nasal polyposis a review of data has been made in a series of patients with diagnosis of nasal polyposis established by clinical examination, resistant to pharmacological therapy and treated between 1983 and 1998 at the Oto-Neuro-Ophthalmology Department of Florence University (Italy). Patients were treated by conventional surgery (386 cases), by microsurgery without resection of the parasympathetic component of the vidian nerve (97 cases), or by microsurgery with resection of this latter component (94 cases). The rate of recurrence and of major post-operative complications, respectively, were: 39.9% and 4.4% for patients treated by conventional surgery; 37.1% and 6.2% with microsurgery without resection of parasympathetic innervation; and 25.5% and 2.1% with resection of this innervation. The difference in recurrence rate between the three groups was significant (p < 0.05). The average disease-free interval was 45.7 months with conventional surgery and 53.5 months with microsurgery (regardless of resection of innervation). Results show that microsurgery for nasal polyposis together with resection of parasympathetic innervation improves results compared to those with conventional surgery and does not cause an increase in post-operative complications.

Adolescent↗
PubMed2000

[Preserving autonomic nerves in rectal surgery. Results of surgical preparation on human cadavers with fixed pelvic sections].

INTRODUCTION: Preservation of sexual function and voiding capacity after rectal cancer surgery has increased after adopting the technique of nerve-sparing dissection and total mesorectal excision. Still the rate of sexual and urinary dysfunction ranges between 25 and 67%. The precise locations where nerve damage occurs have not been looked at systematically. MATERIAL AND METHODS: In ten human corpses and two formalin-fixed human pelvises the autonomous pelvic nerves were isolated. Their relation according to surgical mobilization of the rectum were photodocumented. RESULTS: Pelvic autonomous nerves are clearly defined structures with only minor interindividual variability. The inferior mesenteric plexus forms a dense network around the inferior mesenteric artery (AMI) to a distance of 5 cm from the aorta. The distance between the lateral rectum and the pelvic plexus is only 2-3 mm. The anterior rectum is almost directly adherent to the neurovascular bundle, separated only by Denonvillier's fascia. The parasympathetic branches of the sacral segments S2-S5 cannot be isolated using the standard surgical approach. CONCLUSION: (1) The nomenclature of fascias and the course of the autonomous pelvic nerves is not clearly defined in the literature; (2) a high tie of the AMI leads to damage of the sympathetic nerves; (3) the narrow space between the anterior and lateral rectum makes sharp dissection under direct vision necessary; (4) fascias and nerves can be used as guiding structures during mobilization; (5) a preservation of selected parasympathetic roots in the small pelvis is not feasible using the standard surgical approach.

Autonomic Nervous System↗
PubMedDate not supplied

Evoked cavernous activity: measuring penile autonomic innervation following pelvic surgery.

To assess cavernous nerve integrity, we measured evoked cavernous activity (ECA) in 16 men who underwent nerve sparing radical prostatectomy (NS group) and 11 men who underwent non-nerve-sparing surgery (non-NS group). The right median nerve was electrically stimulated and ECA was recorded with two concentric electromyography needles placed into the right and left cavernous bodies. We simultaneously recorded hand and foot sympathetic skin responses (SSRs) as controls. All subjects had recordable SSR, and all subjects following nerve-sparing radical prostatectomy had reproducible ECA. Of the 11 non-NS subjects, eight had no response, indicating interrupted corporal innervation. Three subjects had reproducible ECA, one of whom had a very late latency, suggesting residual innervation was present. The mean latencies of ECA were similar to foot SSR mean latencies (P>0.05), but not to hand SSR latencies. The non-NS group was significantly different from the NS group for the presence of ECA (P<0.001). ECA is a viable method of evaluating the autonomic innervation of the penis.

Aged↗
PubMed2003

[The importance of isolating septic patients in an autonomous unit in orthopedic surgery and traumatology].

UNLABELLED: To examine whether Sepsis Containment Units are presently in use by French Orthopedic surgeons in a number of hospitals and the subsequent efficacy of these measures in the prevention of risks linked to methicillin resistant Staphylococcus aureus (MRSA), MRSA was used as an example because it is the bacteria most frequently associated with infection in orthopedics. The transient carriage of MRSA on the hands of hospital personnel is the most common mechanism of patient to patient transmission. Consequently, the incidence of nosocomial MRSA in patients can be used to assess the quality of infection control. SETTING: The orthopaedic surgery department (104 beds) of a 1. 228 bed, university affiliated public hospital located in eastern France (Besançon). METHODS: First: a questionnaire was sent out to 71 French university orthopedic departments to investigate the practice in place. Second: to establish whether a significant correlation exists between the colonisation pressure exerted by real imported MRSA, and the number of cases of real acquired MRSA since we know that colonisation pressure of bacteria is a major factor in the prognosis of clinical infection. Third: our orthopedic surgery department was redesigned to study the risks of colonisation pressure with or without Sepsis Containment Units. RESULTS: First: among the 71 orthopedic departments studied, only 11 used a Sepsis Containment Unit. Second: there is a definite, linear relationship between the colonisation pressure exerted in a unit by real imported MRSA and the number of cases of real acquired clinical infection. Third: in the absence of Sepsis Containment Units, the risk of MRSA infections is increased by 160%. Debat: the classical clinical arguments concerning the dangers of hand or aerobic MRSA transmission are confirmed by our figures. The strict use of Sepsis Containment Units prevents contamination of septics by septics. Inversely, the rigorous concentration of means in the Sepsis Containment Units also prevents cross contamination of septics. At question are the psychological and financial inconveniences of Sepsis Containment Units. The results of this experiment, performed in orthopedic surgery, show that the use of Sepsis Containment Units is just as critical in other surgical units: vascular, thoracic, etc., nor should they be overlooked in outpatient and emergency care--often the first step in orthopedic surgery. CONCLUSION: Sepsis Containment Units are essential and merit further development.

Containment of Biohazards↗
PubMed1998

Persistent alterations of the autonomic nervous system after noncardiac surgery.

UNLABELLED: BACKGROUND. Changes in the sympathetic nervous system may be a cause of postoperative cardiovascular complications. The authors hypothesized that changes in both beta-adrenergic receptor (betaAR) function (as assessed in lymphocytes) and in sympathetic activity (assessed by plasma catecholamines and by heart rate variability [HRV] measurements obtained from Holter recordings) occur after operation. METHODS: The HRV parameters were measured in 28 patients having thoracotomy (n = 14) or laparotomy (n = 14) before and for as long as 6 days after operation. Transthoracic echocardiography was performed before and on postoperative day 2. Lymphocytes were also isolated from blood obtained before anesthesia and again on postoperative days 1, 2, 3, and 5 (or 6). They were used to examine betaAR number (Bmax) and cyclic adenosine monophosphate (cAMP) production after stimulation with isoproterenol and prostaglandin E1. In addition, plasma epinephrine, norepinephrine, and cortisol concentrations were determined at similar intervals. RESULTS: After abdominal and thoracic surgery, most time and all frequency indices of HRV decreased significantly, as did Bmax and basal and isoproterenol-stimulated cAMP production. The decrements in HRV correlated with those of Bmax and isoproterenol-stimulated cAMP throughout the first postoperative week and inversely correlated with the increase in heart rate. Plasma catecholamine concentrations did not change significantly from baseline values, but plasma cortisol levels did increase after operation in both groups. Left ventricular ejection fraction was normal in both groups and unaffected by surgery. CONCLUSIONS: Persistent downregulation and desensitization of the lymphocyte betaAR/adenylyl cyclase system correlated with decrements in time and frequency domain indices of HRV throughout the first week after major abdominal or thoracic surgery. These physiologic alterations suggest the continued presence of adaptive autonomic regulatory mechanisms and may explain why the at-risk period after major surgery appears to be about 1 week or more.

Aged↗
PubMed1998

[Surgery of lung metastasis: results of a hospital survey in the Autonomous Community of Madrid. Working Group on Surgery of Lung Metastasis (GT-CMP)].

The Task Force on Pulmonary Metastasis Surgery of the Oncology Department of the Madrid Pneumology and Chest Surgery Society designed a questionnaire to determine guidelines for surgery to resect lung metastases in the Autonomous Community of Madrid, an area with over four million inhabitants. The questionnaire was divided into five sections: indications, diagnostic procedures, extension studies, disciplinary foci and surgical techniques. Ten of the hospitals surveyed answered the questionnaire. We found that disagreement is high regarding patient screening, and that there are differences regarding some preoperative procedures and extension studies, as well as in therapeutic approach. Eighty percent of the respondents were not in favor of using video assisted thoracoscopy as a therapeutic technique, and disagreement was greater regarding approaches technique, and disagreement was greater, regarding approaches to bilateral metastases. We infer that between 100 and 120 cases are treated surgically every year. Procedures to join The International Lung Metastases Registry have started.

Hospitals↗